The Welsh School of Anaesthesia Induction Handbook 2016 PDF
Preview The Welsh School of Anaesthesia Induction Handbook 2016
The Welsh School of Anaesthesia Induction Handbook 2016 Edition 1.2 Edition 1.2 Compiled and edited by Jason Walker and Mark Knights. Last updated 2 July 2016. Contains material previously included in the Core Trainee and Intermediate trainee induction handbooks. Copyright for all material is retained by the individual authors, unless otherwise stated. Illustration credits: Front cover: www.photodrome.co.uk Page 28, NHS Wales website. Used with permission. 2 Contents Introduction ................................................................................................................................................................................. 4 About this handbook ................................................................................................................................................................... 4 Preparing for Core Training ......................................................................................................................................................... 5 Preparing for Intermediate Training. ........................................................................................................................................... 8 The Role of Programme Director & The ARCP Process ............................................................................................................. 12 The roles of the College Tutor and Educational Supervisor ...................................................................................................... 18 Why do some trainees struggle, and how can they be helped? ................................................................................................ 20 Introduction to Cardiothoracic Training .................................................................................................................................... 23 Pain Medicine: Training Requirements in Wales ....................................................................................................................... 24 Transfer Medicine ...................................................................................................................................................................... 26 Other resources ......................................................................................................................................................................... 27 Appendix: Who’s who, and what’s what. .................................................................................................................................. 28 3 Introduction Congratulations on your appointment and a warm welcome to Wales and the Welsh School of Anaesthesia. The Welsh School of Anaesthesia is responsible for ensuring that your training meets the requirements of the curriculum of the Royal College of Anaesthetists, and for ensuring the quality of training across Wales. The School encompasses 12 hospitals distributed across North and South Wales and a wide variety of anaesthetic training opportunities are provided within the hospitals of the school. Training in Anaesthesia is highly structured with a strong emphasis on patient safety and trainee support. During the first 2 years trainees gain a thorough grounding in anaesthesia, acquiring the core basic competencies and the primary FRCA exam. The next 2 years training follows a fixed curriculum, encompassing experience in all the main sub-‐specialties such as paediatric anaesthesia, obstetric anaesthesia, neuro-‐anaesthesia, cardiac anaesthesia, intensive care and chronic pain. During these 2 years trainees pass their final FRCA exam. The final 3 years are more flexible allowing trainees to develop special interests, become involved in research, or spend time abroad. We hope you will enjoy your time in the Welsh School and that you will emerge with the competencies and confidence to further your career in Anaesthesia, and contribute in turn to the training of the next generation of anaesthetists. Training is about more than the acquisition of specific skills, however complex; it is also about developing the professional attitudes and behaviors required of all doctors. The commitment to which should remain with you throughout your career. Eluned Wright Head of School and Regional Educational Advisor June 2015 About this handbook The following articles were put together as a companion to the Welsh School of Anaesthesia Induction Study Day, both as an aide memoire for those who attend but also to be a source of information to those who don’t make it along on the day itself. We have not tried to reproduce the day in its entirety, but rather we have tried to identify those sections which we feel will be most useful to you. Each article is intended to be self contained; for this reason you may find that certain information has been repeated in a number of places. Corrections and suggestions should be sent to [email protected] 4 Preparing for Core Training Lucy Emmett Core Training STC Representative Keep logbook up to date throughout the year as this will How It All Works be reviewed at ARCP (make sure you also take a paper Core Training is 24 months long, of which 3 months will copy to the ARCP). be dedicated entirely to Intensive Care Medicine. Update CV regularly – you will need a copy of this at ACCS Anaesthesia is 36 months long, of which 18 your ARCP. months will be in Anaesthetics, 6 months Acute Medicine, 6 months Emergency Medicine and 6 months Fill in the GMC survey when it comes out in March – this Intensive Care. will again be required at ARCP. There are 8 BASIS units which form the Initial The Welsh School of Anaesthesia has checklists for Assessment of Competency (IAC), with 19 separate paperwork that are required at each ARCP – please assessments. These assessments