Perioperative Medicine Fellowship

General Fellowship with a subspecialty interest in Perioperative Medicine 

Counties Manukau is pleased to offer an ANZCA-approved General Fellowship position with sub-specialisation in Perioperative Medicine. The fellowship runs for 12 months, and in addition to full participation on the anaesthetic clinical roster, the fellow participates with high frequency in activities that will foster and support a greater understanding of this expanding area of anaesthetic practice. 

A significant focus of our fellowship centers around our High Risk Pre-Operative Assessment Clinic where we run hour-long appointments for our most complex and comorbid elective surgical population. The clinic is staffed by a dedicated group of highly experienced nurses, and enthusiastic clinicians with a special interest in perioperative medicine. The position allows the opportunity to work alongside the clinic consultant, but also to take on the responsibility of coordinating the clinic, triaging referrals and problem solving with junior surgical and anaesthesia trainees. This will allow further development of assessment skills, risk stratification, formulating management plans, and liaising with relevant subspecialties alongside patients and their families within a shared decision-making (SDM) model. Where possible, we facilitate following patients through their surgical journey. 

As part of the wider team, our perioperative fellow will have the opportunity to become involved in reviewing current protocols and development of policy, guidelines and initiatives in this evolving speciality.

As a general fellowship with subspecialty interest, fellows can expect approximately 30% rostered exposure to perioperative medicine. This may include. but is not limited to:

1. Regular pre-assessments clinics with both immediate consultant oversight,  and a proportion of time taking the clinical lead in running the clinic and supervising trainees
2. Occasional rostering to an Acute Perioperative session where you will be challenged by assessing, facilitating optimisation, and negotiating postoperative placement plans for acutely unwell patients requiring imminent surgery. 
3. Participation in occasional acute pain rounds alongside anaesthetic consultant and pain nurse specialists.
4. Observation on a Complex Pain Round with our multidisciplinary pain team
5. Exposure to speciality medicine consultant clinics and specialised real-time testing (cardiology / respiratory) *
6. Exposure to our anaesthetic-led high risk echo service *
7. Participate in refining and developing perioperative care pathways and involvement in audit processes
8. Participation in our Perioperative SIG. 
9. Regular meetings with clinical lead(s) to monitor progress

*We offer the flexibility to facilitate tailoring some components of the fellowship to individual areas of interest.

Clinical anaesthesia experience includes rostering to a wide variety of acute and elective lists (including excellent exposure to major complex surgical cases) and full participation in the on-call roster. Clinical exposure is similar to what can be expected for our general fellowships. 

Aims:

1. Understanding the perioperative medical care of the complex surgical patient
2. Formulate clear plans for preoperative optimisation and management 
3. Developing skills in communication and risk discussion with patients and their families in the framework of shared decision-making
4. Refine communication with surgical services, medical teams,  and intensive care in developing individualised pathways for complex patients.
5. Instigating difficult conversations regarding Advanced Care Planning and decisions to not operate.
6. Interpretation of advanced preoperative testing ( eg, echocardiography, sleep studies) 
7. Review, refine, develop patient perioperative care pathways, and participate in Audit/Q&A processes
8. Involvement in the delivery of perioperative medicine education to junior staff ( surgical junior staff, anaesthesia trainees) and subspecialty nursing teams. 

During your tenure, we encourage attendance at an Australasian or international perioperative medicine conference, for example 

• EBPOM (London, annually), 
• Peter MacCallum Perioperative medicine symposium (Melbourne) 
• ANZCA Perioperative SIG meetings 
• POETTS / enhanced recovery workshops

There are an increasing number of short courses and more substantive qualifications which we also support our fellows undertaking, and provide a session of non-clinical time per week that can be utilised for such academic purposes.

Questions?

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