Understanding Junior Doctor Grades and Titles
The increase in reporting and discussion about ‘junior doctors’ in the media has highlighted a massive issue - the term ‘junior doctor’ and the multitude of acronyms used to differentiate doctors are poorly understood by both the general public, the media, and even medical professionals.
From outdated terms to newly invented ones, we have curated and defined a list of confusing terms, acronyms, and abbreviations to help you navigate the broad variety of grades and job titles that currently exist in the UK for doctors.
So whether you are a recent medical graduate or coming to the UK from abroad, aren’t sure if a job listing is the right level for you, or you just want to double check how senior your colleagues are - this article will help you understand all of the junior doctor grades in the UK and the different terms used to describe them.
🩺 Training roles
Foundation Training (FY)
👉 FY1/F1/HO/PRHO: After graduating from UK medical school, doctors enter a training programe called Foundation Training. In their first year of this training programme, they are called Foundation Year 1 doctors (FY1 or F1). Occasionally these doctors may be referred to as House Officers (HO) or Pre-Registration House Officers (PRHO) which were the terms more commonly used pre-2005 (before the Modernising Medical Careers (MMC) changes were instituted).
👉 FY2/F2/SHO: After completing the first year of this two-year programme, doctors gain full registration with the GMC and become Foundation Year 2 (FY2 or F2) doctors. From this point on, they may also be referred to as Senior House Officers (SHOs) which is an umbrella term for multiple grades of UK doctor.
Middle-Grade Specialty Training (SHO)
When a doctor has completed their foundation training years, they can apply for a further training pathway to pursue a career in a particular specialty. Depending on the specialty they choose, they may gain different acronyms to describe their grade.
👉 Internal Medicine Training (IMT): In 2019, changes to the structure of internal medicine training pathways (previously called core medical training (CMT)) extended internal medicine training programmes from 2 to 3 years for some specialties (known as Group 1 specialties). If a doctor joins an internal medicine training programme, they will become an IMT1 and progress to IMT2 and IMT3 after each completed training year (though some trainees will leave this pathway after IMT2 for a Group 2 specialty training programme). *Note that some IMG3’s are referred to as Registrar, not SHO though this is inconsistent across Trusts as the IMG3 role is very new (2019).
👉 Core Training (CT/CST): Core training grades still exist for a number of specialties such as emergency and surgical training pathways. If a doctor enters one of these training programmes, they will become a CT1 and then, after successful competition of the first training year, a CT2 before they move on to higher training. Note that sometimes doctors use the terms CMT and CST to differentiate between Core Medical and Core Surgical Trainees, even though the CMT programme was replaced by the IMT programme in 2019.
👉 Specialty Training (ST): Some training programmes (such as Radiology) consider their trainees ‘specialists’ or ‘registrars’ from the first year they enter the programme. Some people may refer to these doctors as ‘junior registrars’ to differentiate between middle grade and higher grade trainees. If a doctor joins one of these programmes, they become an ST1 and, after completing the first training year, an ST2.
👉 General Practice (GPST): General practice is another specialty that refers to their middle grade trainees as ‘registars’ or ‘GP registrars.’ Entering a general practice training program will earn a doctor the grade GPST1. As they continue along this pathway, they will become GPST2’s and then GPST3’s after which they will have completed the training pathway.
👉 Academic Clinical Fellow (ACF): Not to be confused with clinical fellows (see section on fellowships below), the term can Academic Clinical Fellowship can refer to a national medical training programme that incorporates academic work into a typical training post. Therefore, it comes under the heading of a training role rather than a typical fellowship role.
Higher Specialty Training (Registrar, SpR)
👉 Higher Specialty Training (ST): Once a doctor has completed the IMT/CT/middle-grade ST years (not including general practice), they may need to reapply for a higher specialty training post to continue progressing up their chosen career ladder. Though some programmes are ‘run-through’ meaning doctors do not need to re-apply for training, most programmes will require doctors to complete the middle-grade training programme before entering the higher grade training programmes.
Depending on how many years they did as an IMG/CT/ST when they enter higher level specialty training, they join the ST acronym, plus one more than number of years they have competed in specialty training. For example if they completed IMT3, then they enter higher specialty training as an ST4. If they completed CT2, then they would next become an ST3 if they move onto higher specialty training.
These training paths can last up to 6 years (ST9) in some specialties. During this time, doctors can use the umbrella term Specialty Registrar (SpR) or differentiate themselves by their grade (i.e. ST4 vs ST9).
🩺 Non-training roles
👉 FY3/F3/FY3+ : After completing foundation training, and gaining their Foundation Programme Certificate of Competencies (FPCC), doctors are then free to choose a number of different career avenues. If a doctor choses not to pursue a training pathway, they are usually referred to as an FY3 or F3 doctor. This means that though they have not progressed up the training ladder, but can continue to mark their years of work or experience by adding a number for each year they remain out of training (i.e. FY4, FY5, FY6 etc..).
