1 ARCP advice for Panel MembersDrs. Ramesh Mehay, Paul Johnson & Mike Tomson

Intro & Help

Preparation at Home There will be preparation for each ARCP assessor before the meeting. You

will basically be given 4-5 trainees to assess at home. This means logging into their ePortfolios and determining whether they are making progress.

This document provides detailed guidance for a form called ‘ARCP checklist in 5 steps’ - which tells you exactly what to look for in the ARCP review.

Your ARCP review of each eP should only take 30 minutes – 1 hour. Probably 1 hour if you’re a newbie, but you will speed up as you become more familiar. Remember to slow down if you start sensing areas for concern.

Please note down any areas which are unsatisfactory or for which there is missing evidence. Use the ARCP Checklist in 5 Steps form to record this information. The panel chair will ask you for specifics on the day and this information will be fed back to the trainee and their GP educator(s).

We offer this help file “in your best interests”. We leave it for you to choose and use and we hope it makes your training life a lot easier

More ARCP resources are available at: www.bradfordvts.co.uk

Just click on the ‘Ed Sup/ARCP’ Link.

If you have any concerns or feel confused about any aspect of ARCP assessment, please get in touch with your ARCP panel chair. The scheme administrator will tell you which panel you are on and who will be the panel chair.

ARCP stands for Annual Review of Competency Progression (an annual review to see whether trainees are progressing well towards competence). This formal review has to happen EVERY year AND before they move up an ST year. For most full-time trainees who have not taken any extra time out of training than is allowed – their ARCP can be orchestrated to happen just once a year to cover both things – an annual review and prior to an ST change. It gets more complicated when a trainee become part-time or has taken extended additional leave (like sick leave).

This document gives advice on what to look for in the review. Reviewing a trainee’s e-portfolio (for ARCP or ES) involves making qualitative judgments more than quantitative ones. We are not asking you to look for excellence. All we’re asking you is to determine whether there is ‘good enough’ evidence of satisfactory progression. Don’t lose sight of this.

These judgments need to be holistic too – so, if evidence for a particular competency is lacking in one part of the e-portfolio, check if it is lacking elsewhere; or perhaps it is demonstrated elsewhere! The WPBA is designed so that each professional competency is tested in a number of different places.

The ultimate question for the final ST3 is whether they are ready for independent practice. As the trainee progresses through training, the evidence of competence demonstrated and degree of readiness should gradually accumulate. The picture becomes clearer as more evidence is gathered – look at that big picture, determine whether the evidence is there and remember that ‘good enough is good enough’.

2 ARCP advice for Panel MembersDrs. Ramesh Mehay, Paul Johnson & Mike Tomson

3 ARCP advice for Panel MembersDrs. Ramesh Mehay, Paul Johnson & Mike Tomson

ARCP panel member trainingIf this is the first time you are an ARCP panel member, there are some prerequisites..

You should have been on an ARCP training workshop – contact your scheme administrator if you have not. These are usually Deanery-led and only happen a few times a year (at Autumn/Spring schools). All panel members (lay people & doctors) should do ARCP training every 3 years – unless you have ‘inherited rights’ through your wealth of experience in ARCP panelling.

You should also been on some Equal Opportunities training in the last 3 years – if not, do some online training: http://tinyurl.com/equalops

Please read this document in its entirety (and look at the ARCP checklist in 10 Steps assessment form).

Consider taking this MCQ to boost your confidence: http://tinyurl.com/panelmcq

Making notes for the ARCP Please use the ARCP Checklist in 10 Steps and follow it through. It can be

found at www.bradfordvts.co.uk (click ES/ARCP tab in top navigation menu). Fill this form in electronically and bring a copy on the day. Please send a

copy to the scheme’s administrator so that they can start collating feedback for the trainee.

If you make notes, remember to think about your wording. Your wording is important because

o It helps the panel to create SMART objectives against which progress will be measured and

o The final ARCP feedback is the thing that will be examined for clarity and reasonableness at appeal or in legal challenge.

2 main questions your review needs to answerThe role of the panel member is not to do ‘another’ ES type review – that would simply be too time consuming, unnecessary and it is not good duplicating work already done. Yes, you are quality assuring the ES report to some extent but the 2 main questions that need answering are:

1. Has this trainee met all the stipulated requirements AND2. Are they doing okay? (i.e. no major concerns)

And that’s really it.

We will use your assessment notes as a starting point to formulate the feedback we give to the trainee and their supervisors. The final ‘polished’ version will be done at or after the ARCP panel meeting.

4 ARCP advice for Panel MembersDrs. Ramesh Mehay, Paul Johnson & Mike Tomson

Most of the info for your ARCP review will be in the ES report.Most of the information for the ARCP review can be gleaned from the ES report. And as it’s all in one place, the review really shouldn’t take too long. You may have to dip into other areas of the ePortfolio to get a more informed opinion about the trainee, but again, you’re only dipping in to get a good enough flavour rather than doing a detailed analysis and review. Even if there are concerns your review shouldn’t take too long – because the bottom line is answering the two questions above. If the trainee has not met the stipulated requirements or is not progressing well – don’t give them the green light and instead refer them to the panel to discuss.

Using the ARCP Checklist in 5 Steps formUsing the ARCP Checklist in 5 Steps form

Using the ARCP Checklist in 5 Steps form should help you do the review in 30 minutes to 1 hour (unlike the ES reviews which take 3-4 hours).

The ES report is the main thing you will need to look at. Remember, you are reviewing an ST year (and not just the last 6 months) – so there may be more than one ESR to read.

You shouldn’t have to spend very long on each section of the ARCP Checklist in 5 Steps form. It all depends on the quality of the ES report.

If it is well-written, you have faith in its reliability and the trainee is doing well, we recommend a light touch approach make the judgement and swiftly move onto the next trainee. Simply whizz through most things, perhaps dip into the ePortfolio here and there and get it done within 20-30 mins. However, slow down if you come across areas concerns.

But if the report is shabby, then you will have to dig deeper into the eP in order to get the information to help make your recommendation. The review will take longer (and hence why feedback to the ES is important) – but remember, you only have to dig to the level where you have enough reliable information to make your decision.

To determine whether an ESR is reliable – o Look at the comments the ES has made…

1. Are they specific, measurable, achievable, relevant and timely or SMART?

2. Are they backed up with evidence? (objective more than subjective)

o Two areas of the ES report which in particular will help you decide are 1. the ‘Actions’ section for the Competency Ratings on the 1st

page and

You don’t have to double check everything the ES has written and you don’t need to dig deep into the ePortfolio - but you may just want to dip in to double check some areas.

5 ARCP advice for Panel MembersDrs. Ramesh Mehay, Paul Johnson & Mike Tomson

2. the ‘Agreed Learning Plan’ section on the last page

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An invaluable technical tipThe guidance below relies heavily on the ES report. However, sometimes you will need to dip into other areas of the ePortfolio. It can be quite ‘clunky’, cumbersome and frustrating flitting between the ES report and other areas of the ePortfolio. In the guidance below, we suggest the following. If you need to come out of the ES report and look at another part of the ePortfolio, instead of coming out, stay there. Instead, RIGHT CLICK on the other place you want to go into (usually one of the links in the ePortfolio’s left hand navigation menu) and select the option ‘Open link in a new tab’. This will open that link in a new internet page which you can then view by clicking on its tab at the top. When you’ve read it, you can then click on the tab for the main ES report (which you will not have clicked out of). This is a real time-saver. This ‘right click’ method is a really good tip for Ed Supervisors and Trainers too – for instance, when reading the learning log entries – open multiple log entries all in one go read each one and validate them rather than going in and out of a log entry and the learning log entry list.

Before anything – workout what stage the trainee is atLog into the ePortfolio and click on Summary and figure out where the trainee is in their training programme. For example, are they coming to the end of their final year (ST3) and heading for their Certificate of Completion of Training (CCT) or are they transitioning from their first year (ST1) to their second year (ST2)? This is important because it determines your ARCP approach and how rigid to be with ‘the training rules’. Someone who is moving up an ST year (i.e. transitioning) needs to have all the right numbers of assessments and has to meet all the national requirements. Someone who is having a progress review but not transitioning (usually part-timers, those out-of-sync or returning from maternity), only needs to do the right number of things for where they are at (i.e. pro rata) – in which case you’re simply making sure that they’re making good progress and are on track for training. And, when considering recommendations for CCT, you need to consider whether any concerns are so serious as to need say 6 months extra in training at a minimum cost of £40,000.

