Anaesthetic CCT Curriculum 2020 - what has to be in?

Generic Professional Capabilities

The GMC has described a series of skills, attributes and behaviours that must be embodied by any autonomous clinical practitioner - Generic Professional Capabilities (GPCs) were published in 2017.

The intention from the outset is that these are common and interchangeable across curricula as far as possible. They were described in response to the finding that curricula across colleges vary significantly, and not all college curricula covered the breadth of the domains of Good Medical Practice.

The GMC also wanted to learn the lessons from high profile reports outlining safety failures and the contribution of shortcomings in the care provided by medical leaders. The GMC has stated that these are to be the building blocks for all curricula and that we must include these as we build content and use them to guide our systems of assessment.

The GPCs framework comprises nine domains:

Although not defined as 'Generic Professional Capabilities', the current 2010 Anaesthetic CCT Curriculum already includes many such ‘common competences’. Annex A describes specific professionalism and common competences that are expected throughout training. They are also embedded in the clinical units of training at all levels, and are expected to be included within the assessments of clinical training.  Annex G covers further elements described in the nine GMC domains above.

Specialty Learning Outcomes

The implementation of competency based training has made the achievement of skills and knowledge throughout the training programme more explicit, but it is recognised that it has, in some cases, been unwieldy and over burdensome.
To address this, the GMC has suggested that Colleges should frame their curricula around 15 – 20 ‘learning outcomes’. The outcomes have to be described at a ‘high level’ and define the activities that a clinician at the end of training will be able to perform independently.
This is a significant change from the structure of our current 2010 curriculum.

Critical progression points

The third element of a GPC/ specialty learning outcome-based model is that clear milestones should exist (critical progression points within the curriculum) outlining progress to be made and with a detailed description of how that is evaluated, alongside a range of assessment tools with primacy for expert faculty judgment. 

Assessment

The GMC’s guidance on assessment in postgraduate curricula has shifted from detailed examination of individual elements of competence, towards global assessment of performance based on the opinion of consultant experts.

It is increasingly recognised that this is a valid method of performance assessment, provided it takes into account multiple assessments by multiple assessors. The overall burden of assessment should be reduced, but the GMC suggests that as a minimum, two or three clinical supervisor reports and an educational supervisor report should be recorded every year, and that a team assessment of behaviour should be performed every 12 months.

In keeping with the desire to simplify, and reduce the burden of assessment, the GMC has also suggested that workplace based assessment moves away from separating out individual elements of performance, and replace them with more global assessment of whole clinical tasks, or 'Entrustable Professional Activities' (EPAs).

EPAs have been described as 

‘A clinical activity which a trainee can be trusted to complete with indirect supervision once they have demonstrated the necessary competence to do so’

This approach requires a process whereby ‘entrustment’ is considered. This is the summative decision whereby an expert assessor, or faculty, decides that a learner is ready to work with a proscribed degree of autonomy in the activity in question. At the end of training this level of autonomy is independence. The waypoints to that have been described as milestones or critical progression points.