Latest Trainee Updates

Q&A session at GAT ASM, July 2017  - Topics include Fatigue, Brexit, workforce and training, PA(A)’s and more
16 August 2017
The GAT ASM took place in Cardiff in July this year.  A panel discussion session was held whereby representatives from the AAGBI (Dr Paul Clyburn, President), RCoA (Dr Liam Brennan, President), CAI (Prof Kevin Carson, President), and GAT (Dr Emma Plunkett, Chair) were available to answer questions from the audience. It was excellent to see that lots of questions were submitted via the conference app; however, there were too many to be answered in the session.  Instead, we kept a note of all the questions and the members of the panel have subsequently answered most of those submitted, including topics such as Fatigue, Brexit, workforce and training, PA(A)’s and more. Please click here to read what the panel members had to say.  
GAT update on the implementation of the new Junior Doctor's Contract
31 March 2017
The GAT Committee is aware that the transition for anaesthetists to the new 2016 Junior Doctor’s Contract is due in August 2017. It has also come to our attention that some Trusts have moved to new compliant rotas or even transitioned early to the new contract.

The GAT Committee has spent time discussing and deliberating how best to support and reassure our members in this difficult time. The new contract, in particular the pay conditions contained within, is complex and obscure at first glance. We harbour as much trepidation as our members about the times ahead, but we want to highlight some important points:


  1. This is an uncertain and trying time for junior doctors and Trusts alike. Implementation of a contract of this scale will require many hours of hard work and patience from all involved. However, we can aim to educate ourselves and help our employers get this right.

  2. Under the terms and conditions of the new contract, your Trust is obliged to provide you with a generic work schedule before you start your post. This should include contact details for your Guardian of Safe Working, an example rota, your expected pay and your roles and responsibilities. This should then be personalised once you have met with your Educational/Clinical Supervisor after you have started. Please check this in good time and raise any issues as early as possible.

  3. NHS Employers has published information and guidance for employees and employers on the new contract. This is a good place to start if you think there may be errors in your work schedule i.e. your rota is not compliant with the new contract. http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-2016-contract

  4. The BMA offer a handy booklet and rota checking tool to complement the information published elsewhere. https://www.bma.org.uk/advice/employment/contracts/junior-doctor-contract-2016


We are in the process of trying to get to grips with the details of the contract and are drafting some template work schedules to act as a guide.  Please try to read and understand as much of the contract as you possibly can, so that together we can engage with the process of implementation.

If you are having specific issues with your Trust, we hope the BMA will be able to help, and we advise you to contact them in the first instance (please email juniorscontract@bma.org.uk). However, we are always available to discuss issues at gat@aagbi.org and we will do our best to help.  We can also act as a common point for sharing problems and solutions. If you have examples of specific issues you have encountered please get in touch and we will spread information to others who may benefit.

Best wishes

Simon Denning, Nottingham
GAT Committee

A personal message from GAT Committee Chair in response to The Guardian article highlighting the results of the RCoA survey into the working lives of trainee anaesthetists

On Saturday 11 February The Guardian published an article revealing the results of the RCoA survey into trainee morale, welfare and burnout. 2300 of you responded to the survey (about 60% of anaesthetic trainees).  I think the results are shocking but also sadly unsurprising:

  • 85% of those responding were at risk of burnout
  • 64% reported their work had affected their physical health and 62% their mental health

These findings are deeply concerning for us on the GAT Committee, both as your elected representatives, but also as fellow anaesthetists as we see this in ourselves too.  We recognise that our clinical work alone is demanding both physically and emotionally and the added pressure of exams, workplace based assessments, quality improvement projects, teaching, research and management activities all add to this.  It feels hard to get any kind of work-life balance and we need that to be able to be effective at work. 

Reading The Guardian article made me think, what can we do to help?  We can’t take away the work-related hurdles or commitments at home, but I think there are some strategies that might be able to help.  Here are a few ideas of things I have found useful personally or have noticed to be helpful for others, that come with the caveat that I am far from an expert on this:

  1. Use a mentor:  This has been incredibly valuable for me in recent years.  It has helped me to achieve more than I ever expected by improving my self-belief and making me more effective at work.  The respect, empathy and genuineness in the conversations has helped me to recognise what is important in my life and how I can prioritise it.  The AAGBI has set up a mentoring scheme, available to all members. We can link you up with a mentor near you, and mentoring sessions are available at all AAGBI conferences.
  2. Support each other:  This was mentioned at the recent RCoA Listening Event as being something people found helpful. Sharing challenges and difficulties can be really beneficial; you often find that others have experienced the same thing, even more senior established consultants.   Over recent years the GAT committee has become a bit like a family.  We all have individual stresses, concerns and life events to manage and we share these, as well as our work related concerns.   It’s not easy to find time to connect with colleagues face-to-face but even some virtual empathy via WhatsApp helps.
  3. Prioritise sleep:  As a mother of three young children, I know how hard this can be.  I often fall asleep at the same time as the children - I suppose at least that means I get an occasional early night.  Fatigue is a significant contributory factor to burnout and we are prioritising the work that GAT and the wider the AAGBI family, together with the RCoA are doing on fatigue.   By the summer we hope that robust evidence on the scale of the problem for anaesthetic trainees will be available and that this, in combination with the educational resources and standards for rest facilities we are developing, will prompt change in individual and organisational culture.  We’ll be in touch with more information about this soon.
  4. Find out more about how you can prevent, recognise and manage burnout by watching the talk on burnout by Dr Jon Smith on the Learn@AAGBI platform; it’s really good.  There are also signposts to more information about burnout on the AAGBI Support and Wellbeing webpage.  Knowledge about how the signs of burnout in yourself or colleagues and some ways to help prevent it might just help.

I know it’s hard to get study leave and budget these days, but if you can, come and see us at the GAT ASM in Cardiff from 5-7 July 2017.  You can have a free mentoring session, catch up on some education and together we can share experiences.  We’re working on some wellbeing resources to show you in Cardiff; we want to create a wellbeing wall with tips from you all about how we can help ourselves and each other. We hope we’re going to have our fatigue tools to show you all. 

If you have any suggestions of what you have found helpful in the meantime, please get in touch on gat@aagbi.org.

