Core Surgical

10th April 2024

How to Maximise Points in the 2024 Core Surgical Training (CST) Interview Portfolio

For 2024, Core Surgical Training (CST) interviews are being held in February 2024, earlier than they were in 2023. This year there is a fairly quick turnaround from MSRA results and interview invites to the interview window, so we recommend being fully prepared where you can! 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 break down the Oriel Portfolio Scoring for 2024.

You can also check-out our Core Surgical Training Interview Question Bank which has been put together by previously high scoring trainees to help you prepare for that all important interview.

2024 Core Surgical Training Interview

On the 5th October 2022, the JCST announced that the MSRA would be used for shortlisting in 2023. This continues for 2024. MSRA exams will take place between Thursday 4th January and Tuesday 16th January 2024, and the Core Surgery interviews will run between Monday 19th February and Wednesday 29th February 2024, with invites being sent on Thursday 8th February 2024. This year, a video platform called Qpercom will be replacing Microsoft Teams and you will receive instructions on how to use this prior to your interview. For 2024, the 1200 top MSRA candidates will be invited for interview.

CST interviews will consist of one 20-minute interview divided into 2 x 10-minute stations, comprising a 10-minute management station and a 10-minute clinical station. These stations will be back to back and conducted by the same interview panel.

The domains for 2024 are as follows:

Commitment to surgery
Quality Improvement / Clinical Audit
Presentations and Publications
Teaching experience
Training qualifications

CST Application points

For 2024, the CST portfolio is worth 30% of the overall score, this has decreased from 33% which was the case before the introduction of the MSRA, and is the only aspect which provides guaranteed points. You have until Thursday 23rd November 2023 at 4pm to put your portfolio together.

Note: previously, the portfolio was used to shortlist candidates for interviews, now this is done purely via the MSRA, but the portfolio then makes up 30% of your overall score.

With only a few points between candidates, an extra point can make a significant difference to the outcome of your applications.

The remaining 70% comes from your MSRA score (10%) and interview score (60%). The interview points come from the management and clinical stations for which performance relies on good preparation. All of these points are determined on the day. With the majority of points coming from your interview, preparation is key and our Core Surgery Interview question bank will help. Here is an example of a clinical scenario from our interview question bank so you know what to expect. Our CST trainees have pulled together all of the themes of questions asked in the past years recruitment rounds, ensuring you have all of the tools to help you prepare for your interview.

CST-Question-3

The Core Surgery Training (CST) Portfolio

We have broken down each portfolio section to help guide you when putting your portfolio together.

Commitment to surgery

This is a broad section of the portfolio with points in various categories. Please note, this section no longer includes the MRCS Part A.

Surgical Conferences

This was a new category in 2022 and should be easy points. Conferences can be a good way to learn about your chosen specialty and meet like-minded people.

Option	Score	Notes
Attendance at surgical conferences: choose one of the following options
I have attended 3 surgical conferences	3	Proof of attendance must be provided
I have attended 2 surgical conferences	2
I have attended 1 surgical conference	1
I have not attended any surgical conferences	0

Operative Experience

This changed slightly in 2023 and remains the same for 2024. Having at least 40 surgical cases assisting or supervisor trainer scrubbed is now needed for full points; this is an increase from 30 in 2022, which had already increased from 2021. The increase in cases required year on year reflects the competitive nature of CST. Keeping an eLogbook of surgical cases should begin at medical school and is useful for monitoring your progress through training. The summary sheet is required to be signed by a consultant.

Option	Score	Notes
Operative experience: choose one of the following options
Involvement in 40 or more cases	8	Verified logbook evidence must be provided
Involvement in 30-39 cases	6
Involvement in 20–29 cases	4
Involvement in 11-19 cases	2

If you do not provide any evidence or have been involved in 10 cases or less, you do not score any points.

Surgical Experience

Doing a surgical placement (with redeployment included) OR a surgical elective will get full points here.

