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Hello everyone! As most of you are aware, getting into a surgical training programme in the UK is extremely challenging, even as a local graduate. However, competition ratios are not what they used to be once upon a time, and personally, I think that is due to the harsh lifestyle and poor work-life balance that general surgery offers you at the consultant level – the constant on-calls, difficult patients, complications and the stress that private practice brings. Hence, most people are inclined to pick specialities that work better for their work-life balance and family life – thus making general surgery easier to get into as fewer people want to do it nowadays.
A little bit of background information on me if that helps to put things into perspective. I’m 26 and I graduated after finishing my internship in India in May 2015. The following 12 months of my life, were extremely well planned, and I think this is what helped me beat the system to a large extent.
IELTS and PLAB
I was quick to get IELTS out of the way in May 2015, PLAB 1 in September 2015, PLAB 2 in December 2015 and I did a clinical attachment in General Surgery in Jan 2016. By that time, I was getting non-training SHO level jobs from a lot of hospitals in the UK, but I picked wisely. I chose a DGH which was busy, had a heavy patient load and was relatively understaffed. I know that sounds like a perfect nightmare, but that’s what got me where I am today. Remember – planning is key. Do not leave anything to chance or leave anything unattended to. Every single tiny detail counts.
First Job in the UK
I started working a Trust Grade FY2 from April – August 2016 on a Tier 2 visa sponsored by my hospital and got my certificate of equivalence of Foundation Training signed off in 4 months time. Getting along with the consultants, registrars, being eager to work hard and do the ward cover when needed along with filling in on days when things were difficult and the team was understaffed – all helped me gain their trust and develop a rapport with my bosses and the nurses. They knew what I was all about; they knew I was keen; they knew I’d work hard because I wanted it and my certificate was signed. Just in time to be promoted to a Trust Grade CT1 in August, which is the time when the new trainees join the trust, and so I was on an equal footing with them.
Attempt to Get Into Core Surgical Training
I had applied for CST in 2016 and 2017 – but got rejected both times because of high competition ratios and the fact that I was on a Tier 2 Visa. Somehow this did not seem to matter for ST3.
The next 18 months were spent in the theatre. Developing skills. Staying late and operating. Learning the skills and critical thinking required to make decisions that were hard to make, trying to stay safe and consult senior colleagues when I felt like I needed to.
Buy an ISCP portfolio and register for free with e-logbook. This is absolutely essential. I cannot stress how important this is. I asked one of my consultants if he could become my educational/clinical supervisor and we set objectives at the start of the year, had an interim meeting to assess my progress and an end of placement sign off at the end of my Trust Grade CT1 year. It is important to constantly finish doing assessments at work – CBDs, CEXs, DOPS, etc. And get them all signed off in time, which I managed to accumulate over the next 18 months. E-logbook also has a mobile app through which you can enter all the cases that you do. By the time I was ready to apply for ST3, these were the things that I had accomplished and done, and recommend anyone who wants to do surgical training to tick off their to-do list. There is a Portfolio checklist on the Oriel website which you can refer to see how your portfolio is going to be marked.
Passed the MRCS A Exam in April 2016.
Passed the MRCS B Exam in October 2017.
Completed 7 audits with 4 closed loops.
Published 3 research collaborative articles.
Completed 6 Courses in Surgery – BSS/CCrISP/ALS/ATLS/Lap Skills/Anastomosis Skills.
3 International and 1 National Presentations.
1 International Prize at ASGBI.
Established myself as a part of the Trust teaching programme.
Conducted Suturing and Surgical Teaching sessions for F1/F2 Doctors on a 4-month basis with structured feedback and certificates.
Designed and organised an event: basic surgical skills course for nurses, doctors and paramedics.
Managed the Rota for the whole surgical division of the Trust.
Attended and delivered sessions on leadership and management.
What is key is getting good numbers and experience surgically. And by the end of the 18 months before ST3 applications, I had performed (with a senior trainee/consultant scrubbed with me) the following:
120 diagnostic laparoscopies and appendicectomies (open and lap).
70 groin/ventral hernias.
40 laparoscopic cholecystectomies.
And multiple smaller emergency procedures like incision and drainages, chest drains, etc.
From this alone, you can see the benefits of working in a relatively understaffed DGH with a high volume of patients. My consultants were excellent. Each of them is a brilliant trainer; once they sense that you’re keen, nothing stopped them from wanting to take you through the basics and then the harder skills.
