2021 Curriculum for a CCT in Anaesthetics

This purpose statement addresses the requirements of the ‘GMC Excellence by design: standards for postgraduate curricula’ to include a clear statement, addressing patient and service needs, and the scope of practice and level expected of those completing training.

The curriculum has a stated and clear purpose based on scope of practice, service, and patient and population needs.

The purpose of the anaesthetic curriculum is to enable doctors to become consultant anaesthetists with the generic professional and specialty specific capabilities to lead, develop and deliver high quality anaesthesia, and perioperative, critical care, and pain medicine. The curriculum provides a framework for training, articulating the standard required to work at consultant level and at critical progression points within the programme, as well as encouraging the pursuit of excellence in all aspects of clinical and wider practice.

The need for doctors to follow this training programme is clear; a nationwide survey of all UK hospitals in 2013 demonstrated that anaesthetists are responsible for the care of more than 3.5 million patients per year. This means that in a given year 1 in 20 of the population will require an anaesthetic. The Centre for Workforce Intelligence (CfWI) in-depth review of anaesthesia and Intensive Care Medicine (ICM), published in 2015 [pdf], reported that the demand for anaesthesia and ICM services is expected to exceed supply over the next 20 years. The report also identified an existing unmet need of 15% in anaesthesia. 16% of all hospital consultants are anaesthetists, making anaesthetics the single largest hospital specialty in the UK, and they play a critical role in the care of two-thirds of all hospital patients. Unlike many other specialties there is no potential for crosscover from doctors in other specialties to meet the staffing gap for anaesthesia, as the ability to deliver a safe anaesthetic for even the most straightforward of cases is simply not part of the wider skill set of doctors outside of our specialty.

This curriculum seeks to provide a flexible, attractive programme for doctors training in anaesthetics; ensuring they have the opportunity to develop the full range of knowledge, skills, behaviours, and attributes needed to practice as a consultant anaesthetist in the NHS. The content of the curriculum reflects the wide range of clinical and professional skills required to meet the needs of clinical services across the whole of the UK.

Both clinical and non-clinical practice will be developed and evidenced through achievement of High-level Learning Outcomes (HLOs) across 14 domains, which advance in complexity and sophistication as anaesthetists progress through the 3 stages of the training programme. The HLOs to be achieved by the end of each stage of specialty training capture the skills, knowledge, and behaviours required, incorporating the General Medical Council’s (GMC) Generic Professional Capabilities (GPCs) (GMC GPC Framework [external link], for all doctors-in-training and specialty-specific clinical learning outcomes.

Figure 1 - the domains of learning

 

Training in anaesthetics will be divided into three distinct stages each of which has a specific critical progression point to move to the next stage or be recommended for the CCT.

Stage 1 (indicative three years): anaesthetists in training will be exposed to a comprehensive introduction to elective and emergency anaesthetic practice and perioperative care in areas that reflect ‘generalist’ anaesthetic practice. Time is spent gaining clinical experience primarily in a low to moderate risk patient population although there will be some supervised exposure to more complex cases. Time will also be spent developing relevant skills in ICM. Anaesthetists in training will complete the Primary FRCA examination during this stage of training.

Stage 2 (indicative two years): having gained knowledge of the principles underlying clinical anaesthetic practice at Stage 1, anaesthetists in training are introduced to wider areas of practice during Stage 2. The focus of this part of the training programme is twofold: an introduction to specialist areas of anaesthetic practice and consolidation of the skills gained in Stage 1 in ‘generalist’ practice with greater autonomy whilst developing skills in managing a higher risk patient population. Anaesthetists in training will complete the Final FRCA examination during this stage.

Stage 3 (indicative 2 years): the final stage of training will prepare anaesthetists for the transition to consultant practice. This final level of training allows them to mature for safe independent practice. The final stage of training also allows further development of the generic professional capabilities to a level appropriate for the award of a CCT in areas that include medical leadership, management responsibilities, and the ability to teach, train, and supervise others. This final stage equips anaesthetists with the expertise to manage complex clinical and organisational issues. The generic nature (to anaesthetic practice) of the clinical learning outcomes will allow opportunities for service providers to provide training in clinical areas in a manner that is flexible to meet service requirements and developments. Completion of stage 3 training will ensure that anaesthetists in training are fully prepared for consultant roles in generalist and/or specialist practice and will lead to the award of CCT.

