The Savvy IMG

What IMGs need to know about applications to specialty training (residency) in the UK

All the essential information to help IMGs understand the application process for specialty training (residency) in the UK.

Table of Contents

all the essential information the international medical graduates need to know about applying to specialty training in the UK also known as specialty recruitment

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UPDATED: March 6, 2023

The process of applying for specialty training (residency) in the UK is known as specialty recruitment or national recruitment and can be thought of as similar to “the match” in the US.

It’s a nationally organised process which occurs once a year for most specialties, and at least twice a year for GP, Psychiatry and Anaesthetics. All applications are submitted through the website Oriel.

Specialty recruitment can be a complex process and will be very different to the residency application process that you know of back home.  This article should help clarify several of the key concepts you need to understand as an IMG.

If you’d like an overview of the entire process and our strategy on how to get into specialty training in just 2 years, enrol in our FREE online course here.

No priority for UK graduates

The priority is not actually for those who graduated from a UK medical school. The priority is for doctors who are exempt from the Resident Labour Market Test (RLMT).

RLMT is an immigration rule that basically says that a foreign national cannot work in the UK unless there is no one from the UK suitable for that job. Therefore those who have right to work in the UK are given priority.

Fortunately, as of October 6, 2019, all medical jobs were added to the UK Shortage Occupation List meaning that all foreign doctors applying for jobs in the UK are now automatically exempt from RLMT.

This is a huge milestone for IMGs because it means that your application for specialty training will no longer be dismissed just because of your immigration status. Where you graduated from will have no bearing at all.

Are UK graduates still preferred over IMGs even if IMGs are exempt from RLMT?

No, according to the Medical Recruitment 2020 Applicant Handbook (pg 50), once exempt from RLMT, IMGs and UK graduates are given equal consideration. Each applicant will be given credit solely on the merit of their application.



There is a set number of training jobs available each year and there are usually more applicants than jobs. Therefore applications are highly competitive. Even local graduates can take several years to successfully land a training post in the most competitive specialties.

You can get an idea of how popular a specialty is from the competition ratio. This is the number of applicants divided by the number of available jobs. So for example, if there are 100 doctors applying for Radiology and there are 50 jobs available, the competition ratio is 2. 

  • Low to moderately competitive: Competition ratio of between 1 and 2. You will need a solid application strategy to succeed.
  • Highly competitive: Competition ratio between 2 and 4. You will need a focused application strategy to succeed.
  • Extremely competitive: Competition ratio of more than 4. You will need a highly intense strategy to succeed.

You can find all the competition ratios for the past 5 years on the HEE website.

In this video, Kim explains how why competition ratio is important and it is more than meets the eye.

Difficulty for IMGs

Many IMGs ask how difficult it is to get into UK specialty training. As mentioned above, UK graduates are not given priority so IMGs have the same chances as anyone else. There is no longer a specific disadvantage for IMGs compared to UK graduates.

So if you do thorough research, have a well-developed strategy, and you are ready to put in the hard work required, then it is not that difficult to succeed as an IMG.

However, if you don’t do your due diligence, have a poorly-informed strategy, or expect to succeed without putting in the necessary effort, then you will find it extremely difficult and frustrating.

The good thing about UK specialty training applications is that it is highly objective. You do not need to charm your interview panel to convince them to hire you.

Applications are scored according to a national scoring matrix so that every applicant can be compared numerically. If you achieve everything on that scoring matrix, then there’s no reason you can’t score well and succeed.

Related: 8 tips to succeed when applying for UK specialty training

Entry Requirements

You can find the specific requirements for each specialty in a document called the person specifications. Each specialty at each level will have its own set of person specifications. I’ve listed the basic requirements below. 

For ST1/CT1 posts

For a first-year position (ST1 or CT1), these are the basic requirements:

  • Full GMC registration by the time you start ST1 or CT1
    • This means you have completed internship (FY1 equivalent) and you have GMC registration or you are already in the process of GMC registration with IELTS/OET and PLAB.
    • If you have completed internship overseas, then you do not need to repeat internship in the UK (FY1).
    • Please note that sponsorship or MTI cannot be used for GMC registration for the purpose of a specialty training programme.
  • 12 months post-internship experience by the time you start ST1 or CT1 (not at the time of application)
    • Option A: 12 months of clinical experience in a supervised hospital post in a specialty with acute medical responsibilities either in the UK, overseas, or a combination of both, OR
    • Option B: Standalone FY2 in the UK
  • F2 competences
    • Option 1: A valid CREST 2021 form (previous versions of CREST will no longer be accepted). Applicable to Option 1 above, OR
    • Option 2: Foundation Programme Certificate of Completion (FPCC) – applicable to Option B above

NHS experience is not a requirement to apply but is hugely beneficial. Starting your first job in a training post is challenging and can have negative effects on your career progression if you perform poorly.

Please note that you can be overqualified for an ST1/CT1 post if you have too much experience in the same specialty you are applying for. You can read more about this here.

