THE

RCoA Trainee Committee NewsletterIssue 12 Autumn 2015

Dr Peeyush Kumar (Chairman) | Dr JP Lomas (Deputy Chairman) | Dr Chloe Fairbairns | Dr Adam Low Dr Myra McAdam | Dr Gethin Pugh | Dr Kate Tatham | Dr Benjamin Fox (GAT) | Dr Erica Innes (RCoA/KSS Fellow)

www.rcoa.ac.uk/traineectee

EDITORIALDr Adam Lowaelow@doctors.org.uk

The current medico-political landscape has made the transition from summer to autumn a difficult one. As acute, frontline specialities, there is potentially a lot for us to be concerned about in the junior doctor’s contract that Jeremy Hunt plans to impose from August 2016. While we are all accustomed to 7 day working for emergency care, the proposed removal of EWTD hours monitoring and reduced break time go against the safety culture that we all adhere to. Our specialty has led the way with respect to less than full time training, and whilst in recent decades research activity has dipped in our specialty (but clearly on the up with such active trainee research networks), further disincentives from the proposed contract are a real concern. Articles in this edition on fatigue and wellbeing are therefore all the more timely. This coupled with alterations to salary/banding and locum payments, make recruitment to the specialty and covering all rotas a real concern, and plenty for us to consider from a workforce planning perspective in the wake of the RCoA census results. As a committee we are working hard to highlight the impact the proposed contract changes will have on training and anaesthetist well being. Please continue to feedback to us directly and via the ATRG the issues where you are. As the heat undoubtedly gets turned up as the BMA ballots members over industrial action, please remember to look after and support each other, and act responsibly and professionally in the public eye. Good often springs from adversity, and seeing the medical profession united over patient safety and our own wellbeing must be a good thing.

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NEWSWhile the current junior doctor’s contract issues is at the forefront of everyone’s minds, other important events continue that are worth being aware of:

ELECTION TO COUNCILThere are five consultant vacancies and one SAS vacancy for positions on the RCoA Council. You should have received ballot papers through the post. Please take the time to vote, you can remind yourselves of who is running for election and their statements here.

APPROVED CURRICULA AND THE ROLE OF UK AND OVERSEAS EXAMSAs you are hopefully aware, the GMC has recently published a position statement seeking to clarify the position of examinations within GMC approved curricula, in particular examinations undertaken outside the UK, both in other European countries and outside Europe. The RCoA statement summarises the implications for appointment to, and progression through, UK anaesthetic training. A set of Frequently Asked Questions has been published on the RCoA website which aims to support understanding of this issue.

QUALITY IMPROVEMENTDr Erin Innes is undertaking a survey on training in Quality Improvement. Quality Improvement will be the theme of the Trainee led Bulletin next year. Please take time to complete Erin’s survey.

GENERAL MEDICAL COUNCILInsurance and indemnity It’s now a statutory requirement for doctors to have appropriate insurance or professional indemnity covering the full scope of their practice when working in the UK. Good medical practice already places a professional duty on all doctors to have appropriate insurance or indemnity, but these changes reinforce the importance of having this in place.

Female genital mutilation (FGM) Under the Serious Crime Act 2015, reporting cases of FGM will become mandatory for all health and social care professionals in England and Wales from October 2015. We have pulled together some information on this and other aspects of child protection, which you may find useful.

IMPORTANT NEW GUIDANCEThere is a more comprehensive list for you to catch up on in the bedtime reading section but these two particularly caught our eye:

Perioperative Fasting: the ESA (with AAGBI endorsement) have produced evidence based guidance on pre-operative fasting that addresses controversial areas such as timing of free fluids, carbohydrate drinks pre-operatively, chewing gum and milk in tea/coffee…worth a read!

OAA/DAS obstetric airway guidelines: after three years of development, the joint working group have published these national guidelines on the management of the difficult airway. They have published their literature review in IJOA and the guidelines paper and algorithms in anaesthesia.

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WELCOME TO TWO NEW MEMBERS OF THE TRAINEE COMMITTEE We are pleased to welcome two new members to the RCoA Trainee committee, following voting via the ATRG in the summer.

