What do I need to do to get signed off at ARCP?
- The requirements for ARCP/PYA sign off are in the JRPCTB ARCP decision aid. Make sure you are familiar with both the Respiratory and GIM components well in advance of your ARCP. Be careful, as some of the requirements are not obvious! In addition you will need to make sure all your log books of procedures and clinics are up to date, so that you are working towards CCT requirements. You may wish to provide a summary of your recent publications, courses, meetings, teaching and management experience since the last ARCP period. These should all be in your personal library on your ePortfolio. Save your email receipt for your completed GMC survey as this is required for ARCP. The main thing to plan in advance is getting miniCex/CbD/DOPS/MCRs/ACATs signed off so get started with these as soon as you start your post. For additional information on how to make sure you pass your ARCP see the most up to date advice, highlighting the main problems people had in the last year, and a summary of additional requirements that may not be easy to acquire in day to day practice.
I’ve been out of training and am returning to practice. What has changed in terms of ePortfolio/ARCP requirements?
- It depends when you went out of training, but the first thing to make sure is that you are on the right curriculum. All trainees should have already moved to the most recent (2010) curriculum as per GMC rules. If you are moving from an old to the new curriculum, JRCPTB does not mandate that competencies already achieved are marked off on the new curriculum, but you should talk to your educational supervisor, and you might find subsequent ARCPs go more smoothly if you add ratings for competencies already achieved and in the comments insert “see evidence on 2007 curriculum”. All future evidence of competence progression should be linked to the most recent curriculum (2010). You should have a look at the most up to date ARCP decision aid on the JRPCTB websites and the info on this site. The GMC provides info on moving to current curriculum, and the most recent curriculum changes are highlighted on the JRPCTB site and are:
- Definition of the minimum training requirements for pulmonary vascular diseases (E12), cystic fibrosis (E16), lung transplantation (E20)
- Learning objectives for practical procedural areas (F(b) and Bronchoscopy (F5) clarify the need for formal sign off of competence in safe sedation
- Pleural ultrasound level 1 (F6) updated to reflect Royal College of Radiologists Focused Ultrasound Training Standards, 2012
- Trainees have to comply with the assessment criteria of the latest curriculum – new things if you have been out are likely to include USS, the SCE, and the MCR (multiple Consultant Report, which is different to the MSF or educational supervisor report).
How do I arrange an OOPE/OOPR?
- Time out of programme for research or specific training experiences can greatly enhance your programme and your future career prospects. A large proportion of North East Thames trainees CCT with a higher degree such as an MD or PhD. The key is to plan ahead early. It can take a year to secure time out and the funding required to take up a research position. Talk to your educational supervisor and the Training Programme Director as early as possible about your plans. You will only be able to leave the programme in April or October, when jobs naturally change and you must give a minimum of 6 months notice to leave the programme. There are no guarantees that if you request time out it will be granted, but the TPD will do everything they can to support you. There are lots of bits of paperwork to complete to get the time out and to work out whether any of it will be counted as clinical experience. Further guidance can be found on the London Deanery (now LETB) pages. Additional advice can be found on the Research and Teaching and Training pages.
Are training days mandatory?
- Yes. If you are having problems attending due to service demands please highlight this as early as possible. Training days are a great opportunity to learn from local experts and spend time with other trainees. You should attend 75% of training days, and also ensure you acquire the required number of GIM hours (100). For tips see the pages on the training programme.
Where are all the hospitals I might rotate to?
- You can see the locations of all the hospitals on the rotation on this Google map. Many of them have an individual page on our hospital trusts section (see menu bar above), with links to each Trust’s website, and information on individual jobs.
When should I take my SCE?
- The SCE can be taken at any time once you have a Respiratory training number. It is recommended that trainees consider taking this in their third year of training (ST5). There is only one diet of the exam per year. Failure in the exam will not impede progress through training, but a CCT cannot be awarded without it. See the SCE page for further advice and tips on how to prepare.
How can I arrange a transplant placement?
