Initial Phase of training (ST1 &ST2)
The initial phase of training will consist of an indicative period of two
years. These two years will in turn consist of four modules, each of 6 months.
Depending on circumstances the following modules will be available:
- Critical Care and Post Operative Management
- Cardiac Surgery
- Thoracic Surgery
- Cardiology
- Thoracic Medicine
- Vascular Surgery
- General Surgery
The content for the speciality specific modules is defined in detail in the
syllabus. The aims and levels of competence to be attained at this stage are
defined for each module
The purpose of the initial stage is for the trainee:
- To acquire experience in the management of a post surgical patient on
the critical care, high dependency and post operative wards. To be able to
manage, with appropriate supervision, such a patient.
- To gain experience in aspects of the management of a cardiac surgical
patient. This includes operative management as appropriate and with
supervision.
- To gain experience in the evaluation and management of a patient
undergoing thoracic surgery. Includes operative management with
supervision where appropriate
- To gain experience in the practical applications of cardiopulmonary
bypass, myocardial protection and circulatory support. To understand the
science and technology that underpins these disciplines
During this stage the trainee will be gain competence to the defined level
in a number of technical skills and procedures for example:
- Use of defibrillator
- Use of intra aortic balloon pump
- Echocardiography including TOE
- Arterial and central venous cannulation
- Cannulation and institution of cardiopulmonary bypass
- Weaning from bypass and decannulation
- Femoral cannulation and decannulation
- Pulmonary artery catheterisation
- Intra aortic balloon pump insertion, timing and management
- Tracheostomy
- Fibreoptic rigid and flexible bronchoscopy
- Chest aspiration, chest drain insertion, chest drain management
- Saphenous vein harvest
- Median sternotomy
- Mammary/radial artery harvest
- Preparation for and management of cardiopulmonary bypass
- Proximal aortovenous and distal coronary anastamosis
- Heart valve replacement
- Surgical re-exploration for bleeding or tamponade
- Perform and repair thoracic incisions, including lateral, anterior,
muscle sparing and VATS incisions
- Endoscopic and surgical techniques used in lung biopsy
- Surgery for benign and malignant conditions of the lungs, including
uncomplicated lobectomy for lung cancer, wedge resection and
metastasectomy
- Intraoperative diagnosis and staging
- Open operation for uncomplicated pleural problems e.g. pneumothorax,
effusion, haemothorax including drainage, biopsy, pleurodesis and
pleurectomy
- VATS procedures for uncomplicated pleural problems e.g. pneumothorax,
effusion, haemothorax including drainage, biopsy, pleurodesis and
pleurectomy
- Open and VATS procedures for empyema, including techniques for
decortication
- Median sternotomy open and close
ST1 Attachment in Cardiothoracic Surgery
Purpose
The purpose of the cardiothoracic surgery attachment is to enable the
trainee to:
- Acquire experience in the management of a post surgical patient on the
critical care, high dependency and post operative wards.
- Gain experience in the evaluation and management of a patient undergoing
cardiac surgery.
- Gain experience in the evaluation and management of a patient undergoing
thoracic surgery.
During the attachment it is expected that the trainee will cover the
following (further detail is found in the syllabus)
Knowledge
- Knowledge of the basic sciences underpinning the cardiovascular and
respiratory systems
- Familiarity with the clinical features and management of the following
commonly occurring cardiothoracic conditions:
- coronary artery disease
- valvular heart disease
- lung cancer
- pneumothorax
- Understanding of the principles and consequences of cardiopulmonary
bypass
Clinical Skills
- Clinical assessment and management of preoperative, postoperative and
critically ill patient
- Analysis and interpretation of investigations, including specific
diagnostic tests.
- Critical care management including recognition, evaluation and treatment
of haemodynamic and ventilatory abnormalities.
- Familiarity with the management of multiorgan failure
- The management of chest trauma (ATLS)
Technical Skills
Practical Skills
- Chest drain insertion and management
- Central venous, arterial and pulmonary artery cannulation
- Tracheal intubation
Operative skills
- Basic surgical skills – dissection, suturing, knots etc
- Saphenous vein harvest (CL3)
- Median Sternotomy (CL2)
- Perform and repair thoracic incisions (CL2)
- rigid and flexible bronchoscopy (CL2)
- Develop the ability to function as a competent assistant at commonly
performed cardiothoracic operations including CABG, valve replacement,
lung resection and VATS procedures