Surgeons' News September 2016

MUSEUMS

THE MECKEL MYSTERIES

The tale of the anatomical collection that almost came to the College

BOOK

REMEMBERING SAM GALBRAITH

In celebration of the ‘people’s neurosurgeon’ who became a politician

ANNUAL REPORT

THE COLLEGE’S YEAR IN BRIEF

The President, Chief Executive and Treasurer summarise key activities

Surgeonsnews September 2016

The magazine of The Royal College of Surgeons of Edinburgh

Learners in leadership

The initiatives giving clinicians the skills for management in a modern NHS

www.rcsed.ac.uk

surgeons_news_colour_page_march 03/02/2016 11:59 Page 2

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WELCOME

FROM THE EDITOR John Duncan introduces his final issue as Surgeons’ News editor

W

hen the history books of the United Kingdom in the 21st century are written, the early summer of 2016 will be recognised as an important moment. The Brexit decision and the consequent political upheaval will have repercussions that, as yet, are unclear.

These events, and the lack of resolution of the junior doctors’ dispute, make it important that as a profession we effectively progress those issues that we can influence.

With this backdrop, we present the College’s Annual Report, which outlines the progress we made in 2015. In this edition, we have chosen to highlight the support we have given to an important innovation in medical training. We are about to move into our third year supporting Clinical Leadership Fellows. The Fellowships take trainees out of programme for a year to work with major bodies within the profession – many of the colleges, all of the departments of health and many other professional bodies host the Fellows. I have been enormously impressed by the quality of the individuals I have met in all the programmes. Working with senior members of the profession, their outputs have been considerable and of very high quality. Meeting these individuals and seeing their achievements gives confidence in the future of the profession.

The terrorism and much of the population migration that Europe is experiencing are the effects of the traumas in the Middle East. These problems are put into stark relief by the experiences of a surgeon working in Syria. His account of trying to

provide some sort of surgical care in Aleppo reminds us of the plight of his patients and of his colleagues.

Recently we were asked to review a book that I felt merited significant prominence.

Sam Galbraith was a neurosurgeon in Glasgow who went on to be elected and then to serve as a minister in both the Westminster and Scottish parliaments. He saw life as a patient, becoming one of the world’s longest-surviving lung-transplant patients. The book about his remarkable life is written by many of those who knew him best.

Surgeons’ News has evolved over its 14 years and we need to continue the development of the magazine. For some years, there have been two versions. Surgeons’ News has gone to UK-based Members and Fellows, while Surgeons’ News Global, which omitted some UK-specific content, has gone to our overseas membership. It has been overseen by Robyn Webber and her tireless work has been hugely appreciated by the College. We have now decided to combine the two publications to give our membership articles on the full range of College activities.

For my own part, it has been a privilege to edit the magazine, but as this is my 29th edition, I believe it is time for me to hand over the baton. The production of the magazine is the work of the College’s Marketing and Communications team, but mostly of Mark Baillie, to whom I owe my sincere gratitude.

Clare McNaught, who is a member of Council and Chair of the Younger Fellows Committee, has agreed to take on editing the magazine.

I am very confident that she will move Surgeons’ News on to further success.

John Duncan editor@surgeonsnews.com

We have chosen to highlight the support we have given to an important innovation in medical training. We are about to move into our third year supporting Clinical Leadership Fellows rcsed.ac.uk | 1

34

MUSEUMS

THE MECKEL MYSTERIES

The tale of the anatomical collection that almost came to the College

BOOK

REMEMBERING SAM GALBRAITH

In celebration of the ‘people’s neurosurgeon’ who became a politician

ANNUAL REPORT

THE COLLEGE’S YEAR IN BRIEF

The President, Chief Executive and Treasurer summarise key activities

Surgeonsnews September 2016

The magazine of The Royal College of Surgeons of Edinburgh

Learners in leadership

22

The initiatives giving clinicians the skills for management in a modern NHS

www.rcsed.ac.uk

EDITOR John Duncan DEPUTY EDITOR Robyn Webber EDITORIAL BOARD Mark Baillie Richard McGregor Peter Lamb Peter Douglas Sarah Allen Chris Henry Dr Yvonne Hurst Aoife O’Sullivan Emma Charlesworth PUBLISHED BY The Royal College of Surgeons of Edinburgh, Nicolson Street, Edinburgh EH8 9DW Registered Charity No. SC005317 contributions@surgeonsnews.com Tel: +44 (0)131 527 1600 For editorial enquiries contact Mark Baillie: Tel: +44 (0)131 527 3405

Contents

September 2016

04

AGENDA News and views from the profession, including initiatives to make medicine more accessible to all

08 20

THE PRESIDENT WRITES Regular update on College activities

22

REPORT FROM ALEPPO How war is devastating the healthcare system in Syria

24

SAM GALBRAITH Excerpts from a book about the muchloved neurosurgeon and politician

27

MUSEUMS Jacqueline Cahif on how the Meckel pathology collection got away

30

LEADERSHIP PROGRAMME How Clinical Leadership Fellows are strengthening NHS management

34

SPECIALTY Professor Robert Steele on the rise and rise of coloproctology

37

DENTAL The Dean's update; 2016/2017 Competition; Faculty of Dental Trainers launch

DESIGN AND PRODUCTION

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

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

Cover illustration: Jimmy Turrell

2 | Surgeons’ News | September 2016

24

PERIOPERATIVE CARE The role of perioperative medicine in improving surgical outcomes

41

TRAINEES AND STUDENTS Information Days success; Video and Surgical Skills competitions; ASiT's National Mentoring Scheme

46 52

COLLEGE INFORMATION Awards and grants; diploma listings

55

ANNUAL REPORT The President, Chief Executive and Treasurer summarise the College's performance in 2015

64

FROM THE COLLECTIONS The blackened lung of Dalkeith collier John Hogg

OUT OF HOURS Reviews of restaurants around the world and a selection of Gris wines

JOU RN

S•

ATION REPOR CIT T L A

OM

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2 201

Latest 2011 Impact Impact factor Factor 1.406!

2.046!

SON REU

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Get 10 extra journals when you opt for online only access RCSEd and RCSI Fellows and Members can sign up to read The Surgeon online only and receive unlimited access to 10 additional titles at no extra cost:

r r r r r r r r r r

Surgery International Journal of Cardiology Surgical Oncology Clinical Neurology and Neurosurgery Injury Journal of Dentistry International Journal of Surgery Best Practice and Research Clinical Gastroenterology Current Anaesthesia and Critical Care Seminars in Fetal and Neonatal Medicine

Fellows and Members can sign up for this by contacting: RCSEd: membership@rcsed.ac.uk / +44 (0) 131 527 1654 RCSI: fellows@rcsi.ie / +353 1 40 2235 Please quote your College reference number in all correspondence.

ces, Southern

24/03/2016 10:50:36

Don’t forget, you can sign up separately with Elsevier to receive e-table of contents by email each time a new edition of The Surgeon is published: www.thesurgeon.net

AGENDA

Agenda The latest news from the College and profession / JUNIOR DOCTORS

RCSEd President writes to Hunt

A

t the start of August, College President Mr Michael LavelleJones wrote to Secretary of State for Health Jeremy Hunt asking him to consider a number of practical steps to help improve surgical training and staff morale.

Mr Lavelle-Jones said: “Feedback from our Members and Fellows, as well as staff surveys conducted by the GMC et al, persistently point to declining morale across the NHS. However, we believe that our proposals, namely guaranteed time for training, the introduction of a modern-day apprenticeship model of training, a review of the role of consultants and the development of a UK-wide framework to develop the professional skills of non-medical staff, will fundamentally improve surgical training. We also believe that another term needs to be found to describe ‘junior’ or ‘trainee’ doctors. These are highly skilled and committed professionals and should be recognised as such.”

Morale is low among junior doctors

To view the letter in full visit the College website, rcsed.ac.uk

/ TRAINING

FST/ASME launch research grants

T

he Faculty of Surgical Trainers (FST) has teamed up with the Association for the Study of Medical Education (ASME) to launch a series of new research grants in the field of surgical education and training.

The grants can be used to support either a research study or evaluation of a teaching innovation in any field of surgical education and training. ASME and FST have launched the grants to help promote research

4 | Surgeons’ News | September 2016

in these areas and encourage improvements in surgical training practice.

Craig Mcllhenny, Surgical Director of FST and Consultant Urological Surgeon in NHS Forth Valley (pictured), said: “Research into surgical education training is a vital activity if we are to continue to produce high-quality training programmes. This partnership between FST and ASME will allow surgeons to work with world-class medical education researchers, and it will advance surgical

education research to the benefit of trainers, trainees and patients.”

Professor Jennifer Cleland, Chair of Council for ASME, said: “We are delighted to collaborate with FST to launch these grants and support surgical education research.

There is a lot of exciting research and evaluation being conducted in this field and, having been involved in a number of surgical research projects, I know this will make a real difference. By encouraging innovation and research, these grants will have a huge impact on surgical education and training.”

Presidents and vicepresidents from leading hospitals and medical schools in China

/ GLOBAL REACH

College welcomes international visitors

T

he President welcomed a delegation of presidents and vice-presidents of hospitals in mainland China to the College on 3 August 2016 and on 4 August the College was pleased to host a delegation from the College of Physicians and Surgeons Pakistan.

Discussions with both groups centred on the international work of the College, including examinations, training programme accreditation, curriculum development and the College’s sponsorship programmes, most notably the RCSEd International Surgical Fellowship Programme. The visits also enabled the College to further develop its links with mainland China, where it held

Delegates from the College of Physicians and Surgeons Pakistan

its first ever examinations in May 2015 (examining candidates for the Membership in Orthodontics) and to build on its

long-standing relationship and collaboration with the College of Physicians and Surgeons Pakistan.

The College President and OfficeBearers regularly meet with sister colleges, international members and healthcare professionals from around the world.

Upcoming events include the Canadian Association of General Surgeons meeting and Joint Meeting with the Hong Kong College of Surgeons in September; the American College of Surgeons Annual Conference in Washington; a trip to Oman where the MRCS OSCE preparation course and examination will be held for the first time in October; and a meeting in Malta in February 2017, another first for the College.

/ MUSEUMS

/ FELLOWSHIP

Lister Project wins prestigious Museums prize

Award for ‘unique’ study

The RCSEd’s Lister Project has been recognised as the best permanent exhibition in the UK at the Museums + Heritage Awards for Excellence 2016.

The Lister Project involved complete refurbishment of the College’s Surgeons’ Hall Museums with many more Engaging displays objects now on display, fresh interpretation and modern AV and interactive elements to engage visitors. The Lister Project faced stiff competition from museums across the UK, including the British Museum, the V&A and English Heritage.

Michelle, Bill and Sarah Hickman from Bristol were the 50,000th, 50,001st and 50,002nd visitors to the Museums on 29 July. They received a complimentary bottle of champagne and a goody bag.

An explosion on an oil rig (dramatised on the big screen by Hollywood actors) and a jumbo-jet crash would appear unlikely sources of study for minimising errors in an operating theatre, yet the RCSEd has awarded one of its highest honours to such a body of work.

Rhona Flin, psychology adviser to NASA, the nuclear industry and the Cabinet Office, has been granted a rare award for a non-medically qualified professional by the College.

Professor Flin was given the Fellowship Ad Hominem in recognition of her insightful studies into human behaviour in highpressure situations.

She translated analyses from events such as the explosion on the Deepwater Horizon oil rig – one of the largest environmental disasters in history – into unique behavioural markers that are now implemented in the world of surgery.

Rhona Flin (left) and John Duncan

AGENDA

L-R: Michael Lavelle-Jones, Andrew Leather and Graham Layer

NEWS IN BRIEF Notice of annual general meeting The College will hold its AGM at 12.30pm on Friday 18 November 2016 in the Playfair Main Hall, the Royal College of Surgeons of Edinburgh, Nicolson Street, Edinburgh EH8 9DW.

Report for 2016

/ EVENT

Symposium focuses on the ‘neglected surgical patient’

O

n 30 June, RCSEd held an evening symposium on the topic of global surgery.

This comes on the back of increased interest in global surgery following the Lancet Commission last year.

Consultant Surgeon and Director of the King’s Centre for Global Health Mr Andrew Leather opened the symposium with a talk focusing on the conclusions of the Lancet Commission and the next steps. The Lancet Commission served to focus the attention of the global health community on what Mr Leather called ‘the neglected surgical patient’.

Mr Leather remarked that the impetus now lies with national governments to take on the challenges highlighted by the Commission and urged the surgical community to advocate on behalf of their patients and the health sectors within their country.

Guests were also treated to talks from Professor George Youngson, Paediatric Surgeon and Trustee of the Archie Foundation, Mr Trevor Crofts, General Surgeon based in Malawi, and Mr Ewen Harrison, Clinical Senior Lecturer and Honorary Consultant Surgeon, University of Edinburgh.

Read more at iss.rcsed.ac.uk

The College’s Annual Report is published in this edition of Surgeons’ News (p55), with updates on activities and progress over the last 12 months. The highlights include surgical ward-round toolkits and technological innovations with e-learning programmes, Touch Surgery and the 3D Definitive Human Anatomy Project.

Surgeons’ Hall Museums and the College’s library and archives were renovated, noted College President Mr Michael Lavelle-Jones, “in order to improve physical and intellectual access to the College’s collections and to preserve these historic assets for the benefit of future generations. As part of the process, a programme of ‘contemporary collecting’ has taken place to ensure the displays and archive encompass many of the latest forms of surgical technology”.

/ QUALIFICATIONS

Ten years of excellence for online MSc in surgical sciences The award-winning online MSc in surgical sciences – offered jointly by the University of Edinburgh and the College – saw 46 students graduate this July. Now entering its 10th year, the programme attracts applications from around the world, with current students in more than 40 countries, from Australia to Zimbabwe.

Surgical sciences has the largest number of students of any online distance-learning programme at the university. It is increasingly popular with trainees from developing countries, where online learning enables doctors to continue to train in their own countries to deliver the services so desperately needed by their communities.

6 | Surgeons’ News | September 2016

The interactive virtual learning environment perfectly complements workplace experience and enables students to interact collaboratively with classmates and tutors from around the world. Best of all, surgical sciences students perform better in MRCS examinations than other candidates.

Last list for Graham Layer

Best wishes to Consultant Surgeon at the Royal Surrey County Hospital and RCSEd Vice-President Professor Graham Layer, pictured here with his team during his last list prior to retirement.

l TO Al OPeN h AN w i T ST i N e N i TergiCAl r Su iNg TrAiN

Save the date!

Save date! edinburgh the 21 October 2016

edinburgh 21 October 2016 The Faculty of Surgical Trainers Annual Conference 2016 The Faculty of Surgical Trainers Annual Training by numbers: Conference 2016 Competency vs Time in Surgical Training Training by numbers: Competency vs Time in Abstract submission now open - we accept abstracts on all aspects of Surgical Training surgical education and training, with prizes for best oral and poster presentations.

Abstract submission now open - we accept abstracts on all aspects of surgical education and training, with prizes for best oral and poster New this year: Workshops on giving effectice feedback, presentations.

simulation in training, and better use of ISCP

To book: email education@rcsed.ac.uk call 0131 527 1600 visit www.rcsed.ac.uk

Speakers already confirmed: Mary Klingensmith MD President of the association for Surgical education, distinguished Professor of Surgery and Vice Chair for education at Washington University School of Medicine in St Louis Anthony gallagher Professor of technology enhanced Learning, University College Cork Nick Sevdalis Professor of Implementation Science and Patient Safety, KCL, and editor-in-Chief, BMJ Simulation and technology enhanced Learning Olle Ten Cate Professor of Medical education and director of the Center for Research and development of education, University Medical Center Utrecht ian Curran gMC assistant director of education and Professional Standards and Professor of Innovation and excellence in healthcare education at Queen Mary University of London

RegISteRed ChaRIty No. SC005317

PRESIDENT

THE PRESIDENT WRITES Michael Lavelle-Jones provides his regular update on College activities

L

ast November, when I took up office, I noted in my first President’s column what a difference a day makes. Again, I have a deep sense of déjà vu as I reflect on the outcome of the historic EU referendum vote on 23 June 2016. The impact of this decision on the NHS and on education, assessment, training and research is hard to gauge and may be clearer by the time this column goes to press.

Inevitably, the law of unintended consequences will apply and there will be major implications to our healthcare system, many as yet unseen. Irrespective of your position on the referendum and its outcome, I do hope the coming months will see us all pulling together for the benefit of our health service.

You can be assured that the College will do all in its power to help steer a course through the unknown waters that lie ahead.

WHAT’S IN A NAME? In recent weeks, too, the junior doctors voted to reject the new contract, which now looks set to be imposed by government.

Stepping aside from the result, this longrunning and bitter dispute has awakened a long-held view of mine about the appropriateness of the terms ‘junior doctor’ and ‘trainee’, when you consider they encompass all those in training from the moment they leave medical school to a point in time some 10 years later when they embark on their first positions in independent practice. While both terms might be factually accurate, 8 | Surgeons’ News | September 2016

they are somewhat pejorative and probably don’t instil a huge amount of confidence in our patients.

I am quite comfortable being flown across the Atlantic by a First Officer – who is, after all, a pilot in training – but I wonder how I might feel if they were referred to as a trainee in the preflight preamble. Matters can have been made only worse by the widespread use of the terms in the media during the dispute and I wonder if the time has come to reconsider their designation, taking into account levels in training and professional responsibilities.

By no means do I suggest that we return to the SHO/Registrar/Senior Registrar descriptors that accompanied my progress up the training ladder, but now would be a good time to consider other options. At the ASiT session at the ASGBI meeting in Belfast, there was a groundswell of approval in the audience for such a proposal. Perhaps we should ask our trainees to take the lead on this.

BULLYING AND HARASSMENT It was my privilege to represent our College at the Royal Australasian College of Surgeons’ (RACS) Annual Scientific Conference held in Brisbane in May. The event coincided with the launch of the Australasian College’s Let’s Operate with Respect initiative, a three-year campaign designed to put an end to bullying, discrimination and sexual harassment in the workplace. This has been launched on the shoulders of the output of a RACScommissioned

Britain leaving the EU will have far-reaching consequences for the NHS

Expert Advisory Group, whose findings of widespread abusive behaviours in the workplace thrust the issue on to centre stage. The Australasian College is to be commended on showing strong leadership in this area and adopting a policy of zero tolerance, however hard that might be to achieve.

Closer to home, a report from our sister College, the Royal College of Obstetricians and Gynaecologists (RCOG), has looked at the incidence of bullying and undermining among consultants in the UK in that specialty. The report, published this June by the BMJ, makes for a sobering read. Of those who responded, 44% reported being a victim, with up to half experiencing these behaviours in the long term. It would appear that UK-qualified females and non-UK-trained males and females predominate as recipients. Key perpetrators among other grades are their consultant colleagues. I am quite sure that obstetrics and gynaecology are not alone in this practice and I shall be interested to see the outcome of a similar survey in surgery that our College is due to undertake. I commend the report from RCOG and the RACS’s Let’s Operate with Respect. We know that the GMC’s annual survey of surgeons in training regularly

While the terms ‘junior doctor’ and ‘trainee’ might be factually accurate, they are somewhat pejorative and probably don’t instil a huge amount of confidence in our patients shows that surgeons, obstetricians and gynaecologists hold the unenviable position at the top of the league table of dissatisfaction with their training. Feedback from our own trainee membership has highlighted the negative impact of such damaging behaviours on their performance, ability to deliver safe patient care and the perception of their training. Perhaps this is the right time for us to lead by example.

Michael Lavelle-Jones president@rcsed.ac.uk rcsed.ac.uk | 9

AGENDA

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

Needlestick lesson

CORESS comments

Reporter’s comments

Malignant disease missed

I sustained a needlestick injury during closure of the abdomen. I was using a straight hand needle and was hurrying to complete closure so we could get the next case on table. I became momentarily distracted when the scrub nurse asked for a second swab count.

I should have been using forceps to retrieve the needle after each bite, but wasn’t. I didn’t know the needlestick protocol, but sought advice and do now.

Know the needlestick protocol. Immediately stop operating, de-scrub and wash the wound.

Your blood should be taken and occupational health informed. Someone else should inform the patient and obtain consent for a blood sample to be taken for testing for HIV, hepatitis B and hepatitis C.

10 | Surgeons’ News | September 2016

Despite universal precautions and safe practice, needlestick injuries will occur. All surgeons should be aware of the procedures to be followed in the event of a needlestick injury and of the protocols in their own unit.

Useful guidance can be found in Section 2 (Managing Exposure) of the NHS document at www.nhsemployers. org/~/media/Employers/Publications/Needlestick%20 injury.pdf

I was conducting a general surgery clinic in a peripheral hospital where my registrar saw a patient who had been referred with an axillary lymph node. On examination, it was clear that this was in fact a solitary group of firm lymph nodes. The registrar took a careful history, which included the fact that two years previously the patient had had a skin

nodule from his back removed under local anaesthesia.

This had been done by a locum GP, at another practice, before the patient moved areas and changed GP practice.

The scar on the patient’s back had healed well, but there was a little local induration. My registrar phoned the laboratory for a copy of the histology report, which had not been included with the referral. The report suggested that the lump was malignant and was incompletely excised. The original report was not in the patient’s GP records and could not be found. The original GP practice admitted liability. The locum GP had left the country and was not contactable.

Reporter’s comments

This was a major system error. An appropriate outcome depended on one person seeing the report and taking action. There was no back-up system. The GP practice had provided the patient with a follow-up appointment, which he failed to attend because he had moved, but the practice did not follow up the report when they had no response from the patient; the patient assumed that all was well having not been contacted; there were no checks in the pathology department to ensure that someone was acting on the report of malignancy. Clinicians are under pressure to reduce outpatient follow-up appointments at which important clinical data can be reviewed, before a patient episode is formally closed.

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

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

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

CORESS comments

This is an increasing problem where individual responsibility for patient management and follow-up has been eroded by introduction of pooled clinics, MDTs at which the primary clinician responsible for the patient may not be present, and failure to develop red-flag systems that ensure that important clinical results are acted on. A system should be in place to ensure that relevant pathology reports are reviewed by the responsible clinician and acted on appropriately.

Inadequate preparation for emergency surgery

As the vascular consultant on-call, I was asked by the consultant covering the wards to undertake a femoral endarterectomy and femoro-popliteal bypass for a diabetic patient with critical ischaemia and a gangrenous toe. The patient had been on the ward for several days while his INR was corrected following excessive warfarinisation for atrial fibrillation. I saw the patient on the ward and consented him, having discussed him with the ward consultant. Unfortunately, the ward-based PACS system was down and I did not review the angiograms.

While reviewing another patient in the emergency department, I was called to the emergency theatre to do the femoro-popliteal bypass. When I got there, the

patient had already been anaesthetised by the on-call anaesthetist. Prior to scrubbing, I called up the patient’s angiograms on the theatre computer to find that the patient did indeed require the intended procedure, but also had an extensive iliac stenosis. An earlier MDT report on the computer was not filed in the patient’s notes, but had commented on the fact that angioplasty and stenting of this lesion was indicated, possibly as part of a combined (hybrid) procedure. If the surgery alone was carried out, it was likely that this would fail due to poor inflow.

With the patient already asleep, I went to the radiology department, where fortunately the interventional radiologist had finished a case and reviewed the films. Another lucky break occurred in that the hybrid theatre had just finished their case. The surgeon using that theatre agreed to defer his next case and the radiologist agreed to do the necessary iliac stenting as a combined procedure with the fempop. After a delay of some 40 minutes, the patient was transferred from the emergency theatre to the hybrid theatre where the combined stenting and surgery took place uneventfully.

Reporter’s comments

This case was a serious untoward incident in which the patient would have had to be awakened from anaesthesia because the correct procedure could not be undertaken. A series of events contributed to the adverse event: poor communication at handover; failure of ward-based imaging, absence of the MDT report in the notes and lack of presence of the surgeon at sign-in checks. But the principal cause was my failure to review the necessary imaging before taking responsibility for the procedure. The time-out WHO check would not have prevented this because the imaging review check occurs after the patient has been anaesthetised.

A happy outcome occurred only because of the professionalism and teamwork of the on-call anaesthetist, the radiologist and the hybrid theatre team, all of whom adapted to the situation without fuss or complaint. I have learned a significant lesson from this. The operating surgeon must undertake scrupulous review of all relevant investigations and management plans prior to operating on a pooled list or on a handed-over patient to reduce risk to the patient (and liability to the operator).

CORESS comments

The Advisory Board agreed with these comments.

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

rcsed.ac.uk | 11

AGENDA

The latest guidelines, articles and studies

IN BRIEF Multicentre observational study of outcomes after drainage of acute perianal abscess

This study recruited 141 patients undergoing drainage of acute perianal abscesses. By eight weeks after surgery, 44% of wounds were healed and 86% of patients had returned to normal function.

Also, 8% of abscesses had recurred and 27% of patients had developed a fistula in-ano by six months after surgery. Authors concluded that fistula had occurred in one-quarter of the patients and that postoperative packing is painful and costly.

Pearce L, Newton K, Smith SR and the North West Research Collaborative.

Br J Surg 2016; 103(8): 1063–1068

Comparison of outcomes after endovascular and open repair of abdominal aortic aneurysms in low-risk patients

Authors reviewed elective infrarenal EVARs (n=1070) and OARs (n=476) predicted at low risk of perioperative complications and death in the Vascular Study Group of New England database from 2003 to 2014. EVAR was associated with a lower perioperative complication rate (4.2% versus 26.5%). There was no difference in 30-day mortality (0.4% versus 0.6%) or overall survival at three years (92.5% versus 92.1%). In multivariable analyses, there was no difference in reintervention or survival. Authors concluded that in patients predicted to have a low risk of perioperative death following aneurysm repair, EVAR resulted in fewer perioperative complications. However, mortality, reinterventions and survival rates in the longer term appeared similar between groups.

Siracuse JJ, Schermerhorn ML, Meltzer AJ and the Vascular Study Group of New England. Br J Surg 2016; 103(8): 989–994

12 | Surgeons’ News | September 2016

Why the NHS should do more bariatric surgery; how much should we do?

certification. Seventy candidates took the examination, with their performance evaluated by expert colorectal surgeons using a task-specific checklist, global rating scale and overall performance scale. The pass rate ranged from 85.7% to 90%. Inter-rater reliability (0.85) and reliability of the pass/fail decision (0.87 and 0.84) were high. A low positive correlation (r=0.25) was seen between the COSATS and oral examination. All individuals who failed the COSATS passed the ABCRS oral examination. Authors suggested the current certification process might be failing to identify individuals who demonstrate technical deficiencies on this assessment tool.

Welbourn R, le Roux CW, Owen-Smith A, Wordsworth S, Blazeby JM. BMJ 2016; 353: i1472

de Montbrun S, Roberts P, Satterthwaite L, MacRae H. Ann Surg 2016; 264(1): 1–6

As the epidemic of severe and complex obesity worsens, availability of the most successful treatment, bariatric surgery, is limited – less than 1% of those who could benefit get treatment. The number of people getting bariatric surgery is falling despite rising rates of obesity and diabetes. This BMJ article examines why and the authors argue that better access has the potential to reduce the long-term costs of care. They explore the clinical and cost-effectiveness of bariatric surgery demonstrated through randomised data and national databases and examine the barriers to access.

Implementing and evaluating a national certification technical skills examination: the colorectal objective structured assessment of technical skill In September 2014, the COSATS was a mandatory component of ABCRS

Breast cancer

The NICE quality standard covers the management of early, locally advanced and advanced breast cancer, recurrent breast cancer and familial breast cancer in adults. It includes screening identified and symptomatic breast cancer and covers care from the point of referral to a specialist team.

NICE quality standard [QS12] June 2016. www.nice.org.uk

Using surgical video to improve technique and skill

This article reviewed the challenges of directly evaluating and improving surgeons’ performance using intraoperative video. This work with practising surgeons builds on previous experience of using video to assess laparoscopic skills among residents.

A recent study in bariatric surgery demonstrated that higher peer ratings of surgical skill were associated with lower rates of postoperative adverse events.

Authors believe that video analysis affords the opportunity to study both surgical technique (for instance, the details of how a procedure is conducted) and surgical skill (how well a surgeon undertakes a procedure). This is particularly applicable for complex procedures that already have the capability to capture video (for example, laparoscopy).

Grenda, T, Pradarelli J, Dimick J. Ann Surg 2016; 264(1): 32–33

The Perioperative Practitioner: Setting of Standards An Opportunity or Requirement?

Saturday 29 October 2016 The Studio, Birmingham

Book now!

5 hours of CPD! Session 1:

Session 3:

Educating the surgical team

Working towards acceptable standards

Chaired by Dr Yvonne Hurst, RCSEd Head of Education

Chaired by Mr Adrian Jones, AfPP Vice-President › Challenges faced by students joining the surgical team and the next steps for the professional group

› CPD requirements for the perioperative practitioner Mr Robert R Jeffrey, RCSEd Lead for CPD

› SFA education – fit for purpose?

