ENT training
Training workspace
ENT training roadmap
Browse the indicative route from ST3 to CCT, including curriculum expectations, index procedures and ARCP evidence.
Verified 1 September 2026 against the official Otolaryngology Curriculum August 2021, version 2 July 2023. The national curriculum defines outcomes at the end of phase 2 and at certification, not compulsory targets for each ST year. The year cards are planning prompts and local ARCP requirements may differ.
ST3 to ST8
See the whole route to CCT
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CT1-CT2 / ST1-ST2
Core surgical training or run-through years 1-2
Complete phase 1 requirements and the required membership examination before progression or phase 2 entry
ST3-ST6 (indicative 4 years)
Higher surgical training in general ENT
End-of-phase 2 ARCP Outcome 1 and the knowledge, clinical and professional skills required for ISB examination eligibility
ST7-ST8 (indicative 1-2 years)
Special interest and completion
Pass the ISB examination, meet all curriculum outcomes and receive final ARCP Outcome 6
Foundations of general ENT. Build emergency competence. Begin building logbook across all subspecialties.
Operations focus
- High-volume general lists: tonsillectomy, adenoidectomy, grommets, septoplasty, nasal manipulation
- Start building the operative logbook with the supervision role recorded for every case
Clinical
- Start rotating through general ENT subspecialty clinics (paediatric, otology, rhinology, head & neck, voice)
- Build emergency exposure through the on-call rota and record representative evidence
- Use the learning agreement, mid-point MCR, final MCR and AES review to set placement objectives
Critical conditions
Map all 12 critical conditions early and use CBD or CEX evidence to show progression toward level 4 by certification.
Non-clinical / academic
- Plan completion of the mandated trauma-learning outcomes through ATLS, ETC, DSST or an accepted equivalent
- Start one of the three indicative audit or quality-improvement projects required during specialty training
- Begin research, teaching and leadership evidence against the Generic Professional Capabilities
Use the current ISCP learning agreement, portfolio, logbook, WBAs, MCR and AES report. Check deanery-specific ARCP instructions separately.
Broaden general ENT experience, review progress across the five CiPs and close gaps identified in the learning agreement.
Operations focus
- Review exposure across all seven index procedure groups rather than concentrating on case numbers alone
- Record operative role consistently using ISCP logbook supervision categories
- Begin real-case PBAs for index procedure groups when suitable cases and assessors are available
Clinical
- Increase responsibility for emergency assessment and management at an appropriate supervision level
- Use CBD and CEX evidence for representative critical conditions
- Review breadth across outpatient, emergency, inpatient, operating-list and multidisciplinary CiPs
- Continue rotation through all subspecialty clinics
Critical conditions
Use the phase learning outcomes and supervisor judgement to plan progression. The national curriculum does not prescribe an ST4 level for each condition.
Non-clinical / academic
- Continue audit or quality-improvement evidence and plan at least one completed cycle by certification
- Build research and scholarship evidence without treating publication count as a national requirement
- Record teaching, management and leadership activity with supporting feedback
Review the learning agreement, WBAs, logbook, MCR and AES evidence requested by the current placement and deanery.
Approach FRCS-level knowledge. Cover any remaining subspecialty rotations. Begin choosing special interest.
Operations focus
- Index procedures building: aim for steady progression on mastoid, major neck, FESS, septorhinoplasty
- Confidently performing common operations across general ENT unaided
- Begin PBAs for index procedures (mastoid, FESS, neck dissection components)
Clinical
- Complete rotation through any remaining subspecialty clinics (paediatric ORL, audiovestibular, voice, head & neck oncology, rhinology, thyroid)
- Take leading role in managing on-call patients; supervise SHOs
- Begin thinking about SI fellowship / Phase 3 placement
Critical conditions
Use CBD and CEX evidence to address gaps across the 12 conditions. Final level 4 evidence is required by certification, not at a nationally fixed ST5 milestone.
Non-clinical / academic
- Continue the indicative three audit or quality-improvement projects and complete a cycle in at least one
- Begin FRCS preparation (knowledge base, MCQs, vivas)
- Continue research and scholarship evidence
- Record teaching activity and structured feedback
Use current placement and deanery instructions. The national curriculum does not define one universal annual checklist.
FRCS-ready in knowledge AND clinical skills (day-1 consultant level for Phase 2 capabilities). Eligible to sit Intercollegiate Specialty Board exam.
Operations focus
- Review progress toward the indicative 2,000-operation total and seven index procedure groups
- Use real-case PBAs to demonstrate progression, while recognising that level 4a or 4b is required by certification
- Plan phase 3 opportunities for remaining general, emergency and special-interest technical skills
Clinical
- Demonstrate end-of-phase 2 knowledge, clinical skills and professional behaviours commensurate with certification
- Seek an ARCP Outcome 1 at the end of phase 2 before ISB examination eligibility
- Consolidate experience across the generality of ENT and identify phase 3 special-interest objectives
Critical conditions
Review all 12 conditions at the phase 2 gate. Certification still requires documented CEX or CBD performance at level 4 for every condition.
