Core Anaesthesia is completed after the Introduction to Anaesthetic Practice, and takes 18 months to complete.
Core Anaesthesia Curriculum
The Core Anaesthesia course covers
- airway management,
- critical incidents,
- day surgery,
- general, urological and gynaecological surgery,
- ENT, maxillo-facial and dental surgery,
- intensive care medicine,
- orthopaedic surgery,
- paediatrics – including child protection,
- pain medicine,
- perioperative medicine,
- transfer medicine, and
- trauma and stabilisation.
At the preoperative assessment, trainees should be able to predict any difficulties with a patient’s airway and get help. They should be able to
- maintain a patient’s airway and provide a definitive airway during resuscitation,
- show that they can safely manage patients who they are not able to intubate or ventilate, and
- maintain anaesthesia in spontaneously breathing patients using a facemask – for a surgical procedure lasting less than 30 minutes.
Trainees should know the main causes of critical incidents that may occur in theatre, and how to identify and manage them. They should be able to recognise critical incidents at an early stage and manage them under senior supervision. Trainees should also learn how to follow a critical incident through by reporting it, presenting at audit meetings, and discussing it with patients. They should recognise that non-technical skills and simulation are important in reducing possible harm following a critical incident.
Trainees should obtain the knowledge, skills, and experience of managing perioperative ASA grade 1-2 patients in a dedicated day surgery unit across at least three specialties. They should understand and be able to apply protocols for selecting patients and managing the perioperative care of patients in day surgery. They should also understand the importance of minimising complications postoperatively in patients who are going home the same day after surgery.
General, Urological and Gynaecological Surgery
Incorporating Perioperative Care of the Elderly
Trainees should gain knowledge, skills, and experience in the peri-operative anaesthetic management of patients who need: elective and emergency surgery, general surgery, urological surgery, and gynaecological surgery. They should understand what the peri-operative anaesthetic management of patients who need intra-abdominal laparoscopic surgery are and show that they can manage adult patients who need this surgery under distant supervision. It is important that all trainees be able to recognise and treat perioperative anaesthetic complications that may occur with intra-abdominal surgery, and that they understand the perioperative needs of patients who are elderly and frail.
Trainees should be able to deliver perioperative anaesthetic care to adult patients who are ASA grade 1-3, and in need of elective or emergency surgery such as an appendicectomy, or uncomplicated gynaecological surgery, with distant supervision. They should be able to manage an operating list for adult patients who are ASA grade 1-3 and undergoing elective surgery with distant supervision.
Head, Neck, Maxillofacial, and Dental Surgery
It is anticipated that trainees will achieve the learning outcomes for this unit throughout their core training. Trainees are expected to obtain the skills and knowledge of perioperative anaesthetic management of patients scheduled for ENT, maxillofacial, and dental surgery – both minor and intermediate.
They should be able to
- recognise problems that may arise with a shared airway, and know how to manage them; and
- deliver perioperative anaesthetic care to adults who are ASA grade 1-3, and children over the age of five years who are ASA grade 1-2, who are undergoing uncomplicated ear, nasal, or adenotonsillar surgery under direct supervision.
Trainees should be able to undertake the safe intra-hospital transfer of critically ill but stable adult patients, for diagnostic imaging. They should understand the risk for patients undergoing procedures in these sites, and the responsibilities as a prescriber of this imaging. They should also be able to maintain anaesthesia for these patients under distant supervision.
Trainees should gain knowledge, skills and experience in managing healthy pregnant women, and should be able to pass the IAC in obstetric anaesthesia. Once they have achieved this they should be able to deliver analgesia and anesthesia for women in the delivery suite. They should understand how to manage women with common obstetric emergencies, and be able to perform resuscitation. They should be able to manage women with acute obstetric emergencies such as pre-eclampsia, haemorrhage, and eclampsia under distant supervision – although they should recognise when they need more senior help.
Incorporating Perioperative Care of the Elderly
Trainees should gain the necessary knowledge, skills, and experience in the peri-operative anaesthetic care of patients who need orthopaedic surgery – including elderly patients and those with long-bone fractures. They should therefore understand the relevance of bone and joint disease to anaesthesia, and be able to
- recognise and treat patients with anaesthetic perioperative complications of orthopaedic surgery; and
- deliver perioperative anaesthetic care to adult patients who are ASA grade 1-3 and in need of uncomplicated elective and emergency orthopaedic or trauma surgery to the upper and lower limbs – including open reduction internal fixation surgery, and surgery for a fracture neck of femur, under distant supervision.
Trainees should gain knowledge of anaesthesia in children under one year of age, and must complete child protection training. Trainees should be able to show that they can correctly perform
- correct sizing and insertion of airway devices such as tracheal tubes and oral airways;
- the ventilation of an apnoeic child using a bag and mask with or without an oral airway; and
- the intubating of a child using the most suitably-sized tracheal tube, placed at the proper length.
Trainees should be able to maintain anaesthesia in a child who is spontaneously breathing using a facemask during short surgical operations of less than 15 minutes.
It is particularly important that trainees are aware that non-accidental injury is not uncommon. They should therefore be able to recall the local procedures for safeguarding children.
Trainees should be competent in assessing and managing patients with acute post-operative and non-postoperative pain, as well as chronic pain in adults. They should recognise the special circumstances regarding the assessment and management of pain in children, the elderly, and patients with communication difficulties. They should also be able to show they understand the basic principles of post-operative pain relief in these patients.
Trainees should be able to:
- explain the main factors influencing patient outcomes that are related to the patient, anaesthetics, and also surgery;
- describe the benefits of multidisciplinary care, centered around the patient;
- deliver high-quality preoperative assessment, investigation, and perioperative management to patients who are ASA grade 1-3 for both elective and emergency procedures – there should be an emphasis on the management of patients with co-morbidities perioperatively;
- deliver of high-quality anaesthetic care, individualized for ASA grade 1-2(E) patients, with a focus on optimising their experience and outcomes; and
- plan and implement care that is individualised and high quality for these patients.
Trainees should be competent in performing blocks, and therefore capable of obtaining consent from patients for regional anaesthesia. They should be able to
- create a safe and supportive environment for patients who are awake or sedated in the operating theatre,
- perform regional and local anaesthetic procedures,
- conduct spinal and lumbar epidural blockade,
- perform simple upper and lower limb peripheral nerve blocks under direct senior supervision, and
- identify peripheral nerves using a peripheral nerve stimulator or ultrasound.
Trainees should show that they clearly understand how to safely discharge patients from recovery after surgery under a regional block. They should also recognise that they must receive supervised training, and have passed the necessary assessments, before attempting blocks. They should also accept patients’ rights to refuse regional anaesthesia, even though it might be more advantageous from a clinical perspective for them to undergo regional blockade.
Trainees should show they can safely perform blocks, including marking the side of surgery, and also the site of the regional technique. They should also have fastidious sterile technique, and be able to safely and effectively establish spinal and lumbar epidural blocks, managing under distant supervision any immediate complications in patients who are ASA grade 1-2. As a result, they should be capable of demonstrating how to safely and effectively establish a simple nerve block.
Trainees should gain a thorough understanding of conscious sedation, and the risks of deeper levels of sedation. They should therefore be able to describe the differences between the two, and the risks to patient safety. They should also understand the dangers of using multiple sedative drugs, particularly in elderly patients, and manage any side effects quickly – ensuring patient safety at all times. It is also important that trainees are able to deliver pharmacological sedation safely, and know their own limitations.
All trainees are expected to be able to provide safe and effective sedation using a maximum of two short-acting anaesthetic drugs to adult patients who are ASA grade 1-2, under the age of 80.
Trauma and Stabilization
Trainees should understand how to manage patients with trauma, recognise when they have immediate, life-threatening conditions, and prioritise their treatment. They should also understand the principles of prioritising patients with multiple trauma, including the management of their airway.