CESR - a comprehensive guide for histopathologists
- April 08, 2022
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:
Relevant Jobs
WHAT IS THE NHS TRUST LIKE?
This is one of the country’s top performing NHS foundation trusts, looking after the wellbeing of around half a million people. Hospital services are provided from 4 hospitals, with care also provided in people’s homes and other community facilities. They are also planning to rebuild a nearby existing community hospital, replacing the old hospital with an integrated health and social care facility. They have also opened a state-of-the-art NHS centre to bring together outpatient and diagnostic services, as well as primary care, under one roof. The Trust has received significant recognition including:
- Being named among the 40 best performing NHS organisations in CHKS Top Hospitals programme 2015 for the eighth consecutive year
- Rated 6th in the country for cancer patient experience (Macmillan)
- Named ‘overall best trust’ at Patient Experience Network National Awards 2014
- 11th in country in national A&E patient survey (CQC)
- Named ‘Provider Trust of the Year’ at the HSJ awards 2013
- Special recognition award at the national Patient Safety Congress
- Patient Safety Award for pharmacist prescribing (UK Clinical Pharmacy Association)
- British Medical Journal’s (BMJ) patient safety award for the trust’s Hip Quality
- Improvement Programme
In March 2015, they were also chosen as a ‘vanguard’ site by NHS England – one of eight sites in the country to be tasked with taking a national lead on transforming care for patients and in July 2015, Jeremy Hunt, the health secretary, named the trust as an NHS organisation providing the very best standard of seven-day services for our patients, a standard to which other NHS trusts should aspire. The trust offers a wide range of specialties with some of the largest specialist departments in the region, including the largest trauma and orthopaedics service, one of the largest cardiology departments and one of the largest units in the region for colorectal surgery services.
WHAT IS THE PATHOLOGY DEPARTMENT LIKE?
The department has full UKAS ISO 15189 accreditation. It\'s Histopathology and Cytopathology services are centralised into a custom-built laboratory in April 2003, which has accommodation for eight consultants plus specialist registrars. There is a well-equipped library and teaching suite within the department. Fully automated immunohistochemistry is provided with a comprehensive range of routine antibodies available at the Trust. The laboratories are served by the Telepath computer system with links across the Trust and NHS networks. PathoSys is used for reporting breast cores and resection specimens, colorectal cancer specimens, bowel cancer screening specimens, cervical punch and loop biopsies and bronchial biopsies and in line with recent advances in the field of histopathology, the department has introduced and have recently gone live with skin
reporting. The team consists of five consultant Histopathologists, two Specialty Doctors, plus up to two specialist registrars on rotation from a nearby infirmary who cover histopathology and cytology on a rota basis. The non-gynae cytology plus the surgical histology workload will be shared equally.
WHAT CAREER DEVELOPMENT AND OPPORTUNITIES ARE AVAILABLE?
The Trust and Histopathology team are dedicated to supporting their doctors\' career development through devising a personal development plan, the post holder will be required to agree a programme of continuing professional development which meets his/her and service provision requirements. Regular MDT meetings are held for lung, colorectal, breast and upper GI. High definition videoconferencing and slide projection facilities are available in the MDT suites on the North Tyneside and Wansbeck sites and there will also be opportunity for the development of teaching experience. Undergraduate students from the affiliated University are regularly attached to clinical teams within the Trust and the new appointee would be expected to undertake teaching at an undergraduate level throughout the Trust, including the assessment of clinical medical students and examining from time to time.
They would also be expected to to participate in clinical audit activities (personal, departmental and inter-departmental) including clinical audit meetings. The post holder will have a reflective approach to their own practice with an ability to acknowledge poor behaviour and act upon feedback sought from others during the Trusts 360o appraisal.
The Trust has also puts emphasis on their commitment to the development of leadership skills.
LIFE IN THE REGION:
The region offers both the opportunity for scenery but also city living. Firstly, there is easy accessibility to one of the finest coasts in Britain, with unspoilt sandy beaches and wild rocky headlands, as well as the National Park with its 400 square miles of wooded valleys and open moorland rich in wildlife. The North Pennines are an area of Outstanding Natural Beauty and the wildest and least populated region of high moorland in England. Sailing, golf, fishing, riding, walking, cycling, rock climbing, gliding and watersport facilities abound and there are most types of sporting and leisure pursuits including major national football, rugby, cricket, athletics and horse racing venues within easy reach.
