Core surgical training is one of the most popular medical specialties with over 1200 applicants applying for just over 600 jobs each year. The competitive national selection process can be daunting and knowing where to start and organising focused practise can be difficult.
What Is Core Surgery?
Core surgery is a 2 year surgical training programme that happens after completion of foundation training and is a requirement to progress to higher surgical specialty training in the UK. During core surgical training you typically progress through a variety of surgical specialty rotations to give you a broad experience of surgical principles with some themed programmes offering more placements in specialties like ENT or Orthopaedics. There are also some programmes that offer what's called run-through training where you don't need to do an interview to get into higher specialty training after core surgery and you just run-through ito ST3, though these often limit where you do your training with only some regions and specialties offering them.
How Competitive is Core Surgery?
Core surgical training is one of the most popular medical specialties with over 1200 applicants applying for just over 600 jobs each year. Each region has around 40 core surgery jobs with London and the Northwest having more but I'd recommend applying for the region where you're going to be happiest rather than trying to game the system.
How Do I Apply For Core Surgical Training?
Core surgery, like most other medical interviews, follows a national application process. You apply for core surgical training through the NHS's Oriel job application portal. The job listing and application usually goes live in the first week of November each year and stays open for a month closing in the first or second week of December.
When you apply through Oriel you're asked to enter your personal details, details of your previous jobs and then complete a scored self-assessment of your personal achievements.
As part of the selection process for 2023 recruitment, all longlisted applicants will be required to take a Multi-Specialty Recruitment Assessment (MSRA). This will form the basis of your shortlisting score.
Only the top 1200 applicants at MSRA will be invited to interview. All applicants that score higher than the cut-off score but are not initially invited to interview will be put on a reserve list.
How Is The MSRA Used For Core Surgical Training?
New for 2023 is the MSRA being used for shortlisting during core surgical training selection. The MSRA is a 2hr multiple choice paper sat at a Pearson Vue Test Center and I have a full video covering what the MSRA is and how to pass it so be sure to check that out.
Invitations to book an MSRA test slot are sent out towards the end of December after the application window closes and the test window is in the first two weeks in January with score released at the end of February.
The MSRA is composed of two papers, a clinical multiple choice paper and a situational judgement paper.
Our best advice for passing the MSRA is to do make sure you understand how the paper is scored which you can do by checking out the MSRA video on my channel and then doing as many practise questions as possible. I’ve popped up some links to free resources in the comments below too.
What Is The Core Surgery Interview Self-Assessment?
The self-assessment asks you to complete 4 sections that correspond to something called the person specification. This is basically a list of the essential and desirable criteria that Health Education England who set the standards for medical selection in the UK set. Each section is scored based on the level of your achievements and remember you need to supply evidence backing up your achievements.
The self-assessment for core surgery used to have 9 sections including postgraduate degrees and prizes but these were removed and other sections consolidated from 2023 onwards so there are now just 4.
Let's look through each of the 4 domains:
• Domain 1 Commitment to specialty
Which is broken down into Operative experience where the maximum score is 8 for 40 cases evidenced via a verified log book; attendance at surgical conferences where the maximum score is 3 for attending 3 conferences evidenced by proof of attendance certificates and surgical experience where the maximum score is 3 if you’ve undertaken a 4-week elective in a surgical specialty.
• Domain 2 is Quality improvement / Clinical audit
Where the maximum score is 8 if you were involved as Lead in ALL aspects of a
surgically themed clinical audit or QI project that has demonstrated changeand closed the audit loop. The audit must be surgically themed and this can be evidenced by a presentation given and a letter from the supervising consultant
• Domain 3 is Presentations and Publications
Where a maximum of 10 points are awarded if you have won a prize for delivering a presentation or you are 1st author on a pubmed-cited publication evidenced by the publication or letter of acceptance of presentation
• Domain 4 is Teaching Experience / Training Qualifications
Where you get a maximum of ten marks if you have designed a teaching programme evidenced by feedback forms and a letter from the supervising consultant. There is then a mximum of 5 points available if you have a formal teaching qualification with a masters level degree getting top marks.
Now as you can see knowing the criteria here early is a huge advantage. I geekily had this list in medical school so I knew I needed audits and other things that I then had more time to achieve and tick off. Obviously trying to get all these areas ticked off in your FY2 year is a little trickier so be sure to start earlier.
Whatever you score yourself you need to ensure you have the evidence to back it up. The evidence upload portal opens at the end of Jan and closes in early Feb and you need to upload your evidence as a single document with an index page through the online portal.
What is The Timeline for Core Surgery Interviews?
Applications open via Oriel in November and close in early December each year. You then need to book an MSRA slot and sit the exam in the testing window in January. You then have to upload your self-assessment evidence at the end of Jan beginning of Feb. MSRA results announced in Feb along with invitations to interview and then the interviews are held in march with results announced the following month when you'll also then be asked to preference your jobs in order of where you'd like to work.
What's The Format of The Core Surgery Interview?
The core surgery interview is held oline using microsoft teams and consists of one 20-minute interview station made up of a 10-minute management section and a 10-minute clinical section.
