AnaesthetistThe e-newsletter for international members of the Royal College of Anaesthetists

The International

Welcome to the November 2021 edition of The International Anaesthetist. I open this publication congratulating Dr Fiona Donald as our new president, and thanking Professor Ravi Mahajan, our former president, for leaving a lasting legacy.

With most COVID-19 restrictions lifted, it feels like the UK has returned to what looks pretty much like pre-pandemic life. The College has put in place robust COVID-19 safety measures, which have allowed us to open the building to staff members. I was privileged enough to attend our annual diplomates ceremony in person in central London on 10 September. The College has started to deliver some of its events face to face, providing the much-needed networking opportunity afforded by in-person events. The events team are doing a fantastic job in delivering a wide range of events, both in the College’s building and online. I invite you to book your event here.

Had it not been for the successful rollout of the COVID-19 vaccines, the UK would be in a much more difficult situation, as the pandemic is certainly not over and the future remains uncertain. I am aware that the picture that I am describing from this part of the world may be very different from the current situation in your country. Sadly, access to vaccines differs significantly between lower and higher income countries. The College is committed to advocate for vaccine equity across the world. We have co-signed a letter to the UK government highlighting this need. It is an important issue for our partners in Zambia with whom we recorded an insightful podcast on 8 September entitled ‘Global Perspectives: The COVID-19 response in Zambia’.

Some of you may be pleased to know that we have launched a Global Fellowship Scheme (GFS) for doctors from high-income countries to undertake subspecialty training in the UK. Eligible candidates will have their GMC registration sponsored by the College. Further information on the GFS is available here. Please spread the word!

The 2021 BMA Information Fund is now open for applications. The fund works

2 A day in the life of... A cardiac anaesthesiologist in Canada

3 Transition from a paper-based to a paperless system

4 The impact of unilateral versus bilateral hip and knee arthroplasty on haematological parameters in the perioperative period: a retrospective cohort study

6 The lucky country?

7 An unlikely ally

8 Global Anaesthesia Development Partnerships (GADP) and the Zambian Anaesthetic Development Programme (ZADP): adapting to a global pandemic with remote fellows

9 Partner’s update The International Relations Committee: grants

and bursaries

10 World Congress of Anaesthesiologists 2021: roundup

11 Implementing a new anaesthesia curriculum

November 2021

in partnership with Health Books International to provide resources that are tailored to the specific education and training needs of health workers operating in low-resource settings. Materials available include books, online resources, practical guides and tools, DVDs and CDs.

I am delighted to inform you that our international family has grown and we have now 101 international affiliates. Please keep promoting this membership category among your colleagues.

We are a diverse specialty and College. Our CEO, Jono Brüün, has reflected in an article published in the September Bulletin on the importance of equality, diversity and inclusion, and the work the College is undertaking on these

issues. Last month we celebrated Black History Month under the stewardship of our very dynamic Black Lives Matter group. Let us know how you have celebrated such an important month. The Europeans citizens staff group at the College marked the European Day of Languages 2021 on 26 September by recording a video of themselves speaking in their mother tongues. We would love to hear from you too, speaking in your mother tongue so please, record your own video and share it with us across social media. I look forward to watching your videos.

The College has started developing its new five-year strategy, and equality and diversity, together with sustainability, will be key pillars. The College trustees made a commitment to disinvest from

fossil fuel providers. The College has now fulfilled this commitment. More information can be found here.

In this issue you will read updates from our colleagues in Canada, Australia, New Zealand, Singapore and Sri Lanka. From the UK, there is an update from a ZAPD remote fellow and our partners in the IRC. The WFSA reflects on the World Congress of Anaesthesiologists, which was held online for the first time ever. Finally, from the College, you will read top tips on implementing a new anaesthesia curriculum. Enjoy the reading and keep the articles coming! (global@rcoa.ac.uk).

