Obstetric Anaesthesia Clinical Fellowship
Department of Perioperative Medicine
Coombe Women and Infants University Hospital
Hospital Details
Founded in 1826 CWIUH is one of the largest providers of women and infant healthcare in the Republic of Ireland with approximately 8,500 births annually. It offers highly specialized care for both low and high-risk obstetrical patients in a state-of the-art 16-bedded delivery suite with a fully equipped obstetric operating theatre and high dependency facilities. It is also provides gynaecology procedures to more than 4000 women a year, with a large ambulatory component (70%). The fellow will be exposed to a high volume of complex elective and emergency obstetric and gynaecology cases and procedures.
SYNOPSIS OF ACTIVITY (2020):
8,020 deliveries
Epidural rate: 41.6%
Caesarean section rate: 34%
3,355 obstetrical operations
5,424 gynaecological operations
Supervisors
The fellow will join a team of 7 consultants who oversee the activities of the department aiming to maximise the opportunities for learning by providing a broad range of experience in a supportive environment. Each member of the department has specific sub-specialist interests. The department director Dr Steven Froese, and college tutor Dr Stephen Smith will oversee and supervise the fellowship program.
Duration
12 months fixed term with a possibility of renewal of the post for a further year depending on the educational goals of the fellow.
Grade
This fellowship is designed for anaesthesiologists who have completed an approved anaesthesia-training program or a SAT year 7 trainees as a fellowship year. The candidate is expected to have completed basic training in obstetric anaesthesia. The program will equip graduates who will be planning a career in Obstetric Anaesthesia or for a post with a large obstetric commitment.
Aims of fellowship

• Acquire specialized skills, clinical judgement, and knowledge required to provide safe, evidence based antenatal and peri-partum care for women with or without associated medical conditions.

• To provide a foundation for effective collaboration in a multidisciplinary team for antenatal and peripartum care.

• Acquire skills and knowledge to manage acute, and chronic pain conditions during pregnancy and in the peri-partum period.

• Develop as a clinical leader.

• Develop as a clinical teacher

• Gain familiarity with research methods and carry out a research project.

• Gain familiarity with quality improvement (QI) methods and carry out a QI project

Clinical Activity
To develop clinical skills and expertise in managing a wide variety of elective and emergency obstetric and gynecologic cases and to personally develop gaining experience, skills and maturity to manage patients and collaborate with team members in preparation for a consultant role.
OBSTETRIC ANAESTHESIA & ANALGESIA
The fellow will be an integral member of the team and will have the opportunity to rotate through the delivery suite, obstetric high-dependency unit (HDU) and obstetric theatre. The fellow will also participate in a 1:5 in house on-call rota. The learning objectives are:

• Demonstrate proficiency in a range of neuraxial blockade techniques such as spinal anaesthesia, epidural, combined spinal epidural (CSE).

• Demonstrate proficiency in ultrasound scanning for neuraxial blockade.

• Demonstrate appropriate evidence-based care for the critically ill parturient.

FETAL-MATERNAL MEDICINE
The fellow will join a multidisciplinary team (MDT) to provide collaborative antenatal and peripartum care of a wide variety of parturients with medical disorders such as cardiac disease, haematologic and coagulation disorders, morbid obesity, diabetes and polysubstance abuse along with parturients requiring routine obstetric anaesthesia care. Clinical activity of the fellow will include:

• Weekly antenatal combined clinic with Fetal Maternal specialists, Haematologist, Cardiologist, and Renal physicians.

• Monthly MDT meetings where treatment plans are discussed.

• Peripartum care of all parturients under the care of the MDT team.

PAIN MANAGEMENT
The department of perioperative medicine provides support and assistance in the management of pain during pregnancy and in the peripartum period. The fellow will be involved in the following activities:

• Ward rounds managing post-delivery pain and acute pain after gynaecological surgery.

• In-patient pain consults for pain during pregnancy

• Outpatients’ women’s pain clinic.

FUSIC HEART ACCREDITATION
The fellow will also gain Focused Ultrasound in Intensive Care Society (FUSIC) heart accreditation. FUSIC heart is endorsed by both the British Intensive Care Society and the Joint Faculty of Intensive Care Medicine in Ireland (JFICIMI). Training in ultrasound will be provided in collaboration with St James’s Hospital.
Didatic teaching
The fellow will be expected to partake fully in the following didatic teaching sessions:

• Twice-weekly departmental CEPD academic activity that take the form of didactic sessions, journal clubs, case-based discussions and clinical debates.

• The fellow will also be encouraged to attend other relevant obstetric meetings that occur in the hospital in order to gain an understanding the interdisciplinary approach to the management of high risk parturient.

• To participate in a bi-monthly review of department activity and morbidity.

Research
The department has an extensive research portfolio and proven track record in publishing peer reviewed research in both the clinical and scientific arena. Current areas of interest include:

• Ultrasound-guided neuraxial analgesia and anaesthesia

• Acute and chronic childbirth pain

• Enhanced recovery after caesarean section

• Haemodynamic and cardiac index changes during labour, delivery and caesarean section

• Medical Education

• Virtual pre-operative assessment

• Consent in obstetric anaesthesia

In collaboration with our academic partner, University College Dublin (UCD), the fellow will join The UCD Centre for Human Reproduction as an Honorary Lecturer and Researcher. There is also opportunity for translational research collaborating with science departments of UCD. The fellow will be supported in any endeavors to establish or continue ongoing research projects and will be encouraged to present findings at national and international meetings.
Medical education
The department strives to provide a supportive and safe learning environment emphasizing on a collaborative approach to learning where trainees learn while also developing personally and professionally. There is also a strong emphasis on the development of the non-technical skill in this setting. The fellow can develop as a medical teacher with the following learning goals:
CLINICAL TEACHING & TRAINING

• Engage in the design and content (with specified learning outcomes) of obstetric anaesthesia clinical teaching programme.

• Opportunity to improve and refine teaching skills through a variety of strategies such as peer observation of teaching, cased based teaching; problem-based teaching and in-situ simulation training.

• Participate in multidisciplinary teaching and skills training.

• Develop an appreciation of the role of assessment in the clinical environment and refine feedback provision skills.

EVALUATION AND RESEARCH

• Design and administer trainee evaluation of the teaching and learning environment to feed into the continuous improvement of clinical learning environment.

• Engage in formal evaluation of hospital multidisciplinary team training.

• Participate actively in the design and execution of educational research e.g. acquisition of clinical skills (through application of leaning theory), feedback practices and multidisciplinary team training.

Non-Clinical Activities
There will be training opportunities in hospital management such as patient safety, quality improvement projects, clinical governance, and participation in hospital committees.
QUALITY IMPROVEMENT INITIATIVES
Working under the supervision of the director, the fellow will formulate and implement quality improvement initiatives in the clinical workplace. The learning objectives are:

• Analyse the need for change and opportunities for improvement
• Lead, develop and implement an improvement project in the workplace
• Put the theory of quality improvement into practice
• Recognise what change management is and how to lead change in a healthcare setting
• Motivate teams and improve quality through team based initiatives
• Understand how to engage with patients and implement theories of patient-centred care
• Sustain change and quality improvement

02.09.2024