The Savvy IMG

How specialty training (residency) works in the UK: A complete beginner’s guide

Get to grips with the fundamentals of coming to the UK as an international medical graduate with our comprehensive easy-to-understand crash course. In this post we review the structure of specialty training (residency) in the UK.

Table of Contents

Photo of male doctor with stethoscope and clipboard

UPDATED: May 16, 2021

For IMGs aiming to pursue a medical career in the UK, getting into specialty training (residency) tends to be the ultimate goal.

As an IMG who succeeded with getting into UK specialty training, I know how intimidating achieving this goal is. This is why I created our free online course The IMG Shortcut to show you in simple terms, how you can do it within 2 years.

I also wrote this blog post right here, to give you a breakdown of how UK specialty training works. 


To understand how it all works, there are a number of new terms and concepts that you will need to understand first.

Let’s get the most common ones out of the way.

Term you may be familiar withUK term(s)
Internship / house jobFoundation year 1 / FY1 / F1 / pre-registration year
Intern / house officerFoundation doctor / FY1 / F1 / pre-registration house officer / PRHO / house officer
Residency / postgraduationSpecialty training
ResidentSpecialty trainee / trainee


(referring to a doctor who has completed specialist training AKA residency)


The “match”

(referring to the process of applying for specialty training)

Specialty recruitment / national recruitment


(referring to a doctor who has not completed a training programme)

Junior doctor 

Please note that GPs in the UK are family medicine specialists who have completed at least 5 years of postgraduate training.

Internal medicine Consultant

In the UK there are no IM Consultants. Doctors must complete training in a subspecialty eg. Cardiology, Rheumatology, etc. before registering as a Consultant.

Related: UK doctor titles 101

UK Specialty Training Overview


After medical school there are 2 stages of postgraduate training: foundation training, followed by specialty training

Foundation training is 2 years long while specialty training ranges from 3 years (for GP) to 8 years (for many hospital-based specialties). Additional training after reaching GP or Consultant status is optional.

Once a doctor satisfies all the requirements of a GMC-approved training programme they are awarded a Certificate of Completion of Training (CCT). The CCT is then used to join either the GMC GP register to be recognised as a GP, or the GMC Specialist Register to be recognised as a Consultant.

Postgraduate training in the UK to become a Consultant does not involve degrees like a Masters or MD. These are optional.

Foundation Training

Foundation training in the UK

The UK Foundation Programme is a 2-year programme consisting of Foundation Year 1 (aka FY1 or F1) and Foundation Year 2 (aka FY2 or F2).

Anyone who wants to apply for UK specialty training must have at least 2 years of clinical experience by the time they start training. The UK Foundation Programme is how UK graduates meet that requirement.

IMGs can meet the 2-year requirement either by joining the UK Foundation Programme, or by completing a 12-month internship overseas and working for an additional 12 months after internship.

For more information about this pathway, read our guide here: UK Pre-Specialty Training Guides

Specialty Training (Residency)

To become a Consultant, you must complete specialty training. Official training programmes take place within the NHS (public health care system). There are no training programmes in private hospitals or at universities.

There are 2 types of training programmes: 1) uncoupled or 2) run through.

1) Uncoupled specialty training

Uncoupled specialty training pathway in the UK

In uncoupled training programmes, the specialty programme is split into two stages: core training and higher specialty training

Uncoupled specialties include: All branches of Internal Medicine, most surgical specialties, Anaesthetics, Emergency Medicine & Psychiatry.

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. Eg. A CT2 doctor is in the second year of core training.

After completing core training, doctors will then need to apply for higher specialty training. Each year in higher specialty training is designed ST (for specialty training) and usually starts at ST3 (if core training was 2 years) or ST4 (if core training was 3 years). Every year, the numeric designation increases until the programme is complete eg. ST5, ST6, ST7 etc.

Related: UK doctor titles 101

Just to emphasise, uncoupled training programmes involve 2 applications: one for core training, and one for higher specialty training.

2) Run-through specialty training

Run through specialty training pathway in the UK

In run-through training, doctors apply for the first year of the programme which is called ST1 (Specialty Training year 1). There is no further application process after this.

Just to be clear, the first year of a run-through programme is called ST1, not CT1. Also, in a run-through programme, you only have to apply once, not twice.

Run through specialties include: Paediatrics, Obstetrics & Gynaecology, Ophthalmology, Radiology, Cardiothoracic surgery & Neurosurgery. 

In this video, Kim explains the UK training pathway and where IMGs could fit in. It is a small part of our FREE course “The IMG shortcut” so be sure to enrol and watch the whole series!

Applying for UK Specialty Training

The application process for UK specialty training is called “specialty recruitment” or “national recruitment”. You can think of it as equivalent to the US “match”. 

