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

The Annual Review of Competence Progression (ARCP) is the process used to determine whether trainee doctors in the United Kingdom are safe and competent to progress to the next training stage. Criticisms from doctors led to a review of the ARCP in 2017, for which the current review was commissioned. The aim was to provide an evidence base to inform recommendations that would enhance the validity of the summative and formative elements of the ARCP. Evidence obtained from a systematic search of the peer reviewed and grey literature was synthesised with information from national ARCP guidance documents, and local and specialty-specific ARCP guidance. Evidence from the wider literature on assessing competence in medical education was used to critically evaluate the summative and formative elements of the ARCP. Trainees and trainers were skeptical about the ability of the ARCP to differentiate between different levels of professional competence, and were concerned that the ARCP only reliably identifies the most poorly performing trainees, and not trainees performing at or just under the borderline. National ARCP guidance lacked detail, resulting in variability across locations and specialties in how the ARCP is enacted, threatening the validity and reliability of outcomes. Feedback is not routinely provided to all trainees, which can leave those with performance difficulties unsupported, and high performers demotivated. Variability in the provision and quality of feedback after ARCP panels, and in preparation for panels, can negatively affect learning. The ARCP functions as a high-stakes assessment, likely to have a significant impact on patient care. To ensure it is fit for purpose the ARCP should be subject to the same rigorous evaluation as other high-stakes assessments; there should be consistency in ARCP procedures across locations, specialties and grades; and all trainees should receive high-quality feedback