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Guidance for Applicants to Emergency Medicine Training.doc.doc
Guidance for Applicants to Emergency Medicine Training.doc.doc
Guidance for Applicants to Emergency Medicine Training.doc.doc
Guidance for Applicants to Emergency Medicine Training.doc.doc
Guidance for Applicants to Emergency Medicine Training.doc.doc
Guidance for Applicants to Emergency Medicine Training.doc.doc
Guidance for Applicants to Emergency Medicine Training.doc.doc
Guidance for Applicants to Emergency Medicine Training.doc.doc
Guidance for Applicants to Emergency Medicine Training.doc.doc
Guidance for Applicants to Emergency Medicine Training.doc.doc
Guidance for Applicants to Emergency Medicine Training.doc.doc
Guidance for Applicants to Emergency Medicine Training.doc.doc
Guidance for Applicants to Emergency Medicine Training.doc.doc
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Guidance for Applicants to Emergency Medicine Training.doc.doc

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  • 1. The College of Emergency Medicine Churchill House 35 Red Lion Square London WC1R 4SG Telephone: 020 7404 1999 Fax: 020 7067 1267 web: www.collemergencymed.ac.uk Email: cem@collemergencymed.ac.uk Guidance for applicants to Emergency Medicine training in 2009 (England, Wales and Northern Ireland) Introduction This document provides advice and guidance for applicants to emergency medicine training in 2009, including a description of the training programme and eligibility requirements. The guidance is specifically for those applying to deaneries in England, Wales and Northern Ireland. Scotland has its own person specifications and application process and the MMC Scotland website should be regularly checked by applicants www.mmc.scot.nhs.uk Application Process As in previous years details on how recruitment to specialty training will work is provided by Modernising Medical Careers where a copy of the 2009 Applicant Guide (England) can be located. The national websites will be regularly updated with advice about the process and timetable. Applicants should regularly check MMC websites. MMC England – www.mmc.nhs.uk MMC Wales – www.mmcwales.org MMC Northern Ireland – www.nimdta.gov.uk/mmc Individual deanery websites will give details of vacancies in their programme and these will be regularly updated. The CopMed website provides links to all deanery websites www.copmed.org.uk Recruitment to core training years 1, 2 and 3 (and ST4 in Northern Ireland) will be led by deaneries at a local level. You may apply to as many deaneries as you wish. Recruitment to ST4, for applicants to England and Wales deaneries will be by national recruitment. Guidance for applicants is at appendix 1 of this document. Trainees may be appointed to one year fixed term training posts where vacancies exist. Getting advice You will be able to get advice locally, ideally through your EM Consultant trainer or failing this through the Training Programme Director, Head of School or Specialty Training Committee chair. There are lists of heads of training on the CEM website www.collemergencymed.ac.uk . You can also email the CEM training section if there are remaining unresolved issues training@collemergencymed.ac.uk Training Programme The specialty training programme is competence-based, usually of 6 years duration after the completion of Foundation years 1 and 2 and leads to a Certificate of Completion of Training (CCT) and specialist registration in Emergency Medicine. There is a period of transition which allows doctors to enter training at different levels. However, most doctors will be expected to enter EM training at year one of Core Specialty Training. 1 CEM advice to applicants Dec 08
  • 2. The programme is divided into three years core specialty training and three years higher specialty training. Core Specialty Training consists of two years of Acute Care Common Stem (ACCS) training and one year of CT3 specialties. Entry to higher specialty training is now by competitive application, following the ‘uncoupling’ of the programme in 2008. Higher specialty training is normally three years of emergency medicine. Appendix 2 shows a flowchart of training programme. Training will be continuously assessed in the achievement of competences by workplace based assessment and through the annual deanery assessment process. Core Training Years one and two - Acute Care Common Stem The first year of the ACCS programme normally consists of a year of training in Emergency Medicine and Acute Medicine. Successful completion of Acute Medicine ACCS training will lead to the achievement of level one competences. The second year normally consists of a further year in anaesthetics and intensive care medicine. The split within each year and order in which the specialties are completed will vary according to local deanery arrangements. Applicants will find further information about the programme on the ACCS website www.accsuk.org.uk Core training year three – Emergency Medicine with Paediatric focus + Paediatric EM and Emergency Medicine with musculoskeletal focus or trauma & orthopaedics CT3 training is tailored to enable trainees to achieve the competences required to care for children in the emergency department, as well as adults and children suffering acute musculoskeletal conditions including trauma. The CEM curriculum and CT3 framework are available in the Training & Examinations section of the CEM website. The objective for the Paediatric focused component of the CT3 year is to achieve the competences required to care for children in the emergency department, as defined in the CEM curriculum. Competences can be achieved in paediatric emergency departments, general emergency departments and acute inpatient paediatrics or combinations of all three. The objective of musculoskeletal component of the CT3 year is to achieve competence in the assessment and care of trauma and musculoskeletal injury, as defined in the curriculum. Training is normally within the emergency department with a weighting of duties in the care of musculoskeletal injury and day release to clinics. Less commonly, trainees can complete a CT1 or CT2 post in trauma & orthopaedics. These posts focus on trauma rather than elective orthopaedics. Specialty Training Years four to six – Emergency Medicine Trainees complete three years of higher specialty training in years four to six. Most training takes place in the emergency department gaining progressively more advanced clinical training as well as academic/critical appraisal and managerial training as defined in the CEM curriculum. Six months can be spent outside the emergency department completing competences from earlier in the programme or following special interests but a minimum of 30 months must be spent training in Emergency Medicine. Paediatric emergency medicine sub-specialty training Paediatric emergency medicine is the only recognised sub-specialty of Emergency Medicine and a limited number of training posts exist around the country for trainees interested in completing this training. Details of sub-specialty training competences are outlined in the curriculum page of the CEM website. Training is 12 months in duration consisting of six months in a paediatric emergency medicine department recognised for sub-specialty training and six months of ward based paediatrics, including training in the care of unconscious and critically ill children. Training can be started during the six months allowed out of general emergency medicine training during ST4-6 but many trainees will need to extend their training by the full 12 months. 2 CEM advice to applicants Dec 08
  • 3. Dual accreditation with Intensive Care Medicine Advanced level accreditation in ICM is achieved by a growing number of EM trainees. This training is supervised by Intercollegiate Board for training in Intensive Care Medicine (IBTICM) www.rcoa.ac.uk/index.asp?PageID=36 and leads to dual accreditation in emergency medicine and intensive care medicine. Appointment to post is by competitive application and is normally eighteen months in duration, depending on how much previous training can be recognised. Training can be started during the six months allowed out of general emergency medicine training during ST4-6 but many trainees will need to extend their training for the full duration of the programme. Following other special interests EM trainees also take time out of programme to achieve level two competences in acute medicine or undertake training in pre-hospital care, research or other areas of special interest. The training would not be recorded on the specialist register but, in some circumstances, can partly be recognised toward CCT or CESR. College exams The Membership Examination of the College of Emergency Medicine (MCEM) is required for progression through training. Part A is required for entry to CT3 and Parts B and C are required for entry to ST4. From 2009 entry the College will no longer accept equivalent postgraduate diplomas from other colleges, exceptions to this rule for some trainees who entered training in 2008 are explained in College guidance available in the Training section of the CEM website. Trainees must pass the Fellowship Examination of the College of Emergency Medicine in the last year of training. Life support courses Advanced life support provider training courses (ALS, ATLS and APLS)are required at different levels of training. Completion of training Satisfactory completion of core training and specialty training and both College exams would allow the trainee to be recommended for their Certificate of Completion of Training. Summary of person specifications The person specifications for 2009 entry trainees are available on the Modernising Medical Careers website. They differ from previous year’s specifications in important respects so applicants should study them carefully to be sure they are eligible for the year they are planning to apply for. Trainees may be eligible for appointment to more than one year of training. The person specifications are written so that they can be interpreted with some flexibility. The College supports flexibility in the recognition of previous specialties and the order that the elements of core training are completed. The sections that will help applicants decide at which level to apply are the essential criteria for eligibility and career progression. The requirements of the person specifications are summarised in the table below. The term ‘Core elements’ refer to the specialties that constitute the first three years of emergency medicine training: Emergency Medicine (EM), Acute Medicine (AM), Anaesthetics (Anaes), Intensive Care Medicine (ICM), Paediatric EM/Paediatrics and Trauma & Orthopaedics/ musculoskeletal (MSK) and would not include foundation competences. 3 CEM advice to applicants Dec 08
  • 4. Life support courses Advanced life support provider training courses (ALS, ATLS and APLS)are required at different levels of training. Summary of 2009 person specifications for emergency medicine Eligibility Career Progression Comment CT1 Achievement of foundation competences by August 2009 12 months or less experience at ST/SHO level in core elements. A maximum of six months in each specialty will be counted. If the applicant has completed 18 months in EM, they are eligible for CT1 not CT2 as only the first six months of EM will be counted. CT2 Achievement of foundation competences by August 2009. Evidence of achievement of CT1 ACCS specialties or 2 of the 6 core elements including EM. 1 of 3 life support courses At least 12 months experience at ST/SHO level in core elements including EM. A maximum of six months in each specialty will be counted. If applicant has completed 12 months in EM, they are not eligible for CT2 as only the first six months of EM is counted. CT3 Part A MCEM by application closing date (or check College guidance acceptance of equivalent exams) Achievement of foundation competences by August 2009. Evidence of achievement of CT/ST1 competences in ACCS specialties at time of appointment and CT2/ST2 competences in ACCS specialties by August 2009 or 3 of the 6 core elements including EM. 2 of 3 life support courses At least 24 months experience in acute specialties at ST/SHO level by August 2009. Trainee must have 3 of the 6 core elements including EM. A maximum of six months in each specialty will be counted for eligibility. Applicant must have completed 24 months of post-foundation training, ideally in 4 of the 6 core elements. However they will be eligible with 3 ACCS/CT3 specialties. The remaining six months can be duplicate specialties or non – core element specialties such as general surgery, or non- training posts as they do not count toward CCT. If training in core elements is less than 18 months in total (eg 3, 4 months posts instead of 3, 6 months posts) then the applicant may be best advised to apply for CT2 as it is likely that they will have a large number of competences to make up. Trainees who enter CT3 with only 3 of the core elements are advised to discuss with the appointing deanery the assistance they will be given to make up the missing competences for eligibility for entry to ST4 in 2010 when all six will be required. 4 CEM advice to applicants Dec 08
  • 5. ST4 Full MCEM by application closing date (or check College guidance acceptance of equivalent exams) Achievement of foundation competences by August 2009. Evidence of achievement of CT1 & CT2 competences in EM at time of appointment & CT3 competences by August 2009 or evidence of achievement of 4 of the 6 core elements of emergency medicine including EM. 3 life support courses At least 36 months experience in acute specialties at ST/SHO level by August 2009, with at least 24 months in core elements, supported by evidence from work based assessments of clinical performance. Applicant must have completed 36 months of post-foundation training, ideally in all 6 core elements. However they will be eligible with 4 ACCS/CT3 specialties. The remaining twelve months can be duplicate specialties or non – core element specialties such as general surgery, or non- training posts as they do not count toward CCT. Some notes about eligible posts Applying to train via the CCT or CESR route PMETB will only award a Certificate of Completion of Training (CCT) to trainees who have completed the training programme in prospectively approved posts and programmes in the UK. So if the applicant is applying to a year above CT1 and wish their training to lead to a CCT then they should note that only their UK SHO/ST posts can be recognised for eligibility. Appropriately recognised EEA training will be treated as equivalent to UK training posts but require confirmation from the competent authority in that European country that the training meets minimum requirements of Directive 93/16/EC. Trainees who use non-EEA overseas posts, or unrecognised UK posts, such as Clinical Fellow posts, for eligibility will be able to work toward a Certificate of Eligibility for Specialist Registration (CESR) but they will not be able to get a CCT. CESR training is otherwise identical to CCT training and leads to specialist registration in exactly the same way. CESR- route trainees will have to demonstrate that they covered the competences of the CEM curriculum in their overseas or non-training posts by providing strong evidence of competences achieved, and may follow a different application process at the end of their training. What previous experience might be recognised as an Acute Medical post? Posts specifically designated as Acute Medicine posts can be recognised, as will General Medicine posts which have included exposure to acute undifferentiated medical input. Sub-specialty posts in Medicine (e.g. Endocrinology, Haematology etc.) may be recognised if the post holder participated in the Acute Medical intake. Evidence of the competencies gained will need to be shown in the applicant’s portfolio, preferably by completion of WPBA and a structured training report. However it is recognised that this type of post may have been completed prior to the introduction of WPBA and a supporting letter from the supervising consultant confirming that the competencies in Acute Medicine have been achieved would be satisfactory. This needs to be explicitly stated in the application form/CV and it is the trainee’s responsibility to provide this information. 5 CEM advice to applicants Dec 08
