What can you do in 12 weeks as a house officer in anaesthesia at a District General Hospital?
Luton, UK
E-mail: rbourkiza{at}hotmail.com
Editor—A house officer in anaesthetics and intensive care? It must be a holiday! Do you feel like a medical student again? Are you allowed to do anything? These are some of the comments I repeatedly heard throughout my 3 month placement from doctors in other specialities outside anaesthesia and intensive care (ITU). However, contrary to common belief, doing house jobs in anaesthetics and ITU is not just being an observer. It is a unique opportunity for junior doctors, who are less exposed to practical clinical skills, especially with the pressures of the European Working Time Directive, to acquire competences in performing essential and advanced clinical skills and to build their confidence in managing critically ill patients. Here, I explain how much I was able to do as a house officer in just 12 weeks.
The first thing someone learns at medical school is A B C. Although this is a simple principle known to every junior doctor, it is often not followed properly in practice. My hands-on experience in the anaesthetic room under direct supervision, mostly by a consultant, taught me how to approach a patient who suddenly stops breathing, how to use simple manoeuvres to maintain the airways, and more interestingly how to obtain definitive airways. I was able to perform 35 intubations and 42 LMAs during my time in anaesthetics, which enhanced my confidence in dealing with the unconscious patient and will serve me a great deal in the emergency settings.
Breathing is the second most important aspect after establishing an airway. As soon as I became familiar with the anaesthetic machines, I was able to recognize when a patient needs mechanical ventilation and when they can breathe spontaneously. I also learnt when and how to change the volumes, the rates, and the pressures in relation to different situations.
My competency in managing circulation greatly improved throughout my placement, from using inotropes to fluid management, placing arterial lines and central lines. One of the most basic procedures is obtaining i.v. access, and cannulating nearly every patient who comes for surgery (83 cannulations performed) gave me great confidence. The effect was soon apparent when I was often called to cannulate patients that other junior doctors failed, which was satisfying.
Many people look horrified when entering the intensive care unit, and I certainly did when I first started. The patients are in critical states, and complicated machines are beeping all the time. On the ITU side, my days started with a consultant ward round spending considerable time with each patient, discussing the medical condition, the possible treatments, and at times the prognosis and hence ethical considerations. The ward rounds were certainly a valuable teaching opportunity of physiology, pathology, pain management, data interpretation, and communication skills. After finishing the ward round, I used to join the registrar and get on with the jobs from the round. In ITU, I carried out various procedures after first observing a number of them, and having a proactive approach I was allowed to perform procedures without supervision, such as arterial lines and chest drains.
All in all, my anaesthetic experience as house officer in a District General Hospital (DGH) was a corner stone in my training. With all the opportunities that it presents to acquire core competences and advanced skills, I would recommend it to everyone and I hope more DGHs would be able to offer FY1 posts.
Acknowledgement
I would like to thank Dr C. Karunaratne (Consultant Anaesthetist) for his guidance and support throughout my placement.
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