Competency Based Training What Does it Mean for You

							Competency Based Training
What Does it Mean for You?


       Andrew Bowhay
       Regional Adviser
      Alder Hey Hospital
                  THE CCST IN ANAESTHESIA
    III: Competency Based Specialist Registrar Years 1 and 2
                   Training and Assessment
               A manual for trainees and trainers
                      Edition 2: April 2003



• It should be read in conjunction with The CCST in
  Anaesthesia, I: General Principles.
• Its content has been applied progressively to all SpR
  1/2s taking up a post on or after 1st February 2002 with
  full implementation by 1st February 2004.
However
• SpR 1/2 Training Certificates and supporting Workplace
  Assessment Records are required for all trainees from 1
  February 2005 before they can progress to SpR Year 3.
• There is no „optional‟ time during this phase of training.
5.7: The documentation of training by the
               trainee
• …it is essential that trainees maintain
  proper records.
• It is the trainee‟s responsibility to maintain
  a portfolio of their training activity.
• Trainees must ensure that their
  „Workplace Assessments‟ for individual
  units of training take place by reminding
  those responsible at the appropriate time.
5.7: The documentation of training by the
               trainee
• In due course it will be expected that by the end
  of their SpR 1/2 training, trainees will have
  „Workplace Assessments‟ in all 7 key units of
  training and in the 6 general units of training
  together with some in the additional units of
  training.
• ‘Key Unit of Training’ - SpR 1/2 trainees should
  spend the equivalent of at least 1 month of
  training and, normally, not more than 3 months.
Key Units of Training
•  9 Cardiac / Thoracic anaesthesia III-15
•  10 Intensive Care Medicine III-18
•  11 Neuroanaesthesia III-21
•  12 Obstetric anaesthesia III-24
•  13 Paediatric anaesthesia III-26
•  14 Pain management, acute & chronic III-28
•  15 Vascular anaesthesia III-30

General Units of Training
•  16 Day surgery III-32
•  17 Ear, Nose and Throat (Otorhinolaryngology) III-34
•  18 General surgery / Gynaecology / Urology (+/- Transplantation) III-36
•  19 Orthopaedic anaesthesia III-38
•  20 Regional anaesthesia III-40
•  21 Trauma and accidents III-42

Additional Units of Training
•  22 Diagnostic imaging, anaesthesia & sedation III-44
•  23 Maxillo-facial / Dental anaesthesia III-45
•  24 Ophthalmic anaesthesia III-47
•  25 Plastics / Burns III-49
•  26 Miscellaneous III-51
•  27 Applied physiology III-52
•  28 Applied clinical pharmacology III-54
•  29 Statistical basis of clinical trial management III-56
•  30 Clinical measurement III-57
           Key Units of Training

