Training in anaesthesia and other specialities

EDITOR, - One of the main sources of anxiety among doctors in training is being faced with a patient presenting with an emergency for which the trainee feels insufficiently trained. We believe that the principles that are used to train anaesthetists would be advantageous to trainees in other specialties in which emergencies are a feature.

In paediatrics and general medicine in which we trained to registrar level, we gleaned the principles of managing patients as an emergency largely from our immediate superiors in the course of their busy day and through being “thrown in at the deep end.” During our first month as senior house officers we were supposed to be covered by registrars at all emergencies, who were often busy and even on different sites. This meant that they often arrived late, adding to the stress of the clinical situation. Consequently, we were frequently unsupervised and teaching techniques were inconsistent.

In anaesthesia a period of supernumerary training is necessary to enable anaesthetists to perform at even the most basic level. We remained surplus to service commitments for three months. This entire period was spent attached to the two senior consultants in the department who train novice anaesthetists. During this time we were tirelessly criticised and corrected over mistakes that we made and each situation to which we did not respond rapidly or appropriately. Though on occasions stressed and despondent, we certainly considered afterwards that we had learnt to administer basic anaesthesia and could carry out resuscitation procedures confidently and competently.

The report of the Working Group on Specialist Medical Training recommends the introduction of improved training programmes by the end of 1995 and that the medical royal colleges and their faculties should specify the curricular requirements for planned specialist training programmes no later than this month.1 We think that formal training in the management of common emergencies would improve the quality of medical training and that it should be provided for all new trainees starting in medical specialties in which emergencies regularly feature. Having trained in medicine and anaesthesia, we believe that a short supernumerary introductory training programme, aimed at encouraging rapid, systematic responses to everyday medical emergencies, would have prepared us better to cope with the emergencies we faced at the start of our medical posts.