Why have we done this?
If we think back to some of the drivers for the change and why are we changing the curriculum at all, we need to go back to David Greenaway's report, 'Shape of Training', which outlined what doctors in a modern healthcare system would look like and really trying to reintroduce broad-based training, particularly in the medical specialties. People do respiratory medicine or cardiology and there are very few general physicians left. We need to move away from highly specialised doctors and making sure that everyone within our specialty can deliver basic SRH care and work on on-call rotas.
In tandem with this report, the GMC began to consider what should be the generic skills – non-technical skills such as communication and leadership - that all doctors should possess. These skills have become increasingly important, and although curricula referred to them, they were not sufficiently embedded. When you look at the reasons 2 for referral to the GMC, then it is often not for knowledge skills or technical skills – it is due to those non-technical skills The GMC therefore developed Generic Professional Capabilities, for all medical specialties to incorporate into their curricula, and thus we have a responsibility to make sure that we train our doctors in the skills that they're going to need for the future. So, like all the other postgraduate medical curricula, our curriculum has had to change its emphasis.
In terms of our own specialty curriculum, the need for doctors to follow the Community Sexual and Reproductive Health (CSRH) curriculum is evident in key public health policies in the United Kingdom over the past decade which have acknowledged the return on investment (ROI) and importance of accessible, high quality SRH services within the National Health Service (NHS). Fragmented commissioning pathways can create barriers to accessing SRH care, which in turn exacerbate health inequalities, particularly for those experiencing language, cultural, financial and geographical barriers. In some instances, access to the full range of contraceptive methods may be restricted. GPs, practice nurses and other healthcare professionals must be adequately supported to gain and maintain the necessary competencies to deliver all available methods of contraception in order to reduce unplanned pregnancies and enable individuals to have children at a time of their choosing.
Promoting leadership in the CSRH curriculum will drive change and will also support the needed partnership-working with other healthcare providers, the voluntary sector and patients themselves. Supporting the population to manage their own health is an important part of addressing socio-economic inequalities but also SRH services will strike a balance between providing universal and targeted interventions.
What kind of consultant are we looking for?
The CSRH consultant is a clinical expert, a systems leader of SRH services and provides training and support to a wide body of healthcare professionals.
The CSRH Consultant is a highly skilled doctor trained in Sexual and Reproductive Healthcare throughout the life course, including the following: managing the whole sphere of contraception (contraceptive provision for all people including those with medical or social complexities, and managing complex specialist contraception), gynaecology, abortion, unplanned pregnancy, menopause, PMS, psychosexual care and sexual wellbeing and the immediate management of STI and sexual assault. The CSRH CCT holder is also highly skilled in providing targeted SRH care for individuals with complex psychosocial needs.
The CSRH consultant is able to manage and lead an SRH service in line with the principles of public health, while being able to provide teaching, training, mentoring and assessment support to all professionals providing contraception care and STI and SRH in various settings across the healthcare system.
CSRH specialists are not trained to provide ongoing HIV care and do not undertake maternity or obstetric care.
Presentation for a new curriculum for Comnimuty Sexual and Reproductive Health
How did we get there?
The FSRH embarked on a long journey in 2016, not just to review the CSRH but also to consider changes that were needed for the MFSRH. Activity intensified in 2019, with a number of focus groups and workshops, as outlined in Table 1 below. The FSRH Lay Rep and trainee representatives have played an active part in the creation of the new curriculum.
TABLE 1 CSRH AND MFSRH DEVELOPMENTAL WORKSHOPS |
April 2019 |
Workshop 1
- Develop the Curriculum descriptors for the CSRH Specialty Curriculum, mapped against each Professional Identity and Capability In Practice (CiP).
