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THE TRAINING PROGRAMME IN ANAESTHESIOLOGY, PAIN AND INTENSIVE CARE MEDICINE
MALTA The official training programme leading to specialist registration in Anaesthetics and Intensive Care Medicine in Malta.
-Association of Anaesthesiologists of Malta-
JANUARY 2015
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Table of Contents
Forward p3
Section 1: General Overview ............................................................................................ p4
1.1 Aim
1.2 Objectives
1.3 Entry Requirements
1.4 Minimum Duration of Training
1.5 Maximum Duration of Training
1.6 Suspension or Termination of training
Section 2: The structure of training ................................................................................ p7
2.1 Basic Specialist Training
2.2 Higher Specialist Training
2.3 Training modules
Section 3: Trainee Progression ......................................................................................... p10
3.1 Yearly progression
3.2 The first six months of training -The Initial certificate of competence
3.3 Progression from BST to HST
3.4 Completion of Training
Section 4: The evaluation of progress .............................................................................. p12
4.1 Workplace assessment tools
4.2 Annual in-training assessments
4.3 Annual appraisal with the training coordinators
4.4 Educational events
4.5 Audit, Research and other academic activities
4.6 Core Skill Lectures
Section 5: The European Diploma in Anaesthesiology and Intensive Care ..................... p17
Section 6: Certificate of Completion of Training and Inclusion in the Specialist Register p17 Section 7: Recognition of Training Institutions in Malta and abroad .............................. p18
Section 8: The training committee ................................................................................... p19
6.1 Composition
6.2 The Training Coordinators
Section 9: The Mentorship scheme.................................................................................. p 20
Section 10: Obligations of trainees and trainers .............................................................. p 21
References
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i) Forward
This document is a revision of the Anaesthesiology Training Programme Malta - May 2008. In this
edition we have moved from a simple time based and rotation programme, to a modular and
competency based curriculum. We have also introduced new achievements to be met, which go
beyond the basic clinical requirements and aim for excellence.
We have set out new rules and boundaries. Our previous experience in training, which is now
beyond its tenth year, has shaped this document, thus making the expectations of both trainees
and trainers easier and clearer.
We are hopeful that following this curriculum, trainees in Anaesthesiology1 will become safe,
knowledgeable and skilled anaesthetists. We also hope that future graduates in anaesthesiology
will remain loyal to our profession, be trustworthy and pass on their achievements to the next
generation of anaesthesiologists. We wish good luck to all future trainees.
The AAM committee
ii) SAC approval date
The Association of Anaesthesiologists of Malta (AAM) and the Maltese Specialist Accreditation
Committee (SAC), approved this document as the sole and official training document leading to
specialist accreditation in Anaesthesiology and Intensive Care to be followed in the Malta.
This document has been approved by the SAC on the 13th January 2015
iii) Commencement date
This document shall be the official anaesthetic training document to follow from the 1st of February 2015
iv) Disclaimer
This Document has been written in good faith, after consultation and to the best possible
knowledge of all involved. The AAM will not accept any responsibility for any untoward
consequences suffered by prospective candidates or third parties.
v) Equal Opportunities
This document aims to provide equal opportunities to all trainees irrespective of gender, sexual
orientation, race, religious beliefs and differently abled individuals, who are able to train
successfully to become independent specialists and professionals.
Any references in the text relating to the male gender are equally applicable to the female gender.
1
In the following text, the term Anaesthesiology is taken to refer to the specialty as whole, including Anaesthetics and
Perioperative medicine; Intensive & Acute care medicine and Pain management.
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Section 1: General overview
1.1 Aim
The aim of the Training Programme in Anaesthesiology, Pain and Intensive Care Medicine in Malta
is to offer an interesting and challenging framework for the postgraduate training of medical
doctors committed to attain specialist status in the specialty of Anaesthetics and Intensive Care,
which includes Anaesthetics & Perioperative Medicine, Intensive & Acute care Medicine and Pain
Management.
1.2 Objectives
The achievement of in-depth, accurate and up to date knowledge in the specialty of
Anaesthetics and Intensive Care. This includes basic sciences, clinical anaesthesia, intensive
care medicine, acute medicine and resuscitation, acute and chronic pain.
The achievement of skills necessary to work as an independent specialist in Anaesthesiology.
Nurture team work and good character traits within the environment where the specialty is
practiced.
Ensuring safety during clinical practice by encouraging governance.
Involvement in the improvement of work practices through audit and clinical guidelines.
Achieving excellence by facilitating the exchange of ideas, training in approved foreign
institutions and research.
1.3 Entry Requirements
1.3.1 Entry into 1st Year Basic Specialist Training (BST)
By the date of commencement of the BST post, prospective candidates must be in possession of:
An Undergraduate Degree in Medicine and Surgery recognized by local authorities.
Registration with the Medical Council of Malta. (On the Principal list).
A License to practice medicine in Malta
The Foundation Achievement of Competence Document (FADC) or equivalent
Sufficient linguistic capabilities to communicate with patients and colleagues
Work experience in the Accident and Emergency department, Paediatrics, Obstetrics, ENT and
Cardiology are considered an asset during the selection process to join the anaesthetic training
program.
Prospective candidates should seek to attend an observational taster week in the specialty during
their Foundation Years. Candidates need to be certified ALS providers.
The prospective candidates will be chosen after a competitive interview by a selection board. It is
advisable that the members on the selection board should include one of the anaesthetic training
coordinators.
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1.3.2 Entry into subsequent years of training
The training committee may approve entry into the training programme in subsequent years of
training depending on the experience of the trainee, as long as the criteria in 1.3.1 are met.
However a maximum of one year training in approved foreign teaching institutions, only, may be
counted towards attainment of specialisation in Malta. The trainee can only secure a BST or HST
post after being successful in a competitive interview. The time working in anaesthetics, in a
Maltese teaching hospital, can be counted retrospectively towards attainment of specialisation
and provided the training curriculum is followed.
1.4 Minimum Duration of Training period
The minimum duration of specialist training in Anaesthesiology shall be of 5 years in full time
practice or equivalent part-time/reduced hours practice. It is recommended that the trainee
performs a minimum of 48 hours/week on average of which approximately a third should be out-
of-hours work (i.e. a minimum of 1 duty per week). The out of hours work, shall include duties in
the Operating Theatres, Intensive Care Unit, Labour ward, cover for resuscitation and
transportation of sick patients, depending on individual experience and the modules which are
being completed.
1.4.1 Intensive Care
It is essential that the trainee spends a minimum of 12 months full time commitment in intensive
care medicine during training. Trainees who intend to sit for the European exam in Intensive care
medicine EDIC will need to have a minimum of 24 months experience, that is, a further year after
the training period is finished.
1.4.2 Part-time Training
Part-time training is allowed subject to approval by the training committee. Part-time duration is
pro-rata, however the minimum number of hours worked in a week must be not less than
equivalent half-time. On-call duty commitments must also be worked pro-rata and all necessary
commitments have to be abided to, as in full time training.
1.4.3 Training during pregnancy
The training coordinators will try to assign modules so to accommodate the pregnant trainees’
requests. A pregnant trainee has a right of up to a maximum of eighteen weeks of maternity leave
(in addition to the normal entitlement of leave). The rights of fathers to be are also respected,
according to current employment laws. All modules and competencies have to be completed none
the less, as described in section 2.3.1. Any further parental leave will lead to the training being put
on hold. The maximum duration of training will be extended beyond the four years at BST level
and hence beyond the total ten year period on a pro-rata basis. If more than 18 months are spent
out of training, a number of modules may have to be repeated if deemed necessary by the training
committee.
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1.4.4 Training Sabbaticals
A trainee may request a sabbatical for up to a year. Valid reasons include working in a specialty
post abroad, voluntary work and family reasons as detailed in the civil service code of practice. A
formal request in writing has to be received by the training committee at least three months in
advance, except in cases of sickness. Although the training committee can give a positive
recommendation, it is up to the Chairman of Anaesthesia to grant any absence from work.
1.5 Maximum Duration of Training period
The maximum time period allowed as a Basic Specialist trainee is 4 years. The training program in
anaesthesia has to be completed fully within 10 years from the start of specialist training,
excluding maternity, parental, sick or responsibility leave as laid out in Medical Class Sectorial
agreement. The maximum allowable time for such leave is determined by the civil service rules.
Failure to complete the training within the stipulated time will inevitably lead to redeployment in
the appropriate staff grade. The training committee, however, reserves the right to request the
trainee to repeat a number of modules when more than 18 months are spent out of training.
1.6 Suspension or Termination of training
Training may be suspended or terminated at any time when:
A trainee is deemed responsible for a serious incident where the safety of patients or
colleagues has been compromised.
