Stoke-on-Trent School of Anaesthesia. CCT in Anaesthetics. Intermediate Level Training (ST Years 3 and 4) Workplace Based Assessments.

Transcription

1 Stoke-on-Trent School of Anaesthesia CCT in Anaesthetics Intermediate Level Training (ST Years 3 and 4) Workplace Based Assessments

2 Contents: 1. Guidance for using this document 2. Indicative times 3. Essential Units of Training 4. Optional Units of Training 5. Appendix: Completion of Unit of Training Form, Intermediate Level Training Certificate, List Management Assessment form 2

3 Guidance for using this document 1. Intermediate level training is divided up into Essential and Optional Units of Training. This document sets out the Index Cases and Skills required for satisfactory completion of each Unit. 2. It is expected that for a Unit to be signed off as satisfactory then, as a minimum, one ACEX, one DOPS and one CBD should be completed unless otherwise stated. A list management assessment should be completed where indicated. In addition a supervising consultant should initial against the Core Clinical Learning Outcomes. 3. At the end of each Unit of Training a Completion of Unit of Training form should be signed by the Educational/Clinical Supervisor and the trainee. 4. Evidence in the form of a) a log book summary for that Unit and b) all completed Anaes CEX, DOPS and CBD forms should be presented to the Educational/Clinical Supervisor. 5. In addition a Multi Source Feedback form should be completed annually. Additional Points 1. The Intensive Care Training Summary covers the two three month training periods i.e ST 3/4 and ST 5-7 and should be completed in years 5-7. A Unit of Training Completion form also needs to be signed for each three month period. 2. Copies of all forms required i.e. Anaes CEX, DOPS, CBD, Extended CBD, MSF and Completion of Unit of Training are attached herewith. 3. It is essential that you attend a Difficult Airway and a Transfer Training course during years ST3 and 4. 3

4 Indicative Times Listed below are the suggested times allowed to complete training in each unit. A minimum of 20 half day clinical sessions need to be completed for neuro, cardiac, obstetrics, paediatrics and pain medicine. Time in Intensive Care Medicine must be three months. Unit of training Time in months Neuro 2 Cardiac 2 General Duties 9 Within this Unit: Day surgery General/urol/gynae ENT/Maxfax Trauma and orthopaedics Intensive Care Medicine 3 Obstetrics 2 Paediatrics 2 Pain medicine 2 4

5 Essential Units of Training. 1. Anaesthesia for neurosurgery, neuroradiology and neurocritical care 2. Cardiac/Thoracic 3. General duties Airway management Critical incidents Day surgery General, urological and gynaecological surgery ENT, maxillo-facial and dental surgery Management of respiratory and cardiac arrest Non-theatre Orthopaedic surgery Regional Sedation Transfer medicine Trauma and stabilisation 4. Intensive care medicine 5. Obstetrics 6. Paediatric 7. Pain medicine 5

6 Neuro Anaesthesia Core Clinical Learning Outcomes Deliver safe perioperative anaesthetic care to uncomplicated ASA 1-3 adult patients undergoing non-complex elective intracranial and spinal surgery with direct supervision Achieved Initial Deliver safe perioperative anaesthetic care to uncomplicated ASA 1-3 adult patients undergoing non-complex emergency surgery with distant (or indirect) supervision [e.g. insertion of V-P shunt/evd] Be an effective team member for resuscitation, stabilisation and transfer of adult patients with brain injury with distant supervision (this could also be completed during an ICM unit see ICM training summary) A minimum of 20 clinical sessions must be completed Index Cases: To be supported by Anaes CEX form Index case Craniotomy Index Skills: To be supported by DOPS form Index skill Induction of GA with TCI propofol Case Based Discussion: To be supported by CBD or Extended CBD form Emergency case with indirect supervision Spinal surgery e.g. lumbar microdiscectomy, cervical laminectomy, anterior cervical discectomy Shunt surgery e.g. insertion of VP shunt, revision of VP shunt, insertion of LP shunt 1CBD/extended CBD as a minimum (choose one of the above categories) 6