Professor Ellen O’Sullivan, Chair of the Global Partnerships Committee and RCoA Council Member

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Join us online for our annual two-day symposium and enjoy a lively mix of lectures, debates and interactive sessions.Programme includes:

■ the gender pay gap – Professor Dame Jane Dacre ■ Macintosh Professor Lecture – Dr Brendan McGrath ■ metabolic disorders in children – Dr Russell Perkins ■ winning abstract quick fire session ■ whats new in… Pain, Airway, Obstetrics, Regional Anaesthesia, Intensive Care Medicine

and many more.

The International Anaesthetist | Issue 16 | November 2021

St Boniface Hospital is a 550-bed tertiary care hospital located in Winnipeg, Manitoba, in the centre of Canada, and is affiliated with the University of Manitoba Max Rady College of Medicine. It was established by the Grey Nuns in 1871, being one of the first hospitals in Western Canada.

Our hospital runs a daily total of 14 main operating room slates and five satellite slates. Of these, three cardiac slates are booked daily. Cardiac surgical volume consists of more complicated patients and combined procedures than in the past, including mechanical circulatory support (MCS) as a bridge to transplantation. Cardiac anaesthesiologists also provide anaesthetic care for percutaneous interventional therapies in the cardiac catheterisation lab, such as multi-vessel stenting requiring MCS and transcatheter aortic and mitral valve procedures. Anaesthesiologists also attend in the cardiac surgical intensive care unit as the fast-track intensive care physician, working alongside the surgical intensive care physician and team.

Canadian centres like ours have risen to the challenges presented by COVID-19 by embracing adaptability and innovation in a rapidly changing healthcare environment. Strategies have included converting the peri-operative recovery space into critical care beds and expanding the roles of our team members (including clinical assistants, perioperative nurses and attending anaesthesiologists) to accommodate these changes. Given the expertise with the perioperative care of critically ill patients, anaesthesiologists were redeployed as attending house officers in the intensive care units.

COVID-19 has also presented many opportunities with respect to improving efficiencies in our healthcare system. As the chief medical information officer (CMIO) for digital health in Manitoba, I have been grateful to help lead our team in expanding the electronic health record in Manitoba tertiary care hospitals. We have also been able to rapidly advance the implementation and utilisation of virtual tools for remote home

monitoring, virtual clinic visits and secure messaging.

The practice of anaesthesiology in Canada continues to be very rewarding, despite the challenges presented by the pandemic. It is my hope that the lessons learned and experiences gained will provide the next generation of anaesthesiologists with the tools they need to continue to meet challenges in patient care in the future.

A day in the life of...A cardiac anaesthesiologist in CanadaDr Trevor W Lee, CMIO, Digital Health, Shared HealthProfessor, Max Rady College of Medicine, University of Manitoba, CanadaDepartment of Anaesthesiology, Perioperative and Pain Medicine

As a cardiac anaesthesiologist practising in an urban academic teaching hospital, my clinical practice setting may resemble that of many colleagues living in medium-sized cities (population 800,000) elsewhere in the world.

The International Anaesthetist | Issue 16 | November 2021

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Transition from a paper-based to a paperless systemDr Ang Kai Yun (main author), trainee resident in Anaesthesiology, Ng Teng Fong General Hospital, Singapore

Dr Kale Sugam Suvarn, Senior Consultant Anaesthetist and Associate Programme Director, FPR Anaesthesiology training at the National University Health System, Singapore, Ng Teng Fong General Hospital, Singapore

Our training institution is currently in the midst of transition to a completely electronic system.

We have been charting our anaesthetic records on paper whilst other medical records such as clinic notes, hospital consultation entries are available on the computer system. I have currently rotated to another hospital which was the first in Singapore to use a completely paperless system. This article explores some of the difficulties my colleagues and I face, and hopefully our experience will be useful for healthcare workers all over the world who may be going through the same transition.

Going paperless offers numerous benefits. One great advantage will be the continuum of healthcare. Digital records allow for easy access remotely; information can be readily communicated and shared amongst healthcare providers in different institutions securely, improving quality of care and potentially reducing healthcare costs in the long term. Centralised online data storage equates to the possibility of multi-user access, reduced clutter, and reduced risk of misplacing records.