Since October 2019, UK graduates are no longer prioritised for training jobs so the door is open for IMGs! This may not last for long so this is really a golden opportunity for you to achieve your goal of completing specialist training in the UK.

From my experience of getting into UK specialty training as an IMG, I can say that early strategic preparation is the true key to success. That’s why we have spent a lot of effort creating a step-by-step guide to getting into UK training in our IMG Masterclass. Be sure to check it out if you’re looking for guidance.

GP Training

GP training pathway in the UK

In the UK, GPs are family and community medicine specialists. GP training is 3 years long after the Foundation Programme. This may be extended to 4-5 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. They would not be considered a Consultant in this area, but can incorporate it into their GP practice.

GP is a fantastic specialty with a lot of variety and potential for good work-life balance. If you’re interested in applying for GP training and you’re looking for some resources to prepare for exams, we recommend Arora Medical Education for high yield study materials and courses.

You can get a 10% discount on any product using the code Arorasavvy10. This discount is valid even if something is on sale so don’t miss out on the extra savings. Visit the Arora Medical Education website here.

Tuition Fees & Salary

In the UK, you train while you work therefore there are no tuition fees. In fact, as a working doctor you are paid a salary. All training jobs at all stages are paid.

Postgraduate specialty training in the UK is not a university degree and universities have no role in training programmes.

Related: How much do doctors in specialty training (residency) earn in the UK?

Training-related fees

Although you will not be paying for tuition, there are professional fees such as GMC registration, trade union membership, medical indemnity, and Royal College membership.

There are also costs related to training such as exams, courses, conferences etc. Training jobs do have a study budget but it’s often not enough to cover all these expenses so you will have to shoulder some of the cost.

Despite all these costs, the salary is more than enough to cover all your expenses and live a comfortable life in the UK – provided you live within your means!

Related: The cost of PLAB & GMC fees + tips on saving money

How training is organised

Specialty training is organised on several levels, from national to local. Please see the table below to understand how it works.

Level Responsible organisation(s)
  • Health Education England (HEE)
  • NHS Education for Scotland
  • NHS Wales Shared Service Partnership
  • Northern Ireland Medical and Dental Training Agency
  • Royal College of the relevant specialty
RegionalDeaneries or LETBs  (Local education training board)
Local Individual hospitals

Related: 8 organisations you’ll encounter as a doctor in the UK

Training jobs

Official training jobs are those that are part of a GMC recognised specialty training programme and take place in government-funded NHS hospitals. 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 training jobs, the progression from one year to the next is automatic as long as you satisfy all the requirements for each year. Because of this automatic progression, getting into a recognised training post is the quickest and straightest route to reaching GP or Consultant status.

There are a limited number of training jobs each year, and lots of applicants, so the competition can be fierce.

If you are serious about coming to train in the UK, I recommend getting the relevant Oxford Handbook (available here on Amazon) for your specialty. These pocket-sized reference books are filled with UK-based management guidelines. I’ve personally found them very useful for work.

Non-training jobs

Non-training jobs are those are not part of the official specialty training programmes. 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 by proving you have the equivalent knowledge and skills of someone with a CCT. 

Related: How to become a UK specialist without entering a UK training programme

Hospital Rotations

Training jobs in the UK involve multiple rotations at different hospitals. The length of a rotation can vary from 6 to 24 months, but the usual is 12. Some specialties tell you what your rotations will be throughout training, while others will only tell you 2 months in advance with no opportunity to state your preferences. 

Most rotations are within a small geographic region so you can live in the same house throughout training. However, some regions are very large which unfortunately means that you may have to move house each year.

Although moving constantly is extremely disruptive, especially for those with families, it does provide fantastic opportunities to work with and learn from a variety of patients and mentors. Working in both large district general hospitals (DGH) and tertiary teaching centres gives you a broad range of clinical experience.

Related: 10 ways to prepare for your first job in the NHS as an IMG

Postgraduate Qualifications & Specialty Exams

Each specialty has their own postgraduate qualification eg. MRCP. You achieve the qualification by passing the relevant exams. There are multiple exams for each qualification. 

These exams are known as membership exams because once you pass them, you become a member or fellow or the corresponding Royal College eg. Royal College of Physicians.

Specialty trainees need to pass all the exams during training, not after. And trainees usually need to pass certain exams before progressing to the next stage of training.

Uncoupled specialties

You usually need to pass a set of exams before progressing from core training to higher specialty training. For example in medical specialties you need to pass MRCP (3 parts) before progressing from core training to ST3. For surgical specialties you need to pass MRCS (2 parts) before progressing from core surgery to ST3.

Run-through specialties

In some specialties, you need to pass at least one exam before progressing from the initial years of training to the higher years. For example in Ophthalmology, you should pass FRCOphth Part 1 before you can progress to ST3.

