THE ROYAL AUSTRALIAN AND NEW ZEALAND COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS

CERTIFICATION IN REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY TRAINING PROGRAM HANDBOOK 2004

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists

CERTIFICATION IN REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITYTRAINING PROGRAM HANDBOOK 2004

Published by RANZCOG PublicationsThe Royal Australian and New Zealand College of Obstetricians and Gynaecologists254-260 Albert Street, East Melbourne, Victoria 3002, Australia

© RANZCOG 2004

This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without written permission from The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Request and enquiries concerning reproduction should be directed to the Publications Officer, RANZCOG, 254-260 Albert Street, East Melbourne, Victoria 3002, Australia.

This material is available on the RANZCOG website at http://www.ranzcog.edu.au

IMPORTANT NOTICEON INFORMATION AND REGULATIONS

IN THIS HANDBOOK

Every effort has been made to ensure that the information and College regulations in this handbook were correct

at the time it was produced.

A regularly updated version of the handbook is available on the College website (http://www.ranzcog.edu.au) Readers are strongly advised to consult the website version when checking information or regulations.

TABLE OF CONTENTS

Schedule of Fees 6

Reproductive Endocrinology and Infertility (REI) - Definition 7

Aims of REI Subspecialty 8

Reproductive Endocrinology and Infertility Subspecialty Committee 9

List of current CREI Subspecialists 10

List of current CREI Subspecialists 11

The CREI Training Program 12

Applying for prospective approval to commence the REI Training Program 14

Training Program Assessment Requirements 17

REI Examinations 20

Syllabus for learning in Reproductive Endocrinology and Infertility 24

REI Subspecialty Training Clinical Skills to be Recorded in the Daily Training Record / Training Assessment Record 30

REI Subspecialty Training Clinical Skills to be Recorded in the Daily Training Record / Training Assessment Record 31

Standards for ther Accreditation of a CREI Training Unit 32

Currently Accredited Training Units 34

Continuing Certification 35

Subspecialties Compendium 36

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SCHEDULE OF FEES

Training

Annual Training Fee $AU 780

Late lodgement fee 10% annual fee per month

Re-instatement fee 50% annual fee

Assessment

COGU In-hospital clinical examination $AU 660

MFM In-hospital clinical examination $AU 660

Subspecialty Written Examination $AU 830

Subspecialty Oral Examination $AU 2080

Overseas-trained Subspecialist Assessment $AU 1275

Certification Fee

Subspecialty Certification Fee $AU 465

RANZCOG Privacy Policy

The RANZCOG is committed to the National Principles for the Fair Handling of Personal Information. A copy of these principles can be obtained at http://www.privacy.gov.au or by contacting the Privacy Commissioner on +61 2 9284 9600.

All information submitted to the College by or about Trainees will be handled responsibly and in accordance with these principles.

Only information essential to the legitimate function of the College will be collected. The College will endeavour to ensure that information collected is correct and current, and that it is kept as securely as practicable. On request, Trainees will be told how information collected about them will be used. Trainees may also arrange to view their files by making written application to the College.

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REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY (REI) - DEFINITION

Reproductive Endocrinology and Infertility is a subspecialty of obstetrics and gynaecology. Reproductive Endocrinology and Infertility subspecialists are specialists in Obstetrics and Gynaecology, awarded the FRANZCOG, who are trained and assessed as being competent in the comprehensive management of patients with reproductive endocrine disorders and infertility. A CREI subspecialist must spend at least 67% of his/her clinical time working in the area of this specialty, the remainder being split between obstetrics and gynaecology. At least part of this work must be within a professional setting that provides a comprehensive service for patients with infertility or gynaecological endocrine disorders (this may include private units as well as public hospitals). It is not intended that only persons with the CREI should treat infertile couples. It is probable, though, that specialists with this qualification will be leaders in this area and directors of assisted conception units.

The Certificate of Reproductive Endocrinology and Infertility (CREI) is a qualification only for individuals who hold the qualification of Fellow of The Royal Australian & New Zealand College of Obstetricians and Gynaecologists (FRANZCOG).

The College introduced certification in the five subspecialties in order to:

• improve knowledge, practice, teaching and research

• promote the concentration of specialised expertise, special facilities and clinical material that will be of considerable benefit to some patients

• improve the recruitment of talented graduates into areas of recognised subspecialisation

• establish a close understanding and working relationship with other disciplines

• encourage co-ordinated management of

relevant clinical services throughout a region

• accept a major regional responsibility for higher training, research and audit in areas of recognised subspecialisation

• establish, as far as possible, consistency in recruitment, training and assessment across areas of recognised subspecialisation

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AIMS OF REI SUBSPECIALTY

1. To provide competent management of patients with reproductive endocrine disorders and infertility.

2. To provide a comprehensive service for patients with infertility or gynaecological endocrine disorders.

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REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY SUBSPECIALTY COMMITTEE

The Reproductive Endocrinology and Infertility Subspecialty Committee is a sub-committee of the RANZCOG Council.

Subspecialty Committees comprise:

• Two subspecialists nominated by the Subspecialty Committee and recommended to Council without election

• Two members who hold the subspecialty qualification, nominated and elected by holders of the relevant Subspecialty qualification

• One specialist in obstetrics and gynaecology, nominated by Council

• A Chairman, appointed by Council on the recommendation of the Subspecialty Committee.

The committee is responsible for the development and maintenance of the College’s Reproductive Endocrinology and Infertility subspecialty training program, the approval of training units and training positions, approval of the programs and the assessment of training, development and maintenance of the syllabus, assessment of Overseas Trained Specialists, training and assessment in countries other than Australia and New Zealand, the appointment, support and ongoing training of Training Supervisors, and any other matters relating to the training program as may be directed by Council from time to time.

Subspecialty Committees report to the Training and Accreditation Committee, the Examination Committee, Council, and other Committees of Council as necessary. Subspecialty Committees usually meet three times per year by teleconference or face to face meetings. Meetings tend to be scheduled for the weeks preceding Council. Council meets in March, July and November.

Reproductive Endocrinology and Infertility Subspecialty Committee Correspondence

All correspondence pertaining to the work of the Reproductive Endocrinology and Infertility Committee should be forwarded to the Chairman of the Reproductive Endocrinology And Infertility Subspecialty Committee at the address below. The current Chairman is Professor Geoff Driscoll.

Chairman of RANZCOG Reproductive Endocrinology and Infertility

Subspecialty CommitteeCollege House, 254-260 Albert Street

East Melbourne VIC 3002AUSTRALIA

tel +61 3 9417 1699fax +61 3 9419 7817 or +61 3 9419 0672

email training@ranzcog.edu.auwebsite http://www.ranzcog.edu.au

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LIST OF CURRENT CREI SUBSPECIALISTS

State Subspecialists

New South Wales Dr W BirrellDr M BowmanProfessor M ChapmanDr A ClarkDr M CostelloProfessor G DriscollA/ Professor J EdenProfessor I FraserDr N GayerProfessor P IllingworthProfessor R JansenDr C S JamesDr R LahoudDr M LivingstoneDr D F LokDr R LynehamDr J W PerssonDr R PorterDr F B QuinnProfessor D SaundersDr R TeirneyDr I WangDr R Woolcott

Victoria Dr L BurmeisterDr B DowningDr L HaleProfessor D HealyProfessor G KovacsDr P J LutjenDr L RombautsDr A SpeirsDr C SternDr B VollenhovenDr D Wilkinson

ACT Dr Janelle McDonald

Queensland Dr C V BoothroydDr K Forbes

South Australia Professor J Kerin Professor R NormanDr O Petrucco

Continued over page ...

