No 87: ARCP Needs Review
Its July, which means that it is that dreaded time of year when most post-graduate doctors still in training in the UK are due their annual review of competence and progression (ARCP).
For those readers, who are lucky enough to have completed this process or do not have to go through this process, then think of it like getting your primary school report sent to your parents, except that you left primary school over 20 years ago but still get treated the same.
I am going to start by stating the obvious. I would like all of my healthcare professions that I will ever have to see or work with to be competent professionals. I accept that we must have a system to check that these professionals are competent and have the training and education that they may claim to have.
I accept we need a system, but do we really need THIS system? Is this really the best that our society can come up with?
Lets continue with another obvious point. The current system is cruel and anxiety inducing.
There are thousands of competent, hard working, dedicated doctors across the country who have spent months preparing for this review and who will wait weeks in a state of anxiety because they fear that their training will be interrupted or delayed because of an unjust system that they do NOT trust to look after them.
Most doctors want to progress. We want to learn things. We desire to be better at our jobs/ profession. We have tried our best to learn new skills, memorise more facts, read new guidelines, write more reflections, gather feedback on our performance and tick all of the boxes that we possibly can.
Yet still, I would place a large bet on the fact that most trainees are scared of a technical issue with the portfolio that will cost them time or having to re-do a form to ensure they get through the review process.
The ARCP-Industrial-Academic Complex!
These technicalities are inhumane. They are unnecessary and they are creating a system that is causing some of our best and brightest to burn out.
What happened to giving people the benefit of the doubt? When did ticking a strange box, in a hidden corner of a 50 page form, written in grammatical poor English become so important?
Trying to explain this system to people outside medical education is difficult. Most normal people don’t believe how crazy this system is. They can’t understand how a system design by doctors could end up being so complicated and yet crude. So deviously difficult to understand and yet absolutely necessary to complete. So Kafkaesque and Orwellian (yes I am being melodramatic, but it does feel like Big Brother is watching your every thought).
I am sure there are many ways to improve this system, but off the top of my head, here are mine:
Ensure the minimum standard is very clearly listed on the portfolio and ensure everything that is required is listed on this one page.
Make the process more streamlined. Reduce the number of forms. Reduce the duplication and make the website simpler.
If the multi-source feedback and the educational supervisor think the trainee is good and competent, then the review should be purely a quick double check.
Reduce the number of reflections required. Encourage trainees to spend more time actually learning medicine.
Make sure enough courses are available, at a reasonable price, for trainees to complete the minimum standard - recently, doing BLS has become a signficant challenge for many trainees.
Stop making forms such a big deal. If a trainee is obviously competent and up to date but a tick is in the wrong box or something small hasn’t been uploaded or labelled. Don’t make it a big deal. Give the trainee a few days to update it. Don’t send them a scary email saying that they aren’t able to progress.
Put the review period at the END of the year, not 2 months before the end which considerably reduces the training time and time for updating the portfolio for the review.
Build trust in the system. Reduce the anxiety and the burn out. Tell trainees that they are going to pass and that this is simply a check. This should not be a stressful process. It should not be something that worries trainees. It should not make you feel guilty and on edge, like someone from the FBI is going through your life with a fine-toothed comb.
Do you have any better suggestions?
Personally, I think it should be easy to significantly improve the ARCP process by following the last point above. Tell us that this is a supportive process and a double check and nothing to worry about and I am sure that most of us would feel much better about it.