You may have heard of the certificate of readiness to enter specialty training (CREST), which is required to enter CT1/ST1 training in all specialties. It is also known as certificate of alternative certificate of foundation competences. Getting it signed it an important part of progression into training.

Please note, CREST form is ONLY required if you have not completed UKFPO foundation program or an FY2 standalone post. In those cases, you will be awarded an FPCC (foundation program completion certificate) which is the proof of your foundation competencies.

What are the ‘Foundation Competencies’?

Competency

1. the ability to do something successfully or efficiently.
“This course will improve the competence of doctors”

From the beginning of pre-school to our final exam in medical school, more often than not, our ability to successfully complete a stage had been dependent on exams and assessments. For example, a student of a medical school has a curriculum (set by the authority who runs medical education in that country) and following that, a syllabus is made by the teachers involved who imparts the necessary education for that student to pass the relevant exams.

In plain words, ‘foundation competencies’ is a curriculum developed for foundation doctors in the UK (interns/house officers) to achieve during and by the end of their training. So, how can these competencies be assessed if a doctor has not undertaken an official UK foundation training? This is where the CREST form comes into play.

Check official UKFPO website for the foundation program curriculum.

Do I need a CREST form?

Let’s run you through a few questions:

  1. Are you going to join UKFPO Foundation training for 2 years OR join a one year FY2 Standalone post?
    • If yes, then you do not need to think about CREST form at all. You will be awarded FPCC at the end of that training.
  2. Are you going to start in the NHS in a non-training post (trust grade/clinical fellow)?
    • If yes, then for that post you don’t need a CREST form signed.
  3. Are you planning to apply for any CT1/ST1 level training post and do not have an FPCC (foundation program completion certificate)?
    • If yes, then you NEED to have a CREST form signed (preferably before the training application period).

So, the third point, applying for a training post, can come-

  • after working in the UK for some time or
  • even directly from outside the UK if you are otherwise eligible.

From personal experience, we do not recommend applying for a training post without having any NHS work experience. Training is a big commitment in your career and we think you should make that choice after you know more about the NHS healthcare system, working environment, and life in the UK.

What are the requirements to get a CREST form signed?

The CREST form is nothing but a list of competencies. So, obviously you have to have evidences or convince your signatory that you have those competencies. That is the first thing – your signing consultant knowing that you are capable of doing all those things mentioned in the form. The other technicalities can be found in the following checklist.

Checklist for CREST

Find the CREST Checklist here as a pdf.

If all the clauses mentioned in this checklist are confirmed/completed, then your CREST form is eligible to submit for your training application.

Who can sign my CREST form?

The individual signing your CREST form (or the signatory) needs to be registered with any medical regulatory board. If it is not with GMC, they must submit current evidence of their registration with that board. If it is not in English, a certified translated copy must accompany it.

This signatory must be a consultant who has worked with you for AT LEAST 3 continuous months in that last 3.5 years. They must also currently be on a specialist register. If you’ve worked in the UK in the last 3.5 years for 3 or more months in an acute post, you should have CREST form completed by a UK consultant rather than an overseas consultant.

Please also note that contact details from the individual signing your CREST will be required. This should be an institutional email address and not a personal one (ex: Gmail, Yahoo). The hospital stamp which is used to certify the signatory should also include the details of the hospital, and not just their name and job title.

How can I achieve these CREST form competencies?

As we mentioned already, if your target is to join any speciality training program in the UK, the best thing you can do is to NOT join without NHS work experience. Start your NHS career in a non-training post (where you will get paid the same) and gain experience as well as enrich your portfolio (CV) for the application of your desired training.

Now, if your desired training is at CT1/ST1 level and you have not completed UKFPO foundation program (which is the case for many IMGs) – you will have get this CREST form signed. How can you do that?

Let’s look at the CREST form

If you look at the the CREST form here, each competency in the four sections have three columns:

  • Personally Witnessed
  • Evidence Received
  • Unable to Confirm

Be very clear with your consultant who will be signing it that, if they are unable to confirm any competency, they must tell you before ticking it as that makes the whole form ineligible to submit for your training application. You may have some evidence or reference they can take into account and mention that in the form if they have not personally witnessed any of your competencies.

Unable to confirm is any of the competencies in the whole CREST form makes the form ineligible.

Take CREST & Portfolio course on RoadToUK Academy

Our advice is to go through this FREE COURSE that we made based on our experience of getting a CREST form signed. It covers all the topics related to giving you an introduction as to how you can achieve each of the competencies.

Tap the photo for FREE CREST & Portfolio Course. You can also find it in RoadToUK Academy!

