MAY 2017

Medical Education: are the

days of the ‘unqualified’
medical educator numbered?

Supporting NCEPOD:
a trainee’s approach

Trainee issue:
Advancing
in the face
of adversity
www.rcoa.ac.uk
@RCoANews
Bulletin  |  Issue 103  |  May 2017
Contents
The President’s view4
News in brief8
HRH The Princess Royal joins
RCoA Anniversary celebrations12
Emergency Laparotomy
Pathways20
User-Centered Design26
25th Anniversary RCoA
Trainer Awards28
Revalidation for anaesthetists30
Anaesthesia Clinical Services
Accreditation31
Faculty of Pain Medicine32
Faculty of Intensive Care
Medicine33
Trainee guest editorial: Health Services Research
Advancing in the face of adversity Centre34
Welcome to the Trainee Issue Using NELA data to improve
patient outcomes36
Page 14
Staff, Associate Specialist and
Specialty Doctor38
Getting It Right First Time Through the looking Patient perspective40
Page 4 glass: the management
Journal Watch41
Medical Education: dilemma The Lifebox Fellowship
Page 24 of Anaesthesia42
Are the days of the
‘unqualified’ medical ‘Retyring’ abroad, The UPSTART ABC Project46
educator numbered? not retiring abroad Experiences from Tanzania50
Page 16 Page 44 As we were...52
RAFT and the rise and A USA anaesthesia team’s Clinical Research Network
Award Winners54
rise of trainee-led commitment to Safer
research networks Surgery in Rwanda NIAA Small Grants and
Page 18 Award Winners56
Page 48
Letters to the Editor59
Supporting NCEPOD:
Report of meetings of Council62
a trainee’s approach
Page 22 Notices and adverts64
2  |
Bulletin  |  Issue 103  |  May 2017
From the editor
Professor Monty Mythen
This is the annual trainee issue of the Bulletin so I am going to resist my tip-toe through the articles and direct
you immediately to the guest editorial by Kate Tatham (RCoA Trainee Committee) on page 14: ‘Advancing in
the Face of Adversity’. As well as introducing the trainee-led articles in this Bulletin, Kate reminds us of results
of the Trainee Wellbeing Survey, essential reading for all of us (details on the RCoA website).
I was privileged to attend the 25th Anniversary Meeting in March and heard the introductory remarks made
by Her Royal Highness the Princess Royal celebrating the 25th Anniversary of our royal college. You will
find a transcript of the speech on page 12. HRH describes perioperative medicine as ‘…a natural evolution in
healthcare…’ and points out that:
“The work encompasses the principles of enhanced recovery that we know can deliver better patient experience as
well as a more efficient elective care pathway, and can lead to the delivery of best possible quality care for patients”
In his President’s View, overleaf, Liam expands on Getting it Right First Time (GIRFT) which is the latest
clinician-led programme aimed at improving outcomes by reducing variation. I am delighted that anaesthesia
and perioperative medicine has been selected as one of the specialties to benefit from an additional £60
million of government funding. A joint RCoA/GIRFT clinical lead will be appointed. Soon after that:
‘Providers will be bench marked against one another and against best practice, with each trust receiving a
comprehensive review of it’s data…’ (page 6).
Which will obviously be a walk in the park as we are all practicing the principles of enhanced recovery, aren’t we?
We were global leaders in the widespread adoption of enhanced recovery starting in 2009. In February this
year a similar scheme was announced in the USA some eight years after our enhanced recovery partnership
programme was launched and five years since it was ‘signed off’ as standard of care.
We now think enhanced recovery is standard of care and so does HRH but have you reviewed your results
recently? I looked up the mean length of stay on the open access NHS website for colorectal surgery in the
NHS recently and I was saddened to find that we have seen no improvement since the national enhanced
recovery programme stopped in 2013.
So as we start our next round of innovative, ‘clinician-led’, best practice, reducing variation, etc... I suggest that
an internal review of your own hospitals surgical outcomes and compliance with pathways (or variation) might
be wise. We did this last year at my hospital and the results were shocking for some (not all) of our so-called
enhanced recovery pathways. In one pathway outcomes had drifted back to 2008 standards and compliance
had slipped to 65%. A quick burst of live compliance tracking and public feedback (including the patients and
their families) produced dramatic corrections and great results; very quick, easy and satisfying.
| 3
Bulletin  |  Issue 103  |  May 2017
THE PRESIDENT’S VIEW
GETTING IT RIGHT
FIRST TIME
4  |
Bulletin  |  Issue 103  |  May 2017
Dr Liam Brennan
President
Despite a £2 billion investment in adult social
care over the next three years, the Chancellor’s
2017 Budget was far from a giveaway for the
health and social care system. In response, I
suggested this was a step in the right direction,
but one taken on unstable ground. The
combined £425 million for the NHS, after
one of the most challenging winter periods
ever, may provide some limited respite for the
immediate crisis, but it is far from being the
long-term solution we all wish for.
Therefore the need for us, as a The first steps toward
healthcare community, to devise Getting It Right First Time
and deliver innovative, cost-effective
Getting It Right First Time (GIRFT) is
initiatives which can improve patient
a clinician-led programme aimed at
outcomes has never been more
improving patient care by reducing
important. Your College Council has
unwarranted variation in service
agreed that the ‘Getting It Right First
provision and clinical practice. GIRFT
Time’ programme is one potential
began in 2012 with research from
solution to how we might meet this
leading orthopaedic surgeon Professor
challenge, through collaboration and
Tim Briggs, which identified extensive
shared learning.
cost savings and improvements in
quality of patient care which could be
I am pleased to be able to announce
the College’s involvement in the made in elective orthopaedics.
Getting It Right First Time initiative,
A nationwide £2.5 million pilot within
and I want to provide a bit more
orthopaedic surgery was subsequently
detail about how the programme
conducted as a partnership between
has developed to date, where it
the Royal National Orthopaedic
will be going next, and how we
Hospital NHS Trust, which first hosted
have ensured that anaesthesia and
the pilot programme, and NHS
perioperative medicine are integral to
Improvement.
its development.
| 5
Bulletin  |  Issue 103  |  May 2017
What did the pilot results
show?
Professor Briggs’ report of the pilot
findings, published in March 2015
(http://bit.ly/2mLKLdh), suggested that
despite provision of care accounting
for 80% of the total cost of healthcare,
procedures of low clinical value –
not measured against robust clinical
methodology or patient outcomes –
continue to be commissioned. In one
example the report highlighted that
some surgical procedures for lower back
pain which lacked evidence of long-term
efficacy were still being undertaken, at
an annual cost to the NHS of nearly £40
million.
Overall, the pilot highlighted significant
variation in clinical practice and patient
outcomes. For example, surgical-site
infections across ten trusts in the same
city varied from 0.19%–5% (measured
as % with infections – initial patient spell
plus readmission).
A methodology was developed in
the pilot which, when implemented,
led to a reduction in both the length
of hospital stay and in readmissions,
a win-win situation for patients,
provider organisations and healthcare
commissioners. The GIRFT methodology
involves a peer review of service
performance to assess patient clinical
outcomes and experience, including
waiting times, as well as the financial
impact of commissioning decisions,
the trust’s network arrangements, and
the management of pathways through
primary and secondary care. Alongside
face-to-face interviews, this assessment
uses 12 sets of performance data
from each trust, ranging from Patient
As a specialty we are renowned for our ability to adapt and evolve...
6  |
Reported Outcome Measures through
to payments recorded by the NHS
Litigation Authority.
It rapidly became apparent that the
methodology developed through the
lens of orthopaedics potentially provided
a template transferable to other areas
of secondary care. However, there is an
acknowledgement that rarely does ‘one
size fit all’ and that, to ensure ‘a tailored
fit’, clinical leadership from within each
specialty, including our own, is required.
How is the College helping to
develop the programme?
Expanding the GIRFT programme
was a key part of the roll-out of the
recommendations in Lord Carter’s
February 2016 report, ‘Operational
productivity and performance in English
NHS acute hospitals: Unwarranted
variations’ (http://bit.ly/1ToDcGd).
Lord Carter’s report noted that the
GIRFT initiative,’ is the first time quality,
productivity and efficiency performance
metrics have been pulled together into
a single performance dashboard’, and
consequently the report recommended
that the programme be extended
to further surgical and non-surgical
specialities using the GIRFT methodology,
evaluated ’under one governance
structure within a national clinical quality,
efficiency and productivity unit’.
In November 2016 the government
announced that the GIRFT programme
would receive an additional £60 million in
funding to expand and accelerate delivery
of the programme to a total of 30 clinical
specialties. Projected savings of more
than £5 billion have been identified with
the expansion of the work into these new
areas (http://bit.ly/2n9BC1y).
Putting the patient first every
time
Following representations from the
College, I am pleased to say that one of
those new specialties will be Anaesthesia
and Perioperative Medicine.
To drive this work forward the College
and GIRFT are jointly appointing a clinical
lead for Anaesthesia and Perioperative
Medicine, to oversee the creation of a
national review of clinical and financial
performance data across England, using
the existing GIRFT methodology.
Providers will be benchmarked against
one another and against best practice,
with each trust receiving a comprehensive
review of its data and receiving support to
tackle the challenges and findings behind
the variation that the review highlights.
The programme will inform a national
report setting out recommendations to
be taken forward in collaboration with the
national GIRFT team.
Working in partnership with the College,
we hope that GIRFT will improve the
quality of anaesthesia and perioperative
medicine and help reduce complication
rates and unwanted variation in patient
care. This includes improved preoperative
assessment and other perioperative
interventions – such as smoking cessation
interventions accessed in secondary
care – designed to deliver an enhanced
patient experience, better clinical
outcomes and shorter length of stay.
This will in turn free up clinician time to
make a greater investment in pre-and
postoperative care for other patients.
Bulletin  |  Issue 103  |  May 2017
Final thoughts
Bulletin
Robert F Kennedy, reflecting on the vast
social changes of the 1960s, declared:
’Like it or not, we live in interesting
times. They are times of danger and
uncertainty; but they are also more open
to the creative energy of men than any of the Royal College of Anaesthetists
other time in history.’
Churchill House, 35 Red Lion Square, London WC1R 4SG
020 7092 1500 | www.rcoa.ac.uk/bulletin | bulletin@rcoa.ac.uk
As healthcare professionals operating
in our own ‘interesting times’, we all too Registered Charity No 1013887  Registered Charity in Scotland No
often feel consumed by challenges SC037737
which may seem insurmountable. But I VAT Registration No GB 927 2364 18
would encourage us all to be buoyed up
by reflecting on two important points.
President Lila Dinner
Liam Brennan Lead Regional Adviser
The first of these is that, through
initiatives such as GIRFT, we are Vice-Presidents David Booth
contributing solutions to complex Jeremy Langton Lead College Tutor
Ravi Mahajan
problems and making positive changes Kate Tatham
which place patient outcomes at the Editorial Board Trainee Committee
forefront of our practice. But in doing Monty Mythen
Emma Stiby
this we also benefit the wider healthcare Editor
SAS Member
economy, through increased efficiency
David Bogod Carol Pellowe
and better management of the limited
Council Member Lay Committee
resources available.
Simon Fletcher Gavin Dallas
Secondly, and perhaps most importantly, Council Member
Communications Manager
we are continuing to deliver the quality
Jaideep Pandit Mandie Kelly
of care that patients deserve, something
Council Member Website and Publications Officer
that was highlighted by the results of
Krishna Ramachandran
the SNAP-1 study, which showed that Anamika Trivedi
Council Member
99% of patients would recommend their Website and Publications Officer
hospital’s anaesthesia service to their
friends and family
Articles for submission, together with any declaration of interest, should be
(http://bit.ly/2lnWS4E).
sent to the Editor via email to bulletin@rcoa.ac.uk.
As a specialty we are renowned for our
All contributions will receive an acknowledgement and the Editor reserves
ability to adapt and evolve to changing
the right to edit articles for reasons of space or clarity.
circumstances, and for doing this without
compromising our professionalism and The views and opinions expressed in the Bulletin are solely those of the
commitment to compassionate patient individual authors. Adverts imply no form of endorsement and neither do
care. For that, in these ‘interesting times,’ they represent the view of the Royal College of Anaesthetists.
we should be incredibly proud.
© 2017 Bulletin of the Royal College of Anaesthetists
As always, if you have any comments All Rights Reserved. No part of this publication may be reproduced, stored
on any of the issues discussed in this in a retrieval system, or transmitted in any form or by any other means,
article or would like to express your electronic, mechanical, photocopying, recording, or otherwise, without
views on any other matters, I would like prior permission, in writing, of the Royal College of Anaesthetists.
to hear from you. Please contact me via
presidentnews@rcoa.ac.uk. ISSN (print): 2040-8846  ISSN (online): 2040-8854
| 7
Bulletin  |  Issue 103  |  May 2017
News in brief
News and information
from around the College
#KnockItOut
In April the College’s Trainee Committee
and AAGBI’s Group of Anaesthetists
in Training (GAT) launched their
joint campaign aimed at tackling
bullying, harassment and undermining:
#KnockItOut.
The 2016 GMC survey revealed some doctors still feel they cannot speak up
about bullying and undermining in the workplace. 5% [n=2,818] of doctors said
they experienced or saw bullying and undermining behaviour in their current
post, but also said they would not report it in the national training survey.
The Trainee Committee and GAT recognise this is an important issue. Following
shocking census data (43% of Trauma & Orthopaedics trainees had witnessed
bullying while 70% had witnessed undermining behaviour) our colleagues at
BOTA (the British Orthopaedic Trainees’ Association) developed a campaign
in their own specialty, #HammerItOut. This has gained support across many
organisations and across specialties.
As anaesthetists we share theatre teams with our surgical colleagues and we
too may witness these negative behaviours, either in our specialty or others,
including the multidisciplinary team.
Through #KnockItOut, our aims are:
■■ to promote a positive workplace culture that is free from bullying, harassment
and undermining behaviours
■■ to nurture an environment that empowers individuals to speak up if they
experience or witness unacceptable behaviours
■■ to share examples of those who demonstrate exemplar behaviours in the
workplace and use these to model further improvements in the wider NHS
culture
■■ whatever the specialty, bullying, harassment and undermining are never
acceptable. Let’s #KnockItOut together.
Follow #KnockItOut on Twitter and Facebook for updates
8  |
Clinical Quality
Update
The 2017 edition of the Guidelines of the
Provision of Anaesthetic Services (GPAS)
has been published and is accessible
from the RCoA website.
To date eight chapters have been
developed by the RCoA’s NICE
accredited chapter development
process, and five are currently underway
for the 2018 publication. These include
Day Surgery, Anaesthesia in the non-
theatre environment, Neuroanaesthesia,
Trauma and Orthopaedics and Cardiac
and Thoracic Surgery.
To download the current version of
GPAS please visit
www.rcoa.ac.uk/gpas2017.
The Clinical Quality team is happy to
announce that Dr Jeremy Langton has
recently been appointed as the new
GPAS Editor and will commence the role
in September 2017.
We are also pleased to inform you that
Dr Marie Nixon has been appointed as
the new Clinical Quality Advisor and will
commence in the summer of 2017.
Congratulations to both!
If you have any queries regarding Clinical
Quality please email
clinicalquality@rcoa.ac.uk.
Global Partnerships update
The Global Partnerships team had the pleasure of welcoming a
delegation from the Hong Kong College of Anaesthesiologists
(HKCA) for four days of meetings between 13 and 16 March.
This followed on from previous discussions between the two
Colleges in the summer of 2016, when a Memorandum of
Understanding was signed to enhance the development of
standards for anaesthetics in Hong Kong.
Discussions were wide ranging, focusing on the developing
of HKCA’s education, training and examinations programme.
Key areas of discussion included the development of a new
anaesthetic curriculum which is competency-based and
implementing Workplace Based Assessments (WpBAs) and
arranging an appropriate Training the Trainer course to ensure
trainers are confident with the new methodology.
Discussions are also underway to enable Hong Kong trainees
to sit the MCQ component of the Final FRCA. Discussions
were fruitful, and we look forward to continue working closely
with our colleagues in Hong Kong.
Of the visit, Dr Sion Chan, Honorary Secretary of the HKCA
said: “Although there is a long way for our new curriculum, we
are now more confident on its successful implementation after
this visit. We are looking forward the continued collaboration
between our two Colleges”.
Learn more about our Global Partnership efforts at:
www.rcoa.ac.uk/global-partnerships
ANAESTHESIA RESEARCH INNOVATION EDUCATION SCIENTIFIC
Bulletin  |  Issue 103  |  May 2017
FRCA Examinations update
392 candidates sat the Primary FRCA MCQ held on 28
February 2017, with a pass rate of 53% this directly compares
to previous sittings, with the mean for the last three exams
being 54%. 454 candidates sat the Final FRCA Written
examination on 7 March 2017. The standard setting and
marking process for this two component exam (MCQ and
SAQ), takes around four weeks to complete. The system
used for the SAQ exam, of all examiner “Paper checking”
and “Standard checking” days strives to ensure a diversity of
questions, reflective of the whole curriculum and conformity
of marking across examiners. The use of different examiners
to mark different questions means that there are six separate
examiner assessments per paper. Following this standard
setting and marking process, results were published on
Thursday 6 April. Of the 454 candidates who sat the exam
283 (63%) passed. The pass rate in September 2016 was
70% and in March 2016 it was 52%.
The College believes it is important to provide feedback
to candidates beyond a standard pass-fail result to assist
them in understanding and interpreting their overall result.
Feedback on exam performance is supplied to candidates in
the form of a ‘Result letter’ the feedback provided will vary
according to the exam component attempted. The College
ensures that the feedback given meets Academy of Medical
Royal Colleges and General Medical Council standards
and is in line with other Medical Royal Colleges. A list of
the feedback provided for each component is set out at
Appendix 10 of the FRCA Examinations Regulations at
www.rcoa.ac.uk/examinations/overview/regulations.
Our free ARIES Talks feature a variety
of high profile speakers delivering short,
informative and entertaining talks.
You can book online to attend the next ARIES Talks on
Thursday 1 June 2017 (13:30pm – 16:00pm) and Monday
10 July (6:00pm – 8:30pm) at the Royal College of
Anaesthetists, Churchill House, 35 Red Lion Square,
London WC1R 4SG
All talks are free to attend and can be booked at
www.rcoa.ac.uk/rcoa25/calendar.
All ARIES talks are filmed and are released online on our
YouTube channel. View the ARIES Talks at:
http://bit.ly/2mMa0fz.
| 9
Bulletin  |  Issue 103  |  May 2017
Perioperative Medicine
(POM)
in touch via the below e-mail if you’d like to be involved.
The current list of local leads can be found on the POM
microsite (http://bit.ly/2gkXLIA).
The perioperative medicine animated film, illustrating our
vision of what a successful perioperative pathway can look
like, is freely available online and can be sent to you upon
request for use within your hospitals and at meetings and
events. You can find details on how to request a copy on the
microsite (http://bit.ly/2nitjkG).
The College has also produced a vision document to
communicate our messages (http://bit.ly/POMVision).
On Tuesday 7 March we held the first Perioperative Medicine
Advisory Board meeting, attended by representatives from
If you would like to advertise an event or perioperative
medicine fellowship through the microsite please contact us
a range of healthcare organisations with an interest in with details at perioperativemedicine@rcoa.ac.uk.
perioperative medicine including NHS England, the devolved
nations, and Medical Royal Colleges. The Board will facilitate RCoA believes that collaborative and efficient perioperative
collaborative, cross-organisational working, which will be care is the route to effective and sustainable surgery. With
integral to the success of the POM programme. many components of the perioperative medicine pathway
already existing within the NHS, the College has produced
We are keen to keep expanding our network of perioperative a vision document, Perioperative Medicine: The Pathway
medicine local leads, which currently stands at 170. We will to Better Surgical Care (http://bit.ly/2khYkmK) and has
be working with our local leads to plan regional meetings developed a film (http://bit.ly/2ki1BCx) to illustrate what
and focused workshops later in 2017/2018. Please get good perioperative care can look like.
RCoA Anniversary Meeting
The RCoA Anniversary Meeting held on 8 and 9 March was the flagship event for our 25th Anniversary. With more than 150
members and fellows attending across the two days, the event was a tremendous success.
HRH The Princess Royal, the RCoA’s Royal Patron, spoke to delegates about the significant developments and landmarks that
have taken place during the last 25 years in anaesthesia and acknowledged the unwavering commitment of
anaesthetists to patient safety.
Her Royal Highness also presented the Royal College of Anaesthetists Gold Medal to Professor
David Rowbotham (University Hospitals of Leicester NHS Trust), and National Institute for
Health Research-Clinical Research Network awards to Dr Grudrun Kunst (Consultant,
King’s College Hospital NHS Foundation Trust) and Dr James Sheehan (Trainee, Royal
Berkshire Hospital NHS Foundation Trust).
Delegates were treated to international and local speakers covering subjects
relating to anaesthesia, pain and intensive care; ranging from Global threats –
lessons from anaesthetists on the front line to Effective fluid management – are
we close to an ideal fluid yet?
The Anniversary Meeting is part of a wide range of events being held to celebrate
the RCoA’s 25th Anniversary. More information about events can be found on
the College’s website (www.rcoa.ac.uk/rcoa25).
Bulletin  |  Issue 103  |  May 2017
News in brief
News and information
HSRC from around the College
NIAA
National Institute of Academic
Anaesthesia
Health Services Research Centre
Research and Quality
Improvement
Patient recruitment for SNAP-2: EpiCCS (2nd Sprint National
Anaesthesia Project: Epidemiology of Critical Care Services) Engaging with Members
(www.niaa-hsrc.org.uk/SNAP-2-EpiCCS) has now taken place.
As part of the College’s commitment to increasing
SNAP-2: EpiCCS will describe the epidemiology of engagement with our members, we recently hosted a
perioperative risk and outcome, and critical care referral and workshop with key members of staff to discuss ‘what does
admission after inpatient surgery in the UK. After piloting in engagement mean for the College’.
January, SNAP-2 ran from Tuesday 21 March to Monday 27
March 2017, with one week of follow up. Over 250 sites across From the workshop, a number of action points were
the UK took part, involving over 2,200 collaborators. This was taken, including, how we can make it easier for members
a massive effort from local teams and huge thanks to everyone to locate and speak with College staff. We will also look
who participated. into how we can provide useful information (for example
in the form of FAQs) and access to members at any time,
SNAP-1 (http://bit.ly/2n9JuAv), investigating adult patient even outside College working hours, as we appreciate
satisfaction and experience after undergoing non-obstetric your enquiries might not be 9-5!
surgery, has been published in the BJA. Encompassing over
15,000 patients, SNAP-1 found that 99% of respondents would We are also looking at the way we respond to your
enquiries and improve the way we support you and help
recommend their hospital’s anaesthesia service to friends and
family. Anxiety was most frequently cited as the worst aspect of you get the information you need.
having an operation, reported by 34% of women and 26% of
We would love to hear your ideas about how we can
men.
improve our engagement with you as a member – please
The first episode of the PQIP Podcast is now available. Listen send your ideas to engage@rcoa.ac.uk. For those of you
and subscribe via iTunes (http://apple.co/2n42Fd9), Stitcher that wish to input your ideas into the College’s key work
(http://bit.ly/2n3NfFL), or at www.pqip.org.uk. To get involved streams and projects then please see the website about
with PQIP, contact your R&D department telling them you want joining the Membership Engagement Panel at:
to join this NIHR portfolio adopted study (CPMS ID 32256) or http://bit.ly/RCoAengagement.
contact pqip@rcoa.ac.uk.
Finally, a reminder that NAP6 local coordinators have until
5 May to report incidents of perioperative anaphylaxis to the
audit (http://bit.ly/2nwLSlN). The incident must have occurred
within the NAP6 window of 5 November 2015 – 5 November
2016. Queries to nap6@rcoa.ac.uk.
HSRC was launched in 2011 to be a hub for world-class
anaesthesia research. The HSRC has responsibility for the
National Audit Projects (NAPs) and oversees the National
Emergency Laparotomy Audit on behalf of the RCoA.
| 11
Bulletin  |  Issue 103  |  May 2017
YEARS
HRH The Princess Royal
joins RCoA Anniversary
celebrations
We would like to thank our Royal Patron for
joining us at our Anniversary Meeting as guest of
honour. Here is a transcript of HRH’s speech.
I am delighted to join you to help
celebrate your 25th anniversary. Of
course what it actually marks is a quarter
of a century, which sounds actually more
impressive, and also makes me feel a lot
older.
Although I am delighted that I have
been with the Royal College all the way
really, you were kind enough to give me
an Honorary Fellowship when it was the
College of Anaesthetists back in 1990, and
I won’t go back over my initial connections
with anaesthetists but it was an active and
practical one rather than a theoretical
one. And then you very kindly asked me
to become Patron in 1997. So it’s been
a very interesting progress and I’m really
delighted to see the College flourish in
the way that it has as an organisation,
both in its size, in its reach and very
importantly in your ability to bring in the
patient perspective, that has really been an
important part of that contribution.
12  |
In 1993, Her Majesty the Queen formally
opened the College’s first premises in
Russell Square, and then of course in
2006, I had the pleasure of officially
opening the new College’s home at its
current location in Red Lion Square. And
that was quite a step for the College to
make, but it has given you the opportunity
to carry out an awful lot of events, and
I’ve had the pleasure of attending many
of those, celebrating those achievements
in anaesthesia but also promoting
anaesthesia to a lot more people.
And of course 2007 saw the founding of
the College’s first faculty, the Faculty of
Pain Medicine, which is now celebrating
its tenth anniversary. And in 2010, the
Faculty of Intensive Care Medicine was
founded, and that already has over
3,000 members, so it kind of proves that
it was a faculty that needed to be there.
In 2015 I welcomed the College
launching its national programme of
work promoting perioperative medicine
Dr Liam Brennan and Dr Anne Thornberry (RCoA Honorary Archivist and Chair, Heritage Committee) present HRH The Princess Royal with a Royal edition of the Lives of the Fellows brochure
as a route to deliver more efficient
healthcare, improving patient outcomes
and quality of life.
Perioperative medicine is a natural
evolution in healthcare, using existing skills
and expertise within the NHS to ensure
that the individual needs of those complex
patients are carefully co-ordinated from
the decision to offer surgery, through the
weeks and months after the procedure.
The work encompasses the principles of
enhanced recovery that we know can
deliver better patient experience as well
as a more efficient elective care pathway,
and can lead to the delivery of the best
possible quality of care for patients.
The more faculties you have of course
the more joined up you have to be, so
that still requires work. But the College’s
perioperative medicine programme
will help hospitals reduce variation and
improve patient outcome after surgery,
and I am very pleased to see that two
years after the programme starting, there
are now perioperative medicine leads in
more than 160 hospitals, which again I
think goes to prove that that was a position
worth waiting for, and had a need.
Last year I had the opportunity to see
first-hand the work of the College at
its Patient Safety Conference. Run by
the Safe Anaesthesia Liaison Group, a
partnership between the Royal College
of Anaesthetists, the Association of
Anaesthetists of Great Britain and
Ireland, the Faculty of Intensive Care
Medicine and NHS Improvement, and
it was interesting, I have to say, to hear
some of the obstacles to patient safety
and solutions. And although I suspect
that differs depending on where you are,
because of the mixture of individuals, it
was well worth hearing that experience
to try and fill in those gaps to make sure
they don’t happen again. It’s a testament
to the specialty’s dedication to this cause
that today, anaesthesia has never been
safer—I think that probably comes in
inverted commas, but it is.
So, looking back over that quarter of a
century, well, maybe those who were
first involved would have found it hard
to imagine that, as a Faculty within the
Royal College of Surgeons of England,
comprising of just four staff based in
two rooms, it would become the Royal
College of Anaesthetists as we know it
today. For such a young specialty the
growth in stature and confidence of the
Royal College of Anaesthetists has been
really impressive. Partly I think because
anaesthetists themselves have bought
into the College and what it offers, what
it can do, not just for them professionally
but for the patients they work with.
Today, the College is thriving, as we’ve
heard, with a combined membership of
over twenty-one and a half thousand
doctors and has become the third
largest medical royal college in terms of
UK membership. It has its own distinct
identity and it has very much a distinct
role supporting its anaesthetists and
Bulletin  |  Issue 103  |  May 2017
intensivists across the United Kingdom.
And they do interact with about two-
thirds of all hospital patients. But what I
hope it also does it to raise the profile
of a specialty that would make more
people choose anaesthesia as a first
choice specialty rather than one that
comes a bit later maybe in their careers.
That would be good.
So this meeting I think is an important
meeting on an annual basis anyway,
but I hope that this 25th Anniversary
Meeting will be even better, that you
can take the opportunity to do a bit of
celebrating what you have achieved, not
too much because you’ve got a lot to do
in terms of listening and working for the
future, but have a very good two days.
My congratulations on what you have
achieved in what is actually a remarkably
short space of time. But I’m sure you
all look forward to the next quarter of a
century. Thank you.
| 13
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017

TRAINEE GUEST EDITORIAL

ADVANCING IN THE FACE OF ADVERSITY

Dr Kate Tatham,
RCoA Trainee Committee

Welcome to the annual trainee edition of the Bulletin. Despite trainee morale In this edition, we have commissioned Freeman and Dr Corcoran on raising Finally, we complete our contributions
trainee articles illustrating and outlining awareness about, and the wider impact of, with an article by our outgoing Trainee
in the UK currently running a little on the low side, with uncertainty about new how to maximise the various aspects of NCEPOD reports and recommendations, Committee Chair Dr Peeyush Kumar (see

contracts and concerns about the NHS being ‘in crisis’, the exploits, attributes
and fellowships of our trainees continue to expand and impress.
Recently we had fantastic engagement
at both the President’s Listening Events,
where the President and Council Members
were able to hear about, appreciate and
respond to concerns from the ‘shop floor’.
Concerns were also coupled with regional
examples of best practice and unique
ways to address training issues. We also
received more than 2,000 responses to
the recent Trainee Wellbeing Survey, the
results of which reached the national press
(http://bit.ly/2kTiH8R) and have given us
some important food for thought.
Another highlight from recent months
was the RCoA’s 25th Anniversary Trainer
Awards. To recognise these sometimes
‘unsung heroes’, we asked trainees to
nominate inspirational trainers in their
region, who they believed had gone
above and beyond in their contributions to
maintaining and improving training in their
school. The RCoA received nominations
from all the schools of anaesthesia, with a
full list of winners being published in the
March 2017 Bulletin. The citations were
overwhelmingly positive (see page 28),
demonstrating the numerous excellent
trainers present in all our schools across
the UK, and the positive impact they have
on their trainees.
Annex G. The first of these is a guide
to formal teaching qualifications by
Major Samual Welsh from the Military
Deanery. Following this Dr Sam Clark
and colleagues from RAFT, discuss the
rise of the many trainee research and
audit networks, in which anaesthetists are
leading the way, providing key training and
producing high-impact studies, as a result.
We then turn to quality improvement,
with an article by a group from Dudley
about how to implement an impactful
project aimed at improving outcomes
following emergency laparotomies. This
is complemented by an article by Dr
and how trainees can lead locally with this.
Dr Myra McAdam and Dr Simon Denning
describe unique ways in which to maximise
and achieve your advanced management
training, and understand how to bring
about change from ‘the other side’.
In addition, Dr Jamie Strachan and Dr
Toni
Brunning update us on the RCoA’s
ongoing Technology Strategy Review,
which includes key information on the new
lifelong learning platform and how you can
get involved in shaping the final product.
him being interviewed about his legacy by
new Council Member Dr Jenny Cheung at
(https:/vimeo.com/205792856). His
article summarises the fantastic response
and citations we received for the RCoA’s
Trainer Awards, and exemplifies what’s
great about the trainers and training in
anaesthesia today.
For more on what the trainee committee
do and issues and projects affecting
trainees (current, past or prospective),
take a look at our most recent issue of
The Gas (http://bit.ly/TheGas16) or our
webpage (http:/bit.ly/2o3TR6l). I hope
you enjoy this issue!

14  | | 15
Bulletin  |  Issue 103  |  May 2017
So, is a formal qualification in medical
education becoming a prerequisite for
anaesthetists, despite this not being the
case in other specialties? The criteria
for entry into ST3 medicine place
more emphasis on practical teaching
experience – more than twice as
many points are available for practical
experience, as the points available for
formal qualifications.2 The situation is
similar in the surgical specialties, where
little emphasis is placed on formal
qualifications, and teaching skills are
assessed as part of the interview.
There are now a significant number of
providers offering courses in medical
education. Both face-to-face and
distance-learning options are available,
with some offering a mixture of the two.
Most are structured as master’s level
modular courses, with the opportunity
to exit the programme at various points
in the course. Leaving having gained
60 credits would result in the award of
MEDICAL EDUCATION
a certificate, whilst 120 credits would
earn you the diploma. The final 60
credits required for the master’s degree
involves a research-based dissertation
around 15-20,000 words in length. The
Are the days of the ‘unqualified’ medical distance-learning option offers structured
modules, as well as courses that you
educator numbered?
can work to at your own pace. This
distinction is well worth bearing in mind,
particularly if you plan to undertake the
course whilst also having to revise for the
FRCA exams.
Major Samual Welsh, With so much choice of provider,
Core Trainee in Anaesthesia, delivery and content, how can you
Defence Deanery differentiate between different courses?
Table 1 gives some factors to consider
when choosing a course.
There is no definitive list of course
The self-assessement criteria for entry into ST3 Anaesthesia have been updated providers, but the Academy of Medical
Educators (AoME) keeps a list of
for 2017. They reveal an increased emphasis placed on the attainment of formal accredited courses,3 and if you’re
teaching qualifications. Previously, a certificate in medical education would have thinking of applying, this is a good
place to start your search. Choosing
earned you the highest possible score for teaching: now, the top points are only one of these will also mean that
awarded to those with a master’s degree in the subject.1 your qualification will allow you to
16  |
Bulletin  |  Issue 103  |  May 2017
Table 1 Choosing a course
Factor Considerations
Course delivery ■■ face-to-face (consider study-leave availability)
■■ distance learning
■■ distance learning with optional contact
Study mode ■■ full-time
■■ part-time
■■ start dates (anytime/specific)
Core modules ■■ educational principles and assessment common to all
■■ some offer a specialist module for anaesthetists
Deadlines ■■ specific deadlines for modules
■■ open modules without strict deadlines
■■ maximum permitted duration of course (probably two years per 60
credits)
Exit points ■■ option to finish with certificate (60 credits) or diploma (120 credits)
Cost and ■■ range of £2,500-£4,000 per 60-credit programme
funding ■■ some offer modular payment plans
■■ deanery ‘Education Bursary Schemes’ may be available of up to £2,000
apply for membership of the AoME. Choosing to enroll on a formal
Amongst those on the list is the RCoA medical education programme is
‘Anaesthetists as Educators’ (AaE) not an insignificant undertaking. You
programme. Aimed at senior trainees must ask the question ’is it worth it?’,
(ST5 and above), it comprises four not only in terms of financial cost, but
separate modules that can stand alone also of the time required for study
as qualifications. and how you will utilise it as part of
your career. Unfortunately, there isn’t a
As a general guide, for those looking
straightforward answer to this question.
to pursue careers in educational
The right choice is one that is not only
management (college tutor, programme
good for your career but one that you
director) a formal qualification would
end up enjoying.
seem to be desirable, if not essential.
However, for anaesthetists who simply References
have a passion for teaching on a day-to- 1 2017 Self Assessment Criteria for Anaesthesia
day basis, the decision is less clear-cut. ST3. Anaesthetics National Recruitment
Some are likely to enjoy learning the Office (http://bit.ly/2ncB6QC)
theory underpinning education. Others 2 ST3 recruitment – Application Scoring. Joint
RCP Training Board (http://bit.ly/2n6E1si)
will gain value from becoming more
3 List of accredited courses. Academy of
reflective in their teaching practice.
Medical Educators. (http://bit.ly/2nB2DMt)
Both are key features of all the current
formal education courses. Alternatively,
some might find they are better off
concentrating their efforts on delivering
local teaching. In addition, developing
new teaching programmes or improving
existing ones are both viable options.
| 17
Bulletin  |  Issue 103  |  May 2017
RAFT and the rise and rise of
trainee-led research networks
ON BEHALF OF RAFT
Dr Sam Clark,
Oxford University Trust,
Chair of RAFT
Dr Harriet Kemp, Imperial College London, Vice Chair of RAFT
Dr Jaimin Patel, University of Birmingham, Vice Chair of RAFT
The national anaesthesia Research and Audit Federation of Trainees (RAFT)
and the multiple regional trainee-led research networks (TRNs) have had
a significant impact in recent years. Data collection for our first national
collaborative NIHR portfolio study, iHypE1, was recently completed.
Anaesthesia is at the forefront of
collaborative research and audit,
something that is illustrated by the
success of the National Audit Projects
(NAP)2 and the first Sprint National
Audit Project4 (SNAP1). However, for
anaesthetic trainees following a non-
academic training route, challenges to
becoming involved in impactful research,
audit or quality improvement still exist.
This includes the ability to identify and
complete high-quality projects, in the
time constraints of training rotations.
The first network, the‘South West
Anaesthetic Research Matrix’ (SWARM),
was created in 2012, and aimed to
‘conduct high-quality, high-impact,
trainee-led, multi-centred research
and audit for the benefit of patients
and their future care’.5 Based on similar
principles, there are now 19 TRNs, with
another in development, providing
18  |
complete coverage across the UK for
anaesthetic trainees. In essence, they
provide a framework by which trainees
can develop and deliver high-quality
research and audit projects. Moreover,
they offer the unique ability to include
data collected by trainees ‘on the
ground’ at numerous regional and
national hospitals. In total, the TRNs, in
association with RAFT, have contributed
to eight NIHR portfolio studies including
SNAP-1, POPULAR6 and LAS VEGAS7,
as well as over 50 regional projects
producing numerous publications. At the
heart of the TRNs is strong adherence
to the principles of collaboration and
collective contribution to authorship.
Structure of RAFT
RAFT, formed in December 2013, is an
‘exoskeleton,’ organisation, which allows
support and dialogue between the TRNs
and promotes their sustainability. It is also
Dr Caroline Thomas,
St James University Hospital Leeds,
RAFT Secretary
a point of engagement for the TRNs,
with projects already developed at a
national level, for example, SNAP-2. This
structure also allows RAFT to develop
and conduct its own national studies,
exemplified by IHypE.
RAFT’s executive draws from OxCCARE,
PLAN, AARMY and WMTRAIN.3 Links
have been developed with several
key anaesthetic and research bodies,
including the NIAA and NIHR.
RAFT holds two annual meetings, a
Project Development Meeting and a
second at the AAGBI Winter Scientific
Meeting. The Project Development
Meeting is held during the GAT annual
meeting (Cardiff, 5–7 July 2017), where
the regional TRNs pitch to have their
local, successfully piloted, projects
adopted nationally by the RAFT network.
The Winter Scientific Meeting allows the
regional TRNs to showcase their work.
Intraoperative Hypotension in
Elder People (iHypE) – RAFT’s
Second National Project
This February, RAFT completed its first
national NIHR portfolio study – iHypE.
iHypE is a snapshot observational study
in patients aged 65 years and over
having general or regional anaesthesia.
It aimed to audit documented
intraoperative hypotension to determine
treatment thresholds and to highlight
outcomes.
Nearly 700 contributors (including
over 600 trainees) were involved in
collecting data from over 195 centres in
collaboration with the Anaesthesia. Audit
system. The study included over 8,000
patients and contributed over 3,000
accruals to the NIHR portfolio.
IHypE has been a great success for
RAFT. It demonstrates that trainees can
conduct large-scale trials, mobilising
in a highly co-ordinated manner and
collecting a vast amount of data, with
appropriate information governance.
Many trainees have gained key research
skills through this project. All were
required to undertake formal Good
Clinical Practice training, and many
interacted with trust R&D departments
and grant-funding processes, and
worked to secure ethical approvals.
A post-iHypE survey demonstrated that
85% of trainees felt that the project
helped them achieve curriculum
requirements and that 73% were
more likely to seek further research
opportunities. The institutional memory
that iHypE has developed will also help us
develop current projects and strengthen
collaborations as work goes forward.
Current projects and projects
in development
STAR, SWARM and WAAREN3 have
begun data collection on Satisfaction
and Wellbeing in Anaesthetic Training
(SWeAT), an NIHR portfolio study
Figure 1 What does RAFT look like?
examining burnout and wellbeing amongst
anaesthetic trainees in association with the
AAGBI. PLAN, OxCCARE and SEARCH3
are developing a project in association
with the Obstetric Anaesthetic Association,
examining awareness in the obstetric
population.
Nationally, RAFT is supporting SNAP-2.
It is developing the ‘Drug Allergy Labels
in the Elective Surgical Population’ study
(DALES), a prospective observational
study synergistic with NAP6, examining
patient-reported allergy status. This study
aims to be on a similar scale to iHypE.
Ongoing challenges and the
future
Despite its success, there are challenges
facing RAFT – funding needs to
be secured to allow us to improve
communication amongst trainees, with
an interactive website and online project
management systems. RAFT also aims
to engage more with the deaneries, via
college tutors, to ensure acceptance of
these projects as training opportunities
at Annual Review of Competency
Progression (ARCP) panels. Finally, RAFT
Bulletin  |  Issue 103  |  May 2017
wishes to develop ‘institutional memory’
through a programme of education and
support for trainees through Annex G.
References
1 Clark S, Wickham A. Intraoperative
Hypotension in Elder Patients (iHypE): a RAFT
study. RCoA Bulletin, 2016;100:46.
2 National Audit Projects. NIAA
(www.nationalauditprojects.org.uk) 

3 Table of TRNs (http://bit.ly/2njI5Zy)
4 Sprint National Anaesthesia Projects. HSRC
(www.niaa-hsrc.org.uk/SNAPs). 

5 SWARM Collaborative. South West
Anaesthesia Research Matrix (SWARM):
a new model for trainee research. RCoA
Bulletin 2013;79:21.
6 Fagerlund M et al. Postanaesthesia pulmonary
complications after use of muscle relaxants
in Europe: Study protocol of the POPULAR
study. European Journal of Anaesthesiology
2016;33 (5):381-382.
7 Local Assessment of Ventilatory Management
During General Anesthesia for Surgery
and Effects onPostoperative Pulmonary
Complications: a Prospective Observational
International Multi-centre Cohort Study.
European Society of Anaesthesiology Clinical
Trial Network (http://bit.ly/2nRmyEl).
| 19
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017

of breaking down interface barriers and Figure 1 Door to Theatre (DtT) times
examining delays, and thereby delivering 140
‘detailed timely care’.

