- Email: [email protected]
Higher specialist training in paediatrics
Current Paediatrics (2001) 11, 296d299 ^ 2001 Harcourt Publishers Ltd doi:10.1054/cupe.2001.0189, available online at http://www.idealibrary.com on
Higher specialist training in paediatrics M. J. Brueton Reader in Child Health and Chairman of the Higher Specialist Training Committee of the Royal College of Paediatrics and Child Health, Academic Department of Child Health, Imperial College School of Medicine, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
KEYWORDS higher specialist training, specialist registrars, training programmers, appraisal, assessment
Summary This review provides an overview of the organization of higher specialist training for specialist registrars (SpRs) in paediatric medicine. The context of the relationships of SpR training in the UK to the postgraduate deaneries, the Royal College of Paediatrics and Child Health, and the Specialist Training Authority of the Medical Royal Colleges, are discussed together with the criteria for entry into the grade, and the allocation of training numbers. The content of the training programmes is described, leading on to a review of current approaches to the accreditation of centres for training, and the appraisal and assessment of trainees. ^ 2001 Harcourt Publishers Ltd
INTRODUCTION The basic structure of training in paediatrics following the pre-registration year is to undertake general professional training (GPT) and higher specialist training (HST) in accredited posts. This leads to the award of a certificate of completion of specialist training (CCST), and entry on to the specialist register of the General Medical Council. General professional training lasts for a minimum of 2 years and is spent in Senior House Officer (SHO) posts. Higher specialist training usually lasts for 5 years and requires the allocation of a national training number (NTN), leading to an appointment as a specialist registrar (SpR).
ORGANIZATION The organization of HST involves the Postgraduate Deaneries and the Royal Colleges. Postgraduate training is governed by the European Specialist Medical Qualifications Order of 1995, and the subsequent amendment regulations in 1997. Training in the UK was brought into line with these European objectives following the report Hospital Doctors: Training for the Future, which was produced in 1995 by a working group under the chairmanship of Sir Kenneth Calman. The body which is legally responsible for safeguarding the standards of postgraduate medical training in hospital practice in the UK and for
E-mail: [email protected]
awarding CCSTs is the Specialist Training Authority of the Medical Royal Colleges (STA). The Postgraduate Deans in each Deanery area manage the delivery of postgraduate medical education. They are assisted by the staff in the Departments of Postgraduate, Medical and Dental Education, and they work specifically through Specialty Training Committees (STC) in paediatric medicine. The Chairmen of the STC and the programme directors are appointed by the Deanery. Officers of the STC play lead roles in the organization of HST rotations, the recruitment and selection of SpRs, and in ensuring that appraisal and assessment is undertaken appropriately. The Royal College of Paediatrics and Child Health (RCPCH) has a prime function in setting and maintaining standards and quality, both with regard to clinical care, and education and training. On behalf of the STA, it is responsible for publishing appropriate syllabuses and training programmes, for conducting assessments and examinations, and for visiting paediatric departments and inspecting training programmes and placements. The Royal Colleges, as agents for the STA, also grant educational approval for posts and programmes for both GPT and HST. In the RCPCH, a vice-president takes overall responsibility for education and training. The implementation of these functions is the responsibility of the HST and GPT Committees of the College. The RCPCH appoints College Regional Advisers (RA). These individuals have a complex task in that they undertake HST responsibilities for the College, and they are also the key figures involved in the work of the STCs.
HIGHER SPECIALIST TRAINING IN PAEDIATRICS They are usually the paediatricians to whom the SpRs will relate during their training programmes. Each NHS Trust also has clinical tutors appointed by the Postgraduate Deans. They manage the educational contract for all specialties between the Postgraduate Deanery and the Trust. Each Trust also has an RCPCH Tutor, this is the paediatrician who can provide onsite advice and support to individual trainees. The College tutors co-ordinate educational supervisors who are appointed to have responsibility for a small number of SHOs or SpRs. They provide support in supervision, monitoring competence and assessing training needs, and in mentoring, i.e. personal support, counselling and encouragement. Trainees are expected to see their educational supervisors on a regular basis to discuss mutual expectations and objectives in their training.
