SUMMER 2011 SEA UK Newsletter€¦ · David Greaves was the first President of SEAUK, Dr Keith Myerson was ... SUMMER 2011 . The SEA UK Annual Scientific Meeting was held in Exeter

The popularity of this newsletter, as a forum for anaesthetic trainees to write, is growing. We have seen a rise in the number of submissions this year, a change that is much welcomed. I would like to say thank you to all our contributors.

With the country facing a difficult financial future, many anaesthetists have had to ‘prioritise’ what is included in their continuous professional development plans for the 2011. Trust budget cuts leading up to the new financial year, had resulted in a ‘temporary’ suspension of study leave in a number of hospitals across the country. Unfortunately, for many of us, this coincided with the SEAUK Annual Scientific Meeting on the 14th of March.

It was refreshing to see that our support is still strong. Attendance to this year’s meeting was on par with the previous 3 years and our ability to recruit new members has remained steady. Thank you for making anaesthetic education and training a priority!

This was our first year hosting an annual dinner and the response was good. With 44 attendees and a sociable environment, this provided an excellent forum for members and speakers to engage and exchange ideas. It was a huge success for the organizers and will be repeated in London in 2012.

Finally, I would like to recognize the ongoing hard work performed by the council members of SEAUK. They have contributed countless hours of non-renumerable work and have collectively made the society the success that it is.

See you in London.

Cindy Persad and Yogita Chikermane

SUMMER 2011

Editor’s Note

SEA UK Newsletter

President’s Letter 2

Report on SEA ASM

2011 3-4

Feedback on SEAUK

ASM 2011

5

Emergency skills

teaching in Ethiopia

6-8

Free Paper Winner 9

Poster Winner 10

Clinical Competence 11

Innovative Fellowships

in Medical Education

12

Being a Fellow in Medi-

cal Education

13

New Council Members 14

Tactical Decision

Games Workshop

15

INSIDE THIS ISSUE:

Dear SEAUK member,

For those of you who did not make it to Exeter, you missed an excellent meeting and a big thank to Jo Kerr and Sarah Wimlett who did a magnifi-cent job in organising the whole event. For the first time in several years we had a conference dinner with guest speaker which was also very successful and we hope to include a dinner in next year’s plans. Despite the current climate, attendance in Exeter was excellent and feedback from the meeting very good. Work is already underway on next years programme to ensure this remains an attractive and useful day for you to attend. We have booked a day and a date in London on Friday 9th March 2012, so please put the date in your diaries.

Presentations and the Conference programme will be available from the website but nothing beats the added value of meeting friends and colleagues on the day and hearing speakers “live”. Our Canadian speaker was absolutely excellent and has given many of us a great deal to think about.

In addition to our own activities SEAUK is increasingly being asked to work collaboratively with other organisations like AAGBI and the Royal College of Anaesthetists and this has proved to be very interesting.

SEAUK has now been in existence for just over 10 years and we recently marked the retirement of three very important founding members. Dr David Greaves was the first President of SEAUK, Dr Keith Myerson was the first Treasurer and Prof Chandra Kumar founding Secretary. All three made a significant and vital contribution to the establishment of the Society and council decided to award them Honorary Life Membership. We were delighted that Dr Myerson flew back from the Caribbean to attend the Exeter meeting and receive his award in person, having spent the last few months sailing his boat across the Atlantic! We have also established a further three Educational grants in their honour which will be awarded via the NIAA.

We wish them a long and healthy retirement.

I hope you enjoy reading the newsletter and please feel free to email me any comments or ideas for future SEAUK activities at [email protected]

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PRESIDENT’S REPORT

SE A U K NE W SL E T T ER

Photo gallery

(From top to bottom):

The Mercure Southgate Hotel—site for society’s dinner

Alison Cooper and Keith Myerson at the dinner

‘An excellent opportunity to meet other society members’

SU M M E R 2011

The SEA UK Annual Scientific Meeting was held in Exeter this year. This was the first time the meeting has been held in the South West and we were successful in attracting a number of new members from the region.

In another break from tradition the meeting opened with a dinner on the evening of Sunday 13th March, held at The Southgate Hotel. This provided an excellent opportunity to meet other society members in a convivial atmosphere and is an event which will be repeated at the meeting in London next year. The meal was kindly sponsored by Wesleyan and was followed by an after dinner speech by Professor Glenn Regehr. Prof Regehr is Professor (Department of Surgery) and Associate Director of Research at the Centre for Health Education Sponsorship at the Univer-sity of British Columbia, and despite having landed in the UK only a few hours before, gave a thought provoking talk on our understanding of “Professionalism”. In particular, he encouraged us to challenge our mental constructs of professionalism and resist the urge to use numerical systems to describe patterns of behaviour, a role for which they are ill suited.

