Inter & Higher training guide

WARWICKSHIRE SCHOOL OF ANAESTHESIA
TRAINING GUIDELINES 2010

Introduction
The specialty training programme in anaesthesia is a seven year programme. Having completed core training, applications are made for specialty training posts through the national appointments process. Successful applicants will commence as Specialty Trainees level 3 (ST3). Hospital placements will be decided by the Programme Director. The first two years (ST3 and ST4) are classed as intermediate training (see below). In order to progress to ST5 trainees must have completed all modules as outlined by the Royal College of Anaesthetists (RCOA) intermediate training document and have passed Final FRCA.
Important information and paperwork may be found on the Warwickshire School of Anaesthesia website:
wsoa.org.uk

General

All trainees should be allocated an educational supervisor, usually by the College Tutor. Trainees should meet with their educational supervisor at the start of their placement and at three monthly intervals thereafter. A record of discussions should be kept by the educational supervisor. The aim of these meetings is to review progress and offer guidance where needed, they do not constitute an appraisal although the information gleaned may be used in the appraisal process. At the end of the first year and annually thereafter trainees will attend an annual review of competence progression (ARCP formerly known as RITA). An EXIT ARCP will take place within 3 months of CCT and subsequent to satisfactory grading an application may be made to PMETB and the RCOA for inclusion in the specialty register.
Trainees should aim to meet with the Programme Director to discuss career plans at suitable intervals throughout training.

Intermediate training

During this two year period the following modules must be completed:
Key Modules – ICM, Obstetrics, Paediatrics, Neuroanaesthesia, Cardiothoracic, Pain
General modules – Gen/Urol/Gynae, Orthopaedics, Trauma, Regional, Day surgery, Vascular, ENT
Training will normally consist of 1 year at either Heartlands/Solihull (BHH) or University Hospitals Coventry and Warwickshire (UHCW) and two 6 month placements at one of George Elliot Hospital Nuneaton (GEH), Warwick (War), Alexandra Hospital Redditch (Redd), Good Hope Hospital, Sutton Coldfield (GHH).
The neuro module will be at UHCW or UHB (for trainees not going to UHCW). Paediatric training and UHB neuro will take place at Birmingham Children’s Hospital (BCH) usually as a secondment from one of the smaller hospitals.

The competency training booklet may be found on the website under trainee information. Each competency is split into knowledge skills and attitudes and there are areas which need to be signed off by your trainers.

The workplace assessment (WPA) document is signed by a trainer when the following criteria have been fulfilled:
1. Enough of the competency sheet has been signed (usually about 75%) with no major gaps
2. Your logbook / supervision has been reviewed and deemed to be adequate.
3. One DOPS, one Aneas CEX and one CBD have been completed

In order to progress to higher training a trainee must:
1. Complete two years intermediate training.
2. Have a complete WPA for all the modules or prospective RCOA approval for deferral.
3. Pass final FRCA
4. Have a successful outcome at ARCP

Modules cannot be carried over to higher training unless prospective approval from the RCOA is applied for. In such exceptional cases the module must be completed in the first 6 months of higher training.

Higher training

The final three years may consist of higher and advanced level training in a number of modules. Essential modules include ICM (see ICM training), Obstetrics, Paediatrics, Neuro and Cardiothoracic anaesthesia. Other modules are not compulsory though many are desirable when applying for consultant posts. Trainees should meet the PD to discuss suitable programmes and placements depending on the interests of the trainee and availability of training slots.
By its very nature higher level training is more flexible than intermediate training and should allow the trainee to develop their portfolio and prepare for a consultant post.

Requirements for module sign off are the same as for intermediate modules (see above)

Advanced training

A number of modules for advanced training are available. These modules are intended for trainees with a “special interest” for example in obstetrics, ICM, cardiothoracic etc. Details can be found on the RCOA website.

Intensive Care Medicine training

ICM training may be competed at a number of levels.
Minimum requirement is to spend 6 months in ICM training and complete the WPA in ICM in the same way that other modules are completed. This is usually done in two 3 month blocks and can be done partly at BHH / UHCW and partly at a DGH. During each 3 month block one DOPS, one Anaes CEX and two extended case summaries must be completed.
Intermediate level ICM training requires that the placements take place in hospitals approved for ICM training – these are BHH or UHCW. In addition 10 extended case summaries must be completed in line with recommendations from the intercollegiate board for Intensive care training (ICBICM).
Advanced level training is offered on a regional basis and posts advertised on NHS jobs. The ICM training co-ordinator is Dr Tom Gallagher.

