Knowledge about training program/career Flashcards
What can you tell me about the training program for anaesthesia?
5 years
Core units - IT, BT, AT, Provisional fellowship year. Minimum requirements for each core unit - time, VOP, WBAs, courses (divided into the different clinical fundamentals)
Core unit review before progressing to next stage - extended training if not passed (26wks, IT, 104wks BT, 156wks AT, 52wks PF)
12 specialised study units undertaken during BT/AT (cannot do SSU WBAs as IT but can gain VOP)
5 scholar role activities including audit
- Completed SR - may be eligible for exemption for critical appraisal or topic or paper
ANZCA roles in practice throughout course. Clinical fundamentals from IT to AT (not PFT)
3 months ICU Rural time (not ANZCA requirement but part of QARTS)
Clinical placement review at least every 6 months by supervising senior staff
- Planning CPR at the beginning of placement
- Interim if >6 months placement duration
- Feedback CPR at completion
IT
- first 6 months
- must complete initial assessment of anaesthetic competence
- 100% Level 1 supervision
- Expected to be able to run low risk cases of low complexity with level 3 supervision
BT
- Minimum 18 months in accredited facility
- 2/5 scholar role activities
- ALS course + CICO course
- Primary exam
- 50% level 1-2 supervision
AT
- minimum 104 months in accredited facility
- Remaining scholar role activities
- Pass final exam
- Complete EMAC and EMST
- 50% lvl 1-2 supervision
- Completion of formal project (part of AT module 11)
a. Proposal must by submitted to regional formal project officer
b. Broad range of topics educational, research or quality improvement
Provisional fellowship training
- at least 20% clinical and 10% non clinical (research, audit, teaching, admin etc.)
- Consultant level practice expected by end
- minimum 30% lvl 1-2 supervision
What is CPD?
Process of continual learning and improvement, a necessary part of the first role in practice (Medical expert)
Also a condition of ongoing medical registration to achieve minimum CPD point requirements
Formal
- courses/conferences
- research/ audit - presentations
- formal teaching
- associations/membership can help with this
Informal
- Clinical experience
- practice review - Feedback from colleagues and patients (clinical placement reviews, multi source feedback, case based discussions can all be done informally)
- keeping up to date with relevant literature
- self reflection
- Teaching junior colleagues
- Mentor
Maintaining good health to enable good practice
What is the role of ANZCA vs QARTS?
ANZCA roles - Training - Accreditation - Research - Setting standards QARTS role - Selecting registrars and organising rotations
- QARTS is an approved rotation training program accredited by ANZCA in accordance with the ANZCA handbook for training and accreditation
- QARTS administers selection and placement of registrars throughout Queensland
- Rotation through metropolitan and regional hospitals in QLD, NSW and NT. At trainees required to spend at least 6 months outside of SE QLD
- Registrars expected to accept offered rotations. In exceptional circumstances written applications can be sent to rotational supervisor
- 2 of the first 4 years should be spend in peripheral metropolitan or regional hospitals. Exceptional circumstances –> QARTS rotational coordinator
Who is there to help and guide trainees along the way?
OR
Who do you go to if you’re having trouble with the training program?
a. Supervisor of training
b. Mentor
c. Senior department members
d. Regional education officer
e. Advisor of candidates for anaesthesia training
f. Member of welfare of anaesthetists special interest group
g. Professional counselling services - Doctors health advisory service, lifeline, GP, drug and ETOH services
i. Family, partner, friends, colleagues
Review ANZCA handbook for training which has additional information on flexible training options such as part-time training if required in extreme circumstances
What’s your understanding about the history of the college?
1900s - Anaesthetic training began to be introduced into general medical training as a certificate of proficiency
1909 - Rupert Hornabrook became Australia’s first full time anaesthetist with no particular training or professional organisation. Anaesthetists were members of physician and surgical colleges.
1952 - Royal Australian College of Surgeons founded a Faculty of Anaesthetists
1992 - ANZCA formed. 3rd largest specialty medical group in Australia at the time.
1999 - Faculty of Pain Medicine founded
ANZCA has since advanced anaesthesia throughout south-east Asia and the Pacific, assisting in training in Singapore, Malaysia, Hong Kong and other countries.
Main objectives of ANZCA
- Anaesthesia, periop medicine and pain medicine - education, scientific advancement and promote professional standards and patient safety
Directly responsible for examination and qualification of anaesthetists and the standards of practice in Aus and NZ
ANZCA promotes consistent ratios between rural and remote areas and works closely with hospitals to encourage this
There are now 17 special interest groups within ANZCA for CME
What makes a good anaesthetist?
