Apply or Re-register to become a Menopause Principal Trainer

Please complete all parts of this form before clicking submit.

If you would like a copy of your responses (which can be useful, should you apply for other things in the future), please add your email address in the relevant field at the bottom of this form. 

The information you have shared on this form will be used by the relevant FSRH Committee and FSRH staff for the purposes of administration only. FSRH will keep this information securely on our systems. Our full privacy policy can be viewed here.

* Indicates a required field.

Part One: Principal Trainer's Details and Training Centre Details

Please ensure you complete all sections of this part of the form as it will help us to process your application more quickly.

Part Two: About the Clinic or Service - Menopause

Please tell us about the menopause clinic or service that you are running.

Indicate how many NEW patients are seen each year in your clinic/service.

Part Three: Teaching Qualifications - Menopause

Please confirm your teaching qualifications (tick at least one box below)

Indicate your teaching qualifications:*
Part Four: Confirmation of Training

There are two routes into becoming an SSM trainer that we will recognise:

Option One:

  • Confirm that you have been trained in assessment methodology and feedback

Option Two:

If you have not completed any of these we will ask you to confirm whether you have worked through the following three modules:

  • Structured assessment of Clinical competence
  • Workplace based assessments
  • Teacher’s Toolbox: Guidelines for giving and receiving feedback
Option One: I confirm that I have been trained in methodology and feedback.
Option Two: I confirm completion of these three modules:
Part Five: Menopause Society Membership and Certification

Please tell us:

  • which menopause society membership you belong to
  • your menopause society membership number
  • whether you have completed the Advanced Certification of Menopause Care
I have completed the advanced certificate of menopause care and/ or I am registered with the BMS as a menopause specialist *
Part Six: Data Protection Statement and Confirmation - Menopause

I confirm that I meet the Faculty minimum standards for Principal Trainers and I am able to provide training as described in the Faculty of Sexual and Reproductive Healthcare Special Skills Module ‘Menopause’

Data Protection Information

The Data Protection Act (1998) requires organisations or agencies collecting personal data on individuals to gain their consent before collecting, storing, publishing or analysing their data. By completing and signing this application form you are giving your consent for your data to be stored on databases used by the FSRH of the RCOG for the purposes of administrating its membership database. All data will be treated with the strictest confidence and will only be used for legitimate FSRH purposes.

 

 

I confirm:*
Part Seven: Publication of Details on our 'Find a Trainer' Map - Menopause

We ask all special skills trainers to confirm whether they are happy to have their contact details given on our 'Find a Trainer' map. This map is available behind the log in area of the website for candidates to search for trainers.

I would like to be included on the 'Find a Trainer' toolkit on the FSRH's website, so that those who wish to identify a trainer can contact me directly.

Indicate below:*
Verification

Please click the box to indicate you are a human rather than an automated system completing this form.

Last step