Selection for specialist training: what can we learn from other countries?

BMJ 2007; 334 doi: (Published 21 June 2007) Cite this as: BMJ 2007;334:1302
  1. Tony Jefferis, associate postgraduate dean
  1. Oxford Deanery Postgraduate Medical and Dental Education, Oxford OX3 7LP
  1. afjefferis{at}

    The chaos surrounding the UK's centralised application service led to the system being abandoned. Tony Jefferis examines how similar systems work elsewhere

    The UK Medical Training Application Service (MTAS) for specialist training had a bad start. Doctors were angry at its inefficiencies and unfairness.1 2 Many reasons were cited for its problems including using an untried system,3 using the same system for new entrants as for those already committed to a specialty, underestimating the numbers of international medical graduates applying, using a flawed computer system, and, finally, buckling to public outcry by revising the timetable and conditions of application. The secretary of state for health apologised in the House of Commons, the website closed for a security review, and the system was eventually abandoned.

    Despite all this, a central application portal with local selection has considerable merit. It has been used successfully in the United States, Canada, and, in a modified form, in Australia and New Zealand for at least 30 years (box). It provides an orderly and transparent way for candidates to decide where to train and for programme directors to decide whom to enroll into postgraduate medical training. So how do these countries make it work?

    National application portals for specialty medical training

    United States
    • Electronic Residency Application Service (ERAS) is run by the Association of American Medical Colleges ( It was computerised in 1996

    • Canadian Resident Matching Service is run by the Association of Medical Colleges ( It was computerised in 2002

    Australia and New Zealand
    • The process is run by individual specialty colleges. The Royal Australasian College of Surgeons, for example, computerised in 20074

    Selection process

    All four countries have a clearly publicised timetable, outlining each step of the process. The US, Australia, and New Zealand have one round of applications each year. Canada has two, the second being primarily for international graduates and candidates not matched in …

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