College VOICE Edition 14

Join Digital Heritage and Engagement Officer, Kirsty Earley, as she interviews a brand new set of guests for season 3 of Body of Work. Tune in to hear from a variety of professionals who have a connection to the College and learn about their careers, passions, and weird history obsessions!

Episode 15 - Professor Miles Fisher Retired diabetologist and past Vice President (Medical) Monday 6 February 2023

Episode 16 - Elena Trimarchi

Learning and Engagement Manager at the David Livingstone Birthplace Museum Monday 13 March 2023

Episode 17 - Mr Thisara Weerasuriya Specialty Surgeon in Trauma and Orthopaedics Monday 10 April 2023

Episode 18 - Maggie Reilly

Former Curator of Zoology at the Hunterian Monday 22 May 2023

Episode 19 - Jane Chiodini MBE

Travel Health Specialist and past Dean of the Faculty of Travel Medicine Monday 12 June 2023

Listen to Body of Work at rcp.sg/heritageevents or on Spotify, Apple Podcasts, Google Podcasts, Buzzsprout and more

Welcome to Edition 14 of College Voice, which I hope will bring some support and diversion at this time of considerable concern for all involved in the UK National Health Service. Usual winter pressures have combined with high numbers of Covid and influenza infections, and ongoing issues in social care, to produce a capacity crisis in our hospitals, which is the worst many of us have ever experienced.

The current crisis follows almost three years of disrupted service provision caused by the pandemic. This has resulted in unprecedented waiting lists for elective care, disrupted training, education and assessment, low morale among trainees and trainers alike and difficulties in retention of the NHS workforce across all disciplines and at all career stages.

Workforce issues have been a key College workstream for several years and the data from the Physician Census run by the three UK Royal Colleges of Physicians (p8) confirms the ongoing challenges of staff shortages across medical specialties. The related article on less than full time training (p13) reports on the growing numbers opting to pursue a better work life balance, perhaps in response to the impact of the pandemic, not only on the health service as an institution, but on trainees themselves.

It is wonderful to read of the opportunities for new learning and experience afforded by our College Scholarships (p27) and of work in Global Health (P21). I also urge you to consider the impact of climate change on human health, and the impact of healthcare delivery on carbon output, recognizing the challenges for all of us, as outlined by College Scottish Clinical Leadership Fellow, Alice Harpur, as she reflects on the President’s Conference 2022 (p17). The team from Obesity Action Scotland, housed within our College, describe the obesity crisis and the differential impact it has across our society (p23) This is a subject which College will be addressing in the coming year as we consider our response to the widening gap in health inequalities.

One day, I hope we will look back at this challenging time with some pride and satisfaction that we did our best in difficult circumstances as did our predecessors in the early years of the NHS when they sought to develop postgraduate education in what was then the Royal Faculty. The story of our change of name to become a Royal College (p37) records their effort, diligence, and pragmatism.

Our College is actively involved in discussions about the current NHS crisis with all specialties in primary and secondary care, governments and devolved administrations, the BMA, the GMC and others. We are here to speak up for the professions and are doing so. Please let me know if the College can be of more specific assistance in any situation you and your colleagues are facing by emailing me at president@rcpsg.ac.uk

HYBRID CONFERENCE

Interactive Cardiology Conference

Friday 10 March 2023 9am - 5.30pm GMT

We look forward to welcoming you to this hugely popular, always sold out event. This year’s programme will offer comprehensive updates on key contemporary topics and will provide a practical approach to the management of frequently encountered clinical scenarios. We will welcome national and international experts, who will present reviews of the latest evidence shaping the rapidly changing landscape of cardiovascular medicine. As in previous years, this year’s conference will include keynote lectures, interactive case based discussions, and poster presentations. In addition, for the first time this year, you’ll hear a nursing perspective, and a first-hand account of the patient experience. These unique insights will enhance your knowledge of all aspects of cardiovascular healthcare.

BITES

JANE CHIODINI PRIZE LAUNCHED AT ANNUAL TRAVEL MEDICINE CONFERENCE

A new prize was launched at the College’s Annual Travel Medicine Conference by Professor Sir Chris Whitty, who paid tribute to Jane’s work in the field of Travel Medicine.

The prize recognises the outstanding contribution to Travel Medicine Education made by Jane Chiodini MBE, and will be awarded annually to the highest-performing student in the RCPSG Postgraduate Diploma in Travel Medicine.

The Diploma commenced in January 2022, and the first intake of students will complete their studies in June 2023.

The recipient of the prize will receive a cash award of £250, and will be invited to attend the Annual Conference of the Faculty of Travel Medicine.

Jane Chiodini MBE MSc, RGN, FFTM RCPS(Glasg) QN began nursing in 1973 at St George’s Hospital in London and undertook subsequent postgraduate training in neurosurgery and neuromedicine, as well as completing midwifery training. Her interest in travel health began when a practice nurse in the 1990s. Jane undertook a distance learning travel health medicine course at the University of Glasgow and graduated with a Master of Science degree in Travel Health Medicine in 1998.

Since that time, Jane’s career has developed in travel medicine and she has held a number of prestigious positions in relation to this, both nationally and internationally. Her involvement with the Royal College began in the early 2000s when she was a personal advisor and tutor on the Diploma and Travel Medicine courses run initially by the University of Glasgow and subsequently with the College in conjunction with Health Protection Scotland. In 2006 Jane was one of the founding fellows of the Faculty of Travel Medicine in the College, and between then and 2017 held positions on the Executive Board of the Faculty, including as Honorary Secretary and Education Director. In 2017 she became Dean-Elect and subsequently Dean of the Faculty of Travel Medicine, being the first female Dean of this Faculty and the first nurse to hold the position.

Throughout her career Jane has been a leading figure in the world of Travel Medicine education, strongly advocating for high-quality academic and practical training for those involved in the delivery of travel medicine. She has tutored, mentored and examined countless individuals through their careers and education, and created and delivered material to thousands of nurses, doctors and pharmacists involved in travel medicine. Maintaining and raising standards has also been a priority for Jane and during her Deanship she was instrumental in leading the publication of the Good Practice Guide for Providing a Travel Health Service, which sets the standards of care for practitioners in travel medicine. Jane also drove forward the establishment of the Professional Development Certificate in Travel Medicine and the RCPSG Postgraduate Diploma in Travel Medicine, for which this prize was given.

Jane was awarded an MBE for her services to training and development of travel medicine in 2022. The College recognises Jane’s role as an inspirational contributor and leader in relation to all elements of education for travel medicine.

SURGICAL COLLEGES LAUNCH GREEN THEATRE CHECKLIST

Leaders from three of the UK’s surgical Royal Colleges have come together to declare a climate emergency as they launch new guidance for those in the profession aimed at reducing the environmental impact of surgery.

In response to the ongoing environmental crisis, the Royal College of Physicians and Surgeons of Glasgow, The Royal College of Surgeons of Edinburgh and The Royal College of Surgeons of England, which collectively represent over 75,000 healthcare professionals, have co-authored the ‘Green Theatre Checklist’.

The checklist includes a range of suggested actions to reduce the environmental impact of operating theatres, and the experts who have devised this intercollegiate strategy are hopeful it can eventually be rolled out and introduced as a new standard for operating theatres around the world.

While surgery saves millions of lives and betters the lives of many more, there is an environmental cost, with a typical single operation estimated to generate between 150-170 kgCO2ethe equivalent of driving 450 miles in an average petrol car.

The greenhouse gases used in anaesthetic, the heavy plastic usage to uphold hygiene standards, and other industry specific reasons mean surgery contributes heavily towards global healthcare’s production of carbon emissions, estimated at around 4 to 5 per cent of total carbon emissions per year.

The Green Theatre Checklist can be found on our website at: rcp.sg/GreenTheatreInitiative

THE COLLEGE WELCOMES DR CHRISTINE GOODALL AS DEAN OF THE FACULTY OF DENTAL SURGERY

Dr Christine Goodall has been elected Dean of the Faculty of Dental Surgery at the Faculty’s Annual General Meeting which took place on 11 November. She succeeds Mr Andrew Edwards.

Christine is a Professor of Oral Surgery and Violence Reduction at The University of Glasgow’s School of Medicine Dentistry and Nursing, Lead Clinician for Oral Surgery at NHS Greater Glasgow and Clyde and one of the Directors of the charity, Medics Against Violence.

She has held several college roles including examiner and convener for the MFDS Part 2, Director of Dental Examinations, and Vice Dean of the Dental Faculty. Most recently she served as a member of the College Wellbeing Committee and as Dean-elect.

Christine’s research interests lie in the fields of alcohol, violence and facial trauma. Her work with facial trauma patients over many years led to her founding Medics Against Violence in 2008. The charity now runs several programmes across Scotland that aim to prevent violence and support vulnerable groups.

She is an Honorary Member of the Faculty of Public Health, a Founding Fellow of the Faculty of Medical Leadership and Management and was awarded an OBE for her work in violence prevention in 2016. She was a member of Project Lift’s first ‘Leadership Cubed’ cohort.

On taking up the post of Dean, Dr Goodall said:

I am honoured and delighted to have been elected and I look forward to the opportunity to play such a leading role in the work of our Faculty, particularly as we continue to meet the challenges faced by our membership which have only been exacerbated by the pandemic.

I’d like to place on record my thanks to Andrew Edwards who has been a great support to me in my time as Dean-Elect and I know all in our Faculty are grateful for his service.

As Dean, I hope to focus on the areas of inequality, wellbeing and sustainability in promoting the interests of our profession and our patients. I can’t wait to get started.

HONORARY FELLOWHIP AND PRESIDENT'S MEDAL AWARDED AT DIPLOMA CEREMONY

An Honorary Fellowship and the President’s Medal were awarded at the College’s latest Diploma Ceremony in November.

Professor Brian Kennon received an Honorary Fellowship of the College in recognition of a decades long career at the forefront of diabetic care.

Professor Kennon graduated from Glasgow University with MBChB in 1993 and continued his education by completing his Doctorate in 2003 before becoming a Fellow of the College in 2005.

He was appointed consultant diabetologist at Queen Elizabeth University Hospital in 2004 where his main sub-specialty interests include diabetes foot care, adolescent transitional diabetes services and utilising technologies to improve diabetes care.

He uses his passion and commitment to promote awareness of the issues facing people living with diabetes in Scotland through managed clinical network groups and in recognition of this he was appointed by The Scottish Government in 2017 to the post of National Lead for Diabetes in Scotland and chair of the Scottish Diabetes Group as well as Speciality Adviser for Diabetes & Endocrinology to the Chief Medical Officer Scotland.

Jason Leitch received the President’s Medal for his work during the Covid pandemic, often communicating complex messages at an uncertain time.

Professor Leitch – a Fellow of our Faculty of Dental Surgery - has worked for the Scottish Government since 2007. In January 2015, he was appointed as The National Clinical Director in the Health and Social Care Directorate.

Jason is an Honorary Professor at the University of Dundee. From 2005 to 2006 he was a Quality Improvement Fellow at the Institute for Healthcare Improvement, in Boston, sponsored by the Health Foundation. Jason is also a trustee of the UK wing of the Indian Rural Evangelical Fellowship which runs orphanages in southeast India.

He qualified as a dentist in 1991 and was as a Consultant Oral Surgeon in Glasgow. He has a doctorate from the University of Glasgow and Masters in Public Health from Harvard. He is also a Fellow of the Higher Education Academy.

WORKING DIFFERENTLY IN THE SHADOW OF COVID-19:

THE 2021 UK CENSUS OF CONSULTANT, HIGHER SPECIALTY TRAINEE AND SAS PHYSICIANS

Two and a half years since the UK’s first national lockdown, Covid-19 continues to have a major impact on the NHS, its staff and patients.

The pandemic has created new challenges for everyone working and training in the health service and has required us to re-think the way we deliver care. The latest annual census – conducted jointly with the Royal College of Physicians of Edinburgh and the Royal College of Physicians in London – provides crucial insight. It helps us better understand the issues that consultant and trainee physicians across the UK are currently dealing with, and how the workforce is set to change in the years ahead.

