News

 
18 June 2021

The impact of COVID-19 on training and ARCP

 
Dear colleagues in training,
 
Last month we sent out a survey for you and your trainers to complete looking at the impact of covid on training. We were keen to identify not only the challenges that have arisen but also any educational benefits that may have resulted from the different ways of working. The full results are now available on the ACCS website. A brief summary is set our below:
 
  • 26.5% trainee respondents reported being redeployed during the pandemic, mostly from their anaesthetics placement to support the intensive care units (85%). 45% of these trainees were redeployed for more than 1 month.
  • Of those who responded, both trainees and training leads felt that training had suffered as a result of the pandemic, predominantly due to reduced anaesthetic exposure but also reduced case-mix, cancelled courses and teaching, gruelling rotas and fatigue.
  • There were, however, a number of positives identified; the value of being ‘of use’ during the pandemic was recognised as was the enhanced team building. Other benefits included the additional critical care experience, the acquisition of new skills and the development of remote teaching / meetings which has resulted in improved attendance.
  • Trainers report protecting training wherever possible and prioritising new starters over specialty trainees.
  • While 14.3% of trainees who responded were concerned about not being able to obtain their IAC by August, only 7.7% of training lead respondents felt this would affect any trainees in their region.
 
Thank you for your cooperation with this survey. It has confirmed much of what we were expecting to hear about the challenges, but it has also highlighted how both you and your trainers have managed to find positives in these very difficult times. We are grateful for the significant efforts that have been made to maintain your training while meeting the heavily increased service commitments and we appreciate the high demands on all of you, both clinically and emotionally.
 
There remain a number of you who currently appear unlikely to obtain their IAC by August. If you are in such a position, we would urge you to ensure your educational supervisor is aware ASAP so bespoke arrangements can be made to meet this learning requirement.
 
On behalf of the ICACCST we would like to thank you once again for all your hard work over the past year. We hope there will be calmer days ahead.
 
With best wishes,
 
Dan Becker, Co-chair ICACCST
Karine Zander, Co-chair ICACCST
 

A pfd copy of this letter can be downloaded here.

A copy of the survey results report can be downloaded here.

 


 

29 April 2021

COVID-19 and Trainee Progression in 2021

 

Introduction

As you may recall, we wrote to you on of 25th November 2020 to advise that that the four UK Statutory Education Bodies (HEE, NES, HEIW and NIMDTA), the Medical Royal Colleges and the General Medical Council were keeping the changes from 2020 to enable progression and minimise disruption in 2021 given the ongoing challenges to training due to the pandemic.
The Intercollegiate Committee for Acute Care Common Stem Training (ICACCST) has therefore produced this guidance to support Heads of School and ACCS Leads in managing the assessment and progress of ACCS trainees from all three parent specialties – Acute Medicine, Anaesthesia and Emergency Medicine.
This year’s advice is similar to that in the document circulated in May 2020 to support the 2020 ARCPs, however there is an important shift in emphasis towards using COVID-19 derogations only as the exception with the default expectation being “normal” curricular requirements. This reflects the Education Bodies’ directive that that re-deployment of trainees should be very much a last resort, with far fewer being expected to work in different areas than was the case during the first wave of the pandemic. Secondly, and along similar lines, there is a much greater expectation that all aspects of training will continue to be fully delivered through this training year, including supervision, teaching, assessments, support and study leave.
 

