CMT TRAINEES

HITCHHIKERS GUIDE
TO CMT TRAINING AND
THE E-PORTFOLIO
a practical guide


Oxford Deanery



For trainees commencing CMT
August 2012





Dr Chris Davies CMT TPD
and
Dr Emma Vaux, Former CMT TPD and Chair
CMT SAC
1



Contents

Page:

2. Foreward
3. Contacts
4. Educational and clinical supervision
6. The eportfolio
12. Time line for CT1 trainee
12. Time line for CT2 trainee
12. Pre-ARCP face to face meetings
13. Purpose of Annual Review of Competence Progression (ARCP)
14. ARCP Decision Grids
17. Possible outcomes of ARCP
20. Trainee absences
20. The Support network available to you
21. Feedback on posts and educational process
21. Re CT2 acting up as ST3
22. Time Out of Programme (OOP) during Core Training
22. ST3 progression
22. Acknowledgement

Appendices
23. A Examples of eportfolio completion
25. B Top tips on how to get the most out of workplace based
assessments
2

FOREWARD


This Hitchhikers Guide to Core Medical Training is similar to its namesake Guide to the Galaxy in
that it has needed to be revised and updated as the experiences of trainees hitching around the Oxford
Deanery have been fed back, but the basic plot is still the same.

The whole Specialist Trainee (ST) in Core Medicine can be daunting to start with. Especially as I
felt my preceding four months as a hapless Foundation Year 2 doctor in Public Health didnt leave me
well-equipped to be the Resident Medical Officer as a hapless ST1, taking referrals from A&E, GPs or
actually from anyone who bumped into me in the corridor.

Couple this trepidation with a whole new eportfolio and suddenly I wanted to hide under my desk
(well I call it a desk, it was actually a horizontal piece of chipboard for FY2 Public Health doctors)
and continue my root-cause analysis of a scabies outbreak in a nearby nursing home.

What is the e-portfolio? Am I now indelibly consigned to being a CT1...or is it ST1? What is are
MSFs, WBAs and JRCPTB? Who is the ARCP panel? Is it a group of acronymic aliens from the
Hitchhikers Guide to the Galaxy? Lots of wild thoughts crossed my mind with a rising feeling of
panic. Maybe I had taken advantage of one too many drinks vouchers at the Doctors Mess Party.

Actually, its not that bad at all. The Hitchhikers Guide to Core Medical Training and the e-portfolio-
a practical guide is meant to help us with that transition from Foundation to Specialist Training. As
you read, it magically guesses the next question in your mind and hey presto, the answer is on the next
page. It deciphers the jargon and leads you hand-in-hand to log on to the electronic portfolio (hence
eportfolio- see it has begun to make sense already). Be it details about your assessments or how to
attain the necessary competencies to apply for ST3 level jobs, the guide really does simplify it all. As
well as academic issues being addressed, there is information on how to go about organising out of
training experiences and appropriate support networks if things arent going to plan.Its a great
resource to find out what youre supposed to be doing, when and who with.

Dr. Emma Vaux, (the first CMT Programme Director), has worked tirelessly on the guide to ensure
trainees are given the necessary information as they embark on their Core Medical Training. Having
said that, CMT in the Oxford Deanery does require initiative and self-motivation on the trainees part,
in regularly updating their eportfolio as their clinical experiences accumulate. This is by showing
evidence of your achievements through appropriate assessments, having competencies signed off and
doing reflective practice (a lot more useful than it may initially seem). Before you know it youll not
need that chipboard anymore. Good luck!


Aneil Malhotra, CT2, 2009/10
3


CMT TRAINEES HITCHHIKERS GUIDE TO CMT TRAINING
and the E-PORTFOLIO a practical guide


Contacts

Dr Chris Davies CMT Programme Director
Consultant Respiratory Physician, Reading
Tel : 0118 322 8293 / 8853
chris.davies@royalberkshire.nhs.uk

Jane Exell Programme Manager CMT, Oxford Deanery
Tel : 01865 740657
Jane.Exell@oxforddeanery.nhs.uk

Morgane de Salvage Recruitment and Assessment Adminstrator
Tel : 01865 740632
Morgane.DeSalvage@oxforddeanery.nhs.uk


CMT Specialty College Tutors :

Dr. George Pope Oxford georgepopea@gmail.com
Dr. Grace Robinson Reading grace.robinson@royalberkshire.nhs.uk
Dr. Alan Steuer Wexham alan.steuer@hwph-tr.nhs.uk
Dr. Bill Smith MKH bill.smith@mkhospital.nhs.uk
Dr. Chi Yau SMH chi.yau@buckshosp.nhs.uk
Dr. Charlotte Campbell Wycombe charlotte.campbell@buckshosp.nhs.uk
Dr. Ian Arnold Horton Ian.Arnold@ouh.nhs.uk

Head of School Medicine
Dr. Tony Bradlow Anthony.bradlow@royalberkshire.nhs.uk


Please note:

1. Issues regarding your E-portfolio such as access by you or your supervisors should
be directed to Morgane de Salvage in the first instance

2. It is essential that any changes to your personal details such as email addresses,
contact details and home address are kept up to date by the Deanery. Please let
Morgane de Salvage know immediately

3. There are currently two curricula for CMT training. Trainees appointed to start in 2011
and 2012 should use the 2011 curriculum on the E-portfolio.

