Fig. 29.1
Diagram depicting the two main routes of training to reach consultancy in a given specialty. Table of specialties separated by route of training
The main exams taken by trainee surgeons are the Member of the Royal College of Surgeons (MRCS) and Fellow of the Royal College of Surgeons (FRCS) exams. These exams take place in two parts. Part A is usually comprised of multiple choice or extended matching questions (MCQ/EMQ) which test whether the candidate has adequate basic science knowledge. Part B involves vivas and objective structured clinical examinations (OSCEs) and tests the application of knowledge in a clinical context. The MRCS is taken at the beginning of registrar training (FY2-ST2) and the FRCS is taken at the end of registrar training.
To enter uncoupled specialty training after core training year two (CT2), the trainee must have also passed both parts of the MRCS exam (or the equivalent for their chosen specialty), either during foundation years or core surgical years. Once they have completed their specialist training and exams they are placed on the specialist register, and may apply for consultant posts.
This is the ‘essential’ training required, however competition for any post beyond foundation years is fierce. Many doctors spend a lot more time ‘out of training’, gaining either clinical or research experience, or obtaining a degree to make themselves ‘more suited for the post’. This means that in reality, many don’t reach consultancy until several years after the ‘essential’ training timescale.
Student Tip
The sooner you decide on the specialty you are interested in, the sooner you can begin gaining vital experience. Tailoring your portfolio will increase your success rate when applying for senior clinician posts.
A Week in the Life of a Surgeon
The great number of different surgical specialties translates into huge differences between the ‘day-to-day’ timetables of different surgeons. However, every surgeon attends theatre, outpatient clinics and Multi-Disciplinary Team (MDT) meetings, and has administration responsibilities. Research and private practice commitments are also taken on to different extents by many surgeons. Figure 29.2 shows the typical timetable for a consultant urologist.
Fig. 29.2
A typical weekly timetable of a consultant urologist
Academic Surgery
Recently there has been an increase in the number of applicants applying for the academic foundation programme (AFP). The AFP allows the applicant to engage in teaching, research or management during FY2. Doctors can choose to pursue their chosen option either within a single rotation during FY2, or by taking one day off each week throughout the year of FY2 training. The AFP is particularly popular as both teaching and being involved in research give useful additional skills for the progression of any medical practitioner. The AFP experience also gains doctors points when applying for future registrar posts (see below for more detail.)
Time to carry out research work (while getting paid for it!) may seem like a win-win situation, but is not without downfalls. AFP doctors need to obtain an equivalent level of competency to their non-AFP counterparts in less time. Time management can be difficult, but if handled correctly, AFP doctors may gain a poster presentation or publication from their year. It is useful and important to ask the foundation doctors encountered on placements to find out what AFP has been like for them. In addition, do some research on the foundation programme website, which also has a list of all the current academic posts on offer (www.foundationprogramme.nhs.uk).
Beyond foundation years there are further opportunities that combine both clinical and academic responsibilities. These include academic clinical fellowships, which are essentially registrar posts that can last a maximum of 3 years. You can apply for these at any point after completion of your foundation years. These fellowships provide clinical responsibilities, but 25 % of working hours are allocated to research and teaching. Alternatively, you may propose a project on a particularly interesting aspect of your specialty of choice and source some external funding for it. Finally, if you find a certain area of medical science particularly fascinating, or if you find it difficult to get a registrar training post, doing a PhD would certainly give you a boost when re-applying.
Of course, it is not necessary to do a PhD, and there are many other postgraduate courses available. There is an array of masters degrees that can be attained part time too. These can be found on the postgraduate search website [4]. If academic surgery appeals, you may want to consider a senior lecturer or professor position in the future. Figure 29.3 outlines broadly the advantages and disadvantages of academic surgery.
Fig. 29.3
A table outlining the advantages and disadvantages of a career in academic surgery
Applying for Surgical Training
The application system for surgical training involves two main stages: the application form, and the interview process (for which you need your portfolio).
Application Form
The essential requirements for the application form to enter core training year 1 include a medical degree and full general medical council (GMC) registration for license to practice independently in the UK.
Other desirable criteria include [1]:
Any additional qualifications such as BSc, BA, BMedSci, or higher degree.
Evidence of research and audit skills including relevant academic and research achievements such as prizes, awards, distinctions, publications and presentations.
Evidence of attendance at clinical courses, or of teaching experience with accompanying feedback.
Participation in extracurricular activities and achievements relevant to surgical career progression and development.
Personal skills in management and leadership with evidence of effective multi-disciplinary team working with feedback.
Any organizational skills gained from involvement in society or sports committees.
Interview Process
Although the interview and selection process frequently changes, it is useful to have a general idea of what you may experience.
There are three stations at interview:
Station A – Management station. Two scenario questions will be read to you at this station. You will have 5 min to answer each question. These questions encourage you to think on your feet.
Station B – Portfolio station. You’ll have a checklist to fill showing evidence of additional degrees, exceptional performance at undergraduate or foundation years, clinical and professional development courses, clinical/procedural experience, audits, teaching, presentation/abstracts/publications, demonstration of leadership, commitment to specialty. Proof for your answers in the checklist will be required. See section ‘Beginning a Surgical Portfolio’below for more guidance. Figure 29.4 contains a table of the scoring guidance and supporting evidence.
Fig. 29.4
The scoring system for core surgical training portfolio applications in 2017. Further information can be found online
Station C – Clinical Scenario station. The first question is given outside the interview room, you’ll have 3 min to read the question and prepare, and inside the room you’ll have 5 min to answer. The second question is asked afterwards, and you are required to think on your feet. Both these questions will have an ethical slant.
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