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Dr Andrew Sharman shows us that rotational training, while offering a broad range of training opportunities, doesn’t come without its challenges and tells us what the Faculty is doing to overcome them.

Another year goes by, and again I am humbled by the resilience and resolve of our resident doctors.

Last year, responses to our intensivists in training (IiT) survey were overall very positive for ICM training, with resident doctors appreciating their trainers. Also, our regional advisors survey demonstrated how much excellent work is ongoing across the country. Exam and regional teaching courses, mentoring programmes, and the offering of a variety of Special Skill Years (SSYs) are just some examples of an ever-growing list of successes.

Dr Viola Mendonca and Dr Emma Smith look at the effectiveness of medical students in recognising cardiac arrest, initiating chest compressions, and delivering defibrillation.

The annual incidence of in-hospital cardiac arrest is 1 to 1.5 per 1,000 hospital admissions, and return of spontaneous circulation is achieved in 53% of those who are treated by a hospital’s resuscitation team.

The hospital resuscitation team must, at a minimum, be able to perform basic airway interventions, including the use of a supraglottic airway in adults, intravenous cannulation, intraosseous access, defibrillation, and drug administration. They also should be able to provide immediate post-resuscitation care. In some hospitals, the cardiac-arrest team may not include an anaesthetist, but advanced airway skills such as tracheal intubation should be accessible when needed.

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.

As this issue’s theme is training, we’ve picked out six for anaesthetists in training, supervisors, or anyone involved in training. We hope you find them interesting and helpful.

If you’d like us to feature resources from your subspecialty here, or have any other suggestions or feedback, please email us at education-resources@rcoa.ac.uk.