DR CHLOE FAIRBAIRNS ST7 LEEDSI am one of the new members of the trainee Committee, having been elected along with Myra McAdam. I have been the trainee representative to the West Yorkshire STC for just over a year. It was this role that led to my joining the Trainee Committee - I feel strongly that the trainees’ voice in the college is important, and our input provides a vital oversight to the curriculum and assessment methods.

I will be taking responsibility for representing trainees to the Exams Committee, and liaising with the Academy of Medical Royal Colleges.

I’ve taken the scenic route through training having graduated from Nottingham in 2000. I’ve worked in several regions and spent some time in non-training posts. My experiences have led to my interests in helping people struggling with exams, and trainee support and welfare in general. My clinical interests are anaesthesia for abdominal surgery including colorectal and hepato-biliary.

Outside of work I can usually be found riding a bike or walking a small angry rescue dog called Spock.

DR MYRA MCADAM, ST6 WEST OF SCOTLAND SCHOOL OF ANAESTHESIAI started my anaesthetic training during the birth of MMC, being one of the first cohort to progress through ACCS and anaesthesia run-through training. I spent three years in a district general teaching hospital and have then completed the remainder of my training in Glasgow. I spent a year out of programme as the inaugural RCoA Scottish Clinical Leadership Fellow in 2014/2015. Seconded to Scottish Government Health Workforce, I spent the year developing leadership skills, knowledge and understanding. I focused my project work on Professionalism assurance in working patterns and environments for doctors in training, clinical standards for Anaesthetic services in Scotland and the start of a new national Critical Incident reporting system for anaesthesia in Scotland.

My interests within anaesthesia include perioperative medicine, education/training and intensive care provision and follow up. Having spent eight months out of work on sick leave following a car versus bicycle accident five years ago, I am also very interested in the impact of working on our health, support for doctors with difficulties and am a member of Doctors in Difficulty. I also sit on the BMA West of Scotland RJDC and have a seat on the SJDC this year.

Out with anaesthetics and work, I am a keen baker (becoming a cliché now though!), cyclist and swimmer. I’ll do anything that means I don’t need to think about work too much when I’m not there… including swinging from trees at GoApe!

I look forward to representing trainee interests with the Trainee Committee and am happy to chat to anyone who is interested or wishes to chat to me!

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WHAT TO DO WHEN APPROACHING YOUR CCT DATE Dr Peeyush Kumar

Are you completing your anaesthetic training soon? Do you want information on what to do when approaching the CCT date? In the following article I hope to clarify what to do when approaching completion of training and the small matter of applying for a consultant job.

Ideally you should have started updating your CV a year before your CCT date. You can apply for a job that has the interview date within six months of your CCT date but starts after you CCT. All the hard work you have done in improving your CV should be near completion by now. I would suggest that you request senior consultants to review and critique your CV. It took me multiple drafts over nearly four months to come up with a decent CV. Please also have a look at the NHS jobs website and set up a search and email function for the job and region you desire. I would also recommend, that at this stage, you go through the application form questions and start preparing the answers. Remember, the majority of job advertisements would require completing an application form on the NHS jobs website. You should still have an up-to-date CV for your visit to the potential department as part of your pre-application process. If you are really interested in a particular post, please visit the place and meet the Clinical Director and other consultants. This is especially important if you have never worked there as a trainee.

In your final year of training, RCoA will inform GMC about your CCT date. About four months before the date, GMC will invite you to apply for the entry to the Specialist Register. This is an online process and you will have to pay a fee to the GMC.

Within six months of your potential CCT date, you can complete the Notification of Completion of Training form and send it to the Training department of the College.

You should ideally have your final ARCP within the last three months of your CCT date, where, if everything is in order you will be awarded Outcome 6 and the College will be informed.

Once the College receives both the Notification of Completion of Training form and the ARCP outcome 6, it will recommend award of CCT and entry onto the specialist register, to the GMC.

I hope this clarifies the process. Please refer to RCoA website and GMC website for further details.

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NEWS FROM THE EXAMINATIONS COMMITTEEDr Chloe Fairbairns

Alterations are proposed to the written part of the Final FRCA examination. The intention is to move away from essay-based questions to a more structured format, variously known as ‘constructed response’ or ‘controlled response’ questions.

CHANGES TO THE EXAM STRUCTUREThere is some evidence from other fields of education that such questions are more reproducible and exhibit less bias, improving assessment of the candidate’s data interpretation skills.

The final FRCA SOE will be altered to increase the number of topics covered, and to closely link the basic science elements to clinical topics.

As part of the College’s review of our use of information technology and computer systems the committee will be looking at use of computer based testing systems, similar to those used in driving test centres. They are already in use by other colleges such as the Royal College of General Practitioners.

CHANGES TO ELIGIBILITYThe GMC have recently confirmed that exams taken outside the UK are not acceptable for the purposes of progression through the training programme. This has several implications for appointments and eligibility for the final FRCA. The key points are that the MCAI is no longer acceptable as an exempting qualification for eligibility for the final FRCA, and by December 2016 non-UK exams will no longer be accepted for appointment to or progression through training. Trainees who may be affected by this are strongly advised to seek advice from the training department and to carefully read the advice on the RCoA website.

It is proposed to move the point by which the final FRCA must be achieved to the end of ST5 (as opposed to ST4). The aim of this is to increase the amount of clinical exposure candidates have had by the time of sitting the exam. This change will need to be approved by the GMC.

PASS RATES AND DIFFERENTIAL ATTAINMENTThe examiners take the process of setting and marking the exams very seriously, and a great deal of attention is paid to ensuring that questions are fair and consistent. Pretty much any examination in the UK displays marked differences in results between sexes, ethnic groups and social class. The FRCA is no exception and Liam Brennan and Andrew Lumb published an article in the July 2015 Bulletin examining this in detail. Specific plans to address this include encouraging applications to become examiners from women and BME candidates as well as undertaking further analysis of the exam and the candidates’ characteristics.

The examiners are also concerned about the recent poor pass rates in the written part of the final FRCA. It is to be hoped that altering the point at which people sit the exam may help with this (by increasing clinical experience). More work is needed however to investigate why the pass rate has fallen so dramatically.

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RCoA WORKFORCE CENSUSMiss Afsana Choudhury, RCoA Workforce Planning Co-ordinator

The latest College workforce census was completed in August this year and we received key data from every anaesthetic department across the UK and are proud to have achieved 100% returns.

Previous college censuses in 2007 and 2010 have proved to be invaluable sources of data. Five years on, census 2015 presents robust and current data that is essential to protect anaesthetic numbers and activity into the future and to allow for appropriate strategic planning.

The main findings show that the anaesthetic workforce is made up of 7,439 Consultants. In 2010 the total number of consultants was 6,849 showing an increase of 8.61%. The gender split for consultant anaesthetists UK wide is 68% Male and 32% Female. There was a slight increase in the proportion of female consultants between 2007 and 2010 from just below 28.46% of the workforce to just over 30.28%. For 2015 that trend appears again with a further 2% between 2010 and 2015.

Total number of female consultant anaesthetists UK

Total number of male consultant anaesthetists UK

The Census recorded 2,047 SAS Doctors. In 2010 the numbers of SAS doctors recorded was 1,843 that is a percentage increase of 11% between 2010 and 2015. The service contribution made by SAS doctors to the anaesthetic workforce is still significant today at 21.6% as it was also in 2010 (21.2%).

The number of trainees recorded in the census was a low figure. This could be due to the census being sent during the rotation period and not every trainee was picked up. However we believe there are up to 4,500 trainees within the UK.

In the Census we asked about trainee rota gaps, the reasons for this, how they are being covered, how much reliance on locums there is to fill the gaps and reduction in training posts. The analysis of this data is on-going. In January 2016 a full census report will be available on the College website and an article will be featured in the College bulletin so watch this space…

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CHANGE IN THE LAW ON CONSENT TO TREATMENTDr Peeyush Kumar and Dr Adam Low

On 11 March 2015 the Supreme Court handed down a unanimous judgment in potentially the most significant clinical negligence case of the last 30 years in Montgomery v Lanarkshire Health Board case.

This is a binding decision on the law of consent for the lower courts in England, Wales and Scotland. This has important urgent ramifications for all clinicians and health bodies. We hope to briefly summarise the relevant issues:

In 1999, as a result of complications during delivery, a baby was born with serious disabilities to a diabetic mother of small stature. She had expressed concern about her ability to deliver a large baby vaginally – the planned delivery mode. Her obstetrician did not specifically counsel her patients about shoulder dystocia as, in her view, there was only a small risk of a significant problem for the baby. The obstetrician also believed that if advised of the risks of shoulder dystocia, women would opt for a caesarean section, which was not in the maternal interest.

