arcp policy - South West Peninsula Deanery

South West Peninsula Postgraduate Medical Education
Annual Review of Competence Progression (ARCP)

CONTENTS
SECTION
INTRODUCTION 1
SCOPE OF THE POLICY 2
FREQUENCY OF THE ARCP 3
PANEL OBJECTIVES 4
COMPOSITION OF THE ARCP PANEL 5
COLLECTING THE EVIDENCE 6
HOW THE PANEL WORKS 7
OUTCOME OF THE ARCP 8
ADDITIONAL OR REMEDIAL TRAINING 9
REVIEW OF OUTCOME 2 10
APPEALING OUTCOME 3 AND OUTCOME 4 11
APPENDIX 1
ARCP PROCESS FLOWCHART
APPENDIX 2 MANAGEMENT FLOWCHART FOR REVIEW OF
OUTCOME 2
APPENDIX 3
MANAGEMENT FLOWCHART FOR APPEAL AGAINST
OUTCOMES 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)
APPENDIX 7
MANAGEMENT FLOWCHART FOR LAT / FTSTA
Ratified by Dean’s Education Group 22 nd June 2010
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INTRODUCTION
1.1 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.
2. SCOPE OF THE POLICY
2.1 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)
2.2 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.
3. FREQUENCY OF ARCP
3.1 All trainees in a training post (as defined by 2.1) will be required to undertake
the ARCP process on an annual basis
3.2 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.
4. PANEL OBJECTIVES
4.1 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.
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5. COMPOSITION OF THE ARCP PANEL
5.1 The composition of the panel must comply with the Gold Guide, Section 7.51
– 7.56.
5.2 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
5.3 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.
5.4 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.
5.5 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.
6. COLLECTING THE EVIDENCE
6.1 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.
6.2 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.
6.3 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.
7. HOW THE PANEL WORKS
7.1 The ARCP is not an assessment of the trainee but an assessment of the
documented and submitted evidence that is presented by the trainee.
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7.2 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.
7.3 Trainees should not be present while the panel consider the outcome of the
assessment.
7.4 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.
7.5 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.
7.6 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.
8. OUTCOMES FROM THE ARCP
8.1 The outcome of the ARCP will be recorded on the ARCP Outcome Form.
8.2 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:
Outcome 4:
Outcome 5:
Outcome 6:
Inadequate progress by the trainee – additional training
time required.
Released from training programme with or without
specified competencies.
Incomplete evidence presented – additional training time
may be required.
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).
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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.
8.3 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
8.4 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.
8.5 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.
8.6 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.
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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).
9. ADDITIONAL OR REMEDIAL TRAINING
9.1 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).
9.2 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.
10. REVIEW OF OUTCOME 2
10.1 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.
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10.2 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.
10.3 The trainee may provide additional evidence at this stage which must be
submitted at least five working days prior to the review taking place.
10.4 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.
10.5 The decision of the panel following the review is final and there is no further
appeal process.
11. APPEALING OUTCOME 3 AND OUTCOME 4
11.1 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).
11.2 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)
11.3 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.
11.4 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.
11.5 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
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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)
11.6 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.
11.7 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.
11.8 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.
11.9 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.
11.10 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.
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11.12 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.
11.11 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.
11.12 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: 29 th September 2010
Review Date: 28 th September 2013
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Appendix 1
ARCP Process Flowchart
School Manager requests dates of ARCP from TPD
School Administrator emails all trainees in the relevant specialty the date of
the ARCP.
Trainee is not chased to
provide documentation.
School Manager E-Mails Training Programme Director (TPD) to ask for
identification of any doctors who may receive an Unsatisfactory outcome.
School Administrator collates all paperwork including additional reports for
doctors who may receive an Unsatisfactory outcome.
Trainee MAY NOT be
required to attend if
Satisfactory.
No concerns Identified.
Concerns Identified.
Trainee MAY NOT
be required to attend
ARCP Panel.
Trainee required to attend
ARCP Panel.
Educational Supervisor to provide structured report (Gold Guide 7.35) which
must be received no less than two weeks before the ARCP Panel.
Evidence provided. Trainee should be given the opportunity to respond.
Consider whether trainee needs to be informed of possible outcome of their
assessment. A senior member of the LETB to attend ARCP.
School Administrator prepares ARCP panel bundle of documents /
e-portfolio / learning log.
ARCP Panel Sits.
Panel can reach a decision.
Panel cannot reach a decision.
Outcome 5
Outcome
1, 6, and 8
Satisfactory
Outcome
Outcome 2
Additional
report
required
detailing
specific
competences
and timeline
Outcome 3
Additional
report required
detailing
intended
remedial
training and
timeline.
Outcome 4
Trainee will be
released from
training
programme.
Inform
employer
Outcome 7
For details on
outcome 7’s
please refer to
the table in the
Gold Guide 2010
page 70
Incomplete
evidence
presented. A
further review
date will be
agreed to review
additional
evidence.
Complete outcome report and send to trainee, Training Programme Director, Educational Supervisor, Medical Director,
Director of Medical Education and College Tutor. Place copy on file and e-portfolio.
Trainee to sign and return within 10 working days.
If awarded outcome 2 please refer to Appendix 2 / If awarded an outcome 3 or 4 please refer to Appendix 3
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The opportunity of a
meeting with an Associate
Postgraduate Dean is given
to the trainee in order for
the LETB to offer any help
and support if required

