aic paed experience

8/6/2019 AIC Paed Experience

http://slidepdf.com/reader/full/aic-paed-experience 1/9

Anaesthesia and Intensive Care, Vol. 38, No. 5, September 2010

Childen who ndego anaesthesia and sgehave special eqiements. Not onl ae theeman sgical conditions niqe to childhood, btdiffeences in phsiolog, anatom and dg handlingmean that caing fo childen nde anaesthesiacan be sncanty dfferent t carn fr an adut.The reprt f the Natna Cndenta Enquryinto Peiopeative Deaths in Geat Bitain in1989 ecommended that anaesthetists shold notndetake occasional paediatic pactice as “theotcome of sge and anaesthesia in childen iselated to the expeience of the clinicians involved”1.

Most sgical pocedes pefomed on childenae elective pocedes on othewise well infants andchilden and, in Astalia, these ae often pefomedat hospitals withot specialist paediatic anaestheticstaff. Paediatic anaesthetists sall cae fonenates and sma nfants, chdren wth sncantcomobidities and those ndegoing moe complex pocedes2.

Obviosl, paediatic anaesthesia sbspecialistsare nt aaabe at a centres. Een n centres whereanaesthetists with a special inteest in paediaticanaesthesia povide a sevice fo elective cases,the ma not alwas be available afte-hos. Thsa geneall-tained anaesthetist ma povide caefo childen pesenting fo emegenc sge oeqiing esscitation and stabilisation pio totansfe. Centl, Fellowship of the Astalian andNew Zealand College of Anaesthetists (ANZCA)is not esticted o fthe endosed in an wa.

* M.B., B.S., M.Cn.Ed., F.A.N.Z.C.A., Staff Anaesthetst.† M.B., Ch.B., Povisional Fellow.‡ M.B., B.S., M.Sc., F.A.N.Z.C.A., F.A.C.H.S.E., Drectr.

Addess fo coespondence: D D. Castanelli, email: [email protected]

Accepted fo pblication on Mach 23, 2010.

The povision of anaesthesia fo childen b non-sbspecialist anaesthetists: expectations of newl qalifiedconsltant anaesthetists and thei pospective emploes in

VictoiaD. J. CASTANElli*, K. STEvENSoN†, J. P. MoNAglE‡

Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre, Melbourne, Victoria, Australia

SuMMAry

We surveyed newly qualified consultant anaesthetists and their prospective employers in Victoria, regarding their expectations for the provision of paediatric anaesthesia by anaesthetists who have not completed subspecialty training in paediatric anaesthesia (generally-trained anaesthetists).

Responses were received from 15 of 19 (79%) eligible Directors and 26 of 37 (70%) newly qualified Australian and New Zealand College of Anaesthetists (ANZCA) Fellows. Of those responding, 80% of Directors and 82% of

Fellows would expect a generally-trained anaesthetist to anaesthetise children two years of age or older. Regional Directors expected generally-trained anaesthetists to anaesthetise younger children than metropolitan Directors, and Directors’ expectations were not influenced by their own practice.

Testing these age limits with a series of simple case descriptions showed there is recognition from both Directors and Fellows that the stated age limits would be modified in both directions by case complexity and comorbidities.

The new consultants who responded were significantly less confident than Directors in their ability to resuscitate and stabilise a critically ill child prior to transfer if required. Only 50% agreed they still met all the requirements of the ANZCA paediatric module and only 37.5% had the level of confidence they achieved during their paediatric

rotations.

We suggest that current training provides capacity to routinely anaesthetise well children two years of age or older. However, it appears more training would be required for most anaesthetists undertaking anaesthesia for younger patients or more complex paediatric cases. This raises the question of subspecialty endorsements within ANZCA

Fellowship.

Key Wrds: anaesthesa, paedatrc

Anaesth intense Care 2010; 38: 911-919



912 D. J. C astanelli, K. stevenson, J. P. Monagle


Hence, all ANZCA Fellows shold be expected tobe capable of sch anaesthesia and esscitation.

