We spoke to the Bangkok Anaesthesia Regional Training Center (BARTC) fellow about his paediatric anaesthesia fellowship in Thailand
Please introduce yourself
My name is Than Hoang Son, I’m pursuing a fellowship in paediatric anesthesia through the prestigious Bangkok Anaesthesia Regional Training Center (BARTC) programme in Thailand to further enhance my skills and knowledge in this specialised field.
Where are you from and what work were you doing back home?
Before my fellowship, I was working at the Vietnam National Children’s Hospital, the leading hospital for children in my country. I provided sedation and anaesthesia for paediatric patients inside and outside the operating room.
Why were you interested in anesthesia as a career?
Paediatric anaesthesia combines my interests in paediatrics and anesthesiology. From a young age, I have always been enthusiastic about working with children.
As I progressed through my medical training, I found a particular passion for the paediatric field. My interest in anaesthesia was sparked during my clinical rotations when I was a fifth year medical student. I observed the critical role of paediatric anaesthesiologists to ensure the safety and comfort of young patients intraoperatively.
The moment when children recover well after surgery fills me with happiness and enthusiasm. Seeing their smiles and knowing that I played in their recovery are incredibly rewarding and motivate me to continue in this field.
Why did you want to pursue a fellowship with WFSA?
I wanted to pursue a fellowship with WFSA because it is the largest and most respected organisation of anaesthesiologists globally. The fellowship offers an invaluable opportunity for me to receive advanced training and exposure to the latest techniques and best practices in paediatric anaesthesia.
Being able to collaborate with and learn from leading experts and peers from around the world will significantly enhance my knowledge, skills, and passion as well.
What is the highlight of your working day?
The highlight of my working day are the morning anaesthesia conferences. These sessions are invaluable as they provide me with an opportunity to share my thoughts and learn from experienced professionals.The teachers, whom I respectfully call “Ajarn” in Thai, along with the students, are exceptionally kind and helpful.
During these conferences, we engage in thorough discussions about the anaesthesia risks associated with each case, how to manage them, and the various plans we could implement. This collaborative environment has been instrumental in refining my skills.
I’ve learned practical techniques such as applying face masks, intubating neonates and infants, and inserting arterial and venous lines… to name just a few. While I could perform these tasks as a staff member at my hospital, the guidance and feedback I receive here have been crucial in ensuring I do them correctly and continuously improve.
In the afternoons, I often join the residents in seeing patients scheduled for procedures in the following days and occasionally check on those to whom we provided anesthesia in the ICU and wards. This comprehensive approach to learning and patient care not only enhances my skills but also motivates me to strive for excellence in paediatric anaesthesia.
What are the highlights of your fellowship so far?
Firstly, I have had the opportunity to meet and learn from many experienced professors, residents, and fellows. I have gained valuable knowledge from them, not only in terms of academic content but also in observing how they work and solve problems. This experience has significantly boosted my confidence, knowing that I now have a network of friends and teachers who I can contact and consult with in the future.
Secondly, the teachers have been incredibly motivating, encouraging me to delve into textbooks and articles covering basic sciences such as physiology, pharmacology, and the fundamental concepts of paediatric anaesthesia, as well as the history of anaesthesia. This comprehensive approach has helped me to see the bigger picture of patient situations, enabling me to make more informed and accurate management decisions.
Lastly, I have had the great opportunity to attend two significant anesthesia meetings in Thailand, Royal College of Anesthesiologists of Thailand Congress (RCAT) Congress and Thai Association for the Study of Pain (TASP) Meeting. These events have allowed me to update my knowledge with the latest advancements in paediatric anaesthesia and meet and discuss with experts in the field.
Additionally, I gave presentations at each hospital, and the teachers appreciated my contributions and willingness to learn and discuss. They encouraged me to continue learning and to find answers independently as part of their feedback. For my training, I also had opportunities to practice simulation in Paediatric Advanced Life Support (PALS) and Airway workshops, and to practice on Thai patients under supervision.
What is a standout case during your fellowship?
A standout case during my fellowship involved a 2-month-old female diagnosed with esophageal atresia (EA), initially thought to be type A, but eventually diagnosed as type C after surgery. The patient was scheduled for right thoracotomy with esophagoesophagostomy following a gastrotomy.
From this case, I learned about the different types of EA and the specific anaesthesia considerations, particularly the risks of aspiration and airway management strategies for each type. I realised the importance of preoperative assessment for associated anomalies (VACTERL) and understanding that surgical repair, although urgent, is not always emergent. This necessitates thorough preoperative planning and assessment.
Key takeaways from this case:
- Preoperative Assessment: The need to evaluate associated anomalies and consider the timing of surgery based on the patient’s condition. The initial preoperative diagnosis of type A being corrected to type C postoperatively emphasised the importance of being prepared for diagnostic changes.
- Anaesthesia Induction: Inhalation induction is preferable for EA anesthesia over rapid sequence induction (RSI), but it is crucial to ensure that suction catheters and machines are readily available.
- Airway Management: The complexity of managing the airway in patients with EA, especially when there is an associated tracheoesophageal fistula (TEF).
- Intraoperative Considerations: Understanding the physiological changes in the lateral decubitus position and being prepared to manage potential causes of desaturation effectively.
This case reinforced the importance of comprehensive planning, preparation, and adaptability in managing complex paediatric cases. It highlighted the need to consider both preoperative and intraoperative factors and to be ready for unexpected changes and complications.
The experience significantly enhanced my skills in paediatric anaesthesia, particularly in managing airway challenges and understanding the nuances of EA and TEF cases.
Why were you drawn to Thailand?
Shortly after graduating from university, I learned about BARTC and discovered that several esteemed doctors, who I admired had trained there as alumni. Their achievements and contributions to the field deeply inspired me.
Besides, Thailand is considered an advanced and developing country, which is the same as mine (Viet Nam). The environment of training is such that the expense of living and the cost of anaesthesia services are moderate that I could afford.
I was very surprised by the hospitality of the people here, especially the medical professionals in the hospitals where I have learned. The Thai culture and history are also diverse and interesting, and I really want to explore many other places to learn more about the people and culture. The Thai food is also delicious and well-flavored, with Thai grilled squid being my favorite.
What transferrable skills have you learned that could be applied back home?
Given the lack of specialised paediatric anaesthesia training back home, I plan to share my knowledge and skills with junior doctors. I will teach them the techniques I have learned, ensuring they understand the correct methods and can perform them safely.
This will help to build a stronger foundation of paediatric anaesthesia expertise in our medical community. Besides, The habit of ongoing learning will help me stay updated with the latest advancements and ensure that I provide the best possible care. Additionally, I will encourage my colleagues to adopt a similar approach to learning and professional development.
Overall, my fellowship has been an enriching experience, providing me with both knowledge and technical skills. I plan to apply these skills back home, teach junior doctors, and continue learning to ensure safe anaesthesia practices.
Dr Son’s fellowship has been sponsored by the Society for Pediatric Anesthesia.
The WFSA offers its fellowships to anaesthesiologists from low and middle-income countries to increase their skillset and become leaders for anaesthesia once they return to their home countries. Upcoming WFSA fellowships and how to apply