This ‘right click’ method is a really good tip for Ed Supervisors & Trainers too – for instance, when reading the learning log entries – open multiple log entries all in one go read each one and validate them rather than going in and out of a log entry and the learning log entry list.

7 ARCP advice for Panel MembersDrs. Ramesh Mehay, Paul Johnson & Mike Tomson

Guidance Notes: ‘ARCP Checklist in 5 Steps’

1. Click Progress to Certification – read last ARCP report□ This will give you a good idea of what the trainee was like during their last

review. □ Were there previous areas of concern? Have they been rectified or are

similar problems still going on? Issues may be in relation to WPBA, their post, other parts of their training and even their home/social life. Or it might include more serious stuff like complaints, significant untoward incidents and other serious investigations.

□ You don’t need to spend too long here if everything looks okay

2. Click Review Preparation – read last 2 ESRs□ Most of the information for your ARCP review should be available from the

ES report. □ For each ST year, there will be a minimum of two ES reports to read.

Spend time reading the latest ESR first because it presents cumulative data from previous reports on things like Curriculum Coverage, DOPS, Linked evidence to the Professional Competencies etc.. The last ESR will guide you how quickly to go through the others. If there are no concerns, swiftly read the others (otherwise, slow down).

Look at the following sections of the ESR. Don't spend too long on each section (unless concerns). Also remember, good enough is good enough.

RATING SCALES - both trainee's and the ES's

□ ESR competency ratings: if an Educational Supervisor has rated the trainee BELOW EXPECTATIONS in 3 or more competencies, the ESR should say ‘unsatisfactory progress’ or ‘panel opinion requested’ and the local panel needs to decide whether the trainee is making progress or not. If not, refer to a central deanery panel.

□ Trainee's self-rating: read the 'Evidence' section - is what they have written objective rather than subjective? If not, has the ES written a more objective report?.

□ ES's rating: read 'Actions’ section – are the suggestions SMART (i.e Specific, Measurable, Achievable, Realistic and Timely)?

CURRICULUM COVERAGE

□ Look at 'Linked learning Logs TOTAL' – this will tell you how many total log entries there have been for each curriculum area so far. In terms of where the trainee is at, is there an appropriate level of coverage? Are there deficient areas the trainee needs to work on?

The information hereon provides explanatory notes for each section of the ‘ARCP Checklist in 5 Steps’ form.

The main areas you need to look at with older ESRs are the Competency Rating Scales on the first page, and the last page of the report.

The evidence for the competency rating scales needs to be specific and not vague. For instance ‘6 CBDs out of 8 marked competent for Practising Holistically’ is better than ‘see CBDs’ or ‘6 CBDs competent’

8 ARCP advice for Panel MembersDrs. Ramesh Mehay, Paul Johnson & Mike Tomson

□ Look at 'Linked Learning Log in Current ST Year' – this tells you how well the trainee has been adding things into their eP in their current ST year. In other words, how well engaged they have been with the eP during this ST year. Compare to previous – better, worse, the same? Word of warning though: if numbers low, don’t automatically assume the trainee is not engaging or experiencing difficulty - it may be that the trainee's log entries have been linked to the old curriculum in which case click 'Expand Curriculum Statement Headings 2010'.

□ Overall, what does ES say about coverage? Reasonable?□ By the end of ST3

o There cannot be zero entries for any one curriculum area. o But there is no set number of log entries for each curriculum

heading.o However, for those areas which are frequently encountered in GP -

we would expect double figures. Smaller numbers for areas less frequently encountered.

o Common problems: Management – is not Clinical Management but about Organisational stuff, Teaching – have to do, not simply attend, and cannot link every patient encounter to the Consultation – must write about cons. skills.

DOPS

□ Good progression? (i.e. reasonable for where the trainee is at?) Remember, they have 3 years to get them done. An ST1 might have only got one done – which might be okay. An ST2 should have got 2-3 done. The super keen ones will have got all of the mandatory ones done by end of ST2.

□ What does ES say?

