Modifiable stressors during transition from resident to consultant

We read with interest the study by Gale et al. detailing the many stressors residents face during stage 1 and 2 training in anaesthesia 1. The aim of stage 3 anaesthetic training is to prepare anaesthetists for independent practice 2 and many of the stressors described are also valid for this training period. The 2025 General Medical Council (GMC) national training survey highlighted that 61% of all resident doctors are at moderate or high risk of burnout 3. This is concerning, given that transition points in careers are believed to be a further significant contributory factor for burnout 4. The 2021 curriculum from the Royal College of Anaesthetists (RCoA) aims to ensure the generic professional capabilities from the GMC have been developed on completion of training 2. However, we believe that newly appointed consultants are ill-equipped in some aspects of their role. In November 2024, the RCoA simulation advisory group recommended the provision of consultant readiness training with the intended learning outcome of showing the non-technical skills and behaviours required at consultant-level practice, but with little further detail 5. There are currently no published examples of this. With this in mind, we undertook a survey of all consultant anaesthetists in Scotland to determine which aspects of consultant appointment they found challenging, and to determine what guidance and training they felt would be beneficial before commencing their post. In January 2025, the survey was distributed by departmental anaesthetic secretaries via an email invitation to participate, with one reminder in May 2025. In total, 170 consultants responded from 770 consultants practicing in Scotland (a response rate of 22%) 6. The survey identified key themes, with the focus being on non-clinical aspects of consultant workload. More than half of respondents commented on a lack of previous understanding of contractual issues such as job planning and the appraisal process. Management aspects were described by 58 (34%) as the biggest challenge, such as: non-clinical roles and expectations of a new consultant within a department; a lack of transparency on routes to affect change at a hospital level; and the volume of administrative work. More than one-quarter reported challenging aspects of clinical care, such as the new responsibility of being a senior decision-maker and decision-making fatigue, especially in relation to the cancellation of surgery. This was particularly challenging when compounded by difficulties in interpersonal relationships, as described by 26 (15%), both within and between specialities. Consultants also described feeling unprepared for: moving from a full-shift to a non-resident on-call pattern; juggling the training needs of residents with list management; balancing clinical and non-clinical duties; and uncertainty regarding job security for those in locum posts. Despite the low response rate, key themes evident throughout this survey provide a novel insight into the wellbeing of newly appointed consultants. Although we commend our professional bodies for their focus on resident wellbeing, we believe that wellbeing should not end on completion of training. The survey highlighted the need to provide formal support and training for stage 3 residents and newly appointed consultants. By doing so, it will contribute to the strategies outlined by Gale et al. to improve wellbeing from residency to consultancy and beyond. Within the West of Scotland, we have designed a multi-speciality pilot consultant readiness course. This will encompass aspects from the survey results such as contracts and job planning, hospital management structures, appraisal requirements and complaints processes. Furthermore, this interactive course will use scenarios to develop the socio-cognitive skills and behaviours required at consultant level, focusing on senior decision-making skills, managing residents with difficulties and resolving inter-speciality conflict.