Beruflich Dokumente
Kultur Dokumente
July 2011
Contents
Introduction Section 1: Introduction to RCOG educational roles
1.1 College Tutor 1.2 Educational Supervisor 1.3 ATSM Director 1.4 ATSM Preceptor 1.5 ATSM Educational Supervisor 1.6 Deanery Ultrasound Co-ordinator 1.7 Ultrasound Educational Supervisor 1.8 Subspecialty Training Programme Supervisor (STPS) 4
5 5 7 8 10 12 13 15 16
18 22 25 30 31 32 34
35 35 36 39 39 40
Section 4: Resources
4.1 Bibliography for medical education 4.2 List of educational resources
42 42 42
Section 5: Appendices
5.1 Appendix 1: Sample letter of welcome 5.2 Appendix 2: Example of introductory programme
45 45 47
Introduction
The delivery of training and education is a core responsibility for the National Health Service (NHS). The General Medical Council sets the standards for undergraduate and postgraduate medical education and works with the Colleges to determine the curriculum, assessments and implementation. The Royal College of Obstetricians and Gynaecologists (RCOG) has established specific educational roles to support the delivery of training. This document is provided as guidance for those undertaking these important roles. The main roles are College Tutor, Educational Supervisor, ATSM Director, ATSM Preceptor, ATSM Educational Supervisor and Ultrasound Director. These notes are intended to act as a reference for the RCOG educational roles. In the first section the educational roles are described, in section 2 postgraduate education at the RCOG and within Deaneries is described, in section 3 suggestions are offered for local/regional management of education and in section 4 there is a list of resources that will be useful. These notes are a new development and we would be pleased to receive feedback. We would be particularly keen to hear of any suggestions for inclusions within the next version. If you have ideas, please write to the Chair of the Specialty Education Advisory Committee at the RCOG. Clinical supervision is undertaken by many different professionals. This involves providing direct teaching and assessment of all aspects of the curriculum for obstetrics and gynaecology. In order to undertake teaching and workplace-based assessments, clinical supervisors require more time within the clinical setting to perform these tasks; therefore, direct clinical care activities need to be appropriately modified to allow sufficient time and recognition for this additional work. The RCOG recognises that this will necessitate the tailoring of clinics, theatre lists and so on to the training level of the trainees in these environments and the complexity of the skills being acquired. In order to ensure high-quality education it is recommended that all those involved in these training roles undergo annual appraisal of their educational role. This may be undertaken as part of the job planning process or through a separate arrangement through the deanery; local circumstances will apply.
Provide pastoral care of trainees. Foster a positive educational environment for learning. Organise an in-house (multiprofessional) education programme; this includes arranging an induction programme for new trainees. Ensure local Educational Supervisors have undertaken the appropriate training and remain updated. Assign trainees to Educational Supervisors. Ensure an appropriately balanced timetable is provided to meet individual trainee training requirements (both full-time and flexible trainees). Provide the opportunity to assist trainees with their educational goals and career progression (it is the responsibility of the Educational Supervisor to undertake regular appraisals). Encourage trainers to undertake formative and summative assessments and appraisals of obstetrics and gynaecology trainees (trainees are responsible for undertaking assessments/workplace-based assessments). Oversee competency-based and workplace-based assessments, ensuring departmental trainers are aware of these assessment tools. Facilitate the provision and supervision of the RCOG Advanced Training Skills Modules (ATSMs). Liaise with the local Educational Supervisor on the delivery of ultrasound training within the unit. Identify trainees in difficulty and support them at a local level, in conjunction with the Deanery/School/Training Programme Director.
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Be accountable to the RCOG, the Chairs of the RCOG Education Committees and the Education Board. Take responsibility for identifying, within their unit, individuals to act as
positive role models for the recruitment of undergraduates educational leads and mentors of postgraduates.
Ensure appropriate systems are in place for the clinical and professional supervision of qualified obstetricians and gynaecologists across the trust. Arrange deanery and General Medical Council (GMC) inspection visits. Liaise with deanery/school committees and other hospital departments. Represent the RCOG locally. Ensure timely completion of the RCOG workforce census and timely response to requests by the RCOG for information.
Person specification
Essential characteristics
Be a consultant in obstetrics and gynaecology. Be an RCOG Fellow or Member. Have experience as an educational supervisor. Be continuing professional development (CPD)-maintained (name on CPD roll), if eligible. Be accountable to the Head of School/Chair of the Specialty Training Committee (STC) and Director of Medical Education (of local education provider). Be appointed jointly by the deanery (Head of School/Chair of the STC on behalf of Postgraduate Dean and NHS services representative). Be appointed through a formal process in open competition. Have full knowledge of the current How to be a College Tutor course. Agree to work within the terms of the job description. Attend College Tutors meeting. Encourage trainees to undertake RCOG and GMC survey. Be trained in equality and diversity. Undergo annual appraisal of educational role as per deanery and NHS services processes.
Desirable characteristics
Have training in postgraduate medical education. Have experience of organising training in obstetrics and gynaecology.
Duration of appointment
3 years initially. Optional renewal for a maximum of a further 3 years (in unusual circumstances this could be further extended; however, a further open competition would be required).
Take responsibility for the personal and professional development of a trainee through the programme. Develop a mutually accepted learning agreement. Undertake regular appraisals and feedback. Help trainees maintain their learning portfolio. Complete the Educational Supervisors report. Identify trainees in difficulty and support them at a local level, in conjunction with the Deanery/School/Training Programme Director/College Tutor. Be trained in equality and diversity.