Full-time consultants worked

Only

of advertised posts were filled. This has decreased year on year, and is the lowest rate recorded to date

Key findings 48% 20% 20% 10% 74%

of consultant and SAS physicians said they undertook some work remotely

more than their contracted hours

While those working less than full time worked more than their contracted hours, mainly due to clinical workload

Contract 9

More than half of physicians did not take all of their annual leave entitlement

GEOGRAPHICAL DISTRIBUTION OF HSTS

The census reveals that over half (52%) of advertised consultant posts were unfilled in 2021. This is the highest proportion of unfilled posts since current records began in 2008, and the first time that more than half of advertised posts went unfilled. In three-quarters of cases, posts went unfilled because there were simply no applicants.

The census also shows that workforce pressures will become even more severe without determined action. Almost half (44%) of the consultant physician workforce is set to reach retirement age in the next decade. At the same time, demand for care will increase as the population ages: the ONS projects that the number of people aged 85 and older will double between 2020 and 2045. In this context the wellbeing and development of trainees, who represent the future of the NHS workforce, is particularly important.

The census shows that Covid-19 has had a significant impact, with three-quarters (74%) of higher specialty trainees (HSTs) missing training opportunities. They also missed out on providing outpatient care (67%), local teaching (64%) and gaining exposure to procedures (50%). Nearly a third (30%) had been required to work in an environment that was not relevant to their training.

LESS-THAN-FULL-TIME WORKING IS ON THE RISE

Another key trend for both consultants and HSTs is the continuing rise of less-thanfull-time (LTFT) working. A quarter of consultants and 18% of HSTs worked LTFT in 2021. A higher proportion of women worked LTFT: among consultants, 42% of women compared with 13% of men, and among HSTs 29% of women compared with 7% of men. Coupled with the fact that the proportion of women in the workforce is rising – 39% of consultants and 52% of HSTs were women in 2021, compared with 23% and 42% respectively in 2004 – this has important implications for workforce planning. Two-thirds (62%) of HSTs would like to work on a less than full time basis due to wanting an adequate work–life balance (83%), avoiding burnout (73%) and gaining exposure to other aspects of medicine such as quality improvement, research and leadership (65%). This suggests that the demand for LTFT will only increase, so we will need a higher overall number of doctors.

OUR SOLUTIONS

A long-term solution requires proper workforce planning that aims to match supply of clinicians with demand for care, and the sustained investment necessary to deliver it. But even if that was done today, the length of time it takes to train a doctor means we won’t see the impact for many years, so we also need to think about what we can do now. We have used the findings of the census to emphasise the urgent need for action to ease pressure on the NHS workforce. In short, we need to increase the workforce, improve retention and support doctors who are approaching retirement.

Enabling physician associates to play a bigger role in the delivery of care would be an important part of increasing capacity within the workforce, so we need to bring them into regulation at the earliest opportunity.

While overseas recruitment should not be seen as the primary solution to the workforce crisis, without further significant investment in training more people in the UK this will have to be part of the short- and medium-term solution. And formalising the foundation interim year 1 programme and reforming the CESR system to make it easier for SAS doctors to become consultants are other measures that can be taken.

Next steps

Equally, improving retention of the existing workforce is crucial. We need to get the basics right by ensuring access to hot food and drink and rest facilities at all hours of the day, as well as allowing staff time off for significant life events. Helping employees access affordable childcare is also important, along with enabling staff to work flexibly and remotely as working patterns change. It is also vital to support clinicians who are approaching retirement to continue working for as long as they want to, in a way that works for them. Fundamental to this is finding a permanent solution to issues around pension taxation so that senior consultants are not forced to reduce their hours. Employers should work with doctors in their early 50s to minimise burnout by reviewing job plans, as well as facilitating and supporting retire and return arrangements. Everyone working in the NHS understands the scale of the challenges it currently faces, and that tackling the workforce crisis is fundamental to dealing with them. This is not beyond us, but swift and decisive action is needed to ensure that our health and care service is there for everyone who needs it in the years ahead. We eagerly await the NHS workforce strategy commissioned by the Secretary of State and expect it to address everything we have mentioned here, and more.

Cadaveric Foot and Ankle Masterclass

Thursday 18 May 2023, 9am – 5pm

This cadaveric course will equip trainees in approaches to the foot and ankle as well as modern surgical management of challenging conditions.

Course Director: Mr Bilal Jamal Approaches to the ankle

· Approaches to the midfoot

· Minimal access fixation of Achilles tendon ruptures

· The use of ankle and TTC fusion plates

Midfoot fusions and fixation of Lisfranc fracture dislocations

Fixation of calcaneal osteotomies with step plates

· Lateral column lengthening

· Fixation of posterior malleolar fractures

An introduction to minimally invasive surgery

rcp.sg/FootAnkle

Glasgow International Orthopaedic and Trauma Meeting

Friday 19 May 2023, 9am – 5pm BST

The Glasgow International Orthopaedic and Trauma Meeting is a key event in our educational calendar for 2023. Covering a wide range of subjects including Trauma with Mr William Eardly and Paediatric Surgery with Ms Kim Ferguson. This hybrid conference is relevant for everyone involved in orthopaedics and trauma, including consultants, orthopaedic training and non-training grade doctors, medical students, physiotherapy colleagues and orthopaedic and trauma nurses.

William & Elizabeth Davies Charitable Trust

Within the United Kingdom (UK), doctors in training are eligible to apply for less than full time training (LTFT), defined as working a reduced number of hours compared to a doctor who works full-time (48 hours per week on average). The process of applying for LTFT varies by specialty and across the country. To make the decision whether LTFT can be granted for an individual trainee, the overall training capacity of a training programme in a locality and service provision are taken into consideration.

In addition to capacity considerations, trainees must, at present, fulfil criteria in either of the following two categories: category one applies to trainees with a disability, ill health, or responsibility for providing care; and category two relates to unique opportunities, religious roles, or non-medical professional development.

However, the LTFT landscape has recently changed with the completion of Health Education for England’s (HEE) threeyear pilot project in January 2022 to facilitate LTFT for lifestyle reasons, termed category three. The pilot involved Obstetrics and Gynaecology, Emergency Medicine and Paediatrics. Following the

success of the pilot, category three is now due to be rolled out to other specialities in England in August 2022 though other nations are yet to follow.

LTFT has become increasingly popular year upon year. The GMC National Training Surveys have shown that in 2022 17.1% of trainee doctors are working LTFT compared to 9.1% in 2013. There is growing pressure on trainees to achieve curricular requirements whilst managing a busy hospital workload. This has contributed to exhaustion amongst the workforce which has been exacerbated during the Covid-19 pandemic. The 2022 GMC National Training Survey revealed that 62% of trainees are at moderate or high risk of burnout compared to 56% in 2021.

We hypothesise that this has contributed to the increasing popularity of LTFT, which is likely to have repercussions for workforce planning. We developed our survey in response to the increasing popularity and dynamic changes regarding criteria for LTFT. We sought to provide data on the implications for workforce planning and to capture trainees’ perspectives on LTFT and opportunities for improvement.

ON THE RISE: THE ADVANTAGES AND ACCESS TO LESS THAN FULL TIME WORKING FOR DOCTORS IN TRAINING

Results

DEMOGRAPHICS

There were 846 responses to the survey, 783 of these were completed responses and used in analysis. The responses were divided into the four nations as follows: England 564 (72.2%), Scotland 205 (26.2%), Wales 6 (0.8%) and Northern Ireland 6 (0.8%).

Medical specialties were the largest contributor: 596 medical specialties trainees responded [76% of all respondents] consisting of 234 Internal Medicine Trainees [IMT] and 362 Higher Specialty Trainees [HST] in 26 different higher medical specialties.

EXPERIENCE OF TRAINEES CURRENTLY WORKING LTFT

33%

6 (0.8%)

One third of survey respondents currently work LTFT

One third of survey respondents (33%) currently work LTFT. 80% full-time equivalent was the most common work pattern (47%) followed by 60% full-time equivalent (39%). The primary reason for LTFT was childcare (63.8% of respondents). Other reasons included health reasons (15.1%) and lifestyle (8.2%). Eight trainees chose not to give a reason. Most (87.8%) found the process of applying for LTFT straightforward. Of those who did not, the most common issue cited was the timeconsuming burden of multiple administrative forms. When asked if there were any negative effects of training LTFT, 32% answered yes and 68% said no (4 trainees skipped this question). Eighty-four trainees justified their answers with comments. One third (33%) of trainees commented on reduced training opportunities. Examples given included missed teaching or a specific clinic or procedure list coinciding with their set day off. A small but significant proportion of trainees (8%) felt stigmatised by colleagues, stating they were made to feel a less valued team member. When asked about encountering other difficulties associated with LTFT, there were 109 comments made. Common themes included rota issues (24/109) including delays in receiving rota; being incorrectly allocated duties on days off; nightshifts ending on set days off; and errors in working patterns. Incorrect pay was cited by (16%) trainees. Trainees felt these issues resulted in administrative time burden to rectify. Trainees also cited concerns regarding expectation to achieve a similar number of workplace-based assessments as fulltime trainees (9%).

Comments from respondents by theme Reduced Training Opportunities:

“Less opportunities for presentations/research and teaching offered to LTFT trainees.”

“Inflexibility of the regional teaching days which are always scheduled for the same day each week - which is the day I don't work.”

Stigma:

“Generally consultants are pretty dismissive of it and look down on the fact I am LTFT.”

“Attitudes of colleagues, who resent me having "days off."”

Rota Issues:

“Can be difficult getting rota in enough time to be able to notify nursery if any changes to days my children need to attend.”

“There is always so much additional admin required with every rotation. Trusts don't always understand how it works, you end up writing your own rota or having difficult battles trying to explain process to medical staffing etc.”

Pay Issues: “Pay often wrong.”

“Payroll. Every time I rotate it’s a challenge to be paid correctly. This is often due to delays from the hospital rostering team forwarding."

FUTURE PLANS OF TRAINEES

Of trainees who are not currently LTFT, three quarters (75%) expressed that they intend to work LTFT in future. Almost one quarter (22%) selected they intended to apply for LTFT during 2022 however most (33%) were undecided on timing. More than half (56%) of trainees selected they would apply for LTFT for lifestyle reasons alone if this was available in their specialty.

When we asked trainees their reasons for considering LTFT in the future, the most common response was selected was lifestyle (52%) followed by childcare (28%). Forty-three trainees chose not to give a reason. Eighty-seven trainees made comments within the optional free-text section on their reasons for going LTFT in the future. Common responses were work-life balance, reduction in stress, pressure or burnout. Forty-one trainees who selected ‘other’ made comments that a combination of reasons included lifestyle and childcare or lifestyle and mental health. Seven trainees quoted time for exam preparation, e-portfolio work or research as a reason.

Half of trainees stated concerns about the impact of going LTFT (49%). Of these, 151 trainees chose to expand on their answers. The most common stated reasons were prolonging training (32%), perceived stigma (23%), and reduced training opportunities (13%). Financial considerations were a concern for (9%) respondents.

Comments from respondents by theme

Prolonged

Training:

“Delay in training progression, not achieving operative numbers, being viewed as a less able surgeon.”

“it prolongs my training even further and therefore the stability of a consultant post is even further away.”

Perceived Stigma:

“I am aware of discrimination happening for women in this field already and would not want to be disadvantaged in terms of subspecialty and future career.”

“I have neither children nor a health problem but know I would be much more happy and productive if I was LTFT, however there is a culture within medicine which makes it feel like this would not be acceptable.“

Reduced Training Opportunities:

“ Worry academic opportunities will be less offered when LTFT.”

“That I will miss out on training opportunities. That I will not be offered the consultant job that I want.”

Additionally, we asked all trainees, including those already LTFT, if they intend to work full-time or less-than full-time as a consultant. Most respondents (62%) intend to work less than full-time and only 9% intended to work full-time. More than one quarter (27%) of trainees felt undertaking LTFT would put them at a disadvantage when applying for a consultant post and only 31% of trainees felt satisfied they would not be disadvantaged (42% unsure). 3 respondents skipped this question

Percentage of trainees who plan to work less than full-time training (LTFT) as consultants

Less Than Full-Time 15

EXPERIENCE OF WORKING WITH LTFT COLLEAGUES

The majority of respondents (79%) had experience of working with LTFT trainees of which 17% said they had encountered problems because of this. When asking specifically if there was any rota or workload impact because of working with a LTFT colleague 47% of trainees answered yes. Within the comments section this was explained as either rota gaps or increased workload for the full-time trainee. Some trainees commented that job share arrangements can have a beneficial impact upon the rota. Several trainees also commented that they would rather work with a less burned-out colleague and found LTFT trainees to be great colleagues.

CONCLUSION

LTFT is becoming increasingly popular. There is a shift in focus from childcare reasons to lifestyle reasons from the trainee workforce that responded to this survey. Many are feeling stressed, not simply because of the pandemic but also because of the growing pressures of training. We need to allow wider access to LTFT training to improve work-life balance and allow retention of trainees. We are encouraged that these changes are already taking place in some areas. However, this shift in thinking suggests that a satisfactory work-life balance may be unachievable for most within the current full-time training. While offering LTFT training is not the only solution, it is one option which would help reduce shortages in the NHS workforce by aiding retention of trainees. The growing popularity of LTFT for trainees and future consultants has important implications for workforce planning which needs to urgently be addressed with an increase in trainee numbers otherwise a major shortage of consultants will take place.

ACKNOWLEDGEMENTS

We thank all the trainees who took part in the survey. We also thank several key groups including the Royal College of Physicians & Surgeons of Glasgow and the Joint Royal Colleges of Physicians Training Board (JRCPTB) Management and Policy (MAP) Board who helped distribute the survey. Finally, we thank Logan Parr who helped put together the survey.

Full-Time Unsure EDITION 14

THE TIME FOR CHANGE IS NOW

By Dr Alice Harpur, ST4 Public Health and Scottish Clinical Leadership Fellow (2022-23)

The climate crisis is the biggest global threat to public health. Dr Marina Romanello reminded us of this at the College’s 2022 President’s Conference: Sustainability in Healthcare. The 2022 Report of the Lancet Countdown shows that life-threatening extreme weather events are becoming increasingly more frequent. Between 2012-2021, 29% more global land area was affected by extreme drought for at least one-month compared to 1951-1960, whilst extreme heatwaves in 2020 were associated with 98 million more people suffering from food insecurity than annually in 1981-20101. These health impacts are echoed across the literature, and as our addiction to fossil fuel continues, it is estimated that 40,000 deaths in the UK are attributable to exposure to outdoor air pollution each year2. Bringing these numbers to life, the media brings our attention to the catastrophic effects of the climate crisis; from the recent devastating floods in Pakistan3, to nine-year-old Ella Adoo-KissiDebrah who was the first person in the UK to have air pollution listed as a cause of death4.

We also know that the climate crisis is widening health inequalities, with those who experience the greatest impacts of the climate crisis, often being those who have contributed least to greenhouse gas emissions. At the President’s conference Professor Tahseen Jafry spoke about her research which has shone a light on women in Malawi who are experiencing worsening gender-based violence and mental health problems as a result of climate change5.

Completing the links between health, healthcare, and the climate crisis, is the understanding that healthcare itself is contributing to the problem. In England, the NHS contributes to 4% of the country’s overall carbon footprint6. Healthcare systems must therefore do three things:

1 Adapt to changing patterns of morbidity.

2 Become resilient to the posed threats of the climate crisis.

3 Reduce the negative contribution that healthcare delivery is making to the climate crisis.

The facts and narrative, however, can be overwhelming, anxietyprovoking and stun us into inaction. But now is a time for action. As the impacts of the climate crisis are unfolding before our eyes we must embrace our opportunities to contribute to the change that is required.

Considering opportunities in our personal lives, at the President’s Conference, Professor Lindsay Jaacks challenged us to reflect upon our dietary choices and attitudes towards food waste. She highlighted the significant impact that reducing our consumption of animal-based products can have on our carbon footprint. In addition to dietary change, Imperial College London have worked with colleagues in the NHS, the Institute of Global Health Innovation, and the UK Health Alliance on Climate Change (UKHACC) to develop a resource which outlines 9 key actions that can be taken to have a positive impact on both your health and the planet (and many have the added benefit of being good for our wallets). These include; using our voice for advocacy, eating more plant-based and balanced diets, switching to active transport, insulating our properties, bringing nature into our homes, enjoying and protecting natural spaces, being more conscious consumers, embracing learning and challenge, and speaking openly to others about the climate crisis.

Considering opportunities in our professional lives, we can adopt greener commuting methods, challenge our affinity to single-use items, avoid over-investigation and treatment, and consider our role in disease prevention. As healthcare professionals, we also have powerful and trusted influence: by taking bold and visible action in this space, we can have a ripple effect that sparks change among our patients, colleagues and wider communities. Looking at examples of healthcare professionals who are already putting change into practice, the College recently hosted a series of webinars that showcased actions to achieve more sustainable practice across medicine, surgery, podiatric medicine, travel medicine, and dentistry.

Figure: Sources of carbon emissions by proportion of NHS Carbon Footprint Plus. Sourced from ‘Delivering a ‘Net Zero’ National Health Service: https://www.england.nhs.uk/greenernhs/wpcontent/uploads/sites/51/2022/07/B1728-delivering-a-net-zero-nhs-july-2022.pdf

These are available to watch via the College’s YouTube channel. Across the UK we’ve also seen changes in practice, from the complete cessation of desflurane use in many hospitals, a move away from metre-dose inhalers, and a growing use of reusable surgical caps. In addition, the Centre for Sustainable Healthcare have produced a wealth of resources to support environmental impacts being considered and incorporated into quality improvement projects and have national specialty networks which share opportunities for change and good practice across a range of disciplines.

Whilst “ground-up” action is essential, there is of course a need for action beyond the individual. We need system-wide changes to make sustainable practice the default option by tackling the carbon footprint associated with activities such as procurement, buildings, and transport. In England the Greener NHS programme is leading work to support NHS England to achieve net zero whilst also improving population health and saving money7. In Scotland, NHS Scotland published its climate emergency and sustainability strategy in August 2022 which outlines five themes and associated actions to reduce the environmental impact of healthcare delivery and adapt the system to climate change8. Also, in Wales, the NHS Wales decarbonisation strategic delivery plan outlines 46 initiatives to achieve net zero9.

Here at the College, change is also underway. We’ve already undertaken a carbon footprint analysis and committed to becoming a net zero organization. Using its voice for advocacy, we have published position statements on sustainable health services and food systems and via UKHACC, have joined with organisations across the world to raise awareness of the health impacts of climate change. We’ve also recently partnered with the Royal College of Surgeons of Edinburgh and The Royal College of Surgeons of England to produce a Green Theatre Checklist. Building upon this momentum, the College is excited to have recently launched a Sustainability Steering Group which will continue to oversee its work to address the climate crisis. With representation from both clinicians and College staff, this group will continue work to reduce the College’s carbon footprint, will use our voice to raise awareness of the links between climate change and health, advocate for sustainable healthcare, and will support fellows and members to develop the knowledge and skills to practice more sustainable healthcare.

To conclude, I am reminded of the phrase I dutifully quoted in my medical school interviews:

“I think a career in medicine provides an exciting opportunity for life-long learning…”

In the midst of evenings and weekends revising for exams, I have of course cursed this concept, but I have no doubt that the ongoing opportunities for learning and development are (and will continue to be) key in making my career stimulating and rewarding. I would therefore encourage you, no matter what stage of the sustainability journey you’re on, to commit to starting or continuing to educate yourself about climate change, and embrace new innovations and approaches to living more sustainable lives and delivering more sustainable healthcare. The co-benefits that accompany many of these changes are also huge, for example, our long and short-term health and wellbeing will definitely benefit from cleaner air, healthier diets, and more active lifestyles. So, let’s not be overwhelmed or complacent about the climate crisis that is upon us, but rather embrace the many opportunities we have to overcome it.

(1) The Lancet Coundown (2022). The 2022 Report of the Lancet Countdown: Health at the Mercy of Fossil Fuels. Available at: Visual summary - Lancet Countdown

(2) Royal College of Physicians (2016). Every breath we take: the lifelong impact of air pollution. Report of a working party. London: RCP.

(3) BBC News (2022). Pakstan floods: ‘It’s like fighting a war with no end’. Available at: https://www.bbc.co.uk/news/world-asia-63080101

(4) BBC News (2020). Ella Adoo-Kissi-Debrah: Air pollution a factor in girl’s death, inquest finds. Available at: https://www.bbc.co.uk/news/uk-england-london-55330945

(5) Glasgow Caledonian University (2022). Climate change makes violence against women in Malawi worse, study finds. Available at: https://www.gcu.ac.uk/aboutgcu/universitynews/climatechange-makes-violence-against-women-in-malawi-worse,-study-finds

(6) NHS England (2022). Delivering a ‘Net Zero’ National Health Service. Available at: https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2022/07/B1728-delivering-a-netzero-nhs-july-2022.pdf

(7) NHS Scotland (2022). Climate Emergency & Sustainability Strategy 2022-2026. Available at: https://www.gov.scot/publications/nhs-scotland-climate-emergency-sustainabilitystrategy-2022-2026/pages/2/

(8) NHS Wales (2021). NHS Wales Decarbonisation Strategic Delivery Plan 2021-2030. Available at: https://gov.wales/sites/default/files/publications/2021-03/nhs-wales-decarbonisationstrategic-delivery-plan-2021-2030-summary.pdf

“What you do makes a difference, and you have to decide what kind of difference you want to make.”

– Dr Jane Goodall

EYE ON OPHTHALMOLOGY

COLLEGE AND OPHTHALMOLOGY

– BRIEF HISTORY

Ophthalmology has been part of the College since its foundations, linking current practice to the long-lasting legacy of past Fellows.

Long before the establishment of the ophthalmology specialty, College founder Peter Lowe (c1550 – 1610) wrote about treating the eye in his surgical textbook of 1597 – A Whole Course of Chirurgerie.

The College’s links to the beginnings of the specialty stretches back to the early 1800s, when College Fellow William Mackenzie (1791 – 1868) founded the Glasgow Eye Infirmary in 1824. His textbook Practical Treatise on Diseases of the Eye (1830), became the standard reference work in ophthalmology. He was appointed Surgeon Oculist to Queen Victoria in Scotland in 1838. The College’s collections contain his library and papers, and his portrait hangs in College Hall.

Another key ophthalmologist in the College’s history is Andrew Freeland Fergus (1858 – 1932), who was President of the College from 1918 – 1921. Freeland Fergus dedicated his career to the study, teaching and practice of ophthalmology, as professor at Anderson’s College, and surgeon at the Glasgow Eye Infirmary. He played a leading role in promoting the Blind Persons (Scotland) Act of 1920.

OPHTHALMOLOGY SPECIFIC MEMBER BENEFITS

Membership of the College provides you with access to a wide range of ophthalmology journals, textbooks and Awards and Scholarships.

The Lachlan McNeill Scholarship in Ophthalmology funds junior doctors to extend their knowledge, experience or training in ophthalmology and the Ethicon Foundation Fund Travelling Fellowship promotes international goodwill in medicine and surgery by means of grants to assist the overseas travel of surgeons.

To find out more about the range of journals please visit rcp.sg/eLibrary or email us library@rcpsg.ac.uk.

INTRODUCTION OF MRCS (OPHTH) (GLASG)

From October 2021 the College introduced the new postnominal MRCS (Ophth) (Glasg) to recognise the achievements of those candidates completing the written components of the College’s FRCS Ophthalmology. Candidates who completed the FRCS Ophthalmology Part 2 Problem Solving examination (pre-June 2021) or who have passed the Part 2 MCQ examination (from June 2021) are eligible to apply for the award of the MRCS (Ophth) (Glasg). Further details of how to complete the membership application process can be obtained from membership@rcpsg.ac.uk.

MOHAN EYE INSTITUTE CELEBRATION

This year, we celebrated 20 years of the Mohan Eye Insitute in Delhi, India hosting the FRCPS Ophthalmology exam. Vice President (Medical) Andrew Gallagher presented a commemorative plaque in recognition of the Mohans’ service to the College. Their commitment and support to the College has been of great importance over the last 20 years and is just as crucial now as it was in the beginning.

The initial contact in India for FRCS Ophthalmology was Professor Bhasker Rao, a dentist based in Dharwad. Peter Kyle, then HCR for the exam, met with Prof Rao and contacts within the UAE and conducted site visits. It was agreed to deliver the exam initially in Dharwad and the first written exams were held there for the Part A, conducted by Peter Kyle. The Part A was then rolled out to be delivered in Hyderabad and in Irbid, Jordan.

Front Row L to R: Dr Rajiv Mohan, Professor Andrew Gallagher (VP Medical), Dr Sanjiv Mohan, Dr Ashok Grover, Prof Vijay Arora (International Advisor).

Dr Sadhu Gupta, then based at Inverclyde Hospital, knew Dr Hari Mohan and introduced him to Peter Kyle, and the Mohan Eye Institute became the first host centre for the Part B exams in 2000.

Following the successful delivery of the exam in Delhi, the exam was taken to LV Prasad Eye Institute in Hyderabad, where it ran until 2018. Following that, Professor Mahmoud ElStewi contacted the College to offer a centre in Tripoli, Libya.

The exam then ran in Jordan in 2001 at JUST university hospital (King Abdulla the 1st hospital) in Irbid with Dr Mahmoud al Salem as a host examiner. Then the 2nd year (2002) at Eye Specialty hospital in Amman also with Dr Al Salem and Ayman Mdanat was involved as an examiner. Ayman took over as a host examiner at King Hussein Medical Centre in Amman in 2003, with a second centre opened at the Ammon Eye Centre, hosted by Dr Mdanat in 2017.

FRCS OPHTHALMOLOGY

PART 3 CAIRO

fully refurbished and equipped for the exam. A group of UK and international examiners, led by Dr Tariq Saboor, Honorary Clinical Registrar, travelled to Cairo to deliver the exam with support from Fiona Winter and Kirsty Fleming, Deputy Head of Assessment. The hosts in Cairo, led by Dr Mostafa Salah, President of the Institute and Dr Hisham Ali, Vice President, provided a warm welcome.

The exam was successfully delivered to over 30 candidates and both examiners and candidates were positive about the centre facilities. Mrs Winter commented ‘Dr Hisham’s team, including Dr Sameh Galal, Assistant Professor of Ophthalmology and Dr Ibrahim Hassan, Assistant Professor of Anaesthesia, should be congratulated on the significant efforts we know were put into ensuring that the space was fit for purpose and that all arrangements requested were put into place.’ She added ‘The exam ran incredibly smoothly, particularly for a first running in a venue.’

The College is now working with RIO on exam dates for 2023 with three planned diets at the centre which provides significant additional capacity to the existing schedule of exams held at centres in Bangalore, Amman, New Delhi, and Mumbai.

EXAMINER RECRUITMENT

The College is currently looking for applications from Ophthalmologists and Physicians interested in becoming an examiner for the FRCS Ophthalmology. Whilst we welcome applicants from all locations, the current priority is to focus on expanding our UK-based examiner panel at this time, and to progress applications already on our waiting list to join our international examiner panel.

The College launched a new examination centre for the FRCS Ophthalmology Part 3 examination this year at the Research Institute of Ophthalmology (RIO) in Cairo. This was the first examination to be held in Egypt following the signing of the College’s memorandum of understanding with the Egyptian Government in July 2021.

The centre was initially proposed to the President, Mr Mike McKirdy, by His Excellency Professor Khaled Abdel-Ghaffar. A working party was formed in January 2022 with representatives from the College Education and Assessment Unit and the team at RIO and a successful site visit was carried out in March by Fiona Winter, Director of Education and Assessment.

The exam was delivered between the 20th and 23rd June with two days of structured orals taking place at the Sheraton Hotel and the two days of clinics taking place at RIO. An excellent clinical facility was created at the Institute with one floor having been

As an examiner, you would contribute to question writing and standard setting for Parts 1 and 2, as well as question writing for Part 3, and you would have the opportunity to examine at our centres internationally. If you are a UKbased Ophthalmologist or Physician with 3 years’ experience as a consultant and would like to know more about joining our panel, please contact us at frcs3@rcpsg.ac.uk.

L to R: Fiona Winter (Director of Education and Assessment), Dr Ibrahim Hassan Khalil (Examination Centre Manager), Dr Sameh Galal (Examination Patient Coordinator), Kirsty Fleming (Deputy Head of Assessment).

Examiners, trainee examiners and College staff at the Structured Orals.

GLOBAL HEALTH SPOTLIGHT: ST ANDREW'S CLINICS FOR CHILDREN

By Professor John Briggs, Chair

t Andrew’s Clinics for Children (STACC) was founded in 1992 by staff and students at the University of Glasgow.

Initially, STACC arose from a request by some Sierra Leone colleagues of Professor David Crompton of the then Department of Zoology at the University to see whether some students from the University of Glasgow might be interested in travelling to Sierra Leone to help in a children’s deworming programme. An appeal campaign was launched in the Sunday Post to raise the funds to support the two students’ travel to Sierra Leone, as well as start-up funds for the deworming project. The appeal was so successful that there were surplus funds raised and it was agreed with Robbie Ewen, then the University’s Secretary of Court, that a formal charity should be established in the University with the aim of raising funds to support primary health care in children’s clinics in sub-Saharan Africa. Thus, STACC formally came into being on 4 September 1992, with Robbie Ewen as the first Chair.

Thirty years later, STACC is still going strong and now provides financial support for six children’s clinics in five different subSaharan African Countries, these being Uganda, Nigeria, Kenya, Ghana and, most recently, Malawi. The deworming programme in Sierra Leone continued to be supported financially by STACC for 25 years before being absorbed fully into the national government’s Ministry of Health scaled-up programme for deworming. Recognising that the Sierra Leone government was now funding the programme in a sustainable manner, it was agreed that STACC would discontinue its funding in Sierra Leone and focus its activities on the other clinics which it supports elsewhere in Africa.

The types of clinics which STACC supports vary. Two of them are the children’s wards at two rural hospitals in remote areas of Uganda, these being St Kizito’s in Matany and St John’s in Aber. In both instances, STACC is able to fund about 35-40% of the operating costs of the children’s wards and so make a significant

contribution to primary health care for the children of these areas. In Nigeria, STACC supports a mobile clinic system in Ile Ife which is 100% funded by STACC, unlike the two Ugandan clinics. The mobile clinics visit 12 villages in the region on a monthly basis to provide primary health care support to the local populations. Inevitably, one of the biggest challenges is keeping the vehicles on the road, as the state of Nigerian roads, once away from the main roads, rapidly takes its toll on the vehicles and STACC is currently engaged in a specific appeal at the time of writing to replace one of the vehicles which has come to the end of its life. Like Ile Ife, STACC also provides 100% of the funding for the clinic in Kenya. BION, an acronym from the Maasai language which broadly means ‘Health for Mothers and Children’, focuses more on preventing ill-health among children through feeding programmes and a very active mosquito net distribution programme.

One of the longest-supported activities has been in Ghana through STACC-Ghana. Initially, the focus of this support was on controlling schistosomiasis among the child population in northeast Ghana, and then reducing intestinal worms. More recently, STACC-Ghana has supported the purchase of vital medical equipment to the paediatric department at the Komfo Anokye Teaching Hospital in Kumasi, the central part of which was a ventilator and monitor which Dr John Adabie Appiah, the Head of the Paediatric Intensive Care Unit at the hospital, has described as an absolute lifesaver.

The most recent venture for STACC has been support for a children’s clinic in Masambuka village in a remote part of Machinga district in rural Malawi. The agreement to support STACC-Malawi was signed in early 2022, and the first phase is to upgrade the physical buildings of the site and to install a solar energy plant to support the refrigeration of medicines for the first time at the health centre, as well as to supply electricity more generally to the centre and the surrounding community.

During its 30 years of existence so far, STACC has been able to raise £2.6 million to treat just under 1.7 million children in the clinics, most of whom would not otherwise have received any treatment at all, or, at best, only partial treatments. The one thing that all the clinics have in common is they all share the same three main diseases treated: malaria, by far the most common illness; upper respiratory tract infections; and intestinal disorders. Of course, there are other conditions treated, but these three account for about 80% of all presentations.

Because STACC is run entirely by volunteers, about 95 pence in every pound raised goes directly to the clinics to provide the primary health care required. The reason that this figure is not 100% is because there are unavoidable costs here in Scotland, such as the annual audit, insurance, bank charges and postage. We only wish that were not the case!

In its operations, STACC adheres to the following principles. All clinical and managerial decisions are taken by the directors and staff of the clinics and not by STACC Board members based in Scotland; all treatment and medication is to be provided free of charge to patients at the point of delivery; our focus is on communities which otherwise would have limited or no access to primary health care facilities; clinics should commit to using only bona fide medicines in their treatments; and finally clinics should have in place policies related to safeguarding and equality, diversity and inclusion.

There is no doubt that STACC currently operates in a very challenging funding environment, but is no different from any other charity in this regard. The supported clinics in Africa are equally challenged. The demand on their services by the parents of children is immense, and for most there are no alternative sources of treatment for their children. STACC has been around for 30 years, and it certainly plans on being around for another 30 years.

For further information, please the STACC website at: www.standrewsclinics.org.uk.

STACC has been able to raise £2.6 million to treat just under 1.7 million children in the clinics

TC WHITE CONFERENCE PRESENTATION AWARD REPORT

by Gemma Gaw BSc (Hons) BDS

MFDS RCPS (Glasg)

PhD

Care Dentistry has unique challenges. I particularly enjoyed a session delivered by Dr Karve and Dr Farrell on airway management. They discussed airway assessment, medical factors and risk reduction.

This insight will help me to risk assess patients in the dental clinic and improve communication with the anaesthetics team. Other highlights included learning about education in Special Care Dentistry and applying the IADH curriculum across the world, and treating patients with a neurodisability.

I presented a research project on 'Management of patients at risk of adrenal crisis in the dental setting: A review of current practice in UK dental teaching hospitals'.

It was a pleasure to attend the International Association for Disability and Oral Health (IADH) Conference where I met world leading experts contributing to the rapidly developing specialty of Special Care Dentistry. The IADH is multidisciplinary network who are concerned with the oral health of people living with disabilities, and aims to advocate for equality and promote scientific research. A bi-annual conference provides an opportunity for researchers and clinicians to share knowledge and experiences to improve health outcomes for people with disabilities. The IADH 2022 congress was the first face to face event since the pandemic and was hosted by the French national association Santé Orale et Soins Spécifiques (French association for disability and oral health) in Paris, France. The theme of the conference was 'Quality Matters – ensuring equitable health outcomes'

The conference began with a keynote lecture by Philippe Aubert, a lecturer and author who lives with cerebral palsy.

He spoke about the importance of access to dental care for dignity, respect and self-care. Listening to each patient in the way they express themselves, is required to understand the way their oral health impacts their life. He described his experiences of dental care in the clinic with clinical holding and sedation, as well as general anaesthesia. Philippe encouraged us to question how we share skills and knowledge with patients, and respect their autonomy, trust and humanity.

On the theme of successful ageing, I learned more about the shortened dental arch and nutrition and the association between number of teeth and mortality. The restorative challenges of the elderly patient, with increased risk of aspiration pneumonia and the risks of denture wearing at night were discussed, and I learned that PMPR and intensive oral hygiene reduces this risk. An interesting study from Japan showed that patients have improved oral and respiratory function when they participate in karaoke!

A session on behaviour change, oral hygiene and how to support care givers was very reassuring as this is often a difficult issue to address. Providing dental care under general anaesthesia in Special

This is a particular area of interest to me following referral of steroid dependent patients to the Oral Surgery department at Glasgow Dental Hospital as a DCT1. I was taught the importance of evidence based clinical decision making, and realised this is an area where evidence is lacking and guidance is conflicting. Therefore, I wanted to find out more. The study I presented gives evidence that variation in the management of steroid dependent patients. Identifying patients who are at risk of adrenal crisis due to systemic glucocorticoid use varies, and dose regime for steroid cover varies between hospitals. Participants expressed their wishes for pragmatic evidence-based guidance. From discussions, it appears that the situation is similar to the UK and often surgeon’s preference dictates the identification and management of patients taking exogenous steroids who may be at risk of adrenal crisis whilst undergoing dental treatment. The need for further research, including evidence on the risk of dental procedures to this group of patients was highlighted. The presentation was selected as a finalist in the Clinical Research Presentation Oral Category.

