Author: Dr Lee Jervis, Anaesthesia Provisional Fellow, West Australian Rotational Training Program. Currently working as an anaesthesia fellow at Mount Sinai Hospital, Toronto.
Disclosure: I do not currently have any involvement with trainee selection and much of what is listed below is based on information provided on the ANZCA website or my own opinion based on my training experience.
An overview of ANZCA training
- Australian and New Zealand College of Anaesthetists (ANZCA)
- Doctors who successfully complete the 5-year ANZCA training program receive a Fellowship of the Australian and New Zealand College of Anaesthetists (FANZCA).
- ANZCA training is state-based, meaning that you apply to a regional training program and complete the first 4-years of anaesthesia training in your region.
- ANZCA training includes the following stages:
- Introductory training (6 months)
- Basic training: Level 1 (6 months) and level 2 (12 months)
- Advanced training: levels 1 and 2 (24 months)
- Provisional fellowship year (12 months)
- Assessments
- Exams:
- Part 1 (primary) and Part 2 (fellowship) exams.
- Each exam requires approximately 1000 hours of study over the course of a year.
- Work-based assessments (throughout training): Case-based discussions, mini-CEX, directly observed procedures, and multi-source feedback.
- There is a minimum volume of practice to meet during each training period.
- There are 11 specialised study units (SSUs) that must be completed throughout training.
- Exams:
- Post-training
- Many doctors who receive their FANZCA at the end of the 5-year training program will then progress to consultant positions in the public and/or private setting.
- It is becoming more common for newly graduated FANZCAs to complete additional training in subspecialty areas before moving into a consultant position.
- Overseas and interstate fellowships are popular undertakings and highly encouraged.
What are the entry requirements?
- Entry requirements are largely set by individual regional selection committees (states may differ)
- The general requirements for selection into ANZCA training includes:
- Completion of 24 months of training as a junior doctor after completing medical school.
- Experience: Candidates may accumulate up to 12 months of critical care (anaesthesia, ICU) during their first 2 years, however, there is a strong focus on ensuring that applicants have sufficient general hospital experience. It is therefore recommended that prospective applicants look to complete terms in medicine, surgery, emergency medicine, and other fields of interest to the applicant.
- More information on entry requirements is available at: https://www.anzca.edu.au/education-training/anaesthesia-training-program/training-as-an-anaesthetist
What are the features of a competitive candidate (in my opinion)?
- Experience in critical care medicine: I would encourage prospective candidates to undergo a 6-month perioperative anaesthesia resident term as well as seek rotations in intensive care, emergency medicine and coronary care, in addition to varied medical and surgical rotations. Registrar-level experience in a critical care field is looked upon favourably.
- A commitment to ongoing learning and advocacy: A professionally well-rounded individual who has experience in quality improvement or research, post-graduate studies, teaching, well-being, and advocacy.
- Communication (verbal and written) and teamwork skills: You need to be able to demonstrate this in your selection criteria, CV, interview, and simulation scenarios (part of the WA rotational training program selection process) and these qualities should be reflected in your reference reports.
- General personality traits: Ability to remain calm, clear-headed, and focused in stressful situations, adaptable, resilient.
How difficult is it to get onto anaesthesia training?
- ANZCA training is very competitive.
- Whilst every state is different, in Western Australia, there are approximately 100-120 applicants per year and approximately 10-20 are accepted into the training program. The number of positions offered each year depends on number of senior trainees exiting the program and the amount of additional funding for the year.
- Many rotational programs (as with other specialty training programs) have introduced caps on the number of times a candidate may apply.
- A career in anaesthesia is not for everyone. A large part of the selection committee’s role is to identify which candidates have the qualities suited to be successful trainees and competent and safe future anaesthetists.
- I recommend you contact the individual rotational training programs to find out more information if required.
How does the day-to-day role of the trainee work? (My experience)
- Rotations & allocations
- Regular rotations
- Lists: Trainees are generally allocated to both regular lists (which allows you to settle into a regular team with the same anaesthetist, surgeon/surgical trainee, and nurses) and ad hoc lists throughout the week.
