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Contents
Introduction 4
2
Section 4: Resources 40
Section 5: Appendices 43
3
Introduction
The delivery of training and education is a core responsibility for the National Health
Service (NHS). The General Medical Council sets the standards for undergraduate and
postgraduate medical education and works with the Colleges to determine the curriculum,
assessments and implementation. The Royal College of Obstetricians and Gynaecologists
(RCOG) has established specific educational roles to support the delivery of training. This
document is provided as guidance for those undertaking these important roles. The main
roles are College Tutor, Educational Supervisor, ATSM Director, ATSM Preceptor, ATSM
Educational Supervisor and Ultrasound Director.
These notes are intended to act as a reference for the RCOG educational roles. In the first
section the educational roles are described, in section 2 postgraduate education at the
RCOG and within Deaneries is described, in section 3 suggestions are offered for
local/regional management of education and in section 4 there is a list of resources that
will be useful. These notes are a new development and we would be pleased to receive
feedback. We would be particularly keen to hear of any suggestions for inclusions within
the next version. If you have ideas, please write to the Chair of the Specialty Education
Advisory Committee at the RCOG.
In order to ensure high-quality education it is recommended that all those involved in these
training roles undergo annual appraisal of their educational role. This may be undertaken
as part of the job planning process or through a separate arrangement through the deanery;
local circumstances will apply.
4
Section 1: Introduction to RCOG Educational Roles
This is a specialist post with responsibility for the day-to-day coordination of high-quality
multidisciplinary education in obstetrics and gynaecology. The post is critical to achieving
an integrated multidisciplinary approach to a comprehensive educational package. It is
likely that College Tutors will have dual roles, which could include being an Educational
Supervisor, Clinical Supervisor, ATSM Preceptor or ATSM Educational Supervisor role.
This educational role should be appointed in open competition as per deanery and NHS
services processes.
5
● Be accountable to the RCOG, the Chairs of the RCOG Education Committees and
the Education Board.
● Take responsibility for identifying, within their unit, individuals to act as
❍ positive role models for the recruitment of undergraduates
❍ educational leads and mentors of postgraduates.
● Ensure appropriate systems are in place for the clinical and professional supervision
of qualified obstetricians and gynaecologists across the trust.
● Arrange deanery and General Medical Council (GMC) inspection visits.
● Liaise with deanery/school committees and other hospital departments.
● Represent the RCOG locally.
● Ensure timely completion of the RCOG workforce census and timely response to
requests by the RCOG for information.
Person specification
Essential characteristics
● Be a consultant in obstetrics and gynaecology.
● Be an RCOG Fellow or Member.
● Have experience as an educational supervisor.
● Be continuing professional development (CPD)-maintained (name on CPD roll), if
eligible.
● Be accountable to the Head of School/Chair of the Specialty Training Committee
(STC) and Director of Medical Education (of local education provider).
● Be appointed jointly by the deanery (Head of School/Chair of the STC on behalf of
Postgraduate Dean and NHS services representative).
● Be appointed through a formal process in open competition.
● Have full knowledge of the current ‘How to be a College Tutor’ course.
● Agree to work within the terms of the job description.
● Attend College Tutors meeting.
● Encourage trainees to undertake RCOG and GMC survey.
● Be trained in equality and diversity.
● Undergo annual appraisal of educational role as per deanery and NHS services
processes.
Desirable characteristics
● Have training in postgraduate medical education.
● Have experience of organising training in obstetrics and gynaecology.
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Duration of appointment
● 3 years initially.
● Optional renewal for a maximum of a further 3 years (in unusual circumstances this
could be further extended; however, a further open competition would be required).
Person specification
Essential characteristics
● Be a fully trained medical practitioner (consultant or staff and associate specialist
[SAS] doctor).
● Have an interest in education.
● Have skills in appraisal and feedback.
● Regularly attend Educational Supervisor training courses.
● Be CPD-maintained (name on CPD roll), if eligible.
● Be approved jointly by the deanery and NHS services.
7
● Encourage trainees to undertake RCOG and GMC survey.
● Be trained in equality and diversity.
● Undergo annual appraisal of the educational role as per deanery and NHS processes.
The ATSM Director can also be an ATSM Preceptor, ATSM Educational Supervisor or
both. This educational role should be appointed in open competition as per deanery
processes.
8
Roles and responsibilities
● Oversee and coordinate ATSM training for training and nontraining grades across a
deanery/region.
● Be the contact point within the region for the School Board/STC, ATSM Preceptors,
ATSM Educational Supervisors and College Tutors in all matters related to ATSM
training.
● Be a member of, and report to, the region’s School Board/STC.
● Take responsibility, with the aid of the ATSM Preceptors, for assessing the region’s
capacity for the delivery of ATSMs and deciding which ATSMs will be offered.