Purpose

This document aims to:

  • Promote and support flexibility in the assessment process to minimise any training disadvantages experienced by trainees during the pandemic
  • Provide clarity to allow trainees and trainers to plan for the coming months
  • Ensure a flexible approach to time off due to illness or meeting isolation requirements to ensure that any such instances do not unfairly disadvantage trainees
 

ARCP – Process

The following groups will require an ARCP at the usual time in summer 2021:
  • CT2/ST2 trainees at the end of the common two years of ACCS training
  • CT1/ST1 trainees where specific issues have been identified
  • CT1/ST1 trainees who have applied for other speciality training
Despite the first point above, it is strongly recommended that all CT1/ST1s have an ARCP in the summer in order to fully support trainees and ease transition to the new curriculum If, despite this, it proves impossible for some trainees to have an ARCP in the summer they should be issued with a No Outcome - N13 code specifying COVID 19 and they must have a formal ARCP in later 2021.
Trainees issued with one of the new COVID-19 Outcomes (see below) should have a formal action plan and an interim review may be necessary prior to ARCP in summer 2022.
The precise mechanism by which the ARCP process will be held will follow local office or deanery processes.
Minimum panel requirements:
Panel Chair - whenever possible this should either be an ACCS TPD (or equivalent) or Head of School.
Panel Members - it is strongly recommended to have three panellists. These should comprise: ACCS TPD (or equivalent)/Head of School (Chair) plus one from Anaesthesia/ICM and one from Emergency Medicine/Acute Medicine. If three panellists are not available, one panellist may fulfil two roles e.g. Head of School and Emergency Medicine.
Externality for ARCPs will likely be of limited capacity again in summer 2021. Specific requests can be made through the relevant Colleges and high stake ARCP decisions will be prioritised.
For LTFT trainees the portfolio should include a pro rata reference for competencies attained, as trainees will have been training as ‘normal’ until end of February 2020.
For trainees who have experienced modification of their rotations through redeployment, this should be described in the scope of practice commentary on the revised COVID 19 ARCP checklist and taken into account by the ARCP panel.
Trainees who have had time off to isolate, who have been shielding or who have had amended duties for health reasons must have the exact times of sickness/amended duties documented on form R and this should be taken into account by the ARCP panel.
Progression for such trainees will be based on the pro rata evidence of trainee development and progress to date. Affected trainees must have shown prior engagement with the
training process and have evidence of this in the e-portfolio. Such evidence will include completion of some of the necessary WBAs.
 
 

ARCP - Outcomes

Outcome 1
The minimum data set (see below) is that which is required to evidence safe practice and achieve an Outcome 1 at ARCP for trainees in the first two years of ACCS. This applies from August 2019 onwards until further notice.
There are two new COVID 19 outcomes which should be used where the trainee has been affected by the disruption due to COVID 19. These outcomes should only be used where it clear that COVID-19 has had a direct and significant bearing on trainees’ opportunity to meet the criteria despite their full engagement with training.
Outcome 10 .1
Progress is satisfactory but the acquisition of competencies/capabilities by the trainee has been delayed by COVID-19 disruption. Trainee can progress.
Outcome 10 .2
Progress is satisfactory but the acquisition of competencies/capabilities by the trainee has been delayed by COVID-19 disruption. Trainee is at critical point and additional training time is required.
  • Supplementary codes should be used to document the reason for this outcome
  • Capabilities to be developed should be documented on the ARCP form
  • The trainee should then be able to progress to the next training year
Outcome 10.1/10.2 clarifies this is an outcome which was out of the trainees control i.e. a no fault outcome due to the pandemic and should additional training time be needed this would be a mitigating factor.
Following the Outcome 10.1 or 10.2, the TPD (or equivalent), trainee and educational supervisor should discuss and agree a formal action plan. This should detail the areas that need to be completed in the next year of training and how this can be achieved bearing in mind the introduction of the new ACCS curriculum from August 2021. Interim review may be planned prior to ARCP in summer 2022 if there are issues or concerns that may affect progress or to sign off competencies (e.g. IAC).

