Teaching and training of anaesthesia and critical care technicians in India – Towards a competency-based modular framework

Abstract

There is currently a lack of published guidance on competency-based curriculum design specifically tailored to Anaesthesia and Critical Care Technicians (ACTs) training in India, creating a need for a structured and standardised educational framework. This review was undertaken to address the need for a competency-based educational framework for ACTs in India, aligning existing training programmes with contemporary national educational reforms and international standards while enhancing clinical competence, patient safety, and workforce readiness. In this article, we propose integrating key components, such as competency domains, entrustable professional activities, workplace-based assessments, and simulation-based training, into the existing educational framework without altering the mandated hours or examination weights. We outline ten teaching–learning modules, ensuring a balance across foundational sciences, applied anaesthesia, critical care, ethics, and simulation. This strategic restructuring of Diploma in Anaesthesia and Critical Care Technician training programmes has the potential to significantly improve clinical skills and enhance patient safety protocols. The literature search for this article was conducted in PubMed/MEDLINE, Embase, Scopus, and CINAHL using terms related to competency-based education, allied health training, anaesthesia, and critical care.

INTRODUCTION

The National Education Policy (NEP) 2020 redefines higher education in India around access, equity, quality, and accountability.[1] It promotes moving from rote memorisation to competency-based, outcome-oriented learning across subjects. Professional and allied health training, including anaesthesia and critical care technician (ACT) programmes, must align with these reforms to produce graduates who are workplace-ready, patient-responsive, and prepared for lifelong learning. The perioperative setting is intricate, high-stakes, and relies on smooth teamwork. Anaesthesia technicians maintain equipment, assist with airway management and monitoring, and uphold aseptic standards in operating theatres (OTs) and intensive care units (ICUs). Their dependable performance is vital for patient safety and surgical success.

India faces a dual challenge: rising surgical and critical care needs, along with inconsistent quality in allied health training. In Uttar Pradesh, the Uttar Pradesh state medical faculty (UPSMF) has developed a 2-year Diploma in Anaesthesia and Critical Care Technician (DACCT) programme.[2] Each year comprises roughly 780 hours of theoretical instruction and 780 hours of practical training, totalling 1560 hours annually. Although this is one of India’s most well-organised curricula for allied health technicians, it remains largely syllabus-focused. Current teaching mainly depends on didactic lectures and end-of-year exams, with limited use of formative feedback, programmatic assessment, or competency-based certification. In contrast, international standards, such as those from the American Society of Anesthesia Technologists and Technicians (ASATT) and the UK’s Health and Care Professions Council (HCPC) for Operating Department Practitioners (ODPs), require clear competencies, structured workplace assessments, simulation training, and ongoing professional development.[3,4,5]

Embedding competency-based education (CBE) tools into the UPSMF framework, without altering its mandated hours or examination weights, provides an opportunity to modernise ACT education. This article builds on national competency-based medical education (CBME) reforms, integrates best practices from international benchmarks, and proposes a ten-module competency-based curriculum blueprint, accompanied by annexures for assessment, logbooks, and simulation training. The overarching aim is to standardise quality, improve readiness for independent practice, and enhance patient safety culture in India’s perioperative and critical care environments.[6,7]

This review was undertaken to address gaps in the current training of ACTs in India, particularly the lack of a structured competency-based framework, workplace-based assessments, and simulation-based learning. It also aims to provide guidance for aligning technician training with the NEP and international educational standards.

METHODS

Literature search strategy

A comprehensive literature search was conducted to identify studies on CBE, skills training, and clinical teaching in high-acuity healthcare settings, such as the OT and ICU. The search was performed in PubMed/MEDLINE, Embase, Scopus, and CINAHL from inception until September 2025.

The search strategy combined Medical Subject Headings (MeSH) and free-text keywords. The main concepts were:

1. Medical and health professions education (e.g., Education, Medical; Education, Nursing; Education, Allied Health; Competency-Based Education; Clinical Competence; Teaching; Training Support; Curriculum).

2. Skills and competency assessment (e.g., Clinical Competence; Professional Competence; Psychomotor Performance; Problem-Based Learning; Simulation Training).

