Article 14(4): an alternative route to the top
Authors: Imran Chaudhry
Publication date: 26 May 2007
Shahid Quraishi and Imran Chaudhry take you through the process
There are two methods to get on the GMC's specialist register. The first is by completing specialist higher training and gaining a Certificate of Completion of Training (CCT). The second is by applying for Article 14 (4) of the GMC's specialist register with evidence of relevant training and experience. Although many consider this a route only open to doctors who have qualified overseas it applies to any medical graduate regardless of country of graduation. And given the shortage of places in higher medical training we anticipate that in future more British graduates will use this route not just trust grade doctors from overseas who are likely to be the first to benefit.
The Postgraduate Medical Education and Training Board (PMETB) is an independent statutory body. It was established to set standards of medical education in the United Kingdom. One of its responsibilities is to decide whether doctors are eligible to be included on the specialist register maintained by the General Medical Council (GMC) in order to take up a substantive, honorary, or fixed term appointment at consultant level in the NHS.
Besides the familiar training route, PMETB will be offering another route to doctors who want to be included on the specialist register: article 14(4), (5), and (6). This route will take the doctor's experience, training, and qualifications from any part of the world into account.
PMETB took over the functions of the Specialist Training Authority and Joint Committee on Postgraduate Training for General Practice on 30 September 2005. Functions of both statutory bodies are now incorporated into the responsibilities and functions of PMETB. They started accepting applications under article 14 from July 2005.
How to prepare an application
Before preparing an application, it is advisable to check the specialty you wish to apply to. You should consult PMETB and the relevant royal college website. We found the following guidelines useful:
Guidelines for article 14 application
Specialty specific guidelines
Higher Specialist Training Handbook.
It is also worth reading the GMC's Good Medical Practice.
Once you are clear which specialty or subspecialty you wish to apply for you should consider contacting the human resources departments at the hospitals where you have worked. They should get in touch with the relevant consultants, including medical or clinical directors, to get the required evidence. In some cases it is a good idea to telephone to speed things up.
Royal College of Psychiatrists. A competency based curriculum for specialist training in psychiatry. Core and general module (provisional version—not yet approved by PMETB). London: Royal College of Psychiatrists, 2006
Postgraduate Medical Education and Training Board. Background information on Article 14. London: PMETB, 2005
General Medical Council. Good medical practice. London: GMC, 2001
Royal College of Psychiatrists. Higher specialists training handbook. London, Royal College of Psychiatrists, 1998
Department of Health. Postgraduate medical education and training. The Medical Education Standards Board. A paper for consultation. London: Department of Health Publications, 2001
Department of Health. Medical, health care and associated professions. The general medical practice and specialist medical education, training and qualifications order 2003. Consultation document. London: Department of Health Publications, 2002
You should consider your choice of referees carefully and ask them whether they are willing to be one. The structured reference is a 14 page form, which is very time consuming.
You should ensure that all your evidence is authenticated by a solicitor or issuing authority. In some cases a medical or clinical director can authenticate evidence.
Structuring your application
It is important to present the application and evidence systematically. This enables an assessor to go through your application and supporting evidence easily and avoids delays in making a decision. The application folder should contain a covering letter to PMETB giving a synopsis of your experience, training, and qualifications and highlighting your strengths along with current responsibilities. It should also say why you believe you are suitable for inclusion on the GMC specialist register. The folder should have a contents page, and supporting evidence should be submitted.
The form should be completed either in black ink or using Adobe software. Follow PMETB article 14 application guidelines.
A copy of your passport with a colour passport sized photograph is required. Doctors with overseas qualifications may need to use affidavits if the spelling of their names in their primary medical qualifications differs from that on their passports.
Include your primary medical qualification, degrees, diplomas, and membership or fellowship of relevant royal colleges. You should also include any certified courses leading to achievement of the certificate or honours such as section 12(2) approval from the secretary of state. This should be supported by evidence from the examining body.
This should be detailed and factual, listing everything relevant noted in Good Medical Practice and the Higher Specialist Training Handbook. You should list your experience in reverse order as advised by PMETB. Each job description should include details of clinical work, on-call commitments, regular supervision, training courses, journal clubs, and teaching. It is important to explain any gaps in employment or training.
