SSAI training programme in€¦ · Web viewThis training programme includes anaesthesia and intensive care for the diagnosis and treatment of cardiothoracic and vascular diseases

Version 4.6

SSAI Advanced Educational Programme in

Cardiothoracic and Vascular Anaesthesia and Intensive Care

4th Course 2019-21

1

TABLE OF CONTENT PAGE

Introduction 3

General information 4

Aim of the programme 4

Target group 4

Mentor/supervisor 5

Organization 5

Steering committee 5

Trainees 5

Economy 5

Curriculum – list of topics 6

Courses 7

Course details 7

Echo 8

Learning strategies 8

Learning Objectives 8

Research project 9

Reflective practice 10

Portfolio 11

Personal details 11

Training details 11

Personal development plan 12

Log book 14

Clinical training lists 14

Courses 17

Research project 17

Teaching 17

Portfolio reflective summary 18

AEP in Cardiothoracic and Vascular Anaesthesia and Intensive Care third course June 2018 2

INTRODUCTIONCardiothoracic anaesthesiology started evolving as a subspecialty within the field of anaesthesia and

intensive care more than 25 years ago. Since this was a new field with close cooperation with surgeons it

attracted many of the most proficient and experienced specialists in the field. Over the years these have

accumulated vast experience since most of them have gone through the development of anaesthesiological

and surgical techniques and intensive care methods. Since the expansion of the area came at more or less the

same time in the different parts of the Nordic countries the time has come to the switch to new generations of

specialists. As in all parts of medicine the working hours have gone down and the number of specialists has

increased with the consequence that the bulk of cases for each specialist have gone down. As in

anaesthesiology in general, this necessitates a more intense and structured education and training.

The first SSAI CardioThoracic and Vascular Anaesthesia programme (SSAI-CTVA) was initiated in 2013

after an informal survey had recognized that none of the survey centres had a formal training system though

there are systems for professional development in some. In virtually all departments there was young

colleagues with only a few years of training and are thus eligible for a SSAI training programme. During the

first three courses all together 56 anaesthesiologists has joined the courses and from the first courses 16 of 19

(2013-15) and 18 of 19 (2015-2017) participants has received their diploma.

Following it is believed that there is a need to formalize the handover of experience to the younger

colleagues. Despite the relatively high number of participants in the first courses it seems that there is

requisite for continuing the courses. The older generation further has many members with academic careers

and research competence. The younger generation has not yet achieved this level and the programme should

be an inspiration to pursue the combined path of clinical proficiency and academic skills and not least to

facilitate the development of professional networks. Thus, a formal training will be an asset and an attraction

instrument to an area of the specialty where there is specific need in addition to general anaesthesiological

competence.


GENERAL INFORMATION This training programme includes anaesthesia and intensive care for the diagnosis and treatment of

cardiothoracic and vascular diseases.

The programme is directed towards Scandinavian specialists in anaesthesiology with special interest in

cardiothoracic and vascular anaesthesia and cardiothoracic and vascular intensive care.

The programme consist of three main components1. The clinical training period is 2 years in a department with predominantly cardiothoracic and vascular

cases. At least one year of the training has to be at a university hospital. It is recommended, but not

obligatory, that the trainees spend at least half a year of clinical training outside the host clinic. It is

obligatory to stay at least 1 month in a clinic in another country. This obligation can also be fulfilled as

2 times 2 weeks of observation or work. If the trainees are working in clinics without thoracic or

vascular surgery, the trainee has to be at least one month in a clinic with vascular cases, and 3 months in

a clinic with thoracic cases.

2. The theoretical part of the programme consists of 4-5 courses of each 2-5 days’ length, principally one

course in each of the Scandinavian countries. The courses will be held in English and covers the core

curriculum. A final examination will be held in conjunction with the last theoretical course.

3. The scientific project is described in a separate paragraph, the goal is not a major project, but the

trainees all have to fulfill a minor research project.

Trainees completing the two-year training programme and passing the final examination will receive a

diploma from the SSAI. The programme will be led by a steering committee that refers to the Educational

committee of the SSAI.

