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    CERTIFICATION IN REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY ... CERTIFICATION IN REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY ... Document Transcript

    • T H E R O YA L A U S T R A L I A N A N D NEW ZEALAND COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS CERT I F I C AT I O N I N R EPRODUCTIVE ENDO C R I N O LO G Y A N D INFERTILITY TRAINING PROG R A M H A N DBO O K 2004
    • The Royal Australian and New Zealand College of Obstetricians and Gynaecologists CERTIFICATION IN REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY TRAINING PROGRAM HANDBOOK 2004
    • Published by RANZCOG Publications The Royal Australian and New Zealand College of Obstetricians and Gynaecologists 254-260 Albert Street, East Melbourne, Victoria 3002, Australia © RANZCOG 2004 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without written permission from The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Request and enquiries concerning reproduction should be directed to the Publications Officer, RANZCOG, 254-260 Albert Street, East Melbourne, Victoria 3002, Australia. This material is available on the RANZCOG website at http://www.ranzcog.edu.au
    • IMPORTANT NOTICE ON INFORMATION AND REGULATIONS IN THIS HANDBOOK Every effort has been made to ensure that the information and College regulations in this handbook were correct at the time it was produced. A regularly updated version of the handbook is available on the College website (http://www.ranzcog.edu.au) Readers are strongly advised to consult the website version when checking information or regulations.
    • TABLE OF CONTENTS Schedule of Fees 6 Reproductive Endocrinology and Infertility (REI) - Definition 7 Aims of REI Subspecialty 8 Reproductive Endocrinology and Infertility Subspecialty Committee 9 List of current CREI Subspecialists 10 List of current CREI Subspecialists 11 The CREI Training Program 12 Applying for prospective approval to commence the REI Training Program 14 Training Program Assessment Requirements 17 REI Examinations 20 Syllabus for learning in Reproductive Endocrinology and Infertility 24 REI Subspecialty Training Clinical Skills to be Recorded in the Daily Training Record / Training Assessment Record 30 REI Subspecialty Training Clinical Skills to be Recorded in the Daily Training Record / Training Assessment Record 31 Standards for ther Accreditation of a CREI Training Unit 32 Currently Accredited Training Units 34 Continuing Certification 35 Subspecialties Compendium 36
    • SCHEDULE OF FEES Training Annual Training Fee $AU 780 Late lodgement fee 10% annual fee per month Re-instatement fee 50% annual fee Assessment COGU In-hospital clinical examination $AU 660 MFM In-hospital clinical examination $AU 660 Subspecialty Written Examination $AU 830 Subspecialty Oral Examination $AU 2080 Overseas-trained Subspecialist Assessment $AU 1275 Certification Fee Subspecialty Certification Fee $AU 465 RANZCOG Privacy Policy The RANZCOG is committed to the National Principles for the Fair Handling of Personal Information. A copy of these principles can be obtained at http://www.privacy.gov.au or by contacting the Privacy Commissioner on +61 2 9284 9600. All information submitted to the College by or about Trainees will be handled responsibly and in accordance with these principles. Only information essential to the legitimate function of the College will be collected. The College will endeavour to ensure that information collected is correct and current, and that it is kept as securely as practicable. On request, Trainees will be told how information collected about them will be used. Trainees may also arrange to view their files by making written application to the College. 6
    • REPRODUCTIVE relevant clinical services throughout a region ENDOCRINOLOGY AND INFERTILITY (REI) - • accept a major regional responsibility DEFINITION for higher training, research and audit in areas of recognised subspecialisation Reproductive Endocrinology and Infertility is • establish, as far as possible, a subspecialty of obstetrics and gynaecology. consistency in recruitment, training and Reproductive Endocrinology and Infertility assessment across areas of recognised subspecialists are specialists in Obstetrics and subspecialisation Gynaecology, awarded the FRANZCOG, who are trained and assessed as being competent in the comprehensive management of patients with reproductive endocrine disorders and infertility. A CREI subspecialist must spend at least 67% of his/her clinical time working in the area of this specialty, the remainder being split between obstetrics and gynaecology. At least part of this work must be within a professional setting that provides a comprehensive service for patients with infertility or gynaecological endocrine disorders (this may include private units as well as public hospitals). It is not intended that only persons with the CREI should treat infertile couples. It is probable, though, that specialists with this qualification will be leaders in this area and directors of assisted conception units. The Certificate of Reproductive Endocrinology and Infertility (CREI) is a qualification only for individuals who hold the qualification of Fellow of The Royal Australian & New Zealand College of Obstetricians and Gynaecologists (FRANZCOG). The College introduced certification in the five subspecialties in order to: • improve knowledge, practice, teaching and research • promote the concentration of specialised expertise, special facilities and clinical material that will be of considerable benefit to some patients • improve the recruitment of talented graduates into areas of recognised subspecialisation • establish a close understanding and working relationship with other disciplines • encourage co-ordinated management of 7
    • AIMS OF REI SUBSPECIALTY 1. To provide competent management of patients with reproductive endocrine disorders and infertility. 2. To provide a comprehensive service for patients with infertility or gynaecological endocrine disorders. 8
    • REPRODUCTIVE Reproductive Endocrinology ENDOCRINOLOGY AND and Infertility Subspecialty INFERTILITY SUBSPECIALTY Committee Correspondence COMMITTEE All correspondence pertaining to the work of The Reproductive Endocrinology and Infertility the Reproductive Endocrinology and Infertility Subspecialty Committee is a sub-committee of Committee should be forwarded to the the RANZCOG Council. Chairman of the Reproductive Endocrinology And Infertility Subspecialty Committee at Subspecialty Committees comprise: the address below. The current Chairman is Professor Geoff Driscoll. • Two subspecialists nominated by the Subspecialty Committee and Chairman of RANZCOG recommended to Council without election Reproductive Endocrinology and Infertility • Two members who hold the subspecialty Subspecialty Committee qualification, nominated and elected College House, 254-260 Albert Street by holders of the relevant Subspecialty East Melbourne VIC 3002 qualification AUSTRALIA • One specialist in obstetrics and gynaecology, nominated by Council tel +61 3 9417 1699 • A Chairman, appointed by Council on fax +61 3 9419 7817 or +61 3 9419 0672 the recommendation of the Subspecialty email training@ranzcog.edu.au Committee. website http://www.ranzcog.edu.au The committee is responsible for the development and maintenance of the College’s Reproductive Endocrinology and Infertility subspecialty training program, the approval of training units and training positions, approval of the programs and the assessment of training, development and maintenance of the syllabus, assessment of Overseas Trained Specialists, training and assessment in countries other than Australia and New Zealand, the appointment, support and ongoing training of Training Supervisors, and any other matters relating to the training program as may be directed by Council from time to time. Subspecialty Committees report to the Training and Accreditation Committee, the Examination Committee, Council, and other Committees of Council as necessary. Subspecialty Committees usually meet three times per year by teleconference or face to face meetings. Meetings tend to be scheduled for the weeks preceding Council. Council meets in March, July and November. 9
    • LIST OF CURRENT CREI SUBSPECIALISTS State Subspecialists New South Wales Dr W Birrell Dr M Bowman Professor M Chapman Dr A Clark Dr M Costello Professor G Driscoll A/ Professor J Eden Professor I Fraser Dr N Gayer Professor P Illingworth Professor R Jansen Dr C S James Dr R Lahoud Dr M Livingstone Dr D F Lok Dr R Lyneham Dr J W Persson Dr R Porter Dr F B Quinn Professor D Saunders Dr R Teirney Dr I Wang Dr R Woolcott Victoria Dr L Burmeister Dr B Downing Dr L Hale Professor D Healy Professor G Kovacs Dr P J Lutjen Dr L Rombauts Dr A Speirs Dr C Stern Dr B Vollenhoven Dr D Wilkinson ACT Dr Janelle McDonald Queensland Dr C V Boothroyd Dr K Forbes South Australia Professor J Kerin Professor R Norman Dr O Petrucco Continued over page ... 10