Session 4: Mrs Susan Hall, AfPP Co-lead for Advancing Surgical Roles and Senior Lecturer in Surgical Care Requirements for perioperative practice Practice, Anglia Ruskin University Chaired by Mrs Dawn Stott, Conference › Simulation for perioperative practice Co-Convener and AfPP CEO Mr Alastair Geraghty, Honorary Simulation Fellow, › Revalidation – realising the benefits Scottish Centre for Simulation and Human Factors Ms Ros Moore, AfPP Trustee

Session 2: Providing the evidence/outcome data Chaired by Mr Charles Auld, Conference Co-Convener and RCSEd Council Lead for Perioperative Care › The e-Logbook – not just for surgeons Mr David F Large, Chairman SAC Trauma & Orthopaedics UK, Associate Professor University of Glasgow and Consultant Orthopaedic Surgeon, Ayr Hospital › The value of auditing the team Mr Nathan Stephens, Specialty Registrar, Glasgow Royal Infirmary Mr Charles Auld, Conference Co-Convener and RCSEd Council Lead for Perioperative Care

› Current issues in professional regulation Ms Emma Westcott, Assistant Director Strategy and Insight, Nursing & Midwifery Council

To book: web. rcsed.ac.uk email. education@rcsed.ac.uk tel.

0131 668 9209

AGENDA

FROM THE E LAB TO THEATRE As the College publishes its latest Research Report, Michael Steel reviews our membership’s valuable ongoing contribution to surgical research

14 | Surgeons’ News | September 2016

ach year, the College invites applications for research Fellowships, grants and bursaries.

These range in scope and scale from three-year, full-time research posts jointly supported by the College and the Medical Research Council to eight-week vacation ‘research tasters’ for medical students. All carry an obligation for reports to be submitted to the College at the end of the award period and sometimes at intermediate points as well. A survey of these reports reveals a fascinating picture of industry and achievement in an exceptionally wide field of endeavour.

Some of the awards are funded through endowments that specify the area of study, and cancer figures prominently among these. In recent years, there has been a clear trend towards investigation of the molecular basis of malignancy. Substantial work has been done, for example, on the detection of circulating tumour cells and DNA as sensitive diagnostic tools; the fundamental processes of evolution from in situ pre-cancer through to metastasis; the actual and potential anti-cancer roles of the immune system; and mechanisms of cancer cachexia.

Long before the danger of growing antibiotic resistance became an issue of widespread public concern, research funded by the College was examining alternative approaches to infection control Beyond the cancer field, infection in all its aspects has attracted its due share of attention and it is instructive to note that, long before the danger of growing antibiotic resistance became an issue of widespread public concern, research funded by the College was examining alternative approaches to infection control. These studies included the role of biofilms on ‘clean’ surfaces – for example, on surgical instruments and on implanted prostheses – and how these might be eliminated or overcome.

New alternatives to conventional chemotherapy (use of antibacterial phage; identification of specific bacterial toxins and of naturally occurring mediators of resistance to infection) have also received support. Lister would undoubtedly have approved.

A third recurring area of research that has received a substantial level of support is organ transplantation.

Topics have included experimental development of stem cell-derived mini-organs as potential autologous implants; evaluation of methods of donor-organ handling and preservation to increase the quality and yield of transplantable kidneys, livers and pancreases;

and detailed investigation of factors that determine the outcome of organ transplantation in the immediate, short and long terms.

While most awards continue to be made to practising surgeons, almost all the reports illustrate the interdisciplinary nature of surgical research. Our award holders invariably express their gratitude to the scientists with whom they have collaborated on their projects, but it is clear that the surgeon brings an invaluable clinical perspective to the team and that this is recognised by their collaborators. Whether they return to full-time surgical practice or follow a specifically academic path (some have gone on to careers as ‘clinician scientists’), almost without exception award holders have gained enormously from the experience of being directly involved in research. The College is proud of the contribution it has made (and is still making) to the advance of clinical practice through research.

Michael Steel Member of the RCSEd Research Board rcsed.ac.uk | 15

AGENDA

2014–16 RESEARCH REPORT IN NUMBERS

27

publications have come about through research projects funded by RCSEd

5

15

presentations have resulted from research projects in the Report

prizes have been won at international conferences

£1,042,860 13

4

new international collaborations have been set up

4

new bodies have provided further funding

is the total amount of funding in the Research Report

prizes have been won by researchers at conferences based on their projects

Research has been published in the most renowned journals in the world: Nature, Proceedings of the National Academy of Science of the USA and The Lancet

Notable projects

Professor John V Forrester

(University of Oxford)

(University of Aberdeen)

works on photoreceptor transplantation to cure retinitis pigmentosa

is researching corneal transplantation to overcome blindness

16 | Surgeons’ News | September 2016

Parwez Hossain (University of Southampton)

is studying ways to treat bacterial keratitis caused by the Pseudomonas aeruginosa bacterium

Professor Hamish Simpson (University of Edinburgh)

is researching how to stop non-union of fractures

© 2006 HAMEL

Professor Robert MacLaren

Surgical eLearning Opportunities in partnership with the Royal College of Surgeons of Edinburgh

PART-TIME ONLINE MASTERS PROGRAMMES FOR SURGICAL TRAINEES The Royal College of Surgeons of Edinburgh and the University of Edinburgh offer a range of part-time, online Masters programmes to support the junior and advanced surgical trainee. All of our programmes are taught by distance e-learning designed to run alongside clinical training and complement in-the-workplace assessment.

As a student, all you require is: • A computer • Broadband • 10-15 hours per week of study The MSc in Surgical Sciences (Edinburgh Surgical Sciences Qualification, ESSQ) is based on the MRCS curriculum and taught components are delivered through case scenarios of common surgical diseases, formative MCQs, and discussion forums.

The MSc Primary Care Ophthalmology provides optometrists, GPs, medical and surgical ophthalmology trainees and other eye health professionals with the opportunity to advance their understanding of primary care ophthalmology, in particular, Glaucoma, Macular Disease, Acute Eye Disease and Vision Loss.

The ChM programmes are based on the UK Intercollegiate Surgical Curriculum: ChM in General Surgery ChM in Trauma and Orthopaedics ChM in Urology ChM in Vascular and Endovascular Surgery All of our ChMs support learning for the Fellowship of the Royal College of Surgeons (FRCS) examinations, and offer an alternative to clinical/ laboratory research training for those students who do not wish to take time out of training. The MSc in Primary Care Ophthalmology and ChM in Clinical Ophthalmology programmes follow the Royal College of Ophthalmologists (RCOphth) curriculum, supporting junior and advanced ophthalmic trainees, respectively.

Contact us: MSc in Surgical Sciences MSc in Primary Care Ophthalmology email: essqinfo@rcsed.ac.uk ChM in General Surgery ChM in Trauma and Orthopaedics ChM in Urology ChM in Vascular and Endovascular ChM in Clinical Ophthalmology email: chminfo@rcsed.ac.uk

Apply now!

www.essqchm.rcsed.ac.uk

AGENDA

ROLL CALL With few pupils from comprehensive schools considering a career in medicine, Clare McNaught reports on what can be done to promote social mobility and to make the profession accessible to all

T

he competition for a place at medical school is fierce. Recent figures suggest that for every medical student placement, 11 applications are received. As well as obtaining top grades, applicants must have acquired high recognition in other aspects of life, such as sport or music, and have demonstrated complete dedication to their career by spending all of their free time working with charitable organisations.

These standards are difficult to achieve under any circumstances, but what if you come from an underprivileged background?

I attended a session of the All Party Parliamentary Group (APPG) on social mobility, chaired by Shadow Health Minister Justin Madders, which was looking at ways of helping students from disadvantaged backgrounds gain entry into medicine. Representatives from various organisations such as medical schools, junior doctor committees, the medical royal colleges, the GMC and trust chief executives were questioned by a number of MPs and House of Lords peers. The premise of the discussion was that medicine is still a career for the elite in society and that even if students make it into medical school, their career progression to the top is often hampered. Unfortunately, there is some evidence to support this claim.

A report by the Sutton Trust, Leading People 2016, shows that almost two-thirds of working-age Fellows of the Royal College of Physicians listed in Who’s Who had attended independent schools. A further 22% were educated at grammar schools and only 16% had attended state comprehensives. More than

18 | Surgeons’ News | September 2016

Clare McNaught Consultant General and Colorectal Surgeon based at Scarborough Hospital, a member of the College Council and Chair of the Younger Fellows Network

50% of comprehensives had not put any student forward for medicine in the last three years and the application rates from Scotland, Wales and the north of England were well below expected. Furthermore, admission data from the Medical Schools Council show that 20% of applications come from the most underprivileged groups in society, compared with 40% from the wealthiest in our population, and only 15% of our final medical school intake are from our poorest communities.

The APPG meeting was held in the prestigious committee rooms of the Palace of Westminster and was divided into two sessions. The first session explored the barriers to those from ‘widening participation’ (WP) backgrounds gaining entry into medicine. There was general consensus that many students from WP backgrounds did not have access to professional role models and considered a career in medicine to be unobtainable. The panel also agreed that WP students lack opportunities to obtain the high levels of academic qualifications to meet entry requirements and to gain the work experience needed to support their applications. Surprisingly, there was little mention of the considerable financial debt that would face any potential medical student. Figures published by the BMA show that average student loans will be more than £50,000 and that 75% of doctors will not repay them completely in the 30-year loan period.

The second session explored what more could be done to promote WP in medicine. I was impressed and relieved to hear that many organisations have already implemented a range of activities to address the issue. A number of medical schools, notably Imperial and Hull York, are involved in a Pathways to Medicine project, in which they support students in the last three years of secondary school to obtain work experience and help them prepare for the UKCAT, a clinical aptitude test used by many universities when choosing their students.

The Medical Schools Council in the UK has published a document, Selecting for Excellence, in which they endorse the concept of contextual admissions to ensure that students from WP backgrounds are recognised during the admission process. All the medical school

More than 50% of comprehensive schools had not put any student forward for medicine in the last three years

PARKERPHOTOGRAPHY / ALAMY STOCK PHOTO

A career in medicine should be open to students from all social backgrounds

representatives expressed their frustration at the public league tables that rank them against each other, particularly in relation to their entry requirements for the course. They implied that a reduction in A-level entry qualifications from AAA to ABB would help widen access, but at this time any such move would negatively impact on their international standing and subsequent funding.

During the meeting, I was questioned about the responsibility the medical royal colleges have to participate in the WP programme. I explained that the Royal College of Surgeons of Edinburgh, like many other colleges, has been involved in outreach activities into secondary schools to promote the career of medicine and surgery. I described our collaboration with the University of Edinburgh, as part of the National Reach Scotland project, where we host a workshop for WP students, to allow them to meet doctors and medical students from similar backgrounds who have been successful in pursuing a career in medicine.

I also highlighted our other activities, including the Getting into Medical School course held annually at the College, where we advise students on the application process and provide an opportunity for them to

question representatives from the Scottish medical schools. South of the border, we run a variety of joint ventures with the medical student surgical societies.

For example, the Sheffield Surgical Society runs an essay competition in local schools, which enables four students to attend the National Medical Student and Foundation Doctor Conference, where they hear lectures from internationally renowned surgeons and take part in an afternoon of Skills Lab training.

At this point, the theme of the discussion switched to explore the reasons why doctors from WP backgrounds do not appear to progress to high office in medical and government organisations. I expressed my own opinion that the change in the working practices from a consultantsupervised to a consultant-delivered model of care, and the subsequent squeeze on consultant SPA time, has meant that most external activities have to be performed in the evenings and weekends. Doctors from WP backgrounds are likely to have large debts on graduation and are more likely to take on private practice or waiting-list initiatives during their free time, limiting their capacity to do other important non-clinical duties. I stressed to the Shadow Minister and the MPs that consultant SPA time needs to be protected in the upcoming contract negotiations.

At the end of the meeting, there was a firm commitment from all involved that the career of medicine should be open to students from all walks of life and that we must continue to actively engage with primary and secondary education, particularly in areas of deprivation, to ensure we attract and recruit the very best students. Medicine has lagged behind many of the other professions in its attempts to promote diversity in the workforce. We must address this and ensure that our selection process for medical school is transparent, robust and fair to all.

rcsed.ac.uk | 19

PERIOPERATIVE CARE

AN EXERCISE IN GOOD OUTCOMES Collaboration between specialists in perioperative medicine and sport and exercise medicine is improving the surgical care pathway for thousands of patients

E

ach year in the UK, 10 million patients undergo surgery. The majority of them are cared for according to local pathways that ensure fitness for surgery and aim to ensure good outcomes. Around 250,000 are at greater risk of complications when they have surgery due to significant comorbidities and these patients may not be best served by pre-existing pathways. In order to identify these patients, avoid delays and improve outcomes, the Royal College of Anaesthetists introduced the concept

of perioperative medicine to deal with this unmet treatment need with the goal of reducing variation and improving patient outcomes following surgery.

The RCSEd has since launched its Faculty of Perioperative Care, established in response to changes to the traditional structure of surgical teams and the increasing number of perioperative staff recruited by hospitals. It is now widely acknowledged that more integrated working and communication across the whole surgical team can lead to better patient outcomes, a position that is supported by numerous studies. Jon Dearing, a consultant orthopaedic and sports injuries surgeon in collaboration with the Faculty of Sport and Exercise Medicine (FSEM), has outlined, as part of the College’s exercise and surgery campaign, the importance of perioperative and sport and exercise medicine (SEM) in the surgical pathway.

Perioperative medicine involves using the resources already to hand in hospitals in a more intelligent manner so that patients at increased risk are identified and the risks are assessed and adequately treated prior to admission for surgery. This also establishes any 20 | Surgeons’ News | September 2016

The FSEM and the RCSEd are developing conditionspecific exercise programmes

FSEM and RCoA event In order to share expertise, a joint meeting between the FSEM and the Royal College of Anaesthetists is planned for March 2017 in Edinburgh and those with an interest are encouraged to attend, ideally with their anaesthetist colleagues. Visit fsem.ac.uk for details.

subsequent needs following surgery, including for highdependency or intensive-care beds, and ongoing care in the community. Often, this involves assessment by the GP prior to referral for elective surgery to optimise diabetic control, correct anaemia and address lifestyle and nutritional problems, all of which contribute to perioperative morbidity.

Many hospitals are already performing similar functions with preoperative assessment clinics, joint schools and enhanced recovery programmes. A multidisciplinary approach is advocated, incorporating surgeons, anaesthetists, physiotherapists and occupational therapists, as well as specialist nurses.

