Surgeons Scope Magazine - July 2022 by RCSI

THE MAGAZINE EXCLUSIVELY FOR RCSI FELLOWS AND MEMBERS ISSUE 1 2022

Ms Tafadzwa Mandiwanza

PAEDIATRIC NEUROSURGEON KEEPING BURNOUT AT BAY HOW HOBBIES CAN HELP SCHWARTZ ROUNDS SUPPORTING SURGEONS

ASAU: AN ACUTE ISSUE

''It is proving to be 30-40% faster and I believe it is already saving the HSE and taxpayers money. In some cases, where I predicted a patient may have needed two operations to have the procedure done, this laser has done it in one.’' Derek Hennessey, Consultant Urologist, Mercy University Hospital regarding the SOLTIVE™ system

Find out more about the SOLTIVE™ system here:

› Letter

A Letter from the President, RCSI PROFESSOR LAURA VIANI

Dear RCSI Fellows and Members, “The best way to predict your future is to create it” Abraham Lincoln It is my very great pleasure to welcome you to the first issue of Surgeons Scope since becoming President of your College. Through Surgeons Scope and the various College newsletters, I intend to keep you informed of developments at RCSI over the coming years. I feel privileged to have been elected RCSI President at one of the most exciting times in the history of our College. As the COVID-19 pandemic recedes and as we get back to meeting face to face and travelling without restrictions, we encounter a world that has changed utterly. Events threaten to overtake us. A war in Europe; an uncertain viral future; an unrelenting digital progression and a damaged Irish health service. But we have been here before. Our forebears have recovered from greater devastation, and we have every confidence in the generation of surgeons that we have tutored to restore our healthcare fortunes in the shortest possible time. I intend, with your help, to be an ambassador for the College and those it represents, and I look forward to representing RCSI at a national and international level, at our international campuses and at overseas conferences. SHAPING THE FUTURE I have decided to make Shaping the Future the theme of my presidency. Shaping The Future will also be the theme of the Professor Laura Viani, President, RCSI Charter Day Meeting in 2023. This meeting will provide an RCSI President, Professor Laura Viani ideal platform for our national and international Fellows, Members, Alumni colleagues and associates to display the awesome advances in technology, immunology and oncology, and in artificial Implant Programme helped me build a strong working relationship with the intelligence and informatics. It used to be said that knowledge doubled every Department of Health and the HSE, and provided valuable lessons in political century. But now the world’s knowledge doubles every 70 days. Who can discourse, experience which I intend to employ in positively engaging with keep pace with this rate of change? But we must try. The technologies that are both over the next two years and committing the support of the RCSI to all transforming healthcare are so complex that we must understand them so we positive initiatives. The committees that I have established will also be very can control and direct them to deliver the safest and most effective patient happy to lend their expertise in any way that they can. care. And we need to ensure RCSI trainees have access to every aspect of this It is worth reminding ourselves again why surgery is the most exciting and healthcare revolution. rewarding of careers: it is because it affords us the unparalleled privilege of The COVID-19 pandemic resulted in unprecedented numbers of patients being able to care for our human fellow travellers. having consultation and operations cancelled. It is critical that we address this deficit and ensure that we are back on schedule as soon as possible. RCSI, THE NEXT GENERATION through our programmes in Surgery, can help reduce these waiting lists. Affiliate Membership of RCSI is now available to all medical students, surgical We are ideally positioned to give valuable advice to all of those involved in trainees, interns, NCHDs and junior and foundation doctors interested in delivering healthcare. My experience in establishing the National Cochlear pursuing a career in surgery or already on surgical training programmes. RCSI SURGEONS SCOPE / 1

› Letter

It is important to focus on keeping our young doctors and surgeons in Ireland and ensure we support them in their training, in their work practice and in their choice and preparation for overseas fellowships. Affiliate Members have access to THE FUTURE a wide range of resources aimed Looking forward, we have at supporting and supplementing lots of exciting plans for 2022 their personal, practical, academic and beyond. I am delighted and professional development that RCSI has officially begun through the new RCSI Affiliate construction of 118 St Stephen’s Member Portal. Green – also known as Project Together we must provide the Connect – in Dublin. This highest standards of surgical campus development project training to our young graduates will provide vital infrastructure and foster surgical professional for pioneering health sciences excellence. We must ensure research and innovation, as that those whose training has well as creating a space for been disrupted by the pandemic local community engagement. are supported, and any deficits Scheduled for completion in in their skills and experience 2025, 118 St Stephen’s Green will corrected, before they exit the be home to the new RCSI School programme. And I will advocate of Population Health, the RCSI on behalf of our future surgeons Graduate School of Healthcare to ensure they gain a world-class Management, and a 50sqm virtual training experience. reality surgical training space for It is important to focus on the National Surgical Training keeping our young doctors and Centre. And I am looking forward surgeons in Ireland and ensure to opening the Connolly Project we support them in their training, for graduate entry medicine in their work practice and in students in 2024. their choice and preparation for I would like to thank and overseas fellowships. To this end, I congratulate Professor P Ronan have established a new committee O’Connell, immediate past dedicated to consultant surgical President, RCSI, who showed recruitment and retention, which great leadership for our Fellows will explore a range of options and Members throughout the RCSI Vice President Professor Deborah McNamara and including proleptic appointments COVID-19 pandemic. RCSI President Professor Laura Viani and mid-career fellowships. And I am delighted to welcome I am also concerned about our Professor Deborah McNamara senior surgeons. It takes many years of training and practice for surgeons as Vice President. We are fortunate to have a dedicated and committed to reach the pinnacle of their careers. While many are anxious to continue Council and I look forward to working with every Council member (see Page delivering patient care well into their senior years, some are concerned about 5 for more details) to innovate, lead and deliver with me on the challenges arduous on-call obligations. I will set up a working group to examine how outlined above. we can best support our senior surgical colleagues and benefit from their I look forward to working closely with our Fellows and Members and to expertise, wisdom and experience while avoiding risk and surgeon burnout. meeting many of you in person over the term of my Presidency. Sustainability in surgery is becoming an important issue and the theatre is the hospital carbon hotspot. Together, we must seek ways to reduce our Best wishes hospitals’ carbon footprint. We must visit again the roles of reusable and biodegradable technologies and examine again the areas where conservative Laura Viani management provides safer alternatives to routine surgery. President, RCSI 2

SURGEONS

Contents 04

ON OUR COVER

Ms Tafadzwa Mandiwanza photographed by Alan Betson for The Irish Times.

Scope News

Next phase of the RCSI campus masterplan, Council Elections, 44th Millin Lecture

Navin Hyder

THE MAGAZINE EXCLUSIVELY FOR RCSI FELLOWS AND MEMBERS

28 25

Specialty Spotlight

Cardiothoracic Surgery: Mr John Hinchion on the opportunities and challenges

Charter Report

Scope Diary

A Higher Calling

Keeping Burnout at Bay

The Colles Q&A

Back to the Beginning

Theme: The Career of the Surgeon

Upcoming Fellows, Members and Afﬁliates events

Surgeons, don’t give up your hobbies, they’ll preserve your sanity

It’s My Round

A Surgeon in… Dublin

An Acute Issue

Understanding the emotional impact of working in healthcare

Professor Karen Redmond on work/life balance

In conversation with Professor Eilis McGovern, cardiothoracic surgeon and former President of RCSI

Meet Ms Tafadzwa Mandiwanza, Ireland’s ﬁrst female consultant paediatric neurosurgeon

Professor Paul Ridgway on the beneﬁts of ASAUs

RCSI SURGEONS SCOPE MAGAZINE is published bi-annually by RCSI for its surgical Fellows and Members. Issues are available online at www.rcsi.com. Your comments, ideas, updates and letters are welcome. Please contact Catherine Jordan, Managing Editor, in the Fellows & Members Office, 111 St Stephen’s Green, Dublin 2; telephone: +353 (0) 1 402 2116; email: catherinejordan@rcsi.com. RCSI Surgeons Scope is posted bi-annually to our Fellows and Members in Good Standing. To ensure you continue to receive your copy, please send your current contact details to fellows@ rcsi.com. RCSI Surgeons Scope is produced by Gloss Publications Ltd, The Courtyard, 40 Main Street, Blackrock, Co Dublin. Copyright Gloss Publications.

OUR HERITAGE RCSI’s mission is to educate, nurture and discover for the benefit of human health. Founded in 1784 with surgery at our core, we are an independent, not-for-profit, world leading international health sciences education and research institution, with a deep professional responsibility to enhance human health. SURGEONS SCOPE / 3

› News

Scope News COUNCIL ELECTIONS, CAMPUS MASTERPLAN, 44TH MILLIN LECTURE

WELCOME FROM THE FELLOWS AND MEMBERS OFFICE

A warm welcome to our Fellows, Members and Affiliate Members. We are delighted to bring you the first 2022 edition of the bi-annual Surgeons Scope magazine and some wonderful stories from our community of more than 10,000 Fellows and Members in 87 countries around the world. This edition marks an exciting time as we begin to plan in-person events again and to meet face to face. We report on the first in-person Charter Meeting in two years which was a real joy for everyone involved. We welcome our new President, Professor Laura Viani, and look forward to supporting her during her two-year office as she reaches out to our surgical community around the globe. In addition to Surgeons Scope, our monthly Surgical Bulletin newsletter is a great way to stay in touch and we would love to feature stories and innovations from you and your surgical community. We are very proud of our Fellows and Members whose outstanding skills, leadership and support inspire the next generation of surgeons. Our office wants to support you too, at every stage of your career, from training to examination, admittance and conferring, through to early career, later career and retirement. We continue to update the suite of membership benefits and to enrich the supports and resources available to you. If you are interested in contributing to our publications or in advocacy or mentoring opportunities we want to hear from you at fellows@rcsi.com (for further opportunities, see page 26). We encourage you to keep in touch and we look forward to staying connected. Catherine Jordan, Jenelle Sherlock & Paul O’Reilly, Fellows & Members Office

Catherine Jordan, Membership Manager

Paul O’Reilly, Development Finance Manager

Jenelle Sherlock, Engagement Marketing Executive

New guide for Ukrainian doctors coming to Ireland

RCSI has developed a guide for Ukrainian doctors coming to work in the public healthcare system in Ireland. Recognising the traumatic circumstances those who have been displaced have experienced, the document aims to provide important information to displaced Ukrainians to explore work and training opportunities within the Irish public health system. For displaced doctors with a particular interest in surgery, Affiliate Membership of RCSI is available free of charge for one year. For more information, contact fellows@rcsi.com.

THE NEXT PHASE OF THE CAMPUS MASTERPLAN

Architect’s drawing of 118 St Stephen’s Green.

Irish architects are at the cutting edge of a global third-level building boom, designing international award-winning campuses for leading universities across Europe, and soon the ﬁrst phase of RCSI’s new Medical Quarter campus – 118 St Stephen’s Green – due to open in 2025, will create the same dynamic synergy between town and gown in Dublin. Architects Henry J Lyons’ design for 118 St Stephen’s Green, between two protected structures, William Henry Lynn’s Unitarian Church, built in the Victorian Gothic style, and a pair of unique Georgian houses designed by architect Richard Castle in 1750, will combine facilities for the entire College – students, faculty and researchers – and will be fronted by a welcoming public outreach facility for civic engagement. “We are passionate about growing our city centre campus,” says RCSI CEO Professor Cathal Kelly. “RCSI is opening the campus to the people of Dublin who will be welcomed to a new public space aimed at equipping them to live healthier lives.”

“The College had the great foresight to buy the three office blocks of the Ardilaun Centre in the 1980s. They will eventually be redeveloped into a Medical Quarter extending as far as Cuffe Street,” says Professor Kelly. This landmark development will create a new front door for RCSI, and provide vital infrastructure for pioneering health sciences research and innovation. The form of the new building has largely been shaped by its context. Unlike the more formal Georgian squares in the city, St Stephen’s Green has a diverse character, peppered with buildings from the 18th, 19th and 20th centuries. There is a range of materials and styles present, with the overriding character of the streetscape being one made up of individual buildings rather than a continuous terrace. The west side of the Green has one other unusual feature: the buildings are not orthogonal to the pavement but are staggered in an angular arrangement that may be unique in Dublin.

› News

NATIONAL HEALTHCARE OUTCOMES CONFERENCE

RCSI President Professor Laura Viani and Vice President Professor Deborah McNamara

Council Elections 2022-2024 RCSI announced the election of Professor Laura Viani FRCSI (1987) as the new President of the College and Professor Deborah McNamara FRCSI (1997) as Vice President. For the ﬁrst time in RCSI’s history, a female President and female Vice President are taking up ofﬁce together. Professor Laura Viani, Consultant Otolaryngologist and Neurotologist at Beaumont Hospital and the Children’s University Hospital Temple Street, is Director and Professor of the National Cochlear Implant Programme and Hearing Research Centre and is founder of this national specialty. She replaces outgoing President, Professor P Ronan O’Connell. Professor Deborah McNamara, Consultant General and Colorectal surgeon at Beaumont Hospital, is co-lead of the National Clinical Programme in Surgery and as a national healthcare quality improvement leader. Professor Laura Viani said: “It is my great honour to be elected as President of RCSI. My presidency follows the global pandemic and HSE cyber-attack which have presented our surgical community with challenges that will shape the future of surgery for years to come. “With unprecedented numbers of patients having operations cancelled and on surgical waiting lists, it is critical that we secure the future of surgical services for our patients. Providing the highest standards of surgical training and fostering of surgical professional excellence is central to maintaining these vital services. “I look forward to working with our community of 10,000 Fellows and Members across 87 countries and sharing our expertise as we build a virtual network for continuing surgical education.”