Presenting to a global expert audience was an invaluable opportunity to improve my communication skills to peers with a wide variety of backgrounds, cultures and languages. I enjoyed discussing implications of my findings such as directions for further research and increasing awareness of the risk of adrenal crisis to this group of patients. Undertaking this research project and presenting my findings at the IADH conference has increased my confidence in participating in clinical research. I was keen to find out how colleagues in other countries manage this group of patients and if their practice varies in the same way as the UK.

I wish to sincerely thank the Royal College of Physicians and Surgeons of Glasgow for supporting me to attend this event and to present my research to a worldwide audience through the TC White Conference Presentation Award. I have gained confidence to pursue further research and embark on Specialist Training in Special Care Dentistry. My eyes have been opened to the global challenges in providing dental care to patients with additional needs and I will use all that I have learned to improve the care I deliver in NHS Greater Glasgow & Clyde Special Care Dentistry service.

THE UNEQUAL BURDEN OF OBESITY?

By Lorraine Tulloch and Jennifer Forsyth of Obesity Action Scotland

Health Inequalities has been in the headlines frequently over recent months in Scotland. We have had an Inquiry at Scottish Parliament, an ongoing Independent Review led by Health Foundation due to publish in January, a report from CRUK indicating that cancer incidence rate and cancer outcomes are much worse for those living in deprivation in Scotland. Each report identifies obesity as a major contributing factor in the worsening picture.

This is a seemingly intractable problem we face in Scotland; the challenge of inequalities perpetuates the cycle of poverty, poor diet, overweight and obesity. Data released in the last month shows that rates of overweight and obesity in adults in Scotland are at their highest rates since records began.1 This is not entirely unexpected given that so many people reported gaining weight during the pandemic response measures. However, it should be a concern for us all; these trends pre-date the pandemic, having a higher weight impacts on our health, our quality of life and our length of life. We cannot afford to be numbed or overwhelmed by the statistics. We must see them as the driver for change.

HOW DOES THE BURDEN FALL IN SCOTLAND?

Overall life expectancy in Scotland is lower than in any other part of the UK, and what progress we had made has now been eroded, with life expectancy not just stagnating but actually reducing. Data included in a recently published report from the University of Glasgow2 shows there is a significant inequalities gap, with life expectancy for both men and women in the most deprived tenth of areas being markedly lower than those in the least deprived – a difference of 10.2 years for females, and 13.5 years for men.

When we look at healthy life expectancy, the inequality is even more stark. Babies born in the least deprived areas of Scotland can expect to live a staggering quarter of a century longer in good health than their most deprived counterparts. This pattern is replicated for both men and women. For males, those in the least deprived areas will have an average of 70 years healthy life expectancy compared to just 45 years for those in the most deprived areas. For females, the difference is 73 years and 49 years respectively. That means many people and families struggling in Scotland with their health, their ability to work, provide for themselves and their families before they enter their 50s.

These patterns of inequality are also emerging and changing when we consider weight. Prior to 2018, the risk of childhood obesity had fallen slightly in the least deprived areas, and increased in the most deprived areas. However, in recent years, there has been increase in rates of childhood obesity across all five deprivation quintiles. Significant inequalities still remain; children in the most deprived quintile were twice as likely to be at risk of obesity than their peers in the least deprived quintile, with an actual gap of 7.2%. These statistics show harm to children now, and store up problems for the future.

Deprivation is also linked to differences in adult BMI across Scotland, with those in the most deprived areas consistently showing a higher BMI than those in the least deprived areas.

This is evident across all age groups and for both males and females3, ultimately translating into consistently higher obesity rates in the most compared to the least deprived. For women in particular, the gap has been particularly pronounced. In 2019, 40% of women in the most deprived areas had obesity, compared to 18% in the least deprived.4

Proportion of children in Primary 1 at risk of obesity (%) according to fifths of area-level deprication: 2001/2 to 2019/20

Taken from Miall, N; Fergie, G; Pearce, A. Health Inequalities in Scotland: trends in deaths, health and wellbeing, health behaviours, and health services since 2000. University of Glasgow. November 2022. doi: 10.36399/gla.pubs.282637, page 61

WHAT ABOUT IMPACT ON DIET?

Diet has a profound impact on weight and there are clear influences of deprivation on dietary outcomes. The University of Glasgow report5 highlights that across the board there are low levels of fruit and vegetable consumption but, again, there are profound differences between the most and least deprived – just under a quarter (24%) of those in the most deprived areas had not eaten a whole portion of fruit or vegetables on the previous day, compared to only one-tenth (9.6%) for the least deprived. Inequalities in diet highlight the importance of both availability and affordability of healthy food, with those in more deprived areas facing real barriers to achieving a healthy diet. Data from the 2019 Scottish Health Survey confirms that there are also large inequalities in food insecurity according to arealevel deprivation, with adults living in the most disadvantaged fifth of areas five times as likely to experience food insecurity as those in the least.

The current cost-of-living crisis is presenting even more challenging circumstances. Not only is food getting more expensive but also with rising costs across energy and other

outgoings there is much less money available in household budgets for food. We quote extensively the experience of people in Scotland at the highest and lowest percentages of deprivation, but inequality increasingly affects everyone except the most fortunate in society.

Food inflation continues to rise at a worrying rate, skyrocketing to 16.4% in October 2022 from 14.6% the previous month according to data from the Office for National Statistics. This remains markedly higher than overall inflation which is sitting at 11.1%.6

The rise in price is not equal across all food categories. An analysis of ONS (Office for National Statistics) data by Food Active has demonstrated that low fat milk has risen in price by 42% and frozen vegetables by 20%. By comparison

confectionery has only risen by 6% and soft drinks by 9%.7 The consequences on our diets remain to be seen but Which? have called on supermarkets to take action to ensure the right type of products are affordable and accessible.8 It is too easy to tip the balance of the shopping basket towards harming health.

WHAT ARE THE SOLUTIONS TO HEALTH INEQUALITIES?

There are important income related solutions that have to be found, but there are also structural changes that can be made – changing our relationship with food production, retailing, buying and consuming. This includes changing the marketing and promotional landscape of the food system in Scotland. At a time when trends are heading in the wrong direction, these measures are urgent.

Such interventions are low cost to government, but extremely effective. They influence the causes of inequalities, they are preventative, they are population-wide, they impact on the structures of our society and are examples of ideal public health interventions. Evidence is accumulating of increasing public support to take such measures. They would ensure when we go shopping or eat out the healthiest option is the easiest and cheapest option for everyone. They require bold legislation and brave politicians. The bravery is needed to ensure action is not diluted in the face of a food and drink industry competing to sell at all costs, intent on putting profit before our health and contesting the need for legislation and interventions.

Obesity Action Scotland is working hard to ensure changes to promotions, marketing and advertising of food alongside improving the offer when eating out, to benefit everyone and those who face the greatest challenges most of all. The medical profession can take a strong stance on these issues and be a voice in the call for greater focus and action on prevention.

(1) Scottish Government (2022) The Scottish Health Survey 2021 https://www.gov.scot/publications/scottish-health-survey-2021-volume-1-main-report/

(2) Miall, N; Fergie, G; Pearce, A. Health Inequalities in Scotland: trends in deaths, health and wellbeing, health behaviours, and health services since 2000. University of Glasgow. November 2022. doi: 10.36399/gla.pubs.282637 https://www.gla.ac.uk/media/Media_892338_smxx.pdf

(3) Obesity Action Scotland (2022) The Weight of the Nation https://www.obesityactionscotland.org/media/1841/weight_of_the_nation_report-final.pdf

(4) Scottish Government (2020) Diet and Healthy Weight Monitoring Report https://www.gov.scot/binaries/content/documents/govscot/publications/statistics/2020/10/diet-healthy-weightmonitoring-report-2020/documents/diet-healthy-weight-monitoring-report/diet-healthy-weight-monitoring-report/govscot%3Adocument/diet-healthy-weight-monitoring-report.pdf

(5) Miall, N; Fergie, G; Pearce, A. Health Inequalities in Scotland: trends in deaths, health and wellbeing, health behaviours, and health services since 2000. University of Glasgow. November 2022. doi: 10.36399/gla.pubs.282637 https://www.gla.ac.uk/media/Media_892338_smxx.pdf

(6) Food Foundation, (2022) Food Prices Nov 22 Update https://foodfoundation.org.uk/news/food-prices-nov-22-update-what-are-retailers-doing-help

(7) Food Active (2022) Briefing Paper Cost of Living Crisis and Healthy Weight https://foodactive.org.uk/wp-content/uploads/2022/11/HealthyWeight_CostOfLiving_BriefingPaper_Nov2022-1.pdf

(8) Which? (2022) 10 point action plan for supermarkets https://www.which.co.uk/news/article/the-most-at-risk-areas-for-access-to-affordable-food-revealed-a9JFe8I1qmyx

(9) Food Active (2022) Briefing Paper Cost of Living Crisis and Healthy Weight https://foodactive.org.uk/wp-content/uploads/2022/11/HealthyWeight_CostOfLiving_BriefingPaper_Nov2022-1.pdf

The rise in price in September 20229 compared to September 2021 [Adapted from Food Active Briefing]

MEMBERS’AREA

COLLEGE AWARDS AND SCHOLARSHIPS

listen to their talks was both fascinating and awe-inspiring. One of my highlights was a discussion with Dr Deepak Chopra, author, alternative medicine advocate and a prominent figure in the New Age movement.

The pertinent theme of the meeting was “Heal the Healers” and due focus was given to the immense role and contribution healthcare staff have played during the course of the pandemic and what we can do collectively to aid our recovery through what has been a very difficult time, physically and mentally. It was so enlightening to hear the messages of hope, recovery and continuing self-development. Although juxtaposed with my earlier observations that week, involving very objective clinical marker-driven surgical interactions and measures, this holistic and balanced view on life was refreshing and well-adjusted.

VISITING OBSERVERSHIP

Ankur Mukherjee

The visiting clinical observership provided me exposure to a high-volume prostate cancer practice under the supervision of Professor Ashutosh Tewari), MD, Chairman, Milton and Carroll Petrie Department of Urology at the Icahn School of Medicine at Mount Sinai, New York.

The Department of Urology has been a leader in clinical practice, research, and education since 1852, with the establishment of the Mount Sinai Hospital.

Professor Tewari is a world leader in robotic prostate surgery and has pioneered specific nerve sparing techniques and leads a multidisciplinary team committed to improving prostate cancer treatment, research, and education. He has performed over 10,000 robotic radical prostatectomy surgeries and the Tewari Lab is working on unlocking the genomic causes of prostate cancer and translating genomic information to practical physician application through imaging.

This observership was a self-directed venture and Professor Tewari agreed to host me during a period of time when two other eminent Professors (Professor Thomas Bessede and Associate Professor Nyangoh Timoh) from France were also visiting his unit. I gained a unique opportunity to be amongst the presence of company and conversations that involved understanding the neuroanatomy of the prostate in a unique manner. I also observed several robotic nerve sparing prostatectomies.

Professor Tewari’s clinical schedule involved operating on average 3 RALP (Robot-Assisted Laparoscopic Prostatectomy) cases each day Mon-Thursday. The surgeries took place from 7:30am-12pm. The afternoon schedules involved primarily office-based prostate biopsy procedures and clinic consultations at his other practice down-town in East 98th Street (Faculty Practice). This provided me with in-depth knowledge and detailed understanding of the management of prostate cancer across its spectrum from tailored treatment strategies to the management of the long-term functional sequalae, whilst providing a patient-centred, datadriven, evidence-based, state of the art clinical service.

I was extremely fortunate to be invited to the North American meeting of the Royal College of Physicians and Surgeons of Glasgow I witnessed the conferring of the Honorary FRCS recognition to Professor Tewari and interacted with some of the world leaders in Urological Surgery and Technology. To be able to

Along with great discussions and seminars from eminent urological leaders, I had a fantastic opportunity to interact with the fellows and residents at Mount Sinai Dept. of Urology. The present fellow (Dr Adriana Pedroza) gave me an overview of the work that is involved on a day-to-day basis and her astute and efficient overview of the department settled me into the team. I was also witness to the research meeting discussions that took place on a Wednesday afternoon. Novel and innovative technology-driven research is carried out at Tewari Lab and it was thoroughly enlightening to gain a perspective on the cutting-edge work that his lab is carrying out. From developing cancer vaccines, investigating the epidemiological effects of prostate cancer to novel imaging techniques as biomarkers and working to unlock the genomic causes of prostate cancer are just some of the areas his team are looking at.