The specialty of SEM is now recognised as a key part of the equation in reducing patients’ perioperative risk, resulting in a significant improvement in long-term health if prehabilitation leads to a lifestyle change. Early liaison with a specialist dealing with respiratory or endocrine problems is also encouraged.

Assessment of cardiovascular risk during surgery may be more formally quantified using cardiopulmonary exercise testing (CPET).

This accurately quantifies cardiovascular function and capacity so

patient risk may be stratified and appropriate steps may be taken to minimise risk. CPET is offered in many hospitals, usually supervised by anaesthetists.

One example of the effective use of CPET is from the University Hospital of Wales, where Dr Huw Evans oversees, on average, three CPET clinics per week.

These clinics are run by a consultant anaesthetist and evaluate the cardiorespiratory fitness of patients due to have major intra-abdominal surgery. It is a dynamic test that can be used to quantify an individual patient’s risk and to recommend the most appropriate location for postoperative care (ward care versus critical care).

Currently, the University Hospital of Wales is testing about 300 patients per year.

As well as identifying high-risk patients, the hospital’s CPET clinics provide an important opportunity to assess existing comorbidities and to uncover hidden comorbidities that can impact on their perioperative risk. It allows opportunities for optimisation of conditions such as cardiovascular disease and anaemia, patient medications and appropriate referral for further specialist investigations and management. These

The application of exercise medicine and physical activity in surgery has been recognised by one of the UK’s leading healthcare think tanks preoperative interventions can lead to a reduction in risk during the perioperative period. A specialist in SEM is able to provide valuable input into aspects of exercise specificity with respect to comorbidities, goals and shortterm, targeted preoperative interventions to improve aerobic fitness.

Preoperatively increasing the level of physical activity – for example, taking 30 minutes of moderate physical activity five days a week – will reduce complications and increase early discharge. Therefore, encouragement of the CMO physical activity guidelines as part of the preoperative plan is also strongly emphasised.

One of the UK’s leading healthcare think tanks, the King’s Fund, has recognised the application of exercise medicine and physical activity in surgery. It hosted a session on preoperative optimisation in its February 2016 conference, Integrating Care Through the Patients’ Surgical Journey.

Jon Dearing, representing the RCSEd, led a session on communicating the benefits of moderate physical activity before and after many types of procedure, improving surgical outcomes, aiding the recovery process and enhancing the patient’s own psychological wellbeing. Simon Roberts, orthopaedic surgeon and preoperative fitness representative for the FSEM, was a panellist involved in the discussion on how we develop preoperative intervention, knowledge sharing, and addressing unhealthy patient behaviours and comorbidities at an early stage in the pathway. By getting involved in events such as this, both organisations can help raise awareness of the importance of perioperative care working alongside SEM as part of a multidisciplinary team for patients undergoing major surgery.

The FSEM, in collaboration with the RCSEd, is developing a series of condition-specific exercise programmes that will be available soon. SEM consultants are trained in the prescription of exercise in chronic disease and are useful colleagues to turn to in difficult cases.

The FSEM has published A Fresh Approach, an NHS information document on exercise in the treatment of chronic disease. It has also produced a booklet for medical students outlining how to prescribe exercise, with handy chapters on specific conditions, including hypertension, type 2 diabetes and cancer. Perioperative medicine is still in its infancy, but the benefits will become increasingly clear and surgeons will wish to be at the forefront of its development. fsem.ac.uk rcsed.ac.uk | 21

CRISIS IN SYRIA

‘WE RARELY WAKE UP WITHOUT HEARING AN AIRSTRIKE’

A surgeon working in the besieged Syrian city of Aleppo tells Surgeons’ News about the devastating impact the ongoing crisis is having on the country’s healthcare system and its medical teams

T

he deliberate bombing in April of a hospital in Aleppo and the death of more than 50 civilians and medics, including the last remaining paediatrician, has highlighted the catastrophic humanitarian disaster that continues to unfold in Syria.

Surgeons’ News had the opportunity to interview a medical specialist working in a Syrian conflict area.

Speaking on condition of anonymity, ‘Dr A’ demonstrated the compassion, selflessness and bravery that medical colleagues display on a daily basis to care for their patients caught up in the long-running crisis.

There are stark differences in the provision of medical care between government- and rebel-held areas, as Dr A explains: “Although medical provision in the areas controlled by the Assad Al-Quds r hospital afte airstrikes

22 | Surgeons’ News | September 2016

regime has not been significantly disrupted, the public hospitals are under greater strain due to the increase in military personnel requiring medical treatment. This has driven up prices for private treatment at the same time as general living standards have fallen.”

Despite all this, he says that in general there are enough working hospitals, medical personnel and supplies for a relatively stable service within regime areas. It’s a different story in areas under rebel control. “This is where the real disaster is taking place,” Dr A observes. “A collapse in the healthcare system has been caused by a loss of medical staff and hospitals. And, of course, the ministry of health and various government directorates have lost oversight of healthcare in rebel-held areas.”

Alongside this, there has been an increased presence of non-governmental organisations and charities, which have presented medical staff with the additional challenge of adapting to dramatically changing governance structures, support and responsibilities.

Syria now ranks as one of the most dangerous places in the world to work as a doctor, with estimates that more than 700 doctors have been killed during the conflict and many others have had their medical school education or postgraduate specialist training interrupted.

Medical facilities in these areas have been targeted to “destroy the remaining health system”, and aid supplies have also been disrupted by shelling of transport networks, says Dr A. So what are the daily challenges from Dr A’s perspective? “Aleppo is a city under siege, with aid coming only rarely via the only route in and out of the

If any reader is able to help with any of the College’s initiatives in Syria, contact Catherine Thwaites, International Activities Manager, c.thwaites@rcsed. ac.uk

city, which is constantly under fire,” he says. Asked if he can describe a normal day, he responds: “There is nothing normal in rebel areas. We rarely wake up without hearing the sound of an airstrike, helicopters or the falling of a barrel bomb. We usually work more than 12 hours daily and sleep less than six hours a night.” He adds that most doctors are living at their hospital, away from their families, and working two-week shifts. Some feel it is riskier or too difficult to commute.

By staying to treat civilians caught up in this crisis, doctors are not only risking their lives, but also their future as doctors. While some have left to protect their families and complete their training in other countries, those who stay may be considered unqualified and not recognised as specialists after the war is over. In addition to the international action to ensure their safety during the conflict, these doctors also deserve support and help to protect their future career advancement. Indeed, Dr A says the education system has suffered a “greater collapse” than healthcare and that there are now very few teachers or professors remaining.

THE RCSED AND SYRIA The College has been working as part of an international group to help address the training needs of Syrian medical students and specialist doctors. In collaboration with the International Working Group Supporting Continuing Medical Education for Syrian Doctors and Medical Students, and Syrian doctors who are rebuilding their specialist training programmes, a number of initiatives have been introduced.

Places have been identified for Syrian medical students to complete their degrees at two Jordanian universities and it is hoped to extend this to other institutions throughout the Middle East.

Simon Frostick, Professor of Orthopaedics in Liverpool and Member of RCSEd Council, has offered his time to help develop the medical curriculum for Syrian specialist training. We have also approached our Surgical Speciality Boards to supply mentors to help in an advisory role to the newly formed surgical specialty technical committees in Syria.

The crisis in Syria shows little sign of resolution. We must do all we can to support any initiative that aims to maintain any semblance of a medical training structure so that Syrian doctors have a platform on which to build a future for themselves and the Syrian people when the war is over.

EPA EUROPEAN PRESSPHOTO AGENCY B.V./ALAMY STOCK PHOTO

ABDAIRHMAN ISMAIL/REUTERS

Doctors working in Dar al Shifa in 2012. The hospital has since been destroyed

www.rcsed.ac.uk | 23

REMEMBERING SAM GALBRAITH

We publish excerpts taken from a new book celebrating the extraordinary life of Sam Galbraith, whose socialist values led him from a career in medicine into politics

THE PEOPLE’S NEUROSURGEON

Sam Galbraith, Consultant Neurosurgeon, Institute of Neurological Sciences, Southern General Hospital, Glasgow, 1987

24 | Surgeons’ News | September 2016

Professor Sir Kenneth Calman first encountered Sam Galbraith at university and later as Hall Fellow of Surgery in Glasgow Sam was a most distinguished graduate of the University of Glasgow. He was awarded a first-class honours BSc in Anatomy in 1968 and graduated MB ChB with honours in 1971. His graduation brought him a number of prizes – in particular, the Brunton Memorial Prize for the most distinguished graduate of the year. He completed this academic tour de force with an MD in 1976 on the subject of ‘acute traumatic intracranial haematoma’.

I met him as a student, but we really got to know each other when he became Hall Fellow in Surgery in 1973, a highly prestigious post. This was in the Department of Surgery in the Western Infirmary led by Sir Andrew Watt Kay. I had been Hall Fellow in the same department four years before and was at that time a lecturer there. My annual salary as Hall Fellow was £1,400, so neither I nor Sam entered medicine for the money!

Professor Sir Kenneth Calman KCB Chief Medical Officer for Scotland, 1989–91, for England and Wales, 1991–97; Chancellor of the University of Glasgow, 2006 continuing

Sir Graham Teasdale describes Sam’s entry into neurosurgery When Sam finished his student career he already had a commitment to neurosurgery. This ambition had been implanted when his younger brother, Roderick, had an operation in the Glasgow Unit for a brain haemorrhage.

So, immediately after the usual pre-registration junior medical and surgical posts, he sought practical experience of neurosurgery in short posts in Glasgow and Edinburgh. In 1974, after two years in general surgery, he chose to begin training in the Glasgow neurosurgical unit, bringing us together again because I was then the senior registrar.

The Glasgow unit was the ideal place for Sam. In 1970, for the first time outside London, neurosurgery had been brought together with its allied specialties of neurology, neuroradiology, neuropathology, neurophysiology and neuroanaesthesia in a new, purpose-built Institute of Neurological Sciences (INS).

This served all the three million people in the West of Scotland, was well resourced and in the vanguard of providing the latest technological advances. The neurosurgical unit had a long-standing ethos of team working and had recently gained an extra, academic dimension through the creation of a university department of neurosurgery. This was led by Professor Bryan Jennett, the outstanding neurosurgical thinker of the time. Bryan was to be an inspiration and a careerlong mentor to Sam and myself.

The exciting, heady environment created by this combination of busy surgical service and scientific clinical culture provided a foundation on which Sam flourished. Indeed, he burst onto the neurosurgical scene.

Sir Graham Teasdale Professor and Head of Department of Neurosurgery, University of Glasgow, 1981–2003

Margaret Harkess explains why Sam was so popular with patients and hospital staff Patients loved and respected Sam because he spoke with and to them at their level. When he was the bearer of bad news, Sam would go to see patients on his own, sit on their beds and speak gently and quietly to them.

Weekend ward rounds are less formal, but Sam took ‘dress down’ to a whole new level. His idea of casual was a disreputable brown woollen jersey with large holes in the elbows. So he would wander round, seeing his patients, helping himself to their grapes on the way.

Sam was Sam to everyone. He was easy to talk to and with. With him, the staff found an empathetic ear for their grievances over their pay. So when the Confederation of Health Service Employees (COHSE) organised a nationwide demonstration and 24-hour strike in 1982, Sam was a major supporter and headed the march in Aberdeen. For this deed, the Health Board withheld half a day’s salary. Undeterred, Sam declined to take the full value of a 10% pay rise to doctors when other staff were awarded only 4%, and donated the difference to an NHS hospital. For that, he was even more of a hero to the staff!

Remembering Sam: The Life and Times of Sam Galbraith is published by Birlinn birlinn.co.uk (£12.99, hardback)

Margaret Harkess Charge Nurse in the neurosurgical theatres, Institute of Neurological Sciences, Glasgow, 1973–2009

Professor Sir Harry Burns sought guidance from Sam when he wanted to make a broader contribution to public health in Scotland By 1989, I had been a consultant surgeon for five years.

I had spent those years working in the Royal Infirmary in Glasgow, where the patients were suffering from many of the illnesses of poverty. I wanted to do something more for them than operate on them. Sam was the obvious person from whom to seek advice.

We had spent New Year with Sam and [his wife] Nicola in Kingussie. One afternoon, I told him about my restlessness. We quickly established that I had no interest in becoming a politician. “Why don’t you go and do community medicine? You could do a lot for

Sam and Jonathan Butler with three junior canvassers, 1997

www.rcsed.ac.uk | 25

REMEMBERING SAM GALBRAITH Speaking from the hea lth care workers’ campai gn bus, George Square, Glasgo w, 1982

Sam, Brian Wilson and Donald Dewar: new ministers in the Scottish Office, May 1997

Sam thoroughly approved of the establishment of medical groups such as the Glasgow Medical Group because he saw them as providing the broader educational dimension that many felt was lacking in the training of doctors at that time. He contributed to this educational dimension, and the discussions in turn helped to shape his political views on medical education, the NHS and wider issues.

Sam was able to make successful contributions partly because he had what can be called ‘street cred’.

Medical students are a confident bunch and do not always take seriously points of view other than received medical opinion delivered by medical consultants.

However, when a neurosurgeon speaks, he will certainly be listened to, and what he says will be considered. For example, it is common for medical students to interpret the problems of life in medical terms and to look for medical solutions. However, when Sam told them that many health problems – perhaps the majority – are caused by lifestyle and diet, and that lifestyle and diet are themselves partly or mainly the result of poverty, then they listened. Indeed, speaking more generally, I think it correct to say that Sam’s major contribution to politics was to convince ministers of the link between poverty and ill health.

Sadly, 1987 brought news that would overshadow Sam’s political career. He was diagnosed with fibrosing alveolitis. He was told he would probably have two years to live. As his physical condition deteriorated, it severely affected what he could do in the House of Commons.

With only days to live, he had a lung transplant. It was to give him another 25 years of life.

Sam returned to Westminster after several months’ recuperation. His spirit, indomitable at the worst of times, was even stronger. After the general election of 1992, it was clear that unless the Labour Party changed and began to appeal to the middle ground of politics, not just in Scotland but throughout Britain, we would never win the power needed to change our country for the better. Although Sam had been tempted by the shortlived Scottish Labour Party in the late 1970s, he had soon rejoined the Labour Party and was always what is now referred to as a moderniser.

This was not a matter of left or right, but simply a pragmatic understanding that a Labour Party that is unelectable is as much use as a surgeon without a scalpel.

He was close to Donald Dewar. He, like me, backed John Smith. On his untimely death, many of us agonised over choosing between Gordon Brown and Tony Blair in the leadership election. I remember Sam was one of the first to say it had to be Tony. He, Sam said, could reach out to the millions of voters we needed to win back. And not just in England – middle Scotland exists, too. Sam knew that well – Strathkelvin and Bearsden had its fair share of leafy suburbs, just like so many constituencies south of the border. It had been persuaded to vote Labour and so could they.

