Page 1

SUMMER 2013

NEWSLETTER

SOCIETY FOR EDUCATION

IN ANAESTHESIA

EDITORS NOTE

Welcome to the summer edition of the SEA UK newsletter. 2013 has been an interesting year so far: from even more dramatic weather changes than usual to the birth of Prince George. It has been just as interesting for the society. Our new President has started her term and written her first address to members on page 2. SEA UK hosted yet another successful scientific meeting and many thanks to Simon Mercer, his family and co-workers for their hard work. The quality of trainee abstracts was excellent and I encourage you to read the winning entries on pages 8 – 10. The theory and content of these abstracts, in particular, can be easily applied to everyday anaesthetic practice. Congratulations to Drs Vaughton, Mc

Phereson and Oglesby on their winning presentations. Of note; a sample of abstracts from our scientific meeting are featured in the journal Anaesthesia each year. This service will no longer be available in 2014. I would like to take the opportunity to thank Anaesthesia for their support over the years. Finally, SEA UK travels to Belfast for the 2014 ASM. This will, hopefully, be a welcomed change in venue and scenery (see advert on back cover or visit www.seauk.org). Cindy Persad and Claire Joannides

CONTENTS

EDITORS NOTE 1

PRESIDENT’S REPORT 2

SAFER ANAESTHESIA FROM EDUCATION

3

SEA UK ASM 2013

REPORT 4

WORKSHOP REFLECTIONS 6

FREE PAPER WINNERS 8

POSTER WINNER 10

DIY CO MONITORING MODEL 11

PAEDIATRIC REUSCITATION AND RE-

VALIDATION 14

ADVANCED TRAINING - BLAZING THE

TRAIL 15

COUNCIL APPOINTMENTS 16

LETTERS 17

SEA UK Newsletter – Summer 2013

Page 2

PRESIDENT’S REPORT

TERESA DORMAN

Dear Colleague This is my first newsletter as President. Alison and I handed over in April and as you can see celebrated with a glass of champagne in the champagne bar at St Pancras on the way back from the e-SAFE meeting at the college in April My first job is to say a huge thank you to Alison who has worked with tireless enthusiasm on the society’s behalf and has raised the profile of the society considerably in her five years as president, establishing links with the Association, the College and overseas.

As I become president so Chris Leng becomes Treasurer and I am happy to say he is taking over a treasury that is on a sound footing with stable finances. I am lucky to be supported by Kim Russon our secretary, also a tireless worker, and Cath our administrator, both based in Rotherham. The society is very lucky to have a very talented and enthusiastic council, who I intend to exploit mercilessly! This year’s ASM was in Liverpool, an excellent meeting in the lovely setting of the Maritime museum. It was nice to see a lot of “old faces” at the meeting but also to welcome new faces too, who I hope will continue to come. Once again we had a high standard of paper and poster presentations, which represents the huge amount of enthusiasm in anaesthesia to progress medical education within the speciality, despite the doom and gloom of the recession and the pressures of a service that has to provide quantity for less money whilst trying to maintain the quality of what we do. A huge thank you should go to Simon Mercer, the local organiser, for all his hard work, resulting in a well organised, informative and very enjoyable meeting. Highlights from the meeting can be found in this newsletter and on the website. Next year, the meeting is in Belfast, which is shaping up to be a meeting well worth attending. Hope to see you there! So far this year the society has run a day for educational supervisors, which provided updates on knowledge and skills required for educational supervisors both for revalidation and accreditation with the GMC. We also ran a very successful CPD day in medical education aimed at all consultants and staff grades, again to fulfil what is needed for revalidation. Special thanks to Alison, Charlie, Rob and Chris for organisation and facilitation at both meetings. Both were run in collaboration with the College. We continue to support projects via the NIAA, thanks to the hard work of Rob McCahon, our council member who represents us on the NIAA. On the subject of grants, the society offers travel and research grants each year, which members can apply for, please see the website for details. What is planned for the next couple of years? We are continuing to build the website, which will have a section that will contain resources for educators in anaesthesia with material that can be used as updates as well as for teaching and facilitating. The society is represented on various groups for example, the Anaesthetists as Educators Group, CPD Working Party and Assessment Working Party at the College, the NIAA, the specialist society meeting at the Association and we will continue to work in collaboration on medical education matters. We will be running ad hoc workshop focusing on areas of medical education each year, so if there is a particular area you would like covered let Cath, our administrator know. The first of these workshops, on feedback,

SEA UK Newsletter – Summer 2013

Page 3

will be early next year, facilitated by Professor Colin Beard, who ran an excellent feedback workshop at the recent ASM. Places will be limited so book early through the website! And finally a plea: we know there is a lot of not only experienced educators but also interested and enthusiastic educators in the society and we would very much like you to join in with our activities, especially our teaching. Please let Cath know if you would like to be involved. I hope you all have a good summer and we look forward to hearing from you, feedback, thoughts, ideas, and hopefully contributions to our activities. Teresa Dorman

SAFER ANAESTHESIA FROM EDUCATION ALISON COOPER SEA (UK) PRESIDENT (2008-2013) On 29th April Dr Dorman and I took a day off from the clinical work and went to London for the official launch of the e-SAFE DVD at the Royal College of Anaesthetists, attended by their patron, HRH the Princess Royal. This DVD has been developed to support anaesthetists working in resource-limited areas throughout the developing world. It contains over 90 interactive e-learning sessions and an e-library with over 680 articles covering basic sciences and clinical anaesthesia. It is a stunning example of what can be achieved by collaborating and sharing, for the benefits of patients and is already in use in countries like Liberia. It was also sobering to be reminded that in many parts of the world, patients still die from lack of basic resources and basic skills. We have much to be grateful for in the NHS. Teresa and I also took the opportunity to handover and I can now stand down as President. We celebrated this event in the Champagne Bar at St Pancras (my treat in case any of you are wondering!) I am sure Teresa will do an excellent job in leading the Society onwards and I wish her every success.

Teresa Dorman and Alison Cooper at St Pancras

SEA UK Newsletter – Summer 2013

Page 4

SEA (UK) ANNUAL SCIENTIFIC MEETING REPORT “EDUCATING ANAESTHETISTS – BACK TO THE SHOP FLOOR” MARCH 2012, LIVERPOOL

SIMON MERCER

CONFERENCE ORGANISER AND SEA (UK) COUNCIL MEMBER

This year, our annual scientific meeting moved back to the North of England having been held in London and Exeter in the previous two years. The theme of ‘Educating Anaesthetists -

Back To The Shop Floor’ was adopted to continue some of the themes that were developed in 2012 on ‘making every second count’. It was hoped that the conference would stimulate ideas for busy clinical anaesthetists striving to provide high quality teaching to their trainees in times of limited finances and resources. This year’s meeting was held at Merseyside Maritime Museum in the Liverpool Albert Dock complex and was attended by 85 delegates. Following feedback from a recent members’ survey, it was decided to have two break-out workshop sessions during the day with topics that had been suggested by the membership. Once again we continued the use of social media at our conferences with a dedicated ‘twitter feed’ throughout the day. Professor Martin Leuwer, The Professor of Anaesthesia at the University of Liverpool, opened the meeting with a lecture entitled ‘Clinical Academic Careers in the UK?’ He described the current arrangement for pursuing a career in academic anaesthesia and challenges in funding such posts within the current postgraduate training structure. He then went on to discuss the new Academic Fellowship Programme and introduced his current Fellow, Dr Andrew Fisher, who described his current project. Once again, the ‘open paper’ competition was very competitive with a very high standard of presentation. There were over 40 submitted abstracts and the top six were invited to present. The winner was Dr Andrew Vaughton for his project on improving morbidity and mortality in the emergency laparotomy patient. The runner-up was Dr Kirstie McPherson and it is hoped that the abstracts will be accepted for publication in Anaesthesia. The poster presentations took place in the workshop sessions with the top 10 posters being judged for the poster prize, which was won by Dr K Oglesby on his project looking at the development of a handheld, interactive e-learning template for

anaesthetic equipment.

FEEDBACK FROM OUR LIVE TWITTER

FEED DURING THE ASM

“Opening the mind to

educate in a new way

@SEATWEETUK great

meeting #seauk13”

“Really enjoyed the #seauk13 conference. Slick, informative and engaging.

Great job”

“@SEATWEETUK

excellent meeting... Much

food thought! #seauk13”

“#seauk13 excellent in situ

simulation workshop on going”

“great trainee presentations! Great to see so much

educational enthusiasm”

“Prof Beard on feedback, great workshop at SEA UK

2013, shame not a full afternoon!”

SEA UK Newsletter – Summer 2013

Page 5

Above: Trainee prize winners: K. Oglesby, K. McPhereson, A.

Vaughton (left to right)

Above:Alison Cooper and Cindy Persad (Photos by Kim Russon)

Professor Aidan Byrne, Director of Graduate Studies at Cardiff Medical School, gave a very entertaining talk on Schemata Based Learning and the implications for clinical teachers. Aidan discussed how we work in terms of adaptability, mental workload and action and how these compared with the fictional characters Sherlock Holmes, Yoda from Star Wars and a US Marine. He also discussed the importance of situational awareness in the workplace, cognitive overload and what makes a good teacher. The last two lecturers talked on the use of Simulation in Healthcare. Professor Bryn Baxendale, the current President of the

Association for Simulated Practice in Healthcare discussed how he saw the future of simulation. This concentrated on the driving forces for development including science, technology and society and referenced the recent technology enhanced learning framework and the Francis Report. Professor Ralph MacKinnon rounded up the simulation discussions by describing his work with the North West Regional Simulation Network and the collaborative simulation that has been a great success, particularly the Managing Emergencies in Paediatric Anaesthesia Learning Course (MEPA).

The next ASM has been now confirmed for 10th March 2014 in Belfast and will be organised on behalf of SEA (UK) by Dr Anthony Chisakuta.

Below: Poster display (left) and The Audience (Right)

SEA UK Newsletter – Summer 2013

Page 6

SEA UK ASM WORKSHOP REFLECTION This year we were lucky to be able to offer 3 workshops repeated at each am and pm session covering the following topics that had been highlighted as desirable by the membership:

Learning and the Middle Aged Brain by Dr Chris Leng, Consultant Anaesthetist, Northampton.

Giving Feedback by Professor Colin Beard, Teaching Fellow at Sheffield Business School.

‘Simulation in Situ’ by Mr Jeff Goulding, Manager, Centre for Simulation and Patient Safety and Mr Neal Jones, Director of Medical Education, Whiston Hospital, Liverpool

Our lecture theatre also provided the venue for two plenary sessions; “The Trainee Workshop”, in the morning and “Sequential Simulation” during the afternoon.

LEARNING AND THE MIDDLE-AGED BRAIN JANET BARRIE SEA UK COUNCIL MEMBER Being the proud possessor of a decidedly middle-aged brain, this was a first choice workshop and it was slightly disconcerting to discover that the facilitator was younger than me…

The workshop reviewed many problems with medical practice that are more common in the ‘middle aged’, here defined as 45-65 years. These include reduced likelihood to follow current guidelines, increased frequency of litigation and of harm secondary to an incident. There are suggestions that older doctors may have less current knowledge than younger ones. That these are multinational data suggests that it may not just be a systemic problem. We then considered how the process of learning changed as we got older, by discussing and comparing revision techniques for medical school finals and the final FRCA. The latter was characterised by the use of more sophisticated learning techniques, with a more nuanced approach to the material to be learned. There was also an increased appreciation of the role of context, as by the final FRCA we had a greater depth of experience in which to situate learning. This helped us to appreciate what was important to learn. Since the FRCA and looking to the future, there was a balance between intrinsic and extrinsic motivations for learning. One important discussion was the role of ‘unlearning’, the example being the ever-changing CPR guidelines that regularly have to be learned, modified and relearned. There was a feeling that in an emergency the owner of a middle-aged brain may revert to guidelines learned at an earlier, formative period in training.

SEA UK Newsletter – Summer 2013

Page 7

Learning in the middle aged may be helped by people having an increased depth of experience on which to hang learning, increased ability to see the bigger picture and increased confidence in living with uncertainty. This discussion led neatly into the plenary session on schemata, which addressed the role of context and experience in developing models or frameworks as bases for both decision making and interpreting new material. We felt that incorporating totally new material was challenging and the most common techniques used were repetition and the extraction of salient facts. Finally, we considered whether any decrease in ‘sharpness’ as one entered middle age was offset by an increased ability to manage the entire situation in situ in difficult situations as one got more experienced and the implications for mentoring and supporting new consultants. This supposition doesn’t entirely agree with the increased frequency of incidents with age, reinforcing that the matter is not a simple one.

SEQUENTIAL SIMULATION JANET BARRIE This was a lively presentation by a team from Imperial College led by Dr Fernando Bello (Reader in Surgical Graphics & Computing Division of Surgery, Dept. of Surgery and Cancer Imperial College, London) and his team: Alexander (Sacha) Harris, Helen Laycock, Matt Gold, Zinah Sorefan and Aynkharan Dharmarajah.

They used two scenarios to demonstrate how realistic and immersive simulation may be delivered without full in-situ facilities.

SEA UK Newsletter – Summer 2013

Page 8

Their aim is to re-create the key factors of the situation being simulated rather than reproduce the situation in every detail. In doing so they concentrate on having minimal cues, with high realism for the key components of the simulation. Other aspects may then be less realistic, increasing portability and cost. Their theoretical basis for this is that of the ‘circles of focus’. In this model the circles widen from:

Patient > Place/People > Process > Boundary This was particularly well demonstrated by using a scenario of haemorrhage during a laparotomy. The minimal cues were very well produced with realistic bowel, spurting blood, a small anaesthetic machine and surgical lights. This was enclosed in an inflatable ‘igloo’ which isolated the simulation from the wider surroundings of a lecture theatre with observers. Audience participators described their sense of immersion in the scenario. This workshop encouraged me to think about two key questions:

What is the aim of simulation, i.e. what are we trying to achieve?

