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British Fertility Societyand Royal College of Obstetricians and Gynaecologists

Special Skills Training Module

The Management of the InfertileCouple

June 2002

Published by the RCOG Pressat the Royal College of Obstetricians and Gynaecologists

Registered Charity No. 213280

© British Fertility Society and Royal College of Obstetricians and Gynaecologists 2002

Further copies of this module can be obtained from:

Postgraduate Training DepartmentRoyal College of Obstetricians and Gynaecologists27 Sussex PlaceRegent’s ParkLondonNW1 4RG

Telephone: +44 (0) 20 7772 6200Facsimile: +44 (0) 20 7723 0575Website: www.rcog.org.uk

Printed by Manor Press, Unit 1, Priors Way, Maidenhead, Berks. SL6 2EL

CONTENTS

Page

INTRODUCTION 3

Entry criteria 3

Training programme components 4

The logbook (guide to learning) 4

Guide for Deanery Specialist Training Committee concerning the application for training centre recognition and preceptor’s contract 5

Guide for Deanery Specialist Training Committee concerning trainee’s application for registration for special skills training 6

Application to Deanery Specialist Training Committee for training centre recognition and preceptor’s contract 7

SYLLABUS 9

GUIDE TO LEARNING 10

RECORD OF APPRAISAL 19

LOGBOOK 27

APPRAISAL, ASSESSMENT AND CERTIFICATION 28

SPECIAL SKILLS TRAINEE REGISTRATION FORM 29

SPECIAL SKILLS REGISTRATION FORM FOR NON-TRAINING GRADES 31

CERTIFICATE OF COMPLETION OF TRAINING PROGRAMME 33

The Management of the Infertile Couple Special Skills Training Module 1

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INTRODUCTION

The modern management of the infertile couple is an essential component to the training of everyobstetrician and gynaecologist. The specialist nature of the subject, however, means that duringgeneral training through the specialist registrar years only a relatively superficial knowledge andclinical skills base will be established. This training programme, jointly devised by the BritishFertility Society and the RCOG, is designed to assist trainees, usually in the later years of training,in establishing a level of expertise in the area appropriate to the status of a gynaecologist with astated special interest in the subject.

Once trained a clinician should have:

● acquired an understanding of:i. the endocrine dynamics of the menstrual cycle, and pregnancy.ii. the physiology of conception.iii. the epidemiology of infertility.iv. the causes of infertility and their appropriate management.v. the potential consequences of infertility treatment.

● developed the capacity to:i. interpret laboratory procedures relevant to the investigation and management of infertility.

● acquired clinical competence, relevant to his/her professional status, in the basic managementof infertility including:i. the assessment of an infertile couple.ii. the physical examination of both males and females with infertility.iii. the facilitation of appropriate initial investigations of infertility.iv. the use of ultrasound in assessing pelvic anatomy.v. expertise in invasive techniques of pelvic assessment including laparoscopy,

hysteroscopy and hysterosalpingography and an ability to interpret their findings.vi. the use of clomiphene and gonadotrophins in the management of ovulatory dysfunction.

● acquired experience and knowledge of:i. the use of assisted reproduction procedures in the management of the infertile.ii. relevant administration and management skills, including clinical governance.iii. teaching.iv. legal and ethical issues.v. epidemiology, statistics, research and audit.

The following documents outline the elements involved in the provision of such training. Theseencompass:

● the recognition of training centres and preceptors

● the entry criteria for candidates, the syllabus for learning

● the logbook of recording experience, knowledge acquisition and clinical skills development

● the records of appraisal

● the mechanisms of assessment and certification.

Entry criteriaAs special skills training should follow the completion of core training, the following criteria mustbe met:


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1 The trainee must have passed Part 2 MRCOG or hold an equivalent qualification.

2 The trainee must have satisfactorily completed the Core Logbook requirements.

3 The trainee must have obtained a satisfactory year three RITA.

Registration with the RCOG for special skills training can only be made when the above criteria aremet.

Specialist Registrars with fixed term training appointments (FTTA) who wish to register with theRCOG for special skills training should also fulfil the above criteria.

Training programme componentsThe following are essential components of the training programme, and all of them have to becompleted:

1. Trainees should register at the commencement of special skill training with the BFS/RCOG,and the local College training supervisor should support the application for training.

2. A named preceptor must sign an educational contract confirming that he/she is able andwilling to provide the training contained in the module. The preceptor must be skilled in themanagement of the infertile and have at least two dedicated sessions per week devoted to thearea. The preceptor will agree to supervise the trainee throughout the module. Occasionally,of necessity some sessions of training may be conducted under the supervision of professionalsother than the preceptor. It is the responsibility of the preceptor to ensure that the professionalto whom the duty of training is delegated is sufficiently competent, willing and able to teachthe trainee.

3. The trainee must attend regular infertility clinics during training and a log kept of the clinicalproblems encountered.

4. The trainee must attend a certificate training course in the management of the infertile couple.The course will complement the essential knowledge component of training for this module.The course must be attended during the time of training and when the Logbook is beingcompleted.

5. Training will be deemed to be complete when all components of the guide to learning havebeen completed to the satisfaction of the preceptor, the educational course has been attendedand the case summaries completed and approved by the preceptor. At that point assessmentinterview can take place with independent assessors appointed by the BFS/RCOG.

The Logbook (guide to learning)The Logbook defines the knowledge and clinical skills required for the management of the infertilecouple. Completion of the Logbook will allow the preceptor and trainee to monitor progress andidentify deficiencies over the course of training. It is important to note that the Logbook is a recordof competence as well as experience. The preceptor and trainee will review progress at twomonthly intervals. Progress will be documented through the preceptor signing off the appropriatesections of the Logbook when knowledge has been acquired and independent clinical competencereached.

The Logbook should also include ten summaries, of up to 500 words each, outlining the trainee’sinvolvement in a range of infertility cases, and should include a critical appraisal of the clinicalproblem. The trainee should review suitable cases with his/her preceptor before including them inthe Logbook.

It is imperative that all participants in training appreciate that the trainee’s progress has to meetstandards that will ultimately stand up to independent scrutiny. At the end of the programme thepreceptor has to certify that the skills attained by the trainee are to his/her satisfaction.

4 Special Skills Training Module – The Management of the Infertile Couple

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Guide for Deanery Specialist Training Committeeconcerning the application for training centrerecognition and preceptor’s contract

To be eligible as a training centre in the management of the infertile couple, the following criteriamust be met:

1. The centre should provide a service for the management of patients with endocrine andinfertility problems, within an appropriate setting, encompassing a dedicated infertility clinic,where both male and female partners are seen together.

2. The centre should have an adequate clinical workload (at least 250 new couples per year),incorporating a comprehensive range of disorders associated with infertility, with establishedmechanisms of internal audit in place.

3. The centre should have access to appropriate laboratory (endocrine and andrology) facilitiesto allow appropriate investigation of male and female patients.

4. The centre should have appropriate clinical facilities for investigation of relevant endocrineand infertility disorders, with established written protocols available for external inspection.

5. The centre should have access to daily ultrasound investigations for monitoring women havingovulation induction.

6. If the Centre does not have an in-house IVF unit there must be close cooperation with an HFEAlicensed centre allowing potential trainees appropriate observational and practical experience.

7. The centre should have an identified lead clinician/preceptor (accredited consultant andmember of the British Fertility Society) in charge of the management of women with infertility.

8. The Centre should have an active postgraduate training and education programme.

9. The preceptor must agree to carry out regular appraisal of trainee’s progress and keep recordsof such meetings. In addition the preceptor will agree to carry out end of programmeassessment interviews of trainees not under their supervision as requested by the RCOG/BFS.


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Guide for Deanery Specialist Training Committeeconcerning Trainee’s Application for Registration forSpecial Skills Training

Candidates seeking to register for training in the management of infertility should:

1. Be a member of the British Fertility Society

2. Undertake training over an agreed period of time (normally a minimum of six months) in a unitrecognised as a ‘Training Centre’ by the Society, under the guidance of a designated preceptor(also a member of the British Fertility Society).

