Core Surgical Training (CST) Interview Guide

The Core Surgical Training (CST) interview is the final hurdle you will have to go through before you can get your hands on the prestigious CST training number.

But despite scoring well enough in your MSRA exam to get a slot, the CST interview is still a difficult and competitive process. Don’t let all the hard work that has gone into your CST application and MSRA revision go to waste!

Since 2020 the competition ratio for CST has jumped from ~3:1 to around 4:1. This has been consistent since then, so you’re expecting some competition.

In this article, we will go through the CST interview, including the process, format, and marking scheme.

Updated 30th October for final 2023/24 application guidance.

Hints and Tips by Mr Ash Ahluwalia

I’m Ash, an ST5 Trauma and Orthopaedics Registrar on the UCLH rotation.

After obtaining my first choice Core Surgical Training job in London and completing a PGCert in Medical Education, I created The London Course, which helps core and higher speciality trainees secure their first-choice job.

We run the London Core Surgical Training Interview Course, now in its 5th year, giving candidates a chance to learn new structures for their interview, as well as providing mock interview for candidates to hone their skills.

Following a successful ST3 Trauma and Orthopaedics application, I have set up The London ST3 Trauma and Orthopaedics Interview Course to help applicants on their path into surgery.

Our CST Recruitment Series

Key Documents

CST Recruitment Timeline

The CST Interview Process

The Core Surgical Training interview is held every year around March, and in 2024 is being held online for all candidates.

Previously, interview shortlisting was determined via the portfolio self-assessment score. However in 2023 the MSRA exam was introduced as the tool for shortlisting candidates. Around 1100 candidates with the highest MSRA score (of ~2300 total applicants) will be invited to the interview.

On confirmation of your interview offer, you will be asked to book an interview spot via Oriel. With interviews being held online, there is no need to worry about where your interview will be held, only the timing of the interview.

Interview slots are offered on a first come first served basis, so it’s worth booking as soon as you can to make sure you get a slot that works for you. The interview will take place on Microsoft Teams, with a link to join the interview sent after you have booked your interview spot.

The interview link you are sent will be functional right away (albeit minus the interviewers!) – check that the link works on the device you’re using for the interview as soon as you can. If you are having trouble with the link, contact PGMDE support via their online portal.

Ash’s CST Interview Webinar

This recorded webinar by Ash goes through everything you need to know about the CST interview, including some real life examples.

How Competitive is the CST Interview?

From the 1100 candidates interviewed, around 620 will be offered a post, so if you’ve made it this far you have roughly a 56% chance of being offered a job if you get to this stage.

There will be a small number of candidates who decline their job offer following success at interview, as they have also applied to other training programmes. This means that candidates who miss out narrowly may still be offered a job.

Search Interview Courses

The CST Interview Format – Online

The CST Interview for the 2023/2024 application will take place online on Microsoft Teams. You can join using the link sent after you have booked a slot.

You should join 5+ minutes before the scheduled time and will first have your identity confirmed by a member of admin staff. Make sure that you have photo ID to hand (your passport or UK driving licence) and that you are alone in the room you are interviewing from.

The CST interview online format consists of a 20-minute interview split into two 10-minute sections – the management section and the clinical section. While previous interviews have also included a portfolio station, this will not be part of the 2023 interview, with the portfolio self-assessment score making up 30% of your final application score.

You will be interviewed by two panel members who will be present for both sections of the interview.

You will not be given any advanced notice of the questions in either section, though there are general themes that come up frequently in both sections. For the management section, you will be asked to prepare a 3-minute presentation beforehand.

Following your interview, your score will be adjusted to make up your overall CST application score, which is weighted as follows:

• 30% Interview Management Section
• 30% Interview Clinical Section
• 30% Portfolio Self-assessment Score
• 10% MSRA Score

Section 1 – Management Section

Management Presentation – 5 minutes

The first part of the management section of the CST interview is an opportunity to show off your leadership and management experience with a 3-minute pre-prepared presentation.

The topic for this section will be emailed to you 2 weeks in advance of your interview date. This usually focuses on leadership and management experience, as it relates to the CST person specification.

To score well on this part of the interview you should try to avoid just listing your experience, and instead focus on 2-4 achievements or specific examples of where you have demonstrated your leadership and management experience. Examples of relevant roles include membership of the junior doctors’ forum, mess committee, or national speciality training organisations.

Try to give examples which fulfil the “desirable criteria” of the person specification, demonstrating:

• Involvement in management appropriate for your current stage of training
• Leadership of and work with the MDT (doctors, nurses, and AHPs within your team)
• Good understanding of NHS management and resources
• Leadership within and outside of medicine

You will then have 2 minutes of questions on your presentation from your interviewers. Take some time before the interview to go over the examples you give in your presentation and think about what your interviewers might ask.  

Your interviewers will score three areas out of 6:

• The content of your presentation
• Your presentation skills
• Your ability to answer their questions.

Management Question – 5 minutes

Following your presentation, you will be given a management scenario related to ethical, professional, and personal dilemmas which are common to surgery. The interviewers will ask you a question and give you 5 minutes to answer this.