7 Cardiac and Thoracic Anaesthesia Core Clinical Learning Outcome Deliver safe and effective perioperative anaesthetic care to patients undergoing elective coronary artery surgery and minor thoracic investigative procedures under direct supervision Achieved Initial Lung resection under general anaesthesia (lobectomy or pneumonectomy) Bronchoscopy under general anaesthesia +/- therapeutic intervention Video assisted thoracoscopic surgery under general anaesthesia A minimum of 20 clinical sessions must be completed 1 Anaes CEX, 1 DOPS, 1 CBD and a logbook of 10 pump cases to be achieved for a satisfactory cardiac sign off Index Cases: To be supported by Anaes CEX form Index case Coronary artery and/or valve surgery on cardio-pulmonary bypass Index Skills: To be supported by DOPS form Index skill Establish anaesthesia including invasive arterial and central venous monitoring Insert a double lumen endo-bronchial tube Case Based Discussion: To be supported by CBD or Extended CBD form Case description Coronary artery and/or valve surgery on cardio-pulmonary bypass Date of assessment 7

8 General Duties 1. Airway management 2. Day surgery 3. Critical incidents 4. General, urology and gynaecology 5. ENT, maxillo-facial and dental surgery 6. Management of respiratory and cardiac arrest 7. Non-theatre 8. Orthopaedic surgery 9. Regional 10. Sedation 11. Transfer medicine 12. Trauma and stabilisation 8

9 Airway Management This may be completed as part of the ENT/Maxfax unit. Core Clinical Learning Outcome To be able to demonstrate the ability to perform elective fibreoptic intubation, either for an awake or an anaesthetised patient, with local supervision Achieved Initial Index Case: To be supported by Anaes CEX form Index case Management of case involving a difficult airway Index Skill: To be supported by DOPS form Index skill Fibreoptic intubation with patient asleep or awake Attendance at theoretical Airway Course eg BASDART Course Venue Date Completed 9

10 Critical Incidents Core Clinical Learning Outcomes To demonstrate leadership in the management of critical incidents as and when they arrive Achieved Initial To provide assistance/leadership to more inexperienced colleagues if called to assist in the management of critical incidents To demonstrate leadership in ensuring good team work and communication to help reduce the risks of harm from critical incidents These core learning outcomes can be achieved either with direct clinical experience or by attendance at a suitable simulator course. Index Case: To be supported by Anaes CEX form Index case Management of critical incident Case Based Discussion: To be supported by CBD or Extended CBD form Case description Date of assessment Attendance at Simulator course Course Venue Date Completed 10

11 Anaesthesia for Day Case Surgery Core Clinical Learning Outcomes Deliver safe perioperative anaesthetic care to ASA 1-3 patients having more extensive or specialized day surgery procedures with direct supervision Achieved Initial Index Cases: To be supported by Anaes CEX form Index case One of: Knee arthroscopy, excision of lymph node, excision of breast lump, inguinal hernia repair, varicose vein surgery Case Based Discussion: To be supported by CBD or Extended CBD form Case description Date of assessment This CBD must involve a patient with significant co-morbidities eg diabetes, obesity In addition a List Management Assessment Form should be completed 11

12 General surgery/gynaecology/urology Core Clinical Learning Outcomes Deliver safe perioperative anaesthetic care to complex ASA 1-3 adult patients requiring elective and emergency intra-abdominal surgery [both laparoscopic and open] with distant supervision Manage a list with complex ASA 1-3 adult patients for elective and emergency surgery in all disciplines with distant supervision Achieved Initial Index Cases: To be supported by Anaes CEX form Index case Anaesthesia for colo-rectal surgery Laparoscopic surgery Index Skills: To be supported by DOPS form Index skill Thoracic epidural Case Based Discussion: To be supported by CBD or Extended CBD form Case description Date of assessment In addition a List Management Assessment Form should be completed 12

