How to apply for Medicine A100

Keele University is committed to graduating excellent clinicians. The admissions process is designed to select students with abilities and characteristics that indicate their potential to become an excellent doctor. 

On this page you will find information about:

Selection Process

We advise all applicants who are considering applying to check these web pages thoroughly.  It is the responsibility of the applicant to ensure that you meet academic and other requirements before applying. 

All applications must be submitted via the Universities and Colleges Admissions Service (UCAS). We do not accept direct applications.

The UCAS deadline for submissions is 15 October 2024 for entry in September 2025 or deferred entry in September 2026.  

Applications should include the institution code for Keele University (K12) plus the appropriate course code -  

  • A100 for the Medicine 5-year MBChB degree
  • A104 for the Health Foundation Year route

Applicants will be considered for the route you have applied for. This cannot be changed after the UCAS deadline date for submissions. 

The university primarily communicates with applicants via the email address that has been used on the UCAS application. It is the applicant's responsibility to regularly check this email account and to ensure that university communications are not diverted to a spam/junk folder. Details of the admissions process and updates on the application are also provided in the Applicant Portal. It is the applicant's responsibility to check here for regular updates too. 

All applications are checked to ensure that you meet the minimum academic and aptitude test requirements. 

Applicants must be currently registered for any qualifications that are needed to meet the entry requirements for the course if these have not already been completed at the required standard.

You must declare all qualifications you have completed and any courses you are currently enrolled on within your UCAS application. Withholding information that is relevant to consideration of your application is unacceptable. 

We do not use predicted grades at any point in our selection process for medicine. 

All GCSE or equivalent requirements must be met before you apply. The only exception to this is Access to HE applicants, who may complete GCSE English Language and Maths during the academic year in which they apply. 

All school-level qualification requirements for graduate applicants (GCSE or equivalent and A-Level or equivalent) must be met before you apply. If you are offering GAMSAT in lieu of A-Levels and/or science GCSEs, this test must have been sat before you apply.

Graduate applicants may offer an Access to HE diploma rather than A-Levels or equivalent but it must have been completed before you started your degree course.

UCAT scores will contribute in various ways to selection for interview (see Shortlisting, below) and may be used as a tie-breaker at any stage in the selection process, for example where multiple applicants are tied on the same interview score and a limited number of offers is available. 

International applicants are ranked for interview based on UCAT score. The cut-off score for this test is not set in advance. 

Applicants with a Home fee status: shortlisting for interview is based on a combination of UCAT scores and the UCAS personal statement. The UCAT grade and personal statement grade will be calculated as shown below and combined to give a total on a scale of 1 to 25. This total mark will be used to rank A100 applicants for interview. 

A threshold score will be set to ensure an appropriate number of applicants progress to interview. We are unable to state in advance what this threshold will be, as it depends upon the score achieved by the new cohort of applicants. If a tie-breaker is required (i.e. if there are more people tied on the same total mark than the number of interview slots remaining), the UCAT verbal reasoning score will be used.

For 2025 entry, A104 applicants who meet the eligibility criteria (see Health Foundation Year page) will be ranked on the combined UCAT/personal statement score in the same way as A100 applicants. 

UCAT grade calculation

Applicants with a total UCAT score below 2,280 or a situational judgement test (SJT) result in band 4 will not be considered.

A score between 1 and 10 is calculated from the UCAT scores as follows: 

UCAT quintile Points UCAT SJT band Points
1st (top 20%) 5 1 2
2nd 4 2 1
3rd 3 3 0
4th 2    
5th (scores between 2,280 and 20th percentile, if any) 1    

 

Applicant in receipt of a UCAT bursary: +1 point 

Applicant meeting criteria for contextual offer (see Alternative offers page): +1 point 

Applicant attending school within the Keele region (see Alternative offers page): +1 point 

Personal statement grade calculation

UCAS personal statements will be assessed against the person specification for a Keele medical student (see below) to give a score on a scale of 0 to 15. Your personal statement must provide examples of ways in which you have demonstrated the characteristics listed in the person specification. Please see the guidance notes accompanying the person specification to help you with writing your personal statement.

If you are applying directly from school/college, please make sure your head of sixth form, UCAS adviser and any other relevant member of staff is aware of the need to address these requirements. 

