COVID-19 – guidance on anaesthesia training

Trainee wellbeing

Impacts of COVID-19

We provide resources and advice about trainee health and wellbeing. Trainees are also encouraged to direct suggestions to their trainee representatives.

Recording training time

Trainees redeployed to other clinical areas

Trainees should record  all clinical time undertaken during this period, as follows:

• Record training completed at a College of Intensive Care Medicine (CICM) accredited site for general or limited general training as other clinical time (OCT) – intensive care medicine time.
• Record training completed at a CICM accredited site for foundation training as OCT – other approved training.
• For training completed at a site not accredited by CICM requires submission to director of professional affairs (DPA) assessors for approval.

Trainees must meet minimum CAT requirements for admission to fellowship.

Trainees redeployed to other duties due to health risks, (eg pregnancy, immunosuppression etc), should submit an application to the DPA assessors and these will be reviewed on a case-by-case basis.

22 weeks continuous CAT in introductory training (IT)

Redeployed to high-dependency unit (HDU)/intensive-care unit (ICU)

Trainees completing IT will still need to complete a minimum 22 weeks CAT but do not need to do this time continuously.
 
Time spent at a site accredited for the intensive care medicine (ICM) specialised study unit can count towards the mandatory 11 weeks requirement, provided the time is continuous (interrupted by up to two weeks of non-ICM time).

Leave

Unable to do clinical work

 

Any time spent not spent in training, including self-isolation, quarantine or carer’s leave, should be recorded as leave. 

Trainees off work for 13 weeks or more may apply for interrupted training and may be eligible for a pro-rata refund on the annual training fee.

Volume of practice
(VOP)

Reduced elective surgery
consultant-led intubations and other procedures

Increased flexibility to defer requirements from one core unit to the next. Applications can occur within 13 weeks of the anticipated completion date of the core unit.  

22 continuous weeks clinical anaesthesia time (CAT)

Trainees completing IT will still need to complete a minimum 22 weeks CAT but as a COVID-19 exception, this time does not need to be continuous.

The ANZCA Training Assessments (TA) team should be notified within 13 weeks of completing the IT core unit review.

Redeployed to intensive care units (ICU)

Time spent in intensive care medicine (ICM) during the COVID-19 pandemic can count towards the mandatory 11 weeks requirement, provided it is spent in an ICU accredited for general or limited general training.  

If ICM time is done in a unit only approved for foundation training this is other clinical time (OCT).

Time in other units or departments may count as OCT.  Approval required for an exception to the regulations.  

Retrospective application will be accepted up to 13 weeks after redeployment.
 
ICM specialised study units (SSUs) can be signed off during IT if the usual requirements are met:

• Time spent at a College of Intensive Care Medicine (CICM) site accredited for general and limited general training. 

• Duration of >11 continuous weeks.

• Completion of ICM SSU.

The training portfolio system (TPS) will not normally accept this time in IT therefore all deviations from the normal requirements must be notified to TA team. 

Excess other clinical time (OCT) done during IT may be credited to basic training (BT), by retrospective application. Excess OCT done in BT will automatically be credited to advanced training (AT) as usual up to the other clinical time maximum of 38 weeks by the end of AT.

Advanced Life Support (ALS) completion

Must have been completed in the 78 weeks prior to completion of IT (this is a change from 52 weeks). 

Alternatively, completion of ALS may be undertaken in a one-to-one teaching session rather than as a course, These sessions still need to cover all learning objectives covered in the handbook.

Approved by the supervisor of training as per the standard process in the training portfolio system (TPS). 

The training team should be notified of this so that appropriate credit can be added in TPS.

IAAC

There has been some modification of the requirements when necessary. See Changes to the
initial assessment of anaesthetic competence (IAAC) requirements below.

May be undertaken by an assessor nominated by the supervisor of training and undertaken remotely (via videoconference). 
 
This may utilise those not undertaking frontline clinical duties.
 
A request for deferment must be submitted to seek director of professional affairs (DPA) approval for any WBAs and volumes of practice (VOPs) that trainees are unable to complete as part of the IAAC by end of the IT core unit.

Can’t intubate can’t  oxygenate (CICO)

Remains a requirement for completion.

Completion of CICO training may be undertaken in a 1:1 teaching session, as per section 2.15.4 of the ANZCA handbook for training

The CICO DOPs can be completed instead. 

Workplace-based assessment
(DOPS)

Trainees must complete three DOPS as outlined in IAAC:

• Airway intubation, RSI and extubation.
• Bag/mask ventilation and insertion of LMA.
• Anaesthesia machine check (this could be undertaken at the beginning of a list with the list supervisor).

Workplace-based assessment
(mini-CEX)

Trainees must complete the following:

• Pre-operative airway assessment and the preoperative assessment (a single mini CEX).

Assessment and management of a patient in acute pain on a pain round may be deferred to BT (on application).
 
Of the remaining four non-specific mini-CEXs normally undertaken as part of IAAC the group suggest:

• Personal protective equipment (PPE) donning/doffing could be included.

Time requirements including clinical support time and extended training

Minimum time requirements (Reg 37.13.3)  

Trainees required minimum of 52 weeks FTE with up to eight weeks of leave.

This requirement remains unchanged.

Minimum clinical support time (CST) (Reg 37.3.5)

Trainees redeployed to clinical duties.

ANZCA will allow flexibility with the allocation of clinical support time for provisional fellows and will recognise activities COVID-19-related preparation and management activities.
 
Trainees are encouraged to keep a record of all relevant activities in case CST cannot be achieved in the usual way.

Minimum clinical anaesthesia time (CAT) for admission to fellowship 

Redeployment, decreased elective surgery, other changes in caseload and workload due to COVID.

Requirements unchanged as graduates must have sufficient CAT experience to work as unsupervised specialists. Very unlikely to be an issue however may prolong training for some. 

Extended training – PFT-E (Reg 37.17.3.4)

Trainees unable to meet training requirements and outcomes within usual time frames.  

The extended training of 52 weeks FTE remains unchanged.

Trainees approaching the limit of PFT-E  should apply for consideration of extension in PFT-E beyond the usual limits. Applications will be assessed on a case-by-case basis. 

Returning from interrupted training

If training is interrupted for a continuous period more than 52 calendar weeks, subsequent training must include at least 52 weeks FTE continuous training time.

This requirement remains unchanged and may prolong training for some. Applications for any exception must be submitted to the college and will be reviewed on a case by case basis.

Supervision and supervising others

Supervision of more junior trainees (Reg 37.13.10)

Specialists may be too busy to undertake WBAs for trainees at present. 

Requirement remains unchanged. Whilst this may be a means for more junior trainees to achieve WBAs, PFTs should be supported to ensure that they are not under undue stress to complete WBAs for other trainees, unless circumstances permit this.

Please note: the college does not require a particular WBA run rate at this time, but encourages completion of WBAs as feasible.  

All other training requirements  

Workplace-based assessments (WBA)

This requirement remains unchanged.

Please see COVID-related WBA guidelines. 

Continuing professional development (CPD) points requirement (provisional fellowship training)
(Reg 37.13.12) 

Limited opportunities due to cancellation of events and lack of time/illness

ANZCA recommends trainee undertake activities that can be completed whilst maintaining social distancing (for example, journal reading).

If quarantined or isolated and well enough, trainees are encouraged to complete CPD activities.

ANZCA has a list of resources that may assist in the completion of CPD. This includes COVID-19 related training such as donning and doffing PPE. 

Scholar role requirement:
Regional or greater conferences

Regional or greater events cancelled.

ANZCA will accept local events (departmental or hospital CME meetings) or webinars hosted by ANZCA or other organisations that may be attended via videoconference.

The total time required is 14 hours. Each conference requirement is seven hours, which can be completed incrementally, and should be recorded as one entry in TPS. 

Scholar role requirement: QA meetings

Reduced QA activity.

Attend local M and M meetings via videoconference if these are still being held. 

Consider webinars organised by ANZCA or other organsiations.

Effective Management of Anaesthetic Crises (EMAC) courses

EMAC courses cancelled.

This remains an essential part of training and we encourage all trainees to complete the course within training. 
 
A temporary deferral pathway has been approved by ANZCA council up to the end of the 2022 HEY.  Applications can only be submitted if all other PFT requirements have been met.  Please ensure your TPS is up to date at the time of submitting this request. For further details, please refer to the application form notes. 

ANZCA is working with EMAC providers and will assess who is affected by course cancellation and rescheduling.

Deferred requirements

Trainees will still be required to complete any requirement which has been deferred from a previous core unit.

• Requirements unchanged.

• Can be deferred to a future core unit. 

• Present your appraisal to other trainees and the department scholar role tutor (DSRT) by virtual tutorial/video conferencing.

• Present your appraisal just to the DSRT (or a nominee) by virtual meeting.

• Present your appraisal of COVID-19-related topics to the local group preparing pathways and policies for COVID-19 care.

• In exceptional circumstances, consider providing a written report, assessed by DSRT. DSRT to approve this approach before it is commenced. 

• Requirements unchanged.

• Can be deferred to a future core unit. 

• If you are working in the operating theatre environment, you should be able to complete this activity.

• If you are working in an intensive care unit (ICU), it may be difficult to complete this activity.

• Can teach COVID-19-related simulated activities (for example, donning/doffing personal protective equipment).

• In exceptional circumstances, consider a mock written plan incorporating teaching theory, assessed by the DSRT. DSRT to approve this approach before it is commenced. 

• Requirements unchanged.

• Can be deferred to a future core unit. 

• Facilitate discussion via virtual tutorial/video conferencing to a small group and the DSRT (or nominee). 

• In exceptional circumstances, consider a mock written plan incorporating teaching theory, assessed by the DSRT. DSRT to approve this approach before it is commenced. 

• Requirements unchanged.

• Can be deferred to a future core unit. 

• Present your critical evaluation to other trainees and the department scholar role tutor (DSRT) by virtual tutorial/video conferencing.

• Present your critical evaluation just to the DSRT (or a nominee) by virtual meeting/video conferencing.

• Can critically evaluate relevant COVID-19-related topics, for example, evidence for personal protective equipment (PPE) requirement in different settings, hydroxychloroquine for prophylaxis/treatment and so on.

• In exceptional circumstances, consider a written report, assessed by the DSRT. DSRT to approve this approach before it is commenced. 

• Requirements unchanged.

• Can be deferred to a future core unit. 

• Consider COVID-19-related audits, of relevance to the department.

• Consider retrospective audit of own practice. This can be done simply by accessing electronic medical records if available. The ANZCA audit samples are good examples which can be found on Networks.

• If the above options are not feasible, your DSRT may approve and assess the following:

  • For audits that were started and cannot be completed due to COVID-19 disruptions, the DSRT or SRSC may accept a written report that includes progress and explains the anticipated outcomes and next steps.
  • The DSRT may accept direct involvement in producing COVID-19-related hospital or departmental policies, guidelines or protocols. The DSRT requires evidence of the policy development process, confirming a minimum of 25 hours of work.