Understanding the status of your qualifications when registering with the GMC is critical to finding the best registration route for you and streamlining your journey to the UK and working in the NHS.
The breadth of global postgraduate oncology qualifications can confuse overseas oncologists as to the status of their qualifications in the UK. This blog aims to simplify subject, covering the following topics:
How do I register with the GMC as a European specialist?
EEA Countries
GMC-accepted EEA Primary Medical Qualifications (PMQ)
GMC-accepted EEA Specialist Qualifications
I am on the Specialist Register - what type of post can I be offered?
Skip ahead to the relevant section if you know what you’re looking for.
GMC Registration for European Specialists
When applying for GMC registration, all doctors must provide evidence of sufficient skills and knowledge. For oncologists from certain European countries (those within the European Economic Area or EEA), there is a group of relevant European qualifications which are accepted as sufficient evidence of skills and knowledge to practise in the UK.
These are Primary Medical Qualifications and European Specialist qualifications which provide eligibility for Full and Specialist Registration respectively.
European Economic Area (EEA) Countries
These are the countries from which a relevant European qualification would be accepted by the GMC*:
Austria
Germany
Netherlands
Belgium
Greece
Norway
Bulgaria
Hungary
Poland
Croatia
Iceland
Portugal
Cyprus
Ireland
Romania
Czech Republic
Italy
Slovakia
Denmark
Latvia
Slovenia
Estonia
Lithuania
Spain
Finland
Luxembourg
Sweden
France
Malta
Switzerland
*When determining the eligibility of your EEA qualification, it is important to check the given dates and evidence required by the GMC for acceptance.
EEA Primary Medical Qualifications
If your primary medical qualification was awarded by a medical school in an EEA country, it may be a relevant European qualification. Oncologists with an EEA PMQ are eligible for full GMC registration with licence to practise.
You can find out whether your PMQ is eligible and what qualifications and evidence you need to send to the GMC to support your application here or by selecting your country from the table above.
EEA Specialist Qualifications
If your specialist qualification was awarded after the completion of an EEA training programme, it may also be a relevant European qualification. Oncologists with an EEA specialist qualification are eligible for direct entry to the GMC’s Specialist Register.
You can find out whether your European Specialist Qualification is eligible by searching for oncology within this list and checking whether your country’s evidence is accepted (if your country’s field is blank for oncology, your qualification would not be accepted for Specialist Registration).
You can then check what qualifications and evidence you need to send to the GMC to support your application here or by selecting your country from the table above.
NHS Posts for European Oncologists on the Specialist Register
The NHS post you would be eligible for as a European oncologist would be dependent on your level of experience with your postgraduate qualifications taken into account.
If you are on the Specialist Register for clinical or medical oncology, you are eligible fo substantive consultant positions in the NHS - meaning you can be offered a permanent consultant contract to work in the NHS.
Without GMC Specialist Registration, you can still work as a locum consultant on a fixed-term contract, and attain Specialist Registration via the CESR Portfolio Pathway.
Oncology Consultants are in high demand in the UK, and thus command competitive rates of pay.
As a Consultant Oncologist, the pay you will earn can be broken down as follows:
Basic salary for 40 hours per week or 10 PAs (programmed activities)
Pay for additional hours worked
37% premium for night hours worked
Weekend allowance for hours worked
On-call allowance
There are also other wage premiums that may be offered.
You can find the latest pay scales for NHS Consultants across the UK here.
Please use these pay scales as a guide, but bear in mind that you may be eligible for a different rate of pay than stated, based on experience and/or demand. It is therefore worth checking what you may be entitled to with your IMG Consultant.
Sources
https://www.gmc-uk.org/registration-and-licensing/join-the-register/eea-countries
IMG Connect are here to help
We hope this helps to clear up any doubts around registering to work in the UK as an EEA oncologist and securing an NHS post.
Get in touch with our oncology team if you have any further questions regarding EEA entry to the NHS, CESR or oncology in the NHS more broadly.
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.
Here we take a closer look at the Medical Training Initiative (MTI) for international doctors practicing medicine and its sub-specialties.
Whilst the MTI describes a UK-wide placement scheme for junior overseas doctors, the processes involved vary between specialties.
This blog focuses on the MTI scheme as administered by the RCP, and the particular of this are summarised below along with a broad look the following:
What is the Medical Training Initiative?
What is the RCP and what support does it provide throughout my training?
Am I eligible for an MTI post?
Are there any additional requirements for the RCP?
How can I use the MTI for GMC registration?
What does the application process for the MTI through the RCP involve?
How am I supported in obtaining a visa?
I’m coming to the end of the MTI, what’s next?
Skip ahead to the relevant section if you know what you’re looking for.
The Medical Training Initiative
The Medical Training Initiative, or MTI, is a training programme that provides junior doctors from all over the world the opportunity to gain clinical training and development in the UK for a maximum of 24 months.
The MTI as a training scheme is mutually beneficial for both junior doctors and the NHS, in that doctors from several countries and specialisms around the world can work and train in the UK, gaining knowledge and experience which they can take back to their home country, while giving NHS Trusts a high-quality, longer-term alternative for unfilled training vacancies and rota gaps.
Royal College of Physicians (RCP)
The Royal College of Physicians is the professional body that regulates medicine specialties in the UK, and Membership of the Royal College of Physicians (MRCP) is the full qualification attainable by examination.
Take a look at IMG Resources library for complete guides on MRCP to learn more.
There are several ways you will be supported by the RCP as listed below:
Induction – all MTI candidates are expected to attend an induction at the RCP. The induction is held on a quarterly basis
Free ePortfolio access – this is an electronic portfolio to log all your assessments and training whilst in the UK
Free RCP associate membership – this is for the first year and discounted rate for the second year and comes with a number of benefits
Annual symposium – this is a clinical conference for all RCP MTIs held once a year
Diploma in UK Medical Practice – participants are required to carefully document their training using the ePortfolio system, complete a range of continuing medical education sessions, and submit a written reflection piece at the end of their placement
RCP certificate - at the end of training there is an RCP certificate available to all candidates
Support for any issues that you might encounter relating to your training
Eligibility
The MTI has been designed specifically with junior doctors in mind, therefore sponsorship will not be offered to consultants, specialty doctors or for locum-appointed service posts (LAS).
The eligibility criteria differ among MTI programmes, but for the RCP, eligibility includes the following:
Country Requirements - Priority is given to doctors from countries classified as low income or lower middle income by the World Bank and priority countries as described by the Department for International Development. Doctors from outside these countries may also apply, but there may be a long wait time and no guarantee of acceptance.
