FRCA Curriculum – Perioperative Medicine

Competence Source Curriculum Description
Preoperative Care
HT_BK_01 Basic Lists the important elements of anaesthetic history taking
HT_BK_02 Basic Recognises that patients do not always present history in a structured fashion
HT_BK_03 Basic Lists the likely causes and risk factors for conditions relevant to mode of presentation
HT_BK_04 Basic Uses the patient’s agenda and history to inform examination, investigation and management
CE_BK_01 Basic Describes the need for a targeted and relevant clinical examination
CE_BK_02 Basic Describes the basis for clinical signs and the relevance of positive and negative physical signs
IN_BK_01 Basic Interprets clinical data including, but not exclusively:

  • Patient clinical case notes and associated records
  • Clinical parameters such as:
    • BP, Pulse, CVP
    • BMI
  • Fluid balance
  • Physiological investigations such as:
    • ECGs
    • Echocardiography and stress testing
    • Pulmonary function tests
IN_BS_01 Basic Interprets clinical laboratory data including:

  • Haematology such as routine report of Hb, WBC, haematocrit etc.
  • Biochemistry such as
    • Arterial blood gases/acid-base balance
    • Urea and electrolytes
    • Liver function
    • Endocrine biochemistry such as blood glucose and thyroid function
IN_BS_02 Basic Identifies normal appearances and significant abnormalities in radiographs including:

  • Chest X-rays
  • Trauma films – cervical spine, chest, pelvis, long bones
  • Head CT and MRI showing clear abnormalities
OA_BK_01 Basic Gives examples of methods of anaesthesia that are suitable for common operations.
OA_BK_02 Basic Describes the ASA and NCEPOD classifications and their implications in preparing for and planning anaesthesia and postoperative care
OA_BK_03 Basic Explains the indications for and interpretation of preoperative investigations
OA_BK_04 Basic Lists the indications for preoperative fasting and appropriate regimens
OA_BK_05 Basic Explains the methods commonly used for assessing the airway to predict difficulty with tracheal intubation
OA_BK_06 Basic Lists the indications for Rapid Sequence Induction
OA_BK_07 Basic Gives examples of the effect of common co-existing diseases on anaesthesia and surgery including but not exclusively:

obesity; diabetes; asthma; ischaemic heart disease; hypertension; rheumatoid disease; epilepsy
OA_BK_08 Basic Discusses how to manage drug therapy for co-existing disease in the perioperative period including, but not exclusively:

diabetic treatment; steroids; anti-coagulants; cardiovascular and respiratory medication; anti-convulsants
OA_BK_09 Basic Explains the available methods to minimise the risk of thromboembolic disease following surgery
OA_BK_10 Basic Describes the complications of anaesthetic drugs [including anaphylaxis, suxamethonium apnoea and malignant hyperpyrexia] and how to predict patients who are at increased risk of these complications
OA_BK_11 Basic Identifies the principles of consent for surgery and anaesthesia, including the issue of capacity
OA_BK_12 Basic Explains the guidance given by the GMC on consent, in particular:

  • Understands that consent is a process that may culminate in, but is not limited to, the completion of a consent form 
  • Understands the particular importance of considering the patient’s level of understanding and mental state [and also that of the parents, relatives or carers when appropriate] and how this may impair their capacity for consent
OA_BK_13 Basic Summarises the factors determining a patient’s suitability for treatment as an ambulant or day-stay patient
OA_BK_14 Basic Recalls the factors that affect the risk of a patient suffering post-operative nausea & vomiting
OA_BS_01 Basic Obtains a history specifically relevant to the planned anaesthesia and surgery including:

  • A history of the presenting complaint for surgery
  • A systematic comprehensive relevant medical history
  • Information about current and past medication
  • Drug allergy and intolerance
  • Information about previous anaesthetics and relevant family history
OA_BS_02 Basic Performs a relevant clinical examination including when appropriate:

  • Cardiovascular system
  • Respiratory system
  • Central and peripheral nervous system: GCS, peripheral deficit
  • Musculoskeletal system: patient positioning, neck stability/movement, anatomy for regional blockade
  • Other: nutrition, anaemia, jaundice
  • Airway assessment/dentition
OA_BS_06 Basic Makes appropriate plans for anaesthesia:

  • Reviews current medication and seeks advice where appropriate
  • Plans appropriate anaesthetic technique[s]
  • Secures consent for anaesthesia
  • Recognises the need for additional investigation and acts accordingly
  • Discusses issues of concern with relevant members of the team
  • Reliably predicts the level of supervision they will require
OA_BS_08 Basic Provides a balanced view of care options
POM_BK_01 Basic Describes the importance of comorbid disease in the planning and safe conduct of anaesthesia
POM_BK_02 Basic Describes the role of ‘do not resuscitate’ procedures
POM_BK_03 Basic Describes the effects of acute and chronic disease on patient outcomes after surgery
POM_BK_04 Basic Describes the requirements for preoperative investigations including indications for specific tests
POM_BK_05 Basic Interprets fundamental preoperative investigations
POM_BK_06 Basic Describes the adjustments needed to provide anaesthesia for the following patient groups: the elderly, pregnant women, patients with cognitive impairment, patients with chronic pain, and substance misusers
POM_BK_07 Basic Recounts implications of lifestyle factors such as smoking, alcohol intake and substance abuse on patient outcomes
POM_BK_08 Basic Discusses the management of concurrent medication in the perioperative period
POM_BK_09 Basic Describes thromboprophylaxis in the perioperative period
POM_BK_10 Basic Describes methods of risk assessment and stratification relevant to the provision of perioperative care
POM_BK_11 Basic Describes methods of patient optimisation which reduce risk in the perioperative period
POM_BK_12 Basic Describes how integrated perioperative care pathways in primary and secondary care affect patient outcomes
POM_BK_13 Basic Describes specific organisational interventions which improve patient outcomes (e.g. care bundles, enhanced recovery pathways)
POM_BK_14 Basic Describes the legal and ethical principles for obtaining informed consent in adults and the correct processes for patients who are unable to consent
POM_BK_15 Basic Describes the legal and ethical considerations for determining mental capacity
POM_BK_16 Basic Explains how patients requiring emergency surgery may differ from those presenting for elective surgery in terms of physiology, psychology and preparation
POM_BK_17 Basic Describes optimal perioperative fluid and feeding regimes
POM_BK_18 Basic Describes the impact of nutritional status on patient outcomes
POM_BK_19 Basic Describes the effects of ethnicity on physiology
POM_BS_01 Basic Conducts a comprehensive preoperative assessment in the outpatient clinic
POM_BS_02 Basic Assesses patient suitability for day case admission
POM_BS_03 Basic Evaluates co-morbidity in ASA 1-3 patients
POM_BS_05 Basic Organises appropriate special investigations
POM_BS_06 Basic Makes appropriate referrals to other specialties when required
POM_BS_07 Basic Works in a multi-professional team and ensures effective communication with other members
POM_BS_08 Basic Communicates anaesthetic options with patients or surrogates effectively
POM_BS_09 Basic Synthesises relevant information to develop a safe anaesthetic plan, taking the patient’s wishes into consideration
PD_BK_01 Basic Summarises the value of appropriate explanations and reassurance in alleviating the patient’s anxiety
PD_BK_02 Basic Lists basic indications for prescription of pre-medication
PD_BK_03 Basic Describes the rationale for the use of different anxiolytic and sedative drugs
PD_BK_04 Basic Discusses the applied pharmacology of sedative and anxiolytic drugs
PD_BK_05 Basic Recalls the factors that influence the risk of gastric reflux/aspiration and lists strategies to reduce it
PD_BK_06 Basic Explains the applied pharmacology of pro-kinetic and antacids including simple alkalis, H2 receptor antagonists and proton pump inhibitors
PD_BK_07 Basic Describes the application of local/national guidelines on management of thrombo-embolic risk
PD_BS_01 Basic Prescribes appropriate agents to reduce the risk of regurgitation and aspiration
PD_BS_02 Basic Explains, in a way the patient understands, the benefits and possible risks of sedative premedication
PD_BS_03 Basic Prescribes appropriate anxiolytic/sedative premedication when indicated
POM_IK_01 Intermediate Describes the uses and limitations of common risk scoring systems
Intraoperative Care
POM_BK_20 Basic Describes risks and benefits of different anaesthetic techniques including their effect on early mobilisation and restoration of function
POM_BK_21 Basic Describes the effect of perioperative analgesia on patient outcome
POM_BK_22 Basic Describes strategies to minimise the risk of infection in the postoperative period
POM_BK_23 Basic Describes the effect of hypothermia on patient outcome
POM_BK_24 Basic Develops an effective patient-specific strategy to minimise post-operative nausea and vomiting
POM_BK_25 Basic Lists the risk factors for postoperative cognitive dysfunction
POM_BK_26 Basic Recalls principles of advanced haemodynamic monitoring
POM_BK_27 Basic Describes perioperative fluid management strategies, with reference to maintaining homeostasis
POM_BK_28 Basic Explains the indications for the use of blood products and describes the effective management of major haemorrhage
POM_BK_29 Basic Describes the consequences of failing to maintain normal biochemical parameters, e.g. acid-base balance, blood glucose
ES_BK_01a Basic Discusses the management of common problems encountered in patients requiring emergency surgery
ES_BK_01b Basic Adopts a structured and timely approach to the recognition, assessment and stabilisation of the acutely ill patient with disordered physiology
ES_BK_02 Basic In respect of the preparation of acutely ill patients for emergency surgery:

