Progress+ and our Shape of training plans - frequently asked questions

The GMC has now approved introduction of our two-level, run through specialty training programme by 2023, ensuring it is flexible, fulfilling and fit-for-purpose. New training principles will build on the RCPCH Progress curriculum to become RCPCH Progress+.

Here we provide you with the all-important answers to some of the questions we are sure you have.
Last modified
30 May 2022

This is not an exhaustive list, and if you think there are areas that we have not covered or answered please do get in touch with us on progress-plus@rcpch.ac.uk. We will add your questions and our answer below. 

For additional context, you can also refer to the further information available from our page, RCPCH Progress+ and our Shape of training plans.

Overview

Key changes to the revised training programme

  • The structure will change from a three-level ST1-ST8 programme to a two-level ST1-ST7 programme ('ST' means 'specialty trainee').
  • The positioning of the exams will move so that only the theory exams need to be completed by the end of ST3, before a trainee can take on tier 2 (middle grade) rota responsibilities. The clinical exam will need to be completed by the end of ST4. See examinations section
  • There is a less prescriptive approach to placement requirements, allowing some flexibility to reflect local needs and trainees’ career intentions.
  • Where requested and feasible, a trainee can incorporate Out of Programme (OOP) time to develop more experience as per the Gold Guide.
  • This can happen at any point, but one logical time would be midway through the training programme and before selecting a sub-specialty. This will ensure paediatrics is a more attractive option for those foundation doctors concerned about the contracts of a seven-year programme.
  • Trainees will be able to commence sub-specialty training from ST5 and consequently apply from ST4 onwards providing they have enough indicative time at the start of sub-specialty programme to complete prior to CCT (Certificate of Completion of Training). See sub-specialty training section
  • There will be better facilitation of trainees moving to a different sub-specialty training pathway within paediatrics after making their initial selection, in response to changing demands (workforce needs, career intention, lifestyle requirements).
  • Trainees will move to undertake START (Specialty Trainee Assessment of Readiness for Training) in ST6. See START section
  • The programme will be underpinned by 11 new training principles to articulate the standard that all programmes should be meeting, promote enhanced flexibility and encourage a greater focus on integrated care and efficient multi-disciplinary working. These training principles are introduced in our Paediatrician of the Future document.

Why should we change?

We need more flexibility in training, for both our patients and our trainees. Removing the middle level simplifies the pathway, allowing trainees to move into a chosen subspecialty sooner and also provides a more natural break point for out-of-programme experience.

There will be some flexibility at ST6 to change sub-specialty pathway. The pathway will continue to be capability-based. Trainees can move through the pathway faster – for example, if you have prior capabilities. The Progress+ curriculum places less emphasis on specific placements, allowing more flexibility for differing routes through the pathway.

The aim is to allow the training experience to better match final career; we don’t expect paediatricians to have identical skill sets.

How can we train paediatricians in only seven years?

We aim to improve efficiency of training by removing the current level 2 – accepting that trainees will no longer undertake the current core middle grade years, but will gain a core set of generic capabilities in a variety of settings during ST1-4 which is likely to include neonatology, community paediatrics, general paediatrics and other settings.

In addition, trainees gain specialty-specific capabilities (such as general paediatrics, paediatric oncology and paediatric neurodisability) depending on the chosen specialty pathway.

What about the quality of training?

Our Paediatrician of the Future document sets out how to improve quality, giving primacy to maximising learning opportunities through good supervision. This will be a challenge; the document won’t improve quality in itself, but it does clearly set out the agenda and direction.

On 6 August, we published our good practice maps, showing which regions (or pockets within) are already meeting five key practice areas, from educational supervisors remaining with the trainee for longer than six months to training placements being managed creatively. Take a look and see if your region is starting to meet these.

How many points of entry will there be to the training programme?

Initially entry points will be at ST1, ST2 and ST4. ST2 entry is currently subject to sign off from the MDRS, which will be confirmed in June 2022. There is a plan to move towards a further entry point at ST5, possibly directly into specialty training, but this is something that is still being considered and will likely be introduced no earlier than for 2025 recruitment.

We will provide a further updates in due course.

What will the College be doing to help support the implementation of Progress+?

The College will be working with trainees, supervisors, Heads of School, Training Programme Directors, Trusts and Deaneries to rollout these exciting changes.

