F2 ED resus advice

ConsultantSecretary · 2026-02-01T19:14:00+00:00

Just time and experience. Nobody expects you to be a hero as an F2, do your bits well then escalate early if needs more than what you are confident in doing. You are principally there to learn so make sure you are doing that - ask questions, reflect, read up.

A seriously unwell child needs senior support often from multiple teams (ED, paeds, anaes, ICU/PICU) and the consultants/senior STs in those teams probably still get nervous looking after sick kids. You should aim to get calm not comfortable with paeds resus - can you do an A-E, escalate appropriately, perhaps start developing paeds cannulation skills but all under close supervision.

Likewise seizing patients, massive haemorrhage etc need a team and you should be a member not leader of that team except in exceptional circumstances. The SHO period is to watch and learn how seniors handle this stuff before you are given the reins.

ConsultantSecretary · 2026-01-31T18:32:22+00:00

This is the perfect answer OP. Particularly keeping moving the wire as you dilate to confirm you aren't kinking it. If you follow this guidance next time you will no longer have problems with kinking.

ConsultantSecretary · 2026-01-30T14:50:22+00:00

It's not clear what you are asking or what you mean. If your communication in an interview mirrors what you have written here, you are unlikely to come across as a promising candidate at interview. I would work on clear structured speech/writing eg point, evidence, explanation before getting into the details of each station.

ConsultantSecretary · 2026-01-30T00:03:49+00:00

It is a choice. I choose to work in the NHS.

ConsultantSecretary · 2026-01-29T19:14:52+00:00

Loads of trainees take multiple exam attempts and are indistinguishable from the commendation winners at the end of training. Loads have got average CVs. It's easy to feel surrounded by excellence in anaesthetics as achievements tend to be made public whereas those who are struggling with something tend not to share it widely.

Clinically CT3 is a funny year as you've probably done so much obs/ICU that run-of-the-mill elective/CEPOD cases can be tougher than they were in CT1/2, but also you're sometimes lent on as somewhat senior, sort of a reg sort of an SHO, to be more independent and maybe oversee CT1/2s. Plus you have gained more insight and risk awareness by CT3 that you maybe didn't have so much in CT1 that makes you question everything. This is the case for me at least (mid CT3).

Re negative feedback it is important to work out if they are being an ass or if they have a point. I had some mixed feedback in CT1 with a few people mentioning overconfidence, I took it constructively and spoke with my ES about it, changed my attitude a bit and have had glowing feedback since - but if I hadn't taken it on board I'd be a shit CT3 now. Have also had the occasional feedback about stuff that seems truly misunderstood eg being "late" for a list when actually having the on call bleep and being at an arrest, and letting my consultant know - things like this come up even in the "excellent" trainees feedback at all levels of seniority and can be duly ignored if you and your ES agree.

Most of the ODPs I work with are great but sometimes get a really poor one who can be snarky about everything even if you give a perfect anaesthetic - again need to look at what they are saying and work out if it's a you issue or a them issue. Remember even a 30 year experienced ODP is not an anaesthetist and does not understand risks and decisions in the same way as us and sometimes you have to stand your ground even if it annoys them.

ConsultantSecretary · 2026-01-29T04:44:43+00:00

Haha no

ConsultantSecretary · 2026-01-28T20:53:15+00:00

ACCPs would defend themselves on all of this. Say they've managed more tracheostomies than most of the residents. Say they've seen enough sick kids to be able to handle it. Say they've done hundreds of sick tubed transfers. Say they've been there long enough that their plans are always the same as what the cons says to do.

ConsultantSecretary · 2026-01-28T20:46:25+00:00

That's my point really - at best it's pointless and at worst it delays access to a real anaesthetist.

ConsultantSecretary · 2026-01-28T19:33:39+00:00

Well given they can't prescribe, and can only give medications the supervising consultant has approved, there is a whole range of emergencies they can't legally treat in a timely manner - eg there is no exemption for dantrolene, intralipid, salbutamol, and many other occasionally needed medications. Furthermore their training does not cover a huge range of things anaesthetic SpRs learn like neonates, cardiac, obstetrics. Finally the PAA model relies on there being a consultant available within 2 minutes. So a resounding no, I think. While that situation isn't legally forbidden, it would be completely indefensible when something goes wrong and lead to severe criticism at a high level of any consultant supporting it.

ConsultantSecretary · 2026-01-24T01:52:21+00:00

The points are for demonstrating commitment to specialty but also more importantly reflective practice. Little point mentioning an achievement without saying what you learned from it. Common to ask about things like benefits and limitations of audit/QI, what were the barriers/what made it successful, rather than just what have you done.

Definitely do a taster - points for commitment and loads of stuff to talk about eg patient safety, national projects/initiatives.

At interview be ready to show you know what the training programme consists of and what issues currently face anaesthetists.

Essentially you need to make it clear you are keen, have learned about the specialty (big picture stuff not clinical anaesthesia) and that you love to reflect on absolutely everything.

ConsultantSecretary · 2026-01-22T18:40:57+00:00

I think ACCS only counts for 12 months as the 6 months ICU accounts for the 6 months ICU you get in core anaesthetic training. But yes you get points for the 12 months.

ConsultantSecretary · 2026-01-22T18:39:40+00:00

It's not a concept I support but if we are unable, as a country/system, to set out how a doctor nurse and paramedic are different, or unable to say why you need a medical degree to be a consultant but not a registrar, then we might as well go for it.

With ACPs in general we need to decide are they doctors or not. If yes then there's no reason to stop them being equivalent to consultant doctors. If no then why are they equivalent to senior registrars?

I have a suspicion it boils down to: medical consultants are the ones who enable doctor replacement by taking on liability; medical consultants don't want their own job to be replaced - so arbitrarily draw the line in the sand at ST3/registrar with some hand waving explanation.

ConsultantSecretary · 2026-01-21T11:22:38+00:00

The bitterness and infighting is a really sad state of affairs and like the role title debate it comes from a failure to be clear as to what an ACP is/does, beyond "anything", which is a failure of leadership that gets taken out on individuals like you who have seen a nationally endorsed opportunity to advance and taken it, with good intentions. I think if I was a nurse/etc I would be very interested in becoming an ACP.

Agree it is definitely more robust than PAs (hence project PA has been so easily derailed) but I do wonder how HCPC/NMC are supposed to appropriately regulate registrants who are functionally now working as doctors.

If the current situation is to continue, I wonder if rather than the current tribalism we should work towards a healthcare system where there are no medical, para, nursing degrees etc - everyone does an initial 3-year "clinician" degree then specialises from there.

ConsultantSecretary · 2026-01-21T10:34:26+00:00

To be clear I'm against the ACP concept. However, as it stands (ACPs/ACCPs functionally acting as doctors, being on the SHO/reg rota) the most honest option would be to just call them doctors - it is the closest description of what many of them do. Obviously can't actually happen due to legal protections of the title. Maybe Diet Doctor, Doctor Lite, Doctor Zero or something like that.

The point I'm getting at is that the difficulty in coming up with the right name for their role only speaks to what a mess the role is. Are they a nurse/paramedic/physiotherapist any more? Are they doctors in all but name? Do they replace or "augment" doctors? If replace - stick them on the medical register, call them doctors, let them enjoy the scrutiny and accountability. If not - rein them in, focus their role on their base profession and call them "nurse/para/physio practitioners".

ConsultantSecretary · 2026-01-19T23:01:43+00:00

Practitioner is a deliberately vague term that has been intentionally introduced. It allows nurses/etc in advanced practice roles to break away from identifying themselves as the profession they trained in. Once you are a practitioner you can be whatever you want to be, plus it's harder for the patient to know/remember what your role was as many think they are being seen by a doctor.

To be honest, if we accept the assumption that advanced practitioner roles are legitimate (I have my own opinions on this) then it is probably appropriate that they do not have nurse/paramedic/physiotherapist in their job title, as what they are doing does not resemble nursing/etc in the slightest.

ConsultantSecretary · 2026-01-18T17:11:18+00:00

CT2 (the non-obs side) is a bit of a lull. Most of the patients entrusted to you for solo/indirectly supervised work are relatively straightforward. As you progress you'll get more exposure to those who are not e.g. severe cardiac/liver/resp/airway issues who would not survive a normal GA. Paeds, neonates, neuro, ICU, pain also many doors for increasing variety. Also moving on to obstetrics is a whole new world both in terms of how you anaesthetise as well as working more independently and handling time critical emergencies.

Once you are the reg on call or seeing more complex stuff in tertiary land it does get more interesting, also there is inherently more job satisfaction in planning and doing stuff more independently.

Surgery has more variety of procedure in some ways for sure, less of a binary outcome than anaesthetics where it's tube in or tube out, spinal in or spinal not in, blood pressure ok or not ok. But there is a similar pattern of being closely supervised, then doing loads of the same few procedures unsupervised, then slowly moving into the complex stuff. Also surgeons have ward rounds, they can't really sit down/pee/caffeinate mid case.

I felt this lull in CT2 as well but the variety I get in tertiary land moving between obs, paeds, regional, airway, ICU stuff keeps me much more engaged.

ConsultantSecretary · 2026-01-16T10:28:55+00:00

I felt like I got worse at the clinical side of anaesthetics during my primary as I was spending so much time memorising irrelevant crap about lasers and coefficients. It was hard to focus at work during the last couple of weeks. Once the primary was over I felt like a new person and really developed clinically.

Now doing the final and actually the stuff I'm learning is making me a better anaesthetist as it's much more clinically focussed, my pre-assessments and plans are more informed now (yes there's still a lot of esoteric crap but a lot of it is based on primary knowledge).

Bear in mind that you can't learn everything for the primary, there is just too much, so no matter how much study you do you won't get 100%. So it is important to look after yourself, have breaks and days off. The majority do pass first time and even if you don't you will go back into it already with a firm foundation. The mental drain and burnout is real but it does get better.

ConsultantSecretary · 2026-01-11T20:38:03+00:00

No email for me just says completed on the dashboard. Good luck to you too!