13 ENT and Maxillo-facial Anaesthesia Core Clinical Learning Outcomes Deliver safe perioperative anaesthetic care to ASA 1-3 adult patients requiring routine and emergency non-complex minor/intermediate ENT and maxillo-facial surgery [including list management] under distant supervision Achieved Initial Index Cases: To be supported by Anaes CEX form a minimum of 2 assessments Index case Middle ear surgery inc. hypotensive techniques Microlaryngoscopy inc. use of LASER Dental extraction Management of fractured jaw Index Skills: To be supported by DOPS form a minimum of 2 assessments Index skill Manage the airway for laser surgery Manage the airway for laryngoscopy and micro-laryngeal surgery Manage induction of anaesthesia for and ENT emergency (bleeding tonsil, foreign body, stridor, abscess etc) Nasal intubation Case Based Discussion: To be supported by CBD or Extended CBD form Case description Date of assessment In addition a List Management Assessment Form must be completed Management of respiratory and cardiac arrest in adults and children Core Clinical Learning Outcome Is an effective member of the multi-disciplinary member of the resuscitation team and takes responsibility for the initial airway management Achieved Initial 13

14 In order for this unit to be signed off adult and paediatric life support courses must have been completed and be in date. Course Completion date ALS APLS/EPLS 14

15 Non Theatre Anaesthesia/sedation Core Clinical Learning Outcome To deliver safe peri-procedure anaesthesia/sedation to adult patients outside the operating theatre, but within a hospital setting, for painful or non-painful therapeutic/diagnostic procedures under supervision Achieved Initial Index case: To be supported by Anaes CEX form Index Case General anaesthesia for adult patient undergoing imaging procedure, ECT or cardioversion Date of Assessment 15

16 Orthopaedic Anaesthesia Core Clinical Learning Outcomes Deliver safe perioperative anaesthetic care to complicated ASA 1-3 adult patients for all elective and emergency orthopaedic/trauma surgery identified at the Basic Level as well as those requiring lower limb primary joint replacement surgery Manage elective and emergency operating sessions with such patients with distant supervision Achieved Initial Index Cases: To be supported by Anaes CEX form Index case Lower limb joint replacement Index Skills: To be supported by DOPS form Index skill Positioning of patient in lateral position Positioning of patient in deck chair position Case Based Discussion: To be supported by CBD or Extended CBD form Case description For example: Anaesthesia for a patient with Rheumatoid / Osteoarthritis Arthritis. Date of assessment In addition a List Management Assessment Form must be completed 16

17 Regional Anaesthesia Core Clinical Learning Outcomes Perform one each of the following blocks satisfactorily under local supervision: 1. Thoracic epidural and/or combined spinal/epidural 2. An upper/lower limb plexus block with peripheral nerve stimulation or ultrasound guidance Achieved Initial Index Cases: To be supported by Anaes CEX form Index case Management of a patient with regional blockade as sole form of anaesthesia. Index Skills: To be supported by DOPS form E = essential and must be completed in years 3 and 4 Index skill Brachial Plexus Block (E) Upper Limb Block ( elbow or wrist) Sciatic Nerve Block (E) Femoral Nerve Block (E) Lumbar Plexus Block Popliteal / Ankle Nerve Block Biers Block Epidural (E) Spinal (E) CSE Use of peripheral nerve stimulator Use of ultrasound Case Based Discussion: To be supported by CBD or Extended CBD form Case description For example: Management of a patient with regional blockade combined with a general anaesthetic. Date of assessment 17

18 Sedation Core Clinical Learning Outcomes To recognise the important principal of minimum intervention, where the simplest and safest technique which is likely to be effective is used to achieve the clinical goal Provision of safe and effective sedation to any adult patient using multiple drugs if required Achieved Initial Index Case: To be supported by Anaes CEX form Index case Use of sedation in an adult patient Case Based Discussion: To be supported by CBD or Extended CBD form Case description Date of assessment 18

