Anaesthesia for all ACCS trainees
Welcome to the Anaesthesia section of the ACCS Website.
During the two years of the ACCS programme you will spend between six and nine months in anaesthesia depending on the deanery in which you are working. During this time you should complete the Initial Assessment of Competence, complete the portfolio, anaesthetic competency documents and logbook, complete the work place assessments and attend the specific tutorials and education sessions as required by your deanery.
Trainees begining ACCS prior to 2010 may be required to use the 2007 curriculum and portfolio and this should be confirmed with the appropriate educational supervisor or college tutor prior at the begining of the module. For those trainees requiring to follow the 2007 curriculum please click here.
2010 Anaesthesia curriculum and assessments
- Minimum number of assessments per 6 months: 3 Mini-CEX, 5 DOPs, 7 Cbds plus 1 MSF.
All ACCS trainees must complete the following sections of this section of the ACCS curriculum as a minimum and attain all the identified minimum clinical learning outcomes:
Anaesthesia: Initial Assessment of Competence (IAC)
Initial assessment of competence (IAC): must be completed over the first three months of anaesthesia training and untill successfully completed a trainee may not work without direct supervision. Some deaneries may have specific paperwork for completion of the IAC, others can use the Royal College of Anaesthetists paperwork (found on the RCOA website) - more information can be obtained from the educational supervisor. All anaesthetic assessments are summative and compulsory during the anaesthesia module of ACCS:
**The IAC for ACCS trainees is a slightly modified version of that for anaesthetists. Therefore those trainees in ACCS with anaesthesia as a parent speciality would be advised to discuss completing the full IAC with their supervisor. These additional assessments are highlighted below and a full description can be found on the RCOA website.
| ACCS IAC checklist |
Anaes-CEX
- Anaes-CEX for IAC:
- 1. Pre-operative assessment of a patient undergoing routine surgery
- 2. Manage anaesthesia for a patient who is not intubated and is breathing spontaneously.
- 3. Administer anaesthesia for a laparotomy
- 4. Demonatrate rapid sequence induction
- 5. Recovery of a patient from anaesthesia
- Further Anaes-CEX required for ACCS:
- 1. Manage anaesthesia for a patient who is intubated and ventilated
- 2. Manage anaesthesia for emergency surgery requiring a rapid sequence induction
DOPs required for both the Anaesthesia IAC and ACCS:
- 1. Demonstrate functions of the anaesthetic machine
- 2. Transfer a patient onto the Initial operating table and position them for surgery (lateral, Lloyd Davis or lithotomy position)
- 3. Demonstrates technique of scrubbing up and donning gown and gloves
- 4. Basic Competencies for Pain Management – manages PCA including prescription and adjustment of machinery
- 5. Demonstrate cardio-pulmonary resuscitation on a manikin (both BLS & ALS)
- **6. Demonstrates the routine for dealing with a failed intubation on a manikin (IAC for anaesthesia trainees only)
CbDs required for both the Anaesthesia IAC and ACCS:
- 1. Discuss the steps taken to ensure correct identification of the patient, the operation and the side of operation
- 2. Discuss how the need to minimise postoperative nausea and vomiting influenced the conduct of the anaesthetic
- 3. Discuss how the airway was assessed and how difficult intubation can be predicted
- 4. Discuss how the choice of muscle relaxants and induction agents was made
- 5. Discuss how the trainee’s choice of post-operative analgesics was made
- 6. Discuss how the trainee’s choice of post operative oxygen therapy was made
- 7. Discuss the problems emergency intra-abdominal surgery causes for the anaesthetist and how the trainee dealt with these
- **8. Discuss the routine to be followed in the case of failed intubation (IAC for anaesthesia trainees only)
Anaesthesia: further modules post IAC
The following modules are compulsory for completion of ACCS anaesthesia module regardless of whether 3 or 6 months is spent in anaesthesia. Additional work place assessments are required for the completion of subsequent anaesthesia modules - these are specified in the documents below.
- A. Basis of anaesthetic practice
- 1. Preoperative assessment
- a. History taking
- b. Clinical examination
- c. Specific anaesthetic evaluation
- 2. Premedication
- 3. Induction of general anaesthesia
- 4. Intra-operative care
- 5. Postoperative and recovery room care
- B. Airway management
- C. Critical incidents
- D. The paediatric anaesthetic competences listed for ACCS
It is recognised that this is a challenging list of competences for the few trainees whose programme includes just 3 months of anaesthetics; in this instance, it is essential that they are given as much time out of their Intensive care medicine training as required (which will last nine months for such trainees) to ensure they achieve these essential competences which are core to patient safety. For trainees who complete the ‘usual’ six months of anaesthetic training in a two year ACCS programme, a minimum of one of the additional elements of training listed below must be completed successfully (which, will depend upon trainee interest and local availability):
- Introduction of anaesthesia for emergency surgery
- Transfer medicine
- Sedation
- Aspects of regional anaesthesia
For those trainees whose programme of training includes nine months of anaesthesia, the competences in all the additional areas of practice identified above should be attained for successful completion of their anaesthetics ACCS training.
Anaesthesia portfolio
This document is paper based and contains appraisal information as well as details on your logbook summaries and cases. Please note some deaneries have their own specific versions of the portfolio to follow, individual educational supervisors should be consulted regarding local deanery policy.
Anaesthetic Logbook
As in all ACCS speciality modules, a logbook is required to be kept for your time spent in anaesthesia which will form a vital part for the yearly assessment procedures (ARCP's). ACCS (Anaesthesia) trainees should be aware that the anaesthetic component of their ACCS log book is expected to continue through and form a vital part of their anaesthesia training. For further guidance and facilities on downloading the electronic logbook, see the Royal College of Anaesthetists (ROCA) and Anaesthesia UK websites.
New Anaesthesia e-Learning Website:
www.e-LA.org.uk
There is now an e-learning website for trainees in Anaesthesia. The aims to deliver the first two years of the Anaesthesia curriculum (ST1/2) through a series of teaching sessions, accessible through a central website. The interactive lessons and self-assessment sessions will follow the academic block structure of the Anaesthesia curriculum and support the acquisition of knowledge and skills as trainees’ progress through the training program. The e-Learning resource will operate in synergy with existing resources to prepare trainees for the Primary Examination. It will record the learner’s progress through the curriculum, offer formative assessment/feedback and enhance their knowledge base and clinical skills ready for progression into more advanced training. The first phase of the project will be available on-line in the Autumn 2008 and you will be able to register using your RCoA registration details.
Non-Anaesthetic ACCS trainees can now register for access to the e-learning Anaesthesia website. You can register on the website: www.e-LA.org.uk and no charge is made for this. Non-Anaesthetic ACCS trainees may also apply for inclusion on the Voluntary Register of the RCoA. Benefits include receiving the British Journal of Anaesthesia, Continuing Education in Anaesthesia Critical Care and Pain (CEACCP) and the RCoA Bulletin. Further details and an application form can be obtained from Membership: tel: 020 7092 1701/1702; email subs@rcoa.ac.uk. An annual subscription of £60 is required.