• Cardiac / Thoracic anaesthesia – CTC (2
  supernumerary week attachment)
• Intensive Care Medicine - All hospitals
• Neuroanaesthesia - Aintree
• Obstetric anaesthesia - DGHs and Womens
• Paediatric anaesthesia - DGHs
• Pain management, acute & chronic - All
  hospitals
• Vascular anaesthesia - All hospitals
13: PAEDIATRIC ANAESTHESIA
This is a ‘Key Unit of Training’ in which SpR 1/2 trainees should spend the equivalent of at least 1 month of training and, normally, not more than
        3 months.
Paediatric anaesthesia and pain management includes everything from healthy children in DGHs to the sickest premature babies in tertiary
        referral centres and in paediatric intensive care units (PICU).
It is not expected that all SpR 1/2s will be able to gain experience with neonates and preterm babies. In considering the listed competencies
        required, it should be recognised that these will generally relate more to Knowledge rather than to Skills. However, those who intend to
        progress to a post with an interest in paediatric anaesthesia may be able to gain access to more paediatric training in SpR 1/2, when their
        Skills should begin to include those areas listed under Knowledge: Neonates.
13.1: Knowledge
General
In:13.1.1 Anatomical and physiological characteristics which affect anaesthesia and the changes which take place during growth from neonate
        to a young child
In:13.1.2 Paediatric medical and surgical problems including major congenital abnormalities, congenital heart disease and syndromes e.g.
        Down‟s and their implications for anaesthesia
In:13.1.3 Starvation and hypoglycaemia
In:13.1.4 Preoperative assessment and psychological preparation for surgery
In:13.1.5 Anaesthetic equipment and the differences from adult practice
Children and Infants
In:13.1.6 Anaesthetic management of children for minor operations and major elective and emergency surgery
In:13.1.7 Management of recovery
In:13.1.8 Management of postoperative pain, and nausea and vomiting in children
In:13.1.9 Management of acute airway obstruction including croup and epiglottitis
Neonates
In:13.1.10 Anatomical, physiological and pharmacological differences to the older child / adult
In:13.1.11 Preoperative assessment
In:13.1.12 Anaesthetic techniques and thermoregulation
In:13.1.13 Analgesia
In:13.1.14 Neonatal equipment and monitoring
In:13.1.15 Anaesthetic problems and management of important congenital anomalies including those requiring surgical correction in the
        neonatal period (tracheooesophageal fistula, diaphragmatic hernia, exomphalos, gastroschisis, intestinal obstruction, pyloric stenosis)
In:13.1.16 Special problems of the premature and ex-premature neonate
In:13.1.17 Resuscitation of the newborn
PICU
In:13.1.18 Principles of paediatric intensive care: management of the commoner problems, ventilatory and circulatory support, multi-organ
        failure
In:13.1.19 Principles of safe transport of critically ill children and babies
13.2: Skills
Children and Infants
In:13.2.1 Resuscitation – Basic life support (BLS) and advanced life support (ALS) at all ages
In:13.2.2 Preoperative assessment and preparation
In:13.2.3 Techniques of induction, maintenance and monitoring for elective and emergency anaesthesia
In:13.2.4 Selection, management and monitoring of children for diagnostic and therapeutic procedures carried out
      under sedation
In:13.2.5 Maintenance of physiology: glucose, fluids, temperature
In:13.2.6 Strategies and practice for the management of anaesthetic emergencies in children: loss of airway,
      laryngospasm, failed venous access, suxamethonium apnoea and anaphylaxis including latex allergy.
In:13.2.7 Postoperative pain management including the use of local and regional anaesthetic techniques, simple
      analgesics, NSAIDs and use of opiods (including infusions and PCA)
In:13.2.8 Communication with paediatric patients and their family
13.3: Attitudes and behaviour
To understand consent in children: the law, research, restraint
In:13.3.1 To communicate with parents (carers) and children throughout the surgical episode
13.4: Workplace training objectives
In:13.4.1 The trainee should develop a wide knowledge of the anaesthetic needs of children and neonates. They
      should, as SpR 1/2 trainees at the end of their training, be able to organise and manage safely a list of
      straightforward paediatric cases over the age of 3 years with available consultant cover. They should understand
      the potential hazards of paediatric anaesthesia and have had as much practical training as is possible in planning
      for the management of such events.
Recommended local requirements to support training
· Trainers for the initial period of training should be spending not less than the equivalent of one full operating session a
      week in paediatric anaesthesia
· Anaesthesia for children requires specially trained staff and special facilities
· Provision should be made for parents to be involved in the care of their children
· Adequate assistance for the anaesthetist by staff with paediatric training and skill should be available
· Paediatric anaesthetic equipment must be available where children are treated
                                          Workplace Assessment
School of Anaesthesia:             Mersey
Unit of Training:
Trainee:
NTN:                                                RCA No.:
The above trainee has completed a unit of training that provided the necessary instruction to gain the skills,
       attitudes and behaviour, and in addition to achieve the workplace training objectives as they are set out and
       required by the Royal College of Anaesthetists.
This assessment is based on:
Direct observation on wards/clinics                                                 Y/N
Direct observation in theatre                                                       Y/N
Direct observation in other treatment areas                                         Y/N
Direct observation in critical care areas                                           Y/N
Comments from patients                                                              Y/N
Inspection of logbook summaries indicating:
Attainment of required skills                                                       Y/N
Direct involvement in sufficient clinical cases                                     Y/N
[details of case numbers can be recorded on the back of this form]
Assessment:                         Satisfactory / Unsatisfactory

