Introduction
Subspecialty training in obstetrics and gynaecology involves the following sub-specialty areas:
- urogynaecology
- maternal and fetal medicine
- sexual and reproductive health
- reproductive medicine
- gynaecological oncology
Principles
Approval of subspecialty training programmes within the UK is a statutory function of the GMC. Decisions will be based on information from the deaneries (usually operating through the local deanery STCs or postgraduate schools) who, in turn, may seek information and, where relevant, advice from RCOG (operating through the SSTC).
A consistent process for informing programme approval is desirable for all UK subspecialty training programmes in obstetrics and gynaecology.
GMC approval will be required for all new programmes.
Where deficiencies or potential deficiencies in training (processes and/or outcomes) and/or educational supervision have been identified via the local deanery quality management processes (including reports from trainee reviews, trainees and annual local subspecialty quality control reports), the deanery, with advice from the STC or postgraduate school and, where relevant, the SSTC, will take action to address these. If this action is unsuccessful then the deanery may suspend the training programme and/or seek a triggered visit by the GMC to address outstanding concerns. Such visits normally involve nominated College representation. The result of a triggered visit may include withdrawal of training approval by the GMC. Reinstatement of the programme would then require GMC reapproval.
Where there has been a significant change of programme personnel (e.g. subspecialty training programme supervisor) or local services, the deanery and STC or local postgraduate school should be informed. Local College representatives would normally notify the SSTC of such changes. The deanery, with advice from the STC or postgraduate school and, where relevant, the SSTC, would make a decision regarding continued arrangements for subspecialty training in the locality concerned. In circumstances where the arrangements were not felt suitable and where local attempts to address concerns had been unsuccessful, a report would be sent by the deanery to the GMC asking for a formal review of training approval. This would normally involve a triggered visit.
Quality management approaches should be seen as an opportunity to engage in continual improvement and not just an opportunity to confirm that standards are being met. It should, therefore, be a proactive process and not one where quality of provision is implied following formal/intermittent approval for the nominal duration of the approval.
New Programmes
While the Subspecialty Committee is assessing the RCOG Document ‘The Future Workforce in Obstetrics and Gynaecology' no new applications for subspecialty training programme approvals are being accepted with the exception of Sexual and Reproductive Health (9 July 2009).
Application form A submitted to the deanery and copied to the chairman of the deanery STC or head of postgraduate school. College representatives within the STC or postgraduate school would normally submit a copy to the Chair of SSTC.
The Deanery will submit an application to the GMC but the process of reviewing such an application will include discussion with and input from the local STC or postgraduate school, who would normally seek advice from the SSTC. The following key aspects will be considered before any application to the GMC:
- existing specialty training opportunities in obstetrics and gynaecology within the deanery
- the impact on training opportunities for existing advanced trainees in obstetrics and gynaecology
- funding arrangements (basic salary and banding payments)
- on-call arrangements and European Working Time Directive hours compliance
- capacity of subspecialty training programme supervisor and other local trainers/supervisors to ensure a suitable training environment/delivery of subspecialty curriculum.
The key point is to establish that there is sufficient educational capacity, both educational opportunities and educational and clinical supervision, and clinical activity to continue to deliver all aspects of specialist training whilst developing subspecialist training.
The deanery, via the local STC or postgraduate school, must reach a considered view on the ability of local clinicians and the unit in which they work, to offer a comprehensive learning environment suited to the delivery of the relevant subspecialty training curriculum. It is anticipated that most deaneries would normally seek advice from the SSTC about the following:
- Ability of the submitted programme to deliver the subspecialty curriculum with emphasis on:
- relevant clinical workload/educational opportunities
- programme organisation and trainee timetable (including numbers of available supervisors, clinical and educational)
- research opportunities.
- Capacity of subspecialty training programme supervisor to oversee local delivery of sub-specialty training.
- Previous applications and reports related to the centre (where applicable).
In addition, any new application for approval would be subject to external scrutiny by the GMC.
Centre visit arranged by the local deanery (where the process cannot be completed by other means). The visit would normally be undertaken by:
- one member of the deanery STC, nominated by the chair
- one subspecialist, who is a subspecialty training programme supervisor, nominated by the SSTC
- where appropriate, a deanery representative, e.g. associate dean.
It is important to note that this provision relates to new applications from centres previously not engaged in subspecialty training. Therefore, while a visit is not essential it is thought to be desirable to confirm the details of the application and the facilities available within the unit before submission of the application to the GMC.
Visit report reviewed by STC or postgraduate school and SSTC and recommendation to the deanery to:
- support submission of application for approval to GMC
- not support submission of application for approval to GMC
- defer submission pending further information/arrangements.
Existing programmes (‘triggered' enquiry)
A programme review/enquiry may be instigated by the local deanery in consultation with the deanery STC or postgraduate school, and, where relevant, discussion with the chair of the SSTC, for the following reasons: ( Application Form B )
- Trainee feedback suggests that there is a serious/continuing problem with the programme (training processes or outcomes)/subspecialty training programme supervisor compromising achievement of the clinical and/or research competences identified in the curriculum.
- Trainee mid-term or final review report to SSTC (copied to STC) highlights concern about the arrangements for the delivery of the curriculum including educational opportunities and assessment and/or supervision.
- Annual review of competence progression (ARCP) or RITA highlights potential deficiency in educational opportunities or supervision/assessment of trainees (note: it would be considered best practice to involve an external subspecialist in subspecialty ARCP or RITA reviews).
- Major changes to the programme , e.g. loss of subspecialty training programme supervisor/other major contributor, change of centre, change in workload/referral pattern of centre.
The timetable for undertaking a programme enquiry (and the reappointment of a trainee to the programme pending the review) would be agreed by the chair of the deanery STC or postgraduate school in consultation with the deanery and this would usually include discussion with the Chairman of the SSTC.
The process and documentation involved in a triggered enquiry would be identical to that for a new programme. While this would usually require a site visit, there may be circumstances when the deanery and the deanery STC (where relevant, following consultation with the chairman of the SSTC) feel this is not required.
- An application to GMC would not normally be submitted until a full and satisfactory local review of all the factors outlined has been undertaken and, where relevant, a site visit.
- This would include the national trainee survey results.