imperial school of anaesthesia specialist registrar training

IMPERIAL SCHOOL OF ANAESTHESIA
SPECIALIST REGISTRAR TRAINING PROGRAMME
GUIDE FOR TRAINEES

Contents
Section 1
General Information
1 Introduction
2 Prospectus
3 Starting as a Specialist Registrar
a)Training Numbers
b)Registration
4 Programme Planning
a)Year 1/2
b)Year 3/4/5
5 Competency Assessments
6 Record of In Training Assessment
7 FRCA Examination
8 Out Of Programme Experience
9 Movement between Deaneries
10 Flexible Training
11 Study Leave
12 Clinical Research Methodology Training
13 Simulator Centre
14 Personal Portfolio
15 Completion of Training
16 Counselling
17 Personal Administration
18 Trainee Feedback
19 Indemnity for Staff Undertaking Critical Care Transfers
20 Removal & Excess Travel Expenses
Section 2
Year 1/2 Competencies
Section 3
Year 3/4/5 Competencies
Section 4
Intensive Care Medicine Competencies

Appendix
I Registration Form for the Royal College of Anaesthetists
II Forms for Record of Satisfactory Completion of Unit of Training
III Forms for Record of Satisfactory Completion of Higher Training Module
IV Forms for Record of Satisfactory Completion of Advanced Training Module
V Forms for Record of Satisfactory Completion of Training in Intensive Care Medicine
(all stages)
VI Confidential Trainee Feedback forms

1 Introduction
This folder contains information about the Imperial School of Anaesthesia and the
documentation required for training as a Specialist Registrar in the Imperial School of
Anaesthesia.
Additional information, including contact details, can be obtained from the School website
www.imperial-anaesthesia.org.uk
The programme of training and assessment will be in accordance with the guides published
by the Royal College of Anaesthetists:
The CCST in Anaesthesia I General Principles
The CCST in Anaesthesia II Competency Based Senior House Officer Training and
Assessment
The CCST in Anaesthesia III Competency Based Specialist Registrar Years 1 and 2
Training and Assessment
The CCST in Anaesthesia IV Competency Based Specialist Registrar Years 3,4 and 5
Training and Assessment
The guides are available in full from the Royal College website: www.rcoa.ac.uk
You are also advised to be familiar with “A Guide to Specialist Registrar Training”
(Department of Health, 1998). This document, known as “The Orange Book” is available
from www.doh.gov.uk/hrinthenhs/orange.htlm
Much of the communication within the School is electronic and you are advised to maintain
an active email address, and ensure that the School office is aware of changes to it.
KEY POINT: it is important to maintain an active email address to receive School
communications.

2 Prospectus
The hospitals of the Imperial School are described in the School Prospectus. This is available
from the School website www.imperial-anaesthesia.org.uk
The School is governed by the School Executive Board, taking advice from the School
Advisory Board and chaired by the Regional Adviser. The Training Programme is
coordinated by the Training Programme Directors in accordance with the policies of the
Postgraduate Dean through the Specialty Training Committee, and the curriculum of the
Royal College of Anaesthetists.
The Officers of the School and their contact details are given on the School website.
Each hospital has a Royal College Tutor who will organise the teaching within that
institution, and organise and oversee the local training attachments of the trainee in
discussion with the trainee. The College Tutor is also asked to undertake the local appraisal
process and co-ordinate the regular assessments of the trainee for the RITA process.
Rotational training arrangements are organised by the Training Programme Director (TPD) in
discussion with trainees and trainers.
Tutors, TPDs, and trainees are encouraged to discuss further with the Regional Adviser or a
Deputy RA as required.
Training Programme Directors are appointments of the Postgraduate Dean. Royal College
Tutors, Regional Advisers and their Deputies are appointments of the Royal College of
Anaesthetists. All work together in the operation of the School and effective communication
between them and the trainee is essential.
KEY POINT: it is important for the trainee to maintain efficient communication with
the Training Programme Directors

