All doctors occupying a Specialty training post are required to undertake a yearly assessment of their progress (Annual Review of Competence Progression).
Each annual assessment is carried out by a small specialty-based panel as detailed in the Gold Guide. It will provide an opportunity for the trainee to provide comments on their training to date, as well as reviewing their progress/competences and identifying specific training needs.
The annual review will confirm the progress of Specialty Trainee through the training programme, followed by a documented recommendation for the following year, ie:
- that the trainee is ready to progress to the next year of a structured training programme
- that all the competences have been achieved
- that targeted training or repeat training at the same level is required
- to provide a final statement of the trainee's completion of the training programme
Successful completion of the full training programme will lead to a recommendation from the Specialist Training Committee that a Certificate of Completion of Training be issued - the CCT.
Repeated failure to progress will lead to withdrawal from the training programme.
Severn Postgraduate Medical Education will work with the Specialty Training Committee to ensure that all Specialty Trainees, including LAT and FTSTA appointments are given an assessment.
A Guide for Trainees and Trainers
Just what is ARCP?
This guide aims to introduce and explain the ARCP process, appraisal and assessment. We hope you find it useful.
Annual Review of Competence Progression (ARCP) is an important process in gaining accreditation. The three key elements which support trainees in this process are appraisal, assessment and annual planning. Based on a modified version of PMETB’s assessment framework, these three elements are individual but integrated components of the training process. Together they contribute to the Annual Review of Competence Progression (ARCP). ARCP was conceived as a formalised ASSESSMENT of a trainee's progress towards the achievement of a CCT (Certificate of Completion of Training). Although doctors devised this assessment process and doctors will carry it out, it has to be a transparent process, capable of standing up to public scrutiny. To achieve this, senior colleagues within each specialty have defined criteria, based upon the relevant curricula. At the time of your ARCP meeting, your progress against this set of pre-defined criteria will be measured and recorded regionally and at the Royal College to which you will ultimately be recommended as a doctor who has reached a standard compatible with independent practice.
Assessment and appraisal: what is the difference?
ARCP is a Annual Review of Competence Progression. This means that the annual ARCP review is NOT an assessment in itself; the assessment will have been ongoing and carried out by the educational supervisor (and colleagues) in the working environment throughout the training placement. At the annual ARCP review, the record of that assessment will be reviewed and the appropriate ARCP outcome will be issued.
Assessment is a formally defined process within the curriculum in which a trainee’s progress in the training programme is assessed and measured using a range of defined and validated assessment tools, along with professional and triangulated judgements about the trainee’s rate of progress. It results in an Outcome following evaluation of the written evidence of progress and is essential if the trainee is to progress and to confirm that the required competences are being achieved.
APPRAISAL is also a vital part of a doctor's training. It is concerned entirely with you and your development. An effective appraisal enables you (and your educational supervisor) to reflect on your progress, become aware of your strengths and weaknesses, make you aware of training opportunities, set your own targets for a given time frame, address issues related to your professional development and develop an educational plan to meet your specific educational needs. The outcome from an appraisal will usually be documented as a confidential record for both the trainee and the educational supervisor. You should meet your educational supervisor for an appraisal at the start, mid point and end of each post or at four monthly intervals if you are in a post for more than a year.
Appraisal provides a complementary approach which focuses on the trainee and his or her personal and professional needs (educational appraisal) and how these relate to performance in the work place and related to the needs/requirements of the employer (workplace based appraisal).
All trainees must have a formally appointed Educational Supervisor who should provide, through constructive and regular dialogue, feedback on performance and assistance in career progression.
The educational supervisor will be responsible for bringing together the structured report which looks at the evidence of progress in training and also for undertaking workplace based appraisal with their trainees.
The educational supervisor is the crucial link between the educational and workplace based appraisal process since the trainer’s report provides the summary of the assessment evidence for the annual review process. The outcome from the annual review underpins and provides evidence for the workplace based appraisal process which is designed to reassure employers that the performance of doctors is satisfactory. (see Appendix A for Appraisal documentation). See section 7.16 to 7.27 of the Gold Guide for more information about the work based appraisal that should be carried out for Specialty trainees.