Yes. Health Education England  have said that if a doctor were to start CT1 or ST1 without 12 months post-internship experience, an investigation would take place.

No. Clerkship refers to the clinical rotations undertaken during medical school. It is a basic GMC requirement of an acceptable medical degree (source). It is not considered the same as FY1 or internship therefore it is not counted as part of the clinical experience required to enter ST1/CT1.

Be careful of labelling clerkship or clinical rotations as clinical experience or equivalent to FY1/internship in your CV or job application. You may be accused of inflating your experience which can turn into a serious probity issue with the GMC.

For ST3+ posts

In general, ST3 posts will require you to have:

  • A certificate to confirm previous training equivalent to ST1/CT1 and ST2/CT2
  • Minimum required months of experience
  • Compulsory exams eg. MRCP, MRCS, etc.
As an example of the requirements for ST3 applications, check out this article which explains the requirements for ST3 Cardiology and ST3 General Surgery.

Preparing yourself for applications

We have made a FREE short course where we give you an overview of the application process and how you can prepare early. Join us in the IMG Shortcut now.

If you want an even more in-depth, step-by-step guide, be sure to check out our Masterclass to learn how you can succeed as an IMG.

Allocation to a Hospital

Applications for a training post are not made to individual hospitals. Instead, you submit one application per specialty to the national recruitment office.

You then list all the geographic regions of the UK or each job placement you are willing to work in, and rank them according to preference.

Depending on your performance during the application process, you will be assigned a rank amongst all applicants. The higher your rank, the higher your chance of getting matched to a preferred region/job placement.

If there are special circumstances that require you to be physically present in a specific region or hospital, there is a process to apply for special treatment but these are not always guaranteed.

What if I don’t get a job in my desired location?

If you do not get into your desired region, it is possible to request for a transfer for the next year, a process called Interdeanery Transfer (IDT). You can read about the process here. A successful request depends on the availability of jobs in that region and your circumstances. Those with medical conditions, caring responsibilities (eg. children), and those in committed relationships are considered first and in that order.

So it’s important to emphasise now that unless you have special circumstances: the best way to ensure you get a job in your desired region is to score highly in your application.

Applying to Multiple Specialties

It is possible to apply to multiple specialties without discrimination. The panel of one specialty will not be aware if you’ve applied to another specialty.

If you plan to do this, you will need to prepare a portfolio and be ready to interview for each specialty so beware of spreading yourself too thin.

Related: Comprehensive IMG guides per specialty

Application Fees


In fact, you can usually claim reimbursement for expenses incurred when attending interview. This can be for a train ticket, or a hotel room if you have a morning interview and live far from the interview venue.

Age Limits

There is no age limit for specialty training in the UK. Discrimination based on age is illegal and violates the Equality Act of 2010.


There is one interview per specialty. There is no need to travel to multiple hospitals to interview with each. More and more specialties are moving away from personal questions such as “why this specialty?” or “why this region?” Instead interviews tend to be very structured, almost like an OSCE, with multiple themed stations. Applicants are scored by a panel of Consultants who can come from all over the region or the country.

Examples of stations are:

  • Portfolio – your portfolio is discussed with the panel. Some specialties now mark the portfolio in a separate room away from the candidate.
  • Clinical – a clinical scenario is given and the applicant is asked a series of questions.
  • Communication – this often involves an actor posing as a patient or patient’s relative.
  • Critical appraisal – a research paper is given with a set of questions to answer.
  • Audit/Quality improvement – the candidate is often asked how they would design one for a given scenario.
  • NHS – hot topics or questions about how the NHS works can be asked.

This Medical Interview book (available on Amazon) discusses in detail how to approach each of the stations listed above. It is a favourite amongst UK graduates and is a definite MUST-READ if you are serious about improving your interview skills the UK way.

The exact format of the interview differs per specialty. Details are released online to enable applicants to prepare in advance so be sure to read those too!

New for 2021 applications

There will be no face-to-face in-person interviews for applications for 2021 due to COVID.

Some specialties will hold online interviews instead while others will base applications on other criteria without an interview.

Be sure to check the exact process for the specialty you aim to apply for. You can find the links for this in our Useful Links page under the section Specialty recruitment (residency applications)

Entrance Exams

Some specialties requires applicants to sit the Multi-Specialty Recruitment Assessment (MSRA). 

These include: 

  • General Practice (family medicine)
  • Anaesthetics
  • Core Psychiatry
  • Emergency Medicine
  • Neurosurgery
  • Ophthalmology
  • Obstetrics and Gynaecology
  • Paediatrics
  • Radiology
  • Community Sexual and Reproductive Healthcare (CSRH)
  • Child and Adolescent Mental Health Services (CAMHS) 

The MSRA is a computer based test with 2 components: professional dilemmas (110 minutes), and clinical problem solving (75 minutes). The higher your score in the MSRA, the high

Do you need to pass any other exams?

