2021 Curriculum for a CCT in Anaesthetics

Anaesthetics is a craft specialty and much of the education and training is acquired through experiential learning and reflective practice with trainers. A variety of learning experiences enable the achievement of the capabilities described in the domains. There will be a balance of different learning methods from formal teaching programmes to experiential learning ‘on the job’. The proportion of time allocated to each method may vary depending on the nature of the attachment within a rotation, which should be constructed to enable the anaesthetist in training to experience the full range of educational and training opportunities.

Practice-based experiential learning

Anaesthetic training is largely experiential in nature with any interaction in the workplace having the potential to become a learning episode. The workplace provides learning opportunities on a daily basis for anaesthetists in training and the programme of placements is decided by the local faculty for education within a location.

A minimum of three supervised sessions per week (averaged over three to six months) is required to ensure sufficient workplace based learning to allow most anaesthetists in training to progress to CCT within the seven-year indicative length of the programme; this figure is based on many years of experience. It is accepted that there may be variation from week to week depending on local work patterns and the structure of individual school programmes of training, and that the number of sessions required, in the various settings, to meet curriculum requirements will vary according to the stage of training and the individual interests of the anaesthetist in training as they progress.

To ensure patient safety, anaesthetists in training new to the specialty must, at all times, be directly supervised until they have passed the Initial Assessment of Competence (IAC). This is also the case for those new to special interest areas of practice. These concentrated periods of supervision are essential to ensure that anaesthetists in training complete all the required learning outcomes in a very full programme. Following this, the appropriate level of supervision for the anaesthetist’s level of competence should be provided.

It is important to ensure that supervised sessions have relevance to the curriculum and stage that individual anaesthetists in training are undertaking at the time; the concept of a balanced programme of training is essential.

Independent self-directed learning

Anaesthetists in training will use this time in a variety of ways depending upon their stage of learning. Suggested activities include:

• reading, including web-based material such as e-Learning for Healthcare (e-LfH)
• maintenance of personal portfolio (self-assessment, reflective learning, personal development plan) audit, quality improvement and research projects
• reading journals
•  achieving personal learning goals beyond the essential, core curriculum.

Learning with peers and colleagues

There are many opportunities for anaesthetists in training to learn with their peers and colleagues. Local postgraduate teaching opportunities allow anaesthetists of varied levels of experience to come together for small group sessions. Examination preparation encourages the formation of selfhelp groups and learning sets.

Formal postgraduate education sessions The content of formal postgraduate education sessions and access to other more formal learning opportunities are determined by the local faculty of anaesthetic education and will be based on the curriculum. There are many opportunities throughout the year for formal teaching locally and at regional, national and international meetings. Many of these are organised by the RCoA.

Where appropriate formal teaching/meetings should include the multi-professional team. Access should also be provided to key meetings within the service. Suggested activities include:

• a programme of formal ‘bleep-free’ regular teaching sessions to cohorts of anaesthetists in training
• attendance and presentation at mortality and morbidity meetings
• case presentations
•  research, audit and quality improvement projects
• attendance and presentation at governance and risk meetings
• lectures and small group teaching
• clinical skills demonstrations and teaching
• critical appraisal and evidence-based medicine and journal clubs
• joint specialty and multi-professional meetings
• attendance at training programmes organised on a deanery or regional basis, which are designed to cover aspects of the training programme outlined in this curriculum.

Simulation training

Procedural competency training, using simulation aimed at achieving technical competence for certain anaesthetic procedures should be provided as early as possible in CT1. Scenario-based immersive simulation training is expected to be undertaken in Stage 1 in all relevant specialty specific learning outcomes, with human factors incorporated into the scenarios where appropriate.

Simulation training within anaesthetic practice is a developing field and will also be expected to be incorporated into Stage 2 and 3 learning to enable anaesthetists in training to meet the required Stage key capabilities and learning outcomes in line with the RCoA Simulation Strategy developments.

In addition anaesthetists in training will need to learn to be simulation training faculty members and this should be facilitated.

Examples of simulation-based learning activities that should be used to deliver aspects of Stage 1 of the curriculum include, but are not limited to:

• Novice Anaesthesia Skills and Drills
• Assessment of failed intubation drill
• Critical incident training
• Anaesthetic care in the labour suite and obstetric theatre
• Assessment of general anaesthesia for Caesarean section
• Vascular access
• Transfer training course.

Critical incident training should be undertaken more specifically in year 1 of Stage 1 rather than at any time in Stage 1 and should be revisited again in Stages 2 and 3 in order to address the development of more advanced skills and capabilities pertinent to the more experienced anaesthetist in training and their level of responsibility in practice.

Formal study courses

Time to be made available for formal courses is encouraged, subject to local conditions of service. Examples include life support, management and communication courses.

Educational development time

In order to facilitate the acquisition of the essential generic capabilities required for safe, effective and high quality medical care as prescribed by the GMC GPC framework, and to recognise the contribution anaesthetists in training make outside of the clinical setting, the RCoA recommends that local Schools of Anaesthesia consider mechanisms to enable and encourage trainee involvement in research, audit and quality improvement, as well as allowing time for them to work on publications and presentations and participate in teaching and aspects of hospital management. One way to do so is to allow educational development time to help the development of these important skills and the RCoA recommends that this approach, or something similar, is taken by schools for all anaesthetists in training, although the amount of time required may vary throughout the training programme.