The Annual Scientific meeting was held at Sandy Park Conference Centre, home of Exeter Chiefs Rugby Club. The theme was “Making Sense of Non-Technical Skills” – a full and varied programme constructed by Dr Simon Edgar promised a stimulating and busy day for us all. The meeting was opened by Mr Martin Bromiley, co-founder of The Clinical Human Factors Group. Following his moving talk at last year’s ASM we were delighted that he flew in (quite literally) to open the meeting and support ongoing efforts to promote education in Non-Technical Skills.

The first speaker was Rhona Flin, Professor of Applied Psychology and Director of the Industrial Psychology Research Centre at the Univer-sity of Aberdeen. She gave an insight into the evolution of Non-Technical Skills training and the ANTS, NOTSS and SPLINTS systems. She described how systematic training in NTS at undergraduate, postgraduate and consultant level could lead to a common language of NTS and thus be incorporated into a programme of lifelong learning. Dr Nikki Maran, Consultant Anaesthetist at the Royal Infirmary of Edinburgh and Director of the Scottish Clinical Simulation Centre then followed with a more detailed insight into the development of the ANTS behavioural marker system born out of the difficulties of teaching and assessing NTS. She described the ongoing challenges of “getting ANTS out there” as well as training trainers, using NTS in assessment and remediation.

The next session was opened by our Keynote Speaker, Professor Glenn Regehr. I’m sure many of us were delighted to hear him say there was “no shame in slowing down” as he described the many moments when we move from automatic to effortful processes during clinical work. These “slowing down moments” may take many forms but form an integral part of safe practice. By acknowledging and defining them we can use them as an educational resource to promote good practice.

(Continued on page 4)

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SEA UK ANNUAL SCIENTIFIC MEETING 2011 Sarah Wimlett

Featured speakers at ASM

(From top to bottom):

Prof. Glenn Regehr

Rhona Flinn

Martin Bromiley

Dr Chris Frerk is a Consultant Anaesthetist and member of The Clinical Human Factors Group, he opened the “Learning from Experience” talk using a range of familiar anecdotes to show where many clinical organisations could improve learning from error and incidents. Dr Evie Fioratou, Research Fellow in the School of Psychology at the University of Aberdeen then gave a more detailed description of how anaesthetists could learn from experiences in obstetric theatres.

The final session before lunch was the opportunity to join one of three workshops or attend a parallel session. Detailed descriptions of two of the workshops appear elsewhere in the newsletter. The other workshop demonstrated use of NTS in recruitment to anaesthesia training posts. Using a 3G Sim-Man and role-play, Dr Tom Gale, Consultant Anaesthetist in Plymouth and team gave the opportunity to score a candidate using differ-ent systems, lively discussion followed. The parallel session was lead by Dr N Maran and Dr R Glavin – they gave a more practical guide to the application of the ANTS system in teaching practice. There was then the opportunity to observe key behaviours and score them in a series of videos – again, there was much audience participation and lively debate.

Trainee presentations followed lunch – in keeping with the theme NTS and simulation were particularly well represented as a topic over the six high quality presentations; the first prize went to Dr. P. Isherwood for “Improving patient safety in Critical Care”. A total of 34 posters were displayed with 10 being judged for prizes. The first prize for a poster presentation was won by Dr G. Crossingham for “Assessment of Non-Technical Skills Using Key Index Cases in Anaesthesia”

For the final session of the day we trialled the use of text messaging to send questions to the panel, an innovation which we hope to extend for the ASM in 2012. Dr Martin Rhodes, Senior Advisor at the National Clinical Assessment Service gave an insight into the bespoke assessments conducted at NCAS and how these have been structured to incorporate NTS. In particular, the use of simulation in the assessment of anaesthetists was described. The title of the final talk of the day had clearly impressed Martin Bromiley when he opened the meeting – “RCoA: A College Strategy for NTS Training in Anaesthesia”. Dr T Clutton-Brock, Council Member of the RCoA, confirmed the College’s commitment to the teaching and assessment of NTS but admitted there was work to be done – a fitting note on which to end an inspiring and thought provoking day.

The Olympics is heading to London in 2012 and so is SEA UK - do join us for “How do we make every second count?” on Friday 9th March.

On behalf of all delegates I would like to thank Dr Simon Edgar for creating an excellent programme. I would specifically like to thank my co-organiser Jo Kerr; Kim Russon and Rosslyn Thistlethwaite for their reports on the workshops they attended and Simon Mercer for his IT input.

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REPORT ON SEA ANNUAL SCIENTIFIC MEETING

SE A U K NE W SL E T T ER

Photos (From top to bottom):

Main Hall –delegates meeting for coffee

Poster Judging

Poster Prize Winner—Gemma Crossingham

New Council Member—Chris Leng

SU M M E R 2011

The changed schedule and move to the south west this year was well received. The following is a summary of the feedback received from delegates who attended the Annual Scientific Meeting this year.

Speakers

The overall ratings for all speakers was positive. Many delegates thought that the opening speech by Martin Bromiley ‘Really set the scene’ and ‘put professionalism into context’. The opening session presented by Rhona Flin and Nikki Maran was a large topic but ‘concisely presented’. This left some delegates with the impression that ‘more time’ was needed.

Both the after dinner talk and the key featured speech by Prof. Regehr were considered ‘utterly brilliant and unique’. Following the key speaker was a tough job for Chris Frerk

but most delegates found his a ’useful and interesting talk.’ The final session was late in the afternoon and speakers had to struggle for the attention of the audience but they coped amiably. Martin Rhodes and Tom Clutton-Brock’s talks were both ‘informative’ and ‘relevant’.

Workshops

Feedback on the day’s workshops was more variable. Rona Patey’s demonstration of Tactical Decision Games in teaching non-technical skills received the highest scores. This was a session repeated from last year and may well be included again next year.

The day as a whole

This was an ‘Excellent day’ full of ‘Thought provoking and lots of ideas’. It was a credit to the organisers and SEA UK team. Exeter was a reasonable location but many delegates would prefer a more central one. We hope that London will be a more central and easily accessible venue for next year.

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Feedback on SEAUK ASM 2011 Cindy Persad

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Figures above and below show the Percentage of very good and excellent scores for individual presenters

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Workshops

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20406080

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% very good or excellent

I spent my medical elective in Ethiopia was invited back to teach on the emergency surgical and trauma skills course in association with the Southern Ethiopia Gwent Link charity and the Association of Surgeons of Great Britain and Ireland (ASGBI). I was also asked to teach medical students from Hawassa University Medical School.

Background The World Health Organisation, in its 2006 Report, showed that Ethiopia has just 2.6 doctors per 100,000 people. There are just 3 medical schools, 119 hospitals and 400 health centres (though these are not always staffed by trained medical professionals). Globalisation affects the country heavily, with many educated professionals leaving Ethiopia for better economic opportunities in Western societies.

The Gwent Link was started following a request by a local surgeon, Dr Aberra. He had identified knowledge and skills training gaps for the health officer students and wanted help with filling these.

The college lacked training resources in all areas and the trainers lacked experience and confidence in teaching essential emergency skills. Health officer students, on graduating, would be responsible for the management of emergencies in poorly resourced, remote health centres serving over 100,000 people. In this setting, having only a theoretical grasp of managing emergencies was clearly inadequate.

The Link runs yearly workshops on emergency surgery, trauma and obstetric emergencies. It provides support and aims to improve the clinical experience of health officers waiting to be attached to their local hospitals. Since the start of these programmes, Link has trained over 300 health officer students and 200 graduate health officers. In recognition of the success of this CME programme, in 2009 the Ethiopian Government developed an MSc programme in Emergency Surgery for health officers. The MSc trains students to perform emergency life-saving surgery in the remote setting.

The Link has donated training mannequins, teaching equipment and instruments to the college of health sciences in Hawassa and has setup a well equipped skills laboratory. My Role MSc in Emergency Surgery

During the course, we trained 20 second year MSc students and 10 third year students in Basic surgical skills and emergencies. The students’ knowledge base was very good and their surgical experience vast, however, their basic skills were lacking. For many of these students, a lot of their surgical training was emergency based and of an ad hoc fashion. They have had to learn on the job, picking up numerous ‘bad habits’ along the way. For example many of the students struggled with the first surgical task of the day; hand ties. It was satisfying to work with the students; breaking the skills down and watching them progress and learn. During practical sessions, students were animated and engaged and asked for help appropriately. In contrast, during large group discussion there seemed to be a fear of getting questions wrong, so answers were either not forthcoming or mumbled quietly, often with a reluctance to answer or discuss. This improved as the week went on, with more students getting involved. Teachers had to be careful to ensure everyone participated.

