A PGY4 unaccredited surgical registrar cuts through the confusion to create a step by step guide on how to apply for the surgical training program in Australia

The Surgical Education and Training (SET) Program is overseen by the Royal Australasian College of Surgeons (RACS) in Australia, and trains junior doctors to become competent surgeons who provide the highest standard of patient care.  It is a highly competitive program and just 244 training offers were made in Australia in 2020 across the nine speciality training pathways. The rigorous selection criteria cover the ten RACS competencies by way of a CV, clinical referees and multi-station interview.  Candidates must meet minimal eligibility criteria to apply, including successful completion of the Generic Surgical Sciences Examination (GSSE). In 2021, a Situational Judgement Test to assess situational awareness, ethical decision making, and other non-technical skill sets was also introduced as a pilot program (and will likely contribute to part of the overall applicant score in 2022 onwards). I encourage you to thoroughly read through the information available on the RACS website (including here) and the college specific selection guidelines for each speciality.  The proportion that each section (CV, interview, referees, clinical exam/s) contributes to your overall candidate score varies across specialities.

Are you confused?  I was too!  SET Applications are a multifaceted approach to picking the best candidates for the job, and whilst it is a competitive and gruelling program, it is also one that can be prepared for!  The most common question I get from surgical house medical officer’s (HMOs) is ‘where do I start with surgical applications’!  The great thing is that you will no doubt be working in a team with SET registrars and fellows who would have been through a similar selection process in recent years too.  The hardest part of being a junior doctor is figuring out what training pathway you actually want to narrow down into, the application process pales in comparison to that decision! My biggest piece of advice is to not go at it alone, find the other HMOs who also want to apply for SET training so you can tackle the hurdles and celebrate the triumphs together.  

Step 1: The dreaded GSSE!

The GSSE is a two-day exam focusing on generic surgical sciences to demonstrate that successful candidates have a sound understanding and knowledge in the basic surgical sciences of anatomy, pathology and physiology. It is a mandatory eligibility requirement across all surgical speciality training pathways.  The level of knowledge required is similar to what you learn in your medical degree so attempting to prepare and sit for this exam as close to graduating as possible is my tip!  

Step 2: Build your professional experience and reputation…ie your clinical references

This goes without saying that you need to work hard and demonstrate your skills and capability as a surgical HMO/unaccredited registrar to be able to progress further in your training pathway of choice.  Eventually you will nominate Consultant referees to support you in your application process and they will be asked to assess you based on the RACS competencies – so use these as your guide to understanding what a strong surgical registrar candidate looks like!  

Step 3: Build your CV

CV building is always a huge investment of your time and whilst you want to develop as a well-rounded junior doctor, leader and teacher, it can feel overwhelming with how many options there are to strengthen your CV and skill sets. The other challenge is that each speciality training pathway attributes different weight (marking points) to different aspects of the CV. For example, some will attribute points to each RACS training course you have attended, while others will not. Some will award a lot of points to research oral presentations, others will only award points for publications. 

This is what your unaccredited registrars mean when talking about how many ‘points’ they have so far.  The general consensus is the more points you have the stronger your application (duh!). The challenge is a moving goal post (each year the marking allocation will differ/change) and you also want to be progressing clinically in your career – there is a fine balance between spending too much time chasing points and not enough time developing your clinical experience and skill set.  A good place to start is to look at the CV breakdown for your surgical speciality over the previous few years and highlight which aspects of the CV remain constant. The next thing to do is ensure you choose training experiences and research that you enjoy, because your time is valuable! 

Step 4: Do not forget interview preparation

An excellent (and very cheap!) resource from a current General Surgery SET trainee is the ‘General Surgery SET Interview: The Ultimate Preparation Guide’ and whilst it’s targeted to General Surgery interviews there are many parallels and useful tips for other specialities too. 

Good Luck to all those receiving interview offers in the coming weeks, and for those thinking of applying I hope you have found this a useful resource to plan your attack!