Surgeons' News, March 2018

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PSYCHOPATHY AND SURGEONS: ASSESSING THE PERCEIVED LINKS

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COLLEGE ARCHIVES REVEAL BATTLE OF THE HENRYS IN CREATING GRAY’S ANATOMY

MARCH 2018 rcsed.ac.uk

The road to recovery

Why the perioperative pathway leads to better patient outcomes

surgeons_news_colour_page_MAR 09/01/201 8 1 0:32 Page 1

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FROM THE EDITOR

Clare McNaught on an NHS under pressure and changing workplace culture

W

hat an inauspicious start to 2018.

Our hospitals and ambulance services are overwhelmed by the demand for acute medical care. To ease the pressures on bed occupancy, the Department of Health postponed all non-urgent elective surgery in England throughout January.

Although I understand the reason for this, I cannot help thinking that this is yet another nail in the coffin for elective surgery in the UK. The decision by many Clinical Commissioning Groups to restrict elective surgery in patients with high BMIs or those who smoke indicates that healthcare is now being overtly rationed. This takes us one step closer to a two-tier system where only those who can afford to pay for operations can access care.

This is exemplified by the fact that 68 clinical leaders in Accident and Emergency Medicine have written to the Prime Minister asking her to urgently review the funding of social care, the provision of acute hospital beds and the workforce crisis. They remind us all that we are here to serve the population in their time of need, whatever their financial situation. Radical change of the NHS is undoubtedly required, but is the principle of free at the point of access not something still worth fighting for?

We are here to serve the population in their time of need, whatever their financial situation

Recently, an eminent senior surgeon was quoted as saying that “you have to have the characteristics of a psychopath to be a good surgeon”. David Riding, from our Trainees’ Committee, examines the validity of this statement on page 24 and demonstrates that the workplace culture that promoted poor conduct by surgeons in the past must be eradicated. The timing of this statement was apposite, as it coincided with the trial of disgraced breast surgeon Ian Paterson, who displayed many patterns of behaviour that are no longer acceptable. In this issue, Sir Ian Kennedy explores in depth the lessons that we can learn from this case and how we must strive harder to self-regulate our profession.

Over the last few years, we have seen an evolution in the composition of the surgical team and the delivery of postoperative care. Our feature articles explore the concept of perioperative medicine and the role of multidisciplinary health professionals in the routine care of surgical patients.

This will be a challenging year for surgeons, particularly for those in front-line specialties where emergency demand is certain to outstrip capacity. We must strive to maintain high standards of care, but also support each other to maintain our composure in an environment that is increasingly pressured and litigious. Perhaps we need to focus a little more on the pastoral care of ourselves – surgeons. It will be interesting to see if the newly created Confederation of British Surgeons (see page 19), a trade union for surgeons, will have any impact in this regard.

Clare McNaught editor@surgeonsnews.com rcsed.ac.uk | 1

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EDITOR Clare McNaught PUBLISHED BY The Royal College of Surgeons of Edinburgh Nicolson Street Edinburgh EH8 9DW Registered Charity No. SC005317 contributions@surgeonsnews.com Tel: +44 (0)131 527 1600 For editorial enquiries contact editor@surgeonsnews.com Tel: +44 (0)131 527 1691

Contents

March 2018

04

DESIGN AND PRODUCTION

Think Publishing Ltd Suite 2.3 Red Tree Business Suites 33 Dalmarnock Road Glasgow G40 4LA Tel: +44 (0)141 375 0504 www.thinkpublishing.co.uk ACCOUNT MANAGER Sian Campbell DESIGN Andrew Bell SUB EDITOR Kirsty Fortune MEDICAL SUB EDITOR Dr Arshad Makhdum EDITORIAL ASSISTANTS Jonathan McIntosh and Emma Wilson ACCOUNT DIRECTOR Helen Cassidy helen.cassidy@thinkpublishing.co.uk GROUP ACCOUNT DIRECTOR John Innes john.innes@thinkpublishing.co.uk PRINTED BY Acorn Web Offset Ltd, Yorkshire, UK ISSN 1750-7995 The views expressed in Surgeons’ News are not necessarily those of the editorial team or the Royal College of Surgeons of Edinburgh.

Information printed in this edition of Surgeons’ News is believed to be correct at the time of going to press.

Cover illustration: Eleanor Shakespeare

2 | Surgeons’ News | March 2018

AGENDA News and views from the profession, including tax relief on Specialty Fellowship Examinations, online Masters courses, learning from the young and the birth of the CBS

12

THE PRESIDENT WRITES Michael Lavelle-Jones reflects on College activities this year and last

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THE SURGICAL TRAINER Changes in the training landscape and the emerging model of ‘connectivism’

22

FROM THE ARCHIVES Page proofs of Gray’s Anatomy give a glimpse of a turbulent relationship between writer and illustrator

24

PSYCHOPATHS AND SURGERY Efforts to eradicate the psychopathic stereotype and get rid of unsavoury behaviour in the workplace

26

CAUSES FOR CONCERN Sir Ian Kennedy discusses the lessons to learn from the Ian Paterson case

30

PERIOPERATIVE PATHWAYS The Faculty of Perioperative Care at two years old

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PERIOPERATIVE PATHWAYS Salford's modern model of managing elderly and high-risk patients

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WORKING IN SOUTH AFRICA Alex North's educational but demanding elective in Johannesburg

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TRAINEES AND STUDENTS Making the most of clinical experience; new Chair for Trainees' Committee; nurturing excellence; Bahrain prepares for MPDC exam

47

DENTAL Fraser McDonald and protecting patient data; the latest from the faculties; advisory network; life after winning a Clinical Skills competition

54

COLLEGE INFORMATION Diploma recipients; awards and grants; obituaries; RSA network

62 64

OUT OF HOURS Local luxuries and French classics FROM THE COLLECTIONS Dentures and documents show dramatic developments in dentistry

The RCSEd Triennial Conference The Modern Surgical Team: the Future of Surgery Thursday 22 and Friday 23 March 2018, Edinburgh You are invited to join the President of the Royal College of Surgeons of Edinburgh at the College’s flagship Triennial Conference 2018.

The Modern Surgical Team: the Future of Surgery is for everyone involved in surgical practice, care and delivery. It will examine major themes that affect everyone who works as part of the surgical team, addressing important questions, such as: What will the surgical workforce look like in the future?

training and technology. There will be opportunities to learn from and network with a wide range of experts in different fields. Our speakers include: Sir Ian Kennedy QC, Chair of the Independent Parliamentary Standards Authority and leader of the enquiry into the activities of Ian Paterson Brigadier Tim Hodgetts, Medical Director of the Royal Centre for Defence Medicine Mr Craig McIlhenny, Director of the Faculty of Surgical Trainers

What is the answer to the NHS staffing crisis?

How will we train future generations of surgeons?

How can we make good decisions under pressure and what can we do if things go wrong?

How much do we really know about the safety of cutting-edge surgical devices?

What part will perioperative practitioners play in the future of the surgical team and what impact will this have on surgical training?

We will focus on the hot topics and emerging issues of the day, and explore innovation in surgical education,

Professor Rhona Flin, Emeritus Professor at the University of Aberdeen School of Psychology, and Psychological Advisor to NASA, the nuclear industry and the Cabinet Office Ms Helen Mohan, President of the Association of Surgeons in Training and General Surgery SpR, Ireland The full programme is online and registration is now open. Please check the website for more information, triennialconference.rcsed.ac.uk.

For any further queries, please contact education@ rcsed.ac.uk or telephone +44 (0)131 668 9209

Nicolson Street Edinburgh EH8 9DW +44 (0) 131 527 1600 rcsed.ac.uk Registered Charity No. SC005317

Agenda The latest news from the College and profession

/ TRAINEES

Tax relief for Specialty Fellowship Examination

F

ollowing negotiations between the College’s Trainees’ Committee and HM Revenue & Customs (HMRC), the College has obtained agreement for trainees in the 10 surgical specialties to claim tax relief on the examination fee for the Specialty Fellowship Examinations (FRCS).

HMRC has confirmed in writing to RCSEd that if an individual is employed on a training contract as a specialty trainee and they pay for the Specialty Fellowship exam fees themself, they will qualify for a deduction of the Specialty Fellowship examination fee against their earnings from that employment. This is on the

4 | Surgeons’ News | March 2018

basis that successful completion of the Specialty Fellowship exam is a requirement within a specialty training contract.

The initiative to approach HMRC follows the RCSEd Trainees’ Committee’s successful negotiation to obtain tax relief for the Joint Committee on Surgical Training (JCST) fee, paid by all Core and Higher surgical trainees.

This year’s negotiation was spearheaded by David Riding, Trainees’ Committee Member and vascular surgery trainee in the North West.

Riding said: “As trainee surgeons, we are all too aware of the increasing

Above: Trainees’ Committee Below: David Riding led the negotiation with HMRC

personal costs of training, so I am delighted that we have secured tax relief for the FRCS exam. This will significantly reduce the financial impact of entering the exam and it’s a great example of how the RCSEd Trainees’ Committee works tirelessly to represent the interests of our Members.”

RCSEd President Professor Michael Lavelle-Jones said: “I am delighted to see the successful completion of this initiative led by the College’s Trainees’ Committee, which will be of benefit to all trainees across the country irrespective of their affiliation.

The timing is perfect and reflects our commitment to do all that we can to ease the financial burden on our trainees.”

/ APPOINTMENTS

Younger Fellows’ Committee

appoints Mark Peter as Chair The College’s Younger Fellows’ Committee has appointed Mark Peter as Chair and Peter Driscoll as Deputy Chair.

Mark Peter is a consultant UGI and bariatric surgeon at the Calderdale and Huddersfield Hospitals NHS Foundation Trust. He is one of the inaugural Members of the Younger Fellows’ Committee and has facilitated several of the regional RCSEd Younger Fellows’ meetings and the inaugural RCSEd Younger Fellows’ Residential Forum.

He said: “It is an honour and a privilege to represent the RCSEd Younger Fellows’ Network. I look forward to working with Peter Driscoll and to exciting new challenges ahead. I know we have big shoes to fill given the successes since its inception.

“There is no doubt that the NHS is at a nadir. Austerity measures, contract changes, bed pressures, workforce issues, the list goes on...

But surgery remains one of the most fulfilling careers; always trying to be better while maintaining a sense of fun and camaraderie is the recurring theme we have seen in our recent events.

“We are looking forward to all the new Younger Fellows joining us in future events (and maybe not so young Fellows to continue to guide us!).”

A Younger Fellow is defined as any surgeon who has obtained Fellowship within the last 10 years. The aim of the group is to facilitate younger surgeons of all disciplines and from all locations in the UK to socialise, get involved in

Mark Peter is a consultant UGI and bariatric surgeon

College life and feed back their opinions on professional issues to Council through the Younger Fellows’ Committee, as well as provide an outlet to discuss frustrations or share success stories with new friends and like-minded colleagues.

/ GLOBAL

International office opens in Kuala Lumpur

From left to right: Vice-Chancellor of UKM, Prof Dato’ Seri Dr Noor Azlan Ghazali; Queen of Negeri Sembilan, Tuanku Aishah Rohani; Yang di-Pertuan Besar of Negeri Sembilan, Tuanku Muhriz ibni Almarhum Tuanku Munawir; RCSEd President Michael Lavelle-Jones; and other dignitaries

In January, the RCSEd Office Bearers, including the President, Professor Michael Lavelle-Jones, opened the College’s latest international office, in Kuala Lumpur, Malaysia.

With the College’s international activity growing year by year, and spurred on by the success of the Birmingham regional centre, which opened in 2014, this new international base marks a milestone in the College’s 513-year history.

The office is located at the Advanced Surgical Skills Centre of Universiti Kebangsaan Malaysia (UKM) and will act as a hub for the College’s examinations, courses, assessment programmes and charitable activities in the ASEAN region, also covering Myanmar, the Philippines and Indonesia.

rcsed.ac.uk | 5

AGENDA

/ FPC

Faculty of Perioperative Care welcomes first Member

T

Michael Lavelle-Jones and John Stirling

/ GLOBAL

Hong Kong ceremony for first conjoint Fellow Congratulations to Dr Xu Xiaobo of Zhejiang University, who is the first Chinese Fellow to receive the conjoint Fellowship of General Surgery (FRCSEd (Gen)) with the College of Surgeons of Hong Kong.

Dr Xu is pictured with RCSEd President Professor Michael Lavelle-Jones and College of Surgeons of Hong Kong President Professor Lai Bo San Paul at the September 2017 diploma ceremony held in Hong Kong.

6 | Surgeons’ News | March 2018

he College’s Faculty of Perioperative Care (FPC) welcomed its first Member at a diploma ceremony in November 2017. John Stirling is the National Organ Retrieval Service Workforce Transformation Project Lead with NHS Blood and Transplant.

Stirling said: “Having the opportunity to participate in the diploma ceremony along with surgical colleagues from across the world bears testament

to the commitment that the RCSEd has in supporting and developing perioperative practitioners as part of an evolving surgical community.”

By becoming a Member of the FPC, perioperative practitioners can access a wide range of professional and educational benefits to support their careers, including discounts on courses and online resources, as well as use of the MFPCEd postnominals.

For further information on the FPC, see p30 or visit fpc.rcsed.ac.uk

/ PARTNERSHIP PROJECT

Soutra: Surgery and Superstition Traditional welcome and lunch at the residence of Dr Arunima Verma

/ EVENTS

Jamshedpur hosts International Surgical Meeting The 2017 International Surgical Meeting was held in Jamshedpur, India, on 30 November and 1 December. The two-day academic event was organised by the Jamshedpur Surgical Society, alumni of the RCSEd (East Zone) and Tata Main Hospital.

The Jamshedpur Surgical Society has the majority of surgeons from Jamshedpur as its Members, and is an active academic and social forum.

The alumni of RCSEd (East Zone) are Members of the RCSEd and are based or practising in the East Zone of India.

Tata Main Hospital is a vibrant hospital in Jamshedpur that takes an interest in academic activities.

All three dedicated groups came together to produce a good academic programme and discuss surgical topics across frontiers.

It was a prestigious moment for Jamshedpur and its surgical fraternity, and they were honoured to welcome RCSEd President Professor Michael Lavelle-Jones, his wife Christine LavelleJones, Dr Judy Evans (RCSEd Secretary) and Peter McCollum (ex-exam Convenor of the RCSEd).

Dr Sunil Kumar (pictured below left), Head Consultant, Surgery Department at Tata Main Hospital, who represents India as a Council Member of the RCSEd, was the Organising Chairman for the benefit of surgeons of Jamshedpur patient care in general.

The International Surgical Meeting took place at the Beldih Club and Tata Main Hospital. Other distinguished guests included Sunil Bhaskaran, Vice-President Corporate Services of Tata Steel (who was also the chief patron of the event) and Air Marshal (Retd) Dr Rajan Chaudhry, General Manager (Medical Services) of Tata Steel, who was actively involved in organising the event.

As part of the Year of History, Heritage and Archaeology, Surgeons’ Hall Museums led a large partnership project called Soutra: Surgery and Superstition in collaboration with Traditional Arts and Culture Scotland (TRACS), Dig It! 2017 and Mercat Tours.

This included a series of public events and community outreach workshops inspired by a 12thcentury Soutra Aisle medieval hospital in the Scottish Borders.

The Museums received a £7,000 Stories, Stones and Bones Heritage Lottery Fund to support the various partnership activities.

Throughout the project, they engaged with a number of local communities, heritage professionals and artists in Edinburgh and across the Scottish Borders to uncover stories of medieval surgery and healthcare. The events included talks on medieval healthcare and superstition, workshops for children, community tour guide training sessions and a large multivenue theatrical event.

The Soutra Aisle hospital provided medical treatment and hospitality to local communities, travellers and pilgrims for the best part of 500 years and had direct links to the Surgeons’ Hall early medical collection. Dr Brian Moffat, who has led explorations at Soutra Aisle for more than 20 years, consulted with Surgeons’ Hall Museums and partner organisations throughout the project.

The remains of Soutra Aisle

rcsed.ac.uk | 7

AGENDA

/ OBITUARY

In memory of Professor Arnold Maran

P

rofessor Arnold Maran, past President of the College, passed away on 10 December 2017 after a short illness.

Professor Maran was President of the RCSEd between 1997 and 2000 and made huge contributions to taking the College forward during that time.

Professor Maran was extremely well liked and respected among the College community. Here, two RCSEd members share their memories of him.

Mr Bryan Dale, ENT Specialist Arnold Maran came from Italian stock, retained a southern European temperament, and had outstanding energy and drive, tending to find routine boring. He made his mark nationally and internationally on several aspects of otolaryngology and in surgical affairs.

He graduated from Edinburgh University in 1959, and carried out junior hospital appointments in the Royal Infirmary. He obtained his FRCSE in 1962 and his MD with a thesis about vestibular function in 1967. He then spent one year at the University of Iowa learning head and neck surgery. On his return to the UK, he was appointed to a consultant post in Dundee for a few years before returning to Edinburgh with a special interest in head and neck oncology.

In collaboration with Professor Philip Stell of Liverpool, the Stell and Maran courses and textbook on head and neck surgery became extremely popular and highly esteemed. In the 1980s, Arnold’s interests moved on to endoscopic sinus surgery and in the 1990s to the pathology and treatment of voice disorders.

Arnold was always creative academically, publishing many

8 | Surgeons’ News | March 2018

Outside medicine and in his retirement, Arnold played golf and was a curler, he was a popular after-dinner speaker, and wrote books on such diverse subjects as the mafia and golfing at the North Pole. He was knowledgeable about opera and played in several jazz bands.

papers and editing several textbooks. He was a clear and concise teacher, and attracted many international postgraduate students to the department. He was appointed to a personal chair in otolaryngology in 1988.

Simultaneously, he became deeply involved in the affairs of the RCSEd, serving consecutively as Treasurer, Secretary and, finally, as President. After such an outstanding career, he received honorary fellowships from several colleges of surgeons, was the president of the laryngology section of the Royal Society of Medicine and was particularly proud of a D.Sc from the University of Hong Kong.

Professor Arnold Maran, RCSEd President 1997–2000

Chris Oliver, Professor of Physical Activity for Health at the University of Edinburgh and former Member of the College Council (2002–2012) I most remember Professor Arnie Maran as a charismatic College President who laid the foundations for much innovation at the RCSEd. I first met him just before he became College President. The internet had just come of age and he was keen to get surgeons using modern technology. The College opened one of the first ‘internet cafés’ in the world and got many surgeons using information technology. The foundations were laid for the groundbreaking Diploma in Medical Informatics. Arnie observed that “the College was fit for drinking tea and that we should get rid of all those books and replace them with computers!”

Arnie became Professor of Otolaryngology at the University of Edinburgh. He was described as the world’s leading medical expert on the voice. He wrote textbooks on head and neck surgery and in retirement wrote The Voice Doctor: The Story of Singing, on the physiology of the human voice, and Mafia: Inside the Dark Heart, about the Sicilian Mafia.

In the spirit of the RCSEd, Arnie will be most remembered as an innovator.

Lindsay Stewart was an honorary Fellow and was active at the RCSEd for 30 years

Dr Michael Mwachiro (above) and Dr Lydia Nanjula (left) receive their awards from Mr Denis Robson / AWARDS

Lindsay Stewart Awards for COSECSA 2017 papers

I

n honour of Edinburgh businessman and philanthropist Dr Lindsay Stewart OBE, who passed away in 2012, the Lindsay Stewart Award is open to all young surgeons in training working in East, Central and Southern Africa who wish to present a scientific paper at the COSECSA Scientific Conference held in December each year.

The 2017 winners were Dr Michael Mwachiro from Kenya and Dr Lydia Nanjula from Uganda. Both recipients presented their papers at

COSECSA in Maputo on 7 December 2017. Dr Mwachiro’s presentation was entitled ‘Endoscopic screening with Lugol’s chromoendoscopy’ and Dr Nanjula’s paper was on ‘Competence-based training – the hernioplasty prototype’.

Dr Nanjula said: “I was inspired into surgery by my professor during undergraduate training. He was a meticulous and patient teacher. I love how fast surgery can reverse nearfatal conditions.”

Below: portrait of Dr Lindsay Stewart OBE

Lindsay Stewart was an honorary Fellow of the College and was active at the RCSEd for 30 years, making significant contributions to the growth of our international network through the formation and development of the Ethicon Foundation, which has enabled hundreds of young surgeons from the College to travel to surgical centres internationally. He was also awarded Companion of the College in 2005, which was simultaneously awarded to the Duke of Edinburgh and then UN Secretary-General Kofi Annan. rcsed.ac.uk | 9

AGENDA

Dr Carol-Anne Moulton, Associate Professor & Staff Surgeon, University of Toronto, on women in surgery, decision-making and judgement

Surgical sound bites You can keep your hat on…

Did you always want to be a surgeon?

