2021 Curriculum assessment

Monitoring, managing, and supporting training progression

There has been a fundamental shift in the ethos around assessment to improve learning while maintaining familiar forms and processes.

What we often refer to as assessment covers a much greater breadth of activity than situations that require some form of categorical judgement; realistically, it encompasses the evidence that demonstrates learning, reflection, and progress. An understanding of 'assessment' activities is absolutely key for all anaesthetists involved in training, as it is the interface and practical realisation of the curriculum.

There have been some changes to both our philosophy regarding 'assessment' and how this has become manifest in the forms and procedures anaesthetists will be expected to do to evidence development.

What is new about assessment in 2021:

  • The Anaesthesia Quality Improvement Project Assessment Tool (A-QIPAT) to support formative assessment of QI projects
  • Entrustable Professional Activities (EPAs) for the Initial Assessment of Competence (IAC) and the Initial Assessment of Competence for Obstetric Anaesthesia (IACOA)
  • Holistic Assessments of Learning Outcomes (HALOs) to collate the evidence for completion of the domains of learning at each stage
  • Multiple Trainer Reports (MTRs) to replace existing consultant feedback processes.

What has not changed:

  • Formative assessment using Supervised Learning Events (SLEs) with the emphasis on feedback
  • A single assessment may provide evidence to satisfy multiple key capabilities across any domains
  • SLEs are only one form of evidence used to support achievement of key capabilities
  • Assessment of the initial phase of training in anaesthesia and obstetric anaesthesia with the IAC and IACOA
  • The FRCA Primary exam, to be completed by the end of CT3, and the Final by the end of ST5
  • MSF to be completed annually.

An introduction to assessment in the new curriculum has been published in the article Updating Assessments For 2021 on pages 36 and 37 of the March 2021 issue of the Bulletin.

Assessment philosophy

Many of the assessment types will be familiar to many anaesthetists who have had involvement with the anaesthetics training programme over the last 10 years. However, there has been a shift in the philosophy around assessment. By emphasising the application of a reflective cycle and exploring performance through conversations with supervisors, anaesthetists in training will be able to develop a more meaningful way to navigate the path to independent practice.

The philosophy underpinning the assessment strategy has been outlined in the article Supporting Progress published on pages 34 and 35 of the March 2021 issue of the Bulletin.

To find out more about the overarching philosophy of the curriculum please visit our Curriculum Philosophy webpage.

Assessment guidance

This Assessment Guidance describes the overarching programme of assessment for the 2021 Curriculum and introduces the key components of the new training programme in Anaesthetics.  The programme of assessment defines both formative and summative elements of the new approach to assessment.

Quick links to the different assessment types in the Assessment Guidance:

Holistic Assessment of Learning Outcomes (HALOs)

Signing off domains of learning in each stage

The 'Triple C' form

Assessment of discrete areas of anaesthetic practice within GA and PoM

Supervised Learning Events (SLEs)

Formerly workplace based assessments

Entrustable Professional Activities (EPAs)

For assessment of the IAC and IACOA

Multiple Trainer Reports (MTRs)

Holistic feedback from trainers

The assessment strategy

The assessment strategy comprises the rationale for, and content of the RCoA programme of assessment for the new curriculum and draws on the strengths of previous strategies with some development of existing, effective assessment practices.

This document outlines the purpose of the assessments and the mechanisms by which their on-going validity are ensured and should be read in conjunction with the 2021 Curriculum. 

Glossary of abbreviations and acronyms (Goaaa)

Entrustable Professional Activities

This is a new assessment type that involves 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.

EPAs will be used to manage progress towards completing the Initial Assessment of Competence and the Initial Assessment of Competence in Obstetric Anaesthesia.

Holistic Assessment of Learning Outcomes

This replaces the Completion of Unit of Training forms.  These forms will need to be signed off for each of the 3 stages of training for each of the 14 domains of learning.  All capabilities within each learning stage must be completed; assessment guidance will be published outlining the types of evidence that can support this.

Initial Assessment of Competence

The IAC is the first critical progression point in the anaesthetic curriculum, and the anaesthetic element of the Acute Care Common Stem curriculum.  In the new curriculum, this will be comprise 2 Entrustable Professional Activities in place of the 19 Workplace Based Assessments required for the 2010 curriculum.

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.

Initial Assessment of Competence for Obstetric Anaesthesia

The IACOA must be obtained by all anaesthetists in training before being considered safe to work in an obstetric unit without direct supervision.  In the new curriculum, this will be comprised of 2 Entrustable Professional Activities in place of the 12 Workplace Based Assessments required for the 2010 curriculum.

Multiple Trainer Report

This is a new assessment type to assure whoever approves completion of domains of learning that the anaesthetist in training is considered competent to provide anaesthesia and peri-operative care to the required level.  This does not replace Multi-Source Feedback.

Supervised Learning Events

Formerly known as Workplace Based Assessments.  This includes:

  • Anaesthesia Clinical Evaluation Exercise
  • Anaesthesia Quality Improvement Project Assessment Tool
  • Anaesthesia List Management Tool
  • Case-Based Discussion
  • Directly Observed Procedural Skills

In accordance with the change in philosophy around the new curriculum and assessments moving to emphasise that these things are opportunities for learning and reflection rather than opportunities to grade performance.

The FRCA examinations have had to adapt to the challenges of the COVID-19 pandemic; however, as part of the change to the 2021 curriculum, the examinations are not planned to change in terms of content, difficulty, or timing.

Frequently asked questions

No, both will be required in the new curriculum but in different ways.

The MTR differs from the MSF as it concerns an anaesthetist’s training progress with key capabilities and learning outcomes. MSFs seek feedback from the multidisciplinary team, including consultants, on overall professional behaviour and attitude.

More information about MTRs can be found in the Assessment Guidance.

An MTR will only be required once per year with some exceptional additions to cover specific areas of training, such as the Initial Assessment of Competence.

More information about MTRs can be found in the Assessment Guidance.

A designated trainer of the local Assessment Faculty will be responsible for reviewing the evidence that has been collated to determine if the anaesthetist in training has met the requirements for the domain of training.

The Assessment Faculty includes Consultants who are Clinical Supervisors or Educational Supervisors.  It is intended that this is an evolution of the previous role of Unit of Training supervisors and reflects the greater emphasis on the role of the expert trainer as part of the new Programme of Assessment.

More information about HALOs can be found in the Assessment Guidance.

SLEs can still be completed by all trainers and assessors and is not limited to members of the Assessment Faculty.

Certainly the possession of the IAC, with progression from a supervision level of 1 (direct supervisor involvement, physically present in theatre throughout )to a supervision level of 2b (supervisor within hospital for queries, able to provide prompt direction/assistance).  Supervision levels will be a better indicator of progress than the current system of collecting workplace-based assessments.  A HALO in Procedural Sedation for example, could also be completed in this time.

We will provide guidance for ARCPs in due course, that will have more detailed information about what could be expected by this time.

The level is set for the end of the IAC training period. We expect that at this stage anaesthetists in training will have and need senior help available within the hospital hence level 2b.