From the 30th of November 2023, the UK’s General Medical Council will introduce significant changes to the application process for Specialist Registration, namely CESR (Certificate of Eligibility for Specialist Registration) and CEGPR (Certificate of Eligibility for GP Registration). These changes focus on the evidence required in creating an application for Specialist Registration.  What are the new changes to the CESR and CEGPR process? Doctors who are applying for Specialist or GP Registration will now need to demonstrate that their knowledge, skills, and experience align with the high-level learning outcomes of the GMC-approved UK curriculum in the relevant specialty. These generic professional capabilities will be incorporated into specialty curricula and will therefore be equally demonstrated by UK trainees at the end of their approved training.   Why are these changes being made? The current system for CESR and CEGPR applications requires the mapping of evidence to the detailed CCT (Certificate of Completion of Training) curriculum in a specific specialty. The goal of this change is to ensure that doctors have a comprehensive understanding of the core competencies needed to practice effectively in their chosen specialty, whilst allowing the GMC the flexibility to accept a wider range of evidence.  This change is significant because it shifts the focus from a narrow and specific curriculum to a broader and more comprehensive approach. By aligning with the high-level learning outcomes, doctors will be better equipped to provide quality care and meet the evolving needs of patients.   What will the new system be called? The GMC has confirmed that both the CESR and CEGPR will be known as ‘Portfolio Pathway’ from 30th November 2023. This will be a more appropriate name which aligns with the evidence of knowledge, skills and experience required for practising as an eligible Specialist or GP in the UK.  Sources https://www.gmc-uk.org/registration-and-licensing/join-the-register/registration-applications/cesr-cegpr-application-process/changes-we-are-making-to-cesr-and-cegpr-applications  https://www.gmc-uk.org/registration-and-licensing/join-the-register/applying-for-specialist-or-gp-registration/changes-to-how-doctors-demonstrate-the-standard-required-for-specialist-and-gp-registration/what-is-changing  Connect with us  Get in touch with us to find out more about achieving CESR or CEGPR as an IMG and join our upcoming CESR workshop and webinars on the GMC registration process and working in the UK as a doctor.              

This article delves into the specific guidance on GMC applications for entry onto the UK Specialist Register through the Certificate of Eligibility for Specialist Registration (CESR) for clinical oncologists.  We’ll cover the eligibility criteria, application process, and most importantly the required evidence, along with some other topics, summarised in the headings below:  What is CESR and who is it for? Do overseas oncologists need FRCR (Oncology) for CESR? What is the CESR equivalence process? What evidence is required for a CESR in clinical oncology? Where will I find this evidence? How do I submit a CESR application? How long does it take to complete? How much does CESR cost? How long does it take to receive a decision? Do I have to complete CESR before I can work in the UK? #IMG Tips Skip ahead to the relevant section if you know what you’re looking for.  An Introduction to CESR CESR, or the Certificate of Eligibility for Specialist Registration, is the route to specialist registration for doctors who have not completed a GMC-approved training programme, but can demonstrate that their specialist training, qualifications and experience are equivalent to the requirements for the award of the CCT in the UK.   CESR holders can be appointed to substantive (or permanent) consultant positions in the NHS. As a clinical or radiation oncologist, attaining specialist registration will mean you are qualified to practice independently as a consultant in the NHS.  Oncologists must prove to the GMC that their specialist training or specialist qualifications, when considered together, are equivalent to a CCT in the specialty in question.   In order to be eligible for CESR, doctors should have undertaken a minimum of 6 months training or obtained a specialist qualification and acquired specialist experience or knowledge as a clinical oncologist within a non-training post.  Overseas doctors do not require CESR before moving to the UK to work in the NHS. Often, experienced oncologists will secure a post in the UK, and work towards CESR whilst in post.   FRCR (Oncology) for Specialist Registration Whilst it is always beneficial to complete FRCR (Oncology), particularly for doctors who have trained outside the UK or an EEA country, overseas doctors looking to join the Specialist Register do not need to have completed the Royal College postgraduate exams.  The standard test of knowledge in the Clinical Oncology curriculum is the FRCR exams, so passing these exams confirms the attainment of the competencies of the core curriculum.  FRCR (Oncology) is only a requirement for doctors looking to attain Specialist Registration via the CCT route.  Similarly, UK trainees would have completed MRCP (UK) before beginning their clinical oncology training, which is also not required for oncologists going through the CESR route.  However, CESR applicants who have not successfully completed these exams must provide alternative evidence that demonstrates equivalent knowledge to oncologists who have passed the FRCR (Oncology) exams and the appropriate level of non-oncology expertise and that you can appropriately manage the acutely unwell patient.  Even if the competencies covered by the exam 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.  You can read more about the evidence required in the specialty specific guidance here.  The CESR Equivalence Process Equivalence refers to the process of assessing an overseas applicant’s training and experience against the current clinical oncology training programme requirements, in order to be awarded CESR.  The equivalence process involves submitting a written body of evidence to the GMC, consisting of:  training and/or competence; AND  skills and knowledge  The Royal College of Radiologists 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 Clinical Oncology Skills & Experience: The evidence provided for a CESR application in oncology must cover the knowledge, skills and qualifications to demonstrate the required competencies in all areas of the clinical oncology curriculum. If evidence is missing from any area of the curriculum, the application will fail.  Primary Evidence: To demonstrate that you can do what is required by the curriculum, you need to submit primary evidence of your clinical practice which shows how you work on a day-to-day basis: letters, reports, assessments etc. References, retrospective case summaries, and reflective notes can all be used in a CESR application, but by themselves they are not sufficient.  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  Domain 4 – Maintaining trust  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.  Gathering Evidence for a CESR Application Domain 1 – Knowledge, skills and performance  Qualifications  Primary Medical Qualification (PMQ)  Specialist medical qualification(s)  Curriculum or syllabus (if undertaken outside the UK)  Specialist registration outside the UK  Honours and prizes  Other relevant qualifications  Assessments and appraisals Appraisals and assessments  RITAs, ARCPs and training assessments  360˚ and multi-source feedback  Awards and discretionary points letters  Personal development plans (PDP)  Logbooks, records of daily clinical practice and portfolios Logbooks  Consolidation, cumulative data sheets, summary lists and annual caseload statistics  Medical reports  Case histories  Referral letters discussing patient handling  Patient lists  Departmental (or trust) workload statistics and annual caseload statistics  Rotas, timetables and job plans  Courses relevant to curriculum  Portfolios (electronic or revalidation)  Details of posts and duties (including both training and experience posts) Employment letters and contracts of employment  Job descriptions  Job plans  Research, publications and presentations Research papers, grants, patent designs  Publications within specialty field  Presentations, poster presentations  CPD and CME CPD record certificates, certificates of attendance, workshops and at local, national and international meetings or conferences  CPD registration points from UK Medical Royal College (or equivalent body overseas)  Membership of professional bodies and organisations  Teaching timetables  Lectures  Feedback or evaluation forms from those taught  Letters from colleagues  Attendance at teaching or appraisal courses  Participation in assessment or appraisal and appointments processes  Domain 2 – Safety and quality  Participation in audit, service improvement Audits undertaken by applicant  Reflective diaries  Service improvement and clinical governance meetings  Safety Health and safety  Domains 3 - Communication, partnership and teamwork  Communication  Colleagues  Patients  Partnership and teamwork Working in multidisciplinary teams  Management and leadership experience  Chairing meetings and leading projects  Domain 4 – Maintaining trust  Acting with honesty and integrity Honest and integrity  Equality and human rights (including disability, human rights, race, religion and ethnicity awareness and equal opportunities)  Data protection  Relationships with patients Testimonials and letters from colleagues  Thank you letters, cards from colleagues and patients  Complaints and responses to complaints  For more guidance on the different types of evidence, see the specialty specific guidance from the GMC for clinical oncology.  Validating Evidence   Original documents which are on headed paper with a hospital stamp and original signatures do not need additional validation.   All photocopied evidence should contain a hospital stamp on every page of each document, the validator’s name (printed and in full), job title (printed and in full) and original signature.  Application Submission All CESR applications are submitted online via GMC Online and if you have not already created an account, you can find a guide on how to do so here.  