Certificate of Eligibility for Specialist Registration (CESR)
The General Medical Council has revised the methods for evaluating CESR evidence. The changes came into effect on 30 November 2023. (You can find much more detail about the changes here.)
The new approach means applicants have to move from demonstrating full equivalence to the Certificate of Completion of Training (CCT) programme, to one based on the applicant’s ability to demonstrate they have achieved the Knowledge, Skills and Experience (KSE) required for practising as a Consultant in the UK.
RCEM has worked closely with the GMC to revise our Emergency Medicine Speciality Specific Guidance (SSG) to ensure the change does not compromise the standard an individual has to meet to enter the Specialist Register.
The revised SSG focuses on reducing and not increasing the evidence required.
RCEM has considered the following in the revision of the SSG to reduce the burden of evidence:
RCEM CESR applicants collating evidence should do so with a particular focus on Extended Supervised Learning Events, the core specialities, Continuous Professional Development, reflections and the FRCEM.
One aspect that has changed is the name.
What was known as CESR has changed to the ‘Portfolio Pathway’ with CESR becoming the umbrella term for all alternative routes to the register.
Reviews of unsuccessful applications submitted before 30 November will be considered against the standard and SSG that was in place at the time of the initial submission.
Applicants are encouraged to attend one of our specifically tailored CESR Applicant Training Days. More details about these can be found on our events page .
If you are a CESR Lead/Supervisor in your department, we will be running a few workshops in 2024, specifically for you to network with other leads/supervisors and obtain further information on how to support those in their application process. If you are interested in attending these days please contact Daniah Ahmed, Daniah.ahmed@rcem.ac.uk.
If you have any queries, please feel free to contact the team by emailing cesr@rcem.ac.uk.
The standard changed from equivalence to CCT to Knowledge, Skills and Experience (KSE) required for specialist registration in the United Kingdom on 30 November 2023. RCEM has worked closely with the GMC to support the implementation of a new SSG. The framework for assessing KSE will reflect the Speciality learning outcomes (SLOs) of the Emergency Medicine speciality curriculum.
+ CESR Evaluators requiredAre you interested in this very important role which involves ensuring that Emergency Departments are led by consultants who have all the necessary competences? Are you a Member, Fellow or Associate Fellow of RCEM who is currently practising in EM in the NHS and is informed about the latest EM curriculum?
We currently need evaluators from all over the UK.
If you’re interested in applying, please download the Job Description and send a copy of your CV along with a cover letter about why you wish to be an evaluator and what you think you can bring to the panel to Daniah Ahmed.
It is a legal requirement for doctors to have their names entered on the General Medical Council’s (GMC’s) Specialist Register before taking up a substantive, honorary or fixed term NHS consultant post in the UK. Most doctors achieve this by completing a UK training programme resulting in the award of a Certificate of Completion of Training. However specialists who have not undergone a UK training programme are now able to apply for evaluation of their specialist training, qualifications, experience and knowledge to determine whether it is equivalent to the UK CCT.
For further information please see Eligibility – GMC (gmc-uk.org).
Applications are made directly to the General Medical Council (GMC) under Article 14 of the General Medical Practice and Specialist Medical Evaluation Training and Qualifications Order 2003. You will find an application pack and guidance notes on the GMC website.
The Specialty Specific Guidance 2015 version informs applicants of the criteria against which all applications will be evaluated.
The new 2021 curriculum SSG is now available: Specialty Specific Guidance 2021.
The New Standard SSG will be in effect from 30 November 2023.
Applicants will be expected to meet the skills and knowledge outlined in the Royal College of Emergency Medicine’s current curriculum. Please note that there is a new curriculum planned which is likely to be approved in Spring of 2020, and implemented for trainees in August 2021. Further information regarding submission of CESR applications against the new curriculum will be provided here in due course.
CESR colleagues will be at varying stages of collecting evidence and preparing their CESR applications for submission to the GMC. To help with colleagues following this route to specialist registration the College has agreed with the GMC that until 01 August 2022 CESR applicants can choose to submit on 2015 or 2021 curriculum, depending on their experience and body of evidence. After 01 August 2022, all CESR applicants will be required to demonstrate equivalence against the 2021 curriculum.
FAQs will also be provided on this current site to help support planning for transition in due course. The RCEM CESR group will also provide further clarification to those planning CESR application.
