Anesthesiologist

Occupation
Names	Anesthesiologist Anaesthetist Anaesthesiologist
Activity sectors	medicine, science
Description
Competencies	technical knowledge, sense of responsibility
Education required	see professional requirements

An anesthesiologist (US English) or anaesthetist (British English) is a physician trained in anesthesia and perioperative medicine. In the United Kingdom, the term anaesthetist refers exclusively fully registered medical practitioners (university graduates in medicine). In a very few UK hospitals some duties are performed by non-physicians, but only under close physician anaesthetist supervision. Training of these physicians' assistants (anaesthesia) in the UK has effectively ceased. In the UK training in anaesthesia for a fully registered physician takes seven years full-time.

In the USA, anesthesiologists are physicians who complete an accredited residency program in anesthesiology, usually four years following medical school either with M.D. or D.O. degree.

Role in healthcare delivery

Anesthesiologists (anaesthetists in the UK) are physicians who provide medical care to patients in a wide variety of (usually acute) situations. These can include delivering anesthesia during surgical procedures, caring for critically ill patients in an Intensive Care Unit (ICU), managing medical emergencies such as cardiac arrests and traumas either in-hospital or in the public domain (termed 'pre-hospital medicine'), the inter-hospital transfer of unwell patients, and the management of acute and chronic pain conditions. Anesthesiologists are responsible for ensuring the delivery of anesthesia safely to patients in virtually all health care settings, including all major medical and tertiary care facilities. This includes a preoperative evaluation, consultation with the surgical team, creating a plan for the anesthesia tailored to each individual patient, airway management, intraoperative life support and provision of pain control, intraoperative diagnostic stabilization, and proper post-operative management of patients. Preparation of patients for emergency surgery are mandatory, essential, and critical skills that anesthesiologists have been trained to employ. Because anesthesiologists are physicians, in contrast to other anesthesia providers, they are able to utilize their extensive knowledge of human physiology and diseases to guide their decision making.

Historically there has been a shortage of anesthesiologists. In order to better serve the population, residency positions in anesthesiology for physicians have been steadily increasing the past several years. In addition, physicians supervise ACTs, or Anesthesia Care Teams, which are composed of a supervising physician with several certified registered nurse anesthetists (CRNAs) or anesthesiologist assistants (AAs), working together to provide healthcare to the population. In other areas of the country, anesthesiologists work in what is deemed a "solo" or "MD/DO only" practice, during which they provide anesthesia in a "one on one" relationship with the patient.

A consultant anesthetist in the UK is a fully qualified doctor, who has spent at least 9 years (7 of which should be in anesthesia) after graduation as a trainee, and is appointed as a consultant. A trainee anesthetist in the UK is a fully qualified doctor on their way to become a consultant; they could be 2 years post graduation or may be even 10 years post graduation.

Anesthesiologists and patient-informed consent

Patient-informed consent is a fundamental ethical and legal principle and is considered essential to patient autonomy.The American Society of Anesthesiologists, the American Osteopathic College of Anesthesiologists, and other professional organizations, such as the American Association of Nurse Anesthetists, support the principle that patients should be fully informed regarding the manner in which their anesthetic will be administered.

Due to medications given before, during and after surgery, a patient may sometimes not remember interacting with his or her anesthesiologist, nurse anesthetist, or anesthesiologist assistant, who will be involved in their anesthesia care. The anesthetic plan, as well as alternatives, risks, and benefits of the chosen anesthetic techniques, should be discussed with the patient prior to surgery. (This can be difficult or impossible in some situations, such as unconscious patients, confused patients, or extremely urgent cases. It may be possible to discuss matters with a patient's relative or caretaker.)

Training by country

Physician training in anesthesiology in developed countries is similar.

Guatemala

In Guatemala, a student after obtaining his or her medical degree (Must have a Surgeon and General Medicine skills by law) the new doctor who wants to specialize in Anesthesiology have to go to a residency of 6 years (5 years in residency plus 1 year of practice along with and expert anesthesiologist in an hospital private or public or any healthcare facility) then go to a board examination done by the College Of Medicine of Guatemala alongside Universidade De San Carlos De Guatemala (Medicine Faculty Examination Board) and also a Chief Physician representing the Healthcare Ministry Of The Government Of Guatemala, after completing an extense board examination in the field of anesthesia (Written, Oral and also a special examination regarding Anesthesia Instrumental skills and knowledge, Emergency Treatment skills and knowledge, Pre-Operative Care skills and knowledge, Post-Operative Care skill and knowledge and skill and knowledge in ICU -Intensive Care Unit- and also skills and knowledge in pain medicine) the College Of Medicine Of Guatemala, Universidad De San Carlos De Guatemala and the Healthcare Ministry Of The Government Of Guatemala grants the new anesthesiologist a special license to practice anesthesiology alongside with a Diploma issued by the Universidad De San Carlos De Guatemala granting the degree of Physician with specialization in anesthesiology. Also anesthesiologists in Guatemala are subject of yearly examinations and also is mandatory to any anesthesiologist to participate in a seminary (in a yearly basis) to be update with the latest developments in the anesthesiology field.

