Shaping the Future

THE THEME OF THIS YEAR’S CHARTER MEETING LOOKED TO THE FUTURE OF SURGERY, THE FOCUS OF PRESIDENT LAURA VIANI’S TERM OF OFFICE

CSI was granted a Charter by George III on the 11 February 1784, and for the last 239 years, the College has celebrated the Charter on the Friday closest to that calendar date, falling on 3 February this year. But, in reality, the Charter programme begins the preceding Saturday, with meetings, presentations and parallel sessions held every day leading up to Charter Day itself.

So, it’s a week that sees the College brimming with activities, all focused on a theme chosen by the President. Charter Meeting 2023 commenced on Saturday, 28 January with the Annual Meeting of the Irish Surgical Training Group (ISTG), which included the Bosco O’Mahony Lecture delivered by RCSI Council Member, Professor Michael Kerin. The lecture is named in honour of Mr John Bosco O’Mahony, one of the longest serving members of the RCSI Council. Professor Kerin delivered the prestigious lecture on Irish surgery – A Discipline in Evolution: Implications for Training and Practice.

The National Office of Clinical Audit (NOCA) held its Annual Conference as part of the Charter Meeting on Tuesday, 31 January. NOCA is a publicly funded independent institution, based in and supported by RCSI. The meeting, on the theme of Audit Matters, looked at NOCA’s key achievements, as well as future objectives to develop a national clinical audit across our healthcare system.

Also on 31 January, RCSI hosted the 17th Annual Intercollegiate Case Presentations, an annual competition that brings together the surgical societies of Irish medical schools. The winner of the David Bouchier-Hayes Award was Meadhbh Ní Mhiochain from the School of Medicine, University of Galway.

The Annual Health Service Quality Improvement and Innovations Conference was held on Wednesday, 1 February, hosted by RCSI National Clinical Programmes. The conference’s invited speaker was Mary Dixon Woods, Director of The Healthcare Improvement Studies (THIS) Institute and the Foundation Professor of The Healthcare Improvement Studies in the Department of Public Health and Primary Care at the University of Cambridge. Wednesday afternoon also saw the Faculty of Surgical Trainers’ Meeting, parallel sessions from the RCSI Faculties of Dentistry and Nursing and Midwifery and the Irish Institute of Pharmacy, as well as the 33rd Annual VideoSurgery Meeting that evening.

Key symposiums were held across Thursday and Friday on the future of surgery and healthcare, including those related to technology, training, clinical audit and cancer care. The final symposium on the configuration and staffing of safe surgical services included the official launch of RCSI’s Surgery for Ireland report, which was presented to Dr Colm Henry, HSE Chief Clinical Officer.

With an impressive line-up of speakers this year we present just some of the key highlights:

The Then, Now and When of Personalised Cancer Medicine

Professor Paul Ridgway introduced a very interesting session by Consultant Haematologist Professor Siobhan Glavey on The Then, Now and When of Personalised Cancer Medicine. Professor Glavey described haematology as being the specialty at the frontline of cancer medicine. She explained the concept of precision medicine and how categorising patients into sub-groups of cancers that are completely different genomically means that precision therapeutics targeted to the tumour cells can be so effective. Genomics, she said, is the reason why Multiple Myeloma survival rates have improved. Professor Glavey’s lecture included observations on cancer immunotherapy, and how CAR-T treatment has benefited children who have been diagnosed with ALL (Acute Lymphocytic Leukemia).

Accelerating Genomic Medicine

Next up was Consultant Clinical Geneticist Dr Terri McVeigh who trained in Ireland and is now based at the Royal Marsden in London. Dr McVeigh presented a vivid snapshot of what is happening in the NHS in the UK in terms of genomic profiling. The priority is to establish if a patient has a heritable predisposition

The Charter

The original Charter dates from 1784. It was revised in 1828, 1844, 1883, 1885 (‘And we do hereby, for us, our heirs and successors, grant, declare and appoint, that all provisions of the Charter, Bye-Laws, and Ordinances as to education, examination, and granting diplomas to Fellows or Licentiates shall extend to include women’). In the 20th century it was revised in 1965, when RCSI was designated a Charity. Early in the 21st century, it was amended again, in 2003, paving the way for RCSI to award its own degrees.

integral to characterising tumours. This is critical to treatment, and is shown to detect early relapse. Dr McVeigh said that “every specialist will have to upskill”. She outlined the challenges in cancer care and the development of liquid biopsy, which might lead to overdiagnosis. She observed that while genome sequencing is relatively inexpensive, the staff and infrastructure required to conduct the analysis is not. Dr McVeigh concluded by summarising the NHS Genomic Strategy priority areas in terms of the mainstreaming of services (to include those not trained in genetics), equity of access, data and digital transfer and research and innovation.