ANZCA ecommends that the minimmexpeience in paediatic anaesthesia dingtaining is 50 half das3. ANZCA povides detailed

leaning objectives fo paediatic anaesthesia tainingin its paediatic anaesthesia ciclm modle4.These povide gidance to tainees and spevisosof the knowledge, skills and attitdes that aeecommended b ANZCA. Simila gidelinesegading minimm taining eqiements havebeen pubshed n Eurpe and great Brtan5,6.Howeve, in Astalia thee is no clea gide as tothe minimm level of competence eqied of ageneall-tained anaesthetist who, while not havinga special inteest in paediatic anaesthesia, ma stillbe called pon to povide anaesthesia fo the

occasional paediatic patient. As thee is an inceasing focs on cedentiallingand denn scpe f practce, t wud be tmeyif a minimm standad that the commnit andemploes cold expect of all ANZCA Fellows wasdened. As there s currenty n areed mnmumstandad in Astalia on what the expectationsae fo non-sbspecialist anaesthetists caing fochdren, t s dfcut t jude what ee f trann s requred. it may be that there s a tactndestanding shaed amongst emploes and newlquaed cnsutants f what s expected. if s, thscud be cared and acknweded and used tfurther dene what trann s requred. if nt, thenthe infomation gatheed wold be sefl in deciding

what the minimm standad shold be.

MATERiAl AND METHoDS

A liteate seach was condcted singMEDliNE wth the search terms “pedatrcanesthesia AND taining Or competence”. Aticlesof inteest wee then obtained and thei efeencessceened fo fthe sefl aticles. The eslts

wee sed to help develop two sves, one fonewy quaed ANZCA Fews and the ther frDiectos of Anaesthesia as thei pospectiveemploes (sves available in the Appendices inthe online vesion).

The aim was to test the hpothesis that newlquaed ANZCA Fews and ther empyershave simila expectations egading the minimmcompetence in paediatic anaesthesia of geneall-tained anaesthetists in poviding anaesthesia topaediatic patients.

The sves asked what age childen thepaticipant expected geneall-tained anaesthetiststo anaesthetise in an ot-of-hos setting, and

whether there was an ae mt dened by thedepatment. Paticipants wee then asked to considecommon paediatic scenaios that ma need to bedealt with b anaesthetists, simila to those sedb Ca7, to detemine whethe thei emploes’

expectations of thei abilit to manage thosescenaios matched those of ANZCA Fellowsthemselves.

Diectos wee asked if the wold expect thegeneal on-call anaesthetist to povide anaesthesiafo each scenaio and Fellows wee asked if the

wud prde anaesthesa n that scenar. if theydid not expect the geneall-tained anaesthetist toanaesthetise the patient in that scenaio, the weeasked how the wold expect the sitation woldbe managed. Paticipants wee then povided with aseres f statements reardn ther wn cndencein managing vaios scenaios and wee asked tocategoise thei degee of ageement with thosestatements n a seen-pnt lkert scae (1=strnydsaree t 7=strny aree).

As well as the scenaio-based qestions, bothsves inclded qestions on the extent of paediatic anaesthesia expeience enconteed inthei depatments in an ot-of-hos setting, andhow the espondents maintain thei skills inpaediatic anaesthesia.

Paediatic wokload at Victoian geneal hospitals was detemined b asking Diectos of Depatmentsof Anaesthesia fo the nmbe of afte-hospaediatic anaesthesia cases occing at theihospital. Diectos wee also asked qestionsto ascetain thei own expetise in paediaticanaesthesia.

The sve developed fo the Fellows examinedthe extent of thei expose to paediatic anaesthesiasbseqent to completion of thei paediaticrtatn. in vctra, the paedatrc rtatnotinel takes place in the thid ea of ANZCA taining. The Fellows wee also asked how the feltthei taining had pepaed them to be able toanaesthetise paediatic patients, which was assessedsing thei degee of ageement with sevealstatements n a seen-pnt lkert scae as abe.

O taget poplations wee Diectos of Depatments of Anaesthesia in Victoia and newlquaed ANZCA Fews wh had underne therpaedatrc anaesthesa trann n vctra. Excusnciteia wee Diectos of Depatments belongingto hospitals that do not admit childen and thosedepatments that do not have Fellows of ANZCA.

The newy quaed anaesthetsts were dentedfom the database of the Victoian Obstetic andPaediatic Anaesthetic Taining Scheme. The



913 a naesthesia for ChilDren by non-subsPeCialists in viCtoria


Drectrs were dented frm the st hed by theVictoian Association of Diectos of Anaesthesia,spplemented b contacting individal hospitaldepatments as eqied.

