This document identifies the aims and objectives, content, experiences, outcomes and processes of postgraduate specialist training leading to a Certificate of Completion of Training [CCT] in Anaesthetics. It defines the structure and expected methods of learning, teaching, feedback and supervision.
It sets out the knowledge, skills, attitudes and behaviours expected of the trainee. These are identified as specific learning outcomes to guide trainers and trainees. A system of assessments is used to monitor progress through the stages of training.
Method of development
This curriculum was developed from the previous anaesthetic curriculum [CCT in Anaesthetics, Edition 1: dated April 2009] by a process of expert consultation. Principal amongst those consulted were: the associations and groups devoted to the practice of specialised anaesthesia; College Tutors [CT] and Regional Advisers [RA] of the RCoA; anaesthetic and critical care clinical directors; other management representatives; anaesthetic trainees; representatives of patients. The General Medical Council [GMC] guidance on Good Medical Practice [GMP] was used in the development of curriculum items and assessments at all stages of the programme. The wording in this CCT in Anaesthetics document was reviewed and revised in 2015 with the aim to condense the document, remove repetition, update nomenclature and make it more accessible.
Anaesthesia is a craft specialty and much of the education and training is acquired through experiential learning and reflective practice with trainers. Training is also delivered through a variety of formats including lectures, tutorials, seminars, e-learning and personal study. The instructional arrangements are coordinated within the Schools of Anaesthesia, with each specialist area overseen by consultants with expertise in that field.
This programme leads to the award of a CCT in anaesthetics that entitles admission to the GMC Specialist Register. Its aim is to produce well-trained, high quality clinicians with the broad range of clinical leadership and management skills and professional attitudes necessary to meet the diverse needs of the modern National Health Service [NHS] and who can embark upon safe, independent practice as consultant anaesthetists in the United Kingdom [UK].
Organisation of the curriculum
Training is divided into four stages: Core, Intermediate, Higher and Advanced. Within these, Units of Training are organised by surgical sub-specialty or anaesthetic focus. In addition there is a group of general outcomes common to all clinical practice which is listed separately as ‘Professionalism in Medical Practice’ [Annex A]. Learning outcomes are divided into two categories representing knowledge and skills.
Duration of training
The training programme is competency and not time-based. However the indicative length of the stages of training is as follows:
- Core level, normally two years [CT 1 and 2]
- Intermediate level, normally two years [ST 3 and 4]
- Higher and advanced levels, normally three years [ST 5 to 7]
At current levels of clinical experience it is unlikely that the necessary outcomes can be achieved at an adequate level of performance in less than the seven years identified.
The UK CCT training programme in anaesthetics:
- Is outcome based
- Is planned and managed
- Does not jeopardise safe practice
- Is delivered by appropriately trained and appointed trainers
- Allows time for study
- Includes core professional aspects of medical practice that are essential in the training of all doctors
- Meets the service needs of the NHS
- Is prepared with lay input
- Accommodates the specific career needs of the individual trainee
- Is evaluated
- Is subject to review and revision
Assessment in the training programme is multifaceted; the assessment process contains both formative and summative elements. All assessments are reviewed at the Annual Review of Competence Progression (ARCP). Trainees are required to complete units of training at Basic, Intermediate, Higher and Advanced level. In order to complete a unit of training, trainees should undertake Work Place Based Assessments (WPBA) that contribute to evidence showing the Core Clinical Learning Outcomes have been achieved. WPBA provide only one source of evidence that a trainee has achieved these outcomes alongside the logbook, consultant feedback, teaching and course attendance. The purpose of WPBAs is to demonstrate engagement of trainers and trainees in professional educational conversations, and the most important element is feedback.
The tools used are
- Anaesthetic Clinical Evaluation Exercise [A-CEX]
- Anaesthetic List/Clinic/Ward Management Assessment Tool [ALMAT]
- Acute Care Assessment Tool for Intensive Care Medicine [ICM] [ICAT]
- Direct Observation of Procedural Skills [DOPS]
- Case Based Discussion [CBD]
- Multi-Source Feedback [MSF]
The Fellowship of the Royal College of Anaesthetists [FRCA] examination is a two-part “high-stakes” national assessment. Its major focus is on the knowledge required for practice but the structured oral examination [SOE] and objectively structured clinical examination [OSCE] test decision-making, understanding of procedure and practical elements (including the use of simulation). Possession of the Primary FRCA is a mandatory requirement for entry into the ST3, and the Final FRCA must be passed before progression into the second 6 months of ST5. For further information on assessment, please see section 7 and the separate Assessment Guidance Document.
Achieving the CCT
Trainees must pass the following milestones in order to be awarded the CCT in Anaesthetics:
- Initial Assessment of Competence [IAC] [within first 6 months];
- Initial Assessment of Competence in Obstetric Anaesthesia [IACO] [within CT1-2];
- Primary FRCA examination [in CT1-2];
- Core Level Training Certificate (CLTC) [end of CT2]; when all above and core training units complete
- Apply for ST3 post through a competitive national recruitment process;
- Final FRCA examination [in ST3- first 6 months of ST5];
- Intermediate Level Training Certificate (ILTC) [end of ST4-first 6 months of ST5]; when above and intermediate units complete
- Complete Higher and Advanced essential units of training; and
- Advanced special interest units (1 or 2 units only) of training relevant to ultimate area of practice. This can be undertaken in ST6 or ST7 and must be 12 months in duration.