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NHS Career in Surgery - How to know if this career path is right for me?

Hi, I am Himani, an IMG from India and an SHO in Surgery in the NHS, UK. In today's blog, I would like to share with you my personal experience that may help you decide whether surgery is the right career option for you. In one of my previous blogs, I explained How to apply for training in the UK - Advice, Guidance, Tips

Ask yourself first

Are you in search of another reason to embark on the PLAB journey? Do you have an inclination to pursue further surgical training in the UK? You are at the right place, to delve into the world of an NHS Career in Surgery.

If you are looking for an argument in favour of Surgery, all I would say is that Surgical specialties enjoy the best of both worlds. They allow you to manage patients conservatively with drug therapy as well as empower you to perform a whole range of procedures. If you are someone that enjoys using your hands and tools to resolve your patient's concerns, conduct clinics, be involved in emergency/elective work or enjoy research/academia, the NHS would provide you with the flexibility and support needed to complete your training.

Where to start and how to progress?

Most surgical aspirants are young doctors who are aware of the intense and often expensive training pathway they are signing up for. It is advisable to look up the latest guidance for Core surgical training and/or Specialty training ST3 taking cognizance of the fact that portfolios for the Surgical pathway are often quite demanding. Please have a look here 2022 Core Surgical Training Self-Assessment Scoring Guidance for Candidates

Budding surgeons start working on their portfolios much earlier on, taking an active interest in creating and running a surgical society at medical school, attending conferences, presenting oral or poster presentations, scrubbing in on cases in theatres & maintaining a logbook. If you have completed your foundation equivalent and have not done much in terms of audits/QIPs/academia, it is definitely not the end of the world. There are successful trainees who have begun working on their CV in their FY3 year (the gap year after the foundation programme/the level at which most IMGs start in the NHS).

Challenges unique to IMGs planning to get into surgical training are:

  • Lack of maintaining a proper portfolio, both paper and electronic and hence lost record of all their wonderful domestic achievements.

  • Poor understanding of what the application process requires and what the entry requirements are.

  • Not knowing about the flexibility may lead to disenchantment with the specialty. Lack of clarity on special provisions such as LTFT (less than full-time training), OOP (out of programme) time bearing in mind that trainees could be parents and/or carers.

  • Fixation on the competition ratios and thinking it is impossible before even trying.

Different surgical specialties have different attributes that make them unique.

Here are some qualities of each of the sub-specialties:

  • General Surgery / Trauma & Orthopaedics / Vascular surgery receive a relatively high proportion of emergency work.

  • Cardiothoracics / Urology / Breast surgery is mostly elective work.

  • Some specialties such as Trauma & Orthopaedics have a broader scope for research and academic activities.

  • Breast Surgery / Urology do not typically have on-call commitments. The concept of “office clinic” is emerging in the specialty of Urology which would include conducting clinics and performing endoscopic procedures & not open surgeries.

  • Neurosurgery / Spine surgery / Vascular surgery may limit you geographically as you will be working at tertiary hospitals and specialist centres.

For the more research-oriented, approved academic posts (academic clinical fellowships and clinical required lectureships) are an attractive alternative. It is available to those that have demonstrated potential & excellence in academic medicine as well as through their clinical abilities.


My top tips for those on their journey to a training number in Surgery are:

  1. Begin early by acquainting yourself with the latest self-assessment guidance, to identify where you stand.

  2. Make a personal development plan to fill the lacunae in your portfolio in a time-bound manner.

  3. Maintain documentary evidence for everything done that indicates your dedication to the specialty.

  4. Educate yourself more about the different schemes and options for flexibility in training.

  5. Budget well to spend on the right things such as courses, conferences, presentation opportunities.

Useful websites

1. The Royal College of Surgeons of England provides guidance on 10 recognised surgical specialties, all of which will provide you with different challenges and rewards throughout your career. You will be able to get information on these as well as academic surgery, covering the type of work involved, working conditions (on-call; emergency work; clinics; administration etc.), working options, sub-specialisation and how competitive each specialty is.

2. Guidance on OOP (out of programme) from the NHS Health Education England

Good luck and all the best for your further training,



If you have any questions feel free to ask on the TrewLink website, we are happy to help.

If you found our blog articles helpful, please share them with your IMG friends & colleagues who may also benefit from reading our blog.

Written by Himani

Edited by Julia


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