Core Surgical Training (CST) interviews are usually held between January and March. There have been changes to the 2021 process in light of COVID-19 meaning candidates are now shortlisted based on their portfolio score to reduce the number of interviews. Whether you are a foundation year doctor, medical student or taking a year out of training, if you are serious about applying for surgical training, it is important to review the portfolio points early to put yourself in the strongest position, within your time scale.
We will breakdown the Oriel Portfolio Scoring for 2021 to advise on maximising points in each section.
You can also check-out our Core Surgical Training Interview Question Bank to help you prepare. We will be adding updates to the question bank relevant to COVID-19 in clinical and management scenarios.
As per updates from HEE and RCS: CST application involves a 2-stage shortlisting process. The first stage involves self-assessment portfolio score submitted via Oriel (from 5/11/20), the second stage involves consultant review of evidence provided to justify the score (evidence submitted 23/12/2020 to 7/1/2021).
The interview process will be carried out over Microsoft Team as an online video interview for the first time, due to the COVID-19 situation. These will take place from the 22nd of February to the 5th of March 2021. The interview will involve a similar structure to previously with a 10-minute management station and a 10-minute clinical station.
The portfolio station is worth 33% of the overall score and is the only aspect which provides guaranteed points.
With only a few points between candidates, an extra point can make a significant difference to the outcome of your applications (and in 2021 it may determine if you are offered an interview).
The remaining 66% of interview points come from the management and clinical stations for which performance also relies on good preparation. All these points are determined on the day – please see our core surgery interview question bank for preparation in these areas.
Commitment to surgery
This is a broad section with points in various categories.
MRCS Part A
You must pass this exam to get maximum points here. If not feasible in your timescale at least book an exam before applications to get an easy 1 mark.
There is a wide range of courses available with examples given in the handbook. These should be relatively easy points as you can book many courses within a short time scale. In addition to gaining you vital points, these courses which will benefit your clinical skills and knowledge for your surgical career.
BSS and ATLS are the courses most commonly undertaken, and many trainees find them very useful. Your study budget may also be useful to cover some course fees. But there are many other surgical introductory courses from ASIT, the BMA or Royal Surgical Colleges also accepted which often have lower course fees. It is useful to identify courses which interest you and book early as courses often fill up.
Having at least 15 surgical cases assisting, or supervisor trainer scrubbed is needed for full points here. Keeping an eLogbook of surgical cases should begin at medical school and is useful to monitor your progress through training. The summary sheet is required to be signed by a consultant.
Surgical Taster Week
This should be another easy place to get full marks by doing a 5-day taster week. Use this as an opportunity to try out a subspecialty of interest to help you with preferencing your surgical jobs in CST. You can also use it to increase your operating logbook, network with surgeons and sign up to research or audits.
If you are a student it is recommended you complete a surgical elective, if you have done one ensure you reflect on it for evidence. Although usually undertaken at medical school, you can also do short electives in your FY3 if applying then. Some bursaries are available from surgical societies if undertaken later with potentially more opportunity for hands-on surgical experience.
This section covers additional degrees. There are no easy ways to maximize the points in this section in a short time scale. If you are an applicant for 2021, you either have them or you don’t.
If still at medical school or in a position where you would like to take an additional degree the shortest option to max out points in this section would be an MSc or intercalated BSc (with 1st class honors). However gaining points in this area is certainly the most expensive and time-consuming, and you may be better of focusing on other areas of your portfolio.