Responsibilities of the programme participant, the host clinic / department and SSAI are outlined in the

contract

Aim of the programmeThe programme aims at educating cardiothoracic and vascular anaesthetists with the overall objectives of

enhancing the quality of anaesthesia and intensive care for the cardiothoracic and vascular patients. This

includes improving patient safety by reducing the incidence and severity of anaesthesia and intensive care

related complications, and further increasing patient satisfaction.

Target GroupThe main target group will be young specialists with interest in cardiothoracic and vascular anaesthesia and

intensive care. It would be preferable if the trainees have some experience in the field. It would also be

preferable if there among the course participants are some participants with longer training in the field in

order to facilitate the interactive learning among the trainees themselves.

The primary target group is specialists from Scandinavian countries, but will be open for specialists from the

Baltic countries, if the institutions involved and the training plan can be approved. AEP in Cardiothoracic and Vascular Anaesthesia and Intensive Care third course June 2018 4

Mentor/supervisorThe trainee will have a mentor/supervisor at the host clinic. The tasks of the mentor are:

1. To support and encourage the trainee during the programme.

2. To support the trainee in the work with the theoretical assignments.

3. To discuss cases and problems with the trainee (approximately one case every month)

4. To assess (through the portfolio) that the clinical training is progressing satisfactory.

OrganisationThis is a programme managed by a steering committee under the Educational Committee of the SSAI.

The steering committee consist of one member from each of the Scandinavian countries and a programme

director who is the chair person and secretary of the steering committee.

Carl-Johan Jakobsen (programme director), Aarhus, Denmark, [email protected]

Andreas Nygren, Göteborg, Sweden, [email protected]

Hilde M Norum, Oslo, Norway, [email protected]

Kari Hreinsson, Reykjavik, Iceland, [email protected]

Lisbeth Bredahl Rosengaard, Copenhagen, Denmark, [email protected]

Seppo Hiippala, Helsinki, Finland, [email protected]

Each committee member has an alternate member, who can replace the national member at meetings and

collaborate about the programme and its courses.

There will be an official call for applicants for the programme in Acta Anaesthesioliga Scandinavica and in

the national anaesthesiology journals. The fourth programme will start in June 2019. The steering committee

decides early 2019 in corporation with department chairs the trainees for the programme.

The number of trainees is limited to 15-20 participants..

EconomyAll the educational expenses must be covered by the applicants host department. The fee for the five courses

will be approximately 8000 €, which includes venue, food and accommodation, but not travel expenses. The

programme fees further give access to a strongly reduced fee for participation in SSAI 2019 in Oslo 2021.

The courses are economically self-contained. In the application form and contract, the applicants host clinic

gives binding guarantees for the economical obligations, especially in relation to courses. Economical

support from industrial sponsors will in general not be sought.

CURRICULUMThe following list covers the curriculum, but the limited time demands that only selected topics is reached

in theoretical courses.


mailto:[email protected]






CAD today; Heart valve disease today; Chronic heart failure; Coronary artery anatomy; Aortic valve

pathology; Mitral valve pathology; Tricuspid valve pathology; Diseases of aorta; Myocardial metabolism;

Myocardial preservation; Cardiovascular receptors; Cardiovascular drugs; Monitoring the heart; Monitoring

the circulation; Acute coronary syndrome; Acute complications of AMI; Acute heart failure; IABP;

Conduction disturbances and arrhythmias; Temporary pacing; Pacemakers and ICDs; Pulmonary artery

hypertension; Failing right ventricle; Supporting RV; Platelets; Basic Coagulation; Coagulation disturbances;

Coagulopathy after CBP; Antithrombotic therapy; Congenital heart disease; GUCH; CPB circuits;

Oxygenators; Heat exchange; Safety devices; Controls; Mini-perfusion (MECC); Monitoring CPB;

Physiological effects of CPB; Anticoagulation during CPB; HIT; Alternatives to heparin; Running basic

CPB setup; Mishaps during CPB; Unsuccessful weaning; Basic CABG; UAP/Urgent CABG; OPCAB;

AVR; MVR/MVP; Minimal invasive mitral surgery; Combination procedures; Re-Do operations; Aortic

dissection; Ascending Aorta/Arch reconstruction; DHCA; Accidental hypothermia; Thoracic and thoraco-

abdominal aortic reconstruction; Monitoring the spinal cord; Protecting the spinal cord; Aortic stenting;

Transfemoral aortic valve implantation (TFAVI); Transapical aortic valve implantation (TAAVI);

Pulmonary endarterectomy; ECMO; LVAD and BiVAD; Cardiac transplantation; Robotic surgery;

Complications of cardiac surgery; PCI and coronary stents; Vasoplegia; Sepsis; Renal insufficiency; Acute

renal failure; Renal replacement therapy (RRT); Assessment of cardiorespiratory capacity; Fiberoscopic

bronchial anatomy; Lung separation; Difficult airway in thoracic surgery; VATS and thoracotomy;

Complications of lung surgery; Empyema, mediastinitis; Oesophageal surgery; Thoracic trauma; Pain

control in thoracic surgery; Tracheal surgery; Endstage pulmonary diseases; Lung transplantation;

Immunosuppression; Complications of lung transplantation; Assessment of vascular patient; Reconstruction

of abdominal aorta (AA); AA stenting ; Peripheral vascular surgery; Carotid endarterectomy (CEA);

Ruptured abdominal aortic aneurysm (RAAA); Complications of vascular surgery; Massive transfusion; Use

of blood products; Coagulation concentrates; Cell Salvage; Transfusion protocols; ICU management.

COURSESThe programme includes 4-5 courses of 2-5 days, one in each Scandinavian country. The courses are

gathered in blocks according to optimal planning, news and trends together with request from the trainees.

The overall planning of courses (content, place and dates) will be presented before or at the first course. The

programme intends to finalize the course in connection with the SSAI congress in 2019.


Thoracic Surgerey

Thoracic Anaesthesia Vascular ARDS

Assist devices

CardiologyPractical

presentationPenumonectomy Blocks Surgery Physiology Short term IHD Log book

Lobectomy Fluid EVAR Conventionel Long term Pacemakers Personal planComplications One-lung TAA HFO CO2 removing TAVI Research

Pitfals ECMOThoracic

SpecialitiesHands-on Thoracic

Thoracic/Vascular Anaesthesia

ICUHands-on

Monitoring Heart Failure Organisation

VATS DLT Miscelaneous Ultrasound Acute ORPulmonary Blockers News and trends News and trends Chronic ICU

hypertension Tracheostomy SpecialitiesDHCA Examination

Perfusion I Organ protection

Cardiac Surgery I

Cardiac Surgery II

Cardiac Anaesthesia

Myocardial function

Project Presentation

Priming Cerebral IHD IHD MetabolismCardioplegia Renal & Dialysis Valve Valve Preconditioning OxygenationSide effects/ GUCH GUCH Protection Protection

injuries

Perfusion II HaemostasisAnaesthetic view

valvesGUCH &

TransplantationCardiac

AnaesthesiaMonitoring Miscelaneous

Haemodynamics Bleeding Mitral Cardiac PACHaemostaseology Transfusion Aortic Lungs News and trends TTE/TOE

Coagulation New trends

Indidual presentation

The list of subjects in each course will be elaborated further as the planning of each course progress. In

general, the list of subjects in the curriculum will in major terms be distributed to the different courses.

The core faculty of the different courses is the steering committee. The steering committee members will

give some of the lectures at the different courses.

The trainees have to prepare themselves for the courses, and at the end of the course they will be given some

minor problems to solve or cases to comment on, in order to assess the perception of the content and main

message of the course.

COURSE DETAILSThe courses are structured according to time, venue and interest of organisers. For each course there will be

1: Learning Objectives; 2: Preparation for the course; 3: Pre-course assignment with deadlines and

submission details. The detailed programme will be distributed before the first course which will be in

September 2017.

EchoToday, the perioperative competence of echocardiography is an integer part of cardiothoracic and vascular

anaesthesiology and intensive care. However, the field is so large in itself that it would take the focus away

from the other parts of clinical training and participants are encouraged to be part of the European training

programme organized by European Association of Cardiothoracic Anaesthesiologists and European

Association of Echocardiography. However, participation is not obligatory. The present programme will only

contain basic element of TOE, TTE and FATE.


LEARNING STRATEGIESA high commitment is a prerequisite for good learning. Learning is stimulated by: Perception,

communication, experience, imitation, activity and participation.