3 Starting as a Specialist Registrar
Specialist Registrars are appointed to either Type I or Type II training programmes.
Type I programmes lead towards a Certificate of Completion of Specialist Training (CCST),
and so eligibility for entry to the Specialist Register of the General Medical Council, a
prerequisite of appointment to the Consultant grade.
Type II training programmes (Fixed Term Training Attachment or FTTA) do not lead to a
CCST although Type II training, if appropriate, may be counted towards Type I training if
appointment to such a programme is achieved at a later date.
a) Training Numbers
The Training Programme of the Imperial School of Anaesthesia is operated on behalf of the
Dean of Postgraduate Medicine at the London PMDE, 20 Guilford Street, London WC1N.
Each Specialist Registrar is allocated a unique Training Number by the Deanery when taking
up post. Most of the hospitals of the School are within the London Region but the London
Deanery has a service level agreement to train the SpRs of the School’s hospitals in
Hertfordshire which belong to the Eastern Region. The pool of training numbers available to
the School therefore contains both London Deanery numbers (prefixed LDN) and Eastern
deanery numbers (prefixed EAN). Anaesthesia has a specialty code 091.
National Training Numbers (NTN) are allocated to trainees who benefit from European
Community rights or who have right of indefinite residence or settled status in the United
Kingdom. These numbers are suffixed N.
Visiting Training Numbers (VTN) are allocated to trainees who do not benefit from European
Community rights or who do not have right of indefinite residence or settled status in the
United Kingdom. These numbers are suffixed V.
Type 2 trainees’ numbers are suffixed F.
A Training Number will thus have an appearance similar to LDN /091/xxx/N, where xxx
represents the trainees identity. The number should be quoted in its entirety when
corresponding with the Deanery or Royal College of Anaesthetists.
KEY POINT: Training Numbers are allocated by the London Deanery at the start of
Specialist Registrar Training. This number is unique to the individual and should be
used on all official correspondence

) Registration with Royal College of Anaesthetists
Time spent as a Specialist Registrar will not count towards the CCST programme unless the
trainee has registered with the Royal College of Anaesthetists as a Specialist Registrar.
Training as a Locum Appointment – Training (LAT) must be registered prospectively if it is
to be counted towards Type I training at a later date.
The Royal College requires that all SpRs register as soon as possible after appointment to the
grade. This is the case whether the trainee is Type I, Type II or a LAT.
Previous registration as Senior House Officer is not enough.
The trainee must inform the Royal College of all changes to the registered individual
programme.
A Registration form is included in this folder (Appendix I). Forms are also available from
the Royal College of Anaesthetists and should be completed in as much detail as possible,
signed and sent to the Year 1/2 Training Programme Director for signature. The form then
goes to the Regional Adviser for countersignature. The School office will return a copy to
the trainee, keep a copy and send the original to the Royal College. Trainees should not send
the registration form direct to the Royal College.
It will not be possible to pass smoothly through the RITA process unless a trainee has
registered.
KEY POINT: It is essential to register with the Royal College of Anaesthetists at the
start of Specialist Registrar Training

4 Programme Planning
The Imperial School of Anaesthesia has two Training Programme Directors for SpR
anaesthetists. One of these is responsible for the recruitment to the grade and the
organisation of Years 1 and 2. The other TPD is responsible for the organisation of Years 3,
4 and 5.
Because the two stages of training cannot be planned in isolation from each other, the TPDs
work together to co-ordinate the overall training programme. Advice will also be taken from
College Tutors, Regional Advisers and the RITA panels.
As far as is compatible with the progress of an individual trainee, personal preference may be
taken into account when deciding hospital placements. It is important for the trainee to
understand that moves will be made for training advancement, and that the needs of other
trainees also have to be considered.
It should also be remembered that SpRs are appointed to the training programme as a whole
and not to specific rotations. SpRs are encouraged to train in close relationship to the TPDs –
all trainees will be properly trained but where there are special requests these can be more
easily met if the TPDs are informed early.
Much of the communication within the School is electronic and you are advised to maintain
an active email address, and ensure that the School office is aware of changes to it.
Trainees are encouraged to make full use of the allowance for study leave (see Section I, 11 )
and also attend the Simulator Centre training course which offers a structured programme,
four days in five years during the CCST programme (see Section I, 13).
a) Year 1/2
The School is privileged to comprise a large number of hospitals of differing types. There are
District General Hospitals, Teaching Hospitals and Specialist Hospitals. The distribution of
sub-specialty training between the hospitals of the School is such that it is not always
possible to complete all the specialist modules listed for Year 1/2 within the first two years of
training. The School has dispensation from the Royal College of Anaesthetists to defer
missing sub-specialty modules until Year 3 when this is necessary.
The remaining pre-requisites for entry to Year 3 are success at the Final FRCA exam (or
equivalent), and satisfactory RITA process.
It is important for all trainees in Years 1/2 to understand the importance of informing the
School of progress through the competency programme (see Section 2) to allow efficient
planning of the Year 1/2 phase. It is also beneficial to pass the Final FRCA exam, and inform
the School of success, at an appropriate stage of training so that planning of Years 3/4/5 may
be started.
KEY POINT: trainees must contribute to the planning of their individual training
pathway

) Year 3/4/5
The abundance of multi-specialty Teaching Hospitals, and single specialty Specialist
Hospitals gives the Imperial School a wealth of higher training opportunities.
This phase of training cannot be planned until it is known that the trainee has passed the Final
FRCA or equivalent. The sooner that planning can start, the easier it will be to organise a
suitable and balanced programme for the individual.
Trainees may work towards being an expert in one of six subspecialties, or a generalist. The
described sub-specialties are cardiothoracic anaesthesia, neuroanaesthesia, intensive care
medicine, obstetric anaesthesia, paediatric anaesthesia, and pain management.
There are two levels of training – higher training, typically in modules of three months, and
advanced training for the sub-specialty expert. This will involve training in modules of
usually between six and twelve months.
There are certain requirements of this phase of training:
competency modules left uncompleted from Years 1/2 should be completed in Year 3
generalists will cover the higher training modules of the six sub-specialties
all SpRs are expected during the total of five years to have spent six months training
in Intensive Care Medicine, typically three of these will be in Years 3/4/5
all SpRs must spend at least six months in Years 3/4/5 undertaking general duties
It is permitted, and recommended for major subspecialties, to spend up to one year in a
specific sub-specialty field.
It is also permitted, under certain conditions, to spend up to one year Out Of Programme and
have this time counted towards the CCST. (See Section I, 8).
During the Year 3/4/5 phase the trainee will be expected to attend management training and
also to undertake training in research methodology (see Section I, 12).
Every trainee must complete the full 3 years of SpR 3/4/5 training of which two must be
spent in approved training or research posts in the UK.
KEY POINT: trainees with a major subspecialty interest should express this interest as
soon as possible to facilitate best planning

5 Competency Assessments
The progress of each trainee through the competency training programme is reviewed
informally in the School office on a regular basis. It is important for the review process that
the School office receives early notification of the satisfactory completion of competency
modules as soon as they are achieved. Unless this is done the movement of the trainee
through the programme cannot be planned.
Section 2 contains the competency assessment sheets for Year 1 and 2, and Section 3 those
for Years 3,4 and 5.
For training in Intensive Care Medicine the competency forms of the Intercollegiate Board
for Training in Intensive Care Medicine may be used as an alternative to the Imperial School
forms contained in Section 4. Satisfactory completion of a phase of training in ICM must be
reported to the School on the School module report forms.
It is the responsibility of the individual trainee to seek the assessment of a competency from
the relevant trainer as soon as it is felt that this is appropriate. Completion should be reported
to the School office, either by the trainee or College Tutor, as soon as possible so that the
next phase of training can be planned.
The forms required for this notification are provided in Appendix II for Years 1/2, Appendix
III for Higher Training modules in Years 3, 4 and 5, and Appendix IV for Advanced Training
modules in Years 3, 4, and 5. Notification forms for completion of stages of training in ICM
are provided in Appendix V.
KEY POINT: trainees should seek competency assessments as soon as they feel this to
be appropriate, and notify the School immediately upon their completion

