Assessment review - information and updates

About the assessment review 

When we developed Progress+, the two-level paediatric training curriculum that launched in August 2023, we did not review the programme of assessment. Two years on and with Progress+ embedded in paediatric training across the UK, it's now time to do that.

The assessment review is being led by two groups: one focuses on the MRCPCH Clinical examination; the other focuses on assessments in the workplace (for example, mini-Cex, CbD, DOPS) and START. Both groups include Postgraduate Doctors in Training (PGDiT), trainers and the College assessment and exam staff teams. The assessment review does not include the three theory examinations (FOP, TAS and AKP). 

We are piloting the outcomes of the assessment review. In late 2025 we will conduct a formal consultation. We will then submit our proposal to RCPCH Council and then the General Medical Council in 2026. 

We invite you to read our blogs on the rationale for change by Vice President for Training and Assessment Dr Cathryn Chadwick, and Assessment review - update from the Trainee Committee on starting the pilot stage by Dr Josh Hodgson, Incoming Chair and Dr Emma Dyer, Outgoing Chair of the RCPCH Trainee Committee. We have also published a collection of FAQs below, which we will continue to update as the review progresses. We'll update members through our regular Member eBulletins - make sure you're opted in to the contact preference, 'College updates and professional updates'.

Frequently asked questions 

Why is an assessment review being undertaken?

An assessment review is being undertaken to align the assessment framework with the Progress+ curriculum. The review will look at the way in which Postgraduate Doctors in Training (PGDiT) are assessed along the training pathway to ensure that they are being assessed in the right way and at the right time. As part of the review, the programme of assessment will be scrutinized to ensure assessments are fit for purpose, sustainable, align with the 2-tier programme structure (introduced as part of Progress+) and support high-quality paediatric training.

Who is involved in the assessment review?

Two review groups have been formed; a Clinical Exam Review Group (CERG) and a Training and Assessment Review Group (TARG). The review is being led by our Vice President, Dr Cathryn Chadwick, and each review group is informed by doctors in training, trainers and the college assessment and exam teams, as well as input from RCPCH &Us, which represents the voice of children and young people. Once the reviews have been completed all proposed developments will be ratified through internal College governance processes via the Council and Board of Trustees before being submitted to the General Medical Council for approval ahead of implementation. 

What does the assessment review involve?

Subgroups that sit within CERG and TARG (explained in previous tab) have been formed to review the current assessment tools to ensure there is a clear rationale for undertaking each assessment. As part of the review the teams will establish which assessment tools work, which ones need to be revised, and which ones are no longer fit for purpose or have been covered by other areas of the curriculum. 

What are the timelines for the assessment review?

The provisional timelines for the review, piloting, consultation and implementation are included below. Please note that all timeframes are provisional and subject to change. There will be ongoing communication throughout the process to ensure all stakeholders are kept informed as the review evolves. 

• June 2025: Completion of CERG and TARG workstreams 
• July – November 2025: Pilots 
• November 2025 – January 2026: Consultation 
• February 2026: Approval by Council and Board of Trustees 
• February – April 2026: Approval by GMC 
• October 2026: Implementation

How will the assessment review affect my training?

The assessment review is currently ongoing. There are no immediate changes planned which would affect postgraduate doctors in training (PGDiT) and their training. Once the assessment review has been approved by the GMC, the teams will work towards a staggered implementation from October 2026 onwards, starting with workplace-based assessments. It is anticipated that any changes made to the MRCPCH Clinical exam will need additional preparation time.

Will there be an increase in the number of assessments postgraduate doctors in training (PGDiT) are expected to complete in response to the assessment review?

The College is aware of the assessment burden placed on PGDiT and has been a leading example in ensuring that the number of assessments is proportionate to the training programme. This proportionality and the relevance of assessments will be kept in mind as part of the review. The Training and Assessment Review Group (TARG) do not want to increase the number of assessments that are being asked of PGDiT.

Currently there are mandatory and summative assessment elements which the group want to maintain to ensure a holistic approach to assessment. The aim is to have a range of assessment tools that work together to support PGDiT formative training experience and provide a comprehensive overview of their progression and capability.

Will the assessments that I have completed prior to the assessment review still be valid?

Yes, mandatory, and optional assessments completed by postgraduate doctors in training (PGDiT) during their training can be used to evidence satisfactory completion of the Progress+ curriculum. PGDiT are encouraged to continue to collate and log their assessments on ePortfolio contemporaneously.

