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salamis
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Hi guys!

I don't normally post on here but could do with some advise from someone with anaesthetic training experience.

I've just received an offer for ACCS Anaesthetics and debating whether or not to take it. I am a CST1 but realising that I am not so keen on surgery anymore and the bottleneck ahead to pursue it.

My questions:
1. What are the pros and cons of anaesthetic training? Do trainees feel looked after? Does the rota permit one to have a good family life and time outside medicine?
I've heard anaesthetic training is good and cares for its trainees so I'm hoping that is general view!

2. I assume the level of diagnostics involved is lesser than in other specialities. Do you miss this? I do want diagnostics as part of my career and hence worry this might not fit me well.

Look forward to hearing some thoughts! Thanks!
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Helenia
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I'm an ST5 in anaesthetics, and very happy with my career choice.

Pros: Very supportive - you will be with a consultant all the time for your first 3 months (or until you've got your Initial Assessment of Competency signed off) and for the majority of your lists after that. There's a lot of direct supervision and you build up confidence in your practical skills quickly.

Especially at CT level, there's much less service provision and much more training time than in other jobs - though as a reg you may sometimes get fed up of doing endless labour ward/ICU cover if you're not particularly interested in those areas.

Rota is ok; you will obviously have a reasonably significant out of hours commitment, usually 1:8-1:10 but it's manageable. I didn't do nights as a CT1 but that was an anomaly - I was at a big teaching hospital where the CT2s had a separate rota for nights; in most hospitals you will be combined with them. There are fewer random late finishes than in other specialties - handovers between on-call people are at set times and barring emergencies you can leave once that's done. Even if a regular list overruns, most consultants will send their trainee home rather than insisting you stay late. I'd say it's reasonably family-friendly as acute specialties go, and is very good for LTFT training (I completed up to ST4 full time, then went on mat leave and have returned to ST5 at 60% FTE).

There are lots of different subspecialties within anaesthesia, and even as a generalist there is a fair bit of variety. I like that you get to immediately see the effect of what you're doing, and enjoy hands-on procedures etc (but don't have enough patience to be a surgeon!) It's very flattering that you're the one everyone turns to in a crisis.

You get to go to theatre but you get to sit down, and have time for coffee and a lunch break!

Cons:
The exam is a *****. I never looked at MRCS so don't know how it compares, but the FRCA is notoriously tough, demanding lots of seemingly irrelevant detail on some fairly obscure topics. Vivas are scary.

Some people find it boring. It's very true that you're only doing active stuff at the beginning and end of the case, and there is a fair bit of sitting around in the middle - I like this, but some people find it mind-numbing. As a registrar you often have to cover ICU, even if you're not an ICU trainee, and I'm kind of at the point now where I don't enjoy that - I'd rather be on labour ward, but others can't bear that place!

As you stated in your second question, you don't get involved in diagnostics much in anaesthetics. You do in ICU - and even if you don't dual train, you will still have to do 3 x 3 month pure ICM blocks in your training plus a fair amount of service work there - so you don't miss it so much there, but I can imagine once I finish I might miss that side of things. I used to really enjoy it as a medical FY2 but could never do medicine long term because everything else ground me down!

Early starts - but as a surgeon you're used to that!

Being the difficult cannula monkey.
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salamis
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(Original post by Helenia)
I'm an ST5 in anaesthetics, and very happy with my career choice.

Pros: Very supportive - you will be with a consultant all the time for your first 3 months (or until you've got your Initial Assessment of Competency signed off) and for the majority of your lists after that. There's a lot of direct supervision and you build up confidence in your practical skills quickly.

Especially at CT level, there's much less service provision and much more training time than in other jobs - though as a reg you may sometimes get fed up of doing endless labour ward/ICU cover if you're not particularly interested in those areas.

Rota is ok; you will obviously have a reasonably significant out of hours commitment, usually 1:8-1:10 but it's manageable. I didn't do nights as a CT1 but that was an anomaly - I was at a big teaching hospital where the CT2s had a separate rota for nights; in most hospitals you will be combined with them. There are fewer random late finishes than in other specialties - handovers between on-call people are at set times and barring emergencies you can leave once that's done. Even if a regular list overruns, most consultants will send their trainee home rather than insisting you stay late. I'd say it's reasonably family-friendly as acute specialties go, and is very good for LTFT training (I completed up to ST4 full time, then went on mat leave and have returned to ST5 at 60% FTE).

There are lots of different subspecialties within anaesthesia, and even as a generalist there is a fair bit of variety. I like that you get to immediately see the effect of what you're doing, and enjoy hands-on procedures etc (but don't have enough patience to be a surgeon!) It's very flattering that you're the one everyone turns to in a crisis.

You get to go to theatre but you get to sit down, and have time for coffee and a lunch break!

Cons:
The exam is a *****. I never looked at MRCS so don't know how it compares, but the FRCA is notoriously tough, demanding lots of seemingly irrelevant detail on some fairly obscure topics. Vivas are scary.

Some people find it boring. It's very true that you're only doing active stuff at the beginning and end of the case, and there is a fair bit of sitting around in the middle - I like this, but some people find it mind-numbing. As a registrar you often have to cover ICU, even if you're not an ICU trainee, and I'm kind of at the point now where I don't enjoy that - I'd rather be on labour ward, but others can't bear that place!

As you stated in your second question, you don't get involved in diagnostics much in anaesthetics. You do in ICU - and even if you don't dual train, you will still have to do 3 x 3 month pure ICM blocks in your training plus a fair amount of service work there - so you don't miss it so much there, but I can imagine once I finish I might miss that side of things. I used to really enjoy it as a medical FY2 but could never do medicine long term because everything else ground me down!

Early starts - but as a surgeon you're used to that!

Being the difficult cannula monkey.

Thanks Helenia! Appreciate this.

The other question I had was in terms of ACCS / Core Training - Does this really have an impact on your time in higher training particularly if I may be interested in ITU / Pre-hosp medicine at the time? I have held my offer with upgrades so I am thinking if I should just rank some core training jobs as its quicker and done in 2 years.
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Helenia
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(Original post by salamis)
Thanks Helenia! Appreciate this.

The other question I had was in terms of ACCS / Core Training - Does this really have an impact on your time in higher training particularly if I may be interested in ITU / Pre-hosp medicine at the time? I have held my offer with upgrades so I am thinking if I should just rank some core training jobs as its quicker and done in 2 years.
If you want to do ICM or PHEM, at some point you will need to do additional training time in medicine/EM. Doing ACCS covers some (?all) of those requirements; if you did core anaesthetics you would have to do the extra time in higher training so the overall training time would be very similar.
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banana day
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Hi,I was wondering what does 1:8-1:10 on call mean in terms of the rota? And is that the same for reg and core. How frequent are on calls for consultants?
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Helenia
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(Original post by banana day)
Hi,I was wondering what does 1:8-1:10 on call mean in terms of the rota? And is that the same for reg and core. How frequent are on calls for consultants?
On a basic full shift rota, a 1:8 means that in an 8 week cycle, you'll have 1 week of nights and 1 week of long day on calls in total, though these will usually be split up into blocks of 2-4 at a time (new contract specifies not more than 4 nights in a row) - and will include 2 weekends (1 nights, 1 days). On top of that you'd have normal days and off/zero days over the 8 weeks, allocated in order to make up your hours average. 1:10 is the same but over a 10 week cycle, so slightly less intense. Some places do more complicated things with twilight shifts etc, but I don't have much experience with that.

Consultant on calls work differently as they're mostly non-resident, though that is changing gradually. Usually less frequent, but some new consultant job plans have regular weekend sessions as part of the job plan.
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