Qualifications for entry to the SpR grade This entails completion of GPT and possession of both parts of the MRCPCH examination or its equivalent. General professional training must be undertaken in SHO posts which have educational approval. Over a minimum period of 2 years, the appointments must include 6 months in general paediatric medicine and 6 months in neonatal intensive care. Further posts may be undertaken in community paediatrics and in relevant approved posts such as paediatric sub-specialties, paediatric surgery, obstetrics, child psychiatry, general practice or A&E departments where there is a substantial paediatric component. The RCPCH publishes Syllabus and Training Records for both GPT and HST. These set out the experience and skills needed to complete training, as well as providing an in-training record or log book.
SpR TRAINING Training numbers At appointment, an SpR is issued with a training number. An NTN means that the registrar is on a programme leading to the award of a CCST. The NTN remains with an individual SpR throughout training and it is separate from numbers relating to a particular post. These appointments are made in open competition for training programmes advertised to commence in March or September each year. Other types of training numbers are available. If the applicant does not have European Community Rights, or does not have the right of indefinite residence or settled status in the UK, a Visiting Training Number (VTN) can be issued. This too indicates that the registrar has been accepted on to a programme leading to the award of a CCST. It is also possible to issue a number relating to
297 a short period of training, this is known as a fixed term training appointment (FTTA), and the number is designated an FTN. It does not lead to the award of a CCST. An FTN can, in general, only be awarded to doctors who benefit from European Community Rights but are not UK nationals, or doctors who do not have the right of indefinite residence or settled status in the UK. Training numbers are not available to registrars undertaking locum appointments. There are two particular circumstances in which locum contracts may be issued. If a long-term vacancy has occurred in a training programme following the temporary movement of an SpR to an out-of-programme post, an advertisement may be placed to interview for a locum appointment for training (LAT). These posts are not allocated training numbers; however, the experience gained may be counted towards the award of a CCST should the registrar subsequently gain an NTN or VTN. Trainees must ensure that prospective training recognition is given by the College Regional Adviser and the Deanery, and the requirements for application for these posts are the same as those for entry to the SpR grade. These appointments will usually last between 3 months and 1 year. Short-term locum appointments, normally up to 3 months, may also be made. They are described as locum appointment service posts (LAS), and they contain little structured training. Recruitment to these posts is undertaken by the local employer and not via the Postgraduate Deaneries. Experience gained within them cannot be counted towards the award of a CCST. The MRCPCH is not mandatory; however, the applicants would need to be able to demonstrate a level of ability and expertise equivalent to that of an SpR. Various other appointments can be made which do not attract training numbers and are not accreditable as training grades. These include the staff grade posts and others described as Trust doctors or clinical fellows.
Training programmes Specialist registrars entering HST currently complete a 5-year programme. The first 2 core years must include neonatology and community paediatrics; the subsequent 3 years may also include appointments in one or more paediatric sub-specialties, leading to a CCST in general paediatric medicine. Specialist registrars who wish to be recognized as tertiary specialists will need to undertake a sub-specialty training programme, usually of 3 years duration in posts approved by the Training Adviser of the relevant College Specialist Advisory Committee (CSAC). This training will lead to a CCST with an entry into the Specialist Register of the General Medical Council
298
CURRENT PAEDIATRICS
(GMC), which will be described as general paediatrics with the relevant sub-specialty specified. Specialist registrar programmes will normally rotate between district general hospitals, community settings and teaching centres. It is essential that the initial 2-year core training is completed, after which it is possible to negotiate a degree of flexibility. Out-of-programme training can be accredited with the prior agreement of the RA and the Postgraduate Dean. This will usually involve appointment to a research or training fellowship, which can be in a centre outside the UK. One such year is usually readily acceptable; accreditation of further years involves individual discussion. Many of the subspecialty training programmes include 1 year spent in research, which can also be counted as part of the total training time. The STA have recently accepted proposals from the RCPCH and Voluntary Service Overseas (VSO) that a 1-year period in a structured training setting in a VSO placement can be accreditable towards a CCST.