Based on input from:                            Designation                                   Date
…………………………..                                    …………………...                                    ………….
…………………………..                                    …………………...                                    ………….
…………………………..                                    …………………...                                    ………….
…………………………..                                    …………………...                                    ………….
If an unsatisfactory assessment is given examples of the reasons for this must be given:
……………………………………………………………………………………………………………………………………
       ………………………………………………………………………………………………………………………………
       …………………………………...............................................................................................................................
       ..
Signed by Trainee:                                                                             Date:

Signed by College Tutor:


[A copy of this assessment should be retained by the trainee for inclusion in
their training portfolio and a copy should be kept in the trainee’s file held by
                           the School of Anaesthesia]
               SpR 1/2 Training Certificate
• With effect from 1 February 2005, before entering higher training in
  SpR year 3, trainees will be required to have a SpR 1/2 Training
  Certificate confirming satisfactory completion of SpR 1/2 training.
  The certificate (indicating deferrals where relevant) must be signed
  by the Royal College of Anaesthetists‟ Regional Adviser and another
  designated consultant.
• This document also records the attainment of the various
  Fundamental Transferable Skills by the trainee.
• A copy of this Certificate should also be sent to the Training
  Department at the Royal College of Anaesthetists as an indication of
  when the trainee entered SpR 3/4/5 training.
• Possession of this certificate indicates that the trainee has:
   – passed all the required „Workplace Assessments‟ for SpR 1/2 training
   – demonstrated appropriate attitudes and behaviour
   – has passed the RCA Final examination or the Final examination of the
     College of Anaesthetists, Royal College of Surgeons in Ireland.
What happens if an SpR 1/2 Training
Certificate cannot be issued?


• A RITA E will be issued at the next RITA
   THE CCST IN ANAESTHESIA
      IV: Competency Based
Specialist Registrar Years 3, 4 and 5
    Training and Assessment
 A manual for trainees and trainers
              SpR 3/4/5

• Introduced in February 2003
• Therefore implemented already and that
  by 1 July 2006 Workplace Assessment
  Records will be necessary before RTIA G
  can be issued.
             Specific requirements
•   During SpR years 1-5 trainees should undertake a minimum of 6 months
    training in ICM at the intermediate to higher level.
•   Every trainee must complete the full 3 years of SpR 3/4/5 training.
•   At least 2 of the 3 years must be spent in approved training or research
    posts in the UK.
•   Up to 1 year can be taken as full time dedicated work in a single sub-
    specialty.
•   Up to 1 year can be taken outside the UK as either clinical training or
    research.
•   Only 1 year of full time research can be counted towards the CCST.
•   During these 3 years trainees should normally undertake an aggregate of
    12 months „general duties‟ where they have increased autonomy for their
    own work together with increased daytime and on-call responsibility for the
    activities and distribution of more junior staff. Whatever the agreed
    programme, all trainees must undertake a minimum of 6 months of this type
    of training.
Training in clinical anaesthesia
10 Higher Training in anaesthesia IV-21
10.1 Cardiac/Thoracic IV-22
10.2 Day surgery IV-23
10.3 Ear, Nose and Throat (Otorhinolaryngology) IV-24
10.4 General surgery/Gynaecology/Urology (+/- Transplantation) IV-25
10.5 Intensive Care Medicine IV-26
10.6 Maxillo-facial/Dental IV-27
10.7 Neuroanaesthesia IV-28
10.8 Obstetrics IV-29
10.9 Orthopaedics IV-30
10.10 Ophthalmic anaesthesia IV-31
10.11 Paediatric anaesthesia IV-32
10.12 Pain Management IV-33
10.13 Plastics/Burns IV-34
10.13.1 Burns IV-34
10.13.2 Plastic and maxillofacial surgery IV-35
10.14 Trauma and accidents IV-36
10.15 Vascular IV-37

11 Advanced Training in anaesthesia IV-39
11.1 Cardiac/Thoracic anaesthesia IV-40
11.1 Intensive Care Medicine IV-42
11.3 Neuroanaesthesia IV-43
11.4 Obstetrics IV-46
11.5 Paediatric anaesthesia IV-49
11.6 Pain Management IV-52
12 Academic & Research Anaesthesia IV-55

