Organising a Year Abroad

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1 france canada australia new zealand usa south africa Organising a Year Abroad Out-of-programme advice from the GAT Committee 3rd Edition Editor: Dr Adam M. Paul 1

2 o r g a n i s i n g a year abroa d Contents Foreword...3 Introduction...4 AAGBI & GAT...5 AAGBI affiliates...6 Approval for out-of-programme training / research...7 British Medical Association...9 Some things to consider Before you go Whilst you are away On your return Money Pension Trainee grants Where to go France Canada Australia New Zealand USA South Africa Developing World Working on an expedition cruise ship Copyright of the Association of Anaesthetists of Great Britain and Ireland. No part of this book may be reproduced without the written permission of the AAGBI

3 france canada australia new zealand usa south africa Foreword Organising a year working overseas during the training programme is becoming ever more popular amongst anaesthesia trainees. Oft-cited reasons for doing so include a desire to work in a different culture, for personal academic and social development, to broaden one s anaesthesia experience and any one of: climbing that mountain / skiing those pistes / riding those waves / biking that trail / diving that wreck*. Whatever the reason, advance preparation and heightened organisational skills are the keys to a successful year. This third edition of the handbook, edited by Dr Adam Paul, builds on the previous editions by incorporating the recent changes to postgraduate medical training structure and the complexities of gaining approval from the overarching, responsible organisations in the UK. Adam, a GAT Committee member and veteran of out-of-programme training, has contributed a significant amount of hard work to this publication and should be congratulated. The handbook will, necessarily, evolve and, for this to happen in line with experience, we need your input as members of GAT. Please do contact us via or AAGBI headquarters: 21 Portland Place, London W1B 1PY. Finally, I hope you enjoy reading this booklet and find it useful when planning your trip. Have a great time abroad. Chris Meadows Chairman, GAT Committee (* delete or include as appropriate) The AAGBI makes every effort to ensure that information in this publication is up to date and accurate. However, conditions in different countries and rules can change, and AAGBI cannot accept any responsibility for members travelling to work overseas. Travel safe and take care. 3

4 o r g a n i s i n g a year abroa d Introduction Dear Colleagues, Rather than buying the T-shirt (well, I did that as well), I have been asked to re-write, revise, update and edit this GAT publication about working and training abroad. I should state my conflict of interest here as I spent a year at Middlemore Hospital in Auckland, New Zealand. I had a great year, both professionally and socially. Whilst everyone will have different experiences, different highs and lows and different reasons for going, hopefully you will enjoy and develop as much as I did. I would like to point out that this adventure will take more effort to organise, cost more money and generate more angst than you can ever factor for but, despite this, I still wholeheartedly recommend the effort. There are a great variety of medical placements that can be taken up abroad. The emphasis of this booklet is on training posts, specifically those worked as a year that will count toward a Certificate of Completion of Training (CCT). I would strongly recommend that you choose a placement abroad that will provide curriculum vitae enhancement and assist you in securing a consultant post when you return to the ever more competitive UK market. If you are going abroad post-cct or outwith a training programme then you will still find useful information and contact details herein. I would like to thank the editors and authors of the first and second editions; I have updated much, but the format and some lists remain largely unchanged. Also, big thanks to the AAGBI Council and Executive for their support and suggestions with this publication. Many colleagues have helped and contributed. Their names are attached to their articles, but I want to say another big thank you here for their time in recounting their own experiences and suggestions. What follows are some thoughts, suggestions, facts and contacts to start you down the road and help along the way of organising your year away. Good luck! Dr Adam M. Paul GAT Committee Member and previously Pre-Registration Fellow in General Anaesthesia and Fellow in Simulation, Middlemore Hospital, Auckland, New Zealand. June

