This document is broken down into three parts to explain why trainees may want to go abroad, what impact this will have upon their careers and affects upon their length of time in training. Secondly it aims to provide information about when to consider a period abroad, where to go and how to ensure that your time out of the UK is counted towards your accredited training. Thirdly it aims to provide practical information about financing your visit, documentation you will require and some basic advice about your health and safety abroad.
1. Reasons to go abroad
1.1 Career benefits
Overseas visits offer opportunities of dealing with urology in a number of different environments to those that exists in the NHS. These include:
• accelerating experience of pathologies and surgical techniques that would be encountered in the UK.
• gaining novel experience of conditions and management options not available in the UK.
• concentrating experience in specific areas of sub-specialist interest that are not readily available in the UK.
Working in the developing world, in particular, will help give you insight into practicing medicine where limited diagnostic support is available.
There are risks of training abroad, just as there are in training in the UK. These risks apply to the trainee and the centre visited.
Firstly, your time out of the country will be subject to a process similar to the RITA assessment, as found in the JCHST's "grey book". You will be required to complete documentation similar to the six monthly Joint Committee on Higher Surgical Training (JCHST) ‘yellow form’ (Form D in this document). Second there are risks that a period of poor training will be reflected in your assessment of that institution; if Form E (the JCHST ‘green form’ equivalent) demonstrates poor training potential or poor supervision then it is unlikely that further UK trainees would be allowed to go to that centre in the future
1.2 Personal benefits
The benefits of working abroad are much more than simply professional. Experiences outside the UK help to foster durable relationships with the centres visited which may last the rest of your professional career. Working abroad has the potential to renew your enthusiasm for medicine and may be an experience that is not a module in any part of your UK-based training. It goes without saying that a period abroad enables you to travel and maximise opportunities, offered in the locality, in your leisure time.
1.3 Altruism
Trainees considering working in the developing world may wish to do so for more altruistic reasons. They may wish to contribute to the provision of urological services in the centre, or the country, that they visit. They need to be sure that they are contributing and not going to decrease the opportunities for trainees in the centre they are attached to. For these reasons it is advisable that a trainee wishing to work in the developing world is going somewhere that has already been visited by a UK-based consultant which is appropriately staffed and equipped to realistically provide the experience the visitor wants. Any trainee contemplating such an experience would be best advised to contact the UROLINK office at BAUS.
2. Impacts
Periods abroad will have an impact upon your professional life and your family and need to be part of your decision making process when considering working outside the UK.
2.1 Effects on your training.
It is currently very difficult to obtain permission for periods abroad that are likely to affect your CCT date. You will need to decide whether you intend your experience to be out-if-programme or in-programme.
‘Out-of-programme experience (OOPE)’ of 3 months or less will not affect your CCT date. See section 5.1 below for specific guidance. Visits to developing countries are likely to fall into the OOPE category unless a previous visit has occurred and accreditation has been approved for that particular post.
• ‘In-programme experience’ requires you to have a nominated supervisor overseas who will undertake assessments. Your CCT date is likely to remain unaffected if prospective approval of the post has been obtained. Again, see section 5.1 below.
• In some cases, a period of training abroad, that has not previously gained recognition for training, may qualify retrospectively for accreditation if robust data and assessments are submitted to the SAC.
2.2 Effects on your salary progression.
Your incremental date can be protected if you have undertaken a period of accredited training abroad. This will often require documentary evidence for your own Medical Personnel Department / Finance Department. Unaccredited periods are not usually recognised but it is always worth discussing the situation with your own employer. NHS trusts have often been extremely supportive of non-accredited periods spent in developing countries. The BMA will advise on salary matters where there is dispute between your employer and your own understanding regarding incremental dates.
2.3 How it affects your pensions and National Insurance contributions.
The NHS superannuation scheme is a valuable asset and you must protect your accumulated years of service. If you have been employed by the NHS for more than two years and then return to service with the NHS your membership will be protected. Your contributions will be ‘preserved’ and reinstated on your return. You may need to ‘top-up’ or buy back years to cover your period out of the scheme. Always discuss the specific arrangements with your local NHS pensions Officer or BMA.
