The College of Anaesthetists of Ireland have announced the greatest shakeup in training structure ever. Anaesthesia will now become a 6 year categorical programme with semi-automatic progression from year to year. The final year is a fellowship year in Ireland or abroad. This is an effective 2-3 year reduction in training duration.
The Western Anaesthesia Society strongly supports this initiative.

There are some potential problems on the horizon that need to be aired:

1. Anaesthesia will become hyper-competitive for entry. It seems unlikely in the future that non EU medical graduates will be able to obtain places on the BST.
2. There will be, by necessity a reduction in BST numbers. What happens to all of the non training positions and the NCHDs filling them? Will there be a parallel programme for non-EU medical graduates?
3. Shorter training and the European Work Time Directive – will our trainees obtain sufficient experience to become consultants?
4. Will it be possible to enter mid-point on the scheme – for example trainees transferring from the USA or Australia/New Zealand?
5. Modular training will be essential to ensure competencies – how can this be achieved in the era of theatre closures and austerity?
6. Clearly shorter training means less time spent in community hospitals. How are these institutions going to cope with fewer NCHDs in the future? Is the College responsible for this?
7. What about MD and Phd programs – wherefore academic anesthesia?
8. It is time to reel back the academic and administrative day that the senior SPRs may or may not utilize effectively.
9. Most importantly – what about the service gap? Fewer trainees in shorter programmes is very attractive on the surface if you are a trainee. But there are dozens of maternity wards and ICUs across the country that need nocturnal anaesthesia cover. Who is going to provide this – now that 50% of NCHD positions are no longer “training” (in reality categorical) posts. Further, as non EU graduates are unlikely to be able to access training posts, why would they come to Ireland to fill non training positions? WIll our trainees, constrained by numbers and by EWTD, find themselves working more frequently at night in low impact positions: in other words – an hour at night does not equal an hour during the day in terms of training and experience. This is a problem.