    • LIST OF CURRENT CREI SUBSPECIALISTS (...continued) State Subspecialist West Australia Dr J Yovich Tasmania Dr W Watkins New Zealand Dr P Benny Professor C Farquhar Dr P Fisher Dr W Gillett Dr F Graham Dr G Gudex Professor J Hutton Dr Neil Johnson Dr G Phillipson Overseas Prof B Dunphy 11
    • THE CREI TRAINING PROGRAM The 3-year Training Program comprises clinical training and assessment requirements as follows: Clinical training • must be prospectively approved program • first year must be in Australia or New Zealand • desirable that trainees should not spend all three years in the same training site • minimum one year must be spent in Australia or New Zealand one third of the training period should be spent in active research • minimum number of surgical procedures to be completed over 3 years • completion of an examinable university-based statistics course Training • trainee reports completed by Training Supervisor and documentation submitted to the College for each 6-month period • clinical summaries to be submitted for each 6-month period • all reports must be submitted within 6-8 weeks of completing each 6-month period • Mid –semester assessment to be completed • Trainee feedback form to be completed Research project • research topic to be approved in first 12 months of training, with reports at 18 & 24 months • original research work at a standard to be accepted in a peer- reviewed journal • case reports and review articles not acceptable • research paper must be submitted by 30 April in the year of examination • must have been finally approved at least two months prior to the date of the oral examination Written • applications close on 30 April each year examination • usually held in early August (at same time as MRANZCOG examination) • eligible only if satisfactory Training Assessment Record for 30 months of prospectively approved training • must be attempted for the first time within 2 years of completion of training • maximum of four consecutive attempts allowed • comprises twelve fifteen-minutes short answer questions Oral Examination • only eligible if written examination is passed and research paper approved at least two months prior to the examination • usually held each year within six months of written examination • comprises nine fifteen-minute stations (with fifteen-minute break). Five minutes preparation before each station is allowed • histological sections, article, videos, laboratory worksheets, photographs, journal critiques may be included. 12
    • Regulations governing the timing of the attempt at Examinations are included in the RANZCOG Subspecialty Training and Assessment Regulations in the Subspecialties Compendium. All RANZCOG Trainees must be supervised by an appointed Training Supervisor/Program Director. A detailed description of the Appointment and Duties of Subspecialty Training Supervisors/Program Directors is located in the Subspecialties Compendium. 13
    • APPLYING FOR PROSPECTIVE Clinical Endocrinology and Metabolism. APPROVAL TO COMMENCE THE 5. Candidates must be able to monitor and REI TRAINING PROGRAM manage their own and their institution’s practices, carry out their own research Eligibility studies, and analyse the work of others critically. The candidate must therefore Prospective Trainees must: have a thorough practical understanding of the statistical and managerial methods 1. have satisfactorily completed at least used in the field, such as: 48 months of the RANZCOG Integrated Training Program and have passed the • familiarity with hypothesis Membership Examination, at the time definition, experimental design, training is to commence randomisation procedures, sampling techniques, data OR acquisition, data storage and statistical analysis 2. hold the FRANZCOG qualification. • scientific writing and composition Entry Level Knowledge • application of parametric tests 1. Candidates are strongly advised to including un-paired and paired review the following areas: Anatomy ‘t’-test, correlation, linear and (including male genital anatomy), multiple regression analysis and Surgical Pathology (excepting neoplasia), analysis of variance; on-parametric Reproductive Physiology (including male statistics; Chi-squared tests; the reproductive physiology) and Genetics use of computers for data storage and Ethics (as applied to reproductive and statistical analysis medicine). These areas must be known at the level required for MRANZCOG • computing means, standard and at the applied subspecialty tertiary deviations and standard errors, referral level. computing medians and confidence intervals; comprehension of 2. Candidates must be well acquainted significance testing including with public health and social concerns in understanding of type I and type II the subspecialty, including the concept errors of fecundability (monthly probability of pregnancy), leading to the normal • epidemiological analysis, cohort expectations of pregnancy in the and case control studies, community, the medical, ethical, social, assessment of bias, population and legal aspects of assisted conception, parameters and sampling donor gametes and embryos, and techniques adoption. • life table analysis 3. Candidates should be familiar with current literature that concerns the • the techniques of quality control, subspecialty, especially articles published quality assurance and total quality in the journals Fertility and Sterility and management in clinical and Human Reproduction. General medical laboratory practice. journals, particularly the British Medical Journal, the Lancet, the Medical Journal of Australia and the New England Journal of Medicine also contain articles that concern the subspecialty and are therefore also recommended. 4. Candidates should be familiar with articles on reproduction in the Journal of 14
    • National Selection Process Committee, and Program Directors (or their nominees) from those Training Units which have a vacancy for training in the next two Eligibility years. All applicants will be notified in writing of the outcome of the interview. Prospective Trainees must: Registration 3. have satisfactorily completed at least 48 months of the RANZCOG Integrated Following confirmation of a training post the Training Program and have passed the prospective Trainee will need to register as a Membership Examination, at the time the RANZCOG Trainee and pay the Annual Training training is to commence Fee. OR Trainees who have completed the training requirements, but not all the assessment 4. hold the FRANZCOG qualification. requirements for certification in the subspecialty, must remain registered as a Applications RANZCOG Trainee. They must pay half the Annual Training Fee until the satisfactory The REI Committee will advertise annually completion of all assessment requirements (in the March issue of the O&G magazine) for certification in the subspecialty, unless for prospective REI Trainees to apply for a notification in writing is received of the training position in the REI Training Program Trainee’s intent not to proceed with certification which leads to certification as a subspecialist in in the Subspecialty. Reproductive Endocrinology and Infertility. Trainees who have completed the examination All prospective Trainees must apply via the but have not yet submitted the thesis are National Selection Process to commence required to pay the annual Training Fee. training in the REI Training Program. Trainees who have completed all other Applicants will be asked to forward a assessment requirements (including the curriculum vitae with a list of research and research paper) and are waiting to sit the publications and the names of three referees. examination, are not required to pay the The interviews will usually be held in June/July; Training Fee IF they are sitting the examination applicants may be required to travel to College in the following year as the result of a House for the interview. College decision to postpone a subspecialty examination until more than one candidate is Selection criteria for Trainees eligible.] applying for the REI Training Program Trainees who discontinue their registration as a Applicants will be assessed against the registered RANZCOG Trainee and subsequently following Selection Criteria : decide to obtain subspecialty certification will be required to pay half the Annual Training Fee 1. Previous experience in obstetrics and for the period of time between the last record gynaecology of registration as a RANZCOG Trainee and 2. Previous surgical experience certification as a Subspecialist. 3. Research experience 4. Psychosocial medical experience The RANZCOG registration and prospective 5. Teaching experience approval of training form is distributed in 6. Commitment to Gynaecological Oncology December. 7. Ability to relocate during the Training Program 8. Referee reports Interview Panel The interview panel will comprise two representatives of the REI Subspecialty 15
