1
OFF ROTATION TRAINING GUIDE
INDEX
Acknowledgements
Introduction
Getting started
3
3
3-4
AUSTRALIA
Perth
Royal Perth Hospital
Contacts
Rota
Salary
Clinical experience
Accommodation
Travelling to work
Do I need a car?
5
5
5
5-6
6
6
6
Fremantle Hospital
7
Sydney
Aeromedical Retrieval Service
Medical Simulation Fellowship, Royal North Shore Hospital
Contacts
Rota
Clinical experience
Accommodation
Travelling to work
Do I need a car?
7
7
7
7-8
8
8
Visa applications and paperwork
Medical Board of Western Australia requirements
Banking
Taxation and salary packaging
8
9
9-10
10-11
AMERICA AND CANADA
Ann Arbor, University of Michigan
Rota
Salary
Clinical experience
Accommodation
Travelling to work
Do I need a car?
Visa applications and paperwork
Banking
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12
12-13
13
13
13
13
14
2
University of California, Davis, Sacramento
Rota
Salary
Clinical experience
Accommodation
Do I need a car?
14
14
14
14
14
Vancouver Hospital
Rota
Salary
Accommodation
Travelling to work
Do I need a car?
Visa applications and paperwork
14
14
15
15
15
15
GENERAL INFORMATION
Royal College, Deanery and PMETB approval
Your belongings
Storage and Shipping
Renting your house
16
17-18
18
APPENDIX
Appendix 1: Overseas training experience
(Royal Perth Hospital template)
19-21
ACKNOWLEDGEMENTS
We would like to thank everyone who took the time to fill out our questionnaires from
which we created this guide. We would also like to thank Dr. Paul Spargo for his help
and advice on putting this together.
INTRODUCTION
Getting things set so you can work abroad isn’t as easy as you might think. The
processes and procedures involved in going abroad and getting yourself set up over
there can be stressful, time consuming, bewildering and often bizarre (for instance
having to prove you can speak English adequately - the fact that you are employed as a
registrar in England rather strangely isn’t proof enough!). We have taken a long time and
consulted with many people in order to bring you this guide. We hope it answers all your
questions – and possibly some you haven’t thought of yet. It is an evolving guide,
however, so once you have gone out there and had your fun (sorry furthered your
education) in the great beyond, if you feel there are any glaring omissions in this guide
please let us know. You can contact us at mgirg@doctors.org.uk,
elaineo_shea@hotmail.com
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GETTING STARTED
The whole process takes a surprisingly long time to set up, you need at least a year to
organise it. In addition most overseas places book up several years in advance so it is
important to start thinking about it early. There are also a number of restrictions by both
the Deanery and the RCOA. Only a small number of trainees are allowed to go overseas
and not everyone can go abroad at the same time. Most trainees who wish to go abroad
do get the opportunity but because there are limited places it is important to consider it
early in you training (by SPR 2/3 or ST 4/5 at the latest). So far the Programme Director
has done her best to accommodate everyone’s wishes, but if these places become
overbooked both the Programme Director and the School Board reserves the right to
select the most appropriate trainee. You are only allowed to work abroad for a maximum
of one year. You can go in your 3rd year as a SpR but to get the most out of it, it is best
to go during your 4th or 5th year of SpR training (ST 6 or 7) and you have to spend your
final 6 months before you CCT in England. You are allowed to spend a short time either
side of you trip travelling as unpaid leave. This can be up to 3 months and needs to be
negotiated with the Programme Director as it will delay your CCT.
Your first step should be deciding where you want to go. The best way to do this is to
talk to people who have been before, and use this guide. There are links that are already
in place with the Royal Perth Hospital in Perth, Australia and Ann Arbor, America. In
addition, from January 2008 there will be fellowship places available in Fremantle
Hospital, Perth. (This is a new fellowship so there is not much information about it as
yet).The advantages of these posts are that they are a well trodden path so are often a
great deal easier to organise, both from knowing what to expect from the job and what
you will get out of it, to a deanery/RCA approval point of view. The disadvantages of
these are that there are limited places and they book up a number of years in advance.
Although linked posts are always preferable by both trainees and trainers as plans can
be made several years ahead, you are free to look at alternate posts. The problems with
non-linked posts are that the posts are often not confirmed until 3-6 months in advance
of the start date for the job. This doesn’t give you much time to organise everything you
need to and creates a huge amount of work for the programme director who then has to
organise filling the gap in the rotation left by your absence.
We have compiled opinions from several SpRs who have boldly gone before you, both
to the linked and other non-linked posts. As most people go to Perth or Ann Arbor, the
majority of the information we have is for those places. Please remember they are just
opinions and everyone has a different experience. I have yet to encounter someone who
has regretted their decision, however, so hopefully no matter where you go you will
enjoy yourself. When you have decided that you want to go abroad and have an idea
where and when you wish to go, the next step is to make an appointment to go and see
Dr. Hill to discuss what you would like to do.
