Neobook — clinical reference

Background

Education and training

Diploma in Anaesthetics

Fellowship training for the specialist anaesthesiologist

Sub-speciality training: critical care

General training

Background

Education and training of anaesthesia care providers in South Africa needs to take cognisance of the social setting within which such practice occurs, making them sensitive to both the system and individual needs. Such education and training must be patient-centred, allow for reflective learning and foster lifelong learning by the practitioners. The adequacy of training in respect of preset goals and competencies is seen to be of greater importance than just the training period. Upon completion of appropriate education and training, practitioners need to be certified for an appropriate level of practice. Such practitioners must then register with the HPCSA.

Education and training

Education and training in anaesthesia involves four key role players:

HPCSA – regulations and accreditation
Universities – academic (teaching and learning, training, research)
Departments of Health (DoH) – clinical training platforms and training posts
CMSA – assessments/examinations

Education and training in anaesthesia is expected to occur at any healthcare facility (hospital) where anaesthesia is delivered. However, formal, accredited education and anaesthesia training may only occur at HPCSA-accredited hospitals. The HPCSA determines the criteria for such accreditation. Each training institution/site needs to be accredited for training in that discipline and for that competency.

Diploma in Anaesthetics

The purpose of the DA is to encourage postgraduate training and raise the standards of practice of anaesthesia by evaluating candidates at the level of safe, good, practical general practitioner anaesthetists. The objective of the training programme is to produce medical officer anaesthetists who will be able to provide safe and quality care to their patients.

The full DA curriculum is available at https://www.cmsa.co.za/ view_exam.aspx?QualificationID=46.

Sites

Anaesthesia training in fulfilment of the DA(SA) examination regulations may be undertaken in:

Anaesthetic training posts under the supervision of university departments in teaching hospital complexes, as well as in teaching hospital equivalents or in university satellite departments of non-teaching hospitals.
Post-internship anaesthesia training posts at any of the list of hospitals throughout South Africa.
Post-internship anaesthesia posts at some hospital sites in Zimbabwe and Namibia.

The list of CMSA-accredited South African hospitals is reviewed periodically and may change from time to time and is available on the CMSA website.

Time

The candidate must hold a post-internship qualification to practice medicine, which is registered or registrable with the HPCSA and have six months of training in anaesthesia, either at a recognised site or via a prescribed logbook. Community service doctors are eligible to be trained and write this examination during their year of community service.

Portfolio/logbook

All trainees are encouraged to keep a detailed portfolio of their training and experience. Except in the case of certified supervised training at a teaching or CMSA-approved hospital, a completed logbook is required to substantiate training and/or credit points claimed.

Supervision

A designated supervisor, either a specialist anaesthesiologist or a diplomate, is responsible for training. The level of supervision varies according to the trainee’s experience, and the complexity of patients managed. In the early stages, in-theatre or on-site supervision is mandatory. When the trainee is assessed as having achieved a level of competence, the supervision may then be offsite, with the proviso that the supervisor is readily available for complex cases and emergencies.

Assessments

Trainees are expected to be continually evaluated by supervisors during their training, such evaluation focusing on knowledge, skills, attitudes, and behaviours achieved. The final assessment occurs as the DA examination under the auspices of CMSA.

Fellowship training for the specialist anaesthesiologist

Sites

Training may only take place in an HPCSA-accredited academic department in a teaching hospital under the control of a university with a Faculty of Health Sciences or Medical School.
The following nine anaesthesiology departments affiliated with universities across the country have been accredited by the HPCSA to train specialist anaesthesiologists:
1. Sefako Makgatho Health Sciences University
2. Stellenbosch University
3. University of Cape Town
4. University of KwaZulu-Natal
5. University of Pretoria
6. University of the Free State
7. University of Limpopo
8. University of the Witwatersrand
9. Walter Sisulu University
Each university department consists of one or more training sites, such sites being either accredited for full-time training or as a satellite site where only part of the training may be conducted. The HPCSA accredits all facilities involved in training against a set of predetermined criteria every five years.
Each trainee trains against a specific training number awarded to the training institution by the HPCSA.

Time

Anaesthesiology trainees must spend a minimum duration of education and training equal to 48 months in an HPCSA accredited registrar post under the control of an academic teaching department in a teaching hospital.

Portfolio/logbook

All trainees must keep a detailed electronic portfolio of their training and experience, including a logbook. The portfolio is inspected periodically by the supervisor and signed off before entry into the examination.

Supervision

Trainees function under the supervision of specialist anaesthesiologists at the training institution. The level of supervision varies according to the trainee’s experience, and the complexity of patients managed. When the trainee is assessed as having achieved a level of competence, the supervision may be offsite, with the proviso that the supervisor is readily available for complex cases and emergencies. In more specialised domains (such as anaesthesia for cardiac surgery), constant, on-site supervision is necessary.

Assessments

Trainees are expected to be continually evaluated by supervisors during their training, such evaluation focusing on knowledge, skills, attitudes, and behaviours achieved as per the College of Anaesthetists’ curriculum. The FCA Part 1 examination consisting of three subjects (Physiology, Pharmacology, and Physics & Clinical Measurement) must be completed before entry to the exit FCA Part 2 examination.

MMed research

The HPCSA requires the completion of a research component for registration as a specialist. The HPCSA does not prescribe the nature or the types of research to be undertaken, other than making the following statements:

“All specialist trainees will be required to complete a relevant research study, under the supervision of the Head of Department or nominee”.
“The assessment criteria of the research study would be that appropriate theoretical knowledge is demonstrated; a research protocol is compiled according to required norms; a progress report on the research project is given regularly”.
“Research results should be reported in a dissertation format according to acceptable scientific norms”.
“The research study, which will be assessed at university level, may be used as a credit for Part III of the MMed degree”.

Universities across the country may vary on how the MMed research requirements are instituted. Please refer to the respective university websites.

Sub-speciality training: critical care

The only sub-speciality domain that is fully accredited for training postanaesthetic specialisation is critical care.

Critical care training may only occur in an accredited intensivist-run ICU under the auspices of a university. It may either be full-time over a two-year period or part-time over a four-year period. The final assessment occurs as the Fellowship (previously Certificate) in Critical Care examination under the auspices of CMSA.

Certification

Certification in respect of competencies is collectively completed by the training facility and the CMSA.
The trainee needs to be evaluated and certified as having met the training programme’s requirements by the supervisor/ director of training.
The trainee needs to complete the required assessment by CMSA to be certified as a diplomate anaesthetist, specialist anaesthesiologist or a critical care sub-specialist.

Registration

The HPCSA defines criteria and processes for the registration of practitioners.

Upon completing all training requirements and successfully completing the respective CMSA examination, the practitioner may register the qualification against their name on the HPCSA register. It is essential that all practitioners must:

be registered in the appropriate category before embarking on clinical practice,
only practice within the scope defined by their registration category, and
ensure that their registration is current.

General training

CPD

All anaesthesia practitioners are responsible for continually updating their professional knowledge and skills. In compliance with the HPCSA CPD programme, practitioners must accumulate continuing education units (CEUs) per twelve-month period, including ethics, human rights, and medical law.

Courses

Anaesthesia practitioners may also complete specific national and international accredited courses (e.g., ultrasound, echocardiography) that may enhance their competency and skill in those areas.

Useful sites for further information

Click here to view the full pdf

South African Society of Anaesthesiologists (SASA) Practice Guidelines_2022_Reviewed by: D Gopalan