Applicants often fail due to insufficient evidence of current competences in the allied (Core) specialties of Acute Medicine, Intensive Care Medicine and Anaesthetics. In addition to submitting detailed logbooks, and workplace-based assessments as set out in the curriculum, it is expected that the applicant will have spent a period of time of at least three months (WTE) in each of Anaesthetics and Intensive Care Medicine. A period of time in Acute Medicine is desirable although these competences may be achieved in the Emergency Department. Experience in a Paediatric Emergency Department is recommended, but Paediatric EM competences may be achieved in a General ED with sufficient exposure to paediatric patients. Primary evidence of all competences should have been obtained within five years of submission of the application.
Note that applicants who have not completed FRCEM rarely provide sufficient equivalent evidence of having knowledge of the breadth and depth of the curriculum in order to succeed on a first CESR application.
Other frequent areas of shortfall include Advanced Life Support Courses (ALS, ATLS and APLS or recognised equivalents) not being in date, and lack of evidence to demonstrate completion of an audit cycle. Evidence for audit can include audit reports, presentation slides, publications and any guidelines produced as a result of the audit.
Doctors applying under the general system of assessment will essentially have their training evaluated; this involves a comparison of the curriculum for their specialist qualification to the current CCT curriculum in the UK in the speciality they are applying in. For CESR, a doctor’s current competence is assessed against the full breadth of the UK CCT curriculum of the specialty they are applying in. These two routes are very similar. However, for general system applications, evaluators place less importance upon demonstration of current competence (within the last five years) unless they are addressing gaps identified between the curricula from their practice.
The College would stress, however, that the curricula of most European countries are different to that of the UK to the extent that it is highly unlikely that an application will be acceptable without supporting evidence. We would strongly encourage potential General System applicants to come to one of the RCEM CESR Applicants Training Days to discuss their cases with the panel before applying.
These documents have been assembled by previous CESR applicants, who have kindly offered to share them with the members of the Royal College of Emergency Medicine, in order to aid current and future candidates with their CESR applications.
CESR: Why are you applying for a CESR?
First and foremost, one must be honest to themselves and answer, ‘Why are they opting for CESR pathway rather than regular training?’. Is it because it is an ‘easy’ way out rather than the monotonous process to undergo training selection or is there some other reason? If an applicant is undergoing the CESR route as a ‘default pathway of least resistance’ since there is no formal ‘selection process’ – then this is an incorrect approach and the applicant may be destined to fail. It is important to note that CESR is NOT an easy way out.
Some of the core reasons for clinicians take the CESR pathway are:
Hints and Tips from current CESR assessors:
Overall, if you keep abreast with the latest CESR guidelines from RCEM and GMC, work diligently towards reflective practice with perseverance, you should be able to easily achieve your goal of getting CESR in EM. Once you submit your application on the GMC portal, the quality assurance team is very supportive throughout and if you have done all the groundwork, they shall help you immensely in properly showcasing your work – but there is no shortcut to get that work done in the first place.
Make sure to:
Non-clinical skills are important too, mainly:
Thinking of making an appeal after the GMC’s final decision?
Applying for a Review?
If Reapplying:
Do:
Don’t:
What’s new?
Evidence
In the new Curriculum you will need to gather evidence across all 12 SLO and upload it to the relevant section in your online application. Whereas the old 2015 curriculum is divided in different competencies which include:
These competencies are very similar to the ones in the 2021 curriculum, however, the new curriculum divides these competencies into different SLOs, as explained above.
Form of Competences
The 2015 curriculum gave applicants the option to use a ‘Form of Competences’ to help ensure all your evidence covers all the required competences by the curriculum syllabus. However, on the 2021 curriculum, this form is no longer in use. If you still wish to use this form to help you complete your application please get in touch with the training team RCEM. You can, however, obtain access to the College’s e-portfolio, as a member of the College. Applicants are strongly advised to use e-portfolio, which has been specifically designed to assist CESR applicants in the collation of evidence.
Do I need an FRCEM?
Applicants applying for the new 2021 Curriculum are strongly advised to work towards completing all parts of their FRCEM exam. Both in the old curriculum and the new curriculum, there were a few examples of alternative evidence that could be supplied. Even though, this type of evidence is still acceptable, FRCEM is still highly recommended, as all parts of this exam are adapted to the curriculum and form basic tests of knowledge considered essential for an EM Consultant. equivalent evidence for knowledge of the breadth and depth of the curriculum needs to be extremely robust, and therefore it is rare for those without the qualification to succeed in obtaining CESR on a first application.