Once you have done that it is time to make contact. In our guides to each area there are
contact details for the places Wessex trainees have been before. It is not a complete list
and if you don’t see the place you want to go, it doesn’t mean you can’t go there. You
could always write to the anaesthetic department of the hospital where you wish to go.
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So in summary, the rough order in which to do things is this:
1. Decide where you want to go and what you want to do
2. Talk to the Programme Director to obtain permission/support/advice
3. Make contact with where you want to go (if not going down one of the well
trodden path it may be better making contact and getting an idea about the
job before you speak to the Programme Director)
4. Get the Job offer
5. Apply for Visa
6. Apply for RCA approval (see below)
7. Apply for Deanery approval (see below)
8. Sort out the visa again (there are bound to be some problems along the way!)
9. Sort out your life/house/belongings
10. Go and have fun (I mean a good educational experience of course!)
11. Sort out your life again to move back
Come back and write a report for the RCA
AUSTRALIA
PERTH
Royal Perth Hospital, Western Australia
The jobs available are as follows:
1. Anaesthetic senior registrar
2. ITU senior registrar
Various fellowships are also available: Airway, Regional anaesthesia, Simulation
(CTECH), Cardiac, Malignant hyperpyrexia and Research fellow.
www.rph.wa.gov.au/anaesth
To apply, contact Dr Grant Turner, Consultant Anaesthetist at Royal Perth Hospital
grant.turner@health.wa.gov.au. The Programme Director usually writes to Dr. Turner
first and lets him know you are interested. Once this has been done you can email him
yourself and once he has confirmed he will be able to slot you in he will ask you to send
him an up to date copy of your CV.
There is also an Obstetric anaesthesia fellowship available at King Edward’s Hospital.
Contact Professor Michael Paech
michael.paech@health.wa.gov.au
Rota
80 hours over a 2 week period.
Shifts currently are:
07.45 – 17.45
07.45 – 20.45
12.30 – 22.30
And on weekends 0800-22.30
On average you will do about two sets of nights in an 8 week period. This consists of 2
weekday nights in a row and 3 nights over a weekend. There is usually one set of
weekend days in an eight week period, so in total you work about one weekend in four.
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You will work on average 2 long days per week, but you do get lots of time off in
compensation.
Salary
$100,000 AUD per year (£1 = $2.4 AUD)
You get paid for the actual number of hours worked in a 2 week period, and more for
nights, weekends and public holidays. Also, salary packaging is available to public
health workers and means you are reimbursed for taxable income (see section 9). This
works out at approximately $3000 after tax each fortnight.
Clinical experience
In anaesthetics, generally you work with a consultant or are supervising a junior
Australian registrar. Work load is mainly orthopaedics and trauma (RPH is tertiary
referral centre for trauma in WA), plastics, ENT/Maxillofacial, General, Neurosurgery and
Cardiothoracics.
Royal Perth has an excellent training programme in difficult airway management. You
will have 2 sessions using the Sim-Man in the dry lab, and a session in the wet lab
where you practice needle cricothyrodotomies on anaesthetised sheep. You will also find
good training in fibre-optic intubation.
The acute pain service is very well run.
The department takes part in a teaching programme called Medical Specialists Outreach
Assistance programme (MSOAP) which allows you to take the Sim man to rural
anaesthetic practitioners and teach airway skills and trauma management. Ask early
about these sessions as they are extremely popular and places get booked up quickly.
Accommodation
You will find a large proportion of medical staff living in Cottesloe, which is a very nice
beach suburb. It is however quite expensive. Other nice suburbs include Claremont,
Mosman Park, Nedlands, City Beach and Subiaco. It’s also worth making contact with
registrars who are leaving, to try and arrange to rent their accommodation. Prices
currently range from $400 AUD upwards in Cottesloe for a 2 bed unfurnished flat. Prices
vary according to suburb and proximity to travel links.
Good websites are:
www.aussiehome.com.au
www.reiwa.com.au
www.domain.com.au
www.realestate.com.au
There is slightly less furnished accommodation to rent, but it does make life easier and
cheaper. You can also arrange to buy furniture from people who are leaving. If you need
to buy furniture there is an IKEA store in Osborne Park, and cheap furniture available at
cash converters and other similar shops in Osborne Park. There generally seems to be
less rental accommodation available in January compared with July, so you may need to
look harder for accommodation.
Travelling to work
It takes about 30 minutes on the train from Cottesloe to RPH. There is a train station
adjacent to the hospital. Some people prefer to cycle and that also takes about 30
minutes. Train line stations at most western suburbs makes getting to work easy.
