Mersey Special Interest Area (SIA) Prospectus

For detailed RCoA guidance on SIA modules/requirements, please see RCoA HALO guide here.

The absolute maximum is up to 3 SIA in up to 2 hospitals. If you are LTFT this may have implications for length/timing of SIAs as the required time below is FTE and rotations may vary in length.

SIA Groups

Group 1: 6 months to 1 year

• Anaesthesia for Cardiac Surgery
• Anaesthesia for Neurosurgery
• Obstetric Anaesthesia
• Paediatric Anaesthesia
• Pain Medicine (12 months)

Group 2: 3 to 6 months

• Acute Inpatient Pain (6 months)
• Anaesthesia for Bariatric Surgery
• Anaesthesia for Complex Orthopaedic Surgery
• Anaesthesia for Hepato-Pancreato-Biliary Surgery
• Anaesthesia for Major General Surgery
• Anaesthesia for Ophthalmic Surgery
• Anaesthesia for Patients with Complex Airway
• Anaesthesia for Plastic Surgery and Burns Management
• Anaesthesia in Resource Poor Environments
• Anaesthesia for Thoracic Surgery
• Anaesthesia for Vascular Surgery
• Military Anaesthesia
• Perioperative Medicine
• Regional Anaesthesia
• Transfer Medicine
• Trauma and Stabilization

Additional Intensive Care Medicine: 6 months

Non-clinical: up to 6 months

• Management and Professional and Regulatory Requirements
• Safety and Quality Improvement
• Education and Training
• Research and Managing Data

Please discuss any SIAs you are interested in with the contact or College Tutor at that hospital, including the possibility of combinations, or any that are not listed but you would like to explore.

SIA Group 1

Anaesthesia for Cardiac Surgery

Liverpool Heart and Chest Hospital

Contact: Dr Clare Quarterman (clare.quarterman@lhch.nhs.uk)

Module Details: Liverpool Heart and Chest Hospital is the largest single site heart and chest hospital in the UK, serving a local population of 2.8 million but also receiving specialist referrals from all over the UK. We undertake procedures across 9 operating theatres and 5 catheter laboratories, and also manage patients within a large 32 bedded critical care area. Surgical procedures undertaken range from more routine cardiac surgical operations including CABG and valve surgeries to complex aortovascular and ACHD surgery. We additionally anaesthetise patients undergoing interventional cardiology procedures including TAVI, other structural procedures including for ACHD and electrophysiological procedures. Trainees will be supported to gain experience in the elective management of patients with coronary artery and valvular heart disease presenting for on and off pump cardiac surgery, and patients requiring major aortic surgery. Additionally, trainees will be able to learn more about the management of patients with impaired ventricular function and ACHD during the peri-operative period along with the management of coagulopathy and use of point of care testing. Within critical care, trainees will gain experience of the management of patients following cardiac surgery including identification and management of post cardiac surgical complications, and there are opportunities to learn TOE and TTE, and support to sit BSE accreditation examination in TOE. This is by no means an exhaustive list, so we are well placed to provide trainees with all of the opportunities they need for completion of a Stage 3 SIA. Many of the skills described are transferable to other clinical settings, particularly the ability to assess and manage patients with significant cardiorespiratory disease in the non-cardiac surgical and intensive care setting. We are a supportive department and are keen to support the learning and development of our trainees. We have an ever-evolving educational program involving monthly half-day teaching sessions delivered by expert clinicians with trainee involvement and additional morning meetings. We are also have a very active program of quality improvement and service development, so are able to provide opportunities for meaningful projects, along with the forum to present at bimonthly audit meetings and support to present at national meetings. If you are interested in a stage 3 placement at LHCH we would be happy to discuss this further with you.
As we are a cardiothoracic centre, trainees attending to complete a special interest area in anaesthesia for cardiac surgery would also gain training and experience in the management of patients for thoracic surgery. See also SIA in Anaesthesia for Thoracic Surgery below.

Anaesthesia for Neurosurgery

The Walton Centre

Contact: Dr Elaine Anderson (elaine.anderson30@nhs.net)

Module Details: The Walton Centre is a stand-alone tertiary neuroscience centre, located in the north of Liverpool. The large catchment area and scope of services offered provide anaesthetic trainees with the opportunity to achieve all competencies needed in advanced Neuroanaesthesia and Neurocritical care. The Neurosurgical department in the Walton Centre provides care for a wide range of intracranial pathologies, in Oncology, Vascular, Functional and movement disorders. It has in recent years been performing an ever-increasing array of procedures for spinal pathologies, ranging from microdiscectomies to scoliosis correction. The trauma collaborative with the Liverpool University Hospital (Aintree site) provides the opportunity for managing complex polytrauma cases. The Chronic Pain department undertakes a wide range of interventions under Local and General Anaesthesia. The scope of these procedures will enable the advanced anaesthetic trainee to gain expertise in a wide range of transferable skills – including but not limited to expert management of patients with raised intracranial pressure, intraoperative hypotension, anaesthesia in prone and other non-standard positions, sometimes for very long periods, anaesthesia in the presence of neurophysiological monitoring, one lung anaesthesia, anaesthesia for interventional procedures and MRI(including intraoperative), monitored sedation (including in patients with learning difficulties and cognitive impairment) and a range of regional blocks. The 20-bedded (expandable to 22) critical care unit provides support for all the above, in addition to a wide range of neurology and complex long-term cases providing opportunity to gain expertise in, for example, the management of complex and intractable seizures and difficult ventilatory weaning. Neurointensive care creates unique opportunities to become in skilled in communication in difficult and challenging circumstances. There is an active protected trainee led teaching programme as well as monthly department meetings all of which provide ample teaching and presentation opportunities for trainees. There are also multiple opportunities for audits service improvement projects and, increasingly, research opportunities.

