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The College is moving forward at pace as we work to implement improvements to our member services and benefits. On the staff team we are all too aware of the challenges you are facing at work, and our goal is to meet your professional needs and to support you in delivering safe and effective patient-centred care.

In her President’s View, Dr Fiona Donald outlines our programme of development for exams, including how we will give anaesthetists in training a greater role in our assessment processes. This has been a major priority for us over the last 18 months as we have sought to investigate how we can make improvements across all aspects of our exams. To help us deliver these improvements we are increasing capacity within our exams team. This additional expertise will enable careful implementation of longer-term changes alongside the regular face-to-face and online delivery of our exams.

Welcome to the April 2023 anaesthetist in training (AiT) edition of the Bulletin. As I write this, NHS doctors in training are imminently embarking on industrial action following an unequivocal ballot; unprecedented since 2016. Whatever your opinion on industrial action, the common thread is that these are intense times for those of us within the NHS. It is often these times, however uncertain and unsettling, that further solidarity for the betterment of care for patients and each other. The conversations I have had with anaesthetists across the UK bring forth this sentiment; we are in this together.

‘Adapting to change’ is the theme for this edition of the Bulletin. No better place to start than to introduce our new anaesthetist in training members of the Bulletin’s editorial board, Dr Lauren Elliott and Dr Nipun Agarwal, who have been an absolute joy to work with for this issue.

As your new elected anaesthetist in training (AiT) members of the Bulletin’s editorial board, we would like to welcome you to the AiT edition of the Bulletin. We're very excited to be taking over from Dr Susie Thoms and Dr Soumen Sen, and would like to thank them for their excellent work with both the Bulletin and The Gas Newsletter in recent years.

Looking at the current landscape, we wanted to touch on a few issues that we have recently been discussing within the College’s Anaesthetists in Training Representative Group and its Anaesthetists in Training Committee.

Cardiotocography (CTG) to monitor foetal heart rate is frequently used on the labour ward to monitor for foetal distress. Interpretation of CTG is routinely undertaken by the obstetric and midwifery teams to guide labour interventions, along with the mode and urgency of delivery. Anaesthetists are a key member of the multidisciplinary team, and we should therefore understand CTG. This knowledge can then help with joint decision-making, provide an additional set of eyes observing for foetal distress, and be an aid for choosing an anaesthetic technique.

Current training

The 2021 curriculum mentions CTG knowledge in both Stage 1 and in the Obstetric Anaesthesia Specialist Interest area.¹ However, there is a lack of clarity on how to obtain it. Despite there being excellent resources available for anaesthetists to learn about CTG interpretation, it is not formally taught or assessed.² It is left to the individual anaesthetist in training to obtain this knowledge, creating a lack of consistency in knowledge among anaesthetists.

Planning and implementing one of the new special interest areas (SIAs) available from the 2021 curriculum: a trainee’s and trainer’s perspective.

Authors:

• Dr Gemma Summons, Perioperative Medicine Fellow/SpR Anaesthetics, University College London Hospital
• Professor Tarannum Rampal, Consultant Anaesthetist and Lead, Perioperative Prehabilitation Unit, Princess Royal University Hospital (PRUH), King’s College London NHS Foundation Trust
• Ms Shana Hall, Specialist Physiotherapist, Cancer Rehabilitation, Princess Royal University Hospital (PRUH), King’s College London NHS Foundation Trust

John is a retired white British man, who drove to clinic and has a good rapport with his doctor. He feels motivated by the exercise classes at his private gym and tracks his progress using prehab apps and his FitBit. His wife (who does all the cooking) finds the dietary advice helpful because it gives healthy alternatives for traditional British food that they eat.

Winnie is from Barbados. She had to get the bus to clinic (and now she’s late for her shift). She’s offered exercise sessions, if they can fit around work, but the bus links are awful. The dietary information is unhelpful as she can’t get the ingredients from Brixton Market and her budget is tight. She doesn’t have the time to learn lots of new recipes.

When I was first asked by the College to write a short article on the talk I had given earlier in the year on the history of medicine, I was initially hesitant for the simple reason that the subject was so vast to do justice to, and moreover that it had to be accessible to everyone. The diplomatic and persuasive skills of my colleagues encouraged me to write this short article on an extremely fascinating and illustrious period in the life of medicine and healthcare – the period from the 8th to the 15th century.

I am passionate about patient-centred and evidence-centred medicine, and hope to show how these principles were taken to unprecedented levels of excellence and refinedness in this period by Islamic medicine in a way that is to be seen in very few other areas of the history of medical science. When one elucidates each story in this history it can only be described by Bolt’s phrase: sophistication upon sophistication. Due to prescribed editorial limits, the article will centre on only three illustrious individuals: Abulcasis, Ibn al-Nafis and Avicenna. Firstly, the article looks at the overall contribution, and then secondly at the specific contribution and impact of these master clinicians.

Trigger warning: This article discusses baby loss

1 in 225 foetuses die before or during delivery in the UK each year. A third of these are term babies – born at 37 weeks or beyond – who were considered healthy before their death.

Women in the UK are routinely offered induction of labour after 41 weeks gestation. The risk of stillbirth increases from 0.11 per 1,000 pregnancies at 37 weeks to 3.18 per 1,000 at 42 weeks. In mothers whose pregnancy continued to 41 weeks, there is a 64 per cent increase in the risk of stillbirth compared with mothers who delivered at 40 weeks.¹

Authors:

• Dr Natalie Silvey, ST7 Anaesthetics, London School of Anaesthesia; DAS Trainee Representative
• Dr Moon-Moon Majumdar, ST5 Anaesthetics, London School of Anaesthesia; DAS Trainee Representative
• Dr Abhijoy Chakladar, Consultant Anaesthetist, University Hospitals Sussex NHS Foundation Trust; DAS Surveys Co-ordinator
• Dr Barry McGuire, Consultant Anaesthetist, Ninewells Hospital and Medical School, Dundee; DAS Immediate Past President

‘Her death was wholly avoidable and was contributed to in major part by neglect.’

This was the conclusion of the coroner examining the death of Mrs Glenda Logsdail following her death from hypoxic-ischaemic encephalopathy after an unrecognised oesophageal intubation.

Her death, like those of Sharon Rose Grierson and Peter Saint in 2016, has placed this issue at the forefront of safety strategy within the anaesthetic community. Following Glenda Logsdail’s death, the coroner issued a Regulation 28 report to prevent future deaths: several teaching aids and educational materials were released in the subsequent six months. We wanted to establish what was being done in individual departments to prevent unrecognised oesophageal intubation.

Mrs Shivalkar was a 78-year-old patient with debilitating co-morbidities scheduled for elective revision hip surgery at a stand-alone surgical unit without Level 2 or 3 care facilities. 

The surgical procedure was prolonged, and intraoperatively there was prolonged significant hypotension. In recovery this hypotension continued, but despite this the patient was discharged to the ward, where she sustained cardiac arrest. 

After delayed transfer to a facility with critical care, she was found to be in multiple organ failure with a profound metabolic acidosis, leading to a further cardiac arrest from which, tragically, she died.
The coroner, finding concerns regarding preoperative risk assessment and poor communication between the surgical team and anaesthetist, issued a Report to Prevent Future Deaths to the RCoA and the Royal College of Surgeons for action.