Doctors' training and qualifications


Updated June 2008 Undergraduate and foundation training
  • Medical school
Entrance to medical school is very competitive. Applicants require high grades at A level (or equivalent) and evidence of commitment, such as work experience or voluntary work. Medical schools will have their own admission criteria, and must satisfy themselves that each entrant has the academic attainment and abilities necessary to benefit from the course.

Information about the courses offered by medical schools and about entry requirements is available on the Medical Schools Council website.

The General Medical Council (GMC) oversees the core medical curriculum at undergraduate level. Although this curriculum must be covered in all medical courses, there is some flexibility as to how medical schools organise undergraduate medical education.

The GMC sets out the standards of knowledge, skills, attitudes and behaviours that medical students should acquire at UK medical schools in their 2003 document Tomorrow’s Doctors (Ref 1).

On successful completion of the undergraduate course, which normally lasts five years (there are also now some four-year medical degree courses for graduates), doctors receive their primary medical qualification – typically denoted in the UK by one of the following abbreviations: MBBS, MBChB, BM, MB BCh.

For more detailed information about entry to medical school and undergraduate medical education, the BMA's guide Becoming a Doctor (Ref 2) is a useful resource which aims to address the most commonly asked questions about medical careers. Members of the BMA medical students committee have also written the Insiders Guide to UK Medical Schools(Ref 3) which includes information on all the UK’s medical schools and life as a medical student.
  • The Foundation Programme (after graduation)
The vast majority of medical graduates undertake postgraduate training, carried out in salaried employment within the NHS.

Trainee doctors are now required to complete a two-year Foundation Programme in an NHS hospital. Foundation Year 1 (F1) is equivalent to the old pre-registration house officer (PRHO) year, and Foundation Year 2 (F2) is equivalent to the first year as a senior house officer (SHO).

Learning objectives for F1 are set by the General Medical Council, and doctors are expected to achieve specific competences by the end of this year in order to attain full GMC registration. The GMC has published guidance on F1 training entitled The New Doctor comprising two sections:
  • Outcomes for the first year that doctors must demonstrate before they can move from provisional to full registration.
  • Standards for training for the Foundation Programme that those responsible for delivering Foundation training must meet.
The second year of the Foundation Programme focuses mainly on training in the assessment and management of the acutely ill patient. Training also emphasises professional skills applicable to all areas of medicine - team work, time management, communication and IT skills.

The Foundation Programme was introduced under the Modernising Medical Careers (MMC) initiative within the NHS, in order to reform postgraduate medical training and act as a bridge between medical school and specialist or general practice training.

The Programme provides all trainee doctors with experience in a series of placements in a variety of specialties and healthcare settings.

Specialist training
From 1 August 2007, doctors who have already been through their PRHO year and their first year as an SHO (now renamed Foundation Years 1 and 2) generally go straight into specialist training, where a training place is available.

Structured specialist programmes now begin directly after Foundation training, with a competitive entry process to these training grades. Doctors in training are now called Specialty Registrars (StRs), replacing the former title Specialist Registrar.

The Postgraduate Medical Education and Training Board (PMETB) is the authority responsible for all postgraduate medical training in the UK, including for general practice. PMETB's responsibilities include setting up standards and requirements for postgraduate medical education and training, and ensuring that these standards and requirements are met.

The PMETB quality assures and evaluates the management of postgraduate training, as delivered by Postgraduate Deans and Medical Royal Colleges and Faculties. The Postgraduate Deaneries (or equivalents) in the UK are responsible for implementing specialty training in accordance with PMETB approved specialty curricula.

The PMETB website contains a list of all the different medical specialties (and sub-specialties) it recognises, with links to the curricula that doctors must cover in order to become specialists in the different disciplines.

There is also further information on Speciality Training on the Modernising Medical Careers website, including the Guide to Postgraduate Specialty Training in the UK, published in June 2007 by the Department of Health, NHS Scotland, NHS Wales and the Department of Health, Social Services and Public Safety in Northern Ireland.

This guide, known as the “Gold Guide”, sets out the arrangements for the introduction of competence-based specialty training in the UK, (Ref 4).

Once a doctor has attained the necessary skills and competencies, they will be awarded a Certificate for the Completion of Training (CCT), allowing the doctor to be listed as a specialist on the GMC's Specialist Register. This can take up to seven years following completion of Foundation Training.

