A study to identify the factors that either facilitate or hinder medical specialty trainees in their Annual Review of Competence Progression (ARCP), with a focus on adverse ARCP outcomes

Abstract

Background: Specialty training is a stressful period in medical training. Trainees must work in a busy clinical environment and meet their training competencies. Trainees must complete an annual review to ensure that they are competent to pass to the next level of training. This thesis is interested in why some trainees (5%) have difficulties progressing through their training.
Factors which impact on trainees’ performance are complex and multiple in nature. It may start with their personality or country of graduation (or both). Secondly, it may be that trainees have not received adequate feedback and this has contributed to their underperformance or, thirdly, the service demands and work intensity impact on a trainee’s ability to progress. An in-depth understanding of the factors and how they interact with each other and impact on trainees underperforming is needed.
Aim: This thesis set out to identify the factors that either facilitate or hinder medical specialty trainees in their Annual Review of Competence Progression (ARCP), with a focus on adverse ARCP outcomes.
Methods: Research was conducted across three phases. Phase One was a retrospective observational study investigating which trainees had difficulty progressing through their ARCPs (over a five year period). Phase Two was a systematic literature review to identify indicators that are associated with doctors who experience difficulties with progressing during their specialty training. Phase Three involved a constructivist Grounded Theory study to provide further understanding about what helped or hindered ARCP outcomes.
Results: Findings from Phase One identified that trainees who were older, male or had qualified overseas were found to be at a greater risk of receiving adverse ARCP outcomes. Phase Two identified seven indicators from the literature, these were: overseas graduates and ethnicity, age, gender, personality traits, financial issues, trainee background and issues related to the organisation. Phase Three involved semi-structured interviews with trainees (n=21) and trainers (n=57). Interviews identified risk factors and enablers to progressing through specialty training. The three core categories identified were: individual, training environment and society. Associated risks and enablers were also identified under each of these three core categories. The overall core category, which emerged from the data and explained why trainees had difficulties progressing was focused on a conflict of values. A ‘values model’ was developed to explain why trainees fail their ARCPs.
Discussion: The synthesis of all Phases of this thesis, informed the development of a ‘circuit’ model that identified the barriers and enablers to trainee progression (Phase Four). In addition, a screening tool was devised to help Trusts with the early identification of trainees most at risk of adverse ARCP outcomes, and ensure enabling factors are made available to support trainees.
Conclusion: This thesis has identified why trainees fail ARCPs (conflict in values), the barriers and enablers to progression and has developed a tool to support the early identification of trainees most at risk.