The ARCP This podcast has been developed for use by members and prospective members of ARCP panels in the East of England. The podcast itself is part of a package which includes a pdf file of the slides and script of the podcast. This file can be downloaded from the website of Health Education East of England

Arcp Annual ARCP is the formal review of the annual educational process All trainees are required to have ARCPs ARCP panels can be convened more frequently than annually The ARCP also supports the revalidation process for trainees The Annual Review of Competence Progression, often abbreviated to ARCP or ArcP, is the formal review of the annual educational assessment process. All trainees are required to have ARCPs. The process is an assessment of the documented and submitted evidence that is presented by the trainee and a judgement about progression in the attainment of competences is made. Although described as an Annual Review ARCP panels may be convened more frequently than annually as required to meet the assessment needs of individual trainees. With the introduction of revalidation for the medical profession in the United Kingdom the ARCP process will support the revalidation process for trainees.

aRcp Review 1 Process of review and recording evidence of progress It should not be viewed as an assessment of the trainee on the day The deliberation of the panel should be undertaken without the presence of the trainee It is not required that a trainee attend the ARCP panel, but may be invited to do so The ARCP process is one of reviewing and recording the evidence of competence progression through training. The review process starts with the documentation of progress in the creation of an educational supervisors report. In different specialties these reports may be called different things. As the ARCP itself is a review of the submitted documented evidence that has been agreed with the trainee it should not be viewed as an assessment of the trainee on the day. As the trainee themself is not being assessed the deliberation of the panel should be undertaken without the trainee being present. This is the case even when the trainee has been asked to attend and meet with the panel. It is not required that a trainee attend the ARCP panel. The exception to this is when trainees may be expected to receive an unsatisfactory outcome that is an ARCP outcome 2,3 or 4. In this situation it is useful to commence the process of initiating a remedial plan. Other trainees who may be invited to attend to meet with the panel include those who are at particular transition points in their curriculum.

aRcp Review 2 The trainee should be aware of any probable outcome before the ARCP. Where an outcome 2, 3 or 4 is expected then the trainee should attend Where a trainee is expected to receive an outcome 1 or 2 after a previous outcome 2 or 3 it may be sensible/desirable to see a trainee. The decision reached by an ARCP panel should not be a surprise to the trainee. A discussion of the probable outcome should have taken place between the educational supervisor and the trainee when the documentation for the ARCP was being prepared. It is particularly important that the trainee is aware of the probable outcome when an outcome 2, 3 or 4 is envisaged. It is also important that the trainee is present and informed in person of the unsatisfactory outcome and the reasons for the award of a particular outcome. In order that the trainees view the process of a face to face review to be supportive it may be sensible to meet with trainees when they are expected to receive an outcome 1 or 2 after previous award of an outcome 2 or 3.

arCp Competence Competence should have been assessed throughout the year using the framework for assessment in the curriculum It is not the role of the ARCP panel to determine if the trainee is competent, but to review the evidence of competence An adequate assessment of the development, attainment or maintenance of competence should be evident from the submitted documentation Competence is assessed in a variety of ways throughout the year. Each specialty has its own framework for assessment embedded within their individual curricula. It should be stressed that it is NOT the role of the ARCP panel to determine whether or not a trainee is competent, rather it is the role of the panel to review the documentation submitted to establish that there is sufficient evidence of progress in the development of competences against agreed criteria. Where adequate evidence of progress is documented then trainees are eligible to progress to the next year of training or from training. The ARCP panel should be able to determine from the submitted documentation whether there has been an adequate assessment of not only the attainment of competency but also its development and maintenance. The attainment of competency is not in itself the sole purpose of training.

arcP Progression Aim of the ARCP is to reach a decision on an outcome which will determine whether a trainee is suitable to progress to the next stage of training or completion of training Progress should be assessed against an agreed standard to maintain consistency Progress may be assessed against both clinical and academic criteria as specified in the training programme curriculum It is the aim of the ARCP that the panel should reach a decision whether there is sufficient evidence that the trainee has achieved the competences required to progress to the next stage of training. At the end of training the panel is deciding whether all competences required within the curricula have been met and thus to recommend that the trainee is to ready to complete their training. It is important that the decisions of ARCP panels are consistent. This should be both within a training programme and also between different training programmes. For this reason assessment of progress should be against agreed standards. Some colleges have created training matrices to aid with this process. Progress is assessed against both the development of clinical competences and also the development of knowledge. This is assessed by the achievement of academic competences which are usually in the form of postgraduate exams.

