Assessment guide

RCPCH response to COVID-19 - modified assessments table

For the ARCPs (Annual Review of Competence Progression) held during academic year 2022/23, we have modified the minimum evidence requirements.

This table indicates the minimum evidence requirements to allow an ARCP outcome 1 and/ or trainee progression.

NB - no minimum number of assessments for Case Based Discussions or mini-CEX across the grades - essential element is reflective practice to recognise development and learning.

Our assessments

These assessments are available on your RCPCH ePortfolio (on the risr/advance platform, formerly Kaizen) - you can log in to ePortfolio and read our guidance.

Alignment with RCPCH Progress curriculum

For each assessment described below, we identify which primarily and secondarily link to which Progress domains. Each domain has three levels - see how the curriculum is structured on our Progress guidance page.

When selecting domains, select the learning outcome for your level of training based on your training grade. Only select a level higher than your training grade if advised by your supervisor or ARCP panel:

• If you are in training grade ST1-ST3, select Level 1 learning outcomes only
• If you are in training grade ST4-ST5, select Level 2 learning outcomes only
• If you are in training grade ST6-ST8, select Level 3 learning outcomes only

Notes accompanying table of assessments

Supervised learning events (SLE)

• The purpose of SLEs is as a means of engaging in formative learning; therefore a trainee who presents evidence of SLEs that cover only a restricted area of the curriculum runs the risk of being judged as having poor strategic learning skills.
• Trainees should use SLEs to demonstrate that they have engaged in formative feedback. They should record any learning objectives that arise in their PDP and show evidence that these objectives have subsequently been achieved.
• There are no minimum numbers of SLEs (other than the mandatory assessments described). Trainees and supervisors should aim for quality not quantity. A useful SLE will stretch the trainee, act as a stimulus and mechanism for reflection, uncover learning needs and provide an opportunity for the trainee to receive developmental feedback. Trainees do not need to achieve a prescribed ratio of mini-CEX to CbD assessments; it is anticipated that more junior trainees might undertake relatively more mini-CEX and more senior trainees undertake more CbD, reflecting the increasing complexity of decision-making etc.
• The numbers of SLEs given for ACAT, HAT, LEADER and Safeguarding CbD are minimum requirements; senior trainees in particular should bear in mind that each of the SLEs is designed for formative assessment of different aspects of the curriculum and more than this minimum number of some types of SLE might be required, depending upon the specific requirements and clinical context of a subspecialty. Trainees are therefore advised to consult their relevant subspecialty CSAC curriculum, in case there are additional specified assessment requirements.
• At least one of each of these SLEs must be assessed by a senior supervisory clinician (eg, Consultant or senior SASG/Specialty Doctor) – ie, ACAT and HAT during level 2 training, LEADER during level 2 and level 3 and at least one of the DOCs during level 2 and level 3.

Assessment of Performance (AoP)

• The compulsory procedural skills are listed below in our DOPS section.
• The ePortfolio skills log should be used to demonstrate development and continued competence.

Additional requirements

• Trainees must also complete accredited neonatal and paediatric life support training during Level 1 training (NLS, EPALS, APLS equiv.)
• Trainees must achieve the level 1 and 2 Intercollegiate Safeguarding Competences by the end of ST3, the majority of Level 3 competences by the end of ST5 and all Level 3 competences along with the additional paediatrician competences by the end of ST8.
• Trainees can complete up to 25% of assessments during simulation but they are required to complete a non-simulated assessment for each of the mandatory DOPS.
  

Directly Observed Procedural Skills (DOPS)

A DOPS can demonstrate your practical procedural skill in paediatrics.

You need to be judged as competent to perform without supervision on a range of procedures. You may need to repeat a DOPS for a specific procedure until this standard is achieved. Once you have met that standard,you do not need to repeat a DOPS for that procedure. For example, if you have been signed off as meeting the standard in level 1, you do not need to demonstrate this again in level 2 or 3, though you should record further experiences of applying the procedure in your skills log.

You need to complete one satisfactory DOPS for the specific mandatory procedures stated in your level of the curriculum.

DOPS can be used as a formative development tool. It is often used as a summative tool to demonstrate proficiency in one of the curriculum's required procedures. Both formative and summative DOPS can be signed off by consultants, more senior trainees, nurse practitioners and other professional assessors.