Your new RCSI Council for 2022-2024 is:

President: Professor Laura Viani; Vice President: Professor Deborah McNamara; Council (in order of year of Fellowship): Mr James Geraghty; Professor Kevin Conlon; Mr David Moore; Professor K. Simon Cross; Professor Michael Kerin; Professor Thomas H Lynch; Ms Margaret O’Donnell; Professor Camilla Carroll; Mr Sean Johnston; Mr Paddy Kenny; Professor Kilian Walsh; Mr John Caird; Ms Bridget Egan; Mr Keith Synnott; Professor John Quinlan; Professor Paul Ridgway; Professor Ronan Cahill; Professor David Healy; Professor Calvin Coffey.

Understanding the impact of COVID-19 on population health and the health service was the focus of the recent National Healthcare Outcomes Conference. Hosted by the Healthcare Outcomes Research Centre (HORC) at RCSI University of Medicine and Health Sciences, the conference discussed the broad range of population health impacts and learnings arising from our responses to the pandemic. Dr Anders Tegnell, former State Epidemiologist in Sweden’s Public Health Agency, discussed the Swedish public health response to COVID-19; Dr Jerome Coffey, Chair of the National Cancer Registry, outlined the impact of the pandemic on cancer services; Professor Deborah McNamara, National Clinical Programmes in Surgery, addressed its impact on surgical services, and Professor Ciaran O’Boyle, Director, RCSI Centre for Positive Psychology and Health, discussed the pandemic’s impact on psychological wellbeing. Professor Jan Sorensen, Director

of HORC, said: “For more than two years, the highly contagious COVID-19 virus threatened our health and restricted our lives … Now, it is relevant to ask the question – did we take the right decisions or should we have done something else?” Professor Sorensen added: “We need to evaluate how effective the responses were to avoid illnesses and save lives. Such understanding will make us better prepared for future pandemics.”

“Such understanding will make us better prepared for future pandemics.” Established in 2016, the HORC is dedicated to the development and dissemination of evidence-based research on healthcare outcomes that informs healthcare policy and improves patient outcomes.

Launch of Moodle Portal for RCSI Affiliate Members RCSI Fellows and Members Office is delighted to launch a new Moodle Portal for Affiliate Members. RCSI Affiliate Members now have exclusive access to a range of ‘membersonly’ services aimed at supporting and supplementing their personal, practical, academic and professional development, including access to MRCS exam preparation resources including Surgiquiz, surgical anatomy guides and cutting-edge 360-degree videos; information about the pathway to surgery; opportunities to help grow their surgical career and develop their portfolio; access to surgical news and publications; online courses; and discounts on exam preparation materials. To find out more about RCSI Affiliate Membership and the online portal, visit rcsi.com/surgery/membership/affiliate-members The Fellows and Members Office is also working on developing an online portal for Fellows and Members, due to launch in 2023. If you have any recommendations for what you would like to see included on the Portal, please contact the Fellows Team by emailing fellows@rcsi.ie. SURGEONS SCOPE / 5

› News

THE 44TH MILLIN LECTURE

The 44th Millin Lecture was held at RCSI on Friday, 4 February as part of the 2022 Millin Meeting. The meeting was the ﬁrst live event to be held in RCSI since the campus closed in March 2020. The keynote Millin Lecture was delivered by Professor Joseph Butler FRCSI (2013). A graduate of the National Surgical Training Programme in Trauma & Orthopaedic Surgery at RCSI, Professor Butler is a consultant spine surgeon at the National Spinal Injuries Unit, Mater Misericordiae University Hospital and Mater Private Hospital. He is an active clinical and laboratory researcher, with over 130 publications and 160 presentations at national and international scientiﬁc meetings, and has been awarded over €4m in research funding. His lecture on ‘The Evolution of Spine Surgery: A Paradigm Shift to Precision Medicine’ provided an insightful overview of recent advances in precision surgery. The Millin Meeting programme also included a session from

the Faculty of Surgical Trainers’ Programme, looking at the successes and challenges of the new intercollegiate curriculum in surgery and how training committees and training programme directors can best be supported. Professor Mike Grifﬁn, President of RCS Edinburgh, addressed a symposium exploring the current status of colleagues in ‘non-training scheme’ surgical positions within the health service. A separate symposium provided perspectives for a career in global surgery and included a presentation by Mr Mike McKirdy, President of RCPS Glasgow. The Gerald O’Sullivan medal was awarded in an afternoon ceremony. The medal has been awarded every year since 2012 to the Fellow who graduates top of the class at the annual COSECSA (College of Surgeons of East, Central and Southern Africa) exams. It is named in honour of the former President of RCSI, Professor Gerald (Gerry) O’Sullivan. Professor O’Sullivan was

VIRTUAL FRACTURE ASSESSMENT CLINICS

A consultant-led virtual process now commonly used to manage fractures in patients is improving outcomes and providing a cost saving of over €22m to the health service, according to the National Clinical Programme for Trauma and Orthopaedic Surgery (NCPTOS).

Mr Paddy Kenny, RCSI Council Member and Fellow (1995), Dr Colm Henry, HSE Chief Clinical Ofﬁcer, Ms Sinead Boran, Consultant Orthopaedic Surgeon, National Clinical Advisor vFAC, Mr David Moore, RCSI Council Member and Fellow (1985).

Professor Joseph Butler

instrumental in setting up RCSI’s partnership with COSECSA in 2007, which aims to help train and retain surgeons in sub-Saharan Africa, and make better surgery accessible to more patients. The medal was awarded to Dr Fridah Bosire, a general surgeon in Nairobi and COSECSA graduate/ fellow with afﬁliation to the Pan African Academy of Christian Surgeons. Rounding off the programme, the Irish Surgical Training Group (ISTG) Meeting took place on Saturday, 5 February. ISTG is an independent

entity that represents trainees from all subspecialties and levels of surgical training. The meeting included the Bosco O’Mahony Lecture on ‘Finding your Tribe’, delivered by Professor Deborah McNamara, Consultant General & Colorectal Surgeon at Beaumont Hospital and Clinical Professor in Surgery at RCSI. Other sessions covered the PROGRESS Women in Surgery Fellowship and the potential impact of Slaintecare. Recordings of the Millin Meeting sessions are now available on RCSI’s YouTube channel.

From March 2020-October 2021, over 65,000 patients were assessed remotely through virtual fracture assessment clinics (vFACs). It was found that the majority (63%) of these patients were discharged, 36% required an onward referral and only 1% converted to surgery. Mr Paddy Kenny FRCSI (1995), Joint National Clinical Lead NCPTOS, at the recent virtual Fracture Assessment Clinic seminar held at RCSI highlighted the impact this service redesign has had on all 18 trauma sites where these clinics are now operational. He noted: “Virtual fracture assessment clinics were adopted early during the pandemic and are now part of clinical practice delivering safe, effective and efficient care to patients presenting with stable fractures. These clinics are multidisciplinary in nature and are led by a consultant orthopaedic surgeon.” In an opening address to a recent seminar on virtual fracture assessment clinics, Dr Colm Henry, HSE Chief Clinical Officer, said: “Remote consultations now constitute a significant way in which our services are delivered with the use of both video and audio enabled care, remote monitoring and online supports and therapies both in acute and community services. Both the HSE and the Department of Health recognise the value of this service redesign with its inclusion in the HSE National Service Plan 2022.” Led by Mr David Moore FRCSI (1985) and Mr Paddy Kenny as joint national clinical leads, the National Clinical Programme for Trauma and Orthopaedic Surgery is a joint RCSI and HSE initiative aimed at improving and standardising the quality of care, improving access for patients, and providing a framework for the HSE, hospital managers, clinicians and the multidisciplinary teams caring for trauma and orthopaedic patients. ■

› Charter Day

Back on Track THE RCSI 2022 CHARTER MEETING TOOK PLACE FROM 20-22 APRIL 2022, A MIXTURE OF HYBRID AND IN-PERSON EVENTS, CELEBRATING NOT ONLY THE GRANTING OF THE ROYAL CHARTER IN 1784 BUT A VERY EXCITING DAY FOR THE COLLEGE WITH THE RETURN OF IN PERSON EVENTS

Mr David Moore, Professor P Ronan O’Connell and Mr Roddy Doyle

lthough Charter Day was postponed from the usual February date in the hope that an in-person event could be facilitated, in the end its hybrid character delivered the best of both in-person and virtual. It was truly wonderful to feel the buzz created by the great number of Fellows, Members, Alumni and friends who gathered from around the globe in the Desmond Theatre – but also exciting to feel a real connection between participants and attendees online. The all-encompassing theme of Charter Week 2022, The Career of the Surgeon, set the tone for an ambitious and inspiring programme. “We come together both virtually and in person to consider and reflect on surgery as a career and life choice, as well as focusing on transformation and improvement of surgical care for patients, which is of course central to all we do,” said RCSI President Professor P Ronan O’Connell. Included in the packed programme were symposiums, lectures, the presentation of medals and awards and the conferring of four Honorary Fellowships to Professor Derek Alderson, Emeritus Professor of Surgery, University of Birmingham, UK Editor-in-Chief BJS Open, Past President of the Royal College of Surgeons of England (RCSEng); Professor Trevor McGill FRCSI, Department of Otolaryngology, Harvard Medical School, Boston Children’s Hospital, USA; Professor Stanley Goldberg, Clinical Professor of Surgery, University of Minnesota, USA; and Mr Roddy Doyle, novelist, dramatist and screenwriter. Their achievements were recognised at the very special Charter Dinner held in the College. Among the highlights was a new addition to proceedings from the Fellows and Members office with So You Want to be a Surgeon, hosted by Kevin Barry, Director of Surgical Training RCSI. The practical and inspirational

webinar was aimed at medical students and those considering a career in surgery. A symposium on The Late Career Surgeon inspired and entertained the audience in equal measure. Prompting conversations around how to retain the clinical Professor Frank Keane, Professor John Alverdy, Professor Eilis McGovern, Professor Laura Viani skills and expertise and Professor Peter Gillen gained during long careers and how to pivot to mentorship, training and education, there were contributions from three eminent surgeons. Professor Eilis McGovern FRCSI (1982) spoke of transitioning from clinical practice to management, a move, she says, that offered a rewarding prelude to ultimate retirement. Professor John Alverdy, approaching retirement, reflected on his career, on academic relevance and clinical obsolescence, encouraging the audience not to feel threatened and to celebrate the fact that the next generation of surgeons are embracing technology. Peter Gillen FRCSI (1983) delivered a wonderful and funny lecture, Hero to Zero and Beyond. One of his memorable quotes, “if you get to 60 in good shape, you’ll live another 20 years, plus three if you are female, a long time NOT to be a surgeon”. He urged all surgeons to resist going from Hero to Zero but to take a leaf out of Buzz Lightyear’s book and head for Infinity and Beyond! See over for Charter Week programme in detail. SURGEONS SCOPE / 7

› Charter Day

SYMPOSIUM 1: THE NEW SHAPE OF A SURGICAL CAREER Professor P Ronan O’Connell introduced Symposium 1: The New Shape of a Surgical Career, co-chaired by Professor Deborah McNamara, Council Member, RCSI, and Professor David Healy, Council Member, RCSI. Sessions included Less Than Full Time Training in UK Surgery from Professor Jackie Taylor, Past President RCPS, Glasgow; Surgical Workforce Planning in Ireland – Past, Present and Future Imperfect with Dr Brian Kinirons, Medical Director of the National Doctors Training and Planning Department; From Halstead to Present Time: Surgery in the USA from Dr Marco G Patti, MD Department of Surgery, University of Virginia, Virginia, USA and An Academic Surgical Career – Challenges, Opportunities and Rewards from Professor Aoife Lowery, Consultant Surgeon at Galway University Hospital and Associate Professor in the Discipline of Surgery, NUI Galway.

SYMPOSIUM II: SURGICAL INNOVATION

The theme of SYMPOSIUM II was Innovating Surgery into the 21st Century with Industry, co-chaired by Professor Ronan Cahill, Council Member, RCSI; Professor of Surgery, UCD Centre of Precision Surgery, UCD/Mater Misericordiae University Hospital and Professor H Paul Redmond, Council Member, RCSI, Professor and Chair of the Department of Surgery, Cork University Hospital and University College Cork. Dr Mark Slack, Chief Medical Officer, Cambridge Medical Robotics, Mr Rick Mangat, CEO, Traferox Technologies Inc. and Dr George Murgatroyd, General Manager & Vice President, Digital Surgery, Medtronic, all contributed.

SYMPOSIUM III: PLANNING FOR A MASS CASUALTY EVENT

Professor P Ronan O’Connell President, RCSI, introduced SYMPOSIUM III, themed Thinking About the Unthinkable; Planning for a Mass Casualty Incident, Co-Chaired by Mr Keith Synnott Council Member, RCSI, Consultant Orthopaedic and Spine Surgeon, National Spinal Injuries Unit, Mater Misericordiae University Hospital, Dublin; and Dr Mike O’Connor, National Clinical Advisor, Acute Operations. An Overview of the HSE Approach to a Mass Casualty Incident was deivered by Dr Ciaran Browne, National Emergency Planning Lead, Acute Hospital Operations, and The Plans and Role for Pre-Hospital Care in a Mass Casualty Incident by Dr David Menzies, Consultant in Emergency Medicine, St Vincent’s University Hospital. Dr Morgan P McMonagle, Vascular & Trauma Surgeon, University Hospital Waterford, spoke about The Plans and Role for Hospitals and Trauma Units in a Mass Casualty Incident and Dr Harald Veen of the WHO Academy gave an account of International Experiences Dealing with Mass Casualty Incidents and Assistance Available for Preparedness. The Good Samaritan App and its Potential Use in a Mass Casualty Incident was the subject of a contribution by Professor Mark Wilson of Imperial College Healthcare NHS Trust.

