The College Of Anaesthetists

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Anaesthesia, Intensive Care and Pain Medicine 

Anaesthesia is a large specialty - there are around 350 Consultant Anaesthetists in Ireland; approximately one sixth of the total consultant body, and the second largest single specialty following Psychiatry. The core activity is provision of anaesthesia for surgery. This involves an enormous variety of surgical procedures on all parts of the body, across all ages and in patients with every conceivable co-existing disease. Every anaesthetic is different because every patient is different. The challenge of our specialty is to provide maximum safety and comfort for patients while optimising operating conditions for the surgeon. Looking at every patient in this way makes anaesthesia interesting and satisfying.

 

Anaesthesia has taken a lead role in Intensive Care and in Pain Medicine. Many consultant anaesthetists have major commitments to these sub-specialties and they are an integral part of training in Anaesthesia. Anaesthesia is a satisfying career for doctors who like performing practical procedures, who get satisfaction from seeing immediate results from their efforts, who enjoy working as part of a team and who want to provide the best possible care for their patients.

 

Training

Training in Anaesthesia is the responsibility of the College of Anaesthetists of Ireland which awards a Certificate of Specialist Training (CST) to those who complete training under its supervision.

The six years of Anaesthesia training is based in accredited hospitals recognised by the College . Training is structured to maximise opportunities for learning and to provide a broad range of experience in different types of hospitals and of different sub-specialties in Anaesthesia.

Training comprises a combination of practical experience, clinical learning, theoretical learning, learning in non-clinical areas, individual study, mandatory elements including simulation courses.. Training will be subject to close supervision and trainees will be subject to assessment and formal examination throughout their training and are expected to record their clinical practice through the CAI Logbook and their academic activities through the CAI PCS recording system. Progression through the six year programme will depend upon achieving certain milestones, and competencies, and these will be reviewed through formal CAI interviews arranged by the Deans office.  Training will not be considered complete until after a formal review has taken place, this will then lead to the granting of a CST. 

The SAT Scheme produces approximately 30 doctors per year who receive a CST. At the end of SAT training the trainee will be competent to take up a consultant post in Anaesthesia. Many recipients of a CST undertake further training in Ireland or more commonly abroad. This is to develop sub-specialty interests and expertise, to experience a different healthcare system or to improve their competitive position when applying for consultant posts.  Further information is available under the training section.

 

Role

The responsibilities of the anaesthetist are:

  • appropriate pre-operative assessment and preparation for surgery
  • safe anaesthesia during surgery
  • care of the patient in the immediate post-operative period

The anaesthetist is an independent practitioner who must take responsibility for all of these areas and who is held responsible for any failures that occur. Obviously there is a large area of interaction with surgeons and nurses and the anaesthetist must be able to work as part of a team. However there are areas in patient management where the anaesthetist has the most expertise and he or she must take the lead role in managing these areas.

 

The concept of the anaesthetist as the ´Perioperative Physician´ has been developed in the last few years. The anaesthetist has undertaken responsibilities in the pre-operative and post-operative care of patients that had previously been undertaken by physicians or surgeons. Reasons for this include insight into the effects of surgery, the benefits of continuity in patient care perioperatively, the economic benefits of having fewer doctors involved in patient care, the expertise anaesthetists have developed through their involvement in ICU and the interest of anaesthetists in expanding the boundaries of the specialty. One of the challenges for the specialty is to improve training in perioperative care and to justify our involvement in this area to other specialties and to hospital management.

 

Anaesthesia is the lead specialty in the development of Intensive Care. The vast majority of consultants with a specific interest in Intensive Care in Ireland were trained in the anaesthesia training programme. Intensive Care is an exciting, demanding and satisfying area in hospital medicine. Anaesthetists manage the sickest patients in the hospital using skill and high-tech equipment. Care of ICU patients is multi-disciplinary and the anaesthetist or intensivist must act as a co-coordinatorand leader of those involved in a patient´s care in ICU in order to give the patient the best chance of a successful outcome. Intensive Care is an area where there have been major academic advances in the recent past and many practices in ICU are very different now compared to ten years ago. This development in knowledge makes ICU an exciting and stimulating place to work.

 

Pain Medicine is a sub-specialty which did not exist twenty-five years ago. The development of this discipline has been led by anaesthetists because of their interest in the relief of pain post-operatively, their knowledge of physiology and anatomy and their expertise in regional anaesthesia. More than twenty consultant anaesthetists now have specific clinical sessions for pain management, mostly devoted to the management of chronic pain. They help a large population of patients with chronic pain or cancer pain for which there was until recently no effective treatment. The huge number of patients referred to Pain Clinics is evidence of the demand for this service and of its efficacy. This specialty makes a huge contribution to the quality of life and functional capability of this population of patients.

 

Many anaesthetists in Ireland and in other countries have undertaken significant roles in hospital and medical administration. Perhaps the training and experience of anaesthesia which emphasises teamwork, the anaesthetist´s experience in running theatre suites and the lack of a vested interest in acquiring hospital resources account for this.

 

Anaesthesia is represented in all medical schools in Ireland, with most of them supporting Professorships and university academic departments of anaesthesia. While providing an introduction to the specialty for medical undergraduates and, more recently, Intern Programmes in Perioperative Medicine, this academic structure provides the means for much of the research activity in Irish Anaesthesia, although many anaesthetists also engage in research independently.

 

Career Prospects

There are approximately 230 trainees in Anaesthesia at present. Thus the ratio of trainees to consultants is one of the lowest of all the specialties. The College of Anaesthetists expects increasing service demands on Anaesthetic departments because of the development of the specialty into areas outside the operating theatre, the development of surgical services and increasing emphasis on the quality of medical care. The contribution of trainees to the overall workload of clinical care is likely to diminish because of decreases in trainee working hours, increased emphasis on training rather than service and a better match of trainee numbers with the national requirement for consultants. The logical conclusion seems to be that there would be a significant increased requirement for trained specialist anaesthetists. However it is uncertain that the Irish economy can currently support this within the present career structures.

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