Getting through the ARCP process – a trainees perspective

1. Getting through the ARCP process – a trainees perspective Dr Nicola Gilmour ST4 Histopathology Mersey Deanery

2. Trainees Perspective • Stressful • Every trainee, department and Deanery appears to do it differently • A numbers game • Case numbers, WPBAs, audits...

3. The ARCP Feedback • Documentation Required • Changes on a yearly basis • Trainees are not notified in enough time • Trainees make up their own forms • No examples of how to set out portfolios • Communication • We are not present at the assessment • To see how we are being assessed • To defend ourselves • Lack of feedback, positive and negative

4. The LEPT System Feedback • Ease of Use for Trainees • Difficult / Not very intuitive / Time consuming • Documentation on how to use – 70 pages long! • Ease of Use for Assessors • Lengthy registration process • Need to remember passwords • Possible need for training themselves • Time Lag • Waiting for assessors to sign off assessments • May miss ARCP deadline, even though assessment carried out before this date • Duplication of Work

5. The LEPT System Feedback • Duplication of Work • Uploading relevant information • MSF / Exam Results / Course Certificates • Copies of presentations / audits • Summarising Information • Not presented in a clear and concise manner • Confidence in the System • Crashing / What if this crashes at the time of the ARCP? • Do the ARCP Panel use it? Do they know how?

6. Mersey Deanery Website Feedback • Information out of date and confusing • Some links not active • Not enough links to the relevant paperwork required

7. Where do we go?

8. Relevant Documents • The Gold Guide (2010) • produced by Medical Education and Training Programme Team @ DoH • 112 pages • Section 7: Progressing as a Speciality Registrar 32 pages • Outlines the ARCP Process

9. Relevant Documents • General RCPath Documents • ARCP Pathology Guidance 2011 – 8 pages • Sample ESSR • RCPath Outcome form • Composite Trainers’ Assessment – NOT in use for Histopathology

10. Relevant Documents • Speciality Specific RCPath Documents • Curricula • WPBAs • MSF • FRCPath Examinations • ARCP requirements for ST level Insert amusing image here

11. Relevant Documents • Mersey Deanery Website • Updated recently • Pre-ARCP review documentation checklist • Advise – to provide these requirements in an ordered manner in an up-to-date portfolio

12. Relevant Documents • Medical Leadership Competency Framework • More competencies for which we need to supply evidence of attainment

13. Relevant Documents • The LEPT system • New guidance from November 2011 • Is use of this compulsory? From RCPath point of view ‘Trainees on the 2007/08 and 2010 Curricula must use the LEPT to record their progress in training.’

14. Confused? Insert amusing image here

15. ARCP Sub-Committee • Established to provide 'quality assurance‘ that the process runs smoothly and fairly and that both trainee and trainer fully understand the process. • Summarise the relevant documentation • Compose standardised assessment forms • Decide paperless vs less paper • Possibly, in conjunction with the School of Pathology Committee, set out Deanery based standards of assessment / evidence required • WPBA format / Evidence of Medical Leadership / Reflective Learning

16. The ARCP

17. The ARCP • Annual Review of Competence Progression • Trainees employed from 2007 onwards, or those who have changed to 2007 / 2010 curricula • Formal review • A panel of assessors reviews • Evidence of progress • Enables the trainee, Post Graduate Dean and Employers to document that the competencies required are being gained

18. The ARCP • Overall Process – Gold Guide, produced by Medical Education and Training Programme Team @ DoH • Competencies – RCPathspecialty curricula, which are approved by the GMC • Evidence – RCPathand Deanery • Assessment – Deanery lead Panel • External review and validation • Involvement of Lay person/s who report directly to the Postgraduate Deanery

19. The ARCP: Process • Appraisal • Educational Supervisor • Educational Appraisal, trainees personal and professional needs • Work Place Based Appraisal, needs and requirements of the employer • Annual Planning • Educational Supervisor and trainee • Assessment • Documented evidence of progress

20. The ARCP: Process

21. The ARCP: Competencies • Based on RCPath Speciality Curricula • Chemical Pathology • Histopathology • Medical Microbiology • All have both a 2007/08 and 2010 curricula

22. The ARCP: Competencies • Approval of Curricula • Originally approved by PMETB, now by GMC • Blueprints map each assessment system against its approved, definitive curriculum and is referenced to Good Medical Practice and the four GMC domains • Knowledge, Skills and Performance / Safety and Quality / Communication, Partnership and Teamwork / Maintaining Trust • Demonstrates how the assessments test the structure of the curriculum

24. The ARCP: Competencies • Best example • Curriculum for speciality training in histopathology June 2010 • Aims of each stage • Competencies required to exit each stage • Minimum practical experience • Assessments for each stage

25. The ARCP: Competencies • Outlined in the Curriculum content / Content of Learning • Separated into General Medical Practice Attributes • Good Clinical Care • Maintaining Good Medical Practice • Teaching and Training, Appraising and Assessing • Relationships with Patients • Working with Colleagues • Health • Probity • Three headings • Knowledge • Skills and knowledge application • Attitudes and behaviour

27. The ARCP: Competencies • Achievement of Competencies • Lots of information on RCPath website regarding the number of evidence required for ARCP • Cases / WPBAs / MSF • Up to the trainee to make sure these actually relate to the competencies set out in the curricula

28. The ARCP: Competencies • Assigning to GMC domains and Good Medical Practice Attributes • Refer to curriculum • Blueprint – if you can understand it

29. The ARCP: Competencies • Management and Leadership Competencies • Individual document for each speciality • Suggested assessment methods • Formal examination: MCQs, EMQs, OSPE • MSF • WPBAs • ESSR • Audit assessment

30. The ARCP: Evidence • Portfolio • Educational Supervisor Meetings • How we provide evidence that we are achieving the competencies set out in the curricula WPBAs / MSF and Examinations are NOT competencies they are the tools for proving evidence that the competencies have been achieved

31. The ARCP: Evidence • Portfolio • Evaluate a doctor’s ability to reflect and learn • Demonstrate professional development • Show evidence of attainment of wider experiential nature • Enhance learning and thus improve the ability of the doctor to perform their duties to care for patients

32. The ARCP: Evidence • Portfolio • Information should be clear and well organized • Hand written documents should be legible • Use coloured and clearly labeled tabs to separate the various types of information • Organize into years / stages / groups of information • You can use more than one folder, but each should be clearly labeled.

