Search

Anaesthetists are familiar with the ‘Schimmlebusch Mask’. This article evolves from Arusha, Tanganyika and a small boy’s memory of a white mask descending over his face circa 1963, having fallen while climbing the household log heap and splitting his eyebrow open, requiring sutures by the local doctor.

Open-ether-mask anaesthesia was a common and safe technique utilised in many countries at the time. Tadeusz Szreter’s recollections of performing ether anaesthesia for children in the late 1950s in Poland is an illuminating read. He describes how two facemasks had to be prepared for each procedure, and how when one became covered in frost, it was replaced by the other. Each mask had to be covered with several layers of gauze neatly trimmed to prevent cheek frostbite. With regard to the safety of ether, Perndt in 2010 and Chang et al in 2015 wrote papers advocating a rethink of this abandoned agent.^1,2,3

Numerous articles have been written about Curt Theodor Schimmelbusch (1860–1895) and his eponymous mask; this article is not attempting to review them all, the intention is to stimulate colleagues to explore for themselves.

Being an anaesthetist in training has always had its challenges, alongside the many opportunities and benefits offered by our specialty. However, I think that those of you currently in training are facing a particularly tough time. And without wanting to be too downbeat, I think it’s important for the College to recognise that, to reiterate our commitment to supporting you and to update you on what we are doing to try and improve your working lives.  

There could be no stronger reminder of these challenges than the fact that, as I write this, junior doctors are about to begin the first day of a 72-hour strike. Although unsurprising, the overwhelming support for industrial action among junior doctors is further evidence of just how frustrated and undervalued they are feeling. Our job is to ensure the voices of our members are heard and understood. We do value you, and while we do not have a role in negotiations about terms and conditions of employment, we have made it clear that we believe the exclusion of doctors in training and SAS doctors on the reformed contract from the government’s pay deal is likely to exacerbate the NHS staffing crisis. We will continue to make that point to the government as we advocate action to address workforce shortages and pressures.

In anaesthesia they have been present for the last 10 years but have become more prevalent in the last four years. Many factors have led to this increase, but one of the biggest is the rise in the number of IMGs as new registrants on the GMC register. These totalled 40% of all new registrants in the last year.¹ Other factors include training bottlenecks that have appeared as an unintended consequence of the changes from the 2010 curriculum.

This has led to increased competition for available posts, with significant numbers of doctors sitting in Locally Employed Doctor or Medical Training Initiative posts accumulating competencies that can count towards CESR. Understandably, trusts that can offer all the components of the curriculum in-house have recognised the potential to have a consistently high-quality, in-house workforce, with an ability to fill their own rotas when gaps appear. This is aided by the Lifelong Learning Platform being freely available to all members of the College, enabling training gaps to be easily identified and targeted with in-house training programmes.

Authors:

• Dr Chima Oti, Consultant Anaesthetist, London North West University Healthcare NHS Trust; Anaesthetic Lead for Undergraduate Medicine
• Dr Kimberley Hodge, Squadron Leader, RAF ST6 Anaesthesia and Intensive Care Medicine, Kimberley.hodge@nhs.net
• Dr Cara Lewis, ST5 Anaesthetics, London North West School of Anaesthesia
• Dr Aynkaran Dharmarajah, Consultant Anaesthetist, London North West University Healthcare NHS Trust

With such a minimal amount of time in the undergraduate curriculum allocated to anaesthesia, it is crucial that we maximise learning opportunities to inspire and develop future clinicians. Here is how we revolutionised the undergraduate anaesthetic placement at Northwick Park Hospital.

Why do medical students spend so little time on clinical placement with anaesthetics? As a foundation doctor one must be knowledgeable about a broad collection of topics; these include practical skills such as phlebotomy and cannulation, acute- pain management, and recognition and treatment of an acutely deteriorating patient. All of these are skills found within an anaesthetist’s armamentarium, placing us in the privileged position of being able to impart our knowledge to the next generation of doctors. As anaesthetics is a postgraduate specialty, our primary opportunity to help develop these skills for our colleagues is during their undergraduate attachment.

Since its launch in August 2018, the Lifelong Learning Platform (LLP) has undergone an unprecedented amount of change. As well as adding the new Anaesthetic and ACCS 2021 curricula in August 2021, it also supports CPD Learners for Revalidation and FICM users, and automatically updates member details via our Customer Relationship Management system.

The platform continues to receive extremely high levels of use, supporting the career lifecycle of more than 24,000 fellows and members in the UK. Currently more than 21,000 of these have used the LLP for assessments and documenting their training in general. In a typical month there will be more than 400,000 LLP user interactions, including 100,000 Logbook entries and the addition of 45,000 Workplace Based Assessments or Supervised Learning Events.

December 2022 saw the final conversion of the initial dataset into a web-based survey tool. Further testing followed, which was exciting and challenging in equal measure. We are very grateful to our beta-testers who tested the questionnaire to destruction to ensure its future functionality.

Their feedback has been fundamental to the next steps in the project, even though their key finding was that the questionnaire was too long. The length of the form was originally dictated by airway experts from around the world with the aim of developing a set of questions they believed would capture all relevant data around an eFONA episode. To reduce its length, a ‘Delphi’ exercise is underway which will identify and agree on the fundamental questions to be answered when reporting an eFONA event.

The ‘DrEaMing’ care bundle supports patients to Drink, Eat and Mobilise within 24 hours of major surgery. This simple, patient-centred intervention is associated with decreased length of stay for patients and a lower rate of late postoperative complications.¹ 

Supported by the RCoA and Getting It Right First Time (GIRFT), DrEaMing is a Commissioning for Quality and Innovation (CQUIN) indictor, and was recently updated for 2023/2024. Containing the core features of more complex enhanced recovery pathways, DrEaMing aims to revitalise the quality-improvement (QI) efforts aiding patients’ recovery after surgery.

A positive collaborative culture, with cohesive working between the whole surgical multidisciplinary team, is essential for DrEaMing to become a sustained standard of care. The perioperative team are fundamental in delivering DrEaMing, but the other important party that can drive QI are the patients themselves!

Authors:

• Dr Ros Bacon, Chair, RCoA Equivalence Committee
• Dr Ashwini Keshkamat, Deputy Chair, RCoA Equivalence Committee
• Dr Derek McLaughlin, Deputy Chair, RCoA Equivalence Committee
• Mr Russell Ampofo, RCoA Director of Education, Training and Examinations
• Ms Claudia Moran, RCoA Head of Training

Email our Equivalence team

The College is responsible for ensuring that anaesthetists meet the standards for Specialist Registration with the General Medical Council (GMC) and that UK and international medical professionals who seek independent practice in the UK have the necessary knowledge, skills and experience (KSE).

The increasing number of Certificate of Eligibility for Specialist Registration (CESR) applications and the GMC’s implementation of new regulatory pathways have presented challenges for the Equivalence Committee. The Equivalence Committee is committed, on behalf of the College and members, to maintaining standards. This article explores the proactive steps being taken by the College to support the Equivalence Committee and enhance the process of assessing CESR applications.

I write this month’s President’s View in the week following the death of Her Majesty Queen Elizabeth. On behalf of the College, I extend our condolences to the Royal Family. I hope that the expression of admiration and love felt for the Queen worldwide has been of some comfort to them. Her Royal Highness the Princess Royal has long been a dedicated and supportive patron of the Royal College of Anaesthetists, and our thoughts are with her at this time of personal sadness, with which many of us can empathise.