|PhD or MD by additional research (level 8 qualifications). This can include non-medical qualifications.||4||You undertook full-time research involving original work, usually of at least three years’ duration, and ideally resulting in one or more peer-reviewed publication|
|Bachelor degree (level 6 qualification) in addition to primary medical qualification; 1st class honors or equivalent. This can include non-medical degrees or BDS||4|
|Degree obtained during medical course (e.g. intercalation, BSc, BA, etc.) – 1st class honors or equivalent||3||This must be a specific course that usually lasts for three university terms (or equivalent) and is eight months’ or more duration (full time equivalent);|
|>Taught and research masters degrees (level 7 qualifications). This can include non-medical qualifications||3||You undertook full-time research involving original work, usually of at least two years’ duration, and ideally resulting in one or more peer-reviewed publication|
|Single-year postgraduate course (e.g. MSc, MA, MRes, etc)||2||This must be a specific course that usually lasts for three university terms (or equivalent) and is eight months’ or more duration (full time equivalent); it must not be claimed for upgrading a bachelor’s degree without further study as is offered in some universities|
|MPhil Master of Philosophy||2|
|Degree obtained during medical course (eg intercalation, BSC, BA, etc.) – 2.1 or equivalent||2|
|Degree obtained prior to starting medicine – 2.1 or equivalent (can include non-medical related degrees or BDS)||2|
|Any other degrees or qualifications in addition to PMQ not covered in the above categories||1||For example: certificates or diplomas that do not fall into the above categories, partial higher degrees, intercalated degrees achieving 2.2 or lower.|
|Primary medical qualification only||0|
These can be challenging to achieve in a short space of time if you do not have them already. Potential areas include:
- Essay competitions from medical or surgical societies (e.g. BMA, Royal Colleges, ASIT). These often have poor submission figures with less competition than you may think.
- Conference poster or presentation prizes – try to submit to as many as you can but consider small conferences or regional meetings may be less competitive to win prizes. While larger meeting e.g. RSM may offer a range of prizes.
- Prizes related to Quality improvement projects/ audits (can score points in multiple categories with one project!).
|Awarded national prize related to medicine||8||This means that the prize is open to medical undergraduates and / or postgraduates in the country of training|
|High-achievement award for primary medical qualification (e.g. honors or distinction) awarded to no more than the top 15%||6||If more than 15% of the year receive honors/distinction etc., then it no longer marks you out as exceptional in this category|
|More than one prize / distinction/ merit related to parts of the medical course or Foundation Programme awarded to no more than the top 20%||4||You may only claim this if you were in the top 20% of marks for part of the course on more than one occasion|
|>4||This means that the prize is open to medical undergraduates and/or medical postgraduates in the training region (e.g. foundation school or postgraduate deanery)|
|One prize / distinction / merit related to parts of the medical course or foundation training awarded to no more than the top 20%||3||You may only claim this if you were in the top 20% of marks for one part of the course/training programme|
|Awarded local prize related to medicine||2||This means that the prize is open to medical undergraduates and/or medical postgraduates in a locality/organisation (e.g. NHS trust, hospital, primary care network)|
|Scholarship / bursary / equivalent awarded during medical undergraduate training or Foundation training||2|
Quality Improvement (Clinical Audit)
Full marks in this section requires you to have a “leading role in the design and implementation of a sustained change (i.e. more than one completed cycle) QI methodology or clinical audit AND have presented the results at a Regional or National meeting.” This should be achievable if you choose a project early (ideally FY1 year) and identify regional/ national conferences/ meeting that allow submissions.
Benefits of a large, high-quality surgical audit or quality improvement with significant changes to clinical practice:
- Impress assessors who may give you the benefit of the doubt with some other marks
- Present the results in conferences – poster or oral – extra points
- Win a prize locally or in a meeting – extra points
- If very good project it may be publishable – extra points
These large projects can often take 6-12 months and some many cases they are not be completed due to changing trainees or problems implementing change.
If time-limited there are several straightforward, important (but maybe less interesting) audit subjects which trainees can complete in short spaces of time. For examples:
- Low molecular weight heparin e.g. VTE checklist, prescription in GI malignancy post-discharge, correct dose for weight
- Surgical documentation: based on Royal College guidelines
- Antimicrobial prescription
- Consent forms
- Theatre booking forms
- Hydration – IV and oral fluids
- Oxygen prescription
Remember to register the audit with the audit department and keep evidence of presentation at the local/ regional/ national audit meeting.
Beware of consultants asking you to do an ‘audit’ which involves reviewing a significant number of cases (I’ve heard of >500 patients) which may just be a means of reviewing their operative figures. Frequently these are not audits, with no standards or way to implement change. This may be a poor use of your time and you may wish to find a way to tactfully decline such a request if you do not think it will be worthwhile. If it is not an audit it will not count in this section.
|I played a leading role in the design and implementation of a sustainable change (I.e. more than one completed cycle) using QI methodology or clinical audit AND
I have presented the complete results at a regional or national meeting
|11||You had a lead role in devising the question to be asked (or how an existing project could be developed further/sustained), developing the project plan, identifying potential solutions, implementing repeated change cycles, collating and presenting the data and identifying sustainability for the work.