Non-clinical / academic
- Confirm research, quality-improvement, teaching and leadership evidence against the GPCs
- Plan the ISB examination after satisfactory completion of phase 2
- Agree phase 3 special-interest and remaining general technical objectives
End-of-phase 2 evidence is judged holistically through the portfolio, MCR and AES report. Confirm the exact ARCP evidence list with your training programme.
Focused training in 1 of 7 SI areas (Otology / Rhinology / Head & Neck / Thyroid & Parathyroid / Laryngology / Paediatric / General). Hit remaining index-procedure minima.
Operations focus
- Close gaps against the indicative case numbers for all seven index procedure groups
- Continue special-interest advanced procedures at the supervision level agreed with trainers
- Obtain real-case level 4a or 4b PBA evidence in each index procedure group by certification
Clinical
- Develop advanced knowledge and skills in the agreed special-interest area
- Continue emergency competence; supervise junior trainees confidently
- Sit FRCS (ORL-HNS) if not yet passed
Critical conditions
All 12 at consultant-equivalent level (L4 CEX/CBD).
Non-clinical / academic
- Complete any remaining research and scholarship evidence
- Complete the indicative three audit or quality-improvement projects, including one completed cycle
- Provide evidence of training in teaching others and written structured feedback
- Provide management and leadership training plus participation in a relevant activity
Include special-interest progress and remaining certification gaps in the learning agreement, MCR and AES review.
Meet the day-one consultant standard in general ENT and the chosen special interest, then receive final ARCP Outcome 6.
Operations focus
- Review all seven indicative index procedure numbers
- Review the indicative 2,000-operation total as principal or main assisting surgeon
- Confirm at least one real operation in each index group has level 4a or 4b PBA evidence
- Confirm breadth across the technical syllabus through the logbook and supervisor judgement
Clinical
- Achieve supervision level IV or V in all five CiPs
- Show breadth across the seven placement areas and competence in one special interest
- Show participation in on-call rotas and management of emergency cases
- Pass the ISB examination
Critical conditions
All 12 demonstrated at Day-1 consultant level (CEX/CBD L4 documented).
Non-clinical / academic
- Research and scholarship evidence across the four GPC capability areas
- Three audit or quality-improvement projects, with at least one completed cycle
- Training in teaching others plus written structured feedback on teaching
- Health-service management and leadership training plus a management-related activity
- ATLS, ETC, DSST or an accepted equivalent meeting the mandated trauma-learning outcomes
- Evidence of appropriate national or international specialist conference attendance
The final ARCP reviews the portfolio and AES report against the current curriculum. Outcome 6 permits a recommendation for certification.
Programme-level requirements
| Emergencies managed | Participate in on-call rotas and manage emergency cases. The current national curriculum sets no numeric emergency-case or night minimum. |
| Total operations | Indicative 2000 operations during training as principal or main assisting surgeon |
| Research and scholarship | Evidence of research and scholarship across the four GPC capability areas. The current national curriculum sets no publication-number minimum. |
| Quality improvement | Indicative 3 audit or quality-improvement projects during specialty training, with the cycle completed in at least 1 |
| Regional training days | Record regional teaching and compare attendance with your deanery requirement. The current national curriculum sets no percentage threshold. |
| Courses | Mandated trauma-learning outcomes through ATLS, European Trauma Course, Definitive Surgical Trauma Skills or an accepted equivalent |
| Training units | Training posts in a minimum of 3 units |
| Placement breadth | Experience in a minimum of 3 units and competence in 1 defined special-interest area |
Indicative index procedure numbers
Usually as main surgeon; FESS is counted as only scrubbed surgeon. Numbers alone do not imply competence.
| Mastoid operations (principal) | 10 |
| Major neck operations (principal) | 10 |
| Tracheostomies (principal) | 10 |
| Paediatric endoscopies incl. flexible (principal) | 10 |
| Septorhinoplasties (principal) | 10 |
| FESS (only scrubbed surgeon) | 10 |
| Airway foreign-body removal incl. nasal FBs and fish bones (principal) | 10 |
ARCP evidence guide
- 1.Learning agreement meetings at the start, middle and end of each placement
- 2.Mid-point and final MCR covering the five CiPs and nine GPC domains, normally with at least two clinical supervisors
- 3.AES end-of-placement report and the evidence requested by the current ARCP panel
- 4.Surgical logbook showing operative role and supervision
- 5.Index procedure totals and real-case PBAs
- 6.Critical condition CBD and CEX evidence
- 7.Other WBAs and Multi-source Feedback relevant to the placement
- 8.Research, quality-improvement, teaching, management and leadership evidence
- 9.Mandated trauma course, specialist-conference evidence and breadth of clinical placements
- 10.Any additional checklist or evidence specifically requested by the training programme or deanery