Obstetric Anaesthesia

Liverpool Women’s Hospital

Contact: Dr Carol Kenyon (carol.kenyon1@lwh.nhs.uk)

Module Details: Liverpool Women’s Hospital is the regional tertiary unit and is the area’s only stand-alone maternity unit. We have a busy delivery suite with 3 dedicated obstetric theatres and a dedicated obstetric recovery room. The delivery suite contains a number of obstetric HDU rooms. We also have a busy midwife led unit, post-natal wards, and elective LSCS admissions lounge. We very much work as a team alongside our obstetric, midwifery, and theatre colleagues. You will find a friendly and supportive atmosphere in the delivery suite. During this module trainees have the opportunity to complete Advanced Obstetrics as well as the modules below. We also provide opportunity for trainees to develop across 6 domains; teamworking, leadership, innovation, management, education and clinical practice. Doing advanced training in our department provides trainees with the skills and experience required to work effectively and take a leadership role as part of a busy multi-disciplinary specialist team. All the clinical and non-clinical skills developed during time spent in this department provide a sound foundation for anaesthesia across all fields. As well as the areas listed above you will develop important skills in acute pain management, maternal critical care, multidisciplinary teaching, audit, quality improvement and research. We provide acute response, resuscitation and critical care across the trust in clinical and non-clinical areas. We provide lead services for the transfer of critically ill patients to other trusts. All of this provides an excellent learning opportunity for the development of independent practice. If you are interested in spending advanced training at LWH please come and discuss this with the department. We are a small and friendly department, and are all very approachable. Our commitment to your training is that we will provide an educational agreement and environment that allows you to achieve your objectives and develop your CV for consultant application.
Trainee Feedback: Lots of clinical work and chance to supervise junior trainees. Projects carried out and poster presentations produced.

Whiston Hospital

Contact: Dr Catherine Gerrard (catherine.gerrard@sthk.nhs.uk)

Module Details: The Maternity Unit at Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, is a busy Maternity Unit with approximately 4000 deliveries per year. There is an on-demand epidural service with a rate of approximately 24%. Over 90% of elective caesarean sections are carried out under Regional Anaesthesia, as are a large and increasing proportion of emergency caesarean sections. During this Advanced Obstetric Anaesthesia module, Advanced Trainees will provide perioperative anaesthetic care to a wide-range of complex obstetric cases, both on the Labour Ward and in Theatres. This care may be provided directly by the Advanced Trainee or provided by the more junior Anaesthetic Trainees, being supervised by the Advanced Obstetric Anaesthesia Trainee (in a “step-up to Consultant” role, with appropriate supervision). Advanced Obstetric Anaesthesia Trainees will review patients in Obstetric Anaesthetic Clinics. These clinics will include cases requiring pre-operative clinic assessments and also cases requiring pre-operative / post-operative anaesthetic counselling. There will also be the opportunity to observe Obstetric Maternal Medicine Clinics. Advanced Obstetric Trainees are encouraged to teach on the regular local multidisciplinary PROMPT courses, and also to facilitate Obstetric Anaesthesia teaching sessions (including Simulation teaching sessions) for more junior Anaesthetic Trainees. There will also be opportunities to provide teaching to less experienced colleagues of all grades. Recent Audit and QI Projects have been related to the Royal College of Anaesthetists’ Anaesthesia Clinical Services Accreditation (ACSA) criteria. Current projects include the review and streamlining of the Obstetric Anaesthesia follow-up pathways, to ensure that all Obstetric patients receive appropriate follow-up reviews after Epidurals, Spinals and General Anaesthesia. This Advanced Obstetric Anaesthesia Module will also provide Trainees with exposure to areas of clinical management and leadership within the NHS, e.g. through attendance at local governance meetings / the Labour Ward Forum Meetings. Completion of this Advanced Obstetric Anaesthesia module at Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, will not only provide Trainees with Advanced Obstetric Anaesthesia skills, but will also provide them with opportunities to prepare for a successful future career, as a Consultant Anaesthetist.

Arrowe Park Hospital

Contact: Dr Alice Arch (alicearch@nhs.net)

Module Details: The Maternity Unit at Arrowe Park Hospital has a delivery rate of over 3000 deliveries per year. Due to our co-location with Tertiary Neonatal Services, Adult Critical Care and Adult Acute Care including General and Urological Surgery, Interventional Radiology, Cardiology and Acute General Medicine we have a wide range of presentations of patients who plan to deliver, or are transferred into our unit and therefore are able to offer experience of a wide range of clinical presentations. We have a team of Enhanced Maternity Care (EMC) midwives who are trained to deliver care to patients who require care in our Obstetric HDU rooms and work closely alongside the Obstetric and Anaesthetic teams. Trainees completing their SIA in Obstetric Anaesthesia would be working alongside and within the multidisciplinary team and supervising more junior colleagues. They would have the opportunity to attend Obstetric Anaesthetic Assessment Clinics and to observe Obstetric Clinics. We have a very strong multidisciplinary work ethos and the trainee undertaking an SIA would be supported to delivery teaching as part of the in-house PROMPT teaching, be involved in teaching of the EMC midwifery team and, in discussion with the midwives on our elective Caesarean Section Lotus midwives to facilitate learning for this group. Senior trainees are also encouraged to be actively involved in delivering teaching to the Core Trainees and there are ample opportunities to be involved in delivering Simulation Training. There is the opportunity to develop leadership and management skills through attending Divisional Clinical Governance Meetings, Labour Ward Steering Group, multidisciplinary Maternity Clinical Incident reviews and departmental management opportunities in discussion with the Anaesthetic Department more widely. As an Anaesthesia Clinical Services Accreditation (ACSA) accredited department we encourage trainees to undertake Quality Improvement and Audit projects and as a research active department we are able to support Senior Trainees to participate in Clinical Research. We are open to suggestions as to projects which are of interest and there is a Research Midwife within the Maternity Services who may be able to help with NIHR projects. We aim to offer trainees a breadth of experience to develop their ability to enhance their own career and to prepare for their future role as a Consultant Anaesthetist.

