You will recall that these Working Groups, to develop a White Paper, were established by me at our September 2024 EGM to address the implications of the Medical Council of Ireland (MCI) decision to change our CSCST designation to state “Anaesthesiology” only from 2030. The Role Profiling Group concluded its business last summer, outlining the broad range of knowledge, skills and behaviours necessary to be a consultant in Anaesthesiology in Ireland, which routinely includes elements of Intensive Care Medicine practice. We are indebted to Dr Deirdre McCoy, Chair of that Working Group and all its volunteer members for this important contribution.

The White Paper on Future Relationships Working Group continues its important work. Under the excellent chairmanship of Dr John Bates, it considered in detail the future relationship of Anaesthesiology and Intensive Care Medicine to training, HSE service provision and each other. The group identified a number of recommendations which the College council and the Joint Faculty of Intensive Care Medicine are striving to implement. These include a formal re-naming of our specialty to “Anaesthesiology & Critical Care Medicine’, which would indicate clearly that all Anaesthesiologists, even those not formally registered as Intensive Care practitioners, are effectively intensive care doctors also, and look after patients in our intensive care units all over our country. Among the other recommendations is the formal certification of the approximately 8-months ICM training obtained by SAT graduates within their 6-year training programme.

My sincere thanks to John, to Dr Michelle Duggan, who has now assumed the role of Chairing the White paper Implementation group, and all 15 of its dedicated members, who have served our specialties well in contributing to this crucial initiative.

Gilmartin Lecture

The 2025 Gilmartin Lecture was delivered by Mr Ciarán O’Connor, former State Architect, who enthralled an audience of 60 with his presentation and images of the refurbishment and modernisation of multiple famous Irish heritage sites including the Blasket Islands interpretive centre, the National Concert Hall and the National Botanical Gardens. Ciarán and his wife Ditte joined us for dinner in the boardroom, resplendent with Christmas decorations, while our guest singers, a cohort from the male a capella group, The Ramparts, entertained us with seasonal favourites. A night to remember fondly indeed.

The e-Learning Management System (e-LMS)

An important advance for our College in technology enhanced learning is the introduction last autumn of the new e-Learning Management System (e-LMS). This will be an online resource, accessed through our College website, by which trainees and fellows will access multi-media course material at their own pace and take assessments to receive certification of course/module completion. This should enable consistent delivery of specific College course content in a sustainable way, even as trainee numbers advance. Fellows will be able to access this material, and the National Lecture Series for CEPD purposes It is envisaged that more material will be added gradually as digital versions of our e-curriculum evolve. Our sincere thanks are due to our many colleagues who have generated and developed this online course content. It would not have progressed as rapidly as it has, without the stellar efforts of Ms Orna McSorley and Ms Margaret Jenkinson, alongside many other members of the College staff team. My sincere thanks to all for delivering this training innovation.

Improving our Communication Channels:

Colleagues may have noticed the twice-yearly e-newsletters presented at year end and early July, summarising the main topical issues for our community. In addition, prompted by younger colleagues who indicated that their generation prefers social media, our College has re-engaged with Instagram. I have presented several 1-2 minute video clips, complete with embarrassing “clickbait”, about topical initiatives which have generally been very well received. Again, my thanks to Orna McSorley, senior administrator to the executive, for her encouragement, editing and expertise.

Judicial Review

You are aware that a judicial review case was taken by a non-training programme doctor (applicant) who had already obtained their specialist registration as an independent anaesthesiologist with the Medical Council of Ireland (MCI). They asked the Court to direct that they are entitled to receive the same CSCST as trainees who have completed our CAI SAT programme.

At the insistence of the applicant, the case was scheduled for 8 days oral hearing and it was heard by Mr. Justice Barry O’Donnell in the High Court. It is highly unusual to have oral evidence in a judicial review.