The focus of Progress+ is quality rather than quantity, so residents are encouraged to use their most relevant piece of evidence when mapping to the key capabilities within each learning outcome. All PGDiT are encouraged to continue to follow the current assessment structure until a clear directive is given following the review. 

I am currently undertaking Core Level training. What programme of assessment should I be following while the review is underway? 

The assessment review is currently ongoing. There are no immediate changes planned which would mean that PGDiT need to deviate from their current programme of assessment.

Please continue to refer to the Progress+ Core Level curriculum and the current assessment structure for more information. 

I am currently undertaking Specialty Level Training. What programme of assessment should I be following while the review is underway?

The assessment review is currently ongoing. There are no immediate changes planned which would mean that PGDiTs need to deviate from their current programme of assessment. Please continue to refer to the Progress+ Specialty Level curriculum and the current assessment structure for more information. 

I am undertaking sub-specialty training. Will the assessment review apply to me and if so, how?

The assessment review is looking at the assessment tools used across all paediatric training programmes. Any changes that are introduced as a result of the assessment review will apply to those undertaking sub-specialty training.

Please continue to refer to your Progress+ subs-specialty curriculum and the current assessment structure for more information.

Will the assessment review result in more changes to the ePortfolio?

We appreciate that with the introduction of Progress+ changes had to be made to the ePortfolio to align it with the new curriculum. We do not anticipate introducing any major changes to the current ePortfolio in response to the assessment review, however some assessment forms may be subject to change depending on how each assessment tool evolves.

Where possible we want to continue to make the ePortfolio as accessible as it can be while meeting the needs of postgraduate doctors in training (PGDiT) and trainers.

We encourage all PGDiT to continue to log their evidence contemporaneously on ePortfolio. Any changes to assessments and forms will be communicated to all users once they have been confirmed. 

How can I keep up to date with any changes that might be introduced as a result of the assessment review?

We will continue to keep this page updated with developments as the assessment review progresses, we will also be using a range of communications to keep everyone informed of key milestones. Please continue to keep an eye on our website, college bulletins, social media and Milestones magazine for additional information. 

Who can I speak to if I have more questions about the assessment review?

We appreciate that while the review is underway you may have questions that we are not yet able to answer. However, the team will continue to keep this webpage updated as the assessment review progresses. We anticipate staggering implementation and will provide additional communications regarding all changes and developments as they are confirmed.

If you have any questions which have not been addressed in the above FAQs, please contact the following teams for more information:

• For queries in reference to the Clinical Exam Review Group (CERG), please contact the Clinical Exams Team:clinicalexams@rcpch.ac.uk 
• For queries in reference to the Training and Assessment Review Group (TARG), please contact the Quality Training Projects Team: qualityandtrainingpojects@rcpch.ac.uk 

The next three sections are only for those select deaneries who have kindly agreed to be part of our pilot and trial the use of our new/revised assessments as part of this assessment review. 

Observed assessment of clinical skills (OACS) - pilot

OACS have been developed as a mandatory component of the assessment framework for paediatricians in Core training. It is expected the OACS will be completed during ST1 and ST2.

An OACS demonstrates clinical examination skills and is a summative assessment of performance (AoP), it may be necessary to repeat the OACS for a specific system until the required standard is achieved. Once the standard has been met, the OACS does not need to be repeated.

There is no limit to the number of times an OACS is done until a satisfactory standard is achieved. However we expect most PGDiTs to achieve the standard during ST1-ST2 and repeated difficulty may indicate a specific training need which should be addressed by local trainers.

Below are further details about the OACS:

OACS environment

It is expected that the OACS can take place in the course of day-to-day activity but doctors may need to be released for specific opportunities (such as specialty clinics), and both trainers and PGDiTs should proactively look for opportunities.

The OACS is not an exam and strict exam conditions are not expected. Pragmatic and opportunistic assessment should be the norm, using patients on the wards or in outpatients, whom the PGDiT is seeing for the first time or whose examination findings may have changed or are not already known to the doctor. Care should be taken to ensure a standard approach; for instance, precautions should be taken to ensure that as far as possible information is not shared between doctors which might impact on the fairness. This might be particularly relevant if a patient is being used for several OACS.

Proposed compulsory OACS systems examinations

• Cardiovascular
• Respiratory
• Neurological
• Abdominal
• Development (under 5 years)
• MSK

Our recommendation is that resident doctors complete a minimum of four OACS over ST1 and ST2 and should include one development OACS.

Principles of delivery

The OACS is similar to the mini-CEX with an added capability assessment and as such is a directly observed clinical encounter.

• The assessment is delivered by two assessors
• Assessors must include at least one consultant or SAS doctor.
• The other assessor can be a specialty training level trainee (ST5 or above)
• Assessors must be familiar with the guidelines
• The patient must have identifiable physical signs (as agreed by the assessors)
• The patient’s current clinical examination findings should not be known to the resident
• Patients with a range of ages and in a variety of settings should be used
• Cases may cover long term conditions or acute and emergency presentations

Standard of the assessment

The OACS maps to these parts of Progress+ Core Curriculum

• Learning outcome 2 (key capability 2): Demonstrates excellent communication skills, both spoken and written (including electronic notes) with children, young people, families and colleagues
• Learning Outcome 3 (key capability 1): Performs appropriate clinical assessments of a baby, child and young person
• Learning outcome 4 of the core curriculum: Conducts a clinical assessment of babies, children and young people, formulating an appropriate differential diagnosis; plans appropriate investigations and initiates a treatment plan in accordance with national and local guidelines, tailoring the management plan to meet the needs of the individual

Key clinical findings (as agreed by the assessors) must be identified and the information summarised to the assessors. The findings must be synthesised and an appropriate differential diagnosis formulated.

Appropriate communication and interaction with the child/young person must be maintained throughout.

Satisfactory achievement of the OACS indicates that the doctor has the capability to independently and reliably examine the clinical system, identify key clinical findings and interact effectively with the patient and their carer as well as formulate an appropriate differential diagnosis. Supervision and support will continue to be appropriate in more complex cases or where there is uncertainty.

To successfully achieve the OACS, the doctor must conduct a thorough examination of the system using an age appropriate and opportunistic approach. Safety and dignity of the patient must be maintained throughout.

Key clinical findings (as agreed by the assessors) must be identified and the information summarised to the assessors. The findings must be synthesised and an appropriate differential diagnosis formulated. 

Appropriate communication and interaction with the child/young person must be maintained throughout. 

Identification of cases

Cases may be identified in a range of settings: 

• Neonatal patients 
• Acute and emergency patients 
• Stable ward based cases 
• Community paediatric patients 
• Outpatient clinics 
• A range of patients and settings is encouraged.  

Examples include: 

• Respiratory examination in the admissions unit using a child with acute respiratory signs. 
• Cardiovascular examination in a neonatal patient with a patent ductus arteriosus 
• Developmental assessment in a preschool child in the child development centre 
• Neurological examination in an outreach paediatric neurological clinic 
• MSK examination in an emergency department setting 

This list is not exhaustive. Children with physical signs may be admitted to the ward for an unrelated reason, presenting a good opportunity for an OACS to take place. 

If the patient and their family is willing, OACS for more than one resident may be possible.  

The assessors should gain verbal consent from the carers and/or children and young people (as appropriate). 

Physical findings should be checked and key findings agreed. The key findings should be relevant to the system being examined, important to the formulation of the differential diagnosis and agreed as obvious enough to identify with s degree of certainly.  If signs are equivocal this should be noted. 

Guide to timings

This is not a strictly timed assessment but a focused and timely approach is expected. These timings are a guide only. 

• Physical examination. 6-7 minutes
• Summary of findings and differential diagnosis: 3-5 minutes 

Feedback

A summative assessment will be made as to whether the standard has been met or whether further practice is required. 

Feedback should be given in all cases. This is particularly important if the standard has not yet been met. 

Professional Conversations (PC) - pilot

Professional Conversations (PC) is a mandatory formative assessment focusing less on the clinical elements of an area of practice and more on the leadership and team working capabilities demonstrated.

This assessment includes many elements of a case based discussion and should facilitate an assessor and trainee to reflect on an area of practice (it does not have to be a clinical case) and explore leadership capabilities in a structured manner, record that discussion and consider next steps for improvement, future learning and development.

You should undertake 2 x Professional Conversations in ST6 or ST7 as part of preparation for CCT and stepping-up as a consultant.

