Training during the COVID-19 pandemic

As a Royal College and professional body, the RCoA has a number of national responsibilities, with the aim of ensuring we provide the highest quality of care to patients. These include

  • recruiting new doctors into the specialty
  • setting an appropriate curriculum for anaesthetists in training to follow to obtain their CCT
  • administering high quality examinations
  • provision of specialty specific guidance for CPD, revalidation and appointments to substantive consultant posts.

If you are an anaesthetist in training, at times it can feel these college workstreams are working against you, with job applications, annual ARCPs and attempts at the Primary and Final FRCA featuring high amongst top ten most stressful life events for many.

However, the RCoA is also a membership organisation, here to support and champion you and the anaesthetic profession throughout your career. We constantly strive to provide a professional service to supporting your career, your interests and your progression in the training programme; we work on your behalf to set standards for the specialty and we work to influence national bodies to coordinate and organize training and working conditions.

The balance between supporting the needs of the membership and the expectations of the public and broader healthcare sector is always a challenge; and then along came Covid-19.

Each of us knows the chaos the pandemic brought to our departments and personal lives. Trainees had additional, specific worries: would ARCPs be failed due to missing modules; would job interviews or exams still go ahead; how long would trainees be stranded in their current placements; and would training now be extended?

Along with supporting the national clinical response to the pandemic, the RCoA was faced with the unprecedented task of finding solutions to these concurrent training crises. This required the training, exams and recruitment teams along with our council members to work with a variety of external agencies across the four nations of the UK. When engaged in these negotiations we tried as hard as possible to advocate for what was best for our specialty and our members, in full knowledge that our colleagues from other colleges were doing the same. Sometimes there was alignment of ideas and sometimes not. The resulting decisions were attempts to find the best compromise with the many competing interests from colleges, trade unions, employers and government policy. At times as the complexity and regularity of these discussions increased, communication with our trainee members suffered – not with any malicious or obstructive intent, but because the people involved were concentrating on the task in hand, and because no one wanted to release primitive information that later changed and caused further anxiety.

As currently we are fortunate to be in a period of relative calm, we thought this would be an opportunity to review the areas of greatest concern for trainees, and to provide more detailed explanation than it felt possible to get out as events unfolded. These are issues which not only led to chaos and concern at the peak of the pandemic but may continue to cause uncertainty for anaesthetists in training during the next academic year and beyond. We plan to take each area in turn, beginning in this blog with recruitment.

Recruitment to anaesthetic specialty training posts during the COVID-19 pandemic

At the time of writing, applications are now open for CT1 and ST3 anaesthetic posts commencing in February 2021. This application process has marked differences to previous recruitment rounds, and we spoke to Dr Tom Gale, Chair of the RCoA Recruitment Advisory Group, and Dr Caroline Evans, Bernard Johnson Advisor Less Than Full-time Training and Deputy Chair of the Recruitment Advisory Group, to help us explain these changes and to reflect on the difficulties of recruitment during the peak of the Covid-19 pandemic.

Recruitment to Core and ACCS anaesthetics posts commencing in August 2020 had fortunately been completed before the worst of the pandemic.

However, the ST3 recruitment process had only progressed as far as shortlisting of applicants based on their submitted application forms, with interviews still pending. There was particular interest in this recruitment round all over the UK, with an increased number of applicants, due to the fact that this was scheduled to be the penultimate recruitment round for ST3 prior to the planned introduction of the new curriculum in August 2021. The Training Committee is now planning a staggered start to the new 2021 curriculum, which means that there will continue to be ST3 recruitment for trainees starting ST3 training in August 2021 and February 2022.

Face-to-face interviews could not proceed in April due to government advice on social distancing and the need for interviewers/interviewees to support the clinical surge response locally or at a national level. This was a problem that many Colleges faced, as few had completed recruitment and the national recruitment and selection process is aligned across all specialties. During this period all colleges, the RCoA included, were asked to put forward proposals for completing recruitment to be presented to the national recruitment and selection committee (MDRS), comprised of the four Statutory Education Bodies of the UK, trade unions and junior doctor representatives from the Academy of Medical Royal Colleges and the BMA. The RCoA’s Recruitment Advisory Group formulated proposals that were robustly presented to MDRS, including a detailed proposal for establishing automatic extensions and/or LAT posts and using this as an opportunity to facilitate the early introduction of CT3 training, making the future transition to the new curriculum easier. 

This plan was rejected in early April 2020. The rationale provided was that overall the MDRS committee felt that implementing this option would negatively impact on trainees and their wellbeing, as those appointed to LAT posts would de-facto be required to go through a second recruitment round to access the remainder of a Higher training post the following year - thereby adding to stress and anxiety around career progression during what was an already challenging situation with the Covid pandemic.  

MDRS presented a unified solution requiring all specialties to use portfolio self-scores as the sole means of ranking the short-listed applicants. It was also felt that a verification process for all applicants would not be possible since this would be a significant undertaking for assessors and trainees, with some trainees unable to gain access to documents supporting their self-scores if they were not working from home during the Covid crisis.