Our College position was and remains that, the issues of training and registration were being conflated in the proceedings. While there are multiple avenues available to doctors in Ireland to apply to the MCI to have their training recognised which may then entitle them to specialist registration, and a certificate of that registration, that is distinct from the certification by the College of completion of specialist training of its Tier 1 programme, which is a prospective, competitively appointed, competence-based, tutor-mentored, quality assured training programme with annual progression interviews, and this should not be conflated with any other route to registration. .

Due to the strength of the evidence put forward by the respondents, and in particular, the College, counsel for the applicant capitulated after Day 5 at hearing. It was agreed that we would not pursue the applicant for costs, in a gesture of magnanimous collegiality, consistent with our cultural values.

We will continue to engage with our non-training programme colleagues and our strategic partners in the HSE-NDTP, Dept. Health, MCI, and other postgraduate training bodies to optimize the number of new Recognition of Prior Learning (RPL) training posts (which CAI was the first to implement).

We believe with this outcome, our College’s reputation has been further enhanced throughout the HSE, Dept. Health, the Forum of Postgraduate Medical Training bodies, the Medical Council and the entire regulatory and governance system of our democracy.

I thank you for your steadfast support throughout the past 4 years of arduous engagement in this matter.

The inaugural EELC:

Our sister Australian New Zealand College (ANZCA) instigated their Emerging Leaders Course (ELC) in 2018 and invited us to send a senior SAT after a competitive selection process. This course had an immediate, positive impact on participants, evidenced by our own alumni’s enthusiastic reports and by myself and others who contributed as honorary faculty. On my return from the Cairns ELC meeting last year, I decided that we would no longer send a trainee to ANZCA’s course, but instead that we would create our own Emerging and Established Leaders conference (EELC).

After much careful reflection and preparation, former ANZCA ELC Irish alumni Dr Aislinn Sherwin (currently elected Council member and Chair of Patient Quality and Safety) kindly agreed to head up our inaugural EELC. She was ably assisted by two other former ANZCA SAT alumni, Dr Carrie Murphy and Dr Noelle Healy, and also by immediate past-President Prof George Shorten. A truly outstanding programme of speakers was assembled from business, sport, industry and medicine, with scope for delegate interaction. Some 31 delegates participated, including 2 SATs and one Northern Ireland trainee, who won their respective trainees competition for their all-expenses paid participation. There was with exceptional feedback from all present. Our congratulations and thanks once again to Aislinn, Carrie and Noelle and George, in addition to College team members Ms Leanne McKenna .

College Expansion Options Investigation and our inaugural RPL

Our Strategy Review 2025-30 identified a challenge of the success of our specialty: We have effectively outgrown our premises here in Merrion Square. Anaesthesiology has come a long way since Tommy Gilmartin established the Faculty within RCSI in 1959. Through the vision, acumen and courage of many former presidents and others, The College of Anaesthesiology was formed in 1998 at our current premises in Merrion Square, with the Mews building being completed 10 years later. Since then, our specialty has progressed exponentially, which brings its own challenges of space and capacity requirements.

We are obliged to rent expensive hotel space outside the city to host our exams, particularly the OSCEs and Vivas. We have had to hire external venues to cope with an increasing attendance of >200 at our Winter College-Patient Safety meeting. Moreover, we need to hire UCD O’Reilly Hall for our graduation ceremonies in June. While I envisage that our College will always need to seek an external venue for our annual Congress, attracting as it does, 600-700 delegates, it is unfortunate that we can no longer host these core events within our own premises.

The need for expansion of our physical space is further emphasised by national HSE policy. The National Medical Manpower Workforce Planning Document 2024-38 directs us to double the number of trainees over the next few years. In addition, it invites us to introduce a new, more experienced entry point programme to our SAT programme, via a process called Recognition of Prior Learning. This is a process whereby quality NCHD colleagues, who are on the general register of the MCI and not on our SAT programme, would undergo a competitive process to evaluate their prior learning and experience (RPL), and if successful, they would be entered onto the SAT programme at SAT3 level. Our Working Group for RPL, chaired by Co-Director of Training Dr Amy Donnelly identified criteria of eligibility for RPL SAT 3 admission. A moment of history for our College was made during the new 2026 SAT intake, with 4 RPL SAT3 trainees successfully navigating the highly competitive selection process, and have been appointed, in addition to the usual SAT 1 trainees (n=56). It is noteworthy that an unprecedented 290 applications were received for this year’s intake. It is an exciting time of expansion and popularity for our specialty, which will demand greater training resources and administrative support, and additional demand on our present limited facilities.