Conversely, we have identified multiple challenges faced with transition to a paperless hospital. Firstly, hastened implementation of an electronic system will require considerable cost incursions in the short term: new anaesthetic machines and attached computers

compatible with electronic charting; upgrading of an unstable local area network, for example. Next, there is a huge learning curve for healthcare professionals with the new system. Paper records are flexible and portable, whereas electronic records tend to be more structured with constrained interfaces, and are relatively immobile and cumbersome to navigate. The issue of cybersecurity is also omnipresent.

The technology only requires the initial investment in the purchase of the software and hardware. We overcame the issue of the steep learning curve by organising regular training lectures and hands-on practice sessions leading up

to go-live, coming up with cheat sheets and ensuring easy access to help when required. Different departments were also allowed to contribute to the design of their electronic interfaces to come up with something suited for their use. A clear contingency workflow was drafted up and made known to staff in care of power outages or electronic glitches.

Moving towards a completely paperless healthcare system has its own costs and challenges that may serve as obstacles to its wider implementation, but innovation and integration of advanced technologies into modern healthcare is the only way forward in the current digital climate.

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The International Anaesthetist | Issue 16 | November 2021

The impact of unilateral versus bilateral hip and knee arthroplasty on haematological parameters in the perioperative period: a retrospective cohort studyIshani Oza and Ka Wai Fok, medical students, University of Auckland, Auckland, New Zealand

Dr Louise Sherman, Department of Anaesthesia and Pain Medicine, Counties Manukau Health, Auckland, New Zealand

Dr Nicholas Lightfoot, Department of Anaesthesia and Pain Medicine, Counties Manukau Health, Auckland, New Zealand and Department of Anaesthesiology, University of Auckland, Auckland, New Zealand

Purpose of studyHip and knee arthroplasty (THA / TKA) are common procedures to reduce pain and improve quality of life. Patient blood management describes the optimisation of haematological parameters to facilitate the surgical procedure. The purpose of this study is to determine the adequacy of optimisation of these parameters and their impact on outcomes following unilateral or bilateral arthroplasty.

MethodsThis project was approved by the Counties Manukau Health Research Office (number-1290). Patients undergoing either unilateral or bilateral THA and TKA between 1 January 2017 and 31 December 2018 were identified. Propensity score matching was used to produce two cohorts who had undergone unilateral or bilateral procedures. The primary outcome was the change in haemoglobin

between the pre- and post-operative measurements. Secondary outcomes included haematological and patient-centred measures. A two tailed p-value of <0.05 defined statistical significance.

ResultsOverall, 1,326 patients underwent surgery, with 58 (4.4%) bilateral procedures. Propensity score matching produced two cohorts with 46 (22.3%) bilateral and 160 (77.7%) unilateral procedures. There were no differences in baseline demographics (please see Table 1 on the next page). There was no difference in the incidence of preoperative anaemia (23.9% versus 17.5%, p=0.39) or those with a baseline ferritin <100ug/L (39.4% versus 46.8%, p=0.67). Surgery in the bilateral

group occurred more frequently at Middlemore Hospital (p<0.001) and patients required critical care more frequently (p<0.001). There was no difference in the number who had iron studies prior to surgery (10.9% versus 7.5%, p=0.54) or who received IV iron (2.2% versus 1.3%, p=0.53). The change in haemoglobin was greater in the bilateral group (28 (interquartile range: 20-34) versus 19 (13-25) g/L, p<0.001) with more frequent allogenic transfusion (13.0% versus 1.3%, p=0.002).

ConclusionsBilateral arthroplasty is associated with a greater change in haemoglobin and more transfusion. In this cohort, the rate of optimisation of preoperative iron stores was low.

