Process by which the RCOG will approve centres to deliver subspecialty training
The role of the RCOG in subspecialty training
Since 1984, the RCOG has been responsible for assessing the quality of training of subspecialists in terms of both approving centres for subspecialty training and undertaking review of trainees’ progress in relation to the subspecialty competencies. The information from the latter feeds into the deanery ARCP process. The RCOG is also responsible for developing and updating the subspecialty curricula for approval by the General Medical Council (GMC).
The RCOG regularly reviews how it provides this quality scrutiny to ensure practice is up to date in terms of educational governance and training reflects developments within service provision of the subspecialty areas.
The curricula and trainee review process have been modified to achieve these goals. To better reflect the changes within the curricula and postgraduate education, we undertook an exercise with the specialist societies to redefine the criteria for subspecialty centre approval. This work resulted in both generic and subspecialty specific centre criteria.
The agreed centre criteria reflect minimum levels. This fits well with the GMC requirement to set minimum standards for training across all elements of specialty training. This will be of greater importance given the proposals within the Shape of Training report, and will allow the RCOG to work with the GMC and those commissioning training in the future from a position of agreed standards.
Aim of the revised process for subspecialty training centre approval
The revised RCOG process for centre approval aims to ensure that quality of training is of the highest standard. The RCOG is mindful that current trainees must not be disadvantaged by the process. The approval process is intended to assess the training centre, not the individual trainee.
Throughout the development of the process, we have consulted both subspecialists and Heads of School, recognising that Local Education and Training Boards (LETBs)/deaneries have overarching responsibility for postgraduate education.
Process for assessment of subspecialty submissions
All re-applications are initially electronically graded by the RCOG Subspecialty Committee, which includes Heads of School representatives from the Specialty Education Advisory Committee (SEAC).
Each Subspecialty Committee member reviews applications from their own subspecialty and from one other subspecialty. Two subspecialists each score half of applications to their own subspecialty. We seek disclosures from Subspecialty Committee members and Heads of School before distributing applications and no-one scores applications where a conflict of interest has been disclosed.
We score 5 categories (workload; service organisation; teaching/training; research; performance of centre); workload and service organisation are subdivided, meaning we score 7 domains. The assessors record each criterion as met, unmet, reasons for unmet and score =1 or =0. Additionally, they indicate approval to be granted for 1 or 2 trainees. Clarification may be sought from the STPS if information is found to be insufficient.
Thereafter, each centre is graded as green, amber or red for each of the 7 domains, as follows:
- Green (score 100% of criteria in a domain)
- Amber (score >50% of criteria in a domain)
- Red (meets ≤50% of criteria in a domain)
A Head of School and the Chair of the Subspecialty Committee review the grading assigned to applications.
Approval is granted for centres where all 7 are graded as green. For centres with 1 or more red domains, the RCOG will notify the centre that it has not been approved.
All other centres will be designated as amber gradings and will be discussed at a Subspecialty Committee meeting; a further determination will be made by reviewing the track record of the centre in providing training. A determination will be made according to 3 categories:
- Category 1: Amber grading with no obvious problems noted from track record, supported by good evidence, and centre has achieved a pass (at least 75%) in all domains. Suboptimal areas identified within amber domains do not appear to impact on trainee performance.
- Category 2: Amber grading with insufficient evidence on track record and centre achieves a pass (at least 75%) in all domains.
- Category 3: Amber grading with significant concerns regarding track record.
Duration of approval and implications for current and future trainees
Following the assessment process, the RCOG will contact each subspecialty training centre and LETB/deanery Head of School. Our paramount concern is ensuring trainees have access to appropriate high-quality training in order to achieve all the subspecialty competencies. Any centre that doesn’t achieve all the criteria will need to review the trainee’s needs and make arrangements to ensure that all curriculum competencies can be accessed. This will likely necessitate collaboration of subspecialty training centres in the interest of the trainee.
The RCOG’s recommendations are:
Centre would be recognised for the duration of training of the current trainee and one subsequent trainee.
Centre would be recognised for the duration of training of the current trainee. The centre should address deficient areas to ensure the trainee the completes curriculum. Recognition would expire at exit of current trainee.
For all centres graded as amber, the centre will be recognised for the duration of training of the current trainee; however, the STPS and Head of School must review any deficient areas to ensure that the trainee completes the curriculum objectives. This may require liaison with another subspecialty centre:
- Category 1: Centre could be recognised for the duration of training of the current trainee and one further trainee if at least 5 of the domains are green. However, if <5 of the domains are green, the centre would be required to submit an action plan to address the amber areas. A re-application would be required addressing the unmet domains, ensuring at least 5 domains are green before a new trainee could be registered.
- Category 2: An action plan must be submitted after 12 months and in some cases a centre visit would be required. Additional information would be obtained from the current trainee assessment to inform the review assessment (log of experience, timetabling, modules, supervision, research, etc). A re-application would be required addressing the unmet domains, ensuring at least 5 domains are green before a new trainee could be registered.
- Category 3: A centre would be advised that a reapplication would not be considered without a significant redesign of the programme.