SYMPOSIUM IV: PUBLISH OR PERISH

Professor P Ronan O’Connell, President RCSI introduced the PRESIDENT’S SYMPOSIUM, with Publish or Perish – A View from On High by Professor Melina R Kibbe, MD, FACS, FAHA Dean, UVA School of Medicine, James Carroll Flippin Professor of Medical Science, Chief Health Affairs Officer, UVA Health; Editor in Chief, JAMA Surgery. Professor Kibbe’s research focus on developing novel therapies for patients with vascular disease. She has been continuously funded for her research since 2005 and her research was recognised by President Obama with a PECASE Award. Her bibliography includes more than 300 peerreviewed manuscripts, review articles, and book chapters. Clinically, Professor Kibbe has significant experience with both open and endovascular surgery. 8

Dr Ozanan Ricardo Meireles

Professor P Ronan O’Connell, Professor Melina R Kibbe, Professor Derek Alderson and Professor John Alverdy

SYMPOSIUM V: THE LATE CAREER SURGEON

The Symposium on the Later Career Surgeon was co-chaired by Professor Laura Viani, Vice President, RCSI and Professor Frank Keane, Past President, RCSI. Professor Eilis McGovern, Past President RCSI, spoke on From Surgeon to Manager – Reflections on a Late Career Choice, and The End-of-History Illusion and the Retiring Surgeon was the topic of a session by Professor John C Alverdy, University of Chicago, Pritzker School of Medicine. The title of the session by Professor Peter Gillen, Associate Professor of Surgery, RCSI, Hero to Zero and Beyond, promised a wry look the career of a surgeon and a personal perspective. The entertaining and thoughtful account from the Professor did not disappoint.

JOHNSON & JOHNSON LECTURE

The Johnson & Johnson lecture on Artificial Intelligence – the Next Surgical Revolution – was introduced by Professor Laura Viani, Vice President, RCSI and delivered by Dr Ozanan Ricardo Meireles, Director of the Surgical Artificial Intelligence Unit at Harvard Medical School. Dr Ozanan Meireles is a Bariatric, Foregut, and advanced Endoluminal Surgeon at the Massachusetts General Hospital, and an Assistant Professor of Surgery at Harvard Medical School. He is the co-founder and the director of the Surgical Artificial Intelligence and Innovation Laboratory (SAIIL) at the Massachusetts General Hospital. Dr Meireles has been practicing surgery at MGH for more than ten years, where he has been responsible for the introduction of new technologies and techniques, including Artificial Intelligence, Surgical Telementoring, and novel Laparoscopic and Endoluminal surgical procedures.

ABRAHAM COLLES LECTURE

The most prestigious lecture given at RCSI is The Abraham Colles Lecture, named for the eminent 18th-century surgeon and anatomist, Sir Abraham Colles. The 97th Abraham Colles Lecture, Introduced by Professor P Ronan O’Connell, President RCSI, was given by Professor John Alverdy, MD FACS, Sarah and Harold Lincoln Thompson Professor, Executive Vice Chair, Department of Surgery, University of Chicago, Pritzker School of Medicine. Professor Alverdy has been continuously ROI funded by the NIH for over 20 years and has trained over 100 undergraduate students, graduate students, medical students and surgical research fellows in his laboratory. He studies the molecular pathogenesis of infection-related surgical complications such as sepsis, surgical site infections and anastomotic leak. He is past president of the Surgical Infection Society, past recipient of the Ravdin lectureship and Surgical Forum dedication from the American College of Surgery and recipient of the Flance-Karl Award from the American Surgical Association. He is co-founder and chief scientific officer of Covira Surgica, which develops non-antibiotic polymer based anti-infective compounds to combat postoperative infection. Professor Alverdy has an active practice

› Charter Day

RCSI WELCOMES UN DEPUTY SECRETARY-GENERAL TO DELIVER THE 44TH CARMICHAEL LECTURE

Ms Amina J Mohammed, Deputy Secretary-General of the United Nations

Transforming Education to Transform our World by 2030 was the theme of this year’s Carmichael Lecture on 13 February. Ms Amina J Mohammed, Deputy Secretary-General of the UN thanked RCSI for the honour and spoke with passion of being afforded the rare opportunity to speak about hope because “The hard truth is that our world is in deep trouble and facing tremendous challenges on so many fronts. The COVID-19 pandemic caused massive disruption fuelled by unacceptable levels of vaccine inequity and an international financial system that is failing to support many of the countries that need it so desperately.” She said “We are moving closer and closer to climate catastrophe as governments and businesses drag their heels despite all of the evidence, all of the support from young people and all of the technological developments.” Ms Mohammed highlighted the role of the UN to “close the gap” between reality and aspirations, and spoke of hope as “our most precious commodity”. “Now is the time to shift from crisis to recovery, from conventional to transformational, to have the courage to know that it will take time and it will not be a quick fix. Let us try to imagine a transformed education, that I believe is possible within our lifetimes. Imagine classrooms around the world where the individuality and wellbeing of each child is prized,” said Ms Mohammed. “The time is right for a massive transformation, a rebirth of education

worldwide, that will in turn transform the world. But no single country has the knowledge or research capacity to advance this alone. The global pandemic has taught us that. It’s taught us that we needed solidarity and a global response but it has bared the reality that, when we needed it most, we didn’t get it. And so, we have to learn from that as we take on education.” As she concluded her lecture she reflected on the key elements to the reform of education. She quoted Kofi Annan, ‘Education is a human right with immense power to transform. On its foundation rests the cornerstone of freedom, democracy and sustainable human development’ and called on people to acknowledge their own responsibility. “Today, friends, ladies and gentlemen, each and everyone one of us, individually and collectively, have a responsibility to fight for that because it will affect us. It might not be today but it will be tomorrow and it is in our interest to guard the global family… and take the opportunity to create the education systems we will all need to shape a more just and sustainable world.” Ms Mohammed was also awarded an Honorary Fellowship. Presenting Ms Mohammed for the Fellowship, RCSI Council member Ms Bridget Egan said: “RCSI is very grateful to you for taking the time to join us as we emerge from the pandemic, during which we maintained our undergraduate and post graduate training in surgery, medicine and health sciences.“Our education in the SDG 3 domain, Good Health and Wellbeing, is recognised by the Times Higher University Rankings as among the best in the world, but there is no time for complacency. As former Irish President Mary Robinson, now Chair of the Elders, said in this auditorium, the clock is at one minute to midnight, and we have very little time to stop it ticking.”

involving minimally invasive/robotic surgery of esophagus, stomach and pancreatobiliary tree. As Professor O’Connell, President RCSI observed, the topic of the 97th Abraham Colles Lecture would be one of profound interest to all surgeons, not only those involved in abdominal surgery.

PRESENTATION OF MEDALS & AWARDS

The presentation of Medals and Awards was introduced by Professor Laura Viani, Vice President, RCSI and presented by Professor P Ronan O’Connell, President, RCSI.

RCSI COLLES TRAVELLING FELLOWSHIP IN SURGERY

The RCSI Colles Travelling Fellowship in Surgery is offered by the College to promote the acquisition of additional surgical skills and knowledge that will contribute to advancement of surgical science and practice in Ireland. The 2022 recipient is Michael Eamon Kelly, who also received the Colles Medal. The Fellowship will assist towards his Clinical and Research Fellowship in Advanced Colorectal Malignancy including Pelvic Exenterative and Peritonectomy Techniques (Including Robotics) in the Peter Mac Callum Hospital, Melbourne, Australia.

RCSI TRAVELLING GRANT

• Awarded to Ms Christina Fleming towards her International Fellowship in Robotic Colorectal Surgery and Complex Cancer (Pelvicare and GRECCAR), in Centre Hospitalier Universitaire de Bordeaux, France • Awarded to Mr Adam Daly towards his Fellowship in Advanced Aortic Surgery, in Cleveland Clinic, Ohio, USA • Awarded to Mr Michael Boland towards his Training Interface Group Fellowship – Oncoplastic Breast Surgery, in Dept of Breast Surgery, Imperial College Healthcare Trust, London. • Awarded to Mr Usman Haroon towards his Senior Clinical Fellowship in Renal and Transplant Surgery, in Guys and St Thomas NHS Trust encompassing Evelina and Great Ormond Street Children’s Hospital London • Awarded to Ms Christina Buckley towards her Microsurgical Reconstructive Fellowship, in Health Sciences Centre, University of Manitoba, Canada.

PROFESSOR WAL MACGOWAN MEDAL 2021

This is an award to recognise the highest-performing candidate in the Intercollegiate Specialty examination across all specialties from the RCSI Training Scheme. The 2021 recipient is Ronan Kelly.

RCSI PROGRESS WOMEN IN SURGERY FELLOWSHIP, SUPPORTED BY OLYMPUS MEDICAL

The College has been at the forefront in developing transparent selection future surgeons. Evidence shows that gender diversity within organisations results in better decision making. In 2017 RCSI published a comprehensive report PROGRESS: Promoting Gender Equality in Surgery, which made recommendations to ensure that Surgery as a profession is an attractive and practical career for both men and women. The RCSI PROGRESS Women in Surgery (WiS) Fellowship, funded by Olympus Medical through an educational grant, is a prestigious bursary awarded to promote female participation in surgical training at fellowship level. The 2022 WiS is awarded to Ms Christina Fleming, together with the RCSI PROGRESS Fellowship Medal. The funding will assist towards the cost of her Fellowship, at Centre Hospitalier Universitaire de Bordeaux, France. ■ SURGEONS SCOPE / 9

› Calendar

Dates for your Diary IMPORTANT DATES FOR YOUR CALENDAR

2022 Details >

Monthly

Monthly National Neurotrauma Webinar

Virtual

Free

04 July 2022

RCSI Fellows, Members and Diplomates Conferring Ceremony

Virtual

RCSI Dublin / Invitation only

07 July 2022

Trainee Forum/Induction - CST

Virtual

Free, Limited to CST Trainees

11 July 2022

Enrolment of Continuous Professional Development Support Scheme opens for NCHDs

Virtual

Free

18-20 August 2022

The Alumni Gathering 2022

RCSI Dublin

Cost Associated

19 August 2022

Launch of the CPD Brochure

Virtual

Free

30-31 August 2022

MRCS Part B (OSCE) Prep Course

RCSI Dublin

€615, Limited Capacity

2-3 September 2022

Sir Peter Freyer Memorial Lecture and Surgical Symposium

NUI Galway

Paid event, Registration now open

13 September 2022

MRCS Part A Examination

Worldwide

€645, Registration now open

15-16 September 2022

Care of the Critically Ill Surgical Patient Course

RCSI Dublin

Paid Event, Registration Closed

21 September 2022

Surgical Matters Webinar

Virtual

Free

22 September 2022

Beaumont RCSI Cancer Conference

RCSI ERC, Beaumont Hospital

Free

23 September 2022

Human Factors in Patient Safety Academy Open Symposium for RCSI Dublin Alumni of the PGDip/MSc in Human Factors in Patient Safety

23-24 September 2022

Irish Society of Urology Annual Meeting

Killashee Hotel, Kildare

Paid Event, Registration now open

4-5 October 2022

MRCS Part B (OSCE) Examination

RCSI Dublin

€1125, Registration now open

5 October 2022

Global Surgery Grand Rounds

Virtual

Free

14-15 October 2022

Advanced Trauma Life Support (ATLS) European Association Conference

RCSI Dublin

Invitation only; Paid Event, Registration not yet open

16-20 October 2022

American College of Surgeons (ACS) Clinical Congress 2022

San Diego, USA

Paid Event, Registration not yet open

2 November 2022

Global Surgery Grand Rounds

Virtual

Free

16 November 2022

Surgical Matters Webinar

Virtual

Free

16-17 November 2022

Basic Surgical Skills

RCSI Dublin

Paid Event, Registration not yet open

17-20 November 2022

The Global Alliance for Surgical, Obstetric, Trauma and RCSI Dublin Anaesthesia Care (G4 Alliance) 12th Permanent Council Meeting

Paid Event, Registration not yet open

5 December 2022

RCSI Fellows, Members and Diplomates Conferring Ceremony

RCSI Dublin

Free for Eligible Candidates

8-9 December 2022

Advanced Trauma Life Support Provider Course

Radisson Blu Hotel, Dublin 8

Paid Event, Registration not yet open

2023

Registration Required; free to Surgical Trainees, HF PGDip/MSc Scholars; everyone else charged €40

30 January to 3 February 2023

RCSI Charter Week 2023 (including the Millin Lecture)

RCSI Dublin

Paid Event, Registration not yet open

3 July 2023

RCSI Fellows, Members and Diplomates Conferring Ceremony

RCSI Dublin

Free for Eligible Candidates

4 December 2023

RCSI Fellows, Members and Diplomates Conferring Ceremony

RCSI Dublin

Free for Eligible Candidates

Please note the above event dates were correct at the time of printing and may be subject to change 10

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› Surgeons’ Hobbies

Keeping Burnout at Bay IT’S BEEN PROVEN THAT HOBBIES CAN HELP SURGEONS COPE WITH STRESS AND BUILD PHYSICAL AND MENTAL RESILIENCE. WE TALK TO SURGEONS FOR WHOM A HOBBY IS A LIFELINE

FLYING HIGH Professor Ciaran Bolger FRCSI (1991)

ROCK STAR Professor Austin Leahy FRCSI (1981) RACING DEMONN Professor John RT Monson FRCSI (1983)

EXTREME ENDURANCE Ms Shirley Potter FRCSI (2015)

