Curriculum resources | The Final FRCA

Herein you will find all elements of the intermediate syllabus that can be in examined in a part or all of the the Final FRCA.

The intention is to match a resource for each element, with some resources being matched to multiple elements.

For example, there are areas within the syllabus that allow cross reference to at least one other area (see ‘Xref’): finding a resource to link these will allow for greater breadth of knowledge and depth of understanding.

It is our hope that candidates studying for the Final FRCA will contribute to this website by finding new resources that improve the collective knowledge and understanding or perhaps provide a more contemporary resource that better fits that part of the syllabus.

Please feel free to highlight these resources and any other suggestions in the comments box below.

Resource Key:

The Final FRCA Structured Oral Exam | A Complete Guide, B Krishnachetty (BK)

Anaesthesia for neurosurgery, neuroradiology and neuro critical care

Competence	Description	Resource
NA_IK_01	Recalls/describes the relevance of the anatomy of the skull, skull base, vertebral column and central nervous system to neuroanaesthetic practice [Xref applied sciences]
NA_IK_02	Recalls/explains the relevance of applied physiology and pathophysiology related to the central nervous system to neuroanaesthetic practice [Xref applied sciences]	BK 01.6 BSD BK 03.6 Apnoea physiology
NA_IK_03	Describes techniques for decreasing the intra-cranial pressure	BK 03.8 ICP
NA_IK_04	Explains the indications for using neurophysiological monitoring [inc. EEG, evoked potentials and ICP measurement] to benefit patients requiring neurosurgery/neuro-critical care	BK 03.5 CN Monitoring BK 03.8 ICP BK 06.3 Head Injury
NA_IK_05	Recalls how drugs can impact on neurophysiological monitoring	BK 03.5 CN Monitoring
NA_IK_06	Recalls/explains the pharmacology of drugs which act on the central nervous system [Xref applied basic sciences]	BK 01.7 Parkinson’s BK 03.7 Comparing volatiles
NA_IK_07	Explains the complications of positioning for neurosurgical procedures: prone, sitting, lateral, park bench
NA_IK_08	Demonstrates understanding of the perioperative anaesthetic management of patients for neurosurgery and neuroradiology. This includes: • Preoperative assessment and optimization of patients with neurological disease • Induction and maintenance and reversal of anaesthesia • Early postoperative care including the specific areas of fluid management and the control of pain
NA_IK_09	Demonstrates understanding of anaesthesia for neurosurgical procedures including but not exclusively:  • Shunt surgery • Evacuation of intracranial haematoma • Planned supratentorial and posterior fossa surgery [inc. vascular disease and tumours] • Emergency surgery for traumatic brain injury • Spinal column surgery
NA_IK_10	Discusses the principles of anaesthesia for neuroradiology including but not exclusively: • Emergency and elective imaging of the central nervous system [inc. the principles of stereotactic surgery] • interventional procedures [inc. coiling of intracranial aneurysms] [Xref anaesthesia in the non-theatre environment]
NA_IK_11	Explains the anaesthetic implications of pituitary disease including endocrine effects and trans-sphenoidal surgery	BK 08.5 Pituitary
NA_IK_12	Describes anaesthesia for trigeminal neuralgia including thermocoagulation
NA_IK_13	Explains the anaesthetic implications of spinal cord trauma	BK 02.5 SC Blood Supply
NA_IK_14	Describes how to recognize an unstable cervical spine and explains how it should be managed
NA_IK_15	Discusses the indications for postoperative ventilation
NA_IK_16	Explains the techniques used for recognition and management of air embolism	BK 02.6 Pneumoperitoneum
NA_IK_17	Describes the special risk associated with prion diseases during neurosurgery
NA_IK_18	Demonstrates understanding of the principles of anaesthesia for patients with neurological disease [inc. but not exclusively]: • Guillain-Barre • Myasthenia gravis • Myasthenic syndrome • Dystrophia myotonica • Muscular dystrophy • Paraplegia and long term spinal cord damage	BK 04.1 GBS BK 04.4 Myotonic Dystrophy BK 07.4 Autonomic Dysreflexia
NA_IK_19	Discusses the specific risks of venous thromboembolic disease in neurosurgical patients and how these are managed
NA_IK_20	Demonstrates understanding of the neurocritical care management of traumatic brain injury [inc. but not exclusively]: • indications for ventilation • recognition and management of raised ICP • cerebral protection strategies • fluid and electrolyte balance in the head injured patient • systemic effects of traumatic brain injury	BK 03.8 ICP BK 06.3 Head Injury
NA_IK_20	The principles of management of acute spinal cord injury	BK 07.4 Autonomic Dysreflexia
NA_IK_21	Describes the control of status epilepticus
NA_IK_22	Describes the requirements for safe transfer of patients with brain injury
NA_IK_23	Explains the issues related to the management of organ donation in neuro-critical care [Xref intensive care]	01.6 BSD

