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Regulations for the Certificate of Completion of Specialist Training (CCST)

Author: RxPG Team, Posted on Saturday, October 09 @ 02:48:13 IST by RxPG  

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This page provides information about training in obstetrics and gynaecology in Type 1 training posts leading to the award of a Certificate of Completion of Specialist Training (CCST). Training lasts for a minimum of seven years after registration with the General Medical Council and occurs in two main phases:

Basic Specialist Training, as a Senior House Officer (2 years minimum)
Higher Specialist Training, as a Specialist Registrar (5 years minimum). This is divided into core specialist training (Years 1-3) and advanced specialist training (Years 4-5).

Additional information is provided about the organisation of training, the examinations which are required and training under special circumstance. The award of a CCST entitles the holder to be entered on the Specialist Register of the General Medical Council. This is a legal requirement for a substantive consultant post in the United Kingdom. It is possible to obtain direct entry to the Specialist Register (Article 9 of the European Specialist Medical Qualifications Order 1995) but that is outside the scope of this summary.
The Royal College of Obstetricians and Gynaecologists oversees the standards and regulations set out below and are responsible to the Specialist Training Authority in the recommendation of the award of the CCST. The management of the training programmes is carried out by the Deanery Specialist Training Committees, who certify the successful completion of the CCST programme (RITA G).

Basic specialist training
2.1 Definition
This period of training, lasting a minimum of two years, should be regarded as preparation before making a definite commitment to a career in obstetrics and gynaecology. It is a time when the trainee will acquire skills (laid out in the core skills logbook) applicable to a range of clinical disciplines. During basic training, doctors will acquire sufficient preliminary experience in obstetrics and gynaecology to ensure that they have made a realistic career choice.

2.2 Pre-registration training
It is becoming increasingly common for trainees to acquire pre-registration posts that include a component of obstetrics and gynaecology. These posts permit potential trainees in obstetrics and gynaecology to acquire some initial experience in the discipline. However, they do not at present count toward the specialist component of training.

2.3 First six months of training
During this period, the trainee should acquire generic skills related to general medicine and surgery as well as to obstetrics and gynaecology. These skills are also appropriate for doctors wishing to embark upon a career in general practice. With the agreement of the Royal College of General Practitioners, a Basic Log Book has been drawn up, suitable for all doctors at this stage in training. Completion of this period of training entitles trainees to sit the Diploma of the Royal College of Obstetricians and Gynaecologists (DRCOG), an examination designed for those intending to practise the specialty in a primary health care setting (see paragraph 2.1).

2.4 Subsequent SHO training
Presently one year must be spent in clinical obstetrics and gynaecology in order for a trainee to be eligible to apply for higher training. Furthermore, it is necessary to have been registered as a doctor for a total of two years (i.e. a minimum of 3 years after qualification in the UK) and to have obtained the Part 1 MRCOG Examination (see paragraph 2.6) before an appointment at Specialist Registrar level can be made. Many trainees use this additional time to undertake further training at SHO level, often in obstetrics and gynaecology. Others obtain experience in another specialty, counting the time towards the Elective Year of Training (see paragraph 3). Trainees are strongly advised during this period of basic training to attend as many as possible of the mandatory courses laid out in the core logbook with particular reference to the basic surgical skills course and relevant evidence of resuscitation skills (see paragraph 4.5).

2.5 Basic log book
This is used to record progress within a programme of targeted training leading to the acquisition of basic skills appropriate for the practice of obstetrics and gynaecology within primary health care. These skills are further tested in the DRCOG Examination.

2.6 Examinations available during basic specialist training
Part 1 MRCOG: This examination tests knowledge of basic sciences relevant to the study of human reproduction. It can be taken at any time after qualification in medicine and must have been passed before higher training in obstetrics and gynaecology can be commenced.
DRCOG: This examination tests knowledge and skills in obstetrics and gynaecology relevant to primary health care. Candidates must be fully registered with the General Medical Council of the United Kingdom and although they can sit the DRCOG at any time they cannot be given the diploma until they have completed a minimum of six months in a recognised training post. The DRCOG examination is not mandatory for trainees intending a career as a specialist in obstetrics and gynaecology.

