By Faheem Bhatti
In part 1 of this two-part blog post we covered what the surgical training pathway in the UK involves and focused on the application process for core surgical training (CST). In this blog we will review each of the nine components of the portfolio to highlight areas you can work on whilst you are still a medical student. The full portfolio scoring criteria on which this post is based upon can be found here:
1. Commitment to speciality - 20 points
There are 20 points available for demonstrating commitment to surgery. Of these, 16 can be secured whilst still at medical school (4 points are awarded for passing the MRCS Part A exam which can only be done after graduation).
Firstly, 6 points can be scored for involvement in 30 surgical cases. Whilst this might sound unachievable, if you spread these out over your clinical rotations, electives and student selected components, it is not as bad as it first sounds. Our main advice is to create a surgical elogbook (https://www.elogbook.org/) to record cases and to use as evidence of your involvement. Even if you don’t manage to log the full 30 cases, you will still score points and you will reduce the number of cases you need to find while you are a foundation doctor when opportunities to attend theatre can be scarce.
Secondly, up to 4 points are available for attending surgical courses and up to 3 points are available for attending surgical conferences. Whilst you are a student you are eligible for reduced rates for conferences and courses, and you may be able to secure additional funding from your University. The key thing is to keep your certificates of attendance as proof for your portfolio.
Some examples of courses to look out for are:
National Catheter Education Programme Free
Essential Surgical Skills for Aspiring Surgeons £95
AO Trauma Introductory Course for Undergraduates £67
Surgical Skills for Students and Health Professionals £99
A further 3 points are available for doing a surgical elective. This does not necessarily have to involve travel overseas and can be completed within the UK, if that is easier for you. Be sure to obtain a letter or certificate signed by your supervising consultant stating your attendance as without this you won’t be awarded any points.
2. Postgraduate degrees, qualifications and additional degrees - 4 points
If you happen to be at a university which offers an intercalated degree or a graduate student, you can score points for your extra degree. If not, there is no pressure to go out of your way to intercalate or study for an additional degree as this can be costly and take several years, but will only gain you a maximum of 4 points (awarded for completing a PhD). Given there are many more points which can be scored from much easier and cheaper activities, we would recommend exploring these before looking to complete additional degrees.
3. Prizes and Awards - 6 points
Up to 6 points are available for prizes depending on whether it is from a national, regional or local organisation. Prizes can be won for a variety of competitions including essay competitions, best poster awards, best oral presentation awards etc. Often separate prizes are given for students so you aren’t having to compete against doctors who have graduated! Alternatively, 6 points can be obtained by achieving a distinction in your undergraduate studies.
This can be a hard section to score highly in but by entering several competitions, you increase the chances of winning a prize. Keep a look out for national competitions held by surgical institutions on their social media pages.
Here are some institutions which offer essay competitions:
British Orthopaedic Association
Royal College of Surgeons England
British Association of Urological Surgeons
British Association of Plastic Reconstructive and Aesthetic Surgeons
4. Quality improvement and clinical audit - 8 points
A total of 8 points are available for involvement in quality improvement or clinical audit projects. This is a big section and one which you can definitely start working on whilst at medical school. In order to score the full 8 points, you need to lead the audit, complete at least 2 cycles and have presented the audit at a minimum of a local meeting. Whilst you are at medical school you will have many opportunities to get involved in audit work via your clinical placements or student selected components. Bearing the scoring criteria in mind, it can be useful to speak to your supervisors in advance about your interest in leading an audit so you can devise a project which can run for at least two cycles and involves a manageable amount of work from you. Given there are so many different aspects of the CST portfolio it’s important to avoid duplication of work, thus instead of signing up to collaborate on lots of audits but not leading your own, it might be better to collaborate on one to learn the audit process and then invest a bit more effort on leading your own project to secure the points. This is something to bear in mind for all of the portfolio sections. In some cases you can also try to use an activity to gain points in two sections of the portfolio for example if you complete your audit and present it at a conference you can use the fact you attended that conference to score commitment to specialty points as well.
Here’s a video which delves further into the process of clinical audit:
5. Teaching experience - 10 points
Teaching carries a large weighting in the CST portfolio with 10 points being available. Opportunities to get involved with teaching whilst at university are abundant and by being regularly involved in teaching (providing at least 4 sessions per year) you will gain 4 points. In order to claim these points, be sure to have evidence of feedback from your students. We would recommend investing some time setting up your own feedback forms on google forms or an alternative platform as you can use these in any of your teaching endeavours and keep your own log to put into your portfolio.
To score either 6 or 10 points you have to organise your own teaching programme which is defined as a series of at least 4 sessions at a local or regional level respectively. This requires more work but is definitely achievable if you proactively look out for opportunities. Potential leads could be speaking to a mentor or a lecturer at the university and expressing your interest in leading a teaching programme or working in partnership with a student-led society e.g. running a surgical skills course in partnership with your surgery society. Alternatively, if you identify a gap in curriculum you could work with your peers to put together your own teaching programme and advertise it on social media.