Person specification
Essential characteristics
Be a fully trained medical practitioner (consultant or staff and associate specialist [SAS] doctor). Have an interest in education. Have skills in appraisal and feedback. Regularly attend Educational Supervisor training courses. Be CPD-maintained (name on CPD roll), if eligible. Be approved jointly by the deanery and NHS services.
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Encourage trainees to undertake RCOG and GMC survey. Be trained in equality and diversity. Undergo annual appraisal of the educational role as per deanery and NHS processes.
the availability of ATSMs in the region the regions preferred selection process what should happen if requests for an ATSM exceed the regions training capacity.
ATSM training is open to training and nontraining grades; however, it is acknowledged that as national training number (NTN) holders require two ATSMs for Certificate of Completion of Training (CCT) registration, these trainees will be given priority when training opportunities exist. The ATSM Director can also be an ATSM Preceptor, ATSM Educational Supervisor or both. This educational role should be appointed in open competition as per deanery processes.
Oversee and coordinate ATSM training for training and nontraining grades across a deanery/region. Be the contact point within the region for the School Board/STC, ATSM Preceptors, ATSM Educational Supervisors and College Tutors in all matters related to ATSM training. Be a member of, and report to, the regions School Board/STC. Take responsibility, with the aid of the ATSM Preceptors, for assessing the regions capacity for the delivery of ATSMs and deciding which ATSMs will be offered. Liaise with the ATSM Preceptors and College Tutors to develop ATSM training programmes. Take responsibility for appointing and supporting ATSM Preceptors. Take responsibility for completing the ATSM forms that are sent to the College by the trainee. Take responsibility for overseeing the provision and quality assurance of ATSM training. Take responsibility for preparing material required for quality assurance by the local School Board/STC and the GMC. Provide ATSM career advice. Take responsibility, with support from the ATSM Preceptor, ATSM Educational Supervisor and College Tutor as necessary, for responding to the needs of trainees in difficulty. Keep up to date with RCOG standards in education, new educational initiatives and changes to the ATSM curriculum and assessment. Communicate with the RCOG to provide feedback on the curriculum, implementation and delivery of the ATSM modules within your deanery. Attend the ATSM Directors meeting at the RCOG, which is held at least annually. Cascade ATSM-related information from the RCOG to ATSM Preceptors and ATSM Educational Supervisors.
Person specification
Essential characteristics
Be a consultant in obstetrics and gynaecology. Be an RCOG Fellow or Member. Have experience as an educational supervisor. Have experience of postgraduate education and training. Be a prior/current member of the School Board or equivalent training committee. Be CPD-maintained (name on CPD roll), if eligible. Be appointed jointly by the Deanery (Head of School/Chair STC on behalf of Postgraduate Dean and NHS services representative).
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Have managerial/organisational skills. Have awareness of quality management principles. Agree to work within the terms of the job description. Encourage trainees to undertake RCOG and GMC survey. Be trained in equality and diversity. Undergo annual appraisal of educational role as per Deanery and NHS processes.
Desirable characteristics
Have training in postgraduate medical education. Have experience of organising training in obstetrics and gynaecology.
Duration of appointment
Co-ordinate the delivery and monitor the quality of training for their particular ATSM. Liaise with colleagues in the specialty to ensure that both the ATSM and the core curriculum are delivered without conflicts or adverse service impacts. Ensure that the workplace-based assessments required by the ATSM curriculum are performed and signed off. The trainee must submit these to the annual reviews of competency progression (ARCP) process with all other supporting evidence of progress. Take responsibility for approving local ATSM Educational Supervisors to deliver ATSM training in individual units. Take responsibility for ensuring that the educational opportunities and environment provided by the Educational Supervisors meet the ATSM training needs of the trainee. Ensure that each trainee is allocated an ATSM Educational Supervisor. Undertake regular appraisal and feedback meetings with trainees to ensure that educational objectives are being met. Take responsibility for confirming that the trainee has attended an appropriate theoretical course as set out in the curriculum. Take responsibility for confirming that training is completed and signing the notification form, which the trainee should then send to the ATSM Director. Be involved in the regions agreed selection process. Take responsibility, with support from the ATSM Director, ATSM Educational Supervisor and College Tutor as necessary, for responding to the needs of trainees in difficulty. Keep up to date with the RCOG standards in education, new educational initiatives and changes to ATSM curriculum and assessment. Provide career guidance and discuss the curriculum with the trainee prior to registration. Undertake quality control of the ATSM and report to the ATSM Director any potential concerns regarding delivery. Report to the ATSM Director within the deanery.
Person specification
Essential characteristics
Be a fully trained consultant. Have experience as an educational supervisor. Be CPD-maintained (name on CPD roll), if eligible. Be appointed jointly by Deanery (Head of School/Chair of the STC on behalf of the Postgraduate Dean and NHS services representative).
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Be a specialist in the ATSM clinical area of obstetrics and gynaecology. Be aware of quality management principles. Agree to work within the terms of the job description. Encourage trainees to undertake RCOG and GMC survey. Be trained in equality and diversity. Undergo annual appraisal of educational role as per deanery and NHS processes.
Desirable characteristics
Have training in postgraduate medical education. Have experience of organising training in obstetrics and gynaecology.
