Timing anaesthetic subspecialisation

EDITOR, I wish to compliment Steven Cray on his concise summary of the situation in training in paediatric anaesthesia in Britain at the present time,(1) and I would like to add a few comments.

Cray suggested that the paediatric content of anaesthetic training programmes may determine which registrar posts are applied for. I believe that the intensity of competition for these posts means that in reality there is little room for choice, although it may be possible to move between deaneries following appointment. The award of the certificate of completion of specialist training (CCST) should, in my opinion, be regarded as no more than a very basic qualification in anaesthesia in this country. Anaesthetists who wish to develop a career in a particular branch of the specialty should look to do this outside registrar training because these programmes' primary aims must be to provide broad experience for all trainees and may be unable to provide tailored subspecialty exposure.

Cray is quite correct that time out of the programme is unlikely to count towards the CCST and that short term vacancies are a headache for programme directors. Trainees should be aware that opportunities arise when they are taking time out of the specialist registrar programme, and they may prefer not to be tied to returning to a training scheme. My advice would be to undergo sub-specialty training having obtained the CCST. This would give trainees the freedom and flexibility to pursue their own interests and career, and it frees programme spaces that senior house officers can enter. The new edition of the Guide to Specialist Registrar Training (the orange book) creates the opportunity for trainees who have UK nationality to undertake subspecialty fixed term training appointments in this country following the award of the CCST.(2)

I Barker Programme director, North Trent School of Anaesthesia, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH