Training intensity and consultant support: the Canadian experience
We enjoyed the recent editorial1 and accompanying article2 on training of anaesthetists in the UK. The UK anaesthesia training system has traditionally relied on a long apprenticeship with a large volume of cases from which to draw experience by the time of appointment to consultant grade. In the last few years the reduction in both length of training and number of hours worked has resulted in a reduction in caseload. A system that previously relied on volume and duration of training for success is now being undermined.The Canadian training system differs because, although only 5 yr of residency training are completed, the intensity of teaching both in theatre and by tutorial is much higher than in the UK. For example although Underwood and McIndoe demonstrate that, in Bristol, SHOs are accompanied by a consultant or SpR in 50% of cases in 2004–05, in most Canadian institutions junior anaesthesia trainees will be supervised for all lists by a consultant. Even senior trainees will be accompanied much more than the 40–50% demonstrated.
In addition, daily tutorials and weekly half-day seminar sessions further increase the amount of teaching received. The European Working Time Directive has yet to reach Canada and trainees still work 60–70 h per week for 48 weeks per year. Once Canadian trainees have completed their residency and the Royal College exit exam is passed (FRCPC) they enter consultant practice. In most Canadian hospitals an informal system of support exists that allows the new consultant to obtain advice and assistance from more senior colleagues if required. This is expected of new consultants and is not felt to indicate lack of confidence or ability. Indeed this culture of teamwork facilitates sharing of knowledge at all levels of seniority. In this way, although volume of cases may not have been achieved by completion of training, the Canadian consultant will have been actively taught during the cases he/she has performed and also will have a support system in place for advice and assistance if required.
Greaves assumes that, although new consultants are less experienced, they are also less confident. In fact, in working in our two institutions over the last few years we have seen a number of fellows who have completed training and appear overconfident despite clear lack of experience. This is certainly a more dangerous scenario then the consultant who lacks both experience and confidence and may be more likely to seek help if available.
In summary, the excellent system for training anaesthetists in the UK is being undermined by reduction in caseload and hours of training. We agree that increases in active teaching as well as a culture that supports new consultants has worked well in Canadian practice and may be required if quality of training is to be maintained.
Toronto, Canada
*E-mail: colin.mccartney{at}uhn.on.ca
References
1 Greaves JD. Training time and consultant practice. Br J Anaesth 2005; 95:581
2 Underwood SM and McIndoe AK. Influence of changing work patterns on training in anaesthesia: an analysis of activity in a UK teaching hospital from 1996 to 2004. Br J Anaesth 2005; 95:616–22
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