North West School of Surgery - Cardiothoracic Surgery

North West Postgraduate Medical and Dental Education

Key Contacts

NHS England – North West Programme Support for Cardio-thoracic Surgery

Training Rotation

The North West Cardio-thoracic Surgery Training Programme provides one of the most comprehensive training programmes for Cardiothoracic Surgery in the UK, with opportunities to develop subspecialty interest in all areas of cardiac and thoracic surgery including;

• Major aortic surgery
• Complex mitral valve surgery
• Minimally invasive cardiac surgery including robotic surgery
• Complex congenital surgery
• Heart and lung transplantation
• VADs and ECMO support
• Advanced VATS surgery
• Robotic thoracic surgery
• Advanced lung cancer resections

 
Close links with Liverpool and Manchester Universities and the Paterson’s Institute of research (Christie Hospital) along with the excellent transplant research lab offer excellent opportunities to pursue academic aspirations. The program offers opportunities to actively participate in the Northwest Cardiac / Thoracic surgery audit, North West Quality improvement program, North West Thoracic Society meetings and North West regional teaching sessions. The Northwest consortium also offers excellent high-quality educational resource which is highlighted below.

The specific program for any individual resident doctor will be developed to reflect his/her specific training aspirations, commensurate with the overall requirements of the curriculum and the availability of specific training opportunities. 

Given the size of the region and the sub-specialty strengths, it is possible for doctors to specify from the outset their preferred training program to include either general cardiac surgery, thoracic surgery or congenital surgery.

At present there are two sectors:

• The East Sector (former North Western Deanery) at University Hospital of South Manchester, Manchester Royal Infirmary and Blackpool Victoria Hospital.
• The West Sector (former Mersey Deanery) at Liverpool Heart and Chest Hospital and Alder Hey Children's Hospital.

We take new resident doctors at ST1 level as run-through resident doctors who will automatically progress to ST3 on successful completion of their ST2 year. ST1 and ST2 doctors are allocated to posts that are on the Core Surgical Training programmes of their respective sectors.

Rotation Templates

The below programmes are templates and do not indicate the exact order of placements within a training programme. They are subject to change to suit individual doctors requirements.

Cardiothoracic Surgery Training Rotation (Intention to become a cardiac surgeon):

• ST3 - Thoracic surgery LHCH
• ST4 - 6/12 Congenital Cardiac Surgery Alder Hey / 6/12 Cardiac Surgery LHCH
• ST5 – 1-year cardiac surgery Wythenshawe
• ST6 – 1-year cardiac surgery Blackpool
• ST7 – 1-year cardiac surgery LHCH
• ST8 – 1-year cardiac surgery any cardiac unit tailored to career aim

 
Cardiothoracic Surgery Training Rotation (Intention to become a cardiac surgeon):

• ST3 - Thoracic surgery Wythenshawe
• ST4 - 6/12 Congenital Cardiac Surgery Alder Hey / 6/12 Cardiac Surgery MRI
• ST5 – 1-year cardiac surgery Blackpool
• ST6 – 1-year cardiac surgery LHCH
• ST7 – 1-year cardiac surgery Wythenshawe
• ST8 – 1-year cardiac surgery any cardiac unit tailored to career aim

 
Cardiothoracic Surgery Training Rotation (Intention to become a thoracic surgeon):

• ST3 - Thoracic surgery LHCH
• ST4 - 6/12 Congenital Cardiac Surgery Alder Hey / 6/12 Cardiac Surgery LHCH
• ST5 – 1-year thoracic surgery Wythenshawe
• ST6 – 1-year thoracic surgery LHCH
• ST7 – 1-year thoracic surgery LHCH
• ST8 – 1-year thoracic surgery any thoracic unit tailored to career aim

 
The above programmes are templates and do not indicate the exact order of placements within a training programme. They are subject to change to suit individual doctor’s training needs and requirements.

Resident Doctor Outcomes

In the last 3 years we have had two doctors win the McCormack Medal for their performance in the FRCS CTh examination.

Four of six doctors receiving CCT from the region in the last three years are now working as cardiac or thoracic surgery consultants with the two most recent CCT holders both in post CCT fellowships.

