The Structure

The pertinent Information

• Age, Gender, BMI, ASA, Type of Surgery
• Risk Level – High, moderate or Low risk
• Elective or Emergency/Urgent
• The main issues – some examples are:
  • Hemodynamically unstable (Emergency surgery?)
  • Is there a difficult airway? (Small mouth opening, poor neck extension, difficult BVM)
  • Is there an anaesthetic risk (Family history, bad experience with anaesthesia in the past
  • High BMI, poor exercise tolerance?
  • Significant cardiac or respiratory problems?
• How you would solve these main issues
• Location of hospital/Theatre
• Who do you need. Some Examples
  • Second Anaesthetist?
  • ICU involvement post operation?
  • Blood bank?
  • Tertiary Obstetric Centre?

Once you have summarised the pertinent information, you may continue to provide more specific details if necessary. This would include discussing –

• Previous problems with Anaesthesia – Post-op pain, PONV issues
• Family issues with anaesthesia – Anaphylaxis, malignant hyperthermia, sux apnoea, congenital cardiac issues/arrythmias
• Other issues found in each system – cardiovascular, respiratory, liver, kidney
• Medications (Cardiovascular, Respiratory, Corticosteroids, Diabetic, Anticoagulants)
• Allergies
• Fasting Status
• Reflux
• Examination findings
  • Airway Exam: Mallampati Score, Mouth Opening, Jaw protrusion, Thyromental distance, Neck Extension
  • Heart and Lung auscultation
  • Dental Examination
• Investigation Findings (ECG, CXR, Echo, Coags etc)

Many of these details can be found in the pre-admission clinic note if they have already been seen before the surgery. Otherwise, you may find this in their past medical notes. However it is always important to take another history of the patient in the anaesthetic bay prior to the surgery to ensure that all the information you have is correct.

Here is an example below of how one may be presented

Our next case is a 45 year old male with a BMI 28 who is going for a laparoscopic cholecystectomy. This is a low risk elective procedure. The main issue is that he has aortic stenosis, however we can manage this by monitoring him with an arterial line, and giving him 3mg of Midazolam, 300mg of Fentanyl and 25mg of Propofol on induction. We can also have some metaraminol on hand as well. The surgery will be happening in Theatre 10 at The Royal Melbourne Hospital. There would be no other special staff needed.

In more specific detail,

• GA/PONV/Post-op Pain/Fhx
• CVS/Lungs/Liver/Kidney issues
• Medications and Allergies
• Fasting
• Reflux
• Examination
• Investigations

Here are some other examples that you may practice on

• 40yo F, BMI 35 for large incisional hernia repair. She has had previous issues with PONV, and no family history of anaesthesia problems. She suffers from congestive heart failure and is on an ACE inhibitor, Beta blocker and Furosemide. No allergies. She is fasted however suffers from reflux. An airway examination demonstrates MP 2, MO 5cm, Neck circumference is large, Neck extension is appropriate, TMD is 7cm and Jaw protrusion is A.
  • 
    
• 78yo M, BMI 30, with a ruptured AAA who is going for a laparotomy who is rushed into ED. He has a past medical history of PVD, MI, stents, HTN and currently has a BP of 85/40. Past medical records notes he is on aspirin and clopidogrel, no allergies and suffers from reflux. An airway examination demonstrates MP 4, MO 4cm, Neck circumference is Normal, Neck extension is unable to be ascertained, TMD is 6cm and Jaw protrusion is A.
  • 

Conclusion

As you continue to use a structured format, the presentation of each case will become easier and almost monotonous. However, by having a systematic way to present the case not only allows the other person easily to digest the information but also allows you to sound more expertise about what you are doing. If your anaesthetist only has time to listen to the initial pertinent patient problems, having the rest of the history on hand on a piece of paper to show them later is not a bad idea either. An important point to note is that an excellent presentation can only come after an excellent history. It is a good idea to have the anaesthetic proforma (Link) to develop your skills in history taking when starting out.

Good luck!

Potential Answers

Example 1

Our first patient is [Insert Name] who is a 40 year old female with a BMI of 35 who is undergoing an incisional hernia repair. This would be a moderate risk elective surgery. The main issues with this case would be that

• she suffers from congestive heart failure for which from her notes she seems compliant on her medications of [Insert medications names].
• She suffers from reflux for which is not well controlled
• Large neck circumference.

My plan would be to use a rapid sequence induction to minimise the time needed to bag the patient due to potential difficulty from her large neck and to also protect the airway as soon as possible. For her heart failure, I would use 1mg/kg of Propofol for induction and 5mg of Midazolam as well as 50mcg of fentanyl. I would insert an arterial line and have metaraminol and ephedrine on hand as well.

In further detail.. [Anaesthetic History]

Example 2

Our next patient is [Insert Name], who is a 78yo M with a BMI of 30 undergoing a laparotomy for a AAA repair. This is an urgent high risk procedure. The main issues regarding this case would be

• Currently Hemodynamically unstable with a BP of 85/40 and currently haemorrhaging
• Currently on Aspirin and Clopidogrel, thus exacerbating his AAA
• Potentially difficult airway

My anaesthetic plan would be to do a rapid sequence induction with ketamine and to tube him with a video laryngoscope and a bougie. I would activate the rapid transfusion protocol and call the blood bank, notify ICU and the haematologist as well.

In further detail… [Anaesthetic History]

Dr Dan Tran

I remember the nervous excitement of my first anaesthesia rotation as a medical student. I was assigned a highly sort after 6 weeks at Monash Medical Centre (one of the largest public hospital systems in Australia) and I had little idea what to expect. I just knew that I had learnt very little anaesthesia in my medical student curriculum, and that I needed to perform well to impress my supervisors and hopefully lead to an anaesthesia training position in the future.

