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MTI reference form

This form is to be completed by the referee of a 2016 MTI candidate.

Important information

By completing this form and submitting it online, you are giving a reference for a trainee wishing to apply for the RCOG Medical Training Initiative. As a referee for this trainee, you must either currently supervise the candidate’s training or have supervised them in the past.

Please ensure that you enter the doctor’s full name and RCOG registration number which the doctor has given to you.

As the referee you must:

  • Realise that under the Medical Training Initiative (MTI) if the trainee is assessed in the UK as not meeting the requirements recommended by you and the trainees, the UK employing hospital has the right to terminate the trainee’s contract 3 months after commencing the post
  • Have personal knowledge of the candidate’s clinical obstetrics and gynaecology work, character and suitability for the MTI
  • Select the candidate on merit, training potential and be able to say that the candidate is of high calibre to meet exemption from the GMC’s PLAB test
  • Be able to confirm that there are opportunities for the doctor to be re-employed on his/her return home and to provide details
I confirm that I have read the criteria and guarantee that the doctor fulfils these requirements

For how long has/did this doctor worked/work under your direct supervision?
Clinical experience and skills
Could you please tick the procedures which this doctor can perform safely without direct supervision:
Please note that it is NOT mandatory for doctors to be able to perform all the following procedures without supervision to gain placement to the MTI scheme.
Uncomplicated Caesarean sections
Caesarean section at full dilatation
Manual removal of placentas
Evacuation of retained products of conception
Non-rotational instrumental deliveries (forceps or vacuum)
Repair of 3rd and 4th degree tears
Fetal scalp blood sampling in labour
Rotational instrumental deliveries
Hysteroscopy
Diagnostic laparoscopy
Surgical management of ectopic pregnancy (laparotomy)
Abdominal hysterectomy
Electronic fetal heart rate monitoring
Recognise the acutely ill patient and resuscitate appropriately
Any further comments?

Do you have any concerns about this applicant’s level of knowledge compared with other doctors at this level?
Do you have any concerns about this applicant’s level of knowledge compared with other doctors at this level?
Do you have any concerns about the applicant’s awareness and insight into knowing when it is necessary to seek help/advice?
Do you have any concerns about the applicant’s awareness and insight into knowing when it is necessary to seek help/advice?

Professional values
Personal and professional integrity (displays honesty, is not discriminatory, maintains the trust of patients and colleagues) Do you have any concerns about this applicant’s ability in the above areas?
Personal and professional integrity (displays honesty, is not discriminatory, maintains the trust of patients and colleagues) Do you have any concerns about this applicant’s ability in the above areas?

Personal skills
Decisiveness/accountability/ability to take responsibility, makes decisions and asserts appropriate authority. Do you have any concerns about this applicant’s ability to act decisively and take responsibility?
Decisiveness/accountability/ability to take responsibility, makes decisions and asserts appropriate authority. Do you have any concerns about this applicant’s ability to act decisively and take responsibility?
Interpersonal skills (Respects patients and works co-operatively with others).
Interpersonal skills (Respects patients and works co-operatively with others).
Flexibility/ability to change and adapt to new country/working environment, responds appropriately to rapidly changing circumstances.
Do you have any concerns about this applicant’s ability to demonstrate flexibility in day-to-day work?
Do you have any concerns about this applicant’s ability to demonstrate flexibility in day-to-day work?
Resilience/ability to operate under pressure, copes with stress. Do you have any comments about this applicant’s ability to demonstrate resilience in day-to-day work?
Do you have any comments about this applicant’s ability to demonstrate resilience in day-to-day work?
Thoroughness (is well-prepared, shows self-discipline and commitment). Do you have any concerns about this applicant’s ability to demonstrate thoroughness in their approach to work?
Do you have any concerns about this applicant’s ability to demonstrate thoroughness in their approach to work?
Drive/enthusiasm (is a self-starter, motivated, keen to learn and improve). Do you have any concerns about this applicant’s commitment, enthusiasm and drive for the specialty?
Drive/enthusiasm (is a self-starter, motivated, keen to learn and improve). Do you have any concerns about this applicant’s commitment, enthusiasm and drive for the specialty?
Probity (displays honesty, integrity, aware of ethical dilemmas). Do you have any concerns about this applicant’s probity in the approach to patient care and in dealing with colleagues?
Probity (displays honesty, integrity, aware of ethical dilemmas). Do you have any concerns about this applicant’s probity in the approach to patient care and in dealing with colleagues?
Absence record. Has the applicant, to your knowledge, had any period of sickness absence longer than 5 consecutive days?
Absence record. Has the applicant, to your knowledge, had any period of sickness absence longer than 5 consecutive days?
Punctuality. Is the applicant, to your knowledge, punctual at work and when attending organised teaching sessions?
Punctuality. Is the applicant, to your knowledge, punctual at work and when attending organised teaching sessions?


Your details
Name
Qualifications
Main appointment
Hospital
Telephone number
Email address

Contact us

Should you have any queries about this application form please email mti@rcog.org.uk

Elsewhere on the site

Working in Britain for non-UK doctors
General guidance about working and training in O&G for doctors from outside the UK
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Find out about the RCOG's work to tackle maternal mortality and morbidity worldwide