The CESR Odyssey: Navigating delays, doubts and determination in geriatric medicine

Monday 14 October to Friday 18 October 2024 marks SAS week, which celebrates the value and expertise of specialist, associate specialist and specialty doctors. Dr Nikki Dearnley is a fixed-term Consultant in acute frailty at Worthing Hospital. She is currently awaiting the outcome of her Certificate of Eligibility for Specialist Registration (CESR) in geriatric medicine.

It was September 2023 when I hit the “submit” button on my CESR application in geriatric medicine. I had spent years meticulously pulling together years of evidence, certificates, digging through old case notes and clinic letters, and writing detailed reflections. It felt like assembling an intricate jigsaw puzzle where the pieces didn’t always seem to fit. The pressure was immense - this was my gateway to the specialist register. However, after that initial sense of accomplishment, I stepped into a prolonged period of waiting - one that would test my resilience, patience and confidence.

Anyone who’s navigated the CESR process will know it’s not for the faint-hearted. From gathering evidence to filling out endless forms, the intensity of the process consumes every spare moment. But what I didn’t fully anticipate was the sheer scale of the wait, the long delays at every stage, and the limbo that would define the months to follow.

Thirteen months after submission, I am still waiting for an outcome. For the last five months, my application has sat untouched, awaiting allocation of a CESR assessor. The delays that I and others are facing is compounded by a recent change in curricula and processes, leading to a flurry of applications prior to October 2023. This shift has led to a growing backlog, with many of us, who submitted just before the deadline, feeling like a lost tribe - caught in a system that just cannot meet demand.

In the meantime, I find myself working as a fixed-term consultant. It’s a strange place to be as technically in the role but not quite “officially” there yet. Every decision I make, every meeting I attend, I feel the weight of imposter syndrome. Do I belong in this room? Will my colleagues notice I haven’t received that final stamp of approval yet?

Imposter syndrome is something I never thought I would experience to this extent. As a specialty doctor for years, I was confident in my clinical abilities and my commitment to geriatric medicine. But the limbo created by the CESR process amplified self-doubt in ways I hadn’t imagined. Colleagues, friends, and family would often ask, “how’s the application going?” and I would smile weakly and say, “still waiting.” But internally, it felt anticlimactic, as if this monumental task I had undertaken was somehow fading into the background of bureaucratic delays.

Despite the challenges and the seemingly endless wait, I’m holding onto a sense of hope. The CESR route is, without question, one of the most important pathways for experienced clinicians to gain entry to the specialist register. For those whose training hasn’t followed the traditional route, it’s an invaluable opportunity to be recognised for years of hard work, dedication and skill. It’s a door that remains open for those who are willing to push through the delays and uncertainty.

So, as I wait, I remind myself of the bigger picture. I’m in the job I love, contributing to the care of older adults, and growing in my practice every day. The CESR process, though long and winding, reflects the rigour and commitment required of those working at the highest levels of our profession. When that final approval does come, and I believe it will, it will be a testament to the journey we all embark on when we choose this path. For all its challenges, it’s a journey worth taking.

In the meantime, to anyone in the middle of their CESR odyssey, keep going. You’re not alone and the end, when it comes, will be worth the wait.

The BGS will follow up with the GMC and RCP on members’ concerns about delays in the CESR application process. If you have an experience to share, please get in touch with Mark Stewart m [dot] stewart [at] bgs [dot] org [dot] uk.