CESR - a comprehensive guide for histopathologists
- April 06, 2023
IMGs from any country in the world can apply for Specialist Registration, provided certain eligibility criteria are met, though there are different routes available based on a doctor’s qualifications and training.
Here we explore specialist registration in histopathology for overseas consultant pathologists and specialists more closely. We’ll cover the Certificate of Eligibility for Specialist Registration (CESR) specifically, including the application, costs, and eligibility criteria, along with some other topics, summarised in the headings below:
- What is Specialist Registration?
- What route to Specialist Registration is best for me as an overseas pathologist?
- Do I have to complete CESR before I can work in the UK?
- Do I need FRCPath for Specialist Registration?
- What is the CESR equivalence process?
- What evidence do I need to submit for a CESR in histopathology?
- How much does CESR cost?
- How long is the CESR application process?
- #IMG Tips
- How do I get started?
Skip ahead to the relevant section if you know what you’re looking for.
Specialist Registration
Specialist registration in any specialty means that you can be appointed to a substantive (permanent) consultant position in the NHS. All physicians who wish to take permanent consultant roles in the UK must show evidence of skills, knowledge, and experience in order to gain Specialist Registration.
Specialist Registration is additional to full registration with the GMC and is therefore not required to practice as a histopathologist in the UK.
Routes to Specialist Registration
There are three types of certificates issued by the GMC for specialist registration across all specialties, and the type of certificate you receive depends on which training route you followed.
For pathologists who have completed their full training outside a GMC-approved training programme, CESR is the route they will usually take towards attaining specialist registration. This route does not require further training, but rather the submission of an application.
Doctors who have trained outside the UK or Switzerland, but within an EEA country, will be awarded CCT (Certificate of Completion of Training) after a successful specialist registration application. Specialist Certifications from across the EU are deemed as equivalent by the GMC, and therefore a straightforward application can be made.
Pathology Positions in the NHS without CESR
It is important to note that you attain more senior histopathology roles in the NHS, such as a specialty doctor (SAS), specialist grade or a locum consultant without being on the Specialist Register.
Similarly, overseas doctors do not require CESR before moving to the UK to work in the NHS.
In these NHS roles, you will have better pay and responsibilities that are more appropriate to your level of experience compared to a trainee. While working in these positions, you can collect evidence of your competences, particularly those specific to the UK histopathology curriculum.
These positions also facilitate a faster route to the UK than the CESR route, which can take a substantial amount of time.
FRCPath for Specialist Registration
Whilst it is always beneficial pathologists to complete FRCPath, overseas doctors looking to join the Specialist Register do not necessarily need to have completed the Royal College postgraduate exams.
The standard test of knowledge in the CCT curriculum are the FRCPath exams, so passing these exams confirms the attainment of the competencies of the Histopathology Curriculum.
FRCPath is only a requirement for doctors looking to attain Specialist Registration via the CCT route.
However, if CESR applicants have not successfully completed these exams, they must provide alternative evidence that demonstrates equivalent knowledge to histopathologists who have passed the FRCPath exams.
Even if the competencies covered by the exams require something that someone in your position would not routinely undertake (in your sub-specialty for example), you must still provide evidence of it – as the evaluators will not make assumptions outside the evidence presented.
CESR Equivalence Process
Equivalence describes the process of assessing an overseas applicant’s training and experience against the current histopathology training programme requirements, in order to be awarded CESR.
The equivalence process involves submitting a written body of evidence to the GMC, consisting of:
The Royal College of Pathologists will assess each application against the relevant Curriculum before providing a recommendation to the GMC, who will then make a decision.
Please note that Equivalence procedures are the responsibility of the GMC. Applications are made through their Certification Department and initial enquiries should be directed there.
Evidence Requirements for CESR in Histopathology
Skills & Experience: The evidence provided for a CESR application in histopathology must cover the knowledge, skills, and qualifications to demonstrate the required competencies in all areas of the Curriculum for Specialty Training in Histopathology. If evidence is missing from any area of the curriculum, the application may be unsuccessful.
Capabilities in Practice: The Royal College of Pathologists has divided the Training Curriculum into 11 different Capabilities in Practice (CiPs) – each comes along with its own descriptor and guidance on where such CiPs would be evidenced.
Applicants are required to gather evidence by area of competence and attach this under the relevant section of the online application.
Generic CiPs
- Able to function effectively within healthcare and other organisational and management systems to deliver consistent high-quality patient care.
- Able to work within ethical and legal frameworks across all aspects of clinical practice.
- Communicates effectively and is able to share decisionmaking, while maintaining appropriate situational awareness, professional behaviour and professional judgement.
- Maintains patient safety at the forefront of clinical working. Can utilise quality improvement activity realistically within the constraints of the role.
