Surgical Training in the UK for International Doctors (IMGs)

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training in surgical specialties

You won’t hear a lot of chatter about international medical graduates becoming a surgeon in the UK. The training for surgical specialties in the UK is competitive, long, and stressful but I won’t be the person to say that it’s impossible for international graduates.

The Surgical Specialties are

  • General Surgery
  • Vascular Surgery
  • Pediatric Surgery
  • Trauma & Orthopaedic Surgery
  • Otorhinolaryngology
  • Plastic Surgery
  • Urology
  • Neurosurgery
  • Cardiothoracic Surgery

Neurosurgery, Cardiothoracic Surgery, are run-through, while all other specialties require a Core Training module called ‘Core Surgical Training‘ to pursue higher training in surgical specialties starting from the ST3 level in UK.

Please go through Specialty (or GP) training in the UK for more information regarding how the training is structured.

To simplify- the training in Urology (or any of them listed above except for NS and CTS) starts from ST3 level. There is no ST1 or ST2 for Urology, that core level training is to be completed as Core Surgical Training (CT1 and CT2).

Let’s look at some statistics

CTST fill rates

The statistics above are for the Round 1 fill-up rate for the CT1/ST1 specialties. We can clearly see a few important points:

  • The number of available posts is VERY LOW compared to posts in general practice or internal medicine training
  • In Round 1 of the application, ~100% of the posts get accepted, making these training really competitive to get into.

Let’s look at the competition ratio of higher specialty training below:

2017 – ST3 Competition Ratios

2018 – ST3 Competition Ratios

Cardiothoracic Surgery339
General & Vascular Surgery396257
Pediatric Surgery4210
Plastic Surgery13432
Trauma & Orthopaedics409142


I hope it is clear from the above statistics as to how COMPETITIVE and SCARCE training posts in surgical specialties are in the UK. It’s even competitive in Round 1, with only 35-40% of the applicants actually get into training.

The Pathway of Surgical Training in the UK

Like all the training in the UK for doctors, the surgical training pathway has three parts in it too:

  1. Foundation training
  2. Core training
  3. Specialty training

A few specialties which are run-through doesn’t have separate recruitments for core and specialty training, e.g. neurosurgery, CTS, etc.

Foundation training

If you are a non-UK/EEA medical graduate, then you have three options:

  • Obtain the equivalent of foundation training outside the UK
  • Obtain the equivalent of foundation training inside the UK
  • Getting into the foundation training by UKFPO.

You can get the certificate of readiness to enter the specialty training (CREST) form signed by your overseas consultant if you had worked under them for at least three months after completion of your formal internship/house job, and you fill the other stipulations.

CREST & Portfolio for IMGs
Click the photo to take a FREE COURSE!

In the same way, you can start working in the UK as a non-training doctor at FY2/CT1 level and after working under a consultant for at least three months, you can get those competencies signed off.

More information regarding Internship and UKFPO can be found here.

Getting into UKFPO’s two-year foundation training is not applicable for those who have finished formal internship/house job following their graduation. If you hadn’t done your formal internship/house job after graduation for any reason (like taking USMLE, etc), you should do it before you think about moving to the UK. The reason for this is that until or unless you have a right to work i.e. having UK nationality or having a spouse visa (NOT dependent visa), it is very difficult to get a post in the foundation training by UKFPO. You will have to take PLAB both ways (UKFPO or home country’s internship), as you did not graduate from the UK/EEA.

Core Surgical Training

Core training for surgical specialties is called ‘Core Surgical Training‘. It’s a 2-year program, typically with 4-6 months rotations in different surgical specialties, or occasionally related specialties like ITU.

As we have already established, this training is incredibly competitive to get into, and many UK graduates even take out-of-program, non-training jobs after their foundation training to enrich their application for CST.

On top it being highly competitive, CST, unlike IMT has a big catch in their person specifications:

Applicants must have 18 months’ or less experience in surgery (not including Foundation modules) by the time of the intended start date.” (The experience can be at any level in any country)

To be put plainly – If you have MORE than 18 months of clinical experience in the surgical field, you’re OVERQUALIFIED to apply for core surgical training.

Membership of The Royal College of Surgeons (MRCS)

The Intercollegiate Membership Examination of the Royal Colleges of Surgeons (MRCS) tests the knowledge, experience and clinical competence expected of trainees at the end of their core surgical training.

The MRCS examination has two parts:

  • Part A (written paper)
  • Part B Objective Structured Clinical Examination (OSCE).

Specialty Training

To apply for ST3, your core surgical competencies need to be signed along with MRCS. You will also need to have completed MRCS before you apply. The training post is a direct road towards obtaining Certificate of Completion of Training (CCT).

During this time the trainees take Joint Surgical College Fellowship Examination (JSCFE) which makes them a Fellow of the RCS i.e. FRCS.

