Specialty

Assessment and progression through training

The specialty training programme in Community Sexual & Reproductive Health (CSRH) is a six year training programme divided into basic, intermediate and advanced stages.

As a CSRH Trainee, you need to complete specific tasks successfully if you are to progress through the different stages of the programme. This is particularly important at these three way-points:

• basic to intermediate training (ST3 to ST4): to progress here, you must successfully complete all the basic competences; you must also pass the MFSRH Part 1 exam 
• intermediate to advanced training (ST5 to ST6): to make this transition, you must successfully complete all intermediate competencies and the whole Membership exam
• completion: before taking your final Annual Review of Competence Progression (ARCP) for the CCT, you must successfully complete all the advanced competencies.

We run the MFSRH exams just once each year, so we advise you to think ahead and submit your applications in good time.

If you fail to supply sign-off evidence for these competencies at the required way-points, or if you do not pass the exams, you will delay your progression in training.

N.B. Under GMC rules, we do not require you to attain the FSRH Diploma (DFSRH). However, it is a useful and suitable way of showing early CSRH competences.

Induction and educational meetings (appraisal)

At the start of your CSRH training programme, you must have an induction with your Educational Supervisor; you must also register with FSRH for access to the e-Portfolio.

All trainees must use the CSRH Training e-Portfolio. It provides a comprehensive record of your training and documents your progression through the programme as you achieve the competencies that the curriculum requires.

Each trainee has a nominated CSRH Educational Supervisor for their entire training programme. Make sure you hold regular educational meetings with your Educational Supervisor – these should take place at least every four months, regardless of your stage of training or whether you are on a placement and away from your home Training Centre.

Training matrix

CSRH ARCP Matrix 2017

Your progress will be assessed at your ARCP meetings against the standards laid out in the Matrix. These standards represent the minimum required, so we encourage you to exceed them. The SAC occasionally modifies and/or revises the Matrix.

Workplace-based assessments (WPBAs)

Throughout your training, you will need to take part in a series of workplace-based assessments (WPBAs) to evaluate your progress. There are two types of WPBA:

• Formative: these are assessments for learning and are used to provide feedback via Supervised Learning Events. 
• Summative: these are assessments of learning and allow you to demonstrate your competence in a given clinical situation via Assessments of Performance.

The CSRH training programme includes both formative and summative OSATS (Objective Structured Assessment of Technical Skills). However, mini-clinical evaluation exercises (Mini-CEX) and case-based discussions (CbDs) are only ever formative.

The full Workplace-based assessment forms are listed for download at the bottom of this page.

Please remember these points

• You are responsible for organising your own WPBAs.
• You should discuss with your Educational Supervisor the areas that require assessment at different stages of your programme
• You should also make sure that you take part in WPBAs for a mixture of modules – the exact ratio should reflect the nature of your attachments.
• You must keep all completed WPBA forms on your e-Portfolio, linked to the relevant competence.
• The Matrix contains only the minimum required number of annual WPBAs. 
• You should obtain WPBAs throughout the year, not just in the weeks before your ARCP. Make sure you plan ahead to avoid having to complete all of your WPBAs as you approach your appraisal or ARCP. 
• You cannot ‘fail’ a WPBA – each assessment is useful to you and your assessor, whether or not you show complete competence. 
• If you are finding it difficult to complete your assessments, speak to your Educational Supervisor as soon as possible – do not wait for your appraisal or ARCP to explain your difficulties. 
• Your WPBAs should reflect the level of complexity expected in that year of your training; they should also show progression of competency. 
• Where possible, use electronic forms. If you do use paper, please make sure that you scan and collate them in your e-Portfolio library, and link them to the relevant competence.

Directly Observed Procedural Skills (DOPS)

DOPS is a method of assessment designed specifically to evaluate practical skills, and is similar to the mini-CEX. A DOPS assessment requires you to perform a specific practical procedure. A consultant observer directly observes and scores this procedure in each of the eleven domains, using the standard form. Although performing a DOPS assessment slows down the procedure, the main challenge is finding an assessor at the same time as you will be performing the task.