6. Training in teaching - 4 points
To gain 3 or 4 points here, you would need to do an additional qualification such as a Masters or PGCert in medical education respectively after you graduate from medical school. If you are passionate about teaching this might be something you want to plan ahead for. Part-time, online PGCerts allow you to complete the qualification whilst working as a foundation doctor but require a significant time commitment and can cost between £3000-5000. Some deaneries offer their doctors the opportunity to complete a PGCert for free so this is another opportunity to look out for.
Without committing to an additional qualification, you can still secure 2 points for having ‘substantial training in teaching methods’ which is defined as at least 5 days of training. One scheme which would satisfy this is the online ‘Train the Healthcare Trainer’ course which costs £54 and can be completed in 5 weeks with 5 hours of study each week. This is a time and cost effective way to score 2 points without investing the additional resources required for a PGCert or Masters level qualification.
7. Publications - 6 points
Most medical schools will offer students an opportunity to get involved in some form of research in a field of their interest. This is a great opportunity to secure points for your portfolio. Whilst leading your own project can seem daunting, you can secure points by contributing to a publication that is led by someone else. This year, 3 out of a possible 6 points can be gained by being a named co-author on a publication. From our experience it is very important to be upfront with your supervisors about what you would like to achieve from your research block, i.e. your interest in getting involved with research and contributing to a publication, and to set a clear plan for what work you will be doing. Choosing a supervisor is also critical, ideally you want to work with someone who has worked with medical students in the past and has a good track record of getting their work published. By doing these two things you will boost your chances of success and avoid wasting your time on poorly planned projects without adequate guidance.
In order to gain the full 6 points on offer for publications, you would need a first author publication (excludes case reports or editorial letters). This requires significantly more work than gaining a publication as a co-author but with a good mentor is definitely achievable. One strategy is to initially begin by collaborating on a research project as a co-author to develop your understanding of research methodology and then embarking on your own project where you can draw upon your prior experience. Systematic reviews are a great way to publish your work and there are many useful resources which guide you through conducting one.
Beyond supporting your application, getting involved with research can allow you to work closely with consultants and registrars in your specialty of interest, who could mentor and support you on your journey to becoming a surgeon!
8. Presentations - 6 points
For presentations, there are 6 points available. To score 6 out of 6 you are required to give an oral presentation at a national or international conference. To score 5 out of 6 you need to be first author of 2 posters presented at national or international conferences (does not require oral presentation of work). You can also score points from presenting at regional conferences or by contributing to posters or presentations which others deliver.
At first the thought of needing to present or have a poster accepted to a national conference can be intimidating, however if you are already working on a publication, the results you have obtained can be used as the basis of your oral or poster presentation. Similar principles apply as to those mentioned in the ‘Publications’ section and a good senior supervisor or mentor can go a long way in helping here.
Poster presentations are relatively straightforward to obtain with most national and international conferences having plentiful space for submissions. The key is to identify suitable conferences early, note the deadlines for submission and then prepare and submit your abstracts wherever you can. Oral presentations can be harder to come by as there are fewer slots available at conferences for these, but can be achieved with perseverance in applying and tactful conference selection.
As a student you will be entitled to reduced conference entrance fees and by attending the conference you will not only gain points for presenting, but also a certificate of conference attendance which can be used in the ‘Commitment to specialty’ section. Better still, most conferences award prizes for the best posters or oral presentations, so by presenting your work you also open up the possibility of winning a national prize which will give you even more portfolio points.
https://medall.org/ (to identify upcoming conferences)
https://www.asit.org/ (conferences for medical students)
9. Leadership and Management - 8 points
Depending on whether the leadership or managerial role is local (3), regional (5) or national (8), a different amount of points are awarded. A leadership or managerial role can be anything from a position on a medical committee, representative for a deanery or university or even a position on a charity or sports society. For example a position on the committee of a student led society at your university would score 3 points as a local role and being the representative of your region e.g. East of England for an organisation like the Association of surgeons in training (ASiT) would score 5 points as a regional role. Applications for these roles can be competitive so don’t worry if you can’t find a national leadership role immediately. If you can secure a local or regional role you can bank some points and use the experience you gain on that role to bolster your applications for a national position the following year.
In order to obtain your points you are required to provide evidence that you have had a positive impact in your role. Our advice would be to pick something you are passionate about, whether that’s a hobby or a specific area of medicine and surgery, that way you will have the motivation to be actively involved and produce a positive impact. Additionally, one of the interview stations is all about your leadership and management experience so these roles are very helpful for that too!
Useful links to committees to explore:
Hopefully this brief overview helps to illustrate how many of the portfolio points for CST can be achieved whilst you are still at medical school, reducing how much additional work you need to do when you are in foundation training. If you have any further questions feel free to get in touch!