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The International Anaesthetist | Issue 16 | November 2021

Table 1 Summary of results

Bilateral TKA / THA Unilateral TKA / THA p-value

Number (percent) 46 (22.3) 160 (77.7)

Knee replacement (percent) 36 (78.3) 130 (81.3) 0.67

Female (percent) 24 (52.2) 89 (55.6) 0.74

Age (years) 60.9 (56.4-65.9) 61.7 (57.7-67.5) 0.26

Ethnicity (percent)

European

New Zealand Māori

Pacific Islander

Asian

Other

24 (52.2)

5 (10.9)

9 (19.6)

6 (13.0)

2 (4.3)

58 (36.3)

27 (16.9)

28 (17.5)

33 (20.6)

14 (8.8)

0.27

BMI (kg/m2) 31.8 (28.7-37.0) 32.4 (27.8-36.7) 1.00

ASA Score (percent)

1

2

3

1 (2.2)

42 (91.3)

3 (6.5)

1 (0.6)

145 (90.6)

14 (8.8)

0.58

Charlson Score 2 (1-2) 2 (2-3) <0.001

Baseline Haemoglobin (g/L) 140 (130-150) 143 (133-150) 0.27

<130g/L (percent) 11 (23.9) 28 (17.5) 0.39

D1 Post-operative Haemoglobin (g/L) 110 (103-119) 121 (113-133) <0.001

<130g/L (percent) 43 (93.5) 114 (71.3) 0.001

Change in Haemoglobin (g/L) 28 (20-34) 29 (13-25) <0.001

Iron Studies Within 60 days preop 5 (10.9) 12 (7.5) 0.24

Oral Iron therapy (percent) 0 (0.0) 4 (2.5) 0.58

IV Iron therapy (percent) 1 (2.2) 2 (1.3) 0.53

Surgical Venue (Middlemore, percent) 24 (52.2) 30 (18.8) <0.001

Surgical Duration (minutes) 134.5 (125.0-155.0) 107.0 (88.5-131.0) <0.001

Calculated Blood Loss (mL) 1109 (788-1570) 662 (484-907) <0.001

Blood Transfusion (percent) 6 (13.0) 2 (1.3) 0.002

HDU / ICU care (percent) 27 (58.7) 7 (4.4) <0.001

Length of Stay (days) 6.2 (4.5-7.3) 4.2 (3.2-5.2) <0.001

DAOH30 (days) 23.8 (21.9-24.8) 25.8 (24.7-26.8) <0.001

DAOH90 (days) 83.7 (81.8-84.6) 85.8 (84.2-86.7) <0.001

Data represents number (percent) or median (interquartile range)

Two tailed p-value with <0.05 used for statistical significance

DAOH = Days Alive and Out of Hospital; D1 = Day One; IV = intravenous

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The International Anaesthetist | Issue 16 | November 2021

The lucky country?Dr Gavin Sullivan, Deputy Director of Anaesthetics, Belmont District Hospital, Senior Staff Specialist, John Hunter Hospital, Newcastle, NSW, Australia

I currently work as consultant anaesthetist in Newcastle, New South Wales, approximately two hours north of Sydney. We have a very different experience of COVID-19 in my locale to my UK counterparts. Eighteen months ago, we watched on in horror at the initial outbreaks in Europe and the UK. Simulation training started in earnest and initially elective surgery was suspended as we fully expected to be in the same position. Australia’s very successful management of the original variants of COVID-19 led to survivor guilt. We were prepared and could see what was happening to the rest of the world, but we had so few cases that I never saw a patient with COVID-19.

Unfortunately, the excellent management of COVID-19 was undone by the arrival of the Delta variant. Vaccination rates had been slow and procurement even slower, as the Australian government put all its vaccination eggs in the Astra Zeneca (AZ) basket – as it could be produced locally. Mixed messaging around thromboembolism led to

the general public not wanting AZ, despite availability. There was not much COVID-19, so there was no pressure to vaccinate. The public decided to wait for Pfizer.

Until, unfortunately, there was. Prior strategies to carry out limited lockdowns had worked in northern Sydney, but the Delta variant put paid to that. A single individual in an airport transport job, with inadequate PPE and vaccine hesitancy, led to our current outbreak.