I had wanted to be a doctor since around Grade 4 but my interest in surgery began when I was in my final year as a medical student. I enjoyed the thrill of being called to the OR and assisting, especially if I was first assistant. I took a year off because I didn’t know if I wanted to do medicine or surgery and I wanted to travel. I found I really missed surgery and came back to Australia from my year off and started my basic surgical training, which I loved.

Do you think surgery is a good career for women?

Yes. I think you need to have the ability and confidence to be creative in your career and not necessarily follow everybody else. You have to have support at home, too. There are many choices in surgery, so you can find something that fits in with the life you want.

What inspired your move from Australia to Toronto?

Most surgeons in Australia move overseas as a Fellow – many people go to the UK. My parents and sisters were in Canada, so I thought it was a good time to spend a few years back in Toronto. Plus there was a good Fellowship here, which I think was the main driver. I had no intention of staying.

What brought about your interest in surgical error?

It started with an interest in judgement and recognising that, when I was training, we focused a lot on technical skills.

Judgement isn’t explicit and you pick it up by osmosis as you go through training. I was interested in trying to make it more explicit, thinking that we could teach it more or assess it better. Although we’re not quite there yet I think we’re starting to understand it more.

What do you hope to achieve at the Triennial conference in Edinburgh?

I enjoy talking to different surgeons. I’m doing a panel discussion with surgeons I respect and it’s always interesting to get together with others who are interested in the same general area I am, about decision-making and judgement, but who may think about it quite differently.

Janet: Have you heard the latest controversy surrounding surgical attire?

John: What now? They have taken our ties and our white coats – these days junior doctors look like a scruffy bunch of students going out for Sunday brunch.

Janet: We have some positive news for a change. In the US there was a move to scrap the iconic cloth surgical caps and to switch to disposable hair nets and hoods. A research group has published some complex microbiological results to suggest that cloth caps reduced bacterial shedding. There was just one small issue.

John: What was that?

Janet: The cloth caps had to be freshly laundered every day. Do you recall how often you washed your white coat?

John: Mmm… not very often. If you found one that fitted you never took it off!

Janet: That’s disgusting.

John: They were useful, though, and were such a symbol of our profession that it was sad to see them go.

Janet: Well at least at the moment, in the immortal words of Randy Newman, “you can keep your hat on”.

Send us your ideas for sound bite topics: editor@surgeonsnews.com

The latest guidelines, articles and studies

IN BRIEF Value of social media in advancing surgical research

This leading article evaluates the role of social media in surgical research, highlighting the potential contributions of social media and the platforms already in use, and addressing some of the concerns raised.

Mayol J, Dziakova J. Br J Surg 2017; 104: 1753–1755

Weekend admission and mortality for gastrointestinal disorders across England and Wales

The study involved 2,254,701 people in England and 155,464 in Wales. For 11 general surgical and medical GI disorders, there were little or no significant weekend effects on mortality at 30 days. There were large consistent weekend effects in both countries for severe liver disease and GI cancer. Authors concluded there is little or no evidence of a weekend mortality effect for most major general surgical or medical GI disorders, but large weekend effects for GI cancer and severe liver disease. Lower admission rates at weekends indicate more severe cases. For cancers, reduced availability of end-of-life care in the community at weekends may be the cause.

Roberts SE, Brown TH, Thorne K et al.

Br J Surg 2017; 104: 1723–1734

Prevalence of musculoskeletal disorders among surgeons performing minimally invasive surgery: a systematic review

This systematic review of 35 articles, involving 7,112 respondents, evaluated the prevalence of MSDs among surgeons performing laparoscopic surgery.

The weighted average prevalence of complaints was 74%, but there was high inconsistency across study results and the overall response rate was low. Authors concluded that MSDs were common in

this surgeon group, although low response rates leave some uncertainty.

Fatigue and MSDs impact psychomotor performance, therefore these results warrant further investigation to improve surgeons’ well-being.

Alleblas C, de Man A, van den Haak L et al. Ann Surg 2017; 266: 905–920

Ready for our close-up? Why and how we must embrace video in the OR

This article evaluates the role of video recording surgical procedures in the operating room. Potential benefits include enhancing surgical training, providing useful data for patients’ medical records and enhancing the ability to analyse OR performance and safety. The authors highlight the importance that routine OR recording is instituted in a manner that protects surgical teams, hospitals and, most importantly, patients.

Langerman A, Grantcharov T. Ann Surg 2017; 266: 934–936

Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, threegroup, randomised surgical trial

Arthroscopic subacromial decompression (decompressing the subacromial space by removing bone spurs and soft tissue arthroscopically) is a common surgery for subacromial shoulder pain, but its effectiveness is uncertain. This multicentre trial randomised 313 participants to arthroscopic subacromial decompression, investigational arthroscopy only or no treatment. The primary outcome was the Oxford Shoulder Score (0 [worst] to 48 [best]) at six months, analysed by intention to treat.

Both surgical groups showed a small benefit over no treatment, but

these differences were not clinically important. Authors concluded that the difference between the surgical groups and no treatment might be the result of, for instance, a placebo effect or postoperative physiotherapy.

The findings question the value of this operation for these indications and this should be communicated to patients during the shared treatment decisionmaking process.

Beard DJ, Rees J, Cook J et al.

Lancet 2017 (Abstract)

Mechanical or biologic prostheses for aortic-valve and mitral-valve replacement

This study compared long-term mortality and rates of reoperation, stroke and bleeding between patients who underwent primary aortic-valve replacement or mitral-valve replacement with a mechanical or biologic prosthesis in California. Among patients who underwent aortic-valve replacement, a biologic prosthesis was associated with significantly higher 15-year mortality than a mechanical prosthesis among patients aged 45 to 54 years, but not patients aged 55 to 64 years. Among patients who underwent mitral-valve replacement, a biologic prosthesis was associated with significantly higher mortality than a mechanical prosthesis among patients aged 40 to 49 years and 50 to 69 years. The incidence of reoperation was significantly higher among recipients of a biologic prosthesis.

Authors concluded there was a longterm mortality benefit associated with a mechanical prosthesis that persisted until 70 years of age among patients undergoing mitral-valve replacement and until 55 years of age among those undergoing aortic-valve replacement.

Goldstone A, Chiu P, Baiocchi M et al. N Engl J Med 2017; 1377: 847–1857

rcsed.ac.uk | 11

AGENDA

THE PRESIDENT WRITES Michael Lavelle-Jones on what the new year brings for the College

A

s I sit down to write today, a new year has dawned and Edinburgh and the College are both quiet – perhaps licking their wounds the morning after Hogmanay and the new year’s celebrations. This is a good time to reflect on the preceding 12 months and to make plans for the forthcoming year.

Events leading up to our AGM in November represent the end of our College’s calendar and professional year, with newly elected members of Council taking their seats while others demit. This year, Pala Rajesh, Consultant Cardiothoracic Surgeon in Birmingham, completed his term of office. Pala has made enormous contributions to College life in the UK and the international community, especially in India, Singapore and Hong Kong. I look forward to his continued work with our international portfolio through our Birmingham centre, where he will still lead on one of our International Fellowship Programmes.

Professor Janet Wilson, Clinical and Academic Head of ENT in Newcastle, joins Council and has already made her mark working in shared decision-making and informed consent. These will be themes of emerging importance and activity during the coming year.

Finally, I welcome our new Dental Dean, Professor Fraser McDonald,

Our flagship Triennial Conference will be held this year at the College 12 | Surgeons’ News | March 2018

who took over from Professor Bill Saunders in November and is the Chair of Orthodontics at King’s College London.

Looking back over the past 12 months, the College has achieved several notable firsts: our Let’s Remove It campaign, raising awareness and providing solutions for managing negative culture associated with bullying; our work on improving the working environment for safe surgical care; our partnership with the UK Citizen Aid programme; and in Hong Kong our first Critical Care Course held jointly with the College of Surgeons Hong Kong.

Also, during the 2017 general election year in the UK, we published our first College manifesto as a basis for our interaction with all the major political parties.

Our College faculties have been busy, too, with two major events held within walking distance of our Birmingham hub on Colmore Row. This year’s annual conference of the Faculty of Surgical Trainers focused on identifying ‘Time for Training’ and was followed a couple of weeks later by the Faculty of Perioperative Care conference, which looked at the evolving role of perioperative practitioners in the

surgical team. Both events attracted a significant audience and point towards our College’s pivotal role in shaping governance in these areas.

But what of 2018? This year starts with a landmark event – the opening of an International Office in Malaysia at the Universiti Kebangsaan Malaysia (UKM).

This is the culmination of several years of hard work by our College in partnership with UKM, the Academy of Medicine Malaysia and the College of Surgeons of Malaysia.

I am extremely grateful for the enthusiasm and vision of Professor Hanafiah Harunarashid, President of the College of Surgeons of Malaysia, who has helped to propel this initiative to a satisfactory conclusion.

This international office will help us coordinate and deliver educational activities with our partners in Malaysia, as well as throughout the region in Indonesia, the Philippines, Myanmar, Thailand and beyond.

Closer to home, our programme of regional visits will continue, starting with Belfast in January and Newcastle in February, and other events later in the year. I do hope that you will take the opportunity to come along and meet the Edinburgh team at these events.

In a similar vein, in 2018 we will relaunch our Policy and Consultation group under the chairmanship of Professor Graham Layer, VicePresident. A key element will be virtual reference groups drawn from each of the four nations within the UK. I ask for your full engagement and contribution.

Looking ahead, the College needs to invest in our core College IT systems and in our website if we are to keep pace with the needs

of our evolving membership. Our Professional Activities team will look forward to the output of our Systems Transformation Project, which is under the leadership of Council member Professor Simon Frostick.

His team is currently evaluating the optimum IT package, which will be fit for purpose today and provide the best platform for the future.

Investment in this and other professional development and educational offerings for our membership all come at a cost – a cost that cannot be supported by subscriptions alone. Whenever I travel across the UK and in the international community, I am constantly reminded of the costs of training and the level of professional expenses borne not only by trainees, but established consultants as well.

With this in mind and the need to seek alternative income streams, Council agreed in mid 2017 to embark on a project to extend the College’s Ten Hill Place Hotel in Surgeons Quarter in Edinburgh.

It is an ambitious programme of work underpinned by a deliverable financial model. Work started at the

RCSEd opens a new International Office in Malaysia

beginning of July 2017, with the extension due to be completed by mid-2018 in time for the Edinburgh Festival high season in August. The expansion will provide a substantial additional annual trading surplus, which can be giftaided to the College for investment in our core activities, avoiding the need for substantial increases in membership fees.

Our flagship Triennial Conference will be held at the College on 22 and 23 March. The theme, ‘The Modern Surgical Team: the Future of Surgery’ will examine the key issues that affect everyone who is part of a surgical team. I am extremely grateful to Professor Rowan Parks and all his team for their hard work in drawing together an outstanding programme. I encourage you all to support this event – bring a colleague along!

My final activity this year was to attend ASICON, the 77th Annual Clinical Congress of the Association of Surgeons of India held in Jaipur.

The theme ‘Making Surgery Safer for Patients and Surgeons’ resonated with much of our current aims in the

UK. We are not worlds apart as we all struggle to identify the necessary human, financial and time resource to deliver our health care and our training. A recurring theme during my visit was the need to provide training opportunities for surgeons toward the end of their domestic postgraduate programmes. Our College runs several fellowship programmes in the UK, but the rate-limiting step is the number of available placements.

Could I encourage you to engage with your NHS Trusts to seek out any opportunities for international trainees? Vacant training slots currently filled with locums are one possibility and are a place to start the conversation.

Finally, when I embarked on the Presidency two years ago, I was warned it would be the fastest three years of my life – wise words indeed.

I do hope that this final year will see the realisation of the goals I have outlined above, which will leave the College in a strong position in the coming years.

Michael Lavelle-Jones president@rcsed.ac.uk rcsed.ac.uk | 13

AGENDA

SURGICAL SAFETY UPDATE More cases from the Confidential Reporting System for Surgery Conflicting communication

While on a ward round, I reviewed a patient who had a first presentation of uncomplicated diverticulitis. She had been diagnosed by CT and started on IV antibiotics.

The consultant in charge of her care had seen her the previous day and advised nil by mouth for 24 hours, with IV maintenance fluids.

During a busy morning ward round, I found her in bed, but comfortable and no longer in pain. I explained her diagnosis to her, said that she could now have what she liked to eat, that we would switch to oral antibiotics and that she could go home when she felt ready. She asked what kind of food she could eat to prevent further attacks of diverticulitis, so I explained low- and high-fibre diets for symptom control in the short and long term.

I then moved on to another patient. On leaving the bay, I asked the nurse why the patient was still in bed late in the morning and mentioned that she should be encouraged to sit out if possible. The patient was discharged the following day.

Later in the month, I received a complaint from the patient. She described how she had received conflicting advice from me and from the consultant. She felt that she had been forced out by the hospital despite experiencing persistent symptoms.

From the patient’s point of view, when I saw her on my ward round, she had just come out of the shower and was lying on the bed as she felt light-headed. Her consultant said that she had to remain nil by mouth and on IV

14 | Surgeons’ News | March 2018

antibiotics for at least one week as this would be the only way for her to get better. My advice contradicted this.

Furthermore, she felt that my dietary advice was unhelpful and dismissive of her desire to prevent further attacks. Finally, she also overheard my conversation with the nurse, “ordering” her to “get that patient out of bed!”

Reporter’s comments

By taking more time to assess how the patient felt and what her anxieties were, it might have prevented the conflict of advice and patient confusion. Dietary guidance could have been delegated to dieticians. I obviously need to take care with how I “encourage” patients to mobilise and to note that remarks I make may appear insensitive.

CORESS comments

This case relates to human factors. CORESS appreciated this reporter’s contribution and obvious insight into a case where there were issues with communication.

On a pragmatic basis, during a busy ward round, there may need to be clinical prioritisation, meaning that fitter patients are seen more expeditiously. One Advisory Board member stated that waiting for overstretched dietician advice prior to discharge was living in “cloud cuckoo land”.

However, there is a skill to ensuring that patients are satisfied that their problems have been addressed and explained to their understanding, however brief the contact. It is beyond the scope of this response to discuss

communication in depth. These skills continue to be developed throughout a surgical career.

The Advisory Board members, however, made the following comments: “Checking the depth of the patient’s understanding of his/her condition and what they have been told is important on first contact. Openended questions may form part of this strategy. Writing a management plan in the notes aids clinicians who subsequently review the patient. Gauging the emotional response of the patient, and pitching advice at a level to meet his/her needs, helps understanding. Being aware of the potential cultural differences that may influence interaction helps when imparting advice. Don’t talk to others about the patient in third-person terms within the patient’s earshot.”

Frank CT Smith Programme Director on behalf of the CORESS Advisory Board coress.org.uk

Colostomy-bridge calamity in a patient with latex allergy

A patient was admitted for a revision of an antegrade colonic enema procedure and formation of a loop colostomy. At the WHO sign-in, the trainee involved in the case was present, but the consultant surgeon was not. It was highlighted at the WHO sign-in check as well as the time-out that the patient had a latex allergy.

The case proceeded without complication and a colostomy was raised. The consultant asked for a Jacques catheter to be used to create the colostomy bridge and left the operating room. The trainee put the Jacques catheter on the patient and made the bridge accordingly, but at the same time the patient’s blood pressure dropped precipitously and there was a severe skin reaction.

It took the trainee several minutes to discover that the red Jacques catheter was made of latex. On realising this, the catheter bridge was immediately removed, the skin was washed and the patient subsequently made a good recovery following appropriate management for anaphylaxis.

Reporter’s comments

The absence of the consultant at WHO sign-in may have contributed to this incident. This case should have been flagged up when discussing the list at the team briefing at the beginning of the day, before the sign-in took place. The red Jacques catheter is labelled as being ‘latex positive’. However, this was not recognised by the nursing team or by the trainee. Rapid action by the anaesthetist, who responded to anaphylaxis, saved the patient’s life.

CORESS comments

When a patient is identified as having a latex allergy, all steps in the potential management of that patient in the theatre environment should be considered at the team briefing. NatSSIPs state that the operating surgeon should be present at the sign-in. Hospitals should develop local protocols that deal specifically with the management of latex-sensitive issues and there is a case for identifying this issue as a priority concern in surgical training. Inexpensive, purpose-designed plastic colostomy bridges exist. Using equipment for a purpose for which it was not designed or licensed breaches standard operating procedures.

We are grateful to those who have provided the material for these reports.

The online reporting form is on our website coress.org. uk, which also includes previous Feedback Reports.

Published cases will be acknowledged by a Certificate of Contribution, which may be included in the contributor’s record of continuing professional development.

Unsupported trainee

A teenage male with upper abdominal pain of short duration was seen on a night shift in the emergency department (ED). He had no history of recent travel or trauma, and was otherwise fit and well, although he had felt tired and had had flu-like symptoms for the previous fortnight. His girlfriend had recently been diagnosed with glandular fever.

On arrival in the ED, he was taken to the resuscitation rooms, hypotensive, tachycardic and pale. Blood gases indicated acidosis (pH 7.2) and Hb was 110g/L. U&Es testing suggested an acute kidney injury. On examination he was pale, sweaty and peripherally cool with a soft but tender abdomen, particularly in the left upper quadrant. A CT revealed intra-abdominal free fluid in the upper abdomen.

I contacted the on-call consultant to relay my concerns that this might be a splenic rupture related to possible infection with the Epstein-Barr virus, but was advised to resuscitate with fluids and informed that this was an unlikely diagnosis, given the haemoglobin result and renal injury.

I remained concerned about the patient, whose blood pressure improved with fluid administration, but who continued to look unwell and whose Hb dropped further after fluid resuscitation. After two further phone calls in which I stressed my concerns that this patient needed to go to theatre, the consultant on call agreed to come in and review the patient in ED. Following review, the decision was made to proceed straight to laparotomy. The findings were a ruptured spleen with more than two litres of intra-abdominal blood. The patient required ITU support postoperatively and remained an inpatient for several weeks before being discharged.

CORESS comments

The trainee made a good diagnosis in this case, but irrespective of diagnosis, the patient had clinical signs consistent with a critical illness. When there is any concern about a patient’s wellbeing or the facts are in doubt, the consultant responsible for the patient has a clear responsibility to be contactable and approachable, and to attend to the patient if requested.

Failure to respond to a trainee’s request for assistance is neglect of duty.

The Association of Surgeons in Training trainee representative on the Advisory Board also highlighted the need for two-way communication and advised that trainees develop good communication skills so that when they contact a senior for advice, they have seen the patient, impart a concise and accurate summary of the clinical situation and prioritise the most important clinical details.

Employing the formulaic SBAR (situation, background, assessment, recommendations) approach to communicating clinical information and asking whether the consultant concurs is a proactive way of ensuring a positive response. This enhances the professional relationship between trainee and consultant, and results in a flattening of the hierarchy, which is to the patient’s benefit.

rcsed.ac.uk | 15

AGENDA

SPOTLIGHT ON SCHOLARS Academic eFacilitators Dr Paula Smith and Dr Uzma Tufail-Hanif share reflections on Edinburgh’s online surgical Masters programmes

S

ince the launch of the Edinburgh Surgical Sciences Qualification (MSc in Surgical Sciences) by the RCSEd and the University of Edinburgh in 2007, this and six other Edinburgh surgery online Masters programmes have enrolled more than 1,750 students. For 2017/2018, the total number of registered students is 530. Feedback remains strong and their global outreach has extended to 70 countries.

Surgeons who register for the programmes may find the costs associated with postgraduate study challenging.

However, the distance-learning format avoids the potential penalty of taking time out of training, and fees have been kept purposely well below equivalent Masters programmes at the University of Edinburgh and elsewhere.

A number of funding opportunities have been made available to widen access to these key programmes that complement the workplace experience. Many trainee surgeons have benefited from scholarships that contribute substantially to postgraduate tuition fees. Scholarships are awarded broadly on the basis of academic merit and evidence of a strong commitment, with several awards focusing on the needs of trainees in low- and middle-income countries (LMICs).

From left to right: Dr Maria DlugoleckaGraham (Polish School of Medicine Coordinator for the University of Edinburgh); Lt Col Wishart’s daughter, Morag, and his wife, Skip; Krzysztof Tomaszewski

Since 2010, generous funding from the Johnson & Johnson Corporate Citizenship Trust has provided full-fee scholarships for 16 Malawian surgical trainees, with a further seven surgeons from Malawi receiving Physicians for Peace and RCSEd funding. Recipients have studied part-time on the MSc in Surgical Sciences while maintaining their full-time clinical and academic commitments in the early years of their training. Core academic content has augmented in-hospital training without trainees having to leave their own country for postgraduate study. Feedback from our Malawian graduates has been very positive, especially regarding the interactive online discussion boards where students can learn from expert tutors as well as their global peers.

Here, we highlight other scholarship schemes that have brought considerable benefit to surgical trainees from around the world.

Surgical distance-learning Masters: online Commonwealth scholarships For 2017/18, the university secured five scholarships from the Commonwealth Scholarship Commission in the UK, open to students from Commonwealth countries applying for the MSc in Surgical Sciences, and ChMs in General Surgery, Trauma and Orthopaedics, Urology, and Vascular and Endovascular Surgery. These have been matched by five further Edinburgh Commonwealth Scholarships (ECS) and the number available should increase further in 2018. The ECS scheme provides students with full funding for tuition fees and the participation costs of an outreach school in leadership and advocacy development.

“My knowledge base and skills are enriched via almost real-time online academic discussion boards across the specialty of vascular and endovascular surgery. I appreciate the choice of ChM in Vascular and Endovascular Surgery, which would have been impossible without the scholarship I have. I am equipped to better help my patients and surgical community in my country.”

Mudasiru Adebayo Salami, Cardiothoracic and Vascular Surgeon, Ibadan, Nigeria

16 | Surgeons’ News | March 2018

MSc in Surgical Sciences: The Garden Scholarship Generated through the philanthropic activities of Professor James Garden, this scholarship is offered to students who are both nationals of, and resident in, an LMIC.

Professor James Garden, Director of Edinburgh Surgery Online, after a fundraising marathon in Chicago in 2012

“The Garden Scholarship has been a huge financial help and a great motivation. I initially planned a full self-sponsored course, but there was a sudden depreciation in the economy in Zambia, making salaries half the value of foreign currencies. The scholarship has helped me to overcome that.”

Azad Patel, Surgical Trainee in Lusaka, Zambia

ChM in Trauma and Orthopaedics: The Lt Col Jack Wishart Scholarship

“The Masters in Surgical Sciences is a window of opportunity that has provided me with greater insight needed for my surgical training. The Garden Scholarship has helped to ease the financial burden that would have otherwise been a stumbling block to completing my course.”

In recognition of Lt Col Wishart’s passion for education, this scholarship is awarded annually to a ChM student from an eastern European country.

Constance Cummings-John, Surgical Trainee from Sierra Leone (now in Ibadan, Nigeria)

“Being able to study online was one of the key drivers that helped me evolve from a junior resident surgeon to a fully shaped orthopaedic surgeon with a strong interest in musculoskeletal oncology. The scholarship allows young surgeons from eastern Europe to undertake one of the best postgraduate programmes in orthopaedics and traumatology available worldwide. There is no better choice if you want to advance and excel in orthopaedic surgery.”

Dr Paula Smith Senior Lecturer and Academic eFacilitator for the MSc in Surgical Sciences

Krzysztof Tomaszewski, Orthopaedic Surgeon in Krakow, Poland

ChM in Urology: RCSEd–ESSQ Scholarship “Without the ChM Urology programme, I would have struggled with my Fellowship training, maybe failed completely. The ChM Urol has been key to this Fellowship success. It is one of the reasons I am a qualified urologist today. The programme demanded that I read and contribute to the online discussion boards. This helped me greatly with self-discipline and time management. I also learned to manage my patients based on evidence. Today, when I do something, I always think about the evidence behind it.”

Charles Mabedi, Urologist in Lilongwe, Malawi

Dr Uzma Tufail-Hanif Academic eFacilitator for the ChM in Urology and the ChM in Vascular and Endovascular Surgery

Other paths to funding Additional funding routes are open to LMIC students, including the eoSurgical ESSQ Scholarship and the David E I Pyott Master of Surgery in Clinical Ophthalmology Scholarship (details at www.ed.ac.uk/ student-funding/postgraduate/e-learning). The National Institute for Health Research (NIHR) Unit on Global Surgery, a collaborative research partnership with the universities of Edinburgh, Birmingham and Warwick, launched last year.

The five-year programme award of £7.1m from the NIHR aims to establish a global network of research hubs through the GlobalSurg collaborative. Further distance-learning Masters scholarships will be available to each participating research hub, supporting training LMIC surgeons (globalsurg.org).

Closer to home, the Association of Surgeons in Training bursary is open to its members undertaking the MSc in Surgical Sciences or a ChM in General Surgery, Trauma and Orthopaedics, Urology, or Vascular and Endovascular Surgery (asit.org). We will continue to look at ways of extending bursary and scholarship funding in the future.

For more information on our Masters programmes and scholarships, email surgical.sciences@ed.ac.uk or visit essqchm.rcsed.ac.uk.

Watch out for the launch of the Masters in Patient Safety and Clinical Human Factors due to commence in September 2018. Register your interest at essqchm.rcsed.ac.uk

rcsed.ac.uk | 17

AGENDA

TEACHING AN OLD DOG NEW TRICKS

Dr Benjamin Holdsworth explains the principles of reverse mentoring and the benefits of passing ideas up the ladder

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he BBC has announced that it is adopting a ‘reverse mentoring’ scheme for managers, who will now receive help and guidance from younger colleagues. The aim is that energetic, wide-eyed newbies will advise the older generation on youth trends and lifestyles to stem the audience exodus from traditional broadcasting channels.

Reverse mentoring has been operating in tech industries for the last decade, but is moving more mainstream as companies struggle to keep up with fast-paced technological improvements.

The NHS – not known for its quick take-up of managerial trends – has not jumped on the bandwagon Senior doctors can learn new skills from their junior colleagues

just yet, at least not on paper. We remain fairly hierarchical with clear career paths in place that enable doctors to progress up the ranks, learning from several older influencers along the way.

In practice, however, we see examples of two-way learning all the time. I spoke to an orthopod recently with a highly successful high-profile clinic. He told me he chose to continue with his NHS work not only to enjoy the greater variety of cases, but also because he believed there was much to gain from working with his younger colleagues. They

Junior doctors bring enthusiasm and new skills

Dr Benjamin Holdsworth is Financial Planner and Director at Cavendish Medical

brought exciting new methods and techniques that he might not always agree with, but the ensuing lively debate was good for the mind and the soul! (And they also helped him set up his Twitter account.)

Senior doctors might quibble over who faces the harder times at the coalface – back then or now – but most are buoyed by the infectious enthusiasm that junior doctors bring, the new skills that refresh the team, and the motivation to help others that has yet to be dimmed by decades of red tape and hierarchy. Reverse mentoring can also help senior staff get a real picture of what is going on at lower levels and, in the case of the NHS, what hardships and challenges younger members face.

Of course, despite the phenomenal advances in technology, nothing can come close to the value of a medic with four decades of hard-earned experience who is willing to train and to teach the next cohort.

The greater the numbers of doctors facing tough times on the front line, the greater the need for every member of staff to feel support from both above and below.

The average NHS worker is now taking more than 15 days off sick a year, with stress leave at an all-time high. A cash-strapped organisation would be wise to look at the training potential of all staff – passing ideas up and down the corporate ladder.

Read more on Benjamin Holdsworth’s blog, View from the Inside, at cavendishmedical. com/category/view-from-inside or find him on Twitter at @DrBenHoldsworth

18 | Surgeons’ News | March 2018

AGENDA

It is the first trade union committed to surgeons

STATE OF THE UNION

The birth of the Confederation of British Surgery and the plan of action for the trade union in 2018

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n 8 November 2017, the Certification Office approved the application to add the Confederation of British Surgery (CBS) to the UK’s list of recognised trade unions. For the first time, there will be an organisation, a trade union, recognised in UK law that is committed exclusively to surgeons and their related teams and families.

The declared aim of the CBS is to look after the professional and employment interests of surgeons and their teams irrespective of Surgical Royal College or Surgical Specialty Association affiliation.

As such, the CBS would be able to involve itself in matters relating to terms and conditions of service, contracts of employment, litigation, insurance and other matters from which the Surgical Royal

Colleges and the numerous Surgical Specialty Associations are excluded on the basis of their charitable status and the ‘public benefit’ concept that this entails.

The CBS is emphatically and specifically not in competition with the Surgical Royal Colleges or Surgical Specialty Associations, as these have remits relating to clinical standards, education and membership activities, and are not permitted to act, in any way, as a trade union.

It is our hope and intention that members of the CBS will have access to appropriate cover and advice relevant to working in the unique and often stressful surgical environment. We aim to provide exclusive benefits to surgeons, extended members of the surgical team and their families. In protecting and supporting surgeons

By John MacFie, Nigel Mercer and Tony Narula

and their teams in the workplace, our ultimate aim is to improve the care of all patients requiring surgical care.

The creation and recognition of the CBS has been a long time in gestation – the idea was first mooted more than 10 years ago. There has always been agreement that surgeons were poorly represented by existing trade unions, but considerable debate as to the best way forward. We did enter into discussions with both the BMA and HCSA in an attempt to establish some recognition of the particular needs of surgeons and we did conduct extensive survey work before embarking on the road to recognition for a trade union specifically for surgeons.

The process of recognition has necessitated extensive correspondence and frequent meetings with the Certification Office, which has been most helpful.

We had to produce a ‘rule book’ and a ‘strategy’ document, which are available to download from rebrand. ly/CBS-RuleBook and rebrand.ly/ CBS-Strategy, respectively.

The CBS intends to continue to work closely with the Federation of Surgical Specialty Associations, which has been instrumental in achieving this development.

In 2018 we will: l establish an administrative office l establish an executive and appoint officers l seek to inform all surgeons l inform parliamentarians l inform all hospitals where surgical procedures are undertaken l inform all Colleges and Specialty Associations.

To achieve our objectives will take time, perseverance and resources, and, most importantly, your support.

Please register your interest at CBSGB.co.uk. rcsed.ac.uk | 19

COURSES

AN EVOLVING LANDSCAPE Alistair Geraghty looks at a revamped training course and the new education model of connectivism

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he surgical training landscape is in a state of flux. The ‘surgical trainer’ is developing into a distinct role within surgery just as the academic surgeon did before. Where a traditional training pathway commonly included a PhD or MD in basic or applied science, it is now equally valid to pursue higher qualifications in education. The College’s Faculty of Surgical Trainers (FST) opened in 2013 and its Standards for Surgical Trainers were published the following year. The General Medical Council (GMC) now requires trainer accreditation and revalidation.

At the same time, there are significant changes in surgical training itself. The Shape of Training 20 | Surgeons’ News | March 2018

review was published in 2013 and the resultant Improving Surgical Training Programme will be piloted this year. The Intercollegiate Surgical Curriculum Project is in its 10th iteration and in the coming year will see the introduction of new Competency in Practice work-based assessments. Non-technical skills continue to rise in prominence in the wake of the pioneering work of the Non-Technical Skills for Surgeons programme and this is reflected in the GMC’s new generic professional capabilities. The graduate trainee population is also changing. Rising tuition fees for higher education over the past decade have altered student relationships with education; they are paying consumers and, not unreasonably, expectations are high.

There are increasing numbers of

Connectivism describes how people can interact with the internet as if part of internal knowledge

female trainees and societal changes towards more shared parental responsibilities are such that ‘less than full-time training’ is already commonplace on surgical rotas and set to increase. Finally, the continued rise of technology is changing the way education is accessed.

It was against this backdrop that I joined the revamped RCSEd Training the Trainers course in October 2017.

As an ST7 colorectal trainee I am approaching the end of training and felt it necessary to tick the Training the Trainers box. I have a strong educational background, so I was keen to find out how this revamped course accommodates the changing surgical landscape.

Almost from the first slide, the course is rebranded from Train the Trainers to a trainer development course reflecting the change from training being assumed and static to being earned and in need of continuous development. The

faculty itself felt new, refreshing and different, consisting of two surgeons, a radiologist and a dualaccredited GP/acute physician.

They introduced the new training and trainer environments, outlined the FST Trainer Standards and set us the question – what are OUR training development needs?

Over the following two days, the course continued to use this same mechanism – introducing an idea before engaging us in an exercise to not just practise it, but inhabit it.

We then explored some educational ideas I had met before – behaviourism, cognitivism and humanism – but soon connectivism was introduced to my vocabulary.

The Faculty illustrated the changing nature of medical knowledge with a quote I have since traced back to a paper by Peter Denson entitled ‘Challenges and opportunities facing medical education’: “It is estimated that the doubling time of medical

knowledge in 1950 was 50 years; in 1980, 7 years; and in 2010 3.5 years.

In 2020, it is projected to be 0.2 years – just 73 days.”

This exponential growth in medical literature and resources necessitates a new way of accessing knowledge. Connectivism describes how people can use knowledge rapidly from outside their own internal memory by accessing and interacting with the omniscient internet as if part of internal knowledge. Medical students and trainees regularly check smartphones during tutorials, and even on wards.

Rather than being rude, this can indicate an engaged learner seeking new sources of information. It is now an essential skill for learners to be able to access, evaluate and employ this external knowledge.

This idea was demonstrated in a beautifully orchestrated learning exercise on teaching a practical skill.

I will not expand further for fear of spoiling future groups’ experience, but needless to say it perfectly displayed how wifi and smartphones have changed our learning habits.

More importantly, it encouraged us to harness this energy in the design of our own teaching materials.

The afternoon continued with sessions on presentation skills and feedback before we were set a task for the following morning.

Overnight, we had to create a fiveminute ‘microteaching’ session to be presented to our peers. We were encouraged to consider the resources available, the nature of the audience and strategies for engagement. The morning session was a real highlight of the course.

Each taking turns, my group of 10 presented to each other, with the remaining group members providing both written and verbal feedback on the style, delivery and content.

This was a rare opportunity to get a 360° appraisal of your presenting skills. What was particularly enjoyable from this exercise was to see how different participants had approached the same challenge.

There were, of course, several PowerPoint presentations, but they used a multitude of hooks to engage the group – some had video, others emotive pictures, while others used humour. Some of the group

Alistair Geraghty Scottish Clinical Leadership Fellow, RCSEd & NHS Education for Scotland

made their tutorials interactive discussions, while one gave a simple but impassioned speech using no notes or visual aids at all – a timely reminder that technology can be just as distracting as effective.

One of the areas I had identified in my analysis of training needs at the start of the course was gaining a better understanding of approaches towards a trainee in difficulty, and this session did not disappoint. We began recounting some of the experiences we had had in practice. We next discussed our approaches to a number of interactive cases. What became very clear from these discussions is that the devil is in the detail. How do you approach that trainee in difficulty for the first time? An informal faceto-face invite? An emailed invited discussion? A formal minuted meeting? Following a meeting, how do you get the right balance of documentation with appropriate action plan while still protecting, nurturing and maintaining trust with a struggling trainee?

These in-depth discussions were a marked departure from the quick ‘interview’ responses I could recite to address these types of problems. The exercise concluded by outlining some of the support, levers and devices available to guide a trainee through a period of difficulty while being mindful of the red lines of patient safety, trainee health and legality.

I was really impressed by the updated Training the Trainers course. It embraces the new surgical landscape and encourages trainers to adopt a professionalised role.

It has been designed to deliver content efficiently through the same mechanisms it promotes. It introduced surprises, insights and new ideas to me despite considering education one of my strengths. Training the Trainers should remain an important staple for those approaching their Certificate of Completion of Training and I would strongly encourage established trainers to consider it for a refreshing, punchy update.

It is now an essential skill for learners to be able to access, evaluate and employ external knowledge rcsed.ac.uk | 21

FROM THE ARCHIVES

PICTURE OF HENRY GRAY

While Gray’s Anatomy is essential student reading, the relationship between author and illustrator was fraught

I

n the 1940s, a remarkable manuscript was donated to the Library and Archives: a partial set of first-edition, final-page proofs of medical textbook Anatomy: Descriptive and Surgical (later called Gray’s Anatomy).

First published in 1859, the manuscript includes the final edits made by the text’s author, Henry Gray, (1827–1861). Significantly, this set of Wertheimer proofs, complete with ink splodges, provides a rare glimpse of the relationship between Gray and the text’s medical illustrator, Henry Vandyke Carter (1831–1897).

The latter’s crucial contribution to Gray’s Anatomy has been largely obscured, and, curiously, from a study of the proof’s title page, you could be forgiven for thinking this was the intention of the ambitious anatomist and surgeon.

GRAY’S ANATOMY: THE TEXTBOOK

Now in its 41st revised edition, it could be argued that the success of Gray’s Anatomy rests to a large extent on the 360 meticulous and vivid illustrations created by Carter, apothecary-surgeon, microscopist and artist.

Carter’s illustrated plates were particularly notable for their size, boldness and concise detail, making the quality of Gray’s Anatomy different to contemporary textbooks and anatomical works. Gray’s was not just larger (in light of the enormous woodblocks made from Carter’s drawings by engraving firm Butterworth and Heath), but it was adapted to help anatomy students and surgeons.

The clear layout, easy navigation and greater clarity through new labelling techniques made the text more readable and useful. Most importantly, it was affordable.

four years younger, less advanced in his career than the distinguished anatomist Gray, who was more confident, high-spirited and (it could be argued) fame-hungry.

Importantly, Gray was aware that his illustrative skills were weak compared with Carter’s, whose eye for microscopic precision in drawing was perhaps unrivalled.

Henry Gray

22 | Surgeons’ News | March 2018

WELLCOME IMAGES

HENRY GRAY AND HENRY VANDYKE CARTER

In 1855, when Gray’s was being conceived, Gray was 28 years old and Carter 24. The pair first met in the dissection room at St George’s Hospital in around 1848, when Carter was a student. Throughout the creation of Gray’s, the two friends worked both separately – Gray on the text, Carter on the illustrations – yet also as a joint enterprise. For at least 18 months, they dissected corpses from St George’s Hospital and London’s workhouses and based the text and illustrations on these corpses.

The two Henrys were different: Carter was humble, self-effacing, prone to solitude and, being

Henry Vandyke Carter’s meticulous illustrations were perhaps unrivalled

Carter’s name and his recently awarded MD, repositioning it in a less prominent space and crucially, in a smaller size: “Type size of the name below,” he notes.

Gray also demands to be sent “a revise before finally printing it off”.

Thus, with the author’s name retained in a prominent position below the book title, there would be no doubt on the reader’s part that the distinguished Henry Gray FRS was the main force behind Anatomy, Descriptive and Surgical.

Gray had made an unambiguous statement: Carter belittled to a more lowly status, with a less-meaningful role in the creation of Gray’s Anatomy. And to add insult to injury, while Gray pocketed a healthy sum of £150 for every 1,000 copies sold, his collaborator got no royalties, receiving only a one-off payment of £150.

Moreover, as author and journalist Hugh Aldersey-Williams pointed out: “In later editions, Carter’s name was reduced again, and by the 17th edition, published in 1909, it was gone altogether.”1

JEALOUSY P’RAPS

HENRY GRAY’S EDITS

While there is no doubt that Gray’s Anatomy was the result of a truly collaborative process, Gray’s edits and instructions on the final-proof copy display a grudging spirit toward his illustrator, suggesting the career-minded Gray was focused on the end prize for himself from the outset.

Gray made corrections on the majority of pages, yet the modifications for the most part are unremarkable.

However, the title page tells a different story. As can be seen in the image (left), credit to the authors was originally presented in the same type size, both in capitals, although Carter’s name is strategically placed lower down the page.

Carter had recently been appointed as Professor of Anatomy at Grant College, Bombay, and this was recognised on the proof. Shockingly, though, Gray made what appears to be a determined and heavy-handed slash through the medical illustrator’s new job title. And to make his point as clear as possible, he included the caption: “To be omitted HG”.

Henry Carter is therefore stripped of his latest credentials, being left with the more humble ‘Late Demonstrator of Anatomy at St George’s Hospital’.

Gray didn’t stop there – he also scored through

REFERENCES

1. Aldersey-Williams H. Anatomies: A Cultural History of the Human Body.

WW Norton; 2014 2. Richardson R. The Making of Mr Gray’s Anatomy; Oxford University Press; 2009

Gray’s Anatomy was an immense accomplishment, excelling both as a textbook and a work of art Henry Vandyke Carter

Historian Ruth Richardson has examined the diaries of Henry Carter, which are held at the Wellcome Library and have thrown some light on the relationship between Carter and Gray.

Revealingly, Carter had been quietly seething since Gray’s reluctance to extend courtesy to him for his earlier work, On the Structure and Use of the Spleen (1853), in which he provided the medical illustrations. No obvious gratitude was extended to Carter for the endless hours he spent drawing the specimens for Gray, despite the preface attributing thanks to other individuals and organisations.

Gray had also been the recipient of the Astley Cooper Prize, which furnished him with 300 guineas, again with no credit to Carter. A comment from Carter’s diary regarding Gray’s refusal to recognise Carter’s contributions is illuminating: “jealous p’raps”.2 Thus, while Carter clearly held Gray in high esteem, there was a passive resentment.

It is unfortunate that no personal papers of Henry Gray survive in which he would have opportunity to defend himself. Yet there can be little doubt that in his quest for fame, he made a strategic decision to marginalise image from text and ultimately deny Henry Vandyke Carter due recognition.

