ED Handbook for RCOG Trainer

Handbook for RCOG Trainers

Contents

Introduction 4

Section 1: Introduction to RCOG educational roles 5

1.1 College Tutor 5

1.2 Educational Supervisor 7

1.3 ATSM Director 8

1.4 ATSM Preceptor 10

1.5 ATSM Educational Supervisor 12

1.6 Deanery Ultrasound Co-ordinator 13

1.7 Ultrasound Educational Supervisor 15

Section 2: Structure of postgraduate education 17

2.1 The curriculum 21

2.2 Postgraduate training, assessment and appraisal 24

2.3 Annual review of training 29

2.4 RCOG forms for appraisal 30

2.5 MRCOG examinations 31

2.6 DRCOG examination 32

Section 3: Managing local/regional education 33

3.1 Guidance for dealing with the poorly performing trainee 33

3.2 Regional education 34

3.3 Welcoming the new trainee 37

3.4 Training needs for trainers 38

3.5 Top tips for College Tutors and Educational Supervisors 38

2

Section 4: Resources 40

4.1 Bibliography for medical education 40

4.2 List of educational resources 40

Section 5: Appendices 43

5.1 Appendix 1: Sample letter of welcome 43

5.2 Appendix 2: Example of introductory programme 45

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.

Clinical supervision is undertaken by many different professionals. This involves providing

direct teaching and assessment of all aspects of the curriculum for obstetrics and

gynaecology. In order to undertake teaching and workplace-based assessments, clinical

supervisors require more time within the clinical setting to perform these tasks;

therefore, direct clinical care activities need to be appropriately modified to allow sufficient

time and recognition for this additional work. The RCOG recognises that this will

necessitate the tailoring of clinics, theatre lists and so on to the training level of the trainees

in these environments and the complexity of the skills being acquired.

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

1.1 College Tutor

The role of the College Tutor is to coordinate obstetrics and gynaecology training and

education in an individual trust. The responsibility for delivering that training and

education lies with the Trust, on behalf of and resourced by the Postgraduate Dean. The

Tutor should oversee the provision of the Specialty Training and Education Programme

and should also be involved in assisting the deanery/school in managing the appropriate

components of the foundation programme.

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.

Roles and responsibilities

● Provide pastoral care of trainees.

● Foster a positive educational environment for learning.

● Organise an in-house (multiprofessional) education programme; this includes

arranging an induction programme for new trainees.

● Ensure local Educational Supervisors have undertaken the appropriate training and

remain updated.

● Assign trainees to Educational Supervisors.

● Ensure an appropriately balanced timetable is provided to meet individual trainee

training requirements (both full-time and flexible trainees).

● Provide the opportunity to assist trainees with their educational goals and career

progression (it is the responsibility of the Educational Supervisor to undertake

regular appraisals).

● Encourage trainers to undertake formative and summative assessments and

appraisals of obstetrics and gynaecology trainees (trainees are responsible for

undertaking assessments/workplace-based assessments).

● Oversee competency-based and workplace-based assessments, ensuring

departmental trainers are aware of these assessment tools.

● Facilitate the provision and supervision of the RCOG Advanced Training Skills

Modules (ATSMs).

● Liaise with the local Educational Supervisor on the delivery of ultrasound training

within the unit.

● Identify trainees in difficulty and support them at a local level, in conjunction with

the Deanery/School/Training Programme Director.

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● 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.

6

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).

Time required and job planning

Time is required within job plans to ensure this role is undertaken to a high standard. The

National Association of Clinical Tutors suggests 1 programmed activity (PA) for up to 20

trainees in the specialty (excluding foundation), 1.5 PAs for 20–40 trainees and 2 PAs for

more than 40 trainees.

1.2 Educational Supervisor

All trainees should have a nominated Educational Supervisor who has responsibility for

facilitating and ensuring the progress of trainees through their designated curriculum. The

details of the role are stipulated by the Postgraduate Medical Education and Training Board

(PMETB)/GMC as: “A trainer who is selected and appropriately trained to be responsible

for the overall supervision and management of a specified trainee’s educational progress

during a training placement or series of placements. The educational supervisor is

responsible for the trainee’s educational agreement.”


● Take responsibility for the personal and professional development of a trainee

through the programme.

● Develop a mutually accepted learning agreement.

● Undertake regular appraisals and feedback.

● Help trainees maintain their learning portfolio.

● Complete the Educational Supervisor’s report.

● Identify trainees in difficulty and support them at a local level, in conjunction with

the Deanery/School/Training Programme Director/College Tutor.




● 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



● Undergo annual appraisal of the educational role as per deanery and NHS processes.


Time is required within job plans to undertake the role of Educational Supervisor. The

RCOG recommends that 0.25 PAs are required per trainee per week to fulfil this role.

ATSM roles within a deanery

Each deanery/region will appoint an ATSM Director who has overall responsibility for

managing ATSMs; this includes coordinating the ATSM allocation. The ATSM Director

will work closely with ATSM Preceptors, who have deanery/regional responsibilities for

individual ATSM(s). In particular, they will be aware of specific local provisions for their

ATSM(s) and will liaise with the ATSM Educational Supervisors at unit level who are

offering training in the specific ATSM. The roles are described in more detail below.

1.3 ATSM Director

The ATSM Director is appointed by the School Board/STC of obstetrics and gynaecology.

They are responsible for ensuring the educational opportunities and environment within

their Deanery/Region meet the GMC and RCOG standards. The ATSM Director will be

aware of all training opportunities within the region and will coordinate the trainee

attachments, ensuring all trainees can fulfil their ATSM training objectives. This individual

must take responsibility for the quality management, standards and delivery of training of

all ATSMs. This will be achieved by empowering the ATSM Preceptors to ensure the

standards are delivered for their allocated ATSM(s). Good liaison with ATSM Preceptors

is vital and it is suggested that regular meetings are established at deanery level. The

method by which any individual ATSM Director will undertake their role is dependent

upon the size of the deanery and the communication links. It is recommended that the

ATSM Director provides guidance that is widely available to trainees regarding:

● the availability of ATSMs in the region

● the region’s preferred selection process

● what should happen if requests for an ATSM exceed the region’s training capacity.

ATSM training is open to training and nontraining grades; however, it is acknowledged

that as national training number (NTN) holders require two ATSMs for Certificate of

Completion of Training (CCT) registration, these trainees will be given priority when

training opportunities exist.

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


● 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.



● Be a consultant in obstetrics and gynaecology.

● Be an RCOG Fellow or Member.


● Have experience of postgraduate education and training.

● Be a prior/current member of the School Board or equivalent training committee.


● Be appointed jointly by the Deanery (Head of School/Chair STC on behalf of


9

● Have managerial/organisational skills.

● Have awareness of quality management principles.




● Undergo annual appraisal of educational role as per Deanery and NHS processes.




Duration of appointment

● 3 years initially.

● Optional renewal for a maximum of a further 3 years.


It is essential that time is allocated within the job plan of the ATSM Director. The time

required will be additional supporting professional activities (SPA) time and RCOG

recommends 1 PA for this role. This requirement would be in addition to any that of other

educational roles.

1.4 ATSM Preceptor

ATSM Preceptors are appointed by the School Board /STC of obstetrics and gynaecology

and are responsible for a specific ATSM within a deanery/region (occasionally an

individual will be responsible for more than one ATSM, particularly when they are closely

related). Preceptors will be aware of the provision of their respective ATSM in local units

and will ensure that the appropriate educational support is provided and assessments are

performed. The Preceptor for a particular ATSM will need to liaise with the ATSM

Educational Supervisors in each local unit.

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


● 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.



● Be a fully trained consultant.



● Be appointed jointly by Deanery (Head of School/Chair of the STC on behalf of the


11

● Be a specialist in the ATSM clinical area of obstetrics and gynaecology.

● Be aware of quality management principles.




● Undergo annual appraisal of educational role as per deanery and NHS processes.





It is essential that time is allocated within the job plan of the ATSM Preceptor, which is a

deanery/school appointment. The time required will be proportionate to the number of

trainees for which the Preceptor has responsibility and the degree of liaison required to

ensure quality training. The time required will be part of or additional SPA time and the

RCOG recommends 1 PA for those managing popular, large ATSMs. The Preceptor is

advised to keep a diary to present at the job planning process in order to determine the

individual time required. This requirement would be in addition to any other educational

roles.

1.5 ATSM Educational Supervisor

ATSM Educational Supervisors undertake the day-to-day, hands-on training of trainees in

all aspects of the curriculum at trust level. This will also include workplace-based

assessments and providing feedback to the trainee. The ATSM Educational Supervisor must

possess the necessary clinical skills in the area being taught. For some ATSMs, midwives

and ultrasonographers are considered for the position of ATSM Educational Supervisor.

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.


● Take responsibility for maximising the educational opportunities provided by the

hospital to meet the ATSM training needs of the trainee.

● Take responsibility, with the trainee, to record trainee progress using the ATSM

logbook and appropriate RCOG assessment tools.

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.



● Be a fully trained medical practitioner (consultant or SAS doctor, midwife, specialist

nurse, sonographer).



● Be approved jointly by the deanery and NHS services.




The ATSM Educational Supervisor should have time built into their job plan in order to

deliver this training. It is difficult to suggest a standard amount of SPA time for this role

as it depends upon the amount of the curriculum the ATSM Educational Supervisor is

responsible for. The ATSM Educational Supervisor is advised to keep a diary to present

at the job planning process in order to determine the individual time required. It is possible,

where time allows, that an individual may be an Educational Supervisor for more than

one ATSM.

Ultrasound training roles within a deanery

Each deanery/region will appoint a Deanery Ultrasound Co-ordinator who has overall

responsibility for managing and coordinating ultrasound training. Some deaneries may

choose to appoint more than one Deanery Ultrasound Co-ordinator (often to offer specific

management of obstetric versus gynaecological modules). They will be aware of specific

local provision for ultrasound training relating to the various basic and intermediate

modules and will liaise with the Ultrasound Educational Supervisors at unit level who are

offering training in ultrasound. The roles are described in more detail below.

