The RCoA portfolio requirements aren't flexible about what constitutes a logged anaesthetic. A case counts if it has a start time, finish time, ASA status, supervision level, specialty, and the primary anaesthetic technique. A case without all those fields isn't a counted case — it's an uncategorized event that doesn't contribute to the competency evidence your training programme coordinator needs to sign off on your progression.
Supervision as the Training Record
Supervision is the field that determines the evidential weight of each case. Levels of supervision in UK anaesthetic training — independent, local supervision available, supervised, directly supervised — map to different stages of competency demonstration. An ST3 with 80 cases logged as "supervised" and 20 as "directly supervised" has a very different training picture than one with 40 supervised and 60 independent, and the difference is invisible without consistent supervision level recording.
The supervision field is also the field that makes your logbook defensible if your progress is questioned at an Annual Review of Competence Progression. If the level at which you were expected to be working for a specific procedure type matches what's in your log, the ARCP conversation is straightforward. If it doesn't, you need to explain the gap — and explanation is harder than documentation.
ASA captures the patient risk classification. Fellowship and membership examination requirements, specialty training competencies, and Royal College audit standards all reference ASA distributions. An anaesthetic trainee needs exposure across ASA I through IV within their case mix. A log that doesn't capture ASA status can't demonstrate that breadth of experience.
Regional Anaesthesia Indexing
Regional, Regional index 1, Regional index 2, and Regional - additional info are the specialist fields for neuraxial and peripheral nerve block documentation. Regional anaesthesia subspecialty training requires procedure-specific case counts — a minimum number of spinal anaesthetics, epidurals, and named peripheral nerve blocks. The two regional index fields capture the specific technique identifier (ultrasound-guided femoral nerve block, CSE, TAP block) at a level of specificity that "regional" alone doesn't provide.
Regional - additional info is the performance notes field for regional procedures — the number of attempts, the guidance technique (ultrasound, nerve stimulator, landmark), the first-pass success, any technical difficulty or complication. These are the quality metrics that distinguish a competency demonstration from a simple case count.
The Procedure Triple Entry
Procedures 1, Procedures 2, and Procedures 3 handle the multi-procedure case. A combined spinal-epidural placed before general anaesthesia with an arterial line and a fibreoptic intubation in an ASA IV patient is three separate procedural entries in a single case. Each needs to be in the record because each contributes to a different procedure-specific competency count.
Anaesthetic 1 is the primary technique — general anaesthetic, spinal, epidural, combined, sedation. This is the field that the case-mix analysis uses to ensure the trainee has adequate exposure to the full range of anaesthetic approaches across the training period.
Events is the critical incident and complication field. Failed regional attempts, unexpected difficult airway, anaphylaxis, high spinal — each event logged in the record is a case that contributes to the reflective practice portfolio, the adverse event learning process, and the supervised learning events that document how the trainee responded to clinical challenges. An event that happened but wasn't logged can't contribute to any of those purposes.
Specialty determines which procedure contributes to which specialty-specific competency counts — obstetric anaesthesia cases toward the obstetric certificate requirements, cardiac surgery cases toward advanced training credits, paediatric cases toward the paediatric subspecialty pathway.