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CORE MEDICAL TRAINING – A GUIDE FOR TRAINEES

Drs Marie Freel, James Boyle and David Wilkin

Co-Training Programme Directors, West of Scotland

Introduction Welcome to CMT in West of Scotland!

Your two year programme has been designed to give you relevant experience in a broad range as well as depth of medical training in preparation for future Higher Specialty Training (ST3+) in your chosen specialty. We have designed your rotation to meet CMT Quality Criteria, including (where possible) contributing to the acute medical take in during the majority of your placements, a placement in Geriatric Medicine and exposure to both central Teaching Hospitals and District General Hospitals.

The rules and regulations of what you need to achieve during Core Medical Training are outlined in detail at http://www.jrcptb.org.uk/specialties/core-medical-training-and-acute-care-common-stem-medicine

This document provides a local guide to how you can get the best out of your time with us, and successfully pass the programme. We hope you enjoy your training programme and look forward to meeting you all in due course.

Important contact details:

Dr Stephen Glen Associate PG Dean for CMT: Stephen.glen@nhs.net

Ms Susan Nicol Depute Training Program Manager (NES): Susan.Nicol@nes.scot.nhs.uk

Dr Marie Freel TPD (West Consortium: Marie.Freel@glasgow.ac.uk

Dr James Boyle TPD (North Consortium): James.Boyle@glasgow.ac.uk

Dr David Wilkin TPD (South Consortium): davidwilkin@nhs.net

Mr Stuart Brown Study Leave Officer: stuart.brown@nes.scot.nhs.uk

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Minimum requirements for successful CT1 ARCP, at a glance

We suggest that you use the below pre-ARCP. Further details are in this guide.

o Satisfactory completed Educational Supervisor report for every post □

o At least 4 Multiple Consultant Reports (MCR) by different consultants □

o Part 1 MRCP □

o Valid ALS certificate □ o One completed MSF cycle, with at least 12 contributors of which at least 3

must be consultants □

o 10 consultant SLEs, of which at least 4 must be ACATs □ o Evidence uploaded to demonstrate proportionate progression towards

CT2 clinic requirements (i.e. 40 clinics in two years – min 17 in CT1) □ o One completed Quality Improvement Project, evidence uploaded

including completed Quality Improvement Project Tool (QIPAT) □ o “Common Competencies” signed by ES as CT1 level complete, with

evidence attached and signed off for at least 5 competencies □ o “Emergency Presentations” signed by ES as CMT level achieved, with

evidence recorded & individually signed off for all four competencies □ o “Top Presentations” signed by ES as CT1 level complete, with evidence

attached and signed off for at least 11 presentations □ o “Other Important Presentations” signed by ES as CT1 level complete, with

evidence attached and signed off for at least 15 presentations □ o Skills lab training or satisfactory supervised practice for all “essential CMT procedures (part A)”, evidenced and confirmed by ES □

o Satisfactory teaching attendance record (75% of training days or equiv) □ o SOAR Declarations (health, probity and complaints/critical incidents

statements) submitted online □

o Absence Declaration submitted to Deanery / copy in Personal Library □

o Evidence of participation in GMC National Training Survey □

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Minimum requirements for successful CT2 ARCP, at a glance

o Satisfactory completed Educational Supervisor report for every post □ o > 4 Multiple Consultant Reports (MCR) by different consultants in

each of CT1 and CT2 □

o Successful completion of full MRCP (Part 1, Part 2 and PACES) □

o Valid ALS certificate □ o One completed MSF cycle (in each of CT1 and CT2), with at least 12

contributors of which at least 3 must be consultants □

o 10 consultant SLEs (in each of CT1+CT2), of which > 4 must be ACATs □ o Acceptable performance in at least 40 outpatient clinics across CMT,

evidence uploaded □ o One completed Quality Improvement Project, evidenced by Quality

Improvement Project Tool (QIPAT), in each of CT1 and CT2 □ o “Common Competencies” signed by ES at CMT level complete, with

evidence attached and signed off for at least 10 competencies □ o “Emergency Presentations” signed off by ES as CMT level achieved, with

evidence recorded & individually signed off for all 4 competencies □ o “Top Presentations” signed by ES as CT2 level complete, with evidence

attached and signed off for all presentations □ o “Other Important Presentations” signed by ES as CT2 level complete, with

evidence attached and signed off for at least 30 presentations □ o Clinical independence achieved for all “essential CMT procedures (part A)” (see note in the formal ARCP Decision Aid regarding pleural

aspiration), confirmed by ES □ o Skills lab training or satisfactory clinical supervision for all “essential CMT procedures (part B)”, confirmed by ES □

o Satisfactory teaching attendance record (>75% training days or equiv) □ o SOAR Declarations (health, probity and complaints/critical incidents

statements) submitted online □

o Absence Declaration submitted to Deanery / copy in Personal Library □

o Evidence of participation in GMC National Training Survey □

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ePortfolio

Throughout your training you must populate your ePortfolio with evidence of training and learning, such as Supervised Learning Events (SLEs) and other workplace based assessments (WPBA), Reflective practice, and a summary of clinical activity and teaching attendance. Evidence of teaching attended (certificates) and clinics/procedures (logbooks) should be uploaded to your ePortfolio personal library. In the ARCP folder please also upload your annual Absence Declaration (this is not the same as SOAR – the Deanery will email you a blank form before your ARCP)and evidence of participation in the annual GMC National Training Survey (they will supply you with a completion code that you can use for this purpose).

You should actively seek feedback following SLEs, formulating action plans and agreeing follow up with your assessors. Evidence of such learning events need completed regularly throughout the year, rather than a last minute cluster – your Educational Supervisors will need evidence of these to complete each appraisal (at the end of each post). You should try to approach a range of assessors to ensure breadth of opinion/feedback. Please ensure that you upload a photo to ePortfolio within the first four weeks of CMT – this will help recipients of SLE tickets (the system used to request assessment form completion from colleagues) ensure they are responding to the correct trainees, and often encourages better, and more thorough/relevant, feedback. Further information is available at http://www.jrcptb.org.uk/assessment.

Opportunities to complete SLEs should be sought proactively, and you should ask consultants in advance i.e. commit to doing an SLE before the event, rather than after discussing or reviewing a case. Try to avoid the last couple of weeks before the ARCP deadline – consultants are often flooded with ePortfolio requests around this time and may be less amenable, and you should be aiming to collect SLEs at regular intervals to show consistent engagement with learning rather than a last minute flurry!

All ARCP evidence must be submitted by 10 working days before your ARCP – any evidence submitted after this time cannot be counted at ARCP. This is to allow the ARCP Panel sufficient time to review every trainees’ ePortfolio in sufficient depth to do it justice!

In terms of minimum annual Workplace Based Assessment / SLE requirements, you should seek to complete:

- At least 2 Multiple Consultant Reports (MCRs) per attachment.

- At least 10 consultant SLEs per year, the latter of which must include at least 4 ACATs (Acute Care Assessment Tool). ACATs are designed to be used on the acute medical take (but may be on a ward round or covering a day's management of admissions and ward work), and look at clinical assessment and management, decision making, team working, time management, record keeping and handover for the whole time period and multiple patients. There must be a minimum of 5 cases for a single ACAT assessment. Whilst SLEs can be completed by any healthcare professional of any grade to support your learning, ONLY SLEs completed by a Consultant count towards your ARCP number requirements, so take care when adding these up to ensure ARCP requirements are met!

- A Multi Source Feedback (MSF) cycle, which, to be valid, must include a minimum of 12 raters including > 3 consultants and a mixture of other medical and non-medical staff.

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ePortfolio evidence should be linked to curriculum competencies to show engagement and learning with the CMT curriculum. In general we would encourage you to link at least two or three items per competency, with at least one of these being “hard evidence” from an SLE (rather than evidence subsisting only of teaching attended, for example). SLE linkages should be limited to 8 competencies for ACATs and 2 each for mini-CEX and CbD. This means you should aim to gather a LOT of SLEs throughout the year – whilst 10 consultant ones are required annually, you can ask any other appropriate colleagues to complete other SLEs to link to competencies and build an evidence base (ACATs in particular provide a lot of bang for your buck – ask your Reg or Con to let you lead a ward round under supervision wherever possible, as that may be worth 8 competencies!). Your PDP cannot be linked as evidence (it is evidence of intent to learn, not learning achieved), and reflection, teaching etc. can be included here but are not sufficient if provided as a sole item of evidence.

Once you have linked sufficient evidence to a competency, you should assign a self-rating for this (using the drop-down box) with comments and evidence to support the reasons you believe you have achieved the level required (with options for different levels in the drop-down menu, such as completion of CMT1 or CMT2). We recommend you ask your ES to sign this competency off as “achieved” as early as possible to save a last minute pre-ARCP flurry (which not infrequently results in an Outcome 5).

You should regularly refer to the ARCP Decision Aid for the minimum requirements for satisfactory outcome to make sure you’re on track.

Important requirements in eportfolio

The key targets are outlined very clearly in the ARCP Decision Aid. However, there are a few other requirements that may be less clear and are highlighted below:

Emergency presentations:

All evidence (2 pieces per competency; can include ALS, TACTICS, IMPACT courses) needs to be evaluated and signed off individually by your Educational Supervisor (ES) by the end of CMT1. As it is unlikely that you will see a case of anaphylaxis upon which you could base an assessment, it is acceptable discuss the approach to and management of the patient with anaphylaxis and use this discussion as the basis for a CbD.

Sampling:

In terms of the Top Presentations and Other Important Presentations, your ES will not examine all competencies, but will sample the evidence you provide to determine progress, as per the Decision Aid. This usually requires an in-depth evaluation of the evidence provided (eg SLE etc) for around 10% of the competencies listed to check they are relevant and sufficient. Your Supervisor can then give an overall rating for a group of competencies (e.g. common competencies) to confirm that you have met the curriculum requirements (signed off as CT1 or CT2 level achieved as appropriate).

Educational supervisor report:

While you should meet regularly with your ES, you are required to provide an ES report for ARCP that spans the majority of the training year. This report also needs to be dated to finish at the end of the training year. You therefore must arrange to meet with your ES in plenty of time before the ARCP submission guideline in order for this to be done as well as ensure all relevant competencies in your curriculum are signed off.

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Absence Forms/SOAR sign off

It is a mandatory requirement for your ARCP Review to complete your Self Declaration and have it signed off by your Educational Supervisor on the SOAR database. Information and guidance about this can be found at http://seccare.appraisal.nes.scot.nhs.uk.

You must also complete the Deanery absence form (this will be posted to your prior to ARCP) and return it to NES prior to the pre-specified deadline.

Failure to submit these declarations was a very common reason for trainees being given an unsatisfactory outcome in ARCP which is extremely frustrating and time consuming for all involved.

ePortfolio Personal Library

The Personal Library comes pre-populated with a number of suggested folders in which you can store evidence important to your own professional development and to the ARCP process.

We strongly encourage you to use these folders to ensure that this section remains easily navigable – please do not create a new “CMT” folder and list large numbers of documents there, as it quickly becomes unwieldy and important documents can be difficult to find. The pre-populated folders are designed to match the ARCP Decision Aid and make it easy for the ARCP panel to negotiate and find all the evidence required.

Files should be stored in easily accessible formats that aren’t particular to an unusual type of software of the latest iPhone – as your TPDs need to be able to access it too! We recommend you stick to PDF, Word, PowerPoint or Excel files.

Documents need to be clearly named so that the ARCP Panel can easily identify relevant files e.g. “TACTICS1 certificate”, “CT2 QIP report”. Thank you letters etc. can be included but if from patients/relatives please make sure they’re fully anonymised.

Your clinic logbook belongs in this section. If you choose to create individual documents for clinics in different specialty/attachments, please also create one summary document for the ARCP Panel – we simply don’t have time to tally up clinics across multiple documents. The logbook should include a brief summary (one line is fine) of cases seen.

As a Consultant you will still have to use an ePortfolio, called SOAR, to store evidence under different domains. It is very similar to the ePortfolio Personal Library!

Practical Procedures

Procedural competencies are classified as “Essential (A) – clinical independence essential”, “Essential (B) – clinical independence desirable”, and “Desirable”.

Essential (A) procedures are advanced CPR (may include external pacing)R, ascitic tapR, lumbar punctureR, NG tube placement/checkingR, and pleural aspirationPLT for

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pneumothorax or pleural fluid (with support for ultrasound guidance being provided by another trained professional). By the end of CT1 you should have evidence of completed skills labs training or satisfactory supervised practice in all, and by the end of CT2 you should be signed off as clinically independent.

Essential (B) procedures are central venous cannulationPLT (with support for ultrasound guidance being provided by another trained professional), intercostal chest drain insertionPLT for pneumothorax or pleural fluid (with support for ultrasound guidance being provided by another trained professional) and DC cardioversionR.

You are advised to consider early on into your attachment how you will achieve procedural competencies. We strongly recommend signing up to the advertised Clinical Skills day specifically targeting CMTs for skills lab training in common procedures, and also the Mastery Programme (more on this later), both of which will help you attain these competencies. A valid ALS certificate must be uploaded to your ePortfolio (you must hold a valid ALS certificate throughout training) and can be used as evidence of advanced CPR skills. Some hospitals within the region run their own practical procedures training. RCPSG run a course for Procedural Skills covering a range of simulated procedures. Otherwise you will need to be opportunistic in seeking changes to develop and maintain competency in such practical procedures on the job. This may include use of study leave to attend procedural lists.

Before ARCP at the end of each year you should ensure that your ES signs off both Essential A and Essential B procedures with a group competency rating.

You may wish to remind your ES that, as per the Decision Aid, completion of skills lab practice may suffice for some competencies. These group signs offs supplement, but do not replace, individual procedural competency sign off.

You should aim to undertake DOPS (Directly Observed Procedural Skills) for each procedure, with a formative DOPS (assessment for learning) undertaken before a summative DOPS (assessment of learning). Formative DOPS can be completed as many times as needed. Summative DOPS sign off for routine procedures (marked R above) only need undertaken once, on one occasion with one assessor. Summative DOPS sign off for potentially life threatening procedures (marked PLT above) should be undertaken on at least two occasions with two different assessors (one assessor per occasion) if clinical independence is required.

Reflective Practice

Reflection upon and for learning is a fundamental part of ongoing professional development, and portfolio evidence of regular reflection is expected of consultants as well as trainees. Focussed reflection in your ePortfolio will help you identify your ongoing learning needs in day-to-day practice.

R-cards are simply designed to help teach you the discipline of doing this real-time in your practice in a structured, focused and productive way. These can be downloaded from the JRCPTB website along with instructions and guidance on how to use both tools. You can then use what you capture on the R-card to enable further reflection on your learning. The After-event reflective form is a tool developed by the Institute of Reflective Practice and is available in the Reflective Practice section of ePortfolio. Note you are

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not obliged to use these forms but are strongly encouraged to demonstrate some form of reflective practice on ePortfolio.

Reflection upon learning can be used as linked evidence demonstrating acquisition of curriculum competencies (but cannot be the sole evidence used to demonstrate achievement of a competency i.e. would need accompanying evidence with a workplace-based assessment, for example).

We understand that everyone has anxieties regarding written reflection following the high profile Bawa-Garba case. The Academy of Medical Royal Colleges has produced some guidance in direct response to this, which we have included in this pack as Appendix 3.

Quality Improvement

Quality Improvement, rather than audit, is now considered a core competence, and you are required to complete at least one Quality Improvement Project (QIP) in CT1 and another one in CT2. The national project for this is called Learning To Make a Difference (LTMD), which provides the framework and tools to enhance training of CMTs in QI methodology and enables learning, developing and embedding of new skills in QI and the translation of these into clinical practice to make a real difference to the quality of your clinical practice and patient care. Other projects, including via the Scottish Patient Safety Programme (SPSP), are also available.

We believe that training in QI is important because it is often trainees that see opportunities for improvement in the systems in which they work. QI uses systematic methodology – if it’s not working, move on and test again! It involves small tests of change that can lead to big results, improving patient safety, and complements audit – rather than just data collection, as audit often is, it allows you to put recommendations into place and test the change.

In terms of meeting ARCP requirements, if you are considering doing an audit i.e. against a known standard, you must aim to do this as a proper QIP. Ideally you should complete a QIP within a 4 or 6 month post (although can decide to do a project over an entire year if feasible), with support from your Educational or Clinical Supervisor. You may work on your own, although we would encourage you to work as a group and/or involve the multi-disciplinary team. Once you decide on a project you may wish to follow the guidelines outlined in the “trainee tool kit” at the LTMD website at https://www.rcplondon.ac.uk/projects/learning-make-difference-ltmd. You can document your project plan on ePortfolio to help the planning and process stages.