Take responsibility for maximising the educational opportunities provided by the hospital to meet the ATSM training needs of the trainee. Take responsibility, with the trainee, to record trainee progress using the ATSM logbook and appropriate RCOG assessment tools.
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Ensure that the trainee is able to attend the required training days and course(s). Advise the ATSM Preceptor if any difficulties arise in providing the ATSM training. Take responsibility for early liaison with the ATSM Preceptor to facilitate trainee progression if training needs cannot be met. Countersign the form to confirm that training is completed. This form should be sent to the ATSM Preceptor for completion by the trainee. Take responsibility, with support from the ATSM Director, ATSM Preceptor and College Tutor as necessary, for responding to the needs of trainees in difficulty.
Person specification
Essential characteristics
Be a fully trained medical practitioner (consultant or SAS doctor, midwife, specialist nurse, sonographer). Have an interest in education. Have skills in appraisal and feedback. Be approved jointly by the deanery and NHS services. Be trained in equality and diversity. Undergo annual appraisal of educational role as per deanery and NHS processes.
expected to become a member of (or be seconded onto) the Deanery Specialist Training Committee and will be expected to attend training assessment meetings. The Deanery Ultrasound Co-ordinator will work with the Ultrasound Educational Supervisors/ Ultrasound Trainers within the units to ensure coordinated delivery of the ultrasound curriculum and assessments. The Deanery Ultrasound Co-ordinator should ensure access to good-quality ultrasound equipment and machines. The Deanery Ultrasound Co-ordinator(s) must hold either FRCR or MRCOG/FRCOG and actively participate in obstetric and/or gynaecology ultrasound on a regular basis. This educational role should be appointed in open competition as per deanery processes.
Provide guidance to local ultrasound educational supervisors and other trainers (who may include consultants, midwifes, nurses, sonographers and advanced practitioner sonographers). Ensure the local ultrasound educational supervisors/trainers actively participate in obstetrics/gynaecology ultrasound on a regular basis. Ensure local trainers are aware of the curriculum and assessment processes, including giving feedback. Be involved in the selection process of trainees applying for the intermediate ultrasound modules, Authorise completion of intermediate ultrasound training, Hold an updated record of training centres, local ultrasound educational supervisors and trainers within the deanery. Monitor the quality of training across the region. Keep an updated record of trainees placements and duration of training. Work in collaboration with the Training Programme Director to highlight training opportunities and allocate trainees to available training slots. Report on the trainees progress to the Deanery Specialist Training Committee/School. Ensure trainees have access to the appropriate theoretical courses. Take responsibility, with support from the deanery and College Tutor as necessary, for responding to the needs of trainees in difficulty. Attend the annual RCOG Ultrasound Co-ordinators meeting.
Person specification
Essential characteristics
Be a specialist in obstetrics and gynaecological ultrasound scanning. Hold FRCR or MRCOG/FRCOG. Have experience as an educational supervisor. Have managerial/organisational skills.
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Be CPD-maintained (name on CPD roll), if eligible. Be appointed jointly by the deanery (Head of School/Chair of the STC on behalf of the Postgraduate Dean and NHS services representative). Have awareness of quality management principles. Agree to work within the terms of the job description. Be trained in equality and diversity. Undergo annual appraisal of educational role as per deanery and NHS processes.
Coordinate delivery of the local ultrasound training. Be aware of the RCOG ultrasound curriculum and assessments. Possess the necessary ultrasound scanning skill. Identify and support local ultrasound trainers. Ensure quality control of ultrasound training. Take responsibility, with support from the Deanery Ultrasound Co-ordinator and College Tutor as necessary, for responding to the needs of trainees in difficulty.
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Person specification
Essential characteristics
Be a fully trained medical practitioner (consultant, SAS doctor, ultrasonographer). Have an interest in education. Have skills in appraisal and feedback. Be approved jointly by the deanery/College Tutor and NHS services. Be trained in equality and diversity. Undergo annual appraisal of educational role as per deanery and NHS processes.
Take responsibility for maximising the educational opportunities provided in the accredited subspecialty training centre to meet the training needs of the subspecialty trainee. Ensure all components of the curriculum are included in the subspecialty training programme. Ensure that the trainees mandatory logbook is accurate and up to date. The STPS should check that the trainee has sufficient evidence to allow the assessors to judge the trainees progress at the mid-term and final review. Take responsibility for the completion and submission of the application for recognition as a subspecialty training centre and for liaising with the deanery to arrange the site visit. Take responsibility for ensuring that the subspecialty training programme is advertised nationally and appointed in open competition. Take responsibility for completion and submission of trainee registration documentation (within 6 months of the trainee starting subspecialty training).
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Take responsibility for the completion and submission of mid-term and final review documentation and for coordinating review visits. Take responsibility, in collaboration with the RCOG College Tutor and Head of School/Deanery, for ensuring the subspecialty trainee has an annual RITA/ARCP (including appropriate team observation) and the results of this are available to the assessors undertaking mid-term and final reviews. Take responsibility for ensuring the Head of School/Chair of the Deanery STC is aware of any concerns identified by assessors at the mid-term and final review and for developing action plans to address any trainee or unit issues identified.
Person specification
Essential characteristics
Must be accredited as a subspecialist. Have training in postgraduate medical education. Attend a Training the Trainers course yearly. Have skills in appraisal and feedback. Be approved jointly by the deanery and the NHS. Be trained in equality and diversity. Undergo annual appraisal of educational role as per deanery and NHS processes. Be accountable to the Head of School/Chair of the Specialty Training committee and Director of Medical Education (of local education provider).
