A New Core Curriculum for Obstetrics & Gynaecology

Page 1 of 42

A New Core Curriculum for Obstetrics & Gynaecology

CiPs and Programme of Assessment

Page 2 of 42

1 Summary of Professional Identities and Capabilities in Practice

Developing the doctor

PROFESSIONAL IDENTITY: HEALTHCARE PROFESSIONAL

CiP 1 The doctor is able to apply medical knowledge, clinical skills and professional values for the provision of high-quality and safe patient-centred care

CiP 2 The doctor is able to successfully work within health organisations

CiP 3 The doctor is a leader who has vision, engages and delivers results

CiP 4 The doctor is able to design and implement quality improvement projects or interventions

CiP 5 The doctor understands and applies basic Human Factors principles and practice at individual, team, organisational and system levels

PROFESSIONAL IDENTITY: RESEARCHER, SCHOLAR AND EDUCATOR

CiP6 The doctor takes an active role in helping self and others to develop

CiP7 The doctor is able to engage with research and promote innovation

CiP8 The doctor is effective as a teacher and supervisor of healthcare professionals

Developing the Obstetrician & Gynaecologist

PROFESSIONAL IDENTITY: CLINICAL EXPERT

CiP9 The doctor is competent in recognising, assessing and managing emergencies in gynaecology and early pregnancy

CiP10 The doctor is competent in recognising, assessing and managing emergencies in obstetrics

CiP11 The doctor is competent in recognising, assessing and managing non-emergency gynaecology and early pregnancy care

CiP12 The doctor is competent in recognising, assessing and managing non-emergency obstetrics care

PROFESSIONAL IDENTITY: CHAMPION FOR WOMEN’S HEALTH

CiP13 The doctor is able to champion the healthcare needs of people from all groups within society.

CiP14 The doctor takes an active role in implementing public health priorities for women and works within local, national and international structures to promote health and prevent disease.

2 The organisation and content of the curriculum The practice of O&G requires the generic and specialty knowledge, skills and attitudes to manage patients presenting with a wide range of gynaecological and obstetric conditions and symptoms. It involves particular emphasis on woman-centred care, diagnostic reasoning, managing uncertainty, dealing with comorbidities, and recognising when specialty opinion or care is required. The modern consultant is defined by four Professional Identities (PIs) in the new O&G Curriculum to incorporate all these elements, as demonstrated in Figure 1 below. Figure 1 - Curriculum design structure

Page 3 of 42

3.1 Curriculum framework

CiPs are the high-level learning outcomes within each of the four PIs. Each CiP is supported by the key skills expected to be demonstrated by a CCT holder. The CiPs are divided into generic and specialty, with a set of four clinical CiPs within the specialist category. The Curriculum Framework is laid out in detail in section 3.2. Each key skill has a set of descriptors associated with that activity or task. These are intended to help trainees and trainers recognise the minimum level of knowledge, skills and attitudes which should be demonstrated by O&G doctors. Descriptors may be used to provide guidance to trainees when they self-assess their performance against the minimum expected standards for their year of training. They are not a comprehensive list and there are many more examples that would provide equally valid evidence of performance. Additionally, the key skills repeatedly refer to the need to demonstrate professional behaviour with regard to individuals and their families, colleagues and others. Effective communication in its multiple forms is fundamental to being a high quality specialist in obstetrics and gynaecology. Team working is a key focus. Good doctors work in partnership with patients and respect their rights to privacy and dignity. They treat each patient as an individual. They do their best to make sure all patients receive good care and treatment that will support them to live as well as possible, whatever their illness or disability. Many of the descriptors refer to woman-centred care and shared decision making. This is to emphasise the importance of exploring and discussing care or treatment options, their risks and benefits, with women and their families. Appropriate professional behaviour should reflect the principles of the GMC’s Good Medical Practice and the new Generic Professional Capabilities (GPCs).Therefore all 14 CiPs that

Professional Identity (4)

Capability in Practice (14)

Key Skills

Descriptors

https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice

https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice

https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/generic-professional-capabilities-framework

Page 4 of 42

provide the framework for this curriculum have been mapped to the nine GMC GPC domains. Assessment of the CiPs will be underpinned by the descriptors and judged against the performance and behaviour expected at that stage or year of training. The Education Supervisor will carry out an annual global assessment, and satisfactory sign off will indicate that there are no concerns before the trainee can progress to the next assessment point. For generic and non-clinical CiPs, satisfactory sign off will be required at the end of each stage of training to demonstrate that, for each of the CiPs, the doctor in training meets or exceeds the minimum level of performance expected for completion of that stage of O&G training. In order to complete training and be recommended to the GMC for the award of CCT and entry onto the specialist register, the doctor must demonstrate that they are capable of unsupervised practice in all clinical specialty CiPs and that they meet the minimum requirements for each of the generic CiPs. What follows is the curriculum framework, which articulates the detail for each of the 16 CiPs, including the mapping to the GPCs.

3.2 Developing the Doctor - generic CiPs

This section is divided into two – firstly the CiPs that are purely generic; and secondly the CiPs that are specialty specific. The 8 generic CiPs describe the key skills which develop trainees as a doctor and are essential for a CCT holder in O&G. Educational Supervisors will make a global assessment based on whether the trainee has made satisfactory progress for the defined stage of training. If this is satisfactory for the stage of training, the trainee can progress. More detail is provided in the programme of assessment section of the curriculum.

Professional Identity 1: Healthcare Professional

CiP 1: The doctor is able to apply medical knowledge, clinical skills and professional values for the provision of high quality and safe patient-centred care.

Key Skills Descriptors

Able to take history and perform clinical examination and use appropriate investigations to establish diagnosis

• Can take a detailed, focused history including details of current medication.

• Conducts appropriate clinical examinations for females, transgender and non-binary individuals

• Documents clinical encounters in an accurate, complete, timely and accessible manner, in compliance with legal requirements.

• Can select appropriate investigations and interpret results.

• Lists possible diagnoses and applies clinical judgement to arrive at a working diagnosis.

Page 5 of 42

Facilitates discussions • Uses empathy, respect and compassion when communicating with a patient to build trust and independence.

• Modifies their approach to the patient when cultural background or personal values may have an impact on engagement and care.

Ability to facilitate women’s decision making

• Considers views, preferences and expectations when working with patients and their families to establish patient-centered management plan.

• Shares information with patients and their families clearly, in a timely, non-judgmental fashion and facilitates discussion (including use of a translator when needed).

• Recognises limitations and escalates care where appropriate.

• Creates the conditions for informed consent to be given, explaining the risks and benefits of, or the rationale for, a proposed procedure or treatment.

Provides treatment • Demonstrates a commitment to high quality care, which is safe and effective and delivers a good patient experience.

• Prescribes medicines, blood products and fluids correctly, accurately and unambiguously in accordance with GMC and other guidance.

• Demonstrates ability to deal with complex situations including drug contra-indications and side effects

• Determines responsibility for follow up, including appropriate intervals for monitoring, location of care, instructions on accessing emergency help and changing or cancelling appointments.

• Works effectively within a multiprofessional team to meet the needs of the individual

• Can make referrals for complex cases.

