Neurosurgery ST1 2027: Everything You Need to Know

A computer-based exam taken at a Pearson VUE centre, built around clinical scenarios. It has two papers:

Our advice

• Start revising now. The exam is in January and Clinical Problem Solving covers the whole of general medicine, not just surgery.
• Don't neglect Professional Dilemmas. The ranking logic is learnable, and the same judgement is tested again in the management station.

• 5A national or international prize in full competition at undergraduate level
• 2Two or more local prizes, or distinctions in more than one area, or you led a research project, or you led an audit or QI project
• 1One local prize, or a distinction in a single area, or involvement in research or QI (for example collecting data)
• 0None

Only achievements during your primary medical degree count here, and only work not already credited elsewhere on the form, such as a publication or presentation.

Evidence: certificates or official letters for prizes and distinctions. For research, an abstract signed by your supervisor covering title, background, methods, results, discussion and your role. For audit or QI, a write-up signed by your consultant supervisor.

• 5Two or more separate electives or attachments in the clinical neurosciences or allied fields, each at least 4 weeks, at an institution other than your own
• 3Two or more separate electives or attachments, each longer than 2 weeks, at your own institution
• 2One elective or attachment of at least 4 weeks at another institution
• 1One elective or attachment of at least 2 weeks at another institution, or longer than 2 weeks at your own
• 0None, or only attachments of 2 weeks or less at your own institution

The clinical neurosciences are neurosurgery, neurology, psychiatry and neurophysiology. Trauma and paediatrics count as allied fields.

Evidence: proof you completed each elective, with dates and duration.

• 2A 4-month FY1 or FY2 post in neurosurgery, including one you're due to start before foundation ends
• 2A neurosurgery taster week or observership
• 0No postgraduate neurosurgical experience

Evidence: a continuous employment history from graduation, with the specialty of each post. Add evidence of completed training posts, or the front page of your contract (with dates) for non-training posts.

• 5A PhD or MD by research involving original work, usually 2 to 3 years mostly dedicated to research
• 3A Master's degree (MSc, MA, MRes, MPhil, MCh) of at least 8 months full time, or a PhD or MD thesis submitted but not yet awarded
• 1Another relevant postgraduate diploma or certificate, including a Master's or MD taught mainly through clinical training. Any part of the MRCS counts here.
• 0None

Intercalated degrees don't count, but an MB PhD programme does. Education qualifications are scored separately in domain 11, and part-completed qualifications don't count.

Evidence: degree certificates, or your thesis and proof of submission.

• 5A research grant of £25,000 or more as principal grant holder
• 3A grant of £10,000 to £25,000 as principal holder, or NIHR Associate PI for a clinical study
• 2A grant of £2,000 to £10,000 as principal holder, or local PI for a multicentre NANSIG or BNTRC study
• 1A substantive role in a completed project or recruitment to a major portfolio study (not yet presented or published), or a grant as co-applicant, or a grant under £2,000 as principal holder
• 0None, or data collection only

Evidence: a grant certificate or award letter showing the funding body, the amount and that you were the principal holder.

• 5A major national or international award for outstanding achievement
• 3Two local or regional prizes for different pieces of work in different areas
• 2Second or third place in a major national or international award
• 1One local or regional prize
• 0None

Only prizes after your primary medical degree count. All four UK nations count as national for scoring.

Evidence: a certificate or official letter.

• 5First author (including joint first) of 3 or more papers relevant to the clinical neurosciences and neurosurgery, excluding case reports
• 3First author of 2 such papers
• 2First author of one peer-reviewed paper on any topic (not a case report), or named author on 3 or more peer-reviewed articles (no more than one a case report), or first author of a chapter in a published medical book
• 1Named co-author on 1 or 2 peer-reviewed papers, or first author of a case report, or co-author of a book chapter relevant to neurosurgery
• 0None, or only letters, abstracts, e-comments, pay-to-publish articles, preprints, or papers where you're listed only as a collaborator

Papers must be in PubMed-indexed journals and need a full citation with the PMID. Formally accepted papers count with an acceptance letter. State your position on the author list, or you'll be treated as a co-author.

Evidence: the full PubMed citation (all authors, title, year, reference and PMID), plus acceptance letters for papers not yet published.

• 5Three or more first-author oral presentations at national or international meetings in the last 4 years, on at least 2 different subjects
• 3Two first-author oral presentations at national or international meetings in the last 4 years
• 2One first-author oral presentation at a national or international meeting in the last 4 years
• 1An oral presentation at a regional meeting or society, or a poster at a national or international meeting in the last 4 years
• 0None, or departmental presentations only

• Each presentation must be a different project, and each project counts once however many times you present it.
• Online meetings and conferences don't count, and nor do accepted presentations you haven't yet given.
• Teaching presentations don't count; it must be original work.
• SBNS, BNRG and the subspecialty group meetings are given as examples of national or international meetings. A local or regional meeting held abroad doesn't count as international.

Evidence: a summary of up to 150 words for each, the relevant page of the meeting programme and a certificate of presentation (or a signed supervisor statement).

Each of your two projects is scored separately, up to 3 points each.

• 3You were involved in all aspects of a cycle of an original QI project and showed leadership by supervising other team members
• 2You were involved in all aspects of a cycle: planning, data collection, analysis and change
• 1One aspect of a completed multi-cycle project, or two or more aspects of a single-cycle project
• 0None or other

Each project needs a completed national audit form signed by your consultant supervisor, or it won't be considered. To score 3, your leadership role must be clearly described on the form. On a long-running project you can only claim the cycles you were directly involved in.

Evidence: one completed audit form per project, downloadable from the national recruitment page.

• 4A formal teaching role for 6 months or more, at a minimum of 50% whole time equivalent
• 3You developed and led a course, with a published programme and formal participant feedback
• 2Faculty on a course with a published programme and formal participant feedback
• 1You developed teaching materials such as apps, leaflets or course adjuncts, or gave regular teaching (at least monthly for 6 months) to clinicians or talks to the public
• 0None, or ad hoc teaching

A "course" must run for at least one full day, have at least 15 delegates, focus on a defined topic and collect both pre- and post-course feedback. Online courses aren't considered, and medical student teaching programmes score a maximum of 2 points.

Evidence: a signed letter from a consultant supervisor describing your involvement, plus course agendas listing you as faculty.

• 3Master's in education
• 2Postgraduate Diploma in education
• 1Postgraduate Certificate in education, or Associate Fellowship of Advance HE
• 0None

Evidence: a copy of the certificate.

• 4Chair of a major national or international body, which can include captain of a national or international sports team
• 3Vice chair, secretary or treasurer of a major national or international body
• 2Chair of a local or regional body, which can include captain, secretary or treasurer of a university sports or other society
• 1Vice chair, secretary or treasurer of a local or regional body, or local committee work such as rota coordinator or junior doctor representative
• 0No evidence of leadership

Evidence: letters or certificates of appointment showing your role.

You'll be expected to recognise and start managing the core neurosurgical emergencies safely, and to show you know when and how to escalate. High-yield topics include:

• Traumatic brain injury, extradural and acute subdural haematoma, and interpreting an emergency CT head
• Anticoagulated patients with intracranial bleeding, and reversal
• Subarachnoid haemorrhage and its complications, including delayed deterioration
• Acute hydrocephalus, shunt problems and normal pressure hydrocephalus
• Cauda equina syndrome, metastatic spinal cord compression and cervical spine injury
• Spontaneous intracerebral haemorrhage, brain tumours presenting with seizures, cerebral abscess and pituitary apoplexy
• The deteriorating patient after a craniotomy or posterior fossa surgery

Our advice

• Open with the immediate priorities: ABCDE, GCS and pupils, then imaging and early senior involvement.
• Know the guidance you quote, such as NICE head injury guidance, and be precise.
• Prepare for the follow-ups. Strong candidates get pushed onto complications, operative principles and ethical twists.

This station is unique to neurosurgery and catches out candidates who have only practised answering questions. You have to run the conversation.

Our advice

• Use a consistent structure every time: who is calling and from where, the patient, the history and mechanism, GCS and pupils over time, anticoagulants and antiplatelets, imaging findings, comorbidities and baseline function, then your plan.
• Ask what matters for the condition. For suspected cauda equina, that means bladder and bowel function, saddle sensation and bilateral leg symptoms before the scan.
• Give clear, specific advice, including what to do if the patient deteriorates, and agree how and when you'll be updated.
• Escalate appropriately to your registrar or consultant, and say so.
• Handle the hard calls professionally: an incomplete referral from a junior, a patient who doesn't need transfer, or a decision not to operate.
• Practise it out loud with a partner playing the referrer. Reading model answers isn't enough for this station.

Expect realistic neurosurgical workplace problems: consent discrepancies, fatigue after a night shift, a colleague who seems impaired, a confidentiality breach, competing urgent tasks on call, a patient refusing blood products, a complaint, or two patients and one critical care bed.

Our advice

• Patient safety comes first, then the colleague, the team and the governance follow-up.
• Show your reasoning when prioritising. Panels want to hear why one task comes before another.
• Know when to escalate and to whom, and how you'd document and learn from it.

This station tests the specialty criteria directly: realistic insight into neurosurgery and its demands, and knowledge of the training programme.

Our advice

• Make "why neurosurgery" personal and specific. Name the cases and experiences that shaped your decision.
• Know the pathway: run-through training from ST1, the curriculum, exams and what the job looks like day to day.
• Be honest about the realities: long training, demanding on-call, poor outcomes and difficult conversations, and how you cope.
• Link to your portfolio. Use your audits, research, teaching and electives as evidence of commitment.
• Be ready for current topics such as recent evidence, ethics of decompressive surgery and workforce issues.

Yes. Every neurosurgery applicant must sit the MSRA in the first recruitment round of the year, and it forms 40% of the shortlisting score.

You self-score 12 domains (up to 54 points) on the application form and upload evidence through Qpercom. Assessors check every claim before interviews, tell you about any change to your score with an explanation, and you can appeal. The Appeals Panel has the final decision.

Yes, as long as you have 24 months or less of clinical experience (whole time equivalent, excluding foundation) by the post start date. Earlier handbooks also limited how much of that could be in neuro specialties, so check the 2027 handbook.

Not yet confirmed. Interviews are held online in March; in 2026 they ran on 16 and 17 March.

In 2026 you could use handwritten notes you had prepared yourself. Check the 2027 interview guidance before the day.

For posts starting in 2027, UK medical graduates and the other priority groups defined in the Medical Training (Prioritisation) Act 2026 are prioritised at shortlisting and at offer stage. Within that, your rank still depends on your performance.

Learn a consistent referral structure, then practise live with someone playing the referrer. The PrepSurg Neurosurgery ST1 course includes 18 referral stations with role-player briefs and call scripts, plus live mocks with other candidates.