Following a pilot n of the sves to identif

an potential poblems and obtaining appovalfrm the Suthern Heath Human Research EthcsCommittee, paticipants wee appoached via emailand asked t ut the reeant surey nne usn

www.svemonke.com (Potland, Or, uSA).The investigatos wee blinded to the identities

f the ndduas cmpetn the sureys. Eachpaticipant was allocated a esponde nmbe, sothat nn-respnders were dentabe by a researchassistant not involved in an othe aspect of thestd. This enabled follow-p emails to be sent tonon-espondes to maximise esponse ates.

The esponses wee collated and analsed to obtaindesciptive statistics fo each of the closed esponsefomat qestions. Fee text esponses to open fomatqestions wee eviewed b the investigatos andcmmn themes were dented. lkert scae data

was cmpared usn Mann-Whtney U test and Fishe’s exact test was sed to examine elationshipsbetween categoical vaiables. Statistical analsis was

carred ut usn Mcrsft Exce 2004 fr MacVesion 11.5.5 speadsheet and statistical softwaepackae instat 3 fr Macntsh versn 3.1a.

RESUlTSresponses wee eceived fom 15 of 19

Drectrs (79%) and 26 f 37 newy quaed Fews(70%) dented as meetn the ncusn crtera(Table 1). The following eslts appl onl to theseespondents.

one Drectr dented hs/her hspta as aspecialist ee and ea cente and thei esponses weenot inclded in the analsis fo items that did notappy. Tw Fews dented themsees as abut tcomplete a twelve-month paediatic anaesthesiafellowship and begin pactice as paediatic

anaesthetists, so thei eslts wee not inclded inthe anayss. Seen Fews dented themsees as

planning to wok in hospitals caing onl fo adlts,so thei eslts wee onl inclded in the analsiscompaing thei expeience in paediatic anaesthesiapio to obtaining thei Fellowship.

Diectos wee asked the lowe age limit of

childen the wold expect a geneal anaesthetistto anaesthetise in an ot-of-hos setting. Fellows wee asked the minimm age of childen the woldanaesthetise in an ot-of-hos setting. The esltsae smmaised in Table 2. The expectations of both gops appea to be ve simila and this issupprted by cmparn these ures usn theMann-Whtney U test. ( P =0.79)

t able 1

Distribution of survey respondents by institution type and location

Diectos Fellows

Total 15 26

Metopolitan – all ages 10 13

regional 5 4

Metopolitan – no paediatics n/a 7

Metopolitan – onl paediatics n/a 2

t able 2

Expected lower age limits for children anaesthetised by general anaesthetists

Age of childen Drectrs (n=15) Fews (n=17)

All ages 0 0

≥6 mnths 0 3 (18%)

≥12 mnths 6 (40%) 5 (29%)

≥2 years 6 (40%) 6 (35%)

≥3 years 2 (13%) 2 (12%)

≥5 years 1 (7%) 0

≥10 years 0 1 (6%)

t able 3

Scenarios used to test age expectations and the number of respondents

Cases Diectos, n Fellows, n

A well-esscitated 7-week-old, foploomotom

14 17

An othewise well 4-month-old, fo ahip washot

14 17

An othewise well 10-month-old, foste of a lip laceation

14 17

A 2-ea-old ex-pem with ceebalpals, on home oxgen fo choniclng disease, fo closed edction of afoeam facte

14 17

An othewise well 3-ea-old, fo

emoval of an inhaled foeign bod

15 17

A 3-ea-old with cstic fibosis, foextaction of a boken tooth

14 17

An othewise well 4-ea-old, foclosed edction of a foeam facte

14 17

Stabilisation of a 4-ea-oldnconscios afte a seize 1 da afteappendicectom

14 17

An othewise well 5-ea-old, foappendicectom

14 17

An othewise well 5-ea-old,fo etn to theate with post-tonsillectom bleed

15 17





regional Diectos tended to expect genealanaesthetists to anaesthetise onge childen. Fof e (80%) rena Drectrs expected eneraon-call anaesthetists to anaesthetise childen fom12 months of age, compaed to two of 10 (20%)metopolitan Diectos. This was not statisticallsncant usn Fsher’s exact test (tw-taed,

P =0.09), but the numbers are sma fr nferentastatistics.