In 1997, following Labour’s landslide victory, Sam was appointed Health Minister at the Scottish Office.

He told me at the time how much he valued the opportunity to make changes. He enjoyed having access to civil servants who were a world away from the Yes Minister stereotype. The respect was mutual. When Sam died, a senior civil servant told me of the palpable shock felt as news of his death spread among her colleagues. There was a genuine affection and deep respect for a good man and a fine minister.

Robin Downie Professor of Moral Philosophy, 1969–2002; Emeritus Professor, University of Glasgow, 2002 continuing

Alistair Darling Chancellor of the Exchequer, 2007–10, and Labour Member of Parliament, 1987–2015

poor neighbourhoods from that specialty.” It had never occurred to me to pursue such a career change. I thought about it for about 30 seconds and realised it was the most sensible option available.

Sam was like that. He went straight to the heart of the matter with clear thinking and straight talking. The decision was made. It was the best career move I ever made and I owe it to Sam. Professor Sir Harry Burns Chief Medical Officer for Scotland, 2005–14

Robin Downie got to know Sam through the Glasgow Medical Group, where Sam’s views on medical education, health and politics took shape

Excerpts published by kind permission of Birlinn Limited

Alistair Darling on Sam’s pragmatic attitude to modernisation of the Labour Party

26 | Surgeons’ News | September 2016

Conjoined twins, drawn by Johann Friedrich Meckel

THE ONE THAT GOT AWAY Jacqueline Cahif reveals the fascinating tale of how, in the early 1800s, the College came close to acquiring one of the finest anatomical collections in Europe

www.rcsed.ac.uk | 27

MUSEUMS

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he Meckel Collection, comprising around 8,000 anatomical specimens and housed at the University of Halle in Germany, is said to “rank among the largest and most important of its kind in Europe”.1 This private collection of German anatomist and embryologist Johann Friedrich Meckel the Younger (1781–1833) appears to have had an intriguing history, and in the early 19th century came very close to finding its home in the College’s Museum. Tucked away in a substantial correspondence sequence in the archive at the Royal College of Surgeons of Edinburgh lies a bundle of letters sent by the German anatomist to the College. They reveal that Meckel attempted to sell his entire collection of anatomical preparations to the College in the 1820s.

The Museum was very keen to purchase the collection of this famed German anatomist. The attempt was aborted, however, and the circumstances surrounding the failed sale remain ambiguous, although Meckel’s depressive illness (induced by chronic liver disease), together with his stubborn and impulsive personality, may have been a contributing factor. It is evident from the correspondence that an element of defiance against the Prussian state, and the “academic mediocrity” prevalent in Halle, drove Meckel to pursue the sale of his beloved human and morbid anatomy collection in Scotland.

In 1821, the Museum sought its first serious largescale purchase, turning its attentions to Meckel, whose collection “was considered to be without a rival in Europe [and] now offered for sale”.2

The Meckels’ anatomical collection Johann Friedrich Meckel was born into a medical dynasty comparable to that of the Bells and Monros in Edinburgh. His father, Philipp Friedrich Theodor Meckel, was an anatomist; his grandfather, also named Johann Friedrich Meckel (the Elder), was professor of anatomy in Berlin; and his brother and nephew were also anatomists. It was Johann the Younger whose skills and observations in comparative and pathological anatomy and research on deviations from normal embryonic development earned him the accolade of one of the greatest anatomists of his time. In 1808, he became professor of normal pathological anatomy, surgery and obstetrics at the University of Halle. Together with his father and grandfather, Meckel amassed a substantial

The German anatomist never wavered in his insistence that the family’s prized collection should go to Edinburgh. Indeed, his letters became increasingly explicit over the following year, seething with animosity against the state and his academic institution 28 | Surgeons’ News | September 2016

The tone of a letter from Meckel to RCSEd in 1821 was one of urgency, with the anatomist seemingly desperate to sell his collection to the College as soon as possible in an act of defiance against Halle’s “parcel of rascals”

anatomical and zoological collection, which was housed in the family home and was famous in medical and scientific communities. It is said that Napoleon took up residency at the house, using it as a temporary base in 1806 when troops occupied Halle.

The youngest Meckel spent his life immersed in obtaining specimens and cataloguing his collection.

Passing through Germany in the late 1820s, London physician-accoucheur Augustus Granville made a “digression” to “see the University at Halle, and its principal ornament, Meckel, the first and best anatomist of the age”. Meckel was delighted to show Granville his preparations and invited him to the family museum, where he found “780 very neat preparations, illustrative of normal anatomy, classed according to structure and functions, which include those intended to exhibit the progress and development of the human foetus… these are followed by all deviations of normal structure… both medical and chirurgical. Of such specimens, Meckel’s museum contains not fewer than 2,850 and I could not help being forcibly struck by the great beauty… In part of the museum of comparative anatomy 2,500 preparations in spirits, besides some hundreds of dry preparations and skeletons”.3 In 1821, Meckel wrote to the College about “the number of my preparations of human anatomy, normal, as we shall say, and morbid anatomy amounts to 5,000 pieces”. This was clearly a substantial collection. As Granville remarked: “The family of the Meckels of Halle in Germany had for three generations employed themselves in forming an anatomical museum.” Which begs the question, why did the younger Meckel wish to dispose of the collection “with all my heart… to place it at Edinburgh” and, going by the tone of his letters, with haste? In early 1821, he wrote bitterly to RCSEd: “If I did not desire earnestly to quit the service, in which I have been treated with the most abominable ingratitude and sacrificed to a parcel of rascals, who inspired by envy and malice, have dared against myself every conceivable villainy.”3 In a later letter, he explains: “The only reason, for which I offered my collection, was the most lamentable state of medical instruction in this place, as excepted Prof. Sprengel and perhaps myself, nobody cares about a scientific instruction of the young men… On this account I preferred to quit my place… separating myself from the dearest possession of mine, my collection.”

Granville lamented that “it is to be regretted, that a genius like his [Meckel] should… be wasted or remain useless to science in such a place as Halle, shackled by the toil of an everyday pedagogic instruction”.

Prussian administration and the teaching of anatomy’s “elementary principles” irked Meckel, and he was especially frustrated that Halle was treated as provincial and inferior to Berlin. Throughout his communications with Surgeons’ Hall, the German anatomist never wavered in his insistence that the family’s prized collection should go to Edinburgh. Indeed, his letters became increasingly explicit over the following year, seething with animosity against the state and his academic institution. In 1822, he wrote: “I am forever decided that my collection shall never be sold to the Prussian state in general, nor particularly to this

The College may not have secured Meckel’s famous collection, but it did acquire the collections of Robert Knox and Charles Bell, specimens of which are shown here

References

1. Göbbel L, Schultka R, Klunker R, Stock K, Helm J, Olsson L, Opitz JM, Gerlach A, Tönnies H. Nuchal cystic hygroma in five fetuses from 1819 to 1826 in the Meckel-anatomical collections at the University of Halle, Germany, American Journal of Medical Genetics Part A 2007; 140(2): 119 2. Kemp D & Barnes S. Surgeons’ Hall: A Museum Anthology (2009) 3. Granville AB. St. Petersburgh.

A journal of travels to and from that capital (1829)

university, and there are already taken measures, that if during my lifetime it might not be sold, neither this state nor the university shall get it in any way after my death.”

After a break in communications, the College, worried, wrote to Meckel to enquire of the delay. However, this appears to be down to Meckel’s “very ill state of my health”, as he responded, “I intend by no means to retract the reasons, that engage me to sell my collection, still persisting in the same degree as before”.

Although negotiations with Edinburgh continued, the sale was aborted, being noted in the RCSEd minutes (5 October 1824) as being “withdrawn from sale by the family and this College’s endeavour came to naught”. It is unclear why and is particularly curious given that Meckel was fiercely mistrustful of those around him and adamant his collection would not remain in his home town.

Granville hints to a problem with Meckel’s government salary of “1500 rix thalers as professor, a further sum of 300 rix thalers… for spirits and glass bottles … but he was constantly out of pocket”. However, at some time in the late 1820s (several years after the unsuccessful Edinburgh sale), the Prussian government “added considerably to his salary”.

Following the failure to secure the Meckel pathology collection, the College acquired the collection of John Barclay, comprising around 2,500 specimens. Around this time, the College also acquired the Charles Bell collection from Bell’s anatomy school in Great Windmill Street, which was shipped by horse and cart and docked in Leith in 1825.

Dr Jacqueline Cahif, College Archivist The RCSEd Library and Archive blog is available at rcsedlibraryandarchive.wordpress.com www.rcsed.ac.uk | 29

LEADERSHIP PROGRAMME

New clinical leadership initiatives for trainees are laying the foundations for stronger management in the NHS

HELPING HANDS

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arlier this year the College brought together, for the first time, doctors taking part in a UK-wide Fellowship programme to develop clinical leadership in the NHS. The Clinical Leadership Fellows (CLFs) came from all four UK nations to learn from each other and discuss the potential of leadership and collaboration across boundaries.

The College supports half of the funding for three CLFs, based in Scotland, England and Wales. The oneyear posts are an important part of a strategy to develop professionalism and excellence across medicine and dentistry in the NHS. The aims are wide ranging, but a key target is to identify then progress the significant leadership potential of junior doctors beyond their importance as clinicians.

This has clear benefits for the individuals who become CLFs because they are able to develop leadership skills through interaction with health-service leaders. However, there are benefits for the service too. Peter Lees, Chief Executive and Medical Director of the Faculty of Medical Leadership and Management (FMLM), believes junior doctors and trainees represent a “significant and largely untapped resource of emerging leaders who have a unique perspective on front-line service”.

For Nathan Stephens, the College’s first CLF in 2015, the role allowed him to step away from the surgical front line to explore factors influencing the provision and delivery of healthcare in Scotland and across the UK. He says: “I became involved in several quite diverse aspects of the healthcare machinery along with experiencing how to tackle some of the big challenges that the modern NHS faces. I gained an understanding of the structure

30 | Surgeons’ News | September 2016

of the NHS, along with how organisations such as the RCSEd, the Scottish Government, the GMC and the BMA interact.” He adds that being able to discuss current healthcare challenges with many senior medical leaders from across the UK gave him an awareness of the challenge of making the best decision in the face of complex problems.

Nathan was also able to use the Fellowship to develop his understanding of health-service governance. He explains: “Despite having spent over a decade working within the NHS, my knowledge of the management structures, professional bodies and political machinery that influence and drive front-line services was limited.”

Prior to the CLF, Nathan’s observation was that the most stressful and challenging issues for many senior clinicians were not clinical, but stemmed from management and organisational problems. These two factors would seem to underline the need for CLFs, but perhaps the acid test is how Nathan feels now, having completed the Fellowship. “I am more inclined to embrace challenging roles and confront system problems, or encourage and support peers to do so.

My approach to team working has moved from maintaining stereotyped roles towards valuing the different strengths of each individual and trying to work more cohesively,” he says.

The College’s Immediate Past President, Ian Ritchie, explains that the RCSEd chose to support CLFs as part of its commitment to pursuing excellence in patient care: “As a surgical College, it is essential that we engage in a process that encourages surgeons at all levels to think more widely about the environment in which we practise. It is particularly important that the next generation has an understanding of leadership and management because they will be providing care for all of us in the future and it is best if they’re involved in ensuring that the service is provided to the highest standard within the resources available.”

Critics may argue that there’s only so much that can be achieved in a year, especially when CLFs are juggling clinical commitments at the same time. And isn’t it possible that experience and knowledge gained during

It is important that the next generation has an understanding of leadership and management because they will be providing care for all of us in the future www.rcsed.ac.uk | 31

LEADERSHIP PROGRAMME

the Fellowship will fade once the doctor goes back into full-time training? To ensure this doesn’t happen, there is an alumnus scheme to continue support and development of the Fellows through the remainder of their training and facilitate ongoing networking.

Nevertheless, it is fair to assume that it will take a number of years for the full benefits of CLFs to become apparent. So how might the Fellowships change the nature of NHS clinical leadership in the long term?

The FMLM’s Peter Lees hopes that an enlightened and knowledgeable cadre of emerging leaders will “enable a greater recognition of the value of medical leadership at all levels of the system with attendant improvement in the quality and value of care for patients”.

Ian sees CLFs having a unifying effect between managers and clinicians that will benefit the health service in the long run. “I have a vision that the Clinical Leadership Fellows will be able to spread the news that managers are not bad people, that they have a difficult job to do and that it is incumbent on all of us to work as a team to provide the best care for our patients,” he says.

Clearly, many consultants and senior clinicians of past generations moved into leadership roles, so what is it that CLFs offer in the modern health service? Ian cites developments in the growth and management of the NHS: “In the past, surgeons and senior clinicians generally were involved in medical leadership roles. This was an inevitable part of working in a hospital. However, as the NHS has developed, there has been a tendency towards centralisation of collections of institutions and services. There has also been the development of management that has not included clinicians, but clearly it makes sense for clinicians to be involved in managing the environment and services that affect not only patients but all who work in the NHS.” Is it too early to look for evidence of the effectiveness of CLFs? Lees believes there is already excellent evidence linking leadership to clinical outcomes, pointing out “there is plenty of evidence in national inquiries of what happens to patients if leadership fails”.

Ian Ritchie will be taking a keen interest in the progress of CLFs as their careers develop. He says: “A sufficient number of CLFs have now been completed such that it should be possible for us to gather data on how they have progressed, what they have achieved and how they are continuing to be used in the context of the National Health Service to which the Fellows have returned. I think this is the next stage in the process to ensure that this resource, which has had a significant contribution from the College, is used effectively.”

There is plenty of evidence in national inquiries of what happens to patients if leadership fails 32 | Surgeons’ News | September 2016

Northern Ireland’s ADEPT initiative Professor Keith Gardiner explains how Clinical Leadership Fellowships will help to bring about quality improvement The Northern Ireland Medical and Dental Training Agency’s (NIMDTA) Achieve Develop Explore Programme for Trainees (ADEPT) scheme enables senior doctors and dentists in training to take one year out of programme to work on quality-improvement (QI) projects with senior leaders.

While still in the inaugural year of the programme, the work completed by the Fellows, with the sponsorship of host organisations, has already supported improvements in the care delivered to patients in Northern Ireland.

By complementing structured training on leadership with tailored coaching and mentoring sessions, Fellows have benefited from personal development alongside the acquisition of projectmanagement skills.

