Selection process for trainees during COVID-19: a chance to assess what is important?
The COVID crisis has rocked the medical profession both in and outside the UK at every level, with staff often working outside their comfort zones. Rotas have been redrawn, annual leave cancelled, and traditional weekends are but a distant memory. However, staff morale has been boosted through a wide variety of initiatives. Food donations, ‘wobble rooms’, free parking, etc have all helped. Sadly, for the anaesthetic core trainee a new obstacle looms.
Last year the RCoA planned to introduce a one-year extension on the rotations of core and ACCS trainees in anaesthesia (to apply to current CT2s and below), in order to provide them with more experience in obstetrics before becoming a registrar and extra time to pass the Primary examination [1]. This was a welcome change, guided in part by trainee concerns. However, the response to the COVID crisis has been to set back this transfer to the new curriculum by a year [1]. This leaves trainees such as myself in a predicament.
With a year less than expected to complete exams, there is little time left to polish the CV before its next outing for ST3 applications. For those unfortunate enough to have invested significant time into projects not yet completed pre-COVID, these have been at best placed on hold, and at worst failed altogether. I had intended to devote this year to projects in quality improvement, research and teaching in the developing world to prepare for application to ST4 in 2021, and then focus on the primary examination. These projects have all been abandoned because of the pandemic. The departments involved have lost potentially valuable work that may or may not be picked up at a later date depending on the enthusiasm of my successors, and my CV remains thin. This is not to mention the uncertainty surrounding preparing for exams during a time when lockdowns have precluded their sitting. Undoubtedly there are many such unfortunate candidates who are at the core training stage.
This year’s ST3 selection round, when interviews were cancelled due to the current crisis, has favoured those who were bold in their application claims. Conversely, next year will favour some who have taken time out of training to work overseas, particularly Australasia, as they will have completed their projects without the disruption caused by the pandemic and potentially gained broader clinical experience.
It would be beneficial to both applicants and training departments if post-COVID applications had a slightly different weighting. Far from penalising or inadequately rewarding hard work currently recognised by the system, this could be complemented by other measures which might give an assessor a more accurate reflection of a trainee’s abilities. We all conduct regular MSFs – with minor alteration these could be easily quantified and translated into a score that gave a representation of what your colleagues think of you. This would help separate out the inevitably tighter grouping of candidates whose opportunities to make themselves stand out from the crowd have been curtailed.
COVID has left a cohort of anaesthetists in an awkward position; having stepped up to provide emergency cover, putting themselves in the face of danger, they will find themselves less employable in the future. To address this imbalance we are presented with an opportunity to improve the flawed assessment system we currently have towards one fairer for trainees, potential employers and ultimately patients.
Competing interests: This publication gains the first author 2 points at ST3 application as per the 2020 self assessment.
Aidan Smallwood
ACCS Anaesthetics CT2
Rachel Prout
Consultant in Anaesthetics and Intensive Care
Great Western Hospital, Swindon
Twitter: @smallwoodaidan; @ryoungprout
Reference
- Royal College of Anaesthetists. 2021 Anaesthetics Curriculum, 2020. https://www.rcoa.ac.uk/training-careers/training-anaesthesia/2021-anaesthetics-curriculum (accessed 27/5/2020).
A response from the Association of Anaesthetists
Tuesday 2 June 2020
On 30 March, the four national education leads published a letter outlining the contingency plans for specialty recruitment during the COVID-19 pandemic. The Association of Anaesthetists Trainee Committee had concerns about the use of unvalidated portfolio self-assessment scores alone to allocate ST3 posts for August 2020, and about the adverse effects that this may have on our trainee members. Although we understand and appreciate the reasons behind the decision to cancel ST3 recruitment interviews, we were concerned about the implications of committing trainees to a 5-year training programme using a substandard and unvalidated process. Given this, we wanted to highlight the issues and urge the four statutory education bodies to reconsider their position.
We appreciate that no solution is ideal given the circumstances, and alternatives would not replace the rigorous methodology that an interview process would have provided. However, we felt compelled to offer some alternative suggestions to mitigate the potential detrimental effects on behalf of our trainee members. On 17 April, we sent a letter addressed to the four national education leads emphasising our concerns about the current process for recruitment, and offered them alternative solutions. These included:
- Offering all anaesthetic trainees an automatic extension of the current training contract and running a full formal ST3 recruitment process with interview for a February 2021 start. This 6-month extension could count towards training time as a LAT post. Therefore, trainees would enter ST4 in August 2021.
- Automatically recruit all CT2 trainees into a CT3 year within their current deaneries, with trainees being able to apply to enter ST4 starting August 2021.
We received a response to our letter on the 22 April from the four statutory education bodies stating, “…whilst we understand the arguments you have presented, we do not feel it is wise to change the four nation, cross-Colleges consensus that was achieved on this issue”. We believe this response was disappointing to our members, particularly to those who applied to this August’s ST3 recruitment round. We also had further concerns that the recruitment process chosen might disadvantage some groups, so we wrote to them again on 1 May. In this letter, we asked to see their impact assessment on diversity and equality for the recruitment process, and asked how any potential discrimination was mitigated. At the time of writing (2 June), we are still awaiting a response. We will of course update you when we receive an answer to this query.
We would like to extend our congratulations to those who have received offers recently, and wish you all the best for your specialty training. We appreciate how stressful the uncertainty has been over this period for all those who underwent the recruitment process, and therefore we wanted to raise the issue on behalf of trainees. We have always and will continue to advocate for our members and represent their interests to the best of our ability.
Association of Anaesthetists Trainee Committee