The Faculty of Public Health (FPH) recognises that training in public health takes place in a wide variety of settings and locations, including outside the UK. Because of the excellent experience offered by these placements they should, where appropriate, be recognised as an integral part of a Specialty Registrar's overall training programme rather than viewed as 'time out'.
Working overseas has the potential to provide excellent opportunities in many of the core public health competencies. In addition, it is likely that the experience and level of responsibility obtained may not be possible while working within the NHS.
As well as offering technical assistance to other countries, working in overseas training posts can also be a rewarding personal experience.
Over the past decade there has been increasing demand for overseas experience in areas including Eastern Europe, developing countries, the European Union, USA, Canada and Australasia. European training programmes specifically aimed at public health training have also been launched.
It is important that training experience, wherever it takes place, is carefully planned and structured to maximise the training value. Further details are available in the Overseas Additional Information document. Registrars who complete a placement overseas are asked to complete a report and feedback on their experience to ensure that the placement is of a sufficent quality. The report can be accessed via this link.
Applications for overseas placements are made via the Out of Programme route.
Knowledge of the local language is highly desirable so that the Specialty Registrar can better understand the social and cultural context in which he/she is working. In some instances, such as relief work with a multi-national agency, detailed knowledge may not be a prerequisite. In others, the Specialty Registrar may be required to have a command of one of the languages of the host country to a sufficiently advanced level to benefit from the training attachment. It is suggested that in these cases, either A levels, or equivalent qualifications should be looked for, or the post-holder should agree to being interviewed in the language in which the training will be conducted.
Health and personal insurance cover
Suitable arrangements should be in place for health and personal insurance cover for the duration of the overseas attachments. Arrangements should also ensure that the Specialty Registrar has an adequate understanding of the necessary personal health precautions, eg. malaria prophylaxis, advice on schistosomiasis, and HIV infections and that he/she has also been advised about appropriate immunisations and preventive interventions.
Work permits, medical registration, indemnity
In advance of the Specialty Registrar taking up duties, arrangements should be made to ensure that work permits, medical defence cover, and medical registration are obtained.
Ideally, arrangements should be made to provide suitable accommodation for the post-holder prior to their arrival. The Specialty Registrar may subsequently wish to make alternative arrangements once they are in the post. Arrangements should be in place to provide support and assistance to the Specialty Registrar should the need arise. Someone other than the named trainer/supervisor should be identified for this role.
The local postgraduate dean, usually advised by the Programme Director, determines whether the salary will continue to be paid during the Out of Training Experience (OOPT/OOPR). Other expenses must be paid by the Specialty Registrar or secured from the overseas institution.
Returning to the UK training post
Suitable arrangements should be in place to safeguard the return of the Specialty Registrar to their UK training post at the end of the attachment/secondment.
Requirements of the overseas post/programme
- Facilities at the overseas training location should ideally be equivalent to the standard of those required in the UK. It is recognised that this may not always be possible, but they should at least be equivalent to those offered to doctors in public health training in the host country.
- Agreement should be made on how costs are to be covered, including necessary training activities such as telephone calls, information technology, transport, on duty commitments etc.
- If possible, the post holder should not be the sole Specialty Registrar at a location. It is recognised that this might be very difficult to achieve in many developing countries, and it is important that in these instances adequate arrangements are in place to ensure that Specialty Registrars are not isolated.
- An on-site supervisor, trained in public health, should be appointed to supervise and support the Specialty Registrar on a day-to-day basis. This person must be named and contact information provided to the Faculty Adviser and the Faculty of Public Health (FPH). This supervisor should ensure that liaison with the UK trainer is efficiently organised.
- The host department should be actively involved in audit and continuing professional development (CPD) programmes. It is a minimum requirement that the department is able to demonstrate that it takes a critical approach to its work.
The training programme
- A provisional training programme should be drawn up in advance and submitted for approval to the post-holder's parent public health training committee. Some Specialty Registrars are seconded to work on specific projects rather in a more comprehensive training programme. Details of the project, its aims and objectives and a statement of its training value must be submitted to the parent training committee for approval. The Training Programme Director (TPD) and Educational Supervisor (ES) should be notified promptly of major changes to the programme or project that occur during the attachment.
- The aims and objectives for the attachment must be specified and agreed in advance of the post-holder commencing the attachment. These aims should include statements about the Learning Outcomes (competencies) that will be addressed. The type of activity and projects undertaken should be appropriate for Specialty Registrars in public health.
Monitoring the progress of the Specialty Registrar
The supervisor in the host country and the Specialty Registrar should send regular progress reports (every six months is recommended) to the Specialty Registrar's UK Faculty Adviser. A report from the local supervisor referring to how the agreed objectives were fulfilled will also be required promptly following completion of the attachment. The Specialty Registrar is also required to submit a report.
Additional resources for Specialty Registrars considering overseas training
- Reports by Specialty Registrars on their overseas experiences
- FPH pages on working abroad
- List of overseas regional advisers