Stage 1/Core Training Guide

Stage 1/Core Training Guide

The North West School of Anaesthesia Stage 1 Training New Starter’s Handbook

August 2024

Introduction

Welcome to the North West School of Anaesthesia! We hope this is the start of a long, enjoyable and satisfying career in anaesthesia and its related specialties.

This brief guide has been written by the 2 Core Training Programme Directors - Dr Bishop & Pratt. It contains information we consider essential to smooth your entrance into the start of your anaesthetic training. You must read and absorb the information it contains.

Further information on all of the topics may be obtained from the NW Anaesthesia website (www.mmacc.uk), Health Education England (North West), your College Tutors, TPDs; the Royal College of Anaesthetists website (www.rcoa.ac.uk), and the excellent RCOA novice guide. Please be aware though that some information found on the internet (particularly theNW deanery website) is now out of date.

You can also see our new starter guide

Structure of the NW School of Anaesthesia

The NW School of Anaesthesia is designed to guide and assist you with your training in anaesthesia from CT1 through to ST7. We are committed to providing you with high quality training and our responsibilities include recruitment, appraisal, development of specialty-specific skills and examination preparation. We map your training to the 2021 Curriculum as set out by The Royal College of Anaesthetists. The School Board meets on a regular basis to ensure we provide consistent and ‘joined-up’ training across the region.

The School Board consists of:

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Anaesthetic training is split into:

  • Stage 1 (CT1-3)
  • Stage 2 (ST4&5)
  • Stage 3 (ST6&7)

There is a national recruitment process between stages 1 & 2.

The content & structure of Stage 1 training is set in the 2021 Curriculum from the Royal College of Anaesthetists. You are also required to pass the Primary FRCA examination.

There is currently 1 TPD’s for Stage 1 Training.

Stage 1 training in anaesthesia will normally consist of 3 years, named CT1-3. Trainees joining the programme from ACCS, will normally complete 4 years in total. We would expect each of these years to be spent in a different hospital, but trainees may occasionally rotate between hospitals more frequently in order to maximise learning opportunities. One year you will be placed in one of the following hospitals (Lancaster, Blackpool, Preston or Blackburn).

What To Expect When You Start:

The initial introduction to anaesthesia can seem very daunting for those who have had little exposure during Medical School or Foundation Training. There are many new machines, drugs and personnel to get to grips with. It is important, therefore, to know who to ask advice and get support from.

You will meet up with your College Tutor during the first week and have an induction into both the Trust and the anaesthetic department. You will be allocated an Educational Supervisor. This person should be your first port of call for any concerns you have regarding your training. At your initial meeting with them, you will talk through your personalised work schedule which will form your educational agreement. At this initial meeting you should also touch on areas such as:

  • Supervision in theatre
  • Life-long learning platform
  • RCOA curriculum
  • Logbook
  • Workplace-based Assessments
  • New-starter tutorials

There are other layers of support within the NW School of Anaesthesia. If there are issues which cannot be resolved at a local Trust level, your TPD should be informed and they will endeavour to provide additional support. Sometimes it is appropriate for the Head of School or Regional Advisor to be involved for specific concerns.

You will have contact with the Specialty School Manager at NHSE NW about rotations, ARCPs etc.

Stage One Training

CT1

CT1 represents the introduction to anaesthetic practice, it is normal to feel nervous as you commence anaesthesia, and you will be closely supervised as you get used to anaesthetic practice.

Initial Assessment of Competence (IAC)

The initial aim should be completing the Initial Assessment of Competence (IAC) using the “Entrustable Professional Activity” workbooks (EPA 1&2) which can be downloaded at

The IAC is usually done around 3 months, and we have a School-based IAC Day when you will be assessed on some aspects. Specifically these are:

  • Machine Check
  • Rapid Sequence Induction
  • Failed Intubation

This usually will be late October (for August starters) or late April (for February starters) and you will normally be expected to have all other IAC requirements completed on your life long learning platform.

