Guidance for Clinical Directors on the provision of Stage 2 Equivalent posts
This page aims to provide guidance for Clinical Directors on the provision of posts for Stage 2 equivalence on the 2021 Anaesthetics curriculum.
What is Stage 2 equivalence?
In the 2021 Anaesthetics Curriculum, Stage 2 training is an indicative 2 years duration (ST4 – ST5).
For various reasons, some doctors will work outside national training programmes. It is important to ensure that their time as Locally Employed Doctors (LEDs) or clinical fellows is used effectively to support progression through the curriculum, either with the aim of working towards recognition as a Specialist Doctor or accelerating through training once an ST4 post has been secured.
These anaesthetists will need to gain the necessary experience and demonstrate the learning outcomes required for Stage 2 of the 2021 Anaesthetics Curriculum. Evidence from previous experience may be used, and doctors should consult their Educational Supervisor to determine its suitability.
What should Stage 2 equivalent posts offer?
The contents of the Stage 2 learning syllabus can be downloaded in the form of the HALO guides.
Perioperative Medicine and Health Promotion
- Exposure to pre-operative assessment clinics with experience of ASA 1-4 patients for elective surgery
- Experience of emergency surgery for ASA 1-3 patients
- Safe delivery of perioperative care for these patients with supervisor on call from home for queries able to provide directions via phone or non-immediate attendance (supervision level 3)
General Anaesthesia
- Experience of cardiothoracic, neuro, paediatric and obstetric anaesthesia to achieve the capabilities at the supervision level required
- Evidence of the use of TIVA in different settings
- Exposure to more complex ASA 3 patients for emergency and elective surgery
- Obstetric anaesthesia for increasingly complex patients with reduced levels of supervision
Regional Anaesthesia
- Ultrasound guided blocks including brachial plexus and chest or abdominal wall blocks
Resuscitation and transfer
- Inter hospital transfer
- Trauma and paediatric resuscitation skills
- Post resuscitation management of patients
Procedural Sedation
- Safe delivery of sedation for ASA 1-3 adult patients with supervisor on call from home for queries able to provide directions via phone or non-immediate attendance (supervision level 3)
- Experience of sedation in children
- Use of TCI for sedation
Pain
- Experience of specialist pain clinics and pain intervention lists
- Experience of leading the acute pain round
Intensive Care Medicine
- Three months training in Intensive Care Medicine to demonstrate achievement of the capabilities required for Stage 2
Generic Professional Capabilities
- Experience in the GPC domains of learning
- Quality Improvement project: leadership of a local project with presentation of results and implementation of outcomes.
Doctors in these posts will also require educational supervision, be able to attend teaching sessions, complete departmental quality improvement projects and attend audit and morbidity and morbidity meetings. They may also need guidance in preparing for the Final FRCA exam.
Ideally, the study leave allocation and terms and conditions should reflect those offered to National Training Number (NTN) holders or Medical Training Initiative (MTI) doctors. The rota allocation should ensure that these educational objectives are realistically achievable within the two-year period (or equivalent, depending on prior experience).
Doctors should be allocated to both directly supervised lists and indirectly supervised lists, with structured opportunities to complete appropriate Supervised Learning Events (SLEs) and progress through the supervision levels. This approach will ensure that, as with current higher training pathways, doctors are trained and deemed safe to progress to ST6 level.
Ideally all training evidence should be recorded on the Lifelong Learning Platform (LLP), which will allow alignment of evidence to the expected level of training.
If the department currently provides higher training for NTN holders, and the above conditions are met, job advertisements may state that the department offers RCoA Stage 2 Equivalent Training. In such cases, appointments can be made locally using existing LED/CF contracts.
