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A comprehensive guide through the CESR pathway

If you completed your radiology training outside the UK or do not possess a recognized qualification from the EEA or Switzerland, you need to apply for a Certificate of Eligibility for Specialist Registration (CESR) to obtain specialist registration in the UK.

What is the CESR pathway?

Are you an international graduate pursuing a career in radiology and considering a transition into the UK National Health Service (NHS)? Look no further! This page will guide you through the CESR pathway - a promising route for achieving your goal.

To begin with, registration with the GMC (General Medical Council) is mandatory for all doctors intending to practice in the UK.

Applicants can demonstrate their level of knowledge and skills necessary for medical or specialist registration through various means. The PLAB test is a common method to showcase the appropriate knowledge and skill level for full GMC registration. Alternatively, applicants can apply with an approved postgraduate qualification (PGQ) relevant to their specialty. The GMC maintains a list of approved PGQs for this purpose.

Overseas doctors with acceptable qualifications from the USA, Canada, and Australia can apply for full registration through an Acceptable Overseas Registration Exam (AORE). Another option is to seek sponsorship from an approved sponsor, such as the Medical Training Initiative (MTI), which offers training opportunities in the UK for overseas doctors.

For specialist registration, applicants can apply for a Certificate of Eligibility for Specialist Registration (CESR) which grants entry to the specialist register and waives the PLAB test requirement.

In the UK, Clinical Radiology trainees undergo approximately five years of specialized training, as per the current training curriculum. Upon successful completion of the training, they receive a Certificate of Completion of Training (CCT) in Clinical Radiology, granting them entry to the GMC specialist register. If you have not completed your training in the UK or do not possess a recognized qualification from the EEA or Switzerland, you need to apply for a Certificate of Eligibility for Specialist Registration (CESR) to obtain specialist registration in the UK.

To obtain the CESR, applicants must provide a comprehensive range of evidence demonstrating that their specialty training, qualifications, and experience are equivalent to the CCT in Clinical Radiology, as outlined in the specialty training curriculum. Successful attainment of a CESR also allows entry to the GMC specialist register.

Once registered, you are able to take up a substantive (permanent), fixed-term, or honorary NHS consultant post.


To kickstart your journey, the first step is to register yourself on the Royal College of Radiologists (RCR) website and prepare for the Fellowship of the Royal College of Radiologists (FRCR) exams. The timeline from preparing to taking the exam and registering can take around 2 years given that all the exams are cleared in first attempt. The timeline should look like something below:

For a comprehensive guide to the FRCR exams, you can find valuable resources on the exam section of Radiology Cafe.

Let's cover some key takeaways to get you started:

  1. Radiology Training Post

    • It is essential to have held or be in a radiology training post either in your country of practice or the UK to be eligible for the FRCR exams.
  2. FRCR Part 1

    • No course attendance certificate is required for this exam, and there is no minimum period of training prerequisite. It is important to note that there are no alternative or substitute exams available for FRCR. For bookings from 2023 and onwards, priority access to exam booking will be divided into three categories:
      1. UK Trainees who are Members.
      2. Members (excluding UK Trainees).
      3. Non-members.
    • Starting from the 2024 exams, members (including UK Trainees) will have the opportunity to book their exams two weeks before non-members. If you are interested in becoming a member, it’s essential to apply for membership before proceeding with your exam application. Membership offers valuable benefits, including priority access and reduced exam fees.
  3. Exam Venues

    • The FRCR exams are conducted at nine venues across the UK and six global venues, including Hong Kong, Malta, India, Singapore, and Pakistan. This allows international graduates to conveniently access the examinations.
  4. Exam Fees

    • The fees for FRCR Part 1 range between £319 and £628 GBP, depending on the chosen venue and membership status i.e; RCR members tend to have a discounted exam price compared to non-members.
  5. Exam Schedule

    • The FRCR Part 1 exams are scheduled three times a year in March, June, and September, providing flexibility for candidates to choose a suitable time.

      Moving on to FRCR 2A, this exam is conducted bi-annually in April and November. The fees for FRCR 2A range from £427 to £843 GBP. The examination venues remain the same as FRCR Part 1, offering a broad range of options.

      For FRCR 2B, the exam is held four times a year in June, September-October, January, and March. Excitingly, the global venues for this exam include Egypt and India. The fee for FRCR 2B ranges from £597 to £903 GBP.

Obtaining additional experience prior to CESR application

Firstly, it’s important to note that the Royal College of Radiologists (RCR) advocates for a minimum of five years of training in radiology. However, if your training period falls significantly shorter, such as three years, there’s still a way to meet the requirement. You can work in a specialist post within a hospital setup for an additional two years, and this experience can count towards fulfilling the training period. Keep in mind that teleradiology might not be considered in this context, so it’s advisable to focus on gaining experience in hospital-based roles.

Once you have successfully completed the FRCR exams, you can take the next step and register with the General Medical Council (GMC). Obtaining GMC registration through CESR pathway requires an additional language qualification. Options for this include the Occupational English (minimum requirement: B grade in each domain, with an overall B) or IELTS (minimum requirement: overall score of 7.5 with 7 in individual domains).

