A ‘Rough Guide to the 2010 Curriculum & the new 2021 Curriculum
What do I need to know? (March 2021)
Current curriculum (2010)
Full details of the 2010 curriculum can be found on the RCoA website (link) with an ‘annex’ for each level of training HERE
The workplace based assessments (WBPAs) currently in use to provide constructive formative feedback include:
- Direct Observation of Procedural Skills (DOPS)
- Anaesthesia Clinical Evaluation Exercise (A-CEX)
- Anaesthesia List Management Assessment Tool (ALMAT)
- Case-Based Discussion (CBD)
- Multisource Feedback (MSF)
The first three are used during clinical sessions and are based on the observed performance of the trainee’s knowledge, skills, attitudes and behaviours. The CBD can be used away from the clinical environment & allows the assessor to question the trainee about a clinical episode.
More details can be found here
NEW The A-QIPAT is the Anaesthesia Quality Improvement Project Assessment Tool which has been recently introduced to support structured feedback on QI activities as part of the 2021 Curriculum.
More information & the form is here https://rcoa.ac.uk/training-careers/training-anaesthesia/2021-anaesthetics-curriculum/qipat
NEW 2021 Anaesthetics Curriculum
BRAND NEW Most recent updates form the RCoA on the new curriculum including details of the assessments, ACCS curriculum and more (as well as recorded videos) are here https://www.rcoa.ac.uk/training-careers/training-anaesthesia/2021-anaesthetics-curriculum/2021-curriculum-resources-0
Editorials on the new curriculum are in the RCoA Bulletin:
- Defining Standards: The 2021 Anaesthetics Curriculum Part one. Shippey B, Nixon M. RCoA Bulletin 2021; 125: 48-49
- Supporting progress: The new anaesthetics curriculum Part two. Shippey B, Nixon M. RCoA Bulletin 2021; 126: 34-35
Why do we need a new curriculum?
The full philosophy for the change in curriculum is outlined here (https://rcoa.ac.uk/training-careers/training-anaesthesia/2021-anaesthetics-curriculum/2021-curriculum-philosophy) but has allowed a more learning centred approach to the development of anaesthetists in training.
To comply with GMC guidance, all curricula must include ‘Generic Professional Capabilities’ (GPCs), be structured round a limited number of ‘specialty learning outcomes’ with a reduced assessment burden. GPCs are a series of skills, attributes & behaviours that must be embodied by an autonomous clinical practitioner and although not defined as this are already present in the 2010 curriculum as ‘common competences’
Another driver for the change is the significant ‘hold-up’ point with the Primary FRCA, meaning trainees spend longer than seven years in the training programme. This is reflected in the conversion of the ST3 year to a CT3 ‘top up’ year and as such should improve training for trainees.
What is the structure?
The programme of learning consists of 3 stages. Core Training (CT) now lasts 3 years, Specialty Training (ST) 4 years
- Stage 1: CT1-3. Primary FRCA must be completed by the end of this stage. IAC & IAOC to be revised and are both critical progression points. This stage links with Stage 1 ICM & ACCS curriculums
- Stage 2: ST4-5. Final FRCA must be completed by the end of this stage
- Stage 3: ST6-7. It is assumed that the ‘Special Interest areas’ will be done as the equivalent of the current ‘Advanced Training’ in ST7
When does the new curriculum start?
Planned implementation of the new anaesthetics curriculum in 2020 has been delayed due to Covid-19. There is no doubt that the impact of the pandemic on training has increased the challenges associated with this plan.
Implementation is currently scheduled for August 2021 for Core & ACCS trainees (stage 1) and August 2023 for ST4 (stage 2)
There are likely to be transitional challenges and the period for transition is two years currently.
How can I help my trainee transition?
Last recruitments for ST3 will be Aug 2021 & Feb 2022
Next application for ST4 will be Aug 2022
Trainees therefore who fall between the two curriculums ie have no CT3 year/ST3 year will need a ‘top up’ job. These trainees will need to act early to identify the additional learning requirements they need to complete Stage 1eg Obs, ICU. Full detail of the gap analyses and an excellent summary guide is here https://www.rcoa.ac.uk/training-careers/training-anaesthesia/2021-anaesthetics-curriculum/curriculum-gap-analyses
The CT3 ‘top up’ jobs will be posts that are recognized for training.
LTFT trainees will need to liaise with TPDs for an individual discussion
What is the clinical content?
The new curriculum is organised around the abilities of the anaesthetist in terms of professional and clinical higher learning outcomes and remains outcome based.
There are 14 domains describing the standards anaesthetists must demonstrate as they progress through training and apply to all three stages. Trainees must demonstrate achievement of BOTH GPCs and specialty-specific domains throughout their training in each stage.
