Subspecialties

Subspeciality training is available within the school in:

Intensive Care Medicine (ICM)

This can be divided into three headings; Basic ICM, Intermediate ICM and Advanced ICM.

ICM – Basic

This is acquired by satisfactory completion of a 3month module in Intensive Care during years 1 or 2 of Specialist training (ST 1 or ST2) in either an Acute Care Common Stem (ACCS) or Anaesthesia programme. The trainee must satisfactorily complete the part 3 competencies and the workplace based assessments.

During ST 1/2 and prior to application for a parent specialty programme in Anaesthesia, Medicine or Emergency Medicine you are well advised to complete all the complementary specialty training if you intend to apply for a dual CCT in Intensive Care along with your chosen specialty. The trainee who completes an ACCS programme is therefore well placed as he or she has the opportunity to complete this training within their programme.

Please note that it will not generally be possible to complete the complementary specialty training (ie Acute Medicine) once you have commenced an ST3-7 post in Anaesthesia.

ICM - Intermediate

All trainees intending to complete the Intermediate Intensive Care training should enroll with the Intensive Care Board. Look at the website for the Faculty of Intensive Care Medicine (FICM).

In essence, to be eligible, you should have completed six months of medicine and three months of intensive care at a basic level (ST1-2). After August 2007 this will mainly be done through the ACCS route. The training is achieved by completing two three month blocks of intensive care medicine, which are usually done in ST3-4. You then also have to produce 10 case reports. For examples of what is required see on the IBTICM website in The Curriculum for the CCT in ICM – Part II.

ICM - Advanced

Entry to advanced training is through a competitive interview. This is normally done in years ST5-7. There are 4 posts per year. The posts rotate through Bath, Bristol Royal Infirmary, and Frenchay, with 2 months in Paediatric Intensive Care at The Bristol Royal Hospital for Children and 1 month in Birmingham. Completion of the advanced year will ultimately lead to a joint CCT in anaesthesia and intensive care medicine. When planning your year in Advanced ICM, bear in mind that you have to do at least 18 months of anaesthesia in years ST5-7 to obtain your CCT in anaesthesia.

For more information, please look at the Faculty of Intensive Care Medicine website or contact the Programme Director - Dr Jeremy Bewley. The regional adviser for ICM is Dr Timothy Gould.

For advanced trainees in ICM please see link for QEH, Birmingham and your contact there is Dr Nilesh Parekh, Consultant.

ICU Teaching/Journal Club

There is ICU teaching/journal club for all trainees interested in ICM. It is from 2 - 4 pm (ish), meet in Anaesthetic Department, Frenchay Hospital. For more details email Aidan Marsh at Frenchay or Jules Brown

Also look on the Bristol ITU Trainees website

For further information view the New-2-ICU website.

Cardiac Anaesthesia

The cardiac unit in the newly built (2009) Bristol Heart Institute at the University Hospitals Bristol looks after about 1500 patients a year undergoing coronary artery bypass grafting, both on and off cardiopulmonary bypass, valve procedures, many of which are repairs, complex aortic operations and an increasing number of interventions performed in the cardiac catheter suite including stenting of the aorta and percutaneous insertion of aortic valves. We have a modern nineteen bedded intensive care/high dependency unit. New wards for cardiology and cardiac surgery patients are adjacent to coronary care, operating theatres and new catheter laboratories.

All trainees spend 3 months in the cardiothoracic module at the BRI usually during intermediate training in years ST3, 4. They can return during advanced training to gain further training and experience, including echocardiography. Theatre time is spent on cardiac and thoracic lists with direct supervision by consultant anaesthetists. Cardiac intensive care is covered by a registrar anaesthetist with a consultant based in the unit all week and another dedicated to cardiac patients on call overnight and at weekends. The rota is a shift pattern for eight junior doctors; six registrars in training and two cardiac fellows. Weekly teaching sessions are provided by Consultants, project work and audit is encouraged and an academic evening is held for trainees and consultants during each module.

Cardiac Fellow posts are available for one year and can fom part of a training programme with appropriate prospective recognition. They are especially suitable for senior rainees or those with recent CCT, who would like to pursue a career in cardiothoracic anaesthesia and intensive care. For more information on our cardiac fellow posts please contact Dr Sally Tomkins via the Department of Anaesthesia, tel no 0117 342 2163 or email Dr Ian Ryder who is the lead clinician fo cardiac anaesthesia.