must be signed off by make sure you follow them. consultants. Once achieved, the trainee can go onto the on-‐call rota. Specific information about each unit of training is available on the RCOA website (www.rcoa.ac.uk) There are then 15 BASIC units to get signed off over the and the Welsh School of Anaesthesia website course of the following 18-‐21 months. Each unit of (www.welshschool.co.uk) training requires at least 1 A-‐CEX, 1 CBD and 1 DOPS (plus 1 ALMAT for General, Gynae and Urology) along Exams with logbook and portfolio evidence (eg. transfer THE PRIMARY courses and pain days). • MCQ and OSCE/SOEs (Vivas) Full Primary Exam must be completed within the 2 • Have to have both parts for Basic Level of Training years, and must be passed at the time of application for Cert, and to apply for ST3 ST3 (January of the year you wish to apply). • RCOA run both parts 3 times a year • Can do MCQ in Cardiff (or wherever you like!) Must also have an Anaesthetic MSF each year – do this • OSCE/SOE in the College in London with a few months to spare as it can take a couple of months to sort out. MCQ Courses (The comments on the courses below are from previous For the MSF, there is no specific requirement for the Core Trainees) number of doctors, nurses, or ODPs etc but list is reviewed by your Educational Supervisor prior to Royal College of Anaesthetists Primary FRCA Masterclass submission, so make sure there’s a mix of people. • The Royal College of Anaesthetists – London, 4 days Intensive Care may also ask for an MSF. This is not the • 3 times per year, usually 2 months before the exam same as the anaesthetic one and a separate anaesthesia • Approx £310 MSF is required. • ‘By far the best’ • ‘Useful starting to mid-‐point’ Quarterly meetings (or more frequent if desired) with • ‘Excellent – well run with good lectures’ Educational Supervisor to review progress. Mersey School of Anaesthesia Educational Supervisor produces Educational Supervisor’s Structured Report at the end of the year • Whiston Hospital – Liverpool, 7 days and this is submitted with the College Tutor’s Report to • 3 times per year, usually 3 weeks before the exam the ARCP panel. You are responsible for generating the • Approx £400 ESSR. • ‘Brilliant experience, but some people didn’t get on with their groups’ 5 • ‘Very good if you get on with your group’ • ‘Brilliant’ • ‘Great for practising a huge volume of questions’ • ‘Reasonable course – very restrictive about own • ‘Better later on in revision’ course materials’ • ‘Brilliant – provided you are prepared to put the • ‘Relevant content’ work in!’ • ‘Self-‐directed learning’ • ‘Pricey’ Other popular courses include: Coventry Primary FRCA MCQ Course • South Coast/Bristol Intensive Primary • University Hospital – Coventry, 3 days • Leicester • 3 times per year, usually 3-‐4 weeks before the • Coventry exam • South West OSCE • Approx £260 Exam Tips and Tricks • ‘Really useful as they went through the answers and you got used to doing the questions to time’ • Decide about the exam – when is best for you • ‘Good course’ • Start in plenty of time • Buy (or borrow) all the old primary guides and do We are also very lucky in South Wales to have the the MCQs in the couple of days leading up to the ‘SWABS’ teaching taking place in different hospitals exam every couple of weeks. There are lots of opportunities • E-‐learning is great – use the lectures and do all the for learning and discussing questions with other trainees sets of MCQs several times and consultants. (www.philcoles.org.uk/swabs2) or • Most people seem to use a mixture of bookwork (www.swabs.me.uk) and question practice • Would definitely recommend the Masterclass Programmes available on the websites and will also be • Keep one eye on the OSCE/SOE emailed a couple of weeks in advance out via your • On exam day leave plenty of time for the SBAs – college tutors/head of exams in each department. they are worth a lot of marks too! • Get Viva’ed – LOTS Most Core Trainees find the first few SWABS sessions • Ask lots of different people – including consultants hard work and a lot of theory. This is to get you up to and other trainees the standard required for the FRCA. • Do full practice vivas (30 mins) Trainees in North Wales don’t miss out – a scheme • Don’t forget the OSCE – still lots to learn for it similar to SWABs runs in the three North Wales Books Hospitals MCQ Preparation OSCE/SOE Courses SWAC • Fundamentals of Anaesthesia (Pinnock et al.) • Training in Anaesthesia • Cardiff – 2 days • Primary FRCA in a Box • 3 times per year, 2 weeks before the exam • Oxford Handbook of Anaesthesia • £200 (£100 per day if only sitting OSCE or SOE) • A to Z of Anaesthesia and Intensive Care (Yentis) • 60% of Welsh trainees attended • Pharmacology for Anaesthesia and Intensive Care • ‘Very good – lots of viva practice’ (Peck and Hill) • ‘Would recommend to anyone – I passed both first • Drugs in Anaesthesia and Intensive Care (Smith) time and this was the only course I attended’ • Essentials of Anaesthetic Equipment (Al-‐Shaikh) • ‘Most useful’ • Basic Physics and Measurement (Davis et al.) • ‘Excellent value for money’ • Physics in Anaesthesia (Middleton) • West Respiratory Physiology Mersey School of Anaesthesia • Liverpool – OSCE weekend (2 days), Viva weekend (2 days) or OSCE/Orals course (7 days) • 3 times per year, varying timings pre-‐exam • 7 day course -‐ £600, weekends -‐ £250-‐£300 • 60% of Welsh trainees attended 6 OSCE/SOE Preparation Other things to consider • Try to get as much out of lists as possible – initially • Physics, Pharmacology and Physiology for IAC sign off and then consider DOPS/CBDS/A-‐CEX Anaesthetists – Key Concepts for the FRCA (Cross towards Basic Level Training Certificate. and Plunkett) • Keep logbook up to date – you’ll be grateful before • The OSCE in Anaesthesia your ARCP if you do! • Masterpass Viva Books • Think about IAC/ARCP early – get paperwork done • The Anaesthetic Viva in time. • Dr Podcast • Consider joining other professional bodies such as the AAGBI. Online Question Banks • Book Annual Leave and Study Leave with plenty of • FRCAQ time. • OnExamination • Don’t forget about Audit/Quality Improvement • PasTest projects. • Enjoy Anaesthetics!! Websites • Royal College of Anaesthetists www.rcoa.ac.uk • FRCA Headstart – www.frcaheadstart.org • E-‐learning Anaesthesia • Anaesthesia UK 7 Preparing for Intermediate Training. Jason Walker Having achieved all that was required of you in Core • Neuroanaesthesia, Neuroradiology and Neuro Training, it is a little bit daunting to have to start all over Intensive Care again at intermediate level. In what follows I’ll try to give • Paediatric Anaesthesia you some sort of idea of what is expected of you. For • Obstetric Anaesthesia this, I’m going to make some assumptions – if any of • Pain Management these don’t apply to you, have a chat with your • General Duties, which must include each of the Educational Supervisor or your Royal College Tutor. I’m following: assuming that: you’re registered with the College; you o Airway management keep a logbook; you are registered with the RCoA e-‐ o Day Surgery portfolio; and finally that you are familiar with o Critical incidents workplace-‐based assessments (WPBAs) – CEX, DOPS, o General Surgery / Gynaecology / Urology etc. (+/-‐ Transplantation) o ENT, MaxFax, Dental The rules o Regional Anaesthesia There are a number of documents which lay down what o Respiratory and Cardiac Arrest the various rules of engagement are, and you should be o Non theatre familiar with what’s in them. The first of these is the o Orthopaedic Anaesthesia Gold Guide, or to give it its full title, A Reference Guide o Sedation for Postgraduate Specialty Training in the UK.1 This o Transfer Medicine covers everything to do with training – how training o Trauma and Stabilisation posts are managed, how appointments are made, how progression is assessed, and so forth. Most trainees will The 3 essential non-‐clinical modules (Annex G) are never need to refer to any of it, but if you want to do Academic, Teaching and learning, and Management. anything unusual as part of your training, the Gold Guide contains the rules which must be adhered to. There are also 3 optional modules: Plastics/Burns, Ophthalmic Surgery, and Vascular. The next document you should be aware of is the Curriculum for a CCT in Anaesthetics.2 This is published Competency is assessed using logbook data in in a number of sections, of which Annex C covers conjunction with evidence from a range of assessment intermediate training. You should also be familiar with tools, which should be collated on the RCoA e-‐portfolio. Annex F (Intensive Care Medicine), and Annex G Each unit of training has a list of learning outcomes (Teaching and Training, Academic and Research, and (things you will learn), core learning outcomes (things Management). Of particular interest is the document you must learn, and provide evidence of, to be signed CCT in Anaesthetics: Assessment Guidance. This is a off for the unit of training) and knowledge and skills summary of all the assessments you need to undertake which will be expected of you. To be signed off you need to fulfil Annex C. appropriate logbook evidence and appropriate WPBAs to demonstrate that you have met the core learning The units of training outcomes. There are 18 units of training recognised by the Royal College of Anaesthetists for Intermediate Training It’s worth looking at one of the units in a little more during which competency will be assessed. There are 7 detail. Figure 2 (page 10) shows pages 25 and 26 from essential clinical units which must be completed, plus 3 Annex C. You’ll see that there is a short description of essential non-‐clinical units. the unit, the learning outcomes and then the core learning outcome. Then there follows a list of the Essential Clinical Modules: knowledge and skills that you will be required to achieve. You should achieve these, but you do not • Cardiacthoracic Anaesthesia and Cardiac Intensive necessarily have to be signed off on them – this list is Care there to guide your learning. If you can comfortably say • Intensive Care Medicine (Annex F) that you’re up to speed with everything that’s listed, you should be ready for the exam. If we now look to the Assessment Guidance Document doing a list and then asking to be signed off for (Figure 1), we’ll see that for the same unit it lists the something at the end of it. core learning outcomes and suggests possible evidence that you can use to demonstrate it. For this unit there is Changes in WPBAs a single outcome, and you can demonstrate it with a From August 2015 workplace-‐based assessments for CEX/ALMAT, or a CBD. (There is also the option for Specialty Trainees will change to being formative ‘other evidence,’ but in most cases you should have a assessments; they will no longer be marked as WPBA.) For each signoff, you should have three WPBAs, “satisfactory/unsatisfactory,” but will give you feedback and these should include evidence of core learning on how you performed. The unit signoff will in contrast outcomes. be summative – you will be marked as having achieved the unit or not. For more information see: It is important to plan your WPBAs: they are meant to https://www.rcoa.ac.uk/sites/default/files/WPBA-‐ be an assessment. Before a supervised list it is worth FLYER-‐2015.pdf getting into the habit of thinking about what you would like to achieve, and then discussing this with your The College does not prescribe a set number of cases supervisor. This gives a far more sensible approach than that you need to achieve for a unit to be signed off. This depends on the casemix, the unit of training and on you. Figure 1. The Assessment Guidance entry. 9 Figure 2. An example of a unit of training. 10
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