And yet in Newcastle, despite approximately 500 cases as of mid-September, we are largely unscathed. We have only just been asked to volunteer for ICU should the need arise. Local vaccination rates are roughly 80% first dose and 60% second dose. This could mean that the ICU cases we see are transfers from Sydney.

Australians are `pulling their sleeves up’ and projected vaccination rates in the eligible population look likely to be high, ie 90+%.

As such it’s still entirely feasible that I will not see a COVID-19 patient at all. A Sydney anaesthetist would paint a different picture right now…

I follow numerous British anaesthetists via Twitter and it’s a very useful resource for us in Australia as the UK front runs the pandemic. The next crisis – that of catching up with elective surgery – is looming.

The government has said that restrictions will start to ease after a 70% double vaccination rate. I won’t have seen my UK family for three years. Fingers crossed we can escape our `gilded cage’ …

Twitter:@lotusgav

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The International Anaesthetist | Issue 16 | November 2021

An unlikely allyDr Malaka Munasinghe, Acting Consultant Anaesthetist, District General Hospital, Mannar, Sri Lanka

By the time this article is written, the COVID-19 pandemic will have directly affected around 215 million people and caused 4.5 million deaths. When the news of a novel, highly contagious virus termed COVID-19 erupted, I had been working as an acting consultant anaesthetist in a district general hospital in a once war-ridden northern part of Sri Lanka. With a very young team of doctors, we prepared ourselves and the institution with whatever we could muster, both physically and mentally. Checklists were prepared, the operating theatre was modified, and importantly, we started gulping up as much reliable information on the disease as possible; so began the teaching and training within the unit and the institution. Even though the routine work was cut down to prioritise preparedness for the pandemic, this new work was demanding.

I had been an avid reader since childhood, reading whatever I could get my hands on. This abruptly ended following entry into medical school. Medical books were a necessity, but most of them were tedious reads. Now, with the pandemic, I resumed my medical reading with the intent of improving my knowledge. Interestingly, the words seemed to be more appealing, thought-provoking, and at times captivating, by the simplicity and the relatively unnoticeable, effortless flow of writing. Amidst all the chaos, anticipation of the worst and my professional duties, I started writing bits and pieces of intriguing clinical experiences I had had over the past few years. This brought a sense of fulfilment to a novice author like me, who by now, had not published anything

medical. I gradually built a network of co-authors consisting of my teachers, colleagues and juniors. I was impressed by the calibre of writing of the juniors, the patience and perseverance of my seniors, and humbled by the general appreciation of our work.

Within a year, we published several abstracts, case reports and completed a few audits. Recently, an abstract was presented at the World Congress of Anaesthesiologists, for which we are delighted. My long-lost hobby of reading (even though now in a different scope) and writing has brought me a wealth of knowledge, enduring friendships, and clarity and peace of mind during this unrelenting pandemic, to which I am forever grateful.

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The International Anaesthetist | Issue 16 | November 2021

Global Anaesthesia Development Partnerships (GADP) and the Zambian Anaesthetic Development Programme (ZADP): adapting to a global pandemic with remote fellowsDr Hannah Phelan, GADP remote fellow and ST6 Anaesthetics, Edinburgh Royal Infirmary

Dr Mack Kalenga, first-year anaesthetics trainee, University Teaching Hospital, Lusaka

Dr Holly Andrews, GADP remote fellow, Inverclyde Royal Hospital

As the global pandemic keeps our in-country fellowships on hold, online links to Zambia have flourished. The ZADP needs assessment in 2020 confirmed that there continued to be a requirement to maintain support for teaching and locally-led clinical governance, resulting in the establishment of a remote fellowship.During the first wave of the pandemic, our in-country fellows returned to the UK, where they quickly adapted to the medium of online video conferencing to facilitate programme activities. Since then, GADP has recruited five remote fellows to support their Zambian partnership. In December 2020, despite being separated by distance and the many challenges further exposed by the pandemic, five more physician anaesthetists completed the anaesthetic training programme.