I didn’t realise how crucial this first rotation was for several reasons. Unlike medical, surgical and emergency rotations, this was an optional selective. Not every student is given the opportunity, and I found out years later that the first impression I made here probably set the tone of how this anaesthesia department perceived me into my future anaesthesia rotations.

Insider Tip #1: Make a great first impression

The difficulties in making a great first impression

• Lack of exposure in med school
• Anaesthesia is different
• Multiple consultants
• Newer and more procedures
• Lack of time

Lack of exposure

I realised that I have little recall of any anaesthesia lectures or assessments at all in my medical school days except for learning about the neuromuscular junction. I needed to find a resource ASAP to at least have an idea about was expected of me.

Resources I found useful as a medical student

How to survive anaesthesia was the first book I was recommended. The large books were far too detailed (Millers Anesthesiology). The Oxford Handbook of Anaesthesia was too brief and point form wasn’t easy to for comprehension.

Since then I’ve realised that Clinical Anesthesiology by Morgan and Mikhail is a great all round resource after learning the basics.

And a little plug for my ABCs of Anaesthesia Foundations course: it is a very practical compilation of everything you need to know, and actions/decisions you need to be able to make in your first anaesthesia rotation.

No matter what resources you have access to, having advice from a helpful mentor a year or two ahead was invaluable to uncover the nuances of that specific hospital and demystify the answers to all those little questions and uncertainties that I had.

Anaesthesia is just different. Every surgical or medical job felt more like an administrative position. I would be running around writing to-do lists, making sure work was completed, and then trying to make sense of complex patient plans, or get to theatre to watch a surgeon operate. Anaesthesia felt like I was in a real apprenticeship. My (supervised) daily tasks were:

• Check the theatre setup
• Assessment of each patient (I would take a detailed history lasting about 15 minutes, and my consultant would ask a few brief questions and be done in a minutes)
• Draw up the medications (not always a medical student role)
• Insert an IV cannula
• Transfer the patient
• Attach monitoring
• Manage the airway
• Complete the intraoperative anaesthesia chart
• Rinse repeat

Insider tip #2: Make a checklist of your daily tasks

Except for IV cannulation, EVERY TASK was novel. I felt great! The work was extremely engaging, I felt productive, and I felt like my learning curve was steep and rapid! I kept a logbook (with detailed notes of my learning points), and this was seen as very impressive by my supervisor. I have been recommending this ever since!

Insider tip #3: Keep a logbook

You might work with 10 different consultants/supervisors in 1 week! This is unheard of in any other specialty, but as anaesthesia is often the largest single medical department in hospital, this is common. While it’s great to have so many specialists to teach you, each of them may instruct you in a different and sometimes contradictory way. I found learning one reasonable approach difficult and frustrating. Again, being aware of this, accepting this and using strategies to mitigate this issue is critical!

I would just be appreciative of any learning at all. It felt like a privilege to have one to one tuition from a busy specialist. This rarely happens in any other field! If something was very different to another consultant’s approach or opinion, I would politely mention this other approach and ask why. This would often lead to an interesting discussion which I believe helped create rapport with my supervisor.

Insider tip #4: Ask consultant to justify their approach.

Anaesthesia has many procedures that you may even be able to help with as a medical student or junior doctor! IV cannulation, airway management – bag mask ventilation, LMA insertions, intubation, video laryngoscopy, setting up fluid lines, rapid infusion devices, high flow oxygen, regional anaesthesia, spinal anaesthesia, arterial lines, and central venous lines. The secret to getting these experiences is to know they are options for the case, be extremely prepared, and politely ask for the opportunity.

I’ll write a system for this in more detail in a future article.

Insider tip #5: Preparation leads to opportunity

Anaesthesia has multiple time critical incidents that makes learning a challenge. Every theatre list is busy, airway management = risk of desaturation, hypotension needs rapid meds. There’s just less time to think, ponder options, guide the trainee through a technique, wait for the trainee to act when things could rapidly go disastrously wrong!

So how do we manage to learn all the skills and techniques?

Time and creating opportunities.

Over 5 years of training, with diligent effort, and 2 big exams, most anaesthetists will have the experiences and incidents to be an effective and competent anaesthetist.

But how do you increase ‘time’ when doing a 1 to 6 week rotation? I think it can be achieved by taking a systematic approach.

• Arrive early to the theatre. You’ll need time to orientate, do all the tasks, and assess your patient.
• During the case, check the patient notes for the next case, and even go to see the next patient/have them called to theatre early to give you more time to assess.
• If you are going to do an IV or another procedure, set up your equipment in preparation. Again, request the patient to theatre earlier.
• Plan and know your steps with procedures and verbalise this as you perform the task (more on this in a future blog)

For example

• • Know to escalate bag mask ventilation attempts with 2 hands, manoeuvres like a jaw thrust, adjuncts like a Guedel airway,
  • Verbalise this plan -so your supervisor knows all your next steps and doesn’t intervene too early. You want to get as far as you can with your management before they intervene! The more confidence the boss has in you, the more time they will give you and the more opportunities you’ll have to learn

Insider tip #6: Plan, perform and project (verbalise) your procedures

• When intraoperative problems (hypoxaemia, hypotension) occur, engage in the 4 phase approach to resolution. Again plan, perform and project.

As a supervisor now, I realise that the process of learning is mutual exchange of thoughts. The rate of learning is much slower if the exchange of thoughts happens slowly. The simplest way to each this is verbalisation of ideas and plans as I am performing them, whether it’s airway management or managing a crisis. If the reasons for my actions are glaringly obvious, learning can occur without incorrect assumptions. Conversely, the verbalisation of my trainees’ thoughts means I can either agree or give feedback to why I would have used a different approach.

A few extra ways to make a good impression.

• Anticipate
• Read an article, ask a question with an opinion
• What next

If you can anticipate what your team needs, even at a junior level you can be extremely helpful and less of a hindrance (I’m sure we all felt this going through medical training, when we were high in enthusiasm and low in execution).

For example:

• Your supervisor is placing an urgent IV cannula, bring the sharps bin close to them…
• The patient has a complication, offer to make the referral to ICU
• Everyone’s busy running a difficult case, offer to complete the anaesthesia record to free up time

It is absolutely the role of trainees to ask questions and learn. This is encouraged! But I also know that much of what my teachers tell me, I may forget, and consultants get asked the same questions on repeat. To keep things interesting, why not read a recent or controversial article, form an opinion and quiz your consultant.

You’ve now had to work for your knowledge, formed more stable memory, and potentially sparked your consultant’s interest in something they may have not considered in a while! Check out more of my articles and also directly from journals like the BJA, BJA education, Anesthesia and Analgesia, The ANZCA Blue Book and any anaesthesia journal really.

If you find that you’re not doing much, try to think “what next?”.

• Ask if you can help with anything
• See the next patient
• Complete the anaesthesia chart
• Read an article
• Practice setting up equipment -Optiflow, fluid lines, fibreoptic scopes
• Explore the difficult intubation trolley, MH trolley, Anaphylaxis box, massive transfusion protocol…

I really hope that was useful and provided you with my insights from my experience teaching, medical student supervisor, critical care resident supervisor and as a specialist anaesthetist.

For my information for junior anaesthetists, check out my ABCs Foundations Course, it has everything you need to know in your first 12 months of anaesthesia practice.

Please ask any questions or comment below and share with anyone about to embark on a rotation in anaesthesia!

Good luck in your career!

Dr Lahiru

The ultimate role of the cover letter is to compel the reader to invite you for an interview. It should provide just enough information to convince the reader that you have the motivation, skills and experience suitable for a career in anaesthesia. Additionally, it should leave the reader believing that you have a genuine desire to obtain this role within their health service. Through your writing, the cover letter allows you to express elements of your personality and demonstrate your written communication skills.

A common way to approach the cover letter is to use the below three themes to form the body paragraphs of your letter. Included below are a few points to help get you started.

1) Outline your motivations for pursuing a career in anaesthesia

• What are the core reasons you are pursuing anaesthesia? Give this due consideration. Delve beyond an interest in physiology, pharmacology, and procedural medicine.
• You don’t have long to gain the reader’s interest – keep your introduction sharp and interesting.

2) Highlight key aspects from your CV and why these make you suitable for a career in anaesthesia

• Outline how several of your experiences have given you skills that will benefit your performance in the prospective role.
• What differentiates you from other candidates?
• Include examples unique to you that will help the reader to remember your cover letter.

3) Summarise why you are applying to this health service

Even if this health service is not your first choice, the reader should not be able to tell this.

For applications to external health services, speak to colleagues who work there to find out what is unique about their hospital. What opportunities exist at this health service that are not offered at your current health service? Find ways to acquire information beyond the hospitals intranet to demonstrate you have done your research.

If applying interstate, try and find a way to link your application to the region. Do you have family nearby? Did you grow up here? Health services ideally want to hire candidates who will work in the area at the completion of their training.

The cover letter is not an opportunity for you to provide an in-depth summary of your achievements to date – this is the role of your CV. Similarly, it is not a lengthy dissertation about the challenges of anaesthesia, or what you plan to do in ten years’ time. It should provide a snapshot of your application and serve as a professional introduction to who you are.

General advice

• Job advertisements will typically include instructions for the cover letter. Read these carefully, as they usually contain information including who to address the letter to, and specific details regarding what the letter should address.
• Start drafting your cover letters early to provide you with sufficient time for feedback and editing.
• Each letter must be specific to the health service you are applying to. Your letter should not look like it has been replicated for multiple applications. You need to start this early – researching health services and writing multiple cover letters is time consuming.
• Write impactful statements by using strong words and short sentences. The reader will not appreciate waffle.
• Avoid broad sweeping statements about skills. Provide evidence for the skills you wish to highlight by using examples.
• Selection committees skim through hundreds of cover letters for every role. Make yours memorable by painting a picture of who you are as a person (beyond a hardworking junior doctor who wants to become an anaesthetist). Briefly include appropriate non-medical information, such as unique interests or skills (e.g triathlete, skilled pianist, mountaineer).
• Do you best to avoid cliches such as ‘I enjoy pharmacology, physiology and procedural medicine’.
• Appreciate that your first draft will likely be very different from your final cover letter. Seek feedback from colleagues, especially anaesthetic registrars and consultants.
• Synthesising your motivations to pursue anaesthesia in the cover letter will assist you in preparing for the interview too!

Formatting tips

• This is a professional letter. It should follow the traditional format of a letter and be written to a high standard
• Address your letter to the appropriate people (and the correct health service!)
• Include your name and contact details
• Refer to the job title that you are applying for (and reference number, if applicable)
• Avoid jargon and abbreviations
• Use professional formatting (size 10-12 Times New Roman or Calibri)
• Use appropriate margins
• Your cover letter should be no more than a page
• Spell check, spell check, and spell check again

Conclusion

Creating a cover letter that is succinct and convincing is no easy feat. Read the instructions provided in the application guide carefully and start drafting your letter early. Short sentences and professional language will assist you to clearly highlight your skills, experience, and points of difference. Seek feedback from your colleagues early and be prepared to make many revisions. A well written cover letter will strongly assist you in progressing through to the interview stage.

Planning your Resume

The process of creating your resume starts well before drafting the document itself. It begins with reviewing your experience, identifying your deficiencies, and creating a plan to overcome these. Planning your resume should commence soon after you decide on the career path you wish to pursue. At this point, it is useful to review the selection criteria for your desired role so that you can tailor your Resume toward this over the subsequent years. For those interested in anaesthesia, start by reviewing the selection criteria for your state’s anaesthesia training scheme, alongside the ANZCA ‘roles of practice’ statement.

