The Portfolio Review That Exposes What You Haven't Done
Every anaesthetic training programme requires a logbook that demonstrates breadth: sufficient supervised cases, appropriate exposure to regional techniques, paediatric cases if the curriculum demands it, obstetric cases, emergency cases. The college doesn't care that you did three hundred elective orthopaedic cases under spinal. They care whether you've done enough of the things on the required list. If you haven't logged it contemporaneously, the audit period at the end of your training is when you find out the gaps — too late to fill them before the assessment.
Log every case. Every one.
ASA Score and Priority: The Two Fields That Define Case Complexity
ASA physical status classification — 1 through 5 — is the universal anaesthetic risk stratification tool. One number that tells the college reviewer, the supervising consultant, and your future self exactly how complex the patient was. An ASA 1 elective inguinal hernia under spinal is a very different case from an ASA 4 emergency laparotomy under GA, even if both count as "one case" in an uncategorised logbook.
Priority — elective, urgent, emergency — overlaps with but is distinct from ASA. An ASA 3 patient presenting for elective cardiac bypass surgery is a complex elective. An ASA 2 patient with a ruptured ectopic is a life-threatening emergency with a physiologically normal patient. The combination of ASA and Priority together characterise the anaesthetic challenge in a way neither field alone achieves.
Supervision, Supervisor, Speciality: The Governance Record
Supervision level — supervised, unsupervised, teaching — and Supervisor name. These fields are the accountability trail that the college requires. A trainee logging three hundred "unsupervised" cases who was actually accompanied by a consultant throughout them has created a false record. A trainee who was genuinely working at a level of competence appropriate for unsupervised practice and logged it accurately has created an honest portfolio. The Supervisor field with a named consultant is what makes the log auditable.
Speciality categorises the case: general surgery, orthopaedics, obstetrics, ENT, paediatrics, cardiac, neuro. The distribution across specialities over your training period is the evidence of breadth. Filter by Speciality and you see immediately whether you've hit the minimum requirements for each.
Anaesthetic 1 and 2, Procedure 1-3: The Technique Record
Two anaesthetic agent/technique fields and three procedure fields. The technique fields capture the primary and supplementary approach: GA-TIVA, GA-volatile, spinal, epidural, CSE, peripheral nerve block, sedation. Procedure fields capture the specific interventions: arterial line, central venous access, rapid sequence induction, difficult airway management, awake fibreoptic intubation. Three procedure slots per case is enough for all but the most complex multimodal techniques.
Incidents 1, 2, 3 — three free-text fields for intraoperative events: laryngospasm, bronchospasm, anaphylaxis, failed spinal, awareness. These are the cases you learn the most from and are most likely to misremember if you don't write them down within the hour. The incident field is also the one your educational supervisor will focus on in your next WPB meeting.