LANDSCAPE PHOTOGRAPHY ‘Poolbeg Full Moon’ by Mr Paul O’Brien FRCSI (2000)

› Surgeons’ Hobbies

fter what has been an undeniably tough couple of years for everyone, but particularly for those on the frontline, the topics of stress and wellness as they relate to healthcare professionals have never been more topical. Last year, the Irish Journal of Medical Science reported on an IMO survey of doctor wellbeing in Ireland revealing 70% of doctors are at risk of burnout. Mindfulness and yoga are often recommended as useful antidotes. Ms Shirley Potter, Consultant Plastic and Reconstructive Surgeon, MMUH, Associate Clinical Professor at UCD, switches off with long distance endurance running. She’s participated in ultramarathons ranging in length between 50-250km and also competes in road cycling and open water swimming events. Some of the events in which she’s taken part are the 250km Sahara Desert Race, the Zurich Ironman (3.9km swim, 180km cycle, 42.2km run), the 100km Blue Mountains Race in NSW, Australia, and the 250 km Gobi Desert Race. “In my view,” says Ms Potter, “it is essential for a surgeon to have hobbies. Endurance running has allowed me to build both physical and mental stamina, and resilience, which are important abilities I transfer to my work life as a surgeon. My hobbies give me an enormous sense of achievement, not just the training beforehand but the challenge to complete long distance endurance events, going through tough physical and psychological conditions. “The ability to keep going in spite of extreme physical and mental fatigue, in order to achieve a final goal, has helped me to combat burnout. Running for me is the ultimate escape from stress, it allows me to unwind and clear my head. I’ve never not felt good after exercise. I have met great friends through these activities and have visited amazing, often untouched, places around the world.” Burnout is defined as a psychological condition that emerges from prolonged response to chronic stressors in the workplace. It is characterised by overwhelming exhaustion and depersonalisation, and often results in reduced productivity or capability, low morale and inability to cope. Recognising that burnout is a real and tangible risk, one that could have devastating consequences for patients, impact negatively on relationships with colleagues, and also have serious career-limiting consequences is something of which all surgeons need to be aware. And rather than dismissing burnout as something that happens to others, each surgeon needs to evaluate and acknowledge their personal susceptibility and triggers, and develop an individual strategy to keep it at bay. Of course it’s not only surgeons who are at risk of burnout. People at every level of seniority in every field are susceptible, but when burnout affects those who are expected to perform at the very highest level day in, day out, those whose decisions and actions impact upon the lives of others, it can’t be ignored.

“It allows me to have time to myself and to put everyday stress into perspective.” Shirley Potter

Research backs up Ms Potter’s conviction that hobbies can help. Writing in Forbes, Bob Bennett of EngageSmart, references a study in the Annals of Behavioural Medicine confirming that hobbies can help reduce or prevent burnout by giving us a chance to take a break from everything else in our lives. “Having a [hobby] can actually add years to your brain’s life,” says Bennett, citing another study from Aging showing the best way to improve brain plasticity is to “practice new tasks intensively”. So getting to grips with a new language or learning a new stitch in knitting is proven to keep your brain sharper for longer. Rates of depression also tend to be lower in those who have hobbies. “This may be because they allow us to feel a sense of accomplishment,” writes Bennett. I know that when I was first able to coax a few bars of The White Stripes’ ‘Seven Nation Army’ out of my guitar, I felt a sense of pride that differed from the pride I feel at work.” Golf, tennis and cycling are three of the most popular de-stressors, but others find slower-paced pursuits such as cooking and baking, gardening, playing a musical instrument and singing in a choir work best for them. For a hobby to be an antidote to burnout, it needs to help you disconnect from work, be enjoyable and help you feel good. It helps if it also involves mastery S U R G E O N S S C O P E / 13

› Surgeons’ Hobbies

CaptionRocking It: Professor Ciaran Bolger

“Hobbies add to my overall positivity.” Ciaran Bolger

and gives you a sense of achievement and control. Winston Churchill painted in his spare time, and many believe his hobby made him a more effective leader, thanks to the improved powers of observation and memory the hobby brought him. Churchill himself drew parallels between the role of a general in battle and a painter. Around the world, surgeons have hobbies as diverse as one might expect from a cohort of high-achieving mavericks. There are surgeons who practise aerial silks – a Cirque du Soleil type of acrobatics – and others who keep bees. Surgeon Harold E Chung-Loy, practising in New Jersey, owns a farm in his native Jamaica where he grows Blue Mountain coffee beans and has set up a roastery near home back in the US. Max Emory Lake, an Australian surgeon, Australia’s first specialist hand

‘Upper Boat Lake’, photograph by Mr Paul O’Brien.

surgeon, who died in 2009, was regarded as the founder of the Australian boutique wine industry, running his Lakes Folly winery in the Hunter Valley on his weekends off. He also wrote books on wine, food and surgery and inspired a cohort of surgeons in Australia to get involved in vineyards. While the Irish climate may not lend itself so well to wine-making, there is rarely a television cooking competition that doesn’t feature a medic as a competitive baker or cook. The precision involved in producing intricate dishes and complex bakes chimes well with the surgeon’s skill set. While Ms Potter’s hobby is all about endurance and stamina, hobbies don’t have to be as physically challenging as hers to be beneficial. Research shows that the key thing is that the hobby absorbs you and requires your full attention. Professor Ciaran Bolger, Consultant Neurologist at Beaumont Hospital, holds a private pilot’s licence, flies regularly and says that outside of medicine his major interest is flying. When he was President of Eurospine, he put his twin-engine Beech Baron to good use, flying it around Europe at 25,000 feet between meetings. “By doing something totally different to my work, but that also involves challenge, I get a break from routine and the everyday stress of work,” he explains. “It’s important to have a diversion, to operate in a different space – an escape.” Professor Bolger revealed in a recent interview with Irish comedian and TV show host Tommy Tiernan that he also fronts a rock band and has an XBox on which he plays games. He reckons this is good for hand-eye coordination and mental stimulation. Mr Paul O’Brien, consultant ophthalmic surgeon, Blackrock Clinic, believes it’s important to have several hobbies outside of work.

“Getting out in the wonderful Irish landscape never fails to re-energise me after a busy week at work.” Paul O’Brien

Mr Paul O’Brien

› Surgeons’ Hobbies

Professor John RT Monson

“It’s a break, it doesn’t care about daily worries and doesn’t care how important you might think you are. Especially when racing, your professional reputation doesn’t matter – the other drivers will likely be better and much younger!!”

On The Grid: John RT Monson

“I like to have some that involve physical activity such as cycling or walking, some sporting such as golf and others that can also be continued into latter years of life.” O’Brien’s hobby of landscape photography falls into this latter category and he believes it makes him less susceptible to fatigue. “Getting out in the wonderful Irish landscape never fails to re-energise me after a busy week at work,” he says. “Even if photographic conditions prove less dramatic than expected, the fresh air and experiencing sunrise sets me up well for the day and week ahead. There is a certain satisfaction in catching epic light and the perfect shot. I hear sea swimmers extolling similar virtues of a sunrise swim.” And while photography may appear to be a solitary hobby, Mr O’Brien says it doesn’t have to be that way. “I regularly chat with other photographers whenever I go out early for sunrise. It also helps to grab an early coffee on the way back home. Devotion to work is important but it is even more important to have interests outside of work. After all, when retirement beckons around 65, it’s really important to have something to spur you on to get up every morning with a purpose and the prospect of some social interaction to boot. “I am always trying to land the epic photo. This rarely happens and so a future trip always beckons, a bit like the fisherman waiting for that one big catch. Unlike golf, I never return home after a sunrise photo outing feeling battered and dejected. I forget about the stresses of work whilst out walking to a landscape location and searching for a unique photographic composition. There is the challenge of producing something different as well as technically proficient.” Colorectal surgeon, Professor John RT Monson MD FRCSI, Chair, Digestive Health and Surgery Institute, AdventHealth Central Florida, has had a lifelong interest in motorsports. As a young man he raced motorbikes, latterly it’s been vintage cars. He also collects classic road cars and races other cars when possible. “I am certain hobbies matter,” says Professor Monson. “Some surgeons say ‘my work is my hobby’ but I personally believe that is a slight cop-out. There is a life after surgery and we also don’t know when that might be. I have raced in countries around the world and met many fascinating and wonderful friends.

Having hobbies makes for a more rounded approach to life. It’s a total break from work because driving at John RT Monson 175mph doesn’t permit any focus on work! Several times over the years, colleagues have told me I need to go and race cars for a weekend because I was grumpy!” If the adrenalin rush of racing does not appeal, there’s a different kind of rush to be gained from performing in a blues band, the hobby of Professor Austin Leahy, retired consultant vascular surgeon at the Beacon and Bon Secours hospitals. He says that rock and roll, in all its forms – from avid fan to lead singer with the Transformation Blues Band, to releasing music and performing under his own name – was a lifeline during a stressful career. “Having some creative outlet certainly served as an energiser and stress buster, even if it was sometimes physically

“Surgeons are thought to be primadonnas, but they are way easier to organise than a group of musicians.” Professor Austin Leahy

Austin Leahy

exhausting and emotionally demanding,” he says. “Writing, composing poetry or painting are the acceptable outlets of professionals. Writing, performing or recording rock music proved difficult for some of my colleagues to accept, but it is an excellent way to express emotions and vent. Music is creative, expressive, and rewarding. Surgeons are thought to be primadonnas, but they are way easier to organise than a group of musicians. Was all the effort worth it? Was it more exhausting for me or the listener? You can decide by listening to ‘Austin Leahy’ on Spotify.” ■ S U R G E O N S S C O P E / 15

› Schwartz Rounds

It’s My Round WITH EVIDENCE POINTING TO IMPROVED WELLBEING AND RELATIONSHIPS WITH COLLEAGUES, AND WITH MORE EMPATHIC AND COMPASSIONATE PATIENT CARE, SCHWARTZ ROUNDS ARE A KEY STEP IN ACKNOWLEDGING THE EMOTIONAL IMPACT OF WORKING IN HEALTHCARE

› Schwartz Rounds

chwartz Center Rounds, frequently abbreviated to Rounds, offer a safe, reflective space for staff to share stories with their peers about their work and its impact on them. In 2015, the HSE collaborated with the UK Point of Care Foundation to secure a national license to roll out Schwartz Rounds in hospitals and healthcare organisations throughout the country. These organisation-wide forums, which are open to all staff (clinical and non-clinical) to consider emotional, social or ethical challenges through sharing, in a safe environment, their experiences of caring for patients and families, are intended to help improve staff wellbeing, effectiveness of communication and engagement, and, ultimately, patient care. They are unique in that, unlike other supports for staff, they do not seek to solve problems or look for outcomes. Attendance at Schwartz Rounds is associated with a statistically significant improvement in staff psychological wellbeing. Reported outcomes included increased empathy and compassion for patients and colleagues and positive changes in practice. Schwartz Center Rounds® (or Rounds), were developed by the Schwartz Center for Compassionate Healthcare, in Boston USA in 1995. They are named after Kenneth Schwartz, a patient in whose memory the Schwartz Center for Compassionate Healthcare (a non-profit organisation) was established and are widely adopted in the USA and in the UK. In Ireland, the HSE conducted its own test of concept in University Hospital Galway and the Our Lady’s Hospice and Care Centre at Blackrock and commissioned an independent evaluation with Trinity College Dublin. Recommendations from this and international studies have informed the practice of Schwartz Rounds here. A memo of understanding has been agreed with 26 healthcare organisations around the country and the HSE is committed to rolling it out to many more. They are keen to hear from surgeons interested in the introduction of Rounds within their organisation. According to Dr Maureen Flynn, Director of Nursing, HSE Quality and Patient Safety Directorate, QPS Connect Team Lead, the protocols developed in Schwartz Rounds are carefully constructed for participants as a source of support. They are designed as an opportunity to reflect and, with peer sharing, to normalise the emotional impacts of providing care. “Everyone is invited, food is provided – it is about caring for the whole person,” she says. “Once the doors have closed, it’s a private, supportive space and an opportunity for participants to appreciate more about their colleagues, understand their perspectives and motivations and engage in multidisciplinary peer reflection.” Dr Flynn explains that among the motivations to be involved include coming together around a theme (a joyous or difficult situation) or wanting others to learn from their experience. “Panel preparation is important in shaping the stories and helping panellists feel ‘safe’ to tell their story. The facilitator’s role is important in providing support, guiding the audience conversation sparked by listening to the panellists stories and ensuring that the experience feels safe.” Almost three years ago, colorectal surgeon Ms Aisling Hogan FRCSI was approached to be a panellist on a Schwartz Round at Galway University Hospital. In terms of experiences in a hospital setting, she remembers it

A GUIDE TO SCHWARTZ ROUNDS SCHWARTZ ROUNDS Schwartz Center Rounds® (Rounds) were developed to support healthcare staff to deliver compassionate care by helping them to reflect on their work. ROUNDS CLINICAL LEAD Typically a senior doctor or nurse, an individual who works closely with the facilitator and undertakes a skilled co-facilitation role (responsibilities include helping to find cases/panellists, cofacilitation and championing Rounds). ROUNDS FACILITATOR A person responsible for leading and coordinating the preparation and conduct of Rounds (responsibilities include panel preparation, ensuring safety and confidentiality, opening up reflective discussion, ensuring Rounds fidelity, and managing challenges and uncertainty). ROUNDS ADMINISTRATOR A person who works closely with the facilitator, clinical lead and steering group to enable the efficient running of rounds. For example, booking rooms and organising lunch, promoting the Rounds, co-ordinating steering group meetings, getting the paperwork ready for each Round, sign-in sheets, confidentiality agreement, feedback etc. ROUNDS MENTOR A person experienced in Rounds (usually a facilitator) who supports new facilitators, clinical leads and steering groups in the development and consolidation of the skills required to run high-quality Rounds (e.g. by observing/debriefing, and providing off-site support via e-mail and telephone). ROUNDS STEERING GROUP A group comprising staff from varied clinical and non-clinical disciplines and representing different levels of seniority (e.g. board members, junior nurses/doctors, porters, human resources managers, and marketing/communication professionals). Responsibilities include raising the profile of Rounds, sharing ownership, helping to find cases/panellists, supporting the clinical lead and facilitator, and debriefing Rounds). SCHWARTZ-SAVVY A term referring to Rounds attenders who really understand the purpose of Rounds, know and follow the explicit and implicit rules of how to contribute appropriately, and support each other in a non-judgemental way.

S U R G E O N S S C O P E / 17

› Schwartz Rounds

Dr Maureen Flynn

Professor Eva Doherty

“The principal aim is emotional support – the acknowledgment that there is an emotional burden carried by workers in all aspects of healthcare.” Dr Maureen Flynn felt entirely foreign: “It was at odds with what we are trained to do and in stark contrast to our everyday life. But, it was extremely powerful,” she says. “Perhaps the most extraordinary aspect was the flattening of the hierarchy. Everyone listened, no one’s story was worth more than anyone else’s.” She still recalls the very special atmosphere created during the Schwartz Round: “There was a deeply respectful, almost spiritual feeling in the room.” It has had a lasting impact. “People all over the hospital nod and wave at me, people who I don’t normally encounter in the course of my work but who learned that day that I am, like them, just human with all the flaws, doubts and feelings we all share.” Ms Hogan recognises it may be more challenging to get surgeons involved than other disciplines. “It’s the nature of our job, the life-changing conversations we have daily, the immediacy and gravity of decisions that have to be made all the time that require surgeons to maintain a certain distance and to appear tough. It doesn’t come naturally to surgeons to open up to a wider audience or to invite feelings of vulnerability,“ she says. “As surgeons, we have our own ways of protecting ourselves,” continues Ms Hogan. “We are very close colleagues, a tight-knit group, so when a safety valve is needed, our colleagues are there. It is our names over the patients’ beds; our patients need to believe that we are confident, totally in control – it’s not helpful for a patient to believe their surgeon has doubts or feelings of uncertainty.” Are female surgeons even more wary of demonstrating their softer, perhaps more vulnerable side? “Yes, this is particularly pertinent for female surgeons who are in the vast minority of surgeons,” says Ms Hogan. The break from the mania of hospital life provided by the Schwartz 18

Ms Aisling Hogan

Round was in itself enlightening. “The CEO of the hospital was there, the cleaners and porters, the doctors and nurses. Thanks to the skill of the facilitators, all differences evaporated in the room. The focus was on understanding, learning and empathising,” says Ms Hogan. From an RCSI perspective, the concept of multidisciplinary “rounds” or gatherings that provide emotional support for surgeons has long been of particular interest to Professor Eva Doherty, Director of Human Factors in Patient Safety at RCSI. “Rounds provide a forum for healthcare staff to come together to explore the non-clinical aspects of caring for patients – the psychological, social and emotional challenges. They are a highly structured facilitated space where a panel of staff speak openly about personal experiences of vulnerability and doubt, loss and fear, as well as joy and pride in their role and work,” says Professor Doherty. “Schwartz Rounds are an effective way of breaking down hierarchies and barriers,” says Dr Flynn. “The principal aim is emotional support – the acknowledgment that there is an emotional burden carried by workers in all aspects of healthcare, and in all disciplines, from the cleaner, the financial controller, the porter, the ambulance driver to nurses, doctors and surgeons, is very powerful. Nobody is immune to feeling that emotional impact from their work, and everyone benefits from support from their peers.” For Rounds to succeed, stories must be selected wisely to reflect both individual experiences and universal themes. A Schwartz Round steering group oversees and guides the identification of the theme for each Round. The confidential structured space, created by Schwartz Rounds, showcases the complexity of being a surgeon in high-pressured healthcare systems today and promotes a shared understanding that everyone struggles and that while working in healthcare is rich and meaningful, it requires containment and self-compassion to survive and sustain oneself over time. FURTHER INFORMATION • Surgeons interested in how their own organisations can become involved in Schwartz Rounds should contact Caroline Lennon Nally, HSE Schwartz Rounds Coordinator, caroline.lennonnally@hse.ie. • Further information on the HSE National Quality and Patient Safety Directorate Schwartz Rounds programme can be found at www.hse.ie/eng/ about/who/nqpsd/qps-connect/schwartz-rounds/schwartz-rounds.html. ■

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› A Surgeon in…

A Surgeon in…Dublin MS TAFADZWA MANDIWANZA, CONSULTANT PAEDIATRIC NEUROSURGEON, TEMPLE STREET HOSPITAL, ON LIVING AND WORKING IN THE CAPITAL s Tafadzwa By the time Taffy returned for Mandiwanza college, the city was already home to – known to more immigrants and felt more diverse. everyone as Taffy She enjoyed her studies and got along – was born and well with her classmates. She hardly left raised in Harare, the city during that time, aside from the capital of a couple of short visits to Dublin and Zimbabwe. The trips home. eldest of three children, she says the “Cork was everything,” she says. idea of wanting to work in healthcare After graduating, Taffy did her first came from watching her mother, six months as an intern in Limerick, Francisca, a nurse, at work. before returning to Cork. “My dad, Antony, is in dairy “I loved Limerick and the hospital processing,” she says, “in fact he’s there,” she says, “and was very inspired retiring soon. He is very businessby the surgeons. When I applied for the minded but I don’t have the head for BST, my first choice was the job with six business so I wasn’t tempted to go down months in neurosurgery in Cork and that track.” the rest in Limerick. At that point As a child Taffy says she was I was convinced I wanted to be a obsessed with the books of Enid Blyton, vascular surgeon. particularly the Malory Towers series. “I remember finishing up on a Friday “I really wanted to go to boarding as a dermatology intern in Cork South Ms Tafadzwa Mandiwanza, MB BCH BAO, FRCSI school,” she remembers. “My two Infirmary and on the Saturday at 8 younger brothers were allowed but o’clock in the morning I was the SHO in I wasn’t. And so I said that when it came to my time for university, I was neurosurgery in CUH on call for the weekend! My goodness, I don’t know how definitely going to go away and not live at home.” I did it. I was lucky enough to have a fantastic registrar, Martin Murphy FRCSI Taffy applied to universities in South Africa, but at the time places in (now working in Dublin) that weekend and I was terrified. What did I know Medicine were not open to students coming from another Southern African about neurosurgery? I thought neurosurgeons were scary people who shouted state that had its own medical school. all the time. “My dad had Irish friends in UCC who used to send postgraduate students “I think that weekend Martin had me in theatre for a chronic subdural over to him in Zimbabwe and he had been back and forth a few times and he haematoma and I got to drill a hole in a skull (burr hole) for the first time and thought it was a great place,” she says. “Because he had friends there who could it was amazing. At CUH I worked with Charlie Marks, George Kaar FRCSI act in loco parentis he felt safe sending his young daughter there to study. I and Michael O’Sullivan FRCSI. It was an amazing job. As a SHO you don’t of course had never heard of Cork and the sum total of my knowledge about always get the chance to go into surgery but they had me in theatre learning Ireland was that Mary Robinson had been President and I thought having a how to suture, open the abdomen for shunts and so on. I thought it was female president was amazing. I visited initially for a few weeks in the summer brilliant. At the time, the other specialty I thought I might be interested in was of 1997 and returned in 2000 after my A Levels at home in Zimbabwe to enrol cardiothoracic – I had romanticised it from a young age. There was a Sydney in the School of Medicine at UCC.” Sheldon novel with a female cardiothoracic surgeon as the main character and Back in 1997, Taffy says she often felt as if she was the only black person I wanted to be like that. But in Cork I was hanging out with the cardiothoracic walking down the street. SHO and he was overworked and exhausted and didn’t get to do much else, and “It was obviously very different from a diversity point of view to the way it I thought: No, Neurosurgery is way cooler! was at home,” she says. “That summer I became obsessed with The Corrs – I “Back in Limerick for the next 18 months, I worked mainly in A&E, absolutely loved their music, and someone took me to see the Michael Collins Urology and Colorectal, which gave me a good grounding, but I was drawn movie and I learned about some of the history and the pride in Cork as the back to Neurosurgery.” ‘real’ capital. Everyone was lovely to me and I had a great time.” After completing the BST, Taffy had her first child, Zoe, in 2008 and, on 20

› A Surgeon in…

returning from maternity leave, took standalone SHO jobs in Limerick (Colorectal) and Cork (Neurosurgery). “That cemented what I wanted to do,” she says, “but getting on the higher training programme was slow and hard for me. I had my second daughter, Bella, in 2010, and then I interviewed for an SHO job at Beaumont. They asked me to come on as a reg, which was a huge jump for me. During 2011, I worked in Beaumont and Temple Street, and had my son Matthew in 2012. When I came back from maternity leave it was to a research job in Temple Street. I had a few publications, which helped with applying for Higher Surgical Training. I finally got on in 2014; it took a lot of patience!” Taffy acknowledges the challenges of balancing the needs of three young children with her career goals and those of her husband, Rebabonye Pharithi, a cardiology fellow, who she met when he was attending medical school in UCG at the same time she was studying in Cork. “For a lot of the time I was in Limerick he was in Galway and Sligo. When he came to Limerick we were together for six months before I went to Cork with the kids. Then he went to Dublin and I was in Cork. It was only around 2011 we were finally together in Dublin and lived in the same house for a sustained period of time and got to know each other properly!” Taffy trained in Beaumont, Cork and at Temple Street, and completed her training in July 2020. Later that year she went to Great Ormond Street Hospital (GOSH) for fellowship. “My husband pushed for the whole family to go to London for the year,” says Taffy, “and he got a cardiology fellowship in London too. I was worried we were disrupting the kids’ lives too much, but it was the best thing for us as a family, as travel would have been hard during COVID-19. The kids loved London and blossomed there.” Taffy interviewed for her current position as Consultant Paediatric Neurosurgeon at Temple Street in October 2021 and took up her appointment last December. “This is a new post, in that I am employed purely by CHI,” explains Taffy. “Before this, consultant neurosurgeons looked after both adults and children. I’m managing brain tumours, spinal pathologies, trauma, hydrocephalus, and my sub-specialty interest is in closed dysraphic conditions, such as tethered cord, or closed spina bifida. These are kids with an incomplete spinal arch and fatty lumps (lipomas) in their spine holding their spinal cord down. I am also interested in complex tone which is mainly spasticity as a result of cerebral palsy. One of the things I’d like to do is to be able to offer Selected Dorsal Rhizotomy in Ireland. That’s an operation to cut some of the nerve roots in the lower spine to release some of the tension in the muscles. It’s not for every child, but at the moment the children who are eligible are having to travel to Leeds and some kids are going to the US. It’s very straightforward, and something we can do here and have the expertise to do, not just from my point of view but also from the neuro-rehabillitation and neuro-physiology perspectives. Hopefully that will happen at some point in the next year.” For Taffy, it was the year she spent at Temple Street working with the paediatric neurosurgeons there on research projects that convinced her that she wanted to commit her career to paediatric neurosurgery. “The paediatric subspecialty in neurosurgery is amazing in that it is the one specialty where you can apply all the skills you learn in training,” she explains. “I don’t have to focus on spine pathology or just tumours or just vascular issues, it’s the one area where you can almost be a general neurosurgeon. Another thing I love about paeds is the patients. There is nothing like a child who comes in with a brain tumour and you operate and within two days they are sitting up eating and itching to go home. They are so resilient compared to adults. Obviously it can be very traumatic and sad at times, and there are times I can’t fight the pathology, or whatever I can do is not enough to bring

“You are there at a time when people are very vulnerable and you can be a positive interaction in their lives.”

