The Portfolio Pathway (formerly known as CESR) is the route to specialist registration for doctors who have not completed a GMC-approved training programme, but who are able to demonstrate that they have the knowledge, skills and experience (KSEs) required for practising as an eligible specialist in the UK.
The standards of assessment have changed from ‘equivalent to CCT’ to knowledge, skills and experience and this came into practice in November 2023. Find out more here about the standards that Portfolio Pathway applications are assessed against and for access to the Portfolio Pathway evidence guidance.
Who’s eligible to apply for a Portfolio Pathway (formerly CESR)?
To be eligible to apply for the Portfolio Pathway, you must have either undertaken specialist training for a minimum of six months or been awarded a specialist qualification in O&G by a non-UK country. More information about eligibility and the application process is available via the GMC website.
How do I apply for a Portfolio Pathway (formerly CESR)?
- You will need to apply to the GMC, who will then send your application to the RCOG for evaluation. We urge that when you have started an application with the GMC and are in the process of amassing your evidence you contact the Portfolio Pathway Manager at the College to double check on any curriculum requirements you are unsure of. This is particularly important for all non-UK applicants who are attempting to provide comparable evidence to RCOG approved training, such as ATSMs.
- Once the GMC has informed you that your application is complete and it 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 final decision.
Historically, the CESR (as it used to be known) was ‘equivalent’ to the CCT and certified that the recipient was eligible to apply for consultant posts in the UK. Applicants for a CESR were assessed against the standards required for the award of the CCT in O&G.
Since November 2023, whilst the standards that the applications are assessed against differ, the outcome of a successful Portfolio Pathway application remains the same; a successful applicant will be added to the Specialist Register to work as a O&G consultant in the UK. It is not ‘equivalent’ to CCT, because applicants can now demonstrate they have the ‘knowledge, skills and experience’ to enter the Specialist/GP Register, rather than that their training was ‘equivalent to a CCT in the specialty in question’.
Why were the standards changed?
For further details on why the changes were implemented, please view our recent webinar presentation slides which can be found here.
As stated above, you will need to apply to the GMC, who will then send your application to the RCOG for evaluation. We urge that when you have started an application with the GMC and are in the process of amassing your evidence you contact the Portfolio Pathway Manager at the College to double check on any curriculum requirements you are unsure of. This is particularly important for all non-UK applicants who are attempting to provide comparable evidence to RCOG approved training, such as ATSMs.
Clinical evidence from both obstetrics and gynaecology should be provided from the last five years, demonstrating contemporary, independent competence in the required procedures. This should be evident in your logs of experience and WPBAs.
MRCOG (or equivalent)
Without the MRCOG or one of the other four qualifications listed in the guidance, it is unlikely 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 (MRCOG Part 1, 2 and 3) has been covered in their own qualifications, it will be assessed on a case-by-case basis. The applicant will need to undertake an extensive and onerous level of work to justify the level of equivalence required to be successful. It is, therefore, not recommended.
Applicants must complete the required competences for a minimum of two ATSMs.
If you have completed RCOG ATSMs, please provide the completion certificates only (BSCCP accreditation is considered equivalent to one RCOG ATSM. Therefore, if you have a BSCCP accreditation, please provide your accreditation certificate.)
If you have not completed RCOG ATSMs, you must provide other evidence to meet the requirements of the specific ATSM curricula as outlined on the RCOG website (both theoretical and practical).
Full primary evidence is required, presented in two consolidated files (one for each ATSM). These should be considered as two separate portfolios of evidence, in addition to your required core evidence, even if there is some overlap or repetition. Your evidence should be clearly mapped/cross-referenced to each individual item of the curriculum, for assessor navigation and ease i.e. you may provide a cover sheet or use the GMC’s ‘evidence summary’ section confirming what evidence you have provided to meet each key skill, the same approach that should be taken to present your core evidence.
In these instances, please liaise with the Portfolio Pathway Manager to discuss how you intend to approach presenting your ATSM equivalence evidence, as it can often be a challenge for applicants to do so, therefore college advice from the outset is advised.
A breakdown of knowledge, skills and experience
Each key skill should be linked to evidence of either Knowledge, Skills or Experience.
