After graduation from medical school, they will have undertaken several years of work and training as a pre-registration house officer and senior house officer, and will usually have taken examinations for membership of the Royal College of their speciality. For example, medical registrars will take the MRCP examinations to enable progression to become registrars.
Entry to the grade of SpR is now closed and thus information is largely historical, but competition for specialist registrar posts was regarded as tough. Regional advertisements were placed by local deaneries, which controlled the number of places and the funding for posts. Open competition was afforded and, via shortlisting and interviews, successful applicants were given posts for 4-6 years depending on the speciality. A National Training Number was awarded concurrently and was attached to the post rather than the doctor, again historically. The number of posts available was strictly linked to the number of consultants required in a particular speciality, and therefore in the more popular specialities it often took many attempts to get a post - leading to what is known as the "SHO bottleneck", whereby doctors are stuck at the grade of senior house officer for a number of years. Changes in postgraduate medical training (Modernising Medical Careers) are underway to alleviate this problem. Choice of final specialty is now limited by success in application, rather than time spent waiting for a post to be available and offered to you. This new method is more ruthless, but prevents stalling in career progression and should eliminate the number of doctors uselessly waiting in posts of dubious educational value. It does however hinge on a fair and robust selection process for the highly desirable posts, something that initially was a total and unmitigated disaster (MTAS).
Specialist registrars generally stay in post for around five years (more or less depending on the speciality), gaining experience at first in a broad speciality (e.g. general medicine), later specialising in a subspeciality (e.g. cardiology) after which they receive the Certificate of Completion of Training (CCT). The CCT is awarded based on satisfactory yearly RITA assessments and completion of an 'exit' exam or fellowship diploma in the specialty from one of the UK surgical colleges. After this a Certificate of Eligibility to the Specialist Register (CESR) is awarded. Listing on the Specialist Register permits application to consultant jobs. Specialist registrars are encouraged to undertake research in their field, and many choose to do this by means of a PhD or MD.
The SpR/registrar grade is set to disappear in 2007 with the full introduction of MMC. Instead, trainees will be referred by their ST level (e.g. ST3). ST3 roughly equates to the first year of SpR training, although standards of experience are now often far wide of this, secondary to the diminution of training at work and the effects of the European Working Time Directive