Electronic evidence is required for each of the different evidence sections of the CESR application. Once started, the online application remains open for 12 months, meaning that it can be used as a portfolio to gather evidence against each of the different sections.  Your electronic evidence can be in any of the following formats:  .doc  .pdf  .ppt  .xls  Formats outside of these are unlikely to be accepted.  The Online Application You will be required to complete the following sections once you begin your application:  Specialty details  Qualification details and professional experience  Details of your referees  Registration and licensing history  Evidence summary  Details of your verifiers  Final declaration and payment  Additional Evidence  Once an Adviser on the Specialist Applications Team has reviewed your initial evidence, they will provide you with information on:   What evidence they’ve accepted   What evidence they’re unable to accept (including the reasons for this)   Advice and guidance on how your application could be strengthened   You’ll have up to 60 days to provide additional documentary evidence in support of your application (30 days if you’ve submitted a Review application).  For further information about the online application process, see the GMC’s User Guide.  How long does it take to complete? 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 oncologists, 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 clinical oncology is seven years (not including Foundation Training), 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 clinical or radiation oncologists.  Cost of CESR Applications All oncologists applying for Specialist Registration must pay a fee. For CESR, this fee is £1,727.  For CESR-CP and CCT, the cost is £452.  How long does it take to receive a decision? The GMC estimate that it can take between six and eight months to receive a decision, from the date you submit your CESR application.  Clinical Oncology Jobs in the NHS without CESR Overseas doctors do not require CESR to work in the UK.  There are also roles for more senior oncologists such as a specialty doctor (SAS), specialist grade or acting consultant, where you will likely receive better pay and responsibilities that are more appropriate to your level of experience. While working in these positions, you can also collect evidence of your competences, particularly those specific to the UK clinical oncology curriculum.  Across the UK there are several NHS Trusts with well-established CESR programmes of support for oncology who have taken up a fixed term post with the view to completing CESR.   These positions also facilitate a faster route to working in UK and attaining Specialist Registration when compared to making an application for CESR from overseas, which can take an additional amount of time, depending on the country in which you completed your training.  #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 Clinical Oncology curriculum, not just your sub-specialty.     Remember to refer to the most up-to-date Clinical Oncology CCT Curriculum and Specialty Specific Guidance for the evidence requirements in your specialty.   Create a CESR ‘to-do list’ with sections under the GMC’s 4 domain 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 oncology posts with CESR support. These are not always advertised by a Trust, but we can help you find a role which aligns well with your career goals in the NHS.  Join the online community - join the IMG Oncologists Facebook group for access to a community of like-minded clinical and radiation oncology CESR aspirants and dedicated oncology recruiters. In this group you will find tailored resources for oncology, including guidance on CESR applications, completely free to all doctors. You can access our IMG Oncologists community here. Sources https://www.jrcptb.org.uk/certificate-eligibility-specialist-registration   https://www.gmc-uk.org/registration-and-licensing/join-the-register/registration-applications/specialist-application-guides/specialist-registration-cesr-or-cegpr  https://www.gmc-uk.org/-/media/documents/sat---ssg---clinical-oncology---dc3556_pdf-48456770.pdf   https://www.rcr.ac.uk/sites/default/files/clinical_oncology_curriculum_2021.pdf   Getting started Many senior IMG oncologists looking to develop their careers through Specialist Registration with the GMC may be eligible via the CESR route, and attaining CESR can be a long but very rewarding process. Look at our introduction to CESR for clinical oncologists for a full overview.  If you have any further questions about Specialist Registration, your route to the UK, or would like guidance in finding NHS 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.              

In this article, we’ll be taking a closer look at the specific guidance on NHS applications for entry onto the Specialist Register through the Certificate of Eligibility for Specialist Registration (CESR) for medical oncologists.  We’ll cover the eligibility criteria, application process, and most importantly the required evidence, along with some other topics, summarised in the headings below:  What is CESR and who is it for? Do overseas oncologists need MRCP for CESR? What is the CESR equivalence process? What evidence is required for a CESR in medical oncology? Where will I find this evidence? How do I submit a CESR application? How long does it take to complete? How much does CESR cost? How long does it take to receive a decision? #IMG Tips How do I get started? Skip ahead to the relevant section if you know what you’re looking for.  An Introduction to CESR CESR, or the Certificate of Eligibility for Specialist Registration, is the route to specialist registration for doctors who have not completed a GMC-approved training programme, but can demonstrate that their specialist training, qualifications and experience are equivalent to the requirements for the award of the CCT in the UK.   CESR holders can be appointed to substantive (or permanent) consultant positions in the NHS. As a medical oncologist, attaining specialist registration will mean you are qualified to practice independently as a consultant in the NHS.  Oncologists must prove to the GMC that their specialist training or specialist qualifications, when considered together, are equivalent to a CCT in the specialty in question.   In order to be eligible for CESR, doctors should have undertaken a minimum of 6 months training or obtained a specialist qualification and acquired specialist medical experience or knowledge as a medical oncologist within a non-training post.  Overseas doctors do not require CESR before moving to the UK to work in the NHS. Often, experienced oncologists will secure a post in the UK, and work towards CESR whilst in post.   MRCP for Specialist Registration Whilst it is always beneficial to complete MRCP (UK), particularly for doctors who have trained outside the UK or the EEA, overseas doctors looking to join the Specialist Register do not need to have completed the Royal College postgraduate exams.  The standard test of knowledge in the Medical Oncology curriculum is the MRCP (UK) exams, so passing these exams confirms the attainment of the competencies of the core curriculum.  MRCP (UK) is only a requirement for doctors looking to attain Specialist Registration via the CCT or CESR-CP route.  The structure of medical oncology training in the UK is an indicative two years in Core Medical Training or Acute Care Common Stem (ACCS), followed by an indicative four years of training in Medical Oncology. Therefore, applicants need to demonstrate the appropriate level of acute medicine expertise as well as competencies in medical oncology.  You can read more about the evidence required in the specialty specific guidance here.  CESR Equivalence Process Equivalence refers to the process of assessing an overseas applicant’s training and experience against the current medical oncology training programme requirements, in order to be awarded CESR.  The equivalence process involves submitting a written body of evidence to the GMC, consisting of:  training and/or competence; AND  skills and knowledge  The Royal College of Physicians 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 Medical Oncology Skills & Experience: The evidence provided for a CESR application in oncology must cover the knowledge, skills and qualifications to demonstrate the required competencies in all areas of the Medical Oncology curriculum. If evidence is missing from any area of the curriculum, the application will fail.  Primary Evidence: To demonstrate that you can do what is required by the curriculum, you need to submit primary evidence of your clinical practice which shows how you work on a day-to-day basis: letters, reports, assessments etc. References, retrospective case summaries, and reflective notes can all be used in a CESR application, but by themselves they are not sufficient.  Audit & 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  Domain 4 – Maintaining trust  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.  Gathering Evidence for a CESR Application Domain 1 – Knowledge, skills and performance  Qualifications  Primary Medical Qualification (PMQ)  Specialist medical qualification(s)  Curriculum or syllabus (if undertaken outside the UK)  Specialist registration outside the UK  Honours and prizes  Other relevant qualifications  Assessments and appraisals Appraisals and assessments  RITAs, ARCPs and training assessments  360˚ and multi-source feedback  Awards and discretionary points letters  Personal development plans (PDP)  Logbooks, records of daily clinical practice and portfolios Logbooks  Consolidation, cumulative data sheets, summary lists and annual caseload statistics  Medical reports  Case histories  Referral letters discussing patient handling  Patient lists  Departmental (or trust) workload statistics and annual caseload statistics  Rotas, timetables and job plans  Courses relevant to curriculum  Portfolios (electronic or revalidation)  Details of posts and duties (including both training and experience posts) Employment letters and contracts of employment  Job descriptions  Job plans  Research, publications and presentations Research papers, grants, patent designs  Publications within specialty field  Presentations, poster presentations  CPD and CME CPD record certificates, certificates of attendance, workshops and at local, national and international meetings or conferences  CPD registration points from UK Medical Royal College (or equivalent body overseas)  Membership of professional bodies and organisations  Teaching timetables  Lectures  Feedback or evaluation forms from those taught  Letters from colleagues  Attendance at teaching or appraisal courses  Participation in assessment or appraisal and appointments processes  Domain 2 – Safety and quality Participation in audit, service improvement Audits undertaken by applicant  Reflective diaries  Service improvement and clinical governance meetings  Safety Health and safety  Domains 3 - Communication, partnership and teamwork Communication Colleagues  Patients  Partnership and teamwork Working in multidisciplinary teams  Management and leadership experience  Chairing meetings and leading projects  Domain 4 – Maintaining trust  Acting with honesty and integrity Honest and integrity  Equality and human rights (including disability, human rights, race, religion and ethnicity awareness and equal opportunities)  Data protection  Relationships with patients Testimonials and letters from colleagues  Thank you letters, cards from colleagues and patients  Complaints and responses to complaints  For more guidance on the different types of evidence, see the specialty specific guidance from the GMC for medical oncology.  