place, and led to a consolidation of the supervision and monitoring of trainees which has transformed postgraduate training in this area. The aspects of this range from the accreditation of posts for training, through the approval of education programmes, to the appraisal and assessment of the trainees. Currently, the RCPCH in association with the Postgraduate Deaneries and on behalf of the STA organizes visits to individual hospitals and Trusts in order to assess and accredit individual posts as being appropriate for training both SHOs and SpRs. Mandatory features of an SpR education programme include:
Flexible trainees
E E
Flexible SpR training can be undertaken as a job share or in a supernumerary post. Each region has an associate postgraduate Dean with responsibility and a budget for flexible training. Under these arrangements, each SpR would work six sessions per week, to enable one overlapping handover session to take place.
Academic trainees Training in academic medicine has been disrupted by the implementation of the European Order. Various schemes have been proposed to provide a thorough grounding in research, teaching and clinical practice. All would involve a considerable extension of the basic 5-year SpR programme, with agreement required on national academic training numbers. An initial phase would include 2 years of clinical training and 3 years of research leading to a PhD or MD. A subsequent phase would encompass a further 2 or 3 years of clinical training, and another 3 years of research. These proposals would involve the establishment of an academic advisory committee structure, with medical school agreement, and funding obtained from such sources as research councils, major charities, universities, industry and the NHS. In many regions, MSc courses have been introduced. These cover aspects of clinical paediatrics as well as audit, management, information technology and critical appraisal techniques. They are undertaken over 1 year and may count towards the award of a CCST.
Setting standards The introduction of the unified training grade for SpRs emphasized the structures and procedures previously in
E
E
E
E
E E E E
an educational prospectus including both a timetable of clinical duties and the available education in the department, hospital, local community and associated institutions a named educational supervisor who should meet the registrar at the beginning of the post to agree three to six educational objectives and meet thereafter at 3d4 monthly intervals to review progress an induction programme allocation of a desk with use of a computer with easy access to MedLine and other important databases hospital-based registrars should take part in at least two consultant ward rounds per week, and at least one independent ward round, and also participate in two consultant-led outpatient clinics per week, seeing at least one or two new referrals per week the programme should include at least 3 hours per week of timetabled education to include non-clinical aspects of being a consultant involvement in teaching with feedback and guidance on performance involvement in at least one audit project per year training in the critical appraisal of research findings appropriate allocation of study leave.
Appraisal Appraisal can be defined as a largely confidential process in which the trainee reviews progress and sets goals to facilitate learning with the educational supervisor. Appraisal of trainees is thus part of an education process which: E
E E E E E
identifies the educational and developmental needs of individual doctors and plans clear and agreed achievable objectives in relation to these provides feedback on strengths and weaknesses identifies the relevant learning opportunities assists the trainee to develop the skills of self-appraisal and reflection in order to facilitate reviews of progress leads to informed decisions on career planning promotes a high-quality learning and working environment for the trainee.
HIGHER SPECIALIST TRAINING IN PAEDIATRICS The emphasis of appraisal must be pastoral, jobrelated and non-threatening. Confidentiality is essential to maintain mutual trust and understanding. If severe problems are identified with an indication that it would be in the common interest to pass on information in confidence to the RA and Postgraduate Dean, this must be agreed by both the trainee and the trainer. Such problems might relate to training arrangements and the performance of trainers, or aspects of the health, conduct or competence of the trainee which might threaten the safety of patients, or the effective working of the clinical team. Clearly this may become a difficult area and it should be noted that if disclosure would raise ethical or legal issues, these need to take place outside the appraisal process and should follow agreed local Trust and national procedures. The actual implementation of appraisal tends to vary between regions and should be undertaken by educational or clinical supervisors.