6 Record of In Training Assessment (RITA)
At each stage of training your Consultant trainers will complete School Assessment forms
relating to your overall progress as a trainee. These are returned to the School office in
confidence after you have had the opportunity to review them with your College Tutor. They
will be considered as part of the RITA process.
The RITA process is a formal review process conducted by the London Deanery,
at least annually for each trainee, and is addition to the School review of competency
assessments.
The usual pattern is to conduct RITAs at the end of each year of training, but additional
RITAs will also be held for some trainees under extraordinary circumstances.
The process will be conducted either in the School office, or at the Deanery according to
circumstance. The current usual pattern is listed below.
Year 1 School (to confirm completion of competency modules)
Year 2 Deanery (to confirm suitability for Year 3, and to facilitate further planning)
Year 3 School (to confirm completion of competency modules)
Year 4 Deanery (to make final adjustments to training pathway if necessary)
Year 5 Deanery (to confirm satisfactory completion of programme)
RITAs will also be conducted before and after periods Out Of Programme, to address issues
that might arise in the assessments from trainers, or if discussion at the forum is requested by
the trainee and is felt to be appropriate by the Regional Adviser.
RITA days are held four times per year at the Deanery, the final RITA usually about three
months before the CCST date.
The trainee will be expected to bring or submit documentation to the RITA panel. This will
include:
RITA Form A (this will be sent by the Deanery for correction of background details)
Updated Curriculum Vitae
Training Agreement from current training institution
Log book summary
Certificates of attendance at courses, Simulator Centre etc
Competency assessment certificates
There is a series of RITA forms, one of which will normally be issued at the time of the
RITA.
(Form A holds basic personal details, and is returned at this time by the trainee)
Form C is issued as a Record of satisfactory progress within the SpR Grade
Form D is issued as a Recommendation for Targeted Training
Form E is issued as a Recommendation for Intensified Supervision/Repeat Experience
Form F is a Report of “out of programme” experience
Form G is the Final Record of satisfactory progress
KEY POINT: The RITA process is an integral part of SpR training

7 FRCA Examination
It is expected that SpRs will have been successful at the Final FRCA before the end of Year
2. The earlier the exam is passed within the training programme, the easier it is to plan the
remainder of the training programme for that individual.
All the hospitals of the School that train pre-Fellowship SpRs have active teaching
programmes with additional exam directed teaching at the appropriate times.
Courses are available for additional teaching, and study leave may be used to attend these. It
is unlikely that more than one course will be approved per exam.
It is important to be prepared properly for the examination, and the advice of College Tutors
should be sought if there is uncertainty about preparedness.
If it is thought that a rotational move might disturb a sitting of the examination, then prior
discussion with a TPD might be helpful. Trainees will often be moved after an unsuccessful
attempt at the examination in case a different teaching environment proves better.
There is a set procedure, agreed by the Royal College of Anaesthetists and the Postgraduate
Deans, to accommodate those SpRs who have failed to pass the Final FRCA by the end of the
second year of training and who still have an allowance of attempts remaining. Six attempts
are permitted.
Year 2 may be repeated once whilst continuing to sit for the examination and training under a
RITA Form E. This effectively stops the training clock with deferral of the CCST date by the
amount of delay in training. After this repeat of Year 2 the Training Number may be retained
for a further year whilst working out of programme. If the Final FRCA or equivalent has not
been passed by the end of this second year of extra time then the trainee will be withdrawn
from the programme and the Training Number lost. The trainee may continue to attempt the
examination until the maximum number of permitted attempts is reached, but will have to
reapply for SpR training in open competition to resume in a training programme.
KEY POINT: it is to the advantage of the SpR to have passed the FRCA comfortably
before the end of Year 2

8 Out Of Programme Experience
The CCST training programme allows for up to one year of Specialist Registrar training to be
spent outside the programme and be counted towards the CCST. This is conditional on the
trainee having sought and been granted prospective approval by the Training Committee of
the Royal College of Anaesthetists.
The absence from the training programme is also subject to the approval of the Postgraduate
Dean, and application for this is a separate process. Absence of more than one year is
unlikely to be approved unless the time is leading towards the award of a higher degree.
Out Of Programme Experience (OOPE) counting towards the CCST cannot be taken before
Year 2 has been completed and the SpR eligible for entry to Year 3, although preparation
may be done in advance. The trainee must usually spend the last six months of training
inside the School Training Programme. This leaves a restricted time window in which to take
OOPE.
There is a formal Deanery procedure in the approval of OOPE, and at least three months
notice of intended OOPE is expected.
The trainee should complete a London Deanery OOPE application form, available from the
Training Programme Directors or the School office. The proposal should be discussed with
the TPD, and also the Regional Adviser if necessary. The form should be completed
according to the instructions and returned with a copy of supporting documentation including
job offer, job description, training objectives, named supervisor and relevant contact details
to the TPD. The TPD must sign the form and send it with documents to the Regional
Adviser for approval, and then the form and documents go to the Postgraduate Dean for final
approval.
Separately the applicant must apply directly to the Medical Secretary to the Training
Committee of the Royal College of Anaesthetists for prospective approval for the time to
count towards the CCST. This requires a letter with a copy of supporting documents.
The trainee undertaking OOPE should expect a RITA before and after the period of absence,
and on return will be required to provide a written report of the experience gained. The
OOPE supervisor will also be asked to provide a trainee assessment for the period.
KEY POINT: OOPE must have prospective approval separately from the Dean and the
Royal College of Anaesthetists

9 Movement between Deaneries
Specialist Registrars with well-founded reasons for moving between Deaneries in the United
Kingdom, should approach the TPD or Regional Adviser in the first instance for an Inter-
Deanery Transfer. As well as discussing the proposals and advising as necessary they can
also help with an approach to the prospective new training programme.
Such moves take place only at the discretion of the Postgraduate Dean to whom a formal
application will also be required.
When a transfer is agreed the timing of the move will depend upon the existence of an
appropriate place in the new programme. The new Deanery will issue a replacement training
number at the time of the transfer, and the availability of a number also might delay the
transfer.
KEY POINT: Inter-Deanery transfers might take a significant time to implement

10 Flexible Training
Any trainee who can show that “training on a full-time training is impracticable for wellfounded
individual reasons” (EC Directive 93/16/EEC) is eligible to apply for flexible
training. In the first instance an approach to the Postgraduate Dean responsible for flexible
training should be made.
Trainees wishing to train flexibly should also approach the TPD and the Regional Adviser for
Flexible Trainees. The RA for Flexible Trainees co-ordinates the relevant hospital
attachments and will help the TPD to construct a suitable training scheme. This scheme will
be in accordance with the overall requirements of the individual, as for any other trainee.
The TPD will seek prospective approval from the Royal College for the proposed scheme,
and this approval must have been obtained before the flexible scheme starts.
It should be understood that there are limited funds available to support Flexible Training,
and suitable placements might not be instantly available. Therefore although permission to
train flexibly might have been granted in principle, there might be a delay in commencement
of flexible training.
The training and duties of a flexible trainee are organised pro rata with respect to whole-time
trainees and must be at least 50% whole time. The prospective CCST date is delayed also pro
rata.
Flexible Training is by definition flexible, and changes to training placements, interruptions
to training, and changes in whole time equivalent proportion are commonplace. The flexible
trainee must keep the Royal College and the School office informed of all changes.
KEY POINT: training requirements are the same for all trainees; flexible training takes
longer

