Core Education – Doctors:
Certificate of Eligibility for Specialist Registration
By Dr Jon Spiro
While specialty training, with the aim of obtaining a Certificate of Completion of Training (CCT), is the primary route to become a recognised medical specialist in any specialty, an alternative route to achieving this has existed for over fifteen years. It involves obtaining a Certificate of Eligibility for Specialist Registration (CESR). This route is different from the CCT route, notably that there is no need to complete it in four years (if working full time), nor to have to work in GMC-approved training posts.
Those who wish to pursue this route still need to find work in Occupational Medicine (OM), ideally where they will be supported, mentored and supervised by more senior doctors. The essential requirement is to gather evidence which shows that they, like their trainee counterparts, have achieved the knowledge, experience, capabilities and learning outcomes of the Faculty of Occupational Medicine’s (FOM) specialty training curriculum. This includes passing FOM exams and undertaking research or research-related work. In addition, CESR applicants are required to nominate at least four referees, who supply structured reports on them. The resulting portfolio of accumulated evidence is then submitted to the General Medical Council (GMC) who, in turn, pass it to FOM for evaluation to see if the applicant has met the criteria. (Should they not have done so, they are advised as to exactly what evidence they need to supply, in addition to that already provided, to succeed at a second attempt ).
The CESR route in OM has gained in popularity in recent years. The flexibility to choose your own work and workplaces, although these still need to offer the necessary experience and opportunity to be mentored or supervised, and the lack of restrictions on time make it more attractive to some. Many CESR candidates in the past took the step of making an application after a number of years working in OM, often more than ten. However, a number are now beginning this journey as soon as they enter the specialty, thus aiming for specialist registration at the same stage in their careers as CCT trainees.
There are certain requirements to pursue the CESR route in OM. As with trainees, those interested still need to have suitable experience in medicine prior to working in OM. This is generally at least two years following their foundation years in any of a variety of recognised specialties, with evidence of having gained competencies. There are also more overarching needs to be able to commit to what can be a long and challenging (and sometimes lonely) road and to be organised in gaining and storing the necessary evidence. Before making an actual CESR application, it is essential to have at least one more senior doctor to review this evidence to ensure it meets the standards of quantity and quality. Taking time and not rushing are crucial. Guidance is available on both FOM and GMC websites to inform all those involved about the necessary details of what is required. Potential applicants are encouraged to engage with FOM for support, and to attend one of the FOM’s annual CESR Coaching Days. The Society of Occupational Medicine (SOM) also runs support networks and services for those interested in the CESR route, such as maintaining a voluntary register and running periodic Zoom meetings
In the end, the question is do you want to become a GMC-registered specialist (Consultant), with the added benefit of being able to become a Member of the FOM (MFOM), and if you do, the next step is to decide what the pros and cons of either route are for you.
Dr Jon Spiro trained in Occupational Medicine within the nuclear industry. He is now an Independent Specialist in Occupational Medicine. He has been involved in training of specialists in Occupational Medicine and is the Faculty of Occupational Medicine (FOM)’s Regional Specialty Advisor for the Oxford/Thames Valley region and Training Programme Director for Occupational Medicine for the Thames Valley and Wessex Local Education and Training Boards. He is also the FOM Lead for CESR applications and Deputy Director of training. He is a Fellow of the Faculty and of the Royal College of Physicians of London.