Foundation training overseas: how to apply and the pitfalls to avoid
Authors: John Chetwood
Publication date: 10 Feb 2015
John Chetwood outlines the pathway and potential difficulties for those hoping to complete the second year of the foundation programme overseas
The benefits of gaining an international perspective on health are increasingly recognised.   Overseas experience also allows immersion in a different culture, different epidemiology of diseases, and different healthcare model.
Training abroad during the second year of the foundation programme (F2) has the benefit of allowing such exposure while maintaining a structured environment in which to complete the training year. It has traditionally been an attractive option for those who want to work in another country’s healthcare system but do not want to take time out of training.
The F2 year may be a trainee’s first opportunity to work abroad after full registration with the General Medical Council. This is because most foundation schools will not give permission for the first year of the foundation programme to be completed overseas, particularly if there are no exceptional circumstances to consider.
However, revalidation and the need to show continual professional development can make international work at a junior level a more challenging aspiration. In addition, the playing field for those seeking an F2 post overseas has changed in recent years. Not only have the specifications for the NHS foundation training changed, but there are also tighter immigration rules in countries like Australia and New Zealand and more doctors are being trained in countries that have traditionally hosted UK trainees.
Obtaining competitively placed rotations at F2 level abroad is often just as difficult, if not more difficult, than finding similar rotations at home. This is because domestic trainees are generally given preference to overseas trainees, and the specialties that are competitive in the United Kingdom are usually equally competitive in other countries.
Given the difficulties in the application system, many trainees defer their application to work overseas until after foundation training. For those seeking additional focused experience in a particular field, it may be better to apply after foundation training. There is then less pressure to conform to a standard foundation training year and rotate through posts, and so trainees can have greater flexibility to tailor individual placements to particular goals.
Working in any developed country can theoretically provide equivalent experience, the opportunity for equivalent personal development, and the ability to complete the e-portfolio sign-off. Previous F2 trainees have worked in Brunei, Singapore, Switzerland, and the United States. However, most junior doctors end up applying to Australia and New Zealand. This is partly because Australia and New Zealand have no requirement for trainees to take an equivalency exam, which many other countries require. In addition, most trainees are suited to working in a similar healthcare system, and trainees may have some contact with hospitals or healthcare agencies from friends and families who have worked there. Hospitals in Australia and New Zealand are also often more receptive to UK graduates since previous trainees may have undertaken similar roles.
However, in recent years both Australia and New Zealand have tightened up their immigration rules and increased the numbers of doctors they train. This has made it more difficult for UK doctors to secure medical jobs in these two countries. Vacancies are still available in some unpopular posts, such as a role in emergency medicine or one including relief run. However, such posts are generally unsuitable for training and may not be sanctioned for foundation training by deaneries.
I did my F2 year in New Zealand. I wanted to experience a different healthcare system, and the job I applied for allowed a greater diversity of training as it included four rotations rather than three.
You must apply early (I started applying for overseas posts at the start of my F1 year) and be ready to face lots of rejection. To give up your F2 placement, most deaneries require a finalised offer early in the previous training year.
However, there are several obstacles to achieving an offer so early. One is that hospitals generally recruit international doctors when they want to plug a gap left by a shortage of domestic trainees. Recruiters may be uncertain where they stand in terms of recruitment at the point in the year when foundation schools require them to commit to taking an overseas trainee.
Another obstacle is that the hospital administrators will have to complete forms for your F2 year and guarantee certain training requirements. This means the hospital will have to invest more time and effort than it would for a competitor trainee on a sabbatical year, and this may therefore disadvantage you in the eyes of recruitment agencies.
Junior doctor recruitment often runs on a different schedule in other countries. In New Zealand, for example, the medical training years run from November to November. This meant I had a two week break between starting F1 and F2 to fit in with the beginning of the next run of jobs. When arranging this, it also required special consideration and dispensation from the recruitment office as I was starting at an unconventional time. This break was great for relocation purposes, but starting late may preclude me from going straight into certain specialty training schemes that begin in August as my foundation training will now finish later. If I am interested in those specialties I will need to take a year out of training before applying.
Costs can be important. Trainees must bear the financial burden of flights, medical council registrations alongside domestic General Medical Council registration, visas, medical certificates for visas, notarising and couriering documents, international medical indemnity, and international phone calls. One previous estimate was around £2000, which is probably appropriate although you may be able to reclaim some costs. For instance, in New Zealand you can reclaim medical council and indemnity fees if you are in ongoing employment in a district health board. There are also the costs and logistics of flying back for interviews for further training, although most hospitals are sympathetic with annual leave for this purpose.
The skills and competencies expected in other countries may differ from those in the United Kingdom. In some fields, higher levels of skills or competency may be expected, while in other fields the levels required may be lower.
In terms of training courses, you may not have access to a study budget and if you do, the waiting list for courses may be more than one year. Generally, as a prerequisite to the F2 year the healthcare system should be equivalent to the United Kingdom, but you will still find differences in treatment regimens, drug doses, the structure and style of the healthcare system, funding, and so on. A lack of familiarity with the NHS e-portfolio is another potential hurdle, although in my experience most colleagues are happy to perform assessments if they are explained.
In terms of later training and job applications, how future employers react to an F2 year abroad is extremely hard to predict and will depend on the employer and the specialty you are looking to enter. If you show progression of learning and personal development, however, an F2 year abroad should not be perceived as negative to your learning. In fact, it may provide a talking point in interviews.
Five F2 trainees went abroad in 2014-15, all of them to New Zealand. The deaneries that currently allow F2 trainees to work abroad are East Anglia, North West Thames, Peninsula, Severn, South Thames, and Wessex.
East Anglia allows F2 trainees abroad but this is currently under review. No F2 trainee from East Anglia deanery undertook training abroad this year.
North West Thames deanery allows three trainees to apply directly to complete the F2 year in Wellington, New Zealand, on a reciprocal arrangement (the foundation school manager for this deanery is an ex-resident of Wellington). Selection for these posts is competitive and based on F1 performance and a comparative audit project proposal.
Peninsula allows F2 trainees to train abroad, subject to approval by the foundation school, but none undertook training abroad this year.
Severn allows overseas F2 training and does not “restrict the numbers” allowed, but any post must comply with the deanery’s specifications. This year one trainee from Severn deanery went to New Zealand.
South Thames allows a maximum of four trainees to work abroad for their F2 year. One person from South Thames deanery spent their F2 year in New Zealand.
Wessex allows eight trainees to go to Australia, New Zealand, South Africa, and the United States, but no F2 trainee undertook training abroad this year.
The following deaneries are not allowing an F2 trainee overseas for the training year 2015-16: East Midlands (Leicestershire, Northamptonshire and Rutland), Mersey, North Central Thames, North East Thames, North Western, Northern Ireland, Northern, Oxford, Trent, Scotland, Wales, West Midlands, and Yorkshire and Humber.
Competing interests: I have read and understood BMJ’s policy on declaration of interests and declare that I have no competing interests.
- Department of Health. Modernising Medical Careers. A guide to postgraduate specialty training in the UK. The Gold Guide. DH, 2007.
- British Medical Association. Broadening your horizons: a guide to taking time out to work and train in developing countries. BMA, 2009.
- General Medical Council. Tomorrow’s doctors: outcomes and standards for undergraduate medical education. GMC, 2009.
- Deall C. Going abroad for F2. NHS Medical Careers, 2013.
John Chetwood foundation year 2 doctor
MidCentral District Health Board, New Zealand