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SYMPOSIUM ON ANAESTHETIC TEACHING
Brit. J. Anaesth. (1956), 28, 595.
SYMPOSIUM ON ANAESTHETIC TEACHING
Dr. John Gillies presided on the first day, when the symposium, which had been introduced by Professor Ian Aird, was opened by Professor W. D. M. Paton, who dealt with postgraduate teaching in pharmacology. The main problem was how to combine the teaching of the rational basis of therapeutics with bringing students up to date on the ever increasing stream of important new drugs in the limited time available. Additional problems arose from the interest taken in examination questions, and from students' pre-occupation with the latest " fashion " in therapeutics. To teach so that a man's therapeutic practice would be successful, rational, and interesting to himself would depend increasingly on collaboration between preclinical and clinical teachers. He stressed a need for more intercommunication between pharmacologists and anaesthetists, which could be nurtured by mutually repeated visits to the operating theatre and the laboratory. Professor J. McMichael touched on how postgraduates should be instructed in simple methods of physical examination and stressed the greater value of the history. He indicated a need for physicians and anaesthetists to combine in the investigation of the causes of disorders following surgical operations. Professor W. W. Mushin detailed the " Aims in Training the Specialist Anaesthetist". All specialists should have a wide knowledge of medicine and of the basic sciences and be possessed of a mature personality. The anaesthetic specialist must, in addition, attain a high degree of technical proficiency, and a knowledge of how to apply basic science to his own subject and in other fields. He must be temperamentally fitted for team work, and should have a sympathetic
approach to patients. The possession of all these as well as a critical outlook would qualify him to advise his hospital in clinical and other matters. Professor Mushin outlined the special needs and difficulties of the trainee anaesthetist, and emphasized that only in the teaching hospital or in the largest nonteaching hospitals can these needs be adequately met. The smaller peripheral hospital was unlikely to have the facilities either clinical or scientific to provide a proper background for training the future specialist anaesthetist. Points raised in the discussion were that: (1) trainees were being used as " a pair of hands "; (2) the exchange system between the teaching hospital and the periphery was difficult because of the lack of suitable accommodation; (3) the primary examination for the F.F.A.R.C.S. diploma was a difficulty because at this stage the graduate was mainly at work in the clinical field; if adequate knowledge could be gained at the undergraduate stage, the primary examination might become unnecessary; (4) the teaching hospital contact should be during the first year and at the time of the senior registrarship. Drs. E. J. D'Arcy and E. Harvey Franks put the case for the trainee. Dr. D'Arcy felt the need for a closer relationship between consultants and trainees and for avoiding questions remote from anaesthesia in the examination. Dr. Franks drew attention to the disproportion in extent of practical opportunities existing at teaching, nonteaching and service hospitals, the former offering the greatest scope and the latter the least. It would seem desirable to have more exchanges between the civil and service hospital than exists at present but, as the discussion showed, the service needs had to be considered. Dr. G. W. Organe presided on the second day when Dr. R. F. Woolmer opened with a paper on " Training in Methods of Research". He doubted whether it was worth attempting to give
595
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on September 2, 2015
ON September 27 and 28, 1956, consultants from all parts of the British Isles, as well as from abroad, attended a symposium on anaesthetic teaching. This was organized by the University of London at the Postgraduate Medical School.
596 all doctors training in methods of research, and he was not in favour of the extensive programmes as carried out in some quarters abroad. He thought, however, that more could be done within the present curriculum to interest students in research, and he favoured Professor Paton's approach to this.
A lively discussion followed during which several speakers pointed to the value of teaching medical students how to perform pudendal block with a view to employing this method in domiciliary midwifery; others felt that this procedure might endanger the patient because of sepsis. One suggestion was that the general practitioner ought to be utilized to train students in chloroform anaesthesia. Nitrous oxide oxygen and chloroform was another possibility but there were difficulties in arranging sessions with general practitioners. Dr. A. A. Mason spoke on the teaching of
hypnosis, indicating how this procedure could be carried out by anaesthetists in their daily work. Dr. T. C. Gray drew attention to a fundamental change in outlook in undergraduate teaching. The aim should now be to produce a graduate who could adapt himself for any branch of medicine. The head of each specialty would have to decide how best he could contribute to the more generalized course. As the law stands . today the medical graduate is expected to be able to give an anaesthetic to any patient. Dr. Gray emphasized the need for reform. But until such an event, undergraduate teaching commitments must remain despite the lessened opportunities. He outlined the undergraduate course in practical anaesthesia at Liverpool University and emphasized the importance of a personal interview at the end of the course, so that where experience was lacking the deficiency could be remedied. Professor E. A. Pask discussed what should be taught to undergraduates. The problem was how to reduce the extent of the teaching material and yet give more emphasis to things of value to all doctors. He thought that the opportunity for the student to "do something with his hands " with responsibility was valuable and made the point that the modern tendency to use instruments of various kinds is demanding practical abilities. The anaesthetic course had much of practical value to give in a general medical course, particularly in applied pharmacology and physiology.
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on September 2, 2015
Dr. F. Holmes spoke on " Some Special Problems in the Teaching of Obstetrical Anaesthesia ", and discussed the relative merits of local and general anaesthesia in obstetrics. He was in favour of local methods whenever general anaesthesia presented special dangers to the foetus. He used d-tubocurarine-chloride and light general anaesthesia after gastric aspiration with a polythene tube. He avoided both endotracheal anaesthesia and controlled respiration.
