How to Get CESR in Clinical/Medical Oncology

Many international doctors moving to the UK work in junior positions before training in a specialty. However, that isn’t the only route. If you were a specialist doctor in your home country and have the skills and experience to prove your competencies, there is the option of CESR.

With the CESR (Certificate of Eligibility for Specialist Registration), your name joins the specialist register, allowing you to become a consultant-level doctor in your chosen specialty. In this case, that would mean working as a clinical or medical oncologist, earning between £93,666 to £126,286 per year, and possessing high levels of responsibility.

Clinical Oncology vs Medical Oncology

Some international doctors may be confused about the difference between clinical and medical oncology. Choosing the right specialty is important when applying for the CESR, as you’ll need to prove you have the specific skills required for that specialty.

In the NHS, medical oncologists diagnose, treat, and generally manage cancer patients, with the goal of providing the best possible outcome, whether through a cure or palliative care. Clinical oncologists do not diagnose patients. Instead, they determine the treatment, working with the patient and colleagues to create the best treatment plans. They typically work in the radiotherapy department.

To become either a clinical oncologist or medical oncologist in the NHS, most doctors go through CCT. However, if you have the experience and skills required for the role, you can skip specialty training and go straight to practising as a consultant through CESR. Of course, getting the CESR isn’t exactly easy. It’s a long process that requires you to gather a wide range of evidence proving that you can safely practise as a specialist doctor.

Keep in mind that the curriculum and evidence required for the CESR may change over time – this guide is relevant in August 2023. If you’re reading this later, check the latest GMC guide to CESR to ensure your application is up to date with their requirements.

Eligibility for CESR in Clinical/Medical Oncology

 International doctors can apply for the CESR on the GMC website, where you must supply your evidence documentation. Once the application is sent, the GMC will send the application over to RCR (Royal College of Radiologists) for assessment. You’ll later receive a letter with the final decision about your application. 

To be eligible to apply for the CESR in clinical/medical oncology, you need at least six months of experience in specialist training or a specialist qualification. Keep in mind that while you only need six months of experience in clinical/medical oncology training to apply, the CCT curriculum (Certificate of Completion of Training) covers six years of training for UK doctors, including four years of specialist training. To have the required evidence for the CESR, you’ll likely need the same number of years of training.

You must also be GMC registered to apply for CESR. In terms of evidence, the GMC requires recent, relevant evidence, preferably from the past five years. Evidence from further back than five years will not hold as much weight.

Submitting Evidence for CESR in Medical or Clinical Oncology

You will need a lot of evidence for the CESR application process. The GMC recommends around 100 documents for a completed application, but this can vary. What’s more important is that the evidence you submit is relevant and recent, covering a breadth of cases. The type of evidence you submit will vary, too, from patient feedback to on-call rotas to audit notes. This is to prove you can work as an oncologist in all aspects of the role.

The evidence must be accurate and clear. If any of the evidence is not in English, you will need to submit the original copy alongside a professionally translated version. Also, you must anonymise your evidence to protect patient confidentiality. While you can include the gender and date of birth of a patient, you cannot include any other identifiable personal details, such as names, addresses, patient numbers, or relatives.

You will submit your evidence to the GMC. The application has a structure to follow that is tailored to the CCT curriculum. When giving your evidence, you must cover all areas of the curriculum – you cannot make up for a missing section elsewhere.

Education, Training, and Employment

As you will have already submitted your primary medical qualification for GMC registration, it won’t be necessary during the CESR application. If you have any specialist medical qualifications, you will need to submit those. While a single oncology qualification cannot grant you automatic access to the specialist register, it can help your application overall. You may also submit any other qualifications relevant to your application, such as a teaching or leadership qualification. Make sure you include all relevant details about your qualifications, including the syllabus and assessments.

In terms of training, include any specialist training in approved posts you completed within the last five years. You should also provide an authenticated copy of your specialist registration if you were part of the specialist register in your home country.

You’ll also need to prove your past and current employment as a doctor. That will include submitting employment letters, with details including job title, grade, and type of employment.

Submitting Evidence for Capabilities in Practice

Your evidence needs to meet the current curriculum. That involves ticking off particular CiPs (Capabilities in Practice) learning outcomes. These are crucial, as they prove you have the same capabilities as other specialist NHS doctors and that you, too, can work safely at a consultant level.

When applying for CESR, there’ll be a section for each CiP to prove you meet with evidence. Here, we will dive into all the CiPs for medical and clinical oncology specialty for your CESR application, including what they are and the evidence you should provide for each.

Generic CiPs

These CiPs are general for all specialist doctors working for the NHS.

•  Able to function successfully within the NHS organisational and management systems 

This CiP is specific to working for the NHS. You must demonstrate your awareness of GMC professional requirements and the general public health issues in the UK, alongside other capabilities like the ability to lead a team in a clinical setting. Some of the best evidence to prove this is clinical governance activity, reflective activity, and quality activity. So, for example, for clinical governance activity, you could submit the minutes of a clinical governance meeting, including the agenda, what was discussed, and the outcome.

•  Able to deal with ethical and legal issues related to clinical practice 

To prove you meet this CiP, you’ll need to demonstrate that you can offer apologies (when necessary), behave according to ethical/legal requirements, and always consider ethical/legal requirements when leading a clinical team. Suggested evidence from the GMC includes reflective activity, complaints, and case-based discussions. For example, reflective activity may include a time you reflected on past cases to take the patient’s mental capacity into account.

•  Communicates effectively and is able to share decision-making, while maintaining appropriate situational awareness, professional behaviour, and professional judgement 

This one focuses a lot on communication; your evidence will need to prove you can communicate clearly in a clinical setting (with both patients and colleagues). It’ll also need to show your ability to share decision-making. Good evidence for this would be a report from a colleague you have worked with, such as an MCR.

•  Is focused on patient safety and delivers effective quality improvement in patient care 

For this CiP, you must demonstrate your ability to prioritise patient safety. On top of that, you’ll need to show how you have contributed to quality improvement during your time as a doctor. Good documents for this include quality improvement activity, reflective practice entries, and feedback from colleagues.

• Carries out research and manages data appropriately

To demonstrate that you can professionally manage clinical data and understand its role in the medical world, the GMC requires evidence such as Multiple Consultant Reports, appraisal reports, and feedback from coworkers. Evidence of GCP (Good Clinical Practice) training is also good evidence to prove this.

• Acts as a clinical teacher and clinical supervisor

The key skills you must demonstrate for this CiP include teaching medical students, providing feedback, and supervising clinical trainees. For this, suggested documentation includes MCR, feedback from colleagues (particularly teaching observation feedback), and completion of training courses in leadership or teaching.

Oncology-specific CiPs

These CiPs are specific to any oncology speciality, including medical and clinical oncology.

•  Applying knowledge and understanding of scientific principles that underpin malignancy for the provision of high-quality and safe patient-centred care 

The key skills required for this CiP include knowledge and understanding of cancer biology, radiation biology, anticancer therapies, the physics of radiotherapy, clinical trials, and the causes and risks of cancers. You can use several types of evidence to demonstrate this knowledge, including Specialty certificate examinations, GCP training, reflective activity, and reports from other consultants you have worked with.

•  Delivering the acute oncology take, manage oncological emergencies, provide advice to the other healthcare professionals as part of an Acute Oncology Service (AOS) and manage the AOS team and the palliative care/ end-of-life needs of those with advanced cancer. 

For this CiP, you must show you can assess and manage patients needing acute oncology care. That means liaising with other specialists, managing targeted investigations, making fast decisions (particularly for resuscitation), and leading an Acute Oncology team. The GMC suggests you submit evidence along the lines of reports from consultants you’ve worked with, feedback from colleagues, clinical notes, and work-based assessments.

•  Providing continuity of care to oncology in-patients to include the effective management of disease and treatment-related complications, medical conditions, and the acutely deteriorating patient 

Your evidence must prove you can manage patient care safely while they are an in-patient, particularly when they are showing complications and are at the end of life. You’ll need to consider treatment options, effectively managing symptoms while taking the patient’s wishes into account. You can use reports from consultants, radiotherapy evidence, and colleague feedback to demonstrate your ability to do this.

•  Working effectively within and contribute expert opinion to the tumour-site specific multi-disciplinary team meeting (MDT) to inform evidence-based management plans individualised to the needs of each patient, leading discussions where appropriate. 

For this CiP, you must show you understand the treatment options for different cancers and tumours. You’ll also need to prove you can submit cases in multi-disciplinary team meetings clearly and concisely, answering questions at the end. Documents to back up these skills include reports from consultants you have worked with, reflective activity, and colleague feedback.

•  Assessing patients at all stages of the cancer pathway, from diagnosis to end-of-life care, considering the holistic needs of individuals and the additional needs of vulnerable groups to formulate patient-centred management plans 

This CiP involves taking individual patient needs into account, focusing on vulnerable groups. You’ll need to demonstrate that you can develop appropriate management plans based on each patient as an individual, always considering holistic needs. The GMC suggests providing documents such as consultant reports, clinical documentation, and feedback to prove these skills.

•  Safely and effectively delivering and managing patients receiving standard systemic anticancer therapy (SACT) in the curative, neoadjuvant, adjuvant and palliative settings. 

For this CiP, you must show that you can choose the most appropriate standard systemic anticancer therapy for each case, modifying the treatment plan depending on the patient’s individual needs. You must show you can safely and accurately provide this treatment and can clearly communicate with the patient both the risks and the benefits. Good evidence to prove this includes Multiple Consultant Reports, SACT evidence, and feedback from colleagues.

•  Acting as an advocate for health promotion and high-quality cancer survivorship, advise on cancer prevention, management of long-term treatment-related sequelae and patient self-management strategies 

You will need to show you understand health inequalities, including economic and cultural factors using suggested documents such as reports from other consultants, feedback from colleagues, feedback from patients, and audit notes. You’ll also need to prove your ability to promote survivorship after cancer treatments, taking things like genetics and lifestyle into account.

CiPs for Medical Oncology

These CiPs are specific for a CESR application in medical oncology.

•  Safely and effectively deliver, and manage patients receiving intensive complex systemic anticancer therapies. 

At its core, this CiP is about treating and managing patients while they are going through complex systemic anticancer therapies for their cancer. Some specific skills you need include communicating with the patient about the risks and benefits, reviewing the complex systemic anticancer therapies, generating a prescription that is tailored and safe for the patient, and managing potential complications of the treatment. The GMC suggests using documents like feedback from colleagues and reports from other consultants. A key piece of evidence here is anything demonstrating your SATC competence.

•  Developing guidelines and protocols to safely implement new and emerging diagnostic and systemic anticancer therapeutic approaches 

For this CiP, you’ll need to take regulatory agencies into account for the cancer treatment. You’ll demonstrate you can use a range of data and resources and use them when prescribing treatments. You can use evidence such as GCP training, consultant reports, feedback, and audits for this.

•  Managing the training and supervision of non-medical prescribers of systemic anticancer therapies 

This one is about demonstrating your ability to manage the training of non-medical prescribers. You must show you can support their training, create suitable learning opportunities, and assess their performance throughout. For this, evidence of your supervision works well.

•  Integrating biomarkers and genomic information to refine diagnosis and develop personalised treatment plans for cancer patients 

With evidence such as consultant reports, feedback from other colleagues, and workplace assessments, you will show you understand whole genome sequencing and gene expression. You’ll understand the role of biomarkers and genomics in the development of treatment plans, as well as the ethical issues associated with it. One of the best pieces of evidence for this is a SCE in Medical Oncology.

•  Implement clinical trials of systemic anticancer treatments at investigator level for all phases, with the skills to lead late phase (Phase III) trials as Principal Investigator. 

As a principal investigator, you’ll need to understand the ethical and legal factors of clinical research, the importance of patient safety as an absolute priority, and why it’s necessary to delegate duties during trials. You’ll also need to demonstrate your ability to participate in clinical research trials, always following governance requirements. For this, a good document for evidence would be GCP training. You could also use feedback, evidence of your participation in clinical trials, and consultant reports.

CiPs for Clinical Oncology

These Capabilities in Practice are specific to clinical oncology CESR applications.

•  Correctly interpreting radiological imaging for accurate target volume and organ-at-risk definition in radiotherapy planning. 

For this, the GMC recommends using radiotherapy evidence and case-based discussion to demonstrate your abilities to use diagnostic imaging, including reviewing the imaging in more complex cases. For radiotherapy evidence, you’ll need plans covering a range of tumours from a minimum of twenty patients.

•  Safely and effectively delivering and managing patients receiving a course of radical and combined modality radiotherapy (to include consideration and utilisation of emerging techniques) 

This CiP requires you to demonstrate you can determine doses, identify the best procedures, and take previous radiotherapy sessions into consideration. Overall, you must show you can safely manage and deliver radiotherapy to a patient. The best evidence for this is radiotherapy evidence. Again, this should cover at least twenty patients.

•  Safely and effectively delivering and managing patients receiving a course of palliative radiotherapy. 

You need to demonstrate you can determine the dose, take past radiotherapy treatments into account (and how that may impact the current treatment plan), and determine the appropriate amount of radiotherapy required for the best outcome for palliative purposes. For this, you should submit radiotherapy evidence.

•  Safely and effectively delivering and managing patients receiving a course of radio-isotope therapy using an unsealed source to include post-therapy radiation protection measures 

For this CiP, you’ll need to supply radiotherapy evidence that shows you can identify patients with radio-isotope therapy. It’ll demonstrate that you understand safety measures, can manage complications, understand radiation protection, and know how to determine the proper radio-isotope treatment for the patient.

•  Safely and effectively managing patients treated with brachytherapy and their complications. 

Using Brachytherapy evidence, you will prove you can identify patients suitable for this treatment, determine the appropriate dose, and understand the risks. You need to cover at least five patient cases for the brachytherapy evidence.

•  Participating in clinical research trials and developing guidelines and protocols to safely implement new radiotherapy/combined modality regimens/techniques 

This CiP asks you to demonstrate your understanding of clinical trial rules and laws. It also asks you to demonstrate how you adhere to them. On top of that, you’ll need to show that you keep up with new radiotherapy techniques, understanding both the benefits and risks. You can use several types of documentation here, including GCP certificates, quality improvement projects, and research activities.

Tips for Getting it Right

Acquiring all the evidence and meeting the requirements of each CiP is a strenuous task that will take you a long time. With such a lengthy process, you will want your first application to be accepted. These tips will help ensure your application does not get rejected.

• Read Through the CCT Curriculum

The CCT Curriculum is what is expected of all clinical/medical oncologists in the NHS. Read it thoroughly, making sure the evidence you submit meets the criteria.

• Provide Recent Evidence

Evidence from the last five years holds more weight than evidence from longer than five years ago. While you can include older evidence (particularly when backing up other evidence), try to keep it as recent as possible.

• Make it Clear

Put yourself in the seat of the reader. Make your application as clear to read as possible, placing evidence in a logical order.

• Understand Where Most Applicants Go Wrong

The GMC has a list of areas where most applications go wrong in their  Clinical Oncology Specialty Specific Guidance  (Annex C). The list focuses on poor evidence, with many applicants failing in areas like teaching activity, safety and quality, and referees.

• Cover a Wide Range of Patients

The breadth of evidence matters for your CESR application, so include patient cases covering a wide range of ages, genders, and types of cancers.

• Meet All CiPs

When gathering evidence, you must show evidence for all CiPs. This is essential – your application will not be successful if you miss even just one CiP.

In Summary

If you want to get on the specialist register in the UK and have the skills and experience to back it up, the logical route is CESR. The CESR allows you to work as a medical/clinical oncology consultant, earning a competitive salary and holding high levels of responsibility. Keep in mind that the application process is no walk in the park; it’s crucial to take your time and ensure you meet all requirements before submitting your application to the GMC.

If you are a Medical or Clinical Oncologist who is pursuing their career in the NHS then get in touch with BDI Resourcing so that we can be with you on every step of your journey. Having worked with all of the major cancer centres across the UK we will be able to connect you with the most supportive department for your CESR application.