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LIST OF CURRENT CREI SUBSPECIALISTS(...continued)

State Subspecialist

West Australia Dr J Yovich

Tasmania Dr W Watkins

New Zealand Dr P BennyProfessor C FarquharDr P FisherDr W GillettDr F GrahamDr G GudexProfessor J HuttonDr Neil JohnsonDr G Phillipson

Overseas Prof B Dunphy

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THE CREI TRAINING PROGRAM

The 3-year Training Program comprises clinical training and assessment requirements as follows:

Clinical training program

• must be prospectively approved• first year must be in Australia or New Zealand• desirable that trainees should not spend all three years in the

same training site• minimum one year must be spent in Australia or New Zealand

one third of the training period should be spent in active research

• minimum number of surgical procedures to be completed over 3 years

• completion of an examinable university-based statistics course

Training documentation

• trainee reports completed by Training Supervisor and submitted to the College for each 6-month period

• clinical summaries to be submitted for each 6-month period• all reports must be submitted within 6-8 weeks of completing

each 6-month period• Mid –semester assessment to be completed • Trainee feedback form to be completed

Research project • research topic to be approved in first 12 months of training, with reports at 18 & 24 months

• original research work at a standard to be accepted in a peer-reviewed journal

• case reports and review articles not acceptable• research paper must be submitted by 30 April in the year of

examination• must have been finally approved at least two months prior to

the date of the oral examination

Written examination

• applications close on 30 April each year• usually held in early August (at same time as MRANZCOG

examination)• eligible only if satisfactory Training Assessment Record for 30

months of prospectively approved training• must be attempted for the first time within 2 years of

completion of training• maximum of four consecutive attempts allowed• comprises twelve fifteen-minutes short answer questions

Oral Examination • only eligible if written examination is passed and research paper approved at least two months prior to the examination

• usually held each year within six months of written examination

• comprises nine fifteen-minute stations (with fifteen-minute break). Five minutes preparation before each station is allowed

• histological sections, article, videos, laboratory worksheets, photographs, journal critiques may be included.

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Regulations governing the timing of the attempt at Examinations are included in the RANZCOG Subspecialty Training and Assessment Regulations in the Subspecialties Compendium.

All RANZCOG Trainees must be supervised by an appointed Training Supervisor/Program Director.

A detailed description of the Appointment and Duties of Subspecialty Training Supervisors/Program Directors is located in the Subspecialties Compendium.

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APPLYING FOR PROSPECTIVE APPROVAL TO COMMENCE THE REI TRAINING PROGRAM

Eligibility Prospective Trainees must:

1. have satisfactorily completed at least 48 months of the RANZCOG Integrated Training Program and have passed the Membership Examination, at the time training is to commence

OR

2. hold the FRANZCOG qualification.

Entry Level Knowledge

1. Candidates are strongly advised to review the following areas: Anatomy (including male genital anatomy), Surgical Pathology (excepting neoplasia), Reproductive Physiology (including male reproductive physiology) and Genetics and Ethics (as applied to reproductive medicine). These areas must be known at the level required for MRANZCOG and at the applied subspecialty tertiary referral level.

2. Candidates must be well acquainted with public health and social concerns in the subspecialty, including the concept of fecundability (monthly probability of pregnancy), leading to the normal expectations of pregnancy in the community, the medical, ethical, social, and legal aspects of assisted conception, donor gametes and embryos, and adoption.

3. Candidates should be familiar with current literature that concerns the subspecialty, especially articles published in the journals Fertility and Sterility and Human Reproduction. General medical journals, particularly the British Medical Journal, the Lancet, the Medical Journal of Australia and the New England Journal of Medicine also contain articles that concern the subspecialty and are therefore also recommended.

4. Candidates should be familiar with articles on reproduction in the Journal of

Clinical Endocrinology and Metabolism.

5. Candidates must be able to monitor and manage their own and their institution’s practices, carry out their own research studies, and analyse the work of others critically. The candidate must therefore have a thorough practical understanding of the statistical and managerial methods used in the field, such as:

• familiarity with hypothesis definition, experimental design, randomisation procedures, sampling techniques, data acquisition, data storage and statistical analysis

• scientific writing and composition

• application of parametric tests including un-paired and paired ‘t’-test, correlation, linear and multiple regression analysis and analysis of variance; on-parametric statistics; Chi-squared tests; the use of computers for data storage and statistical analysis

• computing means, standard deviations and standard errors, computing medians and confidence intervals; comprehension of significance testing including understanding of type I and type II errors

• epidemiological analysis, cohort and case control studies, assessment of bias, population parameters and sampling techniques

• life table analysis

• the techniques of quality control, quality assurance and total quality management in clinical and laboratory practice.

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National Selection Process

Eligibility Prospective Trainees must:

3. have satisfactorily completed at least 48 months of the RANZCOG Integrated Training Program and have passed the Membership Examination, at the time the training is to commence

OR

4. hold the FRANZCOG qualification.

Applications

The REI Committee will advertise annually (in the March issue of the O&G magazine) for prospective REI Trainees to apply for a training position in the REI Training Program which leads to certification as a subspecialist in Reproductive Endocrinology and Infertility.

All prospective Trainees must apply via the National Selection Process to commence training in the REI Training Program.

Applicants will be asked to forward a curriculum vitae with a list of research and publications and the names of three referees. The interviews will usually be held in June/July; applicants may be required to travel to College House for the interview.

Selection criteria for Trainees applying for the REI Training Program

Applicants will be assessed against the following Selection Criteria :

1. Previous experience in obstetrics and gynaecology

2. Previous surgical experience3. Research experience4. Psychosocial medical experience5. Teaching experience6. Commitment to Gynaecological Oncology7. Ability to relocate during the Training

Program8. Referee reports

Interview Panel

The interview panel will comprise two representatives of the REI Subspecialty

Committee, and Program Directors (or their nominees) from those Training Units which have a vacancy for training in the next two years. All applicants will be notified in writing of the outcome of the interview.

Registration

Following confirmation of a training post the prospective Trainee will need to register as a RANZCOG Trainee and pay the Annual Training Fee.

Trainees who have completed the training requirements, but not all the assessment requirements for certification in the subspecialty, must remain registered as a RANZCOG Trainee. They must pay half the Annual Training Fee until the satisfactory completion of all assessment requirements for certification in the subspecialty, unless notification in writing is received of the Trainee’s intent not to proceed with certification in the Subspecialty.

Trainees who have completed the examination but have not yet submitted the thesis are required to pay the annual Training Fee.

Trainees who have completed all other assessment requirements (including the research paper) and are waiting to sit the examination, are not required to pay the Training Fee IF they are sitting the examination in the following year as the result of a College decision to postpone a subspecialty examination until more than one candidate is eligible.]

