This information is written for trainees and trainers and details the structures and systems supporting the progression of GPSTs in training. It should be read in conjunction with information found on the RCGP MRCGP Exam Overview webpage and within the Gold Guide. It attempts to answer the following commonly asked questions:
- What evidence does the panel require?
- What does the panel do, and why?
- How often is progress assessed by the panel?
- Who sits on the panel?
- What judgement does the panel make?
- Who is invited to meet with the panel?
- What does meeting with the panel involve?
- Can I ask for judgments to be reviewed? How can I appeal against a judgement?
In August 2007 new assessment procedures were introduced for General Practice Specialty Trainees (GPSTs) which utilised different assessments tools throughout the training programme. Known as Work Place Based Assessments (WPBA), these tools are used along with other evidence, to determine the progress of GPSTs in training. Evidence concerning the GPSTs progress in training is collated within the e-portfolio. This progress is formally reviewed through assessment of the e-portfolio at a minimum annually (calendar) by the ARCP panel. The panel makes a judgement, which is expressed as an outcome, on the GPST’s progress, based on the evidence available in the e-portfolio. The work of the panel is outlined below, but first, the evidence GPSTs must provide is detailed.
The requirements for less than full-time (LTFT) trainees are different but proportionate. For more details, please see ARCP Guidance for LTFT trainees.
A minimum of six CbDs must be completed and entered onto the e-portfolio in each of ST1 and ST2 (three before each six month review) and twelve CbDs in ST3 (six before the six month review and six before the final review)
A minimum of six COTs (primary care) or Mini-CEX (secondary care) must be completed and entered into the e-portfolio in each of ST1 and ST2, (ensuring there are three before each six monthly review), and 12 COTs in ST3 (six before each six monthly review).
Two MSF cycles must be completed in ST1, usually around months 4-6 repeated 2-4 months later (5 clinicians only if in secondary care, but also 5 non-clinicians if in primary care) and two cycles in ST3 around months 28-30 repeated 2-4 months later (5 clinicians and 5 non-clinicians)
The PSQ should be used once during months 31 to 34. PSQ can take place in ST1 or ST2, if the GPST is in primary care. Therefore the PSQ will be used only once if the GPST is in general practice for 12 months but twice if they have more than 12 months in general practice
DOPS - there are eight mandatory procedures to be covered and some of these procedures may be combined, such as prostate and rectal examinations. There are currently eleven optional procedures which should be recorded, if undertaken. The specific list will change from time to time. In addition, should the educational need arise, GPSTs may be requested to repeat DOPS assessment of Foundation procedural skills
A Clinical Supervisors Report (CSR) must be entered onto the e-portfolio for each hospital post. This is especially important for short placements. Clinical Supervisors may access on-line support via the RCGP's MRCGP Exam Overview webpage.
The Educational Supervisor Report is a structured report based on the evidence contained in the trainee’s e-portfolio which concludes by making a recommendation to the ARCP Panel. The ESR must be discussed with the trainee prior to its submission to the Panel. There are three categories of recommendation: Satisfactory progress, Unsatisfactory progress, and Panel review requested. Please visit the RCGP's Trainee ePortfolio webpage for more details.
Failure in these examinations in ST3 will be judged as unsatisfactory progress and prompt referral to the ARCP panel by the Educational Supervisor. This applies to full time and less than full time trainees.
- All GPSTs are required to complete an Enhanced Form R prior to every ARCP panel
- It is the GPST's responsibility to ensure that all evidence is added to his/her ePortfolio by the evidence submission date prior to the ARCP
A GPSTs progress in training is assessed by the deanery ARCP panel. The requirements are set out in what is known as the Gold Guide.
The ARCP panel formally assesses progress from the evidence presented by the GPST (which crucially includes the ESR) in their ePortfolio. The process has two objectives:
- Firstly, to consider and approve the adequacy of the evidence and documentation provided
- Secondly, to make a judgement about the GPSTs suitability to progress to the next stage of training or to confirm that training has been satisfactorily completed
The process is based on an assessment of the documented and submitted evidence presented by the GPST in his/her ePortfolio. For this reason, the GP School performs a ‘screen review’ panel for the majority of GPSTs which prevents the need for a face-to-face meeting with the panel. The panel records its judgement and any comments on the ARCP report held within the ePortfolio. It also provides feedback to Educational Supervisors.
This very much depends on the progress made in training and whether training is full-time or less than full-time.
Full time trainees progressing satisfactorily can expect to have their evidence assessed three times during their three years of training. Those trainees selected for an additional year of training (ST4) will be assessed four times. Full time trainees with unsatisfactory progress will be assessed more than this, the frequency depending on individual circumstances.
For less than full time trainees, the situation is more complex. For details, please refer to ARCP Guidance for LTFT trainees.