Example of and cardiac themed ST8s cardiac experience:

Primary Operator	All cardiac cases as primary operator
All	331
Isolated CABG (on/off pump)	214
Isolated AVR	61
Isolated MVR	14
Other (Ao Root etc)	6
Combined cases	36

Example of and thoracic themed ST8s thoracic index case experience

Procedure (Thoracic)	Number	Mortality %	CVA
Anatomical Lung Resection (VATS/robotic/open)	437	3	0
Correction of Pectus Deformity	12	0	0
Decortication	21	0	0
Thoracotomy for Trauma	9	0	0
Chest Wall Resection and Reconstruction	20	0	0
Tracheal Resection	2	0	0
Surgery of Secondary Pneumothorax (VATS/open)	20	0	0

Strengths of the North West Training Programme

• Comprehensive training in cardiac, thoracic, congenital and transplantation surgery
• Ability to fully train a cardiac or thoracic surgeon
• Ability to provide subspecialty training in Off pump, Aortic, Mitral valve, VATs / Robotic surgery and Transplantation
• Geographic location of hospitals in the programme, excellent motorway network
• Ability to provide training to suit needs of resident doctors with compliant rota (high trainer / resident doctor ratio)
• Excellent Educational Resource as above
• Twice a year assessments
• Track record of high pass rate at FRCS(CTh) and Consultant appointments
• Opportunities for academic development of resident doctors
• Resident doctor representation on regional training committee
• Deanery / School of surgery support
• Centre for Intercollegiate exam (Liverpool / Manchester)
• Simulation centres and resources at several units to provide simulated training

Hospitals on the Cardio-thoracic Surgery rotation

Site	Trust
Alder Hey Children's Hospital	Alder Hey Children's NHS Foundation Trust
Blackpool Victoria Hospital	Blackpool Teaching Hospitals NHS Foundation Trust
Liverpool Heart and Chest Hospital	Liverpool Heart and Chest Hospital NHS Foundation Trust
Manchester Royal Infirmary	Manchester University NHS Foundation Trust
Wythenshawe Hospital	Manchester University NHS Foundation Trust

GMC Programme Code: NWE1041 (was MER970 & NWD905) and NWE1127 (Run-through (was NWD2474)).

Alder Hey Children's Hospital, Liverpool

Alder Hey Children’s Hospital is one of the largest children’s hospitals in Europe, and serves a population of around 7 million, covering the North West of England, North Wales and the Isle of Man. The Heart Centre at Alder Hey manages all aspects of congenital heart disease from premature babies, neonates to adolescents.

Alder Hey is the third largest centre in the UK, performing over 600 cardiac procedures / year including 100 neonates with an active programme of warm heart surgery, early extubation, valve repair, Norwood program. Alder Hey is one of six nationally designated respiratory ECMO centres in UK. There is a large chest wall (Pectus) and Paediatric Airway service. 

Resident doctors in Alder Hey are exposed to all aspects of congenital heart disease.  They are actively involved in pre-operative evaluation, intra operative surgical strategies, operative experience and immediate post-operative critical care management of the children. Opportunities are provided to perform paediatric cases as first operators or “part contribution” to the case. All three established consultants are keen trainers. 

Resident doctors attend two weekly MDTs where active participation is encouraged. They take part in the consent process for all patients and they participate in surgical service and interdepartmental teaching sessions with intensive care and cardiology. There are opportunities to participate in clinical and academic research using the links with the two local universities. Alder Hey has an innovative centre and 3D printing is routinely used for preoperative planning and teaching.

Adult Congenital Cardiac Service (ACHD) at the Liverpool Heart and Chest Hospital

Alder Hey’s congenital team also provides ACHD service at the LHCH, currently with one operating day, a clinic and an MDT with daily ward rounds. The operating opportunities would increase to two days a week in the very near future with the appointment of a fourth consultant. 

