Core Surgical Training Application Guide

Introduction

Core Surgical Training (CST) is the first step for doctors who aim to pursue a career in surgery in the United Kingdom. This guide covers the 2027 recruitment round, for posts starting from August 2027. CST is a two-year programme designed to give doctors the foundational skills needed for higher surgical training (ST3 onwards). The programme is highly competitive. In 2026 there were 4,975 applications for 720 posts (a ratio of 6.91), down from 5,399 applications for 630 posts (8.57) in 2025, so it is essential to understand the recruitment process and optimise every part of your application.

For the 2027 recruitment cycle (posts starting between August and December 2027), the process begins with the Multi-Specialty Recruitment Assessment (MSRA), followed by interviews that assess management, clinical capability and your portfolio. The MSRA forms the basis of the shortlisting score. You no longer self-assess your portfolio on Oriel: you upload an index page giving a letter (A to E) for each domain, and your portfolio is assessed at the interview. The interview is conducted online, and you are scored across two stations: management and clinical, and portfolio.

This guide walks you through each stage: key dates, eligibility, MSRA preparation, the interview, offers and preferencing, and how Medset’s CST course can help. For the detail of the portfolio domains, read our CST Portfolio Guide.

CST 2027 at a glance

What is Core Surgical Training?

Core Surgical Training (CST) is a two-year programme in the UK designed for doctors who have completed the Foundation Programme and wish to pursue a career in surgery. Throughout CST, trainees develop essential skills in surgery, patient management and leadership, which are critical for success in speciality training.

Overview and Outcomes

CST gives trainees the opportunity to work across several surgical specialities, gaining practical experience and skills for higher-level training. Trainees rotate through specialities such as General Surgery, Vascular Surgery and ENT, among others, which offers broad exposure to different areas of surgery.

Upon completing CST, trainees can apply for further training at ST3 in their chosen speciality. The programme also helps prepare candidates for the Membership of the Royal Colleges of Surgeons (MRCS) exam, a key progression requirement.

Improving Surgical Training (IST) in 2027

For 2027, NHS England has paused recruitment to Improving Surgical Training (IST) posts in England, and those posts are being offered as two-year Core Surgical Training posts. Wales and Scotland continue to recruit to run-through IST posts. In Scotland these are in General Surgery, Vascular Surgery, Urology and Trauma and Orthopaedics.

Type of Work and Opportunities

During CST, doctors perform a variety of clinical duties, including:

• Ward Work: Managing patients on surgical wards, handling post-operative care and participating in ward rounds.
• Theatre Work: Assisting in and performing supervised surgeries, gaining practical experience in surgical techniques.
• On-call Duties: Handling emergency surgical admissions, managing acute cases and responding to emergencies.
• Outpatient Clinics: Reviewing and assessing patients in surgical outpatient clinics before and after surgery.

CST trainees are also expected to take part in teaching, research and audit projects. These opportunities develop leadership and academic skills and enhance a portfolio, making trainees more competitive for higher surgical training. Some CST programmes also offer “themed” rotations, which allow trainees to focus on fields such as trauma, orthopaedics or urology, depending on their interests and future career goals.

Surgical Specialities Using CST

CST provides the entry pathway into several surgical specialities. These are the specialities that recruit via CST:

• General Surgery (leads to sub-specialities such as colorectal, upper gastrointestinal and breast surgery)
• Vascular Surgery
• Trauma and Orthopaedics
• Urology
• ENT (Ear, Nose and Throat) Surgery
• Plastic Surgery
• Paediatric Surgery
• Oral and Maxillofacial Surgery

Specialities That Do Not Use CST (Run-through Programmes from ST1)

• Neurosurgery
• Cardiothoracic Surgery
• Ophthalmology

CST Recruitment Timeline

The Core Surgical Training (CST) recruitment process is highly structured, with several critical stages between October 2026 and April 2027. Missing a key deadline can end your application. The timeline covers the application period, the MSRA, interview invitations, preferencing and offers. These are the key dates for the 2027 CST application cycle. NHS England says all dates are subject to change and that it will tell you through Oriel if they do.

Competition Ratios

Core Surgical Training (CST) is a competitive programme, and competition has risen sharply. In 2025 there were 5,399 applications for 630 posts, a competition ratio of 8.57. That compares with 3,384 applications for 645 posts (5.25) in 2024 and 2,539 applications for 609 posts (4.17) in 2023. Applications rose from 1,622 in 2016 to 5,399 in 2025, then fell to 4,975 in 2026, when there were 720 posts (6.91 applications per post, NHS England). CST in Northern Ireland is a separate vacancy (1,013 applications for 42 posts in 2026).

