Australia's New PGY1/PGY2 Framework vs the UK’s FY1/FY2: Key Differences Explained

24/01/2025

Entering the medical workforce as a junior doctor is both exciting and challenging. In Australia and the UK, newly graduated doctors undergo structured prevocational training in their first two years – known as PGY1/PGY2 (Postgraduate Year 1 and 2) in Australia and FY1/FY2 (Foundation Year 1 and 2) in the UK. In 2024, Australia introduced a new National Framework for Prevocational Medical Training for PGY1s and PGY2s, bringing changes that align this period with competency-based education and enhanced supervision. Meanwhile, the UK’s Foundation Programme is a well-established system that has been refining junior doctor training since 2005.

This post, written from the perspective of a doctor who has trained in both the UK and Australia (across rural and metropolitan hospitals), will compare the two systems. We’ll explore how each framework is structured, the key similarities and differences, and how rotations in specialties like cardiology, surgery, respiratory, emergency, and geriatrics shape early-career learning. By the end, final-year medical students and junior doctors will better understand Australia’s new prevocational framework vs the UK’s foundation training, helping inform career decisions, international work plans, and best practices for learning in those crucial first years.

Why does this comparison matter? Both countries aim to produce competent, confident doctors, but they take slightly different approaches. Knowing the differences can help you navigate training requirements, adapt to new environments, and maximise learning opportunities wherever you start your medical career.

Overview of the Australian PGY1/PGY2 System (New Prevocational Framework)

Australia’s prevocational training traditionally centred on a one-year internship (PGY1) followed by one or more years as a resident (PGY2+). However, with the 2024 National Framework for Prevocational Medical Training, PGY1 and PGY2 are now part of a cohesive 2-year program. The goal is to standardise outcomes for junior doctors, improve supervision, and ensure consistent opportunities for skill development across all hospitals. Here are the key components of the Australian system:

• Structure and Length: The prevocational program spans 2 years (PGY1 and PGY2), usually totalling at least 47 weeks of work each year (allowing for annual leave). PGY1 remains the supervised intern year required for general registration as a medical practitioner, and PGY2 is a second year of broadened clinical experience under the framework. Successful completion of PGY1 (internship) leads to general registration with the Medical Board of Australia. PGY2, while now structured, is still considered pre-specialty training, though some doctors may enter certain specialty training programs during or at the end of PGY2.
• Rotations and Clinical Experience Requirements: Under the new framework, the old “core rotations” of medicine, surgery, and emergency are replaced by mandatory clinical experience categories. In PGY1, interns must complete placements covering four key experience areas:
  • Undifferentiated illness care
  • Chronic illness care
  • Acute and critical illness care
  • Peri-operative/procedural care
• Each term (rotation) is usually ~10–12 weeks, and most hospitals will now structure internship as 4 terms of 10–12 weeks (instead of the previous 5 terms) to align with the four categories. This means, for example, an intern might rotate through: an Emergency Department (acute undifferentiated care), a General Medicine or Cardiology ward (chronic illness care), a General Surgery or Orthopaedics unit (peri-operative care), and perhaps a Respiratory or Geriatrics unit (covering another required category). The aim is to ensure interns get broad exposure to different types of patient care scenarios. Notably, there is no longer a strict requirement that one term must be “General Medicine” or “General Surgery” – as long as the four experience categories are met. PGY2 then builds on this: it requires at minimum clinical experiences in undifferentiated, chronic, and acute care again, with peri-operative care recommended (and often provided) but not mandatory in PGY2. This flexibility allows some specialisation or diverse experiences in PGY2 (e.g. a PGY2 could do rotations in Paediatrics, Psychiatry, or other fields, as long as the core experiences are covered across the year).
• Key Outcome Domains: The Australian framework defines prevocational Outcome Statements in four domains that describe the capabilities a PGY1/PGY2 doctor should develop. Some further information can be found here
  • Domain 1: “Practitioner” covers clinical skills and patient care (the practical “doctoring” tasks – assessing patients, formulating management plans, performing procedures, documentation, etc.).
  • Domain 2: “Professional and Leader” covers professional behaviour, ethics, teamwork, and self-management (think of this as how to conduct oneself as a doctor and work in a team).
  • Domain 3: “Health Advocate” involves patient-centred care and advocacy, recognising social determinants of health and ensuring holistic care.
  • Domain 4: “Scientist and Scholar” focuses on applying evidence and continuing learning – basically, using research and quality improvement mindset in practice. These domains are similar to frameworks like CanMEDS and mirror the broad skill areas needed for a competent clinician. Throughout PGY1–2, supervisors will evaluate and give feedback on the junior doctor’s progress in each domain.

Figure: Australia’s new prevocational training framework defines 4 outcome domains for junior doctors – Practitioner, Professional & Leader, Health Advocate, Scientist & Scholar – describing the broad capabilities to be achieved by end of PGY2. These domains ensure a holistic development beyond just clinical knowledge.

• Entrustable Professional Activities (EPAs): A major innovation in the new Australian framework is the introduction of EPA assessments. An EPA is an Entrustable Professional Activity – essentially a common clinical task or responsibility that a junior doctor should become competent in. There are four EPAs identified for PGY1/2 in Australia:. For example, during your cardiology term a consultant might observe you clerk a new patient and fill an EPA1 assessment form with feedback. Later, in your emergency term, a registrar could observe you managing a crashing patient and complete an EPA2 assessment on how you handled recognition and escalation. These EPA assessments are formative – they are not “pass/fail” exams, but rather structured feedback opportunities. The idea is borrowed from modern competency-based training: by repeatedly observing key activities, supervisors can coach interns/residents on improving, and gather evidence of their growing competence. Starting 2025, completing the required EPAs will be mandatory for satisfactory completion of the year (2024 was a transition year where they were encouraged but not required).

