The new Portfolio Pathway in Geriatric Medicine and General Internal Medicine

Published date

15 August 2024

Last updated

15 August 2024

Authors

Dr Amit Arora

Dr Saniya Naseer

Dr Somaditya Bandyopadhyay

Topic tags

Education, Training and Careers

Workforce

From November 2023, the Certificate of Eligibility for Specialist Registration (CESR) route for Specialist and GP registration changed to the new Portfolio Pathway.

The article below offers some clarifcation and answers to common questions about this new pathway.

The old pathway: The CESR route to CCT

The old route, Certificate of Eligibility for Specialist Registration (CESR), was the route to entry into the Specialist and GP Registers for those doctors who have not followed an approved training programme. The Specialist Register is a list of doctors who are legally entitled to accept honorary, substantive, or fixed term consultant posts in the NHS and is maintained by the General Medical Council (GMC).

Previously known as ‘CESR’ and formerly ‘article 14’ (of the General and Specialist Medical Practice – Education, Training and Qualifications order of 2003), this was an equivalence-based approach. The applicant had to provide evidence demonstrating ‘equivalence to a CCT’, therefore the depth and breadth of competencies outlined in the relevant certificate of completion of training (CCT) curriculum. Applications were judged against the GMC-approved curriculum with reference to the Specialty Specific Guidance (SSG) as well as the GMC’s generic guidance of evidence to support a CESR application. The application was made through the GMC. Once the GMC had accumulated what it considered to be a satisfactory range of evidence, it forwarded the application to the faculty at the Royal College of Physicians for consideration. However, this changed in November 2023.

The new route to specialist/GP registration in a CCT specialty: The Portfolio Pathway

CESR was changed to Portfolio Pathway from 30 November 2023. Doctors now must demonstrate that they have the Knowledge, Skills, and Experience (KSEs) required to practise as an eligible specialist in the UK. The emphasis has shifted from ‘equivalence’ to ‘knowledge, skills and experience.’

Comprehensive information is available on the General Medical Council (GMC) website. The GMC website also has comprehensive advice on current application process (Geriatric Medicine). For applicants in Geriatric Medicine, a new curriculum has been in place since 2022. Anyone aspiring to apply in Geriatric Medicine through portfolio pathway should use the SSG.

A new system however brings its own uncertainties, questions, and rumours specially as candidates will now be awarded dual Certification in Geriatric medicine and General Internal Medicine. The BGS Autumn Meeting 2023 had a session in which Rose Jackson, Specialist Applications Team Co-ordinator, Registration and Revalidation Directorate, General Medical Council provided advice and guidance on CESR. Most of the discussion was on CESR process as it was the existing pathway at that time. The talk covered some information on the future Portfolio Pathway as well.

The questions from the floor and online were mostly on the new pathway, which was yet to be announced. Since the Autumn Meeting, more candidates have had experience of submission, and this has resulted in further questions. We collected the questions, organised them and identified a few themes. We met up with Faye Macdonald on 28 May 2024 for advice and guidance on Portfolio Pathway in Geriatric Medicine. We have prepared a summary of the discussion below.

Portfolio Pathway Q&As

Qualifications: Is MRCP an essential requirement for GIM curriculum? What relevant overseas qualifications could be included?

Answer: MRCP has never been, and it still is not a mandatory requirement. If a candidate can demonstrate through the evidence to GMC and structured reports by the referee that they match the competencies, then MRCP is not necessary. Various MD or overseas qualification can be comparable if the evidence maps to the competencies and that could be verified. GMC may not be keen to give a list of qualifications as there may be many and a list would end up in excluding an equivalent degree. The onus to prove competencies lies with the candidate. Specialty Certificate examination (SCE) in Geriatric Medicine is highly recommended.

Will the CMT/IMT portfolio count if one OPT OUT from national training programme & wants to take the Portfolio Pathway route?

Answer: CMT/IMT evidence can be included. There is no time frame regarding how old the evidence is. However, 50% of the overall evidence must be with in the last 5 years. Any older evidence has less value.

Applicants will have to remember that only CMT/IMT evidence will not be sufficient to demonstrate GIM competencies Match the evidence against the SSG.

