Foreign graduate,not sure whether to apply for F1 or F2, thoughts and advice please?

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nmudz_009
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I'm going to be an EU graduate applicant this year of 2018- (Although I was brought up in UK so i speak English fluently). Medical school in European countries is 6 years long with the final year supposed to give you (some) experience of being on and working on the wards. (i suppose its meant to be equivalent to foundation year one, but they make you do it before you get the degree certificate). At the end of my degree I of course want go back home to the UK however, I'm not sure whether to apply to F1 or F2.

On one hand, I've got this extra year of medical school/training and on paper i deserve to be one year higher up than F1 and to be earning the wage of that, but on the other hand, the training probrably isnt up to the same level as f1 training, so if i were to skip the f1 year i don't know if my knowledge or training would be good enough to get through it. Bearing in mind a UK trained F1 will probrably be looking to me as senior support (if I start at f2 level), which could potentially be problematic

I'm desperate to start specialising as soon as possible and any time off the massively long winded UK doctor career ladder is a plus! In Europe, medical students begin the process of specialization straight afterwards, whereas in UK you have to do f1, f2, c1 and c2 not to mention MRCP/MRCS before you even start ST, which is in itself up to 8 years...

Thoughts? Thanks guys for any replies. Much appreciated.
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ahorey
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I don’t think you can skip F1 as it’s a 2 year Program. Could be wrong though. Think it might be depending on your uni.

What you’re describing sounds like an assistantship or “f0” which is what many university’s do here, mine does. We still do F1. It’s expected and normal tbh. One extra year at uni does not automatically mean you “deserve” to be a higher grade nor should you expect to have a f1 looking to you for support as you are still the same level as them if you,are an f1

If you want to specialize earlier then why not just stay in Europe and finish your training?
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Smile88egc
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I would definitely advise starting work as an F1. Although your medical knowledge may be equivalent to someone at the end of their F1 year, a lot of working as a junior doctor in the UK requires knowledge of how the NHS and individual systems within hospitals work. This organisational culture is essential to you carrying out the work expected of you, and as you highlight you would be expected to support F1 doctors in your team if you started work at F2.
It's great that you have an idea of what you'd like to specialise in, and equally you can use your time in F1 and F2 roles to start building your application, you may need some time to do this if it's a particularly competitive specialty you want to go into.
Best of luck!
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hslakaal
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I don't know whether the 6th year counts as an intership, but if it does, you can start from F2 technically.

https://www.gmc-uk.org/doctors/regis...e_slovakia.asp

https://www.gmc-uk.org/doctors/regis...ons/routeJ.asp
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Chi Long Qua
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Even if you are technically eligible for a fy2 post, I wouldn't suggest you this option. I am an EU graduate myself and I'll start this year as fy1 despite having the option of applying for a fy2 LAT/LAS. In my opinion, the "integrated" internship that most EU countries offer with their 6-year formula isn't equivalent, in terms of experience, to the completion of the fy1 (despite being legally equivalent).

I've thought about it and I've come to the conclusion that, even if I might have the clinical competence of an fy2 (still highly debatable), I wouldn't have the necessary knowledge of the system to jump into that role straight away. Life could become miserable if I realize once I start working, that I'm not adequate for that fy2 role.
Not to mention that, since specialty applications open during the fy2, I may not even have the time to build a good portfolio to apply for the specialty I like.
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nexttime
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(Original post by nmudz_009)
I'm desperate to start specialising as soon as possible
Not an easy one. This is a long post, but I'd like to make a few points and let you know of my experience for comparison:

On the one hand i do agree with the others that say FY1 is about learning organisational structures and when/how to escalate concerns. You refer to being behind other FY2s in terms of knowledge - FY years teach you minimal knowledge - in fact what you forget whilst filling out the endless paperwork almost certainly greatly outweighs anything you learn - but you do get some 'real world' knowledge in terms of how to deal with uncertainty, when to seek help etc. And that's important.

On the other hand, you (like many others) want to get to specialising ASAP and i think its pretty universally agreed that your FY years are the worst years of your career, largely due to rotating into jobs you have no interest in, and being the bottom of the ladder when all the **** lands. I personally would really be thinking twice about volunteering for an extra year of it if i had the choice. In fact, i would go as far as to say i would choose not to do it, even without an internship year! Fact is, i dealt with far (far) more on my elective and didn't mind the responsibility then, so i could probably have dealt with it afterwards too. But then i was familiar with the UK structure, so maybe that's why.