Domains have been replaced by SLOs?
Your evidence must cover the knowledge, skills and qualifications to demonstrate the required competences in all areas of the Emergency Medicine Curriculum documentation. If evidence is missing from one area of the curriculum for example, then the application may fail.
In the old 2015/2016 curriculum, evidence could be broken down into 4 different domains. However, in the new 2021/2022 Curriculum, domains have been ‘replaced’ by Specialty Learning Outcomes – SLOs. While the SLOs largely reflect the old curriculum Domains, the 2021 curriculum discourages previous ‘tick box’ methods used in the old curriculum, in favour of a broader approach to the subject.
Therefore, in the new curriculum there are 11 ACCS Learning Outcomes and 12 EM SLOs incorporating the ACCS learning outcomes. Together, these form the RCEM Learning requirements. In each of the SLOs your evidence needs to demonstrate progression to the highest level of entrustment, consistent with operating at consultant level.
Applicants are expected to provide a minimum of 36 WBPAs, in the form of DOPS (12), Mini-CEX (12) and CBDs (12), which should be provided throughout the SLOs according to the Curriculum. This minimum does not include ESLEs, or other assessment formats and does not include the WBPAs associated with the following related specialties; Anaesthetics, ICM, Acute Medicine and Paediatrics.
For each of the SLOs, the new curriculum gives you a list of suggested documentation that you can provide in order to meet the Learning Outcome. It also gives you a list of key capabilities which show what the applicant will be expected to demonstrate, in terms of skills and knowledge, for that specific SLO.
Note: If you have a piece of evidence that is relevant to more than one SLO, do not include multiple copies in your bundle. Instead, provide one copy and list it in your application under each relevant SLO, stating that the document is located elsewhere, and you’d like to cross reference it.
It is also important to note that you will not be able to compensate for shortfalls in your evidence of training and experience in a particular area of the curriculum by providing extra evidence in other areas.
Contact GMC for information about the application process at equivalence@gmc-uk.org.
Contact our CESR Training Officers at CESR@rcem.ac.uk.
Those preparing to apply for a CESR and who meet the experience/training requirements may be eligible to sit the Fellowship exam. It is highly recommended that applicants obtain FRCEM; equivalent evidence for knowledge of the breadth and depth of the curriculum needs to be extremely robust, and therefore it is rare for those without the qualification to succeed in obtaining CESR on a first application. Please email Exams@RCEM.ac.uk for clarification regarding eligibility for FRCEM. The application form, details about the exam and regulations are available on the FRCEM Exams page of this website.
RCEM ePortfolio is available for non-trainees.
The College has an eLearning resource, RCEMLearning, content of which has been mapped to the curriculum. For access information, please contact RCEMLearning@rcem.ac.uk
+ Trainee Recognition
Some trainees who have been appointed to GMC-approved training programmes are able to have some of their non-approved training and experience recognised and enter at a level higher than CT/ST1. These trainees will be training towards CESR-CP rather than CCT. More information about the Combined Programme can be found on the GMC’s website.
From August 2014 the GMC requires that it be notified at the start of their training of all trainees wishing to have previous non-GMC-approved training recognised – for instance training towards CESR-CP. The trainee’s LETB/deanery will contact the College with the entry level. The LETB will then make an application to the GMC to approve the trainee’s enrolment and confirm eligibility to apply for a CESR via a CP application upon successful completion of their training. The GMC will write to the trainee, as well as their LETB and college, confirming that the trainee is working to the award of a CESR via a CP application, and provide a unique number, to be used by the college when making notifications and recommendations for the award of a CESR (CP). The College will then write to the trainee confirming enrolment with the TSC and an expected end of training (CESR(CP)) date.
CESR is an ever evolving process and to ensure you have the right support we do advise reading the SSG thoroughly prior to starting your process and ensuring you are supported as best as possible throughout. We advise CESR applicants to have supervisors in their units who are either evaluators or have attended a College leads training day at least once every two years to ensure the support you receive is fully up to date. It is the applicants responsibility to ensure they are well equipped and where possible to work with the CESR lead within their Department for regular assessments and mentorship. Please also check the RCEM CESR website for updates and help. The College runs CESR Applicant Days at least twice a year, in which an overview of CESR is given by the RCEM CESR team, including the assessors and the GMC. Time is also provided to answer your problems and seek solutions. We would advise all those intending on entering the CESR pathway to attend an applicant training day at least once during the course of their CESR application.