Of these 14 domains, seven are professional domains and seven clinical domains.
- Professional domains (GPCs): These are emphasized in the new curriculum and there is the possibility for crossover between domains eg a good MSF will satisfy requirements in a number of domains.
These domains are Professional behaviours, management, teamworking, QI& safety, safeguarding, teaching and research.
- Clinical domains: These vary in size, the largest being ‘General anaesthesia’ which includes almost all the current UoTs. The others are ICM, pain, sedation, POM, RA and resuscitation & transfer.
Each domain has a High-level Learning Outcome (HLO) and below that is stage learning outcome describing what needs to be achieved at the end of that stage to progress to the next
Next is a set of mandatory key capabilities which must be evidenced in order to meet the stage learning outcome
The ‘annexes’ for each stage are still in draft form but available on the RCoA website. At each stage, every HLO includes examples that trainees (& trainers) can use to support achievement of key capabilities and describes the minimum requirements. There is no set quota or number of pieces of evidence - the aim of assessment is to provide adequate, robust evidence against every key capability to demonstrate acquisition of the HLOs for each stage.
NEW The role of the Educational Supervisor is much more important in the 2021 Curriculum. ESs will be required to make a global judgement as to whether satisfactory progress for the defined stage of training has been made. In particular the ES will have significant input into the new EPAs, and subsequent trainee progression. Details of the new stages are linked to below:
NEW Assessments in the new anaesthetic curriculum
There are important changes to assessment in the new curriculum with a focus on formative assessment (assessment for learning) and reducing the overall burden of assessment.
Key changes are summarised in 'Supporting progress: The new anaesthetics curriculum Part two'. Shippey B, Nixon M. RCoA Bulletin 2021; 126: 34-35
Further information is available at rcoa.ac.uk/2021-curriculum-assessments
- Formative assessment
Supervised Learning Events (SLEs)
Existing and familiar SLEs will still exist as above (CBD, DOPS, A-CEX, MSF, ALMAT) although will be updated to emphasise the importance of feedback and with a revised supervision scale. There will be no minimum number of SLEs for any domain & a single assessment can be used to satisfy key capabilities in any domains. MSF will still need to be completed annually in its current form.
In addition, new assessment methods will be introduced eg A-QIPAT (A-QUIP is already in existence and has been added to the LLP as a QI tool), MTRs
Multiple Trainer Reports (MTRs)
This is different to MSF and replaces the existing consultant feedback process. It will represent the professional judgement of trainers and is mandatory for progression at critical points
- Summative assessments which enable trainees to move between critical progression points will include the IAC and IACOA, FRCA exams, HALOs, the ESSR and EPAs.
Initial Assessments of Competence
The IAC & IACOA (IAC for Obstetric Anaesthesia) will be revised and there will be specific IAC simulation requirements. Other summative assessments are HALOs, EPAs and MCR, along with FRCA exams.
NEW Entrustable Professional Activities (EPAs) replace the IAC (EPA 1/2) & IAOC (EPA 3/4) workplace-based assessments. An EPA is a unit of practice which a trainee is entrusted to perform under distant supervision once they have demonstrated the required competence. There are a number of resources available explaining why & how EPAs are used (with thanks from Dr J Dilley, TPD East):
A short overview is here Ten Cate, O. Entrustability of professional activities and competency-based training. Med Educ 2005;39:1176–1177.
More detail is available here https://www.youtube.com/watch?v=2hB7ytdPh6A
The use of EPAs during the novice period have been trialed in south east London & York. A full description of this pilot and development of EPAs is described here (page 49):
Holistic Assessment of Learning Outcome (HALOs) forms will replace Completion of Units of Training (CUT) forms for all 14 domains.
Assessors should use multiple pieces of evidence eg reflections, SLEs, MTRs and personal activities to inform their decision as to whether learning outcomes have been met.
Since 2018, the Lifelong Learning Platform has replaced the e-portfolio and has logbook functionality. The LLP will be further upgraded to reflect the aditonal assessments in the new curriculum.
Further information is here https://www.rcoa.ac.uk/training-careers/lifelong-learning/guidance-material
Making the most of training opportunities and giving feedback
The Education Checklist was created by Dr Kirsty Maclennan and provides a structure to enhance learning from every clinical session. The checklist and guidance on its use is available here https://loafnbread.com/home/
Giving Feedback: a skill for all. McCahon R. RCoA Bulletin July 2014. Issue 86 pp 17-19
Using ultrasound to teach anatomy - a novel, effective and evidence-based approach. Grant a, May A. RCoA Bulletin Issue 94 Nov 2015 pp 19-21
Putting ANTS into practice. Milligan P et al. RCoA Bulletin March 2015 Issue 90 pp13-15
What does my trainee need to achieve at each stage currently/in the new Curriculum 2021?
