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Implementation note 3

Transition guidance for deaneries: First ARCPs post-transition

This note is based on the outputs from the Curriculum Training Day on 24 May 2019. It is intended to help deaneries plan their management of the ARCP process after transition to the new curriculum. If you have any other suggestions or comments, please let us know.

 

General principles

  1. A trainee having an ARCP within 6 months of the introduction of the new curriculum and insufficient evidence in <50% of non clinical Capabilities in Practice (CiPs) should NOT be given anything other than an outcome 1. However an outcome 3 should be given if there is no evidence in >50% of the non-clinical CiPs. If the trainee is on Out of Programme (OOP) or on maternity leave then the 6 months starts when they return to training. For less-than-full-time (LTFT) this period will depend on their pro rata time (e.g. 10 months for 60% training).
  2. A trainee who is at the end of a training year and has been accumulating evidence on both the old and new curriculum will require both sets of evidence considered in order for a progression decision to be reached.  For an example, if a trainee is on the 2013 curriculum for 90% of the training year it is going to be challenging for them to link all the necessary evidence to the CIPs. A pragmatic approach will be required to ensure that the Education Supervisor (ES) is confident that the trainee has met the old curriculum requirements pro rata, and has made appropriate progress with the new CiPs.
  3. Where the trainee has appropriate evidence within the ePortfolio to inform sign off of CIPs but has failed to use or link it appropriately the use of an outcome 5 (insufficient evidence) is recommended.
  4. A trainee who is not at the end of a training year will need the amount of full-time equivalent clinical training confirmed as part of the ES Report. The ES will need to pay attention to the evidence of progression in the 2013 curriculum and evidence of the necessary number of WPBA. The ES should then make recommendations as to what needs to be achieved in the new curriculum in order to progress. This should focus on the quality of the evidence not necessarily the number of WPBA. For example, a LTFT trainee may have completed 70% equivalent of full-time training in ST4 at the time of transfer. Therefore most ot the evidence to support an outcome 1 at the end of ST4 will be from the old curriculum/ePortfolio. This should be documented in the new ePortfolio.
  5. There is no requirement for ongoing evidence of competence in procedures that have been signed off. Trainees are adult learners and if they feel they are de-skilled in some procedures can use OSATs as a way of obtaining ongoing constructive feedback if needed.

 

Trainees with outcomes 2 and 3

  1. Trainees with outcomes 2 or 3 need their SMART objectives documented clearly on both the old and new curriculum documentation in the ePortfolio.
  2. When recording ARCP outcomes it is recommended that the panel documents on which curriculum the trainee is being judged - 2013 or 2019. Thus after transition if there are some variations in judgements (a common example being an outcome 2 for the incorrect number of Obstetric versus Gynaecology WPBA, which at the next ARCP are not deemed necessary as there is sufficient evidence) the panel can justify an outcome 1 as this is based on the new 2019 curriculum. This will prevent any appeals from trainees remaining on the 2013 curriculum.
  3. Trainees may have an outcome 2 or 3 because of specific developmental training objectives identified from the 2013 curriculum. After transfer the trainee in this situation needs to provide the evidence that they have achieved these objectives and cannot use the “insufficient evidence in <50% of non clinical CiPs” as justification that they should receive an outcome 1.  An example would be if a trainee had been asked to produce evidence around communication within a team, but there was nothing linked to CiP 5, then they would be unable to be awarded an outcome 1, regardless of the fact that allowances are being made for the non-clinical CiPs at the first ARCP following transfer.
  4. Global judgement is a key component of the assessment process in the new curriculum. This is the means by which trainers can (backed by evidence) give  outcomes 2 or 3 when needed that are not simply based on a lack of completion of the log book or WPBA. This will need careful consideration by the ARCP panel whilst ES become familiar with the updated assessment process.
  5. The ARCP Panel should give feedback on the quality of the ES Report as part of the process, in the spirit of promoting good practice. A template will be available.

