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CESR specific guidance for Anaesthetics

• March 15, 2022

This blog aims to give a brief overview of the CESR process for an Anaesthetics Doctor. The indicative period of training for a CCT in anaesthetics is seven years and it is unlikely that a trainee would achieve all the learning outcomes required for a CCT in a shorter period of time.

This needs to be taken into account when gathering and submitting evidence for the CESR application process. The structure of the programme (in indicative timescales) is three years at Stage 1 training - CT1, CT2, CT3 (or two years in Acute Common Stem (ACCS) plus two additional years in anaesthesia, followed by two years at Stage 2 training – ST4, ST5 and then two years at Stage 3 training – ST6, ST7 including Special Interest Areas.

For overseas Doctors that wish to obtain specialist registration they will need to submit a CESR application to demonstrate that they have achieved the Stage 3 High Level learning outcomes for 14 Domains - seven Generic professional capability Domains and seven Clinical domains, and at least one Special Interest Area. There are additional Stage 2 key capabilities from Domain 9 that need to be evidenced.

The Domains

For Anaesthetics the types of evidence are divided into fourteen different domains.

Domain 1 - Professional behaviours and communication. Stage 3 High Level Learning Outcome

Domain 2 - Management and professional/regulatory requirements. Stage 3 High Level Learning Outcome

Domain 3 - Team working. Stage 3 High Level Learning Outcome This is the specialty specific guidance for Anaesthetics updated November 2021 Please make sure you are reading the latest version. You can find all the guidance you need at www.gmc-uk.org.

Domain 4 – Safety & Quality Improvement. Stage 3 High Level Learning Outcome

Domain 5 – Safeguarding. Stage 3 High Level Learning Outcome

Domain 6 – Education and Training. Stage 3 High Learning Outcome

Domain 7 – Research and Managing Data. Stage 3 High Level Learning Outcome

Domain 8 – Perioperative Medicine and Healthcare Promotion. Stage 3 High Level Learning Outcome

Domain 9 – General Anaesthesia. Stage 3 High Level Learning Outcome and Stage 2 key capabilities M,N,O,P,Q,R,

Domain 10 – Regional Anaesthesia. Stage 3 High Level Learning Outcome

Domain 11– Resuscitation & Transfer. Stage 3 High Level Learning Outcome

Domain 12 – Procedural Sedation. Stage 3 High Level Learning Outcome

Domain 13 – Pain Medicine. Stage 3 High Level Learning Outcome

Domain 14 – Intensive Care. Stage 3 Learning Outcome

It is important to note that you will not be able to compensate for shortfalls in your evidence of training and experience in a particular area of the curriculum by providing extra evidence in other areas.

Types of Evidence

In order to demonstrate your competencies in all 14 Domains you will need to collate evidence. Below is a list of possible types of evidence that can be used, it is important to note that these are just some examples and not an exhausted list.

Domain 1 Professional behaviours and communication:

- Experience & Logbook

- Supervised Learning Events (SLEs) can be used to demonstrate:

• Ability to manage lists as a sole anaesthetist including areas of special interest (ALMAT)

• Leadership when discussing the care of a complex patient with the multidisciplinary team

• Evidence of effective shared decision making with patients and colleagues

- Courses and eLearning

Curriculum Domain 2: Management and Professional and Regulatory Requirements

• Leadership of Anaesthetic Departmental Activities
• Rota management for anaesthetists in training e.g. evidence of managing rotas
• Training sessions with members of senior management such as clinical directors, medical directors, Trust Chief Executive e.g
• Training and involvement in investigation of serious incidents e.g. correspondence/ feedback from trainer; reflective piece

Curriculum Domain 3: Team Working

• Range of experience in theatres, obstetrics, pre-operative assessment and including special interest areas.
• Leadership of complex resuscitation cases including team debrief discussion
• Completion of a project demonstrating leadership and team building e.g. feedback from the team; slides/ abstract/ poster from presentation of the project; feedback from supervising consultant

Curriculum Domain 4: Safety and Quality Improvement

• Presentation of QI project results
• Involvement with patient safety investigation such as root cause analysis. e.g. anonymised report, correspondence confirming involvement, reflective piece
• Attendance and presentation at clinical governance meetings e.g. slides/ abstract/ poster of presentation; feedback/ confirmation of attendance from clinical governance lead; meeting programme

Curriculum Domain 5: Safeguarding

• Management of a vulnerable patient for surgical procedure
• Management of a case where cultural or religious differences affect consent and treatment

Curriculum Domain 6: Education and Training

• Range of clinical experience taking advantage of all opportunities for teaching and learning
• Completion of SLEs for more junior colleagues with demonstration of constructive feedback
• Courses: Teaching and training courses such as Generic Instructor (GIC), Anaesthetists as Educators, Train the trainers e.g. certificates showing course or eLearning attendance/ participation

Curriculum Domain 7: Research and managing data

• Management of cases where research data is lacking
• Attendance at scientific meeting e.g. certificate of attendance
• Active involvement with local trainee research network (TRN) such as local lead for a TRN study e.g. correspondence from TRN lead detailing involvement; publications, poster presentations or abstracts

Curriculum Domain 8: Perioperative Medicine and Health Promotion

• Discussion of alternative treatment pathways and their relative risks and benefits
• Courses and eLearning: Scientific meetings on perioperative medicine e.g. certificates showing course or eLearning attendance/participation

Curriculum Domain 9: General Anaesthesia

• SLEs throughout stage of training including special interest areas and out of hours experience: CBDs and ALMATs from a range of surgical specialties
• Courses and eLearning: Trauma management e.g. certificates showing course or eLearning attendance/ participation
• Departmental presentations e.g. slides/ abstract/ poster of presentation at departmental meeting; feedback from department; meeting programme

Curriculum Domain 10: Regional Anaesthesia

• Courses and eLearning: Ultrasound, Regional anaesthesia e.g. certificates showing course or eLearning attendance/participation

Curriculum Domain 11: Resuscitation & Transfer

• Courses and eLearning: Resuscitation, Human Factors, Breaking bad news e.g. certificates showing course or e-learning attendance/participation

Curriculum Domain 12: Procedural Sedation

• Contribution to safe sedation training across hospital e.g. evidence of developing teaching programme/ training with non-anaesthetist
• Involvement with writing local guidelines relating to sedation e.g. copy of local guideline development or revision; correspondence from supervisor detailing involvement

Curriculum Domain 13: Pain

• Attendance at pain clinic, multidisciplinary pain meetings e.g. confirmation of attendance by supervising consultant; reflective piece
• Development of an individual pain management care plan in preoperative assessment clinic e.g. anonymised copy of clinical notes

Curriculum Domain 14: Intensive Care Medicine

• Completion of resuscitation courses
• Simulation training
• Attendance at scientific meetings with focus on intensive care medicine
• Attendance at ICU follow up clinic

Submitting your evidence

It is important that you anonymise your evidence before you submit it to us. You must remove:

• All patient identifying details

• Details of patients’ relatives

• Details of colleagues that you have assessed, written a reference for, or who have been involved in a complaint you have submitted.

This includes:

• Names (first and last)

• Addresses

• Contact details such as phone numbers or email addresses

• NHS numbers

• Other individual patient numbers

• GMC numbers

The following details don’t need to be anonymised:

• Gender

• Date of birth It is your responsibility to make sure that your evidence has been anonymised. Evidence which has not been anonymised will be returned to you. More information can be found on their website.

- Testimonials and letters from colleagues

- Thank you letters, cards from colleagues and patients

-Complaints and responses to complaints

Unsuccessful applications or poor evidence

It is our experience that applications from doctors in the specialty of Anaesthetics are often submitted with inadequate or poor evidence in the following areas:

• Applicants do not provide evidence to cover the full breadth of the CCT curriculum. If you have not covered a specific area of the curriculum in the past five years it is advisable to postpone an application until you have been to gain or revisit this experience. Applicants must ensure they can provide primary contemporaneous evidence of their learning outcomes and key capabilities in all areas of the curriculum.

• Applicants do not have current certification in resuscitation. Applicants must provide valid certification in advanced life support skills e.g. ALS.

• Applicants provide poor evidence of clinical governance. Applicants must provide evidence of various audits in which you played lead role, together with contributions to service improvement and risk management projects. The verified audits are required as evidence, not just email correspondence or statistics. Evidence of service improvement, risk management projects or other clinical governance activity is also needed.

• Applicants provide poor evidence of teaching, training and assessing junior colleagues. These may not form part of your role, however it is essential that evidence is supplied that confirms that you have the skills. This is best demonstrated by attendance at a course and the training or supervision or more junior colleagues. You must also provide evidence of your competence in teaching in the form of presentations or PowerPoint slides, in addition to evidence of feedback from students on your teaching skills and evidence of feedback you have given to students. The latter could take the form of assessments, multisource feedback, reference letters and constructive advice that you have provided to students, junior doctors and colleagues.

• Applicants provide poor evidence of managements skills. It is recognised that you may not have experience of managing a department, however some forms of management should be demonstrated e.g. rota management, budget management, leading ward rounds, leading theatre operating lists, leading on educational or research related activities.

Our top tips for a smooth CESR application process

1. Understand the time and effort that is required to make a successful application. You are asked to provide evidence that you have fulfilled all the learning outcomes defined in the curriculum. Doctors who have gone through the formal training programme will normally have taken around eight years to gain these outcomes, so it is not something you can gather overnight.
2. Recognise that you will need others to support you in the application process. Think about who can help, explain to them what help you need and ask if they can support you
3. CESR places most emphasis on evidence gathered in the last five years. If you are providing evidence from before this time, think about what you can do now to show that you still have these capabilities. For example, if you still have contacts in that unit you could ask if they would be prepared for you to go back and have some workplace-based assessments in that area. The Trust would probably want you to have an honorary contract for this.
4. Choose the referees for your structured reports carefully. The GMC provides guidance on who should give structured reports, but you should also think about who values you enough to put in the time and effort to ensure that their report provides the information you need.
5. Make sure you understand which evidence needs to be verified and that you follow the correct verification procedure, to ensure that all your evidence is accepted and does not need to be resubmitted. If in doubt, the GMC can advise on what needs to be verified and what types of verification can be accepted
6. Take care to arrange your evidence following the order it is set out in this guidance, so it is easier for assessors to find the evidence they need for each of the sections.
7. Finally: keep going and don’t lose heart! There will probably be a point in the middle where the task feels huge. When this happens, allow yourself a couple of weeks off CESR then look at it afresh.

How we can help

Many of the positions we have in Anaesthetics are able to support you with your CESR application. If you would like to speak to our team about these opportunities do send your CV to [email protected].

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