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Paediatric training and capability-based progression

Training & Quality team
This guidance is for paediatric trainees, their supervisors and Heads of School, and outlines when progression through the next gateway of training is appropriate.

Published September 2023

Updated May 2024

Introduction

We have had capability-based progression built into the paediatric curriculum for a long time. It even predates Progress in 2018. Having the flexibility within the [Progress+] curriculum to recognise that trainees arrive in the paediatric training programme with diverse backgrounds and experiences, and are therefore able to demonstrate capabilities at different rates, is a pragmatic and attractive part of our programme.

Dr Cathryn Chadwick, VP for Training and Assessment

The indicative length of paediatric training under Progress+ is seven years WTE (whole time equivalent). This is set by RCPCH and agreed by the General Medical Council (GMC) based on a reasonable time to gain all the experience and curricular capabilities to gain CCT (Certificate of Completion of Training) in Paediatrics (with  sub-specialty or with General Paediatrics - all trainees complete generic paediatric domains). It is predicated on an appointable applicant who may have not done any paediatrics in their postgraduate pathway.

Progression through paediatric training is capability based and not time based. Many trainees will use the full seven years in training. But some trainees will demonstrate the capabilities more quickly depending on prior experience or other opportunities, in which case they may wish to progress quicker at some stages of training.

It is important to recognise that once a trainee has progressed to another level of training and their CCT reset, they cannot be given that time back if they need it (for example, if they struggle to pass exams or to meet capabilities in the time remaining.) In this situation the trainee would be given an outcome 3 at ARCP (Annual Review of Competence Progression).

Principles

  • CCT (Certificate of Completion of Training) for LTFT (Less than Full Time) trainees is set pro rata by WTE (time. This includes trainees at 80% LTFT. Trainees should not automatically be progressed to the next ST (Specialty Training) grade annually having only done 80% of a training year.
  • The decision to progress and reset CCT must be made at ARCP.
  • The decision to progress should only be made at ‘gateway’ points and should be based on capabilities evidenced.
  • All capabilities must be demonstrated within training or OOP (as outlined below)

While capabilities may be gained more quickly, time is still needed to build up the necessary experience to practice as a more senior paediatrician. Trainees and Trainers should have honest conversations about the right time to progress based on all triangulated evidence including local clinical supervision reports, MSF and curricular evidence.

Stages of progression

There are a number of stages or ‘gateways’ in training where specific capabilities/exams or experience are needed. Options 1 and 2 should be carefully considered as the trainee will automatically be time limited if they do not make straightforward continuing progress with exam and curricular capabilities. Progression should only be considered if both trainee and trainer are happy that forward progress is likely to be straightforward.

  1. Progression to independent working on the tier 2 rota at ST3: Requirement: Readiness for tier 2 working form. This includes the need to have completed all DOPs (Direct Observation of Procedures), resuscitation courses, Level 3 safeguarding and (currently optional) ECATs (Entrustment with Care Assessment Tools). Well on track to complete core curricular capabilities. The process of readiness for tier 2 working is designed to be managed by the trainee, educational and clinical supervisor without the need for ARCP at the start of or during ST3. However if the trainee is accelerating their progress to this stage and resetting CCT date, it should be agreed at an ARCP panel.
  2. Progression to ST4:
    Requirement: Readiness for tier 2 working as above, plus all written parts of MRCPCH. Well on track to complete core curricular capabilities.
  3. Progression to ST5 (Specialty level):
    Requirement: full MRCPCH exam and completion of all core curricular capabilities
  4. Progression to CCT
    Requirement: completion of all specialty level capabilities, START including  addressing/demonstrating any outstanding capabilities identified.

Things to consider:

  • Progression should be discussed between trainee and trainer at every supervision meeting.
  • Even if the specified requirements and capabilities have been met, the trainee can choose to progress at the standard rate and keep their CCT unchanged. For instance the trainee may wish to broaden experience at a particular level rather than progressing at an accelerated rate.
  • There should be dialogue between trainee, trainer and school - via TPD (Training Programme Director) or HoS (Head of School) regarding the rate of progression at an early stage.
  • Capability progression will depend on local availability of posts and at least 6m notice of likely capability progression should be given.
  • This process is enabled by longitudinal supervision.
  • Trainees appointed at ST1 or ST3  who come into training programmes wishing to ‘fast track’  their training should make this known to their TPD and educational supervisor at their initial meetings and, where appropriate and possible, should be enabled to demonstrate the capabilities and requirements for progression by considering their placements and PDP. There should be an individualised approach to training and progression, however in general it will take at least 12m in programme for trainers to make a reliable assessment of trainee readiness for progression and for the trainee to gather triangulated portfolio evidence. ‘Fast tracking’ can only be agreed at ARCP and not during the recruitment process. Trainees in this situation can have more than one ARCP in the first year of their training if needed to facilitate the process of assessment. This will require early discussions with their supervisor and TPD/HoS.
  • Although accelerated progression to another level can only be agreed at ARCP, this should not stop trainees being given opportunities to develop more senior capabilities in a supported and supervised environment.

Capabilities acquired during OOP

Capabilities acquired and evidenced during OOP  (Out of Programme) can be used as evidence for progression and CCT. This is irrespective of what sort of OOP is taken.

However the capabilities must be evidenced on ePortfolio and assessed as part of a subsequent ARCP in training.