From the Foundation Programme Reference Guide
Acquisition of foundation outcomes outside of the UK
F2 training outside of the UK
5.32 Foundation doctors wishing to undertake F2 outside of the UK should the foundation school in which they are completing their F1 year. This means that foundation doctors should complete their first year of foundation training in the foundation school considering their application. Foundation doctors should also consult the GMC about the implications for revalidation.
5.33 HEE/NES/NIMDTA/Wales Deanery/foundation schools should publish their policy on acquisition of foundation competences outside of the UK and make this available to those applying to the foundation programme. Not all organisations support F2 abroad.
5.34 Prospective approval from HEE/NES/NIMDTA/Wales Deanery/foundation school, and prior approval from the GMC, must be sought if the training outside of the UK is to count towards the requirements for satisfactory completion of the foundation programme. It is the foundation doctor’s responsibility to arrange a suitable placement and confirm that the unit has agreed to provide training, assessment and support in accordance with the requirements for satisfactory completion of the foundation programme.
The GMC have recently published a statement regarding training overseas, which all potential applicants should note:
Severn do not (currently) restrict the number of trainees undertaking F2 overseas, although - in order for an application to be approved - it must meet the requirements outlined in our F2 Overseas policy. In previous years, the number of approved applications has been between 1 and 11.
Previously Approved Host Institutions
Gold Coast Hospital
Auckland City Hospital
Please note: The following accounts are from trainees applying under previous policies/processes. The current policy/process may differ, particularly in view of the recent GMC statement and requirement for GMC approval of programmes.
Advice from a trainee who completed F2 Overseas during 2012/13
A Year on the Gold Coast as an F2
Reasons for Going
1. I wanted to pick my rotations
2. I like the sun
3. I believe I have something of a sense of adventure and I don't particularly like being told where I have to go or
what I have to do
4. To do something exciting and different while young and (relatively) free of responsibility
The details from the Severn end are on here already. Unless these have changed drastically, you'll need to have a confirmed hospital and placements by January. Which means you need to start applying pretty much from the word go in F1. Essentially, I believe the foundation school are looking for someone with the reliability to get F2 done, clear objectives and aims. F2 abroad is more hassle than at home, and you will (you'll be pleased to know) be distracted with lots of fun and exciting things.
So in rough and brief order:
1. August - October of F1: start applying for hospitals. The list on here is a good starting place, but essentially any large(ish) hospital that are agreeable to providing supply clinical and educational supervisors. Work for Us (Queensland, google it) are a good agency. Australian Medical Recruitment. Emailing people you know / contacts is also invaluable. Sydney and Melbourne will be (ridiculously) competitive. So will Brisbane, to an extend. Perth’s a good shout but in Perth there’s Perth and not much else. The Gold Coast is becoming more competitive since completion of the new hospital, and more Aussie medical graduates coming through.
2. Dec - Jan of F1: confirm your hospital. Assuming you have had some offers and interviews, CONFIRM your placement, set down your objectives and aims and start the lengthy and protracted process of negotiations between the hospital admin, the AMC (Australian Medical Council) and AHPRA (Australian Health Practitioners Regulation Authority, I think), the equivalents of GMC/BMA.
3. AHPRA and AMC. You apply for these concurrently. I'm not exactly sure which does what but they are a hassle and require endless certification of documents. Best advice: you will need your documents to be certified by a lawyer AT LEAST 3 TIMES. A chap on Park Street does a great deal. When you go, ask for TRIPLE or QUADRUPLE copies, otherwise you'll end up doing what I did and going back again and again. Applying for AHRPA and AMC happens around the same sort of time as you apply for jobs. At some stage you may have to make a leap of faith and pay for one of these without actually having a fully firmed up job.
4. Note that 3. will take ages and involve a lot of faff and back-and-forth. Apply for your visa a few weeks before you go. There is no point in applying months in advance as visas are fast-tracked if they are due in a few weeks. I applied for mine 6 weeks before departure and was all set to go no problems. Note you will also need a full healthcheck and CXR by a GP certified by the Oz board to do this. There are only a few places in the country. You can't just go down to ED and get a mate to do it (like I tried to) and it costs, I seem to remember, about 250.
Well now I’ve been here for a year, had all of the F2 jazz ticked off with a lovely certificate waiting in the UK. And I’m staying for the unofficial ‘F3’, working mainly in the Emergency Department. Was it worth it? What was good? What was bad? More importantly: has this year changed me, has it changed the sort of doctor I will be – for better or worse?