This can be achieved by building up the programme and the courses so that the participants are involved as

much as possible.

Therefore, courses includes:

1) Cathedral lectures

2) Problem based interactive sessions

3) Discussion based on case presentations

4) Pro and con sessions in relevant areas

5) Hands-on and simulator where appropriate

6) Presentations/lectures by participants subject of their choice

7) Self-study – that is, reading of relevant literature

8) Literature review

A recommended reading list will be worked out.

Learning objectivesEach course includes pre-course preparations. When the overall planning and placement of courses are

finalized, the information is sent to the trainees with outlines of pre-course preparations and pre-course

assignments.

In due time before each course the final pre-course preparation, pre-course assignments, other possible tasks

and related deadlines with be sent to the trainees.

RESEARCH PROJECTAs part of the two years’ educational programme the trainees must perform a minor research project. After

the trainee has been accepted for the programme it is important that planning of the project starts soon

hereafter. The project must be presented and approved by the Steering Committee before the second course

in the programme. In the preparation of the research project, group work is accepted and encouraged. The

structure for a publication in Acta Anaesthesiologica Scandinavica is encouraged, but publication of the

research project in a peer reviewed journal is not a requirement. This work must be supervised by a

competent research mentor.

ObjectiveAfter this project, participants should be able to:

1. Conduct a systematic literature search and critically appraise scientific articles

2. Design a research project and write a research protocol AEP in Cardiothoracic and Vascular Anaesthesia and Intensive Care third course June 2018 8

3. Deliver a presentation of a project

4. Write a research report in the format of a scientific article

MethodThe topics must be related to cardiothoracic and vascular anaesthesia and intensive care. If the trainee has

already an on-going project it may be included. A minor project could be:

1. A small research project

2. A quality assurance/development project

3. A literature review

The practical handling of the project:

1. Define the topic of the project and decide on the design.

2. Appoint a research mentor to the project. It could be the mentor attached to the educational

programme or a mentor with special knowledge in the topic of the project.

3. Observe that the project has to be performed in accordance with the Helsinki Declaration and that

the necessary permission has been obtained from the appropriate ethics committee and other

relevant, national bodies.

4. Write a report on the project in concordance with the manuscript instructions for ACTA-authors

EndorsementTopic, structured abstract (background, methods, results and conclusion) of 250 words and timetable of the

project should be submitted to the Steering Committee.

PresentationFinal presentation of the projects will be at the end of the programme, either as part of the SSAI meeting or

during the last course. The language is English.


REFLECTIVE PRACTISELearning from experience

A good reflective practice is a core part of any learning programme. Being able to identify your challenges &

discuss them with your colleagues and mentors will help you define future learning opportunities and apply

what you’re learning in a professional environment. Reflective practice will record many of your most

challenging or personal experiences. Reflective practice is designed to encourage you to think about your

work related experience in a structured way, capturing the elements most pertinent to learning and

development. Be mindful of the confidential nature of what you may be writing and who may have access to

it if left unattended in a busy environment.

Gibbs' (1981) model (below) is a simple representation of the reflective practice process.

There is no set formula or format, but it might be helpful to organise the record into sections such as:

What happened?

What and how did I do?

Why did I do it?

What did I learn?

What does it mean?

What should I have done differently?

What do I need to do next time?

What specific areas do I need to improve or extend?

Which aspects were successful?

What do I want to investigate further?

How does this relate to previous knowledge and experience and to future learning activities?


PORTFOLIOPersonal details

Name:

Medical degree (university and year):

Specialist (country and year):

Address:

Telephone:

e-mail:

Training Details

Period of training covered by this portfolio

Training site 1

Hospital

Period

Training site 2

Hospital

Period

Training site 3

Hospital

Period

Training site 4

Hospital

Period

Exchange programme (other country)

Host 1

Hospital:

Department:

Period:

Host 2

Hospital:

Department:

Period:

11

Personal Development Plan (PDP)The personal development plan (PDP) will help you to set up what skills and knowledge you expect to achieve

during each training site and during the exchange programme. The learning objectives with the core curriculum

and the check-list of the SSAI programme in Advanced Cardiothoracic, Vascular and Thoracic Anaesthesia and

Intensive care give guidance of what is appropriate to cover.

