Specialty (or GP) Training (Residency) in the UK

Postgraduate and specialty or GP training is the most important and penultimate step of a doctor in their career. It’s every doctor’s dream to be trained in some specific specialty, maybe in some specific region too. Life starts to get complicated with responsibilities and priorities regarding family and all when you reach that age and that’s how a lot other factors start influencing the career choice too. That’s why I would suggest to gather as much info as you can before you reach that point.

Where is the start of the training as doctor in the UK?

A doctor’s training in the UK is separated roughly in three levels.

  1. Foundation training
  2. Core Training
  3. Specialty training

So, a UK medical graduate starts from the 2 years foundation training. Upon finishing that, they apply and get into a 2/3 years core training in a desired specialty. After that, they again apply and get into 4/5 years of specialty training (sub specialty included).

But an IMG’s route of entry may differ in each individual case. The different levels which an International Medical Graduate can get into is discussed here, Postgraduation Pathways in the UK.

Please refer to the diagram below to have an idea too.

UK career pathway

Click here to see HD

What is a non-training job?

The Local Education and Training Boards (LETBs) can only accommodate specific number of trainees round the year, but the trusts/hospitals need more doctors. That’s why there are jobs for doctors which are termed as non-training. These jobs will give you work experience, but not count towards any formal training.

These are the kind of jobs an IMG generally ends up taking as their first job. And these non-training jobs also run along with the trainee level, e.g. FY2 level non-training, CT level non-training. The responsibilities are quite the same as a trainee, but trainees have a curriculum to go through, whereas non-training are basically doing a service job.

During these non-training jobs you can get your required competencies signed and thus apply for training when the application rounds open.

Levels of Doctors in the NHS

Before commencing the discussion of the complete training structure let’s talk about some terminology. The levels of doctors have shortened form.

  • Foundation year = FY1/F1 or FY2/F2
  • Core Training = CT (Number is added depending which year of the training. e.g. A second year core trainee is CT2)
  • Specialty Training = ST (Number is added depending which year of the training. e.g. A fourth year trainee is ST4)

Now these are trainee levels. How the non-trainee are termed?

All the non-trainee posts are now advertised with their corresponding trainee level so that it’s easier to understand the job description and the modernised level. Still some terminologies for junior doctors are:

  • SHO (Senior House Officer) [FY2 or CT1 level]
  • Trust Grade doctor [FY2 or CT1 level]
  • Junior clinical fellow [FY2 or CT1 level]

And some terminologies for higher grade doctors are:

  • Specialty Registrar [ST3 or up]
  • Senior clinical fellow [ST3 or up]

There is another higher group of non training doctors, they are termed SAS (Specialty and Associate Specialist) doctors. These are non-training roles where the doctor has at least four years of postgraduate training, two of those being in a relevant specialty.

SAS doctors are usually more focused on meeting NHS service requirements, compared to trainee or consultant roles.

My take on the terminologies is to understand the modernized levels first and then ask whatever level the job is.

Training in Medical & Surgical Specialties

Foundation training

The 2 years foundation training by UKFPO is the “internship” equivalent in the UK. If an IMG has completed an acceptable pattern of internship as discussed here, Internship and UKFPO, they don’t need foundation training by UKFPO. Still, you can apply for standalone F1/F2 LAT post, which will make your transition into further training easier.


LAT stands for “Locum Appointment for Training“. LAS is “Locum Appointment for Service“. By definition, “locum” means a person who stands in temporarily for someone else of the same profession.

Someone may have dropped out of their training, LAT fills that. Hospitals need to fill up some gaps temporarily, LAS fills that. So, an LAT job is a training job, but temporary. On the other hand, LAS is a non-training job and also fixed contract i.e. temporary.

During these non-training jobs you can get your required competencies signed and thus apply for training when the application rounds open.

Core Training

This is the start of specialty training after successful completion of the foundation training. Whether or not your core training will be continuous with your specialty training, it depends on the specialty you are going to pursue. There are two types of specialties:

  • Run-through
  • Uncoupled

Run-through Specialties

Run-through specialties like obstetrics & gynaecology, histopathology, paediatrics, neurosurgery, etc recruits trainees straight into the training (ST1 onwards), and no other recruitment process is involved throughout the training except for getting required competencies at each level of their training and obtaining membership of the related royal college. Some of them can be started from ST3 onwards, depending on required competencies obtained. So, there is no CT1/2 in these run-through specialties, rather ST1/2.

Uncoupled Specialties

Uncoupled specialties go through 2 or 3 years of core training (e.g. Internal Medicine Training, Core Surgical Training, Core Psychiatry Training) first, then upon obtaining core competencies, another competitive recruitment process enrolls you into specialty training (ST3/4 onwards) until completion of training. Membership exams have to be completed before getting into ST3/4. So, practically, there is no ST1/2 in these specialties.

To get into core/specialty training, your PLAB scores mean nothing here. You have to meet the eligibility criteria for CT1 recruitment and then you can apply. Then you will be called for an interview and after getting selected you will commence your training. For run through specialties, you will have to search for specific specialties website.

Alternative pathways to Core Training

There are other alternative pathways to core training like ACCS (for anesthesia, emergency and acute medicine) and Broad Based Training (CMT, GP, Paediatrics, Psychiatry) before getting into ST3/4 onwards.

Specialty Training

This is the final step of the training. As mentioned earlier, the training is separate in case of uncoupled specialties but it’s continuous in run-through specialty.

