Medical training in the UK
28 September 2012
Note: This paper is intended as background information for the media. It is not intended as a comprehensive BMA policy briefing paper.
Overview
Within the UK, medical training is designed to meet the needs of the NHS which employs the vast majority of UK trained doctors during at least some part of their career. The main areas of employment include hospital services, general practice, public health medicine and community health.
Areas of work traditionally outside the NHS include occupational health medicine, forensic medicine (i.e. police work) or medical officers in the UK Armed Forces.
On average, it is likely that medical professionals will have spent at the very least nine years in clinical training after graduation from medical school to become a general practitioner (GP) or 11 years to become a hospital consultant.
A radical overhaul of medical training in the UK began in 2003 with the modernising medical careers (MMC) programme. The process of medical training following these changes is described below.
Medical School
The undergraduate degree course is usually five years in duration and provides students with exposure to the different specialties within medicine. It involves basic medical sciences and practical clinical tasks, and seeks to develop attitudes and behaviours appropriate to the medical profession, as well as the skills of independent learning. Undergraduate training takes place under the overall supervision of the General Medical Council (GMC), the independent regulator body for UK doctors. However, supervision of the curriculum and teaching lies with the UK’s 30 medical schools.
The Foundation programme (overview)
Following graduation from medical school, new graduates enter a 2-year foundation programme of training.Foundation training links medical school with general practice or specialty training through a programme of general training which involves several placements in various specialty and healthcare settings.
Foundation year 1 (F1)
Foundation year 1 includes three months of general surgery and three months of general medicine, with the other six months made up of work in other areas of specialist interest. Individuals in F1 posts receive a salary and are allowed to use the courtesy title ‘Dr’. The GMC has responsibility for the F1. These doctors only have provisional registration with the GMC.
Foundation year 2 (F2)
TheGMCis also responsible for the F2. The F2 consists of three, four-month placements and includes opportunities to work in primary care as well as developing core skills in time management, IT and team working. The F2 doctors are fully registered with the GMC. F2 doctors are entitled to full registration for unsupervised medical practice in the NHS or private practice in the UK.
Specialist training
Specialist training begins when an individual has completed F1 and F2. The medical royal colleges and their faculties (royal colleges) draw up the criteria for specialist training curricula and assessments which are submitted to the GMC. The GMC is responsible for approving training posts and programmes.
When an individual successfully completes the foundation programme, they move into a specialty training programme which, upon successful completion, leads to the award of a certificate of completion of training (CCT) either for specialist or general practice training. Eligibility for specialist training for doctors that have qualified overseas may vary and will depend on the level of their experience.
Training for general practice
There is a well-established postgraduate training programme for general practice, the vocational training scheme (VTS). The programme is compulsory for all doctors wishing to work in general practice and lasts for a minimum of three years.
Trainees normally spend two years in posts in hospitals following the completion of the foundation programme. These posts must cover at least two specialties relevant to general practice such as paediatrics, general medicine, geriatrics, obstetrics, psychiatry or accident and emergency.
Following this one year is spent working as a GP registrar in the practice of a GP, who must be recognised as a GP trainer. This is currently under review following a recommendation from the Royal College of General Practitioners that the minimum training time in all general practice programmes is extended to two years in order to meet the future challenges facing general practice. The GMC is responsible for GPs and doctors receiving a certificate of prescribed experience when they have completed their general practice training.