Then, the vibrant and modern city of Newcastle-upon-Tyne is the major educational, cultural and business centre for the North East of England and offers a combination of lively bars, top-rated nightclubs and many musical and theatrical attractions. Eldon Square is an excellent shopping centre in the City and for a complete shopping experience, the Metro Centre in Gateshead boasts over 360 shops and services all under one roof. A magnificent new Concert Hall has been constructed on the opposite side of the river to the Quayside Development.
A neighbouring pleasant market town boasts a race course, three golf courses, an historic abbey and a country park, is located 20 miles west of Newcastle upon-Tyne. Situated in the Tyne Valley, Hexham is the focal point for the rural Tynedale District, the largest local authority district in England and one of the most consistently beautiful. The town enjoys good road and public transport links to Newcastle. To the west of Hexham is the City of Carlisle and the M6. The town is also particularly well placed for access to the Lake District.
For families, local education opportunities are very good, with a number of league-leading junior, senior and sixth form schools and colleges in both the private and public sector. Housing is excellent with a wide range of affordable properties both period and modern. As a result of the proximity to the National Park, its historic centre and relative prosperity, this area is now one of the most popular residential locations in North East England with reasonable house prices. The region also has an excellent road, rail and metro network, and the busy ports have regular sailings to the continent. From Newcastle International Airport, flights are available to most national and international destinations.
AM I ELIGIBLE FOR THIS ROLE?
EEA candidates:
- Recognised European Medical Degree or Specialist Qualification in Histopathology
- Full and specialist registration (and with a license to practice) with the General Medical Council or be eligible for registration within six months of interview
- Experience in postmortem, and prostate and skin pathology
Non-EEA candidates:
- FRCPath
- Full and specialist registration (and with a license to practice) with the General Medical Council or be eligible for registration within six months of interview
- Experience in postmortem, and prostate and skin pathology
UK-based candidates:
- Within 6-months of CESR or CCT in Histopathology
- Experience in postmortem, and prostate and skin pathology
An excellent NHS job opportunity for an experienced Locum Consultant Histopathology to join this NHS Trust as a Consultant working in an established Histopathology department in the UK. This NHS job offers CESR Portfolio Pathway support, and international applications from IMGs are welcome.
The NHS Trust
This NHS Trust is a modern and progressive healthcare organization located in the UK. The Trust provides a wide range of acute and general hospital services, serving a large and diverse population. With state-of-the-art facilities and a commitment to providing the highest quality care, the Trust is dedicated to supporting the professional growth of its staff. The Trust has a strong focus on patient-centered care and works closely with the community to ensure the delivery of comprehensive health services. As an NHS Trust, it offers a dynamic and supportive environment, making it an ideal place for doctors looking to develop their careers within the NHS.
The Trust is also involved in various research initiatives and collaborates with academic institutions, further enhancing its reputation as a leader in healthcare. This is an excellent NHS job opportunity for those interested in joining a forward-thinking organization committed to clinical excellence.
The Department & Team
The Histopathology Department at this NHS Trust is a well-established and highly regarded unit within the organization. The department is equipped with the latest diagnostic technologies, enabling the delivery of high-quality pathology services. The team is composed of experienced consultants, specialty doctors, and a skilled support staff, all working collaboratively to provide accurate and timely diagnostic services. The department plays a crucial role in the diagnosis and management of various medical conditions, making it an integral part of the hospital’s operations.
The team is known for its supportive and inclusive environment, which encourages continuous learning and professional development. Regular multidisciplinary meetings and case discussions are held to ensure the highest standards of patient care. This NHS job offers an excellent opportunity for doctors to join a team that values clinical excellence and is committed to providing the best possible outcomes for patients.
Continued Professional Development
This NHS job offers further training and accreditation within Histopathology, including CESR Portfolio Pathway Support, access to specialty training, and the opportunity to develop sub-specialist interest. The Histopathology Department at this NHS Trust is dedicated to the continuous professional development of its staff. Doctors joining the department will have access to a wide range of educational resources, including regular training sessions, workshops, and seminars. The department also encourages participation in research activities and offers support for those interested in pursuing academic qualifications.
Additionally, there are opportunities to attend national and international conferences, further enhancing the learning experience. The Trust’s commitment to professional development ensures that doctors are well-equipped to achieve their career goals while contributing to the advancement of medical knowledge.
Location
This area in the UK is an excellent place for international doctors to relocate to, offering a high quality of life for both individuals and families. The region is known for its affordable cost of living compared to other parts of the UK, making it an attractive option for those looking to settle in the country. Safety is a top priority, with the area boasting low crime rates and a friendly community atmosphere. The region is home to a variety of schools, both public and private, that provide excellent educational opportunities for children. There are numerous things to do, from exploring beautiful parks and natural areas to enjoying a vibrant arts and culture scene.
