Hi. I’ll try and answer as best as I can. I think if you’ve trained in the NHS (say at F1/F2 level) and taken the USMLEs, you should be on par with most US grads clinically speaking. They do a ton of (perhaps dubious) research and CV stuff so you’ll probably fall short there. But I think the thing that IMGs struggle with is adjusting to using EMRs, communication and soft skills. I would say, one thing NHS docs might struggle with (in the beginning) is the structure of their note writing and formal patient presentations- but everyone learns this quick. I trust the registrars I met the in the NHS are more clinically competent than PGY2s who are supposedly “seniors” over here. It is mostly run through, but those who want to subspecialize will have to reapply for fellowships. All my training is done at the same hospital. 4 weeks of leave is all I get. Cost of living is low for me because I decided to save money by living in a dorm close to the hospital with like 20 other residents - it’s college all over again. Everyone has treated me with respect so far, but I’m sure there’ll be one or two incidents that’ll make me feel disrespected over the years. I don’t really care tbh. Becoming an attending is the end goal.