    • Applying for prospective approval to continue the CREI Training Program The Reproductive Endocrinology and Infertility Subspecialty Committee must prospectively approve all training for EACH year of training, even though prior overall approval for the three-year proposal has been gained. Overseas Trained Subspecialists Overseas Trained Subspecialists applying for Certification as CREI subspecialists are directed to consult the Subspecialties Compendium. 16
    • TRAINING PROGRAM if they choose to do so, provided they meet certain requirements (see below). This record ASSESSMENT REQUIREMENTS of experience, whether in printed or electronic format, has several functions: Minimum Surgical Procedures • It provides you with a personal record of Certification as a CREI Subspecialist requires clinical experience, which can be used to a minimum number of surgical cases to be plan further training with your Training performed, assisted at or observed over the 3- Supervisor or other mentors. year clinical training period as follows: • It provides you with the basis for the 6 • assistance at 10 microsurgical cases monthly summaries of your experience, performed by a CREI training centre which you are obliged to prepare for approved microsurgeon the College. These are used by your • assistance at one anastomosis/ Training Supervisor, the relevant Program performance alternate anastomosis to Co-ordinator, and the REI Committee count as one case when supervised by a to monitor your experience and ensure CREI accredited training centre approved that it is appropriate for your year of microsurgeon training. This information is also used • performance of 10 microsurgical cases by the College to monitor the experience overall provided for you by the hospital. • involvement in a CREI Committee approved laboratory/animal research NOTE: The Logbook is reviewed and signed by project supervised by a CREI training the Training Supervisor every 3 months. centre approved microsurgeon (counts for a maximum of 5 cases overall) • It makes up a component of the formal • documented microsurgical cases proof of training, which you are obliged supervised by a CREI training centre to provide to the College when you apply approved microsurgeon during for Fellowship. FRANZCOG training to count up to a maximum of 5 cases. Important note You are required to use a new Logbook for Daily Training Record Logbook EACH year of training. You will receive a - Printed Version new Logbook at the beginning of each year from the College following registration as a This is for recording on a daily basis: Trainee for that year. There is no charge for the Logbook, as its cost is included in your • clinical experience Annual Training Fee. • attendance at meetings • attendance at outpatient clinics The Logbook includes detailed instructions on • research activities. how to complete it. The information in the Daily Training Record Daily Training Record Logbook must be tallied and recorded in the Training Assessment Record at six-monthly intervals. – Electronic Version NB It may be necessary for the Chairman of Trainees may maintain an electronic Daily the Subspecialty Committee, or the Training Training Record Logbook providing the following Supervisor/Program Director to view the Daily requirements are met. Case Record for verification or clarification of details in the Training and Assessment Record. When setting up an electronic Logbook all the introductory pages of the printed College The Daily Training Record Logbook is a record Daily Training Record Logbook, including of selected aspects of your experience during 1 the Certificate of Accuracy and the Record year of the Training Program. Trainees will be of Discussion and Agreement by Training issued with a printed version of this Logbook, Supervisor must be incorporated. In addition, but they can keep an electronic version instead the headings contained in the Logbook must be 17
    • duplicated in any electronic Logbook. the CREI Training Program. Every 3 months, you must submit a printed The Training and Assessment Record Book Daily Training Record Logbook for signature must be updated every six months and sighted and notation by your Training Supervisor. If by your Training Supervisor, who signs the Six- the data has been maintained electronically, Monthly Training Summary (see below) before then a print-out of the data must be produced it is forwarded to the College. You should also at the time of signing. The print-out must forward the Six-monthly Trainee Report (see also be notated and signed by the Training below). Supervisor and be specifically referred to in the printed Logbook. Completion of Training Assessment Record The RANZCOG will only accept the printed Logbook for assessment purposes. Where • Update as necessary the record electronic records are maintained and the of training sites and dates for Training Supervisor has noted print-outs of commencement and completion of these records, the print-outs must accompany training the Logbook. • At the end of each six-month period: In addition: Clinical training: Tally the clinical experiences • electronic Logbooks must be in a recorded in the Logbook and record the results spreadsheet program, such as Excel on the Six-monthly Clinical Training Summary. • full headings are required and must be Your Training Supervisor must sign this shown on any print-out summary. • annotations used in electronic Logbooks must be fully explained in an Average weekly timetable: Complete an accompanying legend average weekly timetable for the six-month • trainees must regularly back-up any training period. NB If the training program electronically maintained Logbook. altered significantly during the six months, Claims for recognition of training will use photocopies of the page to indicate the not be recognised where data cannot be different training experiences. produced • training periods must also contain Research report: Complete the Trainee all relevant information to determine Research Progress Report and have the the relevant training period (including Training Supervisor complete the Training training year), the name of the training Supervisor Research Progress Report. supervisor, location, and type of training. Training periods should be kept separate Discussion: Discuss your Training Assessment from each other Record and the accompanying Six-monthly Trainee Report (see below) with your Training The privacy of all patients must be protected. Supervisor. Sign the Six-monthly Trainee Report. The guidelines detailed in the printed College Logbook apply to electronically maintained NOTE: the Subspecialties Committee assesses Logbooks and records. all overseas training. Trainees undertaking overseas training will need to forward their Training Assessment Record Training Assessment Record to College House in Melbourne. (TAR) The Training and Assessment Record is Mid-semester assessment designed to provide the Chairman of the Subspecialty Committee and the Training The mid-semester assessment is completed by Supervisor/Program Director with a sequential the trainee and Training Supervisor, each giving presentation of all training and assessment a brief assessment of the trainee’s progress achievements. It will enable you to record over the three-month period. The Training progress made in each of the components of Supervisor must indicate if the assessment is 18
