Applications to the GP and Specialist Registers

Transcription

1 Applicatios to the GP ad Specialist Registers 2015

2 Itroductio This is our third aual report, which gives a overview of decisios we made o applicatios for specialist or GP registratio i It covers decisios about: Certificates of Completio of Traiig (CCT) Certificates of Eligibility for Specialist Registratio (CESR) Certificates of Eligibility for GP Registratio (CEGPR) CESR Combied Programme (CESR (CP)) CEGPR Combied Programme (CEGPR (CP)) This report may be particularly useful for potetial applicats for specialist or GP registratio, medical royal colleges ad faculties, ad NHS employers..what this report shows: How a doctor s ame is added to the specialist or GP Register What happeed i 2015 Where applicats have worked prior to their applicatio Where applicats gaied their primary medical qualificatio What we ve leart from previous applicatios Some experieces ad tips from successful CESR applicats A update o our review of the routes to the Specialist ad GP Registers

3 How a doctor s ame is added to the GP or Specialist Register Before a doctor ca have their ame added to the Specialist or GP Register, we check they have the kowledge, skills ad experiece required for their specialty. This report focuses o the followig ways of qualifyig for etry to the Specialist or GP Registers: Certificates of Completio of Traiig (CCT) Certificates of Eligibility for Specialist Registratio (CESR) Certificates of Eligibility for GP Registratio (CEGPR) CESR Combied Programme (CESR (CP)) CEGPR Combied Programme (CEGPR (CP)) Routes to specialist or GP registratio 2

4 Gettig specialist or GP registratio with a CCT Most doctors that eter the Specialist or GP Register demostrate that they meet the requiremets by completig a full UK traiig programme from competitive etry through to completig specialty curricula desiged by the relevat medical royal college ad approved by the GMC. We issue these doctors with a CCT, which etitles them to specialist or GP registratio. 3

5 Gettig specialist or GP registratio with a CESR or CEGPR For doctors who gaied their skills through traiig or experiece outside a approved UK traiig programme, there are two ways to get a CESR or CEGPR certificate: full applicatio to the GMC for specialist registratio through CESR or GP registratio through CEGPR through combied programme applicatio - CESR (CP) or CEGPR (CP). Full applicatio to the GMC for CESR or CEGPR If a doctor has t completed a UK approved traiig programme, they ca show that they have the full skills, kowledge, qualificatios ad experiece required by the relevat curriculum by gettig a CESR or CEGPR certificate. The diagram below shows the CESR/CEGPR process. 4

6 Combied programme CESR (CP) ad CEGPR (CP) Some doctors already have skills ad kowledge gaied i o-approved traiig or experiece before they apply to eter a UK traiig programme. This meas they ca demostrate they have already acquired some of the curriculum competecies, ad so will eed less time to complete the relevat curriculum. This meas that they ca start their traiig programmes at a higher level tha is usual. Traiees ca oly take this optio with the agreemet of their Local Educatio ad Traiig Board (LETB)/ deaery ad royal college. Whe these doctors complete the remaider of the curriculum we issue them with a CESR or CEGPR, which etitles them to specialist or GP registratio. All applicatios for specialist / GP registratio Whe determiig who is eligible for specialist or GP registratio, we work with the relevat medical royal college ad traiig programme providers. We review all the evidece a doctor submits to make sure the etry requiremets for Specialist or GP Registers have bee met. 5

7 What happeed i 2015 How may applicatios for CCT were approved? I 2015, we grated 6,112 CCT applicatios based o recommedatios from medical royal colleges ad faculties across all specialties. This is fewer tha 2014 whe we grated 6,418 certificates. A full breakdow of applicatios by specialty for 2015 is show i appedix 1, ad by the royal college or faculty that issued the recommedatio i appedix 5. The table below shows the umbers of CCT applicatios received sice This shows that overall, the umbers of applicatios have remaied fairly cosistet: ,280 6,418 6,112 How may combied programme applicatios were grated? I 2015, we grated 109 combied programme applicatios i 120 specialties- some applicatios are made i dual specialties. This is more tha the 92 applicatios grated i A full breakdow of applicatios by specialty for 2015 is show i appedix 2, ad by the royal college or faculty that issued the recommedatio i appedix 4. The table below shows the umbers of combied programme applicatios received sice The figures we report for CCT ad combied programme applicatios are those that were successful. But just because we oly report successful outcomes, it does t mea that all doctors appoited to traiig programmes ecessarily complete their traiig programme. UK traiig programmes ad stadards are robust ad there is a attritio rate for doctors i traiig for various reasos. If a doctor i traiig is performig below the expected stadard, they are offered remedial support at their Aual Review of Competece Progressio (ARCP). This is kow as a usatisfactory ARCP outcome. 6

8 If a doctor i traiig cotiues to perform below the expected stadard, they ca be removed from the traiig programme. This is kow as a ARCP outcome 4. How may decisios were made o CESR ad CEGPR applicatios? I 2015, we made decisios o 537 CESR applicatios ad 31 CEGPR applicatios. This is a overall decrease compared with 2014, whe we made decisios o 551 CESR ad 43 CEGPR applicatios. The table below shows the umbers of applicatios that were grated ad rejected durig total 568 Grated Rejected The full breakdow of umbers of decisios by orgaisatio ad specialty i 2015 is show i appedix 3. We made decisios o applicatios i 66 specialties. The te most commo specialties we made decisios o were: Trauma ad Orthopaedic surgery 50 Geeral surgery 49 Aaesthetics 38 Obstetrics ad gyaecology 36 Geeral psychiatry 30 Paediatrics 29 Cliical radiology 24 Ophthalmology 23 Geeral (iteral) medicie 21 Cardiology 17 Emergecy medicie 15 This icludes both applicatios that were successful ad applicatios that were refused. 7

