Anaesthetists in Training Webinar - Recruitment

The Royal College of Anaesthetists is pleased to present a series of three webinars for Anaesthetists in Training.

Webinar 1 - Recruitment

Chair: Dr Fiona Donald, Chair and RCoA President Elect

Panel members:

  • Dr Helgi Johannsson, Council Member, Chair, RCoA Communications & External Affairs Board

  • Professor Tom Gale, Professor of Medical Education Peninsula Medical School
  • Dr Caroline Evans, Deputy Chair of Recruitment Advisory Group
  • Claudia Moran, RCoA Head of Training

Webinar recorded 19 July, 2021

Q&As

Below is a list of questions submitted by members before and during the webinar. The College is pleased to provide answers to all questions submitted by members to this webinar.

If members have any further questions, please refer to the College website or email recruitment@rcoa.ac.uk.

A lot of applicants had their portfolio scores marked down. At present even one or two points can make the difference between a job and not however we are only allowed to appeal with a five point difference. Will the College consider lowering this threshold? Or having two people verify scores prior to publishing given the very large variability in scores awarded ?

The Recruitment Advisory Group (RAG) has liaised with ANRO and the Medical and Dental Recruitment Selection (MDRS) to review the process for second marking of portfolio scores. It has been agreed that any applicant will be able to request a review of their portfolio scores where there is disagreement on marks awarded following assessor feedback in any of the domains. There is no minimum divergence score required and applicants will not need to follow a complaints process to request certain domains to be re-scored. However, no new documents will be able to be presented as evidence at this stage. The ability to request re-scoring of portfolio domains following assessor feedback will commence for the recruitment round starting in September 2021

Why has the portfolio been so heavily weighted in ST recruitment in the past few rounds? Given most of the outgoing CT2s have completed most of their training during COVID-19 it is undeniable that portfolio opportunities have been harder to seek out especially on COVID-19 rotas. Wouldn’t the re-introduction of a clinical station (even over zoom like the VIVA) help to balance this?

In face-to-face interviews the portfolio station accounted for 50 per cent of the overall interview score. In virtual interviews the weighting is 38 per cent. More interview stations would be preferable in providing a more balanced weighting. The RAG is proposing that two, or three stations with six independent assessors are used for 2022 recruitment. This is currently a proposal and will be dependent on MDRS approval following testing of software platforms which are able to run multiple stations virtually.   

For clarity, this is the RAG proposal for the 2022 recruitment. Those preparing for round three applications in the 2021 recruitment timetable, which is for posts starting in February 2022, will have the same interview station format as in previous rounds this year.

What is the College doing to ensure anaesthetists in training will not have their training unnecessarily prolonged by the recruitment backlog? I am a February 2020 starter and if I don’t get an ST3 job in the final recruitment round then I face a minimum 18-month period before I can get into ST4, despite CT3 only taking one year. Unfortunately the first rounds of ST4 recruitment are likely to be oversubscribed too, so I could be forced to take two years or even more.
The College continues to lobby for an increase in anaesthetic training post numbers. The RCoA President has written to the Secretary of State for Health and Social Care to highlight this and suggest short-and-long term solutions. Following an exceptional request from the RAG, we are awaiting approval from MDRS, for a ST4 recruitment round for a February 2023 intake. This is six months earlier than the original planned first intake for ST4 in August 2023.

I am a prospective trainee who has been unsuccessful with ST3 recruitment for four rounds in a row (some without interview), despite receiving overwhelmingly positive feedback about my clinical practice and interpersonal skills. With the increasing difficulty/competition in gaining an ST3/ST4 post in recent recruitment rounds, what is the College's suggestion for improving the ratios of training places to applicants?

We are awaiting approval from MDRS, for a ST4 recruitment round for a February 2023 intake. This is six months earlier than the original planned first intake for ST4 in August 2023.

Doctors in this situation should discuss with their trainers why their self-score is not translating to interview offers. Review each domain in turn and consider where scores can be increased and the evidence to support this. In addition, feedback around interview practice and technique can be useful.