● Liaise with the ATSM Preceptors and College Tutors to develop ATSM training
programmes.
● Take responsibility for appointing and supporting ATSM Preceptors.
● Take responsibility for completing the ATSM forms that are sent to the College by
the trainee.
● Take responsibility for overseeing the provision and quality assurance of ATSM training.
● Take responsibility for preparing material required for quality assurance by the local
School Board/STC and the GMC.
● Provide ATSM career advice.
● Take responsibility, with support from the ATSM Preceptor, ATSM Educational
Supervisor and College Tutor as necessary, for responding to the needs of trainees in
difficulty.
● Keep up to date with RCOG standards in education, new educational initiatives and
changes to the ATSM curriculum and assessment.
● Communicate with the RCOG to provide feedback on the curriculum,
implementation and delivery of the ATSM modules within your deanery.
● Attend the ATSM Directors’ meeting at the RCOG, which is held at least annually.
● Cascade ATSM-related information from the RCOG to ATSM Preceptors and ATSM
Educational Supervisors.
Person specification
Essential characteristics
● Be a consultant in obstetrics and gynaecology.
● Be an RCOG Fellow or Member.
● Have experience as an educational supervisor.
● Have experience of postgraduate education and training.
● Be a prior/current member of the School Board or equivalent training committee.
● Be CPD-maintained (name on CPD roll), if eligible.
● Be appointed jointly by the Deanery (Head of School/Chair STC on behalf of
Postgraduate Dean and NHS services representative).
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● Have managerial/organisational skills.
● Have awareness of quality management principles.
● Agree to work within the terms of the job description.
● Encourage trainees to undertake RCOG and GMC survey.
● Be trained in equality and diversity.
● Undergo annual appraisal of educational role as per Deanery and NHS processes.
Desirable characteristics
● Have training in postgraduate medical education.
● Have experience of organising training in obstetrics and gynaecology.
Duration of appointment
● 3 years initially.
● Optional renewal for a maximum of a further 3 years.
Where the ATSM requires course attendance, the Preceptor will decide upon the suitability
of courses in conjunction with the suggested ATSM course syllabus (www.rcog.org.uk/
education-and-exams/curriculum/advanced+training+skills). The Preceptor will be
responsible for the quality control of this element of advanced training. Large modules
may result in significant workloads for individuals and deaneries or schools may wish to
have more than one Preceptor for a module. In the situation where a trainee has more than
one Preceptor during their ATSM training, it is recommended that the Preceptor who is
responsible for the final part of the ATSM training undertakes the final assessment and
signs the completed form. Where there are few training opportunities in small ATSMs, it
would be sensible for deaneries to cooperate and appoint one person as a Preceptor
working across the regions.
Consultants with expertise in the clinical area or who are members of the relevant specialist
society may nominate themselves to the local STC or school to become an ATSM
Preceptor. The ATSM Preceptor may also be an ATSM Educational Supervisor.
10
Roles and responsibilities
● Co-ordinate the delivery and monitor the quality of training for their particular
ATSM.
● Liaise with colleagues in the specialty to ensure that both the ATSM and the core
curriculum are delivered without conflicts or adverse service impacts.
● Ensure that the workplace-based assessments required by the ATSM curriculum are
performed and signed off. The trainee must submit these to the annual reviews of
competency progression (ARCP) process with all other supporting evidence of
progress.
● Take responsibility for approving local ATSM Educational Supervisors to deliver
ATSM training in individual units.
● Take responsibility for ensuring that the educational opportunities and environment
provided by the Educational Supervisors meet the ATSM training needs of the
trainee.
● Ensure that each trainee is allocated an ATSM Educational Supervisor.
● Undertake regular appraisal and feedback meetings with trainees to ensure that
educational objectives are being met.
● Take responsibility for confirming that the trainee has attended an appropriate
theoretical course as set out in the curriculum.
● Take responsibility for confirming that training is completed and signing the
notification form, which the trainee should then send to the ATSM Director.
● Be involved in the region’s agreed selection process.
● Take responsibility, with support from the ATSM Director, ATSM Educational
Supervisor and College Tutor as necessary, for responding to the needs of trainees in
difficulty.
● Keep up to date with the RCOG standards in education, new educational initiatives
and changes to ATSM curriculum and assessment.
● Provide career guidance and discuss the curriculum with the trainee prior to
registration.
● Undertake quality control of the ATSM and report to the ATSM Director any
potential concerns regarding delivery.
● Report to the ATSM Director within the deanery.
Person specification
Essential characteristics
● Be a fully trained consultant.
● Have experience as an educational supervisor.
● Be CPD-maintained (name on CPD roll), if eligible.
● Be appointed jointly by Deanery (Head of School/Chair of the STC on behalf of the
Postgraduate Dean and NHS services representative).
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● Be a specialist in the ATSM clinical area of obstetrics and gynaecology.