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provide overall management of the education of doctors in training provide appropriate career counselling and pastoral support manage the postgraduate centre and the centre staff provide leadership and strategy for medical education in the trust.
There is usually also a Clinical Tutor with responsibility for undergraduate education if medical students are attached to the hospital unit. Clinical Tutors/Directors of Medical Education often take on additional duties such as organisation of hospital courses (training the trainers, GP refreshers) and chairing of hospital education committees. Clinical Tutors
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may also be responsible for the study leave budget for all training grades, although this varies across the country.
Email: tchambers@rcog.org.uk
Trainees Register enrolment and enquiries Penny Payne Tel: +44 (0)207 772 6348
Email: ppayne@rcog.org.uk
Curriculum, logbook and workplace-based assessment content enquiries Navin Jaitly Tel: +44 (0)207 772 6460 ePortfolio enquiries Tel: +44 (0)207 772 6204
Email: curriculum@rcog.org.uk
Email: ePortfolio@rcog.org.uk
Subspecialty training enquiries Bettina Muller Tel: +44 (0)207 772 6203
Email: bmuller@rcog.org.uk
ATSM registration enquiries Bettina Muller Tel: +44 (0)207 772 6203
Email: bmuller@rcog.org.uk
Careers advice and advice relating to training in the UK Kay Weir Tel: +44 (0)207 772 6271
Email: kweir@rcog.org.uk
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Email: mhuggins@rcog.org.uk
Recruitment into obstetrics and gynaecology training Matt Huggins Tel: +44 (0)207 772 6262
Email: obsjobs@rcog.org.uk
Overseas training opportunities Binta Patel Tel: +44 (0)207 772 6223
Email: bpatel@rcog.org.uk
MRCOG and DRCOG examinations Examination Department Tel: +44 (0)207 772 6210 Conferences and courses Conference Office Tel: +44 (0)20 7772 6245 StratOG.net E-learning Publication Team Tel: +44 (0)20 7772 6324/431
Email: examsadmin@rcog.org.uk
Email: events@rcog.org.uk
Email: stratog.net@rcog.org.uk
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COUNCIL
Services Board
Educa on Board
Standards Board
Informa on Management and Technology Strategy Group Congress Regional College Advisers Product Management Group Ethics Guidelines Pa ent Informa on Curriculum ORCA Steering Group Recer ca on Safety and Quality Scien c Advisory Equality and Diversity Ac on Group Investment and Advisory Panel NCCWCH Execu ve BJOG Editorial Board BJOG Management Consent Group
Academic
Consumers Forum
Interna onal Fundraising Sub group Interna onal Partnership Management Group Interna onal Representa ve Commi ees (29) Interna onal Liaison Group (6)
Equivalence
Subcommi ees:
Assessment
DRCOG
Heads of School
subspecialty
RCM/RCOG/RCA/RCPCH
Registra on Appeals
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demonstrate a thorough understanding of the principles of the competence/clinical skill/situation, including the indication for the procedure and the common complications be aware that before undertaking any clinical skill under direct supervision they will have observed the procedure on a number of occasions use other methodologies (for example drills, simulation, e-learning and case-based discussion assessments) if direct experience of the procedure or clinical problem is not possible.
Anchor statement: The trainee demonstrates detailed knowledge and understanding and is aware of common complications/issues relating to the competence/clinical skill/situation.
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Level 2 (previously referred to as direct supervision) Trainees must be observed directly in different clinical situations before being signed off at level 2. The trainee should:
perform the clinical skill/manage the case under supervision be aware that the number of times the competence/clinical skill/situation needs to be supervised depends on the complexity of the case and individual aptitude be aware there is therefore no limit to the number of times the procedure can be supervised and there is no advantage in having a module signed up until you and your clinical supervisor are certain that you can safely perform this procedure in a number of different clinical situations and levels of complexity be able to manage any unexpected complications but know when to summon senior help.
Anchor statement: The trainee is capable of performing the task or managing the clinical problem but with senior support. Level 3 (previously referred to as independent practice) The progression to independent practice may be the most difficult for the trainee. Once the trainee has been signed off for direct supervision, they should start the process of performing procedures with less and less supervision, as agreed by their trainer. To be signed off as ready for independent practice, the trainee should demonstrate the following:
the ability and confidence to perform the clinical skill/situation competently when senior staff are not immediately available, e.g. out of the hospital a willingness to move on to experiential learning with further case exposure a willingness to keep a record of the numbers of cases/procedures subsequently managed (including any complications and their resolution).
Once deemed competent at level 3, the trainee must keep a formal record of the numbers of the procedures they subsequently perform and any complications. They will need this information for revalidation. The necessary log of experience forms can be found in Section 8 of the Training Portfolio. Remember that competency is a baseline level for safe independent practice with further exposure and experience leading to proficiency and subsequently expertise (the latter will generally be developed post CCT). Anchor statement: To be deemed competent, the majority of cases are managed with no direct supervision or assistance (senior support will be requested in certain complex cases/complications). Achieving competency using other methodologies When trainees do not see rarer clinical presentations to develop competency and specific competences, it would not be beneficial to remove these rare occurrences from the curriculum. Trainees and trainers must be aware that in such circumstances (and only these circumstances), trainees need not be seen to observe or perform the relevant procedure in
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order to be successfully assessed and in order to progress through training. Instead, alternative training methods should be used (drills, simulation, e-learning) and case-based discussion assessments should be completed until all requirements of the assessment are met. When signing off a trainee using the above approach, trainers must mark OM (i.e. other methodology) alongside their signature.
