Clinical Radiology

Specialty Specific Guidance This guidance is to help doctors who are applying for entry onto the Specialist Register with a CESR in Clinical radiology. You will also need to read the Clinical radiology CCT curriculum.

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Introduction You can contact us and ask to speak to the GMC Specialist Applications team for advice before you apply. You are strongly advised to contact The Royal College of Radiologists for guidance before you submit your application. The RCR has a resources page for CESR applications and can be contacted at specreg@rcr.ac.uk.

What is the indicative period of training for a Certificate of Completion of Training (CCT) in Clinical radiology? The indicative period of training for a CCT in Clinical radiology is five years and it is unlikely that you would achieve all the learning outcomes required for a CCT in a shorter period of time.

To be awarded a CESR, you must demonstrate that your specialist training, qualifications and experience are equivalent to a doctor who has successfully completed training according to the CCT curriculum for Clinical radiology. The curriculum is structured around 12 learning outcomes called “Capabilities in Practice” (CiPs).

The CCT training curriculum aims to produce clinical radiologists with the ability to provide general and emergency radiology in any NHS environment and specialist skills in one or more areas. This allows provision of acute imaging services vital to supporting the swift and accurate diagnoses of patients reporting to emergency departments, as well as meeting demand for specialist diagnostic and treatment services.

It is sometimes more difficult to make a successful CESR application if you have not worked in the NHS. This is because key features of training and practice in the NHS are not always covered in the same way outside it. This might include, for example, multidisciplinary team meetings, appraisal, multisource feedback and patient feedback, safety and quality activity especially in clinical audit and quality improvement projects and other areas. You must look at the curriculum and this guidance carefully to make sure that you can demonstrate equivalence to all the requirements. If you are or have recently been practising in an environment that is not comparable to practice in an NHS clinical radiology department (teleradiology, for example) you might find it useful to consolidate your experience elsewhere before applying.

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Submitting your evidence Do not submit original documents. We strongly recommend you provide your evidence electronically – it’s important that you follow the structure in our userguide when doing so.

All your copies, other than qualifications you’re getting authenticated must be accompanied by a pro-forma signed by the person who is attesting to the validity and accuracy of your evidence (your verifier). It’s very important that you read an explanation of how to this in our important notice about evidence.

You will also need to submit translations of any documents that are not in English. Please ensure the translations you submit meet our translation requirements.

Your evidence must be accurate and may be verified at source should we have any queries or justifiable doubts about the accuracy of your evidence. All evidence submitted will be cross checked against the rest of your application and documents.

Anonymising your evidence It is important that you anonymise your evidence before you submit it to us. You must remove:

• All patient identifying details • Details of patients’ relatives • Details of colleagues that you have assessed, written a reference for, or who have been involved in a complaint you have

submitted. • This includes: • Names (first and last) • Addresses • Contact details such as phone numbers or email addresses • NHS numbers • Other individual patient numbers • GMC numbers

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The following details don’t need to be anonymised:

• Gender • Date of birth • Names of colleagues involved in patient discussions, MDTs or feedback to or about you

It is your responsibility to make sure that your evidence has been anonymised. Evidence which has not been anonymised will be returned to you. More information can be found on our website.

How much evidence to submit As a general guide, most applications contain around 800-1000 pages of evidence. .

This guidance on documents to supply is not exhaustive and you may have alternative evidence. You do not necessarily have to supply every type of evidence listed, but you must submit sufficient evidence to address each of the required learning outcomes and the associated descriptors. If you do not have all the evidence listed here, we recommend that you delay submitting an application until you are able to gather it.

Your evidence must cover the knowledge, skills and qualifications to demonstrate the required CiPs in all areas of the Clinical radiology CCT curriculum. If evidence is missing from any area of the curriculum, then the application may fail.

It will help us to deal with your application more quickly if you make sure that you send us only evidence that is directly relevant.

Evidence of your competence should be recent. Please remember that in general, most weight is placed upon evidence from the last five years. If you have specialised in a limited area for a number of years, you may have difficulty in demonstrating clinical competence across the breadth of the CCT curriculum. Your application must demonstrate that you have acquired the relevant competencies across the breadth of the curriculum and/or demonstrated maintenance of those competencies within the last five years.

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If you have not been in active clinical practice for some time, please consider whether and how you can demonstrate that you have maintained your clinical competencies.

In general, evidence of skills or experience more than five years old should not be submitted, as typically it does not demonstrate that the competences have been recently maintained.

Our guidance on compiling your evidence will help you to decide what is relevant and what is not. Please read it carefully.

Organising your evidence Your evidence will need to be organised to reflect the structure of the online application. You should submit your evidence electronically under the correct section of your online application. If you submit any hard copy evidence, you will need to create your own dividers to confirm which section of the application the hard copy evidence relates to and clearly indicate this within your online application.

The curriculum is structured around twelve Capabilities in Practice (CiPs) and this is how your evidence should be structured. You should also submit the evidence requested about your training, qualifications and employment history and your CV in the format set out in the GMC’s CESR CV guidance. You will also be asked to nominate referees to provide structured reports.

You should provide sufficient evidence in respect of each CiP or the application may fail. If you have a piece of evidence that is relevant to more than one area, do not include multiple copies in your evidence. Instead, include one copy and list it in your application under each relevant area, stating that the evidence is located elsewhere and you would like to cross-reference it.