Although not found guilty by two lower Courts, the Supreme Court ruled in favour of the patient. It was held that the duty to warn about risks would no longer be determined by application of the ‘Bolam test’ (what a responsible body of medical opinion would conclude are the risks that should

be disclosed to a patient) because those authorities are now outdated/unsatisfactory and do not reflect the modern doctor-patient relationship and the shift toward patient self-determination/autonomy.

The new test is patient-sensitive and based upon materiality of risk - in other words, a doctor is under a legal duty to take reasonable care to ensure that the patient is aware of any material risk involved in the recommended treatment and of any reasonable alternative or variant in the treatment. There are only two limited exceptions and these must not be abused: first, a doctor is entitled to withhold information if he or she reasonably considers that its disclosure would be seriously detrimental to the patient’s health (the so-called therapeutic exception); and second, where emergency treatment is required for a patient who is unconscious or otherwise unable to make a decision.

So what are material risks and how does a doctor ensure that he or she has adequately warned a patient about them? A material risk is one where a reasonable person in the patient’s position would

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be likely to attach significance to the risk; or the doctor considers that the particular patient would be likely to attach significance to it. To comply with the law, a doctor will have to engage in a dialogue with the patient about the nature of the risk, the effect the occurrence of said risk would have upon that particular patient, the importance to the patient of the benefits of the proposed treatment, any alternatives or variants available, and the risks versus benefits involved in those alternatives/variants. A different outcome could easily be achieved by applying the same test to two different patients undergoing the same treatment and cannot be reduced to any ‘rule of thumb’ based on the percentage of risk. Many doctors do this anyway. Clear notes must be kept contemporaneously and the evidential value of pro-forma consent forms, information leaflets or similar will be limited unless accompanied by a discussion.

Whilst the judgment was greeted with satisfaction by the GMC and by patient groups, there will be concern that this patient-sensitive test is unpredictable and may be difficult to comply with for busy doctors and nurses. Bolam/Sidaway have informed the way that clinicians were trained to obtain consent for thirty years and the Montgomery decision is only saying that things have moved on, not that they were wrongly decided at the time.

The Montgomery ruling aligns the law with guidance on consent by the GMC. Judges may find it difficult many years later to condemn a doctor as negligent for not warning about a small risk when such a warning would have been against contemporaneous guidance from Royal Colleges or NICE. The decision does also raise the inevitable spectre of a further shift towards defensive medicine and some clinicians will probably opt to warn of any or every risk routinely rather than taking the time of exploring every fact-sensitive financial, religious, familial, social or other imponderable of the particular patient in order to arrive at a considered decision about what risks to warn of or not.

LAY COMMITTEE OPINIONThis issue was discussed by the committee, taking consideration of the constraints of anaesthetic pre-operative assessment and consent on the day of surgery. The committee were sympathetic to the challenges faced by clinicians, but emphasise the need to use professional judgement when discussing risks with patients and reinforce how valuable giving patients choice on their treatment options is. These discussions should obviously be documented in the case notes. The committee accepted that time may be pressured, but also stated that adequate time and place is something that is enquired about on ACSA visits. They urge us to engage with our managers if we feel that time constraints do not allow us to have reasonable conversations with our patients about the anaesthetic options and associated risks.

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TRAINEE WELFAREDr JP Lomas

Times are challenging for doctors in training, in particular those working in the acute specialties. Your representatives at the RCoA, FICM and the AAGBI agree it is crucial that trainees are, and feel, supported.

Trainees are essential to the on-going safe delivery of anaesthesia and critical care; training and service are intrinsically linked.

We have been extremely concerned at the breakdown of negotiations between NHS Employers/Department of Health and the BMA, a decision to impose a contract* and the looming threat of industrial action.

We hope that an agreement is reached soon, resulting in a contract that is both safe and fair.

It is understandable that trainees may currently have higher degrees of stress, anxiety and uncertainty. Those studying for exams, preparing for job applications, interviews, presentations or just the daily challenge of making themselves better anaesthetists may really be feeling the pressure.