To enable the assessor to judge whether or not you can perform the individual procedure without any direct supervision, the assessment should focus on the whole event and not just one part: e.g. the successful insertion of an intra-uterine device. The DOPS is designed to take around 20 minutes and the results should be fed back to you and discussed immediately afterwards. You should complete at least three satisfactory DOPS before the competency is signed off. These can be carried out at different stages of training, and in different settings, in order to ensure that you have maintained the relevant skills.

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 you must demonstrate as you work with multiple patients during the course of the clinic. Although each consultation can be treated as a Mini-CEX, the assessor should also judge your overall performance; in particular, whether you have 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 you 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 you and your trainer. You can also use PSQs developed by the local trust or the CSRH unit.

Multi-source Feedback – Team Observation

As well as recording your attainment of competencies in your e-Portfolio and completing enough formal workplace-based assessments (WPBAs), you need to gather feedback from your colleagues via the team observation forms (TO1 and TO2).

The TO1 form gathers feedback from a range of healthcare professionals and forms part of your assessment. It is based on the principles of good medical practice, as defined by the GMC.

The TO2 form summarises your TO1 forms and informs your Annual Review of Competence Progression (ARCP).

You need to gather at least ten TO1 forms; we suggest sending out more so that you receive enough responses.

Your e-Portfolio lets you manage the process for completing TO1 forms, as follows.

• Decide with your Educational Supervisor who should receive your TO1 forms. It is important that this is a joint decision, that you send the forms to a broad range of colleagues in a variety of disciplines, and that you do this at an appropriate time i.e. before your placement has ended. 
• Use the Ticket Request function in your e-Portfolio to send out the forms. 
• You will be able to see how many forms have been completed; initially, however, only your Educational Supervisor can see what they say.

TO2 form

Your Educational Supervisor is responsible for reviewing the TO1 forms and generating a TO2 form for your ARCP. Having reviewed the content, we encourage Educational Supervisors to let their trainees see their TO2 form for themselves. If yours includes any unexpected ‘unsatisfactory’/‘improvement needed’ results, however, your Educational Supervisor may need to meet you first in order to give constructive feedback and provide suitable support to address the issues identified, and to notify your Training Programme Director of this plan.

TO2 forms are used with other evidence to determine your 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 you receive such a score, your Educational Supervisor will discuss this with you before your ARCP.

Links to sample Multi-source feedback – TO1 and TO2 forms

Multi-source Feedback - /Patient Feedback

Patient feedback is based on the principles of good medical practice, as defined by the General Medical Council (GMC), and is a requirement for revalidation [add link]. We are currently piloting patient feedback forms for CSRH training.

Reflective practice and recording reflection

You also need to record your experiences and development throughout training. This record should include reflective practice, audits and research, publications and presentations, and a log of your experiences.

Read more information from the GMC outlining the importance of reflection, and how much you should be doing. 

The structure of the Reflective Practice Form within your e-Portfolio currently needs revision. You should still use it but do not confine yourself to the existing headings – reflections can be about any aspect of your professional life, not just ‘clinical situations’.

Here are some prompts to help you make useful records of your reflections. 

• Why is it important to you? 
• How does it affect your current practice?
• What did you learn? 
• How might it lead to improvements in patient care or safety?
• How have your knowledge, skills and professional behaviours changed?
• How will you change your current practice as a result?
• How do you feel it has reinforced your current practice?
• Have you identified any skills and/or knowledge gaps relating to your professional practice?
• What changes to your professional behaviour do you now want to make?
• What changes in your team/department/organisation’s working practices do you now feel are necessary?
• Are you planning to make any changes as a result of your learning? If not, say why.
  - Describe what these will be and why you think they are important.
• What difference will this make to patients’ safety and the quality of their care?
• What impact or difference will this make for you personally?
  - Try to identify any needs to help you do this successfully.
• If you have identified further learning and development, how do you intend to address these?
  - Set SMART objectives for these (i.e. Specific, Measurable, Achievable, Relevant and Time-bound). 
• Discuss the reflection with your Educational Supervisor and record the outcomes.
• Did you identify wider learning needs e.g. departmental or organisational? How might you take these forward?
• Can you share your learning? How will you do this?