Take care of yourselves and each other.
With best wishes,
Emma Plunkett
GAT Committee Chair

GAT Committee response to recent Health Education England South London survey
With reference to the recent survey from Health Education England (HEE) South London which sought to investigate the 'burden' of novice anaesthetists on anaesthetic departments.  As anaesthetists, we have all experienced being the novice anaesthetist in a department; it is a unique and crucial time in the career of an anaesthetist and may even be the first exposure to the specialty.  We want doctors starting out in their anaesthetic career to feel inspired and enthused for the speciality and supported in their learning, and we recognise that these early days in the specialty are incredibly important.  Having novices in the department is an opportunity for other anaesthetists to reflect upon why they chose a career in anaesthesia and what they enjoy about it, and we believe it is a privilege to be able to contribute to the education of anaesthetists at such a key time.   Novices come to anaesthesia with different backgrounds and levels of experience and they provide important insights and updates into working in other specialties.  It is rewarding to see them develop their clinical skills in anaesthesia and to begin to practice under less direct supervision.

So we were disappointed to see the wording of the HEE South London survey, with the use of the term ‘burden’ frequently repeated.  ‘Burden’ is an emotive word and we understand the upset that it has caused amongst trainees.  In addition we agree with concerns raised that the phrasing of the questions in the survey appeared biased towards reporting negative outcomes.  We are encouraged that the survey has since been withdrawn and understand that the RCoA President, Dr Liam Brennan, has discussed the issue with HEE who have apologised for the poor choice of words.   Junior doctors have had a challenging year with the contract dispute and increasing rota gaps and we believe it is vital that we value the important role we all play, at every stage of our career. 

Emma Plunkett
Chair of GAT Committee
RAFT update
The data collection period for the RAFT 2015-16 project, iHypE, is rapidly approaching. iHypE (Intraoperative Hypotension in Elder Patients) is a national trainee led, portfolio registered and AAGBI funded research project. All the trainee research groups that form RAFT are participating. Data will be collected over a locally determined 48 hour period between 21st November and 2nd December 2016.

There are multiple benefits of being involved, which include:
- Experience in registering and delivering a National Institute for Health Research Clinical Research Network (NIHR CRN) portfolio registered trainee led study.
- Understanding of research practice.
- NIHR Good Clincial Practice training.
- Being listed as a collaborator on any outputs that RAFT achieve (posters, articles etc).

For more information contact your local trainee research network, visit, follow @PIhype on twitter or e-mail info@i-hype.org.
New Joint Welfare Statement
Since our last welfare statement there have been several developments in the ongoing contract dispute between junior doctors, represented by the BMA, and the Government. It remains a challenging and difficult time for doctors in training.

The Royal College of Anaesthetists, the Faculty of Intensive Care Medicine and The Association of Anaesthetists of Great Britain and Ireland maintain that it is crucial that trainees are, and feel, supported at this time. We are proud of the important role our junior doctors play in the safe delivery of anaesthesia and critical care services and as members of the wider hospital team. Please read our latest joint welfare statement here.

Trainee survey on fatigue - request from the GAT Committee to complete the survey

The recent, tragic death of an anaesthetic trainee has highlighted the need for increased awareness of fatigue amongst doctors and the introduction of changes to prevent and manage its dangerous effects.  Welsh trainees, Jon Holland (ST7) and Laura McClelland (ST6), are in the process of conducting a national survey regarding fatigue amongst anaesthetic trainees CT1 – ST7.  The results will help inform a joint programme of work to address the issue.  A high response rate and comprehensive spread of data from all Trusts will enable robust conclusions to be drawn about fatigue-related problems and available rest facilities. Publication of results will hugely increase their impact.


If you are an anaesthetic trainee and have not already done so, please complete short survey

Trainee update on Physician Assistants Anaesthesia PA(A)s Scope of Practice statement.

In April, the RCoA and AAGBI released a joint position statement regarding the Scope of Practice for PA(A)s.  This statement can be found here with a further link to the updated Scope of Practice.

PAAs are not currently subject to registration and regulation by an independent body, although work is being done to address this.  In the interim, the RCoA has introduced a voluntary register for those PA(A)s who have completed the approved training programme. 

GAT recognises that the role of PA(A)s in the anaesthetic workforce is a controversial topic.  PA(A)s work in many departments in the UK with varying roles, experience and expertise. We wish to highlight the point mentioned on multiple occasions in the Scope of Practice statementPA(A)s should only be supervised by anaesthetic consultants who agree to perform this role.  At no point should anaesthetic trainees be expected to supervise or to be supervised by PA(A)s. If you have any difficulties with this please raise this with your Educational Supervisor, College Tutor or the Training Department at the RCoA.  If you are concerned at any point you can contact us at gat@aagbi.org

Trainee update on the Terms and Conditions for Junior Doctors Contract released on 27 May 2016

GAT was pleased that further contract negotiations, mediated by ACAS, resumed between the Department of Health and the BMA, and that a contract agreed by both sides would be put to members.  The GAT Committee is studying the full terms and conditions of the contract, FAQ documents, and following the BMA webchats to understand better what the contract means for current and future junior doctors, particularly those in anaesthesia and ICM; we’re sure you are similarly considering what the contract means for you. Read more here.

Trainee update: Less than full time (LTFT) trainees in the military

GAT is pleased that a trial of LTFT training has recently been introduced in the military. The AAGBI and GAT have been encouraging the DMSD (Defence Medical Services Department) to make LTFT training available and we are very grateful for their support. We believe it is important that, as far as possible, trainees who work together are treated in the same way. When they work in the NHS, military trainees become part of the 'ordinary' team of trainees, training and working together with their civilian counterparts and we are pleased that they now have the same opportunity for LTFT training.

GAT understands that only a few military trainees have volunteered/applied for LTFT training so far, and places on the one year trial period are limited. As more senior role models appear, we would hope for more military LTFT trainees; we hope the trial continues and military trainees are encouraged and supported to consider the option of LTFT training.

LTFT training is most commonly undertaken by female trainees with caring responsibilities for young children.  This is a group that previously might have considered leaving the military.  We hope that the opportunity to work LTFT means this is no longer necessary.

GAT has considerable experience of LTFT training and its benefits and challenges.  For any assistance for military trainees wishing to know more about working LTFT, please get in touch: ltft@aagbi.org

Junior Doctors’ Contract Negotiations Frequently Asked Questions (FAQs)

Further Industrial Action (IA) is to take place later this month in the on-going dispute between junior doctors (the BMA) and the Government.  This IA is different as it has been up-scaled to a full walk out between 8am and 5pm on Tuesday 26th and Wednesday 27th April.  We discussed the ongoing junior doctors’ contract dispute at our recent GAT Committee meeting in March and, based on our discussion and a recent update from the BMA, we have put together these FAQs to inform our trainee members.  A parliamentary briefing about the junior doctors’ contract published on 1 April 2016 gives a commentary of the process so far.