Paediatric Anaesthesia

Alder Hey Children’s Hospital

Contact: Dr Joanne Haidon (joanne.haidon@alderhey.nhs.uk)

Module Details: We offer exposure to and training in most of the paediatric subspecialities (except solid organ transplant), including cardiac, craniofacial, spine, orthopaedics, regional, trauma, burns, PICU and NWTS. Sedation techniques for MRI imaging. Very strong interest in ultrasound guided regional anaesthesia and vascular access. Lots of opportunities to participate in audit/QI/research projects. Slot at monthly update for trainees to inform of projects. Bimonthly teaching with all Northern paediatric centres for stage 3 trainees. Increasing complexity of solo work as placement progresses. Useful placement for trainees who will work in DGH roles as well as those with a tertiary paediatric interest. Rota’d SPA time, and opportunities to act up in emergency theatres under supervision of named consultant. Opportunities to attend difficult airway course, and ultrasound regional courses, both run twice yearly.
Trainee Feedback: Wide range of paediatric experience and opportunity to develop technical and non-technical skills. Varying specialities including cardiac, regional, trauma and NWTS. Varying projects completed during rotation which were presented. Increasing complexity of solo work and placement progresses. Very supportive department.

Pain Medicine

LUHFT (Broadgreen) or The Walton Centre

Contact: Dr Raj Malhotra (rajiv.malhotra@liverpoolft.nhs.uk)

Module Details:
Top 3 reasons to do pain medicine as a career:
1. Use a different part of brain to anaesthesia
2. Autonomy in your work (independent of surgical schedules)
3. Work/life balance – 0900 start, 1700 finish
We offer extensive training for those trainees interested in pursuing a career in pain medicine. We have a friendly team of consultants, physiotherapists, nurses, and psychologists that will introduce you to this specialty. There will be opportunities to run outpatient clinics, attend palliative care sessions and extensive experience in interventional techniques (including spinal injections, stellate/cervical plexus blocks and peripheral nerve blocks). The post involves 6 months at Broadgreen Hospital and 6 months at the Walton Centre, to experience neuromodulation and the Pain Management Programme. There is an active audit and research plan for the year. You will have specific time allocated for audit and research, as well as exam preparation.
Trainee feedback: Lots of experience using diagnostic skills, history taking and practical procedures. Satisfying following up own patients in clinic and development of autonomy. Pain exam is heavily recommended. Lots of projects, teaching and management opportunities.

SIA Group 2

Acute Inpatient Pain

LUHFT (Royal)

Contact: Dr Raj Malhotra (rajiv.malhotra@liverpoolft.nhs.uk)

Module Details:
Top 3 reasons to do inpatient pain medicine SIA
1. Complements perioperative medicine
2. Vital for preop sessions which form part of most new job plans
3. Delivers a varied job plan outside of theatres
We have a consultant-led inpatient pain service covering complex postoperative pain management, including epidural and regional anaesthetic infusions. You will be able to lead pain rounds, with the pain nurses and psychology staff, assessing patients and producing management plans. There is the opportunity for acute pain interventional procedures (e.g. ESP blocks). We hope that you will take a lead with appropriate opioid prescribing for patients in the hospital. There are opportunities for developing pain pathways within preoperative assessment and you can spend time with paediatric and palliative care inpatient teams. You can also attend interventional pain procedure lists and clinics within the outpatient pain setting.

Arrowe Park Hospital

Contact: Dr Sam Michlig (s.michlig@nhs.net)

Module Details: At Arrowe Park we have an Acute Pain team consisting of 2 anaesthetic consultants, 2 pain nurses and a dedicated pharmacist. We can offer you opportunities to lead inpatient ward rounds, attend dedicated acute pain MDT and governance meetings, perform regional blocks for acute pain and introduce new initiatives. There is a very active schedule of QI, patient satisfaction survey and audit in place, but new ideas are always welcome. There are ample opportunities for interested candidates to write trust wide guidelines. Wirral has a significant community opiate burden which is creating opportunities to improve services around: 1) Surgery for patients with high dose opiates. 2) An inpatient opiate reduction program.

Countess of Chester Hospital

Contact: Dr Mo Khafaga (mohamed.khafaga@nhs.net)

Module Details: The Countess of Chester Hospital has a new and enthusiastic acute pain team consisting of three consultants and two acute pain nurses. It is a busy service with a strong emphasis on regional analgesia. The team deals with pre- and post-operative acute surgical pain, analgesia for traumatic injuries and acute on chronic pain management. You will be expected to take part in acute pain ward rounds, assist with our established regional analgesic service and take part in teaching and QI projects within the subspecialty.

Anaesthesia for Complex Orthopaedic Surgery

LUHFT (Broadgreen and Royal)

Contact: Dr Penny Edmondson (penelope.edmondson@liverpoolft.nhs.uk)

Module Details: This module would take place at Broadgreen site. (With on-call at Royal Liverpool).
With the service realignment within LUHFT we now are performing major lower limb reconstruction work as well as high volume upper limb, hip, knee and ankle surgeries at Broadgreen Hospital. Trainees undertaking this module will be expected to lead these lists, review high risk patients in preoperative clinics and use regional anaesthetic techniques to promote high quality patient care. The orthopaedic and anaesthetic department have an active research and audit portfolio which anaesthetic trainees can access.
If the trainees are interested in spinal surgery, we can arrange days at Walton Neuro Centre.
We would aim to complete an SIA module in Complex Orthopaedics and Regional Anaesthesia during this 6-month rotation.
Orthopaedic Trauma now takes place at Aintree site, so this placement would also include the option to complete time in AUH trauma theatres. There is also an option of completing Complex Orthopaedics with the (major) Trauma and Stabilisation SIA – on-call Aintree site.

LUHFT (Aintree)

Contact: Dr Mike McGovern (michael.mcgovern@liverpoolft.nhs.uk)

Module Details: Please see entry for Royal where elective orthopaedics is based.

Anaesthesia for Hepato-Pancreato-Biliary Surgery

LUHFT (Royal)

Contact: Dr Penny Edmondson (penelope.edmondson@liverpoolft.nhs.uk)

Module Details: We are the regional hepatobiliary and pancreas service. This service enjoys an international reputation in the field of resectional surgery for complex benign and malignant hepatobiliary diseases. Operations range from segmentectomies and hemi-hepatectomies to resection of cholangiocarcinoma’s, open and laparoscopic pancreatic resection. Many of these patients require invasive monitoring, advanced pain relief options (epidurals, rectus sheath catheters) and careful pre-operative decision making. We would hope that trainees undertaking this module will be able to perform anaesthesia for high risk HPB cases with distant supervision, often whilst supervising more junior trainees. We would expect trainees to also participate in the perioperative management of their patients by attending pre-operative assessment, MDT, and reviewing their patients post-operatively on the critical care unit which is located only a short distance away. (There will be the option to attend CPET testing and pre-operative clinics at Aintree site). There will also be opportunities to work with the anaesthetic and surgical team to develop QI and research projects, utilising their world-class facilities and network.
We would expect this module to be taken alongside SIA for advanced general surgery.

