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 with||UK term(s)|
|Internship / house job||Foundation year 1 / FY1 / F1 / pre-registration year|
|Intern / house officer||Foundation doctor / FY1 / F1 / pre-registration house officer / PRHO / house officer|
|Residency / postgraduation||Specialty training|
|Resident||Specialty trainee / trainee|
(referring to a doctor who has completed specialist training AKA residency)
(referring to the process of applying for specialty training)
|Specialty recruitment / national recruitment|
(referring to a doctor who has not completed a training programme)
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.
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
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
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.
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.
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!
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.
|Regional||Deaneries or LETBs (Local education training board)|
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 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.
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.
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.
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.
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)
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.
Find this article useful? Check out more guides on this topic here: UK Specialty Training (Residency)
Once you have a grasp of the basics you can check out these sites for more information.
- NHS health careers – more detailed pathways for each specialty.
- Multi-specialty recruitment assessment (MSRA)
- Want to know what doctors in the UK earn during training?
- If you’re completely new to all of this I recommend going through the IMG Crash Course.
- Follow these tips to improve your application to training.
- Or check out our IMGs for UK ST1/CT1 Masterclass to see if it can help you.
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