Most clinical time in CT1 should be spent in Theatres, but you may undertake a 3 month ICU block towards the end of CT1, depending on the trainee/department. During this year you should start to evidence of Key capabilities in all learning domains, both clinical and generic. ACCS trainees will usually do their 6 months ICU block in ACCS2.

CT2

  • Theatre work continues in CT
  • An initial 3 month block of obstetrics should be undertaken, culminating in the Initial Assessment of Competence in Obstetric Anaesthesia (EPA 3&4)
  • If an initial ICU block was not undertaken in CT1, it should be undertaken in CT
  • Trainees joining from ACCS do not need to undertake an ICU block
  • Theatre work should include experience necessary to complete outstanding Key Capabilities from all domains of learning. This should include initial exposure to paediatric anaesthesia.
  • Evidence of experience in other clinical domains should be accrued – including pain medicine, resuscitation, sedation etc
  • Key capabilities from the Generic Professional Domains should continue to be accrued.
  • The primary FRCA exam has to be passed by the end of CT3. We would advise most trainees to attempt the written paper in CT2 as a minimum, and if passed consider the oral exam towards the end of CT

CT3

  • CT3 will be the final part of Stage 1 training. It is important that the trainee and Educational Supervisor establish what is outstanding at their initial meeting, and formulate a plan to ensure exposure to appropriate clinical areas.
  • A second 3-month ICU block must be undertaken by all (Non-ACCS) CT3s.
  • Experience of out of hours, on-call Obstetrics must be gained in CT3. This should include management of ASA 3 parturients. We expect this to necessitate some daytime obstetrics commitment, but not necessarily a full 3-month block.
  • Experience of paediatric anaesthesia should be expanded, including remote supervision as specified in the General Anaesthesia HALO guide.
  • By the end of CT3, all 14 HALOs must be signed off, and the Primary FRCA passed.

The Primary FRCA Examination

The FRCA examination is essential for progressing in your career. It is divided into 2 parts:

  1. Primary FRCA, which must be passed in order to complete your Stage 1 Training and therefore progression into ST 4. This is composed of 2 sections which are taken separately.
  2. Final FRCA, which is an essential requirement for your Stage 2 Training, must be passed by the time you complete your ST5 year. It also has 2 components.

The Primary FRCA MCQ Exam:

The Primary MCQ is held 3 times per year and is done online at home. The exam has evolved recently to remove MCQ’s and is now just SBA’s. Each SBA question has a stem or a vignette, a lead in question and five plausible options. You must decide which of the five options is the best answer.

It consists of:

  • SBA questions will broadly cover:
    • 30 in pharmacology
    • 30 in physiology (incl. biochemistry/anatomy)
    • 30 in physics, clinical measurement, statistical methods and data interpretation

The questions are linked to the Stage 1 Training Curriculum, which therefore makes up the exam syllabus. It is important to have a working knowledge of this. This can be found in the document ‘CCT in Anaesthetics – Basic Level Training (Annex B)’ on the RCOA website:

This is a difficult examination and requires 6 months of dedicated revision. It would be unusual for trainees to be prepared for the exam before 9 months into their training. You can have up to 6 attempts at the Written Paper and, when passed, it is valid for 3 years.

The Primary FRCA OSCE/SOE:

You must pass the MCQ paper before applying for the OSCE/SOE. At the first attempt, both the OSCE & SOE(Viva) sections must be taken together. If you are unsuccessful in one section, it can then be retaken independently. This part of the exam is also evolving in the next 2 years.

Some Exam Tips:

  • Treat the Primary FRCA with respect. It demands a significant amount of time, dedication and application.
  • Do not take the MCQ too early.
  • Use the Primary Course and Tutorials well by preparing for and reading around the topics.
  • Ensure you organise plenty of local practice for the OSCE/SOE. Find out from your College Tutor which trainers (consultants and senior trainees) are interested in giving exam practice.
  • Try and form a group of trainees who are sitting the exam together and plan your revision and SOE practice together.

The NW Primary FRCA Course

The “Day Release” Tutorial Programme

Aug-Nov: All new starters in anaesthesia (CT1 and ACCS 2) attend the new starter tutorial programme. This runs from early August for about 10 weeks.

