Anesthesiologist

An anesthesiologist (American English) or anaesthetist (British English) is a physician trained in anesthesia and perioperative medicine.

Terminology varies between countries. In the United States, the term anesthesiologist refers to a physician who has completed medical school training and an accredited anesthesiology residency program. In contrast, in the UK and Europe generally, and in most of the former commonwealth countries, the word anaesthetist is used to refer only to the doctors, while their assistants may be termed anaesthetic nurses, anaesthetic technicians, operating department practitioners or physician associates, depending on local practice.

Anesthesiologists provide medical care to patients in many different ways. They provide care during preoperative evaluation, in consultation with the surgical team, and assist physicians in the creation of a plan for anesthetic intervention tailored for each individual patient. Anesthesiologists often provide more intensive care techniques such as assistance with airway management, intraoperative life support and provision of pain control, intraoperative diagnostic stabilisation, and proper postoperative management of patients. An anesthesiologist's scope of practice also involves in-hospital and pre-hospital emergencies, work within intensive care units, acute pain units, and chronic pain consultations.

Patient-informed consent

Patient-informed consent is a medical principle stating that patients should be fully informed about the manner in which anesthesia will be administered to them. It is a fundamental ethical and legal principle and is considered essential for the patient autonomy. The American Society of Anesthesiologists and the American Osteopathic Board of Anesthesiology support this principle. In Germany, the law requires that prior to anaesthesia, informed consent of the patient must be obtained by the anaesthetist.

Due to medications given before, during, and after a surgery, a patient may sometimes not remember interactions with the anaesthetist, nurse anaesthetist, or anaesthesia assistant involved in his anaesthesia care. The anaesthetic plan, as well as alternatives, risks, and benefits of the chosen anaesthetic techniques, should be discussed with the patient prior to the surgery. This can be difficult or impossible in some situations, such as with unconscious patients, confused patients, or extremely urgent cases.

Selection and training

Selection and training process is similar in various countries.

Argentina

In Argentina, anaesthetists are physicians who have specialized in the medical field of anaesthesia. Residency program is 5 years long.

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 anaesthesia. They are represented by the Australian Society of Anaesthetists and the New Zealand Society of Anaesthetists.

Training is supervised by the Australian and New Zealand College of Anaesthetists. The ANZCA-approved training course encompasses an initial two-year long Pre-vocational Medical Education and Training (PMET) and three years of advanced training. Thus the total training is 5 years long. In the course, trainees are required to successfully complete five years of supervised clinical training at approved training sites and pass both the primary and final examinations which consist of both written (multiple choice questions and short-answer questions) and, if successful in the written exams, oral examinations (viva-voce).

In the final written examination, there are many questions of clinical scenarios (including interpretation of radiological exams, EKGs and other special investigations). There are also two cases of real patients with complex medical conditions - for clinical examination and a following discussion. The course has a program of 12 modules such as obstetric anaesthesia, pediatric anaesthesia, cardiothoracic and vascular anaesthesia, neurosurgical anaesthesia and pain management. Trainees also have to complete an advanced project, such as a research publication or paper. They also undergo an EMAC (Effective Management of Anaesthetic Crises) or EMST (Early Management of Severe Trauma) course. On completion of training, the trainees are awarded the Diploma of Fellowship and are entitled to use the qualification of FANZCA – Fellow of the Australian and New Zealand College of Anaesthetists.

Brazil

In Brazil, the anaesthetists are physicians who have specialized in the field of anaesthesia. Approximately 650 physicians are admitted yearly to a three-year specialization program. The residency programs can take place at training centers in university hospitals. These training centres are accredited by the Brazilian Society of Anaesthesiology (SBA), or other referral hospitals accredited by the ministry of health. Most of the residents are trained in different areas, including ICU, pain management, and anaesthesia sub-specialties, including transplants and pediatrics. In order to be a certified anaesthetist in Brazil, the residents must give exams throughout the residency program and at the end of the program. The SBA conducts these examinations. In order to be an instructor of a residency program certified by the SBA, the anaesthetists must have the superior title in anaesthesia, in which the specialist undergoes a multiple choice test followed by an oral examination conducted by a board assigned by the national society.

