Specialty

Overview of the Community Sexual and Reproductive Health Specialty Training Programme

The FSRH oversees the Community Sexual and Reproductive Healthcare (CSRH) Specialty Training Programme. The CSRH Programme is only one of the routes available to medical practitioners who wish to specialise in the area of Sexual and Reproductive Healthcare (SRH). Read more about the Certificate of Equivalence in Specialty Training.

Previously the training pathway in the UK in Sexual and Reproductive Healthcare (SRH) was through Obstetrics and Gynaecology as a sub specialty. In 2009 the UK Parliament recognised SRH as an independent specialty in its own right.

The FSRH is focussed on ensuring the Specialty is established, recognised and influential in practice by producing medical experts in contraception, medical/office gynaecology, menopause, unplanned pregnancy with knowledge in GUM, Public Health and sexually transmitted infection care with the vision that medical practitioners have the skills and tools to lead and manage the community based Sexual Health services of the future and lead large multidisciplinary teams.

How to become an SRH Consultant

The aim of the CSRH Training Programme requires Registrars to successfully complete the six year run-through training programme commencing at ST1.

The programme follows the CSRH curriculum and is divided into basic (years 1-3), intermediate (years 4-5) and advanced (year 6) training. It comprises of basic training in Obstetrics and Gynaecology and Sexual and Reproductive Health. Trainees will follow different competencies from O&G trainees which are focused towards medical Gynaecology rather than Labour Ward expertise. Gynaecological competencies will need to be maintained throughout training. The MFSRH Part 1 must be achieved before entering intermediate training.

Intermediate training will extend the strand of Gynaecology and SRH, which will continue to include unplanned pregnancy and Abortion Care, but now also encompass training in Genitourinary Medicine, Public Health, Sexual Assault and Sexual Problems. The MFSRH Part 2 must be achieved before entering advanced training.
Advanced Training will be a year of completing all outstanding competencies but with opportunities for shadowing and preparing for a role as a consultant.

Throughout the programme the trainee will undergo training in leadership and management. The programme develops the skills required to lead and manage the community based Sexual Health services of the future and lead large multidisciplinary teams.

Once the programme has successfully been completed, the trainee will be able to apply to the GMC for Certificate of Completion of Training (CCT) or a Certificate of Eligibility for Specialist Registration – Combined Programme (CESR(CP)) depending on the route taken.

See below for a diagram outlining the CSRH curriculum

Who is responsible for the Specialty Programme?

The FSRH Specialty Advisory Committee (SAC) has overall responsibility for overseeing the CSRH Specialty Programme. The FSRH SAC works with ARCP Panels to ensure trainees meet required competencies throughout their training journey.

Interested in a career in SRH?

Recruitment to the CSRH specialty programme is conducted centrally. This means that applications to speciality posts will no longer be to individual Deaneries/Local Education and Training Boards but will be managed centrally between the FSRH and Health Education England.

Further information about a career in CSRH can be found in this article published in the BMJ, Careers in community sexual and reproductive health by Heike Gleser.

Personal beliefs guidance:

At the time of application for your FSRH qualification, you need to confirm you have read the 6 principles of care as outlined in the “Guidance for those undertaking or recertifying FSRH qualifications whose personal beliefs conflict with the provision of abortion or any method of contraception” and agree to abide by them in practice. It is, therefore, important to have read this document prior to commencing training.

Assessment & Progression

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.

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

Specialty ARCP

ARCP (Annual Review of Competence Progression)

Your educational progression will be reviewed annually at an ARCP, which will assess you against the minimum standards required by the Matrix. Although ARCPs cannot be precisely 12 months apart, they should take place within three months of this annual interval.

The Faculty runs ARCPs for the CSRH Training Programme. For most other larger specialties, ARCPs are run by the Deaneries or by Local Education and Training Boards (LETBs).