1.6 Deanery Ultrasound Co-ordinator

The Deanery Ultrasound Co-ordinator has formal responsibility for co-ordinating the

delivery of the basic and intermediate ultrasound modules, and will ensure that the quality

of training and assessment in ultrasound within their deanery is to a high standard. The

appointment is made by the deanery; in larger deaneries, more than one Deanery

Ultrasound Co-ordinator may be appointed. The Deanery Ultrasound Co-ordinator is

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.

The Deanery Ultrasound Co-ordinator(s) must hold either FRCR or MRCOG/FRCOG

and actively participate in obstetric and/or gynaecology ultrasound on a regular basis. This

educational role should be appointed in open competition as per deanery processes.


● Provide guidance to local ultrasound educational supervisors and other trainers (who

may include consultants, midwifes, nurses, sonographers and advanced practitioner

sonographers).

● Ensure the local ultrasound educational supervisors/trainers actively participate in

obstetrics/gynaecology ultrasound on a regular basis.

● Ensure local trainers are aware of the curriculum and assessment processes,

including giving feedback.

● Be involved in the selection process of trainees applying for the intermediate

ultrasound modules,

● Authorise completion of intermediate ultrasound training,

● Hold an updated record of training centres, local ultrasound educational supervisors

and trainers within the deanery.

● Monitor the quality of training across the region.

● Keep an updated record of trainees’ placements and duration of training.

● Work in collaboration with the Training Programme Director to highlight training

opportunities and allocate trainees to available training slots.

● Report on the trainee’s progress to the Deanery Specialist Training

Committee/School.

● Ensure trainees have access to the appropriate theoretical courses.

● Take responsibility, with support from the deanery and College Tutor as necessary,

for responding to the needs of trainees in difficulty.

● Attend the annual RCOG Ultrasound Co-ordinators meeting.



● Be a specialist in obstetrics and gynaecological ultrasound scanning.

● Hold FRCR or MRCOG/FRCOG.


● Have managerial/organisational skills.

14


● 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.





It is essential that time is allocated within the job plan of the Deanery Ultrasound

Co-ordinator. The time required will be additional SPA time and the RCOG recommends

1 PA for this role. The Deanery Ultrasound Co-ordinator is advised to keep a diary to

present at the job planning process in order to determine the individual time required.

1.7 Ultrasound Educational Supervisor

Local Ultrasound Educational Supervisors have formal responsibility for coordinating the

delivery of basic ultrasound modules within their units. They will also be responsible for

direct supervision of intermediate ultrasound modules and allocation of additional

trainer(s) as appropriate.

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.


● Coordinate delivery of the local ultrasound training.

● Be aware of the RCOG ultrasound curriculum and assessments.

● Possess the necessary ultrasound scanning skill.

● Identify and support local ultrasound trainers.

● Ensure quality control of ultrasound training.

● Take responsibility, with support from the Deanery Ultrasound Co-ordinator and

College Tutor as necessary, for responding to the needs of trainees in difficulty.

15



● Be a fully trained medical practitioner (consultant, SAS doctor, ultrasonographer).



● Be approved jointly by the deanery/College Tutor and NHS services.




This role will require time within the job plan, which is dependent upon the number of

trainees undergoing training within the unit at any one time and the level of ultrasound

training required. The Ultrasound Educational Supervisor is advised to keep a diary to

present at the job planning process in order to determine the individual time required.

16

Section 2: Structure of Postgraduate Education

Introduction: who manages training?

There is a clear structure of training, which is detailed in The Gold Guide. Quality

management is provided by the postgraduate deans and the day-to-day training programme

is managed by the School Board, Head of School/Chair of the STC and the Training

Programme Directors. At trust level the education programme is managed and quality-

controlled by the Director of Medical Education through a network of College Tutors and

Educational Supervisors.

Deanery education committee structure

Each deanery has a Dean of Postgraduate Education who is responsible for the provision

of postgraduate medical education within that deanery. There are usually several associate

deans, one of whom will have responsibility for obstetrics and gynaecology. Each deanery

will have a School Board or Deanery Speciality Training Committee (STC) and the Head

of the School Board/Chair of the STC (responsible for obstetrics and gynaecology) is a

joint appointment between the Dean and the RCOG. The constitution of the School

Board/STC will vary between deaneries but will always include several if not all College

Tutors. Most Deaneries will organise an annual meeting for all College Tutors/Educational

Supervisors within a deanery.

The Training Programme Director

The Training Programme Director, on behalf of the School Board/STC, is responsible for

organisation of the trainee rotations within the deanery and trainees’ ARCP. The Training

Programme Director is also responsible for dealing with trainees who have problems with

training either because of personal problems or because of the standard of training being

received within a hospital.

NHS education structure

Within each hospital there is a Clinical Tutor or Director of Medical Education who is a

hospital consultant with responsibility for postgraduate medical education within the trust.

They are also involved with the organisation of continuing medical education (CME) for

hospital doctors and general practitioners (GPs).

The role of the Clinical Tutor/Director of Medical Education is wide:

● provide overall management of the education of doctors in training

● provide appropriate career counselling and pastoral support

● manage the postgraduate centre and the centre staff

● provide leadership and strategy for medical education in the trust.