Strengths

One of the largest neonatal, paediatric and ACHD program in the country

Nationally accredited congenital training program in association with Newcastle Freeman congenital service

One of the only programs in the country to have two paediatric SCPs to relieve service commitments of resident doctors

Lancashire Cardiac Centre, Blackpool Victoria Hospital

The Lancashire Cardiac Centre is a separate division, within a purpose-built facility providing tertiary cardiothoracic surgical and cardiology services, within a district general hospital. It serves a population of approximately 1.6 million in Lancashire and Cumbria. The unit offers a full range of adult cardiac and thoracic services excluding transplantation and performs 1200 cardiac and 600 thoracic surgical procedures per year.

The unit comprises four cardiac surgeons, one thoracic surgeon and three cardiothoracic surgeons; currently in post is one locum cardiac and one locum thoracic surgeon. The Lancashire Cardiac Centre has a strong training ethos and its strengths include;

Cardiac Surgery

A “unit mission” to provide comprehensive minimal access surgery for all cardiac procedures;

• in the last year approaching 15% of ALL cardiac cases were performed via a minimally invasive approach.
• one of the largest and longest running thruport mitral centres in the UK, with experience of teaching/training a dedicated mitral fellow. The second largest recruiter to the UKMiniMitral trial with a dedicated, registrar led clinic associated with trial recruitment.
• regular partial sternotomy and/or right anterior thoracotomy approaches for aortic valve replacement performed by all surgeons, with experience of training in the techniques.
• an active MIDCAB and EndoCAB program.

 
A well-established mitral valve program; including dedicated cardiology support and regular MDT. Both conventional sternotomy and thru-port approach to a wide variety of surgical techniques for both repair and replacement.

The largest experience of aortic sutureless prosthesis use in the UK. Ongoing audit and research activity relating to this with invited presentation at the annual Perceval User Group and resident doctors abstracts accepted at international meetings (ie. SCTS and EACTS). This experience has been supported by the development of a high-risk aortic valve MDT.

An active aortic team providing both elective and emergency surgery. Attendance and contribution to regional vascular multi-disciplinary team meeting and both National and Regional aortic forums.

Surgical involvement with a very active and growing TAVI program, including one of the largest and most successful non-femoral series.

Surgical treatment of atrial fibrillation with a joint EP cardiology MDT, VATs and convergent surgical approaches.

Thoracic surgery

Comprehensive clinic and MDT service covering local and all regional hospitals. Established, successful VATs lobectomy program, accounting for over 85% of all relevant cases.

Daily dedicated thoracic surgical theatre lists. High risk thoracic surgery MDT.

Local (Blackpool Victoria) and regional (Preston) emphysema MDTs with VATs lung volume reduction surgery and endobronchial valve therapy available respectively.

Workforce / Teaching

The Lancashire Cardiac Centre has its own independent educational facilities; whilst maintaining access and involvement in the wider educational activities of the trust (i.e. Weekly grand round, weekly senior clinician educational event, active simulation suite and program).

The Lancashire Cardiac Centre has a dedicated wet lab for individual use by resident doctors. We regularly host wet lab-based training events both as part of the north west regional training program and separately for local interdisciplinary training. The formal local educational program is identified within the weekly time-table for protected teaching.

Recently established interdisciplinary cardiothoracic study evenings; planned to run quarterly focused on the interdisciplinary (medical, nursing, perfusion, etc) teaching within the department.

Liverpool Heart and Chest Hospital

Liverpool heart and chest hospital (LHCH) is one of the largest single centre cardiothoracic units in the UK.  It provides tertiary services in cardiac and thoracic surgery as well as cardiology and respiratory medicine to a population of around 2.8 million in Merseyside, North Wales, some of Cheshire and Lancashire as well as the Isle of Man.  It offers a full range of adult cardiac and thoracic surgery excluding transplantation.  LHCH performs around 3000 cardiac operations a year and 1300 thoracic procedures.

Consultant staffing currently compromises 14 cardiac surgeons, 5 thoracic surgeons and 1 cardiothoracic surgeon. The strengths of LHCH as a training unit are:

Cardiac Surgery

The largest aortic service in the UK including complex thoracoabdominal procedures and endovascular work. There is also a separate consultant rota for emergency aortic work with a busy workload.

