Syllabus

Stage 2

Both cardiac and thoracic anaesthesia are key units of ‘Stage 2’ training as part of the Royal College of Anaesthetists’ new 2021 curriculum. This mandates a single module in a tertiary centre, with a balance between anaesthesia and intensive care to allow for experience of the entire patient perioperative journey. Ideally trainees should try to get an experience of different types of cases, including interventional cardiology. However, at this stage there are no specific case requirements.

Examples of evidence can be as follows:

• CBD: discussion about plan for blood management in cardiac case.
• A-CEX: weaning patient off cardiopulmonary bypass; preoperative assessment/discussion of high-risk cardiac/thoracic patient; management of postoperative analgesia.
• ALMAT: management of thoracic/cardiac list under specified supervision level.
• DOPS: insertion of double lumen tube.

O: Applies basic science and clinical anaesthetic principles to patients undergoing cardiac and thoracic surgery
P: Describes the principles of anaesthesia for on and off bypass cardiac and thoracic surgery
Q: Provides safe anaesthetic care to ASA 1-3 adults undergoing elective cardiac revascularisation, valvular surgery and cardiology procedures under direct supervision
R: Demonstrates safe anaesthetic care for adults requiring non-complex thoracic procedures under direct supervision, including one lung ventilation 

Specialist Interest Area (Stage 3) – Thoracic Anaesthesia

Expected duration: 3-6 months

By the end of the a thoracic SIA, trainees would be expected to have a thorough logbook of thoracic surgical cases, including undertaking cases without direct supervision. Most cases are likely to be video assisted surgeries, using double lumen tubes, but a broad spectrum of other cases (e.g. open thoracic cases) and other airway devices (e.g. bronchial blockers) would be expected. The exact case mix will depend on the centre in which the SIA is undertaken. Contribution to departmental activities (e.g. quality improvement projects, teaching etc.) is also generally part of an advanced module.

Further information and examples of SLEs can be found here.

A: Can assess and management the perioperative care thoracoscopic video assisted lung or pleural biopsy independently
B: Manages independently the perioperative care of patients for a wide range of major thoracic surgical procedures
C: Provides a range of appropriate multimodal pain management for thoracic procedures
D: Preoperative assessment and anaesthetic management of patients with recurrent pneumothoraces, pleurectomy or bullectomy
E: Manages airway interventions for benign and malignant disease including tracheal stents and tumour debulking
F: Manages independently the patient with pleuro-pulmonary sepsis

Specialist Interest Area (Stage 3) – Cardiac Anaesthesia and Intensive Care

Expected duration: 6-12 months

Cardiac SIAs are often one year, but can be six months. During this time trainees should develop experience of a broad range of cases, including emergencies and work toward being able to independently provide anaesthesia for cardiac surgical and interventional cardiology procedures. Again, the exact case mix will be centre dependent and there a no pre-specified minimum numbers. Alongside time in theatres, trainees will normally spend time working on the cardiac critical care unit. During stage 3 training most trainees will start to work toward become proficient in transoesophageal echocardiography, although gaining full accreditation within a 12 month period is tight – although it is often possible to complete the logbook, if complete the accreditation process.

Further information and examples of SLEs can be found here.

A: Provides anaesthesia for a cardiac surgical list of uncomplicated CABG, AVR or combined procedures independently
B: Manages the anaesthetic care of a complex valve case and a major aortic case with local supervision
C: Can assess and provide perioperative care for off pump cardiac surgical procedures independently
D: Manages cardiac surgical cases with poor biventricular function and plans on-going care
E: Provides anaesthesia for interventional cardiology procedures eg complex coronary intervention, transcatheter aortic value
F: Evaluates point care tests and utilises appropriate bleeding algorithms to manage peri and post bypass operative bleeding
G: Can manage emergency anaesthesia for post cardiac surgical complications
H: Undertakes learning and delivery of transoesophageal echocardiography
I: Provides intensive care to the post operative cardiac surgical patient
J: Explains the principles of cardiac transplantation
K: Manages patients requiring mechanical circulatory support during the perioperative period

Cardiothoracic Training

In the new curriculum cardiac and thoracic SIAs have been separated. It is possible to complete training in both disciplines, however exactly how this is achieved needs to be planned with your local supervisors and college tutors.

Intensive care trainees spend some time on cardiac (or cardiothoracic) intensive care as part of their special skills module. This is generally three months.

By the end of the placement trainees should feel comfortable working at registrar level on a cardiothoracic intensive care unit, however given the senior led nature of these units, completely independent practice is not expected. As with anaesthesia modules, the exact case mix a trainee is likely to see will vary centre to centre, however achieving the core skills set out in the curriculum should be possible at any site.

Cardiothoracic ICM - Special Skills Module PDF