Argentina

In Argentina, anesthetists are physicians who have specialized in the medical field of anesthesia. Residency is 5 years long.

Australia and New Zealand

In Australia and New Zealand, anesthetists are physicians (with the degree of Bachelor of Medicine and Bachelor of Surgery i.e. MB ChB or MB BS) who have specialized in the medical field of anesthesia.

In Australia and New Zealand, anesthetists are represented by the Australian Society of Anesthetists and the New Zealand Society of Anesthetists. Training is overseen by the Australian and New Zealand College of Anesthetists. The ANZCA approved training sequence encompasses an initial two-year Pre-vocational Medical Education and Training (PMET) period and the five-year period of ANZCA Approved Training (two years Basic Training and three years Advanced Training).

In the course of Approved Training, you are required to successfully complete:

- Five years of supervised clinical training at Approved Training Sites
- Both the Primary and Final Examinations which consist of both written (multiple choice questions and short answer questions) and, if successful at the written component, oral examinations
In the final examination, there are many stations of clinical scenarios (including interpretation of radiological exams, EKGs and other special investigations). There is also two stations of real patients with complex medical conditions - for clinical examination and a following discussion. - A program of 12 modules such as obstetric anesthesia, pediatric anesthesia, cardiothoracic and vascular anesthesia, neurosurgical anesthesia and pain management.
- Completion of an advanced project, such as a research publication or paper.
- An EMAC (Effective Management of Anesthetic Crises) or EMST (Early Management of Severe Trauma) course.

On completion of all Training Program requirements the Trainee will be awarded the Diploma of Fellowship and be entitled to use the qualification of FANZCA – Fellow of the Australian and New Zealand College of Anesthetists.

Canada

In Canada anesthesiologists are physicians (with the degree MD - Medicinae Doctorem or MDCM - Medicinae Doctorem et Chirurgiae Magistrum) who have specialized in the medical field of anesthesiology.

Training is overseen by 16 universities approved by the Royal College of Physicians and Surgeons of Canada. Upon completion of a residency program, the candidate is required to pass a comprehensive objective examination consisting of a written component (two three-hour papers: one featuring 'multiple choice' questions, and the other featuring 'short-answer' questions) and an oral component (a two-hour session made up of stations on the clinical aspects of anesthesiology. The examination of a patient is not required).

Upon completion of all training requirements, the anesthesiology graduate is then entitled to become a "Fellow of the Royal College of Physicians of Canada" and to use the post-nominal letters "FRCPC".

Germany

After earning the right to practice medicine, German physicians who want to be an anesthetist have to go through a 5-year residency, ending with a board examination. During this time, physicians are educated in all aspects of their chosen field of medicine. Usually this includes rotations serving in the operating room to perform anesthesia on a variety of patients being treated by every kind of surgical sub-profession (i.e. general surgery, neurosurgery or invasive urological and gynecological procedures), followed by a rotation on various intensive-care and intermediate-care units. During this time of residency, many physicians choose to complete a course in emergency medicine, which once completed, enables them to be referred to as Notarzt, a physician of the Emergency Medical Service, treating patients at home or on the scene of accidents, either on their own or assisted by paramedics.

Hong Kong

To be qualified as a specialist anaesthetist in Hong Kong, medical practitioners must undergo a minimum of six years of postgraduate training and pass three professional examinations. Upon completion of training, the Fellowship of Hong Kong College of Anesthesiologists and subsequently Fellowship of Hong Kong Academy of Medicine would be awarded. Practicing specialist anesthetists are required to register in the Specialist Register of the Medical Council of Hong Kong and hence would be under the regulation of the Medical Council.

Italy

In Italy, the Anesthesiologist-Intensive Care is a doctor who, after graduation from Medical School (6.5 years), has completed a 4-years (5-years by 2008) residency. They can work in Operating Rooms, ICUs, PACUs, Pain Units, Hyperbaric Units and Emergency Departments.

Scandinavia

In Denmark, Finland, Iceland, Norway and Sweden training is overseen by the national societies of anaesthesiology as well as the Scandinavian Society of Anesthesiology and Intensive Care Medicine (SSAI). In Scandinavia, anesthesiology is the medical specialty that is engaged in the fields anaesthesia, intensive care medicine, pain medicine, and pre- and in-hospital emergency medicine. Anesthesiologist in the Scandinavian countries are doctors who have completed a six-year undergraduate training program (from Medical School), an 12-month internship, as well as a five-year residency program. SSAI currently hosts five training programs for anesthesiologists in Scandinavia. These are: Intensive Care, Pediatric Anesthesia and Intensive Care, Advanced Pain Medicine, Critical Care Medicine, Advanced Obstetric Anesthesia.

