Portfolio Scoring 2027
For 2027, NHS England confirms that candidates will "no longer be asked to complete self-assessment on Oriel". Instead, shortlisted candidates "upload an index page with the appropriate entries for each domain (using a letter from A-E instead of a score)", and the portfolio is scored at a dedicated interview station worth 45% of the overall selection score out of 100.
If you're invited for an interview, you'll be asked to upload evidence for the three domains below between 19 and 24 February 2027, assigning a letter from A to E to each to show which band you believe you meet.
| 2027 domain | What goes in it |
|---|
| 1. Knowledge, Skills and Development | Operative experience (eLogbook) and surgical experience (taster week or elective) |
| 2. Patients, Partnership and Communication | One item from presentations, publications, book chapters, teaching, podcasts or webinars, and patient information leaflets |
| 3. Colleagues, Culture and Safety | Quality improvement or audit, plus how you presented it |
The fourth Good Medical Practice domain, Trust and Professionalism, "will continue to be assessed through the interview process".
Assessors get a 15-minute window to review your evidence, then ask you about two domains. NHS England's guidance says "Candidates will only be asked questions about 'Patient, Partnership and Communication' and the 'Safety and Culture' domains" – that is, domains 2 and 3. Your final portfolio score combines their view of your evidence with your answers, so they can accept or change the letter you gave yourself.
Here's a few points to keep in mind:
- You can only claim after starting your first degree - nothing from before university counts.
- Upload one achievement per domain, and use each achievement in only one domain. Assessors "will only assess and ask questions on the first achievement uploaded per domain", so make it your best.
- A QIP you claim in Colleagues, Culture and Safety cannot also be claimed as a presentation in Patients, Partnership and Communication. Use a different project there.
- Check the cut-off. The portfolio guidance says not to claim anything you "will not have completely achieved by the date of the portfolio upload on Friday 19 of February 2027". NHS England's applying page (reviewed 21 October 2026) now says the same: "competencies/evidence gained after the evidence window has closed cannot be accepted". The portfolio guidance adds that "All achievements / evidence must be completed by the submission date of Friday 19 February 2027", so anything finished after that date scores nothing – plan backwards from 19 February.
- Make sure you don't upload any patient identifiable data, including thank you cards or minutes from a departmental meeting - this could be grounds for a 0 score or GMC referral.
- You don't need to upload your entire logbook, just the consolidation report signed by your supervisor.
Recognised surgical specialities include:
- Plastics
- Neurosurgery
- Vascular
- ENT
- Cardiothoracics
- Urology
- Maxfax
- General surgery
- Orthopaedics
- Paediatric surgery
Maximum CST Portfolio Score
The portfolio station is worth 45% of your overall selection score out of 100. At the station, your 3-minute presentation, the 2 minutes of questions on it, and the two 5-minute portfolio-domain questions are each scored on NHS England's 0–6 scale: "0 - No Evidence, 1 - Very Poor, 2 - Weak, 3 - Satisfactory, 4 - Good, 5 - Excellent, 6 - Outstanding". NHS England has not published how the A–E letters convert into marks, so aim for the top band in every domain you can.
| Section | Maximum Score |
| Domain 1 – Operative Experience | A |
| Domain 1 – Surgical Experience | A |
| Domain 2 – Communication (one item: presentation, publication, teaching, podcast, webinar or leaflet) | A |
| Domain 3 – Quality Improvement Project | A |
| Domain 3 – Quality Improvement Presentation | A |
| Total | Scored at the interview portfolio station — 45% of your final score |
For all these achievements, you must have evidence of completion to score points, as well as an index sheet. Entries without an index sheet, or without evidence, will be marked as 0.
Ash's Tips
A point is a point.
Don’t get bogged down in lengthy projects when a quality improvement project can get you the same number of points. Keep the CST applicant checklist on your phone and see if you work towards scoring a point every day.
Early preparation is the best way to maximise your points and means you can focus on interview technique in the run-up to the CST interview.
Changes for 2027
NHS England published its 2027 CST pages on 5–6 October 2026 and its 2027 portfolio guidance on 15 October 2026. What has changed for your portfolio:
- Three domains, not six sections. The portfolio "has been revised to align more closely with 3 of the 4 domains of the GMC's Good Medical Practice": Knowledge, Skills and Development; Patients, Partnership and Communication; Colleagues, Culture and Safety.
