Returning to practice

Out-of-programme (OOP)

Arranging additional compulsory experiences

Thoracic US competency, Safe sedation and Medical Thoracoscopy

Study leave, training days, SCE and travel expenses

Reflective practice

LETB/Responsible officer

What do I need to do to get signed off at ARCP?

  • The requirements for ARCP sign off are in the JRPCTB ARCP decision aid. Make sure you are familiar with both the Respiratory and GIM components well in advance of your ARCP. The main thing to plan in advance is getting miniCex/CbD/DOPS/MCRs/ACATs signed off so get started with these as soon as you start your post.
  • In addition you will need to make sure all your log books of procedures and clinics are up to date, so that you are working towards CCT requirements.
  • You may wish to  provide a summary of your recent publications, courses, meetings, teaching and management experience since the last ARCP period. These should all be in your personal library on your ePortfolio.
  • Save your email receipt for your completed GMC survey as this is required for ARCP.
  • For additional information on how to make sure you pass your ARCP see the most up to date advice and a summary of additional requirements that may not be easy to acquire in day to day practice.

How many curriculum items can I link to each SLE?

  • There should be a minimum of 5 cases per ACAT. Each ACAT can be linked to 8 curriculum items.
  • Each CBD can be linked to 2 curriculum items.
  • Each Mini-CEX can be linked to 2 curriculum items.

Do I need to have an ARCP whilst I’m on OOP? 

  • Everyone should have an ARCP every year, even while on OOPR or OOPE. There is no need to have one while on maternity leave or career break, if this is for a full year.
  • Before the ARCP, please let the TPD know if you are planning to count any of your research time towards your training. If so, this will have been specified on your OOP approval letter. The easiest way to do this is by simply upload the OOP approval letter to the OOP section of your personal library. Previously, the panel has asked for either the OOP Update form or the ES report. If the ES report is completed with all relevant details of the research, then the OOP Update form will not be required.
  • As usual, you need a Form R and an updated CV every year (the CV should contain the section that is filled in by the SpR in the OOP Update form, describing what you have achieved in your research/other fellowship activities).

I’ve been out of training and am returning to practice. What has changed in terms of ePortfolio/ARCP requirements? 

  • You should have a look at the most up to date ARCP decision aid on the JRPCTB websites and the info on this site. The GMC provides info on moving to current curriculum, and the most recent curriculum changes are highlighted on the JRPCTB site and are:
    • Definition of the minimum training requirements for pulmonary vascular diseases (E12), cystic fibrosis (E16), lung transplantation (E20)
    • Learning objectives for practical procedural areas (F(b) and Bronchoscopy (F5) clarify the need for formal sign off of competence in safe sedation
    • Pleural ultrasound level 1 (F6) updated to reflect Royal College of Radiologists Focused Ultrasound Training Standards, 2012
  • Trainees not already in their final year of training (pro rata for LTFT trainee) in August 2022 will need to transition to the new respiratory curriculum at the earliest convenient point. More news on this coming.

How can I prepare for a return to practice after time out of training?

  • Returning to clinical practice after time out of training for research, an education or leadership fellowship, parental leave or sickness can be daunting. Trainees often worry about running the medical take, due to the need to have up to date knowledge, and exhibit leadership skills under pressure.
  • A number of organisations have produced guidance on how to make the transition as smooth as possible. There are also courses which include updates on key acute guidelines and refreshers on ALS and e-Portfolio requirements.
  • There is a lot of information on Supported Return to Training on the HEE London website.
  • Read the post on returning to practice for more details and make sure you get the support you need for a smooth transition.

How do I arrange an OOPE/OOPR?

  • Time out of programme for research or specific training experiences can greatly enhance your programme and your future career prospects. A large proportion of North East London trainees CCT with a higher degree such as an MD or PhD. The key is to plan ahead early. It can take a year to secure time out and the funding required to take up a research position. Talk to your educational supervisor and the Training Programme Director as early as possible about your plans.
  • You will only be able to leave the programme in April or October, when jobs naturally change and you must give a minimum of 6 months notice to leave the programme. There are no guarantees that if you request time out, it will be granted but the TPD will do everything they can to support you.
  • Please see this guidance on OOP which explains the different types of OOP and how to apply for one. The application is now in the form of a ticket submission to the OOP online portal.
  • The two main documents that you have to complete are the OOP signoff form (which requires the signatures of both your educational supervisor and TPD before uploading as evidence in your ticket submission to the OOP online portal) and the Pre-Absence form (which is an online form and you do not need to print it after completion). This form should be completed for OOP-Pause (OOPP) application and uploaded as evidence in your ticket submission.
  • There are other documents to upload depending on the type of OOP you are applying for such as proof of appointment for OOPR, OOPT & OOPE; an academic supervisor report for OOPR extension and proof of most recent ARCP outcome for all OOP types.
  • OOPP is a pilot out-of-programme opportunity due to the effect of COVID-19 pandemic on training. In OOPP, the experience and competencies gained outside of training may be considered on the trainee’s return to their training programme, unlike OOPE.  During an OOPP, trainees can undertake an NHS non-training post, gain further experience, take stock of their training, work in another related specialty, etc. At the moment, the maximum number of time allowed of an OOPP is 12 months. For more information, please click here
  • Once HEE has approved your application, they will inform JRCPTB of your OOP approval on your behalf.
  • Please see this guidance if you would like to seek credit towards training during your OOP. This guidance outlines which type of OOP is suitable for seeking credit towards training and the documents required.
  • Further guidance can be found on the PGMDE Support Portal. Additional advice can be found on the Research and Teaching and Training pages.