At all hospitals whee <100 sch cases weepefomed afte hos, highe age limits wee chosenthan in those depatments whee moe cases weepefomed.

To test the age limits volnteeed b Diectosand Fellows, both gops wee pesented with aseies of simple case desciptions (Table 3).

Fige 1 shows that in compaison to the expectedanswe based on age, the Diectos wee less likelto expect geneal on-call anaesthetists to anaesthetisechilden with an inhaled foeign bod o co-mobiditiessuch as cystc brss and chrnc un dsease.

Convesel, 36% of Diectos expected thegeneal on-call anaesthetist to anaesthetise the10-month-old with a lip laceation, even thogh norespndent had ndcated that he/she expectedchilden this ong to be anaesthetised b genealanaesthetists. Ths, thee is ecognition that the age

mt wud be nuenced by case cmpexty andcomobidities.

Fige 2 shows that thee is a tendenc foDiectos in egional hospitals to expect genealanaesthetists to do moe complex cases. This ispaticlal evident with the case of the thee-ea-old with an inhaled foeign bod.

The Fellows’ eslts wee similal affected bcomobidit and complexit, as shown in Fige 3.The childen with inhaled foeign bod o thec-mrbdtes cystc brss and chrnc undisease wold be mch less likel to be anaesthetisedb Fellows than wold be pedicted fom thei statedwer ae mts. in addtn, a cases aed essthan one ea who wee well withot comobidities

wold be pefomed b moe Fellows than woldbe pedicted b sing the Fellow’s stated lowe agelimits.

Fige 4 pesents the eslts fo Fellows compaed with Diectos. Thee ae two obvios discepanciesthat ae highlighted. Fist, as noted above, a nmbeof Fellows ae pepaed to anaesthetise healthinfants even thogh the infants ae onge thanthei stated lowe age limit. Fo example, 18%ae willing to anaesthetise a fo-month-old fo ahip washot. Second, moe Diectos expected thegeneal on-call anaesthetist to anaesthetise the

figure 1: Pecentage of Diectos expecting geneal on-call anaesthetist to pefom casescmpared t that expected by knwn ther ae ane. CP=cerebra pasy.





figure 3: Pecentage of Fellows willing to anaesthetise cases, compaedt that expected frm ther stated ae mt. CP=cerebra pasy.

figure 2: Pecentage of Diectos expecting geneal on-call anaesthetist to pefom.Metr=metrptan, CP=cerebra pasy.





two-ea-old with ceebal pals and chonic lngdsease, reectn the ncreased reuctance f Fellows to tackle comobidities compaed to theexpectations of Diectos.

We as asked Fews and Drectrs what they

expected to happen if the on-call anaesthetist didnot anaesthetise a case (Table 4). All Diectos andFellows esponded. The esponses wee fee textand theefoe not exclsive, eslting in moeesponses than espondents.

Diectos and Fellows wee also asked to givethei level of ageement to a seies of statementsreardn cndence n manan arus paedatrcanaesthesia scenaios (Table 5). responses weecmpared usn the Mann-Whtney U test.

The eslts in Table 5 show that while both gopsare cndent they can prde anaesthesa fr

otine elective pocedes and mino emegenc

pocedes in othewise well childen, Fellows aesncanty ess cndent than Drectrs n therabilit to esscitate and stabilise a citicall ill childpio to tansfe if eqied.

Thee was no sggestion that Diectos’ pesonal

expertse n paedatrc anaesthesa nuenced therexpectations of othe consltants (Table 6).

figure 4: Pecentage of Diectos expecting the geneal on-call anaesthetist to anaesthetise acase and the percentae f Fews wn t anaesthetse a case. CP=cerebra pasy.

t able 4

Frequency of options for caring for cases unable to be anaesthetised by the general on-call anaesthetist

Option Fellows, n Diectos, n

Call in paediatic colleage 10 7

Postpone ntil pefomedin-hos b paediatic colleage

1 2

Tansfe to paediatic cente 8 11

t able 5

Summary of statements regarding confidence in managing various paediatric anaesthesia scenarios

Statement Diectosn=15

Fellowsn=17

P vale(two-tailed)

i am cnfdent tesscitate and stabilise aciticall ill child pio totansfe if eqied

6 (5-6.5) 5 (3-6) 0.031

i am cnfdent t prde

anaesthesia fo otineelective pocedes inchilden withot significantco-mobidities

6 (6-7) 6 (6-7) 0.682

i am cnfdent i canpovide anaesthesiafo mino emegencpocedes in childen

withot significantcomobidities

6 (6-7) 6 (6-7) 0.984

Data are presented as medan (nterquarte rane). 1=strnydsaree t 7=strny aree.





