2021 Curriculum Assessment Guidance

General principles

Holistic Assessments of Learning Outcomes (HALOs) are summative assessments used in the 2021 Curriculum to show that an anaesthetist in training has achieved the required learning outcome for a domain of learning and has illustrated this by uploading appropriate evidence to the Lifelong Learning platform (LLp).

Each domain of learning has an overarching learning outcome for each stage.  Within each stage the learning outcome is underpinned by stage-specific key capabilities, which guide the individual towards achieving the learning outcome.

The main focus of each HALO is assessment of achievement of the learning outcome(s), for which the key capabilities provide the supporting evidence.

To complete a HALO, the anaesthetist in training will need to demonstrate the following:

• evidence linked to each key capability or cluster of key capabilities within that domain of learning
• appropriate clinical experience, evidenced by logbook data
• a completed Multiple Trainer Report for the respective stage of training, documenting appropriate progress & performance.

Evidence that may be used to demonstrate attainment of the key capabilities includes:

• Supervised Learning Events (SLEs) as illustrated by the use of ACEX, CBD, ALMAT, DOPS or A-QIPAT. No fixed number is required, but progress in terms of supervision levels should be demonstrated.  Anaesthetists in training should show engagement with learning by regular completion of SLEs as ‘low stakes’ assessments that guide learning and provide feedback.
• Personal Activities such as attendance at courses, teaching sessions or simulation.
• Personal Reflection.

When evidence is uploaded to the LLp, it should be linked to the appropriate key capability or cluster of key capabilities by the anaesthetist in training. A single piece of evidence can be linked to more than one cluster of capabilities and more than one domain of learning.

Once some evidence has been linked to capabilities in a HALO the anaesthetist in training should click on the ‘Create HALO’ tab. This will turn the HALO blue and allows the trainer to see what evidence has been linked to the key capability clusters and the supervision levels that have been recorded for individual SLEs. SLEs will appear in chronological order under the linked key capability or cluster of capabilities, which allows the progression with supervision to be clearly illustrated.  To view progress with any aspect of the HALO the trainer should click on ‘Review HALO’. It is important to note that the trainer must not click on ‘Create HALO’ as this then locks the HALO for the trainee.

Successful completion of all 14 HALOs is required to complete each stage of training. Most HALOs will be approved towards the end of a stage of training. Some HALOs may be approved earlier in the stage, for example ICM, after completion of the relevant clinical attachments.

HALO Approval Procedure

Click here to open and download figure 3 - HAL-gorithm for the approval of a HALO

When approving a HALO, educational supervisors, the assessment faculty, or both should review the evidence presented by the anaesthetist in training, to assure themselves that the evidence indicates that the learning outcomes have been met.

In discussion with the School of Anaesthesia, departments should agree local arrangements for approval of different HALOs. In most cases it is likely that the Educational Supervisor will be responsible for approving the generic professional domains for their respective anaesthetists in training, perhaps with the exception of Safety & Quality Improvement, which could be approved by a QI lead.

For some specialty specific domains, a lead trainer within the assessment faculty may be designated to approve HALOs. This might be the case in Regional Anaesthesia, Resuscitation and Transfer, Procedural Sedation, Pain, or Intensive Care. The lead trainer should have clinical experience in the content of that domain and knowledge of the curriculum requirements. Lead trainers fulfil a similar role to CUT supervisors or module leads from the 2010 curriculum.

For the larger clinical domains such as Perioperative Medicine and Health Promotion and General Anaesthesia, the HALO should usually be approved by an assessment faculty, which would include educational supervisors and lead trainers.

Assessment faculty

Creation of a local assessment faculty facilitates approval of larger clinical domains such as Perioperative Medicine and Health Promotion and General Anaesthesia, which include many different key capabilities across a wide spectrum of clinical practice.

The structure and membership of an assessment faculty can be adapted to account for different local arrangements but members should typically include Educational Supervisors, College Tutors and lead trainers with experience and knowledge in relevant clinical areas. The key requirements for membership of the faculty are knowledge of anaesthetists in training, the clinical area of practice, and the curriculum requirements.

The College Tutor should usually coordinate the assessment faculty, and they should identify the different roles, including curriculum responsibilities for approval of components of training, of faculty members. The faculty should meet to discuss the progress of individual anaesthetists in training and provide expert, global opinion, and judgment with respect to attainment of the learning outcomes as supported by the key capabilities. These decisions should be based on the evidence provided by the anaesthetist in training. This would include evidence linked to the key capabilities within the domain of learning, clinical experience, and logbook data and a Multiple Trainer Report for the respective stage of training, documenting appropriate progress and performance.

Supervision levels for SLEs

Suggested supervision levels for each stage of training are set out in the HALO stage guides. The faculty should discuss the supervision level they think the anaesthetist in training is achieving in practice. This should be reflected in the SLEs, however if a trainee does not have an SLE which demonstrates the required supervision level, the HALO can still be completed if the assessment faculty agree that the trainee is able consistently to perform safely at the required level.

If an anaesthetist in training is not achieving the suggested supervision levels then this may indicate issues with progress and should be discussed by the assessment faculty. Measures may need to be put in place to support the anaesthetist in training to achieve the supervision level required.

Feedback from faculty decisions should be shared with the anaesthetist in training. This may be as a formative discussion, supervisory meeting or a summative recording of the HALO approval.

Evidence: Additional Points

Generic Professional Domains

• Capabilities within the generic professional domains are clustered for the whole domain. Evidence can only be linked to the cluster, not individual capabilities.
• When approving generic professional HALOs, trainers should see evidence relating to a selection of the key capabilities within the domain. Examples of evidence are given in the Assessment Guidance document and are included on the LLp.
• In some situations, a single piece of evidence may cover the majority of key capabilities for a generic professional domain, for example a Good Clinical Practice (GPC) course for Research and Managing Data in stage 1.
• Schools of Anaesthesia are encouraged to develop School specific examples of evidence such as attendance at specific training days.
• There is an expectation that anaesthetists in training are engaged with QI activity throughout their training, and the level of involvement increases with each stage. During stages 2 and 3 it is anticipated that at least one significant project will be undertaken for each stage.
• QI activity should be recorded using the A-QIPAT form, but other evidence may also be presented for example, uploading a project presentation.

Clinical Domains

• Anaesthetists in training are encouraged to use SLEs regularly to capture learning from clinical experience and use of the 'Quick Approve' function helps these to be completed at the time of the formative discussion with the trainer.
• The log book should be reviewed to ascertain that the case numbers and case mix are appropriate.
• Supervision levels can be recorded when completing SLEs. Suggested supervision levels for the end of each stage of training are set out in the chapter on Supervised Learning Events (SLEs). The anaesthetist in training should demonstrate progress in levels of supervision towards those required for the end of the stage of training.
• If the anaesthetist in training has used the ‘Create HALO’ tab then the trainer will be able to see evidence as it is linked to the clusters of key capabilities and will be able to review the supervision levels. This is done by clicking on ‘Review HALO’.
• When reviewing evidence with the anaesthetist in training at regular supervisory meetings, a trainer should see progress with the levels of supervision. The suggested supervision level described in the HALO guide refers to what is expected at the end of the stage of training.
• Towards the end of the stage of training if the anaesthetist in training does not have an SLE which demonstrates the required supervision level, the HALO can still be completed if the assessment faculty agree that the trainee is performing safely at the required level. This should be supported by the Multiple Trainer Report feedback.
• A HALO cannot be approved if there is no evidence linked to a cluster or individual key capability. All clusters or individual key capabilities should have some form of evidence linked.