Assessment The central aspect of a definition of assessment is the making of judgements against defined, usually external, criteria. This is thus an open process and it leads to the completion of an annual review known as the Record of In-Training Assessment (RITA). The RITA is not in itself the means of assessment, but fulfills the function of recording and managing the trainee’s progress. The aims of SpR assessments are to: E E E E
establish the extent to which the trainee has met the educational objectives of the curriculum to ensure that the trainee is ready to move forward into the next stage of training to allow identification of areas of training where the trainee requires additional support at the end of programme assessment, to establish whether or not the trainee is ready for independent practice as a consultant paediatrician.
299 Methods of assessment are areas of intense discussion. There are three principal methods employed; these are: E E E
training reports competence-based assessments portfolios.
Training reports cover aspects such as personal attributes, and interpersonal skills as well as clinical skills. Within each area, the standards range from outstanding or consistently good, through normally acceptable and sometimes inadequate, to often inadequate. At present, competence-based assessment tends to be confined to sub-specialties in which performance in specific procedures can be quantitated. A portfolio is a collection of evidence of learning. It is intended to demonstrate the continued acquisition of knowledge, skills, attitudes, understanding and achievements. Essentially, it consists of three components, the first is confidential in that it comprises appraisal and personal development documentation. The second component is assessment documentation. The third component is virtually a three-dimensional curriculum vitae. It contains, for example, details of courses attended, audit projects, research and critical appraisal, and teaching audio-visual aids. Many regions have linked these arrangements with a trainee feedback process. Implicit within SpR training programmes is a requirement that all those involved in delivering education are well informed and proficient in their roles. Thus a major ‘training the trainers’ organization has been initiated throughout the UK. As a result of this and the work of trainees’ committees, the organization and delivery of training is still continuing to evolve.
FURTHER READING A Guide to Specialist Registrar Training. DHSS, 1998. Paediatric Training Handbook. RCPCH, 1998. General Professional Training Guide. RCPCH, 1999. RCPCH website: http://www.rcpch.ac.uk
Higher specialist training in paediatrics M. J. Brueton Reader in Child Health and Chairman of the Higher Specialist Training Committee of the Royal College of Paediatrics and Child Health, Academic Department of Child Health, Imperial College School of Medicine, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
KEYWORDS higher specialist training, specialist registrars, training programmers, appraisal, assessment
Summary This review provides an overview of the organization of higher specialist training for specialist registrars (SpRs) in paediatric medicine. The context of the relationships of SpR training in the UK to the postgraduate deaneries, the Royal College of Paediatrics and Child Health, and the Specialist Training Authority of the Medical Royal Colleges, are discussed together with the criteria for entry into the grade, and the allocation of training numbers. The content of the training programmes is described, leading on to a review of current approaches to the accreditation of centres for training, and the appraisal and assessment of trainees. ^ 2001 Harcourt Publishers Ltd
INTRODUCTION The basic structure of training in paediatrics following the pre-registration year is to undertake general professional training (GPT) and higher specialist training (HST) in accredited posts. This leads to the award of a certificate of completion of specialist training (CCST), and entry on to the specialist register of the General Medical Council. General professional training lasts for a minimum of 2 years and is spent in Senior House Officer (SHO) posts. Higher specialist training usually lasts for 5 years and requires the allocation of a national training number (NTN), leading to an appointment as a specialist registrar (SpR).
