Foundation ARCP Process

ARCP is an Annual Review of Competence Progression.  This is a process whereby both F1 and F2 doctors have the evidence of their progress reviewed by an appropriately convened panel so that a judgement about their progress can be made and transmitted to the Foundation School Director, the doctor’s employer and the doctor directly.

The following tools are used as learning opportunities in the Foundation Programme:

  • Mini-clinical Evaluation Exercise (mini-CEX)
  • Direct Observation of Procedural Skills (DOPS)
  • Case-based Discussion (CbD)
  • Developing the Clinical Teacher.

These are part of a group of educational tools called supervised learning events (SLEs). Please refer to SLE guidance (Section 5) for further details on these tools. Formal assessment will occur at the end of each placement and at the end of each year. The clinical supervisor and the educational supervisor will prepare reports on the foundation doctor’s performance in the workplace. The reports will be informed by review of the foundation doctor’s e-portfolio including consideration of completion of core procedures (F1), team assessment of behaviour (TAB) and feedback from the placement supervision group.

The Placement Supervision Group consists of trainers nominated in each placement by the named clinical supervisor. Their observations and feedback will inform the clinical supervisor’s end of placement report. The makeup of the Placement Supervision Group will vary depending on the placement but could include:

  • Doctors more senior than F2, including at least one consultant or GP principal
  • Senior nurses (band 5 or above)
  • Allied health professionals.

The Placement Supervision Group is responsible for:

  • observing the foundation doctor’s performance in the workplace
  • providing feedback on practice to the foundation doctor
  • providing structured feedback to the named clinical supervisor
  • undertaking and facilitating supervised learning events (SLEs).
Foundation doctors are expected to demonstrate achievement for each outcome described in the Foundation Programme Curriculum 2012 (the Curriculum).Foundation doctors are expected to record their achievements and evidence of learning within their e-portfolio. However they are not expected to demonstrate that they have met every single competence listed below each outcome. The assessment process is not designed to rank performance against other foundation doctors.
It is a GMC requirement that foundation doctors provide evidence within their e-portfolio of satisfactory performance of each core procedure at least once during F1. By the end of F1, the foundation doctor should be able to competently perform and teach undergraduates these 15 procedures. The core procedures from F1 do not need to be repeated in F2, but evidence of the F1 sign off is required for successful completion of theFoundationProgramme. It should also be recognised that with practice, the doctor will be expected to demonstrate continuing improvement of skills in whichever procedure they perform, within the spiral curriculum framework.
This is a type of Multi-Source Feedback, previously known as 360 degree assessment. Prior to inviting raters to contribute to the TAB process, foundation doctors must complete a self-assessment of behaviour (self-TAB). This includes reflection of their own performance. TAB comprises collated views from a range of multi-professional colleagues. The same sections are used in both the self-assessment and the rater-completed forms

  • TAB must take place at least once a year. Deaneries/foundation schools have the option of increasing the frequency
  • It is suggested that both F1 and F2 TAB is taken in the last month of the first placement during the year. If there are significant concerns about any foundation doctor, TAB should be repeated. This will be with designated respondents.
  • For each assessment, the foundation doctor and the educational supervisor should agree 15 raters/assessors.  A minimum of 10 returns are required. No other foundation doctor can be a rater.

The required mix of raters/assessors must include at least two of each of the following:

  • Doctors more senior than F2, including at least one consultant or GP principal
  • Senior nurses (band 5 or above)
  • Allied health professionals
  • Other team members including ward clerks, secretaries and other healthcare staff.

Following TAB, the foundation doctor should reflect on any sections in which there is variance between their self rating and that of the assessors. The doctor should discuss significant discrepancies with their educational supervisor.

There are two end of placement reports:

  • clinical supervisor’s end of placement report
  • educational supervisor’s end of placement report

The clinical supervisor’s end of placement report describes the foundation doctor’s performance in the workplace. The educational supervisor’s report incorporates the information contained in the clinical supervisor’s report and includes information from the e-portfolio. If the educational and clinical supervisors are one and the same, then the educational supervisor will be responsible for the sections that are usually covered in the clinical supervisor’s report.

Towards the end of each placement, the foundation doctor should meet with their clinical supervisor to complete a summative assessment of their overall performance and progress in the placement. The clinical supervisor’s report should comment specifically on:

  • Any noteworthy aspect of performance
  • Any concerns regarding performance
  • Comments on participation in the agreed educational process
  • Evidence of professional development as a result of feedback and reflection.

The clinical supervisor should seek and record evidence from the Placement Supervision Group to corroborate each of the above. The names of those contributing evidence on performance is recorded in the report. The outcome of the final assessment discussion should be agreed by both the foundation doctor and the clinical supervisor and recorded in the e-portfolio as part of the clinical supervisor’s end of placement report.

The educational supervisor’s end of placement report requires review of the clinical supervisor’s report along with evidence provided within the e-portfolio and any other source. Whilst engagement with SLEs and evidence of curriculum coverage will be taken into account, the overall judgement will include a triangulated view of the foundation doctor’s day to day work performance. This will include the foundation doctor’s participation in, and attendance at, educational activities, appraisals, the learning process and recording of this in the e-portfolio. The outcome of the final assessment discussion should be agreed by both the foundation doctor and the educational supervisor and recorded in the e-portfolio as part of the educational supervisor’s end of placement report.
The decision about whether or not a foundation doctor has achieved the required standard for satisfactory completion of F1, or F2, will draw upon the judgements of theFoundationTraining Programme Director/Tutor, the educational supervisor, and the clinical supervisors supported by a Placement Supervision Group.
The GMC expects satisfactory achievements in all the domains set out in The Trainee Doctor (2011). These are reproduced in the Foundation Programme Curriculum 2012 outcomes. The Foundation School Director, acting on behalf of the Postgraduate Dean, is ultimately responsible for making a recommendation to the medical school, where the foundation doctor graduated, as to whether they should complete and issue the GMC Certificate of Experience. Once the certificate is issued, the foundation doctor is eligible to apply for full registration with the GMC.
Satisfactory completion of F2 will allow the foundation doctor to be eligible to enter core,specialty or general practice training. The Postgraduate Dean is responsible for the final decision about whether a foundation doctor has achieved the required standard for satisfactory completion of the Foundation Programme. This judgement will include an assessment of the foundation doctor’s ability to take on increasing levels of responsibility, and will be marked by the issuing of a Foundation Programme Certificate of Completion (FPCC).

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