- Best item only. "Points are not cumulative", so presentations, publications and teaching now compete for one slot in the communication domain.
- New ways to score in communication. Podcasts, webinars and patient information leaflets with a "demonstrable impact" now count: A if surgically themed, B if not.
- Tasters must be done, not booked. "A 5-day surgical taster booked for 2027 will receive 0 points."
- No Oriel self-assessment. If shortlisted you "upload an index page with the appropriate entries for each domain (using a letter from A-E instead of a score)". The index page is mandatory: "Any evidence submissions without an index sheet will be scored 0 on the domains and evidence will not be reviewed".
- Portfolio station worth 45%. The final score is "MSRA (10%), portfolio station score (45%) and management and clinical station score (45%)".
- Station format: "1 pre-prepared 3 minute presentation", "2 minutes of questioning on presentation", then "2 x Portfolio questions 5 minutes each", with 3 or 4 panel members. The portfolio guidance says these questions cover the communication domain and the safety and culture domain.
- Evidence upload window: Friday 19 to Wednesday 24 February 2027.
- The Medical Training (Prioritisation) Act applies at both the shortlisting and offer stages for 2027, but "Prioritisation does not affect the rank applicants receive following interview".
- Five applications maximum per recruitment round across all specialties.
The rules below were introduced in 2025/26 and still apply under the 2027 guidance:
Intensive Care Medicine (ITU) as a Specialty
From this recruitment window onward, Intensive Care (ITU) will no longer be recognised as a surgical specialty for portfolio scoring purposes.
Foundation Placements and Surgical Experience
Similarly, foundation placements will no longer count as examples of surgical experience.
This temporary allowance was originally introduced during the pandemic, when many applicants were unable to complete undergraduate electives or taster weeks. As training opportunities have now normalised, points will only be awarded for dedicated electives or taster placements in surgical specialties.
Quality Improvement (QI) and Audit Projects
For this recruitment window, panels will be looking for evidence that your QI or audit project was presented within the department or setting it was designed to improve.
In other words, if your audit assessed a department’s compliance with a standard, the first cycle should have been presented locally, as this forms part of the change and feedback process.
How the Sections Below Map to the 2027 Domains
The sections below follow the 2027 domains: operative and surgical experience (Domain 1), quality improvement and audit (Domain 3), then presentations, publications, teaching and other communication (Domain 2). NHS England expects "No major changes" for the 2028 portfolio. Check the official portfolio guidance before you upload.
Operative Experience (Domain 1: Knowledge, Skills and Development)
Gaining operative experience during your foundation years can be difficult, especially if you don’t have a surgical placement. This is an area of the application which might involve getting to theatre on zero days, annual leave, or during an FY3 year.
Involvement in a surgical case is defined as assisting or taking part in supervised trainer scrubbed procedures. It does not include cases which you only observed without scrubbing in.
Here are the scoring categories for this section:
- A – Involved in 40+ cases
- B – Involved in 30-39 cases
- C – Involved in 20-29 cases
- D – Involved in 11-19 cases
- E - Involved in 10 cases or fewer, or have no evidence
To provide evidence for this section, you must upload a consolidation report – a summary of which cases you have been involved in - via the eLogbook format. You do not need to upload your entire logbook, just a consolidation report.
Upload one consolidation report covering all your specialities – "Only 1 consolidation report upload is permitted" – including the following details:
- Summary sheet from this report
- Numbers of procedures & date ranges
It must be signed by a consultant on every page, with their:
- Signature
- Full name
- GMC number (or equivalent in country of registration)
- Date of verification
You cannot report involvement in an operation if you have only observed - you must have some direct involvement.
Ash's Tips
There are no additional points for 40 cases or 300 cases. As much as we enjoy going to theatre, keep this in mind. For your CST applications, added exposure to theatre DOES NOT compensate for points that are missed on the rest of your application.
Attending theatres can be daunting in the earlier Foundation Years. Find a CST, registrar, or consultant that you feel comfortable with, and attend theatre with them. Be sure to introduce yourself to the theatre team, and make sure you know the basics of surgical gowning.