    • satisfactory OR that improvement is expected. receives copies of satisfactory Six-monthly In the latter case a warning is then given that Trainee Reports and Clinical Summaries for that failure to improve may result in a FAIL in the period. next six-monthly Trainee Report. The Training Supervisor and Trainee must both sign and The College will only accept forms where: date the form before it is forwarded to College House. • The Training Supervisor has indicated the Report is either satisfactory or Six-monthly Trainee Report unsatisfactory The Six-monthly Trainee Report, which is • The Report has been signed by the completed by the Training Supervisor, is Training Supervisor a summary of the ratings and comments collected from individual consultants with • The Report has been signed by the whom you work. Each of the relevant Trainee consultants fills out a Trainee Assessment Form. Your Training Supervisor consolidates If any of the above are missing from the form, the information into the single composite Six- it will be returned for completion. monthly Trainee Report. This report is used for two purposes: Trainees who do not submit satisfactory Six-monthly Trainee Reports and • it provides you with feedback on your Clinical Summaries will be discussed performance from the consultants with by the Subspecialties Committee and a whom you work recommendation will be made to the Federal Training and Accreditation Committee that no • it provides the College with feedback on credit is given for the period in question. This your progress will extend the training time for the Trainee. Completion of Six-monthly Trainee Six-monthly Feedback Report Questionnaire on Training Unit by Trainee Your Training Supervisor is responsible for completing the Report, based on the Trainee All RANZCOG REI Trainees are required to Assessment Forms which have been filled out provide a confidential evaluation of their by the consultants. Your Training Supervisor Training Unit. This questionnaire can be will discuss the Report with you before you discussed with the Program Director, although BOTH sign the document. this is not essential, and should be sent to the Chairman of the Reproductive Endocrinology Note: in some overseas hospitals, the Training and Infertility Committee via College House. Supervisor may not be familiar with the forms This report aims to identify strengths and or this requirement, and you will need to weaknesses within Training Units so that, provide him/her with copies of the appropriate where appropriate, improvements in a Training form and explain how it is used. Unit may be encouraged. The Chairman (or nominee) will contact the Trainee to discuss Submitting Training any identified weaknesses and the best Documentation approach to improve the situation. It is essential that the College receives the Removal from Training Program above documentation after the completion of each six-month period. The Six-monthly A trainee who receives 3 consecutive Trainee Report MUST be received at College unsatisfactory reports will be removed from House no later than eight weeks from the END the training program. After 2 unsatisfactory of each six-month training period. reports, an agreed remedial program should be enacted (if not already in place). A period of training CANNOT be credited until the Subspecialties Section at College House 19
    • REI EXAMINATIONS Oral Examination Number of attempts at the Eligibility examination Trainees must have satisfactorily completed the Written Examination and Research Project. Subspecialty Trainees have a maximum of four Candidates will be informed as soon as possible consecutive attempts at the written and oral after the results of the Written Examination examinations. Candidates who believe there become available. are special circumstances preventing them from consecutive attempts may apply to the Subspecialty Committee for consideration of Format their case. The Oral Examination takes approximately three hours to complete and will comprise Written examination nine clinical stations. The candidate will rotate through each of these stations during the Applications examination. The Examination will be held on a date determined by the REI Subspecialty Applications for both the Written and Oral Committee. Examinations will close on 30 April each year. Please contact the Subspecialties Co-ordinator Examination Stations for application and fee details. The application form may also be downloaded from the College There will be 9 separate encounters with 5 Website. minutes preparation time for each encounter. Candidates will pass through each examination Eligibility station and, before each encounter begins, will be given the introductory details of a clinical The Training Assessment Record must have case or cases that will be developed during the been assessed as satisfactory for a minimum of encounter. thirty months of prospectively approved clinical training. This includes the Six-monthly Trainee Stations may consist of two examiners Reports and Six-monthly Training Assessments. examining concurrently or sequentially, or one examiner and an observer. There will be Note: The minimum training period (thirty 9 stations of 15 minutes duration duration. months) is calculated up to three weeks prior Every attempt will be made to ensure that you to the date of the Examination. will not be directly examined by an examiner from your own hospital. Format Candidates should ask explicitly for additional Subspecialty Written Examinations are usually relevant historical and physical details, for held on the same day as the MRANZCOG the results of investigations, for consultations Written Examination in August. The three- if needed, and for responses to treatment. hour Examination comprises 12 short answer Examiners can then formally change these questions with fifteen-minutes allowed for answers to explore candidates’ ability to deal each. with expected or unexpected complications or confounding events, and with simulated late- The CREI Written Examination covers stage referrals. five areas: female reproductive medicine (gynaecological endocrinology), male Histological sections, videos, laboratory reproductive medicine (andrology), work sheets and microscopic photographs reproductive surgery, assisted conception and can be shown. Where a station consists of a applied reproductive physiology, including critique of a journal article, there will be 30 statistics. minutes’ reading time at the beginning of the examination with 5 minutes to review the A selection of past examination questions is article immediately prior to that encounter. available upon request. Questions will not necessarily be restricted to those that would apply to the case. 20
    • Notes may be made during the encounters be the training supervisor, but the relevant (and while reading the published paper) but subspecialty committee must approve the are to be left in the examination room. nomination. Instructions for Candidates Trainees must submit a research paper which attempting the Oral Examination should be at a standard which is suitable for submitting to a peer-reviewed journal, by 30 Candidates who succeed in this examination April in the year of examination. Case reviews will be expected: and reports will not be acceptable. The project must be the result of ongoing research. A • to be clinically competent and doctoral / MD thesis may exempt the trainee authoritative in each of the areas to from the research project component of the be examined (female reproductive training program, but will not reduce the medicine, reproductive surgery, assisted amount of clinical training time. Trainees conception, male reproductive medicine, will still be expected to demonstrate their clinical reproductive physiology); involvement in ongoing research. • to know the principles and limitations of laboratory practice that affect the making The project must have been assessed of clinical decisions; as satisfactory 2 months before the oral • to show skill and sensitivity in informing examination. If the paper is assessed as ‘fail patients and relatives of options and but suitable for resubmission’ a member of implications of alternative plans of the relevant subspecialty committee will be management; assigned to assist the candidate to revise the • to demonstrate detailed practical paper for re-submission within 6 months. If knowledge of the legal, regulatory the paper is failed again the full Subspecialties and ethical framework in which the Committee should review the result with a subspecialty is practised; and report from the Chairman of the relevant • to show knowledge of clinical trial subspecialty. The Subspecialties Committee will methodology and statistics needed both make a recommendation to the Examination to analyse scientific data and published Committee about the next course of action. papers critically and to conduct or supervise such studies. Trainees will not be eligible for the oral examination until the Research Project has The device of simulated clinical encounters, in been passed. Guidelines for assessment of which examiners can, for example, assume the the Research Project are presented in the role of colleague, patient, spouse, scientist- Subspecialties Committee Regulations and technician, nurse, consultant or junior Procedures in the Subspecialties Compendium. researcher will test these skills. Notes: Research Project 1. Three copies of the research paper must be submitted. The Research Project should be prospectively 2. Case reports and review articles are not approved by the relevant subspecialty acceptable for the thesis. committee and the Trainee’s Research and 3. All submissions for assessment must Ethics Committee, and demonstrate the basic include the covering page which is principles of research: original hypothesis located in the Subspecialties Committee testing, research methodology, rigorous Regulations and Procedures. scientific method. The paper should be in a 4. The research project must have been format suitable for submission to a journal. finally approved two months before the The research topic should be submitted to the Oral Examination. relevant subspecialty committee for approval by the end of the first 12 months of training, and progress reports submitted at 18 and 24 months. Research supervisors will be appointed on the nomination of the trainee. The supervisor could 21