In this course we have already covered the following things:

  • How to find the latest CREST form on the internet and guidance
  • An introduction to Supervised Learning Events (SLEs) and Workplace Based Assessments (WPBAs) through which you can collect evidence of multiple competencies.
  • How to get it and navigating through Horus e-portfolio, which is the same e-portfolio used by the foundation training doctors.
  • Exploring different e-Learning websites to provide you with evidence of your knowledge on a specific competency.
  • How to become a clinical teacher and find opportunities of teaching
  • Participating in a QIP is now mandatory in CREST 2021. We have also discussed how you can perform clinical audits and QIPS.

Maybe we are a bit partial, but the amount of guidance this CREST & Portfolio course provides for starter international graduates is invaluable and that is why we made it free!

How long does it take to get the CREST form signed?

Officially the minimum you have to work is for 3 months. But, truth be told, it may not be possible to convince your consultant of your capability to that extent within just three months of working. So, let’s be realistic and set a practical time frame.

If you adhere to updating your e-portfolio regularly and work in a fairly independent specialty like acute medicine or emergency medicine or have medical on-call shifts, it shouldn’t take you more than 1 year to a gain the competencies as outlined by the CREST form. Also take into account that you will have to complete e-learning modules, attend teachings and training courses (like ALS), and participate in audits and QIPs.

Please remember, this is all highly dependent on your communication with your supervising consultant. If they do not know that you are aiming for CREST form, they will not just observe you closely for fun. It is YOUR responsibility (as you are not in a training post) to make them aware what you want to achieve and plan your progression with them.

Frequently Asked Questions

That is all our guidance about the certificate of readiness to enter specialty training (CREST) form. If you have any questions ask in the comments below, we are always happy to help! Good luck 🙂

64 thoughts on “The CREST Form : All you need to know as an IMG”

    1. There is no problem with the site. We have a comment approval system to fight spam. You see your comment when we approve it. And we approve it when we reply to it. And you get an email with the link to the comment when we approve/reply to it. It is not like social media where your comment appears the instant you post it.

      1. When I get email I copy paste the link in “chrome” it does not show me my answers (still it’s showing 43 responses on chrome). But this work fine with edge browser though. Maybe problem on my side. I just wanted to highlight that. Thanks though for answering questions related to CREST form.

    1. You have to click the link in the email sent. If the link does not take you to the comment then you will have to copy the link and open in a new browser.

  1. Nishant Kumar

    If I get a locum work for 5-6 months tenure. Can I get the CREST form signed from the consultant I am working under?

    1. You need to have a minimum of total 3 months working experience under that consultant. Locum work is acceptable as you will be a full registered doctor. In the end, it will depend on the consultant whether they will be happy to sign you off.

  2. Fanny Jocelyn

    Hi for a person who has completed post graduate training in an overseas country and then planning to apply for ST3, is the CREST form essential?

  3. GMC registration – as part of your 24 months, you must have at least 12 months of experience after eligibility for full GMC registration. Candidates who qualified outside the UK can take this to mean 12 months’ experience after their eligibility for full registration with their equivalent of the GMC; you do not necessarily have to have worked for 12 months after full GMC registration in the UK.

    Hi, can you explain what does this mean? I would be eligible for full GMC registration in 1 or 2 months. Do I need to do another 12 months before I apply to IMT?

    1. You need a total 12 months clinical work experience as a full registered doctor (anywhere in the world) before you can apply for IMT.

      1. Can you please elaborate on this as I am unable to understand it properly? After my graduation I did house job in Pakistan for 12 months (not continuous) but my GMC registration is on the basis of USMLE. So can I use those 12 months to show my experience to get into IMT?

        1. No, that’s internship and you were not a fully registered as s doctor then. So you need a total 12 further months of clinical experience as a full registered doctor.

  4. I’m working as a Physician Associate in a GP practice but also applying for full registration in the meanwhile. I have completed 1 year of post medical degree internship (outside of EU) so I require a CREST to apply for a GP training programme. As I await full registration, can I get my CREST form filled out by my clinical director or do I have to wait for full registration to be granted? Also can I get my CREST form signed off at the GP practice or does this have to be as part of a hospital post? I believe a clinical director or GP can sign this? What happens if I get the CREST 2021 version signed this year but then a new form is made available next year? If I apply to a 2022/23 programme, would I have to go back to my employer to sign off on my competencies on the new form (if updated)? Thanks for your help.

    1. CREST form demands that you have achieved the mentioned competencies while working as a full registered doctor (anywhere in the world) while under supervision of the signatory. Not as a physician associate, as a registered working doctor. And the CREST form itself has explanation who can sign this for you, please refer to that. There are chances CREST form may change for the next year, if it does you will need a new one signed, if it doesn’t you can use the old version of it.

      1. Hi,

        Thanks for you reply. Understood the points you mentioned.

