The intensive care module, with the option of acquiring additional qualifications in intensive care, can also be completed separately as a one- or two-year fellowship. A purely anaesthesiological curriculum is offered in the two-year advanced cardioanaesthesiology fellowship.

Prerequisites for application are
▪ Acquisition of the specialist qualification in anaesthesia within the last 3 years,
CME certificates of continuous education in line with the duration of work as a specialist,
completed or ongoing doctorate,
German language skills at C1 level and
English language skills at B2 level.

The DHZC is an equal opportunities, equal rights and diversity employer and has fully committed itself to these ideals by signing the Diversity Charter.

The modular fellowship in cardioanaesthesia and intensive care is designed as on-the-job training. Supplemented by curricular teaching units, the training content relevant for cardioanaesthetists is taught in a clinical context. The fellow works full-time. Payment is based on the collective agreement for specialist physicians (Ä2). After adequate training, the Fellow will be expected to participate in on-call and on-call duty with background support from Senior physicians in the Department.

During the intensive care training, the Fellow will learn the specifics of cardiovascular and thoracic surgical intensive care in addition to the content required by the Berlin Medical Association's intensive care training regulations.

At the beginning of the training, based on the Fellows' previous experience, they will be trained in the intensive care unit, with a focus on haemodynamic monitoring and the recognition and treatment of typical cardiovascular intensive care medical conditions.

The techniques and procedures of advanced haemodynamic monitoring and management are a central part of the training, which runs as a common thread through the entire two-year fellowship. From the outset, the fellow is involved in the instrumentation, application and interpretation of these measures in the day-to-day work of intensive care and surgery, learning them in a didactically sound and constantly supervised environment.

Initially, the fellows learn about the measures for treating specific conditions (including postoperative low cardiac output syndrome, cardiogenic shock, ARDS) in addition to routine postoperative care after elective cardiovascular surgery, and will be able to implement these independently in the course of their intensive care training. Subsequently, the focus of further qualification will be on special surgical and intensive care procedures (transplantation, LVAD, ECMO).

In addition, the Fellows will be taught the basics of transthoracic echocardiography by participating in the TTE basic course (PFE module 1), training on an ultrasound simulator and bedside teaching. After appropriate training, it is expected that the Fellow will supervise and instruct doctors in further training outside of core working hours. The continuous availability of a Senior physician on call for intensive care medicine is guaranteed.

The first few months of the anaesthesiology fellowship module focus on preoperative evaluation and optimisation of cardiac surgery patients as well as anaesthesiological care during standard cardiovascular procedures. In addition, a focus is placed on early post-anaesthesiological care and pain therapy of uncomplicated and, in particular, fast-track surgical procedures in the PACU, which is connected to the operating theatre.

Risk assessment, prevention and treatment of postoperative delirium and postoperative cognitive deficits (POCD) are particularly emphasised training components in this context.

Participation in an ACLS provider training course according to AHA guidelines and in a GCP basic course is supported by the clinic and is required by the end of the fellowship.

During the anaesthesiology fellowship module, the fellows receive comprehensive theoretical and practical training in transesophageal echocardiography by participating in the clinic's echocardiography course (PFE modules 3 and 4), in regular internal echocardiography reviews, as well as through simulator training on the department's own simulator and, above all, through daily hands-on training in the operating room. The case numbers required for certification in transesophageal echocardiography according to the criteria of the EACTAIC / EACVI and the DGAI are easily reached by the fellows over the course of the year. It goes without saying that the fellows receive extensive training in the correct acquisition, manipulation and interpretation of echocardiographic 3D data sets.

The time-critical coagulation management of cardiac surgery patients, including the appropriate and situation-specific use of available point-of-care diagnostics in daily practice, is taught and implemented. Of course, this also includes acquiring the expertise for the perioperative care of patients with HIT II, antiphospholipid syndrome, and other acquired and congenital coagulation disorders.

From the fourth month of training in the operating theatre, there is a slow transition to individualised, focused supervision. The Fellow works increasingly independently and autonomously in their daily clinical routine. Echo examinations in the sense of a ‘comprehensive exam’ according to the guidelines of the American Society of Echocardiography (ASE) are independently acquired, evaluated and electronically reported by the Fellows with decreasing support from Senior physicians.

The performance and learning progress of the fellows are continuously evaluated and accompanied in a motivating way. In addition, a formal evaluation meeting with one of the programme directors takes place after six months, with an additional opportunity for mutual feedback. After six months of echo training, the echo competence acquired so far is assessed in a clinical assessment in order to be able to make adjustments to the focus as necessary in the further course and to identify training content that requires particular support.

