Taking time out of training

Authors: Zoe Barber, Charlotte Jones, Thomas Dobbs 

Publication date:  02 Nov 2015


Taking time out of training gives doctors the chance to experience something new but needs careful planning, say Zoe Barber, Charlotte Jones, and Thomas Dobbs

Doctors may take time out of their clinical training for a number of reasons. Doing so offers them a unique opportunity to learn different skills and work with different people, secure in the knowledge that they will return to training.

Taking time out of programme can be done in various ways:

● An out of programme career break is time out of a training programme to pursue an interest unrelated to your training or deal with ill health, while retaining your training number.

● An out of programme break for clinical experience enables trainees to enhance clinical experience or gain experience as a locum consultant. Trainees may choose to work abroad or gain experience in tropical medicine.

The General Medical Council (GMC) does not need to approve these as neither counts towards the certificate of completion of training. However, they need to be approved by the deanery or local education and training board. Other types of out of programme experience include time out for approved clinical training or time out for research.

Benefits of non-clinical time out of programme

Few clinicians who have taken time out of training regret their experiences. However, those who don’t take up the opportunity for time out often think that they have missed out as current training programmes give doctors little time to pursue interests outside medicine, despite the fact that from medical school application onwards would-be doctors are told they must be good all rounders.

For some, time out of programme is the chance to take time away from medicine without giving up a training number. For others, it is necessary for health or personal reasons. Experience outside the traditional clinical career pathway enables trainees to meet people from a wide range of backgrounds and experiences. Many of the skills acquired will be transferrable and will enable you to discuss something unique at a consultant interview.

Applying successfully for an out of programme career break

The earlier trainees can plan their out of programme career break, the better. Most deaneries require at least six months’ if not 12 months’ notice for applications to allow them to plan placements and allocate trainees for the following year. If trainees are taking more than six months out, the deanery will have to cover the post with a locum appointment for training or a locum appointment for service. Most deaneries do not accept late applications.

Trainees should discuss their plans with their educational supervisor and programme director as they will help to make the most of the year out. Trainees may also want to discuss their plans at their annual review of competence progression to hear opinions from a wider panel.

Applicants must be able to justify their plans and provide evidence of how their time out will be spent. They are unlikely to succeed if they are unable to show that they have carefully considered the benefits of taking time out of training and have documentation supporting their plans. Applicants must also show that they have considered other aspects of taking time out, including GMC registration, indemnity, and pension implications. This evidence must be included in the application form as it will be submitted to the dean for final approval, after being signed off by the educational supervisor or training programme director.

Unsuccessful applicants should ask for feedback from their training programme director and/or the dean, who may be prepared to reconsider an application.

Making the most of your out of programme career break

Although your out of programme career break may be non-clinical, that doesn’t mean that you can’t use it to gain points on your CV. Keep a diary or blog of your experiences so that you can share them with others and show the transferrable skills you’ve learnt and what you’ve achieved from your time out. You may find it useful to write a report at the end of your time out to summarise what you’ve gained.

A non-clinical career break may still offer the opportunity to present or publish your experiences. Alternatively, consider non-clinical conferences and journals as a place to discuss your time out.

Remember the reasons for your career break and stick to them. If you took time out because you have become disillusioned with clinical work, don’t spend your time doing locums. If you want to travel, travel. You have a once in a lifetime opportunity to do something different from your “normal” job, so seize it without feeling guilty that you are missing out on clinical experience or training.

Returning to clinical training

Returning to clinical training after any period of non-clinical work can be challenging. Returners should raise any concerns with their educational and clinical supervisors and explain that they may want to have a period of increased supervision to ease them back into full time clinical work. It may be worthwhile shadowing a senior trainee in the post you will be returning to for a few weeks before going back to training.

Some trainees want to do locum work during their time out, both for financial and clinical reasons, thinking that it is a way to “keep up their clinical skills.” Remember, though, that one of the benefits of a year out is to step away from the clinical environment. When trainees return to the clinical environment they may be surprised at how quickly their confidence and competence returns.

Box 1: Personal experience—Zoe Barber

I am a year 4 specialist trainee in general surgery in the Severn Deanery. I wanted to travel, experience something different from my usual clinical training, and put something different on my CV, so I applied for a Winston Churchill Memorial Trust fellowship. The fellowships are awarded for periods of between four and eight weeks, and my initial plan was to travel for four weeks as annual and study leave during my training. I also wanted to visit Project AngelFood, a charity in Los Angeles, which provides more than 10 000 meals every week, for free, to the terminally ill. No such initiative exists in the United Kingdom.

After winning my fellowship, I was interviewed by local and national press and realised how much interest there was in the charity; the seeds of setting up something similar in the UK were sown. I have received so much support, including financial help in the form of charitable grants as well as logistical support from friends, colleagues, and others who heard about the project and wanted to help.

This led me to think I might be able to do more with my scholarship, so I explored the option of spending longer in Los Angeles, followed by time back in the UK. Doing so would require a period of time out of my clinical training, so I applied to my programme director for a 12 month out of programme career break. I am heading to Los Angeles later this year and will return at the beginning of December to start setting up the charity in the UK.

My application required careful planning and a clear timetable of how I would be spending my year, who would be supporting me, how it would benefit others and my career, and how I would return to clinical training at the end of it. Once I had the support of my programme director, I had to submit my application to the dean for final approval. I was asked to set formal learning objectives for the year at my annual review of competence progression.

My one year out of programme career break will give me a unique opportunity to do something completely different from my clinical training. I will have the chance to help a large number of people but not in the way in which I’m used to. I hope to return to clinical training in October 2016 with new skills, renewed enthusiasm for surgery, and a successful charity providing meals for those who need our support most.

Box 2: Factors to consider when taking a non-clinical year out

Funding—If you do not receive a scholarship or funding, think about how you will pay for usual living costs. You may decide to locum or have income from another source.

GMC registration—If you intend to do any clinical work you must continue your GMC subscription. If you do not plan to do clinical work, you may suspend your GMC fee for the year.

Professional indemnity—You must continue your professional indemnity subscription for any clinical work and inform your indemnity body of your plans for the year.

NHS pension—Your year out will suspend your pension contributions.

Locum work—You may undertake locum work for financial reasons or to maintain your clinical skills. To do this, you need specific permission from the deanery and you must maintain your GMC and indemnity subscriptions.

Competing interests: We have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.

Zoe Barber year 4 specialist trainee in general surgery, Severn Deanery (Winston Churchill Memorial Trust fellow 2015)
Charlotte Jones year 2 core trainee, core surgical training, Severn Deanery
Thomas Dobbs year 3 specialist trainee in plastic and reconstructive surgery, Wales Deanery

 zbarber@doctors.org.uk

Cite this as BMJ Careers ; doi: