Applying for Specialty Training (ST3+)*

@ The Royal Orthopaedic Hospital

Mr Joe Barrett-Lee CT2 in T&O shares his insight into applying for ST3 posts

  • Overview
  • Eligibility Requirements
  • Application Timeline
  • Self-assessment Questions
  • The Interview
  • Logbook and WBA Requirements
  • Useful Links


Application to any specialty training programme is likely to be a daunting process but, as with anything, preparation is key to reducing stress levels.

Trauma and Orthopaedics has historically always been a fiercely competitive specialty to get into, however the odds are improving. In 2016 there were 370 applications for 138 places resulting in a competition ratio of 2.68:1.

The Process

  • Applications open at the beginning of February each year and close between mid-February and March.
  • All applications are submitted online via the Oriel Recruitment Portal. No other form of application is accepted.
  • The Oriel website can be accessed prior to application window opening and candidates can register an account.
  • Note that the deadline for submission of applications is very strict, so don’t leave it to the last minute as the website may run slower toward the end.
  • The online application focused on those essential criteria as laid out in the ST3 Trauma and Orthopaedic Person Specification.
  • It combines a series of bullet points and prose answers, the most of important fo which is the self-assessment questionnaire.
  • Once submitted, everything else is done via the Oriel Portal. This includes booking an interview and seeing the vacancies listed.

Eligibility Requirements 

The requirements to be eligible to apply are laid out in the ST3 Trauma and Orthopaedics Person Specification, which can be found on the Health Education England website. Portfolios and applications should be tailored toward meeting these criteria.

Requirements are separated into:

  • Entry Criteria (assessed on the application form)
  • Selection Criteria
    • Essential and desirable (assessed from application form, interview, references)

Essential entry criteria:

  • Medical degree (MBBS or equivalent)
  • Completion of MRCS (note you can apply without completion of part B, provided the result will be available prior to attending interviews. If you have not passed, you cannot be interviewed)
  • Foundation competencies
  • CT1/ST1 competencies in surgery at time of application
  • CT2/ST2 competencies in surgery at time of appointment
  • CT1/ST1 and CT2/ST2 ISCP competencies relevant to T&O by time of appointment

Essential selection criteria:

  • ATLS completion by interview

Desirable selection criteria:

  • Minimum 10 months experience in T&O
  • CT1/2 ISCP competencies in T&O achieved in the last 24 months
  • At least 8 months comprising 2 related specialties: Acute General Surgery, Vascular Surgery, Plastic Surgery, Neurosurgery, Intensive Care Medicine, Emergency Medicine, Cardiothoracic/Thoracic surgery, ENT surgery
  • At least 12 months experience in trauma-based T&O posts with major commitment to T&O surgery
  • Courses: CCrISP, BSS, basic or generic fracture management course

Note: all candidates considered eligible to apply are invited for interview.

Application Timeline

  • Applications open: start of February
  • Applications close: end of February – March
  • Interviews: end of March
  • Initial offers: end of April
  • Holding deadline: Start of May
  • Upgrade deadline: Start of May

Self-assessment Questions

These comprise a series of questions on the application form that are answered by the candidate. They assess the following areas:

  • Clinical experience (specialty-specific and related)
  • Operative experience
  • Publications and presentations
  • Audit experience
  • Higher degrees
  • Leadership experience
  • Teaching experience

All answers will be scored and a total score given. Evidence to substantiate all responses must be provided in your portfolio. Lack of evidence or misleading evidence may be reported to a Probity Panel.

Questions and responses can be found in the T&O applicant handbook, on the National Trauma and Orthopaedic ST3 Recruitment section of the Yorks and Humber Deanery website.

Top responses:

  • 0 – 27 months in any job in medicine since Foundation Training
  • 10 – 30 months in CT/ST/LAT/LAS/Trust grade posts in T&O surgery
  • At least 4 months in 2 related specialties
  • 11 or more wholly completed fixations (SHS, CMN) for #NOF as STS or STU
  • 1st author publications in pubmed journals – score for each publication
  • Other publications in pubmed journals – score for each publications
  • National or international presentations given by you – score for each
  • Full cycle audits against a published standard – score for each
  • Masters or PhD (does not include intercalated degrees)
  • Evidence of involvement in formal leadership since university
  • Formal teaching qualification (PGcert or equivalent)
  • Regular involvement in formal teaching

The Interview

The interview takes place on once day and consists of a series of stations designed to test the different areas of the Person Specification. The stations are 15 minutes each and candidates rotate around with short breaks in between. The specific content is liable to change each year, however they will broadly assess the same thing. The 2016 stations included:

  • Portfolio
  • Clinical
  • Interactive
  • Technical skills
  • Presentation, prioritizations, handover
  • (Assessment of PSA forms – filled in by candidates supervising consultants)

In 2016 there were no ‘killer stations’, which have been present in previous years. These stations were scored such that not achieving a minimum in that station alone would make a candidate unappointable (despite scoring high enough overall).