Validating Evidence Original documents which are on headed paper with a hospital stamp and original signatures do not need additional validation.   All photocopied evidence should contain a hospital stamp on every page of each document, the validator’s name (printed and in full), job title (printed and in full) and original signature.  Application Submission All CESR applications are submitted online via GMC Online and if you have not already created an account, you can find a guide on how to do so here.  Electronic evidence is required for each of the different evidence sections of the CESR application. Once started, the online application remains open for 12 months, meaning that it can be used as a portfolio to gather evidence against each of the different sections.  Your electronic evidence can be in any of the following formats:  .doc  .pdf  .ppt  .xls  Formats outside of these are unlikely to be accepted.  The Online Application You will be required to complete the following sections once you begin your application:  Specialty details  Qualification details and professional experience  Details of your referees  Registration and licensing history  Evidence summary  Details of your verifiers  Final declaration and payment  Additional Evidence  Once an Adviser on the Specialist Applications Team has reviewed your initial evidence, they will provide you with information on:   What evidence they’ve accepted   What evidence they’re unable to accept (including the reasons for this)   Advice and guidance on how your application could be strengthened   You’ll have up to 60 days to provide additional documentary evidence in support of your application (30 days if you’ve submitted a Review application).  For further information about the online application process, see the GMC’s User Guide.  How long does it take to complete? 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 oncologists, 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 medical oncology is six 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 oncologists.  Cost of CESR Applications All oncologists applying for Specialist Registration must pay a fee. For CESR, this fee is £1,727.  For CESR-CP and CCT, the cost is £452.  How long does it take to receive a decision? The GMC estimate that it can take between six and eight months to receive a decision, from the date you submit your CESR application.  #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 Medical Oncology curriculum, not just your sub-specialty.     Remember to refer to the most up-to-date Medical Oncology CCT Curriculum and Specialty Specific Guidance for the evidence requirements in your specialty.   Create a CESR ‘to-do list’ with sections under the GMC’s 4 domain 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 oncology posts with CESR support. These are not always advertised by a Trust, but we can help you find a role which aligns well with your career goals in the NHS.  Join the online community - join the IMG Oncologists Facebook group for access to a community of like-minded MRCP aspirants and dedicated oncology recruiters. In this group you will find tailored resources for oncology IMGs, including access to our MRCP crash courses, completely free to all doctors. You can access our IMG Oncologists community here. Sources https://www.jrcptb.org.uk/certificate-eligibility-specialist-registration   https://www.gmc-uk.org/registration-and-licensing/join-the-register/registration-applications/specialist-application-guides/specialist-registration-cesr-or-cegpr  https://www.gmc-uk.org/-/media/documents/sat---ssg---medical-oncology---dc2310_pdf-48455474.pdf  Getting started  Attaining Specialist Registration through the CESR pathway can be a long but very rewarding process. Look at our introduction to CESR for medical oncologists for a full overview.  If you have any further questions about Specialist Registration, your route to the UK, or would like guidance in finding NHS 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:              

CESR acts as a route to applying for substantive (permanent) consultant jobs in Emergency Medicine for doctors who have not followed a specialty training programme in the United Kingdom. In a nutshell it is the option available to emergency medicine doctors practicing as consultants, or at a senior level from overseas who wish to gain specialist registration in the UK. Some doctors choose to apply from overseas, others work with IMG Connect to secure a job in the NHS geared at helping them gain entry to the specialist register once in the UK.  If you are working as an Emergency Medicine consultant, or at a senior level in your home country and are eligible for specialist registration in the UK, then as an overseas doctor (IMG) you have a couple of options. Here we focus on applying for CESR from abroad as well as the alternative route, applying for a Specialty Doctor or Fixed Term Consultant job in the UK before applying for CESR with support of your NHS employer.  Both routes lead to gaining CESR and entry to the Specialist Register, meaning that you can work as a substantive consultant in the NHS. Both take hard work, preparation, evidence gathering, time and dedication. Both options have the same end goal, specialist registration.  It is important to say that no matter how you choose to apply, the CESR process involves submitting a large volume of evidence to demonstrate that you have the equivalent experience, skills and competencies as a doctor who has taken the specialty training route in the UK. Whether applying from overseas or not, some doctors are asked to complete additional experiences to meet this strict standard. Because of this, the process can be lengthy.  Applying for CESR from overseas  This is a great option for emergency medicine consultants who are not constrained by time and have an understanding department that will support the additional gathering of evidence. The GMC reckons that it takes between 6 – 9 months between submitting your application and receiving a decision. At IMG Connect our experience tells us that is takes a similar amount of time to gather the evidence prior to submitting. In addition, you must have completed the evidence in the first place in real workplace and clinical scenarios. This can take twice as much time as preparing and submitting. Put simply, the process can be time consuming and laborious.  Add to this the issue of completing and gathering evidence against the CESR application from overseas. It can prove challenging to ensure that you have completed the full complement of competencies for CESR applications. This can result in the GMC asking for further evidence, adding more time to the process. You may have to identify gaps in your learning and then resolve them. It is not all bad though, this is good practice and will benefit you in the long run.  Applying for a specialty doctor job and/or fixed term consultant post before applying for CESR For senior emergency medicine doctors who are keen to secure entry to the Specialist Register quickly, and work in the UK as soon as possible, then taking up a Specialty Doctor role with CESR programme, or a Fixed Term Consultant post with CESR programme/support is a good option. Many NHS hospitals or trusts in the UK will offer access to support, clinical experience and study or preparation time for CESR. This is often built into the weekly job plan, but in some circumstances, this may be arranged informally. Either way, this is a good way for senior emergency medicine doctors to quickly gather the right evidence for their application with the support of their peers, senior colleagues and NHS employer. This can shorten the time spent on the application overall. If this sounds like the best option for you, it is wise to start gathering and signing off evidence in your current consultant post. That way you will already have some or most of the required evidence for CESR in place, allowing you to quickly focus on any elements that are missing once in the UK and working in the NHS Find an emergency medicine job in the NHS with CESR Securing a job as a Specialty Doctor with CESR programme attached, or a job as a Fixed Term Consultant with CESR programme/support attached, gives you instant exposure to the UK system, NHS experience and a great start to your career in the NHS.  To discuss whether applying for CESR from overseas or securing a job as a Specialty Doctor or Fixed term consultant with CESR programme is the right route for you towards specialist registration, speak with an IMG Connect consultant, register or send your CV.  IMG Jobs  Search and find live emergency medicine NHS doctor jobs in the UK IMG Resources Read more useful articles on finding an NHS trust doctor jobs, doctor salary & relocation for emergency medicine specialists Get in Touch Don’t hesitate to get in touch using the buttons above (and below) to discuss emergency medicine doctor job options in the NHS, including discussions regarding a typical doctor salary in the UK and the most suitable hospital locations for you. For the latest news and updates on all things emergency medicine, including the Royal College, GMC registration and the NHS, follow us on social media and join the conversation.              

