The Annual Review of Competence Progression (ARCP)

After medical school, it is easy to assume that the ever-scrutinising assessments of competency will diminish – wrong! 

The utmost priority for any practising doctor should be their ability to provide good and safe medical practice for all their patients. The ARCP initiative allows for structured continuous review of doctor’s competencies throughout their training until consultant level, to ensure a high standard of care is being met.

Evidence for this is recorded in the form of Workplace Based Assessment (WPBA) on an online trainee portfolio. This helps to build up a qualitative picture of your performance in training to be reviewed at least every 12 months by the ARCP panel. Although it is not in itself an assessment, it is a summative judgement of a foundation doctor’s performance and development throughout the year and decides whether an individual doctor can progress to the next stage of training.

Who has an ARCP?

The ARCP process is applicable to all trainees, including foundation trainees, specialty trainees or specialty registrars (including general practice trainees), those in core training and less than full-time training.

This also includes trainees in combined academic or clinical programmes, trainees who are out of programme, trainees in Fixed Term Specialty Training Appointments (FTSTAs), and trainees in Locum Appointments for Training (LATs).

How does the ARCP process work?

An ARCP is held every 12 months for doctors in training and usually coincides with progression to the next year of the training programme. It is an effective mechanism for reviewing and recording the evidence related to a trainee’s performance in the training programme in accordance with GMC requirements. 

How is it assessed?

ARCP provides a means whereby outcomes of formal assessments, through a variety of GMC-approved workplace-based assessment (WPBA) tools and other assessment strategies are coordinated and recorded. The focus is making sure trainees learn and reflect on day-to-day practice, building a more qualitative view on capabilities acquired throughout training. There are variety of ways to accumulate this evidence:

• well-constructed and fit-for-purpose professional examinations that explicitly map back to the curriculum 

• direct observation of procedural skills (DOPS)/clinical examination and procedural skills (CEPS) 

• case note reviews 

• case-based discussion (CBD) 

• multi-source feedback (MSF)  

• team assessment of behaviour (TAB) 

• observed video assessments 

• assessments in clinical skills facilities 

• clinical evaluation exercises (mini-CEX) 

• direct observation of non-clinical skills (DONCS) 

• self-reflective learning logs

Logbooks, audit or quality improvement projects, research activity and publications are also a valid record to demonstrate progress although they are not classified as an assessment tool. 

All evidence of assessments undertaken and their outcome should be recorded in a trainee educational ePortfolio. It would be expected that assessments are spaced throughout the year and recorded as and when they happen so that evidence of achievements are built up over the period being assessed.

Education Supervisors report 

Your assigned educational supervisor will compile all your evidence recorded on ePortfolio to then write a structured report which reflects on the period of training under review. The report should therefore provide a summary of trainee progress, collating the results of WPBAs as well as offer a recommendation to the ARCP panel regarding whether the trainee is fit to progress to the next year of training.

The ARCP panel 

The ARCP panel validates the trainee’s educational supervisor recommended outcome as well as reviews documented and submitted evidence of the trainee. As this is all done via online documentation the trainee is not required to attend. The panel then determines the outcome of the ARCP to recommend to the postgraduate dean. Possible outcomes are listed below.

Possible outcomes of the ARCP 

• Outcome 1: Satisfactory progress. Achieving progress and the development of competences at the expected rate

• Outcome 2: Development of specific competences required – additional training time not required

• Outcome 3: Inadequate progress by the trainee – additional training time required

• Outcome 4: Released from training programme with or without specific competences

• Outcome 5: Incomplete evidence presented – additional training time may be required

• Outcome 6: Recommendation for completion of training. Gained all required competencies 

• Outcome 7: Fixed term specialty outcome

• Outcome 8: Out of programme (for those currently undertaking research or experience)

Where the panel recommends an unsatisfactory outcome (outcomes 2,3,4 or 5) through the ARCP process, the trainee must meet with the ARCP panel at the earliest opportunity. The purpose of this meeting is to discuss the recommendations for focused or additional remedial training if these are required.

How does this fit into GMC revalidation?

The aims of the ARCP map the curricula for GMC’s standards which requires doctors to have the training, skills and experience needed to meet the standards for good medical practice. Every 5 years doctors are required to revalidate their license with the GMC, allowing the practise of medicine. For doctors in training, proof of participation in the ARCP process will provide sufficient evidence for revalidation of their GMC license.

Further information 

• Conference of Postgraduate Medical Deans Gold Guide 8th Edition - Gold Guide - 8th Edition - Conference Of Postgraduate Medical Deans (copmed.org.uk)

• ARCP Foundation Programme ARCP - UK Foundation Programme

• ARCP GMC Annual review of competency progression - GMC (gmc-uk.org)

• Medical appraisal BMA Medical appraisals (bma.org.uk)

• How to revalidate GMC guidance Revalidation - GMC (gmc-uk.org)

• Good Medical Practice - Good medical practice - GMC (gmc-uk.org)