SCTS Bulletin Issue 11

the

bulletin Society for Cardiothoracic Surgery in Great Britain and Ireland

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human r ac e

Issue 11

January 2022

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January 2022

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bulletin

In this issue ...

5 6 7 7 10 13 14 16 18

Only for one stitch Anupama Barua

Simon Kendall, Maninder Kalkat

38

Rise and Bike – Enhances work life stability

Enhancing the working lives of cardiothoracic surgery practitioners Narain Moorjani

39

National Cardiac Surgery Clinical Trials Initiative Update Suraj Pathak, Sue Page,

From the President Simon Kendall From the President and Meetings Secretary

Update from SAC Marjan Jahangiri Cardiothoracic Audit Update Doug West SCTS Surgical Tutors’ Report

Debbie Harrington, George Asimakopoulos

Cardiothoracic Interdisciplinary Research Network (CIRN) Gavin Murphy, Ricky Vaja,

20

SCTS Transplant Education Lead Report

21

Women in Cardiothoracic Surgery Network – On behalf of the WICTS subcommittee

21 22

58

A call for reflection, together

Importance of student mentorship in cardiothoracic surgery Denis Ajdarpasic,

Mohammad Hawari

Chiemezie Okorocha

SCTS Ionescu Traveling Fellowship – Early Thoughts on the Cleveland Clinic Way

60 62 64 65 66

42

Aortic Dissection Awareness Day UK 2021 – In Pictures Christina Bannister

67

SCTS Ionescu – NTN Travelling Fellowship – The Barts Experience Tom Combellack

44

East Midlands simulation training day for cardiothoracic trainees

68 68

SCTS Ionescu Fellowship Anoop Sumal

Maninder Kalkat

Sarah Murray, Gavin Murphy

Annual meeting 2021 Daisy Sandeman

Luke J. Rogers, Julie Sanders, Rosalie Magboo, Keith Wilson, Jeremy Dearling

40

Adam Daly

Mayooran Nithiananthan, Adam Szafranek, Sri Rathinam

45

Innovation is in the air Hazem Fallouh The Oath of Hippocrates Final Ionescu Fellowships 2021 Carol Tan SCTS Ionescu FY Fellowship Jason Trevis SCTS Ionescu Travelling Fellowship University Hospital of Zurich, Zurich, Switzerland Kudzayi Kutywayo

‘A Quote from the Operating Room’ – My Medical Student Fellowship Kirstie Kirkley

Maximising the FY2 Cardiothoracic Surgical Placement Jeremy Chan, Najeeba Lallmahomed, Harry Smith, Amer Harky

69

46

SCTS Ionescu Final Medical Student Fellowship 2021 Award George Liu

A thoracic specialist physiotherapist’s reflection of redeployment during the COVID-19 pandemic Michelle Gibb

70

The future is bright, the future is ST1 entry Duncan Steele, Abdul Badran

48

SCTS Ionescu Medical Student Fellowship 2019 – Congenital Cardiac Surgery, Alder Hey Hospital, Liverpool

Robotic Transcranial Doppler: back to the future? Niamh Hynes

SCTS INSINC Medical Student Committee – What we have achieved in year one Kirstie

50

Robotic cardiothoracic surgery

India Premjithlal Bhaskaran

51

Cardiothoracic training programmes in Europe – a mixed bag Miia Lehtinen,

Espeed Khoshbin

Karen Booth, Narain Moorjani

Kirkley, Josh Brown, Amelia Websdale, Holly Dejsupa, Karen Booth, Farah Bhatti

24

Society for Cardiothoracic Surgery in Great Britain and Ireland

35 36

From the Editor Indu Deglurkar

Challenging normality as we pioneer – Medical Student Education Day

Karen Booth, Farah Bhatti

52

SCTS Education Report

28

The journey of a thousand miles starts with a single step Sri Rathinam

54

30

Equality, Diversity & Inclusion in Cardiothoracic Surgery in the United Kingdom: A baseline analysis

56

Sri Rathinam, Carol Tan

Society for Cardiothoracic Surgery in Great Britain and Ireland

SCTS, 5th Floor, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PE T: 020 7869 6893 E: sctsadmin@scts.org W: www.scts.org

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Tom Eadington

Jason Trevis, Abdul Badran

26

Indu Deglurkar, Narain Moorjani

3

Improving decision-making and sharing of information in aortic disease for patients and clinicians: the DECIDE-TAD initiative Riccardo Abbasciano, Gareth Owens

Setting up a new service in a COVID crisis; a challenging task at the outset of new consultant post M. Asghar Nawaz Introductory guide for ST1 training to be published Devan Limbachia, Andrew Jones,

Walid Mohamed, Duncan Steele, Abdul Badran

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Marian Ionescu Student Fellowship in Congenital Cardiac Surgery, Leeds Teaching Hospital Rishab Makam

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My Medical School Elective During the COVID-19 Pandemic Hanad Ahmed

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Coming home for an elective in cardiac surgery – SCTS Ionescu Fellowship Winners 2021 Report Josh Brown

75 75 76 77 78

Ionescu Fellowship Report Momna Sajjad Raja New consultant appointments Gaudeamus igitu – The Student Song New roles and appointments / Glossary Crossword, Sudoku, Quick Crossword

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January 2022

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From the Editor Indu Deglurkar, Publishing Secretary, SCTS

“A smooth sea never made a skilled sailor.’’ – Franklin D Roosevelt

H

appy New Year. As we embark into 2022, the COVID pandemic continues to wreak havoc with the Omicron variant. The toll on well-being, lives and resources continues relentlessly. Change is not easy, but the pandemic has rapidly accelerated behavioural changes in the way we work and emphasised the importance of the deeper connection of our interpersonal meetings. We have definitively moved into a new hybrid horizon at work, with a mixture of virtual and physical interaction.

It has been a difficult year beyond the problem of the pandemic. Our President Simon Kendall’s article highlights the main themes identified as sources of conflict and the importance of teamwork.

Narain Moorjani as Honorary Secretary describes the numerous initiatives taken by the SCTS to develop a diverse workforce and provide equal opportunities. 2022 will see the introduction of the themed ST4 entry into Thoracic surgery and the ST1 entry in Cardiac surgery. The refreshing enthusiasm displayed by the medical students in the INSINC committee is indicative of very engaged and highly motivated students.

The reports from the various committees emphasises the hard work and drive to ensure overall development as a specialty.

We publish the results of the first ever national SCTS E, D & I survey in Cardiothoracic surgery, with an excellent response rate of 31.9% from a naturally diverse group of Surgeons from 44 nations. The rich insight and information derived from this survey highlights the current dynamics in our specialty and the challenging work that is needed to make our specialty equitable and enjoyable. We welcome letters to the Editor with your ideas to develop various work streams and collectively make a difference.

as the aspirational “dream environment.”

Coincidentally, the article by Anupama Barua highlights the difficulties faced by women in surgery and Chimezie Okorocha’s article makes an impressive comparison of various strategies adopted by the RCS and SCTS in promoting E, D & I. I would like to thank our patron Mr Marian Ionescu for his enriching suggestion to insert the Hippocratic Oath and the Student song into the Bulletin, to add a scholarly look to the Fellowship supplements. I am hoping the excellent articles in this Bulletin will evoke comments, suggestions and responses that will contribute to the improvement of our fraternity.

Finally, the very act of making a new year resolution invites a degree of honesty and acceptance of the current state and a key to improvement.

As we navigate through turbulent times, it is well within our gift to make that New Year resolve that we will contribute to a congenial, collaborative, creative, positive and vibrant environment and move closer to our dream workplace. Harmonised goals with an agreement on clear ground rules and agreeing to norms of behaviour is crucial for building the psychological safety in teams.

Trust and respect are critical and let us dedicate ourselves to strengthen our teams.

“As we navigate through turbulent times, it is well within our gift to make that New Year resolve that we will contribute to a congenial, collaborative, creative, positive and vibrant environment and move closer to our dream workplace. Harmonised goals with an agreement on clear ground rules and agreeing to norms of behaviour is crucial for building the psychological safety in teams.”

Equality, Diversity and Inclusion is not all about black and ethnic minority and should not actually become a barrier between people. These issues have been globally prevalent for centuries but were brought to the forefront during the COVID pandemic. We are one race of distinctly diverse individuals who should maintain their individuality and be allowed to flourish. We are capable of achieving this cultural competence and I see the 269 suggestions received from the members

Look forward to hearing from you. n indu.deglurkar@wales.nhs.uk

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From the President Simon Kendall

W

e emerge into 2022 with our health services struggling to cope with the needs of the population and the reduced establishment of beds and workforce.

All the surgical specialties are facing significant challenges and in our specialty it is cardiac surgery that has the extra challenge with its dependency on level 3 facilities. Our colleagues in intensive care have faced unprecedented demand on their expertise trying to give access to all patients needing their care, including patients following cardiac surgery, much of which is done wearing the uncomfortable and draining personal protection equipment.

Our specialty is challenging on its own merits – major surgical interventions requiring great skill, knowledge, experience, dedication and teamwork.

The first four attributes are almost taken for granted; We are blessed with the most able, intelligent, hard working colleagues which correlates with all the extreme hard work and commitment needed to achieve such responsible roles in a tough specialty. We are admired by other surgical specialties with our approach to patient care and training. The challenging year and the solutions and standards to support units in the pandemic and the toolkit to enhance training and emancipate our allied health care providers have been regarded in a very positive light.

SCTS has also addressed the needs of

the society and has worked with the SAC in the ST4 Thoracic surgery pilot to support specialist thoracic training.

However, our specialty appears to struggle with the fifth attribute – Teamwork.

Why is it that so many units have issues with team working when we all have a strong commitment to patient care as well as possessing all those other skills?

There are five main themes identified as sources of conflict in medical teams: Information – lack of information, lack of communication, choosing to use different information Values – interpersonal, interdisciplinary, inter specialty, organisational i.e. focus on money rather than quality of care Interest – roles, status, private practice, research, innovations, personal life Relationship – a clash of personalities, egos, allegiances Structural – what we all endure with lack of beds, staff, theatre space, funding etc It is not surprising that the impact of the pandemic has amplified these themes. We have not been able to meet with each other to share information, to share our values, to share our interests and to maintain relationships. Leadership

“Together we can make the difference to our working environment and, where necessary, transform them and maintain them as safe, supportive and enjoyable places to work for everyone in the team.”

development and team support agendas have been put on hold. Also, the structural theme of conflict has been exacerbated with less ward beds, less level 3 and level 2 facilities as well as significant issues with retention and recruitment of the workforce.

It is a privilege to belong to a high profile specialty but that also brings great interest from the public and the media.

Although the other surgical and medical specialties may have similar issues it is our specialty that makes the news too often. This is disappointing when so much excellence is achieved but at the same time there are too many units with teamwork issues that impact so negatively on so many dedicated colleagues. Moreover, and most importantly, there is evidence that around four of every ten conflict stories have a negative impact on patient care.

This situation prompted my letter to the membership in November last year challenging the specialty to add respect, civility and kindness to our portfolio of clinical excellence. Furthermore, to challenge ourselves, that it is no longer acceptable to observe poor interactions without supportive and constructive intervention – if we turn away and ignore such behaviours we are inadvertently making them acceptable.

These challenges overlap with the Honorary Secretary’s article on page 7 which summarises all the progress we are making with Equality, Diversity and Inclusivity: respect, civility and kindness absolutely underpin this agenda as well.

My plea as President, as we confront the challenge of 2022 and beyond, is that we really focus on our behaviours and reflect on the impact we have on each other. Together we can make the difference to our working environment and, where necessary, transform them and maintain them as safe, supportive and enjoyable places to work for everyone in the team. n

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From the President and Meetings Secretary Simon Kendall & Maninder Kalkat

F

or those of us who have taken part in ‘real’ face-to-face meetings since restrictions have been eased it has been a most welcome reminder of the immense value of actually meeting with friends and colleagues rather than staring at a computer screen.

With this in mind the meetings team have put together an enthralling AGM

in Belfast – the scientific content, the plenary sessions and the social events are all excellent. It will be a great meeting.

We have all had major professional challenges since our last AGM in 2019 and this will be an excellent opportunity to share experiences, share problems and solutions, catch up with friends and colleagues who you haven’t seen for a long while.

The reason we are strongly promoting this event is we firmly believe it will be beneficial to you professionally and personally and further vitalise your passion for the specialty – which in turn will benefit your unit and your close colleagues.

If you haven’t already please register and we look forward to seeing you. n

Enhancing the working lives of cardiothoracic surgery practitioners Narain Moorjani, Honorary Secretary

A

s well as promoting excellence in the practice of cardiothoracic surgery by continuously improving the quality of healthcare that our specialty delivers to patients, the SCTS’s other primary focus is to enhance the working lives of the practitioners who provide this care. In line with this, the SCTS has recently introduced or is planning to introduce a number of initiatives to help to support its members.

Recognising cardiothoracic surgery as a team-based specialty From April 2021, adult cardiac surgery outcomes will be published on a unit-level basis, as opposed to surgeon-level reporting, bringing it into line with the outcome monitoring programmes in thoracic surgery and congenital cardiac surgery.

The premise behind the changes is that the care of patients undergoing cardiac surgery (as in other cardiothoracic surgery sub-specialties), is delivered by a team of cardiothoracic surgical practitioners

and specialists. This includes surgeons, physicians, anaesthetists, intensivists, surgical care practitioners, nurses and allied health professionals (NAHP), and it is important to recognise the role that these professionals play in a successful outcome for these patients. Hence, as all cardiothoracic surgery is a team-based specialty, the monitoring of outcomes should reflect this.

In line with this, to recognise the vital role that nurses and allied health professionals play in the delivery of highquality patient care in cardiothoracic surgery, the SCTS have developed NAHP team awards for 2021. The nominated work for these awards will have had demonstrable improvements in patient care or in the effectiveness of service provision, with particular focus on originality, evidence of collaboration with other professionals, and opportunities for the project to be adopted in other cardiothoracic surgical units and with long-term sustainability.

In addition, the SCTS has developed a toolkit to help transform the cardiothoracic

surgery workforce by expanding the NAHP role. As well as providing improved patient care and enhancing opportunities for clinical career progression for NAHPs, it will give surgeons in training (both nationally appointed and trust appointed) more access to theatre to develop and refine their operative skills. In the toolkit, examples have been provided from units that have successfully developed a multidisciplinary team model that will help to provide an infrastructure for other units to follow suit and for all to understand the importance of working together to provide excellent services.

Understanding the importance of equality, diversity & inclusion in cardiothoracic surgery Over the past 12 months, the SCTS have introduced a number of initiatives to help develop a diverse cardiothoracic workforce, and to provide equal opportunities and an inclusive environment for all those wishing to develop a career caring for patients >>

Lay Representative: Sarah Murray

Trainee Reps.: Duncan Steele, Abdul Badran

Communication Secretary: Sri Rathinam

Education Secretaries: Carol Tan / Deborah Harrington

Nursing & AHP Rep: Bhuvana Krishnamoorthy

Perfusion Reps.: Phil Botha, Chris Efthymiou

Education Lead: Sri Rathinam Carol Tan

Co-opted Members: Andrew Goodwin (NICOR) Maonj Kuduvalli (UK Aortic Group) Peter Braidley (NHS Commissioning)

Trainee Representative: TBC

NAHP Representative: Kathryn Hewitt Lisa Carson

Co-opted Members: Emma O’Dowd (BTS) Ian Hunt (Commissioning) Richard Steyn (Trauma)

Trainee Representative: Oliver Harrison Jennifer Whitely

NAHP Representative: Xiaohui Liu

Audit Lead: Carin Van Doorn

Audit Lead: Doug West

Education Lead: Deborah Harrington George Asimakopoulos

Audit Lead: Uday Trivedi

Unit Reps.: Chuck McLean Andrew Parry Mohammed Nassar Osama Jaber Andreas Hoschtitzky Phil Botha Tim Jones Conal Austin Mark Redmond Branko Mimic Martin Kostolny

Appointed Members: Juliet King Kandadai Rammohan Babu Naidu Steve Woolley Joel Dunning Leanne Harling David Healy Mark Jones

Appointed Members: Steven Billing Shakil Farid Thanos Athanasiou Mobi Chaudhry

Deputy Audit Lead: Serban Stoica

Trainee Representative: Joesph George

NAHP Representative: TBC

Education Lead: Attilio Lotto

Executive Co-Chair: Narain Moorjani

Executive Co-Chair: Simon Kendall

Executive Co-Chair: Simon Kendall

Co-Chair: Rafael Guerrero

Co-Chair: Aman Coonar

Co-Chair: Enoch Akowuah

Trainee Representative: Abdul Badran

NAHP Representatives: Emma Matthews Amy Chadwick

Education Lead: Espeed Khoshbin

Website Lead: Aisling Kinsella

Audit Lead: Jorge Mascaro Marius Berman

Appointed Members.: Marius Berman Stephen Clark Phil Curry Fabio De Robertis Aisling Kinsella Jorge Mascaro Rajamiyer Venkateswaran

Executive Co-Chair: Simon Kendall

Co-Chair: Steven Tsui

Co-opted Member: Andrew Goodwin (NICOR)

NAHP Representatives: Hemangi Chavan Nisha Bhudia

Congenital Cardiac Surgery Lead: Carin Van Doorn Deputy Congenital Cardiac Surgery Lead: Serban Stoica

Thoracic Surgery Lead: Doug West Deputy Thoracic Surgery Lead: Kandadai Rammohan

Adult Cardiac Surgery Lead: Uday Trivedi Deputy Adult Cardiac Surgery Lead: Umberto Benedetto Regional Deputy Adult Cardiac Surgery Leads: Indu Deglurkar (Wales) Zahid Mahmood (Scotland) Alastair Graham (Northern Ireland)

Co-opted: Andrew Goodwin (NICOR) Luke Rogers (ASSL) Ricky Vaja (ASSL) Serban Stoica (Congenital Audit) Ed Caruana (ASSL) Akshay Patel (ASSL)

Medical Student Lead: Rishab Makam

Trainee Representative: Marius Roman Azar Hussain

NAHP Representative: Rosalie Magboo Zainab Khanbhai

Congenital Cardiac Surgery: Massimo Caputo Nigel Drury

Thoracic Surgery: Babu Naidu

Adult Cardiac Surgery: Enoch Akowuah Gianluca Lucchese

Surgical Tutors: George Asimakopoulos Elizabeth Belcher Congenital Cardiac Surgery Lead: Attilio Lotto Transplant Surgery Lead: Espeed Khoshbin NAHP Representative: Bhuvana Krishnamoortthy Trainee Representatives: Duncan Steele Abdul Badran Consultant Lead: Prakash Punjabi Shahzad Raja Trust Appointed Doctors Leads: Zahid Mahmood (Cardiac) Kandadai Rammohan (Thoracic) Student Lead: Farah Bhatti Karen Booth Accreditation Lead: Shafi Mussa Communication Lead: Vivek Srivastava

Co-Chairs: Eric Lim Mahmoud Loubani Executive Co-Chair: Narain Moorjani

Co-Chairs: Carol Tan Deborah Harrington Executive Co-Chair: Narain Moorjani

Doug West Rafael Guerrero Eric Lim Mahmoud Loubani Innovation Co-Chair: Hunaid Vohra Transplantation Co-Chair: Steven Tsui

Audit Co-Chair: Congenital Co-Chair: Research Co-Chairs:

NAHP Representatives: Una Ahearn ACTSCP president

Trainee Representative: Joshil Lodhia

Appointed Members: Narain Moorjani Ishtiaq Ahmed Alex Cale Massimo Caputo Roberto Casula Joel Dunning Hazem Fallouh Rafael Guerrero Shyam Kolvekar Kelvin Lau Nicolas Nikolaidis Karen Redmond Stephan Schueler

Executive Co-Chair: Simon Kendall

Co-Chair: Hunaid Vohra

Meeting Lead: Daisy Sandeman Cardiac Lead: Kathryn Hewitt Thoracic Lead: Xiaohui Liu Audit Lead: Hemangi Chavan Education Lead: Bhuvaneswari Krishnamoorthy Regional Tutors: Libby Nolan Michael Martin Namita Thomas Sophia Wang Transplantation Lead: Emma Matthews Innovation Lead: Una Ahearn Membership Lead: Jane Dickson Communication Lead: Jeni Palima Pharmacy Lead Nisha Bhudia ODP Lead: TBC Critical Care Lead Ana Gesicka Perfusion Lead: Noel Kelleher Lisa Carson Physiotherapist Lead: Zoe Barrett Brown Occupational therapist Lead: Amy Chadwick Surgical Care Practitioner Lead: ACTSCP President Physician Associate Lead: TBC Research Lead Rosalie Magboo Zainab Khanbhai

Chair: Bhuvaneswari Krishnamoorthy

Tutors: George Asimakopoulos, Elizabeth Belcher Cardiothoracic Dean: Neil Roberts SAC Chair: Marjan Jahangiri Exam Board Chair: Rana Sayeed

Honorary Secretary: Narain Moorjani Co-opted Members

Co-Chair: Doug West Executive Co-Chair: Simon Kendall

Elected Trustees: Carin Van Doorn, Mobi Chaudhry, Enoch Akowuah, Aman Coonar, Betsy Evans, Andrew Parry

Meeting Secretary: Maninder Kalkat

Honorary Treasurer: Amal Bose

President: Simon Kendall

Women in Cardiothoracic Surgery Co-chairs: Karen Booth Narain Moorjani

Equality, Diversity & Inclusion Co-chairs: Indu Deglurkar Narain Moorjani

Meetings Team Meeting Secretary: Maninder Kalkat Deputy Secretary: Cha Rajakaruna Associate Secretary: Sunil Bhudia NAHP rep.: Daisy Sandeman Conf. Organisers: Isabelle Ferner Tilly Mitchell

Communications Sri Rathinam SCTS Website: Clinton Lloyd Bulletin: Indu Deglurkar

Professional Standards Sarah Murray Andrew Parry Betsy Evans Bhuvaneswari Krishnamoorthy Noel Keller Doug West

Taet Chesterton

Emma Ferris

Tilly Mitchell

Isabelle Ferner

the 8 bulletin

January 2022

undergoing cardiothoracic surgery. These include the Women in Cardiothoracic Surgery (WiCTS) Mentorship Programme, expanding the student outreach and immersion programme to increase opportunities to encourage those from all backgrounds to consider cardiothoracic surgery as a career, and the Trust Appointed Doctors (TAD) Mentorship Programme. In addition, the SCTS has formed the Women in Cardiothoracic Surgery Sub-Committee and Equality, Diversity and Inclusion Sub-Committee, further developing these themes to support the cardiothoracic surgical workforce or those aspiring to work within the specialty.

As part of this work stream, the SCTS have surveyed the membership to get a greater understanding of the issues that exist in cardiothoracic surgery in relation to equality, diversity and inclusion, and how members feel the SCTS can contribute to this important agenda (more details to follow later in this Bulletin). The SCTS has also developed a mentoring scheme for surgeons in training, newly appointed consultants and consultants in difficulty, to provide support and advice for cardiothoracic surgeons throughout their career, as well as pastoral support for those experiencing bullying and harassment.

Enhancing communication with members With the constant evolution of all the activities of the SCTS, it is more important than ever for the Society to be able to communicate effectively with its members.

In addition to email and social media platforms, such as LinkedIn, Twitter and Facebook, the SCTS website remains a hub of interaction for both patients and professionals with the Society, as well as being the primary mode to allow members to have a firm understanding of the society’s functions and an opportunity to get involved. In May 2021, the SCTS launched its new website, with a user-friendly design to allow increased communication between the Society and its members. The website has patient specific sections, with information and videos about cardiothoracic surgical disease processes and operations, surgical outcomes and access to support groups.

The professional pages give members the

9

“Over the past 12 months, the SCTS have introduced a number of initiatives to help develop a diverse cardiothoracic workforce, and to provide equal opportunities and an inclusive environment for all those wishing to develop a career caring for patients undergoing cardiothoracic surgery.” opportunity to access educational resources, such as operative videos, recently published research studies, and examples of best practice and quality improvement projects from other units in the country. The website also provides an opportunity for members to be kept informed of all the educational courses and travelling fellowships offered by the SCTS. In addition, the Society produces two high quality Bulletin publications annually, reflecting all the changes occurring in the cardiothoracic community, as well as weekly newsletters.

Engaging with all members of the cardiothoracic community In addition to the traditional opportunities for the Executive to interact with SCTS members at the Annual Meeting and annual Board of Representatives Meeting, changes during the COVID pandemic brought about an opportunity for the Executive to connect with individual units using a virtual platform. Over an eight month period, the Society organised 15 Unit Engagement Sessions, run as informal meetings, that allowed the SCTS senior executive to interact with units around the country. The meetings involved a general discussion regarding the services, staffing, roles, responsibilities, innovation, education, training, satisfaction at work, and challenges in the unit, and what the SCTS can do to help. It also gave all members of the cardiothoracic surgical community, including consultants, NTN trainees, TAD trainees, NAHP and clinical mangers, the opportunity to raise issues, ask any questions and allowed the SCTS to find out what members want from the Society.

Providing opportunities for professional development The SCTS continues to deliver a wide range of cardiothoracic surgery training courses for consultants, NTN trainees, TAD trainees, NAHP, core surgical trainees, foundation year doctors and medical students interested in a career in cardiothoracic surgery, as part of its burgeoning education programme.

In addition, the SCTS has a strong commitment to supporting professional development of all cardiothoracic surgical practitioners by providing travelling fellowships to enable individuals or teams to visit a cardiothoracic surgery centre of excellence, in the UK or abroad, to develop new clinical skills to bring back to their base unit.

Summary Through these different initiatives, the SCTS has been able to help support its members and enhance their working lives, which has never been more important than when working through a pandemic and trying to restore services and patient care in its aftermath. In particular, the Society would like to thank Indu Deglurkar, Karen Booth, Bhuvana Krishnamoorthy, Clinton Lloyd, Uday Trivedi, Tara Bartley, Sri Rathinam, Carol Tan and Mahmoud Loubani, who have helped develop some of these projects on behalf of the SCTS. As members, we would value your support and welcome any other ideas as we continue to help to provide the best working environment for all cardiothoracic surgical practitioners to flourish. n

the 10 bulletin

Annual meeting 2021 Daisy Sandeman, on behalf of the organising team

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n February 2021 the meeting committee and SCTS senior leadership team gathered in Edinburgh to deliver our first totally virtual meeting. It was a successful meeting with a record number of abstracts and high quality content delivered by national and international faculty. Our industry partners brought their innovations on cyber platforms and continued their unconditional support to the Society.

We had three plenary sessions including the Presidential address and lifetime achievement awards. There was no usual splendour of the auditorium nor the warmth and applause of attendees that we are accustomed to during the annual meeting.

We did our best, but we missed you all!

With this in mind, the meeting team have wowed to deliver a physical/face-toface meeting in ICC Belfast from 8th – 10th May 2022. Of course, this will only proceed if there continues to be a break in the diary of the notorious coronavirus. We have drawn lessons from the previous meeting and plan to conduct a virtual arm as well to bring the content to an international audience. The abstract submission closed on the 5th November and the meeting team along with the Review team gathered on 22nd November to organise the accepted abstracts and finalise the programme.

The actual meeting is planned to be packed with a variety ranging from sessions on outstanding cardiothoracic research to practical updates on implementing the SCTS toolkit. On Sunday, 8th May the SCTS University is expected to draw the delegates to an exciting line up of educational streams as part of the SCTS University Day. The hugely popular wet lab in the clinical sessions of the NAHP stream will return to our meeting along with various updated sessions related to nursing and allied health professionals. For the second year running, the well-received NAHP research meeting will have a dedicated stream. We are always delighted to run our medical student engagement sessions, where students present their

abstracts, get the opportunity to interact formally and informally with faculty and get more insight into a cardiothoracic specialty career. The University will boast one thoracic and two cardiac educational streams. After several years break a star studded line up from the world of transplantation are waiting to join us. The organisation of the University programme will see SCTS members contributing from the Heart Valve Society, BISMICS and UK Aortic society. It is expected to be an enriching and interactive day with a bonus of boosting our CME. The meeting will formally open with a welcome reception where our SCTS President and the Executive members meet and greet with attendees and guests for supporting the annual meeting. The toast is to the back drop of light entertainment bringing life to the vast display of our exhibitors. The various symposia will be nestled between the University and main meeting. The trainee meeting and the focus on Women in Cardiothoracic surgery will feature along with industry led sessions.

On Monday, 9th May 2022, the main meeting will commence with the new feature of three plenary sessions bringing to life the President’s vision of promoting togetherness in the speciality.

This session will feature the introduction of the SCTS toolkit, the new aortic dissection toolkit, presentation of the life time achievement award and the presidential address. This will be followed by six parallel streams of abstract driven sessions, some with keynote lectures conducted by invited special guests. There are planned breaks where the delegates will get the opportunity to visit the poster displays, interact with the exhibitors and network with their colleagues. The second plenary will once again draw us all into the auditorium where the SCTS research leads showcase multicentre research within and outside the United Kingdom. There will be presentations from national and international chief investigators giving

insight and encouragement to drive the research agenda forward.

Day two continues to be engaging with several more sessions themed on the trend of abstract topics submitted this year. The newly rebranded CT NAHP forum also has an array of chosen topics with discussions to follow on some of the developments and show case best practice in the different NAHP areas. The meeting committee have taken on board the feedback from previous meetings and plan to have an earlier finish to the concluding day. Participants can therefore make reasonable travel arrangements without having to miss any sessions.

Although the annual meeting is mostly known for the quality of its educational and scientific content, it is also famous for its social diary. This year the meeting team have gone the extra mile to deliver it. We start on Saturday, 7th May 2022 with a day excursion arranged to take delegates to the world-famous Giant’s Causeway with a pit stop to a pub for refreshments and appropriate beverages (after all we are in Northern Ireland). There will be an exclusive drinks reception at the end of the University Day on Sunday 8th May 2022 followed by a cosy but competitive pub quiz to get the delegates in the mood for the rest of the meeting. On Monday, 9th May 2022, the hugely popular and much sought after Annual Gala Dinner will be held at the spectacular Hilton – Lagan Hall. Here the delegates can get all shaken and stirred – à la Bond returns with A Licence to Live.

Belfast city was chosen after much thought for this Comeback Meeting.

Its historic significance along with the flourishing city-life offerings was thought to be ideal and provides delegates ample choices to make the best out of their trip to Belfast. We look forward to welcoming you all again to our annual meeting 2022, which will have more significance than ever before.

Hope you have managed to put in your presentations, book your leave and prepared to get on that flight to attend another memorable annual meeting. n

SCTS ANNUAL MEETING 2022 Sunday 13th - Tuesday 15th March

#SCTS2022

SCTS

Society for Cardiothoracic Surgery in Great Britain and Ireland

the 12 bulletin

From the SCTS annual meeting organising team Dear colleagues We feel a sense of déjà vu as we send you this piece of communication at this time of the year.

The emergence of the Omicron COVID variant in recent days, with increased infectivity and transmissibility, will result in a rapid increase in hospital admissions in the coming weeks.

This will adversely affect our already stretched and fragile health care system, with surgical specialities bearing the brunt of it. The uncertainty, apprehension and preoccupation with preparing and being a part of strategies to confront the surge will leave little appetite for individuals to consider and plan for any other ventures like the Annual Meeting. The NHS and our patients need us now more than ever, we need to support each other demonstrating the rare camaraderie our speciality is proud of and hope the anticipated wave of infection is short and swift, with lesser hospital admissions.

In such difficult and uncertain times, there will be little desire to make arrangements to travel and register for the forthcoming SCTS Annual meeting in Belfast in March.

We have made the decision to postpone the Annual meeting to 8th – 10th May 2022.

This deferment has been agreed after consulting the experts, who are confident about early May being the opportune time to hold such a meeting.

We will continue to monitor the situation and will come back with more information.

We wish you all the best.

SCTS annual meeting organising team

January 2022

13

Update from SAC Marjan Jahangiri, FRCS (CTh), SAC Chair, Professor of Cardiac Surgery, St. George’s Hospital

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ith an increase in both cardiac and thoracic clinical activities in recent months, opportunities for training have increased. I hope that the myriad of problems, ranging from a significantly reduced number of operations to the fear of post-operative Covid-related complications, as well as patients facing greater hurdles to come in for surgery are less now.

There are some developments, since I last wrote in June this year. The 7-year curriculum is implemented and our liaison members have been assisting with its integration into the training programmes.

To provide a more comprehensive training programme and planning for future consultants in paediatric and

transplantation, we have introduced a 3-6 month out of programme option for trainees. These will be recognised attachments. This initiative has been led

by Tim Jones and Steven Tsui and we are grateful for their efforts.

There have been extensive discussions regarding work force planning in thoracic surgery and there will be a shortage of thoracic surgeons in the near future.

We have therefore been discussing the introduction of a pure thoracic entry into the training programme. From 2022, there will be a new entry at the level of ST4 for pure thoracic surgery. The person specification and entry criteria will be available from Wessex Deanery who are administering the National Selection

for 2022. This initiative has been led by colleagues in thoracic surgery, Ehab Bishay, Aman Coonar and Sri Rathinam, and with the oversight of Steven Tsui as SAC Vice Chair. I thank them hugely.

The National Selection is taking place in February 2022 and will be led

by Jonathan Hyde and Steven Tsui. The specifics will be shared with you through Wessex Deanery. Jonathan and Steven ensure a robust, fair and transparent selection process based on their experience of previous years and the feedback they receive from trainees and trainers. After many years Jonathan will be stepping down as the Lead, Steven will take his position and Ehab Bishay is our newly appointed Deputy Lead. We thank Jonathan enormously for all his work at the SAC and at the National Selection.

Prakash Punjabi is leaving the SAC and we thank him for all his excellent work, in particular in the area of work force planning.

We have made significant changes to ISCP which we hope you find helpful. These include easier understanding of types and parts of the operations performed. We thank Abdul Badran, our trainee representative, who has helped with this. We have also introduced the academic criteria with its various domains for our trainees to record on ISCP. The SAC June meeting will be held at the College and I hope that our Training Programmes Director colleagues can attend. In the meantime, if any of the Consultant colleagues or trainees need anything, please contact me and your liaison members at the SAC. n

the 14 bulletin

Cardiothoracic Audit Update Doug West, Audit Committee Co-Chair

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embers across all subspecialties in cardiothoracic surgery should expect to see quite significant changes in national audit and reporting structures this year.

Adult cardiac The 2021 NACSA/NICOR report has recently been released. Overall surgical activity is still decreasing, with 13% fewer cases reported than five years ago. There is some evidence of worsening access to care, with both elective and urgent waiting times increasing slightly.

Just over half of all CABG operations are now performed urgently, but there are still difficulties achieving rapid access to urgent surgery. No hospital met the target of operating on more than 75% of urgent patients within 7 days of angiography.

There have been other quality improvements, with an increase in day of surgery admission rates and a fall in already low rates of bleeding after CABG, now at 1.8%. This year’s report includes data from the Scottish centres, although NICOR has been notified that in future Public Health Scotland will be responsible for publishing the results of cardiac surgery in Scotland.

The Society’s collaboration with NICOR to develop the unit quality programme is making good progress.

34 units have now responded to the unit questionnaire. Preliminary work on this project and mockups of the data visualisation were presented by Uday Trivedi at BORS.

HQIP are currently recommissioning the NACSA audit, and some changes in delivery of the audit are anticipated. Final details are awaited.

NICOR data for the long-awaited SCTS Blue Book in congenital surgery was released to the University of Birmingham (who the Society have commissioned to analyse data for the Blue Book) recently. We are hopeful that the Blue Book, containing many years of UK congenital heart surgery data, can now progress. This will be a major

Lung Cancer Audit (who delivered LCCOP with the support of the SCTS) has been recommissioned, and will now be delivered through the Clinical Evaluation Unit at the Royal College of Surgeons of England.

Previously it was delivered by the College of Physicians. SCTS have worked closely and productively with the CEU before, for example in the pilot HES project reported in the third thoracic Blue Book, and we look forward to collaborating with the new providers.

Reductions in HQIP funding – LCCOP is not included in the commission – will inevitably mean a change in the report structure. This may be an opportunity to increase crossdisciplinary reporting (for example, stage-specific adjuvant therapy rates), and we hope it will continue the focus on reporting the results of integrated clinical teams.

The call for SCTS returns data for the 2020-2021 audit year is due out imminently. This will be very important data, as the effects of the pandemic start to come through.

Please get your activity back to KS Rammohan. We aim to get preliminary data out at the Belfast Meeting in the spring.

“The next few years will be challenging, making sure that we maximise the learning from the pandemic without unfair criticism of units and teams that were most hard-hit.”

Congenital The latest NICOR report was released in October. Reassuringly, no outlier units were identified. After some concerns last year about standardisation of reporting, rates of neurological injury after surgery have not been reported this year. A NACSA working group, including SCTS deputy congenital audit lead Serban Stoica, are looking at improving the reporting of this metric.

SCTS project, funded and delivered by the Society, joining the adult cardiac and thoracic blue books in recent years.

We are looking at developing a SCTS database manger’s educational event, to help database managers update on recent reporting changes.

Thoracic surgery The latest LCCOP report, covering prepandemic 2018 data, was published recently.

The report documents the progress made in recent years, with the highest number of cases, lowest 30 day and one year mortality ever reported. No units were outliers.

The Society were able to obtain funding from industry to support publication of the LCCOP report, and we were able to distribute hard copies to all SCTS audit leads recently. Email me if you want a copythere are a handful left.

Despite these successes, 2021 was the last year of the LCCOP project. The National

Summary The next few years will be challenging, making sure that we maximise the learning from the pandemic without unfair criticism of units and teams that were most hardhit. Recommissioning will change some of the reporting structures that you may be used to, particularly in thoracic surgery, while in adult cardiac surgery the unit quality accreditation programme is moving the focus towards an assessment of team structure and outcomes. The Society continues to produce its own significant outputs, particularly the comprehensive Blue Book programme across the three large subspecialties. We are planning some audit and QI sessions at the Belfast meeting in 2022. Do come along to explore the latest data and to meet the audit team. n

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the 16 bulletin

SCTS Surgical Tutors’ Report Debbie Harrington, SCTS Surgical Tutor George Asimakopoulos, SCTS Surgical Tutor

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e are delighted to report that the NTN course portfolio has been able to continue throughout the second half of 2021 and we have now embarked upon a huge catchup programme in order to reschedule and complete all of the courses postponed due to the COVID pandemic.

The postponed ST5A Intermediate viva course finally took place virtually in June. The ST3A Introduction to specialty training course was able to proceed face-toface as planned at Ashorne Hill in July, and this marked the resumption of our face-toface UK courses. The ST4B core thoracic course, and the ST7A pre-exam revision & viva course then followed in September.

We plan to continue to hold the ST7A course twice a year prior to each diet of the intercollegiate exam, and we will also continue to offer places to hospital appointed doctors as well as NTNs. The ST4A course is also due to take place face-toface at Ashorne Hill in the coming weeks.

Unfortunately, due to ongoing uncertainty with international travel the rescheduled ST3B and ST6A&B courses in Hamburg due for September and October were postponed yet again. Johnson & Johnson, along with many other companies still have an international travel ban in place, but we were extremely pleased that they allowed us to petition them in order to reinstate some of the postponed courses. This application was successful, and as we go to press, we

are planning to hold the 2020 and 2021 postponed ST3B courses and the 2020 and 2021 postponed ST8A courses in Hamburg in December.

As a consequence of the busy schedule in December we have now postponed the ST8B professional development course which will take place virtually from 20th-21st January 2022.

We have updated the provisional course schedule for 2022, and plan to continue using a combination of virtual platforms and face-to-face courses whilst we complete the catch-up programme over the next few months.

Our next priority for 2022 will be to realign the established course portfolio

faculty to please send us your feedback as we continue to evolve the portfolio going forwards. We would like to remind trainees that they are expected to take study leave for the entire duration of virtual courses and that attendance and participation in all sessions is expected.

Once again, we would like to thank all Faculty and Course Directors who have taken time out of their already busy schedules, to continue to provide high quality teaching to our trainees. On behalf of SCTS Education it is much appreciated.

We are also still looking for new Faculty members to complement our existing team so if you are interested, please get in touch with Emma Piotrowski (Emma@SCTS.org) stating your area of sub specialist interest.

We would like to express our continued thanks to Emma Piotrowski in the SCTS administration team who has continued to work tirelessly throughout the pandemic. We are indebted to Emma who has played a pivotal role in setting up & administering the virtual courses, enabling them to continue despite the many and varied technical issues. Going forward Emma will continue to administer the majority of the SCTS Education courses via the booking system on the SCTS website. Once again, if you think you should have been invited to a course but have not been, please get in touch with us.

Finally, we would like to wish everyone a safe and happy festive season and a successful 2022. n

“We have updated the provisional course schedule for 2022, and plan to continue using a combination of virtual platforms and face-to-face courses whilst we complete the catch-up programme over the next few months.” with the new curriculum. This will involve bringing forward several courses to enable trainees to complete the portfolio in the new 7-year timescale. It does mean however that we will no longer run the ST5A intermediate viva course or the ST7B clinical examination course. We do plan to review the remaining courses however, in order to continue to cover the entire syllabus.

We would like to ask both trainees and

January 2022

Provisional 2022 Course Programme Course

Location

Date

Trainee cohorts

ST8B Professional Development course Phase 3: Leadership and Professionalism Course (ST7.2)

Virtual

20th-21st January

2021 cohort

ST3B Operative cardiothoracic surgery Phase 1: Operative Cardiothoracic Surgery Course (ST3.1)

Johnson & Johnson Institute Hamburg

3rd-4th February

2022 cohort

ST6A and ST6B subspecialty practical Phase 2: Cardiothoracic Surgery Sub-specialty Course (ST5)

Johnson & Johnson Institute, Hamburg

22nd-25th February

2021 and 2022 cohorts

ST6A and ST6B subspecialty Phase 2: Cardiothoracic Surgery Sub-specialty Course (ST5) Theory

TBC

TBC

2022 cohort

ST7A Revision & Viva Course for FRCS CTh Phase 3: Revision and Viva Course for the FRCS (C-Th) (ST6)

Ashorne Hill

28th Feb-3rd March

Spring exam cohort

ST8A Cardiothoracic pre -consultant course theory Phase 3: Cardiac and Thoracic Pre Consultant Course (ST7.1) theory

TBC

TBC

2022 cohort

ST8A Cardiothoracic pre -consultant course practical Phase 3: Cardiac and Thoracic Pre Consultant Course (ST7.1) practical

Johnson & Johnson Institute, Hamburg

28th-29th April

2022 cohort

ST4B Core thoracic surgery course Phase 2: Core Thoracic Surgery Course (ST4.2)

Ashorne Hill

4th-6th July

2022 cohort

ST3A Introduction to specialty training course Phase 1: Introduction to Specialty Training in Cardiothoracic Surgery (ST2.2)

Ashorne Hill

11th-13th July

2022 cohort

ST7A Revision & Viva Course for FRCS CTh Phase 3: Revision and Viva Course for the FRCS (C-Th) (ST6)

Virtual

12th-15th September

Autumn exam cohort

ST4A core cardiac surgery course Phase 2: Core Cardiac Surgery Course (ST4.1)

Ashorne Hill

21st-23rd November

2022 cohort

ST8B Professional Development course Phase 3: Leadership and Professionalism Course (ST7.2)

Ashorne Hill

5th-6th December

2022 cohort

ST5B Non operative technical skills for surgeons (NOTSS) Phase 1: Non-Technical Skills for Surgeons Course (ST3.2)

Face-to-face

TBC

2020 and 2021 cohorts

17

the 18 bulletin

Cardiothoracic Interdisciplinary Research Network (CIRN) Professor Gavin Murphy (Cardiac SSL) Ricky Vaja & Luke J. Rogers (Cardiac aSSL) Professor Julie Sanders & Rosalie Magboo (NAHP Leads) Keith Wilson & Jeremy Dearling (Patient & Public Involvement & Engagement Co-Leads)

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ince the last Cardio-Thoracic Interdisciplinary Research Network (CIRN) update in the January 2021 edition, the collaborative has continued to develop academically minded healthcare professionals in cardiothoracic surgery and deliver some high-quality outputs. Most notably, “The early outcomes and complications following cardiac surgery in patients testing positive for coronavirus disease 2019” has been published in collaboration with the COVIDSurg Collaborative in the JTCVS and the protocol for a further Cochrane Review Figure 1. Visual abstract ‘Target Wound Infection’ “Antithrombotic treatment following coronary artery bypass grafting (CABG) Network Meta-Analysis” This work started following the James Lind has been accepted. This has been supported Alliance Priority Setting Partnership in which by a successful application for a BHF CRC 10 key research priorities were identified in Research Development Fund grant. In adult cardiac surgery. “Infection Prevention” addition, the collaboration has undertaken was one of these key priorities leading to a rapid review of consent in adult cardiac the formation of a Clinical Study Group surgery. This has involved the work of nearly (CSG7) which includes patient and public 50 individuals, across 17 UK & Ireland Trusts representation, healthcare professionals from and has collated data from 420 consent forms nursing, cardiac surgery, wound surveillance, in under three weeks from conception of the infection control and microbiology and health audit! An incredible feat in and of itself. The service researches including representatives results of this will hopefully be presented at from Public Health England (PHE). Figure the SCTS Annual Conference 2022 and will 1 illustrates some of the work that has hopefully catalyse a larger program of work. underpinned this successful grant application.

The focus of this update however will be on the NIHR Program Development Grant funded ...

This work will involve three distinct packages, which we hope, will ultimately facilitate a successful application for a Programme Grant for Applied Research (PGfAR) in 18 months’ time. The packages are as follows:

1. A review of all previous studies to identify patient factors that increase the risk of wound infection. These factors will then be used to develop a new risk prediction tool for adult cardiac surgery patients incorporating routinely collected data.

2. Different hospitals and frequently even different consultant teams utilise treatments or preventative strategies to reduce wound infection in a different manner. We hope to identify why this is the case and make recommendations as to how this might be modified.

3. Identification of factors limiting PHE monitoring of wound infection rates in adult cardiac surgery and development of a strategy to improve monitoring and increase the number of participating hospitals.

January 2022

This work will allow the development and implementation of a new national wound infection prevention strategy to reduce the variation in care, rate of wound infection and antimicrobial resistance following adult cardiac surgery in UK centres.

Throughout the application, development and planning of this program of work there has been a committed focus on Patient and Public Involvement and Engagement (PPIE) through regular CSG7 meetings and direction from our PPIE Co-Leads, Keith Wilson and Jeremy Dearling. Jeremy Dearling has provided the following insight on the process so far ...

‘Everyone in the team, and the team is comprehensive in skills and experiences, brings a different perspective to the topic of surgical site infection, and in common with the growing trend to include the public and patient voice in all matters regarding public funded research, the PPIE contributors bring their own insights. As team members who understand the experience and impact of surgery because they have seen it or experienced it as members of the public’, they think of things that academic and clinical team members sometimes overlook, or take for granted.’

Figure 2. Proposed RCT plan for ‘Target Wound Infection’

The ultimate hope is that this work will lead to the delivery of a multicentred, interdisciplinary led randomised control trial (RCT) that will utilise routinely collected data to stratify individuals undergoing adult cardiac surgery and then target wound infection prevention strategies to reduce the incidence of wound infection (surgical site infection) whilst minimising antimicrobial resistance. Figure 2 illustrates the likely overview of this trial.

The Cardio-Thoracic Interdisciplinary Research Network is always looking for individuals to get involved, whatever your profession or experience. If any of the work discussed or proposals below excite you please get in touch via Twitter @CIRNetwork or via email CIRNetwork@outlook.com.

EVERYONE IS WELCOME! Expressions of interest welcome on the following projects ...

• Preventing racial bias in surgical site infection monitoring: a pilot study • Consent in Adult Cardiac Surgery

Useful Links TARGET SSI Trial https://le.ac.uk/cardiovascularsciences/about/heart-surgery/ national-cardiac-surgery-clinicaltrials-initiative/infection-prevention Patient and Public Engagement Events – SCTS Annual Conference 2020 Webinar Series https://le.ac.uk/cardiovascularsciences/about/heart-surgery/eventsand-conferences BHF Data Science https://www.hdruk.ac.uk/helpingwith-health-data/bhf-data-sciencecentre/ n

19

the 20 bulletin

SCTS Transplant Education Lead Report Espeed Khoshbin, SCTS Transplant Lead

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or the first time in its history, cardiothoracic transplantation will be featured this year at the SCTS University. After almost three years, the SCTS is opening its door to a hybrid gathering between 8-10 May 2022 at the ICC in Belfast.

SCTS University: Transplantation and mechanical circulatory support will be featured in the SCTS University amongst other cardiothoracic sub specialities on Sunday 8th May 2022. The theme for this programme will be contemporary approaches to transplantation and mechanical life support systems. There will be several national and internationally renowned presenters.

The Programme will be co-chaired by a close colleague and transplant respiratory physician Dr Anna Reed. It is with great privilege that Mr Asif Hasan will be starting the program with his experience in heart transplantation, especially congenital and paediatric transplant and mechanical circulatory support. We are honoured by the presence of three international speakers from the United States, Dr Robert Kormos from the Texas Heart Institute who has agreed to present his experience with Heart Mate III left ventricular assist device, Dr Abbas Ardehali from UCLA, California will show case his successful lung transplant programme the largest in the west coast of the USA and his involvement with the organ care systems and related multi centred trials. Finally, Dr Ankit Bharat from Chicago Memorial Hospital will present his outcome for lung transplantation after COVID related acute lung injury and ECMO, one of the largest series to date.

This year there will also be a prize for the best cardiothoracic transplant abstract/ video. I am grateful to the SCTS annual meeting organising committee members

Mr Sunil Bhudia and Mr Cha Rajakaruna for approaching me to organise and chair this programme as the SCTS national lead in transplant education.

National Peri CCT Fellowship: The success of the UKs peri-CCT Fellowship programme was assessed through surveys of the past and present peri-CCT fellows and directors of transplant programmes.

Its results were published this year in the Annals of Surgical Education under the title, “The National Surgical Training Scheme in Cardiothoracic Transplantation: Training Competent Transplant Surgeons in the United Kingdom”. The program was reviewed last year by the speciality advisory committee and the joint Committee in surgical training in cardiothoracic surgery.

This year there have been two new recruits into this prestigious post. They were allocated to the Royal Papworth and Wythenshawe Hospitals. There will be a third appointment to the Institute of Transplantation, Freeman Hospital. Training through this Fellowship will take an average of 15 months; however, half are expected to obtain a substantive consultant position within six months of completion of super-speciality training.

Transplant Courses: The Institute of Transplantation at Freeman Hospital enjoys an international reputation for cardiopulmonary transplantation, mechanical assist devices and education in heart and lung failure surgery. After two years of cancellation due to travel restrictions this advanced international surgical course in aspects of heart and lung transplantation and mechanical circulatory support scheduled for 11-12 Jan 2022 unfortunately had to be cancelled at short notice and will be rescheduled some time in 2022. The course is designed to provide cardiothoracic

surgeons with didactic teaching and hands on cadaveric surgical training experience in cardiopulmonary transplantation. Delegates will have the opportunity to perform heart and lung transplantation on fresh frozen cadavers under the guidance of an experienced faculty of transplant surgeons from across the UK. During an intensive two-day course delegates will also implant left ventricular assist devices, practice cannulation for ECMO and gain practical experience of ex-vivo lung perfusion.

Following the success of the virtual study day on core cardiac transplant skills for allied health professionals (AHP) on the 30th October 2021, with guidance from Mr Shahzad Raja, and much organisation by Dr Bhuvaneswari Bibleraaj, Ms Sophia Yi Wang and others from Harefield Hospital, we are planning a face-to-face course and wet lab in London. This course will cover aspects of organ donation, transplantation and mechanical circulatory support aimed at middle grade surgeons, physicians and allied health professionals. The courses will be subsidised through financial assistance secured by Dr Bhuvaneswari through industry sponsorship and therefore should be more affordable.

Future: With some of the restrictions being lifted after the COVID-19 pandemic, we look forward to a new normality, “whatever that is”. Training in transplantation will have to continue to produce competent transplant surgeons to meet the continuing demands of the service.

There must be a change in the way surgical and transplant education/assessment has been conducted to date. Next year there will be a pilot study into computerised learning and assessment, where we will be investing in innovation and research in surgical training and transplant education for the future generation of surgical trainees. n

January 2022

21

Women in Cardiothoracic Surgery Network On behalf of the WICTS subcommittee Karen Booth, Consultant Cardiac Transplant Surgeon Narain Moorjani, Consultant Cardiothoracic Surgeon

A

s women represent less than 5% of the total consultant workforce, President Simon Kendall, honorary secretary Narain Moorjani and the SCTS executive committee are focused on addressing gender disparity within the specialty. Brigadier Nicky Moffat opened the debate at the plenary session virtually last year at SCTS and we now have introduced the WICTS sub-committee made up of women in a diverse range of roles within the specialty.

This subcommittee will meet quarterly and work closely with the SCTS executive to achieve our goal of supported diversity inclusion locally and nationally in leadership positions. We will present our outcomes

through audited feedback and are happy to receive any feedback from the membership community as we embark on this new venture.

Our overarching aim is to enable champions to support this minority group and inform our membership of facts surrounding the barriers faced. The toolkits we will develop over the coming months will include a new webpage with links to role modelling, application for mentorship and useful links and articles. We have designed our new logo and have already attended SCTS sponsored events for Women in Surgery at the RCS WiS national event and local university webinars and teaching days.

We also plan to announce a widening access scheme into local schools through a university network with the Student committee SCTS INSINC, the first sponsored by SCTS. Looking ahead to SCTS 2022, please look out for our new sponsored sessions that will double up as networking opportunities for medical and allied professional groups. We have been asked to organise a breakfast session at the SCTS 2022 Annual Meeting, Belfast, on Monday 9th May, at 8am. Look out in the coming months as we advertise this exciting event. n

The future is bright, the future is ST1 entry Duncan Steele, ST6 Cardiothoracic Surgeon & Senior Cardiothoracic Trainee Representative Abdul Badran, SCTS trainee representative, Specialist Registrar Cardiothoracic Surgery

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rom 2023 entry into the national cardiothoracic training pathway (NTN for short) will be exclusively ST1. This current year’s applicants will be the last time aspiring consultants of the next generation will be able to enter via the ST3 path. This comes with two caveats.

This year we’re also seeing the introduction of ST4 thoracic themed NTNs, helping provide much needed work force planning certainty to our thoracic consultant body.

The second is things change and this is likely, if not a certainty, in years to come. Our memories are however short and ambitions to perpetuate the status quo of any instant is one of our most human responses to changes on the horizon. ST1 entry was eight years of training, it’s now seven. Transplant and circulatory support rotations were sporadic, however now through the tireless efforts of colleagues from the subspecialty group, trainees will be able

to gain this excellent experience irrespective of their denary. In time, experience in congenital cardiac surgery will likely follow in a similar way.

These battles regarding what trainees benefit from most in the metaphorical sweet shop of learning opportunities, are fascinating to witness and often far more complex than they first appear. To a degree the time in training is a zero-sum equation, to give six months here, you must take six months there. It is however encouraging and inspiring to see how forward thinking the members of the various committees we sit on, as trainee representatives, are.

For trainees and trainers alike, reading this, they will likely recognise the gloomier training situation in many regions exacerbated by the pandemic that presents itself as infecting reality and masquerading as the ‘new normal’. In particular cardiac trainees who rely on the availability of

intensive care beds to build their experience have seen a famine of opportunities since March 2020.

It is our responsibility to fight this and adapt. We need to perfect our team’s ability to support learning for the whole team, not just surgeon’s but nurses, perfusionists et al.

There are many ways to start this process but from our experience the two most valued ingredients are the relationships we have between trainer and trainee and the ethos of the whole department that learning is not a cherry on top but the very oven in which great surgeons are baked.

We look forward to receiving nominations for the trainer awards (see the emails and SCTS website for details) to help celebrate those who’ve managed to establish this already and moreover, anticipating a fantastic discussion and series of presentations at the trainee meeting which takes place at the annual SCTS conference in 2022. n

the 22 bulletin

SCTS INSINC Medical Student Committee - What we have achieved in year one Kirstie Kirkley, Josh Brown, Amelia Websdale, Holly Dejsupa – on behalf of the Student Committee, led by Ms K Booth & Prof F Bhatti

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ince its creation at the end of April, the inaugural SCTS Student Committee has been working hard to develop new and engaging opportunities for medical students and sixth formers to gain experience within cardiothoracic surgery. The name INSINC summarises our committee’s goal of “INspiring Students IN Cardiothoracic surgery”. Following the success of the first virtual Student Engagement Day, where students from across the world joined to be inspired by amazing speakers, the committee has been keen to address crucial aims such as mentorship, exposure to surgical subspecialties and nurturing the enthusiasm of aspiring surgeons. Here are some of the things we’ve achieved so far.

The Cardiothoracic Surgery Hub and Boost of Social Media – Holly Dejsupa & Josh Brown We have been gathering all medical schools in the UK and Ireland on a central Facebook page as part of an initiative designed to aid interconnectivity and improve communication between the Student Committee and its members. Whilst still growing, it now hosts almost every surgical, cardiology and cardiothoracic society from across the country, promoting collaborative working, allowing event publicity, and easing the process of networking between students. Improving our social media presence has been essential to promoting both the SCTS and work of the Student Committee, as such we have worked hard to increase our combined audience to almost 1000 students. This will be crucial in facilitating the accessibility of information for our members and removing some of the barriers to opportunity students often face.

Surgeon of the Month – Kirstie Kirkley and Amelia Websdale ‘Surgeon of the Month’ is an interview series introduced in September, with the aim of creating overarching mentorship and helping students find surgeons within the field they can identify with. So far, we have interviewed Mr

Simon Kendall and Prof Farah Bhatti OBE, offering insight into the thoughts and careers of pivotal members of the cardiothoracic community. By interviewing surgeons from a range of demographics, and covering topics from research to leadership and beyond, we hope to answer questions students may not get the opportunity to ask and promote relatable role models that inspire future cardiothoracic surgeons. Our interviews can be found in the SCTS news and on our social media pages.

‘How To ...’ Series With the aim of addressing common practical challenges students encounter, this informal series hopes to offer practical advice on topics such as ‘getting into medical school’, ‘planning a cardiothoracic elective’ and ‘get the most out of being in theatre’. This will be widely available on the ‘Student’ tab of the SCTS website with the interactive option to submit suggestions for other topics that may be helpful.

SCTS Annual Student Engagement Day

Mentorship Scheme

Our biggest project over the last few months has been the organisation of the face-to-face Student Engagement Conference, which this year was hosted in Leeds on Saturday 27th November.

With a theme of ‘Pioneering in Cardiothoracic Surgery’, the event had a jam-packed morning of specialty-wide talks and an exclusive patient interview, followed by an afternoon of workshops tailored to both medical students and sixth formers. After the close competition at the Student Conference in May, we’re excited to see students once again go head-to-head for the prize in the Cardiothoracic University Challenge.

Recognising the importance of personalised guidance and support in maintaining students’ enthusiasm for the specialty, we are working hard to create a mentorship team that caters for both sixth-formers and medical students. We hope to open applications for surgeons to become mentors very soon and will subsequently match these with small groups of mentees according to location, demographic and career interests.

Upcoming schemes:

Cardiothoracic Teaching Series A student-led, student-focussed educational lecture series, focussing on cardiothoracic topics that students may not gain exposure to during their time at medical school. Whilst benefiting students’ revision, we hope it will better prepare attendees for the complex situations encountered as junior doctors and improve their understanding of common surgical procedures – equipping them to get the most from any clinical experiences.

Journal Club We are creating a monthly book/journal club where students can come together to hone their critical appraisal skills, keep up-to-date with breakthroughs in the field and explore their own academic interests.

Diversity Survey Soon to be distributed, we are developing a survey on diversity and inclusivity to allow us to gain some insight into areas requiring improvement, particularly at a medical student level. This will not only better our understanding of what students require from mentors but help find solutions to the loss of aspiring cardiothoracic surgeons at a student level.

Belfast Annual Meeting Finally, as a committee, we are looking forward to the Annual Meeting in Belfast and have begun working closely with the SCTS to develop and host the Student Day, learning from any experiences gained from the conference in Leeds.

You can keep up-to-date with our exciting projects and latest news on Instagram and Twitter @SCTSINSINC, or ‘SCTS Students’ on Facebook. n

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the 24 bulletin

Challenging normality as we pioneer - Medical Student Education Day 27th November 2021, Leeds University

Karen Booth, Consultant Cardiac Transplant Surgeon, SCTS Student Education Co-Lead Professor Farah Bhatti OBE, Consultant Cardiac Surgeon, SCTS Student Education Co-Lead

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s Storm Arwen threatened lives, homes and travel across the UK, Saturday the 27th November was also the return to a face-to- face engagement programme with our medical student population.

The SCTS Student committee, INSINC, chose Leeds University to host this inspiring event. Our Widening Access Officer and Course Director, Javeria Tariq, worked tirelessly to communicate to local consultants and work through the COVID pathway to see how we could safely have as many faceto-face attendees as possible. Tickets cost £15 for face-to-face attendance and £5 for a virtual link with MedAll. Over 60 students Javeria and the Hinkins family

were able to attend and in total, we welcomed 75 students to hear an inspiring day that is in line with our Widening Access Programme as we included six, sixth form students from local schools in Leeds. £1 from every ticket sold was donated to Leeds Children Heart Surgery Fund and we heard from the Hinkin’s family how important support from charities such as the Children’s Heart Surgery Fund, changes lives and makes journeys through complex procedures less stressful. In a fitting testament to the success of congenital cardiac surgery, George celebrated his 8th birthday as a Heart Warrior with us.

Happy birthday George!

consultant career. The difficulty in managing colleagues when you are appointed and how she had developed her ‘Bhudda face’. She reassured the students that outside hobbies are not prohibitive but essential as you establish real relationships and empathy with patients.

As surgeons, there is a balance of the personal risk of taking on challenging and complex procedures. She reminded us that personal courage leads to greater things.

‘Handing your child over to a procedure that could both threaten and save their life, is the hardest experience I have ever gone through.’

Jane Hinkins

Ms Carin Van Doorn, Consultant Congenital Surgeon, told us of her journey from Holland to the UK and how it was standing on the shoulders of giants that saw her go through an inspirational career in which she has seen 85% of patients with congenital heart disease live into adulthood.

Margins of error are so small in congenital surgery and she explained the work involved to strive to innovate and to allow patients the opportunity to survive and live to have a better life. Carin spoke of Marc de Leval, Magdi Yacoub and the biggest inspiration of all, her patients. Every scar tells a story and it is the patients who she cares for that drive her ambition.

Mr Alessandro Brunelli, Consultant Thoracic Surgeon, showed that a truly successful surgeon needs to be mindful, as much in communication as in their ability to operate. Displaying non-verbal and verbal communication of reassurance and faith in us as physicians is important as we recognise that technological changes means that not all treatment modalities need to involve surgery.

Thoracic surgery is truly multi-modality in treatment strategy involving surgery, chemotherapy and radiotherapy.

SCTS president, Mr Simon Kendall got the day off to a fantastic start as he outlined the major changes that the cardiothoracic specialty needed to evolve through if we are really to remain as the pioneers and innovators of the future. He spoke of his passion for cardiac surgery and the standards that patients and their families should expect in the cardiothoracic surgeons of the future.

Ms Antonella Ferrara, Consultant Cardiac Surgeon with a subspecialist interest in Mitral Valve Surgery, gave a very honest account of the rollercoaster life of the cardiothoracic trainee and

‘I feel a certain calm. There is safety in the midst of danger. What would life be if we had no courage to attempt anything?’

Vincent Van Gogh

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surgery challenged us to think what makes up the anatomy of a surgeon. He spoke of the art and philosophy behind surgery; the mixture of manual dexterity and clinical decision-making. It is essential we attain our 10,000 hours in training to ensure we are competent surgeons with adequate exposure to manage complications and that we have the maturity to reflect and understand we will never stop learning on the cardiothoracic surgical journey.

The day rounded off with workshops and our ever-popular university challenge, that saw Professor Bhatti take centre stage and work our two student teams hard for the prize fund of £100!

The cardiothoracic specialty needs humble surgeons who recognise that empathy with patients, kindness to colleagues and the value of teamwork will only ever result in putting the patient first and offering an excellent standard of care to all. n ‘Until the first meeting in clinic, the patient is only a name, a referral letter with a brief medical and social history.’

Mr Alessandro Brunelli

are successful the first time round similar to clinical pathways and academic difficulties can emulate the rollercoaster ride Antonella previously spoke of. She recommended looking for programmes in the UK that start research goals early, such as RESS and ESREP. As a female surgeon, she also sees the importance in role modelling and in promoting diversity within the specialty.

Mr Elmahdy, Consultant Cardiac Surgeon with a subspecialist interest in aortic

Understanding our patient’s values and preferences regarding early stage lung cancer treatment decision making are often in contradiction to the values of the physician and their clinical reasoning skill. Surgeons of the future must remove hierarchical behaviours and spend time with patients if we are going to provide outstanding care. A most inspirational talk.

Looking into an academic surgical career, Ms Cecilia Pompili, Associate Professor at Leeds University explained how you access academia in a world of less prescribed PhD’s in training and less academic role models. She stressed how you should take opportunities that come your way and focus your research streams from a very early stage at medical school with The SCTS INSINC Committee with speakers Mr Mohamed Sherif, Mr Elmadhy, Mr Brunelli, collaboration to succeed.

Ms Pompili, Professor Bhatti and Ms Van Doorn Not all grant applications

Thank you to SCTS INSINC: Amerikos Argyriou Javeria Tariq Bertie Harrington Rishab Makam Amelia Websdale Kirstie Kirkley Josh Brown Alexander Reynolds Chaninda Dejsupa Maria Solange

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SCTS Education Report Sri Rathinam, SCTS Education Secretary Carol Tan, SCTS Education Secretary

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s we reflect on 2021, we recognise and are grateful to the hard work put in by everyone involved in SCTS education to get our programmes almost back fully up and running. We are humbled by the enthusiasm not only of our committee members, but also by the additional offer of time and expertise from both established and new faculty members to help us catch up on courses which were put on hold previously due to the COVID-19 pandemic. As long as pandemic restrictions are not imposed again, we expect to be back on track with all courses by the first half of 2022.

As ever, we have a few changes within the committee to report. The most significant of these is that we bid farewell to Sri Rathinam, as he assumes the position of Communications Secretary for SCTS. Sri has spent eight years in SCTS Education, starting off as Thoracic Tutor in 2013 before becoming Education Secretary three years later. Together with Narain Moorjani, who was Cardiac Tutor at that time, they put together an ISCP syllabus aligned portfolio of courses for National Trainees, a structure

which has continued for the last eight years.

With the support from our industry partners and a common aim to provide better education to the cardiothoracic surgical community and therefore benefitting our patients, the courses have been delivered free of charge not only to trainees but also to all SCTS members. Over the years, Sri has been instrumental in establishing ongoing financial support for the education programme for our membership. We are grateful to Ethicon, Medtronic (Cardiac and Thoracic), Medistim, BD Medical, Terumo Aortic, Cryolife and Corza Medical, who have helped us tremendously this past year.

With each farewell comes new beginnings. We welcomed Deborah Harrington as Education Secretary (CoChair) and Elizabeth Belcher as Thoracic Surgical Tutor in November. As the largest subcommittee within SCTS, we aim to deliver even more in the coming year. Listening to feedback this past year, we also aim to return to more face-to-face events wherever possible, and ensure that all our members get equal opportunities for access to courses.

“A total of 173 fellowships have been awarded over the past decade to the wider cardiothoracic community to advance our skills and improve outcomes for our patients. Although (Mr Marian Ionescu) has decided to move on to different pursuits, we will always be grateful to him for showing us what is possible and will continue to build on his legacy.”

Ionescu collaboration: SCTS has benefitted from the immense generosity of Mr Marian Ionescu over the past 10 years – University Day at the Annual Meeting, the Perspective book publications and fellowships. With the last round of fellowships awarded in September 2021 (see fellowship article), a total of 173 fellowships have been awarded over the past decade to the wider cardiothoracic community to advance our skills and improve outcomes for our patients.

Although he has decided to move on to different pursuits, we will always be grateful to him for showing us what is possible and will continue to build on his legacy.

Consultant Education: Education is a never-ending process and certainly should not stop when we become Consultants. With feedback from colleagues, the Leadership Consultant Masterclass has been put together as a series of four 2-hour virtual sessions. The sessions are led by Vijaya Nath, Founder and Director of Comtemplative Spaces, an experienced developer of Medical Leaders who has worked in this field for over 23 years. The first of four virtual sessions focusing on Leadership, Team Working and Teaming in a High performing Cardiothoracic Unit took place in the summer, with the second session due to take place in December.

Feedback from attendees has been excellent and we encourage our consultant colleagues to find time in their busy schedule and not miss out on this golden opportunity. In addition, there will be a webinar on The Virtues for a Cardiothoracic Surgeon scheduled this year, aiming to look through the lens of virtue ethics rather than conventional ethics, how cardiac and thoracic surgeons develop their professional skills as consultants.

Further information and booking of all courses can be found on the SCTS website through the events page.

January 2022

The Tutors’ report by Debbie Harrington and George Asimakopoulos shows how much work has continued through the pandemic and how much more is required in the coming months to complete all courses that were previously postponed. We are grateful to them for working tirelessly towards this, and to many more in the background without whom none of this would be possible.

Mentoring in Cardiothoracic Course as well as Professional Development Course for TADs took place in the summer on a virtual platform, both of which were well attended. The Cardiothoracic Update and Wetlab course will take place at Ashorne Hill in December and there will be a CESR course in the New Year. TADs will continue to have the opportunity to join NTNs in the professional development course and examination viva courses.

TAD Education:

NAHP Education:

With easing of restrictions imposed by the pandemic, courses aimed at Trust Appointed Doctors have recommenced.

We have addressed our objectives for trust doctors and recognise the need to provide equal opportunities for access to educational courses, but at the same time recognising that TADs have different needs. The

Our NAHP lead Bhuvana Krishnamoorthy, is now supported by a subcommittee and educational regional tutors to assist with running of webinars and courses. With the overflowing enthusiasm from the team, we will be seeing an expansion of the portfolio covering educational, audit and research needs of NAHPs.

NTN Education:

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Medical Student Education: After the last two Student Engagement Days conducted virtually, the last Student Engagement Day took place as a face-to-face event in Leeds on 27th November.

There are so many involved in education, too many to name, that we would like to thank this past year. Our final word of gratitude has to go to Emma Piotrowski, our stalwart educational administrator, Taet Chesterton who has recently joined as a permanent member of the SCTS administrative team, Tilly Mitchell who oversees our accounts, is a whizz at social media and gets the word out for us and Isabelle Ferner, a fountain of knowledge when it comes to all things SCTS. We hope you have had a lovely Christmas and see you all in 2022. n

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The journey of a thousand miles starts with a single step Sri Rathinam, SCTS Education Secretary

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y journey with SCTS Education started with small steps and has grown over the last few years. I’m handing it over to capable hands and moving on to a different role.

It seems like yesterday that I went for the interview for the SCTS tutor position with lots of ideas and visions. I was very excited seeking new challenges having brought the ESTS meeting to the United Kingdom. The

Tutor role was a remunerated position with The Royal College of Surgeons of England.

SCTS decided to bring that role in house as an honorary position in 2013. I was successful and I was advised that I would have a partner to work with; a gentleman called Narain Moorjani, a cardiac surgeon from Papworth Hospital. We had never met before but it has transpired to be a great partnership and working relationship over the years.

SCTS Tutor

Carol Tan, Emma Piotrowski, Sri Rathinam

Narain and I were tasked by the Education secretaries, Mike Lewis and Rajesh Shah, to structure NTN education starting with the Boot Camp which was set up by Trainee representative, David McCormack.

We set out to create a portfolio of 12 courses, which were integrated with the curriculum incorporating dry lab, wet labs, live animal operating, exam revision courses, nontechnical skills and professionalism and leadership. We were ambitious in wanting to offer these courses free for the trainees like the Boot Camp of

2012. We approached various companies seeking sponsorship whilst the senior officers felt this was a nonstarter. I still vividly remember the Johnson & Johnson national manager, Ross Campbell, showing interest and in further meetings which we had between Narain, Ross and I to firm up the plan. Ethicon committed to supporting the whole portfolio of the courses.

Narain and I created 12 courses including the learning objectives and the programmes and identified keen faculty members with 1:2 trainer/trainee ratio. In the first year, we were the course directors for all the courses and identified keen faculty members to take over as directors. We also worked with The Royal College of Surgeons of Edinburgh’s education department to advise and support us with educational modalities assessment and quality assurance.

To be honest, I felt sustainability and continuing the same level of commitment might not continue after a few years, as more specialties would want to replicate our model of the structured portfolio of simulation courses. Thanks to industry sponsors and partners, the portfolio is stable and if anything, expanding over the years.

Thanks to the commitment of the faculty and their motivation and a diligent collection of data and feedback we have generated award-winning abstracts to manuscripts in major peer reviewed journals with more in the pipeline. The role also had its challenges particularly pertaining to professionalism by the delegates and trainees resulting in us writing terms of reference to the trainees attending the SCTS Education courses.

We introduced the operative video prize and pursued many industry partners who contributed to the portfolio of courses.

As a surgeon who came to the United Kingdom from India, I have always felt the

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Sri Rathinam, Narain Moorjani and Trainee rep David McCormack in the SCTS Bootcamp

challenges and needs for trust and locally appointed doctors and hence extended my support to create courses for the Trust appointed doctors and invited Maninder Kalkat to lead on them.

TADs by various measures of inviting them to courses which were previously not available to them.

Education Secretary

SCTS has had a great benefactor in Mr Marian Ionescu. I was requested to meet with Mr Ionescu and Mr Page. It was emphasised how important the collaboration was and he was a great contributor to our activities. It was also known he was a man known for his attention to detail and it was made clear that the meeting was very important. Imagine my situation when I realised I had left my passport at home and when I reached Luton Airport. Fortunately, a friend brought the passport so that I could make the journey in time. The meeting opened a new chapter for SCTS, it created various learning opportunities but most importantly, an abundance of fellowships to various members of SCTS. I do not think any other specialty anywhere in the world has offered so many fellowships to benefit its membership and thereby the patients. My sincere thanks to Mr Ionescu for his support and for allowing me to process all the fellowships. I’ve always enjoyed our meetings and exchanges as they have been quite illuminating.

Narain and I were appointed Education Secretaries in 2017 when Mike Lewis and Rajesh Shah moved to pastures new.

We now had the responsibility of the total portfolio of SCTS Education from consultant to medical students. Narain moved to the Honorary Secretary’s position which meant I was a sole education secretary for a couple of years until Carol Tan joined me as co-education secretary.

The Education subcommittee had enthusiastic members who led and accomplished great things within their streams. The consultant stream introduced masterclasses preceding the SCTS meeting. We have established an SCTS consultant Academy for leadership. The AHP portfolio has constantly grown with courses and series of webinars and virtual learning during the Covid pandemic.

The NTN portfolio has sustained itself and it has been very rewarding. We have bridged the gap between the NTNs and

Ionescu Collaboration

A big Thank You Success would not be possible without all the hard work of my fellow tutor and coeducation secretary, the stream leads and all the faculty members who have made this possible. I thank the SCTS Executive for the confidence in me and more importantly the freedom to execute things. Any organisation cannot succeed without administrative support. Letty Mitchell and Emma Piotrowski have been absolutely integral in the success of the programme. They have been ensuring all the administrative process as well as collecting diligent feedback. My sincere thanks to all our strategic industry partners who have helped us in the successful journey.