The ARCP is a formal meeting with at least three panel members, although there are often many more. The panel must include either your Postgraduate Dean (or deputy) or a Training Programme Director. It may also include the chair of the Specialty Advisory Committee, an Educational Supervisor and a lay representative. Educational Supervisors consider ARCPs to be good learning experiences so a panel will often include one or two additional members. Your own Educational Supervisor will never sit on your panel.

ARCP panels usually aim to rely entirely on the Educational Supervisor's report to reach its recommendation. If panel members are concerned or need some clarification, however, they can access your e-Portfolio. After the panel, its Chair will write to your Dean and recommend an ARCP outcome, copying in you and your Educational Supervisor.

Which trainees must attend the ARCP in person?

We give all trainees the option to attend the ARCP themselves, but we require personal attendance from:

all trainees who are at a way-point i.e. making the transition between basic and intermediate training (ST3/4), intermediate and advanced training (ST5/6), or completing the programme (finishing ST6)
any trainee with an Educational Supervisor’s report that suggests that there have been difficulties – these may be caused by a trainee’s own problems and/or problems with the programme.

Your LETB/Deanery will cover your travel expenses when you attend your ARCP panel.

How ARCP process relates to revalidation

For information on how revalidation affects the ARCP process, please visit the revalidation for trainees section of the RCOG website.

ARCP outcomes

The ARCP panel will recommend one of several outcomes. These are described in the Gold Guide. This also contains information about the general principles and regulations that underpin the ARCP process.

To find out about the ARCP appeals and complaints process, please contact your LETB/Deanery.

ARCP: Preparing for the ARCP

This checklist will help you prepare for your ARCP.

Make sure you understand the expected standards for your training year, as described in the Matrix. This will help you make satisfactory progress.
You and your Educational Supervisor must meet the relevant submission dates and deadlines, so make sure to note them down.
Familiarise yourself with the Educational Supervisor’s (ES) report. To prepare for your end-of-year meeting with your Educational Supervisor, you will need to fill out parts of this document. Your Educational Supervisor will then complete the remaining sections and share these with you before your ARCP. Help yourself by knowing what sections you need to complete yourself and collect the necessary information during the year, rather than rushing to do so in the weeks before your ARCP.
Meet your Educational Supervisor and complete the ES report together. This records your educational achievements and the competencies that you have gained that year.
Your Educational Supervisor will complete the structured reference section of the report and generate the summary of your Multisource Feedback (i.e.TO2 forms . [LINK to..]). This is a summary of your TO1 (team observation) forms.
Your Educational Supervisor must record all leave that you have taken within the ES report. You can read more about this here. [LINK to Absence from work and Time out of Training]
Please remember to complete the Trainee Evaluation Form in your e-Portfolio.

Advice on ARCP outcomes

FSRH has produced the following advice for your possible ARCP outcomes, as they relate to expected benchmarks as laid out in the Matrix.

We have drawn up this specific guidance for ARCP panels assessing trainees who have not met the required standards to ensure consistency. The guidance can also help you anticipate your own outcome by assessing your evidence-based progress against the Matrix.

If you achieve all the standards for your year then you should receive an ARCP outcome 1. If you do not, the Panel should not recommend an outcome 1. Instead, it will recommend a different outcome, and may be advised and supported by your Deanery.

An ARCP outcome 2 will let your Postgraduate Dean ensure that your next attachment can give you the training you need. You should not regard an outcome 2 as a failure, but rather as a chance to receive the necessary education and training to achieve the expected standard. An outcome 2 does not alter your CCT date.

An ARCP outcome 3 will let you obtain specific competencies and give you extra training time. Please note that the Gold Guide limits this extra time to one year, unless there are truly exceptional circumstances.

An ARCP outcome 5 is reserved for the very few cases where the panel has not received enough evidence to reach an informed conclusion. In such cases, the panel should review its outcome 5 recommendation once it has enough information and then issue a new recommendation. This should take place within a short space of time – around two weeks.