The management section is divided into two five-minute sections. In the first part of the management section you'll be asked to give a 3-minute pre-prepared presentation on a topic related to surgery that is emailed out via Oriel when you're invited to the interview. This is then followed by 2-minutes of questions on the presentation from the interviewers. This is a pretty nice way to ease you in since you've had a chance to prepare the topic and the topic is usually related to leadership in surgery or an element of the person specification.
In the second part of the management section of the interview you'll be given a management scenario which requires you to think on your feet. This might be something like “You notice your consultant appears to be drunk at work, what would you do?”. I'll go through how to answer some of these questions later in the video so be sure to stick around.
The second section of the interview is then the clinical section where you'll usually be given two clinical scenarios to work though. They tend to use similar topics each year and they are often based around emergency and post-operative scenarios and are at the level expected of a junior doctor looking after patients on the ward so you won't get advanced operative management questions.
There is no break in between the management and clinical questions and they are asked by the same panel members.
The remote panel is comprised of a maximum of two consultants and there is also a lay representative on the panel whose role is to check for fairness and consistency.
Prior to the COVID pandemic the core surgery interview was held in-person in London with 3 OSCE style stations which were 10-minutes each. They matched the online interview with clinical and management 10-minute stations but they also had an additional portfolio station where you were grilled on your CV and portfolio in person with questions like "why should we choose you?". They might bring back in-person interviews back at some point in the future so it's worth being aware of this but the format and scoring is fundamentally the same.
The online interviews were felt to be more cost effective and efficient but as they're shorter and you don't switch stations like in an OSCE there is more opportunity to mess up and break rapport with the interviewers meaning it's even more important to prepare.
How is The Interview Scored?
Your total score will be a combination of MSRA (10%), verified evidence score (30%) and your overall interview score (60%).
The interview itself carries the most weighting so don’t worry if you don’t score highly on the MSRA or self-assessment as you can still make it up with a good performance at interview which is why it so important to prepare well.
As you can see from the scoring breakdowns each interviewer scores a certain criteria out of six for the management and clinical stations with scoring systems mapped against the person specification.
How Should I Prepare For The Core Surgery Interview?
The competitive national selection process can be daunting and knowing where to start and organising focused practise can be difficult. The best way to ensure success is to practise as many core surgery interview questions as possible and to ensure you understand each of the core surgery interview stations in detail.
Understand the application (and prepare early)
So hopefully this video has helped cover most of the key components of the application and the scoring. Using reverse planning and ticking off the self-assessment sections early is absolutely essential. The self-assessment section counts for a third of your overall interview mark and it's scored before you even get into the interview. To do well at the self-assessment section you need to score well in each of the nine sections, aiming for the highest level of evidence in each section.
Treat the Interview Like an Exam
The core surgery interview will likely be your first proper job interview since you actually applied to medical school. Having coached thousands of doctors the people who do the best are the ones who treat the interview like an exam and spend time preparing for each section using books, courses and practising with colleagues.
For the clinical scenario this means going over your MRCS notes and practising questions on common conditions and emergencies. You need to be practising realistic questions and practising under realistic conditions which means lots of mock interview practise. For the management section you need to practise your presentation and then work through management questions of which there are a limited amount.
Optimise Your Interview Technique
In addition to making sure the content of what you're saying scores points it's also important to work on your interview technique which is a skill in itself. Eye contact, speed and clarity of answers all contribute to how you're perceived at interview.
Things like speaking clearly, giving concise answers and not arguing with the interviewers comes from practising under interview conditions.
Core Surgery Interview Resources
The people who tend to mess up the interview are those who think "it's just a 20-minute online interview. I don't need to prepare for it." when in reality it's pretty important as your interview score dictates where you'll be spending the next two years of your life and affects your prospects of landing a higher specialty training post too so it's definitely worth spending time preparing.
Just like preparing for an exam there are a selection of books, courses and question banks to help you practise questions and optimise your interview technique. The more you can practise the better you'll get at interviewing and the calmer you'll be on the day.
So let's look at the most popular resources out there to help you to ace the core surgery interview.
Core Surgery Interview Books
The most popular book on Amazon for core surgery interviews is Core Surgery Interview. This features a selection of clinical and management questions for you to practise and is specific to the core surgery interview. There is also a new addition of the book out this year with more scenarios and updates for the latest interview format and I've popped a link down below in the description.
The other books that might be useful when preparing for the CST Interview are the books you used to prepare for the clinical management aspects of the MRCS Part B and also medical finals books like Complete Revision Notes For medical and surgical finals.
If you can try and get hold of the handbook for the Care of the Critically Ill Surgical Patient (CCrISP) course. This gives some nice algorithms and information for managing patients preoperatively.
Practise With Others
While books, courses and questions banks are an essential investment practising with others doesn't cost anything but it's pretty crazy how few people actually do it.
When preparing for the core surgery interview speak with core surgery trainees who have been successful and ask them if they could interview you and go through how their interview went. It's best to pick people who have been through the most recent interview sitting as they'll likely have the most up-to-date information and where possible try and do this formally where they time you to give as realistic practise as possible.
Core Surgery Interview Courses
The problem with practising with others is it can be difficult to set up practise sessions, especially if you don't really know the core surgery trainees at your hospital that well. While practising with peers is good you want to try and simulate the real interview as much as possible and this is where mock interview courses come in. With the core surgery interview now being online mock interviews are very accessible and there are a number of free and paid courses you can sign up to.
The most useful courses are those that put you in the hot-seat and give you a full mock interview and also allow you to observe others while receiving feedback from successful candidates.
The most popular Core Surgery Course which comes at the top of google after any paid searches is The Core Surgery Interview Course. The course is run by the highest scoring candidates from previous years and has a pretty insane pass rate as the course uniquely focuses on interview technique and gives you some hacks to be able to deal with any questions you might be asked. The core surgery interview course costs £277 which can be claimed back on study budget and is held in December and January each year to give you time to act on any feedback. The main advantages of paying for a course are that it most realistically simulates the real interview and unlike organising something locally or attending a free course the folks running the core surgery interview course have interviewed thousands of candidates and coached the top scoring candidates nationally so re really well placed to boost your interview technique and overall mark.
The Royal College of Surgeons Edinburgh also runs a paid interview course facilitated by consultants that costs £250 which is core surgery specific and worth checking out and some hospitals run local courses too but these can be quite variable in terms of the feedback you'll receive.
Regardless of which course you choose we'd highly recommend attending at least one mock interview course before the real interview as it could be the difference between getting your first choice job and location for the next two years and somewhere where you might be less happy or less well-trained.
Core Surgery Interview Question Banks
Finally, just like preparing for any exam, the best way to prepare for the core surgery interview is to practise as many questions as possible so that you cover most of the questions that might be asked at the real interview. While books and mock interviews will give you some questions there are also online question banks available featuring hundred of questions along with example answers to save you time and effort.
The largest and most popular core surgery interview question bank is Coresurgeryinterview.com has questions and example answers covering clinical and management stations and includes actual questions that have been asked at previous years together with a bunch of other resources. The idea here is you have a full set of questions you can practise by yourself or you can give to a housemate or colleague to quiz you on.
How Long Should You Prepare For The Core Surgery Interview?
You can get started very early by downloading the self-assessment scoring system in medical school so you know what you need to do for your portfolio and self-assessment. This helps to focus on picking up prizes, completing full audit cycles and essentially ticking as many of the points boxes as possible.
In terms of preparation for the interview itself, with the interview in March we'd suggest starting preparation in November to give yourself a solid 12-16 weeks of practise. Aim to do a few hours most days around work and then set up formal practise with successful CSTs and attend a mock interview in December or Jan. For most people we'd recommend spending 2-4 weeks familiarising yourself with the interview and organising your preparation and then 8-weeks doing a mix of solo prep and formal mock interviews and an interview course in December or January.
What Is The Core Surgery Interview Like?
The core surgery interview can be pretty scary as it's a pretty big deal in terms of your career.
Before The Core Surgery Interview
Just like an exam, make sure you book your interview slot early so that you get a mid-morning slot that is convenient and make sure you get a good night's sleep.
In 2022 the presentation was on leadership in surgery and try to make this personal talking about your own experiences of leadership to try not to bore the interviewers who would be hearing the same presentation from everyone on the day. The presentation goes very quickly and you should try and practise and practise so you arebang on time. The follow-up questions are then usually about your opinions on how leadership could be taught.
There really is no excuse to not score almost 100% on the presentation as it's given to you in advance. If you don't practise enough and run over or run too short you will absolutely kick yourself. If you are struggling the team at coresurgeryinterview.com also help you to nail the presentation at the courses and online. The Royal College of Surgeons also has an ebook they've published on surgical leadership which is worth a read, however I'd try and keep your presentation original and personal to help differentiate yourself from everyone else on the day.
For the management questions you'll usually be given a scenario where you need to think on your feet and use your judgement. For example you are the core training running a lumps and bumps list and some of patients have returned with superficial wound infections. This explores your knowledge of error reporting, surgical hygiene and surgical error root cause analysis.
Our top tip for the management station is to utilise frameworks like SPIES, CAMP and STAR so you have a structure to work through the scenario. Putting patient safety at the front of any answer is key and there are a limited number that can come up so jumping into books and question banks will put you at a huge advantage over people who don't prep for this section.
The clinical scenarios are typically a mix of acute presentations and post-operative complications. For example an upper GI bleed where you need to assess the patient in A&E and then a patient with a post-op arrhythmia secondary to an electrolyte imbalance.
Our advice here is to follow a safe, ABCDE approach treating life-threatening things first. The interviewers will jump in to keep you on your toes with quick fire questions and will push the best candidates so if you don't know everything that's fine provided you are safe and work to your limitations asking for senior help and support when needed. Remember the role of a core trainee is to identify unstable patients and initiate early management you aren't expected to take the patient up to theatre and talk through an operation.
Overall the interview goes very quickly and provided you have put in the effort and prepared you'll hopefully do very well. There is a huge difference between people who have spent time preparing for the interview and those that haven't and this is reflected in the range of scores.
So start early, practise as much as possible and invest study budget into your preparation to get your first choice job where you'll be for the next two years.