National selection to T&O ST3 posts – An update

Lucky Jeyaseelan and Cronan Kerin on behalf of the Selection Design Group

Since 2013, trainees in England and Scotland have gained a National Training Number in Trauma and Orthopaedics at ST3 level through a central process. The purpose of this article is to provide an update on this process since the last article published in JTO in June 2021. The Selection Design Group (SDG) is made up of senior consultants, current and previous Training Programme Directors, SAC members and representatives of the British Orthopaedic Trainees Association (BOTA) all of whom are experienced in many aspects of training and education. The collective aim is to ensure the best potential registrars are chosen to enter higher surgical training.

The SDG convenes several times a year to scrutinise the most recent process using data released by Medical & Dental Recruitment and Selection (MDRS) group, a body responsible to the Statutory Education Bodies (SEBs), and to improve the design of the following year’s process. We then implement delivery of the process used to select T&O ST3s in England and Scotland. The last two recruitment cycles have been led by Cronan Kerin, who took over as Chair from Mark Crowther. We continue to build on his hard work and that of his predecessors David Large and James Hunter.

The remit of the SDG is to develop the selection criteria, ensuring that these criteria used to assess candidates align with the skills and qualities needed in T&O. We also review the assessment methods, evaluating the effectiveness and fairness of the assessment, and implementing measures to ensure that the selection process is equitable and that all candidates are assessed in an unbiased and objective manner.

When the COVID-19 pandemic struck in early 2020, Medical and Dental Recruitment and Selection (MDRS) declared that there would be no face-to-face interviews for any medical specialty. Since that point, the recruitment process has remained an entirely virtual process. MDRS are committed to reinvesting the cost saving into improving the functionality of the Qpercom computer software that is used for the interview process. Since then, we have seen continual development and improvement in both process and assessment modalities.

The recruitment process

The recruitment process begins in November, with all candidates required to submit evidence which covers several domains with their portfolios. This is an online process and covers domains which are validated against this evidence. This evidence is assessed by members of the SDG, Training Programme Directors, and members of the Specialist Advisory Committee (SAC). The top scoring 360 candidates are subsequently shortlisted for interview, which takes place virtually around March/April the following year.

An additional question has been added to the Self-Assessment form for the current 2024/25 cycle, asking candidates to confirm that they will provide the evidence to support their responses to these questions in an organised manner and as specified in the written instructions – an attempt to encourage candidates to submit more clear and structured evidence for the verification process. This has been driven by the complexities of reviewing poorly structured or excessive evidence submission during the validation process.

The use of the ‘N’ number continues, ensuring that core trainees are not disadvantaged in open competition against the cohort of other doctors who have had many years of ‘experience’ and thus more time to develop aspects of their portfolio.

The interview itself is made up of four stations, each assessed independently by two interviewers. These are:

• Commitment to specialty

Candidates are interviewed about elements of their career and experience to date. They are assessed in each of the following domains: Career Motivation, Learning and Development; Leadership and Team Involvement; Organisation and Planning; Communication – Information Giving; Academic.

• Clinical

This station is based on clinical scenario. Assessment is in each of the following domains: Technical Knowledge; Problem Solving and Decision Making; Situational Awareness; Communication – Information Gathering; Communication –Information Giving. Anatomy and clinical knowledge is tested through clinical scenarios.

• Prioritisation

This station is an exercise in which the candidate must demonstrate judgement and reasoning in the setting of a scenario requiring prioritisation of care provision. Interviewers score in each of the following domains: Organisation and Planning; Communication – Information Gathering; Communication – Information Giving; Judgement under Pressure; Situational Awareness.

• Communication

This station is based on a scenario involving communication with a patient, with interviewers scoring in each of the following domains: Technical Knowledge; Situational Awareness; Judgement under Pressure; Communication – Information Gathering; Communication – Information Giving.

Each candidate must score a minimum 3:25 to be deemed appointable. To date we have had clear headroom between this minimum appointable level and the number of posts available.

National selection data

Each year of the selection process generates data that is analysed to enable us to understand patterns of application and recruitment through the National Selection process. This data is made generally available shortly after the completion of each recruitment cycle.

Table 1 shows general application information since the 2019/20 process. Application numbers and competition ratios have remained largely static during this time, with the fluctuance in national training numbers offered each year depending on the number of training posts vacated by those trainees achieving CCT. National training numbers by region (excluding Scottish LAT positions) are shown in Table 2.

Gender application numbers and average interview score trends are shown in Figure 1. It should be noted that a significant number of applicants chose not to state gender and as such, this will lead to a degree of bias in interpreting the data. Based on the information we have, female candidates score consistently higher on average than their male counterparts. Figure 2 shows gender trends in those who were successfully appointed to a national training number. After a consistent two years at just below 20% of successful candidates being female, 2023/24 sees a small drop.

Ethnicity data for candidates both applying and appointed in the 2023/24 recruitment process is shown in Table 3.

The future

Despite the underlying desire by many to go back to a face-to-face interviews, the MDRS have expressed their intention for the virtual format to continue for the foreseeable future. As the recruitment process continues to evolve, our role continues in ensuring appropriate format design that reflects the training syllabus and what is expected of those entering higher specialty training. In doing so, we continue to ensure equality of opportunity throughout the process. The full functionality of the Qpercom software used to deliver the virtual interviews, equally evolves. The aim is to use this as a single platform to comprehensively cover the recruitment process from start to finish.

For the future interview cycles, the most notable changes will include increasing the number of neck of femur cases to score full self-assessment marks from 12 to 18 cases, from the 2025/26 recruitment cycle. The Communication station, re-introduced in the 2023/34 cycle, appears to be a solid addition to the interview process and is set to continue.

Information for candidates applying for ST3 National Selection can be found on the Yorkshire & Humber Deanery website (www.yorksandhumberdeanery.nhs.uk/ recruitment/national_recruitment), where the 2024/25 Applicant Handbook is available, as well as scoring guidance information and timelines.

We believe that the current format of the recruitment process is versatile and gives the opportunity for top-level candidates to excel. It works to differentiate candidates well and as such, has proven to be an excellent modality for selecting the very best candidates to commence higher speciality training.