If you are a student, it is recommended you complete a surgical elective, and then 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 opportunities for hands-on surgical experience.

If you have not had the opportunity to do a surgical placement, a 5 day taster week will get you 3 points. 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.

Option	Score	Notes
Surgical experience: choose one of the following options
I have attended a surgical taster week (minimum 5 days, can be non-consecutive days)	3	Proof of completion required
I have undertaken an elective in a surgical specialty (minimum 4 weeks) OR I have undertaken a surgical placement (see additional notes below) during my foundation training or equivalent (minimum 12 weeks)	2	Proof of completion required
I have not attended a surgical taster/ elective	0

Quality Improvement (Clinical Audit)

Full marks in this section requires you to have “lead in ALL aspects of a surgically themed clinical audit or QI project that has demonstrated change” (i.e. second cycle/ closed audit loop). This should be achievable if you choose a project early (ideally FY1 year) and identify regional/ national conferences/ meetings that allow submissions. This can be presented at national, regional or local level (not nationally only for full points as previously).

Notes:

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 in many cases they are not 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 example:

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.

This section has changed slightly from 2022, with additional points being awarded to those who have at least been a contributor (points 4 and above). These points are awarded separately to the project itself, as opposed to as well as, like previous years.

Option	Score	Notes
I was involved as Lead in ALL aspects of a surgically themed clinical audit or QI project that has demonstrated change (i.e., second cycle/closed audit loop).	8	You participated in all stages of the audit/QI project (planning, data collection, data analysis, implementing change and involvement in at least two cycles). The project must be surgically themed.
I was involved as Lead in ALL aspects of a clinical audit or QI project that has demonstrated change (i.e., second cycle/ closed audit loop).	6	You participated in all stages of the audit (planning, data collection, data analysis, implementing change and involvement in at least two cycles).
I was involved as a contributor in a clinical audit or QI project that has demonstrated change (i.e., second cycle/ closed audit loop).	4	You participated actively through multiple cycles but did not take a leading role in the project.
I was involved in a clinical audit or QI project.	2	For example, you assisted with data collection for the project in at least one cycle. You did not take a leading role.
None/other	0

Additional points:

Option	Score	Notes
Applicant presented the project at national or international meeting (see appendix for definition).	5	The applicant personally presented the project evidenced by first author in the presentation slides and letter of acceptance of presentation for meeting.
Applicant presented the project at a regional meeting (see appendix for definition).	3	The applicant personally presented the project evidenced by first author in the presentation slides and letter of acceptance of presentation for meeting.
Applicant presented the project at a local meeting (see appendix for definition).	1	The applicant personally presented the project evidenced by first author in the presentation slides.

Presentations and Publications

Since 2023, presentations and publications have been merged, having previously carried a separate number of points.

Presentations 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 many conferences, particularly as virtual posters during COVID have increased the number of accepted posters. 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.

Please note you may not gain points for the same audit as gained you points in the Audit/ QI section.

For publications, a first author of a PubMed-cited publication is required for full 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. Also, 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 turnaround for ‘quick points’ 4 points per publication. 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.

