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Author: Dr Carolyn Johnston, Consultant Anaesthetist and Deputy Medical Director, St George’s Hospital; Chair of QI working group

During the early days of the COVID-19 pandemic, the UK government talked about their goal of delivering ‘shots in arms’ as the ultimate goal of the vaccine efforts. This wasn’t an exercise in expanding scientific knowledge or customising production, but the aim was clearly stated as being to deliver those advances to citizens in order to prevent them from becoming patients.

A large number of lives were saved by rapid development and national deployment of the new vaccines: the success of the vaccine programme is a reminder to us all how knowledge without application will not improve care.

The HSRC portfolio of projects creates a huge amount of knowledge that has the potential to improve care for our patients, but this knowledge remains potential unless we implement the recommendations of the various reports and use the rich datasets created to inform us of the most pressing areas for improvement in our clinical pathways.

Authors: 

• Dr Kirsty Maclennan, RCoA Council Member; Committee Member, Obstetric Anaesthetists’ Association
• Dr Nuala Lucas, President, Obstetric Anaesthetists’ Association
• Anna McGilvray, RCoA Education Content Co-ordinator

For this issue, we’re collaborating with the Obstetric Anaesthetists’ Association (OAA) to focus on obstetric anaesthesia.

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.

When English chemist Joseph Priestley discovered ‘dephlogisticated nitrous air’, or nitrous oxide in 1772, he unknowingly revolutionised medical practice. What Mr Priestley didn’t know was the significant impact that N₂O would have on the environment.

With a lifetime of 150 years in the atmosphere and a 100-year global warming potential 10 times that of carbon dioxide, N₂O poses a significant problem.

Are we regularly bulk-buying N₂O just to leak it straight into the sky? This is not a new idea. The Nitrous Oxide Project, started in NHS Lothian in 2021 by Alifia Chakera, found that usage of N₂O in the theatre setting was much lower than anticipated, with significant wastage in the supply chain. In fact, hospitals that have undertaken similar analyses report that 95–99% of the N₂O that’s bought is wasted due to leaks in both outdated manifold systems and in piped N₂O supplies.

Author: Professor Joyce Yeung, Director, RCoA Centre for Research & Improvement; NIHR National Specialty Lead for Anaesthesia, Perioperative Medicine, and Pain Management; Professor of Anaesthesia and Critical Care Medicine, University of Warwick

Anaesthesia and perioperative research in the UK have undergone notable transformation over the past two decades. Once described as facing a ‘severe crisis’ due to diminishing academic output and an increasingly stretched workforce, the specialty has since seen encouraging signs of revival.

Nationally coordinated initiatives and structural changes have helped rebuild a foundation for academic activity. Still, progress hasn’t been without its challenges, and many barriers remain.

From decline to rebuilding

Whenever we introduce ourselves in the team brief, we tend to get the same response: ‘Anaesthetics? As FY1s? That’s unusual!’ They are right, of course, and we feel lucky to be here! Both of us, unsurprisingly, were very nervous about starting our first jobs as doctors in August.

Fortunately, we settled in quickly thanks to being well supported by the anaesthetic consultants, SASs, anaesthetists in training, and operating department practitioners. We thought it would be a great idea to share our unique experience of starting on an anaesthetics rotation straight after medical school.

Whereas many of our FY1 friends describe endless ward rounds, discharge letters and medications, we’ve had a very hands-on first month – lots of cannulas, airway management, iGels, intubations, and even some spinals. We initially found the idea of one-to-one consultant training quite daunting, this being something we hadn’t encountered much at medical school. However, we couldn’t have been more wrong – we’ve had nothing but positive experiences with our seniors, even if we’re taught a different way to tie a knot and secure the airway by each consultant.

An increasing number of residents are having children during training. While some of you might balk at the idea of combining nappies and sleepless nights with stages 1, 2 and 3 of training, others are very happy to go on this journey of paternal and professional bliss.

Many of us know that although parenting and training in anaesthesia are compatible, there are many challenges. Some of these could be addressed to the benefit of anaesthetists, anaesthetic departments and providers alike.

This galvanised us to run a national survey, looking at the impact of parenting on training in anaesthesia from both the parent and non-parent perspectives. 411 residents responded to the survey, with a higher proportion of respondents being white and heterosexual, and training less than full time. A similar proportion of men and women responded, highlighting how these issues affect everyone. We recognise that this is the opinion of one group, albeit a key stakeholder, in a complex situation.

This article highlights a few of the key findings.

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.

Authors:

• Dr Xiaoxi Zhang, ST6 Trainee, University College London Hospitals NHS Foundation Trust
• Dr Helgi Johannsson, Consultant Anaesthetist, Imperial College Healthcare NHS Trust
• Dr Amardeep Riyat, Consultant Anaesthetist, London North West University Healthcare NHS Trust
• Dr Roger Sharpe, Consultant Anaesthetist, London North West University Healthcare NHS Trust

Email Dr Zhang

Becoming a consultant is a stressful and vulnerable time during a doctor’s career. Negotiating a new identity, taking on ultimate responsibility for patient care, becoming the team leader rather than a team member are all difficult even in the best circumstances, especially when integrating into a new team.

When the COVID-19 pandemic struck, changing the role from doctor in training to consultant became even more challenging, especially as many hospitals were at that time utterly overwhelmed. We conducted a qualitative analysis of the experiences of anaesthetists and intensivists transitioning to consultant positions during the pandemic,¹ and in this article we want to share the experiences of those doctors who transitioned into their consultant roles during the absolute peak of this global crisis. Their stories offer unique insights on ways of supporting new consultants and highlight the urgent need to improve staff retention and wellbeing in today’s NHS.

Authors

• Dr Anna Greenwood, ST7 Anaesthetics, Leeds Teaching Hospitals NHS Trust
• Dr Sue Walwyn, Consultant Anaesthetist, Mid-Yorkshire NHS Trust; Regional Advisor West Yorkshire
• Dr Joe Lipton, Consultant Anaesthetist, Guy’s and St Thomas’ NHS Foundation Trust;
• RCoA Lead for Assessment Anaesthetics Curriculum Development and Assurance Group

The concept of entrustment is as ancient as apprenticeship. Anaesthetists reeling from the effects of the pandemic are adjusting to the logistics of the new curriculum, and with it a paradigm shift in workplace-based assessment. 

Cynics may well have thought that it is all a rebranding exercise, yet it is a considered outcomes-based holistic approach to training. The old ‘tick-box’ process has been replaced by qualitative faculty judgements of capability, anchored to more clearly articulated learning outcomes. Progression is explicitly framed around increasing practice autonomy through ‘entrustment’ of responsibility for patient care. Entrustment-based assessment moves beyond the spiral curriculum and being ‘good enough’, replaced instead by promotion of the ideal of an excellent all-round professional anaesthetist.