How can I arrange a transplant placement?

  • Requirements to sign off Lung Transplantation for CCT are attendance at a teaching programme/course + 2 outpatient clinics in specialist/satellite clinic + CbD.
  • As of November 2021, Harefield has started taking face to face placements, conditional on being double vaccinated and having a negative lateral flow test before attending.
  • We have an agreement with Harefield Hospital to facilitate our Transplant experience. Please speak to Dr Carby’s secretary (Patricia Harris) and expect to observe over four days from Tuesday to Friday, which will include an assessment clinic, a follow-up clinic, a ward round and an MDT. Please ensure that you have approval from your educational supervisor before you contact Dr Carby’s secretary suggesting dates.
  • Why not read one of his papers on recipient criteria for transplant, immunosuppression, or minimally-invasive lung transplant surgery before you visit him?
  • Alternatively previous trainees have managed to arrange a similar experience at Papworth by emailing one of the consultants there (Dr Debra Thomas, Dr Caroline Patterson and Dr Jasvir Parmar – can be found on nhs.net address book).

How can I arrange a pulmonary hypertension placement?

  • Good people to start with for Pulmonary Hypertension are Dr Gerry Coghlan, Consultant Cardiologist at the Royal Free (why not read his ERS paper on early detection of PAH before you email him?)
  • You can also contact Dr Luke Howard and Dr Rachel Davies (who happens to be TPD for North West London and is fully aware of the training requirements) at Hammersmith. They have written an e-learning module which is free once you’ve registered.
  • Contact details for all Pulmonary Hypertension centres can be found on the PH professionals site. If you fancy going further afield, to Sheffield for the largest pulmonary hypertension centre in Europe, Richard Turner has some great contacts and is happy for you to contact him.

How much experience do I need in Cystic Fibrosis?

  • Newly clarified minimum requirements are: attendance at a teaching programme session/course + 2 outpatient clinics + MDT + CbD with reflection.  
  • Your Educational Supervisor can help by recommending a recognised course (which should be BTS, RSM or equivalent). You will need to get study leave to attend clinics and an MDT if you do not rotate to a CF centre (i.e. Barts). Contact Dr Danie Watson or Dr Nadia Shafi (emails on nhs.net address book) at Barts to arrange if you do not rotate here during your training.

How much experience do I need in Occupational Lung Disease?

  • There is not the same formal requirement for Occupational Lung Disease as there is for Lung Transplant or CF. This is mainly because across the country it is more difficult for trainees to access such training.
  • We have an excellent Occupational Lung Disease department just down the road at the NHLI. It would be advisable for all NCEL trainees to take advantage of their expertise and arrange some time attending clinic. You can get in touch with Dr Jo Szram and Prof Paul Cullinan (both of whom are extremely helpful and friendly, address on nhs.net address book) at the NHLI to arrange dates. Why not read some of their excellent research before you get in touch?

How do I get signed off for Level 1 USS? 

  • The requirements for Level 1 USS competence are set by the BTS based on the RCR guidelines on focused ultrasound training. **This is going to change with the introduction of the new curriculum in August 2022 – see an overview of what the new specifications will be here.
  • You need to do a course which provides the theoretical knowledge necessary for safe pleural procedures, and then acquire sufficient evidence of competency in the form of a log book. The minimum requirements for the logbook are:
  • Once you have both these pieces of evidence, a Level 2 competent practitioner (or someone who is Level 1 with at least 2 years experience) needs to provide formal sign-off of your Level 1 competence (eg in the form of a letter you can upload to your ePortfolio).

How can I get experience in medical thoracoscopy?

  • Medical Thoracoscopy is done on regular lists at Basildon Hospital. Although Basildon is no longer in the North East Thames rotation, if you contact Dr Mukherjee and get approval for study leave from your clinical supervisor, you can observe a list on a Wednesday.
  • Basildon also has facilities to perform other specialist procedures such as cryobiopsy and radial EBUS.

How can I get signed off for safe sedation in Bronchoscopy?

