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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.

I recently listened to two anaesthetists talking in a coffee-shop queue.
One was of a certain age and clearly exasperated at having to contemplate the supposed burnout levels in my generation of anaesthetists in training. He simply couldn’t understand it. After all, in his day they worked hundred hour weeks! ‘Bloody snowflakes’, he reflected. The other nodded gravely.

‘Snowflake’ is a term commonly wielded by our elders to bludgeon what they deem to be a fragile, over-sensitive and under-resilient youth of today. A people unable to cope with life. It does however require a certain amount of historical amnesia to use this slight without some irony catching in the throat. Did they not enjoy rock bottom housing prices, free higher education and high levels of job security, only to then preside over their decimation?

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.

Airway management is a crucial aspect of patient care, where effective and prompt actions can be life saving. The RCoA recognises the importance of continuous education and training to ensure healthcare professionals are well equipped to handle complex airway scenarios.

Multidisciplinary simulation has arisen as a valuable tool in this regard, offering an immersive and dynamic learning experience that fosters collaboration among different professionals involved in patient care.

Traditionally, training in airway management has often been siloed, with the focus on individual disciplines. However, real-life situations demand a coordinated effort from various healthcare professionals, including anaesthetists, operating department practitioners, nurses, physiotherapists, surgeons and theatre nurses. Therefore, conventional training styles may not adequately prepare individuals for the intricacies of interdisciplinary communication and cooperation.

Read the latest letters submitted by members in Winter's Bulletin. If you'd like to submit a letter to the editor, please email us.

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’.

Our working lives as anaesthetists revolve around effective teamwork, communication, and empathy with the many different professions we interact with. Interprofessional education (IPE) is an increasingly familiar teaching methodology which aims to enhance and improve these collaborative abilities. 

Considering recent critical reports on the lack of teamwork and interprofessional co-operation within clinical systems, we present a review of IPE and how its increased adoption may help address these failings.

Jason Williams-James, RCoA Patients Voices member with personal experience of surgery and anaesthesia, discusses the importance of DrEaMing with Eleanor Warwick, ST6 Anaesthetist and Perioperative Quality Improvement Programme (PQIP) Fellow. They discuss why patients, the surgical multidisciplinary team (MDT), and organisations should be interested in this quality improvement metric.

It is safe to say that the laryngoscope is one of the most recognisable tools within anaesthesia. A piece of equipment that has evolved throughout the years to be used by airway specialists, the humble laryngoscope allows us to perform one of the fundamentals of anaesthesia: to intubate an airway.

The COVID-19 pandemic has accelerated a trend within anaesthesia – a move away from direct laryngoscopy (DL) towards video laryngoscopy (VL) as the primary method of intubating the airway.¹ Indeed, from recent conversations with my colleagues about their choice of airway tool, I’ve noted a general theme: DL is fast becoming an unfavoured and unfamiliar technique for management of a patient’s airway. This sentiment was reflected in the updated Difficult Airway Society (DAS) guidelines in 2015: laryngoscopy as part of Plan A can now comprise either DL or VL attempts.²