Allies, Advocates and Change Agents

After lunch and an exhibition by industry partners Johnson & Johnson, Medtronic and Olympus among others, the O’Flanagan Lecture Theatre filled up when Professor Margaret O’Donnell gave the citation for internationally respected plastic surgeon Dr John G. Meara who delivered the Annual Johnson & Johnson Lecture. He chose the title of his lecture because he said he was “grappling with the neo-colonial aspects” in the world, namely in global surgery. Many people have benefited from serendipity and charity, he said, but “serendipity is not a good strategy, and charity is not a solution. They are seeds, but they don’t grow unless they sit in the soil of a health system.” Dr Meara talked about the key outcomes of the Lancet Commission on Global Surgery, namely the vision and key messages including the fact that five billion people lack access to healthcare, 81 million face catastrophe and $350 billion dollars are needed, but the positive impact of that spend would be $12 trillion dollars. He said that the idea of planetary health and the biosphere is now talked about by the UN and while it is hard to make predictions for surgery of the future, the Venn diagram for surgical care and climate change overlap and the world is finally breaking some ground in this regard. He described the Honorary Fellowship to be bestowed on him later that evening as an “intense honour”, referring to his Irish ancestry and his father’s pride at this accolade.

45th Millin Lecture

The 45th Millin Lecture, on the topic of Malignant Melanoma, An Unlikely Poster Child for Personalised Cancer Treatment, was delivered by Professor Shirley Potter, Consultant Plastic and Reconstructive Surgeon, Mater Misericordiae University Hospital. Professor Potter was the first plastic and reconstructive surgeon to have the honour, and only the seventh female surgeon. Ireland’s skin cancer problem outweighs all other cancers in terms of new cases, and is the fourth most common cancer in men and women, affecting women mainly on limbs and men on the trunk. Professor Potter’s fascinating lecture described the unique properties of melanoma and how immunotherapy has boosted survival rates, with the focus now on moving towards personalised management of the disease.

7 Brent Van Eccelpoel, Dr Ozanan Meireles and Professor Ronan Cahill.

8 Jack Logue and Mary Ellen McMahon.

9 Professor Conor Deasy.

10 Patrick Collins, John O’Kelly and Sarah Norton.

11 Professor Calvin Coffey, Professor Gutschow Christian and Professor P. Ronan O’Connell.

12, 13 An audience of more than 100 medical students, surgical trainees, interns, NCHDs, and junior and foundation doctors attended the Becoming a Standout Surgeon event.

14 Ms Jessica Ryan, Professor David Healy, Mr Dara Kavanagh, Professor Kevin Barry and Ms Ciara Tallon.

98th Abraham Colles Lecture

On Friday, the popular Becoming a Standout Surgeon session for Affiliate Members was followed by the 98th Abraham Colles Lecture, delivered by Luc Morris, Memorial Sloane Kettering Cancer Center. He designed his intriguingly titled presentation The Cobra Effect: How COVID-19, Immunolology and Surgical History Can Help Us Understand Indolent Cancers, he said, to interest the polymath Abraham Colles himself whose 250th anniversary of his birth is marked this year. Dr Morris drew a parallel between the tendency to overdiagnose indolent cancers with how colonial administrators offered a bounty on cobra heads, hoping to reduce the number of deadly snakes only to find that everyone started to breed cobras to avail of the cash, so that there were more at the end of the initiative than there were at the beginning. He said the incentive to find disease leads to more disease being discovered. He questioned if every human condition, including slow growing, highly prevalent indolent cancers, need to be found and treated?

15 RCSI Vice President, Professor Deborah McNamara and Professor Frank Keane.

16 Amit Kalra, outgoing President, RCSI Student Union and Lina Adil, outgoing Vice President and Education Officer, RCSI Student Union.

17 Dr Anna Clarke, Professor Emma Meagher and Professor Noel Williams.

18 Professor Richard Irving, Professor Maria B. Majella Doyle and Dr John G. Meara.

19 Mr Kenneth Mealy and Mr Dennis Lawlor.

20 Jack O’Grady, Dr Frank Kenny and Ailbhe Kenny.

21 Dr Luc Morris, Ms Victoria Rose and Professor Camilla Carroll.

30th Carmichael Lecture

RCSI invited Orla Tinsley, journalist, Cystic Fibrosis campaigner and multimedia artist, to give the 30th Carmichael Lecture. She was the first patient advocate to give the Carmichael Lecture and she proved to be most worthy of this honour. What Good Looks Like – From a Patient Perspective was a deeply moving and inspiring account of her decades-long patient journey and her experiences of patient/practitioner interactions. She highlighted the differences between her very positive experience in New York when undergoing a double lung transplant with her visits to a Dublin hospital during COVID-19 when there were no temperature checks, no name checks, no precautions to protect a vulnerable patient. She talked of how “being born in the kingdom of the sick and holidaying in the kingdom of the well” is somewhat dependent on how clinicians respond to their patients, not just in a treatment sense, but in an emotional sense, creating structure and safety. She urged healthcare professionals to think differently, to use language carefully, to “sit with your patients and spend time”.

Charter Dinner

As proceedings drew to a close, Professor Viani thanked the many colleagues and external faculty who contributed to this really excellent programme and the Surgical Specialties and RCSI Faculties who put together excellent parallel sessions. On Thursday and Friday evening, Professor Viani also conferred Honorary Fellowships on Dr Vivian McAlister, Dr Ajit K. Sachdeva, Dr Maria B. Majella Doyle, Professor Richard Irving and Dr John G. Meara, who have contributed greatly to the science and practice of surgery and society as a whole. Charter celebrations culminated in a most enjoyable Charter Dinner. ■