Flexibility for Stage 2 and Stage 3

Background

The 2021 Anaesthetics Curriculum is 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.

The curriculum describes the capabilities to lead, develop and deliver high quality care in anaesthesia, critical care and pain medicine. Providing a programme for the development and acquisition of knowledge, skills, behaviours for consultant-level autonomous practice in the UK. The curriculum has been designed to be delivered across the 4 nations of the UK.

To complete Stage 2 (ST4-5) training successfully, an anaesthetist in training must pass the Final FRCA in its entirety, as well as attain all of the generic professional capabilities and specialty learning outcomes required for that stage of training. Once completed, a satisfactory ARCP outcome is required for entry to Stage 3 training (ST6-7).

The College recognises that due to geographical considerations, regional service configuration and the availability of some specialties within some Schools of Anaesthesia, the delivery of Stage 2 and Stage 3 curriculum may benefit from flexibility which would also help support Schools to reduce the frequency of rotations, as well as facilitate progression through the training programme. This flexibility should only be needed in exceptional circumstances but will be available to Schools to implement locally to reflect educational and service capacity and capability and enable the attainment of specific curricular outcomes.

Where flexibility is being considered, the TPD and College Tutor should ensure that any anaesthetist in training who is undertaking Stage 3 capabilities in Stage 2 can safely undertake the out of hours work that is required.

The College has received approval from the GMC for this change and therefore with effect from, and subsequent to February 2025, all anaesthetists in training commencing at any stage of training will be subject to this new regulation.

This flexibility is not expected to be the norm but will be available to Schools to implement in exceptional circumstances.

Principles

It is expected that, where possible, Stage 2 training will be delivered entirely within the indicative 24 months (FTE), ie ST4 and ST5, and that the indicative time for completion of stage 2 and 3 would be 48 months full time equivalent (FTE).

If flexibility is required it should be discussed with the Training Programme Director, who will advise if this is appropriate and grant prospective approval. If approved, the option to defer Stage 2 capabilities or advance Stage 3 capabilities is within the boundaries of the last 6 months of ST5 and the first 6 months of ST6.

This may be helpful in certain situations where areas of the curriculum, such as neuro anaesthesia, cardiothoracic and paediatrics, may have geographical constraints that affect training programmes. Schools may be able to defer some of those into the first 6 months of ST6 allowing some Stage 3 general capabilities to be acquired instead in the last 6 months of ST5, if that facilitates local delivery of training and supports progression through the training programme

However, the following still apply to this guidance:

Anaesthetists in training are required to achieve the Final FRCA examination in its entirety by the end of ST5, before they can officially start ST6. Failure to do so would prevent progression to ST6 and the likely need for an extension to training through an ARCP Outcome 3 will be expected to extend the CCT date as normal
Stage 3 domains or Special Interest Area (SIA) training cannot be undertaken until Final FRCA is completed, and the corresponding Stage 2 capabilities have been completed
The Stage 2 Training Certificate can be issued when all Stage 2 domains of learning are completed and the Final FRCA is passed in its entirety
Where flexibility between Stage 2 and Stage 3 has been approved, any advanced or deferred capabilities must be documented at the next ARCP on the LLP ARCP form. The indicative training time for specialty training (Stage 2 and Stage 3) remains 48 months FTE
The anaesthetist in training’s CCT date will not be affected by use of the flexibility guidance. Advancement in CCT date remains a separate process and should be based on sound educational principles. Any reduction in training time remains in line with existing College guidance.

The Training, Curriculum and Assessment committee will be willing to review any concerns raised by anaesthetists in training or trainers at the request of the TPD.

Procedure

Use of this guidance can be initiated by trainers or anaesthetists in training. Early conversations about flexibility requests between anaesthetists in training and their trainers is encouraged. The request, including the initiation of any Special Interest Areas (SIAs), will be prospectively agreed between the TPD and anaesthetist in training, for clearly defined areas and capabilities within the curriculum, and supported by robust evidence of satisfactory performance.

Schools have a responsibility to deliver fair training to all doctors on their training programmes, and it may not be possible or practical to approve a flexibility request when considering others on the rotation. With this in mind, the final decision of its implementation is at the discretion of the TPD and/or head of school, as nominated by the Postgraduate Dean (Gold Guide 1.8).