Once you are familiar with the desired candidate attributes for your preferred role, utilise the suggested resume headings below to make a list of your experiences and achievements. To determine the skills and achievements you wish to highlight in your Resume, write down 5 achievements that you are most proud of, and list 3 things that differentiate you from other candidates. Ensure these elements are clearly highlighted in your CV.

Depending on the stage of your career, the resume subheadings will be filled to varying degrees. Don’t be alarmed if you are not able to fill every heading – identifying deficiencies in your skills and experience is an important part of the process. Make a note of areas in which you wish to improve, and devise a realistic plan to achieve these goals.

When planning how to fill deficiencies in your resume, keep in mind that the selection panel will consider the time commitment and your contribution to each listed achievement or activity. Completing a graduate certificate will award you more points than a short two-day course, while original research will demonstrate a greater time commitment compared to a simple audit. Note that while much can be achieved in a short time (courses, audit, volunteering), some tasks, such as original research, will take longer to complete.

Preparing your Resume

General advice

• The standard required for applications to resident and registrar roles is high. Disregard your high school resume and start again.
• The content of your resume should be consistent for the discipline and level you are applying for.
• Your resume is not only a record of your employment, skills, and achievements, but an opportunity to summarise how these align to the skills and qualities required by the prospective role.
• Only include recent information (within 5 years, or 10 years if particularly impressive).
• Give context to roles and activities. Succinctly list your responsibilities, skills, and what you achieved.
• Only include information that you believe will add value to your application. Listing too many irrelevant achievements can make your resume difficult to assimilate.
• Outline your specific contribution to research or other activities.
• Avoid sweeping, general statements about skills.
• If you highlight a skill, provide specific evidence to support this claim.
• Place achievements that differentiate you from other candidates high up in your resume.
• Consider modifying your resume to align with the strengths of your prospective hospital – e.g. if there is a strong research focus (and this is one of your strengths) place this section higher up in your resume. If the hospital prides themselves on their perioperative service, make sure your experience in this domain is highlighted clearly.
• Small details such as formatting and spelling are important. Errors demonstrate a lack of attention to detail and look unprofessional.
• Ask multiple registrars and consultants for feedback on your resume.

Resume structure

It is vitally important to present the information in your resume professionally, succinctly, and clearly. Subheadings should be used to help organise your experiences and achievements in a logical way. Medical resumes are typically organised using the following subheadings. Note that the exact title of the subheadings is variable. You may wish to merge subheadings with fewer examples.

• Personal identifiers – name, demographics, photo
• Education and qualifications
• Medical training and experience
• Awards and achievements
• Leadership, advocacy, and representation
• Professional development
• Research and quality improvement
• Personal interests

The exact order of these subheadings will depend on your strengths, the role you are applying for, and the narrative you wish to convey to the reader. To assist in helping you stand out from the crowd, it is helpful to place the most relevant and impactful achievements high up in the resume, alongside achievements which differentiate you from other candidates.

Formatting tips

• The layout should be simple, professional, and easy to navigate
• Content should be listed reverse chronologically (start with the most recent)
• This is a professional document, avoid excessive use of colour
• Use consistent formatting (font, size, spacing, indents). Consider size 11-12 Times New Roman or Calibri
• Use appropriate margins
• Consider using bold text and underlines to daw the reader’s attention to key words
• Avoid abbreviations
• Include page numbers
• Your resume should be no longer than 3 pages if possible

Conclusion

Candidates attribute years of time and effort into the achievements listed within their resume. Increase your competitiveness for critical care roles by familiarising yourself with the relevant selection criteria and develop a plan to overcome areas of deficiency. Allow your skills and achievements to shine by including only recent and relevant information, and by adopting a professional, consistent, and well-structured format. Do not forget to spell check, spell check, and spell check again.

For further tips on preparing your resume check out this article from the BMJ.

Most resident and registrar roles require at least three written references which are usually completed online. The referee form typically covers the domains of clinical competency, verbal and written communication skills, and personal and professional conduct. Referees are asked to provide a numeric score (often between 1 to 5) to reflect your performance in each domain. Anecdotally, referees tend to score candidates quite highly resulting in a narrow range of cumulative scores between candidates. Because of this, it is recommended that you encourage your referees to provide comments in the allocated section under each domain. This provides an opportunity for your referee to advocate on your behalf and provide comments which may convince the selection panel to allocate you one of the highly sought-after interview slots.

Choosing the right referee

There are several important factors to consider when selecting the most appropriate referees. Firstly, you should select consultants who have spent enough time with you that they can provide a strong and complete reference. They should be someone who you believe thinks highly of your personal and professional attributes, and clinical skills. This can be difficult to gauge, especially as junior doctors may only work with the same consultant on a few occasions. Make note of positive feedback you receive during your rotations, and of strong connections you form within critical care departments. The friendliest consultant is not necessarily the most suitable referee. Referees should be current – ideally someone you have worked alongside within the last 12 months. Be sure to review the referee requirements outlined in the job application – many of these will request at least one referee be your current clinical supervisor.

When applying for resident level positions, it is advantageous although not compulsory to obtain a reference from a consultant anaesthetist. If you have not yet spent time within the anaesthetics department, consider using referees from other critical care rotations you may have completed. When applying for registrar level positions, consultant anaesthetists should make up the majority, if not all your referees. This will not be an obstacle for most applicants, as 3 to 6 months experience in anaesthesia is a pre-requisite for applying to the anaesthetic training scheme in many states in Australia.

The referees you select should be specific for the health service you are applying to. If you are applying to your current health service, the most appropriate referee is not necessarily the head of department or a supervisor of training, rather someone who you believe will advocate for you strongly. For applications to external health services, consider using at least one consultant who works regularly at both health services. It is not uncommon for selection panels to seek informal verbal insight about external applicants in addition to the formal referee report. Conversely, if your referee is motivated and believes you are a particularly strong candidate, they may approach the selection team to vouch for you in person.

How to approach referees

You should start thinking about potential referees early. At the end of your rotations, supervising consultants may offer to provide a reference in the future. This is typically a positive sign and an indication that you have impressed them. Often however, you will need to seek out referees yourself.

Approaching prospective referees can be a nerve-wracking experience. One way to reduce these nerves is to first gauge a consultant’s opinion of your performance by regularly asking for feedback. If you are unsure about how to go about asking for a reference, consider using something similar to this:

“Hi Dr X, I have really enjoyed spending time with you in theatre over the last few weeks. As you may be aware, job applications for the resident roles are coming up soon, and I am hoping to secure one of the anaesthetic resident positions. Based on your observations of my performance within the department, would you be willing to provide a strong reference to support my application?”

Chances are the consultant will feel flattered and will happily oblige. However, do not be disheartened if your request is declined. Most consultants who decline to be a referee do so because they either do not believe they have adequately observed your skills to provide a complete reference, or they do not believe that they could provide a strong reference. In these situations, it is in your best interest to find alternate options.

Submitting your references

Once you have secured your referees, inform them of the positions you are applying for, when to expect the referee forms, and the dates that these are due. Kindly ask that they inform you once the form is submitted so that you can keep track of all your applications. It is common to ask referees to provide a reference for multiple applications which can be time intensive. Be sure to thank your referees for their time and keep them up to date with the outcome of your applications. It is a nice idea to keep in touch with your referees after the application process, especially as you may wish to use them again for future applications.

Tips for success

• Be familiar with the referee requirements of the positions you are applying for.
• Think about potential referees early and approach them well in advance.
• If possible, use at least one referee who is known to the health service you are applying to.
• Select referees you believe will provide a strong reference on your behalf. This is not necessarily the friendliest consultant or the head of department.
• Registrars can provide useful insight into their experience using referees at your hospital.
• During your anaesthetic rotation, ask if you can be allocated increased theatre time with your intended referees to increase your exposure to them.
• Familiarise yourself with the referee form and the criteria you will be scored against. Work to improve in areas that you may be deficient in.
• Most referee forms have a section for teaching and research. Discuss your experience in these domains with your referee so they can score in these areas. Provide your referees with a copy of your CV to facilitate them scoring the referee form.
• Encourage your referees to complete the comments section on the referee form.
• Ensure your references are submitted well in advance of the due date and that you have confirmation from the health service that they have been received.

Conclusion

Strong referees are vital to your success in obtaining an interview for critical care roles. To optimise your chance of success, familiarise yourself with the referee requirements of the prospective position, seek out referees early and submit them in advance. A strong referee who believes in your potential is an extremally valuable person to have by your side.

Navigating a new career path can be daunting. This is especially true for junior doctors seeking to pursue competitive medical specialties. For prevocational doctors interested in anaesthesia it can be difficult to know how to excel in your anaesthetic rotation, how to position yourself strongly for a trainee position, and how to overcome obstacles you might experience along the way. Mentorship plays a critical role in the training and career development of junior doctors, and is a powerful tool that can assist doctors to navigate the turbulent journey from internship to specialty training. In this blog – we explore how to find (and keep) the right mentor, and the potential benefit this person can bring to your professional life.

Why have a mentor?

The process of mentorship has the potential to bring significant benefit to both the mentor and mentee. If you are interested in pursuing a career in anaesthesia, mentorship with a senior peer in critical care may be able to assist you in the following ways:

• General career and rotation advice.
• Advice specific to the anaesthesia training pathway – from referee selection through to the interview preparation. Advice from senior peers has the potential to significantly strengthen your application for critical care roles.
• Assistance with cover letter preparation, CV review, and interview practice.
• Assistance in identifying realistic career goals and planning to achieve them.
• Provides an opportunity for feedback on clinical skills and professional development.
• Provides a platform for debriefing.
• Enhanced networking which may lead to new opportunities – such as research or audit.
• Creates a professional support to help you celebrate your wins and bounce forward from your struggles.
• Potential for ongoing mentorship as you progress through various stages of your career.
• Your experience as a mentee will greatly inform your role as a mentor down the track.

Several of the benefits available to the mentor included the development of communication skills, expansion of one’s professional network, and the opportunity to reflect on one’s own practice and goals.

Step 1 – Find the right mentor

Finding the right mentor is the most important step in the mentorship process. Start by considering those in your professional networks who you look up to or admire. Broadly speaking a mentor should be approachable, responsive, flexible, honest, and have a genuine interest in the development and wellbeing of junior staff. Look out for these qualities in your clinical encounters – this may or may not be someone you already know. Following this, consider the kind of guidance or advice you are seeking, and who might be best suited to provide this. The perspective of a senior anaesthetic resident will be different yet equally important compared to that of an anaesthetic consultant. Forming strong relationships with individuals at all levels of training will bring you a breadth of perspective, experience, insight, and opportunity.

Your ability to identify a potential mentor will largely depend on the amount of time you have spent in a particular hospital or department, and the quality of relationships you have built with your senior peers. If you are new to a department or relatively junior, this process can be challenging. Many hospitals offer mentorship programs that pair medical interns with residents or registrars with similar professional interests – take advantage of this if available to you. If your hospital does not offer a mentorship program, keep an eye out for supportive residents and registrars. Some of the most useful advice I received early in my career came from surgical registrars and discussions with residents on night shift.

As you progress through your early clinical years you will work in a variety of clinical settings. If you are one of the lucky few to receive a rotation in anaesthesia – use this opportunity to get to know the registrars and consultants well. By the mid-point in your rotation, you should be able to identify at least one person who could be a suitable mentor. Take initiative and explore this with them.

If you do not have direct exposure to anaesthetic residents and registrars, you will likely come across them during your time in theatre, the emergency department, and the intensive care unit. Introduce yourself and show interest in their work. Often, they will be happy to share their journey to specialty training with you and impart some words of wisdom (especially if they are well caffeinated!).

