Whilst the majority of doctors proceed directly into higher specialty training following completion of CMT a significant number are opting not to do so. A minority of these doctors go directly into other non-medical specialty training programmes but the majority simply take a break from training.
If you’re considering or have already decided not to proceed directly into higher specialty training after CMT there are a number of things you need to do in order to be able to come back into a training programme as and when you decide to do so:
Plan what you are going to do
This is the most important step of the process and whilst taking time out before applying to specialty training may provide a number of opportunities, careful thought and planning needs to be put in to fully realise the potential of this period. Make sure you know why you’re doing this, what you’re doing it for, what you want to achieve with your time, what the GMC requires you to do for annual appraisal, how you’re going to do this and what your route back into higher training is.
Reasons for not proceeding directly into higher specialty training
The reasons behind the decision to not proceed directly into higher specialty training are complex and based upon a number of both personal as well as training related factors and it’s probably often a combination of these that persuade someone one way or another.
Although not exhaustive the following are some of the more common reasons:
- Not yet feeling ready to take on the role of the Medical Registrar and consequently choosing to take the opportunity to gain more experience outside of a training post.
- Being unsure as to what specialty to commit to and wanting to use the opportunity to take time over this decision and possibly to gain further experience.
- To improve chances of selection in either highly competitive specialities or locations and to enhance their portfolio to help with this.
- In order to undertake a period of research or obtain a higher qualification
- Finding Core Medical Training hard work and simply wishing to take a break from the rigors of following a directed curriculum.
- Wanting to experience something different either in this country or abroad or to take up a unique opportunity.
Discuss your options
At an early stage of thinking about not proceeding directly in to specialty training it is very important that you talk your reasons and options through to make sure you fully understand the implications of your decision, what you need to do when out of training with regards to your Licence to Practise and to have a plan to come back in to training.
There are many people you may want to talk to but we’d recommend you talk to at least one of your Educational Supervisor, College Tutor or local TPD for either CMT or the specialty you’re considering coming back into.
Take career advice
If you are looking to gain additional experience prior to taking on the role of the Medical Registrar ensure that the posts you are applying to will give you this experience and that you will receive good support while achieving it. Posts in training schemes are subject to quality management processes that ensure the quality and extent of supervision; this is not that case for stand-alone service posts.
When considering gaining additional experience with a view to improving your specialty application it is important that you consult the person specification for the speciality programme and review the application process and scoring scheme. Particularly consider how you are going to demonstrate ‘commitment to specialty’.
You may find that your supervisors or local Health Education England office or equivalent can help direct you to a dedicated career advisor, someone who can offer impartial advice, a coach or mentor or simply someone who can help listen to your reasons and pick up on any inconsistencies.
Keep in touch
Changes happen to both the recruitment timetables and processes on a not-infrequent basis. When taking a break from training it is easy to lose contact with this and so keeping in touch with your old CMT TPD or Head of School or making contact with the specialty TPD in the area to which you are considering applying is highly recommended.
Maintaining your Licence to Practise
Any doctor practising medicine in the UK requires a Licence to Practise. Although there are a few circumstances where you may not want to maintain your licence to practise, the vast majority of doctors not proceeding directly into higher specialty training will want to maintain it. This means going through the revalidation and annual appraisal process and as you’ll be leaving a training programme this will also necessitate a change to your Responsible Officer (RO) who’s role it is to help with your revalidation.
Change of Responsible Officer
When in a training programme your RO is your Postgraduate Dean. When leaving training you will need to arrange for your RO to change to usually the Medical Director of the main trust in which you will be working or the Medical Director of your locum agency if you are going to undertake a series of locum appointments.
Guidance on how to do this can be found on the GMC website as can advice on what to do if you are unsure on who your RO should be.
Yearly appraisal and revalidation
In a training programme revalidation and appraisal is part of the yearly ARCP process. If you choose to opt out of training you must ensure that arrangements are in place to have an annual appraisal and that you collect the necessary information about your practise to support this process.
Guidance on how to do this can be found on the GMC website.
The GMC have identified six main domains to be looked at in appraisal which are:
- Continuing professional development
- Quality improvement activity
- Significant events
- Feedback from colleagues
- Feedback from patients
- Review of complaints and compliments
You are required to provide evidence in all six areas at least once in each five year cycle but not necessarily evidence for every area every year. You can download the GMC guidance Supporting information for appraisal and revalidation for further information.
Things such as reflective logs and teaching attendance fit under continuing professional development whereas supervisor reports, workplace-based assessments as well as multi-source feedbacks are evidence of feedback from colleagues and we’d recommend you continue with all of these every year. Additionally you may want to record evidence that you’re maintaining your procedural skills.
Maintaining a portfolio
The ePortfolio as used during medical training is available for non-training doctors to continue to use (for a small yearly fee) to help collect and store this information. The ePortfolio has the added benefit over other options of being able to easily send out and record assessments in addition to CPD and reflections.
As well as its use for revalidation a portfolio and being able to demonstrate maintenance or improvement of your abilities as a clinician may be useful for subsequent interviews.
Returning to training
If you’ve continued to practise medicine and have undergone appraisal and revalidation processes as required once you are successful in applying for a higher training programme there is nothing further that you have to do. This is not the case if you’ve taken significant time (generally more than three months) out of clinical work even if you’ve undergone appraisal and revalidation. Please see our Guidelines on return to practise advising how best to manage your return to clinical work. You may also get further local information, requirements or advice from your Local Education Training Board or by talking to your TPDs or Head of School.
CMT will be changing in the near future to Internal Medicine Stage 1 (IM). This will usually be a three-year programme with a subsequent four years in higher specialty training for most specialties. It has been agreed that, provided a trainee exited CMT with an outcome 6 or an outcome 3 or 4 needing only to gain the full MRCP diploma, they will be guaranteed entry into the third and final year of Internal Medicine Stage 1 in the same area as their original CMT programme.