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MSRA & Core Surgical Training In The UK | A Guide

Find out all about the UK Core Surgical Training (CST) training program, including what it is and how to prepare adequately for it — and why MSRA is essential for CST.

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Understanding Core Surgical Training

The UK Core Surgical Training (CST) training program is designed to help aspiring surgeons take their first steps along the exciting path of a surgical career.

CST is a highly competitive programme which almost always fills 100% of the available places, so it’s important that you give yourself every possible advantage whilst applying.

The program consists of 2 years (CST1 and CST2) and is designed to provide trainees with the necessary skills and knowledge to become competent and confident surgeons.

It provides an opportunity for trainees to explore different surgical specialties, before ultimately deciding on a particular sub-specialty. Core surgical training also allows trainees to prepare for the next selection stage – ST3 year.

Successful completion of the MSRA for core surgical training is also required.


How does Core Surgical Training Work?

CST is a two-year training program that consists of 6 x four-month placements.

The program is designed to provide trainees with a broad range of surgical experience across a variety of specialties – including general surgery, orthopaedic surgery, plastic surgery, urology and others.

During these two years, trainees gain experience in both outpatient and inpatient care, as well as in surgical procedures.

It’s worth noting that some Core Surgical Training (CST) programs are “themed,” which means that trainees will have a greater emphasis on a specific surgical specialty and its affiliated sub-specialties. This specialised training typically lasts for 12-18 months.

Those NOT in themed programs will rotate across a number of associated surgical specialties in 6-month or 4-month placements.

You are expected to complete MRCS parts A and B during Core Surgical Training, prior to applying for an ST3 post – and is an entry level requirement for application.


Eligibility for CST Application

CST eligibility criteria is slightly different from other training specialities. 

Essential Criteria:

– Must have MBBS, MBChB or equivalent medical qualification.
– Must be eligible for full registration with the GMC and hold a current licence to practise before starting the training programme.
– Must have evidence of achievement of foundation competences within the 3.5 years preceding the advertised post start date:
– 12 months medical experience after full GMC registration (or equivalent post licensing experience)
– Evidence to commence specialty training (either through completion of UK foundation year programme or through evidence of a signed Certificate of Readiness to Enter Specialty Training (CREST) form. For more details on CREST, click here

Career Progression:

– Must provide complete details of employment history and that career progression is consistent.
– Must have 18 months or less experience in Surgical specialties (not including Foundation placements) by the time of application.

Important point to note for International Medical Graduates:

“Where placements in surgical specialties are undertaken without enrolment in a UKFPO programme, no more than 12 months experience will be accepted as foundation equivalent”.

To simplify this… if you have worked 1 year or more post your internship (FY1) in a surgical specialty only the first 12 months will be counted towards FY2 equivalent and any additional experience beyond 12 months will be counted towards the 18 months cut off of surgical specialty experience required for the application.


The Recruitment Process

Core Surgical Training (CST) recruitment occurs twice per year – once during the initial round of specialty recruitment, and again during round 1 re-advert. The round 1 re-advert offers deaneries the opportunity to fill any remaining vacancies, but since CST is a highly sought-after program the re-advert is usually not needed as all places are filled during round 1 itself.

Most surgical specialties recruit trainees at the ST3 level – i.e. following the completion of CST. However, some run-through programmes also exist meaning that trainees enter their choice of sub-speciality at ST1 and do not have to re-apply at ST3 stage. 

Run through Surgical Specialities:

1. Cardiothoracic surgery – Entry at ST4 only for Thoracic surgery
2. Academic surgery – themed surgery specialty 
3. Neurosurgery
4. Oral & Maxillofacial surgery – Entry at ST3 also available

After CST, Higher Specialty Training is a five-year programme (ST3 – ST8), after which trainees attain a CCT (Certificate of Completion of Training). Trainees are ideally required to choose a subspecialty of their interest at ST6 level. 

Completion of FRCS parts A and B is required as an exit examination and must be completed before the end of training.


Portfolio Self-assessment Score

As part of the application process, you are required to complete a portfolio – the verified self-assessment score.

Although this is no longer used for shortlisting candidates for the Core Surgical Training interview, it remains a crucial component of the application process as a whole, comprising 30% of the final score.

Each section of the self-assessment contributes to the overall comprehensiveness of your surgical CV, highlighting the importance of excelling in this aspect of the application. 

From 2023, certain categories including MRCS Part A, attendance at surgical courses, postgraduate qualifications, prizes and leadership & management were excluded from the self-assessment score for CST. 

Despite this, the self-assessment score still plays a vital role, making up 30% of your final score and contributing to the comprehensiveness of your surgical CV. The portfolio self-assessment has been streamlined to five domains for 2023 with a total of 52 points: 

1. Commitment to surgery
2. Quality Improvement/Clinical Audit
3. Presentations and Publications
4. Teaching experience 
5. Training in teaching

Read more: 2023 Core Surgical Training Self-Assessment Scoring Guidance for Candidates.

It is not possible to change your self-assessment score after you have submitted your application under any circumstances.

Keep in mind that this is something you will have been preparing for months, if not years. Being organised and getting your correctly worded certificates and proof of your achievements will hold you in good stead.


CST Application Stages

CST application usually opens around the end of October/early November of the year before the programme start date.

The last date for application is early December. It is important to note that all evidence and work towards the portfolio must be completed before the deadline. Any attendance or work taken after the deadline will not add towards the self-assessment work and will be rejected during assessment. 

Stage 1: Submitting an application

Candidates can submit their application via Oriel website so long as they meet the eligibility requirements. Providing a self-assessment score is a mandatory part of your application form. It is at this stage you are required to upload your CREST form. 

Timeline: Early November – early December

Read more: The CREST Form – Everything You Need To Know

Stage 2: Longlisting

The initial stage of the CST application process is called longlisting, where all applications that do not meet the minimum eligibility requirements are eliminated. If you satisfy the basic eligibility criteria, you will progress to the next phase of the recruitment process – shortlisting. 

Timeline: Few days after application closing deadline 

Stage 3: The MSRA Exam for CST

Is MSRA required for core surgical training? Yes. Prior to 2023, shortlisting for interviews was carried out using the verified self-assessment score.

However, since 2023 this has been replaced by the Multi-Speciality Recruitment Assessment (MSRA). This is the latest addition to the CST application and candidates should provide enough time for its preparation. 

The CST MSRA exam is a computer based assessment which consists of two types of question papers:

a) Clinical questions (75-minute paper)
b) Professional dilemma questions (95-minute paper)

The total duration of the assessment is just under 3 hours (175 minutes, including break).

A 5-minute break occurs between papers (countdown appears on screen). The Professional Dilemma Paper usually happens first and is shortly followed by the Clinical Questions paper.

The Professional dilemma paper (SJT) consists of 50 Situational Judgement Test questions in 95 minutes – this paper occurs first. See below for more details and example questions.

The Clinical problem-solving paper (CPS) consists of 97 clinical questions in 75 minutes – this paper starts 2 minutes after completion of the SJT paper. See below for more details and example questions.

For full details of the MSRA exam, including sample questions, read our guide on MSRA preparation here. 

To pass your Core Surgical Training MSRA success is a must. For the best chances to get prepared, check out our comprehensive All-in-one MSRA Ultimate Package here.


– Invitation to MSRA: Before 3rd week of December
– MSRA exam window: Early-mid January

Good to know
Only the top 1200 applicants at MSRA will be invited to interview. All applicants that score higher than the cut-off score (but are not initially invited to interview) will be put on a reserve list.

Stage 4: Submitting Supporting Evidence

Applicants will then be invited to upload evidence in the requested format. Submitted evidence will be verified against the self-assessment criteria. Where the evidence submitted does not match the score awarded, the score will be adjusted accordingly. 

