CESR Fellowship in Psychiatry: First for Scotland
25 November, 2022
The CESR pathway to specialist registration is a road less travelled.
For those new to this, the Certificate of Equivalence for Specialist Registration (CESR) is an alternative route to CCT (Certificate of Completion of Training) for entry onto the Specialist Register. Like most of my colleagues, I trained via the specialist training route and blindly accepted the unhelpful narrative of CESR being ‘nearly impossible’ as being true. Very few colleagues either knew of anyone who had completed the CESR, or had much understanding of the process of CESR application and the required evidence for a successful application. Recent stats have, however, shown that CESR has become an increasingly popular route for specialist registration, and about half of all applications are successful. Learning more about CESR can demystify the myths – understanding the correct process and the nature of the evidence needed to demonstrate competence can ensure success in achieving CESR.
In Grampian, we started by developing a CESR support group and gaining further expertise by linking in with the extremely useful resources provided by the College for CESR. We also networked with other colleagues and trusts across the nation working on similar pathways and, most crucially, developing ‘CESR Evaluator’ competence which provided us with the key skills to confidentially support a CESR programme. We also expanded our vision to become a CESR-informed service and include both national and international recruitment for CESR specific career pathways.
In 2021, Grampian Mental Health and LD Services launched the first ever sponsored CESR Fellowship programme in Scotland. The programme provides access to a sponsored route for GMC registration for international psychiatrists keen to gain experience and work in Scotland. These doctors hold an international postgraduate qualification in Psychiatry and have extensive experience of working in mental health. The three-year programme provides valuable experience in a specific specialism in Psychiatry and facilitates experience in a variety of specialisms and other non-clinical experience needed for a successful CESR application.
The CESR Fellowship programme provides an innovative solution which is mutually beneficial to the international psychiatrists and to our local health care provision.
As senior international specialists, these doctors are keen to work in the U.K. and gain specialist registration. The sponsored route provides access to GMC registration and work visa sponsorship. The entire application process can be completed from their home country so they arrive in Scotland with the security of employment. They also benefit from local Grampian-based training that provides a bespoke CESR orientated programme of support and mentoring. They are also able to draw support from the Scottish Deanery and access a variety of resources for their professional development.
The CESR Fellows bring rich cultural diversity and expertise in psychiatry to our local teams. The process for international recruitment is fiercely competitive and the candidates already have excellent skills in communication, knowledge and experience within the field. With the right intensive onboarding and support, these doctors will become an asset to our services. As the CESR application requires evidencing of expertise at a ‘near consultant’ level, the CESR Fellows will be proactive in gaining not only clinical expertise but also engaging with non-clinical activities including teaching, research, quality and governance activities. This will provide a chance to support the service in many ways whilst keeping a clear supervisory structure for professional assurance. It is hoped that most CESR Fellows will complete a successful application for CESR within the 3 years of the Fellowship and some may choose to additionally pursue the MRCPsych examinations.
Our first CESR Fellowship programme was advertised in January 2022 and received a high number of international applications. The GMC regulations around sponsorship and further visa delays due to global factors impacted the start dates for the fellows. In September 2022, we warmly welcomed our 5 CESR Fellows in General Adult Psychiatry in Grampian. The CESR Fellows received intensive onboarding and extended induction to acclimatise them to working in the NHS. We are currently developing a CESR specific educational programme to help support the Fellows in the new year, and hope they will be able to take on middle-grade and senior roles in the teams.
Grampian has further expanded the CESR Fellowship to include CESR in CAMHS (Child and Adolescent Mental Health Service) from 2023, and we are looking forward to a second round of recruitment by the end of this year.
We are also strongly encouraging our existing colleagues, including specialty and associate specialist (SAS) doctors and locum consultants, to consider CESR as a workable route for specialist registration. All developed educational resources and learning opportunities for CESR will be equally available for all our CESR-aspirant doctors.
CESR Evaluator roles
For the programme to be successful in its ambition, we need to ensure due diligence with international recruitment processes, provide robust infrastructure, admin support, professional governance and, most importantly, ensure that we can deliver on providing all necessary opportunities and support for a successful CESR application. Having CESR specific understanding is clearly at the heart of this, and we are building our expertise by encouraging colleagues to engage with the ‘CESR Evaluator’ roles with the Royal College.
National workforce and CESR Fellowships
Medical workforce and recruitment are top concerns across the nation. There are several complex national and political factors that have influenced this in recent times and although all of us have faced the impact of this, it is particularly deeply felt in the more remote and rural areas of Scotland. Health care services in Scotland are being increasingly forced to be dependent on a temporary agency workforce which further affects clinical, professional and financial governance.
Despite the fantastic work done by the college with the Choose Psychiatry initiative to improve the uptake of psychiatry and national commitment to increase medical school intake and junior doctor training numbers; we continue to live with a large gap in the service. This gap is deeper at senior and middle-grade levels. Investment in ‘growing our own’ and creating self-resilience is absolutely the right action for Scotland to improve the situation at the grass-roots level, but this strategy is likely to take at least 6-10 years to positively impact fill rates of more senior vacancies.
We believe that innovative programmes like the CESR Fellowship can support our workforce immediately and act as a catalyst in driving us onwards from the current position of mere survival to one of a healthy and competitive service that safeguards the career progression of all our workforce as well as the future of our great organisation. These programmes can promote diversity and inclusion by developing alternative career progression pathways for specialist registration, and provide equal opportunities to all middle-grade doctors to pursue specialist registration.
There is a real immediacy of need to resolve our current workforce crisis, and programmes like the CESR Fellowship can provide a strategic advantage in developing our workforce for the future. To develop these programmes, we need buy-in from key stakeholders and investment in the development of networks to share intelligence and resources across Scotland.
This can be a particular opportunity for recruitment to more rural and remote areas that can be supported by developing clear regional collaborative structures. More Scottish CESR evaluators are urgently needed from all specialties to take up this vital role in supporting CESR-aspirant doctors so that we can all become CESR informed and drive a change to the narrative around CESR and benefit our larger workforce.
Dr Priti Singh