Author: Liz Herrieven / Editor: Charlotte Davies / Codes: CC23 / Published: 27/08/2019
Thank goodness the Summer ARCP season is over. Is it just me, or was that hard work?? Checklists, WPBAs, meetings with supervisors, digging out certificates and trying to work out what all the different Outcomes mean. And that was just being on the panel. It was exhausting! So many of the same issues came up time and time again, so I thought I’d write a little blog to help for next time. This is aimed primarily at EM ST1-6s. It might be useful for you, too, if you’re an ACP, foundation doctor or a trainee in a different specialty, but should be read alongside guidance from your own specialty training school.
What is the ARCP??
The Annual Review of Competence Progression is an annual (!) assessment process, designed to ensure you are progressing through your training appropriately. Every trainee, whether working full time or less than full time, has to have one at least annually (maximum 15 months apart), so it shouldn’t be a surprise. The only trainees who don’t need an ARCP are those on maternity/paternity/adoption leave, or those off sick. You may need one more frequently at times of progression, for example from ST3 to ST4. You should also have an ARCP within 6 months of an “adverse” Outcome.
Although the ARCP process is a national one, there are some local interpretations. Responsibility for this in each area sits with the Postgraduate Dean. The Gold Guide is pretty clear on certain issues though:
You should get a 12 week notice period before your ARCP. With this, you’ll be told a “cut off” date for updating your portfolio. Yes, we know, the portfolios can’t actually be locked down and, at the recent ARCPs in my area, it wasn’t unusual for trainees to be adding to them the night before the panel discussions. However, as a panel member I would beg you to pay attention to this cut-off date. The panel members need time to look through portfolios properly to be able to give you an appropriate Outcome. This is done before the panel meets to discuss the portfolios and make decisions. Adding things late makes this so much more difficult for us. Some regions will be stricter than others, too!
Most ARCPs are now carried out remotely. Panel members (a mix of TPDs, Educational Supervisors, Specialty Tutors, Heads of Schools) will review portfolios against a checklist of requirements. The checklists are based on the curriculum and vary slightly between regions, so make sure you know which checklist is being used in your area. The panel then meets to discuss the portfolios and make decisions about ARCP Outcomes. The panel will usually have a lay member, whose job is to ensure the correct process is being followed and that the panel is conducting itself appropriately. Trainees in dual or subspecialty training will also have their portfolios reviewed by trainers in the other relevant specialty. The panel reviews only the information available in a trainee’s portfolio, nothing from their HEE file and nothing which should be a surprise to you as a trainee. There is specific guidance for the panel to follow and each member must have up to date Equality and Diversity training and declare any conflicts of interest.
Trainees are then informed of their ARCP outcome by their local HEE office. For some, that will be it for another year. For those receiving an adverse outcome (2, 3 or 4), they will either be told they have more work to do before a second review, or asked to attend a face-to-face ARCP panel made up of the same or similar members.
It’s worth noting that the ARCP decisions are made by the panel and then communicated to the trainee. If asked to attend a face-to-face meeting, you wont be expected to “fight” for a particular Outcome, although you should be asked about any mitigating circumstances which the panel should note, or to clarify areas of confusion.
Outcome 1: Satisfactory progress the one you want!!
Outcome 2: Development of specific competencies is required without additional training time. For example, you might be given an Outcome 2 if your ATLS certificate is out of date, or you need to be signed off for a couple of competencies which should be achievable in your next post. An Outcome 2 is for a maximum of 6 months, after which your portfolio will be reviewed again by a panel and youll be given a new Outcome (ideally a 1!).
Outcome 3: Inadequate progress and additional training time required. This one is when you’re not going to be able to catch up without some extra time. The Gold Guide sets out some limits for this extra time, with any additional time only being granted by the Postgraduate Dean or their deputy.
After an Outcome 2 or 3 you can’t apply for a period out of training (OOP) and you can only apply for an inter-deanery transfer with support from the Postgraduate Dean. You can appeal the decision to give you an Outcome 2 or 3 though. The face-to-face panel meeting should include a discussion with you about how you are going to progress from this point.
Outcome 4: Release from the training programme with or without specific competencies. So the end of your training and your employment. This should never happen without you knowing its on its way for example after a maximum period of Outcome 3, if you still haven’t achieved the required competencies. You can appeal an Outcome 4. The face-to-face panel meeting should incorporate a discussion with you about next steps.
Outcome 5: Insufficient evidence presented, additional training time may be required. This one is a short-term measure, usually 2-4 weeks, to hopefully give you time to catch up and convert to an Outcome 1. If you haven’t caught up then youll be asked to attend a face-to-face panel meeting to receive an Outcome 2, 3 or 4.
Outcome 6: Gained all required competencies. The Golden Ticket! Awarded at the end of CT3 (for non-run-through training) or ST6.
Outcome 7: Fixed term post, eg Locum Appointment for Training
Outcome 8: For those on Out Of Programme periods, whether OOPE (experience), OOPC (career break), OOPT (training) or OOPR (research).
The ARCP process forms part of your revalidation process too. Trainees must revalidate every 5 years from F2, then at CCT. The Postgraduate Dean acts as the Responsible Officer for this for trainees, making the appropriate recommendation to the GMC. A Form R must be filled in for each ARCP, in which you must declare any time out of training (sick leave, parental leave, etc), any serious incidents or complaints and all forms of employment (including locum posts). You can also record any compliments received here, too. Processes will vary depending on your region, but its a good idea to upload a copy of your Form R to your portfolio, as well as sending it to your local HEE office.
Revalidation also takes into account all the areas assessed at ARCP CPD, QIP activity, feedback from colleagues, etc.
Basically, its your training, so it’s up to you to get it right! Make sure you know when your ARCP is going to be. Know which checklist you are following and which area of the curriculum you are supposed to be concentrating on. Get started early in each post, getting assessments and educational meetings arranged and keep your portfolio up to date. That way you’ll avoid a mad rush in the run up to your ARCP. The Gold Guide is pretty clear that it is the trainee’s responsibility to manage their learning, collect the relevant evidence and make that evidence available to their trainers. Your supervisors are there to support you, of course, but ultimately, it’s your training and your responsibility.
Although it can all feel a bit daunting, make sure you know when your ARCP is due, find out what exactly is expected of you, start early and keep your portfolio up to date and easy to navigate – link evidence, file certificates and label folders. That way you can make next ARCP season so much easier for me. I mean you. Both of us!
The Gold Guide reference guide for postgraduate training
GMC Good Medical Practice