Option	Score	Notes
I have won a prize for delivering an oral presentation at a national or international medical meeting convened by an accredited institution after being invited/selected to do so	10	Personal delivery of presentation required. This does not include “oral poster presentations”
I am first author (please see appendix for definition) of a PubMed-cited publication (or in press) not including a case report or editorial letter	10	Evidence of PubMed ID number.
I have delivered an oral presentation at a national or international medical meeting convened by an accredited institution after being invited/selected to do so	8	Personal delivery of presentation required. This does not include “oral poster presentations”
I am first author a prize-winning poster or oral poster presentations presented at an international or national medical meeting convened by an accredited institution after being invited/selected to do so	6	Personal delivery of presentation required.
I am first author for 2 or more posters or oral poster presentations presented at an international or national medical meeting convened by an accredited institution after being invited/selected to do so	4
I am first author of a PubMed-cited publication of a case report or editorial letter (or in press) OR I have written a book chapter related to medicine which has been published (not self-published)	4	Evidence of PubMed ID number.
I am a Cited Collaborative author (please see appendix for definition) as part of a research collaborative publication in 3 or more PubMed cited publications	3	Does not require named authorship alongside publication title.
I am a named co-author (please see appendix for definition) of one PubMed-cited publication (or in press)	2
I have given an oral presentation at a regional medical meeting after being invited/selected to do so	2	Personal delivery of presentation required.
I have presented one or more posters as first author at a regional medical meeting(s) after being invited/selected to do so OR I have had a poster accepted for presentation at a national or international meeting but did not attend	1	Does not require oral presentation of work
I am a Cited Collaborative author as part of a research collaborative publication in 2 or more PubMed cited publications	1
None/other	0

Teaching Experience

This has changed slightly since 2022. Previously, you could gain 1 or 2 points for “Teaching medical students or other healthcare professionals occasionally” and realistically, all applicants should have done this. However, now scoring starts at 2 points and is determined as follows:

2 points – Teaching medical students or other healthcare professionals regularly > 4 sessions per year. All applicants should have done this. It can be completed by 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).

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 4 or more sessions (with formal feedback). It 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.

10 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.
Since COVID-19, there has been a proliferation of virtual teaching and webinar series in surgery which offer 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.

Option	Score	Notes
I have worked with local educators to design and organise a teaching programme (a series of sessions defined as 4 or more) to enhance organised teaching for healthcare professionals or medical students at a regional level.	10	You have shown the ability to identify a gap in the teaching provided and have worked with local educators to design, organise and deliver a regional teaching programme. As part of this process, you will have had input into the programme objectives and outline of sessions delivered.
I have worked with local educators to design and organise a teaching programme (a series of sessions defined as 4 or more) to enhance organised teaching for healthcare professionals or medical students at a local level	6	You have shown the ability to identify a gap in the teaching provided and have worked with local educators to design, organise and deliver a local teaching programme. As part of this process, you will have had input into the programme objectives and outline of sessions delivered.
I have provided regular teaching for healthcare professionals or medical students over the last year (4 or more sessions/year)	2	Examples of teaching include but are not restricted to regular bedside or classroom teaching, acting as a mentor to a student, acting as a tutor or delivering teaching in a virtual learning environment.

Training in Teaching

Whilst it’s not feasible for most candidates to achieve the maximum score for teaching (requires a higher teaching qualification) before the interviews, scoring 1 point towards your CST application is definitely achievable. Ensure you sign up and complete a course like the Medibuddy Teach the Teacher Course before applications close to receive the points.

Option	Score	Notes
I have a masters level or higher qualification in teaching e.g. MA or MSc	5	This could be full time over one academic year or part-time over multiple years
Teaching specific postgraduate qualification e.g., Diploma (ISCED level 5/6)	5
Teaching specific postgraduate qualification e.g., PG Cert 3	3	This should be additional to any training received as part of your primary medical qualification.
I have had substantial training in teaching methods lasting at least two days; this could include a completed module which forms part of a postgraduate teaching qualification	1	This should be additional to any training received as part of your primary medical qualification. This could be delivered locally. This can be delivered virtually
I have had no training in teaching methods	0

Teach the Teacher Course by Medibuddy

This two-day CPD-accredited online course will earn you 12 CPD points on completion. It’s entirely flexible, so you can complete it in two days or multiple sessions over a longer period. On completion of the course, you’ll receive a certificate for your portfolio that is accredited for CCT, interviews and appraisals.

Find out more

Evidence

For each portfolio station, 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. More information can be found here. You must have your portfolio completed and submitted by Thursday 1st December at 4pm at the very latest, so ensure you have all of the evidence you need well before then.

Personal background

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)