We have already shared our Paediatrician of the Future guidance from October 2021, and published our good practice maps . We will continue to update these FAQs, as questions arrive, and you can email us on progress-plus@rcpch.ac.uk.

We will also be providing resources and guidance in a number of formats over the coming months. Our 'Training Principle of the Month' resources can be found here.

Curriculum

What is the difference between Progress and Progress+?  Is this a completely new curriculum?

Progress+ is not a new curriculum. The + signifies the changes we are making to the Progress curriculum and the accompanying syllabi to convert training from three levels to two levels.

The current Progress curriculum has been re-structured into two rather than three levels, but the content remains broadly the same. Evidence that trainees have already linked to the Progress curriculum will be pulled across and re-tagged to the Progress+ curriculum so they will not lose any of their evidence. 

There is a slight change of emphasis, with more emphasis being placed on integrated care, public health and mental health competencies. The adapted Progress+ curriculum is available for trainees to see already and trainees can start to think about how they might evidence these competencies. This will be particularly important for current level 1 trainees who will move into the core Progress+ curriculum in Summer 2023.

There are lots of opportunities to gain these competencies within paediatric training, and in line with the Paediatrician of the Future document, trainees should be supported and given time to do so. For example, a trainee may sit in with the CAMHS team for their assessment of a young person presenting to the ED with suicidal ideation to gain competencies within mental health. Or a trainee may spend time having a discussion with vaccine hesitant parents to empower them to make informed choices to evidence public health competencies. 

With the introduction of Progress + and a shorter training programme, will there still be opportunities to fast track through training?

The short answer to this is yes. But, there have always been opportunities to fast track as the curriculum is capability-based and not time-based; as long as you have met the requirements of the curriculum at each level you can progress through your training.

If this is something you are interested in doing, it is important to arrange early discussions with your Educational Supervisor and TPD (Training Programme Director).

I am an academic trainee. How will Progress+ affect me?

In short, the introduction of the new paediatric training programme will not affect academic trainees. If anything, the changes to Level 1 and Level 2 into a new core training level now complement the academic training pathway as it currently stands.

We are currently discussing the various pathways into academic training and how the introduction of Progress+ could potentially impact on access to this area of training.

Core level

ACF appointments are generally made at ST1 for 3 years (WTE). 

This means that trainees will usually still have a year remaining in core training when they finish their ACF as they move to ST4.

Those trainees might have options:

  • Going into a non-academic clinical numbered post for ST4 to consolidate their tier 2 working, before considering OOPR after ST4 or staying on clinical track.
  • Going for OOPR at the end of ST3 but would still need to get core training 'signed off' on their return to programme and before potentially applying for sub-specialty training.
  • With capability based progression, it is possible that ACF trainees will have achieved all core capabilities by the end of their 3 year ACF period and could be signed off for Core Training. This is likely to be the exception rather than the rule but for those coming into training with previous experience it is more likely.

Specialty level

At Specialty Training Level, the NIHR insist that there must be at least 12m WTE left in training at the start of an ACL post and candidates may only apply if they have already submitted their PhD or MD thesis at the time of application and successful candidates may not take up their post until their PhD or MD has been fully awarded. Under Progress+ trainees will need to start an ACL post at the beginning of ST7 at the latest and submit their PhD at the start of ST6.

This guidance has been produced to support the selection of individuals for NIHR Clinical Lectureship (CL) and NIHR-recognised, locally-funded CL posts as part of Integrated Academic Training (IAT).

Trainees considering an academic pathway and ACL should get early career advice in order to be in a position to complete a PhD before the end of ST5.

At what level of training will I be able to apply for an ACF post?

Please see information above.

Will I still be able to do a PHD during my academic training?

The new curriculum encourages trainees to take time out of training to enhance their experiences and an OOPR to pursue an academic career will still be possible. This can best be done between core and specialty training but will be possible during other stages of training too (for examples after ST3 if core competencies have been achieved).

How do I transition onto Progress+ as an academic trainee?

For those trainees already in an ACF post at ST1-2 at the point of transition (Aug/Sept 2023) they will move to Core Training continuing as an ACF at ST2-3.

Those trainees finishing ST3 and therefore finishing their ACF will move to Core Training in a non academic clinical numbered post at ST4. Alternatively they may choose to go OOP with the understanding that they will return to programme at ST4 with Core training still to sign off.

