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THE
RCoA Trainee Committee Newsletter
Issue 9 / Autumn 2014
Dr Peeyush Kumar (Chairman) | Dr JP Lomas (Deputy Chairman) | Dr Gethin Pugh | Dr Natasha Joshi | Dr Kate Tatham
Dr Adam Low | Dr Sarah Gibb (GAT) | Dr Aidan Devlin (RCoA/KSS Education Fellow)
EDITORIAL
Dr Gethin Pugh
Welcome to all new Anaesthetists in Training,
we hope you will find this publication a valuable
guide and resource throughout your training. In
this edition, we take a detailed look at the changes
to the FRCA Examination and provide an update
on the Curriculum Review; and some of the work
streams, which are being developed as a result of
its findings. In addition, we examine some of the
key findings of NAP5 and introduce NAP6 and how
to get involved with latest NCEPOD reports.
Welcome to the Autumn Edition of The GAS, The
Newsletter from the Royal College of Anaesthetists
Trainee Committee. This quarterly publication
highlights important curriculum updates and
developments in the wider medical community
relevant for Anaesthetists in Training. In addition
it provides information on upcoming College
events for trainees in Anaesthesia, as well as regular
features such as Bedtime Reading – signposting
you to the latest publications and guidelines.
1
NEWS
that in some cases trainees are taking their FRCA
Examination components too early in order to
increase points in this area. The matter has been
discussed at Council and agreed that this change
will take effect from August 2015.
NATIONAL TRAINING SURVEY RESULTS
Across all of the hospital specialties, doctors in
training in anaesthesia ranked highest in terms of
their overall satisfaction with a score of 85.6% – only
general practice received a marginally higher score.
SHAPE OF TRAINING
The Shape of Training Review was published
last autumn, setting out a vision of the future of
postgraduate training. Anaesthetists in Training were
fortunate to take part in a number of workshops
across all four nations of the United Kingdom in
September and October. The workshops looked at
different themes of the report and its implications for
postgraduate medical training. The Shape of Training
Steering Group will present their recommendations
soon and we will continue to keep you updated.
VALUING THE DOCTOR IN
TRAINING: A NEW CHARTER FROM
THE ACADEMY OF MEDICAL ROYAL
COLLEGES
Howard Ryland
Doctors in training are a valuable resource, who
make a major contribution to the care of patients
across the health care system through their daily
work. They are also future consultants, whose
potential requires nurturing and, as their job
title of trainee suggests, training. How are these
two closely aligned roles of training and service
provision to be reconciled?
THE ANAESTHESIA TRAINEE
REPRESENTATIVE GROUP (ATRG)
The first meeting of the Anaesthesia Trainee
Representative Group (ATRG) was at the RCoA on
1 July 2014, which was very constructive. This
new system of regional representation ensures
trainees from all areas of the country have a voice
in college activity. Please continue to engage
with your local ATRG representatives. Details of
local ATRG representatives are available on the
College website.
The answer is not simple, however the
Academy Trainee Doctors’ Group (ATDG), which
brings together a huge spectrum of specialty
trainee groups, has formulated a charter to
define the principles. The document considers
the fundamental question of how to balance a
trainee’s commitments and wider aspects of the
training experience. What part do doctors in
training have to play in ensuring patient safety,
quality of care and improving training? How
can the system support them to fulfil these
roles? What can be done to improve the trainee
experience and ensure a good quality of life?
Following the meeting, several members of the group
stood for election for College Trainee Committee and
we are delighted to welcome Dr Adam Low and Dr
Kate Tatham to the College Trainee Committee. We
look forward to working with them.
RECRUITMENT UPDATE
Self-scoring Assessment
If you would be interested in reading more
on this charter, please follow this link:
http://bit.ly/1yXB6Bf.
The Recruitment Committee agreed to reallocate
the scores awarded for attainment of the FRCA in
the self-scoring assessment. Concerns were raised
2
NEW MEMBERS OF RCoA TRAINEE
COMMITTEE
DR ADAM LOW
DR KATE TATHAM
I am currently an ST6 trainee in the West
Midlands Deanery with interests in PreHospital medicine, transfer & retrievals and
regional anaesthesia. I feel very privileged
to be joining the Trainee Committee and
will work hard to represent trainee views.