Also to consider: plenty of EU grads do go straight to FY2 and most are fine. Its hard and you have to adapt, but its fine. I worked alongside a Greek graduate in my first FY2 job, and no concerns whatsoever. As a UK national you will even have some cultural advantage on them, so should be even less risky for you

There is also the big financial knock you would take by doing an FY1 year - you'd be 'paying' circa £10,000 for the privilege vs going straight to FY2.

Below I've briefly summarised my FY1 and FY2 posts so you can see the difference you could expect:

Spoiler:
Show





1) Paeds FY1. My main clinical responsibility was sending home viral wheezers. About 2 days in every month or so i would also see kids in A&E, but all must be run through a reg. Literally everything else was either writing what seniors said on ward rounds or writing discharge summaries/scan requests/etc. There were stretches of multiple days where i didn't even clap eyes on a patient as i was just in the office filling out the paperwork.
2) Psych FY1. I was probably the most medically proficient doctor in the hospital which was a little scary but then everyone was medically fine so it hardly mattered. I was there to scribe for seniors seeing patients and fill out paperwork. I had no other role, never saw patients myself.
3) Respiratory Fy1. A bit of a step up - i did my own ward rounds perhaps once-twice per week, and occasionally had to see a sick patient. I would always be able to ask a reg though, and wasn't allowed to send patients home. Still about 80% paperwork.

4) FY2 Orthopaedics. Patients were seen by a consultant when first admitted. After that, you were the most senior person seeing them. We had a lot of FY1s so there was a fair amount of supporting them (mainly just reassurance). You'd also be alone at night seeing new patients, though you could always phone a reg if you wanted. Scary at first but you eventually realised that the reason they had this set up was that as long as you could recognise an emergency (neurovascular compromise, irreducible dislocation etc) they were never going to act overnight so there wasn't much to do except, surprise surprise, all the admission paperwork. You could send people home as you pleased.
5) AMU FY2. You would see patients with a consultant in the morning but were then left alone after that to do the jobs. Sometimes you'd make some decisions about the patient's care (especially as sometimes some of the consultant decision making was highly questionable), but could get the consultant back if you needed one.
6) O&G FY2. Very variable job. From being on labour ward where you were only there to do cannulas and hold the retractors in emergency c-sections, to being on post-nates alone sending them all home. I hated O&G but the variety made it tolerable






I think its up to you to decide whether you could shoulder the increased responsibility straight away and deal with an especially horrible first month or so, or want an FY1 year first. However, do not overestimate what FY1 year actually teaches you and there are significant downsides by choosing to do one.

Also, there is a third option here: staying in Europe and coming back later. If you train in Europe, and correct me if I'm wrong, you can reach consultancy in 4-5 years post-graduation, no? So you could become a consultant, then come back and be 4+ years ahead of your peers, earning 85k and helping run your own department when UK trainees are on £45k languishing in core medical training (like me lol). If i were in your position I'm pretty sure that's what I'd be doing!

Hope that helps.
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nmudz_009
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(Original post by nexttime)
Not an easy one. This is a long post, but I'd like to make a few points and let you know of my experience for comparison:

On the one hand i do agree with the others that say FY1 is about learning organisational structures and when/how to escalate concerns. You refer to being behind other FY2s in terms of knowledge - FY years teach you minimal knowledge - in fact what you forget whilst filling out the endless paperwork almost certainly greatly outweighs anything you learn - but you do get some 'real world' knowledge in terms of how to deal with uncertainty, when to seek help etc. And that's important.

On the other hand, you (like many others) want to get to specialising ASAP and i think its pretty universally agreed that your FY years are the worst years of your career, largely due to rotating into jobs you have no interest in, and being the bottom of the ladder when all the **** lands. I personally would really be thinking twice about volunteering for an extra year of it if i had the choice. In fact, i would go as far as to say i would choose not to do it, even without an internship year! Fact is, i dealt with far (far) more on my elective and didn't mind the responsibility then, so i could probably have dealt with it afterwards too. But then i was familiar with the UK structure, so maybe that's why.

Also to consider: plenty of EU grads do go straight to FY2 and most are fine. Its hard and you have to adapt, but its fine. I worked alongside a Greek graduate in my first FY2 job, and no concerns whatsoever. As a UK national you will even have some cultural advantage on them, so should be even less risky for you

There is also the big financial knock you would take by doing an FY1 year - you'd be 'paying' circa £10,000 for the privilege vs going straight to FY2.