Source: NHS England Medical Hub, competition ratios. The Hub counts applications, not individual applicants.

2027 CST Application

Application Deadline

The application window for CST 2027 entry opens at 10 am on 22 October 2026 and closes at 4 pm (GMT) on 19 November 2026. All applications must be submitted through the Oriel Recruitment System, the central online portal for medical speciality applications in the UK. NHS England does not accept late applications, so submit well before the deadline. In 2027 you can submit no more than five applications per recruitment round.

During the application period you complete your personal details, education history and employment history, and provide the evidence needed for your qualifications and experience.

CST Longlisting: Eligibility Criteria

Before shortlisting, applicants must pass longlisting, which confirms that they meet the criteria in the CST person specification (2027). NHS England carries out most eligibility checks after the MSRA results are confirmed, which it expects to be in February 2027. The checks include:

• GMC Registration: You must hold full GMC registration at the time of application, and a current licence to practise on the date your post commences (posts start between August and December 2027). International applicants should check the GMC’s registration requirements.
• Foundation Competence: You must evidence foundation competence through current UKFPO or GMC-approved training, a Foundation Programme Certificate of Completion, or a Certificate of Readiness to Enter Specialty Training (CREST), which requires 12 months’ post-registration experience. Only the 2024 and 2027 versions of the CREST form are accepted. You must submit it at the time of your application: if you do not, or if it is completed incorrectly, your application is withdrawn.
• Experience Limit: You must have 18 months or less of surgical experience (whole-time equivalent, excluding foundation placements) at the advertised post start date. The limit stops candidates with extensive surgical experience gaining an undue advantage.
• Fitness to Practise: You must meet the standards in Good Medical Practice. If you answer yes to any fitness to practise question, you complete a declaration form through the support portal.
• Right to Work in the UK: You must be eligible to work in the UK.

Prioritisation. The Medical Training (Prioritisation) Act 2026 applies to this recruitment. NHS England takes priority status into account at shortlisting and says it cannot advise on the likelihood that applicants without priority status will be shortlisted, so do not rely on previous years’ interview numbers.

CST Shortlisting: The MSRA Exam

Shortlisting for interview is based on the Multi-Specialty Recruitment Assessment (MSRA), a computer-based test of the competences in the person specification, taken at a Pearson Professional Examinations test centre. For CST the 2027 MSRA window is Tuesday 5 to Monday 18 January 2027, and NHS England expects to confirm results in February 2027. After the results are released, NHS England says approximately the top 1,200 candidates will be invited to interview and to upload evidence for the portfolio station, and anyone who does not upload their evidence has their interview slot cancelled. The assessment is 170 minutes long (NHS England’s MSRA structure page) and has two sections:

1. Professional Dilemmas (PD)
   Duration: 95 minutes
   Question Format: Situational Judgement Test (SJT)
   Content: This section assesses how you handle professional dilemmas in the workplace. You are presented with scenarios commonly encountered in medical practice and asked either to rank the appropriateness of possible responses or to choose the most appropriate ones. It tests how you prioritise tasks, manage conflict and make decisions under pressure, within a professional and ethical context.
2. Clinical Problem Solving (CPS)
   Duration: 75 minutes
   Question Format: Matching questions (EMQs) and single best answer (SBA) questions.
   Content: This section tests your clinical knowledge across a wide range of scenarios. You diagnose, manage and plan treatment for patients with a variety of conditions.

2027 CST Interview Format

The CST interview for the 2027 application cycle is held online on the Qpercom video platform between Monday 1 March and Wednesday 10 March 2027. You book an interview slot on Oriel (first come, first served) by the deadline in your interview invitation. On the day, log in and click “choose” 10 minutes before your allocated time. You wait in a virtual lobby while an administrator checks your identity. Have photo ID (your passport or UK photo driving licence) ready, and be ready to show the whole room to confirm that you are alone.

The interview consists of two stations, each lasting 15 minutes. You rotate between them in any order.

1. Management and Clinical Station: 15 Minutes

This station has two panel members. You answer three questions in total: one management scenario question and two clinical scenario questions, with 5 minutes allowed for each. The scenarios are given to you during the interview, so you need to think on your feet.

Management Question (5 minutes)

You are presented with a management scenario that relates to ethical, professional or personal dilemmas commonly faced in surgery. It tests your ability to think critically and respond quickly.

Topics worth practising include:

• Conflict Resolution: Handling disputes, complaints or abuse from patients, families or colleagues.
• Capacity and Consent: Assessing capacity, obtaining consent and managing when a patient lacks capacity.
• DNAR Orders: When to consider them, how to discuss them with family and managing disagreements.
• Professional Conduct and Probity: Addressing concerns about colleagues’ adherence to GMC guidelines.
• Confidentiality: What stays confidential, when to share and the exceptions to confidentiality.

Clinical Scenarios (2 x 5 minutes)

The clinical questions test your clinical decision-making through two 5-minute scenarios. They replicate real situations in surgical training, such as managing common surgical cases or acutely unwell patients. You need to show sound clinical reasoning, judgement and the ability to form a management plan under pressure.

Clinical scenarios worth practising include:

• Managing a patient with acute appendicitis.
• Handling postoperative complications on a surgical ward.
• Treating a patient presenting with sepsis.

2. Portfolio Station: 15 Minutes

This station has three or four panel members. Before you join them, the interviewers review the evidence you uploaded. NHS England’s guidance gives both 10 and 15 minutes for this review. There is no self-assessed score on Oriel. Instead you upload an index page giving a letter (A to E) for each domain, and without the index page you score zero for the portfolio. You upload your evidence between Friday 19 and Wednesday 24 February 2027.

When you join, the station is made up of:

• A pre-prepared 3-minute presentation, followed by 2 minutes of questions on it
• Two portfolio questions of 5 minutes each, on two of your portfolio domains. NHS England says these are asked about the Patients, Partnership and Communication domain and the Colleagues, Culture and Safety domain.

NHS England’s pages do not say what the presentation must cover, and say you will be contacted with further information nearer to the interviews, so follow your interview invitation.

NHS England does not publish how the station’s 45 points divide between the presentation, the evidence and the two questions.

Tip: Whatever the presentation topic, choose two to four specific achievements rather than listing everything you have done. Leadership examples that work well include junior doctors’ forum roles, mess committee activity, rota coordination and involvement in national training organisations. Be ready to answer follow-up questions on every example.

Read our CST Portfolio Guide for a detailed review of this year’s portfolio changes.

Interview Scoring Criteria

CST Ranking, Offers and Preferencing

Your final score is made up of three components, combined into an overall selection score out of 100:

• MSRA score: 10%
• Portfolio station score: 45%
• Management and clinical station score: 45%

The two interview stations together make up 90% of your overall result, so a strong interview score matters most. In 2025 there were 630 CST posts. NHS England has not yet published the 2027 post numbers.

You rank your preferred posts on Oriel between 9am on Monday 8 March and 9am on Monday 22 March 2027 (subject to change). Your preferences and your final score together determine your offer. Initial offers are released by 5 pm on Tuesday 6 April 2027.

Post-Interview, Offers and Preferencing

• Initial Offer: Once you receive an offer, you have 48 hours from the time of the offer (excluding weekends) to accept, hold or decline it on Oriel.
• Hold Option: If you are offered a post but are waiting for a higher-ranked preference, you can select the “hold” option. The holding period is time-sensitive, and failing to respond in time could lose you the offer. The hold deadline is 9 am on Friday 9 April 2027.
• Upgrading: If you hold a post, you can be upgraded to a higher-preference post if one becomes available before the upgrade deadline, which is 4 pm on Wednesday 14 April 2027.

NHS England asks for references only after you accept an offer.

When setting your preferences, it is important to:

• Consider your rank. If you are ranked lower, putting only highly competitive posts first might reduce your chances of securing a place.
• Think about your future ST3 speciality. Decide which rotations are essential, which would be beneficial and which you would prefer to avoid.
• Decide whether you prefer district general hospitals or teaching hospitals. Teaching hospitals often offer more research, rarer conditions and CV-building opportunities. District general hospitals may give broader exposure to common conditions and a different skill set.

Available Posts

NHS England has not yet published post numbers for the August 2027 intake. Every region in England, plus Scotland and Wales, is listed as “to be confirmed” on the CST posts page . For scale, there were 720 CST posts in 2026 and 630 in 2025.

How to Prepare for CST 2027

Frequently Asked Questions

How is the CST final score calculated?

MSRA 10%, portfolio station 45%, management and clinical station 45%, combined to a score out of 100.

Is the CST interview online?

Yes. It is held on the Qpercom video platform, with an identity check before you start.

How many stations are there?

Two, each 15 minutes: Management and Clinical, and Portfolio.

When must the CREST form be submitted?

At the time you submit your application. A missing or incorrectly completed form means your application is withdrawn.

How much surgical experience can I have?

18 months or less, excluding foundation placements, at the advertised post start date.

Medset CST Interview Course

At Medset, our CST Interview Course has modules on the clinical stations, the management stations and the leadership presentation, with answer frameworks for each. A CST Mock Interview option adds a full mock interview with personal feedback.