ARCP outcomes at key way-points

The CSRH curriculum contains key way-points when trainees move from basic to intermediate level training (ST3-4) and from intermediate to advanced level training (ST5-6). The ARCP process is particularly important at these way-points, so it is essential that you provide the necessary evidence to show that you have achieved the required competencies. Failure to achieve them usually results in an outcome 3.

At end of ST3, you should have passed MFSRH part 1, completed the basic logbook competencies and have taken the WPBAs listed in the Matrix.

If you have achieved the competencies but fail the MFSRH Part 1, you may be allowed to do clinical work under the educational plan you will receive after your outcome 3. This outcome will require your Educational Supervisor to advise the ARCP Panel that you possess the necessary clinical skills. This advice should be recorded in the ES report.

At end of ST5, you need to must have passed MFSRH part 2 and have all the WPBAs listed in the Matrix to show that you have the competencies and skills required to move to ST6.

Using the Matrix to screen for developing issues

The Matrix is a useful tool for benchmarking trainees objectively. This table provides advice for the ARCP outcome for each of the standards it lists.

An ARCP outcome 2 or 3 should result in an educational plan. This needs to have SMART (Specific, Measurable, Achievable, Realistic and Timely) targets, which should be assessed at a follow-up ARCP. The original ARCP panel should take advice from the local Deanery to determine the timeframe to achieve these targets.

You can download the table here.

ARCP Panel Timing

For organisational reasons, sometimes ARCP panels are convened before the end of the training year. In these situations, a trainee may not have achieved all the Matrix objectives but is expected to do so by the end of the training year. In such cases, the ARCP Panel should recommend an outcome 2, which can be changed to an outcome 1 later on if the trainee submits the remaining evidence in time. If it is clear that the trainee will not achieve the required objectives, the Panel should recommend an outcome 3. This is particularly important at the key way-points of ST3-4 and ST5-6.

Training evaluation form (TEF)

The TEF is compulsory. It allows you to give direct feedback on your training, thereby enabling us to monitor and improve its quality. You will also be asked to give feedback via the national GMC survey; because trainee numbers are small, the GMC does not share localised reports of your feedback.

The ARCP Panel will read your TEF and may discuss it with you at your ARCP. This is your chance to give both general and detailed feedback on your training experience and, with the Panel, to consider how best to address any issues. This information is confidential outside the ARCP process, but may be collated anonymously to review aspects of the training programme overall.

Certification of training & specialist registration

Subject to a satisfactory final ARCP, you will receive an outcome 6. The Faculty will then make a recommendation to the GMC that you have completed your training and are eligible for the award of the CCT or CESR(CP).

For more information about the CCT/CESR(CP) routes to registration, visit the General Medical Council website.

FSRH Guidance to ARCP Panels, Educational Supervisors & Training Programme Directors on bringing forward a CCT date

Specialty Curriculum

Curriculum

CSRH training is a six-year programme, divided into basic, intermediate and advanced training, across 15 modules.

Basic training: ST1, ST2 and ST3 (3 years)
Intermediate training: ST4 and ST5 (2 years)
Advanced training: ST6 (1 year)

To download the entire curriculum, see the link at the foot of this webpage.

The modules are listed below:

Module 1 Basic Clinical Skills
Module 2 Contraception
Module 3 Unplanned Pregnancy & Abortion Care
Module 4 Gynaecology
Module 5 Specialist Gynaecology
Module 6 Pregnancy
Module 7 Menopause & PMS
Module 8 Genitourinary Medicine
Module 9 Public Health
Module 10 Teaching, Appraisal & Assessment
Module 11 Ethics and Legal Issues
Module 12 Leadership, Management & Governance
Module 13 IT, audit and Research
Module 14 Sexual Assault
Module 15 Sexual Problems

CSRH 2017 Specialty Curriculum

The GMC approved the CSRH curriculum, including its content and structure, on Since then, the curriculum has had two small revisions, both approved by the GMC; every CSRH trainee completes this same curriculum. Although there are no sub-specialties, there should be opportunity to develop a special interest within this field, particularly in your final year.

You must maintain any level 3 skills that you gain – these will be assessed every year after they have been signed off. See the document below for more information.
Many trainees and trainers make the mistake of concentrating only on the logbook of competencies. This is just one part of the curriculum – always study the curriculum and syllabus carefully, as well as checking the list of competencies within each module.

Specific Curriculum Issues

Skills relating to Evacuation of the Uterus

Although you can use WPBAs of surgical abortion (STOP) in lieu of WPBAs of Evacuation of Retained Products of Conception (ERPC), the reverse is not true – you cannot use ERPC in place of STOP.

Please note that you should demonstrate your continuing experience in the broader aspects of management of miscarriage.

Resources & Support

e-Portfolio help and guidance

Your e-Portfolio provides a comprehensive record of your training and documents your progress. Both you and your trainer can use it to make your training explicit, accountable, systematic and suitable. Please remember that your e-Portfolio may also be reviewed in your ARCPs. You will receive a CSRH NES e-Portfolio account when you start your training, and you should start building this up straightaway. In particular, your e-Portfolio should include:

your attendance at courses and formal teaching sessions
(i.e. where you were the learner/trainee)
teaching sessions / presentations given
(i.e. where you were the teacher/trainer)
any quality improvement projects you have done
log of procedures
publications
reflections

Your Educational Supervisor should use the Induction and Appraisal form or the Educational Meeting form in your e-Portfolio to record the outcomes of their meetings with you.

You can find a CCT Calculator resource on the RCP website.

Educational logs

The ‘Reflection’ part of your e-Portfolio contains an educational log that lets you record different events and experiences. These are:

• formal presentations (either regional, national or international)
• a general log, which you can use to record procedures you have completed, or other events and activities
• audits (to record audit or other quality improvement projects)
• publication (for posters, journal papers or other publications you have written)
• reflective practice*
• research (for any research activities in which you have been involved)
• teaching sessions (where you were the teacher/trainer)**

*Although the reflective practice form has a ‘clinical situation’ section, please do not limit your reflections only to clinical situations. Instead, use this section to record reflections of any kind that contribute to your professional development.

**The e-Portfolio forms for teaching sessions have no section for audience/learner feedback and the reflections this provokes. This is an oversight on the part of the portfolio and so, we encourage you and your trainer to include your reflections on teaching sessions that you give, for example, in the box about ‘type of audience’.

Personal Development Plan (PDP)

The PDP is your chance to set out what you expect to achieve during each post/attachment and throughout the training programme. You should work with your Educational Supervisor to develop your PDP, and you should update it after your educational / appraisal meetings.

Make sure you review your PDP regularly. Identify learning objectives, outline how you will meet these, how long this will take, and the evidence that you will use to show that you have completed them. You should agree all these with your supervisor and, once achieved, you can tick them off. However, they will remain on your PDP to reflect your achievements during training.

Courses

You should use the ‘Courses’ section in your e-Portfolio profile to record all training courses and conferences that you attend. Although the section contains no space for reflecting on your learning from each event/course, we hope that you will use a reflective practice form to record your personal and professional development in each instance, rather than simply documenting your attendance. (Please ignore the ‘exam passed’ section).

Learning resources for the CSRH programme

This page supplements the learning resources suggested within the curriculum. Here we hope you will find courses, articles and/or ideas that will support your learning. It can quickly incorporate new resources .

However, this ability depends on help and input from trainers and trainees. Please contact the FSRH Specialty Officer if you have any feedback, or suggestions for new resources and learning materials.

List of recommended Courses for the CSRH trainee

The table provides guidance to TPDs and others to indicate which courses should be eligible for funding and study leave in line with your local arrangements. Courses available and their nature of course change over time and no one particular course is absolutely compulsory in the CSRH curriculum. However, all of those above listed as mandatory should be eligible for study leave budget without need for individual consideration, and those listed as optional are also recommended by the FSRH Specialty Advisory Committee (SAC).