Given there are now 700+ anaesthetists already without a ST3 job, are you going to increase the number of ST4 places for August 2023 recruitment? How are you going to manage to backlog?

The College continues to lobby for an increase in anaesthetic training post numbers, most recently writing to the Secretary of State for Health and Social Care to highlight this and suggest short-and-long term solutions. The numbers of training posts available has not changed but there is a higher competition ratio for several reasons including, the posts required to accommodate the CT3 year of the new curriculum, a larger proportion of international medical graduates applying, the impact of the pandemic not allowing anaesthetists in training to pursue jobs abroad, as well as the derogations for the Primary FRCA exam for the last three rounds of recruitment.

How can we ensure that there is not an issue with huge application ratios in August 2023 for the first wave of ST4 recruitment? Lots of doctors who have completed core training will have been out of training by this point for two years, without any opportunity to get back into the training pathway. Are we not just kicking the can down the road?

The College continues to lobby for an increase in anaesthetic training post numbers, and recently the anaesthetic shortages were mentioned in parliament during the second reading of the Health and Social Care Bill.

Clinical Fellow posts are an essential part of the NHS workforce and offer opportunities to gain additional experience, which can be used to boost portfolio self-scores. Collect as much evidence of your educational activities and clinical experience as you can. Using the Lifelong Learning Platform will ensure it can be considered by trainers at a later stage with a view of potentially counting this experience towards training.

There is clear guidance for doctors who will not commence a ST3 anaesthetics post by February 2022. This guidance  sets out the experience and learning outcomes required for stage 1 of the 2021 Anaesthetics curriculum and will require sign off of a Stage 1 equivalence certificate in order to be eligible for recruitment to higher specialty training at the ST4 (Stage 2) entry point. 

Once CT3 equivalent training is completed, it is possible to start collecting evidence towards the capabilities for Stage 2 of the 2021 Anaesthetics Curriculum. This evidence can be presented to an ARCP panel in the future once appointed to a higher specialist training post in anaesthesia, where it will be ratified, and a decision made whether or not it can be counted towards training.

An alternative to training as a route to the GMC Specialist Register is the Certificate of Eligibility for Specialist Registration (CESR) process.  

Will there be any changes to recruitment for trainees with an Intensive Care Medicine number wishing to dual CCT with anaesthesia? Previously there has been a time limit within which both registrar jobs must be obtained. Will there be any extension of this window, given the lack of recruitment opportunities into anaesthesia for 18 months?

The Recruitment Advisory Group has raised this with the Faculty of Intensive Care Medicine. FICM is looking at how this can be managed, with a view to obtaining agreement from the four national statutory education bodies and the GMC to extend the application/appointment window by an additional year.

Post-CT2, I came to Australia, with the plan to come back to ST3 training. The curriculum changes have directly affected me, as there will be no registrar recruitment in August 2022. What assurances are there that there will be available “top up” jobs in August 2022?

Understandably we are unable to guarantee that there will be CT3 equivalent posts next year, however this has been raised with the Lead Dean for Anaesthesia who has fed this back to the four nation statutory education bodies. The College Tutor Network is actively sharing where posts are available that would meet the requirements for CT3 equivalent training, and doctors in training are encouraged to approach local departments. Please contact Training Programme Directors, College Tutors and clinical leads/directors in the area you wish to work to explore what opportunities may be available for you.

Will work abroad e.g., ICU or other anaesthetics work be applicable towards CT3 top-ups?

Providing the experience gained meets the requirements of Stage 1 as described in the CT3 equivalence guidance.

Flexibility for doctors in training has improved recently following changes to GMC requirements, guidance from the Academy of Medical Royal Colleges, and the new out of programme options from HEE; all of which present opportunities to recognise experience from outside of a NTN training post.

The actual process of how this is done is in development with members of the College’s Training Committee. We will publish this guidance as soon as it is complete, but in essence, any experience accrued after the completion of core training could be counted; this will be a year in most cases but could be longer. Potentially up to 12 months of experience towards stage 2 of the curriculum could be recognised.

