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Appealing F1 ARCP decision after failing F1 for the second time

Hi everyone, looking for any advice as I support my brother in writing an appeal to his University after he has failed passing his F1 for the second time. (I'm from Canada and not familiar with the UK licensing process). His Uni has provided 3 possible grounds for appeal:

1) procedural irregularities in the assessment process
2) decision was manifestly unreasonable
3) circumstances affecting performance (i.e. health) that the Dean was unaware of.

His appeal will focus on the first and third grounds for appeal (namely, he received no formal feedback or updates throughout the year and he has ongoing mental health needs that were not accounted for).
I have two general questions:

firstly, has anyone gone through this process before and do you have any tips? Any things we should be focusing on or avoiding in our appeal?

secondly, should this appeal be unsuccessful, what are his options? I read in this forum that he needs complete his F1 within 3 years of graduation. I also think I understand that his university supervises him (at least that's to whom I'm addressing this letter) and if they don't allow his appeal, can he find someone else who will allow him to have a third attempt at passing F1? And if not, what are his career paths with just a medical degree?

Thanks so much in advance!

Reply 1

junior.doctor

Universities have nothing to do with Foundation training and ARCPs. [edit: I read the Gold Guide more carefully and it seems that if the UK graduate fails to complete F1 and is asked to leave, then this / the appeal IS still coordinated by the university, even though they’re not involved in supervision of foundation training day to day). Postgraduate training eg foundation, is organised by whichever Deanery he is doing training in.

What outcome has he been given for ARCP? Outcome 3 (extra time) or outcome 4 (required to leave programme)?

He should have had regular meetings throughout the year with his educational and clinical supervisors - which are his responsibility to organise, and these should have included feedback. Has he done these? Have any concerns been raised with him about his progress in the written forms on his portfolio? If he’s already repeating the F1 year, he should have been given reasons why this was from the first time round. What were the issues? Insufficient portfolio evidence? Too much missed training time? Gaps in clinical skills and knowledge? He should also have done multi source feedback this year from colleagues.

So his university does not supervise him. His allocated educational and clinical supervisors do, under the remit of the postgraduate deanery for whichever deanery he is in. But it seems that the university are still involved where UK graduates have failed to complete a foundation year 1, and they coordinate the appeal.

How did he hope that his training scheme would account for his mental health difficulties? Has he spoken to occupational health and requested any appropriate adjustments or considered less than full time training? Reasonable adjustments can be made by occupational health if deemed appropriate, but things such as training time / missing training over a certain number of days, or not completing his required training, cannot be overlooked.

It’s not really clear quite where things have gone wrong for him. Unfortunately the onus is on him as a professional to organise his supervisor meetings proactively (and raise concerns with his foundation programme training director if his supervisors are not agreeing to meetings) and to complete his training requirements such as training time and portfolio assessments. If he is unable to do these things due to ill health, then he needs to be considering time off work, meeting with occupational health, or consider part time training. It would be very odd, as someone in a repeat year, if his supervisors have not been addressing the original reasons for repeat and discussing his progress in the portfolio forms.

Really need more detail on why you think the training programme has failed in its procedural duty - and also what he’s done to make known his mental health concerns. Most deaneries have a “professional support unit” for trainees in difficulty, which his supervisor can refer him to. The other useful resource is the “Gold Guide” to training - which sets out clear requirements and responsibilities.

I have experience of additional training time and repeat specialty training year - due to not completing membership exam in time. Was possibly looking at a ‘release from training’ at ARCP if I didn’t eventually get it, so I spent a lot of time researching and looking up options and appeals. Thankfully never needed it and passed the exam just in time in my repeat year. But the Gold Guide is the best resource.

Gold Guide: https://www.copmed.org.uk/images/docs/gold_guide_8th_edition/Gold_Guide_8th_Edition_March_2020.pdf

Finally - why are you writing letters on behalf of your brother? It’s kind of you to want to help, but he is a professional and needs to be doing this himself, with support, and should be signed by him. If he is too ill to do this then he needs to take sick leave from work.

(edited 1 year ago)

Reply 2

babycarrots

Hi and thank you so so much for this super thorough response and link to the Gold Guide. You raise a lot of really accurate points - the truth is I'm not sure where things have gone wrong and my brother has a tendency to avoid things that he'd rather not think about - I don't think it affects his patient care but it does affect his employability and manageability. i don't think I have the full picture but I'm sure he has dropped the ball in some areas around organizing ongoing supervision after getting an Outcome 3 after his first attempt at F1. I've asked him a whole bunch of questions regarding this so we'll see what he says.

And also, excellent question as to why I am writing the letter on his behalf. I'm a lawyer and am much more adept at writing these types of things than he is. Not that that means that he gets to shirk his responsibility. But totally get your point that as a professional, he should be doing this himself. I hear you and wonder myself if I'm doing him a disservice... But at a minimum, I would like to understand the process and his options.

One final thing - I see in the Gold Guide that it says on page 71 that if you get an outcome 4, you should speak with your post-graduate dean or employer about career options, including " non-training, service-focused career pathway". Do you happen to know anything about this?

Again, really appreciate your time and labour to respond :smile:

Reply 3

junior.doctor

Ok, I think you probably don’t have the full picture. To be brutally honest, there are objective criteria and hoops to jump through to pass FY1. They are not that difficult - people sometimes have to repeat a rotation because they’ve missed too much time through ill health / not passed the prescribing assessment / some other specific challenge. I’ve nearly finished finished higher specialist training and have been involved in supporting a couple of foundation trainees in the last couple of years who’ve been at risk of failing. Trainees in difficulty are normally highlighted fairly quickly, if obvious things like supervisor meetings or workplace-based assessments / other portfolio things aren’t done in time. Or if other members of the clinical team have raised concerns about competence. The onus is very much on him as a professional to organise his supervisor meetings and get his portfolio and assessments done. I totally appreciate that it’s very easy to bury your head in the sand when things start going wrong and you’re behind with things. The trainee I supported last year, was fine clinically but just seemed to have a complete block as far as getting anything done on their portfolio was concerned. We worked with them to make sure that they understood what was needed and how the portfolio worked, as well as setting deadlines and reviewing progress more closely than the usual 2-monthly supervisor meeting. They scraped through FY1.

I think you need to be Frank with your brother and clear as to what resulted in the outcome 3 the first time round, and whether he’s made any progress with remediation this year and met his supervisor to discuss it. These things all get documented on his eportfolio so it’s reasonably objective evidence that he has met with them (or not) and what has been discussed / what plans have been made to address his failings. I’m assuming he’s been given an outcome 4 this year as you can’t normally have more than one extra year of extended training during foundation training.

Your comment about page 71 of Gold Guide - I don’t think is going to apply to him. Unfortunately (assuming he’s a UK graduate) - he will only have provisional registration. The ONLY way that doctors with provisional registration can work clinically, is in an FY1 post as part of a Foundation Programme. There are no other options for provisionally registered doctors. Once you have full registration (satisfactory FY1 completion), then you can work in other non training posts such as locum posts or clinical fellow posts that are not part of a training scheme.

Unfortunately your brother finds himself in an extremely unusual situation in being removed from his training programme prior to FY1 completion - in honesty, not many people find themselves in this specific circumstance. Getting an Outcome 4 (required to leave programme without achieving competencies) does sometimes happen at later points on training - but as per page 71 there are alternative options as these doctors will have full GMC registration.

Your brother needs to be completely honest with you about exactly what has gone wrong. This is a critical appeal, and essentially if his outcome 4 is upheld, as I understand it his UK medical career would be over. There are other things he can do with his degree, non clinical things - but he cannot be a doctor in the UK. I also note from the Gold Guide that if an FY1 doctor gets an outcome 4, they are referred to the GMC. If he DOES have clear grounds for appeal, the appeal needs to be clear and objective based on what’s actually happened, nothing vague or inaccurate (such as “not supported” when his portfolio will list any meetings that have happened or his attempts to do them), which may disprove this and instead demonstrate that he didn’t engage). His portfolio will show clear evidence of whether or not he’s engaged and got things done, and records of meetings if he’s done them, and records of why his outcome 3 was given last year.

I commend you for trying to help - he’s lucky to have you.