Foundation training represents the last point at which all doctors follow the same curriculum, and it is followed by specialty training – the opportunity for doctors to start carving out their respective niches in the medical profession.
Since the introduction of Modernising Medical Careers (MMC) in 2005, the training structure at this level has undergone a number of changes. In August 2007, the senior house officer (SHO) and specialist registrar (SpR) grades were dissolved, and in their place came the new grade of specialty registrar (StR). This is the grade at which doctors operate throughout their specialty training.
Specialty trainees work towards the certificate of completion of training (CCT), which qualifies them for entry to either the Specialist Register or the GP Register held by the General Medical Council (GMC). Between seven and eight years of specialty training is required to reach consultant level.
Run-through and uncoupled training
Specialty training programmes fall into two different categories: run-through training and uncoupled training. With run-through training, progression is uninterrupted; you start in specialty training year 1 (ST1), and progress through ST2, ST3 etc automatically, provided competency requirements are satisfied. Uncoupled training, however, is split into either two or three years of core training (CT1, CT2 etc), before entering higher specialty training at ST3 level. With this path, entry to ST3 is a competitive process, which involves applying for a post, much as you would at the start of training.
Whether you undertake run-through or uncoupled training depends on your chosen specialty. For example, general practice entails run-through training, whereas anaesthesia follows an uncoupled path. The vast majority of hospital physician specialties are uncoupled, involved core medical training (CMT) or acute care common stem (acute medicine), followed by ST3. For a full breakdown of run-through and uncoupled training permutations, consult the applicant guide on the NHS's specialty training website.
Training bodies
Training programmes are usually delivered by training schools, and the schools are overseen by local deaneries. The deaneries share the ultimate responsibility for training and recruitment at specialty level with the UK’s medical royal colleges. Curricula are set by specialist advisory committees (SACs), which are made up of representatives from colleges, deaneries and specialist societies.
Again, whether your specialty training programme is overseen by a medical royal college or a local deanery depends on which specialty it is. For example, gastroenterology – as with most hospital physician specialties – is overseen by the Royal College of Physicians, whereas rehabilitation medicine is overseen by the Severn deanery. Consult the specialty recruitment profiles on the MMC website for full details of how specialties are allied to colleges or deaneries.
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