The Gold Coast and Around
The Gold Coast is essentially an unbroken stretch of golden sand from the south of Queensland to Brisbane. It’s beautiful. The sun shines most of the time. It does rain: February 2013 was an unheralded and unending semi-cyclone of wind and rain, and not particularly pleasant. The rest of the time it’s feet up, sun-lounger out, beer in hand, shrimp-on-the-barby, any time of year. And if you like the outdoors, and especially the sea, you can’t go wrong. Prerequisites for UK doctors arriving on the coast within three months: road bike, surfboard, skateboard. They will be used to varying degrees. I did/do a lot of surfing along the coast and rock climbing at Kangaroo Point in Brisbane. I cycle to work most days, and did the Gold Coast Triathlon last April. We play in a football league in Tweed Heads on Friday nights.
If you don’t like the outdoors, you won’t make the most of the Gold Coast. There’s not a great deal to do indoors. There are bars and clubs (Sin City, Paris, East, Liv, Love… the list goes on) but there are no ‘pubs’, and the city itself is a plastic shell, only about 60 years old, with minimal infrastructure, less soul and no character. Everything is well rounded and new. It can feel oppressively fake, especially to the European connoisseur, used to his or her coffee shops and pebbled streets and Victorian quaint-ities. This is the new: the Gold Coast; nothing is older than 60 years. Nothing was here before that.
Of course there are gems: restaurant/whiskey bar Black Coffee Lyrics, tucked up some stairs in an otherwise dire corner of Surfers Paradise, the owner has won whiskey cocktail competitions from Scotland to Melbourne; Stingrays bar, as close to classy as the GC gets and perhaps the only place to ban flip flops and singlets; Pablo Pablo, Spanish restaurant, lovely; Hellenikas, the Greek Feast is astonishing and as good as anything in Greece (much more expensive though); Miami Marketta, live music, food stalls in a graffittied ex-industrial estate, every Saturday night; you need to know where to look, and the longer I stay here, the more of these places I find.
But beyond these standouts, which in any UK city would be good but unremarkable, Surfers Paradise is a tasteless, drink-fuelled stretch of concrete, where most of the women are augmented, the men steroided to enormous sizes, and tattoos widely and unashamedly embezzled on just about every patch of skin available. Perhaps that sounds like heaven; but the GC is not a ‘city’ in the sense that Brisbane, or Sydney, or Melbourne are cities; it feels empty, it is, for the most part, it’s face: drunk, brash, fake.
This area described as ‘Surfers Paradise’ is a small and, thankfully, avoidable nook, and so now I must tell you how amazing the rest of the Coast is. Up and down the Gold Coast highway, Aussie surfer life kicks in, from the beautiful Burleigh Heads, laid back, great food, boutique shopping, to Currumbin Creek and it’s famous surfing alley, where you can hurl yourself off the rocks on a board and paddle as hard as you like to avoid getting crunched; then only an hour South, Byron Bay, which despite it’s popularity with tourists is, I am always amazed, relentlessly charming and pleasant to occupy. We saw Paul Simon and The Lumineers there last year.
To the North: Brisbane, only an hour away, a city that gets cosier the longer you stay, that improves and has secrets, like the bar Kerbside, and the little Viatnamese Restaurant on the West Side, and the Botanical Gardens. No culture? We’ve been to a film festival, three music festivals, Neil Young, Michael McIntyre, The Black Keys, The Vaccines… The Rolling Stones are coming in March… (!) A couple of hours further north: Noosa, Australia Zoo, The Glasshouse Mountains. Need I go on?
And there’s two airports, Brisbane and Coolangatta, less than an hour from the GC. Cheap flights all over Oz, NZ and Southeast Asia. Perth, Melbourne (twice), Sydney (x3), The Whitsundays, Thailand… Australia is only far away from Europe; only someone completely lacking in imagination would say it was far away from anything else.
(By the way, the food here is astonishingly good. The fruit is about ten times the size of the stuff in the UK, I don’t know what they feed the chickens but they’re huge and the steak…. For six dollars (three quid) you can get an enormous T-bone or fillet, and unlike the slither of rough, browning Tesco rump, the steak here, even the supermarket’s most basic, is phenomenal.)
I picked my rotations for F2. I said to the admin guys: this is what I’d like to do, please organise it for me. Thus I got about 3 months of surgery (split into urology and general surgery), 3 months of medical / relief work (mainly MAU, ward cover and nights) and most of the rest of the time I spent in the Emergency Department. Consultants in every department were more than happy to do my ePortfolio and act as supervisors. They needed a little prompting, having no familiarity with the system. I concurrently got the Aussie stuff signed off too (just in case I stay here…). Yes, it was a hassle, but not in an impossible sense.
The main issues with doing F2 abroad were with educational supervisors. Gold Coast Hospital was in something of a state of flux when I arrived, about to move to a new site, and ploughing through senior staff like no-one’s business. I think I made my way through three or four different educational supervisors, as they kept resigning. Of course, massive hassle, endless dramas with paper work etc. But to be honest, looking back, I always had great support from the Severn Deanery, and yes, it probably took a little extra work to get everything signed off, but it really wasn’t that bad.