Emergency Laparotomy

Time to theatre (hours)

120

Core elements of EmLap included: 100

1 empowering staff to recognise 80

Pathways
high-risk patients who may require
60
an emergency laparotomy, and
40
triggering a 2222 voice bleep to the
surgical registrar requesting that they 20
attend the bedside within 30 minutes 0

Dr Toni Brunning, Dr Faisal Baig, 2 a novel ‘CTabdo-EmLap’ imaging Historical Pre-EmLap Post-EmLap CTabdo-EmLap

ST6, Anaesthetic Registrar, ST3, Anaesthetic Registrar, request and accompanying

Figure 2 CT times
Birmingham School of escalation process developed with
Birmingham School of
Anaesthesia Radiology, to provide a targeted 35
Anaesthesia
CT scan within two hours, and a
30
consultant report within a further
25
one hour

CT times (hours)
3 for operative cases, a dedicated 20
Dr Adrian Jennings, Consultant Anaesthetist, Dudley Group NHS Foundation Trust
Dr Julian Sonksen, Consultant Anaesthetist, Dudley Group NHS Foundation Trust EmLap theatre-booking process 15

Mr Rajan Patel, Consultant Surgeon, Dudley Group NHS Foundation Trust which highlights to theatre managers 10
the need for prioritisation.
5

After establishing/initiating the EmLap 0

pathway, an audit was performed to Historical Pre-EmLap Post-EmLap CTabdo-EmLap
Emergency laparotomy is common, with up to 50,000 procedures performed assess its impact pathway on two key
annually in the United Kingdom.1 These procedures are associated with high process metrics. We assessed DtT-time Figures 1 and 2 show how the medians, this calculated risk stratification to trigger
and ‘CT-time’ (time from request of CT to
rates of postoperative complications and death, with approximately 15% of report of CT). The audit referenced only
25th and 75th centiles reduced over consultant presence in theatre and a
time, with a marked reduction for those postoperative high-dependency bed.
patients dying within one month of surgery.2 Significant variations in mortality patients admitted as an emergency and on the EmLap pathway.
who subsequently underwent emergency Acknowledgements
following emergency laparotomy exist between UK acute trusts.2 laparotomy, and for whom a preoperative For the CTabdo-EmLap group the DtT We would like to thank the many clinical
CT scan was part of the surgical work-up. and CT times were significantly shorter and managerial staff at DGNHSFT
‘Door-to-balloon’ time is a well-known performed at the Dudley Group NHS two important contributors in delaying
than Pre-EmLap (Dunn’s test for pairwise involved in the development, introduction
quality standard for myocardial infarction Foundation Trust hospitals (DGNHSFT). getting patients to theatre. An Emergency Comparisons were made between four comparison; p=0.001 and p<0.001 and daily implementation of this pathway.
and, with treatment of underlying Historical audit (which had shown delayed Laparotomy (EmLap) pathway was groups – ‘Historical’, ‘Pre-EmLap’, ‘Post- respectively). Median DtT and CT times
pathologies often being time critical, we recognition)4 and access to imaging were introduced in February 2015 with the aim EmLap’ and ‘Post-CTabdo-EmLap’. The for this group were 12.9 hrs and 2.22 hrs References
proposed an analogous ‘Door to Theatre’ Historical group included data collected respectively. 1 Shapter SL, Paul MJ, White SM. Incidence
time (DtT-time – time from arrival at in 2013 before the National Emergency and estimated annual cost of emergency
hospital to start of anaesthetic) as a process Laparotomy Audit (NELA).5 Pre-EmLap Embedding a CTabdo-EmLap process laparotomy in England: is there a major funding
metric for the management of patients included cases between November into the pathway has contributed to shortfall? Anaesthesia 2012;67:474-478.
requiring an emergency laparotomy. 2014 and January 2015, and Post-EmLap decreased DtT-times, and we believe 2 NELA Project Team. Second Patient Report of
the National Emergency Laparotomy Audit,
those between June 2015 and August this is a key step within a package of
Delays in processes of care, especially RCoA London, 2016.
2015. ‘CTabdo-EmLap is a subgroup of ‘marginal gains’ delivered by the EmLap (www.nela.org.uk/reports).
at the interface between specialties,
the Post-EmLap cohort, and specifically pathway. Since its introduction, our trust’s 3 Huddart S et al. Use of a pathway quality
may contribute to patient mortality.
looked at those patients where the postoperative hospital mortality has improvement care bundle to reduce mortality
This patient group may present to the after emergency laparotomy. British Journal of
CT scan was ordered using the newly improved. In the second NELA report,
emergency department or to medical Surgery 2015;102(1):57-66.
introduced CTabdo-EmLap process. risk-adjusted mortality at DGNHSFT was
or surgical specialties, and may require 4 Cooke K, Sonksen J. Emergency surgical
9.2% (national median 11.1%)2
referral for imaging and subsequent admissions to critical care, are we adhering to
Management of case with the EmLap
guidelines? Intensive Care Medicine Suppl 1,
assessment by anaesthetics or critical pathway was associated with a significant We are now focusing on further quality Vol 40 Abst 0206 2014.
care. Streamlining clinical pathways reduction in both DtT and CT times. improvement within our EmLap pathway 5 NELA project team: first patient report of
can enhance timeliness of care and by integrating P-POSSUM scoring into the National Emergency Laparotomy Audit,
improve outcomes.3 Approximately 200 our theatre-booking system, and using RCoA London, 2015
emergency laparotomies per year are (www.nela.org.uk/All-Patient-Reports#pt).

20  | | 21
Bulletin  |  Issue 103  |  May 2017
SUPPORTING NCEPOD
A trainee’s approach
Dr David J Freeman,
ST7 Anaesthetics,
Worcestershire Royal
Hospital
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD)
is a national non-governmental, organisation (NGO) that aims to improve
standards and patient care within the NHS. It achieves this by performing
focused studies into the quality of patient care provided in hospitals.
The results of these are widely
publicised, along with recommendations
to improve outcomes, allowing all
parties to focus on key issues and drive
forward improvements. Examples of
investigations over the last ten years
include the perioperative care of
22  |
patients in paediatric, bariatric, cosmetic
and lower-limb-amputation surgery.
Standards of care have also been
recommended for work in trauma,
abdominal aortic aneurysm rupture and
repair, sepsis, and acute kidney injury.
Dr Felicity Corcoran,
ST5 Anaesthetics,
Worcestershire Royal
Hospital
NCEPOD published its first national
report on perioperative deaths in 1989.1
From then the scope of investigation
has broadened, and it now covers both
surgical and medical areas of clinical
care. It currently studies and publishes
a report on two topics per year. Due
to the far-reaching clinical duties of
anaesthetists, many of these are relevant
to our specialty. For example; the 2014
lower-limb-amputation study ‘Working
Together’2 recommended that all patients
with diabetes undergoing lower-limb-
amputation should be reviewed both
pre- and postoperatively by a specialist
diabetes team to optimise blood sugar
control. In addition, it recommended
that all patients admitted electively for
lower-limb-amputation should be seen in
a pre-assessment clinic, and amputations
should be done on a planned operating
list, during normal working hours, and
within 48 hours of the decision to
operate.2
How to get involved in the
NCEPOD process
NCEPOD actively encourages
involvement from anaesthetists. For each
enquiry, patients are identified that are
relevant to the study topic. Trainees can
assist with an enquiry by completing
clinical questionnaires about the
identified patients. Hospital notes and
these questionnaires are then collated
and assessed further by a team of case
reviewers. Case reviewers are recruited
from the multidisciplinary team relevant
to the study, and can include anaesthetic
registrars, ST6 and above. They are
required to clinically appraise the quality
of care that each patient received,
using a template set by NCEPOD. This
provides the case reviewer with an
excellent opportunity to develop critical
appraisal skills and learn how hospital
trusts differ in their approach, and
provides a valuable contribution to the
national enquiry.
Anaesthesia Quality
Improvement and NCEPOD
A survey of anaesthetic trainees in the
Birmingham School of Anaesthesia found
that very few were aware of the activities
of NCEPOD or of its published reports.3
Following this, a trainee-led scheme
Anaesthetic trainees can make an active
and valuable contribution by supporting
the activities of NCEPOD both locally and
nationally
supporting the activities of NCEPOD
was piloted. The aim was to increase
awareness and disseminate news and
knowledge of NCEPOD to trainees
and other hospital staff. In each of four
hospital trusts within the Birmingham
School, an anaesthetic trainee lead
organised an education session which
staff from NCEPOD attended to discuss
how national confidential enquiries are
conducted, and a published report was
reviewed in more depth. These events
have received excellent positive feedback
from trainees and consultants.
Alongside this, a booklet has been
produced setting out the NCEPOD
report recommendations that are specific
to anaesthesia and critical care.4 This
booklet has been used to encourage
trainees to develop quality-improvement
projects to assess and improve patient
care from these recommendations.
An audit toolkit, and self-assessment
questionnaire is also available from
the NCEPOD website5 to give further
guidance and advice.
Frequent national events are held to
launch new NCEPOD publications and
recommendations, during which there
is the opportunity for trainees to present
work assessing the implementation or
impact of previous recommendations.
The next of these is at the Royal College
of Anaesthetists on the 7 June 2017, where
the report into care of patients requiring
non-invasive ventilation will be presented.
Bulletin  |  Issue 103  |  May 2017
To summarise, NCEPOD is a valuable
organisation for improving patient care.
Anaesthetic trainees can make an active
and valuable contribution by supporting
the activities of NCEPOD both locally
and nationally. Organising NCEPOD
lectures in our trusts, encouraging trainee
audits related to NCEPOD, and recruiting
trainees to become active in the national
enquiry data-collection and appraisal
process within the Birmingham School,
is a first step in engaging anaesthetic
trainees with the work of NCEPOD. We
hope that similar trainee-led schemes
might be introduced in other regions.
For further information see the ‘Trainee
doctors supporting NCEPOD’ website
www.supportingncepod.org.uk.
References
1 The 1989 Report of NCEPOD
(www.ncepod.org.uk/1989.html)
(accessed 6 March 2017).
2 National Confidential Enquiry into Patient
Outcomes and Death. Lower Limb
Amputation; Working Together. Study Report,
2014 (www.ncepod.org.uk/2014lla.html)
3 Freeman DJ. Trainee understanding of
NCEPOD. Presented at the Midlands Society
of Anaesthesia, 11 November 2016.
4 NCEPOD related audit ideas.
(http://bit.ly/2msJ6yl (accessed 6 March 2017).
5 National Confidential Enquiry into Patient
Outcome and Death Toollkits
(www.ncepod.org.uk/toolkits.html)
(accessed 6 March 2017).
| 23
Bulletin  |  Issue 103  |  May 2017
THROUGH THE LOOKING GLASS:
The management dilemma
As doctors, we are well practised in the management of clinical situations,
making decisions in minutes that directly impact on our patients’ outcomes.
We are less familiar with the ’dark side’ of the NHS: non-clinical managers
who work to ensure the care we deliver is possible.
Whilst the value of research and medical
education skills is often highly regarded
by trainees, and are seen as integral
to our training, ’management’ is often
perceived as being in conflict with them.
Furthermore, the term ’management’
sometimes carries negative connotations
for doctors in training, who may feel that
management is the source of policies
that sometimes impede their ability
to conduct safe and effective clinical
practice.
Yet, without engaging with management
processes, we are unable to influence
sustainable change locally or
nationally. This is the crux of the RCoA
24  |
management curriculum – divided into
local and national aspects, it provides
a framework for trainees looking to
expand their management abilities, and
eventually their ability to influence the
system in which they work.
Whilst trainees can often reach the
intermediate and higher levels of training
with one of the many widely available
two- or three-day management and
leadership courses, the advanced
module stipulates that they should
undertake at least a six-month (preferably
a year) secondment, working under the
supervision of a senior manager. This has
generally been as part of a dedicated
fellowship, such as those offered in
partnership with the Faculty of Medical
Leadership and Management or the
Scottish Clinical Leadership Fellowship.
There are, however, ways to meet the
core clinical learning outcomes without
taking a dedicated period of time out of
training.
In this article, we will describe two
trainees’ experiences of the Advanced
Management Module.
THE GAT COMMITTEE APPROACH
Dr Simon Denning,
ST5, elected GAT Committee Member
As Group of Anaesthetists in Training (GAT) Committee
members, we are expected to complete at least a two-
year term, during which we are exposed to, and involved
in national meetings and projects, often leading to local
dissemination of ideas that are all of relevance to the
Advanced Management Module (AMM).
Previous GAT Chair Dr Sarah Gibb, current chair Dr
Emma Plunkett and elected member Dr Surrah Leifer have
completed the AMM within their term of office.
By keeping detailed reflective portfolios of all management
activity both locally and nationally, and, more importantly,
communicating with both the RCoA and their Training
Programme Directors (TPDs), they could demonstrate that
they had met the requirements. We are now providing
support for all interested committee members to complete
the AMM if they wish, and hope to expand this to other
relevant trainee groups in the future.
Those interested in furthering their management experience
should:
■■ discuss this with their educational supervisor or TPD and
find a management module supervisor
■■ explore what their deanery and hospital currently offer as
management experience
■■ make contact with your trust CEO/management team –
medical directors are a great resource and often keen to
take on an ‘apprentice’
■■ consider a formal leadership and management course
■■ keep a portfolio of management activities.
Resources for those who are curious
■■ Faculty of Medical Leadership and Management
(www.fmlm.ac.uk)
■■ Paired Learning (pairing doctors and managers together
to learn from each other) (http://bit.ly/2mQuwMg)
■■ NHS Management Training Scheme
(www.nhsgraduates.co.uk)
Bulletin  |  Issue 103  |  May 2017
THE FELLOWSHIP APPROACH
Dr Myra McAdam,
ST7, Scottish Clinical Leadership Fellow
2014-15
Having become increasingly frustrated with the coffee
room chat where a regular theme was “the management”
impeding clinical services and progress, I was appointed
as Scottish Clinical Leadership Fellow in 2014, working
with both RCoA Clinical Quality Directorate and Scottish
Government Health Workforce. My post was a 12-month
out of programme period where I worked with the most
senior managers within NHS Scotland and the RCoA.
I started the post with a commitment to understanding this
“dark side” of the NHS; the work that goes on behind closed
doors that we don’t see, but enjoy complaining about.
I spent 12 months leading projects involved with quality
improvement in postgraduate medical training, national
clinical anaesthetic standards and the development of
management training for doctors in training.
I gained invaluable insight into the inner workings of the
NHS from a national healthcare delivery point of view, as
well as getting to meet, know and understand the roles and
personalities of the individuals who are involved in the wider
management of the NHS – the people who look at the big
picture, allowing us to focus on the individual patient.
The main thing I learned is that managers want to make a
difference to patients too. They have invaluable insight into
aspects we may not consider, and are very open to being
approached by doctors in training who want to know more,
or who have an improvement idea or a concern that could
inspire change.
If you want to know more, then don’t be intimated about
knocking on the door of your Clinical Director, Medical
Director or even the Clinical Service Manager – you never
know what you might learn!
The most important thing to remember is that at the end of
the day, we are all there to better our patients’ experiences
no matter what our job title or background.
|  25
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017

Technology Strategy Programme (TSP)

USER-CENTERED DESIGN
Dr Toni Brunning, Dr Jamie Strachan,
ST6, Anaesthetic Registrar, RCoA TSP Fellow and
Birmingham School of ST7 Anaesthetics, Oxford
Anaesthesia University Hospitals

The TSP is a three-year change programme which will impact every aspect of
College technology. The first phase is focussed on improving your learning
tools – which means new e-Portfolio, Logbook, CPD and Exams systems. To get
the best system for those who will use it, you have to involve the users from day
one. We at the RCoA’s Technology Strategy Programme (TSP) are putting this
into practice in a number of ways as we work towards providing the College’s
membership and staff with the best solutions for their requirements. Two of these
approaches are prototyping and personalisation. Making it personal

Aaron Woods Alice Dartnell Graham Blair

Try before you buy
A key part of the TSP is the creation of
a lifelong-learning platform. Trainees
are one of the main user groups of
this technology, so the selection of the
platform and the definition of the first
section – a new eportfolio – clearly
needed trainee representation. We were
joined by Dr Karen Pearson (Trainee
member of the RCoA Scottish Advisory
Board) and the rest of the panel (with
RCoA team working with specialist agency Wardour on content options
consultants and trainers) to assess the
shortlisted suppliers for the new lifelong-
learning platform.
The panel’s first task was scoring: a
rigorous process with a lot of text to read
and review in order to rate 14 interested
suppliers’ proposals. The panel whittled
down the long list to a shortlist of four who
then came for a further grilling via formal
presentations and prototyping days.
For the prototyping days, the shortlisted
suppliers were given a scenario 24
hours in advance, with explanations of
our requirements relating to logbooks,
assessment and multi-curriculum
usage. They then spent the next day
with College representatives, asking
questions, testing out designs, mocking
up web pages etc. The aim wasn’t to
end the day having built a great bit
of software, but for the supplier to
demonstrate that they can work with us,
understand what we need, and give us
evidence that , given a proper timeframe,
they could build what we want with
their system. The focus was on getting
beyond the sales people and their
promises, and seeing for real if they can
deliver or not.
We expect to have chosen and be
working with the supplier to develop the
new e-portfolio by the time this edition
of the Bulletin lands on your doorsteps!
Technology Strategy
Programme Director
A key driver of the TSP
is to make the lifelong-
learning experience better for our
members. Personalisation, be it through
tailoring the website or configuring
your e-portfolio homepage, is a way
to achieve this. Personalisation is about
giving you control so you get to define
what you want to be presented with, and
how and when. Personalisation, like all
other TSP aspects, works best when you
directly involve those who will be using
it in defining how it should work. So it
was great to see Jamie our TSP Fellow
working alongside Alice and Graham at
a personalisation workshop with external
experts Wardour, to get the ball rolling in
this area.
Membership
Engagement Manager
One of the ways to
improve engagement
with our members is to improve how
we offer our services and the benefits
we provide. The key way to do this is
through personalisation, so I was excited
to be part of this TSP workshop.
We want to improve the way our
members receive support, whether that
is in the form of alerts about upcoming
events or the latest news in anaesthesia.
We want members to be able to access
the information that is most important
and relevant to them, in the easiest way
possible, and to help them sift through
the jungle of information that is out
there. We know that you are already
pressured enough for your time, so we
want to make sure you receive what you
need and what you want.
Head of Education and
Events
Personalisation will be
a key part of the future
education strategy, so working through
what personal content looks like at this
workshop has helped shape our future
programme.
With over 130 educational events
generating valuable educational content,
we want you to have personalised
relevant content which is easily accessible
when you want it. This could be a
cardiac-focused e-learning session or a
recording from a recent paediatric event,
but whatever it is you would be able to
choose what you wanted to see at a time
convenient to you. Personalisation would
also mean that you could be alerted
about forthcoming events relating to your
specialism or interest in good time to
book study leave.

26  | | 27
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017

25TH ANNIVERSARY
RCoA TRAINER AWARDS goes out of her way to
stand up for trainees
we should all
Dr Peeyush Kumar, aspire to this level
Former Trainee Member of Council, of motivation The consultant we
RCoA (2013-2017) when we become want to be like! absolute legend
the trainers

never-ending
As part of the RCoA’s 25th Anniversary celebrations, there are inspiring educator and
enthusiasm and always available
many unique events planned throughout this year. One of the leader
dedication as a for pastoral and
key functions of our College is training, and indeed excellent supervisor clinical advice
trainers are vital for the future of our specialty. To recognise and brilliant role model
celebrate these sometimes ‘unsung heroes’, we asked trainees
to nominate trainers in their region, who they believe have gone goes above and inspirational
above and beyond normal achievement in their contributions to feel privileged to beyond helping with
maintaining and improving training in their school. know him ideas for projects

We are happy to confirm that RCoA received names from all

the schools of anaesthesia. A full list of award winners by school We would also like to thank all the Anaesthesia Trainee Representative Group (ATRG) members
was published in our March 2017 Bulletin. We would like to for the hard work they have put in to nominate trainers from their schools for the Anniversary
congratulate all these trainers, and here you can read some Trainer Awards. We were overwhelmed on reading the citations and feel proud that we have such
snippets from the citations received for the awards. excellent trainers in all the schools.

