Portfolio Pathway (formerly CESR)

Historically, the CESR (as it used to be known) directly mirrored and was assessed against the standards of the UK’s training programme. However, since November 2023, whilst the assessment standards have changed, the outcome of a successful Portfolio Pathway application remains the same; a successful applicant will be added to the Specialist Register to work as a O&G Consultant in the UK. Applicants can now demonstrate they have the ‘knowledge, skills and experience’ to enter the Specialist/GP Register.

Why were the standards changed?

For further details on why the changes were implemented, please view our recent webinar presentation slides which can be found here.

As stated above, you will need to apply to the GMC, who will then send your application to the RCOG for evaluation. We urge that when you have started an application with the GMC and are in the process of amassing your evidence you contact the Portfolio Pathway Manager at the College to double check on any curriculum requirements you are unsure of. This is particularly important for all non-UK applicants who are attempting to provide comparable evidence to RCOG approved training, such as ATSMs.

Clinical evidence

Clinical evidence from both obstetrics and gynaecology should be provided from the last five years, demonstrating contemporary, independent competence in the required procedures. This should be evident in your logs of experience and WPBAs.

MRCOG (or equivalent)

Without the MRCOG or one of the other four qualifications listed in the guidance, it is unlikely you will be successful. Whilst there is an option for applicants to provide a detailed, thorough and succinct cross-referencing mapping exercise, demonstrating how each and every MRCOG competency (MRCOG Part 1, 2 and 3) has been covered in their own qualifications, it will be assessed on a case-by-case basis. The applicant will need to undertake an extensive and onerous level of work to justify the level of equivalence required to be successful. It is, therefore, not recommended.

Transition to Special Interest Training Modules

Applicants must complete the required competences for a minimum of two ATSMs/SITMs (SIPMs on their own will be not accepted). If you have completed RCOG ATSMs/SITMs, please provide the completion certificates only. (BSCCP accreditation is considered equivalent to one RCOG ATSM/SITM). A combination of ATSMs and SITMs will be accepted during a two-year transition period from 7 August 2024 until 6 August 2026.   Any ATSMs completed before SITMs implementation or within two years of its implementation will continue to be valid for the Portfolio Pathway.  Doctors who have already started their ATSMs at the time of implementation will have the choice to either stay on the ATSMs or move to SITMs. Once the transition period finishes (6 August 2026), ATSMs will be fully decommissioned and Portfolio Pathway applicants will have to apply with the SITMs as part of their  application.

A breakdown of knowledge, skills and experience

Each key skill should be linked to evidence of either Knowledge, Skills or Experience.

The best evidence for a particular key skill will cover all three areas; knowledge, skills and experience. However, an applicant can use their judgement regarding whether they can cover a key skill effectively – i.e. an applicant may have a great deal of experience in one area to cover all descriptors; and courses (knowledge) are therefore not necessary. Some examples of how it may work are below:

• Some may be covered by knowledge, skills and experience (ideal evidence).
• Some may be covered by just skill and experience (i.e. if an applicant’s clinical experience outweighs the need for demonstrating knowledge via a course/teaching session).
• An applicant may be able to cover two key skills at the same time with one piece of good evidence.

The above comes with a strong recommendation for applicants to really ensure key skills and descriptors are met. It is unlikely an applicant will fulfil a CiP demonstrating knowledge alone – a mixture of knowledge and practical experience is therefore strongly advised, in order to be successful.

Any evidence written in bold in the guidance document is mandatory.

WPBAs

Documentary evidence provided must be from the period in which it was undertaken – e.g. WPBAs must be from the period that the applicant undertook training and the summative OSATS required must categorically confirm independent competence with appropriate assessor comments and sign-off. Assessments and appraisals cannot be signed off retrospectively. OSATS, Mini-CEX and CbDs must be signed off by supervisors concurrently with when the assessment takes place.

Appraisal

Sequential annual appraisal along with personal development plans must be provided from the last five years.

For full information on evidence required for the Portfolio Pathway, please read the O&G Portfolio Pathway evidence guidance document.

If you have not completed RCOG ATSMs/SITMs, you must provide primary equivalent evidence to meet the requirements of the specific ATSM/SITM curricula as outlined on the RCOG website (both theoretical and practical). If commencing this work after 7 August 2024, please provide equivalent evidence to RCOG SITMs.  Please refer to the SSG for further details on how to undertake this. Please also liaise with the Portfolio Pathway Manager to discuss how you intend to approach presenting your SITM equivalence evidence, as it can often be a challenge for applicants to do so, therefore college advice from the outset is advised.

Three structured reports are required under the new guidance post November 2023. One must be from your current clinical director/head of department/chief of service and two should be from consultants/senior SAS doctors (acting at consultant level). These should be from current employment (unless you have just taken a new position in the three months prior to submission) and the referees should have worked with you for a minimum of six months. For further information, please contact the GMC directly.

