Who are anaesthetists?
Anaesthetists are generally understood as the doctors who ‘put you to sleep for surgery’. Certainly, this is an important part of their work, but anaesthetists, as highly trained specialists, have a scope of practice which extends beyond anaesthesia for surgery, to include pain management and intensive care. Anaesthetists have a medical background to deal with many emergency situations. In these situations they provide vital care of breathing, resuscitation of the heart and lungs and advanced life support.
Quote from an anaesthetist
"I originally became an anaesthetist in the 1970s because the role offered good promotion prospects and the ability to move around the country. As I became more senior I realised it was a very satisfying job with diverse opportunities."
What is the nature of the work?
With over 6000 consultants and other career grade doctors working within anaesthesia across the UK, this specialty usually forms the largest department in any hospital. Anaesthetists come into contact with two-thirds of all patients admitted to UK hospitals, and they are increasingly called upon as perioperative physicians. Most anaesthetists’ work revolves around operative procedures, but the role is varied, and they are also involved in acute pain rounds, chronic pain clinics, intensive care units and labour ward duties.
What do anaesthetists do outside of theatre?
Although the anaesthetist’s major role is to provide anaesthesia during surgery, only about 50% of their time is spent in the operating theatre overall. The rest of their time is divided among the following areas:
• Preparation of surgical patients
• Relief of postoperative pain
• Obstetric units
• Cardiac arrest teams
• Intensive care units
• Emergency departments
• Chronic pain management
• Acute pain teams
• Dentistry
• Psychiatry for patients receiving electro-convulsive therapy (ECT)
• Radiology and radiotherapy
Anaesthetists may lead or manage various departments, playing a major role in day surgery, operating theatres, recovery units, critical care services, high dependency units and resuscitation services. The specialty has a history of diversification, and pain medicine is a much needed specialty which has spawned from anaesthesia. Anaesthetists are also widely involved in the teaching and training of undergraduate medical students, postgraduates, nurses, midwives and paramedics.
What skills do anaesthetists need?
Anaesthesia allows specialists to work in an intensely practical way. Every patient has a needle inserted in their vein, and, in more complicated cases, arterial or central venous lines are inserted. Airway management is also a key component. This may involve face masks, laryngeal mask airways, endotracheal intubation or tracheostomies. Common regional anaesthetic techniques include epidurals and spinals. Nerve and plexus blocks are also frequently performed.
Are there any associated sub-specialties?
Anaesthetists all learn the same core competencies in their early training. Although the CCT in anaesthesia does not have sub-specialties, anaesthetists develop interest and expertise in an area of their choice in the later years of training. This might be in areas such as:
• Cardiac
• Obstetric
• Neurosurgical or paediatric anaesthesia
• Pain management
Critical care can be accomplished as a joint CCT, but this is not mandatory for consultant appointment with an interest in this subject.
What is an average day like?
Every day is different, but a typical day might begin at 7.30am, visiting pre-operative patients from the morning’s general surgery list. After equipment tests, the anaesthetist administers general anaesthetic for a patient undergoing inguinal hernia repair. The next case is a right hemicolectomy in an 80-year-old patient with COPD which requires a thoracic epidural, and an arterial line and a CVP line once anaesthetised. Then a patient in ITU needs to be handed to an anaesthetic SPR colleague. Lunch could be attending the Grand Medical Round in the Postgraduate Centre. In the afternoon, it’s time to review patients and request an echo on an elderly patient who will have a hip hemiarthroplasty. The first patient of the afternoon is a six-year-old boy requiring a manipulation of a forearm fracture anaesthetic. He needs a patient adult to explain that the magic cream will stop him feeling the needles, and that his mother will stay in the anaesthetic room until he goes to sleep. A quick postoperative round finishes the day, but it’s not uncommon to pick up a gift or card from a grateful patient before leaving.
What are the hours like?
Anaesthetists start their day early, generally before 8am. Their finish time depends on how the surgery goes, but over the week they’re unlikely to have too many late finishes (or else they are reflected in the consultant job plan). The on-call requirement is variable, but typically one night a week and one weekend in anything from one-in-five to one-in-12 (or even less). Good working relationships with colleagues allow shift swaps where possible.
Where is the work based?
