2021 Curriculum for a CCT in Anaesthetics

There are four critical progression points during anaesthetic training:

Critical progression point 1: Initial Assessment of Competence (IAC)

This is the first component of training and in practice normally takes between three and six (indicative) months for most doctors to achieve. It is a summative assessment and anaesthetists in training must complete it in its entirety before trainers consider whether it is acceptable for them to progress to undertake aspects of clinical anaesthetic practice without direct supervision. It is important that anaesthetists and their trainers recognise that possession of the IAC does not imply that an anaesthetist in training may deliver direct anaesthetic care to patients without continuing appropriate supervision, but is the first milestone in the training programme.

Critical progression point 2: End of Stage 1 (CT3)

To complete Stage 1 training successfully, the anaesthetist in training must pass the Primary FRCA in its entirety, as well as attaining all of the generic and specialty learning outcomes required for that stage of training. In signing the Stage One Training Certificate, trainers must be satisfied that the anaesthetist in training has obtained the required level of achievement in all of the learning outcomes for stage 1. If this is not the case, then the anaesthetist in training requires additional training time, as detailed in the Gold Guide. Satisfactory completion of Stage 1 is a prerequisite for eligibility for recruitment, and entry, to stage 2 of the anaesthetic training programme.

Additionally, The Initial Assessment of Competence in Obstetric Anaesthesia (IACOA) must be obtained by all anaesthetists in training during stage 1, before being considered safe to work in an obstetric unit without direct supervision. It is recommended that this is attained after a block of obstetric anaesthetic training, usually commenced after one year in programme. Achieving the IACOA does not signal meeting the obstetric anaesthetic capabilities of Stage 1 training.

Critical progression point 3: End of Stage 2 (ST5)

To complete Stage 2 training successfully, the anaesthetist in training must pass the Final FRCA in its entirety, as well as attaining all of the generic and specialty learning outcomes required for that stage of training. In signing the Stage Two Training Certificate, trainers must be satisfied that the anaesthetist in training has obtained the required level of achievement in all of the learning outcomes for stage 2. If this is not the case, then the anaesthetist in training. requires additional training time, as detailed in the Gold Guide. A satisfactory ARCP outcome will be required for entry to Stage 3 training (ST6-7). 

Critical progression point 4: End of training (ST7)

The final progression point is at the end of training when anaesthetists in training will be required to demonstrate that they have met the specified standard in all of the HLOs for the end of this final stage of training. Trainers must be satisfied that this is the case and a satisfactory outcome will be required before signing a Stage 3 Training Certificate in order that an anaesthetist in training can apply for the award of a CCT.

Flexibility for Stage 2 and Stage 3

The College recognises that due to geographical considerations, regional service configuration and the availability of some specialties within some Schools of Anaesthesia, the delivery of Stage 2 and Stage 3 curriculum may benefit from flexibility which would also help support Schools to reduce the frequency of rotations, as well as facilitate progression through the training programme. This flexibility should only be needed in exceptional circumstances but will be available to Schools to implement locally to reflect educational and service capacity and capability and enable the attainment of specific curricular outcomes.

It is expected that, where possible, Stage 2 training will be delivered entirely within the indicative two-year period (ST4 and ST5) and the indicative time for completion of stage 2 and 3 would be 48 months full time equivalent (FTE).

In exceptional circumstances, if flexibility is required, prospective approval should be sought from the Training Programme Director. If approved, the following rules would apply: 

• The option to defer Stage 2 capabilities or advance Stage 3 capabilities is within the boundaries of the last 6 months of ST5 and the first 6 months of ST6
• Anaesthetists in training must achieve the Final FRCA examination in its entirety by the end of ST5, before they can officially start ST6. Failure to do so would prevent progression to ST6 and the likely need for an extension to training through an ARCP Outcome 3
• Some areas of the curriculum such as neuroanaesthesia, cardiothoracic and paediatrics may have geographical constraints that affect training programmes. Schools may be able to defer some of those into the first 6 months of ST6 allowing some Stage 3 general capabilities to be acquired instead in the last 6 months of ST5 if that facilitates local delivery of training and supports progression through the training programme
• Special Interest Area (SIA) training cannot be undertaken until the Final FRCA is completed
• The Stage 2 Training Certificate can be issued when all Stage 2 domains of learning are completed and the Final FRCA is passed in its entirety
• Where flexibility between Stage 2 and Stage 3 has been approved, deferred capabilities must be documented at the next ARCP on LLP ARCP form. The indicative training time for ST training remains 48 months FTE.

Schools of Anaesthesia will need to consider the appropriate breadth of experience and expected level of performance that must be considered during this phase of the training programme, before such flexibility may be applied. 

In particular, there will need to be a focus on the scope of practice and breadth of experience at the point of flexibility and the specific local training arrangements and supervision requirements to enable transitions and maintain patient safety. This may include the potential impact of a change in training site and arrangements for educational supervision.

Where flexibility is approved, the specific learning outcomes that learners must demonstrate to complete training and to move through critical progression points will be clearly identified and monitored by the local training organisation and trainers.

The principles of the existing Programme of Assessment will continue to be sequenced and applied across the curriculum, including where flexibility between Stage 2 and 3 has been undertaken, to ensure patient and training safety around critical progression points. 

Review of monitoring of such episodes of flexibility will be carefully managed and decisions to progress will be based on robust evidence of satisfactory performance.