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In-training assessment for specialist registrars: views of trainees and trainers in the Mersey Deanery

John Bache FRCS   Jeremy Brown PGCE     David Graham MD FRCP  

Mersey Deanery, Hamilton House, 24 Pall Mall, Liverpool L3 6AL, UK

Correspondence to: Mr John Bache FRCS, Deputy Postgraduate Dean

	SUMMARY

TOP SUMMARY INTRODUCTION METHODS RESULTS DISCUSSION REFERENCES

 
Annual review of specialist registrars and production of a record of in-training assessment (RITA) is a mandatory component of training that has attracted criticism. Mersey Deanery has established a system of review that includes wider evaluation of the trainee's needs and of training requirements. We conducted a survey to ascertain whether this broadened review process was thought beneficial. In one year 1093 questionnaires were distributed to trainees and trainers.

605 (81%) of 744 trainees and 309 (89%) of 349 trainers responded. At least 89% of both groups said that the procedure had been effective in reviewing the previous year and the most recent post and in identifying training requirements. More than 90% rated the overall process positively. Trainees particularly appreciated the advice on future training, on careers and on research.

This form of review is expensive in consultant time but was valued by both trainees and trainers.

	INTRODUCTION

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When the specialist registrar (SpR) grade was introduced, the rules specified mandatory annual assessment. A record of in-training assessment (RITA) collates the evidence for progress through the training programme and the grade¹. The RITA process is conducted in various ways by different deaneries. In the Mersey Deanery, training during the past year is reviewed, a RITA form is issued², and we also take the opportunity, while the trainee and trainer are present, to discuss future requirements for each specialist registrar. Such requirements depend very much upon the individual trainee and the stage of training; for example, towards the end of training they may be influenced by job prospects and the need to develop particular skills. In view of the resource implications, we considered it important to establish whether the trainees and panel members felt that the process was useful.

The main purpose of the RITA process is to determine whether the trainee is on track to become a safe and effective specialist. At each review it is necessary to establish basic facts, including the training number, the year of training under review, and the expected date of the Certificate of Completion of Specialist Training (CCST). Specific documentation collated before the annual review includes trainer's report/assessment forms, curriculum vitae, and the training record/logbook/portfolio. The training to date, particularly the previous year, needs to be reviewed. The RITA panel examines the evidence, meets with the trainee and trainer and decides whether progress has been satisfactory. Any problems need to be identified and future training planned. Research, audit and publications are also reviewed as part of the process. Career intentions are discussed: this is increasingly relevant as the CCST date approaches, since a trainee's aspirations must take account of the employment climate in his or her specialty. During the review, a separate but connected evaluation of the most recent post is conducted for the benefit of both trainees and their trainers.

The make-up of the panel varies between specialties, but it is always chaired by the postgraduate dean or his representative and includes the programme director, the regional adviser and often a university representative. At a penultimate review, there may be an external assessor or a representative of the specialist advisory committee. Most specialties expect the supervising consultant to attend, particularly if a problem has been identified. Often individuals can combine these functions, to limit the size of the committee. The interview is semiformal and is structured to ensure that each aspect is covered.

	METHODS

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At the end of each review, the chairman provided each trainee and trainer with a short questionnaire to be completed and handed in immediately or returned to the Deanery as soon as possible. The trainee was aware that the questionnaire had no bearing on the assessment. Anonymity was optional. The questions were to be answered on a scale of 1 (totally disagree) to 10 (totally agree). In the analyses, scores of 6-10 were rated positive and 1-5 negative.

	RESULTS

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1093 questionnaires were distributed in the year to 10 September 2001. 605 (81%) of 744 trainees and 309 (89%) of 349 trainers completed and returned questionnaires.

On training and progress during the past year, 94% of trainees and 96% of trainees felt that this fundamental purpose of the review had been achieved (i.e. they gave positive answers). Likewise most of them, 95% and 97% respectively, thought that future requirements had been identified. 89% of trainees said that useful career advice had been offered. 89% of trainees and 91% of trainers said that the most recent post had been evaluated. Both trainees and trainers indicated that the process was of benefit—91% and 95%. It was scored 10 out of 10 by 33% and 42% respectively.

	DISCUSSION

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This survey indicates that the trainees and the panel members judged the review process beneficial. We do not think this was because they felt obliged to respond favourably. Although they were handed the questionnaire, usually by JB, immediately after the review, they were at liberty to return the forms to the Deanery by post.

Faux and Bailey³ found that surgical trainees had a low opinion of the efficacy of the RITA; only 30% thought it provided an adequate assessment of their year's training, and not many more (41%) felt it identified areas that required strengthening in the coming years. Unfortunately, their paper does not describe how the annual reviews were conducted. In our survey, certainly, the level of satisfaction was far higher. Paice et al. found that the satisfaction of specialist registrars with training within their current post increased after the implementation of the Calman reforms^4,5. Our findings show that the annual review process within the Mersey Deanery is perceived by most trainees as adding value to specialist registrar training.

The review process as carried out in the Mersey Deanery includes more than the assessment of the trainee as laid out in The Orange Guide¹ and has four elements. The prime purpose is to carry out the RITA review and allowing the award of a C, D, E, F or G. It enables career advice to be provided and, finally, it considers the educational value of the post. This method of undertaking the annual review is labour intensive, but we see it as important in ensuring that consultants of the future proceed through programmes of high quality.

	Acknowledgments

 
We thank the specialist registrars and consultants who took part in the study and the assessment department at the Mersey Deanery for help with survey distribution and retrieval.

	REFERENCES

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1. Department of Health. A Guide to Specialist Registrar Training. London: DoH, 1998:131 -63

2. Bache J. Making friends with RITA. BMJ1999; 318(classified section 13 Feb): 2-3[Free Full Text]

3. Faux JW, Bailey IS. RITA and the general surgical registrar. Ann R Coll Surg Engl2001; 83(suppl):88 -90

4. Paice E, Aitken M, Cowan G, Heard S. Trainee satisfaction before and after the Calman reforms of specialist training: questionnaire survey. BMJ2000; 320:832 -6[Abstract/Free Full Text]

5. Catto G. Specialist registrar training. BMJ2000; 320:817 -18[Free Full Text]

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