H0wever, in other specialties you need to pass all the exams. For example in Paediatrics, you must pass all 4 parts of MRCPCH before you can progress to ST4.

For all specialties

You need to pass all parts of all exams before the end of training in order to be awarded your CCT. You cannot wait until after training to sit the exams.

Please note that passing exams does not allow you to skip any years of training. 

In other words, you cannot skip core training in surgery just because you have passed MRCS. You can read more about this common misconception here.

Subspecialty Training (Post-CCT fellowship)

Run through specialty training pathway in the UK

It is not necessary to complete a post-CCT fellowship in order to recognised as a Consultant in the UK, however, if you do choose to pursue a fellowship after achieving CCT, it is usually for a very niche field.

For example, you can complete core training in Internal Medicine (3 years), followed by higher specialty training in Cardiology (5 years), you then obtain your CCT in Cardiology to become a Cardiology Consultant. You can then opt to pursue further subspecialty training in something very specific like adult congenital heart disease (1-2 years).


  • Postgraduate specialty training in the UK to become a GP or Consultant is streamlined through training programmes that lead to a CCT (Certificate of Completion of Training).
  • Training jobs come with automatic annual progression towards CCT while non-training jobs do not.
  • All training jobs take place within government-funded NHS hospitals.
  • All training jobs are paid a salary. There is no tuition fee.
  • The Oxford Handbooks are great references for UK management. I got mine here on Amazon 
  • Foundation training is a 2-year programme that UK graduates complete in preparation for specialty training.
  • There are 3 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 programmes.
  • Specialty recruitment refers to the process of applying to specialty training. It’s a complex process that you can read more about it here.

Although entry into specialty training as an IMG is challenging, it is very possible. Start your preparation early and check these tips today.

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. Read here for more on that.

Further Resources

Once you have a grasp of the basics you can check out these sites for more information.

Disclosure: There are some affiliate links in the article above. This means that at no additional cost to you, we may earn a commission if you make a booking or purchase by clicking on the link. We only recommend products and services that we use ourselves or have proven success amongst IMGs.

You might also like

31 Responses

  1. hi, i got one doubt. if we pass mrcp, does that mean we get to specialize regardless of how many other doctors scored better than us? whats the criteria for getting into speciality? as in just passing is enough or do we need to be top 100 etc? thank you

    1. The requirements for entering a specialty training program can differ based on factors like the specialty’s competitiveness and available positions. While ranking high can be beneficial, simply passing the MRCP exam makes you eligible to apply for these programs. MRCP is a mandatory requirement, so all applicants must have it. Your score on the MRCP doesn’t impact eligibility; what really matters is your application’s overall score.

      This article might be helpful for you:

  2. Hi I have a question, i studied in turkey and I graduated this year, the system here is 5 years and the 6th is considered an internship, but you get your diploma (officially graduate) after you finish the 6th year. My question is, will my last year in uni be credited as internship and only need to accomplish 12 months of foundation training before I apply for specialty training?

    1. Hi Khalid! If the 6th year of your university program meets all the requirements for an internship, then it may be accepted as FY1 equivalent. Then yes you would have to complete an additional 12 months of clinical experience before you can start specialty training.

    1. Hi Derick! Essentially, if you’re done with FY1, you can now proceed to take your FY2. Anyone who wants to apply for UK specialty training must have at least 2 years of clinical experience by the time they start training.

  3. Hi, I’ve completed my internship training abroad and it says here that you need 2 years of foundation training before entering specialty training (residency). Will my 1 year experience be credited and only need to accomplish 12 months of foundation training before being able to do specialty training? Thanks

    1. Hi Derick! Yes, your internship is accredited so you’d just need an additional 12 months to complete the 2 years experience prior to starting specialty training. Just take note that clerkship is not considered an internship by the GMC.

  4. Hello,

    Just to clarify on the 2 year requirement before being able to apply for specialty training:
    Is the FY2 experience counted only if it’s done in the UK or can it be in your home country, say I have an approved Post-Graduate Internship (FY1), worked at least a year after in a medical capacity in home country, and after getting GMC regustration worked in UK – non training for less than 6 mos..

    Can I already apply for Specialty Training with that experience (and of course with CREST signed etc.)?

    Thank you.

  5. Hi Nik,
    You guys deserve the biggest ‘thanks’ from IMGs like me. This is a great resource.
    I have graduated with my PMQ a decade ago, after that I did a clinical research PhD where I had limited clinical practice (group of neuro-psychiatric disorders). Now I would like to gain some training as well as do research in my areas of relevance.
    How much does my PhD experience count in my applications? (of course it depends on what I will be apply for). Let’s say some job (training or non training) in neurology, psychiatry or genetics. later going into ST into neurology or psychiatry or clinical genetics.
    Are there are any non training clinical research jobs which I can take up while preparing to clear MRCP?. As I understand, identifying a mentor is essential for properly harnessing the flexibility of the UK system.

