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Authors:

• Dr Rachel Holmes, CT4 ACCS Anaesthetics, Leeds Teaching Hospitals Trust
• Dr Suzanne Taylor, Consultant Anaesthetist, Mid-Yorkshire Teaching NHS Trust
• Dr Susannah Thoms, Consultant Anaesthetist, Mid-Yorkshire Teaching NHS Trust

Society for Education in Anaesthesia UK (SEAUK)

Email Dr Holmes

The 2021 RCoA curriculum states that ‘access to high-quality, supportive and constructive feedback is essential for the professional development of the anaesthetist in training’.¹ So, what do we mean by feedback, and what do we want this feedback to achieve?

The Oxford English Dictionary defines feedback as: ‘advice, criticism or information about how good or useful something or somebody’s work is’, only this is just half of the story. Another definition, relevant to us as trainers and learners, would be: ‘the information sent to an entity about its prior behaviour so that the entity may adjust its current and future behaviour to achieve the desired results’.² In the context of anaesthesia training, information is provided on the gap between a learner’s performance and a standard set by the RCoA, with suggestions on how the gap might be bridged. Self-reflection on any feedback is a vital ingredient to consolidating the learning achieved.

This article explores how to make the most of indirect supervision.

The 2021 curriculum was explicit about having ‘levels of supervision’ embedded within it. These are descriptors of the supervision level the anaesthetist in training (AiT) would require if they were to repeat the same Supervised Learning Event (SLE) immediately after. 

Some are very familiar – a growing, aging population with increasing levels of chronic health problems and significant inequalities in care provision. Others are a factor of the Indian system which Ravi describes as ‘chaotic’.

A key issue underpinning that chaos is the distribution of physicians, 80% of whom practice in urban areas while 70% of the population live rural lives.

Ravi and colleagues are using cutting-edge digital technology to improve healthcare provision in India by introducing ‘comprehensive connected care’. This hub-and-spoke model uses digital connectivity to exchange data and information between centrally located expert clinicians and those caring for patients. For example staff in 5G-enabled ambulances transporting very sick people over long distances receive advice from critical care physicians who have all the patient’s clinical data at their fingertips.

I recently listened to two anaesthetists talking in a coffee-shop queue. One was of a certain age and clearly exasperated at having to contemplate the supposed burnout levels in my generation of anaesthetists in training. He simply couldn’t understand it. After all, in his day they worked hundred hour weeks! ‘Bloody snowflakes’, he reflected. The other nodded gravely.

‘Snowflake’ is a term commonly wielded by our elders to bludgeon what they deem to be a fragile, over-sensitive and under-resilient youth of today. A people unable to cope with life. It does however require a certain amount of historical amnesia to use this slight without some irony catching in the throat. Did they not enjoy rock bottom housing prices, free higher education and high levels of job security, only to then preside over their decimation?

Welcome to this special issue of the Bulletin, where we will showcase the work of some of the projects from the College’s Health Services Research Centre (HSRC).

We will also hear from our patient and carer group, PCPIE, who have been crucial in ensuring projects have meaningful involvement from development and delivery through to reporting. We are grateful to them for their wise counsel and insightful challenges. HSRC projects could not run without the dedication and vision of their leads and of the project teams supporting them. This includes strong involvement from our HSRC fellows (who, while often in post for only a year, never really leave the team), and we are delighted to have just welcomed our next six fellows to NELA, PQIP, SNAP, and quality improvement projects.

In this short interview, Dr Sam Black, our Patient Information Lead, explores the key things to consider when communicating risk to patients with Leila Finikarides, Researcher at the Winton Centre, and Jenny Westaway, Chair of PatientsVoices@RCoA.

Since early 2024, the Patient Information Group has been working with the Winton Centre for Risk and Evidence Communication to ensure that our information for patients on risk reflects the latest best practice and learning from the work of the Centre.

We hope you find the interview an interesting insight into our work in this area.

Authors: 

• Dr James Durrand, RCoA Centre for Research and Improvement Fellow; Perioperative Quality Improvement Programme (PQIP); Resident Anaesthetist (ST6), South Tees Hospitals NHS Foundation Trust
• Dr Eimhear Lusby, Honorary Research Fellow, University College London; ST6 Anaesthetist, University Hospitals Sussex NHS Foundation Trust
• Dr Adam Hunt, MPhil/PhD Student, University College London and Resident Anaesthetist, The Royal Marsden NHS Foundation Trust
• Professor S Ramani Moonesinghe, PQIP Chief Investigator

The circumstances in which we are born, grow, live, work and age profoundly influence our health. These complex, reciprocal, and dynamic interactions begin in utero and develop continuously throughout life.

Recognition that socioeconomic deprivation drives poorer health was fundamental to the establishment of the UK NHS in 1948. The key causal relationships and how to intervene in them have been debated since then.

Seventy-five years later, people from more deprived backgrounds still experience less beneficial interactions with the NHS. Individuals present later and with more severe disease. Unhealthy behaviours, including smoking, physical inactivity and poor diet, are more common and often cluster. In turn, rates of chronic ill health and multimorbidity are higher. Wider advances in key disease areas have been unevenly distributed across socioeconomic groups. Consequently, deprived patients continue to die younger.

7 November 1925 to 9 May 2022

DSc, MD, PhD, MB ChB, FRCA ( Hon), FGS, FRCS(Hon), FANZCA (Hon), FCAI(Hon)

Dr John Francis Nunn died after an acute episode of respiratory failure. He had spent the last four years of his life in residential care due to progressive vascular dementia.

John read medicine at Birmingham University, during which period he developed passions for climbing and geology. On graduation he went to Svalbard on a geological expedition as medical officer and ‘rock carrier’.

He returned to Birmingham to undertake his house jobs and, having married in 1949, went to Penang in lieu of conventional national service. There he became an anaesthetist, learning the art by hands-on experience and the science by correspondence with seniors back home.