  1. EPA 1: Clinical Assessment and Management (Admission) – e.g. taking a history, examining a patient, formulating diagnoses and management plans (essentially doing a full patient admission work-up).
  2. EPA 2: Recognising and managing the acutely unwell patient – identifying a deteriorating patient and escalating care appropriately.
  3. EPA 3: Prescribing – safely and appropriately prescribing medications (including choosing the right drug, dose, considering interactions, etc.).
  4. EPA 4: Team communication and documentation – effectively handover, writing clear documentation, communicating plans to the healthcare team.

  Under the framework, junior doctors are expected to undergo direct observations of these EPAs multiple times for feedback. At least 2 EPA assessments per term are required (so roughly 8–10 EPA assessments in a year) and importantly EPA 1 (patient assessment) must be observed in every term

• Supervision Structure: In Australia, PGY1s and 2s practice under supervision at all times, with the level of supervision tapering as one gains experience. The new framework reinforces a structured supervision hierarchy. Each term, you have a Term Supervisor (a senior doctor, often a consultant, in charge of your orientation, mid-term and end-term assessments, and overall term oversight). You also have a Primary Clinical Supervisor (could be the same person or another consultant/senior doctor in the unit) who ensures your day-to-day clinical exposure is appropriate. On a daily basis, much of your supervision comes from the “day-to-day clinical supervisor”, typically a registrar (or experienced resident) on your team who you report to and who directly guides your work (for example, the medical registrar on call would be your go-to person if you’re the intern managing ward issues at night). In addition, hospitals have Medical Education units: a Director of Prevocational Education and Training (DPET) or similar role (sometimes called Director of Clinical Training, DCT) oversees the education program for all interns/residents, ensuring you’re supported and progressing. With the new framework, an Assessment Review Panel at each hospital will formally review each trainee’s progress at year’s end. This panel considers your term reports and EPA feedback to decide if you’ve met requirements to progress to the next year or to complete the program.

• Assessment Methods: Australian prevocational doctors undergo continuous workplace-based assessments rather than big exams in these years. Every term includes a Mid-Term assessment (usually a meeting with your term supervisor to gauge progress and flag any issues early) and an End-of-Term assessment (summative feedback and a global rating of performance). These are now done with revised standardised forms across Australia. The EPAs we discussed form another layer of assessment, contributing to a rich picture of your capabilities. If any performance issues arise, there are structured processes for remediation, supervised by the medical education unit (for instance, if an intern is struggling with a particular skill, the program can arrange extra support or require an additional term to ensure competence). It’s worth noting that general registration (full license) is still granted after PGY1 upon satisfactory completion of internship – this hasn’t changed. The second year (PGY2) doesn’t grant a new license, but completing it within the framework will likely give a completion certificate and also exempts you from the Medical Board’s CPD requirements for that year (new doctors would otherwise need to do continuing professional development credits). Essentially, if you finish the 2-year program, you’ve met all the structured learning goals intended for junior doctors.

• Focus on Trainee Wellbeing and Support: A driver for the new framework was also to improve junior doctor wellbeing. By standardising supervision, limiting heavy service requirements, and formalising feedback, the framework aims to prevent interns from “falling through the cracks.” For example, it limits the amount of time a PGY1 can spend in relief/night float terms to no more than 20% of the year (ensuring most of your time is with a stable team for better learning). It also encourages a culture of feedback and self-reflection – interns are encouraged to self-assess and discuss their self-assessment with supervisors. And importantly, if you feel overwhelmed or experience bullying/harassment, the structure makes it clear whom to approach (Term Supervisor, DPET/DCT, Medical Education Officer, etc., as well as external support). This explicit support system is there to help trainees manage the stress of those early years.

In summary, Australia’s PGY1/PGY2 framework (especially post-2024) is a competency-based, well-supported training period. It ensures exposure to a broad range of clinical scenarios (from acute emergencies to chronic care to surgical patients), formalises feedback through EPAs, and provides multiple layers of supervision. The changes are quite new, so current PGY1s and PGY2s are the first to fully experience this system – which makes understanding it even more important for those about to start.

Overview of the UK FY1/FY2 (Foundation Programme) System

The UK Foundation Programme is a two-year structured training programme that all UK medical graduates (and some international graduates) complete after medical school. The Foundation Programme, established in the mid-2000s, was one of the first structured junior doctor programs of its kind, aiming to bridge the gap between medical school and specialty training. Key features of the UK FY1/FY2 system include:

• Structure and Length: The Foundation Programme is 2 years long, comprising Foundation Year 1 (FY1) and Foundation Year 2 (FY2). Typically, doctors in the foundation programme undertake 6 rotations of roughly 4 months each over the two years (often 3 rotations in FY1 and 3 in FY2, each ~4 months, though some deaneries do 4 rotations of 3 months). These rotations are in a range of specialties and settings – for example, a foundation trainee might do FY1 posts in General Surgery, General Medicine, and Psychiatry, then FY2 posts in Emergency Medicine, Cardiology, and General Practice. The idea is to provide a broad exposure to different fields, helping the doctor develop general skills and also make informed decisions about future specialty choices. All FY1 posts are in hospital settings, whereas in FY2 it’s common to have one community-based post (like General Practice) or other specialty to broaden experience.
• Registration and Progression: UK medical graduates start FY1 with provisional registration with the GMC (General Medical Council). Completion of FY1 (with satisfactory assessments) leads to full GMC registration. This mirrors the Australian intern year outcome of general registration. FY2 is then a fully registered doctor year, after which, upon successful completion, doctors receive a Foundation Programme Certificate of Completion (FPCC). The FPCC is required to enter specialty training. In effect, end of FY2 marks the transition point to either enter a specialist training program or pursue other clinical opportunities. Many UK trainees apply for specialty or core training positions during their FY2 year, aiming to start specialty training in the next year. (Some also take an “FY3” year to even locum with Medlo…).
• Curriculum and Competencies: The foundation programme has a defined curriculum set by the UK Foundation Programme Office (UKFPO). The latest curriculum outlines a set of foundation professional capabilities that align with the GMC’s standards for new doctors. These cover areas such as clinical skills, decision-making, communication, teamwork, professionalism, ethics, and maintaining good medical practice. In practice, this means as an FY1/FY2 you are expected to demonstrate competencies like managing the acutely ill patient, safe prescribing, infection control, breaking bad news, time management, etc. The training is competency-based but also time-delimited (2 years). There isn’t a single high-stakes exam in foundation; instead, trainees build a portfolio of evidence demonstrating these competencies.
• Supervision and Support: During each rotation, an FY1/2 will have a Named Clinical Supervisor – usually a consultant in charge of the team or unit the trainee is working in. The clinical supervisor oversees the trainee’s day-to-day work in that specialty, provides feedback, and does an end-of-placement evaluation of their performance. In addition, each trainee has a Named Educational Supervisor (often one for the whole year or sometimes one per year) who oversees the trainee’s overall progress across the program. The Educational Supervisor meets the trainee periodically (beginning, mid, and end of each year, plus maybe between rotations) to review their portfolio, ensure they are meeting curriculum requirements, and offer career guidance. The educational supervisor also writes a comprehensive report at year’s end, which is reviewed at the ARCP (Annual Review of Competence Progression). Beyond these supervisors, the structure includes a Foundation Training Programme Director (FTPD) or Foundation School Director at the hospital/region level – a consultant or dean in charge of all foundation trainees in that area, ensuring the program runs properly and handling any major issues or remediation. There are also often “Foundation tutors” or administrators in each hospital who organise teaching and serve as a point of contact for trainees.
• Clinical Responsibilities: An FY1 in the UK is broadly equivalent to an intern in Australia in terms of responsibility – they are the most junior doctors on the team, responsible for frontline patient care tasks under supervision. This includes clerking in patients, managing ward rounds tasks, doing procedures like cannulas and bloods, ordering tests, and communicating with families and allied health. There are, however, a few differences in practice. For example, UK FY1s historically did not routinely prescribe certain higher-risk medications without countersignature (like chemotherapy or some IV fluids) when they had provisional registration, although in day-to-day ward work FY1s do prescribe most medications which are then reviewed by seniors or pharmacists. Once they attain full registration (entering FY2), they can independently prescribe all treatments. In contrast, Australian interns, while provisionally registered, generally have full prescribing rights from the get-go – the oversight is more at the hospital level and via supervision. By FY2 in the UK, doctors take on more responsibilities akin to an Australian PGY2 or even a junior registrar in some contexts: for instance, an FY2 might do shifts covering the acute medical admissions unit, or be the doctor in a small peripheral emergency department overnight (with distant supervision), or lead cardiac arrest calls until senior help arrives. UK trainees also commonly rotate through the Emergency Department and Acute Medicine where they handle undifferentiated emergencies, similar to Australian residents in ED.
• Assessment Methods: The Foundation Programme uses a robust e-portfolio system (such as Horus, Turas, or ePortfolio depending on region) to track progress. Throughout each year, foundation doctors must complete a series of Workplace-Based Assessments and other requirements:
  • Supervised Learning Events (SLEs): These include Mini-CEX (mini clinical evaluations) where a senior directly observes an interaction (e.g., history and exam), CBD (case-based discussions) reviewing clinical reasoning on a case, and DOPS (Directly Observed Procedural Skills) for practical procedures. Trainees are expected to accumulate a certain number of these in each rotation (for example, a common requirement might be ~1 mini-CEX, 1 CBD, 1-2 DOPS per month of placement, ensuring maybe 3-4 of each per rotation – the ARCP checklist outlines minimum numbers). The emphasis is on using these as learning opportunities with feedback, not just tick boxes.
  • Multisource Feedback: Once a year, typically, an FY1 and FY2 will solicit feedback from a range of colleagues (consultants, registrars, nurses, pharmacists, etc.) in a Team Assessment of Behaviour (TAB). This is analogous to a 360-degree feedback. The collated feedback is discussed with the trainee to highlight strengths or any professional issues.
  • Procedural Skills: The GMC requires that certain practical skills be signed off during FY1 (like venipuncture, IV cannulation, catheterisation, airway management, etc.). These usually get done as DOPS assessments.
  • Audit/Quality Improvement Project: Foundation trainees are expected to participate in at least one audit or quality improvement project per year. By FY2, a completed QI project is often needed in the portfolio.
  • Teaching and Learning: Attending weekly foundation teaching sessions (most programs have a protected teaching half-day or sessions for junior docs) is required, and sometimes delivering a teaching session is encouraged.
  • Educational Supervisor’s Reports: At the end of each rotation, the clinical supervisor files a report on the trainee. The educational supervisor writes an end-of-year summary drawing on all evidence: SLEs, feedback, curriculum coverage, any exams like ALS (Advanced Life Support certification) completion, etc..
  • All this information is reviewed at the ARCP panel (usually in late spring for FY1 and early summer for FY2). The ARCP is a formal committee that reviews the trainee’s portfolio and supervisor reports and issues an outcome – for most it will be an Outcome 1: Satisfactory (meaning you can progress to the next year or finish the program). If requirements aren’t met, the panel can give an Outcome 5 (incomplete evidence, need to provide more) or in worst case an Outcome 3 or 4 (meaning additional training time required or release from program, respectively). For an FY1, a satisfactory ARCP outcome is required to get the Certificate of Experience which then is sent to the GMC to obtain full registration.
• Work Hours and Conditions: The UK has strict work hour limits under the European Working Time Directive (EWTD) (even post-Brexit, the 48-hour average weekly limit remains in NHS contracts). Most foundation trainees work a shift pattern with on-calls or night shifts, but the total hours per week should average ≤48. Rotas are designed to comply with this, and there are mechanisms for exception reporting if hours get too long. In contrast, Australian PGY1/2s typically have contracts around 38 hours standard plus reasonable overtime; in practice, many work closer to 45-50 hours/week including overtime, depending on the rotation (some can be longer, but hospitals are increasingly mindful of fatigue). While Australia doesn’t have a nationwide law capping hours at 48, there are guidelines and most places try to ensure safe working hours, but the culture may allow a bit more flexibility (and often additional pay for overtime) – for example, an Australian surgical resident might routinely stay late to assist in operations, whereas a UK foundation doctor might be more protected from excessive hours. This difference can affect the experience: UK trainees might have more shift-work patterns (with days off after nights, etc.), whereas Aussies might have a more traditional schedule with late finishes but not strict hour averaging. Both systems are trying to balance service and training needs with doctor wellbeing.
• Career Planning: The Foundation Programme has built-in career support. Trainees discuss career goals during meetings with their Educational Supervisor. FY2s can do “taster” weeks – a short placement in a specialty they’re interested in but not assigned to, which helps them gain insight before committing to a training application. The expectation is that by the end of FY2, doctors will apply to a specialty or core training (such as Core Medical Training, Surgical Training, General Practice, etc.), so a lot of career decision-making happens in these two years. The structured nature of foundation means the timeline is a bit accelerated compared to Australia. (In Australia, it’s common for doctors to take a few more years after PGY2 to try different terms or work as a senior resident before deciding on a specialty or successfully gaining a training spot. In the UK, while some do take an extra year, the majority move straight into training.)

