Rcoa Syllabus 71l3c

Annex B

CCT in Anaesthetics

Annex B – Basic Level Training

Edition 2 August 2010 Version 1.6

The Royal College of Anaesthetists

Table of Contents Glossary of Assessment method decode Good Medical Practice decode

5 7 7

The basis of anaesthetic practice Preoperative assessment a) History taking b) Clinical examination c) Specific anaesthetic evaluation Premedication Induction of general anaesthesia Intra-operative care Postoperative and recovery room care Introduction to anaesthesia for emergency surgery Management of respiratory and cardiac arrest Control of infection

8 8 9 9 10 14 16 20 22 25 27 32

Basic anaesthesia Airway management Critical incidents Day surgery General, urological and gynaecological surgery (incorporating peri-operative care of the elderly) Head, neck, maxillo-facial and dental surgery Intensive care medicine (See Annex F) Non-theatre Obstetrics Orthopaedic surgery (incorporating peri-operative care of the elderly) Paediatrics Child protection Pain medicine Regional Sedation Transfer medicine Trauma and stabilisation

34 35 39 43 45 48

Basic sciences to underpin anaesthetic practice Anatomy Pharmacology Physiology and biochemistry Physics and clinical measurement

76 79 78 83 88 B-2

50 52 55 57 59 61 63 68 71 73

Statistical methods

93

Assessments for the Initial Assessment of Competence

94

Assessments for the Initial Assessment of Competence in Obstetric Anaesthesia

95

Blueprint of the Primary FRCA examination mapped against basic level units of training

96

Blueprint of the Primary FRCA examination mapped against professionalism of medical practice (Annex A)

97

Blueprint of workplace based assessments against the basic level units of training

98

B-3

Intentionally blank

B-4

Glossary of

ALI ALS APLS ARDS ASA ASD BE BIS BP BMI BNF CFAM CFM CO2 EX CSE CSF CSM CT CVP ECG EEG EMG ENT EPLS ERPC GCS GMC Hb IAC IDD IPPV IRMER IT IVRA LiDCOTM MAC MH MRI NAI

Acute Lung Injury Advanced Life Advanced Paediatric Life Acute Respiratory Distress Syndrome American Society of Anesthesiologists Atrial septal defect Base excess Bispectral index Blood pressure Body mass index British national formulary Cerebral function analysis monitor Cerebral function monitor Carbon dioxide Cardiopulmonary exercise testing Combined Spinal Epidural Cerebro spinal fluid Committee on Safety of Medicines Computerised tomograms Central venous pressure Electrocardiogram Electroeucephalogram Electromyogram Ear, Nose and Throat European Paediatric Life Evacuation of Retained Products of Conception Glasgow Coma Score General Medical Council Haemoglobin Initial assessment of competence Intrathecal drug delivery Intermittent positive pressure ventilation Ionisation Radiation (Medical Exposure) Regulations Information technology Intravenous Regional Anaesthesia Lithium indicator dilution cardiac output Minimum alveolar concentration Malignant hyperpyrexia Magnetic resonance imaging Non-accidental Injury B-5

NCEPOD NICE NO NSAID PCA PEA PFO PONV PSI Ref RS RSI SpO2 SVP TCI VSD WCC

National Confidential Enquiry into Perioperative Deaths National Institute for Health and Clinical Excellence Nitric oxide Non-steroid anti-inflammatory drug Patient Controlled Analgesia Pulseless Electrical Activity Patent foramen ovale Postoperative nausea and vomiting Pounds per square inch Reference Respiratory system Rapid sequence induction Saturation of haemoglobin with oxygen Saturated vapour pressure Target Controlled Infusions Ventricular septal defect White cell count

B-6

Assessment method decode A

Anaesthesia Clinical Evaluation Exercise [A-CEX]

C

Case Based Discussion [CBD]

D

Direct Observation of Procedural Skills [DOPS]

E

Examination

I

Intensive Care Medicine Clinical Evaluation Exercise [I-CEX]

L

Anaesthesia List Management Assessment Tool [ALMAT]

M

Multi-source [MSF]

S

Simulation

T

Acute Care Assessment Tool [ACAT]

Good Medical Practice decode 1

Knowledge, skills and performance

2

Safety and quality

3

Communication, partnership and teamwork

4

Maintaining trust

B-7

The basis of anaesthetic practice – the start of training [3-6 months] This provides a comprehensive introduction to the principles and practices of the delivery of safe and effective anaesthetic care to patients for trainees new to the specialty. The following units of training must be completed satisfactorily:        

Preoperative assessment Premedication Induction of general anaesthesia Intra-operative care Postoperative and recovery room care Management of respiratory and cardiac arrest Control of infection Introduction to anaesthesia for emergency surgery

The fundamental importance of the need for trainees to develop [and demonstrate] safe clinical practice [including a basic understanding of basic sciences underpinning practice] means that trainees are expected to have achieved all the minimum clinical learning outcomes detailed in this section and obtained the IAC before progressing to the remainder of BLT. Many years of experience indicate that, in practice, this will take between three and six months for most trainees.

Preoperative assessment Core clinical learning outcomes:  Is able to perform a structured preoperative anaesthetic assessment of a patient prior to surgery and recognise when further assessment/optimisation is required prior to commencing anaesthesia/surgery  To be able to explain options and risks of routine anaesthesia to patients, in a way they understand, and obtain their consent for anaesthesia

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Primary examination identified in the FRCA examination blueprint on page B-99 or in the Final examination identified in the Final FRCA blueprint on page C72 of Annex C.

B-8

A)

History Taking

This training will:  Develop the ability to elicit a relevant structured history from patients  Ensure the history obtained is recorded accurately  Ensure the history is synthesised with the relevant clinical examination

Knowledge Competence

Description

Assessment Methods

GMP

HT_BK_01

Recognises the importance of different elements of history

A,C,E

1

HT_BK_02

Recognises that patients do not always present history in a structured fashion

A,C,E

1

HT_BK_03

Knows the likely causes and risk factors for conditions relevant to mode of presentation

A,C,E

1

HT_BK_04

Recognises that the patient’s agenda and the history should inform examination, investigation and management

A,C,E

1

Assessment Method

GMP

Skills Competence

Description

HT_BS_01

Identifies and overcomes possible barriers to effective communication

A,D

3,4

HT_BS_02

Manages time and draws consultation to a close appropriately Recognises that effective history taking in non-urgent cases may require several discussions with the patient and other parties, over time

A,D

1,3

A,C

1

HT_BS_04

Supplements history with standardised instruments or questionnaires when relevant

A,C

3

HT_BS_05

Manages alternative and conflicting views from family, carers, friends and of the multi-professional team

C,M

3,4

HT_BS_06

Assimilates history from the available information from the patient and other sources including of the multiprofessional team

A,C,M

1,3

HT_BS_07

Recognises and interprets appropriately the use of non verbal communication from patients and carers

A,D

3,4

HT_BS_08

Focuses on relevant aspects of history and maintains focus despite multiple and often conflicting agendas

A,D

1

HT_BS_03

B)

Clinical Examination

This training will enable the learner to:

B-9





Develop the ability to perform focused, relevant and accurate clinical examination in patients with increasingly complex issues and in increasingly challenging circumstances Develop the ability to relate physical findings to history in order to establish diagnosis[es] and formulate management plan[s]


Description

Assessment Methods

GMP

CE_BK_01

Understands the need for a targeted and relevant clinical examination

A,C,E

1

CE_BK_02

Understands the basis for clinical signs and the relevance of positive and negative physical signs

A,C,E

1

CE_BK_03

Recognises constraints to performing physical examination and strategies that may be used to overcome them

A,C

1

CE_BK_04

Recognises the limitations of physical examination and the need for adjunctive forms of assessment to confirm diagnosis

A,C

1

CE_BK_05

Recognises when the offer/ use of a chaperone is appropriate or required

A,C

3,4

Assessment Methods

GMP

A,D

1

A,C,D

2,4

D

1

A,D

1

Skills Competence

Description

CE_BS_01

Performs an examination relevant to the presentation and risk factors that is valid, targeted and time efficient

CE_BS_02

Recognises the possibility of deliberate harm [both self harm and harm by others] in vulnerable patients and report to appropriate agencies

CE_BS_03

Actively elicits important clinical findings

CE_BS_04

Performs relevant adjunctive examinations

c) Specific Anaesthetic Evaluation This training will:  Develop the ability to establish a problem list  Develop the ability to judge whether the patient is fit for and optimally prepared for the proposed intervention  Develop the ability to plan anaesthesia and postoperative care for common surgical procedures  Develop the ability to recognise the trainees limitations and reliably determine the level of supervision they will need  Ensure trainees can explain options and risks of routine anaesthesia to patients, in a way they understand, and obtain their consent for anaesthesia

B-10


Description

Assessment Methods

GMP

A,C,E

1,2

OA_BK_02

Knows the methods of anaesthesia that are suitable for common operations in the surgical specialties for which they have anaesthetised. Typical experience at this early stage of training will be in:  General surgery  Gynaecology  Urology  Orthopaedic surgery  ENT  Dental Describes the ASA and NCEPOD classifications and their implications in preparing for and planning anaesthesia

A,C,E

1

OA_BK_03

Explains the indications for and interpretation of preoperative investigations

A,C,E

1

OA_BK_04

Lists the indications for preoperative fasting and understand appropriate regimens

A,C,E

1

OA_BK_05

Explains the methods commonly used for assessing the airway to predict difficulty with tracheal intubation

A,C,E

1,2

OA_BK_06

Discusses the indications for RSI

A,C,D,E

1,2

A,C,E

1

A,C,E

1

OA_BK_01

OA_BK_07 OA_BK_08

Gives examples of how common co-existing diseases affect anaesthesia and surgery including but not exclusively: obesity; diabetes; asthma; ischaemic heart disease; hypertension and rheumatoid disease; epilepsy Discusses how to manage drug therapy for co-existing disease in the perioperative period including, but not exclusively: obesity; diabetic treatment; steroids; anti-coagulants; cardiovascular medication; epilepsy

OA_BK_09

Explains the available methods to minimise the risk of thrombo-embolic disease following surgery

A,C,E

1,2

OA_BK_10

Knows about the complications of anaesthetic drugs [including anaphylaxis, suxamethonium apnoea and malignant hyperpyrexia] and how to predict patients who are at increased risk of these complications

A,C,E

1,2

OA_BK_11

Identifies the principles of consent for surgery and anaesthesia, including the issue of competence

A,C,E

3,4

A,C,E

3,4

Explains the guidance given by the GMC on consent, in particular: OA_BK_12

 Understands that consent is a process that may culminate in, but is not limited to, the completion of a consent form  Understands the particular importance of considering the patient's level of understanding and mental state [and also that of the parents, relatives or carers when appropriate] and how this may impair their capacity for consent

OA_BK_13

Summarises the factors determining a patient’s suitability for treatment as an ambulant or day-stay patient

A,C,E

1

OA_BK_14

Recalls/lists the factors that affect the risk of a patient suffering PONV

A,C,E

1

B-11

Skills Assessment Method

GMP

OA_BS_01

Demonstrates satisfactory proficiency in obtaining a history specifically relevant to the planned anaesthesia and surgery including:  A history of the presenting complaint for surgery  A systematic comprehensive relevant medical history  Information about current and past medication  Drug allergy and intolerance  Information about previous anaesthetics and relevant family history

A,D,E

1

OA_BS_02

Demonstrates satisfactory proficiency in performing a relevant clinical examination including when appropriate:  Cardiovascular system  Respiratory system  Central and peripheral nervous system: GCS, peripheral deficit  Musculoskeletal system: patient positioning, neck stability/movement, anatomy for regional blockade  Other: nutrition, anaemia, jaundice  Airway assessment/dentition

A,D,E

1

OA_BS_03

Demonstrates understanding of clinical data including, but not exclusively:  Patient clinical case notes and associated records  Clinical parameters such as: o BP, Pulse, CVP o BMI  Fluid balance  Physiological investigations such as: o ECGs o Echocardiography and stress testing o Pulmonary function tests

A,C,E

1

OA_BS_04

Demonstrates understanding of clinical laboratory data including:  Haematology such as o Routine report of Hb, WBC, haematocrit etc  Biochemistry such as o Arterial blood gases/acid-base balance

A,C,E

1

Competence

Description

B-12

o Urea and electrolytes o Liver function o Thyroid function

OA_BS_05

Identifies normal appearances and significant abnormalities in radiographs including:  Chest X-rays  Trauma films – cervical spine, chest, pelvis, long bones  Head CT and MRI showing clear abnormalities

A,C,E

1

OA_BS_06

Makes appropriate plans for surgery:  Manages co-existing medicines in the perioperative period  Plans an appropriate anaesthetic technique[s]  Secures consent for anaesthesia  Recognises the need for additional work-ups and acts accordingly  Discusses issues of concern with relevant of the team  Reliably predicts the level of supervision they will require

A,C,E

1

OA_BS_07

Presents all information to patients [and carers] in a format they understand, checking understanding and allowing time for reflection on the decision to give consent

A,M

3,4

OA_BS_08

Provides a balanced view of all care options

A,C,E,M

2,3

B-13

Premedication Note: This forms part of the comprehensive pre-assessment of patients. Assessment is best included as part of the overall assessment of this process. Learning outcomes:  Understands the issues of preoperative anxiety and the ways to alleviate it  Understands that the majority of patients do not require pre-medication  Understands the use of preoperative medications in connection with anaesthesia and surgery Core clinical learning outcome:  Is able to prescribe premedication as and when indicated, especially for the high risk population



Description

Assessment Methods

GMP

PD_BK_01

Summarises the value of appropriate explanations and reassurance in alleviating the patients anxiety

A,C,E

1,3

PD_BK_02

Lists basic indications for prescription of pre-medicant drugs

A,C,E

1

PD_BK_03

Explains how to select appropriate sedative or anxiolytic agents

A,C,E

1

PD_BK_04

A,C,E

1

A,C,D,E

1,2

A,C,E

2

PD_BK_07

Discusses the applied pharmacology of these drugs Recalls/lists the factors that influence the risk of patients at increased risk of gastric reflux/aspiration and understands strategies to reduce it Recalls/describes the applied pharmacology of pro-kinetic and antacids including simple alkalis, H2 and Proton Pump antagonists Identifies local/national guidelines on management of thrombo-embolic risk and how to apply them

A,C,E

1,2

PD_BK_08

Explains the principles and practice of using prophylactic antibiotics

A,C,E

1

PD_BK_05 PD_BK_06

Skills B-14

Competence

Description

Assessment Method

GMP

PD_BS_01

Selects and prescribes appropriate agents to reduce the risk of regurgitation and aspiration, in timeframe available

A,C,D,E

1,2

PD_BS_02

Explains, in a way the patient understands, the benefits and possible risks of sedative premedication

A,E,M

3,4

PD_BS_03

Selects and prescribes appropriate anxiolytic/sedative premedication when indicated

A,C,E

1

B-15

Induction of general anaesthesia The use of simulators may assist in the teaching and assessment of some aspects of this section e.g. failed intubation drill Learning outcomes:  The ability to conduct safe induction of anaesthesia in ASA grade 1-2 patients confidently  The ability to recognise and treat immediate complications of induction, including tracheal tube misplacement and adverse drug reactions  The ability to manage the effects of common co-morbidities on the induction process Core clinical learning outcomes:  Demonstrates correct pre-anaesthetic check of all equipment required ensuring its safe functioning [including the anaesthetic machine/ventilator in both the anaesthetic room and theatre if necessary]  Demonstrates safe induction of anaesthesia, using preoperative knowledge of individual patients co-morbidity to influence appropriate induction technique; shows awareness of the potential complications of process and how to identify and manage them



IG_BK_01

IG_BK_02

Description

In respect of the drugs used for the induction of anaesthesia:  Recalls/summarises the pharmacology and pharmacokinetics, including doses, interactions and significant side effects of: o Induction agents o Muscle relaxants o Analgesics o Inhalational agents including side effects, interactions and doses  Identifies about the factors that contribute to drug errors in anaesthesia and the systems to reduce them In respect of the equipment in the operating environment:  Describes the basic function of monitors and knows what monitoring is appropriate for induction including consensus minimum monitoring standards and the indications for additional monitoring  Explains the function of the anaesthetic machine including

B-16

Assessment Methods

GMP

A,C,D,E

1

A,C,D,E

1,2


IG_BK_03

IG_BK_04

IG_BK_05

Description

o The basic functions of gas flow o Pre-use checking of the anaesthetic machine o The structural features of the anaesthetic machine that minimise errors o The operation of the anaesthetic ventilator o The function of the anaesthetic vapourisers o The operation of any monitoring equipment that is integral with the anaesthetic machine o Knows how to replenish anaesthetic vapouriser In respect of the induction of anaesthesia:  Describes the effect of pre-oxygenation and knows the correct technique for its use  Explains the techniques of intravenous and inhalational induction and understands the advantages and disadvantages of both techniques  Knows about the common intravenous induction agents and their pharmacology  Knows the physiological effects of intravenous induction including the differences between agents  Recalls/explains how to recognise the intra-arterial injection of a harmful substance and its appropriate management  Describes the features of anaphylactic reactions and understands the appropriate management including follow up and patient information  Knows the factors influencing the choice between agents for inhalational induction of anaesthesia  Discusses the additional hazards associated with induction of anaesthesia in unusual places [e.g. Emergency Room] and in special circumstances including but not exclusively: brain injury; full stomach; sepsis; upper airway obstruction  Identifies the special problems of induction associated with cardiac disease, respiratory disease, musculoskeletal disease, obesity and those at risk of regurgitation/pulmonary aspiration. Describes the principles of management of the airway including:  Techniques to keep the airway open and the use of facemasks, oral and nasopharyngeal airways and laryngeal mask airways In respect of tracheal intubation:  Lists its indications  Lists the available types of tracheal tube and identifies their applications  Explains how to choose the correct size and length of tracheal tube  Explains the advantages/disadvantages of different types of laryngoscopes and blades including, but not exclusively, the Macintosh and McCoy  Outlines how to confirm correct placement of an tracheal tube and knows how to identify the complications of

B-17

Assessment Methods

GMP

A,C,D,E

1,2

A,C,D,E

1,2

A,C,D,E

1,2


IG_BK_06

Description

intubation including endobronchial and oesophageal intubation  Discusses the methods available to manage difficult intubation and failed intubation  Explains how to identify patients who are at increased risk of regurgitation and pulmonary aspiration and knows the measures that minimise the risk  Categorises the signs of pulmonary aspiration and the methods for its emergency management Explains the importance of maintaining the principles of aseptic practice and minimising the risks of hospital acquired infection

Assessment Methods

GMP

A,C,D,E

2

Assessment Methods

GMP

Skills Competence

Description

IG_BS_01

Demonstrates safe practice in checking the patient in the anaesthetic room

A,D

1,2

IG_BS_02

Demonstrates appropriate checking of equipment prior to induction, including equipment for emergency use

A,D

1,2

D

1,2

A,D

1,2,3

D

1

A,D

1

A,D

1,2,3

A,D

1,2,3

IG_BK_03

IG_BS_04

In respect of the equipment in the operating environment:  Demonstrates understanding of the function of the anaesthetic machine including o Performing proper pre-use checks o Changing/checking the breathing system o Replenishing the vapouriser o Changing the vapouriser Demonstrates safe practice in selecting, checking, drawing up, diluting, labelling and istering of drugs

IG_BS_07

In respect of intravenous cannulation:  Obtains intravascular access using appropriate size cannulae in appropriate anatomical location  Demonstrates rigorous aseptic technique when inserting a cannula In respect of monitoring:  Demonstrates appropriate placement of monitoring, including ECG electrodes and NIBP cuff  Manages monitors appropriately e.g. set alarms; start automatic blood pressure  Demonstrates proficiency in the Interpretation of monitors Demonstrates effective pre-oxygenation, including correct use of the mask, head position and clear explanation to the patient

IG_BS_08

In respect of intravenous induction:

IG_BS_05

IG_BS_06

B-18

Skills Competence

Description

IG_BS_11

 Makes necessary explanations to the patient  Demonstrates satisfactory practice in preparing drugs for the induction of anaesthesia  Demonstrates proper technique in injecting drugs at induction of anaesthesia  Manages the cardiovascular and respiratory changes associated with induction of general anaesthesia In respect of inhalational induction of anaesthesia:  Satisfactorily communicates with the patient during induction  Satisfactorily conducts induction In respect of airway management:  Demonstrates optimal patient position for airway management  Manages airway with mask and oral/nasopharyngeal airways  Demonstrates hand ventilation with bag and mask  Able to insert and confirm placement of a Laryngeal Mask Airway  Demonstrates correct head positioning, direct laryngoscopy and successful nasal/oral intubation techniques and confirms correct tracheal tube placement  Demonstrates proper use of bougies  Demonstrates correct securing and protection of LMAs/tracheal tubes during movement, positioning and transfer  Correctly conducts RSI sequence  Correctly demonstrates the technique of cricoid pressure Demonstrates correct use of oropharyngeal, laryngeal and tracheal suctioning

IG_BS_12

Demonstrates failed intubation drill

IG_BS_09

IG_BS_10

B-19

Assessment Methods

GMP

A,D

1,2,3

A,D

1,2,3

A,D

1,2

D,S

1,2

Intra-operative care Learning outcomes:  The ability to maintain anaesthesia for surgery  The ability to use the anaesthesia monitoring systems to guide the progress of the patient and ensure safety  Understanding the importance of taking of the effects that co-existing diseases and planned surgery may have on the progress of anaesthesia  Recognise the importance of working as a member of the theatre team Core clinical learning outcome:  Demonstrates safe maintenance of anaesthesia and shows awareness of the potential complications and how to identify and manage them


Skills Competence

Description

Assessment Method

GMP

A,D

1,2,3

A,D

1

IO_BS_02

Demonstrates how to direct the team to safely transfer the patient and position of patient on the operating table and is aware of the potential hazards including, but not exclusively, nerve injury, pressure points, ophthalmic injuries Manages the intra-operative progress of spontaneously breathing and ventilated patients

IO_BS_03

Demonstrates the ability to maintain anaesthesia with a face mask in the spontaneously breathing patient

A,D

1,2

IO_BS_04

Demonstrates the use of a nerve stimulator to assess the level of neuromuscular blockade

A,D

1

IO_BS_05

Manages the sedated patient for surgery

A,D

1,3

IO_BS_06

Maintains accurate, detailed, legible anaesthetic records and relevant documentation

A,C

1

IO_BS_07

Demonstrates role as team player and when appropriate leader in the intra-operative environment

A,D,M

2,3

IO_BS_08

Communicates with the theatre team in a clear unambiguous style Able to respond in a timely and appropriate manner to events that may affect the safety of patients [e.g. hypotension, massive haemorrhage] [S] Manages common co-existing medical problems [with appropriate supervision] including but not exclusively:  Diabetes  Hypertension

A,D,M

3

A,C,D,E,M,S

1,2

A,C,D

1,2

IO_BS_01

IO_BS_09 IO_BS_10

B-20

 Ischaemic Heart Disease  Asthma and COPD  Patients on steroids

B-21

Postoperative and recovery room care Learning outcomes:  The ability to manage the recovery of patients from general anaesthesia  Understanding the organisation and requirements of a safe recovery room  The ability to identify and manage common postoperative complications in patients with a variety of co-morbidities  The ability to manage postoperative pain and nausea  The ability to manage postoperative fluid therapy Core clinical learning outcomes:  Safely manage emergence from anaesthesia and extubation  Shows awareness of common immediate postoperative complications and how to manage them  Prescribes appropriate postoperative fluid and analgesic regimes and assessment and treatment of PONV



Description

Assessment Method

GMP

PO_BK_01

Lists the equipment required in the recovery unit

A,C,E

1

PO_BK_02

Lists the types of monitoring and the appropriate frequency of observations required for patients having undergone different types of surgery

A,C,E

1

PO_BK_03

Describes the care of an unconscious patient in the recovery room, including safe positioning

A,C,D,E

1,2

PO_BK_04

In respect of restoring spontaneous respiration and maintaining the airway at the end of surgery:  Explains how to remove the tracheal tube and describes the associated problems and complications  Recalls/describes how to manage laryngospasm at extubation  Recalls/lists the reasons why the patient may not breathe adequately at the end of surgery  Recalls/identifies how to distinguish between the possible causes of apnoea  Lists the possible causes of postoperative cyanosis

A,C,E

1

B-22


Description

Assessment Method

GMP

A,C,E

1,2

A,C,E

1

A,C,E

1

A,C,E

1

A,C,E

1

 Understands how to evaluate neuro-muscular block with the nerve stimulator

PO_BK_09

With respect to oxygen therapy:  Lists its indications  Knows the techniques for oxygen therapy and the performance characteristics of available devices  Recalls/explains the causes and management of stridor Outlines/recalls the principles of appropriate post operative fluid regimes including volumes, types of fluids and monitoring of fluid balance including indications for urethral catheterisation In respect of postoperative pain:  Describes how to assess the severity of acute pain  Knows the ‘analgesic ladder’  Discusses how emotions contribute to pain  Identifies appropriate post operative analgesic regimes including types of drugs and doses  Explains how to manage ‘rescue analgesia’ for the patient with severe pain  Lists the complications of analgesic drugs In respect of PONV:  Accepts fully how distressing this symptom is  Recalls/lists the factors that predispose to PONV  Recalls/describes the basic pharmacology of anti-emetic drugs  Describes appropriate regimes for PONV Recalls/lists the possible causes and management of post operative confusion

PO_BK_10

Knows the causes and describes the management of post operative hypotension and hypertension

A,C,E

1

PO_BK_11

Identifies the special precautions necessary for the postoperative management of patients with co-existing diseases including cardiac disease, respiratory disease, metabolic disease, musculoskeletal disease, obesity and those at risk of regurgitation/pulmonary aspiration

A,C,E

1,2

PO_BK_12

Explains the prevention, diagnosis and management of postoperative pulmonary atelectasis

A,C,E

1

PO_BK_13

Lists the appropriate discharge criteria for day stay patients to go home and for patients leaving the recovery room to go to the ward

A,C,E

1

PO_BK_14

Explains the importance of following up patients in the ward after surgery

A,C,E

1,2,3

PO_BK_05

PO_BK_06

PO_BK_07

PO_BK_08

B-23

Skills Assessment Method

GMP

PO_BS_01

Demonstrates appropriate management of tracheal extubation, including;  Assessment of return of protective reflexes  Assessment of adequacy of ventilation  Safe practice in the presence of a potentially full stomach

A,D

1

PO_BS_02

Evaluates partial reversal of neuromuscular blockade, including the use of a nerve stimulator

A,D

1,2

PO_BS_03

Demonstrates the safe transfer of the unconscious patient from the operating theatre to the recovery room

A,C,D

1,2

PO_BS_04

Demonstrates how to turn a patient into the recovery position

A,D

1

PO_BS_05

Makes a clear handover to recovery staff of perioperative management and the postoperative plan

A,D,M

1,3

PO_BS_06

Prescribes appropriate postoperative fluid regimes

A,C

1

PO_BS_07

Demonstrates the assessment of postoperative pain and prescribes appropriate postoperative analgesia regimes

A,C,D

1,3

PO_BS_08

Demonstrates the assessment and management of postoperative nausea and vomiting

A,C

1

PO_BS_09

Demonstrates the assessment and management of postoperative confusion

A,C

1

PO_BS_10

Recognises when discharge criteria have been met for patients going home or to the ward

A,C,D

1,2,3

PO_BS_11

Undertakes follow-up visits to patients after surgery on the ward

A,C,D

1

Competence

Description

B-24

Introduction to anaesthesia for emergency surgery Learning outcomes:  Undertake anaesthesia for ASA 1E and 2E patients requiring emergency surgery for common conditions  Undertake anaesthesia for sick patients and patients with major co-existing diseases, under the supervision of a more senior colleague Core clinical learning outcome:  Delivers safe perioperative anaesthetic care to adult ASA 1E and/or 2E patients requiring uncomplicated emergency surgery [e.g. uncomplicated appendicetomy or manipulation of forearm fracture/uncomplicated open reduction and internal fixation] with local supervision



ES_BK_01

ES_BK_02

Description

Discusses the special problems encountered in patients requiring emergency surgery and how these may be managed including:  Knowing that patients may be very frightened and how this should be managed  Recognising that the patient may have severe pain which needs immediate treatment  Understanding that patients presenting for emergency surgery are more likely to have inadequately treated coexisting disease  Understanding how to decide on the severity of illness in the frightened apprehensive emergency patient  Understanding the pathophysiological changes and organ dysfunction associated with acute illness  How to recognise that the patient may be dehydrated or hypovolaemic and understanding the importance of preoperative resuscitation In respect of the preparation of acutely ill patients for emergency surgery discusses:  How to resuscitate the patient with respect to hypovolaemia and electrolyte abnormalities  The fact that patients may be inadequately fasted and how this problem is managed  The importance of dealing with acute preoperative pain and how this should be managed

B-25

Assessment Methods

GMP

A,C,E

1,2,3,4

A,C,E

1


Description

Assessment Methods

GMP

ES_BK_03

Describes how to recognise the ‘sick’ patient [including sepsis], their appropriate management and the increased risks associated with surgery

A,C,E

1,2

ES_BK_04

Understands the airway management in a patient with acute illness who is at risk of gastric reflux

A,C,E

1

Assessment Methods

GMP

A,C,D

1,2,3,4

A,C,D,M

1,2,3,4

A,D

1

Skills Competence

Description

ES_BS_01

Manages preoperative assessment and resuscitation/optimisation of acutely ill patients correctly

ES_BS_02

Demonstrates safe perioperative management of ASA 1 and 2 patients requiring emergency surgery

ES_BS_03

Manages rapid sequence induction in the high risk situation of emergency surgery for the acutely ill patient

B-26

Management of respiratory and cardiac arrest in adults and children [To be gained during the first 6 months of training] For those who have not completed an ALS/APLS/EPLS course successfully, simulation may be used to assist in the teaching and assessment of these competencies Learning outcomes:  To have gained a thorough understanding of the pathophysiology of respiratory and cardiac arrest and the skills required to resuscitate patients  Understand the ethics associated with resuscitation Core clinical learning outcome:  Be able to resuscitate a patient in accordance with the latest Resuscitation Council (UK) guidelines. [Any trainee who has successfully completed a RC(UK) ALS course in the previous year, or who is an ALS Instructor/Instructor candidate, may be assumed to have achieved this outcome]



RC_BK_01

Description

Recalls/lists the causes of a respiratory arrest, including but not limited to:  Drugs, toxins  Trauma  Pulmonary infection  Neurological disorders  Muscular disorders

B-27

Assessment Methods

GMP

C,E,S

1


RC_BK_02

RC_BK_03

RC_BK_04

RC_BK_05

Description

Identifies the causes of a cardiac arrest, including but not limited to:  Ischaemic heart disease  Valvular heart disease  Drugs  Hereditary cardiac disease  Cardiac conduction abnormalities  Electrolyte abnormalities  Electrocution  Trauma  Thromboembolism Demonstrates an understanding of the basic principles of the ECG, and the ability to recognise arrhythmias including but not exclusively:  Ventricular fibrillation  Ventricular tachycardia  Asystole  Rhythms associated with pulseless electrical activity [PEA] Discusses the mode of action of drugs used in the management of respiratory and cardiac arrest in adults and children, including but not limited to:  Adrenaline  Atropine  Amiodarone  Lidocaine  Magnesium sulphate  Naloxone Identifies the doses of drugs, routes given [including potential difficulty with gaining intravenous access and how this is managed] and frequency, during resuscitation from a respiratory or cardiac arrest

Assessment Methods

GMP

C,E,S

1

C,E,S

1

C,E,S

1

C,E,S

1

RC_BK_06

Explains the physiology underpinning expired air ventilation and external chest compressions

C,E,S

1

RC_BK_07

Explains the need for supplementary oxygen during resuscitation from a respiratory or cardiac arrest in adults and children

C,E,S

1

RC_BK_08

Lists advantages and disadvantages of different techniques for airway management during the resuscitation of adults and

A,C,E,S

1

B-28


RC_BK_09

Description

children, including but not limited to:  Oro and nasopharyngeal airways  Laryngeal Mask type supraglottic airways including but not limited to: LMA, Proseal, LMA supreme, iGel  Tracheal intubation Explains the reasons for avoiding hyperventilation during resuscitation

Assessment Methods

GMP

C,E

1

A,C,E,S

1

C,E,S

1

RC_BK_11

Compares the methods by which ventilation can be maintained in a patient suffering a respiratory or cardiac arrest, using:  Mouth to mask  Self-inflating bag  Anaesthetic circuit  Mechanical ventilator Recalls/explains the mechanism of defibrillation and the factors influencing the success of defibrillation

RC_BK_12

Identifies the energies used to defibrillate a patient

C,E,S

1

RC_BK_13

Recalls/discusses the principles of safely and effectively delivering a shock using both manual and automated defibrillator

C,E,S

1,2

RC_BK_14

Explains the need for continuous chest compressions during resuscitation from cardiac arrest once the trachea is intubated

C,E,S

1

RC_BK_15

Explains the need for minimising interruptions to chest compressions

C,E,S

1

C,E,S

1

C,E,S

1

C,E,S

1

RC_BK_10

RC_BK_16

RC_BK_17 RC_BK_18

Recalls/discusses the reversible causes of cardiac arrest and their treatment, including but not limited to:  Hypoxia  Hypotension  Electrolyte and metabolic disorders  Hypothermia  Tension pneumothorax  Cardiac tamponade  Drugs and toxins  Coronary or pulmonary thrombosis Recalls/describes the Adult and Paediatric Advanced Life algorithms Discusses the specific actions required when managing a cardiac arrest due to:  Poisoning  Electrolyte disorders  Hypo/hyperthermia

B-29


RC_BK_19

Description

 Drowning  Anaphylaxis  Asthma  Trauma  Pregnancy [including peri-mortem Caesarean Section]  Electrocution Identifies the signs indicating return of a spontaneous circulation

Assessment Methods

GMP

A,C,E,S

1

RC_BK_20

Recalls/lists the investigations needed after recovery from a respiratory or cardiac arrest and describes the potential difficulties with obtaining arterial blood samples and how this may be overcome in these patients

C,E,S

1

RC_BK_21

Discusses the principles of care required immediately after successful resuscitation from a respiratory or cardiac arrest

C,E,S

1,3,4

RC_BK_22

Discusses the importance of respecting the wishes of patients regarding end of life decisions

C,E,S

1,3,4

RC_BK_23

Outlines who might benefit from resuscitation attempts and the importance of knowing/accepting when to stop

C,E,S

1,3,4

RC_BK_24

Discusses the importance of respecting the wishes of relatives to be present during a resuscitation attempt

C,E,S

3,4

RC_BK_25

Describes the value of debriefing meetings and the importance of active participation

C,S

3,4

Description

Assessment Methods

GMP

RC_BS_01

Uses an ABCDE approach to diagnose and commence the management of respiratory and cardiac arrest in adults and children

D,S

1

RC_BS_02

Demonstrates correct interpretation of the signs of respiratory and cardiac arrest

S

1,2

RC_BS_03

Maintains a clear airway using basic techniques with or without simple adjuncts:  Head tilt  Chin lift  Jaw thrust  Oro- and nasopharyngeal airways

D,S

1,2

RC_BS_04

Demonstrates correct use of advanced airway techniques including:  Supraglottic devices, including but not limited to LMA, Proseal, LMA supreme, iGel

D,S

1,2

Skills Competence

B-30

Skills Assessment Methods

GMP

RC_BS_05

Maintain ventilation using:  Expired air via a pocket mask  Self-inflating bag via facemask, or advanced airway  Mechanical ventilator

D, S

1,2

RC_BS_06

Performs external cardiac compression

D,S

1,2

RC_BS_07

Monitor cardiac rhythm using defibrillator pads, paddles or ECG lead

D,S

1,2

RC_BS_08

Uses a manual or automated defibrillator to safely defibrillate a patient

D, S

1,2

RC_BS_09

Turn a patient into the recovery position

D

1,2

RC_BS_10

Prepare a patient for transfer to a higher level of care

A,M

1,2

RC_BS_11

Maintains accurate records of all resuscitation events

A,M

1,2

Competence

Description

 Tracheal intubation

B-31

Control of infection Learning Outcomes:  To understand the need for infection control processes  To understand types of possible infections contractible by patients in the clinical setting  To understand and apply most appropriate treatment for contracted infection  To understand the risks of infection and be able to apply mitigation policies and strategies Core clinical learning outcome:  The acquisition of good working practices in the use of aseptic techniques

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Primary examination identified in the FRCA examination blueprint on page B-99 or in the Final examination identified in the Final FRCA blueprint on page C72 of Annex C. Knowledge Competence

IF_BK_01

Description

Identifies the universal precautions and good working practices for the control of infection including but not limited to:  Decontaminate hands before treating patients; when soap and water hand wash is appropriate; when alcohol gel decontamination is appropriate  The use of gloves  The use of sterilised equipment  The disposal of used clinical consumables [single use and reusable]

