Preparing for ARCP
Judging achievement of Specialty Learning Outcomes to support progression decisions
A practical guide for Trainees, Supervisors and ARCP panel
This document describes what an ARCP panel will be looking for at the end points of each level of training to satisfy themselves that trainees are fulfilling the requirements of the RCEM curriculum. It is designed to guide trainees and their Educational Supervisor as to what evidence should be recorded in their ePortfolio through the intervening years, so they can meet the curriculum requirements at the ARCP at the end of each training level.
Trainees and supervisors should also refer to the RCEM curriculum and Clinical Syllabus.
Evidencing the curriculum
In the revised RCEM curriculum there are 12 Speciality Learning Outcomes which map to the GMC’s Generic Professional Capabilities (GPCs). The curriculum is outcome-based, which means that it describes the behaviours and performance required at the completion of the three stages of training (Core training, Intermediate and Higher training, on achieving CCT). Trainees will need to ensure they have provided evidence demonstrating how they have met the Speciality Learning Outcomes.
Supervisors and ARCP panels will make a professional judgement as to the sufficiency of this evidence.
The RCEM Speciality Learning Outcomes contain Key Capabilities (the mandatory aspects that must be explicitly evidenced to satisfy the requirements of the Learning Outcome), and a range of examples (‘descriptors’) of skills, behaviours and attitudes that relate to them.
Trainees will not be expected to provide evidence addressing each of the descriptors; the evidence should be aimed at demonstrating each Key Capability and, therefore, each Specialty Learning Outcome.
Trainees need to demonstrate evidence in their ePortfolio for each Speciality Learning Outcome at their level of training. This will consist of a mixture of documentation of learning from formal training courses, skills log of activities carried out in training, work place based assessments including Multi-Source Feedback, the other RCEM exams and assessments, as well as reflective notes and educational supervisor reports. The ePortfolio has been configured to enable easy display of the data tagged to each domain. This will support the Educational Supervisor and ARCP panel in the way they can evaluate the evidence submitted against the SLOs
How to use this document
This document aims to describe, the standard of evidence and level of performance required for a trainee to show they have satisfactorily demonstrated achievement of the Speciality Learning Outcomes, which is a requirement before they may progress to the next level of training (or CCT). This will ensure that trainees are judged consistently throughout the UK. This guidance should be used by ARCP panels to support their decision making process, and by Educational Supervisors and trainees to help them consider the type, depth and breadth of evidence required.
This is generic guidance and does not replace any specific targeted learning objectives that may have been agreed between the trainee, Supervisor and Deanery/LETB following a previous unsatisfactory ARCP outcome. Supervisors and ARCP panels should also ensure trainees have met the RCEM examination requirements.
The Clinical SLOs have entrustment statements that cover the Key Capabilities. This means that the training faculty will give their opinion about whether the trainee has met the standard in each of these. It is important that trainee’s also record evidence that demonstrates their progress in each of the Clinical SLOs, and do so from the start of each training attachment. Examples of the evidence that would be suitable in each of the Clinical SLOs is provided in Table 1.
Assessment of the Generic Speciality Learning Outcomes is by the professional judgement of the Educational Supervisor/ ARCP panel. To ensure consistency of judgements at each of the three levels of training, a grid has been provided, offering guidance (explicit where possible/appropriate) as to the standard of evidence and level of performance required. Each of the Generic SLOs outline the standard required at key waypoints at the end of training:
• By the end of ST2 (core/ACCS)
• By the end of ST3 (intermediate)
• By the end of ST6, prior to CCT (higher)
Trainees who are not at the end of each level, where the guidance criteria are set, need to show satisfactory progress towards meeting the requirements by the end of their current level.
In addition to describing minimum standards, guidance and pointers as to what might be deemed excellent are also included. The guidance is set out in table form as below:
- Not yet achieved: Details for expected outcomes for this grade
- Good /Acceptable: Details for expected outcomes for this grade
- Excellent: Details for expected outcomes for this grade
Guidance is provided below for the Generic SLOs learning outcomes at each level
- Education and training
- Quality improvement
- Lead, manage, administrate (Intermediate and Higher)
The RCEM curriculum and all syllabus documents, as well as other supporting guidance, are available at www.rcem.ac.uk.
