Certificate of Eligibility for Specialist Registration (CESR)

CESR Training Sessions

The RCPCH holds online briefing and training sessions for prospective CESR applicants two to three times a year. Sessions run over the course of a morning and are presented jointly with the GMC. The next session is expected to be held in October 2023.

Who can apply for a CESR?

Paediatrics

If you have training, qualifications and experience in paediatrics but have gained these partly or completely outside of an approved CCT training programme (for example, you have trained outside the UK or EEA, moved abroad or taken a career break), you may apply for a CESR in a CCT specialty, listing your specialty as paediatrics.

You will need to demonstrate all specialty learning outcomes specified in the CCT curriculum, including clinical capabilities in acute general paediatrics, neonatal medicine, community child health and safeguarding children.

Paediatric sub-specialties 

Specialist Registration in a sub-specialty is only possible if you have undertaken training outside the UK towards a qualification in a sub-specialty of paediatrics, through CESR in a non-CCT specialty. You would be listed on the Specialist Register in your chosen sub-specialty only, as your sub-specialty training is not equivalent to a full CCT programme.

You will need to demonstrate capabilities consistent with practice as a consultant in the NHS.

Please consult the list of GMC-approved sub-specialties in paediatrics to see which may be certified by this route.

Researchers and academics

If you have not followed conventional specialist training and work outside of clinical practice, but have focused on a specific area of research and made a significant contribution to your academic field, you may apply for a CESR in academic and research medicine.

You will need to demonstrate your contribution to your academic field and that you have achieved the knowledge and skill consistent with that of a consultant in the NHS.

Before you apply

All intending CESR applicants are advised first to contact both the RCPCH Certification team and the GMC to discuss the most appropriate route for certification.

Applicants will need to consult the following pages below:

• specialty specific guidance on evidence to be submitted with your application. Use the document listed under ‘Royal College of Paediatrics and Child Health’. This applies particularly to applicants for the CESR in a CCT specialty, but non-CCT CESR applicants should also consult it for examples of evidence
• approved curricula in paediatrics and sub-specialties show the full range of specialist learning outcomes expected of a doctor attaining either a CCT in paediatrics or a paediatric sub-specialty, and thus for a successful CESR applicant

How to apply

Apply online on the GMC website. You will need to supplement your application with supporting evidence and structured reports from four nominated referees.

The application process includes a guide - please read this carefully. CESR applications are often unsuccessful because applicants do not submit sufficient, recent evidence (ie within the past five years) to cover the full breadth of the CCT curriculum or relevant sub-specialty.

Evidence overview

For different routes:

• CESR in a CCT specialty - Ensure you can provide primary evidence of your specialist learning outcomes in your training and experience in acute general and community paediatrics, neonatal medicine and safeguarding children. If you have not covered a specific area of the curriculum, it is advisable to postpone an application until you have been able to gain this experience.
• CESR in a non-CCT specialty - Submit primary evidence that particularly addresses the specialist learning outcomes expected within your sub-specialty syllabus. Such applications may not require evidence to the same standard for all other capabilities outside of their sub-specialty. Nevertheless, you should address all learning outcomes required in the application, to the standard defined in the syllabus of your chosen sub-specialty.
• CESR in academic and research medicine - Submit primary evidence that particularly addresses the capabilities expected within your area of research. Nevertheless, you should address all capabilities required in the application, to a standard appropriate to their research. Applicants to this CESR are expected to submit evidence of additional experience related to research and academia.

All applicants are expected to submit the following evidence:

• Resuscitation - Current, valid APLS certification or equivalent evidence of advanced paediatric and neonatal life support skills. (Academic applicants may not require this level of certification.)
• Child protection - Up-to-date, level three child protection training within the last three to five years, with primary evidence of experience, eg child protection reports, witness statements, case-based discussions. (Non-CCT and academic applicants may not require evidence of practical experience.)
• Clinical governance - Audit reports written by the applicant, and other evidence of service improvement, risk management projects or other clinical governance activity.
• Teaching and supervision - Teaching presentations, with feedback from attendees. Evidence of attendance at a ‘training the trainers’ course and/or the training or supervision of more junior colleagues. Assessments or feedback for students or colleagues, such as workplace-based assessments, multisource feedback, reference letters or other constructive advice.
• Management - Examples of rota management, meeting or event management, budget management, leading ward rounds, leading audits and service improvement projects, leading on educational or research related activities.
• Structured reports - The College strongly recommends that all your nominated referees for the structured reports should be fully conversant with the current curriculum and able to provide detailed support for your capabilities across all or most areas.

Application outcomes

All CESR applications are decided on by the GMC, based upon recommendations by the College. Once the College receives an application from the GMC for evaluation, it can take two to three months for the GMC to determine the final outcome.

Unsuccessful applicants

Should your application be unsuccessful, you have 12 months to submit a review application. The College’s evaluation will specify what further evidence would be required for a successful review. Reviews are evaluated only on the points not previously approved.

If there is insufficient evidence of recent clinical experience, the College will typically recommend the applicant take a six month placement in a given field, such as community paediatrics or neonatal medicine, before submitting a review. Applications are evaluated on evidence of learning outcomes, so this period of time is indicative only as sufficient time to obtain enough new evidence. In some circumstances, usually involving acute paediatrics, a 12-month placement may be recommended. It is not the College’s responsibility to provide additional training for CESR applicants.

Myth busting

There is no need for any specific time in any specific specialty area.

