A winding staircase representing the path of medical training, with milestones symbolizing competency achievements.

Annual Review of Competence Progression: What Trainees Really Think

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Beau Callahan in Mind & Education October 2026 • 4 min read.

"A two-year survey reveals how trainees perceive the ARCP process, highlighting areas of improvement and ongoing challenges in postgraduate medical education."


In the ever-evolving landscape of medical education, competency-based assessments are gaining traction worldwide. Countries like the USA, Canada, and Australia are increasingly adopting this framework to evaluate trainee doctors, ensuring they meet the required standards and skills. Within the UK, significant changes have been implemented to enhance the structure and organization of postgraduate medical education.

Historically, the Record of In-Training Assessment served as the primary method for evaluating specialist registrars in the UK. This annual process involved face-to-face meetings between trainees and assessors, accompanied by detailed reports from trainers or educational supervisors. These reports summarized the trainee's acquired knowledge and skills, along with a compilation of their achievements over the preceding 12 months.

In June 2007, the UK Health Departments introduced A Reference Guide for Postgraduate Specialty Training in the UK, commonly known as the 'Gold Guide.' This guide, updated annually, outlines the Annual Review of Competence Progression (ARCP), a formal framework designed to review the progress of all doctors in training. The ARCP process requires specialty trainees (ST1-6) to collect formative and summative assessments throughout the training year and submit them annually in a portfolio to the ARCP panel.

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The Annual Review of Competence Progression in UK Medical Training

The Annual Review of Competence Progression (ARCP) is a standardized annual assessment process used in UK postgraduate medical education. While exact participation statistics vary by year and training programme, the system evaluates thousands of medical trainees annually across all specialties. The ARCP serves as a central mechanism for monitoring trainee progression and ensuring standards are maintained throughout medical training. Its impact on individual trainees can be significant, affecting career progression, salary advancement, and training timelines.

ARCP as the Standard Assessment Framework

The ARCP is ubiquitous across UK postgraduate medical education and central to the outcomes-based structure of medical training. While not originally designed as a summative assessment process, its purpose has evolved to 'assess trainee achievement and learning, and suitability' for progression, as defined by Health Education England. Evidence suggests the process promotes broad curriculum coverage and enables educational planning, but concerns have been raised that it promotes a reductionist approach to education. The ARCP process has been under review by Health Education England, with professional bodies like the Association of Surgeons in Training contributing to discussions about its effectiveness.

Development and Evolution of ARCP

The ARCP has been integral to UK medical training for many years, though its precise origins and foundational milestones are not well-documented in accessible literature. The system has undergone periodic reviews and adjustments in response to feedback from trainers, trainees, and professional bodies. Key developments have included refinements to the assessment criteria and process modifications aimed at improving fairness and educational value. The evolution of ARCP reflects broader trends in medical education toward more structured competency-based assessment frameworks.

Key Findings from the ARCP Trainee Survey

A winding staircase representing the path of medical training, with milestones symbolizing competency achievements.

A comprehensive two-year survey was conducted to evaluate trainees' perceptions of the Annual Review of Competence Progression (ARCP). The survey, conducted across two years in the north of England, collected feedback from psychiatry trainees on their experiences with the ARCP process. In 2008, 58 out of 92 trainees (63%) completed the survey, while in 2009, 60 out of 96 trainees (63%) participated. The results revealed significant improvements in trainees' perceptions over the year, alongside persistent challenges that warrant attention.

The survey highlighted several key areas where trainees' perceptions improved significantly between 2008 and 2009:

  • Availability of Acceptable Evidence: In 2008, 75% of respondents noted the non-availability of a list of acceptable evidence for the portfolio. This concern decreased significantly to 22% in 2009 (P<0.001).
  • Access to Electronic Portal: The percentage of trainees facing difficulty in accessing the electronic portal reduced substantially from 73% to 28% (P<0.001).
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Current Research Landscape on ARCP

Research into the ARCP continues to evolve, with recent studies employing mixed-methods approaches to examine its impact from multiple perspectives. The evidence base includes both quantitative outcome data and qualitative insights from trainees and trainers about their experiences. Current research themes focus on the balance between summative and formative elements, the relationship between ARCP outcomes and actual competency, and ways to improve the process. However, comprehensive recent systematic reviews specifically focused on trainee perspectives appear limited in the available literature.