Appendix 2 Management Flowchart for Review of Outcome 2
Outcome 2
Development of specific competencies
(Additional training time not required)
Trainee accepts
decision and begins
period of targeted
training
Trainee does not accept outcome/award
Trainee must make a written request for a
review to the Chair of ARCP Panel within 10
working days of the decision
A review of the decision should take place
within 15 working days of the request
Trainee submits any additional evidence no
less than 5 working days prior to the review
Decision reached.
Notes of discussion sent to trainee
No further right of appeal
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Appendix 3
Management Flowchart for Appeal Against Outcomes 3 and
/ or 4
Outcome 3
Outcome 4
Set out
timeframe
Trainee accepts
decision and begins
period of intensified
training
Trainee accepts
decision and is
released from training
programme
Trainee does not accept decision and
appeals in writing to the Post Graduate Dean
within 10 working days of the decision
Step 1
Discussion to reach common understanding
of trainee’s problems and best course of
action
Outcome 4
Trainee accepts
outcome of Step 1 and
begins period of
intensified training
Outcome 3
Trainee does not accept outcome of Step 1
Trainee to meet with an
Associate Postgraduate Dean in
order for the LETB to offer any
help and support if required
Outcome 3 Outcome 4
Trainee appeals
in writing to the
Postgraduate
Dean within 10
working days
Automatic
progression to
Step 2
Step 2
Appeal hearing arranged, where possible,
within 15 working days of written request for
appeal
Trainee submits evidence in support of their
appeal at least 10 working days prior to appeal
hearing
Documentation sent to appeal panel and
trainee within five working days of appeal
hearing
Appeal hearing
Decision reached
Notes of hearing sent to trainee
No further right of appeal (internally)
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Appendix 4
Management Flowchart for Outcome 5 (Incomplete
Evidence)
Outcome 5
(Incomplete Evidence Presented)
Additional evidence
received
A further review date agreed to review
additional evidence.
No additional
evidence received
Evidence Satisfactory
Outcome 1 awarded
Evidence
Unsatisfactory or
Incomplete
Outcome 2 Outcome 3 Outcome 4
Trainee begins
period of targeted
training
Trainee begins
period of intensified
training
Trainee released
from programme
Trainee does not
accept outcome and
requests a review.
Refer to Appendix 2
Trainee does not
accept outcome and
appeals decision.
Refer to Appendix 3
The opportunity of a
meeting with an Associate
Postgraduate Dean is
given to the trainee in
order for the LETB to offer
any help and support if
required
Trainee to meet with an
Associate Postgraduate
Dean in order for the LETB
to offer any help and
support if required
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Appendix 5
Management Flowchart for Outcome 2 (Development of
specific competencies required – additional training time
not required)
Outcome 2
Development of specific competencies
(Additional training time not required)
Additional report required detailing specific
competences and timeline. Must be
demonstrable & realistic.
New review date set in line with timeline
agreed above.
Evidence Satisfactory
Outcome 1 awarded
New Review
Evidence
Unsatisfactory
Outcome 2
Outcome 3 Outcome 4
Trainee begins
period of targeted
training
Trainee begins period
of intensified training
Trainee accepts
decision and is
released from training
programme
Trainee does not
accept outcome and
requests a review.
Refer to Appendix 2
Trainee does not
accept outcome and
appeals decision.
Refer to Appendix 3
Trainee to meet with an
Associate Postgraduate
Dean in order for the LETB
to offer any help and
support if required
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Appendix 6
Management Flowchart for Outcome 3 (Inadequate
progress by the trainee – additional training time required)
Outcome 3
Inadequate progress by the trainee –
additional training time required
Additional report required indicating how a remedial programme will be delivered, the
intended outcome and proposed timescales. This information is to be shared with the
trainee, employer and trainers.
New review date set in line with timeline
agreed above.
Evidence
Satisfactory
Outcome 1
awarded
New Review
Evidence
Unsatisfactory
Amend CCT or
completion of Core
Training date
Outcome 2
Outcome 3 Outcome 4
Trainee does not
accept outcome and
requests a review.
Refer to Appendix 2
If most, but not all,
targets have been
achieved an outcome 2
may be appropriate
Trainee begins second period
of intensified training, the
totality of which should not
exceed 12 months (6 months
for core trainees) without
agreement of the PG Dean or
deputy
Trainee does not
accept outcome and
appeals decision.
Refer to Appendix 3
Trainee accepts
decision and is
released from
training
programme
The opportunity of a
meeting with an Associate
Postgraduate Dean is
given to the trainee in
order for the LETB to offer
any help and support if
required
Trainee to meet with an
Associate Postgraduate
Dean in order for the LETB
to offer any help and
support if required
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APPENDIX 7
Management Flowchart for LAT / FTSTA Trainees
Fixed-term Specialty Training
(LAT or FTSTA)
Outcome 7.1
(Satisfactory
progress in or
completion of LAT /
FTSTA)
Outcome 7.2
(Development of specific
competences – additional
training time not required)
Outcome 7.3
(Inadequate progress by the
trainee)
Outcome 7.4
(Incomplete evidence
presented)
Trainee does not accept
outcome/award.
(Refer to management
flowchart for Review of
Outcome 2)
Trainee
accepts
decision
Trainee does not accept
outcome/award.
(Refer to management
flowchart for Appeal of
Outcome 3)
Trainee
accepts
decision
Refer to
management
flowchart for
Outcome 5.
Panel to specifically identify in
writing further development
required.
Trainee required to repeat
training, not necessarily in the
same post or LETB.
Next Review to assess
whether competences met
(maybe at another LETB)
Failure to provide evidence
will mean that the period of
training cannot count towards
CCT, CESR or CESR (CP).
Evidence
satisfactory
Evidence
unsatisfactory
Outcome 7.1
(Satisfactory
progress in or
completion of LAT
/ FTSTA)
Outcome 7.3
(Inadequate progress by
the trainee)
As these posts are for a fixed tenure, no
trainee requiring remedial training will
have their training contract extended as a
result of an unsatisfactory outcome at their
ARCP.
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