Intended for healthcare professionals


How to apply successfully for an ST1 training post in cardiothoracic surgery

BMJ 2014; 349 doi: (Published 07 October 2014) Cite this as: BMJ 2014;349:g5987
  1. Philip J McElnay, ACF ST1 in cardiothoracic surgery1,
  2. Joseph George, ST1 in cardiothoracic surgery2,
  3. Joshil Lodhia, ST1 in cardiothoracic surgery3,
  4. Daniel Moffat, ST1 in cardiothoracic surgery4,
  5. Akshay Patel, ST1 in cardiothoracic surgery5,
  6. Shubhra Sinha, ST1 in cardiothoracic surgery6,
  7. Charlene Tennyson, ST1 in cardiothoracic surgery7,
  8. Michael Gooseman, ST1 in cardiothoracic surgery8,
  9. Sion Barnard, chair, Cardiothoracic Surgery Specialty Advisory Committee9
  1. 1Department of Cardiothoracic Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle
  2. 2Department of Cardiothoracic Surgery, Morriston Hospital, Swansea
  3. 3Department of Cardiothoracic Surgery, Hull and East Yorkshire Hospitals NHS Trust, Hull
  4. 4Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
  5. 5Department of Cardiothoracic Surgery, Heart of England NHS Foundation Trust, Birmingham
  6. 6Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth
  7. 7Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester
  8. 8Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield
  9. 9Cardiothoracic Surgery Specialty Advisory Committee
  1. pmcelnay{at}


Phil McElnay and colleagues explain how best to approach the new ST1 applications for cardiothoracic surgery

Specialty training (ST) run-through programmes have been used in a number of surgical specialties, including neurosurgery and trauma and orthopaedic surgery in Scotland. Although the third year of specialty training remains a current entry point for training in cardiothoracic surgery, in August 2013 the first intake of cardiothoracic surgery in the ST1 run-through programme began in their posts. This was the first year of a three year pilot programme, which is likely to be extended to four years and has been modelled on the successful neurosurgery programme that has run for seven years.

The application process for cardiothoracic surgery ST1 begins in late autumn when the online application form opens. Candidates who are successful after the shortlisting stage are invited to the assessment centre. Assessment usually takes place in January or February and is hosted by Wessex Deanery.

Structure of ST1 training programme

The run-through programme is eight years long (figure) and consists of three stages: initial (equivalent to core surgical training years 1 and 2), intermediate (ST3-6), and final (ST7-8).


Cardiothoracic surgery training programmes

There is a seamless transition from ST2 to ST3, with as much or greater exposure to cardiothoracic surgery as in the cardiothoracic themed core surgical training posts. Current ST1-2 programmes have between 12 and 18 months of cardiothoracic posts (including cardiac intensive therapy unit), with 6-12 months in other specialties.

Over the course of eight years, trainees can establish themselves within institutions and develop strong links with their trainers. A specific ST1-2 curriculum (similar to neurosurgery ST1-3 or the focused curriculum in the US integrated programmes) is yet to be developed. However, the Intercollegiate Surgical Curriculum Programme’s cardiothoracic surgical curriculum (2013) provides a list of early years competences for core surgical trainees that ST1-2 trainees can target. The run-through trainee would be expected to far exceed those early years’ competences, given the tailored nature of their programme. The scoring matrix for ST3 applications also gives an idea of the numbers expected of the top end of core surgical applicants, and these numbers should be easily reached by the run-through trainee. The indicative minimum number of workplace based assessments is similar to that in core surgical training, as is the requirement to attain membership of the Royal College of Surgeons to progress from ST2 to ST3.

Fellowships, subspecialty training, out of programme training (OOPT), or out of programme research (OOPR) are undertaken by many trainees as they progress through the intermediate and final years. Academic clinical fellowships are available when applying at ST1 or ST3 level.

Preparing in advance for the application process

The ST1 person specification for cardiothoracic surgery highlights exactly how each applicant will be scored. Academic prizes, audits, research projects, presentations, and attendance at cardiothoracic conferences are ways to demonstrate your enthusiasm both as an undergraduate and as a foundation doctor; medical school is the best time to explore the specialty. Self-designed special study modules, a “taster placement,” or a medical elective on a cardiac or thoracic surgical unit are ideal learning opportunities through which you can immerse yourself in the day to day life of a cardiothoracic trainee. By the time your placement is complete you should have equipped yourself with sufficient knowledge to answer the question, “Do I want to be a cardiothoracic surgeon?”

As a foundation doctor it may be beneficial to rotate in a cardiothoracic surgical unit, but there are very few of these posts in the country. Completing courses such as the advanced trauma life support course and the basic surgical skills course will prove useful in the online application process and during practical interview stations. A surgical log of all procedures emphasises clearly how the candidate maximises his or her time in theatre.

Shortlisting: successfully completing the application form

When it comes to completing the ST1 application form, the generic rules apply. Set aside plenty of time to construct your answers; complete the form in stages as there are many different facets; keep within the word limit; ensure the highest quality of grammar and spelling; and use your most powerful examples to illustrate your skill set.

Details of the ST1 application for cardiothoracic surgery are listed on the Health Education England Wessex website,1 which provides essential information including a person specification and the scoring matrix. It also has details on individual programmes including teaching schedules, consultant interests, and specialist areas. It is advisable to read the details of this carefully before submitting your application. The ST1 application for cardiothoracic surgery covers five areas, which are also used to generate the scoring matrix (see box 1)

The assessment centre

The assessment centre includes stations on communication skills, a situational judgment scenario, and objective structured assessment of technical skills (OSATS).

The communication skills station is a 15 minute assessment with a briefed actor. Candidates are given time before the station to read through the scenario, which will aim to emulate day to day clinical practice. There will be marks for your knowledge, but the emphasis will lie with your ability to listen, empathise, and simplify explanations using non-medical jargon, and to build a rapport in a potentially challenging situation. Before the interview, anticipate the possible scenarios and aim to have a broad structure to your consultation. This should include a prepared opening gambit and ascertaining the patient’s or relative’s understanding of the current situation and what he or she expects from this consultation. Most of the consultation should be split into gathering information before delivering information. This will prevent the interview appearing disjointed with the overuse of closed questions. If the scenario involves breaking bad news allow the patient some time to assimilate the information you have given. Before closing the consultation ensure the actor has understood the relevant information. Give yourself sufficient time to address further questions or concerns. Finally, provide the actor with a point of contact should they have questions following the consultation.

At the situational judgment scenario station you will take part in a verbal question and answer session with a panel of consultants during which you will be presented with a number of scenarios. One is usually a clinical scenario and others relate to issues in the workplace. The objectives of this style of questioning are to judge your clinical competences and your ability to deal with challenging situations. You should present a methodical, knowledgeable, and, above all, safe approach to assessing and treating an unwell patient or to dealing with a difficult workplace environment or individual. You will be assessed on your communication skills, leadership, teamwork, problem solving, and management skills throughout. Your body language and presentation styles will also be observed throughout.

The OSATS station assesses six separate surgical tasks using bench model simulators. This assessment has been extensively validated as a tool for evaluating technical skills in general surgery.234 For ST1 selection there are three skill stations designed to assess manual dexterity, economy of movement, and tissue and instrument handling. These skills stations are the same as those included in the skill sets learnt on the basic surgical skills course of the Royal College of Surgeons. The skills learnt on this course should be under direct observation in a simulation setting by senior surgeons who can provide valuable feedback on technique. Repetition of these skills in a simulation centre will improve both the efficiency and efficacy of the task being carried out. Attending theatre regularly under the watchful eye of a senior colleague is a great way of improving your skills, gaining valuable constructive feedback, and developing your theatre logbook.


Before the assessment centre candidates are requested to rank their preferred “unit of application” (that is, the deanery in which the candidate would like to train). Candidates who are deemed “appointable” for a post are ranked in order of their overall application score. In the past, results were released through the UK offers website around two weeks after the interview. Candidates are required to respond within 48 hours to accept, decline, or “hold” a post; they can hold or accept only one post across all specialties in the UK. Documents are collected centrally at the assessment centre, but the deanery to which candidates are appointed may request further documents, such as police disclosure documentation.

The application process for ST1 posts in cardiothoracic surgery is highly competitive. It is worth gaining clinical exposure in a cardiothoracic unit at an early stage and starting your preparation for a career in the specialty as soon as you decide it is what you would like to do (see Further information box).

Box 1: Sections of ST1 application for cardiothoracic surgery

  • Education—This is where you can discuss undergraduate and postgraduate awards, as well as listing higher degrees and diplomas; clinical electives and attachments (including student selected modules) can also be discussed here, particularly if done in cardiothoracic surgery or an allied field.

  • Research—Presentations, publications, and audit experience.

  • Personal and clinical development—Clinical courses attended, organisational and leadership experience, teaching experience, and a subsection called practical and psychomotor skills. This subsection gives the opportunity to describe extracurricular skills such as those gained through musicianship, sportsmanship, or the arts that can be applied to a surgical career.

  • Clinical experience—This area is primarily made up of surgical procedural and operative experience. Procedural examples include incising or suturing skin, appendicectomy, laparotomy, central venous catheterisation, laparoscopic surgery, fracture reduction, or hernia repair. The greater your experience level, the more points you will score on the application.

  • Personal statement—This section allows you to describe why you are choosing to train as a cardiothoracic surgeon and the attributes you possess that will ensure you have a successful career. A clear, well written statement illustrating maturity and insight with use of good examples will score the highest points.

Further information

  • OSATS—Martin JA, Regehr G, Reznick R, Macrae H, Murnaghan J, Hutchison C, et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Brit J Surg1997;84:273-8. This article was released by the national recruitment team and may assist with assessment centre preparations.

  • Society for Cardiothoracic Surgery in Great Britain and Ireland— The SCTS is the principal society representing cardiothoracic surgeons in the UK and Ireland. It provides information on key contacts including trainee representatives and consultants with major educational responsibilities. It also contains educational material that is of interest to the aspiring cardiothoracic trainee. Medical students are encouraged to attend the annual meeting and there is a dedicated poster session for them.

  • Trainee pages for the Society for Cardiothoracic Surgery in Great Britain and Ireland—


  • Competing interests: We have read and understood BMJ’s policy on declaration of interests and declare the following interests: none.


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