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CESR specific guidance for Histopathology

  • December 14, 2021

The aim of this article is to help doctors who are applying for entry onto the Specialist Register with a CESR in Histopathology against the 2021 curriculum.

It is extremely important to note here that the CESR process is lengthy and requires an abundance of documentation and evidence. To ensure a smooth application process we highly recommend that you continually collect the evidence that will be required of you whilst you are still working overseas in order to ensure that you can effectively and efficiently continue to collect evidence when here in the UK.

The guidance given here on documents to supply is not exhaustive and you may have alternative evidence.

Evidence breakdown

As a general guide, they would want no more than between 800 and 1000 pages of evidence. The Histopathology curriculum developed by the Royal College of Pathologists is divided into 11 capabilities in practice (CiPs). Each CiP has a set of descriptors associated with that activity or task.

You need to gather your evidence by area of competence in the curriculum and then attach this under the relevant section in your online application. If evidence is relevant to several CiPs, you will need to add the evidence under the first one available only and make reference to the other CiPs it relates to. Adding duplicates will only slow down your CESR process.

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. The amount of evidence needed for each domain will vary, according to the documentation required to cover each capability.

The seven generic CiPs cover the universal requirements of all specialties as described in the GPC framework. Assessment of the generic CiPs will be underpinned by the GPC descriptors.

The four specialty CiPs describe the laboratory and clinical tasks or activities which are essential to the practice of Histopathology. The specialty CiPs have also been mapped to the GPC domains and subsections to reflect the professional generic capabilities required to undertake the clinical tasks.

The Generic CiPs

  1. Able to function effectively within healthcare and other organisational and management systems to deliver consistent high- quality patient care.
  2. Able to work within ethical and legal frameworks across all aspects of clinical practice.
  3. Communicates effectively and is able to share decision making, while maintaining appropriate situational awareness, professional behaviour and professional judgement.
  4. Maintains patient safety at the forefront of clinical working. Can utilise quality improvement activity realistically within the constraints of the role.
  5. Able to contribute to and support research.
  6. Behaves as an educator in the context of the role and promotes educational culture.
  7. Able to self-appraise, learn and adapt.

Specialty CiPs

  1. Able to demonstrate leadership and management within the laboratory setting for the benefit of patient care.
  2. Able to use laboratory and other services effectively in the investigation, diagnosis, and management of patients, relatives, and the deceased.
  3. Able to manage and contribute to a multidisciplinary team effectively.
  4. Able to take, manage and interpret pathological specimens accurately and safely, mindful of risks to self and others.

Common mistakes

It has been noted by the GMC that applications from doctors in the specialty of Histopathology are often submitted with inadequate or poor evidence in the following areas.

  • No evidence of Fellowship of the Royal College of Pathologists (FRCPath) by examination or equivalent robust evidence of knowledge of the breadth and depth of the curriculum.
  • No evidence of experience or exposure to paediatric and neuropathology.
  • No evidence of competence in Autopsies equivalent to the curriculum. Applicants needs to demonstrate evidence of performing 40 adult autopsies.
  • No evidence of competence in Gynae Cytology equivalent to the curriculum.

Types of evidence required

  • Primary medical Qualification
  • Specialist medical qualification
  • Recent specialist training
  • Specialist registration outside the UK
  • Other relevant qualifications/certificates
  • Curriculum Vitae
  • Employment letters and contracts of employment
  • Job descriptions
  • Logbooks
  • Case histories
  • Appraisals and assessments
  • ARCPs and training assessments
  • 360 and multi-source feedback
  • Management and leadership experience
  • Chairing meetings and leading projects
  • CPD record certificates, certificates of attendance, workshops and at local, national and international meetings or conferences
  • Membership of professional bodies and organisations
  • Multi-source feedback
  • Management and leadership experience
  • Audits undertaken by applicant
  • Reflective diaries
  • Service Improvement and clinical governance meetings
  • Health and safety
  • Communications with colleagues and patients
  • Management and leadership experience
  • Audits undertaken by applicant
  • Reflective Diaries
  • Service improvement and clinical governance meetings
  • Research papers, grants, patent designs
  • Publications within specialty field
  • Presentations, poster presentations
  • Evaluation of research
  • Teaching timetables
  • Lectures
  • Feedback or evaluation forms from those taught
  • Letters from colleagues
  • Attendance at teaching or appraisal courses
  • Participation in assessment or appraisal and appointments processes
  • Working in multidisciplinary teams
  • Data protection
  • Laboratory experience
  • Consolidation, cumulative data sheets, summary lists and annual caseload statistics
  • Medical reports

Specialty specific descriptors:

Curriculum learning outcome 8: Able to demonstrate leadership and management within the laboratory setting for the benefit of patient care:

  • Describes and explains the structure, resources and legislation surrounding laboratory practice
  • Demonstrates awareness of developments, both scientific and managerial, that may affect the organisation and delivery of Pathology services (e.g. commissioning)
  • Demonstrates ability to write a business case and draw upon the expertise and opinions of others in this process
  • Demonstrates understanding of method validation
  • Demonstrates ability to effectively use internal quality control and external quality assurance information to diagnose and resolve analytical problems.

