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I'm the RCoA’s Dinwoodie Simulation Fellow and an ST5 anaesthetist in training in the Thames Valley region. I’m pleased to take the opportunity to update you on some exciting developments in simulation.

Anaesthetics was an early pioneer in utilising simulation, recognising its benefits in rehearsing uncommon emergencies and how it can be used to develop non-technical skills. Anaesthetists in training can now expect simulation-based education to feature frequently throughout their training as they develop skills and practise the management of critical incidents, and it will continue to feature throughout our careers. Anaesthetists are also frequently seen delivering the simulation-based education, whether that is for peers or other members of the multidisciplinary team. Simulation as an educational tool has many guises, including part-task trainers to rehearse a skill before performing on a patient, sessions in a dedicated simulation suite and, most recently, immersive technologies such as virtual reality.

At the end of January 2024, the GMC published an updated version of Good Medical Practice, the core guidance for all registered doctors. This has been accompanied by guidance on a number of other areas, including confidentiality, consent and research, and legal and regulatory proceedings, all of which can be seen on the GMC website.

The opportunity has been taken to conduct a major review of the College’s supporting information for appraisal and revalidation.

Transitioning from Full-Time (FT) to Less-Than-Full-Time (LTFT) training has been a journey in revealing LTFT training disparities and discovering a new Health Education England (HEE) LTFT funding policy.

The Gold Guide’s latest guidance suggests that any trainee can apply for LTFT training (including those not yet in post but who have received an offer) provided they have a ‘well-founded individual reason’. In Yorkshire and Humber Deanery, the number of anaesthetic/ICM LTFT trainees has nearly tripled in the last five years. We anticipate LTFT numbers increasing in the future as more trainees seek better work–life balance. Training Programme Directors (TPDs) are encouraged to slot-share LTFT trainees, as this decreases gaps in rotas and continues to maintain recruitment (as LTFT training prolongs training pro-rata). This is important as the RCoA estimates that there will be a shortfall of 11,000 anaesthetists by 2040. If not slot-shared, a solo LTFT trainee does reduced sessions in a single FT slot.

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. 

Maintaining and improving the LLP

Since its launch in August 2018, the College has committed to improving the reliability, performance and general user experience of the Lifelong Learning Platform (LLP) for our members. With the inclusion of three new curricula and of ICM users in late 2021, it became apparent that the added level of complexity and the need to support more users required additional funding, so a sizeable new budget was approved by the College’s Finance and Resources Board in August 2022.

This additional funding has allowed us to resolve many historic issues, keep the infrastructure and related systems up to date, as well as making significant improvements where needed. We still have a great deal of work to do, but as you will see below, we have already achieved a lot over the last year and have a clear plan of where we are heading in the coming months.

Although many ICM doctors-in-training (DiTs) are now either training in ICM alone or with another partner specialty, just under half of our future ICM workforce are working towards a dual CCT with anaesthesia. 

Furthermore, many intensive care units around the UK rely on the knowledge, skills and experience brought by our anaesthetic colleagues in order to provide high-quality, patient-focused care. 

Consequently, anaesthetists will continue to hold a critical role in training the intensivists of the future.

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.

‘Who still uses succinylcholine?’ would be the first thought that comes to your mind on reading the title. But I am sure some of the experienced anaesthetists still have a soft corner and an emotional bond towards this wonderful short-and swift-acting champion.

I take this opportunity to share my experience with succinylcholine, which happened when I was new to the UK and trying to find my feet.

A 16-year-old boy presented to A&E with torsion testis and was posted for urgent surgical repair in the CEPOD theatre. Within the limited time available, I had taken a brief history and nothing was significant in it. He had never been exposed to anaesthesia in the past, and his parents had undergone general anaesthesia in the past but had no issues. He had food two hours before coming to the hospital.

• Dr Stuart Connal, Specialty Registrar in Anaesthesia, North Central London Deanery

Perioperative Journal Watch is written by TRIPOM (trainees with an interest in perioperative medicine – tripom.org) and is a brief distillation of recent important papers and articles on perioperative medicine from across the spectrum of medical publications.