All documentation must have been shared with the trainee May be paper based or e-portfolio Structured educational supervisors report – including collation of requirements for WPBAs, exams and other experiential activity Multi source feedback Academic supervisors report (if relevant) Additional TPD report may be helpful if concerns An enhanced Form R All documentation must have been shared with the trainee The submitted documentation can be in the form of hard copy or available to panels through e portfolios. The central most important piece of documentation is a structured educational supervisors report.. This report should clearly document that any curricular requirements regarding work placed based assessments have been made. The passing of exams and all other experiential activity, such as involvement in clinical governance should be documented It is desirable that all trainees have a multisource feedback and different variants of this form of assessment are used in different specialties. For academic trainees and also for trainees undertaking out of programme research it is important that a report is received from an academic supervisor. When a trainee has experienced particular issues it may be desirable for the training programme director to provide an additional report. All trainees must submit and sign an enhanced form R which supports their evidence for revalidation. Importantly the trainee must be fully aware of the documentation that is being considered and on which any decisions are based. All documentation must be shared with the trainee and where they disagree with the submitted documentation they must have the opportunity to submit evidence relating to any disagreements.

Outcomes Outcome 1 Outcome 2 Satisfactory process Fulfils all criteria for progression to next year of training Outcome 2 Development of specific competences required No additional training time required Overall progress to CCT unaffected No right to appeal Not applicable to foundation trainees The purpose of the ARCP is to award an outcome that reflects the progress made by the trainee in the period of time under assessment. The majority of trainees should be expected to be given an outcome 1. This reflects that they are progressing satisfactorily. Trainees given an outcome 1 have met the required criteria to enable them to progress to the next stage of training Outcome 2 This is given when it is identified that specific competences have not been achieved. In this situation it is expected that the identified competences can be attained without any additional time in training. Consequently the overall progress towards CCT is unaffected Trainees are not permitted to appeal against the award of an outcome 2 although they may request that the panel reviews the decision An outcome 2 cannot be given to trainees within foundation programmes.

Outcomes Outcome 4 Outcome 3 Inadequate progress Creates an opportunity Additional training time required Panel makes recommendations about additional training Trainee has the right to appeal Outcome 4 Insufficient and sustained lack of progress despite additional training Released from training programme Any achieved competencies should be specified Trainee has the right to appeal Outcome 3 Outcome 3 is recommended when adequate progress against the curriculum standards has not been made. Whilst often considered to be an unsatisfactory outcome, it should be viewed as supportive to the trainee in creating an opportunity for them to address areas of concern or for the panel to consider mitigating circumstances. In this situation a period of additional training is required. Training can be extended for up to one year in total during training (6 months only in core and GP training). Any further extension of training beyond a year can be considered by the postgraduate dean but only when exceptional circumstances exist The panel makes recommendations regarding the required additional training and these should be communicated clearly to the trainee and their trainers. When an outcome 3 is given a trainee has the right to appeal. They should be informed of this right. The appeal follows a well defined and specific process. Outcome 4 An outcome 4 will be awarded when there is documentary evidence of a sustained lack of progress against the defined curricular competencies. This will usually follow a period of additional training on an outcome 3 but can be given after an outcome 2 or in other exceptional circumstances. This outcome results in the release of a trainee from the training programme Consequently clear documentation is required of the competencies that have been acquired on the training programme As for an outcome 3 the trainee has the right to appeal.

Outcomes Outcome 5 Incomplete evidence presented A short term outcome A clear plan to review additional documentation should be made Panel does not need to reconvene Outcome 6 Completion of training All competencies acquired Recommendation for award of CCT or completion of F2 Outcome 5 An outcome 5 is an award that is made when there is incomplete evidence presented to an ARCP panel This is only intended to be an outcome that is used in the short term. When an outcome 5 is given a clear plan should be made to review additional documentation within a specified timeframe There is no need for the panel to reconvene to issue a further outcome as long as the plan is followed. If the plan cannot be followed it may be necessary for a panel to be reconvened. Outcome 6 An outcome 6 is awarded when a trainee successfully completes a training programme. An outcome 6 cannot be awarded until all the competencies specified in a curriculum have been achieved. It is the recommendation of the panel that a CCT should be awarded or that foundation training has been completed

Outcomes Outcome 7 Outcomes awarded to LAT Competencies achieved should be documented Not applicable to foundation trainees Outcome 8 For trainees on OOPT/R/C Outcome 7s are used to assess trainees in Locum Appointment for Training posts. The competencies that are achieved in these posts should be clearly documented. Outcome 7s are not used in foundation programmes. Outcomes 8s are reserved for trainees who are out of programme.