Primary Medical Qualification: You must hold a recognised PMQ by the GMC and verified by Educational Commission for Foreign Medical Graduates (ECFMG)
Have a Postgraduate Medical Qualification: This can be MRCP Part 1, MD or other higher degree in medicine or a medical subspecialty
Skills & Competencies: You must possess the skills, competencies and understanding of medicine at least equivalent to a UK graduate at the end of their core medical training.
Clinical Experience: You must have 3 years post-qualification experience, including 1 year's internship and at least 1 year in the specialty in which you intend to train while in the UK
Active Medical Practice: Candidates must have been actively practicing clinically for at least three out of the last five years including the past 12 months before the application as well as throughout the application process (the GMC does not consider clinical observerships as clinical practice).
Please note, the RCP cannot sponsor doctors who have failed the Professional and Linguistic Assessments Board (PLAB) test.
Additional Requirements
Before you can make an application for the MTI scheme through the RCP, the following criteria must be satisfied:
Verification of PMQ – your primary medical qualification must be independently verified by the ECFMG via their EPIC service.
Complete an English Language test – the test must have been completed within two years of application for GMC registration.
Find an NHS job before applying for the MTI – you are required to apply directly for an NHS post and should have already been formally offered the role before contacting the RCP. The hospitals should also be in support of your intention to seek sponsorship for the post.
Obtain funding - you should already have funding for your post from either a scholarship, official funding, or a salary. The funding should be equivalent to a UK salary for the level of work being undertaken and must last for the duration of the post. The RCP will not sponsor applicants who are self-funded.
Certificate of Good Standing - you must be able to provide a certificate of good standing (CGS) from the regulatory body in the countries where you have practised in the last 5 years. The CGS should be no older than 3 months when submitted.
GMC Registration
All doctors practicing in the UK must be registered with the GMC. For MTI candidates, registration is typically supported by the Royal College, but some NHS Trusts also have the right to register MTI doctors.
English Language Testing – candidates will also need to provide evidence of English language skills. This can be done by passing either IELTS with overall score of 7.5 and 7.0 in all categories or OET with minimum grade B in all categories. Further information on these tests can be found below:
IELTS – a guide for overseas doctors
OET – a guide for overseas doctors
Application Process
Once you fulfill all the eligibility criteria and additional requirements laid out by the RCP, you must complete the initial and professional postgraduate experience (PPE) forms and email these along with your CV to mti@rcplondon.ac.uk.
Once your CV, initial form and PPE forms have been received, the RCP will contact the supervising consultant in the UK and confirm the details of your post. You will then be sent an application pack. You should complete the application form and send it to the RCP with all of the following documents:
sponsor form (forms will be provided by the RCP) – must be completed by your consultant or head of department in your home country
two reference forms (forms will be provided by the RCP)
copy of your passport
copy of your IELTS/OET certificate or details of exemption
copies of your medical qualifications
translations of your medical qualifications if they are not in English
letter from the dean of the medical school from which you graduated
copy of certificate of good standing
letter from the UK hospital confirming your appointment
evidence of funding for the post
your statement agreeing to the level of funding which you have received from any of the sources listed
initial fee of £125
We’ve detailed the general processes involved in MTI applications through the RCP below, from a candidate securing an NHS post, to their eligibility to work in the UK after gaining GMC registration and securing a visa.
Tier 5 Visa for MTI
The MTI scheme falls under the Tier 5 government authorised exchange visa. This visa must only be used for travel to the UK at the beginning of the placement and will activate after your arrival, lasting for exactly 24 months from your arrival date.
For a Tier 5 MTI visa, the RCP needs to provide evidence regarding your post to the Academy of Medical Royal Colleges (AoMRC - the official visa sponsor) once the GMC has approved your application in order to get your Tier 5 Certificate of Sponsorship (CoS) issued.
Once your Tier 5 CoS has been issued it is your responsibility to apply for the Tier 5 visa via https://www.gov.uk/browse/visas-immigration/work-visas.
Applications for Tier 5 visas must be made in your home country (or the country you work in), but never from within the UK.
You can also apply to the AoMRC for Tier 5 dependent visas for your spouse and children, although this is not guaranteed, and you should read the UKVI requirements on this well in advance.
Please note that Tier 5 visas cannot be extended.
Sources
https://www.rcplondon.ac.uk/education-practice/advice/medical-training-initiative-resources-applicants
https://www.rcplondon.ac.uk/education-practice/advice/medical-training-initiative
https://www.rcplondon.ac.uk/file/19236/download
https://www.rcplondon.ac.uk/file/23841/download
https://www.rcplondon.ac.uk/file/4534/download?token=QyAzDCP8
What are my options after I complete the MTI?
Ordinarily, on completion of the MTI scheme, doctors return to their home country with the training and experience they gained from working in the NHS.
Some doctors may want to remain in the UK after completing the MTI for a number of reasons. This can be done if the doctor finds another NHS post, in which case, they may be able to switch from the Tier 5 visa to the Tier 2 Health and Care Worker visa.
If you want to find another NHS post after completing the MTI, you would follow the same process as any other doctor. You will need to consider what job it is you would like to obtain and what location in the UK you would prefer to relocate to.
For guidance on NHS jobs in your specialty, please see our live jobs or get in touch with us to learn more about your options in the NHS.
For regular news and updates on the Royal Colleges, GMC registration and working in the NHS, follow us on social media and join the conversation:
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:
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:
As there is no hard and fast rule for what position you will have after gaining a UK qualification, it is important for IMGs to understand the posts that are available to you after completing FRCR (Oncology).
FRCR (Oncology) is a highly beneficial qualification to achieve, but it does not guarantee you a consultant position in the NHS.
This can be a confusing area for overseas clinical and radiation oncologists, but this blog aims to de-mystify the subject. This article will explain the following topics:
What is FRCR (Oncology) and how does it fit into the UK training programme?
What grade will IMGs, new to the NHS, be offered with FRCR (Oncology)?
Can I take a permanent consultant post if I have FRCR (Oncology)?
CESR opportunities for clinical oncologists in the NHS
Skip ahead to the relevant section if you know what you’re looking for.
FRCR (Oncology) within the UK Oncology Training Programme
Fellowship of the Royal College of Radiologists (Oncology) or FRCR (Oncology) is the postgraduate qualification awarded by the Royal College of Radiologists, the body responsible for the specialties of clinical oncology and clinical radiology throughout the UK.
FRCR (Oncology) is a three-part exam which is a necessary part of the training programme of clinical oncologists in the UK.
For trainees who have chosen to pursue clinical oncology, FRCR (Oncology) Part 1 or CO1 must be passed by the end of ST4.
Clinical oncology trainees will then sit Final FRCR (Oncology), also known as Part 2A and 2B or CO2A and CO2B, usually from ST6 to ST7.
