Novice Guide

How can I get the most out of my training?

Training is a long term commitment and requires effort from not only yourself but also your trainers and departments. There are things that you can control and things they can. 

• contact your educational supervisor as soon as you start. They are there to support and guide you through your training 
• where possible, discuss the patients on your list with your supervisor who will be able to help you identify specific learning opportunities that you can prepare for in advance 
• don’t be afraid to ask questions, the learning curve in your first few months of training will be very steep 
• don’t limit yourself to just the list you are allocated to for that day. If appropriate, make use of learning opportunities in other theatres 
• ask your trainer to give you feedback if it isn’t offered spontaneously. It is an excellent way to improve your anaesthetic practice 
• reflect on the events of the day. Celebrate your successes and turn your perceived failures into learning opportunities 
• keep a logbook to record your experience, it’s a record of your experience but also a useful lever to access educational opportunities that you may require more of 
• ensure that you keep your LLP up to date – it only takes a few people on annual leave close to ARCP to turn last minute form signing into a stressful sprint 
• ask your educational supervisor for help early if you feel that you need more support from your department.

Equally, your department should provide a safe, appropriate learning environment with the right amount of challenge to keep you progressing. It should also be responsive to your educational needs.

A good department:

• will often provide regular anaesthetic specific teaching, covering parts of the curriculum, you should be allowed time away from elective lists to attend 
• should provide a workspace and a place to study 
• should provide a place to eat and to rest whilst on-call 
• should engage the trainee body and include them in service development .

Where do I find where I should be each day?

You should be able to find it either in your department or in theatres. Some hospitals have electronic scheduling software – if in doubt the college tutor or the theatre receptionist should know who to speak to get you access. 

What exactly am I supposed to do before I start my list?

Essentially, you need to: 

• discuss your list with your supervisor 

• assess the patients on the list 

• prepare your theatre which includes: 

  • checking the anaesthetic machine

  • preparing and checking your anaesthetic equipment 

  • preparing the drugs you will need for your first patient. 

Why do I feel like a student again?

Starting your anaesthetic career can be overwhelming. You may have come from a job where you felt confident with a degree of responsibility and autonomy. Now, your job requires more direct supervision in an alien environment. Many novices feel that they are taking a step backwards and consequently feel anxious and stressed. 

Make sure you: 

• start using the e-Learning Anaesthesia sessions in Module 1 early on in your training. They cover the knowledge and skills required in the first 3 - 6 months of your training  

• anaesthesia is a supportive speciality. If you do not understand something, ask your trainer to explain it. Every question you asked will have been asked by someone before you 

• talk to your fellow novices. New starter courses and departmental/regional teaching days are great opportunities to catch up with colleagues and you might find they feel just the same way in the new job

• if you feel that you are not coping, please contact your educational supervisor or college tutor. They are there to support you in all aspects of your training, departments have a duty to your training and welfare. 

Why do consultants do things so differently? 

Anaesthesia has been described an art, as it is practised in many different ways. Consultants and SAS doctors tend to practice anaesthesia according to their own preferences, knowledge and experience, tailoring the technique chosen to the individual patient. This can change throughout the course of their career. 

When you start your training, you will be exposed to many different techniques and schools of thought on how to manage similar situations. Many novices find this perceived inconsistency very frustrating. However, this also leads to many excellent learning opportunities, as you can always discuss the advantages and disadvantages of a particular technique. 

It is essential that in your first few months of training you become familiar with the basic techniques of General Anaesthesia with the patient breathing spontaneously through an LMA or paralysed and ventilated through an endotracheal tube. 

You can discuss these with your educational supervisor. 

What should I do if I feel that I’m not progressing as well as the other novices?  

It is really important to debrief with your fellow novices. You will find that you all have the same worries and you can support each other through what can be a potentially difficult period. However, it is inevitable that you will compare yourselves to one another. You can voice your concerns or worries at the regular meetings you should be having with your Educational Supervisor. The College recognises that it takes trainees between 3-6 months to complete the IAC and that people progress at different rates. 

Why do I feel so tired and sleepy all the time? 

This is a common observation amongst novice anaesthetists. The cause is multi-factorial: 

• early morning starts - you need to assess patients and prepare your anaesthetic room before your first patient arrives. This is often between 8am and 8:30am 

• a steep learning curve - the need to assimilate large quantities of new information can be exhausting 

• the anaesthetic vapours – there is anecdotal evidence that health professionals new to the anaesthetic environment may be affected by the volatile agents although this has been seen in TIVA lists too! 

This feeling will pass once you establish a new routine and get used to your new environment. In the meanwhile, eat healthily, take regular exercise and make sure you get plenty of sleep. 

Is the anaesthetic machine really as complex as it seems? 

Most novices find the anaesthetic machine daunting. Don’t worry - this is completely normal! You will become more confident the more familiar you are with it. Essentially, it delivers a mixture of medical gases (oxygen, air or nitrous oxide) and anaesthetic vapours to the patient at a safe concentration and pressure. 

Make sure you understand the basics of how it works: 

• review the e-Learning Anaesthesia module on anaesthetic equipment 

• familiarise yourself with the Association of Anaesthetists guidelines on checking the machine 

• ask a senior anaesthetic assistant to go through the checking process with you 

• practice, practice, practice. 

Some machines are electronic and conduct their own system test. However, you should always check that the patient circuit is patent, has no leaks and that there is suction available. 

My anaesthetic assistant always checks the anaesthetic machine. Do I need to re-check it? 

Yes, it is the primary responsibility of the anaesthetist to check that all anaesthetic equipment is functioning correctly. 

What is the role of the anaesthetic assistant? 

An anaesthetic assistant is a specially trained health professional responsible for assisting with all aspects of the anaesthetic. It is essential to discuss the anaesthetic plan with them as you work together as a team to deliver a safe anaesthetic to the patient. You also need to highlight any concerns and explain the strategies you would use to manage any expected difficulties. 

They are a great source of help and information when you start. They know how theatres work and can tell you about the preferences of individual consultants. Don’t be offended if they question or challenge your choice of technique. They may be offering advice that others wouldn’t be doing it that way! This is a good time to stop and re-evaluate your plan. 

Can I anaesthetise a patient without an anaesthetic assistant? 

No, although when you work on an Intensive Care ward this assistant may be an ICU nurse or practitioner with experience assisting with anaesthetic induction. 

Can I use alternative logbooks? 

Whilst the use of the LLP to record your cases is the most straightforward way for a panel or supervisor to review your case mix, you can use any tool you prefer to record your work as long as it includes the requisite information. This should be made easily available on LLP in time for supervisor or ARCP panel review.