Workplace based assessments for anaesthetic STs 5,6 and 7 in the Northern Deanery

 Guidance notes October 2005 ( Written by Dr Andrew Skinner, Deputy RA)

 1. By summer of 2006 the RITA panel will require written evidence to support the recommendation to the dean of an award of a RITA G.  Therefore any trainee due to complete his or her training after 01/07/2006 must provide the necessary competency documentation.  This document sets out broadly what will be expected of trainees and how it should be documented.

 2. As time proceeds these guidelines are likely to be refined and trainees must take care to use the latest guidance.  Trainees must use these guidelines to inform their requests for attachments and their career plans.  Although the RA, program directors and their deputies will endeavour to ensure that trainees programs are appropriate and will not delay CCT dates the final responsibility lies with the trainees themselves.  This is especially true of ICM and paediatric ICM specialist training.  More than one RA may need to be consulted and again this lies with the trainees themselves.  

3. This guidance should be read in conjunction with the RCOA documentation.

 General Training – what is required

 4. The Royal College states: 

“In setting out the requirements for training in the SHO and SpR 1/2 Years, the RCA Competency Based Programmes for Training and Assessment adopted a prescriptive approach. However, it is recognised that on entry to Years 3, 4 and 5 of training, and in gaining the broader competencies required for a consultant post, a more flexible approach is necessary. Those involved in the planning and supervision of training should regard this 3 year period as a continuum allowing trainees to rotate between district general and central (university) hospitals to provide them with the appropriate experience. Trainees must be allowed to some degree to follow their own differing paths of training.”

 5. This guidance is therefore broad and non-prescriptive.  Some elements are compulsory or, in our view, essential to demonstrate that trainees have made best use of the training opportunities in the deanery.

 Essential elements of training:

  ·         During SpR years 1-5 (ST 3-7) trainees should undertake a minimum of 6 months training in ICM

  ·         During these [latter] 3 years trainees should normally undertake an aggregate of 12 months ‘general duties5’ 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.  This should ideally include time where a trainee supervises more junior trainees.  

·         Trainees aspiring to be generalists should acquire the competencies listed for higher training in paediatric anaesthesia. Normally this will require a period of higher training in paediatric anaesthesia during SpR years 3, 4 or 5 (ST5-7). This training does not have to be taken as a single block; the important thing is to acquire the necessary competencies.

  ·         Trainees should have on going experience in obstetric anaesthesia for at least some part of their senior training.

 General Training – documentation and competency forms

 Clinical

6. Trainees are at liberty to generate their own documentation de novo (though we would not recommend this as the norm) or to modify the competency forms available on the website to suit their agreed training programme.   

7. The new competency forms are deliberately cast in loose terms, which reflect the RCOA’s stated ethos for later training.  There is a strong element of self-certification in these documents and trainees should reflect on the effect that inappropriate self certification might have on their future relationship with the GMC.  Completion of these certificates will be informed by logbook data.

 8. The compulsory/essential elements detailed above have corresponding “Essential” competency documents for years 3, 4 and 5.  It is also compulsory to have completed the competency documentation required for SpR years 1 and 2.

9. In addition to this trainees should have gathered a broad range of experience, including at least one, ideally several major surgical specialities where unfit patients undergo major operations, such as upper GI, vascular surgery, major head and neck, neuro or similar procedures.  At least one attachment during the post fellowship SpR years should involve thoracic surgery, specifically with lung isolation (this need not necessarily be thoracic surgery per se but may be lung isolation at upper GI surgery).  At least one attachment during the post fellowship SpR years should involve working with surgery on the head and neck, since sharing the airway is an important skill.

 10. Some certification will normally be required for each and every attachment.  If you find you have not completed a workplace assessment record for a whole 6-month attachment you MUST create a generalised form and have that signed off by your college tutor.

 11. Unless there are strong reasons to the contrary, agreed in advance with the RA, program director or their deputies a further attachment to a chronic pain service in the latter 3 years is essential. 

 12. The “Elective” competency documents are aimed at trainees progressing to higher level sub-speciality training – see below.

 Non – clinical

13. Trainees will be expected to document CPD in a range of the following areas:

  ·         The responsibilities of Professional Life

·         Teaching and Medical Education

·         Health Care Management

·         Information Technology

·         Medical Ethics and Law

 Sub-specialist Training

 14. This includes, but is not limited to:

·         Cardiac/Thoracic.

·         Neuroanaesthesia.

·         Obstetrics.

·         Paediatric Anaesthesia.

·         Pain management.

·         Intensive Care Medicine

 15. Trainees must develop their own materials to suit their own particular program.  A suggestion is given in the “Elective” documents.  This is drawn directly from the RCOA documentation, but has been modified for sense, readability and to suit a trainee’s personal career aspirations.

Other training

 16. Trainees will be expected to provide some documentation from supervisors that out of program research and any other training has proceeded satisfactorily.  An example of a suitable form is available below.

 Implementation

 17. It is highly unlikely that retrospective certification of training modules completed after 01/01/2006 will be entertained except in very unusual circumstances.  Retrospective certification is not good educational practice.  It cannot inform future training as effectively as appraisal and assessment at the time of the training.

 Concerning those already in year 3 or higher at the time of publication of this guidance:

 18. The policy of documentation being required for competency based training was explicitly stated in several documents from the RCOA and ignoring this issue will only be to the detriment of the individual trainee.

