Published September 30, 2024 | Updated November 4, 2024
By Ash Ahluwalia
Orthopaedic Registrar in London, surgical director of MedCourse, and founder of The London Course – interview courses for core and higher speciality training programmes.
Core Surgical Training (CST) is one of the most competitive core training programmes out there, and your CST portfolio self-assessment score in 2025 could make the difference between getting your perfect CST job or needing to take another year to develop your portfolio.
Following 2020 changes to immigration rules, which allowed the inclusion of International Medical Graduates (IMGs) in round 1 of recruitment, the race to get a Core Surgical Training post has never been more ruthless.
You have until December 2024 to eke out the last of your CST portfolio interview assessment points – too late for some sections, but plenty of time for others! In this guide to the CST self-assessment scoring 2025, we’ll go through the rules and where you can maximise your points, as well as some tips to get the most out of your portfolio.
2024/25 UpdateFor the 2024/25 application period, the self-assessment section has been moved to the interview portfolio station. You will only be asked to self-assess if you are invited to interview, and these points will be confirmed or changed by your interviewers.
Check out the updates below to see what the new assessment looks like.
Hints and Tips by Mr Aashish Ahluwalia
Ash is an Orthopaedic Registrar based in London. He achieved a maximum score in self-assessment and portfolio at both CST and ST3 levels and will be giving you guidance as we go through the CST portfolio scoring.
Ash is also the founder of The London Course, providing surgical interview and exam courses for trainees. If you want an extra boost to make sure you land your dream job, sign up for his fantastic CST interview course, which will also help you to maximise your portfolio self-assessment score. Feel free to get in contact with him at cstinterview@outlook.com.
Key Documents
CST Recruitment Timeline
August 2025 Start Date (Round 1)
| Applications open | Thursday 24th October 2024 at 10am |
| Applications close | Thursday 21st November 2024 at 4pm |
| MSRA Exam | TBA – planned for two rounds, one in Jan, one in Feb |
| Interview Invites | Thursday 6th February 2025 |
| Evidence Upload | Between Friday 7th and Wednesday 19th February 2025 |
| Preferencing | Between Thursday 1st February and Tuesday 4th March 2025 |
| Interviews | Between Monday 24th February and Friday 7th March 2025 |
| Initial Offers out | By Tuesday 25th March 2025 by 5pm |
| Hold Deadline | 1pm on Thursday 3rd April 2025 |
| Upgrade Deadline | 4pm on Tuesday 8th April 2025 |
| Post start date | Wednesday 6th August 2025 |
Portfolio Scoring 2025
The latest changed, as detailed on the HEE site, is that self-assessment will no longer happen, and instead will be replaced with a scoring system based on a portfolio station at interview.
If you’re invited for an interview, you’ll be asked to upload evidence for the 5 domains below, assigning a letter from A to E to each to see how many “points” you should get at interview for each domain.
The interviewers will look at your evidence during the interview, and accept or change this scoring based on their interpretation.
Here’s a few points to keep in mind:
Recognised surgical specialities include:
Maximum CST Portfolio Score
We don’t yet have an idea of the maximum CST portfolio score, nor do we have any statistics, as now this will move to an A – E letter system during the interview.
| Section | Maximum Score |
| Operative Experience | A |
| Surgical Experience | A |
| Quality Improvement – Project | A |
| Quality Improvement – Presentation | A |
| Presentations and Publications | A |
| Teaching Experience | A |
| Total | AAAAAAA?? |
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 in 2025
Portfolio scoring has changed significantly for 2025.
Instead of a points-based self-assessment on application, portfolio will be assessed on a letter (A to E) basis as an interview station. You will still need to self-assess if you’re shortlisted for interview, but this will only be verified during the interview itself.
| Domain | Potential Changes | 2024 Points | 2025 Scoring | Relative Change |
| Operative Experience | A new, lower scoring category for <10 cases, or no evidence, which will get you an E. | 4 | A – E | ❔ |
| Removed! | 3 | Removed | 🔻 | |
| Surgical Experience | 2024/25 – All of the previous point-scoring categories will now score you an A. Otherwise you get a B. (In 2025/26, foundation placements will no longer count towards this, and ITU will no longer count as a surgical speciality) | 7 | A – B | ❔ |
| QIP and Audit – Involvement | Pretty much the same, except for points weighting which will now just be a letter. | 8 | A – E | ❔ |
| QIP and Audit – Presentation | The points are no longer about presenting to international/national meetings, but instead how many cycles you presented and which aspects were presented. | 5 | A-C | ❔ |
| Presentations & Publications | Changes to points categories based on the new letter system, including better scores for case-reports/editorial letters and book chapters, and less emphasis on the number of publications you have. | 6 | A – E | ❔ |
| Teaching Experience | Teach the teacher courses have been moved to this category, scoring a D. Online teaching appears to be worth more for local teaching programmes. | 3 | A – E | ❔ |
| Removed! | 5 | Removed | 🔻 | |
| Total | Change to letter-based system | 40 | ❔ | ❔ |
Have we missed anything? Get in touch to let us know of any other changes you spotted.
Operative Experience
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:
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.
A consolidation report must be evidenced for each speciality, including the following details:
- Summary sheet from this report
- Numbers of procedures & date ranges
This must be verified by a consultant, 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!
Attendance at Surgical Conferences
This has been removed for 2024/25.
Our condolences to your study budget!
Surgical Experience
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:
Surgical placements which are accepted include:
- Cardiothoracic Surgery
- ENT Surgery
- General Surgery
- ITU (being removed in 2025/26 – this is the last year to use this!)
- Neurosurgery
- Oral & Maxillofacial Surgery
- Orthopaedic Surgery
- Paediatric Surgery
- Plastic Surgery
- Urology
- Vascular Surgery
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:
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
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
*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:
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):
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:
OR
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
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.
Here are the scoring categories for this section:
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 Experience
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 will get you the points! Consider delivering group tutorials, clinical skills tutoring, or exam preparation seminars for medical students.
Here is the scoring for this domain:
Formal feedback is essential – 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.
A regional level includes delivery of teaching across more than one hospital sites, or a regional association or organisation.
To provide evidence for this section, you should upload:
AND
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! However, you can still get points for a teach the teacher course in the above category.