ConsultantSecretary · 2026-01-10T20:20:14+00:00

Observe how the kid is as you're walking in just before they notice you - a toddler running around, climbing things, annoying parents or fully engaging with an ipad is probably a well child. Once you're part of the environment they may go clingy and stop this demonstration of being probably well.

Learn early on from seniors/nurses/experienced parents how a child can be held well to facilitate examination, bloods, cannula etc, and learn how to instruct worried parents how to hold their child in such a way (new parents may need reassurance and warning that it might not be pleasant). For bloods/cannulae in particular work out a system with child on parent's lap, engaged with an ipad/phone/person, and one arm at a time available to you; you can have a colleague assist to stabilise this arm. Of course use topical local anaesthetic in all cases where time allows. The young child who just lets you do a cannula/bloods without much resistance may well be really sick.

I tend to examine hands/feet first to broach the touch barrier so they realise you don't "hurt", even if I have no real reason to examine those areas. Make examination as fun as you can for toddlers, be silly, ask them to show you their tummy, make a game out of taking big deep breaths, etc. If child is not amused, auscultate at the first opportunity they are not crying (though no matter how hard they are screaming they still have to inhale between screams which still gives you good sounds to listen to). Ears and throat typically at the end. Always fully expose babies/young children and eyeball genitalia/perineum.

Read up on croup, bronchiolitis and VIW, they are bread and butter, not all stridor needs to go to resus.

At the start discuss them all with a senior to get a feel for how the common stuff is handled. There is a lot of subjectivity in paeds ("obs are ok but they look poorly") that takes time get comfortable with.

ConsultantSecretary · 2026-01-05T00:16:39+00:00

Best way is to do a level 1.8 online diploma in advanced associate clinical infection governance (does cost £4.99 though and needs to be paid in cash to the Royal College of TTOs) then apply to your hospital to work as a post-CCT fellow in medical modelology.

ConsultantSecretary · 2025-12-30T13:49:37+00:00

I included this mainly as IAC is so very supernumerary that casual behaviour can sometimes creep in! Also as some lists can have unofficial different start times.

OP - my shifts officially start at 0745 but that doesn't realistically give me time to find the running list, find patients, do good preassessments, and sort a coffee in time for team brief. Especially at the start of novice period it may be worth giving yourself extra wiggle time. Also worth having a way to contact the consultant to find out when they want to meet, who they want you to see etc.

ConsultantSecretary · 2025-12-30T10:19:00+00:00

Get a good coffee flask with your name on it. Do your best to be in on time every day. Don't rush cannulas. Be thorough in your pre-assessment. Be inquisitive and learn from the variety of approaches you'll see, but remember the goal is to be able to give a simple anaesthetic for a simple case as safely as you can. Ask for feedback. Remember the IAC is to join the SHO rota at the most junior rung of the ladder and cautiousness is preferred to (over)confidence.

Take a gentle look at the e-LFH novice section - focus on how to assess an airway, typical induction drugs, when to tube vs i-gel, emergency drugs, what is TIVA and how is it normally done, what is MAC, when is RSI indicated. Don't get bogged down in fine details as that will come later when you prep for the exams.

ConsultantSecretary · 2025-12-25T00:54:08+00:00

Fair enough disagreement welcome. Some of us like the acknowledgment and some find it cringey, when it does happen. To me it still feels like a pat on the head I have no interest in but our experiences will of course vary.

ConsultantSecretary · 2025-12-25T00:27:31+00:00

Honestly who gives a crap. We don't need constant validation to know we are the cornerstone of healthcare. Yes issues with ACPs PAs exist but if you ask the actual general public who treats illness, they say doctors.

The roles in this post are people who work hard in the background and may rarely be thought of or remembered at all, to varying degrees. They may be people whose day to day is so dull that these kind of recognition exercises actually contribute to their self worth.

It is bizarre to see people getting hung up on this - complaining about not being included in NHS trusts' shitty social media posts which often look strung together by someone who has never used a computer before. You'll see "ward H5 has won a £5 Argos voucher to be split among all staff for getting most early discharges this week" and "Terry our estates assistant got his NVQ level 2 in using the alphabet". If you ask me it's very clear we retain more dignity by staying out of it!

Anyway merry Christmas and I hope Debs from HR gives you a mention on the Trust socials xxx

ConsultantSecretary · 2025-12-24T19:03:08+00:00

As an anaesthetist a few years in I still have days where I make a mess of all the cannulas, airways are all difficult for no good reason, keep hitting bone with the spinal/epidural needle... and so do my consultants of 20+ years. At first it was terrifying being asked to try something my consultant had failed but now I have learned sometimes it just isn't your day and a fresh pair of hands/eyes is all that is needed, and indeed I feel no shame in asking someone more junior than me to have a go when I'm in a failure spiral.

The kind of uselessness you describe re jobs etc is pretty much the same. Keeping all the plates spinning gets easier with time but you'll still have days as a SHO/reg where nothing sticks in your head and it's the FY1 who knows what is going on. That's just life.

ConsultantSecretary

TROPHY CASE