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.

Different Surgical Specialties in the UK

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

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 Overview of Specialty (or GP) training in the UK for more information regarding how the training is structured.

To simplify and as an exmaple – 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).

So, if you want to be a Urologist – you have to go through 2 years of Core Surgical Training and then 6 years of Urology Higher Specialty Training

Let’s look at some statistics

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

  Applications Posts
Cardiothoracic Surgery 33 9
General & Vascular Surgery 396 257
Neurosurgery 12 2
Ophthalmology 42 18
Otolaryngology 132 56
Pediatric Surgery 42 10
Plastic Surgery 134 32
Trauma & Orthopaedics 409 142
Urology 125 47


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 mentioned in the form along with documentary evidences.

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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 that CREST form signed off.

Can I get into UKFPO Foundation training?

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.

On another thought, you also have the option to try for UKFPO foundation training starting from FY1 as an IMG (only if you have not done any form of internship/house-job following your graduation.

A complete timeline to apply for UKFPO foundation training can be found here- Internship and UKFPO.

Core Surgical Training

Core level 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 ICU.

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.

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.

There is NO WAY to bypass a training (e.g. Foundation Training, Core Surgical Training) without proving that you have achieved those competencies in some way or form. It can be from a non-UK work experience or from UK non-training clinical experience.

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. Please check out complete step-by-step course on RoadtoUK Academy.

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.

Certificate of Readiness to Enter Higher Surgical Training is required to be signed off to prove your alternative Core Surgical Training competencies.

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 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 higher surgical training directly without doing core surgical training (CST)?

Yes, it is possible. But you need to have MRCS completed AND the Certificate of Readiness to Enter Higher Surgical Training signed off before you can apply.

How can I get this “Certificate of Readiness to Enter Higher Surgical Training”?

Download it from the link provided above under the heading of “Evidence of Core Competence” and read the document. It is self-explanatory.

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!

Need further explanation?

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73 thoughts on “Surgical Training in the UK for International Doctors (IMGs)”

  1. Hello!I am Joyanta from Bangladesh. I passed MRCS Part A last year.I don’t exactly know when I will be able to take MRCS Part B exam as there is some issues with travelling to UK from here due to Covid19. I have been working for about 10 months in the department of general surgery of tertiary level hospital here. I have checked person specifications of different surgical specialties. Neurosurgery ST1 mentions applicant must have 24 months or less clinical experience of which no more than 12 months experience in combinations of the following specialties:Neurosurgery, Neurology,Neuro-radiology, Neuro-intensive Care. Does this 24 months clinical experience mean only surgical experience or any clinical experience? I am asking this because there is a requirement of 12 months medical experience after gaining full GMC registration. I hope you will reply.
    Thanks in advance.

    1. It means when you apply for neurosurgery ST1 you can’t have overall more than 2 years of clinical work experience already. This can be any clinical work. In this period you can’t have worked more than 12 months in those specific specialties. It’s an over qualification criteria. Think of it as that they don’t your glass already filled with clinical and neurological experience, they want a certain amount or less than that.

  2. Hi.
    I just came across your page and you’re doing amazing work helping people.
    I’m a mbbs graduate in India and I’ve been really confused regarding working in UK as a surgeon.
    Since we have 2 options of either going now via Plab or after doing Ms surgery from India and then give mrcs and go.
    My main concern is, since i want to be a neuro surgeon what will be my pathway?
    If i give mrcs after pg, I’ll enter st3 so does that mean I’ll have to practice as a General Surgeon?
    Or is there another exam i can clear to Practice neurosurgery.
    Hoping to hear back from you soon, will be of great help. Thankyou!

    1. Neurosurgery training is a run-through pathway. They take trainees at ST1 level. General surgery is a completely separate pathway not related to neurosurgery. In NS training you start from ST1 and follow it’s curriculum throughout until the end.

  3. I have completed MS surgery from Nepal.How to apply for speciality training in Gastrointestinal and hepato pancreatic biliary surgery in UK?

  4. Abdulkadir Abdulkadir Gimba

    If I do my non-training Job in Wales in general surgery or orthopedic and I’m over qualified for CST so I want to enter into Surgical Training at ST3 level, does that mean I can get placement for training in Say England or Scotland? Because in the ST3 placement Preferences documents all I saw was locations in England and Scotland. Does that mean Wales has their training differently.

    1. They may employ via a separate application process but the competencies and requirements are nationwide the same.


    I have a query , I have competed my PG in General surgery back in my home country (3 year) , after that I have almost 2 years exp. in neurosurgery , so can I get my CREST form signed for core surgical competencies by overseas consultant and apply for General surgery specialty training , will my 2 years of neurosurgery exp. in anyway affect that.
    Thank you

    1. Please look at the alternative certificate first and see if you have done everything mentioned there. It is unlikely that you have done everything a core surgical trainee does if you have only worked in neurosurgery.