These final exams are important in that they assess a trainee’s knowledge and skills related to the investigation of malignant disease and the care and management of patients with cancer.
Any UK-trained clinical oncologist applying for a CCT in order to work as a substantive consultant must have completed full FRCR (Oncology).
As shown above, UK trainees will also have completed MRCP (UK), although this is not required for overseas clinical oncologists.
Positions for Doctors new to the NHS with FRCR (Oncology)
As an IMG with full FRCR (Oncology), you will be eligible for consultant grade positions in the UK.
You are not guaranteed a consultant position, particularly if you do not have previous consultant position in your home country, but you will certainly be able to attain more senior positions in the NHS, such as a specialty doctor (SAS) or specialist grade.
Consultant positions are the most senior in the UK, and thus the highest paid position for doctors within the NHS pay system.
For further information on how NHS pay scales work for consultants, please see our detailed article here.
Of course, this is assuming that you have also completed the other necessary components to make you eligible for GMC registration.
Alongside your postgraduate qualification, you will need to have passed an English Language Test (either IELTS or OET).
Additionally, you must obtain a Certificate of Good Standing, and submit this to the GMC. Upon the receipt of these three components, you will receive full GMC registration.
Permanent Consultant Posts with FRCR (Oncology)
To take up a permanent consultant position in the NHS, you would need to have Specialist Registration. Specialist Registration (more specifically CESR for most overseas doctors) allows you to take up permanent or substantive consultant roles in the NHS.
The type of consultant position you would be eligible for with FRCR (Oncology) is a locum consultant post.
Firstly, we should clarify the meaning of the term ‘locum consultant’ in the UK. The NHS has two types of locums - Trust locums and Agency locums.
If you are an IMG with full registration, but you are not on the Specialist Register, you are only able to take on consultant positions as a trust locum, but no permanent positions.
Trust locums are hired on a fixed-term contract and are able to better acclimatize themselves to the NHS system, whilst receiving the support and guidance to work towards consultant positions and CESR.
Please note, you can only work as an agency locum if you have a British passport.
CESR Opportunities in the NHS
CESR or the Certificate of Eligibility for Specialist Registration is a route of entry to the Specialist Register for those doctors who have not followed a GMC-approved training programme.
You can read more about CESR in Clinical Oncology through our IMG Resources library here.
IMG Connect are able to help you to secure senior roles such as specialty doctor (SAS), specialist grade or locum consultant in Trusts that offer CESR support.
In these roles, you will have better pay and responsibilities that are more appropriate to your level of experience compared to a trainee. These Trusts have a lot of experience in supporting overseas doctors to progress their careers through CESR.
You can collect evidence of your competences, particularly those specific to the UK Clinical Oncology curriculum and those you may not be able to achieve outside the UK.
These positions also facilitate a faster route to the UK than applying directly through 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.
Getting started
We hope this blog has been helpful in clarifying your questions about securing senior posts in the NHS with FRCR (Oncology). If you have any further questions regarding the postgraduate exams, CESR or Oncology in the NHS - feel free to contact us directly.
Join the IMG Oncologists Facebook group for access to a community of like-minded clinical and radiation oncologists and dedicated oncology recruiters.
In this group you will find tailored support for oncology IMGs, including access to our NHS and CESR webinars, completely free to all doctors.
You can access our IMG Oncologists community here.
Follow us on social media through the links below for regular news and updates on the Royal College, 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:
The Medical Oncology SCE is a postgraduate qualification delivered by the Royal College of Physicians as a higher specialist qualification for medical oncologists. It is one of 11 SCEs offered by the Royal College and offers physicians a postgraduate qualification which demonstrates achievement of a high standard (equivalent to UK specialist trainees) to prospective employers.
Here we take a closer look at the MRCP (UK) Medical Oncology Specialty Certificate Examination for doctors who have chosen to specialise in medical oncology. We cover the exam content, fees and eligibility, summarised below along with a broad look at the following topics:
What is the medical oncology SCE?
Where does the SCE fit into my oncology training?
What is the structure of the SCE?
How do I apply for the exams and what do they cost?
Where can I sit the exams as an overseas medical oncologist?
How should I prepare for the exams as an IMG?
I’ve passed? What’s next?
Skip ahead to the relevant section if you know what you're looking for.
MRCP (UK) Medical Oncology SCE
The Royal College of Physicians is the professional body responsible for the specialty of medicine throughout the UK.
The medical oncology specialty certificate exams are administered as a compulsory component of assessment for Certificate of Completion of Training (CCT) in medical oncology for all UK trainees.
The purpose of an SCE is to:
ensure that certified specialists have sufficient knowledge of their specialty to practice safely and competently as consultants
complement workplace-based assessments
provide a rigorous national assessment to establish public confidence
offer a challenge similar to sub-specialty certification examination in North America
For in-depth information on each of the MRCP exams, see our IMG Resources library here.
Medical Oncology SCE as Part of Training in Oncology
As the MRCP exams are taken during the Internal Medicine Training years (CT1-CT3), an SCE allows medical oncologists to demonstrate that they are able to practice independently.
The SCE has no official entry requirements (both for UK and overseas candidates), however, UK trainees would normally take the SCE in their penultimate year of higher specialty training (ST5).
To find out more about the medical oncology training pathway in the UK, see our blog on this topic here.
Exam Structure
The SCE assesses candidates on a wide range of common and important disorders, as set out in the syllabus of the curriculum:
Topic
Number of questions
Breast cancer
14
Colorectal and anal cancer
14
Lung and thoracic cancer
14
Carcinoma of unknown origin
7
Ovarian cancer
7
Germ cell tumours
7
Oesophagogastric cancer
6
Lymphoma
3
Uterine cancer
3
Hepatobiliary cancer
5
Skin cancer
5
Sarcoma
5
Leukaemia
1
Prostate cancer
3
Urothelial cancer
3
Cervical cancer
3
Head and neck cancer
2
CNS cancer
2
Renal cell cancer
3
Endocrine cancer
2
Scientific basis of malignancy
18
Professional skills
14
Acute oncology
20
Clinical research, ethics and economics
8
Systemic anticancer therapy
18
Supportive therapies and palliative care
10
Standard operating procedures
3
Total
200
All SCEs are computer-based and are administered by Pearson VUE at a test centre in the UK or internationally.
Medical Oncology SCE Applications
SCEs are held once a year and applications are made online through My MRCP(UK) account, within the Upcoming Exams section of the Royal College website.
The application process is as follows:
Register online through My MRCP(UK) (candidates have the opportunity at this point to register any special arrangements)
Request a preferred test country and city
Pay applicable examination fee
Application is confirmed via an automatically generated email
Receive test centre confirmation email from Pearson VUE within four weeks of the examination date.
