Chapter 9 – The portfolio pathway to Specialist registration
By: Dr John Shubhaker
Please be aware that new processes for the portfolio pathway to Specialist registration (formerly Certificate of Eligibility for Specialist Registration (CESR)) entry will be announced by the General Medical Council (GMC) in November 2023. Please see Changes to how doctors demonstrate the standard required for specialist and GP registration – GMC (gmc-uk.org) and similar part of the GMC website for updates on the changes. This chapter will be reviewed and updated as necessary after November 2023.
To become a substantive consultant in the UK, one needs to be on the GMC Specialist Register. Some SAS doctors may wish to submit an application for specialist registration using the portfolio pathway, to be introduced in November 2023. This process replaces the former CESR process, and completion will ultimately allow successful applicants to apply for substantive consultant posts. The benefits of achieving the traditional career end point of consultant appointment, such as earning a higher salary and potentially having greater access to private practice, may appeal.
The portfolio pathway route to specialist registration is open to applicants who have not completed a GMC approved training programme. Those who apply for specialist registration under the portfolio pathway route must demonstrate their equivalence to a newly trained Certificate of Completion of Training (CCT) holder by providing the GMC with evidence of the requisite standard of knowledge, skills and experience. The evidence must aligned to the Royal College of Anaesthetists (RCoA) CCT curriculum 2021, but will no longer have to be mapped against it in detail. The application must be made and evidence provided to the GMC, whilst the RCoA acts as the assessing body.
Many SAS doctors will have undertaken some training before moving into a substantive post and the experience and evidence gained from any formal training may be submitted for consideration, along with any evidence acquired while in a SAS, locally-employed or locum consultant post; however, all evidence submitted must fulfil the requirements as set out in the GMC Specialty Specific Guidance.
If some of your evidence of training, knowledge and skills is many years old, you may be required to undertake further training or assessments to demonstrate ongoing competence. If you have no evidence to provide in a specific domain or against a mandatory training requirement, your application will fail, hence further training or evidence collection to correct any such deficits must be sought.
While gaining your specialist registration through the portfolio pathway will offer you the opportunity to apply for UK consultant roles, your success at being appointed as a consultant will depend on your performance in competition for these posts, and the international recognition of the portfolio pathway route to specialist registration will depend on the specialty and the country in question should you ever consider relocating overseas.
Demonstrating the required standard
Should you decide to pursue the portfolio pathway to Specialist registration the first ports of call should be the following four important documents:
- GMC Anaesthetic Specialty Specific Guidance 2021
- Online GMC CESR Applicant Guide
- GMC Good Medical Practice
- RCoA CCT Curriculum 2021
These are all essential reading prior to embarking on a portfolio pathway application as they provide the template against which you must match your application. If you cannot demonstrate the required standard with the experience/evidence you have currently, discuss the possibility of obtaining the necessary further training with your Clinical Tutor, College Tutor, Regional Adviser, local Training Programme Director or local portfolio pathway programme coordinator. Also speak to colleagues in formal training and other recent successful portfolio pathway applicants to understand how they achieved their competencies. Some of the necessary training may be achievable within your organisation, some may require time at another organisation to gain experience in other subspecialty areas.
The aforementioned documents also provide details on how you should collate and structure the evidence in your application. It is important to present the information in a manner that satisfies the GMC requirements, which are based on the domains set out in the Good Medical Practice document, yet it also needs to appear intuitive to the RCoA who will be matching your application to the CCT curriculum 2021.
As well as presenting evidence of training and experience, the requirements for CESR include a test of knowledge. A list of the various anaesthetic qualifications deemed acceptable in this regard is available via the RCoA.
Gathering the relevant competencies
You will need to compare any existing documentation you have with the corresponding CCT evidence requirements. Providing contemporaneous assessments is extremely useful to the assessors, as is an indication of complexity of workload, levels of supervision, independent work and supervision of others. Structured references are very helpful to assessors.
Should you feel that your current experience/body of evidence in any particular areas will not be sufficient for a successful portfolio pathway application, you will need to acquire further experience in these areas and demonstrate your competence with the corresponding online assessment forms.
