Career Snakes and Ladders

Medical students in the United Kingdom are led to believe that progression through the various training grades on the ladder is a straightforward process, dependent only on the learning of clinical skills and the passing of postgraduate exams. Unfortunately, competition for training grade jobs, particularly in the transition from senior house officer (SHO) to specialist registrar (SpR) level, has resulted in a bottleneck, with too many doctors competing for too few jobs. A scheme exists where SpRs are given a national training number (NTN), and this number ensures entitlement to a higher specialist training programme.1 Competition for these jobs is particularly fierce.

Potential hospital trainees should be aware that their future careers are by no means assured by simply achieving the minimum requirements needed for entry into the SpR grade. Furthermore, with continued expansion of medical schools and relatively static availability of NTNs, today's medical students may find competition extremely intense when they reach this stage of their career. With the government promising expansion of NHS consultant posts, more NTNs may be made available in the future to facilitate this. But even if this is the case it will not occur overnight and is unlikely to confer an easier passage …