Core Surgical Training Application Guide 2025

Introduction

Core Surgical Training (CST) is the first step for doctors who aim to pursue a career in surgery in the United Kingdom. It is a two-year programme designed to provide doctors with the foundational skills necessary for higher surgical training (ST3+). The programme is highly competitive, with over 2,500 applicants for around 600 posts each year, making it essential to understand the recruitment process and optimise every part of your application.

For the 2024/25 recruitment cycle, the application process begins with the Multi-Specialty Recruitment Assessment (MSRA), followed by interviews that assess management, clinical capabilities, and portfolio achievements. The MSRA is used as the shortlisting tool, and for 2025, the focus has shifted from self-assessment of the portfolio to portfolio-based interviews. The interview is conducted online, and applicants are scored based on their performance across three stations: management, clinical, and portfolio.

This guide will walk you through each stage of the application process, including key dates, eligibility criteria, MSRA preparation, interview tips, post-interview handling, and how Medset’s CST course can help you prepare. By understanding the full recruitment pathway, you can prepare effectively to maximise your chances of securing a CST post.

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 aims to give trainees the opportunity to work across multiple surgical specialities, gaining practical experience and skills that will be needed for higher-level training. During the programme, trainees rotate through different surgical specialities, such as General Surgery, Vascular Surgery, and ENT, among others, offering them broad exposure to various 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.

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 engage in teaching, research, and audit projects. These opportunities develop their leadership and academic skills and enhance their portfolios, making them more competitive for higher surgical training positions. In addition, some CST programmes offer “themed” rotations, which allow trainees to focus on specific fields like trauma, orthopaedics, or urology, depending on their interests and future career goals.

Surgical Specialties Using CST

CST provides the entry pathway into multiple surgical specialities. Below is a comprehensive list of 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 (can recruit at both ST1 and ST3, depending on the region)

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 2024 and March 2025. Understanding the timeline is essential, as missing key deadlines can result in a failed application. The timeline includes the application period, the MSRA exam, interview invitations, and post-preferencing offers. Below is an overview of the key dates for the 2024/25 CST application cycle.

Competition Ratios

Core Surgical Training (CST) remains a competitive programme in the UK, with an average competition ratio of 4:1 over the last few years. For 2023, the ratio was 4.17, meaning that for every four applicants, only one was awarded a post. Although the CST competition ratio ranks 11th among CT/ST1 specialities in 2023, it is still a significant challenge due to the increasing number of eligible candidates. This upward trend is reflected in the growing number of applications, which has risen from approximately 1,600 in 2016 to over 2,500 in 2023, while the number of available posts has remained relatively stable.

2025 CST Application

Application Deadline

The application window for CST 2025 will open on 24 October 2024 and close on 21 November 2024 at 4 pm GMT. All applications must be submitted through the Oriel Recruitment System, the central online portal for medical speciality applications in the UK. Late submissions will not be accepted under any circumstances, so submitting your application well before the deadline is crucial to avoid technical difficulties.

During the application period, you must complete your personal details, education history, and employment history and provide any necessary evidence for your qualifications and experience. Once your application is submitted, you cannot edit it after the closing date.

CST Longlisting – Eligibility Criteria

Before progressing to the shortlisting stage, applicants must pass longlisting, which ensures they meet the basic eligibility criteria for CST. The longlisting stage verifies key aspects of your application, including the following:

• GMC Registration: Applicants must either already hold full GMC registration or be eligible to receive it before starting CST in August 2025. International applicants must ensure they meet GMC requirements and provide evidence of their qualifications and English proficiency.
• Completion of Foundation Competencies: You must have completed the UK Foundation Programme or have equivalent competencies. For those who have not undergone UK Foundation training (such as International Medical Graduates), you must submit a completed Certificate of Readiness to Enter Specialty Training (CREST form) signed by a supervisor who can confirm you have achieved these competencies. The CREST form must be submitted within 72 hours of the application deadline.
• Experience Limit: Applicants must not have more than 18 months of surgical experience (excluding foundation training) by the time they apply. This limit ensures fairness by preventing candidates with extensive surgical experience from having an undue advantage.
• Fitness to Practise: Applicants must meet fitness to practise standards, including physical and mental health requirements that allow them to perform the duties expected of a CST trainee. Applicants with unresolved fitness-to-practise investigations or sanctions may be excluded from progressing.
• Right to Work in the UK: International applicants must hold the necessary visa to work in the UK at the time of application or be eligible to apply for one.

CST Shortlisting – The MSRA Exam

Shortlisting for interviews is based on the Multi-Specialty Recruitment Assessment (MSRA), which plays a crucial role in determining which applicants progress to the interview stage. Only the top 1,200 MSRA scorers will be invited to interview. The MSRA is a computer-based test designed to assess your clinical knowledge and professional judgment. The exam is divided into two sections:

1. Professional Dilemmas (PD)
   Duration: 95 minutes
   Question Format: Situational Judgement Test (SJT)
   Content: This section assesses your ability to handle professional dilemmas in the workplace. You will be presented with various scenarios commonly encountered in medical practice and asked to rank the appropriateness of potential responses. This section tests how you prioritise tasks, manage conflict, and make decisions under pressure, all within a professional and ethical context.


