The College’s Conference is now a distant memory, summer is here (!) and what better way to spend these sun-soaked, balmy evenings than preparing for ARCPs?
For the majority of trainees and educational supervisors, this will be the first time that they prepare for ARCPs (Annual Review of Competence Progression) using the Progress curriculum, which was launched last August. The vast majority of people I meet are very enthusiastic about the curriculum. Nevertheless, I do not underestimate the difficulties we may face when moving away from specific competencies to fewer, but much less specific, capabilities.
Challenge 1: The curriculum is too vague - there is a lack of detail, particularly in the description of specific clinical knowledge and skills. Looking at a portfolio, how can I be sure that I have (or my trainee has) all the necessary skills to be a safe and competent clinician?
Whilst there might be a theoretical argument for describing the curriculum in terms of all the clinical conditions or pathologies a consultant paediatrician needs to manage, this approach is problematic. It's obviously time consuming to tag experiential learning to all conditions but, more importantly, what do you do with a trainee at the end of training who has not been able to evidence management of a specific condition?
The implied message of such a curriculum would be to deny them a CCT (certificate of competence of training), even if their practice was otherwise good, for the safety of future patients presenting with that condition. In reality, under the previous curriculum, some trainees were encouraged to tag everything, but evidence of meaningful learning was rarely assessed, and certainly not across the entirety of the curriculum. As a method of ensuring quality of training, this was delusional and falsely reassuring to the public.
Progress describes things that will increasingly matter...
The Progress curriculum describes things that will increasingly matter in the future. Competencies are sooo yesterday… Capabilities, rather, describe the predicted future performance of a practitioner when faced with a problem.
In the past, doctors were gatekeepers of knowledge; in the future, Dr Google and Google AI will be available to all. Clinicians will only add value by use of skills such as team working, communication, interpretation of data, problem solving, adaptability, empathic understanding of their patients, etc.
Challenge 2: Why do we even need a portfolio?
Portfolios are about learning, not experience. They should demonstrate the process by which learning is sought, achieved and evaluated by the learner. They are not intended to chronicle a series of experiences. Quality of evidence is important; quantity is irrelevant.
One dictionary definition of a portfolio is “a collection of drawings, documents, etc. that represent a person's, especially an artist's, work”. Similarly, training portfolios should contain a representation - a purposive sample - of learning, not the entire training experience.
My analogy is that a portfolio represents the display windows of a department store. The store management decide which samples to display, conveying an idea of the range, quality and style of products on sale within the store.
Portfolios are about learning, not experience...
It is necessary to demonstrate that learning occurs in all curricular domains over each level of training. However, it is unnecessary and unhelpful to tag as many domains as possible for each learning event. People do this because they are anxious to show complete coverage of the curriculum (in a summative mindset), whereas the emphasis should be seeing the focus of the learning for each event (formative mindset). That's why we discourage multiple tagging for each event.
We need to value evidence that our trainees are self-aware and resourceful in meeting their learning needs far more than we do at present. There will always be a degree of subjectivity involved in assessing portfolios, and we have tried to ensure consistency and transparency by issuing guidance on the expected standards for each training level.
To help prepare for ARCPs with RCPCH Progress, we've developed a practical guide for trainees, supervisors and ARCP panels, Preparing for ARCPs with RCPCH Progress: Judging achievement of Learning Outcomes to support progression decisions, which you can download from our Progress guidance and support page. This guidance will undoubtedly need refining as the curriculum embeds.
Challenge 3: Why is the educational supervisor's report for ARCP now so long and difficult to complete?
The intention is that the trainee present a succinct summary of the evidence that shows their learning towards the key capabilities in each of the 11 domains
Trainees should choose a purposive sample, again remembering that quality is valued, quantity is irrelevant. This mirrors the input form used in NHS medical appraisals. The supervisor is able to view the domain summary and click through to the primary evidence, as required, before giving their opinion upon the evidence in each domain, and suggesting points for development, if needed.
The process will work well if: (a) trainees and supervisors value quality and don’t feel pressured to judge on the basis of quantity, (b) the supervisor’s comments can be typed directly underneath the trainee’s summary for each domain (which requires an awaited upgrade of the functionality for Kaizen, the platform for RCPCH ePortfolio), and (c) we try to cut out as much redundant text and space within the forms, in order to improve the layout.
Quality is valued, quantity is irrelevant
As an NHS Trust appraiser and a Certificate of Eligibility for Specialist Registration (CESR) evaluator, I've noticed a steady improvement in how appraisal input and CESR application forms are being completed – both of which use a similar domain-based approach. And so I am confident that, given time and support, we can achieve similar improvement in the quality of our educational supervisor reports for ARCP.
So, my challenge to everyone involved in training is to aim higher than merely ensuring we train competent paediatricians; we are looking to professionals who will need to shape the future of paediatrics.