July 14, 2024

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How Doctor Specialty Training (Residency) Works in the UK

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How specialty training and residency works

Specialty training is the final stage of becoming a fully qualified doctor in the UK. It allows doctors to acquire expertise in a specialist area of medicine or in general practice. This component of the medical career path commences after the attainment of an MBChB from medical school and two years of foundation training. Specialty training is the equivalent of what is termed residency in some other countries.

 

Types of training programmes

Specialty training is delivered in one of two ways. Run-through training features a single recruitment process, training after which covers the whole specialty curriculum. The first year of run-through specialty training is termed ST1, the second is termed ST2 and so on. Specialties that have run-through training are listed in Box 1. All other specialties have uncoupled training. In this type of programme, the first recruitment process is for core training and the second is for higher specialty training. 

Box 1 – Specialties that have run-through training

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Uncoupled training

The first year of core training is termed CT1, the second is termed CT2 and the third is termed CT3. There are several core training programmes to choose from. Trainees should choose the core training programme most appropriate to the specialty they intend to pursue. Internal Medicine Stage 1 Training (IMT) has a duration of three years for group 1 specialties and two years for group 2 specialties. Group 1 and group 2 specialties are listed in Table 1. Acute Care Common Stem (ACCS) and Core Psychiatry Training (CPT) are three-year programmes. IMT features rotations across a selection of medical specialties. ACCS is similar but, in the initial two years, greater focus is assigned to acute medicine, emergency medicine, anaesthetics and intensive care medicine. CPT trainees work in posts across the psychiatric specialties. Core Surgical Training (CST) has a duration of two years and rotations cover a range of surgical specialties. Progression to higher specialty training demands that doctors pass membership exams of the relevant royal colleges (Box 2) during core training.

IMT and ACCS are concluded by the Membership of the Royal College of Physicians of the United Kingdom (MRCP (UK)) examination. Trainees must pass the Membership of the Royal College of Psychiatrists (MRCPsych) and Membership of the Royal College of Surgeons (MRCS) examinations for CPT and CST respectively. Subsequently, trainees apply for higher specialty training. The nomenclature for the first year of higher specialty training is ST3, for the second it is ST4, and so on.

 

Table 1 – Group 1 and group 2 specialties






















Group 1

Group 2

Acute Internal Medicine

Allergy

Cardiology

Audiovestibular Medicine

Clinical Pharmacology and Therapeutics

Aviation and Space Medicine

Endocrinology and Diabetes Mellitus

Clinical Genetics

Gastroenterology

Clinical Neurophysiology

Genitourinary Medicine

Dermatology

Geriatric Medicine

Haematology

Infectious Diseases (except when dual with Medical Microbiology or Virology)

Immunology

Neurology

Infectious Diseases (when dual with Medical Microbiology or Virology)

Palliative Medicine

Medical Oncology

Renal Medicine

Medical Ophthalmology

Respiratory Medicine

Nuclear Medicine

Rheumatology and Tropical Medicine (except when dual with Medical Microbiology or Virology)

Paediatric Cardiology

 

Pharmaceutical Medicine

 

Rehabilitation Medicine

 

Sport and Exercise Medicine

 

Tropical Medicine (when dual with Medical Microbiology or Virology)

 

Box 2 – List of royal colleges

  • Royal College of Anaesthetists

  • Royal College of General Practitioners

  • Royal College of Obstetricians and Gynaecologists

  • Royal College of Ophthalmologists

  • Royal College of Paediatrics and Child Health

  • Royal College of Pathologists

  • Royal College of Physicians and Surgeons of Glasgow

  • Royal College of Physicians of Edinburgh

  • Royal College of Physicians of London

  • Royal College of Psychiatrists

  • Royal College of Radiologists

  • Royal College of Surgeons in Ireland

  • Royal College of Surgeons of Edinburgh

  • Royal College of Surgeons of England

  • Royal Society of Medicine

  • The Royal College of Emergency Medicine

 

The Training

Training jobs are paid and comprise rotations across diverse NHS hospitals and disciplines. Each rotation has a duration of between six months and two years. Each specialty has a curriculum and trainees must pass exams during training.  All General Medical Council (GMC) approved postgraduate curricula are available here. Exams are distinct for each specialty. Typically, these are challenging, and several attempts may be necessary to pass.