Do I need to buy a car?
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Travel in the city itself is very easy by public transport, and there are good train and bus
links to most suburbs. However, if you want to travel outside Perth a car is invaluable.
Some people buy their car from registrars who are leaving. Otherwise there is a local
newspaper called the Quokka which advertises private car sales. If you are planning to
buy a car privately there is a useful website called REVS (Register for Encumbered
Vehicles) which will enable you to discover whether the vehicle has any debt owing on it
or is encumbered in any way. The link is https://bizline.docep.wa.gov.au/revs/
Cars in Western Australia have usually done lots of miles, about 200,000km. $3500AUD
will buy you a reasonable second-hand car. A 4-wheel drive would start at approximately
$5000AUD. If you are planning to drive in rural or outback areas a 4-wheel drive is
recommended.
Insurance in Western Australia is linked to your vehicle tax. It is compulsory to have 3 rd
party personal liability insurance. This means that if you collide with another vehicle it will
cover personal injury sustained to the other driver, but not any damage caused to their
vehicle. There is a 3rd party fire and theft policy available from RAC and other insurance
providers which cover the cost of damage to other vehicles involved in a collision. Of
course there is also fully comprehensive insurance available but this is very expensive
as you are classed as a tourist if you are in the country for less than a year. Do not be
tempted to buy a car which has not had the vehicle licence renewed, as once it has
lapsed the car will need to be tested before the license can be reissued and the
standards are so stringent that it is virtually impossible for a used car to pass.
Fremantle Hospital, Perth, Western Australia
At Fremantle which is a smaller set up than either Royal Perth or Sir Charles Gardiner
Hospitals they offer fellowships for 6 months – 1 year from a committed, friendly, young
department in the following areas:
1. Vascular Anaesthesia
2. Regional Anaesthesia
3. Cardiothoracic Anaesthesia
4. ENT / Difficult Airway
5. Simulation / Resuscitation / Crisis Management
Interested parties should send initial letters/ applications/ expressions of interest to Dr
Alan Millard Supervisor of training alan.millard@health.wa.gov.au or Dr Kevin Elks
kevin.elks@health.wa.gov.au. Applications should include a CV and a letter outlining
what fellowship post is being applied for. These Fellowship posts will be supervised on a
one – one basis by a Consultant Anaesthetist with an interest in the anaesthesia
subspecialty.
SYDNEY
Aeromedical Retrieval Service, Sydney
Medical Simulation Centre, Royal North Shore Hospital, Sydney
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The jobs available are as follows:
1. Retrieval Medicine Fellowship
2. Simulation Medical Fellowship
Contact both separately by e-mail to express an interest, then send a CV and references
on request. There will then be a telephone interview.
One of the SpRs who did both these jobs is happy to be contacted by e-mail if you
require further information.
bensiggers@doctors.org.uk
Rota
Shifts at the Aeromedical Retrieval Service are:
08.00 – 18.00
18.00 – 08.00
Worked approximately 18 shifts per month
Clinical experience
Excellent training in terms of independent practice, but no theatre anaesthetic
experience. Good opportunities for teaching at Simulation centre.
Accommodation
Vaucluse, Eastern suburb of Sydney.
Any eastern suburb recommended. More expensive there, but possible to find bargains
if you look around.
Good website is:
www.wentworthcourier.com.au
Travelling to work
The two posts are geographically quite a distance apart. Travel to helicopter base takes
30 mins by car. Also possible to cycle from some parts eastern suburbs.
Travel to Simulation centre possible by public transport and takes approximately 1 hour.
Do I need to buy a car?
Second-hand estate car cost $10,000AUD. Lots of car dealers in Sydney. Also try
Sydney Morning Herald for private sales.
GENERAL INFORMATION
Visa applications and Paperwork
Once you have a job offer, start early! The visa you need is long stay temporary
business visa e 457. You can apply for this on-line, attaching the relevant paperwork.
You will receive a sponsorship letter from the hospital, but it’s a good idea to arrange
health and police checks even before receiving this. The hospital usually only sends
their sponsorship letter approximately 6 months before you start, so when you have got
everything together make sure they have done their bit before you send your completed
application in.
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A Police clearance (form 47) needs to be completed. You will need to apply for a police
national computer check (PNC) through the Metropolitan police service
www.metpolice.uk/dataprotection which takes approximately 40 days. You will also need
an Australian police check if you have previously been there for over 12 months.
Health check forms to complete are 1163i, 26MP, and 160MP. Health checks need to be
arranged with designated GP surgeries. You will also need a chest Xray reported by a
radiologist nominated by the Australian government, which needs to be done 1-2 weeks
before the medical. For trainees rotating through Poole &RBH Dr. Stevenson at RBH
provides this.