For those who are already medically qualified there are several routes of entry to these registers which are held by the GMC. PMETB can approve doctors through the following routes.

Certificate of Completion of Training (CCT); this confirms satisfactory completion of a full PMETB-approved training programme and makes a doctor eligible for inclusion on the GMC’s Specialist or GP Registers.

Certificate of Eligibility; this is awarded to doctors who have not followed a traditional, PMETB-approved training programme, but whose training, qualifications and experience may be at the same level as CCT holders. A doctor can apply for a Certificate of Eligibility under various articles of the General and Specialist Medical Practice Order:
  • Article 14 of the Order covers those wishing to join the Specialist Register who will apply through it for a Certificate confirming Eligibility to the Specialist Register (CESR)
  • Article 11 of the Order covers those wishing to join the GP Register by applying for a Certificate confirming Eligibility to the GP Register (CEGPR).
The CCT, CESR and CEGPR all confer eligibility for entry to the Specialist and General Practice Registers (see more about GP training below).

On the GMC's website there is a List of Registered Medical Practitioners. By clicking on the GMC reference number provided for a named doctor, one can then see whether a particular doctor is on the Specialist Register.

General Practitioner (GP) training and GPs with Special Interests
  • GP Training
Postgraduate training to become a GP comprises the two-year Foundation Programme and at least three years' further training in posts approved by PMETB, including 12-18 months' vocational training as a GP Registrar, based in an approved training practice under the supervision of a GP trainer.

Detailed information about the training involved in becoming a GP is available on the Royal College of General Practitioners (RCGP) website, as well as information on the new curriculum for general practice training which came into force in August 2007.

PMETB is the body responsible for awarding the Certificate of Completion of Training (CCT) to general practitioners once they have completed the appropriate training.

In 2006, the General Medical Council (GMC) introduced a new Register of GPs, for doctors who have been awarded their CCT (or a Certificate of Equivalent Experience - largely applying to doctors who have completed some or all of their GP training abroad).

All doctors working in general practice in the NHS, other than GPs in training, have to be on the new GP Register. The GMC website contains further information on the GP Register.
  • GPs with Special Interests (GPwSIs)
The White Paper, Our Health, Our Care, Our Say, (Ref 5) outlined the future of care outside hospitals in England, with more patient-centred care, provided by healthcare professionals working in community settings.

The policy aimed to make specialist services more accessible and to minimise waits and delay, especially for diagnostics and outpatient care. It was anticipated that these extended services could be delivered closer to people's homes through Practitioners with Special interests (PwSIs).

Many GPs are now choosing to specialise in a particular clinical area, in addition to family medicine, and to perform procedures that were traditionally undertaken in the acute, or hospital sector, such as minor surgery.

General Practitioners with Specialist Interests, or GPwSIs, can take referrals from other local GPs to carry out clinical services beyond the scope of traditional general practice. Most will continue to be practising GPs, and will only perform GPwSI duties for a limited number of time slots (or sessions) per week. GPwSIs offer specialist treatment in the community for patients, especially those with chronic and long-term conditions, who might otherwise need to visit hospital regularly.

GPwSIs are appointed and paid for by Primary Care Trusts (PCTs) based on local need in a clinical area, such as in geriatric health or musculoskeletal conditions. GPwSIs undertake additional training to develop their expertise, and many will have a postgraduate qualification in their chosen specialist area.

They are not an alternative to hospital consultants and operate within clear lines of competence they must not exceed.

The Royal College of General Practitioners has worked with the Department of Health (DH) to develop standards for GPs with Special Interests (GPwSI), in a whole range of clinical areas including coronary heart disease, dermatology, diabetes, ENT problems, epilepsy and respiratory medicine.

Staff and Associate Specialist (SAS) doctors
In addition to doctors holding consultant posts within NHS hospitals, there are around 12,500 Staff and Associate Specialist (SAS) doctors in the NHS, some trained overseas. They are fully qualified, but are not working at the consultant level; they are in NHS posts which do not require them to be on the specialist register.

Formerly called non-consultant career grade doctors, doctors in the SAS group are working at senior career-grade level in hospital and community specialties. As well as staff and associate specialist grades, this group of doctors comprises clinical assistants, hospital practitioners and other non-standard, non-training "trust" grades.

Further information on the role of SAS doctors in the NHS can be found on the BMA website.

