Cardiothoracic

The School is fortunate in having three separate cardiothoracic centres, carrying out a full range of surgery and intensive care.

The Heart Hospital offers surgical experience in cardiac and thoracic anaesthesia, cardiac intensive care, angiographic procedures and grown-up congenital heart disease (GUCH). Training in transoesophageal echocardiography (TOE) is to accreditable standard.

Harefield Hospital offers comprehensive cardiothoracic experience including cardiac and thoracic anaesthesia and ICU, cardiac and lung transplantation and ventricular assist devices.

The Brompton carries out complex paediatric surgical and angiographic procedures, and in adults provides cardiac and thoracic surgery. There is a specialist thoracic Intensive Care.

All SpR posts in the school rotate through one or other of these hospitals, in order to satisfy the minimum CCST requirements. Additional fellowships for trainees with an interest in cardiothoracic anaesthesia are available at each hospital, and there are research-based fellowships available. These posts are available for 6 or 12 months. Advanced booking is recommended whenever possible.


For further details, contact:-
HEART HOSPITAL Andrew Smith, Elizabeth Ashley or Jane Lockie.
HAREFIELD David Royston
BROMPTON Andrea Kelleher


The School also has a number of links with the USA, and Out-of-Program experiences are encouraged.

Trainees with an interest in cardiothoracic anaesthesia are advised to seek experience in multiple centres/countries. It is also an advantage to gain expertise with echocardiography, paediatrics, transplantation and ICU. To reach a level appropriate for appointment to Consultant needs a minimum of 12 months, but 18-24 is preferable.

ENT and Airway

ENT is an important subspecialty, and it incoporates a significant paediatric component. ENT and Airway skills are taught at some of our District General Hospitals, both our Teaching Hospitals and at the specialist Royal National Throat Nose and Ear Hospital.

We have a one year fellowship post, divided between UCLH and RNTNE. The post is intended for more senior trainees, and it may be suitable for Out-of-Program Training. It offers experience in fibreoptic intubation (awake or asleep), transtracheal ventilation, laser procedures and clinical research.

A fibreoptic intubation course is held every month at UCLH. Participants gain hands-on experience by attempting to intubate one another. Further details are available from Viki Mitchell.

Hepatobiliary

The Royal Free offers a highly specialised and well-established training in hepatobiliary and pancreatic surgery and liver transplantation. Four surgeons perform all types of surgery, including liver resection, pancreatectomy and transplantation. There is a special anaesthetic interest in coagulation monitoring and transfusion management, and there are active research and audit projects.



There are four posts available. Two are 12-month clinical research post, and the other two are six month clinical fellowships. Posts are only offered to post-fellowship trainees, and are usually booked at least a year in advance.



Trainees are advised that some previous cardiac experience is an advantage. Further details can be obtained from Dr Sue Mallett, Consultant Transplant Anaesthetist.

ITU

Experience in ITU is available at almost all the hospitals in the School. We can offer experience in general (DGH) ITU, and can also provide training in more specialised units, including neurosurgical, cardiothoracic, paediatric and hepatobiliary intensive care. We also have specific in-program three month ITU blocks at the Royal Free, University College, Royal London and Barts.

In the first 2 years of training all anaesthetists are required to undertake 'basic training in ICM' in a 3 month block. Our ST 1/2 rotations should include a minimum of three months ICM training.
In the later years of training all anaesthetic trainees are expected to complete 'intermediate training in ICM'. This is another 6 months of ICM training again delivered in 3 month blocks.

Specialty Registrars who wish to pursue a career in ICM can follow two possible pathways.

Step One accreditation involves a six month ICU-specific block, undertaken as an StR. Trainees who achieve Step One would be appointable to a consultant post with some ITU sessions.

Step Two training is intended for people who wish to have a greater role in ITU, including becoming the Unit Director. It involves a further 12 months, up to half of which needs to be spent in a specialist ITU. Step II can only be gained in open competition through a London Deanery interview. All available Intercollegiate board-approved Step II training posts across London are up for grabs twice a year (depending on availability), and are appointed competetively.

If you are seriously thinking of a career involving ICU, you should probably be doing a minimum of Step II anyway, especially if you’re thinking of working in a half-decent Unit! You should also consider joining the Intensive Care Society.

For further details, please contact Prof Mervyn Singer, Educational Supervisor, North Thames Central, or Dr Maire Healy, Educational Supervisor, North Thames East.