My initial areas of input for the committee
will be around work force planning and
providing trainee representation for the
Lay Person committee. There is evidently
increasing pressure on trainee numbers in
anaesthesia, and despite vague reassurances
nationally, we are seeing our training
numbers reduced in our deanery; a familiar
story elsewhere I suspect. How to address
this is far from simple but hearing about how
this is impacting on you as trainees would
be invaluable – either through the ATRG via
your trainee reps or directly.
I am an ST6 Trainee in Anaesthetics &
Intensive Care Medicine at Imperial
School of Anaesthesia (NW Thames). I’m
honoured and excited to be joining the
Trainee Committee as one of the new
representatives. I have been a local trainee
representative for some time and my
interests lie in many aspects of training
and include intensive care research,
preoperative medicine and optimising the
training experience.
UPPER LIMIT ON DUAL TRAINING ENTRY
Please note that potential Dual Anaesthesia and ICM trainees should be advised that from
August 2016 onwards, trainees will not be able to apply for Dual CCTs if they are beyond the
end of ST5 in their initial specialty of appointment. The August 2015 intake is therefore the last
opportunity for trainees above ST5 to enter into the Dual programme (whether they be current
anaesthesia only trainees intending to dual with ICM or ICM only trainees intending to dual with
anaesthesia).
For more information, please see the FICM website. Details will be added to the RCoA Training
website shortly.
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CHANGES TO FRCA EXAMINATIONS
Dr Natasha Joshi and Mr Graham Clissett, RCoA Examinations Manager
INCREASE IN THE NUMBER OF
ATTEMPTS AT FRCA EXAMINATION
COMPONENTS
INCREASE IN THE VALIDITY OF A PASS
IN THE PRIMARY SOE, PRIMARY OSCE
AND FINAL WRITTEN EXAMINATION,
FROM TWO YEARS TO THREE YEARS
WITH EFFECT FROM 1 AUGUST 2014
It was initially reported that the maximum number
of attempts at all FRCA exam components should
be set at six and this would come into effect from
August 2014. However, following a small number
of requests from trainees who had narrowly failed
the Primary OSCE or SOE examinations at their
final (fourth attempt), to be allowed an additional
attempt at the exam before the introduction date
of 1 August 2014, the Examinations Committee
shortened the standard ‘notice for change period’
which is normally one year. After consideration
of the exam calendar dates and the need for
applicants on their sixth attempt to submit an
Additional Educational Training Form AET Form
1, three months before their final attempt, it
was agreed to advance the introduction date
to 1 November 2013. A copy of the AET Form 1
can be found at Appendix 8 of the Examination
Regulations. A Word copy of the form can be found
on the Regulations page of the College Website.
At their meeting on 21 May 2014 College Council
approved a request from the Examinations
Committee to increase the length of the validity of
a pass in the Primary SOE, Primary OSCE and the
Final Written examinations, as part eligibility to
Primary or Final exam completions, from two years
to three years. The validity of the Primary MCQ
remains at three years. As this is a positive change
that will assist candidates and is fully compliant
with the College Equal Opportunities Policy,
the increase in the length of validity for these
components will take effect from 1 August 2014.
Applicants applying for the September 2014 Final
Written and the November OSCE/SOE exam can
take advantage of the extended validity period.
The Examinations Regulations paragraphs 5(d) and
7(b) were amended on 1 August 2014.
CHANGE TO THE COMPOSITION OF
QUESTIONS IN THE FINAL FRCA MCQ
FROM AUGUST 2014
CHANGES TO THE WAY CANDIDATES
RECEIVE ADMISSION NOTICES
In the past the examinations department have sent
‘Admission notices’ by official letter, this takes a few
days to reach candidates and we understand that
candidates are often eager to get the times for their
examinations. To speed up the process, admission
notices will now be sent by email to the exams
candidate as soon as the scheduling of candidates
has been checked and verified. This will speed up
the process. Candidates are asked to print off
the email and provide a copy when attending
exams, candidate information will be posted on
the exam pages of the website. Result letters are
considered official documents and will continued
to be sent by letter on College official paper.
With effect from the 1 August 2014 the
composition of the Final FRCA MCQ examination
will change to ensure the question topics fully
reflect the breadth of the relevant anaesthetic
training curriculum. The question structure of the
Final MCQ will remain unchanged and continue to
consist of 60 x MTF and 30 x SBA. The Primary and
Final FRCA Examination Regulations August 2014,
Appendix 1: Structure of the Examinations – Final
FRCA Examination – Written, will be amended as
follows at paragraph (a) (amendments in red):
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‘MCQ paper: 90 MCQs in three hours: 60 x Multiple
True/False (MTF) plus 30 Single Best Answer
(SBA) questions in three hours, comprising
approximately of:
DISABILITY POLICY
A policy on adjustments to examinations and
arrangements for disabled candidates was added
to the examinations regulations at Appendix 9 in
January 2014. This new College policy gives clear
process, timelines and definitions for candidates
who may require examination adjustment. It is
used alongside ‘standard provisions for Dyslexia’
which remains at Appendix 3 of the regulations.
60 Multiple True-False (MTF):
●●
20 Advanced sciences to underpin anaesthetic
practise
●●
20 General duties (essential units)
●●
17 Specialist (essential units)
●●
3 Optional units
ON-LINE APPLICATION AND PAYMENT
The on-line application and payment project
continues to move to fruition. We are hopeful that
some applications and payment will be accepted
on-line from the January examination application
windows. The present plan is to have a full roll
out of the on-line system by Spring 2015. Further
information will be placed on the College website
in due course.
30 Single Best Answer (SBA):
●●
15 General duties (essential units)
●●
15 Specialist (essential units)/Optional Units’
The Examinations Regulations were amended on
1 August 2014, the above composition was used for
the Final FRCA Written exam on 2 September 2014
and all Final MCQ examinations thereafter until
further notice.
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CURRICULUM REVIEW UPDATE
Dr Aidan Devlin, RCoA/KSS Education Fellow
The Curriculum Review project is now well under
way. The results of the Curriculum Survey have
been published in November’s Bulletin; thank you
again to everyone who took part. The main issues
raised in the survey are summarised here.
EXPOSURE TO EMERGENCY
ANAESTHESIA
Service commitments to ICU and obstetrics were
reported to be reducing the opportunities for
training in emergency anaesthesia for many
trainees. There was also concern from trainers
that many trainees are not getting appropriate
exposure to emergency anaesthesia because
of these service commitments. We have added
a question to the GMC Trainee survey to try to
quantify this problem, and will look at ways of
ensuring that our trainees are having adequate
training in emergency anaesthesia.
HIGHER TRAINING
Many trainees and trainers responded that
mandatory Higher Cardiac and Neuroanaesthesia
modules were reducing the training time available
for experience in other areas which they perceived
to be more relevant to their final career. A subgroup of the training committee has been set
up to look at the issues raised by the survey and
will examine this issue, and look at the way these
modules are delivered by the various schools of
anaesthesia.
THE CURRICULUM DOCUMENT
The Curriculum document itself was felt to be
long and difficult to navigate. We have already
improved access to the Curriculum from the RCoA
website, and will look at making the document
itself easier to use and search.
WORKPLACE-BASED ASSESSMENTS
(WPBA) AND VARIABILITY OF SCHOOL
REQUIREMENTS
There are other ongoing streams of work of interest
including a review of the present documents
related to Unit of Training Sign-Off, Management/
Leadership Competencies at Advanced Level and
Perioperative Medicine; the latter representing a
major body of work for the RCoA. We will keep
you updated as the project progresses but don’t
hesitate to get in touch if you have any comments.
There were numerous comments on the topic
of WPBA, with many trainers expressing fatigue
with the number of assessments they are asked
to complete, and trainees finding that completing
WPBA was detracting from training time. We
undertook a review of the workbooks used by
schools, as some schools have much higher WPBA
requirements than others. As a result of this review
and the survey results, two schools of anaesthesia
have reduced their requirements to the minimum
suggested by the Curriculum. The WPBA group has
been reconvened and will review the use of these
tools and ensure that they are used in a rational
and useful way in training.
ADevlin@rcoa.ac.uk
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NCEPOD – HOW CAN TRAINEES GET
INVOLVED?
