The Annual Review of Competence Progression (ARCP) is the formal method by which a trainee’s progression through her/his training programme is monitored and recorded each year. ARCP is not an assessment – it is the review of evidence of training and assessment.
The ARCP decision is based on the ARCP decision aid so it is worth being very familiar with this grid: ARCP decision aid. There is now (as of Aug 2017) a new ARCP decision aid for GIM only so make sure you have read it in full.
The curriculum states that, in addition to the components of the ePortfolio (meetings, workplace-based assessments, MSF, teaching observations, MCR and audit assessment), trainees should gather evidence of:
- An anonymised record of bronchoscopy experience, including details of exact techniques used, for example, transbronchial biopsy and transbronchial needle biopsy, as well as a record of the positive histology rate for visible tumour. (see logbook)
- An anonymised record of pleural interventional experience. (see logbook)
- An anonmyised record of NIV experience. (see logbook)
- Formal sign off of their NIV competence (perhaps best done as DOPS, miniCex and relevant courses)
- Formal sign off of their Intensive Care Medicine experience (could be end of placement appraisal, letter from supervisor etc)
- Details of training in appropriate specific subject areas within Respiratory Medicine, such as lung cancer and sleep breathing disorders (captured in clinic log and miniCex and CbD in specialist posts)
- Details of special interest training, particularly in transplantation, pulmonary hypertension, adult cystic fibrosis, domiciliary NIV and occupational and environmental disease (see FAQs for more info)
Please ensure that anything uploaded to the personal library section of your ePortfolio is clearly labelled. Anything that eases the job of the ARCP panel will be much appreciated!
The Multiple Consultant Report is now embedded in the ARCP process. As a reminder it is designed to gather evidence-based opinions of up to 6 consultants and collate them automatically to be presented to the Educational Supervisor for inclusion in the Educational Supervisor report. It is focused on the trainee’s clinical ability (rather than teamwork, communication etc that is gathered in the MSF). Official advice is that Respiratory trainees should gather responses from at least 4 consultants, in the last 6 weeks of the post. However, in order to have this available for ARCP it will have to be done earlier. Also, for everyone dual accrediting in GIM (so, everyone) you need to cover GIM in your MCR if appropriate for your post. We advise ask all your Resp Consultants to complete an MCR and also 2 GIM Consultants, or ensure two of your Respiratory Consultants who have also seen you do GIM on calls comment on this aspect of your performance.
Information from the SAC (with thanks to Dr Bhowmik for clarification) indicates that in addition trainees must provide evidence of:
- 186 clinics (these may include General Respiratory clinics and even Lung Cancer clinics where new GP referrals are seen which are often in the nature of “Cough ?cause”)
- 1000 patients seen on the acute take – from 2015 onwards the Firth Calculator should be used, rather than a logbook of patients.
- 6 ACATS per year (during attachments where GIM is a component e.g. not at The London Chest Hospital) which should include a minimum of 5 cases.
- Record of 100 hours of GIM (not including Respiratory) CPD hours over the whole period of training – see training programme for more details
- A separate GIM Educational Supervisor Report, in addition to one for Respiratory, in any post which includes GIM. THis is a common reason for trainees not getting an outcome 1. The reports must be separately logged, even if they are both written by the same supervisor.
- Occupational lung disease clinics (see FAQs for requirements and how to arrange)
- Lung Transplantation attachment (theoretically 1 week, but a Consultant at Harefield has advised us that in reality, only 3 days may be required – this will need to be confirmed at the time of arranging the attachment. See FAQs for further details)
- Pulmonary hypertension –requirements similar to Lung Transplantation (see FAQs)
- Chemotherapy and Radiotherapy clinics – evidence of some experience. Arrange locally in appropriate posts.
- Cystic Fibrosis attachment – see FAQs for requirements and how to arrange. The Educational Supervisor should also agree with the trainee a recognised course (which should be BTS, RSM or equivalent)
- Smoking cessation clinic experience (an online or BTS course is also beneficial, or formal level 1 training, available at The Whittington)
- Pulmonary rehabilitation experience (available at most hospitals if you make friends with your Respiratory Physio. Easy to arrange at the Whittington and Homerton Hospital. Why not give a patient education session and get it signed off as a Teaching Observation?)
- Integrated Respiratory Medicine experience (strict criteria not yet agreed: Dr Bhowmik suggests at least 3 MDTs and a home visit accompanying a specialist nurse with CbD afterwards. Easy to arrange at Whittington and Homerton.)
- HIV clinic experience (available at UCLH and Royal Free).
- Respiratory allergy and immunology (available at Homerton and Southend).
- Thoracic surgical list (arrange locally through the surgeon at your Lung Cancer MDT).
- Safe sedation course (see BTS website or resources – the one at the RCP is comprehensive but not specifically designed for Respiratory trainees. In 2015 a session was arranged on a Royal Free training day which met criteria, so watch out for future similar opportunities).
- Level 1 pleural US – see FAQs for further information
- Complete MSF with minimum of 12 responses including 4 consultants and several AHPs once in first 1-2 years and one in final 2 years.
- Audits or quality improvement projects including GIM
- Separate annual Respiratory and GIM supervisors report (end of placement) – incorporating MCRs (see above)
By the end of programme:
A checklist written by LJ and Dr Bhowmik to make your ARCP go smoothly is available here: UCLP Respiratory Medicine ARCP checklist 2015 FINAL . You must still check the specific requirements for your year of training, in addition to this list.
A new GIM checklist was released by the JRPCTB in 2017. It provides clarification on what needs to be signed off by the trainee and the ES:
- Individual sign off of emergency presentations and procedures by trainee and supervisor
- Other curriculum items – trainee to sign off all, supervisor to sign off 10% each year
- Record ratings at curriculum group level
The penultimate year ARCP, known as the “PYA,” is undertaken 18 months or less prior to the anticipated CCT date, and will include an external assessor from outside the training programme, often from the SAC. JRCPTB and the deanery will coordinate the appointment of this assessor. Whilst the “usual” ARCPs will be a review of evidence, and not necessarily require an “interview,” the PYA will include a face to face component. Its’ intention is to confirm the CCT date with the trainee and the local STC, and to decide what further specific training requirements need to be met during the remaining time in training. CCT date calculator and external assessor marking forms are available from JRPCTB. Trainees and their educational supervisors may find it instructive to review these forms ahead of the PYA. Remember that there will a separate Respiratory and GIM PYA.
It appears that PYAs for GIM have not been going very smoothly in London lately. There has been criticism from external assessors about poor quality educational supervisor reports for GIM and trainees attending their PYAs with a lack of adequate preparation for the process. Hopefully you saw a letter from HEE and a very useful FAQ/checklist document circulated recently. In case you missed them, here they are: