This document identifies the aims and objectives, content, experiences, outcomes and processes of postgraduate specialist training leading to a CCT in Anaesthetics. It defines the structure and expected methods of learning, teaching, feedback and supervision. The expected knowledge, skills, attitudes and behaviours are described as learning outcomes that are specific enough to be a precise guide for trainers and trainees. A system of assessments is used to monitor the trainee’s progress through the stages of training.
1.2 The scope of anaesthetic practice
Anaesthetists form the largest single hospital medical specialty and their skills are used in many aspects of patient care. Whilst the intraoperative care of the surgical patient is the core of specialty work many anaesthetists have a much wider scope of practice including:
- The perioperative medical management of surgical patients
- The resuscitation and stabilisation of patients in the Emergency Department
- Pain relief in labour and peripartum care
- Critical care medicine
- Transport of acutely ill and injured patients
- Pre-hospital emergency care
- Pain medicine including:
- The relief of post-operative pain
- Acute pain medicine and the leadership of acute teams
- Chronic and cancer pain management
- The provision of sedation and anaesthesia for patients undergoing procedures outside the operating theatre.
Anaesthetists are also widely involved in teaching and training medical students, doctors in training, nurses and allied health professionals. In addition they are involved with regional and national bodies and in the leadership and management of hospitals and the wider NHS. Many anaesthetists are involved in research into all areas of anaesthesia, pain, intensive care and perioperative medicine. The CCT programme is thus designed to meet the diverse service needs of the NHS. During the course of anaesthetic training, trainees will develop particular interests within the specialty and in ST5-7 these will be reflected in their choice of optional units of training at the Higher and Advanced levels. At the end of training most anaesthetists will have gained experience and expertise in some special interest areas of practice along with the general training that is common to all. The design of the curriculum reflects and facilitates this diversity.
1.3 Curriculum design and development
1.3.1 The development process
This Curriculum has been developed from previous anaesthetic versions1 by a process of expert consultation, led by a working party that reported to the RCoA Training Committee and Council. The development process involved consultation with: College Tutors, Regional Advisers, specialist anaesthesia societies, clinical directors, trainees and patient representatives [Appendix 1]. The GMC guidance on Good Medical Practice (GMP), Standards for Curricula and Assessment systems (2010) and guidance from the NHS Litigation Authority were used in the development of the curriculum items and assessments at all stages of the programme. The outcomes and assessments have been developed by anaesthetists with experience and specialist knowledge in all areas of anaesthetic, intensive care and pain medicine practice. All review groups included trainee and patient representatives and the complete document has been reviewed and edited following feedback from the Schools of Anaesthesia and Postgraduate Deans.
The Royal College of Anaesthetists acknowledges the wide support that it has received from groups and individuals in the development of this Curriculum, as listed in Appendix 1.
1.3.3 RCoA Training Committee
The RCoA Training Committee is responsible for submitting the curriculum to the GMC. It consists of members of College Council, the Bernard Johnson Advisers for Less Than Full-time Training and International Programmes, the Lead Dean for anaesthesia, and representatives from England, Northern Ireland, Scotland and Wales, the Regional Advisers, College Tutors, the RCoA Lay Committee, trainee representatives, the Faculty of ICM, the Faculty of Pain Medicine and the AAGBI. The Committee is always pleased to receive comments on this training programme from both trainers and trainees. These should be addressed to the Chair of the RCoA Training Committee via: firstname.lastname@example.org.
1.3.4 Ongoing curriculum review
The curriculum is reviewed regularly with an implementation date for any changes being not less than six months after their publication date. All changes to the curriculum are prospectively approved by the GMC before publication. When published, the main document and the annexes will be annotated with the same version number and will be available on the College website. A summary of changes is also published with the new version of the curriculum and available on the website. Occasionally the Training Committee has to take decisions that may affect the immediate interpretation or application of specific items in this manual. These will be published in a ‘Training Programme Update’ circular to all RAs and Deputy Regional Advisers [DRAs], College Tutors, Training Programme Directors [TPDs] and Heads of Schools [or deanery/Local Education Training Board (LETB) equivalent], as well as being published on the College website.
1.4 Structure of the curriculum manual
This document describes the overall structure, delivery, rules and regulations of the anaesthetic CCT training programme. It is accompanied by seven annexes [A-G] as follows:
Annex A: Professionalism in Medical Practice
Annex B: Introduction and Core Level Training
Annex C: Intermediate Level Training
Annex D: Higher Level Training
Annex E: Advanced Level Training
Annex F: Intensive Care Medicine
Annex G: Teaching and training, academic and research (including audit), quality improvement and management for anaesthesia, critical care and pain medicine
The annexes contain the detailed learning outcomes and competences specific to each unit of training. Annex A contains learning outcomes that relate to the general skills of medical practice, which should be embedded throughout the clinical units of training. Likewise the learning outcomes in Annex G are to be achieved throughout the training programme.