Core Surgical Training Portfolio 2024: Maximise your Score

2024 Core Surgical Training Portfolio Self Assessment

We have analysed the self assessment for the 2024 round of recruitment and combined this with the experience of our team to produce our guide on how to maximise your score and appropriately evidence your portfolio. All this content is available completely free.

The contents of this section are not new but have been allocated decreased weighting for the 2023 round of recruitment. There has been removal of the MRCS part A examination and attendance at surgical courses which is frustrating for those who had invested time and money in completing them.

Operative Experience (8 points)

There is no reason why you shouldn't get maximum points in this section.

Involvement in an operation can mean scrubbing in to assist, performing a minor role of the operation or more.

Whenever you are in theatre you should be asking to scrub into every case you can. You will find you will easy exceed the 30-40 needed to gain top points.

If you need to boost your logbook you can arrange a surgical taster. Ask your supervisor for the timetable to be focussed on theatre sessions and try to avoid additional responsibilities on the wards or in the emergency department.

It is also very important to remember that many things you would not consider to be an operation are actually so!

For the classification of what is deemed an operation, I would see whether it is listed on the eLogbook website as one. This is the website all trainees and trainers in the United Kingdom use to verify and log their operations during their training.

Evidence:

• You must log your cases on eLogbook
• Anyone can set up an eLogbook account, even medical students, and you should set one up as soon as possible. Try to get into good habits by uploading your cases on the same day.
• You need to upload a verified consolidation report. To get this: log into your eLogbook > select the consolidation tab on the left > ensure you have the correct speciality selected in the drop down tab > print a normal report with no filters applied > take this to your supervisor, or any consultant, and ask them to sign their name, GMC number and date on the front page and then also initial all other pages. This can then be uploaded as evidence. You can upload separate reports if your cases are in different specialties
• Make sure you obtain a signed copy of the consolidation report before you finish the placement, you don't want to have to chase this months to years later.

Advice:

• These points are comparatively easy and really you need to be hitting maximum points in this section
• A well chosen self-selected component as a medical student can easily yield 30 cases.
• Planning taster weeks in FY1 and early FY2 can also get you the majority of these.
• Prioritise lists with short cases and a high turnover, for example in plastic surgery you will find minor procedure lists which can easily have 10-12 skin biopsies/excisions.
• Most specialities will have lists of the bread and butter procedures which will help you be efficient with your time.

Surgical Conferences (3 points)

Surgical conferences are an important aspect of your career. Your learning is advanced through annual meetings and exposure to new innovations and research.

To be safe you should use conferences that you are not using to score points in the presentation section. It has not been clarified whether you can use conferences you have attended to present at in both sections. However, if you don't have enough to score maximum points in both then we would suggest attributing yourself the points in both sections since you can justify the attendance and presentation as separate achievements, hopefully this will be clarified.

Evidence:

• You must provide a certificate confirming attendance with your details - name, course, organising body and date.

Advice:

• Start early. Ensure to find a conference that will be beneficial to your stage of training and learning. Conferences often stagger their prices based on how early you book and the stage of your training. The earlier you book the lower your price. Medical students will pay less than foundation trainees or surgical trainees.
• Ensure to secure study leave and potentially funding early - there is guidance here.
• Conferences to consider would be those arranged by: ASIT, RSM, ENT UK
• If you are reading this later in the process, you may be able to attend virtual conferences

Surgical Experience (3 Points)

This section is difficult to perform well in retrospectively. It requires some forward planning.

Evidence:

• Surgical Elective / Placement / Taster: Signed letter by your educational supervisor of the surgical placement, hospital, dates, name of supervisor and their GMC number / national medical registration

Advice:

• It is important to plan a surgical elective during your time at medical school. Not only will it give you the opportunity to explore the speciality but having a dedicated elective can help you begin to develop some surgical skill.
• If you have not been able to arrange a surgical elective, it is vital you arrange a surgical placement.
• Most foundation trainee jobs have a surgical placement but this needs to occur before your interview date (NB: they have been previously flexible due to COVID related changes - it is unclear whether this will remain for 2023 applications)
• If your foundation jobs do not include a surgical speciality you can arrange for swaps within your deanery if you do it in advance
• Surgical placements include the following specialities: Plastic Surgery, Neurosurgery, Vascular Surgery, ENT Surgery, Cardiac/Thoracic surgery, ITU, Urology, Oral & Maxillofacial Surgery, General Surgery, Orthopaedic Surgery and Paediatric Surgery.
• Surgical tasters can be arranged during your time in foundation and study leave is often granted. These are often arranged with the involvement of your educational supervisor and a supervising consultant in the speciality of choice. The taster should be at least 5 days but this does not have to be consecutive. Tasters you have arranged but not completed will not count.