Below are further details about the PC:

Focus areas

Examples where PC would be a useful tool is for cases which have involved the following (not an exhaustive list):

• Ethics  
• Consent and law 
• Management of a complaint 
• Research topic, i.e., evidence based medicine, health promotion 
• Supporting trainees 
• Managing conflict 
• Developing a new service 
• Resource management
• Incident review

A professional conversation will be of most value when rooted in something the trainee has experienced or an issue that relates directly to their practice and that they or the wider team have been involved in, but not necessarily in a leadership capacity. The area of practice used should not have been used to evidence another workplace-based assessment.

Assessor focus

Within the areas listed above, your assessor is likely to focus on one or two of the following (it is important that a range of these areas are considered across the two PCs): 

• Decision making - including direction setting and ideas for service development, enabling improvement, senior clinical decision making, understanding of urgency/appropriate time frame, and clear and SMART plans
• Knowledge - including application of clinical knowledge relating to area of practice, key clinical management points where appropriate
• Management of complexity - including recognition of key issues (including ethical & medicolegal), prioritisation, conflict resolution and understanding of change management and wider NHS systems)
• Professional Approach - including leadership and team working, recognition and management of quality, diversity and inclusion issues, the role of clinical and managerial colleagues, involving junior colleagues and recognising training opportunities, supervision and support of multidisciplinary team and resident doctors, and management of conflict
• Safety - including use of audit and QI, using local, network or national care pathways/guidelines, and governance and risk management considerations
• Communication - including documentation, consent, communication with patients (including CYP) and families, team communication (within and outside the organisation), and communication in change management

Links to Progress+ curriculum

Professional Conversations 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) 

Professional Conversations 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 Professional Conversation to demonstrate Procedures (D3) and would need to be carefully explained how this assessment might link.

Example of PC: Consent and law

Opportunity

Tobi is an ST6 trainee seeing a child and their family in the paediatric neurology outpatient clinic. The child is suspected of having a neuromuscular condition and they are discussing trio whole genome sequencing (WGS). Tobi explains the proposed investigation to the family and provides a local information leaflet. The child’s parents are concerned that testing might identify things about their own health and risks that could have an impact on insurance, their work, and future pregnancies. They are unsure if they want to proceed with testing.

Tobi is unsure of the answer to all of their questions, so she makes a list of these with the family in clinic and organises a further appointment to discuss these again.

Professional Conversation

Tobi discusses the family’s questions with her supervisor. They go through each of the questions in turn, discussing how to answer them and the implications of the investigations being requested.

They use the PC form in the ePortfolio to record a summary of their discussion and Tobi’s reflections.

Outcome and further learning

Tobi’s supervisor suggests that she undertake the consent e-learning module for WGS before meeting with the family again in clinic. When Tobi meets with the family, she is able to answer their questions, complete the Record of Discussion form with them, and they consent to the investigations. Tobi reflects on this using a developmental log, in addition to the previously completed PC assessment.

Example of PC: Developing a new service

Opportunity

You are a ST6 trainee, working in a DGH. You have an allergy interest and have noticed that allergy patients are seen by different consultants and there is no dedicated allergy clinic such as you have seen in other hospitals.

You want to explore how to go about setting up such a clinic in theory if you were a consultant and discuss with your supervisor who suggests this could be the basis of a professional conversation (PC) and asks you to do some preparation for the PC.

Ahead of the PC you meet with one of the other consultants who has recently set up a one stop murmur clinic, to understand their experience and prepare some ideas for discussion.

Professional conversation

You discuss your ideas with your supervisor. Steps you have considered include:

• Doing an audit of current practice
• Standardising the allergy protocol and reviewing current evidence
• Identifying MDT staff needed for a clinic, including specialist nurse/ dietician
• Safety aspects: need for resuscitation protocol and training

Your supervisor explores some of these areas with you and helps you consider other aspects:

• Potential conflict with colleagues and how to manage change
• Patient involvement in planning
• How to proceed with a business case.

Outcome and further learning

You agree with your supervisor that you would benefit from knowing more about managing a business case and spend time with the department business manager who explains the process. You then reflect on this learning.

Although this is a theoretical exercise, there may be some practical projects that you can take forward (audit or protocol standardisation) and if there is department interest and support, this might progress to developing a service that you could become involved in.