The NHS offers extensive training schemes and career development for all of its doctors, and such programmes are recognised as a gold standard across the medical world.  Training in the NHS is always in keeping with advances in medical sciences and the progressive landscape of the medical profession, including the more complex ailments of a growing and ageing population. The NHS frequently updates and develops its training programmes, making them attractive to UK graduates and doctors, as well as overseas doctors seeking the very best training.  In this article we will cover the following topics:  The NHS Training Pathway Graduation to Foundation Training Specialty Training Programmes Different types of Specialty Training programmes Completion of Specialty Training Programme Should I apply for a training or service post? As an IMG, can I get onto the specialist register? How do I secure a service post? Skip ahead to the relevant section if you know what you're looking for. The NHS Training Pathway Many IMGs looking to move to the UK (particularly more junior doctors) will be keen to enter into UK Specialty Training at some point, and as such it is important to understand the UK training pathway from start to finish in order to map your NHS career effectively. Furthermore, greater understanding of the NHS structure and training offered to doctors in the UK will help an IMG to understand at what grade they can likely enter the system and the salary most appropriate for them.  The NHS Training Pathway describes the journey from medical school to completion of specialist training and is the path most commonly followed by UK trainees. Graduation to Foundation Training After graduating from a medical school, doctors gain provisional registration with the GMC allowing them to enter the Foundation Programme - a two-year work-based training programme. Upon completion of the first year (FY1 or F1) doctors will gain full registration with the GMC and can apply for further study and training in a specialised area – known as Core or Specialty Training, depending on the specialty. Specialty Training Programmes Completion of the Foundation Programme allows doctors to apply for Specialty Training in an area of medicine or general practice. There are 60 different specialties to choose from.  A doctor entering year one of Specialty Training is known as an ST1 or CT1 doctor. Specialty Training programmes can take between three and eight years depending on the specialism chosen. Doctors can pass through the training quicker depending on how fast they achieve their competencies.  Sometimes doctors do not complete the training pathways in the indicated time for a variety of reasons and it can take between 1 - 4 years longer than indicated in the curricula.  Types of Specialty Training Programmes There are two different structures for Specialty Training programmes, and these vary between specialties. Run-through Training Programmes For these training programmes, you only have to apply once at the beginning of the programme. This is because you are recruited for the full duration of Specialty Training. These training programme can last from approximately three years for general practice, to five or seven for other specialties such as histopathology. Uncoupled Specialty Training Programmes These programmes are split into Core Training and Higher Specialty Training. Core Training lasts for either two or three years and once complete, allows you to apply for Higher Specialty Training, which can take from three to five years.  Overall, Specialty Training programmes can take anywhere from 5 – 8 years in their entirety, depending on your medical specialty, for example 6 years for psychiatry. Doctors are known as ST1-3 or CT1-3 during their Core Training and ST4+ level during Higher Specialty Training programmes. Higher Specialty Training programmes are very competitive, and completion of a UK Core Training programme does not guarantee a Higher Specialty Training post.   Completion of Specialty Training Programme Upon successful completion of either a run-through or coupled training programme, doctors are awarded a Certificate of Completion of Training (CCT). At this point doctors are able to make an application for Specialist Registration (or GP Registration) and are able to take up permanent consultant posts. Training Positions vs Service Posts As above, competition for places on training programmes within the NHS is very high. As such, we advise that IMGs who are interested in entering core or specialty training in the NHS first obtain a service post for 1 – 2 years. Following this contract, you can apply for a training post, for which you will be given priority. Not only will this approach give you the best chance of securing excellent training and career progression opportunities in the NHS, it will also give you the chance to settle in to the UK and the NHS system, and help you understand the training post that will suit you the most.  Service posts also offer very competitive rates, so whilst you are getting to know the NHS and settling into life in the UK, you can also ensure that you are financially rewarded.  Specialist Registration for IMGs IMGs that enter the UK training programmes later on and have not completed the full programme can still get on the specialist register via the CESR-CP route (Certificate of Eligibility for Specialist Registration via a Combined Programme) Check to see if you're eligible for CESR-CP via the GMC website or read through our detailed blog through our IMG Resources library. Secure a Trust Doctor Post (with the view to securing a training post at a later date) You can apply for Trust Doctor or Service Role online via the NHS Jobs website.  However, working with IMG Connect can offer more jobs than are available online with the added benefit of an IMG Consultant speaking directly with services on your behalf to expedite the process and negotiate the best doctor salary for you. Getting started Read more useful articles on finding an NHS trust doctor job, training pathways, doctor salaries in the UK, relocation and much more!   Don’t hesitate to get in touch with our team to learn more about the opportunities available to you once as an IMG new to the UK. For the latest news and updates, including the Royal College, GMC registration and the NHS, follow us on social media and join the conversation:             

Doctors from any country can apply for Specialist Registration in the UK, provided they meet certain eligibility criteria, though there are different routes available based on the doctor’s training and qualifications.  In this blog we’ll be exploring Specialist Registration in medical oncology for overseas medical oncologists more closely. We’ll look at all aspects of Specialist Registration, focusing more closely on the Certificate of Eligibility for Specialist Registration (CESR), including the application process, costs, and eligibility criteria, along with some other topics, summarised in the headings below:  What is Specialist Registration? What route is best for me as an overseas oncologist? Do I have to complete CESR before I can work in the UK? Do I need MRCP (UK) for Specialist Registration? What is the CESR equivalence process? What evidence do I need to submit for a CESR in medical oncology? 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  Holding Specialist Registration in any CCT specialty means that you can be appointed to a substantive (or permanent) consultant position in the NHS. All medical oncologists who wish to take permanent consultant roles in the UK must show evidence of skills, knowledge, and experience equivalent to a CCT in order to apply for Specialist Registration.   For oncologists, attaining specialist registration will mean you are qualified to practice independently as a medical oncology consultant in the NHS.   Specialist Registration is additional to full registration with the GMC and is therefore not required to practice as a medical oncologist in the UK.  Routes to Specialist Registration  There are three types of certificates issued by the GMC for Specialist Registration, and the type of certificate you receive depends on the training route you followed.  CCT for UK-trained Oncologists  For doctors who have completed a GMC-approved training programme, an application must be made to the GMC for a CCT in their specialty within 12 months of their completion date in order to qualify. After this point, they will be required to use the CESR route to apply directly to the GMC if they wish to attain Specialist Registration.  CCT for EEA-trained Oncologists  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. You can read more about this in the Specialist Registration section under your country on the GMC website here.  CESR-CP for Oncologists who have complete part of a GMC-approved training programme  CESR(CP) is a simplified route to Specialist Registration for doctors who joined their specialty training programme after ST1, and therefore do not meet the requirement of 4 years duration in GMC-approved training on completion, as they began their training overseas and completed it in the UK.  