On completion of the verification process, applicants will be sent their MSRA result. Only the top 1200 applicants who have been verified will be sent their verified score (together with the verification panel’s feedback explaining any changes to their score).

Timeline: Last week of January to First week of February

Failure to submit all evidence by the stated deadline will result in your application form being withdrawn by the recruitment team.

Stage 5: Interview Booking and Interview Process

Candidates will be invited to book their interview slot using the Oriel website. All interviews are ideally undertaken online using Microsoft Teams. 


– Booking invitation – Mid February
– Interview – First-third week of March

The interview consists of a single 20-minute interview station, with 2 sections in the following order:

1. Management question (lasting for 10 minutes)
2. Clinical scenarios (lasting for 10 minutes)

There is no break in between the management and clinical questions and they are asked by the same panel members. The two sections contain the following components:

Management Section (10 minutes)

1. A pre-prepared 3-minute presentation followed by 2 minutes of questioning on your presentation.
2. One management scenario question. The question is provided during the interview and encourages the applicant to think on their feet. Five minutes are allowed to answer the management question. 

Clinical Section (10 minutes)

Two clinical scenario questions (lasting 5 minutes each) are usually asked here – again encouraging applicants to think on their feet. Usually one question is based on an acutely unwell patient or trauma patient, testing the A to E protocol. The other question usually focuses on a ward-based scenario or a history taking station with management. 

Good to know:
The questions asked in the interview cover all the surgical specialities and hence the candidate should prepare well in advance and acquaint themselves with common complaints from all specialities.

Stage 6: Preferencing window and initial offers

Preferencing of posts will be available prior to offers being made – irrespective of your scores in the interview. It usually opens at the same time as the interview dates. 


– Preferencing – Early – End March
– Initial Offers – End March

MSRA Core Surgical Training

CST Application Score

Your final score following the interview is made up of three parts:

– MSRA score – 10%
– Verified self-assessment score – 30%
– Interview score – 60%

Obtaining a high score in the interview is crucial for securing your desired Core Surgical Training (CST) post. The top 500-600 applicants with the highest scores will be granted a CST job after the scores have been tallied.

MSRA Core Surgical Training

Looking to improve your MSRA core surgical training score?

Then Arora Medical can help. 

Our most popular and comprehensive MSRA Ultimate Package contains an all round and complete preparation plan for boosting your MSRA score. It contains multiple resources in one discounted bundle – 2x online video courses, Live MSRA crammer course, SJT and clinical mock exams, 2x audiobooks and 3x digital flashcard sets (clinical, pharmacology and SJT).

For individual MSRA resources (e.g. mocks, online courses etc.) check out all of our MSRA courses here.

To register for our next free MSRA webinar click here: Next Free Webinar.

For our Free MSRA Countdown Programmes click here: Free MSRA Downloads.

Core Surgical Training in the UK: What it is and How to Apply

On a final note

If you are preparing for a Surgical Training Application we wish you good luck! 

We look forward to supporting you through your successful application process – in particular for the MSRA.

Good luck and #CanPassWillPass

Author Bio — Dr Aman Arora

Hello and welcome to Arora Medical Education! I am a Portfolio GP with a 24/7/365 passion for helping you fly through your medical exams and maximise your career. You can find out more about me here.

I’ve been fortunate to teach over 50,000 doctors globally through a combination of face-to-face, online, audio and social teaching, helping them pass exams such as MRCGP AKT and RCAMSRA and PLAB. You can find out more about my previous roles and qualifications here.

Feel free to contact me with any thoughts, questions or ideas to help you reach your potential. I look forward to meeting you soon!

Author Bio — Dr Pooja Arora

Dr Pooja Arora is a GP with a background in Medical Politics, where she passionately focuses on improving the opportunities and working conditions for junior doctors. She is proud to hold FRCGP (Fellow of Royal College of General Practitioners).

You can find out more about Pooja’s previous roles and qualifications here.

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