The team Every journey has to come to an end and after eight years in SCTS Education, I have moved to the communications role. I am delighted that the journey has been enjoyable and successful and most importantly the team is left in the capable leadership of Miss Carol Tan and Miss Debbie Harrington.

I am sure SCTS Education will go on to greater success in the years to come and give me more work to publicise this as communication secretary. n

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Equality, Diversity & Inclusion in Cardiothoracic Surgery in the United Kingdom: A baseline analysis Indu Deglurkar & Narain Moorjani, Co-Chairs, E, D & I Subcommittee, SCTS

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he SCTS concluded the first ever Equality, Diversity & Inclusion survey in the UK in Cardiothoracic surgery in June 2021. Thank you all for what is considered to be an excellent response rate of 31.9%. A great deal of thought and research went into the design of the survey to keep it succinct and at the same time address all aspects of the Equality Act 2010 which protects people against discrimination, harassment or victimisation based on the nine protected characteristics. These are age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation.

An anonymised electronic survey (www. surveymonkey) with 40 questions was sent to 686 Surgeons (387 Consultants and 299 trainees and Trust appointed Doctors) across 37 centres in the UK. 214 responses were received from Consultants, Professors, Associate Professors, Senior Lecturers, trainees, Trust appointed Doctors, retired surgeons and students. 19% of the responses were from trainees, 13% from Trust apponted Doctors, 56% from Consultants and 25.9% (55/214) of the responses were from women in cardiothoracic surgery.

It was interesting to note that Cardiothoracic Surgeons in the UK hail from 44 countries. The three most common countries

of birth are UK (36%, 77/214), India (16%, 35/214) with nine European nations jointly accounting for 11% (24/214) of the surgeons.

Overall, 64% of the respondents were from UK, India and other European nations. The rest of the 36% (78/214) originate from 33 other countries. The majority of the surgeons (47%) are white and Christianity (37%) is the most prevalent religion with respondents belonging to 16 ethnic groups. The rich diversity in the specialty is reflected by the fact that only 60% of the surgeons have English as their first language.

50% of the women and 64% of the men hold leadership roles at various levels.

Approximately a third of the respondents have received mentorship and over half of the respondents offer mentorship to surgeons commencing independent practice.

shows that 50% of the women felt unsupported on return from maternity leave whilst only 20% of the male surgeons felt unsupported after paternity leave.

We explored the delicate and sensitive question of bullying, harassment and bias over protected traits in the last 5 years without attempting to get finer details to examine the prevalence of the problem in Cardiothoracic Surgery. Of the 210 responses, 104 (49.5%) stated they have not experienced adverse behaviour whilst 83 (39.5%) felt bullied and harassed and 14 (6.67%) were unsure and 9 (4.3%) preferred not to divulge their experience.

Bullying was reported by 44.5% (37/83) of white respondents and by 55.5% (46/83) of the ethnic groups. All groups i.e., professors, consultants, senior lecturers, trainees, Trust Appointed Doctors, and medical students reported bullying.

It was present in all subspecialties including Adult Cardiac, Thoracic Surgery, Transplantation, Congenital surgery and Academia.

45% of the trainees (18/40) reported bullying.

55% of the respondents had faced discrimination based on one or more of the protected characteristics such as age, sexual orientation, religion, marriage or civil partnership, personal bias, pregnancy and gender discrimination. Five white respondents reported reverse discrimination.

“It is staggering that 22% of male and 25% of female surgeons have contemplated quitting surgery at some stage due to the adverse circumstances. Nearly half the respondents believe that they could not make a complaint without fear of reprisal.”

Both male (45%) and female (55%) surgeons indicated a preference for flexible working and nearly half the respondents have carer responsibilities. Yet, only a third of those who work flexibly and two thirds of those who availed maternity and paternity leave felt supported. Subgroup analysis

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January 2022

It is staggering that 22% of male and 25% of female surgeons have contemplated quitting surgery at some stage due to the adverse circumstances. Nearly half the respondents believe that they could not make a complaint without fear of reprisal.

Work-life balance is most affected in congenital cardiac surgery, transplantation, adult cardiac surgery and cardiothoracic surgery. The intense demands of the profession severely impact on personal lives of both male and female surgeons and unless viable alternative ways of working are drawn up by Professional bodies, there will potentially be a shortage of this highly skilled group.

We received 269 suggestions from the membership to improve the work environment and support Surgeons (Tables 2&3). Recruitment, equity in training, bullying, harassment, bias, governance, leadership, mentorship and career “road blocks” figured prominently in the responses.

Cardiothoracic surgery has a greater ethnic diversity than represented in the general population. Despite the rich diversity in the workforce, equality, inclusion and gender equity are lacking significantly. Fair recruitment process can be challenging due to existing unconscious bias. Policies and

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“This snap shot scrutiny of the current state in UK Cardiothoracic Surgery is reflective of the whole NHS in many aspects. Meaningful action on the data obtained is more difficult.

Although the response rate was 32%, the fact that the response rate of “white” members was 48% and the ethnic group was 52% makes it a reasonably balanced interpretation.” procedures introduced in the NHS have yet to have the desired effect and institutional racism and overt bias remain.

This snap shot scrutiny of the current state in UK Cardiothoracic Surgery is reflective of the whole NHS in many aspects.

Meaningful action on the data obtained is more difficult. Although the response rate was 32%, the fact that the response rate of “white” members was 48% and the ethnic group was 52% makes it a reasonably

balanced interpretation. The compact nature of our tertiary specialty makes it more amenable to institute and monitor changes addressing policies specifically relating to flexible working and parental leave.

Over the past 12 months, the SCTS have introduced a number of initiatives to try and tackle some of these issues pertaining to equality, diversity and inclusion. These include the SCTS mentorship programmes to support trust appointed doctors and

Weighted Average

Total Responses

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

Prefer not to say

I am very satisfied with my professional career.

2.43

210

21% 44

42% 88

20% 41

10% 20

7% 14

1% 3

I am able to strike a workpersonal life balance.

2.76

210

10% 22

36% 76

30% 64

14% 29

8% 16

1% 3

I believe the organisation will take appropriate action to incidents of discrimination.

2.57

209

20% 42

37% 78

19% 40

13% 28

9% 18

1% 3

I have not experienced any unfair barriers in my career progression.

2.79

210

23% 48

30% 64

12% 26

16% 34

16% 33

2% 5

Race, ethnic and gender based jokes are not tolerated.

2.45

209

21% 43

39% 81

23% 48

12% 25

4% 8

2% 4

Employees of different ages are valued in my organisation.

2.38

210

26% 55

43% 91

12% 26

10% 21

7% 15

1% 2

People of all cultures and backgrounds are respected and valued.

2.31

210

26% 55

43% 91

12% 26

10% 21

7% 15

1% 2

Table 1: Overall Equality, Diversity and Inclusion culture

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women in cardiothoracic surgery, and expanding the SCTS student outreach and immersion programme to increase opportunities to encourage those from all backgrounds to consider cardiothoracic surgery as a career. In addition, the SCTS has formed the Women in Cardiothoracic Surgery Sub-Committee and Equality, Diversity and Inclusion Sub-Committee, to further develop these themes to help provide equal opportunities and an inclusive environment for all those wishing to develop a career caring for patients undergoing cardiothoracic surgery. The SCTS has also developed a mentoring scheme for surgeons in training, newly appointed consultants and consultants in difficulty, to provide support and advice for cardiothoracic surgeons throughout their career, as well as pastoral support for those experiencing bullying and harassment.

In Wales, the recently concluded Race, Equality Action Plan consultation is timely and an opportunity to implement recommendations. It should be made mandatory for NHS Trusts to report and publish data on E, D & I, the number of complaints and disciplinary actions and those reported to the GMC. The complex and sensitive issues need collective enforcement by institutions, Professional bodies and the Government made accountable to an independent body.

Our survey captures the current state of affairs to prioritise areas for targeted improvement and to formulate realistic goals. Institution of policy changes with regard to flexible working, education, structured mentorship programmes, raising awareness, developing support structures to facilitate a multi-cultural workforce will be the focus of the E, D & I subcommittee. The organisational culture in terms of recruitment processes, work-life balance, career satisfaction, barriers to progress and equality has to be improved a great deal. We will recruit a wide range of diverse members to help address some of the issues by developing various work streams and aim for equality amongst races. We hope to receive a number of applications from individuals who are keen on improving our work environment.

Equality, diversity and inclusion applies to all individuals because we exist together as one race ... “the human race”. n

Training and job plans: • More training and equal opportunities for trainees and non-trainees.

• Clear career progression pathways with annual evaluations for non-trainees.

• Protected time for non-clinical work.

• Flexible working environment.

• Adequate leave cover.

• Lesser focus on research for non-researchers.

• Realistic job plans with remuneration for work incurred out of contracted hours.

• Multi-disciplinary meetings, Aortic Dissection, Trauma and TAVI cover should be job planned.

• Increase in the number of cardio-thoracic consultants.

Infrastructure, Organisational culture and management: • Better infrastructure with designated offices, parking areas, staff rest areas with basic facilities.

• Better IT and administration support.

• More clinicians in management roles and influence hospital policies.

• Avoid nepotism and cronyism.

• Transparency and meritocracy in appointments.

• Less “suffocating governance”.

Eradication of gender bias: • More women in leadership roles.

• Flexibility in start and finish times and ability to work from home.

• Support for pregnant trainees.

• Parents of non UK citizens should be granted long term visas to support families.

Complaints and Disciplinary Process: • Creation of an Independent body to scrutinize the complaint, complainant and the decision to proceed to Disciplinary Procedures.

• National support with nominated local representatives for whistle-blowers to overcome local irregularities and cover up.

• Support for surgeons who are victims of discrimination, bullying or harassment.

Table 2: Recommendations to improve work environment

Recruitment and retention: • Create more work experience opportunities for students and support international students to enter the Specialty.

• Complete transparency in the National Training Recruitment process.

• Support Clinical Fellows for the Exit exams and Certificate of Eligibility for Specialist Registration.

• Develop flexible working patterns which can be applied locally to enhance recruitment and retention.

Promote women in Cardiothoracic Surgery: • Recognise the gender bias and ensure support for women in Cardiothoracic Surgery.

• Promote women in leadership roles.

Education, Mentorship and Leadership: • Develop structured Mentorship programmes which recognise underlying racism, bias and discrimination and can guide mentees.

• Educational training to incorporate Equality, Diversity and Inclusion.

• Leadership and Unconscious Bias training, networking opportunities promoting diversity in leadership.

• Yearly feedback by surveys.

• Promote non-executive participation in events.

• Webinars for members with protected traits, mental health and well-being.

• Information on retirement and pensions.

Professional support and Policy making: • Peer support for surgeons in difficulty and those targeted by institutional racism and bias.

• Influence Policy making and work with local groups.

• Rate Institutions on Equality, Diversity and Inclusion performance.

Table 3: Recommendations to the SCTS from the membership to support surgeons

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Only for one stitch Anupama Barua FRCS (C-Th)

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t is a snapshot of trainee’s life. The characters are drawn from my own experiences and observations but are amalgamations. Dr Ali is a composite of dominating males in a discriminating society, of a type that can be seen everywhere including cardiac surgery in the UK.

Nirmala wants to be a surgeon – how dare she!

She was our classmate, a dark skinned, slim-built Bengali girl, five feet three inches tall.

We named her “Conscience” after the character in medieval Bengali theatre who would appear between acts to tell the moral of the story to the audience. Nirmala was much too ethical and principled to ask anyone to answer the attendance call on her behalf, and would refuse to sign the attendance sheet for others.

During our internship, she showed her interest in surgery. One of the senior students, Nasrin, asked her, “Why do you want to do surgery? You are like a dwarf trying to touch the moon.”

Nirmala replied, “Surgery is not only for giant men, a little dwarf like me can also work in the surgical ward.”

Nasrin advised, “You can earn more money by palpating a uterus externally during pregnancy and internally during caesarean section.”

Nirmala answered, “I don’t just work for money.”

Nasrin emphasised, “In surgery, you cannot build up a good practice and no patient will trust you.”

Nirmala hesitantly replied, “Trust should be made by rapport, not by physical phenomena.”

The surgical registrar, Dr Ali, was not entirely happy to see her on the induction day.

Usually the female interns came into surgery for two reasons: to avoid a heavy workload in the gynaecology and obstetrics ward and to avoid night duties. Typically, female internees do this placement before leaving for the United States. In the long run, they will be very unlikely to pursue a career in surgery.

Nirmala broke the rules again.

She approached Dr Ali, “I would like to do night duties.”

Dr Ali said, “Why do you need to do nights?

You have to cover male and female wards. It is not safe to work at night in the surgical ward with a male ward boy and male patients.”

Nirmala said, “If you think that a female is at risk working at night in the top medical college hospital, where can she be safe?”

Dr Ali answered after a pause, “You need to do male catheterisations at night with a ward boy or a nurse.”

Nirmala answered,“I do not think catheterisations or examinations change after daylight.”

Dr Ali was not happy but agreed, thinking that Nirmala would give up after working two or three weeks.

Nirmala did not follow the general rules.

She worked hard, day and night. During their six months’ internship, every intern should do at least one appendectomy.

During the first month, Nirmala spent days in wards and clinics. Her friend Jahangir had already done an appendectomy. She could not even scrub for one single day.

Dr Ali said, “Nirmala, you should not scrub during this month, as there’s no water supply, we have to use collected water.”

Two months later, Nirmala was ready to scrub.

Dr Ali said, “Nirmala, you should not scrub today as there is shortage of sterile gowns.”

During the third month, Dr Ali said, “Nirmala, I cannot allow you to do any cases because the patient couldn’t buy enough suture material. We cannot waste this precious stuff for your log book.”

Next weekend, during our weekly shopping trip, Nirmala bought two sutures: one prolene and one silk, from the nearby pharmacy. She wished she could buy water and sterile gowns!

On the fourth month, Nirmala was allowed to scrub for a duodenal perforation.

Dr Ali requested, “Nirmala, come to the surgeon’s side and hold the retractor. I cannot see anything, every thing is so deep and the patient has only fat.”

Nirmala was standing on tiptoes and holding the retractor with all her energy and sweating.

Dr Ali was yelling,“Oh no, we need

one more prolene stitch but the patient didn’t buy enough.”

Nirmala replied promptly, “Don’t worry, I have bought a prolene stitch and it is in the pocket of my apron.”

Nirmala asked the nurse to open the packet of prolene.

Dr Ali was in a rush, “I can’t give you the stitches to do, the perforation is deep down and difficult to tie.” Dr Ali used that suture to close the duodenum.

It was her last day on the surgical ward, Nirmala was not allowed to do a skin closure, let alone an appendectomy.

Dr Ali said, “Today is the last day for your surgical placement. I shall give you an appendectomy.”

Nirmala replied with hope and pleasure, “Yes, I admitted two appendicitis patients.”

During the operation, Dr Ali yelled, “Sh*t, inflamed appendix, I have to ligate and dissect out the appendix.”

Nirmala answered without hesitation, “It should be inflamed, we are not here to dissect the healthy appendix.”

Dr Ali reassured, “Do not worry, Nirmala, you can close the wound.”

Not surprisingly, the patient had not bought any silk.

Dr Ali said, “We can use leftover silk from the sterile pot.”

The so-called sterile pot was filled with Savlon and leftover threads which were kept for emergency use.

Nirmala told Dr Ali, “I do not want to use those threads. I bought silk with a handheld needle.”

When the suture was opened on the table, Dr Ali’s eyes sparkled. He said, “My God, Nirmala, you bought this expensive stitch for this poor patient. I have never used hand-held stitches. The three-centimetre wound needs three stitches. I will do the two corners. You can do the middle one.”

Nirmala did the one stitch in the middle, at 3:00am with tearful eyes.

Nirmala still wants to be a surgeon, of course cardiac surgeon, but can see how many hurdles she needs to overcome, and how many sacrifices she needs to make, to reach her goal. n

the 36 bulletin

A call for reflection, together Chiemezie Okorocha

F

ollowing the events of June 2020 and the reports of the disproportionate effects COVID-19 had on the Black and Minority Ethnic (BAME) community, a spark ignited the resurgence of the Black Lives Matter movement. This prompted many individuals to reflect on their understanding of racism, inequality, and the interpersonal and institutional effects of it.

As a result, organisations were moved to look internally at their structures in leadership, recruitment, and training to improve equality, diversity, and inclusivity (EDI).

One of these organisations includes The Royal College of Surgeons (RCS). In March 2021, they released a report following an independent review into the diversity of the leadership of the surgical profession and of the college (commissioned by Professor Neil Mortensen, President of RCS England in 2020). Key issues were identified and summarised in a 16-point plan with a timeframe of five to ten years.

The Society of Cardiothoracic Surgery (SCTS) in March 2021 also released a statement about how strategies were being

taken to address areas of inequality within cardiothoracic surgery. The main aim is to provide equal opportunities, diversify the workforce and introduce an inclusive environment for those embarking on developing a career in cardiothoracics.

SCTS EDI action points were detailed in seven key areas. Although a timeframe for implementation was not detailed, the society is doing well to effect change within its structures.

The RCS EDI plans are summarised below, mirrored to the SCTS strategy and with personal commentary:

January 2022

RCS Strategy

SCTS Strategy

Commentary

Commitment to RCS England Vision, putting diversity at the heart of College strategy.

The objective of the reform is to ensure the society becomes more diverse and inclusive.

Encouraging to see that this is stated from the outset.

Commit to The Reform Target: Leadership, Presidency, Vice and Council will reflect the diversity of the wider medical workforce in 5 – 6 years with voting-in of candidates.

Committed to encourage the diversity of applications for leadership within the society.

The timeframe and details of methods of action would ensure equity in leadership and aid objective monitoring of progress.

Reform Election for the Three Vice-Presidential Roles by the membership. If the two candidates with the highest votes are male, the third VicePresidential place should go the woman with the highest votes. This should be in place for 10 years only, to shift the dial on equality in leadership.

‘Women in Cardiothoracic Surgery’ (WICS) mentorship programme launched to support career progression for women in the specialty.

A bold stance for the College to make.

With the WICS program, I foresee SCTS being able to do the same in their structural leadership.

Develop a clear SAS Strategy Work with the SAS Forum to create an overall action plan to give due recognition to the role of SAS practitioners.

Launch of the Trust Appointed Doctors Mentorship Programme, ensuring support and increased opportunities are provided for these doctors.

SCTS have gone a step further in the development of this program. An assessment of the tangible impact on career progression and development will steer the program to optimum improvement.

FLAGSHIP PROJECT –Taskforce to support Parents in Surgery.

WICS aims to allow support of achieving a work-life balance, working less-than- full-time, working during pregnancy, and returning to work following maternity leave.

Although SCTS through WICS are aiming to support mothers, the diverse genders of parents are to be considered. The College’s Taskforce is possibly one that SCTS can take the opportunity to emulate.

Launch Two Annual Research Fellowships into Surgery, Diversity, and Inclusion.

Several medical fellowships available through SCTS.

If SCTS were able to support one cardiothoracic fellowship with the focus on increasing black trainees, reasons for disparities within the profession can possibly be identified and resolved.

Support Diverse Grassroots Medical Organisations with Seed Funding - Provide seed funding and/ or support to grassroots organisations or collective efforts that seek to address diversity, equity, and inclusion issues in surgery.

SCTS have been running engagement events and providing bursaries in collaboration with other organisations, to increase access to the speciality as a career.

Commissioned articles by SCTS that journey with BAME 6th formers and medical students through to securing an NTN, would be testimonial to the widening participation schemes.

Data Collection, Monitoring and Career Tracking.

SCTS recently released a survey to all its members to understand the issues they face.

Participation in surveys can prove a challenge, but engagement is often encouraged if clear targeted consultations, goals, and actions are followed through.

Training: The Council and staff in the College will need training on how to implement the Report and how to conduct anti- discriminatory recruitment and interviews.

SCTS stated their policy and documentation will reflect the societies stance for equity and removal of unconscious bias.

To improve on this, SCTS can ensure all staff and committee members are skilled to be public allies and champions for equality, diversity, and inclusion.

In conclusion, making structural changes and advocating equity within established institutions is a challenge that takes time, joint endeavours and is multi-faceted. The first step is to recognise there is room for improvement and SCTS have done so with transparency.

For Black History Month 2021, RCS England discussed the progress they had made since the report, the hurdles impeding completion and welcomed critique from members as part of their

steps to openness and accountability.

The 2022 SCTS meeting would be a prime opportunity to hold panel discussions for a review of the progress made since the release of the report. It will ask for collective accountability to ensure maintenance of trust and inclusivity of all its members – ‘One year on, SCTS reflects together’.

I look forward to seeing how the society’s structural changes and progression will become an example for other organisations to follow. n

37

References: Royal College of Surgeons England, 2021. RCS England Diversity Report. RCS Standards and Guidance. [online] London: Royal College of Surgeons England, pp.3-5, 36-39. Available at: https://www.rcseng.ac.uk/-/media/files/rcs/ about-rcs/about-our-mission/rcs-englanddiversity-report- 11-august.pdf.

Scts.org.2021. Equality, Diversity and Inclusion. [online] Available at: https://scts.org/ professionals/equality_diversity_and_ inclusion.aspx.

the 38 bulletin

Rise and Bike – Enhances work life stability Maninder Kalkat

M

any moons ago, although I’m convinced it was yesterday, I would stare with yearning at mopeds and cars speeding past me as I lumbered to school on my bicycle in India.

I earnestly wished to dump the bike and acquire one of these motorized marvels. It took a long time for the dream to come to fruition. However, a few decades later, there was a reversal of desires and cycling became a hobby and passion. Annoyingly for many and motivational for some, I have become a cycling evangelist.

The enthusiasm was rekindled during summers spent cycling with my son on his school’s cycle tours. The spark it ignited has seen me transform into a full-fledged organiser for annual biking expeditions for friends. In fact, this revelation of hidden organisation skills qualified me for the job of meeting secretary of SCTS. One of these regular tours comprises friends from my alma mater who dispersed after graduation and became incommunicado in an age without social media. Cycling trips

reunited these long-lost friends and soon, a group of more than thirty would meet annually for weeklong summer excursions.

The team includes friends, spouses, and children – two generations, and come from America, Canada, and India. A destination is selected, the bikers assemble with panniers in hand and cover 400 miles over the course of a week. Good food, good wine, and great humour: all owed to the pesky bike I was so keen to ditch as a teenager.

These trips have given us the opportunity to visit and admire remote areas seldom approachable or observed while driving on the roads. These include the western coast of the US, covering Oregon and California, the length of the Danube, Holland, Denmark, the Low countries, Puglia in Italy and Norway to name a few. The pod of whales returning from the South near Coos Bay in Oregon, Kröller Muller museum in Hoge Veluwe National Park in Otterlo in the Netherlands, Matera and Albarello -world heritage sites in Puglia, a dancing waterfall woman at Kjosfossen Waterfall in Norway,

the Vineyards near Passau are a few sights which remain entrenched in the memory.

The COVID pandemic did scupper the best laid plans over the past two years, but the local forays have continued unabated.

These included Lands-end to John-o-Groats in ten days and a few coast to coast rides.

The introduction of emission charges in Birmingham made me realize that cycling to work can be fun, carbon and wallet neutral and no qualms about the traffic and parking jams.

Ours is a high intensity speciality, comprising competitive and motivated individuals, working perpetually in unergonomic and stressful conditions and under constant scrutiny. The current pandemic has further intensified the strain and has tested the resilience to the hilt. It is therefore imperative that we as individuals, and more importantly as teams, work proactively to nurture our mental and physical health. A sound mind and able body are a minimum prerequisite to look after our patients, families and society at large.

It is reassuring to note while conferring with friends in the speciality that the majority of us are already in pursuit of accomplishing a life work balance, sparing time from busy schedules to tend to ourselves.

People are indulging in sports, running, cycling, sailing, hiking, meditating, excelling in various arts, organising virtual meetings (Sri’s fortnightly Inaya Thinnai) and many others.

Many years ago, our president, Simon Kendall motivated me while extolling about his cycling excursions and I hope my small write up might recruit a few more to my cycling group. n

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January 2022

National Cardiac Surgery Clinical Trials Initiative Update Suraj Pathak, Sue Page, Sarah Murray, Gavin Murphy

F

ollowing a very successful first year, the National Cardiac Surgery Clinical Trials initiative has made significant progress towards setting up a national programme of cardiac surgery clinical trials. This has been achieved through the development of nine separate clinical study groups, who have been tasked to tackle each of the top 10 unanswered research priorities in adult cardiac surgery.

Over the past 12 months, with the support of Heart Research UK, Society for Cardiothoracic Surgery (SCTS), British Heart Foundation Clinical Research Collaborative and the Royal College of Surgeons (RCS), the Trials Initiative has hosted in excess of 60 meetings with 470 attendees, of whom 24.5% were registered as members of the public or service users. We also used the platform to host the National PPI group who have been undertaking PPI events that under pinned the trials initiative, five of these PPI events have been hosted so far, with 176 attendees registering. From a total of nine separate clinical study groups, 13 separate studies have been shortlisted for development, of which two have been successful in gaining funding.

