A Guide to O&G Training in the UK

One of the most common interview questions some variation of "Tell us about the structure of O&G training." It sounds simple, but if you cannot confidently outline the training pathway from ST1 through to CCT, it raises a red flag. Interviewers want to see that you have done your homework and understand what you are signing up for.

This blod gives you a clear overview of the O&G training programme in the UK, including the curriculum structure, the training matrix, exams, portfolio requirements, and the options that open up later in training.

The Big Picture: Seven Years to CCT

O&G is a run-through specialty, meaning that once you are appointed at ST1, you have a training number that takes you all the way through to a Certificate of Completion of Training (CCT) at ST7, provided you meet the required competencies at each stage. There is no re-application or competition point at the ST3 transition: you progress automatically if your Annual Review of Competence Progression (ARCP) is satisfactory.

Training is divided into three stages:

• Stage One (ST1--ST2): The foundation of your O&G career. You will rotate through obstetric and gynaecology placements, building core clinical skills under close supervision. The focus is on developing competence in common presentations, emergency management, basic surgical skills, and the fundamentals of antenatal and intrapartum care.

• Stage Two (ST3--ST5): Intermediate training where you develop increasing independence. You will manage more complex clinical scenarios, begin to lead on the labour ward, and start to develop your areas of interest. From ST5, you can begin Special Interest Training Modules (SITMs).

• Stage Three (ST6--ST7): Advanced training where you refine your specialist skills, complete your SITMs or subspecialty training, and prepare for consultant practice. By the end of ST7, you should be functioning at a near-consultant level across both obstetrics and gynaecology.

The 14 Capabilities in Practice (CiPs)

The entire curriculum is built around 14 Capabilities in Practice (CiPs). These are statements describing what a doctor should be able to do by the end of training. Think of them as the pillars of your development: everything you do in training maps back to one or more CiPs.

The CiPs are split into two groups. CiPs 1--8 are generic (sometimes called "Developing the Doctor") and cover professional competencies that apply across all specialties: working within the NHS, leadership, quality improvement, patient safety, evidence-based practice, teaching, research, and health advocacy. CiPs 9--12 are specialty-specific clinical CiPs covering the core clinical work of an obstetrician and gynaecologist. CiPs 13 and 14 cover ultrasound and surgical skills respectively.

Each CiP is assessed using a five-level entrustability scale that reflects how much supervision you need. Level 1 means you can observe only, whilst level 5 means you are trusted to perform independently and can supervise others. By the end of Stage One (ST2), you are expected to be reaching levels 2--3 on the clinical CiPs. By CCT, most should be at level 5.

The Training Matrix: What Is Expected at ST1 and ST2

The RCOG publishes a detailed training matrix each year that sets out exactly what evidence you need to provide at each stage. As per the matrix, here is what is expected at each year of Stage One:

ST1 -- Procedural Requirements

• Cervical smear

ST1 is focused on building your foundational clinical skills. You will also be expected to complete the Basic Practical Skills in Obstetrics and Gynaecology course, CTG training (usually an eLearning package), local mandatory training, and an obstetric simulation course such as PROMPT or ALSO.

ST2 -- Procedural Requirements

ST2 is where the procedural expectations ramp up significantly. You need summative OSATS confirming competence in all of the following:

• Caesarean section (basic) -- defined as first or second caesarean with longitudinal lie

• Non-rotational assisted vaginal delivery (ventouse)

• Non-rotational assisted vaginal delivery (forceps)

• Perineal repair

• Surgical management of miscarriage / surgical termination of pregnancy <16 weeks

• Insertion and removal of IUS or IUCD

• Endometrial biopsy

Recommended courses for ST2 include a basic ultrasound course, a third-degree tear course, a resilience course (such as STEP-UP), and any specific courses required to complete basic competencies.

Your Portfolio: The ePortfolio in Practice

Your ePortfolio is where all of your training evidence lives. It is the single most important tool for demonstrating your progression through the curriculum and it is what the ARCP panel will review.

Your portfolio should contain:

• Workplace-based assessments (OSATS, CBDs, mini-CEX) mapped to the relevant CiPs.

• Reflective entries demonstrating learning from clinical experiences, including adverse events and near misses.

• Evidence of quality improvement projects, audits, and teaching with feedback.

• Personal development plans and records of educational meetings with your supervisor.

• Multi-source feedback (MSF) and patient feedback where required.

The MRCOG Exams

The Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) is a three-part examination and is the postgraduate qualification required for progression through training.

MRCOG Part 1 tests basic and clinical science relevant to O&G. It consists of two papers of 100 single best answer (SBA) questions each, delivered as a computer-based test. You are eligible to sit Part 1 from the point of obtaining your medical degree: some candidates sit it during foundation training, though many take it during ST1 or ST2.

MRCOG Part 2 is a more clinically focused written examination testing knowledge and clinical reasoning. You must have passed Part 1 before sitting Part 2, and you must attempt it within seven years of passing Part 1. UK trainees are required to pass Part 2 as part of intermediate training before progressing to advanced training.

MRCOG Part 3 is a clinical assessment (OSCE-style) testing your ability to apply knowledge, skills, and professional competencies in simulated clinical scenarios. You must have passed Part 2 before sitting Part 3. Passing Part 3 earns you the MRCOG designation. The training matrix requires completion of all three parts by the end of ST5: you cannot start ST6 without your MRCOG.

Special Interest Training Modules (SITMs)

From ST5 onwards, trainees can begin to shape their career through Special Interest Training Modules (SITMs). These replaced the former Advanced Training Skills Modules (ATSMs) under the 2024 Curriculum and allow you to develop focused expertise in areas that interest you.

You are required to complete a minimum of two SITMs for CCT. SITMs are available across a wide range of areas within obstetrics and gynaecology, allowing you to tailor the later years of your training towards the kind of consultant you want to become. Learning for SITMs happens alongside your core training, though certain elements may require protected or supernumerary time.

Subspecialty Training (SST)

For those who wish to pursue a more focused career path, there are four recognised subspecialties within O&G, each requiring competitive entry into a dedicated three-year training programme: Gynaecological Oncology, Maternal and Fetal Medicine, Reproductive Medicine, and Urogynaecology. Subspecialty trainees complete their specialist training alongside their core O&G requirements and graduate with both a CCT in O&G and subspecialty accreditation.

Under the 2024 Curriculum, each subspecialty has its own dedicated set of CiPs and a subspecialty-specific research CiP. Having prior research experience, such as an MD or PhD, will make you more competitive at SST interview but is no longer a formal prerequisite.

Why This Matters for Your Interview

Understanding the training structure underpins your ability to talk convincingly about your career plans, your motivation for the specialty, and your understanding of what the next seven years will look like. If you are asked "Where do you see yourself in five years?", being able to reference Stage Two training, the MRCOG timeline, and emerging areas of interest through SITMs makes your answer far more credible than a vague aspiration.

It also shows the interviewers that you are committed and realistic. O&G training is demanding: seven years of on-calls, exams, portfolio deadlines, and emotional intensity. Candidates who clearly understand what they are getting into, and are enthusiastic about it anyway, are the ones who stand out.