The anaesthetist may be based in theatre, the day stay unit, the pain clinic or the obstetric unit. He or she may also be teaching or carrying out research.
What people work in the same team?
The operating theatre team is made up of the anaesthetist, surgeon, operating department assistant, scrub nurse, runner, recovery nurse and porter.
What types of patients are encountered?
Anaesthetists see all sorts of patients, from neonates (or even foetuses still in utero for some sorts of foetal surgery) to elderly patients. The concomitant illnesses range from none, to all the diseases imaginable and even syndromes one has never heard of – especially in paediatric anaesthesia. The internet comes in handy to check up on anaesthetic implications.
How many patients are seen in a day?
It very much depends on the type of list. A cardiac anaesthetist may only anaesthetise two patients in a day, whereas a dental or gynaecological anaesthetist may well do in excess of a dozen.
What is most enjoyable?
Every anaesthetist will have different views as to the best bits. It could be seeing an individual safely through an operation, delivering a baby by Caesarean section or undergoing a curative surgical procedure. Some enjoy the technical side and love having a new toy to play with in theatre. Others love the immediacy of results, or seeing a patient through a difficult operation safely and giving them the confidence that all will be well.
What is most challenging?
Scared patients or technical difficulties can be tricky, but on occasion the biggest challenge can be the surgeon! Anaesthetists are often seen as the most capable doctors at dealing with sick patients. They are often called on for help in difficult situations. It is not a career for the faint hearted, but supportive consultants encourage trainees to develop critical skills.
Are there opportunities for flexible training?
Flexible training is well established in anaesthesia.
Are there opportunities for research and teaching?
There are many opportunities for teaching. Anaesthetists often teach junior anaesthetists, nurses, midwives, paramedics, medical students – anyone who will listen in fact! Research is encouraged and is usually carried out in the later stages of training. However, the opportunities for research are not universal and may depend on whether there is a university department or an enthusiastic consultant nearby. There are many opportunities for audit. The Royal College of Anaesthetists publishes an audit recipe book in case you are stuck for ideas.
Are there opportunities other than consultant-level work?
There are staff grade and associate specialist posts available. Many anaesthetists do not want the administrative hassle that can go with consultant practice, but love their clinical work and become expert in their own right in particular fields. They can become teachers recognised by the Royal College of Anaesthetists.
What are the key skills and competencies needed?
Anaesthesia is a varied specialty. There are so many separate disciplines within anaesthesia that it should come as no surprise to learn that anaesthetists tend to be a diverse bunch. They can range from computer-loving control freaks to laid back, hippy-surfer types. Most of them are somewhere in between these extremes. The key attributes of a good anaesthetist are:
• Self-reliance and the ability to assess the severity of life-threatening conditions, as well as initiate emergency treatment
• An understanding of their own limitations and the need to call for help
• Attention to detail (especially with regard to monitoring and record-keeping)
• Good communication skills with relatives and patients
• Good interpersonal skills to deal with all members of the theatre team
• Reliability
• Ability to self-motivate
• Punctuality
• Flexibility
• A good team player
• Reasonable manual dexterity
Training in anaesthesia is competency based. This means that the skills, knowledge and behaviours required are identified at each stage of training (see www.rcoa.ac.uk for the full curriculum). Training is organised in schools of anaesthesia throughout the UK, and these ensure that every aspect of training is delivered.
What other specialties use a similar skill and competence set?
Anaesthesia has much in common with acute specialties, such as emergency medicine and acute medicine. In fact, there is a 2-year Acute Care Common Stem (ACCS) programme which incorporates these specialties with anaesthesia and critical care, to provide a broad-based training before starting specialty specific training.
What qualifications are required?
Candidates require MBBS or equivalent medical qualification. Entry into ST3 also requires successful completion in primary FRCA examinations or equivalent.
What is the length of training?
Under the MMC revised curriculum for anaesthetics, the indicative length of training for the award of a Certificate of Completion of Training (CCT) is 7 years. With forethought and planning, a dual CCT in anaesthesia and ICM can be obtained in the same time. Trainees who enter anaesthetic training via the ACCS programme should expect to spend a total of 8 years in training for the award of a CCT in anaesthesia. The postgraduate training curriculum for anaesthetics is approved by the Postgraduate Medical Education Training Board.