The Elective Year
During the seven years (minimum) of training in obstetrics and gynaecology, it is mandatory to spend one year in a discipline outwith the specialty. The essential component of the elective year is that any training should be complementary to the career intentions of the trainee such as neonatology for an individual wishing to specialise in materno-fetal medicine, or in research for those wishing to embark upon an academic career. The elective year can be undertaken at any stage of training:

before commencing specialist training
as part of basic specialist training
as part of higher specialist training.
although it is recommended that it should be completed prior to the start of higher specialist training. Trainees are strongly advised to discuss their plans, prospectively if possible, with the chairman of their Deanery Specialist Training Committee and/or the Careers Adviser at the RCOG. In view of the mandatory aspect of the elective year, trainees should be aware that validated evidence must be provided as to the content and duration of the elective year and should be registered with the RCOG. If there is uncertainty about the appropriateness of a proposal, it should be referred to the RCOG Specialist Training Committee who have ultimate authority to approve the content of an elective year.

Higher specialist training
4.1 Definition
This is the period of training, lasting a minimum of five years, during which skills specific to clinical obstetrics and gynaecology are acquired and perfected. Practically, this is divided into two essential areas of training:

Core specialist training (Years 1-3) which involves wide exposure to the general aspects of the specialty and concentrates on the acquisition of core skills and competencies (see paragraph 4.5).
Advanced specialist training (Year 4/5) where trainees continue to increase their experience and performance in clinical obstetrics and gynaecology and are also provided with the opportunity to take part in a special skills programme in an area of special interest.
4.2 Entry criteria
These are as follows:

Completion of two years of basic specialist training.
Completion of at least one year of training in clinical obstetrics and gynaecology.
Passing Part 1 MRCOG.
Appointment to an approved Type 1 training post carrying an appropriate training number (NTN/VTN) in open competition.
4.3 Core Specialist Training (SpR Years 1-3)
During the first three years of higher specialist training the trainee will acquire generic skills in general obstetrics and gynaecology. The Core Log Book (see paragraph 4.5) will be completed during this part of training, leading to the acquisition of the necessary skills and competencies for the successful completion of the Part 2 MRCOG examination. Failure to reach appropriate standards or to pass the examination may impede progress to advanced higher training.

4.4 Appraisal and Assessment
During each training attachment, an educational supervisor will be assigned to each trainee to appraise the progress of training on an informal basis and to ensure that educational targets are regularly set and achieved. Clinical skills will be regularly assessed throughout and formal assessment of progress will be undertaken annually at deanery level by panels constituted by the Deanery Specialist Training Committee, which oversees training on behalf of the local Postgraduate Dean and of the Royal College of Obstetricians and Gynaecologists (Record of In-Training Assessment [RITA]).

4.5 Core log book
This contains mandatory skills targets to be achieved by the end of core training. Failure to achieve these targets will not prevent a trainee from taking the MRCOG Part 2 examination but it is anticipated that success would be unlikely. Failure to achieve the targets could, however, be used as grounds for recommending targeted training (RITA D) or repeated experience (RITA E) and would therefore prevent a trainee from progressing to advanced higher training (SpR Year 4). The core log book also contains competency levels required by SHOs to demonstrate completion of basic specialist training. It will also be necessary to have completed the mandatory courses learning outcomes by the end of core training (see Portfolio section of the Postgraduate Training File).

4.6 Part 2 MRCOG
This examination can only be taken by those who have successfully passed, or been declared exempt from Part 1 MRCOG and who have undertaken a total of 4 years of training in clinical obstetrics and gynaecology. It comprises written and clinical components. Failure to pass the examination will prevent the award of a CCST.

4.7 Advanced Specialist Training (SpR Years 4-5)
A training portfolio has been developed (log of experience) which will record the trainee’s increasing clinical performance and experience and will provide evidence for the assessment of the completion of the specialist training programme (see training portfolio). Trainees are strongly encouraged to support this mechanism with an electronic method of logging clinical information in order to display increasing performance in a competency based skills escalator. Such validated evidence will be taken into account at the time of yearly assessments (RITAs). During advanced training trainees are encouraged to embark on one or more special skills programmes to develop skills beyond those required for CCST in the areas of special interest (see paragraph 4.8). A modular approach to training will be identified at this time. By the end of training all trainees will have acquired a range of skills and competencies in order to pass their final assessment (RITA G), which precedes recommendation to the Specialist Training Authority for the award of a Certificate of Completion of Specialist Training.