Anaesthesia for Major General Surgery

LUHFT (Royal)

Contact: Dr Penny Edmondson (penelope.edmondson@liverpoolft.nhs.uk)

Module Details: With the service redistribution within LUHFT we can now offer a deep dive into major general surgery on the Royal site. We do regular major surgeries including cancer resections for pancreatic, oesophageal, colorectal, endocrine and urological pathology. These patients require invasive monitoring, advanced pain relief options (epidurals, rectus sheath catheters) and careful pre-operative decision making. Trainees are involved with each of these and it’s a great chance to get experience at thoracic epidurals and one lung ventilation. We have Consultant of the day shifts (‘C1/2’) that trainees can run. This involves liaising with the critical care team, meeting with surgeons to decide which operations requiring critical care can proceed and supervising junior trainees running the emergency list. It’s busy and stressful but great experience. Emergency work in our department is busy and the patient population has significant comorbidities. We would expect trainees completing this rotation to experience the perioperative care of their patients by attending MDT, pre-operative assessment clinic and reviewing their patient on the critical care unit located only across the corridor. We have an active research team and potential QI projects are varied; we encourage trainees to complete a project that they are interested in. Previous work includes rectus sheath catheter use, intrathecal diamorphine and pre- operative anaemia. We are active with NELA which is a constant source of QI work. The focus is on producing trainees that can work with the surgical team in deciding the best plan for a patient being considered for high risk surgeries and can then safety anaesthetise patients having major cancer resections. We expect trainees to be able to risk assess patients for urgent laparotomies and safely deliver anaesthetic care, whilst liaising with critical care colleagues and supervising more junior trainees.

Arrowe Park Hospital

Contact: Dr Martin Kelly (martin.kelly6@nhs.net)

Module Details: Wirral University Teaching Hospital is an efficient trust for Major Surgery and delivers care in line with ACSA standards in a friendly positive environment. We can offer a broad range of surgical specialities, each offering a major caseload. We have Gynaecology, Urology, Colorectal, ENT, Upper GI and we are also a tertiary referral centre for complex hernia repairs. We have two robots within the Trust and there is at least one robotic case each day. Regular robotic cases include: prostatectomies, cystectomies, partial nephrectomies, anterior resections/APRs, complex hernia repairs and hysterectomies. The Trust is one of the two largest urology cancer centres in the Northwest. Anaesthesia for Major General Surgery could be completed together with our Peri-operative Medicine SIA, with time in pre-op clinics. This will give understanding of how to assess, optimise, give information, discuss risk, and reach shared decisions with our patients. Post-operative pain rounds can be attended, and patients can be followed up in post-operative critical care. We also offer pre-habilitation for our major cancer work. A variety of pain and anaesthetic techniques are employed by WUTH consultant anaesthetists including: conventional pump and volatile based anaesthetics +/- diamorphine spinals, occasional epidurals for major open work, opioid free volatile anaesthesia, opioid free TIVA, lidocaine infusions, rectus sheath catheters and various other regional techniques. Surgery School could also be attended. We also have a busy emergency theatre with a mixed major caseload and being one of a few Trusts in the northwest doing big numbers of emergency laparotomies. We will provide the opportunity to act up as a consultant for day-time emergency theatre work. We will also support trainees with the development of their generic competencies, whilst providing audit and QI projects and management and other opportunities that will be helpful for the transition to becoming a consultant. On-calls could be limited to just general theatres if preferred.

Warrington Hospital

Contact: Dr Zoe Apple (zoe.apple@nhs.net)

Module Details: Warrington Hospital provides comprehensive experience in the management of elective major colorectal and urological procedures, including laparoscopic and open bowel resections and nephrectomies. A typical week in Warrington elective theatres includes three major colorectal operating lists, two nephrectomies and also a range of thyroid procedures, through which trainees can gain extensive experience in the management of major general surgical procedures. The major general surgery module would be supervised by a small group of Consultants, with a special interest in this area. The aim is for stage three trainees at Warrington is to develop their skills and become confident in the independent management of these cases. Involvement in the entire perioperative process from MDT discussion, preoperative risk assessment and optimisation through to postoperative review is encouraged and would be part of the role for Stage 3 trainees. The use of TIVA, and multimodal analgesic regimens including intrathecal diamorphine and regional techniques is standard practice and cardiac output monitoring (LiDCO and oesophageal doppler) is routine in more complex cases. The emergency theatre at Warrington has a busy and challenging workload, with a high complexity of medical issues amongst our patient population. Stage three training would include an opportunity to ‘act- up’ as the Consultant on call during the daytime for the emergency list with support available as required. Warrington has established prehabilitation and enhanced recovery programmes for colorectal surgery and there is extensive scope for developing these services further as part of a quality improvement programme. We actively participate in a number of national perioperative projects (including PQIP and NELA data collection) and would expect trainees to be involved with and lead these processes. As well as leadership experience in the clinical domain, non-clinical leadership and management opportunities can be accessed, for example participation in governance meetings, and interaction with the executive team through attendance at medical cabinet meetings.

