Maximising career progression

Steven completed his core anaesthetic training, successfully passing the Primary FRCA and receiving an Outcome 6. Around the same time, he started a family and was keen to remain in the region, close to his home and support network. He applied for ST4 anaesthetics training but was unsuccessful in securing a national training number.

Wanting to continue his career progression and maintain stability, Steven approached his training hospital about remaining in post. The department valued his contributions and offered him a LED role to continue working at a CT3+ level.

Motivated to advance professionally, Steven began working towards the Stage 2 capabilities outlined in the LLP. However, as a non-training doctor, he encountered difficulty accessing certain key subspecialties, including cardiac, neuro, and paediatric anaesthesia.

Recognising his commitment and potential, the hospital offered Steven a Speciality Doctor contract. This included the flexibility to take short-term sabbaticals during the day to gain the required specialist experiences at nearby centres, while continuing his on-call duties at his base hospital. He passed the Final FRCA during this time.

Steven was issued his Stage 2 Equivalence Certificate and successfully secured an ST4 post. He had an early ARCP and his prior experience was counted, meaning he progressed directly to ST6. He began his Special Interest Area (SIA) training in regional anaesthesia and major general surgery and obtained his CCT two years later.

He then applied to the hospital that supported his training and was successfully appointed to a consultant post there.

Steven chose not to pursue the Final FRCA, having grown tired of exams and interviews. For him, the support of his family, and the stability of a job in a hospital he loved outweighed the need for further qualifications. Over the next three years, Steven systematically collected evidence of his clinical and non-clinical work, mapping his achievements to the domains of the Specialist Doctor job description. At his next appraisal, he presented this portfolio and formally requested an upgrade to the specialist contract.

The trust and board approved his application, acknowledging both his demonstrated experience and his positive reputation within the department. As his career progressed, Steven took on educational responsibilities, first becoming an Educational Supervisor, and later being appointed as College Tutor, continuing to make a meaningful impact in training and departmental leadership.

Angela progressed through core anaesthetic training and successfully secured an ST4 post. While she completed all Stage 2 requirements on the LLP, she encountered difficulties passing the Final FRCA. After receiving an extension to training and gaining some Stage 3 general capabilities, she ultimately received an Outcome 4 and exited formal training.

Determined to continue her career in anaesthesia, Angela accepted a Specialty Doctor post at a teaching hospital. Over the next two years, she dedicated herself to clinical work and exam preparation, eventually passing the Final FRCA outside of training.

After this, she pursued SIAs in neuro and regional anaesthesia, effectively completing the requirements for Stage 3. Her department and Regional Advisor reviewed her progress and confirmed equivalence with the training curriculum.

Angela then mapped her evidence against the Anaesthetics Specialty Specific Guidance (SSG) and submitted a successful application via the GMC portfolio pathway. Following approval, she was appointed to a substantive consultant post at the same teaching hospital where she had worked as a Specialty Doctor.

Mary is a foundation doctor with a strong interest in anaesthesia, but due to high competition ratios, she is unable to secure a place in core training. Determined to pursue her goal, she takes an FY3 role in critical care at a district general hospital (DGH) accredited for core equivalence.

During her 12-month critical care post, Mary proactively seeks theatre experience, attending regular afternoon sessions where she quickly demonstrates her aptitude and enthusiasm for anaesthesia. Impressed by her commitment and potential, the department offers her a LED position with a structured plan to support her in achieving Confirmation of Stage 1 Equivalence over the next two and a half years, building on the critical care experience she has already completed.

Within the first six months, Mary obtains her Initial Assessment of Competence (IAC), enabling her to move onto the general anaesthesia on-call rota. In her second year, she completes the Initial Assessment of Competence in Obstetric Anaesthesia (IAOC) and steadily continues to gather evidence across all Stage 1 capabilities.

Over the course of three years at the same hospital, Mary develops a comprehensive portfolio mapped to the Stage 1 curriculum. Her evidence is reviewed and approved by the Regional Adviser, and she is awarded the Confirmation of Stage 1 Equivalence certificate.

Armed with this and a strong application, Mary is successful in gaining a post in the next round of ST4 recruitment.

Dave began his postgraduate training in the ACCS Emergency Medicine (EM) programme, completing the first two years successfully. During this time, he developed a strong interest in anaesthetics and decided to change specialty. To pursue this, he resigned from his EM training post with the intention of applying for core anaesthetics training.

Unfortunately, he was not successful in securing a core training post. However, having enjoyed his six-month anaesthetics rotation, he was offered a LED role at CT1 level within the same department. Working less than full time (LTFT) at 80%, Dave started the position in May.

Over the next two years, Dave proved himself a committed and capable team member. He completed the Primary FRCA exam and developed his clinical skills across a broad range of anaesthetic specialties. With support from the department, he gathered evidence against stage 1 of the Anaesthetics Curriculum and successfully obtained a Confirmation of Stage 1 Equivalence certificate.

Armed with this certification and a strong portfolio, Dave applied for higher training and was successfully appointed to an ST4 anaesthetics post.

Mo is an overseas-trained doctor who moved from India and has been working as a specialty doctor in the same hospital for the past six years. During this time, he successfully completed the Primary FRCA. Despite multiple attempts, he has been unable to secure a place in core or higher training. However, he has now settled into his role and no longer wishes to pursue formal training pathways.

Recognising the potential for career progression, Mo sets his sights on securing a specialist contract. Although highly valued by the department for his flexibility and reliability—often covering any rota gaps—there has been little impetus from the team to support his promotion, as he is already considered indispensable in his current role.

Determined to demonstrate that he is more than just “rota fodder,” Mo completes the specialist doctor job description template, carefully mapping his contributions to the non-clinical domains. He has undertaken the local Educational Supervisors' course and is an enthusiastic educator, regularly presenting at the journal club and delivering teaching sessions for midwives.

Mo has also led three high-quality quality improvement (QI) projects and played a key role in developing a new guideline on safe extubation practices in critical care. These achievements are recognised by the College Tutor, who signs off on his specialist template submission.

At his next job planning meeting, Mo presents his completed portfolio of evidence. His proactive approach and clear alignment with the specialist role requirements result in a successful promotion to a specialist contract.