 

ARCP – Evidence

Modified ARCP data set and anticipated outcomes
The ARCP Decision Tables outline a minimum data set for CT1/ST1 and CT2/ST2. Gold Guide section 4.91 rules will still apply. The minimum dataset is a revision of the original 2015 ARCP checklists due to COVID 19. The 2015 checklists will be no longer used.
Educational Supervisors Structure Training Report (STR/ESR)
The Educational Supervisor’s Structured Training Report (STR/ESR) is essential to this process.
  • There should be a detailed summary and commentary on progress of trainee activity pre pandemic and during pandemic
  • It must include commentary on areas which will require a focus for the following year of training
  • Where the trainee has had an N13 outcome it is the trainee’s responsibility to maintain contact with their ES/CS to ensure that they have an STR covering each year of training
  • Where relevant, it must contain a statement confirming that there are no concerns within the domains covered by any missing MSF and progression towards the appropriate number of common competencies
  • Consideration should be given as to whether the trainee is felt to have engaged with the training process and has some evidence of this in the e-portfolio
  • The STR should state whether there are significant issues and whether these were present pre-COVID-19, occurred as a result of COVID-19 and/or whether COVID-19 has contributed to them.
If the Educational Supervisor is not available the trainee should discuss with their Training Programme Director (or equivalent) and be allocated a trainer who can submit a report.
E-portfolio
Trainees will be expected to have the minimum data set (see Decision Tables) within their e-portfolio.
MSF
Trainees should make every effort to undertake an MSF during this training year and many will already have done so. Progression will still be permitted without an MSF provided the STR explicitly states no concerns in the domains covered by an MSF.
Checklist
The ACCS checklists again include a reduction in the minimum number of competencies expected for each placement (applicable August 2019 onwards) and for ACCS as a whole. Trainees will be expected to upload a checklist within their e-portfolio signed by themselves and their trainers.

Examinations
It is not mandatory for ACCS trainees to have passed any parts of their primary examination by the end of the two common years of ACCS. Postponement or cancellation of examinations will not therefore impact the ARCP process for CT1/ST1s and CT2/ST2s.

 

ARCP – Curricular requirements

Revised checklists and a minimum data set for safe progression have been defined – see decision tables. These are unchanged from the modified 2020 checklists for each of the four placements, revised downwards from the full curricular requirements such that they should be achievable regardless of which placement a trainee was on when COVID-19 became pandemic.
Additionally, many of the ACCS competencies are generic and can be gained in more than one of the four placements over the (indicative) 2-year time frame. Nonetheless there is room for pragmatism and flexibility when applying these new minimum requirements to ensure that trainees who have endeavoured to meet them but failed through no fault of their own are not disadvantaged.
 
NOTE: the revised minimum expectation for competencies achieved in any given placement applies from August 2019 – the 2015 checklists/totals for each placement still apply for placements completed prior to this time (this should only affect LTFT trainees or those who have had time out of programme).
CT1 /ST1
If these trainees have submitted the minimum data set evidence and meet the revised minimum curricular requirements they can be awarded Outcome 1 provided there are no other concerns.
Trainees who have submitted the minimum data set evidence but not achieved the minimum curricular requirements as a result of COVID-19 should be awarded Outcome 10.1 with the relevant supplementary C code.
Deficiencies/concerns for other reasons should be managed using the standard Outcomes as per Gold Guide.
CT2/ST2
If these trainees have submitted the minimum data set evidence and meet the revised minimum curricular requirements (for placements and for completion of CT2/ST2 as a whole) they can be awarded Outcome 1 provided there are no other concerns.
Trainees who have submitted the minimum data set evidence, not achieved the minimum curricular requirements (for placements and for completion of CT2/ST2 as a whole) as a result of COVID-19 but have gained the IAC should be awarded Outcome 10.1 with the relevant supplementary C code.
Trainees who have submitted the minimum data set evidence, not achieved the minimum curricular requirements (for placements and for completion of CT2/ST2 as a whole) as a result of COVID-19 and not gained the IAC should also be awarded Outcome 10.1 with the relevant supplementary C code.
Such trainees may progress but will be required to re-do a period in CT2 Anaesthesia to complete the IAC and cannot successfully complete ACCS training as a whole without it. How this training experience is to be provided will be determined at local level by TPDs (or equivalent) and Heads of School. Trainees who are experiencing difficulties in completion of IAC should be identified by TPDs (or equivalent) as soon as possible. Further advice to Heads of School for those trainees who have not obtained IAC will follow.
 