- Medical expert - knowledge and skills, organised and logical
- communicator - staff, patients, families
- collaborator - negotiate with multidisciplinary teams and resolve conflict
- leader and manager - coordinate theatres, staff and resource allocation, time management
- Health advocate - on behalf of individual patients, patient groups and staff
- Scholar - analysing and performing research, quality improvement, education
- professional - commitment to ethical practice, societal needs and the anaesthetics profession, culturally appropriate health care, recognises own biases
What problems might you experience on the training program and how would you cope with these?
Clinical
- performance below expectations, anaesthetic crises, perceived responsibility for patient outcomes, perceived lack of support (study/CPD, mentor/supports)
- interpersonal conflict
- serious - bullying, substance abuse (know how to escalate and support others)
Training
- exam stress (plan, study group)
- loss of VOP or covid redeployment (contact SOT early, open to new skills)
- rural (don’t previously, enjoyed by getting involved with community and kept in contact with family and friends through FaceTime)
Personal
- loss of time, fatigue from long hours and shift work (horn and work organisation, leave. Supports)
- Financial (funds set aside)
- health -COVID or other workplace hazards (know flexible training options available)
C
- Clinical performance below expectations
- Fatigue and burnout from long hours, shift work, study
a. Experience with shift work from ED and crit care roster
b. Safe working hours standards from AMA
- Stress from anaesthetic crises and perceived responsibility for patient outcomes, workload, perceived lack of support/pressure, self doubt
A
- Exam prep, stress of failing exams
M
- Conflict with other health professionals
- Working to schedule of others (surgeon/theatre coordinator)
P
- Loss of personal time
a. Supportive partner who understands the difficulties of examinations
- Illness or personal problems during (but not related to) training
a. Part time/interrupted training possible in severe circumstances
- Substance abuse
a. Supportive social circle who will look out for me
b. Have previously helped others though mental health issues, willing to support my colleagues through difficulties
- Financial and personal stressors of relocation for rotations
a. Plan for this
b. Supportive family who can support me through this if required
- Rural rotations
a. Worked rurally for 6 months, loved it. Keen on rural work- more opportunities for learning
General things:
- Be organised
- Seek advice early
- Plan for financial stressors
- Help help (e.g. cleaner)
- Eat, sleep, exercise
- Maintain relationships
Supports Self care - Professional, personal, recognise stress Health care Work organisation - leave, CPD Home organisation f
Who do anaesthetic registrars teach?
Patients Community groups (e.g. basic life support)
OT, PACU and anaesthetic nurses
Anaesthesia technicians
Trainee nurses
Medical students
Interns and residents
Other trainees
Specialist anaesthetists (presentations of specific topics, audits etc.)
What are your thoughts about rural rotations? Would you consider working in the country beyond the minimum requirement of your programme?
Yes, I plan to work rurally during my career and find rural rotations give far better learning opportunities.
C
- Significant time rurally as RMO and at JCU and 6 months last year. Exciting clinical challenges of dealing with problems in lower resources settings and accepting additional responsibility.
- Worked with ACCRM anaesthetists and locum rural anaesthetists to get a better understanding of what this involves and pathways to anaesthetics in rural settings which is my career goal
A
- MPH&TM - rural, indigenous and tropical health. Provide culturally appropriate care to underserviced populations
M
- I know how to get help in crises in rural locations, particularly through retrieval services Queensland who can offer phone advice as well as coordinate retrieval + ? Opportunities to be involved in retrieval on rural, which is an interest area of mine
P
- Strong sense of community in rural towns. Have had rewarding experiences like visiting a patients farm and helping muster cattle while on rural in longreach or joining community events
- active lifestyle - hiking, climbing, mountain biking
Disadvantages
- Understand these placements can feel isolated and unsupported - I am able to recognise my limits in practice and know when to seek help.
- Increased workload due to short staffing
- Good coping strategies and who to talk to for help
- was away for 6 months last year and coped well with this so I know I am prepared
Coping with isolation
- regular leave - recreation and CPD
- CPD meetings for education and networking
- peer support group or study group (over zoom if needed)
- professional organisations (rural SIG)
- mentor
- know what resources/supports are available
- enjoy the unique lifestyle opportunities in the town
- recognise symptoms of burnout
When are you sitting the Primary and how are you preparing?
Planning to sit sitting of my second year (2023 provided straight onto pathway) so I have an opportunity to re-sit without causing extended training
I know this is a very hard exam so have started preparing early
Study plan
- MAK95
- Reg’s + fellows
- Study group
- Mentor - Primary tutor at PAH
Knowledge
- ANZCA library
- Past questions/examiners comments
- Previous notes
- Textbooks
- PLP
- PA/Mater primary teaching - SAQs
Personal
- Home organisation
- Financial
- Discussed with fam/partner
- Healthy/Socialisation
- Supports
Consequences/options if fails
Summary - understand challenges I will face, have developed a study plan, bank of resources and strategies to improve resilience
What’s your understanding about the history of Anaesthesia in Australia?
