Faculty of Occupational Medicine Training HandbookSection 2

Guide to Specialist Training Revision 2

Page 1 of 4908/12

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CONTENTS

  1. Bodies responsible For Specialist Registrar

training in occupational medicine

1.1.General Medical Council

1.2.Postgraduate Medical Education & Training Board (PMETB)

1.3.Faculty of Occupational Medicine

1.4.Specialty Advisory Committee of the Faculty

1.5.Regional Postgraduate Dean

1.6.Deanery Specialty Training Committee

  1. ENTRY REQUIREMENTS AND Recruitment procedures for Specialist Registrar-grade Trainees in Occupational Medicine (n.b. There will be no recruitment to SpR Training After 1 August 2007)

2.1.Entry requirements and General Professional Training

2.2.Recruitment to SpR posts in the NHS

2.3.Recruitment to 'industry' posts

2.4.Recruitment of doctors already working within an organisation

2.5.Locum Appointments - Training (LAT posts)

2.6.Fixed Term Training Appointments (FTTAs)

2.7.Registration with the postgraduate dean

2.8.Allocation of Training Numbers

2.9.Registration with the Faculty

  1. CCT training programmes in occupational medicine

3.1.Appointment of an educational supervisor

3.2.Requirements of a training programme

3.3.Supervision

3.4.Research

3.5.Part-time posts in a programme

3.6.Flexible (part-time) training

3.7.Overseas training

4.ABSENCES FROM HIGHER SPECIALIST TRAINING

5.TRAINING AGREEMENTS

6.ASSESSMENT, APPRAISAL AND ANNUAL REVIEWS IN THE SpR GRADE

6.1.Assessment

6.2.Appraisal

6.3.Annual review and record of in-training assessments (RITA)

7.RITA forms

8.The qualifications of AFOM and MFOM

8.1.AFOM examination

8.2.MFOM

9.Completion of training

9.1Recommendation for award of CCT

ANNEX 1 - Model SpR person specification form

ANNEX 2 -Training curriculum in occupational medicine

ANNEX 3 -Core competencies in occupational medicine

ANNEX 4 -Model training agreement

ANNEX 5 -Annual assessment report form

ANNEX 6 -Grievance procedures for trainees

ANNEX 7 - RITA Forms

ANNEX 8 - Generic post approval

1.Bodies responsible for Specialist Registrar (SpR) training in occupational medicine:

1.1. General Medical Council

The General Medical Council is the independent regulator for doctors in the UK. Its statutory purpose is 'to protect, promote, and maintain the health and safety of the public by ensuring proper standards in the practice of medicine'. The GMC's powers and duties are set out in the Medical Act 1983. Its job is to ensure that patients can have confidence in doctors. It does this in the exercise of its four main functions:

i)setting and securing specific standards for UK undergraduate medical education and for the first year of the Foundation Programme leading to full registration and entry to the medical register

ii)keeping up to date registers of qualified doctors. All doctors wishing to practise medicine in the UK must be on the List of Registered Medical Practitioners and since 1st January 1997 it has been a legal requirement that, in order to take up a consultant post (other than a locum consultant appointment) in a medical or surgical specialty in the NHS, a doctor must be included in the specialist register.

iii)determining the principles and values that underpin good medical practice

iv)dealing firmly and fairly with doctors whose fitness to practise is in doubt.

On 1 April 2010 the GMC merged with PMETB (see 1.2 below).

1.2.Postgraduate Medical Education and Training Board (PMETB)

The Postgraduate Medical Education and Training Board (PMETB), was established by the General and Specialist Medical Practice (Medical Education, Training and Qualifications) Order 2003 to develop a single, unifying framework for postgraduate medical education and training and was the competent authority (statutory regulator) for postgraduate medical education from 30 September 2005 until 31 March 2010. It took over the responsibilities of the Specialist Training Authority of the medical Royal Colleges (STA) and the Joint Committee on Postgraduate Training for General Practice.

PMETB’s statutory functions were: (i) to establish standards of postgraduate medical education and training; (ii) to secure these standards; and (iii) to develop and promote postgraduate medical education and training. Its statutory objectives were to safeguard service users and to ensure the needs of trainees and employers were met.

These responsibilities resulted ina body that defined high level principles (e.g. standards for curriculum developmentand the specification of training competencies; generic standards for training; principles of quality assured training and assessment); approved the curricula and assessment arrangements of Royal Colleges and Faculties; approved individual training posts and programmes; inspectedPostgraduate Deaneries; conducted periodic national surveys of trainees and trainers. These activities are now carried out by the GMC.

For more information about the merger visit this GMC webpage.

1.3.Faculty of Occupational Medicine

The Faculty of Occupational Medicine performs the same role as other medical Royal Colleges in specialist medical training. The Faculty is responsible (on behalf of GMC) for setting the curriculum and competencies for SpR training in occupational medicine, and for recommending to GMC that a CCT should be awarded. The award of a CCT will lead to inclusion on the GMC’s Specialist Register. It is also responsible for setting the standards for and awarding the diplomas of Associateship and Membership of the Faculty. Further details of these qualifications are included in this Handbook, and are available separately from the Faculty office. The Faculty is represented at regional level by a Regional Specialty Adviser (RSA) who may also have a Deputy.

1.4.SpecialtyAdvisory Committee of the Faculty

The Specialty Advisory Committee (SAC) advises the Faculty on specialist training in occupational medicine and is accountable to the Faculty Board. It is responsible for giving advice to trainees in the SpR grade and assessing whether a trainee has completed specialist training satisfactorily so that the Faculty may recommend the trainee to GMC for award of a CCT. The terms of reference and membership of the Faculty SAC are set out in Section 1.

1.5.Regional Postgraduate Dean

The Regional Postgraduate Dean oversees all aspects of postgraduate medical training in his/her deanery, including SpR grade trainees in occupational medicine both within and outside the NHS. The dean is responsible for issuing the National Training Number (NTN or NTN(I)) and for the annual review of assessments of these trainees (RITA) with the assistance of a deanery training committee.

1.6.Deanery Specialty Training Committee

The Deanery Specialty Training Committee consists of practicing specialists in the region. The committee and its Chair are appointed by the regional postgraduate dean to advise and assist in all matters relating to the delivery of postgraduate medical education within Faculty guidelines. The Faculty RSA and Deputy will usually be members of the committee, and the RSA often chairs the committee.

Some deaneries may appoint a Programme Director, who is primarily responsible for ensuring the quality and management of training posts (on behalf of the dean), and acts as a point of contact for trainees in the region. In practice, the roles of RSA, STC Chair and Programme Director are often combined, but it must be remembered that the RSA reports to - and represents the interests of - the Faculty, and the STC Chair and Programme Director represent the postgraduate dean.

  1. Entry requirements and recruitment procedures for Specialist Registrar-grade trainees in occupational medicine(N.B. There will be no recruitment to SpR Training after 1 August 2007)

2.1.Entry requirements and General Professional Training

  1. The minimum entry requirements set out by the Faculty for a trainee to enter the SpR training grade are as follows:

a minimum of two years of General Professional Training which must be undertaken in supervised training posts at SHO level

or satisfactory completion of General Practice Vocational Training

or possession of a Certificate of Equivalent Experience.

It is important that the experience gained should be wide and varied, and should be in posts with direct involvement in patient care. Thus, in addition to posts in General (Internal) Medicine, prospective trainees are encouraged to work in other specialties. Multi-disciplinary rotations in educationally approved SHO posts (not necessarily restricted to hospital practice) can offer such experience. In general, any JCHMT approved post is acceptable, however it is unlikely that the minimum amount of GPT acquired in a single specialty would provide enough breadth of experience for entry into specialist training in occupational medicine.

  1. Where candidates have undertaken GPT partly or wholly overseas, the burden is upon them toprovide detailed information on the educational approval and training content of their GPT posts to ensure that the appointments committee has adequate information when assessing their application. The candidate must provide evidence of both breadth of experience and training to a standard equivalent to UK GPT.
  1. The regional postgraduate dean will decide whether an SpR candidate appearing before an appointments committee has fulfilled the requirements for General Professional Training, taking advice from the Faculty representative on the appointments committee, the Regional Specialist Training Committee, or the Faculty Specialty Advisory Committee if necessary.