In summary, the UK FY1/FY2 system is a highly organised, portfolio-driven training programme that ensures junior doctors hit key competencies and are ready for the next stage of training. It’s similar to the new Australian framework in many ways (especially now that Australia also has an e-portfolio and assessments). Both involve supervised rotations, feedback sessions, and a sign-off process for full registration. The differences often lie in the details of implementation and the surrounding context (e.g., work hours, when specialisation happens, etc.).

Comparative Analysis: Australian Prevocational vs UK Foundation – Key Differences and Similarities

Let’s break down the key aspects of Australian PGY1/2 vs UK FY1/2 in a side-by-side comparison. The following table highlights structural elements, supervision, assessments, and more:

PGY2: Must include undifferentiated, chronic, and acute care; peri-op optional but common​. | FY1: Typically must include at least 3 months in medicine and 3 in surgery (or equivalent) to meet GMC requirements​. In practice, foundation schools ensure a mix (one surgical, one medical, one other in FY1).

FY2: Typically includes at least one acute/EM post or community post (e.g. GP). Broad exposure encouraged across the 6 rotations. | | Registration Milestone | General registration with Medical Board achieved after PGY1 (internship), upon meeting outcome standards. PGY2 is fully registered and further builds experience; completion of PGY2 (framework) may yield a certificate of completion (new, post-2024). | Full GMC registration achieved after FY1 (internship equivalent) upon satisfactory completion​. Completion of FY2 awards Foundation Programme Certificate of Completion (FPCC), required to enter specialty training. | | Supervision Hierarchy | Multiple supervisors: Term Supervisor (consultant in charge of the term’s training/assessment) Primary Clinical Supervisor (could be same consultant or another senior overseeing clinical work), and Day-to-Day Supervisor (usually a registrar providing direct supervision)​. Overall program overseen by Director of Prevocational Education & Training (or similar) at hospital. End-of-year Assessment Review Panel evaluates progress​. | Clinical Supervisor (for each rotation, a consultant responsible for trainee’s day-to-day supervision and end-of-placement report), |

Educational Supervisor (usually one per year, oversees trainee’s development, portfolio, and provides longitudinal mentorship). Foundation Programme Director (at trust or deanery level) ensures program quality. Annual ARCP panel reviews portfolio and progression​. | | Assessment & Feedback | - Mid-term and End-of-term assessments every rotation with structured feedback​

• Entrustable Professional Activities (EPAs): 4 defined EPAs; min 2 EPA observations per term (10/year) focusing on key tasks (admission, managing unwell patients, prescribing, handover)​. Used for formative feedback (required from 2025).