Anaesthesia - practice of blocking the feeling of pain to facilitate medical and surgical procedures
Opium and ETOH were previously used, and few operations were possible, with speed being the determinant of a successful surgeon. Patients often had to be restrained and surgery was extremely painful.
1846 - William Morton (an American dentist) proved ether provided suitable analgesia for surgery, performing an operation in front of a crowd of doctors
1847 - William Russ Pugh (Tasmanian Doctor) and John Belisario (Sydney Dentist) fashioned ether inhalers and performed operations under anaesthesia. This practice reached NZ soon after that same year.
Not only did ether improve analgesia, but allowed increased operating time and more complex procedures to be performed.
Could you outline what the daily tasks of an anaesthetic registrar would be?
- Morning meeting or handover after night shift
Pre-op: - Reviewing patients and charts for pre-operative assessment +/- optimisation (often day before)
- Handover of emergency cases
- Coordination with consultant and nursing staff for anaesthetic plan
- IV, art lines, airway management
Intra-operative: - autonomic, analgesia and anti-emetics provision
- Maintenance and emergence of anaesthesia
Post-op: - Management of pain, emesis and complications
Ward: - Peri-op consultations
- Assistance with airways, vascular access, regional anaesthesia
- Pain rounds
Other: - On call for emergency procedures
- Anaesthesia from remote locations (e.g. radiology)
- Pre-admission clinic assessments
Non -clinical
- Research
- Audit
- Reg teaching
- Teaching others
- Study and assessment tasks
Who is in charge when in the operating theatre?
Collaborative and multidisciplinary environment.
Everyone has own tasks
Working together for common good of patient
Surgery can’t exist without anaesthetic but anaesthetists can’t work without surgeons
While we work together we have our own thing a that we specialise in
Collaborative decisions and negotiation such as local doses, although anaesthetics often have final say
The real question of leadership come to emergency situations. While the surgeons have a focused task, the anaesthetists has a global view of the patient and understanding of their physiology and is expected to take a lead role in these situations
Case by case - senior surgeon and junior anaesthetist
What do you see as the negatives of a career in anaesthetics?
Career satisfaction
- not glorious
- not directly contributing to improving the patients health
- no long term doctor patient relationship
- boring - although many sub specialty/ interest areas
Rewarding nature of rural work
Different specialty areas for variety if required (pain medicine for doctor patient relationship and patient outcomes)
Secondary to surgeons
- working to surgeons time
- pressure from surgeons to be quick (particularly private)
- maintain relationships with surgeons for employment (private)
- after hours and on call (particularly as reg)
Done a lot of shit work in the last year, know how to deal with this to prevent fatigue/burnout and maintain social life (but can continue working on this)
Health
- Health hazards of OT (radiation, needlestick, COVID)
- interpersonal issues, burnout fatigue
- suicide, substance use (in yourself and colleagues)
Poor outcomes
- personal responsibility
- mundane with periods of very high stress
- lawsuits/complaints (MDA)
Difficult training pathway - resilience, supports, discussed this with family and partner
C - Stress of managing a multidisciplinary team, emergencies with poor outcomes, limited support after hours, although I recognise my limits and have been told be previous supervisors that I escalate very appropriately. Regarding stress, I believe I have good stress management strategies ___________
A - Registrar training will be difficult, particularly studying for the primary exam. However I have started preparing for this early and have a very supportive partner who is aware of the challenges of registrar examinations in addition to good stress management, so I think I am well equipped to handle this challenge.
M -
P
- Shift work and being tied to OT, lists running late impacting on work-life balance. However I have done 9 months of shift work through ED and rural placement and found ways of managing this. Very supportive partner and family and good social network to spend time with to help deal with stress and prevent burnout. When these groups were unavailable I would use my time to be productive, allowing me free time later to use socially.
Who have you spoken to about a career in anaesthetics?
Discussed with public and private anaesthetists and mentors, anaesthetic registrars, consultants in alternate careers I have considered, family and partner and colleagues.
Private and public anaesthetists through day surgery and junior doctor - better understanding of what the career involves, options for further specialisation and alternate pathways such as pain and allergy.
Anaesthetic registrars in all stages of training - what training involves, personal sacrifices for this, advice for how to get onto and how to succeed in training
Fellows - Advice on how to prepare for fellowship and consultant jobs in terms of qualifications
Rural locum anaesthetists - interest area of mine, pathway to this
ACCRM anaesthetists and GP seditionists - alternative career pathway
ED consultants and Physicians - Alternative career pathways
Family and partner - what training will involve, shift work and exams, time constraints. Potential for financial, psychological and time supports. Delaying personal milestones such as marriage and family.
What do you understand of standard precautions?
- Standard precautions are standard safe work practices that are applied to all patients regardless of infectious status.
