TSRMedics™ BASICS 1 Overview of Specialties - What are they and common misconceptions

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TSRMedics™BASICS is the section for discussion of basic (basic to us anyway!) information about different roles and information in the medical, nursing and allied health professions.

TSRMedics™BASICS 1 Overview of Medical Specialties
What are medical specialties?
Different roles for doctors that you will work and train in.

What are sub-specialties?
Once you are in the specialty, there are sub-specialties that you can join. e.g. Spinal surgery in Neurosurgery, Paediatric Cardiology in Paediatrics.

What specialties are there?
There are many - a lot can be classified into Medicine, Surgery, Psychiatry. The rest are more "standalone". There will be a list further down.

How does a junior doctor join a specialty?
All UK medical graduates have to complete 2 years of Foundation Training (see seperate article) prior to joining a specialty.

Depending on the specialty, a junior doctor may have to do a 2-3 year Core Specialty Training (e.g. Core Surgical Training, Core Psychiatry Training, Internal Medicine Training) and then apply to the specialty.

Some specialties do not have this Core period, and doctors enter into the specialty training straight after Foundation Year 2. These are called "run through" specialties. e.g. Obs and Gynae.

How long does it take to train in a specialty?
It depends on the specialty.

General Practice takes 3 years after Foundation Year 2; total 5 years after medical school.

Most hospital-based specialties take 6-8 years after Foundation Year 2; total 8-10 years after medical school.

Do you get paid during training?
Yes. You get paid for working from the August that you graduate. Your salary will go up after Foundation Year 1, Foundation Year 2, and Core / Specialty Training Year 2. There are plans to introduce another step-up in pay after Specialty Training Year 6.

2018/19 pay:
FY1 - £27,146 / year
FY2 - £31,422 / year
CT1 / CT2 - £37,191 / year
ST3 - ST8 - £47,132 / year
Starting cons - £77,913 / year
(* excluding on-call supplements)

2019/20 pay:
FY1 - £27,689 / year
FY2 - £32,050 / year
CT1 / CT2 - £37,935 / year
ST3 - ST8 - £48,075 / year
Starting cons - £79,860 / year
(* excluding on-call supplements)

2020/21 pay:
FY1 - £28.243 / year
FY2 - £32,691 / year
CT1 / CT2 - £38,693 / year
ST3 - ST5 - £49,036 / year
ST6 - ST8 - £52,036 / year
Starting cons - £82,096 / year
(* excluding on-call supplements)

Current (2021/22) pay:
FY1 - £28.808 / year
FY2 - £33.345 / year
CT1 / CT2 - £39,467 / year
ST3 - ST5 - £50,017 / year
ST6 - ST8 - £53,077 / year
Starting cons - £82,096 / year
(* excluding on-call supplements)

Is optometry / neuroscience / radiography etc. medical specialties?
No.

There are a few commonly mistaken specialites:

Ophthalmology = medical specialty
Optometry = allied healthcare profession
https://aapos.org/glossary/difference-between-an-ophthalmologist-optometrist-and-optician

Neurology / Neurosurgery = medical specialties
Neuroscience = scientific field dedicated to research of the nervous system
https://www.bna.org.uk/careers/neuroscience-career-faqs/#what-is-the-difference-between-a-neuroscientist-neurologist-and-neurosurgeon

Radiology = medical specialty
Radiography = allied healthcare profession
https://www.rcr.ac.uk/public-and-media/common-medical-terms/radiology-faqs#radio

So, what are the specialties at CT1 / ST1 level?
Here goes (list will be updated with information and corrected with time)

ACCS (Acute Care Common Stem)
https://www.rcoa.ac.uk/accs

ACCS is a three year training programme that normally follows Foundation Year 2. It is the only Core training programme for trainees wishing to enter Higher specialty training in Emergency Medicine and is an alternative Core training programme for trainees wishing to enter Higher specialty training in Anaesthesia and any of the Specialties listed on the JRCPTB website. The first two years are spent rotating through Emergency Medicine (EM), Acute Internal Medicine, Anaesthetics and Intensive Care Medicine (ICM). The third year is spent in training that will ensure the trainee meets the minimum requirements for entry into Higher specialty training in their parent specialty (EM, JRCPTB Specialty, Anaesthetics and also ICM). The components of training in ACCS are:

•

1 year Emergency Medicine + Acute Internal Medicine (usually 6 months each)

•

1 year Anaesthesia + Intensive Care Medicine (usually 6 months each)