Gray’s Anatomy was an immense accomplishment, excelling both as a textbook and a work of art. Without Carter’s outstanding illustrative contribution to Gray’s Anatomy, it would not have become the student manual of surgical anatomy it is to this day.

rcsed.ac.uk | 23

ALAMY

BEHAVIOUR

24 | Surgeons’ News | March 2018

The dark side

David Riding assesses the link between psychopathic traits and surgeons, and how to protect patients from such behavioural issues

I

t is difficult to identify when the perceived association between psychopathy and surgeons emerged, but it continues to do so with regularity. In a recent Financial Times article, cardiac surgeon Professor Stephen Westaby argued that “you have to have the characteristics of a psychopath to be a good surgeon”.1 Westaby even suggests that a rugby-related head injury transformed his personality, making him perfect for the job. In 2018, it is unlikely that many Members and Fellows of the College would admit psychopathic tendencies, yet there seems to be a persistent perception that these are required for success, and studies do show that surgeons (and, perhaps surprisingly, paediatricians) score higher on psychopathy screening tools than their peers in other specialties.2 One such screening tool (there are many), the Psychopathic Personality Inventory, states that psychopaths have reduced fear, high stress tolerance, self-confidence and assertiveness,3 all of which could be viewed as aspirational qualities for surgeons.

Unfortunately, the tool also screens for lack of empathy, poor behavioural restraint and inability to plan and predict consequences, which are not typically associated with the delivery of excellent care.

Most of us have an anthology of tales of appalling surgeon behaviour at our disposal, generally told to rapt medical students or queasy non-medical friends and family. One of my early undergraduate experiences of surgery was to witness a cardiac-bypass catheter being angrily thrown out of a patient’s chest. On its way towards the theatre wall, it covered everyone and everything with a horizontal stripe of dripping fresh blood. The horror was compounded by the stark normality in which the operation proceeded, as if this was entirely routine, justifiable behaviour, not worthy of comment from the rest of the team. I continue to hear similar stories from senior colleagues, who (often unintentionally) exonerate the psychopathic

The workplace culture that may have facilitated psychopathic behaviour is changing

David Riding is a Vascular Surgery Trainee ST6 in the North West

References 1. Westaby S, Marsh H. What makes a great surgeon?

Two of Britain’s best discuss.

Financial Times [internet]. 2017.

Available at ft.com/ content/d53f24229314-11e7-a9e611d2f0ebb7f 0#comments 2. Pegrum J, Pearce O. A stressful job: are surgeons psychopaths? Bull R Coll Surg Engl 2015; 87: 331–334.

3. Benning S. Encyclopedia of Personality and Individual Differences: Psychopathic Personality Inventory (PPI) [internet]. US: Springer Link.

Available at springer.com/refere nceworkentry/10.10 07%2F978-3-31928099-8_1098-1

protagonist of their story by concluding that “he was a great surgeon, though”.

It is possible that in the paternalistic era, patients valued the idea of a highly educated, well-spoken, white, middleto upper-class gentleman stepping in and making bold decisions on their behalf, whether psychopathic or not.

Naturally, the patient’s family would grieve in the event of their death, but would understand that the surgeon tried his damned hardest – it just wasn’t meant to be. It would have been unlikely to see any scrutiny of the surgeon’s decision making, operative technique or communication skills. These conditions would enable the psychopathic surgeon to flourish, operating with autonomy, and without empathy and diligence.

In an increasingly accountable era of greater patient involvement and education, the workplace culture that may have facilitated psychopathic behaviour is changing. Greater emphasis on teamworking, reduction of autonomy through MDTs, revalidation, the response to the Shipman, Bristol, Alder Hey and Mid-Staffs scandals, more effective patient representation, and the publication of individual surgeons’ outcome data have all contributed. However, the recent conviction of Ian Paterson and the comparatively high incidence of bullying behaviour in surgery demonstrate that there is much work to be done. There continues to be a significant racial, socioeconomic and gender imbalance within the profession’s workforce that fails to represent wider society. It is likely that potential surgeons reject the career, being unable to self-identify the negative character traits that some deem necessary for success.

This is one of many factors to consider as we seek to understand why the numbers of doctors applying for surgical training is falling.

The RCSEd is determined to drive a progressive culture change through its anti-bullying and undermining behaviour campaign. The College President, Fellows and Members are working with the GMC, the NHS, representatives of the Scottish Parliament and others to ensure we permanently eradicate the psychopathic stereotype and the conditions that enable psychopathy from the surgical workplace, ultimately to protect patients and our profession.

Read more about the College’s Bullying and Undermining campaign at rcsed.ac.uk/bullying rcsed.ac.uk | 25

DR PATERSON CASE

HOME TRUTHS

From better whistleblowing policies to improved consent processes, there is much to learn from the Paterson case, writes Professor Sir Ian Kennedy

I

an Paterson was a surgeon who operated on women with breast cancer.1 He worked in the NHS at Heart of England NHS Foundation Trust, where he was appointed in 1998, and in Spire hospitals in the private sector. Over more than a decade in the NHS, he carried out operations that left women exposed

26 | Surgeons’ News | March 2018

to an increased risk of recurrence of their cancer through resorting to an unknown procedure that acquired the name ‘cleavage-sparing mastectomy’ (CSM). In the private sector, he carried out unnecessary surgery and made fraudulent claims for payment for procedures that had not been done.

I carried out a review into Paterson’s surgical practice for the NHS Trust, which was published in 2013.2 In this note, I confine myself to commenting on his work in the NHS. Paterson was finally excluded from the NHS Trust in 2011, had his registration suspended by the GMC in 2012 and was removed from

the register in 2017. In the summer of 2017, in relation to his private practice, he was convicted on 17 counts of wounding with intent, three other counts of wounding and counts of fraud. Spire paid out £27.2m in compensation. As for the NHS, a settlement was reached with 750 claimants for £37m.

On one level, Paterson can be compared with another doctor who earned notoriety, Dr Harold Shipman. Both were clearly highly exceptional characters: they fitted in on one level, but on another level their behaviour was a daily denial of what doctors up and down the land stand for. So it could be said that Paterson was so off the spectrum of expected, even predictable, behaviour that nothing can be learned from the harm he caused.

This would be wrong. Paterson was part of an organisation. It is proper to ask what the organisation knew of his practice, when they knew it and what they did. These are the central questions I sought to address in my review. Here, I will highlight some issues that may be of particular interest.

Working in a team All surgery involves a team. Nowhere is this more true than in the case of breast cancer.

Paterson was not a team player. He was a bully, prone to ignoring his colleagues or belittling their views.

He dominated the multidisciplinary team meetings.

The nurses in the team were soon seeing patients who had not had a mastectomy, although the notes indicated otherwise.

A mastectomy calls for a flat chest. Patients were being seen who had tissue of varying amounts left behind. When they raised the matter, Paterson told them that the tissue was “just fatty tissue” and would leave them with a cleavage (although not all of the tissue left behind fitted this description). Given his personality and the sense of authority he

Professor Sir Ian Kennedy Professor of Law and a leading expert in the law and ethics of healthcare and in health policy

exuded, they accepted or at least went along with this reassurance.

The radiologists in the team also expressed concerns.

They were effectively told they were not surgeons and therefore not qualified to comment. One radiologist was so concerned that he conducted an audit of 100 patients during 2003, which showed that some patients were being recalled for what were termed “shaves after mastectomy” or were receiving “partial mastectomies”. Despairing of what to do and concerned for their patients, the radiologists on occasions referred women back for further surgery.

Also, on occasions, they decided to expose the women to radiotherapy, aimed at the tissue left behind, when ordinarily such therapy would not have been called for.

The team, the central element in the care of the patients, was not working. This was made known to the senior executives of the NHS Trust. Efforts to remedy its failings were largely unsuccessful. Paterson remained effectively in charge and aloof. A number of opportunities to address this fundamental issue were not taken. The executive allowed the concept of teamwork to be undermined. The reasons were not clear: they may include not wanting to stand up to Paterson, preferring his views as a well-known surgeon to those of others, or satisfaction that targets were being met. Whatever the reasons, when teams do not work and corrective action is not taken patients are harmed.

Knowing what to do The nurses and fellow doctors were concerned. The nurses turned to Paterson and accepted, for a long

Mammogram showing breast cancer

time, his reassurances. The nurses should have pressed their concern, but the NHS Trust did not have any policy or procedures to which they could turn. The only procedure that the NHS Trust ultimately had recourse to was through HR, which, being categorised as ‘confidential’, excluded the nurses. If they felt they were getting nowhere in the NHS Trust, they should have raised their concerns with the relevant regulators.

That they did not is a comment on the culture of the hospital – a culture that is not unusual. Staff are loath to challenge the powerful.

Senior executives rarely create an environment where staff feel safe to do so. And, when they are prepared to do so, they do not seem to be aware of the openings available to them and, as important, their duty to avail themselves of them.

The radiologists did not seem to know where to turn when their initial expressions of concern were effectively rebuffed. Importantly, they were employed by a different NHS Trust and so felt somewhat semidetached from Paterson’s NHS Trust.

They felt ignored by the NHS Trust’s executive. As with the nurses, they could have engaged the regulators, the CQC and the GMC. They did not.

All surgery involves a team. Paterson was not a team player. He was a bully, prone to ignoring his colleagues or belittling their views rcsed.ac.uk | 27

Notes and references 1. I refer to women throughout, although there were a handful of male patients 2. Kennedy Review, Heart of England NHS Foundation Trust.

3. As described by an independent expert brought in by the Trust in 2008, see Kennedy Review, p81–82.

All members of the surgical team must take responsibility for patients’ safety

Their training and the culture they found themselves part of meant they did not contemplate such action. They saw their duty as being to do their best for their patients. However, they interpreted this duty too narrowly.

Doing the best for the patient meant doing something about Paterson.

Doctors need to learn from this, but regulators need also to learn that they must be much more visible and accessible. They must make it clear that they are there to protect patients and should be engaged when concerns arise and those inside the NHS Trust do nothing. If they do not, patients may be harmed.

Training for leaders Paterson was able to continue to put patients in harm’s way for years for a variety of reasons. One of the principal reasons was that colleagues in senior roles were not prepared to stand up to him.

Members of staff who could have done something took the path of least resistance. They worked around him. This, of course, was fine by him because it left him in his own bubble, free to do as he wished.

The lesson that comes through strongly is that those who find themselves in positions of leadership must be prepared for the role. They

must receive appropriate training.

It is unrealistic to expect someone without such preparation to stand up to someone with Paterson’s personality. And so it proved for years. And patients were harmed.

What about consent?

Paterson told women on whom he was going to operate that he would be performing a mastectomy. In many cases (it is still unclear how many), he did not carry out a mastectomy. Instead, he left tissue behind – in some cases because he had decided to perform what became known as a CSM; in other cases because his surgery was ‘slipshod’ or ‘rushed’.3 CSM was a completely unknown procedure. It was not recognised as a surgical response to breast cancer.

Yet Paterson performed it for years. Eventually, in 2007, he was required by the NHS Trust to stop doing it (he still did it on 42 further occasions). It did not occur to the NHS Trust’s senior executives, even when they were aware of Paterson’s practice, to put two and two together and realise that there was a fundamental

It did not occur to the NHS Trust’s senior executives to put two and two together and realise there was a fundamental issue of consent at stake 28 | Surgeons’ News | March 2018

issue of consent at stake. Women had agreed to a mastectomy.

When they had not had one, their agreement, or consent, had been acquired through false pretences.

The information that they had been given, that they would be having a mastectomy, was false. They had not given valid consent.

In legal and ethical terms, this lies at the heart of Paterson’s wrongdoing: his violation of women’s right to be informed and to choose what should happen to their bodies. Apart from a reference to the issue of consent made by an outside expert brought in to review Paterson’s practice in 2008, the centrality of the failure to obtain proper consent was only recognised in 2011 by the new senior team.

The lesson is an unhappy one.

Consent is increasingly trivialised.

It is seen as an administrative chore. ‘Consenting’ a patient is a common expression, despite its illiteracy and complete disregard for the fact that it is the patient who consents and the doctor who seeks permission. Until there is a proper understanding of the role and place of consent in medical practice, the opportunities for abuse will continue to exist. And patients will be harmed – if not by the procedure, then by the failure to obtain their consent.

Save the date!

FST to Host International Conference on Surgical Education & Training (ICOSET) 21–22 March 2019

The Faculty of Surgical Trainers is delighted to inform that it is to host the 2019 International Conference on Surgical Education and Training (ICOSET).

The biennial event will take place in the historic setting of the Royal College of Surgeons of Edinburgh, on 21-22 March 2019.

ICOSET is an international collaboration dedicated to sharing global developments and innovative approaches in surgical education through interactive sessions and debates. The conference provides a unique

opportunity to meet and network with surgeons, leaders in surgical education and policy makers from different jurisdictions.

Surgical Director of the FST, Mr Craig McIlhenny, said: “The FST’s aims and objectives are closely aligned with those of ICOSET, so this is an ideal collaboration, which I hope marks the start of a long and productive relationship.

We look forward to working with the ICOSET committee over the next year to develop a programme that will uphold ICOSET’s world-class reputation.”

PERIOPERATIVE CARE

Team spirit

Two years on, Charles Auld examines the development of the Faculty of Perioperative Care and the future role of perioperative practitioners in the surgical team

T

he Faculty of Perioperative Care was launched in March 2016 to provide educational and training support for the nonmedical members of the surgical team: surgical care practitioners (SCPs), surgical first assistants (SFAs) and other advanced practitioners involved in the care of the surgical patient.

From an educational perspective, courses in surgical anatomy, key skills, non-technical skills, and leadership and development have been developed and delivered in Edinburgh and, more recently, Birmingham to offer participants better accessibility. These are new courses specifically designed for the practitioner and so far they have been well received, with attendees rating them as ‘excellent’ and giving them marks ranging from 73% to 100%. These courses also provide good networking opportunities for delegates and attendance on the courses can satisfy some of the criteria required in the assessment process to achieve full membership of the Faculty. This confers many benefits, which are detailed on the website (fpc.rcsed.ac.uk), and the award of the postnominals ‘MFPCEd’ conferred at one of the College’s diploma ceremonies.

As these roles evolve, it is vital that employers recognise the need to provide these members of the extended surgical team with 30 | Surgeons’ News | March 2018

Charles Auld Faculty of Perioperative Care Lead, a member of the College Council and a Consultant General Surgeon at Dumfries and Galloway Royal Infirmary

dedicated time and financial support for CPD opportunities. We have an obligation to set appropriate standards for practitioners such as SCPs, who may be performing similar duties as the surgeon in training. It is not unreasonable, for example, to expect them to undergo an assessment and competency process with annual appraisals in keeping with their surgical practice. Ensuring that the same standards are applied is important for acceptance not only by the medical profession, but also by the general public.

Setting standards was the theme of the Faculty of Perioperative Care’s annual conference in October 2016.

This event was well attended and the lectures can be downloaded from the Faculty’s website. The third annual conference, entitled ‘The Surgical Team: Are Perioperative Practitioners Increasingly Working Towards a Medical Model of Care?’, was held on 4 November 2017. The issues addressed at the event were timely, given those raised earlier, and covered subjects such as: ‘who should be my line manager?’, the relationship between the SCP (and SFA) and the surgeon, as well as the effect of the perioperative

practitioner on training of the surgical trainee. This conference was extremely well attended, with 94 delegates, and had very generous sponsorship from EIDO Healthcare, Pentland, BMI Healthcare and Smith & Nephew.

Although it is widely recognised that the MSc in Surgical Care Practice is the ‘gold standard’ for SCPs in training, what are the expectations for established SCPs within their chosen specialty? The cardiothoracic exam is currently under review by the RCSEd and the Society of Cardiothoracic Surgery of Great Britain and Ireland, supported by the Association of Cardiothoracic Surgical Assistants.

If this is accepted as a standard for SCPs in this specialty, it could be a blueprint for other surgical specialties. This would also be a key factor in conferring full membership of the Faculty.

The SFA provides competent assistance to the operating surgeon and is becoming an increasingly important member of the team. In the same way that SCPs provide continuity of care for the patient, the SFA can provide consistency to the operating surgeon. The European Working Time Directive, complex

It is vital that employers recognise the need to provide these members of the extended surgical team with dedicated time and financial support for CPD opportunities

rota designs for surgical trainees and the loss of the apprenticeship model make the SFA role extremely appealing in many specialties, and the Faculty’s membership structure has been designed to reflect the importance of the advanced practitioner’s role.

Communication between organisations investing in the future and development of these advanced roles is essential, and the Faculty has been working hard to engage with as many of the key organisations as possible.

The Faculty of Perioperative Care has renewed its partnership with the Association for Perioperative Practice (AfPP), an organisation that has representation on the Faculty Advisory Board, and there is also a close interaction with universities such as Anglia Ruskin and Edge Hill, the latter running excellent courses for SFAs that have been accredited by the RCSEd. The SFA toolkit, produced by the AfPP and endorsed by the RCSEd, is a competency-based tool for SFAs in the workplace.

The Faculty is a member of the Perioperative Care Collaborative, a partnership of professional bodies representing healthcare workers within the perioperative environment that is currently updating the SFA position statement (2012). This is just one of the ways in which the

Below: College President Michael Lavelle-Jones welcomes the Faculty of Perioperative Care’s first Member, John Stirling, at the diploma ceremony in November 2017

Faculty is able, through its work with other organisations, to ensure that the views and priorities of its membership are fed into discussions that will have an impact on them and their practice.

There is also a reciprocal arrangement between the Faculty of Perioperative Care and the Faculty of Physician Associates (FPA), with representation on the FPA’s board and vice versa. Although a voluntary register for physician associates exists, there is no official register or database of either SCPs or SFAs within the UK. This is essential if CPD requirements, an assessment process and regulation are going to be mandatory throughout the UK. Statutory regulation of four relatively new roles of healthcare professionals – SCPs, PAs, advanced critical care practitioners and

physicians’ assistant (anaesthesia) – is being addressed through the Medical Associate Professions Oversight Board, convened by Health Education England (HEE) in 2016. Both surgical colleges (RCSEd and RCSEng) are represented on the board and subcommittees.

Despite the recommendation

by HEE for all four groups to be regulated, the regulation of medical associate professions in the UK, issued for consultation by the Department of Health on 12 October 2016, proposes that statutory regulation should be introduced only for physician associates, while seeking further information on the other groups.

The Faculty of Perioperative Care, together with the Royal College of Anaesthetists and the Faculty of Intensive Care Medicine, will be issuing strong opposition to this, recommending statutory regulation for all groups.

It is important that the Faculty of Perioperative Care continues to provide education and training, and set standards for these practitioners, as well as recognise the importance of this relatively new addition to the surgical workforce. This will, therefore, be a focus for the Faculty going forward.

Preliminary discussions suggest that some of the developments could be transferred to countries where healthcare professionals undertake similar roles to those in the extended surgical team within the UK. rcsed.ac.uk | 31

PERIOPERATIVE CARE

The frailty epidemic John Martin Trotter and Clare McNaught look at modern perioperative management of elderly and high-risk patients

C

all it what you like, the ‘ageing time bomb’ or the ‘frailty epidemic’, statistics predict that by the year 2035 more than 44% of the adult population in the world will be over 65 years of age.

The fact that we are all living to a ripe old age is something we should celebrate, but there is no doubt this will have a significant impact on our medical and social services. For some time our orthopaedic colleagues have recognised the importance of early physician care of the elderly (COE) input in patients who have suffered a fractured neck of femur. Indeed, best practice tariff for this condition is based on timely intervention and multidisciplinary assessment. This has radically driven improvement in patient outcome. We have lagged behind in emergency general surgery, but perhaps we now have the evidence base to support widespread adoption of COE input in the perioperative care of our frail patients.

WHAT IS FRAILTY AND WHY DOES IT MATTER? Frailty is a biologic syndrome of decreased reserve and resistance to stressors causing vulnerability to

John Martin Trotter Clinical Research Fellow, Scarborough Hospital Clare McNaught Consultant General and Colorectal Surgeon, Scarborough Hospital and Editor of Surgeons’ News

adverse outcomes. This is different from age, as you can be young and frail, but it most commonly occurs toward the end of life. Measures of frailty not only assess indicators of physical strength, but also consider patients’ co-morbidities and their social and psychological functioning.

Evidence from the recent National Emergency Laparotomy Audit (NELA) has shown that 90-day mortality rates following emergency laparotomy are 5.6% in those under 60 years of age, but are almost 27% in the over-80 demographic. This fivefold increase in mortality is a concern in itself, but when you consider that many of the survivors may never regain their prior level of physical function (with resulting increased social care demands), the full impact of having an emergency laparotomy on society becomes clear.