Anaesthesia for Patients with Complex Airway

LUHFT (Aintree)

Contact: Dr Mike McGovern (michael.mcgovern@liverpoolft.nhs.uk)

Module Details: Aintree University Hospital is the region’s tertiary care centre for ENT and MFU surgery. It has a dedicated suite of 5 well-equipped Head & Neck operating theatres (Main B) plus a forward wait area adjoining the theatre complex. You will find that the unit enjoys a great working atmosphere. The unit has a worldwide reputation and performs the whole spectrum of elective adult airway surgery from simple tonsillectomy and dental extractions through to complex oncological cases involving laser resections or microvascular free flap surgery. The bulk of the emergency airway work is comprised of patients with fascial space infections (dental abscesses), facial fractures, and airway obstruction due to malignancy or sepsis. Senior help is always close at hand and, like the surgeons, anaesthetists work closely together with much traffic between theatres during the day to observe, help and comment on each other’s cases. You will be encouraged to do and see as much as possible each day and not be restricted to a particular list. You will also be encouraged to attend an ENT outpatient clinic to learn nasal endoscopy, scrub and assist at an elective tracheostomy to become more familiar with front of neck anatomy and to attend the cancer MDT. The Department of Anaesthesia also runs the ADAM (Aintree Difficult Airway Management course), which is an advanced airway-training course of national standing.
Trainee Feedback: Great clinical exposure, opportunities to carry out research/QI with presentation and publications. Great anaesthetic department.

Anaesthesia for Plastic Surgery and Burns Management

Whiston Hospital

Contact: Dr Catherine Gerrard (catherine.gerrard@sthk.nhs.uk)

Module Details: The Mersey Regional Burns & Plastics and Reconstructive Surgery Unit is based at Whiston Hospital. There are 4 plastic surgery theatres within the main theatre complex including a dedicated burns theatre, an ‘awake surgery’ list for plastics trauma where cases are managed under regional anaesthesia alone. There is a close working relationship with the general ITU. Burns & Plastics and Reconstructive Surgery provides much of the planned and emergency workload at Whiston Hospital. Although catering for the whole spectrum of Burns & Plastic cases, surgeons have specific interests in microvascular surgery, major reconstructive -Free Flap surgery, burns surgery and hand surgery. Advanced Burns & Plastics Trainees would be able to gain mastery in the delivery of safe and effective peri-operative anaesthetic care including critical care support to patients undergoing complex burns and plastic surgery procedures, both in the elective and emergency setting. There are opportunities to organise and facilitate teaching in this sub- specialty to less experienced colleagues of all grades. Although there are currently no ongoing audit /QI projects specifically in the area of Burns & Plastics, there would be ample opportunity for Advanced Burns and Plastics Trainees to complete a project after discussion with the module leads.

Anaesthesia for Thoracic Surgery

Liverpool Heart and Chest Hospital

Contact: Dr Clare Quarterman (clare.quarterman@lhch.nhs.uk)

Module Details: Liverpool Heart and Chest Hospital is the largest single site heart and chest hospital in the UK, serving a local population of 2.8 million but also receiving specialist referrals from all over the UK. Trainees at LHCH will be supported to gain experience of the elective management of patients presenting for thoracic surgical procedures via thoracotomy, video- assisted thoracoscopy and robotically. Additionally, there will be opportunities to gain experience of the management of patients undergoing procedures involving a shared airway, including rigid bronchoscopy for management of benign and malignant disease. Training in performance of regional anaesthetic techniques for the chest wall will also be provided. We are a supportive department and are keen to support the learning and development of our trainees. We have an ever-evolving educational program involving monthly half-day teaching sessions delivered by expert clinicians with trainee involvement and additional morning meetings. We are also have a very active program of quality improvement and service development, so are able to provide opportunities for meaningful projects, along with the forum to present at bimonthly audit meetings and support to present at national meetings. If you are interested in a stage 3 placement at LHCH we would be happy to discuss this further with you. As we are a cardiothoracic centre, trainees attending to complete a special interest area in anaesthesia for thoracic surgery would also gain training and experience in the management of patients for cardiac surgery. See also SIA in Anaesthesia for Cardiac Surgery above.

Anaesthesia for Vascular Surgery

Countess of Chester Hospital

Contact: Dr Richard Dodwell (richard.dodwell@nhs.net)

Module Details: The Countess of Chester Hospital is the South of the Mersey Arterial (SMART) Centre covering Wirral, Warrington and the Chester area. Stage 3 trainees will principally be attached to our two vascular theatres, where high-risk patients receive perioperative care for a wide range of complex major procedures, including open and endovascular aortic surgery, carotid endarterectomy and peripheral revascularisation. There is ample opportunity to practice regional anaesthesia, with trainees being encouraged to experience carotid surgery both asleep and awake, gain exposure to peripheral nerve block strategies for lower limb surgery and participate in our growing nerve catheter service. Trainees will experience multidisciplinary working, accompanying consultants at MDT meetings, responding to formal anaesthetic referrals for risk evaluation and optimising comorbidities through the vascular preoperative assessment clinic. We work closely with our Stage 3 trainees and collaborate with our colleagues around the region to offer a comprehensive training experience.

LUHFT (Aintree)

Contact: Dr Mike McGovern (michael.mcgovern@liverpoolft.nhs.uk)

Module Details: We offer an in-depth programme that encompasses complex open and endovascular AAA surgeries, carotid endarterectomies and peripheral vascular work. The patient load is often high risk with significant co-morbidities, requiring invasive monitoring with the potential for catastrophic blood loss. We rotate trainees through extensive pre-operative work including clinics and MDTs. There is the option for joining the vascular team on a morning ward round to provide anaesthetic expertise. The great thing about this module is that the vascular team get to know you well during the 6 months and you become part of the team. They are very supportive of our role in educating the next generation of vascular anaesthetists. Recent QI projects include topics such as frailty, anaemic management, service reorganisation (out-of-hours endovascular repair of ruptured aneurysms), simulation and pre-habilitation. The focus is on producing a trainee who is confident in patient selection for high risk procedures, is able to anaesthetise ASA 4 patients safely and can manage a patient who has lost most of their circulatory volume.
Trainee Feedback: Good exposure to vascular cases, emphasis put on vascular lists. Available QI projects and lots of Consultant support. On call is covering emergency theatre, so good experience for Consultancy. Lots of practice supervising core trainees and stepping up to Consultant C1 role. Attendance at Consultant meetings and MDT. Increasing solo work as rotation progressed.