  • Describes the resuscitation of patient with hypovolaemia and electrolyte abnormalities
  • Discusses how patients may be inadequately fasted and how this problem is managed
  • Discusses the management of acute preoperative pain
ES_BK_03 Basic Lists the indicators of severe illness.
ES_BK_04 Basic Describes Rapid Sequence Induction of Anaesthesia
POM_BS_12 Basic Administers intravenous fluids and blood products appropriately
POM_BS_15 Basic Employs effective strategies to maintain normal body temperature intraoperatively
POM_IK_02 Intermediate Describes the use of ‘do not resuscitate’ procedures and appropriate limitations of care
POM_IK_03 Intermediate Describes strategies for prehabilitation and patient optimisation and the limits of such strategies
POM_IK_04 Intermediate Recalls the principles of enhanced recovery pathways
POM_IK_05 Intermediate Describes the requirements for investigations in patients with complex comorbidities
POM_IK_06 Intermediate Lists methods of assessment of functional cardiorespiratory capacity
POM_IK_07 Intermediate Describes appropriate preoperative strategies for minimising the use of blood products
POM_IK_08 Intermediate Describes the effects of ethnicity on pre-operative assessment
POM_IS_01 Intermediate Assesses the patient with complex comorbidities, taking into account their individual needs and requirements
POM_IS_02 Intermediate Liaises effectively with colleagues in Intensive Care in planning care
POM_IS_03 Intermediate Explains risks and benefits of available anaesthetic techniques to patients in a manner they can understand
POM_IS_04 Intermediate Formulates an individualised perioperative plan with the patient, using an evidence-based approach
POM_IS_05 Intermediate Balances the need for early surgery against the need for further investigation, prehabilitation and pre-optimisation
POM_IS_06 Intermediate Responds appropriately to investigation results when planning perioperative care
POM_IS_09 Intermediate Manages existing medications and makes appropriate changes
POM_IS_10 Intermediate Discusses the risks and benefits of the transfusion of blood products with patients
POM_IS_11 Intermediate Discusses requirements of postoperative organ support and its limitations
POM_IK_09 Intermediate Describes the concept of Goal-Directed Therapy
POM_IK_10 Intermediate Describes the use of different types of intravenous fluid
POM_IK_11 Intermediate Explains the potential impact of anaesthetic technique on patient outcome
POM_IK_12 Intermediate Describes the effects of deviation from normal physiological parameters on short and long-term outcomes
POM_IK_13 Intermediate Describes rationale for point of care testing
POM_IK_14 Intermediate Recalls the principles and interpretation of depth of anaesthesia monitoring
POM_IK_15 Intermediate Explains how ethnicity may influence conduct of anaesthesia
POM_IS_12 Intermediate Chooses appropriate anaesthetic technique for patients with complex comorbidities
POM_IS_13 Intermediate Interprets information from commonly used modalities for advanced haemodynamic monitoring
POM_IS_14 Intermediate Uses results from point of care testing to direct treatment
POM_IS_17 Intermediate Recognises the deteriorating perioperative patient
POM_IS_18 Intermediate Institutes appropriate measures to stabilise the deteriorating patient
POM_IS_20 Intermediate Uses antibiotics and other measures to reduce the risk of infection
POM_IS_21 Intermediate Uses strategies to minimise post-operative cognitive dysfunction
POM_IS_22 Intermediate Uses strategies to minimise the risk of accidental awareness under general anaesthesia
Postoperative Care
PO_BK_01 Basic Lists the equipment required in the recovery unit
PO_BK_02 Basic Lists the types of monitoring and the appropriate frequency of observations required for patients having undergone different types of surgery
PO_BK_03 Basic Describes the care of an unconscious patient in the recovery room, including safe positioning
PO_BK_04 Basic In respect of restoring spontaneous respiration and maintaining the airway at the end of surgery:

  • Explains how to remove the tracheal tube and describes the associated problems and complications 
  • Recalls/describes how to manage laryngospasm at extubation 
  • Recalls/lists the reasons why the patient may not breathe adequately at the end of surgery 
  • Recalls/identifies how to distinguish between the possible causes of apnoea 
  • Lists the possible causes of postoperative cyanosis 
  • Describes how to evaluate neuro-muscular block with the nerve stimulator
PO_BK_05 Basic With respect to oxygen therapy:

  • Lists its indications 
  • Lists the techniques for oxygen therapy and describes the performance characteristics of available devices 
  • Recalls/explains the causes and management of stridor
PO_BK_06 Basic Outlines/recalls the principles of appropriate postoperative fluid regimes including volumes, types of fluids and monitoring of fluid balance including indications for urethral catheterisation
PO_BK_07 Basic In respect of postoperative pain:

  • Describes how to assess the severity of acute pain 
  • Describes the ‘analgesic ladder’ 
  • Discusses how emotions contribute to pain 
  • Identifies appropriate postoperative analgesic regimes including types of drugs and doses 
  • Explains how to manage ‘rescue analgesia’ for the patient with severe pain 
  • Lists the complications of analgesic drugs
PO_BK_08 Basic In respect of PONV:

  • Recognises the impact of PONV 
  • Lists the factors that predispose to PONV 
  • Describes the basic pharmacology of anti-emetic drugs 
  • Describes appropriate regimes for prevention and treatment of PONV
PO_BK_09 Basic Describes the possible causes and management of postoperative confusion
PO_BK_10 Basic Describes the causes and management of postoperative hypotension and hypertension
PO_BK_11 Basic Identifies premorbid disease states that may require patients to have higher (level 2 or 3) levels of care in the postoperative period.
PO_BK_12 Basic Describes the prevention, diagnosis and management of postoperative pulmonary atelectasis
PO_BK_13 Basic Lists the appropriate discharge criteria for patients leaving the recovery room and day stay patients
PO_BK_14 Basic Explains the importance of following up patients in the ward after surgery
POM_BK_30 Basic Describes the consequences of postoperative malnutrition
POM_BK_31 Basic Describes a patient-centred approach to postoperative analgesia and demonstrates understanding of the importance of providing adequate analgesia in the context of perioperative care
POM_BK_32 Basic Describes the indications for Critical Care admission postoperatively
POM_BK_33 Basic Describes the components of a safe and effective immediate postoperative plan (e.g. oxygen therapy, frequency and nature of observations, antibiotic prescription, thromboprophylaxis, management of glycaemic control etc.)
POM_BS_16 Basic Recognises limits of competence and seeks advice where appropriate when managing of postoperative complications
POM_BS_17 Basic Plans the transition from intravenous to enteral hydration, nutrition and analgesia where appropriate
POM_BS_18 Basic Manages postoperative nausea and vomiting effectively
POM_BS_19 Basic Manages coexisting disease and medications in the immediate postoperative period in ASA 1-3 patients
POM_BS_20 Basic Recognises common anaesthetic and surgical complications
POM_BK_30 Basic Describes the consequences of postoperative malnutrition
POM_BK_31 Basic Describes a patient-centred approach to postoperative analgesia and demonstrates understanding of the importance of providing adequate analgesia in the context of perioperative care
POM_BK_32 Basic Describes the indications for Critical Care admission postoperatively
POM_BK_33 Basic Describes the components of a safe and effective immediate postoperative plan (e.g. oxygen therapy, frequency and nature of observations, antibiotic prescription, thromboprophylaxis, management of glycaemic control etc.)
POM_IK_16 Intermediate Explains how a multidisciplinary team approach improves patient recovery and outcomes
POM_IK_17 Intermediate Manages common anaesthetic and surgical complications safely as part of a multidisciplinary team
POM_IK_18 Intermediate Plans appropriate postoperative analgesia using multimodal techniques, including those required for patients with complex analgesic needs
POM_IK_19 Intermediate Initiates communication with patients regarding adverse events and organises appropriate follow up
POM_IK_20 Intermediate Contributes to discharge planning
POM_IK_21 Intermediate Plans postoperative care in keeping with relevant enhanced recovery pathways
POM_IK_22 Intermediate Describes the effects of ethnicity in postoperative management, including pain management