The Core Surgical Training Self-Assessment, commonly referred to as the ‘CST Portfolio’ accounts for 30% of an applicant’s points. The 2024 guide has just been released.
In this article, we demystify the portfolio, break down each section and explain how points can be maximised ahead of submission. The full portfolio can be found here.
General Advice
- Start Early
Candidates often start working on their surgical portfolios during Foundation Year, or even medical school. Projects, audits, publications etc. all take time. The earlier you start working on your portfolio, the better! - Get The Right Evidence
Each section of the CST portfolio carefully specifies the evidence required. Candidates must follow this to the letter. Marks are often deducted for candidates failing to include consultant GMC numbers on letters, for example. - Get The Basics Done First
If starting from scratch, we recommend locking in easier-to-reach points first, before reaching for the higher levels. For example, it’s far easier to present a poster at a regional meeting, and more valuable in terms of points, than spending time and money doing a PGCert. - Invest In A PDF Compiler
Collating and organising certificates can be difficult and time-consuming. Making the effort, however, can pay dividends; having a well-organised and clear portfolio will make it easy to mark and easier for examiners to score you points. One example of an inexpensive simple-to-use PDF editor is DocHub. - Patient Identifiable Data (PID)
No uploaded evidence should identify patients. This includes, for example, thank-you cards/letters from patients’ families. Hospital numbers are also an example of patient-identifiable data.
Operative Experience
Up to 8 points are available for involvement in surgical cases. These should be logged using eLogbook. Any case in which you at least assisted in can count towards the total. eLogbook is a free operative logbook which is required to keep track, reflect on and evidence your operative experience.
Getting to theatres can be challenging as a medical student or Foundation Doctor in some centres. Expressing interest and enthusiasm to senior colleagues (consultants and registrars) is often welcomed. We recommend taking the most of every opportunity, and don’t forget to log your cases! Finally, it’s not unheard of for doctors to stay late or come in on days off to gain operative experience; if you find yourself in this position, don’t worry, you’re not alone.
The evidence required for CST is as follows:
- Consolidation report (generated by eLogbook) for each speciality to include:
- The summary sheet of the consolidation report (detailing the number of procedures undertaken and the date range of the operations undertaken) needs to be
- This should be printed out and “validated” by a consultant.
- Validating comprises each sheet being signed by a consultant, including their
▪ Full name
▪ GMC number (or corresponding national medical registration equivalent)
▪ The date the consultant validated the summary sheet.
- How to generate your consolidation report is shown below
Surgical Conferences
Since covid, online conferences have become far more commonplace (e.g. on platforms such as MedAll). Any surgical conference, regional or national, hosted by a legitimate organisation (e.g. Royal College of Surgeons, a speciality surgical society, or any University or Medical School) is considered legitimate.
Signing up to College mailing lists, and keeping an eye on medical school and College social media pages are a great way to keep up to date with conferences, some of which may be cheap or free!
The evidence required to score maximum marks is as follows:
1. Copy of conference attendance certificate detailing:
1. Name of applicant
2. Name of conference
3. Organising body
4. Date of conference
5. Where appropriate detailing CPD points
Surgical Experience
Points for surgical experience are described in the table above. This is fairly self-explanatory and is likely to be amended in 2024. Seeking evidence based on 2023 guidance however is advised in case it remains the same.
A “Taster Week” is organised during Foundation Training, and is a week spent in a department where you are supernumerary and have opportunities to take part in and observe a variety of clinical activities in that particular speciality. This can be organised through your foundation school/ postgraduate coordinator.
Evidence Required For Confirmation of Surgical Elective
1. A signed letter/document on official letterhead by your educational supervisor including
a. The surgical placement and hospital
b. The dates undertaken,
c. Name of supervisor and their GMC no (or corresponding national medical registration equivalent)
Evidence Required For Confirmation of Surgical Placement
1. A signed letter/document on official letterhead by your educational supervisor including
a. The surgical placement and hospital
b. The dates undertaken,
c. Name of supervisor and their GMC no (or corresponding national medical registration equivalent)
Evidence Required For Confirmation of Surgical Taster
1. A signed letter/document on official letterhead by your educational supervisor including
a. The surgical department and hospital
b. The dates were undertaken
c. Name of supervisor and their GMC no (or corresponding national medical registration equivalent)
Quality Improvement / Clinical Audit
The marking allocation for Audit and QIP is outlined above. There is often confusion regarding audit and QIP which we will attempt to clarify below:
What is a clinical audit?