Below I've briefly summarised my FY1 and FY2 posts so you can see the difference you could expect:

Spoiler:
Show








1) Paeds FY1. My main clinical responsibility was sending home viral wheezers. About 2 days in every month or so i would also see kids in A&E, but all must be run through a reg. Literally everything else was either writing what seniors said on ward rounds or writing discharge summaries/scan requests/etc. There were stretches of multiple days where i didn't even clap eyes on a patient as i was just in the office filling out the paperwork.
2) Psych FY1. I was probably the most medically proficient doctor in the hospital which was a little scary but then everyone was medically fine so it hardly mattered. I was there to scribe for seniors seeing patients and fill out paperwork. I had no other role, never saw patients myself.
3) Respiratory Fy1. A bit of a step up - i did my own ward rounds perhaps once-twice per week, and occasionally had to see a sick patient. I would always be able to ask a reg though, and wasn't allowed to send patients home. Still about 80% paperwork.

4) FY2 Orthopaedics. Patients were seen by a consultant when first admitted. After that, you were the most senior person seeing them. We had a lot of FY1s so there was a fair amount of supporting them (mainly just reassurance). You'd also be alone at night seeing new patients, though you could always phone a reg if you wanted. Scary at first but you eventually realised that the reason they had this set up was that as long as you could recognise an emergency (neurovascular compromise, irreducible dislocation etc) they were never going to act overnight so there wasn't much to do except, surprise surprise, all the admission paperwork. You could send people home as you pleased.
5) AMU FY2. You would see patients with a consultant in the morning but were then left alone after that to do the jobs. Sometimes you'd make some decisions about the patient's care (especially as sometimes some of the consultant decision making was highly questionable), but could get the consultant back if you needed one.
6) O&G FY2. Very variable job. From being on labour ward where you were only there to do cannulas and hold the retractors in emergency c-sections, to being on post-nates alone sending them all home. I hated O&G but the variety made it tolerable









I think its up to you to decide whether you could shoulder the increased responsibility straight away and deal with an especially horrible first month or so, or want an FY1 year first. However, do not overestimate what FY1 year actually teaches you and there are significant downsides by choosing to do one.


Hope that helps.
Where did you do your elective, and what were your responsibilities/tasks during that time? I'm thinking about doing one in the summer before starting work but I don't know how useful it'll be.

I still really want to save a year by going into F2 straight away but as you mentioned it'll probably be really horrible. Some would say there's no harm in trying it out, and if they see that you're out of your depth they'll just send you back down. Still need to decide if im willing to go through that though. You mentioned that F2's dont really have more knowledge than F1, so its more a practical advantage.

From what i've heard from others or watched on TV lol there does seem to be a lot to learn even in f1 in terms of practical experience/confidence/coping with long work days/ building up your speed and efficiency and learning the system. Its basically a practice year isn't it, and as you said not much in terms of new knowledge.

The Greek student you mentioned, had he done like lots of electives in UK and stuff like that. like how did he prepare for it. Do you know if he was fresh out of medical school or had a worked a while in Greece. I do know a lot of Greeks and im told in Greece medical students are pushed quite hard in the hospitals, being given real jobs to do with real patients, left right and center. Especially in the 6th year which is basically their F1 year, so even if he didnt know the system at least he would have been confident in his abilities. I'm not sure the same could be said for me, haha

If you could go back to being a fresh graduate and had the chance to do f2 first would you skip f1?

Thank you so much for taking the time to tell me a bit about your experience in foundation - I wholly and truly appreciate it. Sorry this post is a bit rambly and all over the place as im still just trying to figure stuff out.


(Original post by ahorey)
If you want to specialize earlier then why not just stay in Europe and finish your training?

oh and finally - I recently learned that what they call specialist is not actually a consultant - its actually a registrar. Yeah. They call registrars specialists. So 5 years to become a registrar. and then gosh knows how many years to become a ''prednosta'' as they call it here. Head Physican. Essentially the process of medical specialization it would not be any quicker if i stayed in Europe. The only difference is that registrars (and consultants) are paid significantly more (in comparable EU countries). So ignore what i said before haha.
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nmudz_009
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(Original post by Smile88egc)
I would definitely advise starting work as an F1. Although your medical knowledge may be equivalent to someone at the end of their F1 year, a lot of working as a junior doctor in the UK requires knowledge of how the NHS and individual systems within hospitals work. This organisational culture is essential to you carrying out the work expected of you, and as you highlight you would be expected to support F1 doctors in your team if you started work at F2.
It's great that you have an idea of what you'd like to specialise in, and equally you can use your time in F1 and F2 roles to start building your application, you may need some time to do this if it's a particularly competitive specialty you want to go into.
Best of luck!
Do you think it would make it significantly harder to build up a good application for specialization if I didn't do my F1 year in the UK. I mean I want to be a GP, I really thought that wasn't especially competitive
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nexttime
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(Original post by nmudz_009)
Where did you do your elective, and what were your responsibilities/tasks during that time? I'm thinking about doing one in the summer before starting work but I don't know how useful it'll be.
I did it in rural Tanzania. There were no local doctors in the whole hospital, just assistant medical officers, so it was just me and an FY2 equivalent. Sometimes he would have to leave to do other stuff, so then i would be the only doctor in the whole hospital. The patients were sufficiently sick that we'd probably have had 4-8 paeds ICU patients and 10-20 adult ICU patients at any given time. Except there was no ICU so they were just in normal beds with terrible nurses looking after them!