Procedures for which DOPS are compulsory

• Bag / mask ventilation (can be covered by APLS or NLS or equivalent life support certification)
• Peripheral venous cannulation
• Lumbar puncture
• Airway maintenance (Neonatal) to include airway opening manoeuvres and the use of airway adjuncts to maintain an airway to the point of intubation.
• Umbilical venous cannulation

Procedures for which DOPS are optional

This list should be read in conjunction with the RCPCH Progress curriculum (pages 26, 34 and 35). You will still be required to provide evidence for competence in these procedures, but the evidence need not be from a DOPS (although a DOPS would count). An alternative to a DOPS may be a supervised learning event, with reflection and entry into the skills log. For example, infrequently performed procedures carried out by middle grade staff may rarely be observed by consultant staff, so your log book entry accompanied by a reflective note or evidence from simulation could be an acceptable alternative to a DOPS.

This list not intended to be exclusive and other procedures may also be appropriate.

• Collection of blood from central lines
• Suprapubic aspiration of urine
• Umbilical artery cannulation
• Umbilical vessel sampling
• Urethral catheterisation
• Percutaneous long-line insertion
• Intubation of preterm baby less than 28 weeks
• Administration of surfactant
• Peripheral arterial cannulation
• Intraosseous needle insertion
• Electrocardiogram (ECG)
• External cardiac massage
• Emergency needle thoracocentesis
• Chest drain insertion
• Perform basic lung function tests
• Administer intradermal injections
• Administer subcutaneous injections
• Administer intramuscular injections
• Administer intravenous injections

Links with the RCPCH Progress curriculum

DOPS assessments primarily link to the following curriculum domains:

• Procedures (D3)

DOPS assessments can also be used to secondarily demonstrate the following curriculum domains:

• Professional values and behaviours (D1)
• Communication (D2)
• Patient management (D4)
• Patient safety (D7)
• Leadership and team working (D6)
• Education and training (D10)

It would be unusual for a DOPS to demonstrate Health promotion (D5), Quality improvement (D8), Safeguarding (D9) or Research (D11) and would need to be carefully explained how a DOPS might link to these.

Paediatric Mini Clinical Evaluation Exercise (Mini-CEX)

A mini-CEX is a formative assessment tool designed to generate useful feedback on your essential skills in a paediatric setting.

There is no minimum number of mini-CEX assessments required. You should aim to provide quality assessments rather than meeting a given number.

Each mini-CEX should represent a different clinical problem and could be targeted from a personal development plan you have set. You can choose the timing, problem and assessor. At least one of your mini-CEX assessments should be completed by your supervising consultant.

Using the mini-CEX

Mini-CEX is suitable for use in a broad range of settings. It can be used in outpatient, inpatient or acute care settings. Your assessor must have actually observed the part of the encounter they are rating, and provide you feedback in the aspects they have witnessed.

Ideal areas the mini-CEX can cover include the below.

Level 3 areas depend on your focus of specialty and are identified in your curriculum.

Links with the RCPCH Progress curriculum

Mini-CEX assessments primarily link to the following curriculum domains:

• Professional values and behaviours (D1)
• Communication (D2)
• Procedures (D3)
• Patient management (D4)
• Leadership and team working (D6)
• Patient safety (D7)

Mini-CEX assessments can also be used to secondarily demonstrate the following curriculum domains:

• Health promotion (D5)
• Safeguarding (D9)
• Education and training (D10)

It would be unusual for a Mini-CEX to demonstrate Quality improvement (D8) or Research (D11) and would need to be carefully explained how a Mini-CEX might link to these.

Relevant assessment standards

Paediatric Case Based Discussion (CbD)

A CbD is a formative assessment tool designed to develop and assess clinical reasoning and decision making.

As with mini-CEX, there is no stated minimum requirement, as we ask trainees to provide quality assessments rather than quantity. Good practice recommends that half your assessments for CbD should be selected by you and half by assessors, covering a range of clinical areas.

Using the CbD

The focus of discussion should be around an actual entry made in notes to explore clinical reasoning and decision making.

Example questions that might prove effective:

• Can you outline your thought processes when devising that management plan?
• There are a number of different investigations; can you talk me through how you expected the results to help you?
• You have referenced the ward guidelines in your notes; please could you explain your thinking on using these guidelines for planning patient management and any aspects that didn't fit in this case?
• You have treated a child with [x] - talk me through your decision to prescribe and what alternatives you considered
• You've mentioned you would ask Dr X for advice - what specifics did you want to discuss with them, why was it important in this case, how did their advice help and what did you learn?