Trainees who discontinue their registration as a registered RANZCOG Trainee and subsequently decide to obtain subspecialty certification will be required to pay half the Annual Training Fee for the period of time between the last record of registration as a RANZCOG Trainee and certification as a Subspecialist.

The RANZCOG registration and prospective approval of training form is distributed in December.

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Applying for prospective approval to continue the CREI Training Program

The Reproductive Endocrinology and Infertility Subspecialty Committee must prospectively approve all training for EACH year of training, even though prior overall approval for the three-year proposal has been gained.

Overseas Trained Subspecialists

Overseas Trained Subspecialists applying for Certification as CREI subspecialists are directed to consult the Subspecialties Compendium.

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TRAINING PROGRAM ASSESSMENT REQUIREMENTS

Minimum Surgical Procedures

Certification as a CREI Subspecialist requires a minimum number of surgical cases to be performed, assisted at or observed over the 3-year clinical training period as follows:

• assistance at 10 microsurgical cases performed by a CREI training centre approved microsurgeon

• assistance at one anastomosis/performance alternate anastomosis to count as one case when supervised by a CREI accredited training centre approved microsurgeon

• performance of 10 microsurgical cases overall

• involvement in a CREI Committee approved laboratory/animal research project supervised by a CREI training centre approved microsurgeon (counts for a maximum of 5 cases overall)

• documented microsurgical cases supervised by a CREI training centre approved microsurgeon during FRANZCOG training to count up to a maximum of 5 cases.

Daily Training Record Logbook - Printed Version

This is for recording on a daily basis:

• clinical experience• attendance at meetings • attendance at outpatient clinics • research activities.

The information in the Daily Training Record must be tallied and recorded in the Training Assessment Record at six-monthly intervals.

NB It may be necessary for the Chairman of the Subspecialty Committee, or the Training Supervisor/Program Director to view the Daily Case Record for verification or clarification of details in the Training and Assessment Record.

The Daily Training Record Logbook is a record of selected aspects of your experience during 1 year of the Training Program. Trainees will be issued with a printed version of this Logbook, but they can keep an electronic version instead

if they choose to do so, provided they meet certain requirements (see below). This record of experience, whether in printed or electronic format, has several functions:

• It provides you with a personal record of clinical experience, which can be used to plan further training with your Training Supervisor or other mentors.

• It provides you with the basis for the 6 monthly summaries of your experience, which you are obliged to prepare for the College. These are used by your Training Supervisor, the relevant Program Co-ordinator, and the REI Committee to monitor your experience and ensure that it is appropriate for your year of training. This information is also used by the College to monitor the experience provided for you by the hospital.

NOTE: The Logbook is reviewed and signed by the Training Supervisor every 3 months.

• It makes up a component of the formal proof of training, which you are obliged to provide to the College when you apply for Fellowship.

Important noteYou are required to use a new Logbook for EACH year of training. You will receive a new Logbook at the beginning of each year from the College following registration as a Trainee for that year. There is no charge for the Logbook, as its cost is included in your Annual Training Fee.

The Logbook includes detailed instructions on how to complete it.

Daily Training Record Logbook – Electronic Version

Trainees may maintain an electronic Daily Training Record Logbook providing the following requirements are met.

When setting up an electronic Logbook all the introductory pages of the printed College Daily Training Record Logbook, including the Certificate of Accuracy and the Record of Discussion and Agreement by Training Supervisor must be incorporated. In addition, the headings contained in the Logbook must be

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duplicated in any electronic Logbook.

Every 3 months, you must submit a printed Daily Training Record Logbook for signature and notation by your Training Supervisor. If the data has been maintained electronically, then a print-out of the data must be produced at the time of signing. The print-out must also be notated and signed by the Training Supervisor and be specifically referred to in the printed Logbook.

The RANZCOG will only accept the printed Logbook for assessment purposes. Where electronic records are maintained and the Training Supervisor has noted print-outs of these records, the print-outs must accompany the Logbook.

In addition:

• electronic Logbooks must be in a spreadsheet program, such as Excel

• full headings are required and must be shown on any print-out

• annotations used in electronic Logbooks must be fully explained in an accompanying legend

• trainees must regularly back-up any electronically maintained Logbook. Claims for recognition of training will not be recognised where data cannot be produced

• training periods must also contain all relevant information to determine the relevant training period (including training year), the name of the training supervisor, location, and type of training. Training periods should be kept separate from each other

The privacy of all patients must be protected.

The guidelines detailed in the printed College Logbook apply to electronically maintained Logbooks and records.

Training Assessment Record (TAR)

The Training and Assessment Record is designed to provide the Chairman of the Subspecialty Committee and the Training Supervisor/Program Director with a sequential presentation of all training and assessment achievements. It will enable you to record progress made in each of the components of

the CREI Training Program.

The Training and Assessment Record Book must be updated every six months and sighted by your Training Supervisor, who signs the Six-Monthly Training Summary (see below) before it is forwarded to the College. You should also forward the Six-monthly Trainee Report (see below).

Completion of Training Assessment Record

• Update as necessary the record of training sites and dates for commencement and completion of training

• At the end of each six-month period:

Clinical training: Tally the clinical experiences recorded in the Logbook and record the results on the Six-monthly Clinical Training Summary. Your Training Supervisor must sign this summary.

Average weekly timetable: Complete an average weekly timetable for the six-month training period. NB If the training program altered significantly during the six months, use photocopies of the page to indicate the different training experiences.

Research report: Complete the Trainee Research Progress Report and have the Training Supervisor complete the Training Supervisor Research Progress Report.

Discussion: Discuss your Training Assessment Record and the accompanying Six-monthly Trainee Report (see below) with your Training Supervisor. Sign the Six-monthly Trainee Report.

NOTE: the Subspecialties Committee assesses all overseas training. Trainees undertaking overseas training will need to forward their Training Assessment Record to College House in Melbourne.

Mid-semester assessment

The mid-semester assessment is completed by the trainee and Training Supervisor, each giving a brief assessment of the trainee’s progress over the three-month period. The Training Supervisor must indicate if the assessment is

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satisfactory OR that improvement is expected. In the latter case a warning is then given that failure to improve may result in a FAIL in the next six-monthly Trainee Report. The Training Supervisor and Trainee must both sign and date the form before it is forwarded to College House.

Six-monthly Trainee Report

The Six-monthly Trainee Report, which is completed by the Training Supervisor, is a summary of the ratings and comments collected from individual consultants with whom you work. Each of the relevant consultants fills out a Trainee Assessment Form. Your Training Supervisor consolidates the information into the single composite Six-monthly Trainee Report. This report is used for two purposes:

• it provides you with feedback on your performance from the consultants with whom you work

• it provides the College with feedback on your progress

Completion of Six-monthly Trainee Report

Your Training Supervisor is responsible for completing the Report, based on the Trainee Assessment Forms which have been filled out by the consultants. Your Training Supervisor will discuss the Report with you before you BOTH sign the document.

Note: in some overseas hospitals, the Training Supervisor may not be familiar with the forms or this requirement, and you will need to provide him/her with copies of the appropriate form and explain how it is used.