Other

Some interviews will be allocated to applicants who demonstrate evidence of having overcome significant social, economic and/or educational disadvantage. See our Widening Participation pages. In particular, A100 applicants who have successfully completed a Widening Participation in Medicine programme that is part of the UKWPMED scheme will automatically qualify for interview, subject to meeting our minimum GCSE and UCAT requirements and being due to complete the required A-Levels or equivalent qualifications in the current academic year or having completed them in the previous academic year. UKWPMED programme completion will not be taken into account for applications made after the year following year 13/S6.  

International applicants: shortlisting for interview is based on ranking by UCAT score. Applicants must have a total score of at least 2,600 and an SJT result in band 3 or better to be considered. Eligible applicants will be ranked on total score from the four cognitive subtests. In the event of a tie, the Verbal Reasoning subtest score will be used as a tie-breaker. International applicants are not eligible for A104. 

The threshold score for this test is not set in advance as it depends on the scores achieved by other applicants. 

Keele University seeks to recruit medical students who are committed to the values of the NHS (see NHS Constitution for England). To achieve this, we have developed a person specification for a Keele medical student. This will form the basis of our assessment of personal statements and will also define the content of our interviews. You will be required to provide examples of ways in which you have demonstrated the essential characteristics.  

The essential characteristics are:

a) Awareness of the roles of a doctor within the healthcare team, community and society

b) Ability to engage meaningfully with people who have some need of care, support and/or help

c) Ability to communicate effectively with a variety of people

d) Willingness to take on responsibility and fulfil it to the best of your ability

e) Ability to maintain one or more significant activities alongside your academic studies over a prolonged period

f) Evidence of having made a positive difference to another person’s life 

Guidance notes, incorporating details of how to approach writing the personal statement, are attached here. These will be updated for 2025 entry and you should download the updated notes in May/June 2024. Guidance notes for writing the personal statement (2024 entry)

Please note that the majority of UK medical schools do not score personal statements and use them only for checking broad compatibility with a medical career. All of the criteria Keele asks you address in your personal statement will also be regarded positively by other medical schools.

Interviews will be conducted online using Microsoft Teams. Instructions for accessing online interviews will be provided but it is the applicant’s responsibility to ensure you have access to the necessary technology to complete the interview. Please ask for help from your school/college if you are not confident that your own technology is adequate. Advice on online interviews is offered by the Medical Schools Council.  

Interviewers are drawn from the university, local healthcare settings (hospital and community) and the wider local community. All interviewers have undergone specific training for interviewing prospective medical students and avoiding discrimination. 

The interview will address the attributes listed in the person specification with additional emphasis on the broader roles and responsibilities of doctors, including awareness of ethical and social issues related to health and illness. It will take the form of two 15-minute interviews, usually 2 hours apart. You may be required to read some materials in advance. Please note that you are only provided with these materials in advance so you don’t have to spend time reading them in the interview. You are not required to do any specific preparation for the related sections of the interview other than reading the materials we provide, and you will therefore be given them only a short time before the interview (typically 1–2 days). These materials may differ from those provided to applicants being interviewed in other sessions.

Please note that you will be asked to read some text in advance of your interview. You will be given details in the interview invitations, but the information is also given here for general advice. For one interview you should have visited the General Medical Council’s web site Achieving Good Medical Practice: Guidance for Medical Students and read the section on professionalism – key areas of concern. For the other interview, you will be sent a short case along with your interview invitation. You are not expected to memorise anything from these texts: they are provided in advance so that you don’t have to spend time reading them in the interview.

Interviews will take place during the period December 2024 to April 2025. 

The decision on the offer of a place will be based on an applicant’s performance at interview. 

We anticipate that the earliest date we will be able to confirm a decision is January/February 2024. Some candidates may be placed on a reserve list if their performance at interview was close to our offer threshold. Applicants will be informed if we wish to add you to the reserve list, and you will be asked to consent so we can contact you at a later stage. We will endeavour to make all final decisions (offer, reserve or reject) by April 2025.

Candidates whose interview scores are tied at the final threshold for an offer will be ranked on their aptitude test score to determine who receives an offer.

Successful applicants will be informed of their offer through the UCAS Hub. All offers will include requirements to complete occupational health checks and Disclosure and Barring Service (DBS) clearances. 

The Occupational Health team will contact all applicants who accept their offer regarding the health checks. 

The Admissions team will contact all applicants who accept their offer regarding their DBS clearance.  

Successful applicants will be invited to attend an Applicant Visit Day. 

Applicants holding offers who narrowly miss achieving the required grades in A-Levels (or equivalent level-3 qualification) may receive further consideration if there are places available. In these circumstances, factors taken into consideration in allocating remaining places will include, interview score, UCAT score, UCAT bursary status and other indicators of disadvantage. Places not filled by offer-holders who have missed the conditions of their offer will be made available to applicants on the reserve list. New applications through Clearing will not usually be permitted.

Summary of places available

This table shows a summary of the places available and applications received for 2024 entry.

 

 

Applications 2024 entry

 

Places available 2024

Total applications

Home applications

Overseas applications

A100

164
(154 Home +
10 Overseas)

3188

2748

440

A104 (Health Foundation Year)

up to 20

403

368

(35 - not eligible)

Typically, we receive 2,000 or more applications each year. For 2024 entry we intend to interview approximately 600 applicants in total.

Admissions Policy

The information within this section supplements our University admissions criteria and policies and applies to all applications to our MBChB programme. 

Age on entry

Due to the off-campus clinical placements that students will be involved in from an early stage in the course, applicants must be at least 18 by 1 October of year one of the MBChB programme. For programme A100, If you will not be 18 by that date in the year following application, you must apply for deferred entry. For programme A104, you must be at least 17 by 1 October of the Foundation Year so that you are 18 at the beginning of MBChB year one.

Behaviour / misconduct

Applicants must be aware that your behaviour outside the clinical environment, including in your personal life, may have an impact on your fitness to practise. Applicants’ behaviour at all times must justify the trust the public places in the medical profession. You are advised to consider all evidence of your conduct that exists in the public domain, including social media. Applicants are expected to behave courteously throughout the application and selection process. Abusive or aggressive behaviour towards university staff, students or other applicants will not be tolerated and may result in the cancellation of your application. Applicants who are found to be abusing, insulting or deliberately misleading other applicants in social media and other online settings may also have applications cancelled. Applicants must not share details of the content of interviews with anyone else. If you are put under pressure to do so by your school, college, adviser or agent, please inform us immediately.  

The Medical Schools Council, Dentistry Schools Council and Pharmacy Schools Council maintain a database of students who have been excluded from medical, dental or pharmacy programmes on fitness-to-practise grounds. Applicants who appear in this database will be contacted by the School of Medicine to arrange a review by the School’s Health and Conduct Committee.

As registration with the General Medical Council on graduation is dependent upon being judged fit to practise, applicants are also advised to notify the university if you have been subject to misconduct sanctions in a previous professional role (e.g. removed or suspended from a professional register) or have been the subject of any safeguarding investigation. This will allow any potential bars to registration to be identified before you commence the course.

Applicants who have been excluded or withdrawn from another HE course on grounds of academic performance (i.e. failing assessments), misconduct (e.g. cheating) or failure to meet financial or other contractual commitments (e.g. non-payment of tuition or accommodation fees, breach of behaviour rules) will not be considered. 

Communication

The university communicates with applicants via the email address that they provided on their UCAS application. It is the applicant’s responsibility to regularly check this email account and ensure that university communications are not diverted to a spam/junk folder.

Deferral requests

Requests to defer after an application form has been submitted must be sent to medicine@keele.ac.uk by 31 May 2025 stating the reason for the request to defer.

Exam results and remarks

We will make our confirmation decisions based on the A-Level results published in August 2025. All conditions must be met by 31st August 2025.

If applicants don’t meet the academic conditions of the offer and subsequently decide to appeal to the exam board, we must be advised of this immediately by email to medicine@keele.ac.uk. We may defer applicants to the 2026 intake who do not initially meet the conditions of the offer, but who do so after appeal.  


Any dispute over grades must be conducted between applicants, the school or college, and the relevant exam board or accrediting body. We will not respond to requests for special consideration from students or schools/colleges who feel that grades have been awarded inappropriately. 

Extenuating circumstances

All requests to consider extenuating circumstances should be sent to medicine@keele.ac.uk at the time of application submission and no later than 31 October 2024.

