Aortic Fellow

This is an exciting opportunity to join the Thoracic Aortic Aneurysm Service within Cardiac Surgery at Liverpool Heart and Chest Hospital and gain experience of complex thoracic and thoracoabdominal aortic surgery. The service in integrated with Vascular Surgery through Liverpool Vascular and Endovascular Service (LiVES) and Liverpool Cardiovascular Surgery (LCS).

The position is entirely based within the Thoracic Aortic Aneurysm Service with no obligation to the general cardiothoracic middle grade on-call system, clinic cover or theatres. The post is initially for a 6-month period with a potential for extension to 12 months, after review and mutual agreement.

As the largest single site specialist heart and chest hospital in the UK, we, at Liverpool Heart and Chest Hospital, have a clear vision 'to be the best cardiothoracic integrated healthcare organisation'.

We provide specialist services in cardiothoracic surgery, cardiology, respiratory medicine both in the hospital and out in the community.

We serve a catchment area of 2.8 million people, spanning Merseyside, Cheshire, North Wales and the Isle of Man, and increasingly we receive referrals from outside these areas for highly specialised services such as aortics.

Our reputation for strong performance is important in delivering the best care for our patients and high quality clinical services. This is underpinned by a culture of research and innovation, delivered in modern estate and our encouragement of flexible working in a variety of forms.

**Programme of learning**:
Capabilities in Practice (CiPs)

The Training Fellowship is designed to produce a person capable of safely and effectively performing Complex Aortic Surgery at the level of an independent clinician in addition to CCT/CESR requirements. Clinicians will become an independent operator in specified Index Procedures at the completion of the Fellowship. A capability is a set of skills that can be developed through training from novice to expert and therefore these high-level clinical outcomes are known as Capabilities in Practice (CiPs).

**The 7 CiPs in relation to Complex Aortic Surgery are**:
1) Manages an outpatient clinic with pre and post-operative Complex Aortic Surgery patients.
2) Manages the unselected emergency take with reference to Complex Aortic Surgery.
3) Manages ward rounds and the ongoing care of inpatients who have undergone Complex Aortic Surgery.

4) Manages an operating list which includes Complex Aortic cases.
5) Manages a multi-disciplinary meeting including patients under consideration of Complex Aortic Surgery.

6) Manages patients within the appropriate area following Complex Aortic Surgery.
7) Assesses surgical outcomes following Complex Aortic Surgery both at a personal and unit level.

Index Procedures

Aortic valve and ascending aortic replacement

Aortic root replacement

Hemiarch replacement

Total arch replacement

Repair of Acute Type A aortic dissection

There is an indicative number of procedures during the Fellowship of 30.

In addition Fellows will also have exposure to many more complex procedures or part procedures which may be undertaken under supervision including valve sparing root surgery, complex redo surgery, descending and thoracoabdominal aortic surgery and endovascular procedures in conjunction with the vascular team.

Critical Conditions

Fellows must be able to demonstrate knowledge and understanding of the management of the critical conditions and complications of Complex Aortic Surgery including competence in the management of acute aortic dissection, aneurysmal disease throughout the aorta and aortic infective endocarditis.

Service Commitment

Fellows will be expected to conduct a daily weekday ward round of aortic inpatients and liaise with appropriate Consultant surgeons, ITU and ward-based teams. The Fellows are responsible for attending and running the weekly aortic clinics, one proximal and one distal. In addition, they organise and run the weekly regional proximal and distal aortic MDTs in conjunction with the aortic administrator.

Fellows will be expected to be involved with emergency aortic referrals on an ad hoc basis out of hours but will receive appropriate compensatory rest periods the following day.

**Audit and research**:
Fellows will have opportunities to engage in routine audit of clinical practice and be involved in research projects.

**Additional information**:
**Annual Leave and study leave**:
**Priorities in theatre**:
Where possible the aortic fellow will have priority over in-house SpRs as operating surgeon or first assistant however compromise may be required to meet the needs of our SpRs with some cases performed by SpRs in part or whole.

**Learning agreements**:
An initial Learning Agreement meeting will occur within two weeks of commencement of the Fellowship where objectives will be agreed in line with those stated above. Multiple Consultant Review at three monthly intervals with ongoing assessment and