CREHST/ACEEHST Form: A Practical Guide for Aspiring OMFS Trainees
Author: Luke Western
Do note - OMFS is transitioning to a single-entry ST1 run-through training pathway from August 2027 Entry Application Cycle (Applications opening November 2026). This means that in future, the CREHST form will be less relevant, as there will no longer be a separate entry point at ST3. However, the competencies required for CREHST are similar to those in Phase 1 of the new curriculum, and early evidence of these skills will still be valuable.
What is CREHST?
The CREHST form (Certificate of Readiness to Enter Higher Surgical Training), now formally known as the slightly less catchy ACEEHST (Alternative Certificate of Eligibility to Enter Higher Surgical Training), is a certificate of equivalence for Core Surgical Training (CST). It can be used by individuals who have gained core surgical experience outside a UK CST post but can demonstrate that they have achieved the same outcomes as a trainee completing CST with a satisfactory ARCP.
In essence, it is an alternative route to show you have achieved the core surgical curriculum outcomes. The official form and guidance can be downloaded from the Oriel Resource Bank at:
https://www.oriel.nhs.uk/Web/ResourceBank
Why do it?
The CREHST form is essential for anyone who wants to enter higher surgical training (ST3) but has not completed a UK CST programme. Without a CST ARCP outcome 6 or a completed CREHST form, you cannot progress to ST3 level training.
For OMFS, this can be particularly useful. Many trainees gain a wide range of surgical experience around formal training posts: For example, a junior clinical fellowship, or CT-level work during a second degree. The CREHST route allows these experiences to be recognised formally, avoiding unnecessary extra SHO years and enabling progression to a more appropriate senior role when ready.
Another pulling factor is that it can allow some flexibility in where and how you work. For example, you may be able to design a purpose-built fellowship post in your preferred location to meet the required competencies. For strong candidates, this can be a more efficient way of achieving core surgical outcomes than spending two years in a traditional CST rotation that may be predominantly ward based or not aligned with your long-term specialty interest.
Who can use it?
The CREHST route is intended for doctors or dentists who have undertaken post-foundation surgical work in non-training roles and can demonstrate that they meet CST outcomes. You do not need it if you have already completed CST and received an ARCP outcome confirming satisfactory completion.
To be eligible, you should have:
At least 12 months (full-time equivalent) of post-FY2 CT1/CT2 level surgical experience
Consistent continuing professional development, including audit, teaching, and quality improvement
MRCS (Membership of the Royal College of Surgeons)
Experience in more than one surgical specialty to demonstrate breadth of skills required
It’s worth stressing that this is not a shortcut. Ultimately, you must be considered clinically equivalent to a CST2 trainee in terms of both skill and knowledge, and thus a sufficient level of competency must be demonstrated.
Experience of surgical competency for CREHST as it currently stands, can only be demonstrated after achievement of medical foundation training (or equivalent). Therefore, you cannot state that DCT (dental core training) years prior to medical school second degree equate to CST1 experience. Dentistry second trainees have the benefit of being post FY2 during second degree training and can accrue relevant experience if they are proactive during their studies, although it would be advisable to have also a year of full-time (or near full time) surgical experience before or after second degree to provide crystal clear exposure duration. Due to this, CREHST largely favours medics first trainees, due to the logistics of gaining enough experience. Dentist first after second degree have a more linear training programme into ST1. However, as stated previously, a clinical fellowship year could be considered after FY2 and dual qualification to achieve the CREHST, instead of a formal UK training programme.
When should it be done?
The CREHST form must be signed within three years of your intended training start date. If it becomes outdated prior to starting, you’ll need to have it re-signed.
It must be fully completed before the starting date of your training programme. In practice, it is safest to have the final signed form ready before the Oriel submission window if possible.
How to achieve it
The first step is to work in post-foundation level surgical jobs where you can demonstrate CST1/2 equivalent skills. These might include:
Non-training clinical fellowships (e.g. trust SHO/CT posts)
Long-term locum positions
Equivalent work or structured training abroad
To meet the competencies, your experience must cover a range of settings: elective and emergency theatres, clinics, wards, and on-call work.
The current CREHST/ACEEHST form (as of 2026) includes 16 domains, which align directly with the CST ARCP outcomes:
Good clinical practice – diagnosis, safe prescribing, and infection control
Communication – with patients, colleagues, and in breaking bad news
Teaching and training – ability to teach healthcare professionals
Keeping up to date – lifelong learning and audit participation
Leadership and teamwork – leading and contributing within teams
Quality improvement – participation in governance and QI projects
Health promotion – educating patients and advocating for health improvement
NHS management – understanding the NHS structure and functioning within it
Ethics and legal issues – understanding professional and legal responsibilities
Probity – maintaining the highest professional standards
Management of common surgical conditions – assessment and management across specialties
Perioperative care – safe management before, during, and after surgery
Basic surgical skills – competence in a range of core procedures
Critical care – recognising and managing the acutely unwell or injured
Paediatrics – caring for paediatric surgical patients and safeguarding
The dying patient – end-of-life care, DNAR discussions, and organ donation principles
You must be able to provide evidence for each domain. Consultants will not sign the form unless they can confidently verify your competency.
