ARCP Annual Review of Competency Progression Recommendations for Psychiatry Training, Lecture notes of Psychotherapy

Download ARCP Annual Review of Competency Progression Recommendations for Psychiatry Training and more Lecture notes Psychotherapy in PDF only on Docsity! Recommendations of RCPSYCH Annual Review of Competency Progression (ARCP) Working Group Contents Introduction Summary of Recommendations Recommendations – Process Recommendations – Requirements Recommendations – Clarity Acknowledgements References Executive Summary The working group used quality improvement methodology when carrying out this work and focused on three key areas as primary drivers. Firstly, the process of the ARCP panel and how the Portfolio works within this. Secondly, the requirements of the ARCP and ensuring that these are consistent across the UK in order to guarantee that trainees have the same experience no matter where they train. Finally, examining clarity of communication regarding the process to ensure that these recommendations were communicated and implemented. Figure 1 – Driver Diagram The following table summarises the key recommendations for improving Core Psychiatry ARCP processes: Process All schools must use the online portfolio for the ARCP process. ARCP panels must meet the trainee if there is a possibility of an unsatisfactory outcome. The level 1 and level 2 supervisor reports should be updated to reflect the new curriculum and renamed to provide clarity. The ARCP outcome portfolio form should have a mandatory feedback section added. External college representatives should be appointed to panels where possible and those leading ARCP panels should seek opportunities to visit other schools as part of benchmarking. Requirements Requirements for WPBAs and Psychotherapy must be made clear to trainees and remain consistent throughout the ARCP period, and not be retrospectively altered. Trainees must be given clear guidance about how to map their assessments to competencies through the portfolio. Doctors in training should be supported and encouraged to reflect openly and honestly to aid their learning and training. Examples of this process should be recorded by the trainee using brief anonymised written notes in their e-portfolios, but the majority of a trainee’s reflective practice should be assessed in dialogue with the Psychiatric and Educational Supervisors during supervision and WPBAs and commented on accordingly in their respective reports. It should not rely on written reflective pieces alone. Integrating form R within the e-Portfolio should be piloted in test sites before wider roll out nationally. Deaneries and training boards must not add their own requirements to ARCP that are not included within the curriculum. All further refinements to guidance regarding requirements for psychiatry ARCP must be through consensus UK wide via Heads of Schools meeting at RCPsych and ratified by ETC (Education and Training Committee) Clarity A webpage should be developed to sit within the current RCPsych training section where all guidance relating to ARCP process can be easily found. Heads of School should be asked to sign up to the above recommendations to ensure consistency across the UK and dissemination of agreed practice via local education networks. Section 1 Process 1. All schools must use the online portfolio for the ARCP process. The working group considered that all ARCP panels should be using the standardized e- portfolio for ARCPs and that paper portfolios were now obsolete. 2. ARCP panels must meet the trainee if there is a possibility of an unsatisfactory outcome. As stated in the Gold Guide, ARCP panel decisions must be made in absentia1. However, trainees may be asked to attend if it has been identified that there is a possibility of an unsatisfactory outcome being reached. If an unsatisfactory outcome is recommended, the trainee must meet with either the ARCP panel or a senior educator involved in training as soon as possible2. Following the ARCP, formative feedback should be offered to all doctors, including to those performing well. This should be provided in a timely and supportive manner3. 3. The level 1 and level 2 supervisor reports should be renamed to provide clarity. Amendments to ARCP forms and related e-portfolio functions: Feedback has indicated confusion regarding the use of level 1 and level 2 forms, who should complete these at what stage, particularly when training stages do not fit with calendar years (See Point 5 below), and the need for clarity of benchmarking. The following recommendations focus on Core Training in Psychiatry but take into account higher training also. These aim to clarify terminology and embed in ARCP practice the role of psychiatric supervisor (added to the curriculum in 2017) as distinct from clinical supervision and the role of the educational supervisor. The Level 2 report currently asks for an ARCP outcome recommendation. Whilst there should be advance discussion of assessed/anticipated difficulties with the trainee (‘No Surprises’ as per Gold Guide), the ARCP outcome should not be pre-empted as this is the preserve of the ARCP panel. The recommendation of an outcome should be removed from the form. The only defined benchmarks are those for end of training stage as listed in the curricula. These are the only ones against which progress can be reliably measured. Supervisors should not devise their own interim benchmarks but should comment on whether progression towards the end points is satisfactory for the time at which they are completing the report. The decision of the ARCP panel will be based on the same principle where ARCP does not coincide with the end of a training stage (see point 5 