NHS INTERVIEW GUIDE

Core Surgical Training (CST) Interview: Format, Questions and Preparation

How the CST interview is usually structured, the questions to expect, a worked post-operative scenario, common mistakes and a preparation plan.

Last updated 24 October 2026 · Created by a practising NHS doctor · Independent of the NHS

Quick answer

What is the Core Surgical Training (CST) interview and what questions are asked?

The CST interview is the national interview for UK core surgical training, combined with the MSRA to rank candidates. Recent rounds have been online, with a portfolio station and a clinical and management station. Expect questions on your portfolio and motivation for surgery, acute post-operative scenarios, management dilemmas, communication and ethics. Always check the current applicant guide, as formats change.

Key takeaways

Interview scores are combined with the MSRA.
Expect portfolio and clinical and management stations.
Use ABCDE and escalate early in clinical scenarios.
Only claim portfolio scores your evidence supports.
Check the current applicant guide every year.

The Core Surgical Training (CST) interview is the main assessed stage of national recruitment into the first two years of UK surgical training. In recent rounds it has been held online and built around a portfolio station and a clinical and management station, with scores combined with the MSRA exam to rank candidates. Panels ask you to present and defend your portfolio, manage acute surgical and post-operative scenarios safely, and handle management, communication and ethical problems.

This guide covers the usual format, example questions, a worked post-operative scenario, common mistakes and a preparation plan. Format and scoring change between years, so always read the current applicant guide from the official recruiting body. The questions here are practice themes, not real or leaked questions.

In this guide

What is the Core Surgical Training (CST) interview?
What stations are in the CST interview?
What do CST interviewers look for?
What questions are asked in the CST interview?
How do you answer a post-operative deterioration scenario?
How do you answer CST management and ethics questions?
What are common mistakes in the CST interview?
How should I prepare for the CST interview?

What is the Core Surgical Training (CST) interview?

The CST interview is a structured national interview, run centrally on behalf of the regions, that decides your ranking for core surgical posts alongside your MSRA score. NHS England's Medical Hub leads recruitment in partnership with the Royal College of Surgeons of England, covering England, Scotland and Wales, while Northern Ireland has its own arrangements.

In general, the process runs in this order. Dates, cut-offs and weightings vary by round, so check the current applicant guide.

Application: submitted online through Oriel and checked for eligibility (longlisting).
MSRA: eligible applicants sit the Multi-Specialty Recruitment Assessment, and a set number of the highest scorers are invited to interview.
Portfolio upload: you upload evidence for each portfolio domain before the interview. Missing evidence can lead to your interview being cancelled, so treat the deadline seriously.
Interview: recent rounds have been online, with timed stations assessed by trained surgical interviewers.
Ranking and offers: interview and MSRA scores are combined, and offers are made through Oriel based on rank and preferences.

What stations are in the CST interview?

Recent CST interviews have had two main stations: a portfolio station and a clinical and management station. Communication, professionalism and ethics are usually assessed within these rather than as separate stations, but check how your round is set up.

Portfolio station: often opens with a short prepared presentation or question about your achievements or commitment to surgery, followed by questions on your evidence. Interviewers check that your claims match the domains you have selected, such as audit and quality improvement, teaching, presentations, publications, prizes and surgical experience.
Clinical scenario: usually an acutely unwell surgical patient, such as a post-operative complication or an emergency referral. You are expected to assess and stabilise safely, escalate appropriately and know your limits.
Management scenario: a non-clinical or prioritisation problem, such as competing bleeps, a colleague who seems unwell or unsafe, an error, or a staffing gap.
Communication and ethics: themes such as breaking bad news, an angry relative, consent and capacity, confidentiality, raising concerns and candour may appear within scenarios. Legal frameworks on capacity and consent differ across UK nations, so describe principles and follow local policy.

What do CST interviewers look for?

Interviewers score against structured criteria linked to the person specification, rewarding safe, structured, honest answers. Typical criteria include:

Patient safety first: a structured assessment, such as an ABCDE approach, with early escalation.
Insight into your level: knowing what an FY2 or CT1 should do alone and when to call a registrar or consultant.
Structure: clear signposting so the interviewer can follow and score your answer.
Honest portfolio: evidence that matches the scores you claimed, with genuine reflection on your role.
Teamwork and communication: involving nurses, anaesthetists, critical care outreach and the patient or family.
Professionalism: awareness of GMC guidance, candour and raising concerns.

What questions are asked in the CST interview?

Questions usually cover your portfolio and motivation, acute surgical scenarios, management dilemmas, and communication or ethical issues. These practice questions reflect common themes:

Why do you want a career in surgery, and what have you done to test that choice?
Talk us through the audit or quality improvement project you are most proud of. What was your role and what changed?
Tell us about your teaching experience. How did you gather feedback and improve?
You are called to see a patient two days after a bowel resection who has become tachycardic and hypotensive. How would you manage this?
A patient on the ward after a hip operation suddenly becomes short of breath. What would you do?
You are referred an elderly patient with abdominal pain and you are worried about a serious cause. How do you proceed?
You are bleeped by three wards at once while seeing a sick patient. How do you prioritise?
A senior colleague smells of alcohol before a theatre list. What do you do?
You realise you prescribed the wrong medication to a patient who has already received a dose. How would you handle it?
A patient's relative is angry that an operation has been cancelled for the second time. How do you respond?
A patient who needs urgent surgery refuses consent. How would you approach this?

