The way I see it
How to get ahead
Authors: Amanda Wong
Publication date: 22 Sep 2010
Amanda Wong gives her tips on getting shortlisted for ST3 trauma and orthopaedics posts
So, you have passed your surgical membership exams (membership of the Royal College of Surgeons) and are applying for specialty trainee (ST) year 3 jobs in trauma and orthopaedics?
There are an increasing number of people who were not fortunate enough to get in to run-through training and who are having to reapply after the core trainee (CT) 2 and ST2 level.
How do I get shortlisted for a post?
There are quite a few selection criteria for posts in trauma and orthopaedics. The scoring systems are quite similar, but there are slight differences in the weighting on some criteria. Below are some tips to help you to stand out from other applicants and give you a chance to impress your potential employers face to face.
The basic criteria are registration with the General Medical Council; a primary medical degree; membership of the Royal College of Surgeons; and completion of at least 24 months in surgery, of which a minimum of six months should have been in orthopaedics. Realistically, however, if you are competing for an ST3 post in trauma and orthopaedics, most applicants will have completed ST1 or CT1 and ST2 or CT2 in trauma and orthopaedics.
You will have to show that you are ready to take on the ST3 position. Some deaneries give extra weighting to applicants who have experience beyond the level of ST2 or CT2 orthopaedics; for example, a locum appointment for training or locum appointment for service ST3 orthopaedics post, or a post as a clinical fellow, a clinical teaching fellow, or a clinical research fellow in orthopaedics (for differences, read on). There are also some deaneries, however, who may think you have done too much orthopaedics and will prefer candidates who have just completed the essential 24 months of ST1 and ST2 in orthopaedics or have done an extra ST2 year in another related surgical field such as plastic surgery. The extra ST2 year keeps you in a training position and the related surgical field gives you experience that may prove useful in your career in trauma and orthopaedics—generally, the idea is to show you are progressing in your career.
The basic courses are care of the critically ill surgical patient (CCrISP), the basic surgical skills course, advanced trauma life support (ATLS), and a generic course on fracture management—core skills in orthopaedics surgery (RCSEd), core skills in operative orthopaedics surgery (RCSEng), or AO principles of fracture management course ( [Link] or [Link] ).
As a registrar in orthopaedics, you should be able to operate independently on simple hip fractures (with cannulated hip screw and dynamic hip screw). Ideally, your logbook should, therefore, have details of at least six hip fractures that you have operated on as the principal surgeon. You should also show evidence of good progression in other procedures such as hemiarthroplasty and ankle fixation.
Extra points are awarded for other undergraduate qualifications such as a BSc or a BA. At a postgraduate level, scores are given to those with a PhD, an MD, or an MSc. There are a few orthopaedics oriented postgraduate courses, such as the MSc in trauma and orthopaedic surgery, the MSc in orthopaedic engineering, and others that can be done full time or part time. Prizes and awards will also gain extra weighting.
Presentations, publications, research, and audits
Each of these sections is scored separately. More points are given to candidates who have presented or published at an international meeting, followed by national, regional, and local departmental levels. Points are also given if you have submitted a paper that has not yet been accepted, with more points if you are the first author. Original research published in a peer reviewed publication will gain more points than, for example, a case report. Being involved in an audit will score you a point, but if you presented the audit results at a regional, national, or international meeting, your score will be higher.
A qualification in teaching (PgCert, PgDip, or MSc in medical education) will increase your score. Being an instructor in an advanced medical course and organising formal teaching sessions will usually score higher than informal teaching.
Your portfolio reflects you and your career progression. Even if you are not in a training post, keeping a portfolio shows evidence of your progression. A portfolio should have evidence of your clinical, surgical, and communication skills (mini-clinical evaluation exercise (CEX), directly observed procedural skills (DOPs), case based discussions, mini-peer assessment tools, surgical logbook). It should also contain a summary of meetings with your supervisors; evidence of your presentations; publications; research; audits; teachings; and feedback.
Suitability and commitment
Although vague, this is your chance to prove that you possess the relevant skills and attributes to be an orthopaedic surgeon. You should possess leadership skills, be a good team worker, be able to cope well under pressure, and have good communication and decision making skills.
If you are stuck after ST2 or CT what are your options? Sit down, look through your CV, and score yourself to identify your weak areas, and dedicate your next year to filling in the gaps.
You can do another ST2 or CT2 level post in another surgical field. Plastic surgery complements orthopaedics, as it is about soft tissue management. You can also look into a trust grade position in orthopaedics. There are quite a few fellow posts out there, including clinical fellowships, clinical research fellowships, and clinical teaching fellowships. The difference is that a clinical fellow post is essentially generic and improves your clinical and surgical skills, whereas clinical research fellows and clinical teaching fellows focus on research and teaching, respectively. A clinical research fellowship is ideal for someone who is lacking publications and research; a clinical teaching fellowship, on the other hand, gives you a chance to do a PgCert in medical education, which could advance your career.
If you have done more than three years of other options, however, and are not progressing, you may need to look at other specialties. Some people are happy to be in a staff grade position (associate specialist), which gives them fewer responsibilities and yet still allows them to be orthopaedic surgeons.
Trauma and orthopaedics is one of the most competitive specialties and not everyone makes the cut, but if it is what you really want, don’t stop believing, and pursue your dreams.
Surgicareers ( [Link] )—A new website that helps surgical trainees to develop their career.
La Chirurgia ( [Link] )—Bimonthly newsletter for women in surgery by women in surgery.
Competing interests: None declared.
Department of Trauma and Orthopaedics, Doncaster Royal Infirmary, Armthorpe Road, Doncaster, UK