4. The only trainees currently still on the 2009 curriculum are those who remain within the
programme and who commenced training prior to 2011 (i.e. some ACF trainees and
those in CT3 or who had a gap e.g. maternity leave).

5. The lay-out of the E-portfolio has changed this year but content is essentially the same.
4

1. Educational and clinical supervision

You will be allocated to an Educational Supervisor (ES). This consultant will remain
as your educational supervisor for both years of your CMT training, even if you move
between different hospitals. The educational supervisor has an overview of your
training and the requirements of the curriculum and is responsible for your
educational progress as a whole. The ES is responsible for the trainees Educational
Agreement.

The first meeting with your educational supervisor should be within 4 weeks of you
starting your training. Thereafter you should arrange regular meetings with your ES
to ensure your Personal Development Plan (PDP) and eportfolio is reviewed. It is
recommended that the ES should spend the equivalent of 1 hour per week per
trainee to allow time for educational appraisal.

The Clinical Supervisor (CS) oversees your day to day clinical work and provides
constructive feedback during a training placement. You will also need to meet with
your clinical supervisor within 2 weeks of starting every new placement/post (your
CS and ES is usually the same in your first job in the Deanery)

Any time your CS changes you must inform Morgane de Salvage at the Deanery so
their name may be added to your eportfolio.

Your Trust will also have a CMT Specialty Tutor or College Tutor. The Tutor is
responsible for organising the teaching programme in each trust and provides
overall review of CMT training for the trust. This person will also be reviewing your
E-portfolio regularly and should be meeting with you on a regular basis. If there are
significant problems with access to teaching or issues about poor training or
supervision then the Tutor must be made aware in the first instance.

The CMT Programme Director is responsible for overseeing the whole training
programme, and works closely with the Tutors, Head of the Oxford Deanery School
of Postgraduate Medical Specialities and the Postgraduate Dean to ensure training
is optimal. The PD is also responsible for recruitment, assessment and suitability of
training posts, meeting all trainees face to face and the annual review of progress
(ARCP). The PD will also be reviewing your E-portfolio and will use the messaging
system within the portfolio to contact you if there are problems with the records, thus
creating a permanent record of any discussions.

Any concerns about training, and certainly any concerns about patient safety, should
also be flagged to the CMT PD immediately. The CMT PD will expect trainees to
complete feedback forms for each post they have undertaken during their year and
will use this information to try and improve training.



5

Top tips for appraisal:
o ensure you have all paperwork and e portfolio access before you meet with
your supervisor
o make the appointment for the appraisal through secretary or the ES/CS for an
appropriate amount of time
o be prepared to lead the educational supervisor through the eportfolio
o fill in documentation at the time of appraisal
o make follow up appointments for mid point/end of job appraisals at this time
o make PDP aims SMART: Specific, Measurable, Agreed, Realistic, Time
limited


Appraisal = a formative process to enable trainees to develop; a system of cyclical reviews
setting personal objectives and evaluating progress against them. Value is primarily for the
trainee

Assessment = a summative process evaluating performance against predetermined
criteria; the value is both for the trainee and for regulation

Ensure you keep a steady update of your eportfolio and completion of assessments;
arrange appointments with your ES in a timely fashion. The more (quality) evidence
you have in your eportfolio the more likely the time spent with your ES will be
productive in terms of addressing your PDP and educational planning
Educational supervisors will seek feedback on performance from clinical supervisors

Please understand that completion of your required appraisals, assessments and eportfolio
record is your responsibility. If you have difficulty identifying or meeting with your
educational supervisor you should approach you COLLEGE TUTOR or CMT programme
director.


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2. The E-Portfolio

All trainees should enrol with the JRCPTB promptly this will allow you access to your E-
portfolio and also your CMT certificate once you have completed the training satisfactorily.
The JRCPTB will cross match the E-portfolio users against the list of on-line enrolment
applications. If after two warnings you still have not enrolled, the right to access to the E-
portfolio will be removed.

Entering the eportfolio
You will be given a username and password this should only be used by you

Profile
On the eportfolio ensure all details on your profile are correct, in particular your email
address and GMC number under personal and then profile (menu on top bar)

Check that your educational supervisor is correct under profile and then
posts/supervisor details. The tutor refers to the College Tutor for your
particular Trust.

Under posts/supervisor details
o There are the details for each post you will rotate through the current post is
highlighted and the other post details are above
o Please note that to allow the clinical supervisor access to your eportfolio their
name will be entered against that 4 month post only - the purpose of this is to
enable the clinical supervisor to sign off competencies (with evidence) as
appropriate.

Declarations and agreements the probity and health declarations need to be
completed for each training year; the educational agreement needs to be signed off
once with your educational supervisor your ES may countersign only you have
signed the declarations

Certificates refer to certificates such as ALS your ES must see the original of the
certificate and then sign off that they have done so. A current ALS certificate is
mandatory.

Personal library allows you to upload any relevant documentation the space has
been increased to 40MB.

Absences should record any unplanned absences You should record any
absences from work on your eportfolio this will be cross-referenced with medical
staffing records. This is further mandated by your sign off of your probity and health
declarations. Therefore every time you are absent for reasons of
sickness/compassionate leave etc you must ensure medical staffing are informed for
their records.

You MUST upload your photo it assists administration, trainers and supervisors
who deal with up to 90 trainees

7

Curriculum

You should have Core Medical Training - CMT curriculum for trainees commencing
from August 2011 by clicking on this, there is a list of all the areas of the
curriculum split into sections that need signing off at some stage over your CMT
training period, in addition to examinations and procedures.

The curriculum starts with
o common competencies,
o 4 emergency,
o top 20 presentations
o other presentations (40 of them)
o procedures
o examinations/certificates (MRCP and ALS)

The common competencies (25 of them) have level 1 and level 2 descriptors by
the end of CMT the trainee is expected to be competent in all to level 2 descriptor.
All parts of the curricula have mapped assessments

MRCP in its three components (part 1,2 PACES) maps to all parts of the curriculum
for the CMT stage of GIM training and is necessary for full completion of CMT

Clicking on the i icon against each competency will allow you to see what standards
are required to be achieved for each and what Assessment methods are required

Clicking on the wording of the competence will bring up a window which allows both
you and your CS/ES/Tutor/PD to comment on competency and is the place where
sign off (by the ES or CS) of each competency to the appropriate stage is recorded.
Evidence as to why the competency has been signed off should be entered in the
comment box below.

It is very important the sign off of any competency is accompanied by written
comments stating the evidence as to why this competency has been achieved
(please see appendix A and B for examples). It is not acceptable for your ES (or
clinical supervisor) to simply state a competency has been achieved, the reasons
why must be given ( for example, this might include WPBAs, teaching attendance,
MRCP, validated course/certificate, audit, ward round presentations, tutorial, on-line
learning etc and/or a comment that all evidence stated has been reviewed and
agreed that competency achieved). Therefore you want to ensure your eportfolio is
packed full of evidence and reflects your clinical and other activities. In addition, you
should complete the self-assessment for each competency and support your
comments with what you feel is relevant to support any sign off.

As you can see from the examples in Appendix A and B, trainee self assessment
may also be visualised as to where you see the stage of that competency sign off to
be. Please ensure you provide as much evidence as possible here.

Clicking on the blue icon will now allow you to link many aspects of the evidence (eg
WPBA, reflective log entry, personal library entries) on your eportfolio to a particular
competency and vice versa this evidence is identified in brown against the relevant
8

competency. This will allow a good build up of evidence over time (and should make
the whole process more intuitive. However, you must have written comments by
your ES stating that a thorough review of the evidence has taken place plus any
other additional evidence added in support. This should also be in addition to your
own self assessment as to why you think you are competent.

Please note competencies should be signed off on a regular basis
underpinned by your self assessment and the evidence you have linked in
support. By signing off large numbers (>10) all at once time treats the process
as a tick box exercise, undermines any educational value to you and is
unlikely to result in identification of any further learning and development.


Assessment

Under assessment the WPBAs can be found. These include:
o Directly Observed Procedures (DOPS)
o Mini Clinical examination (Mini-Cex)
o Case based discussion (CbD)
o Multi source Feedback (MSF)
o Teaching Assessment
o Audit Assessment Tool

There are details of what WPBA have been achieved under each post the
magnifying glass means there is an entry and clicking on this will allow you to review
this entry; clicking on add new assessment will enable you to do a new entry

You are able to send tickets to assessors to enable completion of new
assessments; you can also keep track of who and who has not responded. Under no
circumstances may you submit a WPBA on behalf of your assessor this would be
considered a serious probity issue. Constructive feedback on WPBAs is now
mandatory for the assessment to count. Forms have been simplified this year.

You must ensure you do enough WPBAs there are minimum requirements for
each stage of training (see ARCP Decision Grids) but you are advised to do more
than the basics, in particular ACATs to build up evidence for your competencies.

You should ensure your WPBA are done by the most senior doctor; there are now
specific criteria about how many should be done by a consultant (see ARCP
Decision Grids). Where you use a junior member of staff they must be trained in the
use of WPBA. You must have your assessments done by a variety of people there
have been cases where they have all been done by the same person this is not
acceptable. The WPBAs now have a separate section to clearly state what the
competency level achieved in this WPBA has been relevant to their stage in training

The MSF is very important and one of the most informative tools. Replies should be
received within a 3 month time window from a minimum of 12 raters including 3
consultants and a mixture of other staff (medical and non medical) for a valid MSF. If
significant concerns are raised then arrangements should be made for a repeat
MSF(s). Please ensure the person completing the MSF understands what they are
9

doing - saying yes to probity issues by being careless in completion can have major
implications.

You must only link a WPBA to a clearly relevant competency to provide the
appropriate evidence to inform sign off. Creative linking may be a genuine
misunderstanding by the trainee but may suggest a probity issue and will be
reviewed. A WPBA should not be linked to more than 6 competencies
Please see appendix B for top tips on how to do workplace based
assessments


Reflection

This section allows you under reflective practice to input reflection on learning
events or evidence of audit, teaching attendance, out-patient attendance,
conferences, research, publications etc. Each entry should be shared if you want it
to be seen to enable review, discussion with your ES where appropriate and signed
off by your ES.

Development of your reflective practice is such an important part of your learning
and development, it is what makes us mindful as physicians and helps inform our
PDPs. Reflective practice is about you and your work, learning from experience,
valuing what we do and why we do it, learning how to account positively for
ourselves and our work, can help us make sense of our thoughts and actions, and
emphasises the links between values and actions. Learning through reflection
supports acting with care and integrity and acting safely.

You should complete at least 30-40 shared reflection entries for each 12 month
stage. Remember these are very useful to record all other activities such as out-
patient attendance, audit, research and reflective practice. You can link these entries
to your competencies, so this entry maybe used for evidence against the curriculum

You should keep a record of your teaching attendance it is expected you attend
>70% of your 4 hours mandatory teaching per week (this is usually made up of
specific CMT teaching with reference to the curricula, additional CMT teaching,
Grand Round and departmental teaching).

o The educational reflection entry should name the teaching session, the
person who it was delivered by and two or three main things you have learnt
(enter this information under the venue). This applies to all teaching sessions
but also other educational activity such as on-line learning.

In addition you should record any teaching sessions you give this activity should
be encouraged along with documented formal feedback. A teaching observation tool
is now available to be used and should be completed when necessary. You should
review this feedback with your ES.

Careers management enables a record to be kept of any discussions regarding
your career pathway.

10

Appraisal

Appraisals are mandatory for the beginning and end of each job. The mid-post
appraisal is desirable but not mandatory these appraisals are completed ideally by
the clinical supervisor (who will now have access to the eportfolio to do this). Please
encourage this to be completed with detailed written comment by your supervisor.
Any educational meetings (e.g. with the tutor or CMT PD) can also be recorded here

The personal development plan should be completed for each post after
discussion with your ES/CS, regularly updated and added to for changing needs
this can be a very useful to identify areas of weakness and development. It also
needs signing when the post has completed.


Progression

This section contains sections on:
o Summary Overview
o Educational Supervisor Report
o ARCP

Summary overview allows a summary of all assessments, appraisals, supervisor's
reports and ARCP forms recorded by post to be seen together and is a useful way of
looking at what a trainee has been doing during the year and recently.

Your ES will complete the ES report online for each period. The ES is a structured
report which contains a summary of your progress including reference to the
development needs, number or WPBAs, audit, teaching, and complaints or concerns
and feedback on your health and/or probity. The ES report should provide you with
feedback but is a major factor which is considered by the ARCP panel

The ARCP outcome is recorded in a structured form please note this is only done
by the ARCP panel and cannot be viewed by you until it has been released by the
CMT PD. If it appears as a X, then this means it is still in draft format.


Other E-portfolio / curriculum issues

Out-patient attendance - you are required to attend 24 clinics in your two year
training programme each attendance may be documented under reflective
practice and/or as WPBAs.

MRCP. Part 1 is a requirement by the end of CT1 year. Failure to pass in CT1 will
not prevent progression as long as you have engaged with the other requirements.
Full MRCP is a requirement for completion of CT2 - you will not be able to progress
to ST3+ without full MRCP.
11

Audit / Quality Improvement Project (QIP)

All core medical trainees are required to perform an audit each year as part of their
training.
Most projects achieve little but simply consist of an initial data collection exercise
with no subsequent action or second data collection. As a result they learn little and
make no difference to their own practice or the experience of their patients.