ORGANIZATION The organization of HST involves the Postgraduate Deaneries and the Royal Colleges. Postgraduate training is governed by the European Specialist Medical Qualifications Order of 1995, and the subsequent amendment regulations in 1997. Training in the UK was brought into line with these European objectives following the report Hospital Doctors: Training for the Future, which was produced in 1995 by a working group under the chairmanship of Sir Kenneth Calman. The body which is legally responsible for safeguarding the standards of postgraduate medical training in hospital practice in the UK and for
E-mail: [email protected]
awarding CCSTs is the Specialist Training Authority of the Medical Royal Colleges (STA). The Postgraduate Deans in each Deanery area manage the delivery of postgraduate medical education. They are assisted by the staff in the Departments of Postgraduate, Medical and Dental Education, and they work specifically through Specialty Training Committees (STC) in paediatric medicine. The Chairmen of the STC and the programme directors are appointed by the Deanery. Officers of the STC play lead roles in the organization of HST rotations, the recruitment and selection of SpRs, and in ensuring that appraisal and assessment is undertaken appropriately. The Royal College of Paediatrics and Child Health (RCPCH) has a prime function in setting and maintaining standards and quality, both with regard to clinical care, and education and training. On behalf of the STA, it is responsible for publishing appropriate syllabuses and training programmes, for conducting assessments and examinations, and for visiting paediatric departments and inspecting training programmes and placements. The Royal Colleges, as agents for the STA, also grant educational approval for posts and programmes for both GPT and HST. In the RCPCH, a vice-president takes overall responsibility for education and training. The implementation of these functions is the responsibility of the HST and GPT Committees of the College. The RCPCH appoints College Regional Advisers (RA). These individuals have a complex task in that they undertake HST responsibilities for the College, and they are also the key figures involved in the work of the STCs.
HIGHER SPECIALIST TRAINING IN PAEDIATRICS They are usually the paediatricians to whom the SpRs will relate during their training programmes. Each NHS Trust also has clinical tutors appointed by the Postgraduate Deans. They manage the educational contract for all specialties between the Postgraduate Deanery and the Trust. Each Trust also has an RCPCH Tutor, this is the paediatrician who can provide onsite advice and support to individual trainees. The College tutors co-ordinate educational supervisors who are appointed to have responsibility for a small number of SHOs or SpRs. They provide support in supervision, monitoring competence and assessing training needs, and in mentoring, i.e. personal support, counselling and encouragement. Trainees are expected to see their educational supervisors on a regular basis to discuss mutual expectations and objectives in their training.
Qualifications for entry to the SpR grade This entails completion of GPT and possession of both parts of the MRCPCH examination or its equivalent. General professional training must be undertaken in SHO posts which have educational approval. Over a minimum period of 2 years, the appointments must include 6 months in general paediatric medicine and 6 months in neonatal intensive care. Further posts may be undertaken in community paediatrics and in relevant approved posts such as paediatric sub-specialties, paediatric surgery, obstetrics, child psychiatry, general practice or A&E departments where there is a substantial paediatric component. The RCPCH publishes Syllabus and Training Records for both GPT and HST. These set out the experience and skills needed to complete training, as well as providing an in-training record or log book.
SpR TRAINING Training numbers At appointment, an SpR is issued with a training number. An NTN means that the registrar is on a programme leading to the award of a CCST. The NTN remains with an individual SpR throughout training and it is separate from numbers relating to a particular post. These appointments are made in open competition for training programmes advertised to commence in March or September each year. Other types of training numbers are available. If the applicant does not have European Community Rights, or does not have the right of indefinite residence or settled status in the UK, a Visiting Training Number (VTN) can be issued. This too indicates that the registrar has been accepted on to a programme leading to the award of a CCST. It is also possible to issue a number relating to
297 a short period of training, this is known as a fixed term training appointment (FTTA), and the number is designated an FTN. It does not lead to the award of a CCST. An FTN can, in general, only be awarded to doctors who benefit from European Community Rights but are not UK nationals, or doctors who do not have the right of indefinite residence or settled status in the UK. Training numbers are not available to registrars undertaking locum appointments. There are two particular circumstances in which locum contracts may be issued. If a long-term vacancy has occurred in a training programme following the temporary movement of an SpR to an out-of-programme post, an advertisement may be placed to interview for a locum appointment for training (LAT). These posts are not allocated training numbers; however, the experience gained may be counted towards the award of a CCST should the registrar subsequently gain an NTN or VTN. Trainees must ensure that prospective training recognition is given by the College Regional Adviser and the Deanery, and the requirements for application for these posts are the same as those for entry to the SpR grade. These appointments will usually last between 3 months and 1 year. Short-term locum appointments, normally up to 3 months, may also be made. They are described as locum appointment service posts (LAS), and they contain little structured training. Recruitment to these posts is undertaken by the local employer and not via the Postgraduate Deaneries. Experience gained within them cannot be counted towards the award of a CCST. The MRCPCH is not mandatory; however, the applicants would need to be able to demonstrate a level of ability and expertise equivalent to that of an SpR. Various other appointments can be made which do not attract training numbers and are not accreditable as training grades. These include the staff grade posts and others described as Trust doctors or clinical fellows.