    • Special Consideration • adversely affected to a substantial degree by illness or other cause during Guidelines for RANZCOG the performance of an examination. Examinations In cases where candidates feel their Preamble examination preparation has been significantly impaired through illness, the College should be contacted and advice requested. Special consideration is available to candidates who believe their examination preparation and/or performance has been hampered by 2. Consideration illness or other causes to such a substantial degree that it is likely to adversely affect their The RANZCOG Examination Committee performance and, consequently, their result in will consider applications for special a College examination. consideration relating to MRANZCOG and DRANZCOG examinations. Applications for Special consideration is available for all special consideration relating to subspecialty RANZCOG written and oral examinations, examinations will be considered by the relevant including the in-hospital clinical examinations subspecialty Board of Examiners, who will for the subspecialties Maternal Fetal Medicine make recommendations to the RANZCOG and Obstetrical and Gynaecological Ultrasound. Examination Committee. All applications for special consideration must Applications for special consideration will be supported by appropriate documentation, be regarded in the strictest confidence and except in exceptional circumstances that anonymity of applicants will be maintained render this impossible or redundant. where possible. Members of the relevant Appropriate supporting documentation subspecialty Board of Examiners and/or includes, but is not limited to, certificates or the RANZCOG Examination Committee statements from medical professionals licensed will, however, be informed of details of the to issue such certificates or statements, police circumstances relating to the application reports, bereavement notices and statutory in order to make a decision relating to the declarations. In particular, applications for application. special consideration that are based on illness grounds will NOT be considered without Applications for special consideration will only appropriate supporting documentation from be considered by the relevant College body medical professionals licensed to issue such where a candidate has submitted an application certificates or statements. in accordance with the procedures outlined in this document, and where the candidate has 1. Grounds for special consideration not gained a grade of ‘Pass’ in the examination in question under the normal College The most common reasons for applying for procedures. special consideration include serious illness (either yourself or a close family member), 3. Possible outcomes bereavement, family breakdown and personal trauma. If you are in any doubt as to whether The outcome of an application for special particular circumstances warrant special consideration may be any of the following, consideration, you should seek advice from based on material presented to the relevant the Assessment Co-ordinator (MRANZCOG College body considering the application. and DRANZCOG examinations) or the Subspecialties Co-ordinator (all subspecialty • Candidates may be deemed to have written and oral examinations) at the College. passed the examination. • Candidates may be allowed a further Special consideration is available to candidates attempt at the examination without who have been: affecting the number of attempts available to them under relevant College • prevented by illness or other cause from regulations. preparing or presenting for all or part of • Given other consideration as deemed an examination; or appropriate. 22
    • • No action may be taken. was not submitted by the due date. It should be anticipated that any application for special Where the decision relating to an application consideration in an examination made after the for special consideration results in a candidate publication of results in that examination will being granted extra or supplementary attempts not normally be accepted. at an examination, the decision will include a recommendation relating to the charging 6. Appeals of fees or otherwise to the candidate for presenting at those attempts. Applicants for special consideration will be advised of the outcome of their application The remarking of an examination paper is not as soon as is practicable after a decision is an option available under special consideration reached. Applicants may appeal the decision provisions, unless the candidate can made in relation to their application through demonstrate that an error in process or natural the normal College appeals procedure outlined justice has occurred that warrants such action. in Section 19 of the College Regulations. 4. Application Requirements and Applicant’s Checklist Time Limits To assist your application, please ensure that Candidates should advise the College of you have completed these steps. circumstances that they feel may warrant special consideration as soon as they are  Have you read the “Special Consideration aware that such circumstances exist, and Guidelines for RANZCOG Examinations” communication with the College is possible. information? Initial notification may be verbal or written;  Have you notified / discussed your however, formal notification to the College in application with the College Assessment writing (via e-mail acceptable) on the official Co-ordinator or Subspecialties Co- College form MUST occur no later than TWO ordinator as appropriate? days after the relevant examination was  If your application relates to scheduled or held. Applications relating to circumstances that arose during MRANZCOG and DRANZCOG examinations an examination, did you advise the should be directed to the Examinations examination invigilator, local organiser or Officer at the College. Applications relating to examination coordinator as appropriate? subspecialty examinations should be directed If ‘yes’, you should include this in your to the Subspecialties Coordinator at the written statement. College.  Have you attached supporting documentary evidence? The fee payable for lodging an application for  Have you specified why you are seeking special consideration shall be A$150. This fee special consideration? must be included with the written application  Have you written a statement outlining and shall be refunded in the cases where how the illness / difficulty has affected special consideration is granted. In cases your studies or examination preparation where applications are lodged via e-mail or and/or performance? Fax, a written authorisation for debit to the  Have you included or authorised applicant’s credit card is acceptable. payment of the appropriate fee? 5. Late applications An application made after the relevant date, or not on the approved form, must be made to the Chairman of the College Examination Committee. Such applications will only be accepted if the Chairman is satisfied that it was not possible for the application to have been made on the prescribed form or by the required date. Late applications MUST include an outline of the reason(s) why the application 23