WPBA

□ CBDs, COTs, CEXs Numbers: o This bit isn't covered well in the ESR because it is only listed as the

number of assessments done in the period the ESR reviewed and not the whole ST year (which is what the ARCP review period is interested in).

o Therefore, right click on 'Evidence' in the left hand menu and select 'Open in a new tab'. Select the ST year under 'Review Type' and then select 'All Reviews' to see how many have been done in the current ST year so far from its beginning.

o Now look at the table on the summary page: make sure all minimum numbers are satisfied.

o Remember, for trainees who are NOT transitioning (i.e. not moving up an ST year and often part-time) – in terms of numbers, have they done what would be expected on a pro-rata basis? For example, at

Number of Log EntriesWe don’t like to be prescriptive about this because the content is more important than the numbers and one needs to look at the ePortfolio as a whole. But trainers and trainees still look to us for a number to use as a rough benchmark. That’s fine as long as you also use your own judgment about how good they are. On that proviso, we would say that trainees should be logging around 1-3 entries per week. This equates to 25-75 per 6m post or 16-48 at end of month 4 (when ES happens).

Doesn’t a pass in AKT signify Curric. Coverage?If there is some deficiency in the curriculum coverage (providing no zero areas), one might be reassured by a decent AKT mark (the curriculum being the base for the exam syllabus). However, remember that early chapters are not as well addressed as the later ones in the AKT.

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the end of the ST year for a full-time ST2, one would expect 6 CBDs. For a person who has just come back from maternity and has done 4 months at 50% part-time (which is equal to 2 months at full-time equivalent), one might expect 1 CBD (2/12 months x 6 CBDs).

10 ARCP advice for Panel MembersDrs. Ramesh Mehay, Paul Johnson & Mike Tomson

□ Click MSF o You only really need to read 'Comments from supervisor' who

should have summarised 'highlights in performance' and 'areas for development'.

o What does all of this tell you about the trainee? Doing okay or concerns?

□ Click PSQ o Briefly look at the numbers. (But) Remember that numbers DO

NOT TELL YOU THE STORY behind them. For instance, a doctor who gives the patient everything they want may be rated more highly in the PSQ than a doctor with higher skills who appropriately challenges them.

o Read the ES comment at the end. What does all of this tell you about the trainee? Doing okay, or are there concerns?

□ Click CSR o Skim through the report to ensure no big issues. What does this

report tell you about the trainee? Doing okay, or are there concerns?

COMPETENCY AREAS

□ Look at columns 'Linked Forms TOTAL' – this will tell you how many assessments have been done which have looked at each competency. For where the trainee is at, does this look reasonable? Any big deficiencies?

□ 'Linked Learning Logs TOTAL' - this will tell you how many learning logs have been validated against each competency. For where the trainee is at, does this look reasonable? Any big deficiencies?

□ If you see low numbers of validated entries…Validation of learning log entries to competencies can only be done by the Educational or Clinical Supervisor – not the trainee themselves. So, if you see low numbers, quickly check to make sure it is not because there are loads of log entries but the educator has not read and validated them. Right click ‘Learning Log’ in left hand navigation menu and ‘Open in a new tab’ and look at the column which says ‘Read’ and see whether most entries have a tick in them. If they are, then pick a few entries to look at the top to see if the educator has linked them to the professional competencies (i.e. validation).

PDP

□ What does the ES say (esp about quality)? □ Take a peek at the PDP entries themselves - right click PDP in left hand

navigation menu and select 'Open in new tab'. Is there reasonable engagement (i.e. at least 4 PDP entries per post)? It is unacceptable to have zero PDP entries for a post.

MSF: If the ESR hasn’t written much of a summary, then read some of the actual comments yourself (and later feedback to the ES as a suggestion for improvement).

Remember, themes are more important than individual comments.

Also, the MSF is more discriminatory than the PSQ.

CSR: Diagnostics is about decision making rather than diagnosis alone. Management is about organisational things like time-keeping and getting tasks done than clinical management.

The PDP should be a living educational tool which is in a constant state of flux as learning needs are identified, added to it, completed, and then new one’s identified, added and so on. The PDP can give you an idea of how good a trainee is in ‘talking the talk’ or ‘writing the script’

11 ARCP advice for Panel MembersDrs. Ramesh Mehay, Paul Johnson & Mike Tomson

□ The ES report itself should generate at least 3 action points of which can be converted into PDP items. The trainee should generate at least one extra item based on their current post.

QUALITY OF EVIDENCE

□ What does the ES say about the quality of (usually) the log entries? □ Dip in and have a look at a few to get a better idea of the trainee. Right

click 'Learning Log' and select 'Open link in a new tab'. Don't spend too long - only sample enough to give you a reliable flavour of what the trainee is like as a learner. You’re mainly looking for the level of reflection within the entries (superficial or deep & meaningful?).

