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The Royal College of Anaesthetists has undertaken a two-year national project in collaboration with The Healthcare Improvement Studies (THIS) Institute to use new approaches to improve the time it takes for patients to have emergency bowel surgery.

The time taken for patients to get to the emergency operating theatre remains a stubborn problem, despite many years of research and national guidance emphasising the importance of prompt surgery to reduce morbidity and mortality.

The diagnostic and treatment pathways are complex – involving clinicians from emergency medicine, anaesthesia, surgery, critical care, radiology, and often other specialties. Patients also require resources like CT scanners and operating theatres that are often in short supply. Thinking about the multiple steps each patient must traverse, it is no surprise that they often don’t get speedy access to the operating theatre.

Two months ago, we published an updated UK State of the Nation report, providing a comprehensive overview of the anaesthetic workforce, retention challenges, and future projections. The NHS urgently needs more anaesthetists. 

Increasing demand – driven by factors such as an ageing and growing population – combined with an inadequate supply of anaesthetists due to insufficient training places and poor retention, has exacerbated the shortfall. This gap has grown from around 1,400 anaesthetists in 2020 to 1,900 in 2022 (15% below what is needed to meet demand).

We need to act on this and aim to build on progress from the last few years. Our first State of the Nation report, published in 2022, along with a wider programme of influencing work, helped secure government funding for an additional 70 ST4 anaesthetic training places each year from 2022 to 2024 in England. This helped to reduce the bottleneck between core and higher anaesthetic training, with the number of applications per place dropping from 2.67 in 2021 to 1.64 in 2024. In Wales, six new higher anaesthetic training places were granted in 2023; in Scotland, six new places were granted in 2024. However, many more are needed to address the workforce shortfall.

The success of an anaesthetic is traditionally judged by our ability to safely get our patient through an operation. Yet, the more evolving challenge of our specialty is identifying those patients at high risk of postoperative complications where the best course of action may be no surgery at all. A further challenge is that of empowering patients to consider the available evidence to make the best decision for their circumstances.

Shared decision-making, whereby patients and clinicians collaborate to make the best evidence-based decision within the context of the patients’ values, is recognised as a vital component of perioperative care. The benefits of shared decision-making are accepted by NICE and the Centre for Perioperative Care (CPOC), yet evidence suggests we may not be doing it as well as we should. A recent CPOC survey showed that 39% of patients desired more support or information regarding treatment choices. In another study, 14% of patients expressed regret, and said that they would not have had surgery had they understood the risks and alternatives. View the ‘three-talk’ model of shared decision-making suggested by CPOC.

Generative artificial intelligence (AI) describes technology that can create new content, including text, images and audio, based on patterns and structures learnt from existing data. Large language models (LLM) are types of generative AI models that are trained on vast amounts of online data and employ natural language processing, designed to mimic human language and communication. 

Since the release of ChatGPT 3.5 by OpenAI in November 2022, there has been a significant rise in interest in and development of LLM chatbot technology, which has become increasingly sophisticated. Now other companies, such as Google, have developed LLM AI technology integrated into search engines via plug-ins.

ChatGPT, and other AI chatbots, have not been designed for (or licensed to) provide medical information and advice. Despite ChatGPT usage policies dictating that medical and health advice without review by a qualified professional may significantly impair safety and wellbeing, the policy is not prohibitory. Therefore there’s increasing concern regarding the unregulated ‘off licence’ use by members of the public.

The Lifelong Learning Platform (LLP) continues to experience very high levels of use, with each month typically seeing more than 500,000 unique actions taking place among its user-base – which is approaching 24,500 – and the LLP team usually receives around 800 emails per month. This article introduces the team and also some of the wider support and governance around the LLP.

The LLP team is headed by Esma Doganguzel, Product Manager, and she is supported by Avia Spiers and Tunde Arowojolu, Product Owners, and Chris Kennedy, Revalidation and CPD Co-ordinator. The team blends strategic oversight, development, training, and regulatory expertise, and is committed to supporting and addressing the evolving needs of our users and to improving the LLP in innovative and progressive ways.

This article explores how to make the most of indirect supervision.

The 2021 curriculum was explicit about having ‘levels of supervision’ embedded within it. These are descriptors of the supervision level the anaesthetist in training (AiT) would require if they were to repeat the same Supervised Learning Event (SLE) immediately after. 

The past two years as editor have been an honour, and I very much enjoyed reading and reviewing the broad range of interesting articles – from personal experience through to evidence-based initiatives. 

That is what makes the Bulletin so unique, there is an article (or I would hope more!) to suit the interest of each reader. This issue, as is traditional with the autumn issue, focuses on research and innovation within our specialties.

As the first female editor of the Bulletin of ethnic minority descent, it is heartening and relevant to close my tenure with a guest editorial centred on the NIHR’s Race Equality Framework. Ensuring equitable recruitment into research through a framework such as this, underpinned in co-development with those with lived experience, is a significant move forward towards equity and inclusion. Note: I emphasise equity, rather than equality. As a series of specialties, my heartfelt vision would be that, from patient recruitment through to opportunities in research and innovation, we achieve equity – access for all.

My first President’s View features edited highlights from a podcast I recorded with fellow Council Member and Bulletin Editor Dr Ramai Santhirapala. We discussed several topics including questions submitted by our membership engagement panel. 

You can listen to the full conversation on our Anaesthesia on Air podcast. I also recommend that you take a moment to watch or read the CEO update, in which Jono Brüün provides an update on recent decisions about Churchill House and finding a new home for the College.

It’s been nearly a year since we published our independent and internal reviews of the FRCA examination together with a commitment to develop our examination and review our processes. This article provides an overview of the positive steps taken since publication to enhance the quality and effectiveness of the examinations in the RCoA, FICM and FPM.

Our Awards allow us to recognise the outstanding, often hidden achievements in the fields of anaesthesia or relevant science, critical care medicine or pain medicine.