Dr Kathy Wilkinson, Consultant Anaesthetist and Clinical Co-ordinator NCEPOD
The National Confidential Enquiry for Patient
Outcome and Death (NCEPOD) is 26 years old
this year. The organisation conducts in depth
qualitative reviews on medical and nursing
care producing two to three reports per year
on subjects as diverse as Kidney Failure and the
organisation of care for Cosmetic Surgery, with a
total of 37 published reports to date. NCEPOD was
established in 1988 as an independent body and
whilst receiving government funding it is a charity
and company limited by guarantee.
details about particular cases in their care and return
questionnaires and extracts of the clinical record
to NCEPOD where patient data is anonymised. The
cases are then reviewed, generally by clinicians who
are drawn from relevant specialities (including senior
trainees). There is also a detailed organisational
questionnaire which complements the process to
provide a full picture of care. From start to finish
each report typically is about 3 years in production,
and the results are launched at a dedicated scientific
meeting. The report along with a slide set of the
findings are available free on the NCEPOD website.
An audit tool is also provided.
It provided seminal early data on the underlying
causes of peri-operative mortality, and early ‘wins’
stimulated by NCEPOD recommendations which
now form part of everyday practice including
designation of cases according to clinical urgency,
improved allocation of emergency (NCEPOD)
theatres, and better supervision of trainees. Over
subsequent years, NCEPOD has maintained its
independence and has been affiliated to NICE and
to the NPSA, as well as continuing to be closely
linked to the Colleges and professional bodies via a
steering group. Study topics have been extended
to include medical as well as surgical themes.
Since 2011 NCEPOD has been part of the Clinical
Outcome Review Programme of HQIP and is one of
several ongoing major project groups.
This year NCEPOD will launch two reports –
Tracheostomy care (completed in June 2014) and
Lower Limb amputations (which will launch on
14 November – full details on NCEPOD website at
www.ncepod.org). The cost to attend is extremely
modest and there is a poster competition for any
recently completed Audit or QI project on an
NCEPOD topic.
Trainees are actively encouraged to get involved.
Vacancies for study case reviewers are placed on the
NCEPOD website and the launches are advertised
here too as well as the RCoA site. A link has recently
been placed in the NIAA trainee area under ‘resources’.
NCEPOD currently has 7 clinical co-ordinators who
are consultants seconded on a part time basis from
a range of specialities whose main role is to provide
clinical advice to the organisation. We work alongside
highly skilled researchers. We are all very happy to
come and speak to trainee networks about the work
of NCEPOD and our recent studies.
Topics for NCEPOD studies are proposed by
clinicians and there is a rigorous annual selection
process. Study methodology is produced by a team
of experts in the field. Hospitals in all parts of the
UK except Scotland (which has a separate surgical/
anaesthetic mortality review – SASM) have local
reporters who greatly assist with data collection.
Clinicians will often be asked to provide extended
7
NATIONAL AUDIT PROJECTS: LAUNCH
OF NAP5 AND INTRODUCTION TO
NAP6
Dr Adam Low
in intensive care and during patient transfers. The
majority were considered preventable. Drug
errors with administration of muscle relaxant in
error were also included in the report – plenty to
reflect upon from a risk management and human
factors perspective. The long term consequences
for patients, particularly the psychological impact
and potential for post traumatic stress disorder are
highlighted in the report.
NAP5: ACCIDENTAL AWARENESS
UNDER GENERAL ANAESTHESIA
One would struggle to attend an anaesthesia related
scientific meeting, either national or international
and not hear mention made to any one of the
National Audit Projects. The launch of NAP5 this
autumn will surely maintain this momentum. A joint
venture between RCoA and AAGBI, NAP5 tackles
the subject of accidental awareness under general
anaesthesia (AAGA), a complication feared by both
patients and anaesthetists alike. It covered reports
from 5 countries, looking at over 300 new incidences
of awareness in depth. While not only providing us
the incidence of this complication (1:19,000, ranging
between 1:670 for Caesarean Section to 1:136,000
for GA without muscle relaxant), the report also
highlights specific risk factors. These were divided
into drug factors, patient factors, subspecialties and
organisational factors. As trainees we need to take
particular note of this final risk factor, with out of
hours anaesthesia by a junior anaesthetist increasing
the risk of AAGA.
The authors judged the episode preventable in 78%
of cases investigated in further detail. The authors
make recommendations to inform future practice
as a result of the study. The 64 recommendations
are included in the executive summary, categorised
into National themes, institutional and personal
recommendations. The full report can be
downloaded from: http://nap5.org.uk/NAP5report.