Your local LETB, Deanery or Trust will offer many valuable training courses, so we encourage you to explore these.

Mandatory and Optional courses for CSRH Trainees

StratOG

StratOG is the RCOG’s interactive eLearning resource. It supports trainees throughout their core training and helps them to prepare for the MRCOG exams.

CSRH trainees can access StratOG at a reduced ‘non-e-Portfolio’ annual fee of £80.

You can access StratOG on the RCOG website, and will also receive the other benefits of RCOG membership. These include:
• quarterly mailings of (and on-line access to) ‘The Obstetrician and Gynaecologist’ (TOG)
• regular mailings of the College’s ‘Membership Matters’ newsletter
• O&G Trainees’ TROG newsletter, emailed three times a year
• access to the RCOG trainees’ resources
• 20% discount on all Cambridge University Press Academic titles
• discounted subscription rates to ‘BJOG: An International Journal of Obstetrics and Gynaecology’

Other organisations

Society of Consultants and Lead Clinicians in Reproductive Health (SCRH)

Any CSRH trainee can attend the annual meetings of this small membership organisation at a reduced rate. In particular, the meetings should help senior trainees develop their understanding of service development, health policy and commissioning; they will also help you develop leadership skills.

Faculty of Medical Leadership and Management (FMLM)

The FMLM was established in 2011 to raise the standard of patient care by improving medical leadership. It also works to support and develop doctors at all stages of the medical career and across all specialties. The FMLM was set up by all the medical royal colleges and faculties. It is endorsed by the Academy of Medical Royal Colleges (AoMRC).

The FMLM also runs the National Medical Director’s Clinical Fellow Scheme for doctors in training, which offers high-level Out of Programme (OOP) training opportunities.

British Association for Sexual Health and HIV (BASHH)

The British Association for Sexual Health and HIV (BASHH) is a membership organization which runs many useful courses and training sessions. It also produces the national guidelines on management of STIs.

Trainee registration

The current trainee subscription is £75 per year; this money is used primarily to cover the cost of your e-Portfolio. Failure to pay your annual subscription will result in restrictions in your e-Portfolio for your next ST level until you pay your subscription and any associated fees you owe.

Training guidelines

Less than full-time training (LTFT) and advice on how to apply for time out of programme (OOP)

Speak to your Educational Supervisor and get advice from your LETB/Deanery

The RCOG website also has useful information on LTFT and advice on how to apply for OOP time for:
• Clinical training (OOPT)
• Clinical experience (OOPE)
• Research (OOPR)
• Career breaks (OOPC)

Absence from work and Time out of Training

Trainees must record all absences from work in their e-Portfolio, as well as any time out of training. You can read more on the GMC’s website.

‘Absence’ includes all forms of absence such as sickness, maternity, compassionate paid or unpaid leave, other than study or annual leave or prospectively approved OOP training or research.

You must report an absence of 14 days or more in any 12 month period to your LETB/Deanery; you must also record this on your Educational Supervisor’s report for your ARCP.

Returning to training

The Academy of Medical Royal Colleges (AoMRC) Return to Practice guidance suggests that an absence of three months or more may affect your skills and knowledge. It therefore recommends that you seek an assessment upon your return to practice. Please also find out the policy of your LETB/Deanery and inform the Faculty of your plans.

Trainees’ representatives & Trainees Network

CSRH Trainees’ Network

We’re here to provide information and reviews by trainees, for trainees. Anybody currently training in the CSRH specialty is welcome to join. We also have a closed group where trainees can post questions about their training so that, where possible, other trainees can provide information and/or support.

Annual CSRH Trainees Day

Every year FSRH supports , a national training day which provides training on those parts of the curriculum that are more difficult to cover, and gives you a chance to update and expand your knowledge.