There is usually also a Clinical Tutor with responsibility for undergraduate education if

medical students are attached to the hospital unit. Clinical Tutors/Directors of Medical

Education often take on additional duties such as organisation of hospital courses (training

the trainers, GP refreshers) and chairing of hospital education committees. Clinical Tutors

17

may also be responsible for the study leave budget for all training grades, although this

varies across the country.

RCOG education and training structure

The Education Directorate at the RCOG supports all education, training and assessment

requirements for the speciality training and education programme in obstetrics and

gynaecology. The curriculum, trainee registration and educational events are all governed

by committees that report to the Education Board. The Publications Department offers

educational resources such as books, journals and e-learning.

Contacts at the RCOG

Specialty training, CCT, ARCP and flexible training enquiries

Tania Chambers

Tel: +44 (0)207 772 6294 ● Email: [email protected]

Trainees’ Register enrolment and enquiries

Penny Payne


Curriculum, logbook and workplace-based assessment content enquiries

Olly Jones


ePortfolio enquiries


Subspecialty training enquiries

Bettina Muller


ATSM registration enquiries

Bettina Muller


Careers advice and advice relating to training in the UK

Kay Weir


18

RCOG census

Matt Huggins


Recruitment into obstetrics and gynaecology training

Matt Huggins


Overseas training opportunities

Binta Patel


MRCOG and DRCOG examinations

Examination Department


Conferences and courses

Conference Office


StratOG.net

E-learning Publication Team

Tel: +44 (0)20 7772 6324/431 ● Email: [email protected]

The diagram overleaf shows the committee reporting structure.

19

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21

2.1 The curriculum

2.1.1 Core modules

The content of the programme has been designed by the RCOG and approved by the

PMETB (now coordinated by the GMC). To start as a new specialty trainee, trainees will

have to complete the foundation programme (or be able to demonstrate equivalent

competency) and will usually commence training in August (or October in some deaneries).

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.

A description of when it is appropriate to use ‘other methodologies’ in order to sign off

specific skill levels has been included.

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).

Level 1 (previously referred to as ‘Observation’)

The trainee should be signed off at level 1 before moving to level 2 (where the relevant

clinical skill/problem will be undertaken under supervision). The trainee should:

● demonstrate a thorough understanding of the principles of the competence/clinical

skill/situation, including the indication for the procedure and the common

complications

● be aware that before undertaking any clinical skill under direct supervision they will

have observed the procedure on a number of occasions

● use other methodologies (for example drills, simulation, e-learning and case-based

discussion assessments) if direct experience of the procedure or clinical problem is

not possible.

Anchor statement: ‘The trainee demonstrates detailed knowledge and understanding

and is aware of common complications/issues relating to the competence/clinical

skill/situation.’

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:

● perform the clinical skill/manage the case under supervision

● be aware that the number of times the competence/clinical skill/situation needs to be

supervised depends on the complexity of the case and individual aptitude

● be aware there is therefore no limit to the number of times the procedure can be

supervised and there is no advantage in having a module signed up until you and

your clinical supervisor are certain that you can safely perform this procedure in a

number of different clinical situations and levels of complexity

● be able to manage any unexpected complications but know when to summon

senior help.

Anchor statement: ‘The trainee is capable of performing the task or managing the

clinical problem but with senior support.’

Level 3 (previously referred to as ‘independent practice’)

The progression to independent practice may be the most difficult for the trainee. Once

the trainee has been signed off for direct supervision, they should start the process of

performing procedures with less and less supervision, as agreed by their trainer. To be

signed off as ready for independent practice, the trainee should demonstrate the

following:

● 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.

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).’

Achieving competency using other methodologies

When trainees do not see rarer clinical presentations to develop competency and specific

competences, it would not be beneficial to remove these rare occurrences from the

curriculum. Trainees and trainers must be aware that in such circumstances (and only these

circumstances), trainees need not be seen to observe or perform the relevant procedure in

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).

22

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.

2.1.2 Different levels of training

Basic level (ST1 and ST2)

This is the time when trainees will start to gain experience in all areas of obstetrics and

gynaecology. Trainees will work alongside both new and senior trainees and they will

work with several consultants with different skills and interests. Each trainee will have a

consultant who will act as their educational supervisor and this individual will need to

coordinate regular appraisals with the trainee. The trainee will undertake workplace-based

assessments of their training with their educational supervisor and clinical trainers.

Trainees will start to have competences signed off and will be recording all of their training

achievements in their training log. Trainees should add to this log throughout their training.

Progression from ST2 to ST3

One of the key assessment steps is progressing from ST2 to ST3; from basic- to

intermediate-level training. This is where trainees will progress from ‘first on-call’ to

‘second on-call’ duties and will have met the requirements to increase their level of clinical

responsibility. At this level, trainees must be competent to manage the labour ward without

direct consultant supervision. This means that they should be able to assess obstetric and

gynaecological emergencies, assess maternal and fetal progress throughout labour and

undertake uncomplicated obstetric deliveries. Most importantly, trainees must be aware

of the situations where they require senior assistance and must realise their limitations.

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.

