Assessment guide

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

Assessments table

The below tables indicate the minimum evidence requirements in 2023-24 to allow an ARCP (Annual Review of Competence Progression) outcome 1 and/or trainee progression. You can download the table as a PDF from the downloads section below, as well as the RCPCH Assessment Strategy document.

Core training (Progress+)

Supervised learning events

Assessment of Performance (AoP)

Other evidence required for ARCP

MRCPCH exams

Specialty training (Progress+)

Supervised learning events

Assessment of Performance (AoP)

Other evidence required for ARCP

For trainees gaining their CCT before 15 September 2024 (Progress)

	Level 1			Level 2		Level 3
Grade	ST1	ST2	ST3	ST4	ST5	ST6	ST7	ST8
SLEs	Safeguarding CBD minimum 2 per training level Minimum 1 Handover Assessment Tool (HAT) by end of ST3			Safeguarding CBD minimum 1 per training level Minimum 1 ACAT observed by supervising clinician 1 HAT per level 1 LEADER per level 2 DOCs during level 2		Safeguarding CBD minimum 2 per training level 2 LEADER per level 3 DOCs during level 3
MSF	1 MSF per grade			1 MSF per grade		1 MSF per grade
AoP	Minimum 1 satisfactory DOPS for compulsory procedures					DOPS or other evidence of capability in procedures according to L3 curriculum
Life support	Valid life support evidence, APLS, NLS, EPALS or equivalent by end of ST3			Continued valid life support evidence, APLS, NLS, EPALS or equivalent		Continued relevant valid life support evidence
Exams and other assessments	End of ST3 = all theory exams End of ST4 = all theory and clinical - full MRCPCH					Completion of and reflection from RCPCH START assessment
Trainer's report	Satisfactory Educational supervisor report for each year for ARCP			Satisfactory Educational supervisor report for each year for ARCP		Satisfactory Educational supervisor report for each year for ARCP

Explanatory guidance

Supervised Learning Events

1. The purpose of SLEs is as a means of engaging in formative learning.
2. Trainees should use SLEs to demonstrate that they have engaged in formative feedback. They should record any learning objectives that arise in their Personal Development Plan (PDP) and show evidence that these objectives have subsequently been achieved.
3. There is no minimum number of SLEs (other than the mandatory assessments described in note 7). Trainees and supervisors should aim for quality over 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.
4. Trainees are also encouraged to undertake the assessments indicated as optional.
5. Trainees are advised to consult their relevant sub-specialty syllabus, in case there are additional specified assessment requirements.
6. At least one of each of these SLEs must be assessed by a senior supervisory clinician (e.g. a consultant or senior Specialty and Associate Specialist Grade [SASG]/specialty doctor).

Assessment of Performance

7. The compulsory procedural skills are listed on this web page.
8. The ePortfolio skills log should be used to demonstrate development and continued capability.

Additional requirements

9. Trainees must also complete accredited neonatal and paediatric life support training during Core training (NLS, EPALS, APLS or equivalent). The Resuscitation Council have helpfully mapped the courses Progress+. Check the curriculum map section of each course to find out which key capabilities they can be used for.
10. Trainees can complete some of the assessments during simulation, for example Inter-osseous Access.
11. PaedCCF can be used as an additional tool if required.

Additional guidance for ST4 and ST5(C4) trainees

If you are an ST4 or ST5(C4) trainee moving to Progress+ core, and you have been signed off for Level 1 Progress or appointed at ST4 with Level 1 capabilities assessed during the recruitment process, you can find further guidance:

For ST4 or ST5(C4) trainees moving to Progress+ Core - guidance

Alignment with RCPCH Progress+

For each assessment described below, we identify which primarily and secondarily link to which domains as outlined in the Progress+ curricula.

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, you do not need to demonstrate this again, 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

• Peripheral venous cannula
• Lumbar puncture
• Neonatal umbilical venous catheterisation (UVC)
• Intraosseous needle insertion for emergency venous access*

*With the exception of Intraosseous needle insertion (IO) (Domain 3, Key capability 3.4), mandatory DOPS must be completed using non simulated environments. We are awaiting clarification if an APLS course is also considered as an acceptable evidence for IO DOPS

The key capabilities relating to neonatal and paediatric airway (Domain 3, Key Capabilities 4,5 & 6) can be evidenced by Mini-Cex or DOP which can also be in a simulated environment.