• E-Portfolio: New national e-portfolio to log assessments and reflections​.

• End-of-Year Panel: holistic review of performance to allow progression (particularly end of PGY1 for full reg, end of PGY2 for program completion). | - Workplace-Based Assessments: Regular Mini-CEX, CbD, DOPS, etc., each rotation (formative but required in numbers) to evidence competencies.

• Multi-source feedback (TAB) once per year for professional behaviour insight.

• E-Portfolio: (Horus, Turas, etc.) logging all assessments, reflections, learning logs.

• Educational Supervisor Reports: each rotation (clinical supervisor) and end-of-year report (educational supervisor) summarise performance​

ARCP: annual review panel ensures all curriculum outcomes met for progression​ | | Outcome Domains / Curriculum | 4 Outcome Domains: Practitioner, Professional & Leader, Health Advocate, Scientist & Scholar – broad capabilities by end of PGY2. These mirror competencies in clinical skills, professionalism, advocacy, and scholarly approach. EPAs are mapped to these domains​ | Curriculum based on GMC’s Good Medical Practice themes: Professional behavior and trust, Communication and teamwork, Clinical care, Safety and quality, etc. (Foundation Professional Capabilities). Emphasis on acute care, communication, ethics, patient safety, and preparedness for specialty training​ | | Typical Rotations Examples | Intern year often includes: Emergency Medicine (acute care), General Medicine or sub-specialty like Cardiology (undifferentiated/chronic care), General Surgery or equivalent (perioperative), plus another rotation e.g. Geriatrics or Respiratory (to cover remaining category). PGY2 may include: specialty rotations like ICU, Psychiatry, Paediatrics, or a repeat of core specialties at higher responsibility, sometimes a relief term. | Foundation rotations vary widely: e.g. FY1 – General Medicine (or Geriatrics), General Surgery (or Orthopaedics), plus maybe a Psychiatry or Ortho or other. FY2 – Emergency Medicine, General Practice (community), and another like Cardiology or Trauma & Ortho. Mix aims for variety: at least one surgical, one medical, one acute (ED/Acute Med), one community, etc., over 2 years. | | Work Hours | ~38–45 hours/week typically (rostered 38 + overtime). Some shifts can be longer; no strict hour cap, but hospitals follow safe hours policies. Night shifts and weekend on-calls vary by rotation. Usually 5 days/week with some on-call or relief periods. The 2022-2026 VIC EBA can be found here. | ~40–48 hours/week average (strict European Working Time Directive limit of 48h). Rotas include nights, long days, weekends with rest days to ensure compliance. Often a full shift pattern system. Greater enforcement of limits on consecutive work hours (e.g., maximum 13 hour shifts, mandated 11 hours rest between shifts, etc.). | | Leave and Holidays | 5 weeks of annual leave (typically) per year, usually taken split between rotations (or as allowed by employing hospital). | 5–6 weeks of annual leave per year, allocated by rota (typically each rotation has a set amount of leave days you can take). Study leave is limited in foundation but may be granted for courses like ALS. | | Progression to Specialty Training | Not automatically integrated – PGY2s apply to specialty training on their own timeline. Some programs (e.g. GP, some physician training) allow entry in PGY2; many others (surgical, etc.) require 2+ years of experience. It’s common to do PGY3+ as a “resident” or unaccredited registrar before entering training. The framework is new, but it’s expected to give a strong foundation for those years. | Directly integrated – FY2s apply during FY2 for next-stage training. Most will start Specialty/Core training in year 3 post-graduation. The foundation program is designed to feed into this seamlessly with the FPCC. A minority take an “FY3” year out or pursue alternate paths, but generally by end of FY2, a plan for specialisation or further training is in motion. |

Despite differences, there are many similarities in how Australia and the UK approach junior doctor training. Both emphasise hands-on clinical experience, close supervision with increasing autonomy, regular feedback, and a broad exposure to various fields of medicine. Each requires demonstration of competence in key skills like acute care, communication, and professionalism to sign off the training. The recent Australian changes have actually made the systems even more alike, by introducing an e-portfolio, defined outcome statements, and EPA (which parallel the UK’s work-based assessments and curriculum outcomes).

However, the differences in term structure and specialisation timing can influence a junior doctor’s journey. For instance, an Australian PGY2 might still be exploring different specialties or taking on a senior resident role, whereas a UK FY2 of the same experience level might be already prepping for specialty interviews or starting core training. The comparative table above serves as a quick reference for the main points of divergence and convergence between the two systems.