Get to theatre early and try to find out what cases are going to be operated on. The more you know about theatre and the operations (even if it’s the first time you’ve set foot in an operating theatre) the more comfortable you will feel.
Be prepared to be asked questions on anatomy and DO NOT be scared to get questions wrong. Be efficient with your clinical responsibilities, find someone who can hold your bleep and then just go.
My last tip, know where the changing rooms are and invest in a pair of scrub shoes (not Crocs with holes in them, you’ll thank me after your first arthroscopy). You will eventually need them every day, so it will be worth it!
Surgical Experience (Domain 1)
Ideally, every candidate for CST will have managed to get a 3+ month placement in a surgical speciality prior to application. However - that's not always possible.
Thankfully, you can gain the same amount of application points by undertaking a surgical elective. If you plan during your foundation years, you can also take advantage of the 5 days offered for “taster days”.
Here are the scoring categories for this section:
- A - Any of the below
- Surgical taster week - min 5 days total, which can be non-consecutive. It must already be done: "A 5-day surgical taster booked for 2027 will receive 0 points."
- Surgical elective as a medical student - min 4 weeks.
- Surgical placements during foundation do not count — the 2027 A band lists only a taster week or a medical-school elective.
- B – None of the above
Surgical placements which are accepted include:
- Cardiothoracic Surgery
- ENT Surgery
- General Surgery
- Neurosurgery
- Oral & Maxillofacial Surgery
- Orthopaedic Surgery
- Paediatric Surgery
- Plastic Surgery
- Urology
- Vascular Surgery
- Guidance on Specialty Tasters for Foundation Trainees
These experiences must have already been completed on application.
To provide evidence for this section, you must upload a letter on the trust's official letterheaded paper signed by the education supervisor, with details including:
- The surgical department and hospital
- Dates undertaken
- Evidence that you have had learning opportunities or experience (such as attendance at theatre lists or surgical clinics)
- Name of supervisor and their professional registration (e.g. GMC number)
Ash's Tips
Most CST applicants will have done their elective in medical school. The key is to get some form of proof that it was surgical-based when you receive your elective certification. Even if it was a mixed elective, see if you can get some proof of this.
If you haven’t completed a surgical elective, plan early to ensure that one of your placements in Foundation Training is surgically themed. This may require swapping with a colleague and will require early preparation and organisation.
Taster weeks are immensely useful, and you should plan this early. Find a department that you’d like to work in, even if it is in your own hospital, and fill in the necessary documentation and study leave forms early.
If you are interested in a niche in a subspecialty (Robotic Orthopaedic or Urological surgery/Paediatric Cancers) then contact the relevant department at a local hospital. These departments tend to have administrative staff who arrange observerships and will be able to guide you through the process.
Quality Improvement and Clinical Audit (Domain 3: Colleagues, Culture and Safety)
The quality improvement section is a fantastic way to gain some easy points. Compared to other sections, such as degrees and operative experience, you can gain maximum points in this section while only spending a few hours more than is expected for mandatory QIP requirements.
When planning your quality improvement project, it’s important to keep in mind the amount of time you have before submitting your application in late November. If the application closes in 6 months’ time and you’re aiming for max points, you need to make sure you can complete 2 full cycles AND present it to a local meeting before it comes time to hit submit. If you need to get a project together quick-sharp, check out our 5 timesaving tips for your quality improvement project.
This can seem daunting, but if you pick the right subject you can get through 2 cycles, make an improvement, and have something interesting to talk about at the interview. For more information about how to perform a fantastic quality improvement project, see our ultimate guide on quality improvement projects, or for a few quick tips to make sure you complete a quick and efficient QIP.
This section is split into two categories - involvement and presenting. Here are the scoring categories for this section:
Subdomain 1: Involvement in QIP/Audit
- A – Lead, get involved in all aspects of a surgical-themed QI project or audit which demonstrated change.*
- B – Lead, get involved in all aspects of a non-surgical themed QI project or audit which demonstrated change.*
- C – Contribute through multiple cycles of QI project or audit which has demonstrated change.
- D – Involved in a QI project or audit.
- E – None of the above
*To demonstrate change in an audit or QI project, 2 or more cycles should have taken place to provide evidence for a difference in outcomes after an intervention was made.
