Your letters
Dear Editor
Improving motivation in Core Anaesthesia
Trainees during the COVID-19 era
In October 2020 I carried out a survey of 32 CT2/
CT2+ anaesthetics trainees across the North West,
which revealed that trainees’ motivation towards
ST3 applications had suffered significantly
owing to the consequences of COVID-19. More
than 90% reported feeling either somewhat or
completely demotivated to apply.
The main reasons included:
- high self-assessment scores required to
qualify for interviews.
- inability to manage time because of changes
to the new curriculum start date, exam
disruption, and work-related fatigue.
- uncertainty surrounding accessing higher
training once the new curriculum begins.
I believe the following actions could help restore
the frayed motivation of core trainees:
- clarification regarding how interview
capacity for the August 2021 ST3 intake
will differ from the preceding intake. If
capacity has increased, it may increase
motivation regarding achieving sufficient selfassessment
scores.
- regular communication regarding the work
being done to ensure that trainees who do
not enter ST3 training will be able to qualify
for the new ST4 applications in 2022. Trainees
would welcome a viable back-up plan should
their ST3 application be unsuccessful.
- review self-assessment scoring to increase
points available for achievements in
anaesthesia; for example, trainees might
be more motivated if passing Primary FRCA
was rewarded rather than non-anaesthetic
examinations.
It is reasonable to assume that most trainees
appreciate the pressure that the RCoA has
been under to provide fair examinations and
recruitment throughout the pandemic. I believe
that keeping core trainees informed of these
changes on a regular basis is paramount for
maintaining their motivation – a well informed
trainee is a well-prepared trainee; and preparation
breeds confidence.
Liam Sheppard
CT2 Anaesthetic Trainee
Royal Preston Hospital
Congratulations to Liam Sheppard for winning
January's Letter of the Month prize.
Dear Editor
#Rapha4NHS
While cycling to work at the beginning of the lockdown in spring, I was mulling over
the challenges we all faced from the COVID pandemic. Despite the empty roads, a
motorist overtook me at high speed leaving very little space. I wondered whether
drivers would still act like this if they knew that they were endangering the same
people that they were clapping every Thursday evening.
The idea of a cycling jersey exclusively for NHS staff was thus born, with the hope
that it would make commuting safer, put a smile on a few faces, and help boost
morale. It was also a great opportunity to raise money and give something back to
NHS Charities Together, in appreciation of all their great work. With permission, the
Charity logos were incorporated into the jersey design, along with the rainbow that
has become a symbol of hope and support for the NHS.
I approached the cycle-wear producer Rapha; not only were they incredibly helpful,
but they also kindly offered a significant discount in recognition of all the hard work
and sacrifices of NHS staff, and to help encourage us onto our bikes. We’ve now
sold almost 500 jerseys across the UK to NHS departments, including the London
Ambulance Service and organ donation services.
The jerseys are available to buy for just £60 each through the website
www.rapha4nhs.com, which includes all group ordering instructions and details of
how to donate via the Virgin Money giving page. Hopefully we’ll turn the COVID
corner in 2021, but if not maybe we’ll expand the range!
Acknowledgements: fellow Sussex anaesthetic trainees James Roberts for help with
the jersey design; Daniel Puntis and Dan Cottrell for website and graphic design.
Sean Speers
ST6 in Anaesthesia
Brighton
Twitter: @DoctorSpeers
Dear Editor
Unsuitable ventilators for Low & Middle-Income Countries
In his recent article in Anaesthesia News (November page 20),
Craig Thompson of Penlon states that ESO 2 ventilators are being
offered as suitable for sale to ‘the World Bank, and countries of
South America and Africa’. Like most ventilators sold in the UK, the
ESO 2 is powered by compressed gas (typically hospital piped
medical air) of which it consumes on average around 25 l.min-1 with
instantaneous flows up to 60 l.min-1, hugely more than the patient’s
minute volume. The driving gas is discharged into the room, and
a separate flow of oxygen and air is needed for the inspired gas
mixture.
In LMICs few, if any, hospitals have piped medical air supplies, and
piped oxygen is also rare. It is likely that an ESO 2 will be powered
by precious cylinder oxygen, and thus deprive five patients of a
facemask oxygen supply.
It is ironic that, until recently, Penlon was manufacturing a ventilator
purpose-designed by the late Dr Roger Manley specifically for
limited-resource settings. It was oxygen driven, but used only 10%
of the minute volume as driving gas, which was diverted back into
the breathing system and so not wasted.
Too often we have seen simplistic ‘solutions’ for LMICs that involve
rich countries sending unsuitable equipment. Most simply waste
the shipping costs of useless equipment, but sending gas-guzzling
ventilators to countries with poor oxygen supplies may affect
all critically ill patients who depend on additional oxygen. The
only ventilators suitable for such countries use driving gas in an
economical way, either powered by an oxygen concentrator with 1.3
bar outlet pressure, or not using compressed gas as a power source.
Such ventilators do exist, but you won’t find many of them in the UK.
Michael Dobson
Nuffield Department of Anaesthetics, Oxford
A response
Dear Dr Dobson,
At Penlon we have the greatest respect for these views
and valid comments. The ESO 2 Emergency Ventilator
for the treatment of COVID-19 is now available to help
save lives worldwide, but we only recommend its use
where hospitals are equipped with an oxygen and air
supply with sufficient capacity to drive the ventilator
and to treat the patient.
During this global pandemic, we rely wholly on the
due diligence of the respective governing authorities,
as well as the expertise of clinical professionals, to
make decisions regarding their hospital gas supplies,
appropriate medical equipment, and treatment for
those suffering from severe COVID-19, to determine
whether they would benefit from additional oxygen
and/ or invasive ventilation.
Craig Thompson
Business Unit Manager, Penlon
Twitter: @penlonglobal