IAC guidance for non-anaesthetists

The initial assessment of competence (IAC) is the first anaesthesia training milestone for doctors in the Anaesthesia/ACCS training programme. The IAC is normally achieved within the first three to six months of the anaesthesia programme and the learning activities and outcomes to be demonstrated in order to achieve it can be found here.

The purpose of the IAC is to signify that the doctor, has achieved a basic understanding of anaesthesia and is able to give anaesthetics at a level of supervision commensurate with the individual’s skills and the clinical case; and can be added to the on-call rota for anaesthesia. The IAC is not a licence for independent anaesthetic practice. The key point is that the doctor is still under the supervision of a named consultant anaesthetist.

For ACCS doctors not following a training pathway for a CCT in Anaesthetics, the IAC is a mandatory element of the anaesthesia component of ACCS training. Irrespective of the specialty, ACCS doctors should not give anaesthetics without supervision. It is acknowledged that it is not always possible to be supervised by an anaesthetist in the emergency department, intensive care unit or on the ward, so supervision in these locations may be provided by a suitably trained person who is competent at intubation for routine cases.

In an emergency, the doctor should provide a level of care to patients commensurate with their skills and knowledge until senior assistance arrives. Under no circumstances should a doctor with very limited experience and not exposed to ongoing anaesthetic practice be contemplating rapid sequence induction without supervision, irrespective of the location or urgency of the case.

Achievement of the IAC does not confer the ability to practice anaesthesia without close supervision by a senior doctor; senior support remains crucial.

If you require any further information or advice concerning the limitations of the IAC, please contact us via training@rcoa.ac.uk.

NB The initial assessment of competence in obstetric anaesthesia (IACOA) is a specific assessment for competence in obstetric settings, which is required before working unsupervised in maternity units. The learning activities and outcomes to be demonstrated in order to achieve the IACOA can be found here. Achieving the IACOA does not signal the completion of training in obstetrics during Stage 1 of the Anaesthetics training programme. Further training will be required in order to attain the required key capabilities.