How do you answer a post-operative deterioration scenario?

Answer with a safe, structured approach: assess the patient immediately using ABCDE, start appropriate initial management, escalate early to your seniors and document clearly. Keep it at your level and show you know when you need help. The example below is at principle level; always follow local protocols and senior advice.

Worked example: unwell patient after abdominal surgery

You are the core trainee on call. A nurse calls about a patient two days after abdominal surgery whose early warning score has risen. The patient is clammy, tachycardic and has a low blood pressure.

I would go to see the patient straight away, asking for the chart and notes, and call the emergency team if they appeared peri-arrest.

I would assess using ABCDE, treating problems as I find them: airway, breathing and oxygen needs, circulation with access, bloods and cultures, fluid balance and urine output, then the abdomen, wound, drains, drug chart and operation note.

I would keep a broad differential, including bleeding, sepsis such as an anastomotic leak, a cardiac or respiratory event, and a pulmonary embolism, and request investigations accordingly.

I would escalate early to my registrar using SBAR and involve critical care outreach if the patient is not responding. Decisions about imaging or a return to theatre would rest with my seniors.

I would keep the patient and, with consent, their family informed, document clearly, agree a plan for reassessment and hand over at the end of my shift.

How do you answer CST management and ethics questions?

Put patient safety first, gather information, act within your role, escalate to the right person and reflect afterwards. Frameworks help you stay structured, but avoid sounding scripted.

For a colleague who may be unsafe, protect patients first, speak privately with the colleague, involve the consultant and follow local policy. For an error, assess and limit harm, be open with the patient, inform seniors, report it and reflect, in line with the duty of candour.

What are common mistakes in the CST interview?

Most lost marks come from unsafe or unstructured clinical answers and portfolio claims that do not stand up to questioning.

Overclaiming: selecting a portfolio score your evidence does not clearly support.
Skipping ABCDE: jumping to a diagnosis before assessing and stabilising the patient.
Late escalation: trying to manage a deteriorating patient alone to look capable.
Operating beyond your level: describing decisions a consultant would make as if they were yours.
Vague projects: being unable to explain your role, method or the change your audit or QI work produced.
Running out of time: rambling through stations that are tightly timed.
Technical failures: not testing your camera, microphone and connection before an online interview.

How should I prepare for the CST interview?

Start with the official applicant guide and person specification, then prepare your portfolio, clinical scenarios and spoken practice in parallel over several weeks.

Step 1: read the current applicant guide, portfolio guidance and person specification for your round, and note the deadlines.
Step 2: map every piece of evidence to a portfolio domain, check it meets the criteria and organise it clearly.
Step 3: prepare a short, honest account of each item: what you did, your role and what you learned.
Step 4: revise common acute surgical and post-operative presentations at principle level, using ABCDE, SBAR and local escalation pathways.
Step 5: build STAR examples for teamwork, conflict, error, raising concerns and leadership.
Step 6: practise aloud under timed conditions with surgical trainees, your educational supervisor or a peer group. The Royal College of Surgeons of England and some deaneries publish careers advice, and the BMA has guidance on specialty recruitment.
Step 7: for written practice, Healthcare Interview Prep, an independent self-study site created by a practising NHS doctor, covers 471 NHS roles including medical and dental posts, with written model answers. It does not run mock interviews or courses, so pair it with spoken practice.
Step 8: in the final week, test your online set-up and rest.

Frequently asked questions

How many stations are in the CST interview?

In recent rounds the CST interview has had two main stations, a portfolio station and a clinical and management station, each lasting a short, fixed time and containing several questions. Communication and ethics are usually tested within these. The structure can change between years, so check the current applicant guide from NHS England's Medical Hub and the Royal College of Surgeons of England before you prepare.

Is the CST interview online or in person?

Recent CST interviews have been held online, with interview times and joining details managed through the recruitment system. You should test your camera, microphone and connection in advance, choose a quiet, well lit room and have a backup plan for technical problems. Because arrangements can change, always confirm the format in your interview invitation and the current applicant guide.

How is the CST interview scored?

Interviewers score each station against structured criteria linked to the person specification, and the interview scores are combined with your MSRA score to produce a final ranking. The weighting between the MSRA, portfolio and clinical stations has varied between rounds. Read the current applicant guide for the exact scoring and check that every portfolio score you claim is clearly backed by your uploaded evidence.

What clinical scenarios come up in the CST interview?

Scenarios usually involve acutely unwell surgical patients, such as post-operative deterioration, suspected sepsis or bleeding, acute abdominal pain or sudden breathlessness on a surgical ward. Panels want a safe, structured ABCDE approach, appropriate initial management, a sensible differential and early escalation to seniors. You are not expected to make consultant-level decisions, but you are expected to know your limits.

How long should I prepare for the CST interview?

Many candidates start preparing seriously around the time of their MSRA, giving several weeks before the interview window. Portfolio building takes much longer, often across foundation training, so start collecting evidence early. Spend your final weeks on timed spoken practice of clinical and management scenarios and on explaining your portfolio clearly, ideally with feedback from surgical trainees or supervisors.

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Healthcare Interview Prep is an independent NHS interview preparation website. It is not affiliated with, endorsed by or connected to the NHS. Example questions and answers are original practice material, not official or leaked interview questions.

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