Core Surgical Training
How to Maximise Points in the CST Portfolio
The current portfolio scoring tables for every domain, what changed for 2026, the evidence rules, and how to earn the top grades in time.
By the TheatrePass editorial team · updated 3 September 2026 · 12 min read
The portfolio turns years of work into your biggest single scoring block, and the assessors now question you on it face to face. This guide reproduces the published scoring indicators for every domain, sets out what changed for 2026, and explains how to gain points in each domain with the evidence the assessors will accept.
The 2026 timeline
| Stage | Date |
|---|---|
| Applications open | 23 October 2025 |
| Applications close | 20 November 2025 |
| Invitations to the MSRA no later than | 15 December 2025 |
| MSRA exam window | 6 to 19 January 2026 |
| Invitations to interview | 13 February 2026 |
| Portfolio evidence upload window | 16 to 26 February 2026 |
| Interview window (online, Qpercom) | 2 to 11 March 2026 |
| Initial offers released | 24 March 2026 |
How the points are split
| Component | Share of the final ranking |
|---|---|
| MSRA (scaled to a 0 to 10 point scale) | 10 per cent |
| Portfolio station | 45 per cent |
| Management and clinical station | 45 per cent |
The MSRA is sat first, and only the top 1200 MSRA scorers are invited to interview and to upload portfolio evidence. The interview is two 15 minute stations: a management and clinical station, and a portfolio station in which the assessors review your uploaded evidence for 10 to 15 minutes and then question you on two of your achievements.
The portfolio and the index page
There is no Oriel self-assessment. When you are invited to interview you upload your evidence with an index page that states the grade (A to E, A highest) you believe applies to each domain. The index page is mandatory: candidates who fail to include it score 0 for their portfolio evidence. Submit at most one item from each box in each domain, and only the evidence the notes ask for. The assessors confirm or adjust your grade at the station, so grade honestly against the indicators below.
Commitment to surgery
Operative experience
Hands-on surgical involvement is evidenced through a consultant-validated eLogbook. Every row requires verified logbook evidence.
| Evidence | Grade |
|---|---|
| Involvement in 40 or more cases | A |
| Involvement in 30 to 39 cases | B |
| Involvement in 20 to 29 cases | C |
| Involvement in 11 to 19 cases | D |
| Involved in 10 cases or fewer, or no evidence | E |
Forty cases assisting or supervised sounds a lot, but nearly every FY1 post has a surgical rotation: get into theatre on every list you can, log every case the day it happens, and have the summary signed before you rotate.
Surgical experience
| Evidence | Grade |
|---|---|
| A surgical taster week (minimum five days, which may be non-consecutive), or an elective in a surgical specialty as a medical student (minimum four weeks), with proof of completion | A |
| No surgical taster, elective or surgical placement | B |
If you did not do a surgical elective, book a taster week now: it is the cheapest A in the portfolio, it lets you explore a subspecialty, and it adds cases to the logbook. Some surgical societies offer bursaries for electives.
Quality improvement and clinical audit
This domain rewards the complete audit cycle: project design, data collection, analysis, implementing change, and reassessment. Lead means you participated in all stages and in at least two cycles.
| Evidence | Grade |
|---|---|
| Lead in all aspects of a surgically themed clinical audit or QI project that has demonstrated change (second cycle or closed loop) | A |
| Lead in all aspects of a clinical audit or QI project that has demonstrated change (second cycle or closed loop), not surgically themed | B |
| Contributor in a clinical audit or QI project that has demonstrated change: active participation through multiple cycles without a leading role | C |
| Involved in a clinical audit or QI project, for example data collection in at least one cycle | D |
| None or other | E |
Additional points for presenting the project
Evidence is first authorship on the presentation slides plus the letter of acceptance for the meeting; you must have presented it personally.
| Evidence | Grade |
|---|---|
| Presented both cycles of data, or the intervention and change aspects, at a meeting | A |
| Presented one cycle of the project at a meeting | B |
| Did not present any aspect of the project | C |
Choose the project in FY1, ideally at induction, so that both cycles are complete and presented before the upload window. The same project cannot score here and in the presentations and publications domain: credit it in whichever domain gives the higher grade.
Presentations and publications
Original research, case reports and review articles are all routes to a publication. Evidence is the PubMed identifier for publications, an ISBN for book chapters, and the programme or acceptance letter for presentations. Pay-to-present conferences do not count as peer-reviewed presentations, and oral poster presentations are not oral presentations.
| Evidence | Grade |
|---|---|
| Won the top prize for an oral presentation at a national or international medical meeting convened by an accredited institution, after invitation or selection (personal delivery required; not an oral poster) | A |
| First author of a PubMed-cited publication (or in press), not a case report or editorial letter (PubMed ID required) | A |
| Delivered an oral presentation at a national or international medical meeting convened by an accredited institution, after selection (personal delivery required) | B |
| First author of a prize-winning poster or oral poster at a national or international medical meeting (personal delivery required) | B |
| First author of a PubMed-cited case report or editorial letter (or in press), or a published book chapter related to medicine (not self-published) | B |
| Named co-author of one PubMed-cited publication (or in press) | C |
| First author of a poster or oral poster at a national or international medical meeting | D |
| Oral presentation at a regional medical meeting after invitation or selection | D |
| Cited collaborative author in a research collaborative publication (named authorship not required) | D |
| None or other | E |
Publication and presentation take longer than anything else in the portfolio. Submit abstracts early in FY1, join a research collaborative for a guaranteed D, and write the case report or chapter while the research paper is in review.
Teaching experience
Teaching is evidence of your commitment to education, whoever you teach: peers, medical students or other healthcare professionals. The top grades go to a programme of at least four sessions that you designed and organised with local educators and delivered at least four of. The evidence is a consultant's letter confirming your part in designing and delivering it, together with the formal feedback you collected or a senior observer's confirmation.
| Evidence | Grade |
|---|---|
| Worked with local educators to design and organise a face-to-face teaching programme (four or more sessions) for healthcare professionals or medical students, and delivered at least four sessions | A |
| Worked with local educators to design and organise a teaching programme (four or more sessions) in an online format, and delivered at least four sessions | B |
| Worked with local educators to design and organise a teaching programme (four or more sessions), and delivered fewer than four sessions | C |
| Provided regular teaching for healthcare professionals or medical students over the last year (four or more sessions a year), or undertook an educational activity focused on learning to teach | D |
| No teaching provided | E |
How to set up a teaching programme
- 1Start at inductionBegin in the first weeks of FY1; a programme needs months to design, deliver and evidence.
- 2Outline the programmeSession titles, the audience, the setting, the teaching style and who will teach, on one page.
- 3Take it to your educational supervisorDiscuss the outline at your first meeting and ask who in medical education to approach.
- 4Meet the medical education departmentArrange a meeting with the head of medical education; the letter confirming your role in design and delivery comes from here.
- 5Plan in detail once approvedDates, rooms, learning objectives, feedback forms for every session.
- 6Recruit and deliverEducation departments often circulate requests for junior doctors to teach, with certificates and formal feedback attached; answer them, and use the same channel to recruit co-tutors.
- 7Consider an online seriesA virtual teaching or webinar series is accessible and can reach a regional or national audience, though face-to-face delivery earns the A.
The evidence you will need
- Consultant-signed eLogbook summaries for operative experience.
- Taster week or elective completion certificates for surgical experience.
- Both cycles of audit data, the implementation record and the second-cycle results for quality improvement, plus first-author slides and the acceptance letter if presented.
- PubMed identifiers for publications, and slides with acceptance letters for presentations.
- Consultant letters and participant feedback for teaching.
A registrar's perspective
One of our contributors, now a plastic surgery registrar on a competitive London rotation, finished medical school in the lower half of the year academically and still ranked highly for CST, because exam performance is a small slice of the points. Most of the score came from audit work, teaching, clinical performance and projects. The lessons: read the scoring specification closely and set yourself targets against each domain; share the audit and research load with peers, mentors and working groups, because the application costs time and money and nobody does it well alone; and ask for specific guidance and mentorship when you need it.
Interview Library › Management and clinical › Postoperative Sepsis After Emergency Laparotomy
Management and clinical
Postoperative Sepsis After Emergency Laparotomy
You are the surgical SHO covering the wards overnight. A nurse asks you to review a woman in her sixties who is three days after an emergency Hartmann's procedure for perforated diverticulitis. Her NEWS2 score is 7: temperature 38.6, heart rate 118, blood pressure 96 over 58, respiratory rate 24, oxygen saturations 94 per cent on air,…
How would you assess and manage this patient?
“"I have been called about a post-operative patient with a NEWS2 of 7, three days after an emergency Hartmann's procedureSigmoid resection with end colostomy and closure of the rectal stump, described by the French surgeon Henri Hartmann in 1921.Hartmann H, 1921. This patient sounds critically unwell and I would go and assess her immediately. I would ask the nurse to prepare the drug chart, fluid chart and operative notes for my arrival, would kindly request a fresh set of observations, and would alert my registrar on the way that there is a septic…”
“At the bedside, I would first ensure that the patient is stable and would put out an emergency call if there was any concern of haemodynamic compromise. Otherwise, I would begin my assessment following the CCrISP protocol and would first examine the airway. If the patient is talking, then the airway is patent and I would move on to assess breathing.”
Why this scores
“would alert my registrar on the way that there is a septic post-operative patient on the ward”
the CCrISP opening statement: prioritisation is signposted before the bedside is reached, and the senior is warned early rather…
“I would take blood cultures before starting broad-spectrum intravenous antibiotics according to the trust…”
the circulation stage delivers the sepsis six in the correct order, cultures before antibiotics, so treatment does not destroy…
References
Suspected sepsis in people aged 16 or over: recognition, assessment and early management… National Institute for Health and Care Excellence
Management and clinical · 62 scenarios
8 more…
How TheatrePass helps
Portfolio points are banked before interview day, but the assessors then question you on two of the domains for five minutes each. The CST bank pairs every domain with a model answer built on Context, Outcome, Reflection, and the spoken tutor and mock interviews let you defend each grade aloud under follow-up questions, with feedback on what you actually said.
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.
