Initial Assessment of Competencies (IAC)


What is the Initial Assessment of Competence?
The initial assessment of competence is the first anaesthesia training milestone for trainees in the Anaesthesia training programme and the ACCS element of training for anaesthesia, acute medicine, emergency medicine and intensive care (in the future). The purpose of the IAC is to signify that the trainee has achieved a basic understanding of anaesthesia and is able to give anaesthetics at a level of supervision commensurate with the individual trainee’s skills and the clinical case; and the trainee can be added to the on-call rota for anaesthesia. The IAC is not a licence for independent anaesthetic practice. The key point is that trainees are still under the supervision of a named consultant anaesthetist.

The IAC is normally achieved within the first three to six months of the anaesthesia programme and the assessment of the IAC doubles as the required assessments for the basis of anaesthetic practice. To pass the IAC, trainees must successfully complete the following workplace based assessments:

Workplace Based Assessment Tool Number
Anaesthesia Clinical Evaluation Exercise (A-CEX) 5
Case Based Discussion (CBD) 8
Direct Observation of Procedural Skills (DOPS) 6

The blueprint for the workplace based assessment tools and the observation are defined in Annex B of the Curriculum for a CCT in Anaesthetics (2010). Unlike other assessments in the anaesthesia programme, each assessment must be a single assessment event and therefore trainees must complete a minimum of 19 separate assessment events.

RCoA policy for non-anaesthetists
For ACCS trainees not following a training pathway for a CCT in Anaesthetics, the IAC is a mandatory achievement for the completion of the anaesthesia component of ACCS training. Irrespective of the specialty, trainees should not be giving anaesthetics without supervision. It is acknowledged that it is not always possible to be supervised by an anaesthetist in the emergency department, intensive care unit or in the ward, supervision in these locations may be provided by a suitably trained person who is competent at intubation for routine cases.

In an emergency, trainees should provide a level of care to patients commensurate with their skills and knowledge until senior assistance arrives. Under no circumstances should a trainee with very limited experience and not exposed to ongoing anaesthetic practice be contemplating rapid sequence induction without supervision, irrespective of the location or urgency of the case.