Persistent failure on the trainee’s part to show interest in pursuing a career in anaesthesia
A long term illness/disability which may temporarily or permanently affect the potential of the
trainee in becoming an independent specialist.
A trainee commits a serious and deliberate act of unprofessionalism.
The maximum time for training is exceeded, as described above
The trainee wishes to discontinue his training
The particular case will need to be discussed at trainee committee level and also through the civil
service channels if necessary. All the evidence must be presented in confidence.
At least five committee members should be in favor of suspension or termination, using a secret
ballot.
Termination of training does not constitute dismissal from work, but the trainee, may thus be
reassigned according to the exigencies of the service, as laid out in Medical Class Sectorial
agreement.
During suspension of training the time limits detailed in section 1.5 remain in place.
The trainee can appeal against the decision taken by the Training committee (TC) to the Specialist
Accreditation Committee (SAC). The appeal has to reach the SAC within forty five days from the
date of communication of the TC’s decision. The SAC may appoint a body of experts who will
evaluate the case. The decision taken by the SAC shall be final.
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Section 2: The structure of training.
The training programme in anaesthesia consists of a modular structure which is spread over a
minimum of five years. The duration of each module shall be of four months. Thus the minimum
number of modules to be completed shall be fifteen.
2.1 Basic Specialist Training (BST)
BST will be covered during the first two years of training. The BST has to be completed within four
years as detailed in Section 1.5. During this period the trainee will be exposed to general clinical
work, ITU and some subspecialties of anaesthesia. The aim of this initial training is to grasp the
basic knowledge and skills needed to work safely in anaesthesia and intensive care. The first ITU
module should be assigned in the second year.
2.1.1 Supervision during BST
During the first 6 months of training basic specialist trainees should work in the theatre
environment under direct supervision1. Trainees at this stage can however use their skills in
history taking, clinical exam and obtain peripheral venous access under indirect supervision2.
At the end of the 6 months, the trainee has to achieve the initial competencies in anaesthesia.
Thereafter they are allowed to work under indirect supervision. The above applies for both
elective work and on-call commitments. The list of competencies and assessments that need to be
achieved will be provided by the training coordinators.
2.2 Higher Specialist Training (HST)
HST will be covered during the latter three years of training. Both Basic and Higher Specialist
Training have to be completed within the time frame as detailed in Section 1.5
During HST the trainee will be expected to consolidate the knowledge and clinical work in all fields
of anaesthesia, including all the main specialties. The aim of the latter years of training is to slowly
shoulder more responsibility in patient care, so that by the end of completion of training, the
trainee can work independently.
2.2.1 Supervision during HST
Higher specialist trainees are allowed to work under distant supervision3 during elective and on-
call general commitments and in specialties after completion of the first module in that specialty,
excluding cardiothoracic theatre cases and paediatrics cases under three years of age (or < 15kg).
Trainees at any level of training are expected to discuss unfamiliar, unusual and difficult cases
anytime with their immediate senior anesthetist. Discretion and common sense on part of the
trainee are important non-clinical skills, which have to be used at all stages of training and which
are assessed continuously during training.
1Direct supervision: The trainee has to be constantly supervised in theatre & ITU at all times 2Indirect supervision: The trainee may be allowed to work in theatre & ITU while a nominated senior
person, is available on-site when help needed (HST, resident specialist or Consultant grades). 3Distant supervision: The trainee can work in theatre & ITU with a senior colleague readily available for
advice.
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2.3 Training modules
Trainees should rotate progressively through a minimum of fifteen modules during five years of
training. Occasionally extra-modules are assigned depending on overall availability of training
slots. A certificate of completion of training cannot be issued unless all the fifteen modules below
are completed.
General Surgery module including Gynaecology
One module at BST level 4 months
Orthopaedics, Trauma and regional anaesthesia,
One module at BST level and One module at HST level 8 months
Intensive Care including patient resuscitation, outreach and patient transport
One module at BST level and Two modules at HST level 12 months
Obstetrics
Two modules. The first module should be completed within the first three years. 8 months
Paediatrics and ENT
Two modules. The first module should be completed within the first three years. 8 months
Urology and Vascular surgery
One module at any level of training 4 months
Plastics and Dental surgery
One module at any level of training 4 months
Neurosurgery, Advanced General Surgery and Emergency anaesthesia
One module at HST level 4 months
Chronic Pain
One module at HST level 4 months
Cardiac and Thoracic
One module at HST level 4 months
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2.3.1 Completion of Modules
A module is completed when the following criteria have been met:
1. The trainee spends at least 75% of his elective work in relevant clinical and non-clinical duties
pertaining to that specialty during each module.
2. The trainee has to provide evidence of satisfactory performance during his attachment. The
evidence necessary shall be determined from various sources, as determined by the training
committee from time to time. This should include:
attainment of signed competencies for each module.
maintenance of a detailed log book of all cases and procedures. An adequate number
of cases for the level of training will be ascertained by the training coordinators during
the annual appraisal
satisfactory feedback and workplace assessments by the supervising consultants.
any related courses or conferences
2.3.2 Training abroad
Trainees are encouraged to get work experience in a foreign training institution during their HST
years. The trainees are responsible to obtain approval by the Anaesthesiology Training Committee
prior to the start of such training. A maximum of one year training in an approved foreign
institution will be recognized for the purposes of specialist accreditation by the Specialist
Accreditation Committee (SAC).
The Anaesthesiology Training Committee is required to inform the SAC and the Post-graduate
training center that the training abroad is of an adequate quality and is being undertaken in a
training institution. The trainees are to present evidence of satisfactory completion of the modules
undertaken as specified in section 2.3.1, before the training can be recognized for the purposes of
specialist accreditation by Maltese authorities.
The Post-graduate training center may from time to time seek training agreements with foreign
institutions for the pursuit of training abroad in anaesthesia and intensive care. Whilst the trainees
are strongly advised to participate, they should be reminded that by participating they will be
bound by the terms and conditions specific for each agreement.
In the case of doctors who wish to join the Maltese anaesthetic training programme at later stages
of training, the approval of training and work in teaching institutions abroad, will be at the
discretion of the training committee who will advise the SAC accordingly. The maximum time
which can be approved is one year. The trainee has to provide equivalent documentation as
described in section 2.3.1 to support his request.
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Section 3: Trainee Progression
3.1 Yearly progression
A trainee has to achieve the following before he/she can be progress on to the next year of
training:
Completion of the three modules which have been assigned during the previous year.
A satisfactory annual appraisal with the training co-coordinators
A pass in the annual in-training assessment
3.2 The first six months of training - The Initial certificate of competence
Trainees are required to achieve the following basic competencies by the end of their first 6
months in:
Anaesthetic Machine Check
Safe Conduction of a Rapid sequence induction
Advanced life support
Pre-operative assessment
Advanced airway management
Safe delivery of a general anaesthetic to ASA1 and ASA2 patients for minor to intermediate
surgery
Sound clinical judgment and behavior
These shall be assessed formally using the validated tools provided by the training coordinators.
An initial certificate of competence supporting the above, needs to be completed before the
trainee can proceed to his second year.
3.3 Certificate of Completion of Basic Specialist Training (CCBST).
A CCBST is awarded after satisfactory completion of a minimum of two years in anaesthetic
training. The following conditions have to be met:
Satisfactory completion of six modules as per section 2.3
A satisfactory initial competence certificate
A pass in the second annual in-training assessment. This may include a separate MCQ
assessment, sat within the first two years of training.
A satisfactory annual appraisal with the training co-coordinators
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3.4 Progression from BST to HST
Trainees are eligible to apply for HST after they are awarded the CCBST. The appointment to an
HST post is subject to a successful performance during a competitive interview.
The training from BST to HST shall be deemed as continuous, provided the progression of training
is satisfactory, even if the appointment to an HST post is delayed for reasons beyond the remit of
the trainee or the training committee.
3.5 Completion of Training
The trainees are approved by the training committee and recommended by the AAM to the SAC,
for inclusion in the specialist register at the end of their training, which shall be said to be
complete when all the following conditions are met:
a minimum of five years of approved anaesthetic training
completion of all fifteen modules with the relevant supporting documentation
a pass in at least five in-training assessments (see Section 4.2.3)
a pass in the final part of the European diploma in anaesthesiology (EDAIC)
a satisfactory final appraisal with the training co-coordinators
All of the above conditions have to be met before the trainee can be recommended for inclusion
in the specialist register. Therefore the date of completion of training shall be the date when the
last of the above is attained.
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Section 4: The evaluation of progress
Trainees’ progress shall be evaluated by using the following:
Workplace assessment tools leading to a Competency certificate for each module
Annual in-training assessments
Annual appraisal with the training coordinators
Attendance and participation in educational events
Completion of audit and research
4.1 Workplace assessments tools
During each module the trainee has to achieve a safe level of competence in different aspects of
the specialty. A series of objectives have to be achieved by the end of the module. These
objectives shall be given to each trainee at the start of each module. A competency certificate
cannot be issued unless the training coordinator (or the clinician with special interest delegated) is
positive that the criteria have been achieved.
The criteria will be assessed in different ways, using a set of validated assessment tools and as
specified in the specialty competency documents.
4.1.1 Anaesthesia Clinical Evaluation Exercise (A-CEX)
Each trainee has to be assessed in the preoperative evaluation and anaesthetic planning for a
minimum of four different cases relevant to the specialty.
In addition each trainee has to be assessed for a minimum of four other different cases in the
conduct of an anaesthetic (or a related procedure) in theatre under supervision as relevant to
the specialty.
The cases ideally have to be assessed each by a different consultant in the specialty. A list relevant
to each module shall be made available to trainees.
4.1.2 Direct Observed Procedural Skills (DOPS)
Trainees shall be formally assessed by direct observation while performing various skills
throughout their training period. A list of DOPS that have to be achieved during the first 6 months
and during each module shall be made available to the trainees.
4.1.3 Theatre Session Attachment Form (TSAF)
Trainees need to hand a total ten TSAFs during each module. Eight TSAFs are to be completed at
the discretion of the trainee, while another two TSAFs will be allocated on the day by the training
coordinator.
The trainee should inform the consultant with whom he is attached ideally the day before, that an
assessment form is to be completed. A topic related to the module should be agreed beforehand
which the trainee can prepare and expect to be asked about.
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This form should be completed by the consultant at the end of the session and handed to the
training co-ordinators by the trainees. Assessments from at least five different consultants should
be obtained.
The aim of this feedback is both formative and summative. The Consultant should give feedback to
the trainee (what went well and what can be improved), using it as a tool for improvement in the
trainee’s performance.
During ITU and chronic pain modules the equivalent forms shall be used.
4.1.4 Case Based Discussions (CBD)
The trainee has to complete a series of discussions about various aspects of case management. It
is important that half of the cases are actual patients that the trainee has been actively managing.
These can be completed during theatre attachments or as a series of tutorials. The cases that need
to be discussed are found in the list of competencies that need to be achieved for that module.
4.1.5 End of module feedback (EMF)
Near the end of each module, the training coordinators shall obtain in confidence, at least three
EMF forms from three different consultants, with whom each trainee has worked during that
module.
4.1.6 End of Module Competency Certificate (CC)
At the end of each module, a Competency Certificate shall be signed by the lead clinician in that
specialty and a training coordinator. The competency certificate for each module shall have a list
of objectives that have to be met and the workplace assessment tools to complete them. The
training coordinator can only sign the certificate when all the assessments and feedback have
been received.
During the yearly appraisal the training coordinator shall make sure that the Competency
Certificates for the essential modules from the previous year have been completed. Failure to
achieve competence in the allotted time may require repetition of the module. The trainee
cannot progress further until all modules have been signed off which may mean that the total
training time has to be extended.
During the ITU modules the Cobatrice template can be used to assess progression. However at the
end of each module a signed document by two ITU consultants has to be handed to the training
coordinators witnessing satisfactory completion of the module.
4.2 Annual in-training assessments (AiTA)
A summative assessment shall be organized by the training committee at yearly intervals. The
trainees need to sit and obtain a pass in order to progress into the next year of training.
Trainees need to sit and pass a minimum of five in-training assessments, during their five years of
training. Trainees are exempted from the annual in-training assessment while they are pursuing
their training in an approved center abroad. The AiTA has to be taken at yearly intervals, in cases
were the duration of training goes beyond the fifth year.
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4.2.1 Guideline topics for the in-training assessment
The aim of the yearly AiTA should be to test on particular relevant subjects for the level of training.
As a guide please refer to the table below.
Level Focus Topics for Annual In Training Assessment
1st to 2nd year An understanding of basic scientific principles
Basic level case management for surgery. Common anaesthetic emergencies
Domains:1.1 to 1.4 ,1.6 (Refer to EBA guidelines)
2nd to 3rd year A thorough understanding of basic scientific principles.
Basic level case management for surgery including regional anaesthesia
Basic intensive care and emergency management.
Domains:1.1 to 1.6
3rd to 4th year Intermediate level case management for surgery.
Basic Specialty case management (Obstetrics, Paediatrics, & ENT/airway management)
Intermediate intensive care and emergency management.
Domains:1.1 to 1.6 and 2.1 ,2.2, 2.4, 2.5
4th to 5th year Advanced level case management for surgery.
Basic Specialty case management (Pain, Cardiac, Thoracic & Neuroanaesthesia)
Intermediate intensive care and emergency management
Domains:1.1 to 1.6 and 2.3, 2.6, 2.7
End of 5th year Advanced level case management for surgery.
Intermediate Specialty case management.
Advanced intensive care and emergency management.
Ethical principles, management and appraisal of literature
All Domains
The Maltese center has been accredited as an official training center for the preparation and
sitting the European Diploma in Anaesthesia and Intensive Care Medicine. Hence the trainees and
trainers should make themselves familiar with the “Syllabus to the post-graduate training in
Anaesthesiology, Pain and intensive Care” issued by the standing committee on education and
training of the Section and Board of the European Society of Anaesthesiology. This document
should guide the depth and breadth of the curriculum to be followed in Malta, subject to
constraints in the local resources.
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4.2.2 The structure of the AiTA
The date and exact format of the in-training assessment shall be determined by the training
committee at least three months before. The trainees should be given at least two months notice
of the agreed format. Ideally one foreign examiner should be invited to participate in the
assessments.
The assessment may consist of two vivas, each lasting 40 minutes. Each viva is to be given by two
different consultant anaesthetists, who will each give a mark on the performance of the candidate.
Four separate marks should be obtained. The minimum acceptable marks for a pass is 2,2,2,1+ in
any of the sections. Scoring 1 in any section is an outright fail and the candidate will have to do a
resit.
The marks shall consist of the following:
2+: Outstanding performance. Thorough understanding of principles and clinical applications
2 : Pass. Good and adequate knowledge
1+: Fail. Some deficiencies in knowledge are present in parts of the exam
1 : Bad Fail. Serious lack of understanding of basic principles or lack of safety
4.2.3 The end of the 5th Year AiTA
The end of 5th year AiTA is usually the final assessment before the completion of training, hence it
is very important. The main aim should be to ascertain that the trainee has attained the expected
level of clinical acumen in all specialties of anaesthesia and is able to show an understanding of
the responsibilities and roles which an anaesthetist is expected to fulfill, once he/she become an
independent practitioner.
The training has to be completed within 1 year of the last AiTA. If the training is not complete after
a year from passing the end of 5th year AiTA, this has to be repeated at yearly intervals, or at the
first available date after the trainee fulfills the other criteria for completion of training.
4.2.4 Resit sessions
A resit session within six months shall be provided for candidates who fail the initial session. If a
pass is not achieved in the resit session, the trainee will have to repeat that year of training. The
trainee in such case should have an urgent meeting with the training coordinator detailing a way
for improvement. The trainee coordinator will inform the training committee regularly on the
progression of the trainee. During the remedial year, any of the available modules may be
assigned as appropriate to the level of training.
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4.3 Annual appraisal with the training co-ordinators
At least yearly, (but also when the need arises) an individual meeting between the training
coordinators and each trainee shall take place. This is an opportunity for the training coordinator
to go over the trainee’s progress, tackle any problems and discuss achievements and aims for the
next year. Feedback from the consultants will be provided to the trainee.
During the appraisal the trainee needs to provide the following:
A structured logbook summary of cases performed during the previous year
The signed and completed, end of module competency certificates
The mandatory workplace assessment tools.
Examination and yearly in-training assessment results
Their own portfolio with a copy of an updated CV
This exercise is mandatory and any failings in the paperwork are taken very seriously. A further
period of fifteen days will be given to provide the required paperwork. If this is not abided to, the
training committee will be informed with the possibility of putting the training on hold.
4.4 Participation to educational events
The trainees are required to attend and participate in the tutorial program, CME meetings and
Journal Clubs. A signed attendance form by each teacher has to be kept for tutorials. At least 80%
of the tutorials have to be attended.
4.5 Audit, Research and other academic activities
All trainees are expected to perform and present at least four audit projects during their five years
of training. In addition, they are strongly encouraged to participate in or initiate research projects
within the department. The trainees should take an active role in all academic activities of the
Department of Anaesthesia by participating and by helping in their organisation.
In addition, they should consider attending courses in specific aspects of Anaesthesiology/
Intensive Care that are held locally or abroad. Presentation of papers and posters at local and
international events are also strongly encouraged.
4.6 Core skills lectures
Lectures in core skills are organized regularly by the postgraduate center. The trainees are
expected to attend these lectures before they finish their training programme. These lectures
cover domains 1.7 to 1.10 of the EBA training guidelines.
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Section Five: The European Diploma in Anaesthesiology and Intensive Care
All trainees following this training program are to sit the European Diploma in Anaesthesiology and
Intensive Care (EDAIC) examination. The EDAIC examination is the approved examination that
needs to be attained by the end of the training programme and thus essential for the award of
Completion of Specialist Training in Malta.
Since the European Diploma examination is the approved exit examination, the training program
shall take into consideration the syllabus and rules, (including any interim changes) pertaining to
the EDAIC examination.
The trainees are expected to sit for the first part EDAIC about half way through their training. This
is so that they acquire enough clinical experience to master the questions asked. The trainees can
use the On-line assessment (OLA) organized by the ESA, as a preparation for this exam. In the
future the OLA may also be used as part of the local AiTA.
The final part of the EDAIC exam is to be sat during the last year of training. The training
committee shall confirm in writing to the examination board that the trainee is in his last year of
training.
Trainees who complete the five years of training but do not pass the final part of the EDAIC will
have up to a maximum of ten years in their training post, from the date of appointment to the
department of anaesthesia, to attain the examination. During such period the trainee will be
assigned to modules which are available.
Trainees are welcome to sit for other postgraduate examinations within the training period, but
these will not be considered as a replacement for the EDAIC examination.
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Section Six: Certificate of Completion of Training. Inclusion in the Specialist Register
On completion of the training programme, the Anaesthetic Training Committee will recommend to
the Specialist Accreditation Committee (SAC) those trainees who would have satisfied the
requirements for completion of training. The training coordinators are duty bound to certify that
all the necessary paper work, assessments and competencies have been completed.
The training coordinators shall inform in writing to the SAC that the trainee has completed his/her
training.
Trainee doctors in anaesthesia who meet the criteria in Section 3.5 are considered to have finished
their training and are then eligible to apply for specialist registration in Malta.
The SAC will award a Certificate of Completion of Training and recommend the name of the doctor
for inclusion in the Specialist Register under the specialty of Anaesthetics and Intensive Care
Medicine.
Section Seven: Recognition of Training Institutions in Malta and abroad
Any training centre in Malta should comply with and maintain the standards as laid down by the
Hospital Visiting and Accreditation Programme Joint Committee of the European Society of
Anaesthesiology and the European Board of Anaesthesiology, of the UEMS. Currently the only
training institution in the Maltese islands is Mater Dei Hospital, Tal-Qroqq. This hospital received
its accreditation on the 4th March 2010 and is due for renewal on the 4th March 2015.
Trainees have to apply with the training committee before embarking to go abroad for a training
experience. This is to ensure that the center and post abroad is suitable for training purposes and
suffices the prerequisites of this training programme.
In exceptional circumstances, the time spent abroad in a suitable center and a post approved for
training, this can be approved retrospectively by the training committee and with the consent of
the SAC, so that it counts towards specialization certificate from Malta. This time cannot exceed a
year under any circumstance.
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Section Eight. The training committee (TC)
6.1 Composition
The delivery and implementation of this Anaesthesiology Training Programme shall be supervised
and coordinated through the Anaesthesiology Trainee Committee. This shall consist of eight
member anaesthesiologists, whose names appear on the Specialist Register:
Two training coordinators:
o One of the training coordinators shall chair the meetings.
o Minute taking
o Update the TC on the implementation of the program and the progress of the trainees.
o Safeguard trainees’ rights and ensure they respect their obligations
Three members representing the Department of Anaesthesia including:
The Chairperson of the Department:
o Safeguard the smooth running of the anaesthetic service
o Providing and maintaining the facilities for training
o Liaison with the hospital administration
The Trainee Mentorship coordinator
o Safe guard the well-being of the trainees
o Advocating trainee issues
The immediate past Trainee Coordinator
o Liaison and continuity of the training programme
Three AAM members including:
The President and two members nominated by the AAM committee.
o Maintaining standards in anaesthesia
o Patient safety
o Ensuring that the training conforms to this program and to European levels
o Liaising with the SAC
The training committee may at its sole discretion invite the trainee representative on the AAM to
discuss specific issues.
A simple majority rule shall generally be used if a vote needs to be taken on specific issues, unless
specified otherwise in this document. If the number of members on the board is even, then the
training coordinators shall express a single vote.
The chairman shall decide if a secret ballot should be taken. The members should keep the results
of the voting confidential. Only the final decision should be communicated on behalf of the TC.
The TC should meet every six to eight weeks or whenever necessary.
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6.2 The Training Coordinators
The Training Coordinators shall be chosen after an internal call for applications. The applicants
should be practicing anaesthesiologists and having been included in the specialist register for at
least five years before the call for applications. The term served shall be of three years.
The duties of the Training Coordinator in conjunction with the Training Committee shall include:
Implementing this training program
Ensuring the timely and effective delivery of the core content of the curriculum.
Coordinating the trainee rotations in order to cover all the modules
Organizing appraisals and assessments
Ensuring that all the necessary documentation is in order
Chairing the training committee
Liaison between the TC and the trainees
Promoting training of trainers
Communication with the Post-graduate center and the SAC
Budgeting relevant to this training program
Liaising with training in foreign institutions
Sitting on interviews for entry into BST and HST
Section Nine: The Mentorship scheme
The aim of this program is to provide the trainees with an honest and reliable person that they
may relate to, if any personal difficulties arise during training. The mentor is also there to guide
the trainee in his training and in achieving his potential. The trainee can choose his own preferred
mentor. Any issues which may arise should be dealt in confidence. However if it is deemed that
there are serious problems, the trainee should be encouraged to disclose the relevant facts as well
to the trainee coordinators. The Mentor is obliged to divulge any concerns to the training
coordinators should he be very concerned with the safety of the trainee himself, colleagues or
patients. This should be made clear to the trainee at the initial briefing between the mentor and
the mentee.
Further information on the subject can be found in the relevant document on the Mentorship
scheme.
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Section Ten: Obligations of trainees and trainers
10.1 Obligations of the trainees
Trainees shall:
Be committed to pursue the training in anaesthesia to the best of their abilities.
Enrich their knowledge in all the realms of anaesthesia, intensive care, acute and chronic pain.
Put an effort to learn all the necessary skills to practice the specialty.
Record their training activities in a log book and keep a professional portfolio.
Cooperate with the trainers and training coordinators to obtain and maintain the necessary
documentation of their training.
Be proactive in their learning and aim for personal excellence.
Show professionalism in all aspects of clinical work, safeguard patients in their care and
maintain confidentiality.
Be committed to contribute to the professional growth of the department of anaesthesia.
Be respectful towards their trainers and colleagues
10.2 Obligations of the Trainers
All specialists in anaesthesia have a moral obligation to pass on their knowledge, skills and good
personal qualities to their juniors. Hence they need to be up to date with medical science
themselves. The training coordinators should facilitate the teaching work of the trainers, lead and
improve the teaching skills of the trainers in anesthesia. An adequate number of trainers should
be available to support the training programme.
Trainers should:
Be committed to teaching by setting a good example to trainees.
Teach the latest evidence based medicine.
Contribute to the ongoing development of the training programme.
Contribute to the assessment of trainees.
Cooperate with the training coordinators in filling the necessary documentation.
Be fair in the assessment and treatment of the trainees.
Maintain professionalism throughout.
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References:
ANAESTHESIOLOGY, PAIN AND INTENSIVE CARE MEDICINE.
Syllabus to the Postgraduate training program from the Standing Committee on Education and
Training of the Section and Board of Anaesthesiology.
ANAESTHESIOLOGY, PAIN AND INTENSIVE CARE MEDICINE. UEMS/EBA GUIDELINES.
Postgraduate training program from the Standing Committee on Education and Training of the
Section and Board of Anaesthesiology.
The European Diploma in Anaesthesiology and Intensive Care. Diploma Guide.
Official adoption of the European Diploma of Anaesthesiology and Intensive Care (EDAIC) in Malta.
The Anaesthesiology Training Programme Malta May 2008.
Agreement between the Government of Malta and the Medical Association of Malta: 27th February 2013.
Public Administration Act. Chapter 497: Act I of 2009. Code of Ethics. Health Care Professions Act [CAP 464]. Fourth Schedule (Article 30) Professional Associations: Part I and Part II. Fifth Schedule (Article 31) Specialist registers.
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