  • 6. What previous experience might be recognised as a Paediatric post? Posts in Paediatric medicine (ward based) or Paediatric Emergency Medicine can be recognised. Paediatric Surgery posts would not be counted. Can posts not in ACCS/CT3 specialties be recognised for eligibility? Posts such as Cardio-Thoracic Surgery contain, for example, exposure to some relevant part of the EM curriculum. However the only posts which can be recognised as ACCS/CT3 posts are: • Emergency Medicine • Acute Medicine (see above) • Anaesthetics • Intensive Care Medicine • Paediatrics (see above) • Trauma & Orthopaedics Whilst other posts may offer exposure to some of the competencies required this is merely a reflection of the broad based nature of Emergency Medicine which crosses all Specialties. The Emergency Medicine curriculum necessitates exposure to the six ACCS-type Specialties noted above. Applicants applying for CT3 or ST4 may however use these posts to demonstrate career progression as described in the table above. 6 CEM advice to applicants Dec 08
  • 7. Appendix 1 Advice to applicants applying for specialty training in Emergency Medicine at specialty training year 4 (Higher Specialty Training) in 2009 National Recruitment The College of Emergency Medicine has developed a national recruitment process for entry into specialty training year 4 (ST4) (Higher Specialty Training) in 2009. The process will be hosted by the Yorkshire & the Humber deanery for recruitment in all English and Welsh deaneries. Northern Ireland and Scotland will continue to recruit through local deanery processes. Recruitment to Core Training years 1- 3 will continue to be a locally driven deanery function. Who is eligible to apply? An overview of the recruitment process and general principals can be found on the MMC website www.mmc.nhs.uk/default.aspx?page=468. Applicants should refer to the ST4 person specification, available on the CEM and MMC web sites www.mmc.nhs.uk/pdf/PS%202009%20ST4%20EM_3.pdf. Applicants must have completed at least four of the six core elements that make up the first 3 years of Emergency Medicine training by August 2009 (Emergency Medicine, Acute Medicine, Anaesthesia, Intensive Care Medicine, Paediatrics or Paediatric EM and Musculoskeletal) together with a minimum of 36 months postgraduate experience (not including foundation programme training or equivalent). These 36 months may be in any acute specialty, but if an element which makes up the first three years of Emergency Medicine training is repeated only six months is allowable towards training. For example, a trainee who has completed 12 months Emergency Medicine, six months Acute Medicine, six months Anaesthesia and six months Intensive Care Medicine and six months General Surgery would be eligible to apply but only six months of the Emergency Medicine and none of the General Surgery would count towards training. Applicants must have passed the MCEM examination by the application closing date. The circumstances where an equivalent College exam will be acceptable are outlined in College guidance, ‘exams and emergency medicine training in 2008 and subsequent years’ www.collemergencymed.ac.uk/temp/1421-raining-2008_entry_onwards.pdf Trainees appointed to runthrough training posts in 2007 do not need to make a competitive application to ST4. Overseas Doctors Doctors who are not UK or EEA nationals and whose immigration status entitles them to work without restriction in the UK will be considered on an equal basis with UK and EEA nationals. This includes doctors with Highly Skilled Migrant Programme (HSMP) status (and dependents thereof) at the point of short-listing or those entitled to work in the UK under Tier 1 (Highly Skilled Migrant) of the Points Based System. Other non-UK/non-EEA nationals with limited leave to remain in the UK whose employment will require sponsorship under Tier 2 (Skilled Worker with Offer of Employment) (such as those on student or working holiday visas) are subject to the resident labour market test and may only be considered for appointment if there is no other suitable applicants as described above. 7 CEM advice to applicants Dec 08