CAN COE INPUT IMPROVE CLINICAL OUTCOME IN EMERGENCY SURGICAL PATIENTS? Salford Royal NHS Foundation Trust has been one of the pioneering general surgical centres to embrace the challenge of the frail emergency surgical patient. Serving a local

Audit results from this enhanced perioperative pathway have shown a significant reduction in length of stay from a median of 12.2 days prior to the intervention to 9 days after full implementation 32 | Surgeons’ News | March 2018

population of approximately 270,000 patients, Salford has employed two consultant geriatricians to provide five sessions of direct clinical care to the surgical wards every week.

Clinical responsibility for the patient still remains with the surgical team, but they provide regular multidisciplinary input to elderly patients in the emergency and elective setting. They review every electronic patient record of each person over 74 years of age and advise on issues including poly-pharmacy to minimise drug errors. They are on hand to give advice on the management of medical postoperative complications and delirium.

Using the principles of a comprehensive geriatric assessment, they optimise the use of rehabilitation facilities and streamline discharge planning.

The team focuses on improving clinical outcomes, but also on maintaining independence and the length and quality of life.

Patients’ wishes surrounding resuscitation and end-of-life care are carefully documented during the assessment.

Published audit results from this enhanced perioperative pathway have shown a significant reduction in length of stay from a median of 12.2 days prior to the intervention to 9 days after full implementation. If this protocol was replicated throughout the

If this protocol was replicated throughout the nation, the financial and social impact could be immense nation, both the financial and social impact could be immense.

So what is stopping widespread adoption? Like all medical specialties, a workforce crisis looms in geriatric medicine. The NELA audit revealed that less than 10% of organisations are able to provide a COE in-reach service for this high-risk surgical group, despite the obvious benefits. Some units have trained advanced nurse practitioners to help backfill the gap, but at the present time we remain a long way from the goal of true multi-specialty perioperative care of the elderly patient. So is there an alternative?

PATHWAY TO BETTER CARE In 2015 the Royal College of Anaesthetists embarked on an ambitious programme to minimise the morbidity from surgery. As the largest single specialty in hospitals, anaesthetists are uniquely placed to coordinate the perioperative care of high-risk surgical patients, from the decision to operate to the months after the procedure.

Many facets of robust, highquality, evidence-based surgical care already exist in the form of enhanced recovery pathways.

Perioperative medicine takes this one step further by assessing the individual needs of each patient and ensuring the multidisciplinary specialist input is available when required.

For example, patients with rectal cancer with significant COPD may benefit from a consultant respiratory review in the preoperative phase to optimise their lung function. They may also profit from the expertise of the acute pain team, who can ensure adequate perioperative analgesia to facilitate postoperative physiotherapy, preventing bibasal lung collapse.

More than 10 million patients in the UK undergo a surgical procedure every year and over 250,000 patients are classified as as ‘high risk’ due to the nature of their procedure or because of significant co-morbidities.

Few postoperative complications are due to technical surgical error, but are likely to be related to medical conditions such as arrhythmia, venous thromboembolism or pneumonia.

The Royal College of Anaesthetists is updating its training curriculum to reflect the developing practice of perioperative medicine. In this way they will provide a workforce

Further reading Third patient report of the National Emergency Laparotomy Audit (NELA) 2017. www.nela.org.uk Perioperative medicine: The pathway to better surgical care.

Vision Document.

Royal College of Anaesthetists 2015

with the necessary breadth of skills required to best care for the perioperative patient in the UK. So what is the future for perioperative care? It is entirely possible that we may evolve to a situation where specialists in perioperative medicine manage the bulk of postoperative care, thereby releasing surgeons to focus on the technical aspects of our profession.

In the meantime, we must aspire to collaborative multidisciplinary working and focus our scarce resources on the frail, elderly patients who need it most.

Acknowledgements Thanks to Iain Anderson and the Salford team for providing details of their care pathway

rcsed.ac.uk | 33

GLOBAL

A WINDOW ON THE WORLD

Alex North reports on a demanding but educational elective in South Africa at the Charlotte Maxeke Johannesburg Academic Hospital

I

can’t deny the sense of trepidation that had set in during the weeks preceding my departure in October last year for a six-week medical elective in Johannesburg, questioning my decision to trade a sunny beach for a busy metropolis.

I felt unprepared to deal with the trauma and the working conditions I might encounter.

However, reflecting on this experience from the comfort of my desk, it was undoubtedly the greatest learning experience during my time at medical school. I spent four weeks

The resource disparity compared with the NHS was staggering

34 | Surgeons’ News | March 2018

in the trauma unit and two weeks in the plastic surgery department at Charlotte Maxeke Johannesburg Academic Hospital.

From day one I was thrust into the fray, barely having time to take in the numerous casualties strewn

Alex North finds time for some sightseeing

throughout the vastly overpopulated ward before I joined the team for my first resuscitation. During my time in Johannesburg, there was a constant disparity between staffing levels and the needs of the patients, so I had a plentiful workload to fill my shifts. My roles included assisting the team in the resus bay or emergency theatre and, when there was a brief respite in urgent cases, clerking patients to formulate management plans for the doctors to review. The experience was demanding, forcing me to develop fundamental skills. It also exposed some weaknesses in my skillset and helped me rectify them.

The hands-on experience was what attracted me to Johannesburg, and there was no shortage of it (especially during Friday and

The trauma pit was saturated with gunshots, stabbings, assaults, vehicle accidents and further peculiar injuries Saturday night-shifts). The trauma pit was saturated with the gunshot wounds, stabbings, assaults, motor vehicle accidents and numerous other injuries that people had sustained.

I frequently played an active part within the resus team, working to assess compromised airways, perform intubations, recognise and drain haemopneumothoraces, assess blood loss and determine appropriate management plans. I also had to manage fractures, reduce dislocations, assess and care for head injuries, perform CPR and much more. Working with experienced doctors, gaining exposure to a wide range of clinical scenarios and providing acute care for critically unwell patients provided invaluable clinical experience to further my academic development, and will enable me to be a safer and more skilled doctor in the future.

There were a couple of aspects to this placement that I had certainly underestimated. The resource disparity compared with the

NHS was staggering, with patients spending hours waiting to be seen and often having only the floor to lie on.

At times, when ITU was full, patients had to remain ventilated in the resus bays for days. The hospital frequently exhausted its supplies of fundamental resources, such as blood. At one point we ran out of sterile gowns and drapes. It was undeniably frustrating when the standards of patient care were compromised simply because of funding.

During my placement, I tried to follow the shift patterns of the staff,

whose hours tended to exceed 60 a week, and in the unrelenting and unforgiving unit I quickly learned the impact of such working conditions.

I am thankful for the experience, which was made possible by the generous contribution from the College through its Bursary for Elective Placements in Africa.

Both the clinical and personal development I gained from this time will enable me to improve my practice when I qualify. The placement also gave me a much greater appreciation of the NHS.

A home from home while on a trip to Cape Town

rcsed.ac.uk | 35

CAST REMOVAL

A CUT

ABOVE

Retired orthopaedic surgeon David Ross has designed the CasterpillarTM to make orthopaedic cast removal safer and more comfortable for patients and staff

M

ost upper- and lower-limb fractures are still treated by application of a cast. Plaster of Paris is often used for the initial cast and this is relatively easy to remove using plaster shears or scissors cutting the padding of a simple back-slab.

The lightweight synthetic cast materials used for longer-term fracture immobilisation, although lighter and stronger than plaster of Paris, are currently removed using a high-speed oscillating saw.

These synthetic casts have many advantages over plaster of Paris, but the removal of them can cause distress and, in some cases, abrasions or burns.

The problems associated with oscillating cast saws are well

The CasterpillarTM cast remover is quiet, safe and produces little dust

36 | Surgeons’ News | March 2018

documented: they are noisy and can be terrifying, particularly for young children. The noise prevents good communication between the clinician and the patient, and can be so loud that it affects other patients in adjacent rooms or cubicles. It has been suggested that giving the patient ear defenders will mitigate the effect of the noise, but this is likely to compromise the important communication between the clinician and the patient.

Moreover, ear defenders for the patient do not decrease the clinician’s exposure to noise.

Linear skin burns caused by a hot saw blade, most likely to occur when the saw is used by an inexperienced operator, are not common, but are distressing and probably medicolegally indefensible.

A young child can become very distressed when having a cast removed and it may not be possible for the clinician to distinguish between the anxiety caused by the appearance and noise of the saw, and actual pain caused by a hot saw blade.

The hands of the person operating the high-speed oscillating saw are likely to be exposed to a significant level of vibration. Vibration exposure has been linked to hand arm vibration syndrome (HAVS or vibration white finger) and carpal tunnel syndrome. The dust produced

by the saw has to be collected by a large and noisy vacuum extractor, as this dust may be harmful if inhaled.

All of these problems are well recorded in the medical scientific literature. Once the synthetic cast has been cut with the saw, the stockinet and under-cast padding are removed using scissors.

While working as an orthopaedic surgeon in Stirling, I contacted Scottish Enterprise, who introduced me to George Miller, an electronics engineer. We formed Ross Wark Medical Ltd to design and develop a cast-removal device that would be quieter and safer for both the patient and the operator.

We used smart prototyping techniques, including the use of computer-aided design and manufacture and 3D printing, and launched the CasterpillarTM in 2014.

A powered shear rather than a saw, the Casterpillar is quiet, produces

little vibration and virtually no dust. It simultaneously cuts through the synthetic cast material, the stockinet and under-cast padding and so is probably quicker at removing a cast than a cast saw.

It is quiet and does not look like a circular saw, so is unlikely to produce an anxiety reaction in patients.

The Casterpillar is likely to be more economical than a cast saw, as it doesn’t require regular replacement of blades, vacuum filters and tubing.

A limited number of the first version of the Casterpillar have been in use in hospitals in Scotland

The Casterpillar helps make cast removal less noisy and distressing

It simultaneously cuts through the synthetic cast material, the stockinet and under-cast padding and so is probably quicker than a cast saw

and England since 2015, with very positive feedback from the clinicians.

Since retiring from clinical practice, I have been able to concentrate on the further development of the Casterpillar, which now has UK, US, Canadian and German patents.

With help from Business Gateway, we successfully applied for funding from Scottish Enterprise to improve the Casterpillar cast cutter.

Electronic technological advances enabled us to use a smaller, lighter, but more powerful, motor and we were able to simplify the control switches and low-voltage power supply unit.

Our second-generation Casterpillar cast cutter is lighter, easier to use and has a significantly better cutting performance. This was demonstrated at the Association of Orthopaedic Pracitioners Conference in Warwick in 2017.

Our website shows me removing a synthetic cast with the Casterpillar at the Orthopaedic Trauma Alliance Conference in Leicester, and also has references and more information.

We also demonstrated the Casterpillar at MEDICA (a major international medical trade fair) in Dusseldorf in 2017, and at hospitals in Scotland and England. A Casterpillar is currently being demonstrated in Atlanta, Georgia, US. We do not anticipate that the Casterpillar will be able to replace every cast saw, as they will still be required for very thick casts, such as a long-leg cast for a large adult.

However, we hope that most patients, particularly children and the frail elderly, will benefit from having casts removed quietly and safely by a Casterpillar.

For further information, visit rosswarkmedical.co.uk rcsed.ac.uk | 37

TRAINEES AND STUDENTS

HIGH FIVE

Gita Lingam shares her top tips for maximising clinical experience as a student

M

edical school flies by. While trying to juggle your assigned work with a social life, it can sometimes feel overwhelming to even consider polishing your CV to help advance your future career. After almost six years of medical school, completing several audits and research projects, and presenting my work throughout the country, I have compiled my top five tips to making the most of your time at medical school.

Gita Lingam Final-year medical student, University of Birmingham

Be the YES (wo)man

1

Opportunities will not fall into your lap. You need to actively seek and engage in the new ventures that surround you every day. This involves everything from volunteering in your teaching sessions to saying “yes” when offered an audit. The more you say “yes”, the quicker you will realise that you have started to build a repertoire of skills, projects and contacts.

If you have completed an audit or research project, you’ve done the majority of the work! Don’t forget to reap the benefits by presenting your work at local, regional or national conferences. You will often find this information online, advertised in career-specific journals or in your local university bulletin.

Be persistent

2

Persistence comes more naturally to some than others, but it is a vital skill to learn. You will often find that clinicians offer projects, but don’t seem to follow

Interviewers want to see a well-rounded future doctor 38 | Surgeons’ News | March 2018

through with anything concrete. At this point, most medical students will not even attempt to chase this up.

From personal experience, I can say this is a huge mistake. Clinicians are busy people and the lack of an email or phone call is often due to nothing more than not enough hours in a day.

Make the effort to contact them.

This will show your enthusiasm for the venture and demonstrate to the clinician that you have a mature attitude to undertaking and completing the project.

Scrub up for theatre

3

I understand this is a daunting task for some medical students but the more you do it, the better you will become and the more relaxed you will feel being in theatre. Here are a few key tips to help you start: l Identify the surgical procedure beforehand and read up on what it entails. l Arrive promptly and introduce yourself to the team. l Let the surgeon know you are interested in a surgical career and ask to scrub in. l Scrub nurses are your friends!

Explain at the start that you want

to learn how to scrub up and ask politely if they will talk you through how to do it.

Network

4

Don’t think of networking in the traditional sense of the word.

Networking can happen anywhere: in clinics, teaching sessions and wards, as well as at conferences and career events. Several of my audit and research projects have stemmed from simply talking to clinicians about their current work and expressing an interest in getting involved. I am now part of a team working on a medical education app, Pod Doc, which is a library of short podcasts to help medical students revise – this all began with a conversation in a corridor.

Do things you enjoy

5

Remember building a good CV is not just about clinical and academic work.

Interviewers want to see a wellrounded future doctor who knows how to manage his/her time and realises that often non-clinical pursuits can be a good way to de-stress. Your local medical society can be a good place to start.

HUNTER DOIG MEDAL Applications are invited from female Fellows and Members for this year’s award This silver medal is awarded every second year to a female Fellow or Member of the Royal College of Surgeons of Edinburgh who, in the opinion of Council, demonstrates career potential and ambition, as well as: High standards of practice in terms of “good surgical practice” Clinical excellence Ongoing contribution to education and training Clinically based research and audit Laboratory research of direct clinical relevance

Applicants may self-nominate or be proposed by a colleague, board, committee or other body recognised by the College. Applications must be accompanied by a full CV and supported by three referees – two surgeons and one who is not a surgeon. Written references should be submitted at the time of the application.

Applications in the first instance should be submitted to Mrs Irene MacDonald, PA to the Chief Executive, Royal College of Surgeons of Edinburgh, Nicolson Street, Edinburgh, EH8 9DW or by email to i.macdonald@rcsed.ac.uk by Friday 18 May 2018.

Membership Exams The Royal College of Surgeons of Edinburgh has been the professional home for surgery and dentistry for more than 500 years. All through that time, we have never wavered from our commitment to advance surgical excellence through education, training, examination and assessment.

For surgical and dental trainees, by choosing to sit your MRCS or MFDS examinations with the Royal College of Surgeons of Edinburgh, you are joining our membership network of approximately 25,000 professionals in more than 100 countries worldwide, and a College that is committed to support you through every step in your career and professional development.

The MFDS Exam The Diploma of Membership of the Faculty of Dental Surgery (MFDS) is an internationally recognised dental qualification that demonstrates completion of foundation/basic postgraduate dental training. The College offers the examinations at a variety of locations throughout the UK and internationally, from Abu Dhabi to Trinidad.

The MRCS Exam The Membership Examination of the Surgical Royal Colleges of Great Britain and Ireland (the MRCS) is a crucial milestone in a surgical career. The College offers the examinations at a variety of locations throughout the UK and internationally, from Belfast to Riyadh.

NEW! MFDS Part 1 Revision Course Aimed at dental foundation trainees, this course aims to provide an understanding of the breadth of knowledge required for the MFDS examination.

The College also hosts a wide range of preparation courses and events to ensure trainees feel confident and equipped for sitting this significant exam.

MFDS Lectures The College runs MFDS evening lectures throughout the year across the UK, with intercollegiate MFDS examiners providing a unique insight into the examination.

MRCS OSCE Preparation Course This course uses a combination of presentations, discussion groups, practice sessions and individual feedback given by tutors who are experienced in the MRCS exam.

Chennai, 9–10 April 2018 Edinburgh, 7–8 April 2018; 8–9 September 2018 Aberdeen, 8–10 April 2018 Manchester, 21–22 April 2018 MRCS Lectures The College runs MRCS evening lectures throughout the year across the UK. These provide an informal insight into the examination with particular focus on the Part B OSCE. Cardiff, 13 February 2018 Oxford, June 2018 (TBC) Further locations and dates are to be announced in spring 2018

Edinburgh, 23 February 2018 Birmingham, 31 August 2018

Sheffield, February (date TBC) Bristol, 14 February 2018 Birmingham, 20 March 2018 Peninsula, 28 June 2018 Join our RCSEd Affiliate Networks and receive discounts on our preparation courses Affiliation is available for both surgical and dental undergraduates, costs from just £15 per month and has a range of benefits, including: Discounted fees on relevant courses and events in the UK Access to bursaries and grants Access to exclusive educational resources, including webinars, reports, posters, videos of lectures, Acland Anatomy and more Career advice and professional support

TRAINEES AND STUDENTS

MORAN APPOINTED COMMITTEE CHAIR

New appointee is keen to keep trainee voices at the heart of College activities

T

he College’s Trainees’ Committee is the main conduit for ensuring that the views of trainees are considered in all aspects of the College’s activities, and plays a key part in ensuring that the opinions and priorities of the trainee membership are delivered directly to RCSEd Council through its elected representative. In November 2017, Michael Moran was appointed Trainee Member of Council and Chair of the Trainees’ Committee.

Commenting on his role and what the RCSEd does for its trainee membership, Moran said: “The RCSEd Trainees’ Committee is a key part of the College fabric and, since its inception, it has become a really important player in the

The Trainees’ Committee is part of the College fabric

surgical training landscape, both locally and globally. As health services across the UK and beyond continuously change and adapt to the political structures in which they operate, the challenges to maintain excellence in surgical training and first-class patient care become ever more complex.

“Having trainee voices at the heart of the College’s strategies and activities ensures that the RCSEd is always ready to react and adapt. That said, as the oldest and largest Royal College of Surgeons, being a Member of RCSEd connects one to a real sense of the heritage, tradition and prestige of College alumni over the last six centuries.

“We recently did a call-out for nominations for new members of the Trainees’ Committee, and I would urge those who are passionate about driving change, improving training and promoting excellence in patient care to get involved.

Above: Some of the members of the Trainees’ Committee Below: Michael Moran, new Chair of the Trainees’ Committee

“In the next few months, we have several events with a trainee focus, including the RCSEd 17th Annual Audit & QI Symposium (21 March) and the College’s flagship Triennial Conference (22–23 March).

“So the Trainees’ Committee will be out and about – we are looking forward to seeing you soon.”

Moran, from Belfast, is an ENT/Head and Neck Surgery Registrar, and is currently on a year out of programme while working in the pharmaceutical industry. He will serve as Chair of the Trainees’ Committee until November 2019.

Moran was previously employed by the National Institute for Health Research as an Academic Clinical Lecturer at University College London, and as a Specialist Registrar (ST7) in Otorhinolaryngology/ Head and Neck Surgery at the Royal Marsden NHS Foundation Trust. rcsed.ac.uk | 41

TRAINEES AND STUDENTS

Trainees represent future leaders when it comes to driving quality improvement, research and progress.

ASiT aims to develop surgeons to be their best

S

urgical training needs to produce surgeons who can deliver the highest-quality care to patients. Despite falling competition ratios, surgery still attracts high-calibre candidates with huge potential and it is vital that these aspiring surgeons are nurtured to become top of their game. There are a number of ways to achieve this.

Address the barriers Barriers to trainees achieving their potential include unconscious gender bias, ethnicity, social class, trainee morale and bullying.

These issues will be addressed during the Association of Surgeons in Training (ASiT) conference in April (see right), with particular reference to the session on equality and

42 | Surgeons’ News | March 2018

N Rajaretnam, N Walker, J Glasbey, HM Mohan

diversity. This is especially relevant given emerging data on the cost of surgical training and the challenges faced by pregnant trainees.

ASiT supports initiatives by the RCSEd to address bullying and morale, as well as the #hammeritout campaign by the British Orthopaedic Trainees’ Association. Solutions will be developed further at the upcoming conference.

Build relationships Training infrastructure, along with the appropriate trainee–trainer contact, is essential. Since the dissolution of the ‘firm’ structure in many hospitals following the Medical Training Application Service and the European Working Time Directive, the time trainees spend with their trainers has been cut significantly.

Enhance learning The ASiT conference will enable trainees to augment their clinical learning, including technical courses such as cardiothoracics, laparoscopic skills and orthopaedics, as well as non-technical courses such as leadership and non-technical skills for surgeons.

There will also be questionand-answer sessions hosted by the presidents of the Surgical Royal Colleges, the GMC, the Joint Committee on Surgical Training and the Intercollegiate Surgical Curriculum Programme. These will focus on the institutional aspects of training.

