Do I need 3 summative OSATSs at each of the Levels 1-5 for Practical Procedures?

Short answer:

No - only for Level 5.

Long answer:

No - independent competence for practical procedures is evidenced with 3 summative OSATSs signed off at Level 5 "Entrusted to act independently." These 3 OSATSs should be signed by a consultant or equivalent level and ideally by at least two different consultants (this is not always possible in a small specialty, but every effort should be made to try and achieve this as it provides a more objective assessment of competence). The stage of training at which independent competence should be reached for each procedure is shown in the Outline Grid of progress (Table 6, p40) in the Definitive Document. Competence may be signed off at any time before this and subsequent summative OSATSs showing maintenance of competence are not required.

Beyond level 5, completion of further formative OSATSs is one way of demonstrating continuing consolidation of skills, increasing complexity and breadth of experience for some procedures if the opportunity arises (eg speculum examination in the presence of large fibroids, surgical management of miscarriage/Surgical Abortion under Local Anaesthesia with previous traumatic experience) This can also be demonstrated via the Procedures Log or by CBDs and MiniCEXs.

In ST1-3, the Letter of Competence Subdermal Contraceptive Implants Techniques and Letter of Competence Intrauterine Techniques are equivalent to 3 summative OSATSs in the corresponding practical procedures.

In order to complete ST3 successfully, there are 6 practical procedures which should be signed off at Level 5 (bimanual examination, speculum examination, cervical screening, insertion/removal IUC, insertion of contraceptive implant and removal of contraceptive implant). In the event of a trainee attempting to sign off each of those competencies in ST3, rather than having completed some of them in ST1 or 2 and not having completed LoCs, that trainee would require 18 summative OSATSs.

At Levels 1-4, one summative OSATS is the minimum that is required to evidence the trainee's level of competence. A trainee who wishes to demonstrate evidence of full engagement with the training programme should consider providing a range of formative OSATSs each year, showing progress in skill acquisition towards independent practice across the relevant practical procedures, for that stage of training from a variety of trainers/clinical supervisors.