How Specialty Training (Residency) Works In The UK: A Complete Beginner’s Guide

It is obvious UK has a big problem due to doctors shortage, and it is much easier for IMGs to get GMC registration currently but is it possible for them to work in the specialty they prefer?, can they get a training program similar to US residencies?

I read this article on The Savvy IMG and i found it very interesting and informative, if you are interested in working as a foreign doctor in UK, you will find answers for many of your questions here, this is why i wanted to share it with you

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TERMINOLOGY
To understand how it all works there are a number of new terms and concepts that you will need to understand so let’s get the most common ones out of the way first.

TRAINING JOBS
Official training jobs are those that are part of a GMC recognised specialty training programme and will be explained in more detail below. Each post has a unique designated number known as a “National Training Number” aka NTN or sometimes referred to simply as having a “number”.

In these jobs the progression from one year to the next is automatic as long all the requirements are satisfied. Because of this automatic progression, getting into a recognised training post is the quickest and straightest route to reaching GP or Consultant status.

But even though it is the quickest route, specialty training in the UK is very long overall. This appears to be justified by working less hours per week and having lots of annual leave compared to other countries where training is shorter. Although the training is already lengthy, you will find that UK trainees are in no rush to become Consultants as the responsibilities of a Consultant in the UK are significant.



NON-TRAINING JOBS
In non-training jobs there is no automatic progression each year towards Consultant level. You can theoretically work 10 years in the same job and be no closer to becoming a Consultant!

BUT if you choose your jobs wisely and purposefully build up a portfolio of your skills, you can use your non-training job to eventually land a training one. You can also technically can use non-training jobs to become a GP or Consultant without ever entering a training post. It is not recommended but it’s possible.

UK SPECIALTY TRAINING OVERVIEW


After medical school there are 2 stages of training: foundation training, followed by specialty training. Foundation training is 2 years in length; specialty training ranges from 3 years for GP to 9 years for anaesthetics. Additional training after reaching GP or Consultant status is optional. All stages of training are paid.

Once a doctor satisfies all the requirements of a GMC-approved training programme they are awarded a Certificate of Completion of Training (CCT). With a CCT they can join either the GMC GP register as a GP, or the GMC Specialist Register as a Consultant.

FOUNDATION TRAINING


Once UK medical students graduate from medical school they are granted provisional registration with the GMC. The only job they can take up with this type of registration is in the Foundation Programme (FP). It is a 2-year programme consisting of Foundation Year 1 (aka FY1 or F1) and Foundation Year 2 (aka FY2 or F2).

FY1 is considered the internship year. Foundation doctors are granted their full license to practise after FY1. FY2 is an additional year to gain more experience as a fully licensed doctor before applying to specialty training. This additional 12 months experience after gaining full registration is a requirement of all first year specialty training programmes and does not have to be UK experience.


GP TRAINING


GPs need to complete 3 years of training after the Foundation Programme. This may be extended to 4 years in the future. If they wish, GPs can then obtain further training in a “special interest” such as Women’s Health or Minor Surgery and incorporate that into their work timetable.


SPECIALIST TRAINING
To reach Consultant level in a specialty there are 2 types of training programmes: uncoupled or run through. Whether a programme is uncoupled or run through is decided by the specialty itself. Generally each specialty will be one type or other.

Uncoupled specialty training


In uncoupled training the specialty is split into core training and higher specialty training. Core training can be 2 or 3 years in length depending on the specialty. The first year of core training is termed CT1, the second year CT2, and then CT3. Trainees are also referred to by these designations so you will have an idea of a trainee’s experience from their title.

Uncoupled specialties include: Internal Medicine, Surgery, Anaesthetics, Emergency Medicine & psychiatry.

After completing core training doctors will then need to apply for higher specialty training. These years are designated ST and usually start at ST3 (if core training was 2 years) or ST4 (if core training was 3 years). Every year the numeric designation goes up until the programme is complete.