Fellowship of The Royal College of Surgeons (FRCS)

Success in the Joint Surgical College Fellowship Examination (JSCFE), and thus obtaining Fellowship of Royal College of Surgeons (FRCS), is a mandatory requirement for the award of a Certificate of Completion of Training (CCT) or a Certificate of Eligibility for Specialist Registration (CESR). It allows the trainee to formally demonstrate that he or she has attained the standard of clinical competence required of a newly appointed general surgical consultant.

It consists of two sections. Section 1 needs to be completed first in order to be eligible for section 2.

What an IMG (non-UK, non-EEA, without a settled visa) can do to join the surgical training?

I assume that you know that the FIRST TARGET is always to get GMC registration with a license to practice. After getting GMC registration, the initial approach should be to acclimatize yourself with the NHS by way of doing non-training jobs.

Check here about the ways you can get GMC registration.

Competencies are a set of knowledge, skills and abilities, and other requirements that are expected from someone to perform a job. All the training levels have their specific list of competencies to achieve in the end. There are ways to gain those competencies even without being in a formal training program. You would have to take control of your own training. Also, this long route has another blessing- you can do an SHO or registrar level non-training job for 5 years, and become eligible for a settled visa, thus becoming eligible for Round 1 of ST3 applications.

1. Evidence of Foundation Competence

Certificates of Readiness to Enter Specialty Training (CREST) will be accepted where the assessed post has been wholly undertaken in the 3½ years prior to the commencement of the training post to which the applicant is applying.

CREST can be signed off by your supervising UK consultant while you are doing a non-training job or by your consultant back at home while you worked being a fully registered doctor.

CREST form cannot be signed off for the duration of your work while you were in house-job/internship. You have to work as a fully registered doctor.

2. Evidence of Core Competence

You can continue working at the non-training SHO level and find your way to maintain an ISCP e-portfolio and eventually get your Core Surgical Competencies signed by your supervising consultant. This involves clear communication with your supervising consultant(s) and making them aware of your intentions of getting the competencies signed.

3. Passing MRCS and boosting your portfolio

Getting your MRCS done as soon as possible is something you should know already. Other than that, there are many things that influence your specialty training application. As the interviews are very competitive, and that’s why emphasis needs to be given on your portfolio.

  • Postgraduate degrees and qualifications and additional degrees
  • CPD courses
  • Additional Achievements
  • Quality Improvement (clinical audit)
  • Teaching experience
  • Training in teaching
  • Presentations
  • Publications
  • Leadership and management
  • Commitment to surgery
  • Clinical/procedural experience in both surgical and non-surgical posts
  • Organization of your portfolio

4. Getting other specialty-specific criteria fulfilled

Please have a look at the Person specifications for your coveted ST3 training to see what exactly they are looking for.

An overview of Surgical Training in the UK

Surgical training in the UK

Surgical Training Application Process

Unlike many medical specialties, the training application process for surgical specialties in the UK is not all streamlined by one single recruitment office. Each specialty has different recruitment offices. The following links will give you an idea of the timeline of application opening and related handbooks and applicant guidance:

Surgical Ophthalmology Training in the UK

It has a completely separate pathway which does not involve taking MRCS. The surgical ophthalmology training is termed as Ophthalmic Specialist Training (OST), which runs from ST1 to ST7 (7 years).

Trainees will need to pass three exams in order to progress through training:

  • Part 1 FRCOphth, which trainees will need to pass before they enter into the third year (ST3) of ophthalmic specialist training
  • Refraction Certificate, which trainees will need to pass by the end of the third year of ophthalmic specialist training
  • Part 2 FRCOphth, which has a Written and Oral component. Trainees are required to pass this examination by the end of the seventh year (ST7) of ophthalmic specialist training

Check here for recruitment timeline and person specifications- Ophthalmology ST1 & ST3 recruitment

Please note “Medical Ophthalmology” is a separate specialty which involves doing Internal Medicine Training, followed by MRCP and 4 years of Medical Opthalmology Training.

Frequently Asked Questions

So you’re saying it’s not impossible to get into traiing in the UK?

We can clearly see from the statistics how difficult it is for the UK graduates themselves to get into surgical training. But, yes, at the end of the day, it’s just highly competitive, NOT impossible.

What if I never I get into training?

That’s not the end of the world or your NHS career. You can continue working in your non-training registrar level post and still work as a surgeon, you’d just not ever have had a structured training program. Due to the intense level of competition in surgical training, a lot of doctors simply opt for non-training registrar level jobs and hope to achieve CESR in the long run.

So I can enter specialty training without doing core surgical training (CST)?

Yes, but as mentioned above, there are certain stipulations to be followed before you can apply for ST3 posts. Have a look at the specific person specifications.

In the end, I don’t want to inflate anyone’s expectations nor do I want to sound pessimistic. I have met consultants in surgical specialties who are international graduates, senior registrars who have been in the UK for many years and also junior doctors who got into ST3 surgical training from non-training jobs. And all of them expressed in unison that – training in surgical specialties is not impossible, but you would have to be ready for hard work and focus more on the process rather than the outcome.

Good Luck!

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Two international medical graduates who work as Internal Medicine Trainees in the UK write this blog with the aim to guide others around the world.

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