Fitness for purpose in anaesthesiology: a review

Abstract

The purpose of this review is to explore how fitness for purpose can be defined for anaesthesiology graduates and to delineate the parameters of this concept for anaesthesiology. Newly qualified anaesthesiology graduates experience difficulties with the transition from trainee to specialist, with perceptions of unpreparedness especially in non-technical skills. This may be deleterious to the individual, the patient, colleagues and the workplace. It is possible that graduates may be deemed competent yet are unable to fulfil all their specialist roles. Fitness for purpose and its relationship with competence, expertise and excellence in anaesthesiology have been poorly defined in the literature. These concepts are not synonymous but provide a hierarchical framework for the development of a specialist from a beginner to an expert. The uncertainties surrounding competence are numerous, with generic competency frameworks not addressing all aspects unique to anaesthesiology. The applicability of such frameworks in areas outside which they were originally designed and, in particular, in anaesthesiology, is questionable and requires further investigation. Defining fitness for purpose in anaesthesiology will assist training departments, curriculum designers, assessors and regulators to produce specialists that are experts in their chosen field without any deficiencies and thus able to perform all their required roles.

Defining fitness for purpose in South African anaesthesiologists using a Delphi technique to assess the CanMEDS framework

“…Anaesthesiologists' non-technical skills are necessary for the practice of safe anaesthesia with good patient outcomes. 6,19 Several suggestions from the panel alluded to the ability of the anaesthesiologist to be able to perform numerous technical and non-technical skills concurrently. These include situational awareness, not only in the collaborator role as indicated by CanMEDS, 8 but in all roles of the specialist.…”

“…Fitness for purpose (FFP) in anaesthesiology has been defined as an expert without any deficiencies in either their technical or nontechnical skills. 6 It has, however, not been addressed in the South African anaesthesiology context. This elusive concept is closely related to competence and expertise, however, it is imperative that distinctions are made to have a clear understanding of the expectations of graduating specialist anaesthesiologists.…”

“…This elusive concept is closely related to competence and expertise, however, it is imperative that distinctions are made to have a clear understanding of the expectations of graduating specialist anaesthesiologists. 6 In South Africa, anaesthesiologists under the guidance of the Colleges of Medicine of South Africa (CMSA) are trained by university departments and assessed in accordance with the Canadian Medical Education Directives for Specialists (CanMEDS).…”

“…Firstly, it is a competency framework that, despite its many benefits to postgraduate training and improved patient outcomes, does not imply fitness for purpose. 6 Each of the seven meta-competencies consists of several key and enabling competencies incorporated into milestones that the graduate must achieve. 11 However, not all meta-competencies or complex roles can be reduced to component milestones.…”

Are South African anaesthesiologists fit for purpose? A comparison of opinions of graduates, teachers and examiners

“…However, FnFP in medicine and in anaesthesiology is complex and, until recently, has been poorly addressed in the literature. 27 Measuring whether a graduate does what he/she is supposed to in every situation for every patient under every circumstance is not as easy as testing a product in a factory. FnFP of anaesthesiologists is a concept that incorporates essential core elements to ensure an appropriately safe level of specialist practice.…”