Application Routes

A Simple Guide To… Application Routes

When coming from abroad, ‘getting into the system’ can sometimes be easier said than done. Finding a job does not necessarily mean it is the right one for you.

Below we’ve made a simple guide highlighting different routes to consider and some pros and cons with each.

But First.. Terminology!

In the UK, we are OBSESSED with labels,

F1/F2/F3/F4/F5/SHO/CT/ST/SPR/CCT/Trust Grade/ Staff Grade/Fellow – but what do these all mean?

Basic Terminology

Old Terminology Post 2005 Terminology General Role
House Officer
(Partial GMC
F1 – Foundation Year 1 Junior Doctor
Senior House
Officer (SHO)
(Full GMC
F2/CT Foundation/Core Training Junior Doctor
ST – Specialist Trainee (Intermediate level) Junior Doctor
Senior Registrar ST – Specialist Trainee/Middle Grade (Advanced level) Senior Doctor
Consultant Consultant (CESR/CCT) Senior Doctor

Normal Training Timeline for a UK Graduate

Before delving into the pathway of an International Medical Graduate, it can sometimes be easier to understand if we compare to the UK pathway for ‘Home students’.

Once you graduate from a UK medical school – you apply for a ‘Foundation Programme’, you then get the title of: Foundation Year 1 (F1)

Foundation Year 2 (F2)

These jobs are usually applied for as combined two year programmes however stand alone options do exist.

***The Foundation programme (explained above is only two years long so if you see someone who is working as a F3/F4/F5 – these are just colloquial term used for doctors taking optional years out of training!)

All applications must be submitted through Oriel (national online application system). You can access the new version of Oriel here. Applicants are advised to start their applications early to allow sufficient time to complete the necessary sections of the application form and to gather evidence in support of their application.

Career Pathways for International Medical Graduates

Seems simple enough? But what about when you’re not from UK – then what happens?

Well essentially the UK is quite flexible that doctors are able to enter the system via different routes and it’s important to understand the difference between a TRAINING ROUTE and a NON TRAINING ROUTE

Training Route (Gmc Approved Training Programme)

This will depend on whether you have completed an internship or not…

If you HAVE done an internship you have TWO options via a ‘training route’

  1. Applying for a two year foundation programme (in the same way as UK students via Oriel)
  2. Applying for a ‘stand alone F2 year’ (via Oriel)



  • Treated ‘just like a UK student’
  • Good amounts of training with excess to a portfolio/supervisor/weekly teaching
  • Able to rotate through different specialties – good way of broadening knowledge
  • Able to have full 4 month placement in GP as an option
  • Study Budget for courses


  • Time consuming if you already have an idea of what you want to do
  • Limited number of stand-alone F2 places nationally
  • Set application dates and start dates so if you miss it one year, you have to wait until the next entry


If you HAVE NOT completed an internship – you only have one option:

To apply for a two year foundation programme

Non-Training Route

This is only for doctors who HAVE completed an internship.

Before being able to apply for a specialty training post in the UK, you will need:

  1. 12 months experience after full GMC registration
  2. Certificate of Readiness to Enter Specialty Training (CREST – previously known as the Alternative Certificate of Foundation Competencies)

12 months of ‘non-training’ experience in the NHS can be done via:

1. Trust grade/fellow jobs

These are non-training posts that vary in length and specialty. Often, trusts allocate funds specifically to recruitment of Trust Grade Doctors and hence some jobs can offer perks e.g. opportunities to gain extra teaching qualifications.

Pros (Depending on Jobs available)

  • Options to choose/streamline specialties – good for those who already have an idea of what they want to do e.g. surgical specialties
  • Options for additional qualifications PGCERT MedEd
  • Can be more flexible with work/life – letting the trust know days you are able to work, not doing on calls and nights if you don’t want to
  • Able to create a working pattern that suits you; only doing jobs you have an interest in and choosing how long you wish to stay there for


  • Doesn’t always include study budget (depends on trust)
  • Unlikely to gain GP exposure (trust/fellow jobs in GP are very uncommon)
  • May lack learning opportunities as preferences are given to trainees and focus on service provision
  • May face prejudice when applying for training unless time taken out of training spent is justified or seen as ‘productive’

2. WAST (Widening Access to Specialty Training)

WAST is a 12 month programme that will typically involve rotations through acute specialties with potentially 4-6 months in psychiatry and two taster weeks in General Practice.


  • Able to gain GP experience without needing to be on a foundation programme
  • Ideal for those considering psychiatry/GP as a career
  • Start dates in August and February each year


  • Specific for certain specialties
  • Doesn’t always include study budget (depends on trust)

N.B. Due to the ongoing COVID-19 restrictions, the WAST scheme is not currently running. Information updates will be added on their recruitment website.

Applying for Specialist Training Programmes

These programmes are for doctors who have completed their foundation training/12 months experience post GMC registration + CREST (certificate of readiness to enter specialty training), want to now build on the basics and apply for specialties they have an interest in.

This is again done by National Recruitment via Oriel.

Run Through Specialties

In the UK there are certain training programmes which are called “Run Through” which means once you’re on them, as long as you’ve completed your exams and met your annual requirements, you will complete the training needed to work as a consultant (most senior level of doctor in the hospital).

Examples of these programmes are: Radiology, Emergency Medicine, General Practice, Neurosurgery, Paediatrics. They will vary in length and these trainees usually go by ST1-8 depending on their seniority.

Core Training

For the remaining specialties, doctors are expected to complete 2-3 years of ‘core training’ where they can understand the basics before applying for ‘Higher Specialty training’ in their preferred specialty.

Examples of this are Core Surgical Training (CST), Internal Medicine Training (IMT), Core Anaesthetics.

These programmes usually last between 2 and 3 years and thus will be called either CT1/CT2 or CT3

N.B. Similarly with CREST (Certificate of Readiness to Enter Specialty Training), there will be an alternative certificate that can be signed off as an ‘equivalent’ to completion of core training. This will differ according to specialty and will generally be found on the specialties person specification.

Applying for Higher Specialist Training

Like with all training programmes, this is again done via oriel.

Completion of foundation and core training competencies (either via training or a non-training route) must be evident at this stage in order to apply.

Different specialties will have different numbers of years of training. Specialist Registrars will usually go by a training title of ST3-ST6/8 depending on the specialty. Once your training is completed via a recognised training programme, you will be awarded a CCT (certificate of completion of training)


For those doctors who have been working for years in the NHS via non training pathways, you can work towards a Certificate of Eligibility for Specialist Registration (CESR). These are for doctors who have not completed GMC approved programmes but have the skill set and knowledge base and are equivalent to the requirements for the award of the CCT (certificate of completion of training)


  • Able to gain CCT equivalent as long as specialty competencies are met; can use experience and skills gained from non-training posts
  • Able to stay in one place and ‘log experience’ to count towards CESR


  • Not recognised outside of UK

Common Specialties and Length Of Training In UK


General Practice 
Internal Medicine:  
General Surgery  
Trauma and Orthopaedics  
ENT (Otolaryngology)
7 years (on average)  
Obs & Gyne 7
Emergency Medicine  6
Opthalmology  7
Anaesthetics  7

We appreciate this is A LOT of information and not everything is quite as black and white as it seems online. Everyone comes from their own background with their own story, if you’d like any more information on application routes and training pathways, make sure to get in touch!


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