Changes to speciality recruitment 2021—leaves trainees with more questions than answers

On the evening of 21st October, Health Education England (HEE) held a webinar for trainees applying to higher speciality training.

While parts of the webinar were informative, overall it is likely to have left trainees with more questions than answers. There is no doubt that HEE are in an immensely difficult situation, recruiting in the middle of a pandemic. However, there is growing concern among trainees about the recruitment process, particularly regarding the validity of self-assessment and the lack of face to face interviews or, in the case of some specialities, the lack of interviews in any form. 

Earlier this year the move to national lockdown fell right in the middle of speciality recruitment. Carefully curated recruitment timelines were thrown into turmoil and trainees watched as months of portfolio preparation and interview practice became redundant. They waited weeks with little or no information. For the most part, those specialities that were unable to recruit using face to face interviews moved to a self-assessment system. In some specialties, such as neurosurgery, self-assessment is a validated recruitment tool that has been used for years. [1] Elsewhere, however, self-assessment has never been used and has not been validated or tested. 

A major concern is that applicants may never be required to substantiate claims made on their self assessment form. In general surgery, for example, only 30% of applicants’ self-assigned scores were cross checked with evidence that they uploaded, something which applicants were aware of before submitting. [2] A cynic may be concerned that this gave candidates more prone to hyperbole an upper hand in the recruitment process. 

Criticism has also been levelled at the self-assessment forms; they can be ambiguous or subjective with very little guidance. One surgical self-assessment form asked candidates, “Do you operate at the level of a CT2, ST3 or ST5?” with points increasing respectively for each level. My question here would beshould we really be giving higher scores to people who purport to operate at a higher level than expected for their training grade?  Or does this perhaps show a dangerous lack of insight for those candidates who have not had the years of training to support this suggestion? 

The lack of face to face interviews means that candidates who have done multiple courses, PhDs or had innumerable publications, will score best, ignoring those who were perhaps more proficient in communicating with patients or very capable with practical tasks. 

Future psychiatrists and general practitioners will not have any form of interview and I struggle to see how the “reliable and validated” Multi-Speciality Recruitment Assessment will identify those doctors fit to be recruited into a profession that has communication and care as its cornerstone. [3] I think I speak for many trainees when I express concern at a move towards the increased use of scoring matrices and self-assessment during the recruitment of future specialist doctors in training. 

Our profession thrives because of the varied skill base and non-technical skills of doctors and these are not always captured through online tests. There is a growing concern that moving to digital, algorithm-based assessment as the mainstay may mean we miss out on genuinely brilliant doctors. Some trainees may not have published in international journals, but they pass the gold standard colleague test: you would want them to look after your family.

In these unprecedented times most trainees will appreciate, albeit with some reservations, clarification of the plan for the year ahead. That said, whilst HEE have done their best to carry on with specialty recruitment in a difficult situation, I think we should be cautious about accepting the new process as the status quo. In order to continue to provide the best care to our patients and maintain a diverse workforce of compassionate individuals we must ensure that we have a robust method of recruiting doctors. And this, I would argue, might require more than an online test. 

Clara Munro, Editorial registrar and clinical fellow, The BMJ, and general surgical trainee, North East England.


  1. National Neurosurgery ST1 & ST3 Recruitment | Health Education Yorkshire and Humber. (accessed 27 Oct 2020).
  2. National Selection to General Surgery and Vascular Surgery training in 2020. (accessed 27 Oct 2020).
  3. Multi-Specialty Recruitment Assessment (MSRA)-Test Blueprint & Information.