Paediatric anaesthesia

Paediatric anaesthesia

The Royal College of Anaesthetists has produced guidance for specialist training in the senior house officer (SHO) and specialist registrar grades (SpR). SHOs should receive closely supervised training in anaesthesia for children over 3 years old. SpRs should gain experience with the management of children of all ages, including neonates, who are undergoing a variety of major surgery. The difficulty in arranging such training is that many anaesthetists need to be taught, but there are few newborns and infants undergoing surgery. The specialised paediatric component of many four year SpR programmes may be only three to four months, and it is unlikely that there will be much exposure to, for example, neonatal anaesthesia during this time. Valuable skills may be gained during a rotation in neonatal intensive care. The SpR grade is designed to offer flexibility so that individuals can obtain subspecialty training, particularly during the final year. However, trainees continue to fulfil a large service commitment, and it may prove difficult to tailor a training scheme to satisfy individual requirements. Some regions are able to offer more paediatric training than others, and this factor may determine which SpR posts are applied for. Overseas posts can in theory count towards the award of the certificate of completion of specialist training (CCST) if approved in advance by the postgraduate dean and royal college, although the reality is that you are unlikely to get approval for the whole period spent abroad, if at all. Regions have different attitudes to SpRs who take a year outside the scheme to go overseas, as the short term vacancies thus created may be difficult to fill. It is important to have confirmation that a national training number (NTN) can be kept while abroad. The alternative is to obtain specialist training after obtaining the CCST, either overseas or in Britain.

Paediatric intensive care

Training in paediatric intensive care medicine in Britain has been hampered by the lack of organised training programmes and the plethora of small centres. Because of this, many consultants currently working in paediatric intensive care obtained their skills overseas. Recently an Intercollegiate Committee on Training in Paediatric Intensive Care Medicine (ICTPICM) has been formed with representatives from the Royal Colleges of Paediatrics and Child Health, Anaesthetists, and Surgeons. A similar committee exists for adult intensive care medicine. Application has been made for intensive care medicine to be recognised as a specialty, but currently it is necessary to obtain a CCST in the parent specialty. It is proposed that specialist training in paediatric intensive care medicine could be undertaken by trainees from paediatrics, anaesthesia, or paediatric surgery. Trainees will need to have spent some time in other relevant specialties, depending on their parent specialty. The committee will approve hospitals for training purposesÑcurrently Great Ormond Street, Alder Hey, Glasgow, and Birmingham Children's (subject to confirmation) Hospitals have approved posts.

Doctors interested in these and similar posts should check with the relevant royal college and postgraduate dean about approval for the CCST and keeping the NTN. For those who have trained or may wish to train overseas, there is an òequivalenceó committee of the ICTPICM which considers the status of such experience. At present consultants in paediatric intensive care generally have as their base specialty paediatrics or anaesthesia, and many maintain sessions in the primary specialty. Neonatal services are almost exclusively the domain of paediatricians, and there is little overlap with intensive care provision for older children.

Courses such as APLS (advanced paediatric life support) or PALS (paediatric advanced life support) are recommended for anyone who will have to deal with paediatric emergencies. Meetings of relevant societies are always a good place to meet others in the field and perhaps learn something new. The Association of Paediatric Anaesthetists limits membership to consultants who have a major commitment to paediatric anaesthesia, but trainees may attend meetings as guests of a member. The Paediatric Intensive Care Society is a multidisciplinary organisation and holds regular meetings.

Paediatric anaesthesia and paediatric intensive care represent challenging areas of practice. Training programmes, particularly in intensive care, have still to develop in Britain, and a period overseas is likely to prove valuable. There are many opportunities at consultant level, both in specialist units and general hospitals, for doctors with training in paediatric anaesthesia or intensive care.