Read more >

Review on morale

The Academy of Medical Royal Colleges has been commissioned to review the morale and wellbeing of junior doctors. Whilst we are pleased that the morale of NHS staff is now receiving attention we have some concerns and offer potential solutions.

The Health Secretary announced this review shortly after he imposed a contract on doctors in training. We agree that a review into the morale of NHS employees is overdue but conducting it while junior doctors remain in dispute with employers may well result in erroneous conclusions.

Read more >

GAT Statement on imposition of junior doctors’ contract 

GAT was disheartened and disappointed to hear the Secretary of State for Health (SoS) confirm his intention to impose a contract on junior doctors in England from August 2016.  Imposing a contract, especially when progress has been made via negotiation, is a huge backward step. 

Read more >

GAT statement on impending industrial action on 12 January 2016
GAT is saddened that negotiations between the government and the BMA about the junior doctors’ contract failed to reach agreement in time to prevent industrial action. Junior doctors in England will now take industrial action (IA) starting on 12th January 2016. In common with our colleagues in England and beyond, GAT had hoped that mediation and further talks would lead to a compromise that sustained and even promoted in the contract the core values of patient safety, staff wellbeing, fair conditions, employment safeguards, and payment for work done. Even following this latest setback we urge a return to negotiations facilitated by independent conciliation and arbitration. We hope both sides in this dispute can together reach a decision that is safe and fair, meeting the needs of the public and of our members. Each BMA member who is a junior doctor must now make a personal decision whether to participate in IA.  We trust that those decisions made by individual trainees will be respected by their colleagues and departments.
GAT Response to the Suspension of Industrial Action: Junior Doctor’s Contract Negotiations
We are encouraged the BMA, NHS employers and the Department of Health have agreed to return to negotiations, following facilitation by ACAS. The BMA has agreed to suspend any industrial action until the 13th January, and the Department of Health has agreed to suspend implementation of a junior doctor’s contract within this timeframe.

Patient safety and the wellbeing of junior doctors are of paramount importance, and GAT will continue to support its members.

GAT continues to fully support the BMA, and would like to thank the BMA for its ongoing work to resolve this dispute.
GAT statement on the results of the BMA Junior Doctors Ballot
We now know that junior doctors in England have voted overwhelmingly in favour of industrial action as part of the dispute with the Government and NHS employers over a new contract.  The result indicates the enormous strength of feeling amongst them.  Yesterday the AAGBI released a statement in response to the ballot result. GAT  remains hopeful that any industrial action can be avoided by re-opening of negotiations, with an independent mediator if necessary.

The BMA has stated that to avoid industrial action it requires the following:
  • Withdraw the threat to impose a new contract.
  • Proper hours safeguards protecting patients and their doctors.
  • Proper recognition of unsocial hours as premium time.
  • No disadvantage for those working unsocial hours compared to current system.
  • No disadvantage for those working less than full time and taking parental leave compared to the current system.
  • Pay for all work done.

If negotiations do not reopen and industrial action takes place, we hope that the decisions made by our trainee members are respected by their colleagues and departments. As always, patient safety remains our first concern and we must all work together to ensure this is maintained throughout any periods of industrial action. 

The ballot result raises practical questions relating to the processes involved in taking industrial action.  We would point our members towards advice given by both the BMA and the GMC about who can and cannot take industrial action, and what steps can be taken by individuals to minimise disruption to patients:

Junior doctors
Hospital doctors
GMC advice for doctors considering industrial action
GMC response to BMA ballot result

These resources are useful for all doctors, not just BMA members.  We will also keep the AAGBI and GAT web pages up to date with information and links to useful resources. 

We hope that meaningful negotiations can resume and industrial action can be avoided.  We encourage members to continue to raise the contract issue with their MPs; if necessary contact them again to stress the importance of a negotiated, rather than imposed, contract. Patients will also be concerned and it is also important to continue engagement with the public to explain the issues.

Finally, we remind everyone that we must look after each other during this  stressful time.  We would like to draw attention once again to our joint welfare statement, which includes references to sources of support and advice.
If any of you are struggling to get information please do not hesitate to contact us (gat@aabgi.org).

What have GAT and the AAGBI been up to? 

Dr Cathy LawsonGAT committee member Dr Cathy Lawson joined 4000 junior doctors and supporters in a personal capacity on Saturday October 24th at the junior doctors protest in Newcastle. Behind the scenes representatives from GAT and the AAGBI met with Dr Johann Malawana, Chair of BMA JDC, to discuss the contract negotiations.

The BMA has set clear terms for negotiation and once the end goal is agreed upon - a safe and fair contract for junior doctors - the process by which a contract is drafted can be fleshed out.

What can trainees and medical students do?

This should not in anyway be about organisations or figure heads against the system. This is about you. The collective voices of individual junior doctors and your families, educating people about the impact on your lives is vital. GAT have spoken to a wide variety of professionals:

…I know of many people considering leaving medicine before they’ve even begun. Lots of people attending the alternate careers fair…” Final Year Medical Student

…I for one will not be able to continue in a UK training post if this does occur as my salary will no longer even cover my fixed costs of mortgage and child care…” Anaesthetic trainee

Writing to MPs
Both AAGBI and the BMA have prepared guidance on how you can get in touch with your local MP:

AAGBI MP letter guidance
BMA MP email guidance

MPs need to be informed and educated on the real impact on their constituents, regardless of party. If you receive no response from an MP after several attempts, individuals can copy in the BMA to follow up jdcchair@bma.org.uk.

Media
This is a pivotal moment in healthcare and the press (both local and national) are after personal stories. Junior doctors, medical students and their families should write to the papers. There is BMA guidance on preparing for press engagements with key messages available (jdcchair@bma.org.uk).
BMA regional representatives are available to attend and do brief Q&A sessions at regional meetings to answer questions – regional reps are encouraged to engage with regional BMA JDC reps.

What can consultants do?
Continue giving your support to junior doctors that we have seen the across the country. To stress, this does not mean you support industrial action; simply you are supporting a colleague in need. You don’t have to make a song and a dance, simple things such as raising the topic in divisional meetings, or even just asking how a trainee is getting on can be incredibly powerful.

Weekend mortality
The editor of the British Medical Journal, Fiona Godlee, has written to England’s Health Secretary Jeremy Hunt, stating that he has misrepresented data on weekend mortality. Dr Godlee said that the research conducted did not appropriate any cause for the excess deaths or suggest what proportion could be avoidable.

Junior Doctors’ Contract
Over the past fortnight there have been further developments in the junior doctor’s contract negotiations.

BMA
The Secretary of State Jeremy Hunt MP met with the BMA JDC Chair Dr Johann Malawana on the 30th September 2015. Following which a public letter from the Secretary of State to Dr Malawana was issued on the 8th October 2015.

Subsequently, Dr Malawana wrote a letter of reply on the 12th October to the Secretary of State in direct response to this public letter.

The AAGBI is a membership organisation and not a trade union and therefore cannot comment on industrial action.  However, the BMA have released a very informative presentation entitled “Junior doctors contract update” on the evolution of the contract negotiations. The penultimate slide gives information about the ballot for industrial action. You can find this presentation below in the list of key documents

We direct you towards the BMA; you may wish to consider joining if you are not already a member. The deadline for existing BMA members to update their details prior to the ballot is the 23th October 2015.

Protests
Junior doctors feel very strongly over the proposed changes. This sentiment was clearly visible from the thousands of junior doctors who took part in a protest in London on Saturday 17th October 2015.

Press Coverage
Press coverage has continued to gain momentum. Contract negotiations were discussed on BBC Question Time, as well as featuring regularly in headlines.

AAGBI & GAT Committee
The AAGBI and GAT continue their support for junior doctors. Dr Andrew Hartle, President AAGBI has issued a statement on how members can influence change by writing to their local MP. Examples of what to include in such a letter are also highlighted.

Kind regards,
The GAT Committee
 Joint Statement on Trainee Welfare

The subject of contract negotiations was discussed at both the Linkman conference and Annual Congress in Edinburgh last week.  The AAGBI has been actively expressing its concern regarding the implications of an imposed contract for junior doctors in England with the release of a position statement last week and letters to and interviews with the press.  As information has spread about the proposed details of the contract and how it might impact on trainees, so has anxiety about what this means for their future.  Training in anaesthesia is already not without stress and the AAGBI, RCoA and FICM recognise that uncertainty regarding contracts is likely to add to this. On Tuesday, a Joint Welfare Statement written by trainee and consultant leaders of these organisations was released to acknowledge this and to highlight the support services available.  Most importantly, it reminds us to look out for each other.

To read the the statement, visit >

Junior doctors contract negotiations update
There has been an increase in activity in the contract negotiation process for both junior doctors and consultants in the past few weeks. Find out more >
GAT Response to the report by DDRB
Response to the Report by the Review Body on Doctors’ and Dentists’ Remuneration Board (DDRB): Contract reform for consultants and doctors & dentists in training – supporting healthcare services seven days a week, August 2015
Physicians' Assistants Anaesthesia - an opportunity to let us know your thoughts (18 June 2015)

The PA(A) Toolkit for anaesthetic departments is currently being reviewed and revised by the Royal College of Anaesthetists, the Association of Anaesthetists of Great Britain and Ireland and the Association of  Physicians Assistants.

As part of this review there have been some discussions about the scope of practice of PA(A)s. In particular:

Role Advancement: PA(A)s undertaking induction and emergence without the direct supervision of a consultant anaesthetist, and

Role Extension: Following training and assessment PA(A)s undertaking regional anaesthesia (upper and lower limb blocks), spinal anaesthesia, sub-tenon blocks, arterial and central line insertion and out of theatre sedation.

We would be interested in trainee experiences and views on the role of the PA(A) and on any role advancement or extension. Please complete this very short survey https://www.surveymonkey.com/s/75VSPBG to let us know your thoughts. We would also be grateful if you could circulate the survey amongst the trainees within your school of anaesthesia so we can get as many views as possible.

The survey will be open until 28 June 2015 and will help shape discussions that GAT and the AAGBI are having with the Royal College of Anaesthetists, the Association of  Physicians Assistants and Health Education England.

We want to hear your views on Shape recommendations (9 June 2015)

Several collaborating trainee doctor associations (ASiT, BOTA, RCOG, RCSEd, EMTA, RCPath, RCPsych, RCPSG) are conducting a survey to get your views on potential changes to medical training in the UK.  The survey is pan-specialty, and covers a number of topics raised in recent proposals.  It should only take about 10 minutes to complete, but will help to further discussions regarding UK training.  GAT are supporting this survey and wish to ensure that it reaches as many trainees as possible. Please do take the time to fill this out, as we can only represent trainees with your help.

The survey can be found at https://www.surveymonkey.com/s/asit_bota_shot
Please help by sending this on to your colleagues, as the more responses received, the more evidence collected.

Thank you.

GAT Committee election results (3 June 2015)
Following the recent GAT Committee election, those elected to the GAT Committee with effect from the Annual Members’ Meeting at the GAT ASM, Manchester on 17-19 June are:

Deirdre Conway, ST4 Forth Valley Royal Hospital
Satinder Dalay, ST4 Worcestershire Royal Hospital
Ben Greatorex, ST6 Great Western Hospital
Cathy Lawson, ST5 Darlington Memorial Hospital
Victoria McCormack, ST6 Central Manchester Foundation Trust
Anaesthesia Trainee Fellowship (May 2015)
Anaesthesia Applications are invited for a one-year trainee Fellowship attached to the Journal Anaesthesia, starting at the AAGBI Annual Congress in September 2015. Find out more >
Tax relief for FRCA examination fee (02 March 2015)
It has come to our attention, thanks to one of our Trainee Network Leads (Kat Morton, Barts and the London School), that you can claim for tax relief for your FRCA examination fee. The College has introduced this facility this year. If you email exams@rcoa.ac.uk with your name and college reference number, they will send you the necessary paperwork. You can claim exam fees from 2007. A quick calculation of the potential benefit to trainees suggest that if you only took all the RCOA exams once, total tax rebate could be as much as £764 at current exam rates.

GAT Response to the Shape of Training Steering Group Statement (16 February 2015)

The Association of Anaesthetists of Great Britain and Ireland (AAGBI) Group of Anaesthetists in Training (GAT) Committee welcomes the recent statement released by the Shape of Training Steering Group (STSG). We are reassured to hear that the Steering Group will be widened to include doctors in training and that patients' interests will be at the centre of any proposals. We are encouraged by the commitment the STSG have made to properly consider, model, cost and consult on any proposed changes with incremental introduction rather than wholesale change.

We are relieved that there has been no further reference to shortening training and that those aspects of the current training system which are fit for purpose and work well should remain. We have evidence from a survey of AAGBI trainee members that the majority believe the current length of anaesthetic training is right.  This survey, along with feedback from the GMC training survey, supports the fact that most anaesthetic trainees are also satisfied with the quality of their training.

The AAGBI prioritises patient safety and education. The GAT Committee recognise that the health needs of the population are changing and that training programmes need to adapt to reflect this. We look forward to working with the STSG to continue to represent anaesthetic trainees during the next steps of the Shape of Training.

We are interested in any comments that anaesthetic trainees may have regarding the Shape of Training. Please contact gat@aagbi.org.

Recruitment of new NIAA trainee representative (19 February 2015)

The GAT committee would like to highlight an opportunity for academic trainees.  The National Institute for Academic Anaesthesia (NIAA) has a vacancy on its Board for a co-opted Trainee Representative.  The main function of the role is to represent the interest of Trainees, in particular Academic Trainees, to the NIAA and to its partners.  The role involves attending quarterly NIAA Board Meetings and participating in activities to promote and enhance the work of the NIAA and academic anaesthesia in the UK.

Trainees who hold a National Training Number in Anaesthesia, and who are either Academic Clinical Fellows, Academic Clinical Lecturers or who are undertaking or have completed an MD (Res) or PhD are eligible to apply.  The post commences in June 2015 and is for 3 years (or until CCT). Applications should be submitted on-line via the NIAA website and the closing date for submission is 5pm on Monday 18 May 2015.

More information, including a job description, person specification, details of how to apply and who to contact for more information can be found here > 

The Shape of Training Review - Joint RCoA Trainee Committee & GAT Commitee Statement (8 December 2014)

The GAT Committee, along with the Royal College of Anaesthetists (RCoA) Trainee Committee, have been involved throughout the Shape of Training Review process so far. The GAT Committee has continued to represent the views of anaesthetic trainees during the September seminars and we await the report of the Steering Group expected in the New Year.

Read more >

European Working Time Directive (EWTD) - Letter from Jeremy Hunt MP
(16 September 2014)

Mr Jeremy Hunt MP has responded to the AAGBI and GAT about their points of concern relating to the Government's response to the review of the EWTD.

Read the letter here >

Clinical suport for trainees (18 August 2014)

The AAGBI has received reports via its Trainee Network Scheme of situations in which trainees are undertaking cases during normal working hours with no Consultant support.

Read the AAGBI safety statement >

A letter to Mr Jeremy Hunt MP in relation to the review of the impact and implementation of the European Working Time Directive (12 August 2014)

The AAGBI and GAT raise some points of concern relating to the Government’s response to the review of the impact and implementation of the European Working Time Directive on the NHS, in a letter to Mr Jeremy Hunt MP.
Read the full letter here >

Mercy Ships and RCoA Anaesthestic Fellowship (29 May 2014)

Mercy Ships and RCoA Anaesthestic Fellowship

This new collaboration is a unique opportunity for an anaesthetic trainee to gain three months with Mercy Ships experiencing many aspects of Developing World Anaesthesia. The Fellowship runs for three months, commencing February 2015.

Further information >

GAT Response to the Shape of Training Review (18 March 2014)

The Shape of Training Review final report “Securing the future of excellent patient care” was published in October 2013. The Association of Anaesthetists of Great Britain and Ireland Group of Anaesthetists in Training (GAT) represent over 3000 anaesthetic trainees and has participated actively in the review. Written evidence was submitted (GAT written evidence, AAGBI written evidence) followed by attendance at an oral evidence session, informed by a survey of our membership (oral evidence session, additional evidence). Several members of the committee also participated in a workshop for doctors in training. The Faculty of Intensive Care Medicine and Royal College of Anaesthetists have published their responses to the final report (RCoA response, FICM response) and we would like to add our thoughts and concerns.  Read more >

Shape of Training Review: Additional evidence submitted by GAT (27 June 2013)

Following attending the Shape of Training Review (SOTR) oral evidence session on the 30th May, we were given a document describing three possible approaches to postgraduate medical education and training. Using the results of the survey conducted in early May we considered the approaches and wrote an additional paper to submit as evidence to the Review. GAT has subsequently been invited to attend a Shape of Training Review workshop for doctors in training on the 22nd of July. We would be interested to hear your views on the review so far. Please contact us at gat@aagbi.org.
Shape of Training Review: Oral evidence session 30 May 2013 (14 June 2013)

The Shape of Training Review, looking at potential reforms to the structure of Postgraduate Medical Education, has completed the collection of written evidence and has now begun to collect oral evidence. GAT was invited to a session on the 30th May. Sarah Gibb, GAT Vice Chair and Nancy Redfern, AAGBI Council, attended and presented the evidence gathered from a recent trainee membership survey on the themes of the review. For the results of the survey and more information on the review. click here >

BMJ Careers - Three quarters of young anaesthetists might leave NHS if subconsultant grade were introduced (17 April 2013)

More than three quarters of trainees and new consultants in anaesthetics would consider leaving the NHS if a subconsultant grade were introduced to manage the expected oversupply of consultants in the UK, a survey shows. Read more >

RCoA Trainee and GAT Committees Workforce Planning Survey (9 January 2013)

The joint survey results regarding the 'Shape of the Medical Workforce' paper are now available.  The survey asked both anaesthetic trainees and those anaesthetists within 5 years of CCT about potential ways they would like to work in the future, as it is believed that any prospective changes would primarily affect these two groups.

The Centre for Workforce Intelligence (CfWI) document, published in February 2012, used mathematical models to outline seven potential solutions for a future oversupply of consultant-level clinicians (see table below). Most of these have the potential to significantly alter the role of the senior trainee and consultant in healthcare delivery.

Summary of the CfWI proposals

The aim of our survey was to garner the opinion of our profession to these potential solutions, determining which (if any) would be palatable to current anaesthetists. As such, we chose a ranking method for the seven propositions, asking our respondents effectively to tell us which they felt were the most and least acceptable.

