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Medical Education in the United Kingdom

Medical education in the United Kingdom
From Wikipedia, the free encyclopedia (December 2009) and The National Health Service site
Medical education in the United Kingdom includes educational activities involved in the education and
training of medical doctors in the United Kingdom, from entry-level training through to continuing
education of qualified specialists. A typical outline of the medical education pathway is presented here.
However training schemes vary and different pathways may be available.
Medical school
Like many other university degrees, UK medical schools design and deliver their own in-house
assessments. This practice is different from, for example, the United States, where a national licensing
examination has been in place for over 20 years. Each UK undergraduate summative assessment in
medicine is subject to the scrutiny of a formally appointed external examiner.
In 2003 a number of UK medical schools began to work together to increase quality assurance activities
in the area of assessment as part of the Universities Medical Assessment Partnership (UMAP). UMAP is a
collaborative item banking project seeking to build a quality assured written assessment item bank
suitable for high-stakes examinations at all UK medical schools.
Quality assurance of undergraduate medical education
The UK General Medical Council (GMC) has the ability to reverse its endorsement of any medical
undergraduate training course as part of its regular visiting schedule should a course fall short of the
high standards expected.
Vocational training
Following completion of medical school, junior doctors then enter a vocational training phase. In the UK
a doctor's training normally follows this path:
Newly qualified doctors enter a two year Foundation Programme, where they undertake terms in a
variety of different specialities. These must include training in General Medicine and General Surgery
but can also include other fields such as Paediatrics, Anaesthetics or General Practice.
Following completion of the Foundation Programme a doctor can choose to specialise in one field. All
routes involve further assessment and examinations.
To train as a general practitioner (GP), after completing the Foundation Programme, a doctor must
complete eighteen months of posts in a variety of hospital specialities - often including paediatrics,
psychiatry, geriatrics and obstetrics & gynaecology. The trainee also has to spend eighteen months as a
General Practice Speciality Registrar - a trainee based in a GP practice. After completing this training and
the relevant exams, the doctor can become a GP and can practise independently.
Hospital doctors are promoted after sitting relevant postgraduate exams within their chosen speciality
(e.g. Member of the Royal College of Physicians MRCP, Member of the Royal College of Surgeons MRCS)
and a competitive interview selection process from SHO to Speciality Registrar (StR) and eventually
Consultant on completion of the CCT (Certificate of Completion of Training), which is the highest level in
a speciality (with the exception of university-linked professors).
The competition is significant for those who wish to attain consultant level and many now complete
higher degrees in research such as a Doctorate of Medicine (MD), which is a thesis-based award based
on at least two years full-time research; or PhD, which involves at least three years of full-time research.
The time taken to get from medical school graduation to becoming a consultant varies from speciality to
speciality but can be anything from 7 to more than 10 years.
In the United Kingdom, doctors' training will rapidly evolve in the next twelve months, with the
introduction of run-through training. A doctor, after completing their two foundation years, will apply
for a single speciality (including general practice) and be trained solely in that speciality for a fixed
period of years (typically seven) before being awarded a CCT. These changes will take place in
accordance with the government-instituted plan for Modernising Medical Careers.
NHS Medical Career Grades
New system (Modernising Medical Careers)
Old system
Pre-registration house officer (PRHO) Year 1:
one year
Foundation Doctor (FY1 and FY2) - 2 years
Year 2:
a minimum of two years, although
Specialty Registrar
Specialty Registrar
Year 3: often more
Year 4:
GP registrar- one
in a hospital speciality: in general practice:
minimum six years
three years
Year 5: registrar
Years 6- four to six years
General practitioner
General practitioner
total time in training:
total time in training:
total time in
4 years
total time in training: 5 years
Year 9: training:
minimum 7-9
minimum 8 years
Training is competency based, times shown are a
Training may be extended by pursuing minimum.
medical research (usually two-three
Training may be extended by obtaining an
Academic Clinical
usually with clinical duties as well
Fellowship for research or by dual certification
in another speciality
Continuing medical education
Continuing medical education is now mandatory for all doctors, under guidelines from the General
Medical Council and Clinical governance
Specialty training
An overview of what postgraduate specialty training involves
Postgraduate medical training in the UK is delivered using an agreed curriculum for each
specialty that sets the standards against which competencies will be assessed. There is a clear
career structure with explicit paths to follow.
Medical Specialty Training
The modern curriculum aims to improve patient care by streamlining postgraduate medical
training and help meet the changing needs of the NHS.
