Junior doctor and registrar training in the UK

Junior doctor and registrar training in the UK

In this article we will describe junior doctor and registrar (the following period) training in the UK.

We will give the typical ages and (minimum) stages of an NHS hospital doctor’s training and career.

It starts with medical school. But the length of medical school training varies – from 4 to 6 years. Most are 5 years. But postgraduate courses are usually four years, and Oxford/Cambridge have six-year courses.

Here is a timeline for training as a (typical) NHS doctor:

Year 1.   Medical Student (Age 18 years) – training starts
Year 2.   Medical Student
Year 3.   Medical Student
Year 4.   Medical Student
Year 5.   Medical Student, qualifying as a doctor
Year 6.   Foundation Year 1 (F1). Previous term = ‘House officer’, HO (or Junior House Officer, ‘JHO’)
Year 7.   Foundation Year 2 (F2)
Year 8.   Core or Specialty Trainee (CT1/ST1). If medical (not surgical), also called an ‘IMT’. Previous term = ‘SHO’ (Senior House Officer)
Year 9.   Core or Specialty Trainee (CT2/ST2) – SHO
Year 10. Core or Specialty Trainee (CT3/ST3) –  ‘Registrar‘. Previous term ‘SpR’ (Specialist Registrar) and before that ‘SR’ (Senior Registrar)
Year 11.  Specialty Trainee (ST4) – Registrar
Year 12.  Specialty Trainee (ST5) – Registrar
Year 13.  Specialty Trainee (ST6) – Registrar
Year 14.  Specialty Trainee (ST7) – Registrar
Year 15.  Specialty Trainee (ST8) – Registrar
Year 16.  Consultant (Age 34 years) – training complete.

For different types of doctors, the training is slightly different. For example, a GP does a 3 year GP training scheme in years 8-10, and then can work independently (see below).

So tell me some more about training an NHS doctor

1. A level grades. The grades required for undergraduate medical school courses are very high now (‘AAA’ at least). You’ll also need to do an entrance exam which, depending on the medical school would be the UCAT, BMAT or GAMSAT, as well as an interview (“Yes it’s very tough… but you can do it!” Ed). But postgraduate medical school courses often require a lower level of entry (say a 2.1 degree). Some of those schools require a science degree, others any degree.
   2. Age of starting training. Not all students start aged 18 years (i.e. straight after A levels). There are many postgraduate courses, where medical training starts at any age (19-40+ years). Most will have one or more previous degrees. Also many undergraduates take gap year(s) now. However you start, the length of subsequent training is the same.
   3. Registration. After F1, the trainee becomes a fully ‘registered doctor’ in the NHS by the General Medical Council (doctors regulator), and can leave training and work independently. This requirement stems from the Medical Act 1950 which first introduced a compulsory year of training for doctors after their university qualification. Before that it was possible to qualify as a doctor and start working independently the next day.
   4. Extra Years. Many trainees elect to do 2-5 extra years, e.g. research, teaching or clinical skills (certain specialties may wish to gain more experience in certain operations, or procedures). These extra years usually start after F2
   5. ‘Senior Registrar’. There was previously a more senior registrar grade called Senior Registrar (or ‘SR’) which was a 4 year post (usually in one hospital) that started at around Year 12-13. They acted as a junior consultant and led the day-to-day running of the ward and team of more junior doctors. This was changed after the Calman Reforms of 1993, when registrar training was shortened to four years (i.e. the previous registrar period was about six years). After that the registrar grade was called Specialty Registrar (‘SpR’) before the current term of ‘ST’.
   6. Certificate of Eligibility for Specialist Registration (CESR). The Calman Reforms also introduced explicit curricula leading to a ‘Certificate of Completion of Specialist Training’ (CCST) that has to be achieved before applying for a consultant post. This is now called a Certificate of Eligibility for Specialist Registration (CESR). To gain that registration (and be allowed to become a consultant), the doctor must pass a postgraduate degree. This is usually comprised of exams in three parts, taken from Year 8 to 14. After passing the degree (and gaining a CESR), they are a qualified specialist in their chosen area, and are placed on the GMC’s ‘Specialist Register’.
   7. General Practice – is different. They are able to start working as an independent GP at Year 11. This is after a 3 year GP training scheme in years 8-10. And they also need to pass a postgraduate degree (in GP), and on completion, gain the GMC’s Certificate of Eligibility for General Practice Registration (CEGPR), and be placed on a the GMC’s ‘General Practice Register’.
   8. Rotation of doctors. Doctors in the first five years after medical school, rotate roles (and wards) every 4 months (previously every 6 months) – starting in August, December and April (previously August and February). This change used to be called the start of a new ‘house’. That stems from a time when most junior doctors lived in hospital accommodation (which was free and a perk of the job). That place, and their hospital where they worked, felt like a ‘house’, and was their home. This is why you may still occasionally hear the term ‘house officer’ or ‘senior house officer’.

Summary

We have described junior doctor and registrar training in the UK. It seems a long training, but goes by quite quickly. This long is needed to ‘get there’. But even when you ‘are there’, the learning continues. Most doctors peak aged 45-60 years. Many, especially physicians, can go on to their late 60s, even 70s. Yes you can!

Other resource

This is a good account from someone in the current system.

This article was reviewed by Lizzy Shirazu, Medical Student