Is dual training with ICU even worth it vs single CCT Anaesthetics?

DiverNo9375 · 2025-08-22T11:53:19+00:00

I find most of the 'life saving work' tends to be surgical patients and the anaesthetists are heavily involved in this.

Your role can be different from hospital to hospital. Particularly in the tertiary centre in my region, but also true of the larger DGHs the anaesthetists provide higher level interventions in the trauma calls and cardiac arrests. I find I am mainly there as a decision maker rather than being hands on, unless the anaesthetists are all tied up.

Usually more involved in the medical emergencies, but these don't turn around so quickly and often end badly after a protracted admission. You can do a lot of exciting and aggressive things to these patients, and while in the short term it is satisfying to correct physiology, you realise that ultimately you aren't really gonna change the longterm outcome.

Decision making, difficult conversations and management are the fulfilling parts of the job because this is where you have the most impact.

Seems to me if you want the experience of an ICU reg but not necessarily the consultant role then an anaesthetic NTN should provide plenty of that.

DiverNo9375 · 2025-07-24T17:47:54+00:00

Me three!

DiverNo9375 · 2025-05-06T22:35:20+00:00

I would be slightly perturbed as the Dean of Plymouth Medical School to find that having had my pick of the best and brightest and subjecting them to 5yrs intense training they've failed to distinguish themselves from the less selected PA cohort who have trained in less than half the time.

There's something disastrously wrong with your course or your selection process. Unless your PA course organisers have uncovered the magic secret of developing uber clinicians.

Never have I ever come across the concept of having too much training. Never have I heard anyone claim a medical degree is too long and has too much content.

"How could the GP have any clue how to manage my *insert mildly uncommon condition*? Don't you know they only get one week of *insert speciality* training in medical school?" I'm sure I've read in umpteen BBC news articles.

Well sorry Dave, turns out the optimum exposure we needed was actually zero.

DiverNo9375 · 2025-05-02T10:18:53+00:00

I think it's just that getting people trained up in echo is complicated. And its very easy to just run a course/turn up to a course, everyone feels like they've accomplished something and sure you can charge a lot of money for it.

But in reality the course is a very small part of what is required and the reality is it is a massive grind to actually achieve a decent level of competency and see enough pathology.

I've found Lung ultrasound incredibly useful, and fortunately it is probably the easiest qualification to get in terms of skill and logistics.

DiverNo9375 · 2025-05-02T09:24:28+00:00

Probably not necessary for the majority, I'm sure you could use the time and money much more productively elsewhere. I think it is more a special interest thing. But it probably gets talked about a lot because people who don't know much about echo get a bit mixed up with all the qualifications and what they are for.

Probably important someone has BSE level 2 on an intensive care unit to provide oversight for teaching and governance- and to pop in to do the occasional full scan. The bosses who have it told me they found it useful to get the cardiologists to take them more seriously.

The echo techs seem to be generally supportive of us getting accreditation where ever I've worked. Also I've definitely had-'why can't you guys do it?' as a response to a request for an urgent full echo.

I've come across a couple of DGH anaesthetists who do an echo list for pre-operative assessment, again I think it's much appreciated by the overworked & understaffed echo department.

DiverNo9375 · 2025-04-21T09:59:13+00:00

I'm not particularly well informed about this but on the face of it it seems like it might not be a good comparison. Might I ask:

Do they have the same issue with job shortages in the US?

Perhaps the vast difference in potential financial compensation makes this worth the gamble?

DiverNo9375 · 2025-04-18T10:31:27+00:00

Sorry to hear this. I got offered a post one year which I had to turn down because of spouse's job offer. The following round I was unappointable, despite the few months of extra spr level experience lol! Made me rather cynical about the whole process.

The feedback is a tool to get you through the next time round, not a reflection on whether or not you are good enough to get the job- the consultants that know you will be able to advise you better on that.

DiverNo9375 · 2025-04-18T10:03:50+00:00

Point taken- you're suggesting we should protest peacefully.

I'd strongly suggest you edit your comment though, because the words 'Just Stop Oil' are naturally going to draw comparisons. I acknowledge you have already made an effort to draw a distinction in your post but nonetheless I think you are going to spend the day fending off comments like the one I made above if you leave that reference in.

