Changes to ATSMs for August 2011

Introduction

ATSM training has proved extremely popular since the launch in 2007 and the original format has remained unchanged. Following extensive feedback from trainees, trainers and specialist societies it is now timely to make some adjustments to the programme. As before, the underlying principle that trainees complete 2 ATSMs for CCT remains. Training can only start once the trainee is post membership and in year ST6 (or SpR4 year). The types of ATSM available will be dependent on local capacity and resources. Since NTN- holders require 2 ATSMs for CCT they will be given priority over those non-training grades who are also eligible for ATSM training when the opportunity arises.

Rationale for change

Examining feedback and the selection of ATSMs, certain patterns have emerged.

• There is wide variation in the number and timing of ATSM registrations. Whilst some trainees are registering for an ATSM in ST6 then a second ATSM in ST7 (usually after the first ATSM has completed) others are registering for 2 complementary ATSMs at once and a significant minority of trainees are registering for more than 2 concurrent ATSMs.
• The Advanced Labour Ward Practitioner ATSM is the most popular module undertaken by trainees. This reflects the demand for high quality Labour Ward skills for all those who wish to work in the field of Obstetrics & Gynaecology.
• Some ATSMs are only completed by a small minority. Whilst it is inevitable that some ATSMs will prove more popular than others it is hoped that trainees will now be able to broaden their ATSM choices.
• There is the impression, particularly within gynaecology, that to support their key ATSM, trainees would like to accrue certain additional competencies from other ATSMs to create a balanced training programme. Curriculum revision has now revised the spread of competencies. This has created some overlap between modules so that it is no longer necessary for a trainee to take more than 2 ATSMs in order to achieve a balanced programme.

Registration for ATSM

Previously, post membership NTN holders could register for an ATSM at any time from ST6 (SpR4 equivalent) up until 6 months prior to their anticipated CCT date. It is still strongly recommended that trainees register early leaving plenty of time to complete 2 ATSMs prior to CCT. Registering for 2 concurrent ATSMs at the start of ST6 is encouraged, acknowledging that completion of both of these ATSMs is not likely to be accomplished until the later part of ST7.

The restriction preventing ATSM registration within 6 months of the anticipated CCT date has been lifted. Trainees are reminded, however, that starting an ATSM at this late stage in training must have the support of the Deanery ATSM Director and Deanery ATSM Preceptor. Registration for a third ATSM this close to CCT must not compromise the trainee's ability to finish 2 ATSMs before CCT as the CCT date will not be extended.

Deaneries are not required to offer more than 2 ATSMs so the availability of further ATSM training will entirely depend on the local deanery capacity balanced with the needs of other trainees.

Obstetric ATSM curricula

The number of Obstetric ATSMs remains the same and the curriculum for each obstetric ATSM remains unchanged.

Gynaecology ATSM curricula

To reflect the range of clinical skills required at consultant level, the content of several of the gynaecology ATSMs has been broadened. The size and scope of these expanded ATSMs means that they are expected to last a minimum of 12 months but 18-24 months would be typical. It follows that more than one Educational Supervisor may be required to deliver the training across one or more units. As these modules have a broader curriculum and now incorporate aspects of other modules the need to accrue multiple ATSMs is significantly reduced. The revised modules can be accessed below:

1. Benign Abdominal Surgery: open and laparoscopic (pdf)
   The Benign Abdominal Surgery and the Benign Gynaecological Surgery: laparoscopy ATSMs have been combined into a single ‘Benign Gynaecological Surgery: open and laparoscopic' ATSM. This ATSM also incorporates relevant aspects of the Hysteroscopy ATSM.
2. Urogynaecology and Vaginal Surgery (pdf)
   The Urogynaecology ATSM and the Benign Vaginal Surgery ATSM curricula have been updated and combined into a single ‘Urogynaecology and Vaginal Surgery' ATSM.
3. Subfertility and Reproductive Health (pdf)
   The new curriculum has been updated and also now includes expanded surgical (minimally invasive) components.
4. Oncology (pdf)
   The new curriculum has been updated and also includes expanded surgical (minimally invasive) components.

The Work Intensity Score and ATSM Combinations

As ATSMs now vary considerably in their expected duration and work intensity, each ATSM has been given a work intensity score .

