Subspecialty training centres

All 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. Before distributing applications, we seek disclosures from Subspecialty Committee members and Heads of School before to ensure no-one scores applications where a conflict of interest has been disclosed.

We score five categories:

• workload
• service organisation
• teaching/training
• research
• performance of centre

Workload and service organisation are further subdivided, meaning we score seven domains. The assessors record each criterion as met, unmet, reasons for unmet and score = one or = zero. Additionally, they indicate approval to be granted for one or two trainees. Clarification may be sought from the Subspecialty Training Programme Supervisor (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 greater than 50% of criteria in a domain)
• Red (meets less than or equal to 50% of criteria in a domain)

A Head of School and the Chair (or Vice Chair)  of the Subspecialty Committee review the grading assigned to applications.

Approval is granted for centres where all seven are graded as green. For centres with one or more red domains, the RCOG will notify the centre that it has not been approved.

All other centres will be designated as amber grading 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 three categories:

• Category one: 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 two: Amber grading with insufficient evidence on track record and centre achieves a pass (at least 75%) in all domains.
• Category three: Amber grading with significant concerns regarding track record.

Following the assessment process, the RCOG will contact each subspecialty training centre and the deanery Head of School. Centres that do not meet all criteria must review and address trainees' needs to ensure access to all curriculum competencies, likely requiring collaboration between training centres.
The RCOG’s recommendations are:

• Green grading: Centre would be recognised for the duration of training of the current trainee and one subsequent trainee.
• Red grading: 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.
• Amber grading: 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 depending on the subcategory of amber grading:
  • Category one: : Centre could be recognised for the duration of training of the current trainee and one further trainee if at least five of the domains are green. However, if less than five 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 five domains are green before a new trainee could be registered.
  • Category two: 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 five domains are green before a new trainee could be registered.
  • Category three: A centre would be advised that a reapplication would not be considered without a significant redesign of the programme.

The RCOG Subspecialty Committee developed criteria for subspecialty training centre recognition in response to the General Medical Council (GMC)'s demand for minimum training standards across all specialties. These standards, implemented in 2007 after introducing ATSM training, ensure quality across subspecialty training.

Following changes in postgraduate training regulation (PMETB, 2005), the RCOG enforced workforce planning requirements outlined in the "Future Workforce in Obstetrics and Gynaecology" report (2007).

The Shape of Training (SoT) review, published in October 2013, highlighted potential risks concerning the positioning of subspecialty training in relation to the Certificate of Completion of Training (CCT). Currently, subspecialty training is positioned pre-CCT to secure funding from the educational levy (MADEL). However, there is a possibility that in the future, subspecialty training could be pushed beyond the CCT, necessitating a new stream of funding.

Notably, the RCOG report "Tomorrow's Specialist" indicated that the majority of doctors in O&G training, as well as O&G consultants, preferred a post-CCT structure.

These training reviews and the SoT report underscore the importance of establishing standards for subspecialty training centres now. By doing so, we can collaborate with the GMC as the regulator and responsible body for commissioning training, ensuring agreed-upon standards across all elements of the curriculum.