Clinical Study Group

Clinician Researcher: Patient

Total Numbers

CSG 5

Organ Protection

Clinician: 34 Researcher: 9 Patient/Lay Person: 8

51

CSG 6

Atrial Fibrillation

Clinician: 23 Researcher: 9 Patient/Lay Person: 13

45

CSG 7

Infection Prevention

Clinician: 21 Researcher: 13 Patient/Lay Person: 8

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CSG 1

Long Term Outcomes & QoL

Clinician: 28 Researcher: 18 Patient/Lay Person: 26

72

CSG 2

Prehabilitation

Clinician: 27 Researcher: 16 Patient/Lay Person: 13

56

CSG 3

Heart Valve Interventions

Clinician: 35 Researcher: 7 Patient/Lay Person: 14

56

CSG 8

Data Science

Clinician: 19 Researcher: 14 Patient/Lay Person: 13

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CSG 4

Minimally Invasive/ Hybrid/ Percutaneous Techniques

Clinician: 36 Researcher: 8 Patient/Lay Person: 13

57

CSG 9

Frailty and Sarcopaenia

Clinician: 27 Researcher: 11 Patient/Lay Person: 7

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Table 1: Structure, composition and themes of the clinical study groups established

Figure 1: National Cardiac Surgery Clinical Trial Initiative – Current structure of all clinical study groups

We hope to continue supporting and developing new projects into high quality grant applications which will in turn inform best practice in adult cardiac surgery.

We are committed to inclusivity.

If you wish to get involved in any of the clinical study groups please email us on heartsurgerypsp@leicester. ac.uk. Please follow our twitter handle @HeartSurgeryPSP for updates on the project. n

the 40 bulletin

Dr Lars Svensson and Dr Adam Daly

SCTS Ionescu Traveling Fellowship – Early Thoughts on the Cleveland Clinic Way Adam Daly

T

he day had finally come. It was 5.30am, the sun was beginning to creep over the horizon. I couldn’t have been more excited, albeit somewhat apprehensive, to start my fellowship in the world-renowned Cleveland Clinic. This was the culmination of years of work.

Early in training, I developed an interest in Aortic Surgery and attended the AATS Aortic Symposium. While there, I plucked up the courage to introduce myself to Dr Svensson and Dr Roselli, as well as many other “Giants in Aortic Surgery”. Over the

next few months, I visited eight different Aortic Fellowship programmes worldwide.

Cleveland Clinic instantly became my first preference for fellowship. It left such an impression that I couldn’t shake. To me, doing cardiac surgery in Cleveland Clinic was akin to golfing with Tiger Woods or playing football with Ronaldo. Everything about the Clinic represents the top level of performance. Thankfully, Dr Svensson and Dr Roselli agreed to me coming to do an Advanced Aortic Surgery Fellowship over two years. Also thankfully, the SCTS Ionescu

Travelling Fellowship supported me to come for it.

The days are long but the weeks are short, I find it hard to believe I am just over three months in. While initially daunting, I am settling in well. The residents and fellows (nearly 40 of them!) are very welcoming. Fellows are paired with a mentor who helps guide them through their learning experience and with Dr Svensson as my sponsor and Dr Roselli as my mentor, I am certainly in excellent hands. There is a friendly environment and a huge focus

January 2022

on teamwork with each other and allied professionals. Being on fellowship is an education like no other. With over 100 CVICU beds, 20 dedicated operating rooms in action daily, there is a huge amount from which to learn.

The complexity of operations performed is unparalleled. What I considered complex cases before are simply the routine here. In one theatre there may be a redo frozen elephant trunk procedure and, in another room, a bicuspid aortic root reimplantation ongoing. Down the corridor there may be a revision homograft, an LVAD implantation, robotic mitral repair and radical pericardiectomy. Later, on call, there’s not an unrealistic chance you’ll cannulate someone for ECMO. I sat down early with the faculty, identified technical areas for development in which I had limited experience, such as revision sternotomy and dissection (anywhere from 5-10 revisions per day) and axillary cannulation, and now perform these independently, in addition to exposure to an array of complex cases. We have threemonthly assessments and now are making plans for the next period.

The system in Cleveland Clinic is designed for success. It is evident the focus is that of excellence, patient safety and quality outcomes. The Clinic provides world-class experts with the teams, resources and equipment needed to get sick patients through complicated operations in the safest possible manner. Teamwork is key and resonates through all levels.

It is not uncommon to see Dr Roselli scrubbed helping a new faculty member with a challenging aortic pseudoaneurysm.

Surgeons have their own highly trained scrub team who work in unison daily.

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“The system in Cleveland Clinic is designed for success, providing world-class experts with the teams, resources and equipment needed to get sick patients through complicated operations in the safest possible manner.”

Each person is fluid with every step of the operation. The team approach extends to both pre- and post-operative arenas and what becomes apparent is all these elements of patient-care have been fine-tuned, work in concert and are required collectively to deliver a premier service.

There are multiple fringe benefits to such a fellowship, many of which I only see now. The crux of any fellowship is to become a clinical and technical expert in your subspecialist area and with a case-load of 1200 aortic surgeries per annum, it is a given that I will be competent in performing valvesparing root replacement, Branch Stented Anastomosis Frozen Elephant trunk procedure (BSAFER), endovascular aortic surgery or any other aortic procedure. The benefit of being able to ask Dr Svensson the granular detail of bicuspid valve reimplantation, discuss a complex arch problem with Dr Roselli or hear directly from Dr Gillinov “The five techniques for 95% repair rate in Mitral Valve Surgery” cannot be underestimated. Once here, you become a member of the “Cleveland Clinic Family”; you operate with, talk to and know these worldleading authorities, who 5.30am, day one at the Cleveland Clinic otherwise are infamous names that you quote in your FRCS exams or who have instruments and procedures named after them. The membership is lifelong it seems. You have a direct contact point with a world-expert when you encounter a challenging case in your future career.

Furthermore, your nearly 40 resident and fellow colleagues are some of the brightest upcoming

stars – the future leaders in cardiac surgery – who will remain within your network for life.

You will be friends with the stars of cardiac surgery from all corners of the globe; Canada, Israel, Turkey to name a few. Furthermore, you benefit from the nourishing environment here – Cleveland Clinic wants you to succeed!

There are endless research opportunities with a full complement of support staff, a robust database and a massive case volume. There are Leadership Development Programmes, Quality Improvement projects and more, all of which contribute to the success of the Cleveland Clinic.

A few thoughts on considering a fellowship. Establish exactly where you want your area of expertise to lie. Know what you want to learn and seek fellowships that will support your goals. Visit centres early. Come well trained – fellowship is not the time to learn to perform routine AVR but rather the opportunity to develop your subspecialty expertise, learn to do complex cases safely or learn a particular operation.

You would undoubtedly know how to do a phenomenal septal myectomy for HOCM if you spent six months working with Dr Smedira who does two or three every operating day. Plan financially.

I am extremely grateful to have been awarded the SCTS Ionescu Travelling Fellowship, nonetheless, the costs are significant; USMLEs, visas, flights, moving and living expenses. Fellowship is truly the opportunity of a lifetime, a marvelous chance to live abroad and experience a new culture and lifestyle. Plan some enjoyment for your free time, I have certainly made the most of mine having visited Niagara Falls, celebrated the 4th of July and even attended a Cleveland Browns football game to name a few. I’m looking forward to the next year or so and will certainly keep you posted. n

the 42 bulletin

Aortic Dissection Awareness Day UK 2021 – In Pictures Christina Bannister

T

he 6th annual Aortic Dissection Awareness Day UK on 16th September 2021 was hosted by the Bristol Aortic Service, with SCTS member Mr Cha Rajakaruna speaking on behalf of the Society. The theme of the day was ‘Responding to the national challenge of acute Aortic Dissection’.

Mr Rajakaruna spoke about how SCTS has responded to and is engaged with the national patient association, AD Awareness UK & Ireland. He shared the latest data showing a strong upward trend in surgical procedures for acute Type A dissection nationally and explained that the Society attributes this to increased awareness from initiatives such as the patient association’s successful THINK AORTA campaign, in which SCTS is a founding partner, together with the Royal College of Emergency Medicine and Heart Research UK. The Chair of AD Awareness UK & Ireland, Mr Gareth Owens, thanked SCTS for being a good friend to the national patient association and for seeking, through its

“Hands-up if you’ve survived an Aortic Dissection”- patients and relatives gathered in Bristol wanting improved diagnosis, care and outcomes in Aortic Dissection

membership and through the specialist subgroup of the UK Aortic Society, to improve care and outcomes for Aortic Dissection patients like him. He also thanked Terumo Aortic for sponsoring the event.

The keynote speech was delivered

by Dr Stephen Drage, Director of Investigations at the Healthcare Safety

Increased awareness through campaigns like THINK AORTA is driving a strong upward trend in surgical procedures for Type A Aortic Dissection

Investigation Branch, who spoke about HSIB’s investigation, report and recommendations regarding the national problem of delayed recognition of Aortic Dissection, published in January 2020.

The Presidents of the Royal College of Emergency Medicine and the Royal College of Radiologists explained how their respective colleges have worked together in an unprecedented initiative to produce joint guidance on acute Aortic Dissection which they will publish shortly for the guidance of their members. Mr Owens welcomed this great teamwork, noting that multidisciplinary teamwork is what these patients need and reminding clinicians present that “my aorta doesn’t care about your professional boundaries”.

Prof. Rob Sayers, Chair of the NHS England Vascular Clinical Reference Group, spoke about the new NHS England ‘Toolkit’ for acute Aortic Dissection that will apparently replace the long-promised national service specification, which is now not planned to be published. His fellow vascular surgeon, Miss Rachel Bell, President-Elect of the Vascular Society, gave an impassioned

January 2022

speech about the national problem of Aortic Dissection and how the Vascular Society, with others, is responding to the challenge laid down by patients.

A highlight of the day was when the room rose to its feet and gave a standing ovation to Mrs Haleema Saadia, after hearing her powerful and moving account of experiencing an acute Aortic Dissection during pregnancy at the age of 21 and undergoing five cardiac surgeries before her beautiful daughter Ruqqayah (who was also present), was delivered. Mrs Saadia is a patient of SCTS member Mr Jorge Mascaro at the QEII hospital in Birmingham.

For the final session of the day, previous chair of the SCTS Research Committee Prof.

Gavin Murphy gave an update on the strategic research partnership that his team at the BHF Cardiovascular Sciences Research Centre at the University of Leicester have formed with AD Awareness UK & Ireland and the progress being made in creating the necessary evidence and decision support tools to implement a targeted screening pathway for non-syndromic families at risk of Aortic Dissection.

At the close of AD Awareness Day UK, the Chair announced that the honour of hosting next year’s event, on Monday 19th September 2022, has been awarded to University College London, in recognition of their research work in ‘Engineering the Future of Aortic Surgery’, which will be the theme of the day.

Aortic Dissection Awareness UK & Ireland also plan to be present at the SCTS Annual Meeting in Belfast in March. They encourage all SCTS members to visit their stand, meet some patients, hear their amazing stories and talk about their work. n Mr Cha Rajakaruna speaks at AD Awareness Day UK on behalf of SCTS

43

Strong multidisciplinary support for the patient campaign to address the national challenge of acute Aortic Dissection is demonstrated over coffee at AD Awareness Day UK

Prof. Gavin Murphy updates the audience on progress in the strategic research partnership between his team at Leicester and AD Awareness UK & Ireland

Mrs Haleema Saadia, Vice-Chair of the national patient association, received a standing ovation for sharing her powerful story of maternal Aortic Dissection

the 44 bulletin

East Midlands simulation training day for cardiothoracic trainees Mayooran Nithiananthan (Regional trainee representative - East Midlands, ST4 NTN trainee) Adam Szafranek (East Midlands cardiothoracic surgery TPD) Sri Rathinam (Chair, East Midlands cardiothoracic surgery training program)

W

e have successfully organised simulation training day for cardiothoracic trainees in east midlands. It was a one-day training event supported by East Midlands training program and Ethicon. This was the first regional study day of the National roll out of Ethicon/SCTS cardio thoracic simulators, which included Arryo Coronary simulator, aortic valve/root simulator, mitral valve repair simulator and VATS skills simulator.

The study day was facilitated by the Glenfield hospital education department and chaired by Mr Sridhar Rathinam (Chair, East Midlands training program) and Mr Adam Szafranek (East Midlands training program director). The day started with an inspiring video link talk from Mr Tomas Stupnik (VATS simulator developer) from Ljubljana University Medical Centre, Slovenia.

Followed by didactic lectures from regional consultant trainers Ms Niki Nicou (consultant

cardiac surgeon Nottingham City Hospital), Mr Mustafa Zakkar (Assoc. Professor/consultant cardiac surgeon, Glenfield hospital).

Trainees were divided into groups and opportunities were given to perform each simulator under direct supervision of consultant trainers. Also, each procedure performed by trainees were recorded in ISCP as a WBA performed at the course. The informal setting of the course has provided time and relaxed environment for trainees to engage and understand the individual procedures thoroughly. The trainers were also pleased to be a part of a regional training day to support the trainees.

Though the second wave of pandemic has come to an end, its effect on training hasn’t. Most of the cardiothoracic units have reduced their number of operating lists, planned elective operations have developed into complex procedures, ever mounting staffing issues, Brexit and Pingdemic leave us with unresolved challenges for training.

It’s welcoming to notice that SCTS skills courses and training days have been restarted, which has been a huge support for the trainees. There are more and more locally initiated simulation training, wet labs and courses have sprung up during the Pandemic. Ethicon and their engagement with SCTS and SAC to implement regional training hub with award winning simulators are commendable.

Health Education England has also recently announced Covid-19 training fund to support the local proposals to improve training. We at East Midlands recently secured a sum of £7,000, through Covid-19 training fund, which will be used towards training activities and cardiothoracic cadaveric courses in the new year. n

January 2022

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Maximising the FY2 Cardiothoracic Surgical Placement Jeremy Chan, ST1 Cardiothoracic Surgery, Wales Deanery Najeeba Lallmahomed, Foundation Year 2, Wales Deanery Harry Smith, Foundation Year 2, Wales Deanery Amer Harky, ST5 Cardiothoracic Surgery, North West Deanery

T

he cardiothoracic surgical workforce has been transformed significantly in the last 10 years due to the impact of the European work time directive, difficulties in recruiting junior doctors and reduction in training and teaching opportunities secondary to service provision.

Several hospitals adapted the impact of such changes into their training structure, including the introduction of advanced clinical/nurse practitioners (ACPs/ANPs), Surgical Care Practitioners (SCPs) and Advanced Critical Care Practitioners (ACCPs) has been proven to be a successful move. The use of ACPs/SCPs/ACCPs has largely replaced the need for Senior House Officers (SHOs), allowing junior doctors to maximise the training opportunities without the need for service provision. Despite such reductions; several deaneries do offer a small number of rotations for Foundation Year 2 (FY2) doctors to experience the speciality. Currently, there are three FY2 posts in Wales offering a 4-month rotation in Cardiothoracic Surgery; while limited rotation within the North-West deanery.

We aim to share some tips for upcoming FY2s, who have interest in becoming a cardiothoracic surgeon, to maximise the training opportunities within the rotation.

Clinics and pre-operative assessment Pre-operative outpatient clinics are mainly led by speciality registrars and Consultants. We recommend reading about the indication on surgical interventions prior attending the pre-operative clinic. It would be useful to apply the indications into the specific case and discuss with the seniors. Attending the cardiac/thoracic surgical multidisciplinary team (MDT) and reviewing in-hospital referrals with the

speciality registrars would also be beneficial.

Understanding the basics of the core investigations will be an important part of this process as well.

Operative experience Saphenous vein graft (SVG) harvesting is one of the first cardiac surgical procedures FY2s will learn. SVG harvest involves a number of basic surgical skills including incision, tissue handling, dissection, and precise knot-tying.

All of which needs to be performed within a particular time frame. SVG harvesting allows junior surgeons to acquire and develop a number of basic surgical skills regardless of future speciality of choice. FY2 should aim to harvest one length of vein under supervision within the rotation. Under supervision, one may have the opportunity to perform a number of median sternotomies.

More importantly, one should aim to be an effective 2nd assistant and help the “flow” of the operation. Recognising the steps of the operation and acting in advance would certainly benefit your future career in cardiac surgery. While in thoracic surgery, assisting video assisted thoracoscopic surgery (VATs) perfectly will be highly appreciated by the operator and chances to perform basic VATs procedures will certainly arise.

Post-operative experience One of the main duties for FY2s is to manage cardiothoracic surgical patients in the ward. Most patients would be stable by the time they are discharged back to the ward. However, it would be extremely useful to learn about the acute/ late complications after cardiothoracic surgery and identify patients that is/ has the potential to deteriorate. Escalate and discuss your concerns to the seniors

promptly would be highly appreciated by your seniors! Experience in cardiothoracic surgery intensive care unit is also extremely valuable. FY2s are not expected to manage patients independently in the ITU, instead, one should aim to understand the principles of post operative management of cardiothoracic surgical patients. During the 4-month rotation, one should aim to manage common conditions post-operatively such as arrhythmias, chest drain and wound management under supervision. One of the best ways of understanding this pathway is by following a patient that you attended his surgery and understand the journey till he is discharged from the hospital.

Academic achievements We recommend FY2s to complete 1-2 audit(s)/projects during their rotation, with an aim to present at the SCTS Annual Meeting. The annual meeting is one of the best places to meet other junior doctors and consultants to share some tips and experience in cardiothoracic surgery. Publications in cardiothoracic surgery is not easy but not impossible. Be enthusiastic and speak to the consultants for opportunities in advance.

Lastly ...

We encourage to FY2s to follow-up the patients peri-operatively. Seeing the patients in advance if you are allocated to theatre the next day. It would also be highly useful to review all the patients you have been involved in. In short, the cardiothoracic surgery rotation during FY2 is rare but highly educational. Not all FY2s will enter the speciality, but the skills are highly interchangeable and will benefit most in their future career regardless of their choice of speciality. n

the 46 bulletin

A thoracic specialist physiotherapist’s reflection of redeployment during the COVID-19 pandemic Michelle Gibb

T

he COVID-19 pandemic has been an overwhelming and exhausting time for all who work within the NHS presenting challenges and stresses never seen before. Many staff were redeployed into an unfamiliar and the unknown world of COVID-19, including myself.

I am a clinical specialist physiotherapist who has worked on our busy thoracic surgery unit in Leicester for the last five years and prior to this have worked in respiratory wards and ITU’s.

In April 2020 I was redeployed into our adult iTU as the number of critically ill COVID-19 patients increased with us spilling out into three clinical ITU areas including our theatre recovery which brought our thoracic operating to a halt.

Initially critically unwell COVID-19 patients were the unknown, the early reports from colleagues in other countries were that patients presented as serve ARDS with high oxygenation needs but a low secretion load and were not requiring intensive airway clearance, in these early stages patients were not ready for rehabilitation. At this point many of my colleagues from other specialist areas of physiotherapy had been redeployed to work with us on intensive care and the respiratory wards.

We began to see a change in the need for physiotherapy. Patients after being unproned had larger secretion loads often with thick and difficult to clear secretions, this accompanied by patients having an absent cough requiring more intensive airway clearance whilst balancing interventions alongside the

patients cardiovascular stability.

Some of these interventions included percussions and shakes to a patient’s chest to loosen secretions, the use of nebulisation, manual assisted cough, and rehabilitation. This was all heavy work in full PPE. I quickly found that after a few hours working in a bay wearing full PPE it was time for a break.

I had mixed emotions throughout my time of redeployment into ITU. There were some very sad moments when patients lost their battle with this horrible virus and to see family members come in to say goodbye to their loved ones. To the highs and moments of success when patients began to make progress. A moment I will never forget is our first patient admitted to ITU with COVID-19, being ready to trial a speaking valve and hearing his voice for the first time and hearing him speak to his wife. All the successes were excellent motivation to keep going, I would often

think about the thoracic patients having to wait for life saving surgery and how agonising that must have been for them and their families.

On reflection working clinically as a physiotherapist in COVID ITU challenged and progressed my rehabilitation with breathless and anxious patients with higher oxygen needs. These are factors that we see post-operatively in the thoracic population, but this was a new extreme and something I will adapt into my clinical practice for years to come. As COVID-19 numbers in ITU began to settle I went back my home to the thoracic surgery unit and surgeries began to resume. Unfortunately, as winter came around COVID numbers increased and myself and colleagues were redeployed once again to the ITU, this time for myself it was to another UHL hospital to aid with senior physiotherapy support. This time around we knew more of what we were dealing with, but everyone was tired and overwhelmed by COVID.

“A moment I will never forget is our first patient admitted to ITU with COVID-19, being ready to trial a speaking valve and hearing his voice for the first time and hearing him speak to his wife. All the successes were excellent motivation to keep going.”

January 2022

For myself, this time around some of the more specialist ITU physiotherapy skills were more at the forefront of my mind, working with the MDT on weaning plans, tracheostomy decanulation and planning rehabilitation. Some of my personal challenges at this time were working on an unfamiliar site, I was lucky to be surrounded by a fantastic team. During this wave of COVID, thoracic surgery was heavily reduced but continued, it was hard to be away from my specialist area of work and to be providing telephone support to the physiotherapists covering and to those who I would usually supervise. At this time, I also had two students start their 6-week placement. Within our trust physiotherapy student placements were stopped during the first wave and had commenced again. I think it was a challenging environment for both the students to be introduced into but also an excellent insight into the NHS during

the pandemic, and with the prospect of COVID-19 not disappearing anytime soon, hopefully shaping the students’ knowledge and skills for the future.

Balancing all these factors and treating some of the most critically unwell patients was physically and emotionally draining. This time around patients were making excellent progress and then would deteriorate suddenly leading to re-intubation, patients requiring sedation and more ventilation and being unable to wean from ventilators or sadly passed away.

There were again fantastic highs when patients improved and this made every effort worthwhile, but it was tough.

For physiotherapy we were an integral part of the MDT working, leading on weaning plans, rehabilitation, and newer skills of implementing an extubation check list. During the first wave of the pandemic our ITU intensivists and MDT observed post extubation laryngeal odema increased

leading to re-intubation. It was brilliant to be seeing my profession and my colleagues at the forefront of patient care during the pandemic and building on the physiotherapist’s role.

Since coming back from redeployment some of my personal reflections include being grateful for a sense of normality and to be back working with the thoracic MDT and patients. One of my personal observations is that the thoracic surgery patients appear more deconditioned and frailer, this group of patients has unfortunately had delayed surgery and have followed advice to shield at home and this has often led to increase inactivity and loss of fitness. I believe that in thoracic surgery, now more than ever, enhanced recovery is imperative to ensure our patients are as well as they can be prior to, during and after surgery. I hope that by sharing some of my own reflections it highlights and raises awareness of a role that physiotherapists have had during the pandemic. n

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the 48 bulletin

Robotic Transcranial Doppler: back to the future?

Niamh Hynes, Vascular Surgical Fellowship, Liverpool Heart and Chest Hospital

Experiences of Liverpool Heart and Chest as a vascular aortic fellow I was the first vascular aortic fellow at LHCH. Daunting, challenging, call it what you will; to me, it presented an opportunity to be involved in an exciting and pioneering endeavour. As a vascular surgeon, I was chartering new territory and floundering and fumbling as I did so, but when I look back at how I started the journey, and it ended, it was well worth every awkward tumble.

The new post was a shared fellowship between the aortic-cardiac service at LHCH and the aortic-vascular service at RLUH to maximise exposure to both open and endovascular complex aortic surgery.

The reasons for me applying to Liverpool was not just the individual world-leading reputation of the distinguished cardiacaortic and vascular-aortic centres but also their combined vision for the obvious need for multi-disciplinary approaches. I was proud to be working with experts who were able to provide the best advice and offer the optimum treatment to each patient. At times that treatment was no intervention, and having the courage, ethical fortitude and experience to prescribe this was inspiring to Figure 1. Cartoon of TCD and cerebral blood flow

be part of, but undoubtedly facilitated by the confidence gained from experienced multidisciplinary discussion.

As the token on-site vascular surgeon, a welcome and unforeseen aspect to my role at LHCH was my interaction across other disciplines when patients developed vascular complications. By virtue of combined risk factors and co-morbidities, a substantial number of TAVI patients had vascular access issues. Whether planned or an unexpected complication, it was always a pleasure. Integrating my skills into the TAVI team provided me with ringside seats to learn additional catheter skills and pacing knowledge that will stand to me. The TAVI team was also integral to introducing the total endovascular aortic arch service, which came into being during my time at LHCH.

My role in integrating vascular services into a cardiac unit I spent most of my time on-site at LHCH. This helped integrate aorto-cardiac and aorto-vascular services and establish vascular surgery as an independent entity within LHCH. Cardiac and vascular surgeons treat the same fundamental pathologies of atherosclerosis, aneurysm and dissection but in different anatomical locations. However, increasingly, with the advent of endovascular technologies, the lines of delineation between ‘territories’ have blurred.

Vascular surgeons bring endovascular and laparotomy

skills to a combined aortic service, while cardiac surgeons bring thoracotomy, circulatory arrest, and extracorporeal bypass skills. Individually they are gifted; together, they are dynamite.

The seeds for interaction of vascular and cardiac surgery in Liverpool to treat complex aortic disease were sewn in the 1990s. However, it wasn’t until April 2018 that the formal working relationship between five aorto-vascular surgeons at RLUH and five aorto-cardiac surgeons at LHCH was established with a new LCS service at LHCH. When I arrived, the service consisted of a twice-monthly operative list, a monthly MDT and omnipresent but non-standardised on-call cover. When I left, we had a combined weekly LCS clinic, weekly aorto-vascular theatre list, bimonthly MDT, a structured on-call service with dedicated vascular surgeons and electronic medical record templates ratified with documented clinical pathways and StandardOperating Procedures. Working with both teams, in particular, Prof Mark Field as cardiac-aortic lead and Prof Francesco Torella as vascular-aortic lead, I helped formalise the service. Essential to the process were Úna Ahearn, the indispensable Aortic Advanced Nurse Practitioner, fellow healthcare professionals, administrative colleagues and ancillary staff.