Take a minute now to pause and reflect – do you currently have a mentor? If not, can you identify a colleague who has shown a genuine interest in your career aspirations, or perhaps a registrar who has been keen to take you under their wing? Mentorship can be both intentional or incidental, and is often not formalised. Chances are there are already people in your current professional networks who provide elements of mentorship to you. These people are important – maintain these relationships.

Step 2 – Formalise the relationship

Though much of the mentorship you receive throughout your career will be informal, there are benefits to formalising some of these relationships. Formalising a mentorship creates an environment for you to establish goals and expectations for the partnership, increases engagement with and commitment to the process, and can promote feedback that is more frequent and structured. Once you have a potential mentor in mind, consider these tips to formalise the mentorship:

• Find a suitable time to raise the idea of a formal mentorship. Ensure they understand this is an option and not an obligation. Express why you are seeking a mentorship, what you hope to get out from the experience, and why you think this person would be a good fit for you.
• Gauge their interest, and approach the situation with the awareness they may politely decline. Anaesthetic trainees and consultants have many competing demands and may not feel they have the time or experience to invest in a mentorship.
• Discuss your goals for the partnership, specify the type of guidance or feedback you are seeking, and discuss logistics of how the mentorship will work.

Step 3 – Maintain the relationship

Once you have formalised a mentorship, commitment and planning will help maximise the experience for both the mentor and mentee.

• Schedule and attend regular meetings with your mentor
• A mentorship is a professional relationship. Have boundaries and respect them.
• Reassess the relationship as time goes on. Is the mentorship serving the purpose it set out to achieve? Are both parties engaged?
• Appreciate that it may be appropriate to seek alternate or additional mentors as you progress through different stages of your career.
• Show gratitude for your mentor’s time and support.
• Pass it forward by mentoring those who wish to follow in your footsteps.

Conclusion

As you navigate the road from internship to specialty training, consider the difference mentorship could make to the success of your journey. The wisdom and experience of those who have successfully navigated the path before you are powerful tools at your disposal. By seeking and maintaining formalised mentorship throughout your career, you will continuously bridge the gap between where you are and where you want to be. The power of mentorship should not be underestimated.

The idea of contributing to medical research typically evokes a strong range of reactions from junior doctors. Many revel at the chance to advance scientific knowledge, while others despair at the thought of trying to fill the empty space that sits beneath the ‘research and audit’ heading of their CV. Regardless of your level of enthusiasm towards it, research is an important aspect of medical training that has the potential to give you a competitive edge in applications for critical care jobs. Now that I’ve piqued your interest – what’s the smartest way to get involved, and how can you reap the greatest reward for your efforts? Continue reading to find out.

Why get involved?

There are many reasons why medical students and junior doctors seek to get involved with research. Common reasons include:

• For publication (often with the aim of increasing CV points)
• To create opportunities for conference presentations/posters (see above)
• To present findings at hospital/department meetings
• To form professional relationships with people working in their desired profession
• To become ‘known’ to a department
• To gain research and analytical skills
• To demonstrate interest in an area of medicine
• To gain expert insight into a topic
• To pursue a genuine interest in medical research
• For the broader benefit of medicine
• Course/college requirements

Individual motivations for getting involved with research are varied, and reflect many of the benefits you can expect from completing a project. Beyond the advantages listed above, research provides an opportunity for prevocational doctors to demonstrate their suitability for a career in anaesthesia through alignment with the seven key ‘Roles of Practice’ for anaesthetists as described by ANZCA. These roles include that of a medical expert, communicator, collaborator, leader and manager, health advocate, scholar, and professional. Demonstrating behaviour consistent with these roles can signal to others that you are a suitable fit for the profession, and will give you plenty to talk about in the interview!

Before you embark on your first project – it is wise to consider the expected level of involvement with research for someone at your level. As a medical student or prevocational doctor, you are not expected to design, recruit, and complete your own randomised controlled trial. Nor is it imperative that you are first author on a published journal article (although this is great if you are!). In general, it is expected that junior doctors demonstrate an interest in academia by contributing to one or two research projects or audits through data collection, analysis, or manuscript preparation. Given the competitive nature of anaesthetic resident and registrar jobs however, many candidates will strive beyond this and contribute significantly to multiple projects. Getting involved early and choosing your project wisely are two of the greatest keys to your success – more on that later.

To get you started, here are examples of the type of projects you could get involved with:

• Literature review
• Systematic review or meta-analysis
• Data collection for an established project
• Data analysis for a smaller sub-study (larger studies will usually be authored by registrars or PhD candidates)
• Retrospective data analysis for previously collected data
• Clinical audit

How to get involved

Medical students

Most medical students are required to complete a research project as a part of their degree. This is the ideal opportunity to kick start your involvement with research and start building professional connections. If you have identified that you are interested in anaesthesia early – great! Reach out to anaesthetists involved in teaching at your clinical school or approach the anaesthetics department affiliated with your university. This is a great way to make yourself known to the anaesthetics department early, especially if you are hoping to continue working at this hospital as a junior doctor.

If you are involved with research in a non-critical care field – do not worry! Any research experience is worthwhile and will look favourably on your CV. To make the most of this opportunity, see the ‘tips for success’ section below.

Interns/residents

Internship and residency are a busy time for junior doctors, and it is important that the development of clinical skills and sound clinical judgement are prioritised during this time. Alongside this, it is important to prepare and plan for future roles and specialist college applications. For the prepared candidate, this will involve participation in research or audit activities. It is important to seek out opportunities early to provide yourself for ample time to complete, submit and present your work.

Approach your hospitals department of anaesthesia early and find time to meet with the head of research. Note that despite your enthusiasm there may not be any projects currently available, and understand that departments must prioritise these opportunities for their trainees for whom completing a scholarly project is a college requirement. Do not be disheartened by this! Persist. Chat with some of the anaesthetic registrars at your hospital and offer to assist with data collection for their scholarly project. Ensure it is widely known that you are keen to get involved in any capacity, and ensure key clinicians have your contact details should a project become available.

