Providing the right environment for learning

In 1988 Steven Jonas wrote in the forward to one of the first textbooks devoted to clinical teaching, “There are two principal influences on physician behaviour: how they are paid and how they are trained.” 1 Looking round the world we find that there are striking differences in the way anaesthetists are trained; not least in the duration of training, which ranges from two to seven years. Some countries have in-service exams, some have an exit exam and others have no exams (see Table 1 ). 2 We must conclude that there is a lack of consensus about how best to train anaesthetists. The differences run even deeper. There is no consensus as to what a specialist anaesthetist is. In the UK there is one grade of consultant but the job may include sessions in sub-specialties such as critical care and pain management to which some countries devote entire training schemes. Some countries have several grades of specialist with the possibility of promotion with further experience. In the United States, practice and habits of work are divided between university academic and independent institutions. Clearly there are differences in the approach to training that depend on these factors but the educational project is similar wherever anaesthetists train. This text is devoted to those similarities.