Where we ask in our guidance, please group your evidence together to keep the number of individual electronic uploads manageable. This will need to be done prior to uploading on the GMC application. There are many software solutions widely available that can be used for converting documents/excel sheets/PowerPoint presentations and images to PDFs and combining PDF documents. Please see Annex C for more information about how to upload your evidence.

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Submitting your evidence – training, qualifications and employment

You can see below the evidence you must submit in these general areas. Even if your training concluded more than five years ago, it is useful to submit your training curriculum or other evidence of your training as background evidence of the competencies you obtained then.

If you completed your training within the last five years, you will be submitting evidence relating to it but please remember also to include evidence that is as recent as possible and from your current post, which means you might have to include evidence from posts that you have taken up since training.

Evidence of training and qualifications

Primary medical qualification (PMQ)

If you hold full registration with us, you do not need to submit your PMQ as we saw it when we assessed your application for registration. If you do not hold registration, you will need to have your PMQ independently verified by ECFMG before we can grant you full registration with a licence to practise. You can find out more about primary source verification on our website. You only need to get your PMQ verified by ECFMG. The rest of your evidence should be verified in line with our guidance.

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Specialist medical qualification(s) Please provide an authenticated copy of all specialist medical qualifications you hold. There are no qualifications from outside Europe that enable automatic entry to the Specialist Register in any specialty. An evaluation is made based on an applicant’s whole career and therefore two applicants with the same qualifications but different training and/or experience may not receive the same decision. The FRCR is the required test of knowledge for the CCT; applicants who do not have the FRCR must demonstrate an equivalent test of knowledge and therefore should 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. The FRCR is taken at the end of the third year of CCT specialty training; examinations taken at an earlier stage of training than this are unlikely to demonstrate equivalence to the FRCR. If you have failed any part of a qualification without a subsequent pass, 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 competence requirements of that examination, even if you have subsequently passed a different examination. Please list unsuccessful attempts at examinations (where you have not subsequently been successful) in the application form. The RCR will confirm details of any RCR examinations you have taken, including any part in which there is an outstanding failure. It will be difficult for applicants without such a test of knowledge (or who have failed an examination without a subsequent pass) to demonstrate equivalence to this element of the CCT curriculum. You will have to submit very robust and clear alternative evidence of knowledge and skills which covers the syllabus for the First and Final Examinations and that you have been assessed in these areas. 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.

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Recent specialist training More weight is placed upon the past five years but it will be useful if you submit as much information as possible about your training curriculum even if this was more than five years ago. If you have undertaken an approved training programme outside the UK in the past five years, please provide the curriculum or syllabus that was in place when you undertook your training. If a formal curriculum or syllabus (including assessment methods) is not available please provide a letter from the awarding body outlining the content of the training programme or examination. You should not submit a curriculum/syllabus that came into force after your training time. If your training was within the last five years, you should also provide evidence of formal periodic assessment during your training. This evidence must have been completed at the time the training was undertaken (if it is completed retrospectively less weight will be given to it). If you do not supply formal assessment documents, the curriculum must demonstrate how you were assessed. A detailed letter of verification from an educational supervisor may satisfy this requirement. If areas for development were highlighted, please provide evidence to demonstrate that you have subsequently addressed them. If you have undertaken approved specialty training towards a CCT or CESR (CP) in Clinical radiology in the UK in the past five years, you should provide a copy of your ARCPs and Educational and Clinical Supervisor reports. If any difficulty was identified during your training, be sure to include evidence to show that it was addressed.

Please upload in one file per institution your specialist qualification diploma (e.g. FRCR diploma), your curriculum and other evidence about your training.

Call this “Evidence of training and qualifications – institution name”.

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Evidence of employment in posts and duties (including training posts) CV You must provide an up to date copy of your CV, which includes all the details listed in the

guidance on our website. Please upload this in one file. Call this “CV”.

Employment letters The information in these letters must match your CV. They should confirm the following: • dates you were in post • post title, grade, training • type of employment: permanent, fixed term, or part time (including percentage of

whole time equivalent) Usually this will be set out in the letters offering you the post and renewing your contracts. We do not need to see contracts and terms and conditions of employment. We are most interested in the jobs you’ve had within the last five years, but background information particularly about your training is useful even if it is outside of the last five years.

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Job descriptions These must match the information in your CV. They will usually confirm the following: • your position within the structure of your department • your post title • your clinical and non-clinical commitment • your involvement in teaching or training.

Please upload in one file per institution your employment letters and job descriptions, in date order. Call this “Evidence of employment in posts and duties – institution name”.

Submitting your evidence – Capabilities in Practice (CiPs) • Section 2 of the CCT curriculum sets out the curriculum learning outcomes, called “Capabilities in Practice” (CiPs) to which you

must demonstrate equivalence. These are set out below. • The 12 CiPs describe the professional capabilities required of a consultant clinical radiologist. Each CiP has descriptors to provide

guidance about the range of clinical contexts which may support achievement of the CiPs during training. You will find it useful to refer to the descriptors to see what your evidence might need to demonstrate for each CiP.

