Training Assessments

The CCS syllabus covers the full range of surgery from neonates to adults, including transplantation and mechanical support. The learning curve is steep as it encompasses an unfamiliar area of practice, learning new terminology and patient pathways, in a new patient group (children).

• Pump meeting – surgical fellows prepare and present concise patient histories with relevant investigative findings at the pre-surgical planning meeting. This normally includes all patients planned for surgery in the following week. This is a valuable self-directed learning exercise in reviewing all available charts, imaging and results for the patient, understanding the patient journey thus far, and the rationale for intervention. At presentation, the fellow can self-assess their understanding by seeing how the MDT reviewed the relevant positive and negative findings. These presentations may be assessed through CBDs.
• Surgical briefing – surgical fellows prepare and present concise patient histories with relevant investigative findings at the theatre brief. They may discuss the key operative steps relevant for the wider theatre team. This is also a valuable exercise in analysing all available patient data to review the rationale for surgery. These presentations may be assessed through CBDs.
• ICU ward round – Following nights, the surgical fellow presents a brief summary of all the cardiac surgical patients. This necessarily involves reviewing operative details, pre-surgical history, post-operative course, examining the patient and discussing with the ICU team about strategies to optimise management. By regularly reviewing all aspects of the patient’s intensive care (including ventilation, nutrition, communication with parents, etc.) the fellow familiarises themselves with the details of post-operative management. They may be assessed through CBD or CEX.
• Consent process – this is another exercise in reviewing all the primary data and being satisfied that the proposed procedure is appropriate for the patient. If not, it provides an opportunity to discuss with the consultant surgeon and the wider team members including cardiologist and anaesthetist. In cases where parental responsibility may not be clear, where there are other legal considerations, where psychological support may be necessary, or when assessing the capacity to consent is required in children/young adults/parents, the fellow seeks advice and support from the wider team including nursing staff, family liaison members, play specialists, legal team, etc.
• Operating – Pre-operative planning with the consultant including review of imaging, knowing key steps of the operation and formulating bail-out strategies is a key part of the training. The fellow learns the technical aspects by making detailed notes on the operating sequence, and demonstrates understanding by anticipating every step, as well as engaging themselves in a ‘what-should-I-do-here?’ process. The trainee will get experience in low-risk procedures, but first-operator experience in complex surgeries will be extremely limited as they are gained as a consultant with mentorship. Another skill to acquire in the OT is performing epicardial echocardiograms and interpreting trans-oesophageal echocardiograms, as well as discussion with the cardiologist about identifying and deciding on the significance of any residual lesions. The fellow should be comfortable with all aspects of cardiopulmonary bypass including deep circulatory arrest, cerebral perfusion, modes of filtration, undertaking redo sternotomy and salvaging re-entry injuries. This will require effortless communication with the anaesthetist and perfusionist, as well conducting how the assistants and scrub nurses can best help. The fellow will also communicate the vital parts of the surgery and concerns to the intensive care team, to facilitate optimal post-operative management. Assessments in the operating theatre include DOPS, PBA, CBD and CEX.
• ICU and other procedures – insertion of chest drain, PD catheter, delayed sternal closures, urgent re-opening, mediastinal exploration, cannulating and decannulating ECMO including neck, management of wound breakdown/infection, troubleshooting various pathophysiological processes.
• Other opportunities – Cath lab, Attending JCC, M&M, Presenting M&M