It is likely that this involved working as part of a team, but you must evidence your own role within the QI activity with demonstrable leadership in design, implementation and learning
|I played a leading role in the design and implementation of a sustainable change (I.e. more than one completed cycle) using QI methodology or clinical audit AND
I have presented the complete results at a local meeting
|9||As above, but presented within a locality/organisation (e.g. NHS trust, hospital, primary care network)|
|I played a leading role in the design and implementation of a sustainable change (i.e. more than one completed cycle) using QI methodology or clinical audit, but I have not presented the results||8||As above; but the work was not presented by you|
|I have actively participated in the design and implementation of a sustainable change (i.e. more than one completed cycle) using QI methodology or clinical audit, AND
I have presented the complete results at a meeting
|6||You participated actively through multiple cycles and presented the findings, but did not take a leading role in the project|
|I have actively participated in the design and implementation of a sustainable (i.e. more than one completed cycle) change using QI methodology or clinical audit, but I have not presented the complete results at a meeting||4||You participated actively in the project through multiple cycles but did not take a leading role or present the findings|
|I have participated only in certain stages of a quality improvement project or clinical audit, which has completed at least one cycle||2||For example, you assisted with data collection for the project|
1 or 2 points – Teaching medical students or other healthcare professionals occasionally. All applicants should have done this. It can be done as volunteering to do a departmental teaching session or a teaching session for medical students. Many hospitals also offer twilight teaching sessions for students, which you can get involved with (this may now be virtual).
Formal feedback to get you 2 point involves either senior observation/ feedback or independent collection and analysis (which can be arranged through the course organiser e.g. Medical Education department or course lead).
4 points – Teaching medical students or other healthcare professionals regularly > 3 months. As above – this is a very achievable goal.
6 points – Worked with local tutors to design and organise a teaching programme (a series of sessions) to enhance locally organised teaching & provided teaching for 3 months (with formal feedback). Requires you to be very proactive and consider the hospital which you work in, looking for areas where medical student teaching is lacking. Ask the students if you are unsure.
8 points –As per 6 but at a regional level. This involves going beyond your trust to involve other hospitals in your region.
Examples of teaching programmes include:
- Virtual surgical webinar series (during COVID-19)
- Virtual group tutorials
- Structured bedside teaching
- Clinical skills in early years
- OSCE preparation +/- examination
- Surgical teaching delivery e.g. set up a ‘Surgical Series’ of core subjects taught by Junior Doctors
- Communication skills
How to set up a program
- Start as early as possible e.g. in induction week
- Briefly plan a program e.g. session titles, audience, setting, teaching style, teachers e.g. others colleagues/ junior doctors.
- Discuss the plan with your education supervisor during the first meeting as they may be able to assist.
- Discuss with the medical education department and arrange meetings with the head of medical education to discuss your proposal.
- If approved you will need to plan the program in more detail
- Following this the medical education department will usually email junior doctors asking for volunteers to prepare and deliver teaching based on your topics, offering certificates and formal feedback.
- This may be more challenging during COVID-19 but there has been a proliferation of virtual teaching and webinar series in surgery which offers an opportunity for teaching programmes. This may be the most straightforward way to set up a program which is accessible at a regional and even national level.
|I have worked with local tutors to design and organise a teaching programme (a series of sessions) to enhance organised teaching for healthcare professionals or medical students at a regional level
|8||You have identified a gap in teaching provided and have worked with local tutors to design and organise a regional teaching program and arrange teachers.|
|I have worked with local tutors to design and organise a teaching programme (a series of sessions) to enhance organised teaching for healthcare professionals or medical students at a local level
|6||You have identified a gap in teaching provided and have worked with local tutors to design and organise a local teaching program and arrange teachers.|
|I have provided regular teaching for healthcare professionals or medical students over a period of approximately three months or longer
AND I have evidence of formal feedback.