□ The table below covers levels of reflection and should help you with assessing the quality of learning log entries; whether they are superficial

or deep.

PREVIOUS REVIEW

□ Scroll down to the last two. These are the Agreed Learning Plans for the current ST year developed by both ES and the trainee in collaboration. Are they SMART?

□ Three of the items in this list need to be PDP'able (if not, feedback to ES) – in other words, 3 of the items should be things which the trainee can convert into a PDP.

REVALIDATION CONCERNS

□ Are there any? If any concerns, you may wish to look at previous ESR, CSR, MSF & PSQ - these gives valuable information about the trainee’s performance, behaviour and attitude. The MSF is more discriminatory than the PSQ. Previous CSRs and ESRs also provide a reliable source of information.

The competencies NOE & QIA are usually related to are…i) Maintaining Teaching & Learningii) Admin & IMTiii) Working with Colleaguesiv) Fitness to Practise

Although NOE is not compulsory, trainees are strongly encouraged to do them because engagement indicates one’s commitment to improving the quality of care one is giving (GMC requirement although not an RCGP one).

If NOE is missing, you cannot give trainees an adverse outcome. You must look for NOE or Quality Improvement Activities (QIA) elsewhere.

They are best found by clicking on the learning log numbers for Competency 10 on the last page of the ESR.

A comprehensive list of QIA and NOE activities can be found at: http://tinyurl.com/qia-noe

Number of Log EntriesIf a trainee has done say 20 log entries but each is deep & meaningful with good curric. coverage, then that should be fine.

What is more of a concern is the trainee who has done 75 log entries which mostly appear to be superficial (e.g. quick and dirty write ups of e-learning modules or things read about).

Most learning log entries should be about clinical encounters with a mixture of other types, like SEAs, conversations, online modules and reading.

When there is no reflection, it is hard for the trainee to convince us that they have learnt anything.

12 ARCP advice for Panel MembersDrs. Ramesh Mehay, Paul Johnson & Mike Tomson

□ Remember: In most schemes, trainees rotate through jobs every 6 months. In each job, they will have a Clinical Supervisor. Therefore, at the annual ARCP review time, as you are reviewing a year’s worth of evidence, you need to review the last two CS reports.

3. Click Educators’ Notes□ If used well, this is another area which will give you a flavour how the

trainee is doing, whether there are any issues or concerns and may even guide you on how deeply you need to survey the eP. What impression do you get of the trainee? Any concerns?

4. Click Learning Log for NOE□ For each 6m post, it is highly suggested trainees do: 1 x SEA, 1 x Case

Presentation 1 x Reflection of Key Learning Points from that post. In addition, trainees are expected to do 1 audit project throughout their entire scheme that relates to General Practice (can be a project or a QoF thing too).

□ For an ARCP – you just need to check for engagement that these have been done. Hopefully the Ed Supervisor may have made a comment on the ESR. If they haven’t, then it’s worthwhile clicking on Learning Log in the left hand navigation menu and using the drop down list to check for things like SEAs and Audit. For the others, use the search terms Key Learning Points and Case Presentation. You don’t have to read them if they are there and have been read. However, if you’re not sure about whether the trainee is progressing well or not, then it might be worth dipping in (especially into SEAs).

□ Despite the strong recommendation to engage, one cannot mandate these requirements. If absent, look for evidence of Quality Improvement Activity (QIA) elsewhere. In this case, the Educational Supervisor should have highlighted the absence in their ES report and commented on other evidence of QIA. If they haven’t, unfortunately you will have to do this and feed back to the Ed Supervisor. Examples of QIA include prescribing review, referrals review, review of investigations one orders just to name a few. A full list of QIA/NOE activity can be found on this link: www.bradfordvts.co.uk/mrcgp/noe-general . You can find evidence of QIA in the eP by click the learning log numbers for Competency 10 on last page of ESR.

□ The Reflection on the Post should be a concise summary of learning points, including reflections on learning achieved (in terms of knowledge, skills and attitudes), and how this relates to a career in GP; should result in new learning objectives for next post.

□ The Case Study can be a presentation of a clinical case study or a notes review. The presentation may have been given in a departmental setting or VTS group.

The competencies NOE & QIA are usually related to are…i) Maintaining Teaching & Learningii) Admin & IMTiii) Working with Colleaguesiv) Fitness to Practise

Although NOE is not compulsory, trainees are strongly encouraged to do them because engagement indicates one’s commitment to improving the quality of care one is giving (GMC requirement although not an RCGP one).