Firstly, we would like to thank our members who took the time to complete the survey; we very much appreciate your input as the high response rate adds weight to future discussions.

1796 complete responses were obtained. Of those respondents who supplied their grade: 1741 were trainees, 325 were consultants and 94 were made up of Locum Consultants, Specialty Doctors, Clinical and Research Fellows.  There are 4870 RCoA-registered trainees, giving a 35% response rate.  It is harder to numerate for those post CCT.  The RCoA has recommended 2577 doctors for a CCT since 2007 giving a response rate of 15% but we know that not all of those individuals remain in the UK. 

The results demonstrated overwhelmingly that respondents were unhappy about the options modeled by the CfWI.  57.8% of those who ranked the CfWI scenarios placed the ’graded career structure’ as the most undesirable outcome of the seven options. Of the options presented, ‘business as usual’ was the most universally accepted option with 40.7% choosing this as the most acceptable option.

A full version of the survey results, including free text comments, will be available in forthcoming issues of Anaesthesia News and the RCoA Bulletin.

Returning to work after a prolonged period of absence (13 December 2012)

SignsAs a trainee, returning to work after a break for any reason can be daunting, especially with the prospect of solo lists and on calls.  Wessex Trainees, Dr Aarvold, Dr Haigh and Dr King, with consultants Dr Smith and Dr Hopkins developed a Return to Work programme for anaesthetic trainees which was featured in June’s Anaesthesia News (“Returning to Work the Wessex Way” pg 18). This guidance has been recognised as an example of good practice by the Royal College of Anaesthetists.

Following its success within anaesthetics the Wessex Deanery has adapted the guideline for all specialties and condensed it into a flowchart with pre-absence and returning to work forms.  Clearly returning to practice isn’t just an issue affecting trainees and these guidelines could be used as a model on which to base a return to practice programme for any grade of anaesthetist.  The Academy of Medical Royal Colleges and Royal College of Anaesthetists have both issued guidance on returning to practice recently which will also be useful for any departments developing local programmes.

Guidance on returning to practice from the Academy of Medical Royal Colleges >

Guidance on returning to practice from the Royal College of Anaesthetists >

Anaesthetic Sprint Audit Project (ASAP): Great opportunity for trainees to participate in a national audit project. Register your interest NOW! (7 December 2012)
Hip fracture is a serious injury in the elderly resulting in significant morbidity and mortality however there is little evidence based medicine to guide perioperative care and controversy exists over optimal anaesthetic management. Large scale randomised controlled trials are difficult to undertake and there is a growing feeling that large scale audits conducted over short period of time (“sprint audit”) may help to establish potential links between management and outcome.  Read more >
'Shape of Training' and 'Workforce Planning’ – what does it all mean? (21 November 2012)

How we can influence the future of our training

Trainees are never far away from being asked to complete yet another survey. The most recent, “Workforce Planning in 2012”, was born from the executive summary for the CfWI (Centre for Workforce Intelligence) report of February 2012. The survey is now closed and the AAGBI/GAT Committee will formulate a response based on the results which will be published at further notice.

A next big appeal for democratic opinion has come in the form of “The Shape of Training” review which calls for all trainees’ (not just anaesthetists) ideas and thoughts on postgraduate education. The BMA are urging all to take part in this huge appraisal, sponsored by the likes of the GMC, Medical Schools Council, the Academy of Medical Royal Colleges, and UK health departments. Especially for the more junior of us, just starting out in our careers, this potential upheaval of training and career path seems overwhelming and complicated. Although they are asking for our feedback, are we informed enough to give it?

The GAT Committee are committed to trying to demystify, disseminate, and help inform all trainees to understand these concepts. In the meantime, the website (www.shapeoftraining.co.uk) is accessible by all, and everyone can register and participate in giving feedback until 8 February 2013. We encourage all to do so!

The pregnant anaesthetist on-call (13 September 2012)
Pregnant anaesthetist“Guidance for expectant anaesthetists” featured in Trainee Updates in May. There is little information however guiding pregnant doctors as to when it is reasonable to cease out of hours working.  Although there is no evidence to suggest that either is detrimental to mother or baby, long days and nightshifts may become exhausting in the later stages of pregnancy.  Dr Fulton and Dr Savine from St Georges Hospital, London, presented a survey looking at this issue; “The pregnant anaesthetist on-call”, at the GAT ASM. Fifty three episodes of pregnancy were surveyed and results showed that trainees stopped daytime on-calls at a median of 32.5 weeks gestation and nightshifts at a median of 30 weeks gestation.  Although each pregnancy is different this information may prove useful for pregnant anaesthetists, particularly first time expectant mums, who are unsure how to plan for the later stages of pregnancy.
New Returning to Practice Guidance (4 August 2012)

The Academy of the Medical Royal Colleges (AoMRC) has recently published new guidance on returning to practice following an absence (including those returning to their usual practice after working in a different area of clinical practice). Time away from practice can affect a doctor’s confidence, skills and knowledge. The AoMRC was concerned that there was a perceived lack of guidance on supporting a return to practice, potentially compromising patient safety, and so a working party was established.

The recommendations of the working party define a prolonged absence from practice as more than three months and give examples of checklists which should be used pre and post absence to conduct an individual evaluation of the doctor returning to practice, allowing an action plan to be formulated.
The Royal College of Anaesthetists (RCoA) have subsequently updated their return to work guidance using the framework suggested by the AoMRC. A recent article in Anaesthesia News described the Wessex School of Anaesthesia experiences of introducing a return to work programme which has been recognised as an example of good practice by the RCoA. Read the article 'Returning to Work the Wessex Way' on pages 18-19 of Anaesthesia News >

GMC National Training Survey Results (16 July 2012)

The GMC has published its annual national survey of trainee doctors. The survey provides a critical snapshot of the views of more than 51,000 frontline doctors out of 54,000 who were eligible to respond.

Find out more and view the key findings >

Buddy Scheme for New Starters to Anaesthesia: A Model (6 July 2012)

Buddy schemeThe first year of anaesthetic training can be a fairly daunting time; lots of new theory and practical skills to learn, new colleagues and perhaps an unfamiliar hospital in a new part of the country.  Couple this with the need to complete the initial assessment of competency and then start thinking about the primary FRCA within a few months it would not be surprising if some new starters felt a bit overwhelmed and in need of support from someone who has been in their shoes.  With the advent of shift working and the fact that new trainees are likely to spend most days in theatre with a consultant it can take time for new starters to forge links with other trainees in their department. 

