Trends in applications to Core Surgical Training in Great Britain across ten application cycles: A decline in...

Core Surgical Training (CST) is the most common route into Higher Surgical Training (HST) in the UK, yet competition remains high and recruitment processes have changed repeatedly. Rising competition for training programmes has led to alternative routes into HST such as the Certificate of Readiness to Enter HST (CREHST) as well as parallel applications to other training specialties, however the scale of this amongst CST applicants has not been previously described.

Freedom of Information requests were submitted to NHS England to obtain annual CST application counts between 2016-2025, the number applying exclusively to CST, and among multi-programme applicants, the specialties to which they applied. Data was requested on HST applications from CST and CREHST backgrounds.

CST applications in Great Britain increased from 1511 in 2016 to 5399 in 2025, while the number of posts remained largely unchanged. The proportion applying exclusively to CST declined from 49.1% in 2016 to 17.2% in 2025. Ratio of applicants to total applications peaked at 4.9 in 2024 compared with 1.9 in 2016. The most common parallel applications were general practice and run-through ST1 surgical programmes at 16.9% and 16.2%, respectively. In 2025, HST applications from CREHST backgrounds exceeded those from CST in all specialties except otolaryngology and plastic surgery.

CST demand has risen markedly without a similar expansion in posts, accompanied by a substantial reduction in CST only applications and increasing use of alternative routes into HST. These trends suggest applicants are increasingly broadening their applications to maximise progression opportunities.