Towards the end of the anaesthesiology year, the fellow will also be supervised during increasingly demanding and complex procedures such as on- and off-pump assist implantations, thoracic transplantations, thoracoabdominal aortic procedures with neuromonitoring and spinal pressure monitoring, and pulmonary thromboendarterectomy in deep hypothermia.

The academic curriculum is covered by weekly internal training events, echo reviews, cross-departmental case conferences and 1:1 teaching in clinical practice.

The topics and scope of the theoretical study programme are based, among other things, on the recommendations of the DGAI for the teaching content of cardioanaesthesia. The fellow is encouraged to contribute to the Academy for Cardiotechnology associated with the DHZC by giving their own presentations as part of the journal club, case presentations and supporting the teaching staff.

During the two-year training programme, the fellows will, of course, be given the opportunity to actively or passively participate in scientific conferences on cardioanaesthesiological and echocardiographic topics. Participation in scientific studies, quality management projects, publication of case reports, collaboration in the creation and maintenance of internal treatment guidelines (SOPs) and other academic projects are explicitly supported and encouraged.

Month 1 - 2

Familiarisation: instruction in accordance with the German Medical Devices Act (MPG), standard operating procedures (SOPs), ‘nursing day’, sitting in on respiratory therapists, training in cardiopulmonary resuscitation (CPR) after cardiac surgery
Focus on monitoring: advanced haemodynamic monitoring (including PAC, transpulmonary thermodilution), neuromonitoring (processed EEG, NIRS)
Targeted haemodynamic therapy, therapy of postoperative haemorrhaging (including POC diagnostics/ROTEM), scoring systems, sedation management

Months 3–6

Focus: specific diagnostics and therapy of perioperative cardiac insufficiency: left-heart failure, right-heart failure, cardiac arrhythmias, electrotherapy
Focus on ventilation and (extracorporeal) organ replacement therapy / mechanical circulatory support: veno-arterial and veno-venous ECMO (including organ protection, coagulation therapy, weaning), IABP, continuous and intermittent renal replacement therapy, shadowing in bronchoscopy

Months 7–12

Focus on transthoracic echocardiography: participation in echo course PFE module 1, echocardiographic examinations under supervision
anti-infective therapy, nutrition, taking over shift leadership in night duty
Focus on intensive care therapy after heart and lung transplantation: LVAD implantation, thoracoabdominal aortic surgery (including CSF drainage)
Focus on ‘chronic critical illness’: prolonged weaning, pain therapy in the intensive care unit, therapy of delirium, changes in therapy goals, participation in a meeting of the clinical ethics committee

Month 1
Familiarisation: IT infrastructure, local standards, SOPs, instruction according to MPG

Month 2
Continuation of familiarisation: rotation in cardiotechnology, familiarisation with PACU
Start of active participation in internal training, intensified involvement in patient care

Month 3
Coronary surgery (CABG, OPCAB), intensified TEE training on patients, start of participation in shift/on-call duties

Month 4
Aortic valve procedures (SAVR, TAVI)

Month 5
Interventional and non-thoracic aortic procedures (TEVAR, EVAR, BAA)

Month 6
Mitral/tricuspid valve (MKR/E, TKR/R), ascending and aortic arch surgery

Month 7
Minimally invasive heart surgery (MIC-MKR/TKR/AKE, MIDCAB) incl. SVC cannulation, retrograde transjugular cardioplegia, endoclamping

Month 8
CIED procedures (implantation, explantation of systems, probe extractions/revisions) and interventional catheter procedures (e.g. Angiovac)

Month 9, 10
Mechanical support procedures (VAD, ECMO, Impella), complex redo surgery and surgery on multiple valves, pulmonary thrombendarterectomy

Month 11, 12
Thoracoabdominal aortic surgery incl. neuromonitoring (spinal catheter, evoked potentials), echo-guided interventions (MitraClip®, ViV procedures, PVL closures etc.), thoracic transplantations
 

Fellows also assist with thoracic surgery procedures throughout the entire anaesthesiology training year. This includes, among other things, single-lung ventilation in the context of minimally invasive surgery, thoracoabdominal aortic surgery, lateral pericardectomy, thoracic transplantation and, as a rule, complications surgery (hernias, decortication, resection).

All senior clinicians at the clinic meet the DGAI criteria for anaesthetists with particular expertise in cardioanaesthesia and hold certificates in transoesophageal echocardiography, at least from the EACTAIC/EACVI and/or the NBE, and sometimes also from the DGAI. Prof. O'Brien has 36 months of training authorisation in anaesthesiology and 24 months in intensive care medicine. At least one member of the fellowship faculty is available 24/7. The fellowship directors devote a significant portion of their clinical and non-clinical activities to the practical and theoretical training of the fellows, as well as to the maintenance and further development of the fellowship programme.