A large amount of off-pump coronary artery surgery with one of the largest experiences in the UK and Europe.

A team of specialist mitral valve surgeons offering a full range of complex techniques.

A well developed minimally invasive mitral valve programme.

Minimal access aortic valve surgery.

Epicardial pacing.

Robotic cardiac surgery including mitral valve surgery and CABG.

A transcatheter aortic valve implantation service including transfemoral and transapical approaches

Thoracic Surgery

One of the highest volume thoracic surgery units in the UK.

Lung volume reduction surgery, endobronchial valve therapy and an emphysema MDT.

A well established VATS lobectomy service with all early stage lung cancer patients being offered minimally invasive surgery.

Chest wall resection and sarcoma surgery and coverage of the sarcoma MDT.

An advanced colorectal MDT for management of metastasis and complex cases.

A high risk MDT attended by surgeons, anaesthetists, radiologists and surgical resident doctors.

Comprehensive cover and outreach clinics and MDTs for all regional hospitals.

Robotic thoracic surgery including major lung resections and complex mediastinal work.

Workforce

LHCH has made some major changes in its workforce in the last few years to improve both training and patient care.  There is now a well developed team of cardiac and thoracic advanced nurse practitioners who cover both cardiac and thoracic wards as well as doing some outpatient work.  This team supports the surgical resident doctors to maximize their training and learning opportunities.

There is now also a team of advanced critical care practitioners who provide cover for the post operative cardiac care unit (POCCU).  

Teaching

There is a weekly consultant delivered teaching programme covering all aspects of adult cardiac and thoracic surgery as well as a monthly journal club

All middle grade cardiothoracic doctors at LHCH are given to opportunity to have 6 monthly assessments in the knowledge of both cardiac and thoracic surgery.

These assessments take the form of 30 minutes viva’s in both cardiac and thoracic surgery based on the FRCS CTh examination format. Feedback has always been that resident doctors find these very useful and indeed two doctors have won the gold medal for the exam in the last 3 years.

Manchester Heart Centre, Manchester Royal Infirmary

Manchester Heart Centre (MHC) encompasses both the department of Cardiothoracic Surgery and the Department of Cardiology. MHC is a major provider of cardiac care to over 10,000 new patients a year. The Department of Cardiothoracic Surgery offers a full range of Adult Cardiac Surgery with the exception of transplantation and performs 700 - 800 cardiac surgical cases each year – including a substantial element of non-elective and emergency surgery.

Manchester Royal Infirmary offers an extensive Aortic Surgery Service involving close collaboration between Cardiac Surgery and Vascular Surgery. As a leading Tertiary Centre for a variety of Medical Services including Nephrology and Haematology, patients with extremely complex medical issues who require Cardiac Surgery are cared for by the extensive Multi Disciplinary Team within Manchester Royal Infirmary.  A number of MDT meetings have been established as well as a Surgical Activity Meeting in order to provide optimal management of patients with complex medical issues. 

A significant volume of surgery for Infective Endocarditis is undertaken within the Department. There is a substantial Mitral Valve service including complex mitral valve repair. Excellent training in Off-Pump Coronary Artery Surgery has provided over many years.  

An extensive range of TAVI is delivered in close collaboration between Cardiology and Cardiac Surgery and Cardiac Surgical training in TAVI is available. Manchester Royal Infirmary together with Salford Royal Infirmary is an Adult Major Trauma Centre. There has been a very significant year on year increase in Cardiothoracic Trauma admissions since Trauma Centre status was established. There are valuable opportunities for training in the management of blunt and penetrating Cardiac and Thoracic Trauma.

There are important opportunities for research within Manchester Heart Centre. Research studies include both surgical and cardiology studies in both acute/emergency and elective patient groups. These include;

• Heart Failure
• Interventional Cardiology
• TAVI
• Cardiothoracic Surgery
• Quality of Life and Rehabilitation
• Wound Care
• Aortic Surgery

There are 5 Consultant Cardiac Surgeons within the department.

