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CESR specialty specific guidance for Emergency Medicine

• February 22, 2022

The path towards CESR demands becoming a reflective practitioner, broadening and deepening skills and knowledge of the Emergency Medicine curriculum, so being able to demonstrate performance as an Emergency Medicine Consultant equal to that of colleagues who have passed through the Emergency Medicine CCT training scheme.

This article outlines the types of documents that can be used in order to evidence your eligibility for specialist registration in emergency medicine.

The Emergency Medicine curriculum is divided into 12 Specialty Learning Outcomes (SLOs). You will need to ensure that the different types of evidence you provide cover all learning outcomes.

As a general guide, most applications are expected to include around 100 electronically uploaded documents.

Do I have to gain FRCEM in order to obtain a CESR?

It is strongly advised that CESR applicants work towards completing all parts of the FRCEM exam, as these are adapted to the curriculum and form basic tests of knowledge considered essential for an EM consultant. Those applicants without the Fellowship examination rarely provide adequate alternative evidence.

Do I need to demonstrate experience or training in specialties related to Emergency Medicine?

Anaesthetics and Intensive Care Medicine

You are expected to have either completed posts of a minimum of three months (full time equivalent) in each of these specialties, or a combined Anaesthetics/ICM post of a minimum of six months’ (full time equivalent) duration, comprising three months aggregated time in anaesthetics and ICM. Provision of the Initial Assessment of Competence (IAC) in Anaesthesia is mandatory.

Acute Medicine

You are required to demonstrate that you have spent some time in this specialty and that you have acquired knowledge of the treatment of medical patients beyond that given in the Emergency Department. While these competencies could be achieved from within the Emergency Department working with medical colleagues, it is preferable to have worked in areas outside ED in order to demonstrate this. A logbook of medical cases must be provided.

Paediatric Emergency Medicine

In order to achieve sufficient exposure to paediatric patients, you are recommended to have spent a minimum of three months (full time equivalent) in a Paediatric Emergency Department, or a General ED with more than 16K Paediatric attendances a year. A logbook of paediatric cases must be provided, and the majority of paediatric evidence must demonstrate input from PEM or paediatric specialists.

Types of evidence

The types of evidence you can use in your application and include but are not limited to the following:

-Primary medical qualification (PMQ)

- Specialist medical qualification(s)

- Recent specialist training

- Specialist registration outside the UK

- Other relevant qualifications and certificates

- Employment letters and contracts of employment

- Job descriptions

- Departmental (or trust) workload statistics and annual caseload statistics

- Rotas, timetables and job plans

- Appraisals

- CPD record certificates, certificates of attendance, workshops and at local, national and international meetings or conferences

-Membership of professional bodies and organisations

- Higher specialty training (HST) curriculum competences

- Extended Learning Supervised Learning Events (ESLE)

- 360˚ and multi-source feedback

-Logbooks

- Medical reports

- Case histories

- Referral letters discussing patient handling

- Patient lists/caseload statistics

- Courses relevant to the curriculum

Curriculum Speciality Learning Outcomes (SLOs)

There are 11 ACCS Learning Outcomes and 12 Emergency Medicine SLOs incorporating the ACCS learning outcomes. In each of the SLOs your evidence needs to demonstrate progression to the highest level of entrustment, consistent with operating at consultant level.

Thus your evidence should demonstrate the following:

SLO 1: Care for physiologically stable adult patients presenting to acute care across the full range of complexity

SLO 2: Support the ED team by answering clinical questions and making safe decisions

SLO 3: Identify sick adult patients, be able to resuscitate and stabilise and know when it is appropriate to stop

SLO 4: Care for acutely injured patients across the full range of complexity

SLO 5: Care for children of all ages in the ED, at all stages of development and children with complex needs

SLO 6: Deliver key procedural skills

SLO 7: Deal with complex and challenging situations in the workplace

SLO 8: Lead the ED shift

SLO 9: Support, supervise and educate

SLO 10: Participate in research and managing data appropriately

SLO 11: Participate in and promote activity to improve the quality and safety of patient care

SLO 12: Manage, Administer and Lead

Submitting your evidence

It is important that you anonymise your evidence before you submit it to us. 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 It is your responsibility to make sure that your evidence has been anonymised. Evidence which has not been anonymised will be returned to you. More information can be found on their website.

- Testimonials and letters from colleagues

- Thank you letters, cards from colleagues and patients

-Complaints and responses to complaints

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 Emergency Medicine subspecialities are able to support you with your CESR application. If you would like to speak to our team about these opportunities do send your CV to [email protected].

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References

GMC-uk.org, 2022. Specialty specific guidance for CESR in Emergency Medicine. [online] Gmc-uk.org. Available at: [Accessed 16 February 2022].