Novice · up to the IAC
Guidance for novice anaesthetists
The first milestone of anaesthetics training is the Initial Assessment of Competence (IAC), usually achieved within three to six months (full-time equivalent). This site sets out the knowledge and skills required, a suggested order of study, and the relevant e-Learning Anaesthesia (e-LA) sessions for each topic.
Register for e-LfH
e-LA is available free of charge on the NHS e-Learning for Healthcare hub. Module 1 is designed for trainees working towards the IAC.
Two core principles
Anaesthesia aims to facilitate a procedure the patient could not otherwise tolerate, while maintaining acceptable physiology (acceptable, not necessarily normal).
DO2 = CO × Hb × SpO2 × 1.39
The simplified oxygen delivery equation underpins much of perioperative management.
Start with one anaesthetic
Build a thorough understanding of one straightforward general anaesthetic from start to finish, then extend into the wider syllabus topic by topic.
Using this site
The novice syllabus comprises around 80 topics. Study is most effective when new material relates to existing knowledge or recent clinical experience, for example:
- topics that extend what you already know
- topics arising from cases seen that day
- topics of particular current interest
Topics marked Start here are those encountered in a straightforward general anaesthetic and are a sensible starting point. Select I have covered this to record progress, which is stored in this browser only.
Early clinical practice
- Where possible, request lists with a rapid turnover of fit patients and spontaneously breathing cases.
- In the first weeks, the supervisor may complete the anaesthetic record, allowing the trainee to concentrate on the patient, the monitoring and the surgical field.
- Develop bag-mask ventilation with either hand. Maintaining a facemask airway for whole cases builds proficiency.
- Flush the cannula immediately after every intravenous drug.
- For each case, consider the alternative anaesthetic techniques available and discuss with the supervisor why the chosen technique was preferred.
- Record learning contemporaneously on the RCoA Lifelong Learning Platform (LLP), linked to the IAC Key Capabilities.
Novice · worked example
A general anaesthetic, step by step
A worked example: a fit 21-year-old undergoing elective knee arthroscopy. Induction with propofol and fentanyl, maintenance with sevoflurane, and spontaneous ventilation via an LMA. Each stage links to the relevant syllabus topics.
Suitable reading before, or soon after, the first operating lists.
Novice · syllabus
The novice syllabus
Topics are arranged by domain, mapped to the 2021 RCoA curriculum and linked to current e-LA sessions. Tags indicate the IAC Key Capability cluster each topic supports.
No topics match. Try clearing the filters.
Novice · sign-off
The Initial Assessment of Competence
The IAC is the first milestone of the 2021 RCoA anaesthetics curriculum. It is awarded when your training faculty trusts you to do two Entrustable Professional Activities (EPAs) at supervision level 2B.
EPA 1
Perform an anaesthetic pre-operative assessment, recognise what increases risk and tell a senior colleague: severe co-morbidity (ASA III or above), previous anaesthetic problems, and a known or predicted difficult airway.
EPA 2
Provide general anaesthesia for ASA I/II patients having uncomplicated surgery. In practice this prepares you to anaesthetise low-risk patients for unplanned or emergency surgery on call.
Supervision level 2B
Level 2B means your supervisor is in the hospital, available for queries and able to give prompt help. The IAC does not mean you are ready for independent practice. You still work under senior oversight.
- 1 Supervisor in theatre throughout
- 2A Supervisor in the theatre suite, checking in regularly
- 2B Supervisor in the hospital, available promptly IAC
- 3 Supervisor on call from home
- 4 Independent
Key Capability clusters
Link evidence on the LLP to each cluster. You do not need an assessment for every capability. The topics below are the syllabus topics that support each cluster.
Evidence you collect
- Supervised Learning Events (A-CEX, DOPS, CBD, ALMAT). Low-stakes feedback, with supervision levels to show progress over time. There is no minimum number.
- Personal activities: courses, departmental teaching, e-learning and simulation.