  • 8. How does the process work? An advert will appear in the BMJ (hardcopy and website) on 13th December 2008 and the closing date for applications will be 16th January 2009. The whole process will be web-based using a well-validated software system (I:CAMS) with which the Yorkshire & the Humber Deanery has extensive experience. Each applicant will rank the deaneries in order of preference. The long-listing and short-listing process will take place over three weeks and offers to attend a selection centre interview will be made electronically in the week commencing 23rd February 2009. Selection Centre The interviews will be in ‘selection centre format’. Each applicant will complete a number of stations (approximately 8) which will assess key areas such as clinical skills, managerial skills, communication skills, teaching skills and preparation for the post. Most stations will be scored using predetermined marking templates, however, some stations may be pilots. The results of pilot stations will not count towards the applicant’s final score but will help the College to determine whether the station could be used in the future. It will be made clear at the start of the process which stations are weighted and which are pilots. The selection centre will be based at Churchill House, London on the 2nd, 3rd and 4th March 2009. There will be two parallel tracks of stations and we aim to interview 50 applicants per day. Details of what the applicant needs to bring to the selection centre will be provided closer to the date. Offers No offers will be made until all three days of interview have been completed. Each applicant will then be ranked. The top-ranked applicants will be offered their first choice of deanery. If this choice is not available they will be offered their second or third choice and so on, until all posts have been offered. Efforts will be made to accommodate all appointable candidates according to their preference. Applicants will be given 48 hours, excluding weekends and bank holidays, in which to reply to offers. Offers will be made electronically via the web-based service. If the offer is accepted, the applicant is deemed to have been appointed to post. The post is removed from the system and the applicant is removed from the pool. After 48 hours a further 24 hours will be allowed for deaneries to review the number of remaining unfilled posts and further offers may then be made. Once an offer is accepted it cannot be declined at a later date. A clear cut-off date for offering posts will be set, after which no further offers will be made. Any remaining vacancies will be re-advertised and appointed to by individual deaneries. The benefits of national recruitment The CEM believes that trainees will benefit from a transparent application process which avoids multiple interviews. In 2008 other specialties found unified, structured interview processes to be effective and efficient. It is also anticipated that fill rates for posts will be improved. The appointments process will be independently evaluated by the Work Psychology Partnership and their report will be made available to the CEM Council and the MMC. 8 CEM advice to applicants Dec 08
  • 9. Is there another way of applying for a ST4 post? National Recruitment is the only way to apply for an ST4+ post in England and Wales. However there are different appointment processes in Scotland and Northern Ireland. Trainees should refer to MMC Scotland and MMC Northern Ireland websites for details (www.mmc.scot.nhs.uk and www.nimdta.gov.uk/mmc ) Why isn’t there a similar system for ACCS and CT3? Recruitment into ACCS and CT3 will continue by application to individual deaneries in 2009. The success of the emergency medicine ST4 national recruitment project will be evaluated and feedback sought from other ACCS colleges. If this is positive a national recruitment process (possibly based on a different model) could be piloted for ACCS and CT3 in future years. How to find out more information? More information on a career in EM can be found on the CEM website in the ‘EM in the UK section’ and in the ‘Training & Examinations’ section. For general careers advice applicants are advised to look at the MMC web site or discuss with their local heads of training. Further information on vacancies, how to apply and the application module will be available from mid December on the Yorkshire & the Humber Deanery website (www.yorksandhumberdeanery.nhs.uk) 9 CEM advice to applicants Dec 08
  • 10. Appendix 2 10 CEM advice to applicants Dec 08 FY2 FY1 ACUTE CARE COMMON STEM CT1 and CT2 1 year Emergency Medicine & Acute Medicine 1 year Anaesthetics & Intensive Care Medicine Order of rotation and split of each year may vary according to local programmes that, regardless of their structure, will deliver ACCS competences. MCEM Part A CT3 EM + trauma & musculoskeletal or T&O EM with emphasis on Paediatric EM ST4, ST5, ST6 in Emergency Medicine MCEM Part B&C FCEM Competitive entry to ST4 via national recruitment Relevant fixed term posts *** Sub-specialty training in Paediatric EM or dual accreditation in ICM; additional training in Acute Medicine Relevant fixed term posts*** *Trainees who plan to enter training at any level in 2009 must pass the MCEM exam to progress through to ST4 training. Alternative exams will not be acceptable. **The 6 elements of training are EM, AM, Anaesthetics, ICM, PEM and MSK. ***The availability of time-limited posts will vary regionally. 2009 CT3 entry: Competitive entry if completed at least 18 months in recognised training posts and 3 out the 6 elements that make up the first 3 years of EM training** *MCEM A + 2 life support courses. 2009 CT2 entry: Competitive entry if at least 12 months in recognised training posts and 2 of the 6 elements that make up the first 3 years of EM training** No exam required + 1 life support course 2009 ST4 entry: Competitive entry if completed at least 24 months in recognised training posts and 4 out of the 6 elements that make up the first 3 years of EM training** Full *MCEM + 3 life support courses. 2009 Competitive entry to CT1 ACCS (EM) with 12 months or less of any specialty that makes up the first 3 years of EM training** Certificate of Completion of Training in Emergency Medicine1