Since August 2007, Senior House Officer (SHO) and Specialist Registrar (SpR) grades have
combined to form the new Specialty Registrar grade (StR). Depending on your chosen specialty,
you will enter either run-through specialty training, beginning directly after your foundation
years, or core training - usually in medicine or surgery - which typically runs for two years, after
which time and subject to satisfactory progress, you will need to apply to continue your specialty
or GP training through higher specialty training programmes.
Specialty training programmes
Specialty and GP training programmes will normally be delivered by training schools overseen
by local postgraduate deans. Most programmes will initially be broad based and become
specialty focused over time. For example, you might start with core medical training, with the
opportunity to explore career choices and receive informed career guidance, and then move on
to, say, cardiology or gastroenterology.
Specialty training programmes vary in length and are tailored to the needs of the specialty. The
medical royal colleges have produced national curricula for each training programme to meet the
standards required by the General Medical Council (GMC), which has taken on the functions
formerly overseen by the Postgraduate Medical Education and Training Board (PMETB). These
curricula will state the competences you'll gain by following the programme, providing explicit
standards and guidance for assessment.
When you have successfully completed your specialty training programme, you'll receive a
Certificate of Completion of Training (CCT) which will make you eligible for entry to the
GMC's Specialist Register or GP Register.
Application and recruitment
You will need to apply for postgraduate medical training programmes in the UK with the
deanery or college overseeing recruitment to your chosen specialty. You will compete for places
on specialty training programmes with other doctors at similar levels of experience and
competence. Career entry points, person specifications and eligibility requirements are updated
and published each year, and the application and selection period normally runs from early
December to March.
Medical careers in the modern NHS
The role of a doctor has developed significantly in recent years. Now you'll find far greater
emphasis on teamwork, alongside other healthcare professionals such as midwives, scientists and
therapists. There is also a move away from hospital based medicine towards increased
opportunities for working in the community, such as through general practice.
When you choose your specialty you'll need to think realistically about your personal aptitude
for the particularly specialty alongside future career prospects. Your first choice of specialty may
not always hold the best prospects for you, bearing in mind how and where you will train,
together with the specific needs of the NHS and the levels of competition to enter the various
New techniques and treatments are making medicine ever-more challenging so the move towards
joint decision-making and improved communication throughout your training programme is vital
for you and for your patients.
Tailored medical specialty training programmes aim to ensure that the standards of postgraduate
medical training are explicit; that doctors in postgraduate medical training reach these standards
and in so doing, meet the expectations of patients and the changing demands of the NHS. You
will be part of a workforce specifically suited to the requirements of the modern health service.
Information for overseas doctors
Structure of medical training in the UK
From 16 November 2009 all doctors must have a licence in order to legally practise medicine and
undertake activities restricted by law to doctors, such as writing prescriptions and signing death
certificates. The licence to practise which is issued by the General Medical Council (GMC), applies to all
doctors in the UK regardless of whether they are working in the NHS or independent sector, either on a
full or part time, permanent or locum basis. It also applies to all levels of registration, whether
provisional, full or on the specialist or general practitioner (GP) register.
All doctors intending to practise medicine in the UK are still required to be registered with the GMC,
follow the GMC’s Good Medical Practice guidance and be subject to the GMC Fitness to Practise actions.
Doctors who hold registration but not a licence are more likely to be working as an academic or outside
the UK, for example, but cannot undertake any of the activities for which the law requires them to hold
a licence to practise.
Please note that doctors who have never been registered with the GMC will have to apply for a licence
to practise. They will not be able to apply for registration without a licence.
The requirements for registration in the UK will depend on a number of factors:
your nationality
the country in which you gained your primary medical qualification
the type of work you want to do
whether or not you have completed a period of post-graduate training or an internship
First you should check that you possess an acceptable primary medical qualification to apply for
registration. If you are in any doubt you should check your qualifications status with the GMC.
In addition, international medical graduates (IMGs) will be required to demonstrate their medical
knowledge and skills, competence of English language, and fitness to practise before they are registered.
NHS Employers has published a helpful guide for IMGs on their website.
Registration with the GMC does not guarantee that you will find employment within the UK.
If you are not a UK/EEA national you will also need to meet the requirements of the UK Border Agency
regulations to gain the right to enter and work in UK.
All UK medical graduates are required to undertake a 2-year Foundation Programme immediately
following graduation. The Foundation Programme forms the bridge between medical school and
specialist/general practice training. Trainees will have the opportunity to gain experience in a series of
placements in a variety of specialties and healthcare settings.
The first year (F1) is the internship year where doctors are required to work under provisional
registration with the GMC.