Development of Professional Knowledge, Skills & Attitudes
13 General Principles and Training Objectives IV-59
14 The Responsibilities of Professional Life IV-60
15 Teaching and Medical Education IV-63
16 Health Care Management IV-65
16.1 Departmental management IV-65
16.2 Management of health care IV-66
17 Independent Practice IV-67
18 Information Technology IV-69
19 Medical Ethics and Law IV-71
  Paediatric anaesthesia for those intending to
                 work in a DGH

• All trainees aspiring to be generalists should
  acquire the competencies listed for higher training
  in paediatric anaesthesia (page IV-32).
• Normally this will require a period of training in
  paediatric anaesthesia during SpR years 3, 4 or 5,
  the duration of which will depend on the
  competencies acquired during SpR years 1 and 2.
• The training in paediatric anaesthesia during SpR
  years 3, 4 and 5 does not have to be taken as a
  single block; the important thing is to acquire the
  necessary competencies.
                OOPE
Out of Programme Experience is defined as:



    “experience that does not count
     towards the award of a CCST”.
                   OFF-ROTATION TRAINING (ORT)
ORT is training that will count towards the CCST provided certain conditions are
  fulfilled:

•   ORT may be obtained in clinical or research posts in the UK or overseas.
•   Only one year of ORT during the SpR years 3, 4 and 5 can be counted towards a
    CCST.
•   Before starting ORT the trainee must be in a Type 1 SpR post having completed
    SpR Years 1 and 2 in their entirety.
•   The trainee must be eligible for SpR year 3, 4 or 5 training. This does not preclude
    setting up and planning ORT during the SpR year 1/2 period.
•   To ensure that ORT is counted as part of a CCST programme, prospective
    approval must be obtained from the Medical Secretary of the RCA Training
    Committee before taking up the post. The Medical Secretary will consider requests
    on an individual basis and inform the trainee and his/her trainers of the decision as
    soon as possible.
•   Trainees should complete the final 6 months of their CCST training in-programme
    and in the UK. Only in exceptional circumstances will a trainee be allowed to be
    training out of the UK during the final 6 months of training; in such cases, a
    minimum of the final 3 months of training must occur in the UK. This is to allow
    sufficient time to assess satisfactory completion of the CCST programme. This
    must be taken into account if the trainee wants to be interviewed for a job more
    than 3 months before completion of their CCST programme.
    Completion of specialist training - award of the CCT
•   Trainees will undergo a final summative assessment and, if successful, be issued
    with a RITA G by their Postgraduate Dean.
•   This assessment panel should be convened about three months before a trainee's
    provisional date for completion of training.
•   If successful, the trainee's name will be confirmed with the Training Department in the
    College who will:
     –   receive the RITA G form and check the completed information sheet from the trainer about
         the last 3 years‟ training on a „Notification of Completion of Training‟ Form
     –   recommend the trainee to the PMETB for the award of a CCT (batches of names are sent
         fortnightly)
     –   formally recommend confirmation to the Training Committee and inform Council of the RCA
     –   send the trainee an PMETB application form for the award of a CCT - this should be
         completed and sent, with the appropriate fee (currently £250) to the PMETB. The form is
         sent to the trainee on the same day that the PMETB is sent the recommendation.

•   The PMETB will award the CCT on receipt of the College's recommendation, the
    trainee's application and the appropriate fee.
•   The PMETB then advises the GMC that the anaesthetist has completed specialist
    training and is therefore eligible for inclusion in the GMC's Specialist Register.
•   The trainee must then apply directly to the GMC for inclusion in the Specialist
    Register using an application form that will be sent to the trainee by the PMETB.
     –   The GMC does not charge a fee for this registration
     –   Failure to do this by the trainee will delay being able to take up a consultant post.
        Consultant Interview
• The “Orange Guide” states that:
  – „the date of interview for a consultant post
    should never be more than 3 months before a
    trainee‟s expected CCST date.‟
• However, the DoH has changed this so
  that interviews can take place up to 6
  months before a trainee‟s expected CCT
  date. Trainees should take this into
  account when planning off rotation training
  overseas
       Modernising Medical Careers
               The next steps
  The future shape of Foundation, Specialist
  and General Practice Training Programmes

• Foundation Programme start Aug 2005
• Speciality Seams from 2007
• (Seamless training – run through)