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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.