Aims To identify the unique training benefits to the NHS of out of program experience (OOPE) gained through the Voluntary Service Overseas (VSO)/RCPCH fellowship scheme.
Methods Between 2000 and 2010, 30 Paediatric trainees worked for at least 1 year as volunteers in low income countries within the VSO/RCPCH fellowship scheme. Mid-placement questionnaires, return interviews and presentations, and final placement reports were used to qualitatively assess the competencies gained by trainees during their fellowships. These experiences were mapped to the “General Clinical Competencies” within the RCPCH level 2 and 3 competencies frameworks.
Results Fellows universally experienced an extensive clinical workload of diverse, unfamiliar and severe pathology, and, in the context of limited diagnostics, developed a greater reliance on their basic clinical skills. Resource limitations and a frequent lack of senior colleagues, however, meant that this experience often did not translate to enhanced UK standard clinical competencies. In addition to clinical experience, all Fellows participated extensively in a diverse range of management, leadership, teaching, research and service development activities, as prescribed by their roles as VSO development workers. These opportunities were far more extensive, at higher seniority and usually had significantly greater immediate impact than equivalent activities in UK training posts. Examples included organising and teaching on resuscitation or ETAT (Emergency Triage Assessment and Treatment) courses, representing paediatric departments on hospital board meetings, organising undergraduate Paediatric teaching programs, writing regional clinical guidelines, running clinical audits and instigating changes in clinical systems in response to these findings. In addition, the experience of working with, at best, limited support in an extremely challenging clinical environment resulted in greater development of Fellows' autonomy, decision making skills, personal integrity and cultural awareness than they had previously experienced in UK training posts.
Conclusion Although we currently recommend the VSO/RCPCH Fellowship should be undertaken as OOPE, the Fellowship offers an incomparable opportunity for trainees to gain leadership, management, teaching and personal development competencies. These skills are often difficult to gain within UK training posts but are increasingly essential for newly qualified consultants undertaking leadership roles within the NHS.