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UK Training For Anaesthesia

Introduction

To obtain a UK CCT in anaesthetics a trainee has to follow a training programme with a duration of (normally) seven years. There are two entry routes: directly into the anaesthesia programme and via Acute Care Common Stem (ACCS) training which will usually take one year longer. ACCS training is described at the end of this article.

Aim

The aim of the programme is to produce high quality anaesthetists with a broad range of skills that will enable them to practise as consultant anaesthetists in the United Kingdom.

Duration of Training

To obtain a CCT in anaesthesia a trainee has to follow a competency based training programme covering basic, intermediate, higher and/or advanced levels of training in anaesthesia, pain management and Intensive Care Medicine (ICM). The usual duration of training is 7 years of which:

• basic level will normally last 2 years;
• intermediate level will normally last 2 years; and
• higher and/or advanced level will normally last 3 years.

The actual duration of an individual’s training depends on the rate at which they achieve the necessary competences. Basic Level Training (the first 2 years) The time spent in basic training will be normally be two years of which 21 months must be in anaesthesia and three months in ICM. Special arrangements will be made for trainees entering the anaesthesia programme from ACCS training who may have undertaken more than 3 months of ICM training. The RCA encourages modular training whenever possible but recognises that this can cause practical difficulties in smaller hospitals.

The first 3 months

This is normally at around 3 months assuming typical progress. This comprises:

• preoperative assessment;
• general anaesthesia for ASA I or II patients (including equipment and anaesthetic machine checks);
• rapid sequence induction;
• CPR skills; and
• clinical judgement, attitudes and behaviour.

Until this initial assessment of competency is passed trainees are strictly supernumary and cannot practice solo anaesthesia. After passing the assessment, trainees will be allowed onto the on-call rota although still closely supervised The next 6 months Trainees build their skills and knowledge and learn basic principles of safe anaesthesia, resuscitation, and prevention and treatment of pain. Emphasis should be placed on the role of the anaesthetist in peri-operative care stressing the importance of pre-operative and post-operative management. The following basic units should be covered within this period:

• care of the patient;
• anaesthetic equipment;
• basic techniques in anaesthesia;
• basic techniques in local anaesthesia; and
• anaesthetic pharmacology.

Training for the next 18 months

The following areas of basic training should be covered in this period:
• obstetric analgesia, anaesthesia and resuscitation;
• pain management/control/treatment;
• the upper airway and its problems;
• peri-operative care of the patient for major surgery;
• anaesthesia for day case surgery;
• paediatric anaesthesia;
• anaesthesia in the elderly;
• specific anaesthesia and medical problems; and
• ICM (trainees who have filled full time training posts in ICM can count up to 3 months of this training towards their basic level training in Anaesthesia).

In this period trainees widen their experience to obtain the SHO Training Certificate and become eligible to commence intermediate level training. By the end of basic level training trainees should be able to:

• anaesthetise most routine cases;
• assist in anaesthesia for more complex surgery;
• provide anaesthetic care for routine obstetric practice;
• organise the emergency list, identify problems and seek appropriate help;
• understand the principles underlying the care of ITU and HDU patients
• understand the principles of pain management;
• participate in audit; and
• pass the Primary FRCA examination

Dual CCT in Anaesthesia and ICM

It is possible for all trainees from the ACCS route and, with proper career planning, direct entrants to the anaesthesia programme, to obtain a dual CCT in anaesthesia and ICM within the anaesthesia training programme. Anybody considering this option should discuss their career plans with the Regional Advisor for ICM at an early stage of their training and/or the office of the Intercollegiate Board for Training in Intensive Care Medicine (jgoodwin@rcoa.ac.uk).