11 Study Leave
The Specialist Registrar is entitled to 30 days study leave with pay and expenses per annum,
or one day a week with pay and expenses during university terms.
Authorisation of leave of absence for study leave is granted by the employing Trust relevant
at the time of the study leave according to that Trust’s procedures. The purpose of study leave
should be discussed with the relevant College Tutor, and usually will be granted provided
that there is clear training or educational benefit. The timing of Study Leave is subject to the
employer’s discretion because of interference with service.
Most NHS Trusts require at least six weeks notice of intention to take study leave. It is clear
that this should be planned and arranged well in advance, contacting the Training Programme
Director if necessary to ascertain the relevant Trust for the application.
Funds are limited and made available through the Deanery. Since 1 April 2003 the funding of
study leave for the SpR anaesthetists training in the Schools of the London Deanery is
processed through the Deanery direct to the trainee, and no longer through the Trusts’
Clinical Tutors. Once the relevant Trust has authorised the leave, application for the
reimbursement of expenses should be made to the Deanery on the appropriate form. This is
available from the Trust’s College Tutor and should be returned to:
Christobel Gunasekera
London Deanery
Room F3
20 Guilford Street
London WC1N 1DZ
This new arrangement will allow trainees to access funding without the complications caused
by the structure of the rotational pathway and sometimes short clinical attachments involved.
It will also allow the trainee to carry funding from one year to the next and so help with the
variation in yearly demand that accompanies passage through the programme.
Funding for attendance at the Simulator Centre course is deducted from the individual
allowance by the Deanery at rate that spreads the cost of the four days evenly over the five
years of SpR training. This applies to all SpRs training through the London Deanery.
Study Leave should preferably taken for purposes approved by the Specialty Training
Committee through the trainers of the School of Anaesthesia. Although the trainee must be
invited to exercise considerable choice over study leave use there may be some activities,
from time to time, that carry a STC label of compulsory or a strong STC recommendation.
Items in this category currently are:
Simulator Centre training programme Compulsory (four days in five years)
Clinical Research Methodology Course Compulsory if SpR Year 3 starts after 1 August
2003
Management Course Strongly recommended during Year 5
North London Year 3/4/5 study days Compulsory for available Year 3/4/5 trainees
KEY POINT: study leave funds are limited and are the funds of the Postgraduate Dean

12 Clinical Research Methodology Training
The Competency Training Programme for training in Years 3,4 and 5 includes the
requirement for Research training. This coupled with recurrent comment by the Royal
College of Anaesthetists on the limited research activity in the School, has led to the creation
of a Clinical Research Methodology Training Course.
The course will take place over five days. The first episode, of four days, will involve
classroom teaching in aspects of research method, followed after a period of six weeks by a
supplementary day for the prepared course work.
The Specialty Training Committee has given the course a compulsory rating for Imperial
School trainees entering Year 3 on or after 1 August 2003. Those trainees who have
undertaken, or who have registered to undertake a higher, research based degree in the UK
will be exempted, as will those who can produce a satisfactory Competency assessment to
confirm that they have undertaken a similar course elsewhere. Imperial School trainees are
encouraged to attend the local course.
The course will charge a fee, and so should be accompanied by an application for study leave
with expenses in the usual way.
It is not intended that those attending the course are exempt from undertaking research - this
will always be encouraged as part of the training programme.
The course will be run twice per year starting in Autumn 2003, after the new study leave
funding arrangements come into operation.
KEY POINT: research training is a compulsory element of the training programme

13 Simulator Centre
The Simulator Centre at the Chelsea & Westminster Hospital has devised a training
programme for trainees in anaesthesia.
With four days’ attendance over five years the trainee is taken through a sequence of training
episodes commensurate with the professional development of the trainee. There are six
stages in all, two for the SHO years and four for the SpR years.
The Deanery regards attendance at the Simulator programme as an educational objective, and
so it is STC policy that all the School’s trainees should attend. The Royal College of
Anaesthetists also encourages the use of simulators where these are available.
Funding for attendance at the Simulator Centre course is deducted from the individual
allowance by the Deanery at rate that spreads the cost of the four days evenly over the five
years of SpR training. This applies to all SpRs training through the London Deanery.
The Department of Health has suggested that simulators will take an increasingly important
part in the delivery of training as part of the changes resulting from the implementation of the
European Working Time Directive.
The Simulator Centre will publish a list of dates on which the various elements of the course
are available. Booking at the Simulator Centre should be made directly by the SpR with the
centre Administrator. It will be necessary to apply for study leave from the employing Trust
in the usual way, but expenses will have already been allocated through the Deanery.
KEY POINT: attendance at the Simulator programme is a compulsory educational
objective of the London Deanery.

14 Personal Portfolio
The Training Committee of the Royal College of Anaesthetists strongly recommends that
trainees should maintain a portfolio for training activity.
It is mandatory for trainees to record details of anaesthetics they administer in a suitable
paper or electronic format. Diaries of activity in Intensive Care, Pain and obstetrics should be
kept as an alternative. This information constitutes the log book.
Summaries of the log book data will be inspected as part of the RITA process, and so an
electronic format will usually be more convenient. The School recommends that trainees use
the log book provided by the Royal College of Anaesthetists. Your attention should be drawn
to the Data Protection Act (www.dataprotection.gov.uk) which might influence the way that
the log book is used.
An example of how a log book summary might be constructed is given in the SpR
Competency Training Manuals of the Royal College of Anaesthetists.
It will be expected for purposes of professional revalidation throughout your career that you
will maintain a Personal Portfolio. This file can be used to start that process. Full details of
the structure of such a document are available from the website of the Royal College of
Anaesthetists (www.rcoa.ac.uk).
An Outline Training Portfolio Suitable for Senior Trainees is given in The Year 3/4/5
Competency Training Manual of the Royal College of Anaesthetists
KEY POINT: this guide can be used as the foundation of your Personal Portfolio

15 Completion of Training
The prospective CCST date of a Specialist Registrar will be first prompted automatically at
the Deanery when training in the grade starts. At this stage it is a projection from the
appointment date. The official prospective CCST date will be calculated formally by the
Royal College of Anaesthetists at the time of registration and adjusted by the College when
appropriate and when in receipt of any relevant information. The trainee is responsible for
informing the Royal College of all changes to the registered individual programme.
Training is not complete until the Royal College is satisfied that the trainee has satisfactorily
completed the training programme.
About three months before the prospective CCST date, the trainee will be invited to attend a
RITA panel. This will review the entire training programme of the individual and the
training assessments. If all is in order a RITA Form G will be issued, and the College
notified of this.
The Training Programme Director reports to the College describing the training modules and
competency training accomplished during the Years 3/4/5.
When the College is satisfied that the training programme has been satisfactorily completed a
recommendation that a CCST be issued is sent to the Specialist Training Authority (STA).
At the same time the College sends a form to the trainee with which the trainee may apply to
the STA for the issue of a CCST. This involves payment of a fee, determined by the STA.
Once CCST is issued, then an application may be made to the General Medical Council for
entry to the Specialist Register.
Although it is permissible to be interviewed within the last three months before the
prospective CCST date, a substantive Consultant post must not be started before entry on the
Specialist Register has been achieved.
After the RITA Form G is issued, the trainee should expect to receive notice from the
Deanery of intention to withdraw the Training Number six months after the CCST date. This
period is the same as the period of grace allowed for the search for a subsequent post.
The leaving Specialist Registrar must give three months notice of intention to leave the
training programme if the leaving date is to be earlier than the end of the six months period of
grace that follows the CCST date. The period of grace may be declined at the time of the
final RITA, but three months notice of intention to leave the programme is still applicable.
It should be realised that during the period of grace the School has an obligation to retain the
Specialist Registrar in a post that will allow maintenance of skills. It cannot be expected that
the SpR will be given a prime training placement during this period.
The STA will be replaced, in October 2003, by the Postgraduate Medical Education and
Training Board (PMETB).
KEY POINT: three months notice must be given of intention to leave the programme
before the end of the period of grace whether or not this period is wanted

16 Counselling
See also Section 2 Prospectus.
In addition to the Regional Advisers and Training Programme Directors of the School, each
training hospital has a College Tutor who can approach these officers, the College or the
Deanery on the trainee’s behalf if necessary. Some Trusts of the School allocate each trainee
a personal mentor who may also be approached as required.
Confidential adviser
Dr Andrew Rice, Senior Lecturer in the Magill Department of Anaesthesia, Chelsea &
Westminster Hospital, is available for advice should a trainee not wish to use these channels.
All approaches will be treated in complete confidence.
He can be contacted by email :
a.rice@imperial.ac.uk or telephone 020 8746 8156
or: 020 8746 8188 (secretary)
KEY POINT: trainees needing advice or guidance should feel free to approach any
Consultant of the School as necessary

