Stage 2 Training Guide
Firstly, welcome to specialist training in Mersey. I am Stuart McClelland, your Training Programme Director. I work at Aintree Hospital and will be having a lot of communication with you. The Regional Adviser is Andrew Marchetti (a.marchetti@nhs.net) and the Head of School is Simon Mercer (simon.mercer@liverpoolft.nhs.uk). To give you some important information about your training, please read all of this and refer back to it as required.
Curriculum: Full details of the 2021 curriculum, which you should read, are available at www.rcoa.ac.uk/training-careers/training-hub/2021-anaesthetics-curriculum. The curriculum has an emphasis on training as a generalist, with a deeper dive into subspecialities in Stage 2, and opportunity for development of special interests in Stage 3. You must complete all the Stage 2 HALOs and pass the Final FRCA by the end of ST5. There is a lot to cover in the two years, so by the end of ST4 we will be looking for significant progress towards all 14 domains, and completed HALOs or CCC forms as appropriate for all the specialist blocks you have been through. To acquire all the evidence that you need for each key capability across 14 HALOs, and pass the Final in two years, you must plan ahead and ensure that everything is done in an organised fashion from day one and throughout the next two years.
The Stage 2 rotation comprises 3m blocks in the following units:
Alder Hey Hospital (Paediatric Anaesthesia CCC)
Aintree University Hospital
Intensive Care at Aintree or Royal (Intensive Care HALO)
Liverpool Heart and Chest Hospital (Cardiothroacic Anaesthesia CCC)
Liverpool Women’s Hospital (Obstetric Anaesthesia CCC)
Royal Liverpool & Broadgreen Hospitals
Walton Hospital (Neuro Anaesthesia CCC)
Full time trainees have a spare 3m block that can be used to give 6m in one unit. This is dependent on capacity, but preferences are welcome. Most commonly this is at Alder Hey, or alternatively usually with capacity at the Royal. This could also be used for a dedicated 3m Stage 2 pain block.
Less than full time trainees, or those planning this, should get in touch with me about placement lengths, as this may vary e.g. depending on when you change % and what you have done before.
You should meet with your Educational Supervisor and/or College Tutor at the start of each attachment and ensure that there is a plan as to what you are going to do and get signed off in the following 3m. This should be documented on Lifelong Learning as a PDP for the placement. You should also plan for an annual MSF. Furthermore, if there is something you particularly need to get done, getting in contact with the College Tutor as soon as you know your finalised allocation is often a good way of avoiding late panic and ultimate disappointment!
All the Generic Professional Domains and all the Specialty-Specific Domains (except ICM, which is a dedicated block) can and must be worked towards in all units. In liaison with your Educational Supervisors and College Tutor, you should make sure that any key capabilities or practical procedures that are unique to one unit are completed whilst there.
HALO Sign-off: To achieve this, you need to provide evidence for all the key capabilities for the Stage. This will be demonstrated from SLEs, MTRs, relevant courses and logbook data linked to them. There is some flexibility in what evidence you can provide, and remember that you can multiple-count against many key-capabilities e.g. teaching a more junior trainee to do a spinal with sedation. If you intend to have a HALO or CCC form signed off during a placement, it will be vital to discuss what is expected at the start of the placement with your Educational Supervisor / local unit of training lead / College Tutor.
Practical Procedures: There is a table of procedures on the RCoA website that indicates the supervision levels expected at different stages of training. Bear in mind that for both some procedures and also some specialist key capabilities, you may only visit a centre once (unless returning for SIA) and therefore have to achieve the Stage 3 level during your Stage 2 placement. This particularly applies to airway, shared airway surgery, regional techniques, and trauma.
Gathering Evidence: Suggested/recommended evidence for each key capability are in the HALO guides. Because of the large number of capabilities to be achieved in the relatively short time period, you must make the most of every opportunity and try to gather SLE or other evidence every day. Many things can be done in multiple sites, so don’t think e.g. that as you are at LHCH you can only do cardiac general anaesthesia, or only obstetric regional/general anaesthesia at LWH.
Pain: The Pain HALOs at every Stage must be signed off by a Pain Faculty Tutor. In addition to attending chronic pain clinics as below, you also need to generate evidence for inpatient and perioperative pain management in each of the Stage 2 placements, including the specialist centres. This can be through pre-op assessments, pain ward rounds, and ITU ward rounds and outreach. This is similar to Perioperative Medicine.
You must organise a 2-week (LTFT pro-rata) pain secondment during Stage 2, specifically with a chronic pain service. For full time trainees, this should be during your 6m block, or alternatively there is opportunity to use your spare 3m to do a 3m pain block at the Royal instead. For LTFT trainees at 60%, the pain secondment is best done during your Aintree, Royal or Women’s 6m blocks. For LTFT trainees at 80%, the pain secondment is best done during your LHCH or Walton 6m blocks.
The chronic pain secondment can be done at the Royal or Whiston, and you need to organise these yourself by contacting Kirsty Dineley at RLUH (kirsty.dineley@rlbuht.nhs.uk) or Senthil Jayaseelan at Whiston (senthil.jayaseelan@sthk.nhs.uk). You also need to liaise with your base hospital that you are requesting time away from. If this is done in good time, it is easy for the on-call rota to be written around this. Consider how absence for your secondment combined with your exam timing may impact on the hospitals you are at. You will likely be disappointed if you ask for 2 weeks off for a secondment during the same block as significant study/exam leave.
Rotation: You will be allocated to your training units on a 3m basis, even if you are expecting to stay for more than 3m. So you should expect to receive your placement allocation every 3m. Provisional versions of the rotation are sent out from about 4m in advance, followed by the final version approximately 3m prior to the rotation date. You will all receive a trainee ID number, which you should use to find out your allocation from the list of posts that will be sent out: make a careful note of this as you will need it regularly for at least 4 years!
