COVID-19 Trainees FAQs
One result of the current COVID-19 pandemic is uncertainty about what will happen for those doctors currently in training. Geriatric Medicine StRs, and Internal Medicine Trainees and Foundation Year doctors are faced with challenges around exams, training and progression, which could be causing considerable anxiety. The BGS Trainees' Council committee and VP of Education, Professor Mike Vassallo have compiled these FAQs to help provide some clarity on what you can do, and what is being done to minimise the disruption to progression.
You can reach the chair of the Trainees' council committee, Dr Carly Welch, via trainees [at] bgs [dot] org [dot] uk or you can email Geraint Collingridge, as the BGS secretariat representative for the Councils' committee on g [dot] collingridge [at] bgs [dot] org [dot] uk, with further questions or resources to share.
All doctors in training (StRs, clinical fellows, IMT, Foundation year doctors and medical students who are members of the BGS are in the Trainees' Council.
ARCPs
Is there an expectation that any competencies I don’t complete this year, I will have to make up for in the years to come?
Yes before completion of training there is an expectation that all competencies will be completed. However, there is recognition that this year the COVID -19 pandemic has caused significant disruption. It is not the intention of Educational Bodies such as the Specialist Advisory Committee (SAC) in Geriatric Medicine or JRCPTB to hold progress. For the coming ARCPs, the SAC is about to issue a modified ARCP decision aid that reflects this disruption. The required competencies are the same, but the burden of work-based assessments and other requirements are reduced for this period. Critical in ensuring progression is a satisfactory Educational Supervisor (ES) report so make sure you get in touch with them in good time. Any pending competencies deferred to next year will need to be addressed. It will be imperative to identify these early on in your placement with your educational supervisor so that they can be addressed. You still need to pass the SCE exam. In some specialties it may not have been possible to hold the SCE exam this year. Luckily, this is not the case for our specialty. The aim is to hold the exam as planned next year provided the situation normalizes. HEE has also issued detailed FAQs about the ARCP process that may be of interest. (ARCP During COVID-19: Trainee Frequently Asked Questions)
May future geriatrics curriculum/ portfolio requirements change as a result of COVID-19?
During this COVID-19 crisis the ARCP decision aid is changing and portfolio requirements for the coming ARCP are going to be reduced. Longer term the curriculum in Geriatric Medicine is going to change because of the” Shape of Training” review but not as a result of COVID-19. There will be a new ARCP decision aid to complement this new curriculum, but this is still in the discussion phase. For the time being it is increasingly being recognised that the COVID-19 pandemic is providing unique training opportunities that enable trainees achieve competencies in the existing curriculum. Such opportunities include necessity for careful discussions around escalating care, palliative care, knowledge and appreciation for homeostasis, planning transfers of care and Comprehensive Geriatric Assessment to mention a few.
Redeployment
Will my August rotation be delayed? What happens if I missed my Apr/May/June rotation date?
I would like to refer to the document “Trainee progression in August 2020 and beyond - a letter from the four Statutory Education Bodies to Medical Royal Colleges”, 6 May 2020. As the letter suggests there is a drive to start getting things back to normal as quickly as possible but the pace of this is dictated by the National Alert Level. The situation re the Pandemic is still uncertain and things may deteriorate as well as improve. There is likely to be some country and regional variation how rotations will start depending on local circumstances. It is, therefore, best to clarify these with your Training Programme Director (TPD) and deanery.
As to the second part of this question, it is not possible to talk about individual circumstances and these are best addressed with your TPD, but those missing rotations starting in April are likely to move to their intended rotation when normality starts returning.
I have been redeployed (e.g. from Medicine to critical care) - will this be taken into account when assessing competencies at ARCP?
Yes, it will. Working in critical care offers significant opportunities to achieve competencies within the Geriatric Medicine curriculum. These include opportunities to address common competencies (breaking bad news, ethics , research, infection control etc), Comprehensive Geriatric Assessment, diagnosis and management of acute illness, planning transfers of care, delirium, homeostasis and palliative care to mention some of the educational opportunities that will arise in a critical care setting.
Will redeployment count towards training? When can I expect to be redeployed back to my original placement?
That depends on where the redeployment is. If the redeployment is shielding and away from clinical areas, not having patient contact for a significant proportion of time, the duration of training may be affected depending on the previous progress with gaining competencies and meeting curricular requirements. If on the other hand re-deployment is to another clinical area not Geriatric Medicine, the experience is almost certainly going to count for training. It will help if one demonstrates engagement in one’s own training and personal development and demonstrate how you have gained competencies required in the curriculum whilst in your placement.
The answer to the second part of the question is that return to normal will happen when the alert level in the country starts allowing this and normality starts returning.
Completion of training
What will happen if I am unable to reach my training requirements for completion of training (e.g. unable to attend a course that was cancelled, unable to obtain sufficient numbers of workplace-based assessments, unable to obtain subspecialty experience)?
If one has been unable to acquire capabilities in their core programme due to the impact of Covid-19 or if specific components of the curriculum have been unfulfilled, a plan needs to be in place to acquire such competencies. In ST3-ST6 remaining areas in the curriculum will have to be identified early in the next placement with your educational supervisor and arrangements made for time to be allocated to these areas as a matter of priority. The principal is that one cannot get CCT before getting all the competencies required in the curriculum. or without possibly having a plan to get the competencies in a period of grace after training is finished. If one is in the final year, for this year, as mentioned previously, the SAC in Geriatric Medicine is publishing a modified ARCP decision aid with the reduced requirement of work-based assessments and suggestions about doing certain courses during acting up or during a period of grace and should not be a bar to CCT. On the other hand, being unable to obtain subspecialty experience or other mandatory PYA targets may well delay CCT.
