3. Entry to and progression through training
3.1 Trainee registration
All trainees are required to register with the College’s Training Department as soon as possible after appointment to any training post. Copies of the ARCP Outcome forms and any correspondence related to their training are held at the College.
3.2 Progression through the CCT programme
3.2.1 Indicative duration
The indicative duration of the anaesthetic CCT training programme is 7 years, structured as follows:
- Core level- two years [CT1 and 2]
- Intermediate level- two years [ST3 and 4]
- Higher and Advanced levels- three years [ST 5 to 7]
Progression through the curriculum is determined by the rate at which trainees achieve the necessary competencies as well as the experience that underpins competence in clinical practice.
3.2.2 Minimum duration
In current practice the indicative and minimum times for completing training are similar. Though this anaesthetic training programme is designed around a schedule of competencies, and is monitored by acquisition of these rather than the time spent in training, it is unlikely that a trainee will be able to complete the programme to a satisfactory standard in less than the seven years.
3.2.3 Academic trainees
Academic and clinical training should be integrated to enable both to be delivered within the seven year CCT in anaesthetics programme. The academic route is challenging for the trainee as they have to achieve the same competences as non- academic trainees as well as meet their academic milestones. The number of academic trainees as a proportion of the anaesthesia trainees across all levels of training is small and in order to encourage those with an interest in academic anaesthesia, training programme directors need to work with the academic leads to ensure that academic trainees are able to access the required clinical training at an appropriate time with sufficient clinical exposure.
3.2.4 Accreditation of Transferable Competences (ATC)
Many core competences are common across curricula. When moving from one approved training programme to another, a trainee who has gained competences in core, specialty or general practice training should not have to repeat training already achieved. The Academy of Medical Royal Colleges (AoMRC) has developed the ‘Accreditation of Transferable Competences Framework’ to assist trainees in transferring competences from one training programme to another.
The Anaesthetic training programme may employ ATC so that a doctor who has gained competences should not have to repeat training. ATC will apply to successfully completed training or gained competences that are contained in this Curriculum for a CCT, and will be administered in accordance with the Accreditation of Transferable Competences Framework (ATCF).13
This does not change the requirement that satisfactory completion of training for CCT requires a doctor to have completed all elements of the GMC approved curriculum. ATC applies only to those moving between periods of GMC approved training, and is aimed at the early years of training. The time to be recognised within the ATCF is subject to review at the first Annual Review of Competence Progression (ARCP) in the new training programme.
See section 3.9 for the components of other programmes that may be recognised for anaesthesia.
3.3 Entry to core level training
3.3.1 Direct entry
Direct entry to Core Level Training [CT1-2] is by competitive selection under nationally agreed arrangements.
3.3.2 ACCS entry
- ACCS training is a three year programme of training in anaesthesia, acute medicine, emergency medicine and ICM. As such it covers areas of the specialty curricula for the four specialty CCT programmes.
- Entry to ACCS training will be by competitive application under nationally agreed arrangements.
- The duration and content of each ACCS specialty module may vary between Deaneries/LETBs. The three year anaesthetic ACCS training is made up of two years of the ‘generic’ ACCS training followed by one year of specialty specific training; for anaesthetic ACCS trainees, the specialty specific training will be in anaesthetics.
- The minimum learning outcomes for the anaesthesia section of the ‘generic’ ACCS are derived from the first six months of training, principally those in the Introduction to Anaesthesia section.
- For anaesthetics, the combined ACCS and one year specialty specific training will enable trainees to complete the Core Level anaesthetic competencies plus augmented learning outcomes derived from acute medicine and emergency medicine training.
- Trainees must successfully complete all the core assessments in the ACCS and anaesthetics programmes to pass the ACCS element of training.
- The trainee must achieve all the Core level requirements by the end of the three years of ACCS [anaesthetics] training to be eligible to apply for ST3 in anaesthetics; all ACCS trainees who are appointed to a ST3 post in anaesthetics will follow the anaesthetics higher speciality training defined in this curriculum leading to a CCT.
