COVID-19 - guidance on completing ANZCA requirements

We are allowing more flexibility with the completion of some requirements and have specific guidance for trainees completing introductory training, provisional fellowship training or scholar role activities during the COVID-19 pandemic. 


What's not changing in training

Below is a list of training requirements which are still necessary for you to complete your current core unit and overall ANZCA training:

Training requirements

Below is a list of training requirements which are still necessary for you to complete your current core unit and overall ANZCA training:
 
Please note some activities have increased flexibility.

  • ​Minimum training time for each core unit.
  • Minimum clinical anaesthesia time (CAT) time for introductory training (IT).
  • Minimum CAT requirement for admission to fellowship.
  • Effective Management of Anaesthetic Crises (EMAC) course during basic training (BT), advanced training (AT) or provisional fellowship training (PFT).
  • Requirement for 20 quality assurance (QA) meetings.
  • Continuing professional development (CPD) requirements in PFT.
  • Minimum volumes of practice.
  • Completion of specialised study units (SSUs).
  • All workplace-based assessments.
  • Core unit reviews.
  • Clinical placement reviews.
  • Five scholar role activities.
  • Success in initial assessment of anaesthetic competence (IAAC) to progress from IT.
  • Success in primary examination to progress from BT.
  • Success in final examination to progress from AT.
  • Requirement for core intensive care managment (ICM) time and ICM SSU which must be completed in a unit accredited by the College of Intensive Care Medicine (CICM) for core (pre-2014) and, as per current classification, general training.
  • Leave will only accrue towards training time up to the maximum for each core unit.
  • If training is interrupted for more than 52 continuous weeks, subsequent training must include at least 52 weeks' full-time equivalents (FTE) continuous training time.

 See regulation 37 and the ANZCA handbook for training for more information.


Requirements for introductory training and completing IAAC

To try and reduce the impact of this disruption, ANZCA has agreed to temporarily relax some of the requirements for introductory training for the 2020 hospital employment year (HEY) where such flexibility does not impact on overall training outcomes.
 
It is important to note that a number of requirements for introductory training have not changed.

  • Minimum training time is still 26 weeks full-time equivalent (FTE).
  • Minimum clinical anaesthesia time (CAT) is still 22 weeks FTE.
  • Successfully completing the initial assessment of anaesthetic competence (IAAC) is still required for progression to basic training (BT).

    Exceptions to requirements

    The following table lists possible exceptions to the normal regulatory requirements for introductory training (IT) during the 2020 hospital employment year (HEY). The process table outlines how to record/apply for the exception to the regulations.

    ANZCA REQUIREMENT CHANGE PROCESS
    22 continuous weeks clinical anaesthesia time (CAT) Trainees completing IT in the 2020 HEY will still need to complete a minimum 22 weeks CAT but 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 in the 2020 HEY 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 TA 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.
     
    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.
    Primary examination Eligibility to sit requires completion of 26 weeks of training time.  This is applicable only for exam applications received for the 2020 HEY.


    Trainees are still required to complete the minimum workplace-based assessments and volume of practice before completion of the IT core unit review. Those unable to meet these requirements due to the COVID-19 pandemic must submit a deferral request to be completed in basic training.

    Changes to the IAAC requirements

    Trainees must meet the minimum standard requirements for initial assessment of anaesthetic competence (IAAC).

    Below are some alternate options which can allow trainees to meet these IAAC requirements. If trainees are unable to meet the direct observation of procedural skills (DOPS) and mini-clinical evaluation exercise (mini-CEX) targets by end of the core unit review, they may apply for a deferment of this to the basic training (BT) core unit review period.

    The IAAC questions section must still be completed

    ANZCA REQUIREMENT CHANGE
    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.


Information for provisional fellows

The following table outlines ANZCA’s position on training requirements for provisional fellows anticipating admission to fellowship during the 2020 hospital employment year (HEY). We understand there will be individual circumstances (both COVID and non-COVID related).
 
Some changes will be automatically processed in TPS and so do not require an application. All other exceptions will require an applications to be submitted to the college.

PF requirements

ANZCA REQUIREMENT POTENTIAL RISK ANZCA POSITION
Trainee wellbeing Impacts of COVID-19:
  • PFs may find themselves in accelerated positions of leadership in departments due to resource constraints.

  • May already be in positions of leadership (for example, ANZCA trainee committee)

  • This might include looking out for the wellbeing of their more junior colleagues whom they can supervise (Reg 37.22.2).

  • It may include less close supervision.

  • ​They may redeployed to less familiar areas.

PFs should receive appropriate supervision and support as per the ANZCA handbook for training.
​This includes orientation and initial level 1 supervision in unfamiliar areas.

ANZCA provides resources and advice about trainee wellbeing.

