Formative Assessment Changes – Implementation August 2026
This guidance sets out the policy, procedures, and expectations for introducing the new formative assessment framework across all psychiatry training programmes. It covers:
Entrustability scales in CS/ES end-of-placement reviews
Change to the Likert Scale for WPBA
Embedding formulation skills in Case Presentations (CP)
Introducing patient and carer feedback for resident doctors
Establishing Caseload-Based Discussions (CLBD) within Direct Observation of Non-Clinical Skills (DONCS), and expanding DONCS
The aim is to promote consistency, fairness, and educational value across the UK, supporting trainees to meet the High-Level Outcomes (HLOs) and progress safely towards CCT.
Following the Assessment Strategy Review (ASR, Feb 2023), the Formative Assessment Working Group (FAWG) identified four priority areas for development. The Curricula & Assessment Committee oversaw the work, with final recommendations endorsed by the ETC (Feb 2024) and progressed to Council approval and GMC submission in 2025. Implementation is aligned to the new ePortfolio launch in August 2025.
Equality, diversity and inclusion were embedded throughout, with representation from all four UK nations, Heads of School (HoS), Directors of medical education (DMEs), TPDs, SACs/SSAC members, resident doctors (CT/ST) from PRDC, LTFT residents, Educators, SAS doctors, patients/carers and committed college members.
Entrustability Scales in portfolio (CS/ES End-of-Placement Forms)
A 5-point entrustability scale will be used in CS and ES reports to provide developmental judgments on trainee autonomy and supervisory needs.
Levels & Descriptors
Level? | Descriptor? |
Level 1? | Entrusted to act only in the constant presence of the supervisor |
Level 2? | Entrusted to act under indirect supervision, with supervisor intermittently present and monitoring at regular intervals |
Level 3? | Entrusted to act under indirect supervision, with supervisor remote, but present in setting, and able to provide prompt direction / assistance |
Level 4? | Entrusted to act independently with supervisor accessible on call and able to attend if required |
Level 5 | Entrusted to act independently with no supervisor involvement (always operating within local protocols) |
Expected progression: CTs typically start at L1–2, progress through L3–4 and reach L5 by CCT (with local variation per placement and context).
Use: Formative only. Entrustability should not be used for high-stakes decisions in isolation; it complements WPBAs and HLO evidence.
Benefits
- Focus on real world readiness
- Formalises intuitive judgment
- An essential marker of competence
- Richer, more meaningful assessment data
- Reduce halo effects and grade inflation
- Encourage more accurate global judgments
- Focus on supervision level, not personality or likeability, improves fairness
- Maps naturally on to training progression- early learner, developing, competence
- Help ensure patient safety
Likert scale for WPBAs
This will be the standardised Likert scale on the new e-portfolio for WPBAs.
This is a typical five level analytic rubric used across many institutions.
Insufficient evidence | Needs improvement | Satisfactory | Good | Excellent |
Insufficient evidence to make a judgment | Shows limited understanding and struggles with the application of knowledge, with minimal analysis and unclear communication | Displays basic understanding and adequate application of knowledge, with some analysis and clear communication. | Shows strong understanding and effective application of knowledge, with good analysis and clear communication. | Demonstrates comprehensive understanding and exceptional application of knowledge, with insightful analysis and clear communication. |
Psychotherapy WPBAs (CbDGA, SAPE, PACE) will retain their own bespoke scales.
Embedding Formulation Skills throughout Training
This is an attempt to formalise the assessment of formulation skills (and in essence establish a long case presentation). This should be about collaborative discussion rather than supervision, with an emphasis on applicability to patient care.
Case Presentations (CPs) will explicitly assess formulation.
- Core trainees (CT1-3): 1 CP per year, as per normal.
- Higher trainees (ST4–6+): At least one 1 CP per year (replacing one CbD in higher training)
Higher specialist resident doctors are in preparation to work as consultants. We would recommend that these resident doctors develop the practice of peer group discussion of interesting cases as well as discussion with various members of the Multi-Disciplinary Team (MDT). The case presentation for higher resident doctors can be marked by members of the MDT as suggested in the Silver Guide for example a consultant or band 8 professionals including advanced practitioners, psychologists etc.
Required CP Synopsis content:
Biopsychosocial formulation
How formulation including relational factors inform your diagnosis and differentials
Any patient strengths and how these contribute to the overall intervention plan
How the formulation has influenced the way you devise a person-centred plan
Patient and Carer Feedback for Resident Doctors
Mandatory for both CT and ST stages, at least once per stage (with flexibility to complete more frequently). The feedback approach will be consistent across all psychiatric disorders.
