Applying to Core Surgical Training: My Experience

It’s that time of year again where doctors complete their applications on Oriel to embark upon the arduous process to get into surgical training.

Applying to surgical training is arguably one of the toughest and most gruelling application processes on the spectra of medical careers. Not only does it require a clear demonstration of dedication and commitment to surgery, but also an accolade of academic achievements above and beyond what would normally be expected of a medical graduate.

Unfortunately, as a result of the 2019 coronavirus (COVID-19) pandemic, this year’s application process comes with a twist: it’s all virtual.

When I completed my application this time last year, it was via the Oriel portal and involved a pre-interview portfolio assessment to hurdle over. Once I made it through this assessment and was situated amongst the top 1300 or so applicants, I was invited to interview in a swish looking building in Russell Square, London. This was an ordeal in itself comprising 3 stations lasting 10 minutes each, assessing my surgical portfolio, leadership experience and knowledge of surgical emergencies. I remember exiting the interview feeling exhausted and utterly convinced I hadn’t achieved a place on the Core Surgical Training (CST) programme.

Come March, however, the offers came through and I was pleasantly surprised and delighted to see a Trauma & Orthopaedic Surgery themed CST programme nestled in my offers section on Oriel (6 months General Surgery, 18 months Trauma & Orthopaedic Surgery).

My preparation for the interview involved at least 1 month of practice and reading, honing my knowledge of myriad surgical emergencies and learning my leadership speech off by heart, ensuring it was salted and peppered with just the right amount of personality. This segment of the interview is scrutinised on how well rehearsed the speech is, but not too much lest it be delivered like an automaton. I was fortunate enough to obtain some speeches from a couple of friends of mine who had already successfully interviewed and thus developed my speech in accordance with the prescribed question which was:

“Reflect on your experience of leadership when working as a team member and how this will be useful as a core trainee”.

This speech was intended to encompass all of my highest yield leadership experience within 3 minutes, give or take a few seconds for on-the-day nerves. I structured my speech as follows:

1. Leadership experience within medicine
   • Summarise by relating the experience back to CST

2. Leadership experience outside of medicine
   • Summarise by relating the experience back to CST

My final draft wasn’t complete until the 7 days leading up to the interview and it was only really at this point that I started to really knuckle down with the practise of the speech. Coming into the interview, I felt fairly confident with it. Yet, as I sat in the seat in front of the interviewers, my mouth as dry as an arid desert from nerves, I tumbled through the first paragraph of the speech like a bull in a china shop. I thought this was it. Suit, tie and a stern eye bore into me. Miraculously though, the cloud of nerves began to dissipate as I realised I was actually saying the words I’d practiced. I began to settle into the speech and reeled off the remainder with the intended level of pizazz I had practiced.

Once this was over, it was onto the next station: the portfolio station. This was an interesting station where my portfolio had already been scrutinised and scored prior to my entry into the station. A few things were picked out, such as my recent audit and what the results were (I couldn’t reel them off the top of my head – foolish move and one that I wouldn’t recommend – fortunately it turned out ok for me). The main thing, however, which I found to be the biggest challenge was when I was asked which surgical specialty I aspired to pursue. I answered Trauma & Orthopaedic Surgery… which was met with perplexed looks. This is because my entire portfolio was full of experience geared towards a Neurosurgical career. All my top scoring teaching and leadership experience was either Neurology or Neurosurgery oriented. I only had certificates from just one or two orthopaedic courses. On reflection, I think this is the question that threw me the most; you’d think I’d have prepared for it but I genuinely had assumed my portfolio would be scored based on gross content and nobody would care which specialty it was tailored towards. Naturally, this assumption was wholly misconstrued and I should have at least had some coherent answer drafted and stored in my brain.

The final station was the clinical scenario. I think this was by far the most challenging station for me, although ironically not my lowest scorer. It’s always so arbitrary to discuss hypothetical scenarios in an office-like setting with a single question looking for a single answer; in reality you know that you would have 10 hypothetically correct answers. My scenarios were along the lines of:

“You are called to a trauma call in ED. Please talk through what you would do.”

“You are called to see a young girl a few hours post uncomplicated appendicectomy who is pyrexial. What are your differentials and how will you manage this?”

Granted, these questions were relatively innocuous at face value. But after 2 other stations and the adrenaline from the day beginning to ebb in conjunction with a build up of brain fog secondary to mental fatigue, I suspect I resembled a fish out of the water. My mouth was moving, but no sound came out. Well, that’s an exaggeration, but nevertheless the words which did come out exited at what felt like a snail’s pace. When racking my treacle brain for an answer to “so, what’s a complication of flail chest then?” my brain’s reply was to go into existential overdrive:

“Did I even go to medical school? It’s all been a lie, they’ll find out – who even am I?”

Etc.

As I walked out of the building, I felt a wave of fatigue hit me as the last few nanoparticles of adrenaline with which I’d arrived in London that morning faded away. Up until this point, the stress of the interview had been fuelling me on a daily basis, spurring me on like a rag soaked in dopaminergic kerosene. With the endpoint now in the past, I felt almost at a loss, like the energy had been stubbed out. This wasn’t helped by the nagging voice in the back of my mind which kept telling me I’d failed the interview. The interesting thing was that no matter how much preparation I had done for the interview, the only way I felt I could have improved was to have done the interview before. It was purely the aspects that were specific to the day itself which proved to be the biggest hurdle.

So that, in a not-so-nutshell-sized nutshell, is my experience of the CST interview. I’m not sure if I would want to do it all again (jokes on me, ST3 is waving from the not-so-distant future), but I do feel I’d at least be familiar with the process, which would be a sure-fire advantage.

Look out for the next CST related post on things I wish I had known before applying for surgical training; otherwise feel free to drop me a message if you have any questions.

Here are some slides from a recent webinar workshop I delivered for Scalpel, the University of Manchester’s undergraduate surgical society, which contain some photos from my portfolio in relation to the current CST portfolio scoring guidance. Good luck if you’ve applied this year!