Letters to the editor

IS IT TIME FOR A STRUCTURED AND EXPLICIT ANAESTHESIA TRAINING SELECTION PROCESS?

Currently no clear guidance or criteria for applying to anaesthesia training in NSW exists. There is generic advice to “build your CV”, however, what this means is a mystery to me. With increasing competition for anaesthesia registrar positions, this appears to lead to rumour about what is needed, leading our junior colleagues to embark on potentially unnecessary extracurricular work which may include expensive postgraduate courses and distract them from learning how to be a good practical clinician. For example, as a department scholar role tutor, I get regular requests from junior resident medical officers (RMO), critical care RMOs and medical students requesting to perform an audit. Given these requests come from doctors with no or limited experience of anaesthesia, and who are not department members, they require close supervision. This creates a lot of potential work for the supervisor including setting the topic and gold-standard measures, access to limited computing resources, and data analysis requiring software licenses and some skill in using them. Some audit topics likely require assessment by the local ethics committee which for our HREC now requires a fee payment. While an audit is not an explicit requirement to apply for an anaesthesia position, so long as there exist no clear guidelines many RMOs seem to feel it is essential. If performing an audit is an important application criterion, RMOs really should have equitable access to perform them. It seems unfair to me that essential recruitment criteria be allocated by the chance availability and enthusiasm of a supervisor. I would hate to be the person responsible for not helping a good candidate improve “build their CV”. However, with one to two requests for audits per week, I often now feel that I do. The Royal Australasian College of Surgeons has established a very clear points-based criteria for applying to surgical training (www.surgeons.org/become-a-surgeon/ how-do-i-become-a-surgeon/jdocs-by-racs). I wonder if having a more formalised, standardised and explicit process would provide junior doctors and consultant anaesthesia staff with clearer direction. This could help reduce the anxiety induced by uncertainty and focus candidates on activities that would help them develop as a physician in critical care, rather than data entry. Dr Matthew Miller FANZCA Staff Specialist, NSW Ambulance Aeromedical Operations VMO Anaesthetist, St George Hospital NSW

ANZCA responds

ANZCA is undertaking a project focusing on trainee selection in both anaesthesia and pain medicine. As part of this project we have convened a working group that will undertake an environmental scan of selection processes at other medical specialist training colleges and universities with a view to investigating ways to potentially improve the ANZCA processes across Australia and New Zealand. This working group is undertaking the first phase of the work as part of the Training Evolution Project which focuses on the continual improvement of the ANZCA training program. As part of this work a number of areas will be analysed including: 1. Desire to have greater clarity in selection criteria across jurisdictions. 2. Maintenance of consistency in approach to trainee selection across training networks. 3. Ensuring there is equity in trainee selection. 4. Possible creation of pathways for Aboriginal and Torres Strait Islander and Māori trainees. As this project progresses the college will endeavour to update the fellowship, trainees and SIMGs on progress and outcomes upon completion. SECONDING THE CALL FOR VIRTUAL MEETINGS

I laud Dr Richard Barnes’ letter to the Autumn ANZCA Bulletin, calling for virtual anaesthesia meetings as the way forward in this time critical global climate change crisis. The COVID-19 pandemic has amply shown that virtual meetings are a very viable and efficient way of holding meetings and conferences, and as Dr Barnes has proposed “carbon neutral medical conferences should be the norm”, with virtual meetings shown to reduce conference carbon footprint and energy usage by well over 90 per cent. But in the same week in June that the major teaching hospital, at which Dr Barnes is a senior anaesthetist, removed desflurane from its theatres in view of its problematic greenhouse gas effect, the anaesthesia department of this teaching hospital staged the 6th Collaborative Clinical Trials in Anaesthesia Biennial Conference at the hospital’s umbrella organisation’s centre in Prato, near Florence, Italy. A conference that doubtless could have been held virtually. The equivalent number of greenhouse gas emitting VW Golf trips across the Nullarbor from Melbourne to Perth, to staging the Florentine conference would be in the tens of thousands, I suspect. This seems at best ironic, more possibly hypocritical, at a time when a groundswell of TIVA anaesthesia proponents are driving the derailment of the use of desflurane in contemporary anaesthesia; an agent which if used with due care has very real benefits in certain circumstances, where some anaesthetists find it superior to the hard line mantra of TIVA for all cases.

I must say that I did enjoy the ANZCA virtual meeting held this April/May. It proceeded flawlessly. Dr Stuart Skyrme-Jones, FANZCA Richmond, Victoria