|4||For example, regular bedside or classroom teaching, acting as a mentor to a student or acting as a tutor in a virtual learning environment.|
|I have taught medical students or other healthcare professionals occasionally
|I have taught medical students or other healthcare professionals occasionally, but I have no formal feedback||1||If you have no formal feedback then you must upload a 200-250 word reflection on your teaching experience to the evidence verification portal|
Training in Teaching
Whilst it may not be feasible to achieve higher qualifications in teaching before the interviews (maximum), it is definitely achievable to score 2 points for brief training in teaching. There are also plenty of online courses available, from institutions such as the Open University for 1 point. Many of these courses are free, so don’t feel you have to spend lots of money just for a few extra points!
Another tip is to look at what was covered in medical school. Some Undergraduate MBBS courses provide dedicated training in teaching modules – which can get you 2-3 points in this section, with no extra work. Try and find your certificates/ proof of attendance.
|I have a masters level or higher qualification in teaching e.g. PG Cert or PG Diploma||4||This could be full time over one academic year or part-time over multiple years|
|I have had substantial training in teaching methods lasting between five and twenty days; this could include a completed module which forms part of a postgraduate teaching qualification
|3||This should be additional to any training received as part of your primary medical qualification. Please see the notes below on ‘substantial training in teaching’|
|I am currently undertaking a course for a higher qualification in teaching AND
I can provide evidence to demonstrate this
|3||This should be additional to any training received as part of your primary medical qualification.|
|I have had brief training in teaching methods lasting no more than two days
AND I can provide evidence to demonstrate this
|2||This should be additional to any training received as part of your primary medical qualification|
|I have had brief training in teaching via online modules only AND
I can provide evidence to demonstrate this
|I have had no training in teaching methods||0|
These include regional, national and international conferences where you may present posters or oral presentations. Many applicants are unaware of the low rejection rates for posters in small conferences, particularly regional and national. It can be much easier to get accepted than most people think!
Review forthcoming conference deadlines with colleagues including smaller meetings in surgery (and areas such as radiology, pathology and anatomy).
Write abstracts appropriate for the meetings. They do not need to involve ground-breaking research and can include audits, case reports, reviews and even the history of a procedure.
|I have given an oral presentation at a national or international medical meeting after being invited/selected to do so||6|
|I have shown more than one poster at national or international medical meetings after being invited/selected to do so||5|
|I have shown one poster at a national or international medical meeting after being invited/selected to do so||4|
|I have given an oral presentation at a regional medical meeting after being invited/selected to do so||4||If you have contributed to a national or international oral presentation but did not give the presentation yourself, and have not used another option to claim this achievement, you may use this option|
|I have shown one or more posters at a regional medical meeting(s) after being invited/selected to do so||2||If you have contributed to a poster presented nationally or internationally, but were not first author, and have not used another option to claim this achievement, you may use this option|
|I have given an oral presentation, or shown one or more posters at a local medical meeting(s) after being invited/selected to do so||2||Regional and local meetings where you did not make the presentation or were only present for a poster question and answer session do not qualify.|
This section has become tougher over the last 5 years with 2 publications of original research or writing at least 50% of a medical book getting you 6 or 7 points. The top points require a good degree of planning and work and cannot be obtained last minute. Medical school intercalated degrees or academic foundation programs provide the opportunity to undertake original research. While anyone can take initiative and register their interest with consultants and registrars in specialties of interest to get involved in projects (co-author) or lead your own (first author). Original research projects are definitely achievable, however, give plenty of time for finding a supervisor, collecting data, writing up, waiting for peer review etc (usually >1year).