9 Parallels with traiig programmes ad CESR ad CEGPR processes As metioed above, if doctors i UK traiig programmes perform below the expected stadard, they are offered remedial support. This echoes our CESR ad CEGPR processes, where we give usuccessful applicats specific recommedatios o how they should demostrate the stadards for specialist or GP registratio if they wish to apply agai i future. 8

10 Where applicats worked ad where they gaied their primary medical qualificatio Where did our 2015 applicats get their most recet experiece before they applied for CESR ad CEGPR? * All doctors who obtai specialist or GP registratio through CCT ad combied programme routes will be i a UK traiig programme, so their most recet experiece will have bee i the UK. Where applicats were based for majority of time durig 12 moths before applyig for CESR or CEGPR CESR CEGPR Total UK 81.27% 70% 80.41% EEA 2.48% 3.33% 2.54% Rest of the world 16.25% 26.67% 17.05% The majority of CESR ad CEGPR applicats have already worked i the UK for most of the time durig the 12 moths before they made their applicatios. May applicats will have cared for UK patiets i o-cosultat grade roles while preparig their applicatio. Where did our 2015 applicats get their primary medical qualificatio? The table below shows the umber of CCT ad CESR / CEGPR (CP) applicatios, compared with regio of primary medical qualificatio. Where doctors who completed UK postgraduate traiig programmes gaied their primary medical qualificatio CCT CP UK 75.34% 16.51% EEA 3.94% 13.7% Rest of the world 20.71% 69.72% Total umber of doctors * Based o place of employmet at the time of applicatio. 9

11 This shows that the regio where the primary medical qualificatio is awarded is ot a barrier to eterig ad successfully completig a UK traiig programme. More detailed breakdows are available i appedices 5 ad 6. The followig table shows the regio where applicats gaied their primary medical qualificatio, ad the success rates withi those regios of primary medical qualificatio. Where doctors issued with a decisio for CESR ad CEGPR gaied their primary medical qualificatio Proportio of regio by primary medical qualificatio Success rate by primary medical qualificatio regio UK 14.76% 61.90% EEA 6.15% 45.71% Rest of the world 79.09% 47.33% While we ca see that most applicatios through CESR ad CEGPR are from iteratioal medical graduates, a majority of applicats have recet UK experiece prior to applyig. A more detailed breakdow is i appedix 7. 10

12 What we ve leart from previous applicatios With the help of our parters at the medical royal colleges, we ve idetified some reasos why applicatios are ofte rejected i commo specialties. For each of the specialties below, the percetage figure is based o the total umber of applicatios assessed i that specialty. Geeral surgery I 2015, we rejected 38 applicatios (78%) While applicats ted to supply records of what they have doe through logbooks ad cosolidatio sheets, they do t always supply sufficiet umbers of workplace based assessmets (or equivalet) to demostrate competece i procedures required by the curriculum. Logbooks ca ofte be difficult to iterpret if they are t formatted i lie with our specialty specific guidace. Applicats also ofte fail to submit appropriate audit evidece. This ca either be because they have t completed sufficiet umbers of audits, or occasioally the audit loop is icomplete. Applicats sometimes focus o a particular area of practice. This ca mea that they are ofte uable to demostrate maitaiig competecies across the breadth of the curriculum. I geeral surgery, a area of special iterest eeds to be demostrated, but ot at the expese of the breadth of the curriculum. Applicatios are also rejected whe the research requiremets have t bee met. The curriculum is prescriptive about the umber of publicatios ad presetatios required to demostrate the stadards, ad the level of the applicats ivolvemet. Trauma ad orthopaedic surgery I 2015, we rejected 22 applicatios (44%) Applicats ofte use logbooks as evidece of what they ve doe, but do t adequately demostrate all the procedures to meet the curriculum requiremets. The trauma ad orthopaedic surgery curriculum gives iformatio o procedure based assessmet validatio, showig how applicats ca demostrate the breadth of procedures i the curriculum. It ca be very difficult to iterpret logbooks if they are t formatted accordig to our specialty specific guidace. The royal college asks that applicats provide a cosolidatio report filtered to show the umbers of SAC idicative procedures they ve carried out over the last six years. Applicats ofte submit isufficiet evidece of audits that have bee udertake, particularly o closig the audit loop. Failure to demostrate the required level of ivolvemet i research also accouts for applicats ot demostratig the full curriculum requiremets. Trauma ad orthopaedic surgery applicats ofte fail to demostrate the 11

13 required evidece of idex procedures, such as paediatric orthopaedic surgery or spie surgery. Emergecy medicie I 2015, we rejected 7 applicatios (47%) The most commo reaso for a usuccessful applicatio is failure to provide sufficiet evidece of curret competeces i the allied (Core) specialties of Acute Medicie, Itesive Care Medicie ad Aaesthetics. I additio to submittig detailed logbooks ad workplace-based assessmets as specified i the curriculum, it is expected that the applicat will have spet a period of time of at least three moths i each Core specialty. This experiece should have bee withi five years of submissio of the applicatio. Aother frequet area of shortfall is expiry of oe or more Advaced Life Support Courses (ALS, ATLS ad APLS, or recogised equivalets). Evidece provided should iclude a curret certificate of completio for each course. Lack of evidece for completio of a audit cycle is ofte a reaso for failure. Evidece for this ca iclude audit reports, presetatio slides, publicatios ad ay guidelies produced as a result of the audit. Geeral practice I 2015, we rejected 14 applicatios (45%) Overseas applicatios Applicats for a CEGPR ofte provide isufficiet evidece to show how their work as a geeral practitioer compares with our core curriculum statemet, Beig a Geeral Practitioer. The followig areas ofte lack detail ad first had, objective evidece to show persoal participatio i them: exposure to the full rage of patiets ad coditios expected i geeral practice i the UK ad coordiatio of care with other professioals i the commuity ad i secodary care providig logitudial, family orietated, comprehesive care cliical goverace activities icludig audit ad learig from sigificat evets; usig quality systems to improve care 12