5 france canada australia new zealand usa south africa Association of Anaesthetists of Great Britain and Ireland (AAGBI) & Group of Anaesthetists in Training (GAT) The AAGBI was founded in 1932 by Dr Henry W Featherstone ( ) and now has over 10,000 members. The Association represents the medical and political aspirations of anaesthetists in the UK and Ireland and has close links with many other countries societies, which may be very useful in setting up a year abroad. Specific contacts are on the next page and a more exhaustive list can be found at the Association website: There are also a number of AAGBI travel grants available to members from the International Relations Committee (IRC). Further information can be found online at: GAT was founded in 1967 and its objectives are to promote training, the practice of anaesthesia and communication amongst trainees. GAT has over 3500 members, all of whom have voting rights within the Association. All GAT activities are co-ordinated by the GAT Committee, the only democratically elected body that exists to specifically represent the interests of anaesthetic trainees at a national level. This is by far the largest hospital specialist trainee body in the UK. Training abroad is often easier to set up and you are more likely to fulfill your expectations if you can speak to people who have been there before. To this end, the GAT Committee has published this booklet to act as a catalyst for its members wishing to go abroad. Membership also comes with the following benefits and can be continued whilst abroad: Personal injury and life insurance cover of up to 1 million for patient transfer - for more information see: insurance.htm Free subscription to Anaesthesia - the renowned international monthly journal Free copies of the Association guidelines Free monthly newsletter Anaesthesia News keeping you up to date with new developments in the specialty Special rates for scientific meetings including the GAT ASM Priority booking and special rates for seminars at 21 Portland Place Free advice and information Free information handbooks for trainees & SAS grade doctors Representation at Westminster and the DoH AAGBI website with up-to-date news on the Association and anaesthesia Private members forum hosted by Doctors. net Opportunities for grants and awards 20% discount on textbooks from Oxford University Press and Blackwell Publishing AAGBI subscription is on the HM Revenue & Customs approved list of professional organisations for tax relief 5

6 o r g a n i s i n g a year abroa d AAGBI affiliates (via the Common Interests Group, CIG) American Society of Anesthesiologists Headquarters Office 520 N. Northwest Highway Park Ridge, IL United States of America Web: Tel: (847) Fax: (847) New Zealand Society of Anaesthetists (not CIG but close ties with AAGBI) 99 The Terrace Wellington, New Zealand Mail to: PO Box , Wellington Web: Tel: (04) Fax: (04) Australian Society of Anaesthetists Suite 603 Eastpoint Tower 180 Ocean Street Edgecliff NSW 2027 Australia Mail to: PO Box 600, Edgecliff, NSW Web: Tel: (02) Fax: (02) (The GASACT (Group of ASA Clinical Trainees) Committee is the Australian equivalent of GAT and a very good place to start for information. They can be contacted via: Canadian Anesthesiologists Society 1 Eglinton Avenue East, Suite 208 Toronto, ON, M4P 3A1 Canada Web: Tel: (416) Fax: (416)

7 france canada australia new zealand usa south africa Approval for out-of-programme training / research There have been significant changes to the process of gaining approval for a year out since the last edition. Read this section carefully! If your paperwork is not correct you may not get approval for training, which may then mean you end up not going or, if you do, you may have to repeat the training year when you get home and thus delay your CCT. The key changes are: 1) The name. Previously all time out of programme was called out-of-programme experience (OOPE). In order to take up overseas posts which are recognised for training, a trainee must now apply for outof-programme training (OOPT) or out-ofprogramme research (OOPR). OOPE now refers specifically to clinical experience posts that are not approved by PMETB and therefore cannot count toward training and CCT. Out-of-programme career breaks (OOPC) apply to those wanting to spend time off-programme and out of medicine. 2) Approval. Previously the gift of approval was in the hands of the Royal College of Anaesthetists (RCoA). Now, final approval is in the hands of PMETB although the RCoA is still involved and will recommend approval of a post to PMETB. However there have been cases where the post has been recommended by the RCoA but refused by PMETB you are not good to go until they say so! This is particularly relevant in the case of relief work in developing countries, e.g. for Médecins Sans Frontières. Applications have been accepted by the RCoA and then rejected by PMETB. Note that it is the post that is approved and not the applicant. 3) Timing. You must be post-frca and have completed year 2 SpR or ST4. You must also have at least 6 months training time remaining on your programme in the UK upon your return. So how do you get a post approved? Prospective approval must be sought for ALL posts and this will take time leave at least 6 (or more sensibly 12) months for this. The process is as follows: Download the OOPT/R application form and guidance from the RCoA website (www.rcoa. ac.uk/docs/ooptform.pdf) and take this through the following process: Secure provisional approval from your Deanery. This will usually be through your Training Programme Director (TPD). Seek approval from your Regional Advisor (RA) in Anaesthesia and/or ICM that the OOPT/R will form part of a balanced training programme and will contribute towards the training needed for a CCT. Submit the application form to the RCoA together with sufficient evidence to satisfy PMETB that the training will meet their criteria (see below). The RCoA then makes a recommendation and the Deanery makes an application to PMETB. PMETB makes its decision and informs the Deanery and the trainee. 7