The Improving Surgical Training (IST) pilot project from the Royal College of Surgeons of England, which is being rolled out from August, will be the focus of a panel discussion to debate controversial aspects such as the role of the wider surgical team, run-through with benchmarking and deliverability.

ASiT advocates that the endpoint of surgical training – the Certificate of Completion of Training (CCT)

KATIE EDWARDS/IKON

NURTURING EXCELLENCE

This was the subject of the recent Faculty of Surgical Trainers conference in Birmingham. It was clear from feedback that, for instance, intelligent design of rotas and engagement with management are crucial to improving training.

– must not be diluted and the IST project has taken this on board.

There will also be a trauma symposium at the conference, with speakers on managing civilian trauma and mass casualties to educate trainees about this important topic.

Recruit and retain excellent trainees To nurture excellence, we must recruit and retain exceptional juniors. Projects such as the RCSEd’s national Student Surgical Skills Competition and ASiT’s ‘Battle of the medical student surgical society’ are imperative. The ASiT conference will give medical students the chance to engage with trainees from the surgical specialty they are interested in.

Focus on research Surgical research is a cornerstone of surgery. More than 30 prizes from specialty associations will be awarded at the conference, as well as the prestigious ASiT medal.

ASiT Conference ‘The pursuit of excellence in surgical training’ is ASiT’s motto and the theme of this year’s conference (6 to 8 April at the RCSEd) is #nurturingexcellence. For more information, visit asit.org

Trainees can also meet the editors of leading surgical journals to discuss ways to ensure quality research and tips for publishing their work.

Trainees with a specific interest in developing research skills may be interested in the ASiT Research Skills pre-conference course (see www.asit.org/events/2018-asitconference/pre-conference-coursesasit-conference-2018/evt1222).

Prepare for a career It is vital that consultant posts remain attractive and viable for trainees, so these will be highlighted in a session for senior trainees at the ASiT Conference: Getting ready for your consultant career. This will be beneficial for those nearing CCT and for trainees who want to future-proof themselves earlier in their careers.

Being a surgical trainee can be immensely satisfying despite the challenges entailed. We must continue to foster superior training as well as nurture excellence for our patients, future colleagues and ourselves. The ASiT conference hopes to nurture excellence among medical students and surgical trainees.

To nurture excellence, we must recruit and retain exceptional juniors

The award goes to …

To celebrate inspiring trainers, ASiT aims to award its 17th Silver Scalpel winner at the conference gala dinner in Edinburgh. Over the past decade, the prestigious Silver Scalpel Award has played a vital part in recognising trainers and promoting high standards of surgical training.

This year, we will also announce the Silver Suture, a new award for the trainee who is the best trainer of the year, supported by the Faculty of Surgical Trainers.

TRAINEES AND STUDENTS

PICK OF THE POLL

Michael Moran examines key findings from the GMC’s annual survey on postgraduate education and training

T

he GMC does a yearly survey to monitor and report on the quality of postgraduate medical education and training in the UK. All doctors in training and trainers are asked for their views, which are then collated into an annual report. This year’s report, GMC training environments 2017: key findings from the national training surveys, has interesting findings and implications for the surgical specialty.

Thirty per cent of trainers felt that their job plans required further time for their role as an educator and 50% reported that they worked beyond their rostered hours on a weekly basis. Positively, most surgical trainers felt they received good support from their deanery/ Local Education and Training Board (LETB), although 66% reported the intensity of their workloads as ‘heavy’ or ‘very heavy’.

The results show that trainees across all specialties generally rated the quality of their training as ‘good’ or ‘very good’, despite high workloads being reported by just over 40% of trainees, who rated the intensity of their workload as ‘heavy’ or ‘very heavy’.

One issue highlighted is rota design, with only 40% of trainees agreeing that rota design in their department helps to optimise trainee doctors’ education and development.

Additionally, less than 60% of

Michael Moran Trainees’ Committee Member of Council

Trainees across all specialties generally rated the quality of their training as ‘good’ or ‘very good’ 44 | Surgeons’ News | March 2018

trainees rated the encouragement they received to take study leave as ‘good’ or ‘very good’. It is clear that while most trainees feel their training is of high quality, there are pressures from high workloads and rota design, which could be improved to enhance trainees’ experiences.

Another area the report focuses on, particularly within surgery, is less than full time (LTFT) working.

Of those trainees who worked on an LTFT basis, 91.2% were female and childcare was given as the main reason for LTFT working for the majority (77%). Surgery has one of the lowest proportions of LTFT trainees across all specialties (3%). Only 32% of surgical trainees ‘agreed’ or ‘strongly agreed’ that they felt their request for LTFT working would be supported by their deanery/LETB, and surgical trainees were also less likely to believe that their specialty would support them to work on an LTFT basis than those in other specialties.

Bullying and undermining are still causes for concern, which RCSEd is

committed to tackling following the results of previous GMC surveys.

Surgery had the second highest number of reports of bullying and undermining from doctors in training. GMC analysis shows that a victim or witness to bullying and undermining behaviour is 10% more likely to state that they will not be continuing in their current training programme in one year’s time, which has repercussions for the retention of trainees. Worryingly, the majority of respondents who stated they had been a victim or witness of such behaviour did not want to report it through the survey, mainly because they did not believe reporting it would make a difference and may lead to adverse consequences. The need for RCSEd’s approach to tackling bullying and undermining is clear and the Trainees’ Committee will continue to play a vital part in influencing change.

The issues raised in the survey will be a focus of the Trainees’ Committee throughout 2018 and updates will be provided on their work over the next year.

BAHRAIN PREPARES FOR MPDC EXAM College works with tutors in Bahrain to develop residents’ dental skills

A

preparation course for the Conjoint Membership in Primary Dental Care (MPDC) examination was held in Bahrain on 26 and 27 August 2017. This was a brand-new course designed to develop the residents’ skills in diagnosis, treatment planning and clinical judgement.

Lead examiner for MPDC Professor Helen Craddock and examiner for MPDC Dr Anil Shrestha were welcomed by the

Twenty-three residents joined Helen Craddock and Anil Shrestha on the two-day programme

dedicated and knowledgeable Bahraini tutors, who were keen to work with the College to develop the skills of their residents to the highest standards. They were also very interested in the new MAGDS examination.

Twenty-three residents attended the two-day programme, which was delivered as a combination of presentations and role-play examples to illustrate principles from the presentations and a mock examination.

There was much positive feedback from both the tutors and residents on the course. They said the workshop was very beneficial, and gave them good information on how to study and how to prepare for the exam.

They added: “The lecturers had an outstanding approach in presenting such an eye-opening workshop.”

They also said “the presentation was systematic and excellent” and that the mock exam was “extremely coordinated and helpful”.

It is our intention to continue to develop support programmes

for all the Primary Dental Care examinations, both in the UK and internationally, and we are keen to continue to develop our great relationship with the Bahrain Residency Training Programme.

rcsed.ac.uk | 45

DATES FOR YOUR DIARY The latest surgical and dental events, seminars and courses FEBRUARY 21 RCSEd Cadaveric Intermediate Open Abdominal Surgery course 22 RCSEd Cadaveric Major Open Abdominal Surgery course 23 MFDS Part 1 Revision course MARCH 1–2 Basic Surgical Skills 5 Thyroid and Parathyroid Masterclass (Birmingham) 8–9 Basic Surgical Skills (Birmingham) 8–9 Training the Trainers (Birmingham) 10 22nd Annual Conference for Dental Care Professionals 12–14 Edinburgh Hand Surgery 17 Preparation Course for the Membership in Special Care

Dentistry (Birmingham) 17–20 Scottish Surgical Bootcamp (Inverness) 21 The 17th Annual Audit & QI Symposium 22–23 Triennial Conference – the Modern Surgical Team: the Future of Surgery

APRIL 4–6 A Preparation Course for Examinations in General Surgery 7–8 The Edinburgh MRCS OSCE Preparation Course 8–10 The Aberdeen MRCS OSCE Preparation Course (Aberdeen) 9–10 The Edinburgh MRCS Preparation Course (Chennai) 10 Preparation for the Diploma in Implant Dentistry

10 MRCS Anatomy Revision Day (Plymouth) 11–12 ENT Update Course (Malaysia) 13 Plastering Techniques for Fracture Treatment 13 Non-Technical Skills for Surgeons (NOTSS) (Newcastle) 14–15 Basic Surgical Skills (Manchester) 18–19 Emergency Abdominal & Thoracic Surgery for the General Surgeon 20 Perioperative Key Skills Course 20 Non-Technical Skills for Surgeons (NOTSS) (Leeds) 21–22 The Edinburgh MRCS OSCE Preparation Course (Manchester) 27 Tri-Collegiate Membership in

Paediatric Dentistry Examination Preparatory course 30 Musculoskeletal Course MAY 2–4 Core Skills in Orthopaedic Surgery 2–3 Edinburgh MRCS OSCE Preparation Course (Kuching) 9–11 ATLS 12 Future Surgeons: Key Skills (Manchester) 13 Future Surgeons: Key Skills (Manchester) 15 Basic Skills in Paediatric Surgery 17–18 Complete Ear Surgery 18 NOTSS 24–25 Basic Surgical Skills 29–31 Surgical Approaches to the Spine

For further information, visit rcsed.ac.uk/events-courses, email education@rcsed.ac.uk or telephone +44 (0)131 527 1600. Unless otherwise indicated, events are in Edinburgh

DENTAL

IT: for better or worse?

Fraser McDonald explores the issues surrounding data privacy and information technology

W

e work in a world where significant governance policies, including passwords and encryption, are used to manage and protect patient data and information.

However, as with everything, there are also disadvantages.

With the increased speed of computing, internet connectivity and storage capacity, there have been superlative changes in technology when it comes to laptops and mobile phones. This has led to an explosion of accessible data, with the opportunity to copy and store information more easily.

In parallel, health organisations are reducing secretarial costs. Those trained in healthcare delivery are responsible for their own administration and, by extension, need probity and integrity (bound together in the elusive and contextual word ‘professionalism’) when it comes to personal data.

The rule of professionalism applies to all healthcare specialists across an organisation.

Changes in working conditions, such as openplan office spaces and easy access to data, make privacy particularly important.

Within all NHS Trusts, software packages are being developed for different uses, which require various protocols and, inevitably, different login credentials and passwords. In several Trusts, special investigations such as radiographs require at least four distinct software systems: one to order and justify a request, one to view a plain film, one to view a complex 3D image and a fourth to share with other hospital trusts.

This excludes the software required if a letter has to be dictated to another health professional, and authorised and sent.

This strikes a stark contrast with the film images of 20 years ago, which were often the only image available. If lost, it meant adverse consequences for the patient such as a second exposure or loss of diagnostic information.

Today, images are excellent, there is more than one copy and there is a clear paper trail, which can be shared.

An analogy: similar to software development, it’s much more powerful than the previous individual programs.

Not so long ago, there were at least five software programs with spreadsheet capability. Now we recognise Excel™ as the major marketplace representative.

Yet software within NHS organisations seems to be plagued by access to images. Protocols vary: some are changed every two to three months, while others do not have such a requirement. Most clinicians would undertake as much off-site work as necessary to support the patient-care journey provided access was relatively straightforward.

It would be interesting to audit trusts and their IT helplines or online help desks to establish what percentage or number of password queries there are in a one-year period. Yet there is no clear indication that even high-level organisations (apologies to my dental colleagues) such as the Government Communications Headquarters have the confidence in humans’ ability to manage complex password protocols.

Perhaps a risk register needs to be part of IT security measures. What’s the harm in an unauthorised person seeing a radiograph of a tooth? Or would there be consequences?

Professor Fraser McDonald Dean, Faculty of Dental Surgery

Perhaps a risk register needs to be part of IT security measures www.rcsed.ac.uk rcsed.ac.uk || 47

DENTAL

Dublin’s top three

Birmingham heat

Vignesh Eswara Murty, winner at Trinity College Dublin

/ COMPETITION

Dentsply Sirona Skills Competition in full swing

R

unning for the fourth year, heats for the 2017/18 RCSEd Dentsply Sirona Dental Skills Competition are well underway.

Final-year dental students from all over the UK and Ireland were asked to showcase their skills by preparing a metal ceramic full crown preparation for a maxillary canine tooth.

Preparations were then marked against each other and the winning entry from each school was

48 | Surgeons’ News | March 2018

Rhonan Green, Birmingham winner

allocated a place in the Grand Final in Edinburgh.

To date, 15 heats have taken place at Queen Mary University of London, Sheffield, UCLAN, Cork, Birmingham, Plymouth, Manchester, Bristol, Newcastle, Belfast, Dublin, Glasgow, Liverpool, Cardiff and Dundee.

We are looking forward to welcoming the following

finalists to the College in March: Jed Lee, Queen Mary University of London; Ashish Parmar, University of Sheffield; Rowan Glossop, University of Central Lancashire; Shannon Godfrey, Cork University Dental School; Rhonan Green, University of Birmingham; Rumandeep Dhillon, Plymouth University; Joe Reid, Newcastle University; Catherine Black, Queen’s University Belfast; Vignesh Eswara Murty, Trinity College Dublin; Ammar Zaki, University of Liverpool; Kieran Walker, Cardiff University and Iain Ogilvie, University of Glasgow.

/ COLLECTIONS

Toothy tales from the 1700s John Menzies Campbell, a dental surgeon in practice in Glasgow, was a renowned dental historian and avid collector of historical dental instruments and pictures. In 1966, he donated this collection to the RCSEd and it formed the basis of the much-acclaimed Menzies Campbell Dental Collection within the College’s Museum.

A coloured engraving from the collection entitled ‘Transplanting of Teeth’ by Thomas Rowlandson (1756–1827) illustrates a procedure that was popular towards the end of the 18th century.

The central figure of the people portrayed is the fashionable dentist Chevalier Bartholomew Ruspini (1728–1813), dentist to the Royal Household.

Ruspini graduated in surgery in his home town of Bergamo, a city in the Republic of Venice. He then studied dentistry in Paris, the leading centre of dental education in Europe, before settling in London in 1766, where he practised in St Albans St, Pall Mall.

In London, he was a fashionable dental practitioner as well as surgeon, and was dentist to the Prince of Wales, later George IV. Public success frequently brings critical comment and in the latter

A coloured engraving from the ‘Transplanting of Teeth’ collection

part of the 18th century this often took the form of cartoons that lampooned the subjects.

On the wall behind the figures in the engraving is a certificate (barely readable) that states “Baron ..ini... Surgeon Dentist to Her High Majesty Empress of Russia”.

The central figure is removing a tooth with an extraction key from a chimney sweep who is sitting on a very clean chair. A lady of ‘quality’ is watching the operation apprehensively, having had a tooth extracted. Shortly, a tooth from the sweep’s jaw will be inserted into her bleeding socket.

An assistant is extracting a tooth from another lady, while a gentleman admires his newly transplanted teeth in a mirror.

In a part of the engraving not shown below, going out of the door are a boy and a girl, the boy in obvious pain after having had a tooth extracted while the girl ruefully looks at the few coins she was given, which fall short of the notice on the door which reads “Best prices paid for live teeth”.

The procedure of tooth transplantation just did not work – hence the cartoon.

/ ONLINE

Diploma in paediatrics The first intake of RCSEd’s new online Diploma in Paediatric Dentistry commenced in November 2017. This exciting and innovative one-year online programme is the first of its kind to be offered by a Royal College and is open to dental therapists and graduates in oral health sciences.

A further online Diploma in Implant Dentistry is in development and is expected to be launched this year. / QUALIFICATIONS

By Paul R Geissler

New locations for MFDS The College’s Faculty of Dental Surgery is expanding its portfolio, adding Leeds as a new location for the MFDS Part 2 Exam. The Diploma of Membership of the Faculty of Dental Surgery is an internationally recognised dental qualification that demonstrates completion of foundation/basic postgraduate dental training and clearly exhibits an early commitment to professional development.

Part 1 and Part 2 of the MFDS Exam is run by the College in various diets across the UK and internationally, with the MFDS Part 2 portfolio expanding in the UK to Edinburgh, London, Sheffield and Leeds.

rcsed.ac.uk | 49

DENTAL

REGIONAL DENTAL ADVISERS IN YOUR AREA The Faculty of Dental Surgery’s support and advice network throughout the UK and Ireland SCOTLAND

NORTH EAST OF SCOTLAND 1 Martin Donachie, Aberdeen Royal Infirmary

1

TAYSIDE 2 Pauline Maillou, Dundee Dental School 2

WEST OF SCOTLAND 3 Kurt Busuttil-Naudi, Glasgow Dental Hospital and School

3

ENGLAND

EAST OF ENGLAND 4 Simon Wardle, James Paget University Hospital, Great Yarmouth KENT, SURREY & SUSSEX 5 Lindsay Winchester, Queen Victoria Hospital, East Grinstead

16

NORTH WEST OF ENGLAND 6 Callum Youngson, School of Dentistry, Liverpool

15

NORTH LONDON 7 Phil Taylor, Barts and the London School of Medicine and Dentistry, London

6

12

NORTH EAST LONDON 8 Nick Lewis, UCL Eastman Dental Institute, London NORTH WEST LONDON 9 Sumithra Hewage, Northwick Park Hospital, Harrow 10 Kashif Hafeez, City of London Dental School, BPP University

4 11 10 7 9 8

OXFORD 11 Mary McKnight, John Radcliffe Hospital, Oxford SOUTH YORKSHIRE/EAST MIDLANDS 12 Philip Benson, Charles Clifford Dental Hospital, Sheffield

13 14

SOUTH WEST OF ENGLAND 13 Pamela Ellis, Dorset County Hospital, Dorset PENINSULA 14 Ewen McColl, Peninsula Dental School, Plymouth YORKSHIRE 15 Brian Nattress, Leeds Dental Institute, Leeds

NORTHERN IRELAND

16 Gerald McKenna, Queen’s University Belfast

50 | Surgeons’ News | March 2018

RDA VACANCIES

Dundee Liverpool London Manchester North West of England Republic of Ireland Wales

5

Travelling Fellowships

Applications invited The Alban Barros D'Sa Memorial Travelling Fellowship in General Surgery The Sir James Fraser Travelling Fellowship in General Surgery

The Cutner Travelling Fellowship (Orthopaedics) Joint RCSEd/SOMS Shanghai Head and Neck Fellowship

DENTAL

CROWNING ACHIEVEMENT

Hannah Crane reports on life after winning the first Dental Clinical Skills Competition

W

inning the first Dental Clinical Skills Competition was a real privilege and I can’t believe almost four years have passed since then.

Taking part in the competition was a fantastic experience. The heats had a friendly, relaxed atmosphere and were an excellent opportunity to practise technical skills. The final itself in the beautiful city of Edinburgh was exciting. There was a real sense of camaraderie between all the participants from dental schools across the country, and all the representatives from the College and Denstply Sirona were extremely friendly.

I enjoyed the challenging stations that tested a wide range of skills.

The standard of competition was very high and I was delighted and surprised to be announced the overall winner.

It was a great opportunity to meet students from across the country, along with Members and Fellows of the Faculty of Dental Surgery, giving me an insight into future career options. Participating was a very positive experience and it was one of the highlights of my final year at university – I would recommend it to all dental students.

Nearly one year after winning, I was excitedly packing my bags to attend the Chicago Dental Society

52 | Surgeons’ News | March 2018

Hannah Crane shows off her skills in the final of the first ever Dental Clinical Skills Competition

Midwinter conference. Since the competition, I had graduated from dental school and at the time was enjoying working as a Dental Foundation Trainee in practice.

I was really looking forward to the experience, as the Chicago Midwinter Conference is a worldrenowned dental scientific meeting, and I was certain I would pick up advice and skills that would aid me in my career.

On arriving in Chicago, I checked into the hotel and made my way to the conference. The size of the event was incredible and the programme had so many excellent courses to choose from that I was spoilt for choice.

I decided to attend courses on a variety of topics, including endodontics, oral medicine, gerodontology and fixed prosthodontics. These were

The competition is an excellent opportunity to practise skills, network with colleagues and find out what the College can offer

all given by world-renowned speakers and it was very inspiring to hear their advice. I learnt a significant amount about new advances in dentistry, both innovative clinical techniques and state-of-the art materials. I gained great insight into new techniques and an appreciation of the challenges we face treating an ageing population who are keeping their teeth for longer, and have more complex medical and dental needs. The whole conference was inspiring and I went home with a renewed excitement for all the advances in dentistry.

Since then, I have enjoyed 18 months in Dental Core Training in a variety of specialties, including restorative, oral surgery, and oral and maxillofacial surgery, which were all excellent posts and enabled me to develop skills and decide on a future career pathway.

I also completed the Membership of the Faculty of Dental Surgery, taking Part One of the exam in the autumn after qualifying and Part Two a year after that.

