Minimising the impact of rotational training within the anaesthetic training programme

In August 2024, the RCoA published Minimising the impact of rotational training within the anaesthetic training programme.

The report was authored by our rotational training working group, which was established following the 2023 EGM and includes representation from Council (including anaesthetists in training), Training Programme Directors, the Association of Anaesthetists Trainee Committee, the Faculty of Intensive Care Medicine and the RCoA member who proposed the EGM resolution on rotational training.

Anaesthetists in training and trainers have raised concerns over the impact frequent rotations are having on the educational effectiveness of placements as well as on the wellbeing and quality of life of anaesthetists in training. The working group responded to these concerns by reviewing the background to, and impact of, rotational training in the context of the 2021 anaesthetics curriculum. Drawing on these insights, the working group has made recommendations for minimising the frequency and negative impact of rotations.

The report explains the recommendations in full, but in summary:

• Schools of Anaesthesia should review both the number of rotations required to complete each stage of training and the provision and delivery of educational supervision. They should also take steps to give anaesthetists in training as much advance notice of rotations as possible and, where possible, greater choice in their rotations.
• The RCoA should continue to explore appropriate flexibility within the curriculum and to review the support and training available to College Tutors and Educational Supervisors in the delivery and requirements of the 2021 curriculum. The College should also continue to engage with NHS England’s Enhancing Doctors Working Lives Workstream.
• NHS England, HEIW, NES and NIMDTA should implement the recommendations from ‘improving the working lives of doctors in training’ as a matter of priority. They should also ensure appropriate administrative support is provided to their Heads of School and Training Programme Directors.
• Departments of Anaesthesia, Clinical Directors and College Tutors should ensure they are implementing best practice in the delivery of induction and rota management. Departments should also undertake a review of the availability of rest facilities, post-shift accommodation, access to study leave, access to parking, accuracy of payroll and access to hot and cold food 24/7.

Work to implement the recommendations for the RCoA is already underway. In relation to flexibility, we have proposed to the GMC that flexibility be introduced to enable some aspects of the Stage 3 curriculum to be brought forward into ST5 if that enables an anaesthetist in training to remain in a post longer, on the understanding that the remaining aspects of the Stage 2 curriculum are completed before the end of ST6. We have submitted this guidance to the GMC for approval and will publish it in due course.

Throughout this process we have benefited from discussion with our training networks, particularly at the College Tutors meeting in June. Their feedback has shaped our final report and we will continue to work closely with them to ensure the report’s recommendations are implemented. We also thank the College’s Anaesthetist in Training Representative Group who provided feedback on their experiences of rotational training, some of which we have used in the report as examples of best practice.