I am grateful to Dr Sujit Nair, Assistant Professor and Director of GU Immunotherapy Research at the Department of Urology, Icahn School of Medicine at Mount Sinai who also provided me with a great insight into the work the Tewari Lab is doing and is an active presence in the “Coffee with the Chair” meetings every Saturday morning that I have been attending regularly.

This observership, albeit for a short period allowed me to accelerate and advance my knowledge in urology, particularly prostate cancer developments with focus on robotic surgery. This has been one of highlights of my career and the enthusiasm, dynamism and can-do attitudes that I saw amongst this team has allowed me to resume with my own training with similar thoughts. Professor Tewari’s warm, welcoming, and generous leadership qualities are what the international urology community needs. Particularly, the way in which he supports and nurtures his team from non-clinical staff to senior urology peers within his unit. He is a beacon of hard work, technical perfection and convivial attitude, continuing to push the boundaries to achieve the best patient outcomes in his field.

I feel honoured and privileged in having the opportunity to be integrated into this innovative research group and better understand how to maintain the longevity, enthusiasm and dynamism of a longstanding International Research Collaborative. I will endeavour to take the lessons learnt from Mount Sinai and adopt them in my practice upon completion of training in the UK. Professor Tewari’s unit at Mount Sinai has provided me with invaluable clinical lessons, lifelong friendships and a fresh perspective.

I would recommend anyone wishing to undertake a visiting observership to actively communicate with a host organisation and keep an open mind.

TRAVELLING FELLOWSHIP

Helen Wohlgemut

Thanks to the College’s Travelling Fellowship, I was able to visit Shriners Children’s Hospital, Philadelphia.

Shriners is a highly specialised Ortho-Plastic hospital, which offers upper and lower limb Ortho-Plastic care, as well as paediatric neurosurgery care. The hospital is unique within the United States as any child can be treated free of charge, from the United States and around the world. The hospital is supported by charitable donations and patients can present directly to the hospital as a self-referral, or a physician from any speciality can refer directly to the service. Patients can be referred from any part of the globe, although within the USA there is a transport network to assist patients with their travel. The hospital also has a facility to house families during treatment.

In addition to new patients, many patients will transfer their care for a variety of reasons and this referral can also be made by the physician or the patient. The hospital does not have an emergency department as we would recognise it, but does have a walk-in clinic that is primarily run by highly trained physician’s assistants. The clinic is multi-disciplinary in that there is a radiology department, ortho-plastic physician presence, nursing / wound care, theatre scheduler, play therapists, occupational and physiotherapists. The clinic essentially functions as a one-stop shop for outpatient care, and direct access for theatre scheduling to those who need it. The clinic also had a physician capable of

performing ultrasound examination, peripheral nerve studies and genetic screening, among other highly desirable skills. The Ortho-Plastic team was a small but very tight knit group. It was clear to see a family ethos created a warm and friendly working environment which lends itself to collaborative working.

The service is very proactive, providing and designing many adaptive tools to assist children with limb differences to perform activities of daily living independently. The department has a small kitchen where children can enjoy learning to care for themselves through a very practical approach to physical therapy and rehabilitation.

I was also able to learn a lot more about the diagnosis of obstetric brachial plexus injury. This includes initial diagnosis and examining the new-born, pre and post procedure examination and problems these patients might face as they pass through into adulthood. I was able to see a wide range of other congenital limb differences, including arthrogryposis and management of hand spasticity in the child. I learned many tips and tricks in communicating and examining the paediatric hand and upper limb. I was also able to attend part of the microsurgical flap course at Penn University and experience lectures from leaders in the field on microsurgical reconstruction of the upper limb. I am extremely grateful to the wonderful hospitality of Doctors Scott Kozin, Dan Zlotlolow and Eugene Park. I am also very thankful to the college for the financial support to be able to make this educational visit.

My experience of observing at Shriners Children’s Philadelphia has allowed me to better understand the detailed infrastructure required of the service to serve the public well. As we face future staffing difficulties, I have witnessed how speciality nurses and physicians’ assistants might provide valuable skills to this type of service and how a highly effective physiotherapy and occupational therapy department is key to patient success. I have also experienced how certain types of speciality equipment are vital to a good service and the breadth of surgical interventions and services that can be offered to the paediatric population. Hopefully, as I progress in my career I can use this experience, along with my previous fellowship experience in extremity reconstruction and microsurgery to provide good care to paediatric patients with upper limb differences.

TRAVELLING FELLOWSHIP

I was very fortunate to be given the opportunity to undertake The Oxford® Partial Knee Travelling Fellowship at the Nuffield Orthopaedic Centre (NOC) of the Oxford University Hospitals. The NOC is an internationally renowned elective Orthopaedic hospital, with strong affiliations to the University of Oxford. It boasts very well established academic medical practices across specialist Orthopaedic surgery, Plastic surgery, and Rheumatology services. This culminates in excellence in clinical care, research, and innovation. The NOC is also the design centre for the Oxford® Partial Knee, the only medial unicompartmental knee arthroplasty implant with excellent 30-year survivorship data. As a knee surgeon, I was keen to add the surgical knowledge of the Oxford® Partial Knee to my armamentarium so that I will be able to offer this as an option to appropriate patients under my care at the Sengkang General Hospital in Singapore.

The Oxford® Partial Knee is a bone- and soft tissue-preserving procedure which seeks to resurface the worn cartilage of a single compartment of the knee with restoration of the native knee kinematics. Other than superior implant survivorship, this implant

has also shown to produce excellent patient- and physicianreported outcomes.

Through this 2-week travelling fellowship, I hoped to learn the indications, pre-operative assessment and planning for the Oxford® Partial Knee as well as the surgical techniques and pearls from the designer surgeons as well as high-volume surgeons at the NOC. This included plenty of opportunities to scrub up with the knee surgeons at the NOC and assist them with the Oxford® Partial Knee procedure, to observe specialist outpatient clinic sessions which included pre-operative assessment clinics, acute knee clinics as well as post-operative follow-up clinics. I was also involved in the pre-operative planning of the surgeries listed for the 2 weeks as well as in the multi-disciplinary team rounds where complex cases were discussed. I was also involved in discussions for potential longer-term research and academic collaboration between myself and the knee surgeons at the NOC.

The experience, insights and perspectives gained from this travelling fellowship have enriched me greatly. As a knee surgeon who sees patients from all walks of life across all age-groups, it is very important for me to be skilled in various procedures so that I can discuss all possible options with the patients before deciding with the patient which procedure might be most suitable for them. I have been performing arthroscopic procedures, osteotomies, fixed-bearing unicompartmental knee arthroplasties as well as total knee arthroplasties for patients presenting along the spectrum of knee osteoarthritis. However, there remains a significant group of patients who would benefit from a mobilebearing partial knee replacement. I believe that the Oxford® Partial Knee would be the ideal implant to offer these patients as it is a bone- and soft tissue-preserving procedure which best restores the native knee kinematics. With the knowledge and skills gained from this travelling fellowship, I am now confident to be able to offer this as an option to the relevant patients.

Dr Hamid Rahmatullah Bin Abd Razak

2022 SURVEY OF MEDICAL CERTIFICATE OF COMPLETION OF TRAINING (CCT) HOLDERS’ CAREER PROGRESSION

The 14th survey reporting the experiences of, and outcomes for, physicians within a year of gaining their CCT (certificate of completion of training) has now been published. It covers physicians who gained their CCT in 2021 in all 30 medical specialties in the UK.

This unique survey is a collaboration between the RCP’s Medical Workforce Unit and the Joint Royal Colleges of Physicians Training Board (JRCPTB) on behalf of the Federation of the Royal Colleges of Physicians of the UK. It has monitored changing outcomes for CCT holders since 2009.

Key findings

LTFT working

The survey findings highlight the increasing trend towards LTFT working, with 30% of respondents having trained LTFT (up from 27% previously) and the same proportion working LTFT or flexibly after CCT. It appears that more opportunities to take up consultant roles on an LTFT basis would be welcome, given that 17% of those working full time said that they would have preferred an LTFT contract – wider pressures on the health service were cited as a limiting factor.

Clinical research

The survey suggests that there is strong interest in clinical research among CCT holders, with 68% of respondents in touch with local CRN specialty leads and 58% saying that they would like to do more research. However, just 25% undertook research in their consultant post and only 31% had research in their job plan.

Transition from trainee to consultant

The transition from trainee to consultant is a particularly key moment in career progression, and nearly 1 in 12 (8%) respondents said that they were unprepared for this. The survey demonstrates that new consultants feel they would benefit from greater access to mentors and new consultant development programmes, and only a third (32%) of respondents received a specific new consultant induction.

We believe that every newly appointed consultant should be offered mentoring (be it through the department, trust or externally), leadership development, networking and opportunities to improve personal wellbeing. The Royal Colleges are not prescriptive about how the hospital/ trust/health board does this, but do think this opportunity should be available to all new consultants.

NEW YEAR'S HONOURS

The College is delighted to congratulate some prominent members of our community who have recently been recognised for their work. Professor Jackie Taylor, immediate Past President of our College has been awarded an MBE in recognition of her work in medical education and healthcare. Professor Abhay Rane OBE, currently College Registrar and recently Vice President (Surgical), was awarded the Gold Medal of the British Association of Urological Surgeons for 2022, following the success of another College Fellow, Nitin Shrotri, who was also given the BAUS Gold Medal last year.

Professor Ewen Harrison, Professor of Surgery and Data Science at Edinburgh, was awarded an OBE for his work during the pandemic. Professor Harrison is also a pioneering researcher in global surgery and a contributor to our College work in global health. Many congratulations to all.

Chitta Ranjan Chowdhury Ordinary Member

Callum Wemyss Ordinary Member

Ashraf

Vicki

Graphics - Royal College of Physicians of London

Glasgow Oral Surgery Symposium

This will be the third part of the benign clinico-pathological conference which will focus on the management of fibro osseous and giant cell lesions of the jaws. We have gathered 5 specialists nationwide who will present strategies on current management including diagnosis, investigations, surgical advances, and minimising complications and recurrences.

EDUCATION CALENDAR

Non-Clinical Skills

Developing the Clinical Trainer: Teaching Skills for early stage trainees

1 March

Online, 6 CPD Credits

This course will provide foundation doctors and medical students with an overview of teaching, learning and feedback in the clinical environment.

Mentorship in Healthcare

3 March – 10 May, 0900 - 1640

In-person, 18 CPD Credits

Our Mentorship Programme matches members who are seeking mentoring as their careers develop, perhaps when changing roles, with established, trained College mentors.

Royal College Advanced Certificate in Clinical Education

21 March – 4 April

Online

The course focuses on enabling delegates to relate and constructively apply relevant educational theory to their ongoing clinical education practice.

Training the Clinical Trainer: Teaching skills for early stage trainees

28 – 29 March

In-person, 12 CPD Credits

Designed for senior trainees across all specialties and mapped to CCT requirements, this course will provide attendees with knowledge and skills to meet the criteria set out in the GMC’s recognition and approval of trainers’ requirements.

Clinical Courses

Masterclass in Learning Critical Appraisal Research Methodology in Surgical Literature

18 – 25 February, 0900 - 1330

Online, 8 CPD Credits

This course will provide participants with a strategy for reading and critiquing surgical journal papers, with a step-by-step guide to analysing their methodology, statistics and findings.

Basic Surgical Skills

22 - 23 February, 22 – 23 March, 27 – 28 April, 24 – 25 May, 0800 - 1700

In-person, 12 CPD Credits

This course is for trainees anticipating a career in Surgery and preparing for basic surgical examinations.

Basic Surgery Cadaver Skills

23 – 24 February

In-person

This course is for CT1 / ST2 level and will cover areas of the ISCP curriculum required for entry to ST3. Candidates should have previously undertaken a Basic Surgical Skills course.

Basic Orthopaedic Procedural Skills

28 February, 28 March

In-person

Learn the principles of skin suturing, plastering, digital nerve blocks, joint aspiration, emergency fracture treatment and spinal immobilisation.

