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We hope you will find this information useful in helping all anaesthetic staff within your department access the educational supervision or mentorship they require.

Introduction

In addition to consultants and doctors in formal training, anaesthetic departments frequently contain SAS and Locally Employed Doctors. SAS doctors are employed on national SAS contracts, the current of which are ‘Specialty Doctor’ and ‘Specialist’. Locally employed doctors (LEDs) are employed on non-national Trust-derived contracts. LEDs have multiple titles including ‘Clinical Fellow’ and ‘Trust Doctor’. Medical Training Initiative (MTI) doctors are also commonly employed as LEDs and form part of this latter group. 

Within this combined cohort are doctors at all stages of their careers, with individual development needs. To maximise the potential of the existing anaesthetic workforce, it is imperative that these doctors are offered support to achieve their potential and reach their career goals. These goals may include broadening their role into non-clinical domains, (re)entering formal training, becoming consultants through the GMC Portfolio Pathway or becoming Specialists. 

• Dr Dermot McGuckin, ST7 Anaesthesia & Pain Medicine, University College London Hospitals
  Email Dr McGuckin
• Dr Fausto Morell-Ducos, Consultant in Anaesthesia & Pain Medicine, University College London Hospitals
• Dr Jamie Smart, Consultant in Anaesthesia & Pain Management, University College London Hospitals
• Dr Brigitta Brandner, Consultant in Anaesthesia & Pain Management, University College London Hospitals

Opioids play an important role in facilitating recovery and return to function after surgery. 

However, it is now well-established that surgery is a risk factor for persistent postoperative opioid use,¹ and preoperative opioid use is associated with an increased risk of perioperative complications.²

Perioperative opioid stewardship is a practical approach providing a systemic, multi-layered framework aimed at minimising the risks associated with opioid use around the time of surgery, while allowing their safe administration to those patients most likely to benefit from them. It is increasingly regarded as a solution to the problem of prescription opioid-related harm but there is a lack of structured curricula to develop healthcare professionals’ skills in competent opioid management.

The Difficult Airway Society (DAS) recommends awake tracheal intubation as a primary airway management technique in people with difficult airways. It can be achieved either by fibreoptic bronchoscopy or videolaryngoscopy. However, in our experience, despite the guidance, anaesthetists are sometimes reluctant to perform either.

While it’s useful to be able to perform both techniques depending on what’s needed for the patient, videolaryngoscopy requires fewer technical skills and can be applied with a comparable success rate and safety profile to fibreoptic intubation. Furthermore, the more commonly the procedure is undertaken, the more that anaesthetists and the wider anaesthesia and theatre teams come to regard it as a straightforward, almost ‘everyday’ event. This creates a virtuous circle where it then becomes even easier to consider and perform.

With this in mind, we suggest that anaesthetists should be introduced to awake video intubation early in their career. Seeing that airway management can take place without general anaesthesia opens up a range of possibilities and gives them further confidence for managing the various patients that could present with anticipated and unanticipated difficult airways.

Find out the latest appointments approved, and with sadness we record the deaths of some of our fellows. 

When I returned to my role as a CR&I/RCoA perioperative quality improvement programme (PQIP) fellow, I found this came with unique expectations and required planning. Hopefully by sharing what I learnt, it will help those who are returning to work after a period of leave, especially those returning to job roles that do not necessarily fit the norm.

Returning to work: general things to consider

When RTW there are key dates and tasks to consider. Table 1 details some of the things that need to be arranged and when these need to be done. There are also many resources to consult (see below ). Using these in conjunction with your hospital policy is a good starting point.