A new aspect of the 2023 recruitment round was removing the requirement of presenting your audit in order to get the points, but they have introduced additional points based on the level at which you have presented the audit. This means this section now has more marks and is one of the highest weighted aspects of the portfolio.

IF you have scored at least 4 points in the above section AND you have personally presented the audit project at a conference then you are eligible to additional marks from the table below.

Evidence

• Copy of your presentation (on first slide put your name, date and location of presentation). Or a summary of the project detailing scope and impact if not presented.

AND

• Signed letter from your consultant supervisor including: your level of involvement, supervising consultant's GMC number, the date.

AND (For Presentation Points)

• Letter of acceptance from the meeting you presented at confirming: title of project; date of presentation and presenting author.
• A copy of the meeting programme displaying project title and presenting author is an acceptable alternative.

You may wish to use the below template. There are placeholders for you to fill in information for your audit. We suggest you complete the letter and send it to your consultant for a signature.

Advice:

Read the wording of the self assessment document very carefully as if your evidence doesn't tick all of the following boxes then the panel are notoriously strict for docking you marks:

• Surgically themed audit;
• You lead all aspects (specifically planning, data collection, data analysis, implementing change and involvement in at least two cycles);
• Your audit showed an improvement/change;
• You presented the audit at a local/regional/national meeting.

It is important to be aware you cannot get points for the same piece of evidence in multiple domains. Therefore if you have a great audit which you have presented nationally and maybe even won a prize, you will need to choose if you want the points in this section, or the later presentations & publications section.

Audits are a good opportunity to secure marks in the presentation section. You don't need to use your best audit in this section if it scores you marks in another domain, but be sure to forward plan. The audit points are relatively easier to get than other domains and you should be aiming to maximise your score in this section.

Surgically Themed Audit Ideas:

Discuss with your consultant if they have any ideas as they will probably have a more engaging higher quality audit. Below are some generic ideas you can consider.

• Operation note completion using the RCS guidance
• VTE prophylaxis - particularly in orthopaedics - using local/national guidelines
• Consent form completion
• Adherence to the WHO checklist
• Antibiotic prescribing and administration on surgical ward - appropriate antibiotic, duration, indication etc.
• Requesting of CT Heads following head injury using NICE guideline (good option for ED placement)

The Royal College of Surgeons of Edinburgh runs an annual QI and audit symposium which is an excellent opportunity to present your projects at a national conference which is specifically tailored to these projects.

This year, the presentation and publication sections have been combined meaning only your best achievement across these two categories will score you points. Remember, if your only presentation is the audit project you are using to score points in Domain 2 then you should check which section it will score you more points in as you cannot use the same evidence in two domains. In the future, it is highly likely they will uncouple these sections again.

Publications

Publications are seen as elusive and a difficult accomplishment, but they are achievable and there are ways to make life easier for yourself. Many Journals currently have a very slow turn around for reviews, and it often takes months to get comments back on a submission. You can check these metrics beforehand.

A PubMed ID must be provided for publications - make sure you check recent publications in any journal you are considering submitting to to ensure they have a PMID. It can take weeks to months after your work is accepted a PMID to be assigned.

ISBN number must be provided for book chapters

Evidence for Publications:

Published articles:

1. Copy of the article (screenshot or PDF) including the PubMed ID. This may be screenshotted from the PubMed website.
2. Letter of acceptance for publication from accepting PubMED catalogued journal to include - Name of applicant as First author or co-author, Confirmation of acceptance for publication without alteration, Name of accepting journal, Date of acceptance, Title of article

For Articles in Press:

1. Letter of acceptance for publication from accepting PubMED catalogued journal to include - Name of applicant as First author or co-author, Confirmation of acceptance for publication without alteration, Name of accepting journal, Date of acceptance, Title of article
2. Statement confirming that the journal is PubMED indexed. Although not asked for, you may wish to consider putting evidence from the PubMED website in this document to support it.