Work place assessments

These documents (soon to be known as Unit of Training Assessment – UTA) will be signed by a designated trainer when the criteria outlined in the intermediate training section above have been fulfilled. They will be submitted with ARCP paperwork and copies kept on file.

Out of Programme time (OOP)

Time may be taken out of programme for training (OOPT), research (OOPR), experience (OOPE) or carrer break (OOPC). This is normally done in ST6; trainees are required to be back in a UK training post for their last 6 months of training. Details of the application process can be found on the school website on the trainee information and paperwork page.

Non clinical training

Research – a one year research post at Heartlands Hospital forms part of the rotation and is appointed to via interview. This is usually undertaken in ST5 or above.
Management – trainees are required to attend post fellowship study days at Stafford. Towards the end of trainees attendance at a management course (usually at Keele or Warwick University) is encouraged. Details of these are on the WSAO website

Appraisal

Every doctor is required to have an annual NHS appraisal. This is usually done by your educational supervisor. Multisource feedback should be used to inform the process and is compulsory in years ST1 and ST7. The appraisal paperwork may be found on the school website. Evidence of appraisal will need to be submitted at the time of ARCP.

ARCP / RITA

Prior to a RITA or ARCP a list of attendees will be circulated to College Tutors and trainees. Occasionally a trainee is omitted who should be attending and occasionally the opposite occurs. Please check these lists carefully and inform your College Tutor or Programme Director if this is the case. The panel is usually convened in January, April, July and October.
You will be informed of the date by which all paperwork should be submitted and of the date and time of the RITA/ARCP. Please ensure that all paperwork is submitted in a timely manner, failure to do so may result in the RITA/ARCP being deferred until the next panel convenes. A checklist will be sent out to ensure that nothing is omitted. For information the following documents will be required:

1. College Tutor’s report – this includes CEPD record, attendance at meetings, leave record, confirmation of appraisal and a training outline. 1 per placement
2. Form 2 (Training summary) – ARCP only
3. Attitudes, communication skills and behaviour assessment (filled in by your educational supervisor or College Tutor) – 1 per placement
4. Copies of all workplace assessments (or UTAs) for the year being assessed.
5. Logbook summaries in RCOA format – 1 per placement and a cumulative one for ST3/4 and ST5/6/7 at the relevant RITA/ARCP.
6. Placement assessment form – 1 per placement for the trainees to feedback on their training placement (confidential).
7. Evidence of MSF – ST4 and ST7
8. Evidence of completion of child protection training.

Issuing of documentation may be withheld if evidence is not available. The panel consists of the programme director (chair), college tutors, consultant trainers, a regional advisor, a representative of the deanery +/_ and external assessor. At the RITA/ARCP you will be expected to present a summary of your achievements for the year, the panel will review the paperwork, have an opportunity to ask questions and then a recommendation will be made. Details of the outcomes are outlined in the Gold Guide.

Leave

Leave allowance is 30 days annually and pro rata for less than full time trainees (LTFT). Study leave is also 30 days. Details of allowances can be found on the West Midlands Deanery Website. Private study leave is allowed and is allocated locally by individual hospitals. Leave can be tight at certain times of year so forward planning is essential. A minimum of 6 weeks’ notice is required for annual or study leave. Protected teaching is usually taken as study leave as is time spent teaching on provider courses as this forms part of CEPD.

Contacts

West Midlands Deanery website: www.westmidlandsdeanery.nhs.uk

Senior Administrator W Mids Deanery: Clare Kennedy, email Clare.Kennedy@westmidlands.nhs.uk

Training Programme Director CT1 and 2: Dr Jane Boden, email jane.boden@heartofengland.nhs.uk

Training Programme Director ST3 +: Dr Tina McLeod, email tina.mcleod@heartofengland.nhs.uk

PA to Training programme directors: Ann Amos, email ann.amos@heartofengland.nhs.uk