A Character assessment form 80 also needs to be completed.
You will need to send certified copies of your passport, birth certificate, evidence of
spouse relationship and dependants
International draft order in Australian dollars. Currently $180 AUD. I arranged this
through my bank, or you can pay by credit card.
All the forms and visa information can be found at http://www.immi.gov.au
Medical board of Western Australia requirements
Certificate of good standing.
You will need to contact the GMC for this and they will send it directly to the Medical
Board of Western Australia in Perth. It’s a good idea to ask for an additional copy for
your records as they have occasionally gone astray.
IELTS (International English language testing system)
A minimum score of 7 is required OR the following exemptions:
1. certified copy of birth certificate and formal primary education or
2. completion of secondary education (not university) in a country where English is
the native or first language. (I provided a letter from my secondary school with
dates I had attended, or GCSE certificates will also be accepted.)
Making an appointment with the Medical Board of Western Australia
It’s recommended to do this before you leave, as they do get busy at certain times of the
year ie. January, and it’s essential before you can start work. They have currently
stopped taking a certified copy of your medical degree or the original as proof of your
qualifications and these now need to be verified by an overseas company which can
take several days to arrange. The exact details of what and how to do it are available
form the Medical Board, but because it can take a while to sort out make sure you
contact the Board and make arrangements at least a couple of weeks before you are
due to start.
(Check with your employer in Sydney about registration with the Medical Board, as there
may be slight differences from above.)
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Banking
The Australian banking system takes a bit of getting used to. There are bank charges for
absolutely everything – no matter how small the transaction (eg using an ATM, paying
by EFTPOS – the Australian version of switch, telephone banking and withdrawing
money over the counter at your branch). Some bank accounts eg. Commonwealth Bank
Streamline Unlimited gives you unlimited free transactions each month but charge you
$6 AUD per month for the privilege! This includes cash withdrawals at the ATM,
EFTPOS, telephone and internet banking and withdrawals from your branch. Other
banks have recently introduced similar accounts. Cheques are rarely used in Australia,
as bank charges apply. Most banks aren’t open at weekends and close at about 4:30pm
on weekdays. However, some banks in the city have limited opening times on
Saturdays.
To open an account you need a postal or post office box address, a letter confirming
your position at the hospital and your salary and 2 forms of ID. When you receive your
tax file number inform the bank otherwise you may be taxed unfairly. If you bank with
HSBC in England they can open an account for you with their branch in England, but
unless you have a premier account with them they will charge you to do so, and it can
take a few months to sort out.
Taxation and Salary packaging
You will need to apply for a Tax File Number, and inform Medical Personnel to ensure
you pay the correct tax. The easiest way is to do this online at www.ato.gov.au. Click on
“individual application”, then “apply for TFN online.”
It can take up to 30 days, although some people receive their TFN more quickly than
this.
Taxation in Australia is 30%. It may be worth organising an Australian tax accountant
while you are out here as it is possible to claim a large amount of this tax back. A couple
that have been recommended are Scott Disley (scott@disley.com.au) in Cottesloe, and
Smith Coffey in Subiaco.
As mentioned previously you will be eligible for salary packaging as an employee of a
public hospital. The two salary packaging companies used by Royal Perth are: Smart
Salary and Paradigm. Generally, better things have been said about Smart Salary and
they visit the hospital weekly if you need any assistance. I know quite a few people who
have had problems with Paradigm so I would advise avoiding them and using Smart
Salary. Salary packaging is a way of returning taxable income to you.
The system works rather like the childcare voucher scheme in the UK. You are able to
spend some of your pre-tax income on items eg. house rental, restaurant bills, childcare, and are then taxed on the income after these deductions have been made.
www.smartsalary.com.au
www.paradigm.com.au
The problem with salary packaging and saving lots under the Australian tax system is
that, you may still liable to pay UK taxes on your return. The UK and Australian
governments have a double taxation agreement. This means that you are given credit
for the taxes you have paid in Australia, but if you would have paid more in the UK, on
return the balance must be paid. An example is given below:
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In Australia if you earn the equivalent of £50,000, you would pay approximately £12,000
tax. For the same salary in UK you would pay £15,000 tax. So on your return to England
you would be liable for the extra £3,000.
The best thing to do is to contact an accountant on your return to the UK to help you sort
out all the tax issues.
.
On your return from Australia you are also able to claim back your superannuation
contributions. These are tax free automatic deductions from your salary in Australia. Any
return will have 30% tax deducted. The scheme some people have used is
www.superreturn.com.au but we cannot vouch for the company as there is not current
feedback regarding successful claims. The claims require a number of documents but all
of these can be faxed and according to the blurb the process takes about 8 weeks. The
claim can only be made after you leave Australia, so it may be worth leaving your bank
account open until you receive this money. For a 6 month job the amount is likely to be
in the region of $3000-4000 AUS, which is probably worth the effort.
