Are You Overqualified For UK Specialty Training?

Many doctors who carried out the early stages of their training overseas decide to relocate to the UK for their higher specialty training, for various reasons. Some doctors do this before having done any specialty training, whilst some make the decision after they have already gained some experience in their desired specialty.

It is possible to enter UK specialty training with some pre-gained experience, however it is important to be aware that some specialties have ‘experience limits’; a limit to the amount of experience you can have within that specialty to enter the first year of specialty training. If you exceed this limit, it is still possible to become a specialist in the UK through different routes.

This article will discuss the different pathways of UK specialty training, the experience limits for different specialties, and how to still become a specialist in the UK if you exceed those limits.

 

UK specialty training pathways:

Before applying for core and specialty training in the UK, you must have completed a medical degree and 2 years of the UK foundation training programme or an overseas equivalent. There are 3 main types of core and specialty training pathways in the UK:

1. Run-through specialty training: core training is integrated within the specialty training. Trainees begin at ST1 year and continue smoothly through to the end of specialty training which lasts from around 3 years in general practice to 5-7 years in other specialties. Entry into this programme is possible in ST1-ST4 depending on the level of previous experience and acquired competencies

2. Uncoupled: core training is separate to higher specialty training. Cire training lasts 2-3 years and is followed by a competitive application for an ST3 post in your chosen specialty.

3. ACCS (Acute Care Common Stem): 3-year training programme following second year of foundation training (or last year of overseas equivalent). This programme is the only option for trainees wishing to enter higher ST training in emergency medicine, and it is an alternative training programme for trainees wishing to enter ST in general internal medicine, acute internal medicine, or anaesthesia. It is followed by a competitive application for ST3 in one of these specialties

On successful completion of specialty training, you will be awarded a Certificate of Completion of Training (CCT), and will be added to the medical register as a specialist doctor.

 

Experience limits:

Although not all specialties have experience limits, it is important to know of the ones that do if you are considering entering ST after having completed some training in that specialty already. It is mostly the specialties that begin their specialty-specific training at year CT1 or ST1 that have strict specialty experience limits.

This includes run-through specialties, namely surgical specialties, and ACCS specialties. The maximum experience limits are as follows:

 

Specialty training programme	Experience limit
Acute Medicine ACCS CT1	18 months in any medical specialty
Anaesthetics ACCS CT1	18 months in Anaesthetics
Anaesthetics (core anaesthetics) CT1	18 months in Anaesthetics
Ophthalmology	18 months in Ophthalmology
Radiology	18 months in Radiology
Obstetrics and Gynaecology	18 months in Obstetrics and Gynaecology
Surgery (core surgery)	18 months in surgical specialties (excluding Ophthalmology and Obs & Gynae)
Cardiothoracic surgery	18 months in surgical specialties (excluding Ophthalmology and Obs & Gynae)
Neurosurgery	24 months clinical experience (in any specialty) with no more than 12 months combined experience in Neurosurgery, Neurology, Neuro-radiology, and Neuro-intensive care

 

Activities that count towards these limits include:

• Any postgraduate, post-internship (or post-foundation training) clinical experience as a doctor up until the start date of the training programme, ie, residency overseas, postgraduate training overseas, non-training jobs overseas or non-training jobs in the UK at any level

On the contrary, medical school rotations, internship rotations, observerships, clinical attachments, and official FY1 and FY2/Maltese foundation programme training rotations do not count towards these limits.

 

If you surpass these limits, you can still become a UK-recognised specialist through one of these alternative routes:

• Enter training at a level beyond ST1-CT3, usually this would be at ST3/4, and become a consultant through the Certificate of Eligibility for Specialist Registration-Combined Programme (CESR-CP) route. This will likely result in receiving a CCT.

• Do not enter any formal training in the UK but provide evidence that you have all the necessary skills and competencies equivalent to doctors who have completed training in the UK, and become a consultant through the CESR route, but likely without being awarded a CCT.

There is a handful of specialties, particularly surgical specialties, that also have desired maximum experience limits for entry into ST3 of the specialty training programme which may be imposed if there are too many applicants, but these may not always be in place.

Having too much experience can be a disadvantage even if the desired limits are not imposed, as it can result in penalties and having points deducted from your application. The desired maximum experience limits are as follows:

Specialty	Desired experience limit
Obstetrics and Gynaecology ST3	60 months in Obs & Gynae
Anaesthetics ST3	48 months in Anaesthetics or Intensive Care Medicine
General Surgery ST3	48 months in General Surgery
Vascular Surgery ST3	48 months in Vascular surgery
Paediatric Surgery ST3	12 months at ST3 level (registrar or above) in Paediatric Surgery, General Surgery, or Urology
Neurosurgery ST3	More than 5 years since the completion of Foundation Competencies
Trauma and Orthopaedics ST3	No desired maximum experience stated, but the longer you have worked after foundation competencies/internship and the more experience you have in Orthopaedics, the less points you will get on your application
ENT ST3	No desired maximum experience stated, but if you have <5 months or >30 months of experience in ENT, you will not get any points in this section of the application

 

If you exceed these limits and wish to apply for one of these specialties, your only option may be to apply for a CESR-route to become a consultant in the UK.

 

What is the CESR/CEGPR?

Certificate of Eligibility for Specialty Registration/Certificate of Eligibility for General Practice Registration is for doctors who have not completed formal UK training but wish to practice as specialists/general practitioners in the UK. To apply for a CESR or a CEGPR, you will need to provide evidence that you have achieved the required skills and competencies. The application can take 6+ months to process. Guidance is available at the GMC website.

Additionally, the CESR- Combined Programme (CESR-CP) is for doctors who have completed a part of their specialty training in a non-GMC training programme but chose to leave this programme and join a GMC-approved ST programme at a later stage. Upon the completion of a GMC-approved training programme, a CESR-CP is awarded to the doctors, and it is becoming increasingly common for these doctors to also receive a CCT.

There are many different routes to becoming a consultant in the UK, and it may be difficult to know which one is the most appropriate for you. There are several resources available to facilitate this decision, including:

• The GMC website, which details the different specialty training pathways, as well as the different ways to start a career in the UK for international medical graduates.

• The British Medical Association (BMA) website which provides support to all doctors in the UK, as well as helpful resources for overseas doctors who wish to relocate to the UK.

 

References:

1. The British Medical Association (BMA). Medical training pathway. Reviewed Nov 2021. Available from: https://www.bma.org.uk/advice-and-support/studying-medicine/becoming-a-doctor/medical-training-pathway (accessed Apr 2022)

2. Road to UK. Overview of specialty training in the UK. Publishing date not listed. Available from: https://roadtouk.com/training-in-uk/training-overview/specialty-or-gp-training-residency-in-the-uk/ (accessed Apr 2022)

3. The Savvy IMG. Are you overqualified for UK specialty training? Published May 2019. Available from: https://thesavvyimg.co.uk/are-you-overqualified-for-uk-specialty-training/ (accessed Apr 2022)

4. NHS Health Education England- Physical higher specialty training recruitment. Experience. Publishing date not listed. Available from: https://phstrecruitment.org.uk/recruitment-process/am-i-eligible/experience (accessed Apr 2022)

5. NHS Health Education England. CCT or CESR (CP). Pdf. Published Feb 2018. Available from: https://www.nwpgmd.nhs.uk/sites/default/files/CCT%20or%20CESR_0.pdf (accessed Apr 2022)

6. General Medical Council (GMC). Certificate of eligibility for specialist registration or certificate of eligibility for GP registration application. Publishing date not listed. Available from: https://www.gmc-uk.org/registration-and-licensing/join-the-register/registration-applications/specialist-application-guides/specialist-registration-cesr-or-cegpr (accessed Apr 2022)

7. Savvy IMG - https://thesavvyimg.co.uk/are-you-overqualified-for-uk-specialty-training/ (accessed Nov 2022)