Higher/Advanced Training Guide

Now you have progressed to higher training, please find information below about what to plan for the remainder of your training time.

Most importantly, a quote from Simon “DO NOT TAKE YOUR FOOT OFF THE GAS”

Make sure you continue to work on completing General Duties training units, even if you are doing specialist modules. We noticed that it is quite common for trainees to get an ARCP outcome 2 for ST5 due to insufficient progress with UoT completion and the reason given is that it is because they have been allocated to specialist hospitals or ICM. We understand that there are certain units of training that can only be completed in a particular hospital, but the following units can be worked towards or completed in any hospital in the region:

Transfer // Cardiac arrest // Non theatre // Day case // Sedation

The curriculum for higher and advanced training maintains a greater emphasis on general duties.
Higher training occupies two years of ST5-7, with one year of advanced training that can be undertaken in one 12m block or 2x6m blocks in ST6/7 (not ST5).

Higher Training - 24 months in ST5-7

There are 5 Mandatory Higher Training Units:

Neuro-anaesthesia
Cardiothoracic Anaesthesia
Paediatrics Anaesthesia
ICM
General Duties

Within General Duties, there are three units mandated by RCoA:

Airway Management
Management of Cardiorespiratory Arrest
Peri-operative Medicine

Other General Duties (which we expect all trainees to complete in Mersey)

ENT
Max-Fax and Dental
Vascular
Obstetrics
Non Theatre
Orthopaedics
Regional
Sedation
Transfer Medicine
Trauma and Stabilisation

Although the curriculum document states that a minimum of nine Higher General Duties need to be achieved, we would expect you to get all signed off. These units of training reflect what most consultants spend the majority of their clinical time doing and if you don’t have them, you may make yourself less employable on paper in the competitive world of consultant appointments, and also it makes it difficult for us to sign you off as fully trained at the end of ST7. Even if you are aiming for a sub-specialty job in a specialist hospital, it would be unwise to limit your options to that only.

The above is usually covered in the following pattern (order will vary) over 24m in ST5/6/(7):

6 months DGH: Higher General Duties
3 months RLUH: Higher General Duties including vascular +/- 1m at the Women’s if you weren’t able to get Higher Obstetrics signed off during your DGH placement
3 months Walton & Aintree: Neuro-anaesthesia (1 month Walton) and Airway, H&N, Trauma (2m Aintree).
You need the equivalent of 20 sessions for neuro so don’t plan too much leave during that month!
3 months Aintree ICU: Higher ICM
3 months LHCH: Higher Cardiothoracic
3 months Alder Hey: Higher Paediatrics (should be in ST6/7 to give contemporaneous skills at CCT)

This leaves a 3 months block which is usually spent at Alder Hey to give you a continuous 6 months paediatrics training required for some consultant posts.
However, there is flexibility to allocate you in a different unit (usually LHCH) during this period if you choose to.
Be aware that requests for specific allocations once in your grace period are subject to us being able to accommodate them in the rotation, and could not be at the expense of trainees still working towards their CCT.

Advanced Training - 12 months in ST6/7

As a minimum, you must do 6 months of Advanced General Duties in an area of practice relevant to what you want to work in as a consultant.

The other 6m can also be spent in General Duties or in another specialist area of interest:

Cardiothoracic
Neuro
Paediatrics
Obstetrics

We should discuss this at your ARCP prior to entering ST6. However, when you decide on what you would like to do for your advanced module, please follow the following process:

1. Fill in the advanced application form and send to the TPD 6 months in advanced as an absolute minimum. Incomplete forms and late forms will be rejected and you will be allocated according to available vacancies.

2. State your PREFERENCE of modules and hospital.
- I highlight that it is a preference, which means it is not a guaranteed allocation.
- This is due to the limitation in training capacity and the fact that when you do advanced training, you are expected to develop mastery in the requested module rather than just spending time at a certain hospital.
- Therefore there will be a maximum number of trainees doing a particular advanced module to maximise training opportunity.

