Community Sexual and Reproductive Health Specialty Training Programme (CSRH)

The FSRH will launch a new curriculum in August 2021 for the Community Sexual & Reproductive Healthcare (CSRH) specialty training programme. It is designed to equip the SRH profession with the skills, knowledge and attributes needed for the future. The CSRH curriculum has not fundamentally changed since its introduction in 2010, although minor changes have been made over the years.

While the detail of the clinical content remains unchanged, it will be presented in a different way with a much stronger focus on non-technical skills, patient safety and the patient experience.

The purpose of this training package is to guide SRH doctors through the transition to the new curriculum. It explains why a change was needed, what will be changing and the resources that will be available to enable doctors to successfully transfer to the new curriculum.

Additional resources will continue to be added to the Training Package during the implementation of the new curriculum so please do keep checking back!

Learning outcomes

When you have completed this training package, you will be able to:

• understand why a change to the CSRH curriculum was needed
• explain the structure of the new CSRH curricula and how it will be assessed
  • recognise what is different and the impact that this will have on the training programme/educational supervision
  • understand the transition process from the old to new curriculum and how to access the guidance materials/resources available to support this.

Key points

• The FSRH will launch a new CSRH curriculum in 2019 to equip the SRH profession with all the skills, knowledge and attributes needed for the future.
• All colleges and specialties are required by the General Medical Council to move to a high-level outcomes approach. This means specifying the general capabilities that all doctors should have by the end of their training programme. This is a very different approach to the current one which is based on the notion of competency in clinical skills and procedures.
• The core training programme will remain at 6 years, with waypoints also remaining the same.
• Much of the current clinical content is the same. However it will be described, packaged and assessed differently.
• The new curriculum is designed to promote and encourage the exercise of professional judgement, both by the Trainee and the trainer. This is a fundamental concept of the new curriculum.
• The current emphasis on tick-boxes and numbers of assessments will be replaced by an expectation that the Trainee doctor will take responsibility for their own learning, by deciding what evidence will be appropriate to demonstrate progress, and by assessing their own performance.
• Likewise, Educational Supervisors will make global assessments of a Trainee’s performance and make a recommendation to the ARCP panel as to progression. The final decision as to progression will rest with the ARCP panel.
• Detailed guidance for Trainees and Educational Supervisors on the expectations for each year and stage of training has been developed. This guidance is integrated in to the ePortfolio.
• The curriculum will be delivered through a new version of the ePortfolio which has been designed specifically for our curriculum. All Trainees and Educational Supervisors will be able to access their old and new curricula on the new version.

Definitive Document

What is the programme of assessment?

The programme of assessment refers to the integrated framework of examinations, assessments in the workplace and judgements made about a trainee during their approved programme of training.

The purpose of the programme of assessment is to clearly communicate the expected levels of performance and ensure these are met on an annual basis and at other critical progression points. It also demonstrates satisfactory completion of training as required by the curriculum.

What kinds of assessments are there?

The programme of assessment comprises the use of several different assessment types. These include workplace-based assessments (formative and summative) and MFSRH examinations (summative). Multi-source feedback in the form of Team Observation also continues. All our assessments are linked to the relevant Capabilities in Practice.

So what has changed?

In many ways, not much has changed about the way training is assessed. The workplace-based assessments are well established in CSRH training but have been revised to include an element of reflection and, in the case of Team Observation, self-assessment. The MFSRH will be changing to reflect the new curriculum, and there are also some structural changes – but the question types are the same. For the first time, the knowledge requirements for the curriculum will constitute the formal syllabus for the MFSRH.

The two main differences are the embedding of reflective practice and feedback into assessment; and the emphasis on professional judgement in reaching a global assessment. The process of assessment has moved from ticking boxes to professionals making judgements about progress in gaining the capabilities in practice required for independent practice. You will already be making these judgements in your current practice.

WPBA forms and instructions

Presentation on assessment

Curriculum Definitive Document

Knowledge Requirements

Matrix of progression

Trainee video

Case study - Develop case study of a patient as per RCOG

Objective Structured Assessment of Technical Skills (OSATS)

For the procedures that are fundamental to the practice of SRH, an objective assessment tool has been configured to aid the review process. OSATS are validated assessment tools for testing technical competency in a named technique. OSATS will be used throughout training until the trainee has demonstrated that they are competent to practice independently. The use of OSATS formatively can be undertaken as many times as the trainee and their supervisor feel is necessary. A trainee may be regarded as competent to perform a procedure independently after they have completed three summative OSATs by more than one appropriate assessor. For ST1-3 only, a Letter of Competence is equivalent to three summative OSATS for certain procedures.

Formative case-based discussion (CbD)

The CbD assesses the performance of a trainee in their management of a patient, or of clinical and non-clinical situations, to provide an indication of competence in areas such as clinical reasoning, decision making and application of medical knowledge in relation to patient care. It also serves as a method to document conversations about, and presentations of, learning experiences by trainees. The CbD should focus on a written record (such as written case notes, out-patient letter, and discharge summary or learning event, such as a teaching session, meeting or audit). A typical encounter might be when presenting newly referred patients in the outpatient department. The existing tool has been modified so that the trainee completes it and adds an element of reflection, as has been the practice in other specialties for some time. The CbD can be used for both clinical and non-clinical learning experiences.

Mini-Clinical Evaluation Exercise (mini-CEX)

This tool evaluates a clinical encounter with a patient to provide an indication of competence in skills essential for good clinical care such as history taking, examination and clinical reasoning. The trainee receives immediate feedback to aid learning. The mini-CEX can be used at any time and in any setting when there is a trainee and patient interaction and an assessor is available. The existing tool has been modified so that the trainee completes it and adds an element of reflection, as has been the practice in other specialties for some time.