To provide evidence for this section, you should upload:
- The project presentation or a written summary, which includes the scope and impact of the project.
- A signed letter from the supervising consultant – including:
- Name
- GMC number
- Date
- Confirmation that the project met the requirements you have claimed for.
Subdomain 2: Presenting the QIP/Audit
If you have been a contributor to the QIP/Audit and gained at a C so far, you can also score for personally presenting the project (as either oral or poster presentation):
- A - Presented both cycles of data or presented the intervention and change aspects at a meeting
- B - Presented one cycle of the QIP/Audit at a meeting
- C - Did not present.
What does a meeting mean? We're assuming that this can be a local departmental meeting, given "regional/national" aren't specified, and it has asked for a GMC number. However, this hasn't been clarified by PGMDE: self-assess at your own risk.
To provide evidence for this section, you should upload:
- A letter of acceptance from the meeting including:
- The project title
- The presenting author (you)
- The date
- The name and organiser of the meeting
OR
- A copy of the meeting programme which includes:
- The project
- The presenting author (you).
Ash's Tips
The wording couldn’t be clearer and when embarking on the QIP, make sure you tick every box. Surgical, lead, implemented change, presented. These are all parts of the QIP and should be mentioned in the certificate you receive for performing this.
The hardest part is always starting.
Speak to seniors, as everyone needs QIPs and they will have an idea of what is required for the department. Also speak to the audit team of the hospital, who may give you an idea of what has already been done. Sometimes, a previously completed audit can be worked on and will save you a lot of the early legwork that is required.
Get it done, get it closed, and get it presented as an FY1 or the very start of your FY2. Don’t let these be the points you don’t score.
Presentations and Publications (Domain 2: Patients, Partnership and Communication)
This is a category which you need to plan ahead for. Journals and conferences can be slow to review, accept, or publish your work, with it sometimes taking a year or more.
If you'd like to gain maximum points with a publication and you’re not an academic trainee or research fellow, writing as a first author for original research will be difficult. Instead, publications such as a review of a condition might be easier to obtain. Reach out to an academic consultant within your trust or deanery to find opportunities to get publications. These consultants are often busy but appreciate keen and motivated doctors who are willing to put in the work, and might be able to point you in the right direction.
If you’ve managed to complete multiple quality improvement projects, you can use two separate projects to claim in both this and the Quality Improvement domains, without risking losing any points. It’s worth submitting an abstract to national conferences. Acceptance rates are high for poster presentations, and a good project could win you an oral presentation, particularly at smaller or trainee-oriented conferences.
If in doubt, ask a senior for advice or approach an academic consultant to ask whether they have any cases you could write up or present a poster for. Many academic consultants are busy enough to have a backlog of interesting cases or subjects for review and would be happy to guide you through the process if you reach out.
In 2027, presentations, publications, teaching, podcasts, webinars and patient leaflets all sit in one domain, and "Points are not cumulative, please pick the option which you feel scores you the most points." Upload only your single best item. Here are the 2027 scoring categories for the whole domain:
- A - One of:
- Top prize for an oral presentation at a national or international medical meeting convened by an accredited institution*º after being selected to do so.
- First author of a PubMed- or Web of Science-cited publication (or in press), not including case reports and editorial letters.
- Worked with local educators to design and organise a face-to-face teaching programme (4+ sessions) and delivered at least 4 sessions.
- Created and delivered a surgically themed podcast or webinar with a demonstrable impact.
- Led the design, production and implementation of a surgically themed patient information leaflet with a demonstrable impact.
- B - One of:
- Oral presentation at a national or international medical meeting convened by an accredited institution*º after being selected to do so.
- First author of a prize-winning poster or "oral poster presentation" at a national or international medical meeting.
- First author of a PubMed/Web of Science-cited case report or editorial letter, or author of a published book chapter related to medicine (not self-published).
- Designed, organised and delivered 4+ sessions of an online teaching programme.
- A podcast, webinar or patient information leaflet with a demonstrable impact that is not surgically themed.
- C - Regular teaching for healthcare professionals or medical students over the last year (4+ sessions).
- D - One of:
- First author of a poster or "oral poster presentation" at an international or national medical meeting (attendance is mandatory).
