Guidance for Completing ESSRs in the FICM LLP

General principles

IiT's Responsibility

IiTs initiate the form. Care should be taken to ensure that everything which needs to be seen by the ES and subsequently the ARCP panel is linked and viewable via the ESSR form.

PLEASE NOTE: For Dual Anaes IiTs it may appear that your Anaesthetic ESSR (created in your RCoA learner tab) copies over to your FICM LLP. However, your ICM Trainers do not have permission to view this RCoA form, therefore Dual Anaes IiTs will need to create an ICM ESSR in their FICM LLP for their ICM ARCP and an Anaes ESSR in their RCoA LLP for their Anaes ARCP in order for the respective ARCP panels to view your progress against the relevant curriculum. 

ES's Responsibility

The ESSR is a key document for the ARCP panel to review.  The judgements and comments included by the ES are crucial to the decision making process of the ARCP panel. Therefore, the ES needs to take the time to closely review the evidence presented, check what has been included and is viewable (and guide where things may be missing). They should also comment on the StR’s progression in the relevant sections of the form. Qualitative, factual, objective comments and feedback on progression is needed, both for the decision making and for the IiT’s development – commentary on their progression through training should be included, with an indication of what supports that judgement.

The ESSR form has 15 sections in the LLP which are described below:

1)    Overview

Start Date & End Date. The period the ESSR form covers.

2)    Placements in Programme

Placements over the last year. Please remember to fill in placements in your dual specialty as these are still relevant to ICM training. Adding notes summarising placements is also very helpful. See the table below for an example:

3)    Examinations

Please note all IiTs in Stage 1 are required to have FRCA Part 1 MCQ/OSCE/VIVA or MRCP completed, full MRCEM/FRCEM intermediate exam before progression to Stage 2. All are required to have FFICM before progression to Stage 3. ANY ISSUE NEEDS documenting in section 16 - ES comments.

4)    Milestones

Self-propagated

5)    Personal development plan

A PDP should be included that indicates the IiT’s short, medium and longer-term goals. There should be a comment on whether objectives have been achieved or not, with reflections. See the example below:

6)    Supervisory Meeting

Please add a description of what was discussed i.e ‘catch up’ or ‘ESSR completion’.

This section can be populated by the IiT from the documented supervisory meetings. A different way of working is needed by the ES (and IiT) in recording these supervisory meetings, in that the IiT initiates them – two approaches to this: write it together at the meeting, or to copy & paste from an email exchange detailing and agreeing what was discussed between the ES to the IiT.

7)    Review Unit progress

Please be cautious of signing off HiLLO with very little evidence presented, e.g. one SLE. There is no prescriptive number of SLEs but it should be ensured that the scope of the HiLLO’s key capabilities are covered. The Faculty suggest that quality is better than quantity, requiring a broad breadth and depth depending on the stage of training. In the later stages there may be more CbDs ACEXs and ACATs where a broad discussion has occurred. See Faculty guidance for more detail here.

The ES needs to make judgements on the IiTs progression for each HiLLO. You should sign off HiLLOs towards the end of a stage, or the period of time you are providing supervision for, when all evidence is available, with commentary on the evidence considered. 

When a HiLLO is not signed off/partially completed PLEASE comment on evidence gathered towards the HiLLOs in general. For example - Any not done? Any gaps/issues etc.?

Examples of evidence: see the HiLLO and capability blueprints.  This can include SLEs, e-learning, CPD activities, MCR, MSF, Simulation, and personal observations (of the ES).

For non-ICM units, it is key to seek triangulating evidence from the clinical supervisor of that unit. So, an end-of-unit placement report (local format to be used) is required that provides information on the IiT’s progress, engagement and activities during that placement.

8)    Supervised Learning Events 

Most are linked to HiLLOs so won’t necessarily appear here. Only the ones not linked to a HiLLO appear in this section of the ESSR Form and they should ideally be linked in the future. This again is an area where a comment on how many SLEs have been done or what is needed for a particular HiLLO would be useful. Also, a discussion of generic HiLLOs, if not already discussed, would be useful here.

It is important that the StR shows engagement with their training, including its evidencing. This is a key professional responsibility. This includes engaging with seeking assessments.  

It is in either section 7 or 8 of the ESSR Form that the ES should comment on the procedural logbook which is a mandatory requirement of the curriculum. For example, doctors need to evidence the number of intubations/airway procedures/tracheostomies. No. of lines. No. of BSDT etc. See the example below:

9)    Multisource Feedback 

1 MSF is required per year. PLEASE cut and paste key relevant comments and give the no. of respondents so the ARCP panel has an idea of the feedback received and the number of people questioned. If the IiT or ES consider it helpful, an additional MSF may be conducted (e.g. for work within a non-ICM module or where training in a partner specialty). See example below:

10)    Consultant Source Feedback 

These are treated the same as an MSF summary above -  it should list the number of respondents and general comments. MCRs are really important for the ES if they do not work with their IiT. It is this feedback that will help ESs sign off the HiLLOs.

Multiple Consultant Reports (MCRs) may become mandatory in the near future and a comment on how many and the type of feedback received will be important here.

It is not expected that MCRs are needed from every single unit of training; they should be done when working in ICM, assessed by consultant intensivists able to comment on their progression as an intensivist in training.

11)    Non Clinical Activities

Particular comment on the Generic HiLLOs 1-4 is a good idea here. It is helpful to identify here what the doctor has done during the period being assessed. For example - What courses have they attended? What teaching have they delivered? What QI project has been planned/completed with outcomes etc.

12)    Absences 

Self-propagated

ES may wish to comment, factually and constructively, but also with confidentiality in mind.

13)    Form R

Self-propagated.

GMC revalidation process runs in parallel to the ARCP process, and is considered at the same time by the ARCP panel.

All professional activity must be included on this form. This includes dual/triple specialty, locum, prehospital work, crowd doctoring etc.

The ES should provide triangulating commentary that they have reviewed the Form R, and on any declarations that have been made by the IiT, e.g. resolution of complaints, involvement in/reflections on and support provided for any incidents the IiT has been directly involved in.

Please note: If a Form R is not attached to the ESSR, the ES SHOULD NOT APPROVE the form but return it to the IiT, asking for their Form R to be included, as this is essential information for ARCP panels to review to inform their outcome decisions. 

For IiTs in Scotland the process is slightly different as they dot not have Form Rs. The IiT should complete a 'SOAR declaration' that is reviewed by the ES and TPD instead but this document does  not need to be incorporated into the ESSR. 

14)    Details of any concerns/investigations 

Please use this section of the ESSR Form to summarise any issue documented in Sections 12 or 13. If the trainee has filled out a Form R with an incident, please detail it here (Incident, investigation, outcome, reflection) so the ARCP panel can consider. 

15)    Comments

Learner’s Comments
IiTs chance to explain how the year has gone, challenges and achievements.

Supervisor’s comments
Time for the ES to indicate their views on the IiT’s progression covering everything above if you have not put it in the place it should be, and give the ARCP panel an overview of the IiT’s year. It is really important that achievements or difficulties are discussed here to inform the panel.

Faculty Tutor comments
The FT should cross-check whether the ESSR has been adequately completed by both the IiT and ES, and provide any additional comments they feel they can to the document.

SUMMARY

In essence the ESSR form is an assessment to allow an independent ARCP panel to have as CLEAR an idea possible as to what has been achieved in the last year of training, so an informed judgment can be made as to progression. 

It is up to the IiT and the ES to provide the detail to enable the ARCP Panel to make their decision in a timely manner.