Navigating the Portfolio Pathway (CESR) in Geriatric Medicine: A Practical Guide

For international medical graduates or UK doctors who haven't followed a traditional training route, obtaining a Certificate of Eligibility for Specialist Registration (CESR) is an effective route to achieving consultant status in the UK. While the pathway can be complex and time-consuming, with the right preparation, it is entirely achievable.

To help you better understand the Portfolio Pathway process for Geriatric Medicine we’ve outlined what you need to know and included several practical tips to help you on your journey.

 

What is The Portfolio Pathway?

Formerly known as CESR, the Portfolio Pathway is the route to specialist registration for doctors who have not completed a GMC-approved training programme, but who are able to demonstrate that they have the knowledge, skills and experience (KSEs) required for practising as an eligible specialist in the UK.

This route allows doctors who haven’t completed a UK CCT (Certificate of Completion of Training) programme the chance to apply for entry onto the Specialist Register, which is required to work as a substantive consultant in the NHS.

 

The Portfolio Pathway process for Geriatric Medicine

Geriatric Medicine requires broad knowledge in acute medicine, chronic disease management, rehabilitation, mental health, and social care coordination.

Key competencies include:

 

Acute Care of Older Adults – Managing delirium, falls, and polypharmacy

Chronic Disease Management – Dementia, Parkinson’s disease, frailty syndromes

Multidisciplinary Working – Liaison with social workers, therapists, community teams

Ethical and Legal Issues – Capacity assessment, DoLS, advance care planning

Leadership and Teaching – Leading MDTs, teaching juniors, service development

 

Building your Portfolio: Step-by-Step Guidance:

Preparing for the Portfolio Pathway is intensive and requires careful planning, evidence collection, and organisation.

 

1. Curriculum Mapping

Map your existing skills and experiences against the 2022 Geriatric Medicine curriculum which is overseen by the Joint Royal Colleges of Physicians Training Board (JRCPTB) It includes both general Internal Medicine (stage 2 capabilities) and the specialty-specific domains in Geriatric Medicine Identify gaps and plan ways to fill them (courses, placements, additional roles)

 

2. Evidence Collection

Your CESR portfolio must demonstrate evidence across all domains: clinical capabilities, leadership, communication, ethics, education, quality improvement, and research/audit. Gather evidence across all aspects:

• Clinical case logs and reflective entries
• Workplace-based assessments (e.g., mini-CEX, CBDs, DOPS)
• Audit/QI projects
• Teaching feedback and materials
• Leadership and management experience
• CPD certificates and appraisals

Evidence should be recent (within the last five years), anonymised, and in English or translated by a certified translator.

 

3. Focus on Core Capabilities

• Geriatric syndromes (falls, dementia, delirium, frailty)
• Polypharmacy and complex multimorbidity
• End-of-life care and advanced care planning
• Interdisciplinary working and community interface
• Rehabilitation and discharge planning

 

4. Strengthen General Internal Medicine (GIM) Evidence

Since Geriatric Medicine is a dual specialty, your CESR must also cover GIM competencies.

This includes acute unselected take, leading ward rounds, and working in HDU-level care environments.

 

5. Structuring Your Portfolio

Use the GMC’s guidance:

Organise evidence clearly Label each document Ensure every piece of evidence is directly mapped to a curriculum competency

 

6. Submission

Applications are submitted online via the GMC portal. The process includes:

Submitting a detailed application form Uploading your evidence Fees payment Awaiting assessment by the GMC and specialty advisory committees

The process takes several months, and you may be asked to provide further information

 

Tips for Success

• Start early and allow plenty of time to gather evidence.
• Be meticulous with organisation and curriculum mapping.
• Seek regular feedback from supervisors.
• Engage professional support early to avoid costly mistakes.