Leave Spread Across Placements: If full time, in a year you probably have 32 days AL and up to 30 days SL to take. Study leave often occurs in blocks around exam times. As a school, we have advised that in any one placement, SL and AL be considered together so that if you are doing lots of 3m blocks, you can take 15-16 days per 3m block of AL/SL combined (pro-rata for LTFT). This is to enable roughly even leave-use in each department, and also to ensure you are on the shopfloor enough to achieve training objectives. This may require forward planning by you, so that you do not leave too much leave to be taken in your last 3-month block when you are also sitting the exam, for example. Also bear this limit in mind when scheduling the chronic pain secondment.
Maternity/Parental Leave: For organisational purposes, please inform me as soon as possible when you plan to go on ML/PL, and also roughly when you are planning to come back into the rotation (after any accrued leave). Remember that the rotation is worked on from at least 5 months ahead.
Stage 2 Teaching Programme: HEE-NW School of Anaesthesia now ‘top-slice’ Stage 2 trainees £400 in ST4 and ST5 from their study leave allocation. This is to pay for a range of courses, a list of which you will be sent, and further details are available here. You will receive an email with the dates for the MAFIT 1 programme. These dates should go into your diaries and it is your responsibility to request these days off as study leave from the departments in which you work to be able to attend. The education programme will roll annually, so if you miss the day in ST4, you should try to attend the following year, particularly as some days can count towards your evidence for a HALO sign-off. The ARCP panels receive details of your attendance at these sessions. The fees for MAFIT 1 have been top sliced from your study leave budget, so you do not have to pay to attend, but you must ask for permission from your hospital to attend. Any courses on the top-sliced list do not require formal deanery approval but any not on this list require submission of a study leave request via the Accent system. Further information is available here.
Exam Preparation Classes: We expect most of you to take the Final FRCA at the start of ST5 when you have at least a year’s ST experience and have completed the MAFIT 1 educational programme. For 3m prior to your planned written exam date, there will be a weekly morning exam preparation class (MAFIT 2). When you attend it, you should not expect to attend MAFIT 1 at the same time (unless this is in your own time). There is also a viva class (MAFIT 3) along these lines for 3m prior to the Structured Oral Exam.
Stage 2 Certificate: This must be completed by the end of ST5 for you to enter ST6.
ARCP: Whether FT or LTFT, your training progression will continue to be reviewed on an annual basis (or as soon as possible on return from any long leave) by an ARCP panel (usually HoS, RAA, TPD and a deanery representative). In addition to annually, we may also see you at key-progression points. Your attendance is not compulsory, but it is encouraged and 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.
The panel would highly appreciate if you could use the following format when you prepare your essential documents for an ARCP Outcome 1: this is to facilitate the process for the panel and to prepare you for what you will be doing for appraisal when you become a consultant. The below list is for your information so you know what you are aiming for now; you should always follow the specific checklist and advice sent to you at the time of each ARCP, as requirements may change over the coming years.
Essential documents to be prepared for your ARCP:
1. Form R.
2. Upload a nicely laid out and up-to-date CV.
3. Upload a logbook summary covering the year of training being assessed (not your entire logbook or a separate logbook per placement/module). Please name the file using the format “Logbook summary ST4”.
4. Upload a CPD summary listing your educational activities, with CPD points awarded per activity and a running total. This should include local departmental meetings, M&M and audit meetings in addition to regional/national activity. Please name the file using the format “CPD summary ST4”.
5. Upload an Audit and Clinical Governance summary, summarising your specific involvement in any completed or ongoing projects with dates. Please name the file using the format “Audit and Clinical Governance summary ST4”.
6. Ensure that there is an up to date MSF on Lifelong Learning. You only need one per training year.
7. PDP: should have clear and achievable objectives as separate items. Please use the Title/Description box to give a placement title for you PDP rather than individual learning objectives. Ideally, have a PDP per placement titled e.g. “Whiston ST4” and then add the separate objectives within that PDP.
8. At the end of every placement (longer than 1m) we expect a Consultant Feedback Summary from a number of consultants in the department prepared by your ES at the placement. This can be using the department’s own format or an MTR. You must have at least one MTR per year and also for specialist placements towards the CCC. If a local consultant feedback summary, please name the file using the format “Consultant Feedback Summary ST4 Chester”.
9. Ensure that there is an Educational Supervisor’s Structured Report completed from EVERY hospital you have been to (for longer than 1m) during the year of training being reviewed, including your current one if been there more than a few weeks.
10. Evidence of reflection: According to the GMC guidelines, all doctors should keep a record of reflective practice. This needs to cover two aspects of our practice, reflection on educational activities (courses, meetings, etc.) and clinical reflection on significant events, interesting clinical cases and critical incidents. The most important thing is what you have learned rather than the description of the event.
11. We require you to provide feedback on each placement that you have attended. This is now as an online survey form accessible here. Once completed please take a screenshot and upload using the format “Placement Feedback Aintree”.
12. Screenshot of you GMC Survey participation – this is no longer compulsory for a positive ARCP outcome but we would encourage trainees to participate.
The above list of requirements is essential and must be completed, approved and visible on LLp on the day (whether Panel A or B) for a favourable ARCP outcome.
There is increasing bureaucracy in training, and it will be a test of your organisational skills to get everything done and signed off in time. The best consultants are usually the best organised and chaos will inevitably lead to failure. Consultant appraisal and revalidation is following the trainee model to some extent, and therefore the electronic /paper workload will sadly be unending throughout your entire career. Get into good habits now!
Before emailing me with questions, please ensure that you have read everything as there is a lot of information to digest. Then please feel free to come back to me with any queries.