PROFESSIONAL DEVELOPMENT
A guide to succeeding in
the Annual Review of
Competency Progression
(ARCP)
Chee Wan Lai
Adrian Ben Cresswell
Abstract
Regular assessment forms an important component of competency-
based training in modern medical careers. Satisfactory performance
at the Annual Review of Competency Progression (ARCP) is essential
for progression through surgical training. The e-portfolio is central to
the ARCP process and much of the ‘added value’ required to excel
at the ARCP will also support and furnish a rich and strong curriculum
vitae, which will in turn pay dividends in terms of career progression.
The ARCP is often a source of anxiety amongst trainees, but with
adequate preparation and planning the process should be smooth
and stress-free e this article seeks to outline and support the key
steps of the process. In this article, we will describe the ARCP process
and offer some tips on how to not only pass through this process un-
scathed, but also ideally bring the ‘added value’ required to build a
strong portfolio and a competitive CV.
Keywords ARCP; assessment; training
Introduction
Surgical training in the United Kingdom has undergone innu-
merable changes within a relatively short period of time, creating
considerable confusion to a generation of trainees and trainers
alike. Higher Surgical Trainees (HSTs) appointed prior to 1st
August 2007 were known as Specialist Registrars (SpRs) or
Calman trainees, with changes to their training structure having
been introduced and overseen by Kenneth Calman (Calman
Report, 1993).1 A trainees progress was assessed annually using
a process called ‘Record of In-Training Assessment (RITA)’,
which was a predominantly time-based system based on a re-
view of the surgical log-book and subjective reports from the
consultant supervisors.
In 2005, Modernising Medical Careers (MMC) was introduced
as a programme for postgraduate medical training.2 Between
2005 and 2007, many changes to the recruitment process and
training programme were made e some have remained, and
Chee Wan Lai MBBS MRCS MD is an ST7 in General Surgery on the
Wessex Training Rotation, UK. Conflict of interests: none declared.
Adrian Ben Cresswell MD(Res) FRCS (Gen) is a Consultant HPB and
General Surgeon at the Basingstoke Hepatobiliary Unit, Hampshire
Hospitals NHS Foundation Trust, UK. Professor of Clinical Surgery,
St George’s University International Medical School. Clinical Editor,
Surgery. Conflict of interests: none declared.
SURGERY 36:9
some were abandoned. In August 2007 the Modernising Medical
Careers (MMC) Specialty Training programme was introduced,
where trainees are appointed to an approved higher surgical
training in the UK via an interview-based national selection
process and are known as Specialty Registrars (StRs).3 Selection
now varies between surgical specialties, but may either be ‘run
through’, with appointments made at ST1 level or with a second
round of competitive entry at the ST3 level following 2 years of
‘core’ training (CT1e2).
In August 2009, the European Working Time Directive
(EWTD) was incorporated into UK health and safety law,
restricting all UK trainee doctors to an average 48-hour working
week, with further restrictions on maximum shift lengths,
consecutive days of work and minimum periods of rest.4 These
changes to the training process and the implementation of EWTD
called for a more structured competency-based curriculum and
assessment method. The Joint Committee on Surgical Training
(JCST) is an advisory body to the four Surgical Royal Colleges of
the UK and Ireland. The JCST is the parent body for all ten
Specialty Advisory Committees (SACs) responsible for standards
in higher training within the surgical specialties, the Core Sur-
gical Training Committee (CSTAC), the Training Interface
Groups (TIGs) and the Intercollegiate Surgical Curriculum Pro-
gramme (ISCP). The ISCP was launched in 2007 and provides the
approved UK framework for surgical training, from completion of
the foundation years, or core training, through to consultant level
(www.iscp.ac.uk/). The surgical curricula within ISCP have been
designed around four broad areas, which are common to all the
surgical specialties
 syllabus
 teaching and learning
 assessment and feedback
 training systems and resources.
Guidance on the wider arrangements for StR training,
including the ARCP, is set out in the reference guide for post-
graduate specialty training in the UK, known as the ‘Gold
Guide’.3
The Annual Review of Competency (ARCP) process
The ARCP is a formal review of evidence to monitor a trainee’s
progress throughout each stage of their specialty training.3
Trainees are required to ‘pass’ their ARCP to progress through
to the next stage of their training and ultimately achieve a Cer-
tificate of Completion of Training (CCT). The ARCP panel will
base its decision on the evidence submitted by the trainee. The
ARCP usually takes place at the local deanery once a year to-
wards the end of the training year. Some deaneries may hold
more frequent reviews for some trainees e for example, trainees
in the earlier years, or those who have taken a slight tangent to
the usual timeline such as for purposes of research, out of pro-
gramme experience, maternity leave or medical illness. The re-
views usually occur around the same time of year within
deaneries, so bear this in mind when booking annual leave dates
and be sure to book the necessary time away from work to travel
to the ARCP. The meetings are usually conducted on friendly
terms, but most trainees will feel more comfortable if they dress
smartly in a business suit or similar.
472 Ó 2018 Published by Elsevier Ltd.
 PROFESSIONAL DEVELOPMENT

