Specialty training at ST1 and CT1 in England

Authors: Alison Carr, Elaine Sullivan, Steve Buggle, Patricia Hamilton 

Publication date:  30 Nov 2011

Alison Carr and colleagues analyse the competition and ask what lessons can be learnt from 2011

Every year more than 10 000 medical trainees apply for entry into specialty training at the specialty training year 1 (ST1) and core training year 1 (CT1) level, most of whom apply directly from the foundation programme. This article is written for trainees (and their trainers) to guide them in using information available from previous recruitment rounds to help inform their career choices and optimise their success during selection.

This paper relates to specialty training in England, where doctors may apply for up to 10 ST1 run-through specialties and for five core training programmes in specialties at the ST1 and CT1 level. The selection processes are now managed entirely through nationally coordinated recruitment and electronic applications, and thus robust information on competition for specialty training posts is available.

We identify competition ratios in 2011 for entry into specialty training at ST1 and CT1 level across all specialties in England and look at what other factors need to be taken into account when choosing a specialty.

What did the competition for ST1 and CT1 posts look like in 2011?

In 2011, 10 946 applicants made 15 524 applications for 7381 posts in round 1. This equates to an overall competition ratio of 1.5 applicants per post and 2.1 applications per post. Over half (6349 (58%)) of applicants listed their current post as being in the foundation programme. Figure 1 shows the proportions of posts available and applications made for 14 of the specialties in 2011.

Fig 1 CT1 and ST1 posts available and applications made to 14 specialties, as % of total (England*, 2011)

At first glance there did not seem to be large differences in 2011 between the number of posts available and the proportion of applicants for those posts, but multiple applications were often made, and consequently competition varied between specialties. Figure 2 shows the competition ratios (reported as number of applicants per post) for the top five specialties.

Fig 2 Competition ratios in top five specialties, England 2011

Competition ratios are useful to know because they are an indication of the popularity of specialties and the chance of success. The ratios show that neurosurgery (14 posts available) and public health medicine (with 66 posts) were the most competitive specialties at ST1 and CT1 level. Public health medicine is unique because its applicants can be medically qualified or non-medically qualified. Paediatrics, general practice, and core psychiatry had the least competition in applications.

However, competition ratios must never be viewed in isolation, particularly as we now have more detailed information on applicants’ behaviour. Competition ratios would be accurate as indicators of popularity only if applicants applied to one specialty. Figure 3 summarises the numbers of applications made by applicants.

Fig 3 No of specialties applied to by applicants at ST1 and CT1, England 2011

In 2011, 56% of applicants applied to only one specialty, and 83% of applicants applied to only one or two specialties. This contrasts markedly with 2008, when more than 37 000 applications were made at CT1 and ST1 level for 5800 posts, an average of 6.4 applications per post. Clearly the introduction of nationally coordinated recruitment and the year on year improvements in standardisation of selection processes now mean that trainees need to make fewer applications to secure a post. This allows trainees more time to work on the applications they make, and the selectors are now able to concentrate on interviewing applicants face to face rather than devoting time to shortlisting.

Several other important factors need to be taken into account when working out a specialty’s popularity. To assess competition reliably, several variables need to be considered:

  • The number of unique applicants to the specialty in comparison with the number of posts available

  • The number of other specialties the applicants have applied for, and

  • The geographical differences in popularity within specialties.

Unique applications

There are differences between specialties in the proportion of applicants who make a unique application, as shown in figure 4 .

Fig 4 Unique applicants (%) in each specialty at round 1 at CT1 and ST1 level in England, 2011 (n=No of applicants per specialty)

The proportion of unique applicants to specialties varied from 17% for the acute care common stem (ACCS) to 84% for public health (the only specialty available to non-medically qualified applicants). Most doctors applying for ACCS also apply for anaesthetics.

Looking across all specialty applications shows that “job families” (related specialties) emerge. A number of applicants apply for one or more of the “family based” medical specialties, such as general practice, paediatrics, core medical training, and psychiatry. Nearly half of those applying for neurosurgery also apply for core surgical training.

Useful information about competition also comes from considering the number of unique applicants per post in each specialty (figure 5 ).

Fig 5 No of unique applicants per post in 12 specialties, England 2011

In some specialties there are fewer unique applicants than there are posts. Although this does not mean that the specialty won’t fill its posts, it is likely that unless many other trainees apply who are applying to several specialties, the specialties may not be competitive. There are twice the number of posts in ACCS, anaesthetics, and core psychiatry than there are unique applicants to the specialty. In ACCS and anaesthetics most posts are filled in round 1, but core psychiatry often has vacancies at the end of the recruitment round.

In specialties that have more unique applicants than posts available, some applicants will not be appointed to the specialty. In this position, with no other specialty application as a back-up, doctors who are not appointed to the specialty of their choice will be without a job at the end of recruitment round 1. A useful example to illustrate this is from core surgical training. In 2011, 1355 applicants applied for 646 surgical CT1 posts, of whom 837 (62%) applied only to surgery. Almost 200 applicants were unlikely to be appointed to CT1 surgery in round 1 and to be without ST posts.

Applicants who make more than one specialty application often apply to related specialties. Figure 6 shows details of applicants’ behaviour in 2011.

Fig 6 Overlap of applications in 12 specialties

Geography also has an effect on competition. In some specialties, competition ratios in a specialty may vary by 10 times across deaneries in England, so it is useful where possible to find out how many applicants applied to the deaneries in previous years. Figure 6 indicates how likely it is that those who applied for a given specialty may have also applied to other specialties.

What is the advice for applicants to specialty training in 2012?

It is important that those applying to specialty training consider the options very carefully. Making large numbers of applications will never compensate for not having made the best possible application.

Applicants need to decide whether choice of specialty is more important than location. For doctors applying for competitive specialties, a back-up plan is very important. This may be resolved by applying to several units of application or by applying to several specialties in the same location.

Further information about applying to specialty training is available in the applicants’ guide 2012 at [Link] .


Information is now available on selection into ST1 and CT1 in previous recruitment rounds, and all applicants in 2012 to ST1 and CT1 should study the trends that are available. Surgical specialties remain the most highly competitive specialties at this level. The largest specialties providing doctors with the greatest opportunity of appointment are general practice and core medical training, with 3268 and 1181 posts, respectively, and low competition ratios.

We thanks deanery staff and staff involved in selection in the royal medical colleges for their help in data collection. Thanks also to Daniel Smith from London Deanery for his help with data analysis.

Competing interests: None declared.

Alison Carr senior clinical adviserconsultant paediatric anaesthetist  Medical Education and Training Programme (England), Department of Health, London, UK
Elaine Sullivan specialty recruitment manager  Medical Education and Training Programme (England), Department of Health, London, UK
Steve Buggle operations director  Medical Education and Training Programme (England), Department of Health, London, UK
Patricia Hamilton director of medical education  Medical Education and Training Programme (England), Department of Health, London, UK


Cite this as BMJ Careers ; doi: