Portfolio Pathway vs CESR
What has changed? (gmc-uk.org)

This change gives GMC more flexibility to accept a broader range of evidence, and won’t disadvantage any applicants.

It came into effect on 30 November 2023.

What was the previous position?
Previously, we must have been satisfied that:

An applicant’s specialist training and qualifications, when both taken together, were equivalent to CCT in the relevant specialty.

The prescriptive and inflexible nature of the legislation meant that applications for specialist and GP registration were overly bureaucratic, complex to navigate, and burdensome to satisfy.

What is the new position?
The amended legislation no longer refers to equivalence. Instead, it requires applicants to demonstrate that they have the ‘knowledge, skills and experience required for practising as an eligible specialist or GP in the UK’.

This change does not represent a different, or lower expectation of applicants. It ensures consistency across all pathways to specialist and GP registration, now and in the future.

Applicants need to demonstrate that their knowledge, skills and experience align to the high-level learning outcomes of the GMC-approved UK curriculum in the relevant specialty, rather than mapping their evidence to the full detail of the relevant CCT curriculum.

WPBA( work place based assessment) tools used for RCEM-kiazen ePortfolio.

Mini-Clinical Evaluation Exercise (Mini-Cex)

This tool evaluates a clinical encounter with a patient to provide an indication of competence in skills essential for good clinical care such as history taking, examination and clinical reasoning. The trainee receives immediate feedback to aid learning. The mini-CEX can be used at any time and in any setting when there is a trainee and patient interaction and an assessor is available.

Direct Observation of Procedural Skills (DOPS)

A DOPS is an assessment tool designed to evaluate the performance of a trainee in undertaking a practical procedure, against a structured checklist. The trainee receives immediate feedback to identify strengths and areas for development.

Case-based Discussion (CbD)

The CbD assesses the performance of a trainee in their management of a patient to provide an indication of competence in areas such as clinical reasoning, decision-making and application of medical knowledge in relation to patient care. It also serves as a method to document conversations about, and presentations of, cases by trainees. The CbD should focus on a written record (such as written case notes, out-patient letter, discharge summary).

Extended Supervised Learning Event (E or ESLE)

The ESLE is an extended event of observation in the workplace across cases. It covers interactions, decision-making, management and leadership, as well as the trainee’s individual caseload. The event will characteristically be 3 hours in length, with around two hours of observation followed by around one hour of feedback. The trainee will be observed during their usual work on shift, but the consultant observer will be supernumerary, i.e. ‘not in the clinical numbers’. Feedback will take place in a debrief using the RCEM non-technical skills feedback tool. These events will be completed by the educational/ clinical supervisor and at least one other consultant or equivalent. Each will yield an educational prescription to facilitate development across the academic year. The first must be completed within the first three months of the training year.

Acute Care Assessment Tool (ACAT (GIM), ACAT(EM))

The ACAT is designed to assess and facilitate feedback on a doctor’s performance during their practice on the acute medical take, and is used in AM (ACCS). Any doctor who has been responsible for the supervision of the acute medical take can be the assessor for an ACAT. This tool can also be used to assess other situations where a trainee is interacting with a number of different patients (eg in a day hospital or a business ward round). It can be used as a mini ESLE where multiple patients can be assessed at one time especially in EM.

Portfolio Pathway (formerly CESR ) vs CCT

Portfolio pathway(CESR) is the best route for entry on the specialist register especially for those for who have trained outside the UK.

It let's you complete all your competencies in one trust if you get the right support.

Ideal for candidates living with family and having children in school as its difficult to move places as in training.

Your pay scale may be higher if you are working as Specialty doctor or SAS compared to trainee doing CCT.

If you get the right support by your trust you might also submit your application in 3-4 years.

It needs lot of self motivation and zeal to be on the Specialist Register. Key is hard work which requires guidance and collection of evidence to the skills, knowledge and attitude required to fulfill the requirements of the 2021 Emergency Medicine cirriculum.

CCT is ideal for candidates who haven't trained in Emergency Medicine before. Once you are a trainee you will have a dedicated educational supervisor,  yearly ARCP to check your progress and make sure who have exit on the Specialist Register.

Nowadays, candidates doing CESR/portfolio pathway are preferred as they have been working in the same department for years and if they have the right attitude and skills set they might have more chances of being selected as a consultant in their own department.

If you want to work in the UK once you are on the Specialist Register it doesn't matter whether you did CCT or portfolio pathway ( CESR).