The Royal College has created a helpful video guide on SCE applications which you can watch here.
Cost
The cost of the MRCP exams are as follows:
UK centres: £665
International centres: £833
Exam Centres
UK Centres
Candidates choosing to sit the exam in the UK must contact Pearson VUE to book their test. There are up to 137 test centres throughout the UK for each SCE, and the Royal College advise that candidates should book their exam as early as possible to secure their preferred test centre, as bookings operate on a first come, first served basis.
International Centres
Candidates are given a choice of regions and are then asked to nominate a particular city in that region as their desired test location. MRCP (UK) will pass this request to Pearson VUE once the application period has closed, and Pearson VUE will confirm final test centre details to candidates via email at least three weeks before the date of the examination. If the exam is not available in a requested location, candidates will be offered a choice of the nearest available test centres.
Please note, international candidates should not book their own test centre with Pearson VUE, and attempting to do so may delay a candidate's application.
The full list of international SCE test centres can be found here.
Preparation and resources for the Medical Oncology SCE
With lots of resources available online, it can be difficult for IMGs to know where to start with their preparation and revision. This list should provide a good starting point for any international medical oncologists preparing to sit the SCE:
Curriculum - Applicants are tested on a range of common and important disorders in Medical Oncology as set out in the Joint Royal Colleges Specialty Training Curriculum for Core Medical Training. We recommend getting to know the curriculum as early as possible and using it as a roadmap for your study.
Guidelines - These resources are helpful for supplementing your knowledge:
British Journal of Cancer 2009 March 100 (5) 684–692 Jones et al. – guidelines for Herceptin modification
British Thoracic Society (BTS) - pleural disease guidelines
International Prognostic Index score for non-Hodgkin's lymphoma
National Comprehensive Cancer Network (NCCN) - guidelines for follicular lymphoma
NHS Cancer Screening – guidelines for bowel and other cancers
Books
Candidates can find information on genetics and some basic science in the Oxford Desk Reference of Oncology 2011.
Sample questions
It is a good idea to regularly benchmark your knowledge by testing your knowledge and progress throughout your preparation using example questions from the current exam syllabus. You can find these here.
For an overview of how to prepare for exams, including advice on study groups, online community support, the best use of online resources & Royal College materials and courses, take a look at our blog: IMG Connect's Top Tips for exam preparation.
IMG Oncologists
Join the online community - join the IMG Oncologists Facebook group for access to a community of like-minded oncology SCE 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.
I’ve passed? What’s next?
First, congratulations - this is a fantastic achievement! Armed with your MRCP and medical oncology SCE qualifications, you can apply for a full GMC registration with a license to practice. Once the GMC has approved your application, you can work as a doctor in the UK. Nice one!
Don’t hesitate to get in touch with an IMG oncology recruitment specialist to discuss GMC registration, oncology positions in the NHS, including typical NHS salaries, the most suitable UK locations and hospitals for you, and relocation.
To receive the latest news and updates on all things oncology, including the Royal College, GMC registration and the NHS, follow us on social media and join the conversation.
Overseas medical oncologists looking to register with the GMC through the postgraduate qualification route will need to attain Membership of the Royal College of Physicians (MRCP UK).
Here we take a closer look at the MRCP (UK) examinations for doctors who have chosen their specialism in medical oncology, including a breakdown of each exam, fees and eligibility.
International Medical Graduates (IMGs) from any country in the world can sit the MRCP examinations, provided certain eligibility criteria are met. These are summarised below along with a broad look at the following topics:
What is MRCP (UK)?
Where does MRCP fit into my oncology training?
How are the MRCP exams structured?
Eligibility for overseas doctors
How do I apply for the exams and what do they cost?
Where can I sit the exams as an overseas medical oncologist?
How should I prepare for the exams as an IMG?
I’ve passed, what’s next?
Skip ahead to the relevant section if you know what you're looking for.
What is MRCP(UK)?
The Royal College of Physicians is the professional body responsible for the specialty of medicine throughout the UK. Among many other duties, its role is to set and monitor the educational curriculum for those training to enter the profession.
As medical oncology comes under the umbrella of medicine, the postgraduate exams for medical oncologists are set and delivered by the Royal College of Physicians. For clinical oncologists, the Royal College of Radiologists are the overseeing body for training and exams. You can learn more about the clinical oncology postgraduate route here.
The MRCP examinations assess a candidate’s knowledge of basic medical sciences, as well as clinical skills required for the diagnosis and management of disease. The exams are designed to test both applied basic science and principles of medicine to the level of a UK trainee with two to three years postgraduate experience.
Therefore, completion of MRCP will allow you to work in the UK from ST3 level upward, with seniority beyond ST3 level dependent on experience.
MRCP (as a postgraduate qualification) is one of the two main routes an overseas doctor can take to gain full GMC registration, the other being the PLAB route. For in-depth information on each of the MRCP exams, see our IMG Resources library here.
MRCP as Part of Training in Oncology
Full MRCP (UK) is a requirement for all oncologists wishing to go on to a specialty training post in the UK.
For doctors who wish to find more senior roles in the NHS which are reflective of their current practice and experience, IMG Connect advise that MRCP (UK) would be the best route to take to GMC registration.
MRCP (UK) Exams Structure
The MRCP exam has three parts as outlined below:
MRCP (UK) Part 1
The first exam in the MRCP exam suite tests a sample of medical knowledge skills and behavior are specified in the UK specialty training curriculum for core medical training / internal medicine training.
The first examine that MRCP suite is designed to assess the candidate's knowledge and understanding of the clinical silences relevant to medical practice and of common or important disorders to a level appropriate for entry to specialist training.
The examination has a two-paper format - each paper is 3 hours long and contains 100 multiple choice questions in a ‘best of five’ format. The paper both tests core knowledge and comprehension as well as a candidate's ability to interpret information and solve clinical problems.
Each question has five options: one correct answer and four alternatives to the correct answer.
The exam is also designed to help prepare candidates for the more challenging Part 2 written and PACES exam.
Specialty
Number of questions
Cardiology
14
Clinical Pharmacology and Therapeutics
15
Clinical sciences
25
Dermatology
8
Endocrinology, diabetes and metabolic medicine
14
Gastroenterology and Hepatology
14
Geriatric medicine
8
Haematology
14
Infectious diseases
14
Neurology
14
Oncology
5
Medical ophthalmology
4
Palliative medicine and end of life care
4
Psychiatry
9
Renal medicine
14
Respiratory medicine
14
Rheumatology
14
Total
200
For more detailed information on the content of the exam, see the Royal College website here.
