Guide to Anaesthetics Training (The Handbook)

Out of hours work for anaesthetists in training largely involves providing services for emergencies and compared with elective work makes different demands on the anaesthetist. There are several reasons for anaesthetists in training to undertake out of hours work. It provides:

• The opportunity to experience and develop clinical decision making, with reduced resources, under distant supervision
• The opportunity to learn when to seek advice and appreciate that close clinical supervision is required when learning new aspects of emergency work
• A reflection of professional anaesthetic practice, as in most hospitals patients are admitted 24 hours a day, 7 days a week; there is therefore a service commitment

Occasionally there may be a domain of learning where out of hours work is not required; this will be the exception. For the domains of learning where out of hours work is required, anaesthetists in training should not normally work more than a 1 in 8 rota, ie 7 nights in an 8-week period, to ensure that they can meet the many learning outcomes that are gained during normal working hours, in addition to those gained out of hours.

The College recognises that there are occasions when additional out of hours work is required due to local circumstances; when this occurs, it should only be for short periods otherwise the anaesthetist in training will require extended training time to ensure the domains of learning are met. Local trainers, in conjunction with their Clinical Directors [CDs], must recognise this consequence of excessive out of hours commitments. Finally, it is important to ensure that any new aspects of emergency work are undertaken initially with close clinical supervision.

For anaesthetists in training unable to undertake out of hours work due to illness or other debilitating circumstances, the College Tutor, Regional Adviser, Training Programme Director, and Chair of the College Training, Curriculum, and Assessment Committee will determine whether it is possible to obtain all the essential key capabilities of a domain of learning and whether extra training time is required. This may involve extending the period of training and so anaesthetists in training are advised to discuss the potential consequences of inability to perform out of hours work as soon as practicable, as it may have a major impact on the training programme leading to the award of a CCT.

Service commitment to ICM and obstetrics

In many hospitals anaesthetists in training provide out of hours cover to intensive care units and obstetrics. Whilst these provide valuable training and experience, it must not be to the detriment of anaesthetic training; anaesthetists in training must receive a balanced programme of training over their higher specialty training years. It is up to individual Schools, normally via their specialty training committees, to ensure the College recommendations for training are met.

Service commitment to ICM: the College recommends that anaesthetists in training must spend no more than a total of 6 months, when all time spent in ICM duties is considered, in their indicative 2 years of stage 2 training undertaking daytime ICM duties (this is to include their dedicated Intensive Care domain of learning), to ensure they achieve their other anaesthetic key capabilities.

It is important for anaesthetists in training to gain experience in emergency anaesthesia so they need to be on call for general theatre emergencies. The on-call cover for intensive care should not be detrimental to the anaesthetists in training gaining experience in emergency anaesthesia in general theatres or obstetrics.

During stage 3 training, experience in ICM on call could be useful in gaining the capabilities for the Intensive Care or Resuscitation and Transfer or domains of learning. 

Service commitment to obstetrics: the College recommends that no more than a third of service commitments in their indicative 2 years of stage 2 training are dedicated to obstetric anaesthetic services. 

The College expects anaesthetists in training to develop their skills in emergency anaesthesia in all disciplines. Anaesthetists in training exposure to emergency anaesthesia should not be compromised because of service commitments to ICM and obstetric anaesthesia. ‘Sign off’ confirming adequate exposure to emergency anaesthesia related to a particular domain of learning is necessary on the Holistic Assessment of Learning Outcomes (HALO) form.