The RCOG’s Portfolio Pathway Advisory Group assesses applications on behalf of the GMC. Members of the group are trained Fellows and Members of the RCOG who will determine whether an applicant’s knowledge, skills and experience can categorically determine an applicant’s abilities to work as a day one obstetrics and gynaecology consultant in the UK. If you are successful, you will be recommended for entry to the Specialist Register.

The GMC makes the final decision on who enters the Specialist Register and may overturn the RCOG’s decision, but this is rare.

Canvassing on behalf of applicants through any source is not permitted. It is therefore inappropriate to approach members of the group about your application. If a group member has a personal or professional relationship with you, they will be excluded from assessing your application.

You may be able to contact the College's Portfolio Pathway Manager for an update on the status of your application i.e. what stage of the process it is at, but the College can tell you no more than this. In addition, as the GMC have the application for an undetermined period of time after the College has completed their assessment, it may be more beneficial to liaise directly with the GMC regarding when a decision is likely to be made.

The GMC first needs to ensure all application documentation has been received, including structured reports from referees, before sending the completed application to the RCOG. This can involve some back and forth with the applicant until the GMC are happy that all required evidence has been submitted and that it meets all the key skills appropriately. This part of the process can be lengthy, as the GMC may need to ask you for further information.

When they are satisfied with their preliminary assessments it will then be passed onto the College for evaluation. To help the process advance as quickly as possible, please read all the GMC guidance carefully before submitting your application to ensure you provide all the documentation required, and respond promptly to requests for further information from the GMC. Please also check on anything you are unsure of with the Portfolio Pathway Manager at the RCOG, or the GMC.

The College has exactly seven weeks to submit their evaluation. Combined with the time the GMC will then need to reach their final decision, applicants should expect that it will take approximately two to three months before they are informed of the outcome of the assessment.

As stated above, only the GMC can update you on the progress of your application. Please contact the GMC Certification Officer with whom you have been corresponding for further information.

You will be able to submit a review application within twelve months of receiving the decision letter regarding the outcome of your application. This involves submitting the evidence that you did not submit in the first application. Alternatively, under specific circumstances, you may be able to appeal against the decision.

For more information about reviews and appeals, please contact the GMC directly.

One can apply for the Portfolio Pathway in a non-CCT specialty (e.g. gynaecological oncology, maternal and fetal medicine, reproductive medicine, sexual and reproductive health care or urogynaecology).

Trainees on the RCOG sub-specialty training programme in one of these specialties begin their training from ST6 onwards. Therefore, for formal subspecialty accreditation, or equivalent non-CCT Portfolio Pathway applications alike, it is a requirement that doctors demonstrate achievement of both the outcomes set in the approved specialty curriculum and those set out in the approved subspecialty curriculum.

In summary, a ‘day one’ consultant in the UK health services will be required to demonstrate cross-specialty knowledge and experience; covering core O&G competences, in addition to the subspecialty competences. Non-CCT Portfolio Pathway applications must demonstrate up to date, ongoing competence of both O&G and their relevant subspecialty. As a result, the College advises a cross-specialty approach to your application, taking into account the requirements of both the O&G curriculum (outlined in the O&G specialty specific guidance), as well as the relevant subspecialty training requirements. 

For further information, please contact the GMC directly.

Changing working patterns have resulted in many doctors now working in either obstetrics or gynaecology but not across both, some work solely in subspecialist areas. This can cause difficulty in evidencing Knowledge, Skills and Experience across the full curriculum of obstetrics and gynaecology for entry onto the specialist register via the Portfolio Pathway route.

An alternative to the Portfolio Pathway for doctors working at a similar level to consultants but in niche areas is a new post, called specialist grade. This is a new senior medical post which recognises specialist skills, enabling the post holder to work in extended roles with increased autonomy. Appointments to specialist grade can be made in obstetrics alone or gynaecology alone or even in a subspecialty and do not require evidence across the full curriculum.

A doctor does not have to be on the Specialist Register to apply for a specialist doctor post. The entry criteria for the specialist post is minimum twelve years (ten in Scotland) postgraduate experience with minimum six years in relevant specialty. The generic capabilities in the GMC framework need to be evidenced alongside role specific competencies.

Find further information on the specialist grade and via the RCOG SAS & LED committee.

Yes, you are able to apply for the Portfolio Pathway and have your application assessed, but you cannot be awarded the Portfolio Pathway until you have obtained full GMC registration.

No. Unlike the CCT, other EU states are not obliged to recognise the Portfolio Pathway.

If this page doesn’t answer your question, or you need more information, please contact Mrs Gemma Mordecai, the Portfolio Pathway Manager either via email gmordecai@rcog.org.uk or call +44 20 7772 6451.