Evidence to inform decision

• CbD

• Mini-CEX

• Reflective practice

• TO2 (includes SO)

• NOTSS

Mapping to GPCs

Domain 1: Professional values and behaviours Domain 2: Professional skills

• Practical skills

• Communication and interpersonal skills dealing with complexity and uncertainty

• Clinical skills (history taking, diagnosis and management, consent; humane interventions; prescribing medicines safely; using medical devices safely; infection control and communicable diseases)

Domain 3: Professional knowledge

• Professional requirements

• National legislative requirements

Domain 5: Capabilities in leadership and teamworking Domain 6: Patient safety and quality improvement

• Patient safety

Page 6 of 42

CiP 2: The doctor is able to work effectively within health organisations.


Aware of the healthcare systems in the four nations of the UK

• Understands the NHS constitution and its founding principles. • Understands how healthcare services are currently commissioned

and funded and the key organisational structures. • Understands the role of government and the agencies and public

bodies who work with the department of health. • Appreciates the role of other third sector public bodies in regulation

of healthcare. • Demonstrates an awareness of budget and resource management

Aware of and adheres to legal principles and professional requirements

• Understands the legislative and regulatory framework within which healthcare is provided in the four nations of the UK.

• Follows GMC guidance on professionalism and confidentiality (Adheres to GMC Good Medical Practice)

• Understands the human rights principles and legal issues surrounding informed consent and respectful care– including key legal rulings.

Aware of ethical principles • Understands ethical principles and how these underpin practice.

• Acts professionally in difficult ethical situations. Participates in clinical governance processes

• Follows safety processes that exist locally and nationally.

• Actively engages in a culture that promotes safety.

• Understands the ways in which incidents can be investigated and the theory that underpins this.

• Participates in incident investigations and links recommendations to quality improvement.

• Discloses harmful patient safety incidents to patients and their families accurately and appropriately (exercsises within Duty of Candour).

• Demonstrates humanity and empathy for both first and second victims of adverse incidents.

• Actively engage with and learn from women and families in improving patient safety and experience

Works effectively within the digital environment

• Understands the principles of data governance and the legislation around data protection

• Understands the need for proactive and responsible interaction with digital platforms.

• Effectively signposts patients and health professionals to patient support websites and newsletters.

• Is able to work with patients to interpret information in the public domain.

• Maintains an appropriate digital persona.

• Demonstrates ability to interact appropriately with women’s concerns and public campaigns

Page 7 of 42


• CbD


• Local and Deanery Teaching

• RCOG eLearning

• Audit

• Quality improvement

• Incident reporting and investigation

• Complaint management

• Attendance at governance meetings

• Debrief

Mapping to GPCs

Domain 1: Professional values and behaviours Domain 3: Professional knowledge


• National legislative structure

• The health service and healthcare systems in the four nations Domain 4: Capabilities in health promotion and illness prevention Domain 5: Capabilities in leadership and teamworking Domain 6: Capabilities in patient safety and quality improvement

• Patient safety

• Quality improvement Domain 8: Capabilities in education and training Doman 9: Capabilities in research and scholarship

CiP 3: The doctor is a leader and follower who shares vision, engages and delivers results.


Comfortable influencing, and negotiating

• Evaluates own preferred negotiation style.

• Can handle a variety of negotiation challenges.

• Understands and is able to secure and consolidate agreements.

Manages conflict • Understands the concept of conflict in the healthcare setting.

• Understands the challenges and negative effects of conflict within teams and organisations.

• Understands and implements the methods and tools used to manage conflict and its resolution.

Understands human behaviour and demonstrates leadership skills

• Actively contributes to culture and respectful care by role modelling appropriate language and behaviour and challenge when does not happen

• Understands the basic principles and importance of emotional intelligence.

• Reflects on own leadership style and how this can impact on patient and colleague interactions.

• Demonstrates the ability to adapt leadership style to different situations.

• Continues to enhance leadership skills.

Demonstrates insight • Demonstrates insight into own knowledge and performance. • Adapts within the clinical environment. • Can provide evidence that they reflect on practice and demonstrate

learning from it

Page 8 of 42

Manages stress and fatigue

• Understands stress, its impact on personal wellbeing and its potential effect on delivering high quality patient care.

• Develops personal strategies to maintain mental strength and resilience.

• Shows how they are improving resilience as part of their personal development.

• Recognise the impact of stress and fatigue in their team and offer / signpost to support

Able to make effective use of resources and time management

• Can prioritise effectively. • Demonstrates effective time management in clinical settings. • Effectively delegates tasks to other members of the

multiprofessional team • Demonstrates awareness of budget and resource management



• NOTSS



• RCOG e-learning

• Confirmed participation in multidisciplinary team-based simulation training

• Leadership questionnaire

• Leads critical incident review

Mapping to GPCs


• Communication and interpersonal skills

• Dealing with complexity and uncertainty Domain 5: Capabilities in leadership and teamworking Domain 6: Capabilities in patient safety and quality improvement

• Patient safety

• Quality improvement Domain 8: Capabilities in education and training Doman 9: Capabilities in research and scholarship

CiP 4: The doctor is able to design and implement quality improvement projects or interventions.


Understands quality improvement (quality is safety, experience and efficacy)

• Understands the difference between quality improvement and research.

• Understands QI methodology such as Plan, Do, Study, Act cycles (PDSA).

• Understands the concepts of big data and national clinical audit.

• Appreciates the importance of stakeholders in QI work encouraging involvement with patient groups eg Maternity Voices Partnership.

Undertakes and evaluates impact of QI interventions

• Is actively involved in QI initiatives (examples include: clinical audit, guideline development, implementation of national guidance, service improvement).

Page 9 of 42

• Considers the best way to share learning.

• Evaluates quality improvement projects and how these can work at a local, regional and national level.



• RCOG eLearning

• Quality improvement project

• Guideline development and implementation

Mapping to GPCs



• Dealing with complexity and uncertainty Domain 3: Professional knowledge



• The health service and healthcare systems in the four countries Domain 4: Capabilities in health promotion and illness prevention Domain 5: Capabilities in leadership and teamworking Domain 6: Capabilities in patient safety and quality improvement

• Patient safety


CiP 5: The doctor understands and applies basic Human Factors principles and practice at individual, team, organisational and system levels.


Maintains situational awareness

• Understands and applies the three critical stages of situation awareness.

• Understands and applies the techniques to maintain situation awareness, both team and individual factors – e.g. minimising interruptions and distractions.

• Maintains situation awareness in safety-critical environments.

Demonstrates insight into decision making

• Understands the psychological theories on how we make decisions under pressure.

• Understands the different types of decision making (intuitive, rule-based, analytical and creative).

• Demonstrates insight into own decision-making process.

• Can review and analyse the decisions of others.

• Progresses from analytical to intuitive decision making and is able to articulate this as experience develops.

• Reflects on unconscious biases which may influence our interaction and behaviour

• Demonstrates when making clinical decisions the ability to consider a person’s perspective and the reasons for choices and perception of safety.

Page 10 of 42

Ability to respond to human performance within adverse clinical events

• Demonstrates knowledge and effects of various types of human error/violations on outcomes.

• Demonstrates knowledge and effects of unconscious and cognitive biases (e.g. fixation, normalcy, confirmation etc.).

• Reviews effects of human error and biases in clinical practice.

