Health Education England’s Deans
Position Statement: ARCP feedback to trainees
Annual Review of Competency Progression (ARCP) is the means by which doctors in postgraduate training are reviewed each year to ensure that they are offering safe, high quality patient care, and to assess their progression against standards set down in the curriculum for their training programme. It is also the means by which their full scope of work review is undertaken to satisfy revalidation requirements.
Following extensive engagement with trainees, the Royal Colleges and Faculties, GMC, Educational Supervisors, amongst others, and a call for evidence, HEE published Enhancing training and the support for learners: Health Education England’s review of competence progression for healthcare professionals, in February 2018, which recommended changes to improve the assessment experience.
Recommendation 5 from that report was:
Formative feedback is crucial to empower trainees. As per the Gold Guide, ARCP decisions should be made in absentia. Therefore, post-ARCP feedback, including recognition of the achievements of those performing well, should be offered to all trainees in a timely and supportive process.
This position statement seeks to clarify the operational arrangements regarding the provision of feedback to trainees obtaining satisfactory outcomes.
ARCP feedback to trainees
Post-ARCP feedback should be offered to all trainees in a timely and supportive way which minimises the need for trainees to take protracted time away from service and removes the need for additional discussion panels to be set up.
There is a range of options available to support this, for example:
- Remotely through ARCP outcome letters or via trainees being directed to the eportfolio ARCP outcome section, with planned follow up and with a clear feedback discussion at the trainee’s base
- Locally delivered through, for example, feedback from the educational supervisor ensuring trainers are also informed of trainee outcomes in a timely way
- For outcomes other than 1 or 6 the trainee could meet one, or sometimes two, experienced member of the Training Committee
Annual Review of Competence Progression (ARCP): Supporting guidance on the provision of feedback to trainees.
The ARCP process is conducted in accordance with The Gold Guide. The HEE Deans position statement, to which this document is an addendum, sets out the agreed interpretation of both the Gold Guide and the 2018 review.
The key aspects of the position statement are that:
- ARCPs should be made ‘in absentia’
- Post ARCP feedback should be offered to all trainees in a timely and supportive process
This requires a transparent process to ensure that the ARCP outcome is not a surprise to a trainee:
The Gold Guide stipulates:
- The educational supervisor must write a report that is discussed with the trainee prior to the ARCP (paragraph 4.56 & 4.57 GG8);
- Where the TPD, educational supervisor or named academic supervisor has indicated that there may be an unsatisfactory outcome through the ARCP process (Outcomes 2, 3 or 4), the trainee should normally be informed of the possible outcome prior to the panel meeting. After the panel has considered the evidence and made its judgement, if an unsatisfactory outcome is recommended, the trainee must meet with either the ARCP panel or a senior educator involved in their training programme at the earliest opportunity (paragraph 4.83 GG8)
Post ARCP Feedback to Trainees
The position statement provides guidance as to systems that should be in place to provide feedback to trainees confirming the outcome of their ARCP. Given no outcome should be a surprise.
- For an outcome 1 or 6, this would be limited to written confirmation of the outcome referenced in the ARCP documentation, with educational support being provided by the Educational Supervisor.
- For outcomes other than 1 or 6, provision is made for a subgroup of the panel or a senior educator to meet the trainee. This should include 1 or 2 members of the panel as a maximum. Head of School or Training Programme Director should determine how this is provided.
- The Education programme management team will support the TPD and HoS in providing feedback to those trainees receiving an unsatisfactory outcome
It is a view widely expressed among senior trainers in the South West that the personal meeting between the trainee and the panel members which occurs at around the time of the ARCP is greatly valued by them and by trainees, for example, for careers discussions, consideration of the CV, or the raising of other opportunities.
Owing to the geography of the region it may be the only time such a meeting occurs.
It is therefore important that we maintain the positive aspects of the process whilst complying with the requirements of The Gold Guide.
If a School / Training Programme would like to offer a meeting with the Training Programme Director or Senior Educator after the ARCP panel has made its judgement:
- The meeting is not mandatory other that for an unsatisfactory outcome
- This is not a meeting with the panel and should be a 1:1 discussion with the Training Programme Director or a senior educator involved in the training programme
- There should be the option for the trainee to either Skype or telephone into the meeting minimising the need to take protracted time away from service
- The invitation should clearly define the purpose of the meeting. This may include discussion around future placements, special interests, feedback on placements etc.
- As noted, programme team support will only be provided for meetings with trainees receiving feedback about an unsatisfactory outcome
Additional points about ARCPs
The outcome is the decision of the panel.
