Courses & Conferences to Attend
- Intercollegiate Basic Surgical Skills (Royal College of Surgeons)
- CCrISP (Royal College of Surgeons)
- PAR Excellence (Black Belt Academy of Surgical Skills) – coronary anastomosis course
- Cardiothoracic Surgical Skills (Royal Papworth Professional Development)
- The Society of Cardiothoracic Surgery runs several portfolio courses throughout the year – examples include enhanced recovery after surgery, ECMO simulation day, and research skills in cardiothoracic surgery
The above courses are useful not just from a portfolio standpoint but also for gaining theoretical and practical skills, which will benefit your clinical training. The Society for Cardiothoracic Surgery is the specialty’s national society, and attendance at its events is key for demonstrating interest and as with networking and finding mentors. There is an SCTS medical student engagement day that happens every year, which is a must-attend for medical students. For junior doctors, BSS and CCrISP will help you be a good surgical SHO and impress your trainers in theatres and on the wards. Attending any chest drain course will also be useful because it will help you hit the ground running during your SHO years.
How to Maximise Your Portfolio
Start early! As soon as you realise you want to do cardiothoracic surgery, you should download the application matrix from the Wessex Deanery website (they coordinate national selection) and try to tick as many boxes as you can. Every day, you should have something “in progress” – whether that is a research project, an audit, or a presentation you are working on. Do this consistently over 2-3 years, and you will have developed a solid portfolio of evidence for shortlisting at national selection.
Find mentors at your local cardiothoracic unit – friendly trainees and consultants who can help you with giving projects and career advice, and also with interviews and portfolio preparation. They can also help you do things like organise teaching courses to further develop your portfolio.
Making the Most of Your Day Job
Learn how to manage surgical patients on the ward. Interview questions commonly focus on postoperative management, so if you become good at performing systematic A-E assessments and coming up with pragmatic and safe management plans, you will do well. Remember, ST1 recruitment is designed for FY2-qualified doctors to enter, so you do not require in-depth cardiothoracic knowledge – just demonstrate you are sensible and safe. You can also perform audits and research projects in no matter which department you are working in. By the time I applied to cardiothoracic surgery, several of my projects were cardiology projects (and even included general medicine/geriatrics audits!).
Making the Most of Cardiothoracics ST1/4 Placements
Network, network, network. Make sure your senior registrars and consultants know you by name. Act in a way that stands out (in a good way). Come in early, prep the patient lists, work up preop patients, and ensure all the investigations and imaging etc., are sorted. If you look after the bosses’ patients, the bosses will look after you.
Shadow the on-call registrar. When my shift was quiet, I would shadow my registrar and see what kinds of referrals, bleeps, and situations she would commonly have to deal with. Most interview questions, in fact, are based on taking a referral or assessing a patient, so if you see this in real life, you will do well at the interview with your real-life knowledge.
What About Non-Cardiothoracics ST1/4 Placements?
See my point above about doing as many projects and audits as you can, regardless of which specialty you are currently working in. It all counts! That being said, I did organise an honorary contract at my cardiothoracic unit, which helped me go to theatre and do cardiothoracic-related projects during my zero days whilst I was working in a DGH.
Nevertheless, perform each specialty you are doing as if you want to work in that specialty. It will teach you hard work, attention to detail, and give you knowledge you will find useful for your chosen specialty. For example, by the end of my community geriatrics placement, I was leading ward rounds, and I learned several general medical principles that help me look after the frail and elderly patients we often operate on in cardiothoracic surgery.
Top 3 Tips for Getting Into Cardiothoracics ST1/4
- Develop grit and the ability to work hard and push yourself beyond what you think you are capable of.
As someone told me once, you only grow when you are outside your comfort zone. Nevertheless, be cognisant of your limits and do not work beyond your competencies. I often come in early to prepare patient lists, review preoperative patients, and stay late to look after patients I have operated on. I also work on several projects and audits in my own free time, late at night and early in the morning, before going to the hospital. This is how I put together a robust portfolio by the time I applied.
- Be resilient.
There will be many setbacks along the way, but you cannot give up. For example, you can come in early, see the pre-op patients, do the ward round, and find someone to hold your bleep so you can go to theatre, only for the theatre list to be cancelled due to a lack of critical care beds. Similarly, several colleagues got into training after 2-3 attempts at national selection. If you know in your heart you want to do this, you should not give up.
- Be curious and want to learn.
Cardiothoracic surgeons have excellent knowledge of their patients’ physiology and pathophysiology, from managing intraoperative perfusion and postoperative ICU management of patients. It is one of the most “medical” surgical specialties, and having a solid knowledge of internal medicine will help you tremendously.