Critiques and Systemic Problems with ARCP

The ARCP system faces significant criticism for its inherent problems and high-stakes consequences. When trainees fail to progress, they may need to declare a failure outcome, forfeit a pay rise, or experience training delays. Research suggests the process creates considerable stress and may not accurately reflect true competency levels. Replacing the ARCP with more robust independent assessments, such as national exam-style assessment centres, is considered unrealistic. This raises questions about whether there are practical ways to alleviate the system's problems while maintaining its core function.

Comparative Perspectives on Competence Assessment

Studies examining factors affecting ARCP outcomes provide important comparative insights into the assessment process. Research has identified both facilitators and barriers that influence trainee success during ARCP, highlighting systemic issues that extend beyond individual performance. The evidence suggests that concerns about ARCP are not isolated local issues but are mirrored across different regions and training programmes. This comparative perspective underscores the need for standardized approaches while acknowledging the diversity of training contexts.

Despite these improvements, trainees continued to emphasize the need for explicit feedback at ARCP and enhanced training for assessors. The survey also identified ongoing difficulties in gathering evidence and completing workplace-based assessments (WPBAs). These findings underscore the importance of continuous refinement in the ARCP process to better meet the needs of trainees.

Refining the ARCP Process for Future Success

The two-year survey provides valuable insights into the perceptions and experiences of trainee psychiatrists undergoing the Annual Review of Competence Progression (ARCP). While significant improvements have been made, ongoing challenges remain, particularly in the areas of feedback, assessor training, and evidence collection. By addressing these issues and continuously refining the ARCP process, medical education can better support trainees and ensure they achieve the competencies required for successful practice.

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Expert Perspectives on ARCP Validity and Structure

All UK trainees undergo annual ARCP assessment, representing a formal and structured approach to monitoring progression at each training stage. Experts emphasize the importance of validity in this assessment process, examining how well ARCP measures actual competency. The General Medical Council provides ARCP progression reports showing variation across trainees from different medical schools and demographic groups. These expert analyses inform ongoing discussions about how to improve the system while maintaining its essential oversight function.

Emerging Trends and Future Directions in Medical Education Assessment

The medical education landscape is evolving rapidly, with emerging trends emphasizing adaptive educational approaches to meet the demands of a changing healthcare environment. Innovations in web-based education platforms and medical technology are driving new approaches to competency assessment. Future developments in ARCP may incorporate these technological advances while maintaining rigorous standards. The RCOG and other specialty bodies are actively exploring ways to use ARCP screening to identify potential future issues early in training.

Systemic Impact and Educational Governance

The ARCP serves multiple functions beyond simple assessment, including promoting broad curriculum coverage, enabling educational planning, and providing educational governance. The process facilitates relationships between supervisors and trainees while ensuring consistent standards across programmes. However, this comprehensive approach may contribute to the system's complexity and the challenges trainees face. The broader context reveals tensions between maintaining educational standards and providing meaningful formative feedback during training.

Trainee Experiences and Educational Impact

Research examining trainee experiences reveals significant concerns about the ARCP process. Studies using mixed-methods approaches, including questionnaires, interviews, and focus groups, show that trainees often perceive the system as promoting reductionist approaches to education. These human perspectives highlight the tension between standardization requirements and individual learning needs. The real-world impact extends beyond formal assessment to affect trainee wellbeing, motivation, and educational experiences throughout their training.

What trainee accounts reveal about ARCP

Some trainees experienced ARCP as a check on paperwork rather than clinical ability, and felt this could detract from learning. Their accounts also point to a tension: portfolios could contain only positive feedback even as getting assessments signed off was difficult.[1]

These accounts describe how the process was experienced; they do not establish whether ARCP can reliably distinguish levels of competence. A critical review reports that trainees and trainers questioned its ability to identify people performing near the borderline, while considering it more reliable at identifying the poorest performers.[1] [2]

A critical review links limited detail in national guidance with variation in how ARCP is conducted across locations and specialties, raising concerns about the consistency and validity of outcomes.[2]

A later surgical curriculum update made academic requirements uniform across surgical specialties, while variation in operative case load and workplace-based assessments persisted. This is a surgical-specific comparison, not evidence about psychiatry trainees.[3]

What remains unsettled about ARCP

  • Can ARCP distinguish trainees near the competence borderline, or does it mainly identify the most poorly performing? The review records doubts about this distinction but does not resolve it.[2]
  • How consistently do trainees receive useful feedback before and after panels? The review describes variation in feedback provision and quality, with possible effects on learning and support.[2]
  • What level of consistency across specialties, locations and grades would make ARCP outcomes more dependable? The review calls for consistent procedures and high-quality feedback because ARCP has implications for patient care.[2]

Questions about ARCP evidence

What is ARCP used to decide?

