SpR (SAT Year 3 – 6)
Subspecialty & Advanced Training (SAT 3 – 6)
To progress from SAT year 2 to SAT year 3 of anaesthesia training, trainees must have acquired CCSAT2, details of CCSAT2 can be found in SAT Year 1 and 2 section or the training regulations.
The basic premises of Sub-specialty & Advanced Training are that it should –
• Be a minimum of 4 years duration
• Be continuous
• Be well structured and have clear objectives
• Include formal 6 – monthly assessments by way of In Training Assessments (ITAs)
• Be closely monitored and supervised
• Be flexible to allow for individual trainee interests and career objectives
The aim of the SAT year 3 -6 training programme is to produce well-trained Anaesthetists of a high calibre who are capable of independent practice. Rotations are structured to ensure exposure to the sub-specialties
Posts suitable for Intermediate & Advanced training should offer trainees exposure to a high volume of complex and sub-specialty cases with adequate teaching input from consultants / trainers to achieve all mandatory competencies. –These competencies will form part of the electronic portfolio.
The following sub-specialities are essential for SAT training
• Paediatric and Neonatal Anaesthesia
• Anaesthesia for Vascular Surgery
• Anaesthesia for Cardiac and Thoracic Surgery
• Anaesthesia for Neurosurgery and Neuroradiology
• Anaesthesia for Plastic and Maxillofacial Surgery
• Anaesthesia for Ambulatory Surgery
• Anaesthesia for obstetrics
• Regional anaesthesia
• Acute and Chronic Pain Management
• Intensive Care Medicine
• Monitoring and Procedures
• Trauma Management
• Anaesthesia for Orthopaedic Surgery
• Anaesthesia for General and GU surgery
• Anaesthesia for ENT and Maxillofacial Surgery
• Competence in Professionalism for Independent Practice
SAT year 3-6 training should also include further exposure to the sub-specialties experienced in SAT year 1-2 (e.g. Obstetrics, Regional Anaesthesia, ENT, Ophthalmic Surgery, Genitourinary Surgery, Orthopaedic Surgery and General Surgery. Where trainees have received sufficient exposure to individual competencies in SAT years 1-2, they may be credited with that competency, for the purposes of CST.
Where possible, sub-specialty experience should be structured in a modular format. Each post should have an adequate volume of cases and range of experience to provide six months of modular training, with the aim of achieving competencies.
While competence in sub-specialty areas is essential for SATs year 3 – 6 it is also important that they are exposed to different types of practice in different sizes of hospitals. Therefore a number of posts in smaller hospitals are included in the rotations to offer high-quality training in a different environment.
Issues considered during hospital inspection for SAT year 3 – 6 posts include the following
• Number of cases
• Case complexity
• Range of sub-specialities available
• Modular structures for sub-specialty training
• Degree of consultant supervision and teaching
• Quality of teaching
• Availability of research opportunities
Issues relating to the infrastructure for Anaesthesia in the hospital are also considered including equipment, consultant PCS activity, overall quality of Anaesthesia care etc (see Section 2.4 in the training regulations).
Training Content SAT years 3 – 6
SAT years 3 – 5 comprise the Subspecialty years of Anaesthesia training. These years will include time spent before and after sitting the FCAI Examination. Training opportunities in SAT years 3 & 4 should also facilitate the trainee in preparing to sit the FCAI Examination. (See 3.2 of the training regulations)
Some trainees may have the opportunity to acquire some of these modules in SAT year 2.
All trainees should maintain an electronic portfolio i.e. Logbook, PCS and all online competencies, assessments and attendance at mandatory courses. Electronic portfolios will be formally assessed at the end of the second, fourth, fifth and sixth years of training. This will allow for independent verification that trainees have spent time in all necessary clinical modules and have sufficient exposure to academic activities.
SAT years 5 & 6 offer an increased complexity of cases particularly in the recognised sub-specialty areas in Anaesthesia (see 3.3 of the trainig regulations).
Modules in other sub-specialty areas are considered if case complexity and consultant input make these a useful training opportunity at year 5-6 level. Modules which offer training in Research or Management could also be considered.
SAT years 5 & 6 should allow trainees to undertake an increased level of clinical and administrative responsibility while still ensuring there is adequate consultant input to make these training rather than service posts.
Two years of training at this level are seen as essential to develop the clinical expertise and skills, attitudes and interests that will prepare the trainee for independent Consultant practice.
In order to facilitate academic and non-clinical training activities the College recommends that trainees at the level of SAT year 6 should be rostered for one non-clinical day per week separate to time off post-call. The College Tutor (or other designated trainer) should ensure the utilisation of this day for useful training purposes. Trainees should not be granted this day unless it is scheduled and documented for training purposes. (see Non-Clinical day policy at the end of this page)
To be eligible for a Certificate of Specialist Training (CST), trainees must complete all SAT years 1-5 in the National Training Programme and SAT year 6 may be completed either in or out of programme at the discretion of the National Training Committee.