Cardiothoracic anaesthesia and cardiothoracic critical care

Cardiac

Competence	Description	Resource
CT_IK_01	Describes the principles of the perioperative anaesthetic management of patients for cardiac surgery
CT_IK_02	Understands and explains the principles of cardiopulmonary bypass including the use of cardioplegia
CT_IK_03	Learns from the perioperative management of patients with cardiac disease knowledge applicable to those requiring non cardiac surgery
CT_IK_04	Understands the pathophysiological changes and organ dysfunction associated with cardiac disease, and their implications in the perioperative period
CT_IK_05	Correctly assesses the risk of operation in a patient who has cardiac or respiratory disease, using common scoring systems
CT_IK_06	Explains the results of the special investigations used during the assessment of patients with cardiac disease including, Xrays, coronary angiography, ECHO, and Scanning techniques including CT, MRI and PET
CT_IK_07	Understands and explains the principles of antibiotic prophylaxis in patients with cardiac disease
CT_IK_08	Recalls/describes the anaesthetic and surgical problems associated with “off pump” cardiac surgery
CT_IK_09	Describes the problems associated with post-cardiac surgery including bleeding and the clinical signs and symptoms of cardiac tamponade, and its management
CT_IK_10	Evaluates the indications for invasive and non-invasive cardiovascular monitoring, and is able to interpret the common findings	BK 09.8 CO Monitoring
CT_IK_11	Describes the methods used to cool and re-warm patients during cardiac surgery, and the complications
CT_IK_12	Explains the need for, and methods of, altering blood coagulability during cardiac surgery
CT_IK_13	Recalls/describes the indications for cardiac pacing and lists the different modes available
CT_IK_14	Describes the principles of action, and the use of, Intra-aortic balloon counter-pulsation and other assist devices
CT_IK_15	Recalls/explains the abnormalities found in the adult patient with congenital heart disease [inc. corrected or partially corrected], and the implications for anaesthesia in these patients
CT_IK_16	Recalls/explains the indications for the use of inotropes and vasodilators during cardiac surgery
CT_IS_06	Demonstrates an understanding of effective and evidence based use of inotropes and vasodilators

Thoracic

Competence	Description	Resource
CT_IK_17	Explains the significance of preoperative functional investigations of respiratory and cardio-respiratory performance
CT_IK_18	Describes specific risks associated with induction and maintenance of anaesthesia in patients requiring thoracic surgery and precautions to be taken to minimise these risks
CT_IK_19	Describes commonly performed thoracic surgical procedures and the relevant anaesthetic problems
CT_IK_20	Describes commonly used methods of local and general anaesthesia for bronchoscopy including techniques of ventilation
CT_IK_21	Describes the airway management of a patient undergoing one-lung ventilation and anaesthesia including placement of double lumen endobronchial tubes and bronchial blockers [Xref EN_IK_11]
CT_IK_22	Recalls/explains the changes that occur during one lung ventilation and the strategies to manage these changes
CT_IK_23	Recalls the causes, symptoms and signs of a pneumothorax and explains the principles of its management
CT_IK_24	Describes the common problems associated with the postoperative care of patients who have had thoracic surgery and the methods that can be used to minimise these

Airway management

Competence	Description	Resource
AM_IK_01	Lists the risks associated with awake fibreoptic endotracheal intubation and describe the process of obtaining consent for this procedure
AM_IK-02	Discusses the identification and assessment of pathology in or around the airway, including: • History and examination • Anaesthetic chart review • Interpretation of investigations such as lateral C-spine X-ray, cross sectional imaging of the upper airway (MRI/CT), flow volume loops • Discussion with surgeons
AM_IK_03	Outlines the anaesthetic management of potential threats to the airway, including • external compression • Foreign body, blood clots, masses • Inhalational injury, inflammation • Blunt and penetrating trauma [Xref ENT]
AM_IK_04	Lists the indications for tracheostomy [Xref ENT]
AM_IK_05	Outlines the anaesthetic principles for tracheostomy [Xref ENT]
AM_IK_06	Describes the management of the obstructed/misplaced tracheostomy
AM_IK_07	Describes the specialised airway techniques used for laser surgery in, or near, the airway [Xref ENT]
AM_IK_08	Describes the causes, pathophysiology and management of obstructive sleep apnoea and the surgical procedures used to treat it [Xref ENT]
AM_IK_09	Outline appropriate follow up of an unexpected difficult intubation
AM_IK_10	Discuss the risks and benefits of using various supraglottic airways for IPPV
AM_IK_11	Describes the airway management of a patient undergoing one-lung ventilation and anaesthesia, including placement of double lumen endobronchial tubes and bronchial blockers [Xref cardiothoracics]
AM_IK_12	Describes the safe use of equipment and airways devices used for surgery on and below the vocal chords, including bronchoscopes, Venturi devices and fibre-optic scopes [Xref ENT]
AM_IK_13	Describes the principles of jet ventilation [Xref ENT]
AM_IK_14	Recalls the principles underlying the use of helium [Xref ENT]

Day surgery

Competence	Description	Resource
DS_IK_01	Describes the key organisational issues surrounding day surgery including suitability of facilities and staffing
DS_IK_02	Provides a clear explanation of current local and national guidelines for provision of day surgical services
DS_IK_03	Demonstrates knowledge of audit and other quality assurance activities relevant to day surgery
DS_IK_04	Demonstrates knowledge of advances and controversies in anaesthesia for day surgery

General, urological and gynaecological surgery (incorporating peri-operative care of the elderly)

Competence	Description	Resource
GU_IK_01	Recalls/describes the principles off the peri-operative management of the commoner complex cases including, but not exclusively: • Pancreatic and liver resection • Oesophagectomy [inc. one lung ventilation] • Resection of neuroendocrine tumours [e.g. carcinoid and phaeochromocytoma] • Splenectomy • Resection of retroperitoneal masses [inc. management of pleural breach]	BK 01.5 Liver & Spleen
GU_IK_02	Explains the effects of chemotherapy/radiotherapy, and the implications for anaesthesia	BK 07.2 Drugs in malignancy
GU_IK_03	Recalls/describes the anaesthetic considerations of co-existing diseases including problems such as spinal injury	BK 02.5 SC blood supply 04.8 scoliosis & SSEPs BK 07.4 Autonomic Dysreflex
GU_IK_04	Recalls/ describes the ethical considerations of cadaveric and live-related organ donation for the donor [and relatives], recipient and society as a whole
GU_IK_05	Describes the issues of anaesthesia for renal transplant surgery
GU_IK_06	Explains the anaesthetic management of patients with transplanted organs for non-transplant surgery
GU_IK_07	Recalls/explains the anaesthetic complications related to disturbance of fluid balance, oedema, and dehydration
GU_IK_08	Recalls/describes the anaesthetic implications of bariatric surgery
GU_IK_09	Recalls/describes the principles of enhanced recovery programmes
GU_IK_10	Recalls / describes the rationale and principles of perioperative haemodynamic management and optimisation
GU_IK_11	Recalls / describes the principles of preoperative evaluation of patients at risk of post-operative morbidity, including risk stratification tools, for example scoring systems and measures of functional capacity [inc. cardiopulmonary exercise testing]
GU_IK_12	Discusses the importance of the timing of non-elective surgery and the effect that this may have on the delivery of ‘emergency surgery’

