Placement guidance for Anaesthetics
Welcome to the Anaesthetics section of the ACCS website.
During the two years of the ACCS programme you will spend six months in anaesthetics under the supervision of a named clinical supervisor from the anaesthetic dept. During this time, you will concentrate predominantly on the completion of LO7 which is specific to the anaesthetic placement.
In addition to completing LO7, you will also work towards LO3, LO5, LO6 plus the generic LOs 9, 10 and 11 as per the ACCS curriculum. By the end of the anaesthetic placement you will be expected to have reached a minimum level of entrustment for each of these clinical ACCS LOs as detailed in the entrustment matrix.
LO7 involves :
1. Successful completion of the Initial Assessment of Competence (IAC)
2. Successful completion the Anaesthetics Stage 1 Holistic Assessment of Learning Outcomes (HALO) in Procedural Sedation
3. maintaining an anaesthetic logbook
4. developing your portfolio
5. attending the specific tutorials and education sessions as specified by your department.
Initial Assessment of Competence (IAC)
All ACCS trainees should aim to complete the IAC within the first 3 to 6 months of the anaesthetics placement and until successfully completed, may not work without direct supervision.
The previous list of workplace-based assessments has been replaced by the adoption of entrustable professional activities (EPAs) for the assessment of the IAC. Each EPA relates to a discrete area of clinical practice that an anaesthetist is trusted to perform, as defined by the appropriate level of supervision, when they have demonstrated sufficient competence.
There are 2 EPAs to complete for the IAC:
· EPA 1: performing an anaesthetic preoperative assessment
· EPA 2: general anaesthesia for an ASA I/II patient having uncomplicated surgery.
During this training period, workplace-based assessments or ‘WPBAs’ (known as supervised learning events or ‘SLEs’ in the anaesthetic curriculum), personal activities, and personal reflections – as well as a multiple trainer report (MTR) – can be used by the trainee to demonstrate their progress until they reach a point where they can be entrusted to carry out the activity with more distant supervision.
EPAs will be available to complete on the e-portfolios and a copy of the workbook can be downloaded here: https://rcoa.ac.uk/documents/2021-curriculum-assessment-guidance/entrustable-professional-activities-iac-iacoa
Procedural Sedation
As part of the ACCS programme, during the anaesthetic placement, all trainees must complete the Holistic Assessment of Learning Outcomes (HALO) for procedural sedation.
Supervisors draw upon a range of evidence including the logbook of cases completed, SLEs, examples of evidence set out in the curriculum document, and trainer feedback to inform their decision as to whether the element has been achieved. The logbook review should consider the mix of cases, level of supervision and balance of elective and emergency cases, if relevant. This evidence is recorded on the portfolio and linked to the relevant learning outcomes and/or key capabilities and so collated in the HALO for sign-off.
Procedural Sedation Learning Outcome:
provides safe procedural sedation to ASA 1 to 3 adult patients within the theatre complex.
Key capabilities:
A - Conducts appropriate pre-assessment of patients with respect to sedation, understands patient related risk factors, and plans accordingly
B - Chooses safe, appropriate sedative drugs to deliver conscious sedation
C - Describes the particular dangers associated with the use of single or combinations of sedative drugs, particularly in the frail, elderly or critically ill patient and those requiring transfer
D - Monitors a sedated patient’s physiology appropriately
E - Ensures the provision of safe post-procedural care
F - Explains the different levels of sedation and appreciates the risks associated with these
G - Recognises and manages the complications of sedation
Examples of evidence:
SLEs throughout stage of training across range of surgical specialties.
Suggested supervision level:
2a - Supervisor on the ‘shop-floor’ (eg, ED, theatres, AMU, ICU), monitoring at regular intervals.
Other ACCS Learning Outcomes to address during this placement:
• LO3: resuscitation
• LO5: procedural skills
• LO6: challenging situations in the workplace
• LO9: teaching
• LO10: research
• LO11: QI
Assessment Methods
Trainees can use a wide range of WPBAs to evidence progress. There is no minimum number required. Trainees should instead, work with their supervisor to ensure they are able to provide sufficient evidence to demonstrate their progress and achievements.
Panel based judgement: Multiple Trainer Report (MTR)
The MTR is the equivalent of the FEG but carried out during the Anaesthetic placement. It can be performed, like the FEGS, as a collective discussion, or as independent feedback from a selected group of trainers who have worked with the doctor in training. The MTR captures the views of senior clinical staff, based on observation of a trainee’s performance in practice, providing similar valuable insight into how well the trainee is performing, highlighting areas of excellence and areas where support is required. Like the FEGS, it is used to make entrustment decisions. The MTR will be collated through the e-portfolio and will form part of the clinical supervisor’s ‘end of placement report’. The results of the MTR should be discussed with the trainee during or at the end of the placement, prior to sign-off.
MSF
This differs from an MTR as it seeks feedback from the multidisciplinary team, including consultants, on overall professional behaviour and attitude rather than focussing on the trainee’s progress with key capabilities and learning outcomes. The MSF covers areas such as communication and team working. It closely aligns to the generic LOs. Feedback should be sought from a wide range of individuals with whom the doctor in training works including non-clinical staff. Feedback should be discussed with the doctor in training. Repeat MSFs can be undertaken where appropriate.
The minimum number of MSFs required is 1 per year.
Resources: e-Learning Anaesthesia website
Non-Anaesthetic ACCS trainees can also register for access to the e-learning Anaesthesia website via: https://portal.e-lfh.org.uk free of charge. You will require a NHS email address and your GMC number.
Reports
At the end of the placement the clinical supervisor completes an ‘end of placement’ report for each trainee. This report will include the entrustment level the trainee has reached in the relevant clinical LOs (3,5,6,7) plus confirmation of the trainee’s completion of the IAC and HALO for procedural sedation.
Trainees are expected to demonstrate progress against the 3 generic ACCS LOs.