Stage 3

Is able to deliver safe perioperative care for the cardiac surgical patient or for an interventional procedure
Can contribute to a multidisciplinary ward round within the cardiac intensive care unit

A	Provides anaesthesia for a cardiac surgical list of uncomplicated CABG, AVR or combined procedures independently
B	Manages the anaesthetic care of a complex valve case and a major aortic case with local supervision
C	Can assess and provide perioperative care for off pump cardiac surgical procedures independently
D	Manages cardiac surgical cases with poor biventricular function and plans on-going care
E	Provides anaesthesia for interventional cardiology procedures eg complex coronary intervention, transcatheter aortic valve
F	Evaluates point of care tests and utilises appropriate bleeding algorithms to manage peri and post bypass operative bleeding
G	Can manage emergency anaesthesia for post cardiac surgical complications
H	Undertakes learning and delivery of transoesophageal echocardiography
I	Provides intensive care to the post operative cardiac surgical patient
J	Explains the principles of cardiac transplantation
K	Manages patients requiring mechanical circulatory support during the perioperative period

appropriate preoperative assessment whether in a preoperative clinic or ward based assessment with interpretation of the relevant preoperative investigations to plan appropriate care for the patient
logbook should demonstrate a range of cardiac cases - elective, urgent and emergency including coronary artery bypass surgery, valve surgery, and surgery on the thoracic aorta. Some time should be spent in the cardiac catheter suite to support minimally invasive and structural work
centres that do not have access to transplant or ECMO services should encourage their trainees to seek supernumerary visits to other departments
intraoperative care should include appropriate use of inotropes and vasopressors and management of cardiac surgical bleeding supported by Point of Care analysis
anaesthetists in training should start to develop trans-oesophageal echocardiography hands on skills and interpretation of basic images.
participate and go on to lead a cardiac intensive care ward round with the relevant communications to surgeons, senior nurses, and other members of the MDT and escalation or de-escalation of care to patients which may include haemofiltration, percutaneous tracheostomy and referral to a specialist unit.

understanding and discussion of the principles of safe cardiopulmonary bypass
effective communication triad between lead surgeon, lead anaesthetist and clinical perfusionist
advanced vascular access - pulmonary artery catheter
basic TOE logbook with attendance at appropriate course
delivery of anaesthesia with distant supervision for an elective aortic valve replacement, CABG or combination of both
returning a patient to theatre for bleeding independently and escalate the appropriate haemorrhage management
participation in patient MDT in preparation for theatre and/or Cardiac ICU.

Personal Activities and Personal Reflections may include:

national and international meetings related to anaesthesia for cardiac surgery
presentation at relevant meeting eg abstract or free paper
development of guidelines and policies related to management of patients for cardiac surgery
leadership of QI projects related to anaesthesia for cardiac surgery
leadership training.

Other evidence:

3 - supervisor on call from home for queries able to provide directions via phone or non-immediate attendance.