CESR in Gastroenterology

CESR stands for Certificate of Eligibility for Specialist Registration. Doctors who haven’t completed a GMC-approved programme to obtain their CCT, but can evidence that their specialist training, qualifications and experience are equivalent to what is acceptable for CCT in the UK, can apply to join the GMC Specialist Register via the CESR pathway.

This article has been created to assist doctors who are applying for entry onto the GMC Specialist Register with a CESR in Gastroenterology.

• An introduction to CESR in the CCT specialty of Gastroenterology
• Eligibility criteria
• How much evidence is required?
• How recent should the evidence be?
• Which evidence is required?
• Capabilities in Practice (CiPs)
• Evidence types
• Can I apply for CESR without having worked in the NHS?

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An introduction to CESR in the CCT specialty of Gastroenterology

Gastroenterology trainees in the UK will undertake three years of IM training followed by four years of speciality training. Upon their successful completion of training, they are awarded a Certificate of Completion of Training (CCT). This allows them entry to the GMC specialist register. 

To be awarded this CESR, you will need to submit a range of evidence to demonstrate that your specialty training, qualifications and experience taken together are equivalent to the CCT in Gastroenterology, as set out in the specialty training curriculum.

Upon successful completion of a CESR application, you will receive entry to the GMC specialist register.

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Eligibility Criteria

To be eligible to apply under this route, you must have either (1) a specialist qualification in the specialty you apply in or (2) at least six months of continuous specialist training in the specialty you apply in.

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How much evidence is required?

Most CESR applications contain around 800-1000 pages of evidence.

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How recent should the evidence be?

It’s advised that your evidence of skills or experience should be dated within the last five years. Evidence that is more than five years old will be given less weight.

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Which evidence is required?

Your evidence must cover the knowledge, skills and qualifications to demonstrate the required competencies in all areas of the Gastroenterology curriculum.

The curriculum is structured around Capabilities in Practice (CiPs). There are six generic CiPs, eight clinical CiPs for internal medicine
(stage 2) and seven specialty CiPs for Gastroenterology (six core and a choice of one out of two options for complex care).

In order to complete training and be recommended to the GMC for the award of CCT and entry to the specialist register, you must demonstrate that you are capable of unsupervised practice in all generic and clinical CiPs.

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Capabilities in Practice (CiPs)

Generic capabilities in practice (CiPs)

1. Able to function successfully within NHS organisational and management systems
2. Able to deal with ethical and legal issues related to clinical practice
3. Communicates effectively and is able to share decision-making, while maintaining appropriate situational awareness, professional behaviour and professional judgement
4. Is focused on patient safety and delivers effective quality improvement in patient care
5. Carrying out research and managing data appropriately
6. Acting as a clinical teacher and clinical supervisor

Clinical CiPs – Internal Medicine

1. Managing an acute unselected take
2. Managing the acute care of patients within a medical specialty service
3. Providing continuity of care to medical inpatients, including management of comorbidities and cognitive impairment
4. Managing patients in an outpatient clinic, ambulatory or community setting (including management of long-term conditions)
5. Managing medical problems in patients in other specialties and special cases
6. Managing a multidisciplinary team including effective discharge planning
7. Delivering effective resuscitation and managing the acutely deteriorating patient
8. Managing end of life and applying palliative care skills

Specialty capabilities in practice

1. Manage care of Gastroenterology and Hepatology in-patients
2. Managing care of Gastroenterology and Hepatology patients in an outpatient environment
3. Managing care of patients with complex disease across multiple care settings, including interaction with primary care and community networks
4. Managing care pathways for patients with suspected and confirmed gastrointestinal and hepatic malignancy
5. The ability to practice diagnostic and therapeutic upper GI endoscopy and in other practical skills undertaken/overseen by a Gastroenterology Consultant
6. Contributing to the prevention of gastrointestinal and liver disease

Gastroenterology CiPs Themed for service (one of two options)

1. Managing complex problems in luminal gastroenterology
2. Managing complex problems in hepatology

For further information about the CiPs, please carefully read the Specialty Curriculum and CESR Specific Guidance in Gastroenterology.

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Evidence Types

The types of evidence listed below will be required to demonstrate that your specialty training, qualifications and experience are equivalent to the CCT in Gastroenterology:

For explanations of exactly what is required for the evidence types mentioned above, please carefully read the CESR Specific Guidance in Gastroenterology.

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Unsuccessful applications or poor evidence

Unsuccessful applications from doctors in the specialty of Gastroenterology are often submitted with inadequate or poor evidence in these areas:

• Failure to pass the European Specialty Examination in Gastroenterology and Hepatology (ESEGH)
• Lack of evidence of appropriate length and depth of training in Core Hepatology and Core Nutrition as required by the CCT Curriculum in Gastroenterology
• Lack of evidence of adequate numbers of formal assessments reflecting the requirements as set out on the Gastroenterology ARCP Decision Aid.
• Submitting evidence from more than five years ago with no recent supplementary information
• Failure to display evidence clearly – it is vital that your evidence is well organised and clearly structured and indexed fully to allow assessment.

Before making your application for CESR in Gastroenterology you are encouraged to review the CESR Specific Guidance in Gastroenterology in conjunction with the CCT curriculum in Gastroenterology.

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Can I apply for CESR without having worked in the NHS?

If you haven’t worked in the NHS then it can be very difficult to make a successful CESR application. This is because key features of training and practice in the NHS are not always covered in the same way outside it. For example, MDT meetings, appraisal, multisource feedback and patient feedback, safety, and quality activity especially in clinical audit and quality improvement projects and other areas.

The vast majority of international Gastroenterologists will complete their CESR applications from within the UK, having taken up employment with an NHS organisation. If you’re considering making a CESR application and are currently, or have recently, been practising in an environment that is not comparable to practice in an NHS Gastroenterology department, then you might find it useful to consolidate your experience in the UK beforehand.

Doctors Relocate works alongside NHS organisations across the UK that can support CESR applicants. To further discuss how we could assist you, please contact us.

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This article has been created to assist doctors who are applying for entry onto the GMC Specialist Register with a CESR in Gastroenterology only. We do not offer any CESR advice, nor can we comment or assist with any individual application. If you have a query regarding the speciality-specific guidance, then please contact the GMC.