I loved every job out here. Urology was hard work – 630am starts, 8pm finishes. But I got to do cystoscopy lists unsupervised, scrubbed most days, and had a great team. General surgery was likewise long hours, but the team was so great that it didn’t matter. Of course, you’ve probably heard that in Australia, you generally get paid for EVERY bit of overtime that you do. This doesn’t always make up for being stuck in theatre until 8pm, but it certainly helps. MAU was fantastic, lovely consultants, mostly English junior docs. And Emergency, as I’m sure anyone who has done it in the UK, was a completely different challenge, but again, fantastic, super consultants, amazing support.
I think, generally speaking, F2 in Australia will deskill you compared to doing it at home. By Australia I mean the Gold Coast. ED is the same as home, but the ward jobs are incredibly top heavy, to the point of frustration and feeling a little like a monkey with a stethoscope. Surgical registrars check x-rays for chest infections, make every decision from MSUs to bloods, and really you feel quite molly-coddled. This is perhaps the one thing that stands out for me: I think I would have been under more pressure at home, which might have sharpened my clinical skills more acutely. In the long term, I doubt it makes a huge amount of difference, and as an aside, now that I am an SHO, I have far more responsibility.
In fact, I’ll quickly tell you about my first SHO job in orthopaedics, because it’s the best job I’ve ever done, and anyone who comes here, whether they’re interested in ortho or not, should do it. You’re on the registrar roster for on-calls so you see all of the new patients and ED referrals, but at the same time you’re incredibly well supported so never out of depth. Clinic is all day, every day, and the SHOs have literally NOTHING to do with the ward, so you can concentrate on learning about fractures and actually being a useful part of clinic, rather than an add-on. You do the weekend ward round every other weekend, which is great because it’s overtime, and once you’ve finished the round (at 10 or 11am) you go home and can’t be contacted for the rest of the day. So anyone keen on ortho, apply for the ortho SHO job at Robina hospital: from the team to the nursing staff to the job I can’t rate it highly enough.
Back to F2: I suppose what Australia has really shown me is a different work-life balance. As a JHO/SHO (junior/senior house officer) you will work no-more than one weekend in six. By weekend, I mean one day of a weekend. You will never work both days unless you pick up extra shifts. All out of hours, night and overtime work is paid extra, so even on a normal ED roster, nights and evenings and weekends are paid ON TOP of a basic salary. There is no doubt that the money out here is FAR better than at home, if you’re interested in that. And it’s nice to have most weekends free. And even in departments with rosters, like ED and MAU, you generally work 4 on and 3 off, or work 8 and have 6 off. Yup, 6 days! Ridiculous. Did I mention the 6 weeks annual leave and 2 weeks study leave a year?! Did I mention that they pay you 15% EXTRA just to take your leave?!?! Did I mention that you can take all of that leave at once?! That the hospital actually employs cover doctors, so taking leave doesn’t mean leaving the rest of the team understaffed?!
I most definitely have not done as much research/audit/CV stuff out here. There is too much else to do, and life becomes too distracting. This is either a positive or a negative, depending on how you see it. I had (I think) a fairly strong surgical CV before leaving. I have essentially done nothing since being here. This is probably an inevitable symptom of not being in the NHS, where on every job you’re driven to do audits and extra work. That said, I have done a great critical care course (BASIC), am doing Advanced Paediatric Life Support next year and did an audit in the Emergency Department. The question is whether or not I have committed career suicide, and to an extent I believe that I have: I would certainly have been more career minded had I stayed in the UK, would probably have done MRCS part I, and would probably have applied for surgical training. But perhaps it is no bad thing not to have done these things: perhaps, being shown a lighter, more well-paid, less stressful side to life is a good thing, and not a negative. I leave it for you to decide, but to generalise: you will not do as much work out here as you would at home.
I miss home, a lot. I see a map of the UK or of London, or of Bristol, and this makes me feel so homesick. I remember streets and parties and bits of Bristol and it makes me so sad. I wonder if I would be sad anyway, if part of getting older and moving away from the city that defined those early years of adulthood, would be the same if I was in the UK. But the distance does make a difference. Australia is not England. And it is far away. You can’t just pop back.
I miss friends. I miss family. I have missed important events in my own family, and I will probably miss several important weddings and events of close friends this year. Australia is far away from Europe. I miss skiing, and jumping on Easyjet somewhere, and the different cultures and connections within the UK and Europe. The heat can be relentless; the humidity gets up to 100% in summer. It is not for the sun-shy. I miss the cold. Christmas sucks. Big time. A barbeque is not the same as a roast! And it’s so tacky out here.
This is the biggest reason people don’t come, and the main reason why people tend to only stay out here for a year or two. It is an adventure, and it is so much fun, and it is a wonderful country and a beautiful country, and working life is, for the most part, fantastic. I’ll be out here for another year, postponing growing up, but at some stage I’ll have to decide whether to stay, or whether to go. And it won’t be easy.
