Your voice can help improve rotational training
Rotational training. To say this is a controversial aspect of anaesthetics training is putting it mildly. As anaesthetists in training (AiTs), there is not one of us who doesn’t know the emotional, financial and physical consequences that moving hospital every few months has on us and our loved ones.
We have all endured the long commutes, endless paperwork, mandatory training, emergency tax codes, erroneous pay and detrimental effects on our mental and physical health that rotating can bring. Commuting as part of rotational training formed a key part of my decision to go LTFT this year, and I’m sure I’m not alone.
Recently, reform of rotational training has been a major talking point – with key reports highlighting the impact of rotating on trainee fatigue and burnout and the College lobbying for Lead Employer models to be adopted across all regions and nations.
Improving wellbeing and welfare
Improving rotational training is key to improving the wellbeing and welfare of anaesthetists in training. Time and again, AiTs tell us how unnecessary and inflexible rotations disrupt their lives and frequently inhibit rather than enhance their experiences in the workplace.
It is no surprise therefore, that reform of rotational training was one of the resolutions brought to the Extraordinary General Meeting (EGM) last October and with that, the Rotational Training Working Group was born.
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“All the moving around… makes trainees feel like they are never really settled, it is difficult to build longstanding relationships with their trainers or supervisors, and it is very difficult to take on any meaningful quality improvement or research projects while you are constantly moving every 3 months.” “Rota difficulties, arranging leave ahead of time for life events. Multiple inductions, always feeling like a newbie and no-one knowing who you are, learning how the hospital/department works and then moving on.” Feedback from members of the Anaesthetists in Training Representative Group |
Listening to your experiences
We started by seeking feedback and examples of practice from AiTs and trainers across all four nations. Surveying the Anaesthetists in Training Representative Group (comprising a representative from each School of Anaesthesia) highlighted the variation across the UK. In one region it was possible to move seven times in the two years of Stage 2, but despite that there were also examples of good practice.
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“Very good communication, free accommodation, minimal time away from base.” “A lot of thought and care into it. People kept locally as much as possible. Rotating is good for change”. “I think having an educational supervisor or mentor who spans multiple rotations with clinical supervisors for each rotation could help with continuity, feeling some belonging and anchoring to where you up to overall in the training programme.” Feedback from members of the Anaesthetists in Training Representative Group |
Undeniably, there is some degree of geographical rotation that is unavoidable – for example the tertiary subspecialty blocks of cardiothoracics and neurosurgery or rotating to a hospital with an obstetric department for the initial assessment of competence on obstetric anaesthesia (IACOA). In some cases, rotating out of a “bad department” or one where you haven’t settled, can also be seen as the light at the end of the tunnel (!)
Inconsistency in frequency of rotations and support
However, in general, it became clear on surveying trainers and AiTs across the UK that the number of rotations was not consistent and the support available was variable. Some managed advanced notice of whole stages, with others only able to detail the next three months.
The objective of the group became clear; to provide guidance on minimising the number of rotations overall and maximising the advance notice that AiTs receive about placements. All the while advocating for quality-of-life improvements such as the adoption of a Lead Employer model in all regions and nations or maintaining continuity of educational supervision while rotating. From this, our 11 key recommendations were born.
The work to achieve our goals is just beginning. Part of this includes supporting regional trainers to implement these recommendations where they are not already. We understand each region or nation is distinct, with its own quirks and demands. In addition, the College continues to lobby organisations such as NHSE and the GMC in areas we can influence such as curriculum flexibility.
Thank you for working with us
We hope that these changes will make a real difference to you as AiTs, as well as, by extension, your colleagues and loved ones. We are profoundly grateful to the thousands of AiT voices over the years that have informed this report, whether from regional representatives, passionate members emailing us directly, or attendees at the EGM.
It doesn’t stop here.
This is an iterative process and we will continue to seek feedback from AiTs on our progress at improving rotational training at the ground level.
Your welfare and experience in the workplace are at the forefront of our minds and it is a privilege to work on your behalf.
About the authors
Dr Sophie Jackman and Dr Matthew Tuck are elected Council members, representing anaesthetists in training. They are members of the College's Rotational Training Working Group and together with other members of the group have co-authored a new report, Minimising the impact of rotational training within the anaesthetic training programme.