3. Have a basic medical qualification (e.g. MBChB) and have MRCOG or equivalent.

4. Have completed the RCOG Core Logbook.

5. Have obtained a satisfactory year 3 RITA.

6. Apply to the Deanery Specialist Training Committee.

7. Undertake training in the assessment of couples with infertility, including the use ofappropriate biochemical, andrological, ultrasonic, radiological and surgical investigation.

8. Complete ten case summaries of up to 500 words reflecting his or her training experience forassessment by the designated preceptor.

9. Keep a logbook detailing experience in the specialist skill area.

10. Attend a basic course in the management of infertility during the time of training and whenthe logbook is being completed.

11. At the end of training undergo external assessment as proscribed by the RCOG & BFS.


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British Fertility Society/Royal College of Obstetricians and Gynaecologists

Special Skills Training Module: The Management of the Infertile CoupleApplication to Deanery Specialist Training Committee for training centrerecognition and preceptor’s contract

Name of centre: ..............................................................................................................................

Date of application: ........................................................................................................................

Lead applicant (lead clinical consultant): .......................................................................................

Yes NoDoes the centre have facilities for the management of infertile couples incorporating a dedicated infertility clinic? ■■ ■■Does the centre have laboratory facilities for semen assessment? ■■ ■■Does the centre have laboratory facilities for endocrine assessment of infertile couples? ■■ ■■Does the centre have access to ultrasound facilities for ovarian follicular monitoring? ■■ ■■Is there a lead clinician in charge of management of infertility who is a member of the BFS? ■■ ■■Is there a donor insemination service in the hospital? ■■ ■■Is there a gonadotrophin ovulation induction service in the hospital? ■■ ■■Is there an IVF service in the hospital? ■■ ■■If not, what centre will trainees access for appropriate IVF experience? ■■ ■■Is there an in-house postgraduate training programme for all O&G trainees. ■■ ■■Statistics in recent 12-month period New ReturnHow many couples were seen at the infertility clinic in the last 12 months? ■■ ■■How many referrals for gynae-endocrine problems were seen? ■■ ■■

NumberHow many laparoscopy procedures for infertility were carried out? ■■How many hysterosalpingograms were carried out? ■■How many clomiphene cycles for anovulatory infertility were carried out in the centre? ■■How many gonadotrophin cycles for anovulatory infertility were carried out in the centre? ■■How many fresh IVF cycles were carried out in the centre? ■■

STATEMENT BY LEAD APPLICANT/PRECEPTORI confirm that the above information is correct. I enclose a copy of my curriculum vitae and a copyof the local postgraduate education programme for the last 12 months.

I understand and agree to conform to the obligations expected of a preceptor in ensuring adequatesupervision of trainees in The Management of the Infertile Couple training module. I agree to actas an agent of the RCOG/BFS in the assessment of trainees other than my own in this specialty area.

Signed: ............................................................................................................................................

Name (in block capitals): ................................................................................................................

Professional qualifications: ..............................................................................................................


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SYLLABUS

Aims of TrainingThe trainee should acquire an understanding of:

i. the endocrine dynamics of the menstrual cycle, and pregnancy.ii. the physiology of conception.iii. the epidemiology of infertility.iv. the causes of infertility and their appropriate management.v. the potential consequences of infertility treatment.

The trainee should develop the capacity to:

i. interpret laboratory procedures relevant to the investigation and management of infertility.

The trainee should acquire clinical competence, relevant to his or her professional status, in thebasic management of infertility including:

i. the assessment of an infertile couple.ii. the physical examination of both males and females with infertility.iii. the facilitation of appropriate initial investigations of infertility.iv. the use of ultrasound in assessing pelvic anatomy.v. expertise in invasive techniques of pelvic assessment including laparoscopy, hysteroscopy and

hysterosalpingography and an ability to interpret their findings.vi. the use of clomiphene in the management of ovulatory dysfunction.

The trainee should acquire experience and knowledge of:

i. relevant administration and management skills, including clinical governance.ii. teaching.iii. legal and ethical issues.iv. epidemiology, statistics, research and audit.

COMPOSITION OF SYLLABUS (theoretical and practical elements)

Theoretical knowledge should be acquired during the course of training through:

i. Personal study appropriate to the guide for learning.ii. Attendance at a BFS basic infertility course.iii. Tuition from the approved preceptor.

Practical knowledge will be obtained during the course of clinical training. Such experience willcomprise both supervised and unsupervised care of couples undergoing treatment of infertility. Inaddition the trainee should complete ten commentaries of approximately 500 words each,detailing the assessment and management of cases for which he or she has had significant personalresponsibility. Each case should demonstrate that the trainee has knowledge and understanding ofthe pathophysiology underlying the clinical problem, as well as the appropriate skills to manage thecase.


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GUIDE TO LEARNING

The trainee should sign and date when they consider that the knowledge targets of the guide have been achieved(clear boxes). The preceptor should sign off independent clinical skills competence (shaded boxes) targets. Wheneach module is completed the thick-edged box should be signed by the preceptor.

1. The epidemiology of infertility.............

The trainee should understand and be able to:

discuss the assessment of fertility within a population ...........

discuss reproductive trends within the United Kingdom ........

provide a pragmatic definition of infertility............................

discuss the methodological problems in measurement of theprevalence of infertility ..........................................................

discuss the consequential differences between primary andsecondary infertility ...............................................................

discuss the aetiological factors implicated in the genesis ofinfertility ................................................................................

display knowledge of public health strategies to reduce theprevalence of infertility ..........................................................

discuss the organisation of services within the NHS for themanagement of infertility .......................................................

2. The initial assessment of the infertilecouple ..................................................


discuss the role of the general practitioner in the managementof infertile couples.................................................................

conduct a clinical consultation with infertile couples............


take a medical history from infertile males and females ........

carry out a physical examination of infertile males andfemales ..................................................................................

initiate appropriate initial investigations including assessmentof ovulation, semen analysis and be able to interpret results .

provide couples with general advice including lifestyle issuesrelevant to infertility e.g. smoking, weight, alcohol ...............

discuss factors associated with a high risk of pelvicabnormality, including the place of chlamydia screening, andthe need for collaboration with a genitourinary clinic ifappropriate ............................................................................

discuss the role of pelvic evaluation using laparoscopy,hysteroscopy and hysterosalpingography in the furtherassessment of the female and acquire clinical competence incarrying out such procedures.................................................

display critical awareness of the limitations of investigativetechniques in the evaluation of the infertile ...........................

discuss psychosocial factors relevant to appropriateness oftreatment and the welfare of potential children .....................

3. Male factor infertility...........................


discuss the process of spermatogenesis and its control ..........

display knowledge of the impact of male factors in thegenesis of infertility................................................................

discuss the causes of male factor infertility including: ...........

varicocele..............................................................................

endocrine disorders ...............................................................

coital dysfunction including ejaculatory failure, impotence,and retrograde ejaculation.....................................................


genital tract infection.............................................................

immunological causes ...........................................................

testicular maldescent .............................................................

chromosomal abnormality .....................................................

chemotherapy, radiotherapy and toxins (including drugeffects) ...................................................................................

idiopathic male infertility.......................................................

take a detailed history from, and conduct a relevantexamination of the infertile male ...........................................

interpret the results of semen analysis....................................

arrange relevant endocrine investigations ..............................

arrange relevant microbiological investigations .....................

display knowledge of in vitro tests of sperm functionincluding computer assisted sperm analysis, zona freehamster egg penetration tests.................................................

arrange genetic tests if appropriate including karyotyping andcystic fibrosis screening .........................................................

carry out a postcoital test in the rare instances where it maybe indicated...........................................................................

display knowledge of immunological assessment of thepresence of anti-sperm antibodies .........................................

display knowledge, and if possible acquire experience, of themanagement of specific conditions associated with maleinfertility including: ...............................................................

varicocele..............................................................................

gonadotrophin deficiency ......................................................


ejaculatory problems .............................................................

immunological infertility........................................................

genital tract obstruction including vasectomy reversal...........

display knowledge of the place, and limitations of empiricaltreatment in the management of male infertility, e.g.superovulation, intrauterine insemination and in vitrofertilisation.............................................................................

display knowledge of the place of assisted reproduction(including ICSI) in management.............................................

display knowledge of the place of donor insemination inmanagement ..........................................................................