MRCP (UK) Part 2
The second exam in the exam suite builds on the knowledge assessed in Part 1 and again tests the acquisition of a representative sample of medical knowledge skills and behavior.
The questions will usually have a clinical scenario, may include the results of investigations and may be illustrated with images such as clinical photographs, pathology slides, inheritance trees ECGs, X-rays, CT and MR scans and echocardiograms.
Questions are asked about the diagnosis investigation management and prognosis of patients using multiple choice questions in a ‘best of five’ format.
Specialty
Number of questions
Cardiology
19
Clinical Pharmacology and Therapeutics
18
Dermatology
9
Endocrinology, diabetes and metabolic medicine
19
Gastroenterology and Hepatology
19
Geriatric medicine
9
Haematology
9
Infectious diseases
19
Medical ophthalmology
3
Neurology
17
Oncology, Palliative medicine & end-of-life care
9
Psychiatry
3
Renal medicine
19
Respiratory medicine
19
Rheumatology
9
Total
200
For more detailed information on the content of the exam, see the Royal College website here.
MRCP (UK) PACES
The MRCP (UK) Practical Assessment of Clinical Examination Skills (PACES) assesses a candidate’s ability to carry out essential clinical skills.
There are five clinical stations where there are either patients with a given condition, or trained stand-ins (surrogates). At each station, there are two independent examiners who will observe and evaluate the candidates' performance.
PACES Carousel
For more detailed information on the content of the exam, see the Royal College website here.
Eligibility for Overseas Medical Oncologists
Part 1
To be eligible for MRCP (UK) Part 1, you must have a GMC recognised Primary Medical Qualification and a minimum of 12 months postgraduate experience in medical employment.
Part 2 & PACES
To be eligible for MRCP (UK) Part 2 & PACES, you must have passed Part 1 within the last seven years.
Please note, whilst it is not essential to successfully complete Part 2 to sit PACES, the Royal College strongly advises you to do so, as pass-rates are much lower for those who sit PACES before passing Part 2.
Applications
Applications for all MRCP exams are made online through My MRCP(UK) account, via the Royal College website. You will need to create an account and submit evidence of your primary medical qualification, then make a payment online to confirm your application.
The cost of the MRCP exams are as follows:
Candidate
Part 1
Part 2
PACES
UK
£460
£460
£657
International
£616
£616
£1,202
Exam Centres
The MRCP exams are held 4 times a year and can be sat in several locations around the world, including the UK, Manama, Dhaka, Cairo, Accra, Hong Kong, Reykjavik, Chennai, Hyderabad, Kerala, Kolkata, Mumbai, New Delhi, Erbil, Amman, Nairobi, Kuwait City, Kuala Lumpur, Malta, Kathmandu, Muscat, Karachi, Lahore, Doha, Jeddah, Riyadh, Singapore, Sri Lanka, Khartoum, Abu Dhabi, Dubai, New Jersey, Barbados, Jamaica, Trinidad and Harare.
Please note that the number of sittings for each exam varies between countries – you can find the full list of cities and dates here.
The Part 1 and Part 2 exams are held online in the UK for candidates within the UK and Republic of Ireland.
During the COVID-19 pandemic, there is limited availability of spaces for the PACES exam, and whilst every effort will be made to provide as many places as possible, if the number of applications for the exam exceeds the places available, candidates in UK training will be prioritised.
Preparation and Resources
With lots of resources available online, we have discussed with IMGs the best place to start looking for materials relating to the exams. Most IMGs recommended starting with the Royal College, who have created useful resources to help you to prepare for the exams. These include:
Curriculum: Applicants are tested on a range of common and important disorders in General Medicine as set out in the Joint Royal Colleges’ Specialty Training Curriculum for Core Medical Training. We recommend getting to know the curriculum as early as possible and using it as a roadmap for your study.
Sample questions for Part 1 & Part 2: It is a good idea to regularly benchmark your knowledge by testing yourself using example questions from the current exam syllabus provided by the Royal College see below:
Part 1
Part 2
PACES scenarios: To familiarise yourself with the format of the PACES exam, take a look at sample scenarios from the stations. You can find these here.
IMG Oncologists
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.
For an overview of how to prepare for exams, including advice on study groups, online community support, the best use of online resources & Royal College materials and courses, take a look at our blog: IMG Connects Top Tips for exam preparation.
For more information on the MRCP exams including structure, preparation, dates and a content drill down, see the blogs we’ve written on each part of the examination suite:
MRCP (UK) Part 1
MRCP (UK) Part 2
MRCP (UK) PACES
I’ve passed, what’s next?
First of all, congratulations! This is a massive achievement and you deserve to put your feet up after all that hard work. With full MRCP, you can now apply for a full GMC registration with a license to practice (once you’ve passed an English language exam). Once the GMC has approved your application, you can work as a doctor in the UK. Nice one!
Get in touch
Don’t hesitate to contact an IMG oncology recruitment specialist to discuss GMC registration, oncology positions in the NHS, including typical NHS salaries, the most suitable UK locations and hospitals for you, and relocation.
For regular news and updates on the Royal College and all things oncology, follow IMG Connect on social media using the links below:
Are you an overseas oncologist looking to move to the UK? Have you always wanted to hear first-hand the experiences of an international oncologist who has been through the process, from completing their FRCR (Oncology) exams, to GMC registration, securing an NHS job and relocating to the UK?
As part of IMG Stories, we introduce to you, Dr Eric Lee, a wonderful clinical oncologist who relocated to the UK from Hong Kong. Eric has been living and working in the UK with his family after gaining full GMC registration with license to practice.
Today, Eric will be sharing with you his journey and experiences as an IMG oncologist, now working in Colchester in the southeast of England.
Introducing Eric Lee
My name is Eric and I'm a clinical oncologist. I have worked as an oncologist in Hong Kong for 25 years, where I received training in both medical and clinical oncology, in line with the UK system.
Overall, I think the UK system has been so well suited to myself and other generations of doctors and learners, and this was one of my motivations for bringing my family to the UK. Also, for my daughter's education.
Training as a clinical oncologist in Hong Kong
I completed my MBChB and then the FRCR (Oncology) examinations. These were held in Hong Kong with the examiners coming from the UK for assessment. As standard, HK trainees begin FRCR (Oncology) right after becoming medical graduates. Alongside the Royal College exams, you also complete the FHKAM, which is the Hong Kong Academy of Medicine and are the standard qualifications for doctors to complete during their training in Hong Kong.
I began the FRCR (Oncology) training one year after my graduation from medical school. This was in 1996. I spent a total of five years in FRCR (Oncology) training in Hong Kong and received my official FRCR (Oncology) qualification in 2001.
