Specialty Training Competition Ratios 2018


Before making the decision of starting your road to the UK, fair knowledge about the scope in your chosen specialty MUST be obtained in order to allow for better planning and preparation. And that’s why, every year, the Health Education of England publishes competition ratios to give us an idea of what we can expect.

How to make sense of it?

The first thing you need to understand is if your specialty is run-through or uncoupled. Now what does that mean?

If it’s run-through:

  • The training starts at ST1. Core training is not separate from the specialty training.
  • You can gain entry from ST1-ST4 level depending on your experience, competencies, and their vacancies.

If it’s uncoupled:

  • Core training is separate from specialty training.
  • Either you’ll have to finish core training in the UK or have your core competencies signed before you can apply at ST3 level where this specialty training starts.

Remember that some specialties need the MSRA exam before you can apply, while others are content with just conducting interviews.

More information regarding the MSRA exam and which specialties require it can be found at our post on Specialty Training in the UK.

Which specialties are run-through? Which specialties are uncoupled?

Now we know what must be running through your mind: which specialties are run-through and which are uncoupled? Good question. Let’s break it down.

Run-throughUncoupled
Cardio-thoracic surgeryAcute internal medicine
Clinical radiologyAllergy
GPAnesthetics
HistopathologyAudio-vestibular medicine
NeurosurgeryCardiology
OB/GYNClinical genetics
OpthalmologyClinical neurophysiology
Oral and maxillo-facial surgeryClinical oncology
PediatricsClinical pharmacology and therapeutics
Dermatology
Emergency medicine
Gastroenterology
Geriatric medicine
Hematology
Neurology
Pediatric surgery
Otolaryngology
Plastic surgery
Renal medicine
Rheumatology
Urology

This list is not exhaustive, we’ve just made mention of certain specialties that are most often sought after and asked about.

Competition ratios 2018

Source: Competition ratios 2018 by HEE.


So, how is it for IMGs?

It’s not as plain and simple as we’d like it to be unfortunately, but don’t despair! For an IMG, there may be an extra step or hoop to jump through in regards to waiting for Round 2 in order to apply (unless you have a settled visa), but that doesn’t mean you will never be able to apply for the specialty of your choice. 

If you are passionate about wanting to pursue a certain post, by waiting 5 years (and working as a non-training doctor during this time) until you obtain your ILR, you can then apply in Round 1, thereby heightening your chances of securing a spot in your chosen training.

What is ‘ST3 Clearing’?

Not always you will have to wait to be settled to apply for round 1 at ST3 level in some specialties. As the main ST3 recruitment round 1 draws to a close a period of national ‘clearing’ will be introduced only for specialties using the cascadable application model:

  • Acute internal medicine
  • Cardiology
  • Endocrinology and diabetes,
  • Geriatric medicine and
  • Renal medicine.

If you are subject to Resident labor market test (RLMT),  you will be considered after all other eligible candidates, in round 1.

Source: ST3 Clearing

Specialty training interview

As mentioned earlier, some of these posts will require you to prepare for and appear in a competitive interview. The book of choice in order to excel and ensure a spot in your desired specialty is
Medical Interviews: A Comprehensive Guide to CT, ST & Registrar Interview Skills.


We hope that you’ve formed an idea of what you need to work towards in order to secure your future in your specialty of choice. As always, if you have any questions or concerns, feel free to ask. Good luck!

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