Stage 3 Training Guide

Now you have progressed to Stage 3 training, please find information below about what to plan for the remainder of your training time. Please read all of this refer back to it as required.

Curriculum: Full details of the 2021 curriculum, which you should re-read, are available at Having taken a deeper dive into subspecialities in Stage 2, Stage 3 returns to an emphasis on training as a generalist but also development of special interests. You must complete all 14 Stage 3 HALOs, plus HALOs for your SIAs, by the end of ST7. To acquire all the evidence that you need for each key capability across all HALOs, and develop your CV for consultant applications, you must plan ahead and ensure that everything is done in an organised fashion throughout the next two years.

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. Suggested/recommended evidence for each key capability are in the HALO guides. You must continue to make the most of every opportunity and try to gather SLE or other evidence every day. Many things can be done in multiple sites.

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. There may be some very specific subspecialist Stage 3 key capabilities or practical procedure entrustment levels that you will not be able to evidence during your planned Stage 3 placements. You should usually have met these during Stage 2, and it may be appropriate to use this evidence towards Stage 3.

Rotation: Stage 3 will consist of a year in DGHs to cover the general training and a year of Special Interest Areas. These can be in any order, as the rotation accommodates. The full time Stage 3 rotation usually comprises 6m blocks: DGH1, DGH2, SIA1, SIA2. In some circumstances an SIA may optionally or compulsorily last 12m.

DGH Year: Within the Mersey rotation, there are 3 larger DGHs: Chester, Wirral and Whiston. There are 4 smaller DGHs: Crewe, Macclesfield, Southport, Warrington. At least one of your Stage 3 DGH blocks will be in a larger unit. As far as possible, if wished, at least one will be a nearer commute. You may well have other career intentions or geographical considerations steering you towards particular DGHs. You are welcome to let me know about these preferences, although there is no guarantee to always accommodate them as the rotation has to work for all trainees and hospitals.

SIA Year: SIA modules are available in most hospitals in the region and a prospectus will soon be available on this website and will be sent out by email at the appropriate stage of your training. You are encouraged to discuss your choices with supervisors, potential future employers, and the School exec. The curriculum rules about possible combinations of SIA, and minimum lengths of module, are available here.

We should discuss SIAs at your ARCP prior to entering ST6. However, you can inform me of your preference before that as the sooner I know, the more likely I will be able to accommodate you. 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 training in an SIA, 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 SIA module to maximise training opportunity.

Triple C Forms: The CCCs required in Stage 3 are paediatrics and obstetrics. These will need to be completed during your DGH time, unless you know you are going to do an SIA in them. Even then, it is wise to complete them during the DGH year in case you change your mind, or circumstances change regarding your SIAs.

Stage 3 ICM HALO: This does not require a further block of ICM. The key capabilities at this level maintain those achieved at Stage 2 and could be better thought of as capabilities for managing the integration between anaesthetic and ICM services.

Stage 3 Pain HALO: The Pain HALOs at every Stage must be signed off by a local Pain Faculty Tutor. In addition to another 2 weeks attending chronic pain clinics as below, you also need to generate evidence for inpatient and perioperative pain management. 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 second 2-week (LTFT pro-rata) pain secondment during your Stage 3 DGH time, specifically with a chronic pain service. 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 ( or Senthil Jayaseelan at Whiston ( 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.

If you are planning to pursue a career in Pain Medicine, you will be expected to do 12m training in dedicated Advanced Pain Training units. These posts are run by the individual units and subject to a competitive process. They take some time to arrange and to ensure capacity/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.

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.

Post-fellowship Teaching Programme: HEE-NW School of Anaesthesia now ‘top-slice’ Stage 3 trainees £150 per year from their study leave allocation to pay for the bi-monthly Post Fellowship Meetings. PFM organisers keep a mailing list for distribution of further information. Further details of all this are available here. The fees for the PFM have been top sliced from your study leave budget, so 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.

ARCP: 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.

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 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 ST6”.
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 ST6”.
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 ST6”.
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 ST6” and then add the separate objectives within that PDP.
8. At the end of every placement, 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 ST6 Chester”.
9. Ensure that there is an Educational Supervisor’s Structured Report completed from EVERY hospital you have been to 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 and visible on LLP on the day (whether Panel A or B) for a favourable ARCP outcome.

Thank you for getting to the bottom of this page. Before emailing me with questions, please ensure you have read everything as there is a lot of information. Then please feel free to come back to me with any queries.

North West