Out Of Programme Training
Dr Karthik Sabapathi
Out Of Programme Training (OOPT), both within and outside the United Kingdom, can be very rewarding. The wide spectrum of clinical and academic experience gained can help develop a competitive CV. My desire to gain further experience in paediatric anaesthesia has taken me to the American mid-west.
The USA -the land of jazz, blues, rock, Hollywood movies, ‘Anesthesiologists’ and the land of plenty. Well, plenty of acronyms. It took me a little while to decipher the American equivalents of British phrases. It is hardly surprising that I was initially puzzled when a hand-over to the ‘PACU’ (Post-anaesthesia care unit) nurse includes terms like ‘FOG’ and ‘SOG’ (isoflurane/ sevoflurane, oxygen and gas), patients are transferred to the ‘floor’ and not the ‘ward’, trolleys are called ‘stretchers’ and oxygen cylinders are called O2 ‘tanks’! The pinnacle was when I was introduced to ‘cows’ on the obstetric unit! Of course, as you will no doubt have guessed, these are “computers on wheels”.
The thought of relocating to a new place is exciting but, when it involves a job assignment in a foreign health system, it is not an easy task. Like other specialist registrars, I had plans of undergoing a year's training outside the United Kingdom. But I had never anticipated the planning that might be involved in making my dreams a reality. I hope sharing my experiences about (dis)organizing my overseas OOPE will help my colleagues to have a smoother ride.
What and where? Planning for an overseas training placement essentially starts even before the final FRCA. But of course, the opportunity only really presents itself once you have passed the FRCA exam. After you have enjoyed and savoured this life-time achievement, it is time to start mailing applications. The points to consider regarding what and where are:
• your sub-specialty of choice,
• the country and institution where you would like to work ,
• your desire for clinical and/or research experience,
• the amount of time you wish to spend on your OOPT,
• the salary offered
• your plans on returning to the U.K. (including your CCT date)
Speaking on a personal level, I chose to do paediatric anaesthesia in a North American institution. Since very few American hospitals offer programmes that do not require the USMLE (United States Medical Licensing Examination), my choices were fairly limited. Having heard about the scope of clinical experience at the University of Michigan Hospitals, I decided to explore the American mid-west. Then the hard work began.
Planning the paperwork: (6 months to a year in advance): Every OOPT placement is slightly different with regards to the paperwork that is exchanged. Certain requirements are common: your medical school and post-graduate certificates, a completed application form, Curriculum Vitae and medical school transcripts (a transcript is a complete account of a student’s academic history at their medical school with a listing of all courses taken and grades achieved). Obtaining the last one could be time-consuming if you are an international medical graduate. In addition, you need to complete applications to obtain a license to practice in the country/state in question, a criminal record check, employee health clearance, health insurance forms…… It is a long list. The administrative staff at the receiving hospital are generally prompt in making sure that documents reach them on time. It is important that you set yourself deadlines for completion of different stages of this process. On receiving the offer letter, make an appointment with the embassy to obtain a visa at least 4-6 weeks prior to travel. There is no escape from the joys of queuing up outside the American Embassy at Grosvenor Square in London!
Approval of training
The rules for approval of OOPT are in the process of transformation. Presently, OOPT requires prospective approval from the local training committee (through the Programme Director), your Deanery and PMETB (the Post-graduate medical education and training board). It is imperative to discuss your plans with your Programme Director well in advance, making sure they will release you for the time required (up to a year). Following approval by your School of Anaesthesia, the Deanery applies to the PMETB with written confirmation that the post has support of the Royal College representatives and a statement from the supervisor of the foreign training programme detailing its structure and purpose. For further information, I refer you to the GAT handbook on the RCoA’s draft proposal-‘Prospective Approval of OOPT’.
Professional societies: Membership with the General Medical Council needs to remain active (though not mandatory, it involves elaborate paper-work to get fully registered on you return). It is useful to retain memberships with the Royal College of Anaesthetists and the AAGBI. Membership with the Medical Defence Union is not necessary whilst you are away, but make sure you have professional indemnity insurance in the country where you will be practicing.
Things to do 3 to 6 months prior to travel
Housing: Your course of action depends on whether you live in a rented or a mortgaged house. Things may be less complicated with a rented accommodation; a written notice informing your landlord about your proposed date of move should suffice. But, if you own a house and plan to rent it for a year, contact your local estate agents at least 3 months in advance. It is never too early to advertise for prospective tenants.
Drafting a proper lease agreement will make sure your property is well maintained and ready to move into on your return. For legal purposes, inform your mortgage provider about your plans to rent the house. For unoccupied properties, informing the council tax office of your date of move may fetch you rebates. Remember to keep your buildings insurance active.
Service providers: Inform your gas, electricity and water utility providers about your date of move and give them a final meter reading. You might receive those extra pounds over-paid through direct debits. Having a maintenance-cover for the boiler could prove useful; a breakdown in your absence implies money and valuable time lost in organising repairs. About 3 months before your move, find out whether your television cable, telephone (landline/mobile) and internet service providers require a notice period for cancellation of subscriptions. If so, set a deadline and inform them promptly; otherwise they will continue to charge you.
Notification of change of address: This can be managed by using the Royal Mail’s re-direction service (, it’s not free but it is effective). By using this service, you can avoid writing letters and making phone calls individually.
Vehicles/cars: If you own your dream car, you will do anything to keep it safe and running On the contrary, if you decide to sell your vehicle, you need to act quickly and place an advertisement in the local paper, internet, and hospital intranet or with the local car dealer. Cancelling your vehicle insurance and breakdown cover will pay you back some cash.
If you want to keep your car in spite of the hassles of maintaining an active MOT, a third-party insurance and road-tax, then don’t forget the depreciation of your car’s value in a year’s time. You can cancel your road-tax by applying for a SORN (statutory off-road notification) with the DVLA. This only works if you plan to lock your car in the garage (impossible if you rent your house) or leave it on the driveway. But, an idle car does no favours to its well-being. My car needed minor repairs after just 40 days of being idle!
Did you think that was it? Believe me, it is just the beginning! In order to make your entry and stay comfortable in the new place, it is important to do as much ground-work as possible before the final leap. It is useful to contact the programme coordinator at the other end for e-mail addresses of fellows/visiting faculty finishing the programme. They could prove very useful in recommending accommodation, child-care, tips for buying used cars etc. Other valuable information like obtaining a social security number (in the United States), bank accounts and immigration information will be provided by the administrative specialist/coordinator.
I have definitely enjoyed my experience so far. My native Indian English accent which had a British touch now has an American twang. I’m surprised people still understand me! The challenging cases, new friends, international conferences, support for research….have made it all worth the effort. And soon, I have to restart the above process in the reverse order before returning to the land of ‘Anaesthetists’!
RCA OOPT form
Working around the world
(New, comprehensive report re working in Australia)
University of California
(All anaesthetic specialities)
Vancouver General Hospital
We would like to build up a library of OOPT reports. Please use our 'contact us' page to send us your report/comments regarding your year abroad so that others can benefit from your experience. Thank you!