GI Anastomosis Course

2 March, 0830 - 1635

In-person

This one day course provides exposure to the theoretical principles and practical techniques of GI anastomosis. It gives an opportunity to perform a variety of surgical procedures on tissue models under the expert guidance of consultant surgeons.

Vascular Anastomosis Course

2 March, 0830 - 1630

In-person

This one day course provides exposure to the theoretical principles and practical techniques of vascular anastomosis. It gives an opportunity to perform a variety of surgical procedures on tissue models under the expert guidance of consultant surgeons.

Principles

of Intramedullary Nailing

10 March, 18 May, 0900 - 1715

In-person

This practical, one day course introduces the principles of intramedullary nail fixation for fractures of the tibial and femoral shaft. The course will be taught by experienced orthopaedic surgeons with an interest in orthopaedic trauma.

Procedural Skills for Medical Trainees

16 March, 29 June, 28 September, 29 March

In-person

This course is an excellent opportunity to develop your practical skills and gain knowledge in common IMT procedures.

Masterclass in Learning Critical Appraisal Research Methodology in Emergency Medicine and Trauma

18 – 25 March, 0900 - 1330

Online, 8 CPD Credits

This course will provide participants with a strategy for reading and critiquing surgical journal papers, with a step-by-step guide to analysing their methodology, statistics and findings.

Events for all Physicians Surgeons Dentistry Travel Medicine Podiatric Medicine

CADAVERIC

Foundation Skills in Surgery

25 March

In-person

This course provides an introduction to the specific skills of early stages of surgery. It is suitable for foundation year doctors and final year medical students considering a career in surgery.

MRCS Part B Prep Course

3 - 4 April, 0800 - 1600

In-person

This two-day course prepares you for the MRCS Part B OSCE Exam. The course combines online, flexible and independent learning with classroom based scenarios and preparation that benefit from direct interaction and feedback from faculty.

Dental Cone Beam 2A

13 - 14 April

Online, 10 CPD Credits

Delegates will gain a thorough understanding of how to reference legislation as well as the responsibilities around CBCT implementation and operation.

Laparoscopic Colorectal Surgery Cadaveric course

CADAVERIC

13 - 14 April, 0900 - 1630

In-person

This two day cadaver course provides hands-on experience in laparoscopic colorectal procedures using fresh/frozen cadaveric material.

IMPACT

3 – 4 May, 13 – 14 June, 5 – 6 September, 30 – 31 October, 23 – 24 January, 19 – 20 January, 4 – 5 March

In-person

IMPACT is a two-day course introducing the principles and practice of acute medical care and related knowledge, skills, understanding and attitudes.

Cadaveric Foot and Ankle Masterclass

18 May, 0900 - 1700

In-person

Surgical Skills for the Emergency Department Resuscitation Room

24 – 25 May, 0900 - 1700

In-person, 12 CPD Credits

Neurology Conference

31 March, 0830 - 1700

CADAVERIC

This is a cadaveric course to equip trainees in approaches to the foot and ankle as well as modern surgical management of challenging conditions.

An innovative practical training course on the surgical techniques that can save lives when waiting for assistance is not an option.

Head and Neck Dissection Course

22 - 23 June, 0900 - 1700

In-person, 12 CPD Credits

This two day, hands-on dissection course aimed at ST level trainees in Otolaryngology.

Dental Cone Beam 2B

11 August, 0900 - 1600

Online, 6 CPD Credits

Following on from our Dental Cone Beam 2A Certification course, this course offers an interactive, delegate centred approach to learning and will enable attendees to maintain the safe operation and interpretation of CBCTs.

Endoscopic Ear Surgery Cadaver Course

2 – 3 October, 0900 - 1700

In-person, 12 CPD Credits

CADAVERIC

CADAVERIC CADAVERIC

This is an advanced hands-on endoscopic ear surgery dissection course using fresh frozen cadaveric specimens.

Emergency Head and Neck Cadaver Course

4 October, 0800 - 1715

In-person, 6 CPD Credits

CADAVERIC

The course gives hands-on refresher training for consultants and senior trainees in ENT emergencies that occur in areas outside their sub-specialty using fresh frozen cadavers.

Conferences

Interactive Cardiology Conference

10 March

Hybrid, 6 CPD Approved

Join us as we discuss the latest innovations and updates in cardiology at this popular conference.

Hybrid, 6 CPD approved

Join us for this popular conference, where we’ll give you an update on neurosurgery, clinical skills, neuropathy, and personal insights from a neurology appraiser.

Glasgow Oral Surgery Symposium

21 April, Hybrid, 6 CPDA credits

This will be the third part of the benign clinico-pathological conference which will focus on the management of fibro osseous and giant cell lesions of the jaws.

Glasgow International Orthopaedic and Trauma Meeting

19 May, 0900  - 1700, Hybrid

Covering a wide range of subjects, this conference is relevant for everyone involved in orthopaedics and trauma, including consultants, orthopaedic training and non-training grade doctors, medical students, physiotherapy colleagues and orthopaedic and trauma nurses.

Medical Problems in Pregnancy: optimising multi-disciplinary care

8 September, 0900 - 1700, Hybrid

The programme will include sessions with expert speakers, interactive case-based learning and engaging panel discussions, with topics including: cardiac disease; kidney disease; perinatal mental health and infections in pregnancy.

Glasgow Gastro Conference

15 September

This one day conference will consist of interactive presentations, case based learning and state of the art lectures, with both national and international experts providing topical updates on a wide range of gastroenterology, hepatology and endoscopy issues.

Medicine24

26 - 27 October

Hybrid, 12 CPD Credits

Returning for its ninth year, our flagship medical conference will provide up-to-date information on the optimal management of acutely ill patients within the first 24 hours of admission.

TC White Conference

10 November, Hybrid

COMING SOON

COMING SOON

EXAMINATIONS CALENDAR

Physicians

MRCP(UK) Part 1

Exam date: 19 April UK registration: 13 – 20 February

Exam date: 9 August UK registration: 29 May – 5 June

MRCP(UK) Part 2

Exam date: 17 May UK registration: 13 – 20 March Exam date: 6 September UK registration: 3 – 10 July

MRCP(UK) PACES

Exam period: 1 June – 7 August UK registration: 27 March – 3 April

MRCP(UK) PACES

Revision Modules rcp.sg/pacesonline

Each module focuses on one of the PACES stations and includes; an introduction to the station, top tips on that station from a senior clinician and PACES expert, a behind the scenes look at the process of examiner calibration, an example of a satisfactory pass (including the patient examination and examiner questioning) and PACES exam tips from Dr Stuart Hood at the Royal College of Physicians and Surgeons of Glasgow.

MRCP(UK) Specialty Examinations

Dermatology

Exam date: 7 September UK registration: 18 May – 15 June

Endocrinology and Diabetes

Exam date: 14 June UK registration: 22 February – 22 March

European Specialty Examination in Nephrology (ESENeph)

Exam date: 13 September UK registration: 24 May – 21 June

Geriatric Medicine

Exam date: 13 September UK registration: 24 May – 21 June

Medical Oncology

Exam date: 12 July UK registration: 22 March – 19 April

Palliative Medicine

Exam date: 16 August UK registration: 26 April – 24 May

Respiratory Medicine

Exam date: 19 July UK registration: 29 March – 26 April

Rheumatology

Exam date: 28 June UK registration: 8 March – 5 April

PACES Revision Savings

The PACES package costs £99. On signing up to the package you will receive:

• Affiliate membership for up to 12 months (worth £36)

• PACES online revision modules (worth £80 if purchased separately)

• Collegiate membership subscription for up to 12 months after passing MRCP(UK) (save £87)

• College voucher worth £25 after joining as a Collegiate Member

Surgeons

MRCS Part A

Exam date: 16 May

Closing date: 17 February

Exam date: 12 September

Closing date: 16 June Online

MRCS Part B OSCE

Exam date: 9 – 10 May

Closing date: 24 February

Exam date: 17 – 19 October

Closing date: 21 July Glasgow

MRCS Part B OSCE

Preparation Modules

rcp.sg/osceonline

Each module focuses on one element of the MRCS Part B OSCE preparation. The modules include thorough introductions from examiners and demonstrations of how stations work and are to be completed. The scenarios are then summarised and

Dental Surgery

MFDS Part 1

Exam date: 4 April

Closing date: 30 January Online

Exam date: 3 October

Closing date: 31 July

Online

Revision Modules

rcp.sg/mfds1revision

These modules have been developed to give candidates the necessary knowledge about key areas of the exam.

Question Bank rcp.sg/mfds1questions

The Example Question Bank is designed to prepare candidates for the exam.

MFDS Part 2

Exam date: 9 and 10 May

Closing date: 4 March

Exam date: 9 and 10 November Closing date: 1 September

feedback is given to allow you to employ best practice when taking your own exam.

FRCS Ophthalmology – PART 3

Exam date: 18 – 21 September

Closing date: 5 – 7 June New Dehli

Exam date: 21 – 24 November

Closing date: 5 – 7 June Amman

Exam date: 4 – 7 December

Closing date: 5 – 7 June Cairo

MRCS (ENT) OSCE

Written: 22 May

Clinical: 24 - 26 May

Closing date: 3 March Glasgow

Written: 23 October

Clinical: 25 - 27 October

Closing date: 11 August London

MRCS OSCE Package

MRCS Part B exam candidates can access:

• Free Affiliate membership (save £36)

• MRCS Part B OSCE preparation course (save up to £80)

• No Membership subscription fees for up to 12 months after passing MRCS (save up to £87)

Candidates

MFDS Part 1 Revision Savings

The MFDS Part 1 Revision Savings incorporates access to our MFDS Part 1 online revision material, over 100 sample questions, and Affiliate Membership of the Faculty of Dental Surgery while you work towards the exam.

For a total fee of £85 you will receive:

• Sample Questions (£100 value)

• Online Revision Material (£80 value)

• Affiliate Membership (£36 value)

The MFDS Part 1 Revision Savings is only available to Royal College of Physicians and Surgeons of Glasgow candidates of the MFDS Part 1 examination.

MFDS Part 2 Revision Savings

Sign up as an Affiliate member now to start saving on the cost of training

Affiliate members preparing for the MFDS Part 2 exam can:

• Save £50 on the MFDS Part 2 Prep Course

• Save £180 - pay no Membership joining fee upon successful completion of your exam

Affiliate membership costs the equivalent of just £3.00 per month.

NEW MEMBERS

PHYSICIANS

Fellow qua Physician

Mohamed Walid Fawzy Abdalla Ibrahim

Saumyabrata Acharyya

Halgourd Fathulla Ahmed

Irfan Ahsan

Mohammad Ali Arif

Rojith Balakrishnan

Sourin Bhuniya

Partha Pratim Chakraborty

Nandini Chatterjee

Brian Tom Christopher

Saikat Datta

Richard John Dobson Naveen Dutt

Gowrishankar Erode Singaravelu Sin Ying Fan

Shakir Husain Hakim

Mahmud Javed Hasan

Syed Mujtaba Hassan

Christopher Hui Yasir Jassam

Waye Hann Kang

Rituparna Maiti

Saibal Moitra

Kaushik Pandit

Himanshu Patil

M.U. Rabbani

Ramkrishna Ramnauth

Nouman Sadiq

Suresh Sagarad

Arun Sampath

Mukesh Kumar Sarna

Lalith Chandana Seneviratne

Ashok Kumar Shukla

Hpone Ko Ko Soe

Nitin Srivastava

Khalid Yousif

Fady Monir Nessim Zakharious

Member qua Physician

Mustafa Sayed Takroni Abdul-Gaffar

Mairi Blair

Robyn Campbell

Thomas French

Nnamdi Peter Gbajie

Hassan Mansour Hassan Hafez

Raza Manzoor Haideri

Roger Hok Yu Ho

ABM Ashraful Huda

Rachel Hughes

Gareth William Ingram

Steffin Mathai Kattoor

Md. Shahjalal Khan

Lee Peng Koh

Christopher Jiaw Liang Kueh Jasmine Latter Lutfullah

Muhammad Haroon Mujtaba Memon

Ayomikun Olutodimu Odekunle

Kenneth Arinze Ohagwu

Musfira Shakeel Talal Sherazee Bethan Sheridan Steven Smith

Member of the College

John Abraham Mian Abubakr Muhammed Anas Ayoob Aisha Gul Monica Gupta Tanveer Hussain Shehryar Kanju Gibby Koshy Keshavan Vamanan Nampoothiri Babar Suleman