You should use the PDP as a tool to check your progress and refer back to the goals.

The PDP should be developed in collaboration with your mentor and it should be updated at regular intervals

linked to placement and rotation between hospitals.

The personal development plan will be used on every three months evaluation with your mentor. Achieved

competence during the period as well as areas for improvements should be in focus. Discuss and agree with

your mentor targets and record agreements and how and when you will be assessed.

As you are progressing in the training programme your learning needs continuously have to be addressed and

the PDP should be developed.

A key goal of the training programme is to demonstrate, through portfolio evidence, development and

progression towards competence.

What specific development objectives do I have? (What do you intend to learn?)

How will these objectives be addressed? (Which activities should be planned?)

Evaluation (What documentation should be collected to show the objectives have been achieved)

Planned evaluation 3 months later ____________date

Evaluation and outcome-Have the objectives been achieved? (If not what should be done)


LOG BOOK - RECORD OF CLINICAL TRAININGNOTE: The following list of clinical procedures and entities (with abbreviations for shorting) is not

comprehensive and it is neither required that the trainee should gain full clinical experience in all types of

surgeries. The focus should mainly be the common and essential procedures. However, it is highly

recommended, that the clinical training is expanded to cover the local spectrum as comprehensively as possible.

It is also expected, that the clinical responsibility of the trainee becomes more determining as the training

progresses. The minimum number of required cases in each clinical setting is an approximation. However, in

case of notable unbalance in the clinical training, the Programme Steering Committee reserves the right to

demand supplementary training before granting the diploma.

Section 1: Cardiac and aortic surgeries and related procedures The recommended minimum number of cases is 80 and no more than 40 can be elective CABG. The list is

neither inclusive nor exclusive.

“elective CABG (eCABG), urgent CABG (uCABG), off-pump CABG (OP-CABG), aortic valve

replacement/repair (AVR/AVP), mitral valve replacement/repair (MVR/MVP), combined procedures, valve(s)

and CABG (CP), aortic root replacement (ARR), reconstruction of ascending aorta and/or aortic arch (RecAA),

reconstruction of descending aorta or throracoabdominal aorta (DA/TA), acute aortic dissection (AAD), ReDo-

operations (ReDo), deep hypothermic circulatory arrest (DHCA), perioperative intra-aortic balloon pump

implantation (IABP), intravenous temporary pacing (ITP), perioperative transoesophageal echography (TOE),

extracorporeal membrane oxygenator implantation (ECMO), left or biventricular assist device implantation

(LVAD, BiVAD), transcatheter aortic valve implantation (TAVI), grown-up congenital heart disease (GUCH),

cardiac transplantation (TxC), lung transplantation (TxL), other (describe)”

Please double-click the Excel-table below to make your entries. Use the above abbreviations, several if needed,

and also give the abbreviation of the institution, when using the name for the first time. All entries should

secure the anonymity of the patient. Make sure you save the entries, and makes regular back-up copy of the

whole file (portfolio) and make print copy of the case log on a regular basis.

Section 2: Perfusion techniques and settingsNOTE: The trainee familiarizes himself with the cardiopulmonary bypass circuits and techniques, and observes

the work of the perfusionists in various clinical settings. It is allowed to include the patients of Section 1 also AEP in Cardiothoracic and Vascular Anaesthesia and Intensive Care third course June 2018 13

into this section, if sufficient time and effort is focused on the perfusion details in a particular case. The

recommended minimum number of cases is 20. The list is neither inclusive nor exclusive:

“basic cardiopulmonary bypass (bCPB), femoro-femoral cardiopulmonary bypass (ffCBP), perfusion settings

for the reconstruction of ascending aorta and the arch (aaCBP), DHCA, perfusion settings for the reconstruction

thoracoabdominal aorta (taP) , miniaturized extracorporeal circuit perfusion (MECC), cell salvage (CS), other

(describe)”

Section 3: Thoracic surgeryNOTE: Probably you will need to fill in numerous abbreviations to describe the procedure.

The minimum number of cases is 30. The list is neither inclusive nor exclusive.