Learning To Make a Difference (LTMD) is an initiative to enhance the training of core
medical trainees to enable them to learn, develop and embed new skills in quality
improvement and put these new skills into practice. Introducing quality improvement
methodology into training enables trainees to make a real difference to the quality of
their clinical practice and patient care.

The expectation from August 2012 is for all CMT trainees to do a quality
improvement project instead of an audit project. If an audit is done use of quality
improvement methodology is advised at the implementation of change part of the
cycle.

You can complete a QI project within a 4 -6 month training post or can decide to do
a project over the whole year. You will need a QIP supervisor this might be your
educational or clinical supervisor, and you may work on your own, as a group and/or
involve the multi-disciplinary team. Ideally the project would be a trainee-led idea
and then you follow the guidelines outlined in the trainee tool kit

How do I do it?
You will need to test your idea using a simple structured framework such as Plan,
Do, Study, Act (PDSA).

Plan - Define the objective, plan to answer questions: who, what, when, where,
why? Plan for the collection of data and the measures you will be using and
finally record your progress.

Do - Carry out a simple test of change and record what happens.

Study Complete the analysis of your data and record your results.

Act Decide what modifications are needed and if you are ready to make
another change. You are likely to go through a series of PDSA cycles as you
modify your initial change to make a sustained improvement.

LTMD website for trainee packs and example projects
http://www.rcplondon.ac.uk/projects/learning-make-difference-ltmd



12


3. Time line for CT1 trainee

Induction August
3 x 4 month posts (some 2 x 6 month posts)
8 month ES report March
7-8 month E-portfolio review CMT Programme Director March/April
8-9 month face to face meeting if unsatisfactory April
Face to face meeting CMT PD and Tutor (all trainees) May/June
11 month Educational supervisor report June
12 month ARCP July

4. Time line for CT2 trainee

16 month E-portfolio review CMT Programme Director October
16 month face to face meeting if unsatisfactory October
Unsatisfactory portfolios reviewed again December
22 month face to face meeting CMT PD and Tutor May/June
23 month Educational supervisor report June
23 month ARCP July


5. Pre-ARCP Face to face meetings

All trainees will be seen face to face by the CMT PD along with the Tutor for the
hospital in which they work. The purpose of this meeting 2-3 months before your
actual ARCP is to ensure that training has been satisfactory and that you as the
trainee have a clear idea of what remains to be completed ahead of your actual
ARCP outcome.

Prior to the meeting, you should complete all the necessary requirements by
referring to the ARCP Decision Grids, meet your ES and CS and sign off the
curriculum as appropriate. It is vital that you also self rate your perceived
competency before the meeting.

The CMT PD and Tutor will have also reviewed your E-portfolio and will have
identified things which need attention. At the meeting there will be discussion about
various aspects of teaching and a list of remaining objectives given verbally and
subsequently recorded on the ARCP section as an interim report. These objectives
must be completed ahead of the actual ARCP otherwise you will receive an
unsatisfactory outcome. However, once completed, you may be signed off as
satisfactory following the ARCP panel review in July.

13

6. Purpose of Annual Review of Competence Progression (ARCP)

Review training experience and progress
Ensure appropriate evidence to support progression
Identify gaps in knowledge and experience
Completion of core medical training
Ensure career plans realistic

ARCP panel is usually made up of:
- CMT Programme Director
- College Tutors
- Lay member
- External member
- Trust representative usually Tutors
- Deanery administrator
- External advisor (RCP)

Not all trainees will be required to attend the ARCP panel in person. The ARCP process is
essentially a virtual experience and your eportfolio will be accessed remotely by the panel.

The trainees eportfolio, progress, teaching attendance, absences and any other issues
arising are reviewed at this meeting along with the ES report

All trainees who have been identified at the face to face meetings as needing to do
significant work to complete the year are likely to be required to attend, plus anyone
who is confirmed as having an unsatisfactory outcome due to examination failure. All
CT1 trainees must have Part 1 MRCP (UK) failure to do so should lead to outcome
2 at month 11 ARCP if other aspects of training are satisfactory

Please refer to the ARCP Decision Grids over page.





14


15


16


17

7. Possible outcomes of ARCP

These are outlined in the table below, and a chart to show outcomes if there is
examination (MRCP) failure
Outcome 1 indicates satisfactory progress.
Outcomes 2 5 are described below.

CMT ARCP Outcomes Summary Guidance
Mo11 Mo23 Revisable Notes
Outcome 1


Indicates progress to the level required of the ARCP guide
(satisfactory completion CMT in the case of Mo23 ARCP)
Outcome 2
Development of
Specific
Competencies
Required
additional
training time
not required
except at
appeal
/review
Progress unsatisfactory against the requirements of the ARCP
Decision Aid, development of specific competencies required.
However, it is anticipated that any additional competencies required
can still be gained within the planned training time, without
requiring additional training.