Muhammad Usama

SURGEONS

Fellow qua Surgeon

Osama Elfaedy

Nisanthan Rajathurai

Sabah Jalal Shareef Shareef

Fellow qua Surgeon in Ophthalmology

Naveed Ahmed Attar

Iman Muneer Mahmoud Daoud Ashwin Dsouza

Mohamed Gaber Ahmed Mohamed Eissa Lubna Feroz

Hassan Ali Abd EL-Zaher Salman

Sana Mohd Rafiq Sayed Manjula Sharma Ritesh Verma

Fellow in Otolaryngology

Dulani Kumari Senapathi Mendis

Fellow in Plastic Surgery

Riaz Agha

Fellow

in Trauma & Orthopaedics

Zaid Suleiman Moh'd Abual-Rub Abhinandan Kotian Colin Robert Shaw Mukhesh Thangavel

Fellow

in Urology

Imran Ahmad

Fellow in General Surgery

Nauyan Ali

Wadah Abdelazim Ahmed Ali Ross Dean Dolan Wilhelmina Delilah Nesbitt Kelvin Voon

Member qua Surgeon

Ahmed Aly Ibrahim Abouzalat

Esraa Ahmed

Jassim Mohammed Radhi Alaradi

Abdelrafi Yousif Badway Ali

Abubakr Hashim Elrofaie Sayed Ali

Tareq Laith Tareq Altell

Pei Ying Amanda Aw

Mostafa Beshr

Cameron JC Boyle

Tak Kwong Chan

Shameer Deen Saroj Gautam

Jan Sher Khan Georgios Kourounis Shou Kee Ng

Iona Robertson Cameron Simpson Helen Sarah Margaret Smith Minh Tri Jonathan Van

Member qua Surgeon in ENT

Ahmad Mohamad Faleh Al-Tamimi

Govind Shripad Bhuskute

Sultan Saad Fayez Jaber Sonali Malhotra

Member qua Surgeon in Ophthalmology

Azfar Ahmed

Sairam Ahmed

Mohammad Aldabbas

Keegan Joseph Aleong

Ammar Hamad Suliaman Alfarsi

Muhammad Aamir Arain

Islam Mohammed Raafat Abouelmakarem

Atawia

Jayaprasad Bhaskaran

Pushpa Bhatta

Mohamed Mahmoud Ahmed Desokey

Michael Kwame Gyedu Djan

Manal Mahmoud Eljazwi

Walid Mohamed Abdelaziz Gaafar

Anna Gao

Mohamed Abdelhamid Mohamed Ghanem

Mohamed Hammad Hassan Ali

Shahzada Najam ul Hassan

Farrakh Jamil

Dini Sunny Joseph

Enas Mohamed Mohamed Khamiss

Yahya Abdulla Hamed Khedr

Shyji Kumaran

Shahid Hamid Mahmud

Mohamed Mansour

Parimal Peeush

Kaneez Fatima Sajjad Rizvi Arshiya Saini

Member of the College

Mazen Ahmad Alzahrani

Muhammad Asghar

Sudhangshu Kumar Ballav

Rizwan Ghafoor

Kazim Hussain

Fazal Hussain

Tauqeer Khan

Muhammad Tanweer Hassan Khan

Jawad Azeem Khan

Naveed Ahmed Mahar

Maham Qazi

Usman Qureshi

Jehanzaib Rashid

Monsurah Olabimpe Salami

Raghavan Sivaram Naveed Solangi

Firdaus Sukhi

Shahzad Younas Malik Aftab Younus Muhammad Toqeer Zahid

DENTAL SURGERY

Fellow in Dental Surgery

Yasin Alavi A

Salah Al-Din Al-Azri

Talat Al-Gunaid

Khalid Almas Thafar Almela

Arun Arcot Vasantha Rao

David James Macgregor Brunton

Sampath Reddy Cheruku

Kandasamy Ganesan

Miguel Ángel González-Moles Ahmad Faisal Bin Ismail

Ussamah Waheed Jatala

Islam Mohamed El-Said Kassem

Arthur Musakulu Kemoli

Murali Venkata Rama Mohan Kodali

Henriette Lerner Ahmad Liaquat

Shani Ann Mani Farzin Mirzaeeyan

Sathish Kumar Nadanasigamani Kumar Nilesh Shankargouda Patil Indu Raj Asif Shah Gaurav Singh

Islam Ali Naguib Sobeih Mathew Tharakan

Srinivasulu Reddy Velagala Nandagopal Vura Parakrama Wijekoon Conson Yeung

Member of the Faculty of Dental Surgery

Maram Mohamed Saeed Ahmed

Asad Ali

Faisal Alshammari

Rajiv Balachandran

Anam Fayyaz Bashir

Jagan Kumar Baskaradoss

Rachel Sarah Bird

Jamie Clement Katie Dolaghan

Purvil Dipak Doshi

Omar Junaid Ehsan Sara Hassah Ahmed Elhassan

Heba Emad Hamdy

Amy Gunaseelan

Arpita Gur

Hadil Hassanein

Zakaria Mohammed Hekmat

Hasneet Kalsi

Zubair Ahmad Khan

Vishal Kulkarni

Yan Yee Lai

Xiang Yao Lam

Xian Da Andrew Lee

Andrew Donald Leitch

Ali Hatem Ali Ali Marey

Carly Mcmenemy

Arshi Mughal Aditi Nanda Aliya Nazerali Flavio Pisani Janine Quek Irfan Qureshi Shamima Sadiqzai

Mary Vinola Jenifer Selvanathan Panna Shah Kirsty Smith

Amy Erica Sterritt

Ka Hei Tang

Jinesh Jagdish Vaghela Roshan Prakash Vyas Emma Grace Ward Chun Yuen Yung

Member in Paediatric Dentistry

Susan Welford

Membership in Orthodontics Naser Alebrahim

TRAVEL MEDICINE

Fellow in Travel Medicine

Hamad Eid H R Al-Romaihi

Ahmad Bawazir Thomas Kuepper

Member of the Faculty of Travel Medicine

Muhammad Yaqoob Sher Zaman

PODIATRIC MEDICINE

Fellow in Podiatric Medicine

Christopher Coll Christopher Japour Praveen Vohra

BEHIND THE SCENES:

HOW WE BECAME A ROYAL COLLEGE

By Ross McGregor, Deputy Head of Heritage

The College’s name has been the subject of debate and has changed several times since its foundation in 1599. In its first decades it was referred to as simply the ‘Facultie’ and then from 1657 ‘Facultie of Chirurgeons and Physitians’. This is the only time in its history that surgeons have been named before physicians. In around 1700 the name changed to the Faculty of Physicians and Surgeon of Glasgow. Even although the College was granted its royal charter from King James VI of Scotland in 1599, it wasn’t officially named ‘Royal’ until 1909. Finally, in 1962 the name changed to its current title of the Royal College of Physicians and Surgeons of Glasgow.

The process of changing name from Royal Faculty to Royal College began in earnest in 1960 with the then-president Arthur Jacobs, who believed the name ‘Faculty’ was disadvantageous when all other UK medical and surgical corporations were known as Colleges. When Joseph Wright took over as president in late 1960, he ensured the name change was one of his main priorities. However, the name change in 1962 reflects broader changes in the College during the previous decade. This was when the College began to significantly modernise, with future presidents Arthur Jacobs, Charles Illingworth, and Gavin Shaw (as well as Honorary Librarian Archibald Goodall) central tothis modernisation.

EDUCATION AND MODERNISATION

Prior to the mid-1950s the College’s education offer was mainly traditional lecture series. During the 1950s there was a new, younger generation of leaders in the College, particularly Shaw and Goodall, whose development of new courses for hospital specialists in training began to revolutionise the College’s role in postgraduate medical education. In 1956 they also established a new conference series – the first of its kind by any of the UK medical corporations. The series was focused on latest developments in specialties, aimed at registrars and young consultants (the first was on cardiology). This established the College as a centre for advanced postgraduate education.

The College’s ambition was for postgraduate education to be complete training for the College fellowship. The link between education provision and fellowship was key. By 1957 these changes were showing tangible benefits. As well as improvements to education provision, fellowship numbers were increasing, and College finances were revived. Progress continued, and in 1959 the Maurice Block Lecture Theatre was opened to meet the College’s new educational needs.

Therefore by 1960, the College had significantly changed what it offered the medical profession. A change of name to ensure it operated on a level playing field with the other UK colleges was clearly part of this strategy.

A SIMPLE NAME CHANGE?

Changing the name from ‘Faculty’ to ‘College’ wasn’t straightforward. A ‘Change of Name Committee’ was established to progress this work, and during 1960, the College sought legal advice on the process. In the Amalgamated Minutes of December 1960 there are documents recording the substantial legal advice required to instigate the change. This includes a point that the College should “enquire as to the correct procedure for obtaining Her Majesty’s Approval as to the use of the word ‘Royal’ as part of the title of proposed Royal College of Physicians and Surgeons of Glasgow.”

Much of the background work on how to change the name fell to future president Gavin Shaw, whose recollections of the process shed interesting light on how business was done in the mid-20th century!

Joe [then president Joseph Wright] had the idea and it was left to me and one or two others to find out how you did it. Went to see the College lawyer and he said that under Scots Law it was not necessary to get an Act of Parliament… we got it through the Faculty, and we then went to the General Medical Council, and, boy, did we run into trouble. First of all they said we’d taken the wrong route in Parliament, there was no way that we could get this through without a full Act of Parliament. Secondly, they said, this question of the names is a nonsense, we can’t have this. We were very downhearted at that stage, we almost failed. So Joe and his friend Lord Fraser went down to London, and they invited a whole lot of senior GMC people out to a lunch party. They got a little further then, and Joe said I think I see the light at the end of it. The obstacle was the Registrar, who was an English lawyer, and very careful. So then, very fortunately, the then president of the GMC was the Professor of Materia Medica at Aberdeen, Sir David Campbell, a Glasgow graduate and FRFPS, and one of our Fellows. He was a friend of Joe’s, and Joe got him and said, look this has got to be put right, our clerk is absolutely certain that we can do it by this route, which is a quick route, provided we’ve got everyone agreed. One wintry day we were all invited to his house in Aberdeen, so we all went up on the train, plus the lawyer. So Joe started off, and the President [of the GMC] made the case for them. Our lawyer was a silent man… so he sat and not a word was said while this Registrar put his case, and destroyed our case. Then the President [of the GMC] said, well now what does your man have to say, and he said, ‘You may be a very good English lawyer, but you don’t know Scot’s Law!’, and that silenced him completely.

Shaw and Goodall then had to make changes to the ‘provisional order’ before it went to Parliament. However, they also introduced constitutional changes that modernised the College’s governance. These changes allowed all UK Fellows and Members equal voting rights for the election of Council and office bearers, making the Glasgow College the most democratic of all UK Royal Colleges. Shaw recollects that eventually the order passed through the parliamentary processes and "… the next thing we got a letter saying that the Queen was about to sign it, and that was that. It formally put before Parliament. There were no objectors. It took a lot of time, but Joe was the prime mover.” (1)

This process lasted two years, until the very end of Joseph Wright’s presidency, when he was succeeded in December 1962 by Charles Illingworth (who was Honorary Surgeon to the Queen in Scotland from 1961 to 1965).

In the College minutes of 28th December 1962 a letter was read, from the Parliamentary agents, “intimating that Royal Assent had been given to the bill to provide the name of the Royal Faculty of Physicians and Surgeons of Glasgow be changed to the Royal College of Physicians and Surgeons of Glasgow as from 6th December 1962.”

While it may seem like a simple name change, this period can also be viewed as a key period of modernisation of the College and consolidation of its position in the medical landscape. To mark the 60th anniversary of this moment, the portraits of Joseph Wright and Charles Illingworth have been installed in College Hall.

(1) Gavin Shaw, interview with Andrew Hull, 29th October 1997. Quoted in Andrew Hull and Joanna Geyer-Kordesch The shaping of the medical profession: the history of the Royal College of Physicians and Surgeons of Glasgow, 1858 – 1999 (London: The Hambledon Press, 1999)