Finally, one of the best ways to save money is to swap money with someone leaving
Australia. Currently the spread on exchange rates on 7.2.08: sell $2.12 to £1, buy $2.25
difference of 13c (6%). If you are taking £10,000 that works out at £600 paid for the
privilege of changing money. If you do a swap with someone returning from Australia by
taking the middle rate you could both save yourself £300. It will work the same on your
return.
AMERICA AND CANADA
ANN ARBOR (UNIVERSITY OF MICHIGAN)
Liver/Vascular, Cardiothoracic, Paediatrics, Obstetrics. They also offer Intensive Care
Medicine, which is currently not recognised by the RCA, although that may change. Ann
Arbor usually books up very early so it would be wise to start applying about 18 months
to 2 years in advance. It is always better to apply as early as possible and the
Programme Director will give you a better idea about how far in advance you will need to
apply.
To apply the Programme Director usually writes to let them know who is interested, and
then you contact them yourself. Once contact has been made you will need to send an
up to date copy of your CV.
Rota
For Liver/Vascular on average there is one late call a week (until 2200), plus one liver
call (until 2200 then on call from home) and one general on call (resident from 1500 until
the next morning) per month. A normal working day is 0630-1530/1600. The general on
calls will usually be weekends (0700-0700).
For Cardiothoracics there is 1 general night on call per month, and about 4-6
nights/month of cardiac on call from home after 2200. In addition one week in every 6
will be on ICU (either 7 days or 7 nights).
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You get an extra day off if you are in after midnight on a cardiac on call.
Most find the rota pretty civilised but you do work hard when on call.
Salary
The salary is $130,000 USD per year, $10,000 per month. The rotations usually work
from April-April and if you can do this you will get major tax advantages from being out of
the UK for a full tax year
Clinical experience
Most find the jobs very enjoyable. You get great experience and exposure to lots of big
cases.
For cardiothoracics you will have the opportunity to do thoracoabdominal aneurysms,
heart and lung transplants, and mitral valve repairs with EFs of 10%. TOEs are used
universally in cardiac surgery, so some previous experience will be necessary. You will
get good thoracic experience and also some general surgery and ENT/Max-Fax.
The liver/vascular job is only 6 months. This usually translates to 1 day a week of
vascular and 1 day a week of livers and the rest of the week as general surgery. The
other 6 months will be general anaesthetics.
You tend to share your anaesthetics with residents or Nurse Anaesthetists, so you don’t
tend to deliver the anaesthetics yourself, but rather supervise others delivering the
anaesthetic. This can take a bit of getting use to and if you are someone who likes to be
very hands on and do everything themselves this may not be the place to go. Having
said that, everyone I have spoken to has had a great deal of experience especially in
surgery that isn’t performed in Wessex, and has enjoyed it immensely.
Accommodation
Ann Arbor itself is quite a small city and most people tend to live in the city itself. Crime
is fairly low and it is a safe city. The only place to avoid is Ypsilanti (a town to the east of
Ann Arbor) as it is a poorer area. The best way to find accommodation is to talk to the
people leaving when you are arriving and try to rent the places they are vacating. You
don’t need to arrange it before you get there.
The Lake Village apartments which are a popular place to live with people working here
can be found at www.habitat.com. An unfurnished 2 bedroom apartment will set you
back approximately $1200pcm there. You can rent cheap furniture for approximately
$200-400pcm from a shop in town.
There are four fully furnished houses which can be rented from Amy Seeto for
approximately $1850pcm (per house). The advantages are that all the amenities are
already set up. Again the best way to find out more is to contact people who are there at
the moment.
Travelling to work
Both the apartments and the houses are approx. 4 miles from the hospital, which is a
very pleasant cycle ride in spring and autumn. It gets very hot in summer (over 30oC)
and very cold in winter (can get down to -20oC)
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Do I need to buy a car?
A car is vital in America. You can try to get one from the people leaving as you arrive.
Expect to pay approx $5000-7000 USD, if you get it from a garage you may pay up to
$10000 depending on what you want to get. Car insurance is expensive; expect to pay
over $1000 for a year’s insurance.
Visa applications and Paperwork
There is a huge amount of paperwork you need to do before you go out so start early.
You need to get letters from every hospital you have ever worked at and your medical
school. Group individual hospitals together on your CV if possible so you only need one
form for several jobs (e.g. Addenbrooks Hospital Medical Rotation instead of the
individual hospitals in the rotation). The paperwork is coordinated by Jennifer Mason in
the University of Michigan Anaesthesiology Department. She will send you out ‘The
Rotators Guide’ when you have applied to go there which contains more information
about going out there.
