Primary FRCA Research Articles

A sustainable, peer-led teaching model for core trainees

Background: At a teaching hospital with a large cohort of novice trainees each year, we supplemented monthly regional FRCA teaching with a fortnightly small-group, local teaching programme. Feedback collated before implementation of the quality improvement project highlighted a demand for local teaching. We present a sustainable, peer-led teaching programme that is easy to run. Methods: The teaching model used was based on the Self Determination Theory,1 to encourage trainee self-motivation in preparing for the academic demands of core anaesthetics training. The Primary FRCA syllabus was broken down into topics and sub-topics designed to be sufficiently ‘bite-sized’ for trainees. Protected twice-monthly teaching lasting half a day was allocated to cover a key topic. Sub-topics were allocated to trainees in attendance who were given 45 min to research their topics, before regrouping to present back to their colleagues. A post-Primary FRCA trainee facilitated peer-led discussions and ensured topics were explored appropriately throughout each session. Facilitating trainees were permitted to use their Educational Development Time (EDT) to lead these sessions. Results: Feedback was collated pre-implementation and 6 months post-implementation of the teaching programme using Likert scale questionnaires. Some 100% of trainees felt that the small-group teaching environment was conducive to their learning. Feedback obtained from college tutors indicated the model worked well for novice anaesthetists as it required active participation and helped individuals develop skills necessary for the Primary FRCA. It was also noted to aid rapport building between the peer group—part of the hidden curriculum of this programme. Trainers intend to continue this teaching programme for future core trainees after the positive results. Conclusion: Supplementing regional teaching with the local teaching model presented here has increased learner confidence, understanding, and ability to talk through difficult topics. It has increased trainee feelings of preparedness for the Primary FRCA and allowed independent, autonomous learning to take place, with senior guidance. Feedback from both trainee and trainer has been positive, with college tutors supporting the continuation of the programme. All trainees partaking engaged positively with the teaching model, were more likely to carry out personal study outside of teaching, and would recommend this teaching programme to incoming core trainees. 1.Orsini C, Binnie VI, Wilson SL. J Educ Eval Health Prof 2016; 13: 19

P.89 A new teaching programme for novices in obstetric anaesthesia: Basic Obstetric Anaesthetic Skills Training (BOAST)

Introduction: The 2020 Royal College of Anaesthetists’ report Guidelines for the Provision of Anaesthesia Services for an Obstetric Population states that “working on delivery units can be incredibly rewarding for obstetric anaesthetists… but it can also be highly challenging”.1 Anecdotally, it is recognised that many juniors feel unprepared when first rotating into obstetric anaesthesia. Local trainees highlighted that, whilst induction to their obstetric rotation was useful, they felt unprepared for the practical aspects of the job;the different anaesthetic techniques and also the change in working environment with an unfamiliar multidisciplinary team dynamic. Furthermore, the unfamiliar obstetric terms meant that many felt they had little confidence and struggled to ’catch up’ to where they felt they needed to be to work comfortably. We decided to arrange a one-day teaching programme for trainees who were about to rotate into obstetrics to address these shortcomings and demystify some aspects of labour ward. Methods: A survey was sent to core trainees across South Wales to identify interest in the course and main areas of concern. These areas were: anaesthetic techniques, labour ward ‘tips and tricks’, communication and team-working, basic obstetric physiology and jargon-busting, basics of cardiotocography, management of obstetric emergencies, and topics relevant to the Primary FRCA. Colleagues from anaesthetics, obstetrics and midwifery kindly agreed to provide this teaching via lectures, interactive small-group skills stations and faculty-led demonstrations. Delegate numbers were restricted to 12 due to COVID-19 social distancing regulations and a small fee was charged to cover personal protective equipment costs, lunch and refreshments. Results: In the pre-course questionnaire, 91% of respondents felt they would benefit from a course, 63% felt between ‘ambivalent’ and ‘very uncomfortable’ with their understanding for how labour ward works, 54% were ‘uncomfortable’ with their technical skills relating to obstetric anaesthesia, 77% were not comfortable with managing obstetric emergencies and 64% were not comfortable with obstetric terminology and jargon. Post-course feedback was as follows: 86% of candidates reported feeling ‘somewhat’ or ‘very comfortable’ with how labour ward worked. 86% felt confident in their obstetric technical skills, 72% felt confident managing obstetric emergencies and 100% of respondents were comfortable with obstetric terminology. Discussion: We are not aware of any teaching programme in our region for trainees rotating into obstetrics for the first time. Our aim was to address the anxieties identified by junior trainees by providing additional teaching to enhance induction into working on labour ward. The BOAST course was attended by trainees from several hospitals across South Wales. Feedback was extremely positive and as a result we plan to run the course twice a year to facilitate up-to-date teaching for those rotating into obstetric departments.