One of the main differences between the UK and Hong Kong systems is that where FRCR (Oncology) tells the medical council that you are almost at the level to work as a consultant. The medical council in Hong Kong has further requirements for doctors transitioning to consultant grade. So, after receiving FRCR (Oncology), I still had to go through 2 to 3 more years of training.
In regards to the Royal College exams, if there's one thing to mention, it's that the examiners are always looking for safe doctors who make patients' safety and comfort their top priority, therefore, my advice for overseas doctors who are looking towards Royal College examinations, especially in oncology, is to remain conscientious and diligent in every aspect of their clinical care, particularly in protecting patients' privacy, rights and safety.
My career as a clinical oncologist
Over the past twenty-five years, I've had rotations in different oncology sub-specialties, including paediatrics, CNS, GI, GU, breast cancer, haematologic malignancies and forensic malignancy. In the last 15 years however, I've been specialising in forensic and genitourinary cancers.
In 2005/ 2006, I had the opportunity to go to Australia for one year for a fellowship. So, I spent almost a year gaining experience in prostate cancer under the supervision of British oncologists in Sydney.
Over the past few years, I've had many thoughts about moving abroad from Hong Kong and looked at several options, including the UK. Finally, it was a Trust in the UK that offered me a job.
This ended up being a very good choice for me, because the UK system is quite similar to medical system in Hong Kong. As an oncologist, I can administer both radiation therapy and chemotherapy, whereas in Australia for example, I'd only be able to practice radiation oncology. So, in the UK, I'm able to use my full training to practice in both medical and radiation oncology.
Going through English language testing
There were several things to consider before I was able to move.
First of all, I had to pass an English language exam. I initially attempted the IELTS exam, but in the end decided to change to the OET exam, because the OET focuses on medical situations, so you don't need to spend too much time going through subjects in other areas.
I managed to achieve a B grade in all 4 sections of the OET exam, which was not easy as my weakest areas are still speaking and writing, and there is of course speaking in the OET exam. You spend 20 minutes speaking in a seminar, similarly to an OSCE. In my exam, I had to take the patient history and give them advice in English.
When the context of the exam is relevant to your specialty e.g. a breast cancer patient, then it’s much easier. However, in the OET exam, the context is not limited to your specialty alone. My tasks for example included two patients with diabetes mellitus and polymyalgia rheumatica. I've not had experience of psychiatry or endocrinology or orthopaedics for many years, but I had to use this knowledge in the exam and act like an orthopaedic surgeon.
Many who take the OET fall into the mindset of a clinical examination and become nervous when presented with a clinical scenario they don’t identify with. My advice to anyone sitting the OET exam is to forget about all the medical things. Forget all your clinical problems. Just relax. Don't worry if your answers aren't 100% correct. What you're expected to do is speak clearly and have an overall caring manner.
The GMC registration process
During the GMC process, I was asked to submit evidence of my continued medical training over the past 10 years because it has been quite a few years since I received my FRCR (Oncology). The GMC wanted to know more about my further medical education over the past 10 years, so I had to submit evidence of all my CME training.
Personally, I'm incredibly fortunate that I've been in the habit of keeping all my certificates of attendance whenever I attend any workshops, conferences or courses, so I have a good record of all my certificates. I spent around a week scanning in all my certificates of attendance from 2002 to 2021, all into one big PDF file.
This advice was given to me by one of my favourite mentors 20 years ago, Dr F.L. Chan, a renowned radiologist in Hong Kong and the warden of the college in Hong Kong. He passed away 10 years ago, sadly, but he gave me some of the most important advice I've been given. He said, 'Eric, you have to keep every one of your certificates, even if you don't see the benefit of the course or workshop, you will find them useful one day'. Since then, I've held onto that advice, and over the last 20 years, I've kept every last certificate in a hard copy!
Finding a job in the UK
I actually posted my CV on LinkedIn and was then contacted by Marcus from IMG Connect. Initially, I wasn't sure if his offer was real as it sounded too good to be true! But I quickly realised that IMG Connect is incredible and could support me with every stage necessary. I personally had a lot of apprehension about the process of moving overseas. I'd been working in a secure job for 25 years, so for me to move from that into the unknown - I would need a lot of support, a lot of counselling. IMG Connect & Marcus were there to provide me with all the support I needed, from day one.
I received job offers from three different Trusts, each with interview processes that began with a stage of informal question, before two rounds of formal interviews online in Microsoft Teams.
Ultimately, the offer from Colchester was the best fit for me. It is the closest to my previous set-up, because I had been working in a General Hospital in Hong Kong and Colchester has the same kind of general hospital set up. This position also allows me to work in my subspecialties of interest - GU and forensic cancers.
My journey to the UK
The timings worked out well for me when it came to the move. We spent some time considering whether to apply for the Tier 2 or BNO visa. The Tier 2 visa requires additional documentation like police checks, but before we had to decide, we received the BNO visa in a matter of days and the decision was made for us. Luckily, because of this, things were much easier - with the BNO visa, my whole family - that is my wife and daughter - could come to the UK as a unit.
The pandemic was really an issue because there was a lot of uncertainty about things like flights, and new variants. After we landed here, all the flights from Hong Kong to the UK were cancelled, so we wouldn't have been able to travel until 2022 if we hadn't left at the time we did.
Since I still have many family members in Hong Kong, I was able to leave behind a lot of my property and belongings with them, and only brought my most important belongings with me. This meant that it didn't take too much time for me to pack all my things together to move, but I still had to do things like sell my car.
What I wish I’d known before I moved to the UK
I wish I’d known more about driving in the UK! There are rules here that I'm not used to, like driving in bus lanes. If I'd known about these things earlier, it may have been easier for me.
My experience working with IMG Connect
First, I must mention Marcus Anderson and IMG Connect - they were very helpful and did such a great job. Everything they do is perfectly timed. I couldn’t improve anything!
Over the past half a year, Marcus was in constant contact with me over WhatsApp and email, and whenever I had a question, I'd WhatsApp or email him, and he’d always get back to me with the answers I needed.
What’s next for me and my family?
I still see myself as someone who is learning, so I'd like to continue with my career development in GU, GI and forensic cancers. I may also try to continue some of my medical studies, for example in palliative medicine, because I know the training for this is very good in Cardiff, where there is a distance learning programme. I'm also looking forward to joining the specialist register for oncology.
My daughter is now enrolled in a private school in Colchester, where the teachers and students are very lovely, so I hope she'll adapt to the system and be able to enter the grammar school here too.
For my wife, she first wants to be able to drive in the UK. She has a driving license, but she's still quite hesitant, so that's a priority for her.