In the meantime, the advice is to record all experience, preferably on the Lifelong Learning Platform which will make it easier for trainers to review.

In CT3 top-up posts facilitated by College Tutors/TPDs, will part-time work be guaranteed? Or will part-time trainees or those wishing to go part time face having to switch to full time?

Doctors are eligible to apply to work on a less than full time basis, following the normal procedures. This is also an equality and diversity matter covered by legislative regulation.

In the last recruitment round, it was possible for a trainee to be offered a position in a lower ranked school, while posts remained available (i.e., not held by anyone else) in their first ranked school. This seems to be a technical glitch, but it has significant personal impact. What reassurances and safeguards can we offer to prevent this from occurring again?

Offers are issued via Oriel and applicants have the option to ‘accept’, ‘hold with upgrades’ or ‘decline’, and must make a decision within 48 hours.

The offers process means that where an offer is held with upgrades, if a higher ranked post becomes available it is offered to the applicant. However, the same higher ranked post would not be offered to an applicant who had already accepted their original offer: it may be offered to another applicant who scored less in the interview process because the original applicant it was offered to, rejected it.

This is the way that offers are recycled in the system and the process is determined by how offers are accepted or declined.

There were jobs released in South-East Scotland several weeks after the deadline for upgrades and acceptance in offers. This resulted in those who have been ranked lower who did not rank any other region getting a job over those who ranked higher and had the South- East as a top preference. Surely this is a very unfair and quite underhanded recruitment method?

Some additional posts were made available in Scotland at the end of the window for accepting offers. This was done in good faith to improve the availability of jobs and opportunities for all trainees but the exact timing of the release of these posts had an impact on trainees’ ability to upgrade offers if they had already accepted posts. It is important that all regions are aware of the implications related to the timing of making additional posts available at the end of an offers window.   

Do you feel that it is fair that trainees without the full Primary got ST3 jobs, when there were others who had completed their Primary?

The impact and associated uncertainty of the pandemic meant that it was impossible to predict whether there would be capacity to accommodate everyone who wished to sit the Primary FRCA, and so it was deemed fairer to assume that there may not be the opportunity for all to do so.

The curriculum derogation agreed with the GMC allowed completion of core level training without the full complement of core level competences and/or the full Primary FRCA, in order to facilitate applications for ST3 recruitment for February and August starts in 2021 and 2022. In this instance, the Primary MCQ is a prerequisite for eligibility.

Why is the full primary FRCA still not mandatory for ST3 applications February 2022?

The February 2022 intake for recruitment sits within the round and process that was agreed for 2021 national recruitment. Therefore, the principles and ST3 Person Specification that were agreed with MDRS at the end of 2020, continue for this round.

In addition, the curriculum derogation agreed with the GMC remains in place until September 2021 which encompasses the autumn recruitment round.

The full Primary FRCA will be a requirement for ST4 applications in the next recruitment round, which we are planning for a February 2023 start.

Given ‘life has gone back to normal’, why is the College still using COVID-19-style virtual interviews this Autumn?

The February 2022 intake for recruitment sits within the round and process that was agreed for 2021 national recruitment. Therefore, the principles and ST3 Person Specification that were agreed with MDRS at the end of 2020, continue for this round.

Given the gap between what the College advice, and what is actually being advertised, why was core training not extended for current trainees? (Many were initially advised by their College Tutors in 2020 novice period).

It was agreed with the four nation statutory education bodies that appointments to Core Anaesthesia from August 2020 and ACCS Anaesthesia from August 2019 would automatically include an additional year from August 2022.

Jobs are put out by trusts, but are presumably facilitated by anaesthetic departments, including their Training Programme Directors and College Tutors. Why can't the College mandate facilitation of these part-time jobs where the demand exists?"

It is not the remit of the College to mandate this. Doctors are eligible to apply to work on a less-than-full-time basis, following the normal procedures. This is also an equality and diversity matter covered by legislative regulation.