My role in introducing new services: robotic transcranial doppler In my last month at LHCH, I had the privilege of combining vascular and research skills to assist in introducing advanced imaging robotics to LHCH as one of the first sites globally. My experience with transcranial doppler for

January 2022

carotid surgery helped adapt this technology to aortic arch surgery. The technology from Braun Medical allows for automated signal acquisition and requires minimal intra-operative supervision or specialist neuromonitoring.

We applied the technology in several cases, including routine cardiac surgery, aortic arch surgery and TEVAR. Our first case involved a young lady requiring repair of an acute Type A aortic dissection (VSRR and FET), during which we used RCP and ACP (1, 2 and 3 vessel flow). During the subacute phase, she required TEVAR, during which we also used TCD.

Learning points 1) MTT flow: During cooling, CBF reduced significantly as we approached DHCA temperature, allowing us to document the baseline to aim for during ACP. 2) Minimal RCP flow for therapeutic effect: We showed RCP produces measurable flow reversal in the MCA bilaterally, which relates to RCP flow and CVP, allowing us to establish a minimal RCP flow for therapeutic effect.

3) Unilateral vs bilateral ACP: We showed ACP up the right carotid produces flow in the right and left MCA,

confirming a patent CoW and allowing us to potentially flow unilaterally, avoiding unnecessary instrumentation with attendant stroke risk.

Figure 2b. Control Console: the monitoring included TCD, BIS, INVOS (near-infrared spectroscopy), head cooling cap and anaesthetic related ET tube and central lines

4) Cannula Size: We showed that using different sized cannulae for left and right carotids may result in differential flows to respective hemispheres.

While we knew different size cannula might have this effect, we can now detect whether the CoW compensates.

5) Calibration between ACP flow and MCA flow: We established a calibration between ACP flow and MCA flow which allowed us to reduce the flows to a minimal therapeutic effect.

6) Supplementing flow through the LSA: We showed that supplementing flow through the LSA improved flow to the left MCA. 7) Transferable Pulsation: Pulsing through the CPB translated into pulsatile MCA flow.

8) Opportunity to reduce embolisation during TEVAR: Guidewire manipulation in the aortic arch and stentgraft deployment were the procedural steps that resulted in embolisation.

9) Protective Effect of Previous Arch Repair: Previous arch repair reduces the risk of embolisation during TEVAR.

Reflections Figure 2a. Set up in theatre: the monitoring included TCD, BIS, INVOS (near-infrared spectroscopy), head cooling cap and anaesthetic related ET tube and central lines

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My time as a vascular aortic fellow at LHCH has been a defining period in my career. I have made

friends who I hope will be life-long friends, colleagues and collaborators, and it fills me with immense pride to think that I may have contributed in any small way to the establishment of a world-leading service.

It’s never easy to go first, especially when you are not the only one to whom the service is new. But maybe that’s the joy of it, learning together, as a team. n

Abbreviations ACP Antegrade Cerebral Perfusion BIS Bispectral Index Monitor CBF Cerebral Blood Flow CoW Circle of Willis CPB Cardio-Pulmonary Bypass CVP Central Venous Pressure DHCA Deep Hypothermic Circulatory Arrest ET Endotracheal Tube FET Frozen Elephant Trunk INVOS Near-Infrared Spectroscopy LHCH Liverpool Heart and Chest Hospital LCS Liverpool Cardiovascular Service LSA Left Subclavian Artery MCA Middle Cerebral Artery MDT Multi-disciplinary Team meeting MTT Minimal Therapetuic Target RCP Retrogade Cerbral Perfusion RLUH Royal Liverpool University Hospital TAVI Transcatheter Aortic Valve Intervention TCD Transcranial Doppler TEVAR Thoracic Endovascular Aortic Repair VSRR Valve Sparing Root Repair

the 50 bulletin

Robotic cardiothoracic surgery India Premjithlal Bhaskaran, Medical Student, SCTS School Student Ambassador

R

obotic surgery is a type of minimally invasive surgery in which the surgeon is assisted by a computer-controlled robot during the procedure. The surgeon’s skill is enhanced by the robot, which allows them to operate complex surgical tasks in small spaces inside your body that would otherwise need open surgery.

The surgeon directs the robot’s actions and the robot’s precision is superior than that of a human hand working alone.

The surgeon manipulates the instruments using master controls during a robotic surgical system-assisted procedure, allowing for precise and delicate motions and the instruments translate surgeon’s movements into real-time accurate movements within your body. It only reacts to the exact hand and finger motions of the surgeon. It includes a greater selection of specialty equipment, including 8 and 5mm tools, and is lighter and easier to manoeuvre. Longer robotic arms enable surgery on larger patients, allowing surgery to be performed at a greater range of procedures.

While operating, MRI and CT scans can be given to the surgeon and increased high-definition vision can benefit the surgeon because it essentially doubles the resolution. The robotic tool outperforms the human hand in terms of dexterity and range of motion. The robotic arms have a full 360-degree rotational range. This enables your surgeon to do procedures that would be impossible to perform without the robot.

It has been suggested that robotic-assisted surgery is more ergonomic with less surgical fatigue because the surgeon is situated in a comfortable posture away from the patient.

At the same time, two surgeons can operate.

While each surgery is different, the general steps to a robotic-assisted surgery are making one to two centimetre-

long incisions into the body, inserting miniature robotic instruments and a powerful 3D camera into the body and the surgeon then sits at a nearby console (a large computer) to direct the procedure in hard to reach spaces by watching the area of the operation which can be seen at a more highly magnified level, with excellent resolution. The surgeon’s hand, wrist, and finger movements are transferred to the tools attached to the robot’s arms via the computer interface.

The replicated movements have the same range of motion as the surgeon, providing the most precise control possible.

There are numerous advantages of having a robotic assisted surgery, including a shorter recovery time and hospital stay, less blood loss, fewer blood transfusions, improved pain management, smaller incisions with minimal scarring, lower infection risk and a faster return back to normal life.

Robotic cardiac surgery offers lower risks than open-heart surgery, which is one of its key advantages. To open the chest, the surgeon does not need to cut through the sternum in robotic surgery.

Many of the risks associated with openheart surgery are eliminated. As with any type of surgery, robotic cardiac surgery necessitates general anaesthesia with intubation. On the side of the chest, a surgeon will make a series of keyhole-sized incisions to facilitate the insertion of robotic arms. Depending on the treatment, you may need to be placed on a heart-lung machine. In some circumstances, due to the complications and complexity of the case, the surgeon may not be able to complete the surgery using the robot and open-heart surgery will be needed. Other dangers may exist, depending on medical conditions.

The popularity in thoracic procedures is also increasing with satisfactory outcomes.

Complex thoracoscopic treatments such as thymus surgeries, resection of anterior mediastinal tumours and lobectomies are performed with robotic surgery, which has been demonstrated to be safe and successful. For several thoracic surgical diseases, robotic aid considerably simplifies the thoracoscopic approach.

In terms of mortality and significant adverse events, robotic surgery is comparable to traditional surgery. The expensive initial capital investment and continuing maintenance requirements are now impeding its widespread deployment.

It has been chastised for its high costs with an average cost per patient. What is concerning is the procedure’s costeffectiveness, particularly in terms of patient outcomes. The steep learning curve involved with operating robots is another important restriction, as a skilled operator requires more than 200 procedures to become proficient. However, proponents say that the expenditures can be offset by a shorter stay in intensive care and a shorter hospital stay. Suggesting that the total cost of running a hospital has not increased considerably as a result of robotic technology.

In the realm of advanced surgery, safety and quality are the top priorities.

It’s vital to remember that enthusiasm for incorporating the surgical robot into cardiothoracic surgical practice should be followed up by suitable training, cautious patient selection, and the construction of a team-based robotic programme. There are multiple centres in United Kingdom with simulation and educational tools to complement our training and we teach surgeons to be the best and most skilled in their field. n

January 2022

Cardiothoracic training programmes in Europe - a mixed bag Miia Lehtinen, Jason Trevis, Abdul Badran

F

urther exploring how training happens elsewhere, following our article with the TSRA on the North American programme we reached out to European neighbors to see what pathways they have around the continent. Despite efforts to unify cardiothoracic training in Europe, a wide array of programmes with very different content and structure still exists even between neighboring countries. Moreover, no official international body or authority keeps track of these multiple programmes and numbers of trainees enrolled in them so any comparisons are challenging.

In an attempt to better understand the training in each European country, in a recent survey by EACTS completed by 219 trainees in 24 countries showed an interesting mix of training. Whilst in the UK, the Netherlands and Nordic countries, there is a cardiothoracic pathway the majority of respondents were enrolled in a cardiac only programme.

This was largely down to the majority responders being from Germany, Austria and Switzerland, where cardiac and thoracic surgery are separate specialties. The same applies in Italy, Spain and Portugal.

Countries also have a variable need for preparatory general surgery rotations (often called “common trunk”) as well as in the number of procedures needed for training to be completed. In recent years, the length of the common trunk has been cut in many countries, with Germany abandoning it completely in 2018 and Finland reducing the minimum number of months required from 27 to 18 in 2020. This pattern has continued in the UK and Ireland with the new seven year curriculum shaving a year from the

phase one of training and making rotations more cardiothoracic concentrated.

The majority of trainees in Europe have cumulative targets of procedures to complete before completion certification, with 60% of survey responders citing 75 to 150 procedures. However, there can also be marked variation within a country, with Finland and Denmark giving the discretion of procedures required to each individual training center. In the UK and Ireland there is a move away from the indicative numbers to a more competency based training system with the recognition of individual learning curves being variable. There is still a requirement of 250 cases with the majority being in the dominant specialty, however, certification can be considered with other evidence of competency achievement.

stated no final examination was required to complete the program. Moreover, skills assessment was infrequent with just 35% of trainees reporting regular skills evaluation in their center. A stark parallel to the minimum mandatory WBAs required for each trainee in the UK and Ireland.

Unsurprisingly European trainee satisfaction mainly centered around the total number of weekly theatre sessions and proportion of cases performed as first operator. Something that has also been echoed consistently with recent surveys in this country.

Given the numerous challenges that cardiothoracic surgery as a specialty faces today, with the rapid development of catheter-based techniques and more complex patients referred for surgery, finding a uniform international template for training programmes in Europe remains dubious.

Fortunately, changes made to curricula in individual countries seems to be following a common theme, with a greater focus of training programmes on an earlier cardiothoracic experience.

One way of ensuring uniform theoretical skills is the examination by the European Board of Cardiothoracic Surgery (EBCTS). However, with multiple training governing bodies at national, regional and each individual center unifying and standardizing the practical skills required is more demanding. International societies and collaborations will be a natural way forward in realizing these efforts improving training both for the sake of trainees and our patients.n

“The majority of trainees in Europe have cumulative targets of procedures to complete before completion certification, with 60% of survey responders citing 75 to 150 procedures.”

Most of the training programmes in Europe take 5-6 years in total with a written or oral national examination as the final imperative step before board certification.

In Germany, board certification is governed on a regional rather than national level and in Russia, this responsibility lies with the individual training center. Interestingly almost a quarter of survey responders

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the 52 bulletin

Improving decision-making and sharing of information in aortic disease for patients and clinicians: the DECIDE-TAD initiative Riccardo Abbasciano, Clinical Research Fellow, University of Leicester Gareth Owens, Chair, Aortic Dissection Awareness UK & Ireland Four years of intense work to tackle inequalities and improve outcomes in managing families with aortic disease start to bear their first fruits.

M

anagement of thoracic aortic diseases requires a complex, multidisciplinary effort; providing different therapeutic and diagnostic options to patients relies on clinicians’ effective communication strategies, their ability to share information, and carefully explain the balance between risks and benefits of the possible choices.

A Delphi process, conducted in partnership with Aortic Dissection Awareness UK & Ireland (ADA UK&I), the national organisation for people with thoracic aortic diseases and their carers/ families, identified screening, shared decision-making, and addressing regional variations in care as the research areas to prioritise. In a feasibility study conducted in Glenfield Hospital in Leicester, two main aspects of the current pathway were highlighted. The diagnosis rate in 1st and 2nd degree relatives of someone who has had an aortic dissection is significant and may be high enough to warrant screening in patients and families that are currently not considered in the testing criteria. Equally important,

optimal management for their condition.

As part of a four-year (to date) collaboration between a multi-centre research group coordinated by Prof Murphy at University of Leicester and Aortic Dissection Awareness UK & Ireland, we identified the above as a major area of concern for patients and a gap in the knowledge that deserves further research initiatives, and we aim to address this clinical problem through the creation and testing of a Decision Support Tool (DST) for thoracic aortic diseases.

DSTs are invaluable instruments in areas where Gareth Owens and Haleema shared-decision making is Saadia, Chair and Vice-Chair of AD Awareness UK & Ireland crucial. They can clarify the ratio of risks/benefits, provide the necessary information to make a confident choice, and enhance the inclusiveness and equality of the service in which they are employed. Ultimately, they improve outcomes by allowing a consistent, accessible set of recommendations and decision-making processes.

It is easy to see why the benefits of a good DST would fit perfectly into the clinical context of thoracic aortic disease management.

Adherence to therapy and follow-up (often for extended periods of time), a fruitful communication between clinicians and patients, the involvement and update of multiple professional figures

it highlighted how current services offered by the available clinical pathway may be inaccessible for an important section of the public, or may not be adequately promoted.

Multiple scientific reports and direct experience from patients have shown how implementation of the current recommendation translates into a wide variety of approaches. This results in a service offer that is not equal across the country and may under-serve certain patient groups, creating confusion and ultimately preventing access to

January 2022

53

“DSTs are invaluable instruments in areas where shared-decision making is crucial.

They can clarify the ratio of risks/benefits, provide the necessary information to make a confident choice, and enhance the inclusiveness and equality of the service in which they are employed.” with different clinical competencies, and the participation of healthy relatives (of multiple age groups) for potential screening are elements which would make the experience of patients and families affected by aortopathy significantly better.

Our initiative is divided into four main components.

We are forming a group across different specialities and professions with a deep knowledge of the problems related to thoracic aortic diseases and we are putting them in direct contact with patients, relatives and their carers. We will hold focused discussions, organise workshops, disseminate surveys and questionnaires. These initiatives will help us define the scope of the decision support tool and consequently of the whole research programme. They will also be part of the dissemination strategy that will accompany and follow our activity.

Senior statisticians and data scientists are exploring the relation between health inequalities, unwarranted variations in care and clinical outcomes in a longitudinal study conducted through the analysis of routinely collected data. Elements such as

socio-economic status, gender and ethnicity will be taken into account, to clarify whether patients are accessing the same services across the country and whether potential differences in the care that they received determined a difference in the clinical evolution of their disease.

We are performing multiple systematic reviews of the evidence regarding various aspects of management of thoracic aortic disease, for which recommendations in current guidelines are not strong or uniform. In particular, we will focus on understanding what the optimal approach is for cascade screening, how drugs and lifestyle intervention might be used for primary and secondary prevention, and what are the characteristics of the ideal surveillance strategy, both in the presence of a diagnosis of aneurysm and in subjects considered at risk of developing aortopathy.

We will collate the evidence and provide it to a wide panel of international experts, with methodological support from experts of GUIDE. The final product of this effort will be a set of recommendations for topics that are currently underdeveloped and hence create confusion for clinicians and patients.

Prof Gavin Murphy, presenting during the Aortic Dissection Awareness UK 2021 in Bristol

Design and rationale for the Aortic Dissection Awareness UK & Ireland National Survey

Finally, we are working with psychologists and public management experts to document and assess potential barriers (both on an individual and organisational level) to the successful implementation of a DST. Through questionnaires, interviews and Delphi exercises we will aim to anticipate which difficulties might arise when the Decision Support Tool will be adopted in everyday practice. A series of workshops will then explore how the use behavioural science approaches can provide solutions to overcome said barriers.

Since our plan is to design a DST ready to be adopted in a clinical scenario and tested in a trial, whose effectiveness and applicability extends to the whole NHS and not to selected groups, efforts to ensure inclusivity in our works have been put in place from the developing stage, and will be an overarching criteria throughout the conduction of the study.

If you want to join our group in this journey to provide holistic care to patients affected by aortopathy and their families, please do not hesitate to get in touch with the research team coordinator at University of Leicester or via the Aortic Dissection Awareness (UK & Ireland) website www.aorticdissectionawareness.org.

We will welcome every potential expression of interest. n

the 54 bulletin

Setting up a new service in a COVID crisis; a challenging task at the outset of new consultant post M. Asghar Nawaz MBBS, MRCS, FCPS, FRCS, Consultant Cardiothoracic and Transplant Surgeon

I

magine you are offered your very first consultant post in a new healthcare system of a new country. Imagine you start this job during unprecedented times at the start of the COVID-19 pandemic.

Imagine you move to this new country alone, get locked down and placed in isolation for the first two weeks after arrival.

Imagine during the first week you are asked if you want to take the lead for setting up the unit to combat the COVID-19 surge. How does it feel? The first familiar thing that comes to mind for a cardiothoracic surgeon is “palpitations”.

The COVID-19 pandemic and the immense demands it has placed on the healthcare system represents an unprecedented challenge to any country.

I was newly appointed as a consultant cardiothoracic and transplant surgeon in Dublin in March 2020. Having never worked or lived in Ireland before, and starting in mid-March at the peak of the coronavirus lockdown, this was such an extraordinary move. Not only this, but I had to face being separated from my family as they remained in the UK. The travel ban abolished my original plan of weekend travel home and I ended up on my own for months. I was placed at the Mater hospital, which was designated as the main facility to care for COVID patients.

This affected routine working, squeezing elective operating to the minimum. As part of surge planning, the cardiothoracic HDU was upgraded to an ICU to ensure that the hospital remained a sustainable facility to care for COVID-19 patients. In the very first week, I was asked to take the lead for this task. I had not yet seen the entire department, nor had I met my colleagues, so this was a big ask.

With mixed feelings of excitement to lead this project whilst feeling a natural apprehension of being new in the environment, I happily

said “yes”. My colleagues at The Mater are friendly and supportive, particularly Karen Redmond and Lars Nolke who were exceptionally good and guided me throughout. The day I said yes and had my first meeting with the ICU director, I was informed the same afternoon that I would need to be in isolation due to recent travel from the UK. My colleagues remained happy for me to continue leading the project whilst being off-site.

Leadership and management: There were several aspects requiring particular attention, including caring for the carers during COVID-19, looking after colleagues during the crisis, compassionate leadership, effective team working and supporting the ground staff to deliver high-quality care.

Structural modifications: It was not an easy task and involved a variety of actions that to structurally reconfigure the HDU to become an ICU along with the required equipment. The open bays (bed spaces) would need to be converted into isolation rooms by installing floor to ceiling glass fittings, a negative pressure ventilation system, monitors and new doors with a good seal.

Equipment and disposables: Inventory was created with the help of anaesthetic, nursing and pharmacy teams including ventilators, monitors, infusion pumps, medications and stocks of PPE. The management team was also eager and supportive, facilitating an easy purchasing process.

Staff up skilling: Another important element to consider was the up skilling of medical and nursing staff. This was a challenge and required particular attention.

I have to praise all staff who were willing to take this challenge on board. As the cardiothoracic work was limited to urgent care, our junior doctors showed enthusiasm to have training to be able to run the new ICU

under the supervision of the anaesthetic team.

Similarly, nursing staff were also upskilled.

With the help of the senior anaesthetic team, we ran a number of training sessions including virtual and face-to-face sessions, in addition to mock scenarios, particularly to address the monitoring of ventilators and cardiovascular support systems. The world had minimal knowledge of managing this deadly disease, but staff were ready to be in PPE for long exhausting hours.

The project was completed according to the plan and fortunately the hospital’s existing ICU and COVID beds sufficed. So, this new facility gave us the opportunity to do some semi-elective cardiothoracic work and even to reopen the cardiopulmonary transplant programme, making this development still worthwhile.

I learnt quite a lot from this project.

Surgeons are de facto team leaders, yet surgical training focuses predominantly on technical skills. The importance of effective team leadership for achieving surgical excellence is widely accepted though behaviours that achieve this goal are less understood. Leadership is not just an inborn quality but a process and skill that can be learnt through desire. Recently, SCTS has run a leadership course but as NTN trainees you can also register yourself for modules like “Individual as a leader” and “preparing for leadership” through the deanery at your regional university. When it comes to consultant interviews, this makes an important contribution to the outcome.

The junior doctors are the key to the future running of NHS services. One way to inspire these doctors, and thus to safeguard the future of the NHS, is via leadership management. This is not only essential for the future of the NHS, but may also be key to patient safety. n

SCTS ANNUAL MEETING 8th-10th May 2022, ICC Belfast

We are back with our ‘in person’ conference!

SCTS UNIVERSITY

Cardiac & Thoracic Surgery educational sessions by International and National leading experts

FREE

Childcar

Lunchbox Sessions

MAIN MEETING PROGRAMME Contemporary Plenary Sessions Scientific abstracts & lectures Industry Exhibition & Symposiums

CT Nurse & Allied Health Professionals Forum Teaching wetlab day Session Theme: Education, Innovation & Evolution

SOCIAL EVENTS

Saturday 7th May – FREE Trip to the Giant’s Causeway Sunday 8th May – Drinks & Canapé welcome reception in exhibition hall followed by a Pub Quiz Monday 9th May – SCTS Annual Dinner at the Hilton Hotel Belfast Up to 18 CPD points Registration is now open. Early bird discounted rates until 31st March 2022.

To Register or view the detailed programme please visit www.scts.org

#SCTS2022

SCTS

Society for Cardiothoracic Surgery in Great Britain and Ireland

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Introductory guide for ST1 training to be published Devan Limbachia, Andrew Jones, Walid Mohamed, Duncan Steele, Abdul Badran

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o you’ve achieved possibly your biggest life and career ambition to date, entering the national cardiothoracic surgery training programme – but what next?!

Training in the cardiothoracic surgery can be daunting, particularly for those who have not done previous placements in the specialty. There is often a discrepancy between deaneries over who takes responsibility for the now-exclusive ST1 entry trainees, be that Core Surgical Training or Cardiothoracic Surgery TPDs. Information and support for ST1 trainees is likewise variable across the UK, which emphasises the need for signposting

trainees and networking with peers, plus or minus the cup of tea! In an effort to tackle this, the National Trainee Committee for Cardiothoracic Surgery (NTCCTS) has put together an introductory guide aimed at this new cohort of ST1 colleagues.

This guide aims to welcome new trainees to the specialty with a regularly updated resource of tips and advice to hit the ground running in their training. It is a non-exhaustive information bank for trainees in their first few years of training and covers relevant topics such as ISCP, work-based assessments, simulation, reading materials and surgical skills in one userfriendly document.

Below is a taster from one of the fourteen sections.

The guide will be published on the trainee section of the SCTS website and circulated to all newly appointed trainees annually. With the advent of the 7-year curriculum and the impact of the pandemic on training and surgical activity, there really is no time to waste!

Maximising training opportunities early on is the best way to start your journey to being a competent cardiac or thoracic surgeon, and we hope this guide will serve as a starting point as well as ongoing reference for new trainees to find their path in training. n

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FREE

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FREE

Reasons to attend the SCTS Annual Meeting Belfast

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Giant’s Causeway trip

with Network nal Internatio Speakers

FREE

Pub Quiz

FREE

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8th-10th May 2022, ICC Belfast

Registration opens on 1st December Early Bird until 31st March 2022 www.scts.org

SCTS

Society for Cardiothoracic Surgery in Great Britain and Ireland

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Importance of student mentorship in cardiothoracic surgery Denis Ajdarpasic, Final Year Graduate Entry Medicine Student, University of Nottingham Medical School Mohammad Hawari, Consultant Thoracic Surgeon, Nottingham City Hospital

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he traditional way of teaching aspiring surgeons has been “See One, Do One, Teach One”.

However, with a limited number of surgical placements on the undergraduate curriculum, particularly during the pandemic, how does one begin the long journey of becoming a surgeon if we are not seeing, let alone doing or teaching?

Mentorship is one of way of improving access and diversity in surgery by giving mentors an opportunity to guide an aspiring surgeon through the

Practicing opening incision with appropriate haemostasis and asceptic technique

long yet rewarding path that lies ahead.

Competition for places will always be high (113 applicants for six places at ST1 selection in 2021), however, could we be doing more to attract students from under-represented backgrounds and make cardiothoracics appealing to a broad cohort of future surgeons?

My medical school (Nottingham) piloted a mentorship programme called FirstCut, which was 6 months in duration and partnered a medical student with a consultant surgeon from various

Practicing one handed hand tie technique for chest drain insertion

specialties. The structure of the programme involved a minimum of three meetings with our mentors; an introductory meeting to discuss our objectives, a mid-programme review, and an end-of-programme sign-off to reflect on the programme as a whole.

I was fortunate to be given the opportunity to be mentored by Mr Mohammad Hawari in Thoracic Surgery at Nottingham City Hospital. We would like to share our experiences and recommendations on the importance of student mentorship in cardiothoracic surgery.