- Minimum requirements for the control in infection in all settings and all situations, regardless of risk
- Designed to protect patients and staff
Elements of standard precautions:
- Handwashing
- Appropriate PPE for task
- Immunisation of staff
- Aseptic technique
- Management of sharps, blood spills, biological waste
- Routine environment cleaning
Additional precautions are additional measures to prevent transmission of specific diseases
- Include droplet, contact and airborne precautions
Are you familiar with the workplace health and safety regulations as they relate to the practice of anaesthesia in your hospital?
Physical Manual handling injuries - Training programs Electrical defibrillators, diathermy - BLS training Burns secondary to sterilization procedure - falls (lines/spills)
Chemical
Chemical hazards - Industrial cleaners, chemical sterilizers, cytotoxic, anaesthetic gasses
- Elimination, substitution, ventilation, PPE, cleaning spills
Fire
- Fire safety training, extinguishers
Biological Needlestick injuries - Don't re-sheath - Sharps disposal - Needle guards e.g. insyte autoguard Aerosol, skin, body fluid exposure - PPE, handwashing - Vaccination - Body fluid exposure protocol - first aid, post-exposure prophylaxis, test source and staff, report incident
Radiation Radiation exposure - Storage, shielding, regular maintenance and inspection, certification, radiation exposure monitors, appropriate training and accreditation Laser burns - Protective eye equipment
Psychological
Personal violence
- Personal alarms, security staff, restraints/sedation where safe
Fatigue, burnout, stress, abuse from patients, interpersonal problems, bullying
How do you think COVID will impact your training?
C
- VOP - elective cases cancelled. Notify SOT early if not looking like going to reach VOP
- Redeployment to ICU - opportunity to gain experience in another specialty
A
- Exam cancellation - maintain knowledge, additional study time
- Courses cancelled
- Presentation opportunities effected - audit and formal project. New opportunities for virtual presentation
M
- Teaching juniors - rewarding activity and required for scholar role. Look for alternative methods of teaching
P
- Lockdown
- Overtime due to short staffing - resilient with good coping strategies
- Exposure and personal health - PPE, vaccination
While these are challenges we all share in this responsibility as clinicians to serve the greater good. While it is disruptive to training, I understand these are required to provide good patient care. Instead of focusing on negatives think about what can be done about them, as well as positives and new opportunities.
What is your understanding of the training portfolio system?
Online portfolio allowing trainees and supervisors to record and track progress and encourages real-time feedback from supervisors.
Partly viewable to SOTs and others to see trainees progress
Records:
- volume of practice with de-identified patient data
- Training time
View clinical placement plan View WBA results - mini clinical evaluation exercise (Mini CEX) - direct observation of procedural skills (DOPS) - Case-based discussion (CbD) - multisource feedback (MSF) View clinical placement reviews Provide details of courses attended View details of exam attempts
How is registrar performance assessed?
Formal - through TPS
VOP
WBAs - mini-CEX, DOPS, MSF, CbD
Courses - ALS, EMAC, CICO, paeds life support course, neonatal resus
Clinical placement review at the start and end of each placement or at least 6 monthly
Assessments specific to SSU, Core study units and scholar role activities
Initial assessment of anaesthetic competency
All of these include observation of practice or discussion followed by supervisor feedback and trainee reflection (MSF involved feedback from non-anaesthetists as well)
Uploaded on TPS for trainees to review at any time
Informal assessment
Feedback
Reflection
Patient outcomes
Why do people look to anaesthetists as leaders?
- Clinical role in practice, part of training
- Good at communicating and collaborating
- Role in managing teams and allocating resource
- Familiar with high stress situations
- View of whole patient, understanding of surgical and medical problems
What do anaesthetists do?
Wide variety of roles above simply facilitating surgery
- New and expanding areas of practice such as periop and pain medicine and niche areas like retrieval medicine or dive medicine.
- Special interest groups allowing further development of specific skills or non-clinical focuses such as the welfare of anaesthetists SIG
Clinical roles of anaesthetists are outlined in the ANZCA clinical fundamentals:
- GA and sedation
- Airway management
- Regional and local anaesthesia
- Perioperative medicine
- Pain medicine
- Resuscitation, trauma and crisis management
- Safety and quality in anaesthetic practice
Probably better encompassed by the ANZCA roles in practice:
- Medical expert
- Fundamentals fit in here - Communicator - Both with patients, families and other staff members
- Collaborator - Working with other health professionals as part of a team with a common goal for high quality patient care
- Leader and manager - Allocation of finite theatre resources and quality improvement, optimise healthcare systems and quality improvement of these systems
- Health advocate - Both for patients, colleagues and the environment in which we work
- Scholar - Conduct and interpret research
- Professional - Commitment to ethical and culturally appropriate practice
Day to day work will vary greatly depending on area of work, special interests and non-clinically activities. Important non-technical roles in communication, collaboration and leadership.