Anecdotall, tainees epot a decline in paediaticexpetise sbseqent to the completion of theipaediatic otation and a lack of expose to paediaticanaesthesia in the est of thei advanced taining.Newy quaed Fews were asked t state ther

level of ageement with a seies of statementsegading thei expeience in paediatic anaesthesiasince completing thei paediatic anaesthesia otation(Tabe 7) and ther cndence n prdn paedatrcanaesthesia sevices following thei taining (Table 8).

t able 6

Summary of directors’ experience and expectations

regional Expected ae mt After-hurs cases/year n department Own lowe limit Own feqenc of paediatics

Diecto A 12 months 100 12 months weekl

Diecto B 12 months 100 12 months fotnightl

Diecto C 12 months 100 12 months fotnightl

Diecto D 12 months 100 12 months weekl

Drectr E 3 eas 100 3 eas fotnightl

Metopolitan Expected ae mt After-hurs cases/year n department Own lowe limit Own feqenc of paediatics

Diecto F 2 eas 500 10 eas monthl

Diecto G 12 months 350 12 months weekl

Diecto H 2 eas 300 12 months monthl

Drectr i 5 eas 50 5 eas monthl

Diecto J 2 eas 12 2 eas fotnightl

Drectr K 3 eas 75 2 eas less feqent than monthl

Drectr l 12 months 500 6 months fotnightl

Diecto M 2 eas 200 all ages weekl

Diecto N 2 eas 5 10 eas weekl

Diecto O 2 eas 1000 all ages weekl

t able 7

Comparison of frequency of paediatric anaesthesia experience post-paediatric rotation and site of current employment

Feqenc of paediatic anaesthesia povisionsince completion of paediatic otation

Hospitals withot paediaticserces (n=7)

Hospitals with paediaticserces (n=17)

Haven’t anaesthetised a child 1 0

Anaesthetised childen ael 5 4

Anaesthetised childen at least once a month 1 10

Anaesthetised childen at least once a fotnight 0 1

Anaesthetised childen at least once a week 0 2

t able 8

Summary of level of agreement with statements describing Fellows’ training and confidence in paediatric anaesthesia

Statement Fews (n=24) Nmbe (%) agee

i am certan i st meet a the requrements f the ANZCA paedatrc mdue 4.5 (3-5.25) 12 (50%)

i am certan that cmpetn the requrements fr the ANZCA paedatrc mduehas pepaed me adeqatel fo m fte pactice

5 (3-6) 15 (62.5%)

i am at east as cnfdent n my abty t prde apprprate anaesthetc care frchdren, as i was when i cmpeted my paedatrc rtatn n oPATS

3 (2-6) 9 (37.5%)

i am certan i can demnstrate paedatrc resusctatn sks 6 (5-6) 19 (79 %)

i am certan i can demnstrate nenata resusctatn sks 5 (4-6) 17 (71%)

Data are presented as medan (nterquarte rane) where 1=strny dsaree t 7=strny aree. Areement s the number (percentae)f respndents wth a scre f 5, 6 r 7. ANZCA=Austraan and New Zeaand Cee f Anaesthetsts, oPATS=obstetrc and Paedatrc

Anaesthetic Taining Scheme.





Finall, Diectos and Fellows wee asked how

the maintain thei paediatic anaesthesia skills(Table 9). All Diectos and Fellows esponded.Thee wee moe esponses than espondents andthe esponses wee fee text.

DiSCUSSioN

Althogh the nmbes ae small, given o highesponse ate we believe the eslts of o svereect the current pnns f empyers (Drectrs)and emploees (new ANZCA Fellows) in Victoia.

Implications for current training practice

Althogh all Fellows had completed thei ANZCA paediatic modle, onl 50% believed the cold stillmeet its eqiements at the end of taining. Also,onl 62.5% of new ANZCA Fellows ageed thatcompletion of thei ANZCA paediatic modle hadpepaed them adeqatel fo thei fte pactice.There s therefre a sncant number f Fews

who believe thei taining was inadeqate fo theianticipated needs, with an even highe popotion(62.5%) reprtn a decne n cndence sncecompletion of thei dedicated paediatic anaesthesiaotation.