Trainees who are OOPR at the point of transition will move to Progress+ on return to training and should discuss with their supervisors at what level they will return. 

Trainees who are in level 3 training in Summer 2023 and are considering OOPR and subsequently applying for ACL posts should be mindful of the NIHR guidance for eligibility to apply and get expert advice.

Trainees already in ACL posts will continue on the Progress+ Specialty level curriculum unless they are due to CCT before September 2024 in which case they can remain on Progress.

Will I have sufficient time to train as a Paediatrician and to pursue an academic career on Progress+?

Yes, that will be possible, depending on your ultimate career aims. You will have the opportunity to do a period of OOP and you will be given time for your academic work as before. It may be harder to complete all competencies for paediatric training in addition to academic requirements in 7, rather than 8, training years and great care will need to be taken to keep a good ePortfolio as well as documenting academic competencies.

Transition

How will you implement this change?

Transition will take place in summer 2023. A simplified summary is that new and junior trainees (finishing ST1-3 in Summer 2023) will move over to core paediatrics, senior trainees (ST5-7 in Summer 2023) will move into specialty paediatrics (as the curricula are essentially unchanged), and there will be some element of choice for those who are finishing ST4 in summer 2023 about whether they transition to specialty training in the first year or whether they wait a further training year before transitioning.

These trainees will need to have early conversations with their Educational Supervisors and TPDs about what their plans and preferences are.

Trainees who are already in ST8 or moving to ST8 at the point of transition will have the choice to remain on the old Progress curriculum until 15th September 2024 rather than transitioning to Progress+ if they are expecting to CCT within this time period. However, it should be noted that the curricula are essentially unchanged for trainees at this level.

For a more detailed breakdown for trainees by their current training level and exactly what they will need to think, see our leaflet, Progress+ and me: Information for trainees in training in 2021/22.

What training requirements at current level 2 will be required to be eligible for sub-specialty training?

Under the current Progress curriculum, completion of level 2 training requires evidence of the level 2 capabilities across general paediatrics, neonatal and community paediatrics. There is not a requirement for specific time-based placements nor is there a minimum time to spend in level 2 training.

For trainees completing ST5 in Summer 2023 before transition to Progress+  moving to Specialty training should be straightforward as these trainees will expect to spend up to 2y in Level 2 and are likely to have placements including community paediatrics and neonatology.

For trainees completing ST4 in Summer 2023 before transition to Progress+ who wish to sign off level 2 and move directly to Specialty training in August/September 2023 (whether in sub-specialty training or in general paediatrics) there will need to be more advance planning. Evidence against Level 2 can be accrued during level 1 and placements during ST4 should be planned to allow acquisition of capabilities in neonatal and community settings as well as general paediatrics. This may be easier in a DGH setting where general paediatrics and neonates are on the same rota. Community experience may be acquired by clinic attendance alongside a general paediatric post or be evidenced during training during level 1.

Current level 2 capabilities have been reviewed so that they are mainly aligned with core training or moved to specialty training. Overall the capabilities are broadly similar with the main difference being that in Core Progress+ there is more flexibility around the placements and settings those capabilities are evidenced.  We expect the ARCP for trainees wishing to sign off level 2 at the end of ST4 in summer 2023 to take this flexibility into account and to take a holistic view of  trainees readiness to progress.

With advance planning it should be possible for many trainees who wish to move to Specialty training after ST4 to do so. For those wishing to apply for Sub-specialty in Autumn 2022 for a 2023 start, the Head of School will need to confirm that the trainee is on track to complete level 2 training.

All trainees must pass the MRCPCH clinical by the end of ST4 and for those wishing to apply for sub-specialty training they will need to have passed the MRCPCH by the time of interview for sub-specialty.

It is unlikely that trainees will be able to achieve all level 2 capabilities in less than 12m, so trainees who have only been in level 2 training for 6m in summer 2023 are likely to remain in core training.

For LTFT trainees there will need to be a case by case discussion.

Trainees who are completing ST4 Summer 2023, also have the option to remain in core training for a further year, if they feel that they want more time to gain these core competencies, more time to make decisions about sub-specialty training and to make applications for this as appropriate. However this group must also pass the clinical MRCPCH by the end of Summer 2023.

