How often do you get an email from the GMC that says the word ‘Congratulations’?

My first thoughts were that it had to be a scam, when I came across the email after a busy day’s work. I checked the sender’s address, and it really was true. It was a genuine email, and it was telling me that my CESR (certificate of eligibility for specialist registration) application had been approved.

I was so super-excited that I spat my mouthful of tea back into the cup and started phoning my family to tell them the fantastic news.

Wow! What a journey it had been! It started in 2021 and finished in 2025. This doesn’t mean I took several attempts; in fact, I needed only two. But the process took a long, long time.

To go back to the beginning – I submitted my application for the first time in 2021, but it wasn’t until more than a year after that I heard back from the GMC and royal college equivalence committee, in early 2023. They apologised and said there had been some administrative issues post-COVID.

During this waiting period I had a great opportunity to move from my CAMHS (Child and Adolescent Mental Health Services) specialty and associate specialist post to be a CAMHS locum consultant, and I continued with my clinical supervision of resident doctors and medical students.

In July 2023, I was standing on the tarmac of the airport, just about to board the plane for a holiday when I received an email from the GMC saying my application had been rejected owing to a lack of certain areas of evidence. Not a very good start to my long-awaited holidays.

However, I mustered up some courage to download and read the full feedback document on the flight and was somewhat pleased that out of the many objectives for both core and CAMHS curricula, I had very few that did not meet the standards.

This gave me hope and courage to resubmit the application in 2024 by addressing those gaps in my second application and I was so pleased it came out victorious earlier this year. I don’t regret a single moment of this journey, except when I couldn’t indulge in an elaborate gardening session on an unusually sunny day, but instead had to sit on my laptop updating my portfolio evidence.

Having gone through this amazing journey, I just thought it might be helpful to share an overview (it’s not a detailed guide) of my CESR journey, for anyone thinking of the portfolio route towards achieving CCT (certificate of completion of training).

This journey took origin during the beginning of my SAS job in CAMHS back in 2016. I absolutely had no clue what the CESR pathway was, all I had on my mind was how best I could fulfil my job as a SAS doctor, meeting the everyday demands and expectations that CAMHS had to bring and just plough through my clinic work. However, I was curious and gradually gathered ample information and knowledge from the GMC website.

How I got started feels a bit blurry now, but I remember starting off attending a few CESR training/workshops, but soon realised CAMHS has a unique curriculum and a generic CESR training wasn’t enough.

The Royal College of Psychiatrists had organised a few CAMHS-specific CESR training days which were absolutely spot on and I would highly recommend if these are still being delivered. These training days helped me understand my specialty (CAMHS) curriculum inside out and think of creative ways of addressing each ILO (intended learning objective) and its sub-sections in more depth.

During my application process, there were changes in the RCPsych training curriculum, the so-called Silver Guide. The 2022 version has about half of the objectives (both core and CAMHS-specific) of the 2018 curriculum. My first application was based on the old curriculum, and I don’t regret this because it gave me a good breadth and depth of CAMHS experience.

So, once I had decided to go through CESR route, my next job was to get everyone on board with my CESR journey, including my family and work manager/medical colleagues, with a realistic plan and timeframe that this application work might demand from me. This period meant sacrificing some of my annual leave, non-working days and weekends to work on my application, along with a period of secondment to meet some of the mandatory objectives.

Once I got everyone on board, my next task was embedding the curriculum objectives in my daily work and creatively thinking how best I could achieve these either in my on-call, or clinics or, for example, when doing a Mental Health Act assessment.

I made sure I gathered evidence along the way. This included, for example a short email from an allied mental health professional with whom I had spent half a day learning about their job, and my notes from a few days shadowing and seeing patients in a community paediatric set-up for under-fives. I gathered all the evidence too from my secondment in liaison and inpatient units and wrote up the case histories.

A point worth remembering is you have only 12 months from the time you click ‘start’ on the application, so it’s best to save all the evidence in electronic folders before starting the application process.

Once I had collated all the necessary evidence, I needed to share these documents with my nominated supervisors. The GMC sends a sample of evidence documents to supervisors for verification. It’s worth noting that the evidence must be five years old or less. For applicants who have had work experience back in their home country, GMC advisers are very helpful with their guidance.

When I was sure I had gathered all the necessary evidence, it was now crunch time. I needed to sit down and bundle them up nicely under each of the objectives. But this was not as simple as it sounds.

There were a lot of technical things with which I had to familiarise myself and cannot thank my son enough, for his magnificent help with these technical issues – please see below for some useful tips in that respect. (Also special thanks to my daughter for feeding me her excellent bakes and my husband for his amazing moral support throughout this process).

An important point with the evidence is that it’s about the quality, not the quantity, of material that you submit. Don’t make it unnecessarily time-consuming for you or your evaluator. If, for example, you have a piece of evidence that can be cross-referenced to several objectives, then link and triangulate rather than repeat it under different headings. And above all, follow your GMC advisor’s guidance; I found mine to be very patient and helpful.

Looking back on these last many years of my CESR experience, although it’s been a rollercoaster of a journey, I thoroughly appreciate the richness it has added to my CAMHS knowledge and experience. I met fantastic people along the way, including members of the royal college CESR committee, like Dr Nandini Chakraborty, who was exceptionally helpful. I also made new friends with fellow applicants.

I want to give my heartfelt thanks to all those who believed in me and supported me along this journey. I’m proud to share that I have been recently appointed as a substantive CAMHS consultant following my CCT, marking the end of a long CESR journey and start of new beginnings.

Some useful tips for gathering evidence

• With patient-identifiable data, use ‘advanced find and replace’ for redactions, or if doing it manually, use a black crayon, and then scan and upload
• Spell check to keep your language professional and legible
• Save documents in PDF documents only
• I heard that software like Adobe Acrobat, which allows editing, is expensive but is useful for redactions
• I made a list of all abbreviations that I might have come across in my own notes or letters, to make it easier for the evaluator
• I also made an index page for all the contents in a particular bundle of evidence
• Last but not least, maintain a structure to the pieces of evidence and number the pages carefully for each section.

Uma Padmanabhi was recently appointed as a consultant child and adolescent psychiatrist in Hampshire