Head, neck, maxillo-facial and dental surgery

Competence	Description	Resource
EN_IK_01	Explains the special requirements of anaesthesia for all common procedures encountered in specialised head and neck surgery
EN_IK_02	Recalls/explains the principles of anaesthesia for middle ear surgery, including use of TIVA and hypotensive techniques
EN_IK_03	Explains the principles of management of anaesthesia for major head and neck surgery and: • Recalls/describes the pathophysiological changes and co-morbidities associated with head and neck cancer • Identifies the particular requirements for acute maxillo-facial emergencies e.g. fractured mandible, intra-oral abscesses and other pathological causes of upper airway obstruction
EN_IK_04	Recalls/describes the causes, pathophysiology and management of obstructive sleep apnoea and the surgical procedures used to treat it [Xref; AM_IK_08]
EN_IK_05	Recalls/describes the characteristics of the lasers used for surgery and the circumstances in which they are used
EN_IK_06	Recalls the hazards of laser surgery
EN_IK_07	Recalls/describes the specialised airway techniques used for laser surgery in, or near, the airway
EN_IK_08	Describes the safe use of equipment and airways devices used for surgery on and below the vocal chords, including bronchoscopes, Venturi devices and fibre-optic scopes
EN_IK_09	Explains the use of specialised imaging techniques [CT, MRI] in planning anaesthesia and surgery for head and neck surgery
EN_IK_10	Lists the problems associated with chair dental procedures including consent, the specific needs of patients with learning disabilities, Child Protection [Xref paediatrics] and the Mental Capacity Act
EN_IK_11	Explains the principles of the recognition and appropriate management of acute ENT emergencies, including bleeding tonsils, epiglottis, croup, and inhaled foreign body
EN_IK_12	Describes appropriate emergency management of fractures of the face including le Fort fractures and fractures of the mandible
EN_IK_13	Describes the emergency management of the obstructed airway including tracheostomy
EN_IK_14	Recalls the indications for tracheostomy
EN_IK_15	Describes the principles of the care of the tracheostomy
EN_IK_16	Recalls/explains the principles of jet ventilation
EN_IK_17	Recalls/explains the principles underlying the use of helium

Management of respiratory and cardiac arrest in adults and children

Competence	Description	Resource
RC_IK_01	Recalls/describes the interpretation of arrhythmias seen in the peri-arrest period, including but not limited to: • Narrow complex tachycardias • Broad complex tachycardias • Atrial fibrillation • Paroxysmal SVT • Bradycardia • 1st 2nd and 3rd degree heart block
RC_IK_02	Recalls/describes the pharmacology of drugs used to treat common arrhythmias, dosage and frequency, including but not limited to: • Adenosine • Digoxin • Magnesium • Beta-blockers • Amiodarone • Atropine
RC_IK_03	Recalls the indications for performing cardioversion and the energies used
RC_IK_04	Recalls/outlines the indication for, and principles of, pacing including percussion, external and transvenous
RC_IK_05	Recalls the indications for use of thrombolysis
RC_IK_06	Recalls/discusses the indications and principles of therapeutic hypothermia after cardiac arrest
RC_IK_07	Outlines indications and principles of: • Open chest cardiac compressions • Resuscitative thoracotomy [Xref cardiothoracic]
RC_IK_08	Describes the principles of managing cardiac arrest in the prone position
RC_IK_09	Recalls/explains the difference in aetiology of cardiac arrest between adults and children
RC_IK_10	Describes how to recognize the sick/deteriorating ill child and what treatment should be initiated to reverse such deterioration and prevent, where possible, respiratory or cardiac arrest
RC_IK_11	Recalls the specific conditions likely to deteriorate to respiratory or cardiac arrest in children [e.g. meningococcal sepsis] and describes their initial management
RC_IK_12	Recalls/details the indications for, and use of, cuffed and uncuffed tubes in the critically ill child requiring tracheal intubation
RC_IK_13	Describes how to: • Recognise supra-glottic airway obstruction and understands the indications/contra-indications of supra-glottic airway devices to bypass such obstruction • Manage complications of tracheostomy in children [e.g. obstruction and displacement]
RC_IK_14	Outline the principles of safe inter-hospital transfer of the resuscitated patient

Non-theatre

Competence	Description	Resource
DI_IK_01	Describes, and critically evaluates, the different techniques of anaesthesia/sedation for adults and children for procedures that may take place outside the operating theatre, but within a hospital setting, either diagnostic or therapeutic for both elective and emergency procedures, including but not exclusively in the following settings: X-Ray, CT scan, Angiography, MRI scan, Radiotherapy, [ECT]	BK 01.8 MRI
DI_IK_02	Explains the indications/contraindications of sedation for patients in the non-theatre environment [Xref sedation]
DI_IK_03	Explains the problems of providing safe post- anaesthetic care for patients in the out of theatre environment
DI_IK_04	Recalls/discusses the unique safety precautions required in each of the environments, particularly MRI	BK 01.8 MRI

ECT

Competence	Description	Resource
DI_IK_05	Describes the specific physical and physiological effects of ECT
DI_IK_06	Explains the rationale behind the choice of anaesthetic technique for ECT
DI_IK_07	Discusses the physical and psychological needs of patients who present for ECT
DI_IK_08	Discusses the place of the Mental Capacity Act in relation to the provision of ECT

Diagnostic imaging and interventional radiology

Competence	Description	Resource
DI_IK_09	Describes common interventional procedures and their pathophysiological consequences
DI_IK_10	Describes the anaesthetic management of patients for endovascular procedures [Xref vascular]
DI_IK_11	Describes the anaesthetic management of patients for neurological procedures [Xref neuro]

