REDUCTIONS IN TRAINING HOURS FOR ANAESTHESIA REGISTRARS: IMPLICATIONS FOR TRAINEES, DEPARTMENTS, AND ANZCA
Medical Education SIG
AI Gardner
Sir Charles Gairdner Hospital, Nedlands WA
Over the last 10 years within the Western Australian anaesthesia training scheme there has been a greater than 25% reduction in training hours spent in anaesthetising locations.(1) Australia is not unique in reduction of training hours – within the English speaking world there have been similar changes in the UK, the US, and Canada. These changes have occurred as a result of changes to industrial awards and the AMA safe hours campaign, and have happened independently of ANZCA policy.
It is difficult to define the number of cases that will ensure a trainee is deemed ‘competent’ in any specific facet of anaesthesia – trainees have different learning styles and skills, will be instructed in different ways, and will be exposed to different case mixes. Whether the reduction in training hours will enable all trainees to become competent in all facets of anaesthesia is yet to be determined. The effects of limiting trainees hours in other specialities have been documented, yet until recently little has been written about the impact of reduced training hours on anaesthesia practice, or their implications for future service delivery.(2,3,4) Paradoxically, the introduction of new minimally invasive surgical procedures has extended surgical practice to patients with extreme co-morbidities, which has increased the clinical skills required by anaesthetists. Some medical specialties have already defined the need for specialist training programmes with specific skills training to evolve in parallel to reduced training hours.(5)
The ANZCA fellowship examination continues to examine theoretical knowledge to a high degree, and the introduction of simulation and better teaching methods may have resulted in improved training despite the reduction in training hours. The issue of the reduction in training hours is real, but the implications are unknown.
With the changes in working hours, the trainee has responsibility to ensure that opportunities for learning theoretical knowledge and clinical skills are maximised. Strategies such as specific learning objectives for theatre sessions, and methodical covering of the theoretic and clinical aspects of a module syllabus during theatre time are examples of those that could be used. The use of the provisional fellowship to gain and consolidate experience in areas that were previously not considered subspecialty may be required.
For supervising consultants and departments, trainees in a given year of training may not be as experienced as previously. This will necessitate more detailed assessment of a trainee’s capabilities prior to allowing the trainee to give anaesthesia or perform procedures with lower levels of supervision. In the New Zealand context, this has already been tested in court proceedings.(6)
Given the reduction in training hours, even with completion of all twelve FANZCA modules, it may be unreasonable to expect that all new FANZCA specialists will be competent and adequately experienced in all areas of anaesthesia practice. Greaves notes with respect to UK trained consultants that new consultants will be “less experienced and less confident that those of previous times, and as such that managers must make provision for them as they gain the additional experience that they will have missed out on as trainees”.(7) UK training and the FRCA examination are different from Australian and New Zealand training and the FANZCA examination, however similar problems may occur. Credentialling for consultants to perform certain types of anaesthesia and specific procedures may be required to ensure that quality services are maintained. For departments and managers, extra on-call rosters may be required to provide cover for new consultants, with the resultant working hours and cost implications. Responsibility also rests with the new consultant to be aware of his/her limitations, and to seek guidance and assistance when appropriate.
For our College, the challenge is to ensure that the fellowship programme continues to prepare the best quality anaesthetists within the available training hours. The use of new teaching methods and technology such as simulation for teaching skills relating to anaesthesia crisis resource management has been well established with the introduction of the EMAC course. In line with changes in surgical skills training, it may be that other clinical and resource skills relating to anaesthesia may need to be taught with such methods and technologies.
For existing ANZCA fellows, if significant changes to the clinical experience of new consultants have resulted from reduction in working hours, mentoring and support of junior fellows as they establish themselves as consultants will be required. In addition, specific education regarding clinical teaching techniques will increase their ability to be of value to the trainees that they supervise.
It is possible that training hours of previous decades were often inappropriately excessive and poorly supervised. It is extremely unlikely that training hours will increase in the future; in all likelihood they will decrease further. Rather than be caught lagging, the College and its relevant special interest groups must assess where deficiencies in our training system will occur, and work to remedy these deficiencies so that our training schemes continue to produce high quality anaesthetists.
Time of Presentation
Saturday 13 May 2006 - 1030-1200
References
1. Chan SL Gardner AI A Comparison of Working Hours of WA Anaesthetic Training Scheme Registrars between 1996 and 2006. Accepted for presentation at ANZCA ASM Adelaide 2006
2. Romanchuk K The Effect of Limiting Residents’ Work Hours on their Surgical Training: A Canadian Perspective. Academic Medicine 2004 79(5) 384-5
3. White ML Walker IA et al Impact of the European Working Time Directive on the training of paediatric anaesthetists. Anaesthesia 2005 60 870-3
4. Underwood SM McIndoe AK Influence of changing work patterns on training in anaesthesia Br J Anaesth 2005 95(5) 616-21
5. Payne SR Shaw MBK What impact will shortened training have on urological service delivery? Ann R Coll Surg Engl 2005 87 373-8
6. www.cdhb.govt.nz/corpbrd/hacmeetings/2003/nov/item3.pdf - Unpublished NZ District and High Court findings, quoted in this document
7. Greaves JD Training time and consultant practice Br J Anaesth 2005 95 (5) 581-3
