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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'?
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:
- 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.
- 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.
- 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.
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
Yes, you can. Run through the CREST checklist and make sure all are confirmed. Remember to provide/ have enough evidence to support you and show that you have ALL the competencies mentioned in the CREST form. If you don't and later on in your career a question is raised about your competencies, you may get into trouble leading GMC legal action.
As officially answered here from the CREST applicant guidance- "If at any stage investigation shows that the certificate has been fraudulently signed (by you or by the signatory), then instant dismissal and referral of yourself and/or the signatory to the relevant Responsible Officer or the GMC (or equivalent) will be considered." So, not only you are inviting trouble for yourself but also for the consultant who signed it off. Be careful and ensure everything is clear.
No. To directly apply for a ST3 or above level training you need Alternative Certificate of Core Competencies which is not the CREST form. Details of this has been discussed in this article- Specialty Training or NHS job after MRCP MRCS.
Yes, that is also admissible. The consultant can easily tick that as Evidence Received and mention that in the final section of the CREST form.
No. Unpaid honorary/observership/clinical attachments do not count as experience. Paid honorary posts involving broad clinical practice would be recognized.
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 🙂