Training to be peri-operative physicians.

Abstract

In his letter titled ‘Inadequate training?’ (Anaesthesia 1999; 54: 1122) Dr Johnston expresses doubts about the ability of Calman-trained anaesthetists to act as peri-operative physicians. Like Dr Johnston I am approaching the end of my Specialist Registrar (SpR) rotation. Unlike Dr Johnston, however, I feel that the training is more than adequate. Dr Johnston makes the point that the medical knowledge and experience of an anaesthetic trainee are commonly only equivalent to that of a medical house officer (PRHO). I disagree — 6 months as a PRHO may be the only General Medicine post an anaesthetic trainee does but it is not the only source of medical knowledge and experience. This is particularly true when considering the knowledge and experience relevant to managing ICU patients and surgical patients with peri-operative medical problems. We learn the necessary skills as anaesthetic trainees. The syllabus for the Final FRCA examination includes detailed sections on Intensive Care Medicine, Applied Physiology, Applied Clinical Pharmacology and Clinical Measurement. SpRs sitting the Final FRCA examination are often surprised at the considerable proportion of multiple-choice questions that seem to have come straight from an MRCP examination paper. The recent Royal College of Anaesthetists Symposium on The High Risk Surgical Patient stressed the role of anaesthetists as peri-operative physicians. I do agree with Dr Johnston on one point. Consultant physicians should not be asked whether sick surgical patients are fit for anaesthesia — a consultant anaesthetist should make that decision. The question that perhaps should be asked of a consultant physician in these cases is whether the medical condition can be optimised. Unless it is in the intensive care or high-dependency setting it is logistically difficult for anaesthetists to institute and manage treatments that may require follow-up over days or weeks.