While it is ideal to seek out opportunities within your hospital’s anaesthetics department for the benefit of networking, it is wise to look for opportunities within non-critical care rotations too. Involvement in a project outside of your specialty of choice demonstrates broad engagement with your clinical rotations, and affords you many of the skills you would acquire through anaesthesia-based research.

Tips for success

• Get started early! Research takes time, and usually longer than you think.
• Team up with a colleague or jump onboard a project that is already underway. The process of obtaining ethics approval can be time consuming – joining an established project can save you a lot of time.
• Find (or design) a project that you are genuinely interested in. Your best work will come from a topic that interests you.
• Find a supervisor who is supportive and responsive. This is important. Registrars can often steer you in the right direction.
• Ensure the project is realistic and achievable. Do not over commit yourself.
• Discuss expectations and goals with your supervisor and associate researchers early (authorship, frequency of meetings, timelines).
• Set a timeline and stick to it where possible.
• See your project through to the end. The time scale to reward in research can be long, however it is a worthwhile endeavor.
• Submit for publication early. Give yourself enough time to respond to feedback and have your work published well before job applications are due. ‘Manuscript in preparation’ is not nearly as rewarding or impactful as having the article published.
• Capitalize on your efforts by seeking opportunities to present your work at your hospital and at local and international conferences.
• Get involved with additional projects in a reduced capacity (e.g., assisting a registrar with data collection). This is a great way to expand your research experience (and score another publication) without a huge time cost.
• Be clear about your involvement with the project in your CV. Describe your contribution.
• If research isn’t your ‘jam’ – don’t fret. Research is just one component of your CV, and it is okay to place your efforts in areas of your CV which you may be more passionate about. Regardless, evidence of some exposure and participation with research is strongly recommended.

Conclusion

Whether you love or loathe the idea of research, there is much to gain from getting involved in research and audit projects early in your career. Chose a topic that is right for you, and collaborate with colleagues to share the workload and learn from each other. Capitalise on your efforts by submitting your work broadly to conferences, and present your findings at a department meeting at your hospital. The time you invest in contributing to research will yield strong dividends if you see it through to the end.

Critical care disciplines, especially anaesthesia, are becoming increasingly popular. It is now commonplace for Australian tertiary hospitals to receive several hundred applications for only a handful of positions. Trying to work out the best strategy to secure one of these jobs can feel like a bit of a gamble. However, unlike going to the casino, there are several ways that you can stack the odds in your favour.

Engaging in continuing medical education (CME) is one useful way to gain exposure and demonstrate enthusiasm to your specialty of interest. Because training positions are so highly sought after, many junior doctors hold their cards close so as not to give away their competitive edge. For those early on in their career or hoping to break into the field of anaesthesia, it can be difficult to know where to begin with extracurricular courses. This post aims to explore the potential value that CME can bring to your clinical work and job applications, and contains a list of courses that will be of benefit to those wanting to pursue a career in anaesthesia.

Continuing Professional Development (CPD) refers to a range of activities designed to meet individual learning needs and ensure the delivery of safe, current, and high-quality healthcare. CPD activities range from practice-based reflective tasks – including clinical audit, peer-review and performance appraisal, through to participation in CME through courses, conferences and online learning. As a medical student or junior doctor, chances are you have engaged with several of these activities already. In Australia, CPD requirements are mandated and monitored by the Medical Board of Australia, and for anaesthesia and pain medicine, the CPD standard is set by ANZCA. Beyond being a regulatory requirement, CME can benefit your clinical work and career progression.

For those early on in their career, CME provides an opportunity to quickly develop knowledge and skills in an area of interest to the learner. As you progress, participation in CME can be used to demonstrate engagement with and enthusiasm toward your specialty of interest. In fact, CME is possibly the easiest component of your curriculum vitae (CV) to modify and expand. Whilst you should not rely on an exhaustive list of courses to secure a job or position on a training scheme, completion of certain courses is often expected, and consistent engagement with courses will only look favourably in your application.

Through providing learners with skills and knowledge, medical education can lead to increased confidence and clinical competence. This is important for professional growth, and can assist you with making a strong impression on your clinical team and potential referees. Further, regular engagement with medical education demonstrates self-directed ownership of your own education. This is important – because the ability to balance learning alongside working fulltime can demonstrate that you have the maturity and stamina necessary to  prepare for and succeed in specialty training exams. This is something that many employees actively consider when deciding who is most suitable for the position.

CME is delivered in a variety of formats – including short online modules, multi-day intensive courses, through to higher-level degrees. While several formal learning opportunities are free, the majority come with a cost. To help cover this cost, doctors are provided with a fortnightly CME allowance (check your payslip!) and courses are tax deductable. Although it may come at a cost, structured learning is a worthwhile investment in yourself and your career.

Below is a list of critical care courses that you may wish to consider participating in, depending on your experience. This list is by no means an exhaustive collection of available courses; nor is it a list that you should aim to work through in its entirety. Rather, this list contains many of the courses that my peers and I have completed and enjoyed, and that I believe will bring value to your clinical work and job applications. Many of these courses are run online and instantly accessible, however some are delivered in-person and have long waitlists due to COVID-19 restrictions. Courses directed at registrar level and above only have not been included in this list. Courses are listed in alphabetical order under each subheading.