Neuroanaesthesia

Neurosurgery and neurosurgical ITU is one of the Key Competencies for StR 3/4’s, and is an important part of anaesthetic practice. The school can provide neuroanaesthesia training at two sites - the Royal Free Hospital and the National Hospital for Neurology and Neurosurgery at Queen Square.



The Royal Free offers year ST 3/4 training in elective and emergency neurosurgery and neuroradiology (including interventional procedures). At NHNN a wider range of uninterrupted neurosurgical experiences are offered, including neurosurgical ITU and neuro/pain therapy. Trainees at NHNN are usually required to have passed the final FRCA. NHNN also offers dedicated critical care posts, research posts and clinical fellowships (some of which are out-of-program). The fellowship posts allow trainees the chance of a longer attachment (three to twelve months) in the department, performing the same clinical work as the StRs and undertaking research in neurosciences.



Anyone hoping to follow a career in neuroanaesthesia would be expected to have training experience of at least six months anaesthesia and an undefined period of training in a Neuro intensive care facility. A desirable case exposure has been described by the RCoA. Further experience in spinal and head and neck surgery would also be an advantage.



Further information can be obtained from:-

Jeremy Radcliffe at NHNN

Michael Pegg at the Royal Free.

Obstetric analgesia and anaesthesia

Obstetric anaesthesia is taught widely throughout the School, offering trainees the opportunity to experience a variety of different techniques.



The unit at the Royal Free – headed by Roshan Fernando – is a tertiary referral centre for high-risk pregnancies, with an active research team. Areas of interest include preeclampsia and both cardiac and haematological disorders in pregnancy. A number of research and clinical fellowships are available here, both in and out of program. The unit has its own office on the labour ward with internet access.



We also have a post at Queen Charlottes hospital.



Trainees considering a career in obstetric anaesthesia are advised to join the Obstetric Anaesthetists Association, and also the Group of Obstetric Anaesthetists in London (GOAL). Contact Dr Fernando for further details.

Paediatrics

The School has 6 posts at Great Ormond Street Hospital for Children. These posts provide specialist paediatric training in this well-known specialist hospital, which is linked to the Institute of Child Health. Four of the posts are for 6 months and two are for a year. All the posts include acute pain, and the longer posts offer cardiac, neuro and ITU. Trainees who wish to develop an interest in paediatric anaesthesia should have completed a course in paediatric resuscitation, and some experience in Paediatrics would be an advantage.

We also have a post linked with the Evelina hospital. Paediatric experience can also be obtained at many of our other hospitals, including RNOH Stanmore, the Brompton and many of our DGH placements.

As a general rule, anyone who wishes to become a specialist paediatric consultant should have at least 12 months experience. The 6 month jobs are intended for generalists or for trainees aspiring to a consultant post in a general hospital with a “paediatric interest”.

For further information contact Isabeau Walker or Jane Lockie.

Pain

We can offer a well-structured training in Pain at UCLH – a major pain management centre in the UK. There are 5 pain consultants, working in a service covering the Middlesex, UCH, the Heart Hospital and the National Hospital for Neurology and Neurosurgery.


Clinical interests include urogenital pain, adolescent pain, pain in the neurological patient, complex back pain, vascular pain and phantom limb pain. A full range of invasive procedures are performed at NHNN and UCLH, from acupuncture to spinal cord stimulation. There is an outpatient based continuously audited cognitive-behavioural pain management programme (COPE).


Our current protocols can be downloaded from this website (in the Downloads section).

The unit is active in research. Current projects are looking at the changes from acute to non-acute pain, premptive analgesia, drug treatment of neuropathic pain, sensory testing and on the effects of low dose ketamine on pain and memory systems. Research is linked to the Centre of Anaesthesia.



The Pain Management Centre has recognition for higher specialist training. Training is open to all grades of trainee. SHO’s can attend the acute pain rounds and the teaching sessions. Pre-fellowship trainees are offered “taster” modules, and longer fellowships are available for senior StRs.

A 3-month chronic pain “taster” post is available at the Royal Free.
A one-year 50:50 clinical/research post is offered at UCH, which is very popular.
In addition we have 2 Chronic Pain Training Fellowships split between NHNN and RNOH.



Other training is available in the School. Trainees doing neurosurgery at Queen Square can opt for a pain attachment.


Further information:-

UCLH - Brigitta Brandner, John Lee or Andrew Baranowski

NHNN - Paul Nandi

RNOH - Jonathan Berman