Novice Guide

Published: 13/08/2019

Curriculum

You can (and should!) review the full details of the curriculum in order to get the most out of your training. You can find all the relevant supporting information on the 2021 Anaesthetics Curriculum webpages here. Below we have extracted some of the key pieces of information relevant to the initial period of training in Anaesthetics.

Overview of stage 1 training in Anaesthetics

From August 2021, stage 1 training (formerly known as core training) in Anaesthetics is a 3-year programme designed to equip you with a broad range of anaesthetic capabilities. Having successfully completed stage 1 training you will be able to apply for a ST4 post in Anaesthetics and/or Intensive Care Medicine.

There are 14 domains of learning that comprise the Anaesthetics training programme. At each of the 3 stages of the programme the learning outcome(s) for each domain must be successfully met. The domains of learning and the stage 1 learning outcomes are as follows:

Domain of learning Stage 1 learning outcome(s)
Professional Behaviours and Communication

Demonstrates the professional values and behaviours required of doctors in training

Management and Professional and Regulatory Requirements Understands and undertakes managerial, administrative and organisational roles expected of all doctors
Team Working Works effectively as a member of a clinical team
Safety & Quality Improvement

Understands and applies quality improvement methodology

Applies the principles of patient safety to their own clinical practice

Safeguarding Describes the importance of safeguarding vulnerable people
Education and Training Takes responsibility for their own education and training needs and contributes to departmental education
Research and Managing Data Is research aware: demonstrates an understanding of the evidence-based approach to anaesthetic and perioperative care
Perioperative Medicine and Health Promotion

Identifies clinical and social challenges that increase risk for patients undergoing surgery

Appreciates the principles of sustainability in clinical practice

General Anaesthesia Provides safe and effective general anaesthesia with distant supervision for patients undergoing non-complex elective and emergency surgery within a general hospital setting
Regional Anaesthesia Performs simple peripheral nerve blocks and performs spinal anaesthesia and lumbar epidural anaesthesia/analgesia independently
Resuscitation and Transfer

Able to recognise and initiates resuscitation of the deteriorating patient

Works as an effective member of the medical emergency team

Cares for stable critically ill adult patients independently during inter-hospital transfers by road

Procedural Sedation Provides safe procedural sedation to ASA 1 to 3 adult patients within the theatre complex
Pain

Recognises, assesses and treats acute pain independently

Differentiates between acute and chronic pain

Intensive Care Provides safe and effective care for critically ill patients under close supervision

For more information on the details of each of these domains, including the capabilities that must be demonstrated, suggested examples of evidence, and opportunities for crosslinking evidence, please see the learning syllabus for stage 1 in the curriculum section of the website.

In order to complete stage 1 training in Anaesthetics you will also need to complete the Initial Assessment of Competence (IAC), the Initial Assessment of Competence in Obstetric Anaesthesia (IACOA), and all components of the Primary FRCA examinations. The primary examination is a tough test of your knowledge and skills, which requires a lot of work on your part. You should discuss the exam with your Educational Supervisor, College Tutor and/or Training Programme Director before the end of your first six months. On completion of stage 1 training you will be awarded the Stage 1 Certificate.

RCoA policy for non-anaesthetists

For ACCS doctors in training not following a training pathway for a CCT in anaesthetics, the IAC is a mandatory achievement for the completion of the Anaesthetics component of ACCS training. Irrespective of the specialty, doctors in training should not be giving anaesthetics without supervision. It is acknowledged that it is not always possible to be supervised by an anaesthetist in the emergency department, intensive care unit, or in the ward. Supervision in these locations may be provided by a suitably trained person who is competent at intubation for routine cases.

In an emergency, doctors in training should provide a level of care to patients commensurate with their skills and knowledge until senior assistance arrives. Under no circumstances should a doctor in training with very limited experience and not exposed to ongoing anaesthetic practice be contemplating rapid sequence induction without supervision, irrespective of the location or urgency of the case.

Who’s who in your training programme

All UK training hospitals belong to a School of Anaesthesia. Each has a Head of School in overall charge. There is also a Regional Advisor, appointed by the College, who ensures standards are met. In some schools, the Head of School and Regional Advisor are the same person.

Within each School, the Dean appoints Programme Directors. Organisation of each School varies and there may be Programme Directors for each stage of Anaesthetic programme as well as for ICM and/or ACCS. Their role is to organise the training rotations to ensure all required subspecialties are covered.

Each hospital has one or more College Tutors, responsible for overseeing and co-ordinating training in their department.

Anaesthetists in training should be allocated an Educational Supervisor who is responsible for ensuring they receive appropriate training for their level. The Educational Supervisor or College Tutor should be the first port of call for any queries or difficulties. You can find out more about the training faculty in the College's Assessment Guidance document.

Supervised Learning Events

Supervised Learning Events (SLEs) are the records of your day-to-day learning and experience. They are designed to promote professional educational discussions and guide future learning, with the emphasis on feedback.  Developmental conversations that enhance the improvement in performance that comes with repeated cycles of experience, reflection, conceptualisation, and application.

Features that are key to making SLEs effective are that the conversation happens soon after the observed activity, that this dialogue is aided by a credible facilitator, and that the conversation is seen as part of a continual process of development, rather than an assessment of performance at a single point in time.

Anaesthesia is a life-long career that necessitates life-long learning. It is important that we generate constructive feedback that will help inform and empower your personal development. We all aim to help you become an excellent anaesthetist. However, it is also important to identify early if you are struggling with something so that appropriate help can be given.

Your Educational Supervisor or novice trainer will discuss with you which SLEs need to be completed at what time in order to progress through novice training successfully. If you are still unsure, then you can speak to your RCoA College Tutor or Training Programme Director.

For more information about the philosophy underpinning assessment in the 2021 curriculum please read the article Supporting Progress, published in the Bulletin, March 2021 issue.

For details of the types of SLEs you can use to evidence your learning, please see the Assessment Guidance for the 2021 curriculum.

Entrustable Professional Activities

The SLEs you complete during the novice period will be focussed on meeting the learning outcomes outlined in Entrustable Professional Activities (EPAs) 1 and 2; this is a new format for attaining the IAC introduced with the 2021 curriculum:

  • EPA 1: performing an anaesthetic preoperative assessment
  • EPA 2: general anaesthesia for an ASA I/II patient having uncomplicated surgery.

You can download a copy of the workbook directly here; you will also be able to find the relevant information on the LLp.

For further information about EPAs, please see the Assessment Guidance for the 2021 curriculum.

Multiple Trainer Report

In order for the IAC to be signed off, a Multiple Trainer Report (MTR) will also need to be satisfactorily completed. This is a process of collating trainer feedback from at least 3 referees and is compiled by an educational supervisor or College Tutor on the LLp.

This is a different process to Multi-Source Feedback.

For further information about MTRs, please see the Assessment Guidance for the 2021 curriculum.

Multi-Source Feedback

Working within a team and demonstrating the appropriate attitudes and behaviour are a hugely important component of professional life. You will need to complete Multi-Source Feedback (MSF) during your first year of training. You should discuss this assessment with your Educational Supervisor before you commence one.

This process is undertaken by you and signed-off by your educational supervisor, all on the LLp. This is a different process to the Multiple Trainer Report.