Personal Portfolio/ Development Diary
If you have not already done so, now is the time in your career for you to start a personal portfolio (or development diary). This will be a collection of documentary evidence that provides you with a record of your ongoing education and training. It also provides you with an opportunity for mature reflection on your work. It can be used as a basis for your regular meetings with your educational supervisor and to record your appraisal meetings. In the age of continuing professional development (CPD) and revalidation, you will need to keep such a portfolio for as long as you practise medicine.
Each Specialty has developed an assessment process blue-printed against the requirements of the curriculum and approved by PMETB. Most of the Royal Colleges either provide you with a skeleton portfolio (for example, Joint Committee on higher Medical Training (JCHMT) provide one for trainee physicians) or provide guidance as to the contents of your portfolio (for example, Joint Committee on higher Surgical Training (JCHST) for trainee surgeons). An example of best practice is contained in Appendix B.
Assessment strategies will normally also include well-constructed and ‘fit for purpose’ professional examinations which map back to the curriculum, in-work and real-time assessments such as directly observed procedures (DOPS), case note review or case-based discussion (CBD), multi-source feedback reports, observed video assessments or assessments in clinical skills facilities and other documented evidence of progress of the individual against the standards set out in the curriculum for the specialty. The educational supervisor’s structured report (Appendix C) or an equivalent summary should be used to provide a summary of the outcome of these for the annual assessment outcome panel. This report must reflect the learning agreement and objectives developed between the trainee and his/her educational supervisor, must be supported by evidence from the workplace based assessment and take into account any modifications to the learning agreement or remedial action taken during the training period.
Log books, audit reports, research activity and publications document other sorts of experience and attainment of skills which trainees may need to demonstrate. Information about these areas should be retained in a specific specialty professional learning portfolio which all trainees must keep in order to record their evidence and progress in their training. The portfolio will also form the basis of the educational and workplace based appraisal process and the annual planning process.
If you have maintained your portfolio regularly, preparing for the ARCP review will be easy, as all the requisite information will be in one place. However, if there are confidential discussions from appraisal meetings that you would rather not disclose at the ARCP review, you may discuss with your supervisor the possibility of submitting a précis of your portfolio. It can be particularly useful to provide a SUMMARY for the ARCP panel so they do not have to flick through hundreds of pages to find what they are interested in.
What does the educational supervisor do for ARCP?
As already discussed the ARCP process is primarily an ASSESSMENT process, which is a public matter and serves a regulatory function. For it to work effectively however there needs to be an equally effective APPRAISAL process running in parallel as part of EDUCATIONAL SUPERVISION.
The Educational Supervisor must ensure that the trainee:
- is aware of his/her responsibility to initiate workplace based assessments
- maintains an up-to-date log book where this is required
- ensures that the trainee’s professional learning portfolio is adequately developed including undertaking and succeeding in all assessments of knowledge (usually examinations) in a timely fashion based on the recommended timescale set out in the specialty curriculum.
If genuine and reasonable attempts have been made by the trainee to arrange for workplace based assessments to be undertaken but there have been logistic difficulties in achieving this, the trainee must raise this with their educational supervisor immediately since the workplace based assessments must be available for the annual assessment outcome panel. The educational supervisor should raise these difficulties with the programme director and between them, must facilitate appropriate assessment arrangements within the timescales required by the assessment process.
The educational supervisor will be responsible for completing a structured report which must be discussed with the trainee prior to submission. This report is a synthesis of the evidence in the trainee’s learning portfolio which summarises the trainee’s workplace assessments, experience and additional activities which contribute to the training process. The report and the discussion which should ensue following its compilation must be evidence based, timely, open and honest.
If there are concerns about a trainee’s performance, based on the available evidence, the trainee must be made aware of these. Trainees are entitled to a transparent process in which they are assessed against agreed standards, told the outcome of assessments, and given the opportunity to address any shortcomings.
