2021 Curriculum Assessment Guidance

Levels of Supervision summary

• Anaesthetists in training will need to demonstrate progression through the supervision levels for the different key capabilities within the HALOs.
• The assessor should identify the supervision level that the anaesthetist in training requires for that activity at the time the SLE is completed.
• This is the supervision level the anaesthetist in training would require if they were to repeat that same activity right here, right now.

In other words, if the anaesthetist in training were presented with a similar case, what supervision level would the assessor think that they would need? Would they need a supervisor to be with them at all times, to stay close (in the anaesthetic room), to be around but not necessarily that close (in the department), or could the supervisor be at home?

Using supervision level judgments and other evidence to determine progress

• Anaesthetists in training do not have to have a specific SLE with the suggested supervision level to meet the HALO requirements but they do need to demonstrate progress and the faculty decision will be made based on all the evidence supplied and observation in practice.
• Supervision levels are indicative and are intended to guide and reflect progress; SLEs are not individual assessments of competence.
• To allow trainers to review progress we suggest that anaesthetists in training use the ‘Create HALO’ function. This then allows both trainer and anaesthetist in training to see evidence as it is linked to the clusters of capabilities. It will also show the supervision levels in due course, although this function is still being worked on by the LLp team.
• The ‘Create HALO’ can only be used once evidence has been linked to that HALO.
• Trainers must not press ‘Create HALO’ when viewing portfolios as this then means that the anaesthetist in training can no longer add any further evidence and it needs to be ‘unlocked’ by the LLp team.

Levels of Supervision detailed outline

Anaesthetists in training will need to demonstrate progression through the different levels of supervision detailed in the table below for clinical activities.

Table 3 – The levels of supervision

 For some activities it may be more appropriate to assign ‘not applicable’ for the supervision level.

The trainer should identify the level of supervision that the anaesthetist in training requires for that activity at the time the SLE is completed.  This is the supervision level the anaesthetist in training would require if they were to repeat that same activity ‘right here, right now’.

At each stage of training, the specialty specific domains of the curriculum will describe the level of supervision that should be demonstrated by the anaesthetist in training by the end of the stage of training.  Please refer to Appendices 1, 2, and 3.

It is expected that the anaesthetist in training will have demonstrated capabilities at the supervision level described in stage 3 at the time of CCT.

SLEs and other activities should be used to illustrate engagement in the training programme and the opportunity to gain and record structured feedback on performance.  Ongoing engagement in the training programme is also reflected in the Key Capabilities within the generic professional domains.

Key points to remember:

• SLEs are low stakes episodes of feedback and reflection in the workplace.
  They are not individual assessments of competence.
• Supervision levels are indicative and are intended to guide and reflect progress.
• Supervision levels are not marks. They are the outcome of a reflective discussion and feedback between the anaesthetist in training and the trainer.

• Supervision levels should indicate the level of supervision the anaesthetist in training would require for the activity if they were to repeat it ‘right here, right now’

• Supervision levels may not necessarily be the same as the supervision that took place for that activity.
  For example: a senior trainee may require the consultant to attend a challenging case because guidelines dictate that. The anaesthetist in training is observed doing the case, and the reflective discussion during and after the case indicates that if they were given that case to do again, they have the ability to undertake it independently. The supervision they had for the case may indicate a level of 2b but the supervision level that they would need if the activity were to be repeated ‘right here, right now’ is 4.

• Anaesthetists in training do not have to have a specific SLE with the suggested supervision level to meet the HALO requirements but they do need to demonstrate progress and the faculty decision will be made based on all the evidence supplied and observation in practice.

• When completing an SLE, anaesthetists in training can suggest the supervision level that they feel is appropriate for them if they were to repeat this activity.