Katherine Bettany: Our value as doctors cannot be wrapped up in ARCP

Junior doctors know that the third certainty in life, beyond death and taxes, is the annual review of competency progression, or ARCP.

For me at least, I have the same experience every year. The well meaning intention to spread work evenly across the year, but still feeling the inevitable rush as the deadline approaches to pin down remaining supervisors for a signature here, a certificate there. I haggle with my consultant’s secretary for a mutually agreeable time for a meeting. Together we pick apart my failings and achievements in detail, and then leave it all anxiously in the panel’s hands to decide whether I have done enough; whether I am enough.

I have some degree of despondence with the process. Not because I disagree with its purpose — I recognise that there has to be a way to homogenise us to ensure that we are competent to do the jobs that we have. Neither am I particularly unhappy with my portfolio’s content this year. Instead, I feel disappointed that the moments I am most proud of are not quantified or valued by the process.

Feeling like a good doctor, speaking as a relatively junior one, is a fleeting feeling. It is in no way diminishing of the work that we do to say that checking bloods, requesting scans, and writing discharge summaries often provide little opportunity to feel that way. One of the moments in which I did feel like a good doctor was when I held my dying patient’s hand, his grand-daughter holding the other, and helped her to understand what was happening in the middle of an unbearably loud and busy emergency department. There is no skill or curriculum item in my portfolio to file this against, nor should there be.

I’d even go so far as to say that my efforts to be what I consider to be a good doctor have actively detracted from my portfolio. Forgoing the chance to do a procedure, for example, in order to meet with a family that my team had been anxiously waiting to update all morning. Of course balancing training and what we call ‘service provision’ is a skill that can (and should) be acquired, but it is logical that this will get more challenging as demand rises and staff retention falls.

I am not advocating for ARCP to be all encompassing. It is not designed to evaluate every aspect of our work, and how could it? But by extension, then, our entire value as doctors cannot be wrapped up in it. Every meeting should not be dominated by it. We should be prompted to talk about the things we have achieved that are not quantifiable — instead of, like me and many of my wonderful colleagues do, being implicitly led to feel like failures for not checking all of the boxes, when we have many desirable qualities beyond its narrow reach.

ARCP is necessary, but it is not everything. Perhaps it is time for the way in which we are evaluated to have an ARCP process of its own.


Katherine Bettany is a medical trainee in the East of England.  @katybettany

Competing interests: none declared