ACCS anaesthetics / core anaesthetics training
ACCS CT1 anaesthetics - https://specialtytraining.hee.nhs.uk/portals/1/Content/Person%20Specifications/Anaesthetics/Anaesthetics%20ACCS-%20CT1.pdf
CT1 anaesthetics - https://specialtytraining.hee.nhs.uk/portals/1/Content/Person%20Specifications/Anaesthetics/Anaesthetics-%20CT1%20.pdf

The core level is normally two years in duration and consists of the introduction to anaesthetia and core anaesthesia. The introduction to anaesthesia is usually completed within the first six months and includes the initial assessment of competence milestone. The remainder of the two years is dedicated towards completing core anaesthesia and passing the Primary FRCA examination. Trainees who enter via the ACCS route complete the core level in three years. Two of the years are in ACCS and the third year is just anaesthesia.

Cardiothoracic surgery
http://www.wessexdeanery.nhs.uk/pdf/Applicant%20Guide%202020%20-%20Cardiothoracic%20ST1%20National%20Recruitment%20final.pdf

Example of CTS training programme at Severn Deanery: http://surgery.severndeanery.nhs.uk/about-us/surgical-specialties/cardiothoracic-surgery/

Clinical Radiology
https://www.rcr.ac.uk/clinical-radiology/careers-recruitment/specialty-recruitment
https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/clinical-radiology/training-and-development

Training for clinical radiology is a run-through programme that takes five years to complete stages ST1-5. There is a further year, ST6 for those trainees wishing to specialise in interventional radiology. Unlike some other medical specialties, there is no competitive application process at ST3.

It is possible to apply for specialty training directly from foundation training, although because of the competitive nature of the specialty, some previous experience of radiology clinical practice and/or research is likely to be useful. Some applicants have undertaken training in another medical specialty before applying for radiology.

The training involves three years of general radiology training followed by two years of special interest training. Years one to three includes training in each radiology sub-specialty.

During training you will also take examinations leading to Fellowship of the Royal College of Radiologists (FRCR). During your ST1-5/6 training you will be employed as a specialist registrar. At the end of this training you will receive a Certificate of Completion of Training (CCT) and will be eligible to be on the GMC Specialist Register. You can then apply for consultant posts.

Community Sexual and Reproductive Health
https://www.fsrh.org/education-and-training/specialty/
https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/community-sexual-and-reproductive-health

Training in community sexual and reproductive healthcare (CSRH) is a run-through training from ST1-6. Once you have been accepted at ST1, you will not need to apply again. Training normally lasts six years.

You will need to pass part 1 exams of the Faculty of Sexual and Reproductive Health (MFSRH) by the end of ST2. Part 2 of the MFSRH exams must be passed by the end of ST5 and before entering ST6.

Core Psychiatry Training
https://www.nwpgmd.nhs.uk/ct1_psy_recruit_overview
https://www.rcpsych.ac.uk/docs/default-source/training/curricula-and-guidance/curricula-core-psychiatry-curriculum-april-2018.pdf?sfvrsn=881b63ca_2

Psychiatry trainees have to successfully complete the three-year Core Psychiatry Training programme before applying in open competition for a place in a programme leading to a Certificate of Completion of Training (CCT) in one of the six psychiatry specialties.

Trainees who were appointed to Psychiatry Specialty Training prior to August 2008 were generally appointed to ‘run-through’ training posts.

The six psychiatry specialties are Child and Adolescent Psychiatry, Forensic Psychiatry, General Psychiatry, Old Age Psychiatry, the Psychiatry of Learning Disability and Medical Psychotherapy.

In addition, there are two sub- specialties of General Psychiatry; Substance Misuse Psychiatry and Rehabilitation Psychiatry and Liaison Psychiatry is a sub-specialty of both General Psychiatry and Old Age Psychiatry.

Core Surgical Training
https://www.jcst.org/uk-trainees/core-surgical-training/
https://www.rcseng.ac.uk/careers-in-surgery/trainees/foundation-and-core-trainees/surgery-career-paths/

CST has an indicative duration of 24 months. If you are looking to become an OMFS trainee then your CST can last up to 12 months, but this is the only specialty that does not require at least 24 months of CST or equivalent to start training at Specialty Training Level 3 (ST3).

The MRCS exam is an exit requirement for formal CST and must be obtained before you complete CST and start an ST3 post.

