The surgical training pathway

Once a student graduates from medical school, he or she embarks on a further two year period of foundation training to acquire the general competencies needed in a junior hospital doctor. This will involve working with nurses and other allied health professionals in the emergency department and on hospital wards, delivering the day to day medical service to in and out patients.

Foundation Year doctors will be assigned (by the relevant regional post graduate training Dean) a training supervisor who will assess their performance against a common curriculum (approved by the GMC as the regulator) and education syllabus.

Having acquired the necessary foundation in the practice of hospital medicine, the next stage involves two years of core training. At this juncture, the postgraduate doctor in training will have established a clear future medical career preference based on the experience of undergraduate training, aided further by the foundation time. For example, some will opt for general practice, some to be physicians, anaesthetists or radiologists, and some for surgery:  their common training curriculum and educational syllabus will be tailored accordingly.

Those contemplating surgery usually have a clear idea of their potential specialty preference, although this is no guarantee:  the ratio of core trainee T&O applicants to available places in the next stage of training is currently 1.6:1. Core trainees are invited to apply, and are interviewed for posts in the next stage of specialty training, through a national selection process.

If they are successful they are allocated a national training programme number and join a regional training ‘rotation’ as Specialty Trainee 3 (ST3 – designating the fact that they are in the third of a seven year formative training programme – which they finish as ST8).  STs are often called “registrars” to indicate that they are formally registered in surgical specialty training. At this juncture, the content of the STs’ training curriculum is:

    • Endorsed by the Intercollegiate Joint Committee for Surgical Training (JCST –
    • Approved by the GMC, having been constructed and developed as a collaboration between the relevant JCST Specialty Advisory Committee (SAC) and surgical specialty association.
    • For T&O STs, the SAC for T&O and the BOA jointly create and develop the surgical training curriculum.
    • Each rotation has a designated Training Programme Director, and each ST is assigned a supervisor who must be a consultant.
    • The T&O curriculum is available on line via the Intercollegiate Surgical Curriculum Programme (ISCP – ).
    • STs keep comprehensive records of their training progress and assessments in a electronic log book – .
    • The FRCS is taken during years 7 or 8 of the programme.
    • During years 7 and 8 of the programme, the ST may wish to develop a particular sub-specialty field of expertise beyond the generality of T&O.
    • At this juncture the CCT holder is eligible to apply for the GMC’s specialist register and for NHS consultant posts.