It is used to determine whether trainee doctors in the United Kingdom are considered safe and competent to progress to the next training stage.[2]

Sources

  1. The validity of the Annual Review of Competence Progression: a qualitative interview study of the perceptions of junior doctors and their trainers. (journals.sagepub.com)
  2. Assessing professional competence: a critical review of the Annual Review of Competence Progression - UCL Discovery (discovery.ucl.ac.uk)
  3. Differences in progression by surgical specialty: a national cohort study (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

1

What is the Annual Review of Competence Progression (ARCP) and why is it important in UK medical education?

The Annual Review of Competence Progression (ARCP) is a formal framework used in the UK to review the progress of all doctors in training. Introduced in the 'Gold Guide,' it mandates specialty trainees (ST1-6) to submit a portfolio of formative and summative assessments annually to the ARCP panel. Its importance lies in ensuring that trainees are meeting required standards and developing the necessary skills for successful medical practice, reflecting a shift towards competency-based assessments as seen in countries like the USA, Canada, and Australia. The ARCP process helps standardize and streamline the evaluation of postgraduate medical education, making it a crucial component of the UK's training system.

2

How did the ARCP process evolve from the previous method of evaluating specialist registrars?

Before the implementation of the Annual Review of Competence Progression (ARCP), the primary method of evaluating specialist registrars in the UK was the Record of In-Training Assessment. This involved annual face-to-face meetings between trainees and assessors, supported by detailed reports from trainers or educational supervisors. These reports summarized a trainee's knowledge, skills, and achievements over the past 12 months. The ARCP process, as outlined in the 'Gold Guide,' represents a more formalized and structured approach, requiring the collection and submission of a portfolio of assessments, shifting the focus towards a comprehensive, competency-based evaluation.

3

What were the key improvements observed in the trainee perceptions of the ARCP process between 2008 and 2009, according to the survey?

The survey conducted on psychiatry trainees revealed significant improvements in their perceptions of the Annual Review of Competence Progression (ARCP) between 2008 and 2009. Specifically, there was a notable increase in the availability of acceptable evidence for the portfolio and a decrease in the difficulty accessing the electronic portal. In 2008, 75% of respondents noted the non-availability of a list of acceptable evidence for the portfolio, which decreased to 22% in 2009. Similarly, the percentage of trainees struggling to access the electronic portal dropped significantly from 73% to 28%. These improvements reflect the efforts made to refine the ARCP process and make it more accessible and user-friendly for trainees.

4

What ongoing challenges did trainees face, despite the improvements in the ARCP process, and what are the implications of these challenges?

Despite improvements in the Annual Review of Competence Progression (ARCP) process, trainees continued to face challenges, particularly in obtaining explicit feedback at ARCP, enhancing assessor training, and gathering evidence, including completing workplace-based assessments (WPBAs). These ongoing difficulties indicate the need for continuous refinement of the ARCP process. For example, inadequate feedback can hinder trainees' ability to understand their strengths and weaknesses, thereby impeding their professional development. Insufficient training for assessors might lead to inconsistent evaluations and create a lack of clarity in the evaluation process. Addressing these challenges is critical to ensure that the ARCP process effectively supports trainees and promotes the achievement of the competencies necessary for successful medical practice.

5

How can the Annual Review of Competence Progression (ARCP) process be further refined to enhance the experience and outcomes for medical trainees?

To further refine the Annual Review of Competence Progression (ARCP) process and improve trainee outcomes, several key areas require attention. First, providing explicit and actionable feedback at the ARCP is crucial to help trainees understand their performance and areas needing improvement. Second, enhancing assessor training can ensure consistent, fair, and comprehensive evaluations. Additionally, streamlining and clarifying the evidence collection process, including workplace-based assessments (WPBAs), will make it easier for trainees to demonstrate their competencies. These improvements will not only enhance the trainees' experiences but also better prepare them for successful medical careers by ensuring that the ARCP process effectively supports their professional development and competency acquisition.

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