Temple Street Children’s Hospital

Marlay Park

that child back to health or give them a normal life, but it’s still special. You are there at a time when people are very vulnerable and you can be a positive interaction in their lives. “When I went to GOSH it was solely as a paediatric neurosurgery fellow, and to be honest I did not miss adult neurosurgery – that year confirmed for me that I would be happy with a career in paediatrics.” Taffy’s working week starts with a neuro-oncology clinic in OLHSC on Mondays, followed by theatre on Tuesdays. “There are four consultant neurosurgeons at Temple Street,” she says, “and we tend to share the list and operate once or twice a week. On Tuesday afternoons, if I’m not operating, I usually work in the cranio-facial clinic and on Wednesdays I may operate with the cranio-facial team. Then on Thursdays I have my sub-specialty clinic for closed dysraphic with Darach Crimmins FRCSI, two regular spina bifida clinics and an outpatient clinic. I’m on call one in four weekends, and once or twice during the week, and while it’s busy it is more chilled than when I was in training. CHI Temple Street is the only neurosurgery centre for children in Ireland and we do over 580 cases a year with 50-60 new brain tumours being referred yearly. When compared to other centres on UK and Ireland, this is second only to Great Ormond Street Hospital.” Taffy lives in Rathfarnham and spends her free time with her family, getting to drop the children – now 14,12 and 10 – to school some mornings and being home in time to cook dinner a couple of times a week. “I have a bit more time as a consultant than I did as a trainee, and I am still getting my head around that,” she says. “The kids are so independent now they don’t care if I am around! I love being at home, and I spend my free time cooking. I love experimenting and I have piles of cookbooks in the house. I take my time and find it very therapeutic, sometimes my family thinks I take too long – I could be cooking for hours while they are starving. My favourite thing to cook is seafood, and I’m very good at meat, especially pork. I love curries and make a good oxtail stew to a recipe from home. I’m rubbish at baking, you’d think as a surgeon I’d be meticulous enough to be a good baker, but nothing ever seems to turn out right!” When she’s not cooking, Taffy enjoys the parks near her house and often heads to Marlay Park on a summer evening to play tennis with the children. On weekends, when the weather is good, the family drive down to Glendalough to walk and enjoy the scenery. And Taffy’s still an avid reader, although these days it’s more likely to be something by Colson Whitehead – The Nickel Boys is a recent favourite – than Enid Blyton or Sydney Sheldon. ■ S U R G E O N S S C O P E / 21

› General Surgery

An Acute Issue A LACK OF GENERAL SURGERY SPECIALISTS IS AT THE ROOT OF A POTENTIAL CRISIS IN THE ON-CALL SYSTEM FOR ACUTE SURGICAL CARE. PROFESSOR PAUL RIDGWAY FRCSI EXPLAINS HOW ASAUs ARE PART OF THE SOLUTION

The trend in Ireland and Europe towards sub-specialism means that most surgeons now identify themselves by their sub-specialty interest rather than as General Surgeons. But the reality is that General Surgery accounts for the majority of acute surgical admissions across Ireland every day, with most patients operated on by surgical on-call teams doing emergency work on top of their elective work, a system that leads to delays and inefficiencies in emergency care and has a knock-on impact on elective procedures. “As surgery pathways have become more complex,” explains Professor Paul Ridgway FRCSI, National Clinical Advisor in General Surgery to the National Clinical Programme for Surgery (NCPS), “surgeons have learned more, yet with a smaller focus. As this referral base has become narrower and narrower, it has led to a lack of generalists. For most of us, the only time we are true General Surgeons is when we are on call for emergencies. In pure numbers terms, most of us see more acute patients than we do elective as these represent the majority of patients under General Surgical Care. We have to balance those two pulls. As General Surgery is a large specialty, accounting for such a large proportion of acute surgical admissions, we need to encourage more surgical trainees to take up General Surgery as their specialty.” 22

Professor Ridgway believes that the current national on-call system for acute surgical care will soon come under even more negative workforce pressures than currently exist, thanks to a perfect storm currently brewing. “There is an ageing workforce doing significant night-time emergency work, and there are sub-specialty (e.g. Breast and Paediatric Surgery) trainees who won’t have the elective volume of abdominal surgery to allow them to be emergency-safe on-call when they reach consultancy. The reality is that a new breast surgeon may feel very uncomfortable with the generality of the work required when on call. And finally there is the increasing importance of work/ life balance which limits the attractiveness of consultant posts involving smaller on-call rotas. The desire for better balance is undoubtedly reasonable, but does add to the recruitment challenge.” Professor Ridgway advocates a two-pronged approach to solving the problem before it becomes a crisis. The first is to make on-call rotas bigger. “A one in twelve rota is very manageable,” he says, “but in a lot of Model 3 hospitals currently it might be one in three or four, which is very onerous. We have to build bigger rotas to accommodate bigger numbers. We know that Trainees are not coming home from fellowships from abroad, or only coming back to specific jobs because many of the open jobs are not attractive to them.

› General Surgery

They want their elective specialism, but are not willing to partake in an onerous on-call rota. “By the time they have completed their fellowship they have spent eight years training. They are then a well-trained, expensive human resource and we have to incentivise them to take up jobs if we want them to come back, or jobs markets overseas will snap them up.” The logical consequence of building bigger rotas is that they exist in fewer places, which segues nicely towards Professor Ridgway’s view that acute care across Ireland needs to be consolidated into a network of Acute Floors comprising an Emergency Department (ED) with allied assessment units such as Acute Surgical Assessment Units (ASAUs) and Acute Medical Assessment Units (AMAUs). “Building Acute Floors that are fit for purpose with ASAUs that allow for the cohorting of emergency surgical patients will help make General Surgery a specialty people want to go into,” says Professor Ridgway. “This is not about closing hospitals but making the ones we have better. It’s about delivering the patient to the right place quickly, safely and removing inefficiency.”

Professor Paul Ridgway FRCSI

“Building Acute Floors that are ﬁt for purpose with ASAUs that allow for the cohorting of emergency surgical patients will help make General Surgery a specialty people want to go into.”

Professor Ridgway explains that the way a network operates may mean that a patient is assessed in one hospital but sent on somewhere else for surgery. “Currently that’s a grace and favour pattern,” he says, “but it should be formalised. The Acute Floor is a modern way of delivery of emergency care where the patient is streamed to the relevant Senior Decision Maker (SDM) in the first instance, allowing efficient and efficacious care. “In Ireland currently, a key issue is that Acute Floor resources are spread too thin across too many sites. Every night there are 26 acute General Surgical Teams on call for a population of just over five million people. This is a disproportionately large number given the heterogeneity in the number of patients seen and admitted on each site. The vast majority of these surgical oncall teams are doing the emergency work on top of their normal elective work, leading to delay and inefficiencies in emergency care and a knock-on effect on elective work.” A number of ASAUs have been developed and accredited in Ireland over the last five years. These validation standards were developed by a partnership with the NCPS, Healthcare Pricing Office and Acute Hospitals division of the HSE. These ASAUs are located in University Hospital Galway, Mater Misericordiae University Hospital, St Luke’s General Hospital, Kilkenny, University Hospital Limerick, Our Lady of Lourdes Hospital, Drogheda, and Cork University Hospital. These ASAUs have reshaped the way that unscheduled care is delivered to patients who present to hospital with an acute surgical condition.

THE ASAU – 10 GUIDING PRINCIPLES: 1.

The primary aim of an ASAU is to deliver Senior Decision Making early in the pathway of selected acute surgical patients.

The main quality measures are to reduce Patient Experience Times (PET) and reduce inappropriate admissions thus providing better patient care.

Additional gains should include savings in average length of stay (AvLOS), increased patient satisfaction, and decreased time to diagnostics and surgery (if necessary).

There should be a critical referral population size in order to deliver cost and other efﬁciencies.

The ASAU should have robust clinical governance.

The engagement and ongoing support of the hospital Senior Management Team is important.

The ASAU should be in a designated area separate from other units.

ASAU patients must have formally agreed access to a dedicated emergency theatre, diagnostics and inpatient beds.

A review clinic to facilitate admission avoidance and interface with ambulatory care must be available to ASAU patients.

10. An ASAU may contain bespoke elements to provide for speciﬁc local or regional needs.

S U R G E O N S S C O P E / 23

› General Surgery

ASAUs allow Senior Surgical Decision Makers (SSDMs) to see patients promptly, thus facilitating efficient and effective care. The development and expansion of ASAUs is an important component of the Acute Model of Care published by the NCPS in 2013, explains Professor Ridgway. “The development of ASAUs is supported by the National Clinical Adviser and Group Lead (NCAGL) Dr Vida Hamilton and her colleagues in the Acute Hospitals Division,” he says. “For individual hospitals, the accreditation process provides a standard for service improvement and for patients; it ensures consistency of the service received.” In essence, the ASAU provides a dedicated, transitory, bespoke area where acutely ill surgical patients (Manchester Triage Scores 3 and 4) can be assessed. They are then either admitted to hospital or treated and ambulated. It is envisaged that approximately 40-60% of those patients seen will receive community care without the need for admission to the acute hospital setting. The major benefit is that SSDMs is available to the ASAU promptly, which reduces Patient Experience Time (PET) and allows early and robust decision-making. To date, the ASAUs in operation in Ireland are standalone but it is envisaged that they will form part of the wider Acute Floor in the coming years or be networked within hospital groups. “In a mature ASAU model,” explains Professor Ridgway, “we can change so there are never conflicts to the surgeon’s time. On call, 100% of the surgeon’s time is dedicated to emergency work. In Limerick, Galway and Drogheda, the ASAUs follow a ‘surgeon of the week’ model, so during their time on the unit the surgeon does no elective work, and is purely dedicated to acute work. On average they see over ten surgical admissions each day, with the same number in consults that are able to be ambulated to community care.” Professor Ridgway says that ASAUs are an efficient and successful way of delivering emergency care to acute surgical patients. In 2020, the first-ever survey of ASAU by NCPS revealed the vast majority of patients were happy with the service provided by accredited ASAUs, with 98% agreeing that the quality of their care was satisfactory, and 92% saying they were satisfied with the length of time they had to wait before they were assessed. “The success of an ASAU depends on several factors,” says Professor Gerard McCarthy FRCSI, Consultant in Emergency Medicine, Cork University Hospital (CUH), HSE Emergency Medicine Programme Lead. “Here at CUH we have had several iterations of an ASAU over the past six or eight years and have learned many lessons. I would say that the positive experience we have had is down to a coalition of the willing; staff buy-in has been enormously important. “The ASAU works best when it functions as a direct offload from, or alternative to, a patient being ‘triaged to wait’ in the ED, rather than in an urgent outpatient unit. The ideal patient from an ASAU point of view is stable, does not require resuscitation, and has already seen a GP or other Senior Surgical Decision Maker who says the patient may require urgent surgery. A classic example would be the younger adult with abdominal pain. “In Cork, dedicated consultants were appointed to the ASAU. This was crucial to its success, as their ASAU work is not an add-on to their other responsibilities. Consistency of both presence and process is key to the success of the ASAU – it means that if there are recurring systemic issues, we know who to speak to in order to resolve them. “Changes in work practices driven by the COVID-19 pandemic clarified the role of the ASAU in some units around the country, in that the streaming of patients – getting them to the right place with as few intervening steps as possible – became very efficient. “I believe that rather than being set up on an ad hoc basis, the accreditation 24

BENEFITS OF AN ASAU INCLUDE: •

Admissions are concentrated in one area allowing rapid transfer from the Emergency Department or direct referral from Primary Care.

•

Emergencies can be quickly prioritised by experienced staff.

•

Consultant-led assessment can be provided regularly throughout the day.

•

Same-day imaging and diagnostics should be available and provided for.

•

Nurse-led early discharges can be facilitated.

•

Emergency Department waiting time targets are supported.

“The accreditation and proper resourcing of ASAUs with dedicated staff and facilities will ensure the success of these units as more are established around Ireland.” and proper resourcing of ASAUs with dedicated staff and facilities will ensure the success of these units as more are established around Ireland.” Mr Mohamed Yasser Kayyal MRCSI (2007), Consultant General Surgeon, Lead for Emergency Surgery at CUH was appointed in 2017 when the ASAU was first established. “I lead a team of four general surgeons dedicated to emergency surgery at CUH. Generally the ASAU works very well as it releases pressure from the ED. Initially the patient is seen by the triage nurse in the ED and if they feel the individual is a suitable candidate for the ASAU they ask the nurse from there to assess them according to the Standard Operating Policy (SOP) criteria. The patient is then reviewed by a Senior Surgical Decision Maker from the ASAU and the system ensures they have relatively quick access to diagnostics and theatre, and to beds when they are available. The feedback we get from patients is that they like it and appreciate its efficiency.” “Our patients love them,” says Professor Ridgway. “In the early waves of COVID-19, ASAUs proved invaluable in delivering emergency care and worked even more efficiently as surgical teams had reduced elective care to administer at the same time during these waves. “In latter waves, where elective care resumed and where a number of hospital sites used the ASAU space for COVID-19 care, challenges emerged. Now, coming out of the pandemic, the lessons we learned from COVID-19 need to be factored into the design of the system going forward. We in the NCPS believe ASAUs should form a cornerstone of assessment and delivery of acute general surgical care into the future as they deliver acutely unwell surgical patient to the senior decision-making surgeon, first time.” ■

› Specialty Spotlight

Specialty Spotlight Cardiothoracic Surgery ohn Hinchion FRCSI (1995) is a Consultant Cardiothoracic Surgeon working at Cork University Hospital for the last 16 years. He a member of the RCSI Surgical Affairs Committee and a foundation member of the Court of Examiners, and was previously a member of the RCSI Professional Development Committee from 2016 to 2018. An examiner for the Intercollegiate Fellowship, he also represents RCSI as a Board Member on the Intercollegiate Specialty Board in Cardiothoracic Surgery of the UK and Ireland. Mr Hinchion is the founding President of the recently established Irish Association of Cardiothoracic Surgeons. STATISTICS ON THE SPECIALTY Cardiothoracic Surgery is one of the smaller surgical specialties in Ireland, with approximately 25 Consultants in the Republic and ten in Northern Ireland. We currently have seven trainees on the National Training Scheme, and there is significant scope to increase the number of Consultants in Ireland relative to international standards. While some colleagues are specialised in either cardiac or thoracic surgery, many cover both, and others are involved in transplantation/organ support roles. The paediatric cardiothoracic surgeons maintain adult practices and sub-specialty interests, for example, complex aortic surgery. It has been a feature of Cardiothoracic Surgery in Ireland that individual surgeons have undertaken multiple subspecialty interests to provide the full spectrum of cardiothoracic care to the patient population. There will be a progressive move towards more focused subspecialisation going forward. Over the next Mr John Hinchion FRCSI (1995) decade, we can expect up to ten Consultant posts to become available in Ireland. These will be a mixture of newly established posts and replacement posts for retiring Consultants. WHAT ARE THE STRATEGIC INITIATIVES FOR THE SPECIALTY? Essentially, to increase the

throughout the country. The designated trauma centres will also need to have adequate cardiothoracic services on site to fulfil the demand for specialised care of chest trauma. WHAT ARE YOUR KEY OBJECTIVES WHILE IN OFFICE? As foundation President, my role is to facilitate the development of a functional organisation for colleagues which represents the specialty and its members. RCSI has been very helpful in this regard and has given its commitment to ongoing support for the association. WHICH PARTICULAR CHALLENGES, IF ANY, ARE FACED BY YOUR SPECIALTY IN IRELAND AT PRESENT? As with other specialties, the

challenge is in the provision of a high standard of surgical care to a growing population in the setting of a limited workforce and finite resources including funding. ARE THERE ANY SUB-SPECIALTY AREAS THAT YOU SEE PARTICULAR NEEDS IN, AND HOW CAN THEY BE ADDRESSED?