A message to my colleagues in Hong Kong
I have a heartfelt message to my colleagues in Hong Kong, if they are interested in moving to the UK. First of all, there's a lot of negative news in Hong Kong, saying that a lot of good doctors are Hong Kong, leaving those living there unattended. My message to HK doctors is that things aren’t necessarily that bad in HK, but they can be better in the UK.
Moving to live and work in the UK is a big decision to make but can be massively rewarding in many ways. International doctors have the chance to find a new home and the NHS presents an incredible opportunity for IMGs to secure rewarding jobs, progress within their fields and explore adjacent opportunities such as CESR, writing publications, teaching opportunities and research.
Whatever route an overseas doctor may take on their journey to the UK, IMG Connect is here to support them through every step and welcome them to the IMG family.
Join the IMG Oncologists Facebook group for access to a community of like-minded FRCR (Oncology) aspirants and dedicated oncology recruiters.
In this group you will find tailored resources for oncology IMGs, including access to our FRCR (Oncology) crash courses, completely free to all doctors.
You can access our IMG Oncologists community here.
For regular news and updates on the Royal College and all things oncology, follow IMG Connect on social media using the links below:
GMC Registration can be a long and complex process, and with a few routes for medical oncologists to provide evidence of their skills and knowledge, it can be difficult for IMGs to decide the best route to take to register with the GMC.
For international doctors considering their route to the UK, there are two main pathways to consider: PLAB or the postgraduate route - in this case, MRCP (UK).
Whilst these are the most common routes to GMC registration, this is not an exhaustive list. There are other options such as Royal College sponsorship and GMC-approved qualifications or licensing exams, and you can read more about these here.
Here we provide a summary of the two main pathways and briefly consider their benefits, summarised in the headings below:
PLAB for GMC Registration
MRCP (UK) for GMC Registration
Which is better for me as an overseas pathologist, PLAB or MRCP (UK)?
#IMG Tips
How do I get started?
Professional & Linguistics Assessment Board (PLAB)
The most common route which tends to be popular among junior doctors is PLAB.
PLAB is a two-part exam with one written and one practical element, that assesses whether candidates are at least as capable as doctors starting the second year of their Foundation Programme Training, and can therefore work safely as an SHO in the NHS.
The GMC has a useful video summary of the PLAB exams which you can watch here, or for a more detailed overview, see our IMG Resources library.
MRCP (UK) - Postgraduate Qualification for Internal Medicine
The internal medicine postgraduate qualification is a more popular route for senior overseas doctors, and those looking to gain posts in the NHS which are reflective of their experience. Within medical oncology, this can be done by attaining Membership of the Royal College of Physicians. The Royal College of Physicians is the professional body that regulates internal medicine within the UK, including the specialty of medical oncology.
Membership of the Royal College of Physicians (MRCP) is the full qualification attained through the postgraduate exams for physicians. The exams assess a candidate’s knowledge of basic medical sciences, as well as clinical skills required for the diagnosis and management of disease. MRCP (UK) has three components, with two written and one practical element.
For complete guides on MRCP (UK), take a look at our IMG Resources library.
It is important to note that the MRCP (UK) exams are for medical oncologist, and you would not need to sit the FRCR (Oncology) exams, as these apply to clinical or radiation oncologists only.
PLAB vs MRCP (UK)
Both PLAB and MRCP (UK) are legitimate routes that demonstrate skills and knowledge and will allow you to register with the GMC and work in the UK. To decide which route is best for you, you’ll need to consider the benefits of each and how they align with your needs and priorities in moving to the UK.
Seniority of Positions in the NHS
It may be difficult for an overseas medical oncologist to obtain a more senior post without MRCP (UK), GMC-approved training, or extensive experience from a similar, English-speaking healthcare system. PLAB alone will not give overseas doctors access to senior posts in the NHS.
Time
PLAB has two stages and can take anywhere between 3-9 months to prepare from start to finish.
MRCP has three stages, and the Royal College strongly advises that candidates only sit the final exam after 24 months of practical experience.
These exams can take anywhere from 24-36 months to prepare from start to finish.
Cost
MRCP costs just under £2,500 for the three exams. The final exam, PACES, is an in-person exam, so travel to the UK must be factored into the overall cost.
PLAB costs £1,189, and PLAB 1 can be taken in the UK or several overseas centres, which you can find here. PLAB 2 must be taken in the UK.
For both MRCP (UK) PACES and PLAB 2, candidates will have to travel to the UK, meaning that the additional cost of visas, accommodation and flights must be factored in.
It’s important to note that the total cost of each exam can rise if re-sits are necessary.
Summary
PLAB, as an exam which examines a doctor’s ability to work safely as a Senior House Officer (SHO), does not assess ability in oncology or internal medicine specifically. For this reason, PLAB tends to be a route for junior doctors who have not already chosen their field of specialisation in medicine, I.e., medical oncology.
PLAB allows doctors to enter the UK system much faster than other routes and for this reason alone, it is favoured by international doctors when considering their path to the UK.
MRCP (UK) involves three more difficult examinations and takes more time to prepare for. However, for overseas doctors, attaining MRCP (UK) will allow you to jumpstart your career in the UK, as you don't need PLAB or Core Training.
The Royal College of Physicians’ exams will facilitate the application for more senior roles in medical oncology in the UK than PLAB.
#IMG Tips
Determine your priorities – your goals and timeline for relocating to the UK are important in deciding which route is best for, and this is different for everyone.
Plan well ahead – depending on the route you choose, you may be embarking on a long journey through these exams, so plan how you will fit them into your life and how best to prepare to maintain a good work-life balance at the same time.
Find a support network – once you know which exams you will sit, find a support network of others who are also preparing for the exam.
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.
Getting started
Once you’ve decided which exams are best for you, it’s time to delve deeper into the exams and what they entail. For more useful blogs and articles on PLAB, MRCP (UK), GMC registration and finding your dream job in the NHS - take a look at our IMG Resources library.
If you have any further questions on PLAB, MRCP (UK) or your route to the UK as an overseas oncologist, don't hesitate to get in touch with our oncology specialists here. We’d be more than happy to help you.
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:
The NHS offers an extensive training scheme and career development for medical oncologists, and the quality of this programme is recognised as a gold standard across the medical community.
The training provided to UK medical oncology trainees is regularly reviewed and updated, in keeping with advances and progression in the landscape of oncology around the world and throughout the profession.
In this article, we will explore the training pathway for medical oncologists in the UK, covering the following topics:
What is the NHS Training Pathway?
How do you enter the training pathway?
What does the specialty training programme look like for medical oncology?
What happens after completing the medical oncology training programme?
Can I enter specialty training in the UK as an IMG?
Skip ahead to the relevant section if you know what you’re looking for.