3. Healthcare settings (e.g., OTs, ICUs, Critical Care Nursing, Operating Room Nursing).

4. Target groups (e.g., Nursing Education; Allied Health Occupations/education; Technicians; Health Personnel/education).

An example PubMed search string was:

((“Education, Medical”[MeSH] OR “Education, Nursing”[MeSH] OR “Education, Allied Health”[MeSH]

OR “Competency-Based Education”[MeSH] OR “Clinical Competence”[MeSH] OR “Teaching”[MeSH]

OR “Training Support”[MeSH] OR “Curriculum” [MeSH])

AND

(“Operating Rooms”[MeSH] OR “Operating Room Nursing”[MeSH] OR “Intensive Care Units”[MeSH]

OR “Critical Care Nursing”[MeSH])

AND

(“Nursing Education”[MeSH] OR “Allied Health Occupations/education”[MeSH]

OR “Health Personnel/education”[MeSH] OR “Technicians”[MeSH]))

The strategy was adapted for other databases utilising their respective controlled vocabularies (e.g., Emtree for Embase, CINAHL headings). No restrictions were placed on study design. The search was limited to English-language articles. Additionally, the reference lists of included studies and relevant reviews were manually screened to identify any additional eligible studies.

Regulatory baseline: UPSMF [DACCT] structure

The DACCT at UPSMF is a 2-year programme for individuals who have completed 10+2 with science subjects. The first year covers foundational sciences and basic life support training, along with observerships in OTs and ICUs. The final year focuses on clinical practice, including advanced anaesthesia techniques, equipment management, and hands-on ICU experience. Each year includes 780 hours of theoretical and practical training, totalling 1560 hours. Assessments consist of two theory exams and a pragmatic/oral test, with a minimum passing grade of at least 50%. The programme is syllabus-based, unlike CBE, which emphasises ongoing assessment and feedback.

Limitations of didactic instruction

Didactic instruction, while widely used, comes with several limitations that can hinder effective learning. One significant drawback is the tendency towards passive learning; traditional lecture-based formats often emphasise rote memorisation, which undermines the development of critical thinking skills essential for deeper understanding and application of knowledge. Additionally, this approach tends to limit skill transfer as acquiring theoretical knowledge in isolation does not necessarily translate into clinical proficiency in practice. Another concern is the minimal learner engagement that conventional instructional methods create. These methods often fail to promote reflective practice and may discourage meaningful peer interactions, both of which are vital for fostering collaborative learning and a richer educational experience. Overall, these limitations highlight the need for more interactive and engaging teaching strategies that prioritise student involvement and real-world application.

Considerations for the implementation of the programme

Each instructional modality in our programme must be thoughtfully aligned with specific learning outcomes and competencies, ensuring that the teaching methods effectively support the skills and knowledge students are expected to acquire. To accurately assess this acquisition, we will implement a combination of formative and summative assessments. Formative assessments will provide ongoing feedback throughout the learning process, allowing students to identify areas for improvement, while summative assessments will evaluate their overall mastery at the conclusion of each course. To support this approach, faculty development is essential; providing training in facilitation techniques, feedback provision, and competency-based assessment strategies will empower instructors to create engaging and supportive learning environments. Furthermore, promoting reflective practices among learners is vital for enhancing their understanding and fostering self-directed learning. By integrating opportunities for reflection into the curriculum, students can analyse their experiences and solidify their learning, ultimately developing critical thinking skills that will serve them well beyond their educational journey.

Development of review protocol

When the course was initially introduced at our institute, teaching followed the conventional methods prescribed in the UPSMF curriculum. These primarily consisted of lectures, demonstrations, and clinical postings. However, within 6 months of implementation, several deficiencies were identified in the teaching and training of paramedical students. These included inadequate acquisition of clinical skills, difficulty in applying theoretical knowledge to practice, a lack of confidence and preparedness in emergencies, poor communication skills, and limited development of leadership qualities.

To address these shortcomings, an expert panel was constituted. The panel comprised MK, Professor and Head of the Department of Anaesthesia, with 28 years of experience in postgraduate teaching; AS, Professor and Nodal Officer for the course; and senior faculty members MC, PR, and SG, each with over 10 years of teaching experience. The Dean (Paramedics) was invited as an external expert to provide independent oversight and resolve any disputes among the contributors. In addition, NM contributed to the literature search to support evidence-informed modifications in curriculum design and delivery. Apart from the reforms suggested by the National Medical Commission, we also referred to international curricula to enhance the course structure and outcomes. International standards, such as those outlined by the ASATT and HCPC, emphasise clearly defined competencies, structured workplace-based assessments, the incorporation of simulation training, and the need for ongoing professional development.[3,4,5]

FORMATION OF COMPETENCY DOMAINS

Competency domains serve as the foundation for modern allied health education. For DAACTs, six essential domains were identified. These include patient safety and infection control, equipment and technology management, peri-anaesthetic pharmacology and gases, airway and monitoring assistance, basic life support and first aid, documentation, professionalism, and communication [Appendix 1].[8,9]

ENTRUSTABLE PROFESSIONAL ACTIVITIES (EPAs)

These activities translate these domains into measurable workplace tasks. Examples include conducting anaesthesia workstation and pipeline checks; preparing monitors, alarms, and airway carts before cases; assisting in tracheal intubation, regional blocks, or intravenous access; preparing and safely labelling rapid sequence induction drugs, operating ventilators, infusion pumps, and transport monitors; performing basic life support and supporting invasive line management; implementing biomedical waste segregation and infection control; and maintaining patient records and equipment logbooks. Each EPA can be assessed based on entrustment levels, ranging from observation-only to supervision, and ultimately to independent performance through demonstration–observation–assistance–performance (DOAP) model. This framework supports a structured progression. For instance, an ACT trainee might start by observing intubation, then assist with direct supervision, and eventually manage airway procedures independently during routine cases.[10]

TEACHING–LEARNING METHODS

Teaching–learning strategies for ACTs must strike a balance between theory and hands-on skill acquisition. Traditional reliance on didactic lectures must give way to mixed-method approaches, including small-group discussions, case-based learning, skill-lab practice, and supervised workplace immersion. Simulation is compelling in anaesthesia training, enabling exposure to rare but high-stakes crises (e.g., failed airway, equipment malfunction, malignant hyperthermia) in a safe environment.[11,12,13,14,15]

RECOMMENDED TEACHING–TRAINING METHODOLOGY

A combination of small-group discussions, case-based learning, simulation-based skills training, and supervised clinical immersion is recommended to facilitate competency-based learning, with each strategy aligned to specific educational objectives and competency [Table 1].

Table 1.

Recommended teaching and training methodology

Strategy		Educational Rationale
Small Group Discussion		Facilitate peer learning, foster critical analysis, and promote collaborative reasoning.
Case-Based Learning (CBL)		Enhance clinical reasoning by contextualising theoretical knowledge within patient scenarios.
Simulation and Skill Labs		Provide structured environments for repetitive practice, feedback, and mastery of procedures.
Supervised Clinical Immersion		Bridge classroom learning with real-world application under expert mentorship.

Incorporating teaching–training methodology in the weekly schedule

The weekly schedule should combine didactic teaching, simulation-based skills training, workplace learning, and self-directed learning to ensure comprehensive competency development among ACTs. This integrated approach promotes theoretical understanding, hands-on skill acquisition, supervised clinical exposure, reflective practice, and progressive achievement of competency-based learning outcomes [Table 2].

Table 2.

Weekly teaching–training methodology

Teaching methodology		Time [Hours]		Topics
Didactic lectures		6-8		Conceptual frameworks
Skills lab practice		4		Airway manikins, circuit assembly etc.
Workplace learning		12-16		Operation theatre and ICU immersion
Self-directed learning		2		Reflection, online modules, assignments

Digital platforms for learning

Technology is transforming medical education through technology-enhanced learning. Tools such as high-fidelity simulations, virtual patients, massive open online courses (MOOCs), and flipped classrooms are now widely used. This shift is driven by internet accessibility and portable devices, making learning flexible, accessible anytime, and more interactive.[16,17,18]

Electronic libraries and digital platforms can support ongoing learning and education. Teaching across different disciplines, such as with anaesthesiologists, surgeons, and nurses, fosters teamwork and improves communication skills. These can be digitally recorded and shared with students via various platforms.

ASSESSMENT FRAMEWORK

UPSMF recommends a 25% internal assessment; however, the current implementation is limited. Incorporating programmatic assessment is essential. This method employs various tools over time, with the weaknesses of each tool offset by the strengths of others.

TOOLS FOR ASSESSMENT

Suggested tools for assessment may include Direct Observation of Procedural Skills (DOPS), Mini-Clinical Evaluation Exercise (mini-CEX), Objective Structured Clinical Examination (OSCE), Case-based discussion, Logbook reviews, and simulation-based assessments.[19] Continuous feedback loops ensure formative rather than purely summative use. For example, an ACT may perform multiple DOPS across modules, with entrustment levels progressively documented. This mirrors international CBME assessment practices [Appendices 2 and 3, Table 3].

Table 3.

Suggested tools for assessment

Assessment tools		Competency assessed
DOPS		Assembling circuits, checking pipelines, etc.
mini-CEX		Evaluating professional behaviour during OT support
OSCE		Structured stations for crisis drills, drug preparation, or CPR
CBD		Reflecting on operation theatre incidents or ICU challenges
Logbook reviews		Tracking minimum numbers of key tasks
Simulation-based assessments		High-fidelity crisis scenarios

DOPS: Direct Observation of Procedural Skills; mini-CEX: Mini-Clinical Evaluation Exercise; OSCE: Objective Structured Clinical Examination; CBD: Case-based discussion; OT: Operation theatre; CPR: Cardiopulmonary resuscitation

PROPOSED MODULAR CURRICULUM

We propose a ten-module blueprint that will translate the UPSMF syllabus into an organised, competency-based structure. The modules are designed to spiral, where foundational concepts are revisited at increasing levels of complexity. The modules include basic anatomy and physiology, pathology, microbiology and infection control, pharmacology of anaesthetic drugs and gases, anaesthesia workstation and equipment management, monitoring in anaesthesia and ICU, airway management and ventilation, anaesthesia techniques, critical care and emergency management, professionalism, ethics and communication, simulation, and skill reinforcement. Each module integrates didactics, skill practice, supervised immersion, assignments, and assessment (OSCE/DOPS/logbook). The total distribution remains 1,560 hours of theory and 1,560 hours of practical [Appendix 4].

DISCUSSION

The DACCT curriculum is one of the most organised allied health technician programmes in India. It features clearly defined theory and practical hours, covers a broad range of subjects, and offers early exposure to OT/ICU settings. Nevertheless, notable gaps exist in competency clarity, formative assessments, simulation use, and continuing education.

India is actively transforming its medical and nursing education systems to align with the principles of CBME. The National Medical Commission has mandated the implementation of CBME specifically for undergraduate students, emphasising critical components such as skill certification, logbook maintenance, workplace assessments, and programme feedback.[20,21]

The 2018 Allied and Healthcare Professions Bill has initiated significant reforms to establish structured competencies, comprehensive logbooks, and enhanced simulation training for allied health professionals. By aligning the training of allied and healthcare professionals with these educational reforms, we can facilitate a unified, consistent approach across health disciplines. Such alignment is essential to cultivating proficient healthcare professionals equipped to address the evolving demands of the healthcare system.[22]

Internationally, anaesthesia technician training is characterised by a competency-driven educational framework, with programmes in the United States, as recognised by ASATT, employing a blended learning approach that combines classroom instruction with online modules. Their training integrates didactic coursework in anatomy, physiology, pharmacology, and anaesthesia equipment with hands-on lab practice and clinical rotations. The modular, competency-based curriculum progresses from foundational to advanced topics, while student performance is assessed through quizzes, practical skill checks, clinical evaluations, and certification exam preparation. To maintain ASATT certification, ongoing professional development is ensured through Continuing Education Units.[3] We suggest integrating EPAs and competency mapping into each module, supported by programme-based internal assessments such as DOPS, OSCE, and mini-CEX. Establishing simulation centres and incorporating e-learning resources would further enhance practical training, while introducing Continuing Professional Development (CPD) requirements would align UPSMF with international standards. Implementation could face challenges due to resource variability, faculty shortages, and rural–urban disparities. Nevertheless, a phased approach starting with structured logbooks, assignment-based learning modules, and pilot simulation training provides a practical pathway to gradually transform ACT education.