There is currently a worldwide shortage of trained cardiothoracic surgeons which also applies to Ireland. A number of our trainees have decided to specialise in this area, so we anticipate that this will help to meet demand going forward.

WHAT WOULD YOU SAY TO SURGICAL TRAINEES CONSIDERING A CAREER IN THIS SPECIALTY? I would say that Cardiothoracic

Surgery is a fascinating and engaging specialty. Although demanding and challenging at times, it provides great professional satisfaction. I would encourage interested trainees to take the opportunity to experience the specialty for themselves to see if it appeals to them, and if does, to pursue it. Finding a mentor early during your career pathway is an invaluable asset.

“There is currently a worldwide shortage of trained cardiothoracic surgeons ...”

number of Consultant posts, with an associated increase in the allied support services which these posts require. Nationally, the specialty service provision depends hugely on ancillary structures, particularly critical care. The recent COVID-19 pandemic has emphasised the need to substantially increase critical care facilities

DATES AND KEY UPCOMING EVENTS TO NOTE The recently established Irish Association

of Cardiothoracic Surgeons (IACTS) held its inaugural meeting at the RCSI on 22 May 2022. We hope to build on this over the coming years and aim to become a vibrant organisation, which represents the needs and concerns of our specialty. We plan to hold an Annual Scientific Meeting in 2023, as well as continuing our ongoing contributions to Charter Day. ■

S U R G E O N S S C O P E / 25

› Late Career Opportunities

Professor Patrick Broe, FRCSI at a Court of Examiners meeting.

A Higher Calling RCSI PROVIDES LATER CAREER SURGEONS WITH OPPORTUNITIES TO GET INVOLVED IN COLLEGE LIFE

RCSI COUNCIL The governing body of RCSI is the RCSI Council, which is composed of 21 surgeons who are Fellows of the College and are elected by the College’s Fellowship and Membership community. Council delegates a number of its main functions to various boards and committees, which provide many opportunities for Fellows to actively contribute to RCSI’s public engagement and advocacy initiatives. How to get involved: Council election takes place every two years and Fellows in Good Standing are strongly encouraged to put themselves forward. Voting for Council is open to all Fellows and Members in Good Standing and voting takes place at the beginning of June. The next opportunity for election to Council will be in June 2024. The time commitment: This is a voluntary commitment and Council meets once per month during the year with the meetings chaired by RCSI’s President.

CSI is committed to supporting surgeons at every stage on their surgical pathway. We value our relationships with our senior surgical leaders who are stepping back from a fulltime career or retiring from clinical practice, and we want to ensure that we retain their expertise. There are many opportunities for our highly experienced, later career surgeons to contribute significantly to the overall governance, leadership and operational effectiveness of the College, and to take up mentoring opportunities, make contributions to publications, and speak at webinars and events nationally and internationally. If you belong to this late career cohort, we encourage you to explore the opportunities to become involved and actively participate in College life through various boards, committees, publications, events and other initiatives. Many surgeons have found it to be personally and professionally rewarding. RCSI is always grateful for the knowledge and experience that later career surgeons can bring to many aspects of College life.

OTHER COMMITTEES AND ROLES Council delegates a number of its main functions to various boards and committees. The significant activities of these boards and committees are reported to Council on a regular basis. These opportunities include: • Representation on joint surgical training committees (JSCT, JCIE etc.) Input on the standards, policies, regulations and professional conduct of the Specialty Fellowship Examinations. • Surgical Speciality Advisor (SSA) Contributing towards the development of your specialty/sub-specialty • Training Programme Director (TPD) Contributing towards surgical training • Northern Ireland Liaison Committee Collaboration on the delivery of surgical care and education in Northern Ireland Find out more: All Fellows in Good Standing are eligible to put themselves forward for Council and are contacted directly at the time, to encourage participation. To find out more about applying for Council, contact fellows@rcsi.ie.

› Late Career Opportunities

RCSI COURT OF EXAMINERS (IRELAND OR INTERNATIONALLY) RCSI successfully established a Court of Examiners in 2014 to acknowledge the essential contribution made by our Examiners to postgraduate surgical examinations. The Court of Examiners contributes to the development and delivery of postgraduate surgical training examinations. What does this involve: This opportunity is available to RCSI Fellows and membership of the Court allows our Fellows to: • Contribute to the assessment of junior colleagues • Obtain CPD credits • Participate in Annual Meeting/Postgraduate Conferring • Network with colleagues • Examine in Overseas Centres The time commitment: This is a voluntary commitment and the Court meets six times per year. Find out more: To find out more about becoming a Court Member, please contact us at examiners@rcsi.ie or visit: rcsi.ie/coe.

“As an RCSI Fellow I felt I wanted to give back, to help deliver the highest calibre of trainee and by examining we become better trainers. Examining also helps to improve surgical knowledge and develops another aspect of your career. There is collegiality amongst examiners and I’ve made great friends.” Eamonn Mackle FRCSI (1984) PUBLICATIONS AND EVENTS The RCSI Fellows and Members office publishes the online Surgical Bulletin newsletter every month which is sent by email to Fellows and Members. Surgeons Scope magazine is published biannually and is available to all Fellows and Members in Good Standing. We welcome contributions to these publications from the Fellows and Members community. There are also opportunities to contribute as panellists on webinars and podcasts, and to speak at Fellows and Members events. What does this involve: We want to make sure that our news content and publications are relevant to our audience. With information, insights, opinion and analysis from Fellows and Members, we can ensure the content we offer is up to date for our audience. The time commitment: By volunteering on our panel of collaborators, you will contribute to the knowledge base of the RCSI and the time you give to this can be as little or as much as you can make available, depending on your commitments. Find out more: We encourage you to put yourself forward for our Contributor Network by contacting us in the Fellows and Members office, catherinejordan@rcsi.com.

MENTORING AND TEACHING Surgeons approaching retirement have the potential to make very significant contributions to teaching programmes within RCSI. In particular, the combination of clinical knowledge and operative skills accumulated over many years of patient service offers an enormous resource for trainees. The majority of retiring surgeons will have provided many years of mentoring and clinical supervision of trainees and a pathway to provide further teaching opportunities beyond retirement is well established within RCSI. How to get involved: Opportunities are always available to teach in the areas of clinical anatomy, basic and advanced surgical skills, complex patient management scenarios and general career advice and trainee supports. RCSI therefore actively seeks expressions of interest from retiring surgeons at this time. Over the coming years, a more regionalised approach to teaching and skills training including simulation will be developed by RCSI in collaboration with third level institutions across Ireland. This may also attract interest from retiring surgeons who wish to contribute to the education of our future surgical workforce without having to travel to Dublin. The time commitment: Teaching opportunities are currently facilitated at the National Surgical Training Centre and generally consist of either one half day or one full day per week commitment. Find out more: Interested surgeons are encouraged to contact either Professor Kevin Barry, Director of National Surgical Training Programmes, kevinbarry@rcsi.ie or surgicalaffairs@rcsi.com. VOLUNTEERING FOR HUMAN FACTORS IN PATIENT SAFETY The Human Factors in Patient Safety programme is a mandatory eight-year programme for surgical trainees. Trainees come into the college to attend courses on a variety of topics including teamwork, leadership, communication skills, preventing harm and managing adverse events. Surgical trainees attend these courses with other disciplines including Emergency Medicine, Ophthalmology, Radiology, and Anaesthesiology. Each trainee attends 17 days of training over the eight years and their communication skills are assessed in the College at the end of the first two years of training. Courses are also offered on the Continuous Professional Support Scheme. Teaching methods include high and low fidelity simulation training held in the RCSI simulation centre. Each course is facilitated by an expert in human behaviour and a clinician. How to get involved: There is a perennial need for recently retired surgeons to get involved in this teaching. Trainers are paid the faculty rate from the Department of Surgical Affairs and are requested to attend a Train the Trainer course in advance. This course is a free one-day course which focuses on giving feedback in a simulated training environment. The time commitment: Commitment is based on the surgeon’s preferences and availability. Find out more: Interested surgeons should contact humanfactors@rcsi.ie. ■ S U R G E O N S S C O P E / 27

› Q&A

The Colles

Q&A

Professor Karen Redmond

THE FIRST FEMALE LUNG TRANSPLANT SURGEON TO BE APPOINTED IN THE UK AND IRELAND, PROFESSOR KAREN REDMOND IS ALSO ONE OF THE FIRST TO BE TRAINED IN ROBOTIC SURGERY

Professor Karen Redmond FRCSI (2006)

Professor Karen Redmond, Chair of Thoracic Surgery at the Mater Misericordiae University Hospital, specialises in the surgical management of patients with lung cancer, endstage lung disease (emphysema and pulmonary fibrosis) and a range of other conditions. She has specialist expertise in minimally invasive procedures including robotic surgery. She was awarded an honours degree with the Gold Medal in Surgery from UCD in 1997. Following a Young Investigators Award for supervised research in lung cancer from the European Association for Cardiothoracic Surgery, she was awarded the prestigious Society Medal from the Society for Cardiothoracic Surgery in Great Britain and Ireland for her MD work on the “Role of Human Stem Cells in Tumor Angiogenesis”. After completing specialist training in cardiothoracic surgery in 2007, Professor Redmond 28

received a US Surgical Minimally Invasive Lung Cancer Surgery Scholarship and trained in her subspecialty field of thoracic surgery and lung transplantation at Toronto General Hospital, Canada. The first female thoracic lung transplant surgeon to be appointed both in the UK and Ireland, Professor Redmond returned from her consultant post at The Royal Brompton Harefield NHS Trust and Imperial College in London in 2011. Professor Redmond has international expertise in ex-vivo lung perfusion (EVLP), being the Surgical Principal Investigator that started the NIHR-funded UK Develop Trial, a process that allows lungs to be reconditioned (perfused and ventilated) outside the body prior to implantation. These pioneering techniques have helped to increase the number of lung transplants and allow all adult Irish patients to be treated in the Republic. Professor Redmond is one of the first

trained robotic surgeons in the UK and Ireland, with specialist expertise in a range of other minimally invasive techniques including iVATS, PectusUp, Convergent surgical atrial ablation and lung volume reduction surgery. Professor Redmond directs an academic programme, supervising grant-funded MD and PhD students in the area of rehabilitation, health economics and EVLP. She is an associate editor for Transplant International, an examiner for the Intercollegiate Speciality Examinations as well as being a member of several national and international committees, including Council Member of the Irish Thoracic Society, Board of Representatives for the Society of Cardiothoracic Surgeons for the UK and ROI (SCTS) and The Cardiothoracic Advisory Group in the UK (CTAG). She lives in Dublin with her husband and three children.

When and where are you happiest? The quiet and solitude of transplanting at night, away from the organised chaos that daylight brings, ‘so dawn goes down to day, nothing gold can stay’. When did you decide you wanted to become a surgeon? Once I scrubbed into an operation, I knew it was this or becoming a barista. I just needed to be there. It was more a feeling then a realisation. Where would you be if you decided not to become a surgeon? I have an entrepreneurial flair, which led me to achieving an Advanced Leadership Diploma linked to Harvard and ESME Business Schools in 2019. So, I know I would be self-employed and exciting change. In what way do surgeons struggle / what issues do surgeons today face? Surgeons are time poor, with the worst sign of poor time management being symptoms of burnout. The best way to combat this is to give yourself a break, schedule time to rest and enjoy life outside work. As surgeons we try to overpromise and overdeliver. Try to leave the iPhone and laptop behind. What has been your proudest moment? Giving birth to my children. I still remember the look on that poor obstetrics’ registrar’s face when I told her to make the incision bigger! Who have you learned the most from in your life? I have been influenced by so many, my parents, my husband, my children, my siblings … But in surgery I was

› Q&A

“As a female in a leadership role, the experience of not being listened to can make you a more assertive communicator. And that’s ok.” privileged to be mentored by leaders in my field of thoracic surgery and transplantation. My thanks to the late Maurice Neligan FRCSI, and to Freddie Wood FRCSI (1975) at the Mater Misericordiae University Hospital, for helping me to believe in myself, thank you Peter Goldstraw (Royal Brompton Hospital London) for expecting excellence when managing the care of complex cases and thank you Shaf Keshavjee (Toronto General Hospital) for teaching me that there are no limits to what you can achieve. How does a surgeon in 2022 cope with pressure? When dealing with life and death decisions, either inside or outside the operating room, many influencing factors are at play. To lead a team during these difficult times, you must believe in yourself. Only then can people follow. To me, training is key. Humility to ask for help is also important. The pressure is less because you know you are competent. Formal training in stress management should be advocated throughout one’s career. What is the best thing about the system of training young doctors in Ireland? There are many opportunities in training, research, and other areas of

professional development. I have two surgical MD fellows publishing around health economics whilst training in robotics. What is your ideal evening? Laughing, watching the antics of Basil and Sybil Fawlty with my husband and kids on the sofa. ‘I’m actually about to undergo an operation, Basil’! If you could research and write a book on any subject, what would it be? Perfecting the mentor-mentee relationship. Mentorship is so important for surgical trainees to reach their potential. It relies on mutual respect, personal connection, effective communication, realistic expectations and above all trust. What relaxes you most? I live by the sea; I believe in the energy forces that feng shui or ‘wind-water’ has to offer. What is your greatest fear? Flying, although retrieving organs during snow blizzards in small single engine propeller planes over Toronto helped me to acclimatise! Extreme sleep deprivation and fatigue desensitised me – ‘if I live, I live, and if I die, I die, I just need to close my eyes and sleep’. What is your greatest A detail from a theatre drawing by Navin Hyder of Professor Redmond during a live lung transplantation.