8 o r g a n i s i n g a year abroa d You should note the RCoA advises that applicants should not commit themselves financially or professionally until formal approval has been received from PMETB. Appropriate evidence for submission with your application form consists of: a statement from the competent authority in the country concerned, e.g. Training Board, College or Faculty, confirming the hospital (and post) is approved for training and the supervision arrangements are adequate. Irish Trainees For further information please contact: The College of Anaesthetists RCSI 22 Merrion Square North Dublin 2 Tel: Web: The RCoA can help with a list of whom you should contact. Any aid work, developing world medicine, or other posts not covered by recognised Training Boards should be discussed with your RA. Remember, they won t be approved until PMETB says so. On your return, you will need to submit an evaluation, a report and a supervisor s statement to the RCoA. You will need to complete the RITA F or ARCP 5 form and will almost certainly be required to present a completed logbook at your annual review. For further information please contact: Claudia Moran The Royal College of Anaesthetists Training & Examinations Directorate The Royal College of Anaesthetists Churchill House 35 Red Lion Square London WC1R 4SG Tel: Web: 8

9 france canada australia new zealand usa south africa British Medical Association Guidance on working abroad produced by the BMA International Department can be found on the BMA website and provides answers to the most frequently asked questions from doctors intending to work overseas. The two relevant booklets are: Opportunities for doctors within the European Economic Area jsp and: Guide to Working Abroad jsp The BMA can: Provide general information on registration (in the most popular destinations) Guide members to other useful sources of information and the relevant regulatory bodies overseascontracts.jsp It is recommended that an employment contract should be signed by both parties prior to the trainee s departure from the UK. The equivalent BMA organisation in the country of employment should be the first port of call for detailed industrial relations advice. For further information: BMA International Department BMA House Tavistock Square London WC1H 9JP Tel: /6793 Fax: The BMA cannot: Find jobs for members Advise on overseas contracts Provide lists of employers abroad Assist with immigration arrangements Contracts and terms and conditions of service BMA staff cannot advise on specific terms and conditions of employment overseas. This is due to the variations in overseas employment law which govern contracts, and on which BMA staff are not qualified to comment. However, the BMA have produced a checklist of points that they state should be included in any employment contract. This is called Notes on Contracts for Appointments Overseas, and can be found at: 9

