For international medical graduates (IMGs) preparing to enter the UK healthcare system, the titles alone can be confusing: SHO, FY2, Trust Grade, Locum, CT1... What do they mean? How are they different? And most importantly — which one is right for you?
Among the most misunderstood roles are SHO (Senior House Officer) and FY2 (Foundation Year 2). They often seem interchangeable — and in some ways, they are. But if you're planning your first NHS job or mapping out your pathway to training, understanding the difference matters more than you think.
Let’s break it down — not just in definitions, but in real-life expectations, career impact, and IMG experience.
What’s an FY2?
The Foundation Year 2 (FY2) role is part of the UK Foundation Programme, which is a structured two-year program designed for newly graduated doctors. The first year (FY1) focuses on basic clinical skills and supervised practice, while FY2 is when doctors begin to take on more independent responsibilities.
FY2s are usually in training posts, meaning they are working toward a formal curriculum, receiving assessments, and moving through a pathway that leads to full GMC registration (if not already granted in FY1) and eligibility for specialty training.
However, many IMGs do not join the official UK Foundation Programme — instead, they take non-training FY2-equivalent jobs. These are often called "Standalone FY2", "Trust Grade FY2", or simply "FY2-level" posts. They mimic the clinical level of an FY2 doctor but may not offer the same assessments, ARCP, or structured teaching.
What’s an SHO?
The term SHO (Senior House Officer) is a bit of a throwback. Technically, it was phased out with the modernization of UK medical training years ago. But the name stuck — and today, SHO refers broadly to any junior doctor working at the FY2 to CT2 level, regardless of whether they are in training.
In many hospitals, SHO refers to anyone who is:
Not a foundation doctor (FY1)
Not yet a registrar (ST3+)
Able to handle ward-based responsibilities with a decent level of independence
This includes:
Trust Grade FY2s
Standalone FY2s
Clinical Fellows
CT1/CT2 doctors in training
IMGs in non-training posts
So yes — an FY2 can also be called an SHO, but not all SHOs are FY2s.
What IMGs Should Expect When Applying
When IMGs apply for their first NHS job, they often come across titles like “FY2 Trust Grade” or “SHO in General Medicine.” Here’s what to expect in both roles:
Work Responsibilities:
Both SHO and FY2-level doctors will be expected to:
Cover ward rounds
Manage acutely unwell patients (especially on-call)
Document in patient notes
Communicate with nursing staff and seniors
Liaise with family members
Order and interpret tests
Refer to specialties
In other words, the day-to-day clinical tasks are quite similar.
Supervision and Support:
FY2 doctors in official training posts may have more structured teaching, regular supervisor reviews, and mandatory assessments as part of their Foundation Programme. Trust Grade SHOs may not — but many hospitals offer similar support informally, especially for IMGs.
Portfolio Building:
If your long-term goal is to enter specialty training, then having access to things like workplace-based assessments (CBDs, mini-CEX, DOPS), clinical supervisor reports, and an e-portfolio becomes vital.
Some non-training SHO jobs allow you to mirror the foundation portfolio, especially if you're preparing for CREST form or Core Training applications.
Pay and Contracts:
Both FY2 and SHO posts usually offer similar salaries, often Band 1B or 1A depending on on-call commitments. SHO jobs may occasionally be more flexible or less competitive, especially in less urban locations, which can be beneficial for first-time NHS applicants.
What’s Better for an IMG: SHO or FY2?
This depends entirely on your career stage, registration status, and future plans.
If you're not yet GMC registered, you cannot take an FY2 or SHO post that requires it. In that case, you may need to first pass PLAB or obtain registration through sponsorship.
If you're GMC registered and want structured progression into specialty training, a standalone FY2 role with portfolio support may be more beneficial.
If you're ready to work and build clinical confidence, a Trust Grade SHO post may offer more autonomy and exposure to multiple specialties — often with less pressure.
Both roles are valuable. The key is choosing one that:
Matches your current level of experience
Supports your training portfolio
Helps you settle into the NHS system without burnout
Final Thoughts
The NHS structure can feel overwhelming — and terms like SHO and FY2 don't help. But once you understand that SHO is more of a clinical level than a training title, and that FY2 can exist both inside and outside training, the picture gets clearer.
The first NHS job for IMGs is rarely perfect — but every rotation brings learning, growth, and new opportunities. Whether you start as an SHO or an FY2-equivalent doctor, the real goal is to gain confidence, learn the system, and build your portfolio strategically.
And if you're not sure which role is best, you're not alone. Many IMGs face this exact question — and the best answers often come from people who’ve already walked the path.
So, ask your questions, learn from peers, and find your footing faster. Our community is here to support your NHS journey — one post, one connection, and one job at a time.