Often this title is combined with the type of role they are currently doing, for example; ‘F3 locum doctor’, ‘F5 clinical fellow’, or ‘F4 Trust Grade’ though this is not a requirement and a doctor may choose to use either the F3+ title, or the title of the role they are working in i.e. ‘locum doctor’.
👉 Consultant: A consultant is a doctor who has completed their specialty training, are listed on the GMC specialist register, and have gained their Certificate of Completion of Training (CCT). Doctors who are have a achieved their CCT but are not working in a consultant post may may refer to themselves as ‘a post-CCT doctor’ or ‘a post-CCT clinical fellow’.
👉 General Practitioner (GP/GPwSI): A GP is a doctor who has completed the GP specialty training pathway and is on the GMC’s GP register. They are generally not referred to as a consultant, but as a GP. Some GP’s have additional training and accreditations in a particular specialist area, known as ‘special interests’, and are referred to as GP’s with a Special Interest (GPwSI).
👉 Locum: A locum doctor provides ad-hoc or temporary covering in the event of an unexpected rota gap. Any grade of fully qualified (post-FY1) doctor can work as a locum, and their grade will determine their pay rate. Often, locum doctors will describe their role by combining the word ‘locum’ with their grade i.e. ‘locum F3’ or ‘locum consultant’.
🩺 Substantive roles
If a doctor decides to take on a substantive (contracted) non-training post, they can be referred to by the title of that role. The most common substantive roles are fellowships, trust grades, and SAS roles.
👉 Fellowships: Fellowships come in a number of different types (i.e. clinical, academic, research, teaching, etc) though both of the terms ‘fellowships’ or ‘clinical fellowships’ are also used generically. There can be significant variety between different fellowship roles, but they generally include some clinical responsibilities plus additional learning, teaching, or research components. You can learn more about fellowships by exploring the articles in our Clinical Fellowship Hub.
If a doctor between FY2 and IMG2/CT2/ST2 takes on a fellowship role they may be called a junior fellow or a junior clinical fellow. If the doctor has experience of an ST3 - ST9 then may may be referred to as a senior fellow or a senior clinical fellow. Alternatively, in both cases the doctors may simple just be referred to as a ‘clinical fellow’.
👉 Trust Grade: If a middle-grade doctor takes on a fixed-term substantive role offering the same service provision of trainee but without the requirement of being on a training programme, they are typically referred to as a trust grade doctor. Usually these roles are created by Trusts to plug rota gaps created by unfilled training posts, and therefore advertisements for these roles will generally specify the grade of doctor they are looking for i.e. Trust Grade CT2. You can learn more about trust grade roles here.
👉 Staff Grade, Associate Specialist and Specialty Doctors (SAS): These are higher specialty grade doctors or post-CCT doctors who takes on a substantive role offering the same service provision as a registrar but without all of the same requirements and restrictions of a training post. These doctors have at least four years of postgraduate training, two of which are in a relevant specialty to their SAS role and their work as an SAS doctor can be used to progress their career and work towards a Specialist Registration via the CESR (Certificate of Eligibility for Specialist Registration) or CEGPR (Certificate of Eligibility for General Practice Registration) routes.
📑 General terms
👉 International Medical Graduate (IMG): Previously known as a foreign medical graduate (FMG), this term refers to a doctor who gained their medical qualifications outside of a UK-licensed or recognised medical school or region.
👉 Junior Doctor: The umbrella term ‘junior doctor’ is used to indicate a doctor who has not completed a training programme, whether that is in General Practice or another specialty. This encompasses all doctors from grade FY1 - ST9, including all the doctors in non-training roles within these grades. In theory, these doctors cannot work independently and require supervision but in reality, these doctors are often expected to work independently and manage wards and patients on their own.
👉 Senior Doctor: The term ‘senior doctor’ is used to indicate a doctor who has completed training and can practice independently without supervision. This umbrella term can be used to describe consultants and GPs, and post-CCT SAS doctors (staff grade, associate specialist, specialty doctors).
👉 Locum Appointment for Service (LAS): This term is not commonly used but refers to a temporary fixed-term registrar role required to fill a gap in service provision. This may be caused by inadequate recruitment or retention onto a training pathway, or a change in the service requirements of the hospital that requires a more rapid staffing response.
👉 Locum Appointment for Training (LAT): This term refers to a fixed-term registrar role that allows a doctor to temporarily join a training programme. This may be caused by a long term planned absence of a trainee (i.e. due to parental leave or to do research) from training programme.
We would love to know your thoughts on this, so please feel free to get in touch with us at firstname.lastname@example.org if you have any questions or comments about this article.
This article is part of a wider series of comprehensive guides and information to help doctors ensure their F3 year is a success. We cover everything from initial planning, options for moving abroad, help with finding work, and tips for making the most of the experience.
Click here to visit our F3 Resource Hub to explore the full list of guides and articles.
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