How not to run out of oxygen: Primary FRCA forcibly put into practice by COVID-19 to maintain patient safety

Background SARS-CoV-2 is currently the cause of a global pandemic, putting significant strain on healthcare systems worldwide. Reports reaching the United Kingdom, ahead of the pandemic, and previous surge planning (H1N1 influenza) highlighted that pipeline oxygen supply could be strained. Therefore, this study was created to investigate the robustness of pipeline oxygen supply at Darent Valley Hospital. Coinciding news reports of hospitals declaring major incidents, due to oxygen failure, further backed the contingency planning. Methods The maximum sustainable flow from the vacuum insulated evaporator (VIE) was calculated, followed by a snapshot survey identifying the exact usage of oxygen (litres per minute) across the entire hospital, also highlighting areas of high demand. A flowchart protocol was created for clinicians and engineers to follow should pipeline pressure drop. Finally, a second audit, monitoring oxygen usage and pipeline pressure, throughout the surge period, was undertaken. Results The initial survey found a usage of 412.15 L/min, which increased to 1789 L/min during the surge, with the lowest pressure recorded at 3.6 bar. The output from the VIE plant was managed through cycling of its evaporators every 12 h, to prevent pipeline freezing. Conclusions Data and contingency planning ensured maintenance of pipeline pressure throughout a pandemic surge of 576 COVID-19 patients. It also served as the foundation of a business case that resulted in, planning, approval, and installation of a second VIE plant in four weeks, ensuring readiness for further surge activity and future pandemics.

The Primary FRCA Structured Oral Examination Study Guide.

The Primary FRCA Structured Oral Examination Study Guide.

SBA and MTF MCQs for the Primary FRCA

Preparing for the Primary FRCA? Wondering what to expect of the new SBA questions? Help is at hand. This practical book contains 60 single best answer and 120 multiple true/false questions to help you revise for the Primary FRCA MCQ exam. Each question is accompanied by detailed explanations, giving additional information on each topic to enhance revision. SBA and MTF MCQs for the Primary FRCA may be used both for examination practice and as a source of knowledge on many of the key topics in the syllabus. A helpful introductory section gives practical advice on how to approach revision and sitting the exam. From the writing team behind the FRCAQ website (www.frcaq.com), SAQs for the Final FRCA and SBAs for the Final FRCA, this book provides challenging questions and well researched explanations to help you through the Primary FRCA MCQ paper. An invaluable tool for your MCQ exam preparation.

