ST1 Run-through
Cardiothoracic Surgery ST1: Application and Interview Guide 2026
Eligibility, the 2026 recruitment timeline, the published self-assessment criteria, the two-station interview format and how to prepare.
By the TheatrePass editorial team · updated 1 September 2026 · 8 min read
Cardiothoracic surgery advertises a handful of ST1 posts nationally, and in recent published cycles competition has run beyond seventy applicants per post. By ratio it is the steepest entry point in UK surgical training. If you are applying you already know this, and the anxiety it produces is usually unhelpful: it pushes people into frantic, unfocused preparation or quiet self-deselection. This guide takes the opposite line. The odds are long, the process is knowable, and the candidates who reach the top of the rank order tend to have done a small number of specific things well.
Interview format
Recruitment is national, run by NHS England Wessex for posts across all four UK nations, with interviews online via Qpercom on 2 and 3 February 2026 (keep both days free; the office asks for it in case of technical problems). The interview is two stations: five structured questions lasting about 25 minutes, then three communication skills questions lasting about 25 minutes. The official guide warns that the specific areas can change between applications opening and the interview, and publishes no mark scheme, so prepare the skills rather than a script. Your self-assessment score is carried into the total final score after the interview; no split between the two is published.
737
Applications in 2025, for 10 posts (73.7 per post)
2
Stations: 5 structured questions, then 3 communication questions
59
Maximum self-assessment points, published in full
18
Month experience cap: above it you are ineligible
Self-assessment scoring
The 2026 Scores and Descriptors document publishes all 16 domains across five sections. Undergraduate career carries 11 (prizes up to 6, cardiothoracic electives up to 5), postgraduate qualifications 13, professional development 10, operative skills 10 and supporting activities 15. Two lines deserve special attention. Full MRCS scores 4 points even though no exam is required to apply, which makes an MRCS sitting one of the most controllable gains on the whole form. And operative skills score 10 from a consultant-signed consolidated logbook: opening and closing (laparotomy, thoracotomy or sternotomy) as primary surgeon, plus whole procedures such as appendicectomy or saphenous vein harvest, with 16 or more whole cases taking the full 4.
Evidence that scores
- A consolidated logbook, broken down by incision, closure and whole procedure, signed and dated by a consultant
- A PubMed screenshot for every publication claimed (first-author papers climb to 4 points)
- A QI write-up in the required structure, signed by your consultant supervisor
- A teaching contract stating hours per week, signed by HR
Evidence that scores zero
- A domain uploaded as several PDFs: the guide excludes the whole application, not just the domain
- A publication that cannot be retrieved on PubMed
- A top-10% graduation claim without a signed medical school document
- Case reports (excluded from the publication ladder outright)
Key dates for 2026
| Stage | Date |
|---|---|
| Advert published | 22 October 2025 |
| Applications open | 10am, 23 October 2025 |
| Applications close | 4pm, 20 November 2025 |
| Evidence upload window | 8 to 19 December 2025 |
| Evidence verification day | 5 January 2026 |
| Final shortlist and appeals | 6 to 9 January 2026 |
| Interviews (online) | 2 and 3 February 2026 |
| Initial offers | no later than 5 March 2026 |
| Holding deadline | 1pm, 2 April 2026 |
Competition ratios
A ratio that steep tells you three useful things. First, the interview matters enormously: with little separating strong written applications, spoken performance is usually where the final order is decided. Second, a parallel application to another pathway in the same cycle is rational planning, not disloyalty, and panels do not see your other choices. Third, the headline number overstates the serious field, because it includes speculative and incomplete applications. Confirm the current figures in the official competition data for your cycle, then stop looking at them and spend the time preparing.
What panels look for at ST1
Nobody is selecting for operative talent at ST1. The recurring pattern across person specifications and station design is simpler:
- A safe clinical voice: structured assessment, explicit escalation, honest limits.
- Evidence of pursuit: proof you have tested the decision against working reality rather than a media image of the specialty.
- Insight into the road: training length, competition at later stages, examinations, research expectations and the on-call reality.
- Trainability: composure under follow-up questioning, and the ability to take a correction without losing the thread.
Insight is the differentiator panels mention most. Cardiothoracic training is long, the examination and research expectations are real, and the early years are dominated by ward work and critical care rather than the operating you imagine. Candidates who describe that reality accurately, and want the job anyway, read as appointable.
