INTRODUCTION:Without mastery of the anatomy, luck rather than skill becomes the primary determinant of successful neural blockade. In this educational study our intent was to compare the level of nerve roots blocked by these two techniques of peripheral nerve block, widely used in clinical anesthesia practice. AIMS: To have a three dimensional view of nerve plexus involvement in inter scalene and supraclavicular techniques of brachial plexus block and compare in between them. MATERIAL AND METHOD: 6 recently deceased cadavers preserved in formalin were used. In both the techniques the classical methods usually pursued in daily clinical practice were followed. Dyes used were methylene blue and tartrazine of same dilution. RESULTS: Careful dissection showed that in all cases of inter scalene approach the dye was more concentrated in upper and middle trunk than in lower trunk of brachial plexus. In contrast in supraclavicular approach dye concentration was more in lower and middle trunk and less in upper trunk. DISCUSSION: After reviewing the anatomy it can be concluded that injection of local anesthetic at the interscalene level tends to produce a block that is most intense at the C5-C7 distribution and injection at supraclavicular level provide more compact anesthesia in C8-T1 distribution. CONCLUSION: Supraclavicular block is preferable for operations on the elbow, forearm, and hand and inter scalene block for shoulder.

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The trials and tribulations of immigrant professionals such as international medical graduates (IMGs) to the UK have been a topic for discussion and debate over many years. Many challenges faced by immigrant doctors have been reviewed and reformed over time and many rules pertaining to the registration and induction of international doctors to UK practice has been modified to facilitate safe delivery of care in the UK National Health Service (NHS). The General Medical Council (GMC), NHS employers, and the UK Home Office contribute to a three-tier filtration sieve for selecting suitable IMGs who aspire to either education and training or pursue a career in the UK health and care sector. This article pertains to the cohort of IMGs, who have been cleared by immigration regulations to reside in the UK but have not been able to initiate a career or active employment in a medical profession. The process of GMC registration referred to and discussed in this article is based on GMC rules prior to Jan 2021.  The perspective from which some of the attributes of the current system has been observed has shown it to be efficient but not uniform, robust but not considerate, thorough but not perfect. During the research for this article, we realised that there are many different opinions or conflicting views on this topic, which have all developed either from an individual or a group’s own experience in the UK. There are similarities and differences in opinions and thus to broaden the scope of the discussion, we report the results of a survey exploring where and how the IMGs (currently resident in the UK) are at the start of their careers in the UK.