Taking Time Out of Training

Studying medicine is quite unique to other undergraduate degrees, due to the pre-determined career path that awaits the majority of alumni.  Most of us move into the world of clinical practice and tread the path defined by foundation, and later, specialty training, without question. Year after year, this can feel like a constant monotony of service provision, collecting competencies and passing ARCP; which doesn’t quite fit with our original ambitions or detracts from those things we have decided are really important, but we don’t have enough time for, such as family.

Much as we feel we must follow the same path as others, which in broad terms seems to be earning a living, keeping pace with our peers and obtaining our Certificate of Completion of Training (CCT) as soon as possible, there is another way. If you’re looking for excitement and enrichment, or you’re work life balance is simply off kilter from where you want it to be, then maybe it’s worthwhile considering some of the options out there for making training work for you.


Less Than Full Time Training (LTFT)

It is probably fair to say that most of us dream about being able to take a career break, but money is the deciding factor in curtailing our plans.  If you are simply feeling that you’d like a little more time for you, or the family, then LTFT working should be your first consideration.

LTFT working has grown in popularity and all training programmes are now able to offer flexibility in training, for those who cannot work full-time.  In agreement with your Educational Supervisor (ES) and Training Programme Director (TD), applications can be made through the Deanery on either one of two criteria: the first, includes health/disability grounds, carer roles or parental responsibility; while the second, includes unique opportunities for personal/professional development e.g. national/international sports, religious commitments and  non-medical professional development e.g. further studies.

LTFT is a fantastic way of regaining some of your time, but still plugging away towards the end goal of CCT, with ARCP also conducted on a pro-rata basis. Your time in training will be prolonged, as a result, but many feel it is worth it, especially as their circumstances or priorities change throughout their career. In essence, you can still have a medical career, but more on your own terms.

As with anything, there are disadvantages, aside from the reduction in income and delay in CCT. The Deanery may not always be able to accommodate the hours that you wish to work e.g. you would like 60%, but they offer 50% in a job share. This is quite common and you may need to be flexible, as ultimately service provision is still key. On the flip-side, most doctors who work LTFT, without a job share, feel that they simply do the work of a full-time post, but in fewer hours. It is, therefore, important to have exemplary organisation skills, to handle your time and ensure your training requirements are still being met.


Natural Career Breaks

Juniors generally follow the same career path of foundation, followed by specialty training, with additional division into core and higher. The notable exception is the GP pathway, but the same principle still applies.  Division into these specific training programmes creates a number of natural career breaks, that trainees can often use to their advantage, whether it be paid or unpaid.

Many doctors have caught on to the merit of taking an F3 year, so that they can experience working abroad and seeing life outside of the NHS, before entering specialty training. These breaks, however, are also, equally, possible on the completion of CT, ST and CCT, through middle grade, fellowships or SAS roles, which can really enhance your CV. In some cases they may even lead to an entirely new career path i.e. most of us assume that we are working towards Consultancy, but may actually be more fulfilled in an SAS role.

Training is a long pathway and it can, sometimes, be daunting moving straight from one programme to the next. It is becoming increasingly common for trainees to take a year out so that they can pursue something else that is of interest, such as travelling or charity work. Natural career breaks are an easy, hassle-free way of slotting this into your career plan without the rigmarole of having to apply for permission from a Deanery and can be funded by spending some time doing locums, in addition to keeping your skills sharp.

Try to bear in mind how you will justify your time-out on your CV if or when you return to apply for specialty training and attend interview. You don’t have to do anything medical with your time, but you should be able to talk about how the time has developed you as a person i.e. taking the time to travel and broaden your horizons before starting a family, perhaps.  Remember, doctors are expected to demonstrate that they are well-rounded individuals and not just work, work, work!


Out Of Programme (OOP)

Once you have got in to a training programme and received the coveted ‘national training number’, it can sometimes feel like you’re locked in to conform to that pathway for the next X number of years.  This can be extremely difficult and quite daunting, if other opportunities should present themselves or you simply start to struggle part-way through. Many people have a mind-set that training is a run-through, you systematically follow from year-to-year, but this certainly doesn’t have to be the case.

Many Deaneries are prepared to consider applications for time OOP.  Commonly these are inappropriately employed to excuse a few months of absence for some personal reason, such as sickness, fertility treatment or caring commitments, but they can, actually, be so much more. I know many people who have used OOP periods to undertake a variety of things, including; research, undertaking further studies, charitable ventures, starting their own business, and exploring alternative careers. It gives you the safety to explore, while also ensuring that you retain your national training number and a guaranteed return to employment.

You will need the support of your ES and TPD, to apply to the Deanery to be OOP. Often, this is not granted within the first year of a training programme, but each case is assessed on its own merit. Up to 12 months can be granted, in the first instance, but up to 3 years is available, depending on your reason for being OOP. Due to the time needed to plan service provision, you should try to plan your training exit and re-entry, 6 months in advance.

Broadly speaking, time OOP falls into two categories, depending on whether the time out counts towards your GMC approved training programme, or not.  Those that count towards training, are options which allow you to explore additional experiences within your chosen field, but outside of the parameters of the normally specified programme.  This may include research (OOPR) or a specific clinical experience that particularly interests you (OOPT), but you will need to specifically seek approval from the GMC, if it is to count.  Those that do not count towards training, include gaining clinical experience for personal development outside of training e.g. work abroad for a medical charity (OOPE) or taking a career break (OOPC).  In  both of these cases, the time for CCT will be adjusted according to the period of absence.

Just remember, that if you take an OOP it is important, to consider how that fits in to your CV and how that time has contributed to your personal or professional development.



Overall, although we are all inclined to think of our medical career in terms of a continuum, there are actually a number of different options that can inject variety or additional value to what is, fundamentally, a job.  The biggest hurdle is obviously money, few of us can afford to take a career break without money coming in, but many trainees also struggle with the concept of being out of synchronicity with their peers and delaying CCT.  What is important, is that at any stage of training, your job works for you and still allows you to pursue what you feel is important, whether that be personal or professional.  Training is often more flexible than people think, simply because they do not know the options available.  Check out www.healthcareers.nhs.uk for further details and your Deanery’s web page, to find out what is available for your specific training programme and the eligibility criteria.

Written by Kristina Engelbrecht



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