Submitting Training Documentation

It is essential that the College receives the above documentation after the completion of each six-month period. The Six-monthly Trainee Report MUST be received at College House no later than eight weeks from the END of each six-month training period.

A period of training CANNOT be credited until the Subspecialties Section at College House

receives copies of satisfactory Six-monthly Trainee Reports and Clinical Summaries for that period.

The College will only accept forms where:

• The Training Supervisor has indicated the Report is either satisfactory or unsatisfactory

• The Report has been signed by the Training Supervisor

• The Report has been signed by the Trainee

If any of the above are missing from the form, it will be returned for completion.

Trainees who do not submit satisfactory Six-monthly Trainee Reports and Clinical Summaries will be discussed by the Subspecialties Committee and a recommendation will be made to the Federal Training and Accreditation Committee that no credit is given for the period in question. This will extend the training time for the Trainee.

Six-monthly Feedback Questionnaire on Training Unit by Trainee

All RANZCOG REI Trainees are required to provide a confidential evaluation of their Training Unit. This questionnaire can be discussed with the Program Director, although this is not essential, and should be sent to the Chairman of the Reproductive Endocrinology and Infertility Committee via College House. This report aims to identify strengths and weaknesses within Training Units so that, where appropriate, improvements in a Training Unit may be encouraged. The Chairman (or nominee) will contact the Trainee to discuss any identified weaknesses and the best approach to improve the situation.

Removal from Training Program

A trainee who receives 3 consecutive unsatisfactory reports will be removed from the training program. After 2 unsatisfactory reports, an agreed remedial program should be enacted (if not already in place).

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REI EXAMINATIONS

Number of attempts at the examination

Subspecialty Trainees have a maximum of four consecutive attempts at the written and oral examinations. Candidates who believe there are special circumstances preventing them from consecutive attempts may apply to the Subspecialty Committee for consideration of their case.

Written examination

Applications

Applications for both the Written and Oral Examinations will close on 30 April each year. Please contact the Subspecialties Co-ordinator for application and fee details. The application form may also be downloaded from the College Website.

Eligibility

The Training Assessment Record must have been assessed as satisfactory for a minimum of thirty months of prospectively approved clinical training. This includes the Six-monthly Trainee Reports and Six-monthly Training Assessments.

Note: The minimum training period (thirty months) is calculated up to three weeks prior to the date of the Examination.

Format

Subspecialty Written Examinations are usually held on the same day as the MRANZCOG Written Examination in August. The three-hour Examination comprises 12 short answer questions with fifteen-minutes allowed for each.

The CREI Written Examination covers five areas: female reproductive medicine (gynaecological endocrinology), male reproductive medicine (andrology), reproductive surgery, assisted conception and applied reproductive physiology, including statistics.

A selection of past examination questions is available upon request.

Oral Examination

Eligibility

Trainees must have satisfactorily completed the Written Examination and Research Project. Candidates will be informed as soon as possible after the results of the Written Examination become available.

Format

The Oral Examination takes approximately three hours to complete and will comprise nine clinical stations. The candidate will rotate through each of these stations during the examination. The Examination will be held on a date determined by the REI Subspecialty Committee.

Examination Stations

There will be 9 separate encounters with 5 minutes preparation time for each encounter. Candidates will pass through each examination station and, before each encounter begins, will be given the introductory details of a clinical case or cases that will be developed during the encounter.

Stations may consist of two examiners examining concurrently or sequentially, or one examiner and an observer. There will be 9 stations of 15 minutes duration duration. Every attempt will be made to ensure that you will not be directly examined by an examiner from your own hospital.

Candidates should ask explicitly for additional relevant historical and physical details, for the results of investigations, for consultations if needed, and for responses to treatment. Examiners can then formally change these answers to explore candidates’ ability to deal with expected or unexpected complications or confounding events, and with simulated late-stage referrals.

Histological sections, videos, laboratory work sheets and microscopic photographs can be shown. Where a station consists of a critique of a journal article, there will be 30 minutes’ reading time at the beginning of the examination with 5 minutes to review the article immediately prior to that encounter. Questions will not necessarily be restricted to those that would apply to the case.

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Notes may be made during the encounters (and while reading the published paper) but are to be left in the examination room.

Instructions for Candidates attempting the Oral Examination

Candidates who succeed in this examination will be expected:

• to be clinically competent and authoritative in each of the areas to be examined (female reproductive medicine, reproductive surgery, assisted conception, male reproductive medicine, clinical reproductive physiology);

• to know the principles and limitations of laboratory practice that affect the making of clinical decisions;

• to show skill and sensitivity in informing patients and relatives of options and implications of alternative plans of management;

• to demonstrate detailed practical knowledge of the legal, regulatory and ethical framework in which the subspecialty is practised; and

• to show knowledge of clinical trial methodology and statistics needed both to analyse scientific data and published papers critically and to conduct or supervise such studies.

The device of simulated clinical encounters, in which examiners can, for example, assume the role of colleague, patient, spouse, scientist-technician, nurse, consultant or junior researcher will test these skills.

Research Project

The Research Project should be prospectively approved by the relevant subspecialty committee and the Trainee’s Research and Ethics Committee, and demonstrate the basic principles of research: original hypothesis testing, research methodology, rigorous scientific method. The paper should be in a format suitable for submission to a journal. The research topic should be submitted to the relevant subspecialty committee for approval by the end of the first 12 months of training, and progress reports submitted at 18 and 24 months.

Research supervisors will be appointed on the nomination of the trainee. The supervisor could

be the training supervisor, but the relevant subspecialty committee must approve the nomination.

Trainees must submit a research paper which should be at a standard which is suitable for submitting to a peer-reviewed journal, by 30 April in the year of examination. Case reviews and reports will not be acceptable. The project must be the result of ongoing research. A doctoral / MD thesis may exempt the trainee from the research project component of the training program, but will not reduce the amount of clinical training time. Trainees will still be expected to demonstrate their involvement in ongoing research.

The project must have been assessed as satisfactory 2 months before the oral examination. If the paper is assessed as ‘fail but suitable for resubmission’ a member of the relevant subspecialty committee will be assigned to assist the candidate to revise the paper for re-submission within 6 months. If the paper is failed again the full Subspecialties Committee should review the result with a report from the Chairman of the relevant subspecialty. The Subspecialties Committee will make a recommendation to the Examination Committee about the next course of action.

Trainees will not be eligible for the oral examination until the Research Project has been passed. Guidelines for assessment of the Research Project are presented in the Subspecialties Committee Regulations and Procedures in the Subspecialties Compendium.

Notes:

1. Three copies of the research paper must be submitted.

2. Case reports and review articles are not acceptable for the thesis.

3. All submissions for assessment must include the covering page which is located in the Subspecialties Committee Regulations and Procedures.

4. The research project must have been finally approved two months before the Oral Examination.

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Special Consideration Guidelines for RANZCOG Examinations

Preamble

Special consideration is available to candidates who believe their examination preparation and/or performance has been hampered by illness or other causes to such a substantial degree that it is likely to adversely affect their performance and, consequently, their result in a College examination.

