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Authors:

• Dr Sangita Kindred, Anaesthetic Trainee, North Central School of Anaesthesia
• Dr Tim Jackson, Anaesthetic Trainee, North Central School of Anaesthesia
• Dr Kate Sherratt, Consultant Anaesthetist and North Central London Training Programme Director, 
  Royal Free Hospital

We are in the midst of a climate emergency. With record-breaking heat waves and flooding over the last few years, the danger to our patients’ health is undeniable. Even the World Health Organization described climate change as ‘the single biggest health threat facing humanity’.¹ Therefore, we have a duty as healthcare practitioners to change our practice to protect our future patients. Even the GMC has changed its guidance on ‘Outcomes for Graduates’ to reflect this need.²

Anaesthetic gases make up more than 2 per cent of the NHS’s carbon footprint, and reduction in their use is central to the NHS long-term plan to reach carbon net zero by 2045.³ Desflurane is a particularly harmful greenhouse gas, with a global warming potential over 100 years (GWP100) which is 2,540 times greater than carbon dioxide.⁴

We would like to use this Bulletin article to focus on setting up a Personal Development Plan (PDP), some guidance on what should and should not get included, and to address a query about using your PDP in the Lifelong Learning Platform. In providing this advice we are making reference to the Mythbusters¹ guidance which has been produced by the Academy of Medical Royal Colleges.

The goals within the PDP should be taken from your appraisal, and should meet your needs and the context within which you work. It is recommended that goals are developed with your appraiser using SMART (Specific, Measurable, Achievable, Relevant and Timely) objectives, and it often helps to work out how you can demonstrate that a change planned as one of your goals has made a difference, by considering its impact on patients.

Credential

Pain Medicine has now reached a milestone, and for the first time ever doctors trained in specialist pain medicine will be able to have this recognised by the GMC. The credential curriculum is now approved by the GMC and has been developed to take into account the different specialty backgrounds that doctors may come from, providing detailed information for both trainers and trainees alike. Credentialing will be integrated into the CCT curriculum for anaesthetics but will also open the route of training in other specialties.

As I sit down to write this article, I am very much aware that today is the anniversary of the death of my mother. A strong-minded, intelligent and, above all, proud woman, her greatest fear as she became increasingly physically frail was a loss of dignity, something she had witnessed in the slow demise of her own mother.

From middle age onwards, she wrote me detailed letters describing what she would and would not tolerate as she got older, and instructing me, the only doctor in the family, to do everything possible to help her to die peacefully when the intolerable became manifest. Sadly, the law forbade such measures and, despite receiving excellent care in her failing years, she suffered much of the indignity that she most feared before passing.

Cardiotocography (CTG) to monitor foetal heart rate is frequently used on the labour ward to monitor for foetal distress. Interpretation of CTG is routinely undertaken by the obstetric and midwifery teams to guide labour interventions, along with the mode and urgency of delivery. Anaesthetists are a key member of the multidisciplinary team, and we should therefore understand CTG. This knowledge can then help with joint decision-making, provide an additional set of eyes observing for foetal distress, and be an aid for choosing an anaesthetic technique.

Current training

The 2021 curriculum mentions CTG knowledge in both Stage 1 and in the Obstetric Anaesthesia Specialist Interest area.¹ However, there is a lack of clarity on how to obtain it. Despite there being excellent resources available for anaesthetists to learn about CTG interpretation, it is not formally taught or assessed.² It is left to the individual anaesthetist in training to obtain this knowledge, creating a lack of consistency in knowledge among anaesthetists.

The 2021 SAS contract reform introduced a new strategic role to support the health and wellbeing of the SAS workforce, the ‘SAS Advocate’. This role provides an opportunity to challenge the status quo, and to potentially change the culture and expectations associated with being an SAS doctor.

Perhaps the most common barrier to meaningful change is culture. Individuals and organisations can both be guilty of assuming that the status quo always exists for a reason. However, there is perhaps no more dangerous justification for continuing to do something than that ‘we have always done it this way’.

When English chemist Joseph Priestley discovered ‘dephlogisticated nitrous air’, or nitrous oxide in 1772, he unknowingly revolutionised medical practice. What Mr Priestley didn’t know was the significant impact that N₂O would have on the environment.

With a lifetime of 150 years in the atmosphere and a 100-year global warming potential 10 times that of carbon dioxide, N₂O poses a significant problem.

Are we regularly bulk-buying N₂O just to leak it straight into the sky? This is not a new idea. The Nitrous Oxide Project, started in NHS Lothian in 2021 by Alifia Chakera, found that usage of N₂O in the theatre setting was much lower than anticipated, with significant wastage in the supply chain. In fact, hospitals that have undertaken similar analyses report that 95–99% of the N₂O that’s bought is wasted due to leaks in both outdated manifold systems and in piped N₂O supplies.

COVID-19 has dominated and it is easy to focus on the negatives, but, as an eternal optimist, I see many positives. I had three objectives when I became dean, the first of which was to promote our specialty.

I think everyone now knows what we do and, as a result, we have increased training numbers, expanded capacity, and embedded enhanced care. My second objective was to develop international partnerships. Despite travel being restricted, embracing digital platforms afforded us the opportunity to work with the College of Intensive Care Medicine of Australia and New Zealand and the Apollo group in India.

It's been a pleasure working with the Anaesthetists in Training Committee and the Bulletin editorial team, but we will soon be handing over the reins to new representatives as we've moved on to start consultant jobs.

So, for our last training issue of the Bulletin, we thought it would be fitting to write about our personal experiences at the end of training and starting our new roles, along with some insight into how to get through the process smoothly.