The NHS Medical Oncology Training Pathway
The NHS training pathway is the name given to the complete programme undertaken by UK trainees, from medical school to the completion of specialist training within i.e. within medical oncology.
It is important for IMGs to understand this as it helps to provide an understanding of at what stage they can most likely enter the system if they are interested in postgraduate training in the UK.
Entering the NHS Training Pathway
After graduating from medical school, doctors with receive provisional registration from the GMC which allows them to enter the Foundation programme (a two-year work-based training programme).
Upon completion of the first year (FY1), doctors will gain full registration with the GMC and will be able to apply for further study and training in a specialised area I.e. medicine – this is known as Internal Medicine Training (IMT), formerly known as Core Training (CT).
Specialty Training in Medical Oncology
The Specialty Training programme in Medical Oncology runs over a 6-year period, and doctors will usually take the indicated time, or slightly longer to complete the Specialty Training programme.
Successful applicants entering into year one of specialty training (ST1), will follow the Joint Royal Colleges of Physicians Training Board 2021 Medical Oncology Curriculum, which sets the expected syllabus as well as required assessments and workload case numbers.
Medical oncology training as an uncoupled programme
As medical oncology is a medicine specialty, aspiring oncology trainees will complete a period of core/ internal medicine training that lasts a period of two years.
This is followed by an open competition to enter a higher specialty training post. It is important to note that the application following core training is competitive and does not guarantee a specialty training post.
Medical oncology higher specialty training will be in total (including OCS) an indicative four-year clinical training programme leading to single accreditation in the specialty. There are no critical progression points during higher specialty medical oncology training, though trainees will be subject to an annual review of progress via the ARCP process and will have to complete all curriculum requirements including passing the medical oncology Specialty Certificate Examination (SCE) prior to obtaining CCT.
Foundation Training (FY1 – FY2)
The foundation programme usually involves six different rotations or placements in medical or surgical specialties. These rotations enable trainees to practise and gain competence in basic clinical skills and forms the bridge between medical school and speciality training.
Selection
Here, trainees will either choose to enter into either Internal Medicine Training or into training to become a general practitioner.
Specialty Training (ST1 – ST6+)
Internal Medicine Stage 1 Training (ST1 – ST2)
In this first stage of the Internal Medicine training programme, trainees develop a solid foundation of professional and generic clinical capabilities, preparing them for participation in acute medicine at a senior level and to manage patients with acute and chronic medical problems in outpatient and inpatient settings. You can find the Curriculum for Internal Medicine Stage 1 Training here.
This will culminate in trainees sitting the MRCP (UK) exams. For more information on the Royal College of Physicians examination suite, take a look at our IMG Resources library here.
Please note, trainees must pass the MRCP examinations prior to beginning Specialty Training in Medical Oncology.
Selection
Here, trainees will either choose to continue with Internal Medicine Training for a further year, to continue with training in a specialty that supports acute hospital care, or to provide primarily out-patient based services in e.g. oncology.
Medical oncology recruitment into ST4 posts usually occurs after 2 years of Internal Medicine Stage 1 training. However, trainees who complete the full three-year IMT programme are also eligible and there is no preferential selection for trainees who have completed either two or three years of training.
Oncology Common Stem (ST3)
The Oncology Common Stem (OCS) has a duration of one year and usually takes place in year 3 of specialty training. Here, the focus is on a trainee’s development of the common oncology capabilities relating to the key areas of overlap between the two specialties (medical and clinical oncology), as well as continuing to develop the generic capabilities expected of all doctors.
Clinical Oncology and Medical Oncology are the two main medical specialities that manage patients with non-haematological malignancy. They often work in partnership with each other, and both offer systemic therapy to patients, but only clinical oncologists administer radiotherapy and there are other differences in work-pattern, approach and focus.
Medical oncologists will have the scientific understanding which underpins radiation-based cancer treatments. During the OCS training year, trainees will gain knowledge of radiotherapy planning and delivery. This will enable them to coordinate the care of cancer patients with the wider multidisciplinary team (MDT), managing patients throughout a treatment pathway.
The curricula for medical and clinical oncology have been aligned to reflect this relationship and include aspects of common training that constitute the Oncology Common Stem (OCS), improving transferability and flexibility for trainees who wish to move between the two specialties.
Please note that medical oncology trainees will not be expected to independently plan or deliver radiation-based cancer treatments.
Medical Oncology Specialty Training & Maintenance of Common Capabilities (ST4 – ST6)
Following successful completion of OCS, medical oncology trainees will complete a subsequent higher specialty-specific programme, this takes place from year 4 – 6. The focus here for trainees is on acquiring medical oncology-specific capabilities, alongside consolidation and further development of the common oncology and generic capabilities.
Trainees will then sit the Medical Oncology Specialty Certificate Examination, usually in the penultimate year of higher specialty training. The globally-recognised exam offers medical oncologists a postgraduate qualification which demonstrates achievement of a standard required of UK specialist trainees.
Please note, the medical oncology SCE is a compulsory component of assessment for the achievement of Certificate of Completion of Training (CCT).
To learn more about the medical oncology SCE, read our detailed blog here.
Completion of the Medical Oncology Specialty Training Programme
Upon completion of the medical oncology training programme, the choice is made whether the trainee will be awarded a Certificate of Completion of Training (CCT) in Medical Oncology. This will be based on high-level learning outcomes – capabilities in practice (CiPs) set out in the curriculum by the Royal College. You can find the 2021 curriculum here.
At this point, medical oncologists are recommended to the GMC for the award of CCT and entry onto the specialist register and can now take permanent consultant posts in the NHS.
Specialist Registration for overseas doctors
Doctors who completed part or all of their medical oncology training outside the UK are eligible for specialist registration through the CESR or CESR-CP pathways. To learn more about specialist registration for overseas doctors, read our blog here.
Joining the Medical Oncology Specialty Training Programme as an IMG
It is possible for overseas doctors to join the Specialty Training programme in Medical Oncology in the UK, however it is very competitive.
IMGs interested in UK specialty training must have:
Full GMC registration
Completion of a minimum 12-month (FY1 equivalent) internship
English language test
PLAB
AND
12 months post-internship experience by the time you begin ST1
Please note, whilst UK trainees are not given priority for specialty training spaces, it can be extremely difficult to join the Specialty Training programme without prior NHS experience.
So here you have it, the NHS Specialty Training pathway for medical oncology trainees in a nutshell. The training programme forms the basis of medical oncology training in the UK, and for overseas oncologists interested in joining the training programme, good knowledge of the pathway allows you to better understand the alignment of your overseas training with the relevant stage of Specialty Training for medical oncology in the UK.
Join the IMG Oncologists Facebook group for access to a community of like-minded oncologists 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.
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: