If you are an international medical graduate planning a career in UK hospital medicine, the exam pathway can feel labyrinthine. This guide maps the entire route from GMC registration through to CCT, explaining which exams you need at each stage and how they connect.
Stage 1 — GMC registration
Before you can practise in the UK, you need full GMC registration with a licence to practise. For most IMGs, this means passing PLAB 1 (a 180-question SBA exam testing applied medical knowledge) and PLAB 2 (a clinical OSCE). Some IMGs are exempt from PLAB if they hold a recognised primary medical qualification from a scheduled country or have passed equivalent examinations.
From 2025 onwards, the UKMLA is replacing PLAB for new UK medical graduates, but the PLAB pathway remains open for IMGs.
Stage 2 — Core medical training entry
To enter core medical training (CMT or IMT), you need to pass the MSRA (Medical Specialty Recruitment Assessment). The MSRA is a computer-based assessment with two components: Clinical Problem Solving (97 SBAs) and Professional Dilemmas. Your MSRA score determines your competitiveness for training programme allocation.
Stage 3 — MRCP during core training
During core medical training (CT1 to CT3 or IMT1 to IMT3), you need to pass MRCP. This consists of three parts: MRCP Part 1 (200 BOF questions across two papers — general medicine), MRCP Part 2 Written (the same format but with more clinical application), and PACES (a clinical examination with five stations). You must pass all three parts to obtain Membership of the Royal Colleges of Physicians.
MRCP is required to progress into higher specialty training. Without MRCP, you cannot enter an ST3 training number in any medical specialty.
Stage 4 — SCE during higher specialty training
Once you enter higher specialty training (ST3 to ST7), you must pass the Specialty Certificate Examination in your chosen discipline before completing training. There are 13 SCEs covering the medical specialties. The SCE tests specialist knowledge at consultant level — it is substantially more focused and more difficult than MRCP within its specialty domain.
You must attempt the SCE by your penultimate year of training (typically ST6). If you fail, you can resit at the next available sitting, but this may delay your CCT if the timing is tight.
Stage 5 — CCT
Once you have passed the SCE, completed the required training period, and satisfied all ARCP requirements, you receive your Certificate of Completion of Training. CCT entitles you to apply for consultant posts and to be entered on the GMC Specialist Register.
Alternative pathways
Some IMGs enter the UK system at higher levels — for example, as specialty doctors or locally employed doctors — and pursue CESR (Certificate of Eligibility for Specialist Registration) rather than CCT. The CESR pathway does not require the SCE but does require evidence of equivalent specialist knowledge.
Some specialties outside the Federation of Royal Colleges — surgery (MRCS), psychiatry (MRCPsych), paediatrics (MRCPCH), anaesthesia (FRCA), emergency medicine (MRCEM), ophthalmology (FRCOphth) — have their own exam pathways that run parallel to the MRCP/SCE route described above.
Where iatroX fits
iatroX covers exams across the entire pathway: PLAB 1 and UKMLA for registration, MSRA for recruitment, MRCP Part 1 for core training, all 13 SCEs for higher specialty training, plus MRCPCH, MRCPsych, FRCA, MRCEM, and the specialist diplomas. All are included in a single subscription at £29 per month or £99 per year — meaning a single subscription can support an IMG from GMC registration through to consultant-level exams without ever needing a second platform.