Author: Pallavi Rao Majji, William Niven / Editor: Charlotte Davies / Codes: / Published: 07/09/2025
CCT or CESR that’s the question everyone keeps asking me, especially since I chose the CESR (now portfolio pathway) route over CCT.
The CESR or portfolio pathway is an alternative to becoming a Consultant in Emergency Medicine. Lots of EM clinicians choose this wrote.
Conventionally (but not exclusively) who would choose CESR?
- International medical graduates (IMGs) who had completed equivalent training and/or overseas years of experience in emergency medicine
- Trust grade SAS doctors who wish to progress to consultant
- Completed a recognised training programme in a different jurisdiction for example Australia
- UK trainees who discontinued due to personal reasons.
Unlike CCT, where you are guided through the process, pursuing CESR requires a high level of discipline, consistency, attention to detail and strong organisational skills to collect and present your evidence effectively.
Attending RCEM conferences focused on CESR training, where the college demonstrated a genuine commitment to guiding doctors and are encouraged. They offer the opportunity for one-to-one sessions with a CESR evaluator, as part of the CESR Applicants Training Day: Portfolio pathway applicants training day (CESR) | RCEM. My guidance and checklist for collect evidence (which I would describe as a holy book).
Also, RCEM has a dedicated page about portfolio pathway (previously called as CESR) which helps us to understand: Training and Careers > EM Training and Accreditation > CESR.
My Experience: Dr Majii
Yes, I know CCT is indeed seen as the smoother path. Once you get on that track, it like a railway line: once you are on board, you are pushed towards the destination, one way or another, by hook or by crook.
CESR, on the other hand, is more like planning your own journey with multiple changes between buses, trains and walk to get to where you want to be. And let me tell you, there can be delays along the way, for all kinds of reasons.
Of course, both CCT and CESR have their pros and cons. CCT isn’t without its own challenges. But since I started my CESR journey back in 2019 and have now reached the final stage, I thought it was a good time to reflect on how far I have come.
I completed my MBBS in 2015, and from 2016 to 2019 I did my post-grad experience in Emergency medicine in India. Emergency medicine is still relatively new in India, and I wanted to explore it further that’s when I discovered the MRCEM exams and UK training program.
While I was still in India, I managed to pass the MRCEM exams alongside my post-graduation exams something I am proud of. After that, I was interviewed for jobs with NHS trusts and relocated to London, UK.
My first year in the UK was a struggle- trying to figure things out, adapt to the NHS culture, and understand how everything worked. I received a lot of advice about whether I should pursue ST1, the DREAM route via ST3/ST4 or go down the CESR path.
I spoke to many people and concluded that every route has its own pros and cons. For me, staying in one place and being close to family was a priority. After years of living away from family, I didn’t want to keep moving around and miss out on family life. That’s why I did not choose ST3/ST4. ST1 wasn’t a fit either, as I had already completed emergency medicine training in India.
My CESR journey was made smoother thanks to incredible support from consultants, colleagues. I was assigned a dedicated educational supervisor to guide me through the process. I received thorough support from consultants, especially with my work-based assessments, ultrasound signoffs, simulation signoffs and so on. I also had three-month rotations in acute medicine, anaesthesia and ITU. Also helped me complete the required paediatric competences and management portfolio which included complaints, serious incident (SI), coroner report police report etc. Also, with audits and quality improvement project (QIP). Additionally, I was given opportunity to conduct many teaching sessions and supervise junior staff and contribute to mortality-morbidity meetings and many more. I had simultaneously completed my FRCEM.
I firmly believe that the departmental structure and their genuine commitment to support us were fundamental in pursuing entry to the specialist through non-traditional route.
Finally, I would say that CESR is achievable, provided you know what evidence to collect (of course with departmental support!). I am currently preparing an interim checklist spread over four years to help gather evidence gradually, rather than leaving everything until the end which can be overwhelming. I am happy to help and share my journey and can be contacted for a discussion.
Lastly, I would say even the slowest stream can shape mountain through patience and persistence. Best of luck!