Collaborative Authorship:

1. Copy of published articles to include - Title of article, Name of Journal, PubMED ID, Article page where collaborative authors are cited

Published Book Chapters:

1. Front and back cover of book to include - Title of book, Publishing house, ISBN number
2. Contents page showing chapter and applicant as author

Advice:

• Often once a piece of research is completed your supervisor will want to submit it into a high impact factor journal which has a likely lower chance of being accepted (dependent on the work done). It is important to bear this in mind when it comes to timing with your application. You may need to submit to another journal or potentially two other journals.
• Recruitment does not reward candidates on the quality of their publications and you can use this to your advantage. Targeting low impact factor journals will increase your chances of success whilst also reducing the rigour in which your work is reviewed. You will need to be savvy when choosing your supervisor if this is the path you wish to take. Low impact factor journals will accept 'Narrative' Reviews, which simply summarise current evidence for topics. This is a potential low effort avenue to getting full marks, but there is the risk that it will not get accepted.
• Open access journals are becoming more and more common and provide a pay-to-publish option. Although most are expensive, you can find PubMED indexed journals which offer "short communications" or similar options which are cheaper (approximately £250). This fee may be waived if you're affiliated with a university that has an agreement with the publisher. These journals have a shorter review period and may be more inclined to accept your publication. Whilst paying out of pocket is not desirable, if you are desperately short of points in this section it may offer a solution.
• It is easy to get involved in collaborative research, and we would encourage you to do this early. Often collecting a single set of data for a large collaborative such as StarSURG will result in you being named on multiple resulting publications. However, it can take years for these studies to make it to publication and they offer a relatively low amount of points.
• Letters to the editor are a quick asset that can be utilised if your research projects don't come to fruition. You can write a letter, with a unique and valuable response to an article you've read, and have it published. These will often take a couple of hours to produce and it may be worth publishing many in the hope that ONE or more gets accepted in time for your evidence submission.

Presentations

Defining the Nature of a Meeting:

An oral presentation is presenting information, with or without slides, in front of an audience of healthcare professionals - typically a case, case series or other research.

You must not claim an oral or poster presentation in this section if you have used the same quality improvement project/audit to claim points in the QI/audit section.

Evidence for Presentations:

You must provide ALL THREE of the following pieces of evidence.

1. Copy of letter of acceptance of oral/poster presentation or copy of event programme citing presentation to include: Name of presenter OR first author, Institution and date of meeting/presentation
2. Copy of oral presentation slides/poster presentation to include: Title of presentation, name of first author/presenter or author list to include applicant if not first author
3. Certificate of attendance at the conference

AND if you are claiming a prize:

• Copy of the prize certificate or a signed letter from the institution confirming it.

IF your presentation is from a regional or local meeting then a signed letter from your supervisor confirming all the above details will be accepted as evidence.

Advice:

• The first step is to get involved in research which produces conclusions that are worthy of sharing with the wider medical community.
• Often you will get guidance from your seniors regarding which conferences are better to submit to and which are for a particular audience.
• There are an increasing number of conferences with junior doctors in mind - they would be fantastic options to consider when submitting your research. Such examples are those led by ASiT or ENT UK or BOA.
• Another great tip for getting poster presentations accepted is to submit them to very large conferences which have space for hundreds of presentations. You are more likely to have a case report accepted in a conference with 3,000 delegates than one with 150.
• If you have very unique cases that may not appeal to a wider audience there are quite niche meetings available such as the Semon Club - which is a radiology, histopathology and clinical case report meeting held annually.

With appropriate planning the teaching experience points should be achievable to all. The top marks in the teaching qualifications can be time consuming and expensive to obtain, and may not be feasible for those applying straight from FY2, nevertheless there are ways to still score well in this section.

Teaching Experience

This should be relatively straightforward to arrange and complete. It can also be very enjoyable.

The aim is to produce a teaching programme in your area of interest and enhance the delivery of teaching to healthcare professionals / medical students.

Defining Regional Vs Local:

Regional An activity that extends beyond a local hospital, single trust or university setting; for example: the Foundation school, deanery or sub-deanery region or a cluster of hospitals comprising different NHS trusts. If your activity extends beyond this, then this would count as national.

Local An activity that is confined to a hospital, trust or university setting.