What are the key components of fidelity? Both of which are worth considering when planning any simulation session.

THE TRAINEE WORKSHOP CLAIRE JOANNIDES SEA UK COUNCIL TRAINEE MEMBER

Dr Claire Howard (Consultant Anaesthetist, Aintree University Hospitals), Dr Sanjiv Patel, (Consultant Anaesthetist, University College Hospital, London) and Dr Elaine Yip (GAT Committee member and CT2 Anaesthetics) each gave a stimulating talk on issues surrounding anaesthetic training. Claire Howard demystified the practicalities of trainee revalidation by providing everyday examples of how to provide evidence for revalidation. Elaine Yip explained the impact that the CfWI has had on training; the implications they may have on the future of doctors in postgraduate training; and presented the results of a joint survey between the RCoA and GAT, which assessed anaesthetic trainees’ views on the potential scenarios presented by the recent CfWI report. Finally, Sanjiv Patel gave a thought provoking presentation on the ‘Shape of Training’ review, sparking a lively debate on the conflict surrounding the future of training.

SEA UK Newsletter – Summer 2013

Page 9

SEA (UK) ASM FREE PAPER WINNERS IMPROVING MORBIDITY AND MORTALITY IN THE EMERGENCY LAPAROTOMY

PATIENT (FIRST PRIZE)

A. VAUGHTON AND S. BAKER

DORSET COUNTY HOSPITAL, DORCHESTER, UK Recent reports have highlighted a high complication and mortality rate in emergency general surgical patients1. There are many indications that outcomes are much poorer than they should be. Methods To improve outcomes in this group of patients we made a number of interventions. We undertook a staff survey to pin-point key concerns and recommendations. We then reviewed emergency laparotomy admissions highlighting areas for improvement and key learning points. We set up live ward-based multidisciplinary simulation training in the sick surgical patient, focusing on recognition, management and escalation. We also designed an acronym (TARGET) that encompasses the main clinical needs of this group, which was displayed as a poster on the surgical wards and the Trust network. The TARGET course comprises a series of lectures, low fidelity simulation, communication workshop, risk assessment workshop and high fidelity simulation. We then undertook an audit of all emergency laparotomies in our centre.

Results Feedback from the course was excellent – all candidates felt it was relevant, 95% were more aware of the problems when dealing with the sick surgical patient and 96% felt more confident in recognising and managing such patients. There were marked improvements in all key learning points. The audit after our interventions showed a decrease in 30-day mortality from 23% to 9%. Discussion We have demonstrated that combining multidisciplinary simulation training, implementation of recommendations and a targeted systematic approach to the emergency surgical patient led to a reduction in mortality. We will continue to audit results, implement further training and encourage compliance with guidelines, with the aim of continuing such an improvement. References 1. Saunders DI, Murray D, Pichel AC, Varley S, Peden CJ, UK Emergency Laparotomy Network. Variations in mortality after emergency laparotomy: the first report of the UK Emergency Laparotomy Network. British Journal of Anaesthesia 2012; 109: 368–75.

Figure 1. TARGET Poster

SEA UK Newsletter – Summer 2013

Page 10

SIMULATION TRAINING IN PERI-OPERATIVE EMERGENCIES (SECOND PRIZE) K. MCPHERSON AND F. MIR THE ROYAL NATIONAL THROAT, NOSE AND EAR HOSPITAL, LONDON, UK Poor communication has been cited as an important factor in 14% of deaths in hospital1. Communication was judged to be lacking between different grades of doctor, different teams and between other health professionals. Simulation-based training in anaesthesia is well established, and is an important part of training. Benefits include retaining skills for rare, but potentially life-threatening emergencies2. The majority of this training is aimed at specific grade and specialty area of doctor, and multidisciplinary groups may not always be included. We devised a simulation course to include all multidisciplinary personnel in an operating theatre environment. Emphasis on collaborative working and awareness of human factors were the course objectives. Methods A needs-analysis was conducted, with enquiry as to what situations staff found potentially stressful and where training needs were not being met. Subsequently, we devised the STOP course (simulation training of peri-operative emergencies). A manual was written, including simulation-based scenarios such as: anaphylaxis; can’t intubate can’t ventilate; laryngospasm; and advanced life support. A set format was adhered to within the manual, describing individuals roles and the set-up required for each moulage. Simulation training was completed within the department, and involved porters, recovery nurses, scrub staff, anaesthetists,

surgeons and operating department practitioners. Results Twenty-five staff attended the simulation training, with representatives from all groups participating. Facilitation, debrief and feedback identified common themes. There was universal appreciation of human factors and how these can negatively affect performance. The scenarios revealed the need for greater awareness of the working environment. All staff reported that the training was non-threatening and a valuable experience. Discussion Our simulation training involving a range of multi-disciplinary staff within the workplace improved technical and non-technical skills. We believe simulation forms an important facet of training needs and is an integral dimension to ensuring patient safety standards. A rolling six-weekly programme of simulation-based training now runs in the department, and critical incidents are audited as a measure of effectiveness. References 1. National Confidential Enquiry into Patient Outcome and Death. Caring to the End. NCEPOD, London 2009. 2. Complex procedural skills are retained for a minimum of 1 year after a single high-fidelity simulation training session. British Journal of Anaesthesia 2011; 107: 533–9.

SEA UK Newsletter – Summer 2013

Page 11

SEA (UK) ASM POSTER PRESENTATION WINNER THE DEVELOPMENT OF A HANDHELD, INTERACTIVE E-LEARNING TEMPLATE FOR

ANAESTHETIC EQUIPMENT

K. OGLESBY, K. HOPE AND C. MARSH ROYAL UNITED HOSPITAL, BATH, UK National patient safety surveys demonstrate that approximately one in 400 anaesthetics is complicated by equipment problems, leading to varying degrees of harm1. Up to 75% of such incidents are directly attributable to user error2. All anaesthetic departments should provide training sessions for equipment used in their clinical areas, although the individual has ultimate responsibility for its safe use3. Due to the lack of a nationally standardised approach to equipment training, this is often problematic3. Following a ‘near miss’ at our centre, we have developed an interactive e-learning template for handheld devices which is adaptable to all equipment. Methods Thirty-four clinicians completed a written survey exploring their previous training in the use of anaesthetic equipment and the requirement for further updates. Common themes, including the preferred educational medium, accessibility and user features, were identified from the responses. An initial e-learning template for a rapid intravenous infuser was created, demonstrated to the study group and then remodelled following user feedback. Results All responders stated that they needed further equipment training, particularly regarding devices used infrequently but routinely in emergency situations. An ‘on

demand’ educational tool for such emergencies was specifically requested by 32 (94%) anaesthetists. Personalised access via handheld devices, such as smartphones or tablet computers, was deemed to be highly practical. The formal Trust induction period was identified as a suitable time to introduce the learning resources. Modules for other pieces of equipment are also now under development for distribution throughout the Severn training deanery. Discussion Our interactive e-learning template provides an effective facility allowing anaesthetists to become familiar with new equipment and have an ongoing ‘aide-memoire’ for specific devices. Individual centres can adapt the template to suit their own equipment and local requirements. Further work is aimed towards disseminating the resource outside our training region in order to help create a standardised approach to anaesthetic equipment training. References 1. Fasting S, Gisvold SE. Equipment problems during

anaesthesia – are they a quality problem? British Journal of Anaesthesia 2002; 89: 825-31.

2. Cassidy CJ, Smith A, Arnot-Smith J. Critical incident reports concerning anaesthetic equipment: analysis of the UK National Reporting and Learning System (NRLS) data from 2006–2008 Anaesthesia 2011; 66: 879-888.

3. Association of Anaesthetists of Great Britain & Ireland. AAGBI Safety Guideline: Safe Management of Anaesthetic Related Equipment, 2009. www.aagbi.org/sites/default/files/safe_management_2

009_0.pdf (accessed 03/01/13).

SEA UK Newsletter – Summer 2013

Page 12

A DO-IT-YOURSELF MODEL FOR DEMONSTRATING STROKE

VOLUME OPTIMISATION USING PULSE POWER ANALYSIS TIM HOWES FRCA ST 5 ANAESTHETICS, ROYAL UNITED HOSPITAL BATH

Cardiac output (CO) monitoring has a range of clinical applications within anaesthesia and intensive care medicine. There is increasing support for its use from several national bodies:

The NHS Technology Adoption Centre recently published a pack to assist the implementation of CO monitoring to guide intra-operative fluid management, after the Department of Health labelled it a “high-impact innovation” in its 2012 publication Innovation Health and Wealth1,2

The National Institute for Health and Clinical Excellence (NICE) recommend using CO monitoring to guide fluid management in high-risk surgery and critical care3

NHS Trusts are eligible for payments via the Commissioning for Quality and Innovation (CQUIN) framework if they demonstrate use of the technology in a percentage of defined surgical procedures

Good training is essential if usage of CO monitoring is to become widespread. In an effort to provide simple, practical training for staff in our institution, I designed a model to demonstrate use of the LiDCOrapid pulse power analysis monitor to perform stroke volume optimisation. The model is constructed from basic equipment available in any anaesthetic room and can be used to generate live simulation of arterial pressure, with control over haemodynamics including the nominal stroke volume (nSV). The components required are:

Two 1 litre bags of fluid (e.g. 0.9% sodium chloride), each with a giving set

One arterial line transducer set (1 x 500ml bag of fluid within a pressure bag, connected to a giving set and transducer)

One length of large-calibre extension for an intravenous giving set

One 20G arterial cannula

One 18G venous cannula

One anti-reflux valve

One 25G needle

One monitor capable of displaying invasive arterial pressure

One LiDCOrapid monitor, or alternative monitor capable of pulse contour/power analysis

A receptacle for fluid (a sharps bin will be fine)

These components are arranged as shown in Figure 1. This arrangement creates one ‘diastolic’ bag and one ‘systolic’ bag. With the diastolic bag approximately 50cm above the transducer, a ‘diastolic’ pressure in the region of 75mmHg is generated. A ‘systolic’ pressure can then be imposed on the system by intermittent manual compression of the ‘systolic’ bag. When setting up the LiDCOrapid monitor, the following parameters are suggested:

Age 30 years

Height 1.70m

Weight 70kg

SEA UK Newsletter – Summer 2013

Page 13

Using these settings, gentle manual compression of the ‘systolic’ bag produces a nSV of approximately 80-90mls (figure 2). After establishing a regular force of compression, the demonstrator may simulate the effect of an intervention (e.g. fluid challenge, bed tilt) by more forceful compression, producing a rise in the nSV (figure 3). The demonstration may then lead into discussion of the underlying cardiovascular physiology, relating preload and stroke volume by the Frank-Starling mechanism. It should also bring about discussion of how to interpret the result of the intervention, i.e. identifying the patient as fluid-responsive or unresponsive. Since designing the model I have used it to conduct several successful teaching sessions for nursing staff and doctors in anaesthesia and critical care.

Figure 2. Haemodynamic conditions at baseline, with intermittent gentle compression of the ‘systolic’ bag

Figure 3. Haemodynamic conditions following more forceful compression of the ‘systolic’ bag, demonstrating the effects of an

intervention (e.g. fluid challenge)

SEA UK Newsletter – Summer 2013

Page 14

It should be noted that the LiDCOrapid monitor software includes an automated demonstration mode. By comparison, use of this model facilitates user-controlled real-time teaching of the clinical use of the technology. Limitations of the model include difficulty in demonstrating fluid optimisation using stroke volume variation (SVV). In practice it is difficult to maintain sufficiently consistent manual compressions to produce an SVV < 10%. Given that SVV is only useful under certain constrained clinical conditions, this should not limit use of the model.

References: 1. NHS Technology Adoption Centre. Intra-operative Fluid

Management Technologies Adoption Pack. Accessed May 12th 2013 at http://www.ntac.nhs.uk/Publications/TechnologyAdoptionPacks/Intra_Operative_Fluid_Management/Intra_Operative_Fluid_Management.aspx

2. Department of Health, NHS Improvement & Efficiency

Directorate, Innovation and Service Improvement.

Innovation Health and Wealth. Accessed May 12th 2013 at

http://www.tin.nhs.uk/EasysiteWeb/getresource.axd?A

ssetID=44764&type=full&servicetype=Attachment 3. National Institute for Health and Clinical Excellence.

NICE medical technology guidance 3 (2011) Cardio-Q-ODM oesophageal Doppler monitor. Accessed May 12th 2013 at http://www.nice.org.uk/guidance/MTG3

PAEDIATRIC RESUSCITATION AND RE-VALIDATION FOR

ANAESTHETISTS IN A BUSY DISTRICT GENERAL HOSPITAL

MORRIS R1, BRISCOE J2, DENTON M3 1CT2 ANAESTHETIST, DONCASTER ROYAL INFIRMARY, 2CT2 ANAESTHETIST, CHESTERFIELD ROYAL

HOSPITAL, 3CONSULTANT ANAESTHETIST, DONCASTER ROYAL INFIRMARY

At a large district general hospital such as Doncaster Royal Infirmary (DRI), many anaesthetists will be faced with anaesthetising children either on a regular basis or infrequently for elective operations or whilst on call. The maintenance of paediatric resuscitation skills and managing the sick child is therefore important to anaesthetists. Cardiac arrest in children undergoing anaesthesia is rare but this brings problems, as many anaesthetists are not exposed to paediatric emergencies for several months or even years. This leads to unfamiliarity and potential delays in the recognition and management of sick children. Keeping up to date with current paediatric resuscitation guidelines is important. Howard-Quijano et al noted that whilst management of cardiac arrest in children was generally good, many anaesthetists were unfamiliar with the causes of cardiac arrest in children and with drug doses. This is due to the infrequency with which they are exposed to paediatric emergencies1.

Guidance on the provision of paediatric services from The Royal College of Anaesthetists state that all consultants and career grade staff who provide anaesthetic cover for children should participate in CPD relating to paediatric anaesthesia and resuscitation. With the introduction of revalidation, all anaesthetists need to demonstrate proficiency in paediatric resuscitation skills highlighted in the CPD matrix2. Our aim was to determine the current level of paediatric resuscitation training amongst anaesthetists at DRI and determine if staff felt adequately prepared to manage paediatric emergencies. Method A survey of all anaesthetists working at DRI in 2012 was undertaken to assess the current level of paediatric resuscitation training. The results were tabulated and analysed using Excel spreadsheets. Results 78% of staff responded to the questionnaire (42/54). 69% of permanent anaesthetic staff had anaesthetised children in the last year.

SEA UK Newsletter – Summer 2013

Page 15

Only 55% had a current valid paediatric resuscitation certificate. However, of those staff without a current resuscitation certificate, 42% had undertaken local training in paediatric life support within the past year and the majority of staff felt adequately prepared to deal with paediatric emergencies (84%). Discussion The outcome of this survey has allowed the

identification of actions required in order to fall in line with current revalidation. Our department has started automatically filtering staff through paediatric resuscitation training programs to encourage all anaesthetists to keep up to date and feel confident in managing these challenging emergencies. Paediatric resuscitation training should be a priority for all anaesthetic departments, as regular updates will lead to better care in these unfamiliar and stressful situations and such courses allow staff to show evidence for the majority of the paediatric CPD matrix, essential for successful revalidation. References 1. Anaesthesiology 2010 112:993-7 Anesthesiology

Residents’ Performance of Pediatric Resuscitation during a Simulated Hyperkalemic Cardiac Arrest. Howard-Quijano, K et al

2. Royal College of anaesthetists, Paediatric anaesthetic Services, revised 22.4.2010 – Guidance on provision of paediatric anaesthesia services

RESEARCH & TRAVEL GRANT The Society for Education in Anaesthesia UK has agreed to support research and travel grants in fields relevant to

education in anaesthesia.

Guidelines

There is no limit to the number of grants, but SEA UK aims to award both travel and research grants if the quality

of applications are acceptable. Grants are up to £1000 in total per year, £500 maximum for any individual.

Application is by completing the appropriate form (available on www.seauk.org). This will be considered by the

SEAUK Research and Travel Subcommittee. Retrospective applications will not be considered

Applications are reviewed 3 times per year. The 3 deadlines for submission each year are: 1st January, 1st

May and 1st September. Successful recipients will be notified by email within 10 weeks of the closing date. Names

and project titles will also be published on the SEAUK website and announced at the spring Annual Meeting in March.

Recipients of grants must present a paper/poster/report at the SEA UK annual meeting in March (a bursary for

costs may be available depending on circumstances) or write a report for the SEAUK newsletter. The type of report

required will be decided by SEA UK council.

Non-members may apply but would be expected to become a member of SEA UK to receive payment and no payment

will be made without production of the relevant receipts

Research Grant Should be in a field relevant to education in anaesthesia, critical care or pain. May also be for any research of an educational

nature, where the applicant can demonstrate that performance of that research will benefit education in anaesthesia, critical care

or pain (this is intended to allow applicants performing educational research as part of higher degrees in education to be eligible).

Catherine Smith, SEAUK Administrator, Education Centre, D Floor, The Rotherham NHS FT Hospital, Moorgate Road, Rotherham, S60

2UD. Email: administrator@seauk.org

SEA UK Newsletter – Summer 2013

Page 16

ADVANCED TRAINING – BLAZING THE TRAIL CLARE QUARTERMAN ST6 ANAESTHETICS, ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITAL TRUST

Senior trainees in their final stages undertake advanced training modules to tailor training towards specific interests and to prepare for their future role as a consultant. Whether in the form of 12 months of general training, experience in a tertiary centre specialty or a combination of both, trainees can benefit from developing a framework for their attachment to ensure that learning opportunities are maximised. As the first advanced level trainee in vascular anaesthesia in a large teaching hospital, I developed a framework upon which to base both my training and that of future trainees passing through the department. I used the approach outlined below hen I did my vascular module and it could be adapted to develop a programme for any specialty based within a Trust of any size. Trainees are advised to:

Peripheral revascularisation, aortic aneurysm repair, carotid endarterectomy and amputation of limbs were the key procedures that formed part of my framework.

Use of guidance from the RCoA. The Vascular Anaesthesia Society of Great Britain and Ireland (VASGBI), in my case, allowed compilation of a comprehensive list of competencies/areas of knowledge to develop and assess. An excerpt is shown in figure 1.

The role of the consultant frequently involves commitments outside the operating theatre that the trainee can take the opportunity to shadow. Unless pro-active, the theatre based trainee may not necessarily be aware of multi-disciplinary team meetings, divisional meetings, morbidity and mortality discussions and liaison with other areas of the hospital.

Pre-operative assessment clinics present an opportunity to assess the patient in advance of their surgery and arrange targeted investigations. In my case this afforded valuable opportunities to observe the conduct of CPEX testing, echocardiography, pulmonary function tests, transfusion and haematology support.

Engaging with all consultants performing vascular anaesthesia within your department, provides observation of a wide range of attitudes and approaches. With increasing experience within the specialty, trainees can develop their

1. Categorise the surgical procedures performed within their chosen specialty

2. Develop a comprehensive guide to the specialty to direct reading, discussion in theatre and on-going assessment

3. Examine the working pattern of consultants within the specialty

4. Consider the pre-operative journey of the patient

5. Explore the range of anaesthetic approaches - general, regional or combined

SEA UK Newsletter – Summer 2013

Page 17

own methods drawing on the approaches they have viewed.

Audit, and where possible research, are an important role of the specialty anaesthetist and allow the trainee to examine practices, compare them to gold standard approaches and to contribute to the drive of the department to produce a high quality and safe service.

As the advanced trainee develops within their role, the opportunity for involvement in the education of other trainees arises. Theatre based teaching, education on the use of point-of-care testing and small group tutorials help the advanced trainee to develop and reinforce their knowledge and to pass their experiences on to those who may consider an advanced training post in the future. A satisfying experience!

Figure 1 - An extract from the Advanced Vascular Training Framework at RLBUHT

5. Follow the patient’s journey, review patient care and take an active role in clinical governance

6. Instruct junior trainees

SEA UK Newsletter – Summer 2013

Page 18

NEW COUNCIL APPOINTMENTS We are pleased to introduce a new member to our council, Janet Barrie, and welcome back re-elected council members Simon Mercer and Charlie Cooper. JANET BARRIE INTRODUCTION I am honoured to have been elected to the council of the SEA and am looking forward to working with council colleagues. Within anaesthetic education, my main areas of interest are in the nature of teaching and learning and in human factors. The question 'what actually happens when somebody learns something?' is a fascinating one with many ramifications. Thinking about this led me to reading and research (still very much 'in progress'!) about communication and linguistics within medical education and about the nature of understanding and interpretation in general. An interest in human factors arose naturally out of this. A further area of interest is the ethical aspects of education. I am involved in anaesthetic education at the coalface as CS and ES and contributing to a variety of courses, and academically as a member of the educational teams of the Edge Hill University PGCert in workplace based medical education (phew!) and the University of East Anglia's MA in regional anaesthesia. I have been a consultant anaesthetist at the Royal Oldham Hospital since 1996. My clinical interests are obstetric anaesthesia and acute pain. I am also the departmental governance lead. Outside work activities include local history, fell-walking/scrambling, natural history and making cloth dolls.

SEA UK Newsletter – Summer 2013

Page 19

YOUR LETTERS

Dear Editor, We would like to share our experience of the Anaesthetist’s Non-Technical Skills (ANTS) assessment tool. After passing the final FRCA I felt something was lacking in my performance in that my knowledge and expertise were not enough to ensure safety and proficiency. I discovered the ANTS system and started using it in my own reflective practice. The ANTS system was developed by a team of industrial psychologists and anaesthetists using research methods derived from aviation to produce a tool specific to Anaesthesia. There are four taxonomies: Team working, Task Management, Decision Making and Situation Awareness. Each of these is associated with behavioural markers1. I introduced this to Dr Bromley a CT1 trainee with whom I shared on call duties. We learnt to analyse Anaesthesia as a process. Success was more than the completion of a task, that team leadership, team work, contingency planning, setting triggers to call for help, discussing parameters specific to the patient and action required were also important skills. We also discussed how this was altered in different environments and how the task itself could become a distraction (“task fixation”). It provided a structure for discussion and enabled constructive feedback. I believe the presumption that non-technical skills develop with experience is erroneous and that an awareness of this earlier in training would enhance performance, safety and proficiency. Heather Gallie ST7 Dept. Anaesthesia Pinderfields General Hospital Matthew Bromley CT1 Dept. Anaesthesia Pinderfields General Hospital References 1. Anaesthetists Non-Technical Skills Handbook 1999-2003. Rhona Flin, Industrial Psychology University of Aberdeen www.abdn.ac.uk/ipric/ANTS

SEA UK Newsletter – Summer 2013

Page 20

BOOK YOUR LEAVE NOW!