CST Recruitment & Application Guide 2024

Core Surgical Training (CST) is the most common pathway for foundation-equivalent doctors to start their training in surgery, leading to higher surgical training. CST is a highly competitive programme which almost always fills 100% of the available places, so it’s important that you give yourself every possible advantage while applying for CST!

In this guide, we will talk you through everything you need to know about the 2024 CST application, including advice on how to maximise your application points and get the surgical job that you want!

Updated 30th October for final 2024 updates.

Hints and Tips by Mr Aashish Ahluwalia

I am a Trauma and Orthopaedic Registrar at University College London Hospital. After obtaining my first choice Core Surgical Training job in London and completing a PGCert in Medical Education, I designed and lead The London Core Surgical Training Interview Course, to help as many junior doctors achieve success in the CST interview to obtain their first-choice job.

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

How Does Core Surgical Training Work?

Core Surgical Training (CST) is very much the first step of surgical training in the United Kingdom. The programme is open to those who have completed their foundation years 1 & 2 or have earned foundation competencies by other means. On entering Core Surgical Training, you become a Surgical “SHO”, as it was termed before the adoption of CST.

Some training programmes are “themed”, meaning that your CST placements will include a bigger emphasis on the theme speciality and affiliated specialities, usually spending 12-18 months in the speciality of choice. Those not in themed programmes will rotate across a number of associated surgical specialities in 6-month placements.

Those that have ranked highly enough will be able to prioritise the jobs that include your speciality of interest. If you can muster a strong performance in the CST application, you can obtain a competitive placement and can work in a more desirable location. Doing well at the CST stage will also give you a better foundation for when you go on to the ST3 application.

A Core Surgical Trainee will have clinical commitments, regardless of speciality. This includes:

• On-call days, nights, and weekends
• Theatre sessions
• Clinics
• Ward duties

Non-clinical opportunities will exist throughout training, such as audits, research, and teaching. Those successful in their CST applications will be all too familiar with these roles. You will also have regional formal protected teaching sessions which in London, for example, focuses on Anatomy.

You will be expected to complete your MRCS while a Core Surgical Trainee, prior to applying for an ST3 post, which you can do once in your second year of Core Surgical Training.

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The CST Recruitment Process

Recruitment for Core Surgical Training (CST) takes place twice per year – during round 1 of speciality recruitment, and the round 1 re-advert. Round 1 re-advert is a chance for Deaneries to fill remaining posts, however as CST is a very competitive programme this is not usually a viable option for applicants.

To apply for CST, you must have no more than 18 months of experience in Surgery (excluding foundation modules) at the time of application.

Round 1 for CST recruitment 2024 will post vacancies and job adverts in October 2023, on the Oriel platform. You can also find documents relevant to CST recruitment in the Oriel resource bank, and keep on top of updates on their news page.

Who Can Apply for CST?

Suitability to Core Surgical Training is listed in the Person Specification. It is important to ensure you are an applicable candidate.

For those in the Foundation Programme, most of the competencies will be covered in your mandatory portfolio requirements.

For those who are not in the Foundation Programme, please familiarise yourself with the basic level of competencies and essential criteria required prior to applying to Core Surgical Training. 

Most surgical specialities recruit trainees at the ST3 level following the completion of CST. The only surgical specialities which don’t recruit trainees from the CST pathway are:

• Academic – Recruits via Academic Clinical Fellowships only, from ST1.
• Cardiothoracic Surgery – For 2023 recruitment, cardiothoracic surgery will only recruit from ST1 level on their run-through programme.
• Neurosurgery – Run-through programme recruiting only, from ST1 & ST2.
• Surgical Ophthalmology – Run-through programme only recruiting, from ST1.

While run-through programmes also exist for cardiothoracic and oral & maxillofacial surgery trainees, these programmes also recruit at an ST3 level.

There are 10 recognised surgical specialities, excluding surgical ophthalmology, and gynaecological surgery, which recruit via their own pathways. Some of these specialities also allow for sub-specialisation later. For example, general surgeons can later specialise in breast, colorectal, endocrine, upper gastrointestinal, and transplant surgery. 

For international medical graduates (IMGs), entry into the surgical training pathway is possible at the foundation, CT/ST1, and ST3 levels, so long as you meet the eligibility requirements. See more on this excellent article by Road to UK.

The CST Application

Application for Core Surgical Training opens on 26th October 2023 for the August 2024 start date. All applications are processed Vacancies are posted on the Oriel platform, and all applications must be made through Oriel.

Once you have registered on Oriel, you will find CST vacancies on the left-hand side – “Applicants” > “Medical and Public Health Specialities”. Click the vacancies tab at the top left and search “Core Surgical Training” in the “Training programme” box, then click search. There you will find CST posts for Northern Ireland (NI) and the rest of the UK (LaKSS).

Application Deadline

You will have until 4 pm on Thursday 23rd November 2023 to submit your application. In the application form you must fill in:

• Your personal details
• Confirmation of your eligibility for Core Surgical Training
• Equality and diversity details
• A portfolio self-assessment score

CST Portfolio Self-assessment Score

While the Core Surgical Training portfolio self-assessment score is no longer used for CST interview shortlisting, it still makes up 30% of your final score and all sections will add to how comprehensive your surgical CV is.

You will have to back up each claim in your self-assessment with evidence, which will be looked at by a surgical consultant if you make it through to the interview. If you have over-or-under-claimed on your portfolio your score may be amended, and if there are any signs of deception or false representations you may face disciplinary action.

Check out our guide to CST self-assessment scoring for the full low-down on how to get the most of out this section of the application.

CST Longlisting – Eligibility Criteria

Longlisting is the first part of the CST application process, where all ineligible applications are removed – see the eligibility requirements below:

If you meet the minimum requirements for eligibility, you will be longlisted and will move on to the next stage of recruitment – shortlisting.

CST Shortlisting – The MSRA Exam

Prior to 2023, shortlisting for interview was carried out using the verified self-assessment score. However, since 2023 this has been replaced by the Multi-Speciality Recruitment Assessment (MSRA).

The Multi-Speciality Recruitment Assessment is a computer-based exam which is split into two sections – the Professional Dilemmas (PD) paper and the Clinical Problem Solving (CPS) paper.

The Professional Dilemmas (PD) paper is a 95-minute situational judgement test based on 50 questions. In part 1 of the PD paper, you will be given a scenario and asked to rank 4-5 different responses in order of appropriateness. In part 2, you will be given a scenario, presented with 8 options, and asked to choose the most appropriate 3 answers.

The Clinical Problem Solving (CPS) paper is a 75-minute clinical assessment based on 97 questions. The CPS paper is split into two sections. Part 1 is extended matching questions, where you will be given 7-10 responses and asked to choose the most appropriate answer for multiple different scenarios. Part 2 is single best answer questions, where you will be given a scenario and asked to choose the most appropriate answer. The CPS paper covers aspects of clinical knowledge across many different specialities.

The exam is taken at a Pearson Vue exam centre, and places often get booked quickly.

There are plenty of free resources out there, but if you prefer to attend more formal teaching sessions you can check out our MSRA courses.

The top 1200 applicants, based on their MSRA score, will be invited to interview.

The CST Interview

Interviews for CST in 2024 will all be online using Microsoft Teams, and will take place between 19th and 28th February 2024. Your interview will be 20 minutes in total with two main questions, management and clinical scenarios, each lasting 10 minutes. You will have two assessors who will be present for the entire interview.

For more information on the CST Interview, see our CST Interview Guide 2024.

Competition Ratios 2024 – Is CST Competitive?

As of October 2019, medical jobs have been included in the UK shortage occupation list, meaning eligible overseas doctors can now apply to round 1 of training programmes. This has resulted in increased competition for CST posts for the past 2 years, and you should expect this to continue.

Over the past few years, the competition ratio for CST has been 4 on average, meaning that for every 4 applicants to CST, only 1 person was awarded a post!

CST Ranking & Programme Preferences

Total CST Application Score

Your final score following the interview is made up of three parts:

• MSRA score – 10%
• Verified self-assessment score – 30%
• Interview score – 60%

As you can see, a good interview score is the key to getting your number-one-ranked CST job. Once these scores have been calculated, the top 500-600 will be allocated a CST post.

Preferencing

If you have been shortlisted for an interview, you will be invited to preference CST posts around March 2024. When preferencing, you will be asked to sort all of the available CST posts in order of preference, with number 1 being your most desired choice.

You don’t need to worry about choosing your options tactically. When allocating posts, the algorithm goes through candidates starting at #1, looking to see if their top choice is available. If it is, this is offered to them. If not, the algorithm looks at their second choice and repeats the process.

You will be asked to rank all of the placements that you wish to be considered for, leaving out any placements you do not wish to be considered for.

Given all the choices, it’s generally best to start by deciding which geographic regions you don’t want to be considered for. In the UK (excluding Northern Ireland, which recruits separately), you can apply to 15 deaneries areas.

Deaneries in England, Scotland, and Wales

Be aware of your rank; if your rank is on the lower end and you only rank posts with tough competition ratios, you run the danger of missing out on a spot.

You should also think, in terms of your desired future ST3 speciality, about which speciality rotations you must have, which you would want to have but are not essential, and which you would prefer to avoid.

It’s critical to look at whether the hospitals with your selected specialities are district general hospitals or teaching hospitals. The easiest way to determine which hospitals provide trainees with the most chances is to ask around and conduct some online research – such as on juniordoctors.co.uk.

Teaching hospitals often offer additional chances for professional development, to get involved in research, and to find opportunities to bulk up your CV. Additionally, you may receive more assistance and have a greater chance to see rare conditions.

District general hospitals, on the other hand, might be better able to give you the knowledge and abilities to handle a wider variety of common conditions.

Frequently Asked Questions (FAQ)