Core Surgical Training Interview Guide

This article was contributed by Dr Sebastian Vaughan-Burleigh. He scored highly in his CST interview in 2022 and achieved a post in his desired specialty of general/vascular surgery. In this article, he explains the CST application and interview process including tips for maximising your chances of success.

The key to success in your core surgical training application is forward planning, preparation, and plenty of practice. Fortunately, the interview and application process are both highly standardised to make the process as fair as possible, which also means that they become more predictable. The portfolio station is an opportunity to guarantee a third of your points in advance, so maximising this section can have a big impact overall. This guide is an outline of the timeline, goals, and resources that you can utilise when you start preparing for and approaching your interview.

📋  Advance preparation – FY1 / year before your interview / medical school

Planning a timeline for your application is a necessity. CST applications open early in the academic year and your evidence needs to be ready by this point, meaning most of your opportunities will be during medical school and your FY1 rotations. By planning ahead, you can score highly whilst avoiding cramming all your projects in at the last minute.

Maximising your portfolio requires a realistic and strategic approach. Reading the criteria can be quite daunting when you realise you don’t have a PhD or higher qualification in teaching. However, there are many other very high-yield opportunities that earn you many more points and require far less time and dedication (for example a surgically themed QIP is worth twice as many points as a PhD). Some candidates may have taken time out to complete these but be realistic about what you can achieve in the timeframe.

A strategy for where you will gain more points is also important. On the same theme as before, if you currently have no audit or QIP then you have zero points in that section – one surgically themed QIP later and you have eight! A PhD will earn you four points, but you might already have an intercalated degree. In this case, a PhD only earns you one extra point, whereas a QIP earns you eight. Look at the person specification early and see which areas you are already strong in then focus on your weaker areas to balance things out.

Realistic goals include:

Pass the MRCS Part A: Allow for 6 months of preparation during your FY1 year, with fresh finals knowledge you will be in a good position to sit this exam.

Surgical courses (4 for max points): There are several more accessible and less costly courses as well as in person, more expensive courses such as Basic Surgical Skills. Each has its advantages.

Surgical logbook: Most (if not all) FY1 years will have a surgical rotation – get to theatre as much as possible. If you have attended a BSS course you are likely to be more comfortable assisting, which makes these points easier to gain.

Conferences (3 for max points): Maximise your efficiency by attending and presenting at the same conference!

Completion of a QIP: This must be two cycles and surgically themed for maximum points. Get involved early and ask around the department in your surgical rotation.

Presentations: There are often opportunities to be involved in projects waiting to be picked up in most departments – many of these lead to presentations and/or publications.

Leadership: Roles such as junior doctor forums, FY1 reps, and involvement in the doctors’ mess can score you points here.

Teaching: There is always opportunity to teach – ask medical students where gaps are in their knowledge or teaching, design a few sessions, and ask a consultant to supervise you.

The Medibuddy guide to maximising portfolio points provides a detailed breakdown of each section and this is an excellent place to start. It’s also a good idea to download the previous year’s person specification and set up a folder (physical and digital) for each of the sections with all your evidence. Collect evidence for anything and everything that you do at the time, no matter how trivial it seems – you will thank yourself for this when it comes to the next steps!

📋  End of FY1 – 4 months to application, 6 months to interview

At this stage you want to be tying up any loose ends and ensuring all your evidence is collated in one place. Until recently the portfolio station required a physical portfolio which you could be grilled on during the station. The online system now requires you to self-assess the points you have achieved in advance of uploading the evidence – it would be a shame to lose your hard-earned points because you have misplaced a certificate or forgotten to get a letter from a supervising consultant. Whether online or physical, having an organised and up to date portfolio minimises stress at a time when you have plenty of better things to be doing.

At this stage you can also plan your interview preparation strategy. Work out which type of resources you prefer, as there are many choices that you may find useful for the different stations. Resources include:

Question banks

✅  Allow practice, practice, and more practice.
✅  Often more up-to-date than books
✅  There are many of them, some more detailed and varied than others – the Medibuddy question bank is very representative of the interview and is updated every year.

Books

👉  Core Surgery Interview – The Definitive Guide
👉  Advice on how to structure your portfolio if you are stuck.
👉  Covers most of the core scenarios with model answers.
👉  Fewer clinical scenarios than other resources.
👉  ISC Medical Interviews
👉  Good model answers for management and leadership questions.
👉  Limited in clinical section due to less relevance to surgical interviews.

Courses

🧐  More expensive but can be very high yield.

There are so many resources out there that it can be hard to choose – find what works for you and go with that!

