Defining excellence in anaesthesia: the role of personal qualities and practice environment

Calls for reform to postgraduate medical training structures in the UK have included suggestions that training should foster excellence and not simply ensure competence.

We conducted a modified Delphi-type survey starting with an e-mail request to specialist anaesthetists involved in education, asking them to identify the attributes of an excellent anaesthetist. In focused group interviews, their coded and categorized responses were ranked, and suggestions were made for incorporation into anaesthesia education. We also compared the findings with currently available professional and educational guidance.

Our expert group strongly expressed the view that while superior knowledge and skills, associated with exceptional performance in clinical work, were fundamental to the excellent practitioner, they were not sufficient in themselves. A group of attributes that were personal qualities and functions of personality were also considered essential. The defining characteristic of excellence was, perhaps, the continuing urge to seek challenges and learn from them. Other high-ranking characteristics included clinical skills, interest in teaching, conscientiousness, innovation/originality, communication skills, and good relationships with patients. Knowledge for its own sake (personal involvement in research) was not rated highly, but applied knowledge was judged to underlie many of the most important categories.

The achievement of excellence in anaesthesia is likely to depend on the successful interplay of individuals' personal qualities and the environment in which they work. Thus, not only trainees but also educational supervisors, heads of departments, and those responsible for organizing training systems all have a part to play in the encouragement of excellence.