Search

Author: Dr Richard Knight, Retired Anaesthetist, archives@rcoa.ac.uk

In April 1982, I was grinding through a locum session in a Swedish regional hospital when my wife telephoned me to tell me that the duty officer in my UK medical unit has asked her to say a single word to me – the super-secret word designating the necessity to report immediately to the unit. 

This was my initiation into Mrs Thatcher's plan to recapture the Falkland Islands.

Most men in the unit knew where Argentina could be found in an atlas, mainly because of the forthcoming football tournament starring Maradona. This had not been the situation when Dr David Owen as Foreign Secretary, had put the unit on stand-by to repel invading Guatemalans from entering British Honduras. Then, the staff sergeant was compelled to send his wife to the NAAFI to buy an atlas.

After days of packing and repacking equipment, the unit was trucked to Southampton to join 2 Para on board a North Sea car ferry. Cabins were allocated, in the best military tradition, by rank, but in reality were all the same tiered bunks. The major in the overhead bunk was to read and reread his copy of Herodotus, in Greek.

Being an anaesthetist in training has always had its challenges, alongside the many opportunities and benefits offered by our specialty. However, I think that those of you currently in training are facing a particularly tough time. And without wanting to be too downbeat, I think it’s important for the College to recognise that, to reiterate our commitment to supporting you and to update you on what we are doing to try and improve your working lives.  

There could be no stronger reminder of these challenges than the fact that, as I write this, junior doctors are about to begin the first day of a 72-hour strike. Although unsurprising, the overwhelming support for industrial action among junior doctors is further evidence of just how frustrated and undervalued they are feeling. Our job is to ensure the voices of our members are heard and understood. We do value you, and while we do not have a role in negotiations about terms and conditions of employment, we have made it clear that we believe the exclusion of doctors in training and SAS doctors on the reformed contract from the government’s pay deal is likely to exacerbate the NHS staffing crisis. We will continue to make that point to the government as we advocate action to address workforce shortages and pressures.

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.