Overview
The post is based in our cardiothoracic anaesthesia theatres and cardiac intensive care unit.
How we work
The Freeman hospital has two adult cardiac theatres and two adult thoracic theatres (one for robotic surgeries) running on almost daily basis.
However, adult congenital anaesthesia runs in another theatre and is provided by a different congenital anaesthesia team. Patients come to our adult cardiothoracic ICU after surgery where we manage them.
The average number of cases for each cardiac theatre is usually two elective operations daily, while the average number of cases for thoracic theatres is three cases each day.
Parallel to cardiothoracic theatres, we run a daily anaesthetic list for cardiology patients in catheter labs.
The department runs a cardioversion theatre on weekly basis.
The department also provides urgent and emergency perioperative care for all heart, lung or heart lung transplant patients, in addition, the service extends to cover mechanical circulatory support and aortic surgery covering the 24 hrs.
Intensive care for adult cardiac patients
The department’s intensive care unit has twenty-one level three beds (six isolation cubicles) and seven level two beds in an adjoining area. Duties are based in these areas but extend to support deteriorating patients on the wards, support for cardiology emergencies and accompanying patients during transport to other centres.
We work closely with the teams including transplant, ventricular assist device and extracorporeal membrane oxygenation. The successful candidate will be expected to take a particular interest in the management of our complex patients requiring advanced support.
There are twice daily transplant and ventricular assist device rounds with further mutual support and joint decision making as required.
The Freeman Hospital is unique in the UK in offering transplant services for all solid organs on one site and there are close ties with experts in other disciplines such as microbiology, radiology and haematology who frequently assist our team.
We support the cardiothoracic surgical programme which includes revascularisation, valve surgery, aortic root surgery, pericardiectomy and the successful candidate will be involved in the postoperative management of these patients in addition to adult congenital patients.
We are a national centre for adult congenital cardiac surgery and we care for these incredibly complex patients in our intensive care unit following their surgery.
Our cardiology colleagues require support for some primary percutaneous coronary intervention or heart failure patients, and we provide support in the management of patients who have had an out of hospital cardiac arrest.
We have a thoracic surgical programme which includes laser and stents for major airway obstruction, robotic and minimal invasive lung resection. We have a team specialising in the management of pulmonary hypertension and we provide critical care support for their challenging patients.
We offer advanced haemodynamic monitoring for example by PA catheter and echocardiography. Besides pharmacological cardiovascular support we use various forms of mechanical support such as intra-aortic balloon counter pulsation, Impella, LVAD, RVAD, VV and VA ECMO.
There are two medical ward rounds each day led by a consultant with an interest in cardiothoracic critical care. Our morning round which is concerned with the detail of patient management and there is an evening business round to plan for overnight care.
We have a multidisciplinary approach, working closely with, for example nursing, physiotherapy, microbiology, nutrition, pain, psychology, speech and language therapy.
Echocardiography
The fellow will have the opportunity to gain a working knowledge of the fundamentals of echocardiography during the tenure of the post.
The cardiothoracic anaesthetic department runs a week long transoesophageal echocardiogram course once a year.
The fellow will be encouraged to get accredited with British Society of Echocardiography or European Association of Cardiovascular Imaging in trans-oesophageal echo with all possible help for theory exams and collection of cases for the logbook.
Post-operative analgesia techniques, with special reference to thoracic surgery
- Attendance on pain ward rounds is offered.
- Cardiothoracic theatres and cardiothoracic theatres
Audit and research
- The fellow will be encouraged to undertake audit and research projects during the post.
Education
- Participation in teaching for medical students, nursing staff and less experienced trainees, and to undertake the preparation of topical reviews.
- There are weekly departmental educational meetings which are co-ordinated by the specialist trainees.
On-call
- There is a 2-tier rotational trainee / fellow rota, with advanced critical care practitioners participating in the first tier rota. A rotating ST3+ from the Northern region or an advanced critical care practitioner will be on a full shift rota covering ITU mainly.
- The appointee will be 2nd on-call on a full rota covering predominantly ITU, but providing support to theatres if required or appropriate, or if split rota is active which depends on the total number of fellows and trainees, in addition to advanced critical care pracctitioners.
- The fellow appointed to this post will be allocated a consultant educational supervisor. They will be expected to maintain a logbook of activity, to ensure that his/her training can be easily reviewed and optimised in conjunction with the educational supervisor. This logbook should be made available
Typical duties and responsibilities
The following are requirements for the role:
- Provide continuity of ward cover for complex adult congenital heart disease patients on cardiology, cardiac surgery and intensive care wards
- Perform the daily cardiology ward round for these patients either independently, together with a nurse specialist or with a more junior doctor, with direct or indirect consultant supervision
- Join the multidisciplinary mechanical assist or transplant ICU ward round whenever these patients have undergone these procedures.
- Perform the initial assessment of all of these patients referred by other UK centres for cardiac transplantation and/or mechanical assist device.
- Perform and report initial transthoracic echocardiogram on complex transplant referrals
- Perform and report peri-operative transoesophageal echocardiogram on these patients undergoing conventional surgical procedures with direct or indirect consultant supervision
- Attend and present cases at various relevant multidisciplinary meetings (Fontan procedure/fontan associated liver disease, joint cardiac surgical meeting, adult congenital heart disease electrophysiology meeting, heart failure and transplant meetings)
- Contribute to general and specialist outpatient clinics including this type of heart failure, fontan and combined obstetric-cardiac clinics.
- Review and present morbidity and mortality cases at clinical governance meetings
| Requirements | Essential | Desirable | Assessment |
| Education and Qualifications | MBBS or equivalent. Must hold full GMC registration or be eligible to obtain full GMC registration within 3 months. Working towards FFICM, FRCA, MRCP or similar | -Other relevant qualifications (ALS, ATLS, CcrISP, EDIC, FFICM). -TOE certification or working towards it. | Application / Interview |
| Clinical Skills and Knowledge | Good history and examination skills. Ability to formulate a differential diagnosis. Able to order appropriate investigations. Able to manage common medical emergencies and ongoing management in critical care. Knows when to appropriately seek assistance from a senior colleague. | Neat, legible writing of notes/charts. Computer skills. Experience in Echocardiography Previous NHS Experience. | Application / Interview |
| Maintaining Clinical Competence | In 4th year or equivalent of SpR training. Evidence of smooth progression through training programmes. | Application / Interview | |
| Teaching | Have experience in teaching undergraduate medical students, foundation year 1 doctors, nursing or allied health professional staff | Willingness to develop new approaches to teaching and learning. Postgraduate diploma in medical education | Application / Interview |
| Clinical Governance, Audit and Research | Experience of Audit projects. Understanding of research principles. | Current Good Clinical Practice certification Active in research | Application / Interview |
| Communication, Relationships and Working with Colleagues | To be clear, fluent and articulate in communication in English. Experience and ability to work in multi-professional teams. Able to prioritise work appropriately Able to take a clinical leadership role where an acute situation demands. | Ability to organise. Willingness to take part in departmental organisation. | Application / Interview |
| Personal Attributes | Alignment with the Trust’s Values. Flexible approach to service delivery and committed approach to development. A commitment to personal / unit CPD. Time management skills. Honesty, integrity, awareness of ethical dilemmas, respect for confidentiality. | Evidence of leadership skills. IT literate. | Interview |
