Introduction
Scope of the Policy
Frequency of the ARCP
Panel Objectives
Composition of the ARCP Panel
Collecting the Evidence
How the Panel Works
Outcome from the ARCP
Additional or Remedial Training
Review of Outcome 2
Appealing Outcome 3 and Outcome 4

Appendix 1 - ACRP Process Flowchart
Appendix 2 - Management Flowchart for REview of Outcome 2~
Appendix 3 - Management Flowchart for Appeal Against Otucomes 3 and/or 4
Appendix 4 - Management Flowchart for Outcome 5 (Incomplete Evidence)
Appendix 5 - Management Flowchart for Outcome 2 (Development of specific competencies required - additional training time not required)
Appendix 6 - Management Flowchart for Outcome 3 (Inadequate progress by the trainee - additional training time required)
Appenidx 7 - Management Flowchart for LAT/FTSTA Trainees

Introduction

Postgraduate Doctors in training are required to undertake an Annual Review of Competence Progression (ARCP) to demonstrate that they have obtained the necessary competencies to move to the next stage of their training.

The Annual Review Process is a formally defined process within the curriculum in which a trainee’s progress in the training programme is assessed and measured using a range of defined and validated assessment tools, along with professional and triangulated judgements about the trainees’ rate of progress.

Scope of the Policy

The ARCP process is applicable to all trainees who are in a training post within South West Peninsula Postgraduate Medical Education. This includes

Core Trainees (CT)
Specialty Trainees (ST)
General Practice Specialty Trainees (GP ST)
Locum Appoint for Training (LAT)
Fixed Term Specialty Training Appointment (FTSTA)
Trainees in combined Clinical and Academic training (ACF, CL)
Flexible Trainees (CT, ST, LAT)
Trainees on Out Of Programme (OOP)

Specialist Registrars who were appointed to the training programme prior to 2007 should continue to follow the ‘Orange Book – A Guide to Specialist Training in the UK’ and the associated RITA policy.

Frequency of ARCP

All trainees in a training post (as defined by 2.1) will be required to undertake the ARCP process on an annual basis

The trainees ARCP can be conducted more frequently if there is a concern regarding trainee progression within the training programme outside of the annual review.

Panel Objectives

The panel has two objectives (Gold Guide, 7.50):

to consider and approve the adequacy of the evidence and documentation provided by the trainee;
provided that adequate documentation has been presented, to make a judgement about the trainee’s suitability to progress to the next stage of training or confirm training has been satisfactorily completed.

Composition of the ARCP Panel

The composition of the panel must comply with the Gold Guide, Section 7.51 – 7.56.

The panel should consist of a minimum of three panel members appointed by the training committee or equivalent group, one of which must be the Postgraduate Dean (or nominated deputy) or a Training Programme Director. Other appropriate members include:-

Chair of Specialty Training Committee
College / Faculty representative
Educational Supervisors
Associate Deans

The panel should have input from a lay member and external trainer who should review at least a random 10% of the outcomes and supporting evidence and any recommendations from the panel about concerns over progress.

Where academic training is also being assessed there should be two academic representatives present on the ARCP panel, neither of whom should be involved with the trainee’s academic programme.

Where it is likely that the trainee will receive an unsatisfactory outcome requiring an extension to the indicative time for completion of the training programme, the Training Programme Director should inform the relevant School Manager to enable, where possible, the Postgraduate Dean (or nominated deputy) to attend the panel.

Collecting the Evidence

Trainees will be given at least six weeks notification of the date of their ARCP. This will allow sufficient time for trainees to obtain structured reports from their educational supervisors.

Documentation must be received at least two weeks before the date of the ARCP. Trainees will not be “chased” to provide the documentation by the required date but should be aware that failure to do so will result in the panel failing to consider their progress.

Trainees must submit, as part of their documentary evidence for each annual review, an updated Registration Form R, giving accurate demographic details for use on the database.

How the Panel Works

The ARCP is not an assessment of the trainee but an assessment of the documented and submitted evidence that is presented by the trainee.

The panel should systematically consider the evidence as presented for each trainee against the specialty curriculum assessment framework and make a judgement based upon it so that one of the outcomes is agreed.

Trainees should not be present while the panel consider the outcome of the assessment.

Trainees may be requested to be present on the day of the review to meet with the panel after their discussion of the evidence, if required to clarify information, and to discuss the next steps and their future training requirements.

Where the Training Programme Director, educational supervisor or academic supervisor has indicated there may be an unsatisfactory outcome (Outcomes 2, 3 or 4) the trainee must be informed prior to the panel of the possible outcome and must meet with the panel after the panel has considered the evidence and made its judgement.

Panels will consider the anticipated Certificate of Completion of Training (CCT) date, taking into account such factors as less than full time working; leave of absence from the programme due to research, career breaks or delays in achieving the required competencies as set out in the specialty curriculum.

Outcomes from the ARCP

The outcome of the ARCP will be recorded on the ARCP Outcome Form.

The panel will award one of the following outcomes for each trainee (Gold Guide, 7.50):

Outcome 1: Satisfactory Progress – Achieving progress and the development of competencies at the expected rate.

Outcome 2: Development of specific competencies required – additional training time not required.

Outcome 3: Inadequate progress by the trainee – additional training time required.

Outcome 4: Released from training programme with or without specified competencies.

Outcome 5: Incomplete evidence presented – additional training time may be required.

Outcome 6: Gained all required competencies – will be recommended as having completed the training programme and for award of CCT or CESR / CEGPR / CESR(CP) / CEGPR(CP).
Outcome 7.1: Satisfactory progress in or completion of the LAT / FTSTA.

Outcome 7.2: Development of specific competencies required – additional training time not required LAT / FTAT placement.

Outcome 7.3: Inadequate progress by the trainee – additional training time required LAT / FTSTA placement.

Outcome 7.4: Incomplete evidence presented – LAT / FTSTA placement.

Outcome 8: Out of programme

Note: OOPT must be an annual review and would therefore be reviewed under Outcomes 1 – 5.

Copies of the ARCP Outcome will be made available to the following bodies (Gold Guide, 7.67):

Relevant Royal College or Faculty
Training Programme Director
Educational Supervisor
Medical Director

The trainee must sign and return the copy of their outcome within ten working days which will be stored on the trainee’s personal files.

Where the documentary evidence provided is incomplete, no decision should be taken about the performance or progress of the trainee. The failure to produce timely, adequate evidence for the ARCP panel will result in an Incomplete Outcome (Outcome 5) and will require the trainee to explain to the ARCP panel the reasons for any deficiencies in the documentation. The ARCP panel should complete the supplementary documentation detailing additional evidence required and timescale for completion.

Where there is an unsatisfactory outcome (Outcomes 2, 3 or 4) the supplementary documentation for trainees with an unsatisfactory outcome report must be completed by the ARCP panel and made available to the parties listed in paragraph 8.3 above. The trainee must be given the right to appeal against an unsatisfactory outcome (refer to sections 10 and 11).

Outcome 2
Where a trainee is awarded an Outcome 2, the report must set out the specific competences the trainee must achieve and the timescales for this agreed with the trainee (Gold Guide, 7.61). The specific competences identified must be demonstrable and realistic objectives.

Outcome 3
Where a trainee is awarded an Outcome 3, an additional report indicating how a remedial programme will be delivered, the intended outcome and proposed timescales will be required (Gold Guide, 7.62).

The additional training must be agreed with the trainee, the employer and new trainers providing it. Full information about the circumstances leading to the additional training requirement must be transmitted to the employer, including any areas of weakness and any negative reports. The information will be shared with the trainee but agreement to it being shared with the employer and trainers is a requisite to joining the training programme (Gold Guide, 7.63).

Outcome 4
Where the trainee is given an Outcome 4, the trainee is released from the training programme if there is still insufficient and sustained lack of progress, despite having had additional training to address concerns over progress. The panel should ensure relevant competences achieved are documented. The trainee will be required to give up their National Training Number (Gold Guide, 7.70).

Additional or Remedial Training

The panel may identify the need for additional training time (Outcome 3 or 5) which will extend the indicative date for completion of the training programme. Specialty Trainees will be able to have additional aggregated training time of normally up to one year within the total duration of the training programme in the hospital specialties and normally up to six months in general practice because of the short duration of the training programme.

This may be extended at the discretion of the Postgraduate Dean, but with an absolute maximum of two years additional training during the total duration of the training programme (Gold Guide, 7.73).

The arrangements for progression as a core trainee are no different to those of other types of specialty training. The only exception given the short period and nature of core training will be to have additional aggregated training time normally of up to six months within the total duration of the training programme, unless exceptionally, this is extended at the discretion of the postgraduate Dean, but with a maximum of one year additional training during the total duration of the core training programme.

Review of Outcome 2

Trainees awarded an Outcome 2 have the opportunity to request a review whereby a group or individual who originally made the decision reconsider whether it was appropriate. Requests for such reconsideration must be made in writing to the chair within ten working days of being notified of the panel’s decision.

A further interview for the trainee (as far as practical with all parties of the annual review panel) should take place within fifteen working days of receipt from the request from the trainee.

The trainee may provide additional evidence at this stage which must be submitted at least five working days prior to the review taking place.

Trainees are not expected to be represented at a review of an Outcome 2 review; however they may be accompanied by a colleague or a representative of their professional body. The trainee should inform the relevant Manager of who will be accompanying them at least five working days before the review.

The decision of the panel following the review is final and there is no further appeal process.

Appealing Outcome 3 and Outcome 4

Trainees have the right to appeal if they receive an outcome which results in a recommendation for:

An extension of the indicative time to complete the training programme (Outcome 3) or
The trainee to leave the training programme with identified competences achieved, but without completion of the programme (Outcome 4).

Trainees will be asked to indicate at the annual review panel that they understand the panel’s recommendation. Appeals should be made in writing to the Postgraduate Dean within ten working days of the trainee being notified of the panel’s decision.

The appeal procedure has two steps:

Step 1: Discussion (Gold Guide, 7.125 – 7.126)

Provides for a discussion between the trainee, Regional Advisor within the relevant College and Training Programme Director. The purpose of this stage is to reach a common understanding of a trainee’s problems and decide on the best course of action.

An administrator will be present at the Step 1 discussion to make a written summary record of the discussion. The written summary will not be a written verbatim record of the discussion. The written record of the discussion including the decision reached will be given to the trainee.

Trainees are not expected to be represented at a Step 1 Discussion; however they may be accompanied by a colleague or a representative of their professional body. The trainee should inform the relevant Manager of who will be accompanying them at least five working days before the Step 1 discussion.

Step 2: Formal Appeal Hearing (Gold Guide, 7.127 – 7.134)

If a trainee does not accept the outcome of the Step 1 discussion they should inform the Postgraduate Dean in writing within ten working days of it.

Where the recommendation was for the trainee to be withdrawn from the training programme, a Step 2 hearing will automatically follow unless the trainee formally withdraws, in writing, from the programme at this stage. The Postgraduate Dean (or nominated deputy) should confirm the position in writing with the trainee where the trainee declines an appeal hearing.

The Postgraduate Dean (or nominated deputy) will convene an independent appeal panel, where possible, to take place within 15 working days of a request for a Step 2 appeal.

The membership of the panel should not include any of those involved in the discussions under Step 1, nor should it include any members of the original annual review panel.

The appeal panel should include:

Postgraduate Dean (or nominated deputy) as chair
College / Faculty representative
Two senior doctors from within Health Education South West at least one of which should be from outside the specialty
Senior trainee from a different specialty
Personnel representative from the employer or Health Education South West to advise the chair

An administrator will be present to make a written summary of the discussion and the decision made. A verbatim record will not be taken by the administrator.

Trainees have the right to be represented at the Step 2 appeal hearing. They may choose to be represented, for example, by a friend, colleague or representative of their professional body but this should not normally be a legal representative or family member. However, should a trainee wish to be represented by a lawyer a written request should be made to the appeal panel Chairman at least 10 working days before the hearing, the appeal panel Chairman should normally agree to their request. Legal representatives should be reminded that the appeal hearing is not a court of law and the panel governs its own procedure, including the questioning allowed of others by the legal representative. The trainee should inform the relevant Manager of their representative’s name and contact details at least five working days before the appeal hearing.

Trainee’s may support their appeal with further written evidence which must be submitted within 10 working days of the appeal panel hearing. ‘Live evidence’ will not be accepted.

The trainee and appeal panel members should be provided with the following documentation within five working days of the appeal panel hearing:

Trainee’s written appeal
Copies of evidence used at the original ARCP; i.e. Educational Supervisor’s report, report from Training Programme Director, assessments undertaken etc.
Notes of Step 1 discussion
Historical record of the trainee’s programme to date, including ARCP outcomes
Evidence submitted by trainee in support of their appeal

No new evidence will be permitted on the day of the appeal hearing.

Trainees will be notified in writing of the outcome of the appeal hearing. The appeal process described is the final internal avenue of appeal.

Implementation Date: 29th September 2010

Review Date: 28th September 2013