BRITISH JOURNAL OF ANAESTHESIA
SYMPOSIUM ON ANAESTHETIC TEACHING
Dr. John Gillies presided on the first day, when the symposium, which had been introduced by Professor Ian Aird, was opened by Professor W. D. M. Paton, who dealt with postgraduate teaching in pharmacology. The main problem was how to combine the teaching of the rational basis of therapeutics with bringing students up to date on the ever increasing stream of important new drugs in the limited time available. Additional problems arose from the interest taken in examination questions, and from students' pre-occupation with the latest " fashion " in therapeutics. To teach so that a man's therapeutic practice would be successful, rational, and interesting to himself would depend increasingly on collaboration between preclinical and clinical teachers. He stressed a need for more intercommunication between pharmacologists and anaesthetists, which could be nurtured by mutually repeated visits to the operating theatre and the laboratory. Professor J. McMichael touched on how postgraduates should be instructed in simple methods of physical examination and stressed the greater value of the history. He indicated a need for physicians and anaesthetists to combine in the investigation of the causes of disorders following surgical operations. Professor W. W. Mushin detailed the " Aims in Training the Specialist Anaesthetist". All specialists should have a wide knowledge of medicine and of the basic sciences and be possessed of a mature personality. The anaesthetic specialist must, in addition, attain a high degree of technical proficiency, and a knowledge of how to apply basic science to his own subject and in other fields. He must be temperamentally fitted for team work, and should have a sympathetic
approach to patients. The possession of all these as well as a critical outlook would qualify him to advise his hospital in clinical and other matters. Professor Mushin outlined the special needs and difficulties of the trainee anaesthetist, and emphasized that only in the teaching hospital or in the largest nonteaching hospitals can these needs be adequately met. The smaller peripheral hospital was unlikely to have the facilities either clinical or scientific to provide a proper background for training the future specialist anaesthetist. Points raised in the discussion were that: (1) trainees were being used as " a pair of hands "; (2) the exchange system between the teaching hospital and the periphery was difficult because of the lack of suitable accommodation; (3) the primary examination for the F.F.A.R.C.S. diploma was a difficulty because at this stage the graduate was mainly at work in the clinical field; if adequate knowledge could be gained at the undergraduate stage, the primary examination might become unnecessary; (4) the teaching hospital contact should be during the first year and at the time of the senior registrarship. Drs. E. J. D'Arcy and E. Harvey Franks put the case for the trainee. Dr. D'Arcy felt the need for a closer relationship between consultants and trainees and for avoiding questions remote from anaesthesia in the examination. Dr. Franks drew attention to the disproportion in extent of practical opportunities existing at teaching, nonteaching and service hospitals, the former offering the greatest scope and the latter the least. It would seem desirable to have more exchanges between the civil and service hospital than exists at present but, as the discussion showed, the service needs had to be considered. Dr. G. W. Organe presided on the second day when Dr. R. F. Woolmer opened with a paper on " Training in Methods of Research". He doubted whether it was worth attempting to give
595
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on September 2, 2015
ON September 27 and 28, 1956, consultants from all parts of the British Isles, as well as from abroad, attended a symposium on anaesthetic teaching. This was organized by the University of London at the Postgraduate Medical School.
596 all doctors training in methods of research, and he was not in favour of the extensive programmes as carried out in some quarters abroad. He thought, however, that more could be done within the present curriculum to interest students in research, and he favoured Professor Paton's approach to this.
A lively discussion followed during which several speakers pointed to the value of teaching medical students how to perform pudendal block with a view to employing this method in domiciliary midwifery; others felt that this procedure might endanger the patient because of sepsis. One suggestion was that the general practitioner ought to be utilized to train students in chloroform anaesthesia. Nitrous oxide oxygen and chloroform was another possibility but there were difficulties in arranging sessions with general practitioners. Dr. A. A. Mason spoke on the teaching of
hypnosis, indicating how this procedure could be carried out by anaesthetists in their daily work. Dr. T. C. Gray drew attention to a fundamental change in outlook in undergraduate teaching. The aim should now be to produce a graduate who could adapt himself for any branch of medicine. The head of each specialty would have to decide how best he could contribute to the more generalized course. As the law stands . today the medical graduate is expected to be able to give an anaesthetic to any patient. Dr. Gray emphasized the need for reform. But until such an event, undergraduate teaching commitments must remain despite the lessened opportunities. He outlined the undergraduate course in practical anaesthesia at Liverpool University and emphasized the importance of a personal interview at the end of the course, so that where experience was lacking the deficiency could be remedied. Professor E. A. Pask discussed what should be taught to undergraduates. The problem was how to reduce the extent of the teaching material and yet give more emphasis to things of value to all doctors. He thought that the opportunity for the student to "do something with his hands " with responsibility was valuable and made the point that the modern tendency to use instruments of various kinds is demanding practical abilities. The anaesthetic course had much of practical value to give in a general medical course, particularly in applied pharmacology and physiology.
Downloaded from http://bja.oxfordjournals.org/ at University of Birmingham on September 2, 2015
Dr. F. Holmes spoke on " Some Special Problems in the Teaching of Obstetrical Anaesthesia ", and discussed the relative merits of local and general anaesthesia in obstetrics. He was in favour of local methods whenever general anaesthesia presented special dangers to the foetus. He used d-tubocurarine-chloride and light general anaesthesia after gastric aspiration with a polythene tube. He avoided both endotracheal anaesthesia and controlled respiration.
BRITISH JOURNAL OF ANAESTHESIA