Authors: Martinique Vella-Baldacchino(1), Kiron Koshy(2) and Riaz A. Agha(3)
Contact person: Martinique Vella-Baldacchino
1 Department of Emergency General Surgery, John Radcliffe Hospital, Oxford
2 Brighton and Sussex University Hospitals, Brighton
3 Department of Plastic Surgery, Kings College Hospital, London
Training to become a surgeon takes time and is competitive – not everyone who starts the process will finish. As a result, surgical training requires commitment, perseverance, hard work and planning. Since its introduction, core surgical training has been a competitive entry point. In 2016, the competition ratio for 2016 was at 2.53, leaving a large number of unsuccessful applicants (1). In 2017, this has dropped, with a fill rate at 99.8% for the 500 posts offered in 2017 (2) . This paper attempts to guide prospective applicants to achieve a highly successful outcome.
The PDSA cycle
Dr. Deming first introduced the ‘Plan-Do-Study-Act (PDSA) cycle’ which consists of a series of systematic steps to gain more knowledge for the improvement of a process and achieve a particular goal 3. The PDSA cycle concept is a useful aide for a successful core surgical training (CST) application as shown in Figure 1.
Avoid being haunted by the procrastination ghost. Familiarise yourself early with the application guide available online for future applicants on the official Core Surgical National Recruitment Office (CSNRO) website. The portfolio scoring checklist provides a transparent scoring guide for future surgical applicants.
Figure 2 summarises the portfolio checklist published on the CSNRO website and provides examples for applicants in order to achieve maximum points
|Degrees||A necessary evil – one either has them or does not.
Enrolled in a degree, this shows commitment and alsostarts off a conversation with your interviewees. However, if not officially awarded no points are given.
|Maximum of 3 points are offered in the section. Examples of courses are listed in the checklist, it is important to attend courses which will teach attendees valid skills for future surgical careers.
Look up the courses on the host institution website earlyin order to plan your study leave in an orderly manner.
Start early, Speak to colleagues and seniors at conferences who will offer their advice regarding applications and which will help make your application more competitive.
|Exceptional performance in undergraduate/foundation years||The Royal Society of Medicine offers yearly prizes in an array of subjects at all levels of training. Surgical societies (eg. ASIT and BOTA) organise poster competitions and essay competitions.
Points are awarded to any prize of any category.
Look out for roles within the Doctors Mess at your hospital or help out with rotas for your own department. Plan early once again – prior to leaving the department ensure you ask for documented proof of your role within the hospital.
|Clinical/Procedural experience||Ensure each procedure is documented in your portfolio and signed by an observer.
Start a logbook and document all surgical operations you have attended or assisted in.
|Clinical Audit||Speak to your seniors and ask for an audit. Ensure the loop is closed to achieve maximum points.
Speak to previous colleagues and look out for audit loops that need to be closed.
Ensure each audit has an audit summary in order todocument aim, methods, results, implementation of change and presentation level. If presented this should have a copy of the relevant presentation attached.
|Teaching||Foundation doctors teach medical students regularly on the wards. Ensure feedback forms are filled.
Maximum points are awarded for any teaching programme. Act as a team and speak to your peers, think about a teaching programme that may benefit medical students or junior doctors. Once again, feedback forms
|Presentations||There are numerous meetings organised regionally, nationally and internationally. Each audit should ideally be presented locally followed by the necessary adjustments and consequently able to move up the presentation level ladder.|
|Commitment to surgery||The portfolio guide gives enough examples how to demonstrate this.
Following each conference ensure all certificates are collated – avoid being haunted once again by the procrastination ghost!
|Organisation||Being organised is achieving a sense of pride and control. Plan ahead and purchase the necessary stationary, folders and printing supplies as presentation is key. Ensure all certificates are at hand by November and start organising your portfolio by December.
Give your portfolio to a non-medical person and ask their opinion on the portfolio layout. Do it well and award yourself a bonus 3 points.
Figure 2: How to get the most from your portfolio
Preparing for your MRCS
Take your time to settle down in your first year of foundation year. It is rather stressful balancing your first experiences on the ward with your studies. However, do plan ahead! Aim for five months of preparation for your MRCS Part A, use available question banks online and reinforce material by reading around the subjects using textbooks.
Reflect on your treatment plans and management of acutely sick patients. Read around clinical topics which will improve your knowledge, this is helpful when answering questions at the clinical station at the core surgical interview.
The interview will make or break you. It consists of three stations management, portfolio and clinical scenario. Each domain is equal in importance and each station lasts for 10 minutes with a minimum of 3 minutes between each station.
This consists of a three minute presentation and management scenario. The presentation needs to address the question posed by the examiners, however, whenever possible do try to add something unique that will make you stand out from the rest of the crowd. There are multiple resources online and in the press regarding management scenarios for core surgical trainees. Most importantly, ensure you are safe and call a senior when in need!
Try and aim for maximum marks in this station. Start early. Whether this consists of buying a leather bounded personalised file with your name engraved on the front cover or buying extra-wide dividers that will help examiners easily flip through your documents. The portfolio needs to look pristine, if your handwriting requires cryptanalysis, ensure the dividers are labeled using computer generated printable divider tabs. As always, be prepared. Ensure you are able to relay answers to the following questions flawlessly:
1: Describe a project your are proud of
2: Describe one of your audits
3: Describe a course you enjoyed
Having a surgical job as a junior doctor will help, particularly in your second year. It will indeed be a bonus if you are currently working on a general surgical rotation during your interview preparation period. Once again there are multiple scenarios that address this section appropriately found online and in the press (Figure 4) .
The ATLS course will also help you during these scenarios and ensure you know what a trauma call involves and how the team is organised. Once again, know your limits and stay safe.
In all parts of the core surgical training application, early preparation is vital. Aim to excel in every section of the portfolio and make it aesthetically pleasing.
The interview is the key to a future core surgical training programme. Performance during the interview is crucial to getting a competitive rank, particularly if a themed surgical rotation is the primary goal. Prepare for the interview early and think of it as an exam.
As Shakespeare said, ‘All the world is a stage’, but make sure you play your role right! Be organised, be prepared and be determined!
1. NHS Health Education England . 2016. CT1/ST1 Competition ratios. Available online: https://specialtytraining.hee.nhs.uk/Portals/1/Competition%20Ratios%202016%20ST1_1.pdf
2. NHS Health Education England. 2017. Speciality recruitment: round 1 acceptance and fill rate. Available from: https://hee.nhs.uk/our-work/attracting-recruiting/medical-recruitment/specialty-recruitment-round-1-acceptance-fill-rate [Accessed 22 September 2017]
3. Hunter J. 2015. The History and Evolution of the PDSA Cycle. Available online: https://blog.deming.org/2015/05/the-history-and-evolution-of-the-pdsa-cycle/ [Accessed 22 September 2017]