Perioperative Medicine

 

Perioperative / Vascular Fellowship at Broomfield Hospital

 

This is a one year Fellowship in a large district general hospital, with on calls based on the general theatres anaesthetic rota. Theatre experience will be based in the vascular theatres, as available, with exposure to the full range of surgical specialities within the Trust. Exposure to the wide range of surgical specialities available provides the experience required to further advance pre-operative assessment and suitability of patients for anaesthesia/surgery.

 

Surgical specialities

 

  • Regional centre for Upper Gastro-intestinal surgery (including approaching 100 oesophageal resections per year),

  • Regional centre for ENT and Max-Fax emergencies,

  • Part of the Vascular Network within Essex,

  • Orthopeadics including significant numbers of primary and revision joint replacements,

  • Colo-rectal (including a large volume of laparoscopic work),

  • Urological surgery (evolving short stay nephrectomy service),

  • Opthalmology (including increasing paediatric work),

  • Gynaecology,

  • Recently opened 3 theatre dedicated day case unit.

 

 

General duties

 

  • Regular theatre work includes exposure to the above surgical specialities.

  • On call commitment as theatre registrar (1:8) rota.

  • Day time on call during the week involves emergency theatre coverage with dedicated consultant availability within the emergency theatre.

  • 3 out of 5 week days have consultant on site availability until 21:00.

  • Out of hours the theatre on call consists of the registrar and an SHO.

  • Responsibilities include in-hospital cardiac arrests, covering the Emergency department for resuscitation of acutely unwell medical and surgical patients, providing airway support for adult and paediatric trauma calls, assistance as needed for the other anaesthetic middle grades on site as needed (1x in burns ITU, 1x Obs, and support for general ITU as needed).

  • Being a regional centre for ENT and Max-Fax allows good exposure to paediatric general anaesthesia cases.

 

Pre-assessment Experience

 

There is a dedicated pre-assessment clinic at Broomfield hospital. All patients for surgical procedures are seen in the Anaesthetic Assessment Unit (AAU) prior to attending for surgery. There are at least 8 consultant lead clinics each week, at least 4 of these are Cardio-pulmonary Exercise Test (CPET) clinics. There are numerous nurse lead pre-assessment clinics that run in parallel to these consultant clinics. As part of this Fellowship you have the opportunity to run your own patient load in pre-assessment and, if CPET trained, run CPET clinics. At present approximately 25 CPET’s are undertaken each week, this equates to over 1000 CPET’s a year.

 

Within a year trainees perform over 50 solo CPET’s and pre-assess over 120 patients independently in the clinic setting. As there is an exercise program for patients that require increased fitness prior to surgery, there is a significant surgical ‘buy-in’ to this approach and a very good working relationship exists between the AAU, the surgical specialities, the ITU and the department of anaesthesia.

 

Consultant sessions within the AAU are predominately allocated to the high risk patient group, these include those undergoing open abdominal aortic repair, patients presenting with oesophageal cancer who may require neo-adjuvant chemotherapy and then progress to surgery. To this end fellows will be given one session a week within the AAU. There is the possibility to undertake one full day (two sessions) within the AAU every two weeks which can be beneficial.

 

Non-Clinical Skills.

 

An often mystical skill that some people are born with, others are not. This fellowship has given trainees great experience when dealing with difficult situations and patients, both from a medical and inter-personal standpoint.

 

 

 

 

 

 

 

 

 

 

 

 

 

Audit/ Teaching / Research

 

  • There is regular provision of research time with one sessions a week set aside for individual research work. Again this can be taken as one full day every two weeks.

  • There are a number of ongoing research projects which a aiming towards peer reviewed publication.This is a relatively new Fellowship but the opportunities for ongoing research and new research is immense. You will be actively encouraged to continue current projects and to set up and run new projects.

  • There is a developing relationship with Anglia Ruskin University in Chelmsford and this is expected to grow in the coming years.

  • There is the opportunity to lead teaching to junior anaesthetic colleagues and present at the regular monthly audit meetings which are very well attended and supported.

 

This Fellowship offers an opportunity to work in an incredibly supportive, dynamic and motivated department. There is the opportunity to produce transformational change. It provides exposure to what is a crucial component of any anaesthetic practice - the pre-assessment of patients prior to surgical intervention. In addition it promotes a diverse range of opportunities to advance both your clinical and non-clinical practice.

 

If you have any further questions please contact Ben Maddison

 

 

"This year has helped prepare me for life as an anaesthetic consultant (from a non-technical skill standpoint) more quickly and I suggest better than any of my training posts so far. The requirement to balance delicate clinical situations and decisions, discuss these with patients, their families, parent specialities and all members of the multi-disciplinary team requires you to enhance your inter-personal skills to ensure the optimal patient outcome. When these situations have arisen there has always been faultless support from the anaesthetic consultants within the department. Numerous educational experiences are explored. I personally feel much more prepared to function as a consultant anaesthetist after undertaking this year."

 

Al Hughes (Previous Fellow)

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