Deficiencies/concerns for other reasons should be managed using the standard Outcomes.
 

ACCS ARCP 2021 Checklist CT1 - ST1

ACCS ARCP 2021 Checklist CT2 - ST2

ACCS ARCP 2021 Decision Tables

 

 

 

26 November 2020

COVID-19 and trainee progression in 2021

 

On behalf of the Intercollegiate Committee for ACCS Training we are writing with early notification of modifications to the 2021 ARCP process.

Yesterday, the four UK Statutory Education Bodies (HEE, NES, HEIW and NIMDTA), the Medical Royal Colleges and the General Medical Council have issued an update which states:

“To ease pressure on doctors in training, we’re keeping changes that enable progression and minimise disruption during the pandemic. Given the continuing huge challenges that professionals face, the currently agreed more flexible arrangements and derogations will continue until at least September 2021.
This includes retaining:

  • The revised process for doctors completing an Annual Review of Competency Progression (ARCP)
  • The amended process for ARCP appeals
  • Derogations from the Gold Guide to permit the award of the new COVID Outcomes (Outcome 10s)
  • GMC-approved curriculum derogations

Changes to the ARCP process (including amendments to panel composition, use of decision aids, curriculum and Gold Guide derogations, and arrangement of ARCP appeals), were introduced following the UK’s first major Covid-19 outbreak, in April 2020.”

In line with this, the ICACCST will be issuing new advice, decision aids and checklists for the summer 2021 ARCPs for all UK ACCS trainees. These will be available early in the New Year.

The situation, however, has changed since the first wave of the pandemic and as a result there are some differences for the 2021 ARCPs. Firstly, it has been directed by the Statutory Education Bodies (SEBs) that re-deployment of trainees should be very much a last resort, with far fewer being expected to work in different areas than was the case during the first wave of the pandemic. Secondly, and along similar lines, there is a much greater expectation that all aspects of training will continue to be fully delivered through this training year, including supervision, teaching, assessments, support and study leave. As result, the expectation for ARCPs in summer 2021 is very much that trainees will be able to meet the full “normal” ARCP criteria and that use of the COVID Outcomes will only be necessary in exceptional cases. Trainees and trainers should therefore proceed and plan on this basis.

We hope that this information now provides you with some clarity and reassurance, and we thank you for your all your hard work and endurance during what has been a hugely challenging year so far. Please circulate this letter as appropriate and we will write again soon with the full set of documents listed above.

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


4 August 2020

Guidance for Novice Airway Training

 

Background

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.


11 May 2020

COVID-19 and Trainee Progression in 2020

 

ICACCST Advice ARCP 2020 re COVID-19

In line with guidance from the GMC and Statutory Education Bodies (SEBs) the ICACCST has produced advice for ACCS trainees' ARCPs in 2020. This has been done in consultation with the SEBs and parent Colleges/Faculty in order to ensure consistency. The guidance is intended for ACCS Leads and Heads of School and can be found here.

This guidance should be used to direct the approach to, and delivery of, ARCPs for ACCS CT1/ST1 and CT2/ST2 trainees this year for all three parent specialties. The narrative on pages 1-6 sets out the context and details the requirements for each aspect of the process. The decision tables on pages 7 and 8 summarise the exact requirements in terms of the documents to be reviewed, expected coverage of curricular competences and outcomes to be awarded.

The committee has also produced new 2020 ARCP Checklists for trainees and supervisors. These are derived from the Advice document above and apply to all ACCS placements for all ACCS CT1/ST1 and CT2/ST2 trainees from August 2019 onwards until further notice. These can be found here for CT1/ST1 and here for CT2/ST2.

 


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