- Clinical audit is the process of comparing department practice against a gold standard guideline, ideally with the process including a step to improve practice and to demonstrate this by remeasuring. This is what is known as “closing the loop”. Practice can be re-audited regularly to ensure standards are complied with.
What is a quality improvement project?
- A quality improvement project (QIP) represents an intervention or process to improve, streamline or optimise an aspect of patient care or a clinical process.
- It is often performed in a Plan, Do, Study, Act (PDSA) cycle framework.
How to get involved with audits or QIPs?
- The best time to get involved with a surgical audit or QIP, is while working in a surgical department. Registrars and consultants will have projects on the go which they often will happily delegate to you.
- When you start work on a surgical job, we recommend asking your supervisor or registrars you work with what audits are currently being undertaken in the department, or whether you can run one yourself. Almost always they’ll be happy to help.
- Furthermore, they’ll be able to guide you on where the project may best be presented. Trainee or junior doctor conferences can often provide opportunities for poster or oral presentations. An example is the Association of Surgeons in Training (ASiT) national conference
Key information:
- For applicants to score 4 or more points they must have personally been involved in at least 2 cycles of the audit or quality improvement project. If your project has only completed a single cycle or you have only been involved in one of the cycles, then a maximum of 2 points can be awarded. If your project has not yet completed a single cycle no points can be awarded.
- A cycle refers to a round of data collection
- Full points can be scored by performing data collection, implementing an intervention to improve practice (e.g. a training session, posters, or workflow change), and measuring the data again, demonstrating an improvement, with findings then presented at a national meeting.
Evidence required:
- Copy of audit project presentation outlining scope and impact (findings and improvements achieved) of project
OR summary of the project detailing the scope and impact of the project.
- A copy of the audit presentation must be provided to allow for presentation point scoring.
AND a letter from the supervising consultant or QI/audit project stating the level of involvement to satisfy the requirements described in the table above.
The letter must be signed (can be a digital signature to reproduce a physical signature) and include
a. Consultant name and GMC number (or corresponding national medical registration equivalent
b. Date
AND (for presentation points only
- A letter of acceptance from the meeting where presented confirming
a. project title
b. presenting author
c. date
A copy of the meeting programme displaying the project and presenting author will also be acceptable.
Presentations & Publications
Publications and prizes are often the most difficult aspects of the portfolio to achieve – many candidates will not have maximum points in this area.
It’s important to note that a candidate can only score points across one row of the rubric; they cannot with 10 points for a prize and a first-author publication. For the first time in 2023, collaborative authorship was acknowledged as part of the CST portfolio, and this is often easy to complete by getting involved with national projects as a local data collector.
Key Tips:
- Start early
- Papers often take months or years to complete from conception to publication. Getting started with a project in Foundation Year 1, or medical school if possible, is therefore advised.
- Papers often take months or years to complete from conception to publication. Getting started with a project in Foundation Year 1, or medical school if possible, is therefore advised.
- Find a mentor
- Finding a senior colleague with experience in publications and research can massively help junior trainees get started with research. This can be as simple as saying to a consultant “I’m interested in surgery and research, are there any projects that I can get involved in?” Almost always the answer will be yes. If it’s not, don’t be discouraged; try again with someone else! Research is time-consuming, and having an extra pair of hands is often welcome for consultants and registrars.
- Finding a senior colleague with experience in publications and research can massively help junior trainees get started with research. This can be as simple as saying to a consultant “I’m interested in surgery and research, are there any projects that I can get involved in?” Almost always the answer will be yes. If it’s not, don’t be discouraged; try again with someone else! Research is time-consuming, and having an extra pair of hands is often welcome for consultants and registrars.
