Out of Programme.

Every OOPR or OOPE is an individual journey for each trainee that decides to participate in this roller coaster journey. 

For myself I started planning my OOPR whilst I was a very junior trainee at ST-1 level. I had spent time with a consultant with a specialist interest in subfertility and IVF and found this branch of medicine that is still in its infancy fascinating but most importantly the joy this most wanted gift had brought to these couples.  In essence this was due to both our increased understanding of the infertile couple as a result of the large body of on-going research and the technology used to enable the fertilisation and development of an embryo.

Following discussions with the subfertility specialist at HRI, I was given a contact at the University of Hull who had led a previous MD student in subfertility, to ask if there was any scope for an MD project. At this point it is important to mention 3 things; 

1)      Professors will always have projects it is getting the right project for you. I was not interested in a laboratory themed project I wanted to be clinically based with elements of laboratory work because I felt I did not have the temperament of the laboratory. This is very important because no one will do the projects for you so you have to do something you enjoy otherwise it will be a long 2 years.

2)      Most importantly timing. Personally I feel the best time to do an OOPR is once you have the membership exams completed and you have clinical experience that you can bring to your OOPR. The MRCOG is the biggest hurdle to all trainees and entering an OOPR can result in focusing all your time and energy in a certain branch of the speciality resulting in that period of time a loss in your general O&G knowledge base whilst you are undertaking your research, this could affect exam chances once back in your general O&G rotation.

3)      Ensure you have YOU HAVE YOUR FINANCES sorted. OOPR tend to be paid in accordance with the doctors basic pay grade to the level they are at with yearly increments as you progress in your training, however, there is no out of hours banding resulting in a significant pay reduction. Ensure you know what your payscale is, that you are continuing to pay your pension and you have an honorary contract with the hospital and appropriate personal indemnity through the MDU/MPS as this will guarantee you have the appropriate level of indemnity whilst undertaking your OOPR.

Your Programme Director must be made aware of your plans early as they will want to know what arrangements are in place as they will have to authorise the OOPR. At this point you can apply to the Postgraduate Dean (at least 6 months prior to starting the OOPR) who will authorise this and allow you to retain your training number whilst undertaking your OOPR. It is imperative to be organised as everything above takes time to arrange and there will always be hurdles to be overcome on the way.

Testimonial

For my OOPR I spent two years in the Hull IVF Unit undertaking a number of projects looking into differing aspects of subfertility in conjunction with the University of Hull to complete my medical doctorate (MD).

These projects required detailed written protocols, patient information sheets and consent forms in conjunction with ethics applications. I defended these projects at regional ethical committees and in the case of one project this ultimately became a clinical trail under the Medicines Health Regulatory Authority (MHRA). This enabled me to develop sound working knowledge of writing large applications and presenting these, that I am sure I will be able to apply in my clinical practice.

I investigated the effects of chronic exposure of persistent organic pollutants (POP) and their possible endocrine disrupting effect on infertile women, both with and without polycystic ovary disease. This project required me to recruit women from the subfertility clinics and take blood, and follicular fluid samples. To do this I gained ultrasound experience and technical skills to perform ovum retrievals in order to collect the follicular fluid from these subjects. From these samples we could examine whether these POP were detectable in significant amounts in the subject’s blood and follicular fluid and was there any correlation with IVF outcomes and biochemical parameters of both the control and polycystic ovary syndrome subjects.

In another project looked at what effect intralipid, a supplement consisting of long chain non-esterified fatty acids, had on Natural Killer-cells in women with recurrent implantation failure. This project required me to learn laboratory based skills, such as the use of a Flow-Cytometer, and to develop staining protocols to process the blood samples from all subjects.

My week also included an Ultrasound scanning session were I learnt and became independent in follicle tracking, performing ovum retrievals and seeing patients in the weekly subfertility clinic. I had weekly meeting with my professors and other MD/PhD students to ensure all projects were making progress and any hurdles were discussed by the team. I was able to attend and present at national and international meetings which allowed me to meet other young researchers and share ideas, which is invaluable when starting out on research.

I feel I have taken a great deal from my 2 year OOPR, not only hopefully achieving my MD once my thesis is written, but meeting and working next to people I would not have had a chance to work alongside if it was not for this unique experience. I have developed a deeper knowledge of a branch of medicine I am very passionate about and gained a foothold into research that I hope to continue during the completion of my training and into a consultant post.

Dr Keith Cunningham
ST5 Obstetrics and Gynaecology