Changes being introduced by PMETB mean that SAS doctors will be able to apply for entry to the Specialist Register (and hence have the right to take up NHS consultant posts), providing that their qualifications and experience are judged to be equivalent to that of other consultants.

Continuing Medical Education and Continuing Professional Development
The information below is taken from the BMA's Medical Education A-Z.
  • Continuing medical education (CME)
Continuing medical education (CME) is a formal scheme operated by the medical royal colleges in the UK. The purpose is to keep doctors up to date with their medical knowledge, including new diseases and treatment methods.

Through CME, doctors are able to attend conferences and courses to update their knowledge and skills throughout all stages of their careers (Ref 6). In recognition of this continuing education, doctors are awarded accreditation points towards the CPD schemes of the medical Royal Colleges.

All doctors who attend CME events are expected to maintain a record of their activities, including the accreditation points they have been awarded.
  • Continuing professional development (CPD)
Continuing professional development (CPD), is a process of lifelong learning for doctors, which enables them to meet the needs of patients by delivering high quality healthcare - as well as maintaining, expanding and fulfilling their own potential.

In its publication Tomorrow’s Doctors, the General Medical Council recommends that undergraduate curricula should develop the knowledge and understanding, attitudes and skills that will promote effective lifelong learning and professional development throughout a doctor's career.

CPD aims to ensure that doctors develop by identifying what their learning needs are are then finding a way to meet these needs. Strategies can include reflective practice, audit, portfolio development and multidisciplinary cooperation (Ref 7).

Evidence of CPD may form the basis for the regular revalidation (re-licensing) of doctors that is planned in the future.

The GMC has published guidance for doctors on CPD (Ref 8), setting out the principles on which continuous professional development should be based, and the roles of the relevant organisations involved in its delivery.

Common abbreviations of medical qualifications
Systems of medical education in the Republic of Ireland, Australia and New Zealand are similar in structure to those of the UK. It is common for UK doctors to undertake part of their training overseas, or for doctors from those countries to work in the UK, so common qualifications from these countries have also been included.

