Stage 2 Training - RCOA 2021 Curriculum

St. Bartholomew’s perioperative medicine department (POM) provides Stage 2 training in cardiothoracic anaesthesia for North Central and North East London School of Anaesthesia residents.

During this rotation you will receive training in the anaesthesia and perioperative care for patients undergoing cardiac surgery, thoracic surgery and cardiology procedures, which will also include time working on the cardiothoracic intensive care.

We are able to cover all key capabilities for stage 2 cardiothoracic training as set out by the 2021 RCOA Curriculum, and support a wide range of supervised stage 2 practical procedures.

Key aims for stage 2 cardiothoracic training at Barts POM

  • Able to readily apply basic science and clinical anaesthetic principles to patients undergoing cardiac and thoracic surgery

  • Able to describe the principles of on and off bypass cardiac and thoracic surgery

  • Can provide safe anaesthetic care to ASA 1-3 adults undergoing elective cardiac revascularisation, valvular surgery and cardiology procedures under direct supervision

  • Able to demonstrate safe anaesthetic care for adults non-complex thoracic procedures under direct supervision, including one lung ventilation

Suggested supervision level from the RCOA 2021 curriculum: ‘2a - supervisor in theatre suite, available to guide aspects of activity through monitoring at regular intervals’

The role of a stage 2 anaesthetist at Barts

  • Standard working days are typically spent assigned to theatre or cardiology catheter lab lists. Theatre lists include both cardiac and thoracic surgery, while cardiology lab lists are generally for electrophysiology (EP) and structural procedures. We aim to give you a varied experience of all these lists while you are with us at Barts, and try to structure list allocations to do so.

  • For out of hours work, including nights, weekends and evenings, you will be allocated to cover one of our two surgical intensive care units. This also applies to some of the weekday long working days in the rota. Gaining experience of cardiothoracic intensive care is an important outcome of your time here at Barts. There are twice daily consultant ward rounds, with the consultant in charge contactable at night by phone. A senior fellow in cardiothoracic anaesthesia is also present to provide on site support out of hours. While working on the smaller of our two units you will also be expected to attend medical emergency and cardiac arrest calls within the hospital.

  • Another role you will gain experience in will be providing anaesthetic cover for our busy heart attack centre (HAC) and occasionally urgent EP procedures. You will be assigned to cover the HAC bleep on normal days often when already working in the cath labs, as well as out of hours when covering one of our surgical ICUs. Senior support is provided by one of the senior cardiothoracic anaesthesia fellows.

  • We also have a well established 3-monthly teaching programme covering a range of relevant topics. You should be able to leave clinical duties to attend these sessions, as well as a separate weekly journal club. There are also early morning TOE review sessions which you are welcome to join for interest.

Requirements for the completion of stage 2 cardiothoracic anaesthesia

Overall requirements: 

  • Triple C form and MTR signed off by an educational supervisor (ES) / college tutor (CT) for cardiothoracic anaesthesia

    Demonstrating competence in the Stage 2 key capabilities O to R (see the RCOA 2021 stage 2 curriculum guidance)

This forms an essential part of the HALO required for the larger Stage 2 General Anaesthesia learning domain and can crosslink with Perioperative medicine and Health promotion domains

  • Cardiothoracic ESSR to cover the rotation at Barts (can be completed as an ARCP ESSR if near time of ARCP)

All stage 2 trainees will need the following at the end of their rotation at Barts POM:

  • Evidence of initial, halfway and final ES meetings - for placement goals and aims, midpoint check in check in, and then to complete paperwork and reflect at the end

  • Logbook evidence of supervised involvement in the anaesthetic perioperative care for a range of cases, as set out by the stage 2 cardiothoracic anaesthesia key capabilities (O-R) above. This should include a good mix of cardiac, thoracic and cardiology cases

  • SLEs:

    A range of SLEs, reflecting experience in cardiothoracic perioperative care, with reference to the cardiothoracic anaesthesia key capabilities (O-R) in the 2021 RCOA stage 2 curriculum. We would encourage obtaining SLEs in both theatres and critical care

  • Consultant feedback:

    1 x MTR and departmental consultant source feedback collected by ES

  • Completed Triple C form with the above - by ES or CT

  • Completed ESSR covering the period of time spent at Barts

  • We also expect to see evidence of engagement with departmental activities – e.g., local teaching, journal club, governance days, M&M

 Additional:

  • This is also the opportunity to gain evidence of competence in a range of practical procedures with appropriate supervision levels for a stage 2 trainee. The most specific of these are lung isolation techniques e.g. double lumen tubes (2a), but there are also many opportunities to be observed obtaining central venous access, arterial access and in many other skills

If this rotation is directly preceding an ARCP:

  • The ESSR form can be used as the ARCP ESSR and should cover all rotations since the last ARCP, in addition to just the time spent at Barts. See RCOA ARCP guidance and checklist available online for more information

  • For an ARCP at least 1x satisfactory MSF (with 12 or more responses) also needs to be documented in the training year. For any standalone ICM blocks an additional MSF will also be needed