below). Recommendations for Supervisor reports. Level 1 report currently – re-name ‘Psychiatric Supervisor Report (CT/ST 1-3 End of Post; ST 4-6 End of Post/Mid-term) ’ Level 2 report currently – re-name ‘ARCP Educational Supervisor Summary Report’ placements, academic training modules and other relevant academic experience, together with an assessment of the academic competences achieved. The report and any supporting documentation should be submitted to the joint academic/clinical ARCP panel as part of the evidence it receives. The trainee is not required to attend the panel meeting. Plans for academic trainees to meet with members of the panel should only be made if the TPD or the named academic supervisor/lead for academic training indicates that Outcomes 2, 3 or 4, for either clinical or academic components (or both), are a potential outcome from the panel. The ARCP outcome is a global assessment of progress, dependent on both clinical and academic reports to assess achievement. The academic report should be attached to the outcome document. 7. The ARCP for trainees undertaking OOPR Trainees who wish to undertake full-time research out of programme must have their research programme agreed with their named academic supervisor. This should form part of the documentation sent to the Postgraduate Dean when requesting OOPR. Trainees must submit an annual OOPR return to the ARCP panel of their base locality in HEE, NES, the Wales Deanery or NIMDTA along with a report from their named academic supervisor. All academic trainees on OOPR should have a formal assessment of academic progress, which is submitted as part of the documentation for the ARCP panel as described above for joint clinical and academic programmes. The report must indicate whether appropriate progress in the research has taken place during the previous year and also whether the planned date of completion of the research has changed. Any request for a potential extension to the OOPR will need to be considered separately by the Postgraduate Dean. OOPR can provide credit towards a CCT or CESR(CP)/CEGPR(CP) only if it has been prospectively approved by the GMC and demonstrates achievement of competences defined in the relevant specialty curriculum. The purpose of documenting performance during OOPR is therefore both to assess progress towards meeting the approved academic programme requirements and to ensure that progress is made so that return to the clinical training programme is within the agreed timescale. Section 2 -Requirements Requirements for WPBA’s and Psychotherapy must be made clear to trainees. Minimum requirement for WPBA’s in Core Psychiatry Training For those in Core Training the following table shows the minimum number of each assessment that need to be undertaken. Details for requirements for both core and higher training are found within each curriculum. The minimum number has been arrived at in the light of the reliability of each tool, together with an estimate of the numbers that are likely to be needed to ensure a broad coverage of the Curriculum. Many trainees will require more than this minimum, none will require fewer. Work Place Based Assessment Minimum number required per year*** CT1 CT2 CT3 Assessment of Clinical Expertise (ACE) 2 3 3 Mini-Assessed Clinical Encounter (mini-ACE) 4 4 4 Case Based Discussion (CBD) 4 4 4 Direct Observation of Procedural Skills (DOPS) * * * Multi-Source Feedback (MSF) is obtained using the Mini Peer Assessment Tool (mini-PAT) 2 2 2 Case Based Discussion Group Assessment (CBDGA) 2 - - Structured Assessment of Psychotherapy Expertise (SAPE) - 1 2 Psychotherapy Assessment of Clinical Expertise (PACE) - 1** 1** Case Presentation (CP) 1 1 1 Journal Club Presentation (JCP) 1 1 1 Assessment of Teaching (AoT) * * * Direct Observation of non-Clinical Skills (DONCS) * * * * There is no set number to be completed in Core Psychiatry training; they may be performed as the opportunity arises. ** The two PACE assessments can be undertaken whenever appropriate for the short and long cases. However, they are usually undertaken in CT2/CT3. *** Based on 12 calendar month of full time training. Trainees who are LTFT and other trainees who are being assessed on less than 12-month calendar full time training, expectation for pro rata WBPAs. Psychotherapy Core Trainees should complete 2 individual cases in two different modalities of psychotherapy. The work place based assessments related to this are included in the table above Case length is specified as follows: Short psychotherapy case: 12-20 sessions, (12 sessions as a minimum) with one patient. Long psychotherapy case: 20 sessions, as a minimum, with one patient. The precise number of therapy sessions is agreed with respect to the patient's needs, and the model for the psychotherapy, with the clinical supervisor, (e.g. CAT is 24 session model DIT 16 session etc.). The therapy cases need to be supervised by a supervisor who is trained in and in current practice in the therapy model. It should be noted that “DNAs” should not usually be included when thinking quantitatively about case length, so if someone has a 24 session long-case and the patient DNAs 8 session this would not be acceptable as a long case but would be as a short. If, however, 5 sessions were DNAs then the discretion of the supervisor and psychotherapy tutor would play an important role in judging the quality of the therapeutic experience and whether competency in the ‘long case’ had been achieved. If there are local issues with availability of cases, then this can be taken up with the psychotherapy tutor. These should be viewed as minimum requirements and psychotherapy experience beyond minimum requirements is encouraged while