Find out more >

Trainee Network Links update (18 May 2012)

The AAGBI Trainee Network Scheme has now been up and running for a few months now with Trainee Network Links established in the following regions: Belfast, Bristol, West Midlands, Oxfordshire, Shrewsbury, Edinburgh, Peterborough, Aberdeen, Newcastle, Cardiff, London, Sheffield, Sussex and Leeds.

We have already experienced considerable dialogue with the Links already, the feedback of which will go out in the form of a newsletter to them within the next few weeks.  This has been a really positive response to this initiative and we hope to continue to establish Network Links in all regions over the next few months.  If your region is not represented in the list above please contact your regional trainee representatives and help us establish a Link in the Network for your trainees too.  The GAT ASM promises an opportunity for the GAT committee to potentially meet and chat with Links and other trainees in person and we look forward to meeting people in Glasgow. 

Alternatively please email gat@aagbi.org/secretariat@aagbi.org

Guidance for expectant anaesthetists (11 May 2012)

Pregnant womanBeing pregnant is an exciting time, however it can also be exhausting and therefore it is important to be aware of the legislation and advice available to help you look after yourself and your unborn baby whilst continuing to work.

Once your employer knows you are pregnant you are entitled to reasonable paid time off to attend antenatal appointments. A previous article from Anaesthesia News discusses the occupational hazards involved with being a pregnant anaesthetist (The pregnant anaesthetist).  One common query is when is it reasonable to come off the on-call/nightshift rota? Unfortunately there is no clear guidance on this issue.  As soon as you tell your employer you are pregnant they must undertake a risk assessment of your work place and practices which should include looking at shift patterns. Each individual anaesthetist will need to come to an agreement with their department on an arrangement which is acceptable for both the service requirements of the department and the health of your pregnancy.  For trainees it may be sensible to try to do your “share” of nightshifts early in your pregnancy. In the later stages of pregnancy nightshifts can be difficult and most departments are supportive to you performing your duties during daytime hours after the third trimester. If you are finding this difficult a letter from your midwife or GP will support your case for a change to your working pattern. For trainees it is worth noting that if you decide to come off the out of hours rota earlier in your pregnancy then this period may not count as training time and therefore might affect your CCT date.

Further guidance on how to safely work during your pregnancy is available from the government (Pregnancy and work), the Health and Safety Executive (A guide for new and expectant mothers who work)and the NHS Plus/Royal College of Physicians (Physical and shift work in pregnancy). More information relating to pregnancy, maternity leave and less than full time working is available in an A to Z Guide on the GAT pages of the AAGBI website.

Childcare Vouchers: Important changes to entitlement for higher rate tax payers (28 Feb 2012)

Childcare vouchers are a salary sacrifice scheme which may benefit any anaesthetist with young children. The vouchers can be used towards paying for qualifying childcare including nursery, child-minders, nannies or holiday clubs. If you are new to the scheme then higher rate tax payers can benefit from up to £124 per month of childcare vouchers free of tax and National Insurance contributions while lower rate tax payers can receive up to £243 (previously all employees were entitled to the higher benefit).  Partners or spouses may also be entitled to up to £243 of vouchers per month from their employer.

If you are a higher rate tax payer and already receive vouchers and joined your employer’s scheme on or before 5th April 2011 then you will retain your right to receive vouchers up to the value of £243 per month.  There are several different childcare voucher providers therefore if you change employer and have to join a different voucher scheme you will lose the right to the higher benefit.  This is a real disadvantage for trainees who rotate through different employing trusts but unfortunately no allowance is made for this currently. 

It is also important to note that each voucher scheme and employer may have different policies; some allow you to stop claiming or reduce the benefit claimedfor up to a year while retaining protected rights for the £243 benefit but this may not be universal.  It would therefore be wise to check with both your voucher scheme provider and employer before stopping or reducing the benefit claimed if you are likely to require vouchers again in the future (vouchers may be valid for several months after issue and so can be kept and used to pay for childcare at a later date).

Amendments to the Sex Discrimination Act in 2008 have extended the period during which an employee is entitled to receive contractual non-cash benefits including childcare vouchers during maternity leave from 26 to 52 weeks.  This may mean that if you are no longer receiving pay from your employer (usually after 26 weeks) they are required to continue to provide you with vouchers despitebeing unable to sacrifice the amount from your salary.

More information on voucher schemes can be found in the HMRC leaflet “Paying for childcare” and on the Directgov website.   In addition information about childcare vouchers and many other issues affecting less than full time trainees in anaesthesia is available in an A to Z Guide to LTFT training available on this section of the AAGBI website.

Changes in specialty examinations policy & recognition for CCT (15 Feb 2012)

Young male doctor using laptopThe RCoA has formally announced changes to the specialty examinations policy and recognition for CCT as governed by the GMC.

The College now states that if the trainee completes the Primary and/or Final FRCA without a training number they may be eligible for a CCT if they re-enter training within 7 years of a pass.  Trainee eligibility can be determined by contacting the RCoA training department. The RCoA website provides a number of CCT Programme FAQs >

BMA rejects pensions offer and urges government to think again (18 Jan 2012)

Following an overwhelming call from doctors to reject the government’s proposed changes to the NHS Pension Scheme and a willingness to undertake some form of industrial action, the BMA today (Wednesday 18 January 2012) called on the government to urgently reconsider their plans.

Read the full BMA press release >

NEW AAGBI Trainee Network Scheme (5 Dec 2011)

GAT are in the process of establishing a new Trainee Network to enhance dialogue and communication across regions and with the Committee.  Letters and Emails have been sent to heads of schools of anaesthesia over the previous week along with information.  We hope to establish a Trainee Network 'Link' in each region (a motivated trainee) by January 2012.

For more information please contact the head of your school of anaesthesia or gat@aagbi.org

Hot off the Press: GMC Training Survey Results (3 Nov 2011)

Key findings of the GMC's National Training Survey 2011. Find out more >

Survey Results by Specialty. Find out more >

For Anaesthetics UK wide. Find out more >

Letter written to the Faculty of Intensive Care regarding the training structure of Intensive Care Medicine (ICM)

Many thanks to those who replied to our questionnaire about the changes to ICM training. There were 30 responses. The main concern was how the transition from the current to the new system will be conducted, and more specifically whether training already completed will be counted towards the award of a CCT. This was particularly the case for those in ST2-3 and those who have taken time out of training: for these trainees there is a great deal of uncertainty about which programme (old or new) they will be appointed to, and the practicalities of the appointment system.