14 kowledge of how Natioal Health Service geeral practice is orgaised i the UK. The royal college of Geeral Practitioers recommeds that applicats submit a patiet log showig the age, sex ad diagosis of patiets see cosecutively i geeral practice over at least oe moth (the royal college ca provide a template for this). Case studies; cliical records; correspodece with colleagues; otes of meetigs; reports ad maagemet plas ca also help to show exposure to the full rage of patiets ad the geeral practitioer s role i the coordiatio of care. Cliical goverace activities ca be evideced with persoal reflectios or reviews of cases which have led to chage ad improvemet i stadards of care; reflectio o a patiet complait; aalysis of sigificat evets ad learig from error; evidece of persoal cotributios to practice improvemets; examples of protocols ad guidelies used i practice. Applicats are ot expected to have worked i Natioal Health Service (NHS) geeral practice but should write about the research, readig ad learig they have doe i aticipatio of comig to the UK ad practisig i a differet health care system. May successful applicats have reflected o their learig from web based resources, olie modules, from a day of observig i a practice i the UK, courses ad cofereces. They have also cosidered where there may be gaps i their kowledge of NHS systems ad processes. Applicats previously released from a CCT programme Applicats for a CEGPR who previously traied i a CCT programme, but were ot successful i all parts of the MRCGP examiatio, ofte rely etirely o the evidece i their traiee eportfolio. However, much more evidece is eeded to demostrate equivalece to the CCT curriculum stadard. I order to be successful, applicats must show progress has bee made i the areas of weakess ad deficiecy idetified i traiig ad through examiatio. There is o set way of doig this. Applicats should cosider how they ca produce ew, compellig evidece from recet cliical experiece to show that all the curriculum competeces have ow bee attaied. Dermatology I 2015, we rejected 6 applicatios (43%) It s essetial that Core Medical Traiig (CMT) competecies are demostrated. This ca ofte be challegig for dermatologists who do t have ay curret resposibilities for uselected takes. Every applicat who failed i Dermatology durig 2015 did ot preset sufficiet evidece of CMT competece. If a applicat does ot hold MRCP (UK), we would suggest they update their skills i the requiremets of the CMT curriculum, ad obtai assessmets to cofirm this. 13

15 Aother commo reaso that applicatios are t successful is that they do t have ay evidece of completig a full audit cycle. Some applicats also do t have sufficiet experiece of maagemet ad leadership. It s very importat for potetial applicats to review the curret curriculum i full ad esure they are able to preset evidece to show they meet all the cliical competecies. If ot, it s best to delay the applicatio whilst additioal work is udertake to gather this evidece. There is a Specialty Certificate Exam (SCE) i Dermatology which shows applicats have the kowledge base required by the curriculum. It s a good idea to pass the exam before applyig for a CESR. If ot, applicats will have to show that their kowledge from alterative meas is very strog ideed, ad maps to the SCE syllabus. The British Associatio of Dermatologists (BAD) provide support to potetial CESR applicats. Please see their website for details Geeral (iteral) medicie I 2015, we rejected 9 applicatios (41%) Applicats who fail to meet the requiremets i GIM ofte lack Core Medical Traiig (CMT) competecies. If MRCP (UK) has ot bee completed, there will eed to be alterative evidece provided i the form of the followig: A satisfactory Educatioal Supervisors report supported by the completio of a MCR (from 4 Cosultat Cliical Supervisors), a satisfactory MSF ad the miimum umber of SLEs (10 i total icludig 6 ACATs, 2 CPDs ad MiiCEXs each). Applicats sometimes fail to show evidece of the full depth ad breadth of the curriculum beig completed especially i regard to audit or quality improvemet projects (QIP) ad CPD. It is essetial that applicats provide evidece of recet audits ad completio of a full audit loop or QIP, together with evidece of up-to-date CPD, across the GIM curriculum. Cardiology I 2015, we rejected 9 applicatios (53%) Cardiology applicatios geerally are rejected for several reasos ad have lots of recommedatios, suggestig wide ragig deficiecies. Core Medical Traiig (CMT) competecies are ot always demostrated. If MRCP (UK) has ot bee completed, the there will eed to be alterative evidece provided. The full depth & breadth of kowledge ad cliical skills across the etire CCT curriculum is ot always clearly demostrated so attetio to this sectio would be beeficial. There is ofte a lack of evidece of o-goig appraisal/participatio i the appraisal process, particularly MSF. Other issues that regularly occur i this speciality are a lack of recet evidece & completio of the audit loop ad isufficiet evidece of teachig & traiig, with a lack of teachig feedback 14