The flipside was that we had next to no investigations and very limited drugs so what you could actually do was limited and after the shock of the first day you kind of got used to doing what you could, if they got worse seeing if they had money to transfer to the city, and if not accepting that there's nothing more you could do just need to keep reassessing and wait it out.

It was an excellent lesson in not flapping about, making practical workable decisions, and living with the consequences. I would recommend it as a life experience, but only for those accepting that lots of the patients you're responsible for including lots of young children will die.

[quote[You mentioned that F2's dont really have more knowledge than F1, so its more a practical advantage.[/quote]

Yes I'd agree with that.

The Greek student you mentioned, had he done like lots of electives in UK and stuff like that. like how did he prepare for it. Do you know if he was fresh out of medical school or had a worked a while in Greece.
They were straight out of med school yes. They found that first job's on calls hard, but no harder than the UK trainees who had been through FY1.

If you could go back to being a fresh graduate and had the chance to do f2 first would you skip f1?
Probably skip. There were some bits that were useful but the vast majority wasn't - i don't think i learned anything relevant to my future career at all in paeds and psych (at least, anything that i still remember now!). I don't think it was worth a whole year of my life.

oh and finally - I recently learned that what they call specialist is not actually a consultant - its actually a registrar. Yeah. They call registrars specialists. So 5 years to become a registrar.
My knowledge is limited and i know this is a notoriously complicated area, but are you sure? For example, i believe that after you have completed Germany's training program to become a "specialist", you are considered equivalent to a consultant.

For instance, does everyone become this "Prednosta" after just a period of training? Or is it a title of authority that only some achieve? Because if so its definitely not equivalent to 'consultant' here.

(Original post by nmudz_009)
Do you think it would make it significantly harder to build up a good application for specialization if I didn't do my F1 year in the UK. I mean I want to be a GP, I really thought that wasn't especially competitive
You just need to put together an audit - it can be really basic - and do a little teaching early on in your rotation. GP is not competitive in most of the country no.
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Smile88egc
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I'd disagree that F1 jobs are not helpful in terms of gaining knowledge, but I think this varies across specialties and regions in the UK. My foundation jobs were excellent and I learnt a lot, I also really enjoyed them.
I also think it's incorrect to think if you apply for F2 and can't hack it that they will "send you down". No mechanism exists for this, and the trust is unlikely to have a vacancy for you in an F1 capacity.
You're right that GP is not competitive, but if you start straight at F2 you will have to apply only a matter of months after starting work in the UK. The GP training programme is already very short (many agree too short), if be wary of trying to slim down your postgraduate training any further.
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(Original post by Smile88egc)
I'd disagree that F1 jobs are not helpful in terms of gaining knowledge, but I think this varies across specialties and regions in the UK. My foundation jobs were excellent and I learnt a lot,
Do you think that if you had sat finals at the end of FY1 you would have passed them? I certainly wouldn't have.

Can you name any specific bits of knowledge that you gained during FY1 that you did not learn at med school?

(Original post by Smile88egc)
I also think it's incorrect to think if you apply for F2 and can't hack it that they will "send you down". No mechanism exists for this, and the trust is unlikely to have a vacancy for you in an F1 capacity.
I recall the first series of the BBC (or was it C4?) Junior Doctors series - an Italian graduate was doing A&E FY2 but was struggling (he didn't know what a neurological exam was or how to do one). They found him an FY1 post somewhere else in the trust.