Progression from ST5 to ST6; advanced training

This is the second key assessment step and recognises the completion of general obstetric

and gynaecological skills to an intermediate level. Following this, trainees will develop

their clinical interest within the discipline, either to subspecialist level or special interest

level. There are specific waypoints to be achieved:

● completion of all intermediate training competences

● achievement of MRCOG

23

● completion of the two basic ultrasound modules (from August 2011)

● completion of the e-learning package on sexual and reproductive health (from

August 2011).

2.1.3 Core advanced training

All trainees complete 2 years of advanced training before they can apply for their CCT.

This is the time when trainees continue core training and start to develop their own interests

in more detail by completing ATSMs or subspecialty training. Core training at an advanced

level includes areas such as medical management and clinical governance alongside

practical procedures, so that trainees are properly prepared for the nonclinical aspects of

working as a consultant in the NHS.

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 theConsultant. 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 Postgraduate training, assessment and appraisal

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.

The difficult appraisal

● Problem areas need exact definition, not generalisation. Collect objective evidence.

Use description not judgement.

● Discuss performance, not personality.

● Listen and ask questions; keep it friendly.

● Identify and reinforce strengths. Be positive. Praise/encourage.

● Collaborate on constructive solutions.

● Set objectives that are SMART: specific, measureable, achievable, realistic and

timed.

● Identify carrots and sticks to help ensure that objectives are achieved.

● Keep a close eye on future progress.

● Do not capitulate on your bottom line.

2.2.2 Workplace-based assessment tools

Workplace-based assessments aim to evaluate trainees’ progress over time. The purpose of

workplace-based assessments is to link teaching, learning and assessment in a structured way.

To gain an accurate picture of an individual, several workplace-based assessments need to

be used and evaluated together at routine appraisals. The aim of an assessment is not

necessarily to indicate that a trainee is completely competent, but to indicate strengths and

weaknesses so that educational supervisors can organise support for the trainee as necessary.

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.

Judgement of a trainee’s performance by a trainer is a global judgement and these global

judgements allow trainers to assess competence in the context of skill and professionalism.

This ensures that the curriculum and assessment system is used to produce the obstetricians

and gynaecologists of the future.

Objective structured assessments of technical skills (OSATS)

● Formative assessments.

● Used to help to assess the trainee and provide structured assessment.

● OSATS are completed throughout training until the trainee is competent to practise

independently.

● The same OSATS may be used to assess increasing levels of complexity for any

particular procedure.

● The logbook is signed when the trainee is deemed competent to practise

independently. (At least three OSATS must have been completed by at least two

assessors as a reliable indicator that the trainee is competent. One assessor should be

a consultant.)

● Once the trainee is fully competent for independent practice, it is recommended that

they undergo an annual OSATS assessment to demonstrate continued competency.

One OSATS should be completed annually for each procedure until CCT.

● Trainees must also keep a count of the procedures completed annually until CCT.

Mini clinical evaluation exercise (mini-CEX)

● Tests many different and varied competences and is a generic tool.

● Enables the trainer to observe and assess directly the process of history taking,

clinical examination, formulating management plans and communicating with

patients.

● Designed to take about 20 minutes to perform.

● Results should be fed back and discussed immediately after the assessment.

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.

26

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.

2.2.3 Frequently asked questions about workplace-based assessments

How many assessments do I need?

The evidence base for numbers of procedures necessary to confer competence is not

particularly robust. A minimum assessment number (starting by observing cases, then

carrying out competences under supervision and finally independently), and also regular

exposure, is thought to be educationally valid. As we collect data during the first iteration

of the new curriculum there will be evidence produced to allow the RCOG to adjust the

logbook requirements and indicate ‘average numbers’. In the meantime, the training

guidelines have been made as flexible as possible, but we do say that three OSATS should

be completed by more than one assessor (one of whom should be a consultant) for the

core logbook competences that include OSATS.

Why three OSATS?

This is for reliability and validity. Although the curriculum is competency-based and the

training guidelines state that a certain number of assessments must be completed, trainers

must think out of the box and realise that different trainees will progress at different rates.

However, the reason that three has been designated as ‘the’ number is because it is more

reliable. Two assessors should be involved in the assessment, one of whom should be a

consultant because they will have a more experienced judgement of the trainees’

competence.

Are curriculum and logbook requirements for numbers absolute?

Curriculum and logbook requirements for numbers are for guidance only. It is obvious

that each trainee will develop at a different rate, and some trainees will carry out more

supervised procedures than others before the trainer is satisfied that competence has been

achieved and the trainee can practise independently. In order to provide some structure to

the delivery of elements of training and to recognise the relative importance of different

procedures within the curriculum, suggested numbers of procedures are included in the

training documentation.

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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 are responsible for organising their workplace-based assessments. An educational

supervisor and trainee should discuss the areas in which assessment is required regularly,

based on the unit in which they are working and the curriculum requirements set at a

particular level. Whether a trainee is being assessed by an educational supervisor or by

another clinical trainer, a trainee should plan ahead so that they are not completing all of

the necessary assessments in the lead-up to an appraisal or an annual review. If trainees

are struggling to have assessments completed in a unit, they should speak to an educational

supervisor early and not wait for the appraisal meeting.

Trainees don’t perform OSATS until they are performing well, or they may throwaway 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.

How can you maximise the case-based discussion?