Trainees are encouraged to direct suggestions to their trainee representatives.

Concerns should be directed to your supervisor of training (SOT) or education officer (EO). 

Time requirements including clinical support time and extended training

Recording training time Further details can be found here.
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 in 2020 HEY.
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 for the 2020 HEY. 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. 
Exceeding training limits at a training site (Reg 37.27.6.) Trainees can complete no more than 208 weeks of approved vocational training at any training site. This regulation is suspended for the 2020 HEY.

The college will allow provisional fellows in the 2020 HEY to spend all of their training time in one training site.  
Returning from interrupted training If training is interrupted for a continous 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.
Applying for ANZCA Provisional Fellowship
Flexible training: Further details on Interrupted training, part-time training, recording training and return to work can be found here.
Approval of PF plans  Notifying the college of PF study plans. As per usual processes and should meet usual PF requirements. Should occur prospectively & only 4 calendar weeks up to application can count (as per regulation 37.13).

Where sudden changes to study plans occur, ANZCA allows flexibility for submission during the 2020 HEY. 
Change in approved PF plan Redeployment, decreased elective surgery, other changes in caseload and workload due to COVID.  If the ANZCA-approved PF job description changes, PFs should submit a new plan for approval.

PF positions must be at sites accredited by ANZCA & meet usual PFT requirements or for other clinical time placements should seek DPA approval.
Overseas  positions and positions with remote supervision, for example, Pacific Islands Unable to travel for planned provisional fellowship training outside region/overseas.  Provisional fellows who were planning provisional fellowship training outside their region are encouraged to work with their supervisors of training (SOTs), heads of department & employers to develop alternative plans for 2020. Please notify the college of any changes to your PF study plans. 
Supervision and supervising others
Supevision 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.
Other scholar role activies Please see Scholar role requirements below for more information.
Provisional fellowship reviews (PFR) Difficulties meeting due to social distancing measures. May be completed remotely (via videoconference).

ANZCA suggests training sites consider recruiting additional SOTs to assist trainees. Former SOTs are a good resource.  Please email nominations to the college.
Clinical placement review  Difficulties meeting due to social distancing measures. This requirement remains unchanged. May be completed remotely (via videoconference).
Effective Management of Anaesthetic Crises (EMAC) courses EMAC courses cancelled. This remains an essential part of training and must be completed prior to admission to fellowship. 
 
ANZCA is working with EMAC providers and will assess who is affected by course cancellation and rescheduling.

The college will work with providers regarding accommodating provisional fellows whose planned admission to fellowship may be impacted. However, it is recognised that the significant disruption to EMAC may prolong training for some. 
Advanced Life Support (ALS) courses Courses cancelled. This is no longer required for trainees admitted to fellowship in the 2020 HEY. 
Deferred requirements Trainees will still be required to complete any requirement which has been defered from a previous core unit.
Trainee experiencing difficulty process (TDP) and trainee performance review (TPR)
TDP (Reg 37.30) Social distancing measures. Redeployment, decreased elective surgery, other changes in caseload and workload due to COVID. Trainees in the TDP require ongoing support to achieve requirements and ensure ready for independent specialist practice. 
TPR (Reg 37.31) Social distancing measures. Redeployment, decreased elective surgery, other changes in caseload and workload due to COVID. Trainees in the TRP require ongoing support to achieve requirements and ensure ready for independent specialist practice. ANZCA will ensure some flexibility to conduct the process via distance means to ensure timely decisions & support for trainees and supervisors in this process. 


Scholar role requirements during 2020 HEY

With help from the Scholar Role Sub-Committee (SRSC), ANZCA has developed guidance and increased flexibility to defer scholar role activities (SRA) from one unit to the next (including into provisional fellowship training for trainees in advanced training).

Applications will only be considered by the college within 13 weeks of the anticipated completion date of a core unit. Applications will follow usual processes.  

Completing SRAs

SCHOLAR ROLE ACTIVITY REQUIREMENT IN 2020 HOW TO ACHIEVE
Critically appraise a paper published in a peer -reviewed indexed journal for internal assessment.
  • 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. 

Teach a skill
  • 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. 

Facilitate a small group discussion/running a tutorial
  • 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. 

Critically evaluate a topic for internal evaluation and presentation to the department
  • 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. 

Complete an audit with written report
  • 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.
Regional or greater conferences and QA meetings Please see Information for provisional fellows above for more information
Completing option B Requirements unchanged. As currently, trainees may apply to change from option B to audit if they prefer.  
Completing SRAs in Interrupted training Unchanged If well and in isolation/quarantine or in interrupted training, consider working on SRAs

Recognition of prior learning

If considering this, early application is recommended:

- Teach a skill and facilitate a small group discussion.

- Critical appraisal of paper/topic.


 

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Last updated 14:54 2.09.2020