Team working

• Understands team working in complex dynamic situations. • Ability to adapt to changing teams. • Works effectively as part of a multiprofessional team in different

roles. • Communicates effectively within the multiprofessional team and

with patients, relatives and members of the public. Understands that multiple methods of communication are required

• Demonstrates appropriate assertiveness and challenges constructively.

• Reflects on breakdowns in team working and communication. • Recognises and celebrates effective multiprofessional team working

Understands systems and organisational factors

• Recognises how equipment and environment contribute to outcomes and patient safety.

• Is aware of latent and active failures within healthcare systems and the effects on safety eg. Reason’s model (Swiss cheese).

• Promotes a safety culture by role modelling ideal behaviours. • Knows how to escalate safety concerns. • Understands the concept of ‘high reliability’ organisations and the

relevance to improving outcomes in healthcare.



• TO2 (including SO)

• NOTSS


• RCOG e-learning

Mapping to GPCs







• The health service and healthcare systems in the four countries Domain 5: Capabilities in leadership and teamworking Domain 6: Capabilities in patient safety and quality improvement

• Patient safety


Page 11 of 42

Professional Identity 2: Researcher, Scholar and Educator

CiP 6: The doctor takes an active role in helping self and others to develop themselves


Demonstrates a commitment to continued learning

• Understands own learning styles.

• Identifies opportunities for learning and development through regular reflection and feedback.

• Implements personal development plans to enhance and progress professional practice.

• Applies learning to professional practice.

Develops people • Acts as a supportive colleague and critical friend. • Encourages career development in others.

• Understands concepts of formal mentoring and coaching.

Promotes excellence • Encourages and support colleagues in their endeavours.

• Signposts to professional networks to promote high quality and innovative practice.

Provides pastoral care • Identifies and creates a safe and supportive working environment.

• Demonstrates an awareness of the characteristics of a colleague in difficulty.

• Supports and guides a colleague in difficulty using the processes which exist within the NHS.

Provides support to second victims

• Sensitively debriefs after an adverse incident.

• Is aware that traumatic events may lead to psychological effects which may need professional intervention and support.

• Understands the importance of signposting colleagues to psychological support services either through employer or doctors support service.

Demonstrates performance management

• Understands the basic principles of performance management.

• Uses SMART objectives to set personal development goals.

• Understands the use of competency frameworks as a performance management and development tool.


• PDP



• NOTSS


• RCOG eLearning

• Leads a debrief

Mapping to GPCs






Page 12 of 42


• The health service and healthcare system in the four countries Domain 5: Capabilities in leadership and team working Domain 6: Capabilities in patient safety and quality improvement

• Patient safety

Domain 8: Capabilities in education and training Domain 9: Capabilities in research and scholarship

CiP 7: The doctor is able to engage with research and promote innovation.


Demonstrates research skills

• Understands principles of healthcare research and different methodologies.

• Understands the principles of ethics and governance within research, follows guidelines on ethical conduct and consent for research.

• Understands the use of informatics, statistical analysis and emerging research areas.

• Performs literature searches, interrogates evidence and communicates this to colleagues and patients.

• Has the ability to translate research into practice.

Demonstrates critical thinking

• Critically evaluates arguments and evidence.

• Can communicate and interpret research evidence in a meaningful, unbiased way to support informed decision making.

Innovates • Open to innovative ideas and considering views of women.

• Shows initiative by identifying problems and creating solutions.

• Supports change by ability to reach a consensus.

• Understands the value of failure in innovation.



• RCOG eLearning

• Critical appraisal / journal club presentation

• GCP certificate

• Involvement in recruitment for multicentre trials

• APM in Clinical Research

• Peer reviewed publications

• Oral and poster presentations

Mapping to GPCs




• Dealing with complexity and uncertainty




• The health service and healthcare system in the four countries Domain 5: Capabilities in leadership and team working

Page 13 of 42

• Promoting a culture of learning and academic and professional critical enquiry

Domain 6: Capabilities in patient safety and quality improvement



CiP 8: The doctor is effective as a teacher and supervisor of healthcare professionals.


Delivers effective teaching • Understands learning theories relevant to medical education. • Plans and delivers effective learning strategies and activities. • Promotes a safe learning environment and ensures patient safety is

maintained. • Understands techniques for giving feedback and can provide it in a

timely and constructive manner. • Evaluates and reflects on the effectiveness of their educational

activities.

Embraces interprofessional learning

• Understands the value of learning in teams. • Facilitates interprofessional learning. • Participates in interprofessional learning.

Involves stakeholders in education

• Commits to learning from patients and stakeholders. • Demonstrates commitment to patient education.

Supervises and appraises • Contributes towards staff development and training, including supervision, appraisal and workplace assessment.

• Demonstrates ability to act as a Clinical Supervisor. • Understands the appraisal and revalidation process.


• Feedback on teaching


• Multidisciplinary labour ward skills session facilitation



• RCOG eLearning

Mapping to GPCs






Domain 5: Capabilities in leadership and team working Domain 6: Capabilities in patient safety and quality improvement

• Patient safety


Page 14 of 42

3.3 Developing the Obstetrician & Gynaecologist - clinical specialty CiPs

The 4 clinical specialty CiPs describe the clinical tasks or activities, both clinical and non-clinical, which are essential for women’s healthcare. Satisfactory sign off will require Education Supervisors to make decisions on the level of supervision required for each CiP and if this is satisfactory for the stage of training, the trainee can progress. More detail is provided in the programme of assessment section of the curriculum.

Professional Identity 3: Clinical Expert

CiP9: The doctor is competent in recognising, assessing and managing emergencies in gynaecology and early pregnancy.


Manages acute pelvic pain in the non-pregnant woman

• Performs a focused history, appropriate examination and orders appropriate investigations.

• Formulates a differential diagnosis.

• Discusses diagnosis in a sensitive manner.

• Formulates an appropriate individualised management plan taking into account patient preferences and the urgency required.

• Recognises limitations and escalates care to senior colleagues and other specialities when appropriate.

• Performs surgery where appropriate.

• Ensures continuity of care, effective handover and appropriate discharge plan.

• Ensures appropriate risk management procedures are undertaken.

Manages vaginal bleeding in the non-pregnant woman

Manages acute infections

Manages acute complications of gynaecological treatment

Manages vaginal bleeding and pain in early pregnancy

• Performs focused history, appropriate examination and orders appropriate investigations.



• Formulates an appropriate and individualised management plan taking into account patient preferences and the urgency required.




• Demonstrates understanding of the psychological impact of pregnancy loss.

Manages other early pregnancy complications






Page 15 of 42



Manages the acute gynaecological workload

• Is able to prioritise according to clinical need.

• Is able to escalate appropriately according to clinical need and workload.

• Is able to delegate appropriately to other members of the team.

• Demonstrates prompt assessment of the acutely deteriorating patient.

• Is able to give a gynaecological opinion for another specialty.

• Makes safeguarding referrals where appropriate.


• OSAT

• CbD

• Mini-CEX

• MRCOG

• Discussion of correspondence Mini-CEX



• NOTSS


• RCOG eLearning

Mapping to GPCs










• Patient safety

• Quality improvement Domain 7: Capabilities in safeguarding vulnerable groups

Page 16 of 42

CiP 10: The doctor is competent in recognising, assessing and managing emergencies in obstetrics.