In response to these concerns we have written a letter to Professor Bion seeking clarification on the following points:

  1. Will trainees who have had their training lengthened, or are currently ST3 be able to count the Units of Training they have already completed towards a CCT in ICM?
  2. How many years prior to a trainee taking up the post should deaneries appoint ICM trainees to the ‘old’ advanced training posts in 2012 and 2013? Further clarification would allow trainees to better plan their applications.
  3. How will appointments to dual training be conducted? Will trainees apply for dual training, or will they apply initially for ICM and then have to apply separately for anaesthesia?
  4. Will there be an initial entry above the ST3 grade in 2013?

View the letter to the Faculty of Intensive Care Medicine >

An update will be available when we receive further information from the Faculty of Intensive Care Medicine.

Changes to the training structure of Intensive Care Medicine (ICM)
Let us know if you are affected (9 September 2011)

Intensive Care MedicineThere has been a great deal of correspondence in the medical press regarding the establishment of the Faculty of Intensive Care Medicine (FICM) and the associated changes to the structure of ICM training in the UK as proposed in the FICM's letter of the 15 July 2011. More details can be found in the September edition of Anaesthesia News.

This notice is for the attention of trainees who intend to dual accredit in ICM and anaesthesia, but who will be ineligible to be appointed to higher training by July 2013. At that point the single year ‘advanced training ’  is due to be terminated  and to be awarded a dual CCT, a trainee will be required  to undertake units of training in ICM as part of the new curriculum (even if they have already been done as part of the current scheme). Those trainees who are not willing to repeat units might* be awarded a CESR in place of a CCT, which is viewed by the GMC as an equivalent qualification, but does not carry the same recognition as a CCT around the world.

GAT would like to establish how many of our trainee members will be disadvantaged by the proposed changes. We would like to hear from trainees who intend to achieve a dual CCT in ICM and anaesthesia, and who have completed some of the supplementary training required to be appointed to higher ICM training, but who will be unable to be appointed to this post before such schemes terminate in July 2013.

Please complete the the short poll if you think this may affect you and the information will be used to inform our response to the FICM. All of your responses will be anonymous. If there are additional points to make or consultants who wish to express an opinion, please use the free text section.

Complete the online poll >

BMA issues guidance for doctors and medical students on the use of Social Media (1 Sept 2011)

Social mediaThe dramatic expansion of social media resource has created an industry offering extensive access to interaction with friends, family, public and professionals.  It offers forum for career and professional discussion along with the arena for social and personal interaction.   Along with its array of benefits also comes debate as to how professional commitment integrates into its use and how the duties of doctors and medical students should be regarded and respected along the way.  The BMA has issued guidance relating to this issue. Read more >

Some points of interest and importance within this guidance include:

  • Information uploaded onto the web is not always protected and use of conservative privacy settings highly advisable. Default settings are often more ‘public’ than most realize and once on to web, data is not always easily deleted nor can its distribution be controlled.
  • Ethical and Legal duties of confidentiality strictly apply via web-based discussion as they do in any other media. Breaches represent professional misconduct and can therefore question a doctor’s fitness to practice.
  • Inappropriate discussion relating to patient, colleague or employer should, clearly, not be conducted via public websites.
  • Posting comments under a username online does not guarantee anonymity as they can be traced back to the original author.
  • Defamation Law can apply to any comments posted on the web whether in personal or professional context – ‘Defamation’ is the act of making an unjustified statement about a person or organization  which is considered to harm reputation.  This can result in legal action against the individual or organization they represent.
  • BMA recommends that patients (current or former) should not be accepted as friends on facebook
  • Under GMC regulation medical professionals should maintain their duty to declare any conflicts of interests when making postings online (ie. Involvemtent with healthcare/pharmaceutical/healthcare groups)
  • Organisations may have access social media content uploaded by doctors and thus anything viewed as inappropriate could have detrimental professional consequence. Evidence of any unprofessional behaviour can also lead to disciplinary action.

 

New GAT Committee Members (8 June 2011)

The AAGBI GAT Committee is pleased to announce the election of six new members who will take up their posts after the GAT Annual General Meeting in Leeds on 30th June:

  • Dr Annemarie Docherty (ST4, Borders General Hospital, Edinburgh)   
  • Dr Sarah Gibb (SpR3, Royal Victoria Infirmary, Newcastle upon Tyne)
  • Dr Ulka Paralkar (ST5, University Hospital of Lewisham, London)
  • Dr Kiran Tippur (ST6, Western Infirmary, Glasgow)
  • Dr Caroline Wilson (ST4, Wexham Park Hospital, Slough)
  • Dr Samantha Wilson (SpR, University College London Hospitals)
The College of Anaesthetists of Ireland Final Exam and UK CCT (31 May 2011)

The Council of the College of Anaesthetists of Ireland (CAI) has decided that they will not apply for accreditation by the General Medical Council of the Final FCARSI exam for award of an UK Certificate of Completion Training.  On their website, the CAI state that the autonomy of the CAI exam may be compromised if it was to endeavour to meet the current, and future, requirements of both the Irish and UK accreditation processes.

A pass in either the Primary FRCA or Primary FCARSI can be used as entry criteria for the Final FRCA or Final FCARSI. 

A statement can be found on The College of Anaesthetists of Ireland website and the RCoA website.

Ten top tips for your first year as a consultant 

Dr Felicity Howard gives trainees ten top tips for their first year as a consultant. Read more >

 2011 Council and GAT elections (1 March 2011)
Hands in the air  The AAGBI is now accepting nominations for the 2011 Council and GAT Committee elections. Please click on the links below to download pdfs of the relevant documentation. read more >
GMC statement (18 June 2010)
Girl studying for exam

The GMC have issued a statement on examinations taken outside approved postgraduate training.
Read more >

GAT Committee Statement regarding validity of CCT Exams (May 2010)

Read the response from the GAT Committee to the recent debate sparked by the merger of the GMC and PMETB. Read more >

GAT submit comments on the MEE's review of the EWTD (Feb 2010)
The GAT Committee was recently asked to submit comments on MEE's review of the impact of the European Working Time Directive on the quality of postgraduate training. Refer to pages 3 to 8 - Read the report >