General Practice Specialty Training
https://gprecruitment.hee.nhs.uk/recruitment/training
https://www.rcgp.org.uk/training-exams/discover-general-practice/qualifying-as-a-gp-in-the-nhs.aspx

To become an independent General Practitioner in the UK, you must undertake at least three years of GP Specialty Training (GPST), normally including 18 months in an approved training practice with a further 18 months in approved hospital posts.

To ensure that you become a competent, effective and confident GP of tomorrow as well as directly addressing the GP curriculum, Deaneries will tailor your training to your individual needs and your particular rate of progress.

There is an increasing number of four year options available giving extra valuable experience. On joining a GP Specialty Training Programme you should register with the Royal College of General Practitioners. Gaining Valuable Experience.

Histopathology
https://www.rcpath.org/discover-pathology/careers-in-pathology/train-to-work-in-pathology/training-in-histopathology.html
https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/pathology/histopathology-doctor/training-and-development

Training to be a consultant histopathologist takes around five years. Once you have completed the first two years of histopathology training, you can decide to stay in general histopathology or move into one of the related sub-specialties – forensic histopathology, diagnostic neuropathology, paediatric and perinatal pathology or cytopathology.

There are four stages of training for histopathology: A, B, C and D

Stage A covers an introduction to surgical pathology, cytopathology, autopsy pathology and molecular pathology. Trainees can arrange a placement in paediatric pathology and neuropathology in either Stage A or Stage B.

During stage B, you’ll broaden your experience and understanding of histopathology, and will need to demonstrate your ability to perform a number of tasks before moving on – including independently cutting up specimens, screening cervical samples and writing reports on specimens and frozen sections.

During stages C and D you’ll have the opportunity to continue with histopathology, or specialise further in forensics, diagnostic neuropathology, paediatric and perinatal pathology or cytopathology. You’ll also be able to take on optional training in autopsies, cervical cytology and research methodology.

Internal Medicine Training
https://www.imtrecruitment.org.uk/
https://www.jrcptb.org.uk/internal-medicine
https://www.hee.nhs.uk/our-work/doctors-training/internal-medicine-training

Internal Medicine Training (IMT) forms the first stage of specialty training for most doctors training in physicianly specialties and will prepare trainees for participating in the acute medical take at a senior level and managing patients with acute and chronic medical problems in outpatient and inpatient settings.

Trainees must complete IMT and acquire the full MRCP(UK) (link is external) Diploma in order to enter specialty training at ST4 from 2022. Some specialties (group 2 specialties) will recruit trainees who have completed two years of IMT and completed MRCP(UK) at ST3 level.

IMT is a three year programme which will prepare doctors to become a medical registrar and provide them with the skills needed to manage patients presenting with a wide range of general medical symptoms and conditions.

Experience in intensive care medicine, geriatric medicine and outpatients will be mandated and trainees will receive simulation training throughout the programme.

Holistic decisions on progress will be made for the fourteen high level capabilities in practice (CiPs) using the professional judgement of appropriately trained, expert assessors. This represents a significant move away from the much criticised ‘tick box’ approach of the CMT curriculum.

Neurosurgery
https://www.yorksandhumberdeanery.nhs.uk/recruitment/national_recruitment/national_neurosurgery_st1__st3_recruitment
https://www.sbns.org.uk/index.php/education-and-training/how-to-become-a-neurosurgeon/
https://www.rcseng.ac.uk/news-and-events/media-centre/media-background-briefings-and-statistics/neurosurgery/

All neurosurgical jobs in the UK are appointed centrally once a year. The process takes place annually early in the year, hosted by the Yorkshire Deanery.

The MRCS examination is usually taken two to three years after full registration.

Neurosurgical trainees progress through 3 phases of training (ST1 - ST8). This usually takes 8 years.

The specialty board examination in neurosurgery is usually taken after completing ST6 .

After completing training and passing the examination the specialist advisory committee will consider whether a trainee is competent to complete training. A recommendation is made via the JCST to the GMC or Royal College of Surgeons of Ireland, and if a trainee is deemed competent, he or she will be placed on the specialist register and allowed to apply for a consultant job.

Obstetrics and Gynaecology
https://www.rcog.org.uk/en/careers-training/about-specialty-training-in-og/introduction-to-specialty-training-in-og/
https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/obstetrics-and-gynaecology/training-and-development

UK training in O&G requires a minimum of 7 years of specialty training (ST1–ST7), to be completed following the two years of foundation training. The programme is divided into basic, intermediate and advanced levels of training.

