Units of Training.

The Anaesthetic Curriculum is divided up into four levels of training that broadly equate to training years. They are:

  • Basic (or Core training) usually delivered within CT1-CT2 or ACCS 1-3 
  • Intermediate, usually delivered with years ST3-ST4 
  • Higher, usually delivered within year ST5-6
  • Advanced which equates to ST7

Each level of training is delivered through several “Units of Training (UoTs)”. These are specific modules of Anaesthetic sub-speciality practice (e.g. Neuro Anaesthesia) or collections of topics and skills that share common knowledge and are grouped together (e.g. Perioperative Medicine). Units of Training are the building blocks that make up your anaesthetic training. Each stage of training has a defined set of UoT that need to be completed. More details on UoT can be obtained by visiting the “Training and the Training Programme” section of the RCoA website HERE

In order to complete a Unit of Training trainees must demonstrate that they have achieved the “Core Learning Outcomes” for the module. These Core Learning Outcomes are the essential techniques, skills and knowledge that the trainee must achieve, but should be seen as a minimum standard.

Trainees must be familiar with the Core Learning Outcomes for each module for their Stage of Training, more information about which can be found HERE:

In order to demonstrate that a Core Learning Outcome has been achieved, the trainee must collect evidence of their competence. This is the backbone of a “competency-based” training scheme. This evidence consists of

  1. Logbook to show case mix and numbersevidence_triangle.png
  2. The specified minimum number of workplace based assessments in that area (DOPS/ALMAT/CEX/CBD)
  3. Feedback from consultant trainers (formal or informal) that you have progressed appropriately

Once a trainee has collected the evidence that a specific training module has been completed they should show it to the nominated Consultant for that module, called the Module Supervisor. The module supervisors will consider the three areas of evidence, and, if satisfied will issue a Completion Unit of Training (CUT) form. If not, they may suggest what additional evidence you may need to present to get signed off.

Some of the more generic, common or basic modules are signed off by your educational supervisor rather than a specific module supervisor.

Example

 

To get signed off for the Intermediate Level (ST3/4) Regional Anaesthesia Unit of Training....

Core Clinical Learning Outcome (from RCoA curriculum) is specified as:

"Perform one of each of the following blocks under local supervison

  • Thoracic epidural and/or combined spinal epidural
  • An upper/lower limb plexus block with NS or US guidance"

Minimum WPBA are specified as:

  • 1 CEX/ALMAT
  • 1 DOPS
  • 1 CBD

To pass the UOT you would have to meet the Module Supervisor for Regional Anaesthesia UoT and show them: logbook evidence of doing nerve blocks, have at least the minimum WPBA completed and have feedback showing you have progressed in this area.

Your training programme might specify a greater number of UOT than the minimum - after all, no-one wants to complete their training having done the bare minimum (!)

Specific nuances of the UoT required at each level of training are detailed below:

 

Basic Level Training (ACCS/CT 1&2)
Basic Level Training (ACCS/CT 1&2)
The first stage is to gain the Initial assessment of Competence (IAC), usually around the 3 months mark. This involves 19 assessments (DOPS, CEX, CBDs) and is signed off by the College Tutor. 
 
Following on from this you will gain experience in Anaesthesia for general specialities, Transfer Medicine, basic Paediatric Anaesthesia, Obstetric Anaesthesia (and gain the IAC in Obstetric Anaesthesia) and do 3 months of intensive care medicine. If you pass both parts of the Primary FRCA exam you will be awarded the Basic Level Training Certificate which entitles you to apply for a specialist training number.
Intermediate Level Training (ST 3&4)
The ST 3&4 years comprise intermediate training.
 
During these 2 years you will need to do certain mandatory UoT:
 
Neuro anaesthesia
Cardiac anaesthesia,
General duties ( which is made up of 13 sub units, all whivch must be completed),
Intensive care medicine,
Obstetric anaesthesia,
Paediatric anaesthesia
Pain medicine.
 
Each of these are usually delivered in 3 month continuous periods, except for General Duties which is usually 6 months long. The sub-units of General Duties, all of which have to be completed are:
  1. Airway
  2. Critical Incidents
  3. Day Surgery
  4. General, Gynae and Urology Surgery
  5. ENT, maxillo-facial and dental surgery
  6. Management of respiratory and cardiac arrest
  7. Non-theatre
  8. Orthopaedics 
  9. Perioperative Medicine
  10. Regional Anaesthesia
  11. Sedation
  12. Transfer Medicine
  13. Trauma and stabilisation
 
There are also additional Optional units (ophthalmic, plastics/burns, vascular) may or may not be available in your region.
 
If you pass both parts of the Final FRCA and have completed all the UoT modules you will be awarded the Intermediate Level Training Certificate.
 
Your CCT date will calculated from the date of completing intermediate training - it is therefore essential that you send your completed ILTC to the college.
Higher Training (ST 5-6)

Higher training revisits many of the modules covered in intermediate training in keeping with the concept of spiral learning. Thus the following need to be completed:

  • Neuro anaesthesia
  • Cardiac anaesthesia
  • General duties (9 out 14 modules to be done, obs is in  here),
  • Intensive care medicine
  • Paediatrics

 

The General duties modules are:

  • Airway management
  • Day surgery
  • ENT, Maxillo-facial and dental
  • General, urological and gynaecological surgery
  • Management of respiratory and cardiac arrest
  • Non-theatre
  • Obstetrics
  • Orthopaedic
  • Perioperative medicine
  • Regional
  • Sedation
  • Transfer medicine
  • Trauma and stabilisation
  • Vascular surgery

A trainee need only complete 9 out of the 14 General Duties Units, but MUST complete the three in bold- Airway, Management of Cardiac Arrest and Peri-operative Medicine.

Optional units at higher level are pain, ophthalmics, plastics/burns, anaesthesia in developing countries, conscious sedation in dentistry, military anaesthesia and remote/rural anaesthesia.

Advanced Training ST7
Each region has a range of Advanced Training Modules. The idea is that these give you a chance to become more than "competent" and to prepare you for consultant practice in a specialist area.

Advanced training can be tailored to suit individual requirements – you need to discuss with your College Tutor and Programme Director.

In addition, the Advance trainee must complete evidence of completion in specific DOMAINS mapped to the GMC. These are detailed in the next tab.

Having completed higher and advanced training you are eligible for the Certificate of Completion of Training (CCT) and will enter the Specialist Register.

Domains

The GMC domains need evidence linked to them too. The first domain is largely covered by the rest of your clinical training. However, domains 2-6 will need specific evidence collecting during your Specialty Training years. This evidence will largely be achieved through regular portfolio activities such as MSFs, attendance at teaching, delivering teaching etc. Your Educational Supervisor will need to sign these off prior to your final ARCP

  • Domain 1 – Clinical practice
  • Domain 2 – Team working
  • Domain 3 – Leadership
  • Domain 4 – Innovation
  • Domain 5 – Management
  • Domain 6 – Education
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