This will involve some thinking on your feet, as you will not be given the scenario until you are in the interview.

While you may be used to this type of scenario from the MSRA professional dilemmas paper, you must find a way to answer the question with a structured approach such as SPIES:

S – Seek information. Find out all the info you’ll need to assess patient safety, carry out the initial steps, and discuss with a colleague.

P – Prioritise & Patient Safety. Summarise how you would prioritise the issues in the scenario. Address any potential patient safety concerns as your number one priority.

I – Initiative. Take some initial steps that are appropriate for someone of your level of responsibility.

E – Escalate. Discuss the dilemma with an appropriate colleague, highlighting your main concerns and any suggested interventions.

S – Support. Offer your support to help your colleagues with the scenario.

Your interviewers may add additional information and prompts as you work your way through the scenario or might let you talk through what you would do and ask questions at the end.

Some common scenarios you may wish to familiarise yourself with are:

• Do not resuscitate orders – when these should be considered, the rights of the patient and family, and how you would approach this if refused.
• Confidentiality – what information must be kept confidential, when you can pass on confidential information, and when you have the right to break confidentiality despite the patient’s wishes.
• Conflict – how to deal with arguments, complaints, and abuse from patients, relatives, and colleagues.
• Capacity & consent – when it is appropriate for you to consent a patient, how to determine capacity, and what options you have when the patient does not have capacity.
• Probity issues – How to deal with colleagues who are not meeting GMC Good Medical Practice.

If you find yourself finishing with time to go and the interviewers aren’t giving you any additional prompts, think about the three scoring criteria below and whether you could add anything that would gain you some extra marks in these.

Your interviewers will score three areas out of 6:

• Your probity, professional integrity, and understanding and awareness of safety and ethics
• Your judgement and prioritisation skills under pressure
• Your communication skills

Section 2 – Clinical Section

Clinical Scenario – 5 mins x 2

In the clinical station you will be given two scenarios, one you can read before the station and one which the interviewers will ask during the station. Each scenario is marked separately and will last 5 minutes each.

The scenarios given will likely be surgical in nature, and will often be common acute or emergency scenarios, such as trauma calls, post-operative complications, or unwell ward patients.

In the above scenario, you have been called to an acutely unwell patient who is under the care of the urology team. You must now talk through how you would approach information gathering, patient assessment, initial treatment, and escalation.

Information gathering is the first step – you need to be able to prioritise your workload and determine the urgency of the situation. You can ask more about the patient’s background, previous observations, and anything you think that the person on the other end of the phone will be able to tell you.

Next, you need to decide how urgently the patient needs to be seen. Consider:

• Is the situation so urgent that a 2222 cardiac arrest call should be placed?
• Is there anything the nurse can do while you are on your way to the patient (e.g. bloods, obs, emergency fluids, arranging for urgent blood, cultures)?
• Is this the most urgent task on your to-do list?

Always keep in mind a structure for assessing an acutely unwell patient – an ABCDE approach will work for any emergency situation. Your interviewers will give you prompts and information, and will ask you further questions as you work your way through the scenario. Questions might include:

• How would you approach clinical assessment?
• What is your working diagnosis?
• What conditions do you need to rule out?
• What immediate interventions do you want to make?
• Who would you like to contact?

If an assessor believes that you have demonstrated unsafe clinical practice, you may be deemed unappointable. If there is a question you truly don’t know the answer to, use your initiative to demonstrate that you will not work outside of your current level of competency and will escalate to a senior rather than make up a potentially unsafe treatment plan.

Your interviewers will score three areas out of 6:

• Your clinical skills and knowledge
• Your judgement and ability to prioritise under pressure
• Your communications skills

Performing at Your Best on the day

Even if you have the self-confidence of a candidate on The Apprentice, the pre-interview jitters can get to you on the day. There are some simple steps to take to put your best foot forward for the interview.

Take Some Leave

I’m sure you’ll have heard stories of docs who didn’t realise until too late that their set of nights clashed with their interview dates.

Don’t be that doc.

Take some time off before the interview to make sure that you have time to prepare and, most importantly, relax. Rota coordinators are notoriously inflexible – give them plenty of notice and take the time you deserve to prepare for one of the more important days of your life.

Sort Out Your Sleeping Pattern

The life of an SHO is often incompatible with a decent sleeping pattern but try to get into a good rhythm a couple of weeks before your interview.

Without a regular bedtime and morning alarm, you may find yourself answering questions on a couple of hours of sleep – a bad idea.

Make Sure Your Tech Works

How embarrassing would it be to turn up to your interview, adrenaline surging through your body, only to find out that your microphone isn’t working properly?

Take the time the day before your interview to make sure that your webcam and microphone work properly on Microsoft Teams.

Relax…

Interviews are stressful. Always. You’ll be highly strung on the day no matter how zen your day-to-day life is, but if you’re already at your breaking point before the interview day you’re at risk of a full-on breakdown.

Take at least a few hours to chill out on the day before, and ideally the morning of, the interview. Whether you unwind best with a spa day, meditation, or furiously logging appendicectomies, take a break. It’ll do you far more good than cramming in an extra couple of hours of preparation.