Intermediate Anaesthetic Training

Intermediate Training

Induction Days

The Welsh School of Anaesthesia holds an Induction Day for those trainees commencing Intermediate Level Training. The Induction Day is held in early September for trainees who commence ST3 programmes in August, and in late Feb/early March for trainees commencing in February. Please see the Courses & Study Days pages of the website for further information.

Training Overview

The Knowledge, Skills and Attitudes required for Intermediate Training are set out in Annex C of the Curriculum of the Royal College of Anaesthetists. The knowledge element requires success in the Final FRCA (or equivalent) examination and in addition there are 19 essential clinical units of training plus 3 essential non-clinical units.

Essential Clinical Modules:

  • Cardiacthoracic Anaesthesia and Cardiac Intensive Care
  • Intensive Care Medicine (Annex F)
  • Neuroanaesthesia, Neuroradiology and Neuro Intensive Care (completed in Cardiff OR The Walton Centre, Liverpool)
  • Paediatric Anaesthesia
  • Obstetric Anaesthesia
  • Pain Management

General Duties, which must include each of the following:

  • Airway management
  • Day Surgery
  • Critical incidents
  • General Surgery / Gynaecology / Urology (+/- Transplantation)
  • ENT, MaxFax, Dental
  • Regional Anaesthesia
  • Respiratory and Cardiac Arrest
  • Non theatre
  • Orthopaedic Anaesthesia
  • Perioperative Medicine
  • Sedation
  • Transfer Medicine
  • Trauma and Stabilisation

The 3 essential non-clinical modules are:

  • Academic
  • Teaching and learning
  • Management

There are also 3 optional modules:

  • Plastics / Burns
  • Ophthalmic Surgery
  • Vascular

Competency is assessed using logbook data in conjunction with evidence from a range of assessment tools and Consultant feedback within each completion of unit of training sign-off. This should all be collated on the RCoA Lifelong Learning platform in accordance with the blueprint for workplace assessments mapped to intermediate level training on the final page of Annex C

The Faculty of Intensive Care Medicine and the RCoA have revised the competencies to be signed off for ICM at each training level, please see Annex F

Non-clinical modules: Academic, Teaching and Management

Intermediate trainees will have to demonstrate that they are engaging in quality improvement, teaching, participation in departmental meetings, etc. The requirements are set out in Annex G of the curriculum.

Intermediate Training


There will be an ARCP at the end of each year of intermediate level training. You will be sent information in advance of the date(s) detailing what evidence you must provide. ARCP dates can be found on ARCP webpage. The ARCP at the end of Year 4 is a major review that draws everything together, including examination results, and confirms that the totality of the objectives of intermediate level training (ST years 3 and 4), including the assessment of 'attitudes', has been achieved. Once these objectives have been met the Intermediate Level Training Certficate (ILTC) can be awarded and the trainee can progress to Year 5 - Higher Training. As set out below - the RCoA do permit entry to ST5 higher training units if the Final FRCA is outstanding for a period of 12 months. In this instance an Intermediate Level Progress Report is signed, rather then the ILTC. Without either certificate, there can be no entry into higher and advanced levels of training. It is important at this stage to begin planning for your final 3 years of training, including career aims and advanced training options.

Final FRCA Examination

The Final FRCA exam can be a major hurdle for many Intermediate Level trainees. It is important to discuss your exam preparation with your Educational Supervisor/College Tutor early in ST 3 so that appropriate plans can be made. Most departments will be very supportive in allowing study leave for exam preparation and there are a number of Final FRCA Examiners in Wales who can provide advice.

Regional FRCA teaching is provided in North Wales, Newport, Cardiff and Swansea, plus a new Final written FRCA Course and Final VIVA course are delivered in South Wales. Details of which will be updated in latest news and updates

Guidelines for management of trainees who have failed to pass the Final FRCA exam by the end of ST4

The RCoA have decided that as a consequence of COVID and the 2021 Curriculum implementation, ST3 trainees appointed from August 2020 would be allowed until the end of ST5 to pass all elements of the Final FRCA examination. They can make progress with higher units of training/Stage 2 equivalence before a training extension is triggered. Trainees who do not have the Final exam at the end of ST5 year would receive an ARCP outcome 3. This would then trigger a training extension of 6 months and potentially 1 year if the trainee demonstrates no other performance or behavioural concerns and has not had a previous extension in Core Training.

Trainees must also demonstrate that they:

  • Attend classroom/exam teaching sessions
  • Engage with HEIW Professional Support Unit
  • Demonstrate satisfactory attitudes and behaviour
  • Show evidence of progress towards completion of final exam

Feedback from local trainers will be sought to verify that the above requirements are being met. Failure to fulfil these requirements may lead to termination of the training extension. If the trainee has not passed the final FRCA by the end of their one year extension they will not be entitled to any further extension to training. Only in exceptional circumstances, at the discretion of the Postgraduate Dean, will they be given a further training extension. If they leave the training scheme they will relinquish their NTN.

If the trainee passes the final FRCA after an outcome 4 and outside of the training programme they would need to re apply for a National Training Number.

Below are links to a number of useful documents:

Intermediate Level Curriculum