Junior Clinical Fellow (ST1-ST2) in Cardiology/ITU

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The appointee is expected to undertake the admission and day to day care of cardiology patients.  This includes a number of patients admitted for short term investigation and also patients requiring longer term treatment.  Emergency cases are admitted daily incorporating all aspects of tertiary centre cardiology.

Main Duties and Responsibilities

The appointee is expected to attend regular cardiac clinics and ward rounds.

Some experience may be gained in all aspects of non-invasive cardiac investigations and in addition, some experience in assisting at cardiac catheters may be obtained

Some experience in procedural techniques including central line insertion, pleural taps and ascetic taps maybe obtained.

He/she is expected to maintain good professional liaison with colleagues, nursing, para-medical and administrative staff.

The rota is a partial shift working pattern which may be subject to change. Additionally, there is resident on-call cover at SHO level.

A cardiac arrest bleep is always carried by the SHO on call, local resuscitation training will be provided, and completion of the ALS course supported

SHO’s are expected to provide cover for the absence of their colleagues during annual and study leave.

Emergency management of all acute cardiac conditions.

Attendance and case presentations at MDTs.

Communication with primary and secondary care teams to plan safe and appropriate patient discharge will be a key role.

Clinical audit.

         Rota

The European Working Time Directive (EWTD) has set a minimum requirement for working hours, rest periods and annual leave. Junior doctors should not work over 48 hours a week.  (over a 26-week reference period). This is a requirement under UK as well as European law.

The objective of this training programme is to provide the Fellow with advanced knowledge and clinical experience in delivering a broad spectrum of critical care including:

Management of single and multiple organ failure secondary to cardiovascular intervention.

Advanced techniques in ventilation including protective lung strategies and management ALI/ARDS, differential ventilation and prone ventilation.

Management of patients post thoracic organ transplant

Advanced haemodynamic monitoring including pulmonary artery flotation catheters and non-invasive cardiac output monitoring.

In addition the Fellow could acquire experience in:

Postoperative peri-operative management of complex cardiothoracic surgical patients.

Transoesophageal and transthoracic echocardiography and critical care ultrasound techniques.

Intra-aortic counter-pulsation therapy, invasive and non-invasive cardiac output monitoring techniques and pacing.

Non-invasive ventilation.

Contribution to a clinical or basic science research project during their appointment.

Contribution to an audit project

Competency –based training at the Harefield SIM centre

Clinical experience

 TOE training

Basic and advanced peri-operative and critical care echocardiography education

Initial training will focus on basic principles (physics, standard views for examination, Doppler principle, and quantification etc),

Training sessions on the Heartworks TOE simulator

Further training may include sponsorship for attendance at a recognised external advanced training course.

Access to in house 3D echo cardiac training is currently being developed

Critical Care Ultrasound

Vascular access ultrasound

Chest and pleural space ultrasound

FEEL/FATE focussed ultrasound

Transplant experience

Contribution to retrieval, donor TOE and other transplant relating working groups

Monthly morbidity and mortality audit meeting

Education through attendance and participation in the Departmental Education Programme.

Option to participate in assessment and retrieval of donor hearts and lungs

Research experience

The Department actively supports research. The post holder will be encouraged to develop and undertake a research project, which may be undertaken in collaboration with the Heart Science Centre (Imperial College).

There will be an initial assessment at the commencement of the post to assess individual aims and objectives.

Suitable time will be made available within the weekly timetable to participate in appropriate research and clinical audit on discussion with the educational supervisor.

 This is a substantive 6-month post, extendable to 12 months subject to satisfactory internal review, for those interested in developing a career in cardiothoracic medicine and an interest in Cardiothoracic/transplant ITU. The trainee would be expected to have a commitment within the cardiology and ITU services with a 1 in 8 on-call commitment.

The aim of the fellowship position is to enable the Fellow, by the end of twelve months:

To function independently as an SHO to cover Cardio respiratory/Tx ITU

To have gained clinical experience in cardiothoracic medicine relevant to higher medical training

Take part in the non-airway management on call rota for ITU

Expected outcomes

Be able to clinically assess, stabilise and manage sick patients requiring advanced cardiothoracic support

Have a sound knowledge of ventilation, mechanical circulatory support (IABP, VAD – peripheral and central, ECMO) and nitric oxide.

Practical skills to include

• • Line insertion (arterial, central venous, vas cath)
  • Chest drain insertion using Seldinger technique
  • Ultrasound
  • ECHO – TTE and TOE