Intended for healthcare professionals


Specialty training places

BMJ 2010; 341 doi: (Published 01 December 2010) Cite this as: BMJ 2010;341:c6675
  1. Melanie Jones, associate dean for careers, Wales, special adviser careers at UKFPO1,
  2. Alison Carr, senior clinical adviser, Medical Education and Training Programme2,
  3. Jane Montgomery, associate dean for careers3
  1. 1School of Postgraduate Medical and Dental Education, Cardiff University, Cardiff
  2. 2Department of Health, London
  3. 3South East of Scotland Deanery, Edinburgh
  1. JonesMJ4{at}


Melanie Jones, Alison Carr, and Jane Montgomery look at opportunities to enter specialty training programmes leading to a certificate of completion of training in England, Scotland, and Wales

The NHS trains the specialists it needs, and this has been clearly outlined in both the 2008 report from Lord Darzi1 and the recent report from the Centre for Workforce Intelligence2 on medical specialty training numbers for 2011. There are currently postgraduate medical training programmes in 61 specialties that lead to a certificate of completion of training (CCT).

One essential component of realistic career decision making is accurate and timely information on post availability. Selection into specialty programmes has changed in recent years, and since 2008 some training programmes in England and Wales have “uncoupled” the link between basic and higher training. Scotland has had uncoupled posts in some specialties since 2009. These changes make it more challenging for foundation trainees, core specialty trainees, and their educational supervisors to obtain clear information about opportunities to enter a training programme leading to a CCT and thus eligibility for entry on to the specialist register. Other groups who might benefit from this information are medical students considering future career options, school leavers considering their application for medical school, and the various supporting careers services.

It is essential that people entering core training in uncoupled specialties are aware of the likely opportunities to progress to higher training in their chosen field.

Survey of specialty training programmes in 2010

Information on posts available in England, Scotland, and Wales starting in August 2010 or beyond was collected from deaneries and the royal medical colleges and collated. Only posts leading directly to a CCT without further competitive section were included in the survey—that is, run-through training posts and higher specialty training posts in uncoupled specialties. Core training posts and short term training posts were not included.

A total of 6718 specialty training posts were available in the three countries in 2010: 5736 in England (85%), 312 in Wales (5%), and 670 in Scotland (10%).

The number of posts in each specialty was identified in each country (table), and the posts in each specialty across the three countries were displayed to show the percentage contributions made by each specialty (fig). Posts were amalgamated for medical specialties and for surgical specialties at specialty trainee year 3 level.

General practice provides almost half of the opportunities to progress to a CCT in the three countries. The opportunities for higher specialty training posts in medicine (14% of total posts) and surgery (6.8% of total posts) are less than perceived by many trainees and consultants. The NHS offers as many opportunities to train in psychiatry and paediatrics as in surgery, with less competition for posts. In addition, there are opportunities to progress in emergency medicine, and the specialty is actively seeking to encourage doctors to apply for specialty training.

Finally, it should be noted that workforce planning is reviewed annually. Consequently, overall numbers vary each year, though the number of posts over 2008-10 have remained fairly similar in England and Wales but not in Scotland. The number of posts available will continue to fluctuate.


Every career decision should be based on exploring options within a framework that includes an awareness of personal skills and aptitudes. A degree of realism is also vital when considering specialty choice, because consideration must be given to what posts are available, where they are, and how competitive they are likely to be. The authors are aware that opportunities may vary between deaneries, and this comparative information can be explored using the Modernising Medical Careers website ( and deanery websites. Posts available in any given year in specific branches of medicine and surgery may vary depending on both vacancies arising and central planning to increase or reduce numbers. The number of posts available in the small specialties in particular may vary considerably year on year.

Surgical training is competitive and consequently it is important for trainees wishing to progress in surgery to discuss carefully with their educational supervisor or college tutor the likelihood of progression so that realistic career plans can be made and, where appropriate, alternative career options investigated.

Paediatrics, psychiatry, and emergency medicine currently have few applicants for specialty training, with competition ratios of 2:1 or less for specialty training posts in 2010.

Some specialties are not encountered during medical school placements and so may not be an initial choice of career. Widening experiences in the foundation programme in the future may enhance the range of choices, as can encouragement to do student elective work in these specialties.

  • Further information on specialty choice and other career planning tools is on the UK Medical Careers website:


  • We thank the Medical Education and Training Programme, deaneries, and colleges for providing data on the 2010 recruitment process in England, and Helen Baker, in the Wales deanery, for providing information and data on the 2010 recruitment process in Wales.

  • Competing interests: None declared.


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