Guide to Anaesthetics Training (The Handbook)
Out of Programme
There are opportunities for anaesthetists in training to undertake approved periods of time outside of the approved programme as experience, research, or training. When contemplating undertaking a period out of programme, anaesthetists in training should discuss the options and consequences with their Educational Supervisor, College Tutor, and Training Programme Director.
Details of the various out of programme opportunities are available in the Gold Guide [external link]. Although College approval is not required for all types of out of programme, it is essential that anaesthetists in training inform the Training Department of the dates of any such activity so that prospective completion dates can be revised as necessary.
Time out of programme for approved clinical training (OOPT)
OOPT is clinical training, undertaken outside the UK or in non-approved locations in the UK (please refer to the GMC list of approved locations, external link). Placements undertaken in a different Deanery may be referred to as OOPT in respect of that local training programme but would not be considered as an OOPT by the College or GMC and therefore don’t need to be managed via this process.
An OOPT placement will count towards the CCT provided the following conditions and requirements are met:
- on commencing OOPT the anaesthetist in training must be in a GMC approved training programme having completed stage 1 and stage 2 of training in their entirety. This does not preclude setting up and planning OOPT during stage 2
- only 12 months (whole time equivalent) in total during stage 3 can be taken as OOPT
- the OOPT programme must map to capabilities identified in the stage 3 and/or special interest area(s)
- the OOPT post must be prospectively approved by the GMC with support from the Postgraduate Dean and College (a minimum of 3 months should be allowed for GMC approvals processes); you can download a copy of the OOPT application form here
- OOPT must be undertaken in clinical posts locally indicated as being suitable for training
- the last 6 months of the CCT training programme normally should be in the UK
- on return, the anaesthetist in training must complete a report on the time spent on OOPT and submit it, together with an assessment report from the local supervisor, to the Deanery and the College’s Training Department. Until this report has been received and reviewed the College cannot confirm time spent on OOPT towards a CCT.
Time out of programme for research (OOPR)
OOPR is research taken out of programme. The same rules apply as for OOPT.
Up to 12 months (whole time equivalent) of research can be counted towards the CCT, provided there is a clinical element to the programme (this includes out of hours duties within the hospital where the anaesthetist in training is based for their research time). If there is no clinical element to the research programme, a maximum of 6 months only will count towards the CCT.
6 months of research can be counted towards the stage 3 Research and Managing Data domain of learning as well as the SIA in this area. If there is an appropriate clinical element to the OOPR, a further 6 months can be counted towards stage 3 capabilities in other areas.
When planning an OOPR, anaesthetists in training are advised to consider complementary areas and capabilities of stage 3 that may also be evidenced.
Time out of programme for non-clinical Special Interest Area (SIA) training
As for research, opportunities can be taken to undertake training in non-clinical special interest areas of training during Stage 3.
Up to 6 months of SIA time can be used to complete SIAs that relate to generic professional domains of learning in any one of the following:
- Management and Professional and Regulatory Requirements
- Safety and Quality Improvement
- Education and Training
- Research and Managing Data
When planning non-clinical SIA training, anaesthetists in training should consider complementary areas and capabilities of stage 3 that may also be evidenced.
Only 12 months (whole time equivalent) in total during ST6-7 can be taken as either OOPR or OOPT.
Applying for OOPT and OOPR
It is recommended that Schools of Anaesthesia have guidelines that inform anaesthetists in training commencing stage 3 of the requirements for, the notice of and the documentation required for the organisation of OOPT and OOPR. It should be made clear that any proposed period of OOPT or OOPR must be arranged at the earliest opportunity. Gaps created within the rotation will need to be filled and if the OOPT is to be spent overseas, the acquisition of visas and the necessary licensing documentation for clinical work may be lengthy and difficult.
It is the responsibility of the anaesthetist in training to provide all necessary information in their applications to the Deanery. The College application form to request support can be found here.
Anaesthesia in developing countries
The College supports anaesthetists in training taking time out of programme to widen their clinical skills and knowledge. To support individuals undertaking OOPT in a developing country, a Special Interest Area of training (Anaesthesia in Resource Poor Environments) has been developed. Up to 6 months can be counted towards the CCT.
Requirements for consideration
For an OOPT in a developing country to count towards the CCT, the following requirements should be met:
- The anaesthetist in training should have attended a course on Anaesthesia in Developing Countries
- Prior to working in the hospital of choice the anaesthetist in training must have made contact with the hospital to be visited and have a clear idea of what can be achieved there. A ‘risk assessment’ of the environment should be undertaken
- The anaesthetist in training will have a clear pre-placement introduction and familiarisation with the clinical and social context in which they will be working. Where necessary an appropriate induction programme will need to be undertaken (this is the case with some international agencies/NGOs)
For a hospital to be deemed suitable for training the following criteria must be fulfilled:
- An Educational Supervisor must be identified to supervise the anaesthetist in training in the developing country [ESDC] to be visited and the anaesthetist in training must have had a successful selection interview, supported by references from other trainers
- The ESDC must have undertaken a ‘Training the Trainers’ type course. The ESDC may not be familiar with the more recent developments in UK training, so the College strongly recommends that there should also be an Educational Supervisor in the UK who both anaesthetist in training and ESDC in the developing country can liaise with via emails, telephone and video-links
- The anaesthetist in training must have met with the ESDC abroad. Ideally this should be face to face but if necessary could be done by telephone
- The ESDC and Educational Supervisor in the UK must be satisfied that the period of time will fulfil the requirements of the curriculum
- The ESDC should devise a training plan, which should contain detailed proposals in the following fields:
- clinical experience
- audit/quality improvement project
- teaching
- research
- management and logistics
- As with any OOPT, a designated local appraiser must be identified.
On return to the UK, the anaesthetist in training must complete a report on the time spent on OOPT and submit it, together with an assessment report from the local supervisor, and a completed Holistic Assessment of Learning Outcome (HALO) form for Special Interest Area Anaesthesia in Resource Poor Environments to the Deanery and the College Training Department.