Don’t forget the support networks available if you’re feeling overwhelmed:

1 Talk to somebody: fellow trainees, family and friends

2 Meet with your clinical or educational supervisor, College Tutor or mentor

3 Use one of the available support and welfare schemes:

a AAGBI Support and Wellbeing

b RCoA Career and Personal Difficulties

c BMA Doctors’ Wellbeing

We’re always happy to receive your thoughts, comments and opinions: trainee@rcoa.ac.uk.

*An anaesthetics trainee, Dr Steven Bishop, has produced an excellent summary of changes proposed to the new contract on his blog.

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STRESS AND FATIGUEDr Deirdre Conway, GAT Committee

We are living in challenging times for trainees. Exam pressures, changing jobs, shift work, increasingly complex patients and most recently the stress of the imposed changes to junior contracts can all be overwhelming.

Contrary to what Kurt Cobain said it is not better to burn out than fade away. Persistent and perceived unmanageable stress can tip any of us off our stress performance curve and contribute to fatigue.

Much has been written on the effects of fatigue on junior doctors doing shift work. Night shift in particular is non physiological and opportunities for rest overnight are dwindling. Below are some ideas on how to counter stress and fatigue.

TIPS ■ Speak to someone – a colleague, a loved one, a

professional, even anonymously online. There are several networks available to you: RCoA Career and Personal Difficulties, AAGBI Support and Wellbeing, BMA Doctors’ Wellbeing.

■ Take rest where you can. Even a short nap can be refreshing.

■ If you feel tired due to changing shift patterns, tell your supervisor/colleagues.

■ Nap before driving home post nights.

■ Be mindful of your own fatigue levels, especially if taking on extra locum shifts.

■ If you feel overwhelmed by tasks, make a list with achievable outcomes/deadlines. This focuses what needs done and what can wait.

■ Be careful with alcohol intake.

■ Fitting exercise (however small) into your routine can help clear your mind and aid sleep. Slap on your best tunes and get out there!

Please know that the College and GAT are committed to your wellbeing and are always an ear to listen.

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GAT UPDATEDr Benjamin Fox

Much of the focus of the GAT committee has been on the junior doctors contract negotiations. Many committee members, as well as AAGBI Board members, have attended the junior doctors contract protests in a personal capacity. GAT committee member Victoria McCormack appeared on Newsnight giving an insight into the stresses facing a junior doctor.

It has been wonderful to see the unity between our two organisations on this matter. GAT has collaborated with the RCoA as well as the FICM on a wellbeing document for trainees.

Representatives from GAT and the AAGBI recently met with Dr Johann Malawana, Chair of BMA JDC, to discuss the contract negotiations:

■ Dr Malawana has been impressed with how anaesthetists as a whole have spoken out on the issue.

■ The BMA has set clear terms for negotiation - a safe and fair contract for junior doctors.

■ The BMA ballot for industrial action opened on Thursday, 5 November and will close on Wednesday, 18 November.

HOW YOU CAN HELPThe voice of individual junior doctors, and their families, educating people about the impact these changes will have on their lives is vital:

■ Join the discussion in local and national meetings as well as on social media.

■ Write to your local newspaper.

■ Write to your MP – see the AAGBI MP letter guidance and BMA MP email guidance here.

HOW CONSULTANTS CAN HELP ■ Continue to give support to junior doctors

(irrespective of what decision they make).

■ Raise the topic in divisional and audit meetings.

■ Ask trainees how they are getting on.

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TRAINEE LED RESEARCH NETWORKS

THE ANAESTHETIC AUDIT AND RESEARCH NETWORK NORTHERN IRELAND (ARNni) The Anaesthetic Audit and Research Network Northern Ireland (ARNni) is a trainee led collaborative established in 2014. Our aim is to engage trainees in research and quality improvement across Northern Ireland to promote clinical excellence and enhance patient care.

The group consists of a trainee committee supported by an experienced group of consultant advisors. Membership includes a spectrum of anaesthesia trainees rotating through seven teaching hospitals across five Healthcare Trusts.

Our earliest piece of work was a survey of audit and research opportunities in the region, completed during network development. Approximately 50% of trainee respondents felt that research and audit opportunities in Northern Ireland could be improved.

We are currently completing the analysis of our inaugural quality improvement (QI) project entitled

‘Anaesthetic Care of the Elderly’ (ACE), a baseline service evaluation aimed at identifying areas for subsequent focused QI projects.

