Dr Rachael Mitchell | Jenni Thompson

You may have heard that our UK paediatric curriculum is changing. This article explains how and why, and what to expect!

‘Progress’ is the new curriculum for paediatric postgraduate training.

The structure of the curriculum, and way trainees and trainers will use it, has changed a lot. You might remember the old curriculum – all 2650 pages of it! Early feedback on the new curriculum is that it’s much more user-friendly, concise, flexible and responsive to individual trainee needs.

Why does it matter to me?

The paediatric curriculum is the blueprint for UK paediatric training. It set out the standards that are expected of us at different points in their training; all trainees will need to show they’re meeting the curriculum requirements in order to progress through their training. The curriculum helps make sure training is consistent, makes sure we are accountable to patients, the public, and to the GMC. While being robust enough to ensure a standard of care is set, there has to be some flexibility in a curriculum to reflect the different training opportunities across the UK.

How was the new curriculum developed?

Around 200 clinicians, including trainees, were involved in developing the new curriculum. Children, young people and families also took part. RCPCH worked closely with the GMC to ensure the curriculum met their new standards. There was also input from employer representatives, special interest groups, and other Royal Medical Colleges to make sure the new curriculum would meet the needs of patients and the NHS now and in the future.

What will the new curriculum look like? 

The curriculum is structured around 11 domains:

• Professional values and behaviours, and professional knowledge
• Professional skills: communication
• Professional skills: procedures
• Professional skills: patient management
• Health promotion and illness prevention
• Leadership and team working
• Patient safety (including safe prescribing)
• Quality improvement
• Safeguarding
• Education and training
• Research

For each domain, there is a Learning Outcome (LO) for each level, which describes the standard trainees must demonstrate they have met for each domain by the end of Level 1, Level 2 and Level 3.

Level 3 trainees have additional LOs specific to either General Paediatrics or their GRID sub-specialty.

Syllabus documents explain the LOs in more detail. For each learning outcome there is an introductory statement which explains the outcome in more detail. They then list a small number of key capabilities – the mandatory parts of the LO that have to be demonstrated in order to achieve that outcome.

They also include examples (‘illustrations’) of other evidence trainees might want to include, to help show their Supervisor and the ARCP panel that they have met the standard required. We can use some of these, or none, or any other evidence that supports our achievement of the LOs. Each LO also has an assessment grid to show ways that trainees can demonstrate that they have met the expected standard.

 What will be expected of me?

When you add a new assessment to ePortfolio, select which LO it relates to, and which key capability. You and your Educational Supervisor should regularly consider which LOs you’re on target with, and which ones you need to focus on (perhaps using your PDP).

At the end of a placement, you and your supervisor complete a trainee-led supervision meeting form – you can write in this during your placement and save it for later. Kaizen will also pull through any assessments or reflections that you’ve completed during that training period. Your supervisor will then review your progress against each LO and will make a judgement about whether you’ve made adequate progress towards each learning outcome for a training level.

At the end of a training level, we will be expected to provide evidence that we’ve completed all the LOs and key capabilities for that level. This will probably be about 30 pieces of evidence per level – as opposed to the pages and pages of items that could be used in the current curriculum. Your supervisor reviews your evidence and makes a judgement, which will then be reviewed by the ARCP panel.

Do all trainees have to switch over?

All trainees will move from the current curriculum to RCPCH Progress from August 2018 after Summer ARCPs, unless they are due to CCT before 15 September 2019. You don’t need to re-demonstrate achievement of training levels already completed under the old curriculum i.e. Level 2 trainees will not have to show again that they have met the requirements of Level 1 training. Specific guidance about transition is available here.

What support will there be for trainers and supervisors?

There are a range of short videos, fact sheets and other supporting tools for College Tutors, supervisors and trainees, with more to come throughout Spring 2018. College tutors will be supported to cascade the message to supervisors at individual sites, with a toolkit to help trainers and trainees at their site be ready for RCPCH Progress to start in August 2018.

Will there be any new assessments?

