Guidance for Clinical Directors on the provision of Stage 1 Equivalent posts

This page aims to provide guidance for Clinical Directors on the provision of posts for Stage 1 equivalence on the 2021 Anaesthetics curriculum.

What is Stage 1 equivalence?

In the 2021 Anaesthetics Curriculum, Stage 1 training is an indicative 3 years duration (CT1 – CT3).

It is recognised that, for a number of reasons, anaesthetists will work and develop skills outside of the national training programme. It is important to ensure that their time as Locally Employed Doctors (LEDs) or clinical fellows is used effectively to support progression through the curriculum, either with the aim of entering a training programme, working through the Portfolio Pathway or working towards recognition as a Specialist Doctor.

These anaesthetists will need to gain the necessary experience and demonstrate the learning outcomes required for Stage 1 of the 2021 Anaesthetics Curriculum. Evidence from previous experience may be used, and doctors should consult their Educational Supervisor to determine its suitability.

What should Stage 1 equivalent posts offer?

The contents of the Stage 1 learning syllabus can be downloaded in the form of the HALO guides.

Perioperative Medicine and Health Promotion

Access to pre-operative anaesthetic assessment clinics

General anaesthesia

Initial Assessment of Competence (IAC)
Experience of elective and emergency surgery for ASA 1-3 patients including obese, frail and elderly patients
Paediatric experience for children aged five and over
Experience of TIVA
Out of hours on call commitment once IAC achieved

Regional anaesthesia

Training in ultrasound guided regional techniques including upper and lower limb, chest wall and abdominal blocks

Obstetric anaesthesia

Initial Assessment of Competence in Obstetric Anaesthesia (IACOA)
On call experience in obstetrics including management of ASA 3 parturients
Six months of obstetric anaesthesia experience

Resuscitation and transfer

Experience as part of the medical emergency team and involvement in intra-hospital transfers

Pain

Access to pain management clinics (or availability of structured teaching on biopsychosocial model of pain management) and acute pain ward rounds

Intensive Care

A total of six months experience in Intensive Care Medicine is required
Out of hours on call commitment once assessed as safe to work on an ST3/4 level rota.

Generic Professional Capabilities

Experience in the GPC domains of learning

Doctors in these posts will also require educational supervision, be able to attend teaching sessions, complete departmental quality improvement projects and attend audit and morbidity and morbidity meetings. They will also need guidance in preparing for the Primary FRCA exam.

Ideally, the study leave allocation and terms and conditions should reflect those offered to National Training Number (NTN) holders or Medical Training Initiative (MTI) doctors. The rota allocation should ensure that these educational objectives are realistically achievable within the three-year period (or equivalent, depending on prior experience).

Doctors should be allocated to both directly supervised lists and indirectly supervised lists, with structured opportunities to complete appropriate Supervised Learning Events (SLEs) and progress through the supervision levels. This approach will ensure that, as with current core training pathways, doctors are trained and deemed safe to progress to ST4 level (Guidance on supervision levels and practical measures to develop independent practice in training).

Ideally all training evidence should be recorded on the Lifelong Learning Platform (LLP), which will allow alignment of evidence to the expected level of training.

If the department currently provides core training for NTN holders, and the above conditions are met, job advertisements may state that the department offers RCoA Stage 1 Equivalent Training. In such cases, appointments can be made locally using existing LED/CF contracts.

Guidance for issuing ‘Confirmation of Stage 1 Equivalence’ Certificate

Background

The ‘Confirmation of Stage 1 Equivalence’ certificate has been introduced for doctors who are not enrolled in a UK higher-level training programme under the 2021 Anaesthetics curriculum, but who can demonstrate evidence of achieving the Stage 1 domains of learning and have passed the Primary FRCA examination.

This certificate is primarily used to evidence eligibility for recruitment for ST4 anaesthetics applications.

Certificate Policy

Doctors in this category cannot be awarded the full Stage 1 Certificate, as this is reserved for doctors who have completed all Stage 1 requirements within UK higher substantive training posts.

Instead, if an individual:

Has demonstrated achievement of all Stage 1 domains of learning, and
Has successfully passed the Primary FRCA,

then a Regional Adviser Anaesthesia (RAA) or Deputy Regional Adviser Anaesthesia (DRA) may issue the ‘Confirmation of Stage 1 Equivalence Certificate’, which is available from the Royal College of Anaesthetists (RCoA) website.

Requirements for Sign-Off

The certificate must be signed by the local RAA or DRA
The doctor must be known to the RAA/DRA signing the certificate, or be formally recommended by their College Tutor
Prior to signing, the RAA/DRA must conduct a thorough review of the evidence to ensure that all Stage 1 domains of learning have been met.

Important Notes

The certificate may only be issued if the RAA/DRA is fully satisfied with the evidence submitted
If the evidence is insufficient, the RAA/DRA may request additional documentation
If concerns remain after reviewing further evidence, the RAA/DRA should not sign the certificate.

No Affiliation to a UK RAA/DRA?

If the applicant does not have a UK-based RAA or DRA, they must:

Contact the Royal College of Anaesthetists at training@rcoa.ac.uk
Do so at least two months prior to any national recruitment application window.
Refer to the Anaesthetic National Recruitment Office website for published application timelines and further guidance.