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The provision of anaesthesia for children by non-subspecialist anaesthetists: expectations of newly qualified consultant anaesthetists and their prospective employers in Victoria

Department of Anaesthesia and Perioperative Medicine, Monash Medical Centre, Melbourne, Victoria, Australia

Summary

We surveyed newly qualified consultant anaesthetists and their prospective employers in Victoria, regarding their expectations for the provision of paediatric anaesthesia by anaesthetists who have not completed subspecialty training in paediatric anaesthesia (generally-trained anaesthetists).
Responses were received from 15 of 19 (79%) eligible Directors and 26 of 37 (70%) newly qualified Australian and New Zealand College of Anaesthetists (ANZCA) Fellows. Of those responding, 80% of Directors and 82% of Fellows would expect a generally-trained anaesthetist to anaesthetise children two years of age or older. Regional Directors expected generally-trained anaesthetists to anaesthetise younger children than metropolitan Directors, and Directors’ expectations were not influenced by their own practice.
Testing these age limits with a series of simple case descriptions showed there is recognition from both Directors and Fellows that the stated age limits would be modified in both directions by case complexity and comorbidities.
The new consultants who responded were significantly less confident than Directors in their ability to resuscitate and stabilise a critically ill child prior to transfer if required. Only 50% agreed they still met all the requirements of the ANZCA paediatric module and only 37.5% had the level of confidence they achieved during their paediatric rotations.
We suggest that current training provides capacity to routinely anaesthetise well children two years of age or older. However, it appears more training would be required for most anaesthetists undertaking anaesthesia for younger patients or more complex paediatric cases. This raises the question of subspecialty endorsements within ANZCA Fellowship.

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