9.1     The principles of core level training

Core level training (CT1-2) is expected to last for two years; this should normally consist of twenty-one months anaesthesia and three months ICM [see also Section 3.2.2 ACCS]. Core Level is divided into two distinct parts and commences with the Introduction to Anaesthesia:

• Introduction to Anaesthesia (normally completed within three to six months)
• The remainder of Core Level Training, which includes three months ICM, is normally delivered in the remaining time

9.1.1       Introduction to Anaesthesia

This provides a comprehensive introduction to the principles and practices of the delivery of safe and effective anaesthetic care to patients for trainees new to the specialty. The units of training are listed in Annex B. 

To successfully complete Introduction to Anaesthesia, trainees must complete the relevant units of training and obtain the Initial Assessment of Competence (IAC). The latter is a summative assessment and must be completed in its entirety, exactly as written, by trainees before trainers consider whether it is acceptable for them to progress to undertake aspects of clinical anaesthetic practice without direct supervision. It is important that trainees and trainers recognise that possession of the IAC does not imply that a trainee may deliver direct anaesthetic care to patients without continuing appropriate supervision but is the first milestone in the training programme. 

The content of the “Introduction to Anaesthesia” is fundamentally important; therefore trainees must have achieved all the minimum core clinical learning outcomes and obtained the IAC before progressing to the remainder of Core level training [see Annex B]. In practice this will take between three and six months for most trainees.

9.1.1.1       Assessments in Introduction to Anaesthesia

The ‘Introduction to Anaesthesia’ is the first component of training and should be completed within the first 6 months. In order for it to be ‘signed-off’, there should be a CUT form for each of the units in this section confirming that the trainee has achieved all the minimum clinical learning outcomes detailed, demonstrated by a broad range of competences and assessments. By doing this, the ‘signing off’ of the IAC should be a formality.

9.1.2       Core Level Training

This will normally last eighteen to twenty-one months and provides a comprehensive introduction to elective and emergency anaesthesia including perioperative care [with the exception of some special interest areas] and enhanced recovery.

The detailed learning outcomes and competences for these units of training are contained in Annex B.

9.2    Organisation of core level training

9.2.1       Clinical units of training

The College does not define the order in which units of training are completed and it is expected that a number of units of training will run concurrently. The majority of these units of training will not be delivered in dedicated blocks, as this is difficult to provide in most UK hospitals. The intensive care medicine unit must be completed in a dedicated three month block, and trainees may benefit from some of the other units of training being delivered in dedicated blocks, obstetric anaesthesia being the obvious example. 

The Initial Assessment of Competence in Obstetric Anaesthesia [IACOA] must be obtained by all trainees before being considered safe to work in an obstetric unit without direct supervision. Achieving the IACOA does not signal the completion of the core level obstetrics unit of training. The obstetric unit of training should consist of a minimum of 20 directly supervised obstetric anaesthesia sessions to attain the core clinical learning outcomes. At least 50% of these sessions should be supervised by a consultant obstetric anaesthetist.

Each clinical unit of training includes a list of core clinical learning outcomes. These identify the level of performance required to complete the unit successfully. 

Schools of Anaesthesia/hospitals must ensure that their programmes of training allow all the core clinical learning outcomes to be achieved within the identified time; these are identified in detail in Annex B. 

Professionalism and Common Competencies of Medical Practice

In addition to the clinical units of training, trainees must show commitment to many other aspects of professional practice as detailed in Annex A. The majority of these should be demonstrated in the course of clinical practice and satisfactory performance in each domain should be documented as units of training are completed. In addition, there are clearly defined competencies to be attained in the areas of teaching and training, quality improvement, academia and research and management [Annex G]; departments’ educational programmes should allow trainees to develop these competencies. It is also essential that trainees have access to teaching of the basic sciences that underpin safe practice of anaesthesia in order to embed understanding of this knowledge and its application to clinical practice. 

9.2.2       Assessments 

See Section 7 for information on assessment in the training programme.

9.2.3       ACCS 

Trainees who come to anaesthesia via the ACCS programme will already have acquired various competencies identified in the anaesthetics/ICM curriculum. These should be taken into account when assessing progress in core level anaesthetic training and in the completion of the Core Level Training Certificate [see section 3.2.2]. 

9.2.4       Pain medicine training

Pain medicine is a compulsory part of core level anaesthetic training. It commences in Introduction to Anaesthesia; competencies acquired are then developed in core level training, preferably in a dedicated ‘block’.

9.2.5       Intensive care medicine training

Intensive care training [ICM] is mandatory for all trainees at Core level and is completed as a three month block in Core Anaesthesia. The ICM competencies to be achieved are detailed in Annex F. Some trainees [including ACCS trainees] may complete six months of ICM training but must only be assessed against the core level competencies even though they may pick up some intermediate level competencies in the second three months.

9.2.5.1       Dual CCTs in Anaesthetics and ICM

Trainees may apply competitively for a dual CCT post in Anaesthetics and ICM. Anaesthesia trainees wishing to follow a dual CCT programme should contact their local RA in ICM or see the Faculty of Intensive Care Medicine website for more information on the ICM CCT.

Trainees who follow the dual CCTs route will obtain a proportion of their anaesthesia competencies during their ICM training and vice versa. These transferable competencies are documented in the Dual CCTs guidance produced by the RCoA and the FICM, and is available on the RCoA and FICM websites [also see section 3.9].

9.3       Progression to intermediate level training  

To complete core level training successfully, the trainee must achieve all the specified core clinical learning outcomes and pass the Primary FRCA.  The emphasis is on competence, not time. Experience is also an important aspect of competence development and in signing the Core Level Training Certificate, trainers must be satisfied that the trainee has obtained the required level of competence in anaesthesia and ICM, and not that they have just completed two years of training. If the College Tutor feels unable to sign the Core Level Training Certificate within the ‘normal’ two years, the trainee must spend more time in training.  

At the end of Core level training, to be able to progress to Intermediate level training the trainee must have:

• Completed all the Core units of training as evidenced by the ‘Completion of Unit of Training for each
• Obtained the IAC and IACOA;
• Demonstrated acceptable professionalism;
• Passed the RCoA Primary FRCA
• Having achieved all the above, been issued with the Core Level Training Certificate.