The visa requires a visit to the US Embassy in London. It is likely to take the whole day
but try to book the earliest appointment as possible (and a good book as there is lots of
waiting involved). Keep all the receipts for the expenses as can claim them back from
your study allowance once you have arrived in Ann Arbor.
Banking
In the US you will need a credit rating and they don’t care for ratings outside the US.
Some have found it helpful to get an American Express card in the UK and then transfer
it to a US AmEx card when you get there to get a US credit rating.
UNIVERSITY OF CALIFORNIA, DAVIS, SACRAMENTO.
All anaesthetic specialities are catered for. Previous trainees have done paediatrics
including cardiac/thoracic. They contacted the Chair of the Department of
Anaesthesiology by telephone to arrange the job. For details go to http://anessom.ucsd.edu/ or e-mail Dr Raj Dhamrait who is a consultant in the department and
who previously worked as an SpR in Wessex region rajdhamrait@hotmail.com
Rota
Resident on call once a month covering adult anaesthesia with a day off before and
after.
Salary
Like Ann Arbor approximately $10,000 pcm after tax.
Clinical experience
Provides the opportunity to get a great deal of experience in a wide range of subjects.
Previous trainees have had a great time and would definitely recommend it.
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Accommodation
Previously people have lived in Roseville which is about 30 minutes by car from the
hospital, costing approx $3000pcm. It is not as well trodden a path as Ann Arbor so it is
unlikely you will already find someone already there. You can get information from the
local listings and the advice from the faculty members.
Do I need to buy a car?
Again a car is essential. You can get one easily from a local dealer.
VANCOUVER, UNIVERSITY OF BRITISH COLUMBIA, CANADA
Vancouver General Hospital. Previously trainees have done neuroanaesthesia, which
involved doing neuro approximately 40% of the time. The job was applied for by writing
to the Fellowship Director of Anaesthesia with a copy of your CV.
Rota
Weekdays from 7am till 4pm with no nights or weekends.
Salary
The fellow’s salary is approximately $64,000 Canadian Dollars which is equivalent to
£30,000 which will adequately cover your living expenses in Canada.
Accommodation
Trainees have lived in Downtown, Yaletown which is expensive but people have found it
very enjoyable particularly if you are single and will set you back approx $2300CAD
pcm. For couples or people who want to live in a quieter area try Kitsilano Beach. You
can find places by searching the internet.
Travelling to work
Downtown is approximately a 10 minute bike ride to the hospital.
Do I need to buy a car?
You don’t need one and can get by with the great public transport. If, however, you wish
to go skiing to Whistler every weekend it might be worthwhile!
Visa applications and Paperwork
Plan early as it takes about 3 months to get the visa and there is more paperwork to do
for British Columbia Registration. It takes about a year to organize it all.
ROYAL COLLEGE, DEANERY AND PMETB APPROVAL
In order to get deanery approval you first need to get RCA approval. Normally the RCA
doesn’t approve a post unless the deanery has also approved it. To get out of this Catch
22 situation you will have to let the Programme Director know you plan to apply to the
RCA for approval. She will then write a letter to the RCA saying that she has approved
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the post, which is good enough for the RCA. The details you will need to apply for RCA
approval are as follows:








The name of the hospital
The name of the Head of Department at the hospital
The name of the designated supervisor
Written confirmation from the College, Faculty or training board of the relevant
country stating that the post is recognised for training
A full description of the proposed programme
Information on any research within the training
A statement of the specific objectives to be achieved
A letter of support from the Chairman of the Regional Training Committee
and/or the Postgraduate Dean in the UK
For Perth there is already a template (Appendix 1). For other posts we suggest you use
this as a guide.
Once the RCA have written back approving the post you will then need to obtain
Deanery approval by filling in and sending off the OOPE form together with the letter of
approval from the RCA. This form is available on the deanery website
http://www.wessexinstitute.nhs.uk/Default.aspx?page=787 . The deanery requests that
this is done at least 6 months in advance of you leaving.
On your return to the UK, the RCA require a formal report on what you have achieved
during your attachment overseas. They also need the exact dates you started and
finished your post abroad, and the date you started back on the Wessex rotation. These
enable them to calculate your CCT date and make adjustments as necessary.
From January 2007 onwards PMETB approval will need to be sought prospectively for
your ORT. If the deanery has approved your post prior to 1st of January 2007 then there
is nothing more that needs to be done. If you have obtained or are planning to obtain
deanery approval after 1st January 2007 you will also need to get PMETB approval.