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completion of the two basic ultrasound modules (from August 2011) completion of the e-learning package on sexual and reproductive health (from August 2011).
2.1.4 ATSMs
The ATSMs have been designed to develop skills suitable for future career progress within the consultant career pathways detailed in the RCOG document The Future Role of the Consultant. The modules are designed to allow trainees to develop special interest areas within their clinical practice. They have been developed in conjunction with the specialist societies and trainees must complete a minimum of two ATSMs to achieve their CCT.
Subspecialty training can be undertaken as an alternative to higher training (in years 6 and 7) but can also be undertaken after completing specialist training in general obstetrics and gynaecology (i.e. post-CCT). Entry is competitive and subspecialty training programmes are generally between 2 and 3 years in length (depending on prior research activity). The aim is to focus on training in specific skills within a clearly defined specialist area.
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Meetings are confidential but not legally privileged and anything that raises safety issues for patients or trainees can be disclosed. You should feel free to discuss obstacles to progress and an appraiser should show interest in emotional development. Documentation is important, but do not allow it to get in the way of discussion. Set an agenda of points to be covered, have a good dialogue and then complete forms at the end. Create a checklist of individual targets with timelines to help future discussions. The induction appraisal interview should be completed within 2 weeks of starting a new post. The College Tutor will assign an Educational Supervisor to the trainee and it is the Educational Supervisor who will complete the induction interview. At this interview the Educational Supervisor and trainee should review progress to date and set training objectives for the next year of training. This should include a review of the objectives set at the previous ARCP. The process should then be repeated in the middle and at the end of training attachments. This ensures continuing reflection upon progress. Educational Supervisor report The Educational Supervisor should complete a report for each trainee during their placement. This report should include information acquired through the appraisal, workplace-based assessments, achievement of curriculum objectives, TO2s, etc. The report should summarise progress through the year and identify any problems. This report must be submitted to the ARCP panel. The Educational Supervisors report is part of the evidence that informs the ARCP process. What happens if there is a disagreement between the trainee and the clinical trainer? There are many ways that people practise, in terms of their choice of management plan, the way they carry out a procedure or the way they communicate with a patient. Working as part of a team means respecting different individuals professional manner and clinical trainers should be respected for the advice that they give. Trainees should not use the same assessors and they should choose to be assessed by individuals who may be notoriously difficult because they have always set such high standards. Trainees will gain respect from colleagues if they are seen to be working and learning from all colleagues. The difficult appraisal
Problem areas need exact definition, not generalisation. Collect objective evidence. Use description not judgement. Discuss performance, not personality. Listen and ask questions; keep it friendly. Identify and reinforce strengths. Be positive. Praise/encourage. Collaborate on constructive solutions. Set objectives that are SMART: specific, measureable, achievable, realistic and timed. Identify carrots and sticks to help ensure that objectives are achieved. Keep a close eye on future progress. Do not capitulate on your bottom line.
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Formative assessments. Used to help to assess the trainee and provide structured assessment. OSATS are completed throughout training until the trainee is competent to practise independently. The same OSATS may be used to assess increasing levels of complexity for any particular procedure. The logbook is signed when the trainee is deemed competent to practise independently. (At least three OSATS must have been completed by at least two assessors as a reliable indicator that the trainee is competent. One assessor should be a consultant.) Once the trainee is fully competent for independent practice, it is recommended that they undergo an annual OSATS assessment to demonstrate continued competency. One OSATS should be completed annually for each procedure until CCT. Trainees must also keep a count of the procedures completed annually until CCT.
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Tests many different and varied competences and is a generic tool. Enables the trainer to observe and assess directly the process of history taking, clinical examination, formulating management plans and communicating with patients. Designed to take about 20 minutes to perform. Results should be fed back and discussed immediately after the assessment.
Case-based discussion
This generic tool formalises hypothetical case discussions with trainers. Relevant to knowledge criteria and competences in the curriculum. Used to assess clinical decision making, knowledge and application of knowledge. Each case-based discussion should involve slightly different clinical situations in the area to be tested. Discussion will focus on the information that would be given to the patient and recorded in the notes.
Team observation (TO) forms TO1 forms are a multisource feedback tool based on the principles of good medical practice (2006) as defined by the GMC. TO1s are not a confidential document and the trainee should be aware of the contents. However, the Educational Supervisor should manage the release of the forms to the trainee so that they can assist with the interpretation of comments and explain how the comments will be constructive for the trainees development. The TO2 form is a summary of the TO1 forms. It plays an important part in the ARCP process. The Educational Supervisor certifies that this form is a correct summary of the TO1 forms received and also adds comments provided from personal observation. A trainee and Educational Supervisor should agree on at least ten assessors to complete TO1 forms. It is suggested that the selected assessors should include at least three senior medical colleagues (consultant or senior specialist trainee registrar), a senior midwife on the delivery suite and from the antenatal clinic, a senior nurse from the gynaecology ward and a member of the theatre team. Other appropriate staff include midwives from other areas, staff from the specialist clinics that the trainee has been working in and anaesthetic and paediatric colleagues. Generally, it is thought not to be appropriate to ask clerical and support staff to complete TO1 forms, although in certain situations an educational supervisor may request TO1 forms from nonclinical colleagues.