Looking forward to 2016 we hope to expand our membership and our participation in projects both locally and nationally. Our membership of The Research and Audit Federation of Trainees (RAFT) is particularly exciting, giving us the unique opportunity to collaborate with other trainee groups across the UK.

Interestingly, the RAFT inaugural project led by the Perioperative Pan London Audit and Research Network (PLAN) complements our ACE project perfectly. The theme of intra-operative hypotension in the elderly is of particular interest and we look forward to taking part.

Interested in getting involved with ARNni? Join at www.ARNni.org.uk.

SOUTH-COAST PERIOPERATIVE AUDIT AND RESEARCH COLLABORATION (SPARC)

A group of Anaesthetic trainees in the Wessex Region have formed the South-coast Perioperative Audit and Research Collaboration (SPARC). SPARC has now been running for two years, and in that time has already contributed to several national projects, set up an NIAA research training day and addressed regional issues such as fluid prescribing after surgery, concordance with lung protective ventilation and the requesting of preoperative investigations. Most importantly, however, SPARC had provided a way for trainees across the region to work together on large, collaborative regional projects and get involved in research.

2016 will be another busy year for SPARC: we will be running another research training day, looking at the transfusion thresholds we use in critical care, assessing the prevalence of burnout and depression amongst trainees, and contributing to the national RAFT project looking at intraoperative hypotension and its sequelae.

If you are interested in getting involved with any of the above, or would like to share other thoughts or ideas, then please contact us at sparc.wessex@gmail.com. Further details can be found on our website at www.wessex-sparc.com.

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WEST MIDLANDS RESEARCH IN ANAESTHESIA AND INTENSIVE CARE NETWORK (WMTRAIN)The logistic success of the launch project: Adherence to Lung Protective Ventilation in Theatre: A multicentre audit of practice (AProVent), where data was collated from over 400 cases in 14 hospital trusts over a two-day period, has enabled the network to build and test the framework for communication and project delivery across the West Midlands anaesthetic trainee community. This system has been further developed to support larger scale national projects; including the first Sprint National Audit Project (SNAP).

Being fortuitously based alongside the highly successful surgical trainee research group, the West Midlands Research Collaborative, strong links have been developed culminating in the delivery of a multi-disciplinary, multi-centre audit on perioperative pain management. Common interests and shared expertise are providing great promise for future work in this field.

Members of the WMTRAIN committee have supported the national umbrella group, the Research and Audit Federation of Trainees (RAFT), since its inception and the network is providing key support to the next national project, Intraoperative Hypotension in the Elderly (IHype).

The WMTRAIN committee now have regular communication with the West Midlands Clinical Research Network (CRN), with the groups now working together to improve trainee engagement and participation in clinical portfolio trials, as well as providing the trainee network with recognition of trainee involvement and their impact on recruitment. In line with network’s founding aspirations, the research experience of WMTRAIN continues to grow. Increasing numbers of trainees are successfully developing their own research studies, gaining funding and undertaking research fellowships within the West Midlands.

Education

EDITORIAL BOARD MEMBERSHIPTRAINEE MEMBERSThe British Journal of Anaesthesia is looking to recruit two trainee members to the Editorial Board of BJA Education (formerly Continuing Education in Anaesthesia, Critical Care & Pain – CEACCP) to oversee the production of podcasts and assist with social media activities for the journal. The trainees should be in possession of the FRCA and the appointment will be for a three year term to commence in February 2016. Please note that these are non-commissioning editorial roles.

The duties of the podcast editors are:

1 To attend and contribute to the two Editorial Committee Meetings held at the RCoA in May and October each year, the two editorial teleconferences held in February and July each year.

2 To record and edit good quality podcasts in collaboration with authors of articles for BJA Education.

3 To assist the Editors in the development of new media technologies for BJA Education (e.g. Twitter).

4 To assist the Editors by providing trainee input into the planning of future journal content and developments.

The selection process for shortlisted candidates will involve a short presentation and interview to be held at the RCoA on 12 January 2016.

Applications, in the form of a covering letter and a brief CV (maximum two sides of A4) should be sent to: bjaeducation@rcoa.ac.uk by 18 December 2015.

