Novice Guide

Published: 14/08/2019

A typical day as a novice

Getting started – a typical day as a novice

The day before...

first objectives achieved: I find the list and find out which Consultant I will be working with. Together we make a plan for the list and what learning opportunities there will be. Now I know what to read up on tonight. The e-Learning sessions in module 1 of e-Learning Anaesthesia cover the basic knowledge and skills novices need. I consider what else I will need to discuss with patients tomorrow morning and which practical skills I can (hopefully) practice tomorrow. My Consultant also gives me a heads-up about the surgical team we’re working with, how they operate and the various personalities involved!

Pre-op assessment...

chaos. Some hospitals have dedicated pre-op areas, whilst in others patients can be scattered over numerous wards. Today my patients are crammed into the waiting room; I have to compete with nurses who are trying to complete admission paperwork and doctors trying to see everyone before the list starts. I eventually find my first patient and try to remember all the relevant things I should be asking. I notice that it takes me twice as long to see patients compared with the registrars, but I guess that’s what experience
brings.

Preparations in the anaesthetic room…

an oasis of calm after what went before. I meet our anaesthetic assistant, introduce myself and explain that I’m new. She agrees to show me the ropes. I outline putative anaesthetic plans for each of the patients (essentially what the Consultant told me the night before and information I have gleaned from my reading), which she likes, as it helps her prepare the right equipment for the list. I check the anaesthetic machine and then start drawing up induction and emergency drugs. I’m not sure that these are the correct drug choices but decide that, at the very least, my suggestions will provide a topic of discussion later.

Team brief…

very useful. This is part of the 5 steps to safer surgery. It is my first time in this theatre and I’m not really sure who everyone is or their role. It’s useful to know their names and this breaks down barriers to communication. We go through the list in detail and review what we need for each case. It turns out that there is a piece of surgical kit that won’t be ready until this afternoon, so we need to switch the order a bit. Another patient needs to be operated on in the lateral position and we need special patient supports for this.

First patient...

this is more like it. I manage to get the first cannula in, which is more than I did yesterday – maybe I’m starting to get used to performing tasks in front of a Consultant? I can’t get the ETT in at my first attempt, but the Consultant works some black magic with pillows and demonstrates the best position for intubation. At my next attempt I have a great view of the cords and get the ETT in. After a slight delay spent untangling cables, which got entwined during the transfer into theatre, the WHO Time-out check has been done and scalpels are being brandished. Phew, we are on our way. Time now to get to grips with filling out the anaesthetic chart.

During cases…

one-to-one face time with a Consultant. A great teaching/learning opportunity, but also time for some small talk and the occasional coffee break. We chat about my experience on the training programme so far, discuss what went well or not so well with the first patient, what I can improve and what I want to focus on during the rest of the list. I use this time to discuss and expand on the reading I had done the previous evening. After preparing drugs for the next case, I start filling in my logbook and working out which Workplace Based Assessments I need to do for my Initial Assessment of Competence.

Waking the patient up…

I can handle the patient breathing spontaneously with a laryngeal mask, but extubating a patient with an ETT is very different. Experienced anaesthetists seem to just know when to take the tube out but I find this quite difficult. I know I mustn’t do it too early. Fortunately, I know I am not the only novice who is finding this bit difficult.

Debrief…

At the end of the list we have a team debrief and I also get feedback from my Consultant on my progress. It’s been a good day. I attend a further unofficial ‘debrief’ after work with my fellow novices. It turns out that I’m not the only one to struggle with the various practical skills. Everyone is finding it a bit of a shock to be a complete beginner again after developing some confidence previously as doctors. We’re all exhausted and are not sure whether this is the early mornings, the steep learning curve or the amount of volatile agents we’re encountering around the anaesthetic room. The department is sociable and a couple of Registrars join us to confirm our suspicion that we have indeed chosen the best specialty! We wander home in time to be up bright and early, ready for another day in theatre and the chance to further develop our basic anaesthetic skills.