Assessment Strategy for 2021 Anaesthetics Curriculum

Summative is an assessment of learning and is used to evaluate learning against an agreed and predetermined benchmark. Summative assessments count towards progression decisions. They demonstrate to both the learner and trainer that the learner has crossed the threshold of a waypoint and is now eligible to proceed to undertake training or other assessments of a greater degree of complexity. Summative assessment in the workplace test the higher levels of Miller’s Pyramid (‘shows how’ and ‘does’).(Miller, G. (1990). The assessment of clinical skills/competence/performance. Academic Medicine, 65)

The main workplace summative assessments used in the curriculum are:

IAC

The IAC is the first critical progression point in the anaesthetic curriculum, and the anaesthetic element of the ACCS curriculum.

This comprises three arenas of professional activity:

• safe general anaesthesia with spontaneous respiration to ASA 1-2 patients for uncomplicated surgery in the supine position
• safe rapid sequence induction for ASA 1-2 patients aged 16 or older and failed intubation routine
• safe perioperative care to ASA 1E – 2E patients requiring uncomplicated emergency surgery.

The purpose of the IAC is to signify that the anaesthetist in training has achieved a basic understanding of anaesthesia and is able to give anaesthetics at a level of supervision commensurate with the individual anaesthetist in training’s skills and the clinical case; and the anaesthetist in training can be added to the on-call rota for anaesthesia. The IAC is not a licence for independent anaesthetic practice.

SLEs used as formative assessments during the training period should demonstrate progress and when used to assess the IAC, at the end of the relevant training period, should show a consistent level of supervision/entrustment of 2b.

The IAC will also take into account logbook data, consultant feedback and achievement of specific learning objectives from simulation training.

A consultant, recognised by the GMC as a trainer, will be required to sign the IAC certificate.

IACOA

The IACOA must be obtained by all anaesthetists in training before being considered safe to work in an obstetric unit without direct supervision.

This comprises four arenas or professional activity:

• safe administration of epidural/CSE for pain relief in labour
• safe administration of epidural top-up for an emergency caesarean section
• safe administration of spinal/CSE for elective or emergency caesarean section
• safe administration of general anaesthesia for elective or emergency caesarean section.

As with the IAC, SLEs are used as formative assessment during this training period and they should show a consistent supervision/entrustment level of 3 by the end of this period of training so that the trainee can take part in the obstetric anaesthesia on call rota.

The IACOA will also take into account logbook data, consultant feedback and achievement of specific learning objectives from simulation training.

Achieving the IACOA does not signal the completion of training in obstetrics during Stage 1. Further training will be required in order to attain the required key capabilities.

A consultant, recognised by the GMC as a trainer, will be required to sign the IACOA certificate.

Holistic Assessment of Learning Outcomes (HALO)

A satisfactorily completed HALO form provides evidence that an anaesthetist in training has achieved the key capabilities required to demonstrate attainment of a stage learning outcome, in order to progress to the next. Supervisors should draw upon a range of evidence including the logbook of cases completed, WBAs, illustrations set out in the curriculum document, and consultant feedback to inform their decision as to whether the stage learning outcome has been achieved. The logbook review should consider the mix of cases, level of supervision and balance of elective and emergency cases, if relevant, for the stage learning outcome. Evidence for achievement of key capabilities and learning outcomes will be uploaded to the LLp and will be linked by the anaesthetist in training to the relevant stage learning outcome. The supervisor will be able to review this evidence at the end of a stage of training to complete the HALO but it is expected that the evidence will be collected and linked throughout the stage of training period so that educational supervisors and ARCP panels are able to review progress.

All hospitals must identify appropriate designated trainers to sign the HALO form for each stage learning outcome. Each trainer should be familiar with the requirements for the stage learning outcome and be able to provide guidance for anaesthetists in training who have not yet achieved the learning outcomes. It is anticipated that the HALOs for the generic professional capability based stage learning outcomes will be signed by the anaesthetist’s educational supervisor. The professional judgement of the supervisor will ultimately determine whether it is appropriate to sign the HALO form for an anaesthetist in training. 

