Advanced Training Review

The RCOG commissioned the Advanced Training Review in 2020 in direct response to the GMC’s feedback of the 2019 curricula submission and approvals process.

This recognised the need to substantially review and update both the advanced and subspecialty training component. The curricula content of the current advanced training component has been reviewed occasionally but has not been holistically reviewed since its introduction in 2007 nor has the training structure.

The main drivers for changes were:

• The current curricula have been developed in isolation and leaving duplication and overlap between the core curriculum and current advanced training curricula.
• Technical skills and knowledge have advanced and changed, meaning that some of the content is no longer relevant or appropriate.
• A need for new elements within the special interest curricula to train doctors in emerging skills and modernised ways of working.
• A need to reflect more effectively the needs of women and the service.
• The changing needs of the population.

These drivers have been addressed in the new special interest and subspecialty curricula.

• ATSMs have been renamed Special Interest Training Modules (SITMs) and most of the names of the existing modules have been changed
• The APM in Clinical Research has been renamed Special Interest Professional Module (SIPM) but no change to the content has been made
• The ASM has been converted to a SITM but no change to the content has been made
• The subspecialty curricula are made up of the relevant SITM(s) and subspecialty specific CiPs
• A subspecialty specific research CiP generic for all four subspecialties has been developed and the requirement for research accreditation has been removed
• New SITMs in Chronic Pelvic Pain, Robotic Surgery, Complex Early Pregnancy and Emergency Gynaecology, and Prematurity Care have been developed
• New SIPMs in Medical Education and Leadership and Management have been developed
• The Advanced Labour Ward Practice ATSM has been incorporated into the core curriculum and descriptors have been strengthened.
• The emergency aspect of the Acute Gynaecology and Early Pregnancy ATSM has been incorporated into the core curriculum and the non-core capabilities from the ATSM have been covered in the Complex Early Pregnancy and Emergency Gynaecology SITM
• Special interest training normally commences at ST5

• The detail of how the curriculum, assessment and syllabus will work has not changed since its implementation in 2019 and the organisation of the curriculum, the programme of assessment and principles of the curriculum have not changed
• There are no changes to the training matrix or critical progression points.
• There are no changes to the timings at which O&G trainees sit the MRCOG examinations
• Quality assurance has not changed

Please see the implementation and transition document

• The GMC has introduced a transition period in May 2021 for CESR applicants. CESR applicants will have the same transition period as trainees and can apply with current ATSMs or new SITMs during the transition period. Please see the implementation and transition document

• Both the old and the new versions of the curricula will be on the ePortfolio.
• Should trainees wish to switch to the new curriculum version they would have to relink the evidence to the new curriculum

• The O&G training programme produces generalists with skills to manage emergency care, an ability to work collaboratively with other specialties and to deliver patient centred care. In addition, through the completion of SITMs or subspecialty training, it produces consultants with special interest skills that all clinical services and women in general require. Not all CCT holders can develop all special interest skills due to the diversity in O&G which requires expertise in a wide range of practice.
• All obstetrics and gynaecology services rely on a team approach where all consultants can provide general and emergency acute care whilst simultaneously bringing one or more elements of special interest that ensure diverse skills and expertise can be provided locally.
• The skills acquired within the SITMs are fundamental to the effective running of all O&G departments and cannot be exclusively, or even in the main, undertaken post-CCT as significant gaps in service would occur whilst post-CCT doctors developed these necessary skills.

• Trainees will normally have three years to complete 2, or at the most 3 SITMs (initially it is unlikely that many trainees will complete 3 SITMs)
• Trainees in ST5 at the time of the change (currently ST4) will have less than three years in special interest training, but will have at least two years. TPDs may wish to discuss with their ST4s which SITMs they plan to pursue so that their ST5 placements from August 2023 can be suitably aligned with their special interest wishes
• It is expected that trainees will have opportunities to complete a greater range of SITMs. Having 3 years in special interest training should facilitate attaining competencies and enable trainees to have opportunities to complete specific SITMs across a range of clinical rotations
• Training in highly specialised SITMs will have to wait until the trainee is rotated into specific provider units. The SITMs are more focussed and on the whole should be achievable in a 12 months training time frame.
• There will need to be a greater focus on emergency obstetrics and gynaecology training during these three years because of the changes made to the core curriculum with the removal of the Advanced Labour Ward ATSM and the removal of the emergency capabilities from the Acute Gynaecology and Early Pregnancy ATSM. The skills acquired from these ATSMs are a requirement for all CCT holders and so have been included in the Core curriculum.
• Trainees complete special interest modules, and indeed leave the programme, throughout the year. TPDs will already be very experienced in planning placements with this in mind to ensure that training opportunities are used as completely as is possible.
• Feedback from the consultation will be shared with Heads of School to ensure that any difficulties in implementation of the changes can be widely discussed and that Heads of School and their teams will be fundamental to developing solutions to the challenges that are identified.

The proposed points system for the SITMs:

No, no additional gynaecology ultrasound skills have been added to the core curriculum with this change and the requirements for gynaecological ultrasound in core remain the same as now. The more advanced gynaecological ultrasound skills are covered in the new Complex Early Pregnancy and Emergency Gynaecology SITM.