Surgical Training in the UK for International Doctors (IMGs)

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.

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.

Find latest competition ratio of different specialty here – Specialty competition Ratios.

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.

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!