An ideal postgraduate student in anaesthesia.

INTRODUCTION

‘Ideal’ as a noun means a person or thing regarded as perfect. Over the years, the postgraduate (PG) education in India has got transformed to a very different level and so have the PG students! The typical PG residential training programme does still exist but the rules seem to be changing? So we can settle for a near-ideal PG in anaesthesia and the qualities to be expected from such a trainee because if we say “ideal”, we are taking the scope of further enhancement away from him by calling him “already perfect”.

ATTRIBUTES OF AN ‘IDEAL’ PG STUDENT

The first and most important consideration is whether the candidate has the motivation and desire to become an anaesthesiologist. On completion of undergraduate (UG) training, one is eligible to specialise in a chosen branch of medicine. However, As per competency-based medical education (CBME) curriculum 2019, Anaesthesiology has been given due weightage in the UG curriculum; however, exposure like that of surgery, medicine or obstetrics is unmatchable and only limited students at that stage can think of considering anaesthesia as a prime career option. In a cross-sectional study, it was found that only 42.3% of students joined a PG course in anaesthesia out of interest in the subject.[1] Students who do not select anaesthesia out of a passion for the discipline may not have the motivation to excel in the beginning, but preferences may change with time. Therefore, the ideal PG student in anaesthesia should have selected this branch as an informed first ‘choice’ and not simply by ‘chance’.

An important distinguishing characteristic of anaesthesiology is that, unlike many other medical specialities, it deals with the physiological response of the whole body under a variety of stresses. Hence, the ideal student must have a great interest and an excellent grounding in human physiology. During the course of conducting anaesthesia, the anaesthesiologist manipulates physiology through a variety of means such as fluids and drugs. Therefore, the ideal anaesthesiologist should also have an abiding interest in pharmacology. Competence in these disciplines is fundamental for the anaesthesiologists, as they expertly move the body from one physiological state to another in a controlled fashion using drugs. Thus the first virtue for an ideal anaesthesiology PG student is to have sound knowledge of the basic sciences along with reasonable knowledge of other specialities including medicine.

Anaesthesia has gradually evolved to match the pace with the increasing scope of surgical specialities. During the training period, they should learn and become well versed in managing anaesthesia for different speciality surgeries and patients belonging to various categories of the American Society of Anesthesiologists grading including life-threatening emergencies like polytrauma, acute extensive burns and challenges associated with surgeries on extremes of ages. In the current scenario, it is possible that a PG student in anaesthesiology will not be exposed to many of these subspecialities in a given scheduled time period unless he/she devotes more working hours in the job, may be at times, sacrificing other personal, social and non-academic commitments. Thus, he/she should be ready to procure maximum skills in a shorter span of time while remaining absolutely focused.

Anaesthesia is a skill-intensive speciality. The anaesthesiologist performs a variety of invasive procedures that require both, dexterity of the highest order and intimate knowledge of anatomy. Both competencies can be acquired through training. The additional challenge the anaesthesiologist faces is the need to perform these procedures with speed, finesse and fluidity since almost any intervention that the anaesthesiologist performs is done within a specified and relatively narrow window of time. Hence, there is a need to have a strong desire by the trainee anaesthesiologist to learn the subject diligently while simultaneously developing the practical skills for the safe practice of anaesthesia.

The anaesthesia PGs should get trained in cardiopulmonary resuscitation and should be able to perform and handle any crisis situation before they complete their course. They become the central actors when unforeseen incidents occur in the operating theatre. Trainees should have faster reflexes and analytical thinking as the sixth sense for timely identification and management of unanticipated complications. While they may spend much of their time in watchful expectancy when the need arises, they must swing into action, take rapid decisions and perform lightning-fast manoeuvres to extricate the surgeon from a tricky situation.[2]

The major advance in anaesthesiology is on the technology front. With rapid entry of automated anaesthesia workstations, higher electronic monitoring gadgets, advanced models of mechanical ventilators, ultrasound, imaging technology etc., it is inevitable for an anaesthesia PG student to master the nuances and usage of these instruments and be technology savvy before the completion of training. He should be competent enough to detect technical glitches, prevent possible damage and also plan necessary corrective actions. So, an ideal trainee should have an engineering mindset in spite of being in medicine.

The skill in usage of ultrasound (US) has become mandatory as majority of procedures are done under US guidance as per National Institute for Health and Care Excellence (NICE) guidelines to promote patient safety. With recent inclusion of US technology in vascular access, airway and pulmonary assessment, cardiovascular assessment, regional analgesia, etc., it is almost mandatory that reasonable knowledge and skill of its use, is acquired.

By the third year of the PG tenure, he/she should be able to handle the cases independently and train the subordinates in a comprehensive manner and inculcate the hard work culture so that it remains the tradition for the future. He/she also should develop a skill to overcome the stress situations and learn to work effectively under pressure.[3]

Anaesthesiologists never work alone. They are usually part of the operating team along with the surgeon. They must have the emotional quotient to deal firmly with surgeons impatient to complete the surgery even when the patient's general condition warrants a pause. Hence, they need to combine tactfulness and also command the respect of the surgeon.

It is essential to develop good communication skills by being receptive, tolerant, to defuse any serious confrontation. Similar communication skills will come in handy while dealing with patients at times of taking informed high-risk anaesthesia consent, and explaining the possible stormy perioperative course to the well-informed and Google consulting patients and relatives, who may ask some difficult- to- answer questions.

As an anaesthesia PG student, one needs to remember that, besides being good clinicians, anaesthesiologists need to understand all aspects of education and educational outcome in order to teach students, residents and themselves.[4] An ideal trainee should acquire leadership qualities since the beginning as he/she may be asked to lead the team at the time of disaster or any pandemic management.

The ethical responsibilities need to be imbibed on the minds of young PG students, right from the beginning of the tenure and this has widely been reviewed by the American Society in the speciality.[5] Use of computing technology, advanced statistical and predictive models, etc., has made the analytical process simpler, provided one is learning their use. Thus it is imperative that these updates be grasped earlier in the tenure.

Documentation is vital to avoid professional, legal or ethical controversy later. It is essential that a PG student in Anaesthesiology learns documentation right from day one of the training and makes it a habit. The learning process is not limited to the institution where he/she undergoes training, but also involves gaining knowledge and skills through the experiences of others which makes it necessary for the PG student to attend the periodic meetings of the professional organisations, webinars, conferences, continuing medical education (CME) programmes and share experiences by presenting papers in such forums.

An ideal PG should be attending conferences from the first year so as to get updated about what is latest in the speciality. Presentations can also help one in dealing with stage frights and improving communication skills which is utmost for an anaesthesiologist. An ideal PG should be able to work as a team with all ranks of personnel involved in patient care without display of ego or an authoritative attitude.

Last but not the least, the ideal PG student should be involved in research activities and show interest in developing newer modalities of treatment and/or equipment designs. He/she should be habitual of accessing journals and later on publish articles in scientific journals based on the training to do the thesis as a part of the curriculum.

Most importantly, he or she should strike a perfect work–life balance. Taking out time for family, friends and recreation always improves the performance and acts as the best destressor. An ideal trainee should be ready to get inspired by his/her teachers and try to have a mentor at an early stage of the training who can motivate him/her at every step.

SUMMARY

Anaesthesia is a challenging speciality and the expectations from an ideal PG student are high. An ideal PG student should have a profound knowledge of pharmacology and physiology, be competent in skills and techniques and have an aptitude to be a team leader in the situation of crises. The recently introduced competency-based curriculum in anaesthesiology envisions to inculcate these attributes in the anaesthesia PG students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.