- Able to contribute to and support research.
- Behaves as an educator in the context of the role and promotes educational culture.
- Able to self-appraise, learn and adapt.
Histopathology-specific CiPs
- Able to demonstrate leadership and management within the laboratory setting for the benefit of patient care.
- Able to use laboratory and other services effectively in the investigation, diagnosis, and management of patients, relatives, and the deceased.
- Able to manage and contribute to a multidisciplinary team effectively.
- Able to take, manage and interpret pathological specimens accurately and safely, mindful of risks to self and others.
Audit and Governance: You are required to submit evidence of your active leadership in audit, including evidence that you have completed at least one audit cycle.
Currency of evidence: Your evaluators will be looking for evidence of current competency, generally defined as within the last five years. If you have completed training before this point, it is crucial that you provide evidence of maintaining competency across the whole area of the curriculum.
The GMC asks that only evidence that is strictly relevant is sent as it will help them to process the application quicker. The guidance on compiling your evidence will help you to decide what is relevant and what is not – you can find this on the GMC website here.
As a general guide, the GMC usually expects to see about 800-1000 pages of evidence, divided into four different domains, reflecting those of Good Medical Practice. The GMC recommends that you apportion the evidence provided as shown below:
Domain 1 - Knowledge, skills, and performance
Domain 2 – Safety and quality
Domain 3 – Communication, partnership, and teamwork
Please note, you cannot compensate for evidence lacking in one area by providing more evidence in another area.
The full list of evidence required for each domain can be found on the GMC website here.
The Cost of CESR Applications
All histopathology applying for Specialist Registration must pay a fee. For CESR, this fee is £1,676. For CESR-CP and CCT, the cost is £439.
How long does it take to complete a CESR in Histopathology application?
The GMC estimate that it can take between six and eight months to receive a decision, from the date you submit your CESR application.
As there is a substantial amount of evidence to gather for a CESR application, the process of preparing all the necessary documentation and applying for CESR can take even longer than this, and a typical candidate will usually set out to complete this within 1 – 3 years.
It is worth noting that more senior histopathologists, such as consultants, are more likely to have achieved all the competences outlined in the curriculum.
The indicative period of training for a CCT in histopathology is five years, so it is highly unlikely that you would achieve the competencies required for a CCT in a shorter period of time. Therefore, CESR is not suitable for more junior pathologists.
#IMG Tips
- Research/think about the types of evidence you will need and begin to gather your evidence well in advance of making your application.
- Gather evidence prospectively – this is much easier than retrospectively trying to pull together the evidence under additional pressures.
- Make sure that your evidence is of the highest possible quality and is current – you will be assessed against the most recent curriculum.
- Ensure that the evidence you collect demonstrates your competence across the whole of the histopathology curriculum, not just your sub-specialty.
- Remember to refer to the most up-to-date Histopathology Specialty Training Curriculum and Specialty Specific Guidance for the evidence requirements in your specialty.
- Create a CESR ‘to-do list’ with sections under the 11 CiPs headings – organise your evidence directly into these sections to manage your progress.
- Do not submit original documents – all your copies, other than qualifications you’re getting authenticated must be accompanied by a proformas signed by the person who is attesting to the validity and accuracy of your evidence (your verifier).
- Ask an IMG Connect recruitment specialist about NHS histopathology posts with CESR support. These are not always advertised by the Trusts, but we can help you find a role which aligns well with your career goals in the NHS.
- Join the IMG Histopathologists community – as well as support on Royal College exams, our online community of international pathologists and dedicated pathology recruiters offers guidance on other aspects of working in the UK, including finding NHS posts and CESR.
Getting started
Many pathology IMGs likely haven’t completed a UK-approved training programme, but you could be eligible for Specialist Registration with the GMC via the CESR route. Take a look at our guide to CESR Applications for Histopathology for more information on how to apply and what to expect.
If you have any further questions about Specialist Registration, your route to the UK, or would like guidance in finding NHS histopathology posts which offer CESR support, please get in touch with us here.
Follow us on social media through the links below for regular news and updates on the Royal Colleges, relocating to the UK and working in the NHS:
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This is a unique opportunity to work in a developing initiative that will bring immense social good to the local the people of Wales.
Short / mid / long-term ambitions for this role.
Short-term, there is the opportunity to work a close group of four international doctors, with specialist qualifications in histopathology including FRCPath. You\'ll have the opportunity to shape the careers of hungry pathologists ready to absorb all the knowledge and experience from an experienced NHS colleague like yourself.
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Life in the area
It\'s a beautiful life with Wales offering beaches, beautiful forest, lakes and mountains all available to you in your free-time. It\'s a low cost of living and a a bit of a dream for the right person. We can chat more about that over our call.
