This is an update on the Clinical Competency Assessment (CCA) pathway and the changes being planned for 2024 until mid-2025.

As the College is currently working on the design and development of a new Program of Assessments in broad consultation with the relevant stakeholder and trainee groups. The assessment discussion papers, and material are available on the RANZCP Program of Assessments portal. 

The purpose of this communique is to keep members informed and to invite participation and feedback as we develop the new assessments program. 

Clinical Competency Assessment March 2024

The CCA pathway was implemented from September 2022 as a modified form of the original Alternative Assessment Pathway which was offered as an emergency response in November 2021. Consequently, the College engaged Prof Lambert Schuwirth to evaluate the Alternative Assessment Pathway (AAP) to review the strength and rigour of the assessment as compared with the OSCE.

The evaluation of the Alternative Assessment Pathway (AAP) provided a basis for future changes to the Clinical Competency Assessment and direction for consideration of a more programmatic and holistic approach to contemporary assessment and medical education. 

The AAP evaluation found that the combination of the WBA-ITAs and the Portfolio Review processes are better aligned with modern views on the assessment literature and the competence acquired in Psychiatry training. The portfolio review was found to be a robust and defensible assessment that replaced the OSCE and presented a holistic approach to competence judgement. However, the use of a Case-based Discussion (CbD) as a second component of the AAP to assess candidates with an unsatisfactory outcome in the ITA-portfolio review, was found to be less defensible and it was recommended that the role of this assessment needs reconsideration for the formation of the future program of assessment. 

Following the discussions and determinations reached at the College Stakeholder Forum in April 2023, the Board at its July 2023 meeting endorsed the extension of the CCA with the proposed modifications to strengthen the rigour of the CCA and its planned delivery from March 2024 until mid-2025, as a response to the recommendations of the evaluation of AAP/CCA.

The option for Modified Portfolio Review – is explained below, but we are still undertaking a consultation process. 

CCA - Modified Portfolio Review (MPR)

This option does not include the CbD component of the current CCA, but only focuses on end of rotation ITAs and other workplace-based assessments. Under this option, the CCA-MPR assessment will be offered from March 2024 until mid- 2025.

All candidates will be required to undergo a Portfolio Review. 

Structure of Modified Portfolio Review 

The structure of the CCA-MPR will comprise:

• Review of three latest end of rotation ITAs – one of which must be a Stage 3 
   (6 months FTE) duration.
• Review of OCA performance and comments (as part of the three ITAs). Any OCA completed during the rotations selected for the Portfolio Review may be considered. At least one of the OCAs for review must relate to the Stage 3 rotation. 
• Review of supervisor comments in the ITAs and OCAs
• The total training time to be reviewed by PROP must be at least 15 months (FTE). 

Where the 15 months (FTE) requirement is unable to be met through three ITAs (e.g. in case of part time candidates or those in ‘break in training’), the PROP can request for other appropriate ITAs as evidence of having met the required standard, but these ITAs must be within a reasonable recency time frame (e.g. within the last 12-18 months). However, in all cases, candidates must have at least 6 months (FTE) training time in Stage 3.

For part time rotations, where an OCA does not form part of the ITA, the PROP can request other OCAs for review, however, a Stage 3 OCA is essential to be included in the MPR.

In the case of SIMGs, there may be instances where only two ITAs may be considered (as per the current Portfolio Review rules). The total duration covered in two ITAs must be at least 12 months (FTE).  There must also be a minimum of two OCAs.

Consultation Process on the program design and details

We are currently going through a consultation process to refine the details of the program requirements and its implementation. As we continue this broad consultation with many stakeholder groups, including trainee representatives, the final requirements may change and evolve.

As an example of the consultation process for determining the final design, one of the suggestions for this program is to include a longer Stage 3 training time to enable more evidence from Stage 3 to be provided for an assessor to confirm whether the standard for Junior consultant level has been met. This will also have some implications for the Stage 3 component of the total training time requirement. 

Any changes in the above requirements, subject to the stakeholder consultation, will be communicated to the trainees and all other stakeholders.

Eligibility criteria 

Please note the eligibility criteria will slightly change if the requirement for a longer Stage 3 training time and two Stage 3 ITAs is supported.

To be eligible for the CCA - MPR, candidates must have completed at least one Stage 3 rotation of 6 months FTE duration and have at least one Stage 3 ITA (6 months FTE) recorded at the College.

The three latest ITAs/Rotations that are to be reviewed must cover training time of at least 15 months of FTE, comprising at least six months (FTE) of Stage 3 training.

For the March 2024 CCA-MPR enrolment round, trainee end-of-rotation ITAs from Rotation 2, 2023 will be considered for the Portfolio Review as one of the three ITAs required.

For SIMG candidates end of rotation ITAs beginning August 2023 will be considered in scope.

Other requirements for eligibility:

• Candidates must have a current medical registration.
• Trainees must have completed any required ‘Commencement of Targeted Learning’ documentation.
• SIMG candidates must be enrolled on the partial comparability pathway and have current comparability status.

Please note trainees who are categorised with having ‘not in training’ status will not be eligible to apply for CCA-MPR.

Criteria for demonstrating the required standard 

The criteria for demonstrating the standard for ITAs will be similar to the current PR processes. This will further include a review of OCAs.

Candidates will be provided further information when finalised. 

Unsuccessful MPR outcome

• Those candidates who are unsuccessful in meeting the standard can re-apply for MPR once they have completed a further 6 months FTE of Stage 3 and have recorded a Stage 3 ITA (of 6 months FTE duration) with a linked OCA for consideration.

Candidates who are unsuccessful in MPR will not be proceeding for a Case-based Discussion assessment component, as that element of the CCA is being removed from the CCA-MPR assessment.

Delivery of CCA- MPR

The schedule for the CCA-MPR in 2024 will be similar to that of the current CCA assessment for offering in March and September 2024. Candidates will be required to submit their applications online by the application close date. 

A standard CCA fee (to be confirmed) will be charged to all candidates, which must be paid at the time of applying for the CCA - MPR. All candidates will be required to undergo a Portfolio Review.

Stakeholders will continue to be appropriately updated about the delivery of CCA – MPR in the next few months.

Requirement of a new ITA for a subsequent CCA round

Please note candidates who did not meet the standard for CCA, and plan to apply for the CCA-MPR rounds in 2024, will require a new end-of-rotation ITA and the associated OCA to be eligible for each CCA-MPR attempt. 

The new ITA submitted would need to be a Stage 3 ITA of a minimum of six (6) months duration and the associated OCA will also need to be at the standard of Stage 3.

Assessment Portal

The College has set up an Assessment Portal with background materials and encourages submission of comments and feedback via education@ranzcp.org.