United Kingdom

In England, Northern Ireland, Scotland and Wales training is overseen by the Royal College of Anesthetists. Anesthetists in the United Kingdom are doctors who have completed either a five-year or six-year undergraduate training program or a four-year program open only to holders of a first degree.

Following the completion of medical school, doctors enter the two-year Foundation Program which consists of at least six, four-month rotations in various medical specialties. It is mandatory for all doctors to complete a minimum of three months of general medical and general surgical training in this time.

Following the Foundation Programe, doctors compete for specialist training in anaesthetics. The training program in the United Kingdom currently consists of two years of Core Training and five years of Higher Training. Trainees wishing to hold dual accreditation in Anaesthetics and Intensive Care Medicine may enter anesthesia training via the Acute Care Common Stem (ACCS) program which lasts three years and consists of experience in anesthesia, emergency medicine, acute medicine and intensive care. Trainees in anaesthesia are called Specialty Registrars (StR) or Specialist Registrars (SpR).

Before the end of Core Training, all anesthetic trainees must have passed the primary examination of the diploma of Fellowship of the Royal College of Anesthetists (FRCA). The final part of the examination is taken as a higher trainee (usually in the fourth year of training). The FRCA examination is notorious for its difficulty and is said to be the most difficult of all post-graduate medical examinations. The examination covers physics, pharmacology, physiology, anatomy, clinical sciences, pathology, respiratory medicine, emergency medicine, critical care and pain medicine.

The CCT (Certificate of Completion of Training) program in anesthetics is divided into three levels: basic, intermediate and advanced. During this time, doctors experience anesthesia as applicable to all surgical specialties. The curriculum focuses on a modular format, with trainees primarily working in one specialist area during the module, for example: cardiac anesthesia, neuroanesthesia, ENT, maxillofacial, pain medicine, intensive care, trauma.

Traditionally (before the advent of the Foundation Programme) trainees have entered anaesthetics from other specialties, such as medicine or accident and emergency. Specialist training then takes at least seven years.

On completion of specialist training, doctors are awarded the Certificate of Completion of Training (CCT) and are eligible for entry on the GMC Specialist Register and are able to work as Consultant Anesthetists. A new consultant in anesthetics will have completed a minimum of 14 years of training (including: five-to-six years of medical school; two years foundation training; and seven years anesthesia training). It is this level of training that confers the credibility to a CCT holder, referred to as a Consultant in the NHS, and is respected throughout the World.

Those wishing to dual accredit in intensive care are required to undertake an additional year of training and normally complete the Diploma in Intensive Care Medicine (DICM). Pain specialists sit the Fellowship of the Faculty of Pain Medicine of the Royal College of Anesthetists (FFPMRCA) examination.

United States

Anesthesiologists are the most extensively trained anesthesia providers in the United States. Anesthesiologists are physicians (M.D. or D.O.) who have chosen to specialize in anesthesiology. Anesthesiologists in the United States must have completed an undergraduate college degree, including pre-medical requirements. Like other physicians, anesthesiologists complete four years of medical school. Physician training programs in the United States, without exception, require four years of residency training for board certification eligibility in the specialty of anesthesiology. An anesthesiology residency requires a one year medical or surgical internship followed by three years of anesthesiology training.

Anesthesiology residency training in the U.S. encompasses the full scope of perioperative medicine, including pre-operative medical evaluation, management of pre-existing disease in the surgical patient, intraoperative life support, intraoperative pain control, post-operative recovery, intensive care medicine, and chronic and acute pain management. After residency, many anesthesiologists complete an additional fellowship year of subspecialty training in areas such as pain management, cardiothoracic anesthesiology, pediatric anesthesiology, neuro anesthesiology, obstetric anesthesiology or critical care medicine.

The majority of anesthesiologists in the United States are board-certified by a specialty medical board; either the American Board of Anesthesiology (ABA) or the American Osteopathic Board of Anesthesiology (AOBA). The ABA is a member of the American Board of Medical Specialties, while the AOBA falls under the auspices of the American Osteopathic Association. Both Boards are recognized by the major insurance underwriters in the U.S. as well as by all branches of the U.S. Uniformed Services. Board certification by the ABA involves both a written and an oral examination. AOBA certification requires the same exams, in addition to a practical examination with examining physicians observing the applicant actually administering anesthetics in the operating room.

See also

• American Board of Anesthesiology
• American Osteopathic Board of Anesthesiology
• International Anesthesia Research Society

External links

• Anesthesiology at the Open Directory Project
• OpenAnesthesia — the Anesthesiology Wiki (presented by the International Anesthesia Research Society)