● Be aware of quality management principles.
● Agree to work within the terms of the job description.
● Encourage trainees to undertake RCOG and GMC survey.
● Be trained in equality and diversity.
● Undergo annual appraisal of educational role as per deanery and NHS processes.
Desirable characteristics
● Have training in postgraduate medical education.
● Have experience of organising training in obstetrics and gynaecology.
The ATSM Educational Supervisor role is slightly different from that of the Educational
Supervisor as determined by the GMC. The ATSM Educational Supervisor will provide
more of a clinical supervisor role. The ATSM Preceptor will generally undertake the
appraisal and career guidance roles; this allows the Preceptor to have an overview of the
trainee’s progress throughout the ATSM curriculum. The ATSM Educational Supervisor
will work closely with the ATSM Preceptor to address delivery and quality control of the
curriculum.
ATSM Educational Supervisors can be recommended to the ATSM Preceptor or can self-
nominate.
12
● Ensure that the trainee is able to attend the required training days and course(s).
● Advise the ATSM Preceptor if any difficulties arise in providing the ATSM training.
● Take responsibility for early liaison with the ATSM Preceptor to facilitate trainee
progression if training needs cannot be met.
● Countersign the form to confirm that training is completed. This form should be sent
to the ATSM Preceptor for completion by the trainee.
● Take responsibility, with support from the ATSM Director, ATSM Preceptor and
College Tutor as necessary, for responding to the needs of trainees in difficulty.
Person specification
Essential characteristics
● Be a fully trained medical practitioner (consultant or SAS doctor, midwife, specialist
nurse, sonographer).
● Have an interest in education.
● Have skills in appraisal and feedback.
● Be approved jointly by the deanery and NHS services.
● Be trained in equality and diversity.
● Undergo annual appraisal of educational role as per deanery and NHS processes.
13
expected to become a member of (or be seconded onto) the Deanery Specialist Training
Committee and will be expected to attend training assessment meetings. The Deanery
Ultrasound Co-ordinator will work with the Ultrasound Educational Supervisors/
Ultrasound Trainers within the units to ensure coordinated delivery of the ultrasound
curriculum and assessments. The Deanery Ultrasound Co-ordinator should ensure access
to good-quality ultrasound equipment and machines.
Person specification
Essential characteristics
● Be a specialist in obstetrics and gynaecological ultrasound scanning.
● Hold FRCR or MRCOG/FRCOG.
● Have experience as an educational supervisor.
● Have managerial/organisational skills.
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● Be CPD-maintained (name on CPD roll), if eligible.
● Be appointed jointly by the deanery (Head of School/Chair of the STC on behalf of
the Postgraduate Dean and NHS services representative).
● Have awareness of quality management principles.
● Agree to work within the terms of the job description.
● Be trained in equality and diversity.
● Undergo annual appraisal of educational role as per deanery and NHS processes.
All ultrasound training must be undertaken under the supervision of an identified local
Ultrasound Educational Supervisor, with prior approval from the Deanery Ultrasound Co-
ordinator. The local Ultrasound Educational Supervisor should undertake at least one
dedicated imaging session per week and directly supervise the trainee for the majority of
the intermediate module(s). Units may need to appoint one local Educational Supervisor
for obstetrics and another for gynaecology (dependent on the skills of the individual
trainers). Trainees may undertake sessions under the supervision of professionals other
than the local Ultrasound Educational Supervisor (i.e. other trainers). It is the duty of the
local Ultrasound Educational Supervisor to ensure that the professional to whom the duty
of training is delegated to is sufficiently competent, willing and able to teach the trainee.
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Person specification
Essential characteristics
● Be a fully trained medical practitioner (consultant, SAS doctor, ultrasonographer).
● Have an interest in education.
● Have skills in appraisal and feedback.
● Be approved jointly by the deanery/College Tutor and NHS services.
● Be trained in equality and diversity.
● Undergo annual appraisal of educational role as per deanery and NHS processes.
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Section 2: Structure of Postgraduate Education
17
may also be responsible for the study leave budget for all training grades, although this
varies across the country.
ePortfolio enquiries
Tel: +44 (0)207 772 6204 ● Email: ePortfolio@rcog.org.uk
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RCOG census
Matt Huggins
Tel: +44 (0)207 772 6262 ● Email: mhuggins@rcog.org.uk
StratOG.net
E-learning Publication Team
Tel: +44 (0)20 7772 6324/431 ● Email: stratog.net@rcog.org.uk
19
COUNCIL
Services Board Educaon Board Standards Board Finance and Internaonal Board
Execuve
Scosh
20
2.1 The curriculum
The core curriculum consists of the 19 core modules and two basic ultrasound modules. The
modules must be completed by all specialty trainees to be awarded the obstetrics and
gynaecology CCT. Details of the content of the curriculum can be found on the RCOG website.