3.4 Entry to intermediate level training
Entry to Intermediate Level training [ST3-4] is by competitive selection under nationally agreed arrangements.
All trainees progressing to ST3 are required to have the Core Level Training Certificate [CLTC] before they can commence their intermediate level training. See section 9.3 for the requirements for the award of the CLTC.
The following are acceptable alternatives to the CLTC:
- Trainees from outside the UK: Trainees wishing to enter ST3 who completed their core level training outside the UK, should refer to the GMC position statement Approved curricula and the role of UK & overseas exams (http://www.gmc-uk.org/education/27138.asp )
- Specialty Doctors [SDs] and Staff and Associate Specialist [SAS] grades: SDs and SAS grades returning to training without a CLTC may be assessed individually by the local RA prior to applying for intermediate level training. If appropriate the RA will issue the Confirmation of Core Level Equivalence Certificate in lieu of the CLTC; they will also need to be in possession of the Primary FRCA.
3.5 Progression to higher and advanced level training
Before progressing to Higher and Advanced Level training [ST5-7] trainees will normally have an Intermediate Level Training Certificate [ILTC].
Trainees who have not passed the Final FRCA in its entirety by the end of ST4 will be able to move to ST5 providing they have satisfactorily completed all intermediate level units of training. They should be issued with an Intermediate Level Progress Report [ILPR - see section 10.2.3]. The ILTC will be issued once the Final FRCA is passed. The ILTC and the ILPR [indicating deferrals] must be signed by the RCoA RA [or deputy] and College Tutor [or another designated consultant].
Specialty Doctors and SAS grades returning to training who do not have an ILTC will be assessed individually by the local RA prior to applying for Higher Level training; if appropriate, the RA will issue the Confirmation of Intermediate Level Equivalence Certificate in lieu of the ILTC; possession of the Final FRCA is an essential requirement.
A CCT date is estimated, usually on entry to ST5 upon receipt of the ILTC. This is altered if the necessary competences are not obtained by the expected date or other circumstances prevail [such as sick leave or maternity leave].
3.6 Examinations and the award of a CCT
The RCoA FRCA examinations are embedded in the CCT programme and approved by the GMC. It is a legal requirement that the GMC must approve the curriculum, programmes and the assessment system14 .
3.7 Progression through higher/advanced training to the recommendation for CCT/CESR[CP]
The College wishes to allow trainees to achieve their career aspirations; however, it is recognised that training opportunities must be balanced against anticipated career NHS vacancies. Trainees should therefore recognise the need to maintain flexibility in their choices at the higher and advanced level. If a specific training placement is over-subscribed the TPD and local SAC will determine how this is managed. Once all the agreed learning outcomes for higher/advanced training are completed and the ARCP Outcome 6 has been received, the College will formally recommend to the GMC the award of a CCT or CESR[CP] as appropriate.
3.7.1 CCT versus CESR[CP]
The CCT and the CESR[CP] are two recognised routes for specialist registration. To be a substantive consultant in the NHS, the legal requirement is that the individual is on the specialist register and does not stipulate that the individual must have a CCT15. The CCT is awarded to those trainees who have completed a GMC approved CCT training programme in its entirety16 as opposed to the CESR[CP] which is awarded to a trainee who completed a component of their training outside of the approved programme.
Eligibility for a CCT or CESR[CP] will be confirmed by the Training Department and will be based on a case by case basis.
To be able to exercise the rights of freedom of movement between member states and the freedom to provide a service as an anaesthetist in another EU member state, CCT and CESR[CP] holders must satisfy the following criteria:
- Must be a citizen of a European Union state; or
- Has EU community rights (eg a spouse of an EU national); and
- Primary medical degree from a recognised European Union medical school17
Additionally for both CCT and CESR holders:
- If the individual is an EU national or has EU community rights, and has worked for 3 out of the last 5 years as a specialist in the UK then this can be recognised in Europe regardless of where their primary medical qualification was obtained18 [A certificate is required from the GMC as proof – Article 3(3) compliancy certificate]
For those who do not meet this criterion, the individual will be required to be assessed through the European State’s equivalence process.
