Annual Review of Competence Progression: the challenges

1
Annual Review of Competence Progression the
challenges

• Wendy Reid
• Postgraduate Dean
• London Deanery

2
Guiding principles

• The Deanery is required to implement an effective
  ARCP process in line with the requirements of the
  Gold Guide.
• This must not adversely affect, and should
  support training programme management and the
  2008 recruitment process.

3
The aim

• A structured approach to the implementation of
  the ARCP across all specialties
• A process that will support the effective
  delivery of training and recruitment in London
• Must be endorsed by Heads of School and
  implemented via Specialty Schools and Training
  Programme Directors.

4
Key delivery issues

• Broad Brush/Detailed Approach local (TPD)
  regional (Deanery) activities.
• Interdependencies recruitment, placements,
  rotations, new curricula.
• Contingencies identifying and accommodating
  trainees in difficulty.
• Evidence what needs to be reviewed/seen, paper
  or electronic?
• Excellence identifying special achievement

5
Priority actions

• Establish principles for ARCPs and methods of
  delivery within London.
• Determine ARCP dates for August intake
  specialties by end of Jan.
• Agree how trainees in difficulty are to be
  identified and placements managed.
• Consider documents required and how E Portfolios
  may impact on process.
• Agree London approach for identifying clinical /
  academic / organisational excellence.

6
Proposed broad brush approach

• Local assessments by Educational Supervisor
  throughout year.
• Local in person review by TPD and Clinical Tutor
  or similar.
• Outcome form and documents passed to Deanery for
  in-absentia review.
• In person reviews arranged for trainees in
  difficulty at the Deanery.
• Can this be supported within each school?

7
Known interdependencies

• ARCPs will determine eligibility to progress
  within and from programmes.
• Trusts have been informed that all August details
  will be with them by 16 May.
• Available placements will be determined by
  outcomes of ARCPs.
• How will ARCPs get done in a timeframe that
  supports this?

8
Required contingencies

• Trainees in difficulty may not achieve the ARCP
  outcome required to progress.
• They may need to remain in a training placement,
  or take up another specific slot
• For 2008 planning in ST3/4 specialties will be
  dependant on ST2/3 ARCP outcomes.
• How and when can trainees in difficulty, and the
  remedial posts they will need, be identified?

9
The required evidence

• Gold Guide provides only generic template
  documents
• Currently variable guidance / standard
  documentation from Colleges.
• E Portfolios likely to play an increasing role
  but still in development.
• What should the ARCP sign-off look like and what
  evidence needs to be seen?

10
ARCP Briefing

• Heads of Schools and MWO teams, February 2008
• Some Schools decided Face-to-Face was minimum
  requirement this year

11
Total ARCPs required 2008

• 3389 excluding LATs, Transition doctors, FTSTAs
• Completed 30/4/08 1008 ( 29.74)
• Scheduled 1717 (50.66)
• Outstanding664 (19.59)

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Potential challenges

• Readiness of trainers and trainees for new
  system
• New curricula including assessments poorly
  understood
• Trainees in mixed system, ARCP RITA
• Data capture different forms, e-portfolios
• Impact of moving from ST2 to ST3 for some
  specialties significant

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Challenge of new curricula

• Specialty Schools have direct responsibility for
  delivery
• College sets standards
• Deanery through Curriculum Assessment Board
  will review standards, provide data for QA
  process through PMETB

14
Workplace Based Assessments

• Tools familiar to trainers with Foundation
  Programme doctors
• Colleges running training for trainers
• Variation between specialties e.g. MSF techniques
• Little evidence so far that outcomes predict
  performance, professionalism needs to be assessed
• Not only piece of assessment required for progress

15
E-Portfolio Development

• All Colleges, different costs, different add
  -ons
• Different, commonest NES portfolio
• Not all launched
• Training for trainers/trainees vital
• Interface with deanery QA systems

16
Deanery support for E portfolio development

• Surgery Associate Dean working with trusts,
  both trainer and trainee interaction with ISCP
• OG London and KSS trial e-portfolio from
  August 2008 for ST1 and ST2
• PDA pilot proposal

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Moving from ST2 to ST3

• Implications for professional responsibilities
  e.g. OG ST3 covers LW with consultant at home
• More pressure on trainers to slow down
  progress, therefore more trainees spending gt
  1year at ST2 implications for recruitment,
  posts, rotations, ST3 service

18
ARCP outcomes to date

• 2-3 require PGD presence for failure to progress
  decision
• Similar to RITA data
• May change as we see better understanding of
  curriculum delivery and more mandatory outcomes
  from ST2

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Outstanding areas of concern

• Psychiatry ARCP process to be defined by
  RCPsych
• London 20 outstanding mostly in psychiatry
• Links to recruitment effective but details of
  rotations to trusts need to be confirmed asap

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Summary

• ARCP much work to be done
• Documentation,
• Process,
• Timing,
• Understanding of new curricula
• Using assessment tools effectively

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Conclusions

• Specialty Schools are efficient and will learn
  from 2008
• The new curricula will have some problems of
  feasibility and deliverability
• Electronic data collection is the way forward
• London Specialty Schools will be in a position to
  influence the development of the curricula

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Finally

• Patients, employers, trainers and trainees
  must have faith that the new curricula are
  producing well trained doctors that will be
  effective professionals within and be a credit to
  the NHS.