Fellowship in Regional Anaesthesia - Plymouth NHS Trust
This is a 6 month - 1 year (negotiable) Fellowship in Regional Anaesthesia at Derriford Hospital, Plymouth.
Derriford hospital employs 66 Consultant anaesthetists, many of whom have an interest in regional anaesthesia. Our well established departments of orthopaedics and trauma, plastics and vascular surgery ensure that there are plenty of opportunities to observe and perform peripheral and central regional blocks.
As a major trauma centre we have many complex patients where advanced regional anaesthesia techniques can make an important contribution to their recovery.
Training and clinical opportunities will be provided in
- Ultrasound guided Peripheral Nerve Block techniques (main focus)
- Peripheral nerve stimulation techniques
- Continuous catheter techniques
- Acute pain applications of RA (e.g chest trauma)
- Service Developments including logistics of running regional lists
There is widespread use of regional anaesthesia throughout the department, predominantly in the busy orthopaedic/trauma and plastic surgical units.
There are 4 elective orthopaedic theatres and a dedicated trauma theatre. All the usual range of elective orthopaedic sub-specialties are represented - lower limb arthroplasty, pelvis, shoulder and upper limb, hand, and foot & ankle. In addition Plastic surgery, with a dedicated plastics trauma session each afternoon, and vascular surgery theatres offer further opportunities for regional techniques. Regional anaesthesia is well accepted and often encouraged by the surgeons. In addition to single shot nerve blocks, catheter techniques are commonly performed for abdominal surgery, amputations, shoulder arthroplasty and chest trauma. The upper limb service has a weekly hand surgery list where awake surgery is the default.
Nearly all our peripheral regional anaesthetic blocks are now performed using ultrasound guidance - 4 machines are available in the main theatre suite alone. Facilities exist to record ultrasound footage for teaching and assessment purposes. Curved array probes are available for neuroaxial scanning. Currently most regional blocks are placed in the anaesthetic rooms prior to surgery.
Several members of the department have a major sub-specialist interest in regional anaesthesia and are active members of local and national regional anaesthetic organisations (RA-UK & SOWRA), and regularly teach on courses at a regional and national level.
The following peripheral blocks are routinely performed within the dept.
Interscalene (+/- catheters)
Infraclavicular (+/- catheters)
Distal forearm blocks
Superficial cervical plexus
Trunk blocks - TAP and rectus sheath (+/- catheters)
PECS and serratus plane (+/- catheters)
Erector Spinae Plane block (+/- catheters)
Sciatic - proximal and popliteal
Femoral & Adductor canal (+/- catheters)
During the fellowship we will endeavour, where possible to place the fellow in lists where RA can be utilised. There will be a mix of accompanied lists where new skills can be acquired and solo lists, where skills can be consolidated. Naturally the majority of lists will be in the specialties of Orthopaedics, trauma or Plastics, but there is the opportunity to spend time in other areas to gain specific skills e.g breast lists, vascular etc.
The RA fellow will participate in the senior-tier on call rota.
Plenty of opportunities exist to audit practice and the applicant will be expected to participate in at least one major audit or QI project.
Fellows are expected to get involved in a clinical research and are encouraged to initiate a project. Funding for projects is available both nationally and locally (South West Regional Anaesthesia group - www.sowra.org.uk). The applicant will be encouraged to present their work nationally and internationally. Successful applicants are encouraged to discuss proposed research projects prior to taking up the post in order to maximise the time available to undertake the clinical aspects of the project.
The Regional Fellow will be expected to supervise junior colleagues on accompanied lists, and to provide ad-hoc regional anaesthetic support and training to other colleagues (both trainee and Consultant) as necessary. In addition they may have the opportunity to participate as workshop faculty on the annual SOWRA regional anaesthesia course. Previous fellows have contributed chapters to resources such as the e-LA platform.
Management and Administration Experience
Fellows are encouraged to develop service improvement ideas related to the regional anaesthesia service.
Other Training Opportunities
Fellows are encouraged to consider formal higher education in the field of regional anaesthesia. Currently there are 2 popular options:
1) The European Diploma (EDRA)- full details are available on the ESRA website.
The EDRA is a popular choice with UK trainees. Within the department we have several EDRA diplomates and an EDRA examiner and so have a good understanding of the requirements of the exam.
2) MSc course - developed in 2012, this distance learning course run by the University of East Anglia aims to place itself as the UK recognised specialist training in regional anaesthesia. Unlike the ESRA Diploma it includes competency based assessment methods that test an individual’s practical ability to deliver RA techniques. This has widespread national support by the UK regional anaesthetic community and has the backing of RA-UK the UK specialist society. 2 members of the Consultant body are tutors on the MSC course and can provide further advice.
Informal enquiries are always welcome – please contact Dr Matt Oldman, Consultant Anaesthetist (firstname.lastname@example.org)
Clinical Supervisor: Dr M Oldman
College Tutors: Dr M Ward & Dr L Alderson
Anaesthetic Service Line Director: Dr D Adams
Service Line Cluster Manager: Mrs J Edge