Manages pain and bleeding in the obstetric patient


• Establishes fetal wellbeing.




Manages concerns about fetal wellbeing in the non-labouring woman

• Appropriately assesses a woman presenting with concerns about fetal movements.

• Can use appropriate investigations to confirm fetal demise.

• Is able to sensitively discuss management options where fetal death has occurred.

• Can provide a supportive environment and signpost relevant support services for a woman and her partner suffering the loss of a baby.

Manages suspected pre-term labour/ruptured membranes


• Establishes fetal wellbeing.

• Discusses findings in a sensitive manner.


• Aware of additional issues at extremes of viability including ethical concerns and additional therapies which may be of benefit.

Manages labour • Demonstrates understanding of the physiology of labour.

• Is aware of situations where labour may be more complex such as multiple pregnancy.

• Uses history and clinical signs to anticipate possible problems.

• Can formulate safe management plans taking into account the woman’s preferences.

• Can succinctly explain management plans to women and birthing partners.

Manages intrapartum fetal surveillance

• Can use intrapartum fetal surveillance strategies to help assess risk.

• Can recognise abnormal fetal heart rate patterns, perform and interpret related tests.

• Communicates concerns effectively and sensitively with colleagues, women and birthing partners.

Manages induction and augmentation of labour

• Can formulate safe management plans for induction and augmentation taking into account the woman’s preferences.

Manages emergency birth and immediate postpartum problems

• Can recognise when birth may need to be expedited.

• Communicates concerns and recommendations effectively and sensitively with colleagues, women and birthing partners.

Page 17 of 42


• Demonstrates the skills needed to facilitate safe operative birth.

• Demonstrates skills in managing problems arising immediately postpartum.

Manages the unwell pregnant woman and maternal collapse

• Demonstrates prompt assessment of acutely deteriorating patient.

• Performs procedures necessary in emergency situations.

• Escalates to senior colleagues and other specialities.

Manages labour ward

• Demonstrates leadership skills within the multidisciplinary team, anticipating problems, prioritising and managing obstetric care.



• Manages complex problems, including liaison with, and referral to, other specialties where appropriate.

• Demonstrates the skills to sensitively explain unexpected events of labour and birth and anticipates where later debrief may be necessary.


• OSAT

• CbD

• Mini-CEX

• MRCOG



• NOTSS


• RCOG eLearning

Mapping to GPCs










• Patient safety


Page 18 of 42

CiP 11: The doctor is competent in recognising, assessing and managing non-emergency gynaecology and early pregnancy.


Manages abnormal vaginal bleeding







• Ensures appropriate follow up.

• Demonstrates awareness of the quality of patient experience.

Manages pelvic and vulval pain

Manages pelvic masses

Manages the abnormal cervical smear

• Demonstrates ability to counsel about cytology reports and HPV testing.

• Refers to colposcopy services in accordance with national guidelines.

Manages suspected gynaecological cancer symptoms

• Performs focused history, appropriate examination and order appropriate investigations

• Discusses diagnosis and prognosis in a sensitive manner.

• Demonstrates knowledge of when referral to a tertiary gynaecological oncology centre will be required.

• Can counsel about surgical and non-surgical treatment options, taking into account the individual woman’s background health and preferences.

• Ensures appropriate follow up in line with national guidance.

Manages urogynaecological symptoms




• Can counsel about surgical and non-surgical treatment options, taking into account the individual woman’s background health and preferences.

• Ensures appropriate follow up.

• Demonstrates awareness of the quality of patient experience.

Manages vulval symptoms • Performs focused history, appropriate examination and orders appropriate investigations.

• Recognise common vulval disorders


• Discusses diagnosis in a sensitive manner and recognise the psychological impact of vulval disease


Page 19 of 42

• Recognise when to refer to allied specialties and the importance of the multidisciplinary team

Manages menopause and postmenopausal care


• Formulates an appropriate and individualised management plan taking into account patient preferences including complimentary therapies and lifestyle modifications.

• Appreciates the impact that the menopause may have on other aspects of wellbeing.

Manages subfertility • Performs focused history, appropriate examination and orders appropriate investigations.

• Is able to interpret results in order to plan effective care and counsel about management options, including local referral pathways and alternatives for conceiving.

• Understands the ethical issues surrounding IVF treatment.

Manages sexual wellbeing • Performs focused history, appropriate examination and orders appropriate investigations.

• Offers advice regarding all contraceptive methods and understands the factors affecting choice of contraception, including comorbidities, patient preference, failure rates, etc.

• Demonstrates ability to administer/fit different contraceptive methods

• Demonstrates the ability to manage women with unplanned pregnancies (including medical and surgical abortion).

• Is aware of alternative sources of support and follow-up for patients, particularly in cases of unintended pregnancy and termination of pregnancy.

• Offers sexual health screening advice and provides appropriate referral to genitourinary medicine (GUM) services for management of sexually transmitted infections.

• Identifies psychosexual problems, explores and can initiate referral to specialist services where available.

• Recognises the interactions between gynaecological problems and psychosexual problems.


• OSAT

• CbD

• Mini-CEX

• MRCOG



• NOTSS


• RCOG eLearning

• IPM training certificate

Page 20 of 42

Mapping to GPCs










• Patient safety


CiP 12: The doctor is competent in recognising, assessing and managing non-emergency obstetrics.


Manages the woman with pre-existing medical conditions

• Demonstrates the ability to provide preconceptual advice to women and sensitively discuss risks during pregnancy to create tailored management plans with liaison with other specialties where appropriate.

• Identifies, assesses and manages pre-existing medical conditions in the pregnant or postnatal woman.

• Understands the impact of pregnancy on disease and of disease on pregnancy.

• Formulates appropriate and individualised management plans for pregnancy, birth and the postnatal period in consultation with other specialties and obstetric anaesthesia.

• Prescribes safely and understands the challenge of safe prescribing in pregnancy, making changes to medications where necessary.

Manages medical conditions arising in pregnancy

• Demonstrates the ability to recognise when conditions related to pregnancy develop.

• Demonstrates the ability to perform a focused history and undertake an appropriate physical examination of the pregnant patient taking into account the physiological and anatomical changes of pregnancy.

• Identifies, assesses and manages pregnancy-specific conditions, and considers the impact on both maternal and fetal health.

• Demonstrates the ability to order and interpret appropriate investigations to monitor conditions during pregnancy.

Page 21 of 42

• Formulates appropriate and tailored management plans for pregnancy and birth.

• Prescribes medications and antimicrobials appropriately in line with the latest evidence and reviews and monitors therapeutic interventions.

Manages fetal concerns

• Demonstrates ability to perform focused history appropriate examination and order clinically indicated investigation.

• Facilitates timely and appropriate investigation, management and referral to tertiary centres if required.

• Demonstrates knowledge and ability to work within local clinically managed networks.

• Demonstrates ability to discuss concerns and clinical uncertainties in a sensitive manner.

• Formulates appropriate and individualised management plans for pregnancy and birth.

Manages mental health conditions in pregnancy and the postnatal period

• Demonstrates ability to effectively and sensitively screen for mental health concerns arising in the obstetric population.

• Demonstrates ability to formulate the initial diagnosis and management of mental health conditions with appropriate liaison and involvement of mental health services.

• Manages perinatal mental health emergencies in the antenatal and postnatal period effectively.