Curriculum learning outcome 9: Able to use laboratory and other services effectively in the investigation, diagnosis, and management of patients, relatives, and the deceased:

  • Describes and explains Laboratory Information Management Systems and other healthcare IT systems, including understanding the legislation surrounding information governance
  • Effectively liaises with specialty services and requests appropriate investigations
  • Can interpret reports from related clinical disciplines in the light of pathology findings, mindful of the pitfalls of interpretation
  • Describes and explains reasoning behind investigational and diagnostic advice clearly to clinicians, laboratory staff, legal professionals and lay persons

Curriculum learning outcome 10: Able to manage and contribute to a multi-disciplinary team effectively:

  • Demonstrates effective management and team working skills, including influencing, negotiating, continually re-assessing priorities and effectively managing complex, dynamic situations
  • Identifies and supports effective continuity and coordination of patient care through the appropriate transfer of information
  • Recognises the importance of prompt and accurate information sharing with the team primarily responsible for the care of the patient
  • Able to work effectively with outside agencies such as HM Coroner, COPFS, GMC, Charitable organisations and regional, national and international research / diagnostic networks
    Able to integrate the results in order to advise an MDT and able to provide prognostic information

Curriculum learning outcome 11: Able to take, manage and interpret pathological specimens accurately and safely, mindful of risks to self and others:

  • Able to interpret a macroscopic specimen in anatomical terms accurately, for diagnostic, prognostic and therapeutic purposes
  • Able to identify and interpret microscopic features (including additional techniques) in order to provide an accurate surgical pathology report to inform the multidisciplinary team for diagnostic and prognostic purposes
  • Able to perform a post-mortem examination of a type usually encountered in clinical practice, in order to inform the Coroner, Procurator Fiscal hospital team, family and others appropriately
  • Able to interpret all macroscopic and microscopic findings identified from the post-mortem examination in order to evaluate and identify disease processes, and their likely biological and or clinical significance
  • Able to portray an appropriate amount of certainty around a pathological diagnosis so as to influence the multidisciplinary team accordingly
  • Able to provide a timely accurate report in clear and appropriate language, in written and spoken form
  • Able to use appropriate published guidelines and diagnostic coding as required
  • Able to provide a provisional verbal report urgently, according to clinical need, and document appropriately (e.g. for intraoperative pathology
  • Able to counsel next of kin and peer health professionals on the outcomes of pathology investigations and post-mortem examinations
  • Demonstrate the ability to report independently

Submitting your evidence

Do not submit original documents. All your copies, other than qualifications you’re getting authenticated must be accompanied by a proforma signed by the person who is attesting to the validity and accuracy of your evidence (your verifier). It’s very important you read an explanation of how to do this in the important notice about evidence.

You will also need to submit translations of any documents that are not in English. Please ensure the translations you submit meet the translation requirements.

It is important that you anonymise your evidence before you submit it. You must remove:

  • All patient identifying details
  • Details of patients’ relatives
  • Details of colleagues that you have assessed, written a reference for, or who have been involved in a complaint you have submitted.

This includes:

  • Names (first and last)
  • Addresses
  • Contact details such as phone numbers or email addresses
  • NHS numbers
  • Other individual patient numbers
  • GMC numbers

The following details don’t need to be anonymised:

  • Gender
  • Date of birth

Our top tips for a smooth CESR application process

  1. Understand the time and effort that is required to make a successful application. You are asked to provide evidence that you have fulfilled all the learning outcomes defined in the curriculum. Doctors who have gone through the formal training programme will normally have taken around eight years to gain these outcomes, so it is not something you can gather overnight.
  2. Recognise that you will need others to support you in the application process. Think about who can help, explain to them what help you need and ask if they can support you
  3. CESR places most emphasis on evidence gathered in the last five years. If you are providing evidence from before this time, think about what you can do now to show that you still have these capabilities. For example, if you still have contacts in that unit you could ask if they would be prepared for you to go back and have some workplace-based assessments in that area. The Trust would probably want you to have an honorary contract for this.
  4. Choose the referees for your structured reports carefully. The GMC provides guidance on who should give structured reports, but you should also think about who values you enough to put in the time and effort to ensure that their report provides the information you need.
  5. Make sure you understand which evidence needs to be verified and that you follow the correct verification procedure, to ensure that all your evidence is accepted and does not need to be resubmitted. If in doubt, the GMC can advise on what needs to be verified and what types of verification can be accepted
  6. Take care to arrange your evidence following the order it is set out in this guidance, so it is easier for assessors to find the evidence they need for each of the sections.
  7. Finally: keep going and don’t lose heart! There will probably be a point in the middle where the task feels huge. When this happens, allow yourself a couple of weeks off CESR then look at it afresh.

How we can help

Many of the positions we have in Histopathology are able to support you with this CESR application process. If you would like to speak to our Specialist Histopathology department about opportunities please do send your CV to [email protected].


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