Portfolio Pathway (formerly CESR) (Radiology)

What are the evaluators looking for? How should I present my evidence? What if I can’t provide a particular piece of evidence? What does that term mean and does it matter if my workplace calls it something else? This guide will answer some of the questions we’re most often asked by email or at our regular drop-in clinics but don’t worry if you can’t find the solution here – just email us at [email protected] and we’ll be happy to help.

The FRCR is the test of knowledge set out in the CCT curriculum. Applicants who do not have the FRCR must submit evidence relating to all specialist qualifications held. The standards for the award of the FRCR are set out in the syllabus for the First and Final Examinations. If you don’t hold the FRCR, you must submit as much evidence as possible regarding your training to demonstrate that you have the same knowledge, skills and experience and that you have been assessed in your specialty. Such evidence might include emergency radiology in the acute setting, cross-sectional and fluoroscopic imaging, participation in MDT meetings with case histories and notes and assessment of these skills and competencies and regular assessment during training. You should provide the curriculum or syllabus that was in place when you undertook your training. 

In addition, the Specialty Specific Guidance (SSG) will detail where extra evidence is required under the relevant CiP if you don’t hold the FRCR. 

If you have failed any part of a qualification, you should consider delaying your application until you have passed the failed element. Otherwise, you will need to consider very carefully whether and how you can demonstrate that you have since met the competency requirements of that examination, even if you have subsequently passed a different examination. The RCR will check details of any RCR examinations you have taken, including any part in which there is an outstanding failure.

You can provide an index page at the beginning of each CiP to detail what you’ve included and to cross-reference evidence that you’ve included under other CiPs – you don’t have to duplicate evidence if it’s relevant in more than one area. For example, you need to include MDT activity in CiP 12 but can cross-reference it in an index list under CiP 6.  

This may be especially helpful when providing your sample reports. Separating them into separate sections for each system makes your bundle much easier to navigate. Annex A of the SSG has further information about how you should provide these as well as an example of a summary list. 

You should submit your most recent appraisal – this should be from the last year of your clinical practice prior to application. You should also provide evidence of formal appraisal/review over the last three years of your clinical practice. Your appraisals do not all have to be from the same post, but all should be from within the last three years. Your appraisal should contain reflection on your performance over the year and include a personal development plan (PDP) of goals or objectives to be met in the coming year. 

We will not be able to see any attachments to your appraisals (such as your CPD record), so you will need to ensure these are provided where required. 

If your employer doesn’t undertake annual formal appraisal, you must provide other similar evidence of review, which must include a discussion of your clinical practice, teaching and training, managerial and administrative activity.  

If areas for development were highlighted (for example in your MSF), please provide evidence to demonstrate that these have been addressed, with certificates for any courses you’ve done plus reflection on the changes you’ve made.  

Appraisals/assessments completed retrospectively will not be given as much weight as one that was completed at the relevant time. 

Clinical audit is designed to improve quality of care and healthcare outcomes by comparison against agreed standards and measuring the success of interventions. Quality Improvement Projects are designed to improve quality of care and healthcare outcomes by trialling interventions, using repeated measures to assess success. 

Applicants are required to show how they have instigated, collated and presented a piece of work, as well as how they have reflected on any changes in clinical management as a result of the work completed. You should also show evidence of presenting the results, such as at appropriate meetings (for example, appraisal, REALM or clinical governance meetings), and how their messages were made known to the wider department, for example via posters, new/revised protocols or new/revised standard operating procedures (SOPs). 

Completion of clinical audit and/or quality improvement projects is a specific curriculum requirement. You should submit 1-3 clinical audits or quality improvement projects. At least one of them should show completion of the audit cycle (“closing the loop”) either through re-audit or evidence of the implementation of change through quality improvement projects. Make sure you clearly show how and whether improvements or changes have been made. 

The strongest evidence is the report and action plan, any re-audit or changes in practice and a presentation. Reflection on audit and quality improvement activity is required and workplace-based assessments on projects can also be useful. 

The audit and quality improvement pages on the RCR website include the “AuditLive” section, which is a collection of templates identifying best practice in key stages of the audit cycle. 

Letters stating that you have participated in these activities are useful background, but will not be sufficient evidence on their own. 

