Out of Programme – experiences

I had a fantastic year at Royal Pert Hospital (RPH). I completed advanced training in major general and orthopaedics and regional. I also undertook a research fellowship where I recruited patients to trials and wrote a book chapter on recent research into diabetes which was published. This experience really developed my research skills and enabled me to become principal investigator for a trial in my current consultant role.

RPH is a tertiary major trauma center. Highlights of the year included extensive experience of managing major trauma patients. Often these patients had much more significant injuries than I had come across in the UK due to the fact that a lot of patients do not wear seatbelts.

Excellent teaching and experience in regional anaesthesia with a consultant on duty for regional each day and the opportunity to perform many blocks under supervision in the regional block bay.

Excellent opportunity to improve airway skills with many airway lists with patients requiring awake fibreoptic intubations. A specific airway fellowship is available where you are allocated to these lists most days.

You will come across lots of extremely sick patients flown in from remote areas of Australia often with many unmanaged co-morbidities, presenting very late, providing great clinical experience. I returned to ST7 in Wessex much more confident with increased clinical and leadership skills.

Hospital Name/Location: Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

Clinical experience gained:

The Red Cross Hospital is the tertiary referral centre for children across all the southern African counties and as such accommodates all surgical specialties including complex congenital cardiac disease, neurosurgery, trauma, oncology, Ear Nose & Throat (ENT), maxillofacial, general and urological surgery. All children from birth to 13-years of age are treated. The hospital theatres are very modern as it has a large amount of charitable funding but the patients are often from the poorest regions of Africa and as such have advanced, previously untreated disease.

I worked for 3-months as a registrar on the full oncall rota. I was well supported for complex cases but also pushed to take responsibility for routine daytime and emergency out of hours work. My confidence as such on returning to the UK far exceeded that of my grade.

Highlights of work:

Watching the sunrise over Table Mountain every morning through the theatre windows. Working with some inspiring anaesthetists to deliver high quality care to those in most need.

Outside work opportunities/challenges:

Cape Town is an amazing city, which offers everything from hanging out with penguins, climbing then abseiling off Table Mountain, kite surfing, shark cage diving to sampling the vineyard highlights of Stellenbosch and Franschoek.

Hospital Name/Location: Sunnybrook Hospital, Toronto, Canada

Clinical experience gained:
Variety of cases from Endovascular aneurysm repair (EVAR), Hepatopancreaticobiliary (HPB), Neuro, spine, burns, orthopaedics.
All solo with local supervision.
No Operating department practioner (ODP) so time management important including preparation of cases.

Highlights of work:
Improved confidence with independent management of cases, essentially working as a junior consultant
Teaching trainees
Learning different techniques
Improving regional skills
Dealing with trauma laparotomy, major trauma patients
Acute pain cover

Hospital Name/Location:  Vancouver General Hospital (VGH).  The hospital is run by Vancouver Coastal Health (VCH – local health authority) and the fellowship is overseen by the University of British Columbia (UBC).

Clinical experience gained: I did the General Clinical Anaesthesia Fellowship so rotated through HPB, spines, vascular, colorectal, urology, gynae, max-fax/airway, trauma. I completed advanced trauma, HPB and general/uro/gynae. I completed higher vascular, POM, orthopaedics, airway, cardiac – I asked to do this here as an extra.

To supplement advanced trauma I spent a month with the trauma surgical service so attended trauma calls, ward rounds, outpatients etc.

In the course of the year I did 397 cases, 150 arterial lines, 50 thoracic epidurals, similar number of central venous catheter (CVCs) and around 30 upper limb blocks.

In addition to the General Clinical Anaesthesia fellowship VGH support fellowships in cardiac, neuro and peri-operative medicine.

University of British Columbia (UBC) also provide fellowships in obstetrics, paediatrics and regional at other centers in Vancouver. All information can be found on the UBC website.

Highlights of work: Lots of big cases and a real emphasis on your training and education. The fellowship came with an academic day every week for SPA/teaching/sim/research etc. I learnt so much this year and really prepared me well for independent practice. No nights or weekends either – a real bonus.