Jenny Westaway asks if it's inevitable that we all bring our own interests, expertise, and – yes – biases to the table?
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Dr Carolyn Johnston tells us about a new project aiming to find ways to improve the time it takes for patients to have their surgery.
Dr Chris Carey and Dr Lewis Hendon-John tell us what the College is doing to better understand the factors causing low morale and burnout in anaesthetists.
Training in anaesthesia is one of the cornerstones of the profession. It is often cited as one of the specific attractions of choosing anaesthesia as a career. However, anaesthetists in training are unfortunately not immune from the challenges faced by all resident doctors working within the UK.
In recent years, there have been growing concerns about low morale and burnout. Anaesthetists in training provide a pivotal role in the provision of services in many areas of secondary care. Furthermore, there is a well recognised shortage of consultant anaesthetists in the UK. It’s essential that the NHS is able to train and retain this uniquely skilled workforce to provide care for patients both now and in the future.
It’s apparent from both the College’s own work, such as the 2017 survey on morale and welfare in anaesthetists in training (‘A need to listen’) and also evidence from the GMC’s National Trainee Survey (NTS), that there is a high proportion of anaesthetists in training at risk of burnout. There have also been significant external factors impacting on the training programme, such as the transition to the 2021 curriculum and the COVID-19 pandemic. Competition ratios to enter anaesthetic training are at record levels, and concerns remain about training-post numbers and progression between Core and Higher training programmes.
Dr Marie Nixon, Consultant Anaesthetist and Dr Thom O'Dell, ST7 Trainee discuss their experiences of wellbeing and what it means to them.
TRIPOM summarise recent papers and articles on perioperative medicine from across different medical publications.
- Dr Jaimin Arya, ST6, East Midlands Deanery
Perioperative Journal Watch is written by TRIPOM (trainees with an interest in perioperative medicine) and is a brief distillation of recent important papers and articles on perioperative medicine from across the spectrum of medical publications.
This article explores shared decision-making, in which patients and clinicians collaborate to make the best evidence-based decision within the context of the patient’s values.
The success of an anaesthetic is traditionally judged by our ability to safely get our patient through an operation. Yet, the more evolving challenge of our specialty is identifying those patients at high risk of postoperative complications where the best course of action may be no surgery at all. A further challenge is that of empowering patients to consider the available evidence to make the best decision for their circumstances.
Shared decision-making, whereby patients and clinicians collaborate to make the best evidence-based decision within the context of the patients’ values, is recognised as a vital component of perioperative care. The benefits of shared decision-making are accepted by NICE and the Centre for Perioperative Care (CPOC), yet evidence suggests we may not be doing it as well as we should. A recent CPOC survey showed that 39% of patients desired more support or information regarding treatment choices. In another study, 14% of patients expressed regret, and said that they would not have had surgery had they understood the risks and alternatives. View the ‘three-talk’ model of shared decision-making suggested by CPOC.
Dr James Brunning provides some simple steps that are likely to pay real dividends and help you thrive through the long dark winter months.
Winter can be hard for many of us, with the combination of longer nights, shorter days and the rounds of respiratory infections that come our way.
It can help to think of wellbeing as a balance between restorative and protective activities and those activities that are draining or reinvigorating. These are, of course, different for each of us and so the best person to advise you on what works for you is yourself. That said, there are some simple steps that are likely to pay real dividends and help you thrive through the long dark winter months.
Dr Cathryn Malins and Dr Madeleine Storey explain why formalising training time in regional anaesthesia will facilitate the learning of trainees at all stages.
Over the last five years, regional anaesthesia in clinical practice has been on a trajectory – growing in importance and prominence in the anaesthesia community. Efforts by the 8th National Audit Project and the BJA have helped further increase the publicity of regional anaesthesia. While we can all see the merit in this growth, is this the time for a more formalised place in the training programme for regional anaesthesia?
As with any practical procedure, there are many ways to learn, but it is practically impossible to become competent or excellent at regional anaesthesia without regular hands-on patient experience. Recent UK-wide surveys revealed a large proportion of Stage 3 trainees unable to perform all Plan A blocks independently, and found that only a small proportion of consultants and specialists felt confident teaching all these blocks to trainees. It has also been seen that the higher the number of blocks trainees perform, the more confident they feel. Currently, ‘getting numbers’ and achieving the required competence, feels challenging.
We acknowledge that there is an inevitable period of adjustment following curriculum transition, but many of our trainee colleagues still feel their current skills in this area are inadequate for their level of training. To prevent this becoming a perpetual challenge this issue must be proactively addressed across all stages of training.
Dr Tara Keogh looks at how resident doctors can try to implement change and make meaningful contributions while training.
It is not an understatement to say that resident doctors in training often face significant challenges when attempting to implement change initiatives. As they rotate through multiple hospitals, they may struggle to establish rapport and trust with established staff, making it difficult to garner support for new ideas.
The fast-paced environment, heavy workload and burden of exams and portfolio, can leave little time for trainees to engage in the necessary discussions or meetings to advocate for change. Additionally, the hierarchical structure of medical training can inhibit resident doctors from voicing their ideas as they may not feel respected enough to have influence.
‘Safety and Quality Improvement’ is one of the generic professional domains throughout the anaesthetic training programme. Trainees are expected to conduct local quality-improvement projects, in addition to participation in regional or national projects.
As NELA enters its second decade, it's important to look at persisting challenges as well as successes, and consider where improvement efforts should now be concentrated. This article highlights three areas of emphasis from Year 10 (2023) of the audit.