These forms are known as Supervised Learning Events (SLEs) and are available on the RCoA Lifelong Learning Platform (LLP). They take a variety of guises known by various acronyms (e.g. Anaesthesia Clinical Evaluation Exercise (A-CEX), Anaesthesia Quality Improvement Project Assessment Tool (A-QIPAT), Anaesthetic List Management Assessment Tool (ALMAT), Case-Based Discussion (CBD), Direct Observation of Procedural Skills (DOPS)) all of which are explained in the RCoA CCT curriculum 2021 document.
After reviewing the curriculum and perusing the RCoA LLP website, you will understand the nature of each of these assessments and know how many of them you will need to gather to be able to demonstrate competence in each area of the syllabus.
Clearly, therefore, you will need to be in a workplace where you can have all these assessments signed off. This may involve you leaving your current Trust and hence possibly your substantive SAS role, and that may be a hard decision. You will need to acquire and demonstrate the necessary competence to an equal standard to a trainee of corresponding seniority and, depending on your prior demonstrable experience and competence, this might take some time to acquire.
When collating evidence, aim to summit an SLE each day that you acquire a new competency or undertake a relevant subspecialty list. You should ensure this becomes a habit. Alert your supervisors of your need to acquire particular SLEs from the outset (i.e., before undertaking jobs, placements, subspecialty blocks or theatre lists) to ensure you are both agreed on achieving this. Check the minimum requirements for SLEs for each module on the LLP and aim to exceed them. Also, if your hospital has them, ask the relevant module supervisors for any specific Holistic Assessment of Learning Outcomes (HALO) requirements the department may have.
Submitting your application
Focus your evidence on documentation that will demonstrate coverage of the GMC Good Medical Practice domains when considered against the requirements of the 2021 CCT in anaesthetics curriculum. More specifically, the GMC wishes to see demonstration of equivalence of the CCT curriculum 2021 for all Stage 3 modules; some of the Stage 2 modules and one special interest area (SIA). Further details regarding the types of evidence required are available in the aforementioned GMC Specialty Specific Guidance for Anaesthetics, 2021.
If you are able to do so, the best way to demonstrate equivalence is to replicate the relevant CCT curriculum 2021 training modules and corresponding paperwork (e.g. logbooks and assessments) that an aspiring trainee would provide. The best format for acquiring and collating such evidence is the RCoA LLP.
The portfolio pathway application process is conducted by the GMC, with the RCoA acting as the assessor for the GMC. Your application must be uploaded onto the GMC website, whereupon it will be reviewed by a GMC adviser. The average amount of evidence expected for a CESR application was 800–1000 pages or 100–150 submitted files, so expect to submit around this volume of evidence for the portfolio pathway process. At this review stage, there may be revisions that need to be made to your application, after which it should hopefully be approved for submission. Your application is then sent onto the RCoA for assessment and they will provide the GMC with their recommendations on your application.
While the process from the GMC submitting the application to the RCoA to you receiving the GMC recommendation should take no longer than 6 months, it is important to additionally factor in the time needed for evidence acquisition, the uploading of your evidence, plus any revisions the GMC deem necessary prior to your application being submitted by the GMC for assessment.
Before embarking on a portfolio pathway application, ensure that you understand what might be involved in your particular situation. Avail yourself to the webinars on portfolio pathway applications run by multiple organisations, including the Association of Anaesthetists’ SAS Committee. Talk to your clinical and education supervisors and anyone you may consider a mentor. Speak to other portfolio pathway candidates past and present, and try to realistically gauge what further training and demonstrations of competency you may need to acquire.
Examine your own motivations and energy for the task at hand. Discuss this decision with colleagues and friends and, importantly, your family. Plan how you will tackle this logistically and do consider your job security and financial circumstances. What is right for you will be the correct decision. Good luck.
Useful sources of information
Association of Anaesthetists SAS Committee [email protected]
Registration and Revalidation Directorate [email protected]
Royal College of Anaesthetists [email protected]