A senior house officer (SHO) is a junior doctor undergoing training within a certain speciality in the British National Health Service or in the Republic of Ireland. SHOs are supervised by consultants and registrars, who oversee their training and are their designated clinical (and in many cases educational) supervisors. In the United States, physicians in training are also referred to as "senior house officers" in their later years of residency, but the term is more variable in its American than British usage. Since the introduction of Modernising Medical Careers (MMC), the relevant grades have been replaced with other terms, but the term remains in use in many organisations.
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Before MMC, doctors applied for SHO posts after completing their mandatory pre-registration house officer (PRHO) year after qualifying from medical school. They would typically work as an SHO for 2–3 years, or occasionally longer, before to a certain subspeciality where they would take up a specialist registrar post to train as a specialist in that particular field . To qualify for these, SHOs had to be in posts approved by a regional postgraduate dean, as well as passing postgraduate exams (such as the Membership of the Royal College of Physicians, MRCP).
SHO jobs typically lasted 4 or 6 months in various departments and were often provided in 1- or 2-year rotations. Posts not recognised by the Deanery were typically referred to as "Trust SHO", "Junior Clinical Fellow" or with similar terms.
In 2002, the Department of Health announced reforms in the training of newly qualified doctors under the banner of "Modernising Medical Careers",[1][2] merging the PRHO year and the first year of SHO training into a "foundation programme" (FY1 and FY2). This programme was formally introduced in August 2005.[2]
In August 2002, Professor Sir Liam Donaldson, the then Chief Medical Officer, published a report titled "Unfinished Business", which focused on reforming SHO training.[3] The SHO grade was abolished and renamed specialty registrar. This change took place in 2007. Amongst the many changes, many doctors who had completed their Foundation Training were now appointed into a "run-through" training programme that incorporated the previous SHO and specialist registrar grades. The job title changed from "SHO" to "ST1/ST2" (specialist trainee year 1 & year 2). Part of this decision was subsequently reversed in a number of specialties, with competitive entry into the registrar grade ("uncoupled training"), and in these specialties the SHO level posts are referred to as "CT1/CT2" (core trainee year 1 & year 2) and in some "CT3".
Doctors not on a formal training programme may still be appointed in what is referred to as "Fixed Term Specialty Training Appointment" (FTSTA). Many of these positions are advertised by employing hospitals under different names, similar to the pre-MMC situation.
Many hospitals use the term "senior house officer" unofficially for doctors in FY2 and CT1/2 year, who often have similar working patterns in duty shift rotas.
| Old system | New system (Modernising Medical Careers) | |||
| Year 1: | Pre-registration house officer (PRHO) - one year | Foundation Doctor (FY1 and FY2) - 2 years | ||
| Year 2: | Senior house officer (SHO) a minimum of two years, although often more |
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| Year 3: | Specialty Registrar (StR) in a hospital speciality: minimum six years |
Specialty Registrar (StR) in general practice: three years |
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| Year 4: | Specialist registrar four to six years |
GP registrar- one year | ||
| Year 5: | General practitioner total time in training: 4 years |
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| Years 6-8: | General practitioner total time in training: 5 years |
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| Year 9: | Consultant total time in training: minimum 7-9 years |
Consultant total time in training: minimum 8 years |
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| Optional | Training may be extended by pursuing medical research (usually two-three years), usually with clinical duties as well |
Training is competency based, times shown are a minimum. Training may be extended by obtaining an Academic Clinical Fellowship for research or by dual certification in another speciality. |
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