Intended for healthcare professionals

Letters UK training programmes

Apples and oranges: comparing residency models in the UK and North America

BMJ 2018; 360 doi: (Published 09 January 2018) Cite this as: BMJ 2018;360:k59
  1. Eugene Y H Yeung, medical doctor
  1. Royal Lancaster Infirmary, Lancaster LA1 4RP, UK
  1. eugeney{at}

Baddeley mentions medical residency training in the US1; let me elaborate. Residents in North America do rotate because each hospital has its limitations, but their placements are usually in the same city. They have a wider variety of placements (four weeks), including many off-service rotations outside their specialties. This helps residents understand other teams and how to make reasonable referrals. A UK programme placement lasts 4-6 months but does not necessarily makes trainees more familiar with the hospital, because they are restricted to one area of medicine.

In North America, residents complete their training in one location, mainly owing to having run-through training for consecutive years, and write board exams near the end of training. By contrast, UK trainees apply to higher training every few years and write the board exams during their training, failure of which can result in relocation.

If longer local training led to better quality improvement incentives, we should have seen superior projects among the local foundation year doctors.2 Audit and research projects are popular in North America because they give applicants an edge in their residency and fellowship applications. In the UK, application to general practice no longer evaluates applicants’ portfolios and projects. Foundation year programmes select applicants mainly based on exam and situational judgment test scores.

In North America, residents are used to ensure safe coverage in the workplace, such as requiring GP trainees to fill the hospital on-call rota. This is different from many NHS hospitals, which have trainees in unbanded posts but pay expensive fees to locum agencies to fill the rota. NHS hospitals with a limited number of local trainees might threaten trainees with referral to the General Medical Council for refusing to do extra locum work.3

If we are to adapt the residency system, we must first critically analyse why our system fails and how others succeed.