Returning to training following an Out Of Practice Experience (OOPE)

Medicine is not confined to the ward; the call for care can come from the most unexpected places. Taking time off from traditional practice can do so much to renew your respect for your field and provide both a professional and personal challenge. Though making the decision to take time out is never an easy one, Out Of Practice Experiences (OOPEs) are highly transferrable and should be seen as an addition to your training, not a replacement. Although this time away doesn’t always count towards your CCT or CESR(CP), it doesn’t mean it won’t be invaluable to your career as a doctor.
The OOPE can be undertaken in a clinical or research setting either in the UK or abroad. Approval in this is contingent on:

Approval by the GMC
Approval by the JRCPTB
Whether the experience will be beneficial to the doctor themselves (working in a different health environment/ country) or supportive to the needs of other countries (work in voluntary organisations or through supporting global health partnerships)
Funding – a variety of sponsorship schemes exist to support this

The challenges you can expect to face during this time away are as idiosyncratic as your chosen placement, however here are some common ones:

Financial difficulties
Political instability in your hosting country
Unusual, often difficult, working conditions
Physical health issues – exposure to foreign (sometimes tropical) illnesses
VISA/ Work Permit concerns
A toll on mental wellbeing (through loneliness and ‘culture shock’, especially)

Before taking time away, it’s important you have considered such eventualities as this and, if at all possible, planned around them. Ensure your programme director is aware of your application to an OOPE at least 6 months prior to depended departure. This is as much for your benefit as theirs: it allows the school to plan ahead and begin to guide and support you from the earliest possible opportunity. Conditional approval must be gained before your OOPE plans can be confirmed.

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If you would like for your OOPE to count towards your CCT, it is your responsibility to obtain a College letter of support in this. This letter will then be used to apply to the GMC for approval via your Postgraduate Dean’s office, but only once the JRCPTB has first accepted your application. Under no circumstances are retrospective applications permitted so do make sure you allow enough time for this formal process to be completed. Remember – the JRCPTB cannot approve your application for OOPE-based credit if you are undertaking your core medical training (CT1 or CT2). Your educational supervisor is there to assist you in navigating this application – don’t be afraid to get them involved from the very start.

Useful resources in planning your OOPE

The Gold Guide

Download the latest (7th – published 2017) edition of The Gold Guide to stay up to date with OOPE policy and refer to the latest version of the Out Of Programme Form you will need to complete (Appendix 4).

The General Medical Council’s Guide to OOP for Doctors in Training

Given that all applications for time away must be directed to the GMC, knowing exactly what they’re looking for will put you in good stead for being approved. This website is essential reading for this.

London Paediatrics’ Guidance on OOPEs

This site provides a step-by-step breakdown of the application and selection process within any OOP experience that is relevant to any specialism.

Personal Accounts of OOPEs

This site provides a variety of OOPE case studies you may find helpful in planning your own time away. First-hand experiences here include time spent training in South Africa, New Zealand, Bangladesh and Australia. Click through to

More general information provided by the Royal College of Emergency Medicine on all OOP opportunities available here.

The British Medical Journal also includes a helpful blog on the OOPE, outlining pathways of application and potential difficulties whilst training. Click through.

The General Medical Council’s Guide to OOP for Doctors in Training

Given that all applications for time away must be directed to the GMC, knowing exactly what they’re looking for will put you in good stead for being approved. This website is essential reading for this.

Useful resources whilst abroad and when returning to training

BMA guide to working abroad

This guide to working abroad from the BMA doesn’t include developing countries as exhaustively as it does Australia, Canada etc. though most advice here is relevant to any destination. Notably, this resource also supports return to the NHS after time spent away.

Guide for Doctors Applying for Australia

Though specific to Australia, this resource breakdowns costs you will have to consider and manage whilst living abroad.

Wessex Deanery Guide to the OOPE

This document is a fantastic resource to continually refer to whilst away and in transitioning back into training. This guide is the most comprehensive you’ll find on the OOPE, from start to finish.

A Guide To Moving and Working Abroad

World First provides a comprehensive yet easy to digest guide on how to make adjusting to life abroad as straightforward as possible. This guide offers advice for you and your entire family, prioritising housing, healthcare and security.

What Your Deanery Can Do For You

Arrange online ‘top up’ learning

Though residential training courses won’t be possible for you whilst training abroad, online courses can be incredibly helpful in preparing you for your return to the UK clinical setting. The BMJ Learning Portal hosts several of these, see below:

Alternatively, try to attend a ‘Keep In Touch’ style course just prior to your return. London School of Medicine’s ‘Springboard’ Course is one such example of this. This is one-day course is offered twice each year for those looking for both practical and pastoral support prior to returning to training.

Arrange a supernumerary period or phased return

You may wish to consider phasing your return back into training whilst you adjust to life back in the UK. Alternatively, arrange for a supernumerary period with your educational supervisor. This refers to a period of intensive and supervised practice whilst coming back into training, including a variety of focused learning activities under direct observation. This time can rebuild your confidence in your practical abilities in a less pressured environment. Such support will be most beneficial on your first on-call rotas. It is important to be honest about your needs in this, particularly the level of intensity you need in this support. Asking for help saves your confidence and, in turn, helps you keep saving lives.

Ensure first patient lists are as straightforward as possible

It’s important to keep cases as straightforward as possible whilst you’re reacclimatising yourself to the clinical environment in the UK. No one expects you to be back to full competence and confidence on your first day! Your educational supervisor can assist you in working up to more challenging cases over time rather than over-stretching yourself at the beginning.

Provide a designated mentor/coach

Many before you have successfully transitioned from training experiences abroad back into clinical practice in the UK; it is possible some may practice within your own Deanery – enquire as to whether this is the case and if they may be available for support. Some Deaneries even offer funding for this type of mentorship whilst returning to training; it is definitely worth contacting your educational supervisor to see if this is provided within your own Deanery.

Having an international perspective on healthcare will no doubt improve your flexibility as a doctor and broaden your exposure to a wider variety of patients and diseases. Just as learning doesn’t have to be confined to a formal environment, neither does your training have to be.

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