Out of Programme (OOP)

For a variety of reasons trainees may wish to spend some time outside of their EM training programme. All such requests need to be agreed by the Postgraduate Dean or nominated deputy in advance, so trainees are advised to discuss their proposals with their Educational Supervisor and Training Programme Director as early as possible. Trainees undertaking an OOP retain their NTN.

Out of Programme falls into five categories:

  1. Training (OOPT) enables a trainee to undertake clinical training that is not part of their training programme, either within the UK or overseas
  2. Research (OOPR) enables a trainee to undertake a period of research, normally for a PHD or Master’s degree
  3. Experience (OOPE) enables a trainee to gain clinical experience which is not approved by the GMC, e.g. experience different working practices, support overseas work and training (particularly in developing countries), or gain professional skills that would enhance future practice
  4. Career break (OOPC) enables a trainee to step out of training for personal reasons, such as ill health or caring responsibilities; or to pursue other interests, such as working in industry, developing talents in other areas, or entrepreneurship
  5. Pause (OOPP) enables a trainee to undertake a non-training NHS or other UK based patient-facing post with the opportunity to have any capabilities gained whilst out of programme recognised towards CCT. OOPP is a new out of programme initiative being piloted by Health Education England and is currently only available in England.

College approval for OOPs

Prospective College approval is required for all OOPTs and OOPRs, both in GMC-approved and non-GMC approved locations. The RCEM Training Standards Committee reviews all OOPT/OOPR applications to confirm that the post offers sufficient opportunities to meet curriculum and assessment requirements and that appropriate supervision for trainees is in place. The College will issue a ‘letter of endorsement’ stating the maximum time that may be recognised towards training.

The College recommends that trainees apply for prospective OOPT/OOPR approval at least three months before the post is due to commence to allow for the necessary deanery, College and GMC (for non-approved training locations) approval processes to be completed in time.

Trainees wishing to apply for prospective OOPT/OOPR approval will need to submit an application form, signed by their Educational Supervisor and Training Programme Director, to the College Training Team at training@rcem.ac.uk. Please refer to the form and RCEM OOP guidance for further information and details of the documentation required in support of the application.

Prospective approval is not required for OOPC, OOPE and OOPP. However, trainees must still provide the College Training Team with details of the OOP, such as a copy of their deanery approval, so that their expected completion of training date may be adjusted as appropriate. If a trainee is undertaking an OOPP, the CCT date will be adjusted following the ARCP.

Chief Registrar and Clinical Fellow posts

The RCP Chief Registrar Programme can be undertaken either ‘in programme’ or as an OOPT, whilst Clinical Fellow posts must be taken out of programme. Both posts will require prospective College approval following the same process as above.

The RCEM Training Standards Committee has published a position statement on Chief Registrar and Clinical Fellow posts.

Sub-specialty training in Paediatric or Pre-Hospital Emergency Medicine

Sub-specialty training does not require College approval. However, trainees who have been appointed to a sub-specialty training post in PEM or PHEM will need to inform the College Training Team so that their expected completion of training date may be adjusted as appropriate.

Acting up as a consultant

Trainees who are within one year of their anticipated completion of training date are eligible to ‘act up’ as a consultant for a period of up to three months (WTE). Acting up posts allow trainees to navigate the transition from junior doctor to consultant, whilst maintaining the supervision associated with being a trainee. AUC posts count towards CCT and do not require GMC approval, providing the management part of the curriculum will be covered.

Trainees undertaking an AUC post must notify the College Training Team, and the Educational Supervisor will need to submit a short report to the College at the conclusion of the period of acting up before a recommendation for the award of the CCT may be submitted to the GMC.

Please refer to the College guidance on AUC for further information.

Further information

RCEM guidance on taking time out of programme
GMC guidance on taking time out of an approved training programme
COPMeD Gold Guide (8th edition)

For further advice on the College OOPT and OOPR prospective approval process, or to notify the College that you will be taking time out of training as an OOPE, OOPC or OOPP, please contact the RCEM Training Team at training@rcem.ac.uk.