While every effort is being made to optimise regionalisation of training resources, such as simulation facilities, there seems to be a compelling need for us to expand our physical spaces. The executive has actively pursued options to do this.

A number of city architects were engaged to consider expanding our Merrion Square site, mindful of its Georgian heritage. Any development would have to be underground, expanding in front of the lecture theatre and under our backyard / car park, linking the old building to the Mews.

After an open competition-interview among four architects, Mr Martin Henchion was chosen to conduct a feasibility study. He reverted within weeks to advise that this proposal was unfeasible: The costs would be more than our mortgage budget and even still, we would not achieve the increased space requirement of >250m2 to be in a position to host our own exams. This option was therefore deleted with regret from our list of possibilities.

We directly approached our neighbours at No.23 Merrion Square, St. Joseph’s Young Priests Society, enquiring about their willingness to sell. Far from it: in fact, they indicated they would try to purchase our premises if we moved! Council has previously ruled out the idea of purchasing a second property as an exam hall, on the basis that it would create financial and management strain for our College.

This progressive process of considering options for College expansion seems therefore to be landing on a binary decision: Sell and go from Merrion Square to a larger more functional building in an up-and-coming prestigious city centre area, or simply “stay put” as we are, hiring hotels and other venues for all exams and larger meetings.

We remain open to the property market for a building with usable internal floor area of >1,200m2, within which would be a flexible open space of >350m2.

New Blood on Council b

Council elections in the spring of 2025 resulted in no less than 5 newly elected members of Council. Dr Ahmed Shehata, based in Waterford, is Chair of our HSE Liaison committee, and brings much teaching and clinical experience to the College. In this role, he is committed to asking that HSE HR link the increased numbers of training posts being activated to proportionately increased consultant posts in our specialty. To that end, he has undertaken an important survey of departmental chairpersons, to establish the true number of consultant posts coming through or planned.

Dr Róisín Nee, representing University Hospital Limerick, has kindly taken on the role of Wellbeing, Health & Resilience Lead and has already surveyed trainees about their priorities in this area, in collaboration with our Committee of Anaesthesiologists in Training (CAT). She is planning to bring all College training hospital wellness leads together this autumn to discuss how best to support both trainees and colleagues.

Dr Aoibhinn Hutchinson, working in Belfast, is our first elected council member from Northern Ireland in almost 2 decades. She is Co-Chair of exams alongside Dr Michelle Duggan and has contributed not only that, but also to international exams in Malaysia and to our emerging and established leadership course. Dr Pat Neligan (Galway) brings a clinician’s perspective from both Anaesthesiology and Critical Care Medicine and an interest in providing highest quality CEPD opportunities for us all. He is Co-Convenor of our Annual Congress 2026 alongside Dr Gabriella Iohom and both have produced an excellent programme, which provides update and learning opportunities for everyone. Finally, our 2025 intake of elected members includes Prof. John Laffey (University of Galway), who is building on our drive to establish an Irish Perioperative Clinical Studies network under the auspices of our College. To that end, he is Chair of the newly established Outcomes Research committee of council and John is also working with me to re-establish the “Interpretation and evaluation of research for the busy clinician” course, first delivered in 2022, and being reimagined now as an online course, delivered through our new e-LMS.

All continue to contribute actively to the range of issues which come before Council and their diverse insights and opinions are invaluable in guiding our College.

This infusion of new council members, in addition to the five new council members who were elected in 2024, renders our present council the most diverse in the history of our specialty. I am grateful to every council member, each of whom is contributing important work to enable our mission, which many will outline in the following pages of this report.