November Onwards: When the new starter tutorial programme has finished each trainee will have Educational Development time (EDT)-usually Tuesday pm (department dependant). We expect you to cover the main areas in the curriculum. You should use the STEP workbook as a guide to complete the SAVE’d tutorial and resources on e-lfh.

CT2: Once you have passed the Primary FRCA you may use Tuesday afternoons for further educational development, teaching, portfolio and gathering evidence for your GPC’s. We will look at your CPD evidence at your ARCP to ensure you have been using your SPA time effectively.

The 2 Day Study Blocks

Every trainee must register with Elena Wheeler.

This allows attendance at the study blocks, exam practice days and stand alone study days. The money for each trainee is “top-sliced” from each trainees study leave budget and comes to the NW Anaesthesia school from the Deanery. It is a substantial proportion of your annual study leave budget and leaves little else for funding of other courses. Further details on study leave budget and processes are described below.

Each month from November until July a 2 day study block takes place. The whole syllabus is divided into 9 blocks of 2 days. Each block is delivered at a different hospital in the region. It is expected that you do some preparatory reading around the topics that will be discussed at each block. Each block will be a mixture of lectures, small group work, tutorials and some written exam practice practice.

Full details of the 2-day blocks can be found on the in the teaching and training section of the site.

Stage 1 Teaching

“Stand-alone” Study Days

You are expected to attend all the stand-alone study days during Stage 1 Anaesthesia, see Appendix 1 for further details. All Course Information is on https://www.mmacc.uk/.

The cost of these study days is included in the top-sliced portion of your study leave. A cancellation charge exists however if you do not attend when you have said you were going to. You must register for each of these days through the anaesthesia admin team:

Exam Practice Courses

You are expected to attend an MCQ practice course and an OSCE/SOE course. Each course is run 3 times per year. You should attend the course that runs immediately before the exam you are sitting.

The Written exam course: RCOA On-line revision course, you will need to book this course and pay upfront and be re-imbursed by contacting Elena Wheeler. In addition Dr JP Lomas runs an SBA masterclass online session prior to each exam sitting.

The OSCE/SOE course takes place roughly 1 month before each OSCE/SOE exam. It lasts 2 days and is a mixture of formal and informal OSCE/ Viva practice.

Examination Leave and Private Study Leave

Private Study Leave may be granted before the 1st and 2nd exam attempt, up to a maximum of 5 days per year, and subject to the discretion of the department. This is part of the total study leave allowance not in addition to it. Applications should be made well in advance to avoid disruption to Departments’ rotas and to other trainees.

Study Leave is required to sit the Primary FRCA - granted as follows:

  • Up to 3 attempts: Time granted but no expenses paid
  • Subsequent attempts: Unpaid leave only.

Anaesthetic e-Portfolio & Logbook

You are expected to use the Royal College of Anaesthetists “Lifelong Learning Platform” to record all aspects of your training. ARCPs are all conducted electronically using this system – and as such no paper documents will be accepted. If you haven’t already done so, you need to register as a trainee with the Royal College of Anaesthetists. The form you need can be found on line at:

You will be issued with portfolio login details once you have registered.

ARCPs

You will have an ARCP every 12 months. Currently all ARCP’s are carried out on Teams remotely. All your evidence will need to be presented electronically, as we have already mentioned.

The School of anaesthesia has developed a website which tells you what evidence we expect to see at your ARCP. It is worth looking at this list early – so you’ll have plenty of chance to collect it! The list can be found at:

Study Leave

This information is in addition to the Deanery study leave guidelines and is not intended to replace them. These guidelines can be found on the North West Deanery website at:

General Principles:

Core trainees are allowed up to a maximum of 30 days study leave per year and have a fixed budget.

