4 August 2020

Guidance for Novice Airway Training



Every year more than 1000 trainees undertake training in anaesthesia and are required to complete the Initial Assessment of Competence (IAC).  Of these, around 600 come via Core Anaesthetic Training (CAT) or Acute Care Common Stem (ACCS) anaesthetic exit.  The remainder are ACCS trainees exiting to Emergency Medicine or Acute Medicine or ICM trainees.

The skills required to complete the IAC are outlined in the 2010 Anaesthetic Curriculum annex B.  This requires the acquisition of a number of skills in airway management, including the following: 

  • maintains the airway with oral/nasopharyngeal airways 
  • ventilates the lungs with a bag and mask 
  • inserts and confirms placement of a Laryngeal Mask Airway 
  • successfully places nasal/oral tracheal tubes using direct laryngoscopy
  • correctly conducts RSI.

These skills must be assessed as competent as part of the IAC before work is undertaken without direct supervision.  All training required to complete the IAC is undertaken in a supernumerary capacity which places considerable demands on anaesthetic departments.  

Current situation

The COVID pandemic has led to several important changes that will have a detrimental impact on departments’ ability to undertake novice training.  Firstly, advice on airway management that was produced by the joint COVID expert group (representing the RCoA, Association of Anaesthetists, FICM and ICS) in partnership with the Difficult Airway Society (DAS). This included the use endotracheal intubation using video laryngoscopy (VL) for patients requiring surgical procedures which has led to the widespread adoption of this technique in many areas. Secondly, the volume of patients receiving elective surgical care in the NHS has fallen considerably and a proportion of this work is now being undertaken in non-NHS hospitals.  

Both of these factors have had a significant impact on airway training for novice anaesthetists. There is a risk that the cohort of doctors in training who are due to undertake the IAC in the coming year will be unable to gain sufficient clinical experience to develop the skills required for successful completion of the assessment  This is particularly important for ACCS trainees, most of whom will only spend 6 months in an anaesthetic attachment. Completion of the IAC is a mandatory requirement for this group and failure to achieve it within their anaesthetic placements will result in a requirement for additional training time and further impact training capacity in the future.

Measures to support training

The RCoA and DAS are working in partnership to produce guidance for both trainees and trainers to support effective training in airway management for those undertaking the IAC. This will be available shortly via the DAS website. In the meantime we would urge departments to consider the following areas:

  • ensuring that appropriate time is available for trainers and trainees.  This includes building time into both clinical schedules and also allocating sessions to support the use of simulation in the development of airway skills
  • establishing appropriate training facilities both in terms of accommodation and equipment to support the regular use of simulation as an adjunct to clinical practice
  • video laryngoscopy may be used as an alternative to direct laryngoscopy for training and assessment in endotracheal intubation in clinical settings. However, trainees must also be able to demonstrate competence in direct laryngoscopy in simulated settings to achieve successful completion of the IAC.

These measures are essential to support skills development in the current climate. All departments should have a comprehensive plan to ensure that airway training can be optimised in the coming year to ensure successful completion of the assessments that form the IAC.

15 June 2020


Joint Position Statement for Acute Care Common Stem (ACCS) training programme: Initial Assessment of Competence (IAC)


This statement has been prepared by the Intercollegiate Committee for Acute Care Common Stem Training, which includes representation from the Royal College of Anaesthetists (RCoA), the Royal College of Emergency Medicine (RCEM), the Faculty of Intensive Care Medicine (FICM) and the Joint Royal College of Physicians Training Board (JRCPTB).

We recognise and understand that COVID-19 has presented significant challenges for trainees and trainers in accessing and delivering training pathway requirements, and that there is a degree of regional variation in the ability to do so. Data shows a significant number of trainees have been redeployed to support intensive care services during COVID- 19, which has impacted on the ability to complete the anaesthetic block requirement, the Initial Assessment of Competence (IAC), by the time of changeover. We are continuing to work collaboratively to deliver all aspects of the ACCS training programme, and ensure that all trainees are able to complete the IAC.

