Introduction
Sarah Ibitoye is a consultant in Acute Medicine and Perioperative Medicine at North Bristol NHS Trust.
What got you interested in perioperative medicine?
During my Acute Medicine registrar training I was called to see a lot of unwell surgical patients. I quickly noticed a pattern, most of these referrals came at a time when the patient had become critically unwell, and usually earlier intervention could have prevented the deterioration. I realised that this was a big gap in care where a medic, someone like me, could make a big difference to patient outcome and experience.
How did you train in perioperative medicine and what other avenues are there?
Perioperative medicine wasn’t a recognised specialist skill at that time, so I applied to SAM to have it added. Then I sought out a Perioperative Medicine fellowship, and was fortunate to find an opportunity at North Bristol NHS Trust in a new and expanding Perioperative Liaison service led by Geriatricians. I completed the fellowship over 20 months as a 60% less than full time trainee (1 year full time equivalent), with GIM on-calls throughout. This was considered to be my GIM year of Acute Medicine training, so it did not push back my CCT date. The fellowship included experience in a complex pre-operative clinic, and inpatient liaison to vascular, general surgery and trauma. I regularly collaborated with surgeons and anaesthetists to establish patient specific plans, and this helped me to learn a lot about how different surgeries can affect our physiology.
To support my clinical experience, I also completed a Postgraduate Diploma in Perioperative Medicine with University College London – a PG Certificate was required at the time of my training. This degree helped to guide me through the extensive evidence base for perioperative medicine, and challenged me to critically appraise the literature and consider how to optimise my clinical practice and further develop our service. This was expensive, but I managed to get some funding (£1200) through a local bursary. A formal qualification is no longer necessary, but if, like me, you benefit from structured learning and external pressure to do the reading, then you may find it beneficial.
What challenges did you face?
As this was a new field, finding clinical experience was a challenge initially. However, now there are far more physicians involved in perioperative care and thus more training opportunities either for block or sessional exposure. Personally, I would recommend a block placement for the best training experience, and start with tertiary centres which are more likely to have Perioperative services.
As a physician working in a surgical field, I often found myself to be the outsider. But during my fellowship I was able to build up professional relationships with surgeons and anaesthetists, leading to a better workplace experience and improved collaboration on patient care. These relationships now help me in my Acute Medicine work too.
How does this fit into your consultant working?
As a consultant I have a fixed day a week (~2.25 PAs) working in Perioperative Medicine, this includes Complex Preoperative Clinic, Geriatric Trauma and Surgical Liaison (vascular, general). Our Perioperative team also have a weekly case discussion meeting to support the ongoing development of trainees and consultants alike.
Within my Acute Medicine role, my knowledge of perioperative medicine helps me to support the medical registrars when they are called to review surgical patients. Within our team I provide expertise for looking after trauma cases (e.g. chronic subdural haematoma not requiring surgery) that are often cared for in a medical setting. In addition, my established relationships with surgical colleagues can help when there is uncertainty or disagreement about the best place of care for patients with both surgical and medical pathology.
Do you have any tips for trainees who may be interested in Perioperative Medicine?
If you are considering perioperative medicine then first try out the free course on Future Learn, this is a basic introduction but gives you an idea of some of the themes. Other helpful resources include TRIPOM, EBPOM and Age Anaesthesia.
Reach out to a Perioperative Physician in your region and arrange some shadowing. This may be an Acute Medic or Geriatrician, if you are not sure who can help then it is worth asking your TPD or contacting clinical leads in your local hospitals to ask for recommendations, in my experience tertiary centres are more likely to have opportunities. Building connections with local Perioperative physicians will help you to find out about fellowship and training opportunities. If you’re in the Severn region then feel free to get in touch with me.
