The development and introduction of competency‐based training and assessment for the paediatric anaesthetic specialist registrar training module at St Bartholomew's and the Royal London Hospitals
Authors: Curran I. , Challands J. , Chin C. , Davis L. , Mcateer E. , Silk J. , Visram A. , Marshall A. 
Published: March 2003

Introduction  Several recent high profile medical cases where doctors' clinical competence has been questioned has led to questions being asked about their fitness to practise. As a consequence higher medical training has been put under the spotlight. The media circus around such events has raised broader concerns with a public increasingly demanding information about their doctors' abilities. The Royal Medical Colleges in conjunction with central government have accepted the need to develop competency‐based training, in an attempt to address these concerns. We describe the educational process whereby a pragmatic, practical and achievable training programme has been created to provide basic level paediatric anaesthetic competence.

Educational Methods in Programme Development  Competency‐based training requires significant changes in approach for both trainee and trainers. This can be problematic if not introduced in a planned manner. The need for insight into the adult educational process is central to successful implementation. Competence can be defined as the ability of a professional to perform to a predefined standard, tasks appropriate to their position. Establishing whether a trainee is competent or not is more time consuming for the trainers. This is unavoidable, as evidence of learning has to be sought directly for each trainee to support the competence claim. The programme was developed by addressing the following educational requirements.

An educational needs assessment of both trainer and trainee, associated with a learning opportunities assessment. Ultimately this will incorporate the Royal College of Anaesthetists competency‐based training targets once published.

Development of a learning plan, identifying core and secondary learning areas and highlighting teaching methodology and training ethos. Core areas were separated into skills, knowledge and attitudes and standards expected.

Implementation of the learning plan, including module structure, declaration of the curriculum, introduction and orientation of the trainee.

Assessment of learning through a package aimed at identifying evidence of learning including index case, scenarios, resuscitation skills and attitude.

Analgesia required for each surgical approach

Laparotomy (Epidural)
Laparotomy (NCA)
Laparoscopy (NCA)

Intra‐op fentanyl
2 mcg/kg
3 mcg/kg
3 mcg/kg

Intra‐op morphine
0 mg/kg
0.1 mg/kg
0.15 mg/kg

% Patients requiring infusion per day (D)
D1 100
D2 100
D3 95
D4 68
D5 4
D1 100
D2 94
D3 50
D4 17
D5 6
D1 100
D2 100
D3 92
D4 42
D5 8

% Patients requiring paracetamol per day (D)
D1 86
D2 90
D3 80
D4 100
D5 0
D1 100
D2 94
D3 100
D4 100
D5 0
D1 88
D2 68
D3 90
D4 50
D5 0

% Patients requiring diclofenac per day (D)
D1 73
D2 71
D3 67
D4 100
D5 0
D1 67
D2 71
D3 89
D4 100
D5 0
D1 63
D2 41
D3 30
D4 50
D5 0

NCA = nurse controlled analgesia

Evaluation of teaching including feedback from trainees and trainers, other senior members of the paediatric multidisciplinary team.

Discussion  We have been running this assessment package since June 2001 and whilst there were inevitable teething problems the package has been well received by trainees and staff. It confirms the need to be practical when setting core learning goals as these goals essentially become your core curriculum and therefore also become mandatory for inclusion in your assessment package. Other pertinent issues relate to the consequences of deeming a trainee not competent, and the legal implications of this conclusion for service provision and career progression.

Conclusion  Competency based training will require a sea change in attitude of both trainees and trainers. However, demands for proven clinical competence cannot be ignored.