If NOE is missing, you cannot give trainees an adverse outcome. You must look for NOE or Quality Improvement Activities (QIA) elsewhere.

They are best found by clicking on the learning log numbers for Competency 10 on the last page of the ESR.

A comprehensive list of QIA and NOE activities can be found at: http://tinyurl.com/qia-noe

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□ There must be personal involvement in all QIA/NOE activities (i.e. they cannot be spectators!).

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5. Click Learning Log – specific things to checkOpen ‘The ES Workbook’. This should have been uploaded to the Learning Log section of the ePortfolio as ‘The ES Workbook’ – use search term ‘Workbook’ if you can’t see it.

i. Sick/Non-Annual/Non-Study leave must be <2w per year: If it is >2 weeks per year, it has to be made up – in which case, inform the TPD and scheme’s administrator ASAP.

ii. Educational Attendance at HDR should be >75 % iii. Review Mapping Sheets – this will give an overview of what competencies

have been assessed across all the CBDs, COTs and Mini-CEXs.iv. Out of Hours

- The bottom line is that trainees, by the end of their training, should have done 18 sessions of OOH during their GP posts. This equates to ONE session per month in GP.

- They have to be spread out and cannot be done all at the end. - Each OOH session will be of 4-6h in length – need to complete the whole

session. - Forget about working out number of hours, just stick to number of

sessions = 18!- You may wish to sample some of the OOH log entries (esp if trainee is of

concern).

Open ‘Form R’ You can find this in the Learning Log

i. Any Significant Untoward Incidents? Resolved? ii. Any Complaints? Resolved?

iii. Do TPDs/Deanery know about SUI? (if not, inform!)

For ST3s who will be finishing the scheme, double check…i. Both AKT & CSA passed?

ii. CPR/AED certificate: check not expired – should say on certificate! Otherwise, assume 1y.

iii. Check for Child Protection Training (or a PDP relating to it)iv. All Professional Competencies in the ESR must be marked as Competent

for Licensing. v. Double check the whole training period - WPBA numbers met for each ST

year? Click on ‘Evidence’ in left hand menu and go through each ST year and with ‘All Reviews’ set as the default. This webpage tells you which assessments are needed for each ST stage and the corresponding numbers: http://tinyurl.com/wpbanumbers

vi. Is there a log entry on OOH competencies (re: how achieved) [desirable] 1. Ability to manage common medical, surgical and psychiatric

emergencies.

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2. Understanding the organisational aspects of NHS out of hours care (nationally & locally)

3. The ability to make appropriate referral to hospitals and other professionals.

4. The demonstration of communication and consultation skills required for OOH care.

5. Individual personal time and stress management.

Particular CircumstancesIf this is the final ARCP panel for an ST3

As well as doing the normal type of review for the final ST3 year, you must check the whole 3 year training period for correct WPBA numbers. If there is a discrepancy (e.g. missing CBD in ST1), this must be made up in a subsequent ST year. If it has not and you get the impression it is a sign of the trainee underperforming, then give an Outcome 5 – incomplete evidence, additional training time required. However, if this is just an oversight and the trainee is generally okay - use your discretion (award Outcome 1 or 6 - i.e. satisfactory outcomes) but delay signing of the ARCP form until the trainee has filled in the gaps.

There is missing evidence (like log entries, WPBA elements, or a poor PDP)

It depends whether this missing evidence is a sign of underperformance. If so, give Outcome 5 – incomplete evidence, additional training time required.

If the trainee is generally okay, it then depends on how bad the deficit is.o If only a few things are missing

Delay signing off the ARCP form and tell the trainee to ‘sort things out’ by specifying what they need to do. Give an outcome that would have been given if the evidence was there. But do not complete and submit the ARCP form until the panel chair has subsequently checked the gaps have been filled in (if not, give outcome 5).

o If the missing evidence is large - too much to be made up in a short period and/or the missing evidence is thought to be evidence of significant non-engagement with the requirements of WPBA, give Outcome 5 – incomplete evidence, additional training time required and refer to central panel. The central panel may decide to give an outcome 2, 3 or 4 where insufficient evidence is evidence of lack of progression rather than lack of evidence of progression.