- Oral presentation at a regional medical meeting.
- Cited collaborative author of a research collaborative publication†
- E - None/other
The 2027 table has no row for being a named co-author who is not first author.
- * This does not include "oral poster presentations", in which you give a very short oral explanation of your poster.
† Cited collaborative authors are members of a research collaborative publication who have been acknowledged in the manuscript under a collaborative group name but do not appear in the author list on the title page.
º What counts as an accredited institution? This isn't immediately clear from the documentation, however further up when discussing "accredited conferences" in the surgical conference section, it says:
Accredited by one of the UK Royal Colleges of Surgeons, an international/national surgical organisation or regional deanery will be accepted. Alternatively, any surgical themed conference with evidence of CPD accreditation will also be accepted. Non-accredited or undergraduate medical school society organised conferences will not be accepted.
We assume that this would also serve as the definition of an "accredited institution", but this is only an assumption.
Source: CST Portfolio Guidance 2027
You can only claim points for oral presentations if you personally delivered them.
First authorship is defined by meeting the ICJME criteria for authorship, and are cited/listed first on the title page (or as co-author)
For all presentations, you must personally or virtually attend, and you must have been selected to present your work – if you have paid a fee to present your poster or project, it will not count.
Your publication can score points if it is published, in press or if you have evidence that the PubMed catalogued journal has accepted your work for publication without amendments. Cited collaborative authors must have their work published, not in press.
A medical meeting is defined as an audience of healthcare professionals attending away from their normal place of work for CPD purposes. These can be virtual or face-to-face. This includes conferences, symposiums, and other similar events.
You cannot claim in this category for a presentation that you have already claimed in the QI/audit (presentation points) section for the same project.
To provide evidence for this section, you should upload:
Oral and poster presentations - National or International
- A letter of acceptance or copy of the event programme which demonstrates that your poster or presentation is taking place, including the name of you or the first author, the organisation of the meeting, and the date of the meeting.
- A copy of your presentation or poster including the title, first author, and your name.
- A certificate of attendance at the meeting.
- A copy of the prize certificate or signed letter from the organising who awarded you the prize (Prizes only)
Oral and poster presentations - Regional
- A letter from an educational supervisor which includes the information in the national/international category above
First or co-authored publications - published
- Copy of the article (pdf or scanned) including PubMed ID
- Letter of acceptance (without alteration) by a PubMed catalogued journal including:
- Your name as first or co-author
- Title of your article
- Name of the journal
- Date of acceptance
First or co-authored publications - in press
Letter of acceptance (without alteration) by a PubMed catalogued journal including:
- Your name as first or co-author
- Title of your article
- Name of the journal
- Date of acceptance
- Statement confirming PubMed status of journal
Cited collaborative author publications
A copy of the published article including:
- Title of the article
- Name of the journal
- PubMed ID
OR
- The page where collaborative authors are cited
Book Chapter
Sections of the book including:
- The front and back cover which includes the title, publishing house, and ISBN number
- The contents page showing the chapter and your name as the author
Ash's Tips
Presentations
Niche subspecialty conferences are harder to present at than generic conferences. For example, an abstract submitted to the ASiT or Doctor’s Academy conference, at this stage of training, will have a higher chance of being accepted than the British Association for Surgery of the Knee.
If your QIP ends up being selected for an oral national presentation, then try and complete another QIP so that you can achieve maximum points in both sections. Maximise your points.
On that note, there are also QIP sections in the larger conferences which may be more suited for the work you have produced. In terms of getting involved in research, please see below.
Publications
Don’t do the hard work to not get the points.
First author, PubMed, and not case reports. Don’t fall into the trap of committing time to a project that won’t get you the above points. Make sure if you’re putting in the work for a publication, that you are the first author, and it will be submitted to a PubMed-indexed journal.
Speak to the senior authors and establish these parameters early. Getting involved in projects always seems to be the most daunting task. Speak to seniors. Some will have no interest in research, others will publish weekly.
The key is to not take on too many projects and meet the deadlines for the ones you have. Not only does this increase the chances of your work making it to publication but builds up a level of trust which means you’re likely to be involved in more projects.
