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Certificate of Eligibility for Specialist Registration (CESR)

The CESR, or Certificate of Eligibility for Specialist Registration, is the route to specialist registration for doctors who have not completed a GMC-approved programme but who are able to demonstrate that their specialist training, qualifications and experience are equivalent to the requirements for the award of the CCT in the UK.

CESR holders can apply for substantive consultant posts in the UK.

Who’s eligible to apply for a CESR?

To be eligible to apply for a CESR, you must have either undertaken specialist training for a minimum of 6 months or been awarded a specialist qualification in O&G by a non-UK country. More information about eligibility is available from the GMC website.

How do I apply for a CESR?

You will need to apply to the GMC, who will then send your application to the RCOG for evaluation. Making an application to the GMC can be an extremely lengthy and potentially stressful process and it is very important that you read the GMC’s general guidance and specialty-specific guidance before starting to put together an application.

You’ll need to provide a portfolio of evidence demonstrating that your specialist training and/or specialist qualifications are equivalent to the award of a CCT in O&G in the UK.

Full details of the application process are available on the GMC website.

Once the GMC has sent you a letter informing you that your application is complete and has been sent to the RCOG for assessment, the RCOG is not permitted to discuss your case with you until the GMC has sent you a letter informing you of the decision.

The CESR is equivalent to the CCT and certifies that the recipient is eligible to apply for Consultant posts in the UK. Applicants for a CESR are assessed against the standards required for the award of the CCT in O&G.

In essence, you would apply directly via the GMC to register and begin an application. They will advise applicants regarding how to apply, the eligibility criteria and the evidence that would be required.

Clinical evidence

Clinical evidence across both obstetrics and gynaecology should be provided from the last 5 years, demonstrating current, ongoing, independent competence in all surgical procedures i.e. if you are specialising in just one area – for the purposes of CESR, you will still need to demonstrate regular involvement and maintenance of skill across both. This should be evident in recent rotas and your logs of experience.

MRCOG (or equivalent)

Without the MRCOG or one of the other four qualifications listed in the guidance, it is not likely you will be successful. Whilst there is an option for applicants to provide A detailed, thorough and succinct cross-referencing mapping exercise, demonstrating how each and every MRCOG competency (Part 1, 2 and 3) has been covered in their own qualifications and how, it will be assessed on a case by case basis and will involve the applicant to undertake an extensive and onerous level of work to justify the level of equivalence required to be successful. It is therefore not recommended.

WPBAs

Documentary evidence provided must be from the period in which it was undertaken – e.g. WPBAs must be from the period that the applicant undertook training. Assessments and appraisals cannot be signed off retrospectively. OSATS, Mini-CEX and CbDs must be signed off by supervisors concurrently with when the assessment takes place (or no longer than three months after the assessment takes place).

OSATS

3 summative OSATS for each surgical procedure, from the required timeframe are required

Appraisal

Sequential annual appraisal along with personal development plans must be provided from the last 5 years

Communication

Evidence of two-way communication and collaboration over the management of patients must be provided, ensuring your responses to and from colleagues are linked and the patient outcome is clear

Courses

Completion of all courses listed must be evidenced from the last five years, or relevant practical experience will be considered, where stated. Note that completion of Courses in ‘strongly recommended’ areas are generally expected

Case histories

Must be formalised and written as if for publication. (These should not be copies of referral letters or discharge summaries). They should detail the nature of your involvement in the management of the case (including discussion on the patient management plan, the rationale for this management, the nature of your involvement and your own reflections on the case). *Copies of referral letters will not suffice.

Reflective practice

Please ensure your reflection fully details how the activity contributed to the development of your own knowledge, skills or professional behaviours, ways in which your own behaviour may change as a result of reflecting on the event and what difference this will make to patient safety and quality

Multidisciplinary Team meetings (MDT)

There is often confusion between clinical governance and MDT meetings. *Both of which are required. However, MDT meetings should demonstrate your participation in discussions regarding specific patient management discussions and plans e.g. Colposcopy MDT, Urogynaecology MDT, etc.

