How specialty trainees in O&G are assessed

Exams in O&G

As part of their training, specialty trainees in O&G must pass the MRCOG exam (Membership of the RCOG). The MRCOG exam is split into two parts:

Part 1 MRCOG exam

The Part 1 MRCOG exam assesses basic medical science knowledge relevant to O&G. The exam consists of two written papers. Trainee doctors in O&G must pass the Part 1 MRCOG as part of their basic training, before they are permitted to start intermediate training, where they have increased clinical responsibility.

Part 2 MRCOG exam

The Part 2 MRCOG exam has two components: a written exam and an oral assessment. Trainees must pass the written exam before they can sit the oral assessment. The oral exam uses scenarios which may occur as part of a doctor’s clinical duties, and the trainee has to demonstrate to the examiner how they would manage that particular case.

Trainees must pass the Part 2 MRCOG as part of their intermediate training, before they are permitted to start advanced training. Once a doctor has passed the Part 2 MRCOG, they attain membership of the RCOG and can use the letters MRCOG after their name.

Workplace-based assessments

In addition to the MRCOG exam, trainees undertake frequent assessments throughout the training programme called workplace-based assessments (WPBAs). WPBAs look at how a doctor’s skills are developing in the real world of clinics, operating theatres and wards, and are assessed by senior doctors, consultants, midwives and nurses.

The assessments are set at the trainee’s current level of training – basic, intermediate and advanced – and assess the progress expected of the trainee at that level. The different types of assessment are explained in more detail below.

Objective structured assessment of technical competencies (OSATS)

Several procedures are fundamental to the practice of O&G, such as:

• Laparoscopy (keyhole surgery)
• Hysteroscopy
• Caesarean section
• Forceps and vacuum deliveries

OSATS are used to assess these important procedures when the trainee is ready to undertake a procedure independently. They are also used to assess increasing levels of complexity of a particular procedure, for example moving from a straightforward caesarean section earlier on, to developing skills for more complex procedures in later training years.

Doctors complete OSATS throughout their training – once they are fully competent to perform a procedure independently, they are recommended to undergo further OSATS annually to demonstrate continuing competency in that skill.

Mini clinical evaluation exercise (mini-CEX)

Mini-CEX are used to assess trainees on skills essential to the provision of good clinical care, such as:

• Taking a medical history (e.g. the symptoms you’re experiencing, any other illnesses you’ve experienced, any operations you’ve had)
• Performing a clinical examination
• Formulating a care plan for a patient
• Communicating with patients

Mini-CEX also assess a trainee’s professional and interpersonal skills.

Case-based discussion (CbD)

In a CbD, a trainee discusses cases with their trainer, who assesses the trainee’s clinical knowledge and decision-making, and how they apply their medical knowledge in relation to caring for a patient. The trainee has to explain:

• The investigations they would order (e.g. blood tests, scans, X-rays, etc.)
• How they would decide how to treat the patient
• What alternative treatments they would consider (e.g. if the patient couldn’t undergo surgery because of underlying health problems)

Team observation forms (TO1 and TO2 forms)

Team observation forms allow trainees to receive feedback from a range of healthcare professionals about aspects of their day-to-day work on the ward, or in the clinic or operating theatre. This involves asking the people the trainee works with – consultants, nursing and midwifery staff and other clinicians such as anaesthetists and senior trainees – about the trainee’s:

• Empathy and respect: 
  • Does the trainee treat patients politely and considerately?
  • Does the trainee involve patients in decisions about their health care?
• Team working
• Verbal communication:
  • Does the trainee speak good English so patients can understand what they’re being told?
  • Does the trainee provide information about the patient’s condition at an appropriate level so the patient understands what’s going to happen?
• Record keeping
• Organisation

Annual Review of Competence Progression (ARCP)

At the end of each training year, there’s a formal assessment of each trainee’s progress to determine whether they can proceed to the next year of the training programme – the ARCP. Before their ARCP, the trainee meets with their supervisor to complete a form providing evidence of their educational achievements and skills acquired throughout the year.

• If the trainee has satisfactorily completed all the required assessments, they pass their ARCP and advance to the next stage of training.
• If the trainee’s progress is less than expected, or there’s a lack of evidence (documentation) of progress and competence, the ARCP panel recommends a further period of supervised and focused training. A senior trainer will help put together an action plan, which usually helps the trainee get back on track.

Overall, the majority of trainees progress each year throughout their training programme.

Non-Technical Skills for Surgeons (NOTSS)