Overview of the medical training structure
Medical School - undergraduate medical training
The first step for anyone wanting to pursue a career as a doctor is to study medicine at undergraduate level or via a graduate medical course. Normally this will take four to six years of study. Following graduation from medical school, students progress onto postgraduate training, via the foundation programme and higher specialist training, during which time they are known as junior doctors.
Read our how to become a doctor guide
The Foundation Programme - postgraduate medical training (Stage 1)
All medical graduates must undertake and complete an integrated two-year programme of general training in order to practice as a doctor in the UK. The Foundation Programme, comprising foundation year one (F1) and foundation year two (F2), acts as a bridge between undergraduate medical training, and specialty and general practice training. It is designed to provide trainees with defined practical skills and competencies, and sound knowledge of how to manage acutely ill patients.
Foundation doctors in both F1 and F2 can also undertake 'tasters'. A taster is a period of time, usually two to five days, spent in a specialty in which the Foundation trainee has not previously worked, which enables the development of insight into the work of the specialty and which promotes career reflection.
Read our guidance and get specialist advice for FY1 and FY2 doctors
Specialty and general practice training - postgraduate medical training (Stage 2)
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).
Doctors in training have the option to undertake flexible training or 'less than full-time training' (LTFT). Doctors wishing to train flexibly are required to have a well founded individual reason which can include needing to care for a child or an ill or disabled dependent, or wishing to undertake some personal or professional development.
Get advice on flexible training
Changes to postgraduate training
While every effort has been made to ensure accuracy of the information in this resource, it should be noted that the arrangements for postgraduate medical training may be subject to further changes, through the Shape of Training review. Also contact your training body to get the most up to date information.
Get the latest on the Shape of Training review into medical training in the UK