Panel
At the start of the ARCP, the trainee will be introduced to the Summary of possible ARCP outcomes
panel present. This is usually a combination of the following Outcome 1 Satisfactory progress e Achieving progress
assessors e the training programme director (TPD), various and the development of competencies at the
other members of the relevant specialty training committee, a expected rate
JSCT/SAC representative, a deanery representative, an academic Outcome 2 Development of specific competencies
representative, an external representative and a lay required e Additional training time not
representative. required
Outcome 3 Inadequate progress e Additional training
Structure
time required
The panel will assess a trainee’s progress based on evidence
Outcome 4 Released from training programme e With or
presented in their e-portfolio, which uses ISCP as the platform.
without specified competencies
Trainees will be invited to their ARCP in advance and given a
Outcome 5 Incomplete evidence presented e Additional
deadline to submit all evidence, which includes structured re-
training time may be required
ports from their assigned educational supervisor (AES), clinical
Outcome 6 Gained all required competencies e Will be
logbook, e-portfolio and an updated registration form (form R).
recommended as having completed the
The panel will usually have reviewed all submitted evidence,
training programme (core or specialty) and if
discussed each trainee and decided on an outcome prior to the
in a run-through training programme or higher
meeting. In-depth details of each element of the portfolio being
training programme, will be recommended for
reviewed will be discussed in sections to follow. During the
award of a CCT/CESR(CP)/CEGPR(CP)
ARCP, the panel will go through the checklist of assessment and
Outcome 7 Fixed-term posts (e.g. LATs)
evidence required. Where these are not met, the trainees would
Outcome 8 Out of programme for clinical experience,
be given a chance to provide further information. Following this,
research or a career break (OOPE/OOPR/OOPC)
the trainee will also be given an opportunity to discuss any
positive and negative training issues, and any future career Table 1
goals/aims.

Outcomes months placement separately, even if a trainee has been allocated

The panel will recommend one of the eight outcomes described
in Table 1 for each specialty/sub-specialty, for each trainee,
including those on integrated clinical/academic programmes.
Providing evidence and your e-portfolio
The e-portfolio is assessed via the ISCP website and provides an
electronic evidence of training, assessments, other achievements,
feedback and outcomes of ARCP. This is also used for revalida-
tion of doctors in training. Figure 1 outlines the elements con-
tained within the e-portfolio.
Curriculum vitae
An updated curriculum vitae is required to be uploaded onto the
ISCP e-portfolio prior to each ARCP. This could in the format of a
word document or a PDF file and should record all of your
achievements.
Global objectives
At the start of each training placement, your TPD will set your
global objectives which can be viewed on the ISCP website. It is
important for trainees to take time to read these, albeit they may
be fairly repetitive each year. This will give clear instructions on
your learning objectives and achievements/assessments required
for the training year. It will also inform trainees which curricu-
lum they are expected to follow in order to achieve all compe-
tencies/topics required for your specialty interest.
Learning agreements
It is the responsibility of the trainee to log each training placement
in their e-portfolio, which in turn will be validated by the TPD.
Typically, most deaneries will request that trainees log each 6
12 months in a sub-specialty. Without a validated placement,
trainees will not be able to complete or utilize any further elements
of their e-portfolio. This can cause delay in achieving compe-
tencies required. For each validated placement, a learning agree-
ment between trainees and their AES must be completed. A
minimum of three meetings is required and this gives opportunity
for trainees to discuss educational and training needs. This will be
recorded under the headings of ‘objective setting’, ‘interim
review’, and ‘final review’. Following the final review, the AES
will be able to write a final report and comments. In addition to
this, trainees will also need to ensure that at least one clinical
supervisor has entered comments on the trainee’s performance in
each learning agreement. All learning agreements have to be
completed and signed off by the AES prior to the ARCP.
Topics and progress
The syllabus will have been set by the TPD at the start of the
training placement. This is crucial for trainees to ensure they are
using the correct curriculum, as there may be more than one
option of curriculum for a chosen specialty. For example, within
general surgery, there are four sets of curricula available e 2007,
2010, 2013, and 2016. If the incorrect curriculum was used, this
may invalidate all of the trainees’ assessments. For general sur-
gery, each curriculum will be further subdivided into four sub-
sections detailed as below. The subsections are designed to
separate the training programme into blocks of 2 years. Each of
these subsections will have a list of competencies and topics
which trainees are required to achieve. These competencies/
topics can be achieved with the aid of assessment tools such as
work-based assessments (WBAs), which will be described in the
following section.

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 PROFESSIONAL DEVELOPMENT

Summary of contents of an ISCP e-portfolio

CV
Examinations
Awards and Prizes
Presentations
Publications
Higher degree Learning
Grants/Awards agreements
Objective setting
Log Interim Meeting
books Final Meeting
AES report

Global
Objectives ARCPs
ISCP
e-Portfolio Outcomes

Evidence
CBD
CEX Topics
DOPS and Progress
PBA
MSF Other Evidence
Observation Audit
of teaching Courses/e-learning
External conference/meeting
Internal meeting/teaching attended
Patient feedback received
Projects
Research, including reviews
Teaching sessions by trainee

critical incidents
Miscellaneous

Figure 1

At the end of each 2-year block, trainees are required to
complete a checklist, which is available via the JCST website, for
their ARCP. There will be a total of three checklists for general
surgery e ST4, ST6, and Final/CCT.
ARCPs
Details of the annual ARCP and the process are described above.
Evidence
This section covers all the compulsory components of work-
based assessments (WBAs), which is a formative assessment to
provide short-loop feedback between trainers and trainees.
Different deaneries and specialties would have a different set
number of minimum WBAs. A typical example within general
surgery would be a minimum requirement of 10 case-based
discussions (CBDs), 10 clinical evaluation exercises (CEXs), 20
problem-based assessments (PBAs), and 1 multi-source feedback
(MSF) within a training year.
Case-based discussion: this is designed to assess clinical
judgement, decision making and the application of medical
knowledge in relation to patient care.5 It also tests higher order
thinking and syntheses as it allows assessors to explore deeper
understanding of how trainees compile, prioritize and apply
knowledge.5 Cases that are typically used in a CBD assessment
should be complex cases involving clinical uncertainty and
controversies. Completing a CBD usually involves the trainee
presenting a clinical case, followed by an in-depth discussion.
The trainer then provides feedback and recommendations for
development. Trainees are assessed against set criteria and given
a global overall level as detailed in Table 2.

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 PROFESSIONAL DEVELOPMENT

domains of competencies that are common to all procedures, but

Summary of assessment and rating of case-based certain procedures will also have additional specific domains. A
discussions global rating is given for the procedure assessed (Table 4).
Criteria assessed:
Direct observation of procedural skills (DOPS): this is used to
Medical record keeping assess the trainees’ technical, operative and professional skills in
Clinical assessment a range of basic diagnostic and interventional procedures during
Diagnostic skills and underlying knowledge base routine surgical practice.8 This is not a compulsory element of
Management and follow-up planning the e-portfolio but is often used to supplement PBAs as it is used
Clinical judgement and decision making in simpler environments and can take place in wards or out-
Communication and team working skills patients clinic as well as in the operating theatre. The assessment
Leadership skills and scoring are similar to that of PBA.
Reflective practice/writing
Professionalism Multi-source feedback (MSF): in surgery, trainees and trainers
Global summary/overall level:
have to function effectively as part of a multidisciplinary team.
Hence, trainees are expected to understand the range of roles and
Level 0 Below that expected for early years training expertise of team members in order to communicate effectively
Level 1 Appropriate for early years training and work well together to achieve good patient care. MSF, also
Level 2 Appropriate for completion of early years known as peer assessment or 360 assessment, is a method of
training assessing professional competence within a team-working envi-
Level 3 Appropriate for central period of specialty ronment and providing developmental feedback to the trainee.9
training Trainees will initiate a MSF by completing a self-assessment
Level 4 Appropriate for Certification and then nominating up to 12 raters to include a selection from
the multidisciplinary team e consultants (one of which must be
Table 2 the AES), other doctors, senior nurses and other healthcare
professionals. Each complete MSF must have a minimum of eight