• You can look at the suggested evidence in each CiP, then refer to Annex A to see more information about that evidence type (for example, you can look up what we mean by “Multisource Feedback”, “Appraisal”, “Clinical Governance” and so on).

• Some of the suggested evidence is listed more than once, as it is relevant to more than one area of the curriculum. For example, radiology reports are listed in several different learning outcomes. This means that in some cases you can use the same evidence in each area, as long as it is relevant to the CiP for which you’re submitting it. Please don’t submit it more than once; just indicate under which section you have included it. You are not limited only to submitting what’s listed, if you have other evidence that’s directly relevant.

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• You don’t have to include every item that is suggested as evidence, but make sure that you have submitted sufficient to demonstrate equivalence to that CiP.

• If you completed your training within the last five years, you will be submitting evidence of this but please remember also to include evidence that is as recent as possible and from your current post. This means including evidence from posts that you have taken up since training.

• “Secondary” evidence such as references, letters and testimonials is given less weight than “primary” evidence such as appraisals, multisource feedback, audit and QI projects and reports, etc.

• You will be submitting other general evidence including your CV, your referees’ structured reports and evidence of your training curriculum, qualifications and employment. Therefore, these are not listed again in the suggested evidence for each CiP.

Please refer to Annex A for information about how your evidence should be grouped and uploaded.

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CiP 1 - Demonstrate the professional values and behaviours expected of all doctors as outlined in Good medical practice.

As doctors, consultant radiologists adhere to the principles of ‘Good medical practice’ as stipulated by the GMC. CiP descriptors Suggested evidence – refer to Annex A for more information.

Items with an asterisk * are considered to be particularly key to this CiP.

• Make the care of and effective communication with patients their first concern

• Provide a good standard of practice and care • Take prompt action if patient safety, dignity or

comfort is being compromised • Protect and promote the health of patients and the

public • Treat patients as individuals and respect their

dignity, showing sensitivity to religious, cultural and socioeconomic factors

• Work in partnership with patients, their families and carers

• Work with colleagues in the ways that best serve patients’ interests

• Be honest and open and act with integrity

• Multisource feedback* • Patient feedback* • Appraisal* • Complaints and significant incidents* • Courses and CPD activity relevant to this CiP • Multidisciplinary team (MDT) meeting activity • Participation in other meetings involving direct patient care (minutes

etc.) • Participation in developing guidelines, standard operating procedures

etc. (the guideline, SOP and pathway to its design or review)

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CiP 2 - Successfully function within the health service and healthcare systems in the UK.

Like all consultants working within the NHS, radiologists need to understand organisational and management systems so that they can engage positively with them and optimise patient care. CiP descriptors Suggested evidence – refer to Annex A for more information.

Items with an asterisk * are considered to be particularly key to this CiP.

• Understand the structure and organisation of the health service and system including the independent sector and the wider healthcare landscape

• Understand how services are commissioned, funded and audited

• Understand how services are deemed to be clinically effective and cost effective

• Understand how resources are managed, being aware of competing demands and the importance of avoiding waste

• Understand the concept of health screening and appraise whether a proposed screening test is appropriate in the context of imaging

• Apply equality and diversity frameworks and ensure that an equal, non-discriminatory approach is adopted in interactions with both patients and colleagues

• Demonstrate appropriate awareness of, and maintain a professional approach to the use of social media and public communications.

• Complaints and significant incidents* • Courses and CPD activity relevant to this CiP (such as equality and

diversity training)* • Clinical governance activity* • Reflective activity* • Safety and quality activity* • Audit and quality improvement projects • Multisource Feedback • Appraisal • Management and leadership activity

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• Adhere to all relevant professional communication policies

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CiP 3 - Engage in reflection, clinical governance and quality improvement processes to ensure good practice.

Consultant radiologists are expected to stay up to date with their knowledge and skills, and look for ways to improve the quality of their services.

CiP descriptors Suggested evidence – refer to Annex A for more information. Items with an asterisk * are considered to be particularly key to this CiP.

• Facilitate and lead on QI and audit projects to improve patient care and experience

• Promote a culture of openness and accountability including awareness of the duty of candour to patients

• Appropriately raise concerns including errors • Share good practice • Advocate clinical quality improvement • Engage in clinical governance meetings including

peer feedback meetings • Demonstrate commitment to continuing

professional development by maintaining and/or developing skills relevant to higher training special interest area and/or local service need

• Appropriately raise concerns regarding negative professional behaviour e.g. bullying

• Audit and quality improvement projects* • Safety and quality activity* • Complaints and significant incidents* • Clinical governance activity* • Reflective activity* • Courses and CPD activity* (such as what you submit in relation to

other CiPs)

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• Recognise and acknowledge where personal issues impact upon good practice and seek appropriate help

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CiP 4 - Engage in evidence-based practice and safeguard data, including imaging data.

Consultant radiologists require the skills used by all doctors to practise evidence-based medicine

CiP descriptors Suggested evidence – refer to Annex A for more information. Items with an asterisk * are considered to be particularly key to this CiP.