Please note that if you wish extenuating circumstances to be considered, you must notify us in this way. We won't act on details of extenuating circumstances in the UCAS personal statement. We will take account of extenuating circumstances mentioned in the relevant section of the UCAS reference but we may need to request additional information and this should be done as early as possible in the cycle, so you should alert us to any need for extenuating circumstances to be considered by e-mailing before the 31 October deadline. We cannot take supplementary requests for consideration by your school/college, etc., into account unless you have submitted a request by the deadline.

Incomplete applications

We reserve the right to reject applications if they are incomplete or incorrectly completed:  

  • applicants are required to declare all qualifications that have been completed, including those with a failed or low grade, and any courses on which you are currently enrolled
  • if a qualification that is required for entry is not declared, we shall assume it has not been taken or is not being taken; this may lead to the application being rejected
  • if applicants declare incorrect details that do not match the corresponding certificates, this will be taken as evidence of dishonesty and the application will be rejected
  • if you have completed vocational or non-UK qualifications, please enter them by their original name; please do not enter non-GCSE qualifications as “general certificate of secondary education”
  • all applications must include a reference from your current or most recent educational establishment unless you have been out of full-time education for more than 2 years, in which case a reference from a current or recent employer may be accepted; your employer should include details of any additional education or training you have undertaken in your role; if you have not been in employment because you have spent time pursuing other activities (e.g. caring for children or other relatives, travelling, undertaking creative projects, etc.), you should approach your most recent educational establishment to request a reference 

Reapplication

Applicants who have previously commenced study of medicine, dentistry or veterinary medicine elsewhere will not be considered. 

Transfers from other medical schools will not be considered. There is no mechanism to transfer to medicine from any other courses at Keele, or to transfer to the Health Foundation Year for Medicine from other foundation years or degree programmes. 

You may not apply for medicine at Keele (any route) while enrolled on another higher education programme that will not be completed within the current academic year. 

Applicants can only reapply to Keele once. Any further applications will not be considered. 

Resits

Applicants who have taken more than two years to complete three A-Levels or equivalent must apply after completion of these qualifications with the required achieved grades. We will not consider applications from students currently in their third year of A-Level study unless they have already achieved the required grades and are taking additional subjects to meet the subject requirements (see entry requirements).  

Anyone who has not achieved the required A-Levels within three years will not be considered. 

UCAS Similarity Detection Service

UCAS operates a similarity detection service for personal statements. If we see evidence that parts of a personal statement have been copied, shared with other applicants or provided by a third party we shall cancel the application.  We have very limited ability to see the sources or dates of similar text and are therefore unable to make judgements on whether an applicant has copied from another application or has had their application copied. We will simply act on the basis of the degree of similarity. You should therefore take measures to avoid your statement being copied, as well as to avoid copying someone else’s.

Frequently Asked Questions

We've collated our frequently asked questions to help address any queries you may have about our Medicine (A100) and Health Foundation Year for Medicine (A104) selection process.

5-Year MBChB (course code A100)

This is a five-year Bachelor of Medicine and Bachelor of Surgery programme (MBChB) open to home and international school-leaver, graduate and other mature applicants.

6-Year MBChB with Health Foundation Year for Medicine (course code A104)

This is a gateway route into Medicine for applicants from some under-represented groups. This course offers standard medical training with the addition of a Foundation Year and is open to school-leaver applicants with Home fees status.

Will I spend all five years at Keele?

No. You will spend the first two years of the 5-year MBChB (or the first three years of the A104 programme) at Keele, with some clinical placements throughout the two years and regular clinical skills sessions at the Royal Stoke University Hospital (RSUH) in year 2. You will spend most of year 3 at RSUH with some placements in other local hospitals, one day a week at Keele and a 4-week placement in general practice. You will spend either year 4 or year 5 based in Shropshire (Royal Shrewsbury Hospital, Princess Royal Hospital Telford, Redlands Centre Shrewsbury and a GP practice) and the other year in Staffordshire (RSUH, other local specialist hospitals and a GP practice). All medical schools in the UK require students to travel for placements.  

We encourage applications from mature applicants: either recent graduates or people who wish to change career. Applicants should have some experience of recent academic study or certificated continuing professional development (usually within the last 5 years).

Mature learners who do not meet standard academic requirements from their earlier school-leaving and/or university qualifications may undertake an Access to HE diploma. Please note that we only accept Access to HE Diploma (Medicine) qualifications that comply with the Quality Assurance Agency for HE (QAA)’s subject descriptor for medicine. Please check with the college that the diploma complies with the subject descriptor before you enrol, as we will not accept other Access diplomas for entry to medicine. 