Deaneries must not add their own requirements to ARCP that are not included within the curriculum such as mandatory trust training, CVs, completion of the GMC survey, or ad-hoc rules about exam passes. Whilst these are undoubtedly important aspects of professional life their inclusion leads to inevitable national variation.
In addition, all new members of the ARCP panel must have training in the ARCP process and are recommended to undertake training every 3 years (paragraph 4.65).
Regular training is provided by HEESW in the form of the popular masterclasses, ARCPs on the Edge and Advancing the ARCP. Details and dates for these can be found on the website or by contacting faculty development teams. Panel members need to have up to date equality and diversity training (every 3 years).
What should happen next?
Heads of Schools need to consider what changes need to take place in accordance with this guidance. Schools may be helped by their own Royal College response to the ARCP review. We are also attaching some frequently asked questions which may help (appendix 1) and circulating with permission the suggestions put forward by Roger Langford on behalf of the School of Anaesthetics (appendix 2). We will be pleased to help where possible but hope that each school can devise a plan ready for the ARCPs for the forthcoming summer of 2020.
With many thanks for your support of this process.
Sarah Huline-Dickens, Jeremy Langton, Geoff Wright, Neil Squires and Geoff Smith
SHD version 5
Appendix 1: Q & A
What if a trainee looks unlikely to achieve an outcome 1?
They should be informed of this by their educational supervisor in advance of the ARCP panel meeting and given feedback after the ARCP panel in a timely and supportive way to devise an action plan. This meeting is not part of the ARCP but is (post) ARCP feedback.
What if the trainee is doing really well?
They will be informed of this by the educational supervisor, or a member of the panel and given feedback including recognition of achievements.
What opportunities can trainees have to meet senior educators on their training scheme?
There are many opportunities for meeting trainees not related to the ARCP, such as at specialty training committees, education days, and teaching days.
Are there any circumstances in which the whole panel would meet with a trainee?
No, the ARCP review and position statement specifically states that feedback by the panel should be through a meeting with 1-2 members of the panel and the trainee, in the event of a non-standard / unsatisfactory outcome.
What happens about PYAs (penultimate year assessments) in medicine?
It is not envisaged that there will be any changes to these face to face meetings as they are mandated by the Royal College, however the face to face component should be with the external PY assessor rather than the whole panel.
What counts as standard or non-standard?
A standard outcome is a 1 or a 6. Non-standard is everything else, including outcome 8s (OOP)
What is meant by satisfactory or unsatisfactory?
A satisfactory outcome is a 1 or a 6. Outcomes 2, 3 or 4 are unsatisfactory, triggering a ‘U’ classification specifying the reason for the outcome. The term ‘adverse’ should not be used.
Which aspect of the process should a lay rep or external rep attend?
The lay rep or the external rep should be present at the ARCP panel meeting where the decision is made about the outcome (and the trainee is not present).
SHD version 5
Appendix 2: Example from possible plan for ARCPs in 2020 for anaesthetics
courtesy of Dr Roger Langford
- There are two ARCP evaluation stages: Paper (3rd week of June) or Face to Face (F2F) (1st week of July)
- ES meets with the trainee and completes the report by the 1st June. A set deadline date for all will make the whole process much clearer for all.
- Any trainee identified by the ES as having completed all necessary requirements for progression will go straight to the paper ARCP group. They should be asked if they would like to attend a careers/ rotation progression discussion with their TPD/HoS at this point. (This might be useful to discuss OOP, career direction, CV etc).
- Any trainee about whom the ES has concerns- particularly with structured feedback or any other issues -should be flagged by the ES/CT before report submission and the chair of the panel/assessments TPD should be informed. The next step will be based on the outcome of this discussion: Trainees will either be allowed to progress to the paper ARCP stage or will be asked to attend F2F ARCP.
- Paper ARCPs will be held over 1 or 2 consecutive days in the 3rd week of June. It should be a quick process by the panel unless any irregularity is discovered. Any trainee deemed not to have an outcome 1 will be asked to attend the F2F ARCPs (I would anticipate this number to be very few if the ES has done their job properly). This minority will be told their projected outcome beforehand.
- F2F ARCPs will be held in the first week of July (in case of any amendments required for the next stage of training). These will be given to any trainees identified in the paper stage without an outcome 1 and any trainee identified by the ES as requiring an adverse outcome.
- A further meeting in July should be set up for any trainee requesting a careers-type meeting. This may be given on the same day as the F2F ARCPs (which would be allowed as it is separate to the ARCP process).