NOTE: Text in Red in the answers refer to information for the new 2021 curriculum.
+ If I have done a secondment in a specialty but this was more than 5 years ago, how much time do I need to satisfy the evaluators?When a secondment is out of date, the applicant needs to demonstrate that they are current with the skills needed to practise ICM, Anaesthetics, Acute Medicine or Paediatrics.
The longer the time which has passed, the greater the need to demonstrate proficiency. The evaluators cannot therefore specify specific amounts for these ‘update periods’ but would emphasise that there are many ways in which this experience can be gained, for example, top up weeks spent in the specialty, refresher courses on airway skills, or WBA in relevant secondment skills supervised by specialists in these fields.
If there are no relevant skills demonstrated in the evidence bundle, evaluators may suggest, for example, a 3-month full-time secondment in order to demonstrate necessary proficiency.
With a QIP, the key is in the detail, especially the presentation and write-up. With a large project, especially ‘chronic’ ones, a significant leadership role within the project, particularly for a discrete section or for a period of time (as opposed to complete ownership) is likely to meet the exam requirements.
In the new 2021 curriculum, the QIP will no longer be examined. The details of how QI is assessed are in the curriculum, this essentially a reflection on the project by the learner (a form guiding this is part of the curriculum). This is then signed off by a supervisor.
Yes. Candidates are expected to include a QIP in their portfolio, which should include all the background work employed to achieve the QIP. The reason we ask for this is to allow the CESR assessor to get an insight into the work put in the project and to gain an opinion regarding the candidates’ organisational and managerial abilities.
Whether the signatory is external or internal does not make a difference as the pass or fail given to applicants is dependent upon the CESR assessor.
Although it is key to mention that internal mentors/assessors, within the department, may have useful input in order to steer the project towards the most useful outcome.
If the candidate has not passed or not submitted a QIP in time as part of the exam, they should still submit an unassessed QIP with their CESR application. A QIP can be assessed and presented internally in the department with comments from the team before submitting with the CESR application.
Candidates do not need to have membership in order to submit a CESR application. But they will need to have this in order to gain access to the e-portfolio.
FRCEM is not mandatory for CESR applications, but candidates are encouraged to complete FRCEM as it will help provide necessary evidence. If a candidate does not have it they may need to submit more evidence.
Yes, there several ways this can be achieved.
A doctor can apply for subspecialty recognition after a successful CESR in EM. However, they would have to complete the approved subspecialty training programme – either in the UK or an alternative subspecialty training programme from overseas.
It’s possible that a doctor could apply for a non-CCT CESR in a subspecialty area if the College consider that specialty is consistent with the standards of a UK NHS consultant. However, the eligibility requirement is very specific, this includes: six months training or a specialist qualification – of which must have been obtained outside the UK and in a non-CCT specialty.
The assessment standard for a non-CCT CESR would be the standards of a consultant in the NHS – it’s expected the College would use the EM and subspecialty curriculum as a guide to those standards.
We understand candidates may not have a training number to complete training in the UK. Thus, we recommend candidates arranging a sub-specialty training locally with their supervisors, so a training number wouldn’t be needed. Candidates will not be able to do the training in another deanery as they do not have a training number which is required to train elsewhere in the UK.
The candidate needs to present evidence that demonstrates they are competent across the curriculum at the point of the application and evidence from the last five years will have most consideration in the evaluation.
The doctor can choose to provide older evidence where they consider this is necessary to cover the curriculum. However, they will need to indicate how their subsequent evidence from the last five years demonstrates any earlier competencies are current and maintained.
The candidate will need to demonstrate not only a portfolio completion but knowledge and skills which are required as part of a standard in the FRCEM examination current or future.
In addition to the current requirements set out in the SSG, the following will need to be submitted:
Candidates will need to submit two ESLE’s per year over the past 3 years (please see page 36 of the SSG).
The deadline to submit an application for a CESR under the 2015 curriculum was August 2022. All applications will now have to be submitted under the new 2021 Curriculum.
Candidates will be able to submit a review of their application under the 2015 application and they will have 12 months from the date of the GMC decision to do so.
Candidates are advised to read the following document designed for subspecialty training in PEM: Paediatric Emergency Medicine syllabus
The first three Learning Outcomes give a good overview of the range of competencies and aptitudes necessary for a future Emergency Medicine consultant undertaking CESR.