No. The A-Level subject requirements are stated in the academic requirements sections. As long as applicants meet these requirements, it makes no difference what combination of A-Levels is being studied. 

No. We will only look at the best three A-Levels that meet our subject requirements.

Yes. We will accept A-Level grades of AAA (meeting our subject requirements) if accompanied by an EPQ at grade A* or A.  

We have a dedicated webpage which details our alternative offers schemes, including EPQ. 

No. The majority of schools in England do not offer AS-Levels; we therefore cannot use them in assessing applications.

We do not use predicted A-Level grades in any way in selection for our Medicine programmes.

No. We do not distinguish between degree subjects. Graduate applicants must meet GCSE and A-Level requirements or else sit GAMSAT in lieu of these. The subject of your degree does not exempt you from these requirements. 

Yes. We have specific requirements for the situational judgement test (SJT) section of UCAT and your UCAT scores are used in calculating your shortlisting score for interview, so all applicants must sit UCAT.  

Applicants’ school/college should report all extenuating circumstances to the relevant examination board at the time of the examinations. It is the responsibility of that examination board to make adjustments to grades or degree classes if appropriate. We will not respond to requests to consider circumstances involving policies or practices of schools, exam boards or regulators. 

See our Admissions Policy for details of how and when details of extenuating circumstances should be submitted. 

No. You can only change a choice after the deadline if this is agreed by the receiving university. Keele will not agree to requests to swap UCAS choices from another institution to study Medicine after the UCAS deadline of 15 October. 

We are happy to consider applications from those who want to defer their entry. You may apply for deferred entry by choosing the next year as the year of entry on your UCAS application (e.g. selecting 2026 instead of 2025 as the year of entry for an application in October 2024). 

See our Admissions Policy for details of how and when request to defer can be submitted after a UCAS form has been submitted. 

Keele University has an equality and diversity framework and strategy, which states that no student will receive less favourable treatment on the grounds of race, colour, nationality, ethnic or national origins, gender (including gender realignment), marital status, sexuality, disability, religion, political belief, socio-economic background, parental status, age or trade union membership. 

The University is committed to a programme of action to ensure that this policy is fully effective. To support the rights, responsibilities, dignity, health and wellbeing of staff and students through our commitment to equality and diversity. 

UCAS personal statements forms will be assessed in the context of the applicant's age and experience. We have greater expectations of the extent and depth of an applicant’s roles and responsibilities if you have had more opportunities to undertake these during a first degree or career. Expectations of school-leaver applicants are correspondingly lower.

We recognise that some applicants' ability to undertake voluntary experiences may be affected by the need to take on part-time employment or caring responsibilities within the family, and this will be taken into account if it is apparent from your application. We do not require formal, medically related "work experience", and it is possible to make a strong application on the basis of roles and responsibilities within your school/college or part-time job. 

We deliberately exclude experiences that may depend on personal connections (workplace shadowing) or wealth (overseas travel) from gaining credit in the personal statement. Commitments within community or faith groups will be given equal consideration to those within formal caring settings. We only ask for evidence of direct engagement with people to whom you have provided help, support or care. 

No. Transfers from other medical schools are not considered, except as part of formal articulation agreements with medical schools in other countries. We will not usually accept applications from students who have previously commenced study of medicine, dentistry or veterinary medicine elsewhere (including in other countries). We may be able to consider applications for year 1 entry from Home fees-status students who have been displaced from medicine courses in other countries by war, revolution or other extreme circumstances. However, you must still meet our academic entry requirements and must complete our normal selection process. Students in these circumstances should contact the University before applying to determine whether you are eligible.

Due to the off-campus clinical placements that students will be involved in from an early stage in the course, applicants must be at least 18 at the start of year 1 of the MBChB programme. If you will not be 18 by 1 October in the year following application, you must apply for deferred entry the following year. If you are applying for the Health Foundation Year for Medicine (A104), you must be 18 by 1 October of the year following commencement of the foundation year (i.e. year 1 of the normal MBChB programme).

