BULLETIN

Page 32 | Bulletin 93 | September 2015
stroke, this would make the point that
the surgical intervention is merely
a single, though significant, event
in a longer-term disease process,
demonstrate the importance of
teamwork and collaboration, and
encourage students to follow patients for
longer than they often do. We would be
interested to know if anyone has tried,
or is planning to try, such an approach.
The specialties of anaesthesia, critical
care and pain medicine are well placed
to facilitate the acquisition of much
of the knowledge and understanding,
and many of the skills and attitudes
that are relevant to the newly qualified
doctor caring for the patient in the
perioperative period. While many of
these ‘competencies’ lie within the
domains that traditionally have been
taught during anaesthetic attachments
(applied physiology, pain pharmacology,
airway management, for example),
the anaesthetist is also well placed
to demonstrate and discuss topics
that have become the ‘unofficial’ but
customary preserve of our specialty,
such as patient safety and human
factors, consent, and treatment
limitation (see Table 1). In addition,
we have much to contribute both to the
teaching programmes in other clinical
specialties and to the wide promotion
of areas which are new priorities for
the NHS (e.g. prevention of chronic
ill-health through pain clinic work
and promotion of the general public
health benefits from the perioperative
encounter), as well as long-standing
professional principles which are
being re-emphasised currently (e.g.
humanitarian care of the vulnerable).
Our view is that we should move away
from identifying ourselves as mere
technicians and highlight the many
non-technical roles we play within the
operating theatre, and the influence we
exert throughout the hospital.
The undergraduate curriculum is
well developed, but not yet finalised.
We would encourage those working
in anaesthesia, critical care and pain
management both to comment on the
curriculum proposals and also to share,
if they would like, examples of how
they are currently delivering any of the
above elements to undergraduates. As
the programme develops we would like
to publicise existing good ideas. Please
contact us via perioperativemedicine@
rcoa.ac.uk.
Table 1: Specific topics relevant to perioperative medicine with the realms of anaesthesia, critical care and pain medicine.
Pharmacology and physiology
Perioperative care
Critical care
Patient safety, staff safety
and other non-clinical areas
Traditional ‘anaesthesia’
Analgesics (use and side effects), Antibiotics, Anticoagulants.
Concurrent medication.
Elements of cardiovascular, respiratory and neurophysiology.
Fluid, electrolyte and nutritional management and balance.
Pre-op assessment and preparation, and assessment and mitigation of risks.
Consent, capacity, communication of risk vs benefit.
Expected and complicated postoperative course of events.
Transfusion of blood products.
Interpretation, recognition and scoring of deterioration, and management of the acutely ill.
Core critical care topics: shock, hypoxia, sepsis, organ failure and support.
Organ donation.
Treatment limitation/withdrawal.
Planning and communication of the management of postoperative course.
Identification and management of complications.
Principles of invasive monitoring.
Arterial blood gas analysis.
Non-technical skills – task management, team-work strategies, decision-making theory, cognitive
error, conflict, communication, situational awareness.
Use of (and cognitive science behind) checklists.
Handover, briefings, debriefings and continuity.
Pathways, improvement science.
Anaesthetic, autonomic, resuscitation drugs.
Local anaesthesia.
Sedation.
Medical gases.
Medical equipment/monitoring principles.
Physics and electrical safety.
Measurement principles and practice.