When this information was published and communicated to applicants the RCoA received a significant number of concerns from trainees and trainers. Some applicants were worried that they had modestly under-scored themselves, and now had lost the opportunity to demonstrate at interview they deserved a higher score. Conversely, there were concerns that applicants who had overstated their achievements would be rewarded with a post without verification of their scores. Of particular importance were concerns that this situation may disproportionately disadvantage protected groups.

The College challenged this decision at the highest level throughout April, as in our view there were strong educational benefits for moving forward with the new curriculum transition.  However, our appeals were unsuccessful as the SEBs maintained that a unified approach to managing the response to Covid-19 across training and recruitment across all specialties was needed.

The Recruitment Advisory Group worked within these limitations to make appointment to posts as fair as possible for the shortlisted candidates. In particular, decisions needed to be made on how to differentiate between applicants who were matched to the same post with the same (tied) scores.  With input from the Recruitment Advisory Group and Training Committee (including trainee representation),  it was decided that domains in the self-score related to clinical experience rather than academic experience would be used first to differentiate those on the same overall score. This meant that scores for audit and quality improvement, and then teaching experience, were used in preference to scores for academic qualifications and academic prizes.

The Academy of Medical Royal Colleges has asked for retrospective equality and diversity data for recruitment to all specialties conducted in this way, and MDRS has commissioned an independent equality impact study across all specialties as a result. The RCoA will also be examining our own data to determine the impact of changes to the recruitment process in this and future recruitment rounds. It is important to ensure equity for all who apply to work in anaesthesia and to maintain fair assessment processes when making any changes to the recruitment process. Please see our President’s recent statement on equality and diversity.

The impact of this recruitment round has caused the RCoA to reassess its plans for introducing the new curriculum. It was felt that as a significant number of applicants had lost the opportunity to compete in the normal way for ST3, it would be unfair if the smaller recruitment round for February 2021 was the final opportunity to secure an ST3 post. The college has now agreed with the GMC that the new 2021 curriculum will be implemented in a staggered way which will therefore mean that there will continue to be ST3 recruitment for posts starting in August 2021 with final recruitment to ST3 for February 2022.

Plans are now in place for the next recruitment, with applications open until August 13th for posts commencing in February 2021. The knock-on effect of FRCA exam cancellations means that the person specification has been adjusted so that only a pass in the Primary MCQ is required to apply for ST3, and successfully appointed candidates will have until the end of ST3 to pass the Primary SOE and OSCE. No marks are awarded for membership exams for recruitment to any specialty, so this change won’t see candidates who already had the exam get extra points over those who have been prevented from sitting it. To future-proof against further peaks in Covid-19 or enhanced social-distancing measures, the RCoA is seeking approval to conduct the interviews remotely using video calls. The proposed plans would see applicants upload evidence in advance to support their self-assessment scores and use the video call to assess other important domains which are normally assessed at the face-to-face selection centre.

The application portal on the ANRO website contains detailed advice for applicants about what can be used to evidence their portfolio self-score. Candidates will be asked to upload these supporting documents to a secure drive and will be able to write a short commentary to justify the score they have awarded themselves for each domain. Portfolio scores will then be verified against this evidence by a clinical reviewer, drawn from our pool of experienced interviewers who are undergoing additional online training. If it becomes apparent that a candidate has under-scored themselves, the reviewer will award them the appropriately higher mark.

Domains including commitment to specialty, communication, reflective practice, team working, decision making and working under pressure will be assessed during the online interview through questions related to the applicant’s clinical experience to date and their insights into working in the complex environment of the NHS. Applicants will be awarded a total score, with the interview score carrying more weighting than the portfolio score.

Some prospective applicants have raised concerns that due to the disruption of Covid-19 they have been unable to dedicate as much time to clinical governance, teaching and other projects that would normally help them to make a competitive application. Some have been shielding and feel at a disadvantage clinically. Others feel frustrated that having achieved the full Primary before the pandemic, they now don’t necessarily need it to apply for ST3. The Recruitment Advisory Group has two representatives from the Anaesthetists in Training Committee, who are helping to air your views and make recruitment as fair and representative as possible. If you do have worries or questions, please get in touch with your local Anaesthetists in Training Representative, who can be found via our website.

Authors:
Dr Tom Gale, Recruitment Advisory Group chair
Dr Caroline Evans, Recruitment Advisory Group deputy chair
Dr Sarah Muldoon, RCoA Trainee Council Member
Russell Ampofo, Director of Education, Training and Examinations

With acknowledgement to:
Dr Fiona Donald, RCoA Vice President
Dr Chris Carey, RCoA Council Member, Training, Curriculum and Assessment Committee chair
Claudia Moran, Head of Training
Afsana Choudhury, Workforce Planning & Recruitment Coordinator