What is the point of ARCP?

I’m a paediatrics trainee.  By now, I have 7 years worth of ARCPs done. Boxes ticked. Progress made & recorded.

And I still have no idea what the point of the process is other than to make sure that I’ve jumped through enough hoops that I’ll get to be a consultant someday.

It is not an educational experience; I accept that (according to the Gold Guide), it’s not supposed to be.  It’s supposed to be a summing up of the assessment & appraisal that has taken place over the year.

It’s the STOP point for “failing’ trainees.

Where’s the STOP point for a failing training system? or even (radical thought alert) just a training programme that could be made a little bit better?

 

How it can work

I get to see another side of supervision and training through my PhD.

Here’s how it works for my academic work:

I meet with my supervisors every two weeks.  If that doesn’t happen (and quite often, it doesn’t), then we look at how the meetings work.

I get regular e-mail contact and feedback on how I’m doing.

We look at my training needs and what I need to get out of the 4 years.  We talk about other students and what training they’ve accessed. I get encouraged to submit for conferences and presentations.

The expectation is that there is regular feedback between supervisor and student, and that we work together to make sure this is a productive time for me and the research group.

 

This isn’t how it works in medical training.

I was really excited about my first ARCP as a proper paediatrics trainee.  In fact, there were two: an academic one, and a clinical one.  I was present at both; I did a mini-summary of what I’d achieved, and what my plans were for the coming year; I got some advice & suggestions about how to manage some issues.

Last year was the first time I hadn’t been physically present at my ARCP. (I know: I’m lucky that I normally get to go. But I am academic and LTFT, so technically I should have one!)  And it was a worry, because I had concerns about my training. I had definite issues that I needed to discuss; training needs that I wanted to raise.  But we weren’t invited to attend.  In the end, I wrote one of my lovely “unofficial” supervisors who was on the panel a long e-mail with what was annoying me.  None of that is reflected in the panel documentation from the day.

This year, we were allocated a 10 minute slot in the middle of the working day “to receive feedback” at an office complex in the middle of nowhere.  I decided I was going to get more benefit from my training if I stayed and did my shift on admissions.  (Not that there would have been any cover anyway…)

ARCP for Trainees

ARCP is something that happens to trainees, not with them.  We’re told that we’re adult learners with a responsibility to develop our own training but how exactly are we supposed to have a two-way process with a panel that doesn’t meet with us, or invite our feedback on the training that is available?

The Gold Guide would place educational supervisors in this role as a link between trainee and assessor, but it’s not exactly supportive of feedback:

“Trainees should feel able to discuss the merits or otherwise of their training experience. The detailed content of the discussion which takes place within appraisal sessions should normally be confidential…”

We can give feedback, but should expect it to be confidential?  The whole process is about trainees who fail to meet the standards set; trainees who fail to engage; trainees who don’t step up and act like adult learners…

Where’s the two-way dialogue? Where’s the process for improving the training that we get?

My educational & clinical supervisors can support me with a single placement, but what about the training experience as a whole?

If I want to feedback on my overall training experience, then what exactly am I supposed to do?*

There’s no official record of my concerns about my training; of my assessment of what I need to progress; of what experiences that I’m missing.  There’s no recognised place or mechanism for my educational supervisor to give the School & TPDs that information, or any record of what they’re doing to address those needs.  Maybe that didn’t need to happen before, in the good old days of firms and a single consultant? But it needs to happen now.

Maybe all these discussion do take place; maybe the records are being kept & reviewed.  But if that is happening, then it’s taking place without me.

It’s the great irony of modern healthcare.  Patients & clinicians are moving towards a model of shared decision-making and “no decision about me, without me”.  Their clinicians in training don’t seem to be getting the same respect.

 

 

*And yes, I do mean feedback.  I don’t need to complain; I don’t need to go to the GMC about it.  I just need to point out that some things work, and others don’t.

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In praise of e-portfolio

My name is Carmen, and I like e-portfolio….

There. I’ve said it. Confession made.

I’ve confessed to a few things in my time (I’m a pole dancer in my spare time, and I really never have seen all of Star Wars), but this is likely to be the most controversial.

But I do. I think e-portfolio is amazing. Genuinely.

And I know I’m not supposed to think that.  If there’s a social taboo amongst junior (senior?) doctors, it’s admitting that there are any benefits to the current assessment systems.

If there’s one thing that units orthopods, anaesthetists, and microbiologists, it’s a shared loathing for the e-portfolio.

But I quite like it.  I didn’t use to.  I used to agree with the prevailing thought that it was an instrument of torture devised by ARCP assessors to stop us enjoying the summer.

And I no longer think like that.

 

Here are my reasons for liking e-portfolio

Storage

It’s my career development in one neatly organised place.  I normally keep records of conferences I’ve attended and meetings I’ve gone to in a box that I keep meaning to sort out.  Every so often, the pile of papers escape into a second box which is often non-existent, and then start taking over my bed.  I keep meaning to sort it out, but I rarely do.  The last time I opened the box, there were papers in there from 2010. I dread to think what’s on the bottom, but I think it may come to life if it reaches sunlight.

Organised storage

Trying to write a summary of things I’d achieved over the past year (academic ARCP reviews – lovely things) used to be a total nightmare, and would normally involve wrestling THE BOX into submission and trying to find a diary of some sort.  Now, it’s all in one place.  Finding my research development evidence for my upgrade meeting took 10 minutes because it was all in e-portfolio

It’s a way of showing the work that I actually do

I hadn’t realised this until recently, but some people go home after work and switch off.  I spend Sunday mornings dragging my friends out of bed so we can talk about a website whilst consuming far too much caffeine; I run away from barbecues so that I can spend the evenings doing journal clubs and trying to get Tweetdeck to work at a reasonable speed.  E-portfolio is a way of recording all of that, and it genuinely takes a minute of my time.  If I’ve spent an hour at journal club, why not spend 60 seconds inputting that?

It helps me learn

I don’t have an encyclopaedic memory.  I’m a paediatrics trainee for goodness sake, not an anaesthetist.  I don’t remember exactly what the Centor criteria are; or when to scan in UTI.  I don’t really want to trawl through Google every time I have a minor clinical point that I’m sure I’ve considered before.  What I need is one place that stores the answers; a universal notebook (even if it isn’t very pretty)

It stops me exploding

I like the reflective entries.  I think they’re difficult to write, and sometimes they can be very traumatic.  But looking back at some of the entries, I can remember how I’ve dealt with situations in the past.  More than that, sometimes I need to remember that I have survived, and that I can manage.  It can be cathartic writing about difficult things, and I find it helps me.

It’s MY record

It’s a space for me to share my concerns and worries about my training.  Yes, I discuss them with my educational supervisors; my TPDs are aware of my concerns, but that doesn’t mean that they are recorded anywhere or that anything is being done about them.  Part of me feels that I’m clawing back a tiny bit of control by creating a record of my training that isn’t controlled by an official view (or at least, not too much)

 

Ultimately, my e-portfolio is just that: mine.  I don’t use it to comply with the ARCP requirements or my educational supervisor’s demands (to be fair, I’m not convinced my ed sup can access it).  I use it for me, and as my training record.

And yes I will stand up and say, my name is Carmen, and I like e-portfolio.