2.2.Recruitment to SpR posts in the NHS

Recruitment and formal appointment to NHS SpR posts are the responsibility of the Regional Postgraduate Dean. The recruitment procedures are laid down in ‘A Guide to Specialist Registrar Training (February 1998)’ commonly known as the ‘Orange Guide’, and should be closely followed. Before advertising the post, it is essential to ensure that:

  1. the post has full or provisional educational approval from the Faculty
  1. the post has Postgraduate Dean’s approval in regard to:
  • manpower approval;
  • appropriate funding;
  • support of the Deanery Specialty Training Committee.

2.3.Recruitment to ‘industry’ training posts or NHS posts funded through income generation

The same standards should apply to recruitment to both NHS posts and to industry or non-NHS posts to ensure that entry to the two training pathways is comparable. It is recognised, however, that employers in the private sector will have their own recruitment procedures, and that terms and conditions of employment will vary. The following guidance should be followed by non-NHS organisations (or NHS Trusts appointing a trainee to an NTN(I) post funded through income generation):

  1. the post must have full or provisional educational approval from the Faculty before it is advertised. It is therefore essential that any proposed training post is discussed with the Regional Specialty Adviser, and that the application forms for approval of the post are sent to the Faculty SAC for consideration at least one month before the post is advertised. Any time spent in a post that does not have educational approval will not under any circumstances count towards higher specialist training;
  1. the Regional Postgraduate Dean’s approval must be sought, as it is the Dean’s responsibility to ensure that the training post is appropriate before issuing the NTN(I). This will normally be done by the Chair of the Deanery STC;
  1. vacant posts must be advertised, to ensure open ‘competitive entry’ to the training programme;
  1. recruitment procedures must conform with good employment practice, and must not be directly or indirectly discriminatory on the grounds of ethnic origin, country of graduation, gender, age, disability, religion or sexual orientation;
  1. at least two references should be sought for each candidate, with specific reference to the areas outlined in the Person Specification Form, and ideally using a structured reference process. Appropriate checks for criminal convictions should be made;
  1. the appointments board or interview panel will be the responsibility of the employing organisation;
  1. to ensure that potential SpR grade trainees appointed to approved non-NHS training posts are of a standard equivalent to their NHS counterparts, arrangements should be made for both the Faculty and the Regional Postgraduate Dean to be represented on the employer’s appointment board or at one of the appointment interviews if a sequential process is involved. If such arrangements cannot be made, the successful applicant must attend an Appointments Committee with representation of the Faculty and Postgraduate Dean, as soon as possible, to confirm their eligibility to enter higher specialist training. Entry into higher specialist training is conditional upon the agreement of the Postgraduate Dean and the Faculty representative, and failure to attend an appropriate Appointments Committee will lead to a delay in admitting the candidate into higher specialist training. In view of the size of the specialty, it may be necessary for the applicant to attend an Appointments Committee in a neighbouring region, or for an ad hoc committee to be set up by the deanery. In those circumstances, the employer may wish to make the appointment ‘subject to the approval of the Postgraduate Dean and the assignment of a NTN(I)’;
  1. the decision to appoint any particular applicant lies with the employer, but the decision to assign a national training number (NTN(I)) lies with the Postgraduate Dean.

A model Person Specification Form is attached (Annex 1). The Person Specification Form should be used to assist the short-listing process. It may be adapted to the requirements of the employer provided that:

  1. it does not conflict with the constraints of paragraph 2.3d;
  1. the minimum educational criteria are not lower than those specified by the Faculty on behalf of GMC.

2.4.Recruitment into training of a doctor already working within an organisation (creation of a training post)

Occasionally, a doctor who is already working within a non-NHS organisation will wish to enter a Higher Specialist Training programme within that organisation, either full or part-time. It is important that such a request is discussed with the prospective Educational Supervisor and the Regional Speciality Adviser – who will normally consult the Regional Postgraduate Dean - before any decision is made.

In regard to the training post, it is essential that:

  1. an educational supervisor is identified, and a training programme outlined;
  1. application forms are sent to the Faculty for educational approval of the post (any time spent in the post before educational approval is granted will not under any circumstances count towards HST recognised for the purposes of CCT), and
  1. the Regional Postgraduate Dean is informed of the intention to create a non-NHS training post, and that an NTN(I) will be requested.