        Can I gain the CREST competencies whilst working as a Physician associate (after I have been granted full registration)? The reason of my question is that I’m a fully qualified PA and in the process of gaining my GMC Full license. Once gained, then my duties and competencies are similar to those of a Junior Dr in clinical setting (I’ll also have my full license at this stage, hopefully real soon). I’m also under the supervision of a person who is eligible to sign the form. I understand that the CREST can not be filled out before gaining full registration. My main question is, can I get the CREST filled out whilst working as a PA (once fully licensed by the GMC) or does the post have to be as a Dr even though my role and responsibilities overlap.

        1. As my understanding goes after reading the CREST guidance, unfortunately, the post in which you were supervised for all those competencies, it has to be a post of a full registered doctor.

  5. 1). I have never started but not satisfactorily completed a UKFPO-appointed 2-year Foundation programme or FY2 standalone post? I never did that I am signing it by doing the non-training job.
    What to write here? Confirmed?

    2). Where my signatory has selected ‘Evidence Received’ for a competency, they have completed page 11of the CREST which lists the details of the individuals from whom they have received evidence.
    If my consultant has witnessed everything by himself then what to write here? Confirmed or Completed?

    3). In CREST form there is a blank for the employer name? Is this the name of the doctor under which I worked?

    4). In CREST form there is another black for Professional status? Can I write Doctor.

    Thanks

    1. 1) Can you explain the context a bit? Where have you copied this sentence from?
      2) If he has witnessed everything personally, then he doesn’t need to write anything on that page.
      3) Employer is the hospital or institution who paid you for the job.
      4) Professional status is more like the registration status with whichever medical council they are registered with.

      1. Point one is from CREST checklist (first point of that). Should I write confirm or complete. I am unable to understand what they are asking.

  6. Aayush Vashisth

    For a final year med student who is yet to write PLAB and wants to pursue specialty in future, what will be the best route ? Sign up for FY2 or go for non-training job and get a CREST certificate ?

    P.S.- This is my first comment/query on this website. I can’t explain how grateful I’m for your guidance. Thanks.

  7. Aswini Srinivasan

    Hello. So I’m planning to take up a course in the UK this year and I thought until then I could work for the next few months at a hospital. But I will be applying for nhs the following year (2022) after my course completion. Will my crest form be valid until then to directly apply for ST1 or it becomes invalid and I should go through the FY2 for a year?

    1. You can’t clinically work in the UK as a doctor without having GMC registration. If you observe clinical work as a part of your course, it can’t amount to signing a CREST form. They came up with a new CREST form in 2020 and also another new one in 2021, so by likely it is more prudent to get it signed just before your application for it to be valid for the period.

      You can work at any non training level, FY2, CT1 or ST1 or whatever level to get CREST form signed, but that work has to be FULL clinical registered work.

  8. ISHFAQ AHMAD WANI

    Hello
    I have a question , as mentioned above the consultant who signs CREST form should be on Specialist Register , what if consultant is from overseas and not registered with GMC , so , he/she wont be in specialist register , what to do that in that scenario?
    Thankyou

    1. The consultant has to be a recognised ‘consultant’ in their own country. All practicing doctor in any country should legally be registered with their medical regulatory board. If your signatory consultant is not registered in the UK, you have to provide their proof of registration with their own medical regulatory board.

  9. Hello! I am from the UK but completed my medical degree in Chile. I am taking the PLAB in November and am now working in Chile in the meantime. My question is : can you fill out more than one CREST form? For example, if I complete 6 months here and then when I have my GMC licence apply for an acute post for 6 months in the UK and have another crest form signed? That would make up the 12 months needed. Thank you in advance for your response!

    1. CREST form duration does not matter. It’s a document signed by your supervising consultant who is signing off your competencies. So it just needs to be a within 3.5 years of starting the training job your are applying for.

      For example, you intend to apply for August 2023 Internal Medicine training IMT) for which the application opens in November 2022. So, by November 2021 you have to have that year’s valid CREST form signed. If you had gotten it signed in 2021 but they have a new version in 2022 then the previous one is not valid (even though it was signed 3.5 years before the starting of August 2023).

      Hope that makes sense.

  10. I have just graduated, and achieved full GMC registration. I have just missed the date to apply for F2 standalone. I’m currently applying for non-training jobs at FY1/FY2 level and I just want to clarify I can complete the competencies for the crest form in these non-training positions? Is it something I should ask the hospital before applying for their vacancies?

    Thank you so much for your website, your information has been invaluable to me and I appreciate it greatly.

    1. Yes, you can get your CREST from signed for any clinical work when you are full registered. CREST is not your employer’s prerogative though, because it’s your competencies. It’s your own responsibility to plan your work with your supervising consultant so that they can sign you off.