This score reflects the nature and number of competencies that need to be acquired. The larger ATSMs have a score of 2.0 and will typically require 12-18 months to complete. These ATSMs are designed to be ‘career defining', equipping trainees to work as a Consultant in their key area of clinical interest whether obstetrics or gynaecology. ATSMs with a score of 1.0 support the career defining ATSMs and allow flexibility when building a balanced training programme.

ATSM Combinations

Trainees may choose any combination of ATSMs providing that the total concurrent work intensity score is not greater than 3.0. Once an ATSM is complete a trainee may have the opportunity to start another ATSM; this is permissible providing the new total score remains at 3.0 or less.

Modification to work intensity scores for Labour Ward modules

All ATSMs have a work intensity score of either 1.0 or 2.0. This scoring system has been well received and allows trainees to structure their choices such that at any one time the work intensity score does not increase above 3.0. However, trainees taking the Advanced Labour Ward Practitioner ATSM (score 1.0) and the Labour Ward Lead ATSM (score 2.0) at the same time may count the total score as only 2.0.

This modification reflects the fact that the Labour Ward Lead module also requires completion of the Advanced Labour Ward Practitioner module and when taken concurrently the clinical areas overlap considerably. The usual scores apply if either ATSM is taken separately. This change will take immediate effect

Note that the Advanced Labour Ward Practice ATSM has a work intensity score of 1.0 making it suitable for combination with any obstetric or gynaecology ATSM.

The benefits of a work intensity scoring system

It may seem, at first, that the scoring system is restrictive but it has many benefits:

• Trainees across different deaneries will be adhering to national guidance when combining ATSMs.
• Curriculum revisions mean that it is no longer necessary to combine several high work intensity ATSMs when working towards a balanced training programme.
• Where there is training capacity, trainees can undertake more than one ATSM at a time, maximising training opportunities.
• The score prevents trainees over-reaching themselves and allows focus on a career defining ATSM.

Transitional Arrangements for new ATSMs

Registration for the new ATSMs will be accepted from 1st August 2011. Advance notice is given to enable the Deaneries to prepare for the changeover and the impact this will have on local training arrangements.

Trainees who have already registered for an ATSM are strongly recommended to finish the current curriculum in order not to delay meeting the requirements for the CCT. Trainees who have a particular reason for switching to the new curriculum can do so at the discretion of the ATSM Preceptor and ATSM Director. In such circumstances trainees are asked to seek approval at deanery level in the first instance. Subject to the Deanery approval being granted the form should be submitted at the conclusion of the ATSM training and submitted to the Postgraduate Training Department at the RCOG. The RCOG will not charge a new registration fee nor reimburse when two ATSMs have been amalgamated. It should be noted that trainees will not be allowed to extend their projected CCT date on the grounds of having switched ATSM curriculum.

Those trainees who have not yet embarked on their ATSM training and wish to commence with the new curriculum in advance of August can only do so at the discretion of their Deanery. In such circumstances the registration form would need to be completed and submitted to the RCOG. The registration form will not be processed until 1st August 2011.

From 1st February 2012 it will not be possible to register for those ATSMs which have been revised. Those who are already registered will of course be able to complete their current ATSM and subject to satisfactory completion will be awarded a Certificate of Completion.

The registration fee for the new ATSMs will continue to be set at £125 per module irrespective of the work intensity score. From August 2011 the RCOG will monitor all ATSM registrations with a view to setting a maximum work intensity score of 3.0 per trainee. Once a module has successfully been completed it will be possible to register for a further ATSM provided the intensity score of 3.0 is not exceeded at any time.

Identifying which ATSM syllabus has been registered

Where previously separate ATSMs have been combined it is clear from the new name i.e. ‘Urogynaecology with vaginal surgery' and ‘Benign abdominal surgery: open and laparoscopic'.

The name for all other ATSMs remain unchanged but in order to identify which curriculum has been used the name is always followed by the year of the revised curriculum, for example ‘Oncology (2011)'. Any future curriculum changes will also be identified in this manner. Please indicate on the registration form which curriculum the application is for. Future ATSM certificates will indicate the year of the relevant syllabus.

If you have further queries please email the Advanced Training Co-ordinator Bettina Müller at bmuller@rcog.org.uk