Special consideration is available for all RANZCOG written and oral examinations, including the in-hospital clinical examinations for the subspecialties Maternal Fetal Medicine and Obstetrical and Gynaecological Ultrasound.

All applications for special consideration must be supported by appropriate documentation, except in exceptional circumstances that render this impossible or redundant. Appropriate supporting documentation includes, but is not limited to, certificates or statements from medical professionals licensed to issue such certificates or statements, police reports, bereavement notices and statutory declarations. In particular, applications for special consideration that are based on illness grounds will NOT be considered without appropriate supporting documentation from medical professionals licensed to issue such certificates or statements.

1. Grounds for special consideration

The most common reasons for applying for special consideration include serious illness (either yourself or a close family member), bereavement, family breakdown and personal trauma. If you are in any doubt as to whether particular circumstances warrant special consideration, you should seek advice from the Assessment Co-ordinator (MRANZCOG and DRANZCOG examinations) or the Subspecialties Co-ordinator (all subspecialty written and oral examinations) at the College.

Special consideration is available to candidates who have been:

• prevented by illness or other cause from preparing or presenting for all or part of an examination; or

• adversely affected to a substantial degree by illness or other cause during the performance of an examination.

In cases where candidates feel their examination preparation has been significantly impaired through illness, the College should be contacted and advice requested.

2. Consideration

The RANZCOG Examination Committee will consider applications for special consideration relating to MRANZCOG and DRANZCOG examinations. Applications for special consideration relating to subspecialty examinations will be considered by the relevant subspecialty Board of Examiners, who will make recommendations to the RANZCOG Examination Committee.

Applications for special consideration will be regarded in the strictest confidence and anonymity of applicants will be maintained where possible. Members of the relevant subspecialty Board of Examiners and/or the RANZCOG Examination Committee will, however, be informed of details of the circumstances relating to the application in order to make a decision relating to the application.

Applications for special consideration will only be considered by the relevant College body where a candidate has submitted an application in accordance with the procedures outlined in this document, and where the candidate has not gained a grade of ‘Pass’ in the examination in question under the normal College procedures.

3. Possible outcomes

The outcome of an application for special consideration may be any of the following, based on material presented to the relevant College body considering the application.

• Candidates may be deemed to have passed the examination.

• Candidates may be allowed a further attempt at the examination without affecting the number of attempts available to them under relevant College regulations.

• Given other consideration as deemed appropriate.

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• No action may be taken.

Where the decision relating to an application for special consideration results in a candidate being granted extra or supplementary attempts at an examination, the decision will include a recommendation relating to the charging of fees or otherwise to the candidate for presenting at those attempts.

The remarking of an examination paper is not an option available under special consideration provisions, unless the candidate can demonstrate that an error in process or natural justice has occurred that warrants such action.

4. Application Requirements and Time Limits

Candidates should advise the College of circumstances that they feel may warrant special consideration as soon as they are aware that such circumstances exist, and communication with the College is possible. Initial notification may be verbal or written; however, formal notification to the College in writing (via e-mail acceptable) on the official College form MUST occur no later than TWO days after the relevant examination was scheduled or held. Applications relating to MRANZCOG and DRANZCOG examinations should be directed to the Examinations Officer at the College. Applications relating to subspecialty examinations should be directed to the Subspecialties Coordinator at the College.

The fee payable for lodging an application for special consideration shall be A$150. This fee must be included with the written application and shall be refunded in the cases where special consideration is granted. In cases where applications are lodged via e-mail or Fax, a written authorisation for debit to the applicant’s credit card is acceptable. 5. Late applications

An application made after the relevant date, or not on the approved form, must be made to the Chairman of the College Examination Committee. Such applications will only be accepted if the Chairman is satisfied that it was not possible for the application to have been made on the prescribed form or by the required date. Late applications MUST include an outline of the reason(s) why the application

was not submitted by the due date. It should be anticipated that any application for special consideration in an examination made after the publication of results in that examination will not normally be accepted.

6. Appeals

Applicants for special consideration will be advised of the outcome of their application as soon as is practicable after a decision is reached. Applicants may appeal the decision made in relation to their application through the normal College appeals procedure outlined in Section 19 of the College Regulations.

Applicant’s Checklist

To assist your application, please ensure that you have completed these steps.

Have you read the “Special Consideration Guidelines for RANZCOG Examinations” information?

Have you notified / discussed your application with the College Assessment Co-ordinator or Subspecialties Co-ordinator as appropriate?

If your application relates to circumstances that arose during an examination, did you advise the examination invigilator, local organiser or examination coordinator as appropriate? If ‘yes’, you should include this in your written statement.

Have you attached supporting documentary evidence?

Have you specified why you are seeking special consideration?

Have you written a statement outlining how the illness / difficulty has affected your studies or examination preparation and/or performance?

Have you included or authorised payment of the appropriate fee?

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SYLLABUS FOR LEARNING IN REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY

Embryology

• The embryonic development of the genital tract in the male and female, including factors controlling male and female gonadal primordia, internal duct systems and external genitalia.

• Embryology of the hypothalamic/pituitary, adrenal and thyroid endocrine systems.

• The development of the urological system.

• The development of the breast.

• The mechanism, diagnosis, and management of female patients with developmental abnormalities of the genital tract including ambiguous genitalia, imperforate hymen, vaginal septa, uterine anomalies, Mullerian agenesis and gonadal dysgenesis.

• The mechanism, diagnosis, and management of male patients with developmental abnormalities including failure of testicular development and / or testicular descent, penile abnormality, and ambiguous genitalia.

• Anomalies associated with the urological system in the male and female.

Nueroendocrine

• Suprahypothalamic structures and neural systems relevant to the regulation of the reproductive processes.

• The anatomical-functional aspects of the peptidergic, catecholaminergic, and opiode systems in the control of hypothalamic/pituitary function.

• The neurovascular arrangements between the hypothalamus and the pituitary.

• The biochemical basis (including

structure/function) of hypothalamic/pituitary secretion including feedback. The interaction of reproductive steroids with the hypothalamic/pituitary complex.

• The control and functional aspects of rhythmic functions (long and short term) of hypothalamic/pituitary function.

• Distribution and cellular characteristics of pituitary hormone secretion with particular reference to the gonadotrophe and the lactotrophe.

• The function of the pineal gland and melatonin as related to reproduction.

• The site of production, biological action and control of secretion of oxytocin, vasopressin and the neurophysins.

• The neuropharmacology of GnRH and its analogues together with a knowledge of compounds with similar functions in related areas.

• The normal (organic and non-organic) of hypothalamic pituitary, hypo and excess secretion in the female.

• The mechanisms, investigation, and management of hyperprolactinaemia.

• The neuroendocrine control of the male reproductive system. Hypo and hypergonadotrophic states in the male.

• The blood brain barrier.

Hormone Action

• The biosynthesis, secretion, production rate, clearance and plasma binding of the major steroid hormones of reproduction.

• The mechanism of steroid and protein hormone action at a cellular level with particular reference to the reproductive hormones.

• The response of the reproductive tract to cyclical endocrine changes.

• The concepts of receptor activity, specificity, and kinetics and their application to receptor assay methodology.