    Any insights are highly appreciated
    Thanks again

    1. Hi Nikhil, sorry for the extremely delayed response! We’re so glad you find the website helpful. A PhD is highly valued in any setting, but do keep in mind that for clinical jobs, they will also be looking for clinical experience as well so if you can get more clinical experience that would be great in helping land a job, and also to prepare you for returning to clinical work. Yes there are clinical research jobs available that you can look for on the NHS jobs website. You may also find it useful to ask IMGs who have recent experience with that in one of the IMG Facebook groups. You can find the links to relevant Facebook groups here on our Useful Links page.
      Best of luck on your UK journey!

  6. Hi,
    I am Shai and I have completed a residency in anatomical pathology. I am looking for a molecular pathology fellowship program in the UK. So far I was not able to find such programs. I would be very grateful to get some assistance.

    1. Hi there, sorry it’s not a field we are very familiar with. You may find it useful to ask IMGs who have recent experience with that in one of the IMG Facebook groups. You can find the links to relevant Facebook groups here on our Useful Links page. Best of luck!

  7. Hi! I have 2 years left of medical school (7 years in Peru). Can I apply being a medical student? GMC registration is first or the Foundation Programme? Can I do the 2 years of FP o just 1?

    1. Hi there, you can only apply for GMC registration once you have graduated medical school. It’s not possible to apply as a medical student. You need GMC registration before you can work in the Foundation Programme however you will typically apply for both at the same time. You can do the 2 years of FP if you have provisional registration. If you have full GMC registration then you can only do the 2nd year. If you are looking for one-to-one guidance for your specific personal circumstances, you might be interested in booking a session to discuss your options. For more details, please visit our page here.
      Best of luck!

  8. Hi, I have two doubts, I will be very grateful to you if you can clear it
    1) What happens if a doctor cannot pass MRCP/MRCS exam by the end
    of core training ?
    2) If a doctor has passed MRCP/MRCS exam successfully by the end of
    core training but he/she does not want to continue speciality
    training (st3 and above), ​can he/she work as a registrar (in non-
    training job) ?

    1. Hi there!
      1. They’re training can be extended to give them another chance to pass. The deanery can work with them to find out what issues they need help with to pass. Ultimately if they can’t pass the exam in the given time, they will not be signed of for core training. Without this, and without MRCS, they can’t apply for higher surgical training or progress to ST3.
      3. Yes

  9. Hi there
    I remember seeing the pathway images else where on a different websites, describing an array of all the specialities. If you know what website this is please let me know

  10. hello, thank you so much . I’m currently in my fourth year as an international medical student in China. This article has been a very helpful and great guideline. looking forward to learning more as I get prepared to take this path to becoming a cardiologist or cardiac consultant.

    1. Thank you for visiting our site, so glad you found this article helpful! All the best in your UK journey!

  11. Hi good day!.
    I am dr RANA KASHIF RIAZ working in Trinidad and Tobago Westindies since 2014. I have done MRCP part 1,2 waiting to get slot in PACES BUT due to covid19 unable todo so. I am planning to apply for training in acute medicine/internal medicine or cardiology. What are the possible options for me given my circumstances. I am presently working as cardiology registrar in one of the busy hospital. Please advise!
    Best regards

  12. Hi, please I want to know if there’s residency program in public health/community medicine in UK? In my country, family Medicine is totally different from community medicine. With residency in community medicine in my country, one may end up as an epidemiologist, or occupational health physician etc.

    1. Hi there, there is a training programme for public health but I’m afraid it’s very competitive so IMGs can’t really apply unless they have residence status in the UK. You can always do masters or a PhD in public health or epidemiology and find jobs using that qualification.

  13. Hi po! I’m a junior student studying in the Philippines and I am planning to do my residency training (probably staying there for good to) in UK. I just wanted to ask on what are the things I need to prepare as early as now? And what pathway should I take? Thank you so much for answering my query!

  14. I wish to know whom I can contact to get guidance for medical education, Internship, training And work for few years in UK.

    1. Hi there, you can find lots of information on this website and send us a message if you wish. You can also find guidance in the FP IMG groups. Best of luck on your journey!

      1. Hi. I want to know more. May I ask what are the things i need to prepare initially before i can apply to any of your programs?

        Thank you.
        Post-graduate intern graduate

Leave a Reply

Your email address will not be published. Required fields are marked *

Meet the Team

Hi, we’re Drs Nick & Kimberly Tan, the two IMGs behind The Savvy IMG. We write comprehensive guides, create courses, and provide one-to-one guidance to help other overseas qualified doctors on their journey to the UK.
We have scoured the official guidance to put these posts together, but we can make mistakes! If you spot anything that is incorrect, please get in touch and we’ll put it right.
Photo of Dr Nicholas Tan