More information about planning for the transition at this level can be found in Progress+ and me: Information for trainees in training in 2021/22

Will I need to have completed 18 months WTE across general paediatrics/ neonates and community paediatrics at ST4 to be eligible to apply for sub-specialty training in the following year's recruitment round?

The training pathway is capability based, so as long as trainees can demonstrate and evidence that they have met all the level 2/core training competencies, then they will be eligible to apply for sub-specialty training in the 2022/2023 round to commence in Summer 2023. 

Trainees should discuss their plans with the Educational Supervisors and TPDs early so that they can be supported in any way necessary to achieve these. 

I am a LTFT trainee - how will the transition affect me?

The advice for WTE trainees at specific points is a guide and will need to be interpreted on an individual basis for LTFT trainees depending on their stage of training, percentage of LTFT and curricular coverage. Training remains capability based rather than time based, so progress against the curriculum will be an important consideration.

Early conversations with ES and TPDs to discuss individual circumstances and what this will mean for these trainees are really important.

I am currently having winter, rather than summer, ARCPs - how will this affect me?

As for the LTFT trainees, individual circumstances will need to be discussed early with ES and TPDs to plan for each trainee. Progression should be competency based rather than time based, which should be an important consideration.

It is anticipated that more trainees than usual may require a summer ARCP so that these decisions about transition to Progress+ can be made.

As an employing trust we are concerned that the move to allow all ST3s on to the Tier 2 rota before completing their MRCPCH will have pay implications and therefore an impact on budgets – can the RCPCH provide some assurance on this?

We can reassure you that the pay you receive as a trainee is not linked to the rota you are on and so this change to the training programme will not affect trusts.

Many trusts have already progressed ST3 trainees onto the middle grade rota and this is something that is well established. Have a look at our heat maps to see where this is happening already, and you can speak to these trusts to find out more about how it works for them. 

Examinations

In the new training pathway when do I need to have passed my MRCPCH theory and clinical exams?

You will need to have completed MRCPCH theory exams by the end of ST3 to allow progress to ST4 and tier 2 rota (middle grade), and MRCPCH Clinical by the end of ST4 before progressing from core to specialty training.

Sub-specialty training

When will I be able to apply for sub-specialty training in the new training programme?

You will be able to apply for sub-specialty training (previously known as 'Grid') from the start of ST4 training year to commence sub-specialty training from ST5. 

To be eligible to apply for sub-specialty training, you will need to have completed your MRCPCH Clinical by the time of sub-specialty interview and have a satisfactory ARCP (Annual Review of Competence Progression) outcome. You will also need to have enough indicative time at the start of sub-specialty programme for you to complete prior to CCT date.

What happens if my first application to sub-specialty training is unsuccessful and I do not have enough indicative time to complete sub-specialty training from the start of ST6? 

From 2021-22, there is no limit to the number of times you can apply for sub-specialty training, providing you have enough indicative time to complete training prior to your CCT.

if you are applying to start sub-specialty training from ST6 you may need to request that your TPD place you in a suitable training post that can count towards training. You will need to ensure that you have enough time to complete sub-specialty training before CCT and gain CSAC agreement to count any training completed before starting the subspecialty training. This also applies to those wishing to apply to change from one subspecialty to another. There is also the option to apply for OOP time in order to gain more experience and give more time for subspecialty applications. If you are thinking about this, it is important that you arrange an early discussion with your Educational Supervisor and TPD. 

I'm worried that I will not have enough experience to competitively apply for sub-specialty training in my ST4 year. Will I be disadvantaged compared to more experienced trainees who have completed 24 months WTE at level 2 prior to move to Progress+? 

CSAC teams are aware that some trainees will have less exposure to their chosen sub-specialty when they apply for sub-specialty training following the move to Progress+. They will take this into account when reviewing sub-specialty applications. It is important to emphasis that the application process will be looking for aptitude and genuine interest in the subspecialty rather than extensive prior experience.

RCPCH and CSAC teams encourage trainees to explore all avenues of information about their chosen specialty prior to their sub-specialty application to make sure they are both the right fit for the chosen sub-specialty and the sub-specialty is the right fit for them.

Trainees who will be completing ST4 and starting ST5 at the start of Progress + in Summer 2023, have the option to remain in Core training  to do a further year in Core  if they feel that they would like to gain more experience to support their  sub-specialty applications. 

As a trainee if I opt to remain in Core training as proposed, how will this affect my pay?