Portfolio station

  • Make your portfolio look nice! (e.g. faux-leather binder, plastic wallets)
  • Use contents, sub-contents, and page numbers to make it easy to navigate
  • Know your own portfolio well so that you can direct the examiners quickly
  • Be concise with what you include – points-scoring evidence only
  • Honesty is key; don’t include anything without good evidence

Clinical station

  • Tests your knowledge of clinical orthopaedics
  • Patient safety comes first – performing in a safe systematic manner will score points
  • Read common orthopaedic emergencies, presentations, anatomy
  • Practicing anatomy and clinical scenarios will help

Interactive station

  • Role-play communication station with actors
  • Read up different communication scenarios (e.g. angry relative, breaking bad news)
  • Think about how to structure responses
  • Remember to be calm and professional at all times

Technical station

  • Assesses your technical skills by asking the candidate to demonstrate something
  • Includes DHS or lag-screwing with saw bones, external fixation
  • Can include anything that an ST3 would be expected to do in theatre
  • Helpful to practise talking through the various steps of these procedures
  • Skills course will also be useful preparation

Presentation station

  • Split into 2 areas: presenting and case prioritization/handover
  • Test how you can present under pressure, rather than your own knowledge
  • The presentation topic will be given in advance – so be prepared and practise
  • Think outside the box with presentation to keep examiners interested
  • Actively involve yourself in the ordering of lists at work
  • Remember handover structures and consider pertinent points

Logbook and WBA requirements

In addition to the logbook/WBA requirements necessary to achieve CT1/2 competencies in surgery, the 2017 core surgical training syllabus recommends that for ST3 preparation candidates have evidence of performing the below procedures:

With assistance:

  • MUA of fracture/dislocation
  • Reduction of extra-capsular hip fracture and insertion of DHS
  • Hemiarthroplasty for intracapsular hip fracture
  • Closed reduction and casting for wrist fracture
  • Closed reduction and percutaneous pinning for wrist fracture
  • Ankle fracture ORIF

Can do whole, but with assistance:

  • Ankle fracture/dislocation closed reduction
  • Application of back-slab cast
  • Removal of encircling limb cast

Evidence of abilities in the above would be in the form of logbook entries and workplace-based assessments. The ST3 preparation modules also recommend evidence of experience in the following elective procedures:

  • Total hip arthroplasty (at least observed)
  • Total knee arthroplasty (at least observed)
  • Knee arthroscopy (at least observed)

Tips from successful candidates


  • Prepare EARLY.
  • Go on an interview prep course. If for nothing else, having an opportunity to sit down in an “interview” situation and be grilled helps to identify areas you can improve for the interview itself. It also helps you feel more prepared and consequently less nervous on the day.
  • Have practice interviews with your consultants


  • Read the ST3 person specification and tailor your portfolio accordingly.
  • Invest in a decent folder for your portfolio. It helps make a good impression and that you’re serious about your career choice.
  • Ask previous trainees if you can flip through their portfolios for inspiration, but remember that your portfolio is about you.
  • Highlight your strengths regardless of what they are.
  • If there’s an area of your portfolio which is weaker then don’t make it prominent.
  • Also think about ways in which to respond to weaknesses in your portfolio if challenged and show the panel that you know what you are going to do in the future.
Clinical Stations
  • Know your anatomy for the clinical stations inside out.
  • Make a list of ten or so “T&O emergencies or presentations” e.g. Limping febrile child etc and make a list of how you’d assess and manage the patient. Show that you’re thinking like an SpR and think outside the box, be prepared to discuss differential diagnoses and management accordingly.
Technical Skills
  • Bare below the elbow, tuck in ties, no watches
  • Know the names for all instruments used in common procedures
  • Practise as much as possible both in theatre and on dry bones
  • Get your registrars/consultants to quiz you whilst you’re operating
  • Make sure you learn all the common drill, tap and screw sizes for small/large fragment, locking/non-locking plates and DHS
  • Download manufacturer technique guides for common procedures
  • Make sure you know the reasoning behind each step of a procedure, what can go wrong at each step and how to correct this
  • Familiarise yourself with the slightly different instruments supplied by different manufacturers for the same operations e.g. drill guides and triple reamers.

Previous Candidate Experiences

Useful Links 

National Recruitment website:

Person Specifications:

ST3 Specialties Competition Ratios:

Interview Preparation:

*Correct as of 28th September 2017