ADEPT Fellows have completed regional QI projects on communication that have engaged other trainees to improve medical handover in a Trust, standardised morbidity and mortality meetings in an organisation, and have produced regional guidance on best practice for morbidity and mortality meetings. Fellows have collaborated on regional projects, sharing learning from serious adverse incidents, and have teamed up with their counterparts across the UK to promote the lessons learned.

Over the last year, Clinical Leadership Fellows (CLFs) have

contributed to national qualityimprovement initiatives while improving local multi-professional QI training. Fellows have championed formal QI training at an individual and system level, with plans for the 2016/17 cohort to spread this work across the region.

They have improved access to (and therefore improved learning from) simulation training throughout Northern Ireland, while simultaneously supporting the development of a Northern Ireland Simulation and Human Factors Network.

Fellows have listened to trainees and had the opportunity to influence government policy and strategy.

They have explored innovative ways of working, such as paperless patient records, and have presented their work at international forums.

ADEPT Fellows have strengthened local links between regulatory bodies: the GMC and Regulation and Quality Improvement Authority (RQIA). Finally, an ADEPT Fellow, sponsored by the RCSEd and working alongside the Deputy Chief Medical Officer, has been working to strengthen and develop the Improvement Network of Northern Ireland.

Structure

ADEPT Fellows integrate into host organisations, gaining a greater appreciation of the relationship between clinical practice and service management. By thinking

in leadership and QI in Northern Ireland. By appointing senior doctors and dentists in training who are already committed to a training pathway and investing in an ADEPT AlumNI Programme to ensure sustainability, we hope to see that the investment in leadership and management training is reinvested directly back into healthcare.

Time commitment

Taking time out for experience can be difficult for trainees

differently using reflective practice, and leading on QI projects, Fellows have the opportunity to work with senior colleagues facing similar challenges. This creates rich learning opportunities in which Fellows can sharpen their influencing and negotiating skills in a multi-professional environment.

Alongside their supervised role in host organisations, Fellows participate in a Leadership Development Programme through the HSC Leadership Centre. Coaching and mentoring sessions, host organisation insight visits, and completion and presentation of a QI project complement the attainment of a Level 7 Certificate from the Institute of Leadership and Management.

ADEPT is unique in this regard because other leadership

There is already evidence of significant improvement in both the personal and professional skills of ADEPT Fellows programmes for trainees across the UK do not currently offer the opportunity to complete a formal qualification as part of their programme.

Evidence of effectiveness

Although formally evaluating the effects of this programme would be premature, there is already evidence of significant improvement in both the personal and professional skills of ADEPT Fellows during the year.

ADEPT Fellows have been encouraged and enabled to build professional networks

and to draw on the skills and expertise of others.

A challenge faced by similar programmes throughout the UK is how to support and maintain the involvement of Fellows in leadership activities as they return to clinical working environments and the requirements of their training programmes. To ensure sustainability as these trainees continue in their training, NIMDTA has announced the ADEPT AlumNI Programme, which will support, encourage and facilitate the continued involvement of ADEPT Fellows

Taking time out of programme for experience for any reason can be difficult for trainees at all stages of training. Trainees may also wish to pursue time out of programme for research or training, and are acutely aware of the impact this may have on service provision. That said, both cohorts of ADEPT Fellows were appointed following competitive processes with representation across a wide range of specialties.

It is now the responsibility of all HSC organisations to ensure that the programme continues to flourish. As formal evaluation of the ADEPT scheme adds to existing research, which has shown that engaging clinical staff to develop leadership capability improves the outcome and care for patients, it is anticipated that interest will continue to grow. It is expected that the value of taking time out of programme for leadership training will be evidenced in time by the integration of the ADEPT AlumNI within the management and leadership structures in Health and Social Care in Northern Ireland.

Professor Keith Gardiner Chief Executive/ Postgraduate Medical Dean & Administrative Director, Northern Ireland Medical & Dental Training Agency

www.rcsed.ac.uk | 33

SPECIALTY: COLOPROCTOLOGY

From its early pioneers to the live-saving advances in oncology today, Professor Robert Steele looks at the development of coloproctology

GREAT STRIDES

34 | Surgeons’ News | September 2016

WELLCOME LIBRARY, LONDON

C

olorectal surgery – or, to give it its more inclusive title, coloproctology – has moved forward immeasurably in recent years, emerging as a specialty in its own right despite the current reluctance of the UK regulatory authorities to recognise it as such.

The first specialist coloproctologist is thought to have been John of Arderne, who lived between 1307 and 1392 and practised in Newark-on-Trent, England. His lavishly illustrated writings demonstrate quite clearly that he had a good grasp of the principles of managing fistulain-ano and his techniques of using a seton are still in use today. With the advent of effective general anaesthesia, allowing surgeons access to the abdomen, coloproctology really took off in the late 19th century.

One of the most prominent early figures was Ernest Miles (1896–1947), who developed surgical excision of the rectum for cancer, bringing his operative mortality rates down from over 50% to a very respectable 15% by the end of his career. He believed a 5cm clearance of rectal cancer was essential for local disease control.

However, throughout the middle of the 20th century the work of Cuthbert Dukes, John Goligher and, subsequently, Norman Williams made it clear that distal microscopic spread of rectal cancer was, in fact, very rare, and this paved the way for the low anterior resection.

Bill Heald, a charismatic surgeon from Basingstoke, recognised the importance of careful total mesorectal excision both in terms of obtaining appropriate surgical clearance of a rectal cancer and in preserving pelvic nerve function. This became standard practice throughout the coloproctology community and has resulted in a dramatic reduction in local recurrence after surgical excision of rectal cancer and, indeed, in the need for a permanent colostomy. However, in parallel with these developments, it was noticed that patients with very low rectal cancers requiring abdominoperineal excision had a particularly poor prognosis related to local recurrence.

It then fell to the Swedish surgical community under the leadership of Torbjörn Holm to recognise the importance of radical excision of the pelvic floor (the socalled extended levator abdominoperineal excision, or ELAPE). This is now gaining traction and it is hoped that it will result in big improvements for this unfortunate group of patients.

It has always been recognised that the prognosis for colorectal cancer is much better when it is detected early. The UK was the first country in the world to have a fully rolled-out national screening programme based on testing of faecal occult blood. This has resulted in an increase in the detection of early cancer and has stimulated renewed interest in local excision,

Incomplete mid-line sagittal sections carried through from the back and from the front. Two figures included in a manuscript (MS X.118) from c.1412, of a work of John of Arderne (Source: Roberts and Tomlinson, The Fabric of the Body)

Professor Robert JC Steele President of ACPGBI, and Head of Academic Surgery and Head of Cancer Division, Medical Research Institute, Ninewells Hospital and Medical School, Dundee

particularly in the rectum. One of the pioneers in this area was Gerhard Buess, who developed the technique of transanal endoscopic microsurgery. Along with recently developed variations, this technique is now being used widely, although there is still considerable controversy over the ideal method of treating early rectal cancer.

Advances in the surgical treatment of colorectal cancer have run parallel with advances in radiotherapy and chemotherapy, and it has also become evident that selected patients with liver metastases may benefit from partial hepatectomy leading to remarkably good outcomes in some instances.

Advances in coloproctology have not been confined to oncology. In the area of inflammatory bowel disease, the medical treatment of both ulcerative colitis and Crohn’s disease has improved immeasurably, but patients suffering from these conditions may still need surgical treatment.

Perhaps the most important advance has been the development of the ileoanal pouch for patients undergoing total proctocolectomy for ulcerative colitis.

This was pioneered by Sir Alan Parks at St Mark’s in the 1960s and now all patients requiring complete removal of the large bowel should have access to this option.

Anastomotic technique has also improved and the interrupted serosubmucosal method pioneered by Norman Matheson in Aberdeen is associated with the lowest reported rates of anastomotic leakage. However, stapling technology has advanced rapidly since the introduction of the Russian STPU anastomosing stapler in the 1970s and now virtually all anastomoses can be performed using advanced stapling techniques, which have reduced the variability associated with the handsewn anastomosis.

Another spectacular improvement in surgical technology has been the rapid development and dissemination of laparoscopic colorectal surgery, assisted greatly by the government-funded National Training Programme for Laparoscopic Colorectal Surgery. This approach has clear benefits in terms of postoperative pain, hospital stay and scarring, although its place in rectal cancer surgery has yet to be fully established.

Pelvic floor disorders, which make up a large proportion of referrals to any coloproctology service, have also seen major advances, such as ventral mesh rectopexy for rectal prolapse and the increasing use of sacral nerve stimulation for faecal incontinence.

All these advances in surgery have, of course, been accompanied by progress in pathology and imaging, and the emergence of the multidisciplinary team

There has been a major initiative utilising Delphi techniques to identify important research topics in coloproctology and to take forward the resulting research agenda

approach for the care of patients with a variety of colorectal disorders.

In the second half of the 20th century, it became clear that coloproctology was developing as a specialty and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) had its inaugural meeting in 1990 under the presidency of Geoff Oates from Birmingham.

At that time, the Association had 62 members; 10 years later, when John Nicholls was President, the membership was calculated at 900 and currently it has more than 1,300 members throughout the UK. While the majority are colorectal surgeons, the Association also embraces gastroenterologists, pathologists, oncologists, radiologists, nurses and other allied health professionals.

The overarching mission of the ACPGBI is to promote the prevention, care and cure of colorectal disease, and it does this in various ways, notably through education, research, supporting trainees, audit and shaping surgical services for the future. Aside from the Annual Scientific Meeting (which in 2016 is being held in Edinburgh), the Association runs numerous courses, publishes a wide range of educational materials online and, in conjunction with the RCSEd, has run a very successful programme of webinars.

The Association strongly promotes research, and funding is available to its members from its sister organisation, the Bowel Disease Research Foundation.

In addition, there has been a major initiative utilising Delphi techniques to identify important research topics in coloproctology and to take forward the resulting research agenda. The trainee group has always been a valued and important component of the Association and its society, the Dukes’ Club, has strong links with the main Association. Much of the available educational material is aimed at trainees, and every attempt is made to provide this either free of charge or at reasonable cost to trainee members.

Audit as a means of improving outcomes in coloproctology has always been central to the mission of the ACPGBI. The National Bowel Cancer Audit in England and Wales has developed into a key resource for quality assurance, so much so that it has been ‘commandeered’ by the Health Care Quality Improvement Programme for its Consultants Outcomes Project. Thankfully, however, the Association of Coloproctology has managed to retain control over the quality of these data so that its members can be assured that the single surgeon reporting is an accurate reflection of what is actually happening. The Association continues to strive to ensure that audit data are used responsibly and that anything that appears in the public domain is accurate. Finally, the ACPGBI represents its members at many different levels and it is active in supporting individuals, trusts and regions that are seen to be outliers. The Association is taking a very prominent role in the development of emergency general surgical services across the UK and continues to emphasise the importance of coloproctology as a specialty primarily for the benefit of patients suffering from colorectal disease. rcsed.ac.uk | 35

SPECIALTY: COLOPROCTOLOGY

Clubbing together

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Katie Adams President of the Dukes’ Club, the UK National Colorectal Trainee Association thedukes club.org.uk @dukes_club

raining in coloproctology has undergone great changes over the last 20 years.

In 1993, the Calman Report led to numbered specialist registrar posts, with the introduction of regular assessments of progress, a defined curriculum and training being limited to seven years. At the end of this, a trainee could gain a Certificate of Completion of Specialist Training (CCST). For coloproctology trainees, this meant attaining a CCST in general surgery and then using experience to reflect a specialty interest. This system was replaced in 2007 with run-through training, where surgical training could be entered from the third postgraduate year rather than the fifth. The run-through system for general surgery only lasted one year, with training once again uncoupled at the registrar entry level.

The Dukes’ Club was founded at the 1997 European Council of Coloproctology in Edinburgh to represent UK surgical trainees with an interest in coloproctology. John Stebbing was its founding president.

The European Working Time Directive was introduced into UK law the year after the club was founded, although it was not until 2009 that the full restriction on 48 working hours was implemented within the NHS. This significantly reduced the number of hours a trainee was allowed to be scheduled in work, requiring more focused training and the start of shift systems.

In 2004, the club conducted a survey of surgical trainees with a colorectal interest, of whom 92% felt that there should be a specialist qualification in coloproctology, and 90% said this should be at the same time as doing their Certificate of Completion of Training (CCT). Trainees thought

Fellowships in coloproctology are increasingly popular for colorectal trainees and have become more diverse over time 36 | Surgeons’ News | September 2016

Illustration of colorectal cancer cells

that a significant proportion of elective and emergency bowel operations should be done only by coloproctology specialists (eg 100% said colitics should have an acute resection by a specialist).

To date, there is still no specific qualification in colorectal surgery, with trainees obtaining a CCT in general surgery, relying then on their career experience to demonstrate colorectal intent. While there is no formal UK qualification in coloproctology, other options have never been more available or diverse. Trainees can complete a Europeanequivalent exam to become a Fellow of the European Board of Coloproctology. A higher degree in coloproctology is also an option, with certificates, diplomas or Master of Surgery in coloproctology available. In 2014, the club found that more than 75% of colorectal trainees either had or were in the process of obtaining a higher degree, with two-thirds reporting that this was with the aim of improving their prospects of becoming a consultant.

Fellowships in coloproctology are increasingly popular for colorectal trainees and have become more diverse. The Dukes’ Club and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) support this, with the provision of yearly travelling Fellowship awards to allow trainees to travel abroad to visit and train in overseas units to further their experience. Fellowships cover various subspecialties (eg laparoscopic/robotic surgery, pelvic floor, advanced endoscopy, transanal surgery), reflecting the increasing subspecialisation of our field. This year will see the introduction of the first Young Coloproctologist of the Year Award through the ACPGBI, further championing excellence within our field.

Since its inception with 60 trainee members in 1997, the Dukes’ Club has grown along with the field of coloproctology and now has more than 2,000 current and past registered trainee members.

We provide access, discounts and free places on ACPGBI/Dukes’ Club and external courses, educational material, exam preparation material and networking events. Our 19th annual educational meeting this year was our most widely attended yet and we hosted a half-day session at the Association of Coloproctology meeting in Edinburgh in July.

SPENCER SUTTON/SCIENCE PHOTO LIBRARY

Katie Adams examines the history of coloproctology training and the role of the Dukes’ Club

Midway through his term as Dental Dean, Professor Bill Saunders looks at recent developments within the Faculty

HALF-TIME ANALYSIS

I

am more than halfway through my term of office and how the time has flown. It is an opportunity to reflect on the work of the Dental Faculty and how we contribute to the wellbeing of the College. We have embarked on a number of important projects and several are now coming to fruition. Our Secretary, Professor Liz Davenport, has worked tirelessly to update a strategy document for the Faculty as well as working with the Dental Examinations Convener, Professor Fraser McDonald, to produce more relevant Memoranda of Understanding for our conjoint partners and Letters of Agreement to support some of the centres overseas where our examinations are held. It is clear that the quality of our examinations is valued greatly and, with the efforts of our special advisory boards working with our Education Department, we continue to develop and execute assessments that are fair, contemporary and fit for purpose. This involves much review and analysis, but a great strength of our College is the governance we have in place to ensure we maintain quality.