Competency Levels and Sign-off of competency acquisition

This section explains the three different levels of sign-off that you need as you gain new competencies and skills throughout your training. It also describes what you need to do to gain sign off at levels 1, 2 and 3, as well as an ‘anchor statement’ that summarises our expectations at each level.

Both trainees and their trainers should carefully consider what we expect at each level. Please note that interpreting the required competency level in some non-clinical modules of the programme may require a more flexible approach.

Many trainees and trainers make the mistake of concentrating only on the logbook of competences. This is only one part of the curriculum. Remember that you should always study the curriculum and syllabus carefully, as well as looking at the list of competences within each module.

ES countersignatures

Trainees’ competencies should only be signed off on the basis of clear and independent evidence, such as WPBA links in your e-Portfolio. Your Educational Supervisor must also countersign any competence once you have completed all the required levels.

Levels 1-3

The e-Portfolio uses a simple system to record the clinical skills that you acquire. Each module of the curriculum has specific training targets.

Find out more about how competency acquisition is signed off. 

Confirming competence for procedural skills

To confirm (final) level 3 competence for those procedural skills listed in the Matrix you need to have three summative WPBAs that confirm your (level 3) competence in each procedural skill. At least two of these WPBAs should be conducted by a consultant or trainer of equivalent seniority (if your trainers are not consultants or medical professionals).

Other methodology

Unusual situations or presentations may involve competencies that are particularly difficult to acquire. In such exceptional circumstances, it is acceptable to use alternative training methods, such as drills, simulation or e-learning. These should supplement CbD assessments, which should continue until the trainee has met all the requirements for that assessment level.

When alternative training methods are used to sign off a competency on a trainee’s e-Portfolio, the Educational Supervisor or Clinical Supervisor must state in the text box that they have used these other methods.

If other methods may be needed to assess a trainee approaching a way-point, the Educational Supervisor should discuss this with the TPD (and SAC), at the earliest opportunity.

If other methods have been used to assess a trainee at a way-point, the Educational Supervisor must point this out in their report to the ARCP panel.

Demonstrating Maintenance of Competence

As a trainee, it can be easy to forget about a specific area of work once you have completed the relevant module. 

For example, if you have previously completed the menopause module, we still expect you to engage in enough continuing education or training to maintain up-to-date knowledge and skills in this area. You need to demonstrate to your Educational Supervisor – and, through them, to the ARCP Panel – that you have taken steps to maintain your menopause knowledge and skills during the year.

Maintaining competence is a continuous process leading to development of expertise. You must demonstrate such continuous learning across all modules in which you have achieved Level 3 competency. For the procedural skills listed in the Matrix the requirement, you must complete two Objective Structured Assessments of Technical Skills (OSATS) each year. For non-procedural skills/areas of SRH/curriculum modules, we expect you to collect evidence every year to demonstrate that you have continued your education in these areas. This evidence might include WBPAs such as mini-CEX or CBDs. You should begin collecting evidence the year after you achieve the competency. Please note that this would be before the identified year if you achieve a specific competency early in your training.

Useful Documentation

• Annual Educational Supervisory Report for Trainees
• Team Observation Form
• Case-based discussion (CBD) Supervised Learning Event
• Mini-clinical Evaluation Exercise (CEX) Supervised Learning Event
• OSATS Assessment of Performance
• OSATS Supervised Learning Event
• Trainee registration for Postgraduate Specialty Training - Form R (Part A)
• Self-declaration for the Revalidation of Doctors in Training - Form R (Part B)
• FSRH Specialty Training Evaluation Form
• FSRH Guidance to ARCP Panels, Educational Supervisors & Training Programme Directors on bringing forward a CCT date