Before your ARCP review, you should arrange to meet with your educational supervisor. In some specialties you will need to download forms devised by your Royal College, to be completed together with your educational supervisor prior to the ARCP review. You will be expected to submit these forms six weeks in advance of the ARCP meeting, or to take them with you on the day of your interview. Do not forget - failure to provide the necessary documentation may lead to cancellation of your ARCP and delay in your progression!
Preparing for ARCP
It is very important that you prepare well in advance for the ARCP process. You will be notified several weeks beforehand of your ARCP review date or submission of documentation, which will be held annually.
You need to have prepared:
- College assessment forms (where applicable)
- Portfolio - Clinical logbook
- Structured report from your educational supervisor
- Personal portfolio / Development Diary
- Updated Registration form (Form R)
Understandably, this is daunting if you leave it until the day beforehand. Try to keep these documents updated regularly - it is much less stressful!
What to expect from ARCP
The Purpose of ARCP
The ARCP process provides a formal process which uses the evidence gathered by the trainee, relating to his/her progress in the training programme. It will enable the trainee, the Postgraduate Dean and employers to document that the competencies required are being gained at an appropriate rate and through appropriate experience.
The ARCP panel
The panel has two objectives:
- to consider and approve the adequacy of the evidence and documentation provided by the trainee, which at a minimum must consist of a review of the trainee’s portfolio through a structured report from the educational supervisor, documenting assessments and achievements.
- Provided that adequate documentation has been presented, to make a judgement about the trainee’s suitability to progress to the next stage of training or confirm training has been satisfactorily been completed.
The panel should consist of at least three panel members which the Specialty must arrange :-
- One must be the Training Programme Director. (TPD)
- The other two or more members must be made up of the following: the Chair of the Specialty Training Committee, College/Faculty Representative (from the Specialty Training Committee (STC)), educational supervisors and associate directors/deans are all appropriate panel members.
For Academic trainees:
- Where an annual academic assessment outcome is also involved, there should additionally be two academic representatives on the outcome panel neither of whom were involved in the trainee’s academic programme.
Since decisions from the panel have important implications for both the public and for individual trainees there should also be an external scrutiny of its decisions from within the specialty:
- An external trainer from within the specialty but from outside the specialty training programme or school, who should review at least 10% of the outcomes and any recommendations from the panel about concerns over progress. This person must be arranged by the Specialty.
Additional panel members which will be arranged by the Deanery:
- The panel should also have a representative from an employing authority in order to enable employers to be assured that the trainees they employ are robustly assessed and are able to deliver care in their specialty. This person will be an Assistant General Manager person from a Trust.
Since decisions from the panel have important implications for both the public and for individual trainees there should also be an external scrutiny of its decisions:-
- A lay member to ensure consistent, transparent and robust decision-making on behalf of both the public and trainees who should review at least a random 10% of the outcomes and evidence supporting these and any recommendations from the panel about concerns over progress which the Deanery will arrange from a list of Lay Chairs.
The ARCP process
The panel will be convened by the Training Programme Director on behalf of the Deanery. The panel will normally be chaired by the Chair of the Specialty Training Committee (STC) or the TPD or Associate Dean. The external panel member will only be required towards the end of the process.
The process is not an assessment of the trainee in and of itself but it is an assessment of the documented and submitted evidence that is presented by the trainee. Some panels may wish to discuss other issues with the trainees, however this must be kept separate from the assessment of the documented evidence. Trainees must not be present at the panel considering the outcomes unless the educational supervisor, TPD or academic supervisor has indicated that there may be unsatisfactory outcome through the ARCP process. In this case the trainee will have been informed prior to the panel meeting of the possible outcome and must meet with the panel but only after the panel has considered the evidence.
One of the specialties within Severn are recommending a two station approach for this interview. One where the trainee is given the outcome based on the paperwork that was provided prior to the ARCP process and the other station where the trainee is met by members of the panel to discuss their future training and to discuss any concerns or issues the panel or the trainee may have. There may also be discussions regarding focused or additional remedial training depending on the outcome.
The ARCP review is also a useful forum in which to discuss your achievements during the year as well as your future training/educational needs. Many ARCP panels will also wish to obtain some feedback on the merits of your individual training post. If you wish to make any confidential comments about the quality of your training, the panel will be willing to receive them, but if you wish to make such comments on another occasion, feel free to say so. An ARCP should be mutually honest and non-threatening.