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logbook requirements and indicate average numbers. In the meantime, the training guidelines have been made as flexible as possible, but we do say that three OSATS should be completed by more than one assessor (one of whom should be a consultant) for the core logbook competences that include OSATS. Why three OSATS? This is for reliability and validity. Although the curriculum is competency-based and the training guidelines state that a certain number of assessments must be completed, trainers must think out of the box and realise that different trainees will progress at different rates. However, the reason that three has been designated as the number is because it is more reliable. Two assessors should be involved in the assessment, one of whom should be a consultant because they will have a more experienced judgement of the trainees competence. Are curriculum and logbook requirements for numbers absolute? Curriculum and logbook requirements for numbers are for guidance only. It is obvious that each trainee will develop at a different rate, and some trainees will carry out more supervised procedures than others before the trainer is satisfied that competence has been achieved and the trainee can practise independently. In order to provide some structure to the delivery of elements of training and to recognise the relative importance of different procedures within the curriculum, suggested numbers of procedures are included in the training documentation. There is considerable experience in the use of OSATS for the assessment of trainees in obstetrics and gynaecology. Analysing OSATS (both the content of and, in some respects, the number of OSATS) is particularly important at the time of appraisals and particularly at the designated waypoints in the training programme. Trainees are responsible for organising their workplace-based assessments. An educational supervisor and trainee should discuss the areas in which assessment is required regularly, based on the unit in which they are working and the curriculum requirements set at a particular level. Whether a trainee is being assessed by an educational supervisor or by another clinical trainer, a trainee should plan ahead so that they are not completing all of the necessary assessments in the lead-up to an appraisal or an annual review. If trainees are struggling to have assessments completed in a unit, they should speak to an educational supervisor early and not wait for the appraisal meeting. Trainees dont perform OSATS until they are performing well, or they may throw away or not include bad OSATS what can we do? Trainees may not pay attention to the clinical trainers comments because they choose not to insert it into their portfolio. Trainees should now realise that this is not a pass/fail process assessment and that OSATS are formative assessments. There is no such thing as a bad OSATS and there is no such thing as a perfect trainee. Each trainee needs different levels of support, and workplace-based assessments help structure this. Evidence of OSATS undertaken early in training is important for trainers to establish what support a trainee needs and to get a sense of confidence and competence. The aim is not to judge a trainee against another trainee of the same level or a more senior trainee. Do not judge a trainee against how you as a clinical trainer used to be when at the same level. Know the curriculum, know the assessments and get to know the trainee.
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My trainees only perform OSATS when theyre getting skilful what can I do? The trainees are missing the point. Bearing in mind that most trainees fail their ARCP because they have insufficient evidence, surely the more formative evidence, the better? Formative assessment should show progress from basic to advanced level. There is no point in not completing assessments until competent because the trainee will have missed out on the structured feedback when it could have been useful and would actually have made their life easier. How can you maximise the case-based discussion? Use e-learning or other resources before or between case-based discussion assessments for a particular subject area. Make the most of a case-based discussion so that knowledge is gained and a trainee has the opportunity to clarify how they would manage a hypothetical situation and still ask questions away from patients. Make sure this is not a tick-box exercise and that trainees realise that training, workplace-based assessment and the MRCOG examinations all link together and the more the trainee can apply their knowledge, the better they will be at their job. How can you maximise the mini-CEX? A mini-CEX is a snapshot of a trainees interaction with and management of a patient. Not all elements need to be assessed in one situation and a mini-CEX may just focus on improving a particular area of a trainees work, for example history taking. Feedback should be offered to the trainee after the event and areas of development and action points should be identified following the assessment. The trainee should also reflect on experience and make notes that either are private or that they share with an educational supervisor or a clinical trainer.
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programme. Outcome 4 will recommend that the trainee is released from the training programme if there is still insufficient and sustained lack of progress despite having had up to one year of additional training to address concerns over progress. Within six months of the CCT date the trainee will be called for a final assessment. At this review the entirety of the training will be reviewed and, subject to satisfactory completion, the trainee will be issued with an Annual Assessment Outcome 6. This must be submitted with the signed Annual Assessment form to the Postgraduate Training Department at the RCOG; the Secretary to the SEAC will contact the trainee directly with the relevant forms to complete. The RCOG will then make a recommendation to the GMC that the trainee has completed the relevant training and is eligible for the award of the CCT.
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Form to use
Induction/appraisal
APP
2
2.1
2.2
TO2
3.1 3.2
TO2 ARCP
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The purpose of the MRCOG is not to define the specialist (the obstetrician and gynaecologist capable of independent practice). The object of the examination is to provide a marker of the acquisition and development of a body of core knowledge and ability in the subject generally that of a trainee progressing to ST6. Doctors with the MRCOG are ready to proceed to expand their experience into more specialised areas prior to independent practice. MRCOG Part 1 The purpose of the MRCOG Part 1 examination is to assess whether candidates about to embark upon a career in obstetrics and gynaecology have a broad and detailed knowledge of reproductive science. Candidates are eligible to attempt the Part 1 examination when they have obtained their medical degree. The examination consists of two papers, each of which has 20 extended matching questions (EMQs) and 48 five-part multiple choice questions (MCQs). The duration of each paper is 2 hours. Questions in Paper 1 cover anatomy, embryology, endocrinology, microbiology, pharmacology, statistics and epidemiology. Paper 2 includes biochemistry, biophysics, genetics, immunology, pathology and physiology. MRCOG Part 2 Candidates are eligible to take the examination after having passed the Part 1 and completed 4 years of approved training in obstetrics and gynaecology, or 2 years if in the recognised UK specialty training scheme. From March 2011, the format of the written examination will change. The question formats currently used will remain, but the number of questions candidates are required to answer and the time they are allotted to do so will be revised. The revised format will consist of:
two combined MCQ/EMQ papers, each consisting of 120 MCQs and 45 EMQs, of which approximately half are on obstetrics and half on gynaecology, to be answered in 135 minutes one short answer question (SAQ) paper, consisting of four questions to be answered in 105 minutes.