As evidence of completed QIP each year, you must have a completed Quality Improvement Project Tool (QIPAT) on ePortfolio.

You are welcome to participate in national audits (e.g. local data collection against national standards for large scale projects) and also undertake local audit that doesn’t follow QI methodology, but neither of these can be counted towards ARCP QI requirements i.e. you must complete a project using QI methodology. Similarly, taking part in one limb of a project, without either designing the project or making changes after collecting data, is not sufficient to count as completion of QIP for your ARCP. We

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will not accept an audit as evidence in this ARCP domain – please undertake a QIP, and upload it titled QIP (do not label it as audit if you want it to count!).

The LTMD website contains trainee and supervisor resource packs, presentations from peers, guidance as to how to get started, and templates to use. You can also register your QIP on this site – with your experience helping other trainees learn and vice versa.

To give you some ideas, examples of successful QIPs taken by recent CMTs include: testing reminder phone calls to reduce DNA rate at clinics; implementation of 4AT as a screening tool; use of novel apps such as Dr Toolbox; reducing inappropriate echo requesting; improving staff recognition of doctor training grades via colour coded name badges; improving consent for procedures via educational sessions; improving CMT attendance at clinics by optimising rotas; electronic notification of deaths to GPs; improving FY1 management of hypoglycaemia; improving handover; developing specialty info support aids for on-call doctors

We note that you are not obliged to use LTMD and can thus choose to use SPSP or other QIP methodology - generally any is acceptable as long as you can provide evidence of completing QIP rather than traditional audit. You can still register these projects with LTMD and would be eligible for the national QI meeting (publicised annually). Participation in national audits doing data collection etc., whilst a helpful experience, does not count towards this.

Evidence of participation in QIP must be uploaded to your ePortfolio in advance of your ARCP for us to be able to tick off this requirement – there are QIP plans and report forms, and QIPAT (assessment tool) available on ePortfolio to facilitate this, and you can also upload a QIP report to your personal library. Failure to upload evidence will be marked as failure to complete a QIP, and thus failing to meet annual requirements.

The four Scottish CMT regions hold a combined QI Conference each Spring, which is a bespoke opportunity to allow out CMTs to network and share learning, including presentation of your work via short oral/powerpoint presentations and posters. The event is fully sponsored i.e. free to attend, counts as a full day of teaching/CME, and if your poster/presentation is selected (competitive entry) for presentation then you can count this as a presentation/poster at a national meeting. This is therefore a super opportunity, including for scoring points for ST3 applications, and we strongly encourage you to arrange study leave for this as early as possible – date to follow asap.

Outpatient clinics

ARCP requirements dictate that you need to participate in a minimum of 40 outpatient clinics over the 2 year programme; from ST3 onwards you will be expected to participate in even more, reflective of the increasing emphasis on chronic disease management. You should aim to keep an anonymised logbook of patients seen, to enable reflection upon learning.

The definition and objectives of CMT clinics that we have agreed is: * To understand the management of chronic diseases * Be able to assess a patient in a defined time-frame * To interpret and act on the referral letter to clinic

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* To propose an investigation and management plan in a setting different from the acute medical situation * To review and amend existing investigation plans * To write an acceptable letter back to the referrer * To communicate with the patient and, where necessary, relatives and other health care professionals.

These objectives can be achieved in a variety of settings and trainees should seek to attend clinics in a variety of specialities and settings including less traditional clinic models such as Day Hospital or Ambulatory Medicine (providing these above criteria are met). Ward attenders, procedural lists (e.g. endoscopy) and haemodialysis reviews do not count. Trainees should see a range of new and follow-up patients, and should at least some patients on their own but all patients should be reviewed/discussed with a consultant. Clinic letters written by the trainee should also be reviewed and feedback given. The number of patients that a trainee should see in each clinic is not defined, and neither is the time that should be spent in clinic, but as a guide this should be > 2h. Note that single clinics lasting longer than two hours cannot be double-counted i.e. you cannot participate in a 1pm-5pm clinic and count this, for logbook purposes, as two separate clinics!

You will need to be proactive about arranging to participate in clinics, as not all posts will routinely schedule these for you. We strongly suggest that you meet with your ES early into each post to discuss how you will achieve your required clinic numbers. In posts with few clinics available, you may wish to arrange attendance at an alternative specialty clinic and ask your parent specialty to help support you by releasing you to attend these, either as a scheduled session if rotas will allow or as unfunded study leave.

To demonstrate clinic attendance, you should upload a logbook of numbers (forms available at https://www.jrcptb.org.uk/faqs/cmt-trainee-how-can-i-record-my-procedures-and-clinic-attendance) to your ePortfolio personal library. As a bare minimum this should include date, specialty, and number/type of cases seen. Ideally you should expand this to include anonymised details of cases seen, to enable reflection – this can be linked to curriculum competencies as evidence of experience and learning.

Important national guidance about doctors in training and clinical supervision at out-patient clinics is available at https://www.copmed.org.uk/images/docs/Drs_in_training_and_clinical_supervision_at_out-patient_clinics.pdf.

Educational Supervision

For every post you rotate through you will be assigned an Educational Supervisor (ES) who should remain in this role for the entire year. In general, your ES will also be your clinical supervisor (CS) for the first block. There are a few exceptions to this; for example trainees who start in Dumfries and Galloway Royal Infirmary will switch ES from block 2 onwards. Since July 2016 the GMC expects all ES to be trained, recognised and appraised for this role.

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At the beginning of each 4 month post, even if you are staying on in the same unit for two consecutive blocks, you should arrange an “Induction Appraisal” early on into your post, meeting with your ES to set educational objectives for the placement and to create your Personal Development Plan (PDP). Both should be documented in your ePortfolio, with all Appraisal forms and PDP being available under the “Appraisal” ePortfolio tab.

Towards the middle of your post you should arrange to meet with your ES or CSto discuss progress thus far, review your ePortfolio evidence of progression, and amend your PDP if appropriate. This should be recorded as a “Mid-point Review” in the Appraisal section of ePortfolio. The onus is upon trainees, rather than the ES, to arrange all meetings.

Towards the end of every 4 or 6 month attachment you must arrange a final review with your ES or CSto review your PDP and curriculum progress, and record any areas of development required, recording this in the “End of Attachment (EoA) Appraisal” form.

You should also ensure that your ES completes an Educational Supervisor’s Report at the end of every post – this is available under the “Progression – Summary Overview” tab on ePortfolio and is NOT the EoA Appraisal form.

The ES Report is pivotal to the ARCP process and includes a summary of multiple consultant reports (MCRs), multi-source feedback (MSF), summary of clinical skills and procedures, and the outcome of sampling of curriculum competencies. The ES Report must be signed off (not saved in draft – a common pitfall!) to be visible to the ARCP panel, and is so essential to the ARCP process that failure to provide an ES Report for every post will result in an unsatisfactory ARCP outcome. We will not accept an End of Attachment Appraisal in place of an ES Report as the latter is more detailed. Whilst your Educational Supervisor should be aware of these expectations, it is your responsibility to arrange the above meetings with them. You should inform us as early as possible if you are having difficulty meeting with your ES and we will do our best to help.

Study Leave

Contrary to popular belief, trainees are not allocated a ring-fenced individual study leave budget, but rather the entire pool of CMTs is allocated an overall budget. Our aim is to use this in a fair, equitable and transparent manner. Trainees are thus allocated a National Annual Allowance, currently around £500 per trainee per year, plus 30 days study leave per year. These should primarily be used to attain core CMT competencies e.g CMT Training Days, Symposia, TACTICS, Mastery Programme etc. £100 from the budget is taken at source to cover TACTICS and CoMEP for the year.

We will also consider specialty meetings, for example to present a poster to demonstrate commitment to the specialty you plan to later apply for. If in doubt, ask us before booking so you don’t end up out of pocket!

Only one or two specialty courses may be supported after MRCP i.e. after successful completed summative assessment of CMT knowledge. The rationale for this is that only after you have acquired CMT competencies should you be focusing on developing specialty (ST3+) skills and competencies.

If you have sufficient funding remaining after courses such as the above, we will consider part-funding exam preparation courses. This includes up to £500 towards PACES

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preparation courses, but you must bear in mind that any funding towards this is taken from your overall allowance over the two year programme and may leave you short of funds for other opportunities – you have responsibility for managing your own allowance accordingly.

You are also expected to submit Turas study leave requests for events that do not require funding such as CMT Training Days, private study for exams, study leave for clinic attendance (the latter being a creative solution if you struggle to achieve required clinic numbers during the course of your rota).

It is essential that you have approval by your rota master or equivalent before submitting your study leave request to us, and all requests should be submitted to us at least 4 weeks in advance. We may reject requests where sufficient notice is not given. Retrospective claims for support with fees cannot be approved. If in doubt as to whether your leave will be supported, please do drop us a line – we are always happy to discuss before you commit to a course fee!

Applications for study leave are made online using the TURAS database. Further information is available at http://www.scotlanddeanery.nhs.scot/trainee-information/study-leave/. No paper study leave request forms can be accepted.

Following attendance at a pre-approved course or event for which you wish to claim financial support, you must make a claim within 3 months. Keep all receipts! You should submit your claim to Stuart Brown at the NHS Education for Scotland finance department (Ground Floor, 2 Central Quay, 89 Hydepark Street, Glasgow, G3 8BW) within 3 months of the study leave event. If you have queries about your expenses claim you can contact him at Stuart.Brown@nes.scot.nhs.uk.

In some instances the costs approved in advance may have been estimates – the maximum amount you can claim is noted by the approving TPD in Turas, and you should submit exact costs/details after the event. Claims must be accompanied by receipts / tickets / bank or credit card statements for fees, accommodation, meals and travel costs. Proof of attendance at the course will also be required.

If a course or event you have booked study leave for is cancelled, please let us know ASAP so that your study leave record can be amended – failure to do so may affect future applications. If you have any questions about your study leave application, please contact Stuart.Brown@nes.scot.nhs.uk.

Teaching and training days

CoMEP is the Core Medical Education Programme which holds a series of half-day lectures and tutorials on topics mapped to the CMT curriculum. Full details of dates (held every month approximately) and venues (usually NES, Glasgow) are on the CoMEP website (www.comep.co.uk) or twitter feed (@CoreMedicine). All sessions will be filmed and posted on the CoMEP website. It is expected that trainees attend 70% of sessions; the remaining 30% can be made up from online teaching. We expect VC to be available for all sessions depending on the local hospital VC

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capabilities if you are unable to leave your clinical site. Funding for this programme (approximately £100 per trainee) is automatically allocated from your study leave budget. RCPSG and RCPE also host a number of educational events and symposia (including IMAPCT courses) which are relevant to CMT trainees. Details are available from the relevant websites. We require that you attend a minimum of 70% of training days to be successfully signed off as having satisfactory teaching attendance each year. If you cannot attend enough of the above training days to achieve this, for example because of rota or leave commitments, there are plenty of other opportunities provided as part of your CMT teaching package that allow you to make up the difference, as detailed below – please remember that we do not automatically receive a record of your attendance at any other events, so for these to be counted towards your ARCP requirements you should ensure you upload attendance certificates to your Personal Library on ePortfolio. If this evidence is not visible to your TPDs we can’t sign you off as having attended!

