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Deanery management of subspecialty training and trainees

Guidance on how Heads of Schools (HoS) and subspecialty Training Programme Directors (TPDs) should work together to address training requirements for subspecialty trainees.

This is especially important as many subspecialty trainees are on out of programme (OOP) training.

Information for trainees about subspecialty training can be found in the subspecialty training curriculum pages.

Appointment to subspecialty training

Trainees should be appointed to a subspecialty training programme only when they have achieved a satisfactory ARCP outcome. Trainees need to seek support from their HoS before applying to subspecialty training, through discussion. Subspecialty TPDs should ensure it’s a requirement for applicants to have full HoS support, preferably written.

Subspecialty TPDs must be aware that trainees have to complete all of the core advanced competencies described in the GMC-approved curriculum. It’s therefore important to consider the need to assess this aspect of a trainee’s achievements at the time of appointment. HoS or deputies should ideally be on the appointment panel to ensure assessment of core competence is undertaken.

Assessing core competencies

When a trainee is appointed to a subspecialty programme, an assessment must be undertaken to identify any parts of the core curriculum that the trainee must complete before starting the subspecialty programme (this relates to the parts of the advanced curriculum that aren’t included in the subspecialty programme). The process is:

  • If the trainee has completed the advanced competencies in relation to their non-subspecialty interest, they can start subspecialty training following their notice period
  • If the trainee hasn’t complete the advanced competencies, the donor HoS or deputy needs to undertake an assessment to determine how many of the competencies need to be completed; the usual preference is for the trainee to complete these competencies before starting subspecialty training

Managing a trainee who hasn’t yet completed the core competencies

If it’s anticipated that the remaining core competencies can be achieved in a short period (3-4 months), the donor HoS should normally arrange for the trainee to undertake training to allow completion of the non-subspecialty competencies before they start their subspecialty training programme. This is at the deanery’s discretion and must take into account the requirements of other specialty trainees and the need to have a stable, predictable workforce. If the donor deanery can’t provide appropriate training, the host deanery will need to provide training and assessment in the outstanding advanced core competencies during the subspecialty training programme.

Following this time period, the trainee either will have acheived the competencies and can move to subspecialty training, or will still have a small amount of competencies left to achieve. In the latter situation, the donor and host HoS must discuss the issue and consider whether the trainee can start a subspecialty training programme that includes training to achieve the remaining competencies. This will involve discussion with the subspecialty TPDs. The need to allow time within the subspecialty programme for the trainee to achieve the rest of the core competencies must be recorded, to ensure a tailored, individualised training package for the trainee.

If there are a significant number of core competencies still to be achieved at the time of appointment to subspecialty training, the donor HoS should discuss with the host HoS the option of delaying commencement of subspecialty training to the end of ST6, by which time the trainee would be expected to have achieved the competencies. This minimises the possibility of the trainee achieving a non-satisfactory ARCP outcome towards the end of their training because of lack of core competencies. This is very unlikely, provided trainees seek approval from their HoS before applying for subspecialty training and subspecialty TPDs recruit only those trainees who’ve nearly completed all the core competencies. If the trainee can’t complete the core competencies in 1 year, the unit can withdraw the offer of subspecialty training.

Communication during training

Communication between the HoS (on behalf of the Postgraduate Dean), subspecialty TPDs and the RCOG is key to managing these individualised training packages. It’s likely there will be good communication if the trainee isn’t progressing in achieving their subspecialty competencies, but communcation is also vital if the trainee’s falling behind in the core competencies.

As the donor HoS retains overall responsibility for the trainee, the donor HoS should determine the requirements and liaise with the host HoS and subspecialty TPD to develop an action plan to address the issues.

Responsibility for OOP subspecialty trainees

The donor deanery retains responsibility for the trainee, as is the case for all OOP trainees. Any extensions to training time will be the responsibility of the donor Postgraduate Dean. The subspecialty review report will be shared with both donor and host HoS.

  • If issues are identified that relate to the subspecialty training programme, the host deanery will manage the action plan
  • If issues are identified that are outwith the subspecialty training programme, both donor and host HoS must communicate to determine how best to address the issues, and record any action in the donor deanery’s documentation for the trainee, as well as the trainee’s own documentation

ARCP for subspecialty trainees

The RCOG subspecialty assessment informs the ARCP. It’s important to consider the following:

  • If the trainee is OOP, the donor deanery (who holds the trainee’s number) is responsible for the trainee’s assessment. This is particularly important if the trainee requires additional training time.
  • All HoS have ongoing responsibility for all OOP trainees, whether they’re OOP for subspecialty training or for other activities. This means the ARCP is undertaken in the donor deanery.
  • The ARCP process is determined by the donor deanery and will be consistent with their normal ARCP processes. Feedback from the subspecialty review and the Educational Supervisor’s report is vital.
  • The host HoS should make the donor HoS aware of any issues. The host deanery is responsible for collecting all information and providing it to the donor deanery.

RCOG subspecialty assessment

The RCOG notifies the donor and host HoS about the subspecialty assessment. The primary aim of the RCOG subspecialty assessment is to review the progress of the trainee against the subspecialty curriculum. The ARCP process takes the assessment report into account, as well as generic issues in relation to the core curriculum in O&G. The RCOG subspecialty assessment doesn’t replace the ARCP.

It’s good practice for deaneries to be involved in the RCOG subspecialty assessment process, particularly for trainees who are undertaking subspecialty training as OOP. The host HoS should attempt to attend all subspecialty assessments, although it’s recognised this may not be possible. The HoS should attend to:

  • Ensure the subspecialty assessors use a fair process when assessing the trainee. Where concerns are raised about the process, the HoS can notify the Chair of the RCOG Subspecialty Committee.
  • Obtain on-the-spot feedback about the trainee, which may help inform further planning should extensions of training be required. The host HoS can feed back this information to the donor HoS.
  • Discuss feedback from the trainee about the programme. Any concerns raised will be included in the report, and will need to be addressed by the quality management processes in the host deanery as well as the RCOG Subspecialty Committee. If a deanery visit is required, this should be deanery-led with representation from the RCOG’s external assessors.

Find out more

For more information, email the Advanced Training Coordinator at advancedtraining or call +44 20 7772 6271.