  6. When during the year can we apply for core surgical training ? and can you please explain the application process for core surgical training?

  7. Thank u Very Much for this info,,, let’s say I have completed MRCS and have 3 years experience in regarding the alternative core competency certificate,,,,,my Hospital Consultant whom I have work with ,,Is he eligible to sign the Certificate in my home country and then after GMC registration done ,,,Can I Apply for Speciality Training??I’m IMG

  8. 1)with my MRCS done from my home country and no prior surgical experiences and can i join straight to CT-1 non-training jobs or i will need to have CREST signed off?
    2)will i get an Core Surgical Competence signed off from a Non-training jobs to apply for ST-3?

  9. i have passed MBBS & then MRCS exam from India and if i want to get a Core Surgical Competence then how can i get that? if i want to apply for neurosurgery training then do i have to start from CT-1 or ST-3? please advice. thanks

    1. Neurosurgery doesn’t have any core surgical training in its pathway.
      But yes, you will require to pass MRCS by ST2 level but even if you have MRCS, neurosurgery starts from ST3.

  10. Karthikeyan Dhandapani

    hi, thanks for the info, much appreciated. i would like to know whats the best pathway to enter uk and gmc registration , either mti ot mch? please tell the pros and cons, thank you

  11. what about OMFS training? Does it have run through program? Is the “run through program” – just combination of Core surgical training + CT 3 training onwards? Its not really shorter right than normal pathway and Im guessing you just to sit one interview?
    For IMGs, is it possible to start from CT3 after one interview for CT3?. (after getting CREST and passing both MRCS?)

    1. If you directly want to apply for ST3 OMFS you need to have:
      1. MRCS completed
      2. Certificate to enter Higher Surgical Training (NOT CREST) along with minimum 6 months experience in OMFS already.
      3. To have a competitive edge you will also need courses like ATLS, Basic surgical skills, Care of critically ill surgical patient etc.

      1. Thanks. I already have CCrISP, ATLS, BSS etc. I will be sitting MRCS during my second degree. What is “higher surgical training certificate”? I dont need CREST?
        Also, do you know whether 6 months of OMFS experience equates to “dental resident job” that’s required for GDC registration. (in order for 2 years of dental residency waiver)

        1. CREST is required to join ST1/CT1 level training job. As you will already be coming after MRCS you can’t enter CT1 of surgical training (over-qualification). SO your target is to enter ST3 of OMFS training. For that you need a that certificate signed which essentially proves that you have the competencies of a core surgical trainee obtained via a alternate pathway (UK or non-UK work experience). And specifically for OMFS, you need that 6 months of OMFS experience (if during that resident job you worked in OMFS, yes that will be counted).
          Certificate of readiness to enter higher training is already linked in this article under “Evidence of core competence”.

  12. CST is very competitive for everyone. That clause means you have to have an FY2 level experience (post-licensing experience) in the UK or non-UK or even combined of a total 12 months. If you have worked in your country AFTER getting full registration from the local medical council, that will also be counted.

    1. Oh yes, as a surgical trainee you do have to follow a curriculum which involves many procedures that you have to be able to do independently. It is the duty of your consultants to teach you the hands on things practically in the OT, if they are convinced that you have achieved that competency, then you get more opportunity to do things.

  13. I have seen in another post that you have mentioned about the possibility of getting into CST through WAST.But the one year of WAST includes majority of psychiatry and GP postings as far as i understood.So i want to knw whether i will be getting any surgical experience if i take up WAST. (As here it is mentioned we need to have 18months or less postinternship experience in surgery to get into CST)
    Also if i have a post internship clinical experience of few months in my country ,will that be counted while applying for CST?

    1. Previously there was RLMT which barred IMGs to apply for Round 1. But if you were already on a deanery sponsored visa you could have applied in round 1. As CST is a competitive training to get in, not being able to apply in round 1 was a HUGE disadvantage. That’s why the suggestion then was to get deanery sponsored visa in whatever way possible and at least be able to apply based on your previous experience and portfolio.
      But since October 2019, there is no Resident Labour Market Test (RLMT) for medical jobs. Anyone with entry criteria fulfilled can apply in round 1.
      Please point us the post that we said that, we will update it.

  14. Osain Peterside'e

    Waoo… This article has really cleared my mind on what to expect in the UK. I will plan towards that. Thank you

    1. You’re welcome. We’re glad you have got helped from here. Please share this article and help others too.

  15. Enamur Rahman Sadaf

    1) After MRCS from one’s home country, can someone go directly for core training signing off in non training post without CREST?
    2)Is it possible to get into ST3 training of Vascular or Cardiothoracic surgery after MRCS and Core Training competence signed off?