• Demonstrate an understanding of the principles of research, research methods and the translation of research into clinical practice

• Identify and critically appraise literature to inform practice

• Understand and critically appraise new technological developments including radiological applications of Artificial Intelligence (AI)

• Interpret and communicate research evidence in a meaningful way to patients to support them in making informed decisions about treatment

• Follow guidelines on ethical conduct in research and consent for research

• Apply information governance principles to safeguard imaging data in the context of research

• Adhere to Data Protection Regulations and be familiar with Freedom of Information regulations

• Understand the role of the Caldicott Guardian within an institution

• Research activity* • Reflective activity*

Courses and CPD activity relevant to this CiP* (such as in safeguarding, relevant IT and data protection/information governance training, duty of candour)

• Patient consent forms • Good Clinical Practice (GCP) certification and/or other

research/ethics courses or qualifications • Notes from journal clubs • Relevant meeting participation (ethics meetings etc.)

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CiP 5 – Act as a clinical teacher and supervisor.

Consultant radiologists teach medical students, junior doctors and other healthcare professionals.

CiP descriptors Suggested evidence – refer to Annex A for more information. Items with an asterisk * are considered to be particularly key to this CiP.

• Provide teaching, supervision and assessment of clinical trainees and other healthcare professionals

• Understand the role of and develop the ability to act as a Clinical Supervisor to the standard required by the GMC

• Apply information governance principles to safeguard imaging data in context of education

• Teaching activity* • Courses and CPD activity relevant to this CiP* (such as information

governance/data protection, teaching or assessor courses or qualifications)

• Evidence of assessments on others (WpBAs etc.) • Workplace-based Assessments (WpBAs) relevant to this CiP • Multisource Feedback • Appraisal

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CiP 6 - Work well within a variety of different teams, communicating effectively with colleagues and demonstrating the skills required to lead a team.

Clinical radiology relies on a multi-professional team and good communication is an essential component of sound practice, team working and patient centred care. Consultant radiologists must be able to resolve conflict, develop good working relationships and support team development and possess the qualities and behaviours necessary to lead but also to follow, when necessary, in dealing with difficult situations and conflicting attitudes.

CiP descriptors Suggested evidence – refer to Annex A for more information. Items with an asterisk * are considered to be particularly key to this CiP.

• Promote and actively participate in multidisciplinary and interprofessional team working, communicate effectively and recognise and respect the roles of all members of the team

• Effectively lead a multi-professional team allowing all voices to be heard and considered and foster an atmosphere of collaboration

• Critically appraise performance of colleagues, peers and systems, appropriately escalate concerns and promote an open and transparent culture of learning and development

• Show awareness of own leadership style and how this impacts on others

• Demonstrate flexibility in behaviour and ability to adapt techniques and approaches within the multi-professional team to improve engagement in difficult situations

• Multidisciplinary team (MDT) meeting activity* • Management and leadership activity* • Clinical correspondence* • Multisource Feedback* • Appraisal* • Reflective activity • Courses and CPD activity relevant to this CiP (such as

communication skills courses or management qualifications) • Evidence of assessments on others (WpBAs etc.)

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• Supervise, challenge and mentor colleagues and peers to enhance performance

• Recognise own limitations and comprehend situations where others are better equipped to lead or where delegation is appropriate

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CiP 7 - Appropriately select and tailor imaging to patient context and the clinical questions(s).

Consultant radiologists will discuss clinical cases with referrers and allied imaging professionals and advise on appropriate imaging according to the individual patient, clinical background and the clinical question posed. Imaging investigations have varying health and safety risks that need to be considered. Consultant radiologists weigh up the relative clinical risk/benefit when advising on imaging according to clinical information provided by referrers.

CiP descriptors Suggested evidence – refer to Annex A for more information. Items with an asterisk * are considered to be particularly key to this CiP.

• Collaborate effectively with referrers to determine the most appropriate imaging pathway for a given presentation

• Exercise evidence-based practice by utilising current peer-reviewed literature to inform imaging selection for all patient groups

• Protocol CT and MRI scans appropriately • Safeguard patients, including vulnerable groups,

and act in accordance with current safety guidelines and legislation in respect of ionising radiation and other imaging techniques/equipment

• Be able to advise referrers and patients regarding radiation exposure tailored to individual clinical contexts to facilitate informed decision making

• Radiology reports* • Clinical correspondence (including evidence of justification or

protocolling imaging examinations)* • Courses and CPD activity relevant to this CiP* • Workload statistics* • Multisource feedback • Patient feedback • Appraisal

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CiP 8 - Provide timely, accurate and clinically useful reports on imaging studies.

Consultant radiologists provide actionable reports on imaging studies that are performed on patients. They will discuss findings with referrers as required. They will be able to report investigations for common presenting complaints. In addition, they will be able to report more complex investigations as appropriate to their special interest. This may include recommendations regarding onward imaging investigations, imaging follow up and/or other clinical management based on their expert knowledge.

CiP descriptors Suggested evidence – refer to Annex A for more information. Items with an asterisk * are considered to be particularly key to this CiP.

• Possess a sound understanding of radiological anatomy, normal variants and artefacts as demonstrated on all of the common imaging modalities.