Wythenshawe Hospital, Manchester

The hospital is a tertiary referral centre and provides a comprehensive service in cardiothoracic surgery.  The strength of the Wythenshawe unit lies in the ability to provide training across all aspects of Adult Cardiothoracic Surgery with a strong Transplantation unit.  The surgeons in partnership with Cardiologists offer an Advanced Heart failure service including Mechanical Assist Devices.  The unit is one of the specialized service providers of ECMO in the country and there is a 29 bedded Intensive care unit dedicated to the care of the above patients.

The hospital has a catchment population of 3.2 million for specialist services. Consultant staffing includes 7 cardiac surgeons and 6 thoracic surgeons. The majority of the cardiac surgeons are involved in the transplant program with a strong thoracic interest and presence as well. The service performs 1100 cardiac, 1500 thoracic and about 50 heart / lung transplants per year.

Cardiac Surgery

The strengths of the service include the following:

• Heart and Lung Transplantation
• Mitral valve repair
• Complex aortic surgery
• TAVI
• Heart assist device
• ECMO

 
Thoracic Surgery

Wythenshawe has been the centre with the highest number of Lung cancer resections in the country in the last two National publications with excellent survival results.

Highlights of the Service include

• An established Minimal Access Service which includes – VATS lobectomies and lung resections, VATS thymectomies, VATS diaphragm plications
• A large volume open surgical practice including complex resections, redo operations, multi disciplinary procedures
• Metastasectomy practice with the Christie
• Sarcoma/Chest wall service – principal referrals from Christie
• 24/7 Acute Airway intervention service
• Complex procedures with spinal surgeons, cardiac surgeons, plastic surgeons
• National Aspergillus centre with a Surgical MDT for relevant cases
• Sectorized model of MDTs – with videolinking to allow 2 consultant presence at all MDTS
• High Risk MDT – the first of its kind nationally – to address complex cases with anaesthetists, respiratory physicians
• Emphysema MDT – monthly with access to surgical LVRS, Endobronchial valves
• Cardio-thoracic Surgery Curriculum

Cardio-thoracic Surgery Curriculum

For the most up to date syllabus and curriculum, please visit the ISCP website

Certification Guidelines:

Post-August 2021 curriculum ("new" curriculum)

National Cardio-thoracic Surgery Recruitment

National Recruitment for ST1 and ST4 Cardio-thoracic Surgery is managed by NHS England – Wessex. As of 2023 there will be no recruitment at ST3.

NHS England – Wessex's Recruitment website

National NHS England Recruitment Website (includes Timelines, Guidance, Competition Ratios etc.)

ST1 Cardio-thoracic Surgery person specification updated 2 Dec 2024

ST4 Thoracic Surgery person specification updated 2 Dec 2024

JCST:Surgical selection in the UK

National Congenital Cardiac Sub-Specialty Training

The 'Northern' Congenital Cardiac Sub-Specialty training Programme is a 2 year programme across two sites in the North of England. It offers 1 year of sub-specialty training in each hospital, with the first year at Alder Hey Children’s Hospital in Liverpool and the second at Freeman Hospital in Newcastle. There are excellent training opportunities on both sites, and both centres have a track record of successfully training several UK paediatric surgeons over the past 5 years.

Recruitment is managed by NHS England – Wessex.

Click here to go to NHS England – Wessex's Recruitment website

 

NHS England – North West Links

Training Support Network

SuppoRTT (Supported Return to Training)

Study Leave | Email: england.studyleave.nw@nhs.net

Out of Programme (OOP) information

Less Than Full Time (LTFT) Training | Email: england.ltft.nw@nhs.net

Policies and Procedures

Revalidation | Form R | Email: england.revalidation.nw@nhs.net

Leadership courses (Medical Leadership Fellowships, Postgraduate Module in Medical Leadership)

Education courses (PG Certificate in Workplace Based Postgraduate Medical Education Fellowship) | Email: england.facultydevelopment.nw@nhs.net

Careers advice | england.careers.nw@nhs.net

Intra-Deanery Transfer Policy for transferring between sectors within NHS England – North West (on Policies and Procedures page under 'Intra-LETB Transfer')

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Page last updated: 5 January 2024