10 o r g a n i s i n g a year abroa d Some things to consider Why do I want to go away? To pursue an area of Anaesthesia, Pain Medicine or ICM that is unavailable within your rotation or even in the UK? To experience a different medical and social culture? To spend time on a sunny beach sipping cold lager (or equivalent)? The answers to these questions (and others) will determine whether, and where, you choose to go. Some of the features that you need to consider about your chosen destination include: Distance from the UK Climate Language Religion Communication links Diet and hygiene Domestic utilities Social amenities Personal health Personal safety (including transmissible disease, threat from terrorism/war and crime rates) The Foreign and Commonwealth Office (FCO) aims to provide information on issues and risks to British travellers and British citizens resident overseas so as to facilitate informed decisions as to whether or not they travel or stay in a particular location. For up to date information from the FCO, including travel advice by country, navigate to: When to go? Pre-CCT you are allowed up to one year that can be counted towards your training without extending your training time. It can help you to distinguish your CV from those of your peers. It does not preclude spending another year abroad post-cct (and you will find it much easier to organise the second time). An advantage of a pre- CCT year is that you have a job to come home to. The main problem is that when you have really enjoyed yourself, you will still need to leave. There is no opportunity to extend. The return home may be a strange experience - consultants will ask if you have been on the other side of town, as they have not seen you for a while! Post-CCT you may have a better idea about what you want to do as a grown-up and so be able to tailor your year better. It may be used as a stopgap before applying for a UK consultant post if few are available when you finish your training programme. If you love the job and the country, you are not bound to return home. You may be able to take an offered consultant post abroad as you will already have your CCT. You will not be governed by PMETB although you should still keep a logbook and obtain letters of reference when you leave the post. The decision is yours. Good reading: The Medics Guide to Work and Electives around the World. Mark Wilson Arnold, 2004, 14.99, pp 496 ISBN

11 france canada australia new zealand usa south africa Before you go Health and Domestic You may have to undergo a medical examination with or without investigations prior to travel be sure to use a registered doctor and investigation service for the country you wish to visit. Your contact overseas will normally provide a list of approved UK doctors, e.g. the list of Australian Immigration-approved doctors in the UK can be found at: united-kingdom/panel-doctors.htm Take all the relevant paperwork regarding your occupational health immunisations and investigations (Hep B, MMR, TB etc) with you. Find out if you require further immunisations for travel and professionally. Investigate whether you and your family need health insurance - this is a good place to start: Healthadvicefortravellers/Stayinghealthy/ DH_ Visit the dentist. Remember to inform those who need to know your change of address consider a forwarding service from the post office. Take at least one copy of all-important paperwork get it verified as being authentic (a good idea is to digitally scan all paperwork and it to yourself so that it can be accessed anywhere make sure it is password protected if you carry it on a USB stick or equivalent). Get documents translated where needed. Take evidence of your car and home insurance no-claims bonuses. Do you need an international driving licence? At the very least apply for a newstyle UK photo licence no other country s officials ever understand a licence without a photograph! Try to organise somewhere to stay on arrival, e.g. hospital accommodation / hotel / with a friend. Take your mobile phone it will be very useful for the first few days but too expensive to use long term. You may be able to unlock your phone so that all you need is a new SIM card, or alternatively register with a network provider in your destination country and purchase a new phone. Professional indemnity contact your UK defence organisation which may provide cover at your destination or at the very least will be able to tell you who to contact. Agree a return date and a return job with your Deanery and TPD. Also remind them approximately 6 months before you intend to return to the UK. Remember, you will need your work visa, return ticket or funds to show that you intend to (and are financially able to) leave the country after your period of employment, a copy of your contract and evidence of registration with the foreign medical council (or documentation showing intent to do so). Otherwise, it could be a short trip! 11

12 o r g a n i s i n g a year abroa d Whilst you are away On your return Complete and return RITA form F / ARCP 5. Collect a reference. Keep a logbook. Collate demographic and socio-economic data for the hospital and catchment area so that you can compare to your practice at home (useful for conference posters). Keep some form of diary or aide-mémoire. Collect names and addresses of friends, colleagues and contacts. Take photos you are bound to be asked to give a presentation on your return and having photographs makes this very easy. You require a statement from your supervisor confirming the dates that you worked and that you performed to a satisfactory level as evidence for your Specialist Training Committee (you may be immersed into the local appraisal and assessment scheme and so can return with copies of completed forms along with a supervisor s report). Plan your job on return to the UK stay in contact with your Training Programme Director via as post allocations and rotations do change. Write up your experiences whilst you can still remember them. Submit your report and your training supervisor s report to the College. The post will have been approved before you left the UK, but these documents prove that you took up the post and performed to the required level. Write to thank your contacts. Thank any financial body that gave you assistance (and submit a copy of your report to them; you may be surprised by a publication in their journal or newsletter). Don t be disheartened when others do not want to see your 5000 photos! 12

