For the award of a CCT, trainees must complete the GMC approved anaesthetics programme in its entirety³¹. There are opportunities for trainees to undertake approved periods of time outside of the approved programme as experience, research or training. When contemplating undertaking a period out of programme, trainees should discuss the options and consequences with their Educational Supervisor, College Tutor and TPD.

12.1     Out of Programme Clinical Experience [OOPE]

OOPE is defined by the GMC as: 

“’Out of programme clinical experience’ that does not count towards the award of a CCT or CESR[CP].”  

OOPE may be obtained in clinical or research posts in the UK or overseas that have not received prospective approval from the GMC. Although College approval is not required for this out of programme experience, it is essential that trainees inform the Training Department of the dates of all OOPE so that prospective completion dates can be revised.

12.2     Out of Programme Experience for Training [OOPT]

OOPT is clinical training, taken out of programme that will count towards the CCT or CESR[CP] provided the following  conditions and requirements are met:

• On commencing OOPT the trainee must be in a GMC approved training programme having completed the core and intermediate levels of training in their entirety. This does not preclude setting up and planning OOPT during intermediate level training;
• Only one year in total during ST5-7 can be taken as OOPT;
• The OOPT programme must map to competencies identified in the Higher/Advanced CCT programme;
• The OOPT post must be prospectively approved by the GMC with support from the Postgraduate Dean and College [Several months should be allowed for the approvals process];
• OOPT may be in appropriate higher or advanced level clinical posts in the UK or overseas;
• The last 6 months of the CCT training programme normally should be in the UK; and
• The trainee on his/her return 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/LETB and the Chair of the RCoA Training Committee.

12.3     Out of Programme Experience for Research [OOPR]

OOPR is research taken out of programme. The same rules apply as for OOPT.

In-programme research is part of the rotation in some Schools. Up to one year of research can be counted towards the CCT/CESR [CP] whether it is taken in or out of programme. Provided there is a clinical element to the programme [this includes out of hours duties within the hospital where the trainee is based for their research time], the full year may be counted towards the CCT programme. If there is no clinical element to the research programme, a maximum of six months only will count towards the CCT/CESR[CP].

Only one year in total during ST5-7 can be taken as either OOPR or OOPT. 

12.4     In and Out of Programme Experience for Education and Management 

As for research, in and out of programme experience/training can be taken to undertake training in education or management. Up to one year of either can be counted towards the CCT/CESR[CP] whether it is taken in or out of programme. Provided there is a clinical element to the programme [this includes out of hours duties within the hospital where the trainee is based for their education or management time], the full year may be counted towards the CCT programme. If there is no clinical element to the programme, a maximum of six months only will count towards the CCT/CESR[CP].

12.5     Applying for OOPT and OOPR

It is recommended that Schools of Anaesthesia have guidelines that inform trainees commencing their intermediate level training on the requirements for, the notice of and the documentation required for the organisation of OOPT and OOPR. It should be made clear to trainees 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 trainee to provide all necessary information in their applications to the Deanery/LETB. In requesting College support, an application form and checklist can be downloaded from the training pages of the College website.

12.6     Secondment between Schools and Deaneries/LETBs

Secondment of a trainee to an approved training or research post in another School or Deanery/LETB e.g. to obtain training not available in the “home” School or Deanery/LETB is not regarded as OOPT; the secondment is an integral part of that individual’s training programme.

12.7     Anaesthesia in developing countries

The College supports trainees taking time out of programme to widen their clinical skills and knowledge. To support trainees undertaking OOPT in a developing country, a unit of training [Annex D – anaesthesia in developing countries] has been developed to enable trainees to count up to an indicative six months towards the general duties requirement. Trainees who complete this unit must complete 12 months of general duties overall.

The advantages of this unit of training include:

• Increased implementation of Government policy encouraging work in developing countries, 
• A more productive experience for the trainee
• Prevention of ill-prepared and inexperienced doctors going to unsuitable post
• Decreased risk to vulnerable patients
• Improved links between the RCoA and overseas Fellows 

12.7.1       Requirements for consideration

For an OOPT in a developing country to count towards the CCT/CESR[CP], the following requirements should be met:

• The trainee must have completed, wherever possible, higher units of training in ICM, general surgery, urology and gynaecology, obstetrics and paediatrics [and, ideally, trauma]. This would equate with at least ST6;
• The trainee should have attended a course on Anaesthesia in Developing Countries;
• Prior to working in the hospital of choice the trainee must have made contact with the hospital to be visited, and have a clear idea of what can be achieved there. S/he will have made a ‘risk assessment’ of the environment; 
• The trainee 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 trainee in the developing country [ESDC] to be visited and the trainee 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 there should also a ES in the UK [recommended by the RCoA] who both trainee and ESDC in the developing country can liaise with via emails, telephone and video-links; 
  • The trainee 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 ES 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; and
    • Management and logistics; and
  • As with any OOPT, a designated local appraiser must be identified.

12.7.2       Requirements on return to the UK

On return to the UK, the trainee will provide the RCoA with:

• A written report of the experience including a description of how the objectives were achieved;
• A report from the ESDC;
• An appraisal report;
• A log book maintained to the same standard as that required during training in the UK;
• A record of the assessments of skills as required by the GMC;
• Evidence of teaching delivered;
• Results of audit/quality improvement project and research.

As with OOPT, this evidence will be inspected by the RCoA Training Department and the GMC before and after the trainee’s visit, and if at a satisfactory standard, up to six months of the time will be counted towards the CCT.