Use e-learning or other resources before or between case-based discussion assessments

for a particular subject area. Make the most of a case-based discussion so that knowledge

is gained and a trainee has the opportunity to clarify how they would manage a hypothetical

situation and still ask questions away from patients. Make sure this is not a tick-box

exercise and that trainees realise that training, workplace-based assessment and the

MRCOG examinations all link together and the more the trainee can apply their

knowledge, the better they will be at their job.

How can you maximise the mini-CEX?

A mini-CEX is a snapshot of a trainee’s interaction with and management of a patient.

Not all elements need to be assessed in one situation and a mini-CEX may just focus on

improving a particular area of a trainee’s work, for example history taking. Feedback

should be offered to the trainee after the event and areas of development and action points

28

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.

2.3 Annual review of training

At the end of each year of training a more formal assessment of training is made to

determine whether the trainee can progress to the next year. This is the responsibility of

the Postgraduate Dean in conjunction with the deanery School Board/STC. The Annual

Assessment Outcome panel will issue an appropriate Annual Assessment Outcome form.

A copy must be kept by the trainee and a further copy forwarded to the Specialty Education

Advisory Committee (SEAC) at the RCOG.

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.

2.3.1 The obstetrics and gynaecology ePortfolio

The degree to which trainees and trainers use the ePortfolio is entirely dependent on the

relationship they have and whether they prefer face-to-face or online communication.

Whether a trainee finds it easier to use paper and then upload data periodically or whether

it is possible to sit down at a computer every week with an educational supervisor is

entirely dependent upon the trainee. The system is flexible. The ePortfolio allows

deaneries, schools, College Tutors and Training Programme Directors to keep an eye on

progress when data are presented online. When trainees and supervisors are so busy it is

very difficult to schedule meetings, but when communication and progress can be

monitored online, trainees should feel well supported.

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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30

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.

If you have any queries regarding the ePortfolio, email [email protected] or

telephone 020 7772 6204.

2.4 RCOG forms for appraisal

There are a series of forms produced by the RCOG for use at each stage of the education

cycle. The forms are available on the RCOG website at www.rcog.org.uk/education-

and-exams.

Appraising and assessing a trainee: what to do and when Form to use

1 Induction/Appraisal form Induction/appraisal

Completed at start of post. The trainee assesses strengths andweaknesses.

An action plan for the post is formulated.

Completed at e.g. 3, 6 and 9 months (for a 1-year post).

2 Team observation forms

2.1 The TO1 form is a multisource feedback tool based on theprinciples of good medical practice as defined by the GMC. TheTO1 is not a confidential document and the trainee should beaware of the contents. At least 10 TO1 forms should becompleted prior to the ARCP. The trainee can chose the assessorsbut the College Tutor can also send out TO1 forms. The CollegeTutor keeps these forms on file available for inspection.

2.2 A summary of the TO1 forms is completed by the College Tutoror the Educational Supervisor, who submits the collatedinformation in the format of a TO2 form to the ARCP panel. TheCollege Tutor certifies that this form is a correct summary of theTO1s received and can add any comments from personalobservation.

3 Annual summative assessment

This is completed near the end of the post by the EducationalSupervisor, before an ARCP panel meeting. It records what hasbeen achieved by the trainee. Two forms are used.

3.1 Multisource feedback, summarised on the TO2 form.

3.2 Educational Supervisor’s report form.

4 Evaluation of the post (issued by deanery direct to trainee)

At each meeting with the trainer, the trainee is given theopportunity to comment on the training.

At the end of each post (6 months or 1 year), a trainee evaluationform is completed (TEF) and sent directly to the postgraduateclinical tutor by the trainee, or completed on the ePortfolio.

APP

TO1

TO2

TO2

ARCP

TEF

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.

2.5.1 RCOG Membership examination

The Membership examination (MRCOG) of the RCOG is an international examination

based on UK clinical practice. It is arguably the most important international postgraduate

examination in obstetrics and gynaecology. Every 6 months, around 1500 candidates

attempt each Part 1 examination, and currently about 1000 candidates attempt each Part 2

examination.

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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32

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.

2.6 DRCOG examination

The College awards a Diploma to fully registered medical practitioners to recognise a

general practitioner’s interest in obstetrics and gynaecology. It is not a specialist

qualification.

The examination comprises:

● 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 Guidance for dealing with the poorly performing trainee

Hospital medicine is a potentially stressful environment and particularly so for trainees.

It is important that we aim to limit any problems for trainees but also attempt to identify

early those who are finding it difficult to cope. It is important to alert deanery staff if there

is concern about a trainee’s progress in order to develop remedial plans/support for the

trainee and to provide support to trainers.

This section sets out a policy of prevention and remedial action.

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.

3.1.2 Identification of problems

It is an important responsibility of Educational Supervisors and other mentors to meet

with their trainees regularly to offer encouragement but also to screen for any signs of

poor performance. Further, it is helpful if other key members of the team maintain

surveillance of the trainees’ performance. All senior nurses and midwives should feel free

to pass any concerns on to the Educational Supervisor or nursing/midwifery mentor.

Action if problems arise

Please inform the Educational Supervisor or College Tutor. The urgency of this will depend

upon the degree of concern about

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.