4. Disorders of ovulation .........................

The trainee should be able to:

discuss the normal physiology of ovulation ...........................

discuss the pathophysiology underlying disturbances ofovulation ...............................................................................

discuss the clinical presentation of ovulatory dysfunction .....

classify disorders of ovulation on the basis of anatomical sitei.e. hypothalamus, pituitary, ovary, and hypothalamic pituitarydysfunction............................................................................

discuss the appropriate endocrine investigation of disorderedovulation ...............................................................................

discuss the influence of lifestyle factors including diet andweight in the genesis of disordered ovulation........................

determine the appropriate therapeutic approach relevant tothe established diagnosis .......................................................

counsel patients about the risks of treatment of disorders ofovulation including multiple pregnancy and its obstetricconsequences, ovarian hyperstimulation syndrome (OHSS)and ovarian cancer ................................................................

Infertile Couple Special Skills Training Module 13

display knowledge and acquire experience of the use ofovarian ultrasound in the management of ovulation disorders

prescribe and monitor response to clomiphene citrate ..........

display knowledge, and if possible acquire experience, ofgonadotrophin treatment in the management of disorderedovulation, together with the adjuvant use where appropriateof GnRH analogues (agonists and antagonists).......................

understand the pathophysiogy of OHSS, and have knowledgeof strategies for its prevention and management ....................

display knowledge, and if possible acquire experience, of themanagement of hyperprolactinaemia.....................................

display knowledge, and if possible acquire experience, oflaparoscopic ovarian diathermy in the management ofpolycystic ovaries. .................................................................

5. Tubal factor infertility ..........................


discuss the aetiological factors implicated in tubal factorinfertility including infection, surgery, congenitalabnormalities and endometriosis ...........................................

discuss the pathological features of acute and chronicinflammation associated with tubal factor infertility...............

discuss the classification of tubal factor infertility relevant tonatural and therapeutic prognosis..........................................

discuss the prevention of tubal factor infertility, including theplace of screening “at risk” groups ........................................

display knowledge of the prognostic factors relevant indecisions for surgery e.g. female age, cause and extent oftubal disease, presence of other infertility factors, surgicalexperience.............................................................................

display knowledge, and if possible acquire experience in themanagement of proximal tubal obstruction, includingselective salpingography and tubal catheterisation ................


display knowledge, and if possible acquire experience, in themanagement of distal tubal obstruction, includingadhesiolysis, salpingostomy and the management ofhydrosalpinges.......................................................................

display knowledge, and if possible acquire experience, in themanagement of patients seeking reversal of sterilisation ........

display knowledge of the role of assisted reproduction in themanagement of tubal infertility ..............................................

6. Infertility and endometriosis ................


discuss the pathogenesis of endometriosis .............................

discuss the mechanisms by which minimal and mildendometriosis may impair fertility e.g. defective folliculogenesis,ovulatory dysfunction, hyperprolactinaemia, autoimmunedisorders, disturbances in the peritoneal fluid environment ......

discuss the place of expectant management, medical andsurgical treatment in the management of endometriosis ........

display knowledge of the role, possible benefits and potentialside effects of pharmacological agents, e.g. oralcontraceptives, progestogens, danazol, gestrinone, GnRHanalogues, in the management of endometriosis ...................

discuss the place of assisted reproduction in the managementof endometriosis ....................................................................

