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Oxford University Hospitals NHS Foundation Trust
Anaesthetic Fellowships

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Paediatric Anaesthesia

Welcome to the wonderful world of paediatric anaesthesia, a sensitive vulnerable group, but enough about us. Our aim is for you to acquire confidence and hopefully an appreciation that anaesthetising children is no more or less difficult than anaesthetising adults. Whisper it quietly but in anaesthetic terms most children over 2 years are small adults in terms of physiology and pharmacology but without all the comorbidities of age. You will only achieve this goal with sufficient exposure to enough paediatric cases.

Experience

Training in paediatric anaesthesia is provided principally in the West Wing of the John Radcliffe Hospital. During the module, trainees can expect be involved in providing anaesthesia for children of all ages including neonates for a variety of surgical and diagnostic procedures both in theatres and on remote sites.

At the end of your module you should have achieved your core clinical learning outcomes including:

  1. Appropriate level of confidence in providing anaesthesia to children across different age groups and for a wide variety of paediatric procedures
  2. An ability to resuscitate and stabilize sick children appropriate to your level of training prior to transfer to a specialist centre
  3. Develop decision making and organisational skills required to safely manage paediatric surgical/procedural cases and sessions
  4. To communicate compassionately and effectively with children and young people, their carers and other members of the multidisciplinary team
  5. Provide teaching to less experienced colleagues of all grades
  6. Most importantly, ASSUME NOTHING AND TRUST NOBODY.

Consultant Trainers

Training in Paediatric Anaesthesia is principally provided by the Consultants in the Paediatric Group, but also by other Consultants with a paediatric interest.

  • Dr Claire Ansley-Watson
  • Dr Simon Berg (Coordinator for Higher and Advanced Module Training)
  • Dr Stewart Campbell
  • Dr Arnie Choi (Clinical Lead for Paediatric Anaesthesia)
  • Dr Sumit Das (Coordinator of Paediatric Anaesthesia Fellowship)
  • Dr Karen Medlock
  • Dr David Mason (Clinical Lead for ChIMPS)
  • Dr Kim Ng (Coordinator for Intermediate Module Training)
  • Dr Richard Rogers (Clinical Lead for Clinical Governance)
  • Dr Chandrika Sathasivam
  • Dr Tim Whittington*
  • Dr Rebecca Wilde

* Daytime sessions in Paediatric Intensive Care

Geography of the Children’s Hospital

The Oxford Children’s Hospital (CHOX) is located adjacent to the West Wing. On Level 1, there are:

  • Children's Day Care Ward (CDCW)
  • Tom's Ward - General surgical and orthopaedics
  • Robin's Ward - Specialist surgery; and TDA

Wards on Level 0 are:

  • Melanie’s Ward - Adolescents
  • Kamran’s Ward - Haematology and oncology
  • Bellhouse-Drayson Ward - Medical

LG1 has radiology, community paediatrics and the outpatient facilities. The paediatric critical care (PICU and PHDU) are located on Level 1 at the JR next to the Emergency Department.

Paediatric theatres on Level 1 comprise of:

  • Theatres 13 and 14 - General surgery and urology
  • Theatre 10 - Orthopaedics
  • Theatre 8 - Neurosurgery

On Level 0, paediatric patients crop up regularly on mixed specialist surgical lists:

  • Theatre 1, 2 and 3 - Craniofacial, cleft, and plastics
  • Theatres 4 and 5 - ENT
  • Theatres 6 and 7 - Ophthalmology

Paediatric lists also occur on remote sites including CT (West Wing), MRI (JR and the West Wing), paediatric radiology (LG1), endoscopy (CDCW) and haem-oncology (Kamran’s Ward). Scoliosis surgery occurs in the JR Theatre 2. There are also two regular weekly consultant-led paediatric pain rounds (Wednesdays and Fridays).

Emergencies

There is a significant emergency out of hour’s workload for all West Wing surgical services. Oxford is the regional centre for neonatal surgery and paediatric neurosurgery in addition to all local paediatric emergencies that can occur across the various surgical specialties.

Training in paediatric anaesthesia requires exposure to an adequate number of cases and practical procedures; and it also requires a careful pre-operative assessment which includes establishing a rapport with both the child and the parents. To ensure that advantage is taken of all opportunities to achieve the required case-mix and experience, consultant trainers may on occasion move trainees to more valuable teaching lists.

