Anaesthesia

Anaesthesia is the largest department in each hospital with over 5,000 consultants and other career grade doctors in the specialty. Anaesthetists come into contact with two thirds of all patients admitted to hospital. Although most anaesthetists’ work revolves around operative procedures, less than half their time is actually spent in theatre. They are also involved in acute pain rounds, in chronic pain clinics, on the labour ward and in intensive care units. With an ageing population who have a greater range of co-morbidities, anaesthetists are increasingly seen as ‘peri-operative physicians’.

Like all specialties anaesthesia is subject to the European Working Time Directive (EWTD) but even before this, anaesthesia was seen as a well-organised leader in achieving reasonable working hours for trainees. Trainees are instructed in safe anaesthesia of all surgical subspecialties (from cardiac to neurosurgery). As a consultant they can expect to have a regular working week with the same surgical subspecialty but also flexible sessions. This allows particular expertise in one area but also variety to keep the spice of life. The on-call requirement is variable but typically one night a week and one weekend in anything from one in five to one in twelve (or even less). Good working relationships with one’s colleagues allow swaps to be able to attend that special event!

Training pathway

Training in anaesthesia is competence-based. This means that the curriculum is published and the skills, knowledge and behaviour to be achieved at each stage of training are identified (see The Royal College of Anaesthetists for the full curriculum). Training is organised in schools of anaesthesia throughout the UK and these ensure that every aspect of training is delivered.

From August 2007 the new MMC specialty training (ST) programme will be ‘run-through’, normally lasting seven years. An option that will be available is to follow foundation training with a two-year acute care common stem (ACCS) programme which broadens training by combining anaesthesia, critical (intensive) care, acute medicine and emergency medicine. On completing ACCS training trainees will join the anaesthetic programme in ST year two.

Examinations form part of the assessment process and are typically taken during the second and fourth years of specialist training. The primary FRCA examination concentrates on the scientific principles underlying clinical practice (physiology, pharmacology, and physics with clinical measurement). The final FRCA examination is more clinically orientated. Research is encouraged and is usually done in the later stages of training. Trainees are also allowed to spend one of their last three years abroad in a suitable training appointment.

Key skills and aptitudes

Anaesthetists are often seen as the most capable doctors in dealing with sick patients. They are called on for help with tricky situations. It is not a career for the faint hearted but supportive consultants encourage the trainee to develop critical skills. Anaesthetists are often sociable and enjoy the banter in theatre. Some enjoy the technical side and love having a new toy to play with in theatre.

Training posts and competition

During the first few months the novice anaesthetist is directly supervised at all times. After passing the initial test of competence, usually after three to six months, the trainee begins to give anaesthesia with more distant supervision. The sense of elation (and relief when all goes well!) of giving the first general anaesthetic alone stays with the trainee. All trainees do a minimum of nine months, intensive critical care medicine as part of their training for a CCT in anaesthesia. Because anaesthesia is a large specialty there are still plenty of training posts to apply for. Nevertheless it can be competitive because the popularity of the subject has increased as anaesthetists have extended their roles outside the operating theatre.

Best and worst

Every anaesthetist will have different views of the best and the worst bits. For me the best bit is seeing an individual safely through an operation, be it to deliver a baby at Caesarean section or to undergo a curative surgical procedure.

Key information resources

• Royal College of Anaesthetists
• Association of Anaesthetists

There are also many specialist societies within anaesthesia including the Intensive Care Society, British Pain Society and Obstetric Anaesthetists Association. 

Dr Griselda Cooper OBE, FRCA, FRCOG is a senior lecturer in anaesthesia at the University of Birmingham and a vice president of the Royal College of Anaesthetists.