BC, BCh Bachelor of Surgery

BChir Bachelor of Surgery

BDA British Dental Association

BM Bachelor of Medicine

BMedSci Bachelor of Medical Sciences

BPharm Bachelor of Pharmacy

BS Bachelor of Surgery

BSc Bachelor of Science

ChB Bachelor of Surgery

CPH Certificate in Public Health

DA Diploma in Anaesthetics

DAvMed Diploma in Aviation Medicine

DCh Doctor of Surgery

DCH Diploma in Child Health

DCP Diploma in Clinical Pathology

DCPath Diploma College of Pathologists

DDS Doctor of Dental Surgery

DFHom Diploma Faculty of Homoeopathy

DFM Diploma in Forensic Medicine

DGM Diploma in Geriatric Medicine

DGO Diploma in Gynaecology and Obstetrics

Dip GU Med Diploma in Genitourinary Medicine

DMR Diploma in Medical Radiology

DO Diploma in Ophthalmology

DObst Diploma in Obstetrics

DPath Diploma in Pathology

DPhil Doctor of Philosophy

DPhysMed Diploma in Physical Medicine

DPH Diploma in Public Health

DPM Diploma in Psychological Medicine

DR Diploma in Radiology

DRACOG Diploma Royal Australian College of Obstetricians and Gynaecologists

DRACR Diploma Royal Australasian College of Radiologists

DRCOG Diploma Royal College of Obstetricians and Gynaecologists

DRCPath Diploma Royal College of Pathologists

DS Doctor of Surgery

F1 Foundation Year 1

F2 Foundation Year 2

FFA Fellow Faculty of Anaesthetists

FFCM Fellow Faculty of Community Medicine

FFFP Fellow of the Faculty of Family Planning

FFHom Fellow Faculty of Homoeopathy

FFPath Fellow Faculty of Pathology

FFPHM Fellow Faculty of Public Health Medicine

FFR Fellow Faculty of Radiologists

FRACGP Fellow Royal Australian College of General Practitioners

FRACO Fellow Royal Australasian College of Ophthalmologists

FRACOG Fellow Royal Australian College of Obstetricians and Gynaecologists

FRACP Fellow Royal Australasian College of Physicians

FRACR Fellow Royal Australasian College of Radiologists

FRACS Fellow Royal Australasian College of Surgeons

FRANZCP Fellow Royal Australian & New Zealand College of Psychiatrists

FRCA Fellow Royal College of Anaesthetists

FRCGP Fellow Royal College of General Practitioners

FRCOG Fellow Royal College of Obstetricians and Gynaecologists

FRCOphth Fellow College of Ophthalmology

FRCPA Fellow Royal College of Pathologists of Australia

FRCPath Fellow Royal College of Pathologists

FRCPI Fellow Royal College of Physicians of Ireland

FRCPS Fellow Royal College of Physicians & Surgeons

FRCPsych Fellow Royal College of Psychiatrists

FRCR Fellow Royal College of Radiologists

FRCS Fellow Royal College of Surgeons

FRCSI Fellow Royal College of Surgeons of Ireland

FRS Fellow of the Royal Society

FRSH Fellow Royal Society of Health

GP General Practitioner

Honorary e.g. honorary consultant cardiologist – consultant with academic/research responsibilities

LCPS Licentiate College of Physicians & Surgeons

LLB Bachelor of Laws

LMS Licentiate of Medicine & Surgery

LMSSA Licentiate in Medicine & Surgery – Society of Apothecaries London

LRCP Licentiate Royal College of Physicians

LRCPI Licentiate Royal College of Physicians of Ireland

LRCPS Licentiate Royal College of Physicians & Surgeons

LRCS Licentiate Royal College of Surgeons

LRCSI Licentiate Royal College of Surgeons of Ireland

LSA Licentiate Society of Apothecaries London

MA Master of Arts

MACGP Member of the Australasian College of General Practitioners

MACO Member Australian College of Ophthalmologists

MBA Master of Business Administration

MBAcA Member British Acupuncture Association

MBBCh Bachelor of Medicine and Bachelor of Surgery

MBBS Bachelor of Medicine and Bachelor of Surgery

MBChB Bachelor of Medicine and Bachelor of Surgery

MCh Master of Surgery

MChir Master of Surgery

MChOrth Master of Orthopaedic Surgery

MClinPscychol Master of Clinical Psychology

MD Doctor of Medicine

MFFP Member Faculty of Family Planning

MFHom Member Faculty of Homoeopathy

MFOM Member Faculty of Occupational Medicine

MFPHM Member Faculty of Public Health Medicine

MMed Master of Medicine

MMedSc Master of Medical Science

MPhil Master of Philosophy

MRACP Member Royal Australasian College of Physicians

MRCGP Member Royal College of General Practitioners

MRCOG Member Royal College of Obstetricians and Gynaecologists

MRCP Member Royal College of Physicians

MRCPath Member Royal College of Pathologists

MRCPI Member Royal College of Physicians of Ireland

MRCPsych Member Royal College of Psychiatrists

MRCS Member Royal College of Surgeons

MRNZCGP Member Royal New Zealand College of General Practitioners

MS Master of Surgery

MSc Master of Science

PRHO Pre-Registration House Officer (now replaced by Foundation Year 1)

PhD Doctor of Philosophy

SAS Staff and Associate Specialist

StR Specialty Registrar

References
  1. Science and Education Board. Becoming a doctor: Entry in 2008 8th revision. London BMA 2007; http://www.bma.org.uk/ap.nsf/Content/becomingadoctor2008\
  2. GMC. Tomorrows Doctors. London GMC 2003; http://www.gmc-uk.org/education/undergraduate/undergraduate_policy/tomorrows_doctors.asp
  3. Girgis S; Bisset L; Burke D (Eds). The Insiders' Guide to UK Medical Schools 2007/2008 9th Edition. London Blackwell BMJ Books 2008. Further details;http://www.blackwellpublishing.com/book.asp?ref=9781405157483&site=1
  4. Modernising Medical Careers. Guide to Postgraduate Specialty Training in the UK (the Gold Guide) London. 2007; http://www.mmc.nhs.uk/Docs/A%20Guide%20to%20Postgraduate%20Specialty%20Training%20in%20the%20UK%20(Gold%20Guide).doc
  5. Department of Health. Our Health, Our Care, Our Say: a new direction for community services. Norwich 2006; http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4127453
  6. Charlton R (2001) Continuing professional development (CPD) and training. BMJ 323: 2 2-3
  7. Royal College of Physicians
  8. GMC. Continuing Professional Development. London GMC 2004; http://www.gmc-uk.org/education/continuing_professional_development/cpd_guidance.asp

    © British Medical Association 2008

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