RCPSG run a Procedural Skills for Core Medical Trainees course which provides hands-on experience with core procedures and one-to-one guidance from experienced trainers covering central line insertion, LP, knee aspiration, NG tube insertion, basic tracheostomy care, NIV and chest drains. This is a popular course, providing excellent value for money at £20, and books out early. Book via the RCPSG website – upcoming dates include 8th Oct 2018, 22nd Oct 2018, 14th Mar 2019, 26th Mar 2019.

Simulation training is available at the Scottish Centre for Simulation and Clinical Human Factors (SCSCHF) in Larbert, Falkirk. We would strongly encourage all CMTs to sign up for TACTICS (Team Activities for Core Trainees in Clinical Simulation)– small, bespoke courses for small groups, based on the CMT curriculum, covering emergency presentations such as cardiorespiratory arrest as well as more common presentations such as breathlessness, as well as the “human factors” involved in acute medicine. The sequel, TACTICS2, is available for CT2s, and an HDU workshop is in development.

During TACTICS you lead a team in diagnosing and managing the patient, a high-fidelity simulated mannequin, as well as performing practical procedures such as external pacing. The course facilitators will also gladly complete a mini-CEX for your ePortfolio! See http://scschf.org/courses/tactics for information and booking – the course represents excellent value for money at £150 (£100 paid by the Deanery, £50 by the trainee and can be claimed back from the study leave budget) and again we will guarantee to support this study leave funding request providing you have not exceeded your annual allowance.

IMPACT (Ill Medical Patients’ Acute Care & Treatment) is hosted at RCPSG and is a 2 day course introducing the principles and practice of acute medical care, including lectures and practical procedural skills. This is booked directly via the RCPSG website with upcoming courses scheduled for 17th Sep 2018, 11th Dec 2018 and 10th June 2019.

Examinations

Successful acquisition of full MRCP is required for successful completion of CMT; this is the knowledge-based summative assessment of Core Medical Training. The exam comprises three parts - Part 1, Part 2 Written, and Part 2 Clinical (PACES). More is available at

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https://www.mrcpuk.org/mrcpuk-examinations. These exams can take several attempts to get through and you are strongly advised to prepare to sit these as early on in CMT as possible to give yourselves sufficient time to complete them, as you cannot progress from CT1 to CT2 without completion of Part 1, and also cannot progress to Higher Specialty Training (ST3) at the end of CT2 without holding the full MRCP Diploma.

National study leave policy now permits use of study leave funding for examination preparation courses, so we are willing to sign off study leave requests for partially funded time if your local rota master / ES is agreeable (particularly for PACES courses). Full funding is not available as this would exceed your notional allowance, from which budget should also be reserved for other educational activities, but we are willing to negotiate funding support on a case by case basis. A PACES preparation course is held at the Edinburgh Clinical Skills and Assessment Centre (CSAC), jointly badged with RCPE and advertised via http://events.rcpe.ac.uk (cost approx. £800). The RCPE also hosts a series of free PACES Preparation evenings, also listed at http://events.rcpe.ac.uk – these are hosted by experienced PACES examiners and videos of these are available online via the RCPE Online Education Portal (alongside many other educational resources).

PACES examination – the king of OSCEs – requires particular preparation. You should meet with your ES well before attempting PACES to discuss and agree a plan for PACES training, and ideally meet again after the exam for a debrief.

ARCP

The Annual Review of Competence Progression (ARCP) is the formal method by which your progression through the training programme is monitored and recorded as described in the Gold Guide (see www.copmed.org.uk/publications/the-gold-guide).

This is held once per year, towards the end of the academic year (e.g. late May to early July), meaning that you must acquire a year’s worth of evidence by this point in order to be successfully signed off. Your TPDs will also hold a pre-ARCP meeting (Interim ARCP) earlier in the year (e.g. around April) which you will not be expected to attend; during this we review your ePortfolio progress against the ARCP Decision Aid criteria, which you should refer to throughout the year to ensure you are on track, and highlight any issues, allowing you time to rectify any deficiencies in time for your ARCP.

It is, however, your responsibility to ensure that you have collected sufficient evidence on your ePortfolio to ensure successful ARCP. A full year’s worth of evidence must be submitted by two weeks before your ARCP date – this is vitally important to allow your TPDs time to thoroughly assess your evidence, so late submissions cannot be accepted. The requirement for trainees to submit this evidence in the correct timeframe is considered one of professionalism and national policy is that failure to do so will result in an Outcome 5 (unsatisfactory outcome); exceptional circumstances will be accepted provided that they are identified prior to this 2 weeks deadline.

Remember, if it’s not uploaded then we have no evidence – so if you want us to recognise teaching and clinics, completion of QIP etc. you must upload evidence accordingly. This means advance planning by yourself with your Educational Supervisor to ensure that you have met all the necessary requirements for each year in advance of your ARCP. The JRCPTB provide a logbook that you can use to collect evidence of

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clinics and procedures, available to download at https://www.jrcptb.org.uk/faqs/cmt-trainee-how-can-i-record-my-procedures-and-clinic-attendance.