Links with the RCPCH Progress curriculum

CBD assessments primarily link to the following curriculum domains:

• Professional values and behaviours (D1)
• Communication (D2)
• Patient management (D4)
• Patient safety (D7)

CBD assessments can also be used to secondarily demonstrate the following curriculum domains:

• Health promotion (D5)
• Leadership and team working (D6)
• Safeguarding (D9)
• Education and training (D10)

It would be unusual for a CBD to demonstrate Procedures (D3), Quality improvement (D8) or Research (D11) and would need to be carefully explained how a CBD might link to these.

Relevant assessment standards

The table below highlights the relevant RCPCH assessments standards relating to each question

Paediatric Multi-source feedback (MSF)

MSF gathers a range of views on your work around clinical care, applying Good Medical Practice, assessing and teaching, working with colleagues and relationship with patients.

You can start you own MSF in your ePortfolio at any point in the training year. It will remain an open assessment until you close it after receiving at least seven responses. You cannot receive more than 20 replies.

The purpose of this Paediatrics MSF is to provide you with information about your work in the eyes of your colleagues. Only Clinical Staff are meant to complete an MSF for you to help inform your further development. If you mistakenly ask someone who is not a Clinical Staff member, please ask them to ignore.

We have developed this guidance video to help work with the MSF tool in the RCPCH ePortfolio

Note for respondents

Respondents can expect anonymity for their replies. We would expect responses to be professional and objective. We would also encourage respondents to discuss with the trainee requesting the MSF if there are areas for development.

• Be honest and helpful: trainees will get the most from honest and helpful feedback about things they can improve on.
• Explain your ratings: more information on the ratings you give and specific examples are key to offering a more useful MSF outcome to the trainee.

If there are any comments that are untoward, inappropriate, offensive, or malicious, for example comments about protected characteristics in the Equality Act, the RCPCH reserves the right to override a respondent's expectation of anonymity to address these concerns by informing the educational supervisor and training programme director of individual comments.

They may choose to advise the trainee as part of their internal process. We will, however, where possible, inform you if we notify the educational supervisor and training programme director of our concerns.

Who to include

Your assessors must include your educational supervisor and 2/3 medical staff - of which half should be consultant level. It is entirely appropriate that the remaining 1/3 can be nursing or allied health professional.

Removing content or responses

We, the RCPCH, do not, as a rule, remove written feedback submitted to your MSF on your RCPCH ePortfolio. We would encourage you to discuss your feedback with your educational supervisor. You should reflect on the feedback with your educational supervisor and it might be appropriate for your supervisor to discuss with other members of the local team.

We encourage all MSF respondents to have discussed any concerns with you before submitting feedback, however, we recognise this is not always done in practice. The data submitted as part of your MSF are not subject to data regulation requests and we are not required to attribute comments in your MSF to individual respondents.

Guidance

An MSF is required every year of training and will be considered in your ARCP.

Discussion of Correspondence (DOC)

This is a supervised learning event that assesses your clinic letters and other forms of written communication.

As detailed in the table of assessments, from ST4 (start of level 2) you will need to have five letters or communications reviewed in total between ST4 and completing training. In level 1 (ST1-ST3) DOC assessments are optional. This will change when we launch Progress+ in summer 2023.

Please insert a brief summary of the case

This is to be completed at the time of selecting the assessment online, using ePortfolio. It is visible to the assessor or trainee when the notification for completing the assessment is received by them.

Please document your discussion with regard to one of:

• Outpatient letter
• Discharge summary
• Transfer letter
• Safeguarding report
• Education healthcare plan (EHCP)

Your assessor will review using these three boxes with details of the discussion in the following areas:

• Clarity: This section focuses on the usability of the letter. How easily understandable is it? Is it well structured?
• Clinical assessment: This is the space to document discussion of the accuracy of documentation of clinical findings. Is the history, examination, investigation results, treatment and follow up documented accurately? Is anything important missing?
• Communication: Does the letter update the reader on communication with the patient or parents? From review of the notes are all involved professionals sent a copy? Would you as the reader understand any actions asked of you?

Agreed learning objectives

When your assessor has reviewed your DOC, there may be an opportunity to agree learning objectives. Please document clear and achievable learning objectives from any issues highlighted during the discussion.

Links with the RCPCH Progress curriculum

DOC assessments primarily link to the following curriculum domains:

• Professional values and behaviours (D1)
• Communication (D2)
• Patient management (D4)
• Patient safety (D7)

DOC assessments can also be used to secondarily demonstrate the following curriculum domains:

• Health promotion (D5)
• Safeguarding (D9)

It would be unusual for a DOC to demonstrate Procedures (D3), Leadership and Team (D6), Quality improvement (D8), Education and training (D10) or Research (D11) and would need to be carefully explained how a DOCmight link to these.