Table 1. Recommended WPBA to provide evidence for Clinical SLOs
|Care for physiologically stable patients attending the ED across the full range complexity||Mini-CEX; ACAT; RCEM App; RCEMlearning activity; reflective entries||ESLE; CBD; RCEM App||ESLE; RCEM App; CBD||ESLE RCEM App; CBD||RCEM App; CBD|
|Answer clinical questions||CBD, RCEM App; RCEMlearning activity relating to clinical reasoning; reflective activity||ESLE; CBD, RCEM App;||ESLE RCEM App; CBD||ESLE RCEM App; CBD||ESLE RCEM App; CBD|
|Resuscitate and stabilise||ELSE; RCEM App; RCEM Resuscitation Mini-CEX; RCEM Resuscitation CBD; reflective activity||ELSE; RCEM App; RCEM Resuscitation Mini-CEX; RCEM Resuscitation CBD; reflective activity||ESLE; RCEM App; RCEM Resuscitation Mini-CEX; RCEM Resuscitation CBD; reflective activity||ESLE RCEM App; RCEM Resuscitation Mini-CEX; RCEM Resuscitation CBD; reflective activity|
|Care for an injured patient||RCEM App; Mini-CEX; CBD; reflective activity||ELSE; RCEM App; Mini-CEX; CBD; reflective activity||ELSE; RCEM App; RCEM Mini-CEX; CBD; reflective activity||ELSE; RCEM App; Mini-CEX; CBD; reflective activity||ESLE; RCEM App; Mini-CEX; CBD; reflective activity|
|Care for children in the ED||ESLE; Mini-CEX; CBD; RCEM App; RCEM Resuscitation Mini-CEX; RCEM Resuscitation CBD; reflective activity||ESLE; Mini-CEX; CBD; RCEM App; RCEM Resuscitation Mini-CEX; RCEM Resuscitation CBD; reflective activity||ESLE; Mini-CEX; CBD; RCEM App; RCEM Resuscitation Mini-CEX; RCEM Resuscitation CBD; reflective activity|
|Deliver key procedural skills||DOPS; Record of skills lab activity; RCEM logbook||DOPS; Record of skills lab activity; RCEM logbook||DOPS; Record of skills lab activity; RCEM logbook||DOPS; Record of skills lab activity; RCEM logbook||DOPS; Record of skills lab activity; RCEM logbook|
|Deal with complex situations on the shop floor||RCEM App; CBD||RCEM App; CBD||ELSE; RCEM App; CBD||ELSE; RCEM App; CBD||ELSE; RCEM App; CBD|
|Lead the ED shift||ESLE; reflective activity||ESLE; reflective activity||ESLE; reflective activity||ESLE; reflective activity|
|Provide basic anaesthetic care (ACCS)||Mini-CEX, CBD, DOPS, RCEM logbook, RCEMLearning|
|Manage patients with organ dysfunction and failure (ACCS)||Mini-CEX, CBD, DOPS, logbook, RCEMLearning|
The Faculty Entrustment Group (FEG) statement is summative evidence that the trainee has met the required standard for each of the relevant SLOs for their stage of training. The Educational Supervisor can therefore explore in more depth the strengths and areas to work on for their trainee.
The entrustment statement frees the trainee from producing an exhaustive list of episodes to ‘tick off’. The purpose of the e-portfolio is to provide evidence that can be triangulated with the Faculty Entrustment Group statement, but also to ensure the trainee is developing as a self-regulating learner and taking the opportunities to develop in the clinical sphere.
That being said, what follows is some guidance for trainees and trainers about how the supporting evidence in the e-portfolio might be collated.
WPBA Requirements for Clinical SLOs for ARCP
- At least three ESLEs are required in each training year in intermediate and higher training.
- One MSF in each year of training. The MSF must be completed in the first 6 months of the training year so any training needs can be addressed in year, if necessary.
- Evidence of interaction with the training faculty in each of the Clinical SLOs relevant to the stage of training from the outset of training. This will be reviewed at the first 3 month review with the Clinical/Educational Supervisor
- There are no absolute numbers of WPBAs thereafter- the quality of the learning or reflection is of greater importance. There needs to evidence collated of observed practice in each of the Key Capabilities of each of the Clinical SLOs, and assessments in each SLO need to include a number of assessors.
Aiming for around one observed episode every week across each of the Clinical SLOs would be a reasonable aim. These episodes, especially when using the RCEM App, need not necessarily be lengthy. It is more important that the relevant learning point is explored. This may be quite focussed, eg for an intermediate trainee evidencing SLO2- answering questions, this may be an observation of the clinician answering a question posed by a junior staff member. The feedback may be focussed and offer one or two things to reflect upon. It may take a matter of minutes. The trainee would provide a focussed reflection that might take longer, depending upon the learning encounter, but the episode in the work place might be brief.