📋  Upping the intensity – 2-3 months to interview

At this stage it is reasonable to dedicate an hour a day to prepare, increasing this in the weeks approaching the interview. The interview itself is made up of four stations that each last five minutes – one management, one leadership, and two clinical.

👉   Leadership

The leadership station is a 3 minute presentation followed by questions relating to the topics you choose to cover. You will be given the title for the presentation around two weeks ahead of your interview. Prepare your presentation early and practice making it fluent, as you can guarantee what will be coming up for over half the station.

✅  You only have three minutes so an introduction, three core points, and a conclusion is probably the maximum reasonable content.
✅  Practice saying it aloud so that you sound fluent, but don’t become too rigid and sound like a robot.
✅  Ask others to listen to you run through it and quiz you afterwards and see what parts they focus on, then prepare some points for these questions as well.

For the presentation you can expect to be thrown straight into it when you join the interview online – don’t be put off. It’s reasonable to have a short introduction (15 seconds) as to who you are and what the topic is as this makes your presentation more rounded and gives you a second to get your bearings.

👉  Management

The management station is a single scenario lasting five minutes. It’s easy to neglect this station as there are fewer possible scenarios and the approach is less clearly defined. However, there are lots of phrases that the examiner will be listening out for, and it is good to be aware of the key buzzwords to use. There are lots of structures and frameworks that can help you with this, and it is worth learning these.

The majority of management scenarios covered will be familiar to you from situational judgement tests or similar exams. There are hundreds of resources available to cover these, but the Medibuddy question bank is comprehensive in its coverage within the scope of this interview.

👉  Clinical

This is the station most applicants will be drawn to spending the most time preparing for, which is reasonable given it is worth as much as the other two combined. Don’t get bogged down in the very fine details of any scenario, however, as you only have five minutes to cover from start to finish. Common themes include post-operative unwell patients, trauma calls, and acute pathology presenting to ED. Whilst this makes up a vast array of scenarios there are core approaches (A to E!!) that you will always need to offer up to the interviewer.

Useful resources include the ATLS and CCrISP manuals, online and textbook resources, and your senior colleagues. It’s important to practice set phrases, such as running through an A to E assessment, but don’t get too stereotyped and sound like you’re regurgitating the same thing for each scenario. For example, if you have a trauma patient you will likely mention the C-spine, how to immobilise it, and how this might impact airway management, which would be very reasonable – if you have a post-op patient with a fever it’s unlikely that they have a C-spine fracture, so don’t spend too long on it. Your senior colleagues will certainly highlight if you do this, so if you have the chance to practice with them it is worth taking!

A general approach to follow in preparing for any station could be:

✅  Gradually progress from theory and general principles to realistic timed practice
✅  Initially prepare from your chosen resources including your general structure to clinical/management/leadership questions.
✅  Fill any knowledge gaps you identify at this stage (there may be scenarios from a specialty that you have limited experience in).
✅  Streamline model answers from full sentence prompts, into bullet points, and eventually nothing.
✅  In the last month before your interview mainly practice unseen scenarios with your friends/colleagues.

Key points:

✅  Plan each step well in advance, giving yourself plenty of time to avoid extra stress.
✅  Be realistic and strategic about what you can achieve and how you earn your points.
✅  Perfect practice makes perfect.
✅  Don’t just practice on your own, as you can easily get into habits that you don’t notice.
✅  Friends will pick up on unnatural sounding pauses, overuse of certain words, or excessive “umming”.
✅  Utilise a wide variety of resources.
✅  Most importantly, use the resources that you find helpful.
✅  Work with your friends, colleagues, and anyone else who will listen to your endless different scenarios!
✅  Practice with your friends to become comfortable smoothly delivering prepared answers without sounding like a robot.
✅  Ask senior colleagues to do mock interviews with you, especially if they have been through the interview process recently.
✅  Remember – sometimes it can feel difficult to prepare with others who are in the same pool of applicants. You are competing with around 1300 shortlisted candidates for around 600 jobs, so there is virtually no competition with your friends. If you work together all of you are more likely to be successful in the process, and the benefits definitely outweigh any perceived competition.
✅  Finally, do things you enjoy!
✅  There is no point in taking on a long and difficult project in an area that you are not interested in. You may be better placed aiming to complete several smaller, achievable, and more interesting projects for you.
✅  A completed project earns you more points than one you don’t/can’t finish.

Good luck!

If you’re considering applying for CST in the upcoming round, we wish you the best of luck. We'd strongly recommend checking out the Medibuddy CST question bank. It’s a great resource which will help you improve your answers, focusing on both content and delivery.