Improve your ST3 application by making the most of your core surgical training

Plan your training

Think carefully about the balance between district general hospitals and teaching hospitals. Speak to current trainees. Every job will have its advantages and disadvantages, but district general hospitals often allow trainees the most operating experience. Teaching hospitals are good in other ways, but a higher proportion of cases may be complex, reducing the number of teaching cases shared between trainees.

Create opportunities

Make yourself the type of trainee whom people want to train. Ensuring the wards are safe, inpatients are stable, and new patients are seen and their consent obtained will get you noticed. Getting a copy of the list in advance will allow for preparatory reading. Knowing the theory and anatomy of an operation will allow you to take advantage of opportunities offered, be an effective assistant, and ask intelligent questions. Be prepared to stay late and come in on your days off.

Set targets

Set achievable targets over short time frames, and share these with your colleagues. Dividing up the training opportunities available at the start of a list can be useful if your boss is amenable. Try stating your learning objectives at the start of the list. For instance, you might say, “I noticed two laparoscopic cholecystectomies on today’s list. I’m really keen to improve my skills at introducing ports; do you think I would be able to do this for one of the cases?”

Record your cases. Keep an organised logbook as you go, as putting it off makes it a huge job. Phone apps such as elogbook allow you to record and upload cases directly to your logbook online.

Portfolio

Certain numbers of directly observed procedures, mini-clinical evaluation exercises, and case based discussions are expected. Check your local curriculum as deaneries differ. Aim for one or two assessments a week, with half of these being done by consultants. A 360 degree feedback assessment is expected once a year. Regular assessments show progress and save the stress before the annual review of competence progression. In addition to the compulsory assessments you are expected to have completed procedure based assessments, which give feedback on performed surgical procedures or parts of procedures. They are not compulsory at core training level; however, they are one of the best ways of showing progress and they provide objective evidence of improving surgical skills.

Courses

Attendance at courses is an excellent way of proving commitment to specialty. Three are essential (see box). Undertaking further courses—for example, endoscopy courses—can show subspecialty interest. Others may provide evidence of formal training and support your CV—for example, teaching and management courses. To save costs, ask to be an observer on a course; you will not be certified but will still show interest.

Exams

For most surgical trainees membership of the Royal College of Surgeons (MRCS) exam is mandatory for completion of core training. MRCS part A is a multiple choice and extended matching question exam. A grasp of general principles, often learnt on the job, is an important baseline. The volume of information may seem overwhelming, but topics are often repeated. Many banks of questions are available and these are a good revision aid, but an understanding of question material is far more important than pattern recognition. MRCS part B is an 18 station objective structured clinical exam. You are tested on four key areas: anatomy and surgical pathology, applied surgical science and critical care, clinical and procedural skills, and communication skills.

Revising in pairs can make it easier to prepare for the clinical parts of the exam. Senior colleagues may be able to offer some useful tips, and a wide range of resources are available, including courses, books, and anatomy DVDs. If you have access to an anatomy laboratory, use it. This is by far the best way to prepare for the anatomy stations during the exam. Remember that the exam is meant to reflect the day to day skills you use at work, and so nothing beats experience on the job.

For ear, nose, and throat trainees, exam requirements differ. All applicants need to have done the MRCS part A and diploma in otolaryngology—head and neck surgery (DO-HNS) part B. MRCS part B and DO-HNS part A are optional but may broaden your opportunities at ST3 level.

Our advice would be to attempt these exams early, as this allows for second attempts if necessary. Candidates with more surgical experience often perform better, and so rushing to sit the exam is not always advisable.

Teaching

Teaching is highly regarded at ST3 application. However, the key is to use a variety of styles and show adaptability by taking on different roles—for example, organising a teaching course or acting as faculty on established courses. This shows desirable qualities, such as leadership and time management. It does not always have to be a formal process. A teaching ward round can be a valuable experience for your junior colleagues. Collect feedback wherever possible, as evidence is key at interview.

Anatomy demonstrating is available to most core surgical trainees and may be compulsory. Use these sessions to your advantage. They are a great way of preparing for the MRCS part B exam, and lend a deeper understanding to the thought process when operating. Prepare for these sessions with background reading, and familiarise yourself with the pro-sections before sessions. Teaching courses and accreditations are available which provide an insight into how to deliver effective sessions. Formal teaching awards are recognised for ST3 applications.

Publications, presentations, and audits

Making time to develop your CV while working full time can seem overwhelming. To maximise your efficiency, our advice is to find out what scores points in applications.

Obtain details of the application mark scheme early, and plan your work to fit with the application. The mark scheme is very structured, so without forward thinking you may find you are not rewarded in the ST3 application process for your endeavours. In addition, ensure you have senior support as senior colleagues can suggest good projects, give guidance, and review your work for you.

Completing the audit cycle by auditing and re-auditing gains you maximum marks on most application forms. Select amenable projects where robust national or local guidelines exist. Have a clear goal. Often, simple projects dealing with a single issue are the most effective. Quality improvement projects are currently in vogue. These are audit-type projects aiming to improve a single issue by collecting data, implementing change, and re-auditing. Registering your audit with your local audit department is essential. A good audit should be worthy of presentation and publication.

Case reports are a good first step. These should report rare presentations, mistakes, or pitfalls made, or provide novel perspectives or treatment compared with published literature. Descriptions of the presentation, treatment, and outcomes are discussed, usually with a brief review of the literature. Before writing a case report, do a literature search to check what has already been published on the subject.

Literature reviews can be a good way to get published at the same time as studying a topic in depth. The hospital library may run workshops and can help source articles.

Ask your educational supervisor for ideas for research projects. Most large units have trials running, and you may be able to get involved with one of these.

Present your work wherever possible. Maximise the impact of work you have done by submitting it to relevant conferences and meetings. Presenting at national and international conferences earns important points on the application form. Conferences need submission of articles many months in advance, and attending a conference will require time off work for travel, so being organised is essential.