You should submit a range of letters and emails to and from referring clinicians; you can also include patient consent forms and other correspondence you consider relevant. You should provide a range of clinical correspondence with colleagues showing that you can communicate effectively in respect of the clinical questions arising, for example on reviewing images, discussion of findings, offering advice on appropriate imaging, vetting and protocol issues, communicating pertinent findings, consent, asking for a second opinion, on image quality, and arranging IR procedures.  

Evidence of your clinical correspondence can support a number of CiPs, including those relating to communication, patient management and clinical competence. For example, you can include evidence relating to correspondence with radiographers or the PACS team alerting them on issues such as missing images, incorrect markers, inadequate coverage, recalls and similar safety and quality issues and correspondence relating to emergency or on-call findings. Please refer to the CiP descriptors for more specific information as to what your correspondence should demonstrate. 

Vetting and protocolling evidence can be provided as emails or screenshots of the system used by your institution. Correspondence discussing more appropriate imaging or why the request hasn’t been accepted is helpful here. 

You can subdivide within the file as set out in the SSG. For example, clearly indicate that correspondence relates to safety and quality, emergency and on-call findings and so on. 

You should submit minutes of relevant meetings or other relevant activity in which you have participated – for example: 

• clinical governance meetings 
• discrepancy or Radiology Events and Learning meetings (REALMs) 
• radiology department meetings 
• morbidity and mortality (M&M) meetings 

Invitations to meetings or agendas for meetings will be given less weight without the minutes, outcome or confirmation of your attendance. 

Candidates often worry whether their application will be turned down if they provide examples of actual complaints. However, we know that incidents do happen and complaints are made. Complaints should no longer be hypothetical. What we are interested in is: 

• your understanding of the framework for handling adverse events where you work 
• how you deal with or respond to these events 
• what these show about your own insight and professional judgement 
• what you have learnt through dealing with these issues 

Evidence relating to 1-3 examples from the last three years of your clinical practice should be sufficient. 

Complaints can be received against you, but it is also acceptable to include complaints about the department you worked in or against a colleague where you were involved in the resolution. You can provide evidence of your response to any complaint or untoward incident. If you have raised a concern, you could provide relevant evidence of that. Complaints can be formal or informal. 

Please be sure to provide evidence of how the situation was resolved, and reflection or any CPD that resulted.

Evidence of participation in courses and learning events relevant to the curriculum is useful supporting evidence in respect of a number of CiPs, particularly in respect of: 

• clinical courses to show you are making efforts to maintain good practice, including in AI and new technological developments 
• courses relevant to equality and diversity, consent, data protection/information governance, equality, diversity and human rights, ethics, probity and so on 
• courses relevant to maintaining knowledge and skills in procedural activity, such as infection prevention, life support/resuscitation, radiation protection and so on 
• teaching 
• research 
• management and leadership  
• communication 

CPD activity and courses are given less weight if they were completed more than five years ago, so please make sure that you demonstrate such activity from within the last five years. For each course or conference, you should provide a certificate or similar confirmation of participation. 

Please group these together and upload them from the last five years as one file in CiP 3. It would be helpful to subdivide into sections within the file – for example, you might have separate sections for mandatory trust training, clinical courses, teaching-related courses and leadership and management courses. 

Annex A of the SSG provides comprehensive details of how you should present your reports and in what order. Reports can be from more than one role within the last five years of your practice and must be identifiable as being from the institution where they occurred – copied text in isolation will not be considered without certificated authenticity; the reports’ origins must match your CV. 

We do not specify a number of reports to be provided but your reporting output evidence should demonstrate that you have a range of radiological experience, across the spectrum of acute and routine work. The minimum is 60 reports, but you can submit more to ensure that the breadth of areas are covered. It is not usually necessary to submit more than 150 reports. 

If there is an area in which you cannot submit evidence of performing the relevant imaging procedure, you must submit evidence to show that you have appropriate knowledge of its role, indications, contra-indications and limitations and that you can advise on how and when to refer for these procedures (for example through discussions at MDTs, your clinical correspondence, your reflective activity). 

The reporting should be your personally generated, independent reporting activity. A significant amount of reporting completed under supervision or which you have signed off as a supervisor is unlikely to be given as much weight as your personal reporting activity. If it is not clear what your role in generating the report was (for example, primary reporter, secondary reporter, responsible for carrying out a procedure rather than observing it), this will not be considered helpful evidence. 