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BEDTIME READINGDr Myra McAdam

The following are some suggested bedtime reading that may come in handy if you are preparing for an interview or an exam… or just to keep up to date!

Safe Anaesthesia Liaison Group (SALG): ■ Patient Safety Updates (January to March and

April to June 2015)

Association of Anaesthetists of Great Britain and Ireland (AAGBI):

■ Perioperative management of the obese surgical patient (March 2015)

■ Perioperative management of the surgical patient with diabetes (September 2015)

■ Reducing the risk from cemented hemiarthroplasty for hip fracture (February 2015)

Faculty of Intensive Care Medicine (FICM): ■ Guidelines for the Provision of Intensive Care

Services 2015

New England Journal of Medicine: ■ Hypothermia for Intracranial Hypertension after

Traumatic Brain Injury (October 2015)

Resuscitation Council (UK): ■ Resuscitation Guidelines (October 2015)

Education

BJA Education: ■ Tracheostomy management

First published online: 25 April 2014

■ Pain management in day-case surgery First published online: 24 September 2014

■ Major obstetric haemorrhage First published online: 23 October 2014

■ Perioperative acute kidney injury First published online: 14 October 2014

■ Opioid receptors First published online: 14 October 2014

■ The adult patient with hyponatraemia First published online: 15 October 2014

■ Predicting the difficult airway First published online: 11 November 2014

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Q AQ A

FREQUENTLY ASKED QUESTIONSDr Kate Tatham, Miss Claudia Moran

DO I NEED TO INFORM THE COLLEGE OF AN INTER-DEANERY TRANSFER?Yes, you should inform us by completing and returning the Notification of Change of Deanery form, available on our website.

WHAT DOCUMENTATION DO I NEED TO SUBMIT TO THE COLLEGE ON RETURN FROM MY OOPT/R?You will need to provide us with a copy of a signed assessment from your supervisors* at the location you worked in, along with completion of the OOPT report (you should have received this with the prospective approval letter from the College, but can be obtained by contacting the Training team) NB This requires a personal report of your time in the post. Once we have received this paperwork, we will be able to write confirming your prospective completion date.

*Supervisor Reports: This should be from whoever supervised you on your OOPT and it generally comes in the format of an appraisal with specific reference to achievements made during your time on OOPT.

SHOULD I SEND COPIES OF MY COMPLETED ARCPS TO THE COLLEGE?Yes, we require having copies of your ARCPs-which can be added to the e-Portfolio (and named clearly) if these have not already been uploaded- This will allow us to check your progress and ensure that there are no gaps in your training. NB In due course, trainees will not be recommended for CCT/CESR (CP) if they have not provided ARCPs to cover all of their time in training.

If you have any feedback on the content of The Gas or would like to contribute an article of interest to anaesthetists in training then please get in touch.

The RCoA Trainee Committee aims to bridge the gap between trainees and the RCoA. We want to hear about any issues you are experiencing during anaesthetic training so please do not hesitate to contact us: trainee@rcoa.ac.uk.

If you are moving house, it is important that you update the College of this to allow continued delivery of publications. This can be done quickly and easily using the online form.

You can contact us by email or by writing to us at:

The Trainee Committee Royal College of Anaesthetists Churchill House, 35 Red Lion Square London WC1R 4SG

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› 5–8 January 2016PRIMARY FRCA MASTERCLASSRCoA, London£305Further information

› 14 January 2016GASAGAIN (GIVING ANAESTHESIASAFELY AGAIN) COURSERCoA, London£240Further information

› 18–22 January 2016FINAL FRCA REVISION COURSERCoA, London£395Further information

› 9 February 2016AFTER THE FINAL FRCA – MAKING THE MOST OF TRAINING YEARS 5 TO 7RCoA, London£165Further information

› 12 February 2016CPD STUDY DAY: CARE OF THE PATIENT UNDERGOING MAJOR COLORECTAL SURGERYRCoA, London£200 (£150 for RCoA registered trainees)Further information

› 24 February 2016QUALITY IMPROVEMENT AND PATIENT SAFETY: IMPROVEMENT SCIENCE IN ANAESTHESIA TRAININGRCoA, London£150Further information

› 25 February 2016AIRWAY WORKSHOPRCoA, London£260 (£195 for RCoA registered trainees)Further information