During Stage 3 trainees will develop advanced skills that are transferable between generic and specialist areas of practice; all day-1 Anaesthetics CCT holders will be appointable to any Anaesthetics post advertised.

Training and assessment in each of the areas outlined in the domains will take place throughout each of the 3 stages of training.

This curriculum will train doctors to undertake the wide range of diverse roles that are associated with consultant anaesthetic practice throughout the UK. All anaesthetists will have the clinical and professional skills to manage and supervise elective and acute unselected perioperative care in an environment that includes a wide range of surgical specialties, maternity services, pain management and also to provide support for ICM and paediatric services in non-specialist centres. They will also have the capabilities to manage patients requiring specialist treatment until transfer to a definitive area of care. All anaesthetists at the completion of training are trained for “Generalist Practice”.

Additionally, all anaesthetists will undertake specialist training in selected areas of practice such as major general surgery, obstetrics, complex trauma, cardiothoracic anaesthesia, neuroanaesthesia, paediatric anaesthesia, or chronic pain medicine, as well as have the potential to be specialty leads in DGHs in appropriate areas.

The GPCs and the specialty specific learning outcomes required will be identical throughout the duration of the training programme.

On completion of the training programme, an anaesthetist will be equipped with the competence and confidence to treat the full range of emergency and elective patients encountered in a typical general hospital, recognise and stabilise those who require tertiary care, before transferring them onward for definitive treatment.

The curriculum will not equip any doctor with the expertise to become a consultant in highly specialised areas of anaesthetic practice such as anaesthesia for children with significant cardiac abnormalities. However, it will provide the foundation stones for further development of such areas of practice, as per the UK Shape of Training Review (UK Shape of Training Final Report) [pdf], once a legal and regulatory framework for credentialing is developed.

The curriculum considers interdependencies across related specialties and disciplines. It demonstrates that it has addressed the expectations of the service and healthcare system.

Anaesthetists underpin the safe provision of a wide range of essential NHS services and work, and interface with all other medical specialties and hospital teams, facilitating complex and routine surgery of all types by safe anaesthesia and perioperative care. As well as anaesthesia and perioperative care for elective and emergency surgical patients, anaesthetists are also essential to the provision of other services including maternity, critical care, acute and chronic pain management, management of trauma, resuscitation, stabilisation, and transfer of patients.

During its development, the curriculum has undergone extensive consultation with stakeholders including anaesthetists in training, trainers, Heads of Schools, and lay representatives Input from appropriate external stakeholders from other related specialties (notably the Faculty of ICM and the Faculty of Pain Medicine) has been essential. Anaesthetic specialist societies and lay and patient groups have been consulted, to gain their insight into what they require and would want from a high-quality anaesthetic consultant. In addition, there has been formal consultation with the anaesthetic Clinical Directors network and NHS Employers and their equivalent in the devolved nations, and Conference Of Postgraduate Medical Deans (COPMeD) through the lead Postgraduate Dean.

The curriculum supports the flexibility and transferability of learning.

In the early stages of training, Anaesthesia will share transferability with the other specialties that make up the Acute Care Common Stem (ACCS) pathway (Emergency Medicine, Internal Medicine and ICM). On successful completion of these common areas, anaesthetists in training will be able to transfer the skills they have learnt between the anaesthetic and ACCS training programmes. Successful completion of appropriate elements of the anaesthetic curriculum will also be recognised towards the ICM CCT programme (as is currently the case).

By making the GPCs explicit within the curriculum design, ease of transfer between specialties as other curricula are reviewed to incorporate the GPCs is assured. HLOs can be evidenced by experience in a wide range of posts and environments, allowing flexibility to meet the needs of both the service and individual anaesthetists in training.

This purpose statement has been endorsed by the GMC’s Curriculum Oversight Group and confirmed as meeting the needs of the health services of the countries of the UK.