Anesthesiology

Anesthesiology

Role in Healthcare Delivery
 
Anesthesiologists are physicians who provide medical care to patients when doing surgical procedures. Anesthesiologists are responsible for ensuring the delivery of anesthesia safely to patients in virtually all health care settings, including all major medical and tertiary care facilities. This includes a preoperative evaluation, consultation with the surgical team, creating a plan for the anesthesia tailored to each individual patient, airway management, intraoperative life support and provision of pain control, intraoperative diagnostic stabilization, and proper post-operative management of patients. Preparation of patients for emergency surgery are mandatory, essential, and critical skills that anesthesiologists have been trained to employ. Because anesthesiologists are physicians, in contrast to other anesthesia providers, they are able to utilize their extensive knowledge of human physiology and diseases to guide their decision making.
 
Historically there has been a shortage of anesthesiologists. In order to better serve the population, residency positions in anesthesiology for physicians have been steadily increasing the past several years. In addition, physicians supervise ACTs, or Anesthesia Care Teams, which are composed of a supervising physician with several certified registered nurse anesthetists (CRNAs) or anesthesiologist assistants (AAs), working together to provide healthcare to the population. In other areas of the country, anesthesiologists work in what is deemed a "solo" or "MD/DO only" practice, during which they provide anesthesia in a "one on one" relationship with the patient.
 
A consultant anesthetist in the UK is a fully qualified doctor, who has spent at least 9 years (7 of which should be in anesthesia) after graduation as a trainee, and is appointed as a consultant. A trainee anesthetist in the UK is a fully qualified doctor on their way to become a consultant; they could be 2 years post graduation or may be even 10 years post graduation.
 
Anesthesiologists and Patient Informed Consent
 
Patient informed consent is a fundamental ethical and legal principle and is considered essential to patient autonomy.The American Society of Anesthesiologists, the American Osteopathic College of Anesthesiologists, and other professional organizations, such as the American Association of Nurse Anesthetists, support the principle that patients should be fully informed regarding the manner in which their anesthetic will be administered.
 
Due to medications given before, during and after surgery, a patient may sometimes not remember interacting with his or her anesthesiologist, nurse anesthetist, or anesthesiologist assistant, who will be involved in their anesthesia care. The anesthetic plan, as well as alternatives, risks, and benefits of the chosen anesthetic techniques, should be discussed with the patient prior to surgery. (This can be difficult or impossible in some situations, such as unconscious patients, confused patients, or extremely urgent cases. It may be possible to discuss matters with a patient's relative or caretaker).
 
Training by country
 
Physician training in anesthesiology in developed countries is similar.
 
Australia and New Zealand
 
In Australia and New Zealand, anaesthetists are physicians (with the degree of Bachelor of Medicine and Bachelor of Surgery i.e. MB ChB or MB BS) who have specialized in the medical field of anesthesia.
 
In Australia and New Zealand, anesthetists are represented by the Australian Society of Anaesthetists and the New Zealand Society of Anaesthetists. Training is overseen by the Australian and New Zealand College of Anaesthetists. The ANZCA approved training sequence encompasses an initial two-year Prevocational Medical Education and Training (PMET) period and the five-year period of ANZCA Approved Training (two years Basic Training and three years Advanced Training).
In the course of Approved Training, you are required to successfully complete:
  • Five years of supervised clinical training at Approved Training Sites
  • Both the Primary and Final Examinations which consist of both written (multiple choice questions and short answer questions) and, if successful at the written component, oral examinations
  • In the final examination, there are many stations of clinical scenarios (including interpretation of radiological exams, EKGs and other special investigations). There is also two stations of real patients with complex medical conditions - for clinical examination and a following discussion. - A program of 12 modules such as obstetric anesthesia, pediatric anesthesia, cardiothoracic and vascular anesthesia, neurosurgical anesthesia and pain management.
  • Completion of an advanced project, such as a research publication or paper.
  • An EMAC (Effective Management of Anaesthetic Crises) or EMST (Early Management of Severe Trauma) course.
On completion of all Training Program requirements the Trainee will be awarded the Diploma of Fellowship and be entitled to use the qualification of FANZCA – Fellow of the Australian and New Zealand College of Anaesthetists.
 
Canada
 
In Canada anaesthetists are physicians (with the degree MD - Medicinae Doctorem or MDCM - Medicinae Doctorem et Chirurgiae Magistrum) who have specialized in the medical field of anesthesia.
 
Training is overseen by 16 universities approved by the Royal College of Physicians and Surgeons of Canada. Upon completion of a residency program, the candidate is required to pass a comprehensive objective examination consisting of a written component (two three-hour papers: one featuring 'multiple choice' questions, and the other featuring 'short-answer' questions) and an oral component (a two-hour session made up of stations on the clinical aspects of anesthesiology. The examination of a patient is not required).
 
Upon completion of all training requirements, the graduate is then entitled to use the post-nominal letters "FRCPC" or "FRCSC" — "Fellow of the Royal College of Physicians of Canada" or "Fellow of the Royal College of Surgeons of Canada", respectively.
 
