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. Re-entry into both hospital and general practice is also becoming more difficult, but is not impossible.

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 subconsciously '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 an 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 an added burden on your hard pressed colleagues.

• Do not go overseas before completing the foundation years (FY1 & FY2) and completing the requirements for full registration in the UK.
• 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 ie after completing FY2
• Before entering higher specialist training ie between CT2 and ST3
• During ST training, taking time out of programme (OOP) – see below
• On completing your specialist training
• As time out of an established consultant or general practice post
• During retirement

3.3.1 Going between training posts (after FY2 or CT2)

The advantage of going between training programmes is that you can go anywhere for any length of time, though be mindful of the fact that when you apply for future jobs you will be asked about why you went and what you did. The disadvantage is that you will not have a job to come back to as it is not usually possible to defer entry to a training programme. You may have to apply while away, possibly returning for an interview, or wait until you get back – you may want to time your return to coincide with application dates.

3.3.2 Going as a trainee, taking time out of programme (OOP during ST1-7)

Everyone is entitled to apply for time out of programme – see Broadening Your Horizons www.bma.org.uk/international/working_abroad/broadeningyourhorizons.jsp
The Gold Guide www.mmc.nhs.uk/specialty_training_2010/gold_guide.aspx (section 6.68 onwards)

There are four options:

• OOPE – Out of Programme Experience
  This will usually be for a year but can be extended up to two years. It must be approved by your educational supervisor but will not count towards your certificate for completion of training (CCT). Various types of post could be approved as OOPE – it is important to have clear goals and objectives detailed in your application. Both the RCOG and RCPCH run fellowships in conjunction with Voluntary Service Overseas (VSO) which are approved for OOPE.
• OOPR - Out of Programme Research
  If this is to count towards CCT it will require prospective approval by PMETB/GMC and the relevant royal college
• OOPT - Out of Programme Training
  If this is to count towards CCT it will require prospective approval by PMETB/GMC and the relevant royal college.
• OOPC Out of Programme Career Break
  This is usually a break for non-medical activities eg fulfilling domestic responsibilities, pursuing another interest, or during a time of ill-health. It could be used for a period of travel which might encompass some medical work, with more flexibility and less accountability than an OOPE. It must still be agreed with your educational supervisor and will not count towards CCT.

All of these must be applied for well in advance – start planning a year before, discuss with your educational supervisor and submit the OOP application form to the Deanery six months before you want to go. A trainee is usually expected to complete at least a year of the programme before taking time OOP.

The application process can take a long time and requires some perseverance! However, the advantage of going OOP is that you have a job to return to, some on-going supervision and contact with the NHS. The disadvantage is that you may be more restricted with regard to the length of time you can be away and the kind of work you can do.

While abroad...

• Keep a detailed log book 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

3.3.3 Going after completing your training (CCT)

If you are planning to spend a substantial part of your working life overseas, it is best to complete your training first, though short term visits during this time can be useful for working out what kind of setting you will work best in, and for keeping your enthusiasm and vision alive. Having a full training behind you will equip you with many skills to offer, and your postgraduate qualification will enable you to teach and train. It may be worth considering doing some 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 specialities.

3.3.4 Going during an established consultant post or general practice

• The NHS Career Break Scheme enables doctors to take an extended period of unpaid leave without having to resign from NHS employment – see the BMA booklet Broadening Your Horizons (ref above)
• Study leave or sabbatical leave can be used for shorter periods

Discussion with both employers and royal colleges will be necessary and arrangements for keeping in touch while away should be made.

3.3.5 Going after retirement

Specialists or GPs who are recently retired or approaching 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.