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3.3 When is the right time to go?
There never is, and never has been, a 'right time'. It is an age old question currently made more difficult to answer by the increasing rigidity of training schedules in the UK. The increasingly 'seamless' transition from F2 to ST1 right up to ST 5,6,7 provides little space for time out. Re- entry into both Hospital and General Practice is also becoming more difficult.

The answer has to be, 'If you know God is calling you to go now then go now or you may never go'. There will always be some reason to put it off or something that needs to be accomplished beforehand! Many a Christian doctor has limited God by being 'prepared to go' but actually 'planning to stay'.

It is far better to gain some basic training and qualifications in a discipline before you go. You will then be better able to make a more effective contribution overseas. You will find that virtually all overseas posts require an absolute minimum of two years' post-registration experience anyway. To go earlier with limited experience and in need of close supervision may only place and an added burden on your hard pressed colleagues.
Your options will then vary according to your specialty, level of training, family circumstances and the nature of the work you are to undertake.

Possible times to work abroad Before entering specialist training i.e. after completing F2 As a trainee (ST 5-7) During your definitive career Stay put and use annual or study leave, sabbaticals or take unpaid leave Take early retirement As and when God calls you – means taking a risk which will mean taking a step of faith!

3.3.1 As a trainee (ST 1-7)

The Royal Colleges will often look favourably upon short periods of time spent overseas in an accredited post of their choosing, during your training (usually 3-12months). They may even be willing to look at other posts and consider them individually on merit. Their opinion should be sought well in advance. See www.rcog.org.uk/index.asp?PageID=1527 for comments from the Royal College of Obstetricians and links to overseas training opportunities that they offer. You should be able to find similar comments on other College websites

There may well be a trade-off between your level of experience and the timing of an opportunity to go. You may feel any help you can bring is better than none but if you need (or your College insists on) constant supervision, you may only be adding to the workload of someone who is already overworked. On the other hand, if you have a good level of postgraduate experience you may be able to provide service which no one else in the locality can and therefore be very useful.

You will be familiar with Modernising Medical Careers (MMC). The website should be one of the first places to go for advice regarding going abroad as a trainee. - www.mmc.nhs.uk/pages/home

Some comments and advice from FAQS on the MMC website MMC aims to greatly improve the opportunities for those who wish to take a break in their careers and will promote fairness and equality of opportunity at all stages of a doctors' career I want to take some time out to travel and work abroad in the next few years – will that be possible with these new arrangements for training? Yes but be sure to discuss your plans with your postgraduate dean, and make sure you are aware of application deadlines and so on when you are away. However you cannot defer your start date - you will simply need to make your application when you are ready to return. Does any job or post that I held either in the UK or abroad (aside from an F2 pilot - see FAQ 3 above) at the SHO level have to be counted as part of my experience? On the application you will be required to list all of the posts you have held and some details about these. All posts – whether undertaken abroad or in the UK at all levels - must be listed. You will also be required to indicate why you meet the eligibility requirement to apply for the specialty and level of specialty training (ST1/ST2/ST3/ST4) at which you are applying. Any post in the relevant specialty which contributed to your experience and to the gaining of specialty competences should be used to demonstrate your eligibility for the specialty and level at which you are applying

Most would agree that there is considerable advantage – both to the trainee and the host institution – in going overseas later in one's training so that skills already learned can be used, refined and passed on to others, as well as new skills and knowledge gained.

Related articles: careerfocus.bmj.com/cgi/content/full/334/7583/7
careerfocus.bmj.com/cgi/content/full/330/7485/46

While abroad Keep a detailed logbook of all that you see and do. Keep a record of interesting cases (that might be worth writing up for publication) Look for research opportunities Maintain contact with the appropriate authorities and senior colleagues at home

If you are planning to spend your working life overseas, it may well be worth considering spending the majority of your specialty training in the sort of environment you plan to be working in. Such experience would be invaluable and often unobtainable in the UK – especially in the surgical specialties.

If you are looking for surgical training in sub Saharan Africa, visit the website of the College of Surgeons of East, Central and Southern Africa. www.cosecsa.org/ and examine the possibilities At least one CMF member has taken this approach to his training and would be willing to advise if necessary. If you ever had to return to the UK, you might that you had to undertake further training to gain accreditation.

3.3.2 Once in an established Consultant post or General Practice

Obviously many issues will need to be taken into account when considering the possibility of spending more than a few weeks abroad e.g. the need for locum cover for while you are away; UK job security; revalidation issues, pension matters, family situation etc. These will all require careful forward planning.

As a GP, it may be possible to work part time or take up a 'Flexible Career Plan'. The pros and cons of this approach have been reviewed at careerfocus.bmj.com/cgi/reprint/332/7533/gp13-a.pdf

Trusts can sometimes be persuaded that time abroad is an appropriate part of career and skills development. It may even be possible to persuade the Trust to allow such work as 'professional' rather than annual leave. An alternative would be to use sabbatical leave.

3.3.3. Following Retirement

Specialists or GPs approaching or recently post-retirement can be an extremely valuable asset overseas. You have the experience to facilitate, encourage and train others and are often better able to deal with some of the difficult medical/surgical situations that arise. Some may specifically choose to retire early with the intention of giving the final years of their working life to service overseas - while they are young and fit enough to enjoy it. They too must demonstrate a willingness to continue to learn and be adaptable. Those with previous overseas experience can be extremely useful and are often able to short-cut much of the planning and preparation because they have travelled the road before.


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Acknowledgements My thanks to Chris Lavy, Eldryd Parry, Ian Spillman and Nick Wooding, all of whom have worked overseas and have a continuing involvement, for their helpful comments and advice. First edition 1994 - Entitled ‘A Medical Missions Handbook’ by Peter Saunders. Second Edition 1998 (updated April 2000) Third Edition September 2003 - by Peter Armon Fourth Edition 2007 – renamed ‘Working Abroad’ - totally revised & rewritten by Peter Armon All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the CMF. Christian Medical Fellowship 6 Marshalsea Road London SE1 1HL Tel. 020 7234 9660 Fax 020 7234 9661 Websites:www.cmf.org.uk and www.healthserve.org Christian Medical Fellowship is a registered charity No. 1039823 DISCLAIMER While seeking to be accurate in all the details contained in this document, CMF cannot be held responsible for the information contained in this booklet. The reader should double check the information for him/herself