A randomised controlled trial that takes 4 years to publish will get you the same number of points as an educational review publication that can take a week to write. So, pick your projects wisely and pick your journal wisely. These points are worth their weight in gold.
Teaching, Podcasts, Webinars and Leaflets (Domain 2)
Even if you have no interest in a future in medical education, there are many opportunities to bolster your application through regular teaching sessions. This can include your peers, medical students, and other healthcare professionals.
To get maximum points in this section, you need to put on and teach in a minimum of 4 teaching sessions. There is no requirement to do this alone, so long as you can provide evidence that you were involved in designing and organising the teaching programme.
If you work with other trainees, you can all get points for application, and it will be easier to create a teaching programme that blows away an interview panel.
Plan for this by approaching your hospital's undergraduate department, and offering to organise a regional teaching programme. You can also ask your educational supervisor for local opportunities. Enquire as to whether there are any opportunities for you to run a series of teaching sessions for students, or to organise a new lunchtime educational meeting. If you are interested in teaching as a career and are able to take a year out, you can also consider a teaching fellow post to help you get full points here.
If you’re struggling for opportunities to do this during working hours, consider putting on a series of evening virtual webinars for students – even once per month during a 4-month placement can score a B (an online programme scores one band below a face-to-face one). Consider delivering group tutorials, clinical skills tutoring, or exam preparation seminars for medical students.
Teaching now sits in the communication domain (Domain 2), alongside presentations and publications, so it only scores if it is your best item there. The teaching rows in the 2027 table are:
- A – Worked with local educators to design and organise a face-to-face teaching programme (4+ sessions) and delivered at least 4 sessions personally.
- B – The same for an online teaching programme.
- C – Provided regular teaching for healthcare professionals or medical students over the last year (4+ sessions).
The 2027 table has no separate rows for organising a programme but delivering fewer than 4 sessions, or for a teach the teacher course. The 2027 evidence table lists a "teaching or other qualification" as academic evidence under Knowledge, Skills and Development, but no scoring band names one. Treat a teach the teacher course as useful preparation for running a programme, not as points on its own.
Podcasts, webinars and patient information leaflets are new for 2027. They score A if surgically themed and B if not, but only with a "demonstrable impact": "the activity has, where possible, a measurable outcome as to how successful it has been". A podcast's reach and feedback, or a survey showing patients find a leaflet acceptable, would do. Upload a supervisor letter detailing your involvement, plus a link or transcript for a podcast or webinar ("Links must be live for Assessors to access during March 2027") or a PDF of the leaflet.
Formal feedback is essential for teaching, podcasts, webinars and patient information leaflets - without it, you will score 0 points. This can be in the form of participant feedback forms (including scores and number of participants who gave feedback) or formal feedback from a senior observer (such as a portfolio form signed by a registrar or consultant). You do not need to submit the feedback as evidence, but it must be reviewed and verified by a consultant.
To provide evidence for this section, you should upload:
- Letter from a consultant which includes:
- Confirmation that you designed and organised teaching
- Their name and GMC number
- The dates of the activity
AND
- Letter from a consultant with confirmation that you were involved in teaching, which includes:
- Their name and GMC number
- The dates of the activity
- Confirmation that you were involved in teaching
- Confirmation that evidence of formal feedback has been reviewed and found acceptable
- OR
- Anonymised evidence of formal feedback, including participant surveys or ISCP assessment.
Ash's Tips
These are very achievable points and can be done in your non-surgical placements. If a teaching programme for medical students is already set up, speak to the organiser and ensure that you design and organise at least 4 of the sessions.
Print out your own feedback forms and make sure they are filled in. The feedback forms should comprise of “yes/no” questions or “1-5” rankings. This will make it easier for you to collate into a graph and put it in your portfolio, should it be required further down the line. It is also easier to get a consultant to verify it.
If a teaching programme isn’t set up, then speak to the consultant in your department who leads undergraduate teaching (there always is one). Take the reins here and ask to organise the sessions for your entire placement. This can all be done within working hours and requires YOU to take the lead here. Keep in continuous contact with the consultant as their documentation is what will be required.
Training in Teaching
This section has been removed, and no 2027 scoring band names a teach the teacher course (see Teaching above), so do not count on one scoring by itself.
