Key Documents and Help

The curriculum will be ‘outcomes-based’, allowing trainees to be assessed against the standard of a day-one consultant in their specialty i.e. you will reach the end of training when you reach the standard expected of a day-one consultant. The Multiple Consultant Report (MCR) will measure the progression of trainees towards that standard. Trainees will be assessed by the Clinical Supervisors with whom they work on a daily basis, rated on the level of supervision they require to perform the five Capabilities in Practice (CiPs). They will also be rated on the Generic Professional Capabilities (GPCs) required of all doctors which will carry equal weight to the CiPs.

In addition;

• Training will be arranged in phases
• The updated Learning Agreement will help focus training on progression through the CiPs and GPCs
• The role of WBAs will be re-balanced
• New transition arrangements will apply

The CiPs describe the generic clinical activities and skills needed to practice independently at the level of a day-one consultant. When trainees are assessed through the Multiple Consultant Report (MCR) as able to perform these essential activities independently (level IV or V), together with the Generic Professional Capabilities (GPCs), then they are considered safe and ready for certification and appointment to a consultant post.

The five shared CiPs are:

• Manages an out-patient clinic
• Manages the unselected emergency take
• Managing ward rounds and the on-going care of in-patients
• Manages an operating list
• Manages multi-disciplinary team working

The specialties below have described additional specialty-specific CiPs:

Cardiothoracic

• Manage patients within the critical care area
• Assess surgical outcomes both at a personal and unit level

Paediatrics

• Assesses and manages an infant or child in a NICU/PICU environment

Plastics

• Safely assimilates new technologies and advancing techniques in the field of Plastic Surgery into practice

The GPCs describe the essential professional behaviours required of all doctors in the UK, replacing the professional and leadership skills syllabus. They are equivalent in importance to the Capabilities in Practice (CiPs) and satisfactory achievement by trainees will demonstrate that they have the professional behaviours needed to provide safe, effective and high quality medical care in the UK and the Republic of Ireland.

The GPCs were developed by the General Medical Council and Academy of Medical Royal Colleges in response to fitness to practise data and reports from several high profile patient safety inquiries which identified major deficits in basic areas of professional practice. They recommended the need for specific training to address these shortfalls which corresponded with the outcome of the Shape of Training review which recognised the need to develop a consistent approach that embedded common generic outcomes and content across all postgraduate medical curricula. The nine GPC domains are:

• Domain 1: Professional values and behaviours
• Domain 2: Professional skills
• Domain 3: Professional knowledge
• Domain 4: Capabilities in health promotion and illness prevention
• Domain 5: Capabilities in leadership and team working
• Domain 6: Capabilities in patient safety and quality improvement
• Domain 7: Capabilities in safeguarding vulnerable groups
• Domain 8: Capabilities in education and training
• Domain 9: Capabilities in research and scholarship

Generic Professional Capabilities (GPCs) video

The benefit for trainees is that by being assessed against the standard of a day-one consultant, they and their trainers will be able to better monitor whether they are on track to meet that standard at the end of training. Trainees will be able to move through training at their own speed and finish early if they acquire the necessary skills faster than the indicative time. The Multiple Consultant Report (MCR) will also result in improved feedback to drive learning, and workplace-based assessment will be tailored to trainee need rather than requiring a trainee to record a certain number per year.

The benefit for Clinical Supervisors will be that the MCR will centre on their professional judgement of trainee performance based on their knowledge of working with trainees rather than on the use of checklists. Training Programme Directors and Assigned Educational Supervisors should also benefit from the information from the MCR to help them monitor trainee needs and progression and tailor the next period of training to specific areas for development identified by the MCR and self-assessment.

That is correct. In an outcomes based curriculum a trainee can be awarded an ARCP outcome 6 when they reach the level of a day-one consultant (supervision level IV in all the CiPs and ‘appropriate for phase in all the GPCs) and have met any other certification requirement. Certification will follow the rules of the Gold Guide and minimum training times described by legislation.

From August 2021, trainees entering surgical training and starting a new curriculum must follow the new curriculum.

In August 2021, surgical trainees entering the final year of training in their specialty or the final year of decoupled core training can remain on the old curriculum or choose to move to the 2021 curriculum after consultation with their Training Programme Director.

Trainees who have not reached the final year of training must move to the new curriculum as they enter their next training level – for most this will be August or October 2021.

From August 2023, all new surgical placements will be under the 2021 curriculum.

Transition plan

Domain 9 of the GPC framework sets out the broad research capabilities trainees need to acquire for certification. Trainees should draw evidence from multiple domains throughout their training and by certification show research skills at a level commensurate with a day-one consultant. The 2021 curricula allow for multiple ways of meeting these capabilities and, therefore, do not set out a rigid framework that must be followed. The JCST and Confederation of Postgraduate Schools of Surgery (CoPSS) have provided examples of ways to demonstrate research capabilities in our Guidance for certification requirements on research.  

Yes, WBAs will still be important as a formative tool for trainee learning. They can still be used by trainees to generate and record feedback on specific tasks, or by trainers as part of a package to ensure that specific training development needs have been addressed. WBAs will be particularly important for ensuring attainment of breadth and depth of knowledge and skill in the Index Procedures (DOPS and PBA) and Critical Conditions (CEX/C and CBD). However, they will no longer be driven by minimum numbers for all but by trainee learning needs.

Clinical Supervisors will still be able to make short feedback ‘field notes’ in trainee portfolios throughout training, but they will no longer be a mandatory element of the Learning Agreement.

All the Clinical Supervisors (CSs) who work with a trainee should assess the trainee through the MCR, with one CS acting as Lead CS and ensuring trainees receive timely feedback from the mid-point and final MCRs.

The Lead Clinical Supervisor will see a range of alert links on their personalised dashboard and should click the orange link which says ‘the MCR for your trainee is ready for you to complete’. It will also show the trainee’s name and indicate whether it is a midpoint or final MCR.

The MCR form can now be filled in and will need to be completed before the trainee’s next Learning Agreement meeting. Please bear in mind that because the midpoint MCR is optional, if it is not completed by the time the midpoint Learning Agreement meeting is signed off by the trainee and Assigned Educational Supervisor, the dashboard link to the MCR will no longer work and any ‘in progress’ midpoint MCR will be deleted.

No, The MCR has been designed to be assessed by consultant surgeons who act as Clinical Supervisors.

The MCR should include all the CSs who work with the trainee on a day-to-day basis. The minimum is more than one and there is no maximum number.

The MCR should result from a collective discussion between all the CSs who are involved in training the trainee and represent a consensus view of the trainee’s trajectory and any required development. These meetings often happen informally and need to be captured more formally in future e.g. they might typically be fitted in at the end of other scheduled meetings. If any CS cannot attend the MCR meeting or disagrees with the consensus report, they will be able to add comments to the consensus MCR afterwards.

The recommended and preferred method of completing the MCR is through a local faculty meeting as described above. However, if a unit is unable to arrange such a meeting then individual CSs can complete their own MCR form. It would then be up to the AES to collate these opinions with their own additional comments.

A lead Clinical Supervisor (CS) needs to be chosen from among the CSs responsible for a trainee who will organise and chair the MCR meeting, transcribe the consensus MCR during the meeting and provide or delegate an MCR feedback discussion with the trainee after the meeting.

The MCR is a high-level faculty discussion that may encompass more than judgement about trainee performance. It may identify common ground and a plurality of ideas and approaches through small group discussion. It may also review and evaluate areas of the quality management and control of training, as well make decisions about action plans and resources. Trainees will be able to discuss the MCR and their corresponding self-assessment in a subsequent face-to-face feedback session.

The nature of the MCR is subjective because it engages a wide range of professional judgements from a group of consultant Clinical Supervisors (CSs) who have worked with the trainee on a day-to-day basis. A critical role will be played by the Lead CS who will ensure that the group understands their role, helping to ensure balanced views are recorded as well as ensuring all have an opportunity to participate. The MCR approach encourages the sharing and discussion of the reasons for the judgements made.

Trainees will have a corresponding self-assessment and be able to discuss this and the MCR in a face to face feedback session. The trainee’s Assigned Educational Supervisor (AES) will be responsible for taking an overall view of the MCR and it will be important that trainees raise any concerns they may have with their AESs, especially in advance of the mid-point review.  Training Programme Directors will be responsible for quality managing the overall process.

Not a great deal. As with any new system it might take a little longer to use at first until you become familiar with it.  The MCR will put professional judgement of trainers at the centre of assessment, and will also improve feedback for trainees and for these reasons it has been very warmly received in our pilots.

Clinical Supervisors (CSs) - will need to participate in the Multiple Consultant Report (MCR) meeting on two occasions in each placement and one will be nominated as the Lead CS with additional responsibilities. However, this additional assessment will be balanced against the removal of target numbers of workplace-based assessments (WBAs) and the removal of a mandatory requirement for CS Reports.

Assigned Educational Supervisors (AESs) - will need to review the MCR as part of the Learning Agreement meetings. However, the updated Learning Agreement has been streamlined to show information from the MCR in a meaningful way and the final review has been combined with the AES’s end of placement report.