• Understands the impact that birth and adverse outcomes may have on future mental health and is able to signpost women and their families to support services.

Manages pregnancy with complications secondary to lifestyle

• Understands the significant impact that lifestyle factors may have on maternal and fetal health.

• Demonstrates ability to perform a focused history, appropriate examination and to order clinically indicated investigations.

• Sensitively enquires about lifestyle factors to facilitate disclosure.

• Understands and demonstrates ability to manage pregnancies where lifestyle factors cause complications.

• Formulates appropriate individualised management plans for pregnancy, birth and the postnatal period.

• Uses support services appropriately according to local provision and taking into account the wishes of the woman and the needs of the fetus/neonate.

Supports antenatal decision making

• Identifies risk factors relating to previous pregnancy outcomes.

• Effectively estimates risks to inform shared decision making.

• Formulates appropriate and individualised management plans for pregnancy and birth.

Manages women in the postnatal period

• Manages a postnatal consultation.

• Demonstrates ability to sensitively debrief women and their families after an unexpected birth experience or when a baby is admitted to the neonatal unit.

Page 22 of 42

• Advises on the impact of events in this pregnancy on future health and pregnancies.

• Demonstrates ability to discuss and advise on postnatal contraception and administer/fit different contraceptive methods

• Uses support services appropriately according to local provision, taking into account the wishes of the woman and her family.

• Ensures effective handover and discharge to primary care.


• OSAT

• CbD

• Mini-CEX

• MRCOG



• NOTSS


• RCOG eLearning

Mapping to GPCs










• Patient safety


Page 23 of 42

3.4 Developing the Obstetrician & Gynaecologist - non-clinical specialty CiPs

The two non-clinical specialty CiPs describe the key skills which are essential for a CCT holder in O&G. Satisfactory sign off will require Education Supervisors to make a global assessment indicating whether the trainee has made satisfactory progress for the defined stage of training. If this is satisfactory for the stage of training, the trainee can progress. More detail is provided in the programme of assessment section of the curriculum.

Professional Identity 4: Champion for Women’s Health

CiP 13: The doctor is able to champion the healthcare needs of people from all groups within society.


Promotes non-discriminatory practice

• Possesses knowledge of ethical and legal issues and an awareness of the situations where discrimination might occur.

• Respects different values of patients and colleagues. • Recognises how health systems can discriminate against patients

with protected characteristics and works to minimise this discrimination.

• Must not allow their personal beliefs to lead to discrimination. • Adopts patient-centred assessments and interventions that are

inclusive and respectful of diversity. • Is able to perform consultations addressing the specific needs of a

disabled person. • Understands the specific needs of transgender /non-binary

individuals and is able to perform consultations and refer appropriately to specialist services.

Aware of broader social and cultural determinants of health

• Understands the impact of a patient’s social, economic and environmental context on their health.

• Interacts with appropriate patient representatives and engages with colleagues from different professional and personal backgrounds when working in multidisciplinary teams to promote the health of patients and the public.

• Assesses the interaction between women’s health and cultural beliefs and practices.

• Must be aware of and adhere to the legislation regarding certain cultural practices (e.g. FGM, modern slavery) within the UK.

Aware of an individual’s social wellbeing

• Takes an appropriate social history to identify any pertinent social issues and can signpost patients to appropriate services.

• Considers the interaction between medical conditions, care and a woman’s broader work and family life.

• Understands that women who care for dependents may fail or delay to engage with healthcare services and that this can impact on her health.

Page 24 of 42

• Understands the principles of safeguarding and their responsibility in protecting people's health, wellbeing and human rights, and enabling them to live free from harm, abuse and neglect.

Aware of the interaction between mental health and physical health

• Understands how mental health issues can affect a woman’s reproductive health.

• Knows how reproductive health issues can significantly impact on the mental health of a woman and her partner.


• Equality and Diversity training

• FGM training

• MRCOG




• RCOG eLearning

Mapping to GPCs







• Patient safety


CiP 14: The doctor takes an active role in implementing public health priorities for women and works within local, national and international structures to promote health and prevent disease.


Promotes a healthy lifestyle

• Understands lifestyle factors which impact on short- and long-term health.

• Provides appropriate lifestyle advice to women in a sensitive manner and facilitates access to useful support or services.eg. smoking cessation and weight management

• Contributes to developments or education in health promotion.

Promotes illness prevention

• Understands the concept of screening.

• Has an awareness of and promotes the current national screening programmes in women’s health?

• Knows about the current recommended vaccinations available to protect women and their unborn children.

Page 25 of 42

• Is able to provide balanced counselling regarding illness prevention strategies.

Aware of the national and international policies and politics which impact on women’s healthcare

• Is aware of the impact of national policy on influencing local care giving.

• Is able to challenge and advocate to ensure local service provision equates with national standards

• Is aware of the interaction between the NHS and international healthcare bodies (e.g. the WHO).

Aware of the globalisation of healthcare

• Understands how the increasing movement of people and health migration impacts on health services.

• Is aware of the basic principles of global health.


• CbD

• Mini-CEX

• MRCOG


• RCOG eLearning


Mapping to GPCs

Domain 2: Professional skills






• Patient safety

• Quality improvement Domain 7: Capabilities in safeguarding vulnerable groups Domain 8: Capabilities in education and training

Page 26 of 42

3.5 Presentations and conditions

The scope of O&G is broad and cannot be encapsulated by a finite list of presentations and conditions. Any attempt to list all relevant presentations, conditions and issues would be extensive but inevitably incomplete and would rapidly become out of date. These will all be contained in the new knowledge syllabus for MRCOG which will be produced and consulted upon separately.

3.6 Practical procedures

There are a number of procedural skills in which a trainee must become proficient to the level expected by the end of training. Trainees must be able to outline the indications for these procedures and recognise the importance of valid informed consent, and of requesting for help when appropriate. For all practical procedures the trainee must be able to recognise complications and respond appropriately if they arise, including calling for help from colleagues in other specialties when necessary. Trainees will be able to record their procedures in the new ePortfolio. Trainees should ideally receive training in procedural skills in a simulated setting before performing these procedures clinically, but this is not mandatory. Assessment of procedural skills will be made using the OSATS tool. When a trainee has been signed off as being able to perform a procedure independently, they are not required to have any further assessment (OSATS) of that procedure, unless they or their Education Supervisor think that this is required (in line with standard professional conduct).

Page 27 of 42

O&G procedures

Gynaecology

Endometrial biopsy

Cervical smear Vulval biopsy

Insertion/removal of IUCD/IUS

Surgical & medical management of miscarriage or surgical & medical termination of pregnancy

Hysteroscopy

Endometrial ablation

Diagnostic laparoscopy

Simple operative laparoscopy

Laparoscopic management of ectopic pregnancy

Ovarian cystectomy

Midline laparotomy

Obstetrics

Perineal repair Non-rotational instrumental delivery Rotational instrumental delivery Caesarean section Fetal blood sample Manual removal of placenta Surgical management of PPH Surgical management of retained products of conception Surgical wound debridement

Ultrasound

Basic early pregnancy ultrasound Basic ultrasound for assessment of fetal size, liquor and placenta Intermediate ultrasound of normal fetal anatomy (optional) Intermediate ultrasound in gynaecology (optional) Intermediate ultrasound in early pregnancy complications (optional)

4 Learning and teaching

4.1 Purpose of assessment

The purpose of the programme of assessment is to:

• Assess trainees’ actual performance in the workplace.