- Rotations: Cardiac surgery, thoracic surgery, general surgery, head & neck (ENT), neurosurgery, ophthalmology, paediatrics, obstetrics and gynaecology, orthopaedics, vascular surgery, and intensive care medicine.
- Additional roles/allocations: Medical Emergency Team (MET) responses, pre-admission clinic, and acute and/or chronic pain rounds.
- Night shifts: Trainees also do evening and night shifts throughout their training. If I were to average out my night shifts over my training in WA, it would average to around 4 nights every month.
- Regular rotations
- A general day
- Before 0800AM:
- Arrive in the hospital at around 0700AM, see your first 1-2 patients preoperatively to conduct your pre-operative review and answer patient questions.
- 0730AM – prepare your medications, airway equipment and additional equipment required for the case and advise your anaesthesia technician of the plan.
- Junior trainees are expected to see the patient preoperatively and devise their anaesthetic plan before discussing this with their supervising consultant (ideally discussed the day prior).
- As your training level and experience increase, you assume greater autonomy in creating your own anaesthesia plan for each case. Although the consultant anaesthetist has the ultimate responsibility over how the anaesthesia plan is conducted, the majority of anaesthetists are happy (and often expect) the senior trainee to run the list.
- 0800AM: There is a ‘team huddle’ in each theatre where the surgeon and anaesthetist discuss the cases and concerns for the day and finalise their plans for each patient.
- After 8am:
- Wheels in’ to the theatre just after 0800AM, patient cannulated and induced to start the case.
- Cases
- Lists with quick cases can be quite busy and you may look after 5-10 patients/day
- Certain lists have major cases and only do 1-2 cases for the day
- Breaks: Trainees and consultants organise breaks between themselves. You generally get more than sufficient time for breaks (morning tea, lunch, afternoon tea) in the public sector.
- Finish: A day shift often finishes around 5-530PM.
- Before 0800AM:
- Shifts (most common shift patterns for Western Australia):
- Day shift: 0730 – 1730
- Evening shift: 1230 – 2230
- Night shift: 2200 – 0800
- There aren’t any 24-hour on-call shifts in hospitals affiliated with the WA rotational training program.
- Study
- In addition to the above schedule, trainees also attend registrar teaching, the weekly departmental meeting and examination teaching throughout the week.
- It would be amiss of me not to highlight that most trainees studying for the primary and fellowship exams also spend around 20-30-hours per week studying for these exams. This equates to approximately 2-hours per night after work and most of their Saturday and Sundays.
- Do not underestimate the amount of work and commitment required to pass these exams. This should be considered before applying for the training program as the anaesthesia exams are amongst the most challenging of all the specialty exams.
The provisional fellowship (final or 5th) year
- What? The provisional fellowship year is the final year of ANZCA training (year 5) which is undertaken after passing all advanced training requirements.
- Aim: For trainees to gain greater independence and autonomy with running higher complexity lists and develop non-clinical experience in areas of interest (e.g. research and quality improvement, teaching, well-being, and administration)
- Where? The provisional fellowship year can be undertaken in any accredited hospital/institution in Australia or New Zealand or in a suitable overseas hospital (most commonly Canada, UK, and USA)
- Subspecialties:
- Hospital-based: Airway anaesthesia, regional anaesthesia and acute pain, cardiothoracic anaesthesia, upper GI anaesthesia, neuroanaesthesia, perioperative medicine, obstetric anaesthesia, paediatric anaesthesia, transplant anaesthesia, research and quality improvement, education and simulation, chronic pain, point of care ultrasound (including ECHO), and intensive care medicine (requires dual training with college of intensive care medicine).
- Out-of-hospital: Retrieval medicine (e.g. Royal Flying Doctor Service, Care flight)
Why do people travel overseas for fellowship?
- Professional development: It is highly beneficial to gain experience in a different healthcare setting. This includes gaining an understanding of the structure of other healthcare systems, how they function (similarities and differences), learning new methods and skills and bringing these back to Australia. An overseas fellowship also opens many professional opportunities including education and research and allows the fellow to build a relationship between their two institutions for future collaboration.
- Personal development: The opportunity to live abroad for a year or two enables you to gain invaluable personal experiences.
