Training abroad? Not so difficult
Authors: Marisa Casanova Dias, Maria Orlova, Mariana Pinto da Costa
Journal: The Lancet Global Health (2013)

The scientific literature regarding globalisation is growing, and hurdles and opportunities are emerging.1Rechel B Mladovsky P Ingleby D Mackenbach JP McKee M Migration and health in an increasingly diverse Europe.Lancet. 2013; 381: 1235-1245Summary Full Text Full Text PDF PubMed Scopus (552) Google Scholar Mobility of patients and doctors is a reality. In Europe, the European Commission Directive 2005/36/EC on professional qualifications enables freedom of movement for doctors, which raises the need for cross-cultural1Rechel B Mladovsky P Ingleby D Mackenbach JP McKee M Migration and health in an increasingly diverse Europe.Lancet. 2013; 381: 1235-1245Summary Full Text Full Text PDF PubMed Scopus (552) Google Scholar and public-health training.2Lee AC Hall JA Mandeville KL Global public health training in the UK: preparing for the future.J Public Health (Oxf). 2011; 33: 310-316Crossref PubMed Scopus (11) Google Scholar Trainees have advocated for periods of training abroad to meet global health competencies, but face some difficulties.Despite the benefits of exchange programmes,3Jeffrey J Dumont RA Kim GY Kuo T Effects of international health electives on medical student learning and career choice: results of a systematic literature review.Fam Med. 2011; 43: 21-28PubMed Google Scholar not all medical specialties have considered periods of training abroad in the postgraduate curriculum, or make provision for them. Training abroad is usually thought to be very difficult to organise, and many trainees give up before they try. Finding a suitable placement, and difficulties in language, funding, and approval of absences, are some of the most-cited problems.4Drain PK Holmes KK Skeff KM Hall TL Gardner P Global health training and international clinical rotations during residency: current status, needs, and opportunities.Acad Med. 2009; 84: 320-325Crossref PubMed Scopus (232) Google ScholarTo address this issue, junior doctors from the European Federation of Psychiatric Trainees (EFPT) created and run the EFPT Exchange Programme. Through EFPT's networks and coordination, it offers observership placements for psychiatric trainees in Europe since 2011.5Casanova Dias M Pinto da Costa M Bausch-Becker N P-1491—EFPT exchange programme: a new project towards a global future.Eur Psychiatry. 2012; 27 (abstr).: 1Summary Full Text PDF PubMed Google Scholar Trainees can spend 2–6 weeks in more than 30 different placements. They gain experience in specialties not available in their home countries, do joint research projects, and establish lasting friendships.Feedback from participants shows excellent overall satisfaction, and the programme has been improved in response to participants' comments. With 30 completed exchanges and 2 years of experience, we have shown that many barriers can be overcome, and that short periods of training abroad are feasible during specialty training. For example, funding difficulties can be overcome by the visiting doctor being hosted by a local trainee, with subsidised meals or accommodation offered by the host organisation. Language barriers can be overcome through the help of local trainees during clinical shadowing. Short placements can assist with obtaining time off, both from family and professional responsibilities. Many have used vacations or private leave.However, because the postgraduate curriculum in most countries neither makes provision for nor accredits periods spent abroad, the final word relies on the support of consultant supervisors, directors of medical education, and hospital managers. Creativity and goodwill among trainees and seniors are the essence of success of such international experiences.So, how difficult is it to train abroad? Not so difficult, we dare say. We think that exchange programmes should be implemented in postgraduate curricula, which would bring benefits at the individual level for both applicants and host trainees, and at the global health level for participant institutions.MCD, MO, and MPdC are part of the EFPT Exchange working group; MCD is the inceptor and senior adviser, MO is the chair, and MPdC is the co-chair. We thank trainees and supervisors who supported the EFPT Exchange, in particular those from Croatia, France, Denmark, Ireland, Portugal, Spain, and the UK who contributed to the pilot phase. The scientific literature regarding globalisation is growing, and hurdles and opportunities are emerging.1Rechel B Mladovsky P Ingleby D Mackenbach JP McKee M Migration and health in an increasingly diverse Europe.Lancet. 2013; 381: 1235-1245Summary Full Text Full Text PDF PubMed Scopus (552) Google Scholar Mobility of patients and doctors is a reality. In Europe, the European Commission Directive 2005/36/EC on professional qualifications enables freedom of movement for doctors, which raises the need for cross-cultural1Rechel B Mladovsky P Ingleby D Mackenbach JP McKee M Migration and health in an increasingly diverse Europe.Lancet. 2013; 381: 1235-1245Summary Full Text Full Text PDF PubMed Scopus (552) Google Scholar and public-health training.2Lee AC Hall JA Mandeville KL Global public health training in the UK: preparing for the future.J Public Health (Oxf). 2011; 33: 310-316Crossref PubMed Scopus (11) Google Scholar Trainees have advocated for periods of training abroad to meet global health competencies, but face some difficulties. Despite the benefits of exchange programmes,3Jeffrey J Dumont RA Kim GY Kuo T Effects of international health electives on medical student learning and career choice: results of a systematic literature review.Fam Med. 2011; 43: 21-28PubMed Google Scholar not all medical specialties have considered periods of training abroad in the postgraduate curriculum, or make provision for them. Training abroad is usually thought to be very difficult to organise, and many trainees give up before they try. Finding a suitable placement, and difficulties in language, funding, and approval of absences, are some of the most-cited problems.4Drain PK Holmes KK Skeff KM Hall TL Gardner P Global health training and international clinical rotations during residency: current status, needs, and opportunities.Acad Med. 2009; 84: 320-325Crossref PubMed Scopus (232) Google Scholar To address this issue, junior doctors from the European Federation of Psychiatric Trainees (EFPT) created and run the EFPT Exchange Programme. Through EFPT's networks and coordination, it offers observership placements for psychiatric trainees in Europe since 2011.5Casanova Dias M Pinto da Costa M Bausch-Becker N P-1491—EFPT exchange programme: a new project towards a global future.Eur Psychiatry. 2012; 27 (abstr).: 1Summary Full Text PDF PubMed Google Scholar Trainees can spend 2–6 weeks in more than 30 different placements. They gain experience in specialties not available in their home countries, do joint research projects, and establish lasting friendships. Feedback from participants shows excellent overall satisfaction, and the programme has been improved in response to participants' comments. With 30 completed exchanges and 2 years of experience, we have shown that many barriers can be overcome, and that short periods of training abroad are feasible during specialty training. For example, funding difficulties can be overcome by the visiting doctor being hosted by a local trainee, with subsidised meals or accommodation offered by the host organisation. Language barriers can be overcome through the help of local trainees during clinical shadowing. Short placements can assist with obtaining time off, both from family and professional responsibilities. Many have used vacations or private leave. However, because the postgraduate curriculum in most countries neither makes provision for nor accredits periods spent abroad, the final word relies on the support of consultant supervisors, directors of medical education, and hospital managers. Creativity and goodwill among trainees and seniors are the essence of success of such international experiences. So, how difficult is it to train abroad? Not so difficult, we dare say. We think that exchange programmes should be implemented in postgraduate curricula, which would bring benefits at the individual level for both applicants and host trainees, and at the global health level for participant institutions. MCD, MO, and MPdC are part of the EFPT Exchange working group; MCD is the inceptor and senior adviser, MO is the chair, and MPdC is the co-chair. We thank trainees and supervisors who supported the EFPT Exchange, in particular those from Croatia, France, Denmark, Ireland, Portugal, Spain, and the UK who contributed to the pilot phase.