STAGE 1 TRAINING

The focus of stage 1 training should be gaining solid clinical skills in anaesthesia and passing the Primary FRCA Exam. Therefore, in CT1 & CT2, study leave will not usually be granted for anything other than the regional “top sliced” teaching courses & the North West exam preparation courses. In CT3, new training opportunities are being developed which will prepare for transition to the “registrar” grade (ST4 +) and provide training in the generic professional competency elements of the 2021 curriculum. These training opportunities will again be funded by a top-slice, and we expect trainees to attend.

It is common for trainees to ask for life support courses to be funded during stage 1 training (ALS, APLS, ATLS etc). We recommend that these courses are undertaken after success in all parts of the primary FRCA exam. Whenever possible, local part-funded courses should be chosen. It is unusual for more than one resuscitation type course to be funded during stage 1 training.

Locally arranged teaching & exam courses already provide significant time away from clinical work, so further study leave for exam preparation courses will not be supported.

Trainees who are repeating any component of the Primary FRCA may apply to attend the locally arranged teaching in the Mersey side of the School. This is different to the commercial courses run by MSA – which are not usually funded.

Trainees sitting the Primary FRCA MCQ/SBA paper will be offered access to the website http://www.onexamination.com for a 2 - month period & this will be paid for by the School.

We recognize that development of teaching skills is important & features in the 2021 curriculum. In Stage 1 training, teaching skills can be developed within the training programme, and study leave for teaching and instructing is therefore not usually granted in stage 1.

The generic professional capability aspects of the 2021 curriculum are to be catered for in a number of courses. These study days would normally be undertaken in CT3, but there is some flexibility between CT2 & CT3. We would expect all stand-alone study days to be completed by the end of CT3.

Whilst there is discretion for those trainees who pass the Primary FRCA exam early in Stage 1 training, overseas study leave will not usually be supported.

A list of provided courses & study days is seen below in Appendix 1.

The Process:

All study leave applications require approval for both time and funding. If you do not require time off but wish to claim expenses then it is still necessary to apply for study leave. When calculating study leave, all days applied for and carrying a liability for expenses must be counted. This includes weekends and bank holidays.

It is the responsibility of the trainee to plan their required Study Leave well in advance. Most departments will require 6 weeks notice for any study leave due to rotas being planned in advance. Study Leave is an entitlement but not a right and a department may refuse a particular absence if it would unreasonably interfere with service provision or the educational needs of other trainees.

All study leave requests for courses that are not top sliced need to be applied using the accent system. You should have been send an email with log in details. For further information see https://www.nwpgmd.nhs.uk/study-leave.

The application will then be approved by the TPD within Accent. Please note that retrospective study leave applications will not be considered by the Accent sysem. It is your responsibility to ensure that you plan and organise your time appropriately.

Please note we are unable to fund the exam fee or travel/accomodation for the exam.

Cancellation:

You must notify both the Deanery and Study Leave Administrator of any changes to approved study leave. This includes cancellation, date changes etc.

Appendix 1: NW School of Anaesthesia list of provided/approved courses

Year
Approved Courses
Often Refused
CT1/2
Primary FRCA course 18 days in 9 X 2 day blocks Stand-alone mandatory courses (top sliced from budget). Usually attended in CT1/2 – but may be carried over in to CT3 • Transfer course - 1 day • Intro to obstetrics course - 1 day • Airway Course - 1 day • Critical incident Simulation - 1 day • Intensive Care Course - 1 day Exam Preparation Courses • MCQ - 3 days • OSCE/VIVA - 2 days Private study prior to primary FRCA (max five days per core training year) plus study leave to take exam If fail primary examination: • BASICS course in Liverpool (overnight expenses not paid) Subsequent Exam fail: • One RCOA approved exam practice course (time and course fee paid)
Out of region exam courses unless failed after local course. Other courses including ATLS,APLS etc only usually allowed once primary exam completed. Course fees come out of remaining budget.
CT3
CT3 Study Days: Education & Training Teamworking Professional Regulation QI TIVA Research Methodology Need for Paeds Regional Anaesthesia (Stepping Hill) Salford Trauma Course ALS/Resuscitation Course Usual for no more than one course resuscitation course to be funded across stage 1
Resuscitation Council Generic Instructor Course no longer funded