There are certain instances where you can stay in the pension scheme whilst abroad under the ‘direction’ arrangements. These arrangements originate from the Department of Health and cover work for a considerable number of organisations. For example
• Working for the United Nations or for the government or public bodies of certain overseas countries.
• Working for overseas aid organisations (Oxfam, Save the Children, VSO) but certain conditions apply.
Further advice can be obtained from:
NHS Pensions Agency
Hesketh House
200 – 200 Broadway
Fleetwood
Lancashire
FY7 8LG
2.4 Taxation
Taxation can be complicated whilst working abroad. If you receive a local salary, you will be liable for local taxation. You will also be treated as a UK taxpayer unless you are abroad for one complete financial year. Taxation agreements exist between most countries and the UK to ensure equity in your taxation and it is useful to employ the services of an accountant / tax advisor on you return if the situation is complex. Remember that many of your expenses incurred organising the trip will be tax deductible.
2.5 How it might affect your family.
Taking a family abroad is a considerable upheaval and will involve significant planning. Allow plenty of time to make arrangements and consider areas such as letting your own property, accommodation abroad, schooling arrangement and banking facilities. Family members will need visas and you may require student authorisation for accompanying children. Consider house swaps if a trainee is going to fill your UK post. Hospitals may have International Offices or a liaison officer to help you arrange some of these matters. Expect to feel tired, ‘out-of-water’ and even unsure of the wisdom of your trip when you first arrive! It is a very intense period during the initial stages of your trip and you will value having family with you. You will ultimately have fantastic memories to share and many trainees feel a very strong link to countries / centres that they visit during their training.
3. When to go
There is no doubt that any trainee wanting to work abroad needs a basic skill set to be able to capitalise on the experience available. This is especially so if you intend to train in the developing world. You need to have the resilience to make work (in very different conditions to the UK) worthwhile. Trainees would be best advised to make such a trip towards the end of their training when it least conflicts with the pressures of accreditation exams and hunting for consultant jobs. It often takes a surprisingly long time to arrange an extensive trip - so adequate planning early in your career is essential.
4. Where you can go
Within reason you can go anywhere in the world. Whether your visit will be counted as part of your accredited training will depend upon the accreditation status of the centre being visited, the length of time being spent abroad and the benefits expect from the trip. The time you spend away will be determined by whether you expect the experience to be taken so as to minimise the impact on your training (5.1) or by taking time away from training (5.2). A directory of centres visited by previous trainees and the experience they had whilst there is available in the column to your right.
5. How you can go about it
Time abroad might be taken so as to be entirely a part of your postgraduate training or as ‘private’ travel outwith your training programme.
5.1 By minimising your impact on training
The first issue for any surgical trainee to resolve is how you can get time away from their UK training programme without detracting from their accreditation date and compromising their future career.
Section 18 of the Joint Committee on Higher Surgical Training (JCHST) “Pink Book” gives clear guidance about what time may be counted as accredited training if approved prospectively. Support needs to be obtained from the following three groups:
• your trainers in the proposed time of absence
• your programme director
• the Specialty Advisory Committee (SAC) in Urology.
The SAC will demand to have knowledge of:
• a nominated trainer in the centre you are visiting (Form A)
• the length of time you intend to be abroad (Form A)
• a timetable including any on-call commitment (Form A)
• the aims and objectives of your visit (Form A)
If the centre being visited has not been visited before then the SAC will require demographic information about the institution being visited, its facilities and the number of trainees, and training facilities on-site (Form B). This form may need to be completed for a centre that has previously been visited, but more than 3 years previously, and for all centres previously having unsatisfactory training assessments. Trainees may spend up to one year in an overseas centre as long as it fulfils the SAC’s criteria.
5.2 By taking time away from training
Out of programme experience (OOPE) can be agreed with the Postgraduate Dean and your Programme Director. It is usually reserved for non-accredited posts and has a restriction of three months. If you do employ OOPE, remember to keep detailed logbooks etc and ask for appraisals / references as it may be possible to seek accreditation for your time abroad on your return. Typically, OOPE is restricted to three calendar months. OOPE applications forms and guidance are available on the JCST website.