Canada

In Canada anesthesiologists are physicians (with the degree MD - Medicinae Doctorem or DO - Doctor of Osteopathic Medicine, or MDCM - Medicinae Doctorem et Chirurgiae Magistrum) who have specialized in the medical field of anesthesiology. Training is supervised by 17 universities approved by the Royal College of Physicians and Surgeons of Canada.^[1] Upon completion of a residency program (typically five year long), 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 relating to topics on the clinical aspects of anesthesiology). The examination of a patient is not required. Upon completion of training, the anaesthesia graduate is then entitled to become a "Fellow of the Royal College of Physicians of Canada" and to use the post-nominal letters "FRCPC".

Germany

In Germany, anaesthetists (German: Anästhesist or Facharzt für Anästhesiologie) are the only anaesthesia providers as German law does not allow anyone but a physician (doctor) to practice medicine. It is called a "physician centered medicine" (German: Arztvorbehalt).

After earning the right to practice medicine (German: Approbation),^[2] German physicians who want to become anaesthetists must undergo 5 years of training, consisting of anaesthesia, ECG and pulmonary function testing, critical care and pain medicine, and also palliative care medicine. The training includes rotations serving in the operation theatres to perform anaesthesia on a variety of patients being treated by various surgical sub-specialties (e.g. general surgery, neurosurgery, invasive urological and gynecological procedures), followed by a rotation through various intensive-care units.^[3] Many German anaesthetists choose to complete a curriculum in emergency medicine, which once completed, enables them to be referred to as Notarzt, an emergency physician working pre-clinically with the emergency medical service. In pre-clinical settings the emergency physician is assisted by paramedics.^[4]

Netherlands

In the Netherlands, anaesthetists are physicians who have specialized in the medical field of anaesthesia. Anaesthetists in the Netherlands must complete medical school training, which takes six years. After successfully completing medical school training, they start a five-year residency training in anaesthesia. In their fifth year they can choose to spend the year doing research, or to specialize in a certain area, including regular anaesthesia, critical care medicine, pain and palliative medicine, paediatric anaesthesia, cardiothoracic anaesthesia, neuro-anaesthesia or obstetric anaesthesia.

Guatemala

In Guatemala, anaesthetists are physicians who have specialized in the medical field of anaesthesia. For this, a student with a medical degree (he or she must have surgery and general medicine skills by law) has to complete a residency of six years (five years in residency and one year of practice with an expert anaesthetist).

After residency, students take a board examination conducted by the college of medicine of Guatemala, the Universidade De San Carlos De Guatemala (Medicine Faculty Examination Board), and a chief physician who represents the health care ministry of the government of Guatemala. The examination includes a written section, an oral section, and a special examination of skills and knowledge relating to anaesthetic instruments, emergency treatment, pre-operative care, post-operative care, intensive care units, and pain medicine. After passing the examination, the college of medicine of Guatemala, Universidad De San Carlos De Guatemala and the health care ministry of the government of Guatemala grants the candidate a special license to practice anaesthesia as well as a diploma issued by the Universidad De San Carlos De Guatemala granting the degree of physician with specialization in anaesthesia. Anaesthetists in Guatemala are also subject to yearly examinations and mandatory participation in yearly seminars on the latest developments in anaesthetic practice.

Hong Kong

In Hong Kong, anesthesiologists are physicians who have specialized in the medical field of anesthesiology. To be qualified as an anesthesiologist in Hong Kong, medical practitioners must undergo a minimum of six years of postgraduate training and pass three professional examinations. Upon completion of training, the Fellowship of Hong Kong College of Anesthesiologists and subsequently the Fellowship of Hong Kong Academy of Medicine is awarded. Practicing anesthesiologists are required to register in the Specialist register of the Medical council of Hong Kong and hence are under the regulation of the Medical council. ^[5]

Italy

In Italy the term anesthesiologist-intensive care doctor refers to a physician who, after completion of 6.5 years of medical school training, has completed an accredited four (five since 2008) year residency in anesthesiology. Such doctors work in operation theaters, ICUs, PACUs, Pain control units, Hyperbaric units, Emergency rooms, etc.

Scandinavia

In Denmark, Finland, Iceland, Norway, and Sweden, anesthesiologists' training is supervised by the respective national societies of anesthesiology as well as the Scandinavian Society of Anesthesiology and Intensive Care Medicine (SSAI). In Scandinavia, anesthesiology is the medical specialty that is engaged in the fields of anesthesia, intensive care medicine, pain control medicine, pre-hospital and in-hospital emergency medicine. Anesthesiologist in the Scandinavian countries is a doctor who has completed a six-year undergraduate training program (from medical school), a twelve-month internship, and a five-year residency program. SSAI currently hosts five training programs for anesthesiologists in Scandinavia. These are Intensive care, Pediatric anesthesiology and intensive care, Advanced pain medicine, Critical care medicine, and Advanced obstetric anesthesiology.