This outcome is awarded if there is either no MRCP(UK) Part1 or
inadequate progress against other requirements or both.
Outcome 3
Inadequate
Progress
additional
Training Time
Required
except at
appeal
Progress unsatisfactory against the requirements of the ARCP
Decision Aid.
This outcome is awarded if either no full MRCP(UK) or inadequate
progress against other requirements or both.
The trainee will need extra training time extending their CMT
programme by 6 months (exceptionally 12 months with the
agreement of the Postgraduate Dean).
This outcome can also be used if the trainee is voluntarily leaving the
programme having made insufficient progress but would otherwise
be offered extra training time - do not use an outcome 4 in these
circumstances.
Outcome 4
Released from
Training
Programme with
or without
specific
competencies
except at
appeal
Progress unsatisfactory against the requirements of the ARCP
Decision Aid.
Required trainee to leave the programme.
This outcome is awarded after a period of additional training
following Outcome 3 at Mo23 if the required competencies have still
not been gained after the agreed period of additional training.
or
Outcome 4 can be offered at 24 months if there has been complete
failure to attempt any part of MRCP(UK)
or
Outcome 4 can be awarded to a trainee with no part of the
MRCP(UK) and inadequate progress against other requirements.
This outcome is not appropriate for trainees who leave of their own
volition without full competencies, but where additional training
time would normally be offered (use Outcome 3).
Outcome 5
Incomplete
evidence
presented
additional
training time may
be required
must be
revised
within 2-6
weeks
Incomplete evidence presented additional training time may be
required.
An Outcome 5 must always be revised.
The trainee is required to provide a written explanation of why they
were unable to supply the required information within 5 days of the
ARCP and must provide the information within 2 weeks of the ARCP.
The Outcome 5 must then be revised to one of the other Outcomes.

18






Month 11 Allowed Outcome Month 23 Allowed Outcomes ARCP after Additional Training
(after Mo23 Outcome3)
Outcome 1
Outcome 2
Outcome 5 (must be revised within
2 -6 weeks)
Outcome 1
Outcome 3
(Outcome 4)
Outcome 5 (must be revised within 2-6
weeks)
Outcome 1
Outcome 4
Outcome 5 (must be revised within 2-
6 weeks)


Examples
Outcome 2 Mo11 trainee has not attained MRCP(UK) part 1 or/and has not met other requirements of the
Decision Aid by some margin
Outcome 3 At Mo23 trainee has not attained full MRCP(UK) and/or has not met requirements of Decision
Aid by some margin and is therefore given extra training time
Outcome 4 Having completed extra training time the trainee still has not attained full MRCP(UK) and/or has
not met requirements of Decision Aid by some margin
Trainee who has not engaged with the examination aspect of the curriculum further to the
award of Outcome 2 at Mo12, trainee is not entitled to additional training time
Trainee who has not passed any part of the examination and is failing to make progress in other
aspects of training can be awarded an Outcome 4 at 24 months (ie if a trainee is making good
progress with the curriculum, but has not passed the exam, they would normally be awarded an
Outcome 3)
Outcome 5 At either Mo11 or Mo23 the trainee has either MRCP(UK) Part 1 (Mo11) or full MRCP (Mo 23 or
after extra training time) but has marginally not met the requirements of the Decision Aid
and/or does not have a completed ES report. The panel agree that either the trainee has the
required information but not submitted it or can produces the evidence with 2-6 weeks.


19

Possible Outcomes based on MRCP(UK) Attainment.



20

8. Trainee absences

Please note that you must be aware of each trusts process on who to notify when
absent, in particular for any unplanned absence (i.e. other than annual, professional
or study leave)

You must enter all unplanned absences on your eportfolio record and ensure your
educational supervisor is aware of any unplanned absences

Unplanned absences are taken very seriously by the Trusts and the Deanery.

Any recurrent unplanned absences, particularly from night or weekend shifts will be
reviewed

If you have more than one unplanned absence from work this will be reviewed with
you by your educational supervisor and/or college tutor

For repeated unplanned absence you may be referred to Occupational Health, for
counselling, to the Careers Development Unit or for disciplinary procedures.



9. The Support network available to you

Please ensure if you have concerns/issues that you raise them, and raise them early.
The Oxford Deanery is not prepared to tolerate bullying or intimidation within
postgraduate medical and dental education.

Examples of bullying behaviour in the context of PGMDE
Teaching by humiliation;
Undermining status and credibility, e.g. criticism in the presence of others, possibly
patients or the public;
Using threats, abuse or swearwords or shouting inappropriately;
Excessive criticism over minor things;
Undervaluing or even ridiculing contribution and/or genuine effort;
Changing objectives or expectations without consultation or explanation;
Deliberately setting unreasonable objectives or tasks with impossible deadlines;
Sending to Coventry, ignoring or devaluing;
Exclusion from meetings an individual might reasonably expect to attend;
Unrealistic expectations/demands concerning a trainees out of hours
responsibilities.

There are a number of people who are able to provide support to you be it pastoral or
career advice please see below
Educational supervisor
Clinical supervisor
College Tutor/Specialty Tutor
Clinical Tutor/Trust Medical Education Director
CMT Programme Director

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Head of School of Medicine
There are several CMT trainee reps contact the CMT PD

If difficulties are identified there are formal processes in place to address these and
hopefully help and deal with any issues effectively. If you feel your concerns are not
being taken seriously or addressed in a way that you feel they should then please
contact the CMT Programme Director (Chris Davies) or the Head of School of Medicine
(Tony Bradlow) directly.


Oxford Career Development Unit
The CDU is dedicated to helping doctors and dentists across the Oxford Deanery fulfil
their career potential. They work with eligible trainees to help them get to where they
want to be.
One of the CDU team will meet you if you're wondering about your career direction, if
you've hit a rough patch, or need help preparing for the next stage. This coaching
support is free to trainees. You might want to self-refer to the CDU or this may be
agreed or recommended by the CMT PD after identifying specific training problems.
Those entitled to use the services of the CDU are:
Any doctor or dentist, whether in training or not, currently working in an
organisation that is providing services to the NHS under a contract with an
NHS body located within the Oxford Deanery area and irrespective of where
they live. Length of employment can be as little as a day so long as they are
employed in the Deanery area
More information at http://www.oxforddeanerycdu.org.uk/

10. Feedback on posts and educational process

You will be asked to kindly complete as mandatory:
Annual GMC survey - you should upload your receipt onto the E-portfolio
Written trainee feedback form on each post completed requested at time of ARCP
Trainee feedback on educational supervisor and educational process completed -
requested at time of ARCP



11. Re CT2 acting up as ST3

CT2s may not act up as a ST3



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12. Time Out of Programme (OOP) during Core Training

Out of programme for research, approved clinical training or a career break
(OOPR/OOPT/OOPC)

All out of programme experience is at the discretion of the programme director and head
of school of medicine

The GMC and the Deanery discourage this in all but exceptional cases (eg a once in a
lifetime opportunity). Trainees need to get the permission of the Deanery at an early
stage in planning; the relevant forms need to be completed early. There should be no
direct approaches to the JRCPTB. The Deanery is the relevant authority in deciding
whether or not to grant OOP


13. ST3 progression

CMT training provides the basis for starting training in opther specialties including Higher
Specialty Training (HST). ST3 appointments for post-August 2009 appointed trainees are
not run-through and are made through primarily national recruitment programmes, usually
in the spring. Preparation for HST applications should be dicussed with your ES/CS and
TPD if necessary. Full attainment of MRCP is a requirement for both completion of CMT
training and for take up of an ST3 post in most specialties.

You may not take up a ST3 post without an outcome 1 in your 23 month ARCP


14. Acknowledgement

Please acknowledge that you have received and understood the training requirements
laid down in this guide - Please send email acknowledgement as above to Dr Chris
Davies, CMT Programme Director within 4 weeks of receiving this guide to
chris.davies@royalberkshire.nhs.uk


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Appendix A : An example of some Level 1 acute medicine Competencies Record half-way
through CMT training
Emergency Presentations
Cardio-respiratory arrest
Supervisor Rating: Some Experience, 01/04/2008 (by .)
Supervisor Comment: has been on acls course and has attended several arrests when on
call for acute medicine and for ward cover as part of the crash team. Completed DOPS
10/3/08. In addition has a written potfolio of evidence which I have reviewed which
supports previous signed off experience by her clinical supervisior Dr H Clifford.
Trainee Rating: Level 1 Competent, 22/03/2008
Trainee Comment: DOPS 10/3/8, ALS
Evidence:
ACAT (12/11/2008 15:00:55)
ACAT (16/08/2008 21:31:54)
Attendance at organised teaching (02/10/2008 16:13:28)
CbD_11-07.doc
ALS
Shock
Supervisor Rating: Level 1 Competent, 01/04/2008 (by )
Supervisor Comment: Has assessed and managed hypovolaemic, septicaemic and
cardiogenic shock during emergency on calls and on wards, including cases on HDU,
occasionally with CVP monitoring. No ICU experience with inotropes etc. I have supervised
her management of such patients on more than one occasion and she has demonstrated
competence
Trainee Rating: Level 1 Competent, 18/10/2008
Trainee Comment: Seen a wide variety of patients who have been shocked therefore
experienced in the management of the different causes of this. Able to elucidate the main
causes of shock, institute appropriate immediate resuscitation and involve other
specialists ie ITU as needed.
Evidence:
ACAT (12/11/2008 15:00:55)
Attendance at organised teaching (18/11/2008 13:50:47)
ACAT (09/10/2008 14:22:06)
Unconscious patient
Supervisor Rating: Some Experience, 01/04/2008 (by)
Supervisor Comment: Both on call in CDU and during all attachments, has been exposed
to patients with coma and precoma of varying causes, including stroke, metabolic
disturbance, organ failure, space occupying lesion, post ictal state, subdural haematoma,
opiate toxicity, hypoglycaemia. Able to stabilise and resusscitate then reassess for
underlying cause and request appropriate invesgiations. Has also discussed unconscious
patients with worried families and completed mini CEX
Trainee Rating: Level 1 Competent, 22/03/2008
Trainee Comment: Demonstration of competence through clinical experience in the acute
setting across a range of medical specialties. Validation of knowledge and clinical skills
through ward-based assessments and formally through MRCP examination(s). Been part
of and led arrest teams during CMT rotations, most notably during AGM at John Radcliffe
Hospital (ST1) and Chest (ST1) and Renal Medicine (ST2) at Churchill Hospital. Experience
in airway management during AICU & Anaesthetics (FY2), AGM and Chest Medicine (ST1).
Attendance at ALS training (July 2005 - recertifying in 2009), ALERT and BASIC courses.