  • This is essential pre-CCT, and wise to do early in the programme. A number of courses are available although these come and go over time.
  • The BTS currently has online learning available here that is probably the best option for the moment.
  • Sometimes Addenbrookes in Cambridge runs a course, and a more expensive RCoA-accrediated version is available from Sedate UK.
  • The Bronchoscopy training course done in ST4 (and open to other trainees across London) should be sufficient as it includes all you need to know and tests your knowledge of guidelines and evidence with MCQs.
  • In addition to a course, you must have 2 DOPS with a specific focus on safe sedation in bronchoscopy so ask a friendly consultant to assess you after you complete a course.

What can I use my study leave for?  

  • Since April 1st 2018, there is a new policy on study leave, as part of HEE’s initiative ‘Enhancing Junior Doctors’ Working Lives‘. HEE are now managing the Study Leave budget centrally through its local offices. You see all the FAQs on study leave on this PGMDE site. As usual, you will have to complete your local hospital’s study leave form to be submitted to the local education centre.
  • There are 3 levels of courses which are defined for each specialty: Curriculum Mandated, Curriculum Optional and Aspirational. These lists have been compiled by Heads of Schools and Training Programme directors with oversight and approval of the Post Graduate Deans. You can find the approved list here.
  • Essentially, anything on the mandated and optional lists you can go on. For aspirational courses, you will need additional approval from your ES and TPD.

Are training days mandatory?

  • Yes. If you are having problems attending due to service demands, please highlight this as early as possible. Training days are a great opportunity to learn from local experts and spend time with other trainees. You should attend 70% of training days, and also ensure you acquire the required number of 100 GIM hours. For tips see the pages on the training programme.

How can I fulfil my GIM requirement for 100 hours of external CPD? 

  • From the JRCPTB website:
    • External GIM teaching or study is clinical teaching or study that is not within the area of a trainee’s specialty for example, a teaching session on acute kidney injury would be appropriate as GIM teaching for a respiratory medicine trainee but not for a renal medicine trainee. The word ‘external’ does not mean that the teaching or study has to be delivered away from the trainee’s base department or hospital: it refers to the content of teaching or study and not its physical location.
    • Some contribution from online learning modules or courses can count towards external GIM teaching or study, but these would not normally be expected to amount to more than 25% of the total hours of teaching or study.
    • Management and leadership courses do not count as appropriate for GIM teaching or study because they are not clinically based. By convention, ALS (and similar) courses do not count towards GIM teaching or study.
  • The best way to ensure you achieve the 100hrs requirement is to attend the regional GIM training days. Note that most training days count for 6 hours of CPD not 8. Some training days will have a GIM session which counts for 1 hour.
  • You can augment these with online CPD and other relevant courses. RCP London runs a programme of online educational events (acute medicine, specialty and trainee series), although you need to be a member to be able to access. The RSM also runs the Managing acute medical presentations on the frontline series which can count and are free to access. The RCP London sessions are probably of higher quality/in more detail.
  • We will publish posts on GIM training days and these will be advertised on the upcoming events and countdown sections of this website’s homepage.

Where are all the hospitals I might rotate to?

  • You can see the locations of all the hospitals on the rotation on this Google map. Many of them have an individual page on our hospital trusts section (see menu bar above), with links to each Trust’s website, and information on individual jobs.

When should I take my SCE?

  • The SCE can be taken at any time once you have a Respiratory training number. It is recommended that trainees consider taking this in their third year of training  (ST5). There is only one diet of the exam per year. Failure in the exam will not impede progress through training, but a CCT cannot be awarded without it. See the SCE page for further advice and tips on how to prepare.

What should I write (and not write) in my reflections on my ePortfolio? 

  • Being reflective is essential to understanding ourselves and continuing to improve our practice. However, there are controversies around how we should be expected to demonstrate our ability to be reflective.
  • After a trainee was asked to release reflections to a legal agency, and this was later used as evidence in court against them, some trainees have expressed concern about documenting anything that may suggest anything less than perfect practice.  This of course defeats the point of reflective practice and does not support the aim of learning from mistakes.
  • It is a requirement that we submit reflective practice entries to our ePortfolio. A number of useful articles have been highlighted by Dr Bhowmik, which provide thoughts and guidance:

How do I get hold of the HEE representatives? 

You need to make all enquiries through the portal:


Who is my designated body and Responsible Officer?

HEE usually update these details automatically. However, just in case you are asked:

  • Designated Body: Health Education North Central and East London
  • Responsible Officer: Gary Wares

An outcome 1 on ARCP means you are automatically revalidated when it becomes due. 



  1. Pingback: Research opportunity at UCL | Resp NET - September 26, 2015

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  3. Pingback: Lung Transplantation training | Resp NET - February 28, 2016

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  9. Pingback: Pan-London Training Day: OccLD 14/11/17 | Resp NET - January 17, 2018

  10. Pingback: News and opportunities | Resp NET - April 14, 2018

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  15. Pingback: Programme for UCLH Training Day released | Resp NET - February 13, 2019

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