    • SYLLABUS FOR LEARNING structure/function) of hypothalamic/ pituitary secretion including feedback. IN REPRODUCTIVE The interaction of reproductive steroids ENDOCRINOLOGY AND with the hypothalamic/pituitary complex. INFERTILITY • The control and functional aspects of Embryology rhythmic functions (long and short term) of hypothalamic/pituitary function. • The embryonic development of the genital tract in the male and female, • Distribution and cellular characteristics including factors controlling male and of pituitary hormone secretion with female gonadal primordia, internal duct particular reference to the gonadotrophe systems and external genitalia. and the lactotrophe. • Embryology of the hypothalamic/ • The function of the pineal gland and pituitary, adrenal and thyroid endocrine melatonin as related to reproduction. systems. • The site of production, biological action • The development of the urological and control of secretion of oxytocin, system. vasopressin and the neurophysins. • The neuropharmacology of GnRH and • The development of the breast. its analogues together with a knowledge of compounds with similar functions in • The mechanism, diagnosis, and related areas. management of female patients with developmental abnormalities of the • The normal (organic and non-organic) of genital tract including ambiguous hypothalamic pituitary, hypo and excess genitalia, imperforate hymen, vaginal secretion in the female. septa, uterine anomalies, Mullerian agenesis and gonadal dysgenesis. • The mechanisms, investigation, and management of hyperprolactinaemia. • The mechanism, diagnosis, and management of male patients with • The neuroendocrine control of the developmental abnormalities including male reproductive system. Hypo and failure of testicular development and / hypergonadotrophic states in the male. or testicular descent, penile abnormality, and ambiguous genitalia. • The blood brain barrier. • Anomalies associated with the urological Hormone Action system in the male and female. • The biosynthesis, secretion, production Nueroendocrine rate, clearance and plasma binding of the major steroid hormones of reproduction. • Suprahypothalamic structures and neural systems relevant to the regulation of the • The mechanism of steroid and protein reproductive processes. hormone action at a cellular level with particular reference to the reproductive • The anatomical-functional aspects of hormones. the peptidergic, catecholaminergic, and opiode systems in the control of • The response of the reproductive tract to hypothalamic/pituitary function. cyclical endocrine changes. • The neurovascular arrangements • The concepts of receptor activity, between the hypothalamus and the specificity, and kinetics and their pituitary. application to receptor assay methodology. • The biochemical basis (including • The administration, absorption, 24
    • distribution, metabolism, and • The physiology, pathophysiology, excretion of drugs/hormones relevant investigation, and management of to reproduction including during disordered menstruation, anovulation pregnancy. Tetrogenecity tolerance, and endometrial hyperplasia. biological variation, modifying features, interactions of common drug and • Non-gynaecological causes of abnormal hormone therapies. uterine bleeding. • Awareness of Government and • The pathophysiology of amenorrhoeic pharmaceutical regulations pertaining to states, their investigation and drugs/hormones and their development management. together with the design and analysis of clinical trial methodology. Breast Gonadal Function • Benign disorders of the breast. • The development and changes • The breast as an end organ for throughout life inherent in the ovary and reproductive hormone response. testis. Thyroid and Adrenal • The influence of genetic constitution on ovarian and testicular development. • The physiology, biosynthesis, control, and metabolism of normal thyroid and • Cyclical changes in biochemical functions adrenal hormonal function. and control mechanisms within the ovary. • The mechanism, investigation, diagnosis, and management of disordered thyroid/ • The mechanisms of atresia, selection, adrenal states with particular reference and maturation of the dominant to reproductive function. follicle(s). The corpus luteum, its control in the non-conceptual and conceptual • Thyroid/adrenal changes in pregnancy cycle. and the newborn. • The impact of ovulation induction and • The pharmacology and effects of thyroid/ hyperstimulation agents on the ovary. adrenal drug/hormone therapy on the reproductive system and pregnancy • The polycystic and related ovarian including the fetus. syndromes. • The syndromes of congenital disordered • The development, maintenance, and adrenal function. The effect of adreno changes through life of endocrine and cortical hypo and hyper function. The gametogenetic testicular function. normal and disordered renin-angiotensin and catecholamine systems. • The induction and maintenance of normal spermatogenesis including endocrine, Androgen Disorders genetic and local environmental effects. • The production, physiology and Disorders of the Female Reproductive metabolism of androgens in the normal Cycle female together with the mechanism of androgen action. • The neuroendocrinology of the abnormal reproductive cycle. • The clinical syndromes, differential diagnosis, investigation and management • The physiology of development and of syndromes of androgen excess in the regression of normal and abnormal female. endometrial growth and the impact of exogenous hormones. • The physiology of normal/abnormal hair 25
    • growth in the female. Genetics • The diagnosis, investigation, and • The principles of Mendalian inheritance, management of late onset adrenal pedigree, and linkage analysis. hyperplasia. • The genetic basis of clinical syndromes • The pharmacology of antiandrogen including chromosomal abnormalities therapy. with special reference to syndromes affecting sexual development and • The production, physiology, and reproductive function of both the male metabolism of androgen in the normal and the female. male. • Antenatal diagnosis of genetic • The clinical syndromes of androgen abnormalities. The indications and deficiency in the male. arrangements for specialized service for genetic diagnosis and counselling. • Syndromes of receptor and enzyme abnormality in the male and female. • The relevance of genetics to male and female infertility, artificial insemination, Development and Cessation of Mature and early pregnancy loss. Reproductive Function • Familiarity with the standard laboratory • The endocrine changes associated procedures associated with chromosomal with reproduction from conception to preparation, identification, and current the mature development of normal nomenclature. reproductive function including gonadotrophin secretion in the male and • The mechanisms of mitosis and meiosis female fetus and neonate. including the effects of chromosome segregation. • The normal chronology of pubertal changes in the male and female. Immunology • The effects of gonadal and adrenal • The mechanism of antibody response hormones on bone growth and other including the origin and function of IgA, non-reproductive organs. IgM, IgG and IgE. • The mechanism, investigation, diagnosis, • The origin and functions of “T”, “B”, and management of delayed pubertal “helper”, “suppressor”, and “natural development and the syndromes of killer” cells. sexual precocity. • The effect of active and passive • Disorders of sexual development. Male immunization on hormonal specific target and female pseudo hermaphroditism. tissues. • The physiology and pathophysiology of • Knowledge of auto-immune disease the menopause including gynaecological affecting reproduction. and non-gynaecological clinical manifestations. • The basic components of the immune system and their possible role in • The role of replacement and therapeutic male and female reproductive failure, regimes associated with the menopause. recurrent abortion, infertility and contraception. • The mechanism, investigation and management of bone loss. • The place of immunological diagnostic procedures relating to infertility, • The effect of old age on testicular fertility, gonadal failure and endocrine endocrine and gamete function. dysfunction. 26
    • Pathology • The physiology of decidual-chorionic peptide hormones. • The normal histological appearance (together with cyclical changes where • Physiology and pathophysiology of fetal appropriate) of the vagina, endometrium, phypothalamic pituitary, gonadal, and the myometrium, fallopian tube and the pancreatic function. ovary in the female. • The pathophysiology of altered maternal • The normal histological appearance of endocrine states, e.g., thyroid, adrenal, the male reproductive tract and the and pancreatic states during pregnancy. testis. • The feto placental unit as it relates to • The normal histology of the pituitary, the the physiology and pathophysiology of adrenal, and thyroid glands. steroid hormones. • The normal histological features of early • The physiology of the fetal adrenal gland. implantation and of early pregnancy loss. The Control of Fertility • The normal features of aging on the reproductive tract. • The pharmacodynamics, metabolic effects and complications of oral and • The pathological changes characteristic injectable contraceptive preparations. of the impact of endometriosis, antenatal hormone exposure, the action • The mechanism of action and of abnormal levels of endogenous complications of intrauterine reproductive hormones, myofibromata contraceptive devices. and infection. • The efficacy of traditional contraceptive • The histology of physiological, methods. physiopathological, and specific pathological tumours associated with • Surgical techniques associated with male hormonal production from the ovary and and female sterilization. testis. • The techniques of interruption of • The pathological features of gonadal pregnancy. dysgenesis and intersex. • The potential of immunology for • The histological features of tumours contraception. of the pituitary, changed thyroid and adrenal function and other tumours • The status of contraceptive research and associated with reproductive function. its limitations. • The features of altered testicular Female and Male Fertility architecture related to reproduction function. • The normal expectations of fertility in the community and the evaluation of the Fetal Medicine infertile couple. • The maintenance of pregnancy and • The diagnosis, investigation, and the initiation of parturition including management of non-ovulation including physiology, pathophysiology, and modes of investigation and the selection pharmacology of the prostaglandins and of ovulation inducing drugs. related compounds. • The role of microsurgery for tubal • The neuroendocrine and general corrective procedures in the male endocrine changes in the mother during and female and the influences on the pregnancy and the puerperium. expectation of results. 27