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Attendance at relevant organised teaching sessions (see Reflective Practice)
Evidence: MiniCEX (17/10/2008 17:29:37)
ACAT (12/11/2008 15:00:55)
ACAT (11/11/2008 10:12:50)
ACAT (19/10/2008 15:19:23)
miniCEX_3-08.doc





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APPENDIX B

Top Tips Making Workplace Based Assessments work for you and
your trainees

1 Be clear about, and agree, what you and the trainee want to achieve from the WPBA at the
start:

CBD (case-based discussion) uses a case to explore the trainees application of knowledge,
clinical reasoning and decision making including the ethical and professional aspects of the
patients care. CBD is not just a discussion about an interesting case.

ACAT (Acute care assessment tool) is preferably used on an observed take (but may be on a
ward round) assessing clinical assessment & management, decision making, team working,
time management, record keeping and handover.

MiniCEX (clinical evaluation exercise) is an observed trainee/patient interaction designed to
assess clinical skills, attitudes and behaviour of the trainee.

DOPS (Direct observation of procedural skills) is assessing competency in a procedure; DOPS
assessors need to be competent in the procedural skill that is being assessed.

MSF (multi-source feedback) provides a sample of attitudes and opinions of colleagues
(medical, nursing, AHP & clerical) on the clinical performance and professional behaviour of
the trainee; the request to do this WPBA will usually come as an email request from the
trainee.

2 Make it a positive learning experience this is what it is all about and what trainees value the
most.

3 Do the assessment real-time and face-to-face this makes it as close to a real situation in
which the trainee works as possible.

4 Make time to do this expect this to take 10-15 minutes of your time.


5 Do give constructive verbal feedback - face to face immediately after the assessment is
completed enhances the process and encourages immediate trainee reflection.

6 Complete the necessary form on the ePortfolio at the time of the assessment with a
description of the case(s) and written feedback in the white space it is easy to forget very
quickly what was agreed.

7 Do give specific and detailed feedback which outlines development needs, identifies strengths
and weaknesses, with an agreed action plan to guide future learning; this also enables
meaningful linkage of the WPBA by the trainee to appropriate curriculum competencies.

8 Use the anchor statements to guide your judgement on rating the trainee performance.


9 Expect to be asked to do WPBAs - all training doctors require completion of these on a regular
basis throughout their training programmes.

10 It is entirely acceptable for you to trigger a WPBA with a trainee.


11 Once you agree to do a WPBA, then commit to the whole process it is unfair to do it in part,
promise you will do it and never do.

12 If you have not had the training, do not do an assessment; ask your local PGMC, college tutor
or deanery for courses.


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Recommendations for best practice when using WPBAs to provide
supportive evidence in the ePortfolio

1 WPBAs not linked to more than 6 curriculum competencies.


2 WPBAs done proportionately throughout training and not last minute before ARCP.


3 A minimum of 5 cases for an ACAT assessment.


4 WPBA requirements outlined in the ARCP decision aid are the minimum requirement for those
assessed by a consultant; more will inevitably be needed to help provide evidence of
competency.

5 WPBAs assessed by medical staff assessors at least one grade above those they are assessing;
an assessor may be non-medical provided they are competent in the field they are assessing.

6 2 or more pieces of evidence provided for each of the competencies - this may include WPBAs
/ trainee reflection / other evidence e.g. a certificate depending on the competency. A single
assessment is not sufficient evidence of competence in its own right but provides some
evidence towards the demonstration that competence has been achieved.