13 france canada australia new zealand usa south africa Money Everyone who has been abroad has spent more money (usually considerably more!) than they expected, but most trainees say they have no regrets. Just as you should have a contingency fund before you build a house, the same is true before you go away. Major costs before you leave (some of them!): Visa application and document checking. Medical clearance by an approved doctor. Bank account opening you can do it before you leave in most countries. Letting costs if you want to let your property in the UK during your absence this can be time-consuming and costly to set up so start looking early. (Rental properties are subject to an ever-expanding list of rules and regulations). Storage / removal if you cannot afford to leave your home unoccupied for a year you will need to store the contents somewhere. Shipping most people decide not to ship sofas and fridges but there may be some items of furniture you wish to take with you, particularly as most antipodean properties will be rented unfurnished. Travel Insurance. Health Insurance. Flights. Vaccinations (including those required for stopovers). Clothing appropriate to the weather conditions at your destination. Costs whilst you are away: Loan repayments / credit card repayments / insurance / mortgage shortfall all these amounts will seem bigger when trying to pay them in almost any other currency! The biggest potential cost is your mortgage, especially if you cannot let your house or if the tenants move out whilst you are away. Make sure a trusted friend or family member is ready to chase the letting agent and keep an eye on the property for you. Speak to the bank and consider changing to an interest-only mortgage or, better still, a payment holiday (take financial advice on the implications of these). Remember to let your bank and home insurer know if you are letting for a year. Some costs can be recouped abroad, e.g. in New Zealand you can claim back medical registration, medical indemnity, and professional body fees, so keep all receipts. On your return to the UK, you may be able to claim tax relief for the period you have been away. Discuss this directly with your Revenue & Customs office. If you need to let your house: There are many options here and the following suggestions are not meant to be exhaustive. this international e-organisation was set up by an American academic to allow fellow academics to travel and take sabbaticals abroad. The website guides you through 13

14 o r g a n i s i n g a year abroa d locating tenants for rental or house exchange. You are responsible for setting up the let there is no agent so no fees, but on the other hand, there is no-one to fix the leak! An example might be a US professor and a NZ PhD student each offering to rent for 6 months whilst you are away. As a further security, you should telephone their prospective employers (universities or hospitals) for confirmation that they exist! Alternatively, setting up a house exchange can be a great way of organising your accommodation before you leave the UK. Hospitals let your property to colleagues, other medical professionals or, even better, those doing the same as you but in reverse. Ask medical secretaries in other departments as they will know if there are clinical fellows or attachments expected from abroad. Letting agents fees and quality seem to vary hugely so it is best to ask around at work and find people who have used local agents. If you find your own tenants, you can still use an agent to manage your property whilst you are away try to negotiate a better rate as you have done the hard part. 14

15 france canada australia new zealand usa south africa Pension Please read this section very carefully as getting pension payments wrong whilst you are away will cost you a significant amount in the long term. The NHS superannuation scheme is well recognised as a good pension scheme. Your pension is valuable, so try not to lose your accumulated years of service. If you have completed more than two years NHS service and intend to return after an overseas break, it is possible to preserve it by continuing to pay a monthly contribution whilst you are away. This will prevent you losing the time that you were away. You must organise your continued contributions before you leave. You cannot buy back additional years anymore. If in doubt about your pension, it is recommended that advice from your Trust Pensions Officer or local BMA representative is sought before departure. If you are not stopping work, but are having a break from the NHS to work elsewhere, such as overseas for an aid organisation, it may be possible to stay in the pension scheme under the direction arrangements. Further advice on the NHS pension scheme can be obtained from the relevant authority responsible for administering the scheme. NHS Pensions Division Hesketh House Broadway Fleetwood Lancashire FY7 8LG Tel: Web: Scottish Public Pensions Agency 7 Tweedside Park Galashields TD1 3TE Web: 15

16 o r g a n i s i n g a year abroa d Trainee grants There are major changes occurring in the world of research and travel grants in anaesthesia. The following is the latest information at June 2009: Research Grants These will be awarded through the National Institute of Academic Anaesthesia. There is a plethora of grants available from the AAGBI, RCoA and other organisations. Have a look as something may be relevant to what you are going to do. Travel Grants The International Relations Committee (IRC) of the AAGBI considers applications from members who are seeking funding for projects usually, but not exclusively, in the developing world. Further information can be found at: In addition, grants and awards for trainees remain independently funded by the AAGBI Foundation. Reports will be considered for publication in Anaesthesia News. Please contact: A number of grants are available through the RCoA for a variety of educational or training purposes, including travel and subsistence assistance. Each application will be assessed on its merit. Applicants should send details of their proposal including expected personal benefit, expected benefit to the hospital being visited and expected benefit to their UK anaesthetic department. A pre-condition of any grant is that, on return, a report is submitted to the RCoA (maximum 2000 words), which will be considered for publication in the College Bulletin. Enquiries and proposals should be addressed to: Mrs Morgan Cenan Alternatively, further details can be found here: AAGBI Secretariat 21 Portland Place London W1B 1PY Tel: /

17 france canada australia new zealand usa south africa Where to go The world is your oyster. Anaesthesia is a particularly portable specialty and your skills will be useful the world over. What follows are some helpful hints and suggestions from those who have been before you. Please remember that, just as our administrative paperwork is constantly changing, so it is abroad, and therefore check guidelines before you leave and remember that the more time you allocate to organise, the better. For contacts from almost every Medical Association in the world, go to: Europe EU members: Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Hungary, Greece, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, UK. Current negotiating countries: Croatia and Turkey. Current applicant country: FYR of Macedonia. The excellent BMA International handbook is to be recommended it contains a full list of contacts for each country. Free movement and the mutual recognition of professional qualifications, this is what the EU stands for. Of course, in practice, it is always a little more complicated. The following list covers the countries where free movement is permissible. Note that this is not the case for international medical graduates who have completed their primary medical training outside the EU but who are currently working in the UK. The process is different for each country. 17

18 o r g a n i s i n g a year abroa d France Dr John Dick medical degree FRCA certificate identity, e.g. passport curriculum vitae a cheque in Euros (in 2008 this was ) I took a short sabbatical from my consultant job to work in a tertiary hospital in Paris as an anaesthetist in This was definitely the most challenging and educational period of my career so far. Finding a position Individual hospital departments offer jobs and the person to speak to is the Director of the department. How you narrow down your choice of department is likely to be a result of a mixture of factors such as local expertise in a sub-specialty, geographic location, personal recommendations and departmental publishing power. Registration to practice The French equivalent of the General Medical Council is the Conseil de l Ordre des Médecins that covers the Département relevant to your hospital s location. Your hospital s personnel department will be able to assist in finding the right Conseil. Contact them directly and they will explain what you need to furnish them with to have both your basic medical diploma and your anaesthesia qualification recognised. They insist on copies of (at least) the following documents in English and in certified-translated French (contact the French embassy in the UK for a list of certified translators): This is a simplification. Never underestimate French bureaucracy! I was asked for evidence that I had finished my basic medical training (sign-off after house officer posts), which I managed to find, as well as paperwork that I couldn t produce (e.g. confirmation by the UK Minister of Health that I was allowed to work abroad!). This process, including translations, will take months, so plan ahead. You will have to meet the Director of the local Conseil once you are in France, who may interview you briefly before signing you onto the register. 1. Registering your original documents Once in France you will have to make an appointment to produce the originals of your degree / paperwork to be certified by a body known as the DDASS (Directeur Departemental des Affaires Sanitaires et Sociales). 2. Get medical insurance Called assurance, this wasn t expensive and buys you peace of mind. 3. Language proficiency I didn t find there was any formal process for this beyond the informal interview with the Professor of the department. I was encouraged to find an equally laissez-faire attitude towards occupational health! This consisted of a squiggle on a piece of paper by the boss attesting that I was physically and mentally up to the job (luckily he was right!). 18

19 france canada australia new zealand usa south africa How good does your spoken and written French have to be? This is hard to judge, and the best person to ask is a French person, and ultimately the person who is offering the job. There are medical French courses available, but I didn t use them and found that looking through the relevant chapters in a medical English / French book and a very attentive ear sufficed. The most demanding area is telephone conversations when all visual clues are lost! Fortunately in our job, there s not a lot to write! Useful contacts: For medical French courses try either: Alliance Francais - or Institut Francais - business.php France - articles in the College Bulletin about working & living in France as a trainee: (page 951) What are the benefits? The healthcare system is very good and the standard of medicine high. I found that the French medical fraternity has retained some great traditions that we have largely lost; eating together daily in the doctors mess being the most obvious (and most missed!), 24 hour oncalls (European Working Time Regulations? What European Working Time Regulations??) and proper handover. You will see different approaches to the job that make you question all of your practice at home (working with nurse anaesthetists, for example). And of course you will have the pleasure of immersing yourself in the real French way of life once you are on the workforce. Vive la différence! (page 2073) (page 1648) Anglo-French Medical Society Secretary: Dr Mark Cottrill Web: Included below are useful contacts for information gathering about the other more popular countries: Anglo-German Medical Society Web: Medicine in Germany Web: Italian Medical Society of Great Britain Prof Salvatore M. Aloj, Scientific Attaché, Embassy of Italy Web: 19

20 o r g a n i s i n g a year abroa d Canada Canada Dr Jon McCormack Canada is a huge country with dramatic scenery, wide open vistas, some of the world s best skiing and well respected fellowship programmes based in the country s top teaching hospitals. These teaching hospitals are found in Vancouver, Toronto, Montreal, Calgary, Edmonton and London. The working environment in Canada has many similarities to that in the UK but also some key differences. There is a conspicuous absence of ODPs or Anaesthetic Nurses in theatre and there are no anaesthetic induction rooms. Theatres run on fixed time schedules, and delays must be justified. Flexibility is therefore fast learned, with Fellows being expected to recover one patient, pre-op the next patient, prepare airway equipment and drugs and induce anaesthesia, all with minimal assistance, within the allocated 10-minute turnaround time. The hours can be long, with a 7am start usually expected, and the caseload is heavy, although the majority of lists aim to be finished by 4pm. Fellows will usually be appointed a mentor. Contact with that person should be made prior to departure from the UK to ensure that clinical and research objectives are documented before arrival. A Fellow s time will be divided between clinical and non-clinical or research work. Your mentor is usually involved in this work allocation. The posts are for 12 months, typically running from 1 st July onwards, which is usually nonnegotiable. The salary is C$60,000, which, at current exchange rates, equates to roughly 30,000. Fellows receive no supplement for oncall but this is non-resident, and less frequent that most UK posts (typically around 1 in 10). The monthly take-home pay is C$3,500. The cost of living has increased in Canada over the last 5 years. How to get there? Jobs have been advertised in the BMJ but most Registrars who travel appear to choose either a desired location or a desired sub-specialty and make direct enquiries to the teaching hospitals regarding vacancies. Application forms are sent with your references attached, and your referees will be contacted prior to short listing. If you are successful you will be sent a contract by the teaching hospital. Despite having an approved and signed contract you will be unable to take up the post until you have an approved Human Resources Department of Canada (HRDC) file number. This is only issued to you after verification from your prospective employers that there are no suitably qualified Canadian applicants for the offered position. It is this number that entitles you to a work permit which you obtain from the Canadian High Commission in London, currently costing C$150. To obtain a work permit, you will be required to have a medical examination, chest X-ray and blood tests, costing around 250, and which can only be carried out at a Canadian Commissionapproved GP. Once your work permit is approved you will collect it at your port of entry on arrival in Canada. 20

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