Surgical training is becoming increasingly competitive. This is largely due to trainees raising the bar each year, along with a greater expectation from employers and the public to train only the best.
With the shortening and reorganisation of postgraduate training, although not mandatory, it is certainly advantageous for any prospective surgeon to choose their chosen speciality early. In this way you can focus your preparation and ensure you are competitive when applying for core and specialty training by demonstrating commitment to speciality and career progression.
There are several facets to succeeding in achieving your goal in becoming a surgical trainee and these must be evidenced in your CV and portfolio. Our advice is to start compiling this evidence early and take pride in nurturing it. Through self-appraisal and a degree of perspective, you will be able to identify areas in your portfolio that are deficient so that you can work on them early and enhance your chances in succeeding.
Postgraduate surgical trainers are looking for excellent trainees who can demonstrate their interest and enthusiasm for their speciality. Trainees must illustrate how they have developed professionally, how this is valuable for a career in surgery, and demonstrate their involvement in clinical, teaching, pastoral, leadership and managerial roles. This may seem like a big ask, but it is achievable if you start early and are motivated and determined to reach your goal.
Applications for core and speciality training are points based, and it is imperative that you score highly to remain competitive. Although there is variation between specialities, the requirements are broadly similar.
Below we have listed several clinical, academic and pastoral activities that are crucial for surgical trainees to demonstrate involvement in, and how as an undergraduate you might get involved.
Audit/Research
Audit is an integral component of clinical governance. It is the process by which current practices are compared to best standards. It is essentially a quality improvement process to ultimately enhance the standard of patient care that is delivered, which is why it is so important to demonstrate your involvement. Try and involve yourself in 1-2 audit cycles per year. Asking your supervising clinicians during attachments is a good starting point. Ensure you see your contribution to completion, as if you show you are reliable you will get greater roles and better audit projects. Demonstrating that you are able to see through an audit project to completion i.e. closing the audit cycle, scores favourably in applications.
Teaching
The GMC outline teaching and training amongst the core duties of a doctor. As an undergraduate and foundation doctor, take the opportunity to lead teaching sessions and ask for feedback so that you can use it as evidence in your portfolio. If possible ask a senior clinician to sit in on a teaching session and provide feedback too.
Courses/Conferences
Both courses and conferences will demonstrate commitment and interest in a particular surgical specialty. A quick search online is a good place to start to find relevant conferences that you can attend at different points in your career. Once you have decided on a specialty, find the college website which will direct you to relevant conferences. They will provide you with an opportunity to network and to showcase your work such as audits and research projects.
Certain courses may be mandatory e.g. basic surgical skills, whereas others will be optional but helpful. However, the range of courses available is vast and your free time will be limited. Again, college websites will provide some information on courses. It is also helpful to ask senior colleagues for their advice about which courses they found helpful so that you can focus on the most applicable and useful ones.
Oral/Poster Presentations
These are a very important part of your development and are a platform to showcase your work after an audit/research project. All application forms for core or specialty training have a section for presentations and you will gain points for these. It is helpful to have a look at the application form for the specialty you are interested in as early as possible. You will be able to find out the maximum number for points available and how many presentations are required to achieve this. Once you have your target, start as early as possible – time goes very quickly once you start working.
Publications
Similar to presentations, publications will also score valuable points on your application form to core and specialty training. Getting a paper accepted for publication can often take many months including several revisions so keep this in mind.
Leadership and Management
Demonstrating that you are not only a good clinician, but also someone who understands how an NHS organisation works is extremely important. Pursuing a surgical career with the ultimate goal of becoming a consultant requires many different skills including being the leader of a team, taking on various roles of responsibility and communicating with various people within the organisation.
There are many ways that you can demonstrate this including attending leadership events and workshops, taking on positions of responsibility (organising a teaching or staffing rota for example), taking part in quality improvement projects and mentoring of junior colleagues. This is particularly topical in light of the recent failings at Mid-Staffordshire NHS Trust and the Francis Report.
Awards/Prizes
Awards and Prizes are your chance to demonstrate that you have excelled and really give you a chance to showcase your work on your application and during interviews. Many of your colleagues will not have prizes, and this will set you apart.
Extra-curricular activities
Those scoring your application want to see that you are somebody that is a well-rounded individual that would be suited to a demanding career in surgery. It is important to show that you have interests outside of work and that you are a personable character (this should come across during interview).
You do not necessarily need to have scaled Mount Everest or built an orphanage in The Gambia, but demonstrating that you are someone who has sought additional experiences outside of medicine and that you will get along with your peers will be looked upon favourably.
Undergraduate degrees
As well as your primary medical degree you will inevitably hold, many students choose to take a year out to complete an intercalated Bachelors or Masters degree. An intercalated degree can provide you with a wealth of experience and knowledge in an area of interest to you (this could be in research, anatomy, surgical science or even in “softer” areas such as health administration, management and public health). Our advice would be to research the different degrees available to you carefully and choose only those degrees that genuinely interest you. Although, taking a year out to do an intercalated degree will score you extra points on your application, taking on an audit project and closing the loop will probably score you the same number of points. Another option to consider is that there are opportunities to complete part-time, distance learning higher degrees as postgraduates that will not involve taking a year out of your training.
SSC’s, Sign-up Sessions and Electives
All of these provide further opportunities to demonstrate an interest in a particular specialty. They may also provide a chance to do audits/ research, which may lead to a publication or presentation. Try to choose targeted options and if you cannot find an option that is relevant, contact the department and try to set up your own SSC or elective.
A career in surgery is not easy. It is hard work, involves long hours and a lot of motivation and personal sacrifice to succeed. Once you have made your choice, do not leave anything to chance and ensure you are able to tick all the boxes. Read the person specification for your chosen speciality early, and tailor your CV towards gaining the maximum number of points. Good luck!
Mr Omar Mirza
Core Surgical Trainee in ENT, North West Deanery
Mr Moez Zeiton
Core Surgical Trainee in Trauma and Orthopaedics, North West Deanery
Dr Nimisha Vallabh
Foundation Trainee, North West Deanery