Introduction
First, breathe. You’re not alone. In 2025, around 24,000 doctors were unsuccessful at getting into specialty training. This article will help you figure out what your options are and how to give yourself the best chance of success when applying for specialty training.
Keep in mind that different specialties will have intakes at different times of the year, and some may have one intake per year, whilst others will have several.
Your first priority is finding work
While preparing for your next attempt to get into specialty training, you need a job to live!
Your options include:
- recruitment agencies for full-time or part-time work
- locum agencies for ad hoc work
- NHS Jobs
- BMJ Careers website – hyperlink https://www.bmj.com/careers/
- specialty society websites (explain what these are and how to find them)
- deanery websites
- professional networks – ask around/people you know (elaborate) – these are often not advertised on websites
Here are the top 3 options I recommend based on my experience: working as a locum, finding a Trust Grade role, or becoming a clinical fellow.
Option 1: Work as a locum
As a locum you will not have a fixed contract and therefore command a higher hourly rate. The main downsides are:
- less job security, i.e. if they don’t need you, they won’t hire you
- no dedicated supervisor
- no portfolio building
While locuming is not ideal, it does allow a more flexible schedule so you can put more effort into your specialty applications. Although locuming is probably the easiest to get into, you want to focus on finding regular positions at a single or a small number of sites.
Option 2: Find a Trust Grade role
A Trust Grade role is a fixed-term position where you are directly employed by an NHS Trust. These are essentially the same as your rotations, but non-training.
You should arrange clinical supervision and regular appraisal. This is one of the benefits of this option rather than locuming.
Option 3: Become a Clinical Fellow
Becoming a Clinical Fellow is the ideal option, but harder to come by. This is similar to a Trust Grade but with non-clinical time built in to work on one or more of the following:
- research
- quality improvement
- teaching
- simulation
These are invaluable towards building your portfolio and strengthening your application for a speciality.
You can also apply for a Teaching Fellow position, where the focus is on teaching rather than research. You must negotiate clinical supervision to generate portfolio evidence.
The next step is to plan your year
After you’ve got a job, you need to make sure that when the next time to apply for specialty training comes around, you’re ready. There are two things you need to do:
- Read the person specification for your chosen specialty and self-score your portfolio
- Find out the number of intakes available for your chosen specialty
Specialty training Person Specification
Almost all specialties will have a person specification which allows doctors to self-score their portfolio. This is a crucial first step as it will allow you to structure your year and identify specific actionable gaps that you can address in your specialty training application.
You can find the specific one for your specialty on the NHS England HEE website.
Find out when you can apply for specialty training
The next time you can apply for specialty training will differ depending on the specialty. For example, GP has several intakes a year; while others are only once a year. You can find out the next intake for every specialty on the NHS recruitment website.
Knowing the date of the next intake will help you decide what job you can take this year, and how long you can do it for. And you should clarify with your employer a suitable notice period when you start your job.
How to maximise your specialty training application score
It’s important to build your portfolio to give yourself the best chance of getting invited to selection. If you’re wondering how to maximise your specialty training application score, make sure to strengthen your portfolio with:
- Audits
- Quality improvement projects (QIP)
- Teaching
- Publications and presentations
- Work-based assessments and logbooks
- Courses
- Networking
- Peer review
Audits
Speak to your department’s audit lead to find out how to conduct closed-loop audits. This means:
- Audit
- Implement change
- Re-audit
These will score far higher than just an audit alone at selection.
Quality Improvement Projects
Teaching experience and developing skills in teaching feature in many specialty applications. Aim to organise or deliver teaching sessions locally, or nationally or regionally if you have the opportunity. Be sure to collect evidence of feedback for your portfolio.
Speak directly with clinicians working in your chosen specialty to identify useful Quality Improvement Projects (QIPs). Also check NHS Futures or local quality improvement forums for ongoing and completed QIPs. Then register the QIP through your Trust and seek supervision from a consultant you would like to work with to get it approved and signed off.
In recent times there has been a much sharper focus on human factors with an increasing acknowledgement on the profound effect this has on outcomes. This is a great place to start your QIP, and undertaking a focused course on human factors in healthcare is an excellent first step.
Teaching
You can teach medical students and FY1s. Ensure you keep a record and obtain feedback questionnaires as evidence for your portfolio. Undertaking courses in teaching are an excellent way to further enhance this part of your portfolio.
Publications and presentations
These tend to score high points on person specifications, however, get started on these early. A poster presentation at a conference, especially at regional level, can be achieved in months, whilst a paper published in a journal may take longer.
Work-based assessments and logbooks
Keep up with your work-based assessments (WBAs) and/or logbook records. During the application stage or the interview you will often be asked to demonstrate a level of competence or progression in your capabilities. WBAs and logbooks are the ways to evidence this.
Courses
Some specialty application processes award points for courses such as “Trainer the Trainers“.
Check if completing courses specific to your chosen specialty could help with demonstrating a ‘commitment to specialty’. This is often a significant component of interview scoring.
Networking
Network through national associations and specialty societies in your chosen field. Look for opportunities to volunteer at conferences too.
Building relationships this way can open doors for career advice, teaching roles and genuine mentorship. Taking a focused course in advanced communication specifically designed for doctors can help you better navigate building professional relationships.
Peer review
Peer review is the process of reviewing a paper that has been submitted to a journal. If you’re not familiar with papers, there is plenty of guidance on how to do this. Reach out to journals — they regularly welcome peer reviewers, and this looks great on your portfolio.
The final step: Getting through selection
You’ve got a job, set your year up, and have a portfolio to be proud of. The final step is to get through selection. This involves two phases: interview preparation and exam preparation.
Specialty training interview preparation
Specialty training interview preparation is vital and understanding that an interview is an exam itself, not a conversation. It’s prescriptive and you get scored on what you say. This is a positive, even if it doesn’t feel like it. Here’s how to approach it:
- Speak to as many real people as possible who have gone through the interview. Both those who have and have not passed the interview. They can give you first hand experience on what specialty training interview questions will come up.
- Take a course. There are medical specialty interview courses written by experts, where they take you through each step of the specialty interview, down to the minutes to spend on sections and common pitfall areas.
- Practise! Do specialty training mock interviews with colleagues and friends. Speaking in front of a real person is more likely to build up your confidence to help you ace the interview.
- Leadership is a large part of medicine and having a good understanding and examples where you have been in leadership are important. This can be a very complex area, and one many doctors can overlook, so undertaking a focused course on medical leadership and management can greatly enhance your chances of success at interview.
Exam preparation
Written exams are becoming increasingly common, and a great deal of specialties are using exams such as the Multi-Specialty Recruitment Assessment (MSRA). I would strongly recommend an MSRA question bank, which helps you develop good exam technique and allows you to identify high-yield topics to study in detail. Exams are often the hurdle preventing great candidates from going to interview.
All that being said, don’t forget to take some time for your own wellbeing.
Focus on your own wellbeing
While this can be a stressful time, even for the most resilient of people, here are three points I would like you to think about:
- Consider other specialties. You could use this time to explore or do taster days in other specialties. Time is on your side and you have a whole year, so make the most of it.
- You’ve achieved incredible things so far — medical school and foundation training. You’re on a journey countless other doctors have taken before you, so ask them for help if you need it. Be kind to yourself too.
- If you feel you need additional support, reach out to the Practitioner Health Programme, a confidential counselling service that is directly for healthcare staff. The BMA also run a 24/7 counselling service.
