2021 Curriculum structure and learning syllabus

What does the 2021 curriculum look like?

The layout of the programme of learning and the content of the new curriculum

The structure of the new curriculum

The new curriculum has three stages of training, which an anaesthetist in training must progress through and ultimately gain a Certificate of Completion of Training (CCT). These are:

  • Stage 1 encompassing CT1, CT2, CT3
  • Stage 2 encompassing ST4, ST5
  • Stage 3 encompassing ST6, ST7

There are 14 domains of learning in each stage, covering both specialty-specific and generic professional requirements, all of which must be demonstrated throughout the training programme.

Each domain has a High-level Learning Outcome that sets the scene for what constitutes an anaesthetist.

Below that is a stage learning outcome that provides a description of what needs to be achieved at the end of that stage in order to progress to the next.

Next follows a set of key capabilities, which are mandatory and must be evidenced by anaesthetists in training to meet the stage learning outcome.

Every stage learning outcome includes a selection of examples of evidence, which are examples of evidence within a range of clinical contexts that anaesthetists in training may use to support their achievement of the key capabilities.

These are described at a high level below:

Generic professional domains

Domain

High-level Learning Outcome

Professional Behaviours and Communication

Demonstrates the professional values and behaviours that patients expect from their doctors

Management and Professional and Regulatory Requirements

Undertakes managerial, administrative and organisational roles

Team Working

Contributes to teams to enhance patient care

Safety & Quality Improvement

Improves the quality and safety of patient care

Safeguarding

Identifies vulnerable people and takes appropriate action

Education and Training

Helps others to develop their professional practice

Research and Managing Data

Expands the understanding of anaesthetic practice

 Specialty-specific domains

Domain

High-level Learning Outcome

Perioperative Medicine and Health Promotion

Facilitates safe multi-disciplinary peri-operative care and promotes the principles of public health interventions and efficient use of healthcare resources

General Anaesthesia

Provides safe and effective general anaesthesia

Regional Anaesthesia

Provides safe and effective regional anaesthesia

Resuscitation and Transfer

Resuscitates, stabilises and transfers critically ill patients safely

Procedural Sedation

Provides safe & effective sedation

Pain

Manages pain

Intensive Care

Manages critical illness

The learning syllabus

Details of the learning outcomes, capabilities and examples of evidence for each stage and domain of learning can be found here:

Transition information and guidance for dual training in Anaesthetics and Intensive Care Medicine has now been published

Frequently asked questions

The current CCT curriculum was introduced in 2010 and although there have been detail changes, such as the introduction of Units of Training in Perioperative Medicine, it remains largely unchanged over the last decade.  A review of the 2010 curriculum was conducted by Aidan Devlin in 2014 and many of the recommendations have been incorporated into the 2021 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.

No. The 2010 curriculum is an indicative 7 year programme consisting of core training (2 years), intermediate training (2 years), and higher/advanced training (3 years). This totals at 7 years. 

The 2021 curriculum is also an indicative 7 years, consisting of Stage 1 (3 years), Stage 2 (2 years), and Stage 3 (2 years).

CT3s will be completing their third year of Stage 1 and will be expected to be working to complete their Stage 1 training. No anaesthetist in training is expected to work beyond what they feel comfortable with or beyond their stage of training. With regards to rotations and rotas, design and implementation will be led by regional schools of anaesthesia and by local departments, respectively. They will aim to fairly balance training needs and local service commitments.

There will be recruitment (including applications and interview process) into Stage 1 training – the equivalent of the current Core Training recruitment.  A requirement for Stage 1 completion is to complete the FRCA Primary. There will be recruitment (including applications and interview process) at Stage 2 training. A requirement during Stage 2 completion is to complete the FRCA Final . There is no recruitment at Stage 3 but entry into Stage 3 requires a successful ARCP and completion of the FRCA Final in Stage 2.

The College believes that trainees who accept an ICM NTN starting in August 2021, and who wish to subsequently apply to dual train with anaesthetics, should have priority in accessing resources required to complete Stage 1 of the new curriculum, in order to be eligible to apply for ST4 (Stage 2) posts in anaesthetics.

The RCoA will continue to work with stakeholders including the Faculty of Intensive Care Medicine, HEE and its equivalents in the devolved nations, Postgraduate Deans, the GMC and the BMA to try to ensure that these posts offer fair terms and conditions (including pay) for those who need to access them.

For further information about 2021 dual training please click here.

This should be deliverable in a DGH assuming that they manage children aged 5 years and over.

Heads of School and Training Programme Directors are responsible for the organisation of rotations; in some schools they may spend three years in one place, in other schools it will be different.

It is important to remember that the 2021 curriculum is not defined by surgical specialties, as anaesthetic practice is not defined only by surgery; it is defined by capabilities.

There are local training programmes where anaesthetists go through ‘blocks’ of specialist training such as paediatric and cardiothoracic anaesthesia, and we know that there are good systems in place already to facilitate trainer feedback and discussion. This is one element that we are very keen to preserve.  Experience for some specialist areas will cut across several domains of learning and this can be reflected in the LLp.

ICM training can be undertaken at any time in stage 1. It can be undertaken as a single 6-month block but is likely to be of greater value to anaesthetists in training and the intensive care department if it comprises 2 x 3-month blocks.

However, those following the ACCS programme will be required to do a single 6-month block.

It is worth noting that during the ICM placement, key capabilities in the 2021 curriculum Resuscitation and Transfer domain are likely to be achieved and evidenced.  This flexibility is one of the benefits of HALOs although it will take a little time to become familiar with the new curriculum.

Yes. TIVA is contained within the General Anaesthesia domain throughout the 2021 curriculum.

On-call obstetrics is not mandatory but it may be necessary in order to acquire the required experience eg, to gain experience of dealing with emergency procedures for more complex patients.

Yes, because the curriculum requires the demonstration of capability.

For example, if an individual wanted to undertake vascular as one of their special interest areas in stage 3, they would not have to specifically undertaken vascular training before stage three, as they will have the general capability by the end of stage 2 to complete a vascular case, due to exposure to similar cases in other areas.

Yes. The stage 3 Intensive Care learning key capabilities in the 2021 anaesthetics curriculum are not the same as those for dual or single ICM trainees.  These have been developed for anaesthetists and could be better described as capabilities for managing the integration between anaesthetic and ICM services.

Essentially yes. You can apply for the FRCA final exams once you have completed core training and have been awarded the stage 1 certificate.

An important part of the requirements for completing a domain of learning is demonstration of engagement with training and learning.  It is expected that anaesthetists in training will accrue evidence throughout the stages of training.

More succinct domains such as Pain, Procedural Sedation and even Regional Anaesthesia may be completed ahead of the end of the stage of training.  However, General Anaesthesia and Perioperative Medicine and Health Promotion are likely to be completed nearer to the end of the stage of training. Similarly for the generic professional domains, although it is expected that there will be evidence available for review in each of these domains at each ARCP.

Yes, Schools and Deaneries will be able to deliver training programmes as is appropriate and workable in their region.

However, both anaesthetists in training and trainers will need to look at across all the capabilities for any stage of training to develop an understanding of what is required for each domain at each stage; particularly for broad domains such as General Anaesthesia and Perioperative Medicine and Health Promotion. For example, a succinct capability to provide general anaesthesia to an ASA 1-2 patient, or 1-3 patient for non-complex surgery, could be achieved doing an orthopaedic list, a general surgical list, or if you have a patient having cataract under general anaesthesia.

6 months in stage 1 and 3 months in stage 2; there is no mandatory time required to be spent in ICU in stage 3, although the key capabilities in the Intensive Care domain still need to be maintained.