Passing exams does not mean that any years of training can be omitted. However, the exams are compulsory to be awarded a certificate of completion of training (CCT). A CCT signifies that a doctor has completed an approved specialist training programme and allows them to join the GMC GP or Specialist registers to be recognised as a GP or a consultant respectively.  

It is possible to complete training in more than one specialty and achieve a dual CCT. Trainees must cover all competencies in both specialties. The total duration of training may be prolonged.

 

Training duration

The total duration of training varies for different types of doctors. GP training is a minimum of three years. Specialty training programmes for other branches of medicine and surgery are between five and eight years long. 

Trainees may apply for less than full time training (LTFT). They must provide strong reasons for why they are unable to train full time. Examples comprise caring responsibilities, disability, illness, religious commitments and unique opportunities for personal and professional development. The requirements for LTFT differ from training full time only in that there are fewer weekly working hours. Consequently, the total duration of training is extended. Most LTFT trainees work between 50% and 80% of full time. 

 

International medical graduates 

Currently, medical practitioners are included in the Shortage Occupation List. Consequently, international medical graduates (IMGs) and UK graduates applying to specialty training are assigned equal consideration in the recruitment process. IMGs must hold full GMC registration by the time specialty training commences. IMGs are eligible to apply for full GMC registration if they have completed an internship and passed the Professional and Linguistic Assessments Board (PLAB) test.

An acceptable internship is one year of continuous medical practice, immediately prior or subsequent to graduation, in an approved training post in a public hospital. Alternatively, if an internship has not been completed, evidence for two years of continuous medical practice after graduation may be accepted if it was supervised, comprising a minimum of three consecutive months in each of medicine and surgery and was undertaken at a public hospital that meets standards, including for supervision, safety and governance. IMGs must also have one year of post-internship experience by the time specialty training commences. One option is to complete Foundation Year 2 (F2) stand-alone training in the UK, resulting in the attainment of a Foundation Programme Certificate of Completion (FPCC). IMGs can also meet F2 competences by taking a Widening Access to Specialty Training (WAST) post or completing one year in a supervised hospital post in a specialty or with acute medical responsibilities in the UK or abroad, or a combination.  If these alternative options are availed, trainees must provide a Certificate of Readiness to Enter Specialty Training that is signed by a supervising consultant. Entry requirements for ST3 posts vary but, generally, certificates confirming former equivalent training, minimum required length of experience and qualifications, for example, MRCP and MRCS are requisite. 

 

Applying for specialty training

Annually, there are five recruitment rounds for specialty training: one round for Academic Clinical Fellowship posts and two rounds for each of CT1/ST1 posts and ST3/ST4 posts (uncoupled training programmes). Prior to applying, trainees should ensure eligibility. All applicants to CT1/ST1 posts must provide evidence of attainment of foundation competence within the three and a half years before the start date of the advertised post. Additional evidence of core competence differs by specialty. Person specifications for each specialty are available here. Trainees are also advised to consider the likely levels of competition for posts in the specialties and regions of their choice. Competition ratios for all specialties in previous recruitment years are available here. Competition levels for some specialties and regions are high and not all applicants are successful in securing their first choice. 

Entry to some specialties (Box 3) requires trainees to pass the Multi-Specialty Recruitment Assessment (MSRA).

Box 3 – Specialties using the Multi-Specialty Recruitment Assessment (MSRA)

  • Community and sexual reproductive health

  • General practice

  • Neurosurgery

  • Obstetrics and gynaecology

  • Ophthalmology

  • Psychiatry (core and child and adolescent mental health services)

  • Radiology

NHS recruitment for specialty training is conducted on a national level. Applications are submitted through the website Oriel. Trainees may submit one application per specialty for as many specialties as they wish. They then rank all the UK regions in order of preference. Candidates are ranked based on performance during the application process and this determines their chances of being allocated their preferred post and region. The recruitment process includes an interview. There is one interview per specialty that the trainee has applied for. 

 

References:

  1. Savvy IMG – https://thesavvyimg.co.uk/specialty-training-residency-in-the-uk/

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