We aim to vary the event’s location as much as possible from year to year, and welcome trainees’ suggestions for topics to discuss. They can help you achieve curriculum sign-off in these areas, following discussion and reflection with your supervisor, and once you have completed any necessary follow-up sessions.

We also hold a short meeting after the first day of the Annual Scientific Meeting so that trainees can discuss any common issues or concerns that they may have.

For further information about the CSRHTN please contact:

Katie Boog or Lottie Cossey (CSRH Co-representatives): csrh.trainees@gmail.com

Specialty Trainer Support

Resources and support for trainers

GMC 2016 Edition Gold Guide: A reference guide for postgraduate specialty training in the UK

Delivering postgraduate training in CSRH – Who manages training?

Postgraduate medical education has a clear training structure, which Postgraduate deans deliver locally.

The lead dean for CSRH is Professor Selena Grey.

At a local level, the training programme is managed by the Training Programme Director (TPD), with support from the local Deanery. Although a separate specialty, the CSRH Training Programme sits within the School of Obstetricians & Gynecology; the TPD will usually attend O&G School Board Meetings and receive support from the O&G Head of School. In some CSRH training programmes, the TPD will also be an Educational Supervisor.

Each trainee within the CSRH specialty training programme is allocated an Educational Supervisor. Although the Educational Supervisor takes the leading role in the trainee’s development, the process is a team effort.

Trainees have prime responsibility for your learning; this reflects how important it is that they develop lifelong learning skills, and how these skills underpin their continuing fitness to practice.

The explicit learning outcomes of the CSRH curriculum and logbook competencies enhance trainees' accountability and also support them as learners capable of assessing their own progress. By including learning resources in the curriculum and on this website, we are supporting self-managed learning, not only by giving trainees responsibility for their own learning, but also the means to do so.

If you wish to deliver a new training position, you must complete the Faculty Approval form. The Speciality Advisory Committee (SAC) will review your application and, if satisfied, provide the required letter of approval.

Role of the FSRH

The Faculty supports all education, training and assessment that the CSRH specialty training requires. A Specialty Advisory Committee (SAC) deals with all CSRH specialty training issues. The small numbers of CSRH trainees means that FSRH performs some roles that LETB/Deaneries usually manage for larger specialties

Training Programme Directors (TPDs) – roles and responsibilities

TPDs are responsible for designing educational experiences for trainees and ensuring that they remain suitable over time. These experiences include a range of CSRH community and hospital posts, linked with seminars and courses which match the needs of both learners and the curriculum. TPDs manage a team of trainers who are in tunr accountable to the TPD.

TPDs are appointed through open competition by local Deaneries/LETBs. Each LETB will have a person specification and it should recommend the minimum number of Programmed Activities in the individual’s job plan that are required to undertake the TPD role.

Because the CSRH training programme sits within the School of O&G, TPDs should maintain good links with their local Head of School for O&G.

Educational Supervisors and Clinical Supervisors – Roles and responsibilities

Educational Supervisors and Named Clinical Supervisors (‘trainers’) who are medically qualified must be recognised and/or approved in line with GMC guidance on the ‘Role of the Trainer’ and its implementation plan. Deaneries/LETBs and the Faculty also provide useful training and guidance for trainers.

*Each trainee has a specific individual who acts as the Educational Supervisor for their entire training programme, which the Faculty records. The Educational Supervisor must be a consultant or senior SAS doctor within Sexual & Reproductive Health.

Within many placements and for many specialty training modules, the Educational Supervisor may choose to delegate day-to-day supervision to named Clinical Supervisors (e.g. colleagues in O&G, GUM or Public Health) without requiring any formal approval from the Faculty. Trainers may also include non-medical professionals.

However, FSRH must be informed of any changes to the Training Programme e.g. change of Educational Supervisor or TPD. This can be done via the FSRH Specialty Training Programme Approval form.