CESR for Overseas Oncologists  For overseas doctors 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, rather the submission of an application.   You can read a detailed breakdown of Specialist Registration in the UK in our IMG Resources library.  Medical Oncology Positions in the NHS without CESR  It is important to note that you can apply for senior oncology roles in the NHS, such as a specialty doctor (SAS), specialist grade or a locum consultant without being on the Specialist Register.  Similarly, CESR is not required by overseas doctors before moving to the UK to work in the NHS.  In these senior NHS roles, you will have better pay and responsibilities that are more appropriate to your level of experience compared to a trainee. Within these positions, you can collect evidence of your competences, particularly those specific to the UK medical oncology curriculum.  These positions also facilitate a faster route to the UK than the CESR route, which can take a substantial amount of time.  Get in touch with us to find out more about senior positions in the NHS with CESR support.  MRCP (UK) for Specialist Registration  Whilst it is always beneficial to complete MRCP (UK), particularly for doctors who have trained outside of the UK or an EEA country, overseas doctors looking to join the Specialist Register do not need to have completed the Royal College postgraduate exams.  The standard test of knowledge in the Medical Oncology curriculum are the MRCP (UK) exams, so passing these exams confirms the attainment of the competencies of the core curriculum.  MRCP (UK) is only a requirement for doctors looking to attain Specialist Registration via the CCT route.  The structure of the programme is an indicative two years in Core Medical Training or Acute Care Common Stem (ACCS), followed by an indicative four years of training in Medical Oncology. Therefore, applicants need to demonstrate the appropriate level of acute medicine expertise as well as competencies in medical oncology.  You can read more about the evidence required in the specialty specific guidance here.  CESR Equivalence Process  Equivalence describes the process of assessing an overseas applicant’s training and experience against the current medical oncology training programme requirements, in order to be awarded CESR.  The equivalence process involves submitting a written body of evidence to the GMC, consisting of:  training and/or competence  skills and knowledge  The Royal College of Physicians 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 Medical Oncology  Skills & Experience: The evidence provided for a CESR application in oncology must cover the knowledge, skills, and qualifications to demonstrate the required competencies in all areas of the Medical Oncology Curriculum. If evidence is missing from any area of the curriculum, the application will fail.  Primary Evidence: To demonstrate that you can do what is required by the curriculum, you need to submit primary evidence of your medical practice which shows how you work on a day-to-day basis: letters, reports, assessments etc. References, retrospective case summaries, and reflective notes can all be used in a CESR application, but by themselves they are not sufficient.  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  Domain 4 – Maintaining trust  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.  CESR Application Cost  All oncologists applying for Specialist Registration must pay a fee. As of 1st April 2022, for CESR, this fee is £1,727. For CESR-CP and CCT, the cost is £452.  How long does it take to complete an application for CESR in Medical Oncology?  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 oncologists, 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 medical oncology is six 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 oncologists.  #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 Medical Oncology curriculum, not just your sub-specialty.     Remember to refer to the most up-to-date Medical Oncology CCT Curriculum and Specialty Specific Guidance for the evidence requirements in your specialty.   Create a CESR ‘to-do list’ with sections under the GMC’s 4 domain 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 oncology posts with CESR support. These are not always advertised by a Trust, but we can help you find a role which aligns well with your career goals in the NHS.  Join the online community - join the IMG Oncologists Facebook group for access to a community of like-minded MRCP aspirants and dedicated oncology recruiters. In this group you will find tailored resources for oncology IMGs, including access to our MRCP crash courses, completely free to all doctors. You can access our IMG Oncologists community here. Sources  https://www.jrcptb.org.uk/certificate-eligibility-specialist-registration   https://www.gmc-uk.org/registration-and-licensing/join-the-register/registration-applications/specialist-application-guides/specialist-registration-cesr-or-cegpr  https://www.gmc-uk.org/-/media/documents/sat---ssg---medical-oncology---dc2310_pdf-48455474.pdf   Getting started  Many oncology 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 medical oncology 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 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:              

Overseas doctors from any country in the world can apply for Specialist Registration in the UK, provided certain eligibility criteria are met, though there are different routes available based on the doctor’s qualifications and training.  In this blog we’ll be exploring Specialist Registration in clinical oncology for overseas clinical or radiation oncologists more closely. We’ll look at all aspects of Specialist Registration, focusing more closely on the Certificate of Eligibility for Specialist Registration (CESR), including the application process, 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 oncologist? Do I have to complete CESR before I can work in the UK? Do I need FRCR (Oncology) for Specialist Registration? What is the CESR equivalence process? What evidence do I need to submit for a CESR in clinical oncology? 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 CCT specialty means that you can be appointed to a substantive (or permanent) consultant position in the NHS. All clinical oncologists who wish to take permanent consultant roles in the UK must show evidence of skills, knowledge, and experience equivalent to a CCT in order to apply for Specialist Registration.   For clinical oncologists, attaining specialist registration will mean you are qualified to practice independently as a consultant in the NHS.   Specialist Registration is additional to full registration with the GMC and is therefore not required to practice as a clinical oncologist in the UK.  Routes to Specialist Registration  There are three types of certificates issued by the GMC for Specialist Registration, and the type of certificate you receive depends on the training route you followed.  CCT for UK-trained Oncologists  For doctors who have completed a GMC-approved training programme, an application must be made to the GMC for a CCT in their specialty within 12 months of their completion date in order to qualify. After this point, they will be required to use the CESR route to apply directly to the GMC if they wish to attain Specialist Registration.  CCT for EEA-trained Oncologists  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. You can read more about this in the Specialist Registration section under your country on the GMC website here.  CESR-CP for doctors who have completed only part of a GMC-approved training programme CESR(CP) is a simplified route to Specialist Registration for doctors who joined their specialty training programme after ST1, and therefore do not meet the requirement of 4 years duration in GMC-approved training on completion, as they began their training overseas and completed it in the UK.  CESR for Overseas Oncologists  For overseas doctors who have completed their full training outside of a GMC-approved training programme, CESR is the route they will usually take towards attaining Specialist Registration. This route does not require further training, rather the submission of an application.   Clinical Oncology Positions in the NHS without CESR  It is important to note that you can apply for more senior oncology roles 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 clinical oncology curriculum.  These positions also facilitate a faster route to the UK than the CESR route, which can take a substantial amount of time.  Get in touch with us to find out more about senior positions in the NHS with CESR support.  FRCR (Oncology) for Specialist Registration  Whilst it is always beneficial to complete FRCR (Oncology), particularly for doctors who have trained outside the UK or an EEA country, overseas doctors looking to join the Specialist Register do not need to have completed the Royal College postgraduate exams.  