Once doctors have completed the Foundation Programme, they may apply for a specialty or general
practice training programme.
Further details are available on the Modernising Medical Careers website
Types of Registration
Provisional Registration – Provisional registration (alongside a licence to practise) allows newly qualified
doctors to undertake general clinical training required for full registration. This allows doctors to work
only in Foundation Year 1 posts.
Provisional registration is available to doctors with the following nationality, rights and qualifications:
UK medical graduates who have completed their medical degree at a UK University recognised in the
Medical Act 1983
International medical graduates who have an acceptable primary medical qualification and who have
passed the PLAB test but who have not completed an internship
Nationals from the EEA, Switzerland and other countries with EC rights who qualified outside of the
EEA and Switzerland
Nationals from the EEA, Switzerland and doctors who have EC rights who qualified at EEA or Swiss
medical schools
Doctors who have qualified in an EEA member state can apply to do their practical training
(internship) in the UK if the practical training counts towards a medical degree which requires this for
compliance with Directive 2005/36/EC
Full Registration – Full registration enables doctors to work in any form of professional medical practice
in the UK, provided they hold a licence to practise. Doctors must, however, also hold specialist
registration to take up a consultant post (other than a locum consultant post); and those wishing to
work as GPs must be on the GP register.
Doctors qualifying from outside the UK may be eligible to apply directly for full registration if they hold
an acceptable primary medical qualification and have completed a period of postgraduate clinical
experience (internship).
A doctor will need to provide documentary evidence to support their application. Only original
documents can be accepted. To complete the process all doctors must visit the GMC in person to
undergo a pre-registration identity check. A photograph of the doctor will be taken and this will be
made available to employers so they can be assured of the doctor's identity.
UK graduates and IMGs who are new to full registration and taking up a new job, or restoring their
names to the register after a prolonged absence from practice, are required to work within an approved
practice setting (APS) as assessed by the GMC as suitable for doctors new to full registration. The GMC
recommends that EEA graduates ensure that they also work in an APS when they first take up
employment in the UK under full registration.
The purpose of the APS system is to provide public protection by requiring doctors new, or returning, to
full registration in the UK to work within a system with appropriate supervision and appraisal
arrangements or assessments. Further information on APS can be found on the GMC website.
Specialist registration – All consultants (other than a locum consultant appointment) must be on the
specialist register of the General Medical Council (GMC). To be eligible to apply for specialist registration
with the GMC, doctors must have successfully completed a GMC-approved training programme and
been granted one of the following certificates:
Certificate of Completion of Training (CCT)
Certificate confirming Eligibility for Specialist Registration (CESR)
Doctors who have not completed a full GMC-approved training programme and wish to have their
training, qualifications and experience assessed for eligibility for entry onto the specialist register must
make an application under The General and Specialist Medical Practice Order for a CESR. It is not
possible to hold specialist registration without also holding full registration.
GP Registration – Since 1 April 2006, all doctors working in general practice in the NHS in the UK (other
than doctors in training such as GP registrars) are required to be on the GP Register. This requirement
extends to locums.
If you have not completed the UK GP Certificate of Completion of Training programme you will need to
apply for a Certificate of Eligibility for General Practice Registration (CEGPR), which will then enable you
to be entered on the GP Register.
English Language Proficiency
Non-EEA applicants applying for registration must satisfy the GMC that they have the necessary
knowledge of English. Candidates will be required to prove that they have taken the academic version of
the International English Language Testing System (IELTS) test and achieved minimum scores of 7.0 in
each of the four areas: speaking, listening, reading and writing.
Professional and Linguistic Assessment Board (PLAB)
The GMC uses the PLAB test to ensure that international doctors have the basic medical competence
and communication skills to practise in the UK. Doctors wishing to take the PLAB test must have already
successfully completed the International English Language Testing System (IELTS). Currently the
minimum IELTS scores that are accepted in the academic version are 7.0 in speaking, 6.0 in each of the
other three areas tested (reading, writing and listening), and an overall band score of 7.0.
From 1 October 2010, the GMC is changing the minimum IELTS scores and candidates will need to
achieve a minimum score of 7.0 in all four areas of speaking, listening, reading and writing before they
can take the PLAB test. However, the GMC will continue to accept the current IELTS scores for the PLAB
test from all doctors who have, before 1 October 2010, done one of the following:
booked a PLAB Part 1 test place
passed PLAB Part 1
booked a PLAB Part 2 test place
passed Part 2
applied for registration.
The first part of the PLAB test can be taken at a number of test centres overseas, but the second part
must be taken in the UK.
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