Advanced Fellow in Adult ICM with an interest in ECMO

You will become a key member of a highly skilled multi-disciplinary team providing adult intensive care services and gaining valuable experience in the following key areas:

o Air and Road Transport of patients with Severe Respiratory Failure including mobile ECMO.

o Initiation and ongoing management of patients on veno-venous and veno-arterial ECMO o Management of surgical and medical Cardiothoracic intensive care patients - elective and emergency

o Trans-thoracic and trans-oesophageal echocardiography, lung ultrasound.

o Advanced ventilatory techniques - including prone positioning, the use of nitric oxide, APRV and selective lung ventilation.

o The use of a variety of vasoactive drugs, pulmonary artery catheter and intra-aortic balloon pump for cardiac output monitoring and mechanical circulatory support.

o Competence in key practical skills including percutaneous tracheostomy, ECMO cannulation and decannulation, bronchoscopy, intercostal drain insertion and central venous and pulmonary artery catheter insertion for drug delivery, renal support and invasive haemodynamic monitoring.

o Opportunity and support for national presentations of audit / data / research.

This is an exciting opportunity for a dynamic and ambitious individual to further develop key critical care medicine skills in the provision of advanced respiratory care including ECMO and transport of the critically ill adult and work in a leading cardio-thoracic intensive care unit.

1. Day to day care of Adult intensive care patients

You will become a key member of a highly skilled multidisciplinary team (including ECMO consultants, intensivists, AICU nurses, ECMO specialist nurses, perfusionists, cardiothoracic surgeons and anaesthetists, pharmacists, physiotherapists, dieticians, radiologists and radiographers) providing advanced respiratory and cardiovascular critical care support including ECMO (both veno-venous for respiratory support and veno-arterial for cardio/cardiorespiratory support) and inhaled nitric oxide in adult patients. Within the role there is opportunity to become competent in a number of invasive procedures including ECMO cannulation and decannulation, percutaneous tracheostomy, bronchoscopy, central line insertion for drug delivery, renal replacement therapy and invasive monitoring and chest drain insertion.

2. Transport of patients

You will be part of our established transport team, and you will gain experience in transport of critically ill patients by road and by air (when possible). You will liaise with referring hospitals regarding retrieval and repatriation of patients. This will include both short trips within UHL and the local network and transport of patients to and from hospitals anywhere in the United Kingdom. The transport of patients with Severe Acute Respiratory Failure will be achieved by conventional means, with the possible addition of inhaled Nitric Oxide and in prone position. The most unstable patients and those in whom their current treatment cannot be replicated in the ambulance/aircraft will be transported on mobile ECMO. Initially all transfers of patients referred with Severe Acute Respiratory Failure (SARF), whether conventional or mobile ECMO retrievals will be undertaken under the supervision of an ECMO consultant. During the post you will be expected to gain experience and confidence with independent transfers of critical care patients with increasingly complex needs. Fellows will aim to undertake independent conventional retrievals of SARF patients and intra-hospital transfer of ECMO patients by the end of the attachment.

3. Training in ECMO

You will be expected to undertake our ECMO specialist training programme and we guarantee a place on our popular ECMO specialist course. You will attend daily ECMO ward rounds with the resident ECMO consultant, ECMO co-ordinator and specialists. There will be an opportunity to participate and deliver ECMO simulation for clinicians, ECMO specialists and nursing staff utilising the ECMO simulator.

4. Audit, research and teaching

There is an active programme of audit and research, and you will be expected to participate in data collection and analysis - the post holder will undertake a supervised project in the field of ECMO. There are opportunities to present data at local, national and international meetings. The post holder will be responsible in the organization and delivery of a local journal club to the trainees on the unit, present ECMO cases of interset during the ECMO MDTs and participate in the ECMO Fellow teaching programme.

5. Assessment

Each Fellow will be assigned an educational supervisor and will have an initial meeting to discuss educational goals and set a personal development plan for the attachment. Thereafter meetings will be held every 3 months. ECMO specialist training involves attending the theoretical and simulation based course, 40 hours of preceptorship and a written exam. Fellows will be expected to keep a reflective log of all transfers undertaken. ICM Workplace based assessments will be completed to demonstrate practical skills (DOPS and mini-CEX) and each Fellow will be expected to complete adequate breadth and quality of assessments during the post, to allow ECMO trainers to make valid judgements of the doctors performance across all areas of the ECMO curriculum. For those trainees in recognised ICM training posts who wish to undertake the ECMO module as part of their specialist skills year (SSY), assessment will be as above plus documentation of assistance at 10 ECMO cannulations and decannulations and 10 inter- and intra-hospital ECMO transfers and completion of an audit or service improvement project with national publication (in accordance with the FICM SSY ECMO curriculum)

6. On-call duties

On-call commitments are split - 50% providing cover for the unit (resident, 1 in 7) and 50% for ECMO and Severe Respiratory Failure work (supernumerary and non-resident, 1 in 8) with defined rest periods. All daytime on-call duties will include support to the resident on-call staff.

Our new strategy, 'Leading in healthcare, trusted in communities' was developed with the support and feedback of colleagues, patients, and partners and is our compass for the next seven years (2023-2030).

• high-quality care for all,
• being a great place to work,
• partnerships for impact, and
• research and education excellence

And we will embed health equality in all we do - taking active steps to reduce the avoidable differences in healthcare that some people face, working in partnership with communities.

Our strategy is underpinned by new values and we will work to ensure they are an everyday reality for all:

• we are compassionate,
• we are proud,
• we are inclusive, and
• we are one team

This is an exciting moment as we look to the future with clarity on what we already do well and where we need to focus our energies to make an even bigger difference for the people we serve.

training and experience:

Essential: - Full GMC registration; - Completion of stage 1 and part of stage 2 ICM training or overseas equivalent; - 36 months ICU experience; - Final FFICM examination Multiple Choice Question (MCQ) examination or equivalent; - Primary FRCA or full MRCP, MRCEM examination or equivalent; - ALS

Desirable: - Completion of stage 2 and/or 3 ICM training or international equivalent; - FFICM; - Prior experience in transfer of the critically ill, completion of a transfer training course; - Prior experience in cardiothoracic intensive care and / or caring for ECMO/SARF patients; - Full FRCA examination or equivalent

Essential: - Evidence of teaching at an undergraduate or post graduate level

Desirable: - Certification Course/Diploma/Masters in Medical Education

Essential: - Understanding of research methodology

Desirable: - Medical publications or a background of research activity

Essential: - Understanding of the NHS, its strategy and current issues

Desirable: - Management training

Essential: - Clear, fluent and articulate in verbal and written presentation

Desirable: - Leadership skills