It seems that more and more individuals and institutions wish to engage with us and, to facilitate this, we are developing a formal accreditation process.

This will enable overseas training establishments to acknowledge recognition by the College following a rigorous process of evaluation of the training offered and the quality of the facilities in which the training takes place. Recognition of this sort comes with some risks, but a robust periodic review will help mitigate these potential difficulties.

The Dental Faculty will continue to engage with all interested parties in an effort to improve and maintain standards in dentistry and enhance patient safety

One of our great successes is the agreement by Dental Council and College Council that a Faculty of Dental Trainers should be established. The work of development groups led at first by Dr Ulpee Darbar and latterly by the Vice-Dean, Dr Sarah Manton, ensured that a powerful argument for this Faculty was forthcoming. We will launch in September 2016 and we trust that Members and Fellows who are involved with training, education and assessment will consider joining the Faculty as Associates, Members or Fellows.

The Faculty is keen to expand its portfolio of educational activity, ably led by Dr Brian Nattress, our Education Convener. The Clinical Skills Competition was a great success, with all the dental schools in the UK taking part, and both the VDP and DCP conferences had record numbers of delegates. We are looking to increase educational provision in the Faculty and Brian has some excellent ideas to take forward.

The Council continues to respond to consultations with the process being managed by the Vice-Dean and the College’s Public Affairs Manager, Mr Chris Sanderson, and his very able team in our Birmingham office. If Members and Fellows come across any issues to which they feel the Dental Faculty could usefully contribute, please let ViceDean Dr Sarah Manton know.

The country’s decision to Brexit on 23 June will hopefully have no adverse effects on the work and aspirations of the Dental Faculty. We will continue to engage with all interested parties in an effort to improve and maintain standards in dentistry and enhance patient safety. I sincerely hope that the second half of my Deanship will yield as much as the first.

Professor Bill Saunders Dean, Faculty of Dental Surgery rcsed.ac.uk | 37

RCSED DENTSPLY SIRONA DENTAL SKILLS COMPETITION 2016/2017

Following the success of last year’s co etition e o e e s acu o en a ur er n ar ners w en s rona s de ed o run e en a n ca k s o etition or e rd ear.

This unique national competition gives final-year students an opportunity to showcase their restorative dentistry skills through regional heats. All dental schools throughout the UK will take part in the regional heats during autumn/winter 2016, with the best student from each heat winning a travel and accommodation package to compete in the Grand Final in Edinburgh in March 2017.

At the Grand Final, the top 16 finalists from across the UK will face a variety of clinical skills challenges, with the overall winner crowned at the Grand Final Awards Dinner.

or ur er n or ation s www.rcsed.ac.uk e a ou reac @rcsed.ac.uk or e e one 0131 668 9213/0121 647 1567

OPEN WIDE FOR DENTAL TRAINERS The College is set to launch a Faculty specifically designed to support and promote those who provide high-quality dental training

T

he first of its kind in the UK, the Faculty of Dental Trainers (FDT) is open to anyone – both in the UK and internationally, regardless of college affiliation – who can provide evidence of appropriate involvement in dental training.

Today, dentists and dental care professionals form a team that delivers patient care across all sectors and in multiple settings, from public and community services to specialist societies and the armed forces. To achieve the best outcomes for patients, it is essential that all training for the dental team is effective, competent and delivered to the best possible standards.

Vice-Dean of the RCSEd’s Faculty of Dental Surgery Sarah Manton said: “We are absolutely delighted to launch this new Faculty, which will cater for the specific needs of those involved in the delivery of dental training. The FDT’s membership structure has been designed to be broad and inclusive. Not only does this reflect modern dental practice, but it also allows the new Faculty to welcome and provide recognition for as many dental trainers as possible.”

Following its launch, the FDT will work to improve the profile of dental trainers across all care settings and in all fields of dentistry, providing a framework to promote and guide trainers throughout their educational careers.

To achieve its ultimate purpose of improving the quality of patient care, the FDT will: Reward interest, engagement and achievement in dental training Establish a ‘home’ for recognised dental trainers Provide support and guidance for career development in dental training Promote standards in training.

The FDT is offering a broad membership structure for dental trainers at different

MORE INFORMATION To apply to join, please visit the FDT website, download the application form from the FDT website and submit all the required documentation to the Faculty Office.

career stages and in different areas of practice. For those who join, membership will be a ‘badge’ signifying their commitment to the provision of highquality training. Membership of the FDT is available at three levels: Associate,

Member and Fellow. Members and Fellows of the Faculty will be awarded the postnominals MFDTEd and FFDTEd. A successful application depends on providing the appropriate evidence, with the FDT’s assessment panel referring to three educational domains: Teaching and Training activity; Educational Leadership; and Publication, Research and Scholarship.

The full criteria for each domain will be detailed on the FDT website and will clearly identify the appropriate standard for membership of the Faculty. fdt.rcsed.ac.uk fdt@rcsed.ac.uk rcsed.ac.uk | 39

AGENDA

Upcoming Dental Exams Diploma in Implant Dentistry Location: Dubai Exam Dates: 24–26 Feb 2017 Closing Date: 2 December 2016

MFDS Part 2

Location: London Exam Dates: 3–4 March 2017 Closing Dates: 9 December 2016

Tri-Collegiate Membership in Paediatric Dentistry Location: Edinburgh Exam Dates: 25 Apr 2017–28 Apr 2017 Closing Date: 27 Jan 2017

Diploma in Orthodontic Therapy

Location: King’s College London Exam Dates: 15 May 2017–25 May 2017 Closing Date: 3 Mar 2017

Tri-Collegiate Membership in Paediatric Dentistry Location: Edinburgh Exam Dates: 25 Sep 2017–29 Sep 2017 Closing Date: 7 Jul 2017

40 | Surgeons’ News | September 2016 Registered charity number: SC005317

To book visit our website www.rcsed.ac.uk or email dental.exams@rcsed.ac.uk

TRAINEES AND STUDENTS

/ OUTREACH

Tomorrow’s doctors Pupils enjoy information days and practical workshops Pupils at Christ’s Hospital School practise their surgical skills

Zahid Raza, Simon Gibson and Alison Lim from the Getting into Medical School Information Day in Edinburgh

knowledge of the process and understanding of the profession.

Thank you to Mr Tim Graham for convening the event in Birmingham, and Mr Zahid Raza and Mr Simon Gibson, who were co-convenors in Edinburgh. We are equally grateful to all the speakers and

The event promoted medicine as a career, and provided facts and advice about the often daunting process of getting into medical school

pupils who contributed to making both days a success and look forward to welcoming a new group of prospective doctors to similar events in the future.

Christ’s Hospital School events

As well as the events in Edinburgh and Birmingham, RCSEd Council Member Dr Judy Evans organised an information session for sixth form pupils at Christ’s Hospital School in Sussex on 8 March.

Twenty-two pupils from three schools in the area were invited to an afternoon of surgical activities – wound suturing, a dexterity test and wound cleaning – as well as an introduction to surgical equipment and a lecture on what it is like to be a plastic surgeon. Pupils gained a lot from the day and feedback was overwhelmingly positive.

Thank you to Judy Evans and Faculty who attended, as well as staff at Christ’s Hospital School for hosting the event. rcsed.ac.uk | 41

MAIN PHOTOGRAPH COURTESY OF CHRIST’S HOSPITAL SCHOOL

F

ollowing the success of last year’s Getting into Medical School Information Day in Edinburgh, the College’s Outreach team expanded the popular event to run again in two UK locations.

On 18 June 2016, pupils from schools in and around Edinburgh visited the College for a packed day of talks. Then, on 19 July, staff based in the Birmingham Regional Centre invited 16- to 18-year-old pupils from schools in Birmingham City Centre to the Queen Elizabeth Hospital for an equally inspiring programme. In both locations, the event promoted medicine as a career, and provided facts and advice about the often daunting process of getting into medical school.

In Edinburgh, 85 pupils (an increase on last year’s number) from 20 schools were invited to RCSEd’s Symposium Hall.

Medical students, junior doctors, surgeons and university admissions staff all came along to offer advice and guidance.

As one Edinburgh student stated: “All the presentations were very informative, which has given me a much better understanding of getting into medicine.”

Another student went on to say: “I liked how the speakers were supportive, enthusiastic and passionate about medicine, and were relatable.”

In Birmingham, 65 pupils representing 26 schools arrived at the Queen Elizabeth Hospital for a programme of talks guiding them through their medical career. Speakers representing all stages of the surgical career pathway provided a valuable opportunity for discussion and consideration of the application process and options open to pupils beyond this, helping to enhance the aspiring medical students’

TRAINEES AND STUDENTS

/ COMPETITIONS

RCSEd Video Competition 2016/2017

C

ommunication skills are vital for all medical professionals and form a key element of the MRCS OSCE examination. The RCSEd invites all UK and international medical students, doctors and trainees to demonstrate their understanding of good communication skills by creating a video that highlights one of the three elements examined in the MRCS OSCE: talking with relatives and carers, communicating with colleagues and history taking.

The prize winner(s) can choose to attend an RCSEd course (to the value of £110) or go to the RCSEd Audit Symposium 2017. They will receive a travel and accommodation package to take part in the course or symposium, staying at the College’s Ten Hill Place Hotel in Edinburgh. For group submissions, the prize extends to two people only and the travel portion of this prize will only cover travel within the UK. The competition is open for applications from Tuesday 30

Dust off your camera or use your mobile phone to record your video

August 2016. The deadline for submissions is Friday 6 January 2017.

All entrants will receive one year’s affiliation with the College.

For further information, visit www.rcsed.ac.uk or email outreach@rcsed.ac.uk.

RCSEd National Student Surgical Skills Competition 2016/2017 Could your skills take you to the Grand Final?

Final-year students in UK universities with an interest in surgery are invited to take part in the regional heats of the third National Student Surgical Skills Competition. In collaboration with Medtronic, the College is giving a limited number of students per region the opportunity to learn and practise surgical skills, and compete in challenges against their peers. The winners from each heat will win a travel and accommodation package to Edinburgh to take part in the Grand Final in February 2017.

For further information, visit www.rcsed.ac.uk or contact the Outreach Team at outreach@rcsed.ac.uk.

42 | Surgeons’ News | September 2016

NO ONE CAN SOLVE THE WORLD’S HEALTHCARE CHALLENGES ALONE. LET’S TAKE HEALTHCARE FURTHER, TOGETHER.

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UC201700152c EN © 2016 Medtronic. All Rights Reserved. Printed in USA

rcsed.ac.uk | 43

TRAINEES AND STUDENTS

CASES IN POINT ASiT launched its National Mentoring Scheme after identifying a need for informal support among its members. Some mentors give their verdict

Piriyah Sinclair, Emma Court, Shazia Hafiz, James Glasbey

T

he ASiT National Mentoring Scheme is going from strength to strength. It was started in response to the ASiT National Mentoring Scheme Survey1 results, which revealed that only 48.7% of trainees felt they had a surgical mentor. The majority of trainees wanted mentoring during their clinical training and guidance in coaching techniques.

ASiT recognised there was no structure for provision of mentoring training nationally. In collaboration with an accredited trainer, ASiT has developed a national mentoring scheme and outlined consensus recommendations for mentoring programmes.2 After a successful pilot scheme in 2014, the national scheme launched in 2015.

CASE STUDY 1

Shazia Hafiz is an ST4 in general surgery working in Manchester. She trained as a mentor in the second cohort of the ASiT Mentoring Scheme.

Mentoring can be likened to a pastoral role – a support service many surgeons in training wish they had. With the NHS focusing on trainees developing resilience, 44 | Surgeons’ News | September 2016

being an ASiT mentor begins to address the issues of how we can support and nourish trainees during their career progression.

Since having a mentee, I have felt empowered and positively rewarded by giving back and by the progress my mentee has made. We talk every three to four weeks via FaceTime (between 20 minutes to one hour) to discuss the challenges she foresees in her training. She has the opportunity to talk freely about her concerns and career plans. I nurture her thought processes on approaching these challenges, but the mentee comes up with all the solutions.

Get involved ASiT would like to hear from any trainees, from medical students to registrars, who do not have a mentor and would like to have one, or would like to participate in the next mentoring course. If you are interested or have any questions, email: info@asit.org

My mentor encouraged me to explore various aspects of problems and synthesise plans to deal with these, giving me an immense sense of achievement and empowerment

Since I last spoke to my mentee, she has passed her key exams, accomplished some local surgical projects and taken a trip abroad where she contacted me to say how pleased she is with the mentor scheme!

Being a mentor takes time, but it isn’t time-consuming.

It takes a mind shift to appreciate that this is not work – it is reward.

REFERENCES

1. Sinclair P, Fitzgerald JE, Hornby ST, Shalhoub J. Mentorship in surgical training: current status and a needs assessment for future mentoring programs in surgery. World J Surg 2015; 39(2): 303–313; discussion 314. doi: 10.1007/s00268014-2774-x

2. Sinclair P, Fitzgerald JE, McDermott FD, Derbyshire L, Shalhoub J; ASiT Mentoring Collaboration; Council of the Association of Surgeons in Training. Mentoring during surgical training: consensus recommendations for mentoring programmes from the Association of Surgeons in Training. Int J Surg 2014; 12(suppl 3): S5–S8. doi: 10.1016/j. ijsu.2014.08.395

CASE STUDY 2

Emma Court, an ST5 in colorectal surgery in Gloucester, was a mentee in the pilot ASiT Mentoring Scheme and subsequently chose to train as an ASiT mentor.

I volunteered as a mentee for the pilot ASiT Mentoring Scheme without a clear idea of what the mentoring process involved, but wanting some guidance regarding career progression. My matched mentor was a more senior general surgical trainee. He contacted me to establish ground rules, a mentoring contract and a mutually convenient time to begin the process.

Although our backgrounds were different, I found the whole process an overwhelmingly positive experience. We established rapport early on, despite all contact being via telephone. Through careful questioning, my mentor enabled me to identify specific aspects of a particular problem, set goals and work through potential solutions. This was very different to previous experiences when I had sought advice on career progression from senior colleagues.

My mentor did not offer advice or solutions, but encouraged me to explore various aspects of problems and synthesise plans to deal with them, giving me an immense sense of achievement and empowerment.