Procedures for which DOPS are optional

This list should be read in conjunction with the Progress+ curriculum. 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 (now a Mandatory DOPS)
• 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
• Intubation of term baby
• Intubation of pre-term baby 28-37 weeks
• Less invasive surfactant administration (LISA)

Links with Progress+ for DOPS

DOPS assessments primarily link to the curriculum domain:

• Procedures (D3)

DOPS assessments can also be used to secondarily demonstrate the 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. 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 (for trainees on Progress and CCT'ing before 15 September 2024):

Links with Progress+ for the mini-CEX

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 for the mini-CEX

This guidance is for trainees on Progress and CCT'ing before 15 September 2024.

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 Progress+ for the CbD

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 for the CbD

This talbe highlights the relevant RCPCH assessments standards relating to each question. The guidance on levels is for those trainees on Progress and CCT'ing before 15 September 2024.

Paediatric Multi-Source Feedback (MSF)

As of 4 December 2023, the GMC approved a new MSF tool (MSF+), which was developed with and tested by paediatric doctors in training. The updated MSF+ form is shorter, without numerical ratings, and is mapped to the Progress+ curriculum domains. It facilitates meaningful feedback from a wider range respondents and in a concise and user friendly way. We will be continually evaluating the performance of the new MSF+, and we welcome your feedback.

The previous ePaedMSF form is no longer be available to begin, though existing forms can be completed.

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

The purpose of the MSF is to facilitate paediatric doctors in training to receive and reflect on feedback on their performance from a wide range of individuals from their professional sphere.

The new MSF+ format uses a dynamic form, which presents different questions to respondents depending on their professional role. All respondents (who can be consultants, clinicians, nursing and allied health professionals, or admin staff) will be asked to offer feedback in the three key domains of Professional values and behaviours, Professional skills and knowledge: Communication, and Leadership and team working. Only doctors and clinicians will be given the option of providing feedback in the other Progress+ domains, and these areas are optional. If you mistakenly ask someone who is not a clinical staff member, please ask them to ignore.

Who to include on the MSF

Your assessors must include your educational and/or clinical supervisor and two to three medical staff, of which half should be consultant level. It is entirely appropriate that the remaining 1/3 can be nursing or allied health professionals, or admin staff.

This video can help you work with MSF in RCPCH ePortfolio. Please note this is for the previous form of MSF.

Note for respondents on the MSF

Respondents can expect anonymity for their replies. We expect responses to be professional and objective. We 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.

Respondents 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.

Removing content or responses on the MSF

We at RCPCH do not, as a rule, remove written feedback submitted to your MSF on your RCPCH ePortfolio. We 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 for the MSF

A minimum of one MSF per grade of training with a sufficient number and variety of respondents is required, and will be considered in your ARCP.

Discussion of Correspondence (DOC)

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

As detailed in the assessments table at the top of this page, from ST4 (start of level 2 for trainees on Progress and CCT'ing before 15 September 2024) 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 changes under Progress+, and we will provide the new assessments table soon.)

Brief summary of the case for the DOC

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 for the DOC

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 Progress+ for the DOC

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 DOC might 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).

For trainees on Progress and CCT'ing before 15 September 2024, we recommend you complete a minimum of one HAT in level 1 and two HAT in level 2; they are optional for level 3. At least one HAT should be completed by a supervising consultant.

Links with Progress+ for the HAT

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 Progress+ for the ACAT

ACATs 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)

ACATs 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. (This changes under Progress+, and we will provide the new assessments table soon.)

Links with Progress+ for the LEADER

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. (This changes under Progress+, and we will provide the new assessments table soon.)

Links with Progress+ for the SCBD

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 SCBD 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 SCBD might link to these.

Entrustment with Care Assessment Tool (ECAT)

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 do we need the ECAT?

The GMC 'Excellence by Design' standards and RCPCH Progress+ moves 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 helps 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 combined into the curriculum learning outcomes, the use of the ECAT lies in how it reassures you as a trainee you 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, explained 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, and it is currently being run as a pilot. It is targeted mostly at ST3 level paediatricians though others can make use of it via their ePortfolio. It helps 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 in the workplace (consultant or SAS grade supervisor in the workplace) 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 supervising consultant (can be clinical supervisor, educational supervising or supervisor in the workplace) 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 curriculum 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.

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.

The College strives to evaluate and review all of our exams and assessments on an ongoing, dynamic basis. We are currently prioritising review of clinical exams, but as part of this wider post-Progress+ review we will be looking at START in greater detail further into 2024.
 
We are aware there has been some discussion around how  START will fit into the College’s programme of assessment going forward, and would like to clarify that there are no changes planned for START assessments in 2024.

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.