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 Assessments 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 Senior house officer (SHO) Year 2: a minimum of two years, although Specialty Registrar Specialty Registrar Year 3: often more Year 4: GP registrar- one year (StR) (GPST) in a hospital speciality: in general practice: minimum six years three years Specialist Year 5: registrar Years 6- four to six years 8: General practitioner General practitioner Consultant total time in training: total time in training: total time in Consultant 4 years total time in training: 5 years Year 9: training: minimum 7-9 minimum 8 years 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 Optional years), 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 Appendces 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 specialties. 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.