3. Read the Advanced Curriculum guidance on what is expected from advanced training and list the core learning outcomes you expect to achieve by the end of the preferred module on the application form.

It is important to notice early-on that in the Advanced Curriculum there are six domains of advanced training and only one of these is directly clinical! The others are:
- Team working
- Leadership
- Innovation
- Management
- Education

These need to be worked on in parallel to your clinical experience throughout your advanced placements. Non-clinical work done through ST5-7 can count towards this too, but most should be done in the context of whatever advanced module you are doing and will be signed off by your advanced module supervisor. These elements of your efforts are therefore not just ‘CV buffing’ but integral to your award of a CCT.

There is the opportunity to spend 12m in one specialist area (no Advanced General Duties), but you have to be sure that this will be your specialist area of practice as a consultant. If that’s what you plan to do, you need to discuss this first with the TPD and Regional Advisor before submitting your request to the RCoA for prospective approval. For example, if you spend the whole of your advanced training year at Alder Hey or LHCH without having completed any Advanced General Duties, you may potentially be less competitive if applying for non-specialist posts. Therefore, the best arrangement if you want to pursue a career in a specialist area and to keep all your options open is to do 6m of advanced training in the specialist area, 6m of Advanced General Duties, and then to complete your specialist training in a post-CCT fellowship, which shouldn’t be longer than 6-12 months. Another option is to do 12m of Advanced General Duties, followed by a post-CCT fellowship in a specialist area for as long as you like.

If you are planning to pursue a career in Pain Medicine, you will be expected to do 12m training in a dedicated advanced unit (Arrowe/Royal/Walton). These posts are run by the individual units and subject to a competitive process. They take some time to arrange and to ensure funding is in-place. To get more information about pain training, you should contact Dr Raj Malhotra, Regional Advisor for Pain Medicine, at the earliest opportunity.

Workplace Based Assessments

The suggested topics for WPBAs for the curriculum are in the Assessment Guidance document here

Like intermediate training, there are a large number of units of training to be completed in a relatively short time period, so you must plan ahead and ensure that everything is done in an organised fashion.

Unit of Training Sign Off

Similar to Intermediate training, you need 3 things:

Minimum of 3 linked WPBAs (of at least three different types)
Logbook evidence of suitable experience – ideally 20 sessions for the majority of modules, which should all be easy although not always absolutely necessary for a sign-off. It may be more difficult for vascular, obstetrics and non-theatre and impractical for others, so some common sense must prevail about how you demonstrate enough experience.
Evidence of achieving the Core Clinical Learning Outcomes as detailed in the curriculum. This will be demonstrated from your WPBAs, MSF (which needs to be done once per training year), consultant feedback and relevant courses, but this will ultimately be up to you and your College Tutor / Educational Supervisor / local unit of training lead. This should then be signed off on Lifelong Learning.

Post-fellowship teaching programme

HEE-NW School of Anaesthesia now ‘top-slice’ higher/advanced trainees £150 per year from their study leave allocation to pay for the bi-monthly Post Fellowship Meetings (PFM). PFM organisers keep a mailing list for distribution of further information. As the fees for the PFM have been top sliced from your study leave budget, you don't need study leave approval, only permission from your hospital. Any other courses require submission of a study leave request via the Accent system. Further information is available here.

Maternity Leave

For organisational purposes, please inform the TPD as soon as possible when you plan to go on mat leave and when you are likely to be coming back into the rotation (after any accrued leave). Remember the rotation is worked on from at least 5 months ahead.

Finally

Your training progression will continue to be reviewed on an annual basis by an ARCP panel. Your attendance is not compulsory but it is encouraged and highly appreciated! If you cannot attend, you are expected to provide a minimum of 300 words reflective summary for the year of training, which should include your plans and aspirations for the coming year.

For further details of the documentation that we expect at ARCP, click here.

Stuart McClelland (stuart.mcclelland@liverpoolft.nhs.uk)