Case reports and letters are usually the fastest turn around for ‘quick points’ 2 points per publication (max 4). During placement keep a lookout for interesting cases for case reports and consider short projects which may be used as letters to journals. QIPs may be publishable as a short article or letter to a journal.
|I am first author, or joint-first author, of two or more PubMed-cited original research publications (or in press)||7||For this option, you need to be first or joint-first author in all the publications to which you refer|
|I am co-author of two or more PubMed-cited original research publications (or in press)||6||This option can be interpreted as ‘I am at least co-author in more than one…’|
|I am first author, or joint-first author, of one PubMed-cited original research publication (or in press)||6|
|I have written at least 50% of a book related to medicine (this does not include self-published books)||6||This refers to medicine in its broadest sense and not just hospital medicine. Books must be published by an independent publishing house, i.e. not self- published|
|I am co-author of one PubMed-cited original research publication (or in press)||4|
|I am first author, joint-first author, or co-author of more than one PubMed-cited other publication (or in press) such as editorials, reviews, case reports, letters, etc.||4|
|I have written a chapter of a book related to medicine in its broadest sense (this does not include self-published books)||4||This refers to medicine in its broadest sense and not just hospital medicine. Books must be published by an independent publishing house, I.e. not self- published|
|I am first author, joint-first author, or co-author of one PubMed-cited other publication (or in press) such as an editorial, review, case report, letter, etc.||2|
Leadership and management
This can be quite a difficult section to score highly at short notice. Regional/ national leadership positions require application and preparation well in advance, so think about this in FY1 year and before. There has been an update this year to provide points for non-medical based leadership and management. This broadens the scope allowing points to obtained for involvement in sporting, charity, innovation or creative arts. Consider areas which may be interesting and relevant for you and apply/ show interest.
It is very achievable to take up a local role, as there will be several positions available at your local hospital (or even regionally). Examples include
- Trainee rep or FY1/FY2/FY3 representative: This is potentially an easy 4 points. Consider applying for this position if it is available at your trust during induction. If not available, suggest this as a new position.
- Role in the doctors’ mess: Probably the easiest point in the portfolio and something to apply for during induction.
- Rota Coordinator for foundation trainees in your department
- Monthly mortality and morbidity meeting organiser
- Organising a journal club in your department
|I hold/have held a national leadership or managerial role related to the provision of healthcare for 6 or more months and can demonstrate a positive impact||8||Examples include: BMA national executive, trainee representative of a specialist society or college or a nationally held leadership and management fellowship.|
|I hold/have held a national leadership or managerial role in a non-medical voluntary capacity for 6 or more months and can demonstrate a positive impact||8||Examples include: charity, scouting/guides, sports, creative arts at a national level|
|I hold/have held a regional leadership or managerial role related to the provision of healthcare for 6 or more months and can demonstrate a positive impact||6||Examples include a role covering more than one hospital or covering a postgraduate training region|
|I hold/have held a regional leadership or managerial role in a non-medical voluntary capacity for 6 or more months and can demonstrate a positive impact||6||Examples include: charity, scouting/guides, sports, creative arts at a regional level|
|I hold/have held a local leadership or managerial role related to the provision of healthcare for 6 or more months and can demonstrate a positive impact||4||Examples include a role within one hospital or medical school such as junior doctors’ mess president or trainee representative on a hospital committee.|
|I hold/have held a local leadership or managerial role in a non-medical voluntary capacity for 6 or more months and can demonstrate a positive impact||4||Examples include: charity, scouting/guides, sports, creative arts at a local level|
Ensure you look at what evidence is required (e.g. letters, audit presentation etc.) early enough in the process, to give yourself time to gather it.
You can access our other interview resources in the Core Surgical Interview section of the website
I am a registrar who previously worked in a top ranked rotation in London, which includes plastic surgery (my chosen specialty). I was not top ranked at medical school; in fact I was in the 8th decile academically on my foundation application. I was definitely daunted when I first reviewed the points required for CST and did not think I would be able to achieve enough points to obtain a job which included my chosen specialty, let alone in my chosen region. Please do not be put off by the points sheet and note that medical school academic performance is worth a minority of points on the interview application. The majority coming from other work in areas such as audits, teaching, clinical performance and projects work (presentations and publications).
I would suggest you read carefully the previous interview points specifications and set your own objectives on how you can achieve them. I would also recommend that you work with others, find mentors, form groups and share the workload involved in teaching, doing audits and research projects. There is a lot of work (and unfortunately expense) involved in scoring highly on the application and collaborating with peers makes this much more manageable. Please feel free to get in touch if you have any specific questions regarding the portfolio.
Mr Peter Macneal MBChB BSc PGDip (Clin Ed) MRCS (Eng)