• Combining a sound knowledge of radiological anatomy, physiology and pathology, adopt a safe, systematic approach to interpretation of imaging

• Formulate a clinically useful written report targeted appropriately to the referrer, providing where appropriate a refined differential diagnosis, and demonstrate clinical judgement by providing recommendations for further investigation and/or management

• Communicate pertinent imaging findings to referrers, and where appropriate to patients, in a time-appropriate manner, including significant, unexpected or incidental findings

• Radiology reports* • Clinical correspondence* • Reflective activity* • Multisource feedback • Patient feedback • Appraisal

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• Demonstrate insight into level of personal expertise and appropriately refer/seek second opinion

• Identify and appropriately respond to imaging findings that raise safeguarding concerns

• Demonstrate insight into diagnostic certainty and clearly communicate this within written and verbal reports

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CiP 9 - Appropriately manage imaging examination lists/procedures according to clinical need and professional expertise.

Consultant radiologists will be able to directly examine a patient in real time with imaging such as ultrasound and perform image-guided procedures.

CiP descriptors Suggested evidence – refer to Annex A for more information. Items with an asterisk * are considered to be particularly key to this CiP.

• Explain imaging examinations, risks and findings facilitating informed patient choice

• Obtain informed consent for relevant imaging examinations and/or procedures from all patients including vulnerable groups, showing sensitivity to issues of equality and diversity

• Understand and safely prescribe medication relevant to imaging and procedures

• Manage adverse reactions (including anaphylaxis) to administered contrast and drugs

• Maintain an up to date knowledge of cardiopulmonary resuscitation (CPR) techniques

• Implement current health and safety and infection control techniques in the context of imaging examinations/procedures

• Demonstrate insight into level of personal expertise and appropriately refer/seek second opinion

• Radiology reports* including those relating to relevant procedures

• Clinical correspondence* • Patient consent forms* • Courses and CPD activity relevant to this CiP* such as safety-

related training known in the UK as mandatory training • Safety and quality activity* • Multisource feedback • Patient feedback • Appraisal

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CiP 10 - Evaluate image quality and utilise the knowledge of imaging sciences to optimise image quality.

Consultant radiologists need to be able to evaluate image quality and utilise knowledge of imaging physics to maximise the diagnostic certainty of an imaging test.

CiP descriptors Suggested evidence – refer to Annex A for more information. Items with an asterisk * are considered to be particularly key to this CiP.

• Evaluate image quality and feed back to the imaging team appropriately to facilitate maintenance of equipment and/or improve practice

• Appropriately refer to image quality within written reports when there is impact on diagnostic certainty

• Radiology reports* • Clinical correspondence* (including those relevant to technical

recalls, improving image quality, incident reports etc.) • Reflective activity* • Relevant meeting participation (clinical governance activity) • Courses and CPD activity relevant to this CiP (such as training in

radiation protection, IRMER modules etc.)

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CiP 11 - Safely manage the imaging and image-guided intervention needed to support emergency care.

Imaging is required to support the 24/7 emergency service provided by the NHS. Consultant radiologists will be competent in interpreting and performing imaging examinations and/or procedures that are required in the emergency context and where appropriate will suggest use of image-guided intervention or onward referral.

CiP descriptors Suggested evidence – refer to Annex A for more information. Items with an asterisk * are considered to be particularly key to this CiP.

• Produce reports in a timely manner according to clinical need in the context of emergency care

• Maintain knowledge and skills required to perform, interpret and report imaging in an emergency setting

• Maintain an up to date knowledge of appropriate equipment for image guided biopsies and drains

• Perform or arrange (as appropriate) any clinically urgent image-guided interventional procedures

• Radiology reports* in the emergency/on-call setting and review of emergency reports

• Clinical correspondence relevant to this CiP* (for example, arranging an interventional radiology procedure in practice, communicating critical or emergent findings)

• On-call rotas/weekly activity rotas* • Courses and CPD activity relevant to this CiP • Workplace based Assessments (WpBAs) • Participation in morbidity and mortality meetings

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CiP 12 - Effectively contribute a clinical/imaging opinion to a multidisciplinary (MDT) meeting.

Imaging is often central to decision making regarding patient management and onward investigation. Consultant radiologists review imaging of cases to be discussed at MDT meetings and presents relevant findings pertinent to clinical decision making. They will provide explicit recommendations regarding onward imaging investigations and/or image-guided procedures based on their expert knowledge.

CiP descriptors Suggested evidence – refer to Annex A for more information. Items with an asterisk * are considered to be particularly key to this CiP.

• Able to review imaging studies to provide an answer to a clinical question posed by the MDT

• Integrate clinical, pathological and radiological information to refine a differential diagnosis

• Contribute to/lead the decision making of the MDT by clearly articulating a clinical opinion

• Maintain knowledge of local and national guidelines alongside current peer-reviewed literature to ensure recommendations are evidence-based, clinically relevant and safe

• Multidisciplinary team meeting (MDT) activity* • Radiology reports • Clinical correspondence* • Multisource feedback • Workplace based assessments and/or trainer's reports describing

clinical capabilities in multidisciplinary cases

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Annex A Evidence suggested Comments

Appraisal Where possible, you should provide evidence of regular appraisal over the last five years, but

you must submit at least two sets of appraisal evidence. You should submit a current appraisal from within the last year prior to application. We need to see that you have participated in reviews of your practice and where possible, responded to these. Formal appraisal with free text comment from the appraiser, outcomes, objectives, your reflection and a personal development plan is most useful. Your appraisals do not all have to be from the same post, but all should be from within the last five years. If areas for development were highlighted please provide evidence to demonstrate that you have subsequently addressed them. Evidence of appraisal/assessment completed retrospectively will not be given as much weight as one that was completed at the relevant time. Appraisal and Workplace-based assessments (WpBAs) - Please upload in one file per institution your appraisals, WpBAs and any other assessments, in date order.

