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centre. This level of training can only be delivered in centres that allow the trainee the opportunity
to develop the skills required to manage the delivery suite and undertake complex obstetric cases
whilst building and consolidating knowledge of obstetric anaesthesia, obstetrics and neonatology
• Less than full-time (LTFT) trainees: at each level of training, LTFT trainees should be given an
appropriate period of training in obstetric anaesthesia, proportionate to the percentage of whole
time equivalent worked.
Assessment
Completion of the IACOA is mandatory for all core trainees before being allowed to work in an
obstetric unit without direct supervision. Achieving the IACOA, however, does not signal the
completion of the basic level unit of training in obstetric anaesthesia.
Supervision
All trainees should be supervised directly by a trainer present on delivery suite until the IACOA is
completed. In addition, a joint OAA/ RCoA survey in 2010 [5] recommended that:
• The IACOA should be used in conjunction with a local system of review that satisfies local clinical
governance arrangements before a trainee works without immediate supervision
• No trainee who feels unprepared to start obstetric on-call (regardless of completion of IACOA)
should be expected to join the on-call rota unless directly supervised. Departments should make
provision for this eventuality where rotas are written a long time in advance
• All trainees who have completed their basic obstetric training should have some opportunity to
cover the labour ward without immediate supervision, so that they are confident to take on this
responsibility once they are appointed to an ST3 post.
The first two of the above recommendations should also apply to non-trainee anaesthetists. All trainee
and non-trainee anaesthetists working without direct supervision on delivery suite must have a named
supervising consultant and both parties must be happy with the level of supervision available. In
addition, they must know how to contact the supervising consultant in the event of an emergency.
Simulation
Simulation-based educational techniques can be used to assist all anaesthetists to develop the skills
and attributes required to work safely and efficiently within the multidisciplinary obstetric team,
including:
• Technical skill development using part-task simulators e.g. epidural, cricothyroidotomy [39]
• Reinforcement of emergency drills e.g. failed intubation [40]
• Teaching and assessing clinical skills when clinical opportunities are limited e.g. general
anaesthesia for caesarean section
• Maternal and neonatal resuscitation [40]
• Teamwork training emphasising non-technical skills [9]
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