recognising that this is dependent on local resources. Audit and Quality Improvement The core training curriculum (2017) ILO10 requires trainees to develop the ability to conduct and complete audit in clinical practice, with appropriate knowledge, skills and attitudes. The curriculum requires core trainees to complete two audits in core training, with at least one completed by the end of CT2. With the broadening of our understanding of quality improvement and in line with general revalidation requirements, it is appropriate to consider the curriculum requirement in this wider sense. ARCP Panels should consider completed quality improvement projects, even if not strictly using audit methodology, as appropriate evidence for this Learning Outcome. Linking portfolio evidence to PDP and the curriculum: Trainees need to link evidence in their portfolio to their PDP and the curriculum in order for themselves and their trainers to be readily able to track progress and portfolio development. Effective linking allows the ARCP panel to locate evidence efficiently and reduces the likelihood of queries (and potential outcome 5s) arising due to evidence not being located by the panel. There is no minimum or maximum number of ILO’s evidence can be linked to. Trainees should however be able to reasonably justify to the ARCP panel how the selected evidence is relevant. Over a year of training sufficient pieces of evidence should be acquired to demonstrate wide curriculum coverage. If the curriculum is fully linked to PDP items then both the PDP and curriculum mapping views will give a ready summary of evidence for each item when viewed by the trainee, trainer or ARP panel. Adding a formal cap to the number of links is difficult as there will be occasional items (e.g. multi-source feedback) that occur infrequently and really are relevant to multiple curriculum/PDP items – these should be seen as exceptions, however, not the rule. A common-sense approach should be taken where an event has multiple facets – for example, where trainees have attended a multi-session conference, the certificate should not be linked to every ILO/PDP item to which it is relevant, just to one or two main ones. It would be more appropriate to link a note on each specific session attended to the ILO/PDP item to which it is relevant, perhaps cross-referencing the certificate and its location in the note. Reflective Practice Reflective practice is vital to safe medical practice. It is what helps us learn throughout our careers and drives improvement in our practice. It is a key component of all psychiatric curricula. One of the functions of psychiatric supervision is to enable a regular safe space for trainees to reflect on learning experiences throughout their training with a trusted senior colleague. The working group recommend moving away from ARCP panels insisting on variable numbers of written reflective pieces within e-portfolios. This is not a curriculum requirement and we suggest that the psychiatric supervisor is best placed to assess this competency within the psychiatric supervisor’s report. We recommend that the report is specifically modified in Section 3: Clarity A webpage should be developed to sit within the current RCPsych training section where all guidance relating to ARCP process can be easily found. RCPsych Website A website page will be created in the training section of the RCPsych website. This will provide clarity and information for trainees and trainers on the ARCP process that is easy to navigate and contains the requirements as detailed above. Heads of School should be asked to sign up to the above recommendations to ensure consistency across the UK and dissemination of agreed practice via local education networks. Schools of Psychiatry Heads of School will be asked to agree to the guidelines and requirements detailed above. Heads of School will also be expected not to implement modified ARCP requirements before being ratified through ETC. Changes to the psychiatry ARCP guidance must only occur once per annum in line with academic year and must be communicated prior to start of new placements for trainees and their supervisors. Members of Working Group Kate Lovett - Dean and chair of working group Adrian Lloyd – Head of School for North East Chris O’Loughlin – Head of School for East of England Bob Barber - QM lead and TPD in North East Charlotte Blewett - Chair of PTC Alex Till - PTC Vice Chair and lead on Supported and Valued Andrew Bailey - PTC Secretary and lead on PTC ARCP survey Kate Milward - Former PTC Chair (ex-officio PTC member) Damien Longson - Chair of Portfolio Development Group Paul Grocott – RCPsych Training Manager With further thanks to advice from Sara Davies - Specialist Advisor for Less than Full Time Training, Royal College of Psychiatrists Vivienne Curtis - HEE London, Academic Head of School of Psychiatry With thanks to all who contributed to the ARCP working group and in particular to the members of the Psychiatric Trainees’ Committee, College staff, Members and Fellows and the NHS organisations who supported them in this work. References Gold Guide: A Reference Guide for Postgraduate Specialty Training in the UK Seventh Edition January 2018 https://www.copmed.org.uk/images/docs/gold_guide_7th_edition/The_Gold_Guide_7th_Editi on January 2018.pdf Enhancing Training and the Support for learners. Health Education England’s Review of Competence Progression for Healthcare Professionals February 2018 https://hee.nhs.uk/sites/default/files/documents/ARCP_Review_Final.pdf Supported and Valued? A trainee-led review into morale and training Royal College of Psychiatrists 2017. http://www.rcpsych.ac.uk/pdf/Supported_and_valued_final_20_April.pdf