The anaesthetist and peri-operative medicine: migration and evolution

Undergraduate education in anaesthesia, intensive care, pain, and perioperative medicine: The development of a national curriculum framework

INTRODUCTION

The study describes the development of the first UK national framework to guide undergraduate education in anesthesia, perioperative medicine, critical care, and pain medicine.

METHODS

We followed an inclusive process of curriculum design aiming to promote high-level learning amongst students. We conducted telephone interviews with senior anesthetic educators at 33 UK medical schools to establish current provision and practice. We then held a consultative national workshop for educators, using focus group interviews to set broad aims for the final framework and gather information.

RESULT

Anesthesia undergraduate educators demonstrated a conceptual focus that moves beyond simple acquisition of knowledge to one geared to encouraging clinical behavioral change in learners to equip them for practice as new doctors. Respondents also highlighted the opportunities for promoting spiral, integrated, and longitudinal learning within the undergraduate curriculum. We also formulated eight key domains of practice in anesthesia and critical care and mapped 63 of the 106 General Medical Council's Outcomes for Graduates against these domains, and created a brief suggested syllabus.

CONCLUSIONS

The framework aims to provide support and guidance for medical schools in the development of competent, well-rounded doctors who are able to provide safe, patient-centered care in all areas of medical practice.

A Foundation Programme educational placement in peri-operative medicine for older people: mixed methods evaluation

We established an innovative Foundation placement in peri-operative medicine for older patients in response to the need for training in 'whole patient' medicine and the challenge of fewer Foundation doctors in acute surgical roles. The placement and underpinning curriculum were co-designed with junior doctors and other clinical stakeholders. This resulted in a modular design offering acute and community experience and dedicated quality improvement project time. To evaluate the placement we used a mixed methods study based on Kirkpatrick's model of workplace learning. Level 1 (trainee reaction) was evaluated using Job Evaluation Study Tool questionnaires and nominal group technique. Levels 2 and 3 (trainee learning/behaviour) were assessed using a Likert-style survey mapped to curriculum objectives, e-portfolio completion, nominal group technique and documentation of completed quality improvement projects and oral/poster presentations. Sixty-eight foundation trainees underwent the new placement. A similar-sized 'control' sample (n = 57) of surgical Foundation trainees within the same Trust was recruited. The trainees in the peri-operative placement attained both generic Foundation and specific peri-operative curriculum competencies, and gave higher job satisfaction scores than trainees in standard surgical placements. The top three ranked advantages from the nominal group sessions were senior support, clinical variety and project opportunities. Universal project completion resulted in high rates of poster and platform presentations, and in sustained service changes at hospital level.

Enhancing the quality and safety of the perioperative patient

PURPOSE OF REVIEW

Many possible hazards bedevil the perioperative patient. This review focuses on a number of aspects of perioperative management where the patient's quality and safety can be enhanced.

RECENT FINDINGS

Our understanding of the relationship between preoperative preparation and postoperative outcomes has improved. There have also been recent developments in our understanding of how to construct useful cognitive aids and make the best use of checklists by understanding the cultural environment supporting their use. Postoperatively, the concept of 'failure to rescue' in the surgical patients has been explored.

SUMMARY

A clear vision of what postoperative recovery should mean for practitioner and patients; careful risk stratification and prophylactic measures to avoid postoperative complications; the judicious use of checklists and other cognitive aids to complement clinical expertise in promoting safety within each local context; and the prompt recognition and rescue of postoperative problems when they occur are all important aspects of a safe perioperative care.

Clinical guideline and recommendations on pre-operative exercise training in patients awaiting major non-cardiac surgery

Despite calls for the routine implementation of pre-operative exercise programmes to optimise patient fitness before elective major surgery, there is no practical guidance for providing safe and effective exercise in this specific context. The following clinical guideline was developed following a review of the evidence on the effects of pre-operative exercise interventions. We developed a series of best-practice and, where possible, evidence-based statements to advise on patient care with respect to exercise training in the peri-operative period. These statements cover: patient selection for exercise training in surgical patients; integration of exercise training into multi-modal prehabilitation programmes; and advice on exercise prescription factors and follow-up. Although we acknowledge that further research is needed to identify the optimal exercise prescription in different clinical scenarios, we urge peri-operative teams to make use of these recommendations.