Approval criteria and checklists

Education and access to training opportunities

• Subspecialty Training Programme Supervisor (STPS) and Deputy Subspecialty Training Programme Supervisor (DSTPS) are actively involved in clinical work and academic activities
• STPS and DSTPS must be a GMC approved Educational Supervisor. 
• STPS or DSTPS must have evidence of participation in the centralised assessment or ARCP at least every 3 years. To maintain centre recognition, centre must have evidence of contribution to the centralised assessment at least every 3 years.
• The trainee has access to regular dedicated teaching sessions (formal educational activity – minimum 1 per fortnight). This may include activities such as journal clubs, webinars.
• There are adequate audit and/or research opportunities.

Research

• The centre must have a minimum of 10 peer-reviewed papers relevant to the subspecialty over the last 3 years 
• Other evidence of research activity as follows:
• active research projects – at least 1 project
• other academic evidence may be submitted, e.g. grants, chapters in books, Cochrane reviews, presentations (national or international), centre-run journal review group
• The centre must have evidence of recruitment to national trials relevant to the subspecialty.
• The trainee has a named research supervisor with proven research track record or an individual is a registered supervisor for the APM in Clinical Research and able to deliver all elements of the APM curriculum.

Performance of centre

• There must be no unresolved concerns raised in trainee feedback about programme or trainers noted by the Subspecialty Committee.
• There must be no unresolved concerns raised by the deanery quality management processes (either deanery surveys, deanery visits).
• There must be no significant concerns consistently raised by assessors during trainee reviews noted by the Subspecialty Committee
• There must be no significant concerns raised in previous Training Evaluation Form (TEF).
• The centre must meet the standards set out by the Care Quality Commission, Health Improvement Scotland or RQIA in Northern Ireland

Read the criteria below and download the checklist for the gynaecological oncology training centre criteria (Word document)

Workload (per annum) and scope

• Access to a minimum number of 6 lists per week for major surgical procedures or 10 per week if applying for accreditation for 2 trainees
• Minimum number of new cancers – 300 (500 if applying for accreditation for 2 trainees)
• >50 laparoscopic hysterectomies for endometrial cancer
• >15 laparoscopic pelvic lymphadenectomies
• >10 radical surgical procedures for cervical cancer*
     Can include radical trachelectomy
• 10 para-aortic lymphadenectomies
• Evidence of complex surgery for gynaecological cancer including large bowel resection, small bowel resection, diaphragmatic stripping, peritoneal stripping, splenectomy
• >20 radical excision procedures for vulval cancer
• Groin node surgery
  • >6 inguinofemoral groin node dissections
  • >6 groin sentinel nodes
• >5 exenterations for advanced or recurrent gynaecological cancer
• Pre-invasive disease service
  • >250 new referrals for abnormal cervical cytology
  • >15 new referrals for VIN/VaIN

*There are anticipated changes to both practice and disease incidence which may influence the number of cases, so these numbers need to be carefully monitored.

Service organisation

• The centre must have a minimum of 2 accredited subspecialist consultants in Gynaecological Oncology.
• The centre must have weekly, fully constituted centre multidisciplinary team meeting
• The centre must have access to and demonstrate working relationships with radiotherapy, chemotherapy, combined/parallel clinics, colorectal surgery, urological oncology, plastic surgery, ITU and pain management
• Data collection: cancer site breakdown, stage, surgical treatment and peri-operative morbidity/mortality
• Intraoperative frozen section facilities
• The centre must ensure that on-call arrangements do not interfere with elective Gynaecological Oncology activities.

Read the criteria below and download the checklist for the maternal and fetal medicine training centre criteria (Word document 44kb)

Please note: for recognition of a centre for a second simultaneous trainee, some multiplier of minimum case load criteria for MM and FM referrals and procedures is required to ensure the centre has the capacity to deliver adequate training to both trainees.

FM = fetal medicine; MFM = maternal and fetal medicine; MM = maternal medicine

Workload and scope

• The centre must have the following number of MFM sessions (with external referrals):
• Minimum number of FM sessions per week = 6, AND minimum number of FM consultants accepting referrals with ≥2 sessions per week = 3*
• Minimum number of MM sessions per week = 4, AND minimum number of MM consultants undertaking (sub)specialist sessions = 2*
• The centre must have ≥150 referrals for major fetal anomaly per annum coming from at least 2 other referral units
• MM clinic(s)^† – or services if more appropriate – should cover ALL of the following disorders:
• Endocrine (including >20 pregnancies to women with pre-existing diabetes per annum)
• Cardiac
• Respiratory
• Haematology
• Neurology
• Obesity/metabolic
• Renal
• Hypertension
• Anaesthetic
• Infectious diseases
• Fetal invasive procedures:
• Minimum number of CVS procedures per annum = 100 AND >30 average per practitioner AND
• Minimum number of more complex fetal procedures (e.g. multifetal reduction, fetocide, shunt insertions, vesicocentesis, thoracocentesis, fetal transfusions, laser ablation) >30 per annum
• Minimum number of CVS done by previous trainee >30
• Minimum number of amniocentesis by previous trainee >50
• The centre must have an annual delivery rate of >5000 per annum

*To allow for adequate holiday cover and access from peripheral units to an opinion within 2 working days where necessary.

^†Defined as a joint obstetrics/medical clinic run by an obstetrician AND a physician OR a dedicated pregnancy clinic run by a consultant physician/anaesthetist OR a dedicated clinic run by a (sub)specialist in MFM with access to a named relevant physician.

Organisation of services

• The centre must have multidisciplinary MFM meetings with evidence of regular MFM consultant attendance
• The centre must have evidence of ready access to prenatal multidisciplinary counselling
• The centre must have evidence of robust audit/MDT meeting with MFM learning outcomes
• The centre must have a minimum of 2 accredited subspecialist consultants in MFM within unit
• On-site regional neonatal intensive care facility with >10 beds
• Ready access within a <50-mile radius to ALL of the following regional services:
• Paediatric surgery
• Fetal echocardiography/paediatric cardiology
• Fetal MRI
• Genetics: ALL cytogenetics, molecular genetics and clinical genetics sessions
• The centre must ensure that on-call arrangements do not interfere with elective Maternal and Fetal Medicine activities.

Read the criteria below and download the checklist for the reproductive medicine training centre criteria (Word doucment 39kb)

Workload and scope

• Minimum number of new fertility referrals = 400 per annum
• Minimum 1 general fertility clinic per week
• Minimum number of IVF patients seen = 8 per week
• Minimum number of fresh oocyte collection = 500 per annum
• Number of procedures to be available to trainee per annum:
• >100 laparoscopies
• >100 hysteroscopies
• >100 HSG/ HYCOSY
• >20 egg donation cycles
• >50 IUI cycles
• >50 OI cycles
• >50 DI cycles
• >20 reproductive surgery
• >20 surgical sperm retrieval
• >50 reproductive endocrinology
• >50 recurrent miscarriage

Service organisation

• The centre must be a HFEA-licensed centre with comprehensive portfolio of specialist services and have:
• a minimum of 2 accredited subspecialist consultants in Reproductive Medicine within unit
• weekly multidisciplinary team meeting
• on-site facility to manage OHSS
• on-site laboratory for semenology and embryology
• Data collection: HFEA
• The centre must ensure that on-call arrangements do not interfere with elective Reproductive Medicine activities.

Read criteria below and download the checklist for the urogynaecology training centre criteria (Word document 37kb)

Workload and scope

• Minimum number of theatre lists undertaken by designated consultant urogynaecologists = 3 per week
• Minimum number of urogynaecology outpatient clinics = 2 per week
• Minimum number of urodynamics clinics = 4 per week (mix of consultant- and nurse-led clinics)
• Minimum number of new urodynamic referrals >400 per annum
• Minimum number of new urogynaecology referrals >750 per annum
• Referrals should come from at least 3 other units (demonstration of tertiary practice)

Number of operations per annum

• Surgical procedures on site or easily accessed within same service organization:

• >40 primary procedures for SUI (excluding Urethral Bulkers), which could be a combination of the following: mid-urethral tapes/colposuspension (open or lap)/autologous fascial slings for primary stress urinary incontinence
• >20 cases of intra detrusor botulinum toxin A injections
• >20 cases urethral bulking agents
• >100 cases undergoing 1 or more vaginal operations for pelvic organ prolapse
• >30 procedures for vault prolapse/year (mix of sacrocolpopexy and sacrospinous fixation)
• >10 procedures for recurrent/failed prolapse surgery
• >50 diagnostic cystoscopies including flexible and rigid cystoscopy (non SUI procedure cystoscopies)
• >20 Laparoscopic apical procedures (i.e. sacrocolpopexy +/or sacrohysteropexy/cervicopexy)
• Unit should perform, or have arrangements in place for trainee to access, laparoscopic hysterectomies.

• Conservative therapies on-site or easily accessed within the same service organisation:
• Nurse-led urodynamics clinics = at least 2 per week
• Women’s health physiotherapist with range of physical therapies for pelvic floor dysfunction
• Bladder training clinic = 1 per week
• Nurse-led ISC available for outpatients
• Other clinics:
• Perineal clinic/management of third-degree tears at specific clinic (1 per month)
• Availability to perform video urodynamics
• Availability for ambulatory urodynamics

Service organisation

• The centre must have a minimum of 2 accredited urogynaecology subspecialist consultants within unit (minimum 2 consultants or FTE with at least 6 urogynaecology clinical sessions/week)
• The centre must have regular multidisciplinary team meetings
• The centre must have monthly audit meetings and/or risk management meetings
• Easy access to (<30 minutes) within the same service organisation for ALL of the following:
• Urology
• Coloproctology
• Medical physics
• Care of the elderly
• Physiotherapy
• Anorectal physiology including anorectal ultrasound
• Neurology including MS clinics and neurophysiology
• The centre must ensure that on-call arrangements do not interfere with elective urogynaecology activities