Orthopaedic surgery (incorporating peri-operative care of the elderly)

Competence	Description	Resource
OR_IK_01	Explains the difference in anaesthetic and surgical complexity between primary and secondary lower limb arthroplasty
OR_IK_02	Recalls/describes the principles of perioperative anaesthetic care for elective and emergency spinal surgery including but not exclusively: • Scoliosis surgery including the need for, and implications of, neurophysiological monitoring • Spinal trauma and the associated complications of spinal cord trauma	BK 02.5 SC blood supply 04.8 scoliosis & SSEPs BK 07.4 Autonomic Dysreflexia
OR_IK_03	Recalls/describes the principles of perioperative anaesthetic care for pelvic bone and joint surgery
OR_IK_04	Recalls/discusses blood conservation strategies that are used in orthopaedic surgery

Perioperative Medicine

Preoperative care

Competence	Description	Resource
POM_IK_01	Describes the uses and limitations of common risk scoring systems
POM_IK_02	Describes the use of ‘do not resuscitate’ procedures and appropriate limitations of care
POM_IK_03	Describes strategies for prehabilitation and patient optimisation and the limits of such strategies
POM_IK_04	Recalls the principles of enhanced recovery pathways
POM_IK_05	Describes the requirements for investigations in patients with complex comorbidities
POM_IK_06	Lists methods of assessment of functional cardiorespiratory capacity
POM_IK_07	Describes appropriate preoperative strategies for minimising the use of blood products
POM_IK_08	Describes the effects of ethnicity on preoperative assessment

Competence	Description	Resource
POM_IS_01	Assesses the patient with complex comorbidities, taking into account their individual needs and requirements
POM_IS_02	Liaises effectively with colleagues in Intensive Care in planning care
POM_IS_03	Explains risks and benefits of available anaesthetic techniques to patients in a manner they can understand
POM_IS_04	Formulates an individualised perioperative plan with the patient, using an evidence-based approach
POM_IS_05	Balances the need for early surgery against the need for further investigation, prehabilitation and pre-optimisation
POM_IS_06	Responds appropriately to investigation results when planning perioperative care
POM_IS_09	Manages existing medications and makes appropriate changes
POM_IS_10	Discusses the risks and benefits of the transfusion of blood products with patients
POM_IS_11	Discusses requirements of postoperative organ support and its limitations

Intraoperative care

Competence	Description	Resource
POM_IK_09	Describes the concept of Goal-Directed Therapy
POM_IK_10	Describes the use of different types of intravenous fluid
POM_IK_11	Explains the potential impact of anaesthetic technique on patient outcome
POM_IK_12	Describes the effects of deviation from normal physiological parameters on short and long-term outcomes
POM_IK_13	Describes rationale for point of care testing
POM_IK_14	Recalls the principles and interpretation of depth of anaesthesia monitoring
POM_IK_15	Explains how ethnicity may influence conduct of anaesthesia

Competence	Description	Resource
POM_IS_12	Chooses appropriate anaesthetic technique for patients with complex comorbidities
POM_IS_13	Interprets information from commonly used modalities for advanced haemodynamic monitoring
POM_IS_14	Uses results from point of care testing to direct treatment
POM_IS_17	Recognises the deteriorating perioperative patient
POM_IS_18	Institutes appropriate measures to stabilise the deteriorating patient
POM_IS_20	Uses antibiotics and other measures to reduce the risk of infection
POM_IS_21	Uses strategies to minimise post-operative cognitive dysfunction
POM_IS_22	Uses strategies to minimise the risk of accidental awareness under general anaesthesia

Postoperative care

Competence	Description	Resource
POM_IK_16	Explains how a multidisciplinary team approach improves patient recovery and outcomes
POM_IK_17	Manages common anaesthetic and surgical complications safely as part of a multidisciplinary team
POM_IK_18	Plans appropriate postoperative analgesia using multimodal techniques, including those required for patients with complex analgesic needs
POM_IK_19	Initiates communication with patients regarding adverse events and organises appropriate follow up
POM_IK_20	Contributes to discharge planning
POM_IK_21	Plans postoperative care in keeping with relevant enhanced recovery pathways
POM_IK_22	Describes the effects of ethnicity in postoperative management, including pain management

Regional

Competence	Description	Resource
RA_IK_01	Demonstrates understanding of basic sciences as applied to all regional anaesthetic blocks [Xref applied basic sciences]
RA_IK_02	Recalls/discusses advantages and disadvantages, techniques and complications [inc. management] of a wide variety of blocks including, but not exclusively, major peripheral blocks of the limbs, some cranial nerve blocks and blocks used to treat chronic pain conditions [Xref pain medicine]
RA_IK_03	Demonstrates understanding in the choice of local anaesthetic agents, opioids, use of additives and techniques of administration
RA_IK_04	Outlines the principles of continuous catheter techniques for peripheral nerve blockade and for postoperative analgesia
	Demonstrates an in-depth understanding of the principles of ultra sound guided nerve blocks including: • The principles of scanning including machine ergonomics, probe selection/handling and the use of acoustic couplant [ultrasound gel] to improve skin contact • The importance of the angle of insonation on visibility of structures [anisotropy] specifically related to nerves and tendons • The normal sonoanatomy of peripheral nerves and surrounding structures • The basic concepts of needling techniques relating to ultrasound guidance (in plane / out of plane) • Understanding and recognition of spread of local anaesthetic under ultrasound guidance, distinction between normal intraneural and intravascular injection

Sedation

Competence	Description	Resource
CS_IK_01	Explains what is meant by ‘deep sedation’ and when its use may be justifiable, identifies the associated risks and how these may be minimised to ensure patient safety is not compromised [Xref sedation]
CS_IK_02	Discusses how multiple drug use may enhance sedation techniques, whilst detailing how this increases risks
CS_IK_03	Explains why it is essential to titrate multiple drugs [sedatives, analgesics and anaesthetic agents] to effect whilst recognising that the possibility of differing times of onset, peak effect and duration, can result in unpredictable responses
CS_IK_04	Discusses the place of infusions compared to bolus doses as well as target-controlled infusions [TCI], and the pharmacological models and pump technology relevant to their use
CS_IK_05	Discusses options for ‘alternative’ route of delivery of drugs used for conscious sedation including intra-nasal and rectal
CK_IK_06	Discusses the unpredictable nature of sedation techniques in the ‘extremes of life’ and strategies for safe delivery [Xref paeds]

Transfer medicine

Competence	Description	Resource
TF_IK_01	Explains the risks/benefits of interhospital patient transfer
TF_IK_03	Outlines the hazards associated with Interhospital transfer, including but not limited to physical, psychological and organisational
TF_IK_04	Describes the increased risks to critically ill patients of transfer and the reasons for these risks
TF_IK_05	Outlines strategies to minimise risk during Interhospital transfer, including but not limited to: • Stabilisation • Pre-emptive intervention • Sedation • Monitoring • Packaging • Choice of mode of transfer
TF_IK_06	Explains how critical illness affects the risk of transfer
TF_IK_07	Explains how time-critical elements may influence risks to the patient and transfer personnel and how these should be managed to reduce them
TF_IK_08	Understands the increased risk of interventions during Interhospital transfer
TF_IK_09	Outlines the specific considerations for transfer of patients with specific clinical conditions, including but not limited to: • head, spinal, thoracic and pelvic injuries • critically-ill medical patients • burns • children • pregnant women
TF_IK_10	Lists and explains the critical care equipment used during transfer including but not exclusively: • Ventilators • Infusion pumps • Monitoring
TF_IK_11	Lists the different modes of ventilation and explains the selection of appropriate parameters in e.g. Asthma/COPD and ARDS
TF_IK_12	Outlines the different modes of transport available for inter-hospital transfer, including risks/benefits
TF_IK_13	Understand the safety implications of electrical and hydraulic equipment that may be used during patient transfer
TF_IK_14	Recalls/describes the physiological effects of transport including the effects of acceleration and deceleration, including Newton’s laws of motion
TF_IK_15	Understands the effects of high ambient noise on patients and alarm status
TF_IK_16	Recalls/discusses the reasons for patients becoming unstable during transfer and strategies for management
TF_IK_17	Recalls/describes how to manage patients who develop sudden airway difficulties whilst in transit [both in the intubated and un-intubated patient]
TF_IK_18	Outlines the ethical issues related to patient transfer, including the need to brief patients and their relatives
TF_IK_19	Awareness of the laws relating to deaths in transit
TF_IK_20	Outlines how to find and use the national register of critical care beds
TF_IK_21	Outlines the regional protocols for organising transfers between units
TF_IK_22	Outlines the importance of maintaining communications between the transfer team and the base/receiving units
TF_IK_23	Outlines the roles and responsibilities of all staff accompanying the patient during transfer including the ambulance technicians and paramedics
TF_IK_24	Describes the personal equipment needed when leading a transfer, especially when a prolonged journey is anticipated
TF_IK_25	Discusses the importance of auditing practice and reporting critical incidents that arise during Interhospital transfer and the need for appropriate research

Trauma and stabilisation

Competence	Description	Resource
MT_IK_01	Recalls/describes the complex pathophysiological changes that occur in all patients [inc. children] with multiple injuries
MT_IK_02	Describes the perioperative anaesthetic management of patients with multiple injuries including head, facial, neck/spinal, thoracic, abdominal, pelvic and peripheral trauma
MT_IK_03	Explains the reasons for, and benefits of, the hospital triage of trauma patients and the scoring systems used
MT_IK_04	Describes strategies for minimising secondary brain injury in patients with multiple injures
MT_IK_05	Describes the initial assessment, management and resuscitation of patients with: • Severe burns • Electrical injuries • Drowning and near drowning • Hypothermia
MT_IK_06	Recalls/explains the management of massive blood loss including the use of rapid infusion devices
MT_IK_07	Explains the implications, prevention and management of coagulopathy, hypothermia and acidosis in multiply injured patients
MT_IK_08	Describes the management of children with multiple injuries, comparing and contrasting with that of adults [Xref paediatric anaesthesia]
MT_IK_09	Describes the specific ethical and ethnic issues associated with managing the multiply injured patient, including issues that relate to brain stem death and organ donation	BK 01.Y BSD
MT_IK_10	Discusses the indications and contraindications of regional anaesthesia and peripheral nerve blocks in multiply injured patients for the provision of analgesia, both initially and perioperatively
MT_IK_11	Discusses the principles of clinical management for stabilisation of patients with multiple injuries requiring inter-hospital transfer strategies used, how safe transfer is undertaken, monitoring requirements and the options for modes of transfer [Xref Transfer]
MT_IS_04	Demonstrates safe perioperative anaesthetic management of patients with multiple injuries requiring early surgery, including the management of major blood loss and associated coagulopathy, hypothermia and acidosis
MT_IS_05	Demonstrates correct preparation of patients for safe transfer including ensuring adequate resuscitation, appropriate accompanying personnel and the use of checklists
MT_IS_06	Demonstrates safe inter-hospital transfer of stable trauma patient[s], including those with brain injury, whilst also ensuring the safety of accompanying personnel
MT_IS_07	Demonstrates the ability to interpret imaging relevant to the primary survey

Obstetrics

Competence	Description	Resource
OB_IK_01	Recalls/describes the influence of common concurrent medical diseases on pregnancy
OB_IK_02	Discusses the obstetric and anaesthetic management of a premature delivery
OB_IK_03	Discusses the obstetric and anaesthetic management of multiple pregnancy
OB_IK_04	Explains the classification of placenta praevia and the associated risk to the patient
OB_IK_05	Recalls/describes the recognition and management of amniotic fluid embolus
OB_IK_06	Describes the recognition and management of inverted uterus
OB_IK_07	Demonstrates understanding of the methods of treating post-dural puncture headache
OB_IK_08	Discusses common causes of maternal morbidity and mortality, including national reports
OB_IK_09	Discusses the particular sensitivity of patient choices in obstetric practice – even when this is not in line with accepted evidence based best practice e.g. choice of birth plan, and refusal of blood products

