RCPCH START - guidance for trainees

START means Specialty Trainee Assessment of Readiness for Tenure. It guides trainees as they prepare for completion of training and practice as a new consultant paediatrician. Find out how to check your eligibility, apply and pay, and how it fits in with your educational supervision.

Applications for the March 2023 START are now closed.
Last modified
9 January 2023


Ordinarily, START is a three-hour assessment with consultant paediatricians which assesses your abilities relating to clinical decision-making as a new consultant. It helps you address any gaps that you may have in your training.

START has a circuit of stations, which cover different skills. The stations include scenario based discussions on acute disease, chronic problems, behaviour difficulties and neonatal care. Other scenarios include safeguarding, ward handover and ethics. There are also scenarios on critical appraisal and teaching. You can read more about the circuit, watch our videos and download example scenarios on our how it works page.

Who needs to, or should, take START?

You must take START if you are paediatric trainee expecting to attain a CCT (certificate of completion of training) or CESR Combined Programme, ie, will complete a UK Paediatric Training programme leading to entry on the Specialist Register.

You can also take part if you are a doctor in a non-approved training post, such as a Specialty Doctor, Trust Doctor, Associate Specialist, Staff Grade or Locum Approved for Service post. This is subject to availability and capacity, with trainees taking preference.

If you are not sure whether to take it, email us on training.services@rcpch.ac.uk.

When and where does START take place?

We normally host START twice a year, in the spring and autumn. It is currently delivered online.

In 2023, we will run two diets: the spring dates are 14, 16 and 21 March and the autumn dates are 3, 5 and 10 October.

When do I take START?

We determine places for START based on your CCT date as detailed in either your latest ARCP outcome on your ePortfolio or in the Trainee-led Record for Completion of Training Date form on your ePortfolio.

Do not expect to be guaranteed a place even if you have applied previously. If you are expecting to change your CCT date, you need to complete the form on your ePortfolio.

What happens if I am in sub-specialty training (was called Grid)?

If you plan to complete training in an approved sub-specialty training programme, you must have START in that sub-specialty.

We advise that you apply after you have been accepted for a sub-specialty post and are working in that post. You should be confident that you are ready to be assessed in your sub-specialty before you apply.

You will need to include your sub-specialty on your application so we can place you on the relevant circuit.

If you are in a SPIN module, you will sit General Paediatrics START so do not select the subspecialty if doing a SPIN module.

How much does START cost, and how do I pay?

The fees (came into effect as of October 2020 START):

  • Run-through trainees who enrolled with RCPCH for training before 1 August 2019 pay between £268 and £559
  • Run-through trainees who enrolled with the RCPCH for training on or after 1 August 2019 (indicatively taking the START assessment in 2024) pay £850
  • Non run-through trainees - £850
  • For a fuller explanation on how the fees are determined, see our training guide

You'll pay after you are granted a place, and can pay online by card.

We are happy to issue receipts for the assessment fee - please email your request to us at training.services@rcpch.ac.uk

We do not pay for travel or accommodation costs.

How do I apply?

Note on CCT date Before you apply, check your latest ARCP has the correct CCT date, as we use this to prioritise placements for START. If the CCT date is not correct, you will need to get confirmation of your correct CCT date from your Training Programme Director or Head of School, and ask them to complete the Record of Completion of Training Date on your ePortfolio.

To apply during an application window, log in to our online booking system with your RCPCH number and password (as used for your ePortfolio), and follow the on-screen instructions.

The application form will ask you for:

  • Your CCT date - this is so we can prioritise according to training time
  • Your whole time equivalent training time - this is so we can prioritise according to training time
  • Your current grade - this is so we can prioritise according to training time
  • Whether you are subspecialty or general paediatrics (NB SPIN trainees are considered general paediatrics)

This table shows the recent and upcoming START dates and application information.

START dates Application dates Status
Spring: 14, 16 and 21 March 1 - 31 October 2022 Closed
Autumn: 3, 5 and 10 October 1 - 30 April (midnight) 2023 Not yet open

How does RCPCH prioritise applications?

We recommend you apply for START early in the application period. We prioritise as follows:

  1. Applicants in run-through training, particularly those in ST8 posts
  2. Applicants with CCT dates closest to the assessment determined by training time left rather than chronologically - see 'Note on CCT date' above
  3. Date application received

The number of times of you have applied will not be relevant if your CCT date does not warrant a place on the assessment. An expectation to complete your CCT early is insufficient evidence of a change and we will require confirmation from your Training Programme Director and CSAC, if GRID training, before we accept an earlier date. You are now able to submit a Record of Completion of Training Date on your ePortfolio to show us the most accurate CCT date possible.

If you think you may gain your CCT early, or you have any other information that you think would be useful for us to know, you must include this in your application. Make sure you use the comments box on the application form and send support for an earlier CCT date from Programme Director/Head of School or CSAC to training.services@rcpch.ac.uk.

If we don't receive the necessary information and email support before the application window closes, we may not be able to consider you for shortlisting or offer you a place. Please note, there is no guarantee of a place in the assessment even if you do have supporting emails as others may take priority.

The final decision on place allocation rests with the RCPCH office so we need all relevant information to make an informed decision.

Withdrawing and refunds

You can withdraw up to one week before the assessment date. You must inform us in writing to training.services@rcpch.ac.uk and we may ask you to provide supporting documentation.

If you are unable to attend the assessment due to unforeseen circumstances, please inform us in writing no later than the day of the assessment.

Refund policy

Time of cancellation before START date

Refund of START fee

Up to 14 working days

Full refund if place can be filled by another trainee

If place cannot be filled, full refund minus £85 admin fee

Within 14 working days before

Full refund minus £85 admin fee

No refund will be given for non-attendance on the day or cancellation within 24 hours before the assessment, regardless of reason.

How do I prepare?

You aren’t required to do any ‘revision’ – the scenarios should be examples of your ‘day-to-day’ work but you will approach them as if you're a day one consultant.

You will probably find it helpful to familiarise yourself and keep up to date with NICE guidance and GMC guidance on confidentiality, consent, capacity, duty of candour, colleague in difficulty, answering complaints and safeguarding. You may consider going through your drug charts with a pharmacist.

What do I need to know on the day?

At the moment, the assessment is virtual and all trainees are offered a briefing via webinar to explain how the assessment works, including the system used for the assessment.

There is no dress code. Do dress as you would when going to work. There's no need for a suit and tie, or dress - but if that’s more comfortable for you, then that’s fine, too!

What if I need reasonable adjustments?

You are entitled to request reasonable adjustments for START and for all other College education and training activities.

Examples of reasonable adjustments include, but are not limited to, scribes/readers, private areas or additional reading time.

A request for adjustment may be determined as not reasonable if it it has an impact on the integrity of the assessment, or if it involves immoderate or excessive costs.

All requests should be send to the Training & Quality team on training.services@rcpch.ac.uk. We'll fully consider all requests, and inform you if supporting evidence is needed.

For more detail, read our reasonable adjustments policy.

How do assessors judge my performance?

START has anchor statements which allow assessors to make judgments on trainees at each station.

This covers six domains and all stations cover all domains. These are: decision making and prioritising, knowledge, management of complexity, professional approach, safety and risk management, and communication.

A global rating is also made as an assessment of performance overall in the scenario.

Within each domain, the trainee is assessed at three levels - well above expected standard, performed at expected standard and further development required.

Well above equates to performing as if you've been a consultant for a few weeks. Performing at expected standard means day one consultant. Further development means you've performed at trainee standard and there are some areas to work on - this is fine and to be expected as part of the formative nature of the assessment.

You can download the benchmarking standards below.

The assessors complete an assessor feedback form at each station, also available to download below.

How do I get feedback?

We will send your feedback report about six weeks after the assessment. It will appear in your RCPCH ePortfolio, and you can search for it in your timeline.

Your report will include your global rating, your overall score, your performance against the competency domains and the written feedback for each station. It is similar to the MSF report.

There is no pass/ fail mark. However, trainees can under-perform and the feedback will include recommendations to address any development areas.

What do I do with the feedback?

You should discuss your feedback with your educational supervisor within four weeks of getting it. Your supervisor can help you interpret the feedback into a development plan.

You and your supervisor can use the Guide for START assessment feedback and targeted development for educational supervisors, available to download below.

If you are not in training, you will be asked to nominate a supervisor who can assist in the feedback process.

What happens if there are concerns?

The responsibility to remediate concerns will lie with your local education provider. The College works closely with all paediatric schools, College Tutors and educational supervisors to ensure a robust system is implemented in assisting those in training to address issues.

Trainees will not be expected to undertake the assessment again.

How does this relate to ARCPs (Annual Review of Competence Progression)?

START is not designed to gate‐keep progression through training and should not be the sole determinant of ARCP outcome. Rather it is another formative piece of evidence a trainee has in their portfolio on capabilities acquired through training that are relevant to completing training. There is a START feedback PDP form that we would strongly encourage you to use with your supervisor, when you have received your feedback.

We will not allow trainees to re-take START.

You can find out more in the START and ARCPs statement, as well as the Guide for educational supervisors, available to download below.


If you have any queries, please contact training.services@rcpch.ac.uk