CREST & Portfolio Pathway

Overview

If you want to apply for UK training posts (like IMT, CST, or specialty training) without having completed UK Foundation Programme, you will need an alternative way to prove your competencies.

This is where CREST and your portfolio become essential.

What is CREST?

CREST stands for:
Certificate of Readiness to Enter Specialty Training

It is an official form signed by a consultant who confirms that you perform at the level of a UK Foundation Year 2 (FY2) doctor.

In simple terms:

It proves you are safe, competent, and ready for training.

Who Needs CREST?

You will usually need CREST if:

  • You did not complete UK Foundation Programme
  • You are applying for IMT, CST, or specialty training
  • You are working in a trust-grade or non-training job
  • You are an IMG entering the UK system

If you already completed FY2 in the UK, you usually do not need CREST.

What Does CREST Assess?

The form covers real clinical competencies such as:

  • History and examination
  • Clinical reasoning and decision making
  • Safe prescribing
  • Communication skills
  • Teamwork
  • Escalation and professionalism
  • Managing acutely unwell patients

It is not an exam — it is based on your performance at work.

How Do You Get CREST Signed?

You need:

  • A clinical job (usually NHS)
  • A consultant who supervises your work
  • Evidence that you are working at FY2 level

You should:

  • Tell your consultant early that you plan to apply for training
  • Ask for regular feedback
  • Show consistency and professionalism
  • Collect evidence for your portfolio

CREST is built through trust, not rushed at the end.

What is a Portfolio?

Your portfolio is your evidence of development as a doctor.

It typically includes:

  • Teaching activities
  • Audit / QIP projects
  • Courses and certificates
  • Reflections
  • Feedback (TAB, mini-CEX, CBD)
  • Presentations
  • Leadership or teamwork roles

This becomes crucial when applying for training.

Common Mistakes

  • Asking for CREST too late
  • Not discussing goals with supervisors
  • Doing activities but not documenting them
  • Thinking portfolio only matters at application time
  • Assuming good clinical work alone is enough

Evidence matters.

Reality Check

You do not need a “perfect” portfolio.
You need a realistic, consistent, well-documented one.

Small regular efforts beat last-minute panic.

Reassurance

Many IMGs successfully use CREST to enter training every year. With planning and communication, this pathway is absolutely achievable.