19 Transfer Medicine Core Clinical Learning Outcomes To deliver safe and efficient transfer [with distant supervision] of: 1. Complex patients for intra-hospital including retrieving a newly referred ITU patient from A&E or the wards 2. An uncomplicated ventilated patient for inter-hospital transfer by land [Less than 4 hours] Achieved Initial Attendance at Transfer Training Course Course Location Date A log book of transfer cases must accompany this unit Index Case: To be supported by Anaes CEX form Index case Inter or intra hospital transfer of adult patient Case Based Discussion: To be supported by CBD or Extended CBD form Case description Date of assessment 19

20 Trauma Anaesthesia Core Clinical Learning Outcomes Be an effective member of the multi-disciplinary trauma team and takes responsibility for the initial airway management of the multiply injured patient with distant supervision Be able to manage acute life-threatening airway problems safely and effectively with distant supervision. (This can also be assessed in airway or ENT unit.) Provide safe perioperative anaesthetic care [from arrival in the Emergency Department through to post-operative discharge to the ward from recovery or intensive care] for ASA 1-3 patients with multiple injuries with distant supervision, whilst demonstrating understanding of knowing when to seek senior help Achieved Initial Index Cases: To be supported by Anaes CEX form Index case Anaesthesia for Fractured Neck of Femur Index Skills: To be supported by DOPS form Index skill Intubation with cervical spine immobilisation Review neck X rays for the integrity of the cervical spine Score the Glasgow Coma Scale and decide an appropriate level of care Insert a chest drain Case Based Discussion: To be supported by CBD or Extended CBD form Case description Date of assessment For example: Management of a multiply injured patient Attendance at ATLS or equivalent course Course name and location Date 20

21 Intensive Care Medicine Training Objectives At the completion of Intermediate level ICM training [i.e. after a total of nine months ICM training comprising three months Basic ICM [at CT 1/2] and six months ST training which should normally be completed in two three month blocks one in ST 3/4 and the other in ST 5/6] a trainee should: Recognise and manage the factors which may lead to deterioration in sick patients Be able to undertake post-resuscitation management and be able to manage the initial resuscitation of more complex specialist patients. Have an understanding of the pathology, clinical features and prognosis of the majority of problems presenting to ICU, and be able to initiate management of them, with distant supervision. Be able to appropriately request and interpret (in discussion with appropriate specialists) investigations such as CT, ultrasound, and microbiology. Be able to make a critical appraisal of the evidence for treatment and investigations. Appreciate that ICUs are complex systems which require management and leadership skills. Be able to lead a ward round, planning care for the next 24 hours. Please note: The term Anaes CEX is used in the Intensive Care Training Summary for simplicity. This is the same type of assessment as an ICEX i.e a clinical evaluation exercise. The management assessments set out should also be done using the CEX form. Intensive Care Medicine Training Summary ST Years 3 and 4 Date of training 21

22 Hospital Unit details Number of beds Casemix Number of supervised consultant sessions Number of on call sessions ST Years 5-7 Date of training Hospital Unit details Number of beds Casemix Number of supervised consultant sessions Number of on call sessions Intensive Care Medicine Training Summary Index Cases: To be supported by Anaes CEX form At least 6 completed in 6 months Index case Pneumonia Aortic aneurysm Major trauma/major burns 22

23 Non traumatic bowel perforation Acute MI Septic shock Acute renal failure Exacerbation of COPD Acute pancreatitis Head injury resuscitation, stabilisation and transfer. (This is essential for Neuro sign off in years 3/4) Obstetric ICU admission Brain stem death testing Index Skills: To be supported by DOPS form (E = essential) Index skill Safe establishment of mechanical ventilation E Fibreoptic bronchoscopy E Transthoracic pacing Management of renal replacement therapy Appropriate use of inotropes with appropriate cardiac output monitoring E Abdominal paracentesis Intensive Care Medicine Training Summary Case Based Discussion: To be supported by CBD form Year of training Case description ST3/4 ST5-7 Management Anaes CEX Date of assessment Leading daily ward round As a minimum one in years 3/4 and one in years 5-7 Discharge of patients from ICU Management of treatment withdrawal 23

24 Discussion with relatives Practical Procedures Undertaken Procedure ST3/4 total number ST5-7 total number Arterial line CVP line Internal Jugular Subclavian Femoral CVVH line NG tube Chest drain Percutaneous tracheostomy Pulmonary artery catheter Bronchoscopy Transvenous pacing Compliance with local infection control measures: Satisfactory/unsatisfactory Signature (senior nurse on ICU): Intensive Care Medicine Training Summary Name: Transfers Date of transfer Description of case An ACEX assessment of the transport of a ventilated, critically ill patient outside ICU must also be completed Date of assessment: ICM Syllabus 24

25 The following aspects of knowledge, skills, attitudes and behaviour should be achieved during the six months of ICM training. Self assessment (tick) Resuscitation and initial management of the acutely ill patient Triages and prioritises patients appropriately, including timely admission to ICU Assesses and provides initial management of the trauma patient Assesses and provides initial management of the patient with burns Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation Obtains a history and performs an accurate clinical examination Undertakes timely and appropriate investigations Performs electrocardiography [ECG / EKG] and interprets the results Obtains appropriate microbiological samples and interprets results Obtains and interprets the results from blood gas samples Interprets imaging studies Monitors and responds to trends in physiological variables Integrates clinical findings with laboratory investigations to form a differential diagnosis Disease Management Recognises life-threatening maternal peripartum complications and manages care under supervision Therapeutic interventions / Organ system support in single or multiple organ failure Initiates, manages and weans patients from renal replacement therapy Practical procedures Performs difficult and failed airway management according to local protocols Performs fibreoptic bronchoscopy and BAL in the intubated patient under supervision Performs transthoracic cardiac pacing describes transvenous Describes how to perform pericardiocentesis Manages the administration of analgesia via an epidural catheter Performs abdominal paracentesis Describes Sengstaken tube (or equivalent) placement Peri-operative care Manages the care of the patient following craniotomy under supervision Manages the pre- and post-operative care of the trauma patient under supervision Comfort and recovery Manages the safe and timely discharge of patients from the ICU End of life care Manages the process of withholding or withdrawing treatment with the multidisciplinary team Manages palliative care of the critically ill patient Performs brain-stem death testing Manages the physiological support of the organ donor Paediatric care Describes the recognition of the acutely ill child and initial management of paediatric emergencies Describes national legislation and guidelines relating to child protection and their relevance to critical care Transport 25

26 Undertakes transport of the mechanically ventilated critically ill patient outside the ICU Patient safety and health systems management Leads a daily multidisciplinary ward round Organises a case conference Professionalism Involves patients (or their surrogates if applicable) in decisions about care and treatment Demonstrates respect of cultural and religious beliefs and an awareness of their impact on decision making Supports clinical staff outside the ICU to enable the delivery of effective care Appropriately supervises Obstetric Anaesthesia Core Clinical Learning Outcomes Able to provide emergency and non-emergency obstetric anaesthetic care in the majority of patients including those with co-morbidities and obstetric complications with distant supervision Perform immediate resuscitation of acute obstetric emergencies Achieved Initial A minimum of 20 clinical sessions must be completed Index Cases: To be supported by Anaes CEX form Index case Management of a patient for elective caesarean section Management of a patient for emergency caesarean section Index Skills: To be supported by DOPS form Index skill Epidural Analgesia for labour Spinal Anaesthetic CSE (optional) Case Based Discussion: To be supported by CBD or Extended CBD form Case description Management of parturient with post partum haemorrhage Management of parturient with hypertensive disease of pregnancy Management of parturient with BMI above 35 Management of parturient with 26

27 inadvertent dural puncture To do at least 1 CBD/ extended CBD The list above is a guide to possible suitable cases 27

