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More than one in five of the non-trainee anaesthetic workforce are SAS doctors, yet the grade is still sometimes misunderstood.

The College is keen for SAS doctors to get the recognition and support they deserve. As SAS Wellbeing lead, I started an initiative last year to spotlight the achievements of our SAS members by asking them to share their stories with us for publication on the College website and social media. Our aim was to enhance people’s understanding of the huge range of skills, experience and responsibilities of SAS doctors, to boost pride in being an SAS doctor, and to improve wellbeing.

This article looks at why the NHS needs international medical graduates (IMGs) and why we need to do better at integrating them into the workforce to maximise their contribution.

The General Medical Council’s Workforce report 2023 emphasises that the current reliance of the NHS on IMGs will continue in the future, despite an expansion of medical school places. The GMC predicts that almost a third of all doctors will be IMGs by 2036. It declares that the ‘integration and retention….must be improved’ and describes as essential that these colleagues are ‘welcomed into supportive teams’.

The way we welcome our international colleagues not only determines the extent to which they can contribute safely to the service, but also how easy it is to recruit and retain them. Our attitude should include a willingness to learn from their previous expertise and their ability to look at our services with fresh eyes.

The Perioperative Medicine Clinical Trials Network (POMCTN) Research Leader scheme, previously named the Chief Investigator scheme, was founded with the aim of nurturing, training and supporting perioperative researchers to develop as future research leaders. Dr Mouton, a graduate from the Research Leader scheme, shares her experience.

Why did I apply?

A warm welcome to our new HRSC fellows.

Despite national improvement initiatives, such as the National Emergency Laparotomy Audit (NELA), clinical outcomes for older people have remained significantly worse than for their younger counterparts. Frailty confers additional complexity, with risk of mortality and morbidity persisting up to 12 months following surgery, and one-third of this group requiring new or additional social-care support following surgery.¹

Shared decision-making around emergency laparotomy is challenging for both patients and clinicians. When reflecting on decision-making, older patients have indicated that potential long-term quality of life implications, including loss of independence, are more of a priority than numerical mortality-risk assessment tools.² Yet, patient-reported measures are not routinely collected within NELA, nor reflected widely in research studies. ‘Perioperative care of older people living with frailty’, published by the Centre for Perioperative Care and British Geriatrics Society, highlights research into patient experience as a key recommendation.³ 

I am a huge fan of the Beano and sent feedback to the Royal College of Anaesthetists about a special collaborative edition I had read, Dennis has an anaesthetic. My Granny was in hospital at the time, and I was worried about her. She had broken her ankle. I read the Beano comic to help me understand and feel better about her being unwell and having an operation.

Children’s anxiety related to hospital admissions and procedures is a huge problem and affects up to 80% of children. 75% experience anxiety in the anaesthetic room, and 60% develop ‘new’ dysfunctional behaviour in the three weeks after surgery. Sadly, 12% still display this new behaviour one year after surgery. In the US, surveys show that 25% of children are held down for a general anaesthetic.

Dennis has an anaesthetic teaches children about:

• finding out about the operation
• getting ready for the operation
• having the anaesthetic and operation
• waking up and going home.

It has both a favourable side-effect profile compared with traditional anticholinesterases and allows for emergency reversal.

With the expiry of its original patent last year, high cost is no longer a factor prohibiting its use, which will invariably further increase. In this article, we seek to highlight the resulting increased potential for contraceptive failure and propose methods to better inform and protect patients.

The risk of contraceptive failure

Due to its ability to encapsulate progesterone – present in contraceptive pills, vaginal rings, implants and intra-uterine devices – the administration of sugammadex may reduce their biological effect and cause contraceptive failure. This was identified in in-vitro studies, using isothermal microcalorimetry, performed as part of the drug’s development. While in-vivo studies to quantify the reduction in serum progesterone concentration following sugammadex administration have not been performed, these results have shaped current manufacturer guidance.