Directly Observed Clinic (DOC)

The DOC is an assessment technique for senior trainees (ST4 and above) that uses a clinic to assess a number of competencies. The assessor uses multiple Mini-CEX proformas to cover a range of competencies that trainees must demonstrate as they work with multiple patients and colleagues during the course of the clinic. Although each consultation can be treated as a Mini-CEX, the assessor should also judge overall performance; in particular, whether a trainee has demonstrated a level of professionalism consistent with someone who will be mostly practicing independently and will soon be a consultant.

The DOC can, and where possible should, be combined with a short Patient Satisfaction Questionnaire (PSQ). This is given to patients by reception as they enter the clinic and collected as they leave. These patient responses should form part of the feedback trainees receive at the end of the assessed clinic. The PSQs can then be pooled with up to 30 other patient questionnaires from clinics, analysed and then reviewed by the trainee and their trainer. PSQs can also be developed by the local trust or the CSRH unit.

Multi-source feedback

The TO1 form is a multi-source feedback tool based on the principles of Good Medical Practice, as defined by the General Medical Council (GMC, 2019). TO1 forms are used to obtain feedback from a range of healthcare professionals and forms part of a trainee’s assessment. The TO1 is a snapshot feedback tool to be used by individuals at a fixed point in time. Individual team members completing a TO1 form should do so based on their experience of working with the trainee. The trainee will also be able to self-assess using a modified TO1 form (SO). The TO1 forms are summarised in a TO2 form which informs the ARCP. We have introduced the feature of self-assessment to the process, as required by most 360 feedback, thereby introducing trainees to what they will need to do as consultants.

A trainee needs to gather at least ten TO1 forms and complete one themselves as a self-assessment. It is suggested that more forms are sent out so that enough responses are received. The ePortfolio lets the trainee manage the process for completing TO1 forms, as follows:

• Trainee decides with the Educational Supervisor who should receive the TO1 forms. It is important that this is a joint decision, and that the forms are sent to a broad range of colleagues in a variety of disciplines, and that this is done at an appropriate time, ie. before a placement has ended
• Use the Ticket Request function in the ePortfolio to send out the forms
• Trainee will be able to see how many forms have been completed; initially, however, only the Educational Supervisor can see what they say

TO2 form

The Educational Supervisor is responsible for reviewing the TO1 forms and generating a TO2 form for the ARCP. Having reviewed the content, Educational Supervisors should be encouraged to let their trainees see their TO2 form for themselves. If any forms include any unexpected ‘unsatisfactory’/‘improvement needed’ results, however, the Educational Supervisor may need to meet the trainee first in order to give constructive feedback and provide suitable support to address the issues identified, and to notify the training programme director of this plan. TO2 forms are used with other evidence to determine the ARCP outcome.

A particularly poor TO2 form can itself be enough to produce an ARCP outcome 3. A poor TO2 score would include either ‘unsatisfactory’/‘improvement needed’ or substantial negative comments in the free text sections. If a trainee receives such a score, the Educational Supervisor will discuss this with them before the ARCP.

The WBA forms will be embedded in the Training ePortfolio and are provided below for your reference:

Summative Assessment

• Objective Structured Assessment of Technical Skills (OSATS)/Letter of Competence (LOC)

Formative Assessment

• Case-based discussions (CbD)
• Mini-Clinical Evaluation Exercise (mini-CEX)
• OSATS – formative
• Team observation (TO1), TO2 and self-observation (SO)
• Directly Observed Clinic (DOC)
• Patient Satisfaction Questionnaire (PSQ)

The matrix of progression has been adapted for the new curriculum. A downloadable version of the new matrix can be found here.

NEEDS SUBSTANTIAL EDITING

Trainees remaining on the 2017 Curriculum

Trainees remaining on the old curriculum will need to meet the requirements of the 2018-2019 Training matrix(link is external).

They should complete the Pre-2019 Advanced Competencies Form:

• at present, this must be created by the trainee’s assigned Educational Supervisor (we will be introducing the ability for trainees to create this form in the coming weeks)
• the supervisor does this by going into their own profile page, then selecting “Additional forms” > “Create Pre-2019 Advanced Competencies Form”
• further information on this can also be found in Implementation note 8(link is external) on the RCOG website.

They should also complete the Pre-2019 Educational Supervisor’s Report (ESR):

• as above, this must be created by the trainee’s assigned Educational Supervisor
• the supervisor does this by going into their own profile page, then selecting “Additional forms” > “Create Pre-2019 Supervisor’s Report”
• information regarding new ATSM CiP assessments should be added as free text to this form, within the ATSM section.

Trainees on the Post-August 2019 Curriculum

The majority of trainees will have transferred to the Post-August 2019 curriculum and will need to meet the requirements of the 2019-2020 Training matrix.(link is external)

Detailed information and guidance on completion of the new curriculum is available on the RCOG website:

• The Curriculum 2019 hub(link is external) -  this is an excellent source of information on the new curriculum, containing key documents and resources, implementation updates and information on the background and context to the curriculum change
• FAQs on the new ePortfolio and curriculum.(link is external)

They should also complete the New Annual Educational Supervisor’s Report (ESR). The RCOG has created a guide on creating and completing the ESR on the new ePortfolio, which is accessible  here.

Important points to note

• All necessary CiP assessments, WPBAs, log entries, etc. must be completed before the ESR is created – existing draft ESR forms will not auto-populate with any of these items that are completed subsequent to ESR creation
• The ESR has a trainee > supervisor > trainee workflow which must be followed, detailed in the guidance – failure to follow this workflow correctly will lock the form and prevent further data entry, and it is not possible for the RCOG to reverse this process at present.