In-person delivery

Advanced Life Support (ALS) 2

Content: Lectures, practical workshops, moderate fidelity simulations, assessment and certification.
Duration: 2 days
Cost: $600-1200. Hospitals generally provide significant discounts for their own staff.
Available: https://resus.org.au/

Anaesthesia Crisis Resource Management

Content: Covers the key principles of crisis resource management and explores the dynamics of effective team communication through high-fidelity simulation and focused debriefing.
Duration: 1 day
Cost: $610
Available: https://central.csds.qld.edu.au/central/courses/5

Basic Assessment and Support in Intensive Care (BASIC)

Content: Covers fundamental knowledge and skills required for junior medical staff working in intensive care units. Includes a combination of lectures, problem-based learning, and hands-on skills stations.
Duration: 2 days
Cost: Variable $550-800
Available: Widely available

Early Management of Severe Trauma (EMST) – RACS

Content: Teaches a systematic, concise approach to the care of a trauma patient, providing a safe and reliable method for immediate management of injured patients in the first one to two hours following injury. Highly interactive and includes skills stations and scenarios.
Duration:  2.5 days (or 6 sessions broken up over multiple evenings)
Cost: $3090
Available: https://www.surgeons.org/en/Education/skills-training-courses/early-management-of-severe-trauma-emst

*This course is considered equivalent to the Advanced Trauma Life Support course. Consider completing either of these courses once on the anaesthesia training program, as it can be used to facilitate exemption for volume of practice requirements for trauma exposure.

National Airway Training Course for Anaesthesia Trainees (NATCAT)

Content: Hands on skills stations, basic and advanced airway management, high fidelity simulations, problem-based learning.
Duration: 1 day
Cost: $495
Available: https://www.thermh.org.au/health-professionals/continuing-education/anaesthesia-and-pain-management-courses/natcat-national

Skills training for Anaesthesia Residents (STAR)

Content: Combination of hands-on skills stations, low-moderate-high fidelity simulations, problem-based learning, non-technical skills, CV and interview advice.
Duration: 1 day
Cost: $650
Available: https://www.thermh.org.au/health-professionals/continuing-education/anaesthesia-and-pain-management-courses/star-2018

Teaching on the Run – PMCV

Content: Uses theory and applied learning to demonstrate how to plan and deliver learning for small and large groups, effective skills and clinical teaching, assessment fundamentals and feedback.
Duration:  2 days (or 6 sessions broken up over multiple evenings)
Cost: $630
Available: https://www.pmcv.com.au/education-training/teaching-on-the-run/

Online

ABC’s of Anaesthesia Boot Camp – Anaesthesia Collective

Content: Provides a step-by-step practical approach to anaesthesia that aims to help participants make the most out of rotations in anaesthesia. Includes structured approaches to patient assessment and management, reinforced through interactive problem-based learning. Additionally presents practical information about how to arrange your rotation, how to get the most out of working with a consultant, and advice for getting a favourable reference.
Duration: 1 day, online
Cost: $250, which is donated in entirety to a charitable cause
Available: https://www.anaesthesiacollective.com/courses/the-abcs-of-anaesthesia-boot-camp/

Better Pain Management – ANZCA

Content: This program delivers a multidisciplinary understanding and contemporary approach to the assessment, diagnosis, and management of those experiencing persistent pain. Includes interactive modules, problem-based learning, and visual animations.
Duration: 12 modules, 1 hour per module
Cost: $315
Available: https://www.anzca.edu.au/education-training/cme-courses-and-resources/better-pain-management-course

Perioperative Medicine in Action – University College London

Content: Provides an interactive introduction to perioperative medicine, decision making and risk assessment, protocolised care pathways and perioperative care of the elderly.
Duration: 4 weeks, total 12 hours
Cost: Free
Available: https://www.futurelearn.com/courses/perioperative-medicine

Perioperative Medicine Short Course – Monash University

Content: Covers 12 topics related to perioperative medical management delivered through interactive modules which include videos, podcasts, links to key papers and online resources, and practical clinical scenarios. Content is delivered by experts in that field and updated annually.
Duration: 12 weeks, online
Cost: $1400
Available: https://www.periopmedicine.org.au/index.php/pmsc-home

Ultrasound Guided Regional Anaesthesia – Lightbox Radiology

Content: Online lectures and interactive quizzes covering ultrasound guided regional anaesthesia of the neck, upper limb, lower limb, and trunk, as well as principles of ultrasound guided interventional techniques.
Duration: 6 modules, 1 hour per module
Cost: $210
Available: https://lightboxradiology.com/course-details.aspx?c=1156

Higher education

Clinical Ultrasound – Graduate Certificate/Diploma/Masters

Provider: The University of Melbourne
Content: Covers a broad curriculum of the theory and application of clinical ultrasound. There is particular focus on echocardiography, with increasing emphasis on transoesophageal echocardiography at higher levels. This opportunity is best complemented with clinical echocardiography exposure which is to be organised by participants within their local health networks.
Duration: Varies. Online only.
Cost: $8000-$30,000
Available: https://study.unimelb.edu.au/find/courses/graduate/master-of-clinical-ultrasound/

Medicine (Critical Care) – Graduate Certificate/Diploma/Masters

Provider: The University of Sydney
Content: Over 58 available units which explore a broad range of topics from perioperative care through to retrieval medicine. Includes units in physiology, pathology and pharmacology designed to cover some of the Primary or First Part syllabus requirements of the Australian and New Zealand College of Anaesthetists, the College of Intensive Care Medicine, and the Australasian College for Emergency Medicine. Anaesthetic specific units available, including neuromonitoring in anaesthesia, and acute pain.
Duration: Varies. Delivered online with some face-to-face intensive workshops.
Cost: $8,000 – 31,500
Available: https://www.sydney.edu.au/courses/courses/pc/graduate-certificate-in-medicine-critical-care-medicine.html

Medicine (Perioperative) – Graduate Certificate/Masters

Provider: Monash University
Content: This course explores a wide range of topics including perioperative medicine and cardiovascular disease, acute perioperative medicine, human factors and leadership, health economics, perioperative outcomes and the use of protocols and pathways. The Master’s degree includes both a theoretical and a practical capstone project.
Duration: Varies. Online with face-to-face intensive workshops.
Cost: $13,450 – $26,900
Available: https://master.periopmedicine.org.au/

If you have any questions please comment below!