By the end of July 2026, or by completion of Core Training if this is later, how many months will you have spent in total in Paediatric Surgery posts? Please do not include any other posts. Please do not include any Foundation year’s experience or overseas Foundation equivalent

• 60+ months or < 4 months : 0
• 48 to 59 months : 2
• 30 to 47 months : 4
• 4 to 29 months : 8

Evidence:

• Please provide full employment history from qualification date to present, including the specialty of each post and outline the reason for any gaps in employment alongside specific evidence of the paediatric surgery post. In order to do this please download the employment history section from your Oriel application form and upload to the Self Assessment portal (inclusive of the Employment history gaps, Employment History – time in specialty and Employment History – time in specialty/post type)
• Please also provide screenshot from oriel as when downloaded pdf excludes specialty details
• Please provide evidence of completion of training posts
• For non-training posts please provide a copy of the front page of your contract of employment which includes dates and evidence of the specialty
• Do not include Foundation year’s experience or overseas Foundation equivalence in your response

By the end of July 2026, or by completion of Core Training if this is later, how many months will you have spent in total in Adult General Surgery in CT, LAT, LAS and Trust Doctor posts? Please do not include any other posts or posts that only provide general surgical experience when on call.

• < 6 months : 0
• 6 to 12 months : 1
• 13+ : 2

Evidence:

• Please provide full employment history from qualification date to present, including the specialty of each post and outline the reason for any gaps in employment alongside specific evidence of the adult general surgery post. In order to do this please download the employment history section from your Oriel application form and upload to the Self Assessment portal (inclusive of the Employment history gaps, Employment History – time in specialty and Employment History – time in specialty/post type)
• Please also provide screenshot from oriel as when downloaded pdf excludes specialty details
• Please provide evidence of completion of training posts
• For non-training posts please provide a copy of the front page of your contract of employment which includes dates and evidence of the specialty
• Do not include Foundation year’s experience or overseas Foundation equivalence in your response

By the end of July 2026, or by completion of Core Training if this is later, will you have been employed in a “stand alone” post in a Neonatal Unit; minimum of 3 months in post?

• No : 0
• Yes : 1

Evidence:

• Please provide full employment history from qualification date to present, including the specialty of each post and outline the reason for any gaps in employment alongside specific evidence of the neonatal unit post. In order to do this please download the employment history section from your Oriel application form and upload to the Self Assessment portal (inclusive of the Employment history gaps, Employment History – time in specialty and Employment History – time in specialty/post type)
• Please also provide screenshot from oriel as when downloaded pdf excludes specialty details
• Please provide evidence of completion of training posts
• For non-training posts please provide a copy of the front page of your contract of employment which includes dates and evidence of the specialty
• Do not include Foundation year’s experience or overseas Foundation equivalence in your response

By the end of July 2026, or by completion of Core Training if this is later, will you have been employed in a “stand alone” post in a Paediatric Intensive Care Unit; minimum of 3 months in post?

• No : 0
• Yes : 1

Evidence:

• Please provide full employment history from qualification date to present, including the specialty of each post and outline the reason for any gaps in employment alongside specific evidence of the paediatric intensive care unit post. In order to do this please download the employment history section from your Oriel application form and upload to the Self Assessment portal (inclusive of the Employment history gaps, Employment History – time in specialty and Employment History – time in specialty/post type)
• Please also provide screenshot from oriel as when downloaded pdf excludes specialty details
• Please provide evidence of completion of training posts
• For non-training posts please provide a copy of the front page of your contract of employment which includes dates and evidence of the specialty
• Do not include Foundation year’s experience or overseas Foundation equivalence in your response

At the time of application, are you able to demonstrate competence in the management of acutely unwell paediatric patients?

• No : 0
• Yes : 1

Evidence:

Competence can be demonstrated:

• By providing evidence of completion of a relevant course including e.g. APLS PALS, EPLS, EPALS or equivalent

OR

• By providing a statement from a supervisor confirming you have received local training
• and evidence of an assessment in these skills

At the time of application, how many appendicectomies have you completed which have been done either STS or STU? These must be recorded via a signed consolidation sheet and recorded in a validated log book.