Just to emphasise, uncoupled training involves 2 specialty recruitment applications: one for core training, and again for higher specialty training.

Run through specialty training


In run through training doctors only have to apply to the first year – termed ST1 (Specialty Training year 1). Once a run through training programme is started, progression each year is automatic until the trainee has reached Consultant level. As long as all the requirements are satisfied, run through trainees are pretty much on a conveyor belt to Consultant-hood.

SUBSPECIALTY TRAINING (POST-CCT FELLOWSHIP)


As I mentioned earlier, subspecialty training in Internal Medicine is already included pre-CCT. This is also true for Paediatrics and O&G. Further fellowship after reaching CCT will make you extremely niche. For example you can do Internal Medicine, followed by higher specialty training in Cardiology, become a Cardiology Consultant, and then do further subspecialty training in adult congenital heart disease.

For other specialties you are only permitted to subspecialise after reaching CCT. For example in Ophthalmology you are expected to be a General Ophthalmologist after 7 years. If you want to specialise in Vitreoretinal surgery this will be done after gaining CCT. Although for Ophthalmology this is changing and the aim is to complete subspecialty training pre-CCT.

SPECIALTY EXAMS
Each specialty has their own exam which is administered by the corresponding Royal College or Faculty. These need to be passed before reaching the end of specialty training. For example all Ophthalmology trainees need to pass the Fellowship of the Royal College of Ophthalmologists exam (FRCOphth) by the end of ST7 in order to awarded a CCT.

All exams have multiple parts and there is often a requirement to pass certain parts of each exam before progressing through the years of training.Using Ophthalmology as an example again, FRCOphth Part 1 should be passed before progressing from ST2 to ST3.

In other words, an Ophthalmology trainee cannot skip ST2 even if they passed FRCOphth Part 1 during ST1. And an IMG cannot skip specialty training and become a Consultant even if they pass all parts of a specialty exam.

SPECIALTY RECRUITMENT
As mentioned above, the application process for specialty training is called specialty recruitment. You can think of it as equivalent to the US “match”. It runs once a year for most specialties with applications opening around October-November. Interviews are held between December and February with different dates for each specialty. Most training jobs start in August.

SUMMARY

• Postgraduate specialty training in the UK to become a GP or Consultant is streamlined by entering a training job which leads to a CCT.
• Training jobs come with automatic annual progression towards CCT while non-training jobs do not.
• Training jobs are limited and are more competitive to get into vs non-training jobs.
• Foundation training is a 2-year programme that UK graduates complete in preparation for specialty training.
• There are different types of specialty training pathways: GP, uncoupled, and run-through. Uncoupled training requires 2 applications while run-through and GP involves only one.
• Specialty exams are required as part of the CCT requirements but passing exams does not exempt you from completing the training years.
• Specialty recruitment is a straightforward process with several key concepts that differentiate it from residency applications in other countries.
  • Priority is given according to immigration status, not according to the country of the medical school.
  • Competition ratios indicate how competitive a specialty is.
  • Applications are made to geographic region per specialty and not to individual hospitals.
  • Specialty training in the UK involves rotating through different hospitals every 6-24 months, usually every 12 months.
  • Applications can be submitted to multiple specialties without prejudice.
  • There are no fees to apply to specialty training.
  • There is only one interview per specialty. It tends to be highly structured is scored by a panel of Consultants from across the region or country.
  • Eight specialties require the MSRA entrance exam: GP, Radiology, Ophthalmology, Obstetrics and Gynaecology, Community Sexual and Reproductive Healthcare (CSRH), Child and Adolescent Mental Health Services (CAMHS), Core Psychiatry and Neurosurgery.
  • Recruitment timelines are extremely strict and late applications are not accepted under any circumstances.

Although entry into specialty training as an IMG is challenging, it is very possible. If you are unsuccessful in securing a training job but have your heart set on a specific specialty, there are still ways to become a Consultant or GP even without entering a training programme. It’s not the recommended route but it is possible.

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