Training Programme Directors (TPDs) - the introduction of the new curriculum will result in the need for local training and induction for trainers and trainees respectively and consequent quality management. TPDs should make provision at the earliest opportunity to allow for this as well as the transition of trainees to the new curriculum. It is particularly important that arrangements are put in place well in advance for trainees who are out of programme or less than full time.

Trainees - will have an additional self-assessment and feedback session on two occasions in each placement. The MCR might result in the need for further development which might impact on your training. WBAs will still be important and will be required to demonstrate achievement of the index procedures (DOPS and PBA) and critical conditions (CEX/C and CBD) and according to needs rather than a requirement for a target number.

In the early stages of training, a few small tasks relevant to the day-one consultant may reflect very significant responsibilities for junior trainees, and as trainees develop, these become part of larger, more encompassing responsibilities. The MCR can be used to indicate whether trainees are on an appropriate trajectory and highlight areas that they need to consider or develop further over the next 3-6 months. In core surgical training there is a finer gradation of supervision levels to capture early progress more meaningfully and allow demonstration of progress towards consultant level.

The MCR (incorporating the professional judgement of trainers) will provide an additional source of evidence in the trainee portfolios. It must be undertaken towards the mid-point and end of each placement in a formative way and will contribute to the AES’s summative final review meeting of the learning agreement. The ARCP makes the final decision about whether a trainee can progress to the next level or phase of training. It bases its decision on the evidence that has been gathered in the trainee’s learning portfolio during the period between ARCP reviews, particularly the AES report in each training placement. Any appeals following that must follow the appeal process described in the Gold Guide.

The MCR and the trainee self-assessment should allow a smoother transition back into clinical training than is currently the case by helping to identify any specific learning needs soon after return. The MCR will still take place at the mid and end-point of each placement, and before the mid-point it will be important to check on the achievement of the Generic Professional Capabilities (GPCs) and Capabilities in Practice (CiPs) and identify any additional support needed such as additional supervision, time and targeted assessments.

Transition plan

There is no maximum. When setting up a new placement, trainees should list all the Clinical Supervisors (CSs) with whom they will work. The minimum is two. Click in the CS field and type the GMC number of the CS or use the selection adjacent selection box to choose previous CSs.

The MCR is a group opinion rather than the view of one person and is very powerful. It should involve a minimum of two surgical consultants who work with the trainee on a day to day basis. Non-surgical consultants can also be invited to attend if they work with the trainee in particular areas. In rare situations where a trainee may only work with one surgical consultant, it may be necessary to discuss the situation with the Training Programme Director.

Yes. While the MCR is a consultant report, the MSF provides an opportunity for constructive feedback from a wider range multi-professional team members on the attitudes and behaviours that relate to good team working.

The CS Report is no longer mandatory for the Learning Agreement. It remains as an optional tool to enable CSs to continue making short ‘field notes’ about trainee performance. CS Reports will typically refer to observations of a trainee after a specific interaction in the workplace practice. They will appear in the Learning Agreement and provide additional evidence of the trainee’s progression in the placement.

No. The educational principles upon which the MCR is based mean that all clinical supervisors who work with trainees in a placement must have the opportunity to contribute to the MCR. Removing them from the MCR risks aspects of performance being overlooked and may impact patient safety.

After the MCR meeting, all clinical supervisors named in the trainee placement will receive a link to the MCR, giving them the opportunity to add comments. It is the responsibility of each clinical supervisor to act on the invitation, whether it be to agree or disagree with the outcomes of the MCR. Once all contributors have chosen to agree or disagree with the MCR, it will be available for the AES to complete the process.

The Learning Agreement and MCR are linked in order to ensure trainee performance against objectives is reviewed and fed back to trainees midway through a placement. It helps to pick up development needs and ensure a fair final decision is made at the end of the placement by the training body. Each stage in the process has to be completed before the next becomes available. Because the assessment system has been designed to be sequential, a delay in one part of the sequence could impact the next part, delaying, for example, the timely completion of the Learning Agreement and the provision of the MCR. In order to highlight any problems, you may find it helpful to use this reflective template to communicate any mitigating factors or extenuating circumstances relating to the inability to provide the required evidence for the ARCP.

Yes. There is a trial version of the MCR / Self-assessment available here.

Please note:

• It will not be saved into the training portfolio or form part of the learning agreement
• Use the ‘Print’ button on the report page if you wish to save it
• It must not be taken into consideration in formal assessment (ARCP)

The MCR and Self-assessment will become a central part of the Learning Agreement and assessment process after the Trainee has transitioned to the new curriculum.

No. The ISCP MCR is not designed for CESR, see instead the MCR for CESR in the CESR section of the JCST website here.