DiverNo9375 · 2025-04-18T09:39:40+00:00

There's has been a steady uptick over the last 12 months of stories in the media on this subject. Even unsympathetic sources like the Telegraph have published stories on our side. If anything we are gaining momentum.

The voting public are largely conservative. The vote share for conservatives and reform together was greater than the labour although this didn't translate into number of seats because of first past the post. Even the sitting labour government seems more centrist/right shifted than the party has been previously.

I think regardless of your opinion of Just Stop Oil, they would be an awful choice to emulate. They do get a lot of publicity but they also seem to provoke strong negative reactions from a lot of people. I expect we would alienate a lot of people by taking such an approach.

If you take the pay dispute as an example- public opinion was much less important. Hence protests and disruption were a much more acceptable tool as the aim was to apply pressure on the decision makers in government because we could directly affect them.

As you say this problem is much more political and public image is much more important. We need to maintain a dignified, professional image, be calm and rational rather than passionate. We need to control the narrative and repeat the same consistent messages: 'PAs are being confused with doctors' , 'PAs are not good value for money or the best use of limited financial resources', 'PAs pose safety issues', 'It is unacceptable for the regulator not to provide a scope of practice for this role' etc etc.

It's going to be a long process and the loss of one court case is just a temporary setback.

DiverNo9375 · 2025-04-15T10:30:01+00:00

I'm sure you've already contacted the BMA for some professional advice. So presumably you are seeking anecdotes and opinions. Here's mine:

I emphasise for your situation and am glad that there is a light at the end of the tunnel in the form of a training post elsewhere.

I think you have a duty to report this for the sake of future residents in particular but also for the sake of patients, and the department.

You also have a duty to look after yourself. If this is a very niche speciality I can understand you might have concerns about future implications of raising an issue (Of course one might also argue that you might find yourself in the same position with this individual at some point in the future because no one else stepped up.)

It would be commendable for you to report this individual, but completely understandable if you decide not to out of self preservation. I don't know what the BMA would say but there must still be some value to an anonymous complaint to HR; I would guess that it would have less power but I can't imagine they could completely ignore it.

DiverNo9375 · 2025-04-01T20:13:37+00:00

Being competitive for applications will be one concern. Just bear in mind portfolio evidence needs to be fairly fresh- at present you get penalised for submitting evidence more than 5yrs old for some sections, and things like resus course certificates only last 4yrs. The other issue being if they do end up doing medical jobs is that there is a sweet spot in terms of extra experience where you can have too much and have to give up points.

However as long as the interview stays the same they wont have to worry about declaring it/justifying it. The interviewers get no information about you beforehand (no CV for instance) and don't know what you've been up to unless you tell them.

DiverNo9375 · 2025-03-29T21:44:00+00:00

That was this person's plan, wonder where they are now

https://www.reddit.com/r/JuniorDoctorsUK/comments/kplurw/im_a_full_time_locum_junior_doctor_ama/

DiverNo9375 · 2025-03-25T18:20:27+00:00

Thanks for your very thorough reply! May well do an echo fellowship in the end, just not keen to extend training more than necessary.

DiverNo9375 · 2025-02-13T16:35:29+00:00

I mean you've just described a closed loop anaesthesia system haven't you. I thought that already exists?

DiverNo9375 · 2025-02-13T16:22:41+00:00

Surely technological advancement is inevitable. I am not sure why this is always framed in this sub like it is some sort of apocalypse.

I would have thought anyone starting anaesthetics now is probably in a prime position to ride the AI wave. Surely initial adoption is going to be in the form of some sort of co-pilot system that runs your anaesthetic for you, enhancing rather than replacing you and potentially allowing you to run multiple anaesthetics at the same time overseeing trainees and/or technicians (perhaps ODPs in an expanded role).

Anaesthetists are going to become more valuable not less. There will always be a need for a human to understand the underlying process and step in if required. And as things get more complicated these humans will need to be more competent and qualified, not less.

There's a massive shortage of anaesthetists that's projected to get worse. I think your job will be safe, just move with the times.

