HEE ARCP Review and HEE NW Plans. Dr Alistair Thomson Associate PG Dean Educator Development

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1 HEE ARCP Review and HEE NW Plans Dr Alistair Thomson Associate PG Dean Educator Development May 2018

2 Medical Education Reform Programme

3 Published February 2018

4 ARCP Review Reviewed Effectiveness of ARCP process How to ensure process is consistent, reliable, ensures patient safety and supports trainees

5 HEE NW JDAT Headline Messages - 1 Trainee to meet ES/TPD after ARCP to discuss outcome/areas of concern (Gold Guide) 50% not meeting: those meeting more satisfied Significant relationship between those who met and identifying weaknesses ARCP process is 'tick box' exercise Identifies only adequacy, not excellence More detailed feedback would improve the process HEENW JDAT November 2018

6 HEE NW JDAT Headline Messages - 2 Significant relationship between outcome and trainee understanding of: Who makes decisions on outcome The ARCP process What is needed to pass the ARCP Different outcomes Make it more acceptable and less threatening HEENW JDAT November 2018

7 HEE and Annual Review of Competence Progression Health Education England responsibility Ensures doctors progress satisfactorily in training What and how progress is assessed Set out by medical Royal Colleges Based on specialty curricula approved by GMC How assessment is undertaken Varies across specialties and geographies Undermines confidence in ARCP process Needs consistency and clarity

8 ARCP Review - 1 Jan 2017-Feb 2018 Trainees high expectations of annual appraisal and assessment process Value constructive feedback and assessment High quality supervision Documentation provides evidence but ARCP stressful and unnecessarily time-consuming Tick-boxes do not support culture of professionalism or individualism that doctors and public expect

9 ARCP Review - 2 Also an opportunity to explore how principles for medical appraisal and assessment might apply to other healthcare professionals High quality supervision and feedback contributes to a safety culture in which difficulties are discussed, questions are asked and honest reflective practice is necessary to help work though complex clinical problems

10 The Blue Triangle?

11 5 Principles Consistent frameworks underpinned by Outcomes-based curricula Support for appraisal and assessment How portfolios are appreciated by the wider workforce as a tool to support their progression Crucial role of trained and adequately supported supervisors and mentors Consistent assessment processes that ensure patient safety Supporting employers and professionals to build multi-disciplinary skills for the future

12 Key Themes of ARCP Review Delivery of educational supervision Consistency of ARCP panels Professional and personal support for trainees Standardisation of quality assurance and quality management processes Defining and communicating purpose and responsibilities within the ARCP process Promoting Flexibility in Postgraduate Training Utilising the ARCP model for developing and supporting SAS Grade and Trust Grade Doctors Applying principles to the wider workforce

13 What is the purpose of ARCP? Agreement across The Gold Guide The UK Foundation Programme ARCP guidance GMC s Generic Professional Capabilities implementation guidance

14 Purpose of ARCP - Summary Assess suitability to progress in/complete training Identify unsatisfactory progress Feedback to remediate poor performance Guide additional training Fair, consistent, documented judgements Quality assure training Advise RO about revalidation Flag concerns about patient safety or FTP

15 Delivery of Educational and Clinical Supervision Recommendations - 1 Trainees should have regular high-quality formative feedback, which includes preparation for, and timely feedback after ARCP, and should include career discussions at appropriate points The ARCP decision should not be a surprise to trainees, and trainees who are not progressing should be identified and supported in a timely way

16 Delivery of Educational and Clinical Supervision Recommendations - 2 ES should be appropriately supported, trained and given adequate time in their jobs plans to fulfil the role. CS providing day to day support for those they are training should have regular contact with the ES ES reports should be quality assured to ensure they provide a consistent and high quality summative assessment of progress

17 Consistency of ARCP panels Many specialty and sub-specialty curricula Gold Guide does not specify which aspects of curriculum are most important Royal Colleges curriculum-specific ARCP decision aids describe minimal competence at each stage Evidence includes: ES Report Workplace based assessments Examinations Self-reflective learning logs