At this review the provisional expected date for successful completion of specialty training should be reviewed taking into account any factors they may have changed this date ie. Less Than Full Time training, leave of absence, career breaks or delays in achieving the competences for whatever reason.
Outcomes from the ARCP
The outcome recommended by the panel for all trainees will be made available by the Deanery to the following bodies:-
- Relevant College or Faculty – The outcome documents need to be sent to PMETB from the College or Faculty with the recommendation of the award of a CCT.
- Training Programme Director (TPD) – will receive 3 copies of the outcome form who will disseminate as follows:-
- one copy should be sent to the trainee’s educational supervisor (see 7.72 of the Gold Guide document for the role of the Educational Supervisor)
- one copy should be given to the trainee who must sign it and return it to the Deanery within ten working days.
- one copy will be retained by the TPD. (see 7.72 of the Gold Guide document for the role of the TPD)
Each trainee will need to complete Form R, Registering for PostgraduateTraining annually. This enables the trainee to renew their registration as a run-through trainee on an annual basis with Postgraduate Medical Education.
Any concerns on a trainee’s Fitness to Practice must be reported to the Postgraduate Dean.
The panel will recommend one of the following outcomes:
ARCP Outcomes (see Appendix D for outcome form)
Outcome 1 - Achieving progress and the development of competences at the expected rate. The rate of progress should be defined within the specialty curriculum
Unsatisfactory Progress or Insufficient Evidence
Trainees are required to meet with the panel if they receive an outcome 2, 3, or 4.)
Outcome 2 - Development of specific competences required – additional training time not required The trainee’s progress has been acceptable overall but there are some competences which have not been fully achieved and need to be further developed. No need for rate of progress to be delayed or CCT date to be altered. Where should an outcome is expected the trainee should appear before the panel. The panel will need to document the further development required which will be retained by the TPD and educational supervisor. A record should be kept by the Deanery. At the next assessment it is essential to identify whether these competences have been achieved.
Outcome 3 - Inadequate progress by the trainee – additional training time required. The panel has decided that a formal additional period of training is required which will extend the duration of the training programme. Where such an outcome is anticipated the trainee should attend the panel. The Educational Supervisor, the trainee and the employer will need to receive clear recommendations from the panel about what additional training is required. The overall duration of the extension to training should normally be for a maximum of one year, unless exceptionally, this is extended at the discretion of the postgraduate dean, but with an absolute maximum of two years additional training during the total duration of the training programme. The extension does not have to be taken in a block of 1 year, but can be divided over the course of the training programme.
Outcome 4 - Released from the training programme with or without specified competences. The panel will recommend that the trainee is released from the training programme if there is still insufficient and sustained lack of progress, despite having additional training. The trainee will be required to give up their National Training Number.
Outcome 5 - Incomplete evidence presented – additional training time may be required. The panel can make no statement about progress since the trainee has failed to submit any information or incomplete information to the panel. If this occurs the trainee may require additional training time to complete their training. The additional time commences from the date when the panel should have considered the trainee. The trainee will have to supply the panel with a written account within five working days as to why the documentation has not been made available to the panel. The panel does not have to accept the explanation and can request the trainee to submit the required documentation by a given date.
Recommendation for completion of training
Outcome 6 - Gained all required competences; will be recommended as having completed the training programme and for award of a CCT or CESR/CEGPR. The panel will need to consider the overall progress of the trainee and ensure that all of the competences have been achieved before recommending the trainee for completion of training programme to the relevant Royal College.
Outcomes for trainees in FTSTAs, out of programme, or undertaking ‘’top up’ training within a training programme
Outcome 7 - Trainees undertaking FTSTAs will undertake regular in-work assessments and maintain documentary evidence of progress during their fixed-term appointment. This evidence will be considered by the ARCP panel and should result in a FTSTA outcome which should document the competences achieved. The outcome should be sent to the trainee’s educational supervisor for follow-up. The trainee should have a copy to put into their portfolio for future use. The Deanery should retain a copy in the trainee’s personal file.
