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F1's - Foundation Training
Written by Dr Kubli   

Welcome to the Anaesthetic Department in St Peter's Hospital NHS Trust

Welcome to the Ashford & St Peter's Hospital Anaesthetic Department. As a Foundation doctor your role is primarily supernumerary, however to help you get the most out of your placement this guide has been compiled to explain what will be expected of you and what you can expect from the department.

During the 4 months you spend in the department you will spend 2 months theatre and 2 months ICU. There will be 3 FY1 doctors on each rotation and so there may be times where you are the only FY1 in ICU or theatre.

Your working hours are 8:00 am - 17:00, usually with an hour for your lunch break. This will allow you to have the greatest benefit from your time spent in anaesthesia due the normal working hours of the department.

We expect you to actively take part in the educational and work life, thus it is compulsory to attend the departmental morning teaching on Tuesday and Wednesday mornings as well as the Educational Half Day once a month.

During your time on anaesthetics you will have an assigned educational supervisor, whom you should try to meet with in the first 2 weeks of starting, to sign the Induction Meeting (page 24 FY1 portfolio). Before this meeting it is useful to fill out your Personal Development Plan (page 14 FY1 portfolio) where you can outline what learning outcomes you hope to achieve during your four months.


Theatre

After teaching or from 8am you will find the theatre you are attached to on the rota and get involved in assessing the patients for the theatre list. This is best done by finding the consultant you are going to work with and seeing the patients with him/her. However failing this it's recommended that once familiar with an anaesthetic history that you go and see the patients for yourself as this is part of good patient care. This also provides an opportunity for you complete Mini-CEXs, DOPs or CBDs as part of your FY1 portfolio.

During the time in theatre you will have the opportunity to discuss a variety of topics. This will be undertaken as worked based learning and assessment with your assigned consultant. You are expected to prepare for all the work based assessments which will cover a variety of topics including: pre operative assessment, airway management, fluid management, blood products, pain relief, and the anaesthetic machine. You will be provided with work sheets contain these assessments, and there is a recommended reading list below.

It would be beneficial to have basic knowledge of anaesthetic drugs, their indication and contraindications before coming to the department.

During your time in theatre you will also have the opportunity to take part in the weekly pain ward round on Thursday mornings with a consultant anaesthetist and the pain nurse specialists.


Intensive Care Unit

Whilst on ITU you will be expected to attend the teaching on Tuesday and Wednesday mornings, as the ITU ward round is delayed to 8:30 am on theses days, otherwise your day starts at 8am with the ITU ward round. You will be expected to participate in the ward round and will be assigned a patient to look after once settled into the daily workings of the unit. Again there will be plenty of teaching opportunities as in theatre although the unit can be very busy at times. Specific learning outcomes that are suited to the ICU environment include: fluid management, blood products, pain relief, use of inotopes, long term ventilation, clinical skills such as central lines and arterial lines and the advanced medical management of acutely ill patients.

While you are in ITU you will also have the opportunity to be part of the Critical Care Out-reach team who are involved in the care and assessment of critically ill patients in the ward environment. This service is run by highly skilled specialist nurses, who can involve the ITU consultants when appropriate. Specific learning outcomes include: optimizing patient management in a ward setting, non-invasive ventilation, blood gas analysis, resuscitation, and a variety of other topics due to the diverse nature of referrals. This can provide an excellent setting to revise your management of a number of medical emergencies.

There is also the opportunity to accompany the on call junior anaesthetist to the cardiac arrest calls, trauma calls and referrals for pain management. This again will prove invaluable on your other medical and surgical rotations as it will hone your resuscitation skills.


Useful Documents and Recommended Reading

This is the website for the Foundation Programme. It contains both the curriculum and the portfolio, both of which you should be familiar with, as it will aid your progression through the FY1 year. The curriculum is best used as a guide to focus your learning outcomes. The portfolio requires constant updating and has an explanation of the various documentation you need to be signed off at the end of the FY1 year, particularly the DOPs, Mini-CEX and CBDs.

www.foundationprogramme.nhs.uk/pages/home/key-documents

I would not recommend buying the Oxford Handbook of Anaesthesia, by Keith Allman and Iain Wilson as it assumes a certain level of knowledge. I would recommend going back to your basic textbooks (physiology, anatomy, pharmacology, physics) and having a look through one or two of the following.


Books you should buy

1. How to Survive Anaesthesia: A Guide for trainees; Third Edition; Neville Robinson and George Hall

This is a very useful basic textbook that will introduce you gently into the complex world of anaesthesia, would recommend buying this if considering a career in anaesthetics

or

2. Lecture notes on Clinical Anaesthesia; Second Edition; Carl Gwinnutt

This is another useful basic textbook in the classic "Lecture Notes" format, recommended if you like the lecture notes series


Books you should take out the library

3. Anaesthesia and Intensive care A to Z: An Encyclopaedia of Principles and Practice; Third Edition; Yentis, Hirsch and Smith

This encyclopaedia provides a more in depth look all aspects of anaesthesia and critical care but this is probably best used as a reference rather than buying it, unless you are already sold on anaesthetics as a career.

4. Clinical Notes for the FRCA; Second Edition; Charles Deakin

This is not as in depth as the A to Z, and aimed at the CT1's but its layout and bullet point format may be more appealing.


5. Physics, Pharmacology and Physiology for Anaesthetists: Key Concepts for the FRCA; Matthew E. Cross and Emma V. E. Plunkett

This is a comprehensive guide to the practical application of physics, pharmacology and physiological principles used in everyday anaesthesia. This would be a worthwhile investment if planning a career in anaesthetics.


5. ABC of Resuscitation; Fifth Edition; Colquhoun, Handley, and Evans

A short easy to read revision of the basic principles of resuscitation, best used in combination with the trust resuscitation guidelines and protocols


Useful Links

http://www.medicalcareers.nhs.uk/Pages/default.aspx
Last Updated ( Thursday, 07 May 2009 12:51 )