In addition to weekly teaching, we help to facilitate morbidity and mortality (M&M) meetings and the journal club. M&M meetings provide a valuable forum for the hospital MDT to identify targets for future quality improvement, and improve communication between anaesthesia and other specialities. The journal club has helped to highlight the power of data, inspiring many trainees to tackle the evidence gap which exists in Zambia.

As Dr Kalenga explains, ‘it is amazing to get direct feedback on QI projects, M&M, journal club, etc. Positive and constructive feedback may seem like

such a small thing, but in a world where everything is so busy and there is always so much crazy stuff going on all around us, those things really do help decrease the amount of burnout that we get’.

We provide trainees with individual mentoring and support. This provides a valuable opportunity for trainees to discuss their experiences and to receive individualised support with their learning needs.

Furthermore, we are involved in Zambian-led QI projects. One such project is focused on the management of respiratory failure, aiming to increase provision of oxygen delivery equipment and provide training for all healthcare staff by distributing educational videos to facilities across Zambia.

As an emerging speciality in LMICs, recruitment to anaesthesia is often challenging. Dr Kalenga explains that the ethos of the GADP-supported programme drew him to anaesthesia from medical school. The non-hierarchical, approachable nature of the Zambian consultants trained through this system set

the speciality apart from others.

Although as a partnership we look forward to in-country fellowships restarting, we have learnt that remote fellowships provide bi-directional learning and the opportunity to improve skills in leadership, management, innovation and clinical governance. Technology has helped us to communicate between continents as we work together towards safer anaesthesia for all.

AcknowledgementsDr Emma Coley, GADP Secretary and Trustee and Anaesthetic Consultant, Edinburgh Royal Infirmary

References1 GADP Impact Report 2020 ( bit.ly/2ZylFZ1).

2 GADP partnership: (gadpartnerships.com).

3 Global Anaesthesia Development Partnerships (GADP) and COVID-19. The International Anaesthetist, August 2021 (bit.ly/3pFgNMu).

4 Global Citizenship in the Scottish Health Service: The value of international volunteering: (bit.ly/3EjbKFy).

5 Take a Deep Breath Campaign (justgiving.com/campaign/supportingoxygeninzambia).

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The International Anaesthetist | Issue 16 | November 2021

Partner ’s updateThe International Relations Committee: grants and bursariesDr Linden Baxter, ST7 Anaesthetics and Association of Anaesthetists International Fellow

The International Relations Committee (IRC) of the Association of Anaesthetists was established over 40 years ago, with the aim of promoting safe anaesthesia and surgery in low-resource countries through the exchange of knowledge and skills. The IRC reports to the Association of Anaesthetists Charitable Foundation, is chaired by an Association of Anaesthetists board member (currently Tei Sheraton), and has representation from the Association trainee committee, the RCoA, the World Federation of Societies of Anaesthesiologists (WFSA), the World Anaesthesia Society (WAS), and many specialist anaesthesia societies. A core activity of the IRC is the regular distribution of grants to projects and individuals working towards safer anaesthesia worldwide.

Applications for bursaries and grants are considered four times a year. Historically, several grants were aimed at supporting international travel to undertake projects. However, the events of the last 18 months have changed the landscape of international work in numerous ways. Active IRC grants currently focus on applications for projects which do not require international travel, but which support in-country projects, including collaborations with partners already on the ground. All applications must be submitted by an anaesthetist based in the UK or Ireland, and all projects must have a UK partner.

Active grants1 International e-education grant

award

This brand-new award is currently inviting applications from individuals or teams

developing projects such as remote education and learning materials. Grants will be considered for innovative digital educational projects aimed at low to lower-middle income countries.

Projects should be unique and demonstrate sustainability.

Submission deadline: Wednesday 21 December 2021

2 International project grant

This grant is suitable for projects that involve either an individual or a team working to establish new or existing international anaesthesia education or research related projects. Funding up to £20,000 is available.