College Clinical Leaders

Increased trainee numbers beget increased needs for more part-time clinician leaders within College. Prof Maya Contreras, our Director of Simulation, continues to enrich this crucial aspect of our training programme with new ideas and competence priorities, while also growing our volunteer simulation faculty panel.

Prof Camillus Power, our long-serving Director of Training, has been focusing on the MCI-mandated CAI e-curriculum review, whereby every aspect of our programme and learning outcomes is re-evaluated with new content added and redundant areas discarded. This document also outlines the College rules of the training programme and the progression milestones which must be achieved. Accuracy is important to strengthen College resilience in the event of an increasing number of spurious legal challenges to operational training department decisions. I wish to thank Camillus for engaging his career-long expertise in this foundational task, and also the many colleagues and specialist experts who have reviewed and continued to our updated e-curriculum content. Our thanks also to our external curriculum reviewer, Dr. Sarah Nicolson, a council member of the Australian New Zealand College of Anaesthetists, who is overseeing the process. We look forward to thanking her in person when she visits us to contribute to our annual Congress.

Dr Jenny Porter, Co-Director of Training has continued her stellar work, in particular during the SAT intake process last winter, when she oversaw the arduous selection processes after an unprecedented 290 people applied for the 60 places on our programmes. Not to mention her outstanding preparation and star turn in court, defending our College during the judicial review.

In all this commitment, she was ably assisted by Co-Director of Training Dr Amy Donnelly, who, as mentioned previously, delivered our inaugural Recognition of Prior Learning (RPL) SAT3 intake, consistent with department of health policy, with 4 candidates appointed in that category, the first postgraduate medical training body to do so.

Dr Brian McCloskey, Director of Patient Safety and Quality Improvment, whose clinical commitments are in Belfast, delivered a revised Professionalism in Practice course for SAT6, which extended over 2 days, in addition to online teaching on quality improvement methodology. Brian also contributed to Aislinn Sherwin’s leadership of our Winter College day in November, held at the Radisson Blu Hotel, Golden Lane, which set a new record of booming success: No less than 250 delegates were present, with enthusiastic feedback received.

The CAI’s Global Health Charity Outreach

I am inspired to highlight the excellent charitable work of our College in East Africa, which will be outlined in more detail by our Chair of Global Health, Dr Patrick Seigne. College contributes in 2 ways: Firstly, through being a founder supporter of the College of Anaesthesia of Eastern, Central and Southern Africa (CANESCA), whereby we donate modest annual stipends to trainees who commit to their 4 year training programme in the region. This simple strategy, coupled with assisting African colleagues develop their curriculum and quality assuring their exam, has helped retain >90% of trainees to complete their programme and remain working in the 14-nation region afterwards.

The other African charitable area where our College contributes is in Malawi, perhaps the poorest of the 14 countries of CANESCA, where we deliver a HDU-Obstetrics and Trauma (HOT) training course over 2 days to local clinical officers. These are the 2 years’ trained service providers who deliver most Anaesthesia services across sub-Saharan Africa. I was privileged to join Patrick’s team last November, alongside a number of past Presidents and Dr Claire Keaveney, a senior trainee, who won a competition to join the entourage.

Conclusion / Focal Scoir

In summary, I am excited and greatly encouraged by the obvious booming success and progress our College continues to make in delivering our refreshed Strategy objectives from Strategy Review 2025-30, despite the constantly evolving, ever-challenging political, regulatory and legal environment.

We will continue to prioritise excellence in training and continuing education, including practical simulation training both in College and at regional and local centres, and we will continue to quality assure trainee competence through the growing Work-Place Based Assessments (WBA) and e-Learning management system. Our College’s governance, culture and operational practices are founded on integrity and excellence.

I believe the year ahead will present exciting opportunities for us as a specialty and as a community to meet these and the new challenges of expansion, and to continue to deliver the mission and vision of our College, for the benefit of all our patients.