Author: William Niven / Editor: Charlotte Davies, Elizabeth Herrieven / Codes: SLO9 / Published: 22/01/2018


The content you’re about to read or listen to is at least two years old, which means evidence and guidelines may have changed since it was originally published. This content item won’t be edited but there will be a newer version published if warranted. Check the new publications and curriculum map for updates

‘I’m thinking of doing a CESR’ is a statement that I think is heard more and more in the corridors and dark places of UK Emergency Departments as tired trainees, fed-up with the competing demands of service delivery, e-portfolio, exams, switching departments and interrupted circadian rhythms, try to find some way of holding on to their emergency medicine dream. A cursory read of the GMC trainee survey will tell you that trainees are struggling. But before you read any further let me be clear that giving up your training number is not a decision that you should take lightly! As someone who never underwent formal training, I cannot comment on whether life is any better in or out of the system, but I have undergone the CESR process and can say that it doesn’t come easy! Despite that, it worked out for me and I would like to share with you my journey and reflections on what I think you need to bear in mind if you decide that the CESR thing is for you.

I grew up in Zimbabwe and South Africa and did my medical training in Cape Town. I completed my internship and community service (a compulsory year of government work and not the result of any misdemeanour on my part) then worked for a further year as a GP before moving to Ireland to work in a small Emergency Department outside Dublin. It did not take long for me to catch the Emergency Medicine bug, and after a year I decided that I wanted to specialise. I completed the MCEM without too much drama, but, when it came to applying for higher training in Ireland, I was told that because I had not presented a poster or done an audit, I was not eligible. There were 8 applicants for 9 posts as I recall, and no, they still wouldn’t take me. Over the next two years in Ireland I did a secondment in Paeds EM and spent 3 months in an ITU. I applied for an ST4 post in the UK and this time there were 120 posts and I shortly received a cryptic letter to the effect that I had been ranked 89th but they still could not offer me a post. After sending three emails and making countless phone calls, I found out that my lack of anaesthetics training was the reason that I was, once again, ineligible.

So by this stage I had now been doing EM for 5 years and I was well and truly stuck. I wanted to be a Consultant, but I seemed to be out of options when I met an EM Consultant at a conference who made some introductions and within 3 months I had moved my entire life in a Skoda Fabia across the Irish Sea to start a new job at the Homerton Hospital in East London. Two years later I had completed the FRCEM and a year after that I was a locum Consultant. Over the next 15 months I completed the CESR process and the rest is history.

The last paragraph is merely a summary of what happened once I had decided on the CESR route but it in no way reflects the heartache of actually going through the process. It was arduous having to compile the evidence, frustrating having to get every page validated and infuriating when my initial application was rejected on the grounds that I did not have evidence of completing the second cycle of an audit. However, leaving the difficulties aside, I did not lack for cheerleaders in my department. The Consultant and senior nursing staff backed me to the hilt, I was treated as any other higher trainee, released for regional training and given a dedicated Educational Supervisor to help me navigate the process. I strongly believe, therefore, that departmental structure and commitment to helping non-training doctors is fundamental to the success of those wishing to enter the specialist register by the road less traveled…

Conventional training is easier than the CESR path, but doctors wishing to CESR will generally fall into a few different groups including but not exclusively:

  • Those who have completed a recognised training programme in a different jurisdiction for example Australia.
  • Doctors who have already been working in Emergency Medicine at SASG level who wish to progress to Consultant.
  • Junior doctors who may have already started or completed core training
  • Clinicians from other specialities who are looking to reskill in EM.

Owning a house, having children, being older, alternative careers or looking after sick relatives may make the prospect of entering full-time training daunting.  When you consider the relatively inflexible entry points into training at ST/CT1 or ST4 combined with the prospect of moving around different hospitals, subject to biannual ARCPs and exams, the more flexible CESR option might become more attractive. However, because there is no one chasing you, it becomes all the more important that you are sufficiently disciplined, attentive to detail and organised in your approach to collecting evidence.

Had I had been more organised, I would have printed out a copy of the GMC’s speciality specific guidance for EM available here before I lifted a stethoscope in anger. 36 pages of spreadsheet loving may not monopolise your attention but it is specific and detailed on what is required. Your life will be made exponentially easier if you collect evidence prospectively using the SSG framework. The Royal College of Emergency Medicine (RCEM) has shown a real commitment to guiding non-training doctors through CESR and there are some additional resources available on the website which are important to read before deciding whether or not it is for you!

Finally, whilst there are plenty of resources that outline ‘what’ you will require there is relatively little information that tells you how to do it! I have written a guide (handbook to help fill in the gaps. CESR is a completely doable option if you follow the maxim that in order to eat an elephant you need to start somewhere and then proceed one mouthful at a time (apologies vegetarians)! I am happy to be contacted for more specific advice on the above email. My final advice is to remember that your greatest allies on this journey are passion, patience and pragmatism – good luck!

Other Links

St Emlyns Guide to CESR
GMC Specialty Document
RCEM CESR Documents