Portfolio Pathway (CESR)
What is CESR?
In order to work in a substantive consultant post in the UK, doctors must be on the Specialist Register of the UK General Medical Council.
Specialists who trained both in and outside the EEA or completed a non-European recognised specialist training programme within the EEA can apply to the GMC for a Certificate of Eligibility for Specialist Registration (CESR) for Intensive Care Medicine. Please note that there is no 'direct entry' onto the GMC Specialist Register for Intensive Care Medicine (as there is for larger specialties such as anaesthesia); even if doctors qualified in the EEA, they must still undertake the CESR process. This is because ICM is only recognised as a standalone specialty in a small number of countries.
An applicant must have their training and experience assessed against the current UK CCT training programme requirements in order to gain a CESR. The process involves submitting a body of evidence of training and/or competence, skills and knowledge to the GMC. Once the GMC has collected what it considers to be a satisfactory range of evidence, it will send the application to the Faculty for consideration. The FICM CESR Sub Committee will assess the application against the most recent GMC-approved curriculum before providing a recommendation to the GMC, who will then make a final decision.
CESR procedures are the responsibility of the General Medical Council (GMC). For initial enquiries and to start your application you must first contact the GMC (not the Faculty).
Supporting doctors through the Portfolio pathway
The GMC has produced a guide for employers, supervisors or colleagues who have been asked to help with a doctor's CESR application. The GMC have an online application system that requires you to register prior to making your CESR application. It also has an e-Portfolio functionality to help you collate and organise your evidence. The GMC have also published a comprehensive user guide to aide applicants along each step of the online application.
Guidance for initiating and delivering Portfolio Programmes
Organisations or Individuals looking at setting up Portfolio Programmes should understand the breadth of experience doctors require to complete their Portfolio application. It would be beneficial to speak to regions or individuals already running successful CESR programmes when planning to set up your own. There is wide variation in ICM practice overseas and International Medical Graduates (IMGs) will have requirements for placements in Medicine and Anaesthesia. They also require evidence of having completed a Special Skills Year (SSY) so if they do not already possess this they may need dedicated SSY placements. They may also need placements in specialist ICM, such as Paediatric ICM, Cardiothoracic ICM, and Neurological and Neurological ICM as this is a requirement of the ICM Curriculum and they may not have any prior experience in these areas. These placements will require CESR leads to have links within these specialties to ensure support of any candidate aspiring to achieve the relevant capabilities. Managing expectations and delivering what has been promised to the CESR applicant is very important for career progression of these doctors and to maintain the reputation of the organisation.
Portfolio Leads within ICM should forge links not only with the relevant departments within their own hospitals for Anaesthesia, ICM and Medicine experience, but also with regional centres for the specialist blocks required for ICM training (e.g. Paediatric, Neuro and Cardiothoracic ICM).
Placements need to balance the appropriate acuity for signoff of all capabilities within the ICM Curriculum. In areas where candidates have previous experience, arrangements need to be made to help them demonstrate maintenance of those skills.
Supervisors/Mentors for CESR Applicants
The CESR/Portfolio pathway application process will require supervision and support from a dedicated supervisor. Ideally this person should be someone familiar with both the CESR process and educational/clinical supervision of Intensive Care Medicine CCT trainees in the UK. Support from Faculty Tutors can always be sought locally if the supervisor is less familiar initially.
Depending on their entry route and experience, candidates may require support and input from the local International Medical Graduate Lead and their postgraduate medical education and training departments.
The CESR process relies on applicants being very self-motivated and driven. Their supervisor will be required to sign off Supervised Learning Events (SLEs) and High-Level Learning Outcomes (HiLLOs) on FICM’s Lifelong Learning Platform, very much as for those doctors within the UK's ICM CCT Training Programme. They can also signpost to teaching and exam support as required.
Applicants are likely to require some elements of or all of the following training:
- Programme length: 3-5 years depending on the doctor’s previous experience and how much supplementary evidence is required
- Indicative 12 months – Medicine
- Indicative 12 months - Anaesthetics
- 1 year General ICM at Stage 3 of the ICM Curriculum capability level
- Indicative 3 months in each of the Specialist ICM areas e.g. Cardiothoracic ICM, Paediatric ICM, Neuro ICM
- 12 months for a Special Skills Year (SSY) signoff - this should be supported locally
- Evidence of their extensive prior ICM experience
- Any placement completed and evidence over 7 years old will need demonstration of maintenance of skills.
CESR Frequently Asked Questions
The application is made directly to the GMC. Please see the GMC website for further information on how to apply.
The applicant assembles their CESR application in liaison with the GMC. Once the application is deemed complete by the GMC, it is passed to the respective College or Faculty for assessment.
For ICM, applications are assessed by the Faculty’s CESR Sub-Committee. A recommendation report is then written and sent to the GMC.
Information can be found in both the Specialty Specific Guidance and Generic Guidance available on the GMC website. Applicants should read this guidance very carefully because it defines the type of evidence applicants should provide to demonstrate their knowledge, skills and experience (KSE) for specialist practice in the UK.
No. As the Faculty reviews the applications we only review them at the point they are submitted to us by the GMC. We would recommend you liaise with your local ICM trainers for advice regarding your application/evidence.
There are no specialist medical qualifications that enable automatic entry to the Specialist Register in Intensive Care Medicine. Please provide a copy of any specialist medical qualifications you hold. You must provide an authenticated copy of any specialist medical qualifications from outside the UK. The test of knowledge in the ICM CCT curriculum is the Fellowship of the Faculty of Intensive Care Medicine (FFICM) Exam. If an applicant does not hold the FFICM then they must provide evidence of having passed a robust examination (e.g. a nationally or internationally recognised postgraduate examination in ICM) that demonstrates their knowledge and skills to an equivalent standard as the FFICM. An application is unlikely to be successful if an equivalent robust examination, or evidence of considerable formal academic activity in ICM, has not been provided. Currently acceptable examinations include:
- FCICM (including full training programme and success in exam)
If evidence of another specialist medical qualification is being provided, please ensure that you provide the following evidence in addition to your qualification:
- Training curriculum or examination syllabus or standards for its award.
- Formal period assessments completed during training (these may be older than seven years).
These must be authenticated if from outside the UK. If you do not hold the FFICM or a comparable qualification, you must demonstrate the same level of knowledge and skills to an equivalent standard as the FFICM by providing a detailed mapping exercise, demonstrating how each and every FFICM competency has been achieved. You must produce an extensive and detailed portfolio of academic, research and qualification evidence which demonstrates you have achieved the same level of knowledge and skills of each of the ICM syllabus outcomes (mapping to CoBaTrICE). It will then be at the FICM’s discretion to determine on a case-by-case basis whether what has been provided is comprehensive enough to sufficiently demonstrate the same level of knowledge and skills as the FFICM examination. An evaluation is made based on an applicant’s whole career and therefore two applicants with the same qualification(s), but different training/experience may not receive the same decision.
Exams for other specialties which have an ICM component are unlikely to be considered comparable. For example, the EDAIC is insufficient to demonstrate comparability.
You will receive a report from the GMC that will explain why your application has not been successful, this will contain recommendations from the Faculty outlining the additional evidence required.
No, the Faculty does not directly arrange training. Applicants in the UK should speak with the Regional Advisor and/or Faculty Tutor for Intensive Care Medicine in their hospital to discuss the options for obtaining any additional training required.
Yes - if you are eligible to apply and successfully get approval for either FICM Associate Membership or Membership (MFICM).
Other than for doctors on the ICM CCT Training Programme, we can only grant FICM LLP access to Members and Associate Members of the Faculty. If you are not currently a member with us, you may want to look at our membership pages to see which route of membership you are eligible for. RCoA membership does not confer the right to access the FICM LLP.
On our Membership page there is helpful flowchart to help you work out which route of membership you are eligible for. The right membership category for you is dependent on your medical exams and current job role, including the ICM commitments in your job in the UK, so you should check the eligibility criteria and complete the application form for the route that is applicable to your current circumstances and send it to us (firstname.lastname@example.org) for review and approval. It depends on whether you have a contracted daytime clinical commitment to ICM in your job plan of at least 1 DCC per week or not and whether you have a specialty exam from one of our trustee colleges.
Once you have applied for membership and this has been approved by the Faculty, please send the confirmation to us (email@example.com) and we can then set up an LLP account for you.
Want to know more?
Visit the GMC's pages about the CESR process.