Outcome 8 - Out of programme for research, approved clinical training or a career break (OOPR/OOPT/OOPC). The panel should receive documentation from the trainee on the required form indicating what they are doing during their out of programme (OOP) time. If the trainee is out of programme on a PMETB approved training placement which will contribute to their CCT, then an OOPT document as well as in-work assessment etc demonstrating the acquired competences should be made available to the panel. If the purpose of the OOP is research then the trainee must produce a research supervisor’s report along with the OOPR indicating that progress in research is being made, in achievement of the registerable degree. If a doctor is undertaking a career break, a yearly OOPC requests should be sent to the panel, indicating that the trainee is still on a career break with their indicative intended date of return.
Outcome 9 - For doctors undertaking top-up training in a training post. Some doctors who have been recommended for top-up training by PMETB after submitting applicants for consideration for entry to the Specialist Register through Articles 11 and 14 may do so by being appointed competitively to approved specialty training programmes for a limited period of time, where there is the possibility for such competitions to take place. The doctor should submit the appropriate in-work assessments and documentation to the annual assessment outcome so that the panel can make recommendation, based on the evidence, as to whether the objectives set by PMETB have been achieved.
Additional or remedial training
Whilst the review panel must recommend the outcome for an individual trainee on the basis of the submitted evidence it must also take into account any mitigating circumstances on the trainee’s part ie. Ill-health, or domestic circumstances. It should also take into account changes in the training environment such as changing circumstances within the work place (see section 7.76 to 7.82 of the Gold Guide for further information on this section)
The role of the Deanery in the ARCP
The Deanery is responsible for the management of the ARCP process. The process is carried out by a panel under the aegis of the Deanery Specialty Training Committee.
The Deanery will maintain a training record folder for each trainee in which completed review outcome forms are stored. The Deanery will provide administration support to the ARCP panel.
On entry to the training programme the Deanery will:
- send a copy of Form R to the trainee along with the appropriate letter outlining the Conditions for Entry to the Postgraduate Training Programme
- forward a copy of the Form R to the relevant College to register for Postgraduate Training
- place a copy of the Form R on the trainee’s file.
At the end of each annual review process the Deanery will:
- Forward one copy of the outcome document to the trainee’s Training Programme Director
- Forward two copies of the outcome document to the trainee, one of which must be given to the Educational Supervisor and the other copy should be retained by the trainee.
- Forward a copy of the completed outcome document to the relevant Royal College.
- Place a copy on the trainee’s file.
Where concerns about a trainee have been raised with the Postgraduate Dean, they should liaise directly with the Medical Director and the educational lead within the relevant Trust and consider whether any further action needs to be taken.
What is required of the Training Programme Director
The TPD is responsible for ensuring that the trainee and the educational supervisor receive a copy of the annual outcome document within ten working days after they are received by the TPD.
If the outcome is satisfactory and is as anticipated then the TPD and educational supervisor should meet with the trainee to plan and document the next stage of training.
If the outcome is not satisfactory then the TPD and educational supervisor should arrange to meet with the trainee. The meeting time should have already been arranged prior to the ARCP meeting since all parties would have been aware of the possibility of an unsatisfactory outcome. The purpose of this meeting is to discuss the further action which is required as a result of the panel’s recommendations. The TPD should have support from the Deanery staff to document the agreed arrangements. A copy of the outcome documentation and the plan to support further action should be given to the trainee and also put on the trainee’s file at the Deanery. This meeting is about planning the required action to be taken.
What is required of the trainee?
On appointment the trainee must complete a Form R and return it the Deanery promptly. The Form R will need to be up-dated and signed on an annual basis to ensure that the trainee re-affirms his commitment to the training programme. Trainees will also need to sign and return a copy of the Conditions of joining a specialty training programme.
Return of a Form R signals that the doctor has registered with the Deanery for specialty training. It initiates the annual assessment process and triggers the allocation of a National Training Number. All trainees will be required to confirm the content of the Form at the annual review panel. Trainees must ensure that the Deanery has up-to-date email addresses.