Richard Pellatt, F2 Gold Coast Hospital & Robina Hospital, Australia
Advice from a trainee who completed F2 Overseas during 2011/12
The Foundation Programme stipulates that an F2 Overseas has to be a ‘suitable placement that has agreed to provide training, assessment and support in accordance with the requirements of satisfactory completion of the foundation programme.’ Ultimately the decision as to whether these requirements are met will be with the Severn Foundation School Director. In practice, the vast majority of people go to Australia and New Zealand, so I have therefore focused on these countries. However, there are a few that are more intrepid with their choices - for an extensive list of where people have previously gone google: ‘Countries and hospitals where F2 training has been prospectively approved.’ – I cannot seem to cut and paste the link.
Getting an offer
There are currently more jobs than trained doctors in New Zealand and Australia and it is therefore less competitive to get a job there than many other developed countries. However, this is changing as both countries have increased their medical school intake, and there is also added competition from the growing numbers of UK doctors going overseas after F2. That said there is massive variation in competitiveness between large tertiary referral teaching hospitals and small rural centres.
The two most common ways of getting a job in the Antipodes is to either contact hospitals/healthboards directly or to sign up to a recruitment agency. Some agencies are entirely state funded, and therefore minimise the amount of time you need to spend filling separate bits of paperwork etc and no added cost to you. However, they have a particular incentive to recruit people to the least competitive jobs, so they may not be the best means of getting a specific job or working in a specific area. Before signing up to an agency it is worth investigating how they are funded, so that you don’t sign up to a worse contract than if you had contacted the hospital directly. Here are some recruitment agencies:
Alternatively, you can let your mind roam over different locations and contact healthcare trusts directly in New Zealand or Australia.
Getting it approved as your F2 year
From the Foundation School website make yourself aware of the application process and its deadlines. In 2011 the Severn application needed to be submitted in late January and required you to specify the rotations you will undertake and the clinical supervisor for each one, as well as your educational supervisor and an undertaking that you will be part of a teaching programme. Some F2 jobs overseas will not be able to cater for these criteria, and will not therefore count as an F2 overseas. In such cases there is the possibility of having a year out of training. Again, details of these are listed on the Foundation School website.
Passing the F2 year
This is a similar process to passing F1; you need to ensure that your eportfolio meetings and assessment are completed by the relevant people and if there are no concerns you will pass the year. If there are some concerns I assume they will be dealt with on a case to case basis, as was the case in F1.
Is it a good idea? Positives and Negatives
Positives of an F2 Abroad
- It is a great adventure
- There is often the flexibility to undertake jobs in areas you wish to pursue for your career
- It doesn’t necessitate taking time out of training
- Getting a relatively commitment-free ‘taster’ of overseas work
- Challenging yourself to live independently outside of your usual support systems
- Gaining a comparison point to NHS healthcare
- There is the potential to see health care provisions in a very different environment to a culturally very different population
- If you are wishing to apply for a training job in the UK during your F2 year you may feel a ‘bit out of loop’, and may find it logistically hard to coordinate leave, flights and interview dates to coincide with the training posts you want
- It is less easy to build your CV for UK jobs, as many of the UK recognised courses/exams are not available in Australia/New Zealand
- There is less familiarity with various eportfolio processes amongst your assessors
- Money: There are so many potential variables it is very difficult to say whether you will be better off. The salaries in New Zealand and Australia seem to be slightly more than the UK post tax, but that advantage can soon be lost when you factor in start-up costs, flights and red tape expenses . As for the cost of living I think it can be greater or less than the UK depending on your comparison points
- The Antipodean system seems to put less emphasis on audits and research amongst junior doctors, this therefore means there is less expectation, but also less opportunity
Overall opinion: An F2 overseas is a wonderful and fairly unique opportunity to add breadth to your training and is one I would fully advocate. It does take some organising, and there is a certain amount of hassle created from it, however all this can be overcome with good planning and the experience does make it worthwhile.
Jamie Willson, F2 Dunedin Hospital, New Zealand
Advice from a trainee who completed F2 Overseas during 2010/11
Plan ahead! All the paperwork takes longer then you expect.
An excellent resource to use if going to New Zealand would be to go through: Medrose Medical They are two British doctors who are now living full time out in Tauranga, New Zealand and aim to help make the move to NZ an easy one!
Stay on top of DOPs/CEX/CBD from the start, go through them with the doctors on the hospital computers as many of them will get confused with our e-portfolio systems
Get a car with a big boot to transport all your gear (bike, snowboard, surf board).
Ahna Allan, F2 Tauranga Hospital, New Zealand
Working Overseas After F2
Dr Natalie Freeman, one of our former F2 trainees, has written a guide for trainees planning to take a year out in Australia following F2: