Core surgical training: an interview guide for entry in 2016

What is core surgical training?

Core surgical training is a two year programme in the generality of surgery, designed to provide a broad range of experience in a number of surgical specialties. It is not specialty specific run-through training in disguise, so trainees can expect to do specialties complementary to their career preference. Core surgical training can open the door to many careers and does not necessarily have to lead to one specific in surgery; it is a suitable basis for trainees wishing to enter radiology, emergency medicine, or general practice.

Who can apply for core surgical training?

Among other criteria, trainees wishing to apply for core surgical training must:

• Have 12 months’ experience after full General Medical Council registration

• Be in current employment in a UK Foundation Programme Office affiliated foundation programme

• Have less than 18 months post-foundation years’ experience in surgery

• Not have previously held a core surgical training post.

Up to date entry requirements and person specifications are at www.surgeryrecruitment.nhs.uk or www.oxforddeanery.nhs.uk/pdf/2015-PS-CST-CT1-1-0.pdf.

How many core surgical training posts are available?

The number of core surgical training posts has declined in recent years, showing a drop of 13% from 2012 to 2014 (see table⇓) with a relative increase in the number of applicants from 1295 to 1370. This has increased the competition ratio from 1.9 in 2013 to 2.2 in 2014.1

How do I apply for core surgical training?

Up to date information about the national selection process for core surgical training is available at www.surgeryrecruitment.nhs.uk, and this should always be consulted for accurate information.

Recruitment into core surgery has been a national process since 2014. This has allowed a standardised and quality controlled process to be developed, ensuring that the selection process is fair and unbiased. Other advantages to the national process include the ability for applicants to be considered for a wider choice of rotations to suit their particular interests rather than being limited to a rotation in a particular location. All applications, invitations to interview, and job offers are made using a secure online system. The national recruitment process is constantly being evaluated and refined and is therefore subject to change from year to year.

Advertisements for recruitment are published in November of the year before the start of training, with the closing date for online applications usually in December. A screening process is used to ensure that candidates are eligible for interview (this may be a self scoring online system), and then invitations to interview are generated, usually in December. Most well prepared applicants will get through this part of the process.

Interviews are held in a recruitment centre in London over a two week period at the end of January. The interview panel consists of surgical consultants from around the United Kingdom. Offers are sent out in late March, with clearing in April or May.

What is in the application form?

The online application form has four sections. Each must be filled in carefully to avoid failure at the longlisting part of the process. These sections include:

• Personal details

• Eligibility—proof of foundation competencies, fitness to practise, employment history, and references

• Surgery specific information—commitment to surgery, including audits, presentations, publications, and teaching; and a 150 word “white space” section on suitability for core surgical training. Each stand alone piece of information can lead to questioning during the interview itself; it is imperative that candidates have physical proof of all qualifications or experience stated

• Equality and diversity.

What happens at the interview?

The interview takes place in London. You will be invited to select an interview from a number of sessions spread out over a two week period. It makes no difference to the outcome whether you select an interview at the beginning, middle, or end of the fortnight or the time of day you choose. There is a rigorous quality assurance process that ensures the interview experience is identical for all candidates.

On arrival at the interview centre you will be directed to a document checking area and then to a waiting room. A number of parallel interview sessions take place at any one time, so make sure you know which interview circuit you should be attending. At the document check, basic identification details and eligibility for interview will be confirmed. The waiting room will have some refreshments and is a place to relax and prepare mentally.

The interview process is always under modification, reflecting candidate, interviewer, quality assurance, and lay feedback, plus statistical analysis of previous interview data. This information is therefore given in good faith but may be subject to change in 2016.

There are usually three or four stations at the interview: portfolio, clinical, and management are the standard stations, but other stations have been piloted in the past and others may be tested in the future. It is important to note that a pilot station will not be counted in your score but should still be viewed as an important professional challenge. Pilot stations in the past have included technical skills and communication skills, and these may be added to future interviews as part of the marked process.

Each station lasts 10 minutes, with a three minute rest station in between, totalling 40 minutes. Every station has two interviewers, each of whom will present a stem and a series of questions designed to last five minutes. Seventy two marks are available for each station with a total of 216 marks available overall. It should be noted that there is a cut-off score of 136 marks (or 62%, subject to slight yearly variation guided by statistical analysis), whereby any candidate below this score will not be deemed suitable for core surgical training.