• None : 0
• 1 to 9 : 1
• 10 to 19 : 2
• 20 or more : 4

Evidence:

• You must provide full validated signed logbook evidence. Signed consolidation sheets from a validated logbook are acceptable.
• Please do not upload lists of cases in which appendicectomies are not clearly highlighted within them as evidence. Scores may be negatively adjusted to reflect that your evidence is not clearly available to the Verifying Officers.

At the time of application, how many 1st or Last author publications have you had published, or accepted for publication in any peer reviewed journal or a PubMed accredited publication? Do not include published abstracts, letters or case reports. o None : 0 o One : 2 o 2 or more : 4 Evidence:

• Please provide a photocopy of the abstract of the publication on PubMed or a web address for the article or copy of the acceptance letter.
• Please provide a PMID (PubMed identifier) for each paper
• Collaborative group names cannot be considered as first author
• This includes those “in press”. If “accepted without revision” but not yet published, please provide official evidence from journal editor
• Recognised PubMed journals can be found here: https://www.nlm.nih.gov/bsd/serfile_addedinfo.html

At the time of application, how many national/ international presentations have you given as First Author? Do not include poster presentations.

• None : 0

• One : 1

• 2 or more : 2 Evidence:

• Please provide a copy of the relevant page of the meeting programme(s)

• Each project will only be counted once even if presented at more than one meeting

• Collaborative work will only be considered as a presentation if there is clear evidence that you had a significant role in the project such as in the design of the study, data analysis or delivery of the presentation, and you presented this.

• The Selection Design Group Station Leads will be the final arbitrators regarding legitimate conferences and duplicate presentations

• Any probity issues will be reported to the GMC

At the time of application, how many full Quality Improvement Projects/complete audit cycles have you undertaken ie. first audit, institution of action plan, and second audit to assess impact of intervention all done by yourself

• None : 0

• 1 or more : 1 Evidence:

• Please provide a summary of the audit/QIP and your role in this (only the first uploaded audit cycle will be counted)

• Please provide authenticated evidence of completion and presentation such as “Assessment of Audit”, validated certificate or letter from audit lead clinician.

• Do not supply a copy of presentation slides or audit meeting agenda.

• If you can demonstrate active involvement in both cycles of a closed loop audit, each cycle would count e.g. 2 cycles counts as 2 audits. Evidence needs to clearly identify both pieces of work.

• Any probity issues will be reported to the GMC

  At the time of application, have you completed and been awarded a UK higher research degree or equivalent (i.e. after production of a research based thesis and full examination)?

• No : 0
• MSc (thesis and examination) : 1
• PhD/MD : 2

Evidence:

• Do not include intercalated BSc
• Do not include MSc in Education (see next question)
• Do not include if your higher degree is equivalent to FRCS (MSC which is clinical and part of your general or specialty qualification do not count)
• Please provide your degree certificate
• If your degree was taken outside the UK, you must also provide evidence of its equivalence (e.g. a letter from the institution confirming that it was awarded following production of a research based thesis and full examination)
• We are aware of organisations such as UK NARIC however, the Selection Design Group Station Leads will be the final arbitrators.

Please select the statement that best describes your involvement in formal teaching.

• I have not been engaged in a formal teaching role : 0

• I am regularly engaged in formal teaching : 1

• I am engaged on the faculty of a recognised medical course : 2

• I have a formal qualification in teaching – MSc Education/ PGcert /Dip Ed : 3 Evidence:

• Please provide evidence of engagement in formal teaching such as a letter from supervisor or an observation of teaching and evidence of feedback

• Please supply evidence to support your response including certificate to confirm you are Faculty.

• Please provide evidence of teaching qualification (Training the Trainers is NOT included)

I confirm that I will provide the evidence to support the answers to this questionnaire in the manner outlined within the Applicant Handbook

• Portfolio is poorly prepared : 0

• Portfolio is reasonable providing some challenge to selection group to find evidence : 1

• Portfolio is well prepared and easy to navigate with clear evidence : 2 Evidence:

• Candidate has only provided specific documentation to support the specific questions asked within the Self Assessment questionnaire and has not provided excessive documentation or their full Portfolio

• Selection Group will be the final arbitrators