If you decide to remain in Core training, your pay will not be affected by this decision.

We understand that trainees’ movement to the ST6 pay progression may be affected by Progress+ and we are currently in discussions with HEE about how best to manage this.

We can confirm that no trainees will have their pay affected by any ST nomenclature.

If trainees are finishing ST7 when Progress+ comes in, do they become ST7 again or ST8?

There are currently ongoing discussions with HEE about the naming changes. This is complicated by the nodal point at ST6 where there is a pay progression. The college are working with HEE to clarify how the naming of grades will work during this transition, but the solution will ensure that no trainee will have their pay affected or miss out on this pay progression by any change in ST nomenclature. 

Will there be a bottleneck of applicants to sub-specialty training for two or three years until everyone is aligned with Progress+?

There is likely to be increased competition for a time. However, to mitigate against this we will allow trainees to apply to sub-specialty training from ST4. Trainees transitioning from the old training programme structure to the new Progress+ structure can take an extra year of training between the new ST4 and ST5 in Progress+ should they wish, which will also help to even any bottleneck out. Trainees may also consider other options, such as clinical fellow posts in sub-specialty areas or other opportunities, which could be offered as OOP.

It is important to highlight that trainees will not lose their training number as an impact of the proposed changes. The overall number of training posts is not changing and there will be a post for every trainee.

A transition planning group has also been set up since the submission to the GMC, who will be actively looking at this area, and providing initial thoughts on how we expand sub-specialty training programmes, whilst balancing this with available consultant posts and sub-specialty opportunities for General Paediatric trainees. 

We also encourage Schools and TPDs to engage with this group in order to keep up to date with this subject, and to continue this conversation. 

START

START means 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.

When can I apply for START following the commencement of Progress+? 

You will be able to apply for START in your ST6 year. The College will ensure there are additional places available to manage any increased volume of applications during the transition phase.

Workforce

I am concerned that the changes to the paediatric training programme will further exacerbate the rota gap issues that we are already having to deal with.  How are the RCPCH proposing that this is managed? 

The College's Workforce team has been working on different modelling options so that we can anticipate the risks to service with the new training programme.

We plan to work with service leads to identify the impact and possible mitigations, as well as focus on the opportunities that Shape of training presents. Please do look out for further updates on the Shape of training page.

How will we cope with only seven years’ worth of trainees?

Firstly, it is not a given that there will be fewer trainees. The number should be determined by service need, not set by the pathway. The college's workforce team is engaged in long term workforce modelling discussions including looking at the number of trainees, consultants and other non-trainee doctors, as well as developing a diverse workforce fit for future service needs.

Even if we recruit no more as currently at ST1, there would be a transient bulge in those gaining CCT, followed by a fall in trainee numbers, but matched by the increase in CCT holders. Employers need to anticipate this when planning how to resource their service.

What about middle grade rotas?

Progress+ will rebalance the junior/middle grade ratios by supporting more junior trainees moving to tier 2 rotas during ST3. All core trainees should be on tier 2 during ST4. The requirement for MRCPCH will move to the end of ST4, and thus before progression to specialty paediatrics.

Flexibility

I understand that there is a new Out of Programme designation that will allow me to pause my training. How does this work, and will this really increase flexibility?

The ability to pause your training is a relatively new option currently available in England only. Health Education England developed the programme, Out of Programme Pause (OOPP), which is currently being piloted to evaluate opportunities for doctors in training who wish to ‘pause’ their training to undertake an NHS non-training post, gain further experience, take stock of their training, work in another related specialty, etc. OOPP differs from OOPE in that experiences or capabilities gained while out of programme are likely to be counted toward CCT if they are demonstrated and assessed once back in training.

Whether it increases flexibility remains to be seen. But, it is hoped that giving trainees this opportunity to pause their training will at the very least stop them from potentially leaving training and medicine altogether.

Further details about OOPP and flexibility in training can be found in the Academy of Medical Royal Colleges' document, Guidance for flexibility in postgraduate training and changing specialties.

What happens to me if I am on OOP when the Progress+ changes come in?

Broadly speaking you will transition at the point where you come back into training after your OOP. You will transition as laid out above and in Progress+ and me: Information for trainees in training in 2021/22 depending on the grade you were due to be on re-entering training. It will be important to have early discussions with your TPD and ES prior to returning to training to ensure that the transition will work for you and your career plans.