Evidence of commitment
Build evidence in proportion to the time you have. With a year, you can complete a cardiothoracic audit with a closed loop, attend and ideally present at a relevant meeting, arrange taster weeks in a unit, and gather theatre exposure you can describe specifically: what the operation was, what you saw, what you asked. With three months, prioritise a taster week, a tidy local presentation of any existing project, and meticulous mapping of what you already hold against the current self-assessment guidance. Research counts where you can describe your own contribution specifically; a small project you owned and can explain beats a long author list you cannot defend. Verification discipline matters as much as volume: every claim needs a certificate, letter or logbook entry filed and legible before the upload window opens.
Common clinical scenarios
Clinical questioning at ST1 stays at the level of a competent foundation doctor with specialty awareness. A recurring scenario is the post-operative cardiac patient who deteriorates on the ward: falling blood pressure, rising heart rate, poor urine output, perhaps increasing drain losses. The scoring approach is structured and explicit: A to E aloud, oxygen, access, bloods including a gas and crossmatch, fluids considered carefully, and early, named escalation to the registrar or consultant with a clear summary of what you have found and done. Awareness of bleeding and tamponade as causes earns marks at the level of recognition and urgency, not management detail. The panel is listening for the candidate who keeps the patient safe while help arrives, and says so out loud.
Motivation under questioning
Expect the panel to test whether your commitment survives contact with reality: why cardiothoracic surgery, what you saw during your exposure that confirmed it, what nearly put you off, and what your plan is if you are not appointed this cycle. Answer with specifics and a calm reapplication plan. In a field this oversubscribed, panels respect candidates who understand the odds and have prepared for both outcomes.
How to prepare
- 1Weeks 8 to 6: map and learnRead the current applicant guidance and person specification. Work a question bank by station family and collect two or three frameworks you can reuse under pressure.
- 2Weeks 6 to 2: speak everythingMove all preparation aloud: timed answers, daily, with follow-ups. Review recordings or transcripts for filler words, missing safety statements and overruns.
- 3Final fortnight: pressure-testRehearse under interruption and redirection. Prepare one-line spoken defences of every portfolio claim. Taper in the last two days and arrive rested.
Interview Library › Structured questions › Suspected Tamponade (Cardiac ICU)
Structured questions
Suspected Tamponade (Cardiac ICU)
You are the resident doctor covering the cardiac intensive care unit overnight. A patient is six hours out from coronary artery bypass grafting. The nurse calls you: blood pressure has drifted from 115/70 to 85/55 despite a fluid bolus, heart rate is 118, central venous pressure has climbed from 8 to 17, urine output has fallen to 10 ml…
How would you assess and manage this patient?
“"This pattern worries me, so I would go to the bedside immediately and assess with an ABCDE approach while asking the nurse to pull up the trends: blood pressure, heart rate, central venous pressure, hourly drain output and urine output. Falling blood pressure with a rising venous pressure, falling urine output and drains that have gone quiet after earlier brisk drainage is cardiac tamponade until proven otherwise,…”
“At the bedside I would check the airway, give oxygen, listen to the chest, feel the peripheries, and look at the monitor and the pacing box if epicardial wires are connected. I would send an arterial gas for haemoglobin and lactate, request a 12-lead ECG to look for ischaemia or a graft problem, and confirm there is a valid crossmatch with blood available.”
Why this scores
“cardiac tamponade until proven otherwise, because mediastinal drains block with clot, and an empty drain…”
names the diagnosis from the trend and pre-empts the classic false reassurance of a dry drain.
“I would call for senior help early, the cardiothoracic registrar and the intensive care team, and I would say…”
escalates with a specific, named concern rather than a vague request for review.
References
Special Circumstances Guidelines Resuscitation Council UK
Structured questions · 44 scenarios
22 more…
How TheatrePass helps
TheatrePass exists for the spoken half of this plan. Surgeon-written questions and frameworks cover clinical, motivation and professionalism stations, and the mock interviews rehearse you aloud with follow-up pressure and structured feedback, so your first interrupted answer does not happen on interview day.
Interview formats and selection criteria change between recruitment cycles. Content is reviewed each cycle and dated; always confirm details against the current national recruitment guidance.