The revised allocation of marks will be as follows: EMQs (40%); MCQs (30%); SAQs (30%). There is no separate pass mark for the various components of the written examination, but rather an overall pass mark derived by standard setting. Candidates who are successful in the written examination proceed to an oral assessment, which is an objective structured clinical examination (OSCE) consisting of a circuit of 12 stations, ten of which have an examiner present and are marked and two of which are preparatory. At each active station the candidate has to perform a task testing knowledge, skills, communication or problem-solving ability. Depending on the type of station, there may be a role-player, some imaging, surgical equipment, a pelvic model or a clinical scenario. The oral assessment is marked out of 200, and the pass mark is derived by standard setting.
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Paper 1, consisting of 30 EMQs and 18 single best answer (SBA) questions, which candidates have 90 minutes to complete Paper 2, consisting of 40 five-part MCQs, which candidates have 90 minutes to complete.
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3.1.1 Prevention
Trainees will appreciate being positively greeted by staff and it is helpful if we try to make them feel a welcome and integral member of the team. All trainees will attend an induction course to help familiarise them with the workings and fabric of the obstetrics and gynaecology unit. Please help to extend this process of orientation by showing them where equipment is kept, including tea and coffee supplies. Within the first 2 weeks all trainees should meet with their Educational Supervisors for appraisal. Remember this is an opportunity to ask about previous medical experiences, both good and bad, and to inquire about their life outside the hospital. Try to emphasise that we all welcome trainees coming to us about any problems they are facing at any stage. Praise is important to us all, but it is so easy to forget to comment positively to each other. Please make a special effort to point out the contribution that trainees are making to the working of the unit during their first few days and weeks.
phrases such as Mrs X was concerned for you. If the trainee is not forthcoming, a more direct approach may be necessary, but try to avoid being judgemental and try to emphasise the positive attributes of the trainee. The causes of poor performance are often complex and it is helpful to attempt to explore any possible reasons. This can then be useful in discussing ways for improvement. Remember that doctors have a primary responsibility for patient safety and that very serious problems cannot be ignored with the hope that they will go away. If necessary, additional advice can be obtained from other sources such as the Postgraduate Deanery, the Clinical Tutor, the Clinical Director, the Medical Director and the Department of Human Resources. Action if problems persist If the problem is not of a threat to patient safety but persists, a further interview with another professional may be important. It may be wise to consider somebody who is independent such as the Clinical Tutor. Once again it is important to be certain of the facts and to focus on the needs of the trainee. The Postgraduate Deanery will be able to give advice and support for the trainee and trainer.
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Overall aims Think carefully about the overall aims of the programme. Is this a programme aimed primarily at pre- or post-MRCOG trainees? Before designing a programme you need to be explicit about your aims and objectives and ensure that your trainees and trainers are aware of these too. Organisation How are you going to organise your programme? There is evidence to suggest that trainees prefer all-day protected teaching sessions and are prepared to travel if the education is up to scratch. Getting agreement for trainees to be released from their individual units is crucial if attendance is to be monitored and trainers are not to be frustrated by the lack of attendees. Similarly, ensure your trainers are signed up to being involved. If your trainers are not committed, neither will your trainees be. Funding Good education is not cheap. Sponsorship from drug companies has traditionally funded many educational meetings; however, other models do exist. Study leave budgets have been top-sliced in some deaneries, such as Wessex, to fund the education programme, with the consent of the trainees. Content Think hard about content. Remember there are many different learning styles and ways in which key educational principles can be incorporated into the study days. Some of the programme may be amenable to multidisciplinary learning. You are teaching adults; therefore, their active involvement should ensure their interest and participation. Education sessions should be both informative and fun. Feedback Make sure you get regular feedback and act on it to improve and develop your programme.
The 3-year cycle programme should cover the nine main subspecialty headings:
maternal medicine fetal medicine preterm labour/prematurity/perinatal issues general obstetrics/intrapartum care urogynaecology gynaecological oncology infertility gynaecological endocrinology benign gynaecology.
It is suggested that funding would come from the study leave budget with a fixed amount being top-sliced from each trainees allowance. Other means of obtaining funding include pharmaceutical company sponsorship. Study days should incorporate a mixture of learning styles: didactic lectures, debates, small group discussions, quizzes, etc. Speakers within the specialty can provide a greater breadth to training. Examples include:
genitourinary medicine urology haematology general endocrinology/diabetes palliative medicine pelvic inflammatory disease fistula/ureteric damage/recurrent urinary tract infections thrombophilia/transfusion medicine diabetes and pregnancy/pituitary tumours breaking bad news/symptom control.
