Anaesthesia Trainee Case Study - South West Peninsula Deanery

South West Peninsula Deanery
Career Planning Service
Anaesthesia – South West Peninsula Trainee Case Study
Your background prior to studying medicine
I went to medical school straight from 6 th form.
The reason for choosing Anaesthesia
I didn’t always want to be an anaesthetist! I had very little exposure to anaesthesia during
medical school and embarked on an ‘Acute Specialities’ rotation with a view to a career in
Emergency Medicine. This rotation had 18 months of anaesthesia, medicine and A&E. It
took less than 6 months though, for me to decide anaesthesia was what I wanted to do.
I gradually became more confident, especially when dealing with critically ill patients, which
stood me in good stead for the medical job which followed. I learned to appreciate what it
really meant to be working as part of the theatre team.
The variety of patients we see in terms of age, pathology and personal needs is huge and I
enjoy the fact that anaesthesia crosses paths with so many other disciplines in medicine. I
have always been fascinated by physiology and am pleased that I have had to study it in so
much depth, not only for the exams, but to gain a much better understanding of pathology,
particularly in the acute and critically ill.
It goes without saying that the enthusiasm and commitment from the consultant
anaesthetists for training and teaching has perpetuated much of my passion for anaesthesia
and I still have a lot to learn (I’m about to embark on SpR Training) but I am confident in my
choice of specialty and looking forward to what’s ahead……After all, who knows how old
we’ll be when we can draw a pension!
The reality of working in Anaesthesia as a trainee doctor
Starting in anaesthesia can be a little daunting, especially the first few weeks. The operating
department is a unique environment; everyone dressed the same, which doors you can and
can’t go through and (the 8 th deadly sin) of wearing someone else’s shoes! Don’t be put off
by this!
Anaesthesia is a specialty where you have to build up gradually. You won’t be left alone to
begin with and will be expected to discuss everything with one of your seniors. As you pick
up speed you will be gradually left to do more but, in my experience, help and advice has
always been available when needed.
There is a huge variety of problems you will be exposed to from the chronically ill, elective
surgery, major trauma, ICU, difficult airway management, pain, obstetrics (including on-call
cover for the delivery suite) and resuscitation.
The anaesthetic department I work in has over 40 consultants and I’ve worked with all of
them at one stage or another. This gives you a great opportunity to learn many different
techniques and skills and also to develop your own practice (and style!). The possibilities are
endless!
Page 1
I:\Careers Planning\Careers Information\A-Z Careers Information
Sheets\Anaesthesia\Anaesthesia_Trainee_Casestudy_August09.doc

It takes about 3 months before going on the on-call rota. There are competency
assessments at all stages along the way. An SHO rotation will usually incorporate at least 3
months of ICU which, along with a minimum of 21 months in anaesthesia and the primary
FRCA, are minimum requirements in order to get an SpR post.
That being said…this may change next year with MMC. At the moment, you usually aim to
have passed the final FRCA by the end of the 2 nd SpR year and then continue to completion
of the CCST. Most SpR rotations incorporate a year which can be used for ‘off-rotation’
training e.g. working abroad, research, sub-specialisation, but these do have to be approved
for the appropriateness in terms of training, and it’s best to start planning this early.
Daily activities and responsibilities
If possible, the day begins the evening before by seeing the patients pre-op. I say ‘if
possible’ because many patients now come in on the day of the surgery but still all need an
anaesthetic assessment before the list starts. This can make the beginning of the morning a
little hectic…but also a bit of a challenge! You must make time to go and see the patients
first. The consultants, entirely reasonably, will not be impressed if you roll up to theatre at 9
o’clock looking bleary eyed from the night before. You have to be prepared for the lists.
Generally you would be on a consultant-led list throughout the normal working week, but
again the number of solo lists increases alongside your experience. The patients remain
your responsibility in recovery and you may well be called to assess pain, vomiting and other
problems. It’s useful to go and see the patients post-op…Have you given them enough/ too
much analgesia? Has your nerve block/ epidural worked?
At the moment, my on call commitments involve anaesthetics cover for the delivery suite. I
think this is an especially challenging and rewarding environment to work in. It’s very
satisfying to get an epidural up and running, but there can be life-threatening emergencies
which occur completely out of the blue. You have to be on your toes!
Wherever you’re working (be it in theatres, delivery suite, ED) we’re part of a large team. Not
all health professionals will have experience of anaesthesia or appreciate the nuances of a
particular case. Communication is vital. It is often necessary, for example, to discuss the
relative urgency of a case with the surgeon in terms of theatre time, other cases waiting to
be done and the expertise of the staff available. Not always easy!
Likewise, there will sometimes be difficult discussions with patients and their relatives. I’ve
found that asking a senior to come and listen to you take a history or break bad news is
exceptionally helpful. The feedback will be invaluable and although these discussions won’t
get any easier, you will get better at it!
Suggestions for personal development and managing change
Medicine is a huge discipline and, I know that when I started out, I didn’t know quite where I
would fit in. I think once you’ve chosen the specialty that suits you, it does get a bit easier.
Initially time is spent on exams and progressing up the career ladder and that’s usually pretty
well structured. But, I also think it’s important not to forget why you went into medicine in the
first place. My drive came from visiting a war-torn country and working with a Non-
Governmental Organization just before I started medical school. Everyone’s motives will be
different.
There are regular appraisals and assessments which give you a chance to take stock of
where you’re up to. I think it’s important to set short and long-term goals. There’ll always be
exams, assessments, audits, etc…but I think it helps to have an idea of where you would like
to be in 5 or 10 years.
Page 2
I:\Careers Planning\Careers Information\A-Z Careers Information
Sheets\Anaesthesia\Anaesthesia_Trainee_Casestudy_August09.doc

This can also be helpful when it comes to discussing your plans at appraisals or in just
getting informal advice. I’ve found the help and advice from consultants/SpRs invaluable and
they will help you stay focused on the right track. It’s easy to get overwhelmed by exams and
the ongoing workload. It’s best to talk it through; everyone will have a different opinion, but at
least you can make up your own mind after hearing some alternative points of view.
Ways to achieve a successful work-life balance
If I say ‘friends and family’, does that sound lame? I think it’s true. Anaesthesia can be busy,
stressful, exciting and rewarding all at once! I often find it necessary to talk through cases
with other trainees or consultants. I hardly ever make it to the Dr.’s Mess at lunchtimes
because I usually have patients in recovery or will be seeing patients for the afternoon. Also,
I tend to be either working with a Consultant Anaesthetist or on my own, so there’s not
always a lot of contact with other juniors during the day; you may feel a little more isolated
from your colleagues than in other specialties.
Make sure you make time for rest and relaxation. I enjoy diving and, believe me, I’m not
thinking about work as I’m floating around under-water! Do whatever works for you!
Snapshot of your career path to date
PRHO jobs → Acute Specialties Rotation → Hyperbaric Medicine → Anaesthesia
Career goals for the future
I’m glad to say I’m staying put in anaesthesia now! The next major hurdle for me is the Final
FRCA, but I’m looking forward to embarking on SpR training and am especially keen on
anaesthesia for ENT. I’m also planning to spend time working in developing countries and
those effected by violent conflict and hope to use my off-rotation training for this…something
to look forward to while burning the midnight oil for exams!
Page 3
I:\Careers Planning\Careers Information\A-Z Careers Information
Sheets\Anaesthesia\Anaesthesia_Trainee_Casestudy_August09.doc