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By Jennifer Gwyn, dual trainee in Acute Medicine and Intensive Care Medicine

Why ITU needs medical trainees.ITU is not all about the airway“. This is a phrase I often find myself whispering under my breath. I am a dual trainee in Acute Medicine and Intensive Care Medicine and fell in love with Intensive Therapy Unit (ITU) during my medical Senior House Officer (SHO) years. When I found out about the stand-alone training programme I jumped at the opportunity to apply.

The interview

When I arrived at the interview I became apprehensive. I sat in the corner quietly overhearing all the chatter. “I went to a trauma call the other day, really difficult intubation, I was on nights last week as the ITU registrar“. The majority of the interviewees were anaesthetists who already had a lot of experience in ITU.  I felt like an imposter and my confidence started to dwindle. How can I compare to these people and their experience? Have I made the wrong decision?

However, I knew I really wanted to be an intensivist and I had prepared for the interview as if it were an exam. I just had to get this across to the interviewers. I stayed calm, methodical, passionate and confident throughout and was surprised how keen the panel members were to hear about my medical experience.

Sceptic colleagues

I have found it tough being a medic in a world of anaesthetists. There was a massive learning curve with all the anatomy, physics and physiology.

quote2The anaesthetist would question what I would bring to ITU: “But what if there’s a difficult intubation overnight? You are going to have to get me to come in and help”.

On a regular basis I would be assisting a theatre list and the anaesthetist would question what I would bring to ITU: “But what if there’s a difficult intubation overnight? You are going to have to get me to come in and help“.  I was getting the impression that some of my colleagues felt I would be adding to their workload. I felt like screaming: “ITU is not all about the airway!

I understand their concerns and I agree that if is there is a difficult airway I would need help but I am competent in intubating patients independently. I can insert invasive lines, alter ventilation strategies, interpret cardiac output results, manage the use of inotropes and vasopressors as well as transferring and stabalising critically unwell patients.

On top of that I feel that my medical experience gives me added diagnostic skills and management techniques, particularly as patients are getting older, have multiple co-morbidities and are receiving more complex medical treatments. This is as well as the interpersonal, team-working, leadership and communication skills that I have developed as a medical registrar.

More should apply

I have never had any negative comments from the intensivists I work with, but there are still a minority of anaesthetists who do not work on ITU regularly, and who will see me as a hindrance rather than a help.quote2

I hope that with more medical doctors joining the training programme we will see attitudes change over the years.

I always encourage and support any medical trainee who is interested in ITU as a career. I have found that many are put off applying, as they don’t feel that they are good enough, that it will be too difficult and that their colleagues will not accept them.

I hope that with more medical doctors joining the training programme we will see attitudes change over the years. I feel the best ITU care is driven by the complementary skills of a medical and anaesthetic team.

exclamationJennifer presenting at Career Day

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2 thoughts on “Being a medic in a world of anaesthetists

  1. I definitely agree that there should be more medics on ICUs in the UK. I would like nothing more than to reduce ICU’s dependence on Anaesthesia for airway issues: in some units, there is an over-reliance on the on-call Anaesthetist to provide airway support when the unit is staffed by junior clinical fellows out-of-hours, often post-FY2 doctors who have not had adequate training in airway skills. Until there is more funding for increased an ICM junior workforce, Anaesthetists will still be called in to provide support. I call on the ICS to lobby HEE and the other governing bodies for an increase in the number of ICM juniors getting recruited!

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    1. The subject of airway management in critical care medicine and the role of anaesthesia is grossly exaggerated. Consider other clinical areas in our hospitals requiring airway expertise: respiratory physicians performing bronchoscopies, including the OPD setting; the management of the newborn airway in obstetric suites; the PICU and of course the NICU, and not an anaesthetist in sight!
      All acute hospitals require a global approach to ‘acute airway problems’: these can occur in the ED, the ward, the OR and any critical care environment. It is expected that anaesthesia would play a role in the team approach to this issue.
      Airway management in the critical care unit is largely planned and thus managed in a predictive way.
      I have worked with many non- anaesthesia critical care trainees and have never had any concerns regarding airway issues, given appropriate training and support.
      Unfortunately I frequently see good medical trainees either give up their ICU career aspirations because of the ‘airway/anaesthesia’ issue or, worse still, pursue dual training simply to tick the gas box!

      Dr Gwyn raises a very important issue which is crucial to the development of UK critical care medicine.

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