Perioperative Medicine

Countess of Chester Hospital

Contact: Dr Iestyn Harrod (iestyn.harrod@nhs.net)

Module Details: At the Countess of Chester hospital, we are able to offer Advanced Trainees exposure to the following learning opportunities:
• Complex patient general preoperative assessment clinics (pre-listing for surgery)
• Complex patient vascular preoperative assessment clinics (pre-listing for surgery)
• Vascular MDT
• Vascular assessment clinic (post listing for surgery)
These occur weekly. We also offer the usual emergency pre-assessment for inpatients requiring urgent general or vascular surgery, as well as the opportunity to join a perioperative physician on a ward round. Trainees can also join an acute pain round three times a week. This may involve the need for inserting nerve catheters for preoperative patients awaiting lower limb revascularisation. Future developments include the return of our in-house CPEX service and potentially prehabilitation and surgery school setup.
Advanced trainees are encouraged to participate in service development and QI projects of which there are many opportunities.

LUHFT (Royal)

Contact: Dr Penny Edmondson (penelope.edmondson@liverpoolft.nhs.uk)

Module Details: We engage with the peri-operative physician approach endorsed by the RCOA and trainees are exposed to our extensive pre-operative assessment work (clinics, MDTs) as well as post-operative rounds including the option to work with the POPS team. Intra-operative work includes the use of multimodal analgesia, and the use of invasive monitoring (LiDCO, oesophageal Doppler). We have Consultant of the day shifts (C1/2) that trainees can run. This involves liaising with critical care, meeting with surgeons to decide which operations requiring critical care can proceed and supervising junior trainees running the emergency list. It’s busy and stressful but great experience. QI projects are varied and we encourage trainees to complete a project that they are interested in. Previous work includes rectus sheath catheter use, intrathecal diamorphine and pre-operative anaemia. We are active with NELA which is a constant source of QI work. The focus is on producing trainees that can perform interventions during the peri-operative period to enhance patient care and can lead a busy theatre unit with good planning and communication. We also expect trainees in this rotation to provide education and supervision for more junior trainees, knowing when to intervene and when to allow them to proceed.
We would expect this module to be completed alongside the SIA for major general.

Southport and Ormskirk

Contact: Dr Peter Geldhill (peter.gledhill@merseywestlancs.nhs.uk)

Module Details: The resident On-call rota in the department is currently staffed by core anaesthetic and ACCS trainees, as well a clinical fellow. The future staffing model for this resident rota involves the incorporation of the newly re-opened Associate Specialist grade. The plan is that out-of-hours this senior resident doctor will provide senior airway and medical cover for the emergency anaesthetic service and the critical care unit. Any senior trainee allocated to the department, would participate in this rota, rather than the resident maternity and/or ICU rotas, which are currently and will continue to be fully staffed by SAS doctors. The doctors on this night- time would make decisions about night-time theatre activity. Additionally, they would trouble-shoot simple problems, provide additional airway support to the resident anaesthetist on ICU, as well as accept uncomplicated admission requests to critical care. A non-resident on-call consultant would be available at all times for additional help and support. Daytime training opportunities include undertaking elective lists in a range of specialties with local supervision. These opportunities can be augmented with the option of undertaking non-clinical activity to support the High-level Learning Outcomes in a range of key capabilities (outlined below). The absence of routine daytime on-call duties should provide ample opportunity to achieve the required high-level learning outcomes. Projects include assistance with NELA, preparation for ACSA accreditation. Learning outcomes able to be completed include peri-operative medicine and health promotion, leadership and management.

Arrowe Park Hospital

Contact: Dr Sam Michlig (s.michlig@nhs.net)

Module Details: Arrowe Park Hospital carries out a range of emergency and planned surgical services including urology, ophthalmology, orthopaedics and general surgery. We participate in the RCoA/NIAA-HSRC Peri-Operative Quality Improvement Programme. We are an ACSA accredited department and have daily Consultant led preop assessment clinics at our Clatterbridge site with both face-to-face and electronic reviews of patients, providing ample opportunity for experience in and demonstration of the SIA curriculum outcomes including leading in decision making about the suitability of high-risk patients for surgery and leading shared decision making.
Trainees undertaking this placement will also work alongside different specialities to best understand the skills required to manage the complex patient. This will include sessions in:
• Cardiology outpatient clinic
• Respiratory clinic
• Orthogeriatrician led ward rounds
• Colorectal MDT meetings
• Acute pain round
Opportunities for development:
• Development of guidelines and policies in line with GPAS standards.
• Ongoing POPS work in continuing to improve the perioperative care of older people following on from WUTH’s participation in POPS cohort 1.
• Participation in RCoA Perioperative Quality Improvement Programme and use of data to drive QI project related to perioperative medicine.
• All are good opportunity to develop curriculum vitae for Consultant job applications.
Trainees will cover predominantly theatre on calls, contributing to the development of knowledge and skills in cross-speciality working and assessment/ optimisation of the complex patient. Trainees will also undertake theatre sessions across the surgical specialities which will allow opportunities for SLEs and further development towards preparation for Consultant practice. There will be opportunity for trainees to ‘act up’ as Consultant on call during daytime hours under direct supervision to further develop both clinical decision making and management skills.
We undertake major robotic general and urological surgery and therefore there is opportunity to combine this SIA with Anaesthesia for Major General Surgery SIA over a 6-month FTE placement.

Regional Anaesthesia

Countess of Chester Hospital

Contact: Dr Natasha Hettiarachchi (natasha.hettiarachchi@nhs.net)

Module Details: The aim of undertaking a Regional SIA at the Countess of Chester is to produce regional anaesthesia enthusiasts who will have the necessary knowledge and skills to develop the RA service in their chosen hospital during their future consultant career. In addition to developing toward independent practice of regional anaesthesia, they will have experience in the following:
- Who to block and how – Patient selection, pre-op consultation and education, gaining informed consent, safe approach to performing blocks, ergonomics and needling.
- Optimising the block – Approaches for analgesic blocks as well as anaesthetic blocks for awake surgery (both single shot and nerve catheters), block adjuncts, block rescue techniques.
- After the block – follow up of patients via the Acute Pain Service, managing complications.
- Learning to teach – there is a weekly RA program for trainees. A stage 3 trainee would be encouraged to bring their own ideas to develop the program and have a formal role in the delivery of teaching.
- QI and service development – some ongoing projects include for e.g. developing a block bay in theatre recovery and developing a sciatic nerve catheter insertion service for vascular patients awaiting revascularization/amputation. Stage 3 trainees would be mentored and allocated time to get involved in existing projects or to develop their own.
Our anaesthetic department is welcoming and teaching-oriented with a strong focus on regional anaesthesia. The department includes consultants who have undertaken a Masters in RA, the EDRA diploma as well as international fellowships in RA (in Australian and New Zealand) and trainees interested in these additional CV building opportunities would be well supported.