Paediatrics

General

Competence	Description	Resource
PA_IK_01	Recalls/explains the relevance of the knowledge of applied basic sciences to all age groups including neonates
PA_IK_02	Recalls/explains the implications of paediatric medical and surgical problems including major congenital abnormalities (eg tracheoesophageal fistula, diaphragmatic hernia,) congenital heart disease and syndromes eg Down’s for anaesthesia
PA_IK_03	Recalls/explains the adverse effects of starvation and hypoglycaemia in neonates and children
PA_IK_04	Recalls the specific factors in preoperative assessment and preparation of neonates for surgery
PA_IK_05	Describes special anaesthetic techniques for neonates
PA_IK_06	Explains the difficulty of thermoregulation in the newborn and the measure required to prevent hypothermia
PA_IK_07	Explains the law as relates to children in respect of Consent, Restraint and Research and the concept of ‘Gillick competence’
PA_IK_08	Describes the anaesthetic management of neonates and infants for minor operations, major elective and emergency surgery
PA_IK_09	Calculates the analgesic requirements of neonates and infants
PA_IK_10	Describes the specific anaesthetic and monitoring equipment required for neonates
PA_IK_11	Lists common anaesthetic problems in the neonatal period and explains their perioperative anaesthetic management [e.g. inguinal hernia, intestinal obstruction, pyloric stenosis]
PA_IK_12	Describes the special problems of the premature and ex-premature neonate
PA_IK_13	Explains the importance of a comprehensive knowledge of Child Protection and how to be responsible for taking appropriate action when non-accidental injury is suspected

Immediate Care

Competence	Description	Resource
PA_IK_14	Recalls/explains how to recognise the critically ill child with e.g. sepsis, trauma, convulsions, diabetic emergencies and describes their timely management
PA_IK_15	Explains the principles of stabilisation and safe transport of critically ill children and babies

Pain medicine

Competence	Description	Resource
PM_IK_01	Describes the assessment and management of acute pain in all types of surgery
PM_IK_02	Describes the assessment and management of acute non surgical pain
PM_IK_03	Describes the assessment and management of acute pain in special groups to include children, infants, the older person, the cognitive impaired, those with communication difficulties, the unconscious and critically ill patient
PM_IK_04	Describes the basic assessment and management of chronic pain in adults
PM_IK_05	Describes the basic assessment and management of cancer pain in adults
PM_IK_06	Recalls advanced pharmacology of drugs used to manage pain including neuropathic pain
PM_IK_07	Explains the rationale for the use of opioids in the management of chronic non malignant pain
PM_IK_08	Describes the requirement for the multidisciplinary management of chronic pain

Ophthalmic

Competence	Description	Resource
OP_IK_01	Discusses the preoperative assessment of ophthalmic patients with particular reference to associated co-morbidities and how the care of high risk patients requiring ophthalmic surgery may be optimised
OP_IK_02	Recognises that a relatively large proportion of patients requiring ophthalmic surgery are elderly and understands their particular needs including, but not exclusively, the effects of physiological changes associated with ageing and altered pharmacological responses
OP_IK_03	Recalls/discusses the choice of local or general anaesthetic techniques in relation to the patient and surgery including their advantages, disadvantages and indications with particular reference to some or all of the following: • Cataract surgery • Strabismus surgery • Glaucoma surgery • Vitreoretinal surgery • Oculoplastic surgery
OP_IK_04	Recalls/describes the oculocardiac reflex, its treatment and prevention
OP_IK_05	Recalls/describes the action of anaesthetic drugs on the eye
OP_IK_06	Recalls the physiological mechanisms which control intraocular pressure
OP_IK_07	Recalls/discusses the drugs which may alter intraocular pressure
OP_IK_08	Knowledge of precautions required for revision surgery in patients who have had a previous injection of intraocular gas
OP_IK_09	Recalls/discusses the choice of techniques of anaesthesia for patients with penetrating eye injury
OP_IK_10	Describes the operating conditions required for successful outcomes in ophthalmic surgery and how these can be achieved
OP_IK_11	Recalls/discusses the special requirements of children undergoing ophthalmic surgery
OP_IK_12	Describes the advantages and disadvantages of sedation techniques for ophthalmic procedures
OP_IK_13	Outlines the safety precautions required during the use of lasers in ophthalmic surgery
OP_IK_14	Recalls relevant applied anatomy required for insertion of local anaesthetic blocks for ophthalmic surgery [Xref applied basic sciences]
OP_IK_15	Recalls/describes the techniques of local anaesthesia available for ophthalmic surgery including their advantages, disadvantages and indications with particular reference to: • Topical anaesthesia: local anaesthesia drops • Superficial injection anaesthesia: subconjunctival block • Needle blocks: extraconal [peribulbar] and intraconal [retrobulbar] injections • Canular blocks: sub-tenon’s anaesthesia
OP_IK_16	Recalls/describes the risks associated with needle blocks
OP_IK_17	Awareness of the national guidelines regarding local anaesthesia for intraocular surgery
OP_IK_18	Awareness of specific risk of wrong-site surgery when operating on paired organs such as the eyes
OP_IK_19	Outlines the specific factors in the postoperative care of patients who have had ophthalmic surgery

Plastics/burns

Plastics

Competence	Description	Resource
PL_IK_01	Can explain the specific features of preoperative assessment of patients for major plastic surgery procedures
PL_IK_02	Explains and critically evaluates anaesthetic techniques appropriate for plastic surgical procedures including major reconstructive cases procedures
PL_IK_03	Explains the factors affecting tissue blood flow with respect to free-flap surgery
PL_IK_04	Describes methods for improving blood flow to the surgical field during plastic surgery

Burns

Competence	Description	Resource
PL_IK_05	Describes the pathophysiology of burn injury including thermal airway injury and smoke inhalation
PL_IK_06	Describes the initial assessment and management of a patient with severe burns, including electrical & chemical burns
PL_IK_07	Explains the principles of anaesthetic management of burns patients for surgery including dressing changes, grafting and related procedures

Vascular surgery

Competence	Description	Resource
VS_IK_01	Recalls/describes the cardiovascular physiology and pharmacology relevant to perioperative vascular surgery
VS_IK_02	Lists the methods of assessment of the patient’s functional cardiovascular capacity
VS_IK_03	Explains the preoperative management of the patient with atherosclerotic disease
VS_IK_04	Describes the perioperative management of the patient for major vascular surgery
VS_IK_05	Describes the resuscitation and management of major vascular accidents including the management of ruptured aortic aneurysms
VS_IK_06	Explains the management of patients for endovascular radiological procedures [e.g. Stenting] including anaesthesia in isolated locations [Xref non-theatre anaesthesia]
VS_IK_07	Describes the management of elective carotid artery surgery with general or regional anaesthesia
VS_IK_08	Explains the principles and anaesthetic implications of sympathectomy, including thoracoscopic procedures
VS_IK_09	Describes the postoperative management and critical care of vascular patients
VS_IK_10	Explains the effects of smoking on health
VS_IK_11	Recalls/describes the morbidity and mortality associated with vascular surgery
VS_IK_12	Recalls/explains the principles of blood conservation and red cell salvage when major haemorrhage is predicted
VS_IK_13	Recalls the pathophysiology of aortic cross-clamping and of renal protection strategies

Advanced sciences to underpin anaesthetic practice

Anatomy

Competence	Description	Resource
AN_IK_01	Relevant anatomy for understanding of surgical procedures
AN_IK_02	Anatomy relevant to acute and chronic pain management, including the whole range of neural blockade techniques outlined in the pain management section of the intermediate syllabus
AN_IK_03	Anatomy relevant to the whole range of practical procedures outlined in the intensive care medicine section of the intermediate syllabus
AN_IK_04	Anatomy relevant to the regional anaesthetic techniques [central and peripheral blocks, inc. ophthalmic] as outlined in the regional anaesthesia section of the intermediate syllabus; includes anatomy as visualised using ultrasound imaging during regional anaesthesia
AN_IK_05	Anatomy of the airway including anatomical knowledge relevant to the performance of fibre-optic intubation
AN_IK_06	Anatomy of the central veins and adjacent structures as visualised using ultrasound imaging
AN_IK_07	Anatomy relevant to the avoidance of injury to patients due to posture and positioning during anaesthesia
AN_IK_08	Anatomical changes that occur during development from neonate to older child
AN_IK_09	Maternal and fetal anatomy relevant to the practice of obstetric anaesthesia
AN_IK_10	Anatomy relevant to the practice of neuroanaesthesia including anatomy of the skull, skull base, CSF circulation and cerebral blood flow

Applied clinical pharmacology

Competence	Description	Resource
PR_IK_11	The Gastrointestinal System: acid aspiration prophylaxis; anti-emetics
PR_IK_12	CNS: general vs regional anaesthesia in all areas of anaesthesia; action of drugs on the eye; control of convulsions
PR_IK_13	The Musculoskeletal System: muscle relaxants and reversal agents; anaesthetic implications of myasthenia gravis and other neuromuscular disorders
PR_IK_14	Resuscitation: including management of allergy and anaphylaxis
PR_IK_15	Principles of parenteral and enteral nutritional formulas in intensive care
PR_IK_16	Therapeutics in pathologic states: problems associated with organ transplantation; anaesthetic relevance of drugs used in malignancy; therapy in acute and chronic respiratory diseases
PR_IK_17	Problems of drug dependency and addiction
PR_IK_18	Environmental effects of anaesthetic agents
PR_IK_19	Influence of age on drug pharmacokinetics and pharmacodynamics
PR_IK_20	Assessment of cognitive dysfunction issues such as delirium, POCD and dementia, and implications

Applied Physiology and Biochemistry

Cardiovascular

Competence	Description	Resource
PB_IK_01	Abnormal electrocardiogram and arrhythmias; electrophysiological basis of arrhythmias
PB_IK_02	Cardiomyopathy and abnormal ventricular function – congenital and acquired
PB_IK_03	Heart failure – systolic vs diastolic, high vs low cardiac output
PB_IK_04	Hypovolaemia and shock – neurohumoral adaptions
PB_IK_05	Ischaemic heart disease
PB_IK_06	Valvular defects – stenotic vs regurgitant
PB_IK_07	Hypertension – systemic and pulmonary
PB_IK_08	Common congenital heart defects – including PFO, ASD, bicuspid AV, VSD

Kidney and body fluids

Competence	Description	Resource
PB_IK_09	Disturbances of fluid balance, oedema and dehydration
PB_IK_10	Management of acid-base abnormalities
PB_IK_11	Renal tubular acidosis
PB_IK_12	Assessment of renal function
PB_IK_13	Renal failure and its management	BK 07.8 RRT
PB_IK_14	Diuresis – action of diuretics
PB_IK_15	Plasma electrolyte disturbances

Liver

Competence	Description	Resource
PB_IK_16	Hepatic failure
PB_IK_17	Jaundice
PB_IK_18	Porphyria

Applied Physiology and Biochemistry

Respiration

Competence	Description	Resource
PB_IK_19	Disorders of respiratory mechanics, gas exchange and gas transport
PB_IK_20	Disorders of the pulmonary circulation – arterial vs venous
PB_IK_21	Respiratory failure and ventilatory support; consequences of positive pressure ventilation
PB_IK_22	Effects of changes in ambient pressure

