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Editor,—Accident and emergency (A&E) trainees are required to spend a minimum of three months on secondment to anaesthetics and the intensive care unit (ICU) if they have not already obtained adequate anaesthetic/ICU experience before entering the specialty. The depth and breadth of experience varies widely. Sometimes, the trainee is purely supernumerary and gains little experience other than placing laryngeal masks and endotracheal tubes. We have each been fortunate enough to spend six months as trainee senior house officer (SHO) anaesthetists as part of our rotations. We feel that this offers considerable benefit to our training as A&E specialists and recommend it to other A&E trainees.
Anaesthetics is unlike any other clinical specialty. It is impossible to start as the sole “on call” anaesthetic SHO on the first day. Hospitals vary, but most train their new SHOs over three months before allowing them onto the on call rota. In our six month secondments we participated in the on call rota and have benefited from the responsibility of acute decision making. We have become increasingly competent in preanaesthetic assessment, sedation, pain management (including regional anaesthesia), and the induction, maintenance, and recovery phases of a general anaesthetic. We have performed rapid sequence induction independently. Our improved confidence in the management of the airway has to be good for patient care, especially as we often provide initial airway control before the anaesthetist arrives in the A&E department.
A greater understanding of anaesthetic problems and equipment will be increasingly important for A&E consultants as anaesthetics and A&E have a common role in airway management and ventilatory and circulatory support in critically ill patients. We propose that every A&E trainee requiring an anaesthetic secondment undergo six months of anaesthetics/ICU experience with the same commitment and training as a career anaesthetics SHO.
To achieve this, A&E training programmes should routinely allow the trainee to be released to SHO posts in anaesthetics and intensive care for six months. This could be at another hospital, although salary issues would need to be addressed in advance. These include salary protection at the specialist registrar grade, and how much each trust and postgraduate deanery pay.
We accept that both the quality and quantity of dedicated anaesthetic SHOs must be maintained. However, six month slots could still be allocated on a competitive basis, and an anaesthetic specialist registrar or SHO could undertake a similar secondment in A&E on an exchange. A&E medicine has a lot to offer, particularly in those departments that perform regional anaesthesia, rapid sequence induction, advanced life support, and advanced trauma life support without initially involving the on call anaesthetist.
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