The area also benefits from excellent transport connections, with easy access to major cities via road and rail. Additionally, the region is diverse and multicultural, making it a welcoming place for people from all backgrounds.
Am I eligible for this role?
UK based candidates:
- Experience in Histopathology
EEA candidates:
- Experience in Histopathology
- European Specialist Qualification
Non-EEA candidates:
- FRCPath
- Experience in Histopathology
A leading UK-based pathology service is seeking a European or UK accredited Histopathologist to join their expanding team at a newly refurbished pathology hub. The modern laboratory features fully integrated digital pathology services and a highly experienced, diverse team, making it an ideal environment for both newly qualified and experienced pathologists looking to further their specialisation. The department is recognised for its high performance and supportive atmosphere, offering an excellent opportunity for doctors, whether new to the UK healthcare system or those looking to advance their careers.
Pathology Service Overview
This prominent pathology service provides a comprehensive range of diagnostic services, including biochemistry, haematology, microbiology, and histopathology, to a large catchment area. It is supported by a multidisciplinary team of consultants and specialists, ensuring high-quality and timely care across hospitals and clinics.
Career Development Opportunities
The service is committed to the ongoing development of its medical staff, with opportunities to pursue sub-specialisation in areas of anatomical interest. The new appointee will contribute to both formal and informal teaching of trainees and may participate in postgraduate education programs. There are also opportunities for research through the dedicated Research and Development Department, with research actively encouraged during designated sessions. Furthermore, the new consultant will gain valuable experience participating in multidisciplinary team meetings (MDTs), which are regularly held within the department.
Living in the Region
The area offers a unique combination of both tranquil rural settings and vibrant city life. Residents can explore beautiful landscapes or enjoy cultural attractions in nearby cities. The region is home to esteemed universities and quality schools, with well-established transport links connecting it to major cities and airports. Housing options range from charming historic homes in smaller towns to contemporary developments in more urban areas, accommodating a variety of lifestyles.
How will IMG Connect support your application to this role?
Any European or UK-based histopathologists on the specialist register for histopathology will be eligible to apply, as will any IMG having undergone the CESR pathway to secure specialist registration.
IMG Connect can subsequently help you with CV preparation, interview practice, contract negotiations, and subsequent relocation planning to the UK, for you and your family.
For any overseas doctor looking to develop as a specialst in the UK, IMG will keep it simple for you!
IMG Connect are proud to be representing NHS England in the recruitment of a paediatric & perinatal fellowship role, providing overseas pathologist the access to specialist registration / CESR in their field, without the need to enter specialty training. With the opportunity to work in either one or multiple of the UK\'s largest and most established NHS pathology departmetns, this Fellowship in Paediatric and Perinatal Pathology is ideal for either paediatric pathologists with extensive overseas experience, or young-aspiring pathologists with a strong interest and desire to train further in paediatric & perinatal pathology.
The Fellowship is designed as an 18 month training programme for international medical graduates who are experienced paediatric/perinatal foetal pathologists who are willing to work as consultants in this field in the UK. You will work and train in one or two of the NHS\'s largest and most renowned institutions.
Am I eligiible?
- Full FRCPath Histopathology is desirable
- FRCPath Part 1 is essential
- Current active duties in adult autopsy
- 5-years histopathology experience, including some performance of perinatal autopsies as well as adult autopsy.
- Pass in either IELTS or OET
Opportunity for a Consultant Histopathologist at a major University Hospital in the Northeast of Engalnd. The role offers the chance to contribute significantly to pathology services within a regional pathology hub, working with a skilled team of 12 consultants delivering a comprehensive cellular pathology reporting service to a diverse population across several towns, and totaling 1.6 million residents.
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.
The Histopathology Department is a centre of diagnostic excellence, the department handles a diverse caseload, offering comprehensive care ranging from routine diagnostics to complex pathology.
Their main hospital is a major teaching and trauma center with 1,024 beds, a 24-hour acute admissions unit, and an emergency department. The Trust\'s dedication to research and development is evident through active participation in regional and national research programs and clinical trials. The Research and Effectiveness department within the Trust facilitates project coordination, supporting innovation. A specialized member of the research staff brings expertise in managing the pathological aspects of clinical trials.
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.
ARE YOU ELIGIBLE FOR THIS ROLE?
EEA Candidates:
- Experience of working in Histopathology (essential)
- European Specialist Qualification in Anatomical Pathology
Non-EEA Candidates:
- FRCPath (essential)
- ???????Experience of working for Histopathology (essential)
UK based applicants
-
Experience of working in Histopathology (essential)