The UK Lab is based in Surrey, and the facility is ISO 15189 accredited and ISO 27001 certified.
The department provides the latest technology and several years of extensive research offering highly effective treatment solutions to cancer patients for whom, multiple lines of treatment have failed.
The UK lab receives samples that are received from private practices around the UK, Europe and USA.
Responsibilities:
With roughly two hours of work needed per day, mostly remote, with twice weekly attendance onsite likely required, the pathologists responsibilities will be along the lines of the below.
- Authorisation of reports (molecular and tissue)
- Sectioning slides / assessing tumour content - to help identify which sections can be used for processing samples.
- Approving & signing reports.
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Eligibility:
- GMC registration
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- FRCPath or Specialist Registration is not required for this post
A unique opportunity awaits Histopathologists, especially Consultants, to join a dynamic team of 35 professionals at the Histopathology Department within a prestigious NHS Foundation Trust. Engaged in diverse diagnostic tasks, the department encourages research and teaching, offering a platform for career growth. This role is ideal for overseas Histopathologists interested in the UK NHS, with a focus on those specializing in the EEA or experienced IMGs aiming to fulfill CESR requirements.
The Histopathology Department boasts a skilled team of consultants and junior doctors, equipped with cutting-edge facilities for accurate diagnostics. Handling a wide range of cases annually, the department ensures timely and precise reports, contributing to patient care.
The department is part of an NHS Foundation Trust that is considered as a leading healthcare institution, emphasizes staff well-being, inclusivity, and equal opportunities. With 23,500 staff, the Trust is dedicated to creating a compassionate work environment where every team member can thrive. The commitment to inclusivity is deeply ingrained, driven by diverse staff networks and a Fairness Taskforce led by the CEO.
The career development opportunities at University Hospitals Birmingham NHS Foundation Trust extend to research and development initiatives. Actively participating in regional and national research programs and clinical trials, the Trust supports staff in project planning and submission. This role presents a compelling prospect for experienced international histopathologists pursuing CESR and specialist registration in the UK NHS.
ARE YOU ELIGIBLE FOR THIS ROLE?
EEA Candidates:
-
Experience of working in Histopathology (essential)
Non-EEA Candidates:
-
FRCPath or PLAB (essential)
-
Experience of working for Histopathology (essential)
UK based applicants
-
Experience of working in Histopathology (essential)
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This role is particularly advantageous for overseas Consultant Histopathologists aspiring to establish themselves in the NHS. Suited for candidates with specialization in the European Economic Area (EEA) or experienced International Medical Graduates (IMGs) seeking completion of the Certificate of Eligibility for Specialist Registration (CESR), it provides a unique pathway for professional growth.
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The department is part of an NHS Foundation Trust that oversees a diverse healthcare landscape, including their main hospitals that is a major teaching and trauma center with 1,024 beds, a 24-hour acute admissions unit, and an emergency department. The NHS Foundation Trust has another hospital, integral to community care, complements the trust\'s commitment to excellence across Middlesbrough and Northallerton.
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It is part of the Middlesbrough, the urban hub, offers residents a dynamic living experience with access to scenic parks, cultural attractions, quality schools, and Teesside University. Robust transportation links connect Middlesbrough locally and to major cities and airports. Housing options, from historic residences to modern developments, cater to diverse preferences, ensuring a vibrant urban lifestyle with green spaces and educational excellence.
This opportunity, tailor-made for experienced international histopathologists, aligns with the aspiration to achieve CESR and specialist registration within the UK NHS. It not only offers a stimulating professional environment but also serves as a gateway to making a meaningful impact on healthcare.
ARE YOU ELIGIBLE FOR THIS ROLE?
EEA Candidates:
-
Experience of working in Histopathology (essential)
Non-EEA Candidates:
-
FRCPath or PLAB (essential)
-
Experience of working for Histopathology (essential)
UK based applicants
-
Experience of working in Histopathology (essential)
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Currently, there are six consultant pathologists, with capacity for two more, including the current vacancy. The Histopathology and Blood Science services are fully accredited by UKAS, participating in both interpretative and technical EQA schemes. The hospital itself holds HTA approval as an institution.
Beyond the professional realm, life in the region offers an enviable quality of life in a historic town. The area features a wealth of affordable housing in one of the most attractive parts of Britain, while remaining in proximity to one of London\'s major airports and all the facilities of the capital. Families will find excellent schools and a range of leisure facilities to enhance their living experience. Relocation support, including detailed information through a relocation document, is available for those interested in exploring this exciting opportunity further.
Are you eligible for this role?
To be considered for this role you must meet the following requirements:
- Specialist Registration in Histopathology or
- FRCPath and extensive consultant experience or
- GMC registration with reporting experience in a similar healthcare system