Assessment?
Patient feedback would be an addition to the current numbers of assessments; however, this would be deemed minimal disruption and is an important part of training. The feedback should also form part of an ARCP consideration.?
Benefits
Patient and carer feedback is crucial in the assessment of a resident doctor and can support with the?
Enhancement of communication skills?
Improvement of empathy and bedside manner?
Identification of areas for improvement?
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No, not at all | No, not really | Yes, but not fully | Yes | Yes, completely |
Questions (7 total):
Did this doctor make you feel relaxed and welcome?
Do you feel this doctor listened to you?
Did the doctor explain things to you in a way you could understand?
Were you involved as much as you wanted to be in decisions about your care and treatment?
Do you have confidence in the decisions made about your condition or treatment?
Do you know what to do if your condition gets worse?
Did the doctor treat you with respect and dignity?
Free text box: Allows patients to provide qualitative comments.
Use in supervision: Aggregated results are reviewed by CS/ES with the trainee to identify strengths, areas for development, and targeted actions.
Introduce caseload-based discussion
CLBD is meant to strengthen public mental health skills, focusing on population-level/service data (e.g., readmission rates, ED/crisis presentations, equity of access, outcomes). However, we worked towards expanding the use of DONCS to assess leadership, digital/tech, other non-clinical skills to include skills relevant to all HLOs from 1-9, some non-exhaustive examples are included. This helps better alignment with the curriculum and helps future-proof assessments.
DONCS will include a dropdown of HLOs 1–9 to tag observed non-clinical competencies (leadership, governance, digital, advocacy, QI, education, research).
Important: This is formative and developmental—it must not be used as a proxy for performance management.
Benefits
Portfolio Enrichment: Captures non-clinical skills not documented elsewhere.?
Flexible Framework: Nonprescriptive approach allows residents to highlight diverse competencies.?
Support Materials: PRDC to develop supervision guidance; College to provide trainer guidance.
4.1 Training Programme Directors (TPDs)
- Lead local implementation planning, aligning programme calendars with August 2025 go-live.
- Ensure calibration and consistency across sites through briefing, templates, and case examples.
- Monitor compliance (entrustability recorded; MSF completed; CPs scheduled; patient/carer feedback collected; DONCS used for CLBD/HLOs).
- Report progress/issues to Heads of School and College via established channels.
4.2 Directors of Medical Education (DMEs)
- Provide organisational support: clinic workflows for patient feedback, admin resources for scanning/upload where needed, access to tablets/links.
- Embed changes in induction, clinical governance, and local educator development.
- Oversee data protection and confidentiality for patient feedback processes.
- Facilitate MDT participation in CP assessment and DONCS activities.
4.3 Supervisors (CS/ES)
- Use entrustability scales on end-of-placement forms with specific, narrative feedback.
- Schedule and assess CPs (with formulation focus); prompt trainees to flag formulation in case logs.
- Guide trainees to obtain, reflect on, and act upon patient/carer feedback.
- Conduct CLBD sessions and other competencies using DONCS with HLO tagging; document decisions, learning points, and follow-up actions.
- Ensure evidence aligns with ARCP standards and mapped HLOs.
4.4 Deanery Administrators & Faculty Leads
- Update local ePortfolio guidance and assessment dashboards.
- Coordinate communication and booking systems for CPs, MSF cycles, and DONCS sessions.
- Support data collation for ARCP panels and compliance tracking.
Preparatory | Jan–July 2026 | Train supervisors on entrustability, MSF changes, CP formulation requirements, patient feedback workflows, DONCS/HLO mapping. |
Go?Live | August 2026 | ePortfolio release; CS/ES report to capture Entrustability scores, Likert scale changes; enable CP synopsis changes and case log flags; activate patient feedback tools; DONCS HLO mapping live. |
Consolidation | Sep–Dec 2026 | Local calibration sessions; Q&A clinics; early audit of usage and trainee experience; address variability. |
Review | August 2027 | Programme-level review; share good practice; update guidance as needed; feedback to ETC/Council/GMC. |
6.1 Entrustability Documentation
- CS/ES must record level with brief justification and examples of independent tasks, supervisory touchpoints, and risk mitigation.
- Where entrustability is static or reduced, include a support plan (targets, opportunities, timeframe).
