Medical School Interview: Medical Specialities and Routes to Specialisation

The first step toward becoming a doctor is studying Medicine – which you may choose to do as an undergraduate or a graduate. You might expect to study four years as a graduate, or between five to six years as an undergraduate – depending on whether you choose to intercalate (study a separate degree for a year).

After you complete medical school, you will undertake foundation training, followed by specialty training.

Foundation training takes two years, and includes FY1 and FY2. After medical school, you are granted provisional registration, with full registration following after the completion of FY1.

The foundation program links undergraduate medical training and training for general practice, providing doctors with a set of clearly defined essential practical skills, and the ability to manage the acutely unwell patient.

Specialty and GP Training

Further postgraduate training, after the completion of the foundation program, allows you to become a specialist, or a GP. There are many different specialties, for which the training may be delivered in different ways. A run-through training program may last from three years for a GP to between five and seven years for other specialties, and involves, as the name suggests, an ongoing training schedule. Core and higher specialty training programs involve two or three years of core training, before a competition to attain a higher specialty training post. The round of competition after core training is competitive, meaning that it may be tough to find the post that you desire. The Acute Care Common Stem (ACCS) is a three year training program for those wishing to specialise in emergency medicine – an alternative to training in Anesthesia, General Internal Medicine or Acute Internal Medicine.

Core and higher specialty programs are also known as uncoupled programs, and include all areas of internal medicine, most surgical specialties, psychiatry, anaesthetics and emergency medicine. The first year of core training is dubbed CT1, the second CT2, and the third CT3. Specialty training ranks start at ST3 if the core training was two years, or ST4 if it was three years. They will increase in number until training is complete – i.e. an ST7 will be near to completion.

When you complete your run-through program or higher speciality training program, you will be awarded a CCT – the Certificate of Completion of Training, allowing you to enter the GMC’s specialist register, or GP register.

Other Routes

There are various other standalone posts that do not make up a part of a run-through training program. These include LATs – Locum Appointments for Training. Some doctors choose not to become consultants, and are recognised as SAS doctors – meaning staff grade, specialty doctors and associate specialists. SAS doctors make up 20% of the UK workforce, with 70% of them being from overseas. Some become SAS doctors due to their qualifications not being recognised for a consultant post, whereas many others simply prefer the lifestyle or options that being an SAS doctor offers – perhaps allowing you to take up multiple roles at once. For example, an SAS doctor might work as a sports doctor at a football club, as a doctor at a race course, and combine these two jobs with further work as a forensic physician – providing them with multiple income streams and a work life balance very different to that of a consultant.

An Overview of Examinations

The MRCP Diploma and Specialty Certificate Examinations are made up of three parts: MRCP Part 1, MRCP Part 2 Written, and MRCP Part 2 Clinical (PACES). You must complete the entire three part examination before starting specialist training. Most doctors will take the Part 1 after 12-24 months of Foundation Training, and the Part 2 Written after around 24 months – with the Part 2 PACES following a pass in the written component.

You will then be expected to undergo further examinations and assessments dependent on the route or specialty that you choose, in order to become a full member of the respective college, and in turn a consultant in the specialty. For example, those wishing to pursue a career in psychiatry would expect three years of core training – CT1, CT2, CT3 – resulting in becoming an MRCPsych – followed by an additional three years in a chosen psychiatric specialty, before gaining the CCT in that specialty.

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