Starting in anaesthetics can be an intimidating prospect. You’ve picked your specialty, but unless you’ve had a rotation as a foundation doctor you’ve probably not had much first-hand experience of what the nitty gritty of the job really entails. The learning curve in anaesthetics can be a bit of a unique one.
Initially, you can feel like a spare part while the well-oiled machine gets to work. Everything is unfamiliar: from the drugs to the equipment. While you want to help, you might also be acutely aware you don’t want to make a fatal error. In truth, our safety orientated speciality means there is always a beady eye watching. If you don’t know something or you’re just not sure, double check; no one will judge you for it. The patient ‘s safety is always going to be more important that any bruise to your ego.
At the beginning you might be surprised you’re coming home tired, especially with the lack of on calls! Maybe the inability to form a good seal with face mask ventilation means you’re accidentally giving yourself a large daily dose of sevo*; or that your brain is in overdrive absorbing all the new information and skills. Regardless, you are not alone if this is the case.
When you start out, every consultant will tell you to do something differently and it can be quite frustrating as you’ve just learned to do it another way. You will eventually amalgamate all of this information, pick your favourite bits, and cultivate your own way of doing things. I like to think of Anaesthesia as part science, part art (either that or its just black magic). The ODPs will get you out of sticky situations and the best ones will pass you what you need before it has even crossed your mind; make an effort to get to know them.
Gradually you will find your feet; be given more and more independence until you can fly the plane solo. It’s a steep learning curve, but if you’re keen, get stuck in early and ask lots of questions. You’ll be fine.
After a whistle-stop 3 months and an assessment, it’s time for you to go on call. Always remember there will be a more senior anaesthetist to help when you start, particularly for intubation and extubation. It feels like a lot of responsibility, and you’ll probably be a bit nervous, but that’s better than being overconfident. There will always be an on call consultant and if you don’t feel comfortable doing something on your own, call them. In truth, what you learn during your IAC period is not in-depth anaesthesia but knowing what your own limitations are, when to ask for help and how to stay calm and think on your feet.
It’s while you’re on call the real learning begins. Your confidence will grow with your experience, but there will be bumps in the road; knocks to your confidence when you wish you’d managed a complication differently. It’s during these times that the most learning will happen. It’s the mistakes that shape our anaesthetic practice and as you realise you can manage more complications, the confidence will grow again.
However, at some point one of your consultants is going to crack out the inevitable question …. “So, when are going to sit the primary?”. We’ve been there, it can feel like Everest, but remember its a well-trodden path.
There is no good consensus on when is best to sit it or when is best to start studying. I had one consultant who, during my novice period, every day would ask me what I had been reading the night before; redacting any magazines and non-medical literature there wasn’t much to reply. Another consultant, an FRCA examiner, categorically told me to learn the practical part of the job and then the reading should come after. Everyone is different. It’s important to decide what works for you, taking into consideration what is going on in your life outside of work. That physiology you learned at medical school is probably locked away in there somewhere; time to blow away the cobwebs. It will take planning, perseverance and using your brain in a way you might not have done in a while; there is light at the end of the tunnel after all the hard work, I promise.
So...
This is my version of the anaesthetic learning curve in truth it’s more of a learning and confidence rollercoaster. After all, you’re probably a secret adrenaline junkie- you picked this job. Your Gas Novice journey will be challenging at times but rewarding. Embrace the fact that amongst your colleagues you will have different strengths and weakness, you will have good days and bad days. As long as the patient’s safe, that’s what really matters.
*Sevoflurane – type of vapour anaesthetic