Anaesthetics and intensive care medicine as a foundation year doctor

Anaesthesia is the largest secondary care specialty in the UK and posts have been created for doctors in prevocational (foundation year) training since 1997. ¹ Despite this, most receive limited exposure to anaesthetics and intensive care medicine (ICM) and so, the Faculty of Intensive Care Medicine released a framework to help increase opportunity for foundation doctors. ² Opinions regarding the appropriateness of foundation doctors undertaking rotations in anaesthetics or ICM are mixed. Some argue that their involvement in the management of critically ill patients is unsafe, while others proclaim it is more important to first learn the fundamentals of medicine and surgery. ³

In 2016, only around 8% of foundation year doctors completed a four-month rotation in one or both of anaesthetics and ICM. ⁴ In the same year, demand for exposure to both specialties was high, with a ‘taster experience’ being the second most popular choice. ⁴ Experience in anaesthetics and ICM is clearly highly desired among trainees and a rotation can offer a wealth of potential benefits.

Operating theatres and intensive care units (ICU) are closely supervised environments that are ideal for foundation trainees to develop confidence in the recognition and management of common emergencies. Anaesthetic/ICM rotations can improve a foundation doctor’s proficiency in a range of clinical tasks, including acute pain management; recognition and resuscitation of sick patients; when and who to call for help and fluid management. ⁵

Under appropriate supervision, foundation doctors can develop technical skills in airway management, vascular access, lumbar puncture and nerve blocks, that may be useful on other rotations, and observe advanced procedures such as neuraxial blocks, chest drain insertion, and heart/lung ultrasound. Access to training in procedures helps foster interest and broaden understanding in the next generation of trainees.

Anaesthetists are often required to make timely but informed decisions. Under supervision, being faced with evolving situations such desaturation or hypotension can help a foundation doctor to develop a rapid and logical approach to problem solving. First-hand experience within an operating theatre environment helps underpin key teamwork principles and the importance of non-technical skills, including human factors.

Withdrawal of treatment and organ donation are challenging discussions held with the relatives of patients in the ICU. The role of a foundation doctor in such conversations is limited, but observation can offer valuable learning. Anaesthetics/ICM provides opportunity to witness real-time physiology and pharmacology. Peering over the drapes during an operation can demonstrate anatomy in action, while bedside investigations and imaging allow for daily data interpretation in the ICU. Anaesthetists are poised at the intersection between medicine and surgery and can offer a vast breadth of knowledge for teaching.

A foundation year rotation in anaesthetics and/or ICM can provide the ideal environment to begin your career as a doctor with a variety of learning opportunities available. The development of both technical and non-technical skills will be valuable for doctors wishing to pursue a career in any field of medicine or surgery. Foundation programme directors need to work with hospitals to ensure greater access to anaesthetics and ICM during foundation training.