Assessing professional competence: a critical review of the Annual Review of Competence Progression

Abstract

The Annual Review of Competence Progression is used to determine whether trainee doctors in the United Kingdom are safe and competent to progress to the next training stage. In this article we provide evidence to inform recommendations to enhance the validity of the summative and formative elements of the Annual Review of Competency Progression. The work was commissioned as part of a Health Education England review. We systematic searched the peer reviewed and grey literature, synthesising findings with information from national, local and specialty-specific Annual Review of Competence Progression guidance, critically evaluating the findings in the context of literature on assessing competence in medical education. National guidance lacked detail resulting in variability across locations and specialties, threatening validity and reliability. Trainees and trainers were concerned that the Annual Review of Competence Progression only reliably identifies the most poorly performing trainees. Feedback is not routinely provided, which can leave those with performance difficulties unsupported and high performers demotivated. Variability in the provision and quality of feedback can negatively affect learning. The Annual Review of Competence Progression functions as a high-stakes assessment, likely to have a significant impact on patient care. It should be subject to the same rigorous evaluation as other high-stakes assessments; there should be consistency in procedures across locations, specialties and grades; and all trainees should receive high-quality feedback.

Keywords: ARCP; Assessment; competence; formative; summative.

Figure 1.

Variability in the percentage of ‘unsatisfactory’ ARCP outcomes awarded to trainees from 2010 to 2016 across 13 specialties in two Health Education England Local Education and Training Boards: Thames Valley and East of England. ACCS: acute care common stem; CAT: core anaesthetics training; CMT: core medical training; CPT: core psychiatry training; CST: core surgical training; EM: emergency medicine; GP: general practice; O&G: obstetrics & gynaecology; Clin onc: clinical oncology; Clin rad: clinical radiology. Data from http://www.gmc-uk.org/education/14105.asp