33. The ARCP: Evidence • Portfolio Lots of things to include • The training agreement and a copy of form R • The learning agreement and initial educational and learning plan made with the educational supervisor • Mid term appraisals • Details of the individual post including job plan and time table • List of previous posts in chronological order • Log book for all work done throughout the year • Reference what is expected by the Specialtiy Curriculum e.g. number of cases and type of material dealt with if applicable • All WPBAs for the year grouped into categories as specified by the RCPath Speciality curriculum • Examples of reports (if applicable) with patient identifiers removed • Audit reports / records with dates, summary of the audit and outcome • Multisource feedback • Record of any teaching activities (with dates) including feedback • Records of clinical supervision • Records of any research or publications (including a copy, or at least the first page) • Record of meetings and courses you have been on with titles and dates. Including any reflective notes and certificates • Presentations. Including titles, dates and copies with reflective notes and feedback if available • Records in relation to any health issues • Records of management activity • Results of examinations if taken during the year • Copies of GMC registration, defense union membership, incidents and complaints • An up to date CV • Any other information you feel may show new acquired experience relevant to the curriculum • All evidence from previous years , to include any signed off appraisal forms and structured reports

34. The ARCP: Evidence • Portfolio • Structured up to date CV • WPBAs grouped into categories • MSF • Logbook Summary Reference what is required in your curriculum

35. The ARCP: Evidence • Portfolio • Educational Activities Teaching activities, inc feedback Research or publication, with copy of first page Meetings and courses, reflective notes and certificates Presentations, reflective notes and feedback Management activities Examination results Any other information which may show acquired experience

36. The ARCP: Evidence • Portfolio • Personal Development Plan ?learning agreement • Academic Summary • Audit Details • Initial Education Agreement Plan • Interim Reports • Educational Supervisors Report

37. The ARCP: Evidence • Portfolio • Not on check list Records in relation to any health issues Copies of GMC registration, defense union membership, incidents and complaints Training agreement Copy of form R Details of individual post inc. job plan and time table List of previous posts in chronological order Examples of reports (if applicable ) with patient identifiers removed Records of Clinical Supervision All evidence from previous years

38. The ARCP: Evidence • Case numbers • Histopathology curriculum 2007/08 • ‘we believe that a diverse range of material seen under the appropriate supervision and guidance of an educational supervisor is a superior method of working, towards achieving the required competencies, that the indicative figures’ provided in the Curricula. • Case numbers were therefore stated as ‘a guide … indicative estimates of workload’ – did the ARCP panel know this? • Histopathology curriculum 2010 • Minimum practical experience

39. The ARCP: Evidence • Graded Responsibility • Are trainees using this? Have you been signed off? • Have you included it in your portfolio?

40. The ARCP: Evidence • Educational Supervisor Meetings • Initial Meeting • Agree a personal development plan and a learning agreement to be followed during that placement • Give advice on the trainees portfolio • Agree a format for regular feedback and a time for mid-term appraisal • Start the process of educational and workplace based appraisal • Mid-term Appraisal • Make sure trainees are on track

41. The ARCP: Evidence • Educational Supervisor Meetings • End of term Review • Formation of Educational supervisors structure reports (ESSR) • Review of portfolio to make sure it is ready for ARCP • Inform the ARCP panel if a trainee is not likely to be meeting competencies so that a face to face meeting can be arranged

42. The ARCP: Evidence • Educational Supervisors Report • Trainee must see this before it is submitted to the panel • If the report is negative / unsatisfactory • The TPD may produce their own report to explain the reasons for the negative report • The trainee has the right to produce a response in writing • The trainee will be asked to appear before the panel for feedback and an outline of what is expected

43. The ARCP: Panel • Face-less process, most of the time • Do we know what they are looking for? • not just a tick box exercise (?)

44. The ARCP: Panel • TPDs / ESs / Others • Consider the adequacy of evidence produced by the trainee • Make a judgment about the trainee’s progress • Provide a statement of completion of the training programme

45. The ARCP: In Practice • ARCP Panel meet in June and November • Trainees given 6 weeks advanced notice of the meeting of the Panel • Trainees responsibility to submit their evidence at least two weeks before the meeting • Evidence submitted as a hard copy or electronically (needs further clarification)

46. The ARCP: In Practice • The Panels judgment is based on • Evidence of achieving competencies: WPBAs and other documented assessments of performance e.g. examination outcome • Evidence of experience required by the RCPath Specialtiy Curriculum: log books, publications, research, audit • Experience and activities beyond those required by the RCPath curriculum • Educational Supervisors Structured Report, regarding the trainee’s overall performance.

47. The ARCP: In Practice • Non-production of evidence • Incomplete outcome (outcome 5) • Trainee must put in writing the reasons for non-submission of evidence • If this is unsatisfactory a negative outcome may be issued • Incomplete evidence • No decision is made until further evidence is submitted

48. The ARCP: In Practice • Moving Goal posts

49. The ARCP: Feedback • Good Feedback

50. The ARCP: Feedback • Bad Feedbacknot just a tick box exercise (?)