Portfolio Pathway vs CESR: Why the New System Favours International Urologists

As an internationally trained Urology Consultant, you may wonder how to move to the UK and begin your journey towards independent practice without going through the UK’s own training system. If you already have plenty of experience behind you, spending years in training will likely feel like a waste of time… Previously, that’s where CESR would have come in, but the General Medical Council changed CESR to the Portfolio Pathway in November 2023. In this article, we’ll uncover exactly what that means for Urologist IMGs and why it’s a good thing!

An Overview of CESR (The Previous System)

Before August 2021, international urologists typically went through the CESR (Certificate of Eligibility for Specialist Registration) route to get onto the Specialist Register and practice as an independent urologist. The CESR route was an application process that focused on proving that as an international doctor you have completed a rigorous training process that mirrors the UK training curriculum – equivalent to what an NHS urologist would have followed on the way to completing their CCT (Certificate of Completion of Training). The premise was that by evidencing a comparable training journey via CESR, applicants would have the skills, knowledge, and experience equivalent to UK trained doctors at the most senior level. 

To provide a successful CESR submission to the GMC and Royal College of Surgeons, IMGs had to gather a wide range of evidence and put it into a portfolio, which the awarding body would then consider at committee. Ultimately CESR evaluators were looking for substantial evidence that via the urology training received during their career, an IMG had covered and passed all modules expected of a UK trainee pursuing the CCT pathway. It was a lengthy, often challenging application process that required thousands of pages of documentation to be collated – from 360 feedback and personal development plans, to log books and anonymised patient files covering a 5 year period. Even the most skilled international medical graduates were required to prove their expertise in this way and official guidance on what types of evidence were “acceptable” was very vague.

It should be noted that the other option IMG’s have of following the CESR-CP route (the combination of a CESR based evidence submission and 3+ years of formal UK-based training) is still a viable option too.

An Overview of the Portfolio Pathway (The New System)

The Portfolio Pathway gives IMGs the same outcome that CESR did before it – access to the GMC’s Specialist Register without the need to complete a formal UK training program. However, whilst the Portfolio Pathway still requires applicants to offer an evidence based submission, the GMC have provided far more guidance on the types of things they advise doctors to collect as evidence within each of the specialty “CiPs” (Capabilities in Practice), and the burden is on candidates to evidence outcomes rather than process; i.e. the submission should evidence that a doctor can adequately carry out the responsibilities of a UK trained Consultant and has achieved the high-level learning outcomes associated with the specialty’s curriculum – not that they have followed the same training protocols (as was the case with CESR). So, for international urologists, you are now looking at outcomes and not the structure/content of the curriculum, which allows for much more flexibility. You’ll find this on the GMC website. 

The GMC designed the Portfolio Pathway alongside the Joint Surgical Colleges to offer a clearer route to Specialist Registration for IMGs. Here’s what they had to say about it upon its release:

“Doctors applying for specialist or GP registration via the portfolio pathway now need to provide evidence that they have the knowledge, skills and experience required to practise as a specialist or GP in the UK. This pathway was previously known as the CESR or CEGPR pathway.

This is a result of changing legislation introduced by the UK government. It gives us more flexibility to accept a broader range of evidence from doctors applying for specialist or GP registration.”

Changes to Applications and the Benefits for IMGs

The most obvious change is the name – CESR is no longer relevant; it’s now called Portfolio Pathway. The other changes focus on the application process and the type of evidence you need to submit. Here are some of the adjustments:

More Efficient Evidence

One of the biggest changes the GMC have come out with is that they’re focusing more on efficient evidence. They want applicants to choose their evidence carefully, focusing more on recent, relevant documents that really show their expertise. It’s about quality over quantity.

This efficiency makes it easier to navigate the application system – you can easily see what kinds of evidence you should prioritise and which documents are best. Previously, the CESR application was overly complicated for IMGs, making this change a massive improvement.

More Evidence Accepted

The new method is much more flexible. International doctors will be able to submit more types of evidence to support their application, resulting in a higher chance of a successful application – you have a better chance of showing you have the skills, knowledge, and expertise necessary to work as a Consultant Urologist in the UK.

See the specialty specific guidance here for more detail. 

A New Assessment Tool

A new assessment tool is being used to assess applications for Portfolio Pathways. It’s called the Multiple Consultant Report and is used to evaluate the evidence submitted against the level of a day-one consultant working in the UK (rather than against the CCT).

How the Evidence is Assessed

As already described, the final significant change is that the Portfolio Pathway evidence is assessed against some generic professional capabilities alongside those based on the specialisms’ curriculum. International urologists and other surgical specialties will be assessed against these CiPs (Capabilities in Practice) which allow for much more flexibility from the applicants.

Overall, the changes are about applicants demonstrating their skills, knowledge, and expertise to practice as a specialist doctor in the UK rather than proving that they can perfectly match the CCT applications.

If you want to learn more about the type of evidence you need to submit as an international urologist, there’s more on that further down. 

How to Apply and Submit Evidence for Portfolio Pathway

Step One: Get in Touch with GMC

The GMC recommends that you get in touch with their GMC Specialist Applications team before submitting a Portfolio Pathway application. Their guidance will make the process much smoother, and you’ll be able to ask any burning questions you may have.

Step Two: Apply to the GMC

You then need to submit your application to the General Medical Council, which you can do on their website. Be aware that you have 24 months to submit the necessary evidence after you begin the application. Once you have applied, the GMC will send your application to the relevant awarding body; in this case, it is the Royal College of Surgeons.

Step Three: Be Assigned an Advisor and Submit Evidence

If you get through the first checks of the application, you’ll be assigned an advisor who will review your evidence and provide you with feedback. When they do this, you can amend your evidence as appropriate.

You’ll need to collect and submit the relevant evidence to complete the application process. There are a couple of other things you need to do here, including evidence anonymisation, translations, evidence verifications, and obtaining references. It’s not a short process.

Step Four: Evaluation and Decision

Once the GMC has received and verified all the documents, the evidence will be evaluated by the Royal College of Surgeons. From there, a decision will be made as to whether or not your application is successful.

What Evidence Do You Need as an International Urologist?

Are you ready to get started on your portfolio pathway application? As an international urologist, you’ll need to gather specific documents that demonstrate your capabilities in this specialty. This involves ticking off five CiPs (which are the common across all surgical specialities).

Capability in Practice 1: Manages an Out-Patient Clinic

This CiP refers to clinical/administrative tasks. So, you’d need to demonstrate things like time management, adaptable communication, and how you deal with inter-departmental referrals.

Capability in Practice 2: Manages the Unselected Emergency Take

For this CiP, you must show your capabilities of managing emergency patients within your department; for example, you’ll demonstrate that you can fully assess the patient, provide resuscitative treatments, and deliver appropriate treatment plans.

Capability in Practice 3: Manages Ward Rounds and the Ongoing Care of In-Patients

You will show that you can manage in-patients. You’ll need to prove through evidence that you can identify acutely ill patients, manage a multi-disciplinary team on the ward, manage medical complications, and thoroughly assess patients.

Capability in Practice 4: Manages an Operating List

This CiP is all about being able to handle patients receiving operative treatments. For example, you’ll show you can select the right patients for the surgery, arrange anaesthesia when necessary, list patients for surgery, and deliver the operation.

Capability in Practice 5: Manages Multi-Disciplinary working

The last CiP refers to being able to manage patients who require the care of a multi-disciplinary team, including that of a urologist (yourself). Your evidence should back up that you can identify patients with urgent conditions, handle administrative processes, develop management plans, and communicate effectively with the rest of the multi-disciplinary team.

If you want more details on the curriculum for the urology portfolio pathway application, you can find it here. You’ll need to read this in its entirety before starting an application.

Should You Apply for Portfolio Pathway as an International Urologist?

It’s fair to say that the changes made make getting on the specialist register much more accessible for IMGs. However, you still need the experience to get through the application process.

This route makes sense if you’re an international urologist with the skills, training, qualifications, and expertise that puts you on the same level as a UK consultant. If you have the evidence to back this up and your long-term goal is remain in the UK, it’s absolutely worth attempting to build your portfolio evidence as soon as possible. You open the door to more professional opportunities and the prospect of permanent Consultant level contracts.

Portfolio Pathway: A Fantastic Improvement for IMGs

The GMC made a very sensible decision when they introduced the Portfolio Pathway as an more straight forward route for international urologists (and other doctors) to take their skills to the UK without having to adhere to extremely rigorous criteria. With the increase in flexibility, we feel there’s never been a better time for an IMGs to offer their talents to the NHS.

Do you need help with the Portfolio Pathway? Have any questions about the changes? The team here at BDI can make things clearer for you, so get in touch if you’re looking to build your portfolio of evidence and become a Specialist Registered Urologist in the UK.