You should include a current copy of your GMC certificate and may include registration from another country, if relevant, particularly if you have specialist registration there.
Once you are clear which specialty or subspecialty you wish to apply for you should consider contacting the human resources departments at the hospitals where you have worked
Candidates should submit a current appointment letter, job description, and job plan. You may consider including an open reference from a medical director, colleagues, managers, secretary, multidisciplinary team, and trainees to confirm your role.
Evidence should be as above.
This section can be divided into UK training and training received abroad. It can be in the form of a letter from human resources confirming the posts with duties, including on-call commitments. This can be further supported by a consultant's references or testimonials confirming training and specialty experience, including appraisals and attendance at university and/or training courses. References from the supervising consultants may comment on your ability to teach and participation in in-house teaching.
You should provide evidence of teaching trainee doctors, medical students, and nursing staff. You may also include any evidence that you have been a mentor to a trainee or a nurse prescriber. This may include evidence of teaching in the community: carers or patients or in schools.
Continuing professional development
Evidence of at least five years of continuing professional development (CPD) is required. This should be in the form of the college's authenticated CPD certificates. You may submit evidence from in-house teaching and a personal statement for the external CPD obtained for the current year. In the absence of a college CPD certificate you may prepare a personal statement clearly stating the CPD obtained, whether externally or internally, and get this authenticated by your medical or clinical director.
You should submit yearly appraisals. If no appraisals have been performed, you should get in touch with your medical or clinical director and have one done for the current year. It is also advisable to submit 360 degree appraisals/feedback. You should consider including anonymised cards and complimentary letters from patients, carers, and colleagues from your multidisciplinary team.
Log book/anonymised case studies
You should submit your logbook demonstrating training and experience achieved. You may have completed your training before the logbook era, in which case consider submitting anonymised selected case studies for the past five years.
These case studies should contain assessments and treatments offered in a variety of clinical settings such as outpatient consultations, tribunal reports, domiciliary assessments, serious untoward incident reporting, approved social work assessments, and court reports. This highlights your depth of experience and knowledge.
Audit, research, and publications
The first page of all publications and any research that is being planned or in progress should be included. You should submit all the audits done in your department. Audits should be accompanied by a brief description of methodology and results, and this should be authenticated by the medical or clinical director. You may consider giving a brief description of a thesis or dissertation that you have submitted for a higher degree from the university.
Other clinical commitments
You should include evidence of any special responsibility such as supervising or running an electroconvulsive therapy (ECT) department, leading or coordinating a CPD group, or involvement as a lead or special interest in a trust audit. Evidence of membership of committees or specialist working groups could also be included.
This section should contain evidence of any involvement in management. This can include management responsibility for the ward, community, or paediatric intensive care unit; involvement with a drugs and therapeutic committee, local negotiating committee, or the BMA; and minutes of community mental health team, multidisciplinary team, or doctors meetings attended. You may submit evidence of responsibility for college work or evidence of being an appraiser for colleagues or trainees. You may also give evidence of involvement with carers or patients group.
You should submit evidence of membership of steering committees and evidence proving you have contributed to the modernisation of services, such as development of a new community clinic, or have recently started new ways of working.
You can include any communication with senior management and whether they have expressed any opinion about positive changes to your service.
Health and probity
You should provide evidence that you are healthy and fit to practise. A note from your general practitioner can confirm your general state of health; you may also give a note from human resources confirming absences because of sickness. This can be further complemented by yearly appraisals in your folder. Although PMETB has said that there is no need to, we suggest that submitting a certificate of good standing from the General Medical Council will be reasonable evidence that a doctor is not subject to any inquiry or investigations questioning the doctor's practice.
From personal experience we conclude that it is the applicant's responsibility to ensure that he or she provides all relevant evidence to prove that their experience, training, and qualifications are equivalent to those expected from someone who has gone through routine training as a specialist registrar after passing the relevant royal college's entry examination.
Imran Chaudhry consultant psychiatrist and honorary clinical lecturer Lancashire Care NHS Trust and University of Manchester, Rossendale Hospital