Anaesthetic CCT Curriculum 2020
Curriculum review update - July 2019
Fellows and members may be aware that there is a large project to re-write the anaesthetic curriculum in line with new GMC standards that were published in May 2017.
The proposed new curriculum will include three years core training (four years for ACCS) then four years for higher specialty training. The total indicative duration of the anaesthetic training programme will remain at seven years. There will be three ‘stages’ of training representing three/two/two years (Stage 1 = CT1-CT3 / Stage 2 = ST4-ST5 / Stage 3 = ST6/ST7).
The clinical scope of Stage 1 will be similar to the current core programme, albeit at a more challenging level at CT3 with greater exposure to obstetric anaesthesia after completion of the Initial Assessment of Competence in Obstetric Anaesthesia (IACOA) and paediatrics.
The new curriculum may have implications for future recruitment to higher specialty training, which will start at ST4 ie, Stage 2. Anaesthetists in training will be required to demonstrate acquisition of the learning outcomes necessary for completion of the new three year Stage 1 curriculum critical progression point, before starting Stage 2 specialty training (ST4).
We are aware that this may have implications for those trainees who enter and/or complete core training on the existing 2010 curriculum before August 2021. The College is looking at the solutions available to allow these trainees as smooth a transition as possible from CT2 through to ST4. This involves discussion with other bodies involved in the employment of anaesthetists in training, for example the Conference of Postgraduate Deans and the GMC. Until these discussions are complete we are unable to provide specific details of the transitional arrangements. We hope to be in a more informed position in the autumn. However, we at the College would like to reassure all anaesthetists in training that the curriculum changes have been made for their benefit and we are working to ensure no one will be disadvantaged by this change. Those starting CT1 in August 2019 should anticipate spending three years in core/stage 1 training and should address any concerns in the first instance to their Training Programme Director or Regional Adviser Anaesthesia.
We will provide further information as soon as we are able to do so, and in the meantime if you have any concerns, please feel free to contact your Anaesthetists in Training Representative Group (ATRG) representative who can contact the College Training Department or Trainee representatives on Council who are members of the Curriculum Review Group.
More about the 2020 curriculum
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 fulfill 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.
This will be a complex project and we must rewrite the anaesthetic curriculum and submit a proposal to the GMC by December 2020 at the latest. We have established a curriculum working group to undertake a wholesale review and to deliver this project, and our aim is to provide a programme of learning and assessment that meet the needs of our specialty, supports the pursuit of excellence and allows learners to flourish.
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.
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.
The GPCs framework comprises nine domains:
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.
The implementation of competency based training has made the achievement of skills and knowledge throughout the training programme more explicit, but it is recognised that it has, in some cases, been unwieldy and over burdensome.
To address this, the GMC has suggested that Colleges should frame their curricula around 15 – 20 ‘learning outcomes’. The outcomes have to be described at a ‘high level’ and define the activities that a clinician at the end of training will be able to perform independently.
This is a significant change from the structure of our current 2010 curriculum.
The third element of a GPC/ specialty learning outcome-based model is that clear milestones should exist (critical progression points within the curriculum) outlining progress to be made and with a detailed description of how that is evaluated, alongside a range of assessment tools with primacy for expert faculty judgment.
The GMC’s guidance on assessment in postgraduate curricula has shifted from detailed examination of individual elements of competence, towards global assessment of performance based on the opinion of consultant experts.
It is increasingly recognised that this is a valid method of performance assessment, provided it takes into account multiple assessments by multiple assessors. The overall burden of assessment should be reduced, but the GMC suggests that as a minimum, two or three clinical supervisor reports and an educational supervisor report should be recorded every year, and that a team assessment of behaviour should be performed every 12 months.
In keeping with the desire to simplify, and reduce the burden of assessment, the GMC has also suggested that workplace based assessment moves away from separating out individual elements of performance, and replace them with more global assessment of whole clinical tasks, or 'Entrustable Professional Activities' (EPAs).
EPAs have been described as
‘A clinical activity which a trainee can be trusted to complete with indirect supervision once they have demonstrated the necessary competence to do so’
This approach requires a process whereby ‘entrustment’ is considered. This is the summative decision whereby an expert assessor, or faculty, decides that a learner is ready to work with a proscribed degree of autonomy in the activity in question. At the end of training this level of autonomy is independence. The waypoints to that have been described as milestones or critical progression points.
- In 2014 Dr Aidan Devlin undertook a review of the existing 2010 Anaesthetic curriculum, conducting a survey of fellows and members to learn more about rumoured issues.
- Senior members of the ACRG met with the GMC and the Curriculum Oversight Group (COG) which consists of Deans, representatives from the Shape of Training review and representatives from the Departments of Health, in order to discuss our purpose statement which has received conditional approval from the GMC’s Curriculum Oversight Group (COG).
- Attended GMC led workshops on various issues such as governance, consultation, equality and diversity considerations, and writing learning outcomes.
- Delivered presentations at Regional Advisors Anaesthesia and College Tutors meetings.
- Met with representatives from the Joint Royal Colleges of Physicians Training Board, the Royal College of Emergency Medicine, the Intercollegiate ACCS Committee, Health Education England and COPMeD.
- Learned lessons from colleagues at the JRCPTB and the Royal College of Paediatrics and Child Health who have piloted the new GMC standards and received GMC approval of new curricula.
- Contacted specialist societies and subject matter experts to identify the top ten activities that an anaesthetist on completion of the generalist CCT anaesthetic training programme will be able to perform independently in an area of practice.
- Begun to define the high level outcomes that will form the fundamental structure of the 2020 curriculum.
- Delivered presentations at other meetings such as the Edinburgh Update meeting and the Winter Symposium.
Useful links and documents
- Dr Aidan Devlin's review of the existing 2010 Anaesthetic curriculum, 2014
- General Medical Council – Excellence by design
- General Medical Council – Generic Professional Capabilities Framework
- Shape of Training – Report from the UK Shape of Training Steering Group (UKSTSG)
- Health Education England – Enhancing working lives
- Royal College of Paediatrics and Child Health – Progress curriculum
- Joint Royal Colleges of Physicians Training Board – New Internal Medicine curriculum