7. Unexplained infertility .........................


discuss the diagnosis and prevalence of unexplained infertility

discuss the putative causes of unexplained infertility includingluteal phase deficiency, luteinised unruptured follicle syndrome,hyperprolactinaemia, endometriosis, subclinical pregnancy loss,anatomical abnormalities, occult infection, sperm dysfunction,immunological causes and psychological factors.......................

discuss the natural prognosis in unexplained infertility and thefactors which are of importance in influencing prognosis......


discuss the evidence relevant to the role of empiricaltreatment including clomiphene, danazol, bromocriptine,intrauterine insemination, superovulation, in vitro fertilisationand GIFT in the management of unexplained infertility .........

8. Psychological aspects of reproductivemedicine ..............................................

The trainee should understand and be able to discuss:

psychological factors in amenorrhoea ...................................

the psychological changes associated with treatment ofinfertility ................................................................................

the effects of infertility upon the family .................................

local facilities for counselling ................................................

psychosexual disorders causing and resultant from infertility.

9. Ultrasound skills ..................................

The trainee should have knowledge, and if possibleexperience, of the role of ultrasound in:

the assessment of the normal and abnormal uterus includingfibroids ..................................................................................

endometrial assessment, including normal cyclical changes..

the assessment of ovarian, paraovarian and tubal masses ......

tracking of folliculogenesis and formation and disappearanceof corpus luteum ...................................................................

confirmation of intrauterine gestational sac with embryo, yolksac, cardiac pulsation ............................................................

diagnosis of ectopic pregnancy..............................................

the assessment of gestational age...........................................

The trainee should understand the risks and limitations ofprocedures, and understand the need for record keeping anddata storage. ..........................................................................

16 Special Skills Training Module – Infertile Couple

10. In vitro fertilisation (IVF) and otherassisted reproduction techniques .........

The trainee should have knowledge, observationalexperience, and if possible, practical experience, of:

clinical and laboratory aspects of assisted reproductiontechnologies to enable appropriate counselling for patientsrequiring onward referral. ......................................................

11. Epidemiology, research, statistics andaudit.....................................................

The trainee should have some knowledge of:

epidemiological techniques (e.g. cohort studies and casecontrol studies; cumulative rates calculation and assessmentof bias)...................................................................................

comparisons of means ...........................................................

randomised controlled trials and the use of meta-analysis .....

how to critically evaluate research in relation to ovulationinduction ...............................................................................

how to conduct a clinical audit and apply findingsappropriately .........................................................................

guidelines of good practice in the conduct of clinical trials...

The trainee should have the opportunity to attend appropriatenational, and where possible international, meetings relevantto their subspecialty. ..............................................................

12. Teaching...............................................

The trainee should gain experience in teaching,which will include:

some responsibility for teaching junior staff in thissubspecialist area...................................................................

full participation in the unit’s postgraduate programme .........

participation in the undergraduate and nursing students’teaching programme; ............................................................


13. Ethical and legal aspects ......................

The trainee should be able to discuss the ethicaland legal aspects of relevant issues including:

legislation, particularly recent, relevant to their infertilitypractice .................................................................................

ethics of health care provision and resource allocation .........

medical confidentiality ..........................................................

consent ..................................................................................

the role and relevance of ethics committees ..........................

In addition the trainee should be aware of the role of theHuman Fertilisation and Embryology Authority in theregulation of assisted reproduction practice...........................

14. Administration .....................................

The trainee should be given some administrativeexperience and responsibility, which will allowhim/he to acquire skills relevant to the futureprovision and organisation of clinical services inthis area.


RECORD OF APPRAISAL


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Date

Learning targets achieved

Logbook progress

Targets for next two months

Trainee signature

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LOGBOOK


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Case Report Date completed Preceptor’s signature

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APPRAISAL, ASSESSMENT AND CERTIFICATION

1. Appraisal should be carried out at regular intervals (at least every two months) by thedesignated preceptor.

The trainee meets with the preceptor to discuss progress of their training relevant to acquisitionof the necessary elements of knowledge, experience and clinical competence as laid out inthe syllabus. If there are problems in relation to targets for completion of training then remedialaction should be instituted. The preceptor should scrutinise any completed case summaries.Appropriate records should be kept of these meetings, which both preceptor and traineeshould sign.

