Apply or Re-register to become an Abortion Care Principal Trainer

Before completing this form, please ensure that you have a MyFSRH account. Find out how to create a MyFSRH account here.

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.

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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.

Principal Trainer Name*

Principal Trainer's Current Post or Role*

Principal Trainer's Email Address*

GMC Number:*

Principal Trainer's Medical Qualifications*

Principal Trainer's Contact Telephone Number*

Training Centre Name*

Main Training Location Address (including postcode)*

Part Three: Teaching Qualifications - Abortion Care

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

Indicate your teaching qualifications:*

LoC Med
Training the Trainers
GP Trainer
PGA in Medical Education in SRH (Postgraduate Award)

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:

Structured Assessment of Clinical competence
Workplace based assessments
Teacher's Toolbox

Part Five: Data Protection Statement and Confirmation - Abortion Care

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 ‘Abortion Care’

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 Six: Publication of Details on our 'Find a Trainer' Map - Abortion Care

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 on the FSRH website for candidates to search for trainers.

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

Publish my details on the FSRH's 'Find a Trainer' map:*

Yes
No (This means your data will still be on our database, but not publicly available via our find a trainer map)

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Verification

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Last step

Privacy notice

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 ‘Abortion Care’