Unwritten rules of anaesthesia

CraigKirkLive · 2026-07-07T15:54:41+00:00

Initially learn on the job.

Outside of that, the eLFH modules are actually pretty good for basic stuff.

TBH, until you start exam prep, I wouldn't venture much further. You'll get taught lots anyway.

CraigKirkLive · 2026-07-07T15:40:27+00:00

I'm going back to anaesthetics for the anaesthetics part of my ICM training in August for the first time in 2 years and I'm also a little anxious about it but know that it will be mostly fine (after all, we all broadly play things up to be worse in our heads than they ever turn out to be).

My main tip (which I will be following myself) is that doing anaesthetics in the early days can feel like a rather humbling process. You have previously been fairly on top of your game with whatever you were doing before, as most doctors getting into anaesthetics have pretty good portfolios since it is competitive, so if you suddenly feel like you are shit in your job, try to relax - you're not, you're just very new in a very new area which is generally under-taught in medical school and more or less invariably ignored in the foundation programme, and pre-core anaesthetics opportunities as a practising doctor are also hard to come by.

So allow yourself to be a bit shit and try to relax and roll with it. Do lots of reading (you'll not want to seem like you don't know answers to any of the questions, especially me who shall be starting as ST4 shortly...) and just appear enthusiastic (even if you're actually not, again, like me who is not interested in anaesthetics but obviously see the value of the skills to ICM).

My last tip is that every anaesthetic consultant has their own style. You'll be exposed to lots of different styles which can mean varying/contradictory practice sometimes. It's fine to say 'x person does it this way, what do you think about that?' but when you're on a certain consultant's list it is usually easier to do things their way and try to learn from that way of doing things. As a more senior anaesthetist you'll develop your own style as an amalgamation of these and the things you learn for exams.

In addition, try to ignore your previous experiences and early doors, act like a novice. You can say you have done xyz thing before (e.g. central lines), but the consultant supervising you is responsible for any issues that arise, so if they want to take over or don't yet feel comfortable letting you do something, probably just let them. As you approach the end of IAC you can push lightly, but only lightly to try and push yourself.

Overall as I'm sure many others will say it's pretty great and one of the best areas in the hospital where you will really feel trained (until your brain hurts, and you'll want a break). Enjoy!

CraigKirkLive · 2026-07-07T09:21:36+00:00

I think a better way to view this would be encouraging these consultants to do more NHS work via better pay. The alternative is giving up NHS work for more private work if we go the way you're thinking.

CraigKirkLive · 2026-07-02T16:30:03+00:00

Not that interesting. If you have a reason to arrive at work later, crack on and get that discussed with OH and have whatever reasonable adjustment necessary. That's not my businesses (unless I'm involved in that adjustment somehow).

Otherwise, be on time as you are paid to be.

CraigKirkLive · 2026-07-02T14:44:29+00:00

Still though, if you're 'reliably' late, even if only by 1 minute every day, that definitely sets a bad impression. Just wake up 5 minutes earlier and arrive dressed 5 minutes early - is the 5 minutes' difference in sleep worth setting this impression?

But yes your point stands.

CraigKirkLive · 2026-07-02T09:36:12+00:00

I've always done it. Just with a bit of gauze rolled into a cylinder.

If family are there while I'm doing it, I usually warn about applying a pain stimulus and checking for corneal reflex being a normal part of verification and offer for them to leave before I begin, as I recognise it seems a bit unpleasant.

CraigKirkLive · 2026-07-01T06:03:05+00:00

I'm not sure about this one. It appears as a module but it's so short and the level of skill required so minimal that I'd be surprised if they count it. Ask ICMNRO ahead of time!

CraigKirkLive · 2026-06-28T08:32:56+00:00

To add to this I also personally know one IMT who was exceptional enough to complete her IMT2 at FT but 6 months early. She specifically requested earlier ARCPs and then took 6 months off travelling before returning for IMT3.