SUMMARY

ACTs constitute a fundamental component of the perioperative workforce and play a pivotal role in maintaining patient safety across the perioperative continuum. Although the UPSMF DACCT curriculum is systematically structured, there remains a need for competency-based enhancements to ensure alignment with the reforms proposed under the NEP, recommendations of the Nursing and Midwifery Council (NMC), and internationally accepted educational standards. The adoption of a modular competency-based framework incorporating clearly defined competency domains, EPAs, workplace-based assessments, and simulation-based training is essential to promote structured learning, objective assessment, and continuous formative feedback. Furthermore, integrating CPD initiatives and periodic recertification mechanisms would significantly professionalise this workforce, strengthen perioperative patient safety, and support the international recognition and standardisation of Indian ACT qualifications.

Author contributions

MK: Conceptualisation of the curriculum framework, expert panel leadership, curriculum design and revision, supervision of the project, manuscript review and editing. AS: Curriculum coordination as Nodal Officer, curriculum development, competency mapping, preparation of curriculum modules, manuscript drafting and revision. MC: Contribution to curriculum design, development of teaching-learning strategies and assessment methods, manuscript review and editing. PR: Contribution to curriculum design, development of competency-based training modules and assessment framework, manuscript review and editing. SG: Contribution to curriculum design, validation of learning objectives and competencies, manuscript review and editing. NM: Literature search and evidence synthesis, support for evidence-informed curriculum modifications, assistance in manuscript drafting and reference management. All authors participated in curriculum development, critically reviewed the manuscript, approved the final version, and agreed to be accountable for all aspects of the work.

Disclosure of use of artificial intelligence (AI)-assistive or generative tools

The authors used artificial intelligence (AI)-assisted technology (ChatGPT, OpenAI, San Francisco, CA, USA) during the preparation of this manuscript for language editing, grammar correction, and improvement of readability. No AI tool was used for data collection, data analysis, interpretation of results, or generation of scientific conclusions.

Declaration of use of permitted tools

The authors declare that permitted tools, including standard word-processing, reference-management, and language-editing software, were used during the preparation of this manuscript.

Conflicts of interest

There are no conflicts of interest.

APPENDICES

Appendix 1.

Competency Matrix (Sample)

Domain		Competency		Teaching Method		Assessment Tool
Patient Safety		Hand hygiene and asepsis		Demo + Skills lab		DOPS, OSCE
Equipment Management		Anaesthesia machine/Ventilator pre-use check		Checklist + Supervised practice		OSCE, Logbook
Airway and Monitoring		Assist with intubation, set up monitoring		Simulation + Workplace learning		DOPS, Mini-CEX
Pharmacology		Prepare emergency drugs safely and label accurately		Case-based, Worksheet		OSCE, Assignment
Critical Care		Basic ventilator and infusion pump handling		Demonstration + Clinical		DOPS, Viva
Emergency Care		Perform BLS		Skills lab + Simulation		OSCE, DOPS
Professionalism		Teamwork, documentation, and communication		Workplace immersion		Mini-CEX, Logbook

OSCE=Objective structured clinical examination; DOPS=Direct observation of procedural skills; Mini-CEX=Mini clinical evaluation exercise; BLS=Basic life support

Appendix 2.

Sample OSCE/DOPS Station Checklist

Station		Task		Marking Criteria
OSCE-1		Assemble the circle breathing system		Connections correct (2), Leak test done (2), Exp valve checked (1)
OSCE-2		Prepare RSI drugs and label syringes		Correct drug drawn (2), Dilution (2), Labelling (1)
DOPS-1		Perform anaesthesia workstation pre-use check		Pipeline check (2), Cylinder check (2), Alarm check (1)
OSCE-3		Perform the BLS sequence on the manikin		Airway opened (2), Compressions (2), AED use (1)

OSCE=Objective structured clinical examination; DOPS=Direct observation of procedural skills; Exp=Expiratory; AED=Automated external defibrillator; BLS=Basic life support; RSI=Rapid sequence induction

Appendix 3:

The logbook must document the date, procedure, level of supervision, and the signature of the supervising individual. The recommended structure is as follows:

Sample Logbook: DACCT

Section A: General Information

• Student Name/Enrolment: ________________/________________

• Institution and Dept: ________________/Anaesthesia and Critical Care

Section B: Daily Clinical/OT Record (Sample View)

Date		Patient ID		Age/Gender		Diagnosis & Procedure		Anaesthesia Technique		Role of Technician		Incharge Signature

Section C: Skills and Procedures Performed in OT

Procedure/Skill [under supervision]		Date		Count		Level (Observed/Assisted/Performed)
Preparation of OT and Anaesthesia Machine
Checking/Assembly of Breathing Circuits
Airway Equipment Preparation
Assistance in Intubation/Extubation
Patient Monitoring
High quality BLS on simulator
Apply oxygen
Documentation
Preparation of Drugs for Anaesthesia /IV line assistance
Other [specify]

Section D: Skills and Procedures Performed in ICUs

Procedure/Skill [under supervision]		Date		Count		Level (Observed/Assisted/Performed)
Monitoring vitals
Checking/Assembly of Breathing Circuits and ventilators
Airway Equipment Preparation/assistance
Assistance in Intubation/Extubation
Patient Monitoring
Assistance in IV line/Invasive line
Apply Noninvasive ventilation
Sending sample
Documentation
Other [specify]

Section E and F: Academic Activities and Evaluation Summary

Date

Activity/Assessment Topic

Type (CME/Lecture/Test)

Role

Signature faculty

OT = Operation theatre; IV = Intravenous; ICU = Intensive care unit; CME = Continuing medical education; ID = Identification; Post-op = Post-operative; BLS = Basic life support; Dept = Department; DACTT = Diploma in Anaesthesia and Critical Care Technician

Appendix 4

Proposed teaching and training modules: A Curriculum blueprint

To effectively implement the UPSMF Diploma in Anaesthesia and Critical Care Technician (DACCT) programme, within a structured, competency-based framework, the curriculum can be organised into ten modules that incorporate a balanced approach to both theoretical knowledge and practical application.

Curriculum Module Distribution

Module		Theory Hours		Practical Hours		Total Hours		Primary Teaching Methods		Core Assessment Tools
Basic Anatomy and Physiology		150		120		270		Lectures, case-based learning, skills lab		Written exam, OSPE
Pathology, Microbiology and Infection Control		160		150		310		Interactive lectures, demonstrations		OSCE, DOPS, logbook
Pharmacology of anaesthetic Drugs and Medical Gases		200		160		360		Didactic + small-group, worksheets		Written exam, OSCE, checklist
Anaesthesia Workstation and Equipment		160		200		360		Demonstration, supervised practice, simulation		DOPS, OSCE, logbook
Monitoring in Anaesthesia and ICU		140		160		300		Bedside demonstration, simulation, problem-based learning		DOPS, Mini-CEX
Airway Management and Ventilation		200		220		420		Skills lab, supervised OT sessions, and simulation		OSCE, logbook, DOPS
Anaesthesia Techniques		210		220		430		Case-based discussions, workplace immersion		OSCE, logbook, viva
Critical Care and Emergency Management		180		180		360		Simulation, bedside ICU teaching, drills		OSCE, DOPS, Mini-CEX
Professionalism, Ethics and Comm.		80		70		150		Role play, reflective learning, case studies		Portfolio, Mini-CEX, feedback
Simulation and Skill Reinforcement		80		80		160		High-fidelity simulation, crisis drills, BLS		Simulation OSCE, logbook
Total duration[h]		1560		1560		3120

OSCE=Objective structured clinical examination; DOPS=Direct observation of procedural skills; Mini-CEX=Mini clinical evaluation exercise; BLS=Basic life support; ICU=Intensive care unit; OSPE=Objective structured practical examination

Funding Statement

Nil.