No. The descriptors provide prompts to aid the holistic professional judgement made by Clinical Supervisors rather than a competence checklist. They help to provide the language to feedback to trainees about their performance where it is considered necessary. In order to complete training, trainees need to be judged to be at supervision level IV or V in all the CiPs and ‘appropriate for phase’ in all the GPCs within the context of the specialty syllabus.

Not necessarily. During training, trainees may be progressing satisfactorily with some areas marked as ‘for development’. However, in order to complete training, trainees need to be judged to be at supervision level IV or above in all the CiPs and ‘appropriate for phase’ in all the GPCs within the context of the specialty syllabus.

In order to avoid overwhelming the trainee, any feedback for consideration or further development should be focused on what can be achieved over the next 3-6 months.

Collectively, the Clinical Supervisors (CSs) who are involved in training trainees on a day-to-day basis should be able to make judgements about all the CiPs. Some may not be able to make a judgement about all the domains of the GPCs and coverage of these areas will also be provided by the trainee’s Assigned Educational Supervisor.

1. Go to www.iscp.ac.uk and click ‘REGISTER’ in the top right hand corner
2. Select the relevant option to create an account
3. Fill in all the relevant fields providing your information, which will including providing an email and a password
4. Read and agree to the terms and conditions
5. Click ‘Register’ at the bottom of the page

1. Go to the ISCP website at www.iscp.ac.uk
2. In the login section under ‘Your Secure Area’ click ‘Lost your password?'
3. Type in your email address
4. Click ‘Send Reset Password Email’

1. Login to your trainee account at www.iscp.ac.uk
2. Select the ‘DASHBOARD’ tab
3. Trainees – under ‘TRAINEE SETUP’ select ‘Account Details’ / Trainers - under ‘MY DETAILS’ select ‘Personal details’
4. Select the ‘Change your password’ tab
5. Fill in the necessary fields and click ‘Change Password’

The storage capacity has been increased to 200MB per user in v10 of the ISCP website. However, should you come close to exceeding this limit you will need to contact us on helpdesk@iscp.ac.uk or 020 7869 6299 in order to have your limit extended.

Please be aware that you can only change details within your own account. If you call on behalf of someone else, we will be unable to assist you in making any changes to their account.

The ISCP is optional for SAS Doctors. It contains an e-portfolio and workplace-based assessments that could be used to showcase workplace learning and development. For those who wish to use it, a fee is payable (details here) and a technical step guide is available here. The Multiple Consultant Report for CESR is not included in the ISCP and can be found on the JCST website here

1. Login to your trainee account at www.iscp.ac.uk
2. Select the ‘DASHBOARD’ tab
3. Select ‘JCST Fee’ under ‘TRAINEE SETUP’
4. Click the orange button for ‘Make a Payment’
5. Select the relevant academic year with payment amount
6. Confirm the payment details and click to confirm.

Please note: We use Barclays secure website to take your account details. Your order will not be confirmed until after you have completed the Barclays payment process.

We only offer reductions to the JCST fee to surgical trainees in approved training programmes. Surgical Trainees are entitled to claim reductions when undertaking periods of out of programme such as OOPC, OOPE, OOPR (if not counting towards certification) and/or when they are out due to statutory leave such as maternity/paternity leave or long term sick leave. Additionally we offer a reduced fee for trainees on less than full time training.

Please contact the ISCP Helpdesk on helpdesk@iscp.ac.uk or 020 7869 6299 with the details of why you think you might be entitled to a reduced fee. Please note that we will need to confirm these details with your Deanery/LETB, which can take time, so please let us know as far in advance as possible .

Please be aware that you do not have to create a placement in order to record WBAs and/or other evidence. If you wish to create a placement, select the "Demo TPD" and the "Demo Deanery". If the training levels available in the placement are not applicable please select "Other".

Please contact the help-desk here to amend your learning agreement once validated.

You are also able to add comments to input any details you may have missed without needing to amend. You can do this by doing the following:

1. Login to your trainee account at www.iscp.ac.uk
2. Select the ‘LEARNING’ tab
3. Select the Relevant Placement
4. Select the ‘Comments’ tab
5. Type comment into the box provided and click ‘Add Comment’. Comments will be shown in your portfolio within the relevant Learning agreement.

Your AES can add comments to your learning agreement in a similar way through their own ISCP account.

Following the submission of the MSF, you will be given the option to retract your MSF to make amendments.

Possible amendments are:

• Remove a rater if their rating has not yet been submitted
• Add a new rater

Note that retracted MSFs can be deleted.

IMPORTANT - Once an MSF has been validated by the AES, it can no longer be retracted

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