16 provided. Applicats are advised to provide a rage of evidece relatig to commuicatio skills/team workig. Ophthalmology I 2015, we rejected 14 applicatios (61%) The most frequet reaso applicatios i ophthalmology are rejected is a failure to adequately demostrate the kowledge base that uderpis a applicat s cliical skills. The curriculum requires that the applicat passes the Fellowship Exam of the royal college of Ophthalmologists (the FRCOphth exam) this would fully demostrate the kowledge base eeded. Usig alterative exams is acceptable as log as they are equivalet to the kowledge base demostrated by the FRCOphth exam. It s also importat that applicats provide evidece for each of the curriculum competecies. Paediatrics I 2015, we rejected 18 applicatios (60%) It s crucial that applicats read the specialty specific guidace before they submit a applicatio. Doctors i paediatrics typically specialise i oe area of practice. A successful paediatrics applicat eeds to demostrate competecy i acute geeral paediatrics, eoatal medicie ad commuity child health. Usuccessful applicats ofte demostrate extesive experiece i oe of these areas, but isufficiet experiece i others i the previous five years. The royal college of Paediatrics ad Child Health recommeds applicats take a six moth placemet i each of their less recetly experieced areas ad make sure they match their evidece specifically to the curriculum requiremets before they apply. Obstetrics ad gyaecology I 2015, we rejected 15 applicatios (42%) Applicats must demostrate ogoig progressio ad maiteace of skill ad competecy through recet evidece. Specialty experiece ad evidece should be provided agaist the curret curriculum, particularly from the last five years. Ad it s very importat to iclude a completed ad validated logbook i lie with the curret O&G curriculum. Progressio through to idepedet cliical practice must be sufficietly demostrated across both obstetrics ad mior ad major gyaecological surgery. This also icludes completig madatory traiig (such as a Female Geital Mutilatio course) withi the last five years, or providig evidece of equivalet kowledge ad skills. 15

17 Applicats ofte fail due to isufficiet evidece of maagemet ad leadership experiece. We recommed that applicats use miutes of meetigs they have chaired, submit certificates of attedace at approved maagemet or leadership courses, or demostrate evidece of leadig projects. Applicats also sometimes fail to show evidece of their ivolvemet i maagig complaits. We suggest that applicats show evidece of respodig to complaits, or submit evidece of a complait hadlig course. I the evet that o recet complaits have bee received, applicats should demostrate evidece of what they would do i hypothetical situatios. Applicats should esure they provide evidece of two-way commuicatio as part of the overall maagemet of patiet care i collaboratio with multidiscipliary teams, via referral letters. These are sometimes missig from applicatios. Fially, applicats are required to complete a miimum of two Advaced Traiig Skills Modules. Without these, or equivalet evidece, applicatios will be usuccessful. Aaesthetics I 2015, we rejected 18 applicatios (47%) Aaesthetics applicats ofte fail to provide sufficiet evidece relatig to domai 1 of Good medical practice (our core guidace for doctors, o which all curricula are based). We ofte see applicatios where isufficiet cliical evidece is give for itesive care, pai medicie ad cardiothoracic competecies. Failure to provide sufficiet evidece of experiece i euro-aaesthesia, paediatric aaesthesia ad obstetric aaesthesia is also commo, as is isufficiet evidece of audit. The royal college of Aaesthetists recommeds applicats demostrate what they have doe through clear summary logbooks, which show cumulative totals of higher level traiig ad experiece backed up with detailed logbooks. Most importatly, they must demostrate competecy acquisitio to the curriculum stadard through appropriate forms of assessmets. Cliical radiology I 2015, we rejected 7 applicatios (29%) Applicats rejected i cliical radiology most commoly fail to fully demostrate the cliical skills required across the breadth of the curriculum i oe or more areas. Examples iclude itervetioal radiology, radiouclide radiology, radiological procedures, ultrasoud ad mammography. The royal college of Radiologists recommeds applicats have at least 40 radiology reports coverig the breadth of the radiology specific areas of the curriculum. These reports should be supported by workload statistics from the hospital radiology iformatio system, with supportig refereces from supervisors or traiers. Based o the rejectios i 2015, applicats who do t demostrate the curriculum s cliical requiremets i oe of these areas will also fail i other cliical areas. 90% of applicats that were rejected i 2015 also failed to adequately show they met audit ad quality improvemet 16

18 requiremets. Ad over half of rejectios showed isufficiet evidece of cliical goverace, teachig experiece, maagemet activity or ivolvemet i appraisal. Ofte, applicats failed i multiple areas. Failed applicatios frequetly relied too heavily o secodary evidece i areas icludig teachig, appraisal, cliical audit ad quality improvemet ad cliical goverace activity. The royal college of Radiologists recommeds havig two examples of cliical audit activity icludig a re-audit to complete the audit loop. Alteratively, evidece of completed quality improvemet projects demostratig a chage i practice could be submitted. For other areas, applicats should show evidece of attedace at maagemet meetigs, multidiscipliary team meetigs or leadership courses. 17

19 Applicats experieces The followig doctors have bee successful i their applicatios for specialist registratio via a CESR. They ve shared their experieces ad also some tips for other applicats. Dr Asim Ijaz Emergecy medicie I decided to apply for a CESR i Emergecy Medicie i late I d bee workig i the specialty for about 11 years by the, icludig a period i Saudi Arabia. Applyig felt like a atural progressio i my career. I d gradually become more ivolved i decisio makig ad maagemet i the departmet ad wated to cotiue this i a cosultat role. Preparatio for my CESR applicatio was key, ad took me about two years. I cosulted my supervisors ad checked they were happy to support me i gatherig evidece to submit a applicatio. I read the Emergecy medicie speciality specific guidace ad curriculum, as well as the GMC s guidace o applyig. I also wet to a traiig evet ad spoke to the GMC o the phoe. I looked for gaps i my experiece, ad udertook some additioal courses ad traiig to esure I had the right evidece. This meat that by the time I applied, my evidece portfolio was already very well orgaised. The GMC case officer provided excellet support, but I did t eed to do much additioal work o my documets aside from obtaiig some extra validatio ad correctig some data protectio issues. I was very happy ad relieved whe I received the decisio. I read the evaluatio form i full ad felt it was very fair ad thorough. I started a substative cosultat positio two weeks after my specialist registratio was grated. I d advise ayoe thikig about applyig for a CESR to read the speciality specific guidace thoroughly, ad check you have the essetial requiremets. Talk to your referees ad esure you ad they feel cofidet you re ready for cosultat practice. You should provide robust evidece for each competecy this might be WBAs, e-modules, case review, courses with reflectio, audits ad teachig. It s vital for Emergecy Medicie that you have cofirmed paediatric, acute medicie, aaesthesia ad ICU competecies. I d also suggest esurig you have a maagemet portfolio, thorough aual appraisals, ad evidece of a complete audit cycle. Some research experiece is also importat. Most importatly, stay focused ad do t give up! 18

20 Dr Gabriela Fillo Paediatrics I ve bee workig i Paediatrics ever sice I qualified as a doctor i Argetia i My career aim was to secure a cosultat role i the UK, so I decided to apply for specialist registratio. I started to prepare about three years before I submitted my applicatio. I gathered evidece both retrospectively ad as I gaied more experiece. Before I applied, I had several coversatios with both my royal college ad the GMC, but the best preparatio was attedace at a CESR traiig evet for SAS doctors, which icluded a GMC presetatio. That helped a lot with my applicatio ad gave me a clearer idea about the process. Oce I d applied to the GMC, my adviser reviewed my evidece ad set a checklist settig out the evidece that had bee accepted. A sigificat umber of documets were set back, ad this was a little disappoitig, because I d put a lot of effort ito makig the iitial applicatio as good as possible. However, the commets that had bee made were valid, ad the majority of the papers eeded additioal verificatio or redactio. Beig grated specialist registratio i Paediatrics was oe of the happiest days of my life! I re-read the evaluatio several times. I ll cosider applyig for cosultat roles oce I ve fiished my specialty cotract. I d tell ayoe cosiderig applyig for a CESR that the process ca be quite timecosumig ad requires the collectio ad review of a lot of paperwork, so it s really importat to gather all of this evidece i advace. I future, I d like to see the GMC assess capability for specialist registratio by assessig doctors i the workplace that would be much more straightforward! Dr Ahsa Imtiaz Real medicie I started traiig i real medicie i Pakista i I was attracted to the specialty for its mix of hads o ad critical work. I 2010, I came to the UK. The ext year, whe I d take up a locum traiig role, I started cosiderig a CESR applicatio. My first step was to look o the GMC website, ad review all the guidace for applicats. I sat ad passed the MRCP (UK) ad the Specialty Certificate Exam i Real medicie. I 2014, I started gatherig my documets for a applicatio. For me, the most challegig part was obtaiig ad verifyig documets from Pakista, where I d completed much of my traiig. The CESR process is t well kow there, ad may of the people I asked to verify documets were t sure why it was ecessary, particularly whe they were available i electroic format. I had to make several trips to Pakista to make sure I got all the right evidece. There were some similar challeges i the UK too. Gatherig iformatio i a eportfolio was very helpful, but gettig it siged off was sometimes difficult, especially if I d bee 19

21 workig with locum cosultats who had subsequetly moved o. It took me about 16 moths to prepare the documets, ad I had to travel to hospitals all aroud the UK. Oce I d applied, my GMC case adviser provided some very helpful advice. I submitted some additioal logbooks ad audits. Whe I received my successful outcome, I was very relieved. I also ow have over 1100 pages of objective evidece I ca iclude i my CPD ad revalidatio portfolios. I d like to see more guidace o creatig a electroic logbook of procedures for CESR applicats. I collected evidece of procedures i my elogbook, but I created the format myself ad was t sure if I should iclude particular data. I thik a template for physicias would be very helpful. I d advise a doctor thikig of applyig for a CESR to make sure they obtai evidece as they progress through each post. It s much easier to collect ad verify documets whe you complete the relevat work, tha it is to gather them retrospectively. It ca also be really helpful to speak to admiistrative colleagues to ask if they ca provide statistical data ad summaries of patiets ad procedures. I also made sure I spoke to my referees before I omiated them, ad provided them with a copy of my CV. Most of all, make sure you get ivolved ad take opportuities. Get ivolved i teachig, departmetal meetigs, ad complete audits. Make sure you thik about gatherig evidece ad pla ahead. Trauma ad orthopaedic surgery applicat I started workig i trauma ad orthopaedics i 2006, first as a SHO the as a registrar. I was t able to secure a Natioal Traiig Number, but I was fortuate to secure a locum appoitmet for traiig i My mai motivatio i applyig for CESR was a desire to progress i my career; my goal is to become a cosultat orthopaedic surgeo. Preparig to apply was a log process. I started completig olie assessmets o my ISCP e-portfolio aroud five years ago. I ve esured I keep up to date across all the procedures i the curriculum. This meat that by the time I was ready to apply, all I had to do was to take pritouts of from my portfolio ad get them validated. Alog with gettig various other documets verified, like my logbook ad evidece of teachig, the process of gatherig documets took about a year. Before I started doig this, I read the guidace o the GMC s website ad also talked to my colleagues who d already bee successful i applyig for CESR. I submitted my applicatio at the ed of August 2015, ad my adviser suggested I submit a aoymised logbook for each job I d had. This this took me three moths, ad lookig back, I thik this could have bee avoided if I had read the guidelies i full. Whe my decisio was issued I felt elated, ad very proud that I d bee successful. I read the full evaluatio ad it showed that the evaluators had thoroughly assessed my applicatio form. I was particularly pleased to pass o my first attempt, as a reapplicatio 20

22 icurs further costs ad time. I m curretly workig as a BOA fellow, ad ow I have specialist registratio, I hope to secure a cosultat role withi the ext 12 moths. My advice to potetial CESR applicats i Orthopaedics is to look at the CCT guidelies ad esure that you have evidece to show you ve ticked all the boxes. Research ad audits are very importat - they take time ad plaig, so make sure you ve cosidered this. Esure that you get adequate umbers for all idex procedures; if ecessary arrage theatre sessios to fulfil these criteria. You might have to egotiate with your colleagues to atted their sessio, especially if you are lackig i umbers. Overall, preparatio is the key. Dr Susaa Gillibrad Occupatioal medicie I ve bee workig i occupatioal medicie sice 1997, ad had built up sigificat experiece by the time I decided to apply for specialist registratio. I curretly have a portfolio career, icludig work i heavy ad light maufacturig, shipbuildig ad ship support, ad HSE appoited doctor work. I took my AFOM i 2009, ad oce I thought I d reached the stage where I was workig at cosultat level ad I was kee to achieve recogitio of this. There ca be a sese that if you work as a associate that you are differet to cosultat colleagues, ad after may years of accruig experiece I hoped that my kowledge ad traiig was equivalet to cosultat colleagues. Also, I thought that beig o the specialist register was importat i relatio to my work as a idepedet occupatioal physicia. It took me aroud six moths to prepare my applicatio documets for submissio, ad I was able to gather some evidece from my appraisal folders. I atteded a CESR day at the Faculty of Occupatioal Medicie which was ivaluable as several advisers from the GMC were there as well as a colleague who had successfully completed CESR. This was a essetial day to gai advice o how to go about compilig evidece ad esurig it was validated correctly. I also spoke with the GMC, ofte o a weekly basis, whilst I was preparig my applicatio. I foud that it was very importat to speak with a adviser from the Specialist Applicatios Team, as they have the expertise to deal with i depth queries. I made detailed otes of their advice so I had somethig to refer back to. I also ed the GMC regardig my choice of referees. The GMC requests cofirmatio of all employmet sice qualificatio as a doctor, ad trackig dow some of these documets was a little problematic. I foud the NHS Pesios service to be a useful resource i locatig this evidece, ad it would have saved some time if I d kow about this sooer. I additio, the GMC were able to provide details of my traiig posts udertake as part of my GP vocatioal traiig scheme. I esured that my evidece showed the full breadth of my practice. As well as some complex cases I also selected some that showed evidece of more everyday situatios. 21

23 You eed at least 2 workplace assessmets ad at least oe ill health retiremet case, ad to submit at least 2 audits. For each case I did a bullet poit summary of the documets I was submittig, ad the provided a summary. I discussed how I thought the case demostrated compliace with the GMC's four domais of Good Medical Practice. I also stated how the evidece I submitted met the curret curriculum. I was coscious that the assessors were goig to have a cosiderable amout of documetatio to read ad so esured my documets were really well orgaised ad easy to follow. I submitted 25 cases i all, which icluded the workplace visits. Each case had a ID umber, ad I icluded just the relevat correspodece for each referral: my report, ad ay correspodece to a GP or specialist. This preparatio meat that oce I d submitted my applicatio, I had very little additioal work to udertake. All of my documets were accepted as correctly verified, ad my adviser was very good at keepig me updated durig the process after submissio. Oce the applicatio was submitted for evaluatio, it took aroud two moths to receive a decisio. I was relieved, although I had spet a lot of time preparig the best applicatio I could, ad I hoped I had doe eough. I did feel a great sese of achievemet though. I read the evaluatio form i full ad will iclude this i my ext appraisal portfolio. I d advise doctors thikig about applyig for a CESR i Occupatioal Medicie to review the curret curriculum, ad esure you have evidece to demostrate competece i all areas. It s importat to make sure that you clearly set out the skills you thik each piece of evidece demostrates. O a practical level, the most importat tip is to purchase very good redactio software to aoymise your documets. Usig a pe is very difficult ad there is a high risk that iformatio will still be visible. It also meas if you wat to highlight somethig, you ca do so by uderliig or makig a box aroud the paragraph. The assessors will the fid it easier to see why you have submitted that particular piece of evidece. 22

24 The review of the routes to the specialist ad GP register I March 2010, Lord Nare Patel published a series of recommedatios * for how the GMC should regulate medical educatio ad traiig i the future. Oe of the recommedatios was that we should review how doctors ca be grated GP or specialist registratio whe they have ot completed GP or specialist traiig i the UK. We udertook a cosultatio o the Routes to the GP ad Specialist Registers from March 2012 to Jue From the 402 resposes, 13 proposed recommedatios were submitted to GMC Coucil ad approved i October For a full list of the recommedatios, go to Progress Some of the 13 recommedatios were short-term ad medium-term adjustmets i order to improve trasparecy of our processes. Recommedatios 8-12 focus specifically o the role of college evaluators, use of specialist applicatios paels, ad makig sure decisios are fully supported by evidece. We have published approved terms of referece for applicatios paels o our website i respose to these recommedatios. Recommedatio 13 asked for a aual report to be published. We have published two reports sice 2013 ad this is the third report. Meetig recommedatios We established a Equivalece Advisory Group (EAG) to help us implemet the rest of the recommedatios ad i particular those that would eed legislative chage. This group cosists of represetatives from the Academy of Medical Royal Colleges, LETB ad deaeries from each of the four UK coutries, NHS employers ad the BMA s Staff Grade ad Associate Specialists Committee. * Outcome of Cosultatio o the Review of the Future Regulatio of Medical Educatio ad Traiig Aex B Aex_B Outcome_of_Cosultatio_o_the_Review_of_the_Future_Regulatio_of_Medical_E ducatio_ad_traiig.pdf_ pdf Report of the Cosultatio o the Routes to the GP ad Specialist Registers Report_o_the_Cosultatio_o_the_Routes_to_GP.pdf_ pdf 23

25 Our proposals the EAG have give advice o iclude the followig. 1 Requirig CESR ad CEGPR applicats to have a licece to practise ad a miimum of 12 moths experiece of workig i the UK over the past three years. 2 Testig the applicat s kowledge i the relevat specialty. 3 Evaluatig the applicat s performace i the relevat specialty i a workplace based evaluatio i the UK. 4 Amedig legislatio to allow CEGPR applicats to sped time workig i GP practices i the UK. 5 How we iclude idividuals of high iteratioal reow i the process without the eed for acclimatisatio or evaluatio of performace. Proposals so far The diagram below shows the proposed model to implemet recommedatios. Kowledge test Plus accompayig documetary evidece Acclima4sa4o Workplace evalua4o Applicatio to Specialist or GP Register Acclimatisatio We idetified i last year s report ( DC7493.pdf_ pdf page 15) that over 80% of applicats are already based i the UK before they apply. Our proposal will esure all applicats have already worked for a miimum of 12 moths i the last three years i the UK as a registered ad licesed medical practitioer. For clarity, applicats will ot ecessarily eed to be workig i the specialty i which they ited to 24

26 apply for specialist registratio the recommedatio merely asks for experiece of workig i the UK. Kowledge test Our proposal will require applicats to have passed the same exam as that required by the CCT curriculum i order to uderpi the specialty kowledge. Workplace evaluatio To evaluate the applicat s performace i the relevat specialty, we have asked curriculum writers i the medical royal colleges to idetify a set of competecies that will be assessed i the workplace. These competecies will demostrate a applicat s skills at the highest ed of the curriculum. Doctors of high iteratioal reow To meet our eligibility criteria ad apply through this route, the evidece a applicat will eed to preset is likely to iclude: a job offer from a orgaisatio i the UK cofirmatio from the employer that the applicat eeds specialist or GP registratio for the post. Estimates from the origial workig group suggest there will oly be oe or two doctors per year that fit our criteria for doctor of high iteratioal reow. 25

27 Appedices Appedix 1 CCT CCT awarded 2015 by specialty Some doctors udertake traiig i more tha oe specialty which meas that there are more CCTs award tha umber of idividual doctors applyig. I 2015, 6,112 CCTs were awarded coverig 6,772 specialist ad GP register etries. Acute Iteral Medicie 51 Aaesthetics 447 Cardiology 91 Cardio-thoracic surgery 6 Chemical pathology 8 Child ad adolescet psychiatry 57 Cliical geetics 8 Cliical europhysiology 9 Cliical ocology 55 Cliical radiology 179 Dermatology 45 Emergecy medicie 90 Edocriology ad diabetes mellitus 68 Foresic psychiatry 34 Gastroeterology 108 Geeral (iteral) medicie 546 Geeral Practice 2,751 Geeral psychiatry 172 Geeral surgery 159 Geito-uriary medicie 22 Geriatric medicie 107 Haematology 59 Histopathology 56 Immuology 6 26

28 Ifectious diseases 24 Itesive care medicie 101 Medical microbiology 23 Medical microbiology ad virology 24 Medical ocology 29 Medical psychotherapy 14 Neurology 42 Neurosurgery 23 Obstetrics ad gyaecology 162 Occupatioal medicie 15 Old age psychiatry 58 Ophthalmology 97 Oral ad maxillo-facial surgery 18 Otolarygology 42 Paediatric surgery 12 Paediatrics 329 Palliative medicie 48 Pharmaceutical medicie 21 Plastic surgery 37 Psychiatry of learig disability 22 Public health medicie 34 Rehabilitatio medicie 10 Real medicie 69 Respiratory medicie 110 Rheumatology 56 Trauma ad orthopaedic surgery 155 Urology 48 27

29 Specialties umberig fewer tha five applicatios total umber of applicatios across these specialties: 15 Allergy Audio vestibular medicie Cliical pharmacology ad therapeutics Medical Virology Paediatric cardiology Sport ad Exercise Medicie Total umber of CCTs awarded i 2015: 6,112 28

30 Appedix 2 CP Some doctors udertake traiig i more tha oe specialty, which meas that there are more CESRs awarded tha umber of idividual doctors applyig. I 2015, 109 doctors were awarded a CESR through a combied programme with 120 specialist register etries. Specialties with two or fewer applicatios have bee grouped to miimise risk of idetificatio. Acute Iteral Medicie 4 Aaesthetics 12 Commuity Sexual ad Reproductive Health 4 Emergecy medicie 4 Geeral (iteral) medicie 12 Geriatric medicie 5 Obstetrics ad gyaecology 18 Paediatric cardiology 3 Paediatrics 18 Pharmaceutical medicie 3 Rheumatology 5 Sport ad Exercise Medicie 4 Urology 3 29

31 List of specialities with two or fewer applicatios. Total umber of applicatios across these specialties: 25 Child ad adolescet psychiatry Cliical radiology Dermatology Edocriology ad diabetes mellitus Foresic psychiatry Gastroeterology Geeral surgery Haematology Neurosurgery Nuclear medicie Occupatioal medicie Old age psychiatry Ophthalmology Psychiatry of learig disability Rehabilitatio medicie Real medicie Trauma ad orthopaedic surgery Total umber of doctors awarded a CESR through combied programme:

32 Appedix 3 CESR / CEGPR Breakdow of CESR ad CEGPR decisios by orgaisatio ad specialty 2015 Specialties of applicatio with low umbers have bee grouped to miimise risk of idetifyig applicat. Orgaisatio Specialty Registratio Grated Applicatio Rejected Total Faculty of Occupatioal Medicie Faculty of Public Health Faculty of Sexual ad Reproductive Healthcare Occupatioal medicie Public health medicie Commuity Sexual ad Reproductive Health 3 3 Joit Committee o Surgical Traiig Breast Surgery Cardio-thoracic surgery Geeral surgery Neurosurgery Otolarygology Plastic surgery Trauma ad orthopaedic surgery Urology Vascular surgery Paediatric surgery Paediatric orthopaedic surgery Real trasplatatio ad vascular access Trasplat Surgery Joit Royal Colleges of Physicias Traiig Board Cardiology Dermatology Edocriology ad diabetes mellitus 3 3 Gastroeterology 6 6 Geeral (iteral) medicie Medical ocology Neurology

33 Palliative medicie 3 3 Rehabilitatio medicie Respiratory medicie Rheumatology Sport ad Exercise Medicie Acute iteral medicie Allergy Cliical europhysiology Geriatric medicie Haematology Ifectious diseases Medical ophthalmology Paediatric cardiology Real medicie Vascular Complicatios of Diabetes Royal College of Aaesthetists Aaesthetics Cardio-thoracic Aaesthesia 1 1 Itesive care medicie Royal College of Emergecy Medicie Royal College of Geeral Practitioers Royal College of Obstetricias ad Gyaecologists Royal College of Ophthalmologists Emergecy medicie Geeral Practice Obstetrics ad gyaecology Ophthalmology Royal College of Paediatrics ad Child Health Neoatal Medicie Paediatrics Paediatric Allergy Paediatric Allergy, Immuology ad Ifectious Diseases Paediatric Gastroeterology, Hepatology ad Nutritio Paediatric Neurology Paediatric Respiratory Medicie Royal College of Pathologists

34 Histopathology Medical microbiology Chemical pathology Medical microbiology ad virology Royal College of Psychiatrists Child ad adolescet psychiatry Foresic psychiatry Geeral adult psychiatry Geeral psychiatry Medical psychotherapy 1 1 Old age psychiatry 4 4 Psychiatry of learig disability Royal College of Radiologists Cliical radiology Cliical ocology Diagostic radiology Neuroradiology

35 Appedix 4 all SR / GPR All grated specialist ad GP registratio applicatios by orgaisatio 2015 Orgaisatio CCT CESR (CP) CESR /CEGPR TOTAL Faculty of Occupatioal Medicie Faculty of Public Health Faculty of Sexual ad Reproductive Healthcare 4 4 Joit Committee o Surgical Traiig Joit Royal Colleges of Physicias Traiig Board Royal College of Aaesthetists Royal College of Emergecy Medicie Royal College of Geeral Practitioers Royal College of Obstetricias ad Gyaecologists Royal College of Ophthalmologists Royal College of Paediatrics ad Child Health Royal College of Pathologists Royal College of Psychiatrists Royal College of Radiologists

36 Appedix 5 PMQ ad CCT Coutry of primary medical qualificatio for CCT i All coutries with fewer tha te total applicatios have bee grouped to avoid idetificatio. Primary medical qualificatio coutry Number of CCTs awarded % total UK % EEA % Czech Republic % Germay % Greece % Irelad % Polad % Romaia % Spai % All other EEA % ROW % Egypt % Idia % Ira, Islamic Republic Of % Iraq % Myamar % Nigeria % Pakista % Russia Federatio % South Africa % Sri Laka % Suda % Syria Arab Republic % All other ROW % 35

37 Appedix 6 PMQ ad CP Coutry of primary medical qualificatio for combied programme i All coutries with fewer tha five total applicatios have bee grouped to avoid idetificatio. Primary medical qualificatio coutry Number of CESRs awarded through the combied programme % total UK % EEA % Irelad % All other EEA % ROW % Idia % Pakista 6 5.5% All other ROW % 36

38 Appedix 7 PMQ ad CESR / CEGPR Coutry of primary medical qualificatio for CESR ad CEGPR decisios i All coutries with fewer tha five total applicatios have bee grouped to avoid idetificatio Primary medical CESR / CEGPR CESR / CEGPR Total % Success qualificatio coutry approved rejected UK % EEA % Czech Republic % Irelad % Italy % All other EEA % ROW % Australia % Bagladesh % Egypt % Idia % Iraq % Jorda % Libya Arab Jamahiriya % New Zealad % Nigeria % Pakista % South Africa % Sri Laka % Suda % Syria Arab Republic % Uited States % All other ROW % 37

39 Website: Telephoe: Geeral Medical Coucil, 3 Hardma Street, Machester M3 3AW Textphoe: please dial the prefix the to use the Text Relay service, Joi the likd.i/gmcuk facebook.com/gmcuk youtube.com/gmcuktv To ask for this publicatio i Welsh, or i aother format or laguage, please call us o or us at publicatios@gmc-uk.org. Published July Geeral Medical Coucil The text of this documet may be reproduced free of charge i ay format or medium providig it is reproduced accurately ad ot i a misleadig cotext. The material must be ackowledged as GMC copyright ad the documet title specified. The GMC is a charity registered i Eglad ad Wales ( ) ad Scotlad (SC037750) Code: GMC/AGPASR/0716