Multiple Trainer Reports (MTR)

Consultant feedback is a mandatory part of completing a learning outcome and should assure whoever signs the HALO form that the trainee is considered competent to provide anaesthesia and peri-operative care to the required level in this domain of learning.

MTRs will be required evidence for a completion of HALO form. The MTR will need to show that consultant feedback supports completion of the learning outcomes for the stage of training. The number of MTRs will vary depending on the domain of learning. Those with large contents such as general anaesthesia will require several MTRs covering different areas of practice. However, a single MTR may cover multiple domains. 

Educational supervisors structured report (ESSR)

The LLP system allows for multiple ESSRs per year that can be completed at intervals reflective of individual training programmes, as agreed between an anaesthetist in training and an educational supervisor. These will all subsequently feed into an ARCP.

The ESSR will periodically (at least annually) record a longitudinal, global report of an anaesthetist in training’s progress based on a range of assessment, potentially including examinations and observations in practice or reflection on behaviour by those who have appropriate expertise and experience. The ESSR can incorporate commentary or reports from longitudinal observations, such as from supervisors or formative assessments demonstrating progress over time.

Entrustable Professional Activities (EPAs)

The RCoA utilises supervision/entrustment scales for SLEs (DOPS, A-CEX, ALMAT, and CBDs) within the curriculum to provide formative assessment and meaningful feedback on the level of supervision that was required for anaesthetists in training undertaking clinical activities. Entrustable professional activities (EPAs) involve looking across a range of different skills and behaviours to make global decisions about an anaesthetist in training’s suitability to take on particular responsibilities or tasks and help to establish an increase in autonomy and responsibility for the unsupervised practice of key activities. (ten Cate, 2013) Unlike conventional WBAs that assess previous activity, EPAs focus on an anaesthetist in training’s ability to cope with future situations and challenges. (Harm Peters, Ylva Holzhausen, Christy Boscardin, Olle ten Cate & H. Carrie Chen (2017) Twelve tips for the implementation of EPAs for assessment and entrustment decisions, Medical Teacher, 39:8, 802-807, , DOI) .

This curriculum embeds EPAs at two critical progression points to make summative decisions on defined areas of practice confirming that the trainee is able to undertake specific responsibilities safely and independently. These summative assessments will be undertaken by ‘training faculty members ’ who have observed an anaesthetist in training’s performance on multiple occasions and who utilise all available sources of relevant information including; SLEs, clinical logbook, supervisor reports, MSF, and MTRs. Utilising all the relevant information available at each progression point for individual anaesthetists in training will ensure that the curriculum is underpinned by a programmatic approach to assessment (Lambert W. T. Schuwirth & Cees P. M. Van der Vleuten (2011) Programmatic assessment: From assessment of learning to assessment for learning, Medical Teacher, 33:6, 478-485, DOI:) .

The EPAs are centred on an anaesthetist in training’s ability to join the on-call rotas for general and obstetric anaesthesia and are widely recognised as priority areas in which entrustment decisions are required to ensure patient safety.

Initial Assessment of Competence

This comprises three arenas of professional activity:

• safe general anaesthesia with spontaneous respiration to ASA 1-2 patients for uncomplicated surgery in the supine position
• safe rapid sequence induction for ASA 1-2 patients aged 16 or older and failed intubation routine
• safe perioperative care to ASA 1E – 2E patients requiring uncomplicated emergency surgery.

​​​​Initial Assessment of Obstetric Competence

This comprises four arenas of professional activity:

• safe administration of epidural/CSE for pain relief in labour
• safe administration of epidural top-up for an emergency caesarean section
• safe administration of spinal/CSE for elective or emergency caesarean section
• safe administration of general anaesthesia for elective or emergency caesarean section. 

Validity of SLEs

SLEs have been developed in line with internationally agreed principle and guidelines to ensure that they are valid assessments and fit for purpose.(Criteria for good assessment: Consensus statement and recommendations from the Ottawa 2010 Conference).