The best evidence for a particular key skill will cover all three areas; knowledge, skills and experience. However, an applicant can use their judgement regarding whether they can cover a key skill effectively – i.e. an applicant may have a great deal of experience in one area to cover all descriptors; and courses (knowledge) are therefore not necessary. Some examples of how it may work are below:
- Some may be covered by knowledge, skills and experience (ideal evidence).
- Some may be covered by just skill and experience (i.e. if an applicant’s clinical experience outweighs the need for demonstrating knowledge via a course/teaching session).
- An applicant may be able to cover two key skills at the same time with one piece of good evidence.
The above comes with a strong recommendation for applicants to really ensure key skills and descriptors are met. It is unlikely an applicant will fulfil a CiP demonstrating knowledge alone – a mixture of knowledge and practical experience is therefore strongly advised, in order to be successful.
Any evidence written in bold in the guidance document is mandatory.
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 and the summative OSATS required must categorically confirm independent competence with appropriate assessor comments and sign-off. 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.
Sequential annual appraisal along with personal development plans must be provided from the last five years.
For full information on evidence required for the Portfolio Pathway, please read the Portfolio Pathway evidence guidance document here.
SITMS will be available (subject to GMC approval) from August 2024.
Portfolio Pathway (formerly CESR) applicants will then have the option to apply with the current ATSMs or use the 2024 SITMs during a transition period of two years from implementation of 1 August- 31 July 2026. Any ATSMs completed before implementation or within two years of its implementation will continue to be valid for the Portfolio Pathway. Once the transition period finishes (31 July 2026), ATSMS will be fully decommissioned and Portfolio Pathway applicants will have to apply with the SITMs as part of their Portfolio Pathway application. Doctors who have already started their ATSMs at the time of implementation will have the choice to either stay on the ATSMs or move to SITMs. A combination of ATSMS and SITMS will be accepted during the two-year transition period.
Three structured reports are required under the new guidance post November 2023. One must be from your current clinical director/head of department/chief of service and two should be from consultants/senior SAS doctors (acting at consultant level). These should be from current employment (unless you have just taken a new position in the three months prior to submission) and the referees should have worked with you for a minimum of six months. For further information, please contact the GMC directly.
The RCOG’s Portfolio Pathway 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 an applicant’s knowledge, skills and experience can categorically determine an applicant’s abilities to work as a day one obstetrics and gynaecology consultant in the UK. If you are successful, you will be recommended for entry 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 Portfolio Pathway Manager 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. This can involve some back and forth with the applicant until the GMC are happy that all required evidence has been submitted and that it meets all the key skills appropriately. 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. Please also check on anything you are unsure of with the Portfolio Pathway Manager at the RCOG, or 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 they are informed of the outcome of the assessment.
As stated 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 will be able to submit a review application within twelve months of receiving the decision letter regarding the outcome of your application. This involves 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 the Portfolio Pathway 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 Portfolio Pathway applications alike, it is a requirement that doctors 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 Portfolio Pathway 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.
Changing working patterns have resulted in many doctors now working in either obstetrics or gynaecology but not across both, some work solely in subspecialist areas. This can cause difficulty in evidencing Knowledge, Skills and Experience across the full curriculum of obstetrics and gynaecology for entry onto the specialist register via the Portfolio Pathway route.
An alternative to the Portfolio Pathway for doctors working at a similar level to consultants but in niche areas is a new post, called specialist grade. This is a new senior medical post which recognises specialist skills, enabling the post holder to work in extended roles with increased autonomy. Appointments to specialist grade can be made in obstetrics alone or gynaecology alone or even in a subspecialty and do not require evidence across the full curriculum.
A doctor does not have to be on the Specialist Register to apply for a specialist doctor post. The entry criteria for the specialist post is minimum twelve years (ten in Scotland) postgraduate experience with minimum six years in relevant specialty. The generic capabilities in the GMC framework need to be evidenced alongside role specific competencies.
Yes, you are able to apply for the Portfolio Pathway and have your application assessed, but you cannot be awarded the Portfolio Pathway until you have obtained full GMC registration.
No. Unlike the CCT, other EU states are not obliged to recognise the Portfolio Pathway.