Senior house officer

A senior house officer (SHO) is a doctor undergoing specialist training in the United Kingdom National Health Service. A doctor typically works as an SHO for 2-3 years, or occasionally longer, before becoming a registrar. SHOs need to be in posts approved by a postgraduate dean, as well as passing postgraduate exams (such as the Membership of the Royal College of Physicians/MRCP), in order to qualify for a registrar post.

SHO jobs typically last 6 months or multiples of this. Longer SHO posts are typically rotations, where the junior doctor works in different departments or even hospitals consecutively.

In 2002, the Department of Health announced reforms in the training of newly qualified doctors under the banner of "Modernising Medical Careers", merging the internship year ("pre-registration house officer", "PRHO" or "house officer") and the first year of SHO training into a "foundation programme". This programme was formally introduced in August 2005.

In 2005, the British Medical Association (BMA) reported that there were insufficient SHO posts available to provide training for newly qualified doctors who had completed their PRHO year. Postgraduate deans and the Department of Health disputed this.

Modernising Medical Careers
A new concept of post-graduate medical training that is being introduced and which is gradually replacing the old method of training.

The new scheme will see people leaving medical school to enter a Foundation Programme of two years, where they will gain generic skills (i.e. not specific to a particular specialty such as orthopaedics) in caring for the acutely and critically ill. The first group of junior doctors started their training in the first year of the Foundation Pogramme in August 2005.

Once they have completed the Foundation Programme, doctors will then compete to enter specialty training programmes. These programmes combine the two old grades of Senior house officer and Specialist Registrar in a seamless programme of training in a particular specialty (e.g. General medicine, Ophthalmology or Psychiatry). Once in this specialty training programme, the doctor is expected to progress through to the point where they will gain their Certificate of Completion of Training (CCT - formerly known as the Certificate of Completion of Specialist Training or CCST). The first of these specialty training programmes is expected to start in August 2007.

There are several aspects to the MMC programme. In addition to the structural reform of how the training grades are organised, new assessment tools have been introduced to monitor doctors' progress and guide their training. Careers guidance is also supposed to play a large part in the new scheme, as are reforms of the career (non-training) grades known as staff grade, associate specialist and non-consultant career grade. The relatively new and non-standard Trust grade posts will also be addressed by MMC.

The MMC programme has caused a lot of controversy in the medical community in the United Kingdom. Some feel that the reforms have been rushed through without adequate consideration of the problems, while others have welcomed the opportunity to modernise a system which had many shortcomings. The MMC programme has also been accused by some of leading to problems for doctors still training under the old system, particularly Senior House Officers, with the principal fear being that they may be unfairly disadvantaged in their training opportunities compared to those on the new scheme.