- Reflections, with no patient-identifiable information.
- Logbook: the range of cases, especially airway management.
Simulation you must do
- Discuss and rehearse the QRH "unknowns" (usually in months 0 to 3).
- Rehearse, then be assessed on, the failed intubation routine on a manikin, following the DAS guidelines, before sign-off.
How sign-off works
- You record learning on the LLP and link it to the Key Capability clusters.
- Your Educational Supervisor reviews your progress and portfolio.
- Your ES starts a Multiple Trainer Report, completed by at least three consultants.
- You start the HALOs for EPAs 1 and 2, link the MTR, and send them to your ES.
- You start the IAC certificate, add your simulation, link the MTR, and choose your ES and College Tutor as signatories.
The decision is a holistic judgement by the training faculty, drawing on your LLP, the MTR, your logbook, simulation and what they have seen you do.
Source: RCoA IAC Workbook, EPAs 1 & 2 (v1.2, 2022) and the RCoA Novice Guide. The workbook is the authoritative source and should be read in full.
Resources
e-Learning Anaesthesia (e-LfH)
The RCoA's e-LA programme is hosted free on the NHS e-Learning for Healthcare hub. The College strongly encourages it (but does not require it), and it can produce activity reports for your LLP.
- Register for e-LfH
- e-LA Module 1: Introduction to Clinical Anaesthesia. Start here.
- e-LA Core Training: Basic Sciences (Modules 07a–07f)
Module 1's basic science sessions (anatomy, physiology, pharmacology, physics) have been retired. This site links to the equivalent sessions in Modules 07a–07e instead.
RCoA Novice Guide
Guidelines for emergencies
- Association of Anaesthetists Quick Reference Handbook (latest version June 2023)
- Difficult Airway Society guidelines (unanticipated difficult intubation in adults, 2025)
- Resuscitation Council UK 2025 guidelines
Yorkshire and Humber
- School of Anaesthesia and Intensive Care, Yorkshire and Humber
- School induction information
- Sources of help
- YAIRN: Yorkshire Anaesthesia and Intensive Care Regional Network. Its "Core" programme is for CT1–3.
Each hospital runs its own IAC preparation programme, which usually ends with emergency scenario training. Ask your College Tutor about the local programme and critical incident course.
Further resources
Free resources beyond e-LfH that are useful for the novice period. They are also linked from the relevant syllabus topics.
Novice · reference
Glossary
Terms and abbreviations commonly encountered in theatre and in the training portfolio. Elsewhere on the site, underlined terms can be selected to show their definition.
Novice syllabus checklist
About this site
What it is
A companion for anaesthetists in training in the Yorkshire and Humber school, from the first day in theatre to the Certificate of Completion of Training (CCT). It brings together the RCoA curriculum by stage, a guide to the FRCA examinations (including the new formats from July 2027), original revision notes mapped to the RCoA syllabus codes, single-best-answer practice questions, and station practice packs for CASE and FCPE.
It signposts official material and does not replace it. The RCoA curriculum, syllabi and examination regulations are the authoritative sources, and your training faculty decides on progression.
Credit
The novice section's structure, worked example and approach to learning are adapted, with permission, from Dr Alistair Brooks's An Introduction to Anaesthesia, a self-directed learning guide for novice anaesthetists. His original was mapped to the 2010 RCoA curriculum. This version is re-mapped to the 2021 curriculum and the IAC, and links to the current e-LA sessions. The glossary includes definitions adapted from the same guide.
This site was compiled and is maintained by Dr Mark Stubbington.
Clinical reviewers will be credited here as content is checked.
Review status
Every revision note, question and station shows its status. Draft means written and referenced but not yet checked by a clinical reviewer. Reviewed means a named reviewer has checked it. Please read the disclaimer.
Feedback
Spotted something wrong, out of date, or missing? Every note, question and station has a Report a problem link, or you can send general feedback. Both open a GitHub issue, which needs a free GitHub account.
Your progress
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