IF_BK_04

Lists the types and treatment of infections contracted by patients usually in the ward and ITU, including but not limited to:  MRSA  C Diff Recalls/discusses the concept of cross infection including:  Modes of cross infection  Common cross infection agents Recalls/explains the dynamics of bacterial and viral strain mutation and the resulting resistance to antibiotic treatment

IF_BK_05

Explains the need for antibiotic policies in hospitals

IF_BK_02

IF_BK_03

B-32

Assessment Methods

GMP

A,C,D,E

1,2

C,E

1

A,C,E

1

C,E

1

C,E

1,2

IF_BK_08

Recalls/discusses the cause and treatment of common surgical infections including the use of but not limited to:  Antibiotics  Prophylaxis Recalls/lists the types of infection transmitted through contaminated blood including but not limited to:  HIV  Hepatitis B and C Discusses the need for, and application of, hospital immunisation policies

IF_BK_09

Recalls/explains the need for, and methods of, sterilisation

C,E

IF_BK_10

Explains the Trust’s decontamination policy and their application

IF_BK_06

IF_BK_07

C,E

1

C,E

1

C,E

1 1 1

C

Skills Competence

Description

Assessment Methods

GMP

IF_BS_01

Identifies patients at risk of infection and applies an infection mitigation strategy

A,D

1

IF_BS_02

Identifies and appropriately treats the immunocompromised patient

A,C

1,4

IF_BS_03

Be able to ister IV antibiotics taking into and not limited to:  Risk of allergy  Anaphylaxis

A,D

1,2

IF_BS_04

Demonstrates good working practices, following local infection control protocols and the use of aseptic techniques

A,D,M

1,2

IF_BS_05

Demonstrates the correct use of disposable filters and breathing systems

A,D,M

1

IF_BS_06

Demonstrates the correct use and disposal of protective clothing items including but not limited to:  Surgical scrubs  Masks  Gloves

A,D,M

1,2

IF_BS_07

Demonstrates the correct disposal of clinical consumable items [single use and reusable]

A,D,M

1,2

B-33

Basic anaesthesia –[3/6 months to 24 months] Once the trainee has completed all the minimum clinical learning outcomes identified in ‘The basis of anaesthetic practice’ and has obtained the IAC, they will move on to the remainder of Basic Level training. This will provide a comprehensive introduction to all aspects of elective and emergency anaesthetic practice [with the exceptions some special interest areas of practice including that for cardiothoracic surgery, neurosurgery and specialist paediatric surgery amongst others]. The basic anaesthetic units of training are:               

Airway management Critical incidents Day surgery General, urological and gynaecological surgery Head, neck, maxillo-facial and dental surgery Intensive care medicine Non-theatre Obstetrics Orthopaedic surgery Paediatrics o Child protection Pain medicine Regional Sedation Transfer medicine Trauma and stabilisation

It is anticipated that the majority of these units of training will not be delivered in dedicated blocks; the exception is intensive care medicine, which must be completed in a three month block. Trainees would benefit from other units of training being dedicated; obstetrics, paediatrics and pain are three such.

B-34

Airway management Core airway knowledge and skills have also been included within the first six months “Basis of Anaesthetic Practice” section. Those competencies are repeated here in a standalone airway section, designed to reflect the fundamental importance of airway knowledge and skills to the novice Anaesthetist. Core clinical learning outcomes:  Able to predict difficulty with an airway at preoperative assessment and obtain appropriate help  Able to maintain an airway and provide definitive airway management as part of emergency resuscitation  Demonstrates the safe management of the can’t intubate can’t ventilate scenario  Maintains anaesthesia in a spontaneously breathing patient via a facemask for a short surgical procedure [less than 30 mins]



AM_BK_01 AM_BK_02 AM_BK_03 AM_BK_04 AM_BK_05

AM_BK_06

Description

Explains the methods commonly used for assessing the airway to predict difficulty with tracheal intubation [Ref; OA_BK_05] Describes the effect of pre-oxygenation and knows the correct technique for its use [Cross Ref;induction of GA] Describes the principles of management of the airway including techniques to keep the airway open and the use of facemasks, oral and nasopharyngeal airways and laryngeal mask airways [Cross Ref; induction of GA] Explains the technique of inhalational induction and describes the advantages and disadvantages of the technique. [Cross Ref; induction of GA] Knows the factors influencing the choice between agents for inhalational induction of anaesthesia [Cross Ref; induction of GA] In respect of tracheal intubation:  Lists its indications  Lists the available types of tracheal tube and identifies their applications  Explains how to choose the correct size and length of tracheal tube  Explains the advantages/disadvantages of different types the laryngoscopes and blades including, but not exclusively,

B-35

Assessment Methods

GMP

A,C,E

1,2

A,C,D,E

1,2

A,C,D,E

1,2

A,C,D,E

1,2

A,C,D,E

1,2

A,C,D,E

1,2


AM_BK_07

AM_BK_08

AM_BK_09 AM_BK_10

AM_BK_11

AM_BK_12

Description

the Macintosh and McCoy  Outlines how to confirm correct placement of a tracheal tube and knows how to identify the complications of intubation including endobronchial and oesophageal intubation  Discusses the methods available to manage difficult intubation and failed intubation  Explains how to identify patients who are at increased risk of regurgitation and pulmonary aspiration and knows the measures that minimise the risk  Understands the airway management in a patient with acute illness who is at risk of gastric reflux  Categorises the signs of pulmonary aspiration and the methods for its emergency management [ Cross Ref;induction of GA; emergency surgery] In respect of restoring spontaneous respiration and maintaining the airway at the end of surgery:  Explains how to remove the tracheal tube and describes the associated problems and complications  Recalls/describes how to manage laryngospasm at extubation  Recalls/lists the reasons why the patient may not breathe adequately at the end of surgery  Recalls/identifies how to distinguish between the possible causes of apnoea  Lists the possible causes of postoperative cyanosis  Understands how to evaluate neuro-muscular block with the nerve stimulator [Cross Ref; post-operative] With respect to oxygen therapy:  Lists its indications  Knows the techniques for oxygen therapy and the performance characteristics of available devices  Describes the correct prescribing of oxygen  Recalls/explains the causes and management of stridor [Cross Ref; post-operative] Discusses the indications for RSI [Cross Ref; intra-operative] Describes the care of the airway in an unconscious patient in the recovery room, including safe positioning [Cross Ref; postoperative] Lists advantages and disadvantages of different techniques for airway management during resuscitation, including but not limited to:  Oro and nasopharyngeal airways  Laryngeal Mask type supraglottic airways including but not limited to: LMA, Proseal, LMA supreme, iGel  Tracheal intubation [Cross Ref; management of respiratory and cardiac arrest] Compares the methods by which ventilation can be maintained in a patient suffering a respiratory or cardiac arrest, using:

B-36

Assessment Methods

GMP

A,C,E

1

A,C,E

1,2

A,C,D,E

1,2

A,C,D,E

1,2

A,C,E,S

1

A,C,E,S

1

Knowledge Assessment Methods

GMP

AM_BK_13

 Mouth to mask  Self-inflating bag  Anaesthetic breathing system  Mechanical ventilator [Cross Ref; management of respiratory and cardiac arrest] Discusses the different types of laryngoscope blades available in routine practice and the indications for their use

A,C,E

1

AM_BK_14

Outlines the advantages/disadvantages and reasons for development of new laryngoscopes [e.g. glidescope]

A,C,E

1

AM_BK_15

Outlines the indications for fibre-optic intubation and how awake intubation may be achieved

A,C,E

1,2

AM_BK_16

Describes the management of the ‘can’t intubate, can’t ventilate’ scenario

A,C,E

1,2

AM_BK_17

Describes the principles of, and indications for, the use of needle crycothyrotomy and manual jet ventilation

A,C,E

1,2

Assessment Methods

GMP

A,D,E

1

A,C,E

1

A, C,E

1

A,D

1,2,3

A,D

1,2,3

Competence

Description

Skills Competence

AM_BS_01 AM_BS_02 AM_BS_03 AM_BS_04

AM_BS_05

Description

Demonstrates satisfactory proficiency in performing a relevant clinical examination and assessment of the airway and dentition [Cross Ref; intra-operative] Identifies normal appearances and significant abnormalities in radiographs including:  Cervical spine, chest  Head CT and MRI showing clear abnormalities relevant to the airway [Cross Ref; intra-operative] Reliably predicts the level of supervision they will require [Cross Ref; intra-operative] Demonstrates effective pre-oxygenation, including correct use of the mask, head position and clear explanation to the patient [Cross Ref; induction of GA] In respect of airway management:  Demonstrates optimal patient position for airway management, including head tilt, chin lift, jaw thrust  Manages airway with mask and oral/nasopharyngeal airways  Demonstrates hand ventilation with bag and mask [including self- inflating bag]  Able to insert and confirm placement of a Laryngeal Mask Airway  Demonstrates correct head positioning, direct laryngoscopy and successful nasal/oral intubation techniques and confirms correct tracheal tube placement

B-37

Skills Competence

Description

Assessment Methods

GMP

D,S

1,2

A,D

1,2,3

A,D

1,2

D,S

1,2

AM_BS_09

 Demonstrates proper use of bougies  Demonstrates correct securing and protection of LMAs/tracheal tubes during movement, positioning and transfer  Correctly conducts RSI sequence  Correctly demonstrates the technique of cricoid pressure [Cross Ref; management of respiratory and cardiac arrest; induction of GA] Demonstrates correct use of advanced airway techniques including but not limited to Proseal, LMA supreme, iGel [Cross Ref; management of respiratory and cardiac arrest] In respect of inhalational induction of anaesthesia:  Satisfactorily communicates with the patient during induction  Satisfactorily conducts induction [Cross Ref; induction of GA] Demonstrates the ability to maintain anaesthesia with a face mask in the spontaneously breathing patient [Cross Ref; intra-operative] Demonstrates failed intubation drill [Cross Ref; induction of GA]

AM_BS_10

Demonstrates management of ‘can’t intubate, can’t ventilate’ scenario [Cross Ref; critical incidents]

D,S

1,2

AM_BS_11

Demonstrates correct use of oropharyngeal, laryngeal and tracheal suctioning [Cross Ref; induction of GA]

A,D

1,2

AM_BS_12

Demonstrate appropriate management of tracheal extubation, including;  Assessment of return of protective reflexes  Assessment of adequacy of ventilation  Safe practice in the presence of a potentially full stomach [Cross Ref; postoperative]

A,D

1

AM_BS_13

Demonstrates how to turn a patient into the recovery position [Cross Ref; postoperative]

A,D

1

AM_BS_14

Demonstrates small and large bore needle cricothyrotomy and manual jet ventilation

D,S

1,2

AM_BS_15

Demonstrates surgical cricothyrotomy

D,S

1,2

AM_BS_06 AM_BS_07 AM_BS_08

B-38

Critical incidents Many of the critical incidents listed are found elsewhere in the basic level section of the curriculum. Given the importance of the recognition and management of them, they are all included under this one heading for clarity Whilst trainees may come across the critical incidents listed below during the course of clinical practice, it is anticipated that many will not be encountered in this way and as a result, the use of simulation to assist teaching and assessment is expected Core clinical Learning Outcomes:  To gain knowledge of the principle causes, detection and management of critical incidents that can occur in theatre  To be able to recognise critical incidents early and mange them with appropriate supervision  To learn how to follow through a critical incident with reporting, presentation at audit meetings, and discussions with patients  To recognise the importance of personal non-technical skills and the use of simulation in reducing the potential harm caused by critical incidents



Description

Assessment Methods

GMP

Recall/describes the causes, detection and management of the following: CI_BK_01

Cardiac and/or respiratory arrest

A,C,E,S

1

CI_BK_02

Unexpected fall in SpO2with or without cyanosis

A,C,E,S

1

CI_BK_03

Unexpected increase in peak airway pressure

A,C,E,S

1

CI_BK_04

Progressive fall in minute volume during spontaneous respiration or IPPV

A,C,E,S

1

CI_BK_05

Fall in end tidal CO2

A,C,E,S

1

CI_BK_06

Rise in end tidal CO2

A,C,E,S

1

CI_BK_07

Rise in inspired CO2

A,C,E,S

1

CI_BK_08

Unexpected hypotension

A,C,E,S

1

CI_BK_09

Unexpected hypertension

A,C,E,S

1

B-39


Description

Assessment Methods

GMP

CI_BK_10

Sinus tachycardia

A,C,E,S

1

CI_BK_11

Arrhythmias:  ST segment changes  Sudden tachyarrythmias  Sudden bradycardia  Ventricular ectopics  Broad complex tachycardia  Ventricular Fibrillation  Atrial fibrillation  Pulseless electrical activity [PEA]

A,C,E,S

1

CI_BK_12

Convulsions

A,C,E,S

1

Recalls/describes the causes, detection and management of the following specific conditions: CI_BK_13

Difficult/failed mask ventilation

A,C,E,S

1

CI_BK_14

Failed intubation

A,C,E,S

1

CI_BK_15

Can’t intubate, can’t ventilate

A,C,E,S

1

CI_BK_16

Regurgitation/Aspiration of stomach contents

A,C,E,S

1

CI_BK_17

Laryngospasm

A,C,E,S

1

CI_BK_18

Difficulty with IPPV, sudden or progressive loss of minute volume

A,C,E,S

1

CI_BK_19

Bronchospasm

A,C,E,S

1

CI_BK_20

Pneumothorax and tension pneumothorax

A,C,E,S

1

CI_BK_21

Gas / Fat/ Pulmonary embolus

A,C,E,S

1

CI_BK_22

Adverse drug reactions

A,C,E,S

1

CI_BK_23

Anaphylaxis

A,C,E,S

1

CI_BK_24

Transfusion reactions, transfusion of mis-matched blood or blood products

A,C,E,S

1

CI_BK_25

Inadvertent intra-arterial injection of irritant fluids

A,C,E,S

1

B-40


Description

Assessment Methods

GMP

CI_BK_26

High spinal block

A,C,E,S

1

CI_BK_27

Local anaesthetic toxicity

A,C,E,S

1

CI_BK_28

Accidental decannulation of tracheostomy or tracheal tube

A,C,E,S

1

CI_BK_29

Coning due to increased intracranial pressure

A,C,E,S

1

CI_BK_30

Malignant hyperpyrexia

A,C,E,S

1

CI_BK_31

Awareness of human factors concepts and terminology and the importance of non-technical skills in achieving consistently high performance such as: effective communication, team-working, leadership, decision-making and maintenance of high situation awareness

A,C,E,S

1,2,3,4

CI_BK_32

Awareness of the importance and the process of critical incident reporting

A,C,E,S

1,2,3,4

CI_BK_33

Acceptance that it can happen to you; the unexpected can happen to anyone

A,C,E,S

1,2,3,4

CI_BK_34

To practice response protocols in resuscitation room or in simulation with other healthcare professionals as appropriate

C,D,S

1, 2,3,4

A,C,E,S

1,2,3,4

A,C,E,S

1,2,3,4

Assessment Methods

GMP

Discusses the importance of understanding the need for the following attitudes and behaviours:

CI-BK_35 CI_BK_36

The need to follow through a critical incident with proper reporting, presentation at morbidity meetings and warning flags as necessary, with appropriate supervision The provision of information to the patient and where necessary ensuring they get the appropriate counselling and advice, with appropriate supervision

Skills Competence

Description

CI_BS_01

Demonstrates good non-technical skills such as: [effective communication, team-working, leadership, decision-making and maintenance of high situation awareness]

A,C,D,S

1,2,3,4

CI_BS_02

Demonstrates the ability to recognise early a deteriorating situation by careful monitoring

A,C,D,S

1,2,3,4

CI_BS_03

Demonstrates the ability to respond appropriately to each incident listed above

A,C,D,S

1,2,3,4

B-41

Skills Competence

Description

Assessment Methods

GMP

CI_BS_04

Shows how to initiate management of each incident listed above

A,C,D,S

1,2,3,4

CI_BS_05

Demonstrates ability to recognise when a crisis is occurring

A,C,D,S

1,2,3,4

CI_BS_06

Demonstrates how to obtain the attention of others and obtain appropriate help when a crisis is occurring

A,C,D,S

1, 2,3,4

B-42

Day surgery It is anticipated that this unit of training will not be delivered as a dedicated block and that the learning outcomes will be gained throughout the duration of Basic Level training and that these should be achievable in most general hospitals at this level. Inevitably this unit cross references with many of the other Basic Level clinical units of training given the high percentage of day care surgical procedures Learning outcomes:   

To gain knowledge, skills and experience of the perioperative anaesthetic care of ASA 1 and 2 patients presenting in a dedicated Day Surgery Unit involving a range surgical specialities [minimum three] Understand and apply agreed protocols with regard to patient selection and perioperative care of day surgery patients Understand the importance of minimising postoperative complications, such as nausea and pain, in patients who are returning home the same day

Core clinical learning outcome:  Knows the criteria for patient selection and the anaesthetic requirements for day surgical patients



Description

Assessment Methods

GMP

DS_BK_01

Describes the principles of preoperative assessment of patients requiring day surgery including nurse-led assessment

A,C,E

1

DS_BK_02

Explains the role of appropriate preoperative investigations for day surgery patients

A,C,E

1

DS_BK_03

Describes protocols for selection of day surgery patients including medical, surgical and social factors

A,C,E

1

A,C,E

1,2,3,4

A,C,E

1

DS_BK_05

Explains the importance of providing appropriate postoperative instructions to patients and relatives following day surgery including, but not confined to, level of care required following discharge, transport arrangements and when to drive Describes anaesthetic techniques appropriate for day cases

DS_BK_06

Explains the potential causes of unanticipated in-patient ission following day surgery

A,C,E

1

DS_BK_07

Describes the pharmacology & selection of appropriate drugs for day cases [cross ref basic sciences]

A,C,E

1

DS_BK_04

B-43


Description

Assessment Methods

GMP

DS_BK_08

Describes appropriate analgesia for day cases

A,C,E

1

DS_BK_09

Describes strategies to reduce postoperative nausea and vomiting in day case patients

A,C,E

1

DS_BK_10

Explains the management & assessment of recovery of day surgery patients to street fitness

A,C,E

1

Assessment Methods

GMP

Skills Competence

Description

DS_BS_01

Demonstrates appropriate selection and preoperative assessment of day surgery patients

A,C,M

1

DS_BS_02

Demonstrates appropriate anaesthetic management of ASA 1and 2 patients requiring day surgery

A,C,D

1,2

DS_BS_03

Demonstrates appropriate postoperative care of patients who have undergone day surgery including control of pain, nausea, fluid management & assessment of fitness for discharge

A,C

1,3,4

B-44

General, urological and gynaecological surgery (incorporating peri-operative care of the elderly) This unit includes all aspects of elective and emergency general, urological and gynaecological surgery. It is anticipated that this unit of training will not be delivered as a dedicated block and that the learning outcomes will be gained throughout the entire duration of Basic Level training and that these should be achievable in most general hospitals at this level. Learning outcomes:  To gain knowledge, skills and experience of the perioperative anaesthetic care of patients requiring elective and emergency general, urological and gynaecological surgery  To gain understanding of the perioperative management of patients requiring intra-abdominal laparoscopic surgery and the particular issues related to anaesthetic practice, demonstrating the ability to manage such straightforward cases in adults under distant supervision  To be able to recognise and manage the perioperative complications associated with intra-abdominal surgery that are relevant to anaesthesia  To gain understanding of special peri-operative needs of elderly, frail patients Core clinical learning outcomes:  Deliver safe perioperative anaesthetic care to uncomplicated ASA 1-3 adult patients requiring elective and emergency surgery such as body surface surgery, appendicectomy and non-complex gynaecological surgery under distant supervision  Manage a list with uncomplicated ASA 1-3 adults for similar elective surgery under distant supervision



Description

which may be used for GU_BK_01 Outlines the principles of preoperative assessment of patients undergoing major and minor surgery, including guidelines on the appropriateness of simple tests [i.e. NICE guidelines] Describes the anaesthetic management of straightforward common surgical procedures and their complications, including GU_BK_02 but not limited to:  Body surface surgery including breast procedures and thyroid surgery  Urological procedures including TURP and its management [including the TURP syndrome] and procedures on the

B-45

Assessment methods

GMP

A,C,E

1,2

A,C,E

1,2,3,4


Description

which may be used for kidney and urological tract

GU_BK_03 GU_BK_04

 Laparoscopic surgery including but not exclusively: o Diagnostic laparoscopy o Laparoscopic and open cholecystectomy  Intra-abdominal major general surgery procedures including but not exclusively: o Elective colorectal resection o Elective and emergency surgery for peptic ulcer disease  Endoscopic procedures on the GI and GU tracts including, but not exclusively: o OGD; flexible and rigid o Sigmoidoscopy, Colonoscopy o Cystoscopy  Gynaecology o Elective laparoscopic and open procedures on the uterus o Elective and Emergency procedures in patients in early pregnancy such as ERPC and salpino-oophrectomy for ectopic pregnancy Explains the physical and physiological effects of laparoscopic surgery including the effects of positioning [e.g Trendelenberg / reverse Trendelenberg, specifically in the setting of laparoscopic surgery] Describes the principles of the anaesthetic management of patients with renal failure for non-transplant surgery, including care of shunts

Assessment methods

GMP

A,C,E

1

A,C,E

1,2,3,4

A,C,E

1,2

GU_BK_05

Describes the principles of management of non-fasted patients requiring emergency surgery for whatever reason

GU_BK_06

Explains transfusion issues in different surgical procedures

C,E

1,2

GU_BK_07

Recalls/describes the management of major haemorrhage

A,C,E

1,2

GU_BK_08

Recalls/explains the relevance of metabolism and nutrition in the perioperative period

A,C,E

1,2

GU_BK_09

Explains the specific problems of anaesthesia for non-obstetric surgery in the pregnant patient

A,C,E

1,2

GU_BK_10

Recalls the factors associated with regurgitation and airway protection during common surgical procedures

A,C,E

1,2

GU_BK_11

Recalls/describes the anaesthetic implications of abnormal body weight, including morbid obesity

A,C,E

1,2

GU_BK_12

Describes the NCEPOD classifications and explains the importance of these in delivering surgical care to patients

A,C,E

1,2

GU_BK_13

Recalls/describes the peri-operative care of the elderly

A,C,E

1,2

B-46

Skills Competence

Description

Assessment Method

GMP

GU_BS_01

Demonstrates the ability to form an appropriate perioperative management plan for ASA 1-3 surgical patients requiring all types of surgery

A,C,D

1,2,3,4

GU_BS_02

Demonstrates the ability to recognise when more complex perioperative assessment and /or optimisation is required

A,C,D

1,2,3,4

GU_BS_03

Demonstrates the ability to identify the high risk emergency surgical patient and initiate early management/optimisation

A,C,D,M

1,2,3,4

A,C,D,L,M

1,2,3,4

L,M

1,2,3,4

GU_BS_04

GU_BS_05

Demonstrates the ability to deliver safe perioperative anaesthetic care to ASA1-3 patients for straightforward surgical procedures e.g. body surface surgery, appendicectomy, ERPC Demonstrates the ability to manage an elective surgical list with uncomplicated ASA 1-3 adults for straightforward body surface and lower abdominal surgery under distant supervision [Examples of such cases on lists would be:  General surgical: hernia repair; ‘superficial lumps/bumps’; non-complex appendicetomy  Gynaecology: non-complex total abdominal hysterectomy; hysteroscopy; minor superficial surgery

GU_BS_06

Demonstrates sensitive handling of patients with cognitive disturbances/communication problems

A,D,M

1,3,4

GU_BS_07

Shows sensitive handling of patient with cognitive impairment

A,D,M

1,2,3,4

B-47

Head, neck, maxillo-facial and dental surgery It is anticipated that this unit of training will not be delivered as a dedicated block and that the learning outcomes will be gained throughout the duration of Basic Level training and that these should be achievable in most general hospitals at this level. Learning outcomes:  Gain knowledge and skills of the perioperative anaesthetic care of patients undergoing minor to intermediate ear, nose and throat [ENT], maxilla-facial and dental surgery  To be able to recognise the specific problems encountered with a ‘shared airway’ and know the principles of how to manage these correctly Core clinical learning outcome:  Deliver perioperative anaesthetic care to ASA 1-3 adults, and ASA 1 and 2 children over 5, for non-complex ear, adenotonsillar and nasal surgery under direct supervision



Description

Assessment Methods

GMP

EN_BK_01

Lists specific conditions that may complicate airway management [e.g. anatomical variation; tumour; bleeding]

A,C,E

1,2

EN_BK_02

Describes how the surgeon operating in the airway, or requiring access via the airway, complicates anaesthesia for this type of surgery

A,C,E

1

EN_BK_03

Recalls/describes the pathophysiology of obstructive sleep apnoea and its relevance to anaesthesia [AM_BK_07]

A,C,E

1,2

EN_BK_04

Recalls/describes the specialised devices used to maintain the airway during head and neck surgery

A,C,E

1

A,C,E

1,2

A,C,E

1,2,3

EN_BK_05

EN_BK_06

Identifies the indications for the special surgical devices used during surgery including gags, micro-laryngoscopes, oesophagoscopes and laser surgery equipment Describes appropriate anaesthetic techniques for common ENT and dental procedures and lists the particular difficulties that face the anaesthetist including but not exclusively: tonsillectomy, septoplasty, myringotomy, middle ear surgery, dental extractions and apicectomies

B-48

EN_BK_07

Recalls/explains the principles of correct and timely recognition/management of bleeding tonsils

A,C,E

1,2,3

EN_BK_08

Explains the principles of the emergency management of the obstructed airway including tracheostomy

A,C,E

1,2,3,4

EN_BK_09

Describes the special risk of transmitting prion diseases by contamination with tonsillar tissue and explains how this risk is minimised in practice

A,C,E

1,2,3,4

Assessment Methods

GMP

A,D,M

1,2,3

A,D,M

1,2,3,4

A,D

1

A,D

1

A,D,M

1,2,3,4

Skills Competence

EN_BS_01

EN_BS_02

EN_BS_03 EN_BS_04 EN_BS_05

Description

Demonstrates development of preoperative assessment and preparation/optimisation knowledge and skills [as identified in the basis of anaesthetic practice], focused on the specific difficulties presented by these surgical sub-specialties The provision of safe perioperative anaesthetic care for a wide range of commonly performed procedures, with good operating conditions and an appropriate level of analgesia, including:  ENT procedures such as tonsillectomy, septoplasty and myringotomy  Common dental procedures such as extractions and apicectomies Demonstrates the correct use of a variety of specialised airway devices, including RAE tubes, LMAs, throat packs and intubating forceps Manages anaesthesia so as to achieve smooth emergence, with minimal airway disturbance, laryngospasm and bronchospasm Demonstrates awareness of the increased risk of airway complications postoperatively and takes precautions to assist in their early recognition and prompt management

B-49

Non-theatre At basic level it is anticipated that non-theatre anaesthesia will be confined to the provision of anaesthesia for diagnostic imaging Learning outcomes:  To safely undertake the intra-hospital transfer of the stable critically ill adult patient for diagnostic imaging  To understand the risks for the patient of having procedures in these sites  To understand the responsibilities as a /prescriber of diagnostic imaging services Core clinical learning outcome:  Can maintain anaesthesia for stable critically ill adult patients requiring diagnostic imaging under distant supervision [in conjunction with their transfer as indentified in Transfer Medicine]

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Primary examination identified in the FRCA examination blueprint on page B-99 or in the Final examination identified in the Final FRCA blueprint on page C72 of Annex C. Knowledge Competence

DI_BK _01 DI_BK_02 DI_BK_03 DI_BK_04 DI_BK_05

Description

Explains risks and benefits to patients, and risks to staff from common radiological investigations and procedures, including the use of contrast media Explains current statutory radiological regulations e.g. IRMER 2000 as applied to the referrer, practitioner or operator of diagnostic services Explains the general safety precautions and equipment requirements in specific environments e.g. MRI suites Recalls/describes the specific anaesthetic implications of imaging techniques including but not limited to:  MRI scanning  CT scanning  Angiography Recalls/explains the implications of exposing the pregnant or potentially pregnant patient to ionising radiation

B-50

Assessment Methods

GMP

A,C,E

1,2,3,4

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2,3,4

A,C,E

1,2,3,4

Skills Competence

Description

DI_BS_01

Demonstrates the ability to provide safe anaesthesia for a stable adult patient for diagnostic imaging

DI_BS_02

Demonstrates the ability to manage a stable ventilated adult patient for diagnostic imaging

B-51

Assessment Methods

GMP

A,C,D,M

1,2,3,4

C,M

1,2,3,4

Obstetrics Wherever possible, this Basic Level unit of training should occur in a dedicated block. The use of simulators may assist in the teaching and assessment of some aspects of this section e.g. general anaesthesia for Caesarean section Learning outcome:  To gain knowledge, skills and experience of the treatment of the healthy pregnant woman Core clinical learning outcomes:  To the formal practical initial assessment of competence in obstetric anaesthesia and, having achieved this, be able to provide analgesia and anaesthesia as required for the majority of the women in the delivery suite  To understand the management of common obstetric emergencies and be capable of performing immediate resuscitation and care of acute obstetric emergencies [e.g. eclampsia; pre-eclampsia; haemorrhage], under distant supervision but recognising when additional help is required



Description

Assessment Methods

GMP

OB_BK_01

Recalls/describes the anatomy, physiology and pharmacology related to pregnancy and labour [cross ref basic sciences]

A,C,E

1

OB_BK_02

Lists common obstetric indications for anaesthetic intervention on the delivery suite

A,C,E

1

OB_BK_03

Describes the effects of aortocaval compression and how to avoid it

A,C,E

1,2

OB_BK_04

Recalls/describes how to assess fetal well being in utero

A,C,E

1,2

OB_BK_05

Discusses the management of pre-eclampsia and eclampsia

C,E

1,2

OB_BK_06

Lists risk factors and describes the management of major obstetric haemorrhage

C,E

1,2

OB_BK_07

Explains local feeding / starvation policies and the reasons behind them

A,C,E

1,2

OB_BK_08

Explains the thromboprophylaxis requirements in pregnancy

A,C,E

1,2

OB_BK_09

Describes the grading of urgency of Caesarean section

A,C,E

1,2

B-52


Description

Assessment Methods

GMP

OB_BK_10

Explains why anaesthetic techniques must be modified in the pregnant patient

A,C,E

1,2

OB_BK_11

Lists methods of analgesia during labour and discusses their indications and contraindications

A,C,E

1,2

OB_BK_12

Describes epidural or CSE analgesia in labour and recalls/discusses the indications, contraindications and complications

A,C,E

1,2

OB_BK_13

Explains how to provide regional anaesthesia for operative delivery

A,C,E

1

OB_BK_14

Understands the need to call for assistance after several attempts at placement of regional blocks proves unsuccessful

A,C,E

1,2,3

OB_BK_15

Describes the immediate management of accidental dural puncture

A,C,E

1

OB_BK_16

Recalls/describes maternal and basic neonatal resuscitation

A,C,E

1,2

OB_BK_17

Describes how to access local maternity guidelines and the value of having these guidelines

A,C,E

1,2

Assessment Methods

GMP

A,D

1

A,C,D

1,3,4

D

1

A,D,M

1

A,D

1

A,C,D

1

A,C,D,S

1

Skills Competence

Description

OB_BS_01

Undertakes satisfactory preoperative assessment of the pregnant patient

OB_BS_02

Demonstrates the ability to clearly explain and prepare an obstetric patient for surgery

OB_BS_03

Demonstrates the use of techniques to avoid aorto-caval compression

OB_BS_04

Demonstrates the ability to provide epidural analgesia in labour

OB_BS_05

Demonstrates the ability to provide spinal anaesthesia for caesarean section

OB_BS_06

Demonstrates the ability to convert epidural analgesia to epidural anaesthesia for surgical intervention

OB_BS_07

Demonstrates the ability to provide general anaesthesia for caesarean section [S]

OB_BS_08

Demonstrates an appropriate choice of anaesthesia/analgesia for instrumental delivery

C

1

OB_BS_09

Demonstrates an appropriate choice of anaesthesia for retained placenta

C

1,2

OB_BS_10

Demonstrates safe and effective management of post-delivery pain relief

C,M

1

OB_BS_11

Demonstrates ability to recognise when an obstetric patient is sick and the need for urgent assistance

C,M

1

OB_BS_12 OB_BS_13

Demonstrates the ability to provide advanced life for a pregnant patient [S] Demonstrates the ability to provide basic neonatal life [S]

D,S D,S

1 1

B-53

Skills Competence

OB_BS_14

Description

Obtains the Initial Assessment of Competence in Obstetric Anaesthesia

B-54

Assessment Methods

GMP

A,C,D

1,2,3,4

Orthopaedic surgery (incorporating peri-operative care of the elderly) This unit includes all aspects of elective and emergency orthopaedic surgery. It is anticipated that this unit of training will not be delivered as a dedicated block and that the learning outcomes will be gained throughout the entire duration of Basic Level training and that these should be achievable in most general hospitals at this level. Learning outcomes:  To gain knowledge, skills and experience of the perioperative anaesthetic care of patients requiring orthopaedic surgery including the elderly and patients with long-bone fractures  To understand the relevance of diseases of bones and ts to anaesthesia  To be able to recognise and manage the perioperative complications of orthopaedic surgery relevant to anaesthesia Core clinical learning outcome:  Deliver perioperative anaesthetic care to uncomplicated ASA 1-3 adult patients for straightforward elective and emergency orthopaedic/trauma surgery to both upper and lower limbs, including Open Reduction Internal Fixation [ORIF] surgery [which includes fractured neck of femur], under distant supervision



Description

Assessment Methods

GMP

A,C,E

1

A,C,E

1,2

OR_BK_02

Recalls/describes the perioperative implications of rheumatological disease, including but not limited to rheumatoid arthritis, osteoarthritis, osteoporosis and ankylosing spondylitis Recalls the complications of prolonged immobility, including those due to traction

OR_BK_03

Recalls the problems associated with limb tourniquets

A,C,E

1,2

OR_BK_04

Recalls/explains the potential hazards associated with positioning [supine, lateral, prone, sitting]

A,C,E

1,2

OR_BK_05

Recalls/explains the problems associated with anaesthesia for surgery in the prone and lateral positions Recalls/describes the pathophysiology, diagnosis and management of specific orthopaedic surgical complications that are relevant to anaesthesia including but not exclusively:

A,C,E

1,2

A,C,E

1

OR_BK_01

OR_BK_06

B-55

Knowledge Assessment Methods

GMP

A,C,E

1,2

A,C,E

1,2,3

A,C,E

1,2

A,C,E

1,2

A,C,E

1

OR_BK_12

Discusses the timing of surgery, and the need for investigations in urgent [surgical] cases with cardiovascular signs Describes the different surgical procedures for managing hip fractures, the anaesthetic requirements for each and the current evidence for the choice of anaesthetic technique Discusses the importance of consistent decision making on fitness for surgery in elderly patients

A,C,E

1,4

OR_BK_13

Recalls/describes the peri-operative care of the elderly

A,C,E

1,2

Assessment Methods

GMP

OR_BS_01

Demonstrates the provision of perioperative anaesthetic care for patients requiring orthopaedic surgery to the upper and lower limbs including but not exclusively:  ORIF surgery including internal fixation of fractured neck of femur  Lower limb primary arthroplasty including patients in the lateral position

A,D,M

1,2

OR_BS_02

Demonstrates sensitive handling of the patient with cognitive disturbance or communication problems

A,D,M

1,3,4

OR_BS_03

Demonstrates correct assessment and perioperative management of the elderly patient with a hip fracture

A,D,M

1,2,3,4

OR_BS_04

Shows sensitive handling of patient with cognitive impairment in anaesthetic room

A,D,M

1,2,3,4

Competence

OR_BK_07 OR_BK_08 OR_BK_09 OR_BK_10 OR_BK_11

Description

 Bone cement Implantation Syndrome  Diagnosis and management of fat embolism  Upper and lower limb compartment syndromes Discusses strategies for blood conservation in major orthopaedic surgery Describes the principles of perioperative anaesthetic care for elective and emergency upper and lower limb orthopaedic surgery, including primary arthroplasty Discusses the current guidance on early surgical management of hip fractures and the necessary assessment for anaesthesia

Skills Competence

Description

B-56

Paediatrics The use of simulators may assist in the teaching and assessment of some aspects of this section e.g. paediatric resuscitation Learning outcomes:  Obtain knowledge of the principles underlying the practice of anaesthesia for children aged 1 year and older and the specific needs therein  Have completed training in child protection Core clinical learning outcomes:  Demonstrates correct management of the paediatric airway in the following ways [if case mix allows, down to one year of age, but at least down to five years of age]: o Is able to size airway devices correctly [i.e. oral airways and tracheal tubes] o Is able to insert airway devices correctly o Is able to ventilate an apnoeic child using a bag and mask +/- an oral airway o Is able to intubate a child correctly, using the most appropriate size tracheal tube, placed at the correct length  Maintains anaesthesia in a spontaneously breathing patient via a facemask for a short surgical procedure [less than 15 mins]

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Primary examination identified in the FRCA examination blueprint on page B-99 or in the Final examination identified in the Final FRCA blueprint on page C72 of Annex C. It is anticipated that the competences listed will be gained throughout CT1/2 without a dedicated period spent in paediatric anaesthesia. It is accepted that not all trainees will have sufficient clinical opportunity to progress beyond direct supervision as the variation in paediatric exposure will differ amongst trainees during CT 1/2. Trainees should take whatever opportunities they can to obtain the skills listed below.


Description

Assessment Methods

GMP

PA_BK_01

Recalls/explains the relevance of the basic sciences specific to children aged 1 year and above [cross ref basic sciences]

A,C,E

1

PA_BK_02

Describes the preoperative assessment and psychological preparation of children aged 1 year and above [and their parents] for surgery

A,C,E

1,3,4

PA_BK_03

Explains the importance of avoiding excessive starvation times

A,C,E

1,2

PA_BK_04

Describes how anaesthesia can be induced for children aged 1 year and above

A,C,E

1

B-57


Description

Assessment Methods

GMP

PA_BK_05

Describes maintenance of anaesthesia for children aged 1 year and above

A,C,E

1

PA_BK_06

Describes how recovery from anaesthesia is managed in children aged 1 year and above

A,C,E

1,2

PA_BK_07

Explains the management of postoperative pain, nausea and vomiting in children

A,C,E

1

PA_BK_08

Describes the management of acute airway obstruction including croup, epiglottitis and inhaled foreign body

A,C,E

1

PA_BK_09

Recalls/explains how blood volume is estimated and how correct solutions and volumes are used for replacement of fluid loss. Particular attention must be given to the risks of hyponatraemia if hypotonic solutions are used for fluid resuscitation

A,C,E

1,2

PA_BK_10

Explains the importance of modification of drug dosages

A,C,E

1,2

PA_BK_11

Describes how pain-relief is provided for children undergoing surgery including the use of common regional techniques [e.g. Caudal epidural, ilioingiunal block]

A,C,E

1

PA_BK_12

Explains the place of premedication, including topical anaesthesia for venepuncture

A,C,E

1

PA_BK_13

Describes paediatric anaesthetic equipment and the differences from adult practice

A,C,E

1

PA_BK_14

Recalls/explains how to calculate tracheal tube sizes and the reasons for its importance; sizing of face masks and airways [oro- and naso-pharyngeal and LMAs]

A,C,E

1,2

PA_BK_15

Explains the choice of breathing systems and the appropriate fresh gas flow rates

A,C,E

1

PA_BK_16

Explains the importance of identifying when upper respiratory tract infections are/are not significant and, as a result, when to cancel operations

A,C,E

1,2,4

PA_BK_17

Explains how to obtain consent for anaesthesia in children

A,C,E

1,3,4

PA_BK_18

Explains the importance of Child Protection regulations and what action must be taken when non-accidental injury is suspected

A,C,E

1,3,4

Assessment Methods

GMP

Skills Competence

Description

PA_BS_01

Undertakes satisfactory preoperative assessment of fit children aged 5 and over

A,D,M

1,3

PA_BS_02

Demonstrates ability to anaesthetise fit children aged 5 and over for elective and urgent minor surgery [including general, ENT, orthopaedic, minor trauma and other non-specialist procedures]. This includes induction, maintenance and recovery

A,D,M

1,2,3

B-58

Skills Competence

Description

Assessment Methods

GMP

A,D,M

1,3

[including management of pain, nausea and vomiting] PA_BS_03

Shows how to manage the environment during the induction of anaesthesia in children

PA_BS_04

Demonstrates ability to secure peripheral venous access in children aged 5 and over

A,D

1

PA_BS_05

Demonstrates ability to perform intraosseous cannulation [S]

D,S

1

PA_BS_06

Demonstrates ability to manage the airway correctly including selection of the correct masks, airways, laryngeal mask airways and tracheal tubes

A,D

1,2

PA_BS_07

Demonstrates ability to perform both intravenous and gaseous induction of general anaesthesia in children

A,D

1,3

PA_BS_08

Demonstrates the management of laryngospasm in children [S]

A,D,S

1,2

PA_BS_09

Demonstrates ability to stabilise and manage the sick or injured child aged 5 or over until senior help arrives [S]

A,M,S

1,2,3,4

PA_BS_10

Demonstrates ability to perform paediatric resuscitation as described by the Resuscitation Council [UK] [S]

D,S

1,2,3,4

PA_BS_11

Shows sensitivity when communicating with children and their parents/carers

A,D,M

1,3,4

PA_BS_12

Shows how to recognise signs leading to suspicion of non-accidental injury or abuse and the correct action

A,D,S

1,2,3,4

Child protection Anaesthetists may encounter children who have suffered physical and/or sexual abuse including resuscitation, intensive care as well as the routine pre-op examination. In all these situations, it is essential that health care professionals, including the anaesthetist, act in the best interests of the child Minimum acceptable learning outcomes:  Knows that Non-Accidental Injury [NAI] of children is not uncommon and is encountered by anaesthetists  Demonstrates knowledge of local procedures for safeguarding children

Knowledge Competence _BK_01

Description

Discusses the importance of knowing that NIA is not uncommon, is encountered by anaesthetists, that they must act in the child’s best interests and that all hospitals must have a written protocol for its management

B-59

Assessment Methods

GMP

C

1,2,3,4

Knowledge Competence _BK_02

_BK_03

Description

Understands the Child Protection procedures in their current hospital situation, who leads the process and how they may be ed [including out of hours] Describes situations in which abuse of children may present to anaesthetists including, but not exclusively, during care of the injured child whose injury cannot be wholly explained by natural circumstances or during the course of routine perioperative anaesthetic care when unusual or unexplained signs which may indicate abuse are found

Assessment Methods

GMP

C

1,3

A,C

1,2,4

_BK_04

Describes signs indicative of a possible need to safeguard the infant, child or young person

C

1,2,3,4

_BK_05

Describes the importance of communicating concerns within the team and asking for senior help and/or paediatrician when appropriate

C

1,2,3,4

_BK_06

Outlines the importance of acting in the best interests of the child throughout any investigation of NAI

C

1,2,3,4

Assessment Method

GMP

Skills Competence

Description

_BS_01

Demonstrates the ability and willingness to clearly communicate concerns, verbally and in writing

C,M

1,2,3 4

_BS_02

Demonstrates the ability to manage the child and parents in a sensitive, appropriate manner

C,M

1,2,3,4

Further information: See e-Learning module on child protection

B-60

Pain medicine Wherever possible, this Basic Level unit of training should occur in a dedicated block. Learning outcomes:  To be competent in the assessment and effective management of acute post-operative and acute non post-operative pain  To acquire knowledge necessary to provide a basic understanding of the management of chronic pain in adults  To recognise the special circumstances in assessing and treating pain in children, the older person and those with communication difficulties  To demonstrate an understanding of the basic principles of post-op analgesia requirements for children, the older person and those with communication difficulties Core clinical learning outcomes:  Competence in the assessment of acute surgical and non surgical pain and demonstrate the ability to treat effectively  To have an understanding of chronic pain in adults



PM_BK_01 PM_BK_02

Description

Recalls the anatomy and physiology of pain medicine to include nociceptive, visceral and neuropathic pain [cross ref basic sciences ] Describes drugs used to manage pain and their pharmacology [including but not limited to opioids, NSAIDs, Coxibs, local anaesthetics and drugs used to manage neuropathic pain]

Assessment methods

GMP

A,C,E

1

A,C,E

1

PM_BK_03

Explains the principles of neural blockade for acute pain management

A,C,E

1,2

PM_BK_04

Describes the methods of assessment of pain

A,C,E

1

PM_BK_05

Explains the relationship between acute and chronic pain

A,C,E

1

PM_BK_06

Describes a basic understanding of chronic pain in adults

A,C,E

1

PM_BK_07

Explains the importance of the biopsychosocial aspects of pain

A,C

1,2

B-61


Description

Assessment methods

GMP

PM_BK_08

Describes the organisation and objectives of an acute pain service

A,C,E

1

PM_BK_09

Explains the limitations of pain medicine

A,C,E

1

Assessment methods

GMP

A

1,2,3,4

Skills Competence

Description

PM_BS_01

Demonstrates the ability to assess manage and monitor acute surgical and non surgical pain and side effects of medication

PM_BS_02

Demonstrates appropriate and safe drug prescribing

A,C

1,2

PM_BS_03

Demonstrates the safe use of equipment used to manage pain including equipment used for PCA, epidurals and inhalational techniques

A,D

1,2

PM_BS_04

Demonstrates the safe and effective use of local anaesthetic peripheral and regional neural blockade techniques

A,D

1,2

PM_BS_05

Demonstrates the ability to manage severe unrelieved acute pain and distress in a timely, safe and effective manner

A,M

1,2,3,4

PM_BS_06

Demonstrates the importance of regular on-going monitoring of pain management/follow up

A,C,M

1,2,3

PM_BS_07

Demonstrates recognition of acute neuropathic pain

C

1

PM_BS_08

Demonstrates the ability to communicate effectively with patients, relatives and carers including advantages, disadvantages and side effects of pain management

C

1,2,3

B-62

Regional It is anticipated that this unit of training will not be delivered as a dedicated block and that the learning outcomes will be gained throughout the duration of Basic Level training and that these should be achievable in most general hospitals at this level. Learning outcomes:  To become competent in all generic aspects of block performance  Able to obtain consent for regional anaesthesia from patients  Create a safe and ive environment in theatre for awake and sedated patients  Demonstrate knowledge of the principles of how to perform a number of regional and local anaesthetic procedures  Be able specifically to perform spinal and lumbar epidural blockade  Be able to perform some simple upper and lower limb peripheral nerve blocks under direct supervision  Be able to use a peripheral nerve stimulator or ultrasound to identify peripheral nerves  Demonstrate clear understanding of the criteria for safe discharge of patients from recovery following surgery under regional blockade  Recognise that they should not attempt blocks until they have received supervised training, and ed the relevant assessments  Accepts the right of patients to decline regional anaesthesia – even when there are clinical advantages Core clinical learning outcome:  Demonstrates safely at all times during performance of blocks including: marking side of surgery and site of regional technique; meticulous attention to sterility; selecting, checking, drawing up, diluting, and the adding of adjuvants, labelling and istration of local anaesthetic agents  Establish safe and effective spinal and lumbar epidural blockade and manage immediate complications in ASA 1-2 patients under distant supervision  Ability to establish a simple nerve block safely and effectively



RA_BK_01

Description

Recalls/describes the anatomy relevant to regional and peripheral blocks identified [Cross ref basic sciences]

B-63

Assessment Methods

GMP

A,C,E

1

Knowledge Description

Assessment Methods

GMP

RA_BK_02

Recalls the relevant physiology and pharmacology [including toxicity of local anaesthetic agents, its symptoms, signs and management, including the use of lipid rescue] [Cross ref basic sciences]

A,C,E

1

RA_BK_03

Recalls the relevant physics and clinical measurement related to the use of nerve stimulators in regional anaesthesia [Cross ref basic sciences; physics and clinical measurement]

A,C,E

1

A,C,E

1

A,C,E

1,

A,C,E

1,2,3,4

A,C,E

1

A,C,D,E

1,2,3,4

A,C,D,E

1

Competence

RA-BK_04

Recalls the relevant basic physics and clinical application of ultrasound to regional anaesthesia [Cross ref basic sciences; physics and clinical measurement] in respect of:  The components of an ultrasound machine  The interaction of ultrasound with tissues  Picture optimisation using hand movements, adjustment of depth, gain and focus Discusses the advantages/disadvantages, risks/benefits and indications/contra-indications of regional blockade

RA_BK_05

Describes how to obtain consent from patients undergoing regional blockade

RA_BK_03A

RA_BK_06

RA_BK_07

RA_BK_08

Outlines the basic functions of an ultrasound machine [including physics [ref Basic Sciences], picture optimisation and probe selection] and how nerves to and in the upper limb can be identified using ultrasound Describes the principles of performing the following regional and local anaesthetic procedures:  Subarachnoid and Lumbar/caudal epidural blockade  Brachial plexus blocks: axillary, interscalene and supraclavicular  Other more distal upper limb blocks [elbow and wrist]  Lower limb blocks [femoral, sciatic and ankle]  Ilio-inguinal nerve blocks/penile blocks  Ophthalmic blocks [Cross reference to ophthalmic anaesthesia]  Intravenous Regional Anaesthesia [IVRA] Demonstrates understanding of the use of continuous epidural infusions and the need to prescribe correctly

RA_BK_09

Recalls/discusses the complications of spinal and epidural analgesia and their management including, but not exclusively, accidental total spinal blockade and accidental dural tap and post-dural puncture headache

A,C,E

1,2,3,4

RA_BK_10

Describes techniques and complications of other blocks listed in RA_BK_07

A,C,E

1,2

RA_BK_11

Shows understanding of the principles of identification of correct anatomy including the use of nerve stimulators and ultrasound [Cross reference Ultrasound]

A,C,D,E

1,2

B-64

Knowledge Description

Assessment Methods

GMP

RA_BK_12

Outlines the dangers of accidental intravenous istration of local anaesthetic drugs, signs, symptoms and management, including the role of lipid emulsion

A,C,E

1,2,3,4

RA_BK_13

Outlines the management of incomplete or failed regional blockade including, where appropriate, the use of rescue blocks

A,C,D,E

1,2,3,4

RA_BK_14

Demonstrates understanding of the methods of sedation used in conjunction with regional anaesthesia

A,C,D,E

1,2,3,4

RA_BK_15

Recalls/describes absolute and relative contraindications to regional blockade

A,C,E

1,2,3,4

RA_BK_16

Outlines the possible effects regional blockade will have on the patient, list and the theatre staff and how these may be managed

A,C,E

1,2,3,4

RA_BK_17

Lists the advantages and disadvantages of regional anaesthetic techniques for post-operative analgesia

A,C,E

1,2

A,C,E

1,2,3,4

A,C,E

1,2,3

A,C,E

1,2,3,4

A,C,E

1,2,3,4

A,C,E

1

Competence

RA_BK_18 RA_BK_19 RA_BK_20 RA_BK_21

RA_BK_22

Describes the problems and solutions to obtaining adequate post-operative analgesia in the ward or home [if discharged] setting when the regional anaesthetic wears off Understands the need to review patients or patient following regional anaesthetic techniques to ensure block has worn off and there are no residual complications Understand the necessity to document the procedure and any complications e.g. paraesthesia, vascular puncture, pneumothorax and record images / video clip if using ultrasound where appropriate or indicated Be aware of the use of information leaflets in the decision making process and in the reporting of problems or complications following discharge Recalls the relevant basic physics and clinical application of ultrasound to regional anaesthesia [Cross ref basic sciences; physics and clinical measurement] in respect of:  The components of an ultrasound machine  The interaction of ultrasound with tissues  Picture optimisation using hand movements, adjustment of depth, gain and focus

Skills Competence

Description

Assessment Method

GMP

RA_BS_01

Obtains valid consent for regional blockade, including confirmation and marking of side of operation and site or regional technique where indicated

A,D

1,2,3,4

B-65

Skills Competence

RA_BS_02 RA_BS_03 RA_BS_04 RA_BS_05

Description

Demonstrates safe and correct checking of the contents of epidural / spinal packs Practices safely including: meticulous attention to sterility during performance of blockade; selecting, checking, drawing up, diluting, adding adjuvants, labelling and istration of local anaesthetic agents Demonstrates how to undertake a comprehensive and structured pre-operative assessment of patients requiring a subarachnoid blockade, perform the block and manage side effects/complications correctly Demonstrates how to undertake a comprehensive and structured pre-operative assessment of patients requiring a lumbar epidural blockade, perform the block and manage side effects/complications correctly

Assessment Method

GMP

A,D

1,2

A,C,D

1,2,3,4

A,C,D

1,2,3,4

A,C,D

1,2,3,4

RA_BS_06

Recognises which patients are unsuitable for regional blockade

A,C

1,2,3,4

RA_BS_07

Recognises patients in whom a block would be difficult to perform

A,C

1,2,4

RA_BS_08

Demonstrates the management of hypotension, nausea, anxiety and shivering induced by spinal or epidural blockade

A,C,D

1,2,3,4

RA_BS_09

Demonstrates correct post-operative care following spinal or epidural block

A,C,D

1,2,3,4

RA_BS_10

Demonstrates how to use epidural techniques for post-operative pain management

A,C,D

1,2

A,C,D

1,2,3,4

A,C,D

1,2,3,4

RA_BS_12

Demonstrates how to perform some simple nerve blocks from amongst the following:  Femoral  Ankle  Elbow, wrist and or digital  Rectus sheath  Inguinal  Intercostal  Infiltration techniques Shows how to use sedation correctly during surgery under regional blockade

RA_BS_13

Manages patients with combined general and regional anaesthesia

A,C,D

1,2,3,4

RA_BS_14

Shows consideration for the views of patients, surgeons and theatre team with regard to surgery under regional blockade

A,C,D

1,3,4

RA_BS_15

Shows the ability to correctly manage the theatre environment with an awake or sedated patient

A,C,D

1,2,3,4

RA_BS_16

Demonstrates list planning to allow time for the conduct of a block and for it to take effect

A,C,D

1,2,3,4,

RA_BS_17

Shows good communication skills towards the patients and staff during the use of regional blockade

A,C,D

3,4

RA_BS_18

Shows due care and sensitivity to the patient’s needs during performance of regional block

A,C,D

1,2,3,4

RA_BS_11

B-66

Skills Competence

Description

Assessment Method

GMP

RA_BS_19

Demonstrates how to identify peripheral nerves using basic ultrasound technology [e.g. the median, radial and ulnar in the arm]

A,C,D

1

B-67

Sedation The use of sedation in clinical practice, particularly in non-theatre areas, is increasing and anaesthetists are frequently asked to oversee its istration. It is essential that CT 1/2 anaesthetic trainees understand what is meant by conscious sedation [“A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal with the patient is maintained throughout the period of sedation”] and how it is istered safely. Learning outcomes:  To gain a fundamental understanding of what is meant by conscious sedation and the risks associated with deeper levels of sedation  To be able to describe the differences between conscious sedation and deeper levels of sedation, with its attendant risks to patient safety  Understands the particular dangers associated with the use of multiple sedative drugs especially in the elderly  To be able to manage the side effects in a timely manner, ensuring patient safety is of paramount consideration at all times  To be able to safely deliver pharmacological sedation to appropriate patients and recognise their own limitations Core clinical learning outcome:  Provision of safe and effective sedation to ASA 1 and 2 adult patients, aged less than 80 years of age using a maximum of two short acting agents



Description

Assessment Methods

GMP

CS_BK_01

Can explain:  What is meant by conscious sedation and why understanding the definition is crucial to patient safety  The differences between conscious sedation and deep sedation and general anaesthesia  The fundamental differences in techniques /drugs used /patient safety  That the significant risks to patient safety associated with sedation technique requires meticulous attention to detail, the continuous presence of a suitably trained individual with responsibility for patient safety, safe monitoring and contemporaneous record keeping

A,D,E

1,2,3

CS_BK_02

Describes the pharmacology of drugs commonly used to produce sedation

A,C,E

1

B-68


Description

Assessment Methods

GMP

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2,3

A,C,E

1,2,3,4

CS_BK_06

Explains the need for and means of monitoring the sedated patient including the use of commonly used sedation scoring systems Describes how drugs should be titrated to effect and how the use of multiple drugs with synergistic actions can reduce the therapeutic index and hence the margin of safety Describes the importance of recognising the following when multiple drug techniques are employed:  Increased potential for adverse outcomes when two or more sedating/analgesic drugs are istered  The importance of titrating multiple drugs to effect whilst recognising that the possibility of differing times of onset, peak effect and duration, can result in an unpredictable response  Knowledge of each drugs time of onset, peak effect, duration of action and potential for synergism Can list which sedative drugs should not be given to the elderly [over 80 years of age], with reasons

CS_BK_07

Can explain the minimal monitoring required during pharmacological sedation

A,C,E

1

CS_BK_08

Describes the indications for the use of conscious sedation

A,C,E

1,2

CS_BK_09

Describes the risks associated with conscious sedation including [but not exclusively] those affecting the respiratory and cardiovascular systems

A,C,E

1,2

CS_BK_10

Can explain the use of single drug, multiple drug and inhalation techniques

A,C,E

1,2

CS_BK_11

Describes the particular risks of multiple drug sedation techniques

A,C,E

1,2,3

CS_BK_12

Outlines the unpredictable nature of sedation techniques in children [Cross ref paediatrics]

A,C,E

1,2,3

CS_BK_13

Explains the need for robust recovery and discharge criteria when conscious sedation is used for out-patient procedures and the importance of ensuring appropriate escort arrangements are in place [Cross ref day surgery]

A,C,E

1,2,3

Assessment Method

GMP

A,C,D

1,2,3

CS_BK_03 CS_BK_04

CS_BK_05

Skills Competence

Description

CS_BS_01

Demonstrates the ability to select patients for whom sedation is an appropriate part of clinical management

CS_BS_02

Demonstrates the ability to explain sedation to patients and to obtain consent

A,D

1,2,3

CS_BS_03

Demonstrates the ability to ister and monitor inhalational sedation to patients for clinical procedures [Cross ref obstetrics]

A,D

1,2,3

B-69

Skills Competence

Description

Assessment Method

GMP

CS_BS_04

Demonstrates the ability to ister and monitor intravenous sedation to patients for clinical procedures

A,D

1,2,3

CS_BS_05

Demonstrates the ability to recognise and manage the complications of sedation techniques appropriately, including recognition and correct management of loss of verbal responsiveness

A,D

1,2,3

B-70

Transfer Medicine The learning outcomes and competencies listed are those necessary for the first 24 months of anaesthetic training. It is strongly recommended that CT 1/2 trainees complete this unit of training before undertaking intra-hospital transfer with distant supervision. Many of the competencies may be attained whilst gaining training and experience in intensive care. Learning outcomes:  Correctly assesses the clinical status of patients and decides whether they are in a suitably stable condition to allow intra-hospital transfer [only]  Gains understanding of the associated risks and ensures they can put all possible measures in place to minimise these risks Core clinical learning outcome:  Safely manages the intra-hospital transfer of the critically ill but stable adult patient for the purposes of investigations or further treatment [breathing spontaneously or with artificial ventilation] with distant supervision



Description

Assessment Methods

GMP

TF_BK_01

Explains the importance of ensuring the patient’s clinical condition is optimised and stable prior to transfer

A,C,E

1,2

TF_BK_02

Explains the risks/benefits of intra-hospital transfer

A,C,E

1,2

TF_BK_03

A,C,E A,C,E

1,2,3

TF_BK_04

Recalls/describes the minimal monitoring requirements for transfer Lists the equipment [and back up equipment] that is required for intra-hospital transfer

TF_BK_05

Outlines the physical hazards associated with intra-hospital transfer

A,C,E

1,2

TF_BK_06

Explains the problems caused by complications arising during transfer and the measures necessary to minimise and pre-empt difficulties

A,C,E

1

TF_BK_07

Outlines the basic principles of how the ventilators used for transfer function

A,C,E

1

TF_BK_08

Indicates the lines of responsibility that should be followed during transfer

A,C,E

1,2,3

B-71

1,2


Description

Assessment Methods

GMP

TF_BK_09

Outlines the consent requirements and the need to brief patients in transfer situations

A,C,E

1,2,3,4

TF_BK_10

Outline the issues surrounding the carrying/recording of controlled drugs during transfer

A,C,E

1,2,3

TF_BK_11

Describes the importance of keeping records during transfer

A,C,E

1

TF_BK_12

Outlines the problem of infection and contamination risks when moving an infected patient

A,C,E

1,2

TF_BK_13

Explains how to assess and manage an uncooperative and aggressive patient during transfer

A,C,E

1,2,3,4

TF_BK_14

Understands hospital protocols governing transfer of patients between departments

A,C,E

1

TF_BK_15

Outlines the importance of maintaining communication, when appropriate with the patient and of the transfer team.

A,C,E

1,2

Assessment Methods

GMP

Skills Competence

Description

TF_BS_01

Demonstrates the necessary organisational and communication skills to plan, manage and lead the intra- hospital transfer of a stable patient

A,M

1,2,3,4

TF_BS_02

Demonstrates how to set up the ventilator and confirm correct functioning prior to commencing transfer

A,D

1,2

TF_BS_03

Demonstrates safety in securing the tracheal tube securely prior to commencing the movement/transfer

A,D

1,2

TF_BS_04

Demonstrates the ability to calculate oxygen and power requirements for the journey

A,D

1,2

TF_BS_05

Demonstrates safety in securing patient, monitoring and therapeutics before transfer

A,D

1,2,3,4

TF_BK_06

Demonstrates how to check the functioning of drug delivery systems

A,D

2,3

TF_BS_07

Demonstrates appropriate choices of sedation, muscle relaxation and analgesia to maintain the patient’s clinical status during transfer

A,C,D,M

1,2

TF_BS_08

Demonstrates the ability to maintain monitoring of vital signs throughout transfer

A,D

1,2

TF_BS_09

Demonstrates the ability to maintain clinical case recording during transfer

C,M

1

B-72

Trauma and stabilisation It is anticipated that this unit of training will not be delivered as a dedicated block; the learning outcomes will be gained throughout Basic Level training and that this level should be achievable in most general hospitals. Learning outcomes:  To understand the basic principles of how to manage patients presenting with trauma  To recognise immediate life threatening conditions and prioritise their management Core clinical learning outcome:  Understands the principles of prioritizing the care of patients with multi-trauma including airway management



MT_BK_01

Description

Explains the principles of the primary and secondary survey in trauma patients

Assessment Methods

GMP

A,C,E

1,2,3

A,C,E

1

A,C,E

1

MT_BK_03

Recalls/describes the related anatomy, physiology and pharmacology [cross reference Basic anatomy, physiology and pharmacology sections] Recalls/describes the pathophysiological changes occurring in the trauma patient

MT_BK_04

Explains the importance of early recognition of and the potential for airway compromise

A,C,E

1,2

MT_BK_05

Explains the importance of correct airway management in the trauma patient

A,C,E

1,2

MT_BK_06

Describes how to recognise and correctly manage hypovolaemia and other causes of shock

A,C,E

1

A,C,E

1,2

A,C,E

1,2

MT_BK_02

MT_BK_07 MT_BK_08

Recalls/describes the indications for invasive cardiovascular monitoring, the relevant anatomy, principles of placement, associated complications and principles of their management Recalls/discusses the effects of hypothermia, the reasons for its prevention and methods available in trauma patients

B-73


Description

Assessment Methods

GMP

A,C,E

1,2,3

A,C,E

1

MT_BK_10

Explains the importance of correct pain relief in the trauma patient and methods used [from Emergency Dept to postoperatively] Discusses the options available for intravenous access in trauma patients including the intraosseous route

MT_BK_11

Understands the importance of preventing hypothermia and acidosis in the trauma patient

A, C, E

1,2,3

MT_BK_12

Describes the correct initial investigations required in the trauma patient

A,C,E

1

MT_BK_13

Describes the imaging requirements in the emergency room [Cross Ref; non-theatre]

A,C,E

1,2

A,C,E

1,2

A,C,E

1

A,C,E

1,2

A,C,E

1,2,3,4

A,C,E

1,2,3,4

Assessment Methods

GMP

MT_BK_09

MT_BK_14 MT_BK_15

Recalls/explains the principles of assessment and management of patients with brain injury [including the use of the Glasgow Coma Scale [GCS] ] Describes the causes and mechanisms for the prevention of secondary brain injury

MT_BK_17

Outlines the particular problems associated with patients presenting with actual or potential cervical spine injuries particularly airway management Describes the principles of the perioperative management of the trauma patient

MT_BK_18

Describes how to manage intra-hospital transfer of trauma patients [Cross Ref: transfer medicine ]

MT_BK_16

Skills Competence

Description

MT_BS_01

Demonstrates how to perform the Primary survey in a trauma patient [S]

A,D,S

1,2

MT_BS_02

Demonstrates correct emergency airway management in the trauma patient including those with actual or potential cervical spine damage [S]

A,D,S

1,2

MT_BS_03

Demonstrates how to manage a tension pneumothorax [Cross Ref: critical incidents] [S]

A,D,S

1

MT_BS_04

Demonstrates how to insert a chest drain [S]

D,S

1

MT_BS_05

Demonstrates assessment of patients with brain injury including the use of the GCS [cross ref Neuroanaesthesia] [S]

A,D,S

1,2

MT_BS_06

Demonstrates the initial resuscitation of patients with trauma and preparation for further interventions including, emergency surgery

A,D

1,2,3,4

MT_BS_07

Demonstrates provision of safe perioperative anaesthetic management of ASA 1 and 2 patients with multiple trauma

A,C,D

1,2,3,4

B-74

Skills Competence

Description

MT_BS_08

Demonstrates how to perform a secondary survey in a trauma patient

MT_BS_09

Demonstrates the ability to undertake intra-hospital transfer of patients from the Emergency Dept for further management [e.g. to imaging suite, theatre and/or intensive care] [Cross Ref; transfer medicine]

B-75

Assessment Methods

GMP

A, D, S

1,2

A,D

1,2,3,4

Basic sciences to underpin anaesthetic practice Learning Outcomes:    

To gain a good understanding of human anatomy relevant to the safe practice of anaesthesia at basic level and to progress to intermediate level training To acquire a sound understanding of human physiology, biochemistry and pharmacology, and to be able to apply this to clinical practice at a basic level and to progress to intermediate training. To gain a good understanding of the basic principles of physics and clinical measurement; emphasis is on the function of monitoring equipment, equipment safety, and measurement techniques. To gain a good understanding of physiological and pharmacological consequences of ageing.


Anatomy Competence

Description

Assessment Methods

GMP

Demonstrates knowledge of:

Respiratory system A,C,E

1

AN_BK_02

Mouth, nose, pharynx, larynx, trachea, main bronchi, segmental bronchi, structure of the bronchial tree; age-related changes from the neonate to the adult Airway / respiratory tract blood supply and innervation

A,C,E

1

AN_BK_03

Pleura [including surface anatomy], mediastinum and its contents

A,C,E

1

AN_BK_04

Lungs; lobes and microstructure of lungs

A,C,E

1

AN_BK_05

Diaphragm, other muscles of respiration including innervation

A,C,E

1

AN_BK_06

The thoracic inlet and 1st rib

A,C,E

1

AN_BK_07

Interpretation of the normal adult chest x-ray

A,C,E

1

AN_BK_01

Cardiovascular system

B-76

Anatomy Competence

Description

Assessment Methods

GMP


AN_BK_08

Heart - chambers, valves, conducting system and pericardium; blood supply and innervation

A,C,E

1

AN_BK_09

Great vessels, main peripheral arteries and veins

A,C,E

1

Nervous system AN_BK_11

Brain and its subdivisions; blood supply

A,C,E

1

AN_BK_12

Spinal cord, structure of spinal cord, major ascending and descending pathways; blood supply

A,C,E

1

AN_BK_13

Anatomical organisation of pain and sensory pathways from the periphery to the central nervous system

A,C,E

1

AN_BK_14

Pain pathways relevant to the stages of obstetric labour and delivery

A,C,E

1

AN_BK_15

Spinal meninges, subarachnoid and extradural space; contents of extradural space

A,C,E

1

AN_BK_16

Anatomy of CSF system

A,C,E

1

AN_BK_17

Spinal nerves; dermatomes; applied knowledge of dermatomes in regional anaesthesia

A,C,E

1

AN_BK_18

Brachial plexus; nerves of the upper limb

A,C,E

1

AN_BK_19

Intercostal nerves

A,C,E

1

AN_BK_20

Nerves of the abdominal wall including innervation of the inguinal region

A,C,E

1

AN_BK_21

Lumbar and sacral plexuses; nerves of the lower limb

A,C,E

1

AN_BK_22

Anatomical organisation of the autonomic nervous system. [See also PR_BK_21]

A,C,E

1

AN_BK_23

Sympathetic innervation, sympathetic chain, ganglia and plexuses

A,C,E

1

AN_BK_24

Parasympathetic innervation; cranial and sacral outflow

A,C,E

1

AN_BK_25

Stellate ganglion

A,C,E

1

AN_BK_26

Cranial nerves

A,C,E

1

AN_ BK_27

Innervation of the pharynx and larynx

A,C,E

1

AN_BK_28

Eye and orbit

A,C,E

1

Endocrine system AN_BK_29

Functional anatomy of the hypothalamic/pituitary system

A,C,E

1

AN_BK_30

Functional anatomy of the adrenal gland

A,C,E

1

B-77

Anatomy Competence

Description

Assessment Methods

GMP


AN_BK_31

Functional anatomy of the thyroid and parathyroid glands

A,C,E

1

AN_BK_32

Anatomical organisation of the endocrine pancreas

A,C,E

1

Vertebral column AN_BK_33

Cervical, thoracic and lumbar vertebrae

A,C,E

1

AN_BK_34

Sacrum, sacral hiatus

A,C,E

1

AN_BK_35

Ligaments of vertebral column

A,C,E

1

AN_BK_36

Surface anatomy of vertebral spaces; length of spinal cord and subarachnoid space; age-related differences from the neonate to the adult

A,C,E

1

Surface anatomy AN_BK_37

Structures in the antecubital fossa

A,C,E

1

AN_BK_38

Structures in the axilla: landmarks for identifying the brachial plexus in the neck and axilla

A,C,E

1

AN_BK_39

Large veins of the neck and the anterior triangle of the neck; surface anatomy and ultrasound demonstrated anatomy relevant to insertion of central venous cannulae

A,C,E

1

AN_BK_40

Large veins of the leg and femoral triangle

A,C,E

1

AN_BK_41

Arteries of the upper and lower limbs

A,C,E

1

AN_BK_42

Landmarks for performance of cricoid pressure and surgical airway procedures

A,C,E

1

AN_BK_43

Landmarks for insertion of intercostal drainage catheters

A,C,E

1

Pharmacology Competence

Description

GMP

Demonstrates knowledge of: PR_BK_01

Organic chemistry: drugs as organic molecules: types of intermolecular bonds; interactions between molecules; organic compared with inorganic compounds; bond strength; important atomic constituents: C, N, O, P, S and halides

A,C,E

1

PR_BK_02

Organic chemistry: ionization of molecules: type of groups that ionize: amides, hydroxyl, carboxyl. Oxidation and reduction.

