Dr Janice Fazakerley opened the meeting and welcomed everyone to the new academic year for the Society. She introduced the speaker, Dr Ellen O’Sullivan, the current President of the College of Anaesthetists of Ireland.
Dr O’Sullivan began her talk by telling the audience about her first experience at the Liverpool Medical Institution when she presented at the Registrar’s Prize meeting, which unfortunately she didn’t win. However, the content of her presentation was submitted to the British Journal of Anaesthesia, and published in 1988 (BJA (1988) 60(4); 367-371).
Dr O’Sullivan spoke about the history of anaesthesia in Ireland. The first anaesthetic was given on New Year’s Day 1847, when a surgeon, John McDonnell operated on a young woman with suppurative arthritis of the elbow joint. The outcome was successful with the patient feeling no pain and was discharged from hospital a week later. She then looked at the first paper in the BJA from Ireland, which was published in 1930. In the 1930’s, anaesthesia started to be organised both in the UK and Ireland with the formation of the Association of Anaesthetists in 1932, and DA exam in London in 1935. This was followed by a similar exam in Dublin in 1943. The Faculty of Anaesthetists of the Royal College of Surgeons of London was formed in 1947 and a similar body was shaped around the Irish College of Surgeons in 1959.
Dr O’Sullivan then discussed the achievements of Sir Ivan Magill, a man born in Northern Ireland and graduating from Queens in Belfast in 1913. His many achievements included the introduction of his own laryngoscopes, endotracheal and endobronchial tubes, and forceps. She spoke about he first Dean of the Faculty of Anaesthetists of the Royal College of Surgeons of Ireland, Dr Tommy Gilmartin, who coincidentally had worked and trained in Liverpool to become an anaesthetist and introduced curare into Ireland in 1945. He had been a founder member of the AAGBI in 1932 and subsequently became the first Professor of Anaesthesia in Ireland in 1965. The first scientific meeting of the Faculty of Anaesthetists of Ireland was held in July 1960 when Dr Gilmartin invited both Professor Cecil Gray from Liverpool and Dr Derek Wiley from St Thomas’s in London.
The next Irish anaesthetist that Dr O’Sullivan looked at was Dr John Dundee, who like Sir Ivan Magill before him, was also born in Larne and graduated from Queens University in 1946. He trained in Liverpool with Cecil Gray and became a senior lecturer in the Liverpool Department in 1951. He subsequently moved back to Northern Ireland where he had a major impact on training in anaesthesia in both the north and south of the border.
Dr O’Sullivan discussed the influence of Liverpool on anaesthesia in the mid-20th century. In particular, she singled out Cecil Gray and Jackson Rees as being very influential. Liverpool was one of the first postgraduate courses in anaesthesia starting in 1948 and attracted postgraduates from around the world preparing for the FRCA. Many subsequently went back to their own countries to become leaders in the specialty of anaesthesia. She spoke about other influential anaesthetists in Liverpool such as Professor John Utting and Dr J E Riding, the latter having been Dean of the British Faculty of Anaesthetists for 2 years in 1974, as well as being the fifth Editor in Chief of the BJA for 14 years from 1960. She put into context other well-known names from Liverpool such as Dr Tony Gilbertson who started the first adult critical care unit in Liverpool, and Dr Fred Mostafa who founded the Liverpool difficult airway course. She spoke about a couple of publications which she had written in association with other well-known figures in Liverpool such as Dr Gordon Bush, and Professor Jenny Hunter.
Dr O’Sullivan went onto talk about her move back to Ireland and the formation of the College of Anaesthetists of Ireland in 1998. The BJA had recently become the official journal of the College with two members of the College on the editorial board.
Dr O’Sullivan discussed the structure of training in Northern Ireland which mirrored the UK training post MMC. Ireland still had run through training in anaesthesia lasting six years and anaesthesia is the second most popular specialty in Ireland after general practice. The first two years of training in anaesthesia are similar to that in the UK with an initial test of competence and in-hospital training assessments. Successful passage through the membership exam of the College of Anaesthetists (similar to the UK Primary) is required to progress. The following three years of registrar training depend upon passing the final exam and successful completion of all units of training. This allows entry into the final year where a special interest is developed, leading to a certificate of completion of training. Dr O’Sullivan commented that all trainees have to come for simulator training twice a year at the College of Anaesthetists of Ireland, however, with only 300 trainees in the whole of the country, this was not the major logistical challenge it first appeared to be. The College of Ireland still inspects all hospitals where training is undertaken, something that was withdrawn by the GMC in the UK ten years ago. This happens on a five yearly cycle although can be triggered more frequently by trainee feedback. She noted that the Royal College of Anaesthetists had recently introduced the anaesthesia clinical services evaluation scheme which although not mandatory, she thought would help to assure standards in departments taking part in this exercise.
Dr O’Sullivan looked at the final year of training, or Fellowship year which had a similar concept to the advanced year of training for some areas of the RCA 2010 curriculum. Several sub-specialties including critical care, pain and paediatrics had examinations at the end of this year. A further year had been proposed post CCT in Ireland to become specialists in areas such as ICM and pain.
Dr O’Sullivan briefly looked at the structure of exams which mirrored the UK system of a membership exam consisting of an MCQ paper, followed by an OSCE and a structured oral examination. The final Fellowship was expected to be passed by the end of the fourth year of training. The issue of reciprocity between the UK and Irish exams, tended to be an issue more for trainees from Northern Ireland than for those from other parts of the UK.
Dr O’Sullivan then spoke about workforce challenges. 45% of anaesthetists in Ireland were consultants, with a further 25% being trainees and the remaining 30% being in non-training, non-consultant grades. More than a third of the anaesthetic workforce consisted of international medical graduates. In recent years due to the economic crisis that had engulfed the country, there had been a 30% cut in salaries for doctors. Consequently there had been an exodus of doctors from Ireland at a time when the country is trying to maintain its medical workforce. Ireland has just under 9 consultants per 100,000 population in comparison with the UK which has 15. It needs approximately 11 per 100,000 to become European working time directive compliant. Dr O’Sullivan voiced her concerns that Ireland was in danger of losing its best people, not just in anaesthesia but in other areas of medical practice. She then compared what was happening in Ireland to the situation in the UK. A report from September 2012 by the Royal College of Physicians reported that consultants felt under greater pressure compared to three years previously and over a quarter of medical registrars reported an unmanageable workload. Recruitment into emergency medicine is becoming increasingly difficult and there is a reduction in application rates in general medicine. In anaesthesia, some Deaneries had proposed a reduction of training numbers which had recently been strongly criticised by the Royal College of Anaesthetists, particularly in view of the impending report on the shape of the medical workforce by the Centre for Workforce Intelligence.
Dr O’Sullivan looked at Irish involvement in the AAGBI when an Irish standing committee had been established in 1988. Through this committee, a number of AAGBI publications had been produced, specifically relating to practice in Ireland. She discussed the involvement of the College of Anaesthetists of Ireland in training anaesthetists in the third world. In particular, it had become involved in training medical anaesthetists in Malawi. This had culminated in the production of a Masters in Medicine degree programme lasting 4 years, of which 1 year would be spent in South Africa. These doctors would then become the leaders of anaesthesia in Malawi in the future.
Dr O’Sullivan finished her talk by looking at the coat of arms of the College of Anaesthetists with its Latin motto which when literally translated means “safety while we watch”.
Dr Raymond Ahearn gave the vote of thanks.
23rd October 2013