Fellowship Cardiothoracic Anaesthesiology
 


​​Cardiothoracic Anaesthesiology 


Cardiothoracic Anaesthesia is the subspecialty of anaesthesiology devoted to the preoperative, intraoperative, and postoperative care of patients undergoing cardiothoracic surgery both adult and paediatric patients and related invasive procedures.

The fellowship programme is designed to develop knowledgeable, skilled and competent cardiothoracic consultant anaesthetist capable of providing care for all Adult/ paediatric cardiac surgeries and all types of thoracic anaesthesia.

Clinical Educational Objectives

Fellowship goals include maximising proficiency in:

  • assessing cardiovascular and respiratory diseases; from patient history and physical examination to interpretation of invasive and noninvasive diagnostic studies.
  • evaluating anaesthetic risk and necessary interventions to minimise risk. 
  • anaesthetic plan selection (including postoperative analgesic and recovery strategies) suitable for adult/ paediatric cardiac and thoracic surgical patients, based on:
    • determination of cardiovascular and pulmonary monitoring requirements and expertise in invasive monitoring and echocardiography techniques.
    • design and administration of anaesthetic medications and regional  anaesthetic procedures tailored to optimise surgical conditions, with consideration of patient disease processes.
    • understanding of the principles of extracorporeal circulation.
    • understanding of myocardial preservation. 
    • recommendations and consultation in postoperative intensive care and pain management problems.

Research/ Academic Educational Objectives

Involvement in an anaesthesia research project and other academic activities assuring skill development in:

  • The ability to formulate clinically relevant hypotheses in cardiac and thoracic anaesthesiology.
  • Project design skills, to create achievable studies able to answer questions according to execution of research project. (One dissertation during fellowship or two publications in a Pakistan Medical and Dental Council recognised journal).
  • Introduction to statistical analysis techniques.
  • Interpretation of results and preparation of a manuscript.
  • Presentation of research at national/international meetings.
  • Ability to critically evaluate the research of other investigators.
  • Fellow will actively participate in different audits and ongoing research activities
  • Fellowship teaching opportunities include experience in resident education and participation in didactic sessions and other teaching activities including informal teaching in OR/ CICU.

Programme Design

As primary anaesthesiologist of adult/ paediatrics cardiac and thoracic surgical patients, Cardiothoracic Fellow’s initial responsibility is to develop expertise in preoperative assessment, intraoperative and postoperative management (Where required direct faculty supervision will be provided).  During this period, Fellows follow a curriculum that meets the Department and College of Physicians and Surgeons Pakistan (CPSP) curriculum  designed to have them:

  • become familiar with the cardiothoracic surgical and intensive care teams, and the operating room and intensive care facilities.
  • attain proficiency in invasive monitoring and TEE techniques, and intraoperative/ postoperative patient management.
  • experience in perioperative management of emergency adult/paediatric cardiac and thoracic procedures.
  • fulfill designated reading assignments in selected cardiac and thoracic anaesthesia textbooks and journal articles develop objectives for the remainder of the programme with the guidance of the cardiothoracic anaesthesia and critical care faculty under the direct guidance of a mentor, design and initiate a research project (ideally planned between acceptance and starting the Fellowship).  The protocol may entail clinical database and/or laboratory research in original or ongoing projects.  Clinical schedules are flexible to commitments for proposed research projects.  Research is supervised by a faculty member with experience in the area of investigation.

Other features of the clinical experience include:

Four days per week clinical involvement (one day per week is protected for non-clinical activities), and participation in combined cardiothoracic night call schedule to provide experience in the management of emergency cardiothoracic surgeries.

Training in  echocardiography:

2 weeks in cardiology echo lab involving a significant practical experience in transthoracic echocardiography and TEE.

TEE use in all adult/ paediatrics cardiac surgical cases under supervision.

Duration of training - Two years 

Eligibility 

  • MBBS or equivalent degree recognised by PM&DC. 
  • One year house job or internship.
  • Have done FCPS part I or equivalent.
  • FCPS Part II equivalent degree is preferred or at least should have completed the FCPS II training from a reputable institution and eligible for the fellowship exam (Four years structured training in anaesthesia).

Skills 

Fellow should be able to perform, manage and interpret following procedures with minimal assistance from consultants: arterial catheterisation, central venous catheterisation, pulmonary artery catheterisation, double lumen placement/other lung isolation techniques, thoracic epidural insertion, fibreoptic bronchoscopy, TEE for myocardial ischemia and contractility and valvular lesion. 

Evaluation

  • Evaluation of fellow will be done quarterly.  These evaluations will include attitude, interpersonal relationships, professionalism, knowledge, manual skills, patient management, decision-making skills and situational analysis. Viva will be taken every three months and written test (MCQs) every six months
  • The Fellowship Director will meet each fellow individually to discuss their evaluations. 
  • Assessment of presentations. 
  • Assessment of Research Project. 

Goals

At the completion of the Fellowship, successful fellows will have achieved the following goals:

  • safe and skillful management of complicated cardiothoracic surgical patients, including proficiency in intraoperative transesophageal echocardiography techniques.
  • knowledge through organised learning opportunities in a process that is aligned with and complementary to all other aspects of the Fellowship requirements
  • knowledge beyond the level expected of a graduating resident in the general areas of CT anaesthesia.
  • understand the tasks, challenges, and decisions required of professional colleagues in the areas of Cardiothoracic Medicine (e.g., CT surgeons, cardiologists, pulmonologists, perfusion technologists, etc.).
  • completion of a research project and presentation of results at a national meeting
  • understand aspects of CT anaesthesia research
  • a comprehensive understanding of the aspects of perioperative transesophageal echocardiography
  • understand areas of general importance to physicians (e.g., being an effective educator, making good slides, ethics and medicine, patient safety, quality assurance programs, etc.)
  • successful participation in residency education, including conducting didactic lectures and participation in specialty conferences

Administrative set-up 

The Cardiothoracic Anaesthesiology group includes seven full-time faculty members.  A fellowship committee comprising three members including one fellow will look after the affairs of the fellowship programme. 

Faculty Members

Professors 

Dr Fazal H. Khan
MBBS Karachi; FCPS Pakistan; European Diploma in Intensive Care 

Dr Rehana S. Kamal
MBBS Punjab; FRCA UK; FFARCS Ireland; FCPS Pakistan 

Associate Professors 

Dr Hameedullah
MBBS Karachi; FCPS Pakistan

Dr Mohammad Hamid (Coordinator – Cardiothoracic Anaesthesia)
MBBS Karachi; Diplomat American Board of Anaesthesia 

Assistant Professors 

Dr Fauzia Minai
MBBS Karachi; FCPS Pakistan 

Dr Khalid Samad (Programme Director)
MBBS Karachi; MCPS Pakistan; FCPS Pakistan

Dr Khalid Siddiqui
MBBS Karachi; FCPS Pakistan 

Dr Irfan Akhter
MBBS Karachi; MCPS Pakistan; FCPS Pakistan 

Instructor

Dr Aftab Khatri (Programme Coordinator)
MBBS; Karachi​

Related Links

How to Apply