United Kingdom

In England, Northern Ireland, Scotland, and Wales, training is supervised by the Royal College of Anaesthetists. Anaesthetists in the United Kingdom are physicians who have completed either a five-year or six-year undergraduate medical school training program or a four-year medical school program open only for post graduates.

Following the completion of medical school training, physicians enter a two-year foundation program which consists of at least six, four-month rotations in various medical specialties. It is mandatory for all physicians to complete a minimum of three months of general medicine and general surgery training during this time. Following the foundation program, physicians compete for specialist training. The training program in the United Kingdom currently consists of two years of core training and five years of higher training. Also, before the end of core training, all trainees must have passed the primary examination for the diploma of Fellowship of the Royal College of Anaesthetists (FRCA).

Trainees wishing to hold dual accreditation in anaesthesia and intensive care medicine may enter anaesthesia training via the Acute Care Common Stem (ACCS) program which lasts three years and consists of experience in anaesthesia, emergency medicine, acute medicine and intensive care. Trainees in anaesthesia are called Specialty Registrars (StR) or Specialist Registrars (SpR). The Certificate of Completion of Training(CCT) in anaesthesia is divided into three levels: Basic, intermediate and advanced. During this time, physicians learn anaesthesia as applicable to all surgical specialties. The curriculum focuses on a modular format, with trainees primarily working in one special area during one module, for example: cardiac anaesthesia, neuro-anaesthesia, ENT, maxillofacial, pain medicine, intensive care, and trauma. Traditionally (before the advent of the foundation program), trainees entered anaesthesia from other specialties, such as medicine or accidents and emergencies. Specialist training takes at least seven years. On completion of specialist training, physicians are awarded CCT and are eligible for entry on the GMC Specialist register and are also able to work as consultant anaesthetist. A new consultant in anaesthetics must have completed a minimum of 14 years of training (including: five to six years of medical school training, two years of foundation training, and seven years of anaesthesia training).

Those wishing for dual accreditation (in Intensive care and anaesthesia) are required to undergo an additional year of training and also complete the Diploma in Intensive Care Medicine (DICM). Pain specialists give the Fellowship of the Faculty of Pain Medicine of the Royal College of Anaesthetists (FFPMRCA) examination.

United States

Photo of prebriefing for mixed modality simulation being used for anesthesia resident training

In the United States, anesthesiologists are physicians (MD or DO) who have chosen to specialize in anesthesiology and are extensively trained medical care providers in the United States. Anesthesiologists in the United States must have completed an undergraduate college program (that includes pre-medical requirements) and four years of medical school training. Anesthesiology residency programs in the United States require successful completion of four years of residency training for board certification eligibility in the specialty of anesthesiology. An anesthesiology residency requires a one-year medicine or surgery internship followed by three years of anesthesiology training. Anesthesiology residents face multiple examinations during their residency, including exams encompassing physiology, pathophysiology, pharmacology, and other medical sciences addressed in medical school, along with multiple anesthesia knowledge tests which assess progress during residency. Successful completion of a board exam after completion of residency is required for board certification. The total average compensation for full-time anesthesiologists is roughly $466,000, and the average gross revenue per anesthesiologist is almost three times that amount. The number of jobs are rounding to about 170,400 according to statistics in 2014.^[6]

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 sub-specialty training in areas such as pain management, sleep medicine, cardiothoracic anesthesiology, pediatric anesthesiology, neuroanesthesiology, regional anesthesiology/ambulatory anesthesiology, obstetric anesthesiology, or critical care medicine.

The majority of anesthesiologists in the United States are board-certified, either by the American Board of Anesthesiology (ABA) or the American Osteopathic Board of Anesthesiology (AOBA). It should be noted that D.O. anesthesiologists can be certified by the ABA. The ABA is a member of the American Board of Medical Specialties, while the AOBA falls under 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 operating room.

References

External links

• Anesthesiology at DMOZ
• OpenAnesthesia — the Anesthesiology Wiki (presented by the International Anesthesia Research Society)