CESR

The Portfolio Pathway, formerly Certificate of Eligibility for Specialist Registration (CESR) in Emergency Medicine, provides an alternative route to specialist registration for doctors in the UK. This pathway is particularly beneficial for non-trainees who have gained substantial experience in Emergency Medicine (EM) outside the UK or those with commitments preventing them from pursuing traditional training posts. Additionally, it offers an opportunity for doctors who have had to leave training programs to complete their competencies and apply for specialist registration.

The CESR application process involves a thorough documentation of your clinical competencies, mapped against the Royal College of Emergency Medicine (RCEM) curriculum. Key elements include:

• Structured Reports: Prepared during annual appraisals with your educational supervisor.

• Curriculum Vitae (CV): Detailed and up-to-date.

• Evidence Portfolio: Categorized under the four domains set by the GMC, showcasing your broad range of competencies.

Your clinical skills and knowledge will be assessed through a variety of means, including:

• Workplace-Based Assessments (WPBAs): Covering competencies in ACCS curriculum and higher specialty training, with a focus on reflection and mature learning.

• Extended Supervised Learning Events (ESLEs): At least two per year for three years, alongside regular 360° and multi-source feedback.

• Logbooks: Documenting procedural involvement, outcomes, and reflective learning over at least three years.

The CESR application requires evidence of achieving 11 ACCS Learning Outcomes and 12 EM-specific Speciality Learning Outcomes (SLOs). Applicants must demonstrate high levels of entrustment across these outcomes, indicative of readiness for a consultant role. This includes a wide array of competencies from managing adult patients to leadership skills within the ED.

A structured rotation plan, including secondments in critical areas such as Acute Medicine, Intensive Care Medicine (ICM), Anaesthetics, and Paediatric EM, is designed to ensure comprehensive clinical exposure. These secondments are complemented by targeted training sessions and access to regional RCEM teaching resources.

Supporting your CESR application with a robust portfolio of evidence, including medical reports, case histories, referral letters, and patient lists, is crucial. This documentation should comprehensively cover your clinical practice, showcasing your capabilities across the EM curriculum.

The CESR pathway in Emergency Medicine demands a high level of dedication and comprehensive documentation of clinical competencies. Through structured training, assessments, and reflective practice, candidates can demonstrate their readiness for specialist registration and a consultant post in Emergency Medicine. This guide serves as a roadmap for those embarking on this challenging yet rewarding journey towards specialist recognition in the UK.

• CESR Manual - Dr. Shakeel Siddiqui

• CESR Trainees Curriculum - Dr. Shakeel Siddiqui

The Portfolio Pathway, formerly CESR, provides an alternative route for doctors to attain specialist status in the UK, especially in Emergency Medicine (EM). It is intended for individuals without a GMC-approved training program but who demonstrate equivalent knowledge, skills, and experience (KSEs) for specialist practice.

Key Features:

• Reflective Practice: Essential for continuous improvement in EM, enabling doctors to evolve their skills and knowledge.

• Specialty Learning Outcomes (SLOs): Candidates must evidence their proficiency across 12 SLOs, encompassing both clinical abilities and the leadership skills requisite for advanced roles.

1. Commencement

   • Check your eligibility for the CESR pathway.

   • Learn about the specific curriculum for your specialty.

2. Evidence Building

   • Collect and organize your professional evidence.

   • Align your evidence with the required competencies.

   • Maintain a routine of reflective practice.

3. Application Process

   • Assemble your evidence for online CESR application.

   • Proceed with submitting your application to the GMC.

4. Evaluation Procedure

   • Wait for the GMC to review and assess your application.

   • Provide additional information if the GMC requests clarification.

   • Await the final CESR decision from the GMC.

5. Finalization

   • Once successful, apply for your specialist registration.

Evidence Collection

• Compile recent competency evidence from the past five years, allowing for documentation up to six years old, to demonstrate current practice proficiency.

• Ensure your competency evidence aligns with all 12 Specialty Learning Outcomes (SLOs) as stipulated in the RCEM curriculum.

Core Documentation

• FRCEM Qualification: It's recommended to have achieved the FRCEM qualification for a stronger application.

• Knowledge, Skills and Experience (KSE): Provide evidence of your expertise in the core specialties crucial for autonomous Emergency Medicine (EM) practice, which includes:

  • Emergency Medicine

  • Acute Medicine

  • Intensive Care Medicine

  • Anaesthetics

  • Paediatric Emergency Medicine

• Continuing Professional Development (CPD): Document ongoing CPD activities that relate to the EM SLOs, emphasizing the importance of reflective learning.

• Service Improvement: Demonstrate your contributions to enhancing service quality through involvement in Quality Improvement Projects (QIPs) and audits.

• Educational Supervised Learning Events (ESLEs): Submit evidence of at least six ESLEs from the past three years, with a minimum of three completed within the last 12 months before applying.

Application Preparation:

• The CESR application involves preparing a detailed portfolio that showcases the candidate’s competencies across various domains. This includes submitting a range of evidence such as case logs, assessments, appraisals, courses, and reflections.

Application Submission:

• Once the portfolio is complete, the candidate submits it to the GMC for evaluation. The application must be meticulously organized and clearly demonstrate how each requirement is met.

GMC Evaluation:

• The GMC evaluates the application against the standards required for CCT. This process can take up to 6 months and may involve additional queries or requests for information from the candidate.

Outcome:

• If successful, the candidate is granted a CESR and can apply for specialist registration. This allows them to work as a consultant in the NHS or private practice in their specialty.

Appeal Process:

• If the application is unsuccessful, candidates can seek feedback and may appeal the decision or address the identified gaps before reapplying.

Planned Achievement Timeline:
Break down your competency achievements over 5 years, including:

• At least 150 reflective cases, with 10 in-depth analyses.

• Engage in regular Work-Based Assessments (WBAs), including but not limited to:

  • Case-Based Discussions (CBDs)

  • Mini-Clinical Evaluation Exercises (mini-CEX)

  • Directly Observed Procedural Skills (DOPS)

• A minimum of two ESLEs annually, including evaluations from your supervisor.

• Ultrasound Level 1 certification by your fourth year.

• Complete one full Quality Improvement Project (QIP) with three cycles as a mandatory requirement.

• Engage in 1-2 audits per year as a recommended practice.

• Maintenance of valid lifesaving certifications (APLS, ALS, ATLS).

• Process of achieving competencies: Specialty Specific Guidance

• Detailed application guidance: Online Portfolio Application