In regard to the potential trainee:

  1. It is not necessary to advertise a post that is already occupied, but the doctor seeking the NTN(I) must be formally assessed by an Advisory Appointments Committee. If interviews for an NHS post or posts in occupational medicine are occurring, then such a ‘validation’ can be carried out by the Committee set up for the purpose. Otherwise the potential trainee should attend an ad hoc Advisory Committee with representation of the Faculty and Postgraduate Dean as soon as possible to confirm their eligibility to enter specialist training;
  1. If the Regional Postgraduate Dean is satisfied that the candidate is suitable for HST, and that the post has educational approval, an NTN(I) will be issued.

2.5.Locum Appointments – Training (LAT posts)

  1. Appointments to locum positions where the appointee may wish to have the time spent in the post allowed towards Higher Specialist Training should follow the guidelines above for either NHS posts or non-NHS posts. In particular, it is essential that the trainee should occupy the post for a minimum of three months, and that a training programme based on the Faculty’s curriculum is agreed prospectively between the educational supervisor, the programme director (where appropriate) and the Faculty’s Training Committee;
  1. Only those NHS or non-NHS posts that already have educational approval will be suitable for LAT appointments. These posts must be advertised to ensure open competitive entry;
  1. Trainees appointed to LATs will be eligible for a NTN or NTN(I) in open competition with other candidates meeting the person Specification. They are not entitled to preferential consideration.

2.6.Fixed-term Training Appointments (FTTAs)

Appointment to a Type II FTTA is unlikely in occupational medicine, and advice should be sought from both the Regional Postgraduate Dean and the Faculty should a FTTA be suggested.

2.7.Registration with the postgraduate dean

The regional postgraduate dean maintains a register of SpRs. Details of the registration, an estimated CCT date and core personal information on a trainee will be entered by the postgraduate dean in a special form (Form A) which will become part of the trainee’s personal Record of In-Training Assessment (RITA) as described in the “Orange Guide”. A copy of RITA Form A will be sent to the Faculty.

2.8.Allocation of training numbers

SpR trainees will hold the same training numbers throughout their occupational medicine training in the same deanery. They retain their numbers even when they take time out for research, take leave of absence or gain experience abroad as long as such arrangements have been agreed with the postgraduate deans and the trainees intend to return to complete their CCT training. However, a new training number will be issued if there is movement between an NHS and a non-NHS training programme. A new training number will also be issued in the event of permanent transfer between deaneries;

NHS trainees

An SpR appointed to an NHS post funded by the Department of Health or other re-mapped NHS funding will be issued a National Training Number (NTN) by the regional postgraduate dean from the stock available from the Department of Health.

Non-NHS trainees

A non-NHS trainee in SpR training, or an NHS trainee in a post funded from non-NHS sources will be issued an Industrial Training Number [NTN(I)] by the regional postgraduate dean to confirm his/her training status and to assist the postgraduate deans in monitoring the trainee’s training progress. Such numbers are unlimited as they do not form part of the NHS manpower planning process. Armed Forces SpR trainees will be issued NTNs by the Tri-Service Dean from a separate stock. Guidance on movement between training posts that involve a change of deanery can be found in the “Orange Guide”.

2.9.Registration with the Faculty

  1. An occupational medicine SpR trainee is required to register with the Faculty. A registration form (Form M1) is available from the Faculty office and will be sent to the trainee when the Faculty receives his/her RITA Form A (see paragraph 2.6.1). The completed form should be returned to the Faculty with the appropriate fee. A Training Record will be issued by the Faculty for a registered trainee to log all training activities for the purposes of assessment, annual review (RITA) and maintenance of records relevant to revalidation;
  1. A registered trainee who is not yet an Associate of the Faculty will become an SpR member of the Faculty. He/she will receive the Newsletter, journal (Occupational and Environmental Medicine) and other regular mailings of the Faculty.

3.CCT training programmes in occupational medicine

The minimum duration of a CCT training programme in occupational medicine is six years full-time – a minimum of two years of general professional training in SHO posts, followed by a minimum of four years higher specialist training (see paragraph 4 for flexible training).