The General Medical Council has revised the methods for evaluating Certificate of Eligibility for Specialist Registration (CESR) evidence. The changes came into effect on 30 November 2023 and has been renamed ‘Portfolio Pathway’
The Portfolio Pathway is the route to specialist registration for doctors who have not completed a GMC-approved UK specialty training programme but can demonstrate the knowledge, skills and experience (KSE) required to practise as a consultant in Emergency Medicine in the UK.
Applications are made directly to the General Medical Council (GMC). Once accepted, applications are referred to the College for specialist evaluation against the Emergency Medicine Curriculum and the Specialty Specific Guidance (SSG). RCEM provides a recommendation to the GMC, which makes the final decision on specialist registration.
Portfolio Pathway applications are based on the 2021 Emergency Medicine Curriculum and the SSG. Applicants must demonstrate that they have achieved the knowledge, skills and experience required for specialist registration across the breadth of Emergency Medicine practice. Evidence should be clearly mapped to the Specialty Learning Outcomes (SLOs) and supported by relevant documentation.
Before preparing your application, we recommend that you:
- review the GMC Portfolio Pathway guidance;
- read the Specialty Specific Guidance (SSG);
- familiarise yourself with the Emergency Medicine Curriculum;
- attend an RCEM Portfolio Pathway Applicant Training Day; and
- ensure your evidence is organised and mapped to the relevant SLOs.
If you need to contact RCEM regarding Portfolio Pathway, please contact the RCEM Accreditation Team.
Email: portfoliopathway@rcem.ac.uk
RCEM is grateful to the consultants who volunteer their time and expertise to evaluate Portfolio Pathway applications on behalf of the GMC. Portfolio Pathway evaluators play a vital role in supporting specialist registration and maintaining the high standards of Emergency Medicine practice.
If you are interested in becoming a Portfolio Pathway evaluator, or would like to find out more about the role, eligibility criteria and how to apply, please visit our Volunteering Opportunities page.
You can also contact the RCEM Accreditation Team at portfoliopathway@rcem.ac.uk if you have any questions about the evaluator role.
Doctors must be included on the General Medical Council (GMC) Specialist Register before taking up a substantive, honorary or fixed-term NHS consultant post in the UK.
Most doctors achieve specialist registration by completing a GMC-approved UK training programme and being awarded a Certificate of Completion of Training (CCT). Doctors who have not completed a UK training programme may be eligible to apply for specialist registration through the Portfolio Pathway by demonstrating that they have the knowledge, skills and experience (KSE) required for specialist registration in Emergency Medicine.
Applications are made directly to the GMC. Once an application has been accepted, the GMC refers it to RCEM for specialist evaluation. RCEM assesses the evidence against the Emergency Medicine Curriculum and the Emergency Medicine Specialty Specific Guidance (SSG) before providing a recommendation to the GMC. The GMC makes the final decision on specialist registration.
Before starting your application, we recommend that you review the following resources:
Before applying through the Portfolio Pathway, you should ensure that you meet the General Medical Council (GMC) eligibility requirements.
To apply for specialist registration through the Portfolio Pathway, you must:
- hold a primary medical qualification acceptable to the GMC;
- have completed at least six months' continuous specialist training or specialist practice in Emergency Medicine;
- be able to demonstrate the knowledge, skills and experience (KSE) required for specialist registration, as described in the Emergency Medicine Specialty Specific Guidance (SSG).
The GMC determines eligibility for the Portfolio Pathway and manages the application process.
Applications are submitted directly to the GMC
Before submitting your application, you should:
- confirm that you meet the GMC eligibility requirements;
- read the Emergency Medicine Specialty Specific Guidance (SSG);
- review the Emergency Medicine Curriculum (2021);
- prepare evidence that demonstrates the required knowledge, skills and experience (KSE);
- organise your evidence so that it clearly maps to the Specialty Learning Outcomes (SLOs);
- ensure your evidence is current, relevant and clearly labelled.
Once the GMC has confirmed that your application is complete, it will be referred to RCEM for specialist evaluation.
RCEM evaluates the evidence against the Emergency Medicine Curriculum and the Specialty Specific Guidance before providing a recommendation to the GMC. The GMC considers this recommendation and makes the final decision on specialist registration.
For full details of the application process and eligibility requirements, please refer to the GMC Portfolio Pathway guidance.
The SSG is the key guidance document for doctors applying through the Portfolio Pathway.
It explains the knowledge, skills and experience (KSE) required for specialist registration in Emergency Medicine and provides guidance on the types of evidence that can be submitted to demonstrate achievement of the Emergency Medicine Curriculum.
Applicants should read the SSG before collecting evidence or preparing their application, as it forms the basis on which Portfolio Pathway applications are evaluated.
Access the latest version of the SSG here.
Portfolio Pathway applications are evaluated against the 2021 Emergency Medicine Curriculum.
Applicants must demonstrate that they have achieved the knowledge, skills and experience (KSE) required for specialist registration by providing evidence against the Specialty Learning Outcomes (SLOs) within the curriculum.
The curriculum should be used alongside the Specialty Specific Guidance (SSG) when planning and preparing your application. Together, these documents explain the standards expected and the types of evidence that may be submitted in support of your application.
Access the Emergency Medicine Curriculum here.
Most unsuccessful applications are not due to a lack of experience, but because there is insufficient evidence to demonstrate the knowledge, skills and experience (KSE) required for specialist registration.