The standard test of knowledge in the Clinical Oncology curriculum are the FRCR (Oncology) exams, so passing these exams confirms the attainment of the competencies of the core curriculum.  FRCR (Oncology) is only a requirement for doctors looking to attain Specialist Registration via the CCT route.  Similarly, UK trainees would have completed MRCP (UK) before beginning their clinical oncology training, which is also not required for oncologists going through the CESR route.  However, CESR applicants who have not successfully completed these exams must provide alternative evidence that demonstrates equivalent knowledge to oncologists who have passed the FRCR (Oncology) exams and the appropriate level of non-oncology expertise and that you can appropriately manage the acutely unwell patient.  Even if the competencies covered by the exam 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 of the evidence presented.  You can read more about the evidence required in the specialty specific guidance here.  CESR Equivalence Process  Equivalence describes the process of assessing an overseas applicant’s training and experience against the current clinical oncology training programme requirements, in order to be awarded CESR.  The equivalence process involves submitting a written body of evidence to the GMC, consisting of:  training and/or competence  skills and knowledge  The Royal College of Radiologists 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 Clinical Oncology  Skills & Experience: The evidence provided for a CESR application in oncology must cover the knowledge, skills, and qualifications to demonstrate the required competencies in all areas of the Clinical Oncology Curriculum. If evidence is missing from any area of the curriculum, the application will fail.  Primary Evidence: To demonstrate that you can do what is required by the curriculum, you need to submit primary evidence of your clinical practice which shows how you work on a day-to-day basis: letters, reports, assessments etc. References, retrospective case summaries, and reflective notes can all be used in a CESR application, but by themselves they are not sufficient.  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  Domain 4 – Maintaining trust  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 oncologists applying for Specialist Registration must pay a fee. As of 1st April 2022, for CESR, this fee is £1,727. For CESR-CP and CCT, the cost is £452.  How long does it take to complete an application for CESR in Clinical Oncology?  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 oncologists, 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 clinical oncology is seven 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 oncologists.  #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 Clinical Oncology curriculum, not just your sub-specialty.     Remember to refer to the most up-to-date Clinical Oncology CCT Curriculum and Specialty Specific Guidance for the evidence requirements in your specialty.   Create a CESR ‘to-do list’ with sections under the GMC’s 4 domain 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 pro formas 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 oncology posts with CESR support. These are not always advertised by a Trust, but we can help you find a role which aligns well with your career goals in the NHS.  Join the online community - join the IMG Oncologists Facebook group for access to a community of like-minded clinical and radiation oncology CESR aspirants and dedicated oncology recruiters. In this group you will find tailored resources for oncology, including guidance on CESR applications, completely free to all doctors. You can access our IMG Oncologists community here. Sources  https://www.rcr.ac.uk/clinical-oncology/careers-and-recruitment/specialist-registration-cesr  https://www.gmc-uk.org/registration-and-licensing/join-the-register/registration-applications/specialist-application-guides/specialist-registration-cesr-or-cegpr  https://www.gmc-uk.org/-/media/documents/sat---ssg---clinical-oncology---dc3556_pdf-48456770.pdf  Getting started  Many oncology 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 oncology 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 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:              

In this article we look at the guidance on dermatology evidence required for CESR applications... Much evidence must be submitted, and you will only get a full picture of what you specifically require once you've spoken with the GMC and Royal College of Physicians. However, here we broadly discuss the evidence required to submit a complete application for entry onto the specialist register with a certificate of eligibility for specialist registration in dermatology. What is CESR in Dermatology in the NHS? As a Dermatology specialist, attaining CESR will mean you are qualified to practice at consultant level in the NHS in Dermatology. Have a read through our CESR articles found in the IMG Library to understand a little more. Do I need MRCP to attain CESR in Dermatology? No, whilst it is always a benefit to attain MRCP and you may have already attained MRCP as by ways of registering with the GMC, you do not require MRCP to attain CESR in Dermatology. Any doctor wishing to attain Specialist Registration via the CCT route must attain MRCP (UK).  What is the indicative period of training for a CCT in Dermatology? The indicative period of training for CCT in Dermatology is four years full-time training and it is highly unlikely that a CESR applicant with limited experience, applying directly from outside the UK, could achieve these competencies in less time. Experienced dermatologists who take a consultant position in the NHS, with support of their department, can attain CESR in much less time with the right focus and clarity on what they need to sign off.  What is the CCT training pathway? The structure of the CCT training programme is: 2 years in Core Medical Training OR  Acute Care Common Stem (ACCS) OR LEVEL 1 PAEDIATRICS (ST1-3)  How does IMT fit into this? CMT no longer exists as of Aug 2019. Followed by: 4 years training in Dermatology Therefore, CESR applicants need to demonstrate they have achieved the competencies in both of these areas. Where experience has not provided adequate experience in the diagnosis and ongoing inpatient management of patients with a broad range of general medical problems, this will need to be completed to a level equivalent to the experience gained in Core Medical Training before the specialist curriculum may be followed.  For complete details refer to the Dermatology Curriculum documentation. Submitting Evidence Do not submit original documents – this is very important. 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). It is very important that you read an explanation of how to do this in the GMC’s important notice about evidence. How much evidence should you submit? The GMC recognises that doctors will often not have all the evidence required for a complete CESR application, often many doctors will start their application and delay starting their application until they are able to gather all the evidence. The evidence must cover the knowledge, skills and qualifications to demonstrate the required competencies in all areas of the Dermatology Curriculum documentation. If evidence is missing from any one area of the curriculum, then the application will fail. If you have a piece of evidence that is relevant to more than one domain, do not include multiple copies in your bundle. Instead include one copy and list it in your evidence list under each relevant area, stating that the document is located elsewhere.  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 – make sure you are reading the latest version on the GMC website – here. It is important to note that evidence that is more than five years old will be given less weight than more recent evidence, so you may not need to include it.  As a general guide, an application for CESR could expect to see around 800-1000 pages of evidence.  The types of evidence are divided into four different domains, the GMC recommends that you apportion the evidence provided as per the pie chart below: Please note, you cannot compensate for evidence lacking in one area by providing more evidence in another area. Make sure to anonymise your evidence: It is very important to anonymise your evidence before submitting it to the GMC.  You must remove the following: All patient identifying details Details of patients’ relatives Details of colleagues that you have assessed, written a reference for, or who have been involved in a complaint you have submitted. This includes: Names (first and last) addresses  contact details such as phone numbers or email addresses NHS numbers & other individual patient numbers GMC numbers In Summary: If you have any questions or uncertainties, please do not hesitate to get in touch with the IMG Connect team. However, your official point of reference for any queries should the GMC – they can answer and provide the most updated information on CESR applications for senior Dermatologists looking to work as NHS Consultants in Dermatology.

