Volume of practice for trainees

I wanted to continue the TPS tricks and tips covered in previous trainee columns with a focus in this issue on getting your volume of practice (VOP). Specifically, within this new post-Covid world when regular elective lists are frequently changed to acute lists, or being cancelled.

The difficulty for trainees to complete their volume of practice by the end of training is becoming increasingly concerning. It is definitely a worry for me. When I started my anaesthesia training midway through 2020 almost no elective orthopaedic joint replacements were being done at the hospital I was at. More recently, on my cardiac module last year there were multiple list cancellations due to ICU bed shortages during the month I was rostered to cardiac anaesthesia.

Trainees should still be able to complete all of their VOP requirements. However, it may require some more effort, so I have listed some suggestions to help manage this below.

Keep track

I believe having a rough idea of your VOP requirements from the start can assist in meeting your targets and not missing any potential opportunities that come your way. It’s certainly something I wish I’d known more about from the start. However, when you begin training, the sheer amount of requirements you need to tick off within the training portfolio system can seem overwhelming, and confusion reigns for where to look and what to log.

Those trainees that wish to seek further clarification of specific training requirements can keenly go to the tome that is the ANZCA training handbook – a 117 page document which gives some guidance but with anaesthesia being a whole new world for many embarking on training, it can be difficult to figure out exactly what you need to do. All whilst figuring out how to draw up an ampoule of propofol, or learning which muscle relaxant your new consultant prefers each day.

For those of you who are new to training, you can access a page of what VOP you need by clicking for more details underneath your ‘cases and procedures’ pie graph on your dashboard page. You can also look at requirements for your current training period on this page and more usefully your required VOP for the whole of training. This isn’t a list that all trainees have to rote learn, like the alveolar gas equation, but it is good to have an idea of what you may not have realised you need. For example, having to log all of your regional blocks for what they are i.e. a lower limb block, but also having to log separately ‘provision of regional analgesia for the management of acute or chronic pain (must exclude obstetric pain)’.

It is also a good idea to talk to trainees above you in training, as they may have figured things out that can be very useful. Such as knowing that you need to have participated in being part of a trauma team five times and that this is logged under ‘sessions’, rather than ‘cases and procedures’ (if you don’t get this number you will need to do an EMST course).

Troubleshooting lacklustre

VOP numbers Ideally, one could get through training and pick up an abundance of VOP requirements without a second thought. But in this current healthcare climate (or crisis as some might say) the reality is that many of us will need to be on top of our logbook requirements and have a plan on how to boost numbers.

Certainly, it’s important to keep track of what you’re missing from advanced training. You can then highlight your potential gaps to either your supervisor of training and/or the person in charge of rostering lists to ensure you get to do that all important thoracic list you’re missing, rather than your 100th ASA 1 appendix. If you don’t let them know then they can’t help you. I don’t recommend overloading your rostering consultant with loads of missing VOP and lists required all at once and right at the end of advanced training. Instead focus on a small number of things at a time. Then once you’ve ticked off the VOP requirements for those modules, send through some different ones. I also wouldn’t recommend doing this if your hospital rosters specific modules and you’re yet to do one. I suggest reserving this until after you’ve done your module and still don’t have enough VOP.

It’s also important to let SOTS/rosterers know of VOP issues as it may be a more widespread issue for all trainees at your hospital, for example getting five TURP cases, and more creative solutions may need to be instituted such as looking into options for trainees to potentially go to a private hospital. Finally, if you’re unable to complete all your VOP despite these attempts, you can apply to the ANZCA training director of professional affairs (assessor) for special consideration. You may be able to get approval to fulfil some of these VOP requirements in your provisional fellowship year if you can’t get them done before the end of advanced training.

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