Pros and Cons of Each System

Both the Australian prevocational training framework and the UK foundation programme have their strengths and challenges. Neither is “better” in an absolute sense – they each cater to their healthcare system’s needs and have evolved differently. Here’s a breakdown of the pros and cons of each, particularly from the viewpoint of someone who has navigated both:

Australian PGY1/PGY2 System – Pros:

• Broad Clinical Exposure with Flexibility: The new framework ensures a wide exposure (medicine, surgery, ED, etc.) but also offers flexibility in how to meet those experiences. Hospitals can innovate in rotations (e.g., an intern might do an orthopaedics term instead of general surgery and still meet peri-op requirements). As a trainee, you get a diverse case mix. And if you have a particular interest, PGY2 year can sometimes be tailored – e.g. you could do an ICU term or more of something you like, since you’re not locked into a national rotation formula.
• Gradual Increase in Responsibility: With general registration only after PGY1, the first year is well-supervised and somewhat protected. By PGY2, you step up in responsibility (maybe supervising interns or running codes as the first responder) but still within a structured program. This gradual ramp-up can be more comfortable for some.
• New Framework’s Focus on Feedback: The introduction of EPAs and regular assessments means more feedback opportunities. This is great for professional development – you’re less likely to reach end of year and hear about an issue for the first time. It also encourages reflection and self-directed improvement early on, which is a valuable habit.
• Work-Life and Pay: Generally, Australian junior doctor salaries are higher than UK equivalents (when converted), and there’s often overtime pay. The lifestyle in many Australian cities or regional areas can be appealing, and work hours, while sometimes long, come with penalties (pay boosts) that somewhat compensate. Also, there isn’t a culture of routinely moving across the country for training until specialty training perhaps – interns usually stay in one hospital/network for the year, which can mean more stability (UK trainees might move region or hospital between F1 and F2).
• Pathway Flexibility: After PGY1/2, there isn’t immediate pressure to choose a specialty. Many doctors take a PGY3, PGY4… to do diverse senior resident roles, maybe try research, or bolster their CV for competitive specialties. The system can accommodate late bloomers or those who need more experience to decide. In contrast, UK pushes you to decide relatively quickly (by FY2 applications). This flexibility can be a pro for those undecided on their career path.

Australian PGY1/PGY2 System – Cons:

• Variable Structure Historically: Historically, PGY2 (and beyond) in Australia wasn’t standardised – and even with the new framework, how PGY2 is implemented might vary. Some PGY2s end up in “service heavy” roles (like being a relief RMO covering wards or nights frequently) which might not have the same educational value as a structured program. The new framework tries to mitigate that by limiting relief terms, but how well this is enforced might vary by hospital.
• Potential Delays in Career Progression: The flexibility can be a double-edged sword. It’s not uncommon in Australia for doctors to spend several years (PGY3-5) in resident or unaccredited registrar positions trying to get into specialty training. This can feel like career stagnation to some, especially if posts are repetitive or not advancing skills. In the UK, by contrast, most people move into a defined training pathway by year 3. So, one could argue the Australian path can be slower to reach consultant level (many specialties might not finish training until 8-10 years post-grad).
• Geographic Challenges: Australia is big and decentralised. Prevocational training is managed by state-based councils and health networks. This means if you want to move interstate for PGY2, it’s possible (and the new framework states mobility is maintained), but the process might be more complex than the UK’s unified system. Each state may have slightly different terms and application processes for resident jobs. For those who do rural rotations, coming back to metropolitan hospitals for training or vice versa requires planning but is doable. It’s just not as centrally coordinated as the UK Foundation School allocations for F1 and F2.
• Resource Variability: The level of educational support (like formal teaching sessions, exam prep, etc.) can vary by hospital. Some larger hospitals have extensive teaching for juniors; smaller ones might have less. The new standards from AMC should push everyone to improve, but it's an ongoing process. In the UK, every foundation school has a pretty standard teaching program that all F1/F2s attend, which felt more uniform to me.

UK Foundation Programme – Pros:

• Highly Structured and Standardised: Every foundation trainee knows exactly what they need to do: the number of assessments, the competencies required, etc. There’s a national curriculum and consistency. This structure provides clarity and a sense of progress – you know when you tick off boxes that you’re meeting national standards. It’s reassuring and helps with organisation.
• Strong Educational Framework: The UK invests a lot into the Foundation Programme’s educational aspects. Weekly protected teaching sessions are common, e-portfolios are well established, and there's support for things like exam prep if you’re aiming for MRCP or other early exams. The culture of reflection and mentorship is also ingrained – writing reflective entries, having honest discussions with your Educational Supervisor, etc., which helps professional development.
• Work-Hour Regulations and Welfare: The 48-hour work week limit and enforcement of rest periods mean you’re less likely to be overworked to exhaustion (though anyone who’s worked a run of night shifts might still feel tired!). There are also systems for exception reporting if you do stay beyond hours, which can result in overtime pay or work schedule reviews. There is a strong emphasis on doctor wellbeing in recent years – many trusts have a well-being hub, and foundation trainees have access to resources if they feel burnt out or are struggling.
• Early Specialisation (if desired): If you are the type who knows what you want to do, the UK system gets you there faster. By the end of FY2 you could be starting specialty training. This can be motivating and means you dive into your area of interest sooner. It also means by the time your Australian counterpart is a PGY4, you might already be a year 2 or 3 registrar in training.
• Portability of Skills: The UK’s emphasis on universal standards means if you trained in one part of the UK and move to another, things are pretty similar. Also, the foundation programme is well recognised internationally – many countries (like Middle Eastern health systems, or in Singapore/HK) recognise it as a solid internship equivalent, which can be good for job applications abroad.

UK Foundation Programme – Cons:

• One Size Fits All: The standardisation, while largely positive, can sometimes feel a bit tick-boxy. Some trainees feel pressure to do assessments for the sake of numbers rather than learning. There’s a joke about “chasing consultants to fill forms” – it has some truth; you might feel you’re badgering busy seniors to complete yet another mini-CEX so you meet your quota. The focus on portfolio can at times detract from patient-facing time if not managed well.
• Compressed Timeline for Decisions: The requirement to apply for specialties during FY2 means by halfway through your second year as a doctor, you need to decide your career direction and have a competitive application ready. Many feel this is too early – at 18 months into work, how sure can you be that, say, radiology or surgery is your calling? Some do make wrong choices and might switch later, but it’s harder once in a training run. The Australian system, by giving a bit more time, might result in more thoughtful decisions for some (albeit at the cost of a slower start).
• Limited Flexibility in Rotations: You are assigned rotations by your foundation school; while you rank preferences, you often have to do specialties that might not interest you, and you might not get to do one you really wanted. For example, I never did an ICU or cardiothoracic rotation in foundation because it wasn’t in my program, whereas an Australian resident might be able to seek out such a term in PGY2/3 if interested. Changing rotations is usually not possible except in extreme cases. So, if you’re very keen on a field, you might not experience it in foundation (though you can do a taster week).
• Geographical Mobility Requirements: When you get your foundation allocation, you could be placed anywhere within a region, which might mean moving cities after medical school, then possibly moving again for specialty training. This can be disruptive for some personal lives (though some love the adventure). In Australia, generally you apply for a specific hospital or network for internship, and many continue in the same region for residency unless they choose to move – potentially a bit more stability early on.
• Resource Constraints in NHS: This isn’t a direct aspect of the training structure, but it affects the experience. The NHS is often very busy and sometimes understaffed, which can mean as a foundation doc you might feel you're doing more service (covering gaps, dealing with ancillary task loads) and have to be proactive to ensure training needs (like getting to theatre, or attending clinic for experience) are met. To be fair, Australian hospitals can also be busy, but the NHS’s systemic pressures (like winter bed crises, etc.) are a well-known challenge.

In essence, the Australian system shines in offering a supportive yet flexible early career, with recent improvements focusing on competency and feedback, at the cost of potentially longer time to specialisation and some variability in experience. The UK system excels in organisation, clear standards, and efficient career progression, but can sometimes feel rigid or rushed in terms of career choice, and requires juggling portfolio requirements.

For an individual junior doctor, the “better” system might depend on their personality and goals: if you value a slower pace to find your path and maybe a bit more pay early on, Australia might appeal; if you like structure and want to climb the ladder quickly, the UK might suit you. Many doctors, like myself, actually appreciate experiencing both – taking the best of each system to inform our practice.

Implications for Medical Graduates: Career Decisions, Mobility, and Development

Understanding these differences is not just an academic exercise – it has real implications for current medical students and junior doctors plotting out their careers. Here are some key takeaways on how the choice of system (or moving between them) might impact you:

• Career Decision-Making: If you’re a final-year medical student, consider how decided you are on a specialty. In the UK, you’ll be applying to specialty by the end of year 2. In Australia, you typically have a bit more time by default (though ambitious folks can still apply early to things like physician training in PGY2). If you feel you want to try out a few areas and aren’t ready to commit, an Australian approach (or taking an “FY3” year after UK foundation) might give you that flexibility. On the other hand, if you’re gung-ho about a field, the UK will let you start that journey sooner. Also consider which style suits your learning – some thrive under structured guidance (UK style), others under more independent, apprenticeship-style growth (which historically was more Australian, though it’s changing with the new framework).
• International Mobility: Many trainees consider doing a year or more abroad. The good news is PGY1 in Australia and FY1 in UK are considered equivalent for general registration – so a UK-trained doctor after FY1 can get general registration in Australia (subject to some paperwork) and vice versa, because both fulfilled a supervised intern year that meets basic requirements. UK foundation doctors often take advantage of this and come to Australia for a year after FY2 (popularly known as a “FY3” in Oz, working as a resident) – Australian hospitals value the UK foundation training and will usually hire such doctors at a PGY3 equivalent level (or PGY2). Conversely, Australian-trained doctors who complete internship and maybe residency can register with the GMC; typically the GMC requires that the internship included at least 3 months of medicine and 3 of surgery, which the new Aussie framework still provides via the categories (just make sure one of your rotations counts as surgical/periop!). So there is good interchangeability. However, note that to get a training number in the UK, an Australian doc usually would need to do the full UK foundation or prove equivalent competencies – often Aussie PGY2 = UK FY2, so they might slot into FY2 or trust-grade jobs and then apply for training. For UK docs coming to Australia, getting onto specialty training might require a few years working in Australia first and navigating that system (e.g., a UK person with only FY2 might not directly jump into a Australian advanced training post; they might need to do SHO/RMO jobs for a bit). Key point: both systems’ credentials are well-recognised in Commonwealth countries, making mobility feasible. Just be mindful of paperwork and licensing: e.g., the UK requires the Certificate of Experience after FY1 to give full GMC registration, and Australia requires an internship certificate for general registration. Plan ahead to have those documents if you move.
• Professional Development: Experiencing both systems, I found I could bring back lessons from each. For instance, the strong portfolio culture in the UK made me more attuned to continuing professional development – even in Australia now I keep a log of my learning and feedback, which isn’t strictly required at the resident level, but it helps me. Likewise, colleagues who come from the UK to Australia often shine in their communication and team skills (the NHS environment hones those, given the diverse teams and structured comms, plus courses like Simulation training they might have done). On the flip side, UK trainees who have worked in Australia often return to the NHS with improved confidence in procedures and perhaps a broader perspective from working in a different healthcare system. So, don’t view the two systems in isolation; think of it as a continuum of learning. If you’re undecided about where to train, you could do one system then the other – e.g. complete foundation in UK, then do a year in Australia before specialty; or do PGY1-2 in Australia, then go to UK for a bit as an SHO. It’s quite possible to do and many people do it. This can enrich your CV and experience (just keep track of the requirements so you don’t miss a credential needed for progression in either country).
• Impact on Career Pathways: Some specialties are easier to pursue in one country versus the other, at least initially. For example, if you’re interested in General Practice, the UK offers a direct path starting right after FY2 (3-year GP training program). Australia also offers GP training that you can start in PGY2 or PGY3, but you might spend some time in hospital jobs first. If you’re aiming for something like cardiology or surgery, both systems are competitive, but the approach differs: UK you’d do core training then competitive application to specialty fellowship; Australia you’d do a few residency years then apply to the college. Neither is “easier,” but the timing of when you need to have certain exams (like MRCP in UK for medicine) or prerequisites differ. One could argue that the Australian system gives more time to buff your resume (publications, research, diverse experience) before the big application, whereas the UK expects those things earlier. For a graduate thinking globally, it might even be strategic: e.g., do foundation in UK, maybe do core training in medicine there to get MRCP, then move to Australia at registrar level (some do this, as MRCP is valued and can exempt you from some Aussie exams). Or vice versa, do a few years in Australia to get solid clinical experience and maybe primaries, then go to UK for higher training. The possibilities are numerous.
• Licensing and Exams: Be aware of licensing differences. Australia doesn’t require a separate exam for general registration beyond finishing internship (though from 2024, they require an AMC CAT exam for international graduates, but that’s another discussion). The UK doesn’t have an exam for full registration either if you go through FY1, though international grads take PLAB/UKMLA. However, postgraduate exams (like membership exams) come into play if you enter specialty training (e.g., MRCP, MRCS in UK; Part 1 exams for colleges in Australia like RACP or RACS primary). The timing differs: in UK, you might start MRCP in FY2 or CT1; in Australia, you won’t do RACP Part 1 until maybe PGY3 or 4 after entering Basic Training. That means if academics/ exams aren’t your strength, you might appreciate the little delay in Australia to get clinical grounding first. Conversely, if you’re academic and keen, the UK system rewards getting those done early. So think about your style of learning when considering these pathways.
• Migration and Life Considerations: Beyond training, think of lifestyle. Do you see yourself enjoying life in a UK city or countryside vs an Australian city or rural town? For many, non-career factors like family, culture, weather (!) play a role. I’ve seen peers unhappy in one system simply because they didn’t like living there, which affected their work. A happy doctor is a better doctor, so where you think you’ll thrive personally is important. The nice thing is early career is a relatively flexible time to experiment – doing a couple of years abroad doesn’t usually burn bridges and can actually enhance your resume. Hospitals often appreciate doctors who bring different experiences.

Ultimately, medical graduates today have a global career landscape. The prevocational years lay the foundation not only for your clinical skills but also for your professional identity and networks. Whether you start in Australia or the UK, be proactive in your training: take advantage of the systems (mentors, courses, opportunities) available to you, and don’t be afraid to seek experiences in the other if it interests you. Both systems aim to produce competent, compassionate, and skilled doctors – and they do. The route and pace just differ a bit.

Conclusion

The first two years as a doctor – whether under Australia’s new prevocational framework or the UK’s foundation programme – are transformative. They are the time when medical knowledge meets real-world practice, when you learn to multitask the care of multiple patients, and when you transition from being a student to being someone’s doctor. Comparing the Australian PGY1/PGY2 and UK FY1/FY2 systems, we find more similarities than differences in the core mission: to ensure junior doctors become safe, competent and well-rounded clinicians. Australia’s recent updates have modernised its approach, incorporating competency-based training and formal assessments much like the UK model, while maintaining some flexibility that has been a hallmark of its system.

From a personal standpoint, training in both systems has been immensely rewarding. The UK gave me structure and discipline, Australia gave me autonomy and breadth – both shaped the doctor I am today. For current trainees, understanding these differences means you can better navigate your own journey. If you have the chance, embrace the best of both worlds: the rigorous training and early responsibility of the UK, and the diverse experience and reflective learning culture of the new Australian framework. Collaboratively, both countries’ medical training systems continue to evolve, learning from each other and global best practices.

In making your choice or preparing for either system, remember the key takeaways:

• Master the fundamentals (clinical skills, communication, teamwork) – they transcend any system and are exactly what these programs are built to teach you.
• Use your rotations wisely – each is an opportunity to gain not just medical knowledge but insights into what you enjoy and how you work best.
• Seek feedback and mentorship – both frameworks have mechanisms for this (be it EPA assessments or SLEs, meetings with supervisors – don’t skip them; they’re gold for growth).
• Take care of your wellbeing – junior doctor years can be tough anywhere. Know your support systems (colleagues, supervisors, family, friends) and don’t hesitate to use them.

Whether you’re a final-year student weighing up a move abroad, or a PGY1/FY1 wondering how your counterparts across the world are training, we hope this comparison sheds light on what to expect. Both Australia and the UK offer fantastic training grounds for new doctors. With the right mindset, you’ll thrive in either – and the patients you care for will be better for it.