The positive experience of the Dental Clinical Skills competition certainly influenced my decision to take the examinations

Above: Hannah Crane visited Chicago for the Dental Society Midwinter Conference Below: Professor Richard Ibbetson congratulates Hannah on winning the competition

through the College, which I didn’t regret. The examinations were fair, but also very friendly. I am now a member of the Faculty of Dental Surgery, which I have found useful in my career – its extensive library and online anatomy resources are invaluable.

I am currently an Academic Clinical Fellow in oral pathology, undertaking specialist training alongside academic training. Part of this role involves a teaching commitment and I am now doing a Postgraduate Certificate in Teaching and Learning. I am really enjoying my current post and definitely feel winning the Dental Clinical Skills Competition has boosted my CV and helped my career so far. The competition is also an excellent opportunity to practise skills, network with colleagues and find out what the College can offer.

It’s fantastic that the College and Dentsply Sirona continue to provide this opportunity for final-year dental students. I thank them for the opportunities it has given me and I would encourage all final-year dental students to take part and enjoy the experience. rcsed.ac.uk | 53

COLLEGE INFORMATION

DIPLOMA CEREMONIES Congratulations to all our new Fellows and Members who were presented with diplomas at ceremonies in Edinburgh and Myanmar FRIDAY 13 OCTOBER 2017 Admission to Fellowship Ad Hominem Captain Martin Bromiley OBE, airline captain and Founder and Chairman of Clinical Human Factors Group Professor Randall Morton, Honorary Professor of Otolaryngology, Head and Neck Surgery, University of Auckland; Consultant Otolaryngologist, Head and Neck Surgeon, Counties Manukau Health; and Visiting Laryngologist/Head and Neck Surgeon, Auckland District Health Board, New Zealand Award of Fellowship in Dental Surgery Without Examination Dr Donald B McNicol FDS RCSGlasg FFGDP, General Dental Practitioner, Stenhousemuir Diploma of Fellowship in the Specialty of Cardiothoracic Surgery Vamsidhar Bharadwaz Dronavalli, University of London Diplomas of Fellowship in the Specialty of General Surgery Sumanta Dutta, University of Burdwan, India Fiona Elizabeth Langlands, University of Leeds Hammad Raza Sheikh, University of the Punjab, Pakistan Sumit Kumar Sood, University of Calcutta, India Nathan Andrew Stephens, University of Edinburgh Diplomas of Fellowship in the Specialty of Trauma and Orthopaedic Surgery Omar Ali Abouazza, National University of Ireland Fouad Ahmed Chaudhry, University of the Punjab, Pakistan Simon James Harrison, University of Dundee

54 | Surgeons’ News | March 2018

Muhammad Munir Ahmed Khan, University of Peshawar, Pakistan Intercollegiate Diplomas of Membership in Surgery in General Mohamed Elfatih Elgainad Abdelmagid, University of Khartoum, Sudan Ahmed Elamin Elsadig Abdulmanan, Bukovinian State Medical University, Ukraine Rahul Dhar, West Bengal University of Health Sciences, India Mohamed Faisal Hassan Elsheikh, University of Khartoum, Sudan Mohamed Hassan Gendil, Al Fateh University, Libya Mohamed Ansar Mohamed Ashiq Jabir, Manipal University, India Mohamed Albagir Ahmed Mohamed, Upper Nile University, South Sudan Waleed Riaz, University of Health Sciences, Lahore, Pakistan Reem Saad, University of the Punjab, Pakistan Karl Walsh, University of Manchester Sarah Mohamed Abdalrahim Yassin, University of Khartoum, Sudan Shahbaz Zafar, National University of Sciences and Technology, Pakistan The Lister Medal in Surgical Sciences 2016–2017 Awarded to the highest-placed graduate of the MSc in Surgical Sciences programme during an academic year James John Moss Loan, University of Edinburgh Diploma in Immediate Medical Care Rachel Samantha Hawes, Newcastle University Diplomas of Fellowship in Dental Surgery Without Examination (By Application) Ritul Agarwal, Manipal University, India Ailsa Margaret Morrison, University of Dundee

Diplomas of Fellowship of the Faculty of Dental Trainers Paul David Blaylock, Newcastle University Fiona Ruth Ellwood, National Certificate in Dental Surgery Assisting Diploma of Membership in Orthodontics Shabeena Abdul Kader, Rajiv Gandhi University of Health Sciences, India Awadh Bark Awadh Abood, Cairo University, Egypt Meshari Ams Al Nafisi, Ajman University, United Arab Emirates Jaclyn @ Marilyn George, University of Malaya, Malaysia Gayatri Mago, Maharashtra University of Health Sciences, India Khaled Medhat Mohamed Morsi Mohamed, Cairo University, Egypt Tusar Kanti Nayak, Utkal University, India G C Ramesh, Rajiv Gandhi University of Health Sciences, India Ka Wai Frank Wong, University of Hong Kong Muhaini Binti Yakob @ Yaacob, Universiti Sains Malaysia Diploma of Membership in Primary Dental Care Christian Daniel Pirlog, Technical University of Cluj-Napoca, Romania Diplomas of Membership of the Faculty of Dental Surgery Ahmed Maged Youssef Mohamed Abdou, Mansoura University, Egypt Andrea Agius, University of Malta Elaine Lee-Ying Dang, University of Birmingham Ardalan Eghtedar, University of Liverpool Eleanor Maria Haywood, University of Birmingham Sandeep Subramanian Iyer, University of Leeds

Sarah Jadun, University of Manchester Hayley Louise Leather, University of Liverpool Amardeep Kaur Mahal, University of Sheffield Charlotte Anne Mc Carra, University of Dublin David Graham Murray, University of Dundee Sukbir Nandra, University of Sheffield Reshma Al-Karim Ratansi, University of London Ponnuthurai Sivakumar, University of Peradeniya, Sri Lanka Duncan Macdonald Smith, University of Glasgow Marisa Cristina Vila Bea, University of Liverpool Hannah Walsh, University of Sheffield Joe Benjamin White, University of Sheffield

Nishant Pramit Yadev, University of Sheffield Nabeel Zahid, University of Health Sciences, Lahore, Pakistan The Dean of the Faculty of Dental Surgery Medal 2016 Awarded for distinguished performance in the Part 2 MFDS Examination Charlotte Anne McCarra, University of Dublin Diplomas in Clinical Dental Technology Alan Patrick Lyons, Higher National Certificate BTEC John Tyrone Wedgwood, National Diploma in Dental Technology BTEC Diploma in Implant Dentistry Nadim Majid, University of Liverpool

FRIDAY 17 NOVEMBER 2017 Admission to Fellowship Ad Hominem Professor Rui Fernandes FACS, Chief, Division of Head and Neck Surgery; Associate Professor, Departments of Oral and Maxillofacial Surgery, Neurosurgery, Orthopaedic Surgery and Surgical Oncology, College of Medicine, Jacksonville, University of Florida Dr Alistair Fraser FFOM FRCP (Glasg) DSc (Hons), Vice-President Health, Royal Dutch Shell Award of Fellowship in Dental Surgery without Examination Dr Crawford Gray DDS MSc BDS MFGDP (UK), General Dental Practitioner, Dental Implants Aberdeen

rcsed.ac.uk | 55

COLLEGE INFORMATION

Professor Satyawan G Damle FDS RCPSGlasg FDS RCSEng, ViceChancellor, Maharishi Markandeshwar University, Ambala, India Diplomas of Fellowship in the Specialty of Cardiothoracic Surgery Anas Boulemden, University of Algiers, Algeria Sotirios Papaspyros, University of Athens, Greece Diploma of Joint Specialty Fellowship in Neurosurgery Chi Hung Yu, Chinese University of Hong Kong Diplomas of Fellowship in the Specialty of General Surgery Gareth William Irwin, University of Belfast Ian Michael Thomas, University of Wales Andrew Gerard Ninian Robertson, University of Glasgow Diplomas of Fellowship in the Specialty of Oral and Maxillofacial Surgery Aidan John Adams, University of Leeds Kenneth Gilchrist Corsar, University of Glasgow Diplomas of Fellowship in the Specialty of Trauma and Orthopaedic Surgery Nicholas Beattie, University of Manchester Adeline Thiruchella Clement, University of Aberdeen Syed Farrukh Murad Gillani, University of Health Sciences, Lahore, Pakistan David Manzi Hughes, University of London Hatem Mostafa Salem-Saqer, University of Mosul, Iraq Shiv Kamal Sha, Rajiv Gandhi University of Health Sciences, India Innes Donald Mackenzie Smith, University of Edinburgh Diplomas of Fellowship in the Specialty of Plastic Surgery Nathan Thomas James Hamnett, University of Liverpool Kathryn Emma Nelson, University of Liverpool

Sunil Kumar, Ranchi University, India David Tolley, University of London The Council Medal Mrs Susan M Grant, Retired Surgical Examinations Manager, RCSEd Intercollegiate Diplomas of Membership in Surgery in General Mohamed Khalid Mohamed Ahmed, University of Khartoum, Sudan Rizwan Arshad, University of Liverpool Robert Henry John Blair, Queen’s University, Belfast Noman Ali Ghazanfar, University of Health Sciences, Lahore, Pakistan Duaa Gamal Hussien Gumaa, Alexandria University, Egypt Yousif Mohmmed Abdelrazig Hussein, University of Medical Sciences and Technology, Sudan Tamjid Mohammad Najmus Sakib Khan, University of Chittagong, Bangladesh Tharaphi Khin, Yangon University, Myanmar Prashanth Nagaraj, Kuvempu University, India Khaing Khant Oo, Yangon University, Myanmar Shwe Yamin Oo, Yangon University, Myanmar Ahmad Arsalan Tahir, Khyber Medical University, Pakistan Sai Moe Thiha Tun, Yangon University, Myanmar Diplomas of Membership in Otolaryngology Rhona Helen Hurley, University of Glasgow Gordon Arthur George McKenzie, University of Birmingham Robbie Stewart, Queen’s University, Belfast Diplomas of Membership of the Faculty of Surgical Trainers Devender Mittapalli, Dr NTR University of Health Sciences, India Andrew Gerard Ninian Robertson, University of Glasgow Diploma of Membership of the Faculty of Perioperative Care John Stirling, Robert Gordon University

Diploma of Fellowship in the Specialty of Otolaryngology Tamsin Mayberry, University of Glasgow

Diploma in Remote and Offshore Medicine Arlena Kuenzel, University of Leicester

Diplomas of Fellowship of the Faculty of Surgical Trainers Nigel Rossiter, University of London

The Sir David Brewster Medal Awarded to the highest-placed graduate of the MSc in Primary Care

56 | Surgeons’ News | March 2018

Ophthalmology programme during an academic year Lyndsay Brown, University of Edinburgh Diploma of Fellowship in Dental Surgery in the Specialty of Orthodontics Sapna Radia, University of London Diplomas of Fellowship of the Faculty of Dental Trainers Nigel Douglas Robb, University of Edinburgh Lindsay Jane Winchester, University of London Diplomas of Membership in Orthodontics Ayesha Anwar, National University of Sciences and Technology, Pakistan Carlen Oni Chandler, University of the West Indies Sunil Kumar Farmah, University of Manchester William Gerald Fitzpatrick, University of Leeds Yun Zi Neo, University of Malaya Diploma of Membership in Periodontics Jacopo Buti, University of Florence, Italy Diploma of Membership in Primary Dental Care Matthew Andrew Crawford Peters, University of Manchester

IN MEMORY HONORARY FELLOW Robin Sydney Mackwood LING (FRCSEd(Hon) 1989) SURGICAL FELLOWS John Edward BRIDGER (FRCSEd 1961) Terence John CAIN (FRCSEd 1974) David William CAIRNS (FRCSEd 1967) Tanima Narahari DAVE (FRCSEd 1976) Arthur James Nicholas DENNISON (FRCSEd 1970) Alan David HEWSON (FRCSEd 1966) Thakur Vasiomal HINGORANI (FRCSEd 1958) Michael John Stewart HUBBARD (FRCSEd 1967) Roger Hughes JOHNSON

(FRCSEd 1967) Charles Owen Roundel KING (FRCSEd 1960) James Cull McGRAND (FRCSEd 1966) Robert Edward MICKEL (FRCSEd 1958) John Joseph O’NEILL (FRCSEd 1965) Nicholas SMITH (FRCSEd 1986) Norman Leslie STOKOE (FRCSEd 1953) Raymond James WILSON (FRCSEd 1951) FACULTY OF PRE-HOSPITAL CARE FELLOW Priscilla Mary NOBLEMATHEWS (FIMC RCSEd 2000)

Sally Anne Shimmin, University of London Lisa Andrina Turner, University of London Diplomas of Membership of the Faculty of Dental Surgery Lucy Alice Caldwell, University of Sheffield Maryam Ezzeldin, University of Birmingham Jayamalathi Jagaveeran, Sri Ramachandra University, India Vidhiya Kanthimathinathan Subbiah, Rajiv Gandhi University of Health Sciences, India Sualeh Khan, Baqai Medical University, Pakistan Eleftherios Martinis, University of Belgrade, Serbia Dinah Judy Naasan, University of Dundee Divya Bangalore Rangaswamy, University of Bangalore, India Ankita Lia Ribeiro, University of Sheffield Laura Jane Hillarby Timms, University of Manchester Smitha Walsh, Rajiv Gandhi University of Health Sciences, India Laura Tatiana Husak, University of Birmingham Diplomas in Orthodontic Therapy Lorraine Michelle Booth, University of Bristol Alicia Parker, University of Central Lancashire The John Smith Medal The John Smith Medal is awarded for the best performance by a candidate in the Part 1 Fellowship Examinations in Dental Surgery held during the academic year Richard Eggleton, University of Dundee The Dean of the Faculty of Dental Surgery Medal Awarded for distinguished performance in the Part 2 MFDS Examination Laura Tatiana Husak, University of Birmingham YANGON, MYANMAR WEDNESDAY 10 JANUARY 2018 Diploma of Fellowship in Ophthalmology Ma Ma Yin Minn Pann, University of Yangon, Myanmar Diplomas of Membership in Ophthalmology Htat Htat Aung, University of Yangon, Myanmar

Nandar Aung, University of Yangon, Myanmar Tha Pyay Aung, University of Yangon, Myanmar Wint Wah Hlaing, University of Yangon, Myanmar Min Aung Khant, University of Yangon, Myanmar Khin Phyu Lwin, University of Medicine Magway, Myanmar Wuthmone Lwin, University of Yangon, Myanmar Aye Kyaw Maung, University of Mandalay, Myanmar Moe San, University of Yangon, Myanmar Phyu Mar Thin, University of Yangon, Myanmar Hnin Yu Win, University of Yangon, Myanmar Lei Lei Win, University of Medicine Magway, Myanmar Ni Ni Win, University of Yangon, Myanmar Mon Mon Yi, University of Yangon, Myanmar Nyi Nyi Zaw, University of Yangon, Myanmar Su Nyunt Zaw, University of Yangon, Myanmar Intercollegiate Diplomas of Membership in Surgery in General Khin Thandar Aung, University of Yangon, Myanmar Htet Htet Soe Aung, University of Yangon, Myanmar Kyaw Htet Aung, University of Yangon, Myanmar L Graung San Aung, University of Mandalay, Myanmar Nyi Lynn Aung, University of Yangon, Myanmar Pyi Soe Aung, University of Yangon, Myanmar Mi Thida Aung, University of Yangon, Myanmar Ye Htet Aung, University of Yangon, Myanmar Wai Phyo Aye, Defence Services Medical Academy, Myanmar Khin Hsu Hlaing, University of Yangon, Myanmar Thet Htay, University of Mandalay, Myanmar Aleinmar Htoo, University of Yangon, Myanmar Win Htut, University of Yangon, Myanmar Aung Thein Htut, University of Yangon, Myanmar Sai Saing Wan Kham, University of Medicine, Magway, Myanmar Ei Ei Khine, University of Yangon, Myanmar

Myo Khant Ko Ko, University of Medicine, Magway, Myanmar Pyae Phyo Kyaw, University of Yangon, Myanmar Than Latt Aung, University of Yangon, Myanmar Kyaw Linn Linn, University of Yangon, Myanmar Zaw Myint Maung, University of Yangon, Myanmar Pyae Phyo Maung Maung, University of Yangon, Myanmar Khine Thandar Moe, University of Yangon, Myanmar May Mie Thet Mon, University of Yangon, Myanmar Aye Myat Mon, University of Yangon, Myanmar Yan Naing Myo, University of Yangon, Myanmar Win Zaw Myo, University of Yangon, Myanmar Zay Yar Naing, University of Yangon, Myanmar Ye Aung Naing, Defence Services Medical Academy, Myanmar Lwin Htoo Naung, University of Mandalay, Myanmar Aung Thar Oo, University of Yangon, Myanmar Sit Paing, University of Yangon, Myanmar Nay Lynn Phyo, University of Mandalay, Myanmar Kaung Myat Phyo, Defence Services Medical Academy, Myanmar Maung Maung San, University of Mandalay, Myanmar May Thant Sin, University of Yangon, Myanmar Myat Hsu Mon Soe, University of Medicine, Magway, Myanmar Thet Naung Soe, University of Yangon, Myanmar Chaw Phyu Phyu Than, University of Yangon, Myanmar Myat Mon Zin Thein, University of Yangon, Myanmar Chan Min Thwin, University of Yangon, Myanmar Aung Ko Tun, University of Yangon, Myanmar The Nu Wai, University of Yangon, Myanmar Kyaw Naing Win, University of Yangon, Myanmar Chit Nyi Kyaw Win, University of Yangon, Myanmar Lei Lei Wynn, University of Yangon, Myanmar Aung Satt Zaw, University of Yangon, Myanmar

rcsed.ac.uk | 57

COLLEGE INFORMATION

All the latest grants, Fellowships and bursaries from the RCSEd

AWARDS & GRANTS Undergraduate Student Bursaries

The RCSEd is offering bursaries to undergraduate students of medicine or dentistry to enable them to work for elective or vacation periods in universities, medical schools, NHS laboratories or research institutes in the UK and Ireland.

Proposals for work on research projects in any branch of surgery are eligible for consideration. Students must be affiliates of the RCSEd.

from the FST website (fst.rcsed.ac.uk/ grants.aspx).

Email or post applications to Cathy McCartney (see box, below).

Closing date for applications is Wednesday 16 May 2018.

Joint RCSEd/SOMS/Shanghai Head & Neck Fellowship 2018

Applications are invited from Members/ Fellows (MRCS/FRCS) of the RCSEd and the Scottish Oral and Maxillofacial

Society for a four-to-six-week Fellowship in head and neck oncology in Shanghai at the department of Cranio-Maxillofacial Science, School of Stomatology, Ninth People’s Hospital, Shanghai Jiao Tong University. The funding is up to £3,000 to cover costs.

The level of operative experience required to benefit most from the time is equivalent to a final-year post FRCS (Intercollegiate) trainee. Other applicants will be considered on merit, but this level should be seen as a benchmark.

Closing date for applications is Wednesday 21 March 2018.

Faculty of Surgical Trainers/ASME Educational Research Grant

Applications for the joint Faculty of Surgical Trainers (FST)/Association for the Study of Medical Education (ASME) small educational research grant(s) are invited from surgical trainees and consultants who are members of the FST and/or ASME. Grants are awarded for projects for a period of one year only and funding will be for grant applications up to £3,000.

For full details and to apply, download the guidance notes and application form

58 | Surgeons’ News | March 2018

FOR MORE INFORMATION ABOUT THE COLLEGE’S AWARDS AND GRANTS, CONTACT: Cathy McCartney, Research and Grants Co-ordinator Development Office The Royal College of Surgeons of Edinburgh Nicolson Street, Edinburgh EH8 9DW Tel: +44 (0)131 527 1618 Email: c.mccartney@rcsed.ac.uk For further information, visit rcsed.ac.uk/professional-support-

development-resources/grants-jobsand-placements/research-travel-andaward-opportunities The RCSEd collects personal data from you during the application process for awards and grants. We will not share this information with any third parties, and your data will be used solely for processing and administrating applications.

Application is by letter and CV (no more than four pages), along with two references, which should be sent to Mrs Cathy McCartney at c.mccartney@ rcsed.ac.uk. Further information can be obtained from Mr Roger Currie at r.currie@rcsed.ac.uk

Travelling Fellowships

Closing date for applications is Wednesday 27 June 2018.

Closing date for applications is Wednesday 6 June 2018.

Closing date for applications is Wednesday 6 June 2018.

Small Research Grants (up to £10,000)

Syme Medal

Dundas Medal

The College’s Research Strategy highlights the following areas of research as priorities for the College to support: Surgical/dental translational research Surgical/dental health services research Research into surgical/dental aspects of patient safety, simulation and nonoperative technical skills Cancer research of demonstrable direct clinical relevance to the management of solid tumours.

Applications are invited from surgical trainees and recently appointed consultants who are Fellows/Members of the College in good standing.

Grants are awarded for pump priming projects for a period of one year only.

Please note that requests for running costs to support established projects will be less favourably reviewed than those for pilot work that has the potential to facilitate applications for more substantial funding in the future.

Research project submissions should satisfy one or more of the College’s four priority areas for research, as listed above.

The application should also include a well-defined exit strategy (that is, how the project will be taken forward).

Closing date for applications is Wednesday 6 June 2018.

King James IV Professorships

Applications are invited from practitioners of surgery or dental surgery who have made a significant contribution to the clinical and/or scientific basis of surgery. The courtesy title of Professor will be accorded to the individuals for the duration of the College year in which their lectures are delivered. Applicants must be Fellows/Members of the College, in good standing.

Closing date for applications is Wednesday 6 June 2018.

l The Cutner Travelling Fellowship in

Orthopaedics

l Sir James Fraser Travelling Fellowship

in General Surgery

l Alban Barros D’SA Memorial Travelling

Fellowship in General Surgery

James Syme (1799–1870) was a leading surgeon of his day and an enthusiastic teacher and surgical innovator. He was also the mentor of Joseph Lister. The Syme Medal is a prestigious mark of excellence awarded by the College to a Fellow or Member of the College in good standing on the basis of a recently submitted thesis (MD or PhD), published body of research or educational development.

Research should have been published in high-quality, peer-reviewed journals.

Consideration will be given to the impact of work on future research or clinical practice. The Medal is to be awarded to Surgeons in Training or recently appointed consultants, and is distinct from the King James IV Professorship.

With their written application, candidates must submit a CV (no more than two pages) along with a discourse of up to 1,500 words (excluding references, prior publications and papers in press), summarising their recent research or educational development. The essay must refer to and contain findings emanating from the candidate’s own work. A list of prior publications and papers currently in press should be included. The names of any supervisors and collaborative workers must be acknowledged, as well as the name of the institution(s) where the work was carried out.

Appointments to the Syme Medal are made on the understanding that those elected submit a manuscript for publication in the Journal of the Royal College of Surgeons of Edinburgh and Ireland. Depending on the nature of the work and the topic, the successful candidate may be invited to present a lecture at the College.

Closing date for applications is Wednesday 6 June 2018.

Faculty of Dental Surgery Grants for Education

The Faculty of Dental Surgery of the RCSEd supports educational endeavours

for individuals who are Affiliates, Members and Fellows of the Dental Faculty and/or the Faculty of Dental Trainers. Grants (up to £3,000) will be available to defray expenses for those undertaking an appropriate educational qualification.

The medal is in commemoration of Dr Charles Robert (Bertie) Dundas FFARCS FRCP Glasgow. Dr Dundas was a senior lecturer in the Department of Surgery (Anaesthetics) in Aberdeen and honorary consultant anaesthetist from 1975 to 1995. He died in 2014 from biliary carcinoma. He was never offered palliative care while he was ill and spent his last months waiting for chemotherapy while enduring a poor quality of life.

His widow, Dr Valerie Dundas, made a donation to PATCH (Palliation and the Caring Hospital) to improve the provision of palliative care in hospital.

In recognition of Dr Dundas’ lifelong enthusiasm for teaching, research and innovation, an annual award to recognise efforts to improve the provision of palliative care for patients when they are in hospital is fitting. The award is open to individuals or teams (medical, nursing or paramedical) working in any hospital in the UK. It is not essential that the applicant should be an FRCSEd. The term ‘hospital’ applies to both acute and community hospitals.

Closing date for applications is Wednesday 4 July 2018.

Wong Choon Hee Medical Student Elective Travel Bursaries The RCSEd, in association with Meducatus (meducatus.com), is pleased to offer medical students the opportunity to apply for financial support towards their elective in surgery.

This award is open to medical students in the UK and the Republic of Ireland who are undertaking approved surgical electives abroad.

This award will be advertised and given out annually in September. It provides a contribution towards the overall costs of travel and subsistence.

Travel must be undertaken after the award is made in September.

Closing date for applications is Wednesday 4 July 2018.

rcsed.ac.uk | 59

COLLEGE INFORMATION

CONGRATULATIONS TO THE FOLLOWING AWARDS AND GRANTS RECIPIENTS Dundas Medal

Dr Alistair McKeown, Consultant, The Prince & Princess of Wales Hospice, Glasgow; Queen Elizabeth University Hospital Specialist Palliative Care Team, Glasgow.

Small Pump Priming Grants

Mark Hughes, ECAT Clinical Lecturer, Centre for Integrative Physiology, University of Edinburgh.

Exploring the effect of nanoscale mechano-transduction on human glioblastoma stem-like cell differentiation.

Adam Frampton, Honorary Clinical Lecturer in Surgery and Cancer, Department of Surgery and Cancer, Imperial College London.

Endoscopic molecular markers for detecting pancreatic malignant transformation.

Rachael Forsyth, Honorary Research Fellow, Centre for Cardiovascular Science, University of Edinburgh.

Edin-Vasc molecular imaging study.

Richard Taylor, Clinical Research Fellow, Division of Cancer Research, University of Dundee.

The mechanism of action of protumourigenic TGFB signalling in head and neck squamous cell carcinoma.

Li Yong, Clinical Research Fellow, MRC Centre for Regenerative Medicine, University of Edinburgh.

Tissue-specific stem cells and tissuematched hydrogels: the natural answer for auricular tissue engineering.

John Kennedy, Orthopaedic Registrar, Centre for Cellular Engineering, University of Glasgow.

Nanoscale vibrations to modulate osteogenesis.

Janice Miller, Specialist Registrar in General Surgery, Clinical Surgery, University of Edinburgh.

Adipose depot gene expression in cancer cachexia.

Aidan Rose, SCREDS Clinical Lecturer in Plastic Surgery, Department of Cancer Research, School of Medicine, University of Dundee.

The role of TGF-beta signalling in human cutaneous squamous cell carcinoma.

Mary Eastwood, Trust Fellow in Paediatric Surgical Specialties, Great Ormond Street, London.

Perinatal solutions for congenital diaphragmatic hernia.

Iain Nixon, Consultant ENT Surgeon, NHS Lothian, Edinburgh.

The impact of my research on management of differentiated thyroid cancer.

King James IV Professorship

Jon Clasper, Consultant Orthopaedic Surgeon, Frimley Park Hospital Foundation Trust, Camberley.

New insights into the mechanisms of injury from blasts.

Fergal Monsell, Consultant Paediatric Orthopaedic Surgeon, The Children’s Hospital for Wales, Cardiff.

Some observations on limb reconstruction in children: where are we, how did we get here and where are we going?

The Alban Barros D’SA Travelling Fellowship in General Surgery

Claire Rutherford, ST4 General Surgery, Queen Elizabeth University Hospital, Glasgow.

Breast reconstruction Fellowship and outreach, KK Women’s and Children’s Hospital, Singapore.

Sir James Fraser Travelling Fellowship in General Surgery

Adam Frampton, ST6 General & HPB Surgical Unit, Imperial College, London.

To observe HPB surgery and transplantation at Heidelberg University Hospital Surgical Centre and the European Pancreas Centre, Germany.

The John Steyn Travelling Fellowship in Urology

Mr James Donaldson, ST7 in Urology, Western General Hospital, Edinburgh.

Renal Fellowship (laparoscopic and robotic), Princess Alexandra Hospital, Brisbane, Australia.

The Cutner Travelling Fellowship in Orthopaedics

Simon Graham, Specialist Training Registrar Year 8, Orthopaedics and Trauma, Mersey Deanery.

Orthopaedic Trauma and Research Fellowship, Groote Schuur Hospital, University of Cape Town, South Africa.

Muhammed Choudhury, Spinal Fellow, Scottish National Deformity Service, Royal Hospital for Sick Children, Edinburgh.

To study the technique of anterior vertebral body tethering in the treatment of scoliosis, Shriners Hospital, Philadelphia, US.

Syme Medal

Nicholas Ventham, Speciality Training General Surgery, University of Edinburgh.

Integrative epigenome-wide analysis demonstrates that DNA methylation may mediate genetic risk in inflammatory bowel disease.

60 | Surgeons’ News | March 2018

Awards and grants make research into many fields, such as thyroid cancer, possible

REGIONAL SURGICAL ADVISERS IN YOUR AREA

7

8

The College’s support and advice network throughout the country

12 11 9

Council Member with Responsibility for Regional Surgical Advisers 1 Roger Currie, Crosshouse Hospital, Kilmarnock Surgical Director of the Advisory Network 2 Steven Backhouse, Princess of Wales Hospital, Bridgend, Wales

10

1

24 38 39 25

Deputy Surgical Director of the Advisory Network 3 Mike Silva, Churchill Hospital, Oxford

34

Advisory Network Group Members 4 Stuart Clark, Manchester Royal Infirmary 5 David Exon, Leicester Royal Infirmary 6 Vijay Santhanam, Addenbrooke’s Hospital, Cambridge 7 Sean Kelly, Raigmore Hospital, Inverness

33

22 4 37

20

21

23

19

SCOTLAND

29

NORTH OF SCOTLAND 7 Morag Hogg, Raigmore Hospital, Inverness 8 Lynn Stevenson, Aberdeen Royal Infirmary, Aberdeen

5 15

30 31 36 2

WEST OF SCOTLAND 9 Simon Gibson, Queen Elizabeth University Hospital, Glasgow

13 14

32

6 26 3

35 17 18

SOUTH EAST OF SCOTLAND 10 Farhat Din, Western General Hospital, Edinburgh 11 Robyn Webber, Victoria Hospital, Kirkcaldy

27

28 16

EAST OF SCOTLAND 12 Musheer Hussain, Ninewells Hospital, Dundee

ENGLAND

EAST OF ENGLAND 13 Stuart Irving, Norfolk and Norwich University Hospital, Norwich 14 Roshan Lal, James Paget University Hospital, Great Yarmouth EAST MIDLANDS 15 Sridhar Rathinam, Glenfield Hospital, Leicester KENT, SURREY & SUSSEX 16 Mike Williams, Eastbourne District General Hospital, Eastbourne LONDON 17 Cynthia-Michelle Borg, University Hospital Lewisham 18 Ziali Sivardeen, Homerton University Hospital MERSEY 19 Janardhan Rao, Countess of Chester Hospital, Chester 20 John Taylor, University Hospital Aintree, Liverpool 21 Ravi Pydisetty, St Helen’s & Knowsley Teaching Hospitals NHS Trust NORTH WESTERN 22 Mike Woodruff, Royal Preston Hospital, Preston 23 Richard Graham, North Manchester General Hospital NORTHERN 24 Paul Gallagher, Wansbeck Hospital, Northumberland 25 Barney Green, James Cook University Hospital, Middlesbrough 25 Peng Wong, James Cook University Hospital, Middlesbrough OXFORD 26 Giles Bond-Smith, Oxford University Hospitals NHS Trust

SOUTH WEST PENINSULA 27 Neil Smart, Royal Devon & Exeter Foundation Trust, Exeter WESSEX 28 Arjun Takhar, University Hospital of Southampton NHS Trust WEST MIDLANDS 29 Ishan Bhoora, Cannock Chase Hospital, Staffordshire 30 Pradeep Kumar, Queens Hospital, Staffordshire 31 Ramanan Vadivelu, Royal Wolverhampton Hospital NHS Trust 32 Giles Pattison, University Hospital of Coventry and Warwickshire, Coventry YORKSHIRE & HUMBER 33 David O’Regan, Leeds General Infirmary, Leeds 34 Mark Peter, Scarborough General Hospital, Scarborough

WALES

35 Sanjeev Agarwal, University Hospital Wales, Cardiff 36 Raymond Delicata, Nevill Hall Hospital, Abergavenny 37 Vaikuntam Srinivasan, Glan Clywd Hospital, Rhyl

NORTHERN IRELAND 38 Catherine Scally, Antrim Hospital 39 Colin Weir, Craigavon Area Hospital

RSA VACANCIES

Aberdeen, Birmingham, Bradford, East Midlands, Kent, Surrey & Sussex, London, Newcastle, Oxford, Peterborough, Plymouth, Portsmouth, Preston, Severn, Wessex, and West of Scotland

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OUT OF HOURS

Beautiful presentation at Hélène Darroze

Whether it’s going Mexican in San Diego or sampling lamb’s brains in Annecy, Graham Layer cherishes each eatery’s special atmosphere

Local heroes

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Graham Layer RCSEd Vice-President

élène Darroze at The Connaught is a Mayfair institution renowned for its two stars and exceptional service. Three of us celebrated two special birthdays there and ordered the reasonably priced set lunch accompanied by specific wines. The three fish and cheese canapés were presented beautifully and we enjoyed them with a delightful champagne, Fluence, which cut knife-like through the flavours. The appetisers were a choice of a foie gras, grouse and pistachio terrine with a thick skin of puff pastry; a delicious mousse served on a silver spoon whose flavour I could not identify; and a biopsy-sized portion of (very) smoked eel, balanced with girolles. There were two main courses, the first being a large portion of flaky cod served in an oyster and champagne sauce and partially hidden by an enormous fascinator of potato and dill crisp. The alternative was rare loin of peppered juicy venison with accompanying vegetables dominated by butternut squash. The intercourse was a wonderful chilled dill creation in Greek yoghurt followed by a caramelised pineapple dessert with a ball of coconut fluff on top of six chocolate cubes – all cleverly enhanced by vanilla and cardamom. The petits fours were bright green, translucent synovial hemispheres with an intense basil aura. Coffee was exceptional, so we each had to order a duplicate cup.

Annecy is tucked away lakeside in France. A while back, I had an unforgettable Sunday lunch at the two-star Relais and Châteaux Clos Des Sens so, on my return, I chose to

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have supper in its sister brasserie/bistro, Café Brunet.

The signature appetiser was lamb’s brains. Actually, it was the whole neuroanatomical specimen on my plate, thinly disguised by a layer of tempura batter and a wispy leaf of something green. It tasted of the red wine with which I washed it down. The rest of the meal was a haze, interrupted by further generous dishes of artisan-esque French mountain food. This restaurant is a must.

At Duingt, I enjoyed a delicious meal lakeside at Clos Marcel with a presse of foie gras followed by scallops accompanied by a risotto, and a then a pretty fruit dessert, which I found too sweet. L’Auberge du Lyonnais hosted us for a magnificent lunch with a main course of essentially beef Wellington – the pastry was as outstanding as the beef. For a really hearty meal, visit Chez Constance, a café restaurant on the bleak Plateau des Glières, where huge platters of local cheeses and charcuterie appear with the lightest of breads, followed by moreish beignets.

For more than a couple of decades, I have supported the American College of Surgeons’ annual meeting, but last year was the first time it had been held in San Diego.

There was a true Californian side of life on Pacific Beach in its bars and numerous independent restaurants. I want to mention Tom Ham’s Lighthouse on the Harbor Island waterfront. Seafood is the staple, and four of us were treated to three courses of substantial, nicely cooked and presented food, which we were able to share and taste.

Mussels with chorizo and pecorino served in a stout-based tomato sauce were plump and healthy. Scallops were

even plumper and healthier, served peculiarly on a bed of southern grits and sausage with a vegetable concoction of leeks and artichokes. The whole crispy roasted local fish required expert dissection, and was perfect with a slaw and lime with chilli. This was a great recommendation.

In town, Eddie V’s is a seafood and steakhouse with live jazz and a dusky atmosphere, but the quality of the steaks came through. We also dined at George’s at the Cove, La Jolla. Perfect fish tacos, seared foie gras, beef cheeks with horseradish mash, lobster, oats ice cream with chocolate mousse and salted caramel added up to a great meal. Eight of us sampled the very extensive menu at Jimmy Carter’s Mexican Cafe. We munched happily through our foods and beers, celebrating the extraordinary ambience.

Moving up the coast to Carmel and another fish restaurant, Flaherty’s. A mixed seafood grill occupying the whole plate and a bouillabaisse-type dish brimming with every conceivable crustacean and Pacific fish were generous and tasty, although not necessarily attractive.

Next stop, Seattle and Shuckers. There are oysters of all varieties on the menu and an outstanding classic west coast Crab Louie oozing plentiful sauce.

Then Sidney, Vancouver Island. At Haro’s near the pier I enjoyed a generous portion of the freshest, whitest, smooth-flaked halibut I have ever eaten. Halibut was also on the menu at the fine dining restaurant Deep Cove Chalet, a family-run institution with an innovative French-influenced menu. Their fish was more elaborately presented, but its flavours were perhaps hidden by some of the accompaniments. Their lobster bisque was rich and creamy, and contained real lobster. The West Coast Grill at Sooke is a simple brasserie on the Pacific, but its smoked salmon lunch was muscular and flavourful. A popular Canadian-wide chain is Milestones, which is on the harbour front at Victoria. Although the coconut-covered calamari dish is different, it’s the fluctuant doughnuts filled with ricotta that are the stars of the show. Better food can be found at Fireside Grill. The clam chowder was really tasty, the scallop and shrimp linguine full of shellfish and the endless barbecued ribs wallowing in clotting sauce seemed to come from an unusual beast with rather more than 12 ribs.

Old school Bernard Ferrie revisits French classics

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speaking engagement resulted in a fine gift of French wine. Merci beaucoup Urologistes d’Ecosse.

So wines from long-established vintners.

Corney and Barrow (since 1780) Margaux 2012 (£21.95) from Chateau Angludet. Margaux should have divine perfume after seven to 12 years, says Oz Clarke. I quaffed this at five years with a succulent Irish sirloin steak – perfect. The best red I have ever drunk? Juicy and fresh.

St Emilion 2012 (£16.95). Described as accessible – that means we can just about afford it – but find a corkscrew. Full ripe red fruit. Spag bol as partner.

Deepest red comrade.

Special birthdays demand special appetisers

Macon-Chaintre White Burgundy Domaine Dominique Cornin 2015 (£16.95). Floral, this was so good my tasting notes vanished. Apparently perfect with afternoon tea.

Why confuse tea and dinner?

Tanners (since 1842) Chateau La Fage Monbazillac 2011 (half £6.80) from near Bergerac. Very sweet-fresh. Add Somerset raspberries. Or blue cheese. Delish.

Berry Brothers and Rudd (since 1689): Good Ordinary Claret 2015 (£9.95). GOC is for what used to be called – pre-Chief Medical Officer – everyday drinking. BBR the seller, Dourth the cellar. Cherry bramble and wood smoke. Or Extra Ordinary Claret 2014 (£15.50). From Graves – cherry chocolate blackcurrant and cedar wood.

With roast lamb and mature hard cheese. Hard cheese if you don’t try this.

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FROM THE COLLECTIONS

DENTAL REWIND Dentistry may have questionable roots but this collection shows how far the field has come

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entistry as a formal profession emerged in the late-17th and early-18th centuries and has advanced dramatically since its rudimentary beginnings. Although, astonishingly, the field was not regulated until the late 19th century – a legally binding register was only established in 1921, which authorised qualified and registered dentists to practise – there have been vast developments in the field, turning dentistry into a specialty.

The College has one of the best dental collections in Britain representing these developments, with particular focus on prosthodontics. This includes a range of dentures dating back to the early-18th and -19th centuries featuring horseshoe styles made of expensive materials such as ivory and gold, with inserted human teeth or later porcelain replicas. Also of interest is the range of vulcanite dentures from the 1870s through to the 1930s, as well as modern dentures and jaw implants.

Take these recently accessioned dentures, discovered in 1942 by an army dentist while in Africa during the Second World War. The pictures and letter attached to the ivory dentures, which include roughly carved lines to represent teeth, report that the soldier could use them to eat and held them in place with his lip. The soldier purchased the dentures from an African dentist for between £3 and £10.

The College has one of the best dental collections in Britain, with particular focus on prosthodontics

The letter (below) explains that the dentures (right) were purchased by a soldier from an African dentist in the Second World War

This piece, with its wonderfully descriptive history, is a great addition to our denture collections and to the history of prosthodontics. It shows the previously simple constructions of dentures and how far the field has come since the early 20th century.

In comparison, there is little to document the development of orthodontics. While orthodontics as a word was not recognised until the mid-19th century, the practice can be found in earlier texts such as Pierre Fauchard’s Le Chirurgien Dentiste in 1728 or later in Joseph Fox’s 1803 text with special instructions for correcting the position of teeth.

Fauchard stated that teeth could be straightened by “the fingers, common thread, silk, little plates or strips of gold or silver or other suitable material, or finally by means of the pelican, or straight forceps”. Such texts are excellent for highlighting previous techniques, but it would be fantastic to have physical examples.

Our aim is to showcase the history of orthodontics and developments in materials, instruments and techniques over the last 100 years, from dental dam and impressions to headgear and invisible appliances.

We are actively collecting in the area of orthodontics and welcome donations. If you wish to contribute material, please phone 0131 527 1720 or email l.wilkie@rcsed.ac.uk.

Louise Wilkie Assistant Curator, Surgeons’ Hall Museum

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