    1. 1. You can’t join any CT1/ST1 training without CREST.
      2. You can’t join any ST3 level training without EITHER doing the core level training OR getting the alternative core competence certificate. For the latter you have to do non-training job and collect evidences of your own accord.

  16. Ukkasha M Nasir

    So if I have morethan 18 months surgical experience post internship, I can get into coresurgical non training jobs and then apply for ST3 surgical training afterwards?


    Does this mean that an IMG who has 1 year internship, and now working in Surgery should not exceed the 18 months experience.? I am rather confused about the Foundation aspects of this clause.

    1. Your surgical rotations during your internship is excluded from the 18 months time frame. As a rule of thumb, your internship doesn’t amount to anything else other than forming your base to become a doctor.

  18. Jalilarah Nassozi

    I have three years experience as a medicalofficer post internship how will igo about surgical residency if people with 18+ months of experience in surgical field dont qualify for core surgical training

    1. Jalilarah Nassozi

      Yes am placed in both surgical and medical departments, my hospital as a doctor you have to work in all departments simulteneously so i do work in obs/gyean, pediatric, general surgery internal medicine and psychiatry

        1. Enamur Rahman Sadaf

          So if the Medical officer job is specifically in any of the surgical departments will be counted, and the combo experience in different departments (I mean generalized role) won’t be counted under the rule of less then 18 month exposure in surgery…or anything other?

        2. Anything not related to surgery, like medicine, emergency medicine, psychiatry etc. these experiences will not include in that 18 months rule.

  19. Is it necessary to have settled Visa or 5 years stay duration to apply for ST1 level ?
    Even we as IMG with CREST signed in our home country can apply can for ST1 or not once we are in U.K and working under NES ( or NHS)?
    You mean Neurosurgery,CTS and ophthalmology dont have separate recruitment as core training or speciality, so does it mean that after Foundation competency we can directly apply for ST1 which is beginning of Run through in those speciality?
    Plz kindly advise. And thank you?

    1. Your previous experience along with any publications, research that you have participated in also teaching and leadership experiences all play a role in any job application in the UK

  20. Switching from a TIer 4 visa , I mean how does that work? Do i get into any Masters course in surgery then switch ? My situation is I have MRCS and and almost 5 years post-internship experience in surgery and i want to get into orthopedics. So to get into round one in ST3 do I look for LAT posts or is there anu another way to do it.

    1. If you are want to do any master’s course in the UK, then upon finishing you want to apply for training – then it will be a switch from Tier 4 to Tier 2. As you have completed MRCS, your target should solely be working in orthopedics department and building a portfolio and when you are able, apply for ST3 level training. It can take 5 years, there might be some posts open as LAT even.

  21. So there is a mention of 3 and 1/2 year gap after foundation competency signed off.i want to know is it the ending date of internship in my home country or fy2 competency that i would get after entering uk?

    1. I think you misunderstood the condition. The foundation competencies need to signed off for a post which was in the last three and a half years of the starting of the training post.
      For example, a training post will start on 7 Aug 2020. So the post for which you will get your foundation competencies signed has to be after 7 February, 2017. You can’t use a post in 2015 for foundation competency for a training post in 2020.
      I hope I was clear.

  22. Seif eldin Ghareeb

    Hello. Thank you do much for your help its invaluable to us really. I want to know about clinical gaps for like less than a year after finishing my residency in egypt before applying for jobs in nhs. The time will be needed to finish mrcs part b. OET. ALS. Publishing my papers.

  23. Simon Sonny Abraham

    my wife is a british national and therefore i have a spouse visa.Will i be eligible for Round 1 of CT?

  24. so i have my mrcs qualificaiton and have started applying for my GMC registration. Heres the issue i need help with
    i have completed my superspecialty trainng in paediatric surgery in India. so in the part of the form that asks If iam applying in a CCT specialty ,to select my specialty from the list below: So do i apply for paediatric surgery or general surgery

  25. Thank you. That was very much informative. Although , I have a question. If I complete MRCS in Bangladesh and then try to enter UK, where do I need to start from? What are the chances?

    1. If you had completed MRCS before coming to the UK, you will need to work to get your core surgical competencies signed along with getting with portfolio enriched. It is difficult to talk about your chances as everyone’s CV is different. But, even with a perfect CV, if there is no post for you to apply because of your visa restriction – then you will have to spend years doing non-training job and find other ways as mentioned in the post.
      Edit: There is no visa-restriction now. 🙂

  26. I personally want to seek a career in oncosurgery…I don’t even see a specialty training for that…how can I pursue a career in this field then

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