The Log the RCoA Requires and Nobody Enjoys Keeping
ARCP time. You need to demonstrate your caseload across specialties, your anaesthetic technique variety, your supervision levels, and any incidents from the training year. If you have been logging cases as you go, this is a retrieval exercise. If you have not, it is a reconstruction exercise — and reconstruction from theatre lists and memory is how portfolios end up with gaps and approximations that a educational supervisor will notice.
The UK anaesthesia training logbook exists because the Royal College of Anaesthetists requires evidence of supervised practice across a defined competency framework. The practical question is whether you log cases on paper, in ANAES, or in a mobile database that you can actually use in the anaesthetic room.
ASA Status as the Case Complexity Dimension
ASA physical status — I through V — is the risk classification that stratifies the case complexity dimension across your logbook. An ASA I patient undergoing elective laparoscopic cholecystectomy is a different clinical encounter than an ASA IV patient with severe systemic disease requiring emergency bowel resection. Both may involve GA with LMA, endotracheal intubation, and intraoperative monitoring, but the physiological management, the decision-making complexity, and the learning value are different.
When you pull your caseload data at the end of the year, the ASA distribution tells your educational supervisor whether you have been managing sick patients or primarily low-risk elective lists. An ST4 whose logbook is predominantly ASA I-II across twelve months has a training gap that needs addressing before progression.
Priority — elective, urgent, emergency, immediate — adds the acuity dimension that ASA alone does not capture. An emergency ASA III case is not the same as an elective ASA III. The urgency classification changes the preparation time available, the decision-making environment, and the anaesthetic choices that are practically available.
Three Anaesthetic Slots and Three Procedure Slots
Anaesthetic 1, 2, and 3 — and Procedure 1, 2, and 3 — handle the reality that complex cases involve multiple anaesthetic techniques and multiple invasive procedures simultaneously. A major vascular case might involve GA, epidural, and arterial line placement in the induction room before the patient enters theatre. Logging that as "GA" in a single field understates the case complexity and misrepresents the competencies demonstrated.
The three-slot structure allows accurate documentation without requiring a narrative description of everything that happened. Each slot captures one technique or procedure, which is how the caseload counts aggregate correctly across the year — the epidural count is correct because every epidural is logged in one of the Procedure slots, not buried in a Notes field where it cannot be extracted.
Incidents 1, 2, and 3 operate on the same logic. A case involving a difficult airway that required a grade III laryngoscopic view, followed by successful intubation with a bougie, with a subsequent oxygen desaturation event requiring CPAP — that is three incident entries, each with its own field. Logging all of them as "difficult airway case" in Notes produces a narrative but not a searchable incident record.
Supervision Levels and the Training Record They Create
Supervision — Local, Distant, Consultant, NCCG, ST, Teaching: ST, Teaching: CT, Teaching: Med Student — creates the training relationship record that the ARCP requires. Local supervision means a consultant was present in the same list. Distant means contactable but not physically present. NCCG (Non-Consultant Career Grade) as a supervision category reflects UK anaesthesia staffing reality where experienced staff grades and associate specialists provide supervision that falls outside the standard consultant category.
The Teaching designations — supervising an ST, supervising a CT, teaching a medical student — flip the direction of the learning relationship. A consultant's logbook that includes Teaching entries demonstrates both maintained clinical practice and educational contribution. An ST's logbook that shows only Local and Consultant supervision entries with no instances of providing Teaching to more junior trainees may indicate insufficient progression toward independent practice.
Organisation as a field captures the hospital or trust where the case occurred — essential for trainees who rotate between base hospitals, visiting hospitals, and locum posts, where the case mix varies significantly by institution.