The highlight of my MSc teaching week was, the basic airway skills ses-sion followed by surgical airways on a sheep’s heart and lung dissec-tion the faculty had prepared for the course. Rather than the white fluffy things we would identify as a sheep, something resembling a goat was proudly brought forward on day one of the weeks activities. I am reliably informed that the only visible difference between sheep and goats in Ethiopia is sheep’s tails point down and goat’s tails point up! I fondly referred to this specimen as a ‘Geet’ for the rest of the week. The ‘Geet’ was carefully butchered by my surgical colleagues and placed in a sink of water to try and preserve it as best as possible without the aid of refrigeration on site. This method of preserving the tissue was useful for the debridement and tendon repairs performed 2 days later as the water had softened the tough skin and made it more realistic to human tissue (minus its fur!).

(Continued on page 7)

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Emergency Skills Teaching – Hawassa University Hospital, Ethiopia Dr Ruth Bird

SE A U K NE W SL E T T ER

Above: ‘The Geet’

SUMMER 2011

The Emergency Airways session was taught in small groups. The students became more involved than in previous sessions, answering questions knowledgably and asking pertinent questions on how one might put the skills into practice. We used PowerPoint presentations for the theory, integrated with anecdotes followed by questions to ensure we had a good grasp of the level of the students existing knowledge. Due to frequent power failures we were prepared to go back to ‘pens and paper’ route. Luckily the power held out and these were not needed. These MSc students are very bright but did not have the opportunity to go to medical school. They are nonetheless, very committed to a career in surgery and will be an asset to emergency healthcare.

Hawassa University Medical School

In the medical student lectures I gave, the students also seemed reluctant to discuss their experiences and share their knowledge. It seemed that they were used to more a didactic style, where the tutor gives the information directly to the students. With a lecture room of between 40-70 students it’s difficult to try and involve everyone in the session and perhaps in smaller groups they would have been more keen to engage with the material without the fear of making mistakes.

My main Medical student session of the week was on Post-operative pain control, a difficult topic to tackle due to Ethiopian doctors’ fear of patients becoming addicted to pain relief and also limited analgesic options (when compared with the western world). Postoperative pain killers are prescribed on an ‘as required’ basis and intravenous morphine is not available. I knew from working as a student in Hawassa, that paracetamol was mostly used for its antipyretic effects and that the only opiates available were tramadol, an oral preparation of morphine and pethadine. Although oral morphine was available this is rarely used except in patients with pain from malignancy. I had to modify the analgesic ladder to take into account supplies and tried to focus my talk on the negative systemic effects of pain to try and encourage the use of analgesia from a multi systemic approach. I wanted to ensure students knew that adequate pain relief could impact on the patient’s general state of health postoperatively and to encourage them to introduce more analgesia into their daily practice as appropriate. Certainly cultural ideas of pain had to be considered; many patients viewed pain as just part of an illness or operation and were reluctant to take anything despite their discomfort, yet as doctors it is our responsibility to give patients all the facts to allow them to make an informed choice.

In the future I want to do more small group, scenario based, teaching to encourage students to think through the problem and come up with adequate analgesic solutions. By using different styles of teaching concurrently, I hope to further encourage students to integrate theoretical learning into daily practice.

Audit

I undertook an audit on pain relief following caesarean section (C-section). The aim was to see determine the incidence of postoperative pain and the quality of pain relief / teaching on analgesia. In Ethiopia C-sections were either performed under General Anaesthesia (ketamine and suxamethonium induction) or spinal (5% lignocaine or 2% if supplies of the former were low). Although bupivicaine was available this was re-served for longer operations. No analgesia was given pre-operatively or intra-operatively and the surgeons assumed responsibility for post-operative pain relief. Most patients received diclofenac postoperatively but I did not witness any other analgesia being used. The diclofenac was on an as required basis. Many patients had adequate pain scores, or even no pain, 12 hours postoperatively but the majority of these complained of severe pain when asked directly. A significant number had unsatisfactory pain scores 24 hours post operatively, which tells us adequate analgesia is a problem.

Hopefully by teaching medical students from an early stage in their career and encouraging them to prescribe analgesia, titrated to the level of a patients pain, we can help reduce both pain and in turn post operative complications related to pain.

Students in Ethiopia have a good knowledge base and work extremely hard.

(Continued)

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Emergency Skills Teaching – Hawassa University Hospital, Ethiopia (CONTINUED)

Above: Dr Ruth Bird in Hawassa

Via the ongoing partnership between: Hawassa’s Professor of Surgery, Dr Aberra; Head of Obstetrics, Dr Yifru; UK surgeon, Mr Lane of the ASGBI and team leader Biku Ghosh from the Southern Ethiopia Gwent Link, we are making a difference year by year. The hospital has improved significantly since my last visit and has great vision and prospects for the future. Through successful training we hope to be able to create a self-sufficient emergency skills training course with some of last year’s students taking on a teaching role this year.

