Changes to the CESR pathway

The GMC renamed the CESR pathway to Portfolio pathway on 30 November 2023. The GMC states that the new name better describes the application process. Portfolio pathway will be used in the GMC’s documentation, correspondence, and webpages from this date. For more information about the changes visit here.

Key changes

Key to abbreviations

• CbD – Case-based discussions
• DOPS – Direct observation of practical skills
• ES – Educational supervisor
• MCR – Multiple Consultant Reports
• Mini CEXs – Mini clinical evaluation exercise
• MSF – Multi-source feedback
• QIPAT – Quality Improvement Project Assessment Tool

Eligibility guidance for applicants

Doctors may apply via the Portfolio pathway in a CCT specialty if they have training, qualifications and experience in dermatology but have gained these partly or completely outside of an approved UK CCT training programme eg have trained outside the UK, moved abroad or taken a career break. The Portfolio pathway in the UK CCT specialty of dermatology requires demonstration of competences according to the CCT curriculum, which includes acute dermatology, paediatric dermatology, and community dermatology.

Eligibility to start an application

• You must have a specialist qualification in dermatology e.g. Specialty Certificate Examination (SCE) or at least six months continuous specialist training in dermatology
• The specialist qualifications are:
  • Internal Medicine (IM) – MRCP (UK) or comparable qualification to the same level
  • Dermatology – SCE in dermatology or comparable test of knowledge to the same level

The Royal College of Physicians (RCP) is responsible for setting Internal Medicine (IM) requirements and the BAD is unable to respond to applicants’ questions regarding IM Training (IMT). We recommend applicants contact the IMT or Training Programme Director (TPD) at the Deanery of their local Trust for guidance and advice in meeting these requirements, which may require a period of time in an IMT level job.

For applicants who do not have MRCP or SCE

If you do not hold the MRCP (UK) or SCE or a comparable qualification, you can demonstrate the same level of knowledge by providing a detailed, thorough and succinct cross-referencing mapping exercise. This must demonstrate how each competency in the qualification has been covered by your own qualifications. The evaluators will then determine whether your evidence is comprehensive enough to demonstrate the same level of knowledge. It will be assessed on a case-by-case basis and will require you to produce a portfolio of evidence.

Before you apply

You are advised to contact the GMC at portfolio@gmc-uk.org to discuss the collection and collation of evidence.

• Refer to the Specialty specific guidance on evidence to be submitted with your dermatology application. This applies particularly to applicants for the Portfolio pathway in a CCT specialty, but most non-CCT Portfolio pathway applicants should also consult it for examples of evidence. All the specialty specific guidance documents are based on the latest curricula and information provided by the RCP.
• The dermatology curriculum states that doctors must be able to manage concurrent general medical problems in adult patients, within the context of dermatological disease, without immediate recourse to other specialists and in isolated units
• Review the Internal Medicine as well as the Dermatology Curriculum 2021 which includes the high-level learning outcomes or Capabilities in Practice against which your evidence will be assessed. Internal medicine core training can also be found on the same GMC webpage.
• Review the JRCPTB Workplace Based Assessment tools which may also be adopted by Portfolio pathway applicants; these will assist in the assessment of existing or new dermatology competences. The dermatology curriculum makes specific reference to these assessment tools against the relevant competence.

Required evidence

Primary evidence outweighs secondary. You must provide a variety of sources to meet the Capabilities in Practice and overall domain requirements. Do not duplicate evidence, it should be triangulated through your referencing.

Primary evidence

• Qualifications
• Medical reports, clinic letters, meeting minutes
• Logbooks
• Training assessments and supervised learning events

Secondary evidence

• 360^o multi-source feedback
• Testimonials
• Structured reports and supervisor reports
• Reflective diaries

Currency of evidence

• Evidence can be drawn from any point in your career
• Corresponding evidence within the last five years of clinical practice whole time equivalent (WTE) to confirm maintenance of skill or competency, approximately 50% of evidence for each curriculum outcome
• If evidence is not within the last five years (WTE), provide further evidence demonstrating maintained capabilities in those specific areas at the level of senior independent clinician
• More weight is given to recent practice in the last five years to reflect current capabilities

Internal Medical Training (IMT) experience and competencies

Provide evidence demonstrating medical knowledge and application of this knowledge in practice to the level of completion of Internal Medicine stage 1 training. This can be demonstrated through the general and clinical CiPs of the curriculum. Applicants will need MRCP (UK) or a comparable assessment of applied knowledge, and the additional evidence on page 16 to demonstrate IMY2 clinical competencies. There is no specific mention of qualifications other than MRCP (UK) in the Dermatology Specialty Specific Guidance.

IMT year 2 competencies

• ES report covering IM competencies
• One MCR covering IM experience
• One of the referees for the structured report must be from Internal Medicine
• Advanced Life Support (ALS) certification
• Supervised learning events (SLEs) e.g. Outpatient Care Assessment Tool (OPCAT), Acute Care Assessment Tool (ACAT), CbD, mini-CEX and DOPS
• Evidence showing experience in critical care, this can come from any point in your career

How to apply

Applications are made online, through the GMC website. Visit the Portfolio pathway application webpage for full information. Your application will need to be supplemented by supporting evidence and structured reports from four nominated referees.

The GMC online portal application is open for 24 months once initiated.

Guidance on selecting referees

Applicants must provide the names and details of four referees whom the GMC can contact to ask for structured reports.  Further details on how to select your referees can be found on the GMC website here.

Application outcomes and appealing a decision

You can apply for a review within 12 months of receiving the decision on your application if:

You have additional relevant documentary evidence that addresses the shortfalls set out in the decision that you have not previously submitted, or

You have completed the top-up training set out in the decision, or

You consider that there has been a procedural error or other unfairness in the way the GMC has processed your application or made their decision.

Keep track of your progress

• Have a supervisor and regular appraisals
• Check your progress every 6-12 months
  • How much of the curriculum have you met?
  • Do you have enough appropriate evidence?
  • Are your evidence types acceptable?
  • Do you need to spend some time at a different department or hospital?