“lobe/lung resection (LR), videoscope assisted thoracic surgery (VATS), oesophageal surgery (OS),

oesophageal stenting (OSt), mediastinal surgery (MS), tracheal surgery (TS), tracheal stenting (TSt), thoracic

trauma (TT), surgical treatment of empyema (STE), thoracic epidural (TE), fiberoscopy (FS), lung separation

with a blocker (LSB), other (describe)”


Section 4: Vascular surgeryThe recommended minimum number of cases is 20 (or 1 month training on special vascular anaesthesia

department). The list is neither inclusive nor exclusive.

“reconstruction of abdominal aorta (RecAA), stenting of abdominal aorta (StAA), stenting of thoracic aorta

(StTA), ruptured abdominal aortic aneurysm (RAAA), vascular injuries (VI), carotid endarterectomy (CEA),

other (describe)”

Section 5: Intensive Care. NOTE: The trainee is expected to participate in the treatment of cardiac, thoracic and vascular patients in the

intensive care unit. The treatment comprises daily routines, special procedures and conferring with colleagues

about clinical problems. Patients from sections 1, 3 or 4 may also be included in this section, when applicable.

Again, usually more than one abbreviation is needed to describe the case. The date in this case refers to the day

the patient is met for the first time in the ICU.

Recommended minimum number of cases: 50 (or 2 weeks practice on an Intensive Care Unit with

cardiothoracic and vascular patients). The list is neither inclusive nor exclusive.

“perioperative heart failure (HF), maintenance of IABP (IABP), maintenance of LVAD/BiVAD (LVAD,

BiVAD), perioperative respiratory failure (PRF), maintenance of ECMO (ECMO), excessive post-operative

bleeding (EPB), renal failure (RF), renal replacement therapy (RRT), creating dialysis access (DA), life-

threatening arrhythmias (LTA), temporary pacing (TP), NO-therapy (NO), fiberoscopy (FS), sepsis (S),

vasoplegia (VP), thromboembolic complications (TEC), heparin induced thrombocytopenia (HIT), critical

illness polyneuropathy (CIP), enteral and parenteral nutrition problems (EN, PN), pain control problems (PC),

sedation problems (Sed), ethical problems (EP), other (describe)”

SSAI CoursesDate Course Location Signed by


course director

Other courses attended during the training period Enclose: Course title, location, date and duration, short summery of course content and the educational

objective in attending the course.

Summary of any meetings, seminars, workshop organized by you and colleagues

Topic Participants Location Date


RESEARCH PROJECTRetrospective review, prospective study, part of an ongoing project such as PhD work, case report, literature

review, audit

Plan: Following parts should be included

Title of project

Research supervisor and collaborators

Aims/Objectives

Material and methods

Findings/Results

Discussion

References

Conflicts of interest

The project should be presented as a poster or oral presentation at an SSAI congress.

TEACHINGSummary of any significant teaching you have undertaken

Topic Audience Location Date


PORTFOLIO REFLECTIVE SUMMERYThe portfolio reflective summery is an assessment of your professional development during the programme.

This reflection should be undertaken at half-time and at the end of the period. This is an opportunity to evaluate

the development of your portfolio and what has been learned over the last year. Begin with reviewing what is in

your portfolio, concentrating on those things that have been added in the last year.

Choose three things that have been included into your portfolio of which you are particularly proud and

summarize why you are proud of them and how you think they have enhanced your development as a clinician,

teacher and researcher. Examples:

A clinical incident or a difficult case and how you learned from it.

A successful teaching session as a result of good planning and preparing.

A summary of a particularly useful and interesting course.

Research report/presentation, publication

Then identify one or two things you would like to have included in your portfolio but have not managed to

achieve. Summarise why you think they would enhance your professional development, why you have not

managed to achieve them and how you are going to ensure you do achieve them next year.

Involve your tutor in the reflective summery and the tutor may help you to go through the portfolio and to

identify the strengths and omissions.

Summary - Three things of which you are particularly proud and why:

One or two things you which you had included in your portfolio, why you have not, and how you are going to

ensure that it will be done in the future:


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SSAI training programme in€¦ · Web viewThis training programme includes anaesthesia and intensive care for the diagnosis and treatment of cardiothoracic and vascular diseases