Detailed job description and main responsibilities

The post holder will function at senior trainee-equivalent level across theatres, labour ward, the intensive care unit, and on the on-call rota, with consultant support available at all times. Clinical time is divided into 3-month rotations across these areas; the first 6 months will be ICU-based to support integration into the department.

Intensive Care Unit (ICU)

·       Attend twice-daily ward rounds as the senior resident, reviewing all Level 2 and Level 3 patients, generating and documenting management plans, and identifying patients requiring escalation to consultant level.

·       Initiate and titrate ventilatory support, sedation and analgesia regimens, vasopressor and inotrope therapy, and renal replacement and other organ support in conjunction with the consultant team.

·       Perform and supervise core ICU procedures including central venous access, arterial line insertion, bronchoscopy, and chest drain insertion, using an appropriate safety and consent framework.

·       Act as the first senior clinical responder to acutely deteriorating ICU patients, initiating management of sepsis, respiratory failure, haemodynamic instability, and multi-organ dysfunction, and escalating appropriately.

·       Contribute to escalation discussions and goals-of-care conversations with patients and families, with consultant guidance, including in the context of end-of-life decision-making.

·       Coordinate safe intra-hospital and inter-hospital transfer of critically ill patients, including full pre-transfer assessment, stabilisation, documentation, and handover.

·       Contribute to ICU governance: attending M&M and clinical governance meetings, completing audit and QIP work, and engaging with departmental quality improvement priorities.

Theatres

·       Conduct pre-operative anaesthetic assessment of elective and emergency surgical patients, formulate an appropriate anaesthetic plan, and identify and escalate high-risk cases to consultant level.

·       Deliver general, regional, and combined anaesthesia for cases of varying complexity across vascular, colorectal, maxillofacial, ENT, major gynaecology, urology and orthopaedic surgery, adapting technique to patient comorbidity and surgical requirements.

·       Manage intra-operative physiological instability, including haemodynamic compromise, airway difficulty, and acute deterioration, with the judgement and skill expected of a senior trainee.

·       Provide post-operative handover to the recovery team and initiate immediate analgesia planning, including referral to the Acute Pain Service where appropriate.

·       Assess and manage emergency surgical referrals out of hours, including pre-operative workup and conduct of unplanned or urgent cases overnight and at weekends with consultant support available.

·       Contribute to peri-operative care of high-risk patients, including those with significant cardiorespiratory comorbidity, in liaison with the consultant team.

Labour ward

·       Conduct obstetric anaesthetic assessment of women referred for epidural analgesia or anaesthetic review, including those with significant medical or obstetric comorbidity, and formulate an appropriate management plan.

·       Site and manage labour epidurals, including troubleshooting of inadequate or patchy blocks, conversion for operative delivery, and recognition and management of complications.

·       Deliver spinal and general anaesthesia for elective and emergency operative deliveries, including category 1 caesarean section, with the speed, competence, and composure expected at senior trainee level.

·       Respond to obstetric emergencies including major obstetric haemorrhage, eclampsia, cord prolapse, and maternal collapse, taking an active clinical lead with consultant guidance as appropriate.

·       Provide anaesthetic input to the management of high-risk antenatal patients in liaison with the obstetric and midwifery teams, including pre-operative review and planning for women with complex medical histories.

·       Participate in multidisciplinary review and handover of complex or deteriorating obstetric patients.

On-call responsibilities

The post holder will provide resident registrar-level anaesthetic and critical care cover overnight and at weekends as part of the department’s on-call rota, with an approximate frequency of 1 in 5. Consultant support is available at all times, on-site or by immediate telephone, but the post holder is expected to exercise independent senior clinical judgement.

·       Provide senior resident anaesthetic cover for emergency theatre work overnight and at weekends, including pre-operative assessment, conduct of anaesthesia, and post-operative care for unplanned and urgent surgical cases across all specialties.

·       Provide senior resident cover on labour ward out of hours, including response to obstetric anaesthetic emergencies, category 1 caesarean section, and major obstetric haemorrhage, with consultant backup available.

·       Conduct senior review of acutely deteriorating ward and ICU patients out of hours, including initiation of immediate management and escalation to the on-call consultant where indicated.

·       Provide clinical oversight and supervision of more junior resident medical staff on the on-call rota, including foundation doctors and core trainees.

·       Attend and contribute to crash calls and cardiac arrests as a senior member of the resuscitation team.

·       Maintain clear contemporaneous documentation and ensure safe clinical handover at the end of each on-call period.

Hours of work are 48 per week on a full shift pattern, compliant with the Resident Doctor Contract 2016 and the European Working Time Directive. Rota patterns may evolve over time; changes will be implemented fairly and with appropriate notice.

Teaching, education and supervision

·       Attend and contribute to the department’s FRCA teaching programme.

·       Participate in simulation and skills workshops.

·       Support and supervise more junior doctors on the shop floor and on-call.

·       Maintain a clinical logbook and engage with annual appraisal in line with GMC revalidation requirements.

Clinical governance and quality improvement

·       Contribute actively to the department’s governance agenda: reporting incidents and near misses, participating in audit and QIP cycles, contributing to M&M reviews, and maintaining compliance with NICE guidelines, RCoA and FICM standards, and Trust policies.

·       Ensure all clinical practice reflects the principles of GMC Good Medical Practice.