Keywords
shortlisting - application process - career progression - core surgical training
In recent years, core surgical training (CST) in the United Kingdom has become more competitive, highlighting the importance of preparation and planning. The general principles of the application process and specifications can be determined from previous years; however, these are liable to change. Assuming applicants meet eligibility criteria, they will undertake a self-assessment in which the applicant demonstrates their commitment to specialty and research capabilities. In the 2023 intake, applicants were shortlisted for interview using the multi-specialty recruitment assessment (MSRA) examination.[1] Successful candidates had their self-assessment scores verified. Finally, applications are concluded with an online interview covering management/leadership skills and clinical knowledge. The weighting for applications are broken down as follows; MSRA: 10%, self-assessment: 30%, and interview: 60%.[2]
Applicant Eligibility
Health Education England releases person specifications at the outset of the recruitment cycle. To apply, the applicant must have completed an MBBS or equivalent medical qualification.[3]
Candidates must be eligible for or already hold a license to practice from the general medical council by the post start date. Applicants must demonstrate completion of foundation competencies within 3 years and 6 months of the proposed start date. This can be achieved by evidencing present employment in a UK foundation program affiliated foundation post. If this has been completed, evidence of the program certificate of completion will satisfy this criterion. Alternatively, 1 year of medical experience post full general medical council registration and a certificate of readiness to enter specialty training would suffice.[3]
All prospective candidates must ensure fitness to practice is up to date and be able to recognise personal training needs. Written and spoken English skills are further required. In keeping with the general medical council standards, candidates must meet professional health regulations.[3] Candidates should also be aware that surgical specialty post foundation training experience should be limited to 18 months, otherwise they would be ineligible for the post.[3]
The MSRA
The first step in securing a CST post is succeeding in the MSRA. This is a computer-based assessment comprised of two parts, professional dilemmas and clinical problem solving. Professional dilemmas consider workplace scenarios and assess candidate judgment regarding the appropriateness of certain behaviours, whilst clinical problem-solving assesses' medical knowledge. If the applicant receives a score surpassing the cutoff they will be invited to interview.[1]
Tip
Amongst applicants, the use of question banks is becoming more popular; however, sample questions are also provided by Pearson VUE.
Self-Assessment
Potential applicants award themselves a score over five domains based on the self-assessment handbook produced by Health Education England. This is later reviewed by a consultant-led panel and either accepted, upgraded, or downgraded based on their judgment of points claimed and evidence submitted. The self-assessment score comprises 30% of the candidate's overall score.[4]
Tip
Ensure when attending surgical conferences and courses that this is evidenced with a certificate. Making online copies can prevent these from being lost. It is of utmost importance that evidence meets the exact specifications set out by the handbook,[4] otherwise these points are liable to be downgraded.
Commitment to Surgery
The first self-assessment domain considers the applicant's commitment to surgery with points awarded based on operative experience, conference attendance, and electives/taster weeks (with a surgical theme). If the applicant is prepared, this domain represents straightforward points.[4]
Tip
As a student or foundation doctor, using a surgical logbook is an efficient way to keep track of and evidence surgical experience.
Quality Improvement and Audit
Quality Improvement and Audit
Quality improvement and audit is a vital part of clinical practice. It concerns itself with comparing current clinical practice to that of predetermined standards of care. It can help identify reasons for shortcomings in practice and allow them to be addressed.[5] The importance of audit in clinical practice is reflected by the domain scoring, with maximum points being awarded to those who have led closed-loop audits and supplementary points are available for the presentation of results.[4]
Tip
Most hospitals have audit/quality improvement clinical leads. Contacting these individuals can be useful for project planning and advice.
Presentation and Publications
Presentation and Publications
The maximum number of points is achieved by those with a first-author paper or an award-winning oral presentation at a national or international conference. Whilst these can be daunting and difficult to achieve at the foundation level, there are more easily achievable points for poster presentations and co-author papers available.[4]
Tip
When completing an audit, seek out related conferences and submit poster/oral presentations of results. This will not only give extra points but allow for critique and feedback on processes.
Teaching Experience
Core surgical trainees will be expected to perform teaching sessions at departmental meetings or with medical students/foundation doctors. This is reflected in the self assessment scoring in which applicants that have organised teaching programs will score the maximum number of points. Organising teaching sessions for medical students meets the criteria of this domain, it is also a useful way of consolidating your own knowledge of surgical topics.[4]
Tip
A useful tip for this section is to ensure that accompanying evidence directly matches that of the guidance, for example, specifying the number of teaching sessions provided, and evidence of formal feedback.
Training Qualifications
The final domain considers postgraduate study in medical education. A variety of points are awarded, with the maximum being PHD level. Again, this domain is a difficult section for foundation-level doctors to achieve; however, compared to other self-assessment domains there are fewer points available.[4]
Interview
Commanding 60% of the overall points, to succeed in CST applications the candidate must succeed in the interview. The format has remained unchanged for several years and is comprised of two parts.
First, a management station incorporating a pre-prepared 3-minute presentation with questions followed by a 5-minute management scenario. This station is primarily concerned with leadership and management qualities, a sound understanding of management structure is also useful.
The interview ends with two clinical management stations, both of which last 5 minutes. Scenarios change, however, are typically comprised of core clinical problems such as assessment and management of deteriorate postoperative patients and trauma cases.[6]
Tip
Forming a study group with other trainees can be useful for refining interview skills and becoming familiar with the interview format.
Conclusion
Whilst the application is lengthy and competitive, with forward planning and organisation it is possible to make the process more straightforward. Furthermore, undertaking audits, courses, and attending conferences will give transferrable skills useful for everyday clinical practice.
Bibliographical Record
Keir Mailley. Core Surgical Training in the United Kingdom: How to Succeed in the Application Process. Surg J (N Y) 2025; 11: s00451807258.
DOI: 10.1055/s-0045-1807258
