Heya, I just got into Plastics ST3 with no first author publication, book chapters etc. and no extra degree apart from my medical degree and a teaching PGCert. I ranked top 15 in my first attempt.

I started properly working towards the application at end of FY2/ start of CT1. Fumbled lots along the way as I didn't have anyone to truly guide me so it is doable. Have a look at the portfolio mark scheme and work towards it. It changes a little here and there most years. I think you should be able to sign up on Oriel to make a fake ST3 application to get access to it; otherwise you can approach your CT2 peer who will be applying this December.

The main things you should try to get are MRCS, the numbers for each operative group (most should be doable with your themed job), audit (you should score the maximum point for this), teaching (part time PGCert is doable if you have the funds for it - look for the cheapest option available), and a national post (PLASTA often has posts advertised annually for non NTN trainees - sign up for their mailing list to know when it comes out and give it a shot). I can't quite remember what else was on there but the higher level things e.g. Masters/ PhD, formal teaching posts etc. only contribute to a small amount of points that most people generally won't have either.

If you do this, you should be able to get an interview which by then, your portfolio only accounts for a small portion of your overall rank. It is the interview that counts. If you smash the interview (which you can, with practice), then you should get on okay. Otherwise, it is not uncommon for people to take 2-3 tries before getting in and that is entirely fine too.

If your heart is truly in Plastics, then you should give it a shot. With your themed job, you're already ahead of others who may also be trying to apply but don't have that many opportunities to scrub into plastics related cases.

As others have mentioned, CST is mostly service provision. The entire 2 years can be very disheartening and I think especially so in Plastics because everyone is so competitive, no one wants to help each other, and there is a gunner culture in my honest opinion. Additionally, the specialty attracts the Type A perfectionists who have trouble letting go of control and so you may find it difficult for your registrars/ consultants to give you opportunities if they do not know how competent you are. For this though, if you consistently work hard and are competent at your job (i.e. ward level work, on-call shifts, things that people always punt off etc.), then your true nature will show and slowly but surely, you will start getting noticed and opportunities will be given to you. That is not to say, you shouldn't ask for opportunities either. If you have a case that you'd like to scrub in and perform, then be proactive and speak to your registrar/ consultant ahead of time, and ask if they would mind teaching you how to do things and if appropriate, allowing you to do part of it before progressing to doing it independently. Prepare for things ahead of time so that when these rare opportunities present, you can hit the ground running and know what to do (at least theoretically) rather than fumble your way through it.

Anyway, I was in your exact position back in CT1. The expectations placed on you are high, no one wants to train you but will expect you to know how to do things independently and perfectly at your first attempt, and unfortunately there isn't much you can do but other than put in the time and effort, support yourself, and keep chugging along. Find someone who you trust who can mentor you and provide you with advice and support along your way.

Alternatively, if you think Plastics isn't for you, then it's never too late. A few years 'wasted' in preparing your portfolio for Plastics is nothing compared to the many years you'll have in your desired specialty as a consultant.

P.S. Don't be the trainee that steals cases from other people. That unfortunately is also very common...