What has been the trend of portfolio scores over the last few years? Anecdotally, the feeling is that there has been an increase and trainees are having to do more and more to get a job (with several Consultants saying they would never get a registrar job now). Is there a plan or way to stop this arms race - because surely beyond a certain point the portfolio score becomes unhelpful?

Higher competition ratios inevitably lead to a higher cut-off score for interview. However, offers are based on portfolio and interview scores combined. The portfolio self-assessment criteria are well publicised and doctors work towards this goal years in advance, this is why it remains fairly consistent and can result in higher portfolio scores.

The RAG is proposing that two or three stations with six independent assessors are used for the 2022 recruitment year. This still requires MDRS approval but would decrease the weighting of the portfolio score.

Do you think that core trainees are disadvantaged compared to ACCS trainees, given that ACCS trainees can score themselves at least two extra points for ‘time in other specialties’, as well as the extra time to score points during anaesthetic training? Is there a way this can be accounted for?

ACCS trainees complete an indicative eight years in total, compared to straight anaesthetics which is an indicative seven years.

The range of specialties that can be used in the portfolio self-assessment criteria has been widened for ST4, recognising that many transferable skills are useful to anaesthesia.

Will the College think in the future to recruit at levels above ST4 in future,    like in the old days where there were local recruitments for ST5/6 posts even in small numbers?

This is something that the RAG could consider, however, it would need to be approved by the four nation statutory education bodies and MDRS.

The RAG feel there is no requirement to recruit to grades higher than ST4.

We currently run national recruitment to CT1 and ST3 (ST4 from 2023). If a trainee can demonstrate evidence of capability at a higher level within the curriculum, then it is possible to be accelerated through the training programme if this can be accommodated locally; this is in discussion with the Training Programme Director, Head of School and the RCoA Training Committee who make a review of the evidence and accelerate the trainee if appropriate.

When will we have a definitive answer about whether Stage 2 competencies will be counted and time taken off training once in training? This would impact on my decision making around applying for ST3 in February 2022 (which obviously opens soon)

If a trainee can demonstrate evidence of Stage 2 capabilities, then it is possible to be accelerated through the training programme if this can be accommodated locally. It will also be possible to recognise experience from outside of a National Training Number training post. The actual process of how this is done is in development with members of the College’s Training Committee and will be published as soon as defined. In the meantime, the advice is to record all experience, preferably on the Lifelong Learning Platform which will make it easier for trainers to review.

Given the curriculum change was signposted from 2019 and therefore a gap in recruitment was always inevitable - can the panel appreciate that publishing guidance on CT3 top-up posts just weeks before they are due to start and the very last minute nature and chaotic implementation of the last few weeks was completely avoidable?

We do appreciate that some doctors felt that requirements for CT3 top up years were published late. However, this was due to the tight timescales we were required to work to including agreement from the four nation statutory education bodies and GMC before we could confirm that the 2021 curriculum had been approved. Only with this approval could we publicise requirements for top-up posts.

You mentioned changing interview style to reduce percentage of focus on portfolio content for future rounds, however, what are you doing to help trainees who's portfolio may be weaker due to 18 months of their anaesthetics training being COVID-19 related and will be applying for February 2022?

The cut-off score for interview changes in each recruitment round. Many applicants will have been impacted by COVID-19 disruption and so their respective portfolio scores may be lower, resulting in a lower threshold for interview. Many organisations have facilitated ways for trainees to present posters, or partake in conferences and applicants are encouraged to speak to their local trainers for advice on how to increase portfolio scores in the coming months.

In terms of CT3 top-up posts, the advice given tonight differs significantly from direct conversations with College Tutors at multiple trusts given to trainees. A number have been categorically told they cannot work part-time in CT3 top-ups advertised. Can the advice given tonight please trickle down to the local levels of the College and be published, so that we have more of a standing to argue our case?

Doctors are eligible to apply to work on a less than full time basis, following the normal procedures. This is also an equality and diversity matter covered by legislative regulation. We have escalated this matter to the COPMeD Lead Dean for Less than Full Time Training.