But obviously just one anecdote.
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Smile88egc
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Yeah our finals were OSCEs and a progress test and I had general surgery, general medicine and paeds rotations in F1 which were broad enough to teach me a huge variety of things, mainly in terms of developing some of the more superficial learning that had gone on in medical school.
For me FY1 was very much an extension of medical school as I undertook a PBL based curriculum with early clinical placements, we had our final OSCE in year 4 and final year was basically apprenticeships which blended pretty seamlessly with foundation years.
I was lucky I continued to get excellent teaching in F1/F2 both in terms of the formal taught programme and ward-based ad hoc teaching from senior clinicians. Obviously the latter does not require a foundation post but the formal protected time for training is not something that is so easily found outside of foundation jobs.
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(Original post by Smile88egc)
Yeah our finals were OSCEs and a progress test and I had general surgery, general medicine and paeds rotations in F1 which were broad enough to teach me a huge variety of things, mainly in terms of developing some of the more superficial learning that had gone on in medical school.
For me, i think there is literally nothing relevant I learned from psych. Paeds gave me an interesting insight in how to manage respiratory conditions without using blood gases, but that doesn't stop medical seniors being like 'this person has asthma why haven't you done a blood gas :mad: . But that's about it. And resp had me managing a lot of pneumonia, COPD, lung cancer, but honestly my management plans would have been exactly the same during final year (hell even 3rd year) med school than at the end of that. I learned a bit about NIV, but through formal teaching not ward stuff really (where they'd just say 16/8 or whatever with little explanation). The one thing i did learn which is useful is to not be so het up over target sats - sometimes 92, or 85 for a COPD person, is fine... but again medical seniors in other specialities tend to have a fit when i do this :mad:

Whereas you compare that to the amount of knowledge i forgot during an entire year of barely using my knowledge of hepatology, or cardiology, or dermatology, or literally anything else... vastly outweighed I'm afraid.

I think we should be practising evidence-based medicine but FY is entirely about apprentice-ship 'do what your senior tells you because they are senior' type medicine. I hate it.

I was lucky I continued to get excellent teaching in F1/F2 both in terms of the formal taught programme...
I thought our formal teaching program was substantially, substantially below the level taught in med school :p: Our med school lectures always justified themselves based on x and y studies and z national guidelines. FY teaching was some reg who clearly had very little time to prepare doing 20 slides on what they remember about pneumonia or whatever. Pretty disappointing :p:

Anyway i have typed far too much about this topic. I hate FY years and would rather be in a country where they don't do them (i.e. most other countries in the world). That is all.
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papnarus
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Hi, i'm a french student graduating in 2019. I am also debating going straight into F2, did you end up doing it?
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Anonymous #1
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IMG here who has just started FY1. Less
Than one month in I have already been told people are not satisfied with my performance and I will need extra support. I recommend starting in FY1......
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ecolier
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(Original post by Anonymous)
IMG here who has just started FY1. Less than one month in I have already been told people are not satisfied with my performance and I will need extra support. I recommend starting in FY1......
I haven't had a chance to read above what everyone has said, but I do think that starting at FY1, taking one more year has its advantages.

Those who are trained overseas do not know the culture of how the UK medical system works, so it is useful to get to know it in the FY1 year. It will be a throw into the incredibly deep end (in my opinion) if someone who has never worked in the UK suddenly finds themself on the SHO rota at night assisting surgery (for example).

Good luck to you, I hope the support works out well.
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nmudz_009
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(Original post by papnarus)
Hi, i'm a french student graduating in 2019. I am also debating going straight into F2, did you end up doing it?
Hi, no I have accepted an F1 post at Barnsely as I felt I needed the extra training and support.


(Original post by Anonymous)
IMG here who has just started FY1. Less
Than one month in I have already been told people are not satisfied with my performance and I will need extra support. I recommend starting in FY1......
Where did u graduate from?
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papnarus
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(Original post by nmudz_009)
Hi, no I have accepted an F1 post at Barnsely as I felt I needed the extra training and support.
Congratulations ! How is it going so far ? did you apply for F1 stand alone ?
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(Original post by papnarus)
Congratulations ! How is it going so far ? did you apply for F1 stand alone ?
Nah not started yet, they still sorting through paperwork. Its just a LAS post tbh
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So glad I found this post. Thank you for making it. I'm brought up in the UK like you and studying abroad in Europe. I have a few questions I'd like to ask if you don't mind.Why did you apply for LAS instead of LAT? Isn't LAT with training as compared to LAS? Is the LAS easier to apply to than the LAS? I'm worried about being thrown in the deep end so I want as much training as possible.I'm also studying in Europe and want to know did you have to do the IELTS? I want to apply for the F1 programme but a bit confused. I looked online and saw that there is an SJT test so did you have to do that too or is that for people that studied in the UK or for anyone who wants to start in F1?
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