If you do not generally perform interventional procedures, you can submit evidence that you have recent knowledge of IR strategies when investigating common presentations and conditions – for example, by recommending relevant investigations in your reporting and in the emergency setting, by arranging procedures as appropriate or discussing them in clinical correspondence and at MDT. 

Evidence of relevant activity – for example: 

• rota management, 
• responsibility for finances/budgets 
• assessments on others, such as workplace-based assessments (these are particularly useful) 
• relevant courses and qualifications 
• leading MDTs (required for CiP 12) 
• chairing other meetings 
• acting as audit lead 
• setting up new services/service mapping, participation in wider trust consultations, protocol or pathway development, or where you helped to address a service problem or new demand, evidence of course organisation and so on 

MDT meeting-related activity may be referred to outside the UK as grand rounds, tumour boards, etc. It may also be called multidisciplinary meetings or MDMs. 

You should submit evidence of your activity, such as logbooks or a rota of MDT attendance. This evidence should include: 

• your attendance and exact role 
• dates or frequency of meetings 
• examples of numbers and type of imaging relevant detail, including outcome decisions 

You should also include reflective activity on MDTs, especially on your personal contribution. We need to see not only that you are a core member of one or more MDT meetings, but also primary evidence of your leading the discussions. 

An assessment of your performance at MDTs should also be submitted – for example, in your structured reports, by way of a letter or assessment from the MDT lead or person in a similar capacity or by MDTA workplace-based assessment. 

In the absence of formal MDT or tumor board setting, clinical correspondence discussing radiological reports must be provided, showing specific multidisciplinary patient care. 

This is a method used to assess common skills, including behaviours, team working and communication skills. It is sometimes called 360-degree feedback.  

You should supply evidence of feedback from colleagues of all levels (senior doctors and consultants, doctors in training, radiographers, nurses/allied health professionals, clerks, secretaries and auxiliary staff), preferably as part of a structured, unselected MSF package completed at the relevant time. This evidence must be as recent as possible and at least within the last five years of practice. The MSF must be conducted anonymously. One round of formal MSF is the minimum you should submit. 

Structured, unselected patient feedback is the best evidence to submit to demonstrate good patient relationships and communication but you can also provide other objective evidence that demonstrates effective communication with patients and obtaining consent where necessary; for example, patient feedback forms, workplace-based assessments, appraisals. 

Personal reflection on this MSF and self-assessment are also useful. 

Letters, references for posts applied for and so on are useful, but may not be given as much weight as structured, unselected MSF. Invited testimonials, personal greetings or thank-you notes from patients are also less relevant here. 

MSF may not be offered in all workplaces. If you do not have any MSF available, please provide the following instead: 

• Anonymised colleague feedback 
• Personal reflection on, and your contribution to, collaborative working. This must include: 
  • 6–10 examples of work output, including rotas/timetables 
  • coverage of all specialties, with clarity on how you use radiology reports to enable clinical colleagues to handle or manage patients, and comments on image quality and studies. 

You can submit a range of these as objective confirmation that you are participating in on-call activity and of your other timetabled activity. It is usually sufficient to provide 2–3 months of these from your recent employment. It must be clear what any rota activity involved, such as elective, emergency, adult, paediatric, procedural, cross-sectional or fluoroscopy. Organisation-specific but unclear terminology (e.g. “reporting on 5th floor”) must be explained to allow assessors to know what this involved. 

This is extremely important to your application. Throughout the evidence listed, reflective practice is requested. Reflecting on your experience is important to your development as a doctor and in improving the quality of patient care. Your evidence should demonstrate reflective activity as a regular feature of your practice, not all completed on one day.  

You should submit a range of your reflective activity on areas such as CPD, learning events, teaching, research, audit and quality improvement activity, discrepancies, complaints and significant events, appraisal, MSF and MDT activity. 

We want to see specific examples of your own experiences and how a particular situation has impacted you and what you have learnt, such as 

• how the activity contributed to the development of your knowledge, skills or professional behaviours 
• ways in which your own behaviour may change as a result of reflecting on the event 
• what difference this will make to patient safety and quality 

If you are unfamiliar with reflective practice, you should read the GMC guidance on reflection to help you understand the principles behind it and how to demonstrate it. You may find it helpful to use the RCR’s reflection template to help with structuring your activity. A reflective template has been incorporated into the RCR’s CPD online journal to help you create your reflective activity each time you undertake CPD. This can also be followed for all your activity. Additional resources can be found on the CPD section of the RCR website. 