Professor Magdi Yacoub

extravagance? It is not how I spend money that matters to me, it is how I spend my time. My children are a priority but only in later years do I understand the importance of self. Do you have a mantra to live by? From my grandmother, ‘God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference. From my school motto, ‘Unus Dominus, Una Fides’ (One God, One Faith). What do you consider your greatest achievement? As an enthusiastic recruit to the NHS, I was the first female consultant performing lung transplantation either in the UK or globally. Although cases can be gruelling at times, having experience, judgment and operative skills delivers a good surgical result. It is so rewarding to deliver a second chance of life for patients with debilitating dyspnea. Would you have any advice for your younger self? You can’t change how people treat you or what they say about you. All you can do is change how you react to it. As a female in a leadership role, the experience of not being listened to can make you a more assertive communicator. And that’s ok. How do you have fun? I like to listen to music and either walk or dance. Listening to Trixie & The Illusions ‘Tricks Up My Sleeve’ as I write this up. I have had 14 over for dinner, so it’s late! In your profession, a historical ﬁgure you admire? In 1983, Professor Sir Magdi Yacoub carried

Fawlty Towers

out the first heart/lung transplant worldwide. Then in 1987, the first ‘Domino Procedure’ was performed. I recall meeting two such patients (donor and recipient) sitting side-byside in the outpatients in Harefield, living life many years after transplant. Professor Sir Yacoub is a very charismatic man. What is your favourite memory? The day I got married, it was during the ash cloud following the eruption of Grímsvötn, Iceland’s most active volcano. Not a cloud in the sky! So many ferried from overseas, the craic was almighty. If you have a hobby, what do you enjoy about it? I, like so many before me have started to walk every day. The joy is in the fresh air, the monologue, the music, the quiet, the freedom. I am walking and going nowhere, no scheduled destination, waiting for Godot I suppose. Name your favourite writer. Reading is a luxury. I am currently reading Pure, White and Deadly by John Yudkin in my efforts to look after self. How sugar is killing us and what we can do to stop it. Which talent would you most like to have? I would like to be a better chef. My husband seasons the food in our home, I am the sous chef! What is the wisest thing you have ever said? I am not wise, just hard-working. Outcomes are predicted by the micro decisions we make. Name one virtue all surgeons ought to have. Patience is a virtue. Name one vice no surgeon should have. Patience can also be a vice! ■ S U R G E O N S S C O P E / 29

› Back to the Beginning

Back to the Beginning AS SHE REFLECTS ON AN OUTSTANDING CAREER AND A LEGACY OF PROFESSIONAL ACHIEVEMENTS, INCLUDING BEING APPOINTED THE FIRST FEMALE CARDIOTHORACIC SURGEON IN IRELAND, AND ELECTED THE FIRST FEMALE PRESIDENT OF RCSI, PROFESSOR EILIS MCGOVERN IS GRATEFUL FOR THE SUPPORT AND ENCOURAGEMENT SHE HAS RECEIVED ALONG THE WAY FROM HER FAMILY AND COLLEAGUES

rofessor Eilis McGovern grew up in the small Donegal village of Mountcharles, the second eldest of five. “My father Enda was a civil engineer and my mother Eileen a primary school teacher,” she explains. “We walked to school and came home for dinner in the middle of the day; in many ways it was quite a typical country upbringing. “Teachers are always very aware of how important education is for their kids, and in those days [the 1960s] just before free education came in, the local secondary schools offered a limited range of subjects. My mother wanted us to be able to do science subjects, languages and honours maths, so we all went to boarding school. I went to the St Louis convent in Monaghan. When it came to the CAO I really didn’t know what I wanted to do. My father was very happy in his work and so I put down civil engineering! I do remember the nun in charge of career guidance asking me: ‘Do you think you’re the masculine type?’ when I told her what I was thinking!” By the time the results were out Professor McGovern was having second thoughts, and an impressive points tally meant she could do any course she wanted. Professor Eilis McGovern at Charter Day 2022 “When I was twelve, in 1967, Christiaan Barnard carried out the first heart transplant, and it caught my imagination. I wrote an essay about it at the time. Looking hospitals for UCD were the Mater and St Vincent’s University Hospital (SVUH), back, I think that’s what drew me to medicine – it was a fascination with how and the tradition back then was that the country people and the northsiders went the body worked and how it went wrong, that was the context, rather than to the Mater and the southsiders went to SVUH. My very first clinical rotation having medicine in the family, or knowing a doctor or having had an illness … at the age of 21 was cardiac surgery and I was absolutely hooked from day one. I wanted to know what went wrong with that man’s heart, and how it was fixed.” At the time it was the only cardiac surgery unit in the country so if I’d gone to That autumn, McGovern enrolled in UCD. “My dad had gone there,” she Trinity or Cork or Galway, it wouldn’t have happened, and even within UCD if I’d recalls, “and we had relatives in Dublin. If you were a student from the country gone to SVUH it wouldn’t have happened. It felt like a circle coming around after coming up to the city you’d stay with relatives for the first year. The two teaching the heart transplant that had so fascinated me when I was twelve.” 30

› Back to the Beginning

Mountcharles, Co Donegal

RCSI Presidency (2010-2012)

Mayo Clinic

Professor McGovern recalls there were far fewer junior doctors then than there are now, and students attached to surgical rotations were valuable members of the team. “On my very first day I scrubbed in as one of the assistants to Professor Eoin O’Malley FRCSI and Past President, RCSI on an aortic valve replacement. It was 9am. In those days the surgeries were very long, much longer than they are now, and at around 3pm one nurse nudged another and said, ‘You’d better let that medical student have a break now’. I didn’t want to leave, I was so absorbed.” At the time, there were no women surgeons in Ireland. “There were some female obstetricians and gynaecologists, and some ophthalmologists, but no female consultants in orthopaedics, general surgery or urology, for example, and only one in training who was two years ahead of me. Medical students now are much more career-focused in a very practical, pragmatic way, but we were so naive, we didn’t think about quality of life as a doctor, or what our earning potential would be, or what the ‘on call’ would be like … we just went with our hearts. I remember thinking I would love to do surgery but didn’t know any other women doing it and then having that conversation with a friend one day and she said she was going to do surgery, and I thought: I’ve studied with her and I’m as bright as she is, if she can do it, I can do it.” Even though Professor McGovern’s decision to pursue a career in surgery was an unusual one, once the decision was made she got huge encouragement, particularly from the late Mr Maurice Neligan FRCSI. “The exams were a meritocracy, so they were not an obstacle, and getting onto the basic training scheme was relatively straightforward because there were lots of places. I did work with some surgeons who were bemused to have a female trainee, but most of them parked their bemusement when they saw I was a hard worker and got things done. There were a couple of people I worked with in those early years who I think struggled with their own prejudices.” Professor McGovern did her specialist training between the Mater for cardiac and Baggot Street for thoracic, working mainly under Professor Eoin O’Malley FRCSI and Professor Keith Shaw FRCSI. “I loved Baggot Street,” she remembers. “We had great days in the small hospitals, everyone knew everyone, unlike in the Mater or SVUH where there might be hundreds of junior doctors, in the small hospitals there might only be 20 and the atmosphere was very different.” After she completed her specialist training, Professor McGovern headed to the Mayo Clinic on fellowship. “It was an incredible year professionally,” she recalls. “Being at the end of my training, I knew enough to be discriminating

Baggot Street Hospital

“It was the nearest thing to perfection I ever experienced in my career. It became the bar I aspired to for the rest of my professional life.” about what I was seeing and it was the nearest thing to perfection I ever experienced in my career. It became the bar I aspired to for the rest of my professional life.” Having married recently, and with her husband Mr Joseph Duignan FRCSI having recently been appointed to a consultant post in Dublin, Professor McGovern did not stay in the US, but brought the lessons she learned there back to Dublin. “The work ethic at the Mayo Clinic aspired to the very best for every patient. The team worked in a positive way focused on the consistent application of care. Teams of surgeons used the same approach agreed by everybody for every patient, so there was never any doubt about how that patient should be treated. There was a protocol for everything – if someone had an irregular heartbeat this is what you did, it wasn’t a question of, ‘What will I do?’. The result of that consistency and teamwork was a very high standard of care, and patients did

Eilis and her husband Joe in Washington DC. Caption

S U R G E O N S S C O P E / 31

› Back to the Beginning

Eilis on a hill walking holiday in Italy.

Eilis at the ﬁrst Women in Surgery meeting to take place in Ireland in 2018.

really well. It wasn’t about any individual surgeon doing his own thing, it was about every surgeon buying into a system based on achieving the very best outcomes for patients. I had assumed when I went there that they’d have all sorts of fancy equipment that we didn’t have in Dublin but it wasn’t the case. Some of what we had in Dublin was actually newer. That was a wonderful message: it’s not about fancy equipment, it’s the people, the teams and the culture that are key to good healthcare and good outcomes.” Professor McGovern came back to Dublin in 1987 at the age of 31, seven months pregnant with her first child, Emma, to take up a post as a consultant attached to the Mater and Baggot Street, the first woman consultant cardiothoracic surgeon in Ireland. “It was definitely newsworthy,” she says. “Female surgeons of any kind were a rarity and cardiac surgery at that time was internationally – not just in Ireland – regarded as a very unusual niche speciality even within surgery because of the whole drama of anything to do with your heart. It’s much more accepted today but back then the idea of heart surgery was something that scared the life out of people. “When I was appointed there were only two public cardiac units in Ireland, the Mater and Cork University Hospital, but as the waiting lists got longer and longer, the decision was made to expand cardiac surgery. I was part of the group which applied to set up a third centre at St James’s, and I moved there full time at the end of 1999, after twelve years going between the Mater, Baggot Street and the Blackrock Clinic. We did our first case in 2000, and the waiting lists started to come down. I was also in a position where I had an opportunity to establish more of the ways of working I had seen in the Mayo Clinic. It was very satisfying, as it would be for anyone, to be there at the very beginning of something where you could influence at every level how the care was going to be delivered. My bible was the Mayo Clinic. And it was life-changing for me to be parking my car in the same place every day, and being on call in only one hospital. My quality of life improved hugely. I gave up private work outside of St James’s when the new unit opened, and in 2008 when the new consultants’ contract came in I gave up private practice altogether.” Throughout her career, Professor McGovern has played an active role in the College, and in 1995 was elected the first female Council member in RCSI’s long history. “I was very proud of that,” she says, “and also found it a wonderful contrast to my day job. As a surgeon you tend to be very involved in your own specialty to the exclusion of others, so I very much enjoyed being involved in the College and its role overseeing all surgical training, making recommendations to the Medical Council for the specialist register and being involved in the medical school. I enjoyed meeting different people and being exposed to different parts of the whole medical scene.” 32

Eilis speaking at a HSE event.

In 2008 Professor McGovern was elected Vice President of the College and assumed the role of President in 2010, the first female president of any of the Colleges in either the UK or Ireland, another historic achievement. During her two-year term, Professor McGovern operated half-time and did not do on-call, and in 2012, when her presidential term came to an end, she made the decision to give up clinical practice. “Joe had just retired and I thought I would find it very hard to go back to fulltime cardiothoracic surgery and on-call at the age of 57. I was fortunate that a senior management role in charge of medical education and training came up in the HSE, looking after all aspects – other than HR – of the role of the doctor in the health service. As Director of the National Doctors Training and Planning unit, we covered everything from internship up to consultant level, for all specialties including, for example, general practice and psychiatry. “I did not miss clinical practice at all. I qualified at the age of 23 and worked until 57, with long hours on-call, working weekends, bank holidays and many Christmases. And with the two of us being surgeons, we were always juggling. I remember feeling this was an opportunity that wasn’t going to come again. I had also seen surgeons operate beyond their peak and I didn’t want that to happen to me; I wanted to stop operating when I was still really good at it and I wanted a better quality of life, and to reclaim my evenings, nights and weekends. I wasn’t ready to retire fully, and wanted something meaningful that would allow me to improve the lot of doctors, especially trainees. The role was attractive because it had a budget, and if you have a budget you can change things. It turned out to be a really satisfying role, and my team was able to bring about a lot of positive changes for interns and trainees.” In 2015, at the invitation of the Minister for Health, she chaired a steering committee tasked with making recommendations for a trauma system for Ireland and which reported in 2018. “Modern trauma care is about getting seriously injured people treated as quickly as possible, and making sure they are brought to the appropriate facility to be managed,” she explains. “The committee drew on multidisciplinary expertise both locally and internationally, and our report is now being implemented in an incremental way. It’s an achievement of which I am very proud.” Professor McGovern says she “retired gracefully” in 2018 at the age of 63, although she has since come back to work on a couple of projects for the HSE. She says she has taken to retirement “very easily”, singing in a choir, resuming piano lessons after a gap of many years, playing bridge and golf, and spending time with Joe and her Dublin-based daughters – Emma is an ophthalmologist and Sophie a trainee in paediatric cardiology – and her grandchildren. “I feel very lucky,” she says, “to have had such a fulfilling career and to be enjoying my retirement so much.” ■

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Surgeons Scope Magazine - July 2022

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