Specialty Training in the UK: Opportunities and Challenge

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

How to understand the specialty training pathway?

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:

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 Overview of specialty or GP training (residency) 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.

Cardio-thoracic surgeryAcute internal medicine
Clinical radiologyAllergy
HistopathologyAudio-vestibular medicine
OB/GYNClinical genetics
OpthalmologyClinical neurophysiology
Oral and maxillo-facial surgeryClinical oncology
PediatricsClinical pharmacology and therapeutics
Emergency medicine
Geriatric medicine
Pediatric surgery
Plastic surgery
Renal medicine

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

Application rounds

Unlike non-training jobs, training jobs can not be applied throughout the year. There are specific time slots in the year where the training jobs will start and also the recruitment process will take place. There is a common misnomer – Round 1 re-advert for CT1/ST1 level doctors are mistakenly called Round 2, where officially Round 2 is the initial round for ST3/4 training level doctors.

The entire process is done via Oriel, where you submit your application, book your interview, and choose your preferences.

For CT1/ST1 training level doctors

Round 1

This encompasses recruitment to all CT1/ST1 specialty training programs, across the UK and some run through specialties at higher entry levels. Posts appointed in this round will normally start in August (next year) and generally no later than December (next year). Adverts will appear in November (current year) for posts commencing in August (next year).

Round 1 re-advert

Where training programs advertised in Round 1 remain vacant, a second round, known as Round 1 re-advert is run to try and fill the remaining posts. Adverts will appear in February (current year) for posts commencing in August (current year).

For ST3/ST4 training level doctors

Round 2

This is the first time that ST3 and ST4 specialties in uncoupled training programs will be advertised. This round may also include ST3 entry level posts in run through specialties. Posts advertised in this round will normally commence between August (current year) and December (current year). Adverts will appear in late January (current year) for posts commencing in August (current year).

Round 2 re-advert

This round encompasses all recruitment for posts starting later than December (current year), but before August (next year). Generally, posts advertised in this round will have a commencement date in February (next year). Not all specialties will advertise in this round. This round includes adverts for posts at all entry levels and is not limited to CT1/ST1 or ST3/ST4 like some of the earlier recruitment rounds.

Eligibility for application in specialty training in the UK

Fitness to practice

  • Are you currently bound over, or do you have any convictions or cautions (including warnings and reprimands) which are not deemed ‘protected’ under the amendment to the Exceptions Order 1975, issued by a Court or Court Martial in the United Kingdom or in any other country?
  • Have you been charged with any offence in the United Kingdom or in any other country that has not yet been disposed of?
  • Are you aware of any current NHS Counter Fraud and Security Management Service (CFSMS) investigation following allegations made against you?
  • Have you been investigated by the Police, NHS CFSMS or any other Investigatory Body resulting in a current conviction or dismissal from your employment or volunteering position?
  • Have you ever been dismissed by reason of misconduct from any employment, volunteering, office or other position previously held by you?
  • Have you ever been disqualified from the practice of a profession or required to practice subject to specified limitations/conditions/warnings following fitness to practice proceedings by a regulatory or licensing body in the United Kingdom or any other country?
  • Are you currently the subject of any investigation or fitness to practice proceeding by any licensing or regulatory body in the United Kingdom or any other country?
  • Are you subject to any other prohibition, limitation, or restriction that means we are unable to consider you for any position for which you are applying?
  • Do you know of any other matters in your background which might cause your reliability or suitability for employment to be called into question?

If your answer is YES to any of the above questions you will need to provide further information regarding the issue/incidents.

Right to work in the UK

From 6 October 2019, all medical practitioners have been added to the Shortage Occupation List in the UK. This means that all medical practitioners are exempt from the Resident Labour Market Test (RLMT) and can apply for any specialty in any recruitment round, subject to eligibility.

Please remember, just because you are ELIGIBLE to apply doesn’t mean you will get into specialty training in the UK. The specialties which are seemed as competitive, they will still remain to be competitive. IMGs has a chance now.

Evidence of Foundation Competence

Certificates of Readiness to Enter Specialty Training (CREST) will be accepted where the assessed post has been wholly undertaken in the 3½ years prior to the commencement of the training post to which the applicant is applying.

CREST can be signed off by your supervising UK consultant while you are doing a non-training job or by your consultant back at home while you worked being a full registered doctor.

CREST form can not be signed off for the duration of your work while you were in house-job/internship. You have to work as a full registered doctor.

Evidence of Core Competence

If you are applying for an ST3/4 level specialty training post directly then acceptable forms of evidence for demonstration of core competence will vary between specialties. Please refer to specialty-specific guidance for further information. Check this article as well- Specialty Training or NHS job after MRCP MRCS.

Person specifications for training jobs

Each specialty (and entry-level for training) has a nationally agreed person specification that lists the required competencies for that specialty. When completing applications, applicants will need to provide evidence of achievement of the specified competences; some will need to be demonstrated at the time of application, others by the commencement of post.

Please look here for all the person specifications for all the specialties.

Which specialty training in the UK are ‘IMG Friendly’?

With the advent of all medical practitioners being on the shortage occupation list – anyone can apply in the initial round of training in any specialties. But as mentioned earlier, just because you can apply that doesn’t mean you will get into training. You still have to be:

  • Eligible to apply for that training post according to the person specifications laid out for that.
  • Get long-listed and go through the recruitment process (if MSRA is required for your specialty, then passing that)
  • Get shortlisted and called for the interview
  • Be successful in the specialty training interview.

Also, you need knowledge of how competitive one specialty is compared to another in order to predict how solid your application should be. Let’s have a look at the filled rates of different CT1/ST1 specialties:

Source: ORIEL

These are the fill up rates after both round 1 and the round 1 re-advert (also known as round 1A) for the years of 2018, 2019, and 2020. There is no distinction or restriction based on your application if you do not hold British citizenship. The Resident Labor Market Test (RLMT) has been lifted, and doctors are now listed as shortage occupancy, meaning that there is an equal footing for all specialties.

That’s why, in our opinion, the term ‘IMG friendly’ should not exist as there is no barrier if you are an IMG.

You can apply in as many ST1/CT1 or ST3/ST4 posts if you are found to be eligible to apply, and unlike matching in the US, the application for training (residency) doesn’t cost you anything. When you get the results of your application, if you get selected for multiple specialties (ex: GP and also IMT), then you have to choose one and let the other go. That vacancy in training will be either re-advertised in the next round or filled with a non-trainee for a fixed period of time.

Specialty training in the UK competition ratios

The previous table showed the number of posts that were ACCEPTED already after the initial round. The following table is showing the APPLICATIONS vs the number of posts available.

You can APPLY in as many specialties as you want if you are eligible, but you will be accepting only one. By looking at the competition ratios you can estimate what’s the actual load on the specific specialties are.

For example, a specialty with 40 posts had 50 applications where another specialty with 40 posts had 500 applications. So you know which one will eventually have a higher acceptance rate by the candidates and lower re-adverts – thus very competitive.

See here: Competition ratios by HEE.

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.

Frequently asked questions

Please check the FAQs in the Overview of Specialty Training in the UK article.

Good luck!