For ST1/CT1 level:

MRCS, MRCP or any other college exams are not required to apply for training at ST1/CT1 level, however, passing the first part of these exams attracts points for your application so you may want to consider taking them.

For ST3+ level:

College exams are usually compulsory for applications to this stage of training. The type of exam you need to take depends on the specialty.

Please see these articles to find out which exam you need to take for your specialty:


The timelines for specialty recruitment are very strict and there is no tolerance for late applications. The exact dates are different for each specialty but in general, these are the important dates.

Round 1

This round is for applications to ST1 and CT1 posts, and some ST3 posts.

NovApplications open
Jan-MarInterview season
Feb-MarResults are released
AugJobs start

Round 1 re-advert

Sometimes referred to as Round 2. This is when you can apply for leftover posts from Round 1 – if there are any jobs leftover.

FebApplications open
AprilInterview season
End of AprResults are released
AugJobs start

Round 2

This is the proper Round 2 where applications are open for most ST3 posts.

Jan-FebApplications open
Mar-AprInterview season
AprResults are released
Aug-OctJobs start

Round 2 re-advert

This is when you can apply for leftover ST3 posts from Round 2 but these jobs do not start in August, they usually start in February.

Jul-AugApplications open
Aug-OctInterview season
OctResults are released
FebJob starts

Exact dates for this year

Please see the official website for the up to date timelines. You can find them on our Useful Links page under the section “Specialty recruitment (residency applications)”

Further Information

You will find all the official information about applying to specialty training in the UK through the links on our Useful Links page under the section “Specialty recruitment (residency applications)”

If you can’t find the answer to your query about specialty training, the first thing to do is email the official office. Make sure you check the FAQ pages of these websites first before emailing. All the offices are extremely responsive and their advice supersedes anything written in The Savvy IMG.

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Looking for a step-by-step guide?

Subscribe to the Savvy IMG and grab your FREE 2-year roadmap to UK residency as an IMG.


Looking for a step-by-step guide?

Subscribe to the Savvy IMG and grab your FREE 2-year roadmap to UK residency as an IMG.


68 Responses

  1. Hi both,
    I have a few questions. Sorry about that.

    Firstly, I wondered how you would prove you have 12 months of post-GMC registration experience. Because at the time of application in November/December you may still be working in that post. Let’s say you started working a post in June then you would only have 6 months by the time of application.

    Secondly, there is a difference in start dates between London and the rest of the UK. In order to be eligible for the London intake in October you’d have to start a job by September the year prior the latest, correct? And for the rest of the UK in July at the latest?

    Thirdly, for those 12 months do they need to be in a permanent post or would locum work be acceptable?

    And lastly, in order to get the CREST form signed, do you need a permanent post or is that possible with irregular locum work? Does it really just depend on finding a consultant to sign it off?

    Thank you in advance

    1. Hi Marv!

      1. They just assume you’ll continue working until the start of the training job. If you get accepted but then quit your job and don’t complete 24 months clinical experience, they can withdraw your place in training.
      2. Most training jobs in London and throughout the UK start in the first week of August so it’s best to plan for that.
      3. If by locums you mean irregular shifts, it will probably be difficult to get that accepted. You need 12 months full time equivalent after internship, so unless you can find regular work with locums for 12 months, it may not be accepted. But you don’t need a permanent job either, tbh there aren’t many permanent jobs for juniors. By permanent I mean there’s no end date to the job. Most jobs are just contracts for a set period of time, like 6-12 months. You can use these. Some of these posts are termed “locum” posts but this is different from irregular shifts.
      4. You may be able to get it signed off through locum posts, but you still need to fulfill the requirement of working with the same consultant for the equivalent of 3 months.

      Hope that helps! Definitely download the latest CREST guidance for the most up to date info.

  2. Hi, I am currently a resident in paediatrics for over 1year. But I have attempted and failed plab2 once. Will I be eligible to apply for specialty training in paediatrics in the UK?

    1. Hi Osas, failed attempts of the PLAB exams do not affect your application to specialty training as long as you eventually pass the exams and gain GMC registration.

  3. Hello, Nick. God bless you for this tremendous work you have been doing.My Query: What are the best options available for a Senior General Surgeon in India with 20 years of experience, recently appearing the MRCS, if planning to explore options in UK or Ireland? Can I get an admission into CT3? If not, what are the chances of getting a Non-training job (SHO, etc) and later FRCS – Speciality register – Consultant? I think satisfying the documentations of CSER pathway are too cumbersome and not practical. I will try to consult you on Calendly once I pass both teh MRCS parts, OET and get a GMC regn.

    1. Hi Raju! Great to hear from you. As a very experienced surgeon, you will be penalised in your application to training but it’s still possible to enter successfully. Although I have to say, it’s unlikely that you’ll be satisfied working as a trainee again with long hours and relatively low pay compared to a consultant. You might find it more fulfilling to work as a locum consultant and go through the CESR route over time. But all routes are possible!

      I look forward to speaking with you in the future.

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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.
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