RCOG MTI Application form 2020

Important: Please read before starting your application

The RCOG (Royal College of Obstetricians and Gynaecologists) understands that clinical training and
non-clinical skills opportunities vary between different countries and even between different
hospitals in the same country. Therefore applicants should not feel potentially disadvantaged if they
have not had the opportunity to be involved in non-clinical activities (such as audit or research) or
have not been exposed to certain clinical procedures (such as hysteroscopy or laparoscopy), as these
are not necessarily essential to gain a placement through the MTI programme.

You must complete this form with honesty and integrity. The information in this entire application
must be true and complete. Any false statements, deliberate omissions or misrepresentations will
be negatively regarded and may be grounds for your application being disqualified.

Please only type information directly into this online form. Do not copy and paste any text, boxes,
bullet points, tables or any other items from a separate document into this form. Items copied and
pasted from other sources will corrupt the final document that we receive and we will not be able to
view what you have entered into the form. If this happens, we cannot guarantee that your
application form will be accepted. Please also make sure that you send us all of the other required
documents together with this application form.

Personal details
Surname:

First name:

Nationality:

Date of birth:

Address:

Telephone:

E-mail address:

Exams and Registration number

RCOG Registration Number:

Date passed Part 1 MRCOG:

Date when RCOG Examination

Department accepted
Training for Part 2 MRCOG:

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Agreements and consents
☐By ticking this box you are agreeing to the terms and eligibility requirements for the MTI and
confirm that you are not currently suspended or removed from medical practice by any authorising
body or involved in disciplinary proceedings related to medical practice in any country.

☐By ticking this box you confirm that you have completed this form with honesty and integrity. You
understand that making false statements will be negatively regarded and may result in your
application being disqualified.

☐By ticking this box you confirm that you have not attempted and failed GMC's PLAB test. We are
unable to accept any applications from candidates who have failed the PLAB test in the past.

☐ By ticking this box you confirm that you have not had significant exposure to and are not carrying
or being treated for a serious communicable condition such as Hepatitis B or C or HIV that would
prevent you from undertaking exposure prone procedures.

☐ By ticking this box you confirm that you give consent for the RCOG to share information relating
to the outcome of your application with the relevant IRC Chair or Fellow who conducted the
interview for your application

☐ By ticking this box you confirm that you give consent for the RCOG to share your contact details
with the Deanery / Head of School responsible for overseeing O&G training within the hospital you
are placed. They will use this information to offer you local education support and teaching
opportunities. You can withdraw your consent at any time by contacting mti@rcog.org.uk / +44 (0)
20 772 6344

Which medical school/university did you attend?

Medical School:

Date Started:

Date Finished:

Please write your basic medical degree and awarding body:

Have you completed any postgraduate medical degrees? Please list and provide dates and
awarding body:

Where you are currently employed?

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Job:

Grade:

Hospital:

Date Started:

Please list all of your previous appointments in O&G (including dates and duration in
months). Please note that your employment history (in this box and the box below) must
cover the entire period from completion of your primary medical degree (including
internship period where applicable) to date. There must be no unexplained gaps in the
employment history. Applications where there are gaps in employment history will be
rejected.

If applicable, please list your previous appointments in other specialties (including dates).
Please note that research in Obstetrics and Gynaecology (where applicable) should be
included in the box above and will count towards the period of experience in Obstetrics and
Gynaecology:

Do you have any gaps in your employment?

Note: Please be aware that the GMC requires MTI doctors to be in full-time medical practice for ALL of the last
12 months before making an application and for three of the last five years. If you have not been in full-time
medical practice (observerships and clinical attachments do NOT count as full-time medical practice) this may
result in an application for GMC registration being denied.

☐Yes ☐No

If yes, please give dates and details:

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Clinical experience
In the box next to each procedure, please insert a number (score) which corresponds to the
appropriate level of competency on this scale:

1 = Observed / assisted

2 = Able to perform under direct supervision

3 = Able to perform under indirect supervision / independently

Procedure Score Procedure Score

Caesarean section: Rotational ventouse or rotational forceps
delivery:

Caesarean section at full dilation: Hysteroscopy:

Manual removal of placenta: Diagnostic laparoscopy:

Evacuation of retained products of Surgical management of ectopic pregnancy

conception: (laparotomy):

Ventouse or forceps delivery (non Repair of third and fourth degree vaginal
rotational): tears:

Repair of episiotomy and 2nd perineal tears Experience of CTG fetal monitoring:

Fetal scalp blood sampling in labour: Adult resuscitation*:

*Please state course and year of training if you attended formal training - you must include a copy of
the certificate of training with your application.