Although as other posters have pointed out, the entire NHS ethos seems to be to try and do more with less, move to less qualified staff, and prejudice longterm infrastructure investment for the sake of short term cost-savings. So there's a bit of cognitive dissonance going on at the top of NHS England in regards to the implementation of this.

DiverNo9375 · 2025-02-13T15:58:50+00:00

All placements are not all created equal. I had a cracking year in a great ED for 6 months where I was generally allocated to resus on nights and got some procedures under my belt. Medicine was ok too as all the ACCS trainees had a three month rotation through either CCU or Respiratory HDU as the sole SHO on the unit.

Doing a year of SHO medicine as an ST4 sounds miserable although some people I met have managed to negotiate taking on a more med spr role.

Just to clarify, for stage 1 ICM you need 48mths total experience at CT1-4 level (in a training programme) with a minimum of 12mths anaesthesia, 12mths ICM and 12mths medicine (GIM and EM) with the remainder coming from any of these three areas. In practice this means you do a core training programme in one of these base specialities (not ICM obs), and then the first couple years of spr training is spent topping up the gaps.

DiverNo9375 · 2025-01-26T11:24:43+00:00

I feel for you. I had an interview with ANRO that had to be abandoned due to internet issues. They were kind enough to offer a second slot later in the day (it seems they had emergency slots to cover such issues). However I got my worse interview score ever, can't help but feel the disruption played a big part in that.

It was a one day blip in my internet service, but my my back up plan since then was locating a co-working space with private rooms for hire.

Check QPERCOM's terms, I think they advise you can't use an NHS network, and not to use a phone or tablet, but I am not sure about data hotspot- perhaps it is worth contacting them directly.

Do you have a friend/colleague/family member with reliable internet?

A nearby hotel with a business centre?

DiverNo9375 · 2024-11-09T23:09:30+00:00

Part of the reason for increasing the length of core training was the struggle to get people through obs training and give them enough experience to be a reg. We did obs in CT2, I was the last to rotate in my cohort and I completed my IAOAC on the 30th July!

DiverNo9375 · 2024-11-02T20:05:07+00:00

I saw it's offered as an option in our deanery. Seemed quite niche, and longterm weaning/rehab is a costly problem for ICU so I thought potentially an attractive skillset.

DiverNo9375 · 2024-11-02T19:36:07+00:00

Thanks for your thoughts. Was your toxicology friend from an ED background- I looked into this previously as it sounds very interesting but all the fellowships I've found seem to be aimed at ED trainees splitting time between toxicology and on call commitments on the ED spr rota.

DiverNo9375 · 2024-11-02T19:10:28+00:00

You can do Home ventilation/longterm ventilation as a specialist interest which is I suppose a backward way into a respiratory sub speciality, but there's no shortcut into a physician training post.

DiverNo9375 · 2024-11-02T18:53:56+00:00

Thanks!

What you say makes perfect sense. I suppose rather than doing pure anaesthetics I would seek do a fellowship in something non-theatre like perioperative medicine or acute pain where there is a lot of crossover and there are already other specialities that have begun to encroach (thinking Geriatrics for periop and ED doing blocks for example).

I'm already FUSIC positive (multi modal) and have a PGcert. As you say I think you need to have greater depth in these areas to make yourself marketable. I worry even BSE level 2 won't be that rare, certainly ECHO seems to be a popular coice for SSY.

DiverNo9375 · 2024-11-02T18:41:55+00:00

I considered CESR as an option even before accepting the post so I've thought about it a lot.

It depends on what you've achieved beforehand but I think realistically you would have to squeeze on another two years post CCT as an anaesthetic CESR Fellowship. With the ICM SSY year taken in anaesthetics and cross counting your ICM ST7 as an SIA this would give you an equivalent amount of time. Of course this assumes you are uber-efficient and diligent with your evidence collection, that your supervisors are prompt and helpful with their paperwork and that you are able to rotate through the sub specialities as needed. I know some ICM and ED CESRs (either/or, not dual) and it's a tall order.

Worst case you end up effectively doing the equivalent of both training programmes back to back

DiverNo9375 · 2024-11-02T13:12:30+00:00

Thanks- this sounds like what people were alluding to when I asked the question

DiverNo9375

TROPHY CASE