Call this “Appraisals and assessments 20XX-20XX – institution name”. Upload it under CiP1

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Audit and Quality Improvement projects 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 is designed to improve quality of care and healthcare outcomes by trialling interventions, using repeated measures to assess success. The CCT curriculum requires a trainee to show how they have instigated, collated and presented a piece of work, as well as reflected upon any changes in clinical management as a result of work completed. Completion of clinical audit and/or Quality Improvement projects is a specific curriculum requirement. You should submit at least two clinical audits or quality improvement projects, at least one of which should show completion of the audit cycle 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 also useful. You can refer to the audit and quality improvement pages on the RCR website – this includes the “AuditLive” section which is a collection of templates providing a framework 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. Audit and Quality Improvement projects - Please upload your projects and related evidence in one file per institution. These should be in order of project, grouping

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together everything related to each project (eg audit proposal, audit, presentation, re-audit).

Call this “Audit and Quality Improvement projects – institution name”. Upload it under CiP3

Clinical correspondence 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. Evidence of your clinical correspondence can support a number of CiPs including those relating to communication, patient management and clinical competence. You can include evidence relating to correspondence with radiographers / PACS team alerting them on issues such as missing images, incorrect marker, inadequate coverage, recalls and similar safety and quality issues and correspondence relating to emergency/on-call findings. Clinical correspondence - Please group together emails and letters and upload them as one file per institution. You can subdivide within the file as set out in the SSG. For example, clearly indicate that it relates to safety and quality, emergency/on-call findings and so on.

Call this “Clinical correspondence – institution name”. Upload it under CiP7 Clinical governance activity Minutes of relevant meetings in which you have participated – for example:

• clinical governance meetings; • discrepancy/Radiology Events and Learning meetings (REALMs); • radiology department meetings; • MDT meetings (see below);

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• Morbidity and mortality (M&M) meetings Invitations to meetings or agenda for meetings will be give less weight without the minutes or outcome. Clinical governance activity - Your MDT activity should be uploaded separately but other activity such as relevant meeting attendance and reflection on it can be grouped together and uploaded as one file per institution.

Call this “Clinical governance activity - institution name”. Upload this under CiP2

Complaints and significant incidents We know that incidents happen and complaints are made; for a CESR application we are

interested in how you respond to these. Evidence relating to two examples should be sufficient. You may include complaints received against you, the department within which you worked or one against a colleague where you have been involved in the resolution. You can provide evidence of your response to any complaint or untoward incident and evidence of reflective activity. If you have raised a concern, you could provide relevant evidence of that. If you have not been involved in any complaint or significant event, you may provide reflection on how you would handle a hypothetical complaint. Please be sure to provide evidence of how the situation was resolved, and reflection or any CPD that resulted. Complaints and significant incidents - Please upload in one file per institution your evidence about handling complaints and any reflective activity or CPD that resulted.

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Call this “Complaints and significant incidents – institution name”. Upload it under CiP1

Courses and CPD activity relevant to the CiP 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; • courses relevant to equality and diversity, consent, data protection/information

governance, equal opportunities, ethics, probity, infection control, safety 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. Invitations to meetings or agenda for meetings will be give less weight without the certificate or similar confirmation of participation. Courses and CPD activity relevant to the CiP - Please group these together and upload them from the last five years as one file. You can subdivide into sections within the file - for example, you might list data protection etc courses relating to CiP4 and teaching related courses relating to CiP5.

Call this “Courses and CPD”. Upload it under CiP3

Management and leadership activity Evidence of relevant activity - for example: rota management, responsibility for

finances/budgets, assessments on others such as WpBAs, relevant courses and qualifications, leading MDTs, chairing other meetings, audit lead, head of department, setting up new

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services/service mapping, participation in wider trust consultations, protocol or pathway development, or examples where you helped address a service problem or new demand etc. Management and leadership activity - Relevant activity such as listed in the SSG should be uploaded into one file per institution.

Call this “Management and leadership activity – institution name”. Upload it under CiP6

Multisource feedback (MSF) This can also be known as 360 degree feedback. You should supply evidence of feedback from colleagues of all levels (senior doctors, 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. One round of MSF is the minimum you should submit. Reflection on MSF and self-assessment is also useful here. Evidence in the format of letters, references for posts applied for etc. is useful but may not be given as much weight as structured, unselected multi-source feedback. Multi source feedback and patient feedback Please upload in one file your multisource and patient feedback and forms, in date order.

Call this “MSF and patient feedback”. Upload it under CiP1

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Multidisciplinary team (MDT) meeting activity MDT meeting related activity may be referred to outside the UK as grand rounds, tumour

boards, etc. You should submit minutes and records of your participation in MDT meetings covering a period of at least six months with patient histories and any notes. Include your reflective activity on MDTs especially on your personal contribution. Evidence of you leading the MDT is also useful – this is expected from the CCT curriculum. Multidisciplinary team (MDT) meeting activity – Please group together minutes, patient histories, reflective activity and whatever else is relevant into one file per institution.