Logbook terminology
The logbook uses three levels of skill acquisition as trainees move towards independent
practice. We have previously used the terminology ‘observation’, ‘direct supervision’ and
‘independent practice’ to confirm progress towards competency.
The three levels of skill acquisition will now be termed ‘Level 1’, ‘Level 2’ and ‘Level 3’.
The expectations for signing off at the different levels are detailed below, with each level
ending with an anchor statement as an overall summary of expectations at that level.
The descriptors are to encourage both trainees and trainers to critically review what is
expected at each level. As an example, ‘observation’ is not just simply ‘seeing a procedure
performed once’ or ‘seeing one particular case’. There is an implicit need to ensure
appropriate knowledge and understanding – even at ‘Level 1’ (previously ‘observation’).
The descriptors were already in use, but have been expanded to aid clarity.
Finally, we have confirmed that competency is a baseline level for safe independent
practice with further exposure and experience leading to proficiency and subsequently
expertise (the latter will generally be developed post-CCT).
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Level 2 (previously referred to as ‘direct supervision’)
Trainees must be observed directly in different clinical situations before being signed off
at level 2. The trainee should:
● the ability and confidence to perform the clinical skill/situation competently when
senior staff are not immediately available, e.g. out of the hospital
● a willingness to move on to experiential learning with further case exposure
● a willingness to keep a record of the numbers of cases/procedures subsequently
managed (including any complications and their resolution).
Once deemed competent at level 3, the trainee must keep a formal record of the numbers
of the procedures they subsequently perform and any complications. They will need this
information for revalidation. The necessary log of experience forms can be found in
Section 8 of the Training Portfolio.
Remember that competency is a baseline level for safe independent practice with
further exposure and experience leading to proficiency and subsequently expertise
(the latter will generally be developed post CCT).
Anchor statement: ‘To be deemed competent, the majority of cases are managed with
no direct supervision or assistance (senior support will be requested in certain
complex cases/complications).’
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order to be successfully assessed and in order to progress through training. Instead,
alternative training methods should be used (drills, simulation, e-learning) and case-based
discussion assessments should be completed until all requirements of the assessment are
met. When signing off a trainee using the above approach, trainers must mark ‘OM’ (i.e.
other methodology) alongside their signature.
During training at ST2 level it is important for a trainee to bear in mind the competences
that they will require and to discuss these with their educational supervisor early in
training. This will require trainees to highlight their clinical strengths and weaknesses so
that they can concentrate on developing skills. There are some mandatory requirements
for progression from ST2 to ST3: attainment of the MRCOG Part 1 examination,
completion of the RCOG Basic Practical Skills in Obstetrics and Gynaecology course and
satisfactory attainment of the relevant competences for independent practice in certain
specific skills.
Good communication with patients, relatives, nursing and midwifery staff is essential to
a trainee’s professional development. Within the intermediate years of training the trainee
should consider laying down plans for how they can develop their interests further.
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● completion of the two basic ultrasound modules (from August 2011)
● completion of the e-learning package on sexual and reproductive health (from
August 2011).
2.1.4 ATSMs
The ATSMs have been designed to develop skills suitable for future career progress within
the consultant career pathways detailed in the RCOG document The Future Role of the
Consultant. The modules are designed to allow trainees to develop special interest areas
within their clinical practice. They have been developed in conjunction with the specialist
societies and trainees must complete a minimum of two ATSMs to achieve their CCT.
2.2.1 Induction/appraisal
Appraisal is an important component of effective adult learning. The process collates past
achievement and plans future progress. It is mandatory but flexible, structured yet informal,
challenging yet an opportunity to provide support. It is not a formal assessment, so health
and serious conduct issues must be dealt with outside of the appraisal in specific meetings,
as required. Trainees must keep their portfolio up to date and orderly and use it with the
curriculum to inform the next phase of learning. Trainers must think about the requirements
of training (knowledge, skills and attitudes) and be prepared to value success explicitly
and to discuss tough issues thoroughly. Trainers must always accentuate the positive
comments and have a critical yet constructive approach for progression.
Meetings are confidential but not legally privileged and anything that raises safety issues
for patients or trainees can be disclosed. You should feel free to discuss obstacles to
progress and an appraiser should show interest in emotional development. Documentation
is important, but do not allow it to get in the way of discussion. Set an agenda of points to
be covered, have a good dialogue and then complete forms at the end. Create a checklist
of individual targets with timelines to help future discussions.
The induction appraisal interview should be completed within 2 weeks of starting a new
post. The College Tutor will assign an Educational Supervisor to the trainee and it is the
Educational Supervisor who will complete the induction interview. At this interview the
Educational Supervisor and trainee should review progress to date and set training
objectives for the next year of training. This should include a review of the objectives set
at the previous ARCP. The process should then be repeated in the middle and at the end
of training attachments. This ensures continuing reflection upon progress.