Acute specialty takes – can this be evidence from geriatric inpatients, geriatric outpatients, and front door frailty – or do the doctors need a “block” of time in a sub-specialty to achieve competencies?

Answer: Acute unselected take patients could be from any time in one’s career but 50% evidence needs to be in last 5 years. When putting evidence together in the logbook, they can be grouped into in-patient/out-patient etc. No specific time was mentioned; however, it is advisable to follow the SSG.

DOPS procedures – Could you tell us the minimum number needed (i.e. we need to do 1 or 5 or 10 for signing off)? Can a consultant or supervisor sign off competencies without stating how many procedures the applicant has done or without a logbook as the su

Answer: Please refer to the SSG – DOPS need to cover each procedure highlighted. There needs to one summative DOP for all GIM requirement. If DOPS are signed off by someone who is not doing the structured report for GIM part, then he/she needs to mention clearly that individual is competent in each DOP.

Do we need to show evidence of doing 80 clinics (as mentioned in the new curriculum ARCP checklist)? If it is 80 clinics, then do they need to be in 12 months, 24 months – or over 5 years?

Answer: The evidence needs to be in total from one’s clinical experience but at least half of the clinics need to be recent in last 5 years. Regarding the number of clinics from different specialties, it is best to read the Speciality Specific Guidance (SSG) very thoroughly.

For SLEs/CBDs/ACATs/OPCATs – do they need to show ‘progression’ of a candidate from level 2 to level 4 over the years?

Answer: They are not required to show progression of individuals. They are essential to show that the applicant can work independently. If at any point in the previous 5 years, one reached level 4 – then it is accepted. Hence the CiPs in SSG can be collected in one year if people are working prospectively (e.g. an/a IMT/CMT taken portfolio pathway to progress rather than National Training program) or retrospectively (e.g. someone is working as SAS or locum consultant over last 5 years).

Will there be new forms for SLEs/ACATs/OPCATs? The current forms do not have levels 2 or 3 or 4 competencies.

Answer: The assessors should mention that candidates can work independently, there is no need to specifically write ‘at level 4’ if this is not an option on the form.

Could you give a summary of the required time spent/cases seen to achieve competencies in specific areas?

Do these have to be at level 3 or 4? Do we need to produce logbooks?

These four specific areas are:

Stroke
Palliative care
Old age Psychiatry
Community Geriatrics

Answer: There is no defined number, but entry in the logbook helps demonstrate the breadth of experience. However, it is important to remember, logbooks alone are not enough – there may be need for other evidence to achieve competency.

(GMC representative did not mention any minimum number of patients needed for Stroke, Palliative care, old age Psychiatry, or Community Geriatrics).

How do we count months for colleagues in flexible (less than full time – LTFT) posts?

Answer: The best advice is to look into ‘of clinical practice’ references. It is likely that for LTFT – 5 years’ worth of clinical experience is mandatory. For example, if someone is working LTFT at 60%, they need at least last 8 years of experience. For someone who is LTFT at 80%, they will need 6 years of experience. The total experience should be equivalent to approximately 5 years of clinical experience.

Sometimes referees are unsure about the pathway. Is there any teaching/help for them?

Answer: GMC does courses for referees: https://www.gmc-uk.org/registration-and-licensing/employers-medical-schools-and-colleges/information-for-referees-and-verifiers

How many referees are necessary?

Answer: GMC will need 3 referees/verifiers – one has to be clinical director/head of service or educational supervisor who knows the process and is familiar with the entire curriculum and evidence. One colleague from Geriatric medicine and one for General Internal Medicine (GIM) is necessary.

We hope that this information will be helpful for doctors planning to apply in Geriatric Medicine through the Portfolio Pathway. We appreciate there will be many more questions and confusions which need to be addressed. We have a WhatsApp peer support group for portfolio applicants. We encourage anyone to join (there is no strict need to be a member of the BGS, but we do recommend becoming a member if you are pursuing a career in geriatric medicine). Please join and share your knowledge and provide support to your peers. Do please ask questions as we will be meeting GMC advisors from time to time and will be sharing their responses with you. For further information or joining the group, please ask any of the authors of this paper.

More information

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Specialty and Associate Specialist (SAS) doctors are senior physicians with at least four years' postgraduate training, including two or more within the specialty.