2. When training is complete, the Notification of Completion of Training form should be sent tothe RCOG, who will inform the BFS in order that an assessment viva can be arranged at theappropriate BFS meeting.

3. Assessment should be carried out, in the form of a structured viva, by an assessment panelcomprising two independent assessors, i.e. an assessor approved by the British Fertility Societyand the RCOG, and/or the College Tutor or one other member of the relevant postgraduatetraining committee.

The trainee is required to submit for scrutiny:

● the Logbook and signed guide to learning

● the ten case summaries, approved by the preceptor

● the BFS BASIC INFERTILITY course certificate

● the records of appraisal.

Should the assessors decide that the trainee has not adequately fulfilled the criteria for approval ofsatisfactory completion of training, a written report and suggestions for remedial training, ifappropriate, will be sent to the RCOG. A copy of this will be sent to the trainee, who may appealif he or she wishes, in writing, to the Specialist Training Committee of the RCOG. The Committeewill then scrutinise the case and, if deemed appropriate, the trainee may be invited for a furtherinterview at the RCOG.

If the assessment panel determines that training has been completed satisfactorily then the traineeshould be provided with a letter of support, which will be passed to the Postgraduate TrainingDepartment of the RCOG.

4. Certificate of completion of training will be issued, signed by the Chairman of the BritishFertility Society and the President of the RCOG.


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To be completed and returned to the:Special Skills Secretary,Postgraduate Training Department, RCOG, 27 Sussex Place, Regent’s Park, London NW1 4RG.

Please complete both sides of the form in block letters in black ink.

TO BE COMPLETED BY TRAINEE

SURNAME: .....................................................................................................................................................

OTHER NAMES: .............................................................................................................................................

RCOG REG NO: (V)NTN:__ __ __/__ __ __/__ __ __/__ MALE ■■ FEMALE ■■

ENTRY CRITERIA: (you must have possession of the MRCOG)

Date obtained MRCOG: __ __/__ __/__ __

NAME AND ADDRESS OF TRAINING CENTRE:

........................................................................................................................................................................

........................................................................................................................................................................

DATE OF COMMENCEMENT OF TRAINING: __ __/__ __/__ __

I WILL/HAVE ATTEND(ED) THE APPROVED THEORETICAL COURSE:

If you have attended please give date: __ __/__ __/__ __

Would you like to receive information on the approved theoretical course: YES ■■ NO ■■

Trainee’s signature: ........................................................................Date: .........................................................

Please complete overleaf

Please insert name of module:

Royal College of Obstetricians and Gynaecologists

SPECIAL SKILLS TRAINEE REGISTRATION FORM

TO BE COMPLETED BY PRECEPTOR(S)

Name of preceptor(s) in charge of training:

1. Name: .................................................................. 2. Name: ..................................................................

Post: ......................................................................... Post: .........................................................................

Department address: Department address:

................................................................................. .................................................................................

................................................................................. .................................................................................

................................................................................. .................................................................................

I agree to provide the training necessary for the completion of this Special Skills Module.

Preceptor name (1): Preceptor name (2):

................................................................................. .................................................................................

Date: ........................................................................ Date: ........................................................................

TO BE COMPLETED BY THE RCOG COLLEGE TUTORI confirm that the trainee can undertake this module of Special Skills Training under the supervision of thepreceptor(s) listed above.

Please print name:

................................................................................. Signature: .................................................................

Date: ........................................................................

TO BE COMPLETED BY THE CHAIRMAN OF THE DEANERY SPECIALISTTRAINING COMMITTEEI confirm that the trainee has completed core training and that the Deanery Specialist Training Committee hasapproved the training module for the trainee, preceptor(s) and programme of training.

Please print name:

................................................................................. Signature: .................................................................

Date: ........................................................................