Example of completion of PC form by supervisor

Decision making:

Remi brought a good and realistic idea for service development and identified many key steps needed for the preparation of a business case. They recognised that this would need time and support if it were a real project.

Knowledge:

Good clinical knowledge of allergy and what might be delivered clinically at a one stop allergy clinic and what staff might be needed.

Management of complexity:

Remi’s knowledge of the complex business case process was understandably less secure, and they would benefit from learning more about this and understanding the current commissioning structures.

Professional Approach:

With some prompting, Remi recognised that developing a new service might lead to some conflict with colleagues and we discussed ways of managing this. Remi had good recognition about how to manage conflict and develop a team approach. Their suggestion of presenting audit and patient views to their colleagues and of seeking their colleagues’ input to the service were good ones.

Remi was proactive in suggesting that a new allergy clinic would be an excellent training opportunity and how they might involve resident doctors in audit and protocol development.

There was an excellent discussion about multidisciplinary working in such a service, Remi clearly understands and values the roles of different members of the team. 

Safety:

Remi had thought about safety aspects thoroughly. They had a clear audit plan and clear suggestions about clinical safety within a clinic.

Communication:

Remi had drafted a suggested clinic proformas well as some patient information which might be very useful to develop further. They had some good ideas about how to involve patients and families in service development.

Overall feedback:

Remi had thoroughly prepared for this PC and brought some excellent and realistic suggestions about how to set up a new service. They demonstrated particularly good awareness of the clinical aspects, team working and patient involvement. There were good suggestions about audit and documentation which would be useful to develop further.

They would benefit from further learning about the mechanics of a business case and local commissioning processes.

Action Plan:

• Spend time with the unit business manager to learn about how to develop a business case

• Suggest that audit of our current service and a QI project to develop the documentation discussed would be useful.

Reflection (by trainee)

I found it very useful to go through this exercise and feel more confident that I could develop a service idea as a new consultant. I was pleased that my clinical knowledge enabled me to come up with some useful and realistic suggestions. I have found out more about the support available from managerial colleagues and the local NHS structures.

Example of PC: Incident review

Opportunity

Robert is an ST7 trainee who is working towards CCT in the next twelve months and looking for opportunities for leadership experience. One of his PDP items for his final placement is to gain experience of incident investigations, and he has completed local training provided by his Trust on incident reviews.

Robert’s supervisor suggests that he undertake the rapid review for an incident involving a child who received a 10 times dose of Gentamicin. Robert has not previously been involved in the child’s care.

Professional Conversation

Robert undertakes the review using the local rapid response tool and drafts a letter to the family as part of the Duty of Candour process. The supervising consultant checks and edits both documents with Robert and is present while Robert presents the case in the local incident group meeting.

After this, Robert and his supervisor meet to discuss his learning and what he might choose to do differently next time.

Their conversation focuses on the process of the rapid review, using the tool to guide the investigation, and the practicalities of seeking further information from the professionals involved in the incident. They also spend some time discussing how to word a letter to the parents and looking at examples of other letters the consultant has written to parents in the past.

Outcome and further learning

The final version of the Duty of Candour letter is co-signed by Robert and his consultant, and they arrange a meeting with the family to discuss the outcome of the investigation, apologise for the error on behalf of the department, and answer any questions the family may have.

Robert and his supervisor completed the PC form together after the event to summarise their discussion and reflections.

Robert plans to explore how the department might update their prescribing tool for Gentamicin within the Electronic Patient Record to avoid future similar incidents, and plans to present this at the local Clinical Governance meeting.

Example of PC: Ethics/Consent and law

Opportunity

You are a ST6 trainee, working in a DGH. You have admitted a 13 year-old, Oscar, with sepsis. He is sick but does not require transfer to critical care.

Just before you obtain intravenous access and sending investigations, his mother asks you to also send genetic investigations and tests for Alzheimer's disease. She has a very strong family history of the condition and has consulted a private physician who advised that the impact of the condition, if present, can be ameliorated with a good diet and regular intravenous vitamins.

She does not wish you discuss this with her child as this has already happened with the private physician.

