2021 Curriculum philosophy

What's the thinking behind the new curriculum?

Here you will find information about the underlying principles that determined the approach of the new curriculum as well as the reasons for introducing this change at all.

Our philosophy

The requirement to produce a new curriculum for anaesthetics has given us an opportunity to create a more learning-centred approach to the development of anaesthetists in training. Partly, this means we can build upon holistic approaches to assessment that already exist but haven't yet been formally incorporated into the learning journey. It also means that we can reframe what we consider to be best practice and how we can create a framework that enables learners to be more active participants in their own development.

The consultant anaesthetist must possess the capacity for wise judgement, grounded in the values and norms of anaesthetic practice and ably embrace the complexity and uncertainty of practice.

Dr Ben Shippey, Dr Marie Nixon
Anaesthetics Curriculum Implementation Group members

Our philosophy has been outlined in the article Defining Standards published on pages 48 and 49 of the January 2021 issue of the Bulletin.

Further reading:

  • Carr W (1995) For Education: Towards Critical Educational Enquiry, Buckingham, Open University Press
  • Fish D & Coles C (1998) Developing Professional Judgement in Healthcare, Learning through Critical Appreciation of Practice, Oxford, Butterworth-Heinemann
  • Fish D & Coles C (2005) Developing a Curriculum for Practice, Buckingham, Open University Press
  • Fish D & de Cossart L (2007) Developing the Wise Doctor. A resource for Trainers and Trainees on MMC, London, The Royal Society of Medicine Press.

Why is the curriculum changing?

The current curriculum for a CCT in Anaesthetics was published in 2010. Although a comprehensive review was undertaken in 2015 and changes have been made, the details within the annexes have remained as initially written, and further feedback within the anaesthetic community indicates that there remains room for improvement.

In 2017 the GMC published a new document Excellence by design: standards for postgraduate curricula  which requires the curricula for all medical specialties to be revised by 2020, and to comply with certain requirements:

  • curricula must introduce Generic Professional Capabilities
  • curricula must be structured round a limited number of ‘specialty learning outcomes’ – activities that describe the work of an independent clinician in each particular discipline
  • each College must demonstrate stakeholder involvement in developing their curriculum
  • assessment burden is to be reduced and a ‘tick-box’ approach avoided.

Implementation of the recommendations of The Shape of Training Report also requires all Colleges/Faculties to review their training programmes and curricula content to ensure they fulfil the following key principles of the report, which are that the curriculum:

  • takes account of and describes how the [revised curriculum] proposal will better support the needs of patients and service providers
  • ensures that the proposed CCT curriculum equips doctors with the generic skills to participate in the acute unselected take and to provide continuity of care thereafter
  • where appropriate describes how the proposal would better support the delivery of care in the community
  • describes how the proposal will support a more flexible approach to training
  • describes the role that credentialing will play in delivering the specialist and sub-specialist components of the curriculum.

The RCoA has used this opportunity to try and improve training for anaesthetists in training. Current data shows that more than 40% of CT2s do not complete core training and move into ST3 after two years. Pressure to pass the FRCA Primary exam and a desire to gain further anaesthetic experience (especially in obstetrics) were cited as particular stressors in the College’s Welfare and Morale Report published in 2017. These issues are addressed in the 2021 curriculum.

Generic Professional Capabilities

The GMC has described a series of skills, attributes and behaviours that must be embodied by any autonomous clinical practitioner - Generic Professional Capabilities (GPCs) were published in 2017. A copy of this document can be downloaded from the links below.

The intention from the outset is that these are common and interchangeable across curricula as far as possible. They were described in response to the finding that curricula across colleges vary significantly, and not all college curricula covered the breadth of the domains of Good Medical Practice.

The GMC also wanted to learn the lessons from high profile reports outlining safety failures and the contribution of shortcomings in the care provided by medical leaders. The GMC has stated that these are to be the building blocks for all curricula and that we must include these as we build content and use them to guide our systems of assessment.

Although not defined as 'Generic Professional Capabilities', the current 2010 Anaesthetic CCT Curriculum already includes many such ‘common competences’. Annex A describes specific professionalism and common competences that are expected throughout training. They are also embedded in the clinical units of training at all levels, and are expected to be included within the assessments of clinical training.  Annex G covers further elements described in the nine GMC domains above.