P050 Certificate of Eligibility for Specialist Registration (CESR) (portfolio pathway) satisfaction survey for dermatology trainees: a comparison of current CESR vs. national trainees, within a large UK teaching hospital

Abstract Over the past 10 years, the UK has seen a consistent rise in the number of dermatology trainees pursuing alternative training pathways to the traditional national training scheme. During this period, the number of trainees awarded a Certificate of Eligibility for Specialist Registration (CESR) more than tripled. This trend appears to be multifactorial, driven by a shortage of national training numbers (NTNs), geographical preferences and a rising number of vacant consultant posts nationally. The CESR route was renamed the ‘portfolio pathway’ in November 2023. It is equivalent to a Certificate of Completion of Training in dermatology. Since 2018, this large teaching hospital has created a CESR training programme that mirrors the NTN programme. In June 2023, a survey was distributed to all dermatology registrars (ST3–ST6) working within the dermatology department. The responses comprised six CESR trainees and 13 NTNs. Modelled on the General Medical Council’s annual National Training Survey, questions were written with grading on a Likert scale, capturing information including training and research opportunities, access to teaching, personal wellbeing and rota design. There were two sections: section 1 was completed by both CESR and national trainees, in order to obtain a direct comparison of training experience, while section 2 was completed exclusively by CESR trainees. Section one revealed that no trainee felt that there was a notable difference in training opportunities or access to teaching, or that there was a perceived difference in clinical competency. All CESR trainees felt that they were treated equally to national trainees, with 50% rating their job satisfaction as ‘very good’, compared with 31% of national trainees. In regard to audits and quality improvement project opportunities, both cohorts felt that the geographical continuity offered with a CESR contract was advantageous, enabling CESR trainees to commit to long-term projects. Conversely, 50% of CESR trainees felt that research opportunities were limited by the 5-year timeframe of the CESR application process. ‘Geographical stability’ was the primary motivator for 50% of trainees pursuing a CESR contract and/or rejecting an NTN. That said, when applying for consultant positions, 67% felt disadvantaged by not having an NTN. This is the first CESR (portfolio pathway) satisfaction survey for dermatology trainees in this hospital. We have collated the experiences of our current CESR trainees, assessing the pros and cons of the pathway, while highlighting the beneficial role of a formalized survey to both monitor and improve their experience. We feel this is imperative, in light of rising number of trainees and the need for dermatologists to be trained via the CESR pathway.