Senior Clinical Fellow in Vascular & Bariatric Anaesthesia

Bariatric

The post will be available as a full time (described below) or part time post. Job plan of a part-time post will be by agreement with the Supervisor of Post. The post holder will undertake two all day bariatric / upper GI lists during each week of elective work. The post holder will also regularly attend the multidisciplinary meeting and attend Bariatric Pre-Assessment (POAC) clinics, where in addition to anaesthetic pre-operative assessments, he/ she will have the opportunity to observe surgical (both new and follow-up), psychological and dietetic assessments.

The centre performs 650-750 bariatric surgical procedures annually in addition to /in

combination with other benign upper GI procedures. These cases are divided across three

regular full day lists (Mon/Wed/Fri) with 3-6 cases on each list. All elective bariatric cases

are pre-assessed and pass via the MDT. Anaesthesia is delivered by a core team of 6

Consultants Anaesthetists and supported frequently by any grade of junior anaesthetists.

There is a special interest and experience in the ultra/super-obese who undergo predominantly Roux-en-Y Gastric Bypass and Sleeve Gastrectomy surgery. Within this group we have experience of many patients with BMI >70, and frequently patients weighing over 200kg and occasionally >300kg. This sub-group have a very high incidence of obstructive sleep apnoea and other co-morbidities and are frequently managed post-operatively after careful preparation on the Bariatric ward. Only rarely is HDU/ICU required electively. There is a high number of cases with renal failure/transplantation and a selection of untreatable cardiac disease and pulmonary hypertensive patients that still require weight loss surgery. The surgical service attracts many bariatric revision cases and specific techniques such a deep Neuro-Muscular Blockade are employed to support these challenging cases.

Additional lists in this post may include anaesthesia for any lists at SMH campus. It is expected that more than 70% of all elective lists undertaken in this post will be in bariatric surgery. The post holder will take part in the registrar on call rota at a proportional level, including the proportionate number of on-call long day and night shifts.

The post will be covered by the same arrangements for study leave and supervision that apply to trainees in PMETB approved posts. Study leave and annual leave will have to be taken during weeks when not on call, or sessions moved accordingly.

The Bariatric Service (theatres /OPD /Group Sessions /Ward /Research Meetings) is mostly contained with the Surgical Innovation Centre adjacent to the A+E Dept at SMH campus. The MDT and Medical Clinics are held on SMH main campus. Upper GI Cancer surgery is at Hammersmith Hospital.

Academic output

• There is a strong departmental tradition of performing research and audit in this service and of publishing results

• Previous experience of research and completed audit will be expected

• There is a full time Bariatric Surgical fellow with whom close working/academic relationships are expected

Completion/Exit Standards

• Expected to complete the SOBA Core Skills in preparations for a Consultant Position with an interest in Bariatric Anaesthesia

• The successful applicant will develop experience in all areas of bariatric anaesthesia and become highly proficient in managing all patients with morbid obesity not just within bariatric surgery. This is an ever-expanding field of anaesthesia and there is a demand in future for Consultant Anaesthetists with these specialist skills

• The AAGBI already recommend each hospital has an Obesity Lead Anaesthetist for preparing and maintaining departmental systems/service for managing the obese anaesthetic patient. This post is ideal preparation.

• The post will provide training to Level 3 (see below in Core Topics) as recommended by SOBA (Society for Obesity and Bariatric Anaesthesia) and the Royal College of Anaesthetists

• There will be opportunities for developing expertise in fast track surgery and enhanced recovery programmes in bariatrics/obesity anaesthesia

Vascular

Job purpose and main roles and responsibilities

• To provide high quality vascular and emergency anaesthesia within a one-to-one consultant supervised environment initially, and then go on to manage cases within the tertiary vascular centre with indirect supervision.
• To gain specialist vascular anaesthetic experience within the vascular theatres which includes endovascular, thoraco-abdominal aneurysms, carotid and L heart bypass cases.
• To communicate with and participate in anaesthetic services for high dependency and critical care specialities.
• To engage in clinical governance activities specific to vascular anaesthesia as well as for general anaesthesia including critical incident reporting, attendance of morbidity and mortality meetings, perform audit and participate in mandatory training.
• To actively engage in the vascular teaching and training of other members of the anaesthetic department and hospital staff.
• Engage in quality improvement activity, additional management and administrative tasks as deemed appropriate to the position.
• To actively support and participate in audit and research projects to increase clinical and academic excellence within the department.
• To contribute to the development of anaesthetic vascular guidelines at a local, regional and national level.
• The post holder will also have an NHS service commitment to the anaesthetic on call rota, a 1 in 8 full shift pattern, as the senior registrar on call. This covers emergency theatre work, anaesthetic requirements for trauma calls at the Major Trauma Centre and overseeing anaesthetic care of the obstetric anaesthetic registrar. Emergency theatres include specialities for general surgery, vascular, orthopaedics, gynaecology and orthoplastics as well as the occasional medical emergency. They will participate as a trauma team member at trauma calls when on duty.