ATSMs

Applicants who haven’t completed two RCOG ATSMs are strongly advised to carefully follow the ATSM curriculum outlined on the RCOG website and complete all relevant logbooks and additional work and documentation that goes with that – WPBAs, audits, reflection, etc.

Who should I ask to be my referees?

You need to provide the details of 6 people who have agreed to act as your referees, who can attest that you possess the full range, depth and breadth of competencies in the curriculum document. One of your referees must be your current Clinical or Medical Director.

For further information, please see the GMC’s guidance on selecting referees.

You will need to submit your application to the GMC. The RCOG’s Equivalence Advisory Group assesses applications on behalf of the GMC. Members of the Group are trained Fellows and Members of the RCOG who will determine whether your training, qualifications and experience are equivalent to the requirements of a CCT. If they are found to be equivalent, you will be recommended for entry on to the Specialist register.

The GMC makes the final decision on who enters the Specialist register and may overturn the RCOG’s decision, but this is rare.

Canvassing on behalf of applicants through any source is not permitted. It is therefore inappropriate to approach members of the Group about your application. If a Group member has a personal or professional relationship with you, they will be excluded from assessing your application.

You may be able to contact the College's Policy Coordinator for an update on the status of your application i.e. what stage of the process it is at, but the College can tell you no more than this. In addition, as the GMC have the application for an undetermined period of time after the College has completed their assessment, it may be more beneficial to liaise directly with the GMC regarding when a decision is likely to be made.

The GMC first needs to ensure all application documentation has been received, including structured reports from referees, before sending the completed application to the RCOG. They can involve some back and forth with the applicant until the GMC are happy that all required evidence has been submitted. This part of the process can be lengthy, as the GMC may need to ask you for further information.

When they are satisfied with their preliminary assessments it will then be passed onto the College for evaluation. To help the process advance as quickly as possible, please read all the GMC guidance carefully before submitting your application to ensure you provide all the documentation required, and respond promptly to requests for further information from the GMC.

The College has exactly seven weeks to submit their evaluation. Combined with the time the GMC will then need to reach their final decision, applicants should expect that it will take approximately two to three months before and they are informed of the outcome of the assessment.

As above, only the GMC can update you on the progress of your application. Please contact the GMC Certification Officer with whom you have been corresponding for further information.

You would be able to submit a review application within twelve months of receiving the decision letter regarding the outcome of your application. This would involve submitting the evidence that you did not submit in the first application. Alternatively, under specific circumstances, you may be able to appeal against the decision.

For more information about reviews and appeals, please contact the GMC directly.

One can apply for a CESR in a non-CCT specialty (e.g. gynaecological oncology, maternal and fetal medicine, reproductive medicine, sexual and reproductive health care or urogynaecology).

Trainees on the RCOG sub-specialty training programme in one of these specialties begin their training from ST6 onwards. Therefore, for formal subspecialty accreditation, *or equivalent non-CCT CESR applications alike, it is a requirement that trainees demonstrate achievement of both the outcomes set in the approved specialty curriculum and those set out in the approved subspecialty curriculum.

In summary, a ‘day one’ consultant in the UK health services will be required to demonstrate cross-specialty knowledge and experience; covering core O&G competences, in addition to the subspecialty competences. Non-CCT CESR applications must demonstrate up to date, ongoing competence of both O&G and their relevant subspecialty. As a result, the College advises a cross-specialty approach to your application, taking into account the requirements of both the O&G curriculum (outlined in the O&G specialty specific guidance), as well as the relevant subspecialty training requirements. 

For further information, please contact the GMC directly.

Yes, you would be able to apply for the CESR and have your application assessed, but you would not be awarded the CESR until you had obtained full GMC registration.

No. Unlike the CCT, other EU states are not obliged to recognise the CESR.

If this page doesn’t answer your question, or you need more information, please contact Mrs Gemma Mordecai via email at  or call +44 20 7772 6451.