When preparing your application, particular attention should be given to the following areas:
Core specialty experience
Applicants should provide evidence demonstrating experience across the breadth of Emergency Medicine, including:
- Acute Medicine
- Anaesthetics
- Intensive Care Medicine
- Paediatric Emergency Medicine
As a guide, applicants are normally expected to have completed at least three months' whole-time equivalent (WTE) experience in both Anaesthetics and Intensive Care Medicine. Experience in Acute Medicine is desirable, although the required capabilities may be demonstrated through Emergency Medicine practice where appropriate.
Experience in a Paediatric Emergency Department is recommended. However, the required capabilities may also be achieved within a General Emergency Department where there is sufficient exposure to paediatric patients.
Evidence
Applications should include a broad range of evidence, including workplace-based assessments, supervised learning events, logbooks and other supporting documentation that demonstrates achievement of the curriculum.
Where possible, evidence should be current, with the majority obtained within five years of submitting the application.
Fellowship of the Royal College of Emergency Medicine (FRCEM)
Applicants who have not completed FRCEM should ensure they provide sufficient alternative evidence to demonstrate the breadth and depth of knowledge expected of a consultant in Emergency Medicine.
Mandatory courses
Evidence should demonstrate that relevant life support courses (such as ALS, ATLS and APLS, or recognised equivalents) are current where appropriate.
Quality Improvement
Applicants should include evidence of meaningful involvement in Quality Improvement (QI) activities. This may include completed audit or QI projects, presentations, publications or local guidance developed as a result of the work.
Preparing a Portfolio Pathway application takes time, planning and careful organisation. Successful applicants consistently demonstrate that they have met the knowledge, skills and experience (KSE) required for specialist registration through a well-structured portfolio supported by clear, relevant evidence.
The following guidance and resources have been developed to help applicants prepare a strong Portfolio Pathway application.
Preparing your portfolio
When preparing your application, we recommend that you:
- read the Emergency Medicine Curriculum and the Specialty Specific Guidance (SSG) before collecting evidence;
- plan your evidence against the Specialty Learning Outcomes (SLOs);
- ensure your portfolio demonstrates the breadth of Emergency Medicine practice;
- use workplace-based assessments, supervised learning events and reflective practice to support your evidence where appropriate;
- organise your evidence clearly and consistently; and
- regularly review your progress throughout the preparation of your portfolio.
Where one piece of evidence demonstrates more than one SLO, reference it against each relevant SLO rather than including multiple copies.
Applicants should also ensure that the majority of their evidence reflects current clinical practice.
Fellowship of the Royal College of Emergency Medicine (FRCEM)
Applicants are strongly encouraged to complete FRCEM, as it provides evidence of the knowledge expected of a consultant in Emergency Medicine.
Applicants who do not hold FRCEM should ensure they provide robust alternative evidence demonstrating the breadth and depth of knowledge expected for specialist registration.
Advice from previous applicants
The following resources have been kindly shared by previous applicants and experienced clinicians to support others preparing a Portfolio Pathway application.
These resources are intended to complement the SSG and Emergency Medicine Curriculum and should not replace the official guidance.
- Doctor's Guide to the Portfolio Pathway - Practical guidance from Dr Rakan Khalifah.
- Crossing the Rubicon: My Portfolio Pathway Journey in Emergency Medicine - A personal account by Dr William Niven, sharing practical advice and reflections from preparing a successful application.
For queries about the Portfolio Pathway application process, including eligibility, submitting an application and specialist registration, please contact the GMC
If you need to contact RCEM regarding your Portfolio Pathway application, please contact the RCEM Accreditation Team.
Applicants preparing a Portfolio Pathway application who meet the eligibility requirements are strongly encouraged to complete the Fellowship of the Royal College of Emergency Medicine (FRCEM).
FRCEM provides evidence of the knowledge expected of a consultant in Emergency Medicine and is aligned to the Emergency Medicine Curriculum. Whilst it is not a mandatory requirement for specialist registration through the Portfolio Pathway, applicants who do not hold FRCEM should ensure they provide robust alternative evidence demonstrating the breadth and depth of knowledge required for specialist registration.
Information on eligibility, examination regulations and how to apply can be found on the FRCEM Exams page.
The RCEM ePortfolio is available to non-trainees and can be used to support the preparation of a Portfolio Pathway application.
Access to the RCEM ePortfolio is available to members with the appropriate membership category. Further information on eligibility and how to access the platform can be found on the RCEM ePortfolio Access page.
RCEMLearning is the College’s online learning platform, providing curriculum-aligned educational resources to support learning and professional development.
Portfolio Pathway applicants may find RCEMLearning useful for maintaining and developing knowledge across the breadth of Emergency Medicine, supporting continuing professional development (CPD), and identifying learning relevant to the Emergency Medicine Curriculum.
RCEMLearning includes a wide range of educational resources, including:
- Learning Sessions
- Clinical Cases
- Blogs
- Podcasts
- EM Quizzes
- Single Best Answer (SBA) questions
- Reference resources
- An integrated CPD diary
Some content is exclusive to RCEM members.
Further information on accessing RCEMLearning is available on the RCEMLearning page.
Frequently Asked Questions
NOTE: Text in Red in the answers refer to information for the new 2021 curriculum.
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:
- QIP and CLA more depth of evidence
- Additional 10-15 reflections. It is a key component for ACP credentialling portfolio as it enables the portfolio reviewer to really gauge the learner and their development, their challenges, insight, their drive, motivation, leadership skills and views.
- 5 further ESLEs
- 5 SRs
Candidates will need to submit two ESLE’s per year over the past 3 years (please see page 36 of the SSG).
- Additional 10-15 reflections. It is a key component for ACP credentialling portfolio as it enables the portfolio reviewer to really gauge the learner and their development, their challenges, insight, their drive, motivation, leadership skills and views.
- 5 further ESLEs
- 5 SRs
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.
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.
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