U and N Codes Explanatory codes used to explain an outcome or the absence of an outcome Provides further information regarding reasons for outcome awarded U codes used to provide further information regarding the award of an unsatisfactory outcome (2,3,4 or 5) N codes used when trainee not assigned any outcome In addition to numerical outcomes explanatory codes (known as U and N codes) are also used They explain the award of an unsatisfactory outcome or when an award is not made U codes are therefore used to provide further information regarding the award of an outcome 2, 3, 4 or 5 N codes are used to explain the reasons for not assigning an outcome These codes provide additional information to the GMC who collate ARCP outcome data on a national basis

This flow chart, taken from the foundation programme, highlights the use of outcome numbers and codes. A trainee at the end of F1 making satisfactory progress is awarded an outcome 1 and is able to progress to the second foundation year. Satisfactory completion of the second foundation year results in the award of an outcome 6 and trainees then would be able to progress to either core or specialty training. When a trainee has failed to achieve the required competences then an unsatisfactory outcome is awarded. For foundation trainees these are outcomes 3,4 or 5 as outcome 2s are not used in foundation programmes. In addition to the unsatisfactory outcome a U code or codes should also be used to explain the reasons for the award of the outcome.

Revalidation Information from the ARCP process supports the RO’s recommendation to GMC Trainees receive full GMC registration at the end of Foundation Year 1 All trainees will receive a revalidation recommendation from the RO Five years after gaining full GMC registration On applying for CCT (under review) With introduction of revalidation for registered medical practitioners in the United Kingdom the ARCP has taken on an additional role, with the information obtained supporting the recommendation for revalidation by the responsible officer to the GMC. Trainees receive full registration at the end of the first foundation year. Subsequently all trainees will receive a recommendation from the responsible officer on two occasions The first of these is five years after gaining full registration. The second is when a trainee applies for CCT, although this is under review.

Revalidation For all trainees the Responsible Officer (RO) is the Postgraduate Dean The ARCP needs to equate to an enhanced NHS appraisal The full scope of a doctor’s practice needs to be considered Self declaration on enhanced Form R Fitness to practice concerns will be obtained from employers The Responsible Officer for all trainees is the post graduate dean and the dean will make a recommendation to the GMC regarding revalidation. This recommendation is independent of the outcome awarded by the ARCP panel. In order that the responsible officer can make informed recommendations to the GMC the ARCP must equate to an enhanced NHS appraisal. The ARC panel is only required to state whether there are any unresolved concerns about a doctors fitness to practice from the information available on the day for the period of time under review. The responsible officer may undertake additional investigations but will make their recommendation to the GMC based on up to 5 ARCPs. The full scope of a doctor’s practice needs to be considered and not only those related to the training programme. This includes locum work and voluntary work for example at sports events. The enhanced form R which now needs to be submitted as part of the documentation for ARCP is a self declaration by the individual trainee. Where there have been specific concerns over clinical practice and fitness to practice employers should provide documentation regarding these concerns through exception reports. If these are unresolved the ARCP panel should note this by ticking the ‘cause for concern’ box on the ARCP form. This will direct the RO towards further review.

On the Day Review E-portfolio for outstanding issues Check all submitted documentation for educational progression Review enhanced form R – if not available the trainee must be awarded an outcome 5 Chair to Review employer exception report if employer exit report identifies an unresolved matter On the day of the ARCP the panel has a number of tasks. An ARCP does not take place in isolation and is an annual review of progression. It is therefore important that the trainees E-portfolio is reviewed to ascertain whether there are any outstanding issues. The panel should then review all submitted documentation for education progress In support of the revalidation process the enhanced form R should be reviewed and ARCP outcome form completed accordingly. If this form is not available the trainee must be issued with an outcome 5 even if all other submitted documents are complete and would enable the panel to issue another ARCP outcome. Where employers have submitted exception reports the panel chair should review these to identify if there are any unresolved issues.

On the Day Agree ARCP outcome to be awarded and ensure recorded in e- portfolio / on enhanced ARCP form Agree recommendation to RO – no cause for concern or cause for concern recorded on enhanced ARCP form Check for absence since last ARCP Review and amend CCT date as necessary Discuss remedial plan if required Agree date of next assessment The agreed ARCP outcome should be recorded either on the enhanced ARCP form or within the trainees e-portfolio. In addition the panel must agree what recommendation they will make to the responsible officer. This is either that there are no causes for concern or there is cause for concern. Where there is cause for concern the reasons for this must be clearly documented on the enhanced ARCP outcome form. The panel musts also review whether the trainee has had significant absence that will have impacted on training since they were last reviewed. Absence in excess of 14 working days may result in a change to CCT date. If required the expected CCT date should be amended and the amended date recorded. For trainees awarded an unsatisfactory outcome a remedial plan should be discussed Finally for all trainees the date of the next assessment should be agreed.

We hope that the information presented in this podcast will help guide you through the ARCP process and revalidation but please visit our website, where information on e-learning tools and dates for training courses may be available.