My trainee is a…….
(please be advised this information will be updated as further details of the 2021 Curriculum are released)
- ‘Novice’ anaesthetist. Trainee is starting out in anaesthetics. Can be either an ACCS trainee or CT. Trainee needs to achieve the Initial Assessment of Competence (IAC) before being allowed to practice unsupervised. This is usually achieved over 3-6 months
- ACCS (Acute Common Core Stem) trainee. https://www.accs.ac.uk/accs
ACCS is a three-year training programme and trainees are from a parent specialty of ED, acute medicine (AM) or anaesthetics. All ACCS trainees have a year in anaesthetics (including six months in ICM), six months in ED & six months in AM. The third years of ACCS is spent in the base specialty, so for anaesthetics ACCS trainees they will complete CT over the three years of ACCS.
ACCS (An) trainees usually complete six months in AM & six months in EM first before starting two consecutive years of anaesthetics.
For ESs of ACCS (An) trainees in anaesthesia https://www.accs.ac.uk/accs/anaesthesia-all-accs-trainees
Knowledge of, and reference to the ARCP checklist for each year is an easy way to ensure appropriate number & type of WPBAs are completed and the CUT forms required at each stage of training.
Current checklists for ACCS Year 1 &2 are here & have been modified for Covid https://www.rcem.ac.uk/RCEM/Exams_Training/UK_Trainees/Assessment_Schedule/RCEM/Exams_Training/UK_Trainees/Assessment_Schedule.aspx?hkey=67d9cac9-8e51-4c86-b559-a1fa5c826530
NEW 2021 ACCS Curriculum is here and consists of 11 learning outcomes https://www.accs.ac.uk/accs/2021-curriculum
The RCoA usually runs an annual ACCS Trainer Day & a handbook specifically for ACCS ESs is here https://rcoa.ac.uk/sites/default/files/documents/2020-08/ACCS-EdSupervis...
- Core trainee (CT). Core training is currently completed over two years, starting with achieving the IAC. The remainder of the two years is spent completing the general anaesthesia UoTs, ICM and obstetrics (IAOC). The primary FRCA must also be achieved in this time
- Specialty trainee (ST). Currently ST3-4 is Intermediate, ST5-6 Higher & ST7 Advanced. This is changing imminently in the 2021 Curriculum
- COMING SOON Dual or single-stream trainee ICM Update with new curriculum to follow from RS
- An ‘Academic’ (ACF) trainee (with thanks to Dr Sue Walwyn)
The Academic Clinical Fellows are part of an integrated pathway in medicine. They undergo a rigorous selection process and enter into run through training on starting their post. https://www.rcoa.ac.uk/research/get-involved-research/academic-training
Recruitment: The trainee is post foundation and has demonstrated an interest and involvement in Research. They apply in September / October of their second foundation year, to start in August as a core anaesthetist.
Training: The ACF trainees have 3 years to complete core and their academic requirements (75:25 split). This is not easy and needs exceptional commitment. The new curriculum will affect academic trainees but detail not yet known.
Clinical training: Core training as for any other CT
Academic training: During these 3 years the trainees have to do sufficient academic work to satisfy their Academic supervisor and attend the appraisals.
The guide on academic progress: https://acmedsci.ac.uk/policy/policy-projects/guidelines-for-monitoring-academic-training-and-progress
ARCP: This is as for any other trainee, but in addition to furnishing a supervisor report for Academic training review. The academic supervisor will have input into the trainee's review and there needs to be satisfactory progress in both specialties for the trainee to progress.
Training process: The ACF training is a 3-year programme (FT) as a run through. They will then take 3 year's Time out of programme to complete their PhD. Once successful, they return to their training, with the aim of applying and becoming a senior lecturer. This post is 4 years in duration with a split academic/ clinical commitment.
Supervisors: Current Academic supervisors are Professor's Phil Hopkins and Simon Howell.
Current Clinical supervisor is Dr Sue Walwyn. Dr Krishnan Melarkode supports the senior clinical lecturer.
- MTI doctor:
The Medical Training Initiative (MTI) is a government-authorised scheme allowing doctors form low & middle income countries to undertake anaesthesia training within the NHS for a maximum of 24 months
Full information including requirements for supervision, appraisal etc is available here https://www.rcoa.ac.uk/about-college/global-partnerships/overseas-doctors-training-uk/medical-training-initiative-0
Specific advice for ESs of MTIs can be found here & the annual RCoA ‘New to the NHS Meeting’ has invaluable information for trainees & trainers
Support for International Medical Graduates https://www.yorksandhumberdeanery.nhs.uk/sites/default/files/induction_g...