Decoding the Annual Review of Competence Progression (ARCP): A Psychiatrist's Guide
"A deep dive into the two-year survey revealing trainee perceptions and practical improvements in psychiatric training assessment."
In an era where competency-based assessments are becoming the gold standard in medical training worldwide, the UK has been undergoing significant changes in its postgraduate medical education system. Historically, specialist registrars in the UK were evaluated annually through the Record of In-Training Assessment. This involved a face-to-face meeting with assessors, supplemented by reports from trainers and summaries of achievements compiled by the trainees themselves.
However, in June 2007, a transformative shift occurred with the publication of 'A Reference Guide for Postgraduate Specialty Training in the UK,' also known as the 'Gold Guide.' This guide, regularly updated since its inception, introduced the Annual Review of Competence Progression (ARCP) in Section 7. The ARCP provides a structured framework for evaluating the progress of every doctor in training, now referred to as 'specialty trainees' (ST1-6).
Under the ARCP framework, specialty trainee doctors are expected to proactively gather formative and summative assessments throughout the training year. These assessments are then compiled into a portfolio, which is submitted annually to the ARCP panel for review. Additional documentation may be included as evidence of competency for the panel's consideration.
ARCP's Role in Training
The Annual Review of Competency Progression was introduced in 2007 as the key summative assessment process in British postgraduate medical training. An ARCP panel reviews whether a trainee has achieved the competencies outlined in the curriculum. GMC progression reports compare developmental outcomes across specialties and include information about progression journeys and differential attainment.
Key Findings: How Trainee Perceptions Have Evolved
A pivotal study was conducted to gauge the perceptions of trainee psychiatrists regarding the ARCP process. This study involved two cross-sectional electronic surveys administered a year apart in the north of England. The first survey in 2008 included 58 out of 92 psychiatry trainees (63%), while the second in 2009 had 60 respondents out of 96 trainees (63%).
- Availability of Acceptable Evidence: In 2008, 75% of respondents reported issues with the non-availability of a list of acceptable evidence for the portfolio. By 2009, this figure significantly decreased to 22% (P<0.001).
- Access to Electronic Portal: Trainees facing difficulties in accessing the electronic portal reduced substantially from 73% to 28% (P<0.001).
- Feedback and Assessor Training: Trainees continued to emphasize the need for explicit feedback at ARCP and highlighted the importance of improved training for assessors.
Evidence and Process Improvements
Recent discussions of ARCP examine trainee perceptions, process improvements and practical implications for psychiatric training. GMC reporting shows variation across the postgraduate organisations responsible for training and provides additional breakdowns by demographic characteristics. Operational guidance states that panels usually consider evidence in the trainee's e-portfolio, which trainees must complete contemporaneously and in a timely manner.
Validity and High Stakes
ARCP is described as a yearly competency-based review of whether a trainee is suitable to progress or complete training, with the aim of protecting patients and the public. However, concerns have been raised about the validity of ARCP as an assessment. The stakes can include declaring receipt of a failure outcome, forfeiting a pay rise or having training delayed.
Trainee Experience Across Time
In one mixed-methods study, less than 50% of trainees agreed that their ARCP experience matched Health Education England's aspiration to assess achievement, learning and suitability to progress in training. The same source identifies ARCP validity as a key concern. In a separate two-year survey, the percentage of trainees reporting difficulty accessing the electronic portal fell from 73% to 28% (P<0.001), indicating improvement in that aspect of the process.
Looking Ahead: Refining the ARCP Process
This study provides valuable insights into the perceptions and experiences of trainee psychiatrists undergoing the Annual Review of Competence Progression. The improvements observed between 2008 and 2009 suggest that the ARCP process is becoming more streamlined and effective. However, ongoing efforts are needed to address remaining challenges, such as providing clear guidance on portfolio requirements, ensuring easy access to electronic resources, and enhancing feedback mechanisms. By continuously listening to trainee feedback and refining the ARCP process, the UK can further strengthen its competency-based assessment system and support the development of highly skilled and competent psychiatrists.
ARCP in Modern Training
The Annual Review of Competence Progression was introduced in 2007 as part of Modernising Medical Careers. Modernising Medical Careers was described as a complete overhaul of the design and assessment of postgraduate medical training. ARCP therefore sits within a broader shift toward structured postgraduate training and assessment.
Adapting Psychiatry Training
Recent work on psychiatric residency asks how training should adapt to innovations now and in the future. It also considers whether major changes are required and which skill sets are needed to care more effectively for underserved populations. These questions arise alongside reported recruitment challenges in psychiatry training, unfilled consultant posts and concerns about the quality of patient care.
High-Stakes Human Consequences
ARCP is ubiquitous across UK postgraduate medical education and central to the outcomes-based structure of medical training. Although it was not originally designed as a summative assessment process, its purpose is now defined by Health Education England as assessing trainee progress. A mixed-methods case study characterises ARCP as a high-stakes assessment likely to have a significant impact on patient care.