Evidence can include:
Direct observation by supervising consultant
Trusted feedback from another consultant to your supervising consultant of directly observed competency
Surgical logbooks with sufficient case mix
Workplace-based assessments (CBDs, DOPS, Mini-CEX)
Reflective pieces or case-based discussions
Completed audits and QI projects
Teaching feedback
Course attendance and CPD documentation
Exam results
The more complete your evidence, the easier it will be for your consultant to confirm each domain. It’s good practice to keep your ePortfolio or logbook up to date throughout your posts, rather than trying to gather everything retrospectively.
It’s also important to remember that the CREHST covers more than just clinical ability. It includes professionalism, leadership, and governance skills that you must be able to demonstrate in your everyday work.
Who can sign the form?
The form must be signed by a consultant surgeon with a CCT who has worked directly with you for at least three months. They must fully understand the expectations of a CST candidate.
For OMFS applicants, it is preferable that your signatory is an OMFS consultant, as they are most familiar with the specialty’s expectations at ST3 level. Although not a formal requirement, having an OMFS signatory provides confidence to future assessors that your skills have been evaluated by someone who understands the scope of the specialty.
The consultant’s signature carries personal professional weight to them. They are effectively confirming your readiness for higher surgical training, putting their professional reputation on the line and will not sign if they cannot verify your abilities. It is essential to be completely honest about your competencies with your supervising consultant. Misrepresenting your skills is a serious professionalism issue.
If for some reason competencies cannot be confirmed by one consultant, you can use multiple consultants. They should initial same competency list but complete a separate declaration page.
The form should always be signed, dated, and stamped with an official hospital stamp on the declaration page(s). Use clear, legible handwriting or pre-fill digitally. Then scan and store a high-quality copy securely. This is the document you will upload to Oriel.
Significant considerations for OMFS trainees
Transition to the run-through training model
OMFS is transitioning to a single-entry ST1 run-through training pathway from August 2027. This means that in future, the CREHST form will be less relevant, as there will no longer be a separate entry point at ST3.
However, the competencies required for CREHST are similar to those in Phase 1 of the new curriculum, and early evidence of these skills will still be valuable. Completing the CREHST form or gathering equivalent evidence before entering ST1 may support earlier progression to Phase 2 (ST3 equivalent) once in the programme.
For those currently between degrees or in clinical fellow roles, completing a CREHST remains an excellent way to formalise experience and strengthen future applications.
CCT (Certificate of Completion of Training) eligibility and GMC considerations
In the past, candidates who entered higher surgical training through the CREHST route were classed as “combined training” and awarded a CESR (CP) rather than a CCT. Although both are recognised for consultant practice in the UK, the CESR (CP) has not always been well understood internationally, which could limit mobility for those wishing to work abroad.
Following discussions with international medical councils, the GMC has revised its positionin 2021. Trainees with combined training backgrounds can now be considered for a CCT, provided they complete a minimum amount of training in a recognised UK programme. For OMFS, this is four years.
In practice, this means that those who progress into higher OMFS training through the CREHST route are likely to receive a CCT, but it is not formally guaranteed and remains subject to GMC assessment at the end of training.
The introduction of the ST1 run-through pathway will simplify this in future, as all training will take place within approved programmes.
Sources:
• GMC: A guide to our registers
• GMC: Guide to a Certificate of Completion of Training
• GMC: Applications for retrospective CCTs
Consultant perspectives and consistency
Because changes for CCT is recent, CREHST is a relatively recent tool, and opinions among consultants vary. Some trainers feel the form can introduce variability, as its outcomes depend heavily on the supervising consultant’s judgement rather than a formal ARCP process. There have been isolated cases where individuals entering ST3 via the CREHST route were perceived as underprepared for the responsibilities expected at that level. This has led to understandable caution among training programme directors.
The key message is to be truthful and reflective. Only pursue the CREHST route if you genuinely meet CST-equivalent standards across all domains. Seek honest feedback from your consultants and make sure you are operating at the right level before applying. Entering ST3 underprepared can create lasting challenges for your training reputation.
Final thoughts
The CREHST form provides a valuable and flexible route into higher surgical training for those who have gained experience outside a formal CST programme. It rewards initiative, adaptability, and self-directed learning – qualities that are particularly relevant in OMFS, where many trainees follow non-standard early career paths.
However, it also carries responsibility. To complete the form successfully, you must demonstrate not only the technical skills but also the judgement, professionalism, and insight expected of a CST2 trainee. Be proactive in collecting evidence, honest about your abilities, and selective about your signatory.
Used correctly, the CREHST can open the door to higher OMFS training and streamline your progression. Used carelessly, it can expose gaps that are difficult to recover from.
In short: treat it as it is – a formal certification of your readiness for higher training, not simply a piece of paperwork to shortcut training years.