Handover Tool (HAT)

This is a formative supervised learning event assessing your ability to safely handover patients.

The assessment seeks information on your capability in some or all of the following areas:

• structure of handover and organisation (eg action planning, SBAR)
• safety briefing (eg high risk patients, safeguarding
• unit ward management (eg staffing and bed status)
• workload (eg discharges, follow-ups and expected patients)
• non-technical skills (eg, time management and prioritisation).

We recommend trainees complete a minimum of one HAT in level 1 and two HAT in level 2. They are optional for level 3. At least one of these should be completed by a supervising consultant. This will change when we launch Progress+ in summer 2023.

Links with the RCPCH Progress curriculum

HAT assessments primarily link to the following curriculum domains:

• Professional values and behaviours (D1)
• Communication (D2)
• Patient management (D4)
• Leadership and team working (D6)
• Patient safety (D7)

HAT assessments can also be used to secondarily demonstrate the following curriculum domains:

• Quality improvement (D8)
• Safeguarding (D9)
• Education and training (D10)

It would be unusual for a HAT to demonstrate Procedures (D3), Health promotion (D5) or Research (D11) and would need to be carefully explained how a HAT might link to these.

Acute Care Assessment Tool (ACAT)

This assessment is most effective when contemporaneously completed with your assessor. We recommend you select an occasion when you and your assessor will both be present during acute paediatric care. Indicatively this would be post take ward round, acute take in the emergency setting or when carrying the "consultant on call" bleep (for more senior trainees).

Observing the whole shift is unnecessary as long as the majority of the following areas can be commented on (but not intended to have each area ticked off in turn):

• Clinical assessment
• Medical record keeping
• Investigations and referrals
• Safe prescribing
• Management of the acutely unwell patient
• Time management
• Team management
• Conflict resolution
• Clinical leadership
• Decision making
• Teaching

From these areas, an assessor will be able to advise on an overall rating. Assessors may ask for and take account of comments from other team members. For this reason, we recommend that ACATs are assessed by consultant supervisors as likely being the most senior member of the medical team.

Links with the RCPCH curriculum

ACAT assessments primarily link to the following curriculum domains:

• Professional values and behaviours (D1)
• Communication (D2)
• Patient management (D4)
• Leadership and team working (D6)
• Patient safety (D7)

ACAT assessments can also be used to secondarily demonstrate the following curriculum domains:

• Procedures (D3)
• Quality improvement (D8)
• Safeguarding (D9)
• Education and training (D10)

It would be unusual for an ACAT to demonstrate Health promotion (D5) or Research (D11) and would need to be carefully explained how an ACAT might link to these.

LEADER

A LEADER is a formative assessment that focuses more on your leadership and team working capabilities than on the clinical elements in the case. Your assessor is likely to focus in one or two of the following domains:

• Leadership in a team
• Effective services
• Acting in a team
• Direction setting
• Enabling improvement
• Reflection

For 2022/23 training year, the minimum requirement is one LEADER CBD in level 2 and two in level 3. We recommend you complete one LEADER per training grade. In level 1, a LEADER CBD is optional. Things will change when Progress+ is launched in summer 2023.

Links with the RCPCH Progress curriculum

LEADER assessments primarily link to the following curriculum domains:

• Professional values and behaviours (D1)
• Communication (D2)
• Patient management (D4)
• Leadership and team working (D6) (most common)
• Patient safety (D7)
• Education and training (D10)

LEADER assessments can also be used to secondarily demonstrate the following curriculum domains:

• Health promotion (D5)
• Quality improvement (D8)
• Safeguarding (D9)
• Research (D11)

It would be unusual for a LEADER to demonstrate Procedures (D3) and would need to be carefully explained how a LEADER might link.

Safeguarding Case Based Discussion (SCBD)

A Safeguarding CBD is to be used like a CBD with a focus on managing safeguarding.

For 2022/23, the minimum required SCBDs is two in level 1, one in level 2 and two in level 3. We recommend at least one per training grade given the importance of safeguarding in paediatrics. Things will change with the launch of Progress+ in summer 2023.

Links with the RCPCH Progress curriculum

Safeguarding CBD assessments primarily link to the following curriculum domains:

• Professional values and behaviours (D1)
• Communication (D2)
• Patient management (D4)
• Leadership and team working (D6)
• Safeguarding (D9)

Safeguarding CBD assessments can also be used to secondarily demonstrate the following curriculum domains:

• Patient safety (D7)

It would be unusual for a Safeguarding CBD to demonstrate Procedures (D3), Health promotion (D5), Quality improvement (D8), Education and training (D10) or Research (D11) and would need to be carefully explained how a Safeguarding CBD might link to these.

