Higher Surgical Training in UK
Structure Of Training
This page provides a brief introduction to the structure and various levels of medical training in UK. If you are already aware of this please move to next page.
House Officer : This is a 1-year compulsory training undertaken immediately after medical school. It can be several 3months/ 6 months in various medical/surgical sub-specialties. Appointment is by open competition.
Senior House Officer (SHO) : Otherwise known as basic surgical training. The duties of SHO include admission of elective/ day case patients and pre and post-operative work-up. The operative experience involves basic surgical aspects.
Appointment is by open competition. The current MRCS regulations require 3 years of basic surgical training to be eligible to sit the exam. It can be multiple postings of 6 months or a 3-year rotation involving A&E, orthopaedics, general surgery, related surgical specialties (breast, GI, colorectal, vascular, paediatric surgery).
Often the trainee develops an interest towards the end of this posting. Those interested in a particular speciality (i.e. urology) often spend 6 months in that. Most of the person specifications for higher surgical training often have these as desirable criteria.
Specialist Registrar (SpR) : Otherwise known as higher surgical training. The duties of SpR include providing middle grade cover for elective / emergency admissions, conducting clinics and operative sessions. The operative experience centres on supervised performance of regular surgical conditions and assisting major/complex procedures.
Appointment is by open competition. The Calman training programme involves 6-year training programme at this stage. By the end of 4th year the candidate becomes eligible to sit the FRCS part III exam. It allows rotation into 3 centres and allows one year to be spent in research / training abroad. By the end of this training certificate of completion of surgical training (CCST) is awarded and the candidates become eligible to register in specialist register.
Consultant : Appointment is by open competition. CCST and entry in specialist register are basic requirements. Research leading to special degrees (MD, MSc), publications, active participation in audit and teaching are often included in the desirable criteria. Most of the surgical specialities are consultant led now and consultants are expected to take a lead role in outpatient, inpatient and operative decision-making process.
The Firm: A typical surgical firm is made of three medical staff: Consultant (Lead), Specialist Registrar (Middle Grade), and Senior House Officer (Junior Grade). The other important members include the secretary, who would be the main point of contact for each consultant and nursing staff.
Appointment Procedures : The appointments to any of the above posts are by a competitive process. Vacancies are advertised in the British Medical Journal (Classified section) and are available on the website BMJ Applications are often made by curriculum vitae (CV), which provides the important information on the candidates qualifications, training, experience, and academic/other achievements. More details that would be useful for overseas doctors in preparing CV are given below.
Short listed candidates often find it useful to visit the prospective departments or enquire the details of the post by ringing the necessary consultants. Short listed candidates are invited for an Interview (often has 4-6 members who include Local, Deanery, Trust, Royal College representatives in addition to the medical personnel) and appointment is offered for successful candidates by writing.
Curriculum Vitae (CV) : It is very important to provide accurate dates and details of the type of the training in various areas, as CV is often used in short listing a candidate for interview and further by the medical personnel department for salary calculations. There are 2 areas of confusion, which might arise on looking at a CV of an overseas candidate.
a) Qualifications: often MD, MS, MCh etc. are described in CVs. It is very important to clarify more about these qualifications, whether they are conferred following a research (as a doctorate, PhD) or whether they are qualifications following clinical training and exams (like FRCS).
b) Training details: Often terms like interns, post graduate training, resident, senior resident, registrar, assistant, assistant professor etc are used abroad. It is important to classify what level of training these actually mean. It might be useful to provide the equivalent UK grade within brackets i.e. postgraduate trainee (SHO). More detailed description of the hospital (No. of beds, whether tertiary centre), type of unit/department, and the activities included in the job are useful. For example give details as follows:
1. CRRI (House Officer) Kilpauk Medical College, Chennai, India: March 1985- Feb 1986 (1 year)
2. Post graduate Training (SHO in General Surgery)- M.S. Madras Medical College, Chennai, India: April 1988- March 1991 (3 years)
a. General Surgery 18 months
b. Urology 6 months
c. Plastic Surgery 6 months
d. GI Surgery 6 months
3. Higher Surgical Training (Specialist Registrar in Urology) – M.Ch in Urology, Sri Ramachandra Medical College (Deemed University), Chennai, India: May 1992 – April 1995 (3 years)
4. Further Experience as Assistant Professor in Urology (Senior Registrar in Urology) –, Sri Ramachandra Medical College (Deemed University), Chennai, India: May 1995 – April 1998 (3 years)
Referees : The last section of CV often contains 2-3 referees who would be contacted prior to interview and requested to fax references on the candidate’s performance in their prior postings. It is important to have correct and clear contact address and phone/fax numbers. Structured application forms have replaced CVs for middle grade and consultant appointments.
For the first job: Getting references from abroad is generally more time consuming. It is essential to have correct phone number and fax number and check that the Referee abroad has actually faxed it to UK. It is essential to ring the referee and warn about the possible request from a hospital for a reference and request the secretary to fax it once it is done. If there is no secretary, it is essential to have a friend to collect the reference and fax it.
Further references: After 2-3 months in the first clinical job or attachment, it is possible to get a reference from the supervising consultant in UK. This saves the hassle of chasing up the referee abroad. However a referee who does not know the candidate or who has seen the candidate for only a few weeks, obviously cannot add much about him on the reference. This should be born in mind by the candidates.