After years at medical school, you have finally made it and are ready to start practicing as a doctor. It is a time to feel proud of what you have accomplished. You are at a point after many months of revising for your finals, that you can’t quite possibly believe there is anything more to learn. Fast forward to your first day of work and you realise there is so much more knowledge to grasp. It can often feel overwhelming to think about the future and how much more work there is to come.
There are a few lucky individuals who have known exactly what sort of doctor they want to be from day 1 of medical school. However, most of us don’t have a clue. Luckily you still have at least two years of your foundation programme (plus F3, F4 and so on if you wish) to figure this out.
Choosing what specialty training pathway to venture down can feel daunting. They vary from 3-8+ years after your foundation training. If you find yourself wanting a career that is built on camaraderie and teamwork, involves a lot of patient contact, is varied, and allows you to work with all specialities and often provides instant results, then anaesthetics might be the right speciality for you. Anaesthetic training is also known as one of the most supported training pathways, with trainees being surrounding by highly skilled seniors willing to help for a large proportion of the time.
There are two pathways that you can apply to after your foundation years that will allow you to become an anaesthetist: Core Anaesthetic Training (CAT) and Acute Care Common Stem (ACCS) training. Below I am going to explain what CAT involves.
To understand where CAT fits into your career, it is useful to understand the whole pathway (Figure 1). Once you finish medical school you will complete your two years of foundation training. After this you can apply for specialty training. This is where you would apply to do CAT or ACCS. CAT is a three-year programme, during which you would also need to sit a series of exams. After this, you would then be able to apply for later stages of training. This involves another 4 years of training.
(Figure 1. Anaesthetic training pathway)
The old training programme meant that CAT used to last only two years, and then stage 2/3 of training was five years long. Trainees were expected to complete the primary exam within the 2 years of CAT. However, data showed that more than 40% of trainees at CT2 level did not complete their core training and could not move on to the next stage (2). Particular stressors contributing to this included pressure to pass the primary exam, as well as not gaining enough experience in certain specialities such as obstetrics (3).
This has led to a change in the programme, with CAT now being 3 years in length to ensure trainees finish CAT feeling confident, equipped, and energised for the next stage.
So you have decided that a career in anaesthetics is for you, what next? What does CAT really involve? Firstly, you need to be accepted to a training programme. This involves completing the MSRA exam and an interview.
Once successful, you are ready to embark on your journey through CAT. Some general aims for the entire three years include gradually gaining confidence in autonomy and responsibility; whilst always having a high level of support from seniors. Trainees also gain experience in general anaesthesia, intensive care medicine, obstetrics, and more specialised fields. A by-product of training normally includes an increase in your knowledge of cycling and consumption of coffee!
CT1
This tends to be your hardest year as it is a steep learning curve. During your first few months you will need to complete your initial anaesthetic competencies. This allows you to fly solo on your on-calls. Your shifts will vary from day shifts, which involve elective theatre lists under direct supervision of a senior, to on-call shifts which can involve emergency theatre, cardiac arrests, and cannula/line requests.
It is a requirement to complete 6 months of intensive care medicine by the end of CAT1, and you tend to do your first block in CT1. It is a great time to get comfortable managing critically unwell patients, as well as becoming competent in vascular access techniques.
CT2
This year includes more intensive care medicine and general anaesthetic duties, whilst giving you time to build on your skills learnt during CT1. The one new block for this year includes obstetrics. You will spend 2-3 months completing your initial obstetrics anaesthesia competencies, including epidurals amongst other procedures. After this you will be ready to independently embrace on-call obstetric shifts.
CT3
This year involves more intensive care medicine, on-calls, and general duties. You are also able to explore some other subspecialities, such as paediatrics, perioperative medicine, and pain medicine.
The slightly less exciting bits…
You have completed your 3 years of CAT, learnt many new skills and are feeling confident with your anaesthetic abilities to progress to stage 2 training. There are a few extra things that you need to have done during CAT to allow you to move up the ladder:
Pass the FRCA Primary exam. This can be done at any time during the 3 years and includes a written exam and an objective structured clinical examination/structured oral examination.
Complete 3 Annual Review of Competency Progressions.
Complete your online ‘doughnut’ portfolio. This includes a logbook of cases and structured learning events.
Once all those boxes are checked you are ready to apply to the next stage!
Author: Rosie EdgeleyReferences
1) Rees, T. Anaesthesia Training Programme and Support. RCoA. Presented 14/10/2021 at a career in anaesthesia.
2) 2021 Curriculum philosophy, RCoA [internet]. Available from: https://www.rcoa.ac.uk/training-careers/training-anaesthesia/2021-anaesthetics-curriculum/2021-curriculum-philosophy
3) A report on the welfare, morale and experiences of anaesthetists in training: the need to listen, RCoA [internet]. Available from: https://www.rcoa.ac.uk/sites/default/files/documents/2019-08/Welfare-Morale2017.pdf
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