Psychiatric Bulletin (2004) 28: 123-125. doi: 10.1192/pb.28.4.123
© 2004 The Royal College of Psychiatrists
Psychiatric Bulletin (2004) 28: 123-125
© 2004 The Royal College of Psychiatrists
Trainee psychiatrists’ assessment outcomes
Michael Tunbridge, Formerly Postgraduate Dean and Director
c/o Department of Postgraduate Medical and Dental Education, The
Triangle, Roosevelt Drive, Headington, Oxford OX3 7XP
David Dickinson, Business Manager and
Pauline Swan, Head of Medical Personnel
Department of Postgraduate Medical and Dental Education, University of
Oxford on behalf of the Conference of Postgraduate Medical Deans of the United
Kingdom
Declaration of interest
None.
Correspondence:
(tel: 01865 740605; fax: 01865 740604; e-mail:
pgdean{at}oxford-pgmde.co.uk)
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Abstract
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AIMS AND METHOD
The Record of In-Training Assessment grades of all registrars in the
psychiatric specialties in the UK were analysed for each of three successive
years, specialty by specialty, and compared with the average outcome for
registrars in all disciplines over the same period.
RESULTS
Over 98% of psychiatry registrars were assessed as satisfactory, 1.2%
needed targeted training and 0.7% were graded as unsatisfactory, requiring
repeat training. Targeted training and repeat training led to a satisfactory
outcome in the majority of cases.
CLINICAL IMPLICATIONS
The process of assessment needs to become more objective, and should do so
as the Royal Colleges develop better measures of clinical competence.
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Introduction
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One of the most important aspects of the introduction of the unified
specialist registrar grade in 1996-7 was the requirement for a formal annual
documented assessment (Department of
Health, 1998). The Record of In-Training Assessment (RITA) was
developed, based on reports from educational supervisors about the clinical
competence of the trainees, trainees’ logbooks in some specialties, and
generic skills according to the criteria set out in Good Medical
Practice (General Medical Council,
2001). The assessments were conducted by a panel representing the
relevant deanery, the deanery specialty training committee and the Royal
College concerned. The RITAs are graded as C if satisfactory (or G in the
final year of training), D if recommended for targeted training and E if
recommended for intensified supervision and repeat training. RITA F is a
record of out-of-programme experience such as research, for which up to 12
months’ credit is usually given by most specialties.
The process of assessment took some time to develop and is not without
criticism, especially concerning the lack of objective measurements of
competency (Wragg et al,
2003). The principles of assessment were nevertheless rapidly
accepted by the specialist registrars themselves, and they and their seniors
recognise the value of the process of formative appraisal and summative
assessment, which will soon be required of all members of the profession to
inform their revalidation as doctors.
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Method
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Postgraduate deans in the UK have audited the results of the RITAs for all
specialist registrars in their deaneries over the past 4 years. The analysis
includes registrars on type 1 programmes leading to a Certificate of
Completion of Specialist Training (CCST), whether holders of national training
or visiting training numbers, and those on short-term fixed (type 2)
appointments, whether as locums for training (LAT) or on a fixed-term training
appointment (FTTA). The records reflect an average 87% ascertainment each year
of those eligible for assessment, excluding recent joiners in the year and
leavers assessed as satisfactory (G) the previous year. The shortfall of
records, after allowing for sickness absence and maternity leave (1%), was
mainly among registrars on short-term appointments (LATs and FTTAs), who left
without adequate documentation.
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Results
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The outcomes of the assessments in the psychiatry specialties for each of
the years 2000, 2001 and 2002 are shown in
Table 1 and are compared with
the average for registrars in all specialties over the same 3-year period. The
results are consistent over each of the years. Overall 95% of psychiatry
specialist registrars were graded as satisfactory (C and G); 1.2% needed
targeted training (D) and 0.7% (E) needed to retrain for a defined period. An
average of 2.7% of psychiatric specialist registrars were out of programme and
given RITA grade F, reflecting the smaller proportion of psychiatrists in
training who undertake research compared with the national average of 6.7%.
Almost all RITA grade F reports are satisfactory, and overall the outcomes of
C, F and G grades combined are probably not very different across all
specialties if allowance is made for the different sizes of the specialty
pools and the different durations of training – i.e. the ratio of the
RITA grades G to C will be higher in shorter programmes. The grades of all
psychiatry registrars assessed in the 12 months to 30 September 2002 are shown
by specialty in Table 2 and
compared with the national total for all specialist registrars in the same
year. Numbers are too small in some specialties to permit valid comparison of
the outcomes in any one specialty with another.
Reasons given for assignment to grade D included poor communication skills,
poor interpersonal skills, lack of competencies in particular areas,
weaknesses in management or organisational skills and weakness in research, as
well as poor record-keeping and lack of documentation. Reasons given for a
grade E were broadly similar but usually multiple and more severe, and judged
to necessitate retraining. In some other non-psychiatric specialties, failure
to pass College examinations was a barrier to progression of training.
Nationally across all specialties, three-quarters of those graded D and more
than half of those graded E had a subsequent satisfactory outcome at their
next assessment up to a year later. However, about a quarter of those graded E
in all specialties subsequently resigned or were withdrawn from the programme
(Tunbridge et al,
2002).
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Discussion
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There is concern that a proportion of trainees, particularly those in
short-term appointments (notably locums in post for 3-12 months), escape the
assessment process. No one should leave an appointment without a properly
documented assessment. A RITA grade D should not be perceived as damaging
because it does not prevent progression of training; rather, it should be seen
as constructive, and arguably used more often to focus training on areas
needing attention. The outcomes at subsequent assessments are satisfactory in
75% of cases. A RITA grade E, on the other hand, does indicate serious concern
about the trainee’s progress such that repeat training is needed, which
inevitably postpones the achievement of the CCST. Trainees have the right of
appeal against an E grade to the postgraduate dean, and a new panel of
external as well as internal assessors is usually convened when necessary. The
original assessment is usually upheld, but in some cases it has been modified
or overturned by the appeal panel. It is encouraging that after further repeat
training over half of those given a grade E nationally across all specialties
achieved a satisfactory outcome. Those who at subsequent assessment again
received an E grade did not usually complete their training programme and
either withdrew voluntarily or at the direction of the deanery concerned.
Trainees whose contract of employment is terminated have the subsequent right
to go to an employment tribunal. However, postgraduate deans do their best to
help trainees find a more suitable career direction.
The medical Royal Colleges have developed curricula for their specialties
and are also developing measures by which the defined competencies required at
different stages of training can be recorded. These will greatly help the
assessment process to become more objective, but will require more time and
effort on the part of trainees and trainers. The records of assessment
continue to develop, and should inform the process of revalidation of doctors
and reassure the public about the quality of doctors in training.
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Acknowledgments
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The authors thank the postgraduate deans and their data managers across the
UK for supplying the data on which this analysis is based.
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References
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DEPARTMENT OF HEALTH (1998) A Guide to
Specialist Registrar Training. London: DoH.
GENERAL MEDICAL COUNCIL (2001) Good Medical
Practice. London: GMC.
TUNBRIDGE, M., DICKINSON, D. & SWAN, P. (2002)
Outcomes of specialist registrar assessment. Hospital
Medicine, 63, 684
-687.[Medline]
WRAGG, A., WADE, W., FULLER, F., et al (2003)
Assessing the performance of Specialist Registrars. Clinical
Medicine, 3, 131
-134.[Medline]
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Abstract
Introduction