• The administration, absorption,

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distribution, metabolism, and excretion of drugs/hormones relevant to reproduction including during pregnancy. Tetrogenecity tolerance, biological variation, modifying features, interactions of common drug and hormone therapies.

• Awareness of Government and pharmaceutical regulations pertaining to drugs/hormones and their development together with the design and analysis of clinical trial methodology.

Gonadal Function

• The development and changes throughout life inherent in the ovary and testis.

• The influence of genetic constitution on ovarian and testicular development.

• Cyclical changes in biochemical functions and control mechanisms within the ovary.

• The mechanisms of atresia, selection, and maturation of the dominant follicle(s). The corpus luteum, its control in the non-conceptual and conceptual cycle.

• The impact of ovulation induction and hyperstimulation agents on the ovary.

• The polycystic and related ovarian syndromes.

• The development, maintenance, and changes through life of endocrine and gametogenetic testicular function.

• The induction and maintenance of normal spermatogenesis including endocrine, genetic and local environmental effects.

Disorders of the Female Reproductive Cycle

• The neuroendocrinology of the abnormal reproductive cycle.

• The physiology of development and regression of normal and abnormal endometrial growth and the impact of exogenous hormones.

• The physiology, pathophysiology, investigation, and management of disordered menstruation, anovulation and endometrial hyperplasia.

• Non-gynaecological causes of abnormal uterine bleeding.

• The pathophysiology of amenorrhoeic states, their investigation and management.

Breast

• Benign disorders of the breast.

• The breast as an end organ for reproductive hormone response.

Thyroid and Adrenal

• The physiology, biosynthesis, control, and metabolism of normal thyroid and adrenal hormonal function.

• The mechanism, investigation, diagnosis, and management of disordered thyroid/adrenal states with particular reference to reproductive function.

• Thyroid/adrenal changes in pregnancy and the newborn.

• The pharmacology and effects of thyroid/adrenal drug/hormone therapy on the reproductive system and pregnancy including the fetus.

• The syndromes of congenital disordered adrenal function. The effect of adreno cortical hypo and hyper function. The normal and disordered renin-angiotensin and catecholamine systems.

Androgen Disorders

• The production, physiology and metabolism of androgens in the normal female together with the mechanism of androgen action.

• The clinical syndromes, differential diagnosis, investigation and management of syndromes of androgen excess in the female.

• The physiology of normal/abnormal hair

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growth in the female.

• The diagnosis, investigation, and management of late onset adrenal hyperplasia.

• The pharmacology of antiandrogen therapy.

• The production, physiology, and metabolism of androgen in the normal male.

• The clinical syndromes of androgen deficiency in the male.

• Syndromes of receptor and enzyme abnormality in the male and female.

Development and Cessation of Mature Reproductive Function

• The endocrine changes associated with reproduction from conception to the mature development of normal reproductive function including gonadotrophin secretion in the male and female fetus and neonate.

• The normal chronology of pubertal changes in the male and female.

• The effects of gonadal and adrenal hormones on bone growth and other non-reproductive organs.

• The mechanism, investigation, diagnosis, and management of delayed pubertal development and the syndromes of sexual precocity.

• Disorders of sexual development. Male and female pseudo hermaphroditism.

• The physiology and pathophysiology of the menopause including gynaecological and non-gynaecological clinical manifestations.

• The role of replacement and therapeutic regimes associated with the menopause.

• The mechanism, investigation and management of bone loss.

• The effect of old age on testicular endocrine and gamete function.

Genetics

• The principles of Mendalian inheritance, pedigree, and linkage analysis.

• The genetic basis of clinical syndromes including chromosomal abnormalities with special reference to syndromes affecting sexual development and reproductive function of both the male and the female.

• Antenatal diagnosis of genetic abnormalities. The indications and arrangements for specialized service for genetic diagnosis and counselling.

• The relevance of genetics to male and female infertility, artificial insemination, and early pregnancy loss.

• Familiarity with the standard laboratory procedures associated with chromosomal preparation, identification, and current nomenclature.

• The mechanisms of mitosis and meiosis including the effects of chromosome segregation.

Immunology

• The mechanism of antibody response including the origin and function of IgA, IgM, IgG and IgE.

• The origin and functions of “T”, “B”, “helper”, “suppressor”, and “natural killer” cells.

• The effect of active and passive immunization on hormonal specific target tissues.

• Knowledge of auto-immune disease affecting reproduction.

• The basic components of the immune system and their possible role in male and female reproductive failure, recurrent abortion, infertility and contraception.

• The place of immunological diagnostic procedures relating to infertility, fertility, gonadal failure and endocrine dysfunction.

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Pathology

• The normal histological appearance (together with cyclical changes where appropriate) of the vagina, endometrium, the myometrium, fallopian tube and the ovary in the female.

• The normal histological appearance of the male reproductive tract and the testis.

• The normal histology of the pituitary, the adrenal, and thyroid glands.

• The normal histological features of early implantation and of early pregnancy loss.

• The normal features of aging on the reproductive tract.

• The pathological changes characteristic of the impact of endometriosis, antenatal hormone exposure, the action of abnormal levels of endogenous reproductive hormones, myofibromata and infection.

• The histology of physiological, physiopathological, and specific pathological tumours associated with hormonal production from the ovary and testis.

• The pathological features of gonadal dysgenesis and intersex.

• The histological features of tumours of the pituitary, changed thyroid and adrenal function and other tumours associated with reproductive function.

• The features of altered testicular architecture related to reproduction function.

Fetal Medicine

• The maintenance of pregnancy and the initiation of parturition including physiology, pathophysiology, and pharmacology of the prostaglandins and related compounds.

• The neuroendocrine and general endocrine changes in the mother during pregnancy and the puerperium.

• The physiology of decidual-chorionic peptide hormones.

• Physiology and pathophysiology of fetal phypothalamic pituitary, gonadal, and pancreatic function.

• The pathophysiology of altered maternal endocrine states, e.g., thyroid, adrenal, and pancreatic states during pregnancy.

• The feto placental unit as it relates to the physiology and pathophysiology of steroid hormones.

• The physiology of the fetal adrenal gland.

The Control of Fertility

• The pharmacodynamics, metabolic effects and complications of oral and injectable contraceptive preparations.

• The mechanism of action and complications of intrauterine contraceptive devices.

• The efficacy of traditional contraceptive methods.

• Surgical techniques associated with male and female sterilization.

• The techniques of interruption of pregnancy.

• The potential of immunology for contraception.

• The status of contraceptive research and its limitations.

Female and Male Fertility

• The normal expectations of fertility in the community and the evaluation of the infertile couple.

• The diagnosis, investigation, and management of non-ovulation including modes of investigation and the selection of ovulation inducing drugs.

• The role of microsurgery for tubal corrective procedures in the male and female and the influences on the expectation of results.

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• The evaluation of uterine and cervical factors in infertility including the indications for corrective procedures.

• The mechanism, diagnosis, investigation, and management of endometriosis.

• Artificial Insemination (husband) - indications, methods applicable, results, and limitations.

• Donor Insemination - indications for therapy, selection of donors, methods of therapy, results, medical, legal, and ethical aspects.