NAP6: PERIOPERATIVE ANAPHYLAXIS
Before the NAP5 report was even published the
cogs had started turning for the launch of NAP6. A
topic familiar to anyone attending a critical incidents
simulator session, the subject for NAP6 has been
confirmed as ‘Anaphylaxis during perioperative care’.
Data collection is anticipated to start in February–
March 2015. While full details are yet to be finalised
it is anticipated that some of the potential questions
that NAP6 will answer include: the incidence of
serious reactions, the epidemiology, outcome,
investigation compared to published guidelines,
severity of reaction according to causative agent
and proportion of suspected cases that are proven/
referred for specialist investigation.
The report includes an interesting discussion around
TIVA as a risk factor for awareness – key reading
to reinforce the importance of understanding the
pharmacological principles underpinning target
controlled infusions and to ensure familiarity with the
technique. There were also recommendations that
familiarity and understanding of depth of anaesthesia
monitoring techniques should be a core part of our
training. As with NAP4, anaesthesia outside of the
theatre environment provides additional challenges
and risk of accidental awareness, including cases
8
CHANGES TO HMRC POLICY
REGARDING ESSENTIAL COURSE
FEES
Dr Katy Nicholson
Following a court case in 2010 (Revenue & Customs Commissioners v Dr Piu Banerjee [2010]
EWCA Civ. 843) HMRC have reviewed their policy of not allowing junior doctors to claim back
examination and other essential course fees.
Their guidance EIM32546 states:
‘A trainee doctor employed as a registrar on a training contract is required, as a stated contractual
duty of the employment, to attend various external training courses. As part of the duties of
the employment there is a mandatory requirement to maintain a national training number by
attending a series of training courses and events. Failure to complete the course and obtain the
qualification will mean that he cannot proceed to the next stage of his chosen profession.
Attendance at the training events is an intrinsic part of the employment and one of the duties of the
employment. The costs of travel to the events, course fees and other associated costs met by the
employee are deductible’.
In practice it appears that junior doctors who are required to pass examinations to maintain
their National Training Number are being allowed to claim tax relief against the cost of these
examinations. Taxation claims can be made retrospectively so if you sat FRCA after April 2010
you should be able to claim tax relief.
In addition we would like to remind junior doctors that subscriptions to professional bodies
(eg. RCoA, AAGBI, OAA) are all tax allowable. Current guidance from HMRC EIM 32530 states
the CPD costs are not tax allowable even if these are essential to perform your job.
In the first instance you should contact HMRC. A template letter is available on their website.
9
BEDTIME READING
Our regular round up of documents that trainees should know about. Don’t approach an
interview/exam without checking these out!
NATIONAL AUDIT PROJECT 5
Accidental Awareness during General Anaesthesia
September 2014
NATIONAL CONFIDENTIAL ENQUIRY INTO PATIENT OUTCOME AND
DEATH (NCEPOD)
On the right Trach – a review of the care received by patients who underwent trachestomy
June 2014
ASSOCIATION OF ANAESTHETISTS OF GREAT BRITAIN AND IRELAND (AAGBI)
Peri-operative care of the elderly
January 2014
Perioperative management for patients with chronic spinal cord injury (July 2014)
Uses of Tranexamic Acid (May 2014)
SAFE ANAESTHESIA LIAISON GROUP (SALG)
Patient Safety Update
April–June 2014
10
COMMUNIC@TION
The RCoA Trainee Committee aims to bridge the gap between trainees and the RCoA. We want to
hear about any issues you are experiencing during anaesthetic training so please do not hesitate to
contact us: trainee@rcoa.ac.uk.
If you have any suggestions for articles for either The Gas or the RCoA Bulletin then let us know. We
suggest that you contact us prior to writing an in depth article.
If you are moving house it is important that you update the College of this to allow continued
delivery of publications. This can be done quickly and easily using the online form.
You can contact us by email or by writing to us at: The Trainee Committee, Royal College of
Anaesthetists, Churchill House, 35 Red Lion Square, London, WC1R 4SG.
We look forward to hearing from you.
LIFEBOX FELLOWSHIP FOR SENIOR ANAESTHETIC TRAINEES
An exciting opportunity to make a significant contribution to quality improvement and
anaesthesia care in Uganda or Ethiopia.