High fidelity simulation training for the primary FRCA OSCE, UK

High fidelity simulation training for the primary FRCA OSCE, UK

Dr Podcast Scripts for the Primary FRCA

Dr Podcast Scripts for the Primary FRCA

Book Review: MCQs for the Primary FRCA

Book Review: MCQs for the Primary FRCA

MCQs for the Primary FRCA

MCQs for the Primary FRCA

MCQs for the Primary FRCA

Elfituri, K., Arthurs, G. & Gemmell, L. MCQs for the Primary FRCA Cambridge University Press , ISBN 978-0-521-70509-7 , 442 pp ., Price £29.99 This is a new addition to the ranks of the Primary FRCA MCQ books and it provides 540 questions laid out over six papers. The book provides tables for answers at the end of each question paper and also tables of answers for ease-of-marking alongside the answer explanations. Where this book scores highly is its ample answers section; it has dedicated over two-thirds of its 442 pages to this end. Many of the answers summarise the subject of the stem question and provide a miniature tutorial on it. The explanations classify these subjects logically and would be useful as a prototype viva answer; they also include the occasional graph or diagram for clarity. A real strength of the book lies in collating disparate subject matter and providing answers that would take some time to collect, e.g. lists of drugs undergoing extensive metabolism or factors potentiating neuromuscular blockade. You could research these answers in other texts, but this method saves time and the explanations are eminently readable. There is also the occasional snippet of newer information such as COX-2 inhibitors and their cardiac side-effects. The foreword warns of the need for using this book only after 6 months’ preparation which does not sit with some of the more straightforward explanations that can readily be looked up in a standard textbook. It could be argued that some of the explanations are simply padding, especially given the relative size of many of the rival books. Unfortunately this book is let down by many of the answers which opt for providing the overview of the subject; this is not always helpful in understanding why a specific branch of the question is right or wrong. This last point is of fundamental importance with respect to MCQ books since many MCQs are ambiguous and the answers could be argued either way, making it increasingly important for books to justify their answers. Finally, what really prevents this good MCQ book from being an excellent MCQ book is the lack of proper proof-reading. The incidences of spelling and other errors, e.g. branches of the question repeating or discrepancies between the textual explanation and the answers provided, begin to undermine the credibility of the book. It is not necessary for all the answers to be unambiguously correct – after all this is not the case in the rival publications currently available – but without showing adequate reasoning it is difficult to take the answers on faith. In fairness the authors have tried a slightly new format on the ‘standard’ MCQ book. This has worked quite well; the questions are of the right standard and spectrum. The aforementioned criticisms give the impression of a slightly unfinished book, but overall we would still recommend it.

The primary FRCA OSCE – an accurate measure of communication skills?

Effective communication between doctors and patients is a central requirement for good clinical practice. The doctor’s interpersonal skills contribute to patient satisfaction and compliance and can positively influence health outcomes [1]. The Royal College of Anaesthetists seeks to assess candidates’ communication skills through simulated patient interviews at the primary FRCA objective structured clinical examination (OSCE). We examined the relationship between the objective OSCE mark and the subjective opinions of the participants in the interview. Candidates at the Coventry Primary FRCA Viva/OSCE course take part in mock OSCE examinations which include communication skills stations in which professional actors play the role of patients. After each such station, both the actor and the candidate were asked to complete a proforma giving their opinions of the candidates’ communication skills during the interview. A total of 32 doctor:patient encounters were recorded. These were converted to percentages and compared with each other and with the OSCE mark. Comparisons showed that there was no correlation between the OSCE score and either the patient score or the candidate score suggesting that the OSCE score was a poor predictor of simulated patient satisfaction with the interpersonal and communication skills of the doctor. Mean OSCE marks were 87%, exceeding the mean scores given by simulated patients of 65% and by candidates of 77%. The OSCE scores were compared to the simulated patient scores using the paired t-test. This showed that OSCE marks significantly exceeded the simulated patient score (p < 0.0001). The mean scores given by candidates exceeded those given by actors for all criteria measuring communication skills and satisfaction. These results suggest that the OSCE station fails adequately to assess patient satisfaction with doctors’ communication skills. The results also demonstrate that candidates have a falsely high opinion of how effectively they are communicating with patients. In training anaesthetists we must stress the importance of communication and there may be an argument for subjective patient input in the scoring of communication skills stations.