28 Paediatric Anaesthesia Core Clinical Learning Outcomes Deliver safe perioperative anaesthetic care to ASA 1 and 2 children aged 5 years and over for minor elective and emergency surgery (e.g. inguinal hernia repair, orchidopexy, circumcision, superficial plastic surgery, grommets, manipulation of fractures, appendicectomy) with distant supervision Achieved Initial A minimum of 20 clinical sessions must be completed Index Cases: To be supported by Anaes CEX form One of: Index case Inguinal hernia/ppv ligation/orchidopexy/circumcision/ hypospadias repair Tonsillectomy/adenotonsillectomy Squint repair Index Skills: To be supported by DOPS form A minimum of 2 need to be completed Index skill Gas induction IV cannulation of the infant/child Use of T-piece and mask to maintain spontaneous ventilation/assisted ventilation Intubation in child Case Based Discussion: To be supported by CBD or Extended CBD form Case description Date of assessment 28

29 Pain Medicine Wherever possible this unit should be completed as a dedicated block Core Clinical Learning Outcomes To be competent in the assessment and management of acute surgical and non-surgical pain in most patient groups and circumstances To be an effective member of the acute pain team Achieved Initial To understand the importance of managing acute on chronic pain in a timely manner To have knowledge of assessment and management of chronic and cancer pain Index Cases: To be supported by Anaes CEX form Index case Taking history from chronic pain patient Management of acute pain round (observed this may be by pain nurse) Index Skills: To be supported by DOPS form Index skill Facet joint injection Chronic pain epidural Post-op pain relief procedure eg PCA set up Case Based Discussion: To be supported by CBD or Extended CBD form Case description Date of assessment Examples include: treatment for neuropathic pain, difficult post-operative pain case. Pain Medicine cont d Number of chronic pain clinics attended Number of chronic pain procedure lists attended Number of acute pain ward rounds attended 29

30 A minimum of 20 clinical sessions must be completed 30

31 Optional Units of Training 1. Ophthalmic anaesthesia 2. Plastics/burns 3. Vascular 31

32 Ophthalmic Anaesthesia Core Clinical Learning Outcomes Deliver safe perioperative anaesthetic care to adults and children requiring routine ophthalmic surgery under direct supervision, and emergency anaesthesia for ASA 1 and 2 patients requiring minor/ intermediate ophthalmic surgery under distant supervision Demonstrates the ability to provide local anaesthesia for eye surgery with competence in one technique Achieved Initial Index Cases: To be supported by Anaes CEX form Index case Cataract surgery under local anaesthesia Eye surgery under general anaesthesia Index Skills: To be supported by DOPS form Index skill Sub-Tenon block (essential) Peribulbar block Case Based Discussion: To be supported by CBD or Extended CBD form Case description Date of assessment 32

33 Burns and Plastics Anaesthesia Core Clinical Learning Outcomes Delivers safe perioperative anaesthetic care to ASA 1-3 adult patients for minor to intermediate plastic surgery [e.g. tendon repair or split skin grafting] with distant supervision Achieved Initial Index Cases: To be supported by Anaes CEX form One of: Index case Excision & Grafting of major burn (>15% BSA in one session) SSG to burn Anaesthesia for facial/airway burn Major free-flap repair e. g. DI-EPP flap breast reconstruction Rotational flap Breast Augmentation Abdominoplasty Index Skills: To be supported by DOPS form Index skill Fluid therapy of the burned patient Case Based Discussion: To be supported by CBD or Extended CBD form Case description For example: Airway management of facial burn Date of assessment A List Management Assessment form should accompany this unit Vascular Anaesthesia Core Clinical Learning Outcomes To gain knowledge of the perioperative anaesthetic management of patients undergoing elective and emergency abdominal aortic surgery and newer stenting techniques Achieved Initial 33

34 Index Cases: To be supported by Anaes CEX form One of: Index case Abdominal aortic aneurysm, elective or emergency open repair EVAR Index Skills: To be supported by DOPS form (not essential for vascular sign off) Index skill CVP line insertion A-line insertion Thoracic epidural Use of cell saver Case Based Discussion: To be supported by CBD or Extended CBD form Case description Date of assessment Must include either carotid endarterectomy or peripheral vascular graft 34

35 Appendix 1. RCoA Unit of Training Completion Form 2. Intermediate Level Training Certificate 3. List Management Assessment form 35

36 The Royal College of Anaesthetists Completion of Unit of Training Trainee: GMC number College Reference Number Unit of Training: Assessments Has the trainee completed successfully an appropriate number of WPBA? Yes No Log book Review Is the case mix, complexity and numbers appropriate for the level of training? Yes No Multi- source Feedback Has a MSF been satisfactorily completed? (Only for units of training requiring MSF) Yes No Minimum clinical learning outcomes Has the trainee demonstrated achievement of the minimum clinical learning outcomes? Yes No Comments Signed: Name (Print): Date: (Clinical Supervisor, Educational Supervisor or College Tutor) Signed: Name (Print): Date: (Trainee)

37 The Royal College of Anaesthetists Intermediate Level Training Certificate This is to certify that: GMC number College Reference Number has completed (subject to any units exceptionally deferred to ST year 5) the full intermediate level competency based programme of training in anaesthesia; has satisfactorily passed the workplace assessments and demonstrated the minimum clinical learning outcomes as defined in Annex C to the CCT in Anaesthetics; and passed the FRCA Final Examination 1 on / (month/year) He/she has thereby successfully completed intermediate level training (subject to the units listed overleaf that have been exceptionally deferred to ST year 5) and can therefore commence higher level training from: / / (day/month/year). Signed: Name (Print): Date: (Regional or Deputy Regional Adviser in Anaesthesia) Signed: Name (Print): Date: (College Tutor or other designated trainer) 2 The Regional or Deputy Regional Adviser and one other designated trainer must sign this certificate 2 Hospital or department date stamp 1 The CARCSI Final Examination is an accepted examination 2 Other designated trainer must be a consultant anaesthetist The original of this certificate should be kept by the trainee with copies held by the School of Anaesthesia and/or hospital. A copy should also be sent to the Training Department at the Royal College of Anaesthetists in order to confirm the completion date of intermediate training.

38 Record of intermediate level units of training Unit of training Anaesthesia for neurosurgery, neuroradiology and neurocritical care Cardiac/Thoracic Completion date Essential units Competent Signed/dated Intensive care medicine Obstetrics Paediatric Pain medicine General duties Airway management Critical incidents Day surgery General, urological and gynaecological surgery Head, neck, maxillo- facial and dental surgery Management of respiratory and cardiac arrest Non- theatre Orthopaedic surgery Regional Sedation Transfer medicine Trauma and stabilisation Optional units Ophthalmic Plastics/burns Vascular surgery

39 Higher level units brought forward to ST year 4 3 Unit of training Completion date Competent Signed/dated Intermediate level units deferred to ST year 5 4 Unit of training Deferral Approval Number 5 Completion date Competent Signed/dated 3, 4 Prospective approval required from the RCoA Medical Secretary 5 Approval number issued by the College This section to be signed when the deferred units of training have been completed. The completed certificate should be kept by the trainee and copies of this page sent to the trainee s School of Anaesthesia and/or hospital. A copy should also be sent to the Training Department at the Royal College of Anaesthetists in order to confirm completion of all the essential units of training. Signed: Name (Print): Date: (Regional or Deputy Regional Adviser in Anaesthesia) Signed: Name (Print): Date: (College Tutor or other designated trainer) 5 5 Other designated trainer must be a consultant anaesthetist

40 List Management Assessment Form Trainee Name: Date of Assessment: Surgical specialty: Pre-operative assessment Satisfactory Unsatisfactory Comments Management of bed issues, sending, communication with theatre staff Preparation for case: equipment, drug checks Pre-operative checks: WHO guidelines followed Conduct of anaesthesia; situational awareness, vigilance Management of patient turnaround Communication and management in recovery Overall efficiency and time management General comments Consultant Trainer Signature: Trainee signature: 40