Viewpoints: The alternative path to Consultant grade



Emergency doctor Paul Robinson explains why he is taking a less usual route to senior grade – via the Certificate of Eligibility for Specialist Registration

My department lead winced, and had the good grace to look embarrassed as I described the teaching component of my third year of Core Training at a governance meeting.

I was pretty fed up. As part of the training contract, I was meant to receive a full afternoon of structured teaching every two weeks. I was three-quarters of the way through the year and had received this twice.

Like many doctors, I am in part driven by an excited, bounding desire to learn, and the absence of structured education was hitting me hard. The unforgiving emergency medicine rota was taking its toll and my own learning – outside work – had stalled. I had been reduced to a machine of service provision, desperately stuffing cajoled assessments into my portfolio, and running into delayed outcomes at every Annual Review of Competence Progress (ARCP).

In searching for an alternative route to the Certificate of Completion of Training (CCT), I recalled some teaching delivered by an adventurous physician who had announced to the lecture theatre she was qualifying by the “CESR” route – the Certificate of Eligibility for Specialist Registration.

It was prolonged, but she had a career scattered with fascinating, interesting jobs. Unorthodox methods can be refreshing. So what did I do?

A consultant mentor (and now Trust Guardian) spoke to me about the process. “The only disadvantage,” he said, “is that it’s a lot of paperwork and it’s not transferable overseas. It’s unclear if that was intentional. They probably forgot.”

Training runs offer a structured approach to CCT with timetabled features and checklists. Writing one’s own book is more of a challenge. As the Twittersphere said, “Find yourself a mentor, a copy of your most recent syllabus, and start.”

Where there is a curriculum for a speciality, you already have a training framework. E-portfolios are available to many specialties as “associate” or “affiliate” of their college, allowing for an electronic resource. 

The disadvantages are there too, however. Driving one’s own development is fraught with difficulty, particularly retaining enthusiasm and making sure teaching days are covered independently to meet key skills. There is a clear need to argue for study leave and a study budget, to which potential employers may be sceptical.

Purpose is a challenge by either pathway, and submission of documents at the end of the process carries a hefty fee from the GMC with no guarantee of passing – candidates frequently need more time for additional work and competencies.

Further, there are some specialties which have specific training requirements that are hard to meet independently – for example the six-month Anaesthetic block in Emergency Medicine CT2.

Finding an employer willing to push a non-training SHO through their Initial Assessment of Competence is no easy feat.

There are equivalent problems in surgery and in medicine, not to mention having the ruthlessness to pursue Consultants and mentors for portfolio material – a process subject to the same pressures in both training and non-training grades.

So far, however, it seems to be working. My enthusiasm for learning and for work returned once I was master of my own fate. I persuaded my Trust to take me on as a 50 per cent educator, 50 per cent clinical ED doctor, providing them with a Registrar and giving me a fresh outlet for my passions.

The portfolio submissions have been a challenge, and the process will take longer than the standard training equivalent, but it is all down to me – no more fights with the deanery, no more cancelled training days. And no more persistant hoop-jumping for ARCPs. 

Trade union considerations and work indemnity need attention for the non-training doctor. I moved to the HCSA because I felt their more individual approach would fit with CESR route training. I’ve felt well supported.

A nasty shock came three-quarters of the way through the year when my indemnifier heard I wasn’t in a training post and almost doubled their fee. A brief search meant I located an alternative at a better price, but there are few resources aside from hearsay, guile, and the experience of others.

This may be changing, as a second hospital has been subsequently persuaded to employ me in a similar role. Hopefully, there is a growing recognition that embracing the unorthodox can be hugely empowering.