On the subject of A&E SHO training can I just add a comment in favour of
anaesthesia/ITU? There has been a lot of discussion regarding MRCP and
FRCS(A&E), but very little regarding the value of anaethesia. It's good
to see this included on John Ryan's rotation, but only for those who
can't pass their exams first time.
It may be a little heretical in these days of ever-reducing training
schemes, but I really don't think that two years as an SHO in any
combination of jobs represents adeqaute preparation for an SpR post in
A&E, and in fact I suspect that very few (if any) of the current
consultants or registrars got appointed with just two years of
post-registration experience.
Whether we like it or not A&E is too wide a subject to get away with the
sort of short SHO apprenticeship that is becoming popular in other
specialities. Anaesthesia/ITU is an essential skill since it facilitates
confident management of the compromised airway and the critically ill
patient. It is very easy to spot those who have and haven't got
anaesthetic experience in resus; faced with a very sick medical patient
A&E SHOs will put a line in (because they know how to) whilst calling
for help. When the help arrives they will go straight to the airway (we
hope). If that help is an A&E SpR with no anaesthetic experience then
the patient may end up with a line in the other arm whilst somebody goes
off to find an anaesthetist and the patient deteriorates further.
Airways scare people who are not faimilar with them, and the best way to
get familiar with them is to do an anaesthetic job. This in turn will
reduce our reliance on anaesthetists and enhance the strength and
independence of the speciality.
Whilst anaesthesia is an essential part of an A&E registrar's training
there is to my mind a clear difference between working in anaesthesia
and being seconded into it. On a secondment there is a tendency to be
surplus to requirements, and the incentive to learn skills is easily
diminshed. Medical students cannot insert lines because they never
really have to; they make two attempts and then get the houseman to do
it. The following year they qualify and suddenly learn to put a line in
overnight; because they have to. So it is with all practical skills, and
there are few more practical (and useful) skills than those found in
anaesthesia. Secondments work well for gaining information and
knowledge, but doing the job for real is the best way of learning and
refining a practical skill.
Jonathan Benger.
SpR, Bristol.
"I thought I'd spotted the light at the end of the tunnel, but it turned
out to be a bloke with a torch bringing some more work"
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