Call it “MDT activity – institution name”. Upload it under CiP12 On-call/weekly activity rotas A range of these covering a period of at least six months will support evidence of your ability to

perform in the emergency context as well as support your general activity. On-call/weekly rotas - Upload these in one file in date order per institution.

Call it “on-call/weekly rotas – institution name”. Upload it under CiP 11 Patient feedback Structured, unselected patient feedback as part of a multi-source feedback package is good

evidence to submit to demonstrate good patient relationships and communication. If you do not submit patient feedback you must submit other objective evidence which demonstrates effective communication with patients and obtaining consent where necessary.

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For example - letters and notes of thanks from patients, workplace–based assessments, appraisal, multisource feedback. Multi source feedback and patient feedback - Please upload in one file your multisource and patient feedback and forms, in date order.

Call this “MSF and patient feedback”. Upload it under CiP1

Radiology reports You must submit sufficient examples of personally generated, dated and anonymised radiology reports, in the order of the radiology-specific content set out in the CCT curriculum and covering the appropriate range of techniques. See particularly the descriptors for CiPs 7, 8 and 9 for more information. Your reports must be from within the last five years and preferably as recent as possible. These form part of the evidence assessed to establish your competence across the breadth of the CCT curriculum, so the range of reports should be varied and include examples of normal and abnormal reporting. 60 reports is a minimum to submit, but you can submit more to ensure that the breadth of the CCT curriculum is covered. It is not usually necessary to submit more than 150 reports. You must look at the presentations and conditions in each curriculum area for an indication of what you need to cover - Table 1 in section 2.3 of the CCT curriculum sets out a range of key clinical presentations and features by body system and includes a list of modalities and techniques which the trainee

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should demonstrate as indicated at the level of proficient, experienced and specialist (defined in that table). Table 2 in section 2.3 sets out examples of clinical use of radionuclide imaging, along with an outline of imaging and therapy approaches and the biological processes that can be interrogated using molecular imaging. Table 3 in section 2.3 sets out the key practical techniques and procedures in which trainees are expected to have experience. Table 8 in section 4.5 sets out key milestones a CCT trainee is expected to accomplish. You must cover the appropriate range of modalities and techniques within each body system (including plain film, mammography, CT, US, MRI, fluoroscopy – refer to Table 1; radionuclide studies – refer to Table 2; practical procedures - refer to Table 3). You must demonstrate that you are competent in interpreting and performing imaging examinations and/or procedures that are required in the emergency context. All radiologists are required to be trained in a number of basic image guided procedures such as performing biopsies and inserting tubes and drains, as well as performing diagnostic procedural work such as fluoroscopy, so this should also be reflected in your evidence. The inclusion of some reports referring to image quality and impact on diagnostic certainty will also be helpful. Do not submit teleradiology reports of practical procedures that you have not performed. They may not be accorded the same weight as activity undertaken in an NHS hospital or comparable clinical environment.

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Please include a summary list of the reports in the order that they are submitted. You don’t have to submit a report covering every presentation and feature in the curriculum, but you should submit a good range by body system. Please submit your reports in order of system as set out in the CCT curriculum as follows: breast cardiac GI and hepatobiliary head and neck MSK neuroradiology obstetrics and gynaecology paediatric thoracic uroradiology vascular (basic) haematology and oncology All systems – (incidental findings, post-op appearances, iatrogenic, post-mortem)

Reporting submitted other than in system order makes it less easy for the evaluators to identify everything relevant.

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Ensure the example reporting is your personally generated, independent reporting activity and that this is confirmed appropriately by a head of department or similar. A significant amount of reporting completed under supervision, or indeed 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 (primary reporter, secondary reporter, responsible for carrying out a procedure, rather than observing it), this will not be considered helpful evidence, and reports should ideally be identifiable from the institution where they were performed.

Common reasons for unsuccessful applications include a failure to provide sufficient evidence of competence in one or more areas (such as paediatric radiology, body MR imaging, radionuclide radiology etc.). It is also important that you demonstrate the core range of activity expected in respect of each system – for example, in cross-sectional body imaging and in relevant image guided procedures.

The RCR publication Standards for interpretation and reporting of imaging investigations sets out the standards that should be achieved by those providing a report on an imaging investigation in the NHS. Radiology reports - Please group these together by order of system in the order requested in the SSG with the summary list included at the start of the file. Clearly indicate your reporting in the emergency/on-call setting. Please upload your reporting in one file per institution.

Call this “Radiology reports – institution name”. Upload it under Cip7 Reflective activity Reflective activity notes and diaries - for example, on CPD and learning events, teaching,

research, audit and QI activity, discrepancies, complaints and significant events, appraisal and feedback, MDT activity.

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Your evidence should demonstrate reflective activity as a regular feature of your practice, not all completed on one day. You can find a generic reflective template in the CPD section of the RCR website https://www.rcr.ac.uk/clinical-oncology/cpd/reflecting-your-cpd Reflective activity - Your reflection can be included in the file for other relevant sections – for example, CPD; clinical governance; audit and QI; etc.

Or you can include it all in one file in date order called “Reflective activity”. Upload this under CiP2.