    • • The evaluation of uterine and cervical • The role of endogenous and exogenous factors in infertility including the androgens to infertility in the male. indications for corrective procedures. • The usefulness of diagnostic procedures • The mechanism, diagnosis, investigation, in the infertile male. and management of endometriosis. • The mechanisms, investigation, and • Artificial Insemination (husband) - management of azoospermia and indications, methods applicable, results, oligospermia. and limitations. Early Pregnancy Loss • Donor Insemination - indications for therapy, selection of donors, methods • The mechanism of implantation and of therapy, results, medical, legal, and the physiology of early pregnancy ethical aspects. recognition. • Adoption - medical, legal aspects, areas • The mechanisms investigation, diagnosis, of counselling, adoption agencies, local and management of patients with regulations, outcome of procedures. multiple early pregnancy loss. • IVF/GIFT and related procedures - the • The immunology of early pregnancy loss choice of hyperstimulation regimes, and the role of therapy. normal and abnormal responses, decision making, methods of oocyte collection, • The genetics of early pregnancy loss. oocyte recognition, influences on the rates of fertilization, methods of gamete Sexual ASpects of Reproduction and embryo transfer, the expectation of results, medical and ethical aspects • Physiodynamics of normal psychosexual of this technology. Federal and State development and the establishment legislation relating to the above of the gender role through childhood, procedures including the constraints on puberty, and adulthood. research. • Normal and abnormal psychosexual • Sperm-oocyte interaction, fertilization function and gender disturbance. and early embryonic development. • Psychological factors in disordered male • The practical approaches to ovum and female reproductive function. and embryo donation and recipient preparation. • Psychological changes associated with infertility and the impact on the family. • Scientific methods used for infertility programs including life table analysis. • The psychological and endocrine changes associated with premenstrual syndrome, • The formation, composition, and analysis the menopause and the impact of of seminal fluid. Tests of spermatozoa hormonal therapy. function. • The principles of sexual counselling and modes of therapy. • The physiology and pathophysiology of ejaculation and sexual function including Clinical Diagnostic Techniques / hormonal and non-hormonal influences. Surgical Techniques • The male reproductive tract and • Be able to interpret findings, and perform conditions relevant to infertility, sperm competently when appropriate: operative transport, and accessory duct function. biopsy of the lower reproductive tract, cytology, endoscopy, laparoscopy, • The medical and surgical approaches to hysteroscopy with assorted techniques, therapy of male infertility. reversal of sterilization, infertility surgery 28
    • including reconstruction of bicornuate Research Methods or septate uterus, myomata, uterine synechiae, cervical incompetence, • Familiarity with hypothesis definition, reparative techniques for tubal and/or experimental design, sampling adhesive pelvic disease, wedge resection techniques, data acquisition, data of the ovaries, ovarian cystectomy, the storage, selection of appropriate staging of endometriosis and surgical statistical analysis and scientific writing. management. The place of laser surgery. • Knowledge of the appropriate • Radiographic/imaging associated with application of statistical parametric reproduction, hysterosalpingography, tests including unpaired and paired, “T” pituitary radiology, arteriography, test, correlation, linear, and multiple arterial catheterisation, urography, regression analysis, and analysis of isotope imaging and ultrasound, nuclear variance. Non-parametric statistics. The magnetic resonance and thermography. use of computers for data storage and statistical analysis. • Dynamic endocrine testing. Visual field examination. • Computing means, standard deviations and standard errors. Comprehensions of • The surgery of development disorders significance, confidence interval, type I including neovaginal, vulva construction, and type II errors. imperforate hymen, vaginal septate, • Epidemiological analysis, cohort and mullerian anomalies with obstruction of case control studies, assessment of bias, drainage. population parameters and sampling techniques. • Surgical techniques for the management of ambiguous genitalia. • Familiarity with the techniques of quality control in laboratory procedures. • The indications and techniques for gonadectomy in the female. Molecular Biology Laboratory Prcedures • A general appreciation of recombinant technology and its potential impact in • The methods and kinetics associated medicine through the availability of with the production, distribution, and purified proteins and improved diagnostic metabolism of reproductive hormones. techniques. • Immuno and bioassay methodology for • A general understanding of the basic common reproductive steroid and protein techniques of gene manipulation hormones. including the use of restriction endonucleases and specific hybridization • Receptor identification, function, and probes to isolate genes, the use of analysis. cloning vectors in gene propagation, the techniques of DNA sequencing and • The culture and maintenance of oocytes, synthesis. fertilization, and preparation for embryo transfer. • An appreciation of the potential application of rDNA technology in biology • The role of the micromanipulator in and medicine with particular reference to gamete handling. rDNA probes for the diagnosis of genetic disease in adult and fetal medicine. • The techniques of sperm analysis and the procedures associated with the isolation • The engineering of transgenic of motile spermatozoa. organisms and their use as a source of human proteins and other reagents of • Cryobiology associated with gamete and pharmaceutical interest. embryo preservation. 29
    • REI SUBSPECIALTY TRAINING CLINICAL SKILLS TO BE RECORDED IN THE DAILY TRAINING RECORD / TRAINING ASSESSMENT RECORD It is appreciated that as the subspecialty evolves there will be Trainees who will be at the forefront of its evolution and who do not intend to practise clinically in every area of the subspecialty. Nevertheless they must, in their training, acquire a working knowledge of these skills in order to place themselves properly in the context of any given situation and the enquiries of their non-subspecialist colleagues. The skills required are listed as follows, together with their abbreviations (which can be used in trainees’ Daily Case Record and Training Assessment Record): Female Reproductive Medicine OI-C Ovulation induction with clomiphene OI-FSH Ovulation induction with follicle stimulating hormone OI-GrRH Ovulation induction with pulsatile GnRH Ovarian suppression with Oral contraceptives or other steroid OS-OC combinations OS-GnRHA Ovarian suppression with GnRH agonists or antagonists HRT Hormone replacement therapy AAT Anti-androgen therapy GEC General Endocrinology cases PAG Puberty/adolescent gynaecology FPC Family Planning (contraceptive) cases NEC Neuro-endocrinology cases Female reproductive surgery TMS Tubal micro-surgery TR Tubal reversal (microsurgical anastomosis) BAS Benign adnexal surgery (ovarian cystectomies etc) MM Myomectomy (laparotomy) MP Metroplasty (laparotomy) HABL Hysteroscopic endometrial ablation HPP Hysteroscopic Polypectomy HMM Hysteroscopic Myomectomy HDA Hysteroscopic division of adhesions HMP Hysteroscopic matroplasty (septoplasty) LAH Laparoscopic assisted hysterectomy LAS Laparoscopic excision adnexal tissue LEE Laparoscopic excision extensive endometriosis TAH/BSO Total abdominal Hysterectomy/bilateral salpingo-oopherectomy Andrology and male reproductive surgery MFC Male factor (male infertility ) cases DAC Diagnostic andrology cases (non-infertility) DUC Diagnostic Urology cases MHRT Male Hormone replacement therapy VR Vasectomy reversal MESA Microsurgical epididymal sperm aspiration TESE Testicular sperm or spermatid extraction TB Testicular Biopsy Continued over page ... 30
