CST Portfolio Self-Assessment Guide 2024

Core Surgical Training (CST) is one of the most competitive core training programmes out there, and your CST portfolio self-assessment score in 2024 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 2023 to eke out the last of your CST portfolio self-assessment points – too late for some sections, but plenty of time for others! In this guide to the CST self-assessment scoring 2024, 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.

Updated 30th October for final 2023/24 updates.

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 application 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.

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Key Documents

CST Recruitment Timeline

Self-Assessment Scoring 2024

As we will discuss in our guide to application and recruitment, the CST application portfolio self-assessment score contributes to 30% of your final score. This score is what decides your ranking and whether you get a CST job or not, so maximising your self-assessment is vital!

In 2023, around 960 of the roughly 2300 applicants will be invited to interview based on their MSRA score. The portfolio self-assessment score was previously used in this shortlisting, however the MDRS announced a change in 2023 application whereby the shortlisting process uses MSRA scores rather than portfolio self-assessment. Final allocation of CST jobs will still depend on the total score, which will be made up of your MSRA score (10%), verified self-assessment score (30%) and interview score (60%).

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Maximum CST Portfolio Score

The maximum points available in the CST application portfolio self-assessment in 2024 is 52.

For all these achievements, you must have evidence of completion to score points. You have until the end of November to complete, gather evidence, and upload this.

Your self-assessment score will be verified by a surgical consultant if you make it into the top 1100, so make sure you’re as accurate as possible when scoring points. These consultants can change your score if they feel you have done this incorrectly, and it if appears that you are deliberately trying to misrepresent your achievements to gain an advantage, you could face a probity probe by the GMC.

Changes in 2024

After the significant changes made in the 2022/23 cycle, we can’t find many changes for the 2023/24 application scoring. Here are the three changes that we found:

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.

There are a maximum of 8 points available in this section:

• 8 points – Involved in 40+ cases
• 6 points – Involved in 30-39 cases
• 4 points – Involved in 20-29 cases
• 2 points – Involved in 11-19 cases

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.

Attendance at Surgical Conferences

Attending surgical conferences could be a way to score easy points, so long as you plan ahead. You should be able to maximise your core surgical training application points by booking 3 surgical conferences, taking care to find conferences which take place before the application submission date.

There are a maximum of 3 points available in this section:

• 3 points – Attended 3 surgical conferences
• 2 points – Attended 2 surgical conferences
• 1 point – Attended 1 surgical conference

For a conference to qualify as surgical, it must be surgically themed and fulfil at least one of the following criteria:

• Organised by a UK-based Royal College of Surgeons
• Organised by a national or international surgical organisation
• Organised by a regional deanery
• Accredited for CPD points

To provide evidence for this section, you must upload a copy of the conference attendance certificate, which must include:

• Your name
• Conference name
• Organiser
• Date attended
• CPD points if appropriate

You should collate all of these certificates into a single document. You can do this on a service like iLovePDF. This is then uploaded.

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”.

There are a maximum of 3 points available in this section:

• 3 points – Surgical taster week (min 5 days total)
• 2 points – Surgical elective (min 4 weeks)
• 2 points – Surgical placement during training (min 12 weeks)

Surgical placements which are accepted include:

• Cardiothoracic Surgery
• ENT Surgery
• General Surgery
• ITU
• 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 your trust’s official letterheaded paper signed by your education supervisor, with details including:

• The surgical department and hospital
• Dates undertaken
• Name of supervisor and their professional registration (e.g. GMC number)

All surgical experience should be evidenced in the UK Pan-Surgical Logbook.

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.

There are a maximum of 13 points available for this section – 8 for being involved in the project and 5 for presenting the project.

Involvement in the Quality Improvement Project/Clinical Audit

• 8 points – Lead, get involved in all aspects of a surgical-themed QI project or audit which demonstrated change.*
• 6 points – Lead, get involved in all aspects of a non-surgical themed QI project or audit which demonstrated change.*
• 4 points – Contribute through multiple cycles of QI project or audit which has demonstrated change.
• 2 points – Involved in a QI project or audit.

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 their name, GMC number, and the date – confirming that the project met the requirements you have claimed for.

Presenting the Project

If you have been a contributor to the QIP/Audit and gained at least 4 points so far, there are a further 5 points available for personally presenting the project (as either oral or poster presentation):

• 5 points – Presented to a national or international meeting
• 3 points – Presented to a regional meeting
• 1 point – Presented to a local meeting

To provide evidence for this section, you should upload:

• A letter of acceptance from the meeting including the project title, presenting author (you), and date

OR

• A copy of the meeting programme which includes the project and presenting author (you).

Using a QIP in Multiple Domains

There may be an opportunity to use a quality improvement project in both this section and the presentations and publications section, though you must be careful when doing this.