3.8 Re-entering training after a break
Doctors who want to re-enter training after a break and are no longer in possession of a training number are required to apply via the national recruitment programme.
For those who have continued to practise anaesthesia [for instance as SDs or SAS grades] the point of reentry will depend on the level of previous training and subsequent experience. Advice should be sought from the RCoA Training department (firstname.lastname@example.org).
3.8.1 Re-orientation/Phased return
Trainees returning to the specialty after a substantial break will require a period of re-orientation through a phased return programme. This will vary with the length of the break and the nature of any medical work the trainee has been engaged in during the interim. The Postgraduate Dean, through the School of Anaesthesia/Local Specialty Training Committee, should ask the appropriate College Tutor to monitor the trainee’s induction and progress and make recommendations about the requirements for their future training. Advice may be sought from the RCoA Training Committee.
3.9 Transferable components of other GMC approved programmes to Anaesthesia
Trainees may commence GMC approved training programmes in ACCS [EM], ACCS [General Internal Medicine] [GIM], ACCS [ICM], Core Medical Training [CMT] or Core Surgical Training [CST] but decide to change career direction and apply for anaesthesia. When a trainee changes from the above listed programmes to anaesthesia, some components are deemed to be identical in content and outcome, and therefore transferable to anaesthesia providing the programme component had been successfully completed and appropriately assessed in accordance with the assessment requirements of the previous specialty’s training programme. These transferable components will normally be recognised for a CCT but trainees contemplating transferring to anaesthesia should contact the RCoA Training Department for advice. Table 2 defines which components of other programmes will be recognised for anaesthesia.
|1st CCT Programme||Transferring to||Completed Component||Expected counted time||Maximum counted time|
|ACCS [EM] [GIM] [ICM]||ACCS [Anaes]||EM, GIM, ICM||Time taken for each completed components||24 months|
|ACCS [EM]||Core Anaes||Introduction to Anaesthesia||6 months||6 months|
|ACCS [EM]||Core Anaes||ICM||3 months||3 months|
|ACCS [GIM]||Core Anaes||Introduction to Anaesthesia||6 months||6 months|
|ACCS [GIM]||Core Anaes||ICM||3 months||3 months|
|ACCS [Anaes]||Core Anaes||Introduction to Anaesthesia||6 months||9 months|
|EM Run-through||Core Anaes||Introduction to Anaesthesia||6 months||6 months|
|EM Run-through||Core Anaes||ICM||3 months||3 months|
|EM Run-through||ACCS [Anaes]||EM, GIM, ICM||Time taken for each completed components||24 months|
|CMT||Core Anaes||Medicine||6 months||6 months|
|CMT||Core Anaes||ICM||3 months||6 months|
|CMT||Core Anaes||ICM||3 months||3 months|
|CST||Core Anaes||ICM||3 months||3 months|
|CST||ACCS [Anaes]||ICM||3 months||6 months|
Table 1 Transferable programme components to core anaesthesia and ACCS anaesthesia
In addition, trainees in GMC approved single ICM training programmes may have undertaken one of three Core programmes; ACCS, Anaesthesia training, and CMT. Those trainees who do not come from the Anaesthesia training route may subsequently wish to undertake Dual training in ICM and Anaesthetics. The anaesthetic competences obtained within the single ICM training programme can be recognised towards the core Anaesthetic training programme to enable a trainee to apply to also undertake Dual training in ICM and Anaesthetics. Single programme ICM trainees who then go on to also be appointed to an anaesthesia programme, can count the anaesthetic competences achieved during Stage 1 of the ICM post towards the Intermediate anaesthetic training, rather than revisiting these competences once appointed to a ST3 Anaesthetics post. This is because the anaesthetic competences obtained during Stage 1 of an ICM training post will be of a general nature.
