Global Health and MMC

1
Global Health and MMC

• Fred Martineau
• Alma Mata

2
Overview

• Wider context
• Opportunities within Run-Through Training
• Delay
• Deferment
• OOPE
• Problems
• Reasons to be hopeful
• Increasing chances of successful application
• Moving forward

3
Wider context

• The Government has stated that UK health
  professionals working in the developing world
  form an important part of the countrys
  contribution to global health.
• Global Health Partnerships The UK contribution
  to health in developing countries. Lord Crisp,
  February 2007.
• The Tooke report into MMC highlighted its impact
  on opportunities for global health experience.
• The DoHs response stated that Doctors should be
  allowed to interrupt their training to gain
  experience that enhances their career and the
  contribution they make to the NHS.
• The Secretary of States response to Aspiring
  to Excellence the Independent Inquiry into
  Modernising Medical Careers, Secretary of State
  for Health, February 2008

4
Time outside Run-Through

• Delay application to ST
• Between F2/ST1 or core/specialist training
• Will need to be back in country to reapply
• Improved chances at interview?
• Deferment of successful application
• Up to three years if accepted to higher degree
• Deferral in General Practice is unlikely to be
  agreed
• Will not normally be granted for any other reason
• Quit(!)

5
Time Out of Programme

• OOPT PMETB prospectively approved training post
• OOPR up to 3 years usually for registered
  higher degree
• OOPC planned career break to pursue other
  interests or for period of ill-health
• OOPE unapproved training that may benefit the
  doctor or help support the health needs of other
  countries

6
Working in developing countries

• Usually not possible or desirable to get your
  training PMETB prospectively approved
• OOPE is the most likely option
• You must have completed ST1, i.e. you cannot
  normally defer ST1 to go abroad
• OOPE is for one year (two in exceptional
  circumstances) and not shorter periods

7
How does it work?

• PMETB, Royal Colleges and Deanery are responsible
  for your training
• PMETB will become Medical Education England on
  1st January 2009
• Specialty training is based on the Gold Guide
• The Gold guide allows for time out of run
  through training.

8
What the Gold Guide says...

• Reasons for granting OOPE
• Experience different working practices or gain
  specific experience in an area of practice
• Support recommendations in Global Health
  Partnerships
• explicitly recognise the value of overseas
  experience and training for UK health workers
• Normally for 1 year total, can be extended to up
  to 2 years

9
What it doesnt say...

• No explicit criteria for what constitutes a
  successful application
• No need for deanery to say why an application is
  refused
• Misunderstanding/misquoting Gold Guide
• No appeal process?
• Huge variation between deaneries and specialties
• Not always clear who actually makes the decision

10
Reasons to be hopeful

• Deaneries equally affected by initial chaos of
  MMC
• Case law the more successful applications,
  the harder it is to refuse.
• Realisation by deaneries that there is a problem
• Service gaps created by run-through training
• National commitment to Global Health
• Involvement of BMA, RCP, RSTMH, DoH...

11
How can I get time out?

• Postgrad Dean decides, but on the basis of the
  Gold Guide
• PMETB is not involved unless OOPT
• Firstly, discuss and get support of your local
  clinical and educational supervisors
• Find a mentor with international experience to
  help you make decisions e.g. from the Royal
  College
• Check out your Deanery website for any
  tips/rules/contacts (there may not be any!)
• Then prepare an application, including the
  appropriate form (Appendix in the Gold Guide or
  ask your Deanery for one)

12
How to (successfully) apply

• Apply early
• Minimum 3 months, in reality 12-24 months
• Discuss plans with as many people as possible
• Approach deanery/educational supervisor
  beforehand
• Letters of support/CV
• Personal statement
• Detailed structure for year out
• Include explicit learning objectives/competencies
• Why important to you

13
What do deaneries want?

• An easy life
• Training responsibility vs Service commitment
• Different people within the deanery will have
  different priorities
• Find out what these are
• Training
• Clear educational benefit
• Relevant to training competencies/career plan
• Service commitment
• Enough time to find a replacement
• Sufficiently desirable post for someone to fill

14
Personal Considerations

• What is important to Deaneries, also important to
  you
• What are your motivations?
• What do you hope to get out of it? What do you
  hope to give?
• What kind of work do you want to do and why?
• E.g. development vs. emergency relief, rural vs.
  urban, NGO vs. government run
• What skills do you have? (medical/non medical)
• Go on a course e.g. RedR, Merlin, teaching
  courses

15
What if they say no?

• Find out why they have refused your application
  and compare this to Gold Guide regulations
• Let Alma Mata know (please!)
• Contact BMA International Committee for advice
• Arrange to meet and discuss it with Deanery
• Ask about the appeals process

16
What else is happening?

• Alma Mata are collecting case studies and
  supporting people applying for OOPE
• The BMA international department has had several
  meetings and is preparing guidelines on applying
  for OOPE with Deaneries, Royal Colleges, PMETB
  etc
• Moves for collaboration between RSTMH RCP/other
  colleges on improving GH training overall

17
Summary

• Applying for OOPE is not easy, but certainly
  possible
• Start planning early
• Ensure application form appeals to all involved
• LET ALMA MATA KNOW ABOUT ANY SUCCESSFUL OR
  UNSUCCESSFUL APPLICATIONSinfo_at_almamata.net,
  fredmart_at_gmail.com, emilyspry_at_gmail.com
• Dont give up!