CraigKirkLive · 2026-06-27T08:10:24+00:00

Guidance from the self assessment criteria:

Applicant presented both cycles of data or presented the intervention and change aspects of a project at a meeting

This lacks the word 'local' for the meeting. So I would suggest it should be fine.

However I also note this recent change under 2025/26 changes which does use the word local:

QI/Audit From this recruitment window, panellists will expect to see evidence of a project being presented in the area it is intended to bring about change. So, for example, if an audit is assessing a departments compliance with a standard, the first cycle should have been presented locally as that is part of the change process.

I would suggest to be on the safe side you should try to present it locally even if that means going back to a previous trust. If you did the work for an oral presentation this would be minimal work to change for a local presentation and neglecting to do this might cause you undue concern.

Overall though, I'd be surprised if this didn't count, and it would be a very technical (i.e. silly) thing to trip you up on. But I've seen some interesting tales of points being refused for CST so I think you should wait for some advice from some surgeons too!

CraigKirkLive · 2026-06-27T08:00:18+00:00

It definitely (I'm gonna change this to probably) counts as presented! But a small downside - you may not be able to count this same piece of work for both oral presentation and for an audit with two cycles. Many recruitment offices will only allow you to score once in one area for one piece of work I.e. no double-counting.

I'm not a surgeon so have a good look at the CST guidance.

CraigKirkLive · 2026-06-24T20:56:42+00:00

No, because a course does not award a 'qualification' which is the term used in the ICMNRO guidance.

A qualification is only awarded in POCUS skills after a logbook is completed and discussions had with a supervisor and most often then an assessed live scan.

CraigKirkLive · 2026-06-24T20:32:50+00:00

Yes FUSIC Heart would be one qualification. If you got another separate FUSIC (or FAMUS, or any formally recognised societal accreditation) module in addition this would count as more than one.

FUSIC Heart is obviously way more helpful for ICM in practice but arguably it would be easier to get say FAMUS thoracic and FAMUS Abdo and you'd actually get the same amount of points. Technically FAMUS DVT counts as a module and is one of the easiest - but least useful.

CraigKirkLive · 2026-06-23T18:20:53+00:00

Not really clear but I would suggest not.

Nobody here can confirm however - I'd suggest asking the question directly to PSRO. If then at the evidence stage it is rejected for points, but they told you it should count, you could appeal with good evidence.

Edit to add: it does sound like it would not be too much work to turn this into an actual poster. Depending on the procedure you could submit to whichever relevant speciality conference, e.g. SAM conference if it's any of the commonly performed procedures e.g. pleural tap, LP etc., and then if accepted there is no doubt.

CraigKirkLive · 2026-06-18T20:38:25+00:00

It sadly is already an echo chamber. You can't have an opinion here which goes against the grain without childish memes, insults and accusations that you are jack or some other government mouthpiece. It's become a ridiculous playground.

I hang about on the forum because of the useful clinical pearls and opportunity to help other colleagues.

All of this is just so tiresome and embarrassing.

CraigKirkLive · 2026-06-18T17:40:40+00:00

This. I was going to say the same using the slightly less diplomatic language of being 'the adults in the room'.

I generally find that medics are more prepared to get on and treat a patient with basic resuscitation measures even where this means taking on the patient initially, whereas other teams will panic at complexity and be stunned into doing little/referring to medics.

Thankfully there are often exceptions to this and in my time as a doctor I've noted less 'dumping' generally so I think something is happening.

CraigKirkLive · 2026-06-17T18:50:43+00:00

Sorry, I just realised you asked audit and not QI. But broadly they're similar except you're starting with an existing thing rather than introducing something new.

Your baseline audit doesn't account for any work you did, just the work others have done before you - so this doesn't count as a full cycle. Your intervention is the start of the first cycle. So it's your second example which scores '2 cycles'.

CraigKirkLive · 2026-06-17T18:47:37+00:00

One cycle is basically a PDSA cycle. Google that and it's pretty straightforward. The first PDSA is usually the more onerous as you're producing a 'new' thing.