4.8 Special skills modules
A number of programmes are being developed to allow trainees to acquire skills and experience in fields of special interest additional to those covered in the core curriculum, beyond those required for CCST. Special skills modules on menopause, maternal obstetric medicine, urodynamics, ultrasound for gynaecologists and infertility are already available. Two additional modules, Medical Education and Preparing for Obstetric Leadership in the Labour Ward, will be introduced in 2004. Diplomas already available in obstetric ultrasound, minimal access surgery and colposcopy, are at present being re-examined by specialist groups with the intention that these three areas will be included in the special skills modules. The process of registration and content of programmes, including lists of preceptors, can be provided through the College’s Special Skills Officer who is a member of the Specialist Training Committee. A list of successful courses completed by trainees is recorded with the Specialist Training Committee showing evidence of completion of training. Plans for application for special skills training should be formulated by the end of core training prior to the commencement of advanced training and applications should be signed by the Chairman of the Deanery Specialist Training Committee who holds the overall picture of training opportunities in deaneries.

4.9 CCST notification
On satisfactory completion of the entire programme of specialist training, the local Postgraduate Dean and the Chairman of the Deanery Specialist Training Committee jointly notify the RCOG Specialist Training Committee, by the issue of a RITA G and a signed CCST Notification Form, that a trainee is eligible for the award of a CCST. The programme of training is reviewed by the RCOG Committee and, if the information provided is satisfactory, the Specialist Training Authority is notified. It is essential that the trainees indicate on their CCST Notification Form the mandatory elective year (see 3.0). The Specialist Training Authority then issues a CCST and notifies the General Medical Council that the individual’s name may be entered in the UK Specialist Register. Specialist registration is a legal requirement for a substantive consultant post in the National Health Service. It must be noted that a trainee must be working in-programme in the UK to undergo the RITA G assessment, which should not take place more than three months prior to the CCST date.

Special circumstances
5.1 Absences from training
Trainees are statutorily entitled to absence for special leave, compassionate leave, sick leave and maternity leave. If the totality of leave for these purposes during both components of training (basic and higher) exceeds three months, additional training will be required and the date of award of the CCST will be postponed. Trainees are expected to make every effort to compensate for specific elements of training which have been missed and this should be assessed and recorded at the yearly deanery assessment (RITA).

5.2 Flexible training
It is possible to train on a part-time basis at all stages of training. Appointments must be made in open competition, however, and appropriate arrangements must be made through the office of the local postgraduate dean. Time spent during training will be calculated on a pro rata basis depending upon the percentage of full-time worked per week. The training programme must be approved not only by the Deanery Specialist Training Committee, with Deanery College Adviser approval, but also by the RCOG. Flexible trainees must be aware that the College requires continual confirmation of educational programmes registered with the Deanery STCs. Each deanery designates a lead consultant to oversee the provision of flexible training, who should be the first point of contact with any problems. Further advice can be obtained from the RCOG Flexible Training Adviser who is a member of the Specialist Training Committee and can help plan appropriate training arrangements on an individual basis. Failure to maintain educational approval may lead to loss of training time for CCST.

5.3 Allowance for time spent in Type 2 training posts
In order to obtain a CCST it is essential to have been appointed in open competition to a Type 1 training post and to have acquired an appropriate training number (NTN or VTN). At the time of appointment it is possible for previous time spent in Type 2 (FTTA or LAT), to be taken into account when placing a successful trainee in the appropriate year of training and in the calculation of the potential date of award of the CCST. It should be noted that normally only one year can be counted towards a CCST from a LAT post unless it can be demonstrated that it is identical to a Type 1 training programme.

The precise duration and content of a subsequent Type 1 training post will be decided by agreement between the trainee and the Deanery Specialist Training Committee at the time of appointment based on the production of validated evidence by the trainee involved. Any previous assessment undertaken by the STA must also be made available at that time. This will be a minimum of one year unless there are exceptional circumstances, which must be prospectively approved by the Specialist Training Committee. If there are any disagreements concerning the amount of time involved it should be referred to the RCOG Specialist Training Committee. It must be noted that Type 1 and Type 2 training programmes do have different training objectives and the amount of time allocated towards completion of training is based on an assessment of competencies rather than time in programme.