Trainees contemplating this are strongly advised to contact the RCoA Training Department for advice.
3.10 Principles for approving previous training and experience
In a competency based training programme previous training and experience obtained outside a standard training programme may be accepted by the Deanery/LETB [subject to confirmation by the College] when an applicant is appointed to a GMC approved training programme at ST3. The duration of previous training and experience that can be accepted will be defined by the national person specification relevant to the year of entry. Trainees appointed to the anaesthetics programme above CT1 will normally only be eligible for the CESR[CP]. Special provisions exist for EU trainees who have undertaken anaesthesia training in another EU country and eligibility for a CCT. The College will confirm whether the trainee is on the CCT or CESR[CP] route when they register with the College in accordance with GMC rules (http://www.gmc-uk.org/education/27138.asp).
3.10.1 Types of posts where approval of training in the UK and EU might be sought
- Locum Appointments for Training [LAT]:
- A LAT post can count towards a CCT if it covers a clearly identifiable portion of the approved training programme specified in this curriculum, has been correctly delivered and assessed and it is properly documented.
- If a doctor is appointed to a UK anaesthesia training programme through open competition, the documented competencies achieved during a LAT[s] may be taken into account by the TPD and ratified by the RCoA when determining the trainee’s remaining training programme.
- The GMC does not have limits on the maximum time spent in LATs except that they can only count towards a CCT if the doctor subsequently enters an approved training programme. Deaneries/LETBs should keep a careful record of these appointments on the trainee’s file. A doctor cannot obtain a CCT with only LAT appointments; they can, however, use LATs towards their Certificate of Eligibility for Specialist Registration [CESR] application.
- Trainees must submit the form – Application for recognition of LAT/FTSTA for a CCT/CESR[CP] – to the Training department. This form is available in the Careers and Training section on the College website.
- Locum Appointments for Service [LAS]: cannot count towards CCT training but may count as experience towards a CESR.
- Training in another European Union [EU] state: Prospectively approved and documented training in another EU state may be accepted on the same basis as UK approved training, subject to certain conditions. Advice on this can be obtained from the College, at email@example.com, and the GMC website www.gmc-uk.org.
3.10.2 Unapproved training and experience
Experience gained outside GMC-approved training posts may be accepted by a deanery/LETB as proof of competencies when an applicant is appointed to a GMC approved training programme at ST3. Any training gained in non-GMC approved posts cannot count towards a CCT but may count towards a CESR[CP]. The College will advise on the recognition of non-GMC approved training, however the final decision rests with the GMC. The duration of previous training and experience that can be accepted for specific points of entry in the training programme will be defined by the national person specification relevant to the year of entry.
3.10.3 Recognition of higher and advanced level training
This can only be obtained with prospective approval; the rules for the prospective recognition of higher and advanced level training in unapproved posts in the UK or abroad, i.e. Out of Programme Training [OOPT], are described in Section 12.
3.11 Military service
Military trainees are normally attached to Schools of Anaesthesia and are trained alongside civilian trainees, following the same Curriculum. All military medical education is commissioned by the Defence Postgraduate Dean on behalf of the Defence Medical Services.
Due to the nature of military service, military trainees may be deployed away from their training rotations as required by the Ministry of Defence. It is recognised that there are training opportunities while deployed on operations; these learning outcomes have been formalised in the military unit of training, which may form part of Higher Level general duties training.
The military unit of training can only account for three months of the total indicative twelve months higher level general duties. Only one deployment will count and any additional time deployed beyond three months will extend the calculated CCT date. Deployment time will not count towards the allowable twelve months overseas out of programme training [OOPT] in ST5-7. Trainees should discuss overseas OOPT opportunities with the Tri-services RA before applying for such a placement. For OOPT see section 12.
There may be additional opportunities for training while on deployment. The Training Committee will examine requests for training recognition; however such requests must first be approved by the Tri-services Deanery. This is to ensure that the proposed training meets the requirements of the Curriculum and benefits all defence anaesthesia trainees.