Training time and calculation of CCT dates

Shortening training time and bringing forward a CCT date: high level principles

Training in anaesthesia requires the completion of learning outcomes as set out in the 2010 and 2021 Anaesthetics curricula. (See the full 2010 Anaesthetics curriculum and 2021 Anaesthetics curriculum for further information.)

Generic guidance for training is also set out in the Gold Guide which should be referred to for processes such as decision making at ARCP.

As well as the gaining of specific capabilities, safe and expert autonomous care for patients also requires a level of experience which comes through exposure to clinical practice over a period of time. The 2021 Anaesthetics CCT curriculum defines the default time for anaesthetics training as three years at core level (Stage 1) and four years at higher level (Stages 2 and 3). The ACCS programme provides an additional year of core training. These timeframes have been approved by the GMC and Statutory Education Bodies and provide a default position which allows for planning of training rotations.

The College recognises that individual circumstances and experience may provide opportunities for anaesthetists in training to complete a training programme in less time. There are two ways in which this may be achieved which are outlined below.

Recognition of prior learning

Experience that might count towards CCT could be from work undertaken in the UK before recruitment to a core or higher training post. The maximum length of time counted is 12 months whole time equivalent (WTE).

This is in addition to any time spent completing Stage 1 equivalence (eg CT3 ‘top up’ training), or any other ‘top up’ training needed for transition to the 2021 curriculum.

The experience to be counted should match the stage of training at that time, and should show an increase in capability and responsibility (ie those entering higher specialty training at ST4 would be able to count previous experience towards Stage 2 training, but not Stage 3.)

Schools have a responsibility to deliver fair training to all doctors on their training programmes, and at times it may not be possible or practical to accelerate one doctor’s training at the expense of others on the rotation.

In the 2021 Anaesthetics CCT curriculum there is now just a single three-month attachment to Intensive Care Medicine in the higher training programme, which is expected to be delivered within programme.

In summary, up to two years can be counted from outside of training if one of those is a ‘top up’ CT3 year.

Process for recognition

All requests for recognition should be evidenced using the RCoA Lifelong Learning Platform (LLP).

• Doctors should ensure their LLP indicates an Out of Programme (OOP) placement for the review period. They can still continue to record supervised learning events (SLEs) during this time and/or record training evidence as personal activities on the LLP
• Holistic Assessments of Learning Outcomes (HALOs) or Completion of Unit Training (CUT) forms should not be submitted on the LLP whilst outside of a training programme

At the start of a training programme, the doctor should meet with their Educational Supervisor and Training Programme Director (TPD), undertake a gap analysis of their experience and develop a training plan.

• The Educational Supervisor’s Structured Report (ESSR) form can be used to collate the evidence and support this process, with the TPD assigned to the College Tutor role. (TPDs may need to contact the college at lifelong@rcoa.ac.uk to get their account adjusted to accommodate this)
• The training plan, gap analysis, and any other relevant documentation should be reviewed within the first three months of starting a training post in an ARCP-style process. This may require a panel and can be face-to-face or virtual
• The panel will make a recommendation on how much time can count towards CCT, and summarise the domains of learning, or units of training that have been completed
• A notification of the above recommendations should be sent to the Training department at the College (training@rcoa.ac.uk) after being approved by the TPD or Head of School, and the Regional Adviser (RA(A)) or Deputy RA(A)

The notification and supporting evidence will be reviewed by the RCoA Training, Curriculum, and Assessment Committee. Our response including, if necessary, a new prospective completion date will be confirmed in writing to the anaesthetist in training and TPD.

Advancement of CCT date

The College recognises that not all anaesthetists in training will progress at the same rate. To reflect this there is a process whereby a CCT date may be advanced by up to three months (WTE) within the higher training programme, providing all areas of the curriculum have been completed for the stage being undertaken. This time is in addition to recognition of prior learning and may bring forward the completion of either Stage 2 or Stage 3 of the training programme.