Book Reviews

Preparing for the primary FRCA exam is a daunting prospect. Although I consider myself a veteran of Royal College exams, this particular one seems to me like the coming of Armageddon. Get through FRCA Primary: 710 MCQs by RLA Jayaweera and R Jayaweera is aimed at all anaesthetists attempting this particular exam. Whether they think they know it all and want to test themselves or they know very little and would like to find out about the scope and the depth of MCQs they may encounter, they will find something in it for themselves. The book has arisen

A View from the Head End: Medical Cartoons to Ease the Pain

S. Yentis tfm Publishing Ltd , ISBN: 1903378 42 7 , Price: £14.95, 128 pp Some people just make you sick. Steve Yentis has written more papers than most mere mortal anaesthetists have read, all of them informative and articulate, many of them ground-breaking. He is the author of that indispensable exam-time tome ‘Anaesthesia and Intensive Care A-Z’. He is an internationally renowned speaker, an ethics maven, Honorary Secretary of the Obstetric Anaesthetists Association, an editor of Anaesthesia, and a member of the editorial board of at least one other journal. It now seems that he is a talented cartoonist as well. Many of the cartoons which make up this book were, in his own words ‘drawn between cases’. An elderly colleague once told me that, had he practised the violin regularly while waiting for his surgeon, he would by now have reached virtuoso standard. I just tend to twiddle my thumbs and seethe quietly: Yentis picks up his pen and draws. Some of these cartoons have already seen the light of day, brightening the pages of ‘The Primary FRCA: A Complete Guide to Preparation and Passing’, but the great majority are newly minted. They are subdivided very loosely into themed chapters, but all share a recognisably anaesthetic sense of humour (an anaesthetist explains to a recumbent patient: ‘I’ll just inject a knock-out drug and connect you to a life-support machine, then brave surgeons will battle against all odds to perform life-saving wonder-surgery'). At their best, they are reminiscent of the great James Thurber (two dogs in tiny cages on the research lab shelf: One says ‘Personally I’ll be sorry to see the end of diethyl ether'). They range from the state of the NHS (an ODP helpless with laughter, saying: ‘You want to use WHAT?’) to handling the modern empowered patient (‘I’d like to ask for your permission now to seek informed consent…'). All of anaesthetic life is there: indeed, those of us who know the artist well might even worry whether we might have inspired the odd gag – the lecturer saying ‘I think you’ll find the next slide especially interesting because of the way I've blended a two-tone pink background with graduated vermillion running title, and crimson sans-serif 24 point text with intermittent strikethrough' looks horribly familiar. Yentis explains in the foreword that these cartoons are presented as drawn – whether on glove packets or non-vital bits of patient notes. This gives them a rough, naif, feel but adds to their immediacy and impact. He will forgive me if I say that, unlike his other books, this is not an essential addition to the departmental library. It will, however, make a great stocking-filler for an anaesthetic – or even surgical – colleague.