Newborn Life Support

On the final day I traveled to Wondo Genet village health centre with the charity to train: 2 midwives, 1 clinical nurse and a traditional birthing assistant (from the community) in Newborn Life Support. Using training aids from the UK we were able to, not only teach the skills required to successfully resuscitate a newborn, but use simulated scenarios to aid training. The trainees were grateful for the chance to learn and refresh their skills and to practice in a safe environment.

In Conclusion

This trip allowed me to continue to explore medicine in a different environment, seeing how it is practised in a different social and cultural setting, gain a greater understanding of the healthcare problems affecting Africa and be able to relate this in context to global health, especially in relation to pain relief and training. It was beneficial to pursue my interest in medical education and particularly useful in challenging me to adapt my teaching sessions according to available resources.

The placement I undertook in Ethiopia (in 2009) and the teaching I participated in 2011 has helped me throughout my life as a doctor and has been a constant reminder of the benefits of a National Health Ser-vice. In 2011, I was a beneficial resource in a country short of trainers. I hope this trip has provided a foundation of ex-perience for me to become more involved in the Link’s work in future teaching and training.

I would like to thank people who made this trip possible:

SEA(UK) for helping to fund this trip,

Biku Ghosh from the Southern Ethiopia Gwent Link for organising the course,

Robert Lane and the ASGBI team who kindly adopted me into their teaching faculty,

Dr Aberra Gobeze and Dr Yifru Berhan for their support and advice, and lastly

My audit and research partner from the UK FY1 doctor Sarah Aulds.

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Emergency Skills Teaching – Hawassa University Hospital, Ethiopia (CONTINUED)

SE A U K NE W SL E T T ER

Top:

Airway skills training on sheep heart and lung dissec-

tions

Below:

Typical classroom based teaching for 40-70 students

SU M M E R 2011

Dr Peter Isherwood - Speaker

SpR Anaesthesia & ICM KSS & London Deanery Aims & Objectives:

Our vision is to develop a pioneering multidisciplinary high fidelity simulation programme to improve non-technical and clinical skills and hence patient safety in the Intensive Care setting.

Methodology:

By combining the educational needs of nurses, doctors and the ICU physiotherapists we have moulded a curriculum that we have then integrated with the Anaesthetic Non-Technical Skills system. Each simulation day has a 50:50 nurse : doctor ratio and 1 or 2 ICM physiotherapists, involves a patient safety lecture, Introduction to Sim-Man, 6 x 15 minute scenarios and a 30 to 45 minute debrief of each scenario. Those not directly involved watch the scenarios via a video link and all candidates are involved in each debrief where they are enabled to address clinical questions and focus on how non-technical skills can be improved. All candi-dates fill in a feedback sheet at the end of each day and this feedback is used to continually develop the program to enhance future learning.

Results:

Our results to date are reflected in our feedback (Table 1).

Our feedback shows that the candidates feel an in-creased awareness of the importance of non-technical skills in the workplace.

Key discussion points:

We are providing a truly multidisciplinary approach with both faculty and candidate involvement of different healthcare professionals.

We have carefully considered the learning needs of each profession to produce a combined curricu-lum of technical and nontechnical skills within one curriculum.

We continually mould our program based on our feedback.

We believe the increased awareness of non-technical skills and there importance in the workplace will improve patient safety in the ICU.

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Improving patient safety in critical care:

Multidisciplinary high fidelity simulation training

SEA UK TRAINEE FREE PAPER WINNER

Table1; Summative Feedback to Date

Please rate each component of the course: 1 = terrible 7 = terrific

Did you enjoy the course? 1 2 3 4 5 6 7

Evaluation 2 17 19

How relevant was this course to your

Clinical practice?

1 2 3 4 5 6 7

Evaluation 6 31

Familiarisation with Sim-Man 1 2 3 4 5 6 7

Evaluation 1 6 14 16

Non-technical skills lecture 1 2 3 4 5 6 7

Evaluation 2 7 12 17

Simulation scenarios 1 2 3 4 5 6 7

Evaluation 2 4 31

Debriefing sessions 1 2 3 4 5 6 7

Evaluation 1 4 10 22

Faculty/staff 1 2 3 4 5 6 7

Evaluation 8 29

Venue 1 2 3 4 5 6 7

Evaluation 1 10 26

Length of course 1 2 3 4 5 6 7

Evaluation

1 3 10 22

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Assessment of non-technical skills using key index cases in anaesthesia

G. Crossingham, P. Sice, M. Roberts, T. Gale

Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, PL6 8DH

Introduction

Non-technical skills (NTS) influence the performance of an anaesthetist and deficiency in this skill set may impact on patient safety1. Despite this, NTS are not fully embedded in the anaesthetic curriculum and trainee assessment tools are lacking. Since 2007, we have developed a workplace based assessment to annually assess the NTS of all local trainees using key index cases.

Method

Ethical approval was granted. Trainees appointed since 2007 consented to an additional annual non-mandatory assess-ment. Job analysis and expert consensus identified the important NTS for assessment. The assessment was based on key index cases performed in theatre which were matched to trainee grade: rapid sequence induction on an ASA 1/ 2 patient (ST1), anaesthetise a patient for fractured neck of femur (ST2) and deliver anaesthesia for an elective Caesarean section (ST3). These cases ensured that assessment was appropriate to the level of trainee experience. The ODP and consultant assigned to the list independently scored the trainees using a behaviourally anchored scoring matrix for each of six NTS assessed. The 4-point scales originally used were subsequently increased to 5-point scales.

Results

The distribution of total assessment scores showed strong ceiling effects in 2008/9. This resolved with the introduction of 5-point scales in 2010.

Figure 1: Frequency distributions of assessment scores by year. N=27(2008), 40(2008), 31(2010)

Discussion The ceiling effect, which we might have attributed to the high calibre of the trainees or insufficient challenge in the key index cases, seems to have been an artefact of the scoring scales. The current form of the assessment appears able to discriminate between trainees on the basis of their NTS. References

1.Fletcher G, McGeorge P, Flin R, Glavin R, Maran N. The role of non-technical skills in anaesthesia: a review of the current literature. BJA (2002) 88(3):418-429

7065605550454035

2008

2009

2010

In-theatre assessment score

One symbol = one trainee

SEA UK POSTER PRIZE WINNER

SU M M E R 2011

Clinical competence is the buzz word in today’s medical practice. The General Medical Council (GMC)’s Good Medical Practice states “In providing care you must recognise and work within the limits of your professional competence.”1

The Royal College of Anaesthetists has defined competence as acquisition of appropriate knowledge, skills and attitudes. 2

Medical graduates are routinely assessed in various basic core skills competencies before being granted their qualifications. Assessment and documentation of clinical competence has thus assumed very high significance. Achieving and maintaining competence is also relevant for the GMC revalidation.

Despite all this, there seems very limited guidance available to the individuals as regards to what constitutes clinical competence, how to achieve and maintain it. This short article attempts to address and clarify some of these points.

To achieve a certain competency, one has to ask the question “How do I do it?” The simple steps to follow are

Identify: Identify topic about which you aim to achieve competency. Categorise what is it that you wish to achieve and how the end point is to be assessed. For example, if you wish to achieve iv cannulation, you need to know whether you will be considered to have been achieved the skills if you cannulate at the ‘n’th effort. You also should know whether you would be assessed regarding explanation of the procedure, consent, aseptic technique, etc.

Gain knowledge: from various sources i.e. books, internet, guide, colleagues, journals, etc. Find out as much as possible about the topic and the skills you wish to acquire. To achieve certain practical skills, you may need to find out whether it is possible to use a skills laboratory or to work with a known expert.

Know the skills that are essential for the task. It is worthwhile not only to read about these skills but also to talk to the colleagues and observe someone perform them. Some common tasks are often available as videos.

Attitude: Develop an attitude that may be essential to fulfil the aim. It is often easy to master certain competency but to maintain the skill, one has to keep on practicing. Be open to suggestions, audit your practice and be ready to adapt and learn. Remember that team working is extremely important. Often test scenarios, OSCEs, simulators etc. do not reflect real life situations. Although trained actors may help in certain assessment processes, they suffer from the same limitations as above.

To achieve and sustain a skill, there are four steps: observe, practice, repeat and maintain.

This is exemplified if you imagine you are pushing a heavy ball up a straight slope. As you progress up the (career) slope, the ball (skill) is in the danger of rolling back. But if you keep trying and maintaining your progress, you push the ball up the slope. As you ascend the slope you not only gather higher position but also learn to maintain the skill upfront. A slight lack of concentration can result in a hard fall

In conclusion Clinical competency is having up to date knowledge, maintaining skills, developing attitude and performing to the level expected in given environment. It is essential not only to maintain validation but more importantly to reassure patients and the society about one’s abilities as a competent doctor.