The ARCP Decision Aid (included at the end of this document as an Appendix) defines the targets that have to be achieved for a satisfactory ARCP outcome at the end of each training year for core medical training (CMT) and higher medical training specialties. The CMT Decision Aid is available online at http://www.jrcptb.org.uk/training-certification/arcp-decision-aids. You should check this regularly to ensure that you are making adequate progress towards this throughout your training. Where local expectations differ (acknowledging that the Decision Aid is a national document rather than tailored to your local programme) we will notify our trainees accordingly. You should re-read this guide, and carefully double-check the ARCP Decision Aid, before your ARCP (deadline for final submission is 2 weeks / 10 working days before your ARCP) to ensure you have met all requirements. We cannot stress enough that we will follow the ARCP Decision Aid precisely, to ensure consistency, fairness and transparency in our approach to assessment – so you need to follow it to the letter too, to ensure a positive ARCP outcome!

As well as the above, you must submit your annual Health and Probity declarations in advance of your ARCP via SOAR, the Scottish Online Appraisal Resource (www.appraisal.nes.scot.nhs.uk) – all declarations must be made via this site rather than ePortfolio, and will be signed off there by your TPD (one of whom will, for the purposes of declarations only, be listed on that site as your ES). The Deanery will arrange for you to have access to this in advance of your ARCPs – if you have not received this within 4 weeks in advance of your ARCP date you should let us know. Similarly you will be asked to submit an Absence Declaration form to the Deanery in advance of ARCP – all declarations re Health, Probity and Absence are considered essential aspects of professionalism and breaches of this, including failure to submit declarations, will be challenged as probity concerns. Thankfully they are all quick and easy to submit!

We also expect you to complete the annual GMC National Training Survey (NTS) as a matter of professionalism. The NTS gives you an opportunity to provide confidential feedback on your training that can be used to make improvements, as well as reward good practice in medical education. Your deaneries/LETBs and local education providers must use the survey results with other sources of information to review and improve their training programmes and posts, so we take the results very seriously. This is your best opportunity to effect change where required and it is therefore in everyone’s interests that you complete it by the deadline. The survey usually run around March/April and you will receive an email invitation. If you do not complete the NTS we will seek to discuss this further at your ARCP. You are also strongly encouraged to complete the Scottish Training Survey (STS) which takes a different perspective/focus from the NTS with more emphasis on individual units (rather than whole hospitals) within the rotation.

Akin to marking exam papers, the ARCP outcome is decided in your absence, although we intend to routinely invite all trainees to subsequently meet us to discuss the outcome and reflect upon their training and any outstanding needs, as we do recognise that not only are you likely to wish to discuss your outcome, but also that an annual review provides excellent opportunity for us to catch up and receive feedback from you about your training. We will therefore aim to meet with you face to face within 2 to 4 weeks of ARCPs wherever possible. If you are unavailable to attend in person we will try to offer

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telephone or videolink facilities, and hope to see or at least speak to you on the day! We note that, for trainees with an unsuccessful ARCP outcome, this meeting is mandatory.

The ARCP Panel has two objectives – to consider and approve the adequacy of the evidence and documentation you have provided, as per the ARCP Decision Aid, and, provided that adequate documentation has been presented, to make a judgment about your suitability to progress to the next stage of training (or to confirm that Core Medical Training has been satisfactorily completed). The Panel is composed of at least three members appointed by the Specialty Training Committee, of which one must either by your TPD or the Postgraduate Dean (or deputy). The other members may be College representatives, Educational Supervisors or Associate Deans. The Panel will also have input from a Lay Member (who scrutinises our governance) and an External trainer who reviews a random 10% of outcomes and the evidence supporting these and any associated recommendations from the Panel. The successful ARCP outcomes that you are aiming for are Outcome 1 (successful completion of CT1) or Outcome 6 (successful completion of CT2; CMT complete), the latter of which is required for progression to Higher Specialty Training i.e. ST3. If you have not uploaded all of the required evidence, or have yet to pass the required examinations, you may be issued with an Outcome 5 (incomplete evidence presented) and an extended deadline, usually ten working days, after which your ARCP will be repeated and a final decision issued.

An unsatisfactory outcome at this time means that you cannot progress and depending on your individual circumstances you may be offered an extension of training or released from programme. Trainees with an Outcome 2, 3, or 4, or Outcome 5 with failure to subsequently submit the required evidence within 2 weeks (allowing conversion to a successful outcome) must attend a face-to-face meeting with the TPDs. This is all a nationally agreed process and thus practised across all regions.

If you encounter difficulties during your training and believe you may fail to meet all requirements by the required deadline, you should contact us as early as possible. We will make every effort to support you and find a solution, providing we know in advance. Failure to communicate with us coupled with failure to submit the required evidence will result in an unsatisfactory ARCP Outcome, which we are all keen to avoid!

Common Pitfalls at ARCP – top tips!

Unsuccessful ARCPs are very common, particularly Outcome 5s (which signify insufficient evidence completed) – 60% of our 2017 ARCPs resulted in this outcome. Thankfully most later convert to a successful outcome (though the initial outcome is also permanently recorded), but only with a bit of stress and a last minute flurry of work in the interim.

The best way to avoid this is to follow the ARCP Decision Aid and the checklist at the start of this handbook exactly, taking care to note the small print. The devil is often in the detail!

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Here are some of the common pitfalls that have been the themes behind recent Outcome 5s (note this list is not exhaustive and it is your responsibility to make sure you’ve met all requirements):

• Failing to submit all evidence before the deadline; evidence submitted late, even if over a week before your ARCP, cannot be counted.

• Forgetting to submit your SOAR declarations (or using an old SOAR account e.g. for a previous LAS or other post; make sure it’s your active/CMT post!) or Absence Declaration in advance.

• Not uploading documents demonstrating your teaching attendance, QIP or clinic attendance in a visible location (we recommend using appropriately headed folder names in your Personal Library) or in a file that can be opened using common programmes (we recommend pdf, Word or Excel).