Progression to SAT 6
Progression from SAT Year 5 to Year 6 of training depends on the trainees meeting the following criteria:
1. Success in the FCAI Examination.
2. Completion of a minimum five years of SAT training.
3. Satisfactory In-Training Assessments.
4. Completion of the electronic portfolio.
5. The College of Anaesthetists of Ireland Training Committee deems the overall performance of the trainee to be satisfactory.
A formal interview will be conducted at completion of Year 5 to confirm the suitability of the trainee to progress to Year 6 on the basis of these criteria. Trainees who meet these criteria but have not completed all required competencies may not avail of SI posts or Special Leave during SAT year 6, and must complete their outstanding competencies in Year 6 within the National Training Programme.
Criteria for exiting SAT 6
Completion of the National Training Programme for the award of CST will therefore require the Year 5 to 6 Progression Interview PLUS any of the following:
1. Satisfactory progress reports from the relevant hospital providing a Special Interest post
2. Satisfactory progress report from the hospital or institution providing approved Year 6 out-of-programme experience
3. Satisfactory ITAs and competency certifications for any outstanding competencies identified at the start of Year 6.
4. SAT 6 Exit interview
Exit interview at the end of SAT Year 6
Completion of training for all trainees is subject to an interview to approve their accreditation. The purpose of the interview is to ensure those accredited by the College have the skills, experience and personal attributes for independent practice in Anaesthesia, Intensive Care and Pain Medicine.
This interview should be straightforward for the vast majority of trainees as deficiencies in experience or in clinical abilities should have been detected and resolved before this stage.
Trainees should provide a written summary of their Anaesthesia training to include their rotations, sub-specialty areas experienced, a summary of academic activities and of management training, details of time spent away from the Programme in research, in training abroad or in training in other disciplines and details of time away from training due to illness, pregnancy, leave of absence etc.
Accreditation will be based on the following criteria;
1) Appropriate duration of training with adequate exposure to sub-specialty areas.
Completion of compulsory modules in Intensive Care, in Pain Medicine, in Obstetric Medicine and in Paediatrics from relevant training sites will be assessed and the duration of any leave of absence from the Programme will be considered. Training summary forms will be reviewed.
2) In-Training Assessments (ITAs) will be reviewed.
3) Assessment of academic activity. Involvement in the academic programme in each training hospital is an essential part of training. The Training Committee must also be satisfied that the trainee has participated in educational activities outside the hospital. In addition it is considered appropriate for trainees to gain experience in research activities, in writing and in presenting to national meetings.
3) Completion of the CAI electronic portfolio.
4) Completion of the Professionalism in Practice Module of the CAI MSc
This interview also provides the trainee an opportunity for feedback to the Training Committee on the strengths and weaknesses of the Training Programme. The Training Committee is also interested in the future career plans of those completing training in Ireland.
A situation may arise where the Training Committee is unable to recommend the accreditation of a trainee at the end of Year 6. The Training Committee will then make recommendations for the trainee so that they may complete training at a later date or alternatively that they are not suitable to be accredited to undertake independent practice.
Leave from the National Anaesthesia Training Programme
Final Year (SAT 6) Leave
The College of Anaesthetists and the National Training Committee encourage trainees to become involved in educational or research projects which are properly planned and supervised and are likely to produce valuable information. The National Anaesthesia Training Programme (NATP) is a continuous 6 year programme and the final or sixth year may be spent in approved out-of-programme (OOP) posts here in Ireland or overseas.
Trainees applying for final year OOP should supply the following information along with a formal letter of application to the Chairman of the Training Committee at least six months before taking leave:
1. Letter supporting the application from the supervisor of the educational or research project
2. Outline of the proposed research project of the training to be undergone in the post
3. Where-a higher degree is being pursued, a synopsis of the proposed thesis and evidence of registration on a university higher
4. The application must be submitted in writing at least six months in advance of the date on which the Leave is to begin.
5. Applicants may be required to attend an interview at the College of Anaesthetists to discuss their research project
Trainees may for a variety of reasons such as maternity, illness or personal, seek to take leave during their training programme. Trainees should give the CAI as much advance notice of such leave as possible, although the CAI of course recognises that this may not always be possible.
When the cumulative duration of such leave exceeds three months, the trainee must make up this shortfall in training (in minimum blocks of six months). When the period of such leave from the training programme is greater than one year, training will be considered to be suspended. This means the trainee must apply in writing to rejoin the programme but may be eligible for reappointment without interview. The Training Committee will decide the date of re-appointment and the year at which the trainee recommences training.
In the case of maternity leave not coinciding exactly with six monthly training rotations, provided the duration of maternity leave is not greater than six months, a six month balance of time remaining in the two six month training periods within which the leave occurs will be accredited towards training.
Further details on SAT Year 1 and 2 training can be found in the training regulations which can be downloaded here