Evidence:

1. A letter from a consultant confirming that you were involved in designing and organising the teaching programme (or delivered teaching). This letter must include the consultants name, GMC number, date of activity, and refer to the results of your collected feedback.
2. Make sure your letter specifically references the number of sessions that were included since the criteria specifically references it as 4 or more.

Formal Feedback:

This doesn't need to be submitted but ensure that your evidence refers to it, therefore the consultant writing your letter will need to review it.

• Formal feedback constitutes evidence of senior observation or feedback
• OR collection and analysis of participants' feedback forms

Advice:

• I would start by choosing a topic you feel passionate about and would be happy investing extra time learning and then teaching.
• If you work in a teaching hospital, find out from the undergraduate clinical lead which consultants are supervising which aspect of the curriculum.
• I would then state my intention, as laid out by the score sheet above, in designing and organising a teaching programme at a REGIONAL level.
• The easiest way to achieve regional teaching is to use an online platform, this will allow you to extend your teaching across multiple trusts or universities.
• They may be able to put you in touch with a neighbouring trust or you may be able to contact a neighbouring university to ensure that this goes beyond your local vicinity making it regional.
• I would design the programme and deliver it over the year.
• I would ensure to collect feedback forms via Google Forms or equivalent to allow ease of collection and analysis as per the formal feedback guidance
• I would ensure to get the supervising consultant to review your feedback and write you a letter confirming your sessions, dates and involvement. Often you may have to write the draft yourself to save a busy consultant time.

Training Qualifications

This is a notoriously difficult section to score points in. It often takes a lot of time and money dedication to maximise your score here. Many of our top scoring faculty scored 1 here as they did not want to make an investment into a PG Cert / Diploma or MSc for the sake of 4 points, as the same level of effort would score you higher points in other sections. It will be uncommon for applicants to get full marks in this section, so don't be disheartened if you only have 1 point.

If you are passionate about medical education and have the opportunity to enrol in a qualification without it preventing you from completing your audits, presentations/publications and teaching experience, then you can set yourself apart with these hard to score points. It will also benefit you in your application to higher surgical training.

Evidence:

• Copy of degree / certificate - including name, institution, date of award
• Copy of certificate confirming attendance of substantial training - including name, institution, dates of award (2 days)

Train the Trainer Course:

• Getting three points in this section should be guaranteed points, and whilst the RCS course can be difficult to get onto and expensive, there are online alternatives.
• One such alternative can be found below:

Online Teach the Teacher Course | ISC Medical

The E-learning version of our two-day live course, consisting of 18 comprehensive modules featuring thought-provoking videos and inspiring talks by experts.

MedCourseISCMedical

Advice:

• The Royal college of surgeons 'Train the Trainer" course will secure you one point, but there are cheaper alternatives.
• Teach the Trainer is a two day course that costs £400 that will give you a single point. This course can sometimes be funding by your medical school / foundation trust - it is worth attending if you can get funding.
• Certain universities will equip their undergraduates with training in teaching, you may be able to ask your dean / medical societies to facilitate this, but be aware you wont get points if this is part of your primary medical qualification.
• Finally, if you would like to pursue a postgraduate qualification they can be completed part-time alongside your time at work. You can do these remotely, so shop around to find the best option for you.
• If you are taking a year out then it may be possible to get a "Teaching Fellow" job where they fund a PG Cert or PG Dip for you. If you are planning to take on this sort of role, try and prioritise a trust that will provide this. However be aware that you need to apply early in the year and you will not have received this qualification by this time so it will not benefit you.
• Our advice is to explore the free options and aim to attain at least two days of training.

Our Portfolio Review Service

If you want to maximise your chances of getting your top ranking job then you need to prioritise your portfolio score as these are the only marks you have total control over.

For candidates who want to take their portfolio to the next level we offer an exclusive portfolio review service. Our team will go through your portfolio with a fine tooth comb and offer you constructive critique on its content, your self-assessment score, and any gaps in the supporting evidence.

Portfolio Content From Previous Years

If you are here and your application is not imminent then you should familiarise yourself with domains which have previously been present in the portfolio self assessment. It is not uncommon for content which had been previously removed to be re-added with little or no notice, and you may wish to consider obtaining some evidence in these sections just in case.

Look out for our upcoming blog post on this very topic!