There is no upper age limit. However, applicants who would be close to or above normal retirement age by the time of graduation will be invited to discuss their application with one or more senior clinicians. Students at the School of Medicine come from a wide age range and have a variety of previous work and study experiences. We feel that having such a variety of students benefits everyone in the school. 

No. We do not expect applicants to have experience in medical settings, and we do not give any credit for shadowing or observation of doctors or other healthcare professionals when assessing applications. You will need to have some understanding of the role of a doctor and how healthcare is delivered for your personal statement and to succeed at interview, so if you don’t have experience in medical settings you should read about this or take advantage of any opportunities to talk to current practitioners. A number of organisations run virtual work experience (e.g. Brighton & Sussex Medical School, Royal College of General Practitioners), summer schools or other activities that allow prospective medical students to find out more about what being a doctor involves. Please check with local organisations such as Integrated Care Systems to see whether there is a scheme operating in your region.

With effect from the 2024 admissions cycle, we shall be using the UCAS personal statement in selection of applicants for interview. This will be scored on the basis of the person specification for a Keele medical student provided on these web pages. 

We shall refer to references as necessary to verify educational context and personal circumstances affecting applicants. Please note that all applicants are required to provide a reference. If you are applying directly (i.e. not through your school/college), you are responsible for contacting a suitable referee and ensuring the reference is submitted on time.  

The requirements for content of the reference are defined by UCAS with effect from the 2024 entry cycle. Your school or college will be aware of these requirements. If you are applying as a graduate or are requesting a reference from an employer, please make sure the referee is aware of the requirements.  

If you experience any extenuating circumstances at the time of your examinations, your school or college should report this immediately to the relevant examination board(s) using the Joint Council for Qualifications form 10 (special consideration), so that any adjustments to marks can be made. If we consider that extenuating circumstances brought up in the reference should be taken into account formally in the assessment of your application, we shall write to your referee to request further details. Please do not send such details unsolicited. 

You may do this if you wish. However, you will only have one interview and be made one offer for one course. If you do not meet the conditions of your A100 offer at confirmation, but did meet the eligibility criteria for A104 at initial screening, we will automatically consider you for a foundation-year place. If you receive an offer for A104 it will be because you didn’t meet one of the requirements for an A100 offer (e.g. your GCSE grades or shortlisting score were too low), so the offer will only be for foundation-year entry: we will not normally consider you for an A100 place if you go on to achieve A*AA or better in your A-Levels or equivalent. 

If you have completed any UKWPMED programme you should include this in your UCAS application. Applicants who have completed a UKWPMED programme and who meet Keele’s minimum GCSE and UCAT requirements for A100 will automatically be invited for interview; if you are made an offer it will be for A-level grades of ABB or equivalent. 

Level-3 BTEC qualifications and T-Levels are not accepted for entry to A100 (standard 5-year MBChB). However, they are accepted for applications for A104 (Health Foundation year for Medicine) from students who meet the eligibility criteria. 

No. You will have to meet UCAT requirements and pass the interview to join the Health Foundation Year for Medicine. Once you have done that, you only have to pass the foundation year at the required grades (pass all modules and achieve 70% in all semester-2 modules and year-long modules) and be in good standing academically and behaviourally to progress to year 1 of the MBChB programme.

There will be a national Medical Licensing Assessment (MLA) in place from 2025. Anyone who wants to practise medicine in the UK will have to pass this assessment. The MLA consists of two parts, an Applied Knowledge Test (AKT) and a Clinical and Professional Skills Assessment (CPSA). The AKT will be the final written exam at Keele, to be sat at the end of year 4. The CPSA will be the final skills exam (OSCE: objective structured skills examination) and will be sat during year 5. If you pass these exams to complete the Keele MBChB, you will also have passed the MLA and will be eligible to register with the General Medical Council (GMC) to become a doctor. You must also sit the national Prescribing Safety Assessment in year 5. Passing this is not currently (2024) a condition of graduation or provisional registration with the GMC. However, if you have not passed it while at medical school you must pass it during your first foundation training year to be allowed to progress to FY2.

At present, medicine graduates gain provisional registration with the GMC when they complete their medicine degree. They then have to complete the first year of a 2-year foundation training programme (FY1) to gain full registration and then a second year of foundation training (FY2) to be eligible to apply for specialist training. You are a doctor from the beginning of FY1 and will earn a doctor’s salary throughout foundation training and subsequent specialist training.