Gabriel Gurman | Editor
Anaesthesia residents- far from being a homogenous professional group.
First of all a confession: the idea of writing this editorial is the byproduct of the paper published in the last issue of the ESA Newsletter about the trainee representation in our organisation Council. Reading this excellent paper I felt the need to open a discussion on this theme, which it seems to be more relevant now than anytime in the past.
Today nobody would dare to question the need for training in anaesthesia . We cannot afford leaving our patients fate in the hands of an inexperienced person. This is why residency in anaesthesiology is an integral part of our system, and it includes not only crucial educational aspects, but also the need of establishing the efficient role of the trainee in the daily activity of a busy anaesthesia department.
I am not at all familiar with the residency details in any other medical profession and this is the reason why I am not able to compare our problems related to the process of residency with other specialties. I can only imagine that many of the points which I do intend to approach in this paper could be familiar to many other medical domains.
But I think that the large variety in dealing with the residency track in anaesthesiology is to be addressed and since a good part of our readers are still residents (or just finished their training) it seems to be appropriate to create in the pages of this newsletter a framework for discussion and exchange of opinions.
Too many differences in the system:
I would start by mentioning the fact that in some countries the process of enrolling a young physician in the anaesthesia residency track implies a competition or at least a test, but in the same time in many other parts of the continent the process of selection is reduced to an interview followed by the decision of the director of the department or the coordinator of the residency track. So my first question would be: what are the criteria for selecting a candidate for the position of resident in our profession? And a second one: what could be the logic of establishing such criteria in those countries where, because of scarcity of anesthesiologists, first come is the first served?
Then I could build up a full list of items which differ from one country to another, among them: duration of training, the obligation to expose the resident to anaesthesia procedures for all the surgical specialties, the need to rotate through all extra-operating room (OR) fields of interest (critical care, pain management, sedation for nonsurgical painful procedures, etc), the existence of a compulsory minimal list of anaesthesia procedures to be performed by a resident during his/her residency track, etc.
In some countries in the world the person in charge with the residency program is obliged to periodically report about the progress made by each resident during the previous months. This could be an essential document which would assist the system in its efforts to optimise the residency track and tailor it for each specific case. Unfortunately this is not the rule in Europe.
But differences are also substantial in the domain of the daily activity.
Here are just a few examples.
I am not aware of any strict criteria according to which an anaesthesia resident is permitted to act independently and not fully supervised in the OR: patient condition, difficulty of the surgical act, the need for a special anesthesia technique, etc.
And what happens during the on calls hours, when in many hospitals the resident is left alone, without any specialist supervision ? How efficient is the process of getting the specialist’s advise by phone? And what are the criteria for asking the specialist to come to the hospital during the night on call and offer his help and expertise?
Another very important point is the number of hours per week an anaesthesia resident is supposed to be active in the hospital? Are there any criteria for establishing the number of nights and weekends on calls in accordance to the residency stage and personal progress in managing most techniques, expertise and clinical judgment?
Finally, what about the free day after the night on call? In some countries this represents an obligation stipulated by law. In other parts of the continent, the resident continues next day the usual activity , without any connection to the fact that she/he was on call for the last 24 hours.
The differences do not stop here.
In some countries the resident is not paid at all for his/her professional activity. In other parts of the continent the resident gets a fixed salary, not related to the number of on calls performed each month. In some anaesthesia departments senior residents (in their last stage of training) are permitted to take part to the usual off-hours OR activity and are reimbursed accordingly.
One cannot forget the substantial differences regarding the process of final examination at the end of residency, not mentioning the fact that in some countries the specialist degree is not the last one on the professional ladder. In some countries the European Diploma in Anaesthesiology examination replaced the national system of checking the resident knowledge and abilities. In other countries there is no need for certification examination and there are many countries in which the national examination is the final request for getting the specialist degree.
Does it have any impact on our profession as a whole?
This seems to be an appropriate question. We all speak the same professional language, use (more or less) the same equipment and drugs) follow the same guidelines and protocols and have access to the same kind of electronic information.
But from what was described above, it is obvious that there are significant differences regarding the organisation of the residency track. It means that in practice we do not create a standardised anaesthesia specialist, whom by definition would be the possessor of a accepted minimum of knowledge, experience and exposure to all the fields of our profession.
How much does this reality affect our profession? I do not know.
But the simple fact that decades ago some people on this continent decided to introduce, for the first time in the field of medicine, an European examination for obtaining a continental diploma (EDAIC ) establishes the need for a uniform system, if not a residency track, at least for its final stage.
Is the existence of EDAIC enough for the purpose of unifying the system in Europe ? If the answer is yes, we have to leave the situation as it is.
But if not, the time has arrived for action and ESA is supposed- in my opinion- to take the lead in this direction.
And what is our readers opinion in this subject?
The Newsletter is waiting for their letters and messages.