Professional conversation

Several issues to consider in no particular order:

• What are the ethics of genetic testing in children in this condition?
• Balancing prevention/amelioration of a condition vs imposing a burden on a child when there is no immediate harm
• The mother has provided consent but what about the child? His capacity and competence? Is this his wish?
• What are the legal considerations of genetic testing in paediatrics? (RCPath Genetic testing in childhood – guidance for clinical practice)
• Would explore in more detail why the mother wants this and if she understands the implications/significance of the results for the child and his life.
• Would need to discuss with legal department and potentially ethics committee

Outcome and further learning

The trainee knew to refer to more senior colleagues and involving the legal department. However, did not address with the parent and used the intercurrent illness to avoid managing the situation. This is understandable. With prompting and direction to think hypothetically, the trainee struggled to discuss the legal and ethical arguments in a balanced way. The trainee suggested using an educational session to explore the topic.

Example of Completion of PC form by supervisor

Decision making:

You were correct to prioritise managing the immediate clinical issue and obtaining further advice. I prompted you to consider what you would advise once the child had recovered and there was no other advice immediately available. The key issues here are the legal and ethical positions of genetic testing in children where there is no scientifically proven treatment or risk of immediate harm. This is similar to other conditions such as Huntington’s Chorea. You may find it a useful strategy to extrapolate from examples that you are aware of.

Knowledge:

You recognised that advice from clinical geneticists and the legal department would be useful here.

Management of complexity:

You considered the capacity and Gillick competence of the child and planned to discuss testing with him after he recovered. This would allow you to gather more information. I encouraged you to consider what would happen if the law permitted or prevented genetic testing in this case. This highlighted that the law is our boundary but tends to shut down ethical discussions. I liked that you wanted to use this as an educational opportunity.

You also considered the role of testing in private medicine (vs NHS) and the advice from the physician

Professional Approach:

Your current approach of escalating is appropriate, given your level of training. With significant prompting, you approached the situation as if you were the consultant. You understood that this was not a situation that could or needed to be resolved urgently and that guidance from clinical geneticists and lawyers was vital. The prompting also allowed you to explore the ethical benefits and demerits for the child to understand now if her had potential for Alzheimer's disease.

It is worth remembering that you are not alone but have other consultant colleagues and your CD and senior management team to support and advise you.  

Safety:

We both wondered about the veracity of the private physician’s approach and potential treatment, and this could have triggered GMC referral.

You considered whether this child should be referred to safeguarding. This is a good decision.

Communication:

I liked your approach to document the conversation(s) with the family and child in case this matter progresses to a complaint.

Overall feedback

This was a very challenging case. You demonstrated a safe resident doctor approach. You have appreciated that the law brings clarity to action but shuts down ethical debate. It is critical to all discussions to be able to analyse situations and to balance opposing views. Ethics is a perfect vehicle for this.

• Consider in this case whether it is right to genetically test children for conditions where there is no useful treatment and does not bring immediate morbidity
• Consider the role of the mother to advocate for this line of treatment
• Consider the strategy of the physician to suggest genetic testing and his proposed treatment plan.

Action Plan:

• Discuss the case in an educational meeting, bring in representation from legal and you local ethics committee
• Consider reading the RCPath guidance on genetic testing on children.

Reflection (by trainee)

This was really hard and I have learnt so much. I am beginning to understand why discussions can be protracted – there is a lot to think about. However, by organising this meeting, I hope to better understand how different perspectives can come together to bring a consensus.

Example of PC: Supporting trainees

Opportunity

You are a ST6 trainee, working in a DGH. You have an ST5 colleague, AA, who missed the ward round on a Saturday morning. She is frequently late for the start of shifts; she is always rushing and is apologetic. She often hands over tasks she has not been able to complete in her shifts, including tests and documentation. When you have been on a shift together, she seems busy and is happy to do her allocated tasks. She is flexible so will swap shifts with others as requested.

Professional conversation

Goal: How much of a problem are the lateness and unfinished tasks? Might this escalate if not raised?

Reality: Explore informally with AA why these events happen:

• Personal – issues outside work e.g., health, financial, carer responsibilities
• Environment – stressful/toxic atmosphere
• Workload – overwhelm, resources, training, support

What feedback has AA received from peers and seniors? Do they see this as a problem?

Options: what solutions can be found together? Encourage AA to discuss with their ES so that they can support and supervise

Way forward: Support – ES, CT, PSU, mentoring

Outcome and further learning

The trainee (BB) was well-versed in highlighting issues to ES, counselling/OH and to school/deanery resources such as PSU. However, they were less sure on their personal role as a senior trainee or consultant. You agree to do more learning in supporting a trainee in difficulty through EES courses, exploring how to have a coaching conversation.