The cent Victoian pactice of concentatingpaediatic anaesthetic expeience to ense thelagest nmbe of tainees can meet the minimm

ANZCA eqiements ma have podced thenintended conseqence of deceasing the exposeof tainees to this expeience at othe times in theitaining. That this is not meeting Fellows’ peceivedneeds is less spising when we epot thatmaintaining expose is the majo wa Diectosand Fellows seek to maintain thei skills in this aea.

Mxed adut/paedatrc sts at suburban andegional hospitals might be tilised fthe as an

oppotnit fo senio egistas to maintain theiskills. Howeve, man of these lists in sbbancentres hae aready been dented and utsed bythe Obstetic and Paediatic Anaesthetic TainingScheme as pat of the coe paediatic anaesthesia

taining. Those lists in egional centes ae not, btthe majoit of egional otations in Victoia aeed by junr tranees.

To allow tainees contining expose to paediaticanaesthesia afte thei dedicated otation woldrequre dentcatn and utsatn f mre sts,edcing the nmbe of tainees o thei expose inthe dedicated otation, o a decease in the expectedcmpetence f newy quaed ANZCA Fews.

our ndns reect the stuatn n vctra; ther Astalian states and ANZCA egions oganisetaining in paediatic anaesthesia diffeentl so o

eslts ma not be tansfeable to othe egions.it wud be nterestn t knw f prsn f adeqate taining in paediatic anaesthesia hasbecome poblematic in othe aeas as taineenmbes have geneall inceased in ecent eas.

Implications for accreditation of generally-trained anaesthetists

The majr ndn frm ur surey s that there sa boad ange of expectations amongst Diectos andnew ANZCA Fellows egading the minimm agechilden that geneall-tained anaesthetists, athethan paediatic sbspecialist anaesthetists, can beexpected t anaesthetse. What are the mpcatnsof this infomation?

The rst mpcatn s that bth newy tranedanaesthetists and thei emploes acknowledge thatcent taining does not eqip an anaesthetist tocae fo all patients of all ages. Given this ecognitionthat geneall-tained anaesthetists’ paediaticpactice is necessail limited, and that opinion on

whee this limit lies vaies consideabl amongstespondents, what is a sensible limit fo tainees andthei spevisos to aim fo?

The onl jisdiction which has mandated sch aeqiement fo end-of-taining expetise, as fa as

we ae awae, is Geat Bitain. The roal Collegeof Anaesthetists has pblished gidelines on theminimm level of competence eqied in paediaticanaesthesia following taining2. The state that aftebasic paediatic anaesthetic taining, all consltantanaesthetists “shold, as a minimm, have beencompetent to povide anaesthesia fo staight-fowad elective and emegenc sge fo childenof Ameican Societ of Anesthesiologists phsicalscre cateres 1 r 2 wh hae reached ther fthbrthday”. it s as expected that ths cmpetence

t able 9

Methods of maintaining skills in paediatric anaesthesia

Fellows,n

Diectos,n

Spoadic expose, both in- and afte-hos 5 5

regla paediatic lists 6 5

Staing p to date with liteate 2 1

interactn wth paedatrc ceaues 1 1

Cnferences/wrkshps 4 3

regla simlation execises 0 1

inement wth sck chdren n iCU 0 1

regla attendance at a paediatic cente 1 1

CME a 3 0

iCU=ntense care unt, CME=Cntnun Medca Educatn.





will need to be sstained thogh egla exposeand contining edcation, nless thee is noeqiement to anaesthetise childen2. Thesegidelines have not been ecognised in Astalia,thogh 100% of o espondents wold expect

newy quaed anaesthetsts t meet ths standard.Ove 80% of Diectos and Fellows espondingt ur surey expected newy quaed anaesthetststo anaesthetise non-complex childen ove two

years f ae. We wud arue that ths represents aeasonable aim fo tainees and thei spevisos,and a easonable expectation of geneall-tainedanaesthetsts n the Austraan cntext. As t reectsthe stats qo, at least in Victoia, we wold agethis shold be acknowledged b ANZCA and sedt hep dene trann as and deneate requredexpeience. This wold povide clait to spevisos

and tainees and align the povision of taining tothe anticipated needs expessed b the Diectosand Fellows esponding to o sve.

