I was interested in anatomy and surgery as a second and third year medical student. I was encouraged to keep an open mind throughout training up to Core Surgical Training and sought placements in general surgery, paediatric surgery, orthopaedics and plastics. I think this was valuable to my training.
For me, the greatest appeal is the problem solving approach to reconstruction. Plastics also remains a very broad specialty covering many aspects of trauma, lower limb reconstruction, hand surgery, breast surgery, skin cancer, burns, cleft lip and palate, ear reconstruction, facial reanimation, head and neck etc…
The competition rate has certainly fallen since the early millennium with ST3 ratios now around 3 - 4:1 at National Selection. That said, most applicants are well prepared.
When building your application, you will score points for having Plastics-related publications and presentations. You also score points separately for non-Plastics work. If there is no Plastic Surgery department where you are based, check if there is an outreach clinic. Failing that, approach one of the Consultants from the nearest hospital with Plastics to see if they have any ideas for projects or publications.
For audit, there is no rule regarding Plastics-specific projects. I had a couple of Plastic Surgery themed audits, but the others related to handover standards, VTE and peri-operative hypothermia.
Ultimately, there are index procedures for which you need operative numbers otherwise your application will look weak. These are achievable in Core Surgical Training and including nail bed repair, tendon repair, digital nerve repair, debridement/closure of a wound, excision of skin cancer +/- skin graft or flap, burns debridement + skin graft and burns management.
Every year in February, applications open on Oriel (the NHS application website). It’s worth setting up an application just to look at how to score points.
Hope that helps, let me know if you have any further questions!