The College has a responsibility to quality assure the delivery of the curriculum and monitor this change, reporting to the GMC with an update on the implementation. For this purpose, schools of anaesthesia should notify the Training department by email when flexibility for an anaesthetist in training has been approved.

Standing requests:

Some schools of anaesthesia will require a standing arrangement for flexibility between Stage 2 and Stage 3. TPDs should inform the Training department that a standing request has been agreed as soon as the need is identified. The request should include the capabilities/domains, the reason for flexibility and when the domains of learning are being deferred/advanced to. Anaesthetists in training should be informed by their TPD/trainers through the appropriate local channels.

With the exception of deferred domains, HALOs should be signed off towards the end of each stage training, in line with existing College guidance and the Gold Guide. The Stage 2 training certificate will continue to be populated on the LLP and Stage 3 capabilities can be recorded simultaneously. Only when all Stage 2 domains of learning have been achieved can this be sent for approval. The date of completion of Stage 2 training on the certificate should reflect the date that all Stage 2 domains have been completed, including those that were deferred.

Deferred or advanced capabilities should be recorded on the LLP ARCP form.

Individual requests:

The request should be raised with the TPD, who will review and consider the needs of the anaesthetist in training, along with the needs of the training programme
There should be a specific discussion between the TPD and anaesthetist in training to discuss the arrangement, with a defined training timeline and the options if capabilities are not achieved after deferring/bringing forward domains of learning
Where flexibility between Stage 2 and Stage 3 has been prospectively approved, any deferred capabilities must be documented at the next ARCP on the LLP ARCP form
Any deferred or advanced capabilities must be documented at the next ARCP on the LLP ARCP form
The school should inform the Training department of any flexibility requests by submitting this form: https://www.rcoa.ac.uk/form/flexibility-stage2-and-stage3.This is needed to meet our quality monitoring responsibilities to the GMC. Once this has been satisfied, recording the details on the LLP ARCP form will be sufficient.

Dual anaesthetics and intensive care medicine

Flexibility between Stage 2 and Stage 3 for dual anaesthetic and ICM resident doctors requires early and close collaboration between anaesthetic and ICM trainers. If flexibility has been approved and Stage 2 ICM has been completed, dual anaesthetists in training can defer Stage 2 anaesthetics capabilities into the first 6 months of ST6 and bring forward Stage 3 anaesthetics capabilities to the last 6 months of ST5.

It should be noted that this flexibility only applies to anaesthetic domains of learning and does not apply to ICM HiLLOs. All ICM Stage 2 learning outcomes must be completed before a resident doctor can move to Stage 3 ICM.

The procedure for approval follows the same as above, with the addition that approval should be sought from both anaesthetics and ICM TPDs locally before notifying the Training department.

FAQs

As a School of Anaesthesia, due to constraints on capacity, we occasionally struggle to accommodate all anaesthetists in training during their Stage 2 paediatric anaesthesia at the tertiary centre. If this is the case, can we defer Stage 2 paediatrics to the beginning of ST6 for some AiTs?
Yes, you can. Ideally this should also benefit those anaesthetists in training by keeping them at the same hospital for longer, enabling them to obtain some Stage 3 capabilities before rotating to the children’s hospital/tertiary centre at the start of ST6.
I’m a ST5 AiT and have passed the Final FRCA in its entirety. I have not yet achieved all of the Stage 2 domains of learning, but I have received approval from my TPD to defer those Stage 2 capabilities and advance some Stage 3 capabilities. Can I progress to ST6?Providing you have received prospective approval from your TPD to defer Stage 2 capabilities and advance some Stage 3 capabilities and there is a plan to achieve them by the end of ST5, you can officially commence your ST6 post. You will be required to achieve all of your outstanding Stage 2 capabilities within the first 6 months of ST6; failure to do so will prevent progression to ST7. You will still need to complete a further indicative 2 years of training from the start of ST6.
I have achieved all of the Stage 2 domains of learning and have passed the Final FRCA in its entirety. Can I accrue Stage 3 capabilities towards Stage 3 domains of learning during ST5, before officially starting an ST6 post.
Yes, you can begin to accrue Stage 3 capabilities towards Stage 3 domains of learning during the last 6 months of ST5, before officially starting an ST6 post. This will not shorten your training beyond the time currently allowed by RCoA and this is dependent on your TPD/HoS approval that all learning outcomes have been achieved.