Abstract
Reproductive medicine is an exciting specialty. It encompasses both medicine and surgery. It brings together far-flung disciplines such as gynaecology, endocrinology, genetics, embryology, andrology, imaging and more. It deals with women, men and yet to be born individuals. It is a constantly evolving field as our understanding of the complex process of reproduction is enriched at a break-neck pace. It is a specialty within which there are numerous job opportunities and career paths. An area where both academic and clinical work can coexist. Nevertheless, it is not always clear what the best pathways to gain training are.
Reproductive medicine is an exciting specialty. It encompasses both medicine and surgery. It brings together far-flung disciplines such as gynaecology, endocrinology, genetics, embryology, andrology, imaging and more. It deals with women, men and yet to be born individuals. It is a constantly evolving field as our understanding of the complex process of reproduction is enriched at a break-neck pace. It is a specialty within which there are numerous job opportunities and career paths. An area where both academic and clinical work can coexist. Nevertheless, it is not always clear what the best pathways to gain training are.
All the chapters up to this point have been aimed at conveying scientific and practical knowledge in the field of reproductive medicine and assisted conception. The purpose of this chapter is different, in that it aims to shed some light in to the different training pathways available to junior doctors contemplating training and a career in reproductive medicine in the United Kingdom.
When choosing a training programme, it should be one that is suitable to the needs of the trainee and matches their expectations.
1 Future Job Role – The Destination
It is beyond the scope of this chapter to try and predict the future job market, as this is in a constant state of flux. The Royal College of Obstetrics and Gynaecology (RCOG) is always in a process of looking at the needs of the profession. However, as national needs and funding priorities change, predicting the future is not possible. Although presently there appears to be a focus on primarily providing delivery suite cover and a reduction in the NHS funding for IVF, and with the current financial climate it is unlikely that this is going to improve in the near future, subfertility is increasing in the general population and more couples are seeking treatment. Nevertheless, the National Institute for Clinical Excellence (NICE) has made some robust recommendations regarding the ideal funding for couples requiring fertility treatment and patients are willing to turn to the private provision of care in clinics around the United Kingdom. Therefore, the need for trained doctors in the field of reproductive medicine and surgery will not necessarily diminish.
When looking at a training pathway, traines should first start by looking at the type of job they would like to have in the future. Job requirements are specific to the needs that the person employed in them will undertake. These requirements differ according to the knowledge and skills required to fulfil them. Jobs in stand alone IVF units deliver specialised tertiary services. Jobs in a clinic or unit within a hospital setting tend to deliver secondary with or without tertiary services. In the NHS setting, emphasis is placed either in secondary or tertiary services and this is reflected in the types of NHS consultant posts. These tend to be either subspecialist consultant posts in reproductive medicine or general obstetric and gynaecology consultant posts with a special interest in reproductive medicine or subfertility.
In broad terms the differences between these posts can be summarised in Table 33.1.
Table 33.1 Differences between type of NHS consultant posts
A subspecialist consultant is more likely to be dealing with the medical, surgical and assisted conception management of tertiary subfertility patients and complex cases. In addition, they are expected to take on a leadership role in the field, be active in research and contribute to teaching.
A consultant with a special interest in subfertility is more likely to be dealing with the secondary-level management of patients and perhaps be involved with the running of a satellite unit for an assisted conception unit. Complex cases or those requiring tertiary level services, such as IVF, are usually referred on. Although this distinction might be relatively clear within their NHS consultant job plan, on occasion consultants who are not accredited subspecialists might still be employed to work at a private IVF unit outside of their NHS contractual obligations.
These two different types of posts require a different skill set to fulfil and consequently different training opportunities.
2 Training Programmes – The Pathway
In the United Kingdom there are two potential ways to train in reproductive medicine. One of them is accredited by the GMC and the other one is not. The GMC accredited pathway involves completion of either a Subspecialty Training (SST) Programme or an RCOG Advanced Training Study Module (ATSM). However, training can be gained through non-GMC accredited fellowships and the British Fertility Society (BFS) offers the opportunity to apply and gain certifications in modules relevant to practicing in the field.
2.1 GMC Accredited Training
The two GMC accredited training programmes, subspecialty training and RCOG ATSM, have very distinct and different objectives, entry criteria, structure and curriculum. These different training objectives reflect the different types of career pathways intended for those completing them. Subspecialist trained doctors are usually expected to take up subspecialist consultant posts, whilst ATSM trained doctors usually take up general consultant posts with a special interest in fertility. This is reflected by a recent RCOG survey that found that of those that remained in the United Kingdom and place of work was known, over 75% of trainees completing subspecialty training had moved in to a pure subspecialist consultant post.
2.1.1 Entry Criteria
The entry criteria for both subspecialty training and ATSM can be found on the RCOG website. Both are undertaken at the earliest during the last two years of the general core training programme, and once all the intermediate training competencies have been achieved (Figure 33.1). Trainees are expected to have passed all their membership exams (MRCOG). Applicants should usually hold a National Training Number (NTN) and should have completed satisfactorily year 5 before registering (i.e. be at a level of ST6/7, SpR 4/5 or on equivalent LAT). However, both types of training programmes can be entered and completed by non-training grade doctors. The ATSM can be completed by SAS doctors and consultants as long as they have completed the equivalent of the intermediate competences, have completed a minimum of 5 years in O&G or hold a UK CCT or CESR and are entered on the UK Specialist register in O&G. Subspecialty training programmes can be completed by candidates who hold a UK CCT or CESR and are entered on the UK Specialist register in O&G.
Fig. 33.1 Schematic layout of GMC accredited training in Obstetrics and Gynaecology
2.1.2 How to Apply
All applications and registrations are prospective. Although previous experience can contribute to the development of competence, the assessment of competence can only be performed following registration.
To register for the ATSM in subfertility and reproductive health, one has to apply directly to the RCOG. However, the support from those involved in this specific ATSM is required. This includes:
The ATSM Educational Supervisor
The ATSM Preceptor with responsibility for that module
The deanery director of ATSMs
Advanced planning is recommended and NTN holders are usually given priority for ATSM training.
The RCOG does not organise subspecialty training posts or programmes. For these, one has to apply directly to the Deaneries/Trusts as set out in individual adverts, all of which are found in the BMJ or the NHS jobs website.
It is expected that during the training period trainees will be working in the United Kingdom for the duration of the ATSM or subspecialty training programme (or have sought prospective approval for recognition of overseas training if the applicant is a NTN holder).
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