My life as a ST7 Anaesthetics Trainee

In this edition of ‘My life as…’ we’re talking to a ST7 Anaesthetics trainee

What training stage are you in?

Anaesthetics training ST7 – I should begin CCT at the beginning of February.

Where are you working?

South East London currently. I did my core training in SESA deanery, and my ST3 onwards in KSS (Kent, Surrey, Sussex). ST4, ST6 and ST7 were all in London.

What stage did you decide on your speciality, what other specialities were you considering?

I was considering anaesthetics in my final year of medicine. I did two weeks of anaesthetics during my final year surgical rotation. I then applied for an F1 job that included anaesthetics and ITU. That’s what confirmed it for me.

I was also considering Obs & Gynae, as I loved obstetrics.

What brought you to your decision?

As a student I had very little idea what I wanted to do but vaguely thought it would be surgical as I like being in theatre (and hated ward rounds and clinics!).

I also enjoyed O&G when I did it in the 4th year of medical school, and then I did some ‘proper’ anaesthetics in my final year of medical school during my surgical rotation and loved that.

I applied for an F1 job with anaesthetics and ITU. I’d decided at that time that it seemed interesting and fun and the trainees that I worked with all seemed happy with their lives! There was plenty of tea breaks and a great level of supervision and training that I hadn’t seen in other specialties. I also enjoyed having procedures to do and as a very impatient person, the immediacy of anaesthesia suited me!

How have you found the exams so far? How did you revise for them?

The exams were pretty awful at the time. But they’re a means to an end. I revised for the primary with on-line MCQs and MCQs from the RCOA books, lots of books, Dr Podcast on the way to and from work and by writing hundreds of notes (probably unnecessarily). I did an OSCE/VIVA course for that part of the exam.

For the final I did an online writers’ course to help with the short-answer questions. And again, loads of online MCQs. I read all the British Journal of Anaesthetists (BJA) education supplements for the previous 3-5 years (1 every 3 months I think). I’m a crammer but most people say you need 3-6 months to revise for each exam and it took up all my evenings and weekends for 1-2 months each time.

How is your day job split up – when you’re not on-call?

When not on call, I’ll be assigned to an elective operating list. The list depends on which training module I’m doing at that time and what year of training/what hospital I’m working at.

My most recent module was maxillo-facial/airway so all my non on-call days I was assigned to a list that was max-fax or dental, whether day surgery or main theatre. Now I’m doing general surgery and will do another neuroanaesthesia module in the next few months (anaesthesia for neurosurgery). These lists start at 8:30 and finish at 5-6pm usually.

What aspects of being an Anaesthetist have you enjoyed the most? What has been hard?

I’ve enjoyed working with so many different people – with so much knowledge and skill to impart. I love helping countless people through very difficult times in their lives, whether they have appreciated me or not! I’ve enjoyed alleviating pain and helping to save the lives of babies, children, adults and the very elderly.

I’ve enjoyed working in Ecuador helping those without access to health care to get their cleft lip and palate repaired. I’ve enjoyed working in Vancouver and realising how well we are trained in the UK.

What’s the best thing about being an Anaesthetist?

We’re the Ghost Busters of the Hospital: ‘Who you gonna call?’

Also, we get plenty of tea breaks. Plenty of time for fun chat, or teaching whilst in theatre with a long case. It has a nice balance of excitement and ‘boredom’ (I appreciate boredom!).

What’s the worst thing about being an Anaesthetist?

It can be very stressful. Also, working with surgeons.

Could you share with us your most challenging moment as an Anaesthetist?

I’ve been lucky that I’ve never had a death on the table, but that’s more luck than anything else. I’ve had a couple patients that I’ve been involved with in paediatrics and obstetrics that eventually died and for several reasons really affected me.

I’ve found it hard at times to juggle shifts (especially night shifts) and get my CV buffed up and have a life. It always seems like something has to give.

What’s your response to those who say you’re just putting people to sleep and that your job seems boring?

Well, I won’t help them with their patient ‘with no veins’ if they really think that, haha!

But seriously, my job is so much more than that! It used to irritate me much more than it does now. I’m happy with my job, I certainly couldn’t see myself doing anything else in medicine. I love the variety and the fact that I can often catch up on emails in those ‘boring’ moments!

There is truly something for every personality though. For instance, you can do HEMS (helicopter response pre-hospital) and liver transplants (very bloody and high-stakes ops) or you can do day surgery knee arthroscopies and obstetrics (lots of hand holding lovely babies to cuddle). Personally, I started out loving the stressful stuff and intensive care but now I appreciate how many things that I used to find stressful are very routine. It’s all part of getting better and my job!

Many members of the public (and some doctors!) think of anaesthetists as technicians. How do you deal with that having gone through so much training to get to where you are?

I think the role of the anaesthetist has really expanded in the last couple of decades. In the UK we are truly peri-operatively physicians and have a very big role in so many different patients. Public perception is difficult, especially with so much misinformation out there from the media and in films. I’ve never seen a sexy, capable anaesthetist on Holby City!

I explain to people that want to know what we actually do but mostly I just laugh along and let it go over my head. I try not to get too annoyed (difficult sometimes). My husband doesn’t even really understand exactly what I do and lots people have asked me lots of frustrating questions over the years. I do feel like the royal college of anaesthetists (RCOA) should probably do a better job of advertising how important we are but then again, it doesn’t really matter as long as the patients get through their operations/cardiac arrests/pain procedures/ITU admissions as successfully as possible.

What do you think are the most critical personality traits that a doctor should possess for a career in anaesthetics?

A degree of patience and good negotiating skills for difficult (usually surgical) colleagues. Good hand-eye coordination helps! An ability to stay calm under pressure. Some creativity (anaesthetics are a bit like cooking). Some people say anaesthetists are perfectionists. I’m not sure about that but I am much tidier at work than I am at home!

The RCP recently published a report on the welfare of junior doctors which made for harsh reading; what needs to be done to make anaesthetics training fit for purpose?

I think the most important things for anaesthetics is to make sure those in charge of trainees are actually invested in their welfare and training and not just doing it for an extra PA.

I think hospitals need to bring back rest facilities, I nearly died many times driving 50 miles back from my fourth night shift home. There needs to be more time given to trainees to take on projects. There needs to be less talk about ‘resilience’ and ‘in my day…’ and more listening to the trainees and how they are struggling.

There needs to be less negative judgement for those that are finding exams/work/life difficult whilst in training. More though put into the distances that trainees need to travel within deaneries.

A concern of many trainees applying for anaesthetics training is the work-life balance; how do you cope with incessant nights and weekends?

I do struggle at times but I think one good thing with shifts is you hardly ever get ‘stuck’ at work, you hand over the bleep and go at the end of the on-call. I try to plan lots of holidays and fun stuff to do between nights and I remind myself that however stressful it gets it will always come to an end!

What opportunities are there in anaesthetic training to ‘deviate’ from the standard pathway? Can you tell us about any interesting breaks or side projects you have taken during your training? How did you organise these?

Lots. I think deaneries are more supportive of career breaks now than they used to be. If you want to work abroad, there’s lots of opportunities, the skills we have are very transferable and we have longer training than other countries so British trainees are valued. I spent last year in Vancouver, Canada doing an obstetric anaesthesia research (and skiing!) fellowship. I know people that have been to New Zealand, Australia, America, Canada. I’ve also done charity work in Ecuador for a cleft lip and palate charity.

If you want a break from work there are management fellowships, I know someone who left to do law and I know someone who took a total career break so go and live in another country with their partner and didn’t work!

I organised my OOPE by looking for obstetric fellowship on the OAA website, talking to other people and then applying! You often need to apply at least a year in advance, if not 18 months. The paperwork was pretty extra but I’m so glad I did it, it was so much fun. Anaesthetists are very friendly on the whole so an enquiry email is always a good first start!

What’s your number one piece of advice to junior doctors who are considering applying for anaesthetics training?

Spend some time in theatres and talk to trainees in the area you want to apply to get their honest opinion. Make peace with doing hard exams and occasionally being bored!