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Mrs Shivalkar was a 78-year-old patient with debilitating co-morbidities, scheduled for elective revision hip-surgery at a stand-alone surgical unit without level-2 or level-3 care facilities. Intraoperatively, significant hypotension was poorly recognised and treated. By the time care was escalated, she had developed severe metabolic acidosis and multi-organ failure leading to her death.

The coroner issued a ‘Report to Prevent Future Deaths’ to the RCoA and the Royal College of Surgeons for action. From our review of the available information, the lessons to be learnt by our specialty  were related broadly to risk assessment, remote-site working and team working. My previous article (Part 1) addressed the first two areas, while this follow-up article focuses on team working and the role of multidisciplinary team (MDT) training.

The Anaesthetic Workforce: UK State of the Nation Report 2024 was a sobering reminder of the challenging working environment we find ourselves in. An Anaesthetic Wellbeing Network was born two years before that, meeting online for the first time in February 2022. 

It was an attempt to share ideas on how to improve the working conditions of healthcare providers within a network of anaesthetists and clinicians with an interest in this field from the Kent, Surrey and Sussex/London region. The group has proved to be very successful, and has grown, with colleagues from around the country joining virtually, every few months.

So, what have we achieved as a group and what do we hope to do next?

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.

Part of the Quality Improvement Working Group’s (QIWG) role is to deliver the College’s Quality Improvement (QI) strategy. To accomplish this, we have been working to strengthen the Quality Network (QN), plan projects and events to promote QI development, and consider how best to engage members.

Context

After previously focusing on the QI compendium¹ and facilitating resource sharing during the COVID pandemic, this year the QIWG has worked to assess and strengthen the QN. Our ‘Prep, Stop, Block’ project was part of this strategy, a summary of which was included in July’s Bulletin,² with the full report available on the our website.

Anaesthetists in training, whatever route they are taking, are the future of our specialty. This is a guiding principle of the College and it cuts across all aspects of our work.

I have always been incredibly impressed by the professionalism, compassion, skill and knowledge of the anaesthetists in training I work with and, as a prospective service user, I can see that the future is bright but that we need to play our part by supporting you to realise that promise.

I hear many positive things from anaesthetists in training, ranging from what you love about the job, to your well-deserved pride in your achievements and your commitment to supporting your patients and colleagues. But I also hear the negative aspects. I hear you when you tell me about training interrupted by the pandemic and the unaddressed trauma from that time. Or how your life and career have been impacted by frequent rotations, exam pressures or difficulty securing a higher training place.

Critical terms must be clearly and consistently used. 

For example, UK law recognises protected titles; ‘general practitioner’, ‘registered nurse’, or ‘paramedic’ have specific meanings, and to use one carries legal weight. Interestingly ‘surgeon’ appears on the GMC’s list of legally protected titles, but ‘anaesthetist’ does not.

While meaning can appear clear from context, ambiguity creates risk. It need not be highly technical terminology to cause problems. Misunderstanding of ‘OK’ contributed to the 1977 Tenerife air disaster, where a tower controller probably intended ‘I acknowledge your request to take off’, but the flight commander understood ‘you are giving me clearance for take-off’. The Boeing 747 accelerated down the runway, and shortly thereafter collided with another aircraft.

Would you like dedicated time to build your experience in research and QI while continuing clinical practice? Perhaps, you’re looking for mentorship from leading clinicians, researchers and policymakers in perioperative medicine? A fellowship with the Centre for Research and Improvement (CR&I) could be a perfect fit.

Alongside several other fellows, I’ve had the pleasure of a CR&I fellowship for the past year. Fellowships generally last 12 months, however several previous fellows have used the opportunity to develop proposals and obtain funding for higher degrees to continue their work. Fellows are attached to RCoA research projects, previously including PQIP, NELA, the QI Working Group, SNAPs and NAPs, among others.

Welcome to a new feature in this Bulletin issue in which we share and showcase education and training content to keep you up-to-date on good practice and ways of working.

In this recurring series, we’ll post event video clips, podcasts, and links to downloadable resources, some of them available exclusively to members, via the Bulletin. We’d love to know how you find this. Tell us what content you want to see here and what professional-development areas you’d benefit from.

In this issue we’re focusing on patient safety, looking at communication and simulation and featuring videos, audio, and downloadable resources drawn from across our website and beyond.