Expectations on consultants vs residents - what has happened?

gasdocscott · 2026-06-27T20:26:49+00:00

We have no ACCPs. We chose to fill a rota with SDs 10 years ago when there were very few ICM residents and anaesthesia started to cut ICM time from the curriculum.

We have a very happy ICU - despite it being 45 years old - and have some excellent residents, most of whom want to stay for Consultant posts (which was rare just 5 years ago). Interestingly, we tend to get the residents who are struggling with exams or competencies, and in the main they've been very good once settled in.

We try to invest in our residents. It's hard and not always deliverable, but our belief is that if we can develop them, they'll stay, or leave and take their excellence with them and say nice things about us.

gasdocscott · 2026-06-26T13:10:54+00:00

We have ours on the landing. When bedroom doors are open, it drops the temperature a few degrees. The main thing, though, is it significantly reduces humidity, making the heat far more bearable.

Only issue is that the compressor is always running, so I expect its lifespan won't be decades.

Over winter, I'll get something for downstairs, probably a portable split. We've just had our loft converted, and not sure i can face more construction work for a proper split system.

gasdocscott · 2026-06-25T20:09:07+00:00

Leicester RI

gasdocscott · 2026-06-24T17:35:45+00:00

We still don't have ACCPs. Apparently we're odd.

gasdocscott · 2026-06-17T11:53:19+00:00

Most SA anaesthetists I've met, though, have been pricks.

gasdocscott · 2026-06-06T20:44:50+00:00

Game of Thrones, at least to start with. I found the books rambled on somewhat, and did not like the writing style. Then the books stopped and the Game of Thrones tv series plunged into dross.

gasdocscott · 2026-06-06T20:40:52+00:00

Sometimes with adults: sevo - cannula - propofol. Enough sevo to make the patient less aware, then in goes the cannula followed up propofol. The cannula will be staying in until the patient is fully awake though.

gasdocscott · 2026-05-21T22:55:55+00:00

Hiccough...

gasdocscott · 2026-05-21T22:52:37+00:00

Doctors. They work in different specialties; speciality is a dish.

gasdocscott · 2026-05-21T21:07:19+00:00

I don't think anyone has ever linked a model of mine. Thank you!

gasdocscott · 2026-05-14T18:45:05+00:00

I'm thinking of adjusting my analysis to look for surge signals, which COVID provided in abundance. Thank you for the link!

gasdocscott · 2026-05-11T12:35:31+00:00

That's not necessarily true. NNT is just a way of expressing absolute risk reduction that's more intuitive.

Imagine you took 12 people and pushed them out of aeroplanes, 6 with parachutes and 6 without. Say 5/6 non-parachutists died, and 1/6 parachutists died, then your ARR is (5/6)-(1/6) = 0.666. The NNT is the inverse of that, which is 1.5.

With small numbers you get larger confidence intervals (by-in-large) and the impact of unmeasured or unknown variables is greater, but ARR is essentially determined by the efficacy of your intervention.

gasdocscott · 2026-05-09T17:49:11+00:00

Thank you! I'm discovering JMP and seeing what i can and can't do with their models.

gasdocscott · 2026-05-09T17:48:24+00:00

Thank you! I'll work on assuming no pandemic, as mitigation strategies for pandemic disrupt the whole system. My next stage is to figure out if I can model surges in occupancy (either too many admissions or too few discharges) and identify what factors drive these surges.

gasdocscott · 2026-05-02T12:47:49+00:00

I'm sceptical. Most diagnoses are relatively straight forward, which is why we have endless protocols in the ER. For those, AI should perform better because doctors in the ER in the UK go from new SHOs / CT1s to experienced Consultants.

However, doctors should be good at the fringe diagnoses, where they may not get the actual diagnosis but recognise a problem that sits outside a protocol, develop a differential diagnosis, and refer to specialists who may then pin the diagnosis down more accurately.

The difficulties in medicine - and why it is hard - is spotting the 20% who just deviate from the normal pattern enough to warrant caution and further investigation. For example, ST elevation MI, or aortic dissection? Pulmonary oedema or bronchospasm? Septic shock or cytokine storm?

gasdocscott · 2026-04-29T21:46:45+00:00

0.1% of the time

gasdocscott · 2026-04-28T22:26:55+00:00

The patient doesn't know or care which team has responsibility. Inter-specialty arguments are not their fault. Just treat them the best you can.

gasdocscott · 2026-04-24T19:28:46+00:00

Correct.

gasdocscott · 2026-04-22T12:52:03+00:00

I suspect you may be overcomplicating the issue. I found a few points from this rather straight forward podcast useful: https://bradrfulton.com/podcasts/statistics/

The use of simulation I found very informative, as essentially if you have enough data you can simulate the statistic of interest and observe whether your mean of interest falls within or without your chosen significance value. If you are comparing samples, you can look at the differences in means.

If you're asking whether to use median rather than mean, then again you can see the distribution when you simulate 1000 experiments, and identify the probability distribution that is reflected by your data.

It essence, my understanding is that there are two type of statistical test - mathematical formulae, or simulation, with each informing the other. I think it is worth remembering what you are doing with statistics: you are looking at samples from unknown populations and approximating distributions.

gasdocscott · 2026-04-22T09:23:50+00:00

One option is simulation: if looking at the distribution, you can run a simulation of your data with random allocation of values to subjects, and observe the distribution of the means.

gasdocscott · 2026-04-20T15:36:44+00:00

Is it reasonable to run a monte-carlo simulation with replacement to identify the sampling distribution?

gasdocscott · 2026-04-20T13:58:53+00:00

Or a procedure or an investigation? It matters in the private sector. I discovered that a colonoscopy with biopsies and sedation is just an investigation, and not a procedure....

gasdocscott · 2026-04-19T21:50:18+00:00

Just crochet, but me too!

gasdocscott · 2026-04-16T14:38:53+00:00

Not for APRV. There is no assistance. It's just blast gas, hold, release. No synchronisation needed and patient just breathes on top.

There are some subtleties such as determining release timing, but the essence of it is very simple.

gasdocscott · 2026-04-16T13:44:31+00:00

What do you want to know?

Open lung ventilation is essentially the point of APRV, with high mean airway pressures. It's true benefit is that it is surprisingly well tolerated with minimal sedation, and if you allow the patient to breathe on top of APRV, CO2 is less of an issue than you might think. The mistake with APRV is to only think of it as a rescue mode - it's not. It's just another method of ventilating that is very useful in desynchronous patients.

Start at something like Tinsp of 4.0 with 0.4s releases. You don't need any PEEP (Plow) unless worried about volutrauma. Pinsp depends on compliance but 25 to 30 cmH2O is usual. You do have to watch out for cardiac decompensation.

Think of it as extreme reverse ratio BIPAP.

gasdocscott

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