- Prizes
- Winning prizes is a terrific CV boost. One key tip to maximise your chances of winning an oral presentation or poster prize is to submit to less popular, regional or trainee-specific conferences. As a Junior, your research is unlikely to be able to compete with research from PhD candidates or practising surgeons at large meetings. However, your project may be niche or interesting enough to pick up silverware at smaller conferences, for example, those organised by Medical School Societies or Trainee Societies. The Royal Society of Medicine also has a very large and expansive catalogue of prizes to apply for.
- Winning prizes is a terrific CV boost. One key tip to maximise your chances of winning an oral presentation or poster prize is to submit to less popular, regional or trainee-specific conferences. As a Junior, your research is unlikely to be able to compete with research from PhD candidates or practising surgeons at large meetings. However, your project may be niche or interesting enough to pick up silverware at smaller conferences, for example, those organised by Medical School Societies or Trainee Societies. The Royal Society of Medicine also has a very large and expansive catalogue of prizes to apply for.
- PubMed ID
- Only publications indexed on PubMed, the authoritative repository for peer-reviewed research, will be accepted. Such publications are associated with a PubMed ID. Be careful therefore, when submitted to a journal, that it is in fact indexed on PubMed, otherwise, your paper will not be counted.
The evidence specifications for this section are lengthy; we recommend checking the document in full and reading carefully to ensure your evidence submitted is correct.
Teaching Experience
As you can see, the top marks go towards teaching delivered by leading a team, across a number of centres, and a number of sessions. Since COVID-19, online and distance learning has become far more commonplace, which is to the advantage of this category! Regional, and even national teaching programs are organised and hosted by trainee societies over Zoom, for example. Here are some ideas to score maximum marks in this area:
- Teaching Program via Zoom
- Take a topic that you’re interested, for example ENT. Setup a teaching program for your local Medical School and deliver online teaching to Medical Students in different hospital trusts on common ENT presentations and examination skills.
- Take a topic that you’re interested, for example ENT. Setup a teaching program for your local Medical School and deliver online teaching to Medical Students in different hospital trusts on common ENT presentations and examination skills.
- Surgical Skills
- Suturing workshops are always well attended by medical students. This could be expanded into a series of teaching sessions to include practical skills like nasal packing, managing emergencies or knot tying.
- Suturing workshops are always well attended by medical students. This could be expanded into a series of teaching sessions to include practical skills like nasal packing, managing emergencies or knot tying.
- Simulation
- If your hospital has a sim suite, they may be happy to help facilitate and teach skills using their resources. Given the interest in surgical simulation, collecting data on such a teaching session may inform a paper in the field of medical education.
Ensure you collect formal feedback, either online or on paper, to evidence your teaching and help improve your sessions.
Training Qualifications
Finally, up to five points are awarded for formal training in teaching. Qualifications in teaching, such as the PGCert, PGDip or MSc can be substantially time-consuming and expensive during Foundation Training. It is rare for CST applicants to score more than 3 in this category. We recommend only undertaking a qualification in higher teaching if (a) you have a genuine interest in medical education and (b) you have optimised other aspects of your portfolio. As you can see, a PGCert is only worth 5 points but requires a year’s time and money. This time may be better spent more economically in other areas worth the same or more points, for example, audit and QIP or gaining operative experience which is worth up to 8 points.
How to find a PGCert/Dip/MSc:
- UCAS website
- The UCAS website comprehensively indexes postgraduate degree opportunities, which can be sorted by in-person versus distance learning options
Conclusion
The CST Portfolio required prolonged and careful preparation. It’s vitally important to read the 2024 Self-Assessment carefully, ensuring the evidence you submit is correct. Collecting evidence is time-consuming, so start early. Taking the time and making the effort is worthwhile; it is the part of the application that you have the most control over and, assuming you have the correct evidence, can essentially guarantee points. Remember, not all candidates will have top marks in all areas. Focussing on the most valuable points areas (Audit, QIP and Presentations) is a great place to start, before moving on to other parts of the portfolio once you’ve satisfied the criteria in these areas.
The portfolio can be tedious and time-consuming, but ultimately rewarding. Good luck!