28 | | 29
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017

Revalidation for anaesthetists Anaesthesia Clinical Services Accreditation

Military anaesthesia in the Supporting the delivery of

CPD matrix clinical services accreditation
Chris Kennedy, Lieutenant Colonel Jonathan Round Carly Melbourne Sharon Drake
RCoA CPD and Revalidation Consultant Anaesthetist RCoA Quality and Safety RCoA Deputy Chief Executive
Co-ordinator Manager and Director of Clinical
Major Andrew Maund
Quality and Research
Specialty Registrar

As part of its supporting strategy for the development of Anaesthesia Clinical

For many years the CPD Matrix1 has been available as an optional resource
Services Accreditation (ACSA), RCoA has been part of a collaboration of
to guide appraisal and personal development plan discussions. Level 3 covers
professional bodies which form the Clinical Services Accreditation Alliance (CSAA).
the knowledge and skills required by those whose routine clinical practice
includes one or more special interest areas. One example of this is military The remit of the CSAA since its inception With the CSAA’s original work complete, The RCoA’s Anaesthesia Clinical Services
in 2013 has been to ensure that all we are delighted that HQIP has agreed Accreditation (ACSA) scheme closely
anaesthesia, which was added to the matrix in July 2013. affiliated schemes are patient focused to take on the development of the aligns to the outputs of the CSAA, and
and clinician led, and this has resulted CSAA’s remit, which includes maintaining our continued involvement in standards
As with other sub-specialty groups, A working group has recently updated Accordingly, the new matrix has increased in a suite of six resources to support and developing the existing workstreams for clinical service accreditation scheme
military anaesthetists are geographically this matrix, with input from consultants emphasis on casualty management professional bodies looking to develop and resources. The RCoA is a member will help provide consistency for
dispersed, with diverse interests and representing different areas of expertise where evacuation is delayed, regional patient-centred, professionally-led of the CSAA Sponsor Group, which clinicians and lead to improvements in
practices beyond their military work. A within military anaesthesia. The new anaesthesia, TIVA, and resource- accreditation schemes. These are: will oversee this work and includes patient care. For further information on
common skill set and knowledge base matrix reflects lessons learnt from constrained clinical decision making. 1 requirements and guidance for membership from the Royal College of CSAA, please visit www.csaa.uk.
is essential to facilitate interoperability recent operations and anticipated Elements from the previous iteration of the accreditation of certification Nursing, Royal College of Physicians,
when individuals are formed into future challenges. It is likely that future the matrix have become routine (e.g. bodies (with the UK Accreditation For further information please contact
Royal College of Surgeons, Royal
deployed units on operations. In order deployments will consist of smaller ketamine usage) and no longer require Service and the Healthcare Quality ACSA@rcoa.ac.uk or visit
Pharmaceutical Society and Allied Health
to achieve this, military anaesthetists teams to more remote and resource- specifying. Careful analysis of the new Improvement Partnership (HQIP) ) www.rcoa.ac.uk/acsa
Care Professionals.
undertake CPD mapped to the Level 3 constrained environments. matrix against the requirements for
2 sharing and improving accreditation
matrix for military anaesthesia. training delivery has ensured that mapped
methodologies (with RCoA)
CPD opportunities are available to all
Defence Anaesthetists. 3 a map of clinical services for clinical
service accreditation schemes (with
As part of the College Technology the Royal College of Surgeons)
Strategy Programme, the CPD Matrix is
4 the British Standards Institute
going to be replaced in due course by
document ‘Healthcare – Provision
an online CPD Framework which will be
of clinical services – Specification’
more interactive and personalised. It is
http://shop.bsigroup.com/
clear that military anaesthesia will continue
to be a key part of the Framework, as it is 5 requirements for clinical service
within the current matrix. accreditation of IT systems (with the
Royal College of Physicians)
Reference http://bit.ly/2nTG6ep
1 RCoA CPD Matrix 6 developing accreditation schemes
(www.rcoa.ac.uk/document-store/cpd-matrix)
for clinical services (with HQIP).

30  | | 31
Bulletin  |  Issue 103  |  May 2017
Faculty of Pain Medicine (FPM)
Five questions about e-PAIN
Dr Douglas Natusch,
Torbay Hospital,
Torquay, Devon
Clinical Lead, e-PAIN
1. What is e-PAIN ?
e-PAIN is a free online education which
distils leading professional expertise in UK
Pain Management into 11 modules. Each
module has around five sessions, with
each session taking about 30 minutes
to complete. Every module has its own
certificate that can be downloaded
to claim CPD points. e-PAIN is a
collaboration between the Faculty of Pain
Medicine (FPM), the British Pain Society
and e-Learning for Healthcare.
e-PAIN can be found at www.e-lfh.org.uk
32  |
2. Why should an anaesthetist be
interested in e-PAIN?
Managing pain is a core skill of all
anaesthetists. Anaesthetists often look
after people with pre-existing pain
conditions, those prescribed complex
analgesics, or those worried about their
surgery or experiencing pain afterwards.
e-PAIN offers the opportunity to learn
more about managing acute pain and
pain in complex conditions.
Dr Rhian Lewis,
Ysbyty Gwynedd,
Bangor
Clinical Lead, e-PAIN
3. What about e-LA and e-ICM
– the other e-learning platforms -
don’t they have sessions on pain?
Yes, all three platforms share some
sessions. However, e-PAIN is unique in
following the International Association
for the Study of Pain curriculum for
multidisciplinary learning. e-PAIN covers
specialist areas of practice, for example,
pain in pregnancy, pain in children, pain
in the elderly and in the addictions.
4. Can trainee anaesthetists use
e-PAIN?
Yes, e-PAIN is a useful resource for
anyone undertaking UK anaesthetic
training beyond basic specialist
training. The e-PAIN library also holds
publications on pain from BJA Education
(formerly CEACCP).
5. Where can I find e-PAIN ?
e-PAIN is hosted on the e-LfH
(e-Learning for Healthcare) website at
www.e-lfh.org.uk
A link can be found on the FPM’s
e-PAIN webpage or via
www.e-pain.org.uk or on
Twitter: follow @eLANews
Bulletin  |  Issue 103  |  May 2017
Faculty of Intensive Care Medicine (FICM)
Smaller Units Advisory Group
Dr Chris Thorpe,
Chair, FICM Smaller Units Advisory Group
Although the majority of units within the UK are outside large tertiary centres
(Figure 1), this majority is poorly represented on UK national committees
and the FICM were keen to address this discrepancy. The Smaller Units
Advisory Group (SUAG) was set up in 2016 to represent smaller units, and has
representation from all four countries in the UK.
The main purpose of the committee is are continually updated. Increasing and stroke. In the UK, outcomes in ICM
to ensure that critical care support will numbers of FICM-qualified trainees are not improved in bigger centres and
continue, and develop, in smaller acute are coming through the system, and evidence is continually emerging to guide
hospitals. Probably one of the main many will find a DGH job attractive. It is our future direction – for example, a recent
difficulties has been that Edition 1 of therefore important that we get this right, paper showed that the optimum patient to
‘Guidelines for the Provision of Intensive and that ICM posts in DGHs continue to intensivist ratio is 7.5:1.
Care Services’ (GPICS) did not have be seen as a viable alternative to posts in
enough input from smaller hospitals, and tertiary centres. Further articles on the progress of the
therefore they have been left feeling Group can be found in Critical Eye, and if
Lastly, it is worth looking at the evidence you are interested in emerging evidence
somewhat adrift in the brave new world.
on outcomes. Generally, there is little and research on this topic, I will share any
This is acknowledged by FICM, and is
evidence for improved outcomes in useful articles I find through Twitter.
to be addressed in the next edition of
centralised services, apart from a small
GPICS. Areas to be explored include Email: christhorpe@me.com
number of highly specialised services such
greater use of networks in providing Twitter: christhorpe@christhorpe5
as percutaneous coronary intervention
care, a model shown to be successful in
Holland. This could provide an individual
25
Figure 1 Frequency
approach to a particular patient’s care that
distribution of critical care
would result in many patients staying in 20
Percentage of critical care units
units annual volume of
local facilities, but with some transferred
mechanically ventilated
elsewhere after discussion. The Dutch 15
admissions
experience was that in practice the
10
Reference Shahin, J., Harrison,
vast majority of patients stayed in local
D.A. & Rowan, K.M. Intensive
facilities and had good outcomes. 5
Care Med (2014) 40: 353.
doi:10.1007/s00134-013-3205-4
One necessity for smaller hospitals is 0
0 200 400 600 800
to attract FICM-trained consultants to
Volume of mechanically ventilated admissions
ensure that current practices and systems
| 33
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017

Health Services Research Centre (HSRC)

In recent years, QI methodology has
been embraced in adult perioperative
medicine with great effect. This has
been championed by the Royal College
of Anaesthetists (RCoA), the National
Institute of Academic Anaesthesia
(NIAA), and the Health Services Research
Centre (HSRC), in the knowledge that
anaesthesia takes centre stage in the
surgical care pathway. Local trusts have
been empowered by having access
to their own risk-adjusted outcome
measures, such as those provided by the
National Emergency Laparotomy Audit.
The paediatric surgical population is
yet to benefit in this way, as those aged
under 18 are often excluded. Indeed,
since we lack reliable paediatric surgical
denominator data, we are yet to establish
The paediatric cohort is arguably more
complex… a de novo approach is required
equally problematic, as studies using
outcomes of such low incidence are likely
to result in insufficient statistical power
to demonstrate a true effect.2 Instead,
paediatric-specific quality indicators must
be identified.
The solution
The paediatric perioperative community
is stepping up to the challenge. In the
Whilst the road to improving paediatric
perioperative medicine here in the UK
will be littered with many obstacles,
the need to tread this path cannot be
denied. To do so will not only enable us
to better serve our paediatric population
but crucially, in this current time of
austerity, to also address the moral
obligation we all have to the wider
population to ensure that resources

Health services research in

how much we are doing, let alone how
well we are doing it. There remains no
doubt, however, that there is a need to
address problematic areas of care in
are utilised in the most effective way
US, a rapidly expanding paediatric
possible.
version of the National Surgical
Quality Improvement Program is using
References

children undergoing surgery

children’s surgery.1
The challenge
The paediatric cohort is arguably more
complex than its adult counterpart such
that the direct mapping of adult QI
initiatives to children’s perioperative care
is likely to be of limited use. Instead a de
novo approach is required for a number
of reasons. Structural aspects relating to
Dr Amaki Sogbodjor, the centralisation of services influence
HSRC Research Fellow in the shape of the patient pathway, for
Paediatric Perioperative Medicine example, by increasing the need for inter-
hospital transfers. Engagement from a
large number of specialties is needed to
capture all aspects of such a pathway. This
includes paediatricians and intensivists
as well as both general and specialist
Health services research involves the evaluation of healthcare provision with paediatric surgeons and anaesthetists. In
the aim of improving outcomes. It represents the interface between academia addition to these macro-level intricacies,
there are complexities which arise at
and healthcare delivery, seeking to determine how best to ensure that the care patient level. The needs of the neonate
that is delivered is safe, effective, efficient and agreeable to patients. and adolescent are as different from one
another as is their ability to express them,
Quality Improvement (QI) requires time and different institutions. Only then allows interventions to be implemented resulting in complications in the process
measurement to define the current can reasons for variations in care be to both remedy poor performance and of collecting increasingly important
status quo and enable comparisons to explored. Understanding why hospitals reinforce examples of good care. patient-reported outcomes. Traditional
be made between different points in are performing to the level they are outcome measures such as mortality are
prospectively collected data to provide
1 National Confidential Enquiry into Patient
institutions with their own risk-adjusted
Outcome and Death. Are We There Yet?: A
outcomes. Here in the UK, the HSRC Review of Organisational and Clinical Aspects
has committed to develop its quality of Children’s Surgery. NCEPOD 2011
(http://bit.ly/1mrKJrh) (accessed February 2017)
improvement programme to include
2 Walker K et al. Public reporting of surgeon
paediatric perioperative medicine.3 This
outcomes: low numbers of procedures
is to be a collaborative effort with the lead to false complacency. The Lancet
RCoA, the Association of Paediatric 2013;382(9905):1674-1677.
Anaesthetists and the Royal College of 3 The Next Five Years. Health Services Research
Paediatrics and Child Health, and will Centre of the National Institute of Academic
Anaesthesia. (http://bit.ly/2nTwY9M)
aim to address the lack of paediatric-
(accessed February 2017)
specific quality indicators available in
4 Boney O et al. Standardizing endpoints
our healthcare system. In recognition of in perioperative research. Can J Anaesth
the need for these indicators to be valid, 2016;63(2):159-168.
reliable and relatively easy to measure,
this process requires a combination of
expert opinion and a sound evidence
base. The HSRC’s initiative to develop
a core outcome-set for trials in adult
perioperative medicine is already in
full swing.4 Such work will be of equal
importance in children’s medicine. As
with the adult population in the UK, it
is likely that attention will initially focus
on the care and outcomes of children’s
emergency abdominal surgery, a
priority area identified by the clinical
and scientific community for quality
evaluation and improvement.1

34  | | 35
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017

However collecting the data is only

one aspect of the audit, and NELA has
always had the use of data to improve
care as its core objective. Clinicians
are able to view their own data on the
quality improvement (QI) dashboards
as soon as it is entered into the audit.
These dashboards show up-to-date,
real-time information on how your
hospital is doing compared to national
figures for all the key metrics, such as
consultant-delivered care, and delays in
theatres and in critical care admission.
The use of these dashboards has been
variable, with some trusts regularly
reviewing data and using it to drive
improvement, whilst other trusts do
not access their data at all. Nearly 60
percent of local teams say they do To watch the video on using NELA data to improve data
not use common QI methodology to feedback visit http://bit.ly/2nwbEph
implement improvements in emergency
laparotomy care.

There is a disconnection between

Using NELA data to improve working hard to capture data, but not
using it to its best potential to improve
care. To a large extent, this means
2. Run charts
The NELA QI dashboards and annual
References
1 Ivers N et al. Audit and feedback:

patient outcomes
that much of the effort of timely data
collection is wasted.
It is far easier to bring about improvement
if we review our data regularly and feed it
back without delay to clinicians involved
Dr Carolyn Johnston in delivering care. After all, knowing how
NELA QI Lead well you did last week is far more relevant
and interesting than knowing how well
you did a year ago.
NELA have produced three short
animations to help local teams use
The most valuable commodity I know of is information evidence-based approaches to use their
Gordon Gekko data to best effect.
These cover three important topics:
The National Emergency Laparotomy Audit (NELA) is in its fourth year,
1. Data feedback
and over 60,000 patients have had their care recorded via the audit and This gives some useful tips to help
shared through the annual national reports. This is only possible because of you feed this data on patients back to
colleagues once it has been entered,
the diligent efforts of local leads and clinicians in continual monitoring of thereby avoiding the dreaded group
this high-risk surgery; a huge amount of work goes into collecting data and email that nobody reads.1
reports display data as time-series or effects on professional practice and
healthcare outcomes. Cochrane Library 2012
run-charts that show change over time;
(http://bit.ly/20K6wZ8).
this animation explains the basics of run-
2 Perla RJ, Provost LP, Murray SK. The run chart:
charts and how to use them – they are a simple analytical tool for learning from
one of the most important tools in quality variation in healthcare processes.
BMJ Quality & Safety 2011;201:46-51.
improvement.2
3 Siriwardena AN, Gillam S. Understanding
3. Understanding your system processes and how to improve them.
Quality in Primary Care 2013
It is far easier to identify what needs to (http://bit.ly/2n2ok3Z).
change if you understand how things
really work in your hospital, and the third
animation describes process maps and
driver diagrams – simple graphical tools
can help make sense of a seemingly
complex patient pathway.3
Over the coming months, the NELA
project team will be trialling some other
ways to help teams use their data to
improve emergency laparotomy care,
so look out for these on the NELA
website www.nela.org.uk and
NELA twitter feed @NELAnews

NELA’s success depends on this work.

36  | | 37
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017

Staff, Associate Specialist and Specialty Doctor (SAS)

SAS SURVEY 2016

Dr Lucy Williams,
RCoA SAS Member of Council

Patience is the companion of wisdom

Saint Augustine

It seems a long time ago that we asked SAS anaesthetists to complete a survey
about their work patterns and concerns. We are very grateful to all 634 of you
who participated, and we have some very useful and interesting data. Some
may be concerned that the results have all been buried and that nothing will
happen. I would like to reassure you that this is far from the case.
Hopefully you will have already seen a
summary document.1 This covered some
headline figures, and briefly explained
how we are bringing the findings to
relevant College committees. This is
where subjects can be explored and
debated to agree the best way to bring
about change. But it all takes a little time.
I have presented a paper to the
Training Committee. There were several
survey findings that were relevant to
this particular committee. They can
be divided broadly into access to the
training programme; examinations,
teaching and training opportunities, and
specific career guidance and support.
This is a massive amount to cover and
discuss in a meaningful way, and it will be
an agenda item at several meetings.
Many SAS anaesthetists want to return to
training, sit the Fellowship exam, or apply
for a Certificate of Eligibility for Specialist
Registration (CESR). But it is not clear
who best to turn to for advice. These are
complex issues and the College must
work within the regulatory framework of
the GMC; as a consequence the process
may sometimes appear unhelpful.
The Regional Advisor Anaesthesia (RAA)
role has recently been reviewed, and
the Training Committee agreed that
they were best placed to offer career
advice and guidance. The RAAs have
a good understanding of their local
workforce, and close connections with
other College staff and with their local
Training Programme Director. Basically,
if they don’t know the answer, they know
someone who will. This role needs to be
publicised, so that SAS anaesthetists know
to get in contact with their local RAA.
The next big topic for the Training
Committee is how to promote return
to training. Again, there are strict
regulations about entry to training
programmes. In many parts of the
country, there are unfilled training places.
If there is an appetite for training among
SAS anaesthetists, how can we help
them into these vacancies? Doing so
would kill two birds with one stone, and
seems an obvious way to address some
of the predicted workforce problems of
the future.
I have also shared findings with the
Education Committee. The survey
showed that many of you wanted
SAS-specific events. The Education
Committee is currently reviewing its
meetings and educational provision
to align it with the College’s Strategic
Plan.2 This is a perfect time to organise
a meeting to address many issues of
interest to SAS doctors. The training
programme and CESR are obvious
subjects, and this may help to clear up
some apparent misunderstanding of the
College’s role in these. The ‘New to the
NHS Day’ will run again on Monday
17 July at the College. This is for MTI
and SAS doctors joining the NHS from
abroad.
The subject of CESR is a major concern
that stood out in the survey’s free-text
responses. The whole process is seen
as unnecessarily complicated; but it is
run by the GMC, with each College
acting only to assess equivalence of
knowledge and skills with those of a
new CCT holder. Dr Kirstin May, SAS
Member of the RCoA Council, wrote a
recent Bulletin article on this subject.3 It
is also covered in detail on the GMC4
and College5 websites, but not in a way
that seems to be very helpful. According
to the recent joint document on SAS
Development,6 the GMC is currently
looking at how to streamline the process.
Kirstin will discuss the survey comments
at the RCoA’s Equivalence Committee.
The initial impetus for the survey came
from the findings of the 2015 College
Census.7 The Workforce Advisory Group
was keen to learn more about what 6 SAS doctor development. BMA
(http://bit.ly/2oBqnNn).
SAS doctors were doing, and how their
development should be supported 7 RCoA Census 2015 – Final Report. RCoA
(http://bit.ly/2niLoeR).
in order to have a safe, experienced
workforce in the future. It is expected
that demand will grow faster than the
numbers of trained anaesthetists, so
it is vital to retain and to offer career
progression to this large group of
capable anaesthetists. The Workforce
Advisory Group meets in May, and will
discuss the implications of the survey.
Hopefully you can see that there is a
lot of action behind the scenes at the
College. The College takes the concerns
of SAS doctors seriously, and now has
the data to build a constructive way
forward. So, be patient, and you will see
changes over the next few months.
References
1 SAS Survey Summary: Interim Results
(www.rcoa.ac.uk/node/25481).
2 The RCoA Strategic Plan 2016-2021. RCoA
www.rcoa.ac.uk/strategic-plan-2016-2021
3 May K. CESR – Should you? Could you?
Would you? RCoA Bulletin 2017;102:28-29.
4 Specialty specific guidance for CESR and
CEGPR applicants (http://bit.ly/2odOB43).
5 CESR and equivalence. RCoA
(http://bit.ly/2odOdCZ).