There are many myths around the CESR process and what is needed for CESR. One of the most prevalent myths is about time in a post. To help clarify, there is no need for any specific time in any specific specialty area (eg Neonates or Community) - and there hasn't been since 2007. Time-based and competency-based curricula that preceded the RCPCH Progress curriculum, launched in 2018, asked for time or competencies in those areas. While competency-based curricula were intended to be time free, rotations were usually six months whole time training, so it became normal for trainees to complete six months neonates and six months in community during level 2 training. This normality emerged into a fixed expectation and seemed set in stone. The RCPCH Progress curriculum (and Progress+ from Aug 2023) against which CESR applications in paediatrics are evaluated requires no such time or placement, it only requires that curriculum learning outcomes are demonstrated.

FAQs

These questions have been collected by the Soft Landings team based on their interactions with international doctors enquiring about the UK CESR process in paediatrics.

What are the minimum number of work based assessments, eg CBDs and Mini-CEXs that are considered sufficient for a CESR application?

There is no minimum number for workplace-based assessments. The intention is to demonstrate quality over quantity, which is the guidance to doctors in training. Our assessment table is purely an indicative absolute minimum for meeting grade level requirements in training and you can see our guidance on how to use assessments to best effect. Any assessments or development logs used in CESR evidence need to match level 3 training (to be renamed specialty level with Progress+ as of summer 2023). 

Extensive guidance is available in our Specialty Specific Guidance (opens in new window) hosted by the General Medical Council (GMC).

How much evidence is required as a minimum for each domain?

As with the above, there is no minimum. One hundred and fifty poor, unclear pieces of evidence is worse than 20 clear, well structured and reflective pieces of evidence. It is not a tick box exercise. Our guidance (SSG) shows the indicative spread of evidence across the domains based on the submissions so far, but this is not a template for guaranteeing success.

What is the best way to collect evidence like reflections and work-based assessments without an ePortfolio?

If working in the UK, all doctors must meet the requirements of revalidation. This means employers will offer ways of recording continuous professional development (CPD) activity, which can be used to demonstrate reflections and clinical activity through a CPD diary or similar. The RCPCH does also offer a CPD Diary inclusive with membership or payable without membership. If working outside the UK, we recommend using guidance documents and resources available on the RCPCH and GMC websites to structure and order your evidence.

Is there a minimum number of years of NHS experience needed before CESR application or is the assessment of equivalence just based on evidence of competencies?

There is no minimum tenure of NHS working experience needed. As long as you meet the GMC's eligibility for applying to CESR, your work experience is only relevant for demonstrating your capabilities. The CESR application is judgement based on your evidence and how you meet the RCPCH curriculum requirements or standard of a day-one consultant. Evidence from within the 5 years closest to application will be given precedence when evaluated, as indicated in the specialty specific guidance. This doesn't discount older evidence but indicates that some topping up or revisiting in these areas would be necessary, especially if it is much older than 5 years.

Is neonatal level 3 required or is DGH level 2 adequate?

There are no experiential-based requirements to meet the CESR application level. The focus is on how your experience (from wherever it comes) meets the standard of the curriculum or the standard of a day-one consultant.

If applying for a neonatal CESR [application would be CESR in a non-CCT specialty], is DGH level 3 experience adequate or do you need tertiary experience? Similarly, is neonatal experience adequate for a neonatal CESR or do you need a certificate in neonatology training?

You do not need a certificate in neonatal training. While tertiary experience would be supportive, it is not mandatory. It is only because tertiary neonates experience might give you the strongest opportunities to demonstrate the required standards for CESR.

For community experience, do you need a community placement or are child protection courses sufficient? How do you show evidence of community competencies without having a community placement/ rotation?

For the purposes of the curriculum, there are no specific community competencies. The curriculum is based on learning outcomes within which there are key capabilities. The SSG outlines the indicative evidence along with the key capabilities. If applying for a CESR in non-CCT in Community Child Health, it would be difficult to demonstrate the depth of standards for a day-one consultant without having had experience in community placements - however, this is still not mandatory, and it is the required standard that needs to be demonstrated rather than where you have worked.

Do you have to be working full time before submitting your application?

No. That would contravene many aspects of the GMC and RCPCH commitment to Equality, Diversity and Inclusion to insist on this. It will not be a consideration in any CESR evaluation.

With the new training modules starting, will the CESR tick boxes change?

The curriculum is the "tick box". Applicants have to meet the curriculum requirements in full or standards of a day-one consultant.

Can you give any guidance on how to group evidence? (previous examples of candidates being asked for 150 entries)

Evidence grouping is usually up to the individual though we do have guidance of how that might work on our curriculum web pages. The curriculum has 11 domains and for those applying for CESR in a CCT specialty (Paediatrics), the higher level general paediatrics outcomes need evidencing too (and are included in our SSG). A process that has worked for some applicants is to group items first by topic, eg, assessments, appraisals, CPD activity, reflections, referral letters, audits, etc. and then align them to the curriculum domains. When submitting the evidence, the same piece of evidence can cross reference other domains (ideally not more than two or three). For example, a verified account of stepping in to assist a doctor in training undertaking a procedure could contribute to leadership, patient management or teaching domains.

Contact

Prospective CESR applicants are advised to contact the Training Services team (in Training & Quality) at RCPCH to discuss the most appropriate route to obtaining certification, at equivalence@rcpch.ac.uk or on 020 7092 6000.