Novice Guide

Published: 13/08/2019

FAQs

Professionalism

The General Medical Council (GMC) sets standards of professional and ethical conduct that all doctors are required to follow. The core guidance that the GMC provides is outlined in the document “Good Medical Practice”.

The latest edition came into force in April 2013. It is the responsibility of every doctor to be familiar with Good Medical Practice and to follow the guidance it contains.

Professionalism in action
Every doctor must:

  • make sure their practice is patient centered
  • respect the dignity and privacy of patients at all time
  • keep their knowledge and skills up to date
  • establish and maintain good relationships with their patients and colleagues
  • be honest and trustworthy
  • act with integrity and within the law.

It is the view of the RCoA that professional attitudes and skills should be developed and practiced throughout your training. Specific professional competencies are embedded within clinical units and therefore will be assessed continuously via a range of assessment tools.

Professionalism and social media
Social media is now widely used in both social and professional settings. The GMC recognises that this creates risks to both doctors and patients by blurring the boundaries between private and professional life. It has published a document “Doctors’ use of social media (2013)” which contains guidance on how to comply with the principles of Good Medical Practice when using social media. Inappropriate use of social media can have serious implications and raise questions about a doctor’s professionalism.

Other elements of professionalism include:

  • familiarizing yourself with your departmental guidelines
  • taking advantage of educational opportunities that arise
  • familiarizing yourself with the day-to-day running of theatres. You will be spending most of your time there!
  • being prompt and always ensuring that you arrive in plenty of time so see your patients and start the list
  • if you are delayed for any reason or cannot come to work make sure you notify your supervising Consultant or someone in the anaesthetic office
  • introducing yourself by name, explaining your role and level of seniority. This will prevent other health professionals pressurizing you to engage in activities outside your level of competency
  • not entering an anaesthetic room during an induction as it may cause a distraction
  • valuing your anaesthetic assistant. They are an excellent source of information and you need to work as a team when difficult situations arise
  • saying thank you to all the team members at the end of a list. This is not only polite but it fosters good working relationships
  • trying to achieve a good work/life balance. Make sure you schedule plenty of time to recover from the stresses of working and plan your annual and study leave well in advance.

 

How to get the most out of your training

Be proactive:

  • contact your educational supervisor as soon as you start. They are there to support and guide you through your training
  • discuss the patients on your list with your consultant who will be able to help you identify specific learning opportunities that you can read up about the night before
  • don’t be afraid to ask questions, however minor or stupid they might seem to you. Your learning curve in your first few months of training will be very steep
  • don’t limit yourself to just the list you are allocated to for that day. If appropriate, make use of learning opportunities in other theatres
  • encourage your trainer to give you feedback. It is an excellent way to improve your anaesthetic practice
  • reflect on the events of the day. Celebrate your successes and turn your perceived failures into learning opportunities
  • keep a logbook to record your experience. This will allow you to address any gaps in your training with your educational supervisor
  • ensure that you complete any assessments or documentation in time. Do not leave it to the last minute
  • ask your Educational Supervisor for help early if you feel that you are not coping.

 

FAQs

Where do I find where I should be each day?
Each department has their own way of doing this and most produce a weekly rota. The departmental secretary will let you know when it is available and how to access it. Some departments will e-mail it to you before the start of the week.

Where do I find my list?
You should be able to find it either in your department or in theatres.

What exactly am I supposed to do before I start my list?
Essentially, you need to:

  • discuss your list with your supervising consultant
  • pre-assess the patients on the list
  • prepare your theatre which includes:
    • checking the anaesthetic machine
    • preparing and checking your anaesthetic equipment
    • preparing the drugs you will need for your first patient.

Further information is available in the getting started section.

Why do I feel like a medical student again?
Starting your anaesthetic career can be overwhelming. You may have come from a job where you felt confident with a degree of responsibility and autonomy. Now, your job requires direct supervision in an alien environment. Many novices feel that they are taking a step backwards and consequently feel anxious and stressed.