Germany
 
After earning the right to practice medicine, German physicians who want to be an anesthetist have to go through a 5-year residency, ending with a board examination. During this time, physicians are educated in all aspects of their chosen field of medicine. Usually this includes rotations serving in the operating room to perform anesthesia on a variety of patients being treated by every kind of surgical sub-profession (i.e. general surgery, neurosurgery or invasive urological and gynecological procedures), followed by a rotation on various intensive-care and intermediate-care units. During this time of residency, many physicians choose to complete a course in emergency medicine, which once completed, enables them to be referred to as Notarzt, a physician of the Emergency Medical Service, treating patients at home or on the scene of accidents, either on their own or assisted by paramedics.
 
Italy
 
In Italy, the Anaesthesiologist-Intensive Care is a doctor who, after graduation from Medical School (6.5 years), has completed a 4-years (5-years by 2008) residency. They can work in Operating Rooms, ICUs, PACUs, Pain Units, Hyperbaric Units and Emergency Departments.
 
United Kingdom
 
In England, Northern Ireland, Scotland and Wales training is overseen by the Royal College of Anaesthetists. Anaesthetists in the United Kingdom are doctors who have completed either a five-year or six-year undergraduate training program or a four-year program open only to holders of a first degree.
 
Following the completion of medical school, doctors enter the two-year Foundation Program which consists of at least six, four-month rotations in various medical specialties. It is mandatory for all doctors to complete a minimum of three months of general medical and general surgical training in this time.
 
Following the Foundation Programme, doctors compete for specialist training in anesthetics. The training program in the United Kingdom currently consists of two years of Core Training and five years of Higher Training. Trainees wishing to hold dual accreditation in Anaesthetics and Intensive Care Medicine may enter anesthesia training via the Acute Care Common Stem (ACCS) program which lasts three years and consists of experience in anesthesia, emergency medicine, acute medicine and intensive care. Trainees in anesthesia are called Specialty Registrars (StR) or Specialist Registrars (SpR).
 
Before the end of Core Training, all anesthetic trainees are expected to have passed the primary examination of the diploma of Fellowship of the Royal College of Anaesthetists (FRCA). The final part of the examination is taken as a higher trainee (usually in the five year of training). The FRCA examination is notorious for its difficulty and is said to be the most difficult of all post-graduate medical examinations. The examination covers physics, pharmacology, physiology, anatomy, clinical sciences, pathology, respiratory medicine, emergency medicine, critical care, pain medicine.
 
The CCT program in anesthetics is divided into three levels: basic, intermediate and advanced. During this time, doctors experience anesthesia as applicable to all surgical specialties. The curriculum focuses on a modular format, with trainees primarily working in one specialist area during the module, for example: cardiac anesthesia, neuroanesthesia, ENT, maxillofacial, pain medicine, intensive care, trauma.
 
Traditionally (before the advent of the Foundation Programme) trainees have entered anesthetics from other specialties, such as medicine or accident and emergency. Specialist training then takes at least seven years.
 
On completion of specialist training, doctors are awarded the Certificate of Completion of Training (CCT) and are eligible for entry on the GMC Specialist Register and are able to work as Consultant Anaesthetists. A new consultant in anesthetics will have completed a minimum of 14 years of training (including: GCSEs; A levels; four years medical school; two years foundation training; and seven years anesthesia training).
 
Those wishing to dual accredit in intensive care are required to undertake an additional year of training and normally complete the Diploma in Intensive Care Medicine (DICM). Pain specialists sit the Fellowship of the Faculty of Pain Medicine of the Royal College of Anaesthetists (FFPMRCA) examination.
 
United States
 
Anesthesiologists are the most extensively-trained anesthesia providers in the United States. Anesthesiologists are physicians (MD or DO) who have chosen to specialize in anesthesiology. Anesthesiologists in the United States must have completed an undergraduate college degree, including pre-medical requirements. Like other physicians, anesthesiologists complete four years of medical school. Physician training programs in the United States, without exception, require four years of residency training for board certification eligibility in the specialty of anesthesiology. An anesthesiology residency requires a one year medical or surgical internship followed by three years of anesthesiology training.
 
Anesthesiology residency training in the U.S. encompasses the full scope of perioperative medicine, including pre-operative medical evaluation, management of pre-existing disease in the surgical patient, intraoperative life support, intraoperative pain control, post-operative recovery, intensive care medicine, and chronic and acute pain management. After residency, many anesthesiologists complete an additional fellowship year of subspecialty training in areas such as pain management, cardiac anesthesiology, pediatric anesthesiology, neuro anesthesiology, obstetric anesthesiology or critical care medicine.
 
The majority of Anesthesiologists in the United States are board-certified by a specialty medical board; either the American Board of Anesthesiology (ABA) or the American Osteopathic Board of Anesthesiology (AOBA). The ABA is a member of the American Board of Medical Specialties, while the AOBA falls under the auspices of the American Osteopathic Association. Both Boards are recognized by the major insurance underwriters in the U.S. as well as by all branches of the U.S. Uniformed Services. Board certification by the ABA involves both a written and an oral examination. AOBA certification requires the same exams, in addition to a practical examination with examining physicians observing the applicant actually administering anesthetics in the O.R.
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