Core Training Competencies
I got my certificate of completion of Core Training signed before my ST3 application and for the next 6 months, my consultants had decided to place me on the SpR rota. And now that I have an ST3 number, the next 6 months as an SHO acting up on the SpR rota will be an invaluable experience.
ST3 Online Application
At the time of the interview applications, I started filling in the online application form early. There’s lots of information you will need to type in, so start early is my advice. You will need three referees, so ask your consultants if they will be happy for you to include them in your applications. You will also need to collect cumulative numbers and details of all the assessments, operations, audits, research publication, presentations, exams, courses that you have taken and done over the last few years.
The interview itself is explained in detail on the Oriel website – including the different stations with the timings and the type of questions asked. My interview this year had 4 stations:
- Clinical Knowledge and Management.
- Professional Communication.
- Academic and Teaching.
I bought a large 4 lever arch shiny black smart folder to put all my documents in. I printed all the evidence I needed and placed them in plastic wallets with coloured dividers between each section specified in the portfolio checklist and made sure everything was clearly legible. The presentation of your portfolio is extremely important. Make sure your folder looks the part and is designed to be easy to navigate through as this is one station where points will be thrown at you.
I did not do an interview course. I only practiced with two of my colleagues – one who got her ST3 number the year before, and one CT2 who was in my trust. It really does help to chat with someone and practice scenarios with them. Reading information off a paper or the internet is absolutely useless – just like an exam: practice is the key. Courses are expensive and I have received mixed reviews on them, but the choice to do one rests on the individual. On the whole, it was a very transparent and simple interview process not designed to trick you or befuddle you, but to essentially recognise whether you are knowledgeable and safe potential Registrar. They basically want to know whether they can trust you with their patients and whether you have the communication skills to relay information across safely.
I was lucky received my 4th choice Job in the East of England. I have family in the south and did not want to move to Northern Ireland, Scotland or Wales. My preferences were KSS, Wessex, Thames Valley and East of England in that order with the Midlands and the Northern half of the country coming after that. I am still in shock and in utter disbelief that I have got a training number when almost everyone I met or came across from the IMG world were quick to discourage. But with the support of my colleagues, excellent consultants, a supportive family and nights of hard work, I did it. And if I can, there’s no telling that you can’t either! So put your mind to it.
- Be organised and planned.
- Give your self enough time to pass each exam. Do not rush. Slow and steady.
- Pick a DGH to start your surgical journey in. There is no benefit from taking up a Trust Grade job in a large teaching hospital. The senior surgeons will be doing all of the operating while you develop your skills in tissue retraction.
- Develop good communication skills and be kind to people at work and your colleagues. There is no telling as to how much it helps to have supportive nurses and consultants by your side.
- Try and get your FP Equivalence certificate signed in 4 months and then start focussing on operating. There might be a struggle to get to theatre vs the Core Trainees (I never faced that problem myself) but talk to them and sensibly try to come up with a plan to share cases. If needed get your consultant involved in a non-controversial manner.
- Register with ISCP and eLogbook. Ask someone to be your supervisor and have regular meetings with them at 0, 6 and 12 months document this in your ISCP portfolio. Do constant assessments and get them signed off in time.
- Pass your MRCS exams. Do Part A around 4 to 6 months after you start working so you have a good feel of the surgical world. Do Part B 12 to 16 months after, so that your clinical knowledge and communication skills develop.
- Use your study budget at the trust to do all the courses I have listed above. Do as many audits as you can. I would recommend doing 1 every 4 months at least so you have a constant in flow of audits.
- Get involved in teaching. Speak to your Post Graduation Centre and ask them if you can have an hour or two to do this regularly.
- Your audits are automatic presentations. Write them up as an abstract, make slides and submit them to conferences and regional teaching days.
- Research is not key. It is not required for you to get an ST3 number. Neither are publications. They help, but you are not loosing out much if you do not have them.
- And most importantly, be organised. Get evidence for all your achievement on paper.
- Get consultants to write letters of recommendation for you and letters to certify the work you have done. I wish I could share my portfolio with all of you if it was possible, but just follow the guidelines set out by Oriel.
I wish you guys all the best in realizing your surgical dream. I once thought it wasn’t possible and was toying with the idea of getting into A&E/CMT to get exempt from the RLMT and then applying for CST. But the thought of doing anything else except surgery did not work for me. So I committed myself to applying for ST3 and if I was not successful I would wait till I got my ILR to get into ST3. But luck, hard work and being organised paid off.
Good luck to everyone here! Aim high and strike hard.
(This post was shared with the author’s consent).