The scoring document says “The same Quality Improvement/Clinical Audit may be also put forward in the publications domain if it may score in that domain should the applicant wish.“

They also say in the presentations and publications section that “You must not in any circumstances claim an oral or poster presentation in this section if you have used the same quality improvement project/audit to claim points in the QI/audit section (Presentation points). Any points claimed for oral or poster presentations in this section must be completely different projects to any QI or audit work used to claim points in any other section.“

An example of where you may be able to use this project in both sections is by leading a surgically themed project (8 QIP points), presenting it at a national meeting (5 additional QIP points), and then publishing it as the first author as part of a PubMed-cited publication (10 publication points).

Presentations and Publications

This section has undergone a transformation in 2023, merging presentations and publications.

The door has also been opened to applicants claiming in both this section and the Quality Improvement section for the same QIP, so long as you are not claiming points for a presentation in both this section and the Quality Improvement section. See above.

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.

There are a maximum of 10 points available in this section:

• 10 points – Prize for an oral presentation at a national or international medical meeting organised by an accredited institution*º after being invited to do so.
• 10 points – First author of a PubMed-cited publication not including case reports and editorial letters.
• 8 points – Oral presentation at a national or international medical meeting organised by an accredited institution*º after being invited to do so.
• 6 points – Prize for a poster or oral poster presentation, for a project you are first author on, at a national or international medical meeting organised by an accredited institution.º
• 4 points – First author for 2 or more posters or oral poster presentations at a national or international medical meeting organised by an accredited institution.º
• 4 points – First author of PubMed-cited care report or editorial letter.
• 4 points – Author of a book chapter related to medicine (not self-published).
• 3 points – Cited collaborative author for 3+ PubMed-cited publications.^†
• 2 points – Named co-author of one PubMed-cited publication.
• 2 points – Oral presentation at a regional medical meeting.
• 1 point – Presented 1 or more posters at a regional medical meeting.
• 1 point – Poster accepted for presentation at a national or international meeting but did not attend.
• 1 point – Cited collaborative author for 2 PubMed-cited publications.^†

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.

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 title, your name, the organisation of the meeting, and the date of the meeting.

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
• 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

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.

There are a maximum of 10 points available in this section:

• 10 points – Worked with local educators to design and organise a teaching programme (4+ sessions) at a regional level.
• 8 points – Worked with local educators to design and organise a teaching programme (4+ sessions) in an online format for a regional or larger audience.
• 6 points – Worked with local educators to design and organise a teaching programme (4+ sessions) at a local level.
• 2 points – Provided regular teaching (4+ occasions/year).

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:

• Letter from a consultant which includes:
  • Confirmation that you designed and organised teaching
  • Their name and GMC number
  • The dates of the activity

AND/OR

• 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

Training in Teaching

To gain points in this section requires forward thinking and effort, though if you can see a future in medical education, you may be planning to undertake these activities anyway!

While you will likely need to take time out of training to complete a master’s, postgraduate qualifications such as a PGDip and PGCert in medical education can be done part-time, and you can use your study leave to undertake a teach the teacher course.

There are a maximum of 4 points available in this section:

• 5 points – Postgraduate Teaching qualification – ISCED level 4 or above (such as PGCert)
• 3 points – Substantial training* in teaching lasting 2 or more days
• 1 point – Some training in teaching methods, beyond those delivered as part of medical school.

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Training can take place virtually. This may include on-demand training in teaching courses but this is not confirmed in the HEE application scoring document.

To provide evidence for this section, you should upload a copy of the certificate confirming your qualification or attendance at training, which should include:

• Your name
• The awarding institution
• Date awarded

Do Virtual Teach the Teacher Courses Count For 3 Points in CST Application Teaching Qualifications?

The answer to this, however confusing scoring criteria, is yes.

Initially, we thought that a “face-to-face” component of a course, which is the requirement for 3 points in Teaching Qualifications, would require you to attend an in-person training. This was hinted at in the Self-Assessment Guidance Document which says “This does not include online only courses“.

However, more recently, HEE have updated their website guidance on CST points. The additional notes now say “Substantial training is defined as formal training either face to face or virtual that should be of at least 2 full days in duration.“

Stephen McGuire at Oxford Medical has been in touch with London & KSS, NHS England which confirmed that a virtual teach the teacher course of 2 full days duration would count as substantial training and therefore achieve 3 points.

We got in touch and received a reply from Selina Wildman at the PGMDE support desk who said “to confirm, both online and face-to-face courses for teaching qualifications will be accepted, which will be 3 points“. We assume this doesn’t include on-demand courses.

However, the statements around “online only” vs “substantial training” are still confusing, and we cannot guarantee that those verifying your portfolio score will score according to this clarification. If you’re unsure, you can get in touch with HEE through the PGMDE Support Portal.

Frequently Asked Questions