2. Clinical Problem Solving (CPS)
   Duration: 75 minutes
   Question Format: Extended matching questions (EMQs) and single best answer (SBA) questions.
   Content: This section tests your clinical knowledge across a wide range of scenarios. You will be required to diagnose, manage, and provide treatment plans for patients presenting with a variety of conditions.

2025 CST Interview Format

The CST Interview for the 2024/2025 application cycle will be conducted online via Microsoft Teams. Once you’ve booked a slot, you will receive a link to join. Be sure to log in at least 5 minutes early, as the first step involves verifying your identity. You will need to have a photo ID (either your passport or UK driving licence) ready, and it’s crucial that you are alone in the room during the interview. Two panel members will conduct the interview, and they will assess you across all sections.

The CST interview consists of three stations, each lasting 10 minutes:

1. Management Station (2 Parts) – 10 Minutes

Management Presentation (5 minutes): You’ll deliver a 3-minute pre-prepared presentation, with the topic sent to you via email two weeks before the interview. The focus is usually on leadership and management topics that align with the CST Person Specification. After your presentation, you will be asked questions related to your management experience.

To perform well in this section, it’s important to avoid simply listing your experiences. Instead, highlight specific achievements or examples (2-4) that showcase your leadership abilities. Relevant roles may include membership of the junior doctors’ forum, participation in mess committee activities, or involvement in national speciality training organisations.

When preparing your examples, ensure they meet the desirable criteria from the person specification:

• MDT: Leading and working with doctors, nurses, and AHPs.
• Broader Leadership: Experience leading within and outside of medicine.
• Management Involvement: Relevant to your current training level.
• NHS Knowledge: Understanding NHS management and resources

After your presentation, the panel will ask questions for 2 minutes. Make sure you are familiar with the examples you present so you can respond confidently to potential follow-up questions.

Management Question (5 minutes)

Following your presentation, you will be presented with a management scenario that relates to ethical, professional, or personal dilemmas commonly faced in surgery. This part of the interview will test your ability to think critically and respond quickly, as the scenario will only be revealed during the interview.

Example management questions might include:

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

2. Clinical Station – 10 Minutes

The Clinical Station will test your clinical decision-making skills through two 5-minute scenarios. These scenarios replicate real-world situations that you might encounter in surgical training, such as managing common surgical cases or handling acutely unwell patients. You will need to demonstrate sound clinical reasoning, judgment, and the ability to develop appropriate management plans under pressure.

Example Clinical Questions/Scenarios:

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

3. Portfolio Station – 10 Minutes

The Portfolio Station will focus on two portfolio domains, each lasting 5 minutes. Unlike previous years, there is no self-assessed score. Instead, candidates must upload their portfolio and evidence, which will be reviewed during a 10-minute pre-interview period, followed by a 10-minute discussion. During this station, you should highlight your clinical experience, research, teaching, and leadership accomplishments.

The Portfolio Station allows you to showcase your past achievements and your commitment to surgical training and development. Ensure your portfolio is well-organised and provides clear evidence of your skills and experiences relevant to the CST Person Specification.

Read our new 2025 CST Portfolio Assessment for a detailed review of this year’s changes.

Interview Scoring Criteria

CST Ranking Offers & Preferencing

Your final score following the interview is composed of three key components:

• MSRA score: 10%
• Verified self-assessment score: 30%
• Interview score: 60%

This breakdown clearly shows the importance of securing a strong interview score, as it makes up the largest portion of your overall result. Typically, the top 500-600 candidates will be allocated a Core Surgical Training (CST) post.

Once the interview process is complete, you will enter the preferencing period, where you rank your choices for training posts. These rankings, combined with your final score, will determine your offer. The first round of offers is usually released in late March.

Post-Interview, Offers & Preferencing

• Initial Offer: Once you receive an offer, you will generally have 48 hours to accept, hold, or decline it via the Oriel recruitment system.
• Hold Option: If you are offered a post but are waiting for an offer from a higher-ranked preference, you can select the “holding” option. Be mindful that the holding period is time-sensitive, and failing to respond in time could result in losing the offer.
• Upgrading: If you’ve placed a post on hold, you may be upgraded to a higher-preference post if one becomes available before the upgrade deadline, which is typically in April.

When reviewing your preferences, it’s important to:

• Consider your rank. If you are ranked on the lower end, prioritising posts with high competition ratios might decrease your chances of securing a spot.
• Think about your future ST3 speciality. Consider which speciality rotations are essential, which would be beneficial but not critical, and which you would prefer to avoid.
• Determine whether you prefer district general hospitals or teaching hospitals for your rotations. Teaching hospitals often offer additional opportunities for professional development, such as involvement in research, exposure to rare conditions, and better CV-building opportunities. However, district general hospitals may provide broader exposure to a variety of common conditions and allow you to develop a different skill set.

Available Posts

Medset CST Interview Course

At Medset, we offer a comprehensive CST preparation course that covers every stage of the interview with key strategies for both the management and clinical stations, as well as tips on building a strong portfolio. We also run a popular CST Mock Interview so you can confidently prepare with experts with real-time feedback.