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Educational Supervisor report
The Educational Supervisor should complete a report for each trainee during their
placement. This report should include information acquired through the appraisal,
workplace-based assessments, achievement of curriculum objectives, TO2s, etc. The report
should summarise progress through the year and identify any problems. This report must
be submitted to the ARCP panel. The Educational Supervisor’s report is part of the
evidence that informs the ARCP process.
What happens if there is a disagreement between the trainee and the clinical trainer?
There are many ways that people practise, in terms of their choice of management plan,
the way they carry out a procedure or the way they communicate with a patient. Working
as part of a team means respecting different individuals’ professional manner and clinical
trainers should be respected for the advice that they give. Trainees should not use the same
assessors and they should choose to be assessed by individuals who may be notoriously
difficult because they have always set such high standards. Trainees will gain respect from
colleagues if they are seen to be working and learning from all colleagues.
If a supervisor is not always with a trainee, the only way of identifying a trainee in
difficulty early is to monitor workplace-based assessments and identify areas where a
trainee admits that they are struggling to progress. It is likely that a trainee who is
struggling could feel ashamed and take drastic measures to collect evidence of competence;
therefore, if workplace-based assessments are used properly, they structure training and
provide reliable evidence of progression.
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Global judgement
Where a trainer is satisfied that a trainee is competent, it is entirely appropriate for them
to sign off the competence for a trainee, recognising that in a competency-based training
programme any numbers suggested in the curriculum are a guideline.
Case-based discussion
● This generic tool formalises hypothetical case discussions with trainers.
● Relevant to knowledge criteria and competences in the curriculum.
● Used to assess clinical decision making, knowledge and application of knowledge.
● Each case-based discussion should involve slightly different clinical situations in the
area to be tested.
● Discussion will focus on the information that would be given to the patient and
recorded in the notes.
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Team observation (TO) forms
TO1 forms are a multisource feedback tool based on the principles of good medical
practice (2006) as defined by the GMC. TO1s are not a confidential document and the
trainee should be aware of the contents. However, the Educational Supervisor should
manage the release of the forms to the trainee so that they can assist with the interpretation
of comments and explain how the comments will be constructive for the trainee’s
development. The TO2 form is a summary of the TO1 forms. It plays an important part in
the ARCP process. The Educational Supervisor certifies that this form is a correct summary
of the TO1 forms received and also adds comments provided from personal observation.
A trainee and Educational Supervisor should agree on at least ten assessors to complete
TO1 forms. It is suggested that the selected assessors should include at least three senior
medical colleagues (consultant or senior specialist trainee registrar), a senior midwife on
the delivery suite and from the antenatal clinic, a senior nurse from the gynaecology ward
and a member of the theatre team. Other appropriate staff include midwives from other
areas, staff from the specialist clinics that the trainee has been working in and anaesthetic
and paediatric colleagues. Generally, it is thought not to be appropriate to ask clerical and
support staff to complete TO1 forms, although in certain situations an educational
supervisor may request TO1 forms from nonclinical colleagues.
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There is considerable experience in the use of OSATS for the assessment of trainees in
obstetrics and gynaecology. Analysing OSATS (both the content of and, in some respects,
the number of OSATS) is particularly important at the time of appraisals and particularly
at the designated waypoints in the training programme.
Trainees don’t perform OSATS until they are performing well, or they may throw
away or not include ‘bad’ OSATS – what can we do?
Trainees may not pay attention to the clinical trainer’s comments because they choose not
to insert it into their portfolio. Trainees should now realise that this is not a pass/fail process
assessment and that OSATS are formative assessments. There is no such thing as a ‘bad’
OSATS and there is no such thing as a perfect trainee. Each trainee needs different levels
of support, and workplace-based assessments help structure this. Evidence of OSATS
undertaken early in training is important for trainers to establish what support a trainee
needs and to get a sense of confidence and competence. The aim is not to judge a trainee
against another trainee of the same level or a more senior trainee.
Do not judge a trainee against how you as a clinical trainer used to be when at the same
level. Know the curriculum, know the assessments and get to know the trainee.
My trainees only perform OSATS when they’re getting skilful – what can I do?
The trainees are missing the point. Bearing in mind that most trainees fail their ARCP
because they have insufficient evidence, surely the more formative evidence, the better?
Formative assessment should show progress from basic to advanced level. There is no
point in not completing assessments until competent because the trainee will have missed
out on the structured feedback when it could have been useful and would actually have
made their life easier.
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should be identified following the assessment. The trainee should also reflect on experience
and make notes that either are private or that they share with an educational supervisor or
a clinical trainer.
