Crammer's Corner
GP at the Fern Hill Practice, Faringdon, UK and RCGP Curriculum Development Fellow
E-mail: ben.riley{at}nhs.net
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Abstract |
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 TOP Abstract Reviews during trainingSix-monthly reviewsThe final reviewAnnual Review of Competence...The ARCP PanelThe minimal evidence requirement |
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Each month, Crammer's Corner features information and practical advice to help you learn the core knowledge and skills described in the RCGP curriculum and prepare for the new MRCGP assessments.
This month, Crammer's Corner focuses on the regular reviews that every GP Specialty Registrar must undertake during training, including the six-monthly reviews as part of Workplace-Based Assessment (WPBA) and the role of the Annual Review of Competence Progression (ARCP) Panel.
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Reviews during training |
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TOPAbstractReviews during trainingSix-monthly reviewsThe final reviewAnnual Review of Competence...The ARCP PanelThe minimal evidence requirement |
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The evidence collected in your ePortfolio is reviewed at six-monthly intervals throughout your whole 3-year Specialty Training programme, and there is a holistic final judgement of your competence to practice independently at the end of training.
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Six-monthly reviews |
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TOPAbstractReviews during trainingSix-monthly reviewsThe final reviewAnnual Review of Competence...The ARCP PanelThe minimal evidence requirement |
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Every 6 months throughout your GP Specialty Training period, your progress is assessed by your Educational Supervisor (local arrangements vary and your Educational Supervisor may be your GP Trainer, Training Programme Director or another nominated individual) against each of the 12 competency areas of WPBA (see Crammer's Corner 5 for more information on these areas). The review is informed by the evidence collected by the WPBA tools [such as the Mini-CEX, Case-Based Discussions (CBD), Multi-Source Feedback (MSF), Patient Satisfaction Questionnaire (PSQ)] and by any ‘naturally occurring’ evidence. A Clinical Supervisors Report (CSR) is also required every 6 months, regardless of the length of your posts.
Before each of the six-monthly reviews, you conduct a self-assessment and, following the review, a learning plan will be agreed. Both of these are recorded in your ePortfolio.
The six-monthly reviews provide you with an important opportunity to consider the breadth of coverage you have achieved across the GP curriculum as a whole. The structured way of recording and reviewing evidence in the ePortfolio is intended to highlight the areas where you are making good progress as well as those areas where more learning and support are required. This allows your training programme to be adjusted accordingly, the aim being to address any problems well before you reach your final review at the end of training.
At every review, the GP Specialty Registrar is always judged against the level of performance expected of a doctor certified to practice independently as a general practitioner. This standard is used as the benchmark throughout all 3 years of training. This means that you are always being judged against the standard you should have reached at the end of training. It is not expected, therefore, that a GP Specialty Registrar will be able to demonstrate this standard in the earlier stages, and so further developmental needs should be identified at your reviews. Detecting these needs, and planning your training accordingly, is what the WPBA system is designed to do, so that training experiences can be targeted at the individual developmental needs of each trainee.
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The final review |
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TOPAbstractReviews during trainingSix-monthly reviewsThe final reviewAnnual Review of Competence...The ARCP PanelThe minimal evidence requirement |
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Towards the end of GP Specialty Training (usually at about 34 months), a final summative review is conducted, this time without the self-assessment phase. Your Educational Supervisor will then make a recommendation to the local deanery regarding your overall competence. This recommendation is subject to external moderation in the deanery by the ARCP Panel.
| What if I fail my final review? To gain your Certificate of Completion of Training (CCT) for general practice, you must complete all three components of the new MRCGP (the AKT, CSA and WPBA). Until you complete all of these successfully, your local deanery ARCP Panel cannot recommend that you are competent to work independently as a GP. In the past, deaneries have funded additional training for up to 6 months for GP trainees who need additional training, and there are currently no plans to change this general approach. How long an individual trainee's training would need to be extended for depends on their educational needs and on the timing of any individual components of the new MRCGP that may need to be retaken.
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Annual Review of Competence Progression |
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TOPAbstractReviews during trainingSix-monthly reviewsThe final reviewAnnual Review of Competence...The ARCP PanelThe minimal evidence requirement |
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The ARCP is a formal deanery process that scrutinizes whether each GP Specialty Registrar is suitable to progress to the next stage of training, or, at the end of the Specialty Training period, is suitable for independent practice. The process is carried out by an ‘ARCP Panel’, made up of educators, experts and various representatives. The ARCP Panel is not in itself assessing each trainee's clinical and professional competence but is conducting an evaluation of the evidence presented in that trainee's ePortfolio to check that the required assessments have been completed appropriately.