Currently there is not a form that needs to be filled in, and the deanery will seek approval
from the PMETB on your behalf. In order to do this you will need to provide the deanery
with all the information required by the PMETB. The information required by the PMETB
is as follows:
1.
A formal covering letter from the Deanery to PMETB seeking prospective approval
of the OOPE post and confirming that this post has Deanery support.
2.
Confirmation that the OOPE post has the explicit written support of the relevant
royal medical college representative.
3.
A statement from the competent authority in the country where the OOPE will take
place which details the purpose and structure of the post to the satisfaction of the
Deanery and the College.
4.
If the documentation outlined in point 3 above is not provided, then a brief
description of the OOPE post which covers the following points: a) where the OOPE is
based, b) the structure of the OOPE, c) the educational goals and characteristics of the
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OOPE, and d) confirmation that the post is subject to quality management in line with
PMETB requirements.
Applications must come from the Deanery. This is to maintain consistency with PMETB
policy of holding the Deaneries responsible for local level quality management of
education and training. Trainees are therefore advised to liaise with their Deaneries to
co-ordinate the applications for approval.
PMETB guidance on this has been issued and is available on the website at the
following link:
http://www.pmetb.org.uk/index.php?id=postandprogrammeapproval
YOUR BELONGINGS
Storage and shipping – there are lots of companies that will store your belongings while
away and ship things out. Costs of shipping things and even your flights out to the
country may be tax deductible in the country you end up working in, so it is worth
keeping your receipts. Companies previous people have used are as follows (the prices
quoted are just a rough guide to help you budget, obviously it will vary quite a bit
depending on how much stuff you have and the type of storage):
Storage
Bradbeers of Romsey: They will come and pack, move and store it all. Removal
will cost approx £450 and a years storage just over £2000
Pickfords: Reliable. Approx £1000 for a year
Maidman's: Very reliable. One container for a year costs approx £80pcm. They
will also pack and unpack your belongings as required.
Shipping things out
To the US:
FedEx – Expensive, depends on the weight and size but reliable (more so
than the US postal service)
Pickfords International – Reliable, can take 2-3 months to arrive and can
cost £2500
To Australia:
Australasian relocations – Sydney and Melbourne based company have a
good reputation www.austrelo.com
.
Shipping things back:
From the US:
www.upakweship.com has been recommended
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Pickfords International
From Australia:
Seven Seas International
www.sevenseasinternational.com
Pack&Send
Be aware when shipping belongings back to the UK you may be charged for
customs .
RENTING YOUR HOUSE
Again there are numerous companies you can use and we have listed a few which
previous trainees have used and recommended below. It is always worth talking to the
Programme Director and finding out if anyone is rotating to a hospital near where you
live while you are away, to enquire whether they want to rent your house.
Pearson’s Estate Agents of Romsey: Efficient and helpful but quite expensive
Bassetts Property Management: discount for doctors
Tailor Made: reported as very unreliable and not recommended.
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Appendix 1
Overseas Training Experience – Royal Perth Hospital
Specialist Registrar in Anaesthesia, Wessex Region
NTN:
Current CCST date:
I have been offered on overseas training post in anaesthesia and Intensive Care
Medicine at the Royal Perth Hospital in Western Australia for the period -------- until -------. This will be split into a -----month period in Intensive Care and a ----month period in
Anaesthesia.
I hope the following provides all the information necessary for College approval of the
post.
DEPARTMENT OF ANAESTHESIA
From:---------- To--------------.
The Department hosts the University of Western Australia’s academic Anaesthesia unit
with two professors, one associate professor and two lecturers on site. There are 24
full-time Consultants, 26 part-time Consultants, 15 Registrars with Fellowship, 11 Pre
Fellowship Registrars, 3 Residents, 3 Pain Service Nurses, 2 Research Nurses and 4
administrative staff.

Head of Department is Dr ---------------

Designated overseas SR supervisors are Dr ----------- and Dr --------------.

Training recognition from the Australian and New Zealand College of
Anaesthetists is approved for these posts.
GENERAL ROTATION
Anaesthesia is provided for all adult surgical specialities except obstetrics and
gynaecology;
-
General
Orthopaedics/Trauma
Urology/Renal transplant
ENT
Plastics
Burns
Vascular
Maxillofacial
Neurosurgery
Radiology/Neuroradiology
RPH has become a tertiary and quaternary referral centre for specialised aspects of
Neurosurgery and Neuroradiology. These are rapidly expanding areas of clinical
activity.
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TRAINING
The Department accommodates trainees from the Australian and New Zealand College
of anaesthetists [ANZCA] and the Royal College of anaesthetists [RCA]. It also appoints
Senior Registrars who have completed their training through ANZCA, RCA and other
national training schemes.
