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“Hybrid” medical leadership emergency medicine training for international medical graduates

Prakash Subedi (University of Worcester, Worcester, UK; Doncaster Bassetlaw Hospitals NHS Foundation Trust, Doncaster, UK and QiMET International Ltd., Doncaster, UK)
Jill Aylott (Post-Gradute Medical Leadership, World Academy of Medical Leadership, Sheffield, UK; University of Bolton, Bolton, UK and QiMET International Ltd., Doncaster, UK)
Naushad Khan (Emergency Department, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Doncaster, UK and QiMET International Ltd., Doncaster, UK)
Niki Shrestha (Chitwan Medical College, Bharatpur, Nepal)
Dayaram Lamsal (Chitwan Medical College, Bharatpur, Nepal)
Pamela Goff (World Academy of Medical Leadership, Sheffield, UK)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 13 November 2020

Issue publication date: 31 August 2021




The purpose of this paper is to outline the “Hybrid” “International” Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and training of Emergency Medicine doctors; with a rotation through the NHS on a two-year medical training initiative with a Tier 5 visa, “earn, learn and return” programme. The HIEM programme offers an advantage to the Tier 2 visa by combining training, education and employment resulting in new learning to help improve the health system in Nepal and provide continued cultural support, clinical and leadership development experience in the UK NHS. Finally, this programme also provides a Return on Investment to the NHS.


A shortage of doctors in the UK, combined with a need to develop Emergency Medicine doctors in Nepal, led to a UK Emergency Medicine Physician (PS) to facilitate collaboration between UK/Nepal partners. A mapping exercise of the Royal College of Emergency Medicine curriculum with the competencies for the health system and quality improvement leaders and partners with patients produced a “HIEM programme”. The HIEM programme aims to develop first-class doctors to study in Emergency Departments in the UK NHS while also building trainee capability to improve the health system in Nepal with a research thesis.


The HIEM programme has 12 doctors on its programme across years one and two, with the first six doctors working in the UK NHS and progressing well. There are reports of high levels of satisfaction with the trainees in their transition from Nepal to the UK and the hospital is due to save £720,000 (after costs) over two years. Each trainee will earn £79,200 over two years which is enough to pay back the £16,000 cost for the course fees. Nepal as a country will benefit from the HIEM programme as each trainee will submit a health system improvement Thesis.

Research limitations/implications

The HIEM programme is in its infancy as it is two years through a four-year programme. Further evaluation data are required to assess the full impact of this programme. In addition, the HIEM programme has only focussed on the development of one medical speciality which is Emergency Medicine. Further research is required to evaluate the impact of this model across other medical and surgical specialties.

Practical implications

The HIEM programme has exciting potential to support International Medical Graduates undertake a planned programme of development while they study in the UK with a Tier 5 visa. IMGs require continuous support while in the UK and are required to demonstrate continued learning through continuous professional development (CPD). The HIEM programme offers an opportunity for this CPD learning to be structured, meaningful and progressive to enable new learning. There is also specific support to develop academic and research skills to undertake a thesis in an area that requires health system improvement in Nepal.


This is the first time an integrated clinical, leadership, quality improvement and patient partnership model curriculum has been developed. The integrated nature of the curriculum saves precious time, money and resources. The integrated nature of this “hybrid” curriculum supports the development of an evidence-based approach to generating attitudes of collaboration, partnership and facilitation and team building in medical leadership with patient engagement. This “hybrid” model gives hope for the increased added value of the programme at a time of global austerity and challenges in healthcare.



The authors thanks and appreciation are extended to Professor Dr, Harish Nuepane, Chairman, Chitwan Medical College and the HIEM Trainees who continue to inspire us with their vision for creating better healthcare for the people of Nepal. There has been no funding for the HIEM programme development process described in this paper.


Subedi, P., Aylott, J., Khan, N., Shrestha, N., Lamsal, D. and Goff, P. (2021), "“Hybrid” medical leadership emergency medicine training for international medical graduates", Leadership in Health Services, Vol. 34 No. 3, pp. 313-332.



Emerald Publishing Limited

Copyright © 2020, Emerald Publishing Limited

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