The programme follows the core curriculum, and also incorporates ultrasound training. Once you progress into advanced training, you’ll start to develop the specific skills needed for the areas in which you wish to practise as a consultant by choosing Advanced Training Skills Modules (ATSMs) or by applying for subspecialty training. If you wish to pursue an academic career, you’ll need to complete the academic curriculum.

Once you’ve successfully completed the programme, you’ll be awarded a Certificate of Completion of Training (CCT) or a Certificate of Eligibility for Specialist Registration – Combined Programme (CESR(CP)), depending on your route through training. This qualifies you for entry onto the Specialist Register in the UK, which you need to be able to practise as a consultant in the NHS.

Ophthalmology
https://www.rcophth.ac.uk/training/ost-information/
https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/ophthalmology/training-and-development

Ophthalmic Specialist Training (OST) requires a minimum of seven years of specialty training (ST1–ST7) to be completed following the two years of foundation training.

The award of a CCT is normally achieved after seven years in OST. Progress from one year to the next is determined by the achievement of learning outcomes as defined in the OST Curriculum. Achievement is determined by defined assessments, which is appropriately documented and scrutinised at the Annual Review of Competence Progression (ARCP). Assessment panels are convened from LETB/Deanery training committees and determine whether a trainee can progress to the next year, requires additional training time or should be released from the programme.

Trainees will need to pass three exams in order to progress through training:

Part 1 FRCOphth, which trainees will need to pass before they enter into the third year of ophthalmic specialist training

Refraction Certificate, which trainees will need to pass by the end of the third year of ophthalmic specialist training

Part 2 FRCOphth, which has a Written and Oral component. Trainees are required to pass this examination by the end of the seventh year of ophthalmic specialist training

Oral and Maxillofacial surgery
https://www.baoms.org.uk/professionals/careers_in_omfs.aspx
https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/surgery/oral-and-maxillofacial-surgery/training-and-development

To enter higher training in OMFS requires a registrable dental degree, a medical degree, a minimum of 12 months core surgical training, and possession of the MRCS. The MRCS (Membership of the Royal College of Surgeons) is the assessment of the required knowledge for completion of Core Training in surgery and is common across all surgical specialties.

Higher training in OMFS (5 years) is a year shorter than other surgical specialties. Throughout training progress is monitored and assessed utilising the on line Intercollegiate Surgical Curriculum Project (ISCP) with work based placed assessments and feedback linked to the curriculum. Every year there is an Annual Record of Competency Progression (ARCP). In the last year of training, each trainee must pass the Intercollegiate Fellowship Examination, leading to the award of the FRCS (OMFS) - the exit exam for our specialty. With the exam and a successful ARCP trainees are eligible for application for a Certificate of Completion of Training (CCT) to gain entry onto the GMC specialist list in OMFS.

Towards the end of training some OMFS trainees complete Interface Training Fellowships in Head & Neck Cancer, Cleft Surgery, Aesthetic Surgery, Laser Surgery or Trauma & Reconstructive Surgery. These fellowships are open to and interface with other specialties, hence their name.

Paediatrics
https://www.rcpch.ac.uk/resources/training-guide
https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/paediatrics/paediatrics/training-and-development

The training pathway consists of three levels. All trainees follow levels one and two of the general paediatric curriculum. At level three they decide whether to continue in general paediatrics or to apply to complete their training in a chosen sub-specialty.

Level 1 – ST1-3 (2-3 years) – provides basic knowledge of paediatrics and child health, with placements in acute general, neonatal and community paediatric posts. Full MRCPCH will be necessary to progress into level 2 training.

Level 2 – ST4-5 (1-2 years) – training will be provided mainly in district general hospitals (DGHs) using existing core training posts and rotations including community paediatrics and neonatology. There’ll be a greater emphasis on outpatient presentations, and the expectation of a higher level of performance in relation to common paediatric conditions, child development and safeguarding.

Level 3 – ST6-8 (2-3 years) – at Level 3, trainees may choose to enter subspecialty training in one of the accredited subspecialties or to stay on in general training.

Those wishing to enter subspecialty training may apply in competition for National Grid training in one of the 17 paediatric subspecialties, with entry at ST6 or 7 depending on the specialty curriculum.

StRs who are training in general paediatrics will be matched to year ST 6-8 posts by their local training programme directors (TPDs) in accordance with local availability of training opportunities, trainee requirements and preferences.