Lifebox Foundation in collaboration with the Association of Anaesthetists of Great Britain
and Ireland, the Difficult Airway Society, World Anaesthesia Society and the Royal College of
Anaesthetists are looking to recruit two exceptional ST6+ UK anaesthetic trainees to undertake
Fellowships in Uganda and Ethiopia.
The Fellowships will commence in August 2015 or February 2016 and will be of 6-12 months
duration. The Fellows will be supported to develop and deliver a sustainable and high-impact QI
project in collaboration with local colleagues, in addition to taking part in delivery of anaesthetic
care. Upon completion of the Fellowship, Fellows can expect to have completed the ‘Anaesthesia
in developing countries’ and ‘Improvement Science, Safe and Reliable Systems’ units within the
RCoA 2010 Curriculum.
Application deadline: Friday 5 December 2014
Further details, including how to apply, can be found on the International Programmes webpage.
11
RCoA
EVENTS
EVENT ONLINE SERVICES
Revalidation
for anaesthetists
events@rcoa.ac.uk 020 7092 1673 www.rcoa.ac.uk/events
COURSES & EVENTS
FINAL FRCA REVISION COURSE
This course is designed to provide candidates with a detailed knowledge and understanding of topics
covered in the exam syllabus and identify what examiners expect from answers to exam questions
When: 12–16 January 2015
Location: The Royal College of Anaesthetists, London
Fee: £395
Further info: http://bit.ly/1zgY7zg
PRIMARY FRCA MASTERCLASS
This course is intended for those studying for the Primary FRCA exam and will only cover the key areas
in Pharmacology, Physics, Statistics and Clinical Measurement that candidates have difficulty with in the
examination.
When: 19–22nd February 2015
Location: The Royal College of Anaesthetists, London
Fee: £305
Further info: http://bit.ly/1zgY8n0
JOINT BECOMING A CONSULTANT EVENT (WITH THE AAGBI)
This joint Seminar with the AAGBI is for specialist trainees who are preparing to apply for a Consultant post
and for newly appointed Consultants. The aim of this Seminar is to give you an understanding of important
themes and issues that will affect you in your first year of Consultant life and how to deal with them. There
is also an opportunity to talk to all our speakers at the end of the meeting and learn from their experiences
and knowledge.
When: 4 February 2015
Location: The Association of Anaesthetists of Great Britain and Ireland, London
Fee: Please see website for fees
Further info: http://bit.ly/1zgYav7
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RCoA
EVENTS
EVENT ONLINE SERVICES
Revalidation
for anaesthetists
events@rcoa.ac.uk 020 7092 1673 www.rcoa.ac.uk/events
COURSES & EVENTS
BJA/NIAA RESEARCH METHODOLOGY WORKSHOP
The workshop will be useful for anaesthetists of any grade who are already involved in research or those
who are about to embark on a research project. Teaching sessions will address: developing a research idea;
study design; project management; analysis; presentation and interpretation of data; dissemination of
results. Group sessions will allow participants to: provide criticism of a published research paper; design a
clinical trial; detect common pitfalls in analysis and interpretation of data.
When: 9 March 2015
Location: The Royal College of Anaesthetists, London
Fee: £150
Further info: http://bit.ly/1zgYdai
ANNIVERSARY MEETING: BEYOND THE BOUNDARIES
The Anniversary meeting is an annual event which celebrates the creation of the Faculty in March 1948 and
the creation of the Royal College in March 1992. The topics for the meetings change annually and include
lectures presented by national speakers.
The topic of the two day meeting this year is ‘Beyond the Boundaries’ which focuses on some of the hidden
activities which we, as a profession support.
When: 10 March 2015
Location: The Mermaid Conference Centre, London
Fee: £415 (£315 for RCoA registered trainees and affiliates)
Further info: http://bit.ly/1zgYf1U
AFTER THE FINAL FRCA – MAKING THE MOST OF ST5-7
At this event explore how best to enhance your learning experiences in years ST5-7. Presentations from
experienced anaesthetists who specialise in paediatrics, neuroanaesthesia, regional anaesthesia and
cardiothoracics. Workshops focusing on management, teaching and research.
When: 17 March 2015
Location: The Royal College of Anaesthetists, London
Fee: £165
Further info: http://bit.ly/1zgYjP0
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