6.2 MSF Cycle (Colleague and Patient/Carer)
- Initiation: Trainee requests MSF via ePortfolio; nominates raters in line with MDT composition.
- Completion: Minimum rater numbers (at least 6) achieved; ensure breadth across professions and contacts.
- Review: CS/ES meets trainee to discuss aggregated scores, comments, and actions; record reflection and plan.
- Privacy: Maintain anonymity of individual raters; follow organisational data protection policies.
6.3 Case Presentation (CP) with Formulation
- Scheduling: Annual CP per trainee (CT annually; ST at least one annually).
- Assessment: Use updated CP form; evaluate formulation quality, relational factors, strengths, and person-centred planning.
- Feedback: Provide balanced, actionable feedback; record HLO mapping.
- Case Logs: Encourage trainees to flag Formulation entries to demonstrate progression.
6.4 Caseload-Based Discussion/others via DONCS
- Preparation: Identify relevant service metrics (e.g., crisis contact rates, DNA rates, acute bed utilisation, readmissions).
- Discussion: Explore root causes, equity, safeguarding, QI opportunities, system interfaces; reference guidelines/policies where relevant.
- Recording: Use DONCS with HLO dropdown tagging; include next steps (e.g., micro-QI activity, stakeholder engagement, patient/carer voice).
Supervisors and Resident Doctors are encouraged to participate in the College’s survey, which aims to monitor the effectiveness of recent assessment changes. Feedback collected through this survey will help inform ongoing improvements and will also be shared with the General Medical Council (GMC) to ensure alignment with regulatory standards.
Appendix A: Entrustability Scale (for CS/ES)
- Levels 1–5 with descriptors
- Example narrative anchors for calibration:
- Level 2 → 3: Conducts risk assessments independently; supervisor reviews plans within same day.
- Level 3 → 4: Manages routine clinic lists; seeks advice appropriately for complex MHA cases; on-call contact model clear.
- Level 4 → 5: Leads MDT huddles; initiates crisis safety plans; escalates safeguarding concerns without prompt; adheres to local protocols.
Appendix B: Likert scale and Rating Descriptors
- Map to HLOs, include “Insufficient evidence” option.
- Provide examples of action-oriented feedback (e.g., “Improve safety-netting script for relapse prevention; co-create written plan with patient”).
Appendix C: CP Formulation Checklist (for Assessors and Trainees)
- Evidence of biological, psychological, social factors
- Relational dynamics and system context
- Strengths-based formulation elements
- Clear link to diagnosis, risk, and person-centred plan
- Reflection on change over time (e.g., ST4 vs ST6 sophistication)
Appendix D: Patient & Carer Feedback – Workflow
- Identify suitable encounters (outpatient, ward review, liaison clinics).
- Provide access (link/tablet/paper) and ensure informed participation.
- Collate 6–10 responses; ensure administrators upload scanned forms where needed.
- Review aggregated results with trainee; document agreed actions.
Appendix E: DONCS – Example Activities by HLO (Non-Exhaustive)
HLO 1 – Professional values and behaviours |
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HLO 2 – Professional skills |
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HLO 3 – Professional knowledge |
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HLO 4 – Health promotion and illness prevention |
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HLO 5 – Leadership and team working |
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HLO 6 – Safeguarding vulnerable people |
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HLO 7 – Patient safety and quality improvement |
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HLO 8 – Education and training |
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HLO 9 – Research and scholarship |
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Q1: Is patient/carer feedback required in every placement?
No. It is required at least once in CT and at least once in ST years, with flexibility to complete more as locally appropriate.
Q2: Should psychotherapy WPBAs use the new LIkert scale?
No. Psychotherapy assessments retain their existing scales (CbDGA, SAPE, PACE).
Q3: Should entrustability affect ARCP outcomes directly?
Entrustability informs developmental progression and supervisory planning. ARCP decisions consider the whole portfolio against HLOs.
Q4: Who can assess higher trainee CPs?
MDT members including consultants and Band 8 professionals; SASG; aligned to Silver Guide principles of readiness for consultant practice.
Q5: Are DONCS entries prescriptive?
No. Use the HLO dropdown and select activities relevant to local service context; examples are illustrative.
Q6: When must all Resident Doctors transfer to the changes?
August 2027, there will be no extensions granted. The college would advise changing post ARCP to minimize disruption. However, ultimately, it will be decided between the resident and supervisor as to what would work best.???