38  | | 39
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017

Patient perspective Journal Watch

Accountability matters PERIOPERATIVE MEDICINE

Dr Jonathan Lacey, Dr Nazia Khan, Dr Hoon-Ying Lau,
Mr Rob Thompson, Perioperative Medicine Fellows, University College London Hospitals, London
Chair, RCoA Lay Committee Dr John Whittle, ST7, Central London School of Anaesthesia

Public trust in charities in England and Wales has fallen to the lowest recorded
level since monitoring began in 2005, in the wake of a series of high profile
scandals. These include the collapse of Kids Company and Age UK’s deal with
energy supplier E.ON.
The College has had the foresight and
fortitude to carry out a comprehensive
review of its governance arrangements,
which the President has described in
earlier Bulletin articles.
Council has decided to appoint a
number of lay trustees. It is hoped that
this will bring a wider perspective to
the work of the Council, and a broader
range of skills in areas such as Finance,
Investment and Risk Management. Of
course, by Charity Commission rules,
trustees cannot be paid, so this valuable
expertise will benefit the College and
represent good value for money.
At the same time the governance of
Faculties, Boards and Committees of the
College have been reviewed, including the
delegation of responsibility and authority.
This should lead to clearer and more
efficient decision-making and enable the
College to move forward with confidence.
So, why should this matter to patients
and the public more generally?
First, two of the four main objects of
the College are about the education
of the public in all matters relating
to anaesthesia, and the education of
medical practitioners for the protection
and benefit of the public.
Second, patients and the public want
charities to improve the way they
manage themselves and expect them to
operate in a fair and transparent way
Third, patients want to know that charities
such as the College are making a
positive difference to their cause.
In this anniversary year, the College
should be congratulated for carrying out
this review so that it can face the future
with more purpose.
Journal Watch is written by TRIPOM (tripom.squarespace.com) and is a brief
summary of recent important papers and articles in perioperative medicine
from across the spectrum of medical publications.
Intraoperative hypotension associated with
myocardial and kidney injury
This retrospective cohort study (n=57,315) evaluated the
effect of absolute and relative hypotension on postoperative
myocardial and kidney injury. MAPs below an absolute
threshold (65 mmHg) or a relative threshold (>20%) were
related to both myocardial and kidney injury. Absolute and
relative thresholds had comparable discriminative ability. The
authors concluded that anaesthetic management could thus
be based on intraoperative pressures only, without regard to
pre­operative measurement.
Salmasi V et al. Anesthesiology 2017;126(1):47–65
Cognitive decline after anaesthesia
This cohort study (n=394) sought to examine concerns that
anaesthesia induces long­-term cognitive dysfunction in
the elderly. The OPTIMA database was studied: cognitive
decline appears to accelerate after surgery in elderly
patients already diagnosed with cognitive impairment (but
not other elderly patients). Further work must seek to define
all susceptible populations, specify the harmful anaesthetic
agents and discover appropriate solutions.
Patel D et al. Anaesthesia 2016;71:114-1­1152
ERAS/fast track surgery associated with
reduced hospital-associated infection
This systematic review (n=4142) showed ERAS and FTS
pathways are associated with significant reductions in postop
lung infection, urinary tract infection and surgical site infection.
The findings are particularly important as complications often
cluster. The authors urge healthcare providers to adopt
ERAS/FTS programmes to help prevent postoperative
infections.
Grant M et al. Annals of Surgery 2017;265(1):68­79
Withholding ACE-I/ARBs associated with
lower risk of death and postop vascular events
This international prospective cohort study (part of the
VISION study) analysed patients (n=14,687) who were
taking either an ACEi or ARB prior to surgery. Of these, a
quarter did not receive their antihypertensive in the 24 hours
prior to surgery and on follow up had a lower adjusted risk
of death, vascular events, and intraoperative hypotension.
Roshanov P et al. Anesthesiology 2017;126(1):16­27

A call for standardised anaesthesia for hip fractures

This editorial highlights the wide variation in anaesthetic practice for hip-fracture patients. Non­patient factors account for the
majority of the variation. The authors describe the existence of a ‘cycle of uncertainty’ whereby the wide­-ranging management
makes it difficult to identify best practice. Anaesthetists are the only professionals within the MDT who have not standardised
practice. The authors state that standardised care should be seen as a valuable resource with which to improve patient
outcome, rather than a threat to professional autonomy.
White S, Griffiths R and Moppett I. Anaesthesia 2016;71:1391-­1407

40  | | 41
Bulletin  |  Issue 103  |  May 2017
Following this publication, the Royal
College of Anaesthetists was quick
to pledge its commitment to tackling
the issues highlighted. Included in
this multifaceted approach has been
the development of fellowships in
resource-poor countries for UK trainees,
who follow the specially designed
‘Anaesthesia in developing countries’
unit of training within the anaesthetic
curriculum. Aligning with the College’s
focus on teaching and training, the
fellowships aim to enhance the current
and longer-term anaesthetic service
and training needs for low and middle
income countries (LMICs).
Out of this commitment, which was
funded by the Royal College of
Anaesthetists, Lifebox, the Difficult
Airway Society and the World
Anaesthesia Society, came the Lifebox
Fellowship. In 2015-16, the two inaugural
Fellows spent six months respectively at
Jimma University Specialised Hospital,
THE LIFEBOX FELLOWSHIP
Ethiopia (JUH), and Mbarara Regional
Referral Hospital, Uganda. Our remit was
50% clinical activity and education and
OF ANAESTHESIA
50% quality improvement. As with other
similar fellowships supported by the
College, the Lifebox Fellowships can be
taken as Out of Programme Experience
or Training (OOPE/OOPT).
The Ethiopia Fellow took six months
Dr Nicholas Owen, Dr Rachel Freedman,
as OOPE. Clinical supervision
ST6 Anaesthetics Trainee, ST7 Anaesthetics Trainee, was undertaken by one of the two
Royal Marsden Hospital, Great Ormond Street Hospital, anaesthesiologists at JUH, with an
London; Lifebox Fellow London; Lifebox Fellow 2016 Educational Supervisor back in the UK
2015-16 Jimma, Ethiopia Mbarara, Uganda who was very familiar with the set-up in
Jimma through having initiated a Visiting
Lecturer programme there previously.
Although no formal workplace-based
assessments need to be completed
It has been nearly two years since the report of the Lancet Commission on in an OOPE, we exchanged informal
weekly emails for me to debrief about
Global Surgery was published.1 An estimated five billion people lack access to my experiences. While back in the UK
safe, affordable surgical and anaesthetic care. The five key messages focused to visit family and pick up some sample
spinal packs from China (a necessary
on the inherent global inequality in healthcare and the financial burden this measure due to the intricacies of
carries for individuals and national economies. Ethiopian bureaucracy) there was also
42  |
The NHS will benefit greatly from these
skills when you return, galvanised and
invigorated, to clinical training
the opportunity for a catch-up drink to
reflect and plan the objectives for the
remainder of my placement. In Jimma,
I undertook theatre lists with the three
anaesthesiology residents, and devised
teaching sessions and simulation
scenarios for them whilst engaging in a
procurement and educational quality-
improvement project to increase the use
of spinal anaesthesia in the maternity
unit. Other activities included a Lifebox
distribution, engagement with multiple
non-governmental organisations
(NGOs), WHO Checklist reintroduction,
carrying out the groundwork for Lifebox’s
‘Clean Cut’ pilot, and course-directing
SAFE Paediatrics (‘Safer Anaesthesia from
Education’).
The Uganda Fellow took six months
as OOPT. Local clinical supervision
was provided by the team of five
consultant anaesthetists in Mbarara,
with educational and quality-
improvement supervision provided by
two UK anaesthetists. Workplace-based
assessments consisted of email or video-
call exchanges, and these provided
some of the most in-depth and reflective
assessments that I have achieved
during my seven years of anaesthesia
training. They allowed a mechanism for
debrief following clinical challenges,
and one case-based discussion was
subsequently presented as a poster
at the recent AAGBI Winter Scientific
Meeting (WSM), achieving third prize
in the case-report category. Quality-
improvement projects centering around
the WHO surgical checklist relaunch
Bulletin  |  Issue 103  |  May 2017
and electrical resilience have also been
presented at the WSM. Clinically, the
experience provided by being “floor
manager” to five theatres, each run by
an anaesthetic resident or anaesthetic
officer (non-physician anaesthetist), gave
excellent management experience prior
to being in this role as a consultant, with
all the juggling, communication skills and
clinical prioritisation that this entails.
As these fellowships are taken later
in training, there is no doubt that
personal circumstances can restrict their
accessibility to many trainees. However,
for those who are able to immerse
themselves in the developing world,
there are many benefits the experience
can offer, arguably well beyond those
the host institution will gain from their
presence. Skills such as improvisation,
resilience, adaptability, diplomacy and
clinical acumen will be developed,
and the NHS will benefit greatly from
these when you return, galvanised and
invigorated, to clinical training. We
can’t recommend the experience highly
enough, both to potential trainees and
to the training programme directors
required to release them for out-of-
programme projects.
Reference
1 Meara, John G et al. Global Surgery 2030:
evidence and solutions for achieving health,
welfare, and economic development. The
Lancet 2015; 386: 569–624
| 43
Bulletin  |  Issue 103  |  May 2017
‘Retyring’ abroad,
not retiring abroad
Dr Colm Lanigan
Consultant Anaesthetist
University Hospital Lewisham
Should retirement waste the benefits of your career in anaesthesia, teaching
and training, when some five billion people cannot access timely, affordable
and safe surgical care in the developing world,1 and when, outside major cities,
anaesthesia providers are often not medically qualified, have limited formal
training (sometimes received decades ago), and are often working with old
drugs, equipment and facilities? Should we not try to help with the provision of
training and facilities overseas?2
What to do, and where?
Aid should be based on the recipient’s
wants, rather than the donor’s
preferences.3 Yet perhaps the greatest
need is for educators to support the
local delivery of training to anaesthesia
providers through, for example, the
Zambia Anaesthesia Development
Project, primary trauma care and
the SAFE Obstetric and Paediatric
Anaesthesia courses.1 Equipment, drugs
and facilities may differ, but basic skills,
scientific principles, and much anatomy
and pharmacology do not. Thousands
of large and small aid organisations exist,
but larger ones, such as Médecins Sans
Frontières, tend to have better support
systems.4 Word of mouth is helpful.
Preparation
Be prepared! It will take months longer
than you expect – identifying a suitable
placement, completing necessary
44  |
Dr Lanigan (left) with three of the anaesthetic nurse students in Nepal
paperwork, and obtaining visas, work
permits and duplicate original certificates5
– and some documents can only be
obtained in the destination country.
Teaching tours are often simpler, but
even so don’t forget vaccinations,
dental and health checks. Refresher and
update courses in advanced paediatric
life support, PLS, obstetrics, pre-trauma
care, tropical medicine, etc can be costly,
but can also be helpful. Remember that
for your listeners English or French may
be a third or even fourth language.6 A
‘Train the trainers’ course and the RCoA’s
’Anaesthesia for humanitarian and austere
environments’ are well worth studying.7
If working with smaller charities or
contacting hospitals abroad directly, do
clarify conditions in advance.5 Will there
be a handover on arrival? Will you be on
call 24/7? What type of cases will you
face? Does the unit accept paediatric,
obstetric or trauma cases? What back-up
equipment, drugs, staff, postoperative
care and transfers will you have?
Organising leave may be less difficult as
retirement approaches. A discretionary
sabbatical, a half-time or an annualised
contract may all be possible, aided by
study, professional or even annual leave
– for example, Médecins Sans Vacances.
Seek travel and project grants from the
AAGBI and other charities months in
advance. Allow extra time and money
to process paperwork in the destination
country, and also to get to your base,
as roads are often poor and hazardous.
Many smaller organisations will expect
you to pay for flights, insurance,
accommodation and maintenance. As
small overseas camps may be cancelled,
book accordingly. Register with the local
medical authorities if providing substantive
clinical care, as failure to do so may later
lead to a GMC enquiry. Free medical
litigation cover may be offered if booked
in advance for charitable work.
Downsides include being away from
family and friends, which can create
isolation, exacerbated by language and
culture, but lessened by the internet. Bring
treats for yourself and others! Culture
shock on arrival (and return) may be
lessened by good preparation. Feeling
out of one’s depth is common, so prepare
the way with some trusted colleagues
who can help with advice. Ill-health
episodes due to sunburn, diarrhoea, and
vomiting are reduced by a sunhat, and
scrupulous hand hygiene. Loss of income
and pension contributions may need to
be considered.8
Short-term, high-tech missions do
have a place in delivering otherwise
unaffordable surgery, but may deprive
local healthcare providers of income by
offering free surgery; and can displace
local staff, equipment and supplies.9
At worst, inferior outcomes at greater
expense, with a residual local burden of
long-term postoperative care, may be
the result.10 So plan ahead, and avoid
unrealistic expectations on either side by
good communication.
Benefits
Working abroad gives a completely
different experience to that of a tourist.
Being welcomed into someone’s home
is a privilege, and you will make deep
friendships with local and expat staff. From
a professional point of view, the case mix
and pathology may differ – for example,
lots of paediatrics, obstetrics, trauma
and burns, but few elderly patients.11 As
a senior anaesthetist you may reuse old
techniques such as spinals; ketamine
for sedation, anaesthesia and analgesia;
halothane; draw-over vaporisers, or the
oesophageal-intubation detector device.12
You will also encounter the unexpected
– such as a cobra bite producing
neuromuscular paralysis. Ventilation
involves basic clinical principles and is
hampered by frequent power cuts, but
also means less paperwork and admin!
Besides caring for individual patients,
perhaps the most rewarding aspect is
teaching. Anaesthesia providers are keen
to learn, and SAFE and Lifebox courses
improve the knowledge and skills of
participants, leaving a long-term legacy.
Returning home, a broader clinical and
’can-do’ life experience helps one focus
on patient care amidst the increasing
demands of the NHS.
Other thoughts
The ideal volunteer probably needs
good communication skills, flexibility,
team working, relevant clinical
experience and confidence, plus
tolerance, patience and cultural
Bulletin  |  Issue 103  |  May 2017
sensitivity.5 So not for everyone!10
Nevertheless, if one chooses not to
volunteer overseas, one can still support
colleagues who do. For example, several
consultants could each backfill a session
to enable a colleague to work overseas
for short periods. Alternatively, consider
fundraising, donation, writing a topic for
the Anaesthesia Tutorial of the Week,
or helping with online mentoring of
overseas trainees as an educational
supervisor. The need is great, and the
opportunities are huge. Do it!
References
1 Meara JG et al. Global Surgery 2030:
evidence and solutions for achieving health,
welfare and economic development. Lancet
2015; 386: 569-624. (http://bit.ly/2n6zllF)
(accessed 23/9/2016)
2 World Health Report 2006 – working together
for health. (www.who.int/whr/2006/en)
(accessed 23/09/2016).
3 Crisp N. Global Health Partnerships: the
UK contribution to health in developing
countries. DH, 2007. (http://bit.ly/2ojcrYk)
4 AAGBI: Global Anaesthesia Partnerships
Map. (www.aagbi.org/international/thet)
5 Gedde M, Edjang S, Mandeville K. Working
in International Health. Oxford University
Press, 2011.
6 Dobson S, Bromley L, Dobson M. How to
teach: a handbook for clinicians. Oxford
University Press, 2011.
7 E-learning anaesthesia module on Anaesthesia
in humanitarian and austere environments.
RCoA (http://bit.ly/2n4XPL8 ) (accessed
23/9/2016).
8 All Party Parliamentary Group on Global
Health, 2007; website at
(www.appg-globalhealth.org.uk) (accessed
23/9/2016).
9 Shrime MG, Sleemi A, Ravilla TD. Specialised
surgical platforms: in Debas HT et al, (eds).
Essential Surgery: Disease Control Priorities,
Third Edition (Volume 1). Washington (DC):
The International Bank for Reconstruction
and Development/The World Bank, 2015;
Chapter 13. (http://bit.ly/2nWqB5o).
10 W. Macaskill. Doing good better. Guardian
Books, London 2015.
11 Bickler SW, Rode H. Surgical services for
children in developing countries. Bull World
Health Organ 2002; 80:829-835.
12 Wee MYK. The oesophageal detector device.
Assessment of a new method to distinguish
oesophageal from tracheal intubation.
Anaesthesia 1988; 43:27-29.
| 45
Bulletin  |  Issue 103  |  May 2017
THE UPSTART ABC PROJECT
Dr Rebecca Parker,
ST4 Anaesthetics,
James Cook University Hospital,
Middlesbrough
The Upstart ABC project began after a consultant colleague and friend said to
me: ‘Why don’t you do it? Try….’
At the time we were visiting Rajarata games and low-fidelity simulation.
Medical School in Anuradhapura, Sri The emphasis is on improving patient
Lanka. I had queried why the students morbidity and mortality through early
were not trained in the ‘ABCDE’ recognition and treatment of acute
approach to patient assessment. His illness, within the constraints of the
response was that it had never been locally available resources.
done that way, but it could be. My initial
I am currently working with
reaction was ’I can’t do that!’. But the
Rajarata University Medical School,
seed took hold, and from tiny acorns,
Anuradhapura, Sri Lanka and
great oaks grow. This was how Upstart
Battambang Provincial Hospital,
began; it has become my passion and an
Cambodia. In Sri Lanka we are working
integral part of my life.
towards integrating Upstart into the
So what is it? Upstart is a training final-year medical school curriculum.
package for resource-poor Thus far, after one full academic year,
environments. It is free to attend, and 180 medical students have completed
trains doctors, medical students and the Upstart course. We are looking to
associated healthcare professionals to continue this each year for the next
adopt a structured approach to patient five years, and also to develop more
assessment. A variety of teaching advanced in-house resuscitation courses.
modalities are used, including a course In Cambodia, around 75 staff members
manual, lectures, workshops, icebreaker have participated in Upstart, and 24 in
To donate equipment or to volunteer, please email
(Rebecca@upstartabc.com) or visit our
Facebook page (www.facebook.com/upstartABC)
46  |
Upstart Plus (a new program, providing
training in cardiopulmonary resuscitation
and the use of an automated external
defibrillator).
Assessing the effectiveness of the
training is essential to the continuing
development and improvement of
the Upstart programs. I have been
experimenting with different forms of
feedback, including objective knowledge
assessments, subjective confidence
assessments and free-text comments.
In addition to the development of
the training courses, there is a parallel
branch of the project that focuses on
building local sustainability. The Upstart
trainer course is still in development, and
the goal is to provide training to local
staff to enable them to independently
deliver the Upstart courses using the
The Upstart Faculty Dr’s Lucy Venyo, Bryony Burrill, Maria Rehnstrom, Rebecca Parker, Lisa Macbeth and
Alexandra Marsh) with Medical Students of Rajarata University, Sri Lanka
materials provided. Ideally, we will
provide practical advice about running
the course, guidance on training using
simulation, advice on how to give
feedback, and support in establishing
resuscitation training at their respective
institutions.
Working overseas
Working in Sri Lanka and Cambodia
are very similar, but at the same time
remarkably different experiences. Sri
Lanka has a recognisable intensive
care unit, dialysis machines, and a well-
equipped acute admissions unit (although
atropine comes in 20ml vials to treat
organophosphate poisoning, and their
theatre trolleys are made from bare metal).
In contrast, ’intensive care’ in Cambodia
means a drip, four-hourly observations,
and oxygen via a reused facemask. The
hospital lacks basic infrastructure, the
reuse of single-use equipment is common
despite the high infection risk, most
patients don’t have a bed, none of the
beds have a mattress, and everything costs
money. Many local people simply cannot
afford medical care; it is sad that so many
die from treatable diseases. Upstart aims
to improve this.
Resources aside, teaching in Sri Lanka
and Cambodia requires similar skills.
It’s important to build solid foundations
based on mutual trust and respect, as
well as delivering effective up-to-date
training. This often requires imagination,
honesty, and an ability to think on your
feet. Both countries are recovering
from civil wars – in Sri Lanka between
the Tamils and the Sinhalese, and in
Cambodia against the infamous Khmer
Rouge regime. Sensitivity to this recent
history is vital. Many of the doctors we
work with have been treating horrific
injuries for years without ABCDE. So,
change comes slowly: have patience and
be realistic about what can be achieved.
The future
I don’t know exactly what the future
holds for Upstart ABC, but I hope
it continues to be as exciting as the
last four years. The priorities are to
cement the relationships with our
current partners, to build on the training
delivered so far and to introduce new
programs. I would also like to expand
the project to new institutions and new
countries but to do this I need:
Bulletin  |  Issue 103  |  May 2017
■■ funding – to support volunteers,
produce materials and help with the
purchasing of equipment
■■ secondhand resuscitation equipment
– the institutions and hospitals we
work with do not have resuscitation
manikins
■■ volunteers – it is impossible to run
the courses without the generous
donation of time.
If anyone would like more information, to
donate equipment or to volunteer,please
get in touch, either by email
(rebecca@upstartabc.com), or go to the
Upstart Facebook page
(www.facebook.com/upstartABC)
Acknowledgements
AAGBI Travel Grant
Transform Healthcare Cambodia
Endocrine and Metabolic Diseases Trust
Professor Sisira Siribaddana, Dean of
Medicine, Rajarata University, Sri Lanka
Dr Kak Selia, Medical Director,
Battambang Provincial Hospital,
Cambodia
Upstart Faculty Members
| 47
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017

A USA anaesthesia team’s commitment to

SAFER SURGERY IN RWANDA

Dr Megan Chacon, Dr Andrew Patterson,
Assistant Professor, Professor,
University of Nebraska University of Nebraska
Medical Center Medical Center

Dr Daniel Walsh, Resident Physician, University of Nebraska Medical Center

Dr Kristi Lorenzen, Resident Physician, University of Nebraksa Medical Center
Dr Nicholas Wasson, Assistant Professor, Ann and Robert H. Lurie Children’s Hospital of Chicago Dr Merry Sebelik (second from the right) teaches Rwandan medical students about airway anatomy