Consideration should be given to asking some speakers to use their topic to demonstrate principles of medical practice. Examples might include:
testing for Down syndrome cervical cytology cerebral palsy tocolysis breech presentation/delivery cervical cerclage
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principles of screening medico-legal practice (duty of care, etc.) using evidence-based medicine intention-to-treat studies benefits and drawbacks of random-allocation trials.
It is suggested that the attendance of trainees is recorded and formally reviewed at the ARCP. Targets for attendance can be decided at regional level according to local factors.
write to the trainee 1 month before arrival (see Appendix 5.1) organise an introductory day and tour of unit (see Appendix 5.2) provide formal praise by interview or letter within the first 4 weeks.
Type of course Training the Trainers Certificate/diploma/MEd in medical education MEd in higher education Accreditation via experience
Institution RCOG Dundee University Most universities Institute of Learning and Teaching
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write welcoming trainees just before they take up the post provide a folder with important information (contact points/telephone numbers, etc.) consider having multiple mentors (consultant, midwife, nurse, registrar) provide positive written feedback after the first 2 weeks use every opportunity to give verbal praise avoid negative criticism in public focus on means of improvement rather than chastisement ensure good communication about all the educational events within your unit.
Organisation of appraisal
Have a master sheet detailing what should occur in each week of the year. It is useful to timetable appraisals into the education programme. Request that trainees send TO1 forms at least 1 month before assessment at the end of the attachment.
Share responsibilities It is important to encourage all Educational Supervisors and trainees to take an active role in the programme. Hold a meeting as part of the education programme every 6 months. Discuss a programme for the months to come and share work out as much as possible.
Plan well ahead to encourage preparation. Ensure the room is booked 1 month in advance and confirm in writing. Send reminders of responsibilities 2 weeks before the session. Keep two prepared tutorials in reserve in case of cancellations.
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Keep the programme fresh It is not always possible to have a completely new programme every year. Techniques you can use to prevent it becoming stale include:
use differing seminar techniques (role play, skills training) encourage outside speakers (other departments in the hospital) take note if you hear of a good speaker promote active participation socialise afterwards.
Collate clinical cases It can be difficult to find suitable clinical cases for discussion. Keep a library of a few very instructive cases that can be reused from time to time. Emphasise that cases do not have to be rare topics or controversial issues but simply need to be illustrative of a particular presentation, treatment or complication. Keep attendees motivated Keep seminar rooms cool and comfortable. Make sure there are enough seats. Avoid long lectures with the lights down. Have a break in the middle for tea. Make the second half of the programme more interactive: eclampsia rehearsals, basic life support, risk management tasks, etc. Encourage attendance Obviously, having a dynamic fun programme helps, but even so attendance can still be a problem. Several techniques may help maximise attendance of trainees:
find out why attendance is an issue as the consultant to hold trainees bleeps make trainees responsible for running as much of the seminar as possible keep a register of attendance.
Conducting meetings There needs to be informality but with a structure. Meetings need a chairperson to time proceedings, facilitate discussion and thank contributors at the end. Maintaining and assessing quality For a learning programme to succeed, it has to be liked. By using feedback, it is easy to learn what works well, what does not and what has been left out. Written and anonymous feedback has many advantages, but an informal debrief meeting may provide additional valuable information.
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Section 4: Resources
Newble D, Cannon R. A handbook for medical teachers. 3rd edition. Alphen aan den Rijn, the Netherlands: Kluwer Academic Publishers; 1994. McAllister L, Lincoln M, Mcleod S, Maloney D. Facilitating learning in clinical settings. Chentenham: Nelson Thornes; 1997. Ramsden R. Learning to teach in higher education. 2nd edition. Oxford: Routledge; 2003. Abbatt F, McMahin R, Pridmore P, Harman P. Teaching health-care workers: a practical guide. 2nd edition. Oxford: MacMillan Education; 1993. Harden R, Dent J. A practical guide for medical teachers. London: Churchill Livingstone; 2001. Keighley DB, Murray TS. Guide to postgraduate medical education. Oxford: WileyBlackwell; 1996.
interactive assessments with instant detailed feedback the facility to save assessment scores links to guidelines and reading material streamed videos of procedures and scans animations to simplify complex principles the facility to attach reflective notes to web pages.
Conferences and courses The RCOG holds a number of conferences and courses suitable for trainees and trainers. The entire listing is available on the RCOG website at www.rcog.org.uk/events. Recommended conferences and courses for trainers include:
Training the Trainers How to be a College Tutor College Tutors Meeting RCOG Annual Professional Development Conference (formerly Senior Staff Conference).
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Section 5: Appendices
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Important topics We feel it would be helpful to you to read up about a number of topics early on and review the unit guidelines folder. The most common and serious topics are:
pre-eclampsia preterm labour antepartum haemorrhage fetal monitoring acute pelvic pain early pregnancy assessment.
Remember: we want you to learn in an enjoyable atmosphere. Ask questions, challenge us and have fun.
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Day 2
Meet in postgraduate centre at 9.30 a.m. for breakfast 10.00 11.00 11.30 12.00 14.00 15.00 15.30 16.30 17.00 Appraisal Visit library Visit IT facilities Lunch break Pre-eclampsia theory Tea break Eclampsia rehearsals Cardiotocography Close Labour ward Brad E Cardia Ann Uria Consultant Isa Bein Meg Abite
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