Tips for GP trainees wishing to undertake an international experience

INTRODUCTION

International work … what does it mean these days? Is it largely medical aid or development work? A surf-laden Antipodean stint or a cutting-edge research fellowship overseas? Does it even need to take place outside the UK? Many GP trainees already have experience of international work by the time they reach vocational training; often during the undergraduate elective period. International experiences, in addition to those mentioned above, can range from expedition medicine, to health policy work within global organisations. Working with refugees and asylum seekers in the UK can provide a hugely valuable international experience without the need to venture abroad. On reaching GP training, fresh prospects can present themselves alongside existing opportunities. The Tooke report into Modernising Medical Careers confirms that time out programmes should be:

‘… positively facilitated and encouraged … as it enriches the skill base and professional life of doctors, as well as promoting research and development and the global health agenda.’1

In addition to providing new perspectives on medicine, health systems, and the role of primary care in different countries and cultures, international work offers opportunities to develop a vast array of skills that are transferable to the UK setting. Among these are clinical, managerial, educational, and leadership components that contribute to a more effective and motivated NHS workforce.2–4 In the Global Health Partnerships report, Lord Crisp indicates that while the UK has much to offer other countries in terms of healthcare experience and expertise, it can also benefit by broadening the education of health professionals and developing stronger global partnerships.5

What follows are suggestions for GP trainees considering broadening their horizons through an international experience.

1. What are you planning to do and why? Be clear and realistic about your objectives and expectations.

2. When are you going to go? Most GP time out of programme (OOP) is taken between ST2 and ST3. Short periods of time can be taken as leave for activities such as an exchange or attendance at conferences, and remember you can have an international experience without leaving the UK.

PROFESSIONAL ORGANISATIONS

• 3. The World Organisation of Family Doctors (WONCA) runs regular conferences across the world. These are unique opportunities to meet colleagues from other countries, publish, present, and share experiences.

• 4. There are numerous international general practice networks with special interests such as research (EGPRN), education (EURACT), quality (EQuiP), or even rural general practice (EURIPA). Most of these can be accessed through the WONCA network or other primary care organisations.

• 5. The Vasco da Gama Movement is WONCA Europe's network for trainees and newly qualified GPs. Its Hippokrates exchange programme offers a 1–2 week international exchange as a visitor or host.

ORGANISING TIME OUT OF PROGRAMME

• 6. If considering time OOP, look into deanery-managed placements. However, few deaneries currently offer these, therefore it will probably be down to you to organise the placement.

• 7. Give yourself enough time. To give yourself the best chance of success, planning and organisation should really start at least 12 months before you plan to go.

• 8. Most international time OOP opportunities will fall under the category of ‘out-of-programme experience’, that does not require accreditation by the General Medical Council (GMC). In some cases it may be possible for some time spent abroad to be accredited towards UK GP training.

• 9. Do not assume you will be allowed to go, the deanery must grant you permission. Hence, make sure you have valid reasons to go that are in keeping with The Gold Guide.6

PRACTICALITIES

• 10. Explore funding options early. Will you earn a salary while working abroad? Possible sources of assistance include the RCGP International Travel Scholarships, regional RCGP faculties, deaneries, non-governmental organisations, and other charities.

• 11. Always keep a record of your work for your professional portfolio. If planning to go after your certificate of completion of training be aware of UK appraisal and revalidation requirements. The RCGP and GMC websites are the best places to keep updated about this.

• 12. Consider seeking guidance from the British Medical Association and NHS Pension Scheme regarding UK contributions if you plan to work abroad for some time.

• 13. Organise appropriate travel insurance, vaccinations, medical indemnity, and licence to practise for the countries you will be working in.

DEVELOPMENT AND HUMANITARIAN WORK

• 14. Review your skills, qualifications, and clinical experience. Would it be beneficial to attain further specific skills before you go? Examples of qualifications to consider are the diplomas in tropical medicine and hygiene, travel medicine, medical care for catastrophes, MSc in public health or global health, and postgraduate qualifications in medical education.

• 15. If going to a conflict zone, go with a recognised agency that offers training in both security and humanitarian laws and practice.

• 16. Be aware of the ethical implications of projects that you plan to work on and the local impact, together with potential sustainability of any development or relief work.

• 17. In the field, you may be asked to undertake clinical work beyond your level of competence. Consider the risks, benefits, and consequences when deciding how you will respond.

• 18. If undertaking research, be aware of ethical issues as well as the implications for future policy. Explore research networks for ideas, existing projects, and collaborative projects.

• 19. Don't burn out. Pressures can be more intense abroad than when working in the NHS. Carve out personal time and space, take regular breaks.

• 20. While away know where to seek guidance and senior support. Ensure that availability is adequate.

• 21. Even scrupulous preparation cannot prevent culture shock! Do your research, but be prepared for the unexpected.

• 22. Be respectful toward other cultures and understand that our way may not be the best way, or even the right way.

• 23. Make an effort to learn the language of where you plan to visit.

FURTHER AFIELD

• 24. Aim high. Expedition medicine can include mountain medicine, deep sea diving, or desert expeditions to name a few. There are UK courses in expedition and wilderness medicine to help you prepare. The Royal Geographical Society regularly publishes a bulletin of expedition vacancies.

• 25. Aim higher. Think about being a plane, train, or ship's doctor. Projects are of variable length and can range from repatriation duties to over 6 months on a cruise ship.

• 26. Aim higher still. The World Health Organization offers 6–12-week internships to those currently enrolled in a graduate degree programme.

WHEN YOU COME BACK

• 27. Share what you learned, publish a report of your experiences, and consider presenting to your VTS group and GP practice on return.

• 28. Think about how you could continue to contribute to international projects on your return. Plan a return trip to review sustainability and impact of your work.

• 29. De-brief and reflect on your time abroad on your return to the NHS. How will your experience shape your future and possibly the future of others?