In preparation for the annual assessment, the trainee must meet with the Educational
Supervisor to complete the annual assessment review form detailing the educational
achievements and logbook modules completed for the year. The Educational Supervisor
will also complete the structured reference section of this form and the TO2 form. The
trainee must complete the National Trainee Assessment Questionnaire and take it with
them to the annual assessment.
If the evidence provided at the annual assessment is satisfactory, the panel will recommend
outcome 1 indicating successful transition to the next training year. Deficiencies identified
in training or poor performance will usually result in the award of an outcome 2, which is
a recommendation for targeted training, which if successfully completed will not delay
progression to CCT. Outcome 3 will indicate that the panel has identified that a formal
additional period of training is required that will extend the duration of the training
programme. Outcome 4 will recommend that the trainee is released from the training
programme if there is still insufficient and sustained lack of progress despite having had
up to one year of additional training to address concerns over progress.
Within six months of the CCT date the trainee will be called for a final assessment. At this
review the entirety of the training will be reviewed and, subject to satisfactory completion,
the trainee will be issued with an Annual Assessment Outcome 6. This must be submitted
with the signed Annual Assessment form to the Postgraduate Training Department at the
RCOG; the Secretary to the SEAC will contact the trainee directly with the relevant forms
to complete. The RCOG will then make a recommendation to the GMC that the trainee has
completed the relevant training and is eligible for the award of the CCT.
Providing the portfolio in an electronic format enables more practical, portable recordings
of clinical skill development. The electronic format also improves the process for quickly
locating and accessing information within the curriculum. College Tutors should ensure
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their ePortfolio is configured with the role of College Tutor so that they can access the
ePortfolios of all trainees in their trust throughout the year, particularly at times of
appraisal. The ePortfolio provides tools for trainees to note reflections of their learning
experiences and identify future learning needs by communicating online with supervisors.
Reflective entries can be typed within organised logs and assessments. The electronic
format is proved to encourage organisation of reflective entries more so than in a paper
format and this should be encouraged.
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2.5 MRCOG examinations
This assessment is an integral part of the obstetrics and gynaecology specialty curriculum.
It is an international examination covering the formal testing of the full range of special-
ist working knowledge in obstetrics and gynaecology. It must be achieved prior to entry
into ST6.
The purpose of the MRCOG is not to define the specialist (the obstetrician and
gynaecologist capable of independent practice). The object of the examination is to provide
a marker of the acquisition and development of a body of core knowledge and ability in
the subject – generally that of a trainee progressing to ST6. Doctors with the MRCOG
are ready to proceed to expand their experience into more specialised areas prior to
independent practice.
MRCOG Part 1
The purpose of the MRCOG Part 1 examination is to assess whether candidates about to
embark upon a career in obstetrics and gynaecology have a broad and detailed knowledge
of reproductive science. Candidates are eligible to attempt the Part 1 examination when
they have obtained their medical degree.
The examination consists of two papers, each of which has 20 extended matching questions
(EMQs) and 48 five-part multiple choice questions (MCQs). The duration of each paper
is 2 hours. Questions in Paper 1 cover anatomy, embryology, endocrinology, microbiology,
pharmacology, statistics and epidemiology. Paper 2 includes biochemistry, biophysics,
genetics, immunology, pathology and physiology.
MRCOG Part 2
Candidates are eligible to take the examination after having passed the Part 1 and
completed 4 years of approved training in obstetrics and gynaecology, or 2 years if in the
recognised UK specialty training scheme.
From March 2011, the format of the written examination will change. The question
formats currently used will remain, but the number of questions candidates are required
to answer and the time they are allotted to do so will be revised. The revised format will
consist of:
● two combined MCQ/EMQ papers, each consisting of 120 MCQs and 45 EMQs, of
which approximately half are on obstetrics and half on gynaecology, to be answered
in 135 minutes
● one short answer question (SAQ) paper, consisting of four questions to be
answered in 105 minutes.
The revised allocation of marks will be as follows: EMQs (40%); MCQs (30%); SAQs
(30%).
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There is no separate pass mark for the various components of the written examination,
but rather an overall pass mark derived by standard setting.
Candidates who are successful in the written examination proceed to an oral assessment,
which is an objective structured clinical examination (OSCE) consisting of a circuit of 12
stations, ten of which have an examiner present and are marked and two of which are
preparatory. At each ‘active’ station the candidate has to perform a task testing knowledge,
skills, communication or problem-solving ability. Depending on the type of station, there
may be a role-player, some imaging, surgical equipment, a pelvic model or a clinical
scenario. The oral assessment is marked out of 200, and the pass mark is derived by
standard setting.
● Paper 1, consisting of 30 EMQs and 18 single best answer (SBA) questions, which
candidates have 90 minutes to complete
● Paper 2, consisting of 40 five-part MCQs, which candidates have 90 minutes to
complete.