Example of Completion of PC form by supervisor

Decision making:

It was important to consider the extent of the problem as we do not want to be too sensitive to an issue and to ensure our response is proportionate. Here, an exploratory conversation may reveal real issues that can be supported and also the absence of contributory factors – meaning that the behaviour is a reflection of AA’s approach, which equally needs addressing.

Knowledge:

You had a good understanding of resources available to trainees in difficulty. I would have liked to hear more about how you could personally support AA alongside these resources.

Management of complexity:

The complexity in this case lies in teasing out any underlying/contributory factors in a systematic way before concluding that this is indicative of underperformance. Added to this is the temptation to manage the punctuality and tasks (i.e., the effects) before understanding and managing the causes. You had some ideas of the causes of underperformance and focussed heavily on emotional needs such as burnout. While this is important, many causes of underperformance can be supported before burnout is established and we should be watching for these too.

Professional Approach:

With prompting, you were able to consider that this was not clearly burnout or an attitudinal issue. I encouraged you to focus on what we can do as colleagues. We discussed how you were not sure of the answers, but taking the approach of advocacy with enquiry from your APLS instructor training, allows AA to reflect and generate her own next steps. This is a really good way to document and monitor progress.

It is worth remembering that you are not alone but have other consultant colleagues and your CT and DME to support and advise you.  

Safety:

You had considered the impact on patient care and safety and the criteria to remove AA from the rota (either as supernumerary or time away from work). We also discussed the impact of progressive burnout causing friction and arguments with staff (incivility costs lives etc).

Communication:

I liked your approach to discuss the matter with AA and encourage them to discuss it proactively with their ES. This maintains AA’s agency in the matter. As an ES we would document the conversation and share with AA for accuracy and transparency; this could be as part of the portfolio or separately. I would also suggest that AA understands that you would be happy to support AA when they discuss it with their ES.

Overall feedback:

You showed a strong initial approach in supporting your colleague. At present you are well aware of resources to support individuals. You needed prompting to consider how you could support AA directly; remember this is the position for both trainees and consultants as we are likely to be more available to provide continuous support.

You would benefit from refreshing your coaching skills.

Action Plan:

• Spend some time reviewing coaching skills; explore if there are any short courses you can undertake
• Spend some time with your DME or CT to understand how they are integrated in supporting trainees in difficulty.

Reflection (trainee):

I am aware of support services from my local PSU and mental health teams. I had not realised how problem solving might land as “handing off” AA to these other services. I never view myself as being able to support people because I am only a trainee but if I could role model active listening skills more, when I am a consultant, I can hit the ground running.

Paediatric Entrustment Assessment for Consultancy (PEAC) - pilot

A PEAC enables you as a trainee to elicit feedback from a faculty of consultants on an area of professional practice that encompass multiple key capabilities. It is designed to be practically applied to work that you are already doing to progress towards independent working as a consultant paediatrician.

A PEAC is not based on a single event like other portfolio assessments. It is a summation of multiple assessments and experiences to enable a entrustment decision about your work at consultant level. It should be completed by your supervisor or another named consultant, and should have input from at least one other named consultant.

The end point of a PEAC form is a decision that you are entrusted to undertake that area of practice independently at the level of a day one consultant. Where this threshold has not yet been reached, the assessors should specify what learning or activity should be undertaken by you to progress towards entrustment.

Not all of the PEAC domains will be applicable to all Paediatric Subspecialty Training programmes. For example, doctors training in Neonatal Medicine or Paediatric Emergency Medicine are less likely to find a PEAC focused on managing an outpatient clinic to be helpful. For this reason, a doctor should select two of the available PEAC areas of practice.  