- Review competencies from 2017 CSRH Curriculum including clinical skills requirements (taking into account Aug 2018 Focus Group feedback, module guardian feedback 2018, stakeholder consultation feedback)
- Categories of the competencies including patient presentations and conditions
- Benchmark requirements against national standards and guidance
|
May 2019 |
Workshop 2
- Further development of key skills and curriculum descriptors for the Capabilities in Practice
|
June 2019 |
Workshop 3
- Develop programme of assessment
|
June 2019 |
Workshop 4
- Further develop programme of assessment
- Evidence to inform decision,
- Level descriptors, entrustment decision scales
- Review summative MFSRH assessment
|
July 2019 |
Workshop 5
- Further develop programme of assessment
- Review existing CSRH 2017 formative assessments (identify gaps, limitations)
- Develop 2020 CSRH Matrix of progression
- Develop blueprint of assessments mapped to CiPs
|
September 2019 |
Workshop 6
- Review further modifications required to make current assessment tools suitable for the new curriculum
- Develop CiP Guidance/Syllabus for 2020 CSRH Curriculum
|
September 2019 |
September 2019 Examiners Conference
- Review proposals for changing the exams
|
January 2020 |
Examinations Convenor Workshop
- Map existing MFSRH exams components against new 2020 Curriculum
- Review existing blueprinting methods
|
January 2020 |
Workshop 7
- Agree syllabus mapping and alignment between MFSRH Exams Question Bank and CSRH 2020 curriculum and syllabus.
- Discuss gaps, levels, areas over/underassessed, and finalise MFSRH exams syllabus for each exam component
|
February 2020 |
Examinations Committee Meeting – Post workshop session
- Review test blueprint and overarching blueprint
- Review question weightings for the MFSRH exam components
- Review exams mapping gap report
|
July 2020 |
CiP Guide Workshop
- Workshop to review the CiP guides
- Review the evidence required by a trainee for each CiP
|
July 2020 |
CESR Workshop to review Specialty Specific Guidance
- Workshop to review the evidence required for the equivalence route to CSRH
|
As a necessary part of the process, the FSRH consulted widely about the changes it intended to make as outlined in Table 2 below. It also consulted the Lead Dean, Dr Ann Boyle, and NHS Employers.
TABLE 2 FSRH ONLINE CONSULTATIONS |
July - August 2018 |
CSRH Sexual Assault Components Survey |
September - November 2018 |
CSRH Curriculum Review Stakeholder Survey |
September - November 2019 |
MFSRH Exams Review Stakeholder Survey |
6 December 2019 – 20 January 2020 |
CSRH Curriculum Review Survey- internal curriculum (examiners, educational supervisors, trainees) |
5 March 2020 – 24 March 2020 |
CSRH Curriculum Survey – Wider stakeholders |
18 May 2020 – 31 May 2020 |
MFSRH changes survey – Wider stakeholders, internal curriculum (examiners, educational supervisors, trainees) |
Who oversaw the development of our new curriculum?
The Specialty and Exams Review Project Steering Group (SESG)/Assessment & Curriculum Committee was responsible for overseeing the Specialty Curriculum Review Project, and the MFSRH Exams Review Project. As the project progressed, the Steering Group signed off progression and delivery of project milestones ensuring quality and educational robustness, as well as alignment with GMC standards and FSRH strategy. Members of the Steering Group met on a weekly basis to finalise the new curriculum and MFSRH for submission to the GMC. The SESG is the authority for this project and had final sign off all products to do with the review and implementation plan. The SESG reports to the Education Strategy Board and works closely with the main Assessment & Curriculum Committee, Examinations Committee and Specialty Advisory Committee.
The membership of SESG is shown below.
Co-Chair/Executive Sponsor |
Dr Janet Barter (Vice President Specialty) |
Co-Chair/Executive Sponsor (Internal FSRH) |
Dr Jo Lawton (FSRH Director for Education and Training) |
VP Specialty |
Dr Janet Barter |
Clinical Lead: CSRH Curriculum Review and Assessments |
Dr Catherine Schunmann |
Clinical Lead: MFSRH Exams Review Project |
Dr Gillian Robinson |
Education Lead: Project Manager |
Kim Scrivener |
Specialty Advisory Committee Chair |
Dr Charlotte Porter |
Examinations Committee Chair |
Dr Indhu Prabakar |
Senior Users – CSRH Trainee Representatives |
Dr Tom Hesse and Charlotte Gatenby |
Patient and Public Consumer Representative |
Toni Benfield |
Trainer Representative (Educational Supervisor/Trainer Representative) |
Dr Manisha Singh |