Other marking elements may be used in assessing suitability, such as the modified Angoff method or a weighting being given to the clinical station, and this means that there is no guarantee of success even if the candidate scores a total mark above the cut-off. An example of this might be if the interviewers deem an answer to have shown unsafe practice.

The station details are listed below. Plenty of books on how to prepare for these interviews are available, though ultimately it comes down to having a structure in your mind on how to answer questions and being as safe a clinician as possible.

The management station

Management questions deal with clinically related ethical and logistical issues common to surgical practice. Examples may be dealing with ethical dilemmas, communication situations, legal and moral obligations under General Medical Council guidance, leadership, and time management. This station is designed to see how you think and relate to the wider world of working in the NHS.

There may be a presentation, prepared in advance, as part of this station (this is under consideration and, if included, will be publicised) and then a scenario to answer under some pressure, with a series of structured questions.

The portfolio station

You will be asked to prepare and bring a physical portfolio to interview. The portfolio will be given to the interviewers on the day of the interview but in advance of your actual portfolio station, so that they have time to go through the documents and understand the evidence that you are presenting before you come in.

Interviewers are looking for particular types of evidence in your portfolio so that they can give you a score. You may be asked to show this evidence if it is hard to find. You may be asked questions relating to any of the items in the portfolio—this may be to clarify uncertainties or to allow your answers to add more depth to the information presented. Questions may be broad and non-specific and test your initiative, organisation, and integrity.

Compiling a portfolio is a lengthy task that should not be taken lightly. You should think about and plan your portfolio for weeks, potentially months, in advance. You will be given a standard portfolio checklist and you must keep to this structure so that interviewers can find your information in an efficient manner. However, your portfolio should be viewed as an opportunity to showcase initiative, organisational skills, and perhaps even flair.

In 2015, there was a two minute introductory leadership presentation at the beginning of this station. If repeated, this should be used as an immediate opportunity to tick as many boxes as possible by applying previous experiences, both clinical and extracurricular, into potential future positives that can be brought to the core surgical training experience. As already stated, it is vital that this can all be seen within the portfolio itself, and future applicants should be aware of this new feature of the interview to prepare adequately.

The clinical station

While waiting outside the room, you will be given a clinical scenario to prepare. The scenarios will be from a range of thoroughly piloted situations that a core surgical trainee may be expected to deal with on any given day. On entering the room, you will be asked structured questions by the interviewers, testing not only knowledge on common topics but also general, non-technical skills. After five minutes, there will be a knock on the door, and the interviewers will ask a different question (even if they have to interrupt you to do so), and this will require you to think “on your feet.” As stated above, it is possible to be unsuccessful at interview on this station alone; it is therefore important to prepare thoroughly with a structure in mind as to how to answer questions methodically and safely.

How do I know the recruitment process is fair?

A rigorous quality assurance process is in place. The whole recruitment process, from application form, through question setting, to interviews and offers, is overseen by independent and experienced lay people as well as surgeons, deanery staff, and independent statistical experts.

All interviewers have to undergo identical training in the interview process each year and must be up to date with their equality and diversity training.

During the interview itself, there may be observers sitting in some stations (clinical or lay observers); they are there to ensure that the process is fair and that the interview experience is identical for candidates, no matter which circuit they are on at any time. They are not there to mark the candidates.

What happens after the interview?

All successful candidates are ranked by their overall score. Candidates are then offered places depending on their score—a higher ranked trainee will be offered their choice of place above a lower ranked trainee. Offers are made until the training posts run out.

Trainees may choose to accept, hold, or reject an offer. An offer may be held for a specified period of time before a decision has to be made. Trainees may also decide to apply for an upgrade in the hope that a preferred post becomes available.

If posts are still left at the end of the offer process, then further rounds of offers may be made to lower ranked candidates until all the posts have been taken.

Summary

Many applicants for core surgical training will be in their foundation year 2, although only just. The early advertisement represents a challenge for the candidate to be sufficiently organised to be able to put together a competitive application. It is advisable for potential applicants to be familiar with the above process and get any forms and evidence they need to be ready in ample time. It is also advisable to ask any current or past core surgical trainees, including your registrars and consultants, to check over any forms and provide interview practice. Several courses are available around the UK, both paid and free, which can be accessed by all potential applicants, and it is certainly beneficial to go on one of these courses to give yourself as good a chance as possible at the interview.