• Encourage the development of the trainee as an adult responsible for their own learning.

• Enhance learning by providing formative assessment, enabling trainees to receive immediate feedback, understand their own performance and identify areas for development.

• Drive learning and enhance the training process by making it clear what is required of trainees and motivating them to ensure they receive suitable training and experience.

• Demonstrate trainees have acquired the GPCs and meet the requirements of good medical practice.

• Ensure that trainees possess the essential underlying knowledge required for their specialty.

Page 28 of 42

• Provide robust, summative evidence that trainees are meeting the curriculum standards during the training programme.

• Inform the ARCP, identifying any requirements for targeted or additional training where necessary and facilitating decisions regarding progression through the training programme.

• Identify trainees who should be advised to consider changes of career direction.

4.2 Programme of assessment Our programme of assessment refers to the integrated framework of exams, assessments in the workplace and judgements made about a learner during their approved programme of training. The purpose of the programme of assessment is to clearly communicate the expected levels of performance and ensure these are met on an annual basis and at other critical progression points, and to demonstrate satisfactory completion of training as required by the curriculum. Detailed guidance will be drafted to assist trainers and trainees. The programme of assessment comprises the use of a number of individual assessment tools. These include the MRCOG examination, and summative and formative workplace-based assessments. A range of assessments is needed to generate the necessary evidence required for global judgements to be made about satisfactory performance, progression in, and completion of, training. All assessments, including those conducted in the workplace, are linked to the relevant learning outcomes stated in the core curriculum. The programme of assessment emphasises the importance of professional judgment in making sure learners have met the learning outcomes and expected levels of performance set out in the approved curriculum. It also focuses on the learner as a reflective practitioner. Assessors will make accountable, professional judgements on whether progress has been made according to a learner’s self-assessment. The programme of assessment explains how professional judgements are used and collated to support decisions on progression and satisfactory completion of training. Assessments will be supported by structured feedback for trainees. Assessment tools, which are well established in O&G training, will be both formative and summative and have been selected on the basis of their fitness for purpose and their familiarity to trainees and trainers. Trainees will be assessed throughout the training programme, allowing them to continually gather evidence of learning and to provide formative feedback. Those assessment tools which are not identified individually as summative will contribute to summative judgements about a trainee’s progress as part of the programme of assessment. The number and range of these will ensure a reliable assessment of the training relevant to their stage of training and achieve coverage of the curriculum. Reflection and feedback should be an integral component to all workplace-based assessments. Every clinical encounter can provide a unique opportunity for reflection and feedback and this process should occur frequently – and as soon as possible after any event to maximise benefit for the trainee. Feedback should be of high quality and should include an action plan for future development for the trainee. Both trainees and trainers should

Page 29 of 42

recognise and respect cultural differences when giving and receiving feedback. Our assessment tools have been revised to include reflection and will be piloted during 2018.

5.3 Assessment of CiPs

The CiP is the fundamental basis of global assessment. Assessment of CiPs involves looking across a range of key skills and evidence to make a judgement about a trainee’s suitability to take on particular responsibilities or tasks as appropriate to their stage of training. It also involves the trainee providing self-assessment of their performance for that stage of training. Clinical Supervisors and others contributing to assessment will provide formative feedback to the trainee on their performance throughout the training year. This feedback will include a global rating in order to indicate to the trainee and their Education Supervisor how they are progressing at that stage of training. Evidence to support the global rating for the CiP will be derived from workplace-based assessments and other evidence, e.g. TO2.

5.4 The global assessment process

Towards the end of the training year, trainees will assess their own progression for each CiP (Figure 2) and record this in the ePortfolio, signposting to the evidence that supports their rating. The Education Supervisor will review the evidence in the ePortfolio including workplace-based assessments, the TO2 and the trainee’s self-assessment and record their global assessment of the trainee’s performance in the Education Supervisor Report (ESR), with commentary. Figure 3 shows how the trainee’s self-assessment and the evidence feed into the global assessment of the Education Supervisor.

Page 30 of 42

Figure 2 – Trainee self-assessment of a CiP

Figure 3 – Education Supervisor’s assessment of all CiPs

CiPTrainee

self-assessment

Key skills Evidence

Descriptors

Global assessment of

CiP

Trainee self-assessment

Evidence for each CiP

Guidance on expectations for stage of training

Guidance on expectations for stage of training

Page 31 of 42

Each CiP will be globally assessed against the expectations for the particular stage of training. However, there will be a difference between the global assessment of generic and non-clinical specialty CiPs, and clinical specialty CiPs. This is because of the need to allow the Education Supervisor to make a decision about how much supervision a trainee requires before they reach the designated level of supervision for a particular CiP. Generic and non-clinical specialty CiPs, The trainee will make a self-assessment to consider whether they meet expectations for the stage of training, highlighting the evidence in the ePortfolio. The Education Supervisor will indicate whether the trainee is meeting expectations or not using an anchor statement, as in the template below. Trainees will need to meet expectations for the stage of training as a minimum to be judged satisfactory to progress. The expectations for each stage of training for generic and non-clinical CiPs will be specified in the guidance.

Global assessment to be used for generic and non-clinical specialty CiP Trainee self-assessment FOR EACH CiP Statement of whether performance is considered by trainee to be: ➢ Below expectations for this year of training; may not meet the requirements for critical

progression point ➢ Meeting expectations for this year of training; expected to progress to next stage of

training ➢ Above expectations for this year of training; expected to progress to next stage of

training. Link to key skills evidence on ePortfolio. Education Supervisors assessment I agree with the trainee’s self-assessment of this CiP. I do not agree with the trainee’s self-assessment for the following reasons: Education Supervisors global assessment for all generic and non-clinical specialty CiPs Based on the trainee’s self-assessment and the evidence provided, I therefore consider that the trainee’s performance is: ➢ Below expectations for this year of training; may not meet the requirements for critical



training.

Page 32 of 42

Clinical specialty CiPs The trainee will make a self-assessment to consider whether they meet expectations for the year of training, using the four supervision levels listed in Table 3 and highlighting the evidence in the ePortfolio. The Education Supervisor will indicate whether the trainee is meeting expectations or not by assigning one of the four supervision levels, as in the template below. Trainees will need to meet expectations for the year of training as a minimum to be judged satisfactory to progress. The expectations for each year of training for clinical specialty CiPs will be specified in the guidance. Table 3 shows the five supervision levels that are based on an entrustability scale which is a behaviourally anchored ordinal scale based on progression to competence and reflects judgments that have clinical meaning for assessors1 . Table 3 – Levels of supervision

Level Descriptor Level 1 Entrusted to observe

Level 2 Entrusted to act under direct supervision: (within sight of the supervisor).

