RCPCH START - guidance for trainees by trainees

START means Specialty Trainee Assessment of Readiness for Tenure, and is for trainees in level 3 training.

Written by trainees and the START team, this is an an informal insight into the assessment. We aim to help you understand its format and make the most of the learning opportunities.
Last modified
27 July 2022


START is not an exam and should not be seen as one. It is an assessment tool used to highlight areas requiring focus for the last leg of your specialist training. It is an opportunity to practice scenarios and questions which you could face as a new consultant. START is not a pass or fail assessment. It simply provides you, as an individual clinician, with robust feedback to help you develop.

The College has guidance about START, including eligibility criteria, costs, dates and feedback information.

This guide, on the other hand, is written by trainees and the START team to provide an informal insight into the RCPCHStart process. The aim is to help trainees understand the format of the assessment and enable them to make the most of the learning opportunities it presents.

We focus on these main areas:

  1. The application process
  2. Structure and tips for success
  3. Key areas to focus on
  4. Your feedback after START

1. The application process

    START usually runs two times a year. Specific sub-specialties are run on set dates - so be aware of which date you are applying to.

    You can apply for START from ST6, but it is expected that most trainees will complete START during their ST7 year. This allows enough training time to address any highlighted learning requirements.

    Priority is given to applicants nearer the end of training (ST8>ST7>ST6) The cost of the START assessment will be advised on the RCPCH website at the time. You will receive email confirmation around 14 working days after closure of the application period.

    To apply, you will need to log in to the booking system during the application window.

    Find out more about how and when to apply

    2. Structure and tips for success


    If held as a face to face assessment, you will be told to arrive 45 minutes beforehand and will be briefed with information on what to expect. If the assessment is taking place virtually, you will invited to attend both a briefing prior to the assessment date, and on the day itself.

    • Remember that we are all paediatricians and the START team is there to help. They will remind you that this is an assessment, not an examination, and that the feedback provided is to support your professional development.
    • They will inform you of any other professionals who may be present during your assessment. These are most commonly supporting assessors and external observers.
    • START is still a relatively new form of professional assessment and as such is continually training new assessors and being observed by other Royal Colleges who want to learn about the process.

    Assessment structure

    The assessment currently consists of 10 scenarios.

    • Seven of the scenarios will be general paediatrics and the remaining three will be in your sub-specialty.
    • If you are a general paediatric trainee, all ten will be relating to general paediatrics.
    • If it's a face to face assessment, scenario sheets are provided under the chairs outside each room. You pick a coloured sheet if you a sub-specialty trainee and a white sheet if a general paediatric trainee. If it's a virtual assessment, you will see both the general and subspecialty scenario on the screen, and you select which applies to you.

    The information below relates to the face to face assessment - the virtual assessment takes place online, and you'll be sent a URL and instructions.

    If START is face to face, it is usually held at the Royal College of General Practice assessment centre, pictured below, which is specifically designed for this kind of professional assessment. It is easy to see where you are going and there will be numerous people present to help you find your way around scenarios.

    • You are given four minutes to read each scenario before entering the room.
    • You can make notes on the sheet and bring it in with you to refer to in the scenario.
    • Ensure you always read the question/ scenario carefully.
    • You are then given eight minutes with the assessor to discuss the scenario.
    • The only scenario currently where you are not supposed to engage solely with the assessor is the teaching scenario in which you should engage directly with the student(s).
    • At two minutes left there will be a knock on the door to remind you to begin concluding the scenario.
    • There is another knock or buzz when the eight minutes is up at which point you should leave and find your next scenario. Please do not try to continue after the time is up, it is much better to move on and use your time to prepare for the next scenario.

    Some scenarios may feel like an eight-minute monologue and others like a conversation with a colleague. This will vary based on the scenario, the assessor, and your style of communication. Neither format is intrinsically right or wrong.

    Preparation time

    You will have 16 minutes preparation time for safe prescribing. If it's a face to face assessment, you will have a shared space with a group of up to four trainees, if it's virtual you will be in a prep station with the scenario and medication monograph.

    Prescribing is the scenario that most commonly raises concerns during START:

    • You won't need to write a prescription - the scenario will be about safe prescribing rather than having to fill out a chart.
    • You won't need the BNFC - a medication monograph will be provided.
    • Remember that this is not an examination and this is to identify learning points for you.
    • You get the four minutes preparation time prior to the actual scenario to remind yourself of your notes.

    For critical appraisal, you will have been sent the paper 1 week in advance of the assessment.

    • Make sure you relate it to the clinical scenario - don't just critically appraise the paper. Think “how does this piece of literature effect how I treat the patient in front of me?”
    • If anything is unclear from the scenario, clarify this with the assessor and try not to fall in the trap of making assumptions.