How do you decide whether a trainee is generally doing okay or not? Reviewing the last two sets of ESRs and CSRs, and the Educator’s Notes will give you some idea about this.

Mapping Sheets: The odd NFD may be present in ST3 in a high flying GP trainee who may have already passed the CSA and is being encouraged to bring along more challenging cases where there may be a chance to stretch them. The odd NFD therefore should not be a significant concern for CCT.

Out of Hours: There needs to be a reasonable mix of OOH sessions. For instance, 10 triage + 2 face-face OOH sessions is unsatisfactory. We suggest more face-face (at least 50%).

Child Protection Training - is not an RCGP requirement but it is considered a professional obligation by the GMC. See this article: http://tinyurl.com/childprot. If it is missing, the trainee should mark it as a PDP item for their GP appraisal

Missing EvidenceMake sure you detail exactly what evidence is missing in the ARCP form and paste a copy to the Educator’s Notes.

Missing evidence is often a result of an oversight and/or poor organisation on the part of the trainee.

However, sometimes it can indicate something more serious. For instance, a significant deficiency in one’s organisational skills –in practice, does the trainee have outstanding referral letters or blood results that still need looking at? Is this acceptable?

And occasionally, it may represent an issue in professionalism too.

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Missing Naturally Occurring Evidence

No one can force a trainee to do NOE. It is not a national requirement and individual Deaneries cannot enforce it. Therefore, a missing SEA, audit, or lack of a presentation does not mean that you can automatically mark the trainee as unsatisfactory.

However, it is a national expectation that the trainee is involved in some sort of Quality Improvement Activity (QIA) – of which audit, SEA and a case presentation are great examples. Good Medical Practice states that such activity is expected of all doctors and an absence of QIA should be noted and should raise concerns about whether there has been satisfactory progress.

So, if these are missing, you have to look elsewhere in the ePortfolio (usually the Log Entries) for QIA things. A comprehensive list of QIA and NOE activities can be found at: http://tinyurl.com/qia-noe but they include things like analysis of one’s referrals, prescribing, investigations, reviewing mortality data, significant events, case reviews and new service implementation.

An adverse ARCP outcome can only be given if there is a competency deficiency and NOT because of missing NOE or QIA.

No Form R uploaded

Automatically give an Outcome 5 (incomplete evidence) – no exceptions. Form R basically details things like – additional time taken out of training

(like sick leave), whether a trainee is involved in a hospital or GMC investigation, complaints against them and things about their own health.

A panel cannot judge whether a trainee is deemed satisfactory in the absence of this data – hence Outcome 5 (incomplete evidence).

Not passed AKT or CSA by the end of training but everything else is okay

In terms of competency rating scales – trainees can still be rated as Competent for Licensing even if they have failed AKT/CSA. But the ES outcome will need to be ‘unsatisfactory progress’ and be referred to a central deanery panel (because passing AKT/CSA are mandatory). Usually, an extension will be granted by the Deanery up to the date of the result and 2w after (unless they have failed WPBA too).

If they then fail again - what happens next depends on their score compared to the previous one. The following is decided by the Deanery.

o If there is a significant improvement in score AND their score is within 5 marks of passing, the trainee is given Outcome 3 - extra training time required (6m max).

o If there is little improvement in score AND score greater than 5 marks away from the pass mark, the trainee is given Outcome 4 - released from training.

Look at ‘The ES Workbook’ where trainees should have uploaded their number of OOH sessions.

17 ARCP advice for Panel MembersDrs. Ramesh Mehay, Paul Johnson & Mike Tomson

Out of Hours Requirements

The simple thing to remember is that there must be 18 sessions of OOH by the time of CCT (i.e. one session per month when in GP). Forget working out the number of hours.

All trainees should be strongly encouraged to get all 18 sessions done before their final ST3 ARCP panel. However, it is okay to defer 2 of the 18 OOH sessions after their last ARCP panel (but before CCT) – but check to make sure the trainee has logged dates when these will be done and nominate someone at the scheme to check completion (?scheme administrator). Please note, this creates extra work for the scheme organisers. Failure to complete these sessions should result in a phone call to the RCGP certification unit asking them to halt the issuing of the CCT (Tel 020 3188 7656).

Prior to the final ST3 panels GPRs should be encouraged to include a log entry detailing the evidence contained within the eP which demonstrates the competencies in OOH care.