Access to surgical care is a worldwide problem for as many as two billion
people. In fact, the poorest third of the global population receives only 3%
of total surgical care. One of the limiting factors in the delivery of surgical
services in low-income countries is safe anaesthesia.1
In most low-income countries, few
anaesthesia providers receive advanced
training. Several sub-Saharan African
countries, for example, have fewer than
one formally-trained anaesthesia provider
per 100,000 people (in contrast to the
United States where there are 24 formally-
trained anaesthesia providers per 100,000
people). Rwanda has 0.1 anaesthesia
providers per 100,000 people.2,3
The most significant consequence
of having too few formally-trained
anaesthesia providers is high anaesthetic
mortality. Mortality rates in low-income
countries range from 1 in every 133 to
1 in every 504 anaesthetics, and are
significantly greater than in the United
States and in Europe. Many of the deaths
are due to preventable airway issues
and hypovolemia. By teaching and by
4
helping to enhance anaesthesia and
surgical resources in the village of Gitwe
in Rwanda, a team from the University of
Nebraska and Northwestern University is
improving the situation in one region of
sub-Saharan Africa.
The project in the community of Gitwe
is part of a broad medical education
collaboration between the University
of Gitwe, the Gitwe Hospital, the
Childrens Hospital and Medical Center
in Omaha, the University of Nebraska
Medical Center, and Northwestern
University. The initiative is supported
by the Hellman Foundation, Medical
Missions for Children, and Verathon
Inc. In October, a group from Omaha
and Boston performed 22 large thyroid
goiter resections and 13 cleft-lip repairs
in Gitwe with the help of the local
healthcare team.
Previous teams had focused on
improving medical education resources
and delivering simulators. October’s
trip was more complicated because it
involved provision of complex clinical
care in a resource-limited environment.
The care team had to manage the
very issues that make anaesthesia in
low-income countries so dangerous
(for example, difficult airways and
hypovolemia). Using portable ultrasound
devices provided by the University of
Nebraska and videolaryngoscopes
donated by Verathon Inc., the
anaesthesia providers optimised
haemodynamic status and performed
endotracheal intubations for patients
with goiters the size of grapefruits. Many
of these patients had travelled in warm
conditions for kilometers to reach Gitwe.
Intravascular volume depletion was,
therefore, a significant problem. Some
patients required litres of intravenous
crystalloid administration prior to
induction of anaesthesia.
By far the most valuable pieces of
equipment for the anaesthesia team in
Gitwe were the portable anaesthesia
machines, one of which now resides in
Gitwe permanently. The devices were
donated by the Hellman Foundation.
The DRE Integra SP VSO2 portable
anaesthesia machines the team
used do not require electricity, and
reliably deliver anaesthetic gases like
sevoflurane. To avoid complications
in the postoperative period due to
cardiorespiratory monitoring resource
limitations, the Nebraska/Northwestern
team and their Rwandan colleagues
administered adjunctive analgesics (like
ketamine, ketorolac, and acetaminophen)
and performed regional anaesthetic
blocks. Most cases were completed with
no paralytics for the children and only
intubating doses of succinylcholine for
the adults.
Anaesthesia providers from the
University of Nebraska have committed
to work with the clinical team at the
Gitwe Hospital two to three times each
year. There is a signed memorandum
of understanding between the two
hospitals, and a strong commitment
to continue this partnership for the
long-term benefit of both institutions.
Research projects in Gitwe supported
by the Society of Critical Care Medicine
and the European Society of Intensive
Care Medicine will continue. Education
initiatives will expand, with an emphasis
on increasing the use of computers
and internet-based resources. First-year
medical students from the University of
Nebraska and the University of Gitwe
will collaborate on technology-based
education projects. And, the University
of Nebraska College of Medicine will
send students to Gitwe on elective
rotations, as it did in 2016. The University
of Nebraska–Northwestern University–
Gitwe Rwanda collaboration represents
a commitment to making access to
essential surgical services a safer reality
in even the most remote locations.
The partnership established between the
University of Gitwe and the University
of Nebraska is beneficial to both
parties. Physicians in Rwanda benefit
from sub-specialty teaching by the
visiting anaesthesiologists. Physicians
and trainees from the department of
anaesthesiology at the University of
Nebraska learn to improve their skills
while working in a limited-resource
environment. Additionally, global health
opportunities like this can be a powerful
recruiting tool for resident physicians
and medical students. Well-resourced
departments who are in search of strong
candidates should consider a partnership
with an under-served rural hospital such
as the one described here.
References
1 Casey KM. Putting the “global” back in global
health. Arch Surg 2012;147(5):404-407.
2 Harris MJ. We need more reports of global
health anaesthesia articles. Anaesthesiology
2016;124:267-269.
3 Dubowitz GI, Detlefs S, McQueen KA.
Global anaesthesia workforce crisis: A
preliminary survey revealing shortages
contributing to undesirable outcomes
and unsafe practices. World J Surg
2010;34(3):438-444.
4 Walker IA, Wilson IH. Anaesthesia in
developing countries – a risk for patients.
Lancet 2008; 371:968-969.

48  | | 49
Bulletin  |  Issue 103  |  May 2017
An encounter with an anaesthetic
colleague and returned volunteer, led
me to apply through VSO (Voluntary
Service Overseas) to be placed at CCBRT
(Comprehensive Community Based
Rehabilitation in Tanzania) Disability
Hospital. Established in 1994, this
Tanzanian NGO is the largest provider of
disability services for adults and children
in the country. The hospital undertakes
plastic surgery, focusing on cleft lip/palate
and post-burn contractures; orthopaedic
surgery, carrying out a range of paediatric
procedures as well as hip and knee
replacements; obstetric fistula surgery,
and eye surgery, of which the majority is
done under local anaesthetic blocks.
While the hospital is better equipped
than many facilities in resource-limited
settings, working at CCBRT has presented
some interesting challenges. We have
Dräger anaesthetic machines, but use
halothane without end-tidal agent
Photograph © CCBRT/Sala Lewis – Verve Photography Ltd
monitoring, so giving an anaesthetic
was a little interesting to begin with. The
combination of halothane and ‘jungle
Experiences from Tanzania juice’ – a lidocaine and adrenaline mixture
infiltrated by the surgeons – can cause
interesting arrhythmias, which has led to
opportunities for the team to develop
skills in intraoperative cardiopulmonary
resuscitation.
Dr Victoria Howell,
Consultant Anaesthetist, CCBRT is currently building a 200-bed
CCBRT Disability Hospital, maternity hospital for high-risk referral
Tanzania patients which is due to open in 2018.
To support this, a capacity-building
programme in maternal and newborn
health has been running for the past
four years, to improve infrastructure,
training and outcomes. I worked one
day a week with this team, supporting
Tanzania has just 22 medically qualified anaesthetists serving a population of the anaesthesia heads of department
almost 50 million. The vast majority of anaesthetics are therefore provided from the eight facilities with surgical
by non-physician anaesthetists – a combination of nurses, clinical officers capability to provide a good standard of
anaesthetic care, and arranged training
and assistant medical officers with 1-2 years training in anaesthesia – and it is for the anaesthetists working in these
alongside these anaesthetists that I have been working in Dar es Salaam. facilities. We provided laryngeal mask
airways (LMAs) to the hospitals, and
ran an extensive training programme
50  |
Understanding the culture, social
hierarchies and language has been
invaluable
in the use of LMA as an airway-rescue
device in an attempt to reduce maternal
mortality from failed intubation.
Complex training programmes such
as this are only possible due to the
long-term nature of my placement,
where looking at the local mortality
statistics, collectively identifying areas of
potential improvement, visiting each of
the health facilities and acknowledging
the barriers faced, were fundamental in
ensuring successful engagement with
the training. Understanding the culture,
social hierarchies and language has been
invaluable in forming relationships with
colleagues, and has allowed me to lead
meetings where a significant proportion of
the discussion is in Swahili. Appreciating
the complexities of healthcare systems
takes time and, whilst as an outsider it may
appear obvious where changes could
be made, simple solutions to complex
problems are rarely effective. It takes
considerably longer to truly comprehend
the issues involved and ensure local
ownership of sustainable change.
As a long-term volunteer, it has been
interesting to witness the other side of
short-term clinical trips. Whilst these are
often a great opportunity to get insights
into working in a resource-limited setting,
short-term stand-alone missions often
achieve little other than the direct clinical
care that they provide, and may even
be harmful to the host organisation.1
Certainly leaving behind unusable
equipment and unfamiliar drugs is not
always helpful. The real value of short-
term trips comes through long-term
Bulletin  |  Issue 103  |  May 2017
health partnerships which have local
engagement and sustainability as an
integral part of the collaboration.
The fantastic year-round sunshine is a
definite advantage to living in Tanzania,
but it isn’t all idyllic beaches, stunning
sunsets and safari adventures. There
are the usual frustrations of living in
a large, busy, low-income country.
Moving abroad for 1-2 years has
personal, professional and, with the
less than generous living allowance
from VSO, financial costs. But for me,
working in Tanzania has been a fantastic
experience. It is challenging work, but
has given me great flexibility in my
anaesthetic skills, and experiences in
leadership, management and Swahili that
I could not have obtained otherwise.
There are many opportunities for long-
term anaesthetic placements overseas.
VSO places anaesthetists in several
countries worldwide, and the Zambia
Anaesthesia Development Project, King’s
Sierra Leone Partnership and Lifebox
Fellowships all offer opportunities for
senior trainees to gain experience abroad.
I would encourage anyone with a real
passion for global anaesthesia to explore
these – and the many other – options.
Acknowledgements
Many thanks to Pippa Page, Head of
Communications at CCBRT and Dr Tom Bashford,
Anaesthetist and former VSO Volunteer, for their
helpful comments on this article.
Reference
1 Sykes KJ. Short-term medical service trips:
a systematic review of the evidence. Am J
Public Health 2014;104:e38-e48.
| 51
Bulletin  |  Issue 103  |  May 2017
AS WE WERE
Once upon a time ‘history’ was in the
Fellowship curriculum, but it fell victim
to the expansion of more clinically
relevant knowledge, and to changes in
continued...
the format of examination questions.
However, well-educated (rather than just
examination ‘ready’) professionals should
know their subject’s history. It is a cliché,
but still true, that unless you know what
has gone before, you will not understand
how things are, nor have insight into
Professor Tony Wildsmith, future developments.
RCoA Past Honorary
Thus, this column will continue to look
Archivist into the past, aiming to educate and,
hopefully, entertain. We cannot replace
David’s wide knowledge or his ‘nose’ for
a good story, but we can use the same
This column has long provided resources – and some new ones. This
year sees the 25th anniversary of our
historical insights into College, the wisdom of its separation
anaesthesia, medicine and life. from the Royal College of Surgeons
(RCSEng) proven by its growth and
It was originally compiled by success. The one negative outcome
the late Dr David Zuck, past was the lack of archive. Specific reasons
for this are unclear, but an overarching
President of the History of
Anaesthesia Society, doyen
one was that there were barely enough
resources then to deal with the present,
of those with that interest,
let alone the past! That situation has
changed completely, and our current and
and one of the few to have immediate past Presidents have been very
supportive of the archiving function.
acquired the Diploma in the Dr J-P van Besouw worked clinically
History of Medicine. Now with his opposite number at RCSEng,
the Heritage Committee will and their good relationship allowed
access to archive material on the
oversee the column. Diploma in Anaesthetics (DA) and the
‘Faculty’ years. More recently, Dr Liam
Brennan encouraged expansion of the
small Archive Committee into a larger
Heritage group with a wider remit. These
articles will continue under the auspices
of the Heritage Committee, chaired
by the Honorary Archivist, currently Dr
Anne Thornberry. Contributions will be
welcome on any historical aspect of the
College’s remit, and from anyone so
Dr David Zuck interested. If that’s you, send a note to
(1923-2016) archives@rcoa.ac.uk to avoid duplication
– but recognise that the Editor will make
the final decision on publication.
52 |
’But’, I hear the cynic say, ’it has all been
said before.’ Well, David proved that
wrong, and (avoiding the debate on
‘when history begins’) remember that
every day a previous day becomes
history! So, as well as reviewing
traditionally historical periods, it is time
to consider more recent developments
and individuals. When I started my
anaesthetic career the Faculty was a
small, 22-year-old, slightly subservient,
relative newcomer. Much has happened
since, but the story of our College (now
the largest in the UK) began far earlier:
before, during and after 1948. In material
from the minutes of RCSEng Council
and Conjoint Examination Board (which
ran the original DA) we have a valuable
resource for researching ‘new’ history.
Our journals (Anaesthesia and BJA) often
have useful information on events, as
well as on the science of the day.
‘‘Let me tell you something about our
profession: The day after you retire they
will say, ‘What a great party’...’’
The other ‘new’ resources are the
biographies in the ‘Lives of the Fellows’
project which you can download from
the College website at
www.rcoa.ac.uk/lives-of-the-fellows.
Information on any Fellow is welcome,
but the current foci are the 170 elected
FFARCS between 1948 and 1953, a
group who established anaesthesia as
For more information visit www.rcoa.ac.uk/heritage
The Lives of Fellows -
First Board of Faculty 1948
can be downloaded at
http://bit.ly/2mSLOx1
an independent specialty. The older
Colleges have large collections of
biographies, but we started after a
delay of 67 years, so there is some
backlog! The number of biographies
is increasing slowly as individuals
identify predecessors (through a
hospital, geographical or sub-specialty
connection) to research. I thank them
Bulletin  |  Issue 103  |  May 2017
all for their valuable contributions, but
must make special mention of Dr Bob
Palmer. He hasn’t just promised to
research all Wessex-based Fellows, he
is well on his way to completion! Please
look at our section of the website, find
someone who interests you, let us know
(archives@rcoa.ac.uk), again to avoid
duplication, and we will send you the
relevant materials. Maybe you can
challenge Bob for the record number of
forms, (remembering to include one for
yourself) but you will have to go some to
catch him!
Many ‘Foundation’ Fellows, although
unknown now, made important
contributions, but the ‘Lives’ format
only allows brief description even if
the individual often merits extended
consideration. To start this process,
Anne Thornberry edited a booklet (on
the Foundation Board of Faculty); this
column will be the ideal setting for
continuing that work. In final exhortation,
an anecdote, surprising in that it came
from the biggest surgical ego I have ever
encountered:
“Let me tell you something about our
profession: The day after you retire they
will say, ‘What a great party’; a month later
it will be, ‘Oh I remember him’; and a year
later, ‘Who?’”
Fellows of the Royal College of
Anaesthetists, we can do better than that!
Acknowledgement
The Zuck family for the photograph of
Dr David Zuck.
| 53
Bulletin | Issue
Bulletin  |  Issue 103 | May
103  |  May 2017
Clinical Research Network
25TH ANNIVERSARY
AWARD WINNERS RCoA TRAINER
RCoA Patron HRH Princess Anne presented the inaugural joint RCoA/
National Institute for Health Research Clinical Research Network awards to
Dr Gudrun Kunst and Dr James Sheehan at the RCoA Anniversary Meeting in
March. The winners have written about their experience of the day and the
research work that won them the awards.
DR GUDRUN KUNST
Consultant Anaesthetist and Reader in Cardiothoracic Anaesthesia
King’s College Hospital
The National Institute for Health Research (NIHR) was developed by
Professor Dame Sally Davies over ten years ago, with the clinical research
networks (CRNs) as the delivery arm of NIHR-funded trials. The two largest
Medical Royal Colleges, the Royal College of Physicians and the Royal
College of General Practitioners, introduced national NIHR CRN prizes in
order to recognise contributions of clinicians to portfolio trials, particularly
against the background of their limited amount of time and resources. It is
inspirational to see that the Royal College of Anaesthetists is now rewarding
clinicians engaged in clinical research.
What did I do to qualify for this award? As a full-time NHS anaesthetist, I set up
several clinical research studies in perioperative medicine to investigate whether cardiac
surgical patients benefit from organ-protection techniques, such as remote intermittent ischaemia or a single dose of
cyclosporine. We also assessed the feasibility of enhanced recovery in cardiac anaesthesia. Apart from conducting our
own local and multicentre portfolio trials, we engaged with other NIHR CRN chief investigators recruiting for studies
that are of relevance for perioperative anaesthesia and postoperative outcomes and that were within the themes of
national anaesthetic research priorities. Under my leadership, the anaesthetic clinical research group at King’s College
Hospital participated in several national and international clinical trials, which resulted in collaborative authorships as
named members or local PIs of our clinical study group in the Lancet, BJA, NEJM, and JAMA and a co-authorship in
the NEJM. Our strategy is aimed at delivering world-class biomedical and health research in clinical and translational
anaesthesia and perioperative medicine.
I feel very honoured to have received the very first RCoA NIHR award at the recent RCoA 25th Anniversary Meeting.
It was a very special experience that the Royal Patron of the RCoA, HRH The Princess Royal, presented this prestigious
prize. She met several individuals afterwards, and we had an inspiring discussion about clinical research and safe
anaesthesia with her. The successful Anniversary Meeting combined excellent talks about all relevant aspects of
anaesthesia during the last 25 years, with visions for anaesthesia in the future.
54  |
Bulletin | Issue
Bulletin  |  Issue 103 | May
103  |  May 2017
DR JAMES SHEEHAN
Specialty Trainee,
Royal Berkshire Hospital
I was encouraged to apply for the joint RCoA/National
Institute for Health Research (NIHR) award by my clinical
supervisors at the Royal Berkshire Hospital as recognition
for the contribution I had made to NIHR Clinical Research
Network portfolio studies. As a core trainee I obtained
my Good Clinical Practice certification, and began data
collection for studies such as ProMISe and SNAP-1. While
I was working in obstetric anaesthesia, I became interested
in improving the management of accidental dural puncture,
and worked with the clinical leads to facilitate the setting up of the
department’s first recruiting NIHR portfolio study – MRiADP.
My main research interest, however, is pain, and I became part of a team
focusing on acute pain management in the Emergency Department. I am now Chief Investigator for
the Prescription of Analgesia in Emergency Medicine (POEM) study, which has just finished recruiting
over 8,000 patients from 12 different NHS trusts. POEM represents my trust’s first ever sponsorship
of an NIHR portfolio multicentre study, so I was therefore able to demonstrate in my application a
significant measurable change in the local environment for research.
I felt honoured to discover that I had been successful in my application for the award, and even more
so when I learnt it would be presented to me at the anniversary conference by the patron of the
RCoA, HRH The Princess Royal. The conference was excellent, and I was privileged to hear talks from
such eminent speakers about the various landmarks in UK anaesthesia over the past 25 years.
The award ceremony was a memorable experience, and hearing the citations for the other award
winners was inspiring, but also humbling. Hearing my own citation and receiving my award from HRH
The Princess Royal, who congratulated me, made this a very proud moment in my career. After the
award ceremony, I had a further opportunity to meet Her Royal Highness, and she enquired about
my anaesthetic career and the POEM study. The whole conference was an unforgettable experience,
and one I will carry with me throughout the rest of my career.
The award recognises my contribution to an excellent research team at the Royal Berkshire Hospital,
and with the award I plan to create a short video for the NIHR website, detailing how trainees who
are not on traditional research-training programmes can become more active in research and
develop their own research ideas.
|  55
Bulletin  |  Issue 103  |  May 2017
NIAA
National Institute of Academic
Anaesthesia
SMALL
GRANTS AND
AWARDS
RCoA Small Grants
The National Institute of Academic
Anaesthesia (NIAA) has several small
grants, funded by the Royal College
of Anaesthetists for the purpose of
supporting research, education or travel
connected with the study of anaesthesia.
Priority will be given to educational
projects, the presentation of original
work, or the provision of education to
developing countries.
Applications are invited for the following
funds:
Ernest Leach Research Fund
This fund was established in June 2011 to
be utilised for the purposes of research.
Value up to £2,500
Sargant Fund
For education and research purposes.
Value up to £2,500
Belfast Fund
To fund grants for educational purposes.
Value up to £600
Eligibility
All Fellows in good standing and
registered trainees are eligible to
apply for the above grants. We regret
that applications for funding towards
registration for higher degrees or college
course fees will not be considered.
56  |
To apply
Please visit http://bit.ly/1QGy7rU
to view the assessment criteria and
download a copy of the application
form. The deadline for applications is
5pm on Friday 1 September 2017.
Payne Stafford Tan Award: An
Award for Clinical Excellence
This award was originally established
through the generosity of an American
friend of the College, Mr Norman
Knight. The aim of the prize is to mark
excellence in clinical practice, teaching
or research in anaesthesia, critical care
or pain management. The award is open
to any Fellow or Member of the College,
and comprises a grant (to a maximum
of £1,000) to be used for educational
purposes such as attendance at a
major conference or the purchase of
educational materials. The recipient will
be expected to provide a short report
outlining how the funds have been used.
To apply
Nominations are now invited for the
2017 award, and must be made by a
Fellow or Member of the College. The
nomination should be in the form of a
letter outlining the particular merits of
the individual nominated, and should
be accompanied by a full curriculum
vitae for that individual. Self nominations
are also permitted. Nominations should
be sent to the NIAA Coordinator at
the address below by 5pm on Friday
1 September 2017.
Macintosh Professorship
The Royal College of Anaesthetists has
established a number of initiatives to
foster research in anaesthesia, critical
care and pain management. Their aim is
to encourage experienced researchers
as well as those who are in the early
stages of developing a research
portfolio. Macintosh Professorships
are aimed at established clinical or
laboratory researchers who are already
performing at a high level. Their purpose
is to recognise and disseminate the work
of the award holders and facilitate their
progress in the academic world.
Recipients of the award will have a national
or international reputation in their field.
Their curriculum vitae will be consistent
with an individual who is performing at, or
is on the cusp of, professorial level through
research, innovation, and leadership.
Those who show equivalent excellence
in teaching and education will also be
eligible for the award.
Macintosh Professorships are awarded
for one year (normally the College
academic year). Recipients are required,
within that time or soon after, to give a
keynote lecture at a meeting organised
by the Royal College of Anaesthetists
or its associated Faculties, other related
organisations and specialist societies.
The lecture is commemorated by the
presentation of a certificate.
Applications for Macintosh
Professorships are open to Fellows
and Members of the Royal College of
Anaesthetists and other clinicians and
scientists involved in anaesthesia, critical
care and pain management within the
United Kingdom. Applications will be
considered by the Board of the National
Institute of Academic Anaesthesia and
expert external advisers.
The College welcomes nominations from
national and/or specialist societies in
anaesthesia within the UK. If successful,
the title of the Professorship will reflect
a joint award from the College and
nominating body.
To apply
Please submit a synopsis of your
proposed lecture, along with a CV and
covering letter by email AND post to the
NIAA Coordinator at the address below
by 5pm on Friday 1 September 2017.
Bulletin  |  Issue 103  |  May 2017
Maurice P Hudson Prize
Dr Maurice Hudson was a consultant
anaesthetist in London, took the Diploma
in Anaesthetics (DA) in 1936, was awarded
the Diploma in Anaesthetics (FFARCS)
in 1948 and had a particular interest in
dental anaesthesia. The Hudson Harness
was one of his innovations.
The late Dr Maurice Hudson’s daughter
generously donated money to the
College in memory of her father for an
annual prize for the best paper on his
favourite subject: resuscitation.
The criteria for this prize has now been
extended, and the prize will be awarded
to the anaesthetic or intensive care
trainee who is the principal author of the
best paper relating to the management
of acutely ill patients published, or
accepted for publication, in a peer
reviewed journal.
RCoA 25TH ANNIVERSARY
PHOTOGRAPHY COMPETITION
To apply
If you are such a trainee and would like
to apply for the prize and have published In collaboration with the Royal Photographic Society we are
an article since 1 August 2016, please running a photographic competition open to members and
submit your article by email and post to fellows of the College to celebrate our 25th Anniversary.
the address below, along with a copy of
your CV and a covering letter by 5pm The competition will be launching on Monday 15 May 2017
on Friday 1 September 2017. A prize of and closing on 28 August 2017.
£500 is available this year.
The theme for the competition is ‘In Safe Hands’. We
Please note that only one article may be
encourage participants to interpret this theme broadly
submitted per applicant.
and creatively. There are prizes to be won and selected
Applications for all of the above grants, photographs will be exhibited at the College.
awards and prizes should be sent to the
NIAA Coordinator, Ms Pamela Hines,
Further information can be found at
by post and email to: The Royal College
www.rcoa.ac.uk/rcoa25/awards-competitions, with the
of Anaesthetists, 35 Red Lion Square,
website competition platform going live on 15 May 2017.
London, WC1R 4SG.
Email: phines@rcoa.ac.uk.
| 57
Bulletin  |  Issue 103  |  May 2017 Bulletin | Issue 103 | May 2017

NIAA
National Institute of Academic
Anaesthesia
NIAA RESEARCH GRANTS
Results of 2016 Round 2
Letters to the
On Thursday 8 December, the NIAA Grants Committee met to consider the second round of applications for 2016 on behalf of
the Association of Anaesthetists of Great Britain & Ireland (AAGBI), the Royal College of Anaesthetists (RCoA), the Association for
Cardiothoracic Anaesthesia and Critical Care (ACTACC), the Difficult Airway Society (DAS), and the journals Anaesthesia and the
British Journal of Anaesthesia (BJA) .
Editor Professor Monty Mythen
Editor

The committee considered 18 applications over four grant categories for a requested sum of £488,328, and made a total of nine
awards over three categories to a value of £249,393. The success rate of applications was 50%.

