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Read the latest letters submitted by members in Winter's Bulletin. If you'd like to submit a letter to the editor, please email us.

It has both a favourable side-effect profile compared with traditional anticholinesterases and allows for emergency reversal.

With the expiry of its original patent last year, high cost is no longer a factor prohibiting its use, which will invariably further increase. In this article, we seek to highlight the resulting increased potential for contraceptive failure and propose methods to better inform and protect patients.

The risk of contraceptive failure

Due to its ability to encapsulate progesterone – present in contraceptive pills, vaginal rings, implants and intra-uterine devices – the administration of sugammadex may reduce their biological effect and cause contraceptive failure. This was identified in in-vitro studies, using isothermal microcalorimetry, performed as part of the drug’s development. While in-vivo studies to quantify the reduction in serum progesterone concentration following sugammadex administration have not been performed, these results have shaped current manufacturer guidance.

It's also associated with other risk factors for poor outcomes, including multimorbidity, sarcopenia and disability. Despite the prevalence of these conditions, current perioperative pathways are not always tailored to high-risk, older surgical patients, resulting in unacceptable variation in access to and quality of care across the UK. 

Comprehensive geriatric assessment (CGA) can be used to assess and optimise frailty, multimorbidity and other age-related syndromes, reducing postoperative morbidity and mortality with proven cost-effectiveness. Implementing CGA-based perioperative services is therefore key in delivering high-quality and cost-effective care of older people undergoing surgery.

It’s a sad truth that necessary change sometimes only comes in the aftermath of something going terribly wrong.

When I see a family that has suffered a tragedy calling for change – and it often seems to be a family campaign that makes the difference – I find myself in awe of their courage. Stephen Lawrence’s family working for a more equitable society, Molly Russell’s family calling for greater online safety and support for young people, Natasha Ednan-Laperouse’s family campaigning for better food labelling to protect allergies. I also wish that they’d never had to find themselves in that position.

These colleagues are easily recognised and often appreciated but, with the merry-go-round of training and rotational placements, attaining formal acknowledgement of their work can be overlooked. 

We recently took steps to nominate our College tutor and were delighted when he received a President’s Commendation from our College.

Several years ago, Dr Minich took over the school-wide final FRCA teaching programme. With his dedication and blindingly structured approach, it quickly became clear that we were fortunate to have an excellent educator in our midst. To say we all benefited from the provision of exam-practice resources and Dr Minich’s efforts coordinating hours of SOE practice feels like an understatement; it simply does not portray the level of help and support Dr Minich provided to the trainee body preparing for the exams.

In this second of our ‘Education resources of the quarter’ feature, we’re taking a look at recent College talks and podcasts on airway matters, and taking videos from our events and podcast programme from the last few years and re-sharing them here.

I'm the RCoA’s Dinwoodie Simulation Fellow and an ST5 anaesthetist in training in the Thames Valley region. I’m pleased to take the opportunity to update you on some exciting developments in simulation.

Anaesthetics was an early pioneer in utilising simulation, recognising its benefits in rehearsing uncommon emergencies and how it can be used to develop non-technical skills. Anaesthetists in training can now expect simulation-based education to feature frequently throughout their training as they develop skills and practise the management of critical incidents, and it will continue to feature throughout our careers. Anaesthetists are also frequently seen delivering the simulation-based education, whether that is for peers or other members of the multidisciplinary team. Simulation as an educational tool has many guises, including part-task trainers to rehearse a skill before performing on a patient, sessions in a dedicated simulation suite and, most recently, immersive technologies such as virtual reality.

At the end of January 2024, the GMC published an updated version of Good Medical Practice, the core guidance for all registered doctors. This has been accompanied by guidance on a number of other areas, including confidentiality, consent and research, and legal and regulatory proceedings, all of which can be seen on the GMC website.

The opportunity has been taken to conduct a major review of the College’s supporting information for appraisal and revalidation.

Transitioning from Full-Time (FT) to Less-Than-Full-Time (LTFT) training has been a journey in revealing LTFT training disparities and discovering a new Health Education England (HEE) LTFT funding policy.

The Gold Guide’s latest guidance suggests that any trainee can apply for LTFT training (including those not yet in post but who have received an offer) provided they have a ‘well-founded individual reason’. In Yorkshire and Humber Deanery, the number of anaesthetic/ICM LTFT trainees has nearly tripled in the last five years. We anticipate LTFT numbers increasing in the future as more trainees seek better work–life balance. Training Programme Directors (TPDs) are encouraged to slot-share LTFT trainees, as this decreases gaps in rotas and continues to maintain recruitment (as LTFT training prolongs training pro-rata). This is important as the RCoA estimates that there will be a shortfall of 11,000 anaesthetists by 2040. If not slot-shared, a solo LTFT trainee does reduced sessions in a single FT slot.