- Requirements to sign of Lung Transplantation for CCT are attendance at a teaching programme/course + 2 outpatient clinics in specialist/satellite clinic + CbD. We have an agreement with Harefield Hospital to facilitate Transplant experience. Please speak to Dr Carby’s secretary (Patricia Harris) and expect to observe on a Monday, Wednesday and Thursday, which will include an assessment clinic, a follow-up clinic, a ward round and an MDT. Please ensure that you have approval from your educational supervisor before you contact Dr Carby suggesting dates. And think (months) ahead – he gets booked up! Why not read one of his papers on recipient criteria for transplant, immunosuppression, or minimally-invasive lung transplant surgery before you visit him?
How can I arrange a pulmonary hypertension placement?
- Good people to start with for Pulmonary Hypertension are Dr Gerry Coghlan, Consultant Cardiologist at the Royal Free (why not read his ERS paper on early detection of PAH before you email him?) as well as Dr Luke Howard and Dr Rachel Davies (who happens to be TPD for NWT and is fully aware of the training requirements) at Hammersmith. They have written an e-learning module which is free once you’ve registered. Contact details for all Pulmonary Hypertension centres can be found on the PH professionals site. If you fancy going further afield, to Sheffield for the largest pulmonary hypertension centre in Europe, Richard Turner (who did a PhD with Prof Bothamley and has recently CCT-ed after completing training in NE Thames) has some great contacts and is happy for you to contact him.
How much experience do I need in Cystic Fibrosis?
- Newly clarified minimum requirements are: attendance at a teaching programme session/course + 2 outpatient clinics + MDT + CbD with reflection. Your Educational Supervisor can help by recommending a recognised course (which should be BTS, RSM or equivalent). You will need to get study leave to attend clinics and an MDT if you do not rotate to a CF centre (ie The Royal London, Barts).
How much experience do I need in Occupational Lung Disease?
- There is not the same formal requirement for Occupational Lung Disease as there is for Lung Transplant or CF. This is mainly because across the country it is more difficult for trainees to access such training. Since we have such an excellent Occupational Lung Disease department just down the road at the NHLI, it would be advisable for all NE Thames trainees to take advantage of their expertise and arrange some time attending clinic. Contact Dr Jo Szram or Prof Paul Cullinan at NHLI to arrange dates, both of whom are extremely helpful and friendly. You can get in touch with Julie Cannon, clinical nurse specialist to check dates (MDT and clinic is on a Monday). Why not read some of their excellent research before you get in touch?
How do I get signed off for Level 1 USS?
- The requirements for Level 1 USS competence are set by the BTS based on the RCR guidelines on focused ultrasound training. You need to do a course which provides the theoretical knowledge necessary for safe pleural procedures, and then acquire sufficient evidence of competency in the form of a log book. Once you have both these pieces of evidence a Level 2 competent practitioner (or someone who is Level 1 with at least 2 years experience) needs to provide formal sign-off of your Level 1 competence (eg in the form of a letter you can upload to your ePortfolio). Different people will achieve competency and confidence at different rates, but the minimum requirements for the logbook are:
Why am I being sent out to deepest Essex?
- Although centrally located hospitals are convenient for many trainees, there are a limited number of places at these hospitals. They also tend to have specialist services and do not provide the necessary general respiratory and GIM experience that is essential in the early years of training. Most doctors will work in DGHs in the longterm and experience in these environments is valuable, particularly in the context of their diverse populations, and organisational challenges. In fact several DGHs on the rotation have specialist services that trainees would not experience in central hospitals (EBUS, thoracoscopy, allergy), and are often able to access more hands-on training in these centres. All trainees should expect to be at a more peripheral hospital in ST3 and 4. Everyone will get time in specialist and central centres at some point. Flexibilty is needed to ensure service provision is not compromised, whilst ensuring fair allocations and diverse experience for all trainees on the rotation. The job of a TPD is not easy…
How can I get experience in medical thoracoscopy?