My PYA was delayed due to the pandemic, how can I ensure that my training requirements are obtainable so that my CCT is not delayed?
In accordance with the contingency planning statement published by the four UK Statutory Education Bodies on 19th March 2020, Penultimate Year Assessments (PYAs) have been suspended for the 2020/21 training year. A decision on the reinstatement of PYAs cannot be made until after COVID-19 restrictions have been lifted. Therefore, it might be worth checking whether the situation has changed seeing that there is some lifting of restrictions. Unfortunately, this is not in anybody’s control. However you can do some preparation yourself. You can analyse your portfolio with the ARCP decision aid in mind identifying areas of need. You might want to consider making an appointment with your educational supervisor to see how you can achieve some of the competencies locally even during this time. If not able, then make an appointment with your local Training Programme Director and start planning from now the next steps.
New geriatric medicine ST3 posts
I applied for an ST3 post in geriatric medicine but feel I have been unfairly affected by the shortlisting system - is there an appeals process I can follow?
National recruitment offices use a nationally agreed process for handling complaints about recruitment. Applicants with concerns about the recruitment process or who wish to make a complaint should contact the recruitment office to which they applied to obtain further information on the complaints procedure.
I have been appointed into an ST3 post in geriatric medicine but was unable to sit my PACES exam as this was cancelled – will I still be able to progress to ST3 level?
It looks like you can. The document “ARCP outcomes for CMT trainees who are expecting to finish this programme in August 2020” states that if you Passed MRCP(UK) Part 1 and Part 2, no PACES (or passed PACES and Part 1, but not Part 2) and unable to sit until Autumn 2020 and if curriculum sign off, supervisor’s reports and SLEs are up to date, you will be eligible to take up any ST3 post to which you are appointed. Progression beyond end of ST3 will not be possible without MRCP diploma. You will need a training plan at the start of ST3 to address issues and you will need ARCP at the end of ST3 that reviews progress in outstanding issues. Further details about different scenarios can be found on the above document on the JRCPTB website.
I have been appointed to an ST3 post in geriatric medicine but there is a possibility that I will not achieve all my ARCP competencies for completion of core medical training in light of the COVID-19 pandemic; will I still be able to progress?
Like the previous reply refer to the document “ARCP outcomes for CMT trainees who are expecting to finish this programme in August 2020” The document provides various scenarios that may apply to you. In general, lack of progress will result from a complete lack of engagement prior to COVID-19 pandemic or a missing/poor ES report, MCRs or MSF (or other evidence) that raise significant performance or patient safety concerns. In most other circumstances progress is not going to be stopped.
Academic training
All academic trainees were asked to return to full-time clinical service, as admissions are now declining, when can we expect to be able to return to academic work?
Like everybody else it is not clear when this will happen although as mentioned above there is a strong desire across all nations to start normalising processes. It is likely to depend on local circumstances and how quickly things are returning to normal in the country and in the area you are working in. It may be worth also referring to https://www.rcplondon.ac.uk/news/clinical-academics-and-covid-19 for more information.
Is there a possibility for flexibility if research is COVID-19 related?
I cannot answer this question and best addressed locally and with the funding body or University sponsoring your research. There is considerable research interest in COVID-19 so interesting proposals could generate support and it is possible that on an individual basis one can do research on COVID-19 instead of clinical work. I must stress again however that this is very much dependent on local support.
Out of programme
I was out of programme but have now returned to clinical service, will this time be prospectively recognised towards clinical training?
Yes: I will refer to the document from HEE “ARCP During COVID-19: Trainee Frequently Asked Questions”. The Statutory Education Bodies have agreed that experience gained by trainees who have returned from OOP to take up clinical duties may be used as evidence for their progression. On your return to work you will need to have a named educational and clinical supervisor who can support your educational development. Make an appointment with them in the usual way. It is important that you demonstrate how the work you are doing relates to the curriculum through work based assessments if possible, reflection and consultant report etc.
I was requested to return to full-time clinical service from OOP. As admissions are now declining, when can I expect to be able to return to my OOP? Will the end date of my OOP be automatically extended?
Educational bodies have stated that they wish to provide assurance to trainees who have returned to frontline services, that they will be able to return Out of Programme(OOP) or to complete their parental leave after the peak of the COVID-19 crisis has passed, assuming the OOP provider can accommodate this. It is unlikely that the situation is going to change significantly before August 2020. OOP’s are going to need to be considered on an individual basis as to extensions. It will be good therefore if you see what the demand is in your locality and then discuss with your TPD and sponsor when you can move back to OOP.
My OOP has been approved for the next academic year - is there a possibility that this might be cancelled?
Unfortunately, it may be in the same way OOPs have been cancelled this year if this pandemic persists. Hopefully, there will not be a second spike or new variant COVID-20 and we can all return to normal ASAP.
COVID-19 Training opportunities within Geriatric Medicine HST
The impact of the COVID-19 pandemic on training across all specialties remains unclear, though disruption is expected. However, early insights from those geriatric medicine trainees and trainers supporting COVID-19 cohort specific wards highlights an abundance of although challenging, highly applicable and varied training opportunities. The emergence of necessity for careful discussions around escalating care, robust palliative care knowledge and appreciation for homeostasis without previously encouraged ‘hands-on’ clinical approaches indicates a close alignment with the Geriatric Medicine HST.