To accelerate in training and bring a CCT date forward, an anaesthetist in training (LTFT or full time) should demonstrate via their LLP the following:

• all mandatory components of the curriculum are completed/on course to be completed within the proposed timeframe
• evidence on the LLP of Supervised Learning Events (SLEs) and logbook cases which demonstrate the anaesthetist in training has sufficient breadth and depth of experience and has achieved and sustained the capabilities required for completion of the stage in question

We would therefore encourage anaesthetists in training who wish to pursue the advancement of their CCT date to be proactive in evidencing their LLP, and discuss their ambitions with their educational supervisor, college tutor and TPD at the earliest opportunity. This should be evidenced by their ESSR report and their ARCP outcome forms.

Anaesthetists in training and TPDs may wish to request an earlier CCT date for a variety of reasons but any decision to bring forward a CCT must be based on sound educational principles and not predicated, for example, on upcoming consultant vacancies.

Process for approval of amended CCT date

It is anticipated that an anaesthetist in training and their educational supervisor should have discussed early completion at an educational meeting before it is raised more formally during an ARCP. For an early CCT to be recommended, the following conditions would need to be met:

• There should have been a successful outcome at the previous ARCP
• Local support should be provided by the educational supervisor and college tutor
• There must be specific discussion with the relevant TPD who may then provide their support
• Applications should be made to the RCoA Training department (training@rcoa.ac.uk) who will arrange for a review
• Once College approval has been obtained, the final approval should take place via the ARCP process

The Gold Guide now states that any doctor in training may work less than full time. This change has meant that working at 80% LTFT has become a much more common choice at all stages of training. The College has the following guidance for schools.

• The College welcomes the change in policy which enables anyone to work in a LTFT capacity
• For the reasons stated in this document the expectation, in all cases, is that anaesthetists in training will complete an equivalent time in training to their counterparts who are working in a full-time capacity
• This principle applies to all stages of the training programme and also for specific time-defined areas of the training programme, such as ICM attachments and special interest modules
• Placements should be continuous for LTFT anaesthetists in training wherever possible to ensure that they are not required to move around more frequently. As an example, for those working at 80%, a six-month attachment should be adjusted to a single 7.5- or 8-month block rather than separate attachments of six and two months
• The definition of what constitutes full-time or LTFT in any given post will be in comparison with colleagues in the same attachment or on the same on-call rotas
• The same principles for recognition of prior learning and advancement of CCT dates apply. By this principle, it will be feasible for those working 80% LTFT to reduce a WTE training year of 15 months to a 12-month period, providing all the same criteria are met
• Time allowed for recognition of prior learning will remain at 12 months WTE and the process will be the same for all applications
• Time allowed for advancement of CCT will remain at three months WTE and the process will be the same for all applications

The above guidance is intended to support schools in providing a fair and equitable way for managing those within their training programmes. The College will be happy to provide guidance on an individualised basis whenever requested.

All queries should be addressed to the Training department at training@rcoa.ac.uk.

Less than full-time training and alteration of CCT dates

The Gold Guide now states that any doctor in training may work less than full time. This change has meant that working at 80% LTFT has become a much more common choice at all stages of training. The College has the following guidance for schools.

• The College welcomes the change in policy which enables anyone to work in a LTFT capacity
• For the reasons stated in this document the expectation, in all cases, is that anaesthetists in training will complete an equivalent time in training to their counterparts who are working in a full-time capacity
• This principle applies to all stages of the training programme and also for specific time-defined areas of the training programme, such as ICM attachments and special interest modules
• Placements should be continuous for LTFT anaesthetists in training wherever possible to ensure that they are not required to move around more frequently. As an example, for those working at 80%, a six-month attachment should be adjusted to a single 7.5- or 8-month block rather than separate attachments of six and two months
• The definition of what constitutes full-time or LTFT in any given post will be in comparison with colleagues in the same attachment or on the same on-call rotas
• The same principles for recognition of prior learning and advancement of CCT dates apply. By this principle, it will be feasible for those working 80% LTFT to reduce a WTE training year of 15 months to a 12-month period, providing all the same criteria are met
• Time allowed for recognition of prior learning will remain at 12 months WTE and the process will be the same for all applications
• Time allowed for advancement of CCT will remain at three months WTE and the process will be the same for all applications