Book reviews

J. Urquhart, M. Blunt, C. Pinnock, M. Dixon Greenwich Medical Media, 2003 This is the second edition of what has become an essential book for candidates preparing for the Primary FRCA and it has also been very popular with senior anaesthetic colleagues undertaking practice viva sessions. In addition, with the increasing emphasis on basic science in the Final FRCA, it is being revisited by candidates for this part of the examination. The Anaesthesia Viva 1 book addresses the physiology and pharmacology components of the examination syllabus. (A Viva 2 book published separately covers the questions on physics & clinical measurement, clinical anaesthesia, anatomy and safety). The format and style of the book remains the same as the first edition with the sub-division of the sections on physiology and pharmacology into chapters on each of the body systems. Two appendices and a good index conclude the book. Comprehensive answers accompany the questions posed in a viva style. A short highlighted textbox focuses on how to approach the question and where it may lead. A specimen answer then follows, frequently with clear diagrams, tables or ‘hooks’ on which to structure the required explanations. This is one of the strongest features of the book as it clearly demonstrates that success in a viva is not just about knowledge, but the ability to present material in a clear and organised manner. The publication of the syllabus for the primary examination by the Royal College of Anaesthetists has now changed. It is now contained within the ‘Knowledge’ section of the SHO Competency Based Training document, it is a formidable list of basic science subjects and is a challenge for the authors of such books attempting to cover it. These authors have based their selection of questions on their experience as examiners and this is very rewarding to candidates. However, I would disagree with the claims on the back cover of this issue that it is a ‘fully updated and revised second edition’. With only a few of the 164 questions being omitted or replaced, the vast majority are replicas of the first edition. This was particularly evident in the physiology chapter, where there is a absence of questions on the neuromuscular junction, and the pharmacology chapter, where questions on new drugs in the local anaesthetic and analgesic classes, and the concepts of TIVA/TCI were lacking. In this edition, I believe the expansion of the two appendices at the end of the book is the largest but unnecessary addition. The appendices cover 75 of the 193 pages in the book. Appendix 1 shows respiratory physiology curves and equations, most of which are already covered in the questions section. Appendix 2 lists the pharmacology of most of the drugs encountered by anaesthetists today. However, this information is readily available and with more detail in other pocket sized reference texts and the opportunity to ask more pharmacology questions in the viva style (e.g. compare and contrast) has been lost. Notable omissions in the appendix are the lack of chemical structure drawings that are so beloved by examiners, and the important new antiplatelet drugs. For the most part, this book achieves its aim of being a ‘source of vital information…and supply of questions’ for the intended readership. It does well to cover almost all of the fundamental areas of physiology and pharmacology. In particular, I valued the inclusion of the often skipped-over areas such as antibiotics, composition and production of bile and gastric juice. The succinct explanations of renal function and the clinical applications of respiratory principles (exercise, altitude) are also appreciated. To my knowledge, there are at present no direct competitors to this book. Until there are, it therefore remains an essential companion to candidates for the Primary FRCA exam and their teachers, and it therefore deserves a place in every departmental library.

Book review

Book review

Book reviews

P. Hutton, G.M. Cooper and F.M. James III, eds Butterworth, 2002 I was delighted to be asked to review this book, particularly as one of the editors is the current President of the Royal College of Anaesthetists. I set about my task with enthusiasm. However, two things became immediately apparent. The first was that the errata came before any written text. To quote the legendary Willie John McBride, captain of the British Lions in South Africa, ‘get your retaliation in first’. The second was that the first of the four sections was written almost completely by Professor Hutton which is unusual, considering that he is one of the main editors. Although the chapters in the first section are clearly set out and well written, they do not flow in a set pattern, for example, emergence from anaesthesia precedes the major chapters on peri-operative care. This may leave the reader slightly confused. Nevertheless, as befits the author, this section is full of good common sense allied to the appropriate science. Any tyro in anaesthesia would benefit enormously from spending time reading this section. The second section is devoted to integrated basic sciences which are the foundation of anaesthetic practice. Each chapter is written by colleagues well versed in their subjects, and it is mandatory reading for those preparing for examinations. However, it may well be advisable to read one chapter at fixed intervals otherwise the reader may become overwhelmed by, or even drown in, facts, figures and diagrams. Furthermore, clinical teachers may also benefit from these chapters as they form an excellent basis for tutorials and presentations. It was about this far into the book that the colour and lay out of tables and graphs began to impinge on the memory. The background colour of purple seems to throw the various messages towards the reader. However, the continued absence of American authors and the very limited, rather dated, references had also become apparent, which was somewhat disappointing. Nevertheless, armed with the knowledge gained in this section, vanity raised its ugly head and your reviewer felt he could tackle the Primary FRCA examination. Whether he would have passed, fortunately will never be tested! The third section regarding the presenting patient was therefore a logical progression. Once again, it is based on a solid scientific background and leads the reader into the best practice regarding patient care. It is highly recommended for both trainees and trainers. At the start of the fourth and final section, more than three-quarters of the way through this tome of some 1000 pages, I felt like an early settler in the western exploration of the USA, Red Indians all around and things looking grim. However, at the last minute come the bugle and the 7th Cavalry, alias most of the contributions from the USA. To my mind, this section is quite extraordinary. Some chapters are no more than two pages long and, I regret to say that, in my view, many would not have been accepted by most peer-reviewed journals. In fact, I have read better accounts of many of these subjects in recent journals relating to continuing professional development . Thus, after more than three months reading this latest textbook, I find myself in a quandary. The first three sections are of excellent quality and are of benefit to those who wish to establish their practice on the biblical rock. They are, therefore, recommended reading for those who aspire to the highest standards. However, the last section most certainly detracted from the excellent standard set in the first three sections. This weakness must be addressed in future editions. It comes as no surprise that I would not recommend the purchase of this textbook by individuals. However, both library and departmental copies would be most beneficial.