Practicing instrument tie technique for chest drain insertion

January 2022

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Mentee perspective

Mentor perspective

Being on the same page as your mentor is crucial and I would advise medical students to be open and direct with their mentor so that you have a shared goal from the outset. During the first meeting I expressed my desire to gain hands on exposure in theatre and get involved with research projects. The pandemic was at its peak so both parties had to be flexible and realistic on what was achievable given the huge constraints. I would recommend you make the most of your other placements, even if they are not surgical in nature, as you will develop transferrable skills that you can bring into theatre. I was on an obstetrics and gynaecology placement at the time of our first meeting and got involved in a few c-sections where I was able to get the tactile feedback when performing a subcuticular closure that you cannot get from artificial skin pads.

It is important to mention that mentorship is not a one-way street. You get what you put in, and it is up to you to seek the opportunities and be persistent if you want the privilege of being part of the surgical team. Be flexible and have a long-term vision when it comes to developing your surgical skills. I started by doing closures and manoeuvring the thoracoscope, progressing onto opening incisions and port insertion/ set-up, to finally performing pleural biopsies and wedge resections over the course of the 6 months. I was also keen to get involved in a research project that culminated in a poster presentation at the British Thoracic Oncology Group annual meeting. Having said that, the one skill that I developed throughout this time was resilience. There is a realistic perspective you can only get when you are in theatre for the whole day, some cases may be more complicated than anticipated, maintaining focus at the beginning to ensure your opening incision is performed with adequate haemostasis, but also throughout the operation where the consultant will go through their reasoning for performing the operation in a certain way. Finally, all those long hours of practicing your skin closure and one-handed knot tying technique can be put into practice as you get the opportunity

I was intrigued by this mentorship programme as I benefited from having mentors during my training years and could see the value it may have for an aspiring surgeon. My approach was to gain an understanding of the prior experience Denis had alongside his aims for the programme. There were active and passive elements of this programme that I wanted Denis to be exposed to, such as the surgical decision-making process and how surgeons lead and work effectively within the wider team to ensure patients received the best outcomes. I also wanted him to implement the lessons he learnt whilst performing parts of the operation and give him feedback and motivate him to keep improving and enjoy the added responsibility that came with increased exposure. Reflection is a crucial part of the process, my recommendation is to be proactive as a medical student, you will get opportunities if you put in the effort and be receptive to the advice you receive. I would also recommend keeping a log of all the operations you have been involved in.

Cardiothoracic surgery is a very demanding yet immensely rewarding profession.

Assisting and observing complex cases with consultant teaching throughout

“Being on the same page as your mentor is crucial and I would advise medical students to be open and direct with their mentor so that you have a shared goal from the outset.” to close. Constructive feedback is crucial at every stage, regardless how well or not you may have done, always seek feedback on how you could improve next time. Mr Hawari and his registrars ensured that I was aware of how I was progressing and the aspects in my approach that needed improving. “The only difference between feedback and criticism is how you choose to hear it”, which is why I would also recommend a reflective diary.

Choose the experiences where you learnt the most, irrespective of how you performed, to ensure these experiences stick in your mind and your future self will thank you for putting in the effort now.

Finally, in deciding if cardiothoracic surgery is for you, ask yourself: Can I see myself doing this job in years to come, and do the positive and negative aspects of the specialty suit my personality and plans outside of work?

Our recommendations Based on our experiences we would recommend a similar approach by students wishing to explore the specialty and consultants with an interest in teaching and inspiring the next generation of cardiothoracic surgeons. The experiences gained during the programme provide value to both the mentor and mentee, and we would be happy to work with SCTS in implementing this on a larger scale.

Finally, I would like to thank Mr Hawari and the team at City Hospital for making me feel welcome and part of the team from day one. This has been a fantastic learning opportunity that has enabled me to gain a realistic insight into the specialty whilst working in a dedicated and supportive team. n

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Innovation is in the air Hazem Fallouh

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ost of us get to experience the power of healthcare innovation during our day-to-day job over the years. But more recently, we as human beings felt the triumph of innovation, like never before, through a two-dose jab to liberate us from the shackles of the worst pandemic in a century.

The speed of implementing this innovation was unprecedented and continues to beg the question about the responsibility and the safety of implementing the vaccine so soon. On the other hand, it was not soon enough for my friend and Cardiothoracic Surgeon Jitendra Rathood and many million others.

These were my thoughts when I was waiting my 15 minutes having had my third booster dose in the basement of the old building of the Queen Elizabeth Hospital, in Birmingham, on a rainy autumn morning.

The rain didn’t bother me much as I had a trip to look forward to soon, to Barcelona EACTS, after nearly two years of commuting by car only.

While waiting, I turned on my laptop and here is an email from Hunaid Vohra and Simon Kendall, the Chairmen of our spanking new SCTS Innovation Sub-Committee, of which I am a member commenting, on a piece of work I did for the sub-committee.

Innovation does feel finally right at the heart of our beloved SCTS with this new innovation sub-committee.

We have had three meetings so far and fellow members are talking about robotics, minimally invasive cardiac surgery, intellectual property, new devices, and technologies, etc. Simon and Narain from the executives set

the scene for a very supportive and a laissez-faire approach. This environment has encouraged all twenty-two members to share their aspirations passionately in creating, developing and disseminating new innovative ideas into our speciality.

The training in innovation was a major feature in the discussion and surely the importance of responsible cost-effective approach of implementing innovation was not overlooked.

Having been involved in innovation for nearly two decades now, I became familiar with Rogers Bells curve which looks at the distribution of population based on their tendency to adopt innovation. The shape of the distribution curve varies based on the socioeconomic and educational background of the group. I always thought it is easy to place me along this curve but as time went on, I found myself sliding rightward up the curve in the direction towards the majority; I used to make sure I had the

latest iphone money can buy. Now I am still quite happy with my iphone 7 (2017 release).

The intriguing question for me is what the shape of this curve would be like in a group of cardiothoracic surgeons. We are a naturally adventurous risk-taking bunch to dare doing the job in the first place so you would expect a lot of innovators and early adopters, on the other hand we thrive on familiarity and repetitiveness to reach excellence and therefore we will be more resistant to change. I concluded that exactly this contradiction makes us extraordinarily ordinary ... like the masses. Some thrive on the perfection and safety of the old, well established, tried and tested safe lobectomy, thoracotomy, sternotomy 1+2 grafts and others crave for the mini mitral, robotic uniportal segmentectomies etc.

Wherever we are individually on this graph below, sitting on the innovation subcommittee gives the impression that our speciality in the country could be moving confidently and safely into the twenty first

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“Innovation does feel finally right at the heart of our beloved SCTS with this new innovation sub-committee.

We had three meetings so far and fellow members are talking about robotics, minimally invasive cardiac surgery, intellectual property, new devices, and technologies.” century. However, the success of this subcommittee will be judged based on its ability to engage with wider member base.

Ten minutes have passed since my state-of-the-art 2020 vaccine, accurately announces the massive clock laid on an old metal chair that stood the test of time and could have supported the weights of pioneering surgeons at the Queen Elizabeth Hospital from the last century who have long passed.

Five minutes to go and time for one more email. It read Congratulations, your submission has been selected for the finals at the Techno-College Innovation Award at the annual meeting of the European Society of Cardiothoracic

Surgery in Barcelona. This is an idea for a device to predict the development of cardiac tamponade following cardiac surgery I had over a decade since I was a trainee struggling to decide whether to drag my boss out of bed to explore the patient in the middle of the night or not, risking having to ask the nurse to call him a couple of hours later when I The clock at the QE had to open the chest in ITU vaccination centre following arrest. A problem I have no doubt my boss had as a trainee four decades ago and our trainees fist triumphantly which triggered the pain would still have to this day. I clenched my off the jab higher in my arm. It is a great opportunity that I have an international platform to share the solution to a problem in cardiac surgery older than the chair holding the clock in front of me and maybe this could be the jab against a problem all the current technological innovations have failed to eradicate.

I walk out of the vaccination centre at the old Queen Elizabeth Hospital building and travel through time via the glass link bridge into the glossy new building feeling liberated more than ever with my third jab that I was apprehensive in receiving a couple of days ago and feeling so despite less-than-optimal evidence to support it but I am grateful to have a choice.

This encounter made me realise that innovation is the destiny that define us as human beings, and we have a choice, more than ever before through the SCTS Innovation Sub-Committee to shape it. n

Oath of

Hippocrates I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

To consider dear to me, as my parents, him who taught me this art; to

live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

But I will preserve the purity of my life and my arts. I will not cut for

stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

In every house where I come I will enter only for the good of my

patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

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Final Ionescu Fellowships 2021 Carol Tan, SCTS Education Secretary

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he Society for Cardiothoracic Surgery in Great Britain & Ireland (SCTS) invited applications for the final round of Fellowships sponsored by Mr Marian Ionescu. As a surgeon, educator and trainer, Mr Ionescu has seen the value of helping the development of trainees, consultants and the teams in which they work. The broad range of the fellowships was aimed benefit all members of the SCTS: Consultants, Surgeons in training, Nurses, Allied Health Professionals and Medical Students.

The applications were advertised in the SCTS website as well as by flyers to all the members. The deadline was the 15th August 2021. All applications were scored to the SCTS Scoring Matrix, by a panel of SCTS Officers and the scores were averaged to rank the candidates.

We can confirm that all applications were duly considered and recommended by section leads and relevant teams due to the spread of experience and variation in the specialty. The recommendations were finalised by unanimous decision by the scoring teams for various streams and were submitted to the President and Mr Ionescu for approval.

Although it is with sadness that this is the final round of fellowships by Mr Ionescu, SCTS and its membership has greatly benefited from his benevolence over the last decade with contributions enabling the Ionescu University, Ionescu Fellowships and the Perspectives in Cardiothoracic Surgery. No words can express the heartfelt gratitude SCTS Education owe him with his contributions directly reaching hundreds of our wider cardiothoracic surgical community and indirectly hundreds of thousands of the patients we care for.

Ionescu Consultant Team Fellowship: 1 award, £15,000

Ionescu NTN early years (ST1-4) travel award: 2 awards, £5,000

Mr Sri Rathinam, Consultant Thoracic

Miss Alina-Maria Budacan, NTN West

Surgeon, University Hospital of Leicester to visit Shanghai, Pisa and Paris, to focus on advanced uni-portal resection, robotic surgery and sub-lobar resections under Dr Gonzales Rivas, Prof Franca Melfi and Dr Dominic Gossot respectively.

Midlands currently in New Cross Hospital, Wolverhampton. The fellowship is to Toronto General Hospital under Prof Keshavjee, to gain insight into patient pathways and compare our local practice with the Toronto practice to identify areas for improvement and increase organ donation in the UK and donor assessment and retrieval, recipient selection and operation, pre and postoperative care as well as the use of the Toronto XVIVO Lung Perfusion System.

Ionescu NTN Trainee Travelling Fellowship: 4 awards, £10,000 each Mr Ahmed Al-Adhami, Scottish NTN

from Golden Jubilee National Hospital to visit Duke University under Prof Paul Schroder, to learn from Duke University experience in DCD heart procurement and implantation, use of the Organ Care System, use of the LUNGguard Cold Transport for procured lungs, longterm LVAD and total artificial heart implantation.

Ms Katie O’Sullivan, Irish Specialist

Miss Georgia R. Layton, East Midlands NTN

in Glenfield Hospital. The fellowship will be under Dr Andrew Civitello for an arranged observership in cardiac transplant and mechanical circulatory support at the Texas Heart Institute within Baylor St Luke’s Medical Centre, Houston, TX, USA. Ionescu Trust Appointed Doctors Surgical Fellowships: 2 awards, £10,000 each

Registrar currently in Royal Victoria Hospital to visit The Cleveland Clinic, to learn advance cardiac surgery including aortic and TEVAR under Prof E Rosellli.

Miss Maria Cannoletta, Senior Clinical

Ms Caroline Toolan, Northwest NTN

Dr Andreas Gkikas, Research Fellow in Thoracic

currently in Wythenshawe Hospital to complete a year’s fellowship at CedarSinai Medical Centre in Los Angeles within the Cardiac Surgery Programme led by Professor Chikwe, to develop expertise in operative management of both mitral and aortic valve disease.

Surgery, Glenfield Hospital and Research student UCL for a fellowship under Mr Antonopoulos & Professor Tomos in Athens and Mr Mark Jones in Belfast, to enhance understanding of cardiothoracic surgery.

Miss Jennifer Whiteley, NTN in Scotland

Mr Benjamin Irene Omoregbee, Specialty Registrar (Trust Grade) Castle Hill Hospital to visit various centres including Blackpool under Mr Joe Zacharias, to focus on minimally invasive cardiac surgery.

in the Golden Jubilee National Hospital to visit Toronto General Hospital for a fellowship in Lung Transplantation under Prof S Khesavjee.

Fellow, Royal Brompton Hospital for a fellowship under Mattia Glauber, to improve skills in cardiac minimally invasive surgery.

Ionescu Trust Appointed Doctors small travel grants: 2 awards, £5,000 each

January 2022

Mr Anchal Jain, Trust appointed doctor, University Hospitals of North Midlands to visit Birmingham Heartlands Hospital under the supervision of Mr Maninder Kalkat, to gain advance VATS skills and thoracic surgical skills.

Ionescu small travel awards for FYs and CTs: 3 awards, £5,000 each Dr Ramanish Ravishankar, FY1 in

Scarborough General Hospital for fellowships at Papworth Hospital under Mr Stephen Large in the field of cardiac transplantation and the Duke University Hospital under Dr Ryan Plichta in high-volume aortic surgery; and in the University of Washington under Dr Maziar Khorsandi in cardiothoracic transplantation.

Dr Savannah Gysling, Academic

Foundation Doctor in Nottingham University Hospitals to visit the Aortic Institute of Yale New-Haven Hospital under Professor Elefteriades, to focus on cardiac surgery particularly in the field of thoracic aortic disease.

Ms Shwe Yamin Oo, CT2 in Musgrove Park Hospital to complete a clinical immersion in Bristol Royal Infirmary, including a part time MD degree, with Mr H Vohra and Professor S Suleimann on biomarkers of cardiac injury and inflammation in minimally invasive cardiac surgery.

Ionescu Nursing & Allied Health Professional Fellowships: 4 awards, £5,000 each Mrs Xiao Liu, Advanced Nurse Practitioner, University Hospital Southampton NHS foundation Trust to visit the University Hospital Mainz, Germany, to focus on an advanced Thoracic postoperative clinical pathway and Bristol to observe enhanced post thoracic operation recovery.

Ionescu Medical Student Fellowships: 6 awards, £500 each Miss Asmita Singhania, Medical student, University of Manchester to visit the Paediatric Cardiothoracic department at Hassenfeld Children’s Hospital, NYU Langone under Prof Susheel Kumar.

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Mr Alexander Reynolds, Medical Student, Swansea University Medical School to visit Bristol Royal Infirmary, to gain insight into paediatrcic Cardiac Surgery under Professor Massimo Caputo.

Miss Kirstie Kirkley, Medical Student, University of Bristol Medical School to visit Middlesbrough, to gain experience in cardiac surgery under Mr Simon Kendall.

Mr Sean Pattinson, Medical Student,

Newcastle University for clinical immersion in the Royal Papworth Hospital under Mr David Jenkins.

Mr Denis Ajdarpasic, Medical Student,

University of Nottingham for clinical immersion in the Royal Papworth Hospital under Mr Samer Nashef.

Mr George Liu, Medical Student, Anglia

Ruskin University School of Medicine for a clinical immersion in cardiac surgery in Basildon Hospital. n

SCTS Ionescu FY Fellowship Jason Trevis (Academic F2 at James Cook University Hospital, Middlesbrough)

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y Ionescu foundation doctors fellowship saw me spend two weeks at Royal Papworth Hospital, Cambridge, with Mr Aman Coonar. As a dedicated cardiothoracic centre, the experience and learning I received exceeded all expectation.

My introduction to cardiothoracic surgery at Papworth opened up with quite a bang, with an aspect of the speciality I had not previous witnessed; a postoperative deterioration led to a patient requiring emergency extracorporeal membrane oxygenation (ECMO).

The team work was a true spectacle to behold; from recognition of the clinical need for ECMO to an entire dedicated team descending on the theatre. This set a precedence for the entirety of my time at Papworth, namely, exposure to uncommon/‘hard to reach’ areas of the speciality such as uniportal minimally invasive thoracic surgery, tracheal stenting for a rare carcinoma, mechanical circulatory support devices and pulmonary endarterectomy.

Under the supervision of Mr Coonar, I was able to experience the full breadth of

the speciality, with multiple opportunities to broaden my skill set. The theatre team and registrars were fantastic in allowing me to scrub for the majority of procedures, as well as close most cases where appropriate.

I feel my time at Papworth has solidified my passion for speciality, developed my operative skills, clinical reasoning and laid foundations for future projects within thoracic surgery.

Finally, I would like to thank both SCTS and Mr Ionescu for their support, which enabled me encounter elements of the speciality seldom experienced. n

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SCTS Ionescu Travelling Fellowship University Hospital of Zurich, Zurich, Switzerland November 1st-12th 2021 Kudzayi Kutywayo During my stay, I got to experience the following:

Pulmonary Endarterectomy for CTEPH USZ is an established center for the surgical management for the treatment of chronic thromboembolic pulmonary hypertension, CTEPH. I had the privilege of observing two pulmonary endarterectomies and following up on their early postoperative course.

Robotic Thoracic Surgery The USZ Thoracic Surgery department now has an established robotic thoracic surgery programme which is led by the two leading surgeons in the unit.

It was the first institution in Switzerland and one of the first University Hospitals in Europe starting a thoracic-robotic program (Da Vinci 3-Arm) as early as 2004. At present, 31% of lobectomies performed in the unit are performed as RATS procedures.

Performing a pulmonary endarterectomy

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had the honour of being awarded the 2020 SCTS Non-NTN Ionescu Fellowship. Multiple adjustments to travel plans had to be made along the way in view of the ongoing Coronavirus pandemic. However, I am grateful that the trip happened in the end. With a keen interest in Thoracic surgery, I had chosen to visit the Thoracic surgery department at the University Hospital of Zurich, Switzerland.

The University Hospital of Zurich, USZ is in Zurich’s Old town. The Thoracic surgery department is a renowned centre for surgery, research and training. The director of the department is Professor SchmmitOpitz, president elect of the ESTS. I received a warm welcome from the team.

Coincidentally, two other international observers (Portugual and Greece) were already undertaking their observership upon my arrival, testament to their culture of education and training. I was quickly indoctrinated into their daily routine which included ICU ward rounds, transplant ward round, surgery, multidisciplinary meetings (tumour boards) and educational meetings.

What was immediately apparent from the outset was the efficiency of the workflow which understandably like the rest of the world’s health care systems, had to adopt in light of the Coronavirus pandemic. Surgeries start promptly with minimal intermission between cases.

Performing a RATS thymectomy

January 2022

Lung transplantation The unit has a robust lung transplantation service which, to date, has performed in excess of 500 transplantations. It is a close collaboration between the transplant surgeon and the transplant Pulmonologist.

The unit’s work has been internationally recognised. During my visit, I got to experience the in-hospital post-operative care of lung transplantations.

In addition, the department has a strong culture of clinical and experimental research embedded in their practice. Active areas of

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interest include malignant mesothelioma, lung transplant and pulmonary hypertension. Quality research meetings and symposiums are held regularly.

Overall, this was an enlightening and self-expansive experience for me.

A debt of gratitude is owed by myself to the SCTS Ionescu Fellowship for affording me this opportunity and my unit, Glenfield Hospital, Department of Thoracic surgery for allowing me time off to make this trip.

Finally, I would like to extend my wholehearted appreciation and thanks to Professor Schmmit-Opitz and her team for making my stay worthwhile and indeed memorable. n

SCTS Ionescu – NTN Travelling Fellowship – The Barts Experience Tom Combellack

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had the good fortune to undertake a fellowship in Barts under the supervision of Mr Stamenkovic, who is Director of Robotic Surgery and founder European proctor for Intuitive – the company that makes the Da Vinci robot. There is another robotic fellowship opportunity in Guys under the supervision of Mr Routledge.

What is unique about the Barts robotic programme is that it has the most advanced Da Vinci – 4th generation Xi. It is a dedicated thoracic robot with access five days per week for use by all five consultant surgeons including two European proctors, effectively delivering a standardised training experience. In addition, there is a large volume of segmentectomies with full use of robotic adjuncts such as ICG (indocyanine green), exposure to innovative procedures and ideas and involvement in high quality research.

My fellowship was for three months prior to gaining a substantive consultant post in Cardiff but the fellowship usually lasts for 6-12 months.

My typical week involved one clinic/MDT day, two days in theatre and one in six non-resident on call with relatively light intensity.

Prior to my arrival I completed the Da Vinci online learning modules. Once at Barts I dedicated myself to the simulation training package that comes with the robot.

I completed these modules within my first week. The first two weeks I watched on the second console, immersed in the operation, learning the set up and tips and tricks for thoracic robotic operating. In my third week I was signed off on Da Vinci in-service and emergency undock training by one of the Intuitive representatives and performed my first case the same week.

Within three months I had performed 23 independent cases supported both by Mr Stamenkovic and my registrar colleagues on a range of lung resections including advanced segmentectomies and mediastinal procedures. I felt incredibly well supported throughout my learning curve especially with such a slick theatre team. Personal highlights include a robotic lung and chest wall resection and a hybrid robotic procedure with cone beam CT fiducial insertion and localisation.

The whole thoracic team was very welcoming and I was invited to learn in other theatres too. For example, I performed robot procedures with Ms Wilson (European proctor), an extended pleurectomy decortication with Mr Waller and navigational bronchoscopy with Mr Lau. The robotic experience alone was fantastic but the opportunity to see and perform some of the other most innovative and advanced techniques has taken my development to a whole new level. My only regret is that I wish I could have stayed longer!

I think the Barts Robotic Fellowship is a phenomenal opportunity, especially as a post FRCS finishing school. Not only will it be stimulating and broaden your professional network with some of the highest profile surgeons in the country but it will also put you in a very strong position for any consultant post. I cannot rate it highly enough.

I would like to offer my sincere thanks to Mr Ionescu for giving me this fantastic opportunity to learn new skills. n

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SCTS Ionescu Fellowship Anoop Sumal, Recipient of SCTS Ionescu Medical Student Fellowship 2021 Final year medical student at the University of Cambridge

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completed a four-week placement with Mr Simon Kendall (current SCTS President), at the James Cook University Hospital to gain an insight into the role and qualities required of a Cardiothoracic surgeon. This placement was kindly funded by the SCTS Ionescu Fellowship.

During the placement, I assisted in 17 cardiothoracic operations which ranged

Performing an aortic valve replacement at the Wet lab session.

from valve replacements, CABGs to lobectomies and pleural biopsies.

I frequently assisted in closing the chest/leg and harvesting the great saphenous vein and near the end of the placement performed three sternotomies. I also experienced being the first assistant during a CABG which was very exciting. In between robotic cases, I spent time on the simulation mode Using the da Vinci surgical system of the da Vinci surgical system to get used to the controls. speciality. I feel more confident in my Outside of theatre, I attended surgical skills and by spending many the Cardiothoracic wards to examine hours in theatres I have developed a sense patients and document the ward round of ‘surgical stamina’, which will come in notes, and participated in a Wet lab useful as I prepare for my future surgical session where I performed an aortic application. I am indebted to the SCTS valve replacement in a porcine heart. and Mr Ionescu for their support and Overall, I thoroughly enjoyed look forward to getting involved in future this experience and I am left even SCTS events. n more captivated by this exhilarating

‘A Quote from the Operating Room’ – My Medical Student Fellowship Kirstie Kirkley

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quote from a consultant anaesthetist, ‘I don’t need help, I need time’ – likely unheard by anyone else, but really resonated with me. If I have taken anything away from my fellowship experience, it is that someone’s time is truly invaluable. As a medical student, you have lots of it, yet often rely on other people to give you some of theirs – be this to share skills, experiences or encouragement.

During my four weeks at James Cook, I was lucky enough to be ‘lent’ time, by many, very patient colleagues. Under their guidance, I assisted with sternotomies, harvested saphenous veins for CABG and honed my suturing skills. I learned of new techniques within the field – from off-pump surgery, to robotics and some even born within this unit, such as the ‘mini mitral’ approach to valve replacement / repair.

What I came to appreciate most is just how imbedded the culture of teaching

is within surgical careers. It is very easy as a medical student to feel overwhelmed by how far you’ve got to go. In contrast, it is refreshing to see true teamwork at play, that is, learning from others, at all levels. I saw consultants conferring during complex cases and trainees, praised for mastering new skills and earning more responsibility.

The mentorship I received, yes, was a lot of help, but perhaps most importantly, the time, patience and relative independence to ‘give things a go’ myself. n

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SCTS Ionescu Final Medical Student Fellowship 2021 Award George Liu

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uring my time at the Essex Cardiothoracic Centre my main objectives were to gain surgical experience, participate in research and form a holistic understanding of what Cardiothoracics means in this current era, especially post-COVID-19.

I spent my first week in theatres, learning about the roles of each member of the team and the rationale behind the surgical procedures being performed.

During this time, I also learnt about cardiopulmonary bypass, echocardiography, and applied my surgical skills under the care of the Surgical Care Practitioner team, suturing and assisting in saphenous vein graft harvesting and chest wound closure.

My remaining three weeks were spent on the ward, assisting

in ward rounds and jobs. It was clear from the number of postponed surgeries that the backlog from COVID-19 still plagued the wards. The most important lesson I learnt was that delivering bad news to patients does not always go to plan, as the spectrum of responses is vast and therefore unpredictable.

However, with good communication and rapport, the doctors were able to support patients, physically and mentally, through this difficult time.

I was keen to incorporate a couple of audits into my schedule based on my ward observations. The first audit was about chest delays and their potential to cause a delayed discharge. The second audit was regarding the completion rate of ward round jobs. These topics are both critical to patient care, but are not limited to cardiothoracic patients, therefore they will have a broader benefit for the Trust. The first of my two audit presentations was well received.

Finally, I’d like to thank Mr Ionescu for this amazing opportunity. His generosity will continue to aid me throughout my career. n

“The most important lesson I learnt was that delivering bad news to patients does not always go to plan, as the spectrum of responses is vast and therefore unpredictable.”

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SCTS Ionescu Medical Student Fellowship 2019 – Congenital Cardiac Surgery, Alder Hey Hospital, Liverpool Tom Eadington, FY1, Manchester University NHS Foundation Trust

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had originally organised a visit to Fortis Hospital in Mumbai for my SCTS medical student fellowship. However, this goal looked improbable when in April 2020, I received the news from my medical school that all our electives were to be cancelled due to the COVD-19 pandemic and India was closed to all international travel. Instead, like most of the UK, I spent much of that summer shut inside my house – at least my garden was grateful for the attention!

I had optimistically hoped that I would be able to visit Mumbai the following summer, as surely things would have settled down by then? When this clearly became unrealistic, I started searching for an institution in the UK at which to undertake the placement. Luckily Mr Dhannapuneni kindly agreed to supervise me at Alder Hey Hospital, so after finishing medical school I was to spend four weeks in the slightly less exotic destination of Liverpool.

Alder Hey is one of the largest congenital cardiac centres in the UK, performing approximately 450-500 operations per year. This fellowship represented a fantastic opportunity for me to gain experience in a field I had always been interested in, but had limited exposure to.

During my time at Alder Hey I spent time in the intensive care unit, assisting in theatre, attending MDT meetings and clinics, as well as being involved in departmental and audit meetings. Entering such a highly specialised clinical environment was a steep learning curve but this was made easier by the friendly and welcoming nature of all the staff.

I was very well supported and quickly felt like part of the team.

In the intensive care unit, I learnt about complex post-operative management as well as the acute management of emergency admissions. I had previous experience of ECMO and mechanical circulatory support in adult patients however, seeing this technology utilised in neonates and children was fascinating. I was amazed at the resilience and fortitude of these young patients and their families, with some of the most challenging patients often undergoing multiple operations and enduring long intensive care stays. How these parents were counselled through these difficult times was inspiring to witness and demonstrated the importance of putting patients at the centre of care.

I had excellent exposure in theatre.

I gained experience in a wide range of procedures including complex mitral and aortic valve surgery, aortic surgery for hypoplasia and coarctation, atrial and ventricular septal defects, Fontan procedures, Tetralogy of Fallot, pulmonary atresia and PDA closure. The range of patients from impossibly small neonates to teenagers who closer resembled adults made every day different. Each case presented a new challenge, with wide variations in anatomy even for different examples of the same pathology. The level of technical skill displayed in performing these operations was inspiring, however these were not solo efforts. As was the case in all aspects of this placement, teamwork was the key to being able to deliver these life-saving interventions. This was particularly

evident during the more challenging cases, where there were often multiple surgeons, cardiologists and anaesthetists all working together to decide on the best way to proceed.

The effect this team had on the patients and their families was immeasurable, and it was humbling to witness. Combining innovation and expert technical knowledge with empathy and compassion to deliver some of the most advanced healthcare in the world – everything that attracts me to a career in cardiothoracic surgery. This fellowship gave me an immersive experience in congenital cardiac surgery. The days were often long and always challenging, but the rewards were worth every minute. I loved it.

I would like to thank Mr Ionescu for his generous support in making this fellowship possible. I would also like to thank Ram Dhannapuneni, Rafael Guerrero and the rest of the team at Alder Hey for welcoming me so kindly into the department and giving me such a valuable and enjoyable experience. n

January 2022

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Marian Ionescu Student Fellowship in Congenital Cardiac Surgery, Leeds Teaching Hospital Rishab Makam

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rom the outset, I would like to say that I am incredibly grateful for the generosity and support from Mr Ionescu and the SCTS fellowship which allowed me to undertake a 6-week elective at the Leeds congenital cardiac surgery unit.

I am positive I speak for every medical student when I say that our final year elective is something we all look forward to from the moment we are first exposed to clinical placements. Not only does this part of curriculum offer a break from the responsibilities of medical school, but it also provides an opportunity for exploration of those specialties that we want to see more of, but that the constraints of university don’t allow.

As an aspiring cardiothoracic surgeon still exploring the specialty, I wanted to use my elective as an outlet to discover the breadth of the field. Considering that I had already been involved with the adult subspecialty, this left me with transplant, congenital and minimally invasive. When Ms Van Doorn, a leading surgeon involved in humanitarian work, agreed to mentor me, the budding global surgeon in me could not pass up the chance to learn from a giant such as her. Furthermore, Leeds is home to a rich history in cardiothoracic surgery and home even to the first pericardial valves from Mr Ionescu himself. It would have been sacrilegious of me to turn down an opportunity to learn from such an environment.

During my time there, I learnt that the Leeds Unit operates as a closely integrated multidisciplinary team, while caring for both paediatric and adult congenital cardiac patients.

The fellowship exposed me to many aspects of congenital cardiac surgery including daily ward rounds on the paediatric and adult ICU’s and nursing wards, operating sessions, multidisciplinary meetings, surgical and cardiology teaching, outpatient clinics and clinical governance meetings. I also had the opportunity to spend time in the cardiac catheter lab, echocardiography, cardiac MRI and intensive care.

Although COVID has changed the way hospital medicine works, student electives are still very much possible. I want to use this blog to impart some of the valuable lessons I learnt about making the most of the medical student elective and hopefully offer some insight and help others in my place.

I think one of the most important aspects of the elective is ones’ educational mentor and the relationship you build with them.

Firstly, you should find a tutor with common interests. This makes collaborative learning easier and contributes to a more personalised and stimulating experience. I found it very useful to build an early rapport with my mentor and compile a list of mutually agreed learning outcomes for the placement. This mitigates any unreasonable expectations of what you can achieve under their supervision while also establishing standards of the teaching they can provide. Next try to create a mutually agreed organisation schedule to navigate your elective. For instance, in my case, Miss Van Doorn and I had a virtual meeting a few weeks before to discuss what the department can offer and subsequently drafted a schedule for each week of the placement. The meeting also helped curb my expectations as it gave me an understanding of the opportunities and limitations that came with undertaking such a specialised elective especially during a global pandemic.

For those students interested specifically in congenital surgery electives, I can recommend the following learning outcome which I have derived from my experience: 1. Aim to participate in the operative procedures at least three times a week.

2. Visit the cardiac catheter lab to watch diagnostic and interventional procedures.

3. Arrange dedicated time with imaging consultants and technicians to gain a basic understanding of Imaging (echocardiography, CT and MRI) in congenital heart disease.

4. Attend daily ward rounds and weekly MDTs. 5. Shadow the paediatric cardiologists and explore the importance of medical management.

6. Familiarise yourself with the dialogue which must exist between the physician and the patient’s family by attending clinics and consent conversations.

7. Familiarise yourself with the surgical techniques and operations within congenital surgery.

8. Record your surgical experience in a logbook (and continue after your elective).

9. Attend monthly governance meetings.

10. Participate in an audit/QIP with the department or write a case report of an interesting case.

The best advice I can offer to students is to be as present as possible during the elective.

The best way to learn in to immerse yourself into the clinical setting and be proactive in looking for learning opportunities. But above all, ask questions! There is nothing worse than watching a 9-hour surgery when you have no idea what the surgeons are doing. Moreover, a more enthusiastic student will receive more attention and better guidance. Aim to go out of your comfort zone and get involved with discussions on patient care, operative decisions and MDT meetings.

My time with Miss Van Doorn and the team at LGI has profoundly impacted my outlook on the specialty. Their shared passion for the work they do made an everlasting impression. I am also beyond grateful to the all the registrars who took me under their wing and went out of their way to make me feel included and ensure that I never felt out of my depth. This placement left with me a profound appreciation for the deeply rooted complexities of such a highly specialised practice. But primarily, this experience strengthened my conviction to pursue a career in congenital cardiac surgery. n

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My Medical School Elective During the COVID-19 Pandemic Hanad Ahmed Dr Pierce bestowing his wisdom by way of humour, and the final episode in the anaesthetic room

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plan was made, an application approved, a bursary secured from the SCTS for travel to Toronto ... then COVID-19 happened.

The shortfalls of not experiencing an international elective are abundant I am sure, but this article focuses on the tremendous reception and experience I gained during my domestic 3-month clinical elective at University Hospital Southampton.

Like many students, I decided to take the remaining option of completing my clinical elective at my home institution. ­­­It was supposed to be a 6-week elective that furthers my interests in the specialty and fulfils the medical school requirement; instead, it turned into a 3-month rollercoaster in cardiothoracic surgery where I breathed, dreamed, and immersed in cardiothoracics.

From witnessing lifesaving emergency interventions in neonates to assisting in major trauma cases. It is safe to say that I found my calling and this piece will outline a fraction

of my experiences and reflections in each of the subspecialties.

Adult Thoracic Surgery I spent the first part of my elective with my longstanding undergraduate supervisor, Mr Aiman Alzetani.

This block provided an understanding of the complete responsibilities of a surgeonfrom operating, to teaching, managing, and conducting research. I was keen on emulating each of these domains and was given the opportunity to do so.

I got uninterrupted time in theatre, starting with the basics of learning to make incisions, inserting ports for VATS, before progressing to closing port sites and being a regular first assistant. When I didn’t have theatre days, I spent my time running surgical skills courses for the junior medical students rotating through cardiothoracic surgery. I discovered the fulfilling nature of passing on skills that I only recently acquired.

This experience kickstarted my drive to teach and gave me an appreciation for why it is such an important area of a clinician’s role.

I was fortunate enough to be involved in cases where new techniques and technology was being applied. I found myself engrossed in understanding and writing up these cases after long days in theatre and did so with the realisation that this was likely the spirit through which legends and long-term inspirations such as Professor Michael DeBakey, Professor Sir Magdi Yacoub and Mr Marian Ionescu innovated in the specialty.

A spirit that drives me to continue to carry on discovering interests through research and pursue my dream of following in the footsteps of these giants.

The thoracic block laid solid foundations for the rest of my elective and propelled me into the world of Cardiac surgery with Mr Clifford Barlow.

Adult Cardiac Surgery My time with Mr Barlow and the wider team in cardiac surgery romanticised my interests in the specialty. The vividness of dynamic red flowing through plastic tubes, to the gentle manoeuvres performed by size 8 hands. The entire process of watching valve and coronary surgery was a spectacle. The orchestra between the surgeon, registrar, anaesthetist, perfusionists, scrub nurse and theatre staff was an exemplification of teamwork and surgical leadership. I stood there in awe watching technically challenging tasks being performed with such composure and occasionally a sense of Dutch humour.

Despite the amazing exposure to the technical and clinical aspects of the surgery, what I learnt from Mr Barlow was that to become an extraordinary surgeon, you must do more than just being able to execute the operations.

January 2022

Mr Viola and I on my very last day of the cardiothoracic elective at Southampton, with a gift that will continue to fuel my journey through this incredible specialty

Much of the extraordinary was achieved outside of the operating theatre, an idea that made logical sense, but one Mr Barlow refocused in my mind. I thank him and the team for welcoming me into their world and for encouraging my ambitions in the specialty.

Adult Cardiac Anaesthesia and Intensive Care After my cardiac surgery rotation, I began to appreciate the importance of the anaesthetic and intensive care management of the patients. I was taken under the wing of Dr Tom Pierce. Here I was taught the intertwined nature of the surgery, the anaesthetic, and the post-operative

Mr Alzetani and I at the end of the last thoracic operating list of the elective

management of the patient.

What was interesting was that an almost equal if not greater emphasis was placed on the nontechnical aspects of the patient’s management including the human factors and the importance of a harmonious working relationship between surgeon and anaesthetist/intensivist.

Mutual respect, attention to detail and an appreciation of each other’s role and expertise was key to sailing out of treacherous waters and making the challenging enjoyable.

In acute situations it was the collaboration and combined efforts between surgeon and anaesthetist/intensivist that often made the difference, more than what any one individual in that equation could achieve alone.

I appreciated how a positive working relationship benefitted patients and staff by avoiding unchecked clinical errors and staff burnout. I thank Dr Pierce for giving me a perspective I never considered, and one that I now have in the forefront of my mind every time I step into an operating theatre. An

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experience that can be summarised by the quote “We see only what we know”.

Congenital Cardiac Surgery and Paediatric Anaesthesia and Intensive Care Following the end of my adult block, I spent time on the paediatric side of cardiac surgery and intensive care under Mr Nicola Viola, Dr Michael Griksaitis and Dr Andy Curry.

During this block I experienced the highs of highs watching lifesaving procedures such as the arterial switch with the touching sigh of relief from anxiously waiting parents. I also witnessed the lows of lows with emergency laparotomies and crucial interventions in fragile neonates on PICU. I tuned into the way clinicians recalibrated the threshold of stress and how the tiniest of movements and clinical decisions made all the difference in outcome.

For better or for worse, it often felt like a TV drama, except I was standing in the middle of it!

This rotation embodied teamwork and communication. The intensity of the medicine and surgery meant an even greater emphasis on self-awareness, situational awareness and integrity, a lesson gifted by my long-term mentor, Mr Nicola Viola.

This piece is dedicated to all the staff and supervisors at University Hospital Southampton cardiothoracic department, as well as Mr Ionescu and the SCTS whom made my elective possible. n

Mr Barlow and I on the last day of the cardiac surgery block

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Coming home for an elective in cardiac surgery SCTS Ionescu Fellowship Winners 2021 Report Josh Brown, Medical Student Queen’s University Belfast

Amazing teaching experience being carefully shown and supervised how to harvest veins to be used as conduits for CABG by the surgeons and surgical technician

I

board meeting discussing the surgeries for the day, before heading on the cardiac ICU ward round. I was then able to vary my week by attending clinics, going to theatres or by following the registrars on call, learning how to manage referrals and the complex post-op patients on the ICU. I got to scrub in and assist on a huge variety of cardiac operations and was able to be closely supervised and taught basic surgical skills and how to safely harvest veins for conduits for CABG surgery (thank you to the very patient registrars and surgical technicians).

Being able to be part of the team and seeing patients at all different stages of

had been excited for the elective component of medical school since day one. The possibility of going to a completely different country and getting the privilege to learn, and help where possible, was something I couldn’t have looked forward to more. This was however not possible because of the global COVID situation.

UK electives were thankfully still allowed to go ahead and so I opted to do mine under the supervision of Mr Mike Lewis with the cardiac surgery team at the Royal Sussex County Hospital. I saw this as an amazing opportunity to combine getting more time at home in Brighton with my family than I have in years, and massively increase my exposure to cardiac surgery.

I was fully integrated into the View of the Royal Sussex County Hospital Barry building first opened in 1828, as team in Brighton for almost seven seen on my walk to the hospital every day weeks. My day would start with the

View of Brighton seafront from the pier, you can see the Royal Sussex County Hospital buildings including the helipad towering over the surrounding houses

their journey within cardiac surgery has fully ignited my enthusiasm, and the time spent learning from different surgeons has reaffirmed my passion to pursue cardiothoracic surgery, but also the type of surgeon I aspire to be.

I would like to sincerely thank Mr Ionescu for awarding me this fellowship, allowing me to spend my summer completely immersed in cardiac surgery. I would also like to say a massive thank you to Mr Mike Lewis and Mr Jonathan Hyde and the rest of the cardiac team in Brighton for being so welcoming and supportive during my elective, and lastly to thank Mr Mark Jones for supporting me in my application for this fellowship. n

January 2022

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Ionescu Fellowship Report Momna Sajjad Raja, 5th Year Medical Student, Brighton and Sussex Medical School Elective details: Department of Cardiac Surgery, Faisalabad Institute of Cardiology Elective Period: 2/7/2021 – 27/7/2021 Elective Supervisor: Professor Shahbaz Ahmad Khilji FCPS

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aving had most of my exposure to cardiothoracic surgery in the United Kingdom, I was grateful to receive support from Mr Ionescu to fully immerse myself in a high paced elective abroad at the Faisalabad Institute of Cardiology (FIC) for four weeks. FIC is a high-volume governmentfunded tertiary centre with a catchment area of 7 million people. The next closest cardiac centre is 128 kilometres away in Lahore.

The elective at FIC was a life-changing experience as I was able to follow patients throughout their journey; from preoperative clinic to theatres, cardiac intensive care unit and follow-up appointments. I was able to clerk my patients separately during their clinic appointments. Some of them had travelled hours and were staying outside as they were unable to afford accommodation in the vibrant city.

In theatres, I observed various cardiac procedures such as CABG, ablation, mitral valve replacement and repairs.

The patient population were experiencing diseases that are at the verge of being eradicated in high-income countries, such as rheumatic heart disease. Moreover, the burden of cardiac disease was higher as

the patients tended to present during later stages of disease progression due to the challenging economic conditions. Despite the high-volume load, the quality of care the hospital staff provided was exemplary.

Moreover, patients had their surgeon’s personal numbers to contact them if they had any troubles in the post-operative period. This was done in hopes to provide continuity of care and save patients from travelling for hours for advice.

Reflecting, this experience allowed me to learn about global cardiac surgery, identify and prioritise patients for surgery based on clinical assessment. Furthermore, I was able to learn about resource management and allocation as well as sharping my clinical and practical skills. n

New Consultant Appointments Name

Hospital

Consultant or Locum Consultant

Starting Date

Mr Kaj Mahendran

Royal Stoke University Hospital

Locum Consultant Thoracic Surgeon

October 2020

Mr Syed Sadeque

Northern General Hospital, Sheffield

Consultant Cardiac Surgeon

August 2021

Mr Edward Caruana

Glenfield Hospital, Leicester

Locum Consultant Thoracic Surgeon

October 2021

Mr Tom Combellack

Cardiff and Vale NHS Trust

Consultant Thoracic Surgeon (Minimal invasive/robotic thoracic surgery)

October 2021

Mr Simon Messer

Golden Jubilee National Hospital, Glasgow

Consultant Cardiac/Transplant Surgeon

October 2021

Mr Emad Al-Jaaly

St Thomas’ Hospital, London

Locum Consultant Cardiac Surgeon (Adult)

December 2021

Mrs Susan Montgomery

Golden Jubilee National Hospital, Glasgow

Clinical Nurse Manager – Cardiothoracic/National Services Division

November 2020

Mr Ruaidhri Cantillon

Oxford Heart Centre, John Radcliffe Hospital

Matron Cardiothoracic Surgery

November 2021

Mrs Olivia Johnson

Oxford Heart Centre, John Radcliffe Hospital

Cardiothoracic Critical Care Lead Nurse

TBC

Mr Saleem Jahangeer

St James’s Hospital, Dublin

Consultant Cardiac Surgeon

Q4 2021

the 76 bulletin

Gaudeamus igitur Gaudeamus igitur, Juvenes dum sumus; Post icundum iuventutem, Post molestam senectutem Nos habebit humus.

So let us rejoice Let us therefore rejoice, While we are young; After our youth, After a troublesome old age The ground will hold us.

Vita nostra brevis est, Brevi finietur; Venit mors velociter, Rapit nos atrociter; Nemini parcetur.

Our life is brief, It will shortly end; Death comes quickly, Cruelly snatches us; No-one is spared.

Ubi sint qui ante nos In mundo fuere?

Vadite ad superos, Transite in inferos Hos si vis videre.

Where are those who before us Existed in the world?

You may go up to the gods, You may cross into the underworld If you wish to see them.

Vivat academia, Vivant professores, Vivat membrum quodlibet, Vivat membra quaelibet; Semper sint in flore!

Long live the university, Long live the teachers, Long live each male student, Long live each female student; May they always flourish!

Vivat et republica Et qui illam regit.

Vivat nostra civitas, Maecenatum caritas Quae nos hic protegit.

Long live the state And those who rule it.

Long live our city, And the charity of benefactors Which protects us here.

Vivant omnes virgines, Faciles, formosae!

Vivant et mulieres, Tenerae, amabiles, Bonae, laboriosae.

Pereat tristitia, Pereant osores.

Pereat diabolus, Quivis antiburschius Atque irrisores!

Long live all young women, Easy and beautiful!

Long live wives as well, Tender, loveable, Honest, hardworking.

Perish sadness, Perish haters.

Perish the devil, Whoever is against the student fraternity, As well those who mock us!

Quis confluxus hodie Academicorum?

E longinquo convenerunt, Protinusque successerunt In commune forum.

Who has gathered now Of the university?

They gather from long distances, Immediately joining Our common forum.

Vivat nostra societas, Vivant studiosi!

Crescat una veritas, Floreat fraternitas, Patriae prosperitas.

Long live our fellowship, Long live the studious!

May truth and honesty thrive, Flourish with our fraternity, And our homeland be prosperous.

Alma Mater floreat, Quae nos educavit; Caros et commilitones, Dissitas in regiones Sparsos, congregavit.

May our Alma Mater thrive, That which educated us; Dear ones and comrades, Who we let scatter afar, Let us assemble.

January 2022

New roles and appointments Congratulations to the following ...

Role

Name

SCTS Communication Secretary

Sri Rathinam

SCTS Education Secretary

Debbie Harrington

SCTS Thoracic Surgical Tutor

Elizabeth Belcher

SCTS Office Administrator

Taet Chesterton

SCTS Student Education Lead

Amerikos Aryriou from Manchester University

SCTS Student National Events Officer

Bertie Harrington from Newcastle University

SCTS Student Research Collaborative Officer

Maria Solange de Paiva Moura from Universidade Potiguar, Brazil

SCTS Student Committee Treasurer

Rishab Makam from Hull York Medical School

SCTS Student Committee Widening Access Officer

Javeria Tariq from Leeds School of Medicine

SCTS Student Committee Regional Events Officer

Amelia Websdale from University of Leeds

SCTS Student Committee Mentorship Officer

Kirstie Kirkley from University of Bristol Medical School

SCTS Student Committee Communications Officer

Josh Brown from Queen’s University, Belfast

SCTS Student Committee Equality and Diversity Officer

Alexander Reynolds from Swansea University Medical School

SCTS Student Committee Medical School Liaison Officer

Chaninda (Holly) Dejsupa from University of Bristol

Glossary AATS American Association for Thoracic Surgery

ISCP Intercollegiate Surgical Curriculum Programme

RATS Robotic Assisted Thoracic Surgery

ARDS Acute Respiratory Distress Syndrome

LVAD Left Ventricular Assist Device

VATS Video-assisted thoracoscopic surgery

ECMO Extracorporeal Membrane Oxygenation

PPE Personal Protective Equipment

WBA Workplace-based Assessment

GIRFT Getting it Right First Time

PPI Public & Patient Involvement

HOCM Hypertrophic Obstructive Cardiomyopathy

TSRA Thoracic Surgery Residents Association

77

the 78 bulletin

Crossword

Across Set by Samer Nashef

1/25

5/9 10 12

13 14 16 19

21 24

25 27 28 29 30

Onlooker’s dodgy candy, best not served in private (8, 9) What’s naughty but nice? Mea culpa, of course (6, 8) Complaint of pain rehashed and rejected (6) Lands in trouble, surrounded by police at winter events (4, 5) Cinema’s first film basket (5) Grass exercise? (4) USSR in a crisis affected him (7) Notice a port in a storm, then die?

It provides compatibility (7) What sounds do when turning deaf (4) Initially very good to embrace the female principle in competition (5) See 1 Leaves party (6) Outline, V-shaped, with rolled edges (8) Silly silly me! I lost rank (6) With others present inside, it’s very delicate (8)

Down

Please email solutions by 31/03/22 to: isabelle@scts.org or send to Isabelle Ferner, SCTS, 35-43, Lincoln’s Inn Fields, London WC2A 3PE The winner will be randomly selected from successful solutions and will win either a bottle of ‘fizz’ or fine olive oil.

Congratulations to Richard Milton for winning the August 2021 Bulletin crossword competition (right) who chose a handmade ceramic bottle of olive oil as his prize.

Sudoku

1 2 3 4

6 7 8 11 15 17 18

20 21 22 23 26

Compiler’s agreement, in effect (6) Badger indicator (6) They are paid to put babies finally in their beds (5) Provide a commentary rejecting part of secret arrangement (7) Copper in nude sex dance is not forgiven (9) Hang about - that’s pants! (8) You, old girl, with an unruly youngster (8) Emperor partly beats a retreat (4) Month of death is of a certain shape (9) Girl, around age 5, popping up in Sin City (3, 5) One detects gift bearers: close Yorkshire’s borders!

(5, 3) A stone thrown up in the hurly burly (4) The fins’ entanglement (7) Ask for a flower to go with evening wear (6) Trial uncovered work transaction (6) Make up a voice that’s united (5)

Quick Crossword Across

Down

6 Veg used in stir fry 1 Paddington (4, 7) for one (4) 7 Part of percussion (4) 2 Again (3, 4, 4) 8 Keep busy (6) 3 Arranged 9 They look at stars (11) meeting (11) 11 Lowest point (6) 4 Taking place 12 Powder (4) at the same time (11) 14 For good (11) 5 Trance (6) 10 Spade (6) 13 Flower (4)

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