Please list any academic achievements:

Note: Any academic achievements will require supporting evidence attached to the application to
be considered as part of your application. Acceptable evidence can include: a copy of published
paper or abstract, conference programme, a link to conference website showing program, etc.

Publications

Presentations at national or
international meetings

Q1. What are the main strengths and weaknesses of your training to date? (max 250
words)

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Q2. How would you organise a forum to reduce clinical risks in your hospital? (max 250
words )

Q3. How would you organise a meeting in your hospital to discuss maternal/perinatal
mortality and morbidity? (max 250 words)

Q4. Please provide ideas for two audits (one Obstetrics and one Gynaecology) that would be
useful to undertake in your hospital, explaining how you will undertake the audit, the expected
outcome and plans for implementing recommendations (max 500 words)

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Q5. What do you hope to gain from training in UK? (max 250 words)

Q6. How will your time in MTI benefit local healthcare in your home country? (max 250 words)

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Q7. Any further information? (Please use this section to indicate any serious/family reasons why
you require to be placed in a certain region or hospital in the UK)

Thank you for completing the application. Please save it in a pdf/word format together with other
required documents.

Please ensure that you also submit the following documents to MTI@rcog.org.uk together with this
form:

 Scanned copy of your Assessment of Training Letter from RCOG Examinations Department
(for any enquiries email eadmin@rcog.org.uk)
 Scanned copy of IELTS (Academic version) or Occupational English Test (OET) valid to
December 2020
 Scanned copy of your passport
 Scanned copies of publications, certificates, diplomas etc. Please do not include certificates
of attendance for conferences / meetings etc.
 Certificate of training in adult resuscitation

In addition:

 Ensure that your two referees complete and submit the professional references by email to
mti@rcog.org.uk . These forms should be submitted directly from your referees’ email
address, otherwise these forms will not be accepted. Please note that the person completing
the HoD form cannot also be one of your referees.
 Ensure that your Head of Department completes the HoD form and emails a copy directly to
mti@rcog.org.uk . The form should be submitted directly from your Head of Department’s
email address, otherwise this form will not be accepted.

All of the above documents must be received by the RCOG by 23.59GMT on Friday 22 November
2019.

It is your responsibility to ensure that all required documents are submitted to the RCOG by the
deadline, confirming with your two (2) professional referees and HoD that they have submitted their
completed forms by the deadline. The MTI office cannot chase up any outstanding documentation.
Any incomplete applications will not be assessed.

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Please do not enquire as to the status of your application. All applicants who have submitted
complete applications which fulfil all of the MTI criteria will be informed about the outcome of their
assessment in due course.

How we use your information

In accordance with the General Data Protection Regulation (GDPR) 2016 and Data Protection Act
(DPA) 2018, the RCOG will process your personal data, to provide you with your member benefits
and services, and to carry out its day to day business.

RCOG requires the above information to process your application and to administrate your training
records. We will store your personal information such as name, nationality, date of birth, address,
telephone number, email address, employment status and location, RCOG No. and educational
information. Your name and RCOG number will be used to verify your identity.

Where RCOG is required to confirm details of your qualifications and membership we will only share
this data with bona fide third parties. These include governmental and medical regulatory bodies,
educational institutions and prospective employers. The information will only be released where
there is a statutory, regulatory or lawful basis to do so and RCOG will obtain your consent where we
do not.

Full information on how the RCOG processes your personal data can be found in our Data Protection
Policy and Privacy Policy on our website: www.rcog.org.uk

If you are unhappy with the way we are processing your data and would like to make a complaint or
wish to make an individual rights request, please contact the Research and Information Services
Team at dataprotection@rcog.org.uk or in writing to:

Royal College of Obstetricians and Gynaecologists

27 Sussex Place
Regent’s Park
London NW1 4RG.

If you are unhappy with the response you receive or wish to make a complaint to the Information
Commissioner’s Office. Please see the ICO website for details: https://ico.org.uk/make-a-
complaint/your-personal-information-concerns.

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