• Educational Supervisor Reports saved in draft format (so invisible to ARCP Panel).

• Not meeting the minimum number of Consultant MSF or Consultant workplace-based assessments (minimum 3 as part of your >12 MSF, and all WPBAs that you wish to count). Whilst WBPAs done with non-consultants can be helpful in building up an evidence base to link to competencies, only WPBAs completed by Consultants “count” towards the overall numbers required at ARCP.

• Over-linking of SLEs, resulting in this being discounted as evidence (or, in extreme cases, being raised as a probity concern) at ARCP – maximum number of competencies that each SLE can be linked to are 2 per mini-CEX/CbD and 8 per ACAT. There is no limit to the number of unique pieces of evidence that can be used against each outcome (providing each item not linked to excessive others) but multiple e.g. >5 can slow down ePortfolio, become unwieldy to review, and is also unnecessary!

• ES not having signed off sufficient number of individual competencies or not signing off group competencies as CT1/CT2 achieved (either individual sign offs or group sign off required as outlined in decision aid).

• Insufficient evidence linked to individual competencies to allow ES sign off (aim min. 2 pieces and never reflection or teaching as a single item i.e. will be considered in conjunction with SLE evidence).

What next: after CMT

After successful ARCP in CT1, you automatically progress to CT2 – out of programme experience/training is not an option until Higher Specialty Training, so our assumption will always be that you plan to progress!

ST3 posts recruitment begins early into CT2, with round 1 of adverts/applications occurring around January, shortlisting completed by early March, and interviews held from March to April. Full details of the application process are available at www.st3recruitment.org.uk.

Whilst the majority of doctors choose to proceed directly into higher specialty training (ST3) following completion of CMT, a significant number opt not to do so. A minority of

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these doctors go directly into other non-medical specialty training programmes, but the majority simply take a break from training. To read more about your options, see www.jrcptb.org.uk/taking-time-out-after-core-medical-training.

Feedback and Support

As your TPDs, we are here to support you both collectively and individually.

Marie Freel (Marie.Freel@glasgow.ac.uk) is a Consultant Endocrinologist based at the Queen Elizabeth University Hospital, Glasgow; she is also TPD for General (Internal) Medicine (GIM) training for ST3+ trainees in West of Scotland.

Dr David Wilkin (davidwilkin@nhs.net) is a Consultant in Acute and General Medicine in Crosshouse Hospital, Kilmarnock and Dr James Boyle (james.boyle@glasgow.ac.uk) is a Consultant Diabetologist and Endocrinologist at Glasgow Royal Infirmary.

In addition to the TPD, there are a number of CMT training leads based at various sites throughout the WOS training programme and they may be a more appropriate local point of contact in the first instance.

Ayr Hospital- Professor Andrew Collier

Inverclyde Royal Hospital- Dr Nma Campbell

Royal Alexandra Hospital- Dr Douglas Grieve

Beatson Oncology Centre- Dr Nicholas MacLeod

Forth Valley Royal Hospital- Dr Claire Copland

Queen Elizabeth University Hospital- Dr Beth White

Wishaw General Hospital- Dr Manish Patel

Hairmyres Hospital- Dr Claire McDougall

Monklands Hospital- Dr Ilona Shilliday

Dumfries and Galloway Royal Infirmary- Dr Nadeeka Rathnamalala

We are happy to be approached at any time regarding queries or concerns; whenever the latter we will do our best to meet you face to face at a time that suits.

You are also supported by the following:

- Susan Nicol, Depute Training Program Manager at NHS Education for Scotland (NES) responsible for CMT: Susan.Nicol@nes.scot.nhs.uk

Susan is currently covering the vacant CMT administrator role at NES. Her roles include distribution of information from your TPDs, coordinating rotations, organising ARCPs, organisation of the Specialty Training Committee meetings, ePortfolio support etc. She works closely with the TPDs.

- Stuart Brown, responsible for CMT Study Leave at NES: Stuart.Brown@nes.scot.nhs.uk

- Lillian Cumming, Administrative Assistant at NES responsible for coordinating/promoting CoMEP training days keeping a register of attendance: Lillian.Cumming@nes.scot.nhs.uk

You can read more about NHS Education for Scotland (NES) and its role in your training in Scotland at http://www.scotlanddeanery.nhs.scot/

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Specialty Training Committee

Your TPDs are informed and supported by a Specialty Training Committee (STC), which meets regularly and is chaired directly by the TPDs. This includes a number of Trainee Representatives from both CT1 and CT2, and Consultants from a number of relevant hospitals/specialties in the region, who meet to discuss a set agenda and share information.

The STCs main purpose is to advise and help manage training programmes by ensuring delivery of education to the standards set out in the Gold Guide and GMC documents, as well as complying with NES specific policies and procedures.

The TPDs will consider all feedback, concerns and suggestions received at the STC and may use this to influence change where appropriate, although in many cases a concern or feedback may trigger a period of observation rather than immediate change (for example, when one trainee reports a concern regarding a training environment that is in incongruous to others experience).

The STC members, including Trainee Reps, act in an advisory role but do not directly control the programme, which is under the direct control/discretion of the TPDs and Associate Postgraduate Dean.

Consultants reps on the STC support direct liaison between trainees, the Deanery and individual units, and also participate in CMT ARCPs as a panel member.

New Trainee Reps are competitively appointed at the start of each academic year; to apply, please email your TPDs with a short bio and outline of why you are interested in the role.

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Appendix 1 – ARCP Decision Aid

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Appendix 2 – Claiming tax relief

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Appendix 3 – Guidance on Reflection

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