The Department operates a system whereby each registrar is assigned a mentor. The
mentor is separate from the Supervisor of Training who deals with training difficulties.
The supervisor of Training will complete 6 monthly ANZCA approved In Training
assessment [ITA] for each registrar.
There is ample opportunity and systems to ensure Clinical governance:
-
Quarterly peer Review meetings
Quarterly Morbidity meetings
Quarterly Mortality meetings
Automated review of recovery room critical incidence, data presented regularly
The Department contributes to the Australian Incident Monitoring Study [AIMS]
Opportunities for a wide variety of clinical audit exist and are encouraged
Postoperative pain management is reviewed twice daily via the Pain Service.
The Department has created on-site facilities and programmes for structured skills
training. This is carried out both formally in a specially developed simulation area using
SimManTM [Laerdal] as well as informally during operating lists. The programme involves
all staff either as trainer or trainees. Registrars are especially encouraged to be involved
as it is an excellent opportunity for learning and teaching. This facility is being expanded
so that all hospital interns and residents will participate in skills education. Current
modules include airway crisis management, fibreoptic bronchoscopy, central venous
access and regional anaesthesia.
The department is also actively involved with the Medical Specialists Outreach
Assistance Programme [MSOAP] in association with the WA rural medicine body
[WACCRM]. This programme commenced in early May 2002 and is designed to
educate rural GP anaesthetists in anaesthetic skills and crisis management. It is a longterm project with visits throughout WA scheduled on a monthly basis. both Consultant
and registrar staff are the driving forces behind this rewarding endeavour.
All overseas registrars are expected to contribute to teaching, research and quality
assurance projects. There are a variety of ongoing and new projects and this is an area
in which we strongly encourage participation. All registrars are required to attend
departmental and trainee meetings both of which are held weekly.
Regular
presentations in an interactive fashion are expected and are coordinated at consultant
level.
There are excellent library facilities both in the department and the hospital, with up to
date medical texts and journals. Computer facilities are available to all trainees within
the department.
The Department has recently been re-equipped with Datex Ohmeda S5 anaesthesia
monitoring systems, Aestiva/5 (7900) anaesthesia machines and new Olympus video
bronchoscopes. A HP Image Point Echo system and Omniplain II TOE probe
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commenced service in the Cardiac Theatres in May 2002. An Aloka echo system with
colour Doppler commenced service in 2001 to aid CVC placement in general theatres.
INTENSIVE CARE MEDICINE
I will be spending ----- months [from----- to------ ] as Senior Registrar on the Intensive
Care Unit at the Royal Perth Hospital.
-
Head of department is Dr -----------------
-
My designated supervisor will be Dr ----------------------
The unit has 22 beds and is divided nominally into a general and surgical area. It
receives all adult specialties and is the tertiary referral unit for the whole of Western
Australia.
The unit is fully accredited with the new Joint Faculty of Intensive Care Medicine for core
and elective training in ICU. It is also accredited with the Australian and New Zealand
College of Anaesthetists for training in ICU.
Some of the special interests of the department that are of particular interest to
Anaesthetists are Cardiac, Trauma and Neuro intensive care and trans oesophageal
echocardiography. Registrars on rotation to ICU are expected to actively participate in
their weekly grand rounds and educational meetings.
RESEARCH
There is a highly developed structure and an ongoing programme for research in the
Department. This is led by Prof. Michael Paech (Coordinator of Clinical Research), Prof.
Stephan Schug (Director of Pain Medicine) and Prof. Teik Oh (professor of Anaesthesia)
with the assistance of two half time Clinical Lecturers and two part time research nurses.
There is an established rolling programme of high quality, academically led, protocol
established, funded and ethics committee approved research projects. The Department
strongly encourages participation in these projects by all overseas Post Fellowship
Registrars.
SPECIFIC GOALS
1.
To further my clinical experience in adult anaesthesia in a dynamic teaching
environment under both direct and indirect consultant supervision.
2.
To develop leadership skills when acting in the role of duty anaesthetist for the
hospital.
3.
To acquire new clinical skills and ideas by working in an overseas hospital and
thereby allow exchange of knowledge between institutions.
4.
To actively participate in formal and informal registrar training.
5.
To prepare for the CCST by developing confidence in adopting an autonomous
role in clinical practice.
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6.
To participate in educational sessions on medical simulation, airway
management, fibreoptic techniques, crisis management, venous access and
regional anaesthesia.
7.
To obtain subspecialty experience in intensive care medicine.
8.
To develop and participate in Research and QA projects
9.
To develop presentation and discussion skills by contributing to regular
departmental educational meetings
10.
To develop management and interpersonal skills through participation in clinical
and management committees.
August 2006
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