2021 Curriculum for a CCT in Anaesthetics

This section of the curriculum describes how anaesthetists in training will be supervised, and how they will receive feedback on performance. For further information please refer to the Academy of Medical Royal Colleges (AoMRC) guidance on Improving feedback and reflection to improve learning.

Access to high quality, supportive and constructive feedback is essential for the professional development of the anaesthetist in training. Anaesthetist in training reflection is an important part of the feedback process and exploration of that reflection with the trainer should ideally be a two-way dialogue. Effective feedback is known to enhance learning and combining self-reflection to feedback promotes deeper learning.

Trainers should be supported to deliver valuable and high-quality feedback. This can be by providing face to face training to trainers. Anaesthetists in training would also benefit from such training as they frequently act as assessors to junior doctors, and all involved could also be shown how best to carry out and record reflection.

Supervision

All elements of work in training posts must be supervised with the level of clinical supervision varying depending on the experience of the anaesthetist in training and the clinical exposure and case mix undertaken. As training progresses the anaesthetist should have the opportunity for increasing autonomy, consistent with safe and effective care for the patient.

Organisations must make sure that each anaesthetist in training has access to a named clinical supervisor and a named educational supervisor. The role and responsibilities of supervisors have been defined by the GMC in their standards for medical education and training [external link].

Educational supervisor

The educational supervisor is responsible for the overall supervision and management of a doctor’s educational progress during a placement or a series of placements. They regularly meet with the doctor in training to help plan their training, review progress and achieve agreed learning outcomes. They are also responsible for the educational agreement, and for bringing together all relevant evidence to form a summative judgement about progression at the end of the placement or a series of placements.

Clinical supervisor

The clinical supervisor oversees the anaesthetist’s clinical work throughout a placement and should be a member of the anaesthetist in training’s clinical specialty team. The clinical supervisor leads on reviewing the anaesthetist in training’s clinical or medical practice throughout a placement, and contributes to the educational supervisor’s report on whether the doctor should progress to the next stage of their training.

The clinical and educational supervisors, when meeting with the anaesthetist in training, should discuss issues of clinical governance, risk management and any report of any untoward clinical incidents involving the anaesthetist. If the clinical directorate (clinical director) has any concerns about the performance of the anaesthetist in training, or there were issues of doctor or patient safety, these would be discussed with the relevant clinical and educational supervisors. These processes, which are integral to an anaesthetist’s development, must not detract from the statutory duty of the trust to deliver effective clinical governance through its management systems.

Educational and clinical supervisors need to be formally recognised by the GMC to carry out their roles. It is essential that training in assessment is provided for trainers and anaesthetists in training in order to ensure that there is complete understanding of the assessment system, assessment methods, their purposes and use. Training will ensure a shared understanding and a consistency in the use of the SLEs and the application of standards.

Opportunities for feedback to anaesthetists in training about their performance will arise through the use of the SLEs, regular appraisal meetings with supervisors, other meetings and discussions with supervisors and colleagues and feedback from ARCP.

Sessional supervisor

All consultant anaesthetists who have anaesthetists in training attached to them in any clinical area are Sessional Supervisors. They have direct responsibility for what that trainee does in the workplace while they are supervising them.

Anaesthetists in training

Anaesthetists in training should make the safety of patients their first priority. Furthermore, anaesthetists in training should not be practising in clinical scenarios which are beyond their experiences and competences without supervision.

Anaesthetists in training should actively devise individual learning goals in discussion with their trainers and should subsequently identify the appropriate opportunities to achieve said learning goals. Anaesthetists in training need to plan their SLEs accordingly to enable their SLEs to collectively provide a picture of their development during a training period. Anaesthetists in training should actively seek guidance from their trainers in order to identify the appropriate learning opportunities and plan the appropriate frequencies and types of SLEs according to their individual learning needs. It is the responsibility of anaesthetists in training to seek feedback following learning opportunities and SLEs. Anaesthetists in training should self-reflect and self-evaluate regularly with the aid of feedback. Furthermore, anaesthetists in training should formulate action plans with further learning goals in discussion with their trainers.

Appraisal

A formal process of appraisals and reviews underpins training. This process ensures adequate supervision during training, provides continuity between posts and different supervisors and is one of the main ways of providing feedback to anaesthetists in training. All appraisals should be recorded in the LLp.

Induction appraisal

The anaesthetist in training and Educational Supervisor should have an appraisal meeting at the beginning of each post to review the anaesthetist in training’s progress so far (including the previous ESSR), agree learning objectives for the post ahead and identify the learning opportunities presented by the post. Reviewing progress through the curriculum will help anaesthetists in training to compile an effective Personal Development Plan (PDP) of objectives for the upcoming post. This PDP should be agreed during the Induction Appraisal. The anaesthetist in training and supervisor should also both sign the educational agreement in the LLp at this time, recording their commitment to the training process.

Monthly meetings

Monthly meetings between anaesthetist in training and Educational Supervisor are not mandatory but are strongly encouraged. These are particularly important if either the anaesthetist in training or educational or clinical supervisor has training concerns, or the anaesthetist in training has been set specific targeted training objectives at their ARCP. At these meeting anaesthetists in training should review their PDP with their supervisor using evidence from the LLp. SLEs and progress through the curriculum can be reviewed to ensure anaesthetists in training are progressing satisfactorily, and attendance at educational events should also be reviewed.

End of attachment appraisal

Anaesthetists in training should review the PDP and curriculum progress with their Educational Supervisor using evidence from the LLp. Specific concerns may be highlighted from this appraisal. The end of attachment appraisal should record the areas where further work is required to overcome any shortcomings. Further evidence of competence in certain areas may be needed, such as planned workplace-based assessments, and this should be recorded. If there are significant concerns following the end of attachment appraisal, then the TPD should be informed. Information gathered from this meeting should be incorporated into the Educational Supervisor’s Structured Report.