6. What you need to do
6.1 Agreeing your trip with your educational supervisors.
Your trainers at the point of your absence from the UK need to have agreed to you being abroad and to be happy that appropriate ‘cover’ for daytime and out-of-hours activity can be provided. They also will need to be assured that your absence is not financially detrimental to their institution.
6.2 Getting permission from your programme director
Your programme director is key to the whole discussion and needs to be happy that your progress, in UK training, is satisfactory. It is extremely unlikely that anyone being assessed into RITA D or E categories would be acceptable for training abroad. Your programme director will have to agree your educational objectives with your nominated trainer abroad (Form C in all four categories) and to debrief you on your return (Forms D and E)
6.3 Applying to the SAC in urology
The SAC in urology will need to have agreed Form A, your plea for time out of the UK, and Form B, a demonstration of what the centre abroad has to offer. This form will not be processed unless it has the signatures of your local trainers and your programme director on the bottom of Form B. This form can be sent to the SAC in urology:
• by post to
• by fax to
• by e-mail to
Following receipt, nominated representatives of the SAC and UROLINK will vet each application and respond, initially, within four weeks. You can only make plans for your visit once the SAC has confirmed, in writing, that they are happy for your time out of UK-based training.
7. Once you know you can go
7.1 Gaining knowledge about where you are going
Get as much information as you possibly can about the country, and centre, you are going to before you depart. Much information can be gleaned from the internet and from various travel guides. Specific information is best obtained from people who have travelled specifically with the purpose of undergoing training abroad; the gazetteer associated with this guide gives you some contacts that may be useful.
7.2 Finance
You need to be able to financially support your visit. This can be achieved in a number of different ways detailed below. Prior to departure, ensure that you have made banking arrangements in your destination country and try to have a ‘float’ in a bank account at home to cover unexpected events / standing orders. Internet banking will greatly facilitate your arrangements. Where possible, inform your bank/ bank manager of your plans and aim to set up telephone authorisation of payments / transfers should they be required.
7.2.1 Maintaining your UK salary/ salary swapping
This will be very dependent on the geographical area you chose to work in. Developed countries will generally offer you a salary in line with your experience on a comparable scale to the local trainees. In developing countries, it is highly likely that you will be unsalaried or, at best receive a local salary. Although this local salary can be modest (£100 – 150 a month), there are advantages to receiving it. It means you will be a salaried member of the visiting institution rather than simply a visitor and this can be important if there are any problems with your post during the stay.
7.2.2 Gaining funding
A number of travel bursaries and prizes are available for overseas travel. These are accessible via the relevant surgical college’s websites or via the speciality associations sites. Travel to the developing world attracts specific funding and UROLINK has a number of different prizes for this purpose. Other organisations offering sponsorship / fellowships to the developing world include the Royal College of Surgeons and the Department for International Development (DFID).
7.2.3 Sponsorship
Sponsorship is another way of underwriting the costs of your trip abroad. You would be best advised to secure this funding so that you know that your costs can be covered before leaving the UK. Commercial organisations may cover different aspects of your trip, often with your demonstration of the role they paid in supporting your trip.
7.3 Documentation
You need to ensure that you have all of the documentation you need to allow you to travel and work wherever you are going. Getting this documentation needs time and you need to make sure you have everything you could possibly need with you before you leave the UK.
7.3.1 Visas
This will depend upon where you are going and how long you are going to be there. Obtaining a visa can sometimes be a lengthy process and you would be best advised to look at the Foreign and Commonwealth Office (FCO) website and go to the travel advice by country section for up-to-date information. This site provides information about how to contact the consulates and embassies of all of the countries throughout the world. Remember you will need a passport, often valid for up to six month following your return to obtain a visa. Any doubts about your passport’s validity, go to the UK Passport Service (UKPS) site.
7.3.2 Work Permits
You need to check what permits you will require to allow you to achieve your expected levels of experience whilst abroad. Your supervisor abroad should be able to advise you about this; alternatively the appropriate HR department in the developed world should be able to assist you with this process or further information may be found on the relevant embassy website of the country you are visiting. When obtaining work permits in the developing world, allow months rather than weeks to obtain the necessary documentation. It is often necessary to have a local contact as fees may need to be paid in cash (dollars often) and you may require written support of the department you are visiting.
