G&M Today Issue 3 - Page 1

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Today’s anaesthetist by Mark Stoker BA(Oxon) FRCA

Mark Stoker is a Consultant Anaesthetist and member of General & Medical’s Medical Advisory Panel

Anaesthetists now form one of the largest groups of doctors in any busy hospital. From a total of 117,000 doctors, there are now approximately 12,600 anaesthetists in the UK, comprising 6,200 consultant anaesthetists, 4500 trainee anaesthetists and 1900 non-consultant career grade anaesthetists.

Up to 60% of hospital patients can now expect to meet an anaesthetist at some point during their stay. The development of the art and science of anaesthesia has allowed the evolution of ever more complex surgery, and anaesthesia is now routine for operations or procedures covering numerous surgical sub-specialties.

Providing anaesthesia for operations now represents only part of our work, and a substantial part of our day is spent working outside the operating theatre. Our responsibilities include the relief of pain following surgery (acute pain service) and during labour (obstetric epidural service). Anaesthetists based in hospital pain management clinics also treat more prolonged, incapacitating pain. Anaesthetists provide critical care for the sickest patients in hospitals by running the majority of UK intensive care units. Anaesthetists were instrumental in developing the “kiss of life” and are highly >trained in the skills of resuscitation, which are required when serious injuries or illnesses overcome patients. Our responsibilities include teaching these life saving skills to other doctors and ambulance paramedics.

Are all anaesthetists doctors?

In the UK only fully qualified doctors administer anaesthetics. This practice stems from the earliest days of anaesthesia in the late 1800s when UK anaesthetists favoured chloroform as their anaesthetic agent of choice as opposed to ether which was more popular in the United States. Chloroform was much more difficult to administer safely than ether since it made the patient more prone to cardiac arrest and “sudden sniffer’s death”. Ether remains the agent of choice in developing countries today because of its safety and low cost. Modern anaesthetics in common use today are all based upon ether.

How are anaesthetists trained?

From entering medical school to becoming eligible to take up a Consultant post, our training totals 15 years. During each of the seven or more years of postgraduate training in anaesthesia, the trainee will have been involved in the care of approximately 600 patients per year. All anaesthesia trainees receive a thorough grounding in anaesthesia for all the surgical specialties, the management of pain, intensive care medicine and resuscitation of the sickest patients. At the end of each year of specialist training, the trainee must appear before a regional specialty training committee, which decides whether progress has been satisfactory enough to allow continuation into the next year of training.

The final yearly review determines whether the trainee has satisfactorily completed specialty training and can be recommended by the Royal College of Anaesthetists to the Postgraduate Medical Education and Training Board (PMETB) for the award of a Certificate of Completion of Training (CCT). The CCT represents a “ticket” allowing application and competitive interview for a consultant post in the UK National Health Service or any country within the European Union. Appointment to an NHS Consultant post is used by most providers of private medical insurance as a prerequisite for recognition of the specialist for payment of benefits.

Intensive care medicine and pain management are currently in the process of separating from their parent specialty of anaesthesia with the creation of the Intercollegiate Board for Training in Intensive Care Medicine (ICBTICM) and the Faculty of Pain Management (FPM), both of which are physically accommodated within the Royal College of Anaesthetists. These separating sub-specialties are developing their own training programmes in order to improve the consistency and quality of training in the UK.


PMETB is responsible for approving specialty training programmes in the UK and also for the award of a CCT on completion of training.

The Royal College of Anaesthetists (RCOA) is responsible for setting the training curriculum in anaesthesia. The College is also responsible for administering the two parts of the FRCA diploma examination. A College representative also sits on the interview panel for all NHS consultant posts.

The Association of Anaesthetists of Great Britain and Ireland (AAGBI) is responsible for the promotion of good anaesthetic practice by publishing clinical guidelines for its members. Areas upon which guidance has been issued include standards of patient monitoring during anaesthesia and recovery including information and consent for anaesthesia and private practice.

The Healthcare Commission is the independent watchdog in England that exists to promote continuous improvement in the delivery of healthcare by both NHS and independent providers.

Ultimately the General Medical Council (GMC) is responsible for registering and guiding alld octors and foremost,protecting patients from poor medical practice. The GMC is currently involved with the Royal College of Anaesthetists, as it is with the other specialty colleges, in sketching out a process for “revalidation.” All doctors will have to demonstrate at regular intervals that they are committed to the process of lifelong learning or continuing professional development (CPD), and be practising to a satisfactory standard, in order to retain their registration.

Further Information

The Royal College of Anaesthetists

www.rcoa.ac.uk

The Association of Anaesthetists of Great Britain & Ireland

www.aagbi.org

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