What is a patient clinical interaction assessment (PCIA)?
The PCIA is a one-off workplace-based assessment undertaken during Advanced Training, typically in a pre-assessment clinic. Anaesthesia trainees and specialist international medical graduates (SIMGs) are observed by an appointed PCIA assessor while they interact with a patient.
The assessment considers whether the trainees or SIMGs can:
- Independently assess complex patients.
- Obtain a comprehensive clinical history.
- Perform a focused physical examination.
- Identify perioperative risks.
- Develop appropriate optimisation strategies.
- Communicate effectively and professionally with patients.
- Demonstrate consultant-level clinical judgement and decision-making.
Following the patient consultation, the assessor will discuss the patient's comorbidities, perioperative risks, optimisation and surgical planning with the trainee or SIMG. The assessment concludes with a structured feedback discussion focused on learning and professional development.
Successful completion of the PCIA is a prerequisite for progression to provisional fellowship and fellowship.
Undertaking and recording the PCIA
- Plan your PCIA Advise the PCIA assessor/lead and supervisor of training (SOT) that you intend to complete a PCIA during your anaesthesia rotation. The PCIA case will be selected by the assessor. Schedule the assessment only when you feel adequately prepared to demonstrate independent preoperative assessment of a patient with significant co-morbidities. Should you have trouble finding a PCIA assessor to undertake the PCIA during your placement, please contact [email protected] and we’ll be able to help.
- Undertake PCIA assessment Successfully complete and document at least one PCIA that demonstrates you can independently undertake the preoperative assessment of patients with significant co-morbidities.
- You can repeat the assessment There is no limit to the number of attempts you can make. If you don’t achieve the required standard, you can undertake another PCIA when you are ready. Unsuccessful attempts are not recorded in MyPortfolio or the SIMG e-portfolio; however, the number of attempts is documented on the PCIA form.
- Outcome of assessment The PCIA is marked on a standardised rubric which uses the ANZCA entrustment scale to make the decision that the trainee either can be trusted with the preoperative assessment of a patient with significant co-morbidities, or that they have not yet reached this stage, and still require supervisory input into this assessment. The scoring rubric is available to trainees.
- Recording the completion of PCIA Once successfully completed, the PCIA must be documented in MyPortfolio or the SIMG e-portfolio. A successfully completed PCIA is required for progression to provisional fellowship for advanced trainees or fellowship for SIMGs.
Information for anaesthesia departments
All departments accredited within the ANZCA Anaesthesia Training Program that employ advanced trainees or SIMGs are expected to support PCIA.
To ensure this assessment can be delivered effectively, the head of department (HOD) should appoint one or more PCIA assessors. The number of assessors should reflect the number of advanced trainees and SIMGs within the department. If your department has multiple assessors, the HOD needs to nominate a lead assessor.
Local implementation
Each department should establish local processes to support the consistent delivery of PCIAs. These should include guidance on:
- Assessment settings.
- Scheduling and coordination of assessments.
- Identifying appropriate patient cohorts.
- Obtaining patient consent.
- Privacy and confidentiality requirements.
- Assessor appointment and accreditation processes.
Resources
Resources are available to support departments with implementing the PCIA, including PCIA Implementation Guide and PCIA Resource Pack. These can be accessed through the PCIA Library Guide and the SIMG Library Guide.
Becoming a PCIA assessor/lead
PCIA assessors/leads play a vital role in supporting advanced trainees and SIMGs.
Who can be a PCIA assessor/lead?
PCIA assessors are consultant anaesthetists within the trainee's or SIMG's department. They have extensive experience in managing patients with complex comorbidities and, ideally, a particular interest or expertise in perioperative medicine.
Appointment process
PCIA assessors/leads are appointed by the HOD, with the appointment recorded by the relevant state or national education officer.
If you’re interested in becoming a PCIA assessor, discuss your interest with your HOD.
The position description and assessor agreement form are here. A copy of the signed agreement form must be sent to our Training team.
Mandatory training
Before conducting PCIAs, all assessors must complete the online PCIA assessor training module (approximately 45 minutes). The module provides guidance on the purpose of the assessment, the assessment process, and the standards used to determine whether a trainee or SIMG has successfully demonstrated independent practice.
PCIA: Frequently asked questions
The PCIA was introduced to restore the direct observation component previously included in the Final Examination medical viva. This direct observation component involved observing trainees’ interactions with complex patients with comorbidities to elicit a clinical history and examination. It was removed from the Final Examination in 2020 due to restrictions imposed by the COVID-19 pandemic.
No. The key difference between the PCIA and the new format Final Examination medical viva, introduced in 2020, is that the PCIA involves real time observation of the trainee interacting with a real patient in the clinical environment.
No, only advanced trainees and SIMGs that commenced from 2025 are required to complete the PCIA.
No – the PCIA only needs to be completed by SIMGs who are undertaking the exam route (as well as advanced trainees).
For advanced trainees (AT), the PCIA can be undertaken at any time within advanced training before progressing to the provisional fellowship year (PFY) at the core unit review.
SIMGs who are required to complete the examination can undertake the PCIA after a satisfactory CPA report covering at least three months prior to applying for fellowship.
No. Completion of the PCIA is not a prerequisite for eligibility to enrol in the ANZCA Final Examination.
PCIA assessors must directly observe the trainee when undertaking a PCIA. A trainee may undertake the PCIA while on rotation to another hospital where a PCIA assessor is available to conduct the assessment. If you take up this option, please get in touch with the ANZCA Training team who can help you to log your assessment.
Should you have trouble finding a PCIA assessor to undertake the PCIA during your placement, please contact [email protected] and we’ll be able to help.
Trainees and SIMGs must demonstrate that they could be entrusted with preoperative assessment of patients with comorbidities of ASA III complexity or above.
The assessor should be comfortable that the trainee is assessing the patient at the level of a consultant, that their assessment is accurate, complete, and that patient communication is professional, empathetic and effective. The assessor should be confident that the preoperative assessment provided by this trainee is safe, effective and efficient and the procedural anaesthetists will be satisfied that the patient has been adequately prepared for surgery, or that the rationale for postponement or cancellation of surgery is robust.
If the assessor considers there are deficiencies that could compromise optimal care or patient safety, or that there are important areas for improvement before the trainee reaches consultant level, the assessor should not pass that attempt and provide constructive feedback to help the trainee improve.
A scoring rubric, the Entrustment Scale and Scoring Guide, is available to trainees, SIMGs and assessors to support the assessment.
Video demonstrations of a hypothetical PCIA assessment in which the trainee achieves a “pass” are available in the PCIA assessors training module (available on Learn@ANZCA). The exemplar focuses on the cardiovascular system in a patient scheduled for surgery who has aortic stenosis.
An additional useful reference for the PCIA is “The medical vivas”, Chapter 4, in Examination Anaesthesia 2nd Ed, December 13, 2010 Christopher Thomas BMedSc MBBS FANZCA and Christopher Butler MBBS FANZCA MPH&TM CertDHM PGDipEcho, p 35-76 ISBN: 9780729539470
These documents are available via the ANZCA PCIA Libguide.
The PCIA assessor will provide you with detailed feedback on each attempt which should guide future preparation. Practice PCIAs may be able to be organised outside of the formal PCIA assessment.
Advanced trainees will not be able to proceed to provisional fellowship and exam SIMGs will not be able to apply for fellowship if the PCIA is not successfully completed.
Only mobile phones are allowed during the assessment. Any large devices, such as laptops, are not permitted. You can take materials into the PCIA that would normally be used at the bedside or in clinic to stratify a patient’s perioperative risks or to optimise their preparedness for surgery. Examples of acceptable materials include tools that quantify perioperative mortality (such as NSQIP), functional status (such as DASI questionnaires) or to classify disease states (e.g. Haematological disorders). It is impractical to rely upon reference materials that require lengthy review.
A PCIA assessor/lead is a formal ANZCA appointment and will build an educational CV for those wishing to undertake further roles in ANZCA (such as on committees or examination panels).
Completion of a PCIA qualifies as a CPD activity under Category 2 Knowledge & skills of the ANZCA CPD programs with other educational activities, PCIA assessors may also undertake activities such as peer review or critical reflection upon practice which may be eligible within Category 1 Practice Evaluation.