Fundamental Principles and Clinical Practice of Anaesthesia

Fundamental Principles and Clinical Practice of Anaesthesia

Book review

Moyle, John T. B. This is more than a book on pulse oximetry. It covers a significant amount of cardiovascular and respiratory physiology as well as providing a historical background to the development of the oximeter. The book begins with a rather dry historical account of prototype oximeters and then progresses to optical principles, spectrophotometry and an in-depth explanation of the workings of a pulse oximeter. The content is detailed and often technical, but simple diagrams and graphs are used to good effect and facilitate the understanding of quite complex text (for those of us less technically inclined!). At times an assumption of prior knowledge is made, but in general the text is easy to follow and the physics is well explained. A detailed section on in vivo and in vitro calibrations of pulse oximeters and accuracy will appeal to those physics-lovers amongst us. The physiology of oxygen transport is core knowledge for anaesthetists and is a commonly asked question in both the Primary and Final FRCA, the intricacies of which are not always well explained in larger textbooks. This section in Pulse Oximetry, however, is well set out and is dealt with in a clear and thorough fashion. I enjoyed the section on pulse oximetry at high altitude as this combined the application of knowledge of the oximeter with interesting physiology in a clinical setting, albeit it a different scenario to the one where we usually encounter oximeters. The book also provides a fairly exhaustive list of clinical applications of the pulse oximeter which includes the expected medical conditions such as asthma and COAD, but also discusses its use in surgical conditions such as the assessment of a threatened limb and in obstetrics to assess fetal wellbeing during labour. I thought this clinical section in the book was particularly well thought out and thorough. A significant amount of background physiology and pathology is included as well as a brief discussion of the correct management of each of the different conditions. Topics of particular relevance to anaesthetists include postoperative hypoxaemia in recovery, the effect of pre-oxygenation and the different methods by which it may be achieved and specific conditions such as obstructive sleep apnoea. Importantly, the book contains a chapter on the limitations of pulse oximetry. In order to ensure safe practice and limit morbidity, it is vital to have a thorough understanding of a device that is used by anaesthetists and nurses on a daily basis and which is considered to be an essential monitor during anaesthesia. The book is well set out with clear and appropriate headings. Boxes are used to highlight points and summarise lists of causes which was useful as they stand out visually. Good use was made of diagrams and graphs to explain some of the complex physics. Each chapter contains up-to-date evidence-based material to substantiate the text and this is well referenced at the end of each chapter. The index is thorough and a specific topic may be looked up with ease. In summary, I think Pulse Oximetry is an excellent book. It is a good read for any anaesthetist, but I would particularly recommend it to anaesthetic department libraries, anaesthetic SHO's attempting the Primary and any anaesthetist with an interest in physics.

Book Review: The Primary FRCA: A Complete Guide to Preparation and Passing.

Book Review: The Primary FRCA: A Complete Guide to Preparation and Passing.

Continuous regional analgesia: can we afford not to use it?

Continuous regional analgesia: can we afford not to use it?