Training programmes Specialist registrars entering HST currently complete a 5-year programme. The first 2 core years must include neonatology and community paediatrics; the subsequent 3 years may also include appointments in one or more paediatric sub-specialties, leading to a CCST in general paediatric medicine. Specialist registrars who wish to be recognized as tertiary specialists will need to undertake a sub-specialty training programme, usually of 3 years duration in posts approved by the Training Adviser of the relevant College Specialist Advisory Committee (CSAC). This training will lead to a CCST with an entry into the Specialist Register of the General Medical Council
298
CURRENT PAEDIATRICS
(GMC), which will be described as general paediatrics with the relevant sub-specialty specified. Specialist registrar programmes will normally rotate between district general hospitals, community settings and teaching centres. It is essential that the initial 2-year core training is completed, after which it is possible to negotiate a degree of flexibility. Out-of-programme training can be accredited with the prior agreement of the RA and the Postgraduate Dean. This will usually involve appointment to a research or training fellowship, which can be in a centre outside the UK. One such year is usually readily acceptable; accreditation of further years involves individual discussion. Many of the subspecialty training programmes include 1 year spent in research, which can also be counted as part of the total training time. The STA have recently accepted proposals from the RCPCH and Voluntary Service Overseas (VSO) that a 1-year period in a structured training setting in a VSO placement can be accreditable towards a CCST.
place, and led to a consolidation of the supervision and monitoring of trainees which has transformed postgraduate training in this area. The aspects of this range from the accreditation of posts for training, through the approval of education programmes, to the appraisal and assessment of the trainees. Currently, the RCPCH in association with the Postgraduate Deaneries and on behalf of the STA organizes visits to individual hospitals and Trusts in order to assess and accredit individual posts as being appropriate for training both SHOs and SpRs. Mandatory features of an SpR education programme include:
Flexible trainees
E E
Flexible SpR training can be undertaken as a job share or in a supernumerary post. Each region has an associate postgraduate Dean with responsibility and a budget for flexible training. Under these arrangements, each SpR would work six sessions per week, to enable one overlapping handover session to take place.
Academic trainees Training in academic medicine has been disrupted by the implementation of the European Order. Various schemes have been proposed to provide a thorough grounding in research, teaching and clinical practice. All would involve a considerable extension of the basic 5-year SpR programme, with agreement required on national academic training numbers. An initial phase would include 2 years of clinical training and 3 years of research leading to a PhD or MD. A subsequent phase would encompass a further 2 or 3 years of clinical training, and another 3 years of research. These proposals would involve the establishment of an academic advisory committee structure, with medical school agreement, and funding obtained from such sources as research councils, major charities, universities, industry and the NHS. In many regions, MSc courses have been introduced. These cover aspects of clinical paediatrics as well as audit, management, information technology and critical appraisal techniques. They are undertaken over 1 year and may count towards the award of a CCST.