Make sure you:

  • use the resources in this guide. It has been designed specifically with you in mind and it will support you during your first few months in anaesthesia
  • start using the e-Learning Anaesthesia sessions in Module 1 early on in your training. They cover the knowledge and skills required in the first 3 - 6 months of your training and are available on this memory stick without the need to login
  • Anaesthesia is an extremely supportive speciality. If you do not understand something, ask your trainer to explain it. No question is too stupid.
  • Talk to your fellow novices. You will find that they feel exactly the same way as you do.
  • If you feel that you are not coping, please contact your educational supervisor or college tutor. They are there to support you in all aspects of your training.

Why do consultants do things so differently?
Anaesthesia is often considered to be an art, as it is practised in many different ways. Consultants tend to practice anaesthesia according to their own preferences, knowledge and experience, tailoring the technique chosen to the individual patient. This can change throughout the course of their career.

When you start your training, you will be exposed to many different techniques and schools of thought on how to manage similar situations. Many novices find this perceived inconsistency very frustrating. However, this also leads to many excellent learning opportunities, as you can always discuss the advantages and disadvantages of a particular technique.

It is essential that in your first few months of training you become familiar with the basic techniques of General Anaesthesia with the patient breathing spontaneously through an LMA or paralysed and ventilated through an endotracheal tube.

You can discuss these with your educational supervisor.

What should I do if I feel that I’m not progressing as well as the other novices?
It is really important to debrief with your fellow novices. You will find that you all have the same worries and you can support each other through what can be a potentially difficult period. However, it is inevitable that you will compare yourselves to one another.

Novices progress at different rates. You can voice your concerns or worries at the regular meetings you should be having with your Educational Supervisor. The College recognizes that it takes trainees between 3-6 months to complete the IAC and Basis of Anaesthetic Practice Training units.

Why do I feel so tired and sleepy all the time?
This is a common observation amongst novice anaesthetists. The cause is multi-factorial:

  • early morning starts - you need to pre-assess patients and prepare your anaesthetic room before your first patient arrives. This is often between 8am and 8:30am
  • a steep learning curve - the need to assimilate large quantities of new information can be exhausting
  • the anaesthetic vapours – there is anecdotal evidence that health professionals new to the anaesthetic environment may be affected by the volatile agents.

This feeling will pass once you establish a new routine and get used to your new environment. In the meanwhile, eat healthily, take regular exercise and make sure you get plenty of sleep.

Is the anaesthetic machine really as complex as it seems?
Most novices find the anaesthetic machine daunting. Don’t worry - this is completely normal! You will become more confident the more familiar you are with it. Essentially, it delivers a mixture of medical gases (oxygen, air or nitrous oxide) and anaesthetic vapours to the patient at a safe concentration and pressure.

Make sure you understand the basics of how it works:

  • review the e-Learning Anaesthesia module on anaesthetic equipment
  • familiarize yourself with the AAGBI guidelines on checking the machine
  • ask a senior anaesthetic assistant to go through the checking process with you
  • practice, practice, practice.

Some machines are electronic and conduct their own system test. However, you should always check that the patient circuit is patent, has no leaks and that there is suction available.

My anaesthetic assistant always checks the anaesthetic machine. Do I need to re-check it?
YES - ALWAYS. It is the primary responsibility of the anaesthetist to check that all anaesthetic equipment is functioning correctly.

What is the role of the anaesthetic assistant?
An anaesthetic assistant is a specially trained health professional responsible for assisting with all aspects of the anaesthetic. It is essential to discuss the anaesthetic plan with them as you work together as a team to deliver a safe anaesthetic to the patient. You also need to highlight any concerns and explain the strategies you would use to manage any expected difficulties.

They are a great source of help and information when you start. They know how theatres work and can tell you about the preferences of individual consultants. Don’t be offended if they question or challenge your choice of technique. They may be offering advice that others wouldn’t be doing it that way! This is a good time to stop and re-evaluate your plan.

Can I anaesthetise a patient without an anaesthetic assistant?
NO – NEVER. Anaesthetists must have a dedicated skilled assistant when administering an anaesthetic.

Can I ever leave an anaesthetised patient?
NO – NEVER. Under no circumstances should you leave an anaesthetised patient. The role of the anaesthetist is to care for the patient throughout the anaesthetic.