Whether it is for the experience of working abroad or to undertake additional research, an increasing number of doctors are deciding to take time out of training. Some feel a need for greater flexibility within their training programme while others use the time to gain a competitive edge in their chosen future career.

Although many may not have previously considered an out of programme (OoP) experience as an option there are a growing number of opportunities to suit a wide range of preferences. Rayna Patel looks at the possibilities.

One of the first things to understand when considering an OoP experience are the types of out of programme time which are acceptable. The options available vary between local education and training boards but four broad categories are currently recognised:

1. Approved clinical training (OoPT)

Clinical training might include a higher degree in a subject allied to medicine and might also count towards your certificate of completion of training (CCT). In the past, these have included leadership positions, vocational or academic qualifications and overseas posts that are not part of an approved programme. OoPTs require prospective approval from the General Medical Council (GMC) and candidates can retain their national training numbers during this period.

2. Research (OoPR)

Most commonly, OoPRs are taken to complete a PhD in an area of research although they may also be taken for MD or Master’s degrees. The abolishment of mandatory research for career progression by the MMC was intended to encourage those with a genuine interest in academic medicine and thus raise the quality of research published.

Bearing this in mind, those with an aptitude for research should seriously consider the merits of being able to dedicate a significant period of time to produce worthwhile results. This time can contribute to CCT if optional research is stipulated by the relevant speciality curriculum but requires prospective GMC approval to ensure that clinical competencies can continue to be met during this time.

3. Clinical experience (OoPE)

OoP clinical experiences may relate to opportunities not offered by your deanery e.g. experiences of humanitarian situations or positions with the British Council or Voluntary Service Overseas (VSO). Overwhelmingly, trainees are keen to supplement their training with time spent abroad, and this is usually recognised by employers as a valid and useful means of expanding your medical expertise by practising in differing healthcare organisations and structures.

OoPEs will not count towards CCT. Nevertheless, for example, OoPE time as a locum consultant, while not being credited for CCT, can provide invaluable support for subsequent career progression.

4. Planned career break (OoPC)

Planned breaks are no longer considered to be the career transgression that they once were. Although these will not count towards CCT. Such breaks may include domestic responsibilities, work in industry or time to deal with a period of ill health. Duration is usually limited to two years. Longer OoPCs may require relinquishment of a national training number although they may be granted in exceptional circumstances.

ORGANISATION OF OOP TIME

When to take OoP time during training

OoP has traditionally been more available to senior trainees but is increasingly being taken by doctors early in their training. NHS guidance states that trainees should have completed at least one year of their training programme before applying for OoP and must be able to demonstrate satisfactory progress thus far. At least 12 months should be allowed for planning of OoP time. For those wishing to undertake research, this time should include sourcing supervisors and ensuring that intended projects are viable.

Deciding what to do

It is important that you have a genuine interest in your chosen OoP and that this complements or is at least compatible with your chosen career. Be aware that you will need to be able to justify any time out of programme during applications for your next post. In addition, consider your personal objectives for reaching consultancy and whether the OoP time you want may count towards CCT.

Requirements/eligibility

Any time out of programme must be approved by your educational supervisor or postgraduate dean and the necessary forms completed (see www.medicalcareers.nhs.uk). Plans usually need to be finalised at least three to six months in advance of the start date, depending on the Deanery.

For those organising time out of specialty training, the ‘Gold Guide’ produced by MMC provides information regarding examples of approved OoP experiences and the relevant application processes. Two years is normally the maximum time allowed out of training (three years if undertaking a PhD), and at least six month’s notice must be given before your return to the training programme.

Funding

Increasingly, funding is becoming notoriously difficult to secure and the effect on earnings and your pension should be clear before you embark on any OoP time.

Is OoP for me?

Deciding to take time out of programme shouldn’t be undertaken lightly. In addition to the financial considerations, poorly planned or executed experiences can be detrimental to your career in the long-run. Equally, well-thought out OoP time can be hugely beneficial in both professional and personal capacities. Allowing sufficient time to consider the available options and make an informed decision is crucial in achieving the experience you want.

PROS

• Add greater flexibility and variety to your training
• Time to rekindle interest in your chosen speciality
• Demonstrate early commitment to a particular sub-specialty
• May contribute to CCT
• Applying for your next post as a more well-rounded, experienced, and therefore employable , individual

CONS

• Plans that fall through or projects that never reach completion may be difficult to explain later on
• Greater degree of organisation and decision-making required in comparison to progressing through a centrally -organised training programme
• Requirement of long-term selfmotivation and less teamwork, particularly for research positions
• Possible delay in reaching CCT and therefore consultancy

References

Modernising Medical Careers NHS website. Accessed on 21 June 2013
www.medicalcareers.nhs.uk/postgraduate_doctors/out_of_programme_opportunities.aspx

MMC Gold Guide 4th edition June 2010. A Reference Guide for Postgraduate Specialty Training in the UK. Accessed on 21 June 2013
www.mmc.nhs.uk/pdf/Gold%20Guide%202010%20Fourth%20Edition%20v08.pdf