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Doctors jump through loads of hoops to get through university and then training, so what is it about ARCP that makes it a uniquely stressful event?
This turned into a lot of a thread 1/ https://twitter.com/tariqjenner/status/1279298159852822529
This turned into a lot of a thread 1/ https://twitter.com/tariqjenner/status/1279298159852822529
ARCP is a centrally administers process through Health Education England.
Your Royal College provides guidance for ARCP criteria, but it doesn’t have any influence on, or responsibility for the event itself.
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Your Royal College provides guidance for ARCP criteria, but it doesn’t have any influence on, or responsibility for the event itself.
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Likewise, your employer and your department have no direct involvement in ARCP, outside of having contributed to your portfolio.
This means the vital yes/no progression decision for a whole year is often made by people you don’t know, far removed from you and your work.
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This means the vital yes/no progression decision for a whole year is often made by people you don’t know, far removed from you and your work.
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The Panel will include your Head of School, or Training Programme Director. Depending on where you work they might know you well, or might have never met you. Despite this, they are responsible, in this one moment, for passing judgement on your past year of training 4/
To inform the decision of the Panel, you submit a Form R, and they have access to your portfolio.
When you apply to medical school, I don’t think many people do it because they love keeping a portfolio... so some doctors may not feel this is representative of them. 5/
When you apply to medical school, I don’t think many people do it because they love keeping a portfolio... so some doctors may not feel this is representative of them. 5/
By HEE policy, ARCPs are no longer face to face, so the first info you get afterwards is your outcome.
The panel might provide feedback, but the doctor has no immediate ability to discuss this or clarify questions. Communication is often by email, with someone you don’t know. 6/
The panel might provide feedback, but the doctor has no immediate ability to discuss this or clarify questions. Communication is often by email, with someone you don’t know. 6/
ARCP exists to ensure a doctor is meeting a minimum standard. This results in a perception that adverse events and negative feedback are given disproportionate attention, at the expense of all the excellent work that doctors do.
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We don’t recruit in this way though. Doctors are highly selected and socialised into exceptional performance, so having your faults picked over just to get a “pass” is unlikely to be a fulfilling experience. 8/
The commonest adverse outcome from ARCP is an outcome 5, insufficient evidence. This might be because you forgot to link your GMC survey certificate, or missed out a single compulsory ePortfolio assessment.
Correcting this can take time, and that 5 is recorded forever. 9/
Correcting this can take time, and that 5 is recorded forever. 9/
To compound this, ARCP requirements often change, with small criteria added or removed.
There is also considerable regional variation and institutional misremembering of requirements. Your supervisor might be right that you needed 20 WPBA a few years ago, you don’t now. 10/
There is also considerable regional variation and institutional misremembering of requirements. Your supervisor might be right that you needed 20 WPBA a few years ago, you don’t now. 10/
So; ARCP is a high stakes assessment of a doctor based mostly on their ePortfolio, without their direct face to face involvement.
There is a risk that a panel of people you don’t know, tells you that you’re not good enough to do the job you’ve been doing for 10+ years. 11/
There is a risk that a panel of people you don’t know, tells you that you’re not good enough to do the job you’ve been doing for 10+ years. 11/
And they tell you this by email.
All of this makes doctors in training feel highly vulnerable, in order to be allowed to continue doing a job they are already doing.
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All of this makes doctors in training feel highly vulnerable, in order to be allowed to continue doing a job they are already doing.
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This risks significant disruption to a doctor’s self image, where external feedback is in conflict with what a doctor feels about themselves.
E.g. “you are not progressing well because of insufficient evidce,” vs “I work really hard for my patients and I’m good at my job.” 13/
E.g. “you are not progressing well because of insufficient evidce,” vs “I work really hard for my patients and I’m good at my job.” 13/
All that said; doctors in training need a way of knowing their progress is sufficient, and identifying areas to focus on. This process would be too much responsibility to place on one educational supervisor.
So how could we improve this? 14/
So how could we improve this? 14/
These are just a few quick thoughts...
1: ARCP could be performed locally, in a place you know, with people who work with you.
2: The process could allow built in time for additional information to be provided prior to an outcome being issued.
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1: ARCP could be performed locally, in a place you know, with people who work with you.
2: The process could allow built in time for additional information to be provided prior to an outcome being issued.
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3: Doctors could book their ARCP slot, giving them control over when this occurs, and increasing accessibility.
4: Panels could engage in a feedback dialogue in person, enabling a discussion about career ambitions, what’s going well, and how it could be even better. 16/
4: Panels could engage in a feedback dialogue in person, enabling a discussion about career ambitions, what’s going well, and how it could be even better. 16/
Overall, the ARCP process could trust doctors in training much more, and treat them as the highly qualified professionals they are.
It is right that we are held to rigorous high standards, however the mechanism that does this must be accessible and transparent. /end
It is right that we are held to rigorous high standards, however the mechanism that does this must be accessible and transparent. /end