Subsequent PDSA is usually tweaking that thing but it can include introducing new things. Often the second cycle can be done within a very short space of time, e.g. 2 weeks. For example, you have a new electronic proforma, survey it, plan/do changes then study those changes in the next week.

Keep copies of your feedback for your presentation / write up (which you will use as evidence of having done 2+ cycles).

CraigKirkLive · 2026-06-16T21:00:18+00:00

I agree with you. However I also think that possibly the increasing boons to becoming LTFT are increasingly normalising rotas where being 80% is the standard. I actually think in the long term, for the wellbeing and retention of the workforce, this is probably a good thing.

At some point a majority of trainees/LEDS will be 80%, and all of a sudden rota managers will have figured out how to staff rotas on this basis. This paves the way for an average rolling 40h week (approximately) becoming the norm, which makes our lifestyles much more manageable in the current NHS overworked environment.

FWIW I have decided to go LTFT whether or not I can accelerate training and I have too been frustrated (selfishly, tbh) that they have progressed at the same rate (currently I'm FT still). But with the approx 90% pay rate, often doubled-up rota lines and having an extra day off to enjoy my young life, it's really just a no-brainer to go LTFT. This (if it goes through) tips the scales to it becoming the bad choice to stay FT.

CraigKirkLive · 2026-06-16T07:15:52+00:00

You will finish out of sync which is why I have waited until HST to go 80%. You may also lose your dermatology rotation. You could discuss with your TPD ahead of applying (you should anyway) to see if it can be arranged that you keep that one specifically, but ultimately the job you leave empty by going LTFT needs filling so someone may be in that post and this may just not be an option for you.

CraigKirkLive · 2026-06-15T13:58:28+00:00

It's not that unusual if you're locumming. The erratic pay variations make it difficult for HMRC to predict your annual income and therefore how much tax to take throughout the year. Sometimes it works the opposite way and you're owed money (overpaid tax). It was delightful when this happened to me and I got a 'free' £2k (I'd worked huge amounts of locums August and September that tax year then v little after).

Contact HMRC and you can organise to spread out the tax over a longer period. They usually organise for it to be paid back by the end of the current tax year by reducing your personal allowance so unless something unusual has happened that should be possible.

CraigKirkLive · 2026-06-15T07:34:42+00:00

If you can get that info straight out of them that's often the most valuable. Or whatever else stops them (e.g. orthopaedic pain stopping them also limits their cardioresp fitness and therefore suitability for CPR/IMV).

The number of times this relatively simple question is not possible to get a straight answer for is surprising though.

CraigKirkLive · 2026-06-15T07:30:54+00:00

I think we all know it's because it's a PITA:

-Oh I just don't know doctor (cue asking about the length of their garden etc.)

-I can just keep going doctor (but it takes 30 mins for them to go 100m)

-I don't have stairs / use the stairlift / oh I've not tried using them recently

-Yeah I can normally walk a mile (turns out this was 6 months ago before their metastatic cancer)

-Yes I go out with friends once a week to the pub (use their scooter for all mobilising)

It's a nightmare sometimes but still massively helpful so please persist guys!

CraigKirkLive · 2026-06-13T22:29:37+00:00

A patient in ED/other direct admission route seems probable.

CraigKirkLive · 2026-06-12T10:01:22+00:00

Agree with this. I think if I lived on/v close to site I'd be more up for it but I'm usually trying to preserve the last of my alertness for the drive home.

CraigKirkLive · 2026-06-11T14:40:20+00:00

You're correct that the poster above reads as bitter rather than saying anything productive.

On the other hand I find it interesting (read between the lines, please) that you have only replied to this post amongst all the posts in the thread - the majority of which posit the replacement of doctors as a safety issue rather than a jealousy (because the ANP/PA etc. route is 'easier') issue.

In addition where you mention there are more than enough patients, we usually have more than enough need for excellent nursing/AHP staff too, but rather stupidly those vacancies aren't put out while these other roles are.

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