A plea for standardisation in the duration of training in anaesthesiology and intensive care medicine across Europe: A survey of representatives of the European National Anaesthesia Societies Committee.

BACKGROUND: Anaesthesiologists and intensive care doctors have become progressively more mobile across Europe. The standardisation of training systems has been recommended by the European Union of Medical Specialist (UEMS) to facilitate the mutual recognition of professionals. OBJECTIVE: We aimed to assess the level of compliance with the 2018 European training requirements (ETR) for the specialty of anaesthesiology, pain and intensive care medicine. METHODS: An electronic questionnaire on the duration of the training and assessment methods in anaesthesiology and intensive care medicine was circulated via e-mail to the National Anaesthesia Societies Committee (NASC) representatives of all 41 European countries as defined by the WHO. RESULTS: All 41 countries replied. The average duration of training was 4.7 years; in 29% of the countries, it was less than 5 years. In 78% of the countries, a mandatory written examination was required, and the most common form was a national test (44%), with only 27% using the European Diploma of Anaesthesia and Intensive Care. In the subgroup of the 26 EU countries investigated, the average duration of the training was 5 years and in 19% was less than 5 years. In the subgroup of the 15 non-EU countries, the average duration of training was 4.25 years, with 46% of the countries having a duration shorter than 5 years. CONCLUSIONS: This survey highlighted the diversity in the training in anaesthesiology and intensive care medicine in Europe despite the recommendations advocated by the EBA-UEMS. The findings on the duration of training demonstrated that the target of 5 years has not been universally achieved yet with a substantial difference between EU and non-EU countries. The presented evidence suggests the need for initiatives dedicated to implement compliance with the advocated duration and competence requirements reported in the European Training Requirement for anaesthesiology and intensive care by UEMS.

European Section/Board of Anaesthesiology/European Society of Anaesthesiology consensus statement on competency-based education and training in anaesthesiology.

: The change from time-based to competency-based medical education has been driven by society's requirement for greater accountability of medical practitioners and those who train them. The European Society of Anaesthesiology and European Section/Board of Anaesthesiology (Anaesthesiology Section of the European Union Medical Specialists) endorse the general principles of competency-based medical education and training (CBMET) outlined by the international competency-based medical education collaborators. A CBMET curriculum is built on unambiguously defined learning objectives, each of which offers a measurable outcome, amenable to assessment using valid and reliable tools. The European training requirements laid out by the European Board of Anaesthesiology define four 'Generic Competences', namely expert clinician, professional leader, academic scholar and inspired humanitarian. A CBMET programme should clearly document core competencies, defined end-points, proficiency standards, practical descriptions of teaching and assessment practices and an assessment plan. The assessment plan should balance the need to provide regular, multidimensional formative feedback to the trainee with the need to inform high stakes decisions. A trainee who has not achieved a proficiency standard should be provided with an individualised training plan to address specific competencies or deficits. Programme formats will inevitably differ given the constraints of scale and resource that apply in different settings. The resources necessary to develop and maintain a CBMET programme in anaesthesiology include human capital, access to clinical learning opportunities, information technology and physical infrastructure dedicated to training and education. Simulation facilities and faculty development require specific attention. Reflective practice is an important programme element that supports wellbeing, resilience and achievement of professional goals. CBMET programmes should enable establishment of a culture of lifelong learning for the anaesthesiology community.

Quality and safety guidelines of postanaesthesia care: Working Party on Post Anaesthesia Care (approved by the European Board and Section of Anaesthesiology, Union Européenne des Médecins Spécialistes).

Postanaesthesia care units are standard parts of hospital care in most European Union countries. Their main purpose is to identify and immediately treat early complications of surgery or anaesthesia, before they develop into deleterious problems. This review, prepared by the Working Party on Post Anaesthesia Care of the European Board of Anaesthesiology. European Union of Medical Specialists (Union Européenne des Médecins Spécialistes) and approved by the European Board and Section of Anaesthesiology, gives recommendations on relevant aspects of organization, responsibilities, methods, safety and quality control of postanaesthesia care.

WHO Needs High FIO2?

World Health Organization and the United States Center for Disease Control have recently recommended the use of 0.8 FIO2 in all adult surgical patients undergoing general anaesthesia, to prevent surgical site infections. This recommendation has arisen several discussions: As a matter of fact, there are numerous studies with different results about the effect of FIO2 on surgical site infection. Moreover, the clinical effects of FIO2 are not limited to infection control. We asked some prominent authors about their comments regarding the recent recommendations.

Airway management by physicians wearing anti-chemical warfare gear: comparison between laryngeal mask airway and endotracheal intubation.

BACKGROUND AND OBJECTIVE: To evaluate the ease with which successful insertion of a laryngeal mask airway can be performed in comparison with endotracheal intubation by medical personnel wearing chemical protective equipment. METHODS: Anaesthetists and non-anaesthetists (each n = 20) participated in the prospective comparative trial in an animal laboratory. The time and success rates of laryngeal mask airway vs. endotracheal tube insertions were measured as performed on anaesthetized monkeys. RESULTS: The results showed that the laryngeal mask airway was inserted more rapidly than the endotracheal tube by both groups (3.6 s and 28.6 s, P < 0.0001). Failed intubation occurred in 35% (anaesthetists) vs. 55% (non-anaesthetists) (P = 0.17). CONCLUSIONS: In view of the 100% success rate of insertion even in unfavourable conditions, the possible role of the laryngeal mask airway in the scenario of a toxic mass casualty event should be considered.