*The Educational Supervisor has overall responsibility for a trainee’s educational management plan and for monitoring a trainee’s progress. They must therefore stay in regular contact and should meet for a structured review at least every four months. The Educational Supervisor should also complete trainees’ Induction/Appraisal forms and ES reports ahead of ARCP panel meetings.

*Although the Educational Supervisor may delegate assessments of competence to Named Clinical Supervisors and other trainers, good practice requires him/her to review and counter-sign these assessments. The Educational Supervisor must also counter-sign:

every obligatory assessment (such as those that confirm competence or confirm continuing competence afterwards)
any completion of an entire module within the trainee's e-Portfolio.

CSRH trainers have several responsibilities:

overseeing the trainee’s daily work when posted in the community or in a hospital
holding regular feedback meetings with the trainee
being the trainee’s initial point of contact for training opportunities, progress and resources
ensuring that their learning environment meets national standards, as defined by the local Deanery/LETB and quality assured by the GMC
continually assessing the trainee via WPBAs – this also allows the Educational Supervisor to monitor curriculum coverage and identify gaps.

Useful resources for trainers

Assessment and appraisal – information for trainers

Educational Supervisors must meet their trainees regularly – at least every four months – and should complete the Induction / Appraisal forms or Educational Meeting forms to record the outcomes of these meetings.

The Meeting or Supervision Forms on the e-Portfolio have three options.
• Induction and Appraisal
• Educational Meeting
• Team Observation Summary (TO2)

Trainers should encourage trainees to record reflections and review these to support continuous review of the trainee’s Personal Development Plan (PDP).

Annual review of training – information for trainers

Educational Supervisor’s Report
Educational Supervisors should use this form for their annual reports to ARCP panels. The report can be found (& completed) online via the CSRH ePortfolio. If you are having difficulty accessing the report, please contact the specialty Officer at specialtyofficer@fsrh.org.

Although Educational Supervisors learn about the ARCP process as part of their professional development and accreditation (to GMC standards), we have found that trainers find it useful to participate as a member of an ARCP Panel. We therefore recommend taking up any opportunity to do this – ideally for a CSRH trainee. Although invitations will be issued, early volunteers are always welcome. Alternatively, educational supervisors can offer to sit as an external representative on a local panel for another specialty.

Approval for a Training Programme or the addition of a new Training Programme or site

The GMC is responsible for approving all Postgraduate training sites. If a centre or NHS Trust wishes to start a training programme or use a new site, it must follow the GMC’s instructions.

To apply for approval, the TPD or Educational Supervisor should work with their local Deanery/LETB to apply for approval on the GMC’s new form B. You can find this on the GMC website or at GMC Connect. Please note that trainees cannot apply for GMC approval.

The Faculty is also involved in ensuring the quality of new training sites. This is in line with the GMC’s Quality Improvement Framework (page 8).

We need to be sure that any proposed training centre is of a sufficiently high quality and can give trainees suitable access to training. Therefore, we need to know:

who is delivering the training
whether the trainers are appropriately trained and qualified
how they will provide the training
whether the clinical material is diverse enough to provide adequate training.

If you wish to develop a new training position, you must complete the Faculty Approval form. The Specialty Advisory Committee (SAC) will review your application and, if satisfied, provide the required letter of approval.

Equally, if a Deanery / LETB intends to develop a new training centre, it must complete the relevant parts of the Faculty Approval form. If it is a brand new site that will cover the whole CSRH curriculum, the entire form must be completed. The Deanery/LETB must also complete the relevant parts of the form if there is any significant change to the training programme, such as a change of Educational or Clinical Supervisor.

Once you have the SAC’s letter of approval, the Deanery can upload GMC Form A (approval of a whole new training programme) or B (approval of a new training site) to GMC Connect.

If you want to add an extra training site for specific training (e.g. a BPAS centre for managing unplanned pregnancies), simply complete the appropriate box on the Faculty Approval form, rather than the whole form. In this instance, you need to provide the name of the principal trainer, the relevant clinics and how many patients they see each year. The GMC gives its approval to Local Education Providers (LEPs) for specific sites, rather than to NHS Trusts. For CSRH training, the GMC gives Programme/Deanery approval for a particular site. This means that a Trust can fill in a single GMC form B, but must include all the LEP sites, along with the ODS codes. The GMC will approve these sites, rather than the Trust itself.

