At least one question in most higher anaesthetic training interviews asks about the state of the specialty: what the biggest issues are, how they affect training, and what you would do about them. It is scored under commitment and professional behaviour, and it rewards candidates who have a view rather than a list. This guide covers the issues to know this year and how to answer with them.
How the question is asked
- What are the biggest issues facing anaesthetics in the NHS at the moment?
- How do current NHS pressures affect anaesthetic training?
- What did you make of the latest workforce census?
- What is your view on anaesthesia associates?
- What do you understand by perioperative medicine, and what is the anaesthetist's role in it?
- What has the specialty learned from NAP7?
- What would you change about the way theatres run in your trust?
The issues to know
The workforce. The Royal College of Anaesthetists' 2025 census found a shortfall of anaesthetists equivalent to well over a million operations a year, alongside growing concerns about wellbeing, retention, and the number of trainees who cannot progress because of the ST4 bottleneck. Know the headline numbers and what they mean locally: lists cancelled for lack of an anaesthetist, consultants working extra sessions, the effect on training opportunities.
The training bottleneck. Competition for ST4 posts has risen sharply and the college has argued for more higher training places. As a candidate you are living this; say what it means for trainees stuck at core level and what the specialty should do about it, with a view rather than a complaint.
Theatre productivity and the waiting list. Elective recovery depends on theatre efficiency, and GIRFT has published recommendations on list utilisation, start times, day case rates and surgical hubs. Anaesthetists control much of this through pre assessment, scheduling and turnaround. Have one example from your own trust of something that works and something that does not.
Anaesthesia associates. The Leng review of physician and anaesthesia associates reported in 2025 and the scope of practice debate continues. Know what the review recommended, what the college's position is, and have a measured view that respects both patient safety and the associates as colleagues.
Perioperative medicine. The move to assess and optimise patients earlier and better before surgery, shared decision making, prehabilitation, the Centre for Perioperative Care's guidance. Say what the anaesthetist's role is and what you have seen done well.
NAP7. The seventh national audit project on perioperative cardiac arrest, its findings on the frequency and causes of arrest, and what it means for practice: the role of frailty, bradycardic arrests, the importance of the pre operative assessment and the team's response. Know two or three findings and one change in practice.
Sustainability. The carbon footprint of inhaled anaesthetics, the move away from desflurane and nitrous oxide, and the broader greener theatre agenda. Have one thing you have done or would do.
Industrial action and training. The effect of resident doctor industrial action on lists, on training opportunities and on departmental morale, and a view on how departments should protect training through it.
Answering with a view
Pick three issues. For each, say what the issue is in a sentence, what you have seen of it in your own practice, and what you think should be done, or what a registrar can do. Then stop. The assessors want evidence that you read the college's material and think about your specialty, not a survey of everything in the news.
Where there is a contested issue, such as anaesthesia associates, give a measured view and acknowledge the other side. The assessors may hold the other view, and they are scoring judgement, not agreement.
Linking to training
Many of these questions end with "and how does that affect training?". Have an answer: fewer lists means fewer training opportunities, pressure on productivity can squeeze out supervised cases, associates change the mix of cases trainees see, and the bottleneck itself changes how trainees plan their careers. Say what you would want the department to protect.
Preparing
Read the college's census summaries, its position on associates, the GIRFT anaesthesia recommendations and the NAP7 summary. Write three one minute answers with your own view and one example each. Say them aloud. Then have someone ask the follow ups: "what would you actually do about that?" and "what if your consultant disagreed?".