Your reflection can be included in the file next to the item on which you have reflected – for example, CPD, clinical governance, audit/QI and so on – or can be grouped together in CiP 2. 

You should provide evidence of your ability to engage in evidence-based practice. This can include such things as: 

• publications 
• posters 
• abstracts 
• literature reviews and/or examples of how you have identified and appraised literature to inform practice such as correspondence with colleagues 
• clinical correspondence that refers to relevant activity 
• applications for research projects 
• ethics committee participation 
• patient consent forms 
• Good Clinical Practice (GCP) certificate (including an Introduction to GCP course or a CGP Refresher course) and or other relevant course or qualification, such as duty of candour, AI and other activity relating to emerging technologies, research/ethics courses or qualifications 

Publications available in the public domain can be uploaded into one file as they do not need to be verified. 

For example: 

• clinical governance activity 
• participation in a review of patient leaflets 
• development of standard operating procedures and protocols 
• participation in clinical trials 
• relevant publications 
• evidence of presentations at audit meetings 
• reflective activity 
• CPD related to safety and quality 

Letters stating that you have participated in these activities are useful supporting evidence but are insufficient evidence on their own. Much of your evidence may be included under other CiPs but anything that has not can be uploaded into one file per institution here. 

You should provide evidence of acting as a clinical teacher or supervisor – for example: 

• formal learner feedback – this is extremely important; it is the impact of your teaching activity that is being evaluated here, not just what you say by way of your presentation content. 
• example presentations (PowerPoint etc). Two of these are usually sufficient for this CiP. You can submit two more if you feel they are particularly clinically or otherwise relevant to other CiPs. 
• confirmation that you delivered these by way of invitations, correspondence, timetables etc. or other evidence to show how teaching is delivered 

You can also include: 

• relevant courses or qualifications in teaching 
• formal workplace-based assessments of your teaching 

Please ensure that your evidence is consistent and triangulates together – for example, if you provide a PowerPoint presentation, that it is consistent with any timetable, correspondence or invitation if you’re submitting those, and that you submit learner feedback relevant to that presentation. 

This is required to demonstrate the breadth and depth of your recent radiology-specific practice. This can be from the relevant department’s radiology information system (RIS) to show your range of practice, particularly over at least the last five years. This should also support the range of reporting that you submit. 

This evidence can be modality based, but please make sure the examination types (for example, Cardiac CT, CTPA, MRI Liver, etc.) are clear in the totality of your evidence, as well as which examinations were performed in the paediatric population. A breakdown of total number of each type of examination reported/procedures undertaken should be summarised in a table. 

If you maintained a logbook for any post during the last five years, you can submit that. 

Even if you have been working recently in a limited special-interest area, the evaluators need to be satisfied that, within the last five years, you can demonstrate competence in all modalities, body systems and basic image-guided procedures. Limited general ultrasound workload and limited cross-sectional non-neurological studies (body CT and MRI and musculoskeletal studies, for example) are among the most common reasons for unsuccessful applications. Special interest/subspecialty level is not required in all complex modalities, but limited evidence of activity and low workload numbers (particularly in common and acute general radiology) may reduce your chance of success. 

CCT trainees complete a range of assessments in the workplace regularly in each year of their training (see section 4.5.3 of the curriculum for what these are). 

We understand that training outside the NHS will not feature these assessments in the same way. For those who have finished training and are working in non-training jobs, you will not necessarily undergo similar assessment in your current job. 

WpBAs are not generally expected for clinical activity you have undertaken recently, which is confirmed by your radiology reports and other evidence. However, assessments such as Rad-DOPs and Mini-IPX can be useful if they support a particular range of procedures (such as intervention), a period of additional training you have had, or a clinical activity you do less regularly. 

Assessments of your MDT activity (MDTA), teaching (TO) and audit and quality improvement (QIPAT) activity might be useful. Evidence of appraisal/assessment completed retrospectively will not be given as much weight as one that was completed at the relevant time. 

If you have completed training within the last five years, you should submit evidence of how you were assessed during your training. 

Structured, unselected multisource feedback and patient feedback is the most effective way to evidence your communication and teamworking skills.