Selection into higher surgical training

Authors: Alison S Carr, Chris Munsch, Steve Buggle, Patricia Hamilton 

Publication date:  03 Nov 2011

Alison S Carr and colleagues review this year’s competition for training places

Surgery is a highly popular career choice, and entry into surgical specialty training programmes at specialty training year 3 (ST3) is extremely competitive. Each year in England there are roughly 1800 applicants for the 450 available posts. As well as those applying directly from core surgical training, large numbers of doctors apply from outside recognised training programmes, many of whom have acquired substantial additional surgical experience. The purpose of this article is to provide trainees and trainers with up to date information on the competition ratios and the factors affecting selection, to inform career planning, and to help manage the expectations of doctors wishing to train in surgery.

Lessons learnt from the 2010 selection round

We have previously analysed the 2010 selection round in England for surgical specialties (fig 1 ).[1] In this analysis we used the year of primary medical qualification as a surrogate marker for surgical experience, assuming doctors qualifying in 2005-6 to be those applying for ST3 posts directly from core surgical training, while those with earlier qualification dates were likely to have acquired additional surgical experience. The analysis showed that the prospect of gaining an ST3 surgical post directly from core surgical training was only 24%. The success rate for doctors with more experience was 13%, but because of the larger overall number of these doctors, they filled two thirds of the total available posts.

The relatively low number of core surgical training applicants who achieved ST3 posts gave considerable cause for concern. The reason for this was clearly multifactorial, but it was widely considered that the existing selection process had an inherent bias towards more experienced candidates and that applicants from core surgical training were not being given adequate opportunity to demonstrate their aptitude.

The 2011 selection round

In an attempt to mitigate this bias, for 2011 each surgical specialty was requested by the Medical Programme Board of Medical Education England to introduce a measurement of career progression into selection to ST3. This request reflected the person specification requirement that career progression in surgery be appropriate to the time spent in the specialty. Measuring career progression was achieved in a number of ways at shortlisting and during the interview process (fig 2 ).

A career progression matrix for use at shortlisting was developed initially by cardiothoracic surgery and, with appropriate modifications, was adopted by other specialties. The larger specialties of general surgery and trauma and orthopaedics interviewed all eligible applicants. Selection stations have focused on assessing performance and aptitude rather than assessing knowledge recall gained through prolonged surgical experience.

The selection process in 2011 was managed for all ST3 surgical specialties through nationally coordinated recruitment and electronic applications. This provided robust information on competition into ST3 surgery in 2011, allowing comparison of selection success rates for those applying directly from core surgical training and those applying with more experience.

What did we find?

In 2011 there were 1760 applicants for 425 ST3 surgical posts, of which 325 were substantive ST3 posts and 100 were locum appointments for training. The overall competition ratio was 5.5:1 for a substantive ST3 rotation, similar to 2010. Competition varied between specialties (fig 3 ).

The differences in competition ratios across specialties in 2010 and 2011 are largely due to differences in numbers of posts. Ninety eight per cent of applicants applied to only one specialty.

Doctors who qualified in 2006-7 (who probably applied directly from core surgical training) were more likely overall to be appointed to ST3 surgery posts than doctors qualifying before 2006 (figs 4 and 5 ). Doctors likely to be applying with all levels of experience continue to be appointed to ST3 surgery posts in 2011.

In 2011, 43% of the doctors applying from core surgical training were appointed into substantive ST3 posts or locum appointments for training in surgery. In contrast, only 19% of doctors applying for surgical training from outside core surgical training were successful in selection.

The likelihood of appointment to substantive ST3 posts and locum appointments for training from core surgical training varied between ST3 surgical specialties (fig 6 ). The percentage of core trainee applicants who were successful ranged from 62% in ear, nose, and throat surgery down to 11% in plastic surgery.

How should the findings be interpreted, and how do they inform career planning?

There has been a noticeable rise in the proportion of core surgical trainees appointed to substantive ST3 posts and locum appointments for training in surgery in 2011. The use of measures to recognise career progression (or lack of it) have had a considerable impact on this situation. Compared with 2010, in 2011 doctors applying from core surgical training posts were generally more likely to be successful in gaining an ST3 post in surgery than those not on core surgical training programmes. Trainees should therefore be encouraged to gain membership of the Royal College of Surgeons during core surgical training so that they can apply for an ST3 post directly from core training rather than extending the duration of surgical experience before making an application.

Doctors applying from existing locum appointments for training and fixed term specialty training appointments are also reasonably successful in gaining ST3 posts in surgery. Many of these doctors may have applied for substantive ST3 posts in 2010; consequently, continuing to acquire surgical experience in an ST3 training post if not recruited into a substantive ST3 post also seems beneficial.

In most surgical specialties, roughly a third of applicants to ST3 are from service posts. Many of these doctors are currently in one year clinical fellow or trust doctor posts rather than in permanent posts in the staff and associate specialist grade. Doctors in these service posts are generally less successful at entering higher surgical training than those applying from training posts.

Doctors with substantial surgical experience who have been unsuccessful at gaining an ST3 surgical post should be encouraged to seek career guidance on the most appropriate way of continuing their career. For some doctors it may be more appropriate to try to obtain more specialist experience and apply for entry to the specialist register by the certificate of eligibility for specialist registration route rather than continue to apply for an ST3 post in surgery. Other doctors wishing to continue practising in surgery may consider obtaining a permanent position such as a surgical post in the staff and associate specialist grade. Other doctors may be advised to consider changing specialty.

Selection into higher surgical training remains highly competitive. In this article we provide up to date information on applicants and appointees so that doctors wishing to pursue a surgical career may gain a realistic insight into selection into ST3 surgery.

We thank deanery staff and surgeons and medical royal college staff involved in selection into surgery for their help in data collection.

Competing interests: None declared.


  1. Carr AS, Munsch C, Buggle S, Hamilton P. Core surgical training and progression into specialty surgical training: how do we get the balance right? Ann R Coll Surg Engl  2011;93:244-8. doi: [Link] .

Alison S Carr senior clinical adviser, Medical Education and Training Programme (England), and consultant paediatric anaesthetist, Plymouth Hospitals NHS Trust, Plymouth, UK
Chris Munsch former chairman, Joint Committee on Surgical Training, and consultant cardiac surgeon, Leeds General Infirmary, Leeds, UK
Steve Buggle operations director, Medical Education and Training Programme (England)
Patricia Hamilton director of medical education, Medical Education and Training Programme (England)

Cite this as BMJ Careers ; doi: