/ The Royal College of Anaesthetists
Educating, Training and Setting Standards in
Anaesthesia, Critical Care and Pain Management
Churchill House
35 Lion Red Square
Chief ExecutiveLondon WC1R 4SG
Kevin StoreyTel: 020 7092 1500
Fax: 020 7092 1730
email:
website:

16th July 2008

Dear Professor Kumar

Re-validation processes:

I am writing to seek the help of your Society / association / faculty in defining the range of clinical skills, knowledge and attitudes required by anaesthetists not in training posts for the purpose of re-validation.

This has to be demonstrable (for example, by logbook data, CPD activity, reflective diaries) at all levels and in all hospitals in the UK. It has to be reality based and already being delivered. The process will be retrospective; those being revalidated in 2010 will have to produce evidence from 2005 onwards.

Explicitly, the level will vary between hospitals where there is no direct daily care for your speciality (and the requirement is to manage the emergency patient who co-incidentally falls into your area of expertise) to single speciality, usually tertiary, hospitals such as children’s hospitals. An example of the range would be the different expectations for demonstrating an understanding of the anaesthetic management of a pregnant female at 24 week gestation with appendicitis, presenting in a hospital without an obstetric unit, to a patient at 34 weeks gestation presenting with established HELLP to a major obstetric unit.

This is not a process to raise standards or to incorporate initiatives into practice but to identify what essential ‘core’ knowledge should be maintained and used by >95% of safe anaesthetic practitioners. There will need to be an escalating level to enable specialists to demonstrate their expertise

We would like your Society’s examples in the following format.

Hospital Type / Grade of Doctor / Essential / Evidence / GMC Domain
Small DGH / Consultant
SAS Grade
Trust Grade
Large comprehensive Hospital
Consultant
SAS Grade
Trust Grade
Mono-specialist unit
Consultant
SAS Grade
Trust Grade

We will need to incorporate the edited version of your contribution into the RCoA Revalidation documentation by the end of this year. Could we ask that you seek views from your members, for instance at your scientific meetings, to help complete this process by the end of October?

I have completed an example to help clarify the process and appended the recent GMC Good Medical Practice Domains for information.

Care of the elderly:

Hospital Type / Grade of Doctor / Essential / Evidence / GMC Domains
Small DGH / Consultant /
  • Assessment of cognitive state
  • Assessment of co-morbidity
  • Assessment of multiple drug therapy Assessment of hydration / nutrition status
  • Use of physiological markers (METS for example) in assessment for surgery
  • Demonstration of communication skills, with the patient, their relatives and advocates
  • Effective pain management
  • Management of anaesthesia
  • Appropriate teaching and training of other clinical staff
  • Liaison with other members of the surgical and anaesthesia teams
/
  • Logbook data
  • Appraisal
  • CPD portfolio
  • MSF
  • Reflective diaries

SAS Grade /
  • Demonstration of an understanding of the complexity of a case
  • Evidence of ability to seek senior help in appropriate cases
  • Demonstration of ability to lead the anaesthesia team in caring for elderly patients
  • Demonstrating good practice in the care of the elderly and their carers
/
  • Logbook data
  • Appraisal
  • CPD portfolio
  • MSF
  • Reflective diaries

Large comprehensive Hospital
Consultant / As above but with:
  • Assessment of acute trauma
  • Scoring systems such as ISS
  • Management of major vascular emergencies
  • Ability to balance risk and operative procedure
  • Management of peri-operative care to include non-anaesthetic staff
/
  • Logbook data
  • Appraisal
  • CPD portfolio
  • MSF
  • Reflective diaries

SAS Grade
Trust Grade
Mono-specialist unit
Consultant / As above but with:
  • Specialist care for complex surgery
  • Optimisation strategies prior to surgery
  • Management of major transfusion in the elderly
  • Identification and amelioration strategies for POCD
  • Thromboprophylaxis
Mental capacity act issues /
  • Logbook data
  • Appraisal
  • CPD portfolio
  • MSF
  • Reflective diaries

Please do not hesitate to get in touch with me at any time.

My contact details are:

or

Thanks you

Yours sincerely

Chirs Dodds

Vice President

The RCOA: Advancing Patient Care and Promoting Safety

Patron: HRH The Princess Royal

REGISTERED CHARITY NO: 1013887VAT REGISTRATION NO: GB 927 2364 18