LUHFT (Royal)

Contact: Dr Penny Edmondson (penelope.edmondson@liverpoolft.nhs.uk)

Module Details: We perform regular regional anaesthesia for patients undergoing orthopaedic (femoral/saphenous/sciatic/ankle/brachial plexus) operations. We have an active pain intervention department where you can learn various peripheral nerve blocks (suprascapular nerve) and paravertebral injections. Awake brachial plexus blocks are performed for patients undergoing renal vascular access procedures, abdominal wall blocks for general surgery, chest wall blocks including Erector Spinae Block / Catheters for rib fracture patients and eye blocks for ophthalmic surgery. Trainees undertaking this module will have a chance to contribute to departmental teaching, encouraging the use of regional anaesthesia amongst colleagues. Time will be allocated for QI work. We are in the process of starting to use liposomal bupivacaine, which we hope to roll further out.
We would expect this module to be completed alongside the SIA in complex orthopaedics.

LUHFT (Aintree)

Contact: Dr Mike McGovern (michael.mcgovern@liverpoolft.nhs.uk)

Module Details: We perform regular regional anaesthesia for patients undergoing vascular and orthopaedic trauma operations. We have an active pain intervention department where you can learn various peripheral nerve blocks and catheter techniques. Trainees undertaking this module will have a chance to contribute to departmental teaching, encouraging the use of regional anaesthesia amongst colleagues. Time will be allocated for QI work.

Whiston Hospital

Contact: Dr Catherine Gerrard (catherine.gerrard@sthk.nhs.uk)

Module Details: At St Helens and Knowsley Teaching Hospitals NHS Trust, the scope for Regional Anaesthesia is significant. There are a broad range of surgical specialities based at Whiston and St Helens Hospitals which lend themselves to Regional Anaesthesia, including General, Plastics (including Trauma and Reconstructive), Burns, Ophthalmic, Urology, Orthopaedics with dedicated upper limb services, Orthopaedic Trauma, Day-case, Paediatrics, Gynaecology, Breast and Obstetric surgery. There is also a dedicated ‘awake surgery’ list for Plastics Trauma, where cases are managed exclusively under Regional Anaesthesia. The surgical team are eager to explore more avenues for awake surgeries and therefore welcome anaesthetic enthusiasm for Regional Anaesthesia. In order to consolidate knowledge and skills, supervision and teaching is provided by Regional Anaesthesia experts who are recognised both regionally and internationally. Trainees are encouraged to teach both within and outside the Anaesthetic Department. There is an established weekly Regional Anaesthetic teaching programme provided by Advanced Regional Anaesthesia Trainees. Future Advanced Regional Anaesthesia Trainees will be expected to continue to facilitate and develop this teaching programme. There will also be opportunities to get involved in regional and national teaching bodies and to build substantial networks within the speciality. There are Quality Improvement projects currently in place in the department. These welcome the involvement of Advanced Regional Anaesthesia Trainees e.g. the nurse-led fascia iliaca block pathway for fractured neck of femur cases, and the introduction of rectus sheath catheters for emergency and elective laparotomies. There is ample room for future developments in this area and Trainees are encouraged to bring their ideas to the department. Previous projects have included a retrospective review of two anaesthetic techniques used during laparoscopic bowel resection; intrathecal diamorphine vs Fentanyl-Ketamine-Lidocaine infusion. We see the Advanced Module in Regional Anaesthesia as a well-established and satisfying placement, despite the recent significant setbacks related to the Covid-19 pandemic. As and when it is safe to progress, we anticipate more opportunities for research and development and teaching and training and no doubt, placement within our department will bring several opportunities to prepare for a successful future as a Consultant in Anaesthesia. Other modules potentially able to be completed: Orthopaedics Previous trainee feedback: Module was in infancy, so took personal initiative. Excellent one to one teaching. Projects need to be manageable and realistic in timeframe. In Covid, when elective surgery was reduced, there was a strong focus on regional so this is a very useful and widely applicable skill.
Trainee feedback: Excellent one to one teaching. Projects need to be manageable and realistic in timeframe. In Covid, when elective surgery was reduced, there was a strong focus on regional so this is a very useful and widely applicable skill.

Warrington Hospital

Contact: Dr Zoe Apple (zoe.apple@nhs.net)

Module Details: Warrington Hospital offers orthopaedic surgery at two sites; the main Warrington hospital (mainly non-elective trauma surgery) and also at the Captain Sir Tom Moore Hospital. This is a purpose built elective hospital with four operating theatres, which is mainly used for elective orthopaedic surgery but which also performs breast surgery. We have a number of Consultant Anaesthetists with an interest in regional anaesthesia, who regularly perform awake surgery under upper or lower limb regional anaesthesia only. This module offers stage three trainees the opportunity to develop and refine their upper and lower limb regional anaesthetic techniques and to become confident in the management of lists delivered using solely regional anaesthesia. Other techniques, for example abdominal and chest wall regional anaesthesia, are routinely performed; either as analgesia for elective procedures (for example in breast and general surgery) or as part of an analgesic regimen for patients with rib fractures. We have successfully introduced erector spinae catheters which have been very effective in the management of pain in rib fracture patients. We hope to increase the number and range of peripheral nerve catheters undertaken and this would be an example of an area that a stage three trainee could make a significant impact through service development. As well as developing the leadership and decision making skills necessary to lead an operating list, we would expect trainees to lead a QI project of their choice whilst at Warrington. This project would be fully supported, with time allocated for data collection and to implement recommendations and also to attend and present at National and International Conferences. We are currently designing a Warrington regional anaesthesia course which aims to match the requirements of the RA-UK requirements for blocks for District General Hospitals. Trainees would be encouraged to deliver and develop this course further and also contribute towards two weekly departmental teaching programme and simulation sessions involving more junior trainees.