Research activity For example – • publications; • posters; • abstracts; • applications for research projects; • Ethics Committee participation; • patient consent forms; • Good Clinical Practice (GCP) certificate or other relevant course or qualification

Research activity - Publications, posters, a thesis and other things such as listed in your SSG should be uploaded into one file per institution.

Call this “Research activity – institution name”. Upload this under CiP4

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

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Safety and quality activity 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. Safety and Quality activity - Much of your evidence may be included in other files but anything that has not can be uploaded into one file per institution here.

Call it “Safety and quality activity – institution name”. Upload this under CiP3 Teaching activity For example -

• Example presentations (PowerPoint etc. – at least two); • confirmation that you delivered these by way of invitations, timetables etc. or other

evidence to show how teaching is delivered • formal learner feedback; • relevant courses or qualifications in teaching; • assessments of your teaching

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Teaching activity - Everything you submit here – such as presentations (only two or three needed), timetables/invitations, learner feedback, assessments etc. – can be uploaded in one file per institution. Call this “Teaching activity – institution name”. Upload this under CiP 5

Workload statistics This is required to demonstrate the breadth and depth of your recent practice across the range of the radiology-specific content of the CCT curriculum.

This can be from the relevant department’s radiology information system 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.

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

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.

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 equivalent competence to all modalities, body systems and basic image guided procedures to those set out in the curriculum. 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.

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Workload statistics - This can also include logbooks. Please upload these in one file per institution, in date order. Include a summary of the numbers in front of each section.

Call this “Workload statistics – institution name”. Upload it under CiP7

Workplace-based assessments (WpBAs) 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, and for those who have finished training and are working in non-training jobs, that 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 or mini-IPX can be useful if they support a particular range of procedures (such as intervention) or a period of additional training you have had, or for a clinical activity in which you participate less regularly. Assessments of your MDT, teaching and audit and quality improvement activity might also 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.

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Structured, unselected multisource feedback and patient feedback is the most effective way to evidence your communication and teamworking skills. Appraisal and Workplace-based assessments (WpBAs) - Please upload in one file per institution your appraisals, WpBAs and any other assessments, in date order.

Call this “Appraisals and assessments 20XX-20XX – institution name”. Upload it under CiP1

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Annex B

Unsuccessful applications or poor evidence It is our experience that unsuccessful applications are most commonly submitted with inadequate or poor evidence in the following areas. This list is not exhaustive; see more information about what you need to submit above. However, these documents are particularly key to your application.

• Sufficient recent and personally generated radiology reports covering the breadth of the radiology specific content of the CCT curriculum, as set out in more detail above.

• Evidence of clinical audit activity to demonstrate individual clinical effectiveness and completion of the audit cycle (re-audit), and/or evidence of quality improvement projects which have led to changes in practice. A list of audits or projects undertaken will not be accorded sufficient weight in this application; you must provide the complete audits or projects.

• Evidence of safety, clinical governance and service improvement activity, particularly multidisciplinary team (MDT) meetings and activity, to include examples of cases discussed, reflective activity and minutes of meetings attended, and of other governance activity such as discrepancy meetings, radiology meetings and similar

• Formal appraisal information, and multi source feedback, patient feedback where available, reflective learning diaries and personal development plans to evidence how you are addressing objectives

• Research activity • Evidence of teaching and teaching feedback • Evidence of management activity – such as appraising and assessing others, leading MDTs and similar activity, rota management,

chairing meetings, budget management, relevant courses, protocol or pathway development, or examples where you helped address a service problem or new demand

• We recommend that your referees are able to provide detailed support for your competences across all or most areas, and understand the requirements for specialist training in Clinical radiology and Specialist Registration in the UK.

• Your referees should be able to comment on your current employment and employment from the last five years.

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Annex C

RCR Guidance for uploading your evidence Demonstrating equivalence to a five year training curriculum means of course that you must submit a significant amount of evidence, as you will realise once you look at the curriculum.

The RCR evaluators must spend significant time and effort reviewing the evidence submitted for each application to make a robust, evidence-based recommendation to the GMC, which takes full account of everything you have provided. The electronic upload process makes this very difficult if there are a significant number of uploads, or if the title of your upload does not properly reflect what is in it.

It will help the evaluators considerably if you can follow our suggestions in Annex A when you upload your evidence. The most useful way of doing this is to keep a folder of your evidence physically or on your computer and then upload in the relevant sections as one .pdf file. You can note any subdivisions you want to within that file. Fewer uploads, preferably in a pdf format, will make your evidence clearer and facilitate its evaluation. There are many software solutions widely available that can be used for converting documents/excel sheets/PowerPoint presentations and images to PDFs and combining PDF documents.

You don’t need to duplicate evidence if you submit in this way. Your evaluators will more easily be able to cross-reference your evidence where required (so for example, your radiology reports will be under one CiP, but we can cross-reference to other CiPs where relevant). You can note subdivisions within each file if you’d like to.

Please avoid uploading one document at a time. If we find a particular difficulty in understanding the way the evidence has been uploaded, it may result in a delay while we seek clarification from the GMC and a delay in the evaluation of your application.

If you upload anything other than as set out above, please clearly indicate what it is in the title of the upload and keep to as few uploads as possible.

Please make sure that when you submit your application, the evidence is as recent as possible at the point of submission of your application. If you have stored documents in your account for a year before you submit it, some of this could be outdated before the evaluators see it.