Physicians’ Assistant (Anaesthesia) (PA(A)s) were introduced in 2004 and are now established within many NHS hospitals. In July 2019 PA(A)s formally changed their name to Anaesthesia Associates (AAs), recognising their role within the anaesthesia team and also within medical associate professions.
Who are Anaesthesia Associates (AAs)?
Anaesthesia Associates are highly trained, skilled practitioners that work within the anaesthetic team under the supervision of a consultant anaesthetist. All qualified AAs have successfully completed an Anaesthesia Associate training programme and are encouraged to maintain their presence on the AA Managed Voluntary Register held by the RCoA.
What do AAs do?
AAs provide perioperative patient care, generally in either a 1: 1 or 2:1 capacity depending on patient acuity. In a 2:1 model, one consultant anaesthetist supervises two AAs, or a trainee anaesthetist and an AA, providing anaesthetic care in two adjacent operating theatres. For patients with more complex needs, a 1:1 model may be employed where one AA works directly alongside a consultant anaesthetist to provide care for the patient.
AAs may be utilised to reduce operating theatre downtime, leading to increased throughput on operating lists and improved theatre utilisation. Depending on local needs, AAs play a role in preoperative assessment, provision of sedation, cardiac arrest teams, and offer a range of other perioperative and non-perioperative support. AAs may prove beneficial in supporting education for colleagues and students, and are often engaged in local research projects and audits.
Training and careers
Introduction of the AA role and training requires the support of individual NHS trusts or boards. See planning the introduction and training for Anaesthesia Associates. Once this has been established, the main groups of people eligible to commence training as an AA are:
- Registered healthcare professionals (examples are nurses or operating department practitioners) with at least three years clinical experience and/or degree level studies,
- Graduates with a biomedical science or biological science 2:1 honours degree or better.
Currently AAs practice across a broad range of specialities, including day case surgery, robotic surgery, cardiac surgery and transplantation to name but a few. Many organisations have trained AAs to perform advanced skills such as regional and local anaesthesia procedures. In such instances, local training packages and governance policies are utilised to ensure a competent workforce where patient safety remains paramount.
Training and Education
University of Birmingham
The postgraduate diploma which all qualified AAs hold is studied over 24 months with an additional three months probationary period served in clinical practice to conclude training. The course comprises of 12 two-month teaching blocks within four modules, which introduce trainee AAs to the clinical practice of anaesthesia, applied physics, the anaesthetic machine, and monitoring principles. In later modules trainees study anatomy and physiology related to anaesthesia and surgery. The final assessments are based on the management of life-threatening emergencies and advanced practice. Weekly teaching and tutorials are delivered by a Consultant Anaesthetist through the university e-learning interface. A typical week may consist of a tutorial, two to four days in the clinical practice and the rest involving clinical skills training and self-directed study. The standards of training are high and demanding on individuals to ensure a high calibre of competent AA graduates. More details can be found at University of Birmingham website.
University College London (UCL)
The UCL Anaesthesia and Perioperative Science course prepares students for clinical practice with a 24 month Masters degree (MSc), incorporating all the necessary academic and professional qualities needed for the AA role. Blending online learning with practical experience in the clinical environment, high-fidelity simulations, tutorial groups and teaching by a faculty of experts, the MSc puts a strong emphasis on applied science and rigorous training.
Clinical placements occur in University College London Hospitals (or our selected partners), whilst the academic training benefits from the extensive student resources offered by UCL. As part of the programme, students are supported to complete a research project or structured quality improvement initiative, including learning how to use data and evidence synthesis to improve an area of clinical practice. The MSc benefits from expert mentorship and innovative learning methods. Funding and bursaries are available, depending upon set criteria. More information can be found at the University College London website.
Lancaster Medical School
Lancaster Medical School’s new postgraduate diploma in anaesthesia and perioperative sciences will commence in March 2023. It will run over two years and offer a blend of in-person learning on the University campus (e.g., simulation, clinical skills, keynote lectures), online resources (e.g., lectures, virtual anatomy, online simulation), and ‘flipped classroom’ learning in the clinical workplace. The four taught modules cover the fundamentals of operating theatre practice, anatomy and physiology, applied pharmacology and therapeutics, and safety, quality and population health. The fifth module is achieved through completion of the workplace-based assessments specified in the Anaesthesia Associates Curriculum. A typical week consists of three days in clinical practice, half a day of self-directed study using online resources, and a half-day tutorial. Assessments will comprise single best answer questions, reflective case reports, and workplace-based assessments (e.g., of practical skills). More details can be found via the Lancaster Medical School Postgraduate Study website.
Anaesthesia Associates Curriculum
The RCoA worked in close collaboration with the General Medical Council (GMC) and others to develop a new Anaesthesia Associates Curriculum, which is aligned to the GMC’s Physicians Associate and Anaesthesia Associate Generic & Shared Learning Outcomes and the professional standards in Good Medical Practice: interim standards for Physician Associates and Anaesthesia Associates.
Following a GMC consultation in 2021 and recommendation from an independent panel of GMC Associates in 2022, the RCoA is pleased to publish the draft curriculum which course providers can use in developing their courses.
This is the version we intend to submit to the GMC’s curricula approval processes when that organisation becomes the regulator of AAs. Until then, the GMC cannot legally approve the curriculum and as such, there remains the possibility of further changes before that point.
Assessment and Examination
Successful graduation requires passing assessments consisting of MCQ exams, Clinical skills Workbook completion, Record of In Training Experience Diary, Tutor Assessments and at 24 months the Objective Structured Clinical Examination (OSCE) that takes place at the Royal College of Anaesthetists. Only after this are practitioners awarded the status of Anaesthesia Associate and are invited to become an Affiliate of the Royal College of Anaesthetists. The RCoA, alongside the University of Birmingham and University College London, have a duty to ensure that the relevant standards are upheld to ensure highly skilled and safe to practice graduates.
Anaesthesia Associates Register
If you are qualified Anaesthesia Associate and would like to join the Managed Voluntary Register, please complete the AA registration form. For any other enquiries, please email: firstname.lastname@example.org
HEE London have developed some useful resources for departments considering employing and training AAs.
For examples of job descriptions, business cases and governance documents.
Information about bringing AAs into regulation