Nervous System

Competence	Description	Resource
PB_IK_23	Consciousness and sleep
PB_IK_24	Depth of anaesthesia – effects of anaesthetics on neurotransmission
PB_IK_25	Consequences of spinal cord injury and deafferentation	BK 02.5 SC blood supply BK 07.4 Autonomic Dysreflexia
PB_IK_26	Monitoring of spinal cord function under general anaesthesia	BK 04.8 Scoliosis & SSEPs
PB_IK_27	Mechanisms of pain; somatic, visceral, neuropathic
PB_IK_28	Control of cerebral circulation, intracranial and intraocular pressures	BK 04.6 Cerebral circulation BK 03.8 ICP
PB_IK_29	Disorders of the autonomic nervous system

Gastrointestinal tract

Competence	Description	Resource
PB_IK_30	Nausea and vomiting
PB_IK_31	Oesophageal reflux
PB_IK_32	Obstruction of bowel – physiological consequences
PB_IK_33	Swallowing disorders
PB_IK_34	The mucosal barrier

Metabolism and body temperature

Competence	Description	Resource
PB_IK_35	Hormonal and metabolic response to trauma
PB_IK_36	Hyperthermia and hypothermia
PB_IK_37	Starvation / obesity

Endocrinology

Competence	Description	Resource
PB_IK_38	Structure and function of the endocrine system; endocrine abnormalities of significance to anaesthesia: • Cushing’s • Addison’s • Diabetes mellitus • Hypothyroidism • Hypopituitarism • Phaeochromocytoma • The stress response	BK 04.7 Serotonin (syndrome)

Obstetrics, paediatrics and advancing age

Competence	Description	Resource
PB_IK_39	Effects of prematurity
PB_IK_40	Developmental changes in infancy and childhood, including psychological aspects
PB_IK_41	Physiology of normal and abnormal pregnancy, including physiology of labour and childbirth
PB_IK_42	Changes in the elderly

Nutrition

Competence	Description	Resource
NU_IK_01	Nutritional assessment techniques including laboratory tests
NU_IK_02	Clinical consequences of poor nutritional status: including wound healing, infection, cardiovascular stability, thermoregulation, respiratory control
NU_IK_03	The role of artificial nutritional support in improving surgical outcome – enteral and parenteral. Nutritional supplements
NU_IK_03	Mechanics of providing parenteral and enteral nutrition and different routes; pre and post pyloric
NU_IK_04	Complications of parenteral and enteral nutritional support
NU_IK_05	Consequences of overfeeding: CO2 production, uraemia, hypermetabolism, hypertryglyceridaemia, hepatic steatosis
NU_IK_06	Changes in intestinal blood flow with injury/sepsis/critical illness
NU_IK_07	Choice of artificial nutritional support in trauma/sepsis/critical illness. Principles of enteral and parenteral feeding including trace elements
NU_IK_08	Knowledge of the vulnerability of certain groups [very old, very young] to malnutrition and its effects

Physics and Clinical Measurement

Competence	Description	Resource
PC_IK_01	Assessment of respiratory function: blood gases, including capillary, venous and mixed venous; flow-volume loops, diffusion capacity
PC_IK_02	Assessment of cardiac function, including exercise testing: METS, stair climbing, shuttle test
PC_IK_03	Measurement of nerve conduction
PC_IK_04	Operative spinal cord monitoring	BK 02.5 SC blood supply 04.8 Scoliosis & SSEPs
PC_IK_05	Peripheral nerve stimulators: assessment of neuromuscular function. Identification of nerves with needle electrode.	BK 10.8 PN Monitoring
PC_IK_06	Interpretation of biochemical data
PC_IK_07	Interpretation of – haematological data
PC_IK_08	Measurement of coagulation of the blood and interpretation of data
PC_IK_09	Interpretation and errors of dynamic pressure measurements: systemic, pulmonary, arterial and venous pressures
PC_IK_10	Interpretation and errors of dynamic pressure measurements: intracranial, intrathoracic, intra-abdominal and intraocular pressures
PC_IK_11	Cardiac output measurement: interpretation and limitations of derived indices: PiCO, LiDCO, bioimpedance, contour analysis	BK 09.8 CO Monitoring
PC_IK_12	Trans-oesophageal ECHO [TOE]
PC_IK_13	Principles of imaging: principle characteristics of medical imaging devices [inc. X-rays, CT, MRI, ultrasound], including principles, construction, artefacts, bio-effects, hazards and safety	BK 01.8 MRI
PC_IK_14	Radiation protection
PC_IK_15	Capnography: interpretation and errors
PC_IK_16	Pulse oximetry
PC_IK_17	Ventilatory and respiratory gas analysis
PC_IK_18	Sleep studies – principles
PC_IK_19	Principles of hygiene, including cleaning and sterilisation of equipment, and care of fibre-optic instruments
PC_IK_20	Principles of fibre-optic instruments
PC_IK_21	Principles of haemofiltration and renal support	BK 07.8 RRT
PC_IK_22	Assessment of the depth of general anaesthesia and avoidance of awareness
PC_IK_23	Measurement of evoked potentials in the clinical situation
PC_IK_24	Glasgow coma score [GCS]
PC_IK_25	Anaesthetic and surgical outcome scoring systems: including Goldman, Detsky, APACHE, POSSUM etc
PC_IK_26	Sedation scoring systems
PC_IK_27	Assessment of cognitive function e.g. abbreviated mental test score and confusion assessment method

Statistical basis of clinical trial management

Data collection and analysis

Competence	Description	Resource
SM_IK_01	Explains the simple aspects of study design defining the outcome measures and the uncertainty of measuring them

Application to clinical practice

Competence	Description	Resource
SM_IK_02	Explains the difference between statistical and clinical significance
SM_IK_03	Recalls the limits of clinical trials
SM_IK_04	Recalls the basics of systemic review and its pitfalls

Study design

Competence	Description	Resource
SM_IK_05	Recalls how to define a clinical research question
SM_IK_06	Explains the effects of bias
SM_IK_07	Recalls the use of controls, placebos, randomisation and binding exclusion criteria
SM_IK_08	Explains statistical issues including sample size and ethical issues