A,C,E

1

B-78


Description

GMP

Demonstrates knowledge of: Permanently charged [quaternary ammonium] drugs. PR_BK_03

Drug chemistry: solubility, partition coefficients and movement of drugs through membranes: Lipid solubility; influence of pKa and pH; partition coefficients. ive and active transport mechanisms

A,C,E

1

PR_BK_04

Isomers: structural and stereoisomers: classification systems; clinical relevance

A,C,E

1

PR_BK_05

Mechanisms of drug action: physicochemical; pharmacodynamic; pharmacokinetic: drug-receptor interactions; doseresponse and log[dose]-response curves; agonists, partial agonists, antagonists. Reversible and irreversible antagonism. Potency and efficacy

A,C,E

1

PR_BK_06

Non-specific drug actions: Physicochemical mechanisms: e.g. adsorption; chelation; neutralization

A,C,E

1,2

A,C,E

1,2

A,C,E

1

A,C,E

1

A,C,E

1

A,C,E

1

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2

A,C,E

1

PR_BK_07 PR_BK_08 PR_BK_09 PR_BK_10 PR_BK_11 PR_BK_12 PR_BK_13 PR_BK_14 PR_BK_15 PR_BK_16

Voltage-gated ion channels; membrane-bound transport pumps. Sodium, potassium and calcium channels as targets for drug action Receptors as proteins; ion channels; transmembrane transduction and intermediate messenger systems; intracellular/nuclear receptors. Receptor regulation and tachyphylaxis Transduction systems as receptors: G-protein coupled receptors [GPCRs] and non-GPCR systems. Nuclear receptors: Intracellular hormone receptors. e.g. cytoplasmic receptors for steroids; corticosteroids vs. mineralocorticoid receptors Enzymes as drug targets: Michaelis-Menten kinetics. Direct and allosteric mechanisms. e.g. acetylcholinesterase; cyclooxygenase; phosphodiesterase Anticholinesterases: Classification of drugs that inhibit acetylcholinesterase and plasma cholinesterase including organophosphates Predictable side effects of drugs: non-selective actions of drugs; action at multiple receptors; multiple anatomical locations; predictable enzyme induction-inhibition Idiosyncratic side effects of drugs: e.g. blood and bone-marrow dyscrasias; pulmonary fibrosis; anti-platelet effects. Anaphylactic and anaphylactoid reactions: comparison; treatment; identification of responsible drug; risks with polypharmacy Tachyphylaxis and tolerance: Examples of drugs demonstrating tachyphylaxis; proposed mechanisms. Opioid dependence and tolerance Drug interactions: Types of interaction: synergism, additivity, antagonism; isobolograms. Classification of mechanisms of drug

B-79


Description

GMP

Demonstrates knowledge of: interaction PR_BK_17

PR_BK_18 PR_BK_19

PR_BK_20

Pharmacokinetics: general principles: absorption, distribution and redistribution; elimination, excretion. Chemical properties of drugs and their pharmacokinetics: blood-brain-barrier and placental barrier. Protein binding: plasma and tissue. Body compartments; adipose and vessel-poor tissue. Bioavailability; clearance istration and absorption: routes of istration; first- metabolism and bioavailability. Selection of appropriate route. Drug delivery systems: e.g. sustained release, enteric coated, transdermal patch and iontophoretic systems Oral istration: Time-course for systemic appearance; factors e.g. pKa, lipid solubility, active transport. Bioavailability of drugs given orally and its measurement Drug elimination from plasma. Mechanisms: distribution; metabolism; excretion: exhalation; renal; biliary; sweat; breast milk. Factors affecting e.g.: pathological state: renal and hepatic failure; age, including extremes of age; gender; drug interactions. Active and inactive metabolites; pro-drugs. Enzyme induction and inhibition

A,C,E

1

A,C,E

1

A,C,E

1

A,C,E

1,2

PR_BK_21

Non-enzymatic drug elimination: Hofmann degradation

A,C,E

1

PR_BK_22

Pharmacokinetic modelling: types of models available: one, two and three-compartment models; non-compartmental; physiological. Pharmacokinetic parameters: volume of distribution, half-life and time constant, clearance

A,C,E

1,2

PR_BK_23

Context-sensitive half-time: comparison of drugs e.g. propofol, fentanyl and remifentanil. Target-controlled infusions [TCI]

A,C,E

1

PR_BK_24

TCI in practice: accuracy, applicability, cost. Variations due to patient differences: predictable and unpredictable

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2

A,C,E

1

A,C,E

1,2

A,C,E

1

PR_BK_25 PR_BK_26

PR_BK_27

PR_BK_28 PR_BK_29

Differences in patient response to therapy: gender; pathology; polypharmacy; in particular, changes occurring with increasing age Pharmacogenetics: pharmacokinetic variation e.g. pseudocholinesterase; acetylation; CYP450 variants. Poor and fast metabolizers; racial and geographic distribution of common abnormal genes Volatile and gaseous anaesthetic agents: Structure of available agents. MAC. Clinical effects: CNS [including I], CVS, RS. Unwanted effects of individual agents. MH susceptibility; hepatitis risks. Factors affecting onset and offset time. Oil/gas partition coefficient Intravenous anaesthetic agents: Chemical classes. Properties of an ideal induction agent. Adverse effects on CNS [including effects on I], CVS, RS; pharmacokinetics including metabolism Mechanisms of general anaesthetic action

B-80


Description

GMP

Demonstrates knowledge of: PR_BK_30 PR_BK_31

PR_BK_32 PR_BK_33 PR_BK_34 PR_BK_35 PR_BK_36 PR_BK_37

PR_BK_38

PR_BK_39 PR_BK_40

PR_BK_41

PR_BK_42

Benzodiazepines: classification of action. Clinical actions. Synergism with anaesthetic agents. Antidote in overdose Local anaesthetic agents. Additional effects, including anti-arrhythmic effects. Mechanism of action. Clinical factors influencing choice: operative site, patient, available agents. Toxicity syndrome; safe clinical and maximum clinical doses; treatment of overdose Analgesics. Simple analgesics, NSAIDs and opioids. Available routes of istration; peri-operative prescribing; chronic compared with acute pain prescribing Aspirin and paracetamol. Comparison of structures; indications and contraindications; mechanisms of action. Bioavailability; metabolism; toxicity Non-steroidal anti-inflammatory analgesics: Classification. Mechanism of action. Clinical effects and uses; unwanted effects, contraindications Opioid analgesics: Receptor classification. Mechanism of action. Inhibitory effects, sites of action on pain pathways. Unwanted effects. Full and partial agonists and partial agonists. Routes of istration Muscle relaxants. Classification. Sites of action. Properties of an ideal muscle relaxant. Dantrolene and management of MH Depolarizing muscle relaxants: Structure, mechanism of action. Organophosphate poisoning. Adverse effects and contraindications Non-depolarizing muscle relaxants: Structural classification; sub-classification according to onset-time and duration of action. General comparison of aminosteroids and bisbenzyisoquinoliniums. Comparison of individual agents; metabolism and active metabolites. Unwanted effects. Reversal of neuromuscular blockade: Indications for use; mechanisms of action; clinically unwanted effects of reversal of neuromuscular blockade Drugs and the autonomic nervous system: anatomy; myelinated and unmyelinated nerves; ganglia and rami communicantes. Neurotransmitters. Sites at which drugs can interfere with autonomic transmission Drugs and the sympathetic nervous system: adrenergic receptors and molecular mechanisms of action: Indications for pharmacological use of naturally occurring catecholamines and synthetic analogues. Other classes of drugs active in the sympathetic system: e.g. MAOIs: Drugs and the parasympathetic nervous system: nicotinic and muscarinic receptors with subgroups. Mechanism of action. Agonists, antagonists. Comparison of available drugs. Hyoscine and antiemesis

B-81

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2

A,C,E

1

A,C,E

1,2

A,C,E

1,2


Description

GMP


Cardiovascular system: general: drug effects on the heart [inotropy and chronotropy] and on the circulation: arterial and venous effects; systemic and pulmonary effects

A,C,E

1

PR_BK_44

Inotropes and pressors: Classification; site of action. Synthetic inotropes compared with adrenaline

A,C,E

1,2

PR_BK_45

Drugs used in ischaemic heart disease: Classification of drugs used. Mechanisms of drug action. Unstable angina

A,C,E

1,2

PR_BK_46

Antiarrhythmics: Classification. Indications for use, including use in resuscitation

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2

PR_BK_47 PR_BK_48

Hypotensive agents: Classes of drugs to produce acute hypotension in theatre. Therapeutic antihypertensive agents: classification according to mechanism of action. Adverse effects of drugs in each class Anticoagulants: oral and parenteral. Sites of action; indications use; monitoring effect. Comparison of heparins: unfractionated and fractionated. Newer anticoagulants

PR_BK_49

Antiplatelet agents. Perioperative management of antiplatelet medication

A,C,E

1,2

PR_BK_50

Pro-coagulants: Drugs. Individual factor concentrates; multi-factor preparations including FFP; vitamin K

A,C,E

1,2

PR_BK_51

Colloids, including blood and blood products: Composition of preparations; safe use and avoidance of errors

A,C,E

1,2

A,C,E

1,2

A,C,E

1,2

PR_BK_52 PR_BK_53

Crystalloid fluids: Composition; suitable fluids for maintenance and replacement of losses. Comparison with colloids; unwanted effects Respiratory system: general: Classes of drugs acting on the respiratory tract including bronchodilators; oxygen; surfactant; mucolytics; pulmonary vasodilators. Methods of istration; indications for use; mechanisms of action; adverse effects

PR_BK_54

Respiratory system: drugs used in acute severe asthma and chronic asthma; volatile agents. Mechanisms of action

A,C,E

1,2

PR_BK_55

Gastrointestinal system: general: antisialogogues; drugs reducing gastric acidity; drug effects on the GI tract including gastric and bowel motility

A,C,E

1,2

PR_BK_56

Antiemetics: Anatomical sites for antiemetic action; central and peripheral inputs to vomiting centre; use of dexamethasone

A,C,E

1,2

PR_BK_57

Renal system: diuretics: Classification of diuretics. Unwanted effects; indications for use

A,C,E

1,2

PR_BK_58

CNS: antiepileptic agents: Mechanisms of action; unwanted side effects

A,C,E

1,2

PR_BK_59

CNS: antidepressants: Classes of drug: anaesthetic relevance

A,C,E

1,2

PR_BK_60

Therapy for diabetes mellitus: Drugs used in type 1 and type 2 diabetes: Insulins: classification of types available; routes of istration; perioperative management. Unwanted effects and risks and therapy of hypo- or hyperglyaemia

A,C,E

1,2

B-82


Description

GMP


Hormones: corticosteroids: Indications for use; clinical effects; long-term complications of glucocorticoid use

A,C,E

1,2

PR_BK_63

Hormones: treatment of thyroid disorders: Synthesis and release of thyroid hormones. Preparations used in hyper- and hypothyroidism

A,C,E

1,2

PR_BK_64

CNS stimulants; classes, mechanisms of action, uses in anaesthesia

A,C,E

1,2

PR_BK_65

RS stimulants including theophyllines, doxapram

A,C,E

1,2

PR_BK_66

Antimicrobial agents: general classification: Types of antimicrobial agents: antiviral; antibacterial; antifungal; bacteriostatic and bacteriocidal. Mechanism of action. Indications for use of different classes of antibiotics. Bacterial resistance

A,C,E

1,2

PR_BK_67

Effects of drugs on the eye and vision; includes intra-ocular pressure

A,C,E

1.2

PR_BK_68

Social drugs including tobacco, alcohol and non-legal drugs: anaesthetic relevance

A,C,E

1.2

Assessment Methods

GMP

Physiology and Biochemistry Competence

Description

Demonstrates knowledge of: GENERAL

PB_BK_01

Organization of the human body and control of internal environment

A,C,E

1

PB_BK_02a

Changes at birth and in early life

A,C,E

1

PB_BK_02b

Changes with advancing age

A,C,E

1

PB_BK_03

Cells; components and organelles

A,C,E

1

PB_BK_04

Function of cells; genes and their expression

A,C,E

1

PB_BK_05

Cell membrane characteristics; cell junctions, receptors

A,C,E

1

PB_BK_06

Protective mechanisms of the body

A,C,E

1

BIOCHEMISTRY

B-83


Description

Assessment Methods

GMP


PB_BK_07

Definition of pH. Strong and weak acids.

A,C,E

1

PB_BK_08

Acid base balance. Includes buffers, Henderson-Hasselbalch equation and anion gap

A,C,E

1

A,C,E

1

+

+

++

++

-

HCO3-

PB_BK_09

Ions e.g. Na , K , Ca , Mg , Cl ,

PB_BK_10

Cellular metabolism; aerobic vs anaerobic

A,C,E

1

PB_BK_11

Enzymes

A,C,E

1

BODY FLUIDS AND THE FUNCTIONS AND CONSTITUENTS

PB_BK_12

Capillary dynamics and interstitial fluid; osmosis, filtration and convection

A,C,E

1

PB_BK_13

Osmolarity: osmolality, partition of fluids across membranes, tonicity

A,C,E

1

PB_BK_14

Lymphatic system

A,C,E

1

PB_BK_15

Special fluids especially cerebrospinal fluid: also pleural, pericardial and peritoneal fluids

A,C,E

1

PB_BK_16

Active cellular transport mechanisms

A,C,E

1

A,C,E

1

A,C,E

1

PB_BK_19

Blood: physical properties, components, functions Red blood cells: production and turnover, haematinics, haemoglobin and its variants including abnormal haemoglobins eg thalassaemia, HbS Anaemia: acute and chronic adaptations – Iron absorption, transportation, metabolism

A,C,E

1

PB_BK_20

Polycythaemia: causes and implications

A,C,E

1

PB_BK_21

Blood groups: ABO, Rhesus, others

A,C,E

1

PB_BK_22

Transfusion reactions; rhesus incompatibility

A,C,E

1

PB_BK_23

Haemostasis and coagulation, fibrinolysis – including abnormalities, congenital and acquired

A,C,E

1

PB_BK_24

Alternative oxygen carrying solutions

A,C,E

1

PB_BK_25

White blood cells: types, origins, characteristics, turnover

A,C,E

1

PB_BK_26

The inflammatory response, systemic inflammatory responses, hypersensitivity reactions

A,C,E

1

PB_BK_27

Immunity and allergy; innate vs acquired, non-specific vs specific, humoral vs cellular

A,C,E

1

HAEMATOLOGY AND IMMUNOLOGY

PB_BK_17 PB_BK_18

B-84


Description

Assessment Methods

GMP

A,C,E

1


PB_BK_28

Immunodeficiency – congenital and acquired MUSCLE

PB_BK_29

Action potential generation and its transmission

A,C,E

1

PB_BK_30

Neuromuscular junction and transmission, motor end-plate

A,C,E

1

PB_BK_31

Disturbances of neuromuscular transmission

A,C,E

1

PB_BK_32

Myopathies – congenital and acquired

A,C,E

1

PB_BK_33

Muscle contracture – malignant hyperthermia, myoclonus, burns

A,C,E

1

PB_BK_34

Muscle types; skeletal, smooth, cardiac

A,C,E

1

PB_BK_35

Skeletal muscle excitation-contraction coupling

A,C,E

1

PB_BK_36

Smooth muscle contraction: sphincters

A,C,E

1

PB_BK_37

Motor unit concept

A,C,E

1

HEART/CIRCULATION

PB_BK_38

Cardiac muscle contraction

A,C,E

1

PB_BK_39

The cardiac cycle: pressure volume relationships, work and power

A,C,E

1

PB_BK_40

Rhythmicity of the heart; cardiac impulse generation

A,C,E

1

PB_BK_41

Regulation of cardiac function; general and cellular

A,C,E

1

PB_BK_42

Control of cardiac output [including Starling relationship]

A,C,E

1

PB_BK_43

Fluid challenge and heart failure, types of shock

A,C,E

1

PB_BK_44

Electrocardiogram and arrhythmias, origin of ECG, effects of temperature, ischaemia, infarction and electrolyte imbalance

A,C,E

1

PB_BK_45

Neurological and humoral control of systemic blood pressures, blood volume and blood flow [at rest and during physiological disturbances e.g. exercise, haemorrhage and Valsalva manoeuvre]

A,C,E

1

PB_BK_46

Peripheral circulation: capillaries, vascular endothelium and arteriolar smooth muscle

A,C,E

1

PB_BK_47

Functions of endothelium

A,C,E

1

PB_BK_48

Characteristics of special circulations including: pulmonary, coronary, cerebral, renal, portal, transitional and fetal

A,C,E

1

B-85


Description

Assessment Methods

GMP

Demonstrates knowledge of: RENAL TRACT

PB_BK_49

Structure and function, renal circulation

A,C,E

1

PB_BK_50

Blood flow and glomerular filtration, plasma clearance and tubulo-glomerular

A,C,E

1

PB_BK_51

Tubular function and urine formation; transport processes

A,C,E

1

PB_BK_52

A,C,E

1

A,C,E

1

PB_BK_54

Assessment of renal function Regulation of water and electrolyte [Na+, K+, Ca++, Mg++, PO4--,] balance; response to fluid loss /hypovolaemia. Role of urea and creatinine measurement. Regulation of acid-base balance

A,C,E

1

PB_BK_55

Micturition

A,C,E

1

PB_BK_56

Pathophysiology of acute renal failure

A,C,E

1

PB_BK_53

RESPIRATION

PB_BK_57

Gaseous exchange: O2 and CO2 transport, hypoxia and hyper- and hypocapnia, hyper- and hypobaric pressures

A,C,E

1

PB_BK_58

Function of haemoglobin in oxygen carriage and acid-base equilibrium

A,C,E

1

PB_BK_59

Pulmonary ventilation: volumes, capacities, flows, dead space, compliance, work of breathing

A,C,E

1

PB_BK_60

Effect of IPPV on lungs

A,C,E

1

PB_BK_61

Mechanics of ventilation: ventilation/perfusion abnormalities, regional V/Q, surfactant

A,C,E

1

PB_BK_62

Control of breathing, acute and chronic ventilatory failure, effect of oxygen therapy

A,C,E

1

PB_BK_63

Effects of altitude

A,C,E

1

PB_BK_64

Non-respiratory functions of the lungs

A,C,E

1

NERVOUS SYSTEM

PB_BK_65

Neuronal structure and function

A,C,E

1

PB_BK_66

Resting membrane potential, action potentials, conduction, synaptic mechanisms, actions of neurotransmitters

A,C,E

1

PB_BK_67

The brain: functional divisions

A,C,E

1

PB_BK_68

Brain stem; organization, interconnections

A,C,E

1

B-86


Description

Assessment Methods

GMP


PB_BK_69

Intracranial pressure: cerebrospinal fluid, blood flow

A,C,E

1

PB_BK_70

Maintenance of posture

A,C,E

1

PB_BK_71

Autonomic nervous system; organization, ganglia, adrenergic vs cholinergic

A,C,E

1

PB_BK_72

Neurological reflexes: monosynaptic, polysynaptic, stretch, inhibition

A,C,E

1

PB_BK_73

Motor function: basal ganglia, spinal and peripheral

A,C,E

1

PB_BK_74

Sense: receptors, nociception, proprioception, sight, taste, smell, hearing, balance, touch, temperature

A,C,E

1

PB_BK_75

Pain: afferent nociceptive pathways, dorsal horn, peripheral and central mechanisms, neuromodulatory systems, supraspinal mechanisms, visceral pain, neuropathic pain, influence of therapy on nociceptive mechanisms

A,C,E

1

PB_BK_76

Spinal cord: anatomy and blood supply, effects of spinal cord section

A,C,E

1

PB_BK_77

Nausea and vomiting

A,C,E

1

LIVER

PB_BK_78

Functional anatomy and blood supply, immunological functions

A,C,E

1

PB_BK_79

Metabolic and digestive functions

A,C,E

1

GASTROINTESTINAL

PB_BK_80

Gastric function; secretions, nausea and vomiting

A,C,E

1

PB_BK_81

Gut motility, sphincters and reflex control – neurohumoral integration

A,C,E

1

PB_BK_82

Digestive functions; composition of secretions; digestion of carbohydrates, lipids, proteins, vitamins, minerals

A,C,E

1

PB_BK_83

Immune functions

A,C,E

1

METABOLISM

PB_BK_84

Energy homeostasis. Energy balance and nutritional status. Body mass/composition: body mass index, body fat estimation. Functional measurements: e.g. handgrip strength, work/exercise capacity. Biochemical measurements. Immune function.

A,C,E

1

PB_BK_85

Principles of nutrition: carbohydrates, fats, proteins, vitamins and minerals. Energy requirements/expenditure and measurement.

A,C,E

1

PB_BK_86

Metabolic pathways, energy production and enzymes; metabolic rate; lactate metabolism

A,C,E

1

B-87


Description

Assessment Methods

GMP


PB_BK_87

Hormonal control of metabolism: regulation of plasma glucose, response to trauma

A,C,E

1

PB_BK_88

Physiological alterations in starvation, obesity [including normal and abnormal BMI ranges], exercise and the stress response.

A,C,E

1

PB_BK_89

Body temperature and its regulation, [including differences at extremes of age]

A,C,E

1

ENDOCRINOLOGY

PB_BK_90

Hormones; types, receptors, heirarchy, extracellular signalling

A,C,E

1

PB_BK_91

Mechanisms of hormonal control; mechanisms, effects on membrane and intracellular receptors

A,C,E

1

PB_BK_92

Hypothalamic and pituitary function

A,C,E

1

PB_BK_93

Adrenocortical hormones

A,C,E

1

PB_BK_94

Adrenal medulla; adrenaline and noradrenaline

A,C,E

1

PB_BK_95

Pancreas; insulin, glucagons and exocrine function

A,C,E

1

PB_BK_96

Thyroid and parathyroid hormones and calcium homeostasis

A,C,E

1

PREGNANCY

PB_BK_97

Physiological changes associated with pregnancy

A,C,E

1

PB_BK_98

Materno-fetal, fetal and neonatal circulation

A,C,E

1

PB_BK_99

Function of placenta; placental transfer

A,C,E

1

PB_BK_100

Fetus; physiological changes at birth

A,C,E

1

PB_BK_101

Lactation

A,C,E

1

Assessment Methods

GMP

Physics and Clinical Measurement Competence

Description

Demonstrates knowledge of: PC_BK_01

Mathematical concepts: relationships and graphs

A,C,E

1

PC_BK_02

Exponential functions including wash-in, wash-out, tear-away

A,C,E

1

B-88


Description

Assessment Methods

GMP


Logarithms

A,C,E

1

PC_BK_04

Area under the curve [integration] and rate of change [differentiation]

A,C,E

1

A,C,E

1

A,C,E

1

PC_BK_06

Basic measurement concepts relevant to understanding of monitoring in anaesthesia:  linearity  drift  hysteresis  signal to noise ratio  static and dynamic response Electrolyte solutions [also drug doses]: conversion between units e.g. molar, mg/ml, %

PC_BK_07

SI Units: fundamental units and derived units

A,C,E

1

PC_BK_08

Other non SI units relevant to anaesthesia: including mmHg, bar, atmospheres, cm H2O, psi

A,C,E

1

PC_BK_09

Simple mechanics: mass, force, work, energy, power

A,C,E

1

PC_BK_10

Heat: including temperature, absolute zero

A,C,E

1

PC_BK_11

Heat transfer and loss: conduction, convection, radiation, evaporation

A,C,E

1

PC_BK_12

Temperature measurement: including Hg, alcohol, infrared, thermistor, thermocouple, Bourdon gauge, liquid crystal. Anatomical sites used for measurement

A,C,E

1

PC_BK_13

Latent heats, triple point of water

A,C,E

1

PC_BK_14

Patient warming systems: principles

A,C,E

1

PC_BK_15

Warming equipment for intravenous fluids: principles

A,C,E

1

PC_BK_16

Laws of thermodynamics; mechanical equivalent of heat

A,C,E

1

PC_BK_17

Humidity, absolute and relative; including measurement

A,C,E

1

PC_BK_18

Colligative properties: osmolarity, osmolality, osmometry, diffusion

A,C,E

1

PC_BK_19

Physics of gases. Gas Laws: kinetic theory of gases, Boyles, Henry’s, Dalton, Charles, Gay-Lussac

A,C,E

1

PC_BK_20

Critical temperature, critical pressure

A,C,E

1

PC_BK_21

Physics of vapours

A,C,E

1

PC_BK_05

B-89


Description

Assessment Methods

GMP


Pressure: absolute and relative pressure; gauge pressure

A,C,E

1

PC_BK_23

Manufacture and storage of gases and vapours, safety

A,C,E

1

PC_BK_24

Cylinders and pipelines, Bourdon gauge

A,C,E

1

PC_BK_25

Suction devices

A,C,E

1

PC_BK_26

Scavenging devices

A,C,E

1

PC_BK_27

Measurement of lung volumes and diffusion

A,C,E

1

PC_BK_28

Density and viscosity of gases

A,C,E

1

PC_BK_29

Laminar and turbulent flow: Hagen-Poiseuille equation, Reynold’s number, examples including helium

A,C,E

1

PC_BK_30

Measurement of volume and flow in gases and liquids, including pneumotachograph and other respirometers

A,C,E

1

PC_BK_31

Bernoulli principle

A,C,E

1

PC_BK_32

Venturi effect and entrainment devices

A,C,E

1

PC_BK_33

Vapour pressure: saturated vapour pressure

A,C,E

1

PC_BK_34

Vaporisation: process of vaporisation

A,C,E

1

PC_BK_35

Vaporisers: principles, including plenum and draw-over, temperature compensation, concentration

A,C,E

1

PC_BK_36

Principles of surface tension

A,C,E

1

PC_BK_37

Basic concepts of electricity and magnetism

A,C,E

1

PC_BK_38

Electrical voltage, AC and DC current, resistance, impedance

A,C,E

1

PC_BK_39

Electrical circuits: series and parallel

A,C,E

1

PC_BK_40

Symbols of basic components of electrical circuits

A,C,E

1

PC_BK_41

Capacitance, inductance

A,C,E

1

PC_BK_42

Wheatstone bridge: principles, uses

A,C,E

1

PC_BK_43

Electrical hazards: causes and prevention

A,C,E

1

PC_BK_44

Electrocution: including microshock, earth faults, leakage

A,C,E

1

PC_BK_45

Electrical equipment safety: domestic and medical, classification/types of equipment, symbols

A,C,E

1

B-90


Description

Assessment Methods

GMP


Circuit breakers, fuses

A,C,E

1

PC_BK_47

Transformers, inductance

A,C,E

1

PC_BK_48

Transistors, diodes

A,C,E

1

PC_BK_49

Amplifiers: band width, low , high , band filters

A,C,E

1

PC_BK_50

ECG: principles including electrodes and electrode placement

A,C,E

1

PC_BK_51

Fourier analysis

A,C,E

1

PC_BK_52

Amplification of biological signals: including ECG, EMG, EEG, BIS, CFM, CFAM

A,C,E

1

PC_BK_53

Piezo-electric devices

A,C,E

1

PC_BK_54

Electrical interference: sources, methods of reduction

A,C,E

1

PC_BK_55

Processing, storage, display of physiological measurements

A,C,E

1

PC_BK_56

Transducers and strain gauges

A,C,E

1

PC_BK_57

Lasers: basic principles and safety

A,C,E

1

PC_BK_58

Ultrasound: basic principles of ultrasound

A,C,E

1

PC_BK_59

Demonstrates knowledge of the physics relevant to optical fibres

A,C,E

1

PC_BK_60

Doppler effect, principle and clinical application

A,C,E

1

PC_BK_61

Cardiac pacemakers: principles and classification

A,C,E

1

PC_BK_62

Defibrillators and defibrillation: principles, including thoracic impedance, monophasic, multiphasic, implantable devices

A,C,E

1

PC_BK_63

Diathermy: monopolar, bipolar; safety and uses

A,C,E

1

PC_BK_64

Pressure transducers

A,C,E

1

PC_BK_65

Resonance, damping, frequency response

A,C,E

1

PC_BK_66

Plenum systems: warming blankets, theatre and anaesthetic room ventilation

A,C,E

1

PC_BK_67

Breathing systems: Maplesons’ classification, coaxial systems, circle systems, T-piece; resuscitation breathing devices

A,C,E

1

PC_BK_68

Ventilators: principles, including pressure and flow generators, cycling, minute volume dividers, jet and oscillator ventilators

A,C,E

1

PC_BK_69

Disconnection: monitoring of patient ventilatory disconnection

A,C,E

1

B-91


Description

Assessment Methods

GMP


CO2 absorption: chemistry, complications

A,C,E

1

PC_BK_71

Capnography

A,C,E

1

PC_BK_72

Pulse oximetry

A,C,E

1

PC_BK_73

Fires and explosions: risks and prevention

A,C,E

1

PC_BK_74

Measurement of gas pressures

A,C,E

1

PC_BK_75

Blood pressure: direct and indirect measurement

A,C,E

1

PC_BK_76

Pulmonary artery pressure measurement

A,C,E

1

PC_BK_77

Cardiac output: principles of measurement

A,C,E

1

PC_BK_78

Measurement of gas and vapour concentrations: e.g. infra-red, paramagnetic, fuel cell, oxygen electrode, mass spectrometry

A,C,E

1

PC_BK_79

Measurement of pH, PCO2, PO2, electrolytes

A,C,E

1

PC_BK_80

Derived blood gas variables, e.g. HCO3a, HCO3s, BE. Siggaard-Andersen nomogram

A,C,E

1

PC_BK_81

Measurement of CO2 production, oxygen consumption, respiratory quotient

A,C,E

1

PC_BK_82

Simple tests of pulmonary function: peak flow rate, spirometry

A,C,E

1

PC_BK_83

Measurement of perfusion: coronary, cerebral, splanchnic, renal

A,C,E

1

PC_BK_84

A,C,E

1

A,C,E

1

PC_BK_86

Assessment of neuromuscular blockade Infusion pumps and syringe drivers; including PCA drivers and epidural infusion devices: principles, use, safety, and relevant drug infusion calculations Environmental monitoring: contamination by anaesthetic gases and vapours

A,C,E

1

PC_BK_87

Minimum monitoring standards

A,C,E

1

PC_BK_88

Understanding the limits of monitoring equipment

A,C,E

1

PC_BK_89

Principles of calibration of monitoring equipment

A,C,E

1

PC_BK_90

Principles of hygiene, including cleaning and sterilisation of equipment

A,C,E

1

PC_BK_85

B-92

Statistical Methods Learning Outcomes:  To understand the basis of statistical concepts  To understand the statistical background to measurement error and statistical uncertainty


Description

Assessment methods

GMP

Demonstrates knowledge of: Data Collection SM_BK_01

Recalls the simple aspects of study design

A,C,E

1

SM_BK_02

Explains the outcomes measures and the uncertainty in their definition

A,C,E

1

SM_BK_03

Explains the basis of meta-analysis and evidence based medicine

A,C,E

1

Descriptive statistics SM_BK_04

Recalls the types of data and their representation

A,C,E

1

SM_BK_05

Explains the normal distribution as an example of parametric distribution

A,C,E

1

SM_BK_06

Explains indices of central tendency and variability

A,C,E

1

Deductive and inferential statistics SM_BK_07

Recalls simple probability theory and the relationship to confidence values

A,C,E

1

SM_BK_08

Explains the null hypothesis

A,C,E

1

SM_BK_09

Explains the choices for simple statistical tests for different types of data

A,C,E

1

SM_BK_10

Recalls type I and type II errors

A,C,E

1

B-93

Assessments to be used for the Initial Assessment of Competence A-CEX Assessment Code

Assessment

IAC_A03

Preoperative assessment of a patient who is scheduled for a routine operating list [not urgent or emergency] [0-3 months] Manage anaesthesia for a patient who is not intubated and is breathing spontaneously [0-3 months] ister anaesthesia for acute abdominal surgery [0-3 months]

IAC_A04

Demonstrate Rapid Sequence Induction [0-3 months]

IAC_A05

Recover a patient from anaesthesia [0-3 months]

IAC_A01 IAC_A02

DOPS Assessment Code IAC_D01 IAC_D02 IAC_D03 IAC_D04 IAC_D05 IAC_D06

Assessment Demonstrate functions of the anaesthetic machine [0-3 months] Transfer a patient onto the operating table and position them for surgery [lateral, Lloyd Davis or lithotomy position] [0-3 months] Demonstrate cardio-pulmonary resuscitation on a manikin. [0-3 months] Demonstrates technique of scrubbing up and donning gown and gloves. [0-3 months] Basic Competencies for Pain Management – manages PCA including prescription and adjustment of machinery [0-3 months] Demonstrates the routine for dealing with failed intubation on a manikin.

CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to pre-op preparation, choice of induction, maintenance, post op care. Select each one of the following topics and discuss the trainees understanding of the issues in context. Assessment Code

IAC_C01 IAC_C02

Assessment

Discuss the steps taken to ensure correct identification of the patient, the operation and the side of operation Discuss how the need to minimise postoperative nausea and vomiting influenced the conduct of the anaesthetic

IAC_C03

Discuss how the airway was assessed and how difficult intubation can be predicted

IAC_C04

Discuss how the choice of muscle relaxants and induction agents was made

IAC_C05

Discuss how the trainee’s choice of post-operative analgesics was made

IAC_C06

Discuss how the trainee’s choice of post-operative oxygen therapy was made

IAC_C07

Discuss the problems emergency intra-abdominal surgery causes for the anaesthetist and how the trainee dealt with these

IAC_C08

Discuss the routine to be followed in the case of failed intubation.

The Initial Assessment of Competence Certificate is available for from the secure area of the College website.

B-94

Assessments for the Initial Assessment for Competence in Obstetric Anaesthesia A-CEX Assessment Code

OB_BTC_A01 OB_BTC_A02 OB_BTC_A03

Assessment

Basic Competencies for Obstetric Anaesthesia – conduct epidural analgesia for labour [12-24 months] Basic Competencies for Obstetric Anaesthesia – conduct regional anaesthesia for caesarean section [12-24 months] Basic Competencies for Obstetric Anaesthesia – conduct general anaesthesia for caesarean section [12-24 months][S]

DOPS Assessment Code

OB_BTC_D01 OB_BTC_D02 OB_BTC_D03

Assessment

Basic Competencies for Obstetric Anaesthesia – top up epidural for labour analgesia [12-24 months] Basic Competencies for Obstetric Anaesthesia – top up epidural for caesarean section [12-24 months] Basic Competencies for Obstetric Anaesthesia – Perform spinal anaesthesia [12-24 months]

CBD Examine the case-notes. Discuss how the anaesthetic plan was developed. Ask the trainee to explain their approach to pre-op preparation, choice of induction, maintenance, post op care. Select each one of the following topics and discuss the trainees understanding of the issues in context Assessment Code

OB_BTC_C01 OB_BTC_C02 OB_BTC_C03 OB_BTC_C04

OB_BTC_C05 OB_BTC_C06

Assessment

Discuss how changes in the anatomy and physiology due to pregnancy influenced the conduct of anaesthesia Discuss whether pregnancy influenced the choice of drugs used during anaesthesia Discuss how the conduct of general anaesthesia is affected by late pregnancy Examine the case records of a patient that the trainee has anaesthetised for operative delivery in a situation where major haemorrhage might be expected. Discuss the factors that influence the likelihood of major obstetric haemorrhage, the precautions that should be taken to deal with it and the principles of its management. Examine the case records of a patient with pregnancy associated hypertension that the trainee has treated. Discuss how this influences anaesthetic management. Examine the case records of a patient for whom the trainee provided extradural analgesia for normal labour. Discuss the methods of pain relief available for normal delivery.

The obstetric basic test of competence certificate can be ed from the secure area of the College website.

B-95

Blueprint of the Primary FRCA examination mapped against the basic level units of training Unit of Training

MCQ

OSCE

SOE 1

SOE 2

Preoperative assessment

√

√

√**

√

Premedication

√

√

√

√

Induction of general anaesthesia

√

√

√

√

Intra-operative care including sedation

√

√

√

√

Postoperative and recovery room care

√

√

√

√

Introduction to anaesthesia for emergency surgery

√

√

√

√

Transfer medicine

√

√

Management of respiratory and cardiac arrest

√

√

√

√

Control of infection

√

√

√

√***

Academic and research

√*

Airway management

√

√

√

Critical incidents

√

√

√

Day surgery

√

√

General, urological and gynaecological surgery

√

√

√

Head, neck, maxillo-facial and dental surgery

√

√

√

Intensive care medicine

√

√

Non-theatre

√

√

Obstetrics

√

√

Orthopaedic surgery

√

√

Sedation

√

√

√

√

Paediatrics including child protection

√

√

√

√

Pain medicine

√

√

√

√

Regional

√

√

√

√

Trauma and stabilisation

√

√

Anatomy

√

√

Physiology and biochemistry

√

√

√

√***

Pharmacology

√

√

√

√***

Physics and Clinical measurement

√

√

Statistical methods

√

OSCE: * SOE1: **

√

√

√

√ √

√

√ √

√

√ √

Communicates risk information, and risk-benefit trade-offs, in ways appropriate for individual patients. All the drugs patients may be on preoperatively. SOE2: *** Partially covered

B-96

Blueprint of the Primary FRCA examination mapped against the professionalism of medical practice [Annex A] Domain

MCQ

OSCE

SOE 1

SOE 2

Domain 1 – Professional attitudes a. Commitment

√

√

b. Comion

√

√

c. Honesty and integrity

√

√

d. Respect for others

√

√

e. Community

√

√

f.

Competence

√

√

Domain 2 – Clinical practice

√

√

Domain 5 – Innovation

√

√

√

√

Domain 8 - Safety in clinical practice

√

√

√

Domain 9 - Medical ethics and confidentiality

√

√

Domain 10 – Relationships with patients

√

√

Domain 11 – Legal framework for practice

√

B-97

Blueprint for workplace based assessments against the basic level units of training CBD

DOPS

ALMAT

A-CEX √

√

√

History taking

√

√

√

Clinical examination

√

√

√

Specific anaesthetic evaluation

√

√

√

Premedication

√

√

√

Induction of general anaesthesia

√

√

√

Intra-operative care including sedation

√

√

√

Postoperative and recovery room care

√

√

√

Introduction to anaesthesia for emergency surgery

√

√

√

Management of respiratory and cardiac arrest

√

√

√

Control of infection

√

√

√

Airway management

√

√

√

Critical incidents

√

√

√

Day surgery

√

√

√

General, urological and gynaecological surgery

√

√

√

Head, neck, maxillo-facial and dental surgery

√

√

√

Unit of Training The basis of anaesthetic practice Preoperative assessment

Basic anaesthesia

Intensive care medicine

√

See Annex F

Non-theatre

√

√

√

Obstetrics

√

√

√

Orthopaedic surgery

√

√

√

Paediatrics

√

√

√

Child protection

√

√

√

Pain medicine

√

√

√

Regional

√

√

√

Sedation

√

√

√

Transfer medicine

√

√

√

Trauma and stabilisation

√

√

√

B-98

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