Getting into training is the same process as before. No exam. To find out the eligibility criteria for application at the level of ST3/4, please have a look here Eligibility for ST3 Recruitment.

After ST5 or somewhere in between (depending on the specialty), Specialty Certificate examinations will be held and upon finishing the rest of the training certificate of completion of training (CCT) can be obtained thus enabling to get entry into the specialist register and work as a consultant.

Sub-specialty Training

Subspecialties are also a part of this section of the training. It can be taken at ST3 level onwards or maybe after ST6 onwards, depends on the specialty. I’m talking about subspecialties like Paediatric oncology/nephrology (Paediatrics), Maternal and fetal medicine (OBGYN), Hepatology (Gastroenterology), Stroke medicine (Cardiology, Acute internal medicine, Neurology).

General Practice (GP) Training

On the other hand, GP has a very different pathway both in terms of length and progression.  As mentioned above like other 7 medical & surgical specialties, GP also has the exam, MSRA, to get into the training.  The recruitment process is outlined below:

  1. Application
  2. Assessment of eligibility (Stage 1)
  3. Long listing
  4. Multi Specialty Recruitment Assessment (MRSA): The MSRA is a computer based assessment which forms the short-listing process (Stage 2). It consists of two papers: a) Clinical Paper, b) Professional dilemma paper (Situational Judgement test).
  5. Offers: Their is a direct pathway to offers if you score ≥575 in MRSA. Otherwise you will have to face an assessment in the selection centre (Stage 3) where the applicants will go through simulated consultations and a written prioritization task.
  6. References
  7. Clearing
  8. Offers of employment and Preemployment checks.

So after foundation training is done/ competencies are obtained, one have to go through this process to get into a 3 years GP Training. Upon successful completion and obtaining MRCGP (UK), they are awarded CCT and thus entry into GP register.

All the related information can be found here, GP Recruitment.

Frequently asked questions

Is there any exam to get into Core/Specialty Training?

Yes and no. When most of the specialties don’t need exams to get into, just application in Oriel (thus being eligible first, according to the criteria set for core/specialty training) then interview and then the whole recruitment process, some medical & surgical specialties DO NEED an exam to get into training. These are:

1. Radiology
2. Ophthalmology
3. Obstetrics and Gynaecology,
4. Psychiatry
5. Neurosurgery
6. Child and Adolescent Mental Health Services (CAMHS) and
7. Community Sexual and Reproductive Healthcare (CSRH)

The exam that is held for these specialties is called Multi-Specialty Recruitment Assessment (MSRA). To know further about this exam, please check this post, The SRA- What to expect & how to prepare.

How can I be [this] specialist in the UK? Can you tell me the training pathway of [this] specialty?

All the curricula and labelled training pathways of all the specialties can be found here, Full list of approved curricula of the Royal Colleges.  You can also see how long your specific specialty training is, what are the steps, like getting a membership or fellowship, you will have to cross and everything else. This list is a GOLD MINE and everyone should find their specialty in this list and have a look at the training pathway.

Cardiology training UK

Am I eligible to apply for [this] training?

They periodically publish person specification for ALL the specialties, Person specifications for specialty training.  

When and how do I apply for training?

All the training posts are advertised in the Oriel website, and it has to applied online. Even the eligibility papers are to be uploaded online via Oriel.

CT1/ST1 training posts can be applied for in two rounds.
Round 1: The application time is in October -November previous year.
Round 2: The application time is in February -March current year.
For both parties, the training starts in August of that year.

ST3 posts also can be applied in two rounds:
Round 1: The application time is in January -February current year.
Round 2: The application time is in July – August current year.
For Round 1 applicants the training may commence staring from August till December current year. For Round 2, from October current year to April next year.

Disclaimer: The dates are subject to change. Always have a look in these websites, CT1 Recruitment & ST3 recruitment. For GP Specialty training timetable and Applicant guidance, please have a look in their website, GP ST1 recruitement.

Can I apply for training right after passing PLAB?

The training is not a race in the UK.  It’s a long winding road which needs planning and acclimatization. So, with zilch NHS experience it is not advised to think or attempt at training.  You are getting paid the same amount in the non-training job, you are doing/learning the same thing as a trainee. So, I would suggest at least work >6 months in the NHS for experience (if you had work experience before), for fresh graduates it should be at least a year, before you try and apply for training when the rounds open.

How difficult it is to get into training of [this] specialty? How many posts are there?

They periodically publish competition ratio of every specialty so that you know how many people are applying against how many posts. Thus you have a rough idea how competitive a specialty training is. Check specialty competition ratios 2018 for further discussion.

Is there any separate statistics for IMG doctors?

No. The above statistics of competition ratio is for both rounds. As an IMG generally can apply only in round 2, acceptance and fill up rate is a good indicator to find out which specialties is easier for IMGs to get into. Here they are,  specialty recruitment acceptance and fill rate. If you see any specialty is filled 100% in round 1, that means there are no posts left for round 2, thus IMGs can’t get into that specialty.

To conclude, a sound idea about what’s ahead is always needed to succeed in life. Training/residency in the UK is longer in comparison to other countries, especially the USA, but the opportunity to hold non-training jobs and less restrictions to apply for training posts (compared to matching in the USA) are plus points for IMGs who make a big transition from their homeland to a foreign land. At the end of the day, it’s you who will choose what’s ideal for you.

Good luck to you all!


Anything you might want to clarify/ask?

This site uses Akismet to reduce spam. Learn how your comment data is processed.