Non-acute surgery is gradually being reinstated across the UK to varying degrees. The ICACCST agrees that flexibility in when the IAC is delivered is essential and offer a number of recommendations to , ensure a flexible and timely approach for those trainees who have been unable to achieve the requirements of the IAC as a result of COVID-19 disruption. These include:

  • We advise that ACCS trainees currently redeployed to ICM from Anaesthesia, are urgently prioritised to return to anaesthetics in order to complete the IAC where possible.
  • We support local private hospital sites becoming approved training locations (subject to GMC approval) to offer additional opportunities
  • We advise that trainees who are estimated to have less than one month remaining to complete IAC before changeover, continue training in anaesthesia before moving to their next rotation
  • We support the use of local bespoke options in delivering the IAC for individual trainees who are near to completion by the time of changeover e.g. one-day per week or in one-week blocks (subject to local trainer and School approval)
  • We will allow trainees to demonstrate competence in either Direct Laryngoscopy (DL) or Video Laryngoscopy (VL) in clinical practice in order to achieve the IAC. However, all trainees must demonstrate competence in DL in a simulated environment.
  • We advise forward planning for trainees who have more than one month remaining to complete IAC before changeover and support them returning to an anaesthetic rotation later in the year (October onwards). This will also apply to trainees due to commence in August 2020 and February 2021.
  • Trainees who are currently shielding will require an individualised training plan for when it is safe to return.

Please note that all assessments must be completed without exception.

The Royal Colleges and Faculty will continue to monitor the position of completion of the IAC at intervals during 2020.

Trainees who have any specific concerns are advised to raise these with their local Educational Supervisor, Training Programme Director or Head of School as soon as possible.

18 May 2020


ARCP 2020 – advice for trainers and trainees


The ICACCST has produced advice for trainers and new 2020 ARCP checklists for supervisors and trainees.

These can be found here.

26 March 2020


ARCP 2020 – letter to trainees


On behalf of the Intercollegiate Committee for ACCS Training we would firstly like to thank you for your support, understanding and hard work in these exceedingly challenging and uncertain times. We have been overwhelmed by how readily trainees have been offering help, be it to cover for absent colleagues or to assist with preparations for what lies in store for us all.

We would like to take this opportunity to address some of the concerns, which you will understandably have. As ACCS trainees you possess considerable generic skills which will be much needed in the coming months. It is very likely that many of you will be redeployed, particularly from your anaesthesia placement to support clinical work in emergency departments, intensive care units and acute medical units. This is being done out of necessity to bolster the workforce in these areas and to make maximum use of the skill set you have, in order to keep patients safe.

This, together with the prospect of a potentially overwhelmed trainer body, has led to concerns about the ability to complete WBAs, arrange supervision meetings and subsequently progress through training. These concerns have been further exacerbated by the cancellation of study leave, conferences, local and regional teaching and examinations.

We fully understand your concerns and would like to reassure you that during this unprecedented period all four ACCS parent specialties will support the principle of a balanced and flexible approach to assessment (see links below also). Where appropriate, sign-off for placements will be, in part at least, based on global judgement and generic acute experience gained. Many of the ACCS competencies are generic and can be gained in a number of specialties, however for those that aren’t, e.g. the IAC, additional experience in anaesthesia may need to be sought at a later time in training, without necessarily delaying progression. Your local TPD/Training School will be able to offer further detail on ARCP and rotation etc.

This principle of flexibility has also been endorsed by all leading educational bodies as stated in this communication from the GMC:

"The 4 UK Statutory Education Bodies (HEE, NES, HEIW and NIMDTA), the Medical Royal Colleges and the General Medical Council are working together to minimise the impact of any delayed attainment of capabilities due to current circumstances, and will ensure that these circumstances are taken into consideration in ARCP and recruitment and selection processes. We will also work with NHS service providers to ensure education and training requirements are delivered after this difficult period."

We are aware of the huge challenges facing us all and we need to look out for each other. If you are struggling, please let someone know - your clinical or educational supervisor, your trust trainee welfare lead or your deanery.

We wish you all the very best and thank you again for your commitment.

With best wishes,

Karine Zander, Co-chair ICACCST
Dan Becker, Co-chair ICACCST