- Medical Thoracoscopy is done on regular lists at Basildon Hospital. If you contact Dr Mukherjee, and get approval for study leave from your clinical supervisor, you can observe a list on a Wednesday. A better option is to rotate to Basildon, particularly as a more senior trainee, when you can attend lists regularly and acquire skills in thoracoscopy, putting you in an enviable position at Consultant interviews (this may not be possible in the future when EoE repatriation is completed). Basildon also has facilities to perform other specialist procedures such as cryobiopsy and radial EBUS.
How can I get signed off for safe sedation in Bronchoscopy?
- This is essential pre-CCT, and wise to do early in the programme. The RCP runs a ‘Safe sedation for non-anaesthetists’ course, which is covers everything you need but is not specifically aimed at Respiratory trainees (expect discussion of Endoscopy and TOE as well as Bronchoscopy – not necessarily worth your time or money in our opinion). The course at Addenbrookes in Cambridge is similarly focused on non-anaesthetists, rather than Respiratory trainees. The RSM has also previously run a course so look out for future dates on their website. The Royal Free included training in this area with a pre and post-session MCQ at the training day in May 2015 which was excellent. They may run this again, but probably not imminently. The Bronchoscopy training course done in ST3 in NET (and open to other trainees across London) should be sufficient as it includes all you need to know and tests your knowledge of guidelines and evidence with MCQs. In addition to a course, you must have 2 DOPS with a specific focus on safe sedation in bronchoscopy so ask a friendly consultant to assess you after you complete a course.
How can I prepare for a return to practice after time out of training?
- Returning to clinical practice after time out of training for research, an education or leadership fellowship, parental leave or sickness can be daunting. Trainees often worry about running the medical take, due to the need to have up to date knowledge, and exhibit leadership skills under pressure. A number of organisations have produced guidance on how to make the transition as smooth as possible. There are also courses which include updates on key acute guidelines and refreshers on ALS and e-Portfolio requirements. Read the post on returning to practice for more details and make sure you get the support you need for a smooth transition.
Can I claim excess travel expenses when I rotate to a far away placement?
- You may be eligible for relocation expenses if you move to the area at ST3 from somewhere outside London. Alternatively you may be able to claim excess travel expenses if you need to go to a hospital far away from your home and ‘base hospital’ during your rotation. You would usually be able to claim mileage or the difference in cost between zone 3 and the hospital (eg the excess cost of travelling to zone 6 compared to zone 3). The complication is that trainees often go furthest out for their first placement, but the rules state that the first placement is the ‘base hospital’. Some trainees have successfully challenged this rule, others have struggled. You may have to prove every individual journey so use a registered Oyster card rather than contactless. The information is available on the old London Deanery site, and the contact is in the HEE South London team. We have asked for clarification from HEE regarding base hospital rules but have had no answers as yet….
How can I fulfil my GIM requirement for 100hrs of external CPD?
- The best way to ensure you achieve the 100hrs requirement is to attend the regional GIM training days. You can augment these with online CPD (up to 15hours) and other relevant courses from bodies such as the RCP, RSM and BMA. Note that most training days count for 6 hours of CPD not 8. Some training days will have a GIM session which counts for 1hr. Internal training (grand rounds, dept meetings etc) are a separate requirement and don’t contribute to the 100 hours. ALS and generic courses (management, teaching etc) are also a separate requirement. ID/GIM trainee Sadiq has created a handy Google Calendar of GIM CPD (passwords provided to you already via email). It includes London-based events from the RSM, RCP(s), BMJ, BMA, BIA, RCPath as well as the regional GIM teaching days and the excellent monthly GIM 4-6pm sessions at UCLP.
What should I write (and not write) in my reflections on my ePortfolio?
- Being reflective is essential to understanding ourselves and continuing to improve our practice. However, there are controversies around how we should be expected to demonstrate our ability to be reflective. It is a requirement that we submit reflective practice entries to our ePortfolio. After a trainee was asked to release reflections to a legal agency, and this was later used as evidence in court against them, some trainees have expressed concern about documenting anything that may suggest anything less than perfect practice. This of course defeats the point of reflective practice and does not support the aim of learning from mistakes. A number of useful articles have been highlighted by Angshu, which provide thoughts and guidance: