Diploma In Anaesthetics Research Articles

Survey of the degree of burnout in state hospitals among Durban and Pietermaritzburg anaesthetists in KwaZulu Natal, South Africa.

Background: The most widely accepted model that defines the syndrome of burnout is Maslach Multidimensional Theory of Burnout. According to the theory burnout has three dimensions: emotional exhaustion (EE), depersonalisation (DP), and reduced personal accomplishment (PA). The primary aim of this study is to describe the degree of burnout experienced by anaesthetists working in the eThekwini Hospital Complex and Pietermaritzburg Metropolitan state hospitals in KwaZulu Natal in South Africa.
 Methods: The Maslach Burnout Inventory a well‐tested instrument with high reliability and validity was used as a measure of burnout with three subscales of emotional exhaustion, depersonalisation, and personal accomplishment.
 Results: Of the 160 anaesthetic care givers available, 139 completed the questionnaires giving a response rate of 86.8%. Burnout occurred in all participants that is medical officers (general medical doctors with a diploma in anaesthetics), registrars (general medical doctors with a diploma in anaesthetics or residents training and specializing in anaesthesiology) and consultants (specialists anaesthesiologists with a diploma and a fellowship in anaesthesiology). The prevalence of burnout was 17.9%. Of the total number of participants, greater proportion of anaesthetic care givers were female aged 31 to 40 years and that a substantial percentage had 4 to 8 years’ experience in anaesthesiology. The dimensional scores when considered individually showed that 42% of anaesthetists experienced high levels of emotional exhaustion, 38% reported high levels of depersonalisation and the lack of personal achievements was observed in more than 50% of the practising anaesthetists.
 Conclusion:. High levels of burnout were noted among anaesthetists in Kwazulu Natal. An association was noted between quality of sleep and emotional exhaustion and depersonalization. This information could be of value to the department of anaesthesiology as they are in position to implement interventions that promote participants well-being. Anaesthesiology practices should evaluate the balance between the demands they place on anaesthetic care providers and the resources provided to sustain an engaged, productive, and satisfied anaesthetic workforce. If the multiple stressors that lead to burnout are not addressed the department of anaesthesiology will be plagued by burnout.

Drug Errors and Protocol for Prevention among Anaesthetists in Nigeria

Background Drugs are often prescribed, dispensed, and administered by the same person during anaesthesia, and this may increase the risk of drug error. Objectives To assess the frequency of drug administration errors by anaesthetists, the drugs commonly involved, and the effects of such errors. Method A questionnaire-based study was carried out among participants at an annual conference of Nigerian anaesthetists. Sixty-six of the 80 participants returned the completed questionnaire. The respondents comprised 1 nurse anaesthetist, 34 resident doctors, 3 doctors with diploma in anaesthesia, and 28 consultant anaesthetists. The collated data on drug errors, the effect of such errors on patients, and formulated protocols to prevent future occurrence were subjected to descriptive analysis using Microsoft Excel. Result Drug error was reported by 71.21% and witnessed by 22.72% of the respondents. Most of the drug errors occurred during general anaesthesia (90.3%) for emergency procedures (51.61%), and muscle relaxants were most commonly involved (58.06%). Conclusion Drug errors are common among anaesthetists in Nigeria and their incidence is greater during general anaesthesia for emergency procedures, largely as a result of ampoule swaps due to similarities in ampoule design and packaging. Guidelines on their prevention should be developed by all health institutions.

Henry Malcolm Hardy

Malcolm Hardy obtained his diploma in anaesthetics in 1950 and worked in several hospitals in the Leeds region before emigrating to the USA in 1957. He met …

Awareness about scope of anaesthesiology, attitudes towards the speciality and stress levels amongst postgraduate students in anaesthesiology: A cross-sectional study.

Trends in selection of a career in medicine vary from country to country. To plan future recruitment strategies and to balance distribution of physicians among medical specialties, each country needs to examine these reasons as part of educational research. The aim of this study was to explore the Anaesthesiology postgraduate students’ knowledge about anaesthesia as a speciality, their attitude towards anaesthesia as a career choice, stress levels during the period of postgraduation, views regarding Diploma in Anaesthesiology and undergraduate exposure to the subject. Eight hundred pretested questionnaires were provided to the anaesthesia postgraduate students attending various national level conferences in India. The collected data were statistically analysed using SPSS version 20. Only 31.6% of the students were aware of scope of anaesthesiology and 42.3% of students joined the speciality out of the interest to learn the subject, whereas 55.7% joined for other reasons, including non-availability of other specialties during medical postgraduate counselling. About 70% of students were stressed out during postgraduation, 31.6% found difficulty in accommodating the demands of challenging job and 3.8% went into depression. Majority of anaesthesiology postgraduate students were unaware of the scope of Anaesthesiology at the time of medical postgraduate counselling; only two-fifth of the students joined the speciality out of interest to learn the subject and most of them felt stressed out during the period of postgraduation. Majority of the students were of the opinion that Diploma in Anaesthesia was not a viable career option and should be scrapped.

Obstetric anaesthesia at district and regional hospitals in KwaZulu-Natal: human resources, caseloads and the experience of doctors

Objectives: Suboptimal treatment as a result of lack of basic skills in anaesthesia and resuscitation contributes significantly to the continuing increase in anaesthetic-related maternal deaths in South Africa. This study aimed to determine the number of doctors providing obstetric anaesthesia at district and regional hospitals in KwaZulu-Natal, their level of experience and caseload, and to identify specific groups that could be targeted for support and training. Design: This was a prospective open cohort observational study of obstetric anaesthetic services in KwaZulu-Natal, which considered the human resources, caseloads and the experience of doctors. Setting and subjects: Two separate questionnaires, directed independently to medical managers and doctors providing operative obstetric services, were sent to 48 district and regional hospitals in KwaZulu-Natal. One third of the hospitals, selected by stratified randomisation, were visited to improve response rates. Outcome measures: Medical managers were asked for caseload and staffing data. Doctors were asked for details of their qualifications, experience and their current workload. Results: Thirty-eight (a 79% response rate) medical managers and 266 doctors (an estimated response rate of 65%) completed questionnaires. Community service medical officers (CSMOs) at rural district hospitals constituted 27% of fulltime staff. CSMOs at all responding district hospitals were expected to provide obstetric anaesthesia independently. Foreign medical graduates provided obstetric anaesthesia in 71% (27/38) of hospitals and constituted 27% of full-time staff at rural district hospitals. Twenty-four doctors (all foreign-trained) reported no anaesthesia training during their internship. District hospitals were more reliant on part-time (sessional) appointments. Fifty-eight per cent of all (22/38) hospitals reported that a number of sessional appointments provided obstetric anaesthesia. In October 2010, 58% (22/38 active during the month) of sessional appointments at district-level hospitals administered only one obstetric anaesthetic, whereas all 15 sessional appointments who were active at regional level administered two or more. Only 24% of responding doctors had more than five years’ experience in their current employment. Only 3% of responding doctors working in rural hospitals had a Diploma in Anaesthesia, compared to 26% in urban hospitals. Only one doctor with more than five years of employment history and a Diploma in Anaesthesia worked at district level. Conclusion: This study highlights the lack of training and experience of doctors in obstetric anaesthesia and documents workload patterns at district hospitals. It also identifies specific target groups for future support and training.

Pioneers in South African Anaesthesia:

Arthur Barclay Bull graduated MBChB at the University of Cape Town (UCT) in 1943. After internship at the New Somerset Hospital he joined the SA Medical Corps during the 2nd World War where be developed an interest in clinical anaesthesia. From 1948 – 1951 he underwent training as a registrar in anaesthesia at Groote Schuur Hospital. In 1953 he obtained the Diploma in Anaesthesia of the College of Physicians and Surgeons in Ireland and in 1960 became one of the 40 Foundation Fellows of the Anaesthetists of the Royal College of Surgeons in Ireland. From 1954-1955 he was appointed the Nuffield Dominion Clinical Assistant for South Africa in the Department of Anaesthesia at Oxford under Sir Robert Macintosh. In 1956 he was appointed Senior Anaesthetist at the newly opened Red Cross War Memorial Children’s Hospital. During that time he, together with Prof Pat Smythye, pioneered the use of prolonged curarisation and IPPV for treating tetanus. In 1960 he was awarded a WHO Travelling Fellowship and in 1977 an honorary fellowship from the Australian and New Zealand College of Anaesthetists. He succeeded Dr CS Jones as Head of the UCT Department in 1961, was appointed Associate Professor in 1963 and became the first holder of the UCT Chair of Anaesthetics in 1963. He served two terms as President of the SA Society of Anaesthetists and was Chairman of the SASA Committee that drew up the first Guidelines for Practice in 1987. He passed away in 2001aged 80 years.

Pioneers in South African Anaesthesia:

Thomas James “Tom” Voss was born in Windhoek, Namibia, on 26 March 1926. He matriculated in South Africa from Pretoria Boys High School, and qualified with a Bachelor of Medicine, Bachelor of Surgery degree from the University of Cape Town (UCT) in 1950. After passing the Conjoint Diploma in Anaesthesia in London, he was appointed as a registrar in the Department of Anaesthesia at Groote Schuur Hospital in 1954. He was appointed as a specialist at Groote Schuur Hospital in 1958, and developed a special interest in the relatively new discipline of paediatric anaesthesia. In 1961, he became Head of Department at the Red Cross War Memorial Children’s Hospital, taking over from his mentor, Arthur Bull. In 1975, he was promoted ad hoc to Associate Professor at UCT.

The Development of Postgraduate Anaesthesia and Intensive Care Training at the University of the West Indies

The one-year Diploma in Anaesthetics (DA) was the first postgraduate programme offered by the then Faculty of Medicine of The University of the West Indies (UWI). It was instituted in 1966, when the need for trained physician anaesthetists became paramount. Over 200 physicians have been awarded the DA which was discontinued in 1994. The four-year Doctor of Medicine in Anaesthetics [DM (Anaesthetics)] was commenced in 1974 and continues to train most of the region's physician anaesthetists. The majority of the 119 graduates (as of December 2011) are providing invaluable services to the people of the Caribbean. The time has come for the establishment of a regional certifying body, the Caribbean College of Anaesthetists. This college would determine the standards for the training and clinical practice of anaesthetists as perioperative physicians including: the conduct of anaesthesia, critical care, acute and chronic pain management. It would also facilitate continuing medical education and recertification of all practising anaesthetists within the region.

Obituary

Obituary

Diploma in Anaesthesia, Trauma, and Critical Care (Dip ATACC)

Doctors from acute specialties with an interest in multiple trauma. Also, ambulance personnel, firemen, and combat medical technicians. Any time from senior house officer to consultant. It teaches advanced management of multiply injured patients, both prehospital and in the resuscitation room. One month reading for the course; three months for the dissertation. Two nights on call with the emergency response team and two occasions on subsequent courses as …

Stanley Arthur Mason MB BS, FRCA, MRCS LRCP, DA, AKC

Stanley Arthur Mason MB BS, FRCA, MRCS LRCP, DA, AKC

Emergency physicians and rapid sequence intubation: a survey of Scottish teaching hospitals.

Emergency definitive airway management is a fundamental skill for physicians in the emergency department. The aim of this survey was to determine the perceived confidence in the assessment and control of the emergency airway, including rapid sequence intubation, among physicians in Scottish teaching hospital emergency departments. A postal survey of senior and middle-grade physicians in seven Scottish teaching hospital emergency departments. The response rate was 78% (47/60). A total of 98% of physicians rated their confidence at assessing the difficult airway as 'reasonable' to 'very high'; 79% were confident concerning their ability to administer drugs to facilitate emergency intubation; 47% had used drugs for emergency intubation within the month preceding the survey, and 72% had done so within the 6 months before the survey. Consultants were more confident than trainees, as were those possessing the Fellow of the Royal College of Anaesthetists qualification or a Diploma in Anaesthetics (UK). Those possessing the Fellowship of the Royal College of Anaesthetists qualification had all performed a rapid sequence intubation within the past month. Physicians in Scottish teaching hospital emergency departments have high levels of self-rated confidence in assessment and their ability to secure the emergency airway utilizing drugs to facilitate emergency intubation. Consultants and those with anaesthetic qualifications are more confident than trainees and those without such a qualification.

The development of formal anesthesia training in Canada, the United States of America and the United Kingdom

Introduction: At the beginning of the 20th century, most anesthetics were administered by medical students and surgical residents in hospitals, or by general practitioners in private clinics or homes. The few specialist anesthetists who existed were usually self-trained and poorly respected by practitioners in other fields. The development of formal anesthesia training was a driving force for anesthesia gaining acceptance as a specialty. Methods: We reviewed published histories of the three countries' national anesthesia associations and examining bodies, biographies of key individuals, and searched medline and the internet. Results and Discussion: In 1935, the Association of Anaesthetists of Great Britain and Ireland, through the Royal College of Surgeons, introduced the Diploma in Anaesthetics (DA), setting a training standard to establish the specialist nature of anesthesia in the UK. Across the Atlantic, the New York Society of Anesthetists (later re-named the American Society of Anesthesiologists) successfully lobbied for national qualification in anesthesia three years later. Influenced by the events in the UK and the USA, the Royal College of Physicians and Surgeons of Canada approved anesthesia as a specialty in 1942, and introduced the Certificate in Anaesthesia. The Canadian Anaesthetists' Society was formed in response and helped organise programs to prepare candidates for examination. World War II demonstrated the need for properly trained physician-anesthetists. Short courses were offered at the University of Wisconsin, Madison in the USA; at McGill University, Montreal in Canada; and at the Nuffield Department, Oxford in the United Kingdom. Demobilisation resulted in the return of anesthetists at various levels of competence, led to the expansion of existing departments, and necessitated more stringent testing. Certification by the Canadian Royal College could only be obtained through examinations as of 1947, and the British DA was expanded to two parts in 1948. Early residencies in all three countries lasted 1 year, but were gradually superseded by multiple-year training to secure equal respect to other specialties and adequate remuneration. The USA granted Board Certification first, in 1938, followed by Royal College Fellowship in Canada in 1951, and Fellowship in the Faculty of Anaesthetists in the UK in 1953. Current standards for specialist qualification in the three countries are alike, though not identical. Conclusions: The motivation and means by which anesthesia training programs came into existence were largely similar. The national anesthesia societies were critical to establishing initial standards, while World War II and a desire for equal respect to other specialties were catalysts for the expansion of existing training.

Gordon Jackson Rees FRCA FRCP FRCPCH, Pioneer of Paediatric Anaesthesia

1Gordon Jackson Rees, known to all his friends as ‘Jack’, was born on 8 December 1918. He was educated at Oswestry School and entered the University of Liverpool to study medicine in 1937, and qualified M.B.Ch.B. in late 1942. His scholastic achievements, by his standards, were modest and gave little hint of his later academic brilliance and practical innovative ability. Early in 1943, Jack was called up into the Royal Air Force medical branch and served as a station medical officer before being sent to the Radcliffe Infirmary, Oxford, to study anaesthesia under Professor Robert Macintosh and William Mushin. He obtained the one part Diploma in Anaesthetics in 1946. He became a consultant anaesthetist to the Royal Liverpool Hospitals in 1949 and, on the invitation of Professor Cecil Gray, joined the new University Department of Anaesthesia as a part-time demonstrator. Together, using different drugs to produce specific effects, they introduced the revolutionary concept of the ‘triad of anaesthesia’. Shortly afterwards, Jack was persuaded to assist Miss Forshall, a paediatric surgeon, to develop paediatric anaesthesia. The so-called Jackson Rees technique of paediatric anaesthesia initially developed as a result of his experiences in adult anaesthesia and an intense desire to humanise the management of children in hospital. In 1950, he published a seminal article in the British Medical Journal on Neonatal Anaesthesia. This technique soon became known throughout other paediatric centres and, as a result, Jack was invited to lecture and demonstrate at many national and international meetings. He travelled widely visiting many centres as a visiting Professor and invited lecturer, was made a member of a large number of prominent learned societies and was presented with many prestigious awards in this country and abroad. He was extremely popular and became well known as a superb speaker, a witty panellist and a persuasive debater. His writings are a model of lucidity and a pleasure to read, though Jack confessed that he was ‘a reluctant writer’. He was elected a Fellow of the Faculty of Anaesthetists of the Royal College of Surgeons of England, Fellow of the Faculty of Anaesthetists of the Royal Australian College of Surgeons, Fellow of the Faculty of Anaesthetists of the Royal College of Surgeons of Ireland, Fellow of the Royal College of Physicians of London, and Fellow of the Royal College of Paediatrics and Child Health; not bad as Jack remarked, for someone who had only sat one postgraduate degree examination! He was awarded the Medal of the Faculty of Anaesthetists of the Royal College of Surgeons of England, the Frederick Hewitt Medal of the Royal College of Surgeons of England, the Henry Hill Hickman Medal of the Royal Society of Medicine, London, the John Snow Medal of the Association of Anaesthetists of Great Britain and Ireland and the Robert M. Smith Award of the American Academy of Pediatrics. He was particularly proud to have been a guiding founder member and later a President of the Association of Paediatric Anaesthetists of Great Britain and Ireland and also the first President of the federation of Association of European Associations of Paediatric Anaesthesia. The recognition of his achievements was not confined solely to the field of medicine. He was made an honorary citizen of the ancient university city of Coimbra, Portugal, and in 1998, he was recognised by the Athenaeum club as only one of five distinguished citizens of Merseyside for his contribution to the welfare of children; unique awards for a unique man. His flair for appreciating the clarity of issues together with his modesty and courtesy made him eminently qualified for membership of numerous examining bodies for various university degrees and a natural President and Chairman of many important committees, both locally and nationally. Jack retired from active anaesthetic practice in 1983 but was quickly invited to be guest Professor of Paediatric Anaesthesia in the Erasmus University, Rotterdam, for a year. Jack loved life and fellowship. He was generous, genial and genuinely interested in everyone and gleefully admitted to being ‘a social animal’. He bore his last illness with characteristic good humour and immense fortitude. We shall all miss him dreadfully. Dr Jackson Rees died peacefully at home on Friday 19 January 2001. He leaves his wife, Elisabeth, a Consultant in Genito-Urinary Medicine, and four children, one of whom is Regius Professor of Medicine in the University of Aberdeen.

Training, skills and approach to potentially difficult anaesthesia in general practitioner anaesthetists.

Seventy-six of the 92 practising South Australian rural general practitioner anaesthetists responded to a questionnaire on anaesthetic training, skills and approach to potentially difficult anaesthesia. The mean training period in anaesthesia was 7.5 months, 24% at registrar level. Eight per cent had no training, and 40% had 3 months or less. Thirty-three per cent trained exclusively overseas and 13% hold a Diploma in Anaesthesia. A total of 11,400 anaesthetics were performed by 76 general practitioners in 1992 at an average of 152 (range 2 to 1500). The mean visual analog "comfort score" in performing anaesthesia was 6.6 and correlated best with the number of procedures per year (r = 0.32, P = 0.03). Forty-six per cent of general practitioners provided anaesthesia for the 0 to 12 month age group, and only 35% had regional skills to use in obstetric anaesthesia. Patients classified as ASA grade 3 to 5, disease states such as unstable angina, severe asthma, and risk factors such as skeletal myopathy, were avoided by most general practitioners. The failed intubation rate was 50/10,000. The conclusion is that South Australian general practitioner anaesthetists exhibit a generally safe approach to selection of patients for anaesthesia, although in some instances the approach to potentially difficult anaesthesia should be more conservative.

European diploma in anaesthesia and intensive care

European diploma in anaesthesia and intensive care

Training needs of postgraduates in dental general anaesthesia.

Questionnaires given to 25 dentists and eight doctors attending a course on dental general anaesthesia showed that only four of the eight doctors had a diploma in anaesthetics. One of the doctors and eight of the dentists had had no postgraduate instruction in anaesthesia. More short courses of postgraduate instruction should be provided and some of these should be designed for the team of dental operator, anaesthetist, and dental surgery assistant.

The Diploma in Anaesthetics

The Diploma in Anaesthetics

The Diploma in Anaesthetics.

The Diploma in Anaesthetics.

Diploma in Anaesthesia

Diploma in Anaesthesia