Level 3

Entrusted to act under indirect supervision: (supervisor immediately available on site if needed to provide direct supervision)

Level 4 Level 5

Entrusted to act independently with support (supervisor not required to be immediately available on site, but there is provision for advice or to attend if required) Entrusted to act independently

Global assessment to be used for clinical specialty CiP Trainee self-assessment FOR EACH CiP Statement of what level of supervision is required. Link to evidence on the ePortfolio. Education Supervisors assessment I agree with the trainee’s self-assessment and have added my comments to each CiP. I do not agree with the trainee’s self-assessment for the following reasons: 1 Entrustability Scales: Outlining Their Usefulness for Competency-Based Clinical Assessment

https://www.ncbi.nlm.nih.gov/labs/articles/26630609/

Page 33 of 42

Education Supervisors global assessment of the clinical CiPs I consider that the trainee’s performance overall meets the clinical entrustability scale of 1-5 (specify) and that the trainee is: ➢ Below expectations for this year of training; may not meet the requirements for critical



training.

5.5 Critical progression points

There will be two key progression points during O&G training – the waypoints. The outline grid below sets out the expected level of supervision and entrustment for the clinical specialty CiPs and the critical progression points for the whole of O&G training. The first critical progression point will be from ST2 to ST3 as the trainee will be ‘stepping up’ to become the obstetrics and gynaecology registrar. It is essential that educational and clinical supervisors are confident that the trainee has the ability to perform in this role. Trainees will be required to complete Part 1 MRCOG by the end of year 2 of training (ST2). The ARCP at the end of ST2 will play an important role in determining personalised, supportive plans for transition to the O&G registrar role. The second critical progression point will be at the end of ST5 when the trainee must pass the Part 2 and 3 MRCOG, as well as be signed off for the relevant generic and specialty outcomes and practical procedures. A satisfactory ARCP outcome will be required for entry to advanced training (ST6-7).

There will be a final critical progression point at the end of training. Doctors in training will be required to reach level 5 in all clinical specialty key skills by the completion of training. They will need to meet the appropriate level expectation for the key progression point between ST2 and ST3 and at completion of ST7. The ESR will make a recommendation to the ARCP panel as to whether the trainee has met the defined levels of achievement for the CiPs and acquired the procedural competence required for each year of training as specified in the Matrix and, where relevant, the critical progression points. The ARCP panel will make the final decision on whether the trainee can be signed off and progress to the next year/level of training [see section 5.6]. Tables 4-7 below outline the expectations for progress for the clinical CiPs and procedure

Page 34 of 42

Table 4 - Outline grid of progress expected for clinical CiPs

Level descriptors for clinical CiPs Level 1. Entrusted to observe. Level 2. Entrusted to act under direct supervision Level 3. Entrusted to act under indirect supervision Level 4. Entrusted to act independently with support Level 5. Entrusted to act independently.

Basic training Intermediate training Advanced

training CCT

Ccapabilities in practice ST1 ST2

CR

ITIC

AL

PR

OG

RES

SIO

N P

OIN

T

ST3 ST4 ST5

CR

ITIC

AL

PR

OG

RES

SIO

N P

OIN

T

ST6 ST7

CR

ITIC

AL

PR

OG

RES

SIO

N P

OIN

T

The doctor is competent in recognising, assessing and managing emergencies in gynaecology and early pregnancy.

1 2 3

4 5

The doctor is competent in recognising, assessing and managing emergencies in obstetrics.

1 2 3

4 5

The doctor is competent in recognising, assessing and managing non-emergency gynaecology and early pregnancy.

1 2

3 4 5

The doctor is competent in recognising, assessing and managing non-emergency obstetrics.

1 2

3 4 5

Table 5 – Outline grid of progress expected for gynaecology procedures

X = Competent to perform practical procedure independently with support Procedures Basic training Intermediate training Advanced

training CCT

ST1 ST2

CR

ITIC

AL

PR

OG

RES

SIO

N P

OIN

T

ST3 ST4 ST5

CR

ITIC

AL

PR

OG

RES

SIO

N P

OIN

T

ST6 ST7 C

RIT

ICA

L P

RO

GR

ESSI

ON

PO

INT

Endometrial biopsy X

Cervical smear X

Insertion of IUCD/IUS X

Surgical management of miscarriage or surgical termination of pregnancy

X

Hysteroscopy

X

Endometrial ablation

X

Page 35 of 42

Diagnostic laparoscopy

X

Simple operative laparoscopy

X

Laparoscopic management of ectopic pregnancy

X

Ovarian cystectomy

X

Midline laparotomy

X

Table 6 – Outline grid of progress for obstetric procedures

X = Competent to perform practical procedure independently with support

Procedures Basic training Intermediate training Advanced training

CCT

ST1 ST2 C

RIT

ICA

L P

RO

GR

ESSI

ON

PO

INT

ST3 ST4 ST5

CR

ITIC

AL

PR

OG

RES

SIO

N P

OIN

T

ST6 ST7

CR

ITIC

AL

PR

OG

RES

SIO

N P

OIN

T

Perineal repair X

Non-rotational instrumental delivery

X

Rotational instrumental delivery

X

Caesarean section (basic) X

Caesarean section (intermediate)

X

Caesarean section (complex)

X

Manual removal of placenta X

Surgical management of PPH

X

Surgical management of retained products of conception

X

Surgical wound debridement

X

Page 36 of 42

Table 7 – Grid of progress for ultrasound procedures X = Competent to perform practical procedure independently with support

Basic training Intermediate training Advanced training

CCT

Procedures ST1 ST2

CR

ITIC

AL

PR

OG

RES

SIO

N

PO

INT

ST3 ST4 ST5

CR

ITIC

AL

PR

OG

RES

SIO

N

PO

INT

ST6 ST7

CR

ITIC

AL

PR

OG

RES

SIO

N

PO

INT

Basic early pregnancy ultrasound X

Basic ultrasound for assessment of fetal size, liquor and placenta

X

5.6 Evidence of progress

The following methods of assessment will provide evidence of progress in the integrated programme of assessment. The requirements for each training year/level are stipulated in the Matrix of Progression. Evidence is a crucial concept in the new curriculum, and as well as the methods listed below, can include other sources, such as the Personal Development Plan or quality improvement project or procedure log. The trainee will collect evidence to support their self-assessment, and the Education Supervisor will use it to reach a global assessment.

Summative assessment

• The MRCOG examination: Part 1, Part 2 and Part 3 Clinical Assessment

• Objective Structured Assessment of Technical Skills (OSATS) - summative

Formative assessment

• Case-Based Discussions (CbD)

• Mini-Clinical Evaluation Exercise (mini-CEX)

• OSATS - formative

• Team Observation (TO1), TO2 and Self-observation (SO)