Below are further details about the PEAC:

PEAC areas of practice

As part of Paediatric Specialty Training, a doctor should have two successful PEAC assessments in at least two different areas of practice from the following list: 

• Patient safety (including leading the completion of a full audit cycle, managing change, writing a business case, or conducting service evaluation, duty of candour, Martha’s law) 
• Leading a child safeguarding case (including safeguarding medical examination, participation in strategy meeting, safeguarding medical report writing, and communication with CYP, families, and medical professionals) 
• Supporting CYP and families at the end of life (including advanced care planning, discissions regarding resuscitation, symptom management, and communication with the CYP and family) 
• Managing an outpatient clinic (Including triaging referrals, preparing for and conduction outpatient clinical work, outcoming clinical activity, writing medical correspondence to CYP, families, and medical professionals) 
• Leading an acute take, Assessment Unit or Emergency Department (Including handover, ward rounds, task allocation, and clinical prioritisation) 
• Management of a patient with medical complexity (Including review of investigation, outpatient clinic, MDT participation, medical record keeping, and communication with the CYP and family) 
• Managing child death (Including the Sudden Unexpected Death in Children (SUDIC) process, SUDIC sampling, report writing, supporting team wellbeing, and discussion with the family) 

Entrustment decision

The summative element of the PEAC assessment is an entrustment decision made by (preferably) two or more consultants who undertake the area of practice being assessed as part of their consultant role. Some departments might choose to widen this faculty out to multiple members of the consultant team to broaden the feedback offered. One consultant should complete the form, and all other contributing consultants should be named within the assessment.  

The entrustment decision states that either: 

1. There are significant concerns that require addressing prior to the doctor undertaking further supervised practice in this area
2. The doctor requires continued consultant supervision to undertake this area of practice with the following recommendations
3. The doctor is entrusted to independently undertake this area of practice at the level of a new consultant (with recognition that all doctors in training work as part of a wider team under the supervision of a responsible consultant)

Evidencing a PEAC

The doctor submitting the PEAC form should list evidence of the work they have undertaken in the chosen area of practice. This might include patient or procedural logs, reflective and developmental logs, and other workplace based assessments such as CBDs, PCs, and DOCs.

Feedback

It is incumbent on the assessing consultants to review all evidence and add constructive developmental comments from the assessing consultant faculty to justify the entrustment decision that they come to.  

Feedback and developmental comments as part of the PEAC assessment should ideally be co-constructed by the doctor in training and the consultant who is completing the form. The later will often be the clinical or educational supervisor, but does not have to be. This is likely to work best when the doctor in training has submitted the PEAC assessment to a consultant, the consultant then seeks wider consultant faculty feedback on the area of practice concerned, and subsequently both doctor in training and consultant meet face to face to complete the final form. This is similar to how the Educational Supervisor Training Report form is completed. 

Example of a PEAC opportunity

The following is a worked example of how a PEAC form might be completed. 

A trainee is an ST7 in General Paediatric Specialty Training. They want to complete a PEAC form regarding their ability to run an paediatric outpatient clinic.  

The trainee discussed this with their clinical supervisor, who supports them to identify several outpatient clinics as part of their normal work, each alongside a different paediatric consultant, and to spend an afternoon triaging GP referrals into those clinics.  

Over the following month the trainee undertakes 3 different clinics, each with a different consultant. They keep a brief, anonymised log of the diagnosis and outcome of each patient seen. They also complete a DOC assessment based on a clinic letter, and two CBDs based on some of the more complex patients that were seen.  

When completing their PEAC form, the trainee links to: 

• The anonymised case log, uploaded as a PDF to ePortfolio 
• The DOC assessment 
• Two CBDs 
• A developmental log on following up outpatient results 
• A PC assessment based on triaging outpatient referrals 

The form is then submitted on ePortfolio to the supervising consultant.  

When the supervising consultant receives the PEAC form, they discuss this in their monthly consultant supervision faculty meeting with other consultants who know and have supervised this trainee. The supervising consultant collates this feedback in the PEAC form, and saves it as a draft.  

The trainee and the supervising consultant then meet to discuss their evidence, and the feedback offered by the consultant team.  

The two main possible outcomes at this point are: 

• The supervising consultant and consultant faculty share that they feel this trainee needs further development to be able to undertake independent clinics. They offer clear and actionable feedback which includes reading the AoMRC guidance on how to write a clinic letter addressed to the patient, and that they undertake further supervised outpatient clinics. They agree to review this in two months and complete a new PEAC form, prior to ARCP.  
• The supervising consultant and consultant faculty agree that this trainee can be entrusted to independently undertake outpatient clinics, including triaging referrals and following up on investigations.

There is also the possibility that during this process the supervising consultant and faculty are concerned that the trainee's ability to make decisions in the outpatient clinic is not yet where it should be for an ST7. They therefore organised enhanced supervision, and explore how they are going to improve this and evidence the improvement in the ePortfolio.