EWTD and Anaesthesia

1
EWTD and Anaesthesia

• Rory Dwyer
• Training Committee,
• College of Anaesthetists

2
EWTD issues specific to Anaesthesia

• Pressure on service provision
• - nightime ? NCHDs will work mostly out of
  hours to maintain service
• - daytime decreased elective surgery

3
Service issues in Anaesthesia

• No scope for cross-cover on rotas by other
• specialties

4
Service issues in Anaesthesia

• Little scope for duties to be undertaken by
• paramedics / nurses

5
Service issues in Anaesthesia

• Little scope for reducing tiers on rota
• Very few cover from home in Anaesthesia

6
Service issues in Anaesthesia

• Pressure on other specialties will increase
• demands on Anaesthesia at night

7
Service issues in Anaesthesia

• Pressure to provide service in theatre will
  prevent involvement in other areas e.g. Pain,
  ICU, Pre-op assessment etc

8
Service issues in Anaesthesia

• Concern that a move to a consultant - provided
  service will happen in Anaesthesia but not in
  other specialties
• Consultant / NCHD ratio in Anaesthesia currently
  1 1. 5

9
Service issues in Anaesthesia

• Out-of-hours commitment and other factors could
  make specialty unattractive with recruitment
  problems

10
EWTD impact on training trainee factors

• Decreased clinical experience
• Decreased contact time with trainers
• Decreased contact time with other trainees
• Decreased time for formal training activities

11
EWTD impact on training trainer factors

• Increased service demands will reduce time for
  training activities
• Difficulty in arranging times for formal teaching

12
EWTD College policies to maintain quality of
training

• Duration of training to remain 7 yrs
• Increase quality of training to compensate for
  decreased training time
• - structured modular training
• - focus trainees on suitable caseload
• - improve clinical and non-clinical teaching
• - service provision is an integral part of
  training!

13
EWTD and Quality of training

• Improved monitoring of training
• - more frequent assessment and feedback
• - competency based assessment
• - hospital inspection process
• - trainee choice in hospital assignments
• - hospital tutor system

14
Training trainer issues

• Protected time for trainers
• Training and motivation for trainers
• Need huge manpower increase to deliver this

15
EWTD and training specific proposals

• 50-75 of hours should be worked 08.00-18.00
  Monday - Friday
• ATI sample rota suggests 1 8 rota needed to
  make this work although theoretically possible on
  16

16
EWTD rotas

• Rota time 08.00 - 18.00
• 14 38
• 15 49.5
• 16 58
• 17 63
• 18 68

17
EWTD and training specific proposals

• Protected training time of 220 hrs / annum
  rostered within 58 hr week (includes study leave)
• Junior trainees to have 3 hrs / week for
  structured teaching
• Payment for further training time undertaken
  beyond 58 hrs

18
Conclusion

• 50-75 of working time 08.00 to 18.00
• 220 hrs / annum protected training time within 58
  hr week