Arrowe Park Hospital

Contact: Dr Sharon Acheson (sharon.acheson1@nhs.net)

Module Details: WUTH offers a broad range of clinical experience in regional anaesthesia to both adult and paediatric patients. Opportunities include regional anaesthesia for upper and lower limb orthopaedics, vascular access lists under awake brachial plexus blocks, abdominal wall blocks for general surgery, chest wall blocks including Erector Spinae Catheters for rib fracture patients and eye blocks for ophthalmic surgery. Clinical opportunities provide cross links with other domains and capabilities. Trainees would be encouraged towards independent management and provision of safe and effective peri-operative analgesia through relevant ultrasound guided regional anaesthesia lists. There are opportunities to demonstrate leadership and organisational skills through organising and providing teaching to trainees through a weekly ultrasound guided regional anaesthesia teaching programme. We are proud to have hosted the national Arrowe Park Ultrasound Guided Regional Anaesthesia (APUSRA) Course on 12 previous occasions that has received excellent feedback. The trainee would have opportunities to get involved in organising subsequent courses. Trainees would be encouraged to bring their own ideas, engage with quality improvement work and development of guidelines. They would be encouraged to submit projects for presentation to national and international meetings related to regional anaesthesia (e.g. RAUK). Previous QI projects include formulating guidance on FICB for NOF fracture patients including teaching and training of the multi-disciplinary team. The trainee would be supported through further learning in EDRA exams if desired. This would be an excellent time of training to be involved in a welcoming and supportive anaesthetic department in preparation for a future consultant career.

Trauma and Stabilization

LUFHT (Aintree)

Contact: Dr Mike McGovern (michael.mcgovern@liverpoolft.nhs.uk)

Module Details: Aintree University Hospital sees the largest volume of acute major trauma within the Merseyside Major Trauma Centre Collaborative. The Walton Centre neurosurgical unit is on our hospital site and we have a close working relationship with them to manage all major head injuries in the region. Aintree currently has 100 trauma team activations per month and this is likely to increase with the transition to a single receiving site. All trauma calls are attended by the senior anaesthetic trainee on-call, where you will become very experienced in the efficient and effective management of acute trauma. You will also gain experience of acute major trauma surgery in our dedicated major trauma theatre, which is available 24/7 and backed by resources such as near patient coagulation testing using RoTEM®, and full haematological service support with the use of shock packs and rapid infusion devices (including The Belmont Infusion Device). For the non-clinical curriculum, anaesthetists are involved in service delivery and improvement, morbidity and mortality review and training for major trauma. We have a comprehensive urgent orthopaedic trauma service. We manage all common orthopaedic injuries, plus specialist foot and ankle, upper limb, peri- prosthetic femoral and pelvic surgery. We are amongst the first centres nationally performing fractured rib-fixation. We are also seeing increasing repeat visits to theatre for staged procedures in those with complex major polytrauma. We have an active service improvement dialogue with orthopaedic surgeons and orthogeriatricians, our fractured neck of femur service having been noted nationally as having a short time to theatre. There is ample opportunity for audit and service improvement projects. We are the regional centre for maxillofacial trauma, one of the largest in the UK. You can gain experience and confidence managing all maxillofacial injuries from the large volume of fractured mandibles to more complex mid-face and periorbital trauma. Transfer medicine is increasingly important in view of Aintree’s Major Trauma Centre status. Many of the 100 trauma team activations per month require intra- hospital transfer to Radiology for urgent CT scanning, and a significant proportion of patients are transferred to the Walton Centre for ongoing management of head injuries.

Additional Intensive Care Medicine

Please discuss with TPD.

Non-clinical

Management and Professional and Regulatory Requirements

Whiston Hospital

Contact: Dr Catherine Gerrard (catherine.gerrard@sthk.nhs.uk)

Module Details: Undertaking the Advanced Leadership and Management Module at Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, will enable Trainees to achieve the skills necessary to have significant impact as Leaders and to develop Management skills as required in today’s NHS. It can be completed in conjunction with another SIA module. This module will provide Trainees with exposure to the area of Clinical Management and Leadership within the NHS and broaden their understanding of the Management process and structures at both Trust and National Level. It will facilitate a deeper understanding of the role of the different professionals in the organisation of the Health Service and the importance of encouraging inter- professional understanding and effective team working. Trainees will regularly attend Management meetings with the Clinical Director of Anaesthesia and Deputy Clinical Directors. They will participate in Management projects as deemed appropriate by the Department Management Team.

Southport and Ormskirk Hospital

Contact: Dr Peter Gledhill (peter.gledhill@merseywestlancs.nhs.uk)

Module Details: The resident On-call rota in the department is currently staffed by core anaesthetic and ACCS trainees, as well a clinical fellow. The future staffing model for this resident rota involves the incorporation of the newly re-opened Associate Specialist grade. The plan is that out-of-hours this senior resident doctor will provide senior airway and medical cover for the emergency anaesthetic service and the critical care unit. Any senior trainee allocated to the department, would participate in this rota, rather than the resident maternity and/or ICU rotas, which are currently and will continue to be fully staffed by SAS doctors. The doctors on this night- time would make decisions about night-time theatre activity. Additionally, they would trouble- shoot simple problems, provide additional airway support to the resident anaesthetist on ICU, as well as accept uncomplicated admission requests to critical care. A non-resident on-call consultant would be available at all times for additional help and support. Daytime training opportunities include undertaking elective lists in a range of specialties with local supervision. These opportunities can be augmented with the option of undertaking non-clinical activity to support the High-level Learning Outcomes in a range of key capabilities (outlined below). The absence of routine daytime on-call duties should provide ample opportunity to achieve the required high- level learning outcomes. Projects include assistance with NELA, preparation for ACSA accreditation. Learning outcomes able to be completed include peri-operative medicine and health promotion, leadership and management.