 

Advanced trainees ST6-7

  1. An advanced trainee (ATSM or subspecialty) who chooses to remain on the 2013 Core Curriculum must fulfil the requirements of the current Matrix (2018) in terms of numbers of WBAs and ongoing competency OSATS. The ES will need to ensure that the 30 advanced competencies (dark pink boxes) and the other elements of the ES report are completed on the forms available in the ePortfolio. The old-style ES report will be available on the new ePortfolio only for this group of trainees.  The ARCP Panel’s attention should be drawn to this. The 2018 training matrix (with the required numbers of WPBA, reflective practice, etc., will remain the assessment standard for these trainees until completion of their training and will be available on the RCOG website).
  2. The reformatted ATSMs and subspecialties have had some generic skills removed e.g. communication skills and governance as these are now in the new core curriculum. For trainees who choose to remain on the 2013 Core Curriculum, some attention needs to be paid to this as part of the overall ES Report, as these generic skills are not part of the 2013 advanced competencies.
  3. An advanced trainee who is undertaking but not completing their ATSMs atior to the point of transfer should have a discussion, based on the key skills and descriptors of the relevant ATSMs, as to what is left to complete to meet the requirements of the new curriculum. This should be undertaken by their relevant ATSM educational supervisor and communicated to the ES. This information needs to be transferred to the new ePortfolio so progress from transition can be assessed at the ARCP.
  4. When the ATSMs are completed  on the new ePortfolio the global assessment made by the ATSM supervisor for the ATSM CIPs and the comments outlining the rationale for this decision will be visible in the ESR on the ePortfolio prior to the ARCP. The ES will review this judgement when compiling the ESR to submit to the ARCP panel. This will be considered by the ARCP Panel.
  5. When the subspecialty annual assessment and CiPs are completed on the new ePortfolio, the global assessment made by the SST Supervisor for the subspecialty CiPs, the comments outlining the rationale for this decision and the annual assessment outcome will be visible in the ESR on the ePortfolio prior to the ARCP. The ES will review this judgement when compiling the ESR to submit to the ARCP panel. This will be considered by the ARCP panel.
  6. It is more likely that ST7 trainees will stay on the old curriculum. Therefore the ARCP panel need to be satisfied that they have completed all the requirements of the old curriculum in order to be awarded an outcome 6. For those that choose to transfer to the new curriculum, the ES should review the evidence from old and new curricula in the ES report.  The ARCP Panel will need to review as to whether there is sufficient evidence from both old and new curricula to justify the award of an Outcome 6. 

 

LTFT, academic, maternity leave, OOP

  1. The issues for academic trainees are broadly similar to those of LTFT trainees at whatever stage of training they are at. The need to apply the % Whole Time Equivalent (WTE) to progression applies to transition planning.
  2. Trainees on maternity leave should be encouraged to attend a training day on the new curriculum as one of their Keeping In Touch (KIT) days. It may be appropriate for the Training Programme Director (TPD) or College Tutor (CT) to provide oversight of the progression of these trainees to ensure that they are not disadvantaged. The Return To Work (RTW) process is very important for these group of trainees, and should include an assessment of what they need to do to progress in the new curriculum.
  3. Formative assessments will now be available for ES to see in the new curriculum. The ES should use monthly meetings and the PDP to support trainees. These trainees may need more support when transferring to the new curriculum and ePortfolio.
  4. It is recommended that a summary of progress is undertaken before OOP is taken, with a plan for what needs to happen in terms of the curricular requirements on their return.

 

Subsequent ARCPs

  1. A trainee who is at the end of a training year and has accumulated evidence in the new curriculum will have their progress recorded against the CiPs in the ESR. The ARCP Panel should then consider whether they agree with the global judgement of the ES. They may do this by reviewing the evidence accrued, including the required procedures. Satisfactory progress in both clinical and non-clinical CiPs must be made. The requirements of the new Matrix and sign-off of procedures must be met, as well as the defined entrustable levels of supervision for clinical CIPs for progression from one ST year to the next.
  2. A trainee who is not at the end of a training year and who has accumulated evidence in the new curriculum will have their progress recorded against the CiPs in the ESR. The ES will need to pay attention to the quality of evidence. The ES should then make recommendations as to what needs to be achieved in order to progress.

 

Education Directorate
RCOG
June 2019