• Adoption - medical, legal aspects, areas of counselling, adoption agencies, local regulations, outcome of procedures.

• IVF/GIFT and related procedures - the choice of hyperstimulation regimes, normal and abnormal responses, decision making, methods of oocyte collection, oocyte recognition, influences on the rates of fertilization, methods of gamete and embryo transfer, the expectation of results, medical and ethical aspects of this technology. Federal and State legislation relating to the above procedures including the constraints on research.

• Sperm-oocyte interaction, fertilization and early embryonic development.

• The practical approaches to ovum and embryo donation and recipient preparation.

• Scientific methods used for infertility programs including life table analysis.

• The formation, composition, and analysis of seminal fluid. Tests of spermatozoa function.

• The physiology and pathophysiology of ejaculation and sexual function including hormonal and non-hormonal influences.

• The male reproductive tract and conditions relevant to infertility, sperm transport, and accessory duct function.

• The medical and surgical approaches to therapy of male infertility.

• The role of endogenous and exogenous androgens to infertility in the male.

• The usefulness of diagnostic procedures in the infertile male.

• The mechanisms, investigation, and management of azoospermia and oligospermia.

Early Pregnancy Loss

• The mechanism of implantation and the physiology of early pregnancy recognition.

• The mechanisms investigation, diagnosis, and management of patients with multiple early pregnancy loss.

• The immunology of early pregnancy loss and the role of therapy.

• The genetics of early pregnancy loss.

Sexual ASpects of Reproduction

• Physiodynamics of normal psychosexual development and the establishment of the gender role through childhood, puberty, and adulthood.

• Normal and abnormal psychosexual function and gender disturbance.

• Psychological factors in disordered male and female reproductive function.

• Psychological changes associated with infertility and the impact on the family.

• The psychological and endocrine changes associated with premenstrual syndrome, the menopause and the impact of hormonal therapy.

• The principles of sexual counselling and modes of therapy.

Clinical Diagnostic Techniques / Surgical Techniques

• Be able to interpret findings, and perform competently when appropriate: operative biopsy of the lower reproductive tract, cytology, endoscopy, laparoscopy, hysteroscopy with assorted techniques, reversal of sterilization, infertility surgery

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including reconstruction of bicornuate or septate uterus, myomata, uterine synechiae, cervical incompetence, reparative techniques for tubal and/or adhesive pelvic disease, wedge resection of the ovaries, ovarian cystectomy, the staging of endometriosis and surgical management. The place of laser surgery.

• Radiographic/imaging associated with reproduction, hysterosalpingography, pituitary radiology, arteriography, arterial catheterisation, urography, isotope imaging and ultrasound, nuclear magnetic resonance and thermography.

• Dynamic endocrine testing. Visual field examination.

• The surgery of development disorders including neovaginal, vulva construction, imperforate hymen, vaginal septate, mullerian anomalies with obstruction of drainage.

• Surgical techniques for the management of ambiguous genitalia.

• The indications and techniques for gonadectomy in the female.

Laboratory Prcedures

• The methods and kinetics associated with the production, distribution, and metabolism of reproductive hormones.

• Immuno and bioassay methodology for common reproductive steroid and protein hormones.

• Receptor identification, function, and analysis.

• The culture and maintenance of oocytes, fertilization, and preparation for embryo transfer.

• The role of the micromanipulator in gamete handling.

• The techniques of sperm analysis and the procedures associated with the isolation of motile spermatozoa.

• Cryobiology associated with gamete and embryo preservation.

Research Methods

• Familiarity with hypothesis definition, experimental design, sampling techniques, data acquisition, data storage, selection of appropriate statistical analysis and scientific writing.

• Knowledge of the appropriate application of statistical parametric tests including unpaired and paired, “T” test, correlation, linear, and multiple regression analysis, and analysis of variance. Non-parametric statistics. The use of computers for data storage and statistical analysis.

• Computing means, standard deviations and standard errors. Comprehensions of significance, confidence interval, type I and type II errors.

• Epidemiological analysis, cohort and case control studies, assessment of bias, population parameters and sampling techniques.

• Familiarity with the techniques of quality control in laboratory procedures.

Molecular Biology

• A general appreciation of recombinant technology and its potential impact in medicine through the availability of purified proteins and improved diagnostic techniques.

• A general understanding of the basic techniques of gene manipulation including the use of restriction endonucleases and specific hybridization probes to isolate genes, the use of cloning vectors in gene propagation, the techniques of DNA sequencing and synthesis.

• An appreciation of the potential application of rDNA technology in biology and medicine with particular reference to rDNA probes for the diagnosis of genetic disease in adult and fetal medicine.

• The engineering of transgenic organisms and their use as a source of human proteins and other reagents of pharmaceutical interest.

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REI SUBSPECIALTY TRAINING CLINICAL SKILLS TO BE RECORDED IN THE DAILY TRAINING RECORD / TRAINING ASSESSMENT RECORD

It is appreciated that as the subspecialty evolves there will be Trainees who will be at the forefront of its evolution and who do not intend to practise clinically in every area of the subspecialty. Nevertheless they must, in their training, acquire a working knowledge of these skills in order to place themselves properly in the context of any given situation and the enquiries of their non-subspecialist colleagues.

The skills required are listed as follows, together with their abbreviations (which can be used in trainees’ Daily Case Record and Training Assessment Record):

Female Reproductive MedicineOI-C Ovulation induction with clomipheneOI-FSH Ovulation induction with follicle stimulating hormoneOI-GrRH Ovulation induction with pulsatile GnRH

OS-OC Ovarian suppression with Oral contraceptives or other steroid combinations

OS-GnRHA Ovarian suppression with GnRH agonists or antagonistsHRT Hormone replacement therapyAAT Anti-androgen therapyGEC General Endocrinology casesPAG Puberty/adolescent gynaecologyFPC Family Planning (contraceptive) casesNEC Neuro-endocrinology casesFemale reproductive surgeryTMS Tubal micro-surgeryTR Tubal reversal (microsurgical anastomosis)BAS Benign adnexal surgery (ovarian cystectomies etc)MM Myomectomy (laparotomy)MP Metroplasty (laparotomy)HABL Hysteroscopic endometrial ablationHPP Hysteroscopic PolypectomyHMM Hysteroscopic MyomectomyHDA Hysteroscopic division of adhesionsHMP Hysteroscopic matroplasty (septoplasty)LAH Laparoscopic assisted hysterectomyLAS Laparoscopic excision adnexal tissueLEE Laparoscopic excision extensive endometriosisTAH/BSO Total abdominal Hysterectomy/bilateral salpingo-oopherectomyAndrology and male reproductive surgeryMFC Male factor (male infertility ) casesDAC Diagnostic andrology cases (non-infertility)DUC Diagnostic Urology casesMHRT Male Hormone replacement therapyVR Vasectomy reversalMESA Microsurgical epididymal sperm aspirationTESE Testicular sperm or spermatid extractionTB Testicular Biopsy

Continued over page ...

