Background

The 2021 Curriculum was introduced in response to the 2017 GMC document ‘Excellence by Design’ which mandated a review of all postgraduate medical training curricula in the UK. Its recommendations included incorporating Good Medical Practice and Generic Professional Capabilities (the professional skills required by all doctors) into the curriculum, as well as implementing an outcomes based (rather than competency based) curriculum, involving stakeholders in its development, and improving flexibility and transferability between different training curricula.

The new curriculum also drew on the findings of the 2013 Shape of Training review, the 2015 Royal College of Anaesthetists Curriculum Review, and the 2017 ‘The Need to Listen’ report on the welfare, morale and experiences of anaesthetists in training.

Goals and Philosophy

Below are some of the issues identified with the 2010 curriculum, and the ways in which the 2021 curriculum aimed to address them:

• Many anaesthetists did not finish the Primary FRCA by the end of CT2 - adding an additional CT year would avoid these trainees having to extend their training.

• Managerial skills which are required for consultant practice were not included - these would be added under the Generic Professional Capabilities framework.

• The 2010 curriculum was largely organised around surgical specialties - the new curriculum would be based around the abilities of anaesthetists.

• Supervised learning events (e.g. DOPS, CEX, CBD etc.) were seen as summative requirements - moving away from this would allow the expert trainer to enable continuous reflection and consolidation throughout all learning experiences.

More broadly, it was felt that moving from a competency-based to an outcomes-based approach to training would allow a change in the perception of anaesthetic practice - from a Technical Rational view (‘a practice which follows rules, where knowledge is graspable, and the the focus is on visible performance and technical expertise’) to a Professional Artistry view (‘one with frameworks but which starts when rules fade, where knowledge is temporary, dynamic and problematic, and where judgement is key’).

Rather than through completion of a set number of ‘sign-offs’, anaesthetic expertise is developed by immersion in a ‘community of practice’ whereby every experience is an opportunity for learning. The process that underpins that learning is an experiential cycle of concrete experience, reflective observation and abstract conceptualisation.

Structure of the Curriculum

The new curriculum is divided into 14 Domains of Learning: 7 ‘Generic Professional Capabilities’ (as required by GMC ‘Excellence by Design’) and 7 ‘Specialty Specific Domains’ (those relating directly to anaesthesia).

Generic Professional Capabilities (GPCs)

• Professional Behaviours and Communication

• Management and Professional and Regulatory Requirements

• Team Working

• Safety and Quality Improvement

• Safeguarding

• Education and Training

• Research and Managing Data

Specialty Specific Domains

• Perioperative Medicine and Health Promotion

• General Anaesthesia

• Regional Anaesthesia

• Resuscitation and Transfer

• Procedural Sedation

• Pain Medicine

• Intensive Care

Each domain of learning has a high level learning outcome (HLO) (not to be confused with HALO - see below) which ‘sets the scene for what constitutes an anaesthetist’.

Below that is a stage learning outcome for each of the three stages.

Next follows a set of key capabilities which are mandatory and must be evidenced by anaesthetists in training to meet the stage learning outcome.

Click here to see the high level learning outcomes for each of the Domains of Learning.

Stages of Training

The training programme is delivered in three Stages:

Stage 1 (CT1-CT3)

• From novice to able to anaesthetise ASA 1 or 2 patients for non complex surgery with distant supervision.

• Includes two Entrustable Professional Activities: Initial Assessment of Competencies (IAC) and Initial Assessment of Obstetric Competencies (IAOC).

• Must pass Primary FRCA.

Stage 2 (ST4-ST5)

• Introduction to specialist areas of practice e.g. neurosurgery, cardiothoracics.

• Consolidation of skills gained in Stage 1 in ‘generalist’ practice with greater autonomy.

• Developing skills in managing higher risk populations.

• Must pass Final FRCA.

Stage 3 (ST6-ST7)

• Prepare for the transition to consultant level practice.

• Mature clinical skills for safe independent practice.

• Development of GPCs to level appropriate for award of CCT e.g. leadership, management, teaching/training and supervision.

• Equip anaesthetists with the expertise to treat patients with complex clinical needs and manage organisational issues.

• 12 months spent developing knowledge and skills in one or more Special Interest Areas (SIAs).

Assessment in the 2021 Curriculum

• To indicate completion of each Domain of Learning at each Stage, i.e. for each high level learning outcome (HLO), there is a Holistic Assessment of Learning Outcome (HALO) form, which should be completed by the appropriate member of the assessment faculty.

• The assessment faculty consists of designated trainers at each trust (consultants, SAS etc) and should be coordinated by the College Tutor.

• In order to complete the HALO the trainee should be able to demonstrate:

  • Evidence e.g. Supervised Learning Events (SLEs), Personal Activities and reflections, linked to each Key Capability within that HLO.

  • Appropriate clinical experience evidenced by logbook data.

  • A completed Multiple Trainer Report for the Stage of Training.

• There is no minimum number of SLEs or set quota of evidence. The aim of assessment is to provide adequate, robust evidence against every key capability to demonstrate acquisition of the stage learning outcome.

Completion of Capability Cluster (‘Triple C’) Forms

The structure of the curriculum can lead to issues where discrete areas of a Domain of Learning take place before the end of a Stage.

For example, rotations in cardiothoracic surgery, neurosurgery, paediatrics and obstetrics are commonly completed in ST4. These form part of the Stage 2 General Anaesthesia Domain of Learning, but the HALO form for this Domain is not signed off until the end of ST5.

Completion of the specific key capabilities associated with these areas can be evidenced by a Completion of Capability Cluster (‘Triple C’) form, using the same requirements as a HALO form. This allows the trainee to ‘carry forward’ the evidence for these discrete areas to the end of the Stage (i.e. the end of ST5), when it is used as part of the evidence for the overall Stage 2 General Anaesthesia HALO form.

Recommended Learning Methods for the 2021 Curriculum

The following list is not exhaustive.

Practice based experiential learning

• Anaesthetic training is largely experiential in nature with any interaction in the workplace having the potential to become a learning episode.

• A minimum of three supervised sessions per week (averaged over 3-6 months) is required to ensure sufficient progression.

• This will inevitably vary from week to week and with progression through the training programme.

Learning with peers and colleagues

• Local postgrad teaching opportunities should facilitate small group learning.

• Exam preparation encourages formation of self help groups.

Formal postgraduate education sessions

• A programme of regular ‘bleep free’ formal teaching sessions is recommended.

• Involvement in meetings e.g. M&M, clinical governance.

• Clinical skills demonstrations/teaching.

• Critical appraisal/journal clubs.

• Attendance at regional/Deanery teaching days etc.

Simulation

• Should be regular and include e.g. CICO, novice skills, etc.

• Anaesthetists in training should be facilitated to become simulation faculty.

Formal study courses

• Time should be made available to attend these subject to local conditions of service.

Educational development time

• Recommended for all anaesthetists in training although the amount of time required may vary throughout the training programme.

Further Reading

Royal College of Anaesthetists 2021 Anaesthetics Curriculum

Royal College of Anaesthetists 2021 Curriculum - Philosophy