REFERENCES:

Good Medical Practice http://www.gmc-uk.org/guidance/ good_medical_practice/. Accessed 27 march 2010 Curriculum for a CCT in Anaesthetics, 9.1.1; 49, Edition 2, August 2010; http://www.rcoa.ac.uk/docs/CCTinAnaesthetics_PMETB.pdf. Accessed 27

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Clinical Competence Abhay, Vaidya

KHP is the largest centre for healthcare education in Europe, providing education in the widest range of subjects. In 2008 changes in service demands at the King’s College Hospital site meant that the Department of Anaesthesia and Critical Care was unable to reliably provide an individual with airway skills on-demand e.g. for the cardiac arrest team. The reasons for this were multi-factorial and, anecdotally, included an increased number of novice anaesthetic trainees, an increased number of non-anaesthetic junior Doctors on ITU, new clinical services such as Acute Stroke, Primary-angioplasty for Acute MI and Major Trauma. The Anaesthetic and ITU consultants submitted a series of Adverse Incident (AI) reports and successfully lobbied for the risk this represented to be raised to the maximum level on the hospital’s risk register.

As a result we were allocated funding for a new full-shift tier on the Anaesthetic and Critical Care rotas. Of the 8 posts we were able to staff 3 from Advanced Trainees in ICM and 1 from a pre-existing clinical research post which did not attract any on-call supplement. We decided to try and get the remaining four posts recognised for training in Anaesthesia as Fellowships in Medical Education.

We discussed the proposal with our Regional Advisor and mapped the learning objectives of the posts to higher training in Trauma Anaesthesia and the various learning objectives for Medical Education contained within the curriculum. We created a structured programme of training in Medical Education, supervised by the two Consultants in the Department with higher qualifications in Medical Education. Each FME has a series of small projects plus one major educational project. They are encouraged to partake of a range of opportunities offered by the AHSC, ranging from writing and administering MBBS OSCE exams through to Pedagogic research at the King’s Learning Institute or the management, planning and administration of region-wide education and training innovations. All are encouraged to enrol on a programme of study in Medical Education which will lead to a higher-level qualification.

The posts have been approved for training for a total of six months each. We have so far been able to consistently staff

three of the four posts continuously over the past two years.

I am currently an ST5 in Anaesthetics and throughout my career have always had an interest in Medical Education.

Since February I have taken a year out of training to be a Fellow in Medical Education at King’s College Hospital. Prior

to this job I was an instructor on a number of acute medical and trauma courses and after doing the Simulation and

Technology-enhanced Learning Initiative (STeLI) Training the Trainers course I had the opportunity to facilitate on a

number of simulator days involving final year medical students, FY1s, FY2s and paediatric ST3s. The job plan involves

short days being non-clinical and fully committed to education, whilst on calls are as part of a full shift 1:8 senior tier on

the Critical Care rota. During my second six months I also plan to spend time in trauma theatres so I can obtain the

necessary competencies for higher training in trauma anaesthesia.

I have now been an FME for almost three months. To date I have been involved in the delivery of simulator based

training to an inter-professional group of undergraduates, the facilitation of tutorials to anaesthetic novices and the

organisation of weekly intensive care medicine (ICM) seminars for trainees. My major project has been the

development of a Novice Intensive Care course which we feel is required due to changes in doctors’ training and hours,

leading to the presence of more junior doctors on intensive care units without previous exposure to ICM.

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Being a Fellow in Medical Education at an Academic Health Sciences Centre

Ed Denison Davies

Innovative Fellowships in Medical Education in an Academic Health Sciences

Centre Chris Holland

SE A U K NE W SL E T T ER

SU M M E R 2011

We plan to stage the first course in August, and have developed the program after consulting both novices and content-

experts (consultants) using a learning needs assessment questionnaire mapped to the new Faculty of Intensive Care

Medicine (FICM) curriculum. We plan to evaluate the impact of this course using validated pedagogic tools, and have

recently applied to the National Institute of Academic Anaesthesia (NIAA) for a grant to help towards start up costs.

In tandem with these activities I have enrolled on the University of Dundee Postgraduate Certificate in Medical Education. Over the next few months I will also be involved in the examination of OSCEs for final year medical students, facilitate on a number of simulator based trauma study days and present an update of our progress with the Novice Intensive Care course at an educational conference.

This is very rewarding, enabling me to develop the knowledge, skills and attitudes required to become an expert

educator, and so deliver high quality instruction to the health care practitioners that are the future of the NHS.

PAG E 13

Being a Fellow in Medical Education at an Academic Health Sciences Centre

(continued)

SEA(UK) Research and Travel Grants

The Society for Education in Anaesthesia UK has agreed to support re-

search and travel grants in fields relevant to education in anaesthesia.

These grants are made available in addition to the four SEAUK sponsored

NIAA grants set out in this section of the website.

Guidelines

There is no limit to the number of grants, but SEA UK aims to award both

travel and research grants if the quality of applications is acceptable.

These grants may total £1000 each year; £500 maximum for any

individual.

Details of the grants process (as a PDF) and the two applications forms

(Research +Travel in MSWord format) can be downloaded from the

SEA(UK) website: www.seauk.org

The deadline for application is the 14th January each year.

At the SEA(UK) Annual General Meeting held on the 14th of March, two appointments to council were made .

Below is a brief introduction to Drs. Chris Leng and Yogita Chikermane.

Dr Chris Leng

I am a consultant anaesthetist at Northampton General Hospital with an interest in intensive care and paediatric anaesthesia. I have been a College Tutor for 4 years and am now in my fourth year as Regional Adviser. I have been a Primary FRCA examiner since 2008.

I am particularly interested in trainee recruitment and the challenges of

providing good quality CPD for consultants as required for revalidation. I am

very grateful to be given the opportunity to join the Council of SEA(UK).

Dr Yogita Chikermane (co-opted to council to continue work on the SEA Newsletter)

I am an anaesthetic consultant at Heart of England NHS Trust and have been a SEA(UK) member as a trainee and a consultant. I have presented in the annual meetings & was also awarded the trainee prize for the oral presentation at the 2005 meeting. I am the current editor of our Newsletter.

I feel that with the current system, SEA(UK) has a very important role to play in influencing the way we train trainees and trainers.

I have done the PGCME from the University of Dundee, and am currently studying for a diploma in medical education.

I have taken up the responsibility of organizing the Primary FRCA teaching for the Warwickshire School Of Anaesthesia (WSOA), and am also in the process of developing a simulator based assessment programmes for core trainees (CTs) at our local simulator centre.

I am regularly involved in teaching roles as ALS/APLS instructor.

In my role as a council member, I would like to develop the newer aspects of training & support that are emerging as a part of holistic professional development. I would also like to raise the profile of our society.

Council vacancies are advertised to all SEA(UK) members prior to the annual general meeting each year. If you have a background in medical education and may be interested in working for SEA(UK) , please apply.

PAG E 14

NEW COUNCIL MEMBERS

SE A U K NE W SL E T T ER

SU M M E R 2011

Following the popularity of this workshop last year Dr Rona Patey kindly returned to run it again.

TDG are defined as a low fidelity training intervention which can be used to enhance non technical skills. They were developed in the military and are used in high risk industries e.g. nuclear . TDG give the participants an opportunity to consider the options available for a difficult situation that is are. Decision making and communication is an essential component.

A scenario is presented to the participants, usually a group 4-10. It is usually a rarely occurring event/emergency. There will be limited information, and sometimes misleading information – as may be the case in a real life emergency. The scenario inevitably ends with a dilemma. The participants are given a short time to formulate a plan. The subsequent discussion enables sharing of options and discussion of the consequences of decisions. Prioritisation, communication and consideration of the resources available are required.

This was a very enjoyable workshop. Once TDG concept was explained to us we were given a non-medical scenario with several dilemmas! Two minutes to make our own plan and priorities and then it was opened to group discussion. This was very lively as it became clear each option had consequences and there was no one ideal answer. Time flew by and the group worked through things and came out with an agreed plan.

TDGs has been successfully used with anaesthetic beginners giving them the opportunity to work through in advance

some of the challenging decisions that may face them as they start on-calls. These may however be decisions a

consultant/expert may not consider challenging. I think TDG have the potential to be an invaluable educational resource

for all grades of anaesthetist so when confronted with an unusual “crisis” you may have considered some of the options

and consequences before and thus ease the process of managing the situation.

PAG E 15

Tactical Decision Games (TDG) workshop Kim Russon

Join SEA UK

SEA(UK) membership is open to any practicing, anaesthetist. You do not need to be very

academic or have any educational qualifications! All you need is to be interested and

enthusiastic about teaching anaesthesia and keen to meet like minded colleagues.

Trainees, staff grade, associate specialist and trust doctors are all welcome to join.

Membership costs are kept as low as possible and members are entitled to a discount

at our annual meeting. They will also be able to access teaching and learning resources

via the website (currently being developed).

For application forms please visit www.seauk.org or contact the administrator at

[email protected]

The Annual Scientific Meeting in 2012 will be held in London jointly with the RSM on Friday the 9th

March