IT IS THE RESPONSIBILITY OF THE TRAINEE TO OBTAIN THE REQUIRED SIGNATURES FOR THISFORM BEFORE FORWARDING TO THE COLLEGE

To be completed and returned to the:Special Skills Secretary,Postgraduate Training Department, RCOG, 27 Sussex Place, Regent’s Park, London NW1 4RG.

Please complete both sides of the form in block letters in black ink.

TO BE COMPLETED BY DOCTOR

SURNAME: .....................................................................................................................................................

OTHER NAMES: .............................................................................................................................................

RCOG REG NO:........................................................................ MALE ■■ FEMALE ■■

ENTRY CRITERIA: (you must have possession of the MRCOG)

Date obtained MRCOG: __ __/__ __/__ __

NAME AND ADDRESS OF TRAINING CENTRE:

........................................................................................................................................................................

........................................................................................................................................................................

DATE OF COMMENCEMENT OF TRAINING: __ __/__ __/__ __

I WILL/HAVE ATTEND(ED) THE APPROVED THEORETICAL COURSE:

If you have attended please give date: __ __/__ __/__ __

Would you like to receive information on the approved theoretical course: YES ■■ NO ■■

Doctor’s signature: ........................................................................Date: .........................................................

Please complete overleaf

Please insert name of module:


SPECIAL SKILLS REGISTRATION FORM FOR NON-TRAINING GRADES

TO BE COMPLETED BY PRECEPTOR(S)

Name of preceptor(s) in charge of training (please print name):

1. Name: .................................................................. 2. Name: ..................................................................

Post: ......................................................................... Post: .........................................................................


................................................................................. .................................................................................

................................................................................. .................................................................................

................................................................................. .................................................................................

I agree to provide the training necessary for the completion of this Special Skills Module.

Preceptor signature (1): Preceptor signature (2):

................................................................................. .................................................................................

Date: ........................................................................ Date: ........................................................................

TO BE COMPLETED BY THE CLINICAL DIRECTORI confirm that the doctor can undertake this module of Special Skills Training under the supervision of thepreceptor(s) listed above.

Please print name:

................................................................................. Signature: .................................................................

Date: ........................................................................

TO BE COMPLETED BY THE CHAIRMAN OF THE DEANERY SPECIALISTTRAINING COMMITTEEI confirm that the trainee has completed core training and that the Deanery Specialist Training Committee hasapproved the training module for the doctor, preceptor(s) and programme of training.

Please print name:

................................................................................. Signature: .................................................................

Date: ........................................................................

IT IS THE RESPONSIBILITY OF THE DOCTOR TO OBTAIN THE REQUIRED SIGNATURES FOR THISFORM BEFORE FORWARDING TO THE COLLEGE


NOTIFICATION OF COMPLETION OF TRAINING MODULE(To be completed by preceptor)

I certify that

has completed the training module in the management of the infertile couple to my satisfaction. I confirm that I have had regular assessment sessions with the trainee

and each of the required skills in the logbook has been attained.

Date of commencement of practical training: __ __/__ __/__ __

Date satisfactorily completed theoretical course: __ __/__ __/__ __

Trainee name: ..................................................................................................................................................

Trainee signature: ..................................................................... Date: .........................................................

Preceptor(s) in charge of training.


................................................................................. .................................................................................


................................................................................. .................................................................................

Date: ........................................................................ Date: ........................................................................


................................................................................. .................................................................................

................................................................................. .................................................................................

................................................................................. .................................................................................

Authorised by the Chairman of the Deanery Specialist Training Committee

Please print name:............................................. Signature: .........................................................................

Date: .................................................................

This certificate of completion of training should be sent to the

Special Skills Secretary, Postgraduate Training Department, RCOG, 27 Sussex Place, Regent’s Park, London NW1 4RG.

On receipt of this certificate, the RCOG will inform the BFS so that the assessment viva can be arranged.

Special Skills Training Module - RCOG › ... › ed-ssm-infertile-couple.pdf · 2014-02-12 · 4...

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Transcript of Special Skills Training Module - RCOG › ... › ed-ssm-infertile-couple.pdf · 2014-02-12 · 4...