In addition to clinical experience, trainees will also have the opportunity to undertake quality improvement projects and take part in the journal club.

What should Fellows achieve during their Fellowship

Advanced training in paediatric anaesthesia should be delivered in a designated specialist centre undertaking a wide variety of complex elective and emergency paediatric procedures, with the necessary associated paediatric critical care facilities. This Paediatric unit is designed for those trainees who wish to be paediatric leads in the DGH environment (6 months) and those trainees who wish to specialise as paediatric anaesthetists in a tertiary centre (12 months).

By the end of the Fellowship, the Fellow should be able to demonstrate:

  • Competency in practicing anaesthesia post-CCT with a special interest in paediatric anaesthesia as a consultant with specific responsibility for paediatric anaesthesia. This implies ability to:
    • Gain mastery in the delivery of safe and effective perioperative / peri-procedural anaesthetic care to a wide-range of paediatric surgery / procedures including those with complex co-existing disease
    • Gain mastery in the management of such cases, and the critically ill child when needed, and in doing so demonstrating the necessary multi-disciplinary leadership, communication and team-working skills necessary to ensure the care delivered benefits both the patient and the organization
    • Gain maturity in understanding the importance of utilising the time allocated to paediatric clinical sessions effectively, optimising throughput whilst not compromising patient safety
    • Communicate compassionately and effectively with children and young people, parents and other carers throughout the surgical episode, and also communicate effectively within the multi-disciplinary paediatric team
    • Gains the necessary maturity to guide the choice of audit cycles in developing practice within this subspecialty area and understands the legality of consent in children and young people, in relation to research, restraint and procedures
    • Becomes familiar with recent developments in perioperative anaesthetic care to this area of practice, to evaluate these developments and to advise colleagues of useful changes in practice
  • Knowledge of the drivers for the provision of paediatric services in the DGH [National Service Frameworks etc.]

For the Paediatric specialist in a Tertiary centre, in addition to the above:

  • To be capable of practicing post-CCT anaesthesia as a consultant paediatric anaesthetist in a specialist paediatric hospital or tertiary referral centre. This implies ability to:
    • Gain mastery in the delivery of safe and effective perioperative anaesthetic care to a wide range of complex paediatric surgical cases, including the very premature sick neonate and those children with complex co-existing disease. The precise skill mix required will depend upon the nature of the post and may or may not include patients undergoing cardiothoracic or neurosurgery.
  • Knowledge of the drivers for the provision of paediatric services in the tertiary centre

Sources of information

Protocols and Guidelines

There are protocols, guidelines and ‘room tips’ for paediatric lists on the intranet. There are also a number of books and journals in the paediatric section of the NDA. Please feel free to use them.

Recommended Reading

Paediatric & Neonatal Anaesthesia: Anaesthesia in a Nutshell,

By Ann Black MB BS DRCOG FRCA, Angus McEwan MBchB FRCA

This is an excellent and up to date book and is essential reading for all trainees. It is comprehensive without being too long. There are other short handbooks on the market, but this is by far the best.

Oxford Handbook of Anaesthesia: Section on Paediatric Anaesthesia

Comprehensive and very well written

The Literature

The following journals are sources of excellent review articles on various aspects of paediatric anaesthesia:

BJA Pediatric Anaesthesia Anaesthesia

The Association of Paediatric Anaesthetists

Interested trainees should consider joining our sub-specialty association.

The Web

In addition to the RCA e-learning website, the websites of the following organisations contain important guidelines and recommendations:

The Association of Paediatric Anaesthetists (APA) The Association of Anaesthetists (AAGBI)

APA Virtual Patients and Hot Topics

Virtual patients are interactive cases that have been developed by members of the education and training committee to support members in gaining or refreshing the knowledge base required for revalidation against the Level 2 CPD matrix (continuing professional development matrix). ‘Hot Topics’ provides an interactive poll and discussions around topical and controversial areas of paediatric anaesthesia.

Contact

Dr Sumit Das Head of Paediatric Anaesthesia Fellowship Programme Email: sumit.das@ouh.nhs.uk