    If the assessment is face to face:

    • A highlighter or two can be helpful for this scenario, they are not provided, bring them with you.
    • You are provided with additional paper to make notes. Use this liberally; however, it is often a good idea to make a short summary of bullet points for your own quick reference in the scenario.
    • You can bring the paper and notes with you to the scenario.

    3. Key areas to focus on

    It is not necessary to prepare for START. Some trainees choose to approach the assessment with their “normal” daily practice. Other trainees feel more comfortable having done some preparation. Keep in mind that a small amount of revision and preparation can help you avoid simple mistakes. This will ensure your feedback focuses on the most useful areas for development. We have identified several key areas that may be useful to focus on if you choose to prepare in advance.

    • Critical appraisal: Practice critically appraising papers and presenting in journal clubs. Ask for feedback and don’t forget to use these as Case Based Discussions.
    • Handover: Read the paper by Klaber et al from ADC (2009) entitled Maximising learning opportunities in handover.
    • Consider using a Handover Assessment Tool (HAT) both as an assessment for you and for you to assess a peer or junior.
    • Prescribing:
      • Prescribing modules are available on the RCPCH Learning website.
      • Consider performing a local audit reviewing drug charts with your pharmacist to help embed best practice habits before the day.
    • Ethics: Try to attend local ethics meetings/ debates. If these are not available locally, the Ethics and Law forum runs a meeting each year at the RCPCH conference.
    • Online modules are available again on RCPCH Learning website, including:
      • Healthy child programme (module 2: record keeping).
      • Adolescent health programme (module 3: legal framework, confidentiality, consent, ethics).
      • Some face to face courses may also be useful
    • Safeguarding:
      • Attend a level 3 safeguarding course. You may wish to find a face to face course. Online models are available via the RCPCH Learning website.
      • Get involved in strategy meetings, CAF/team around the child meetings, and report writing.
      • Perform safeguarding CBD with your local safeguarding lead.
    • Teaching and training:
      • Consider local teaching courses such as Teaching the Teachers to Teach. Your postgraduate centre will have a list of available courses in your area.
      • Be involved in local departmental teaching.
      • The MiniCEX assessment can be used to seek formal feedback on your clinical teaching.

    It can be difficult to prepare for the clinical scenarios due to the wide variety and breadth of general paediatrics. The best planning for these is to do your job, seize every opportunity to discuss your practice with colleagues, and observe others. Meeting with friends, peers, and senior colleagues who have completed START can be useful. Many regions now run START preparation courses and you should talk to your Training Programme Director about what is available in your region. Keep in mind that most people complete START without having done any “formal” preparation and that is a reasonable approach too.

    Three hours will go quickly but is in fact a long time!

    You can download benchmarking standards used in assessing and an example of the assessor feedback form at the bottom of this page.

    4. Your feedback after the assessment

    Feedback is given about six weeks after completing your START to ensure the feedback is as useful as possible. It is available to view on your RCPCH ePortfolio.

    It is not uncommon to become disheartened if you see 'development needed' on any of your stations. Remember, the standard being assessed is a “day-one consultant” so all feedback is intended to be constructive advice for your personal development. This can be used as evidence to agree development plans with your Educational supervisor or Training Programme Director to enhance your training placement. For example, if a clinic-based scenario highlights an area for development, this can empower you to ask for protected clinic time in your Trust, or for a stint in a DGH known to provide trainees with supported outpatient experience. The same applies to your reflections, which could be tailored to support requests for your final rotations based on the clinical experience you feel you still need to gain.

    This is followed by comments on each individual scenario.

    Your Educational Supervisor can view your feedback. Plans to address highlighted issues should be discussed within four weeks, and a START PDP completed (available on your ePortfolio). Escalation to Training Programme Directors and Heads of School may be needed if broader training needs cannot be provided at the current placement. The aim of the assessment is to provide constructive feedback on areas of focus not as a list of things you did wrong. Supervisors are provided with written guidance on how to manage issues highlighted from START. If you feel these have not been appropriately addressed, you should discuss with your College Tutor.

    Much of this is mentioned in our preparation advice for Educational Supervisors. You can download this guide to START assessment feedback and targeted development for educational supervisors below.

    More FAQs and contacts

    You can read the College's guidance, including frequently asked questions.

    If you have any questions relating to START, contact training.services@rcpch.ac.uk.

    If you have feedback about this guide including clarifications, additional details, or comments to assist other trainees relating to START, please contact the START Trainee Representative Assim Javaid, assimjavaid@doctors.org.uk .

    Good luck!