› 26 February 2016ULTRASOUND WORKSHOPRCoA, London£240 (£180 for RCoA registered trainees)Further information

› 2 March 2016CPD STUDY DAY: ANAESTHESIA AND ACUTE CARE IN AUSTERE ENVIRONMENTSRCoA, London£200 (£150 for RCoA registered trainees)Further information

› 9–10 March 2016ANNIVERSARY MEETING – INNOVATING AND IMPROVING WITHIN PERIOPERATIVE MEDICINEThe Mermaid, London£395 (£295 for RCoA registered trainees)Further information

› 10 March 2016AIRWAY WORKSHOPHotel Marriott, Cardiff£260 (£195 for RCoA registered trainees)Further information

AFTER THE FINAL FRCA: MAKING THE MOST OF TRAINING YEARS 5 TO 7

9 FEBRUARY 2016 RCoA, LONDON£165 Organiser: Dr P Kumar CPD Matrix Codes Covered: 1H02, 3J02

CPDCREDITS

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9.30 am Registration

› How I became a specialist Perioperative medicine: Speaker TBC ICM: Dr Gethin Pugh, Cardiff Paediatrics: Dr Claire Sheppey, London PHEM: Dr Nageena Hussain, Birmingham

› How I became a specialist Regional/Orthopaedics: Dr Sanjiv Patel, London Cardiothoracic: Dr Amit Ranjan, Bristol Pain: Dr Shyam Balasubramanian, Coventry Obstetrics: Speaker tbc

› How to manage training as a LTFT trainee Dr Emma Plunkett, Birmingham

› Higher degrees Dr Keith Clayton, Coventry

› How to enhance your CV Dr Alex Goodwin, Bath

› Management and leadership opportunities for trainees Dr Marc Wittenberg, London

› Changes in training Dr Nigel Penfold, Suffolk

› OOPT, year abroad, Fellowships, locum consultancy Dr Robert Self, London

› Job application, shortlisting and interview Speaker TBC

› Q&A panel All speakers

4.45 pm Close

RCoA Events of trainee interest 2016020 7092 1673events@rcoa.ac.ukwww.rcoa.ac.uk/events

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ANNIVERSARY MEETING – INNOVATING AND IMPROVING WITHIN PERIOPERATIVE MEDICINE

9–10 MARCH 2016 THE MERMAID, LONDON£395 (£295 for RCoA registered trainees) Organiser: Dr S Patel

CPDCREDITS

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This two-day meeting will focus on why anaesthetists are so well placed to help transform our NHS. Sessions include:

■ Innovation in airway management. ■ Making innovation work. ■ NIAA Health Services Research Centre. ■ Paediatric updates. ■ Lets get digital. ■ What is perioperative medicine? ■ Updates in perioperative medicine. ■ Obstetric updates.

KEYNOTE LECTURESThe John Snow Oration: Professor Don Berwick – Old Myths and New Designs

The Macintosh Lecture: Professor Carol Peden – Improvement Science for Anaesthesia and Intensive Care

The 2016 Anniversary Meeting will bring clarity as to how and why anaesthetists can play a crucial role in innovating and improving within healthcare, in a time when our own specialty faces new challenges.

Further information is available here.

SUMMER SYMPOSIUM – IMPROVING PATIENT OUTCOMES IN ANAESTHESIA AND PERIOPERATIVE MEDICINE

7–8 JUNE 2016 HILTON BRIGHTON METROPOLE HOTEL£395 (£295 for RCoA registered trainees) Organiser: Dr C Carey

CPDCREDITS

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Improving outcomes for patients is one of the key aims for developing practice in anaesthesia and perioperative medicine. Increasing challenges in clinical care arise from both population demographics and the ever expanding boundaries of interventional treatment.

This year we have assembled a group of renowned experts who will present on a wide range of subjects with a common theme of improving outcomes. Subjects will include the latest developments in the care of patient groups with specific medical and surgical conditions as well as looking at a broad range of clinical and organisational areas of anaesthetic practice which will benefit our patients now and in the future.

SOCIAL EVENINGAn informal event (included in the fee for the event), held on the first evening of the Symposium, providing the opportunity to meet the speakers and network in a social environment. There will be drinks, dinner and entertainment in an exciting venue in the heart of Brighton’s vibrant city.

Further information is available here.

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