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CESR speciality specific guidance for Acute Internal Medicine

  • May 21, 2021

This Blog post aims to help Doctors who are applying for entry onto the Specialist Register via CESR in General (Internal) Medicine. Here we outline the types of evidence you can use and how to organize your evidence. Please note, this Blog is not an exhaustive list of evidence or competencies, and the full guidance can be found on the GMC website.

One of the most important things to acknowledge, if you’re considering CESR, is that the process is very lengthy and requires huge amounts of documentation/evidence. It is vital that you continually collect your documentation over time whilst you are working in your home country and/or overseas, to give yourself the best head-start at producing your portfolio when in the UK.

As a General Guide, the GMC would expect to see at least 800 -1000 pages of evidence. To see the actual curriculum, that the following lists of evidence are expected to reference, click here.

Organising your evidence: The 4 Domains

The General (Internal) Medicine CESR evidence/documentation is divided into four different domains. The GMC recommend that you apportion the evidence you provide in the following capacities:

Domain 1 - Knowledge, Skills and Performance 75%

Domain 2 - Safety and Quality 20%

Domains 3 and 4 - Communication, Partnership and Teamwork / Maintaining Trust: 5%

It is important to note that you will not be able to compensate for shortfalls in your evidence of training and experience in a particular area of the curriculum by providing extra evidence in other areas.

Domain 1: Knowledge Skills and Performance (75%)

Most parts of the General Internal Medicine syllabus relate to “Knowledge, Skills and Performance”, which means that this evidence will be the largest. The following list outlines the different types of evidence expected of you for Domain 1. This list is not exhaustive.

  • Qualifications
    • Primary Medical Qualification
    • Specialist Medical Qualification
    • Curriculum or Syllabus (if undertaken outside of the UK)
    • Specialist Registrations
    • Honours and Prizes
    • ALS
    • Other relevant qualifications and certificates
  • Appraisals and Assessments
    • RITAs, ARCPs and training assessments
    • Feedback from colleagues at all levels (peers, nursing, staff, patients, management)
    • References and Multi-Source Feedback
    • Awards and Discretionary Points Letters
    • Personal Development Plans
  • Logbooks, Records of Daily Clinical Practice and Portfolios
    • Logbooks
    • Consolidation, cumulative data sheets, summary lists and annual caseload statistics
    • Medical Reports, outlining your specific involvement and handling
    • Case Histories
    • Referral Letters discussing patient handling
    • Patient Lists
    • Departmental workload statistics and annual caseload statistics
    • Rotas, Timetables and Job Plans
    • Courses relevant to the Curriculum
    • Portfolios (electronic or revalidation)
  • Details of posts and duties (including both training and experience posts)
    • Employment Letters/Contracts of employment
    • Job Descriptions
    • Job Plans
  • Research, Publications and Presentations
    • Research Papers, Grants, Patent Designs
    • Publications
    • Presentations / Poster Presentations
  • CPD and CME
    • CPD Record Certificates, Certificates of Attendance, workshops and at local, national and international meetings or conferences
    • CPD Registration points
    • Memberships of Professional Bodies and Organisations
  • Teaching and Training
    • Teaching Timetables
    • Lectures
    • Feedback or evaluation forms from those taught
    • Letters from colleagues
    • Attendance record of teaching and appraisal courses

Domain 2: Safety and Quality

Within this section, you will need to demonstrate that you’re focused on patient safety and will deliver effective quality improvement, whilst practising within established legal and ethical frameworks

Within this section the GMC recommend that you provide evidence of:

  • Participation in audit and service improvement
    • Audits undertaken by applicant
    • Reflective Diaries
    • Service Improvement and Clinical Governance Meetings
  • Safety
    • Health and Safety Declaration Form
    • Attendance at Courses
    • Involvement in Infection Control

Domain 3: Communication, Partnership and Teamwork

Within this section the GMC recommend that you provide evidence of:

  • Communication
    • Letters and correspondence between you and your colleagues
    • Presentations
    • References written for colleagues
    • Evidence of working within a multidisciplinary team
    • Community Work
    • Wider Healthcare team meetings include Primary Care, intermediate and secondary teams
    • Partnership and Teamwork
      • Working in Multidisciplinary teams
      • Management and Leadership experience
      • Chairing Meetings and Leading Projects

Domain 4: Maintaining Trust

Within this section the GMC recommend that you provide evidence of:

  • Acting with Honesty and Integrity
    • Appraisal Forms
    • Statements
    • Equality and Human Rights (including Disability, human rights, race, religion and ethnicity awareness and equal opportunities)
    • Data Protection
  • Relationships with patients
    • Testimonials and letters from colleagues
    • Thank you letters, cards from colleagues and patients
    • Complaints and responses to complaints

References 2021. [online] Available at: [Accessed 18 May 2021].


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