Maternity

All trainees must continue to have annual ARCP assessments – even if this falls during a period when they are away (e.g. on maternity, extended sick leave etc).

An ESR must be done before someone goes off on maternity leave for three reasons1. To validate the evidence submitted so far so that it counts towards

training2. To record progress3. To help formulate a development plan (i.e. what they need to do) upon

their return. If a trainee is out of programme for more than 12 months, they need to

have their Professional Competences reassessed in training once back from leave.

If very little training time – i.e. less than 6 weeks - remains after the trainee returns from planned leave then the penultimate ESR and ARCP should state that the trainee is fully competent and the ES/Panel is happy to recommend them for CCT once the remainder of their training time is completed (record in the Additional Comments section of the ARCP form). Otherwise, there will not be enough time to get everything together for a timely CCT. The final ESR and ARCP (done within 6w) would then officially sign everything off having made reference to the penultimate ARCP (again, in the Additional Comments section).

Actually, this also applies if a trainee is coming back from extended sick leave.

The Trainee is involved in a Significant Untoward Incident (SUI)

Please note: Extended hours attendance is not OOH work.

Advice to trainees on Mat leave is that they should continue to make some entries on their eP and gather evidence that they are (or remain) competent. However this cannot be mandated and can only happen with their consent. But we could ‘carefully‘(mindful of employment law) make them aware that CCT could be delayed if they don’t engage.

SUIs: The panel makes an assessment of the educational progress and awarding an outcome 6 (award CCT) is appropriate if all the evidence in the eP is fine – despite outstanding GMC investigations.

18 ARCP advice for Panel MembersDrs. Ramesh Mehay, Paul Johnson & Mike Tomson

Review the SUI and see whether progress is being made on it. If the SUI is minor and the trainee has learnt from it with a good reflective

log entry, make a note of it and approve if all else in the eP is okay. If SUI is serious and is being investigated, again identify the nature of the

problem. In this case, the ARCP panel still judges the trainee based on the remaining evidence in their ePortfolio and gives a grade as if the SUI wasn’t there.

The reason is that it is not the panel’s job to make a decision on the SUI. The panel decides whether the trainee is educationally progressing well. The SUI will be dealt with by the dean (as Responsible Officer for trainees) and certification unit – who will decide whether to involve the GMC.

Double check to ensure deanery are aware of the major SUI though (via panel chair).

Conflicts of Interest – ‘I know the trainee’

Where the panel includes a member who has been ES or CS for the trainee or worked closely with the trainee in the previous 12 months, and especially where there are possibilities of that trainee receiving an adverse outcome, the GP educator should not take part in the discussion.

As they have not been involved in the discussion about that particular trainee, their name should not appear on the list of Panel members for that trainee's ARCP. This will ensure that the trainee does not come to the conclusion that their ARCP was prejudiced by the subjective opinion of an educator who knew them - which would be particularly important if the trainee appealed against an adverse outcome.

Feedback to Educational Supervisors It can be quite demotivating and demoralising to be told you don’t meet the

college standard for a job you didn’t necessarily volunteer for. Therefore, we ask all ARCP members to invest some careful time and

thought when constructing their feedback. Write feedback in a way that is more likely to be accepted than rejected.

Be balanced – give a balance of positive and negative feedback. And don’t be over-inclusive; one or two points for each is fine. If there isn’t anything negative, just concentrate on the positive. If there’s quite a lot of negative – just concentrate on the one or two things that will make a difference. Don’t nit-pick! But always be careful with the way you phrase things. Reading what you have written and asking yourself how you would feel if you received it, is a good approach.

Well done for reaching the end of this document. We hope it has not left you with brain fog. The purpose of this document is

not to supersede the DALEA doc, but to make it easier to understand the ARCP rules and present them in a more engaging way. However,

Conflicts of Interest: It is best practice for educators in this position to leave the room until after the trainee has had their meeting with the panel.

Feedback is important. How can ESs improve if we don’t give them feedback? But one also has to be mindful of the fact that the ES job is not well paid & involves hard work.

19 ARCP advice for Panel MembersDrs. Ramesh Mehay, Paul Johnson & Mike Tomson

if you spot a difference between the DALEA doc and this one, then take the DALEA one to be current & true.

Full DALEA document at http://tinyurl.com/dalea2013Have any suggestions to make this document better?

Email: rameshmehay@googlemail.comLAST UPDATE JUNE 2014