Public Health Medicine
https://www.fph.org.uk/training-careers/specialty-training/
https://www.healthcareers.nhs.uk/career-planning/study-and-training/graduate-training-opportunities/specialty-training-public-health

If you're accepted on the training programme, you'll usually be employed full time for five years (or longer if part time) to complete the training. This typically includes spending one year on an academic course and four years training on the job within public health teams.

You will also have assessments in the workplace and have to pass the Faculty of Public Health membership exams.

Once your training is complete, you'll be eligible for specialist registration via the relevant professional body. You can then apply for consultant-level posts in local authorities, the NHS or other settings.

References
https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors
https://www.st3recruitment.org.uk/
https://www.rcpch.ac.uk/education-careers/careers-paediatrics
https://www.nhsemployers.org/-/media/Employers/Documents/Pay-and-Conditions-Circular-MD-32018-270918.pdf

Post originally created by ecolier.

(edited 3 years ago)

Scroll to see replies

Reply 1

TSR George

All updated!! Feel free to suggest new specialties.

Post originally created by ecolier.

(edited 3 years ago)

Reply 2

Helenia

You can do Core Anaesthetics at CT1, doesn't have to be done via ACCS.

Reply 3

TSR George

Original post by Helenia

You can do Core Anaesthetics at CT1, doesn't have to be done via ACCS.

Will update

Post originally created by ecolier.

Reply 4

Democracy

Radiology and histopathology are both five year run throughs.

Is this going to be added onto to the TSR Medicine wiki?

Reply 5

TSR George

Original post by Democracy

Radiology and histopathology are both five year run throughs.

Is this going to be added onto to the TSR Medicine wiki?

Cool, will update.

That is not my intention as this format allows discussion. Also who knows that TSR Medicine wiki exists anyway?

Post originally created by ecolier.

Reply 6

Democracy

More people might if it were better promoted and editable :tongue:

A lot of time and effort went into it.

Is this going to be similar to a megathread...?

Reply 7

TSR George

Original post by Democracy

More people might if it were better promoted and editable :tongue:

A lot of time and effort went into it.

Is this going to be similar to a megathread...?

Probably not, it may consist of a few threads. It's not just basic medical specialty information but also discussion of scientific topics and other things .

Read https://www.thestudentroom.co.uk/showthread.php?t=6021440

Post originally created by ecolier.

Reply 8

Democracy

I have

Though BASICS makes it sound all PHEM-y :tongue:

Reply 9

TSR George

Original post by Democracy

I have

Though BASICS makes it sound all PHEM-y :tongue:

It's only for the "basic" information. The things that most people are actually going to be interested in is going to be in "topics" :smile:

Post originally created by ecolier.

Reply 10

username3901812

Is this the place to ask related questions? I'm interested to know what Public Health doctors do, and why is it so competitive to become one?

Reply 11

TSR George

Original post by jzdzm

Is this the place to ask related questions? I'm interested to know what Public Health doctors do, and why is it so competitive to become one?

Yes! I will be updating the first post with more information but you have asked a very good question.

Read https://www.fph.org.uk/training-careers/careers-in-public-health/ and https://www.fph.org.uk/training-careers/specialty-training/

There are many reasons why Public Health Medicine specialty training is super competitive, one of them is because it allows non-medical doctors to apply as well as medics. It usually attracts very well-qualified non-medics (e.g. Midwife with PhD in a Public Health or something similar).

I did 4 months as an FY2 in Public Health, it was amazing (not as good as neurology, obviously :giggle:

)

Post originally created by ecolier.

Reply 12

Beska

Since it was tucked away, nearly nobody. However provides enough information to answer the vast majority of questions asked on this forum and my and colleagues spent a vast amount of time creating and updating it over the years..!

Reply 13

GANFYD

Original post by Beska

It is where I started all my research, so thank you very much!

Reply 14

TSR George

Don't worry I haven't forgotten about this. I have updated a few bits (including the first few specialties and the latest wages!!) for now :h:

Post originally created by ecolier.

Reply 15

Reality Check

Original post by Beska

I thought I was relatively well versed in the nooks and crannies of TSR and I must admit I'd not heard of it. Couldn't it be promoted again - the TSR medics are the stand-out part of the website, and it seems a terrible shame that such a valuable resource should be hidden away.

Reply 16

Angury

That is my contribution.

(Also great idea and happy to answer questions re Psychiatry training as it seems to be becoming quite popular amongst medical applicants).