  • 11. 11 CEM advice to applicants Dec 08
  • 12. Appendix 3 Interview It should be clear that at interview, you will need to provide evidence to support your application. You will need to bring a portfolio with you. The PMETB advice asks that you provide documentary evidence that a post you completed had educational approval. The following are acceptable sources of evidence of satisfactory completion of a post with attainment of competence. You will be able to think of others, but this is to get you started: • Assessment documentation from an SHO or equivalent post, such as the RITA/ARCP assessments completed for trainees at the end of each of their SHO posts in Scotland. Posts undertaken in the Republic of Ireland are equivalent in designation and content to those in the UK. • Local or regional appraisal documentation • A report from your supervising consultant (this is a requirement in Scotland and every shortlisted applicant will be asked to provide 2 such Educational Supervisors Reports), if appropriate outlining the work practice and caseload of the post as well as the level of supervision and training given and your performance in the post. This would be useful proof to bring in your portfolio for example if you have worked in the following posts in any specialty: o A Clinical Fellow or Trust Grade Doctor in the UK or Republic of Ireland. o A post undertaken elsewhere in the European Union. Your supervising consultant will need to describe the post and level of responsibility in more detail, as outlined in the bullet point above. This is because terminology and nomenclature of posts for doctors varies across the EU. o Documentation from the Australasian College for EM that the post you completed there was recognised for training – you can check the list of approved hospitals for specialist training in EM on the ACEM website at www.acem.org.au . The CEM recognises all such posts as providing equivalent competences to training posts in the UK. o Documentation from the appropriate local or national body that a post completed in North America was recognised for training in EM. o Documentation from the appropriate local or national body that a post completed in South Africa was recognised for training. o Documentation from the University of the West Indies that a post completed in that country was recognised for training in EM. 12 CEM advice to applicants Dec 08
  • 13. Appendix 4 Evidence that you have attained Foundation competences. Foundation competences should ideally be shown by providing a certificate of completion of a foundation programme – FACD 5.2. The following 4 methods of demonstration foundation competences (or equivalent), as evident in your portfolio when you attend for interview, would be acceptable. • If you are currently undertaking a foundation programme in the UK, you will be asked you to confirm the name of your Foundation School. Any offer of a programme will be conditional upon you successfully completing this programme and being awarded an FACD 5.2 before August 2009. • If you have undertaken a UK foundation programme within the last 3 years – i.e. since 2nd August 2006, you will be asked you to confirm that you have been awarded an FACD 5.2. You may be asked to attach a scanned copy to your application form, but will be expected to provide the original certificate in your portfolio when you attend for interview. • If you have not undertaken a UK foundation programme within the last 3 years – i.e. since 2nd August 2006, then evidence of satisfactory completion of 12 months SHO, ST, or FTSTA posts since August 2006 will also be accepted provided it relates to a post with acute medical responsibilities. In this case you will be expected to provide a RITA C or a satisfactory ARCP panel outcome. You may be asked to attach scanned copies to your application form and originals will have to be provided when you attend for interview. • If none of the above applies, or if you are unable to provide the evidence required for any of the above, you will be able to submit alternative evidence by asking someone who has supervised you for at least 3 months since 2nd August 2006 to attest to your achievement of foundation competency. This will have to be demonstrated by completing a form (Alternative Certificate) which is available on request form the UoA. • If you are unable to provide any of the above because, for example, you have not worked since 2nd August 2006 then you are advised to secure a second year UK foundation programme post before applying for a post. Alternatively, you could secure a post that will enable you to demonstrate foundation competency to someone who could then provide you with an "Alternative Certificate", e.g. a locum or Trust post or FTSTA post in an acute speciality. We understand, however, that Refugee doctors may have less access to standardised documentation and may not be able to obtain an "Alternative Certificate". If you are unable to provide any of the above because of your Refugee status, you should contact the UoA. 13 CEM advice to applicants Dec 08

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