2021 Curriculum Assessment Guidance

Published: 24/05/2021

Holistic Assessment of Learning Outcomes (HALOs)

HALOs provide a structured framework to reflect the evidence that the anaesthetist in training has achieved the required learning outcome for the Domain of Learning. 

Holistic Assessment of Learning Outcomes (HALO) is the Summative Assessment for each domain of the 2021 Curriculum.

The anaesthetist in training will need to demonstrate the following to complete the respective HALO assessment:

  • attainment of all of the Key Capabilities within the Domain of Learning
  • appropriate clinical experience and logbook data in the case of specialty specific domains
  • successful completion of a Multiple Trainer Report for the respective stage of training.

Evidence that may be used to demonstrate attainment of the Key Capabilities includes:

  • clinical experience and logbook data
  • Supervised Learning Events (as illustrated by the use of ACEX, CBD, ALMAT, DOPS or A-QIPAT)
  • Personal Activities including attending courses, teaching sessions or simulation
  • Personal Reflection.

Evidence may be linked to the different Key Capabilities by the anaesthetist in training or trainer, by selecting the Key Capability when the evidence is entered into the LLp. 

Appendices 1, 2, and 3 of this guidance includes stage specific HALO Guides that provide further information on the suggested evidence for each of the Key Capabilities, for each of the Domains of Learning.

Click here to open and download figure 2 - Illustrated extract from the HALO Guide for stage 1

Anaesthetists in training and trainers will need to engage routinely with the LLp as part of training.  As HALOs are unlikely to be completed until the latter phase of a stage of training, ARCPs will need evidence of engagement with training process throughout the stage of training and not reserved until the end of the stage.

All HALOs for all 14 domains must be completed for a stage of training in order to progress to the next stage.

Successful completion of the Primary FRCA and Final FRCA examination is also essential for the completion of some Domains of Learning at the respective stage.

Shared Capabilities & Curriculum Cross References

The 2021 Curriculum contains a number of shared themes that span multiple Key Capabilities across both the specialty specific and general professional domains.  Anaesthetists in training should consider such areas across all domains of the curriculum when recording SLEs and other educational activities.

A single piece of evidence can be used to evidence more than one of the Key Capabilities, further details on how capabilities can be evidenced and crosslinked can be found in Appendices 1, 2, and 3.

Who can complete assessment of the HALOs for each Domain of Learning of the new Curriculum?

A designated trainer of the local Assessment Faculty will be responsible for reviewing the evidence that has been collated to determine if the anaesthetist in training has met the requirements for the Domain of Learning.

This may be the Educational Supervisor or a Clinical Supervisor who is a member of the Assessment Faculty with responsibility for completion of the HALO for the specific Domain of Learning.

College Tutors will have an important role in working with and coordinating the Assessment Faculty roles within departments and signposting anaesthetists in training to different trainers within the local Assessment Faculty.


Is there a difference between assessment of specialty specific domains and generic professional domains?

Assessment of HALOs for specialty specific domains:

Within the local Assessment Faculty, one or more of the faculty will be designated as being responsible for assessment and completion of the HALO for a given Domain of Learning.

These individual trainers and their responsibilities should be clearly identifiable as holding such roles within each department, to allow developmental discussions between trainer and anaesthetist in training.

In many cases this is likely to be an evolution of the existing role of Unit of Training Supervisors within departments.

Assessment of HALOs for generic professional domains:

In the case of the generic professional domains, these are skills that are considered to be intrinsic to the activities of all professional doctors and thus it is likely that such domains can be reviewed and completed by the Educational Supervisor. 

However, it is recommended that for the Safety and Quality Improvement domain, that the designated trainer has experience and engagement in QI activities is responsible for the assessment and completion of this domain.


Role of Educational Supervisor

Educational Supervisors have a vital role in the assessment of the new curriculum.  Educational Supervisors will have responsibility for reviewing the overall progress of the attainment of the Key Capabilities and other evidence, to support for the completion of HALOs, as well as informing the wider educational development of the anaesthetist in training.



For further information about HALOs, a presentation was recorded at the Curriculum Webinar on 25 March 2021. You can watch the recording of this presentation here.

Frequently asked questions
  • Does the consultant responsible for signing off domains on HALOs need to be a recognised trainer?

This will not change from the arrangements for the existing curriculum. If trainer recognition is required for a trainer to approve a CUT form then this will be required to sign off a HALO.

  • Will just one HALO for General Anaesthesia be sufficient for an entire stage of training?

Yes. There are many different capabilities within General Anaesthesia domain, but some have been clustered some together and some stand alone.

For example, in stage 1 there is a key capability to be able to provide safe general anaesthesia for ASA 1-3 patients for non-complex surgery. That is a short sentence but encapsulates an enormous amount of training in order to achieve the suggested level of supervision.

  • How will assessments work for HALOs when anaesthetists in training move trusts with a level of training?

Current units of training, like orthopaedics, can be observed and completed within one trust, but the key capabilities for General Anaesthesia in the 2021 curriculum span many different areas of training and surgical specialties. The educational supervisor will be able review the evidence that has been provided and use their professional judgement to assess whether the trainee has achieved that key capability.  Trainers will be able to look at the range of supervised learning events and observe progress as indicated by the supervision scale.

  • How do we avoid a massive last-minute rush for HALO sign offs just before ARCP dates?

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.

  • Will anaesthetists in training need 14 HALOs per stage of training rather than every year in training?

Yes, 14 HALOs need to be completed in each stage of training but you will be expected to show progression towards HALO sign off in each year of each stage.

  • Stage 2 Perioperative Medicine and Healthcare capability D references 6 body systems (cardiovascular, neurological, respiratory, endocrine, haematological and rheumatological diseases). Can it be signed off if they only demonstrate evidence of 5?

NB For reference, stage 2 Perioperative Medicine and Healthcare capability D can be viewed here.

This list is indicative rather than exhaustive.

The HALO guides will include examples and encourage a diversity of evidence beyond SLEs as well as looking across domains. In the 2010 vernacular, a HALO can be thought of as a major CUT and the ‘Triple C’ as a minor CUT.

This particular capability can also be evidence by completion of the Final FRCA, which is still valid evidence.

  • Can the HALO in ICM be completed without a 'module', using supervision when on-call and working during the day; or is a formal module still required?

The HALOs for ICM in stages 1 and 2 need a period of training in ICU. The HALO for stage 3 ICM will not require a ‘module’ in ICM but will likely need some ICM on call in order to acquire the key capabilities.

  • How do you determine appropriate clinical exposure/logbook contents for HALO sign off? Will there be standardisation nationally or across schools?

There is guidance on the experience required in the Assessment Guidance. Schools can adapt this HALO guidance according to local circumstances but the anaesthetist in training will still need to meet the key capabilities at the supervision level advised.