No, trainees will still complete the MRCPCH exams, START and use the existing workplace based assessment (WPBA) tools. There will be a wider range of reflective notes which can be used to record other evidence for the LOs, but these aren’t mandatory. When carrying out a WPBA, trainees should focus on which Learning Outcome they were seeking to address.

Should I be doing anything now to prepare for transition?

Make sure you have had a look at the RCPCH Progress curriculum structure, and the LOs for your training level from 2018-19. There are videos available at the RCPCH website showing how ePortfolio interacts with the new curriculum.

The college will do their best to map any tagged items of the current curriculum, to the new curriculum. This will need a ‘sense check’ after the transition in August, to see that everything is under the LO you want it to be tagged to. The learning outcomes in the new curriculum may require trainees to record things that previously wouldn’t have been recorded (for example for leadership or communication). Get to know the LOs, and then if you are in a situation that could be used to evidence the new curriculum, you can record this in one of the new reflective notes; then after transition just open up the note and select the relevant LO to tag it to from the drop-down menu.

How will this work in Kaizen?

The Kaizen team have been an integral part of curriculum development – so there should be a smooth transition for trainees. All evidence already recorded in ePortfolio will stay there and can be used to demonstrate achievement of the new curriculum. Where trainees have tagged their evidence to a competency in the current curriculum, this will be mapped by the College to the LO we think it is most likely to apply to. Trainees need to review this after 1st August, and can move any of their evidence to a different LO if needed. Any untagged ePortfolio evidence will remain untagged, and so trainees will need to attach untagged evidence to a LO if they want it to count as demonstrating achievement of the outcome.

The forms for recording assessments are going to be updated and simplified: we will be able to select (from a drop down menu) which curriculum domain and LO an assessment relates to, (and also to tag a key capability or illustration that relates to that outcome). The RCPCH Progress webpage has some video examples of this form.

The Educational Supervisor form will also be updated, to be structured around the new RCPCH Progress domains, and taking a similar form to the consultant revalidation forms. During supervision meetings, you and your supervisors will review evidence that you have recorded for each LO.

What is it like in practice?

The new curriculum is already being used by a group of early adopters in London, Wessex, EoE, Mersey, and more recently Scotland. Kate Renton, an ST7 doing Paediatric Palliative Care training in Yorkshire, was keen to share her experiences:

“When my subspecialty elected to be involved in the pilot for the RCPCH Progress curriculum, I felt a little trepidation, but was generally optimistic. The old curriculum had felt so unachievable that it became more of a tick box exercise than a tool to guide my learning. RCPCH Progress is a breath of fresh air by comparison, and I’m a bit sad that I’m only getting to use it right at the end of my training. The generic curriculum appears to have been designed with the aim of turning out well rounded paediatricians, as opposed to those that merely have scientific and clinical knowledge. There is a much greater emphasis on preparation for becoming a consultant, with key capabilities including quality improvement and leadership. It allows for more flexible training to meet a trainee’s needs. Workplace based assessments have changed slightly too. There is a requirement to consider relevant learning objectives prior to requesting an assessment from a senior and this provokes reflection in the trainee prior to discussion. However, discussion may lead in an alternative direction, and learning objectives may need to be reconsidered and changed. And Kaizen? Well…it was not well received when it was first introduced. But even the haters must agree there have been vast improvements and the new curriculum integrates better with it than the old. Overall, I believe RCPCH Progress is a positive development by the college to improve and meet the needs of trainees. It may need some tweaking here and there, but the team at the college have been receptive to this. There will be some who are frustrated by the idea we are forced to follow a structured curriculum at all, but wow – it’s a thousand times better than the old version and Paediatric trainees will be all the better for it.”

Where can I find out more?

The curriculum, syllabi and a full range of resources designed to help trainees and trainers as they prepare for the transition to RCPCH Progress are available here. Your Educational Supervisor, Training Programme Director or College Tutor are also able to help with most queries. If you need further support, contact the RCPCH team by emailing progress@rcpch.ac.uk.

Dr Rachael Mitchell, Paediatric Emergency Medicine Registrar and RCPCH Curriculum Trainee Representative, with Jenni Thompson, Quality and Standards Manager (Education and Training).