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As the 2021 curriculum enters its second year, the new curriculum continues to evolve. At each step, this process has been informed by feedback from anaesthetists in training and trainers to guide changes, aid additional clarification, and influence future improvements.

In this article, we explore some of the recent key updates and improvements in the curriculum and look forward to future developments.

As this issue’s theme is training, we’ve picked out six for anaesthetists in training, supervisors, or anyone involved in training. We hope you find them interesting and helpful.

If you’d like us to feature resources from your subspecialty here, or have any other suggestions or feedback, please email us at education-resources@rcoa.ac.uk.

Dr Jon Chambers picks up the reins as Editor of the Bulletin and welcomes you to the year's first issue.

As I pick up the reins as Editor of the Bulletin, I do so with an appropriate degree of trepidation. The Bulletin has been a constant throughout my anaesthetic career, and it remains a window into our specialty that combines a mix of news, developments within the specialty, personal stories and guidance. In my short time in the role, I’ve already been humbled by the quality of contributions from the anaesthetic community willing to share their stories and their work with colleagues.

The start of a new year is often a time to look to the future and the new challenges ahead. In the midst of this newness I have always believed that we should also take the time to look back, and to learn from and reflect on the lessons of our past. In the run up to LGBT+ History Month (February) Professor Andrew Hartle does just that, and he writes openly and honestly on the challenges he has faced as an out gay anaesthetist throughout his career in the NHS and the military. His reflections take us through his journey of exclusion and stigmatisation, and then ultimately of acceptance, recognition and celebration. It is an incredible journey and ends with him rightly encouraging us all to feel prouder in 2025.

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.

At Newham University Hospital there were extensive refurbishments taking place in order to make the theatre complex compliant with current fire-safety regulations. As well as this, there have been a number of fires in intensive care units in the UK over the past decade requiring full-scale staff and patient evacuation.

We realised that we were unsure ourselves of how we would manage such a situation, and so we looked up whether there were fire-safety guidelines specifically for anaesthetists. We came across the recent Association of Anaesthetists fire-safety and emergency evacuation guidelines, published in May 2021. One of the key recommendations was that all healthcare workers should have ‘practical walk-through and/or simulated evacuation training’ at least every two years.

At Nottingham University Hospitals (NUH), it was felt that for our patients with cardiovascular disease, obtaining a preoperative cardiology assessment and perioperative management strategy was prolonging non-cardiac surgery waiting times. 

This was especially compounded by the surgical backlog and increased demand on preoperative services following the COVID-19 pandemic. In order to streamline the assessment process and facilitate safer surgery, a joint cardiology-anaesthesia multidisciplinary team (MDT) meeting was established.

The global problem

It is no surprise that underlying cardiovascular disease can contribute significantly to perioperative morbidity and mortality, with cardiac events being the leading cause of such.¹ Almost half of adults aged over 45 years undergoing major non-cardiac surgery have at least two cardiovascular risk factors, and conditions such as coronary heart disease, heart failure and arrhythmias put patients at increased risk of cardio- and cerebrovascular events in the immediate postoperative period.²

Authors:

• Dr Caroline Phillips, ST6, Peterborough City Hospital
• Dr Lara Allen, ST7, Cambridge University Hospitals

Trainee Research Networks (TRNs) provide resident doctors with a valuable opportunity to obtain research experience. 

In the 2021 curriculum, the College introduced ‘Research and Managing Data’ as one of seven generic professional domains, emphasising the importance of research in the consultant anaesthetist’s skill-set. However, the East of England was among a few UK regions without an active TRN. In 2022, together with a group of colleagues, we identified a need for research led by anaesthetists in training in the East of England and began a journey to establish a new TRN.

The College hosts regular online ‘Let’s Talk’ events for our members. These meetings are an opportunity for you to talk with College representatives about whatever’s on your mind. 

You might have questions or feedback for us, or you might want to share your views or experiences on any number of issues affecting the specialty.

‘Who still uses succinylcholine?’ would be the first thought that comes to your mind on reading the title. But I am sure some of the experienced anaesthetists still have a soft corner and an emotional bond towards this wonderful short-and swift-acting champion.

I take this opportunity to share my experience with succinylcholine, which happened when I was new to the UK and trying to find my feet.

A 16-year-old boy presented to A&E with torsion testis and was posted for urgent surgical repair in the CEPOD theatre. Within the limited time available, I had taken a brief history and nothing was significant in it. He had never been exposed to anaesthesia in the past, and his parents had undergone general anaesthesia in the past but had no issues. He had food two hours before coming to the hospital.