    • REI SUBSPECIALTY TRAINING CLINICAL SKILLS TO BE RECORDED IN THE DAILY TRAINING RECORD / TRAINING ASSESSMENT RECORD (...continued) Assisted Conception LAP-OPU laporoscopic egg pick-up (do not code in addition to LAP-GIFT) LAP-GIFT Laparoscopic Gamete Intrafallopian Transfer LAP-ZIFT Laporoscopic zygote (or pre-embryo) intrafallopian transfer TV-OPU Transvaginal egg pick-up (do not include in addition to LAP-GIFT) TV-GIFT Transvaginal gamete intrafallopian transfer TV-ZIFT Transvaginal zygote (or pre-embryo) intrafallopian transfer UET Uterine embryo transfer Imaging LAP Diagnostic Laparoscopy (+/- minor intervention) HYST Diagnostic Hysteroscopy FAL Falloposcopy SAL Salpingoscopy HSG Hysterosalpingogram US Diagnostic Ultrasound UFT Ultrasound follicle tracking CT CT Scan (interpretation with radiologist) MRI MRI scan (interpretation with radiologist) Laboratory Skills IA Sessions in an immuno-assay laboratory SA Semen analysis SP Sperm preparation procedures IVF IVF procedures IVF-FERT IVF fertilisation checks ICSI ICSI procedures CYRO Embryo freezing procedures PCR Polymeras chain reaction procedures FISH Fluorescent in-situ hybridisation procedures TEM Transmission electron microscopy examinations SEM Scanning electron microscopy examinations Research RES Half days spent on research projects 31
    • STANDARDS FOR THER complications contraception ACCREDITATION OF A CREI adolescent and paediatric TRAINING UNIT gynaecology NB: Departments need not necessarily 2. Female reproductive surgery carry out every possible subspecialty endoscopic (minimally invasive) activity to be involved in the training surgery of specialists for the qualification of pelvic microsurgery CREI. In applying for accreditation, prospective training units can submit joint applications in which activities in 3. Endometriosis more than one institution complement endocrine management each other. operative management The application documents must include: 4. Assisted conception in vitro fertilization A. Evidence of activities: general gamete intrafallopian transfer artificial insemination (donor or Names and subspecialty time-commitment of husband) subspecialists cryopreservation facility for gametes and embryos List of those practitioners who have obtained the CREI will be needed, with an account of 5. Andrology past responsibility for CREI trainees semenology and laboratory procedures Letter from the Head of Department stating medical andrology explicitly the Trainee’s involvement with the surgical andrology, including CREI Training Program microsurgery sperm antibody laboratory facilities B. Evidence of activities: publications 6. Fetal Medicine The last 5 years’ publications from the Unit clinical genetics and genetic should be listed under the following headings counselling (or the publications can be set out with the recurrent abortion management information required for requirement C, below): 7. Pathology subspecialty-level (tertiary- Reproductive endocrinology referral) reproductive Female reproductive surgery histopathology Endometriosis cytogenetics and molecular biology Assisted conception Andrology / urology 8. Diagnostic imaging Fetal medicine laparoscopy Other hysteroscopy hysterosalpingography C. Areas of activity: qualitative ultrasound, including facilities for colour Doppler A qualitative description of subspecialty tertiary referral neuroradiology activities of the Unit under each of the following headings and subheadings. 9. Psychosocial subspecialty level counselling by 1. Endocrinology medical social workers or qualified anovulation counsellors hirsutism menopause 10. Ethical and Administrative early pregnancy and its institutional ethics committee that has considered reproductive 32
    • research and is properly application in advance by a trainee registered composed to satisfy NH&MRC with the College. Ultimately, responsibility criteria for the trainee receiving suitable training will computerised data analysis and continue to rest with the Trainee. management formal quality assurance program The advantage in being an accredited Unit is that prospective trainees will know in B and C can be combined to give a full advance that the Unit has the capacity to offer qualitative account of activity, and would them the training they need. The fact of the usefully also include contributions by past and appointment will then ordinarily be accepted as present trainees where appropriate. evidence that their position is a suitable one. D. Evidence of activities: quantitative List the number of “procedures” performed (or expected to be performed) at subspecialty level in a 12-month period. The procedures should be restricted to those which will either be performed by trainees or at which trainees will act as first assistant. The numbers of procedures submitted will be compared with subspecialty trainees’ past and future Training Assessment Records where appropriate. E. Evidence that activities are integrated 1 Timetable of regular educational, peer-review and clinical management meetings at the subspecialist level. 2 Details of clinical and research activities of all trainees attached to the subspecialist Units (this can be incorporated with requirement C, above). 3. Detailed formulation of training programs incorporating the acquisition of practical skills; or a copy of the relevant departmental policy and procedures manual in which the manner of, and criteria for, credentialling of trainees is specified. Summary Unit accreditation and re-accreditation for REI subspecialty training will depend on demonstrating the capacity to develop trainees across the whole subspecialty. Training can take place in non-accredited training units, but such positions would be approved (for 12 months at a time) only after 33
    • CURRENTLY ACCREDITED TRAINING UNITS Royal Prince Alfred Hospital + Sydney IVF, Sydney Monash Medical Centre, Melbourne Royal North Shore Hospital, Sydney Queen Elizabeth Hospital + Wakefield Hospital, Adelaide Royal Women’s Hospital + Melbourne IVF, Melbourne Royal Hospital for Women + Prince of Wales Hospital, Sydney Westmead Hospital, Sydney Pivet Medical Centre, Perth Christchurch Women’s Hospital Fertility Plus & National Women’s Hospital, Auckland Royal Brisbane, Royal Women’s, Mater & Princess Alexandra Hospital, Monash IVF Qld, Brisbane National Women’s Hospital, Auckland 34
    • CONTINUING CERTIFICATION Please refer to the Subspecialties Committee Regulations and Procedures for information about Log Book, Cognate Point requirements for recertification, and the process for dealing with Specialists who default, which is relevant to all Subspecialties. Log Book requirements for REI Subspecialists Applicants for continuing certification will be required to forward the following documentation for assessment: 1. A list of patients seen (no names to be recorded) for the first time, their diagnosis and treatment, for a consecutive six week period. 2. A list of surgical procedures performed which includes the date, diagnosis and procedure, for the same six-week period as for 1 above. 3. Record on the Clinical Skills list the number of procedures performed for the same six week period. The Clinical Skills list is on page 4/5 of the Logbook. 4. Present a weekly timetable for each of the six weeks. Please note, if the Subspecialist is absent for more than one week then additional weeks will need to be added to total six working weeks. The documents will be assessed in accordance with the requirement that 67% of professional activity is in the Subspecialty. 35
    • SUBSPECIALTIES COMPENDIUM The Subspecialties Compendium is a separate publication to this handbook. Please refer to the Compendium for the following information: • RANZCOG Subspecialty Training and Assessment Regulations • Appointment and Duties of Training Supervisors/Program Directors • RANZCOG Subspecialty Diploma Qualification • RANZCOG Emeritus qualification • Continuing Certification • Defaulting Subspecialists • Procedures for the Assessment of Overseas Trained Subspecialists • Assessment of Dissertations and Theses 36