Candidates are particularly directed to the RCEM grid on page 20 of this document, which contains 15 elements.
Candidates are free to choose what they consider the most effective means to demonstrate their competence in each of the elements of this grid. This could include demonstrating adequate coverage of the 52 clinical conditions from Learning Outcome 1 in this PEM document, the leadership roles of Learning Outcome 2, and the 21 practical procedures outlined in Learning Outcome 3.
Candidates are also reminded that knowledge of the interactions between hospital and the community are of particular importance in paediatrics and experience of this relationship should be demonstrated.
We do not stipulate a minimum or maximum number of work-based assessments for this branch of emergency medicine. However, it is unlikely that the candidate will be successful unless at least one item of evidence has been demonstrated for each one of the elements of the grid shown on page 20 of the document.
The SSG states that a minimum of 3 months full time is needed and in effect mandatory to gain enough experience.
Candidates may find this difficult to pass by their seniors and get given misleading solutions to avoid doing this. In such a case, the candidate could potentially do between 1- 2 months full-time in the relevant specialties, depending upon the calibre of the other work.
Candidates are expected to do between 1 and 2 months full-time in each of the specialties: AM, Anaesthetics and ICM; depending upon the quality of the work-based assessments, reflections, and other types of evidence.
With regards to having all the Acute Medicine WBA signed off by ED consultants, this is not acceptable. The SSG states that, although these competencies could be gained within the ED, they, or the majority of them, must be signed off by an acute medicine consultant or medicine consultant in order to demonstrate that they have been assessed by doctors who are aware of the patient lifecycle beyond their time in the Emergency Department. For instance, having done medicine posts over 10 years ago will not be sufficient to gain any leniency here.
Specifically, over 2022 we are predominantly running ‘train the trainers’ courses aimed to produce a large number of Ultrasound leads courses. There are at least 6 courses planned to be delivered in 2022 – we may fit in more as the year progresses, especially regional courses. We are starting in Bournemouth with a trial course, and once there’s enough sign-ups for the course we can then organise an “industrial size” course.
This course is designed to upskill current leads and make a whole load of new group of leads as well as upskilled seniors, especially in the new elements. Our hope is that as 2022 develops we will have increased numbers of consultants who are entirely happy with the process/new requirements and importantly the sign-off process.
The 2021 curriculum discourages ‘tick box’ methods in favour of a broader approach to the subject. Therefore, for ICM it would be helpful to have a more specific task-list for applicants to accomplish during the 3-months they are in this specialty. As for Anaesthetics the IAC caters for the majority of the trainees needs.
We recognise that it may be difficult for trainers in ICM to know which procedures and competencies are required by CESR doctors while rotating in this specialty. Therefore, we have provided guidance for trainers and trainees to assist them in providing an appropriate level of evidence required for a CESR doctor.
Please click on the link below to see a list of topics to be covered in the Work Based Assessments for CESR doctors during their secondment in ICM.
ICM Competencies CESR1 (PDF)
At least one FEG a year should be enough, as long as it is a detailed one. However, during the course of each year, CESR doctors should be having annual appraisals, interim appraisals, ESLEs and a FEG in each year.
There is currently no exemption for FACEM positive graduates. They are subject to the same stipulations as other CESR applicants.
Acting up can mean taking on a post as a consultant (locum), within a 6-month period of obtaining CCT or CESR specialist registration. It also applies to any role which is taken on above the doctor’s contracted position, for instance, a junior SAS doctor taking on the role of heading the department.
RCEM advises that any CESR doctor contemplating a consultant role should have obtained FRCEM and be no more than 6-months from their anticipated date for obtaining Specialist Registration.
For CESR doctors, this would mean that the date of a consultant interview should consider the length of time it takes for the GMC and RCEM assessors to review an application. Please bear in mind that an application may not pass first time, meaning that the period of time before resubmission and success may be up to one year or longer depending upon the recommendations given by the assessors. Please see the following document for further advice from RCEM concerning acting up as a consultant prior to specialist registration.
You wouldn’t need to apply for a CESR if you complete a post-CCT subspecialty training. You would apply for subspecialty recognition instead, which is quite different and just requires the doctor to present evidence they have completed the approved subspecialty training programme.
GMC guidance on this can be found here: https://www.gmc-uk.org/registration-and-licensing/join-the-register/registration-applications/specialist-application-guides/sub-specialty
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