17 Personal Administration
Each NHS Trust to which a trainee moves will demand to see evidence of current registration
with the General Medical Council and immunity to Hepatitis B. Trainees are advised to keep
these up to date. The introduction of trainee “Smartcards” is expected to facilitate this
process.
Although clinical duties within the National Health Service are covered by the Clinical
Negligence Scheme for Trusts, trainees are advised to maintain personal membership of a
medical defence organisation to protect individual interests.
KEY POINT: trainees must maintain current registration with the General Medical
Council

18 Trainee Feedback
It is valuable to the School to receive feedback from the trainees about the quality of training
they have received during the various attachments. All such feedback will be treated in
confidence.
Trainees are encouraged to complete a Confidential Trainee Feedback form at the end of each
attachment.
Blank forms are provided in Appendix VI of the Training Portfolio. Completed forms should
be returned to the School office.
Trainees should feel free to discuss their training with College Tutors, Training Programme
Directors or Regional Advisers as necessary, or at the RITA committees, in addition to the
confidential reports.
KEY POINT: Feedback is a valuable tool in the organisation of the training programme

19 Indemnity for Staff Undertaking Critical Care Transfers
It is likely under current policies and work practices that at some time during training most
trainees can expect to escort patients being transferred to other NHS Trusts, particularly to
receive Critical Care.
The following statement was released by the Department of Health in June 2003.
All employees of NHS Trusts that are members of the Liabilities to Third Parties
Scheme (LTPS) are automatically covered should they undertake patient transfers.
The LTPS, which is operated by the NHS Litigation Authority (NHSLA), provides
personal accident cover for staff up to a ceiling of £20,000 per individual and
£250.000 per incident (i.e. where more than one member of staff is injured in the
same accident). NHS Trusts are prohibited from taking out commercial insurance to
cover any liabilities in this respect.
The Department is aware that a number of Trusts and staff representative bodies
have been pressing for the ceiling to be increased. However, it was never the
intention that the scheme would provide infinite cover for every eventuality. For it to
do so would mean increasing the contribution members pay into the scheme at an
unattractive level and would tie up large sums of NHS money against relatively rare
events since the number of personal accident claims reported by the NHSLA is rather
small.
In the rare event that compensation is required in excess of the amounts available
through the LTPS, or in exceptional circumstances not covered by the scheme at all,
then NHS bodies are expected to cover the excess amounts themselves.
Nonetheless, where individual members of staff wish to increase their cover, by for
example joining the Intensive Care Society or some other body that provides cover
as a membership benefit, there is no obligation on NHS Trusts, as far as the
Department is aware, to reimburse the membership fee to staff should they decide to
take that option.
Because insurance is provided, patients must be escorted when necessary.
Trainees who feel that the level of personal accident cover provided by the LTPS scheme
might be inadequate are recommended to consider membership of an organisation such as the
Intensive Care Society or the Association of Anaesthetists for more favourable terms.
KEY POINT: membership of some professional bodies includes personal accident cover
whilst undertaking inter-hospital transfers

20 Removal & Excess Travel Expenses
The policy regarding claims for removals expenses or excess travel changed on 1 April 2005
without prior notice to the School.
These funds are no longer distributed via the Human Resources Department at Hammersmith
Hospital on behalf of the Deanery. Instead claims should be submitted to the employing
Trust in the London Deanery area. Eastern Deanery policy is different.
The details of the new guidelines have not yet been made available to the School, but have
been agreed between the Department of Health and British Medical Association.
Specialist Registrars coming to the Imperial School who might be making claims in these
categories are advised to contact the employing Trust before expenses are incurred to plan the
appropriate eligibility and claims that will be honoured.
When the guidelines are available they will be summarised on this page.
Charing Cross Hospital continues to be the “base hospital” for excess travel claims.
This reflects the revised situation at at 1 August 2005
KEY POINT: after eligibility is confirmed, reimbursement of removal or excess travel
expenses is available within a combined and limited ceiling