Subspecialty training centres

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.

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:

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:

• 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

The RCOG Subspecialty Committee has developed subspecialty-specific and generic centre criteria for subspecialty training centre recognition.

The developmental process has been driven by the General Medical Council (GMC) demand that the RCOG set minimum standards for training across all elements of specialty training. These standards would then be clarified following the introduction of ATSM training (2007).

They also requested that we, in response to changes in regulation of postgraduate training (PMETB, 2005), enforce a requirement for workforce planning (the RCOG’s Future Workforce in Obstetrics and Gynaecology, 2007).

The Shape of Training (SoT) review, published in October 2013, drew attention to the possible risk of where subspecialty training would sit in relation to the CCT. Currently positioned pre-CCT to protect the funding from the educational levy (MADEL), subspecialty training could, in future, be pushed beyond the CCT. Hence a new stream of funding would need to be assured.

It should be noted that in the RCOG report Tomorrow's Specialist, the majority of doctors in O&G training, and O&G consultants), wanted the post-CCT structure.

The training reviews and SoT report highlight the importance of setting standards for subspecialty training centres now. We can then work with the GMC as the regulator and responsible body for commissioning training, from a position of agreed standards across all elements of the curriculum.