The ARCP process is carried out each year to check that each trainee is acquiring the necessary curriculum competencies and experiences and that he or she is managing to do this at an appropriate rate. It also provides the deanery with an ongoing record of every trainee's progress. This helps to identify posts where training opportunities are poor and ensures that the ultimate aim of GP training to become an independent GP is kept in focus throughout the whole 3-year training period.
The ARCP process should be undertaken at least annually for all GP Specialty Registrars. The date of the ARCP Panel is set by each local deanery (not the RCGP) that should communicate this date to their trainees at least 6 weeks in advance. Extraordinary ARCP Panel meetings may be set up by the deanery at any time if there are trainees with particular issues which need to be addressed. The RCGP, through its representative on the ARCP Panel, monitors the quality of training being delivered by local training programmes and posts, gathers feedback on the curriculum and gains an overview of how GP training is being managed across the UK.
Further detailed information on the ARCP process can be found in the Guide to Postgraduate Specialty Training in the UK (known as ‘The Gold Guide’, June 2007, First Edition), which is available online at: www.mmc.nhs.uk. The Gold Guide regulations require that trainees should be given at least 6 weeks’ notice of the date of the ARCP Panel (paragraph 7.44).
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The ARCP Panel |
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TOPAbstractReviews during trainingSix-monthly reviewsThe final reviewAnnual Review of Competence...The ARCP PanelThe minimal evidence requirement |
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So who sits on the ARCP Panel? The members are appointed by the local deanery and are likely to include:
- Postgraduate Dean or deputy
- Associate Directors/Deans
- Programme Director
- Chair of the Specialty Training Committee
- RCGP representatives
- Educational Supervisors
- Academic representatives (for academic programmes)
- A representative from an employing authority (e.g. Hospital Trust)
- Laypersons
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The minimal evidence requirement |
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TOPAbstractReviews during trainingSix-monthly reviewsThe final reviewAnnual Review of Competence...The ARCP PanelThe minimal evidence requirement |
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The ARCP Panel bases its judgements on the evidence of performance recorded in your ePortfolio during the period since your last review and the direct observations of your trainer/clinical supervisor. If you have not recorded a minimal amount of evidence in your ePortfolio to demonstrate your performance as a developing GP, it will be difficult for the Panel to make a reasonable judgement about your progress and they may be unable to recommend that you should continue or complete your training.
A timetable of the minimal evidence required at each stage of GP Specialty Training has been defined by the Postgraduate Medical Education and Training Board (PMETB), and this evidence must be available in the ePortfolio in time for the ARCP Panel meeting. For example, in ST3 this includes 12x Consultation Observations, 12x CBD, 1x MSF and 1x PSQ and the eight mandatory Direct Observation of Procedural Skills. The schedule of evidence is available on the RCGP Curriculum and Assessment website: www.rcgp-curriculum.org.uk
There is also evidence recorded through direct observation of the trainee by the trainer in primary care and the CSR in Secondary care.
| What is the minimal evidence requirement? Case-Based Discussions:
Consultation Observation in primary care or Mini-CEX in secondary care:
Direct Observation of Procedural Skills:
Multi-Source Feedback:
Patient Satisfaction Questionnaire:
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It is one of the Specialty Registrar's own responsibilities, as a professional adult learner, to ensure that the evidence in his or her ePortfolio is ready in time for the ARCP. Be aware that in the ST3 year, the final ARCP Panel sits about 2 months before the end of your training period (at around 34 months rather than 36), to allow time for CCT to be processed. For a Specialty Registrar starting in August, this means that all the required assessments and evidence need to be collected by the end of May or early June at the latest.
Because the timetable approved by PMETB describes the ‘minimum’ amount of evidence required in the ePortfolio, part-time and flexible trainees are also required to submit this same amount of evidence. It is expected that full-time trainees should be able to post ‘more’ than the minimum amount of evidence, so it is important to get into the habit of recording naturally occurring evidence on a daily basis and to build sufficient time to undertake the formal assessments into your learning plans at an early stage. There is no question that the assessments involve a lot of work and need careful attention—proving you are competent to become an independent GP is now a tough business!
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