In this article, we’ll be taking a closer look at the specific guidance on NHS applications for entry onto the Specialist Register through the Certificate of Eligibility for Specialist Registration (CESR) for psychiatrists.  We’ll cover the eligibility criteria, application process, and most importantly the required evidence, along with some other topics, summarised in the headings below:  What is CESR and who is it for? Do overseas psychiatrists need MRCPsych for CESR? What is the CESR equivalence process? What evidence is required for a CESR in psychiatry? Where will I find this evidence? Submitting a CESR Application How much does CESR cost? How long does it take to receive a decision? How long does it take to complete? Do I have to complete CESR before I can work in the UK? #IMG Tips How do I get started? Skip ahead to the relevant section if you know what you’re looking for.  An Introduction to CESR  The CESR, or Certificate of Eligibility for Specialist Registration, is the route to specialist registration for psychiatrists who have not completed a GMC-approved training programme but who are able to demonstrate that their specialist training, qualifications and experience are equivalent to the requirements for the award of CCT in the UK.   CESR holders can be appointed to substantive (or permanent) consultant positions in the NHS. As a psychiatrist, attaining specialist registration will mean you are qualified to practice independently as a psychiatry consultant in the NHS.  Psychiatrists must satisfy the GMC that their specialist training or specialist qualifications, when considered together, are equivalent to a CCT in the specialty in question. Doctors who have undertaken a minimum of 6 months training or obtained a specialist qualification and acquired specialist medical experience or knowledge as a psychiatrist within a non-training post, and are currently practicing, may apply to the GMC for assessment of their competencies.  Overseas doctors do not require CESR before moving to the UK to work in the NHS. Often, experienced psychiatrists will secure a post in the UK, and work towards CESR whilst in post. Typically, CESR is a preferred route towards specialist registration for overseas trained psychiatrists.  An overseas psychiatrists training may not have covered all the ground of the CCT curriculum, but they may be able to show competence in the missing area through experience in a fixed term Specialty Doctor, Specialty Grade, Associate Specialist, or Acting Consultant post in the NHS. In this case, overseas psychiatrists will likely complete the MRCPsych exams to gain GMC registration and start working in the NHS, before completing CESR.   MRCPsych for Specialist Registration  Overseas doctors looking to join the Specialist Register are not required to have completed the Royal College postgraduate exams. In this case, MRCPsych is only a requirement for doctors looking to attain Specialist Registration via the CCT route.   The standard test of knowledge in the CCT curriculum is the MRCPsych exam, so passing these exams confirms the attainment of the competencies of the core Curriculum.  However, if CESR applicants have not successfully completed MRCPsych, they must provide alternative evidence that demonstrates equivalent knowledge to psychiatrists who have passed the exams.  Even if the competencies covered by the exam 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 of the evidence presented.  This is not to be confused with the requirements for registering for a full licence to practice with the GMC – many overseas applicants choose to complete MRCPsych. Specialist Registration is additional to full registration with the GMC and is therefore not required to practice as a psychiatrist in the UK.  You can read more about the full MRCPsych examination suite in our IMG Resources library.  The CESR Equivalence Process  Equivalence refers to the process of assessing an overseas applicant’s training and experience against the current psychiatry training programme requirements, in order to be awarded CESR.  The equivalence process involves submitting a written body of evidence to the GMC, consisting of:  training and/or competence; AND  skills and knowledge  The Royal College of Psychiatrists 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 Psychiatry  Skills & Experience: The evidence provided for a CESR application in psychiatry must cover the knowledge, skills and qualifications to demonstrate the required competencies in all areas of the General Psychiatry Curriculum, and the Advanced Module in the sub-specialty you are applying in. If evidence is missing from any area of the curriculum, the application will fail.  Primary Evidence: To demonstrate that you can do what is required by the curriculum, you need to submit primary evidence of your clinical practice which shows how you work on a day-to-day basis: letters, reports, assessments etc. References, retrospective case summaries, and reflective notes can all be used in a CESR application, but by themselves they are not sufficient.  Audit & 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 - 1200 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  Domain 4 – Maintaining trust  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.  Gathering Evidence for a CESR Application  Domain 1 – Knowledge, skills and performance  Qualifications  Primary Medical Qualification (PMQ)  Specialist medical qualification(s)  Curriculum or syllabus (if undertaken outside the UK)  Specialist registration outside the UK  Honours and prizes  Other relevant qualifications  Assessments and appraisals  Appraisals and assessments  RITAs, ARCPs and training assessments  360˚ and multi-source feedback  Awards and discretionary points letters  Personal development plans (PDP)  Logbooks, records of daily clinical practice and portfolios  Logbooks  Consolidation, cumulative data sheets, summary lists and annual caseload statistics  Medical reports  Case histories  Referral letters discussing patient handling  Patient lists  Departmental (or trust) workload statistics and annual caseload statistics  Rotas, timetables and job plans  Portfolios (electronic or revalidation)  Details of posts and duties (including both training and experience posts)  Employment letters and contracts of employment  Job descriptions  Job plans  Research, publications and presentations  Research papers, grants, patent designs  Publications within specialty field  Presentations, poster presentations  CPD and CME  CPD record certificates, certificates of attendance, workshops and at local, national and international meetings or conferences  CPD registration points from UK Medical Royal College (or equivalent body overseas)  Membership of professional bodies and organisations  Teaching timetables  Lectures  Feedback or evaluation forms from those taught  Letters from colleagues  Attendance at teaching or appraisal courses  Participation in assessment or appraisal and appointments processes  Domain 2 – Safety and quality  Participation in audit, service improvement  Audits undertaken by applicant  Reflective diaries  Service Improvement and clinical governance meetings  Safety  Health and safety  Domain 3 - Communication, partnership and teamwork  Communication  Colleagues  Patients  Partnership and teamwork  Working in multidisciplinary teams  Management and leadership experience  Chairing meetings and leading projects  Domain 4 – Maintaining trust  Acting with honesty and integrity  Honest and integrity  Equality and human rights (including disability, human rights, race, religion and ethnicity awareness and equal opportunities)  Data protection  Relationships with patients  Testimonials and letters from colleagues  Thank you letters, cards from colleagues and patients  Complaints and responses to complaints  Additional areas of evidence  Topics Covered in the MRCPsych Exams  Paper A:  Behavioural science and sociocultural psychiatry  Basic psychology  Social psychology  Social science and sociocultural psychiatry   Human development   Basic neurosciences  Neuroanatomy  Neurophysiology   Neurochemistry   Molecular genetics  Neuropathology   Clinical psychopharmacology  General principles  Pharmacokinetics   Pharmacodynamics  Adverse drug reactions   Classification and assessment in psychiatry  Paper B:  Organisation and delivery of psychiatric services   General adult psychiatry   Prevalence/incidence, aetiology, presentation, treatment and outcome of psychiatric disorder in adulthood   Disorders related to pregnancy and childbirth   General hospital psychiatry   Emergency psychiatry   Eating disorders   Psychosexual disorders   Old age psychiatry   Psychotherapy   Dynamic psychotherapy   Family therapy   Cognitive-behavioural therapies   Other therapeutic models   Effectiveness of psychotherapy   Group therapy   Child and adolescent psychiatry   Substance misuse/addictions   Forensic psychiatry   Relationship between crime and mental disorder   Psychiatry and the criminal justice system   Practicing psychiatry in a secure setting   Human rights legislation as it affects patients and psychiatric practice   Learning disability   Services   Epidemiology/Aetiology   Clinical   Research methods, statistics, critical review and evidence-based practice   Translation of clinical uncertainty into an answerable question   Systematic retrieval of the best available evidence   Critical appraisal of the evidence   Application of the results in practice   Evaluation of performance  All these topics covered in the MRCPsych exams can be found in the Core Training in Psychiatry curriculum.   For more guidance on the different types of evidence, see the specialty specific guidance from the GMC for psychiatry.  Validating the evidence   Original documents which are on headed paper with a hospital stamp and original signatures do not need additional validation.   All photocopied evidence should contain a hospital stamp on every page of each document, the validator’s name (printed and in full), job title (printed and in full) and original signature.  Submitting a CESR Application  All CESR applications are submitted online via GMC Online and if you have not already created an account, you can find a guide on how to do so here.  Electronic evidence is required for each of the different evidence sections of the CESR application. Once started, the online application remains open for 12 months, meaning that it can be used as a portfolio to gather evidence against each of the different sections.  Your electronic evidence can be in any of the following formats:  .doc  .pdf  .ppt  .xls  Formats outside of these are unlikely to be accepted.  The Online Application  You will be required to complete the following sections once you begin your application:  Specialty details  Qualification details and professional experience  Details of your referees  Registration and licensing history  Evidence summary  Details of your verifiers  Final declaration and payment  Additional Evidence  Once an Adviser on the Specialist Applications Team has reviewed your initial evidence, they will provide you with information on:   What evidence they’ve accepted   What evidence they’re unable to accept (including the reasons for this)   Advice and guidance on how your application could be strengthened   You’ll have up to 60 days to provide additional documentary evidence in support of your application (30 days if you’ve submitted a Review application).  For further information about the online application process, see the GMC’s User Guide.  The Cost of CESR Applications  All psychiatrists 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 receive a decision?  The GMC estimate that it can take between six and eight months to receive a decision, from the date you submit your CESR application.  How long does it take to complete?   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 psychiatrists, 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 psychiatry is six 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 psychiatrists.  NHS Positions in the NHS without CESR  It is important to note that you can apply for more senior psychiatry roles such as a specialty doctor (SAS), specialist grade or acting consultant without being on the Specialist Register.  Similarly, overseas doctors do not require CESR before moving to the UK to work in the NHS.  When compared to a trainee post, you will likely receive better pay and responsibilities that are more appropriate to your level of experience. While working in these positions, you can collect evidence of your competences, particularly those specific to the UK psychiatry curriculum.  Across the UK there are several NHS Trusts with well-established CESR programmes of support for psychiatrists who have taken up a fixed term post with the view to completing CESR.   These positions also facilitate a faster route to working in UK and attaining Specialist Registration when compared to making an application for CESR from overseas, which can take an additional amount of time.   #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 psychiatry curriculum, not just your sub-specialty.     Remember to refer to the most up-to-date Psychiatry CCT Curriculum and Specialty Specific Guidance for the evidence requirements in your specialty.   Create a CESR ‘to-do list’ with sections under the GMC’s 4 domain 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).  Choose your referees carefully - they will need to be able to comment on direct observation of your clinical competences. At least six (from the last 5 years) are required but it would be preferable to give provide eight to ten (based on previous experience).   Reconstruct your CV from scratch so that it matches the application form - if you submit a CV that doesn’t contain the required information or you have not submitted all evidence as mentioned on the CV, this will delay your application.   Request a CV consultation with one of our experts Ask an IMG Connect recruitment specialist about NHS psychiatry posts with CESR support. These are not always advertised by a Trust, but we can help you find a role which aligns well with your career goals in the NHS.  Join the IMG Psychiatrists community – as well as support on Royal College exams, our online community of international psychiatrists and dedicated psychiatry recruiters offers guidance on other aspects of working in the UK, including finding NHS posts and CESR.  Getting started  Attaining Specialist Registration through the CESR pathway can be a long but very rewarding process. Look at our introduction to CESR for psychiatrists for a full overview.  If you have any further questions about Specialist Registration, your route to the UK, or would like guidance in finding NHS posts which offer CESR support, please get in touch with us here.   To receive the latest news and updates on all things psychiatry, including the Royal College, GMC registration and the NHS, follow us on social media and join the conversation.              