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REI SUBSPECIALTY TRAINING CLINICAL SKILLS TO BE RECORDED IN THE DAILY TRAINING RECORD / TRAINING ASSESSMENT RECORD(...continued)

Assisted ConceptionLAP-OPU laporoscopic egg pick-up (do not code in addition to LAP-GIFT)LAP-GIFT Laparoscopic Gamete Intrafallopian TransferLAP-ZIFT Laporoscopic zygote (or pre-embryo) intrafallopian transferTV-OPU Transvaginal egg pick-up (do not include in addition to LAP-GIFT)TV-GIFT Transvaginal gamete intrafallopian transferTV-ZIFT Transvaginal zygote (or pre-embryo) intrafallopian transferUET Uterine embryo transferImagingLAP Diagnostic Laparoscopy (+/- minor intervention)HYST Diagnostic HysteroscopyFAL FalloposcopySAL SalpingoscopyHSG HysterosalpingogramUS Diagnostic UltrasoundUFT Ultrasound follicle trackingCT CT Scan (interpretation with radiologist)MRI MRI scan (interpretation with radiologist)Laboratory SkillsIA Sessions in an immuno-assay laboratorySA Semen analysisSP Sperm preparation proceduresIVF IVF proceduresIVF-FERT IVF fertilisation checksICSI ICSI proceduresCYRO Embryo freezing proceduresPCR Polymeras chain reaction proceduresFISH Fluorescent in-situ hybridisation proceduresTEM Transmission electron microscopy examinationsSEM Scanning electron microscopy examinationsResearchRES Half days spent on research projects

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STANDARDS FOR THER ACCREDITATION OF A CREI TRAINING UNIT

NB: Departments need not necessarily carry out every possible subspecialty activity to be involved in the training of specialists for the qualification of CREI. In applying for accreditation, prospective training units can submit joint applications in which activities in more than one institution complement each other.

The application documents must include:

A. Evidence of activities: general

Names and subspecialty time-commitment of subspecialists

List of those practitioners who have obtained the CREI will be needed, with an account of past responsibility for CREI trainees

Letter from the Head of Department stating explicitly the Trainee’s involvement with the CREI Training Program

B. Evidence of activities: publications

The last 5 years’ publications from the Unit should be listed under the following headings (or the publications can be set out with the information required for requirement C, below): Reproductive endocrinology Female reproductive surgery Endometriosis Assisted conception Andrology / urology Fetal medicine Other

C. Areas of activity: qualitative

A qualitative description of subspecialty activities of the Unit under each of the following headings and subheadings.

1. Endocrinology anovulation hirsutism menopause early pregnancy and its

complications contraception adolescent and paediatric

gynaecology

2. Female reproductive surgery endoscopic (minimally invasive)

surgery pelvic microsurgery

3. Endometriosis endocrine management operative management

4. Assisted conception in vitro fertilization gamete intrafallopian transfer artificial insemination (donor or

husband) cryopreservation facility for

gametes and embryos

5. Andrology semenology and laboratory

procedures medical andrology surgical andrology, including

microsurgery sperm antibody laboratory facilities

6. Fetal Medicine clinical genetics and genetic

counselling recurrent abortion management

7. Pathology subspecialty-level (tertiary-

referral) reproductive histopathology

cytogenetics and molecular biology

8. Diagnostic imaging laparoscopy hysteroscopy hysterosalpingography ultrasound, including facilities for

colour Doppler tertiary referral neuroradiology

9. Psychosocial subspecialty level counselling by

medical social workers or qualified counsellors

10. Ethical and Administrative institutional ethics committee

that has considered reproductive

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research and is properly composed to satisfy NH&MRC

criteria computerised data analysis and

management formal quality assurance program

B and C can be combined to give a full qualitative account of activity, and would usefully also include contributions by past and present trainees where appropriate.

D. Evidence of activities: quantitative

List the number of “procedures” performed (or expected to be performed) at subspecialty level in a 12-month period. The procedures should be restricted to those which will either be performed by trainees or at which trainees will act as first assistant.

The numbers of procedures submitted will be compared with subspecialty trainees’ past and future Training Assessment Records where appropriate.

E. Evidence that activities are integrated

1 Timetable of regular educational, peer-review and clinical management meetings at the subspecialist level.

2 Details of clinical and research activities of all trainees attached to the subspecialist Units (this can be incorporated with requirement C, above).

3. Detailed formulation of training programs incorporating the acquisition of practical skills;

or

a copy of the relevant departmental policy and procedures manual in which the manner of, and criteria for, credentialling of trainees is specified.

Summary

Unit accreditation and re-accreditation for REI subspecialty training will depend on demonstrating the capacity to develop trainees across the whole subspecialty.

Training can take place in non-accredited training units, but such positions would be approved (for 12 months at a time) only after

application in advance by a trainee registered with the College. Ultimately, responsibility for the trainee receiving suitable training will continue to rest with the Trainee.

The advantage in being an accredited Unit is that prospective trainees will know in advance that the Unit has the capacity to offer them the training they need. The fact of the appointment will then ordinarily be accepted as evidence that their position is a suitable one.

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CURRENTLY ACCREDITED TRAINING UNITS

Royal Prince Alfred Hospital + Sydney IVF, Sydney

Monash Medical Centre, Melbourne

Royal North Shore Hospital, Sydney

Queen Elizabeth Hospital + Wakefield Hospital, Adelaide

Royal Women’s Hospital + Melbourne IVF, Melbourne

Royal Hospital for Women + Prince of Wales Hospital, Sydney

Westmead Hospital, Sydney

Pivet Medical Centre, Perth

Christchurch Women’s Hospital

Fertility Plus & National Women’s Hospital, Auckland

Royal Brisbane, Royal Women’s, Mater & Princess Alexandra Hospital, Monash IVF Qld, Brisbane

National Women’s Hospital, Auckland

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CONTINUING CERTIFICATION

Please refer to the Subspecialties Committee Regulations and Procedures for information about Log Book, Cognate Point requirements for recertification, and the process for dealing with Specialists who default, which is relevant to all Subspecialties.

Log Book requirements for REI Subspecialists

Applicants for continuing certification will be required to forward the following documentation for assessment:

1. A list of patients seen (no names to be recorded) for the first time, their diagnosis and treatment, for a consecutive six week period.

2. A list of surgical procedures performed which includes the date, diagnosis and procedure, for the same six-week period as for 1 above.

3. Record on the Clinical Skills list the number of procedures performed for the same six week period. The Clinical Skills list is on page 4/5 of the Logbook.

4. Present a weekly timetable for each of the six weeks.

Please note, if the Subspecialist is absent for more than one week then additional weeks will need to be added to total six working weeks.

The documents will be assessed in accordance with the requirement that 67% of professional activity is in the Subspecialty.

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SUBSPECIALTIES COMPENDIUM

The Subspecialties Compendium is a separate publication to this handbook. Please refer to the Compendium for the following information:

• RANZCOG Subspecialty Training and Assessment Regulations

• Appointment and Duties of Training Supervisors/Program Directors

• RANZCOG Subspecialty Diploma

Qualification

• RANZCOG Emeritus qualification • Continuing Certification

• Defaulting Subspecialists

• Procedures for the Assessment of Overseas Trained Subspecialists

• Assessment of Dissertations and Theses