Information regarding the process for joint clinical and academic training programmes can be found in sections 7.95 to 7.105 of the Gold Guide for Specialty Training.
Rarely, as the trainee, you may disagree with the ARCP panel. In this situation, there is an established appeals process, which is explained in the Gold Guide for Specialty Training, or can be discussed with the relevant specialty manager.
Annual assessment by a ARCP is mandatory for all trainees, including LATs. All periods of training should be signed off as satisfactory by a ARCP panel. Ultimately, once you secure a NTN, periods of training certified by a ARCP panel will usually be counted as part of your total training experience. Note however, that the actual amount of LAT experience that will be recognised towards a CCT varies between specialties.
Most LTFT trainees work 6/10ths and necessarily take longer to complete their training. However, an annual ARCP is still mandatory for all trainees. The annual review process will take place at the same frequency as full-time trainees ie. Once per calendar year. The panel should take particular care to consider that progress has been appropriate and that the estimated time for completion of the training programme is reviewed. It is helpful to express the part-time training undertaken by a trainee as a percentage of full-time training so that the calculation of the date for the end of training can be calculated based on the specific specialty curriculum requirements.
Once the outcome for a trainee is know, trainees must meet with their educational supervisor and/or TPD to place the next phase of their training.
A face-to-face meeting is required for this planning. A specialty within the Severn Deanery is proposing that this meeting takes place at the same time as the ARCP panel meet However the outcome and the planning must take place separately. The trainee must not be present at the panel considering the outcome.
The plan for the trainee’s next phase of training should be set within the context of the objectives and must reflect the curriculum of the relevant College.
Once the plan for the trainee’s next phase of training has been agreed this should be documented in the trainee’s portfolio.
Getting a CCT from ARCP
Award of your CCT marks the end point of your specialist training. In accordance with European law, it signifies that a doctor has completed a defined training programme to a standard compatible with independent practice and eligibility for consultant appointment. The final ARCP review must usually take place between 3 to 6 months of the expected CCT. Where the panel are satisfied with the training completed, a Outcome 6 form will be completed.
Once your Outcome 6 form has been issued, it is forwarded directly to the College or the Faculty responsible for your training. Upon receipt of the Outcome 6 form, the College will send you an application form for a CCT. This form assimilates all your relevant training information and must be countersigned by your Regional Postgraduate Dean and then forwarded to the Specialist Training Authority, together with a rather large fee. Once your application form, your money and a recommendation from your College or Faculty have been received. The Specialist Training Authority can issue your CCT.
The Specialist Training Authority is a statutory body made up of Medical Royal Colleges and Faculties and representatives of the GMC (and two Postgraduate Deans and two lay members). Its function is to assess the quality and content of specialist training programmes. It is legally responsible for safeguarding standards of postgraduate medical training and for ensuring adherence to the training requirements stipulated in the European Council Directive 93/16/EEC. Individual Colleges are responsible for publishing syllabuses, conducting examinations and visiting and inspecting training programmes and placements. The Specialist Training Authority is responsible for ensuring compliance with the European Medical Directive.
The CCT will at last be sent recorded delivery to the address that you gave on your application form. Be warned - although you have worked long and hard for it, the piece of paper itself is a rather boring photocopied sheet!
Included with your CCT is yet another application form, which must be completed and sent to the General Medical Council in order for your name to be formally included in the Specialist Register. You do not have to send the CCT itself away, as the STA also inform the GMC directly. Finally, you will receive formal notification from the GMC of your entry in the Specialist Register.
Points to Remember
- Take it seriously: prepare in advance, dress smartly as if for an interview, arrive on time, have all the necessary documentation with you (or ensure that it has been sent in beforehand). The outcome of your ARCP review is being publicised at your Royal College: it's better not to upset them!
- Meet with your educational supervisor in advance. Their report is the most influential piece of documentation at your ARCP meeting.
- Keep an updated portfolio. It will make preparing for the ARCP review so much easier.
- Approach the Specialty Manager at your Deanery if you are having any difficulties. They keep a file for every trainee and will know who best to take up your difficulties with.
- Inform your Deanery of any changes to contact details (contact number, address and email address)