Clinical evaluation exercise (CEX): this is a method of assessing

skills essential to the provision of good clinical care and to facil- Summary of assessment and rating of a problem-based
itate feedback.6 It assesses the trainees’ clinical and professional assessment (PBA)
skills on the ward, on ward rounds, in Accident and Emergency or
in outpatient clinics.6 The assessment involves observing the Domains of competency:
trainee interact with a patient in a clinical encounter. The overall
Preoperative planning
global scoring is the same as in a CBD assessment but the criteria
Preoperative preparation
being assessed differ slightly (Table 3).
Exposure and closure
Intraoperative technique
Problem-based assessment (PBA): this assesses the trainees’
Postoperative management
technical, operative and professional skills in a range of specialty
procedures or parts of procedure during routine surgical practice Global rating:
up to the level of certification.7 The procedures chosen should be
Level 0 Insufficient evidence observed to support a
representative of those that the trainee would normally carry out
summary judgement
at that training level and will be one of an indicative list of index
Level 1a Able to assist with guidance (was not familiar
procedures relevant to the specialty.7 Assessment is based on five
with all steps of procedure)
Level 1b Able to assist without guidance (knew all
steps of procedure and anticipated next move)
Summary of criteria assessed in a clinical evaluation Level 2a Guidance required for most/all of the
exercise (CEX) procedure (or part performed)
Criteria assessed: Level 2b Guidance or intervention required for key
steps only
History taking skills Level 3a Procedure performed with minimal guidance
Physical examination skills or intervention (needed occasional help)
Diagnostic skills and underlying knowledge base Level 3b Procedure performed competently without
Management and follow-up planning guidance or intervention but lacked fluency
Clinical judgement and decision making Level 4a Procedure performed fluently without
Communication and listening skills guidance or intervention
Organization and time management Level 4b As 4a and was able to anticipate, avoid and/or
Professionalism deal with common problems/complications