The composition of the Panel will normally comprise or a minimum of three members drawn from the following: GP Director, Head of School, Associate Postgraduate Deans (APDs), Training Programme Directors (TPDs), Educational Supervisors (ESs), GP Trainers, RCGP assessors, and lay representatives.
The panel’s primary purpose is to make a judgement concerning the GPSTs progression in training. This judgement is expressed by the awarding of an outcome. The following outcomes may be awarded:
- Achieving progress and the development of competences at the expected rate
- The GPST may continue training with no restrictions
- Development of specific competences required – additional training time not required
- The GPST will be allowed to progress but will have to provide specified evidence stated on the ARCP Report within a given time frame
- Inadequate progress by the trainee – additional training time required
- the GPST requires an extension to training because they have not made adequate progress in training but might do so with further training
This outcome is most commonly awarded at the final ARCP panel in ST3 to trainees failing one or more of the three components of the MRCGP: AKT, CSA, WPBA. The reasons for the outcome and plans covering remedial training are documented in the ARCP Report
- Released from training programme with or without specified competences
- the GPST has been dismissed from training.
The reasons for the outcome and passes in any of the three components of MRCGP will be documented in the ARCP report
- Incomplete evidence presented – additional training time may be required
- The GPST has presented incomplete evidence to the panel such that the panel is unable to make a judgment on progress
The trainee will be given explicit requirements, time-framed with a review date usually 6 to 8 weeks following the outcome being awarded. At this time, the evidence will be further assesses via an additional ARCP and another outcome awarded
- Gained all required competences
- This outcome is awarded at the end of ST3 and means the GPST has successfully completed training
Most GPST ePortfolios are fully assessed by the ARCP panel remotely by means of a ‘screen review’ and therefore the majority of trainees never meet with the panel. Trainees invited to meet the panel include:
Those judged on the evidence submitted to the ‘screen review’ panel to
- require further evidence demonstrating progress on identified, specific competences (Outcome 2)
- require additional training because of inadequate progress (Outcome 3)
- be required to leave the training programme before training is completed (Outcome 4)
- have submitted incomplete evidence (Outcome 5) and who have failed to provide specified evidence by a date preceding the face-to-face Panel
- referred for a panel opinion by their Educational Supervisor
GPSTs considered ‘high-flyers’
- Those who are judged to require support beyond that normally available
GPSTs judged to need additional support
- Due to health or disability issues which might impact on training
Trainees called to attend panel in person are notified no later than 1 week prior to the ARCP date.
GPSTs invited to meet with the panel will be informed of their outcome at the beginning of the meeting. The meeting is not about negotiating an outcome, rather establishing why the trainee has been awarded the outcome and importantly formulating an action plan to guide their training. This formative, supportive function of panels adopts a holistic approach to ensure that all factors impacting on learning and training are considered. The meeting is documented in the ARCP report, which is held on the e-portfolio
Every GPST who attends panel in person, except those randomly selected and awarded Outcome 1, must meet with his/her educational supervisor and/or local training programme director (TPD) to plan the next phase of his/her training, referring to the action plan documented in the ARCP report.
Notes on failure to achieve ARCP competency
- At every level there is an appeals process and details can be found below.
- GPSTs having difficulty with MRCGP will normally have been identified in advance by the trainer and with deanery support will have developed an action plan.
- If MRCGP (AKT and/or CSA and/or WPBA) is subsequently failed, an extension to training may be granted. This is at the discretion of the GP Dean in discussion with the GPST, the trainer, the local TPD team and the patch Associate Dean, all of whom will have been involved in developing the action plan.
A GPST has the right to request a review and, in some circumstances, an appeal.
A review is a process where an individual or a group who originally made a decision return to it to reconsider whether it was appropriate.
An appeal is a procedure whereby the decision of one individual or a group is considered by another (different) individual or body.
Those involved in an appeal must not have played a part in the original decision or the review.
If the trainee disagrees with the decision they have a right to ask for it to be reconsidered. Requests must be made in writing within ten working days of being notified of the panel’s decision. The chair will then arrange a further interview which should take place within fifteen working days of receipt of such a request.
A decision of the panel following such a review is final and there is normally no further appeal process.
Step 1: Discussion
The purpose of this stage is to reach a common understanding of a trainee's problems and to decide on the best course of action.
Where, following the Step 1 process, trainees accept that competences have not been achieved an action plan should be developed.
Step 2: Formal appeal hearing
If a trainee does not accept the outcome of Step 1, they should inform both the Postgraduate Dean and GP Dean within ten working days. A formal appeal hearing should normally take place within fifteen working days of receipt of a request.
Members of the original annual review panel must not take part in the appeal process.
If a trainee wishes to be represented by a lawyer, the appeal panel Chairmen should normally agree to this request.
The review or appeal panels may decide at any stage that an Outcomes 2, 3 or 4 is not justified.
The award of the CCT/CESR/CEGPR is the responsibility of the GMC and therefore all appeals against decisions not to award such a certificate should be directed to the GMC.