Introduction
There are a growing number of non-clinical roles that resident doctors can apply for, which increases knowledge and skills in non-clinical areas. The way in which these roles are undertaken and the impact on clinical training needs to be carefully considered. Academic training, alongside clinical training, is a well-established pathway but other roles include fellowships (eg Royal College of Anaesthetists), NHS England improvement fellows, and the Chief Registrar programme. There is now also the option of a portfolio fellow – a resident in later stages of training with a particular other role, agreed by the department they are working in.
These roles give anaesthetists in training a number of opportunities, including but not limited to:
- Developing an area of expertise in a non-clinical domain
- Exposure and experience of management wider than departmental level
- Paid time to complete larger scale audit, quality improvement, research and education projects
- More flexible working patterns
As part of the academic programmes (ACF, ACL) the time in academia is counted towards training time. This includes 6 months of a DPhil programme. The understanding has always been that aspects of an academic programme are relevant to all training. For craft specialties such as anaesthesia, a resident might choose to delay their CCT date in order to gain more clinical experience, despite having completed the training time on paper. The new portfolio roles that are now possible are, likewise, often in areas that are broadly relevant to training, particularly to the Generic Professional Capabilities.
The 2021 curriculum in Anaesthetics shortens higher specialty training to 4 years instead of 5, and the last few years have shown that this truncated time is being felt by most residents in terms of pressure to achieve the required capabilities. The implications of this are that should portfolio roles be taken on and counted towards training time, there is a significant risk that even an exceptional resident will find it challenging to get HALO sign offs as they approach the end of a Stage.
The options differ slightly for each portfolio role, but the principles of training time and whether or not it is counted remains the same. Trainers and residents are invited to think carefully about the options available for these roles before committing.
General principles to consider before applying
· When applying for one of these roles the approval of their ES and their TPD / HoS must be sought.
· The options available to do these roles regarding training time or moving to LTFT are to be made clear in these early discussions; consistent advice and transparency over options is key.
· The School strongly advises moving to LTFT and not compromising clinical training time.
· If the resident is planning on remaining FT, and counting the additional role towards training, the possible consequences of not completing all competencies and requiring an extension should be made clear. This may also mean that the application is not supported by the trainers.
· The department hosting the resident must be aware and agree to the reduced clinical working.
· While there is a breadth of experience that can be gained during on calls (whether in general anaesthesia, obstetric anaesthesia or intensive care), exposure to elective activity is necessary to progress.
· Reducing the number of standard clinical working days reduces the time available to gain this exposure and puts pressure on achieving HALO requirements. Other reasons for a reduction in standard clinical days (eg sick leave, excess annual leave, return to work after parental leave) can increase this pressure.
Key decisions
Whether to remain in full time clinical training or reduce to LTFT clinical
Full time clinical training: No change to expected CCT date. Anaesthetists in training will therefore need to meet all the required clinical competencies with less clinical time.
Less than full time clinical training (although still full-time hours worked): Training progress continues, but at a slower rate. Time in the non-clinical role does not count towards the total required, so the expected CCT date is delayed accordingly. For example, a non-clinical role taking 40% of time would mean clinical training at 60%. If the non-clinical role lasted 1 year, this would delay CCT by around 5 months allowing additional clinical time to gain experience.
On call frequency
The clinical time could remain at the normal on call frequency or reduce proportionately with the reduction in clinical time. Reducing on call frequency would reduce salary but allow additional days in elective lists to gain specific experience which would aid gathering capabilities to progress towards certain HALOs. This would need to be agreed by the relevant parties, including hosting department. This decision applies whether remaining at full or less than full time clinical training.
Specific examples
Academic residents
Time in academia will continue to count towards training.
Should competencies not be met at a critical progression point (usually applies to ACF only), the resident may be offered an extension to training. As CCT approaches, the resident can choose to move their CCT date should they wish to gain more clinical exposure (usually more relevant to ACLs).
NHSE improvement fellows
These roles are paid for, on top of the Tariff payment the Trust receives for the resident placement. This gives the option of moving to LTFT for clinical training time for both regular and on call sessions, ie CCT moves later. The pay drops a little in line with 60% on call banding; 16 hours a week are paid by NHSE in addition to anaesthetic pay.
This is the preferred option for Anaesthesia as well as other Schools.
If the resident chooses to count their fellow time towards training, there is likely to be a strong departmental preference that they remain at 100% on calls. The impact on clinical exposure should not be underestimated. In order to move to 60% on calls as well, there needs to be agreement from the department that this gap can be managed. There is a small drop in pay commensurate with the reduction on call.
There is more information available on TIFs here: https://thamesvalley.hee.nhs.uk/resources-information/trainee-information/training-options/development-opportunities/
Other fellowships, eg RCoA
These roles are usually paid by the host organisation so similar options apply as above.
Chief Registrar scheme
The Chief Registrar program is designed by the Royal College of Physicians and is an external appointment, advertised via NHS jobs and appointment involves an online application form and face to face interview. Whilst it is usually a role undertaken by medical registrars, RBH is one of 5 trusts in the country to have had an anaesthetic resident doctor as part of their chief registrar team.
The scheme is run nationally and there are 10 teaching days across the year with other chief registrars across the country, who are mostly medical registrars. This course is funded by the Trust, and involves teaching on QI and leadership which fits in well with the non clinical domains of our anaesthetic non clinical curriculum.
The chief registrar non-clinical days can be used for project work (either self directed or from ideas suggested by the department), educational programs, management work (e.g. helping write rotas as needed, feedback to junior doctor rep meetings) and associated self development e.g. shadowing the COO, attending business case meetings, attending board/directorate level meetings etc. It's a great opportunity during training to be exposed to the non-clinical side of the hospital and how it functions.
Many departments, if they agree to have a CR, will ask for 100% on call duties.
Again, this can count as 100% training with the caveat above; it may be challenging to complete all competencies in the remaining available time.
FELLOWSHIPS
Oxford University Hospitals offers Fellowships in Obstetric, Airway, Regional and Neuro Anaesthesia as well as Fellowships in Perioperative or Pain medicine. We welcome applications from UK trainees who have completed 5 years of training in Anaesthesia as well as similarly qualified international graduates who are eligible for registration with the GMC.