ODS codes

Please make sure that you use the correct ONS (site) code for each site. You can find the relevant ODS codes on the ONS website:

Maximum Training Capacity (MTC)

This is the maximum number of whole time equivalent (WTE) people that a training programme can sustain effectively.
You no longer need to give the MTC in your application.

We cannot currently remove the MTC section from GMC Connect, so will list it as 0 for new programmes. For previously-approved programmes, the MTC will stay at the last reported number. This means that Deaneries/LETBs are responsible for deciding the capacity of their programmes. Postgraduate deans must ensure that their trainees receive enough work and supervision to gain the necessary competencies and complete the required assessments.

View our Specialty-related FAQs here

Curriculum Review

Why review the CSRH curriculum?

We're conducting an extensive revision of all Community of Sexual Reproductive Health training curriculum, to be completed in 2020.

This will meet the new standards set by the GMC, and make sure the training programme is in line with the principles of the Shape of Training review.

The new requirements signal a departure from providing lists of granular competencies towards areas of capability, with emphasis on the knowledge, skills and attitudes that can be applied to a wide range of circumstances.

About the 2020 CSRH Curriculum
There are 12 learning outcomes, or Capabilities in Practice (CiP) – these are general statements of what a doctor is supposed to be able to do by the end of training.

The whole curriculum is designed to produce a consultant who is a NHS Professional , System leader and Champion - Design, Clinical Expert - Deliver, Trainer/Educator - Train.

Much of the current clinical content will be the same. However, it will be described, packaged and assessed differently.

How to get involved
The Working Group will be undertaking extensive stakeholder engagement throughout the revision process and will be inviting stakeholders to input into the work.

Contact
Mitesh Chauhan
specialty@fsrh.org

Certificate of Eligibility for Specialist Registration (CESR) Route

Please download the GMC Specialty Specific Guidance for ‘Community Sexual and Reproductive Health’, which provides a detailed overview of application requirements and evidence required for CESR applications.

CSRH Specialty Curriculum
Please refer to the latest version of the CSRH Specialty Curriculum at the time of submission

Programme information [CESR Applicant Guide download]
The CESR is one of three training routes available through the FSRH for medical practitioners who wish to gain specialist registration in Sexual and Reproductive Healthcare (SRH).

Who is it for?

A CESR is a way for doctors who have not completed a UK approved training programme to gain a specialist qualification, providing they can show they have the full skills, knowledge, qualifications and experience required by the relevant curriculum (e.g. CSRH Curriculum)

The Equivalence CESR programme requires you to submit evidence in support of your application for a CESR. Evidence must cover the knowledge, skills and qualifications to demonstrate the required competencies in all areas of the CSRH Curriculum.

What are the outcomes of completing the CESR route?

Successful CESR applicants will be eligible to apply for:

Entry onto the Specialist Register with a Certificate of Eligibility for Specialist Registration (CESR)
Specialist Registration, eligible to register as a Specialist GP

(The application for full registration is separate to the CESR application, but can be applied for at the same time)

How much does it cost?

A fee is paid to the GMC. For a list of all their fees please follow this link.

How do I apply for a CESR qualification?

Doctors who wish to find out more about the application process for a CESR should refer to the GMC´s specialty specific guidance for CESR and CEGPR applicants available on its website. This pack provides applicants with the generic information they need to start putting together an application.

Is there any funding available?

There is up to £5,000 funding per applicant

If you are applying for Equivalence (CESR), there is an opportunity to apply for a grant towards your application. Grants will be awarded up to £5,000 per successful applicant.

CESR Top-Up-Fund Application and criteria
Please follow this link to apply for the CESR top-up fund