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Section 3: Managing local/regional education
3.1.1 Prevention
Trainees will appreciate being positively greeted by staff and it is helpful if we try to make
them feel a welcome and integral member of the team.
All trainees will attend an induction course to help familiarise them with the workings
and fabric of the obstetrics and gynaecology unit. Please help to extend this process of
orientation by showing them where equipment is kept, including tea and coffee supplies.
Within the first 2 weeks all trainees should meet with their Educational Supervisors for
appraisal. Remember this is an opportunity to ask about previous medical experiences,
both good and bad, and to inquire about their life outside the hospital. Try to emphasise
that we all welcome trainees coming to us about any problems they are facing at any stage.
Praise is important to us all, but it is so easy to forget to comment positively to each other.
Please make a special effort to point out the contribution that trainees are making to the
working of the unit during their first few days and weeks.
The Educational Supervisor should arrange to meet with the trainee in private. Before this
it is useful to have a clear idea about the nature of the problems and it may help to ring
previous Educational Supervisors. The trainee should be aware that the interview is
confidential but this is not binding if patient safety is being compromised, for example in
cases of drug abuse or severe alcohol problems.
It is helpful to see this meeting as an opportunity to help the trainee and to focus on their
needs. Try to give praise while gently exploring the issues that have been passed on to
you. Initially, it can be easier to avoid talking of ‘problems’ and ‘reports’ but rather to use
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phrases such as ‘Mrs X was concerned for you’. If the trainee is not forthcoming, a more
direct approach may be necessary, but try to avoid being judgemental and try to emphasise
the positive attributes of the trainee.
The causes of poor performance are often complex and it is helpful to attempt to explore
any possible reasons. This can then be useful in discussing ways for improvement.
Remember that doctors have a primary responsibility for patient safety and that very
serious problems cannot be ignored with the hope that they will go away. If necessary,
additional advice can be obtained from other sources such as the Postgraduate Deanery,
the Clinical Tutor, the Clinical Director, the Medical Director and the Department of
Human Resources.
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Overall aims
Think carefully about the overall aims of the programme. Is this a programme aimed
primarily at pre- or post-MRCOG trainees? Before designing a programme you need to
be explicit about your aims and objectives and ensure that your trainees and trainers are
aware of these too.
Organisation
How are you going to organise your programme? There is evidence to suggest that trainees
prefer all-day protected teaching sessions and are prepared to travel if the education is up
to scratch. Getting agreement for trainees to be released from their individual units is
crucial if attendance is to be monitored and trainers are not to be frustrated by the lack of
attendees. Similarly, ensure your trainers are signed up to being involved. If your trainers
are not committed, neither will your trainees be.
Funding
Good education is not cheap. Sponsorship from drug companies has traditionally funded
many educational meetings; however, other models do exist. Study leave budgets have
been top-sliced in some deaneries, such as Wessex, to fund the education programme, with
the consent of the trainees.
Content
Think hard about content. Remember there are many different learning styles and ways in
which key educational principles can be incorporated into the study days. Some of the
programme may be amenable to multidisciplinary learning. You are teaching adults;
therefore, their active involvement should ensure their interest and participation. Education
sessions should be both informative and fun.
Feedback
Make sure you get regular feedback and act on it to improve and develop your programme.
The meetings would probably be primarily intended for, although not exclusive to, pre-
MRCOG specialty trainees. ST6–7 specialty trainees/subspecialty trainees should attend
study days devoted to their chosen subspecialty. In addition, senior trainees should be
encouraged play a role in organising the study days and providing teaching materials.
One example would be for each region to organise a 3-year programme of three terms
with three one-day sessions each term (no meetings in April, August or December: nine
meetings a year). The trainees would be released by their base units as part of their study
leave allocation.
Each region can decide on the type of meetings and their location. Thus far, most regions
have chosen to develop theme days allocated to a subspecialty and to rotate the meetings
around individual units.
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The 3-year cycle programme should cover the nine main subspecialty headings:
● maternal medicine
● fetal medicine
● preterm labour/prematurity/perinatal issues
● general obstetrics/intrapartum care
● urogynaecology
● gynaecological oncology
● infertility
● gynaecological endocrinology
● benign gynaecology.
It is suggested that funding would come from the study leave budget with a fixed amount
being top-sliced from each trainee’s allowance. Other means of obtaining funding include
pharmaceutical company sponsorship.
Study days should incorporate a mixture of learning styles: didactic lectures, debates,
small group discussions, quizzes, etc. Speakers within the specialty can provide a greater
breadth to training. Examples include:
● genitourinary medicine
● urology
● haematology
● general endocrinology/diabetes
● palliative medicine
● pelvic inflammatory disease
● fistula/ureteric damage/recurrent urinary tract infections
● thrombophilia/transfusion medicine
● diabetes and pregnancy/pituitary tumours
● breaking bad news/symptom control.