RCPCH START

START stands for Specialty Trainee Assessment of Readiness for Tenure, and it guides trainees as they prepare for completion of training and practice as a new consultant paediatrician.

Our RCPCH START guidance for trainees lets you know how to check your eligibility, apply and pay and understanding how it fits in with your educational supervision.

Entrustment with Care Assessment Tool (ECAT) - pilot

The ECAT is an assessment modelled on an Entrustable Professional Activity (EPA), which can be defined as:

a unit of professional practice that can be fully entrusted to a trainee, as soon as he or she has demonstrated the necessary competence to execute this activity unsupervised

Ten Cate et al 2015

Why might we need the ECAT?

Excellence by Design standards from the GMC and our RCPCH Progress+ (responding to Shape of training) work will move the MRCPCH requirement to the end of ST4. This means we need a way of determining doctors are ready to move to tier 2 working (ST4 level).

We commonly hear from tier 1 doctors who are worried about stepping up. This tool will help you to gain experience, gather specific, constructive feedback about your work and evidence, when you are ready to progress.

So although an EPA is a collection of competencies, which we have already combined into the curriculum learning outcomes, the use of the ECAT lies in how it reassures a trainee that they have met the requirements for stepping up to tier 2 rota.

Former RCPCH Officer for Assessment, Ashley Reece, and former Trainee Committee Assessment rep, Nick Schindler, explain the rationale for the ECAT and how it would help support trainees to move on to the middle grade rota.

The ECAT is available to all trainees as an optional tool for this purpose. It is accordingly targeted mostly at ST3 level paediatricians though others can make use of it via their ePortfolio. It will help contribute to trainees demonstrating their readiness for tier 2 working, as requested by Paediatrics Heads of School.

How to use the ECAT with your supervisor

The ECAT presents you with an opportunity to get feedback on your tier 2 readiness. The feedback should enable you to reflect and focus your development towards the next level of responsibility.

We suggest the ECAT is used by you and your supervisor to record observations of you undertaking normal core middle grade activities in your workplace such as:

• Post-take ward round
• Managing admissions
• Ongoing care for infants on neonatal units
• Running acute take
• Covering an assessment unit

To facilitate this, you should be given the opportunity to "act-up" and perform the role of a tier 2 doctor when being observed and assessed. Your supervisor or other supervising consultant might be present the whole time or available remotely depending on how you set it up. Information from your colleagues may also be included in your feedback from nursing staff, allied health professionals, peers and other consultants.

Towards the end of ST3 there would be a local faculty 'entrustment decision' detailing the level of independence to which your consultants feel you can be entrusted to work at tier 2. This would be reviewed by your ARCP panel to decide on progress to ST4.

Examples of activities suited to ECAT

It is important to note you do not have to complete an ECAT for all these activities. ARCP panels will be looking for entrustment decisions in core areas. The following is not an exhaustive list of areas for an ECAT:

• Running acute paediatric take
• Coordinating patient care with common acute presentations across multiple care settings (ie, an assessment unit, paediatric ward, neonatal ward, postnatal ward)
• Leading a discharge planning meeting
• Managing admissions (including pre-term infants) to the Neonatal Unit, over the course of a shift
• Supervising management of infants receiving high dependency and special care on the neonatal unit, over the course of a shift

Assessment parameters

You will be assessed whether you:

• Can undertake activity with reactive supervision, ie on request and quickly available, OR
  Cannot yet undertake activity without direct, proactive supervision

There will be space to detail what you and your supervisor determine is needed to progress to the next stage of entrustment, or to improve your practise further.

Completing an ECAT

The ECAT form is housed in your RCPCH ePortfolio. You and your assessor should select an occasion when you are both present during an appropriate episode of paediatric care

It is not necessary for the whole shift or ward round to be observed though sufficient time must be allowed for observing the domains outlined in each ECAT form. The form also contains optional domains as the opportunity to demonstrate these may not naturally occur.

A short period should be set aside for feedback at the end of the observation, either immediately or soon after.

Feedback and reflection

Following the discussion, the assessment can be completed on your ePortfolio making reference to the RCPCH Progress curriculum level 1 learning outcomes. Feedback will identify areas performed well and suggestions for development along with actions that could be added to your PDP.

You should take the the opportunity to reflect on the episode and feedback, recalling what went well and where development might be needed.