• Non-Technical Skills for Surgeons (NOTSS) Supervisor report

• Education Supervisor Report (ESR) These methods are described briefly below. More information and guidance for trainees and assessors are available in the ePortfolio and on the RCOG website (www.rcog.org.uk). Case-based Discussion (CbD) The CbD assesses the performance of a trainee in their management of a patient to provide an indication of competence in areas such as clinical reasoning, decision making and application of medical knowledge in relation to patient care. It also serves as a method to document conversations about, and presentations of, cases by trainees. The CbD should focus on a written record (such as written case notes, out-patient letter, discharge

http://www.rcog.org.uk/

Page 37 of 42

summary). A typical encounter might be when presenting newly referred patients in the outpatient department. Mini-Clinical Evaluation Exercise (mini-CEX) This tool evaluates a clinical encounter with a patient to provide an indication of competence in skills essential for good clinical care such as history taking, examination and clinical reasoning. The trainee receives immediate feedback to aid learning. The mini-CEX can be used at any time and in any setting when there is a trainee and patient interaction and an assessor is available. Objective Structured Assessment of Technical Skills (OSATS) A small number of procedures are so fundamental to the practice of O&G that they require an objective assessment tool to aid the review process. OSATS are validated assessment tools that assess technical competency in a particular technique. OSATS will be completed throughout training until the trainee is competent to practise independently. OSATS can be undertaken as many times as the trainee and their supervisor feel is necessary (formative). A trainee can be regarded as competent to perform a procedure independently after they have completed 3 OSATs by more than one appropriate assessor (summative). Multi-source feedback The TO1 form is a multi-source feedback tool based on the principles of good medical practice, as defined by the General Medical Council (GMC). TO1 forms are used to obtain feedback from a range of healthcare professionals and forms part of a trainee’s assessment. The TO1 is a snapshot feedback tool to be used by individuals at a fixed point in time. Individual team members completing a TO1 form should do so based on their experience of working with the trainee. The trainee will also be able to self-assess using a modified TO1 form (SO). The TO1 forms are summarised in a TO2 form which informs the ARCP. Non-Technical Skills for Surgeons (NOTSS) The NOTSS system provides a framework and common terminology for rating and giving feedback on non-technical skills. Used in conjunction with medical knowledge and clinical skills, NOTSS is a tool to observe and rate behaviour in theatre in a structured manner. This enables clear and transparent assessment of training needs. NOTSS describes the main observable non-technical skills associated with good surgical practice, under the following headings:

• Situation awareness • Decision making • Communication and teamwork • Leadership.

The RCOG has been piloting the NOTSS system for use on the labour ward and in the gynaecological operating room. We have removed the rating system to focus on providing constructive and timely feedback. The system includes only those behaviours that are directly observable or that can be inferred through communication. NOTSS covers a wide range of non-technical skills in as few categories as possible.

http://www.gmc-uk.org/guidance/good_medical_practice.asp

http://www.gmc-uk.org/guidance/good_medical_practice.asp

http://www.gmc-uk.org/

Page 38 of 42

Education supervisors report (ESR) The Education Supervisors will annually record a longitudinal, global report of a trainee’s progress based on a range of assessments, including exams and observations in practice or reflection on behaviour by those who have appropriate expertise and experience. The ESR can incorporate commentary or reports from observations, such as from supervisors, or formative assessments demonstrating progress over time. The Education Supervisor will offer a global assessment as to whether the trainee should progress to the next year of training.

Training evaluation form (TEF) Trainees are required to complete a TEF on annual basis. The data from the TEF enables a proactive approach to the monitoring of quality of training by triangulating with other available data eg. GMC National Training Survey. This data is shared with deaneries and will assist them with their quality management arrangments. In recognition of the importance that the RCOG places on trainee feedback, completion of the TEF is a requirement in the training matrix of progression.

5.7 Annual Review of Progression (ARCP)

The decisions made at critical progression points and upon completion of training should be clear and defensible. They must be fair and robust and make use of evidence from a range of assessments, potentially including exams and observations in practice or reflection on behaviour by those who have appropriate expertise or experience. They can also incorporate commentary or reports from longitudinal observations, such as from supervisors, or formative assessments demonstrating progress over time. Decisions on progression fundamentally rely on the professional judgement of the Education Supervisor based on the global assessment produced for each CiP. Table 4 sets out the level of expected performance for each of the CiPs. Tables 5-7 of practical procedures sets out the minimum level of performance expected at the end of each stage of training. The requirements for progression are set out in the Matrix of Progression. Periodic (at least annual) reviews should be used to collate and systematically examine evidence about a doctor’s performance and progress in a holistic way and make decisions about their progression in training. The ARCP process supports the collation and integration of evidence to make decisions about the achievement of expected outcomes. In order to guide trainees, supervisors and the ARCP panel, the RCOG has produced the Matrix of Progression, revised annually and shown in Table 8. It is essentially an ARCP decision aid which sets out the requirements for a satisfactory ARCP outcome at the end of each training year and critical progression point. The ARCP process is described in the Gold Guide. LETBs/deaneries are responsible for organising and conducting ARCPs. The evidence to be reviewed by ARCP panels should be collected in the trainee’s ePortfolio. As a precursor to ARCPs, the RCOG strongly recommends that trainees have an informal ePortfolio review either with their Education

Page 39 of 42

Supervisor or arranged by the local school of medicine. These provide opportunities for early detection of trainees who are failing to gather the required evidence for ARCP. Table 8 – Matrix of progression

5.8 Blueprint of assessments mapped to CiPs

Table 9 shows the possible formal methods of assessment for each CiP. It is not expected that every method will be used for each CiP and additional evidence will be suggested as indicated in the Matrix of Progression.

Basic Intermediate Advanced

ST1 ST2 ST3 ST4 ST5 ST6 and ST7

Formative workplace-based assessments These are encouraged as a method to provide evidence for CiPs. The aim is for quality over quantity. Useful WBAs will challenge, act as a stimulus and mechanism for reflection, uncover learning needs and provide an opportunity for developmental feedback

Mini-CEX

CBD

NOTSS

Reflective practice

Formative OSATS

Optional but encouraged

Summative workplace-based assessments

Competent Summative OSATS

3 3 3 3 3 3 3

TO2 2 2 2 2 2 2 2

Other evidence required for ARCP (to be specified in guidance for each CiP)

MRCOG examinations

Part 1 desirable essential

Part 2 desirable desirable essential

Part 3 desirable essential

Education Supervisor’s Report

Supervisor’s report

1 1 1 1 1 1 1

Trainee feedback

Training evaluation form (TEF)

Page 40 of 42

Table 9 - Blueprint of Assessments mapped to CiPs

CiPs OSATS Mini-CEX

CbD NOTSS TO1/ TO2

Reflective practice

MRCOG Part 1

Part 2 Part 3

Developing the doctor-Generic CiPs

The doctor is able to apply medical knowledge, clinical skills and professional values for the provision of high quality and safe patient-centred care

X X X X X X X X

The doctor is able to successfully work within health organisations

X X X X X

The doctor is a leader who has vision, engages and delivers results

X X X X X X

The doctor is able to design and implement quality improvement projects or interventions

X X X

The doctor understands and applies basic Human Factors principles and practice at individual, team, organisational

X X X X X X

Page 41 of 42

and system levels

The doctor takes an active role in helping self and others to develop

X X X X X X

The doctor is able to engage with research and promote innovation

The doctor is effective as a teacher and supervisor of healthcare professionals

X X X X X

Developing the obstetrician and gynaecologist-Specialty CiPs The doctor is competent in recognising, assessing and managing emergencies in gynaecology and early pregnancy

X X X X X X X X X

The doctor is competent in recognising, assessing and managing emergencies in obstetrics

X X X X X X X X X

The doctor is competent in recognising, assessing and managing non-emergency gynaecology and early pregnancy

X X X X X X X X X

The doctor is competent in recognising, assessing and managing non-

X X X X X X X X X

Page 42 of 42

emergency obstetrics

The doctor is able to champion the healthcare needs of people from all groups within society

X X X X X

The doctor takes an active role in implementing public health priorities for women and works within local, national and international structures to promote health and prevent disease

X X X X X X