A list of the successful applicants can be found in the following table, and abstracts can be viewed at: More on the challenges in a level of skill and a pattern of working the increasing complexity of the patients
www.niaa.org.uk/2016---Round-2 paediatrics faced by district that will allow control to be gained in the involved. No one is suggesting that
general hospitals majority of circumstances very quickly. It anaesthetists should not be involved at
should however be recognised that no all. We have valuable skills that are useful
Dear Editor amount of paediatric updates, courses in any situation. However, given that
Award: Anaesthesia/AAGBI Research Grants and APLS certificates is going to turn an the Tanner report2,3 recommended that
The article by Wang and Sinha1 outlining
Dr Oliver Boney, Patient-Centred Outcome Measures for Major Surgery (P-COMMaS) £5,179 anaesthetist into a neonatologist. Given the correct system to deal with this issue
the loss of confidence of senior general
University College Hospital, London the size of anaesthetic departments is to concentrate on competencies of
anaesthetists in their ability to deal with
nowadays, even if the experience to team members rather than professional
Dr Simon Howell, MET-REPAIR-FRAILTY: REevaluation for Perioperative cArdIac Risk £21,759 increasingly complex neonatal/baby
Leeds Institute of Biomedical & Clinical Sciences, and FRAILTY deal with such children is acquired, labels, it should be recognised that
resuscitation and transfers is timely. The
School of Medicine, University of Leeds it will be difficult to maintain without the solution to the problem of the sick
authors are not alone in experiencing
major readjustments to on-call rotas. In baby in a DGH does not rest only with
apprehension related to this issue.
Dr Surrah Leifer, Upper limb disorders in anaesthetists £4,920 addition, it is not clear what exact level the anaesthetic department, but with a
Increasingly, colleagues are expressing
Bolton NHS Foundation Trust of experience needs to be acquired, and wide based multidisciplinary team that
concerns that they are unable to acquire
how many cases per year one would between them will possess and maintain
Professor Gary Mills, PROtective ventilation with high versus low PEEP during one-lung £11,725 or maintain the skills that they need to
Sheffield Teaching Hospitals NHS Foundation ventilation for THORacic surgery – PROTHOR: A randomised controlled need to do to maintain this experience. the correct level of skills.
Trust trial
deal with this situation.
Calling for DGH anaesthetists to attend
the paediatric centre for regular updates Dr J Watts
Dr David Saunders, Emergency Laparotomy Follow-up Study: a pilot, single-centre, £9,913 Due to centralisation of paediatric
Royal Victoria Infirmary observational study into the medical, functional and social impact of is laudable, but how often and for how Consultant in Anaesthesia and Critical
services, it is often forgotten that those
emergency abdominal surgery during the first year of recovery (ELFUS1)
long should one go? A week per year? Care Medicine
in a DGH must be prepared to deal
Two weeks? A day per month? And do East Lancashire NHS Trust
ACTACC Project Grants with critically ill children of all sizes
and physiology who present to their the tertiary paediatric units have the
Dr Alistair Proudfoot, A quantitative and qualitative analysis of the impact of a SHOCK team £7,300 References
St Bartholomew’s Hospital, London and structured SHOCK call system in the management of acute Emergency Department or paediatric capacity to cope with a large number of
1 Wang N, Sinha A. Distance-Skill-Decay:
severe cardiogenic shock colleagues. Whilst the confidence extraneous consultants arriving en masse
challenges in paediatrics faced by district
to deal with what is effectively an throughout the year? general hospitals. RCoA Bulletin 2017;101
Dr Ben Shelley, Right ventricular inflammation after lung resection £12,358 (part-funded £4,658
Golden Jubilee National Hospital from AAGBI/Anaesthesia) uncomplicated small adult is one 55-57 (2017).
Anaesthesia is known for its “can do, let’s 2 The acutely or critically sick or injured child in
thing, but the further a patient is from
BJA/RCoA Non-clinical PhD Studentships get on” attitude. However, perhaps it the district general hospital A team response
adult physiology, the more anxious the
is time to recognise that things have in (http://bit.ly/2nj0OjO).
Professor Helen Galley and Effect of melatonin and its metabolites on key molecular pathways in £85,751 situation becomes. In addition, the ability
Professor Nigel Webster, sepsis fact changed, even in the last ten years. 3 Rollin A-M. Working together for the sick or
to cope with a 1 year old for an EUA,
University of Aberdeen In the case of such tiny, unwell babies, injured child: the Tanner report. Anaesthesia
or a ten year old for an appendix, is 61 (12) 1135-1137 (2006).
Dr Kieran O’Dea, Cellular interactions and functions of microvesicles in the systemic £90,488 perhaps our role is as part of a team in
different to the skill set required required
Imperial College, London inflammatory response syndrome which the neonatologist takes the lead
to cope with a premature neonate who
and, in fact, may be the appropriate
has bronchiolitis and a congenital
specialist to intubate and ventilate such
circulation. Clearly, anaesthetists are
a child. This would recognise both
experts in airway management, and
the limits of anaesthetic training, the
what we are able to bring in a crisis is
unintended effects of centralisation, and

58  | | 59
Bulletin | Issue 103 | May 2017
Letters to the
Editor
Dear Editor
Two articles in the January Bulletin
(Alladi, R; Sadler J and Carey C.)
highlight the College’s current interest in
advancing the teaching of anaesthesia to
medical undergraduates. I was surprised
that neither of these articles gave credit
to the published contributions that
Dr Griselda Cooper, Professor Peter
Hutton and I made following a survey of
undergraduate teaching of anaesthesia
and allied subjects in all 26 UK medical
schools, and 13 universities in other
European countries. 1,2,,3 Surveys in 1985
had shown serious deficiencies in the
resuscitation skills of pre-registration
house-doctors,4,5 and my colleague, the
late Dr Peter Baskett, with support from
the then Faculty of Anaesthetists, and the
Resuscitation Council, emphasized the
need for medical students to be taught
about resuscitation equipment and how
to use it.6
Sadler and Carey state that the College
has had limited links with undergraduate
education. This is simply not true. In 1980
the GMC had reinstated the teaching of
anaesthesia, and resuscitation into the
clinical medical curriculum.7 At that time
I was able to persuade the University
of Bristol to expand the duration of the
clinical undergraduate course in these
subjects, from two to four weeks, with
additional emphasis on attachment
to an intensive care facility at the
participating hospitals in the SW Region.
60  |
In the two years before my election as
President of the College I served on the
General Medical Council (GMC) and
its Education Committee. During that
time I emphasized the huge potential for
undergraduate exposure to resuscitation,
anaesthesia, intensive care medicine, and
pain management. The GMC Education
Committee incorporated these into
a new set of recommendations on
undergraduate medical education.8
One of my first actions as President, and
chairman of the College’s Institute of
Education, in 1994, was to send Professor
John Norman and Dr David Wilkins to
the USA to assess the advisability of
importing a human patient simulator
to the UK. The trustees of the United
Bristol Hospitals made funds available
to establish a Simulator Centre in Bristol,
the first in the UK. As the University of
Bristol collaborated in this venture I was
able to introduce simulator experience
for the medical students to learn
and practice basic and advanced life
support techniques, which they much
appreciated.
The Professor of Surgery, the late John
Farndon, and I organized clinically
orientated seminars to show first year
medical students how a knowledge of
anatomy, physiology and biochemistry
could be applied in caring for patients
with complex pathologies - perioperative
medicine at its best!
One consequence was a substantial
increase, during the eighties and nineties,
in the number of Bristol graduates who
chose a career in anaesthesia and/or
intensive care medicine. I am pleased to
see that trend continues9.
Professor Cedric Prys-Roberts
RCoA Past-President
References
1 Prys-Roberts C, Cooper GM, Hutton P.
Editorial: Anaesthesia in the undergraduate
medical curriculum. BrJ Anaesth 1988; 60(4):
355-357.
2 Cooper GM, Prys-Roberts C. Anaesthesia
and resuscitation in the undergraduate
curriculum. Bailliere’s Clinical Anaesthesiology
1988; 2(2): 243-252
3 Prys-Roberts C. Role of anaesthesiologists in
undergraduate medical education. Curr Opin
Anaesthesiology 2000; 13 ( ); 653-657.
4 Casey WF. Cardiopulmonary resuscitation:
a survey of standards among junior hospital
doctors. J Roy Soc Med 1984; 77 ( ): 921-924.
5 Skinner DV, Camm AJ, Miles S.
Cardiopulmonary resuscitation skills of pre-
registration house officers. Br Med J 1985;
290( ):1549-1550.
6 Baskett PJF. Resuscitation needed for the
curriculum? Br Med J 1985;290:1531-1532.
7 General Medical Council Education
Committee. Recommendations on Basic
Medical Education. London: General Medical
Council; 1980.
8 Education Committee of the General
Medical Council. Tomorrow’s doctors:
recommendations on undergraduate medical
education. London: General Medical
Council; 1993.
9 Alladi R. Undergraduate training in
anaesthesia. A personal viewpoint RCoA
Bulletin 2017;101: 30-31.
Dr Chris Carey was invited to respond
to Professor Prys-Roberts’ letter on
the previous page.
Dear Editor
Thank you for the opportunity to
respond to the comments received from
Professor Prys-Roberts in response to
the articles published by Dr Alladi and
me1,2 in January’s edition of the Bulletin.
We note Professor Prys-Roberts’ work
in the 1980s and 90s, in particular with
regard to training in cardio-pulmonary
resuscitation and the developments he
promoted at Bristol University.
Dr Alladi’s article was presented as
a personal opinion piece based on
his own experience, albeit one which
reflects widely held views regarding
undergraduate training in anaesthesia.
Our accompanying article presented a
brief, forward-looking overview of the
new initiatives that are being undertaken
by the College to support this important
area of education. It was not our
intention to give an account of the
historical developments in this field.
The College’s 2016-2021 Strategic Plan
specifically highlights undergraduate
training in anaesthesia and perioperative
medicine3. New initiatives include
the formation of an undergraduate
trainers’ network for those involved in
undergraduate education in anaesthesia
and related specialties from medical
schools throughout the UK. An
educational framework document to
If you would like to submit a letter to the editor please email bulletin@rcoa.ac.uk
support undergraduate training is in
development and is planned for release
later this year.
Prys-Roberts’ data suggested that time
spent in undergraduate anaesthesia in
the UK varied from 0-4 weeks in the late
1980s4. A survey undertaken in 2016
found the range to be from 2 days to 4
weeks suggesting little progress in this
particular area. Furthermore, there are
still some medical schools in the UK that
do not undertake any formal assessment
in anaesthesia and related specialties.
Whilst we recognise that there have
been individuals who have made notable
historical contributions in advancing
undergraduate training in anaesthesia,
we reiterate our view that links in general
have been limited and that the College’s
evolving role in this area is both timely
and beneficial.
Dr Chris Carey
Consultant Anaesthetist BSUH NHS Trust
and RCoA Council Member
References
1 Alladi R. Undergraduate training in
anaesthesia. RCoA Bulletin 2017;101:30-31.
2 Sadler J, Carey C. Developing undergraduate
education in anaesthesia. RCoA Bulletin 2017;
101:32-33
3 Our Strategic Plan 2016-21. RCoA
(http://bit.ly/2nMKHeD)
4 Prys-Roberts C, Cooper GM, Hutton P.
Editorial: Anaesthesia in the undergraduate
medical curriculum. Br J Anaesth 1988; 60(4):
355-357
Bulletin  |  Issue 103  |  May 2017
Dear Editor
We read with interest the recent
article Sleeping Beauty (RCoA
Bulletin;2016;96:31-33).
Dr Szekely put together an excellent
summary of the implications and
potential pitfalls of modern cosmetic
and fashion trends, and when it was
presented at our Trainee Journal Club it
was agreed that it had the potential to be
genuinely practice-changing.
However we would like to highlight
what we feel is an important omission.
Presence of a beard has long been
acknowledged as a predictor of difficult
bag-mask-ventilation, and we believe
this should be specifically considered in
light of the ‘hipster beard’ phenomenon.
Trendy British males often now sport
spectacular amounts of facial hair, a
trend we have noticed has spread far
beyond the fashionable districts of
South Manchester to the whole city, and
indeed, the North West region.
We understand ‘peak beard’ has already
passed in London, but due to the time-
lag involved in such matters we urge
anaesthetists up and down the country
to remain vigilant in the pre-operative
airway assessment to the presence of
male facial hair.
Dr M Bowker, ST5, Salford Royal
Foundation Trust
Dr T Mount, ST7, Salford Royal
Foundation Trust
Dr S Yadthore, Consultant Anaesthetist
Salford Royal Foundation Trust
| 61
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017

REPORT OF MEETINGS OF COUNCIL Northern Ireland

Dr Earlene Armstrong
Dr Valerie Marshall
Dr Declan McCawley
Stoke
Dr Thy Do
Dr Niroshini Karunasekara
Dr Sivakumar Balasubramanian
Certificate of Completion of
Training
To note recommendations made to the
GMC for approval, that CCTs/CESR
At a meeting of Council held on Imperial Certificate of Completion of Dr Karen Orr Joint ICM
(CP)s be awarded to those set out below,
Wednesday, 8 February 2017 *Dr E L Morecroft, Hillingdon Hospital Training Dr Patricia Anagnostides Warwickshire
who have satisfactorily completed the
the following appointments/ *Dr A A Kalbag, Charing Cross Hospital Dr Caroline Curry Dr Ahamed Azhar
To note recommendations made to the full period of higher specialist training
re-appointments were approved *Dr N Stranix, Charing Cross Hospital GMC for approval, that CCTs/CESR Leeds & Bradford in Anaesthesia, or Anaesthesia with
Northern
(re-appointments marked with an *Dr R Dhesi St Mary’s Hospital (CP)s be awarded to those set out below, Dr Sarah Cooper Intensive Care Medicine or Pre-Hospital
Dr Rhiannon Hackett
asterisk): *Dr M Kumar, Watford General Hospital who have satisfactorily completed the Dr Ntima Ntima Emergency Medicine where highlighted.
full period of higher specialist training Dr Shaun Knight Joint ICM
North West
Regional Advisers South East in Anaesthesia, or Anaesthesia with
Dr Anuradha Kurvey
Defence
There were no appointments or *Dr A Barry, Queen Elizabeth Hospital, Intensive Care Medicine or Pre-Hospital At a meeting of Council held Dr George Evetts Joint ICM
Dr Jennifer Cunningham Joint ICM
re-appointments this month. Woolwich Emergency Medicine where highlighted. on Wednesday, 7 March 2017
Dr Eleanor Chapman
the following appointments/ East Midlands North
Deputy Regional Advisers North East Anglia re-appointments were approved Dr Sonia Poulose
Oxford
There were no appointments or Northern Dr Benjamin Marriage
(re-appointments marked with an
Dr Natasha Lee Joint ICM
Dr Nicholas Taylor
re-appointments this month. Dr P R Ricketts, Queen Elizabeth Dr Nazia Khan
asterisk):
Hospital, Gateshead in succession to Dr East of England
Scotland
College Tutors M Gaughan East Midlands Dr Maziar Sadri Joint ICM
Tayside Regional Advisers
Leicester Dr Christine Tjen
Wales West Midlands Dr Dave Patel Dr Neil Shaw There are no appointments or
*Dr K E Lewis, Princess of Wales Hospital re-appointments this month. Kent, Surrey & Sussex
Birmingham Dr Nathan Ware
West of Scotland Dr Abhijoy Chakladar
*Dr G L J Nicol, Worcester Royal
Northern Ireland
Hospital Nottingham Dr Elaine Armstrong Joint ICM Deputy Regional Advisers Dr Anthony Cochrane Joint ICM
Dr R James, Royal Victoria Hospital in Dr Itsuki Miura Dr Lorna Gallacher There are no appointments or Dr Edward Mathers
succession to Dr M Molloy Dr Euan McIntosh re-appointments this month. Dr Susan Abiks
Stoke
*Dr E J F Jayadoss, New Cross Hospital, Bart’s and The London
Dr A J Naphade, Royal Victoria Hospital Severn Imperial
Wolverhampton Dr Katie Richardson College Tutors
*Dr J R Adams, Musgrave Park Hospital Dr Nicole Trask Dr Melanie Poole Dr Nishanthi Nimalan
Northern Ireland Dr Fiona Ramsden
*Dr D T Lee, Ulster Hospital *Dr M Haldar, Burton Hospital
South East Tri Services *Dr R O Laird, Altnagelvin Area Hospital, Dr Sanjeevan Shanmuganathan
West of Scotland Warwickshire Dr Jonathan Aron Joint ICM Dr Jeyasangar Jeyanathan Joint ICM Dr Richard Paul Joint ICM
London
Dr J H Duffty, Hairmyres Hospital in *Dr N A Osborn, Birmingham Heartlands Dr Preeya Chakraborty Dr David Cain Joint ICM
succession to Dr S Gambhir Hospital Dr Michael Shaw Wales North Central London Dr Ruth Cowen
Dr Claire Halligan *Dr T Jones, Royal Free Hospital Dr Vivian Sathianathan Joint ICM
Dr D A W Reid, Golden Jubilee Hospital *Dr A N Kelly, University Hospital, St George’s Dr Danielle Huckle
in succession to Dr I Quasim Coventry & Warwick Dr Sohail Bampoe Dr Claire Jones Imperial North Central London
Dr Irfan Raza Dr Luis Macchiavello Joint ICM *Dr K Rao, Northwick Park Hospital Dr Jakob Johannesson
*Dr C L Harper, Queen Elizabeth
Dr Eloise Helme Joint ICM Dr Christine Sathananthan
University Hospital St George’s
Dr Liana Vele Wessex Dr Umbareen Siddiqi
Dr Robert Charnock Joint ICM Dr D Mathew, St George’s Hospital, in Dr Caroline Moss Joint ICM
England
Mersey Dr Louise Young succession to Dr M Farrar
East of England Dr Bethan Armstrong Dr Philip McGlone Joint ICM Bart’s and The London
Dr A Agrawal, Luton & Dunstable Dr Graeme Fitzpatrick North West Dr Daniel Bell
Hospital in succession to Dr M Brackin Birmingham *Dr O Pratt (Salford Royal Hospital)
Dr John Harris
Dr James Burns South East
Dr Ruth Vlies
London Dr Mark Howes South Yorkshire Dr Manojit Sinha
Dr Victoria Wroe
Barts and The London Dr Jane Pilsbury Dr A Hartog, Rotherham District
Dr H Ahmad, Moorfields Eye Hospital in Dr Laura Troth General Hospital in succession to Dr M St George’s
succession to Dr M Raval Shekar Dr Nirav Shah Joint ICM

62  | | 63
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017

Northern CONSULTATIONS
Dr Fiona Smith
Certificate of Eligibility APPOINTMENT OF The following is a list of consultations which the RCoA has responded to in the
Dr Anand Damodaran Joint ICM
for Specialist Registration MEMBERS, ASSOCIATE last two months. Those published on the RCoA website via our Responses to

