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Dear Editor,

I read the wellbeing and burnout articles in the Bulletin (Summer 2024) with interest. Though highlighted for some, it is an ‘eyeroll subject’, but the importance of wellbeing is undeniable. In particular, it is important to ensure that anaesthetists and the wider multidisciplinary team receive appropriate wellbeing and psychological support after traumatic incidents. Exposure to traumatic events is inevitable in anaesthesia. Having systems to support staff afterwards is crucial to recovery and to reduce long-term burnout and emotional toll.

Our full selection of back digital issues will keep you up-to-date and informed on what’s happening in our specialty. We hope you continue enjoying your membership magazine.

I’m hoping that no one reading this has missed the launch of NAP7: perioperative cardiac arrest. The NAP7 data touched every part of anaesthesia practice – from maternity and neonates right through to the frail and older patient – so there’s something there for everyone.

But NAPs don’t stand still; NAP8 is on its way and will be looking at regional anaesthesia and neurological complications of anaesthesia. We are delighted that Professor Alan MacFarlane has been appointed to lead NAP8 – more news will be coming soon.

The work of CR&I is supported by a diverse group of clinical fellows (and this issue of the Bulletin even has a piece from a future research leader – aged 11). We couldn’t do our work without them, and they in turn are supported by their clinical workplaces – both in the NHS and the independent sector – who pay their salaries and give them the space to work with CR&I. I’m delighted that some of our fellows have given an insight into what the role is like – and the challenges of going and coming back from maternity leave.

CESR (Certificate of Eligibility for Specialist Registration) programmes now called the ‘portfolio pathway’ have become popular among many trusts. With more than 2,000 LED & SAS doctors in the UK, there is a growing need for structured CESR programmes to ensure a successful application via the portfolio pathway. 

In 2019, we initiated the CESR programme at Addenbrookes Hospital. This is a three-year structured programme based upon the RCoA curriculum for already experienced anaesthetic CESR aspirants, with dedicated educational supervision and an ARCP-like process. Now, with six years of running, the programme has proved to be an excellent platform for achieving successful registration on the GMC specialist register, as it mirrors the GMC and RCoA requirements for CESR. So far, five out of six CESR fellows have been successfully appointed to substantive consultant posts within the UK.

While anaesthesia has always taken great care to tread the tightrope between training and patient safety, new technologies and innovation in education practices are further improving the risk-to-benefit ratio.

The acquisition and maintenance of airway skills are fundamental for all anaesthetists. A delicate balance exists between allowing the trainee to learn practical techniques and exposing patients to potential harm, a situation which is no greater than during airway management. Clinical pressures, demands on training time and reduced operating capacity since the COVID-19 pandemic have had a major impact on learning opportunities for anaesthetists in training.

In this article, we review some new technologies which are changing how airway management is taught.

Firstly, participation in research can be claimed as a CPD activity to help meet this supporting information requirement. Research will often be done online and may be used to supplement the knowledge gained from another CPD activity such as attending a course or event. 

It can be claimed on the basis of one credit per hour when accompanied by reflection showing how it has applied to your scope of clinical practice.

Some doctors make reference to the prompts: ‘What?’, ‘So what?’, and ‘Now what?’, and the CPD activities section in the Lifelong Learning Platform features three corresponding boxes for reflection entitled: ‘Review’, ‘Experience gained’ and ‘Resulting change’.

I have recently been appointed as an Examiner for the Royal College of Anaesthetists FRCA examination. It was a moment of great pride and achievement for me, but also very humbling and surprising to know that I was the first SAS doctor to be appointed as an examiner for the College. It has made me reflect on my journey as an SAS doctor and how I got to become an examiner.

I completed my undergraduate medical and postgraduate anaesthetic training in Mumbai, India. Like a lot of doctors from India in the early 2000s, I chose to come to the UK on a ‘permit-free training’ visa to train and work in the NHS, be better paid, and have a better balance between work and life. I first applied as a clinical observer at Basingstoke hospital and then was successful at interview for the senior house officer (SHO) post in August 2003. This was the first time that I became aware of the SAS grade of non-training doctors in the UK. In 2003, Basingstoke already had six SAS doctors on full-time or part-time contracts. They were a motivated group of doctors who had their own fixed lists and worked independently anaesthetising for complex cases. But at that time, like everyone else, I was intent on trying to train and become a consultant.

In my role as a patient representative, I am committed to represent the patient voice to ensure it is at the centre of everything we do.

For those who may not know, CPOC is a cross-specialty initiative made up of 11 partners dedicated to the advancement and development of perioperative care. Perioperative care means the whole patient journey from the GP’s, to when a patient returns home after surgery. Our vision is to improve the health of people of all ages, at all stages of their surgical journey, by promoting the highest standards of perioperative care.

Improving perioperative care will make a difference to a lot of things important to patients, including getting fitter before surgery, better pain management (getting mobile quicker), recovery (getting out of hospital faster), reducing anxiety felt, and putting the patient at the centre of all decisions about treatment.