Case Study: Royal College of Anaesthetists (RCoA)

Delivering a visionary learning platform

The Royal College of Anaesthetists (RCoA) was established in 1992. As the largest single hospital speciality in the NHS, they are responsible for safeguarding patients as well as practice and standards in anaesthesia, intensive care and pain medicine.

Each of us experience information overload on a daily basis and we turn to digital experiences to alleviate some of this noise. We expect technology to be seamless, human-centric and light, because it enables us to cope in a high pressured modern world. For anaesthetists, this need is even greater.

There are over 7,000 anaesthetists currently training in the UK and have already spent years studying and working in the healthcare sector. RCoA wanted us to design an experience for their users that enhanced the quality of their learning, developing better doctors across their whole career and driving educational transformation. We called it the Lifelong Learning Platform.


RCoA's existing solution was a suite of separate tools, with different interfaces, passwords, functionality; at best jarring to use and at worst entirely prohibitive to completing critical tasks. The technical debt accrued by manually linking multiple systems was proving ever-the-more expensive and opened the door to human error. Add to this mix the introduction of a new dual curriculum (allowing students to 'mix and match' competencies from different specialities) and it was clear a new approach was desperately needed. 

The platform would be used by over 7,000 trainees and thousands of other general users, encompassing trainee consultants and senior consultants, not to mention admin and training staff.

Our goal was also to design a tool that would:

  • Support the RCoA's vision of educational and cultural transformation
  • Provide data to drive policy and education through human behaviour and insight
  • Be resilient to inevitable change, and ensure a consistent user experience was maintained long term
  • Help defuse some of the day-to-day stress anaesthetists face
  • Streamline compulsory tasks behind a user friendly interface that was a joy to use
  • Improve quality of learning through recording tasks in real time

The latter objective was particularly important, as memory is famously volatile. The longer we leave between the lesson and its recording, the murkier it becomes. Hence, by filling in forms in real-time we get a better quality information retention, and as a result, we get better doctors.


In August 2018, the Lifelong Leaning Platform went live to the delight of RCoA stakeholders. Organisations from across the sector and beyond are already recognising the value of the system, and for good reason. While the stats are still to come, as of the end of September 2018:

  • 12,282 users registered
  • 5,319 have logged in
  • 2,745 have filled out a form

This is just the start. We have also seen other significant improvements following its rollout, most notably:

  • Cheaper operational and maintenance costs
  • For the first time, the E-Portfolio and Logbook sit together in an aligned solution that is accessible with one password. CPD due to follow in 2019 which will make this the only solution in the market that aligns all three workstreams
  • Clean, intuitive dashboard with a consistent look
  • Easier for the college to update and refine themselves - gives them control over changes free of charge
  • Reduced administration time
  • Superior user experience designed around the needs of practitioners
  • An exemplary product for other Royal Colleges to emulate

This project was utterly bespoke; our incredible team of developers took highly specialised processes steeped with esoteric language and turned it into a lovingly handcrafted, unique system.


From day one, a heightened level of communication and collaboration was needed on this project. The users and industry were so niche and specialised; our team needed the college's expert insight to strip back any uncertainty around medical language, internal rules and processes, as well as its plethora of acronyms. We held weekly catch ups, frequent workshops, user testing and ad-hoc daily conversations. This relationship was instrumental to the project’s success, as it meant that we got unparalleled insight into the college’s practices and how our UX design expertise could enhance them.

Beginning with user needs

The core challenge for the team was understanding the various user types and needs. We began by mapping out all the colleges' current process including paper based ones, and over-layed each with the core user types. It was an engaging and rewarding research process then to help the RCoA ‘join the dots’ of where their digital tools, the people and the process combined to provide the insights needed. 

The RCoA’s digital tools were serving members and staff in a way that reflected internal structures rather than common tasks, or how users naturally sought information. It was clear that the RCoA would have to challenge and adapt their internal processes – but in a way that balanced the needs of their users whilst adhering to GMC (regulators of training body) guidelines.

Creating a platform from the user up

We started by conducting research at the RCoA Annual Conference. This provided a gold mine of insight. By tapping into such a highly engaged testing group, we were able to really get under the skin of the culture, the users and the challenges that the platform needed to cater for.

We held guerrilla testing in Belfast and remote sessions in Bristol. All our learning processes were user tested as prototypes, while testing at the RCoA offices meant we could capitalise on stakeholder expertise. We spoke to office support staff and consultants, as well as over 50 trainees, trainers and assessors to glean a unique insight into their real-world challenges. Such extensive user testing ensured that design decisions were validated by feedback and had user needs at its core.

Agile development

Over the course of one year, four of our developers wrote over 1,330,000 lines of code. However, while an impressive number, this made up just 16% of the platform's coding. Our project was propelled by over 8.5 million lines of open-sourced coding. This collaborative kind of coding meant we could build frameworks efficiently, which saved money and enabled rapid application development.

Those who have worked with developers before will be familiar with how fragile code is. By writing automated test coverage, we bolstered our confidence, empowering us to boldly refactor and rework code without fear of causing unforeseen problems. It also meant that bugs and issues could be identified and rectified early on, resulting in a higher quality end-product.

Post launch, we implemented New Relic; a tool that allows us to track the performance of a live platform. This means we can predict and resolve brewing issues before they impact the end user. This kind of proactive monitoring has also shaped the back bone of our Service Desk offering; ongoing maintenance and support for our client's platform that operates around a three tier system and total flexibility to scale up or down, depending on needs and seasonal milestones.

Moving forwards

We have designed an experience that will shift trainee's thinking from considering the platform a chore, to envisioning it as lifelong companion intrinsic to their daily working life. We wanted it to feel like second nature to use – ultimately making their practice more efficient and valuable. It will help them to work through their own thoughts and progression, and simplify current processes. In short: our platform will reduce stress and support better doctors.

We’ve been so inspired by the project that we are continuing to invest in its development as a Nomensa product. Since the platform went live, we have been exploring how a licence model and how the success of our solution could be replicated for other Royal Colleges, as well as be adapted for use outside of the education sector.

Through aligning the thoughts and talents of everyone across the whole process and feeding it back into our system, we created options for our users. And by creating choices, we created excellence.

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We wanted to move away from an ‘ePortfolio’ to a ‘Lifelong Learning’ system that is embedded within the culture and training of anaesthetists (reflecting what clinicians do on a day-to-day basis).