Obstetric Anaesthesia

St Michael’s Hospital, Bristol

A three month obstetric module at St Michael’s Hospital, part of the University Hospitals Bristol NHS Foundation Trust (UHB), is available for senior trainees wishing to pursue an interest in obstetrics. The labour ward sees 5000 deliveries a year and has a 25% epidural rate. It is a tertiary referral centre for complex maternal and neonatal care. This includes complex cardiac disease.

As well as the potential to develop research/audit interests, there is the opportunity to attend management meetings including CDS working party and St Michael’s clinical governance meetings. There are also opportunities to develop an interest in teaching by becoming involved in the Emergency and HDU Study days, and midwifery, obstetric and medical student updates.

During daytime hours the senior obstetric trainee is part of the obstetric anaesthetic team, along with a junior trainee and consultant covering labour ward and the elective Caesarean sections. After 5pm, the junior obstetric trainee covers labour ward, and the senior obstetric trainee joins the 2nd on call rota which covers general theatres across the UHB precinct as well as obstetrics.

For more information or if you wish to express an interest in doing the module please speak to Dr Mark Scrutton.

Royal United Hospital, Bath

An advanced obstetric module has recently been set up at RUH, Bath. There are clinical as well as teaching, audit and research opportunities in obstetric anaesthesia. The unit sees 5000 deliveries per year and has a 19% epidural rate.

For more information or if you wish to express an interest in doing the module please speak to Dr Jenny Tuckey.

Paediatric Anaesthesia

The advanced paediatric training consists of six month slots comprising:

two months general paediatric anaesthesia
two months paediatric cardiac with PICU on call
two months PICU

You must be in year ST5 or more at the start of the module and you must have completed the module before your expected CCT date.

Please note that there is a limit on how much time you can spend training in any one subspecialty. Therefore, if you plan to do a paediatric year abroad these local slots may not be for you. Please discuss with the programme director.

The one year training at Great Ormond Street is also good and is advertised from time-to-time. That covers all areas of paediatric anaesthesia and is treated as an interdeanery secondment from the paperwork point of view.

Pain Medicine

Pain medicine incorporates acute, chronic and cancer pain. It is an core part of the anaesthesia curriculum at basic and intermediate levels. For those who wish to subspecialise in pain medicine there are optional higher and advanced modules available.

Basic (CT1/2) – core
Intermediate (ST3/4) – core
Higher (ST5/6/7) – optional 3 months
Advanced (ST6/7) – optional 12 months (after completion of higher module)

For training objectives at each level see the CCT in Anaesthetics [2010 Curriculum] in the training section of the Royal College of Anaesthetists website. For current senior trainees still on the 2007 curriculum theirs is also in the training section of the college website.

For more information, please see the website for the Faculty of Pain Medicine of the Royal College of Anaesthetists.

Pain Medicine – Basic and Intermediate

Local minimum standards

Basic CT1/2

4 acute pain rounds and 2 chronic pain teaching clinics each year
Start pain medicine logbook – keep throughout training (to download the logbook click the link below)

Intermediate ST3/4

10 chronic pain clinics as module (plus acute pain rounds)
At least one session should be a procedure list
Experience of acute pain, postoperative analgesia as well as regional anaesthetic and other analgesic techniques will be gained outside of the formal pain module

Pain Medicine – Higher and Advanced

Higher ST5/6/7

Optional 3 months
Essential for all trainees who wish to progress to advanced pain medicine training
Recommended for trainees considering a future consultant post with an interest in acute pain medicine

Advanced ST5/6/7

Advanced Pain Medicine training in ST5/6/7 is available within the Bristol School
Trainees spend six months at Frenchay and six months at either Cheltenham/Gloucester, Bath or BRI
All advanced pain medicine trainees become members of the Pain Faculty of the Royal College of Anaesthetists

For more information download the Advanced Pain Medicine training handbook and the Advanced Pain Medicine training logbook from the Faculty of Pain Medicine, Royal College of Anaesthetists website.

If interested in advanced training please inform both Ted Rees (Anaesthesia Specialty Programme Director, based in Cheltenham) and Mark Taylor (Pain Medicine Regional Adviser, based in Plymouth) of your intentions, as early as possible.

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