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:  training and/or competence  skills and knowledge  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  Domain 4 – Maintaining trust  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:              

Experienced overseas Emergency Medicine trust doctors, or consultants who have completed specialist training, can apply for specialty doctor posts in the NHS with CESR programmes included in the job plan.  So, if you are committed, motivated and enthusiastic in embracing the CESR application once in the UK, this could be the best route towards gaining entry to the specialist register. Many trusts are piloting such projects, which will support you via a CESR programme tailored to your needs. Specialist Register for Emergency Medicine All consultants (other than a locum consultant appointments) must be on the specialist register of the General Medical Council (GMC). To be eligible to apply for specialist registration with the GMC, doctors must have successfully completed a GMC-approved training programme leading to CCT, or applied for a certificate confirming Eligibility for Specialist Registration (CESR). Doctors who have not completed a full GMC-approved training programme and wish to have their training, qualifications and experience assessed for eligibility for entry onto the specialist register must make an application under The General and Specialist Medical Practice Order for a CESR. Working with IMG Connect & our NHS Clients Working with our NHS clients, we are offering CESR Specialty doctor roles, with the opportunity of being mentored by CESR Consultants to guide you in your application toward CESR and to participate in a job plan that is tailored to your needs. Such CESR programmes are locally developed and targeted for both International Doctors coming to work in the NHS and non-trainees wanting to apply for a CESR in Emergency Medicine. As an Emergency Medicine doctor your CESR programme will include dedicated one-to-one mentoring and a course mapped on the GMC domains for successful completion of your application.  Benefits of the CESR programme Such Specialty doctor vacancies will give you the benefit of support on your journey to achieving consultant status, give you the opportunity to adapt to working in the NHS, and help you to further your career at the most senior level.  Furthermore, job plans will typically provide you with a dedicated mentor for CESR applicants by Emergency Medicine CESR Consultants who will take you through the application process. In some circumstances practical experience will be delivered via simulation and workshops where you are at the centre of the learning experience. Most NHS trusts have experienced Emergency Medicine CESR consultants who will be available to give you support, mentorship and coaching. The post are intended to provide the emergency medicine clinician with the support and training required to successfully complete all aspects of the CESR process and attain specialist registration, allowing you to take a substantive emergency medicine post and work as a consultant in the NHS.  IMG Jobs  Search and find live emergency medicine NHS doctor jobs in the UK IMG Resources Read more useful articles on finding an NHS trust doctor jobs, doctor salary & relocation for emergency medicine specialists Get in Touch Don’t hesitate to get in touch using the buttons above (and below) to discuss emergency medicine doctor job options in the NHS, including discussions regarding a typical doctor salary in the UK and the most suitable hospital locations for you. For the latest news and updates on all things emergency medicine, including the Royal College, GMC registration and the NHS, follow us on social media and join the conversation.              

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 psychiatry for overseas consultant psychiatrists and specialists more closely. We’ll cover the Certificate of Eligibility for Specialist Registration (CESR) in more detail, including the application process, 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 psychiatrist? Do I have to complete CESR before I can work in the UK? Do I need MRCPsych for Specialist Registration? What is the CESR equivalence process? What evidence do I need to submit for a CESR in psychiatry? 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 psychiatrists who wish to take permanent consultant roles in the UK must show evidence of skills, knowledge, and experience in order to apply for Specialist Registration.   For psychiatrists, attaining specialist registration will mean you are qualified to practice independently as a consultant in the NHS.   Specialist Registration is additional to full registration with the GMC and is therefore not required to practice as a psychiatrist in the UK.  Routes to Specialist Registration  There are three types of certificates issued by the GMC for specialist registration, and the type of certificate you receive depends on which training route you followed.  For overseas doctors 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, 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. You can read more about this in the Specialist Registration section under your country on the GMC website here.  Psychiatry Positions in the NHS without CESR  It is important to note that you can apply for more senior psychiatry roles 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 psychiatry curriculum.  These positions also facilitate a faster route to the UK than the CESR route, which can take a substantial amount of time.  MRCPsych for Specialist Registration  Whilst it is always beneficial to complete MRCPsych, 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 is the MRCPsych exam, so passing these exams confirms the attainment of the competencies of the Core Curriculum.  MRCPsych 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 psychiatrists who have passed the MRCPsych exams.  Even if the competencies covered by the exam 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 psychiatry training programme requirements, in order to be awarded CESR.  The equivalence process involves submitting a written body of evidence to the GMC, consisting of:  training and/or competence  skills and knowledge  The Royal College of Psychiatrists 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 Psychiatry  Skills & Experience: The evidence provided for a CESR application in psychiatry must cover the knowledge, skills, and qualifications to demonstrate the required competencies in all areas of the General Psychiatry Curriculum, and the Advanced Module in the sub-specialty you are applying in. If evidence is missing from any area of the curriculum, the application will fail.  Primary Evidence: To demonstrate that you can do what is required by the curriculum, you need to submit primary evidence of your clinical practice which shows how you work on a day-to-day basis: letters, reports, assessments etc. References, retrospective case summaries, and reflective notes can all be used in a CESR application, but by themselves they are not sufficient.  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 800-1200 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  Domain 4 – Maintaining trust  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 psychiatrists 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 is the application process for CESR in Psychiatry?  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 psychiatrists, 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 psychiatry is six 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 psychiatrists.  #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 psychiatry curriculum, not just your sub-specialty.     Remember to refer to the most up-to-date Psychiatry CCT Curriculum and Specialty Specific Guidance for the evidence requirements in your specialty.   Create a CESR ‘to-do list’ with sections under the GMC’s 4 domain 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 psychiatry posts with CESR support. These are not always advertised by a Trust, but we can help you to find a role which aligns well with your career goals in the NHS.  Join the IMG Psychiatrists community – as well as support on Royal College exams, our online community of international psychiatrists and dedicated psychiatry recruiters offers guidance on other aspects of working in the UK, including finding NHS posts and CESR.  Getting started  Many psychiatry 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 psychiatry 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 posts which offer CESR support, please get in touch with us here.   To receive the latest news and updates on all things psychiatry, including the Royal College, GMC registration and the NHS, follow us on social media and join the conversation.