Trust Fellow in Cardiothoracic Anaesthesia and Intensive Care (ST5+)

Job responsibilities

The post involves working in cardiothoracic theatres, cath labs and the cardiac intensive care unit. About half of the working time would be in theatres, with the other half in the cardiac intensive care unit. Training could be tailored to each individuals specific needs and includes the following:

Anaesthesia for all types of adult cardiac and thoracic surgery

This will initially be under direct supervision, but as the experience and competence of the appointee increases this will be under extended supervision by a named consultant. Experience in cardiopulmonary transplantation will mainly be out of hours and includes heart, heart-lung, single lung and bilateral sequential lung transplantation. Live related donor lung transplantation has also been performed at the Freeman Hospital. There is also a Ventricular Assist Device Programme for chronic heart failure patients as a bridge to transplantation.

Recent introduction of TAVI and Robotic CABG surgery.

Adult congenital surgery.

Principles and practice of cardiopulmonary bypass

A 2 week block in the perfusion may be arranged if requested.

Thoracic Anaesthesia

There are 5 all day thoracic lists per week. It is anticipated that the appointee will acquire basic skills in fibre-optic and rigid bronchoscopy in adults during his/her tenure.

Intensive care for adult cardiac patients

This is with particular emphasis on pharmacological and mechanical support of the cardiovascular system following cardiothoracic surgery. There are daily teaching/business ward rounds in the adult ITU led by consultant anaesthetists, with a further business round in the evening. The anaesthetic department is responsible for the post-operative management of transplant and VAD patients. Experience and training in the use of inhaled nitric oxide therapy and Novalung therapy is provided during the tenure of the post.

On-call

There is a 2-tier anaesthetic trainee rota. The rotating ST3+ from the Northern region will be on a full shift rota covering ITU mainly. The appointee will be 2nd on-call on a full shift 1:7 frequency rota covering both theatre and ITU. We are looking to expand this tier to allow an additional fellow to cover cardiac theatres.

Duties and Responsibilities for Cardiothoracic Intensive Care:

The post is based in our Cardiothoracic Intensive Care unit. The 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.

Intensive care for adult cardiac patients

We work closely with the transplant, VAD and ECMO teams, and 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 VAD rounds with further mutual support and joint decision making as required. Freeman 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, ASD repair, VSD repair, pericardectomy and the successful candidate will be involved in the post operative management of these patients. We are a national centre for adult congenital cardiac surgery and we care for these incredibly complex patients on our ITU following their surgery. Our cardiology colleagues require support for some primary PCI 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. 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 counterpulsation, Impella, LVAD, RVAD, VV and VA ECMO. We frequently use Nitric Oxide.

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.

The trust is in the process of adopting a paperless medical record. Our medicines prescription, administration, investigation ordering and results with various documentations are electronic, and we will be adopting a fully paperless system for critical care medical and nursing records in the near future.

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 ACCP will be on a full shift rota covering ITU mainly. The appointee will be 2nd on-call on a full shift 1:7 frequency rota covering predominantly ITU, but providing support to theatres if required or appropriate.

Duties and Responsibilities for both Cardiothoracic Anaesthesia and/or Intensive Care:

Echocardiography

The appointee is expected to acquire a working knowledge of the fundamentals of echocardiography during the tenure of the post. The cardiothoracic anaesthetic department runs a week long TOE course twice a year. It would be an opportunity to acquire the certification in transoesophageal echocardiography.

Post-operative analgesia techniques, with special reference to thoracic surgery

Attendance on pain ward rounds is recommended.

Audit and research

The appointee will be encouraged to undertake audit and research projects during the post.

Education

The appointee will be encouraged to participate 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.

The Trust Fellow appointed to this post will be allocated a consultant educational supervisor. He/she 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 for external assessment if required.

Flexibility:

In line with the Trusts core value of placing patients at the heart of everything we do, we are developing our service provision to be responsive to the needs of our patients. To meet those needs some staff groups will be increasingly asked to work a more flexible work pattern so that they can offer services in the evening or weekend. As a result any offer of employment to a consultant post will be subject to you agreeing to work a new more flexible pattern or working in the future if required, including evening and weekend work.

For full details please see attached Job Description and Person Specification

Education and Qualifications

Essential

• MBBS or equivalent.
• Working towards FRCA and/or FFICM(for intensive care fellows) or equivalent.
• Must hold full GMC registration or be eligible to obtain full GMC registration within 3 months.

Desirable

• Other relevant qualifications (ALS, ATLS, CCrISP).

Clinical Skills and Knowledge

Essential

• Good history & examination skills.
• Able to formulate a working diagnosis.
• Able to order appropriate investigations.
• Image interpretation relevant to practice.
• Knows when to appropriately seek assistance from a senior colleague.
• Experience in Cardiothoracic Anaesthesia and Intensive care

Desirable

• Neat, legible writing of notes/charts.
• Computer skills.
• Previous NHS Experience.
• Experience in transoesophageal Echocardiography.

Maintaining Clinical Competence

Essential

• In 4th year of anaesthetic ST training or equivalent.
• Evidence of smooth progression through training programmes.

Teaching

Essential

• Have experience in teaching undergraduate medical students and/or Foundation Year 1 Doctors.

Desirable

• Willingness to develop new approaches to teaching and learning.

Clinical Governance, Audit and Research

Essential

• Experience of Audit projects.
• Understanding of research principles

Communication, Relationships and Working with Colleagues

Essential

• To be clear, fluent and articulate in communication in English
• Experience and ability to work in multi-professional teams.

Desirable

• Ability to organise.

Personal Attributes

Essential

• 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.

Desirable

• Evidence of leadership skills.
• IT literate.

Disclosure and Barring Service Check

This post is subject to the Rehabilitation of Offenders Act (Exceptions Order) 1975 and as such it will be necessary for a submission for Disclosure to be made to the Disclosure and Barring Service (formerly known as CRB) to check for any previous criminal convictions.

Certificate of Sponsorship

Applications from job seekers who require current Skilled worker sponsorship to work in the UK are welcome and will be considered alongside all other applications. For further information visit the UK Visas and Immigration website (Opens in a new tab).

From 6 April 2017, skilled worker applicants, applying for entry clearance into the UK, have had to present a criminal record certificate from each country they have resided continuously or cumulatively for 12 months or more in the past 10 years. Adult dependants (over 18 years old) are also subject to this requirement. Guidance can be found here Criminal records checks for overseas applicants (Opens in a new tab).

UK Registration

Applicants must have current UK professional registration. For further information please see NHS Careers website (opens in a new window).