North West (CESR) Consultations area (http://bit.ly/2kz1uB3) are marked with an asterisk.
To note recommendations
MEMBERS AND ASSOCIATE
Dr Ahmad Moetamin
Dr Kathryn Wood approved by the GMC, that a CESR FELLOWS Originator Consultation
be awarded to those set out below: Associate Fellows
Mersey Dr Sarka Moravcova Academy of Medical Royal Generic Professional Capabilities:
Dr Elizabeth Huddlestone Dr Loku Warnapura
Dr Inga Misane Colleges guidance on implementation for colleges 2nd Annual
CTN Autumn
and faculties
Oxford Member
Dr Tahir Ali Joint ICM
Meeting
Dr Geoffrey Julian Wigmore
APPOINTMENT OF National Institute for Health and Chronic obstructive pulmonary disease
South-East Scotland Care Excellence in over 16s: diagnosis and management
Dr Thomas Anderson Joint ICM
FELLOWS TO CONSULTANT Associate Members
update (draft scope consultation) Wednesday 2 November 2017
Dr Shashiharen Gnanapandithen
AND SIMILAR POSTS Dr Ahsin Jawad Crowne Plaza,
Severn Dr Sahar Abdul-Salam Biuk British Pain Society Understanding and managing pain after Manchester City Centre
The College congratulates the
Dr Rebecca Leslie Dr Victoria Waugh
following Fellows on their consultant surgery - information for patients and their
Dr Magdalena Smith Along with the presentation of major
appointments: carers
Dr Benjamin Greatorex Joint ICM Affiliate new trial proposals, plenary sessions
Dr Nishita Patel Dr Gyanesh Namjoshi Mr Barry David Joseph will include:
National Institute for Health and Child abuse and neglect: Draft guidance
Basildon and Thurrock University
Wales Care Excellence consultation ■■ Qualitative Data – More Than Just
Hospital
Dr Joseph Riddell Joint ICM Numbers
Dr Navneet Sinha Dr Maria Eleni Garside General Medical Council Securing the licence to practise - ■■ Big Data- the Future?
Bradford Teaching Hospitals DEATHS introducing a Medical Licensing ■■ Using Clinical Research to Influence
Wessex With regret, we record the death of Assessment Policy
Dr Christian Schopflin Dr Louise Young
those listed below. ■■ Working Together with Surgeons to
University Hospital Southampton
Department of Health Fixed recoverable costs for clinical Deliver Perioperative Studies
Birmingham Dr Anthony D Reynolds
Dr Caroline Moss
Dr John Kelly Joint ICM Lincolnshire negligence claims The meeting will also offer small group
St Richard’s Hospital, Chichester
Dr Leon Kaufman interactive training sessions on:
Stoke Dr George Evetts Department of Health Protecting whistleblowers seeking jobs in ■■ Who is the Chief Investigator?
London
Dr Elin Jones Frimley Park Hospital the NHS - Employment Rights Act 1996 ■■ Surviving the Approval Process
Dr Chandy Verghese
(NHS Recruitment Protected Disclosure)
Warwickshire Dr Gunchu Randhawa Berkshire ■■ How can the CRN help you?
Regulations
Dr Gemma Dignam Joint ICM Leeds Teaching Hospitals
Dr Krystyna Lubomirska With lectures from distinguished
Dr Rajen Nathwani Joint ICM health care leaders, delegates will
Dr Sailaja Pothuneedi Essex
House of Commons Select Inquiry: older people and employment: Is
Sheffield Teaching Hospitals also have the opportunity to provide
West Yorkshire Committee on Women and Government policy effective?
Please submit obituaries of no more and receive constructive feedback on
Dr James Sira Joint ICM Equalities
Dr Lorna Stevens than 500 words, with a photo if future studies and network with fellow
Dr Caroline Thomas Forth Valley Royal Hospital desired, of Fellows, Members or researchers across the UK. This is a full
Trainees to: website@rcoa.ac.uk. Department of Health Introducing a rapid resolution and redress day not to be missed!
Apologies to Dr Charlotte Cattlin Dr Luis Macchiavello scheme for severe aviodable birth injury
for incorrectly spelling her name in Cwm Taf UHB All obituaries received will be PLACES ARE LIMITED SO PLEASE
the March issue. Dr Cattlin has been published on the College website APPLY EARLY.
awarded dual CCTs in Anaesthesia (www.rcoa.ac.uk/obituaries).
For more information, please go to
with Intensive Care Medicine.
www.pomctn.org.uk or tweet us at
@pomctn.

64  | | 65
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017
Find us on Facebook Badge CMYK / .ai

AIRWAY
WORKSHOPS THE MSA SAQ WRITERS CLUB
The Writers Club has seen more than 700+ trainees through the SAQ Papers with a successful Pass Rate for those who have
kept to the Necessary Disciplines. But many trainees apply far too close to the examination to derive anything like the full
The airway workshops provide an opportunity to learn
benefit from Membership. That Full Benefit includes Free Admission to the SAQ Weekend Courses, the Acquisition of a large
core airway management techniques from experienced
and useful Collection of Answer Sheets and a Valuable Motivation towards Sustained Revision
consultants. There is hands-on practical experience
with commonplace airway equipment as well as plenty Membership Fee: A single payment of £400
of discussion on airway management including current Members are entitled to all benefits until successful in the SAQ Paper
UK guidelines. Appropriate for all grades of anaesthetic Attendance to the SAQ Weekend Course – Free of Charge
trainees, speciality doctors and consultants. Writers Club Motto: ‘Within the Discipline, Lies the Reward’
Candidates are urged to join before September 2017 for the Spring 2018 Examination to reap Maximum Benefit
FUTURE DATES Enquiries to: writersclub.msa@gmail.com
■■ 28 June 2017, RCoA, London
Courses for the Royal College of Anaesthetists Examinations
■■ 20 September 2017, RCoA, London (Advanced Airway)
■■ 12 October 2017 at the G&V Royal Mile Hotel, Edinburgh Courses Dates 2017/2018 Capacity

■■ 7 February 2018 at the RCoA, London Primary SBA/MCQ 21–27 July 6 – 12 October No Limit

Primary OSCE Weekend 13–15 October December 2017 48

Book your place at: www.rcoa.ac.uk/events
Primary Viva Weekend 20–22 October January 2018 No Limit

Primary OSCE/Orals 27 Oct–3 Nov January 2018 48

History of
Anaesthesia Society
Meeting
Wakefield
Friday 16 June -
Saturday 17 June 2017
A Symposium on the History of
Neuro-Muscular Blockade
will be held on the Friday morning
Speakers: Professors Jennifer Hunter (Liverpool),
Rajinder Mirakhur (Belfast),
Roger Maltby (Calgary) and
Dr Ann Ferguson (Broadstairs)
Meeting open to non-members as well as Society members
Day registration available
For further details, registration forms and
submission of abstracts see:
www.histansoc.org.uk/events
Anaesthetists in training who have abstracts accepted for
presentation get free registration and accommodation
Final SBA/MCQ 11–17 August February 2018 No Limit
® Final SAQ Weekend 18–20 August February 2018 No Limit
Revalidation
for anaesthetists
Final Written ‘Booker’ 20–25 August February 2018 90
Final Viva Revision 13–18 May November 2017 No Limit
Final Viva Weekend 9–11 June November 2017 100
‘I don’t know how to thank you and the MSA enough for all the help occasion! – and later he told me, ‘your problem, it seems to me, was
that you have given me… I have felt such personal and genuine
support through every single exam and I worked so hard to get the
not a lack of knowledge but a lack of confidence...I’ve gone from
thinking you had every chance of failing to thinking you now have
leave arranged to attend each and every course because every time every chance of passing... whatever they taught you on that course
I believe that it was the difference that meant I passed each section has obviously worked for you!’
first time… Your personal words of advice have always been so spot
I would thoroughly recommend your courses to anyone facing the
on and every detail has been what I needed to hear and focus on’
Final FRCA. I’m convinced it gave me just the psychological boost
– Final SOE Candidate, December 2016
I needed. So thanks again, I’m forever indebted to you and your
‘I’d like to add my thanks for all of your help in preparing me for my fantastic team!’ – Final SOE Candidate, December 2016
Final SOE. I thought you might be particularly interested to hear
Thank you MSA and all who assist with the courses! I have attended
about the feedback I got from a local consultant and Final FRCA
all of the Mersey courses through Primary and Final and can
examiner who viva’d me both before and after the MSA Course. I
thoroughly recommend them all. They help not only with knowledge
went to see him – admittedly against the advice, which was to avoid
but technique and pattern recognition as well. Dr Gray’s advice is
last-minute viva practice - just two days after I got back from the
sound and allows you to come up with answers to questions you
MSA. Firstly he said, ‘you seem MUCH brighter since the last time I
didn’t know you knew’– Final SOE Candidate, December 2016
saw you’ – I’d admittedly been fairly close to tears on that previous
To see details of all of our courses please visit: www.msoa.org.uk or contact us at: enquiries@msoa.org.uk

66  | 67  |
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017

Education

EDITORIAL BOARD
MEMBERSHIP VACANCIES

The British Journal of Anaesthesia invites applications for

membership of the Editorial Board of BJA Education
(formerly Continuing Education in Anaesthesia, Critical
Care & Pain – CEACCP) to commence in Summer 2017.
The appointment will be for a 5 year term in the first
instance, renewable for a further 5 years.

To be eligible for appointment, applicants should be

engaged in a substantive academic or clinical position,
with significant clinical experience in one or more
fields of anaesthesia, in or outside of the UK; the BJA
is particularly interested in hearing from applicants with
expertise in obstetric anaesthesia, basic science,
regional anaesthesia and intensive care medicine.

Applicants should, in addition, have experience of

the editorial process for medical journals and in the
preparation and submission of high quality articles for
publication.

This role requires significant commitment to the

development of the journal and we will expect
appointed Editors to be able to commit to:

1 Commissioning at least six continuing education

articles per year
2 Attending and contributing to the Editorial Board
Meetings each year (two in London and two via
videoconferencing)
3 Assisting the Editor in Chief by providing editorial
expertise and reviewing articles submitted for
publication
4 Keeping on top of editorial tasks and meeting
editorial deadlines to ensure timely publication of
commissioned articles.
If you are committed, enthusiastic and willing to join a
highly performing team to further develop BJA Education,
please send your application (in the form of a covering
letter, a brief CV and a list of publications in the past
5 years) to the Editor-in-Chief, Dr Jeremy Langton, to
bjaeducation@rcoa.ac.uk by 31 May 2017.

(Shortlisted candidates may be asked to complete a

short exercise via email as part of the selection process.)

68  | 69  |
Bulletin  |  Issue 103  |  May 2017 Bulletin  |  Issue 103  |  May 2017

26–27 JUNE 2017 27 SEPTEMBER 2017

SEPTEMBER
EVENTS UK Training In Emergency Airway
Management (TEAM) Course
Anaesthetists as Educators: an
Introduction

CALENDAR Royal United Hospital, Bath

£450
1 SEPTEMBER 2017
FPM Exam Tutorial
RCoA, London
£220 (£165 for RCoA registered
Further information about all trainees)
RCoA, London
of our events can be found on
our website. 27 JUNE 2017 £95

events@rcoa.ac.uk
www.rcoa.ac.uk/events
GASAgain (Giving Anaesthesia
Safely Again) Return to Work 6-8 SEPTEMBER 2017
OCTOBER
Simulation Course
Updates in Anaesthesia, Critical Care
Royal Bournemouth Hospital 2 OCTOBER 2017
and Pain Management
24 MAY 2017 9 JUNE 2017
MAY FICM Annual Meeting: Hard Cases or FICM Advanced Critical Care
£240 RCoA, London Developing World Anaesthesia
RCoA, London
£490
Bad Laws? Practitioners Conference     £150
9–10 MAY 2017 27–30 JUNE 2017
RCoA, London RCoA, London
Cardiac Disease and Anaesthesia Primary FRCA Masterclass
£170 (£90 for RCoA registered £45 15 SEPTEMBER 2017
Symposium RCoA, London 2 OCTOBER 2017
trainees) Paediatric Emergency Management
RCoA, London £305 CPD Study Day
for the Anaesthetic Team
£395 (£295 for RCoA registered trainees) 12–13 JUNE 2017 RCoA, London
RCoA, London
30–31 MAY 2017 UK Training in Emergency Airway £200 (£150 for RCoA registered
28 JUNE 2017 £240 (£180 for RCoA registered
CPD Study Days Management (TEAM) Course trainees)
11 MAY 2017 Airway Workshop
trainees)
RCoA, London Solihull Hospital, Solihull
Ethics and Law for Anaesthetists RCoA, London
£355 (£270 for RCoA registered £450
RCoA, London 3 OCTOBER 2017
trainees) £240 (£180 for RCoA registered 18–19 SEPTEMBER 2017
FULLY BOOKED trainees) Ultrasound Workshop
Anaesthetists as Educators: Teaching
13–14 JUNE 2017 and Training in the Workplace
RCoA, London
£240 (£180 for RCoA registered
12 MAY 2017 JUNE Summer Symposium – Providing RCoA, London
trainees)
NIAA Annual Scientific Meeting
High Quality Anaesthetic Care in a
Sustainable Healthcare System
JULY £425 (£320 for RCoA registered
RCoA, London 1 JUNE 2017 trainees)
The Waterfront Hall, Belfast
£45 ARIES Talks 3–7 JULY 2017 4 OCTOBER 2017
£395 (£295 for RCoA registered
RCoA, London Final FRCA Revision Course A career in Anaesthesia
trainees) 20 SEPTEMBER 2017
Free of charge RCoA, London RCoA, London
22 MAY 2017 Advanced Airway Workshop
£45
£395 RCoA, London
Joint RCoA/RCEM Major Trauma 14 JUNE 2017
Study Day 5 JUNE 2017 FPM Diagnosis and Imaging in Pain
£240 (£180 for RCoA registered
RCoA, London Anaesthetists as Educators: an 10 JULY 2017 trainees) 13 OCTOBER 2017
Medicine    
£200 (£150 for RCoA registered Introduction Anaesthetists as Educators:
RCoA, London ARIES Talks
trainees) RCoA, London Simulation Unplugged
£175 (£140 for RCoA registered RCoA, London 25–26 SEPTEMBER 2017
FULLY BOOKED RCoA, London
trainees) Free of charge
CPD Study Days £220 (£165 for RCoA registered
23–24 MAY 2017 RCoA, London trainees)
Introduction to Leadership and 8 JUNE 2017 15–16 JUNE 2017 14 JULY 2017 £355 (£270 for RCoA registered
Management: the Essentials BJA, NIAA and Cochrane ACE trainees)
College Tutors Meeting Patient Safety in Perioperative
RCoA, London Systematic Review and Meta-analysis
19-20 OCTOBER 2017
The Waterfront Hall, Belfast Practice
Workshop UK Training in Emergency Airway
£395 RCoA, London
BY INVITATION ONLY Management (TEAM) Course - London
RCoA, London £200 (£150 for RCoA registered
RCoA, London
£150 trainees)
£450

Book your place at: www.rcoa.ac.uk/events Book your place at: www.rcoa.ac.uk/events
70  | | 71
Bulletin  |  Issue 103  |  May 2017

PATIENT SAFETY IN UPDATES

PERIOPERATIVE in anaesthesia, critical care and pain
PRACTICE
Saving lives through safer surgery

The RCoA will make management

RCoA SUMMER SYMPOSIUM – BELFAST
a donation of £25
to Lifebox for every
delegate attending
this event.
CPD 10
Providing High Quality Anaesthetic Care credits

CPD 5
in a Sustainable Healthcare System credits
#RCoAUpdates
#PSPP2017

CPD 10 14 JULY 2017 6-8 SEPTEMBER 2017

#RCoASummer credits

RCoA, London  RCoA, London

13–14 JUNE 2017
£200 (£150 for RCoA registered trainees) £490
The Waterfront Hall, Belfast  |  £395 (£295 for RCoA registered trainees) A one-day meeting to discuss patient safety, A three-day meeting consisting of lectures and
including the barriers to delivering safe perioperative topical discussion. The meeting is intended for
■  TRADE EXHIBITIONS  ■  SOCIAL EVENING  ■  ABSTRACT COMPETITION  ■ WORKSHOPS
care, and strategies on how to overcome them. doctors engaged in clinical anaesthesia, pain
For the 2017 RCoA Summer Symposium we have assembled a group of renowned national and international management and intensive care medicine (i.e.
Its aims are to build upon existing knowledge and
experts, who will present on a wide range of topics related to developing sustainable anaesthetic services which Consultants, Staff and Associate Specialist Grades
clinical practice to make systems, processes and
respond to the needs of the population, including the management of pain, patient safety, the perioperative or their overseas equivalent) who feel they may
organisations safer.
pathways and ultimately patient outcomes. benefit from a refresher of the latest updates in areas
Lectures on the day may include: of practice they may be exposed to regularly or
Workshops only occasionally. Experts will present up-to-date
■■ Airway management update
The following optional workshops are available to book at £25 per workshop and there will be 1 CPD credit information on a wide range of topics, informing
■■ Patient safety, the CQC and me
awarded for each: Mentoring, One lung anaesthesia, Regional anaesthesia and Surgical management of the participants on updates in basic sciences relevant to
failed airway. ■■ Checklists and Lifebox
anaesthesia and allied specialties.
■■ Engineered solutions to never events and novel
Social Evening simulation methods The learning objectives are to facilitate
Join us at the Arc Bar and restaurant on Tuesday, 13 June for a summer social evening with drinks, waterfront ■■ Technology to improve safety: a human factors familiarisation with the latest developments and to
views and entertainment. This informal event (included in the registration fee) will provide delegates with the approach make participants aware of progress in a structured
opportunity to network and meet speakers in a social environment. manner, bringing a better understanding of how
■■ The future of patient safety
changes in practice, based on new information, will
benefit their patients.
Book your place at:
www.rcoa.ac.uk/SummerSymposium
Book your place at: www.rcoa.ac.uk/events Book your place at: www.rcoa.ac.uk/events

72  |
CONTACT INFORMATION FOR COLLEGE STAFF
Liam Brennan
President
CLINICAL QUALITY EDUCATION, TRAINING COMMUNICATIONS
president@rcoa.ac.uk AND RESEARCH AND EXAMINATIONS AND EXTERNAL
020 7092 1600 DIRECTORATE DIRECTORATE AFFAIRS DIRECTORATE
Tom Grinyer James Goodwin Graham Clissett Gavin Dallas
Chief Executive Research Manager Examinations Manager Communications
ceo@rcoa.ac.uk research@rcoa.ac.uk exams@rcoa.ac.uk Manager
020 7092 1612 020 7092 1689 020 7092 1521 comms@rcoa.ac.uk
020 7092 1696
Sharon Drake Carly Melbourne Claudia Moran
Deputy Chief Executive Quality and Safety Training Manager Alice Dartnell
and Director of Clinical Manager training@rcoa.ac.uk Membership Engagement
Quality and Research clinicalquality@rcoa.ac.uk 020 7092 1557 Manager
020 7092 1681 020 7092 1699 adartnell@rcoa.ac.uk
Equivalence 020 7092 1670
Mark Blaney Advisory Appointment equivalence@rcoa.ac.uk
Director of Finance and Committees (AACs) 020 7092 1555 Chris Woodhall
Resources aac@rcoa.ac.uk Policy and Public Affairs
020 7092 1581 020 7092 1571 Events Manager
events@rcoa.ac.uk cwoodhall@rcoa.ac.uk
Russell Ampofo Anaesthesia Clinical 020 7092 1673 020 7092 1500
Director of Education, Services Accreditation
Training and (ACSA) Global Partnerships Bulletin
Examinations acsa@rcoa.ac.uk global@rcoa.ac.uk bulletin@rcoa.ac.uk
020 7092 1522 020 7092 1575 020 7092 1559 020 7092 1692
Regional 020 7092 1693
Kathryn Stillman (Anaesthesia Review
Director of Team) Invited Representatives Support Media enquiries
Communications and Reviews (ART) (College Tutors and media@rcoa.ac.uk
External Affairs art@rcoa.ac.uk Regional Advisers) 020 7092 1698
020 7092 1532 020 7092 1571 reps@rcoa.ac.uk
020 7092 1573 Membership and
Aaron Woods Guidelines for the subscriptions
Technology Strategy Provision of Anaesthetic Revalidation and CPD subs@rcoa.ac.uk
Programme Director Services (GPAS) revalidation@rcoa.ac.uk 020 7092 1701
020 7092 1716 gpas@rcoa.ac.uk 020 7092 1729 020 7092 1702
020 7092 1572 SAS and Specialty 020 7092 1703
Daniel Waeland
Head of Faculties National Institute of Doctors
(Faculty of Intensive Care Academic Anaesthesia sas@rcoa.ac.uk
Medicine and Faculty of (NIAA) 020 7092 1559
Pain Medicine) info@niaa.org.uk Trainee Committee
020 7092 1727 020 7092 1680 trainee@rcoa.ac.uk
Graham Blair Patient Safety 020 7092 1573
Head of Education and salg@rcoa.ac.uk Workforce Planning
Events 020 7092 1574 workforce@rcoa.ac.uk
020 7092 1561 020 7092 1652
Perioperative Medicine
perioperativemedicine@
rcoa.ac.uk
020 7092 1678