Senior Entry: The following criteria must be fulfilled for consideration for Senior Entry by the Appointments Advisory Committee:

the candidate must be able to demonstrate acquisition of all core skills in line with the RCOG Core Logbook (first three years of SpR training);
the candidate must be able to demonstrate educational progression, supported by, but not limited to, at least three RITA C’s; and
the candidate must hold MRCOG Part 2.
Senior entry trainees will normally be assessed after six months to confirm appropriate placement in the training programme.
5.4 Out of programme experience (OPE)
The Calman structured training programme allows flexibility for trainees to acquire experience outside the programme but complementary to it. Once a trainee has been appointed to a higher training programme it is possible to apply for out of programme experience which must be agreed with the local Postgraduate Dean and the Deanery Specialist Training Committee who will issue a RITA form F. Such programmes are managed by the Deanery Specialist Training Committee and would be expected to be granted on the basis of the following criteria:

clear objectives of the programme with prospective outcomes
sound reasons why the intended experience cannot be obtained within programme
clear details of the educational content of the programme including methods of assessment and educational supervision
experience should be appropriate for the trainee at this stage of their training.
It is possible for out of programme experience to be counted towards CCST. The assessment of the amount of time which can be allocated to CCST will be made by the RCOG Specialist Training Committee and will depend on the evidence of the clinical content of the training programme, clinical activity and successful assessment. Evidence of support by the Deanery Specialist Training Committee should also be included.
5.5 Clinical research
A period of time spent in clinical research is likely to be of benefit to any trainee, whether or not intending an academic career. This is still part of an 'out of programme' experience and approval for this purpose must be agreed with the local Postgraduate Dean and the Deanery Specialist Training Committee (see paragraph 5.4). One year of research may be accepted as the elective year of training and is an essential component of subspecialist training (see paragraph 5.7). Exceptionally, a research post that permits the acquisition of specialised clinical skills may be permitted to count towards the clinical component of specialist training. Such an arrangement must be agreed prospectively between the trainee and the Deanery Specialist Training Committee. The assessment of research time towards CCST has already been described in paragraph 5.4. The totality of time allowed will not normally exceed six months of a specialist training programme.

5.6 Overseas training
The College encourages trainees to acquire experience outside the British Isles as part of an 'out of programme' experience. Prospective approval should be obtained through the Deanery Specialist Training Committee. It is possible that some, if not all of this time can be allocated towards CCST training time by application to the RCOG Specialist Training Committee along the criteria already described for out of programme experience.

5.7 Academic training
Those intending a career in academic obstetrics and gynaecology require specific training and experience in research and teaching as well as in clinical obstetrics and gynaecology. Local and national specialist training committees are encouraged to be as flexible as possible in integrating these additional requirements into a programme of clinical training without compromising the standards to be achieved. Individuals who are able to secure research training fellowships or clinician scientist awards (Research NTN) can negotiate special arrangements with the local specialist training committee and postgraduate dean. These may include time out of training or a flexible combination of simultaneous clinical and academic training. Where arrangements are unconventional, it is in the trainee’s interest to keep the RCOG Specialist Training Committee informed in order to avoid potential problems in recommending the award of the CCST.

5.8 Subspecialty training
The RCOG has produced detailed programmes of training for the subspecialties of Fetal and Maternal Medicine, Gynaecological Oncology, Reproductive Medicine, Urogynaecology and Sexual and Reproductive Health (formerly known as Community Gynaecology). Entry to a subspecialty training programme is by open competition and the trainee is required to register with the College once they have completed core training, Part 2 MRCOG, or equivalent specialist award, and completion of core training competencies as demonstrated by a satisfactory Year 3 RITA. Trainees interested in pursuing training in these fields are recommended to seek advice directly from the RCOG Subspecialty Committee. Requests for subspecialty training in sexual and reproductive health will be passed on to the Joint Committee of the RCOG/Faculty of Family Planning and Reproductive Health. A subspecialty trainee cannot be awarded the CCST until their subspecialty programme has been completed.

5.9 Acting-up as locum consultant
In the final year of advanced training it is possible with the approval of the Postgraduate Dean for a trainee to act up in a locum consultant capacity. However, the trainee must be continually supervised during this time and be responsible to an Educational Supervisor. Arrangements of this nature must be approved prospectively to the RCOG Specialist Training Committee. The totality of time allowed will not normally exceed six months of a specialist training programme.

There are formal mechanisms for appealing against decisions taken at all stages of training. Appeals against decisions of the Deanery Specialist Training Committee are conducted locally under the supervision of the postgraduate dean. Appeals against examination results are conducted by the RCOG according to regulations available from the Examination Department. Appeals against failure to award a CCST may be made to the RCOG or to the Specialist Training Authority. It is important to be aware that all of the relevant regulations specify strict time limits within which appeals must be lodged.

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