Perioperative Medicine Provisional Fellowship 2018

The Westmead Anaesthetic Department offers a one year Perioperative Medicine provisional fellowship which has been accredited by ANZCA. This position has been available since 2015 and is currently limited to 1 fellow per year.

Perioperative medicine is an area of expansion in Anaesthesia as our patients become increasingly complex. As we proceed, anaesthetists will gradually change from being primarily involved in preoperative assessment and intraoperative care to becoming involved in the care and management of the surgical patient from decision for surgery to the postoperative period. This new concept is called the ‘Perioperative Surgical Home’. This fellowship is for provisional fellows (PF) to enhance their skills in this area.

The PF will be exposed to a wide range of theatre lists which are likely to contain high risk patients or lists with major complex surgical cases. These include major trauma and orthopaedic surgery, complex general surgery, transplant surgery, neurosurgery, spine surgery, complex endocrine surgery and surgeries involving difficult airway management.

In addition, the PF will gain vital experience in the perioperative optimisation and management of patients by undergoing internal medicine training one day a week. The medical specialities on offer include Cardiology, Respiratory Medicine, Geriatrics (specifically orthogeriatrics and trauma geriatrics), Renal and Transplant medicine. These are three monthly rotations. There will be opportunity to gain skills in echocardiography and to observe real-time pre-operative testing including exercise stress tests, CPET, sleep studies, respiratory function testing, etc.

The PF will also be allocated to the high risk anaesthetic clinic with one of the perioperative anaesthetic consultants, one day a week. The surgical teams refer high risk patients to this clinic not only for pre-operative optimisation but rely on our assessment to decide whether surgery is suitable for their patients. This is an excellent opportunity for the trainee to be able to explore the patient’s medical, surgical and social issues and be a key member of the perioperative team. If surgery does go ahead, the PF will most likely be allocated to that patient’s list on the day and will have the opportunity to follow-up the patient in the post-operative setting, liaising with the surgeons and medical teams for optimum care of the patient.

During their non-clinical time, trainees will be part of ongoing perioperative medicine research projects including audits, RCTs, etc. These will be overseen by consultants with an interest in perioperative medicine and research.

By the end of the clinical year, the trainee will be highly proficient in the art and science of the care of the high risk surgical patient. They will have been given the opportunity to make an impact in the patient’s journey from pre-operative optimisation, to safely anaesthetising them for their procedure and then caring for them in the immediate post-operative period. These skills and knowledge will be invaluable in their future practice.

- Madhav Pendyala

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