      But you can definitely ask about teaching and learning opportunities which will help you increase and prove your competencies. Please check this article – The Interview: Finalizing your first NHS job

  11. Jayashankar Jayarajan

    Hi Dr Ibrahim , could you tell me how difficult would it be to get into a standalone fy2 post after my plabs . Is it easier to go for a non training post and get my crest signed or is the standalone fy2 a better/easier path . In I either case would I be earning enough to support my self during that time . Thanks ,Jay

    1. Getting into FY2 standalone requires you to pass extra exams like SJT. So from the point of view it is difficult to obtain than getting a non-training post. As for earning, we don’t know you personal financial situation. The definition of “ENOUGH” is so different among different persons. So you need to know how much and then YOU will know whether that will be enough for you. Watch this video explaining a doctor’s pay in the UK.

  12. Hello! Thank you for your information! I have a job offer for a non-training ST3 level Clinical fellowship in Cardiothoracic Surgery of 12 months. Can I make my consultant fill the CREST during this period? Thank you in advance

    1. In theory, CREST is the equivalence of foundation-level doctors. If you are already working at the ST3 level, it may be unlikely the consultant will be willing to sign you off a CREST form, just on the basis that your job description will not be the same as a junior doctor and thus they will not be able to assess your competencies. But, you can always ask them and explain your career plan and see what they say.

      1. Thank you for ur reply , i read what is being said on the form ..
        But i am not sure still if associate specialist can sign it or not , that’s why i asked you .. !!!

        1. I am really sorry to ask you this again, but what is not clear from this sentence?

          “This certificate can only be signed by a Consultant or equivalent. For the purposes of this documentation, Consultant includes General Practitioners, Clinical Directors, Medical Superintendents, Academic Professors, and locum Consultants with a CCT/CESR and who are on the specialist register.”

          So if the associate specialist is a locum consultant, do they have CCT/CESR?
          If they are not acting on a consultant post, do you think after reading this sentence, they are eligible to sign this form?

          Instead of asking a Yes/No answer from us, please find the answer yourself from the content what’s already available.

  13. Can the form signed by associate specialist specialist (in pediatrics) ? Or this position does not consider as consultant ?

  14. Hi, thanks for this article!

    As far as I know, most (if not all) CT1/ST1 posts limit the applicant’s experience in the field for a certain period. Does this working experience include the internship period done outside the UK PLUS the non-training job experience where we work towards a CREST form?

    If yes, and the whole duration exceeds the maximum limit for applying to CT1/ST1, what can we do?

    Thank you!

    1. It includes any clinical work experience being a full registered doctor anywhere. So, during internship you are not a full registered doctor, that’s why it does not count.
      If you are over that criteria, I will still advise you to apply and see what happens. But if you are not shortlisted then your option is to target higher training by obtaining core competencies in a non-training jobs. Read more here – Specialty Training or NHS job after MRCP MRCS

  15. Hi,
    I want to get my CREST form signed from oversea.
    Can it be signed by someone who is a consultant now, but was a senior registrar as at the time I worked with him? Thank you.

  16. Hi , while filling out the crest form , there is “date of completetion” column at the end of each competency section. what date should be put there ? The date when the form is being signed by the consultant which would mean the same date for all competencies OR the different dates when each competency was likely achieved through the employment ? Kindly advise.

  17. 1.What if my consultant has no official mail address.
    2.Regarding hospital stamp is this the logo of hospital? If yes so can I insert that logo or stamp after downloading from net? IF no is this the seal what most Bangladeshi consultant have?

    1. You have to use, either hospital’s email address. You have to use the official seal of the hospital you were working in under that consultant. The consultant can use their stamp under their signature, but the hospital seal has to be the hospital’s actual stamp.

  18. hello,
    if I started working in UK exactly 3 months before the adv date. will I be able to sign it by an overseas consultant ?
    i started my clinical work on 7th of August , but my contract starting date is 5th of August.
    and how strict will it be regarding people who have started working in UK recently

  19. I’m working in a hospital in my home country and involved in an audit. So what kind of evidence is needed to show that I did an audit, when I apply for a post in UK. Right now I’m waiting to give my plab 2 exam and hoping to apply for psychiatry post in future.

  20. hi i am working in NHS and planning to apply for ct psychiatry training. As my current supervisor can only sign off some sections of crest form but i can get it signed of from consultant back home. is it ok if signed off some part or sections of the crest form from the current and some from the consultant back home?

    1. A CREST form has to be signed off by one consultant in entirety. If that consultant is unable to confirm then they can be shown evidence to those competencies and they can tick evidence received and add the other consultant’s details in the last page of that CREST from.

  21. I have had experience for 4 four years after the graduation. Do I need to have Crest for training position.I have also four year clinic gap so far.
    thank you for answering

    1. If you have not completed UK’s foundation programme (most of the international doctors), then to join any CT1/ST1 level training you will need a CREST form signed irrespective of how many years of work experience or postgraduate degrees you have.

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