Submission deadline: Wednesday 21 December 2021

Grants to be aware of (currently on hold) The IRC are not currently accepting applications for these awards, but do check back as international travel circumstances change.

■ SAFE project grant funding: the Association's Safer Anaesthesia from Education (SAFE) course has been developed collaboratively by the Association and the WFSA, and has been delivered to thousands of delegates around the world. SAFE project grants are usually considered twice a year to support travel and the running of courses.

■ The international volunteer grant: this supports long-term international voluntary work, generally longer than one month.

■ The international travel grant: this is awarded for short-term travel (usually less than one month), which should usually be to the benefit of the receiving country.

Further information on these grants can be found on the Association’s website here or by contacting the governance team on secretariat@anaesthetists.org

The International Anaesthetist | Issue 16 | November 2021

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World Congress of Anaesthesiologists 2021: roundupFrancis Peel, Communications and Advocacy Manager, World Federation of Societies of Anaesthesiologists

Since its inception in 1955, the World Congress of Anaesthesiologists (WCA) has been renowned for its ability to bring together anaesthesia professionals from across the globe. On 1 to 5 September 2021, despite the ongoing devastating impact of COVID-19 on health systems around the world, the 17th WCA again lived up to its name, welcoming 6,539 delegates from 132 countries for five days of networking, discussions and learning. The entirely virtual WCA 2021 was organised by the World Federation of Societies of Anaesthesiologists (WFSA) and the Czech Society of Anaesthesiology and Intensive Care Medicine (CSARIM), and was originally planned as an in-person event during September 2020 in Prague, Czech Republic, until COVID-19 made this event impossible.

What a virtual WCA 2021 lost in terms of in-person networking and hands-on training, it gained in accessibility. Delegates for whom the expense of congress travel and accommodation are often insurmountable barriers were for the first time able to attend and actively participate in a WCA. This accessibility

was further bolstered by 483 scholarships provided to anaesthesia professionals from low- and middle-income countries. 

WCA 2021 realised an ambitious 25 track scientific programme that featured 479 presenters giving over 640 presentations in 200 sessions.

A key theme running throughout WCA 2021 was the strengthening of the anaesthesia workforce, with sessions and discussions ranging from professional wellbeing through to the policies and practices which strengthen national anaesthesia provision. This was articulated in the exceptional joint keynote Harold Griffith lectures

given by Professor Christine Maslach (University of California, Berkley) on professional burnout, and Nobel Prize nominee Edna Adan Ismail (Edna Adan University Teaching Hospital, Somaliland) on transforming healthcare in Somaliland. 

Alongside the scientific sessions, over 1,400 abstracts were accepted and presented during the live event. This wealth of new research is available in a special WCA 2021 Abstract Book published in Anesthesia & Analgesia. 

The wealth of knowledge and expertise encapsulated at the meeting can still be accessed through the WCA2021 on-demand feature. It’s an opportunity to catch up on sessions you missed or watch those you loved again. All sessions are subtitled in English, French and Spanish. 

Those already registered can access the on-demand programme with their WCA login. Those who weren’t delegates can register for on-demand access here. All sessions are available on demand for delegates until 5 December 2021.

The 18th WCA is scheduled to be a hybrid online /in person congress held in Singapore in 2024. We look forward to seeing you there.

Users are able to access on the on-demand video library through the WCA platform.

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The International Anaesthetist | Issue 16 | November 2021

Implementing a new anaesthesia curriculum Rajashree Krishnian, RCoA Specialty Training Administrator

Since 2017, the General Medical Council (GMC) in the UK has required medical colleges to embed good medical practice and the Generic professional capabilities framework within curricula, alongside specialty-specific capabilities. The 2021 curriculum is our response to these requirements. There is a firm move away from over-specification of competencies that can be accumulated individually, towards examining the whole. This a welcome step for our profession, as it is widely understood that attempting to simplify the complexity of anaesthetic practice by breaking it down into component parts is inadequate. In educating anaesthetists, we are not producing trained performers, but educating wise professionals who engage in intelligent practice.

This moves away from the previous structure, where the activities were defined ‘by proxy’ according to the surgical activity that the anaesthetist supported. The curriculum remains outcome based, as required by the GMC, as opposed to relying on case numbers and training duration as proxies for educational attainment.

The curriculum review group met in February 2020 and set out an ambitious

programme of in-person events to launch the 2021 anaesthetics curriculum. The very next month, the College would shut its doors and halt all face-to-face meetings for the foreseeable future.

Over the course of the year, we initiated the curriculum launch online – training news items were published every two weeks and a website hub was developed with articles, podcasts and webinars from members of the curriculum review group. Events were held on topics from the underlying philosophy of the curriculum to the fine details of the assessments.

What we found was that members were hungry for information, and providing that information through existing support structures helped funnel the right information to the right people at the right time. The College sent information to regional representatives, who cascaded this to their college tutors and supervisors, who then had discussions

with their trainees and other learners in their hospitals. This ensured that learners and trainers were able to engage with senior clinicians they trusted about how the curriculum change would affect their particular situation.

Curriculum updates were also made more accessible to everyone through the frequent webinars and live Q&A sessions, with extensive signposting to regional representatives. Members engaged with pre-course content in their own time and were invited to ask members of the curriculum review group questions during the webinar. This helped boost the face-to-face aspect while also maintaining flexibility for attendees.

Going forward, we are improving the accessibility and personalisation of our online resources, enabling our members to access filtered information without feeling overwhelmed.

Further information is available at: rcoa.ac.uk/anaesthetic-cct-curriculum-2021

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The International Anaesthetist | Issue 16 | November 2021

The College has developed a toolkit that offers patients the information they need to prepare for surgery, including the important steps they can take to improve health and speed up recovery after an operation.

The Fitter Better Sooner toolkit consists of:

■ one main leaflet on preparing for surgery ■ six specific leaflets on preparing for some of the most common surgical procedures

■ an animation which can be shown on tablets, smart phones, laptops and TVs.

You can view the toolkit here: rcoa.ac.uk/fitterbettersooner

We have also created printable posters, flyers and stickers to help you signpost patients to the toolkit. The animation can be shown on TVs in waiting areas. You can find all these additional resources and instructions on how to download the animation in MP4 format (or request a version in PowerPoint) on our website here: rcoa.ac.uk/patientinfo/healthcare-professionals

Please share this toolkit with colleagues in both primary and secondary care settings.

It has been shown that people who improve their lifestyle in the run up to surgery are much more likely to keep up these changes after surgery.

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NEW PATIENT INFORMATION LEAFLET TRANSLATIONS AVAILABLEThe following patient information leaflets have been translated into the 20 most common languages used in the UK. This is part of the College’s ongoing partnership with the international translation charity, Translators without Borders.

■ You and your anaesthetic

■ Your spinal anaesthetic

■ Your child’s general anaesthetic

■ Anaesthetic choices for hip or knee replacement

■ Caring for someone who has had an anaesthetic or sedation

■ Sedation explained

■ Anaesthesia and your weight

■ Nerve blocks for surgery on the shoulder, arm or hand

■ Local anaesthesia for your eye operation

We have also translated our risk infographic.

Please see our website for further details: rcoa.ac.uk/patientinfo/translations

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AnaesthetistThe e-newsletter for international members of the Royal College of Anaesthetists

The International

PresidentDr Fiona Donald

Vice-PresidentsProfessor William Harrop-Griffiths and Dr Russell Perkins

Royal College of AnaesthetistsChurchill House, 35 Red Lion Square, London WC1R 4SG

global@rcoa.ac.uk rcoa.ac.uk/global-partnerships

© 2021 The International Anaesthetist e-newsletter of the Royal College of AnaesthetistsAll Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any other means, electronic, mechanical, photocopying, recording, or otherwise, without prior permission, in writing, of the Royal College of Anaesthetists.