Working abroad whilst in training : Being "Out of Programme"

Working abroad whilst in training counts as being "Out of Programme". Anyone contemplating this needs to start their planning early and seek the advice of their Training Programme Director and/or College Adviser.

Gaining experience abroad is generally encouraged by the Royal Colleges, but there can be very practical problems e.g. filling the rota to provide a service in a Wessex hospital which mean that it has to be well planned and the trainee may need to adjust expectations to the types of Out of Programme Experience that are recognised.

The following summarises the various forms of being Out of Programme that are recognised by the General Medical Council. Detailed information should be sought from the GMC website.

Summary of General Medical Council Guidance on Trainees being Out of Programme

Context

The General Medical Council (GMC) has the ultimate responsibility for approving medical training in the UK. It approves the curricula that have been prepared by the Colleges and the training programmes delivered by Deaneries. These programmes are designed to provide the training required to enable trainees to achieve the learning outcomes identified by the curricula. Only time spent in an approved training programme will count towards the award of a Certificate of Completion of Training (CCT).

Out of Programme

Time spent out of an approved training programme can count towards a CCT, but in order for this to happen it has to have prospective educational approval by the GMC and meet the requirements of the curriculum.

There are other good reasons why time can also be spent out of an approved training programme that does not count towards training.

The GMC recognises four categories for being Out of Programme (OOP). These are : -

  1. OOPT (Out of Programme, Training)

Experience gained in a placement outside an accredited training programme can only be counted as training experience if it meets the normal criteria used to accredit a training placement and the content of the experience meets the requirements of the curriculum. The GMC has take a judgement about this before a placement is taken up. This cannot be done retrospectively.

Time spent in one of these approved placements can be contribute towards time gaining a CCT (Certificate of Completion of Training). The same is true for trainees that "act up" as a consultant, provided that this is prospectively approved by the GMC, there is appropriate supervision and the placements is relevant to gaining the competences, knowledge, skills and behaviours required by the curriculum.

Placements are normally for up to one year in total, but can be for 2 years. During this time trainees need to submit the assessments required by the specialty curriculum to the home Deanery's annual review panel in the usual way, along with an annual OOPT document.

2. OOPE (Out of Programme, Experience) 

This does not count towards the CCT, but it can be taken to

• enhance clinical experience for the individual so that they may experience different working practices or gain specific experience in an area of practice and/or
• support the recommendations in Global health partnerships: the UK contribution to health in developing countries (2007)
• take time out of programme to gain experience as a locum consultant which cannot be credited towards training.

OOPE requires agreement by the Postgraduate Dean, but the placement does not have to be approved by GMC.

OOPEs are normally for one year in total, but can be extended for up to two years with the agreement of the Postgraduate Dean.

3. OOPC (Out of Programme, Career Break) 

A planned OOPC will permit a trainee to:

• step out of the training programme for a designated and agreed period of time to pursue other interests, e.g. domestic responsibilities, work in industry, developing talents in other areas
• take a career break to deal with a period of ill health, secure in the knowledge that they can re-join the training scheme when they are well enough to continue.

Limiting factors include :

• the ability of the programme to fill the resulting gap in the interests of patient care
• the capacity of the programme to accommodate the trainee's return at the end of the planned break
• evidence of the trainee's on-going commitment to and suitability for training in the specialty.

Postgraduate Dean approval is required, but GMC approval not. Usually these breaks are less than 2 years, but, with agreement they can be more. If the break is for a particularly long period, then the trainee may have to relinquish their NTN and re-apply for training at a later date.

 4. OOPR (Out of Programme, Research)

If the curriculum includes a research element and the time spent on research contributes to achieving the learning outcomes in the curriculum then PMETB can approve the time spent in this and it will contribute towards the CCT. College/Faculty and Deanery support is required when applying prospectively for this.

The usual documentation and annual review processes apply.

Time doing research can also be agreed, even if it does not contribute to the curriculum. In this case, it would be counted as OOP (Experience) and only require the postgraduate dean's approval.