Table 3 Table 4

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 PROFESSIONAL DEVELOPMENT
responses from raters. The trainee is assessed on five main
domains
 clinical care
 maintaining good medical practice
 learning and teaching
 relationships with patients and colleagues
 summary.
Trainees do not have access to individual assessments but can
review summary written feedback/comments, which are ano-
nymized. When a MSF is complete, the AES will discuss the
trainees’ performance and then sign off the assessment. Trainees
should bear in mind that raters will often take some time to
complete the assessment, and therefore should start a MSF early
in their training year.
Observation of teaching (OoT): this is a formative feedback tool
used when the trainee is delivering formal teaching.10 It is
intended for use when teaching by trainees is directly observed
by the assessor in a formal situation and does not include bedside
teaching. This is not a compulsory element of the e-portfolio but
it is good practice to complete a few OoTs as learning and
teaching forms a part of a surgical trainees’ curriculum.
Other evidence: this section covers all the other elements of the
e-portfolio, which does not comprise of the compulsory assessment
or WBAs. Whilst not every subsection within this is compulsory,
most elements are required to complete the ST/CCT checklist for an
ARCP and also aids to maintain a good CV. It is therefore good
practice to aim to have evidence uploaded for every subsection.
Most of these subsections are evidence of trainees’ training devel-
opment outside of clinical practice and forms a major part of the
GMC’s Good clinical practice. This includes audit, award and prizes,
courses/e-learning, examinations, external conference/meeting,
internal meeting/teaching attended, patient feedback received,
presentations, projects, publications, research, teaching sessions by
the trainee, significant event/critical incidents and miscellaneous.
E-logbook: this provides an electronic record of a trainees’
operative experience. Trainees record all cases/procedures that
they have been involved with in the Pan-Surgical Electronic
Logbook. Trainees are required to enter their role in each pro-
cedure as below. As trainees are not always expected to complete
each procedure in its entirety, the role of the trainee will depend
on how much of the procedure the trainee performed. It is
important to review e-logbooks regularly and not just prior to an
upcoming ARCP, as the ST/CCT checklist has an indicative
number of key procedures required.
Tips on preparation for your ARCP
Most trainees often have multiple urgent matters to contend with
throughout a training year e both career related and personal
issues. Often, the ARCP is not contemplated until the time draws
closer and for some trainees, the ARCP can be a stressful process.
I understand that many trainees will have different strategies on
how to prepare for an ARCP but below are a few tips, which I
find helpful and make the whole process flow smoothly.
SURGERY 36:9
Before the ARCP
1. Start thinking about the ARCP at the start of the training year
as some foundations can be laid to help achieve compe-
tencies required.
2. Identify your AES as soon as possible (within days of start of
placement).
3. As soon as you have identified your AES, record your
placements for validation from your TPD.
4. Spend a few minutes to read through the global objectives
set by your TPD.
5. Once your TPD has validated your placement, arrange a
meeting with your AES to complete the initial objective
setting on your learning agreement. Your AES may also be
able to give you tips on how to achieve certain learning goals
within a hospital/trust which you are new to.
6. At your first meeting with your AES, ensure you make a
provisional date for your interim meeting.
7. Download the ST/CCT checklist (via the JCST website),
which is most relevant to your level of training, even if you
are not due to complete one in that training year. This is
often a source of great stress at ARCP and resulting in an
outcome 5. This will help you to prepare well in advance, as
the checklist requirements are very specific. It will ask of a
trainee a set minimum numbers of CBD/PBA, which are
scored at a certain level. (For example, a general surgery ST6
checklist requires a trainee to have at least 6 CBD at level 4
for emergency general surgery, a level 4 PBA for hernia
surgery etc).
8. Complete WBAs at every given opportunity. It is better to
have too many than too few! On calls and post-take hand-
overs are often a good time to complete CBDs. Do not miss
the opportunity to complete CEXs in outpatient clinics.
Trainees should always think about PBAs/DOPS whenever
they spend time in an operating theatre. Don’t just complete
a WBA for the sake of meeting minimum required number e
remember to refer to the ST/CCT checklist to ensure you
achieve the level required.
9. Always refer to your ‘topics and progress’ to ensure your
WBAs cover most topics that are required to be signed off
(for general surgery, all topics need to be completed at
training levels ST4, ST6 and ST8/CCT).
10. If there are any topics which you have not/will not
encounter in your clinical practice, then you may need to
think ahead on how to achieve these. Some AES will have a
clinical discussion, but some will prefer uploaded evidence.
For the latter, I found it useful to read an up to date journal
publication and write a summary. You can then upload the
journal article together with your notes under the miscella-
neous subsection or other evidence.
11. As soon as you’re settled into your placement and have had
the chance to meet the multidisciplinary team, get started on
your MSF. It often takes months before you can get all 12
raters to complete their assessments.
12. Don’t forget the ‘other evidence’ section. Aim to achieve at
least one of all the following: audit, presentation, publica-
tion, and national/international meetings.
476 Ó 2018 Published by Elsevier Ltd.
 PROFESSIONAL DEVELOPMENT

At the ARCP Conclusion

1. You will have received notification on the time and venue for
The ARCP sets a format in which trainees have a framework to
your ARCP in advance. Ensure you have informed your
guide and assess their training and learning. It is not solely a tool
clinical team and allow ample travel (and parking!) time.
to assess a trainee, but it is also a platform for trainees to discuss
2. There will be times when you have personal or social com-
their progress through surgical training. We are all well too
mitments during the ARCP period. If you know this at the
aware of the difficulties of multi-tasking between surgical
beginning of the training year, you should contact your TPD
training, examinations, and personal life. We often forget that
to enquire of forthcoming ARCP dates and plan around this if
various people within the system of the ARCP can sometimes
possible. In certain circumstances, some deaneries may be
provide help/advice on personal matters that affect our training.
able to change your ARCP date if enough notice has been
From the deaneries’ perspective, the ARCP is not just a tool to
given. (ARCP is a mandatory part of training).
assess a trainee. It allows the deanery to monitor the training
3. Dress code will vary between deaneries and also depend on
quality of each placement. In the era of continuous assessment
trainee’s preference. Most trainees will opt for a formal suit.
and feedback, it is easier for the deanery to identify areas of
However, it is also acceptable for trainees to wear smart
deficiency in training and therefore able to improve this.
attire that they would normally, when attending outpatient
Although some trainees may disagree and still view the ARCP
clinic or when going for a clinical examination.
as a source of stress, formative assessment and feedback is
4. During your ARCP, you would be introduced to the panel.
inevitable in the current times of surgical training. Hopefully, you
Reviewing your e-portfolio and your outcome usually fol-
will find this guide somewhat useful and reassuring and maybe
lows this. You will also have the opportunity to discuss your
even start to enjoy the process! A
training experience so far and your future career goals. Do
not hesitate to ask for advice/suggestion if you need to e
your ARCP is not solely a scrutiny of your performance but REFERENCES
also a process to discuss your training needs. 1 Department of Health. Hospital doctors: training for the future. The
5. If you did not achieve an outcome 1, make sure you are clear on report of the working group on specialist medical raining. London:
what is required to rectify this prior to leaving your ARCP. DoH, 1993.
Informal discussions with fellow trainees in the waiting room 2 Tooke J. Aspiring to excellence: final report of the independent
can sometimes give you pointers on how to resolve any issues. inquiry into modernising medical careers. London: MMC Inquiry,
2008.
Excelling at the ARCP 3 Department of Health, NHS Scotland, NHS Wales. A guide to
postgraduate speciality training in the UK. The Gold guide. June
Whilst attending your ARCP with all parts of the e-portfolio
2007, https://www.copmed.org.uk/images/docs/publications/
present and intact and a log book reflecting good engagement
Gold-Guide-6th-Edition-February-2016.pdf. [Accessed 28 June
and adequate operative exposure will ensure an Outcome 1 in
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most circumstances, all fields of surgery remain competitive and
4 European Union’s Working Time Directive (2003/88/EC).
trainees are always best advised to strive for excellence over
5 https://www.iscp.ac.uk/curriculum/surgical/assessment_cbd.
mediocrity. Items of added value for the ARCP will translate to a
aspx.
stronger CV and this will pay dividends to future applications to
6 https://www.iscp.ac.uk/curriculum/surgical/assessment_cex.
fellowships and, ultimately to consultant jobs. The ARCP pro-
aspx.
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7 https://www.iscp.ac.uk/curriculum/surgical/assessment_pba.
arduous undertaking and so a trainee bringing items of ‘added
aspx.
value’ to their ARCP will always be welcomed.
8 https://www.iscp.ac.uk/curriculum/surgical/assessment_dops.
Take every opportunity to strengthen your portfolio with
aspx.
research, audit and presentations. Courses and meetings are an
9 https://www.iscp.ac.uk/curriculum/surgical/assessment_msf.
expectation but look for additional opportunities that may in-
aspx.
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10 https://www.iscp.ac.uk/curriculum/surgical/assessment_oot.
of the usual range and may include areas such as management,
aspx.
leadership, education and remote surgery. Many trusts will offer
more senior trainees the opportunity to sit in on various trust FURTHER READING
management meetings and more junior trainees may want to dip Department of Health, NHS Scotland, NHS Wales. A guide to post-
their toes into rota management or formal teaching commit- graduate speciality training in the UK. The Gold guide. June 2007,
ments. External organizations often have trainee representatives https://www.copmed.org.uk/images/docs/publications/Gold-
and various trainee organizations do good work, with high-level Guide-6th-Edition-February-2016.pdf.
representation on national bodies. http://www.severndeanery.nhs.uk/about-us/education-and-training/
Finally, never underestimate your value and interest as an doctors-in-training/annual-review-of-competence-progression-
individual and always include your interesting hobbies and arcp/.
achievements outside of medicine on your CV.

SURGERY 36:9 477 Ó 2018 Published by Elsevier Ltd.