On successful completion of the foundation programme, doctors continue training in either a specialist area of medicine or in general practice. There are around 60 different specialties to choose from and the area of medicine doctors choose will determine the length of training required before becoming a fully qualified doctor.
Those doctors that undertake specialty training programmes are known as specialty trainees and those that undertake general practice training are known as GP specialty trainees or more commonly, GP trainees. You may also hear the older terms for these terms, registrar or specialty registrars.
Specialty training can be delivered through
- Run-through training programmes, lasting from approximately three years for general practice to five to seven years in other specialties. These programmes will initially give trainees a broad overview of the specialty, and become more specialised over time.
- Core and higher specialty training programmes (also referred to as 'uncoupled' due to the break between early and later training). In these programmes, trainees undertake core training which lasts two to three years, depending on the specialty. This is followed by an open competition to enter a higher specialty training post. It is important to note that the application following core training is competitive and does not guarantee a specialty training post.
- Acute Care Common Stem (ACCS) is a three year training programme that normally follows F2. It is the only core training programme for trainees wishing to enter higher specialty training in Emergency Medicine (EM), and is an alternative core training programme for trainees wishing to enter higher specialty training in General Internal Medicine (GIM), Acute Internal Medicine (AIM) or Anaesthesia. The first two years are spent rotating through EM, GIM, Anaesthetics, and Intensive Care Medicine (ICM). The third year is spent providing training that will ensure the trainee meets the minimum requirements for entry into higher specialty training in their parent specialty. The components of training in ACCS are:
- one year emergency medicine and general internal medicine: acute (usually six months each)
- one year anaesthesia intensive care (minimum of three months in each)
- one further year within chosen parent speciality
For more information on specialty training, please see Health Education England's guidance on Specialty Training. On successful completion of a run-through or higher specialty training programme, doctors are awarded a Certificate of Completion of Training (CCT) which allows them entry onto the GMC specialist or general practice register.
In addition there are also stand-alone but educationally equivalent training posts which are not part of run-through training programmes. As these are educationally approved posts, they may contribute to a CCT. These posts include Fixed-Term Specialty Training Appointments (FTSTAs) and Locum Appointments for Training (LAT).
There are also career options for doctors who choose not to become consultants, or are unable to do so, for instance because their qualifications, training, skills and experience may not be recognised under the UK specialty training system. The umbrella term for this group of doctors is staff, specialty and associate specialist grade (SAS grade) but the only future option will be to enter the new specialty doctor grade.
Entry criteria for the specialty doctor grade requires doctors to have undertaken at least four years full-time postgraduate training (or its equivalent gained on a part-time or flexible basis) at least two of which will be in a specialty training programme in a relevant specialty or as a fixed-term specialty trainee in a relevant specialty.
Doctors who have not completed an approved UK training programme for entry to either the specialist or GP register can have their training and experience assessed to see whether or not it is deemed equivalent for entry.
Entry to the specialist register is dependent on the award of a Certificate of Eligibility for Specialist Registration (CESR). Similarly, for the General Practice Register this is dependent on the award of a Certificate of Eligibility for General Practice Registration (CEGPR).