Implications for anaesthetic practice in regional areas

Althogh the nmbe of espondents is small,thee is a clea implication fom o sve thategional emploes, as epesented b thei Diectosof Anaesthesia, expect geneal anaesthetists toanaesthetse yuner chdren. We dd nt exprethe easons fo this in o sve, bt possibleexplanations cold inclde:

• the geate distance and inconvenience of

tansfeing patients, • a smalle pool of local anaesthetists with extapaediatic expetise to daw on fo assistance,

• geate expose in thei pactice that allows themto moe easil maintain thei skills at this highelevel.

The minimm expectation of anaesthetising non-complex childen ove two eas of age which wehave ecommended above wold not meet theexpectations of most Diectos esponding fomegional centes. regional centes in othe statesae often moe geogaphicall isolated than theiVictoian contepats, so it wold be inteesting toknow if egional centes elsewhee in Astalia alsoeqie geate expetise in paediatic anaesthesiafom thei geneall-tained anaesthetists.

Given this infomation, anaesthetists planningto wok in egional centes ma wish to fthethei paediatic expeience befoe the take psch positions. Similal, pospective egionalemploes shold be awae that expectations of newy quaed Fews f the requred ee f expetise in paediatic anaesthesia might besncanty ess than ther wn. indeed, the need

fr specc recntn f the requrements f ruraand egional anaesthetic pactice ma need to beconsideed.

Implications for specialist training in paediatric anaesthesia

A fthe implication fom o eslts is that theeis a lack of eglation, oganisation of taining oendrsement n paedatrc anaesthesa. in practcethee has been an acknowledgement that neonatalanaesthesia eqies special expetise, bt it appeasthat o espondents believe this applies to a boaderane f chdren. in Austraasa, there s currentyno fomal management o eglation of sbspecialttrann n paedatrc anaesthesa; there s nacceditation eithe of taining posts o individals,and no assessment of sbspecialt competence.

As the medical wokfoce contines to specialise,

eqiements fo anaesthetists to sbspecialise will become moe appaent. ANZCA will needto continall eview its position to ense itsquacatns accuratey reect the cmpetences f anaesthetists who hold ANZCA Fellowship.

ACKNoWlEDgEMENTS

The athos wish to thank the sve espondentsfr partcpatn n the study. We wud as ke tthank Ms Maie Backstom fo assisting with thefollow-p emindes fo non-espondes to the sve.

REFERENCES1. Buck N, Den HB, lunn JN. The reprt f the Natna

Cnfdenta Enqury nt Perperate Deaths (1987). Frm

http://www.ncepd.r.uk/pdf/1989/1989sum.pdf AccessedSeptembe 2008.

2. The roal College of Anaesthetists. Gidance on the povision

of Paediatic Anaesthetic Sevices. Gidelines fo the Povisionf Anaesthetc Serce 2004. Frm http://www.rca.ac.uk/dcs/

GPAS.pdf Accessed Septembe 2008.3. Astalian and New Zealand College of Anaesthetists.

recommendations fo Vocational Taining Pogams, ANZCA

Prfessna Dcument TE10 2003. Frm http://www.anzca.edu.au/resurces/prfessna-dcuments/trann-educatn-

a/pdfs/TE10.pdf Accessed September 2008.

4. Astalian and New Zealand College of Anaesthetists. Oveviewof Ciclm Modles, Modle 8- Paediatic Anaesthesia

2007. Frm: http://www.anzca.edu.au/tranees/atp/currcuum/ mdue-8/erew Accessed September 2008.

5. Federatn f the Eurpean Asscatns f Paedatrc

Anaesthesa. Eurpean gudenes fr Trann n Paedatrc Anaesthesa. Frm http://www.feapa.r/ Accessed September

2008.6. Association of Paediatic Anaesthetists of Geat Bitain and

ireand. Trann n Paedatrc Anaesthesa, 2002. Frm http://

www.apab.r.uk/dcs/apa_udenes_n_trann.pdf Accessed Septembe 2008.

7. Ca A. Competence. Pape pesented at: Annal ScientificMeeting of the Association of Paediatic Anaesthetists of

great Brtan and ireand; 2008 May 8-10; lndn, UK.

aic paed experience

Documents