Action if problems persist

If the problem is not of a threat to patient safety but persists, a further interview with

another professional may be important. It may be wise to consider somebody who is

independent such as the Clinical Tutor. Once again it is important to be certain of the facts

and to focus on the needs of the trainee. The Postgraduate Deanery will be able to give

advice and support for the trainee and trainer.

3.2 Regional Education

3.2.1 Educational subcommittee

Deaneries working through the School Board are better placed than the College to organise

a programme of interactive study days and examination practice sessions.

3.2.2 Setting up a regional education programme – general principles

What follows is a simple guide to the features that underpin a successful regional education

programme.

Get people involved

Before undertaking a regional education programme you need to get key people involved.

Inevitably, you will need the support of other Educational Supervisors and the Training

Programme Director as well as approval from your deanery’s STC/School. Try to organise

a small steering group to drive the programme and involve people from different

geographical areas. Make sure you have a least one interested educationalist involved to

help guide you and, crucially, involve trainees in the development. Often trainees come

up with the most innovative ideas.

Know your needs

When developing an education programme, the next step after identifying the steering

group is to perform a needs analysis. In other words, find out what your trainees and

trainers expect and want to gain from the programme. There are many ways of achieving

this, from designing a questionnaire to simply talking to a cross-section of trainees and

trainers. If you do not know what people need, you will not be able to deliver it

successfully.

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.

3.2.3 Setting up a regional education programme – study days

Study days provide a forum for presentations, debate and discussion. The involvement of

local consultants as presenters and as participants is essential to maximise the learning

value of the meetings.

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:

● testing for Down syndrome

● cervical cytology

● cerebral palsy

● tocolysis

● breech presentation/delivery

● cervical cerclage

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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.

3.3 Welcoming the new trainee

Starting at a new hospital is a stressful time for many trainees and anything the trainers

(College Tutor/Educational Supervisors) can do to alleviate this should be undertaken.

The following programme is one example for welcoming the new trainee and helping

them to settle into the team. You may wish to consider the following options.

● write to the trainee 1 month before arrival (see Appendix 5.1)

● organise an introductory day and tour of unit (see Appendix 5.2)

● provide formal praise by interview or letter within the first 4 weeks.

3.4 Training needs of trainers

Like any professional skill, teaching and facilitating medical education requires develop-

ment. Educational Supervisors should be encouraged to seek training in educational theory

and practice.

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.

Type of course Institution

Training the Trainers RCOG

Certificate/diploma/MEd in medical education Dundee University

MEd in higher education Most universities

Accreditation via experience Institute of Learning and

Teaching

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3.5 Top tips for College Tutors and Educational Supervisors

A good environment for learning

A good environment for learning needs to feel welcoming and supportive. You may wish

to try the following:

● write welcoming trainees just before they take up the post

● provide a folder with important information (contact points/telephone numbers, etc.)

● consider having multiple mentors (consultant, midwife, nurse, registrar)

● provide positive written feedback after the first 2 weeks

● use every opportunity to give verbal praise

● avoid negative criticism in public

● focus on means of improvement rather than chastisement

● ensure good communication about all the educational events within your unit.

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.

3.5.1 Top Tips for Educational Meetings

Have joint meetings

Wherever possible, interlink obstetrics and gynaecology meetings with other professions’/

disciplines’ teaching programmes, such as midwives, nurses, anaesthetists and paediatricians.

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.

Avoid cancelled meetings

● Plan well ahead to encourage preparation.

● Ensure the room is booked 1 month in advance and confirm in writing.

● Send reminders of responsibilities 2 weeks before the session.

● Keep two prepared tutorials in reserve in case of cancellations.

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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:

● use differing seminar techniques (role play, skills training)

● encourage outside speakers (other departments in the hospital)

● take note if you hear of a good speaker

● promote active participation

● socialise afterwards.

Collate clinical cases

It can be difficult to find suitable clinical cases for discussion. Keep a library of a few

very instructive cases that can be reused from time to time.

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.

Keep attendees motivated

Keep seminar rooms cool and comfortable. Make sure there are enough seats. Avoid long

lectures with the lights down. Have a break in the middle for tea. Make the second half of

the programme more interactive: eclampsia rehearsals, basic life support, risk management

tasks, etc.

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:

● find out why attendance is an issue

● as the consultant to hold trainees’ bleeps

● make trainees responsible for running as much of the seminar as possible

● keep a register of attendance.

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.

Maintaining and assessing quality

For a learning programme to succeed, it has to be liked. By using feedback, it is easy to

learn what works well, what does not and what has been left out.

Written and anonymous feedback has many advantages, but an informal debrief meeting

may provide additional valuable information.

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Section 4: Resources

4.1 Bibliography for medical education

● Newble D, Cannon R. A handbook for medical teachers. 3rd edition. Alphen aan den

Rijn, the Netherlands: Kluwer Academic Publishers; 1994.

● McAllister L, Lincoln M, Mcleod S, Maloney D. Facilitating learning in clinical

settings. Chentenham: Nelson Thornes; 1997.

● Ramsden R. Learning to teach in higher education. 2nd edition. Oxford: Routledge; 2003.