Setting standards The introduction of the unified training grade for SpRs emphasized the structures and procedures previously in
E
E
E
E
E E E E
an educational prospectus including both a timetable of clinical duties and the available education in the department, hospital, local community and associated institutions a named educational supervisor who should meet the registrar at the beginning of the post to agree three to six educational objectives and meet thereafter at 3d4 monthly intervals to review progress an induction programme allocation of a desk with use of a computer with easy access to MedLine and other important databases hospital-based registrars should take part in at least two consultant ward rounds per week, and at least one independent ward round, and also participate in two consultant-led outpatient clinics per week, seeing at least one or two new referrals per week the programme should include at least 3 hours per week of timetabled education to include non-clinical aspects of being a consultant involvement in teaching with feedback and guidance on performance involvement in at least one audit project per year training in the critical appraisal of research findings appropriate allocation of study leave.
Appraisal Appraisal can be defined as a largely confidential process in which the trainee reviews progress and sets goals to facilitate learning with the educational supervisor. Appraisal of trainees is thus part of an education process which: E
E E E E E
identifies the educational and developmental needs of individual doctors and plans clear and agreed achievable objectives in relation to these provides feedback on strengths and weaknesses identifies the relevant learning opportunities assists the trainee to develop the skills of self-appraisal and reflection in order to facilitate reviews of progress leads to informed decisions on career planning promotes a high-quality learning and working environment for the trainee.
HIGHER SPECIALIST TRAINING IN PAEDIATRICS The emphasis of appraisal must be pastoral, jobrelated and non-threatening. Confidentiality is essential to maintain mutual trust and understanding. If severe problems are identified with an indication that it would be in the common interest to pass on information in confidence to the RA and Postgraduate Dean, this must be agreed by both the trainee and the trainer. Such problems might relate to training arrangements and the performance of trainers, or aspects of the health, conduct or competence of the trainee which might threaten the safety of patients, or the effective working of the clinical team. Clearly this may become a difficult area and it should be noted that if disclosure would raise ethical or legal issues, these need to take place outside the appraisal process and should follow agreed local Trust and national procedures. The actual implementation of appraisal tends to vary between regions and should be undertaken by educational or clinical supervisors.
Assessment The central aspect of a definition of assessment is the making of judgements against defined, usually external, criteria. This is thus an open process and it leads to the completion of an annual review known as the Record of In-Training Assessment (RITA). The RITA is not in itself the means of assessment, but fulfills the function of recording and managing the trainee’s progress. The aims of SpR assessments are to: E E E E
establish the extent to which the trainee has met the educational objectives of the curriculum to ensure that the trainee is ready to move forward into the next stage of training to allow identification of areas of training where the trainee requires additional support at the end of programme assessment, to establish whether or not the trainee is ready for independent practice as a consultant paediatrician.
299 Methods of assessment are areas of intense discussion. There are three principal methods employed; these are: E E E
training reports competence-based assessments portfolios.
Training reports cover aspects such as personal attributes, and interpersonal skills as well as clinical skills. Within each area, the standards range from outstanding or consistently good, through normally acceptable and sometimes inadequate, to often inadequate. At present, competence-based assessment tends to be confined to sub-specialties in which performance in specific procedures can be quantitated. A portfolio is a collection of evidence of learning. It is intended to demonstrate the continued acquisition of knowledge, skills, attitudes, understanding and achievements. Essentially, it consists of three components, the first is confidential in that it comprises appraisal and personal development documentation. The second component is assessment documentation. The third component is virtually a three-dimensional curriculum vitae. It contains, for example, details of courses attended, audit projects, research and critical appraisal, and teaching audio-visual aids. Many regions have linked these arrangements with a trainee feedback process. Implicit within SpR training programmes is a requirement that all those involved in delivering education are well informed and proficient in their roles. Thus a major ‘training the trainers’ organization has been initiated throughout the UK. As a result of this and the work of trainees’ committees, the organization and delivery of training is still continuing to evolve.
FURTHER READING A Guide to Specialist Registrar Training. DHSS, 1998. Paediatric Training Handbook. RCPCH, 1998. General Professional Training Guide. RCPCH, 1999. RCPCH website: http://www.rcpch.ac.uk