The journey towards achieving a Certificate of Completion of Training (CCT) in surgery requires a systematic approach. The first step is to qualify for entry into UK specialty training. This is done through the process of national post-graduate medical or specialty recruitment, a once-a-year event that awards successful applicants with a National Training Number (NTN).
To apply for this recruitment, one needs access to the oriel portal (https://www.oriel.nhs.uk/Web/), a centralized website for post-graduate medical training recruitment in the UK. The recruitment process is entirely merit-based, with applications scored against an objectively-determined matrix. Successful applicants are then ranked based on their numerical scores.
The key to success in this highly competitive process lies in a deep understanding of the requirements. Knowing what assessors are looking for can increase your chances of scoring highly and earning a training post. Be sure to do your research, connect with others in the field. With the right strategy, you can achieve this in your 1st attempt, even as an IMG.
Because there are typically more applicants than available training posts, getting into specialty training is highly competitive. The Health Education England website (https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios/2022-competition-ratios) has information on competition ratios for various specialties.
In order to be considered for specialty training you must have completed all UK foundation programme doctor competencies. This includes 24 months of clinical experience, 12 months of internship, and 12 months post-internship. A fully filled Certificate of Readiness to Enter Specialty Training (CREST) form (https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/foundation-competencies/certificate-of-readiness) can provide satisfactory evidence for IMGs. Consultants in your country of origin can sign this off. Alternatively, those who have taken part in a UK Foundation training program would need to provide a Foundation Programme Certificate of Completion (FPCC).
Subsequently, entry into specialty training can happen at two different stages: either as an ST1 (Specialty training year 1) /CT1 (Core training year 1) or at the ST3 level or higher. CT1-2 provides core training in your chosen field of specialisation. In surgery, this involves 4-6 month rotation through different surgical specialties. For the ST1 level, specialty exams are generally not required, although one must take the Multi-Specialty Recruitment Assessment (MSRA) (https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/general-practice-gp/how-to-apply-for-gp-specialty-training/taking-the-msra). Additionally, keep in mind that if you have more than 18 months of experience in a surgical field post-foundation training, you may be overqualified and ineligible to apply for core surgical training.
Take note that certain surgical specialties follow a “run-through” programme, which requires entry at the ST1 level. This includes Cardiothoracic or Neurosurgery surgery, though most programmes mandate completion of Core Surgical Training or its equivalent, followed by higher surgical training at the ST3 level thereafter.
There are four main requirements to qualify for ST3 training. First, relevant career progression/ experience must be demonstrated. This entails at least 24 months of experience in a surgical field, with 6-12 months of it in the intended specialty one is applying for (eg. General surgery if applying for general surgery). Second, proof of achievement of ST1/CT1 & ST2/CT2 level competencies must be provided i.e. core surgical training competencies or equivalent. This can be achieved by having a signed Certificate of Readiness to Enter Higher Surgical Training (CREHST form) (https://specialtytraining.hee.nhs.uk/portals/1/Content/Resource%20Bank/Recruitment%20Documents/Certificate%20of%20Readiness%20to%20Enter%20Higher%20Surgical%20Training%202021.docx). As an IMG, you can also achieve this in your home country. Third, successful completion of the pre-requisite specialty royal college examination (i.e. Membership of the Royal College of Surgeons (MRCS) in surgery) by the offer date is mandatory. Fourth, a full license to practice in the UK from the GMC.
Each specialty sets out individual, non-essential/desirable specifications as per their person specification (https://medical.hee.nhs.uk/medical-training-recruitment/person-specifications). To obtain a high rank in the recruitment process, you’ll not only need to meet the essential criteria but also attain all the desirable requirements. This can be accomplished by building a strong portfolio that showcases your achievements and experiences in surgical procedures, presentations, quality improvement (or audit), research publications, training/teaching, and leadership/management. Standing out is a function of only two variables: interview performance and portfolio score. The core of the book covers how to improve both of these variables.
When it comes to securing a post in General and Vascular Surgery, it’s important to stay on top of the recruitment process. This means being prepared well in advance of the national recruitment process, which takes place on the Oriel platform around November of each year.
To start, you’ll want to visit the Oriel platform and select your desired specialty recruitment. Once you’ve done this, make sure to subscribe for alerts so you’ll be notified as soon as the recruitment process begins. Missing this notification could mean waiting an entire year before you can participate again, so be thorough. It’s worth noting that General and Vascular Surgery specialty recruitment is led by the Health Education England London and Kent, Surrey and Sussex (LaKSS).
Once the application process opens, you’ll need to submit your initial application and relevant documents. The recruitment team will then longlist candidates who meet the eligibility criteria. Those who make the cut will be asked to upload evidence and perform a self-assessment based on set criteria. After this, the recruitment team assessors will review the application evidence and self-assessment scores, giving a final score based on a predetermined scoring matrix. Applicants who are unhappy with their score can appeal before a final decision is made.
Next, the recruitment team will invite a shortlisted number of candidates for an interview, depending on their capacity. The interviews are conducted remotely, with candidates scored according to individual performance. Before the interview scores are released, candidates are invited to preferentially rank regions/deaneries where they would like to train. About a month after the interview, the recruitment team will tally the scores and rank the candidates. Only the top candidates will receive an offer for a training position, depending on the number of posts available. Candidates’ preferences will be matched according to their achieved rank, and they will be offered a preferred location based on this.
To summarize, the application process for national training recruitment involves an initial oriel application, submission of documents, longlisting of candidates, uploading of evidence and self-assessment, review by assessors, shortlisting for interviews, remote interviews, final ranking and offering of training positions based on individual performance and preference. Being proactive and staying on top of the recruitment process is central for securing a post in General and Vascular Surgery. Stay up-to-date with notifications, submit a strong application and evidence, and perform well in the interview to increase your chances of matching with your preferred location.
The higher specialty training program typically spans 72 months. During the training one is required to pass the Joint Surgical College Fellowship Examination (JSCFE) and attain the Fellowship of the Royal College of Surgeons (FRCS), usually after ST6 level.
Once the CCT (Certificate of Completion of Training) has been earned, you may choose to pursue additional sub-specialty fellowship training for an additional 1-2 years.
As an International Medical Graduate (IMG), there are opportunities to apply for training positions in the UK provided the eligibility criteria are met. A strong performance in rankings coupled with relevant experience and qualifications will facilitate acquiring a desirable training post. However, it is advisable to have at least 6-12 months of UK experience before starting such training programs. This will give the IMG ample time to assimilate into the ethos and functioning of the NHS system and align with the expectations.
Figure 1: https://roadtouk.com/training-in-uk/training-overview/specialty-or-gp-training-residency-in-the-uk/