18 Consistency of ARCP panels - Recommendations Formative feedback crucial to empower trainees Make ARCP decisions in absentia (Gold Guide) Post-ARCP feedback, including to those performing well, should be offered to all trainees in a timely and supportive process Training and national guidance should be provided to ARCP panels to aid consistent decision making, with provision of decision-aids that are applicable nationally and are consistent in quality across specialties

19 Professional and personal support for trainees ARCP an opportunity to: Identify poor progress Signpost support services, e.g. Targeted programmes for distinct areas of practice Careers guidance Variation in Provision of services and their access Awareness amongst trainees and trainers

20 Professional and personal support for trainees - Recommendation ESs, ARCP Panels and trainees should be provided with high quality information about the professional and personal support available to all trainees

21 Standardisation of quality assurance and quality management processes Structure for annual collation of evidence helps Trainees build and enhance portfolio E.g. reflection on practice, clinical audit and QI Demonstrates to public that Rigorous, standardised process in place Trainees competent to practice and meet requirements of their Royal College Royal Colleges should Review the number and structure of WPBAs

22 Standardisation of quality assurance and quality management processes - Recommendation HEE should work with the AoMRC and medical Royal Colleges to ensure a standardised approach to improving the quality of ARCP processes, ensuring that good practice is shared across specialties and geographies

23 Defining and communicating the ARCP process For ARCP to deliver valid, consistent outcomes it is essential that all parties are clear on: Their role and responsibilities Overall purpose of the ARCP cycle Information regarding the process should be easily accessible to all, to ensure Transparency Effectiveness

24 Defining and communicating the ARCP process - Recommendations A shared understanding of the purpose of ARCP (as per Gold Guide), is needed, with clarity on the steps involved (including for revalidation) All involved in ARCP processes should understand their responsibilities Trainees to know competences they need to achieve at the start of each year (and face no later amendments) National training bodies to implement system wide communications on expectations of system

25 Promoting flexibility in postgraduate training - Recommendations Out of Programme (OOP) arrangements should be adapted to allow a Step-on/Step-off approach for a more flexible training pathway Building on the evaluation of GP training, deferred entry should be explored in other specialties in the future All trainees should have equitable principles applied to requests to train LTFT HEE s Return to Training (SupoRTT) programme

26 Utilising the ARCP model for supporting SAS grade and developing trust grade doctors - Recommendation There should be a more flexible, evolving approach to supporting the professional development for SAS grade and trust grade doctors

27 Competency progression within the wider workforce - Recommendation HEE will work with stakeholders to further explore and pilot a structured, consistent and sustainable national clinical competency process in line with the 5 principles to support Advanced Clinical Practice development across several specialties

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30 HEE NW Perspective Standard Every trainee and ES should be able to accurately predict their ARCP outcome when the ES report is submitted to the panel

31 HEE NW Perspective on Panels ARCP processes consistently transparent, objective and fair Occasional exceptions acted on by ADs Processes are reasonable with information they can review in the e-portfolio ES reports Problem with quality If completed well, ARCP panel work straight forward Work improving these underway Aim to develop ES faculty

32 HEE NW Perspective on Standards Some curriculae imprecise Expectations of competency progression unclear Criteria for failing to progress unclear Some ESs misunderstand Contribution of ESR to ARCP decision Timing of decision Professional role in assessing these standards

33 HEE NW Perspective on ARCP Feedback Inconsistent approaches Timing Who: panel, HoS, TPD or ES? Objective setting and PDP Trainees may Perceive they are attending the ARCP Panel Try to influence the outcome (already issued)

34 HEE NW ARCP Development Strategy HEE NW to concentrate on: Develop ES faculty Be consistent with feedback from ARCP ARCPs may need modifying? Encourage use of decision aids Ensuring curriculae consistent in standards HEE & GMC task New round of RC simplification underway

35 Your mission if you choose to accept it Consider all this during ARCP season Feedback to HEENW Particular issues Educate and empower ESs Induction & CPD for TPDs/HoS Ensure proper PDPs for all SMART objectives for ARCP other than 1 Contribute to national consultation