 19. Those trainees in years 3, 4 and 5, who are due to finish after 01/07/2006, and do not have a full and current quota of competency documentation, must immediately begin to organise retrospective documentation.  Please note that it has been agreed that if you have entered year 3 without needing competency documentation, due to the time you entered, then your competencies for the SpR years 1 and 2 will be assumed to be fulfilled.  However, all documentation for years 3, 4 and 5 MUST be completed.

 20. It is recognised that the implementation of these competency documents for those in later years will not be without some difficulty for both trainees and trainers, and therefore an interim solution involving retrospective certification will be needed.  College tutors have been asked to make arrangements for retrospective documentation.  Suggestions made by the STC include a trainee providing the relevant appraisal form and logbook data for the attachment at a formal meeting with a relevant consultant.  Forms signed in retrospect may be signed by any 2 appropriate consultants from that attachment, not necessarily the college tutor or lead clinician.

 21. Any trainee who feels disadvantaged by this should speak to the RA, program director or their deputies as a matter of urgency. 

 22. Trainees should also review their SpR 3 4 5 training program as a matter of extreme urgency and speak to the program director, the RA or their deputies if there is a large discrepancy between the recommendations in this documentation and their training.

23. We accept that trainees abroad at the time of this guidance will face some extra difficulties and will view these sympathetically.

 24. Any queries regarding these guidelines should be first addressed to your current college tutor.

Advice to Trainers about Workplace Based Assessments for RITAs

   1. You are doubtless aware that we are obliged to conduct RITAs in a more structured way than in the past and that this includes documentary evidence of satisfactory performance in the work place.

 2. To this end you will be asked, by trainees, to sign such documents from time to time.  Trainees should do this in the context of a formal meeting, in an appropriate location with sufficient time set aside.  A casual meeting is not appropriate.  It should ideally be at such a time that you are not being asked to certify performance in training that took place long ago.  

3. This certification is now a since qua non of training.  If you are to have trainees you must be in a position to either certify or give reasons why certification is inappropriate for each and every trainee.  Not certifying must be an active decision based on poor performance, it is unacceptable for trainers to find themselves in a position where they simply do not have sufficient knowledge to certify in the face of apparently satisfactory performance.  Nor is it appropriate for the first intimation of poor performance to be in the context of refusal to certify.  Poor performance should have been identified and a remedial plan put in place at the earliest opportunity.

 4. Trainees will make all the arrangements for this.  It is not your job to “chase” this up.

 5. Similarly trainees will provide the documentation.  In the early years of training they will use approved forms from the School web site.  In the latter years much of the documentation will be individualised by the trainee to suit their training program and career aspirations.

 6. You must make a judgement about what evidence you require.  For example you could take the view that if a senior trainee has done obstetric on call in your hospital, has had no or few adverse reports and has logbook data of activity at a reasonable level then it is reasonable to sign them off as competent in, say, epidural analgesia for labour.  Conversely you could take the view that you want to witness them doing epidurals, but if you take this view you must make suitable arrangements to observe, even if it is out of normal working hours.  It is unacceptable to come to the end of a period of training without being able to certify acceptable performance simply for lack of evidence.  For the bulk of “routine” work a review of logbook data in the face of no adverse reports, probably after consultation with colleagues, should be sufficient to certify.

 Similarly you must take a view about how comprehensive the experience needs to be.  If the documentation lists a specific skill the trainee has not been able to acquire then provided the bulk of the skills are satisfactory the attachment can still be certified as satisfactory and the paperwork annotated to that effect.  For example one could spend a lot of time in a pain clinic without the opportunity to see some aspects of pain work.  This would not be a reason to mark the whole attachment as unsatisfactory.

 Implementation

 7. It is highly unlikely that retrospective certification of training modules completed after 01/01/2006 will be entertained except in very unusual circumstances.  Retrospective certification is not good educational practice.  It cannot inform future training as effectively as appraisal and assessment at the time of the training.

WPBAs are already in place for SpRs 1 and 2 but concerning those already in year 3 or higher at the time of publication of this guidance:

 8. The policy of documentation being required for competency based training was explicitly stated in several documents from the RCOA and ignoring this issue will only be to the detriment of the individual trainee.

 9. Those trainees in years 3, 4 and 5, who are due to finish after June 2006, and do not have a full and current quota of competency documentation, must immediately begin to organise retrospective documentation.  All trainees are strongly advised to collect this evidence even if they expect a CCT before the deadline.  It will be a useful part of a professional portfolio, will inform CPD planning in the early consultant years and would be useful evidence were their performance to be called into doubt in a consultant post.

10. It is recognised that the implementation of these competency documents for those in the later years of training will not be without some difficulty for both trainees and trainers, and therefore an interim solution involving retrospective certification will be needed.  College tutors have been asked to make arrangements for retrospective documentation.  Suggestions made by the STC include a trainee providing the relevant appraisal form and logbook data for the attachment at a formal meeting with a relevant consultant.  Forms signed in retrospect may be signed by any 2 appropriate consultants from that attachment, not necessarily the college tutor or lead clinician.

 11. It is recognised that there will be a period during implementation where certification will be less satisfactory than is ideal, but there is an absolute need to have this paperwork at all final RITAs from July 2006.  It is hoped that trainers and college tutors will recognise this and take a somewhat pragmatic view.

 12. If the question of retrospective certification of a trainee arises in the face of reservations about performance the appropriate college tutors and the RA or deputy RAs will need to examine the problem on an individual, case by case basis.  It is hoped that this will be unusual, since poor performance should be identified early and acted upon.

 13. Please feel free to approach your college tutors or the RA or deputy RAs about this guidance.  

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