Consideration should be given to asking some speakers to use their topic to demonstrate
principles of medical practice. Examples might include:
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● principles of screening
● medico-legal practice (duty of care, etc.)
● using evidence-based medicine
● intention-to-treat studies
● benefits and drawbacks of random-allocation trials.
It is suggested that the attendance of trainees is recorded and formally reviewed at the
ARCP. Targets for attendance can be decided at regional level according to local factors.
The RCOG runs a series of Training the Trainers (T3) and How to be a College Tutor courses
for those undertaking education roles. For further information on these courses please visit
the RCOG website (www.rcog.org.uk/events). Some may wish to extend themselves more,
so a number of courses leading to Diplomas or Masters are listed in the table below.
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3.5 Top tips for College Tutors and Educational Supervisors
Organisation of appraisal
● Have a master sheet detailing what should occur in each week of the year.
● It is useful to timetable appraisals into the education programme.
● Request that trainees send TO1 forms at least 1 month before assessment at the end
of the attachment.
Share responsibilities
It is important to encourage all Educational Supervisors and trainees to take an active role
in the programme. Hold a meeting as part of the education programme every 6 months.
Discuss a programme for the months to come and share work out as much as possible.
Joint meetings with some departments might maintain good relations, especially if they
are combined with a social event afterwards. Examples include chronic pain management,
blood transfusion and wound management.
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Keep the programme fresh
It is not always possible to have a completely new programme every year. Techniques you
can use to prevent it becoming stale include:
Emphasise that cases do not have to be rare topics or controversial issues but simply need
to be illustrative of a particular presentation, treatment or complication.
Encourage attendance
Obviously, having a dynamic fun programme helps, but even so attendance can still be a
problem. Several techniques may help maximise attendance of trainees:
Conducting meetings
There needs to be informality but with a structure. Meetings need a chairperson to time
proceedings, facilitate discussion and thank contributors at the end.
Written and anonymous feedback has many advantages, but an informal debrief meeting
may provide additional valuable information.
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Section 4: Resources
E-learning: StratOG.net
StratOG.net has been designed to support trainee learning in obstetrics and gynaecology
using web technology, as an interactive resource. StratOG.net includes:
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4.2.2 Useful websites
Evidence-based medicine
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Online indexed databases (with search capability)
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Section 5: Appendices
Introduction
Welcome to the Goodtown OBGYN team. We all hope that you enjoy your time here and
that you find the experience rewarding. We all believe that you are an important part of the
team, but also that you can only be expected to fulfil your role if we provide proper teaching
and support. We aim to provide a good environment for learning and development.
Support
We would like you to feel free to approach any of the consultants, senior O&G trainees
and midwives at any time. You will have a consultant educational supervisor and also a
midwifery mentor. You will meet formally with your supervisor and midwifery mentor at
the start and end of your post. This is an opportunity for you to ask questions and seek
guidance about learning.
Teaching
In the first week you will have an introductory day. Thereafter, formal teaching is mostly
organised on Wednesday afternoons. A detailed programme is included. Please note that
your responsibilities include the tutorials and the gynaecological pathology meetings. Ask
the consultants or senior O&G trainees for guidance.
Miss Smith chairs the gynaecological pathology meeting. We ask the ST1/2, Foundation
or GP-VTS trainees to organise cases in turn. You need to seek out cases from consultants
and then organise the ordering of the clinical notes. At the meeting, the trainees present
the cases in brief form. Miss Smith is now retaining details of good teaching cases that
can be used repeatedly, so please liaise with her before any meeting.
There is always a need for new ideas and new educational material. I want to encourage
you to let me know of any new initiatives you would like to see but also to inform me of
any cases that you found interesting or informative.
Assessment
The consultant educational supervisor has a dual role of providing guidance but also of
acting as assessor. Part of your assessment will include completion of 360º feedback forms,
which are passed to a variety of senior team members in the latter half of your attachment.
Some of your peers may also be involved. This process of ‘multisource feedback’ is
intended to provide information for both you and us about your relationships with staff
and patients etc. It is only one element of the information that helps us to assess whether
you are progressing well. Your other workplace-based assessments will also be reviewed
(as relevant to the individual trainee) as well as a logbook and portfolio review.
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Important topics
We feel it would be helpful to you to read up about a number of topics early on and review
the unit guidelines folder. The most common and serious topics are:
● pre-eclampsia
● preterm labour
● antepartum haemorrhage
● fetal monitoring
● acute pelvic pain
● early pregnancy assessment.
Remember: we want you to learn in an enjoyable atmosphere. Ask questions, challenge
us and have fun.
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5.2 Appendix 2: Example of an introductory programme
Day 1
Meet in postgraduate centre at 9.30 a.m. for breakfast.
Day 2
Meet in postgraduate centre at 9.30 a.m. for breakfast
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