● Abbatt F, McMahin R, Pridmore P, Harman P. Teaching health-care workers: apractical guide. 2nd edition. Oxford: MacMillan Education; 1993.

● Harden R, Dent J. A practical guide for medical teachers. London: Churchill

Livingstone; 2001.

● Keighley DB, Murray TS. Guide to postgraduate medical education. Oxford: Wiley-

Blackwell; 1996.

4.2 List of educational resources

4.2.1 RCOG 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:

● interactive assessments with instant detailed feedback

● the facility to save assessment scores

● links to guidelines and reading material

● streamed videos of procedures and scans

● animations to simplify complex principles

● the facility to attach reflective notes to web pages.

Conferences and courses

The RCOG holds a number of conferences and courses suitable for trainees and trainers.

The entire listing is available on the RCOG website at www.rcog.org.uk/events.

Recommended conferences and courses for trainers include:

● Training the Trainers

● How to be a College Tutor

● College Tutors’ Meeting

● RCOG Annual Professional Development Conference (formerly Senior Staff

Conference).

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4.2.2 Useful websites

Evidence-based medicine

Medico-legal services and ethics

Medical guidelines and patient information sheets

http://www.library.nhs.uk/ National electronic library for health

Provides an introduction to the principles of

evidence-based medicine

http://www.sign.ac.uk/ Scottish Intercollegiate Guidelines Network (SIGN)

http://www.ahrq.gov/ US Agency for Healthcare Research and Quality

(AHRQ)

http://www.cebm.net/ Centre for Evidence-based Medicine (CEBM)

http://www.york.ac.uk/inst/crd/ Centre for Reviews and Dissemination (CRD)

http://www.nice.org.uk/ National Institute for Health and Clinical Excellence

(NICE)

http://www.controlled-trials.com/ Database of controlled trials (password required)

http://www.hta.ac.uk/ Health Technology Assessment programme

http://www.discern.org.uk/ Instructs on assessment of health information

(experimental site funded by NHS Research and

Development programme)

http://www.gmc-uk.org/ General Medical Council (GMC);

information on consent/ethics/good practice

http://www.bma.org.uk/ British Medical Association (BMA);

has sections on ethics

http://www.dh.gov.uk/en/Publications Downloadable document on confidentiality

andstatistics/Publications/Publications

PolicyAndGuidance/DH_114509

http://www.guideline.gov/ Collection of US government guidelines

http://www.nhsdirect.nhs.uk/ NHS site for patients

http://healthguides.mapofmedicine.com/ NHS Choices – Map of Medicine patient

choices/map/index.html information collection

http://www.dh.gov.uk/en/Publicationsand NHS examples of best practice and official

statistics/Publications/DH_074279 guidance

http://www.library.nhs.uk/ National electronic library for health

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Online indexed databases (with search capability)

Governmental and international organisations

http://health.nih.gov/ US government health site with access to

Medline and biomedical databases, clinical

trials database, consumer groups, etc.

http://www.hpa.org.uk/web/HPAweb& Health Protection Agency (HPA) information

Page&HPAwebAutoListName/Page/ information page on how to access the

1217835684939 national teratology information service

http://www.intute.ac.uk/medicine/ UK gateway to biomedical resources

http://www.dh.gov.uk/ Department of Health site; provides info on

health statistics

http://www.opsi.gov.uk/ Office of Public Sector Information (OPSI)

site; provides access to statutory health

documents

http://www.nhs.uk/ NHS website

http://www.mhra.gov.uk/index.htm Medicines and Healthcare products

Regulatory Agency (MHRA) site

http://www.who.int/ World Health Organization (WHO) site

http://www.cdc.gov/ US Centers for Disease Control and

Prevention (CDC) site

http://www.cmace.org.uk/Publications/ Centre for Maternal and Child Enquiries

CEMACH-Publications/CESDI-Public (CMACE) site; contains Confidential

ations.aspx Enquiry into Stillbirths and Deaths in

Infancy (CESDI) publications

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Section 5: Appendices

5.1 Appendix 1: Sample letter of welcome

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.

The only stupid question is the one that is not asked.

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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.

10.00 Meet the team Roy Keane

10.20 Health and safety Ron Hazard

10.40 Acute gynaecology Senior trainee

11.00 Visit the unit Will Come

12.00 Lunch break

14.00 Basic antenatal care Ann T Natal

14.30 Early pregnancy assessment clinic Geoff Station

15.00 Tea break

15.15 Massive haemorrhage Ron Sanguine

15.45 Resuscitation rehearsal Abby Cee

16.45 The rota and holidays Thomas Cook

17.00 Close

Meet at 7.00 p.m. for skittles and meal

Day 2

Meet in postgraduate centre at 9.30 a.m. for breakfast

10.00 Appraisal Consultant

11.00 Visit library Isa Bein

11.30 Visit IT facilities Meg Abite

12.00 Lunch break

14.00 Pre-eclampsia theory Ann Uria

15.00 Tea break

15.30 Eclampsia rehearsals Labour ward

16.30 Cardiotocography Brad E Cardia

17.00 Close

Please ensure you collect your handbook before leaving.

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Documents

ED Handbook for RCOG Trainer