Anaesthetists in Training who are shielding
This statement is intended to be a guide for continued progression for anaesthetists in training if they are shielding or have been identified as belonging to a clinically vulnerable group. This guide supports decision making for anaesthetists in training and their trainers.
It goes without saying that any trainee in this group is acting in accordance with the latest government guidance on shielding.
Both as trainers and colleagues, we have a responsibility to support those shielding or identified as clinically vulnerable. This is clearly outlined in the GMC document Good Medical Practice.
In preparing this statement, the Royal College of Anaesthetists (RCoA)’s Training Committee and our trainee representatives reviewed feedback from anaesthetists in training. Based on that feedback the following areas should be considered.
All trainees who have shielded should be risk assessed before their return to clinical work and be aware of the Supported Return to Training programme, or equivalent, in their place of work. There is also useful information at on the joint COVID information and guidance hub.
It is likely the risk assessment will determine those doctors in higher clinical risk groups should not be working in red or amber pathways (COVID positive or COVID status unknown). However, clinical work in areas that have been identified as ‘green’ (COVID negative) may be suitable, and experience in these areas can be counted towards any appropriate Units of Training. If clinical areas, including theatres, critical care or labour ward, do not have clear COVID secure areas and pathways, shielding anaesthetists are unlikely to be able to work in these environments.
Where an anaesthetist in training are able to gain an extensive amount of experience towards a clinical module in this way, it is acceptable to complete intermediate and higher modules in a single attachment. In this situation, the core clinical learning outcomes must be completed for both stages of training, for example intermediate and higher regional, intermediate and higher perioperative medicine.
There may also be other ways anaesthetists in training in higher risk groups can achieve progression through training.
Various educational activities and QI projects can be conducted remotely and can be evidenced against the domains in Annex G and the non-clinical advanced curriculum. Project work may be completed that maps to many clinical units of training. Some clinical work can be conducted remotely, such as pre-operative assessment clinics and some outpatient pain clinics. This allows collation of evidence towards the Perioperative Medicine and Pain Medicine modules respectively.
At the earliest opportunity the ES/CT/TPD should perform a ‘gap’ analysis with all anaesthetists in training who have taken time out of clinical work to ensure all training activities that have taken place remotely are appropriately evidenced against the curriculum. This will establish outstanding clinical experience and allow training programme directors to plan ahead within the constraints of what clinical work the anaesthetist in training can safely perform. Local flexibility between trainers and trainees will be needed when planning module allocations.
Derogation to curriculum
The GMC will continue to honour derogations to the curriculum at ARCPs in 2021, and the anaesthetic curriculum is designed to be competency rather than time based, allowing some flexibility to accommodate lost ‘time’ if progress has been satisfactory. All mandatory components of the curriculum must be completed however for the award of a CCT.
Out of hours
Out of hours clinical work is an essential part of the consultant anaesthetist role. It is accepted that doctors in the early stages of the anaesthesia training programme will be able to be exposed to out of hours in training at a later stage. Those who were approaching the end of their training programme may have already undertaken extensive on-call duties prior to the arrival of the COVID-19 pandemic, but this may not be the case for all those who are close to completing their training.
The RCoA Training Committee will support local trainers on a case-by-case basis when considering if an ST7 trainee approaching their CCT date has had sufficient exposure to on-call duties to be able to CCT as anticipated, or whether an extension to training is required.
Extensions and loss of clinical experience
There are likely to be some anaesthetists in training who will require an extension to their CCT date because of the loss of clinical experience while shielding and/or limitations on which clinical work/training they can undertake on their return to clinical practice.
It is important this is identified early on, and a new CCT date planned. The College is committed to supporting anaesthetists throughout their career and maintaining quality of training. With reasonable adjustments, and/or extension of training, every trainee should have the opportunity to access and experience units of training essential for a successful CCT.
Pregnant trainees who are unable to continue patient-facing duties after 28 weeks gestation, can also evidence other activities that will be recognised for training. An example can be found via the Welsh School of Anaesthesia. This activity should be recorded in the non-clinical domains of the LLP.
Further information is also available on the HEE website.
The College would like to thank Dr Sethina Watson for her assistance in preparing this guidance.
Dr Sarah Muldoon, RCoA Trainee Council Member
Dr Ros Bacon, RCoA Council Member
Dr Caroline Evans, RCoA Bernard Johnson Advisor for LTFT Training