Collecting evidence for CESR

To complete your registration, you must demonstrate that your specialist training, qualifications, and experience are equivalent to those of a doctor who has successfully completed training according to the Certificate of Completion of Training (CCT) curriculum for Clinical Radiology. This curriculum is built around 12 learning outcomes called “Capabilities in Practice” (CiPs). These CiPs assess your ability to provide general and emergency radiology in any NHS environment, as well as your specialist skills in one or more areas.

Be prepared for the paperwork involved in this step, as it can be quite extensive, often requiring around 800 to 1000 pages of evidence. Starting early and staying organized will prove beneficial throughout this process.

Now, let’s talk about the variety of evidence you can present. The list we provide isn’t set in stone; it’s more like a buffet of options. You don’t have to serve up every dish, but you need to ensure you’ve got enough to cover each of those learning outcomes and their trusty sidekicks, the associated descriptors.

If, by any chance, you find yourself with a missing piece or two from this evidence puzzle, fear not. Our recommendation is to hold off on applying until your evidence collection is complete. Trust me, it’s worth the wait!

As you assemble your evidence, keep in mind that it’s like putting together a mosaic of your expertise. You’ll need to showcase your knowledge, skills, and qualifications to prove your prowess in every nook and cranny of the Clinical Radiology CCT curriculum. If any of those areas are left unattended in your evidence, it might give your application a bit of a wobble.

Now, here’s a little secret to grease the wheels of your application process: Stick to sending evidence that’s directly relevant. Speaking of evidence, freshness is the name of the game – the most weight is placed on evidence from the past five years. If you’ve been honing your skills in a particular niche for a while, showcasing your competence across the broader curriculum might be a bit of a jig.

For those who’ve taken a break from the clinical hustle, don’t fret. You’ve got this! Find ways to demonstrate that your clinical prowess has remained intact. And remember, evidence that’s more than five years old is a bit like a dusty relic – it might not reflect your current competency shine.

Evidence database

Your evidence should be as organized as a well-decorated room. Just like you’d arrange your favourite items on different shelves, your evidence needs to follow the structure of the online application.

Pop your evidence into the right sections of your online application. If you’re feeling old school and have some hard copies to share, don’t worry – just make sure to label them clearly with dividers that match the online sections.

The backbone of your application are the curriculum’s twelve Capabilities in Practice (CiPs). The CiPs are categorised into generic and speciality specific:

  • Requires you to demonstrate professional values and behavior as per good medical practice.
  • Includes domains such as teaching, audit, research, leadership, and general team work.
  • Evidence for thie first 6 CiPs include Multisource feedback forms, teaching evaluation, QI participation assessment tool, MDT assessment, leadership, management courses etc.
  • Clinical radiology oriented.
  • Includes domains such as imaging specific team work, accuracy in reporting, procedural skills, assessing image quality, maintaining patient safety in image guided interventions, MDT participation and working in a team.
  • Evidence for the final 6 CiPs include MDT assessment tools, FRCR exams, Mini image interpretation exercises, Radiology DOPs, Advanced life support course and MDTA.

It’s worth mentioning that all radiologists are expected to be trained in basic image-guided procedures, including performing biopsies, inserting tubes and drains, and conducting diagnostic procedural work.

   Further information

So, armed with this knowledge and the official guidelines at your disposal, you’re well-equipped to pursue your passion for radiology and embark on an exciting career within the NHS. Best of luck as you navigate this rewarding path!

Working with a CESR

Once you have successfully registered and are ready to practice in the UK, you can choose your desired role based on your level of experience and confidence.

Depending on your qualifications, you can opt to start directly as a consultant or as a specialty doctor (Registrar/Clinical Fellow).

If you have the necessary expertise and experience, starting as a consultant allows you to take on a more senior role, providing specialized care and leading a team. This position comes with increased responsibility and the opportunity to contribute to shaping the field of radiology.

On the other hand, if you feel more comfortable starting at a slightly lower level or gaining further experience in the UK healthcare system, you can begin as a specialty doctor. This role offers a valuable opportunity to refine your skills, work closely with consultants, and gradually take on more responsibilities as you become more familiar with the local practices and procedures.

If you have a specific sub-specialty interest, such as a diagnostic radiologist wanting to further specialize in Interventional Radiology (IR), you can negotiate this during the interview process. Expressing your passion and enthusiasm for a particular sub-specialty and demonstrating your willingness to undergo additional training or professional development can increase your chances of being considered for such opportunities. The interview serves as a platform to showcase your commitment to continuous learning and growth within your chosen field.

Remember to be prepared to highlight any relevant experience or additional qualifications that make you a strong candidate for the desired sub-specialty. This could include prior training, research, or clinical exposure in the field of interest.

Negotiating your desired sub-specialty during the interview demonstrates your dedication to advancing your skills and contributing to the specific area of radiology you are passionate about. It also allows potential employers to understand your career aspirations and consider how your expertise aligns with their department’s needs.

By being proactive and showcasing your commitment to professional growth, you can open doors to exciting sub-specialty opportunities and shape your career in radiology according to your interests and aspirations. Good luck with your journey and the pursuit of your desired sub-specialty!

So, embark on this rewarding journey, immerse yourself in the world of radiology, and open doors to exciting possibilities within the field. The CESR pathway awaits your talent and dedication!

Summary of the CESR pathway

  • Apply via Trac/NHS jobs and explore possibilities of sub-speciality interest. Read our Finding a consultant job article for more information.