7.3.4 Professional documentation
You need to check with your supervisor abroad what documentation you will need to take with you to allow you to practice at the level you expect whilst you are away. Certification such as GMC registration, Fellowship and Accreditation certificates may also be required as may evidence of your hepatitis and HIV status. In certain countries you may also be required to demonstrate that you are able to financially support yourself with a verified statement of credit-worthiness.
7.3.5 Medical Indemnity
Your professional indemnity cover will entirely depend upon where you are going and what you are going to be doing. You would be best to approach the organisation providing professional indemnity cover to sort out what cover you will be provided with. If you are travelling to the developing world then short periods of experience abroad will often be covered by your UK indemnity. Longer periods, on an entirely humanitarian basis, may be covered by a reduced cost ‘missionary’ level of cover. The arrangements are often agreed on a case-by-case approach so take the opportunity to personally discuss your arrangements with your protection society.
7.3.6 Other
Remember to inform those who need to know of your change of address such as the GMC, RCS, Medical Indemnity and the BMA. Take evidence of no-claims bonuses if you intend buying a car.
7.4 Personal health, and safety
It is essential that you return fit and well from your trip abroad and are able to resume your training as son as you get back to the UK.
Sensible advice, regarding health and safety whilst out of the UK, can be found on the DOH website.
Contact the Occupational Health Department in your current hospital. You will usually find them very helpful in advising you on inoculations / precautions abroad. They may be able to help provide anti-retroviral drugs, for example, if you are travelling to an endemic area. In such cases, it is often helpful to identify an individual in the Occupational Health Department whom you can contact for urgent advice whilst abroad. In the developing world, it can be extremely difficult to get good advice locally on the risk assessment of a needlestick-injury or exposure-prone work. Contact the department on your return to seek clearance for your normal clinical duties.
If you are on regular medication, make arrangements for the overlap period whilst you settle in.
It is essential that you check what inoculations you will need for where you are travelling and whether anti-malarial prophylaxis is required. The DOH website provides you with a resource to demonstrate the indigenous health risks in the country you are planning to go to. You need to identify whether anti-HIV treatment may be required should you sustain a needle stick injury and you need to take the relevant precautionary treatments with you.
Travel insurance is an absolute and the FCO gives good advice about this. .
7.4.1 What you need to take with you
This will obviously depend upon where in the world you are going.
In the developing world gloves, masks, eye protection and HIV prophylaxis are all vital pieces of equipment to stuff into your luggage as are a hat, sun screen, mosquito repellent, anti-malarial prophylaxis and anti-diarrhoea medication. You can also take equipment with you that can be left behind after your visit such as pairs of gloves, suture materials or catheters as well as single-use items which are date expired.
Current journal articles, a lap top with power point presentations and electronic operative texts will be useful if you are going to do any teaching and a digital camera, with which to record your trip, is essential. You need to keep a diary of what you did and what experience was gained to enable us to demonstrate the worth of your visits.
7.4.2 Other
Keep in regular contact with those at home, both family and colleagues. Keep your department up-to-date and engage them in your visit with regular feedback / pictures. Collect names and addresses of individuals you work with. Make arrangements regarding your return to work in the UK, remembering to contact Medical personnel and not just your supervising consultant Allow yourself sufficient time on your return to accommodate the ‘reverse culture shock’.
8. When you get back
You will need a debrief with your programme director on your return and will be expected to bring back Form D, the trainers feedback about the trainee (JCHST ‘yellow form’ equivalent) and Form E, the trainees assessment of the centre visited (‘Green form’ equivalent) to enable your RITA progression and data-basing of information about the centre visited.
Write and thank your host department – this will reinforce the foundations for future visits. Thank any sponsors who have supported your trip. Consider writing your experience up to enthuse others to visit the centre / plan their own trip. Try to honour any promises you have made with the host department such as sending journals, facilitating reciprocal visits etc.