My mentor was so skilled that the meetings felt like informal chats. It was not until I began mentor training myself that I realised he was systematically working through the key mentoring stages to improve my insight in certain areas of my career and take control of improving opportunities for career progression.

At the end of each session, we set a date to review progress. Over the course of six months, we had five sessions, which took the same format and focused on the six foundation principles of mentoring.

When the pilot drew to a close, I felt the process had been very beneficial in many aspects of my life and I was inspired to apply for mentor training myself.

ASiT wants every trainee to feel supported through their training and mentoring can help to maximise every trainee’s potential. The mentee sets the agenda, but is not given advice or answers. The mentee is challenged and expected to be resourceful.

Mentees can discuss anything they choose such as deciding on a specialty; taking time out of training programmes; exams; job applications; a difficult day at work or a difficult working relationship; the impact of major life events such as marriage, children, return to work; academic development and career progression.

All trainee mentors are educated by a professional accredited coach. Mentors are independent to the clinical and educational environments, are nonjudgemental and want their mentee to succeed. Both parties sign a confidentiality agreement. The process can benefit the mentee, mentor, mentee’s colleagues and patients.

CASE STUDY 3

James Glasbey, an academic foundation doctor in Wales, took mentoring training in the early part of a postgraduate career.

I have benefitted hugely from informal mentoring throughout my early career to date and hoped the ASiT Mentoring Scheme would give me the tools to support local medical students and junior doctors as I move forward in my career.

Mentoring training can be undertaken by anyone, of any level of seniority and from any specialty background. A deep understanding of surgical training or career progression is not required; in fact, this type of knowledge could be seen as a disadvantage! The answers come from the mentee’s resourcefulness, not from the mentor – and it can be difficult to avoid giving advice.

I highly recommend this course for junior doctors interested in teaching and medical education. I now feel able to develop deeper and more productive mentoring relationships using just a few simple rules and techniques. rcsed.ac.uk | 45

COLLEGE INFORMATION

All the latest grants, Fellowships and bursaries from the RCSEd

AWARDS & GRANTS Ethicon Foundation Fund Travel Grants

Grants are awarded towards travel overseas to gain further training or experience, and are restricted to the cost of one return airfare only.

Travel for the sole purpose of attending a scientific meeting will not be supported. Requests for retrospective awards will not be considered.

Closing date for applications is Wednesday 15 February 2017.

Elective Travel Bursaries

The RCSEd, in association with Ethicon, is pleased to offer students an opportunity to apply for a travel bursary towards their elective in surgery. The bursaries to the value of £250 are open to medical students in the UK and Ireland who are affiliates of RCSEd and who are undertaking approved surgical electives overseas.

Closing date for applications is Wednesday 15 February 2017.

Small Research Pump Priming Grant

The College’s Research Strategy highlights the following areas of research as priorities for the College to support: Surgical/dental translational research Surgical/dental health services research Research into surgical/dental aspects of patient safety, simulation and nonoperative technical skills Cancer research of demonstrable direct clinical relevance to the management of solid tumours Applications for grants of up to £10,000 are invited from surgical trainees and

46 | Surgeons’ News | September 2016

recently appointed consultants who are Fellows/Members of the College in good standing. Grants are awarded for pump priming projects for a period of one year only. Please note that requests for running costs to support established projects will be less favourably reviewed than those for pilot work that has the potential to facilitate applications for more substantial funding in the future.

Research project submissions should satisfy one or more of the College’s four priority areas for research, as listed in the previous bullet points. The application should also include a well-defined exit strategy (that is, how the project will be taken forward).

Closing date for applications is Wednesday 16 November 2016.

The Robertson Trust Research/ Training Fellowship

Applications for funding (£50,000 for one year) are invited from Fellows/Members of the College in good standing. The successful candidate must be from

Scotland and working within the UK, or the research itself must be undertaken in Scotland. Surgical trainees who are within one year of completing the MRCS and would want to join the RCSEd are also eligible.

Closing date for applications is Wednesday 16 November 2016.

RCSEd & MRC Joint Clinical Research Training Fellowship

The Medical Research Council (MRC) is now inviting applications for the next round of the jointly funded clinical Research Training Fellowship (CRTF).

The MRC provides opportunities for additional clinical research training Fellowships through collaborations with the Royal Colleges and charity funders.

Any jointly funded Fellowships will be offered under standard MRC terms and conditions and at the same funding level as any other MRC clinical research training Fellowship.

Currently one joint clinical research training Fellowship is available, open

FOR MORE INFORMATION ABOUT THE COLLEGE’S AWARDS AND GRANTS CONTACT: Cathy McCartney, Awards and Grants Administrator The Royal College of Surgeons of Edinburgh Nicolson Street, Edinburgh EH8 9DW Tel: +44 (0)131 527 1618 Email: c.mccartney@rcsed.ac.uk Only Fellows, Members and Affiliates in good standing are eligible to apply.

The RCSEd collects personal data from you during the application process for awards and grants. We will not share this information with any third parties and your data will be used solely for the purpose of processing and administrating applications.

to RCSEd Fellows and Members who meet the eligibility criteria set out by the MRC under guidance for applicants.

Areas to be considered for support are surgical/dental translational research, surgical/dental health services research, research into surgical/dental aspects of patient safety, simulation and nonoperative technical skills, and cancer research of direct clinical relevance to the management of solid tumours.

For more details, contact Cathy McCartney at c.mccartney@rcsed.ac.uk or to apply visit the MRC website.

Closing date for submissions for this round is 4pm on 8 September 2016, with shortlisting taking place in February 2017. Interviews will be held on 1 and 2 March 2017 and take-up dates will be between April to September 2017.

Ophthalmology Research Grants

Sponsored by Royal Blind, these are for major project grants (up to £60,000) and small research support grants for ongoing research (up to £10,000).

Applications for funding under the above categories are invited from ophthalmologists currently working in Scotland and all Fellows/Members of the College in good standing undertaking research projects in the UK. Applicants must use the current application form (which can be downloaded from the College website) or they can email Cathy McCartney.

Closing date for applications is Wednesday 2 November 2016.

Bursaries for Affiliate Medical Student Elective Placements in Africa 2017

The College is offering a number of bursaries to Undergraduate Affiliates enrolled at UK universities who plan to carry out their elective placements in Africa. The elective need not necessarily be in a surgical unit, but priority may be given to students demonstrating a special interest in surgery. You must be an RCSEd Student Affiliate. Each bursary is normally in the region of £500, which can be used towards travel and accommodation costs or other expenses involved with the placement.

Application forms can be downloaded from the College’s website or email Cathy McCartney.

Closing date for applications is Wednesday 4 January 2017.

CONGRATULATIONS TO THE FOLLOWING AWARDS AND GRANTS RECIPIENTS The Lorna Smith Charitable Trust Fellowship

Tariq Farrah, Specialist Trainee in Renal Medicine/General Internal Medicine, University of Edinburgh. MicroRNA biomarkers in ANCA vasculitis: a prospective cohort study.

Ophthalmology grants Major grants

Shareen Forbes, Endocrinology Unit, University of Edinburgh.

Impact of insulin pump therapy and islet transplantation on progression of diabetic retinopathy in type 1 diabetes.

John Forrester, School of Medical Sciences and Nutrition, University of Aberdeen. In vitro responses of dendritic cells to crosslinked recombinant human collagen hydrogels in corneal regeneration for pre-clinical applications.

Andrew Tatham, Princess Alexander Eye Pavilion (NHS Lothian), Edinburgh. The Scottish Glaucoma Biobank: developing a national resource for the study of disease mechanisms, risk markers for blindness and novel drug discovery in glaucoma.

Robert MacLaren, Nuffield Laboratory of Ophthalmology, University of Oxford. Optimising gene therapy to improve patient safety.

Small grants

Harminder Dua, Academic Section of Ophthalmology, University of Nottingham. Evaluation of antimicrobial peptide synergism against ocular surface pathogens.

Undergraduate bursaries

Heather Leather, Centre for Global Health, King’s College London. A systematic review of community health workers’ role in surgical assessment within low- and middle-income settings.

Marc Walton, Centre for Integrative Physiology, University of Edinburgh. Implanted silicon systems for monitoring and targeted drug delivery in glioblastoma multiforme: assessing the biocompatibility for candidate flexible electronic substrates.

Ellhia Sudan, University of Edinburgh. A characterisation of the microenvironment of hepatocellular carcinoma in non-alcoholic fatty liver disease with or without cirrhosis.

Savva Pronin, Department of Clinical Neuroscience, Western General Hospital, Edinburgh. Audit of management of cauda equina syndrome and MRI-negative cauda equina syndrome in NHS Lothian.

Sonia Soopen, School of Dentistry, University of Birmingham.

An in vitro study of the ability of a tricalcium silicate-based endodontic sealer to produce an effective three-dimensional seal using the single-cone obturation technique.

Ananyo Bagchi, the Walton Centre NHS Foundation Trust, Liverpool. Incidence of postoperative epilepsy in seizure-naïve patients undergoing craniotomy for surgical resection of meningioma.

rcsed.ac.uk | 47

COLLEGE INFORMATION

DIPLOMA CEREMONIES Congratulations to all our new Fellows and Members who were presented with diplomas at a ceremony in Edinburgh on Friday 1 July 2016 Fellowship Ad Hominem Mr Andrew Leather FRCSEng MS, Director, King’s Centre for Global Health, London, Senior Lecturer, Global Health and Surgery, King’s College London, Co-chair Lancet Commission on Global Surgery Professor John N Primrose FMedSci, FRCS RCPSG, FRCSEng, Professor of Surgery and Chair of Clinical Group, University of Southampton and Honorary Consultant Surgeon, Southampton University Hospitals NHS Trust Fellowship in Dental Surgery Ad Hominem Dr David C Craig, Consultant, Honorary Senior Lecturer and Head of Sedation and Special Care Dentistry, Guy’s and St Thomas’ NHS Foundation Trust, KCL Dental Institute, London Professor Edward Ellis III, Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Texas Health Centre, San Antonio, USA Fellowship Without Examination Dr Patrishia Bordbar FRACDS(OMS), Consultant Oral and Maxillofacial Surgeon, Royal Melbourne Hospital and Royal Children’s Hospital, Melbourne, Australia Dr Philip R Devesahayam FRCSGlasg, Consultant Otorhinolaryngologist, Dept of Otolaryngology, Hospital Raja Permaisuri Bainun and Jalan Hospital, Ipoh, Malaysia Mr Julian C L Wong FRCSGlasg, FRCSEng, Head and Senior Consultant, Division of Vascular and Endovascular Surgery, CTVS, National University Heart Centre, NUHS Singapore Diploma of Fellowship in the Specialty of Cardiothoracic Surgery Mohammad Hamad Hawari, Al-Quds University, Palestine Diplomas of Fellowship in the Specialty of General Surgery Ruvinder Athwal, University of Liverpool

48 | Surgeons’ News | September 2016

Ricky Harminder Bhogal, University of Leicester Abigail Claire Mawhinney, University of Southampton Devender Mittapalli, Dr NTR University of Health Sciences, India Amit Nair, Mahatma Gandhi University, India Harjeet Singh Rayt, University of Leicester Sanjeev Rohatgi, Aligarh Muslim University, India Diploma of Fellowship in the Specialty of Otolaryngology Sampath Kumar Raghu Nandhan, Manipal University, India Chuan Loong Yeo, University of Birmingham Diploma of Fellowship in the Specialty of Paediatric Surgery Alice Louise Mears, University of Bristol Diploma of Fellowship in the Specialty of Plastic Surgery Robert Choa, University of Liverpool

IN MEMORY

SURGICAL FELLOWS Brij Mohan BHAN (FRCSEd 1959) Roger Harvey FREEMAN (FRCSEd 1950) Alan John Lewington HART (FRCSEd 1972) Peter Douglas JACKSON (FRCSEd 1962) Alan Albert JONES (FRCSEd 1974) Rohana Jaliya Wijeratna Perera LOKUKETAGODA (FRCSEd 1996) Donald Arthur SHAKESPEARE (FRCSEd 1976) DENTAL FELLOWS Henry Forman ATKINSON (FDS RCSEd 1955) William James Mackenzie BARRIE (FDS RCSEd 1972)

Juliana Maria Fonseca Hughes, University of Leeds Lydia Tang, University of London Diplomas of Fellowship in the Specialty of Trauma and Orthopaedic Surgery Vinay Kumar Aggarwal, University of Delhi, India James Thomas Bourne, University of Birmingham Dhirajkumar Ramshankarji Gupta, Nagpur University, India Daoud Y Makki, Lebanese University, Lebanon Sunil Kumar Santhapuri, Dr NTR University of Health Sciences, India Diploma of Fellowship in the Specialty of Urology Mithal Sabah Abdulnabi, University of Baghdad, Iraq Richard Alexander Chapman, University of Sheffield Rajendar Reddy Marri, Dr NTR University of Health Sciences, India Fiona Mary McCaig, University of Edinburgh Diplomas of the Joint Surgical Colleges’ Fellowship in General Surgery Mark Hampton, Stellenbosch University, South Africa Kausik Ray, University of Calcutta, India Fellowship of the Faculty of Surgical Trainers John Laing Duncan OBE, University of Aberdeen Stephen Patrick Robert MacLeod, University of Dundee The Joint Surgical Colleges’ Medal Mark Hampton, Stellenbosch University, South Africa The Syme Medal Mark Hughes, University of Edinburgh Diploma of Membership in Otolaryngology Paul Michael Davies, University of Birmingham

Diplomas of Membership in Ophthalmology Chaw Su Latt, University of Yangon, Myanmar Mya Wut Yee Soe, University of Yangon, Myanmar

Liam Zen Yapp, University of Dundee Li Yenn Yong, University of Edinburgh Tay Za, University of Birmingham Amy Sulan Zheng, University of Oxford

Intercollegiate Diplomas of Membership in Surgery in General Omer Osman Eltayb Ahmed, University of Gezira, Sudan Khalifah Alyatama, National University of Ireland Jessica Lee Yin Chang, University of Nottingham Waradana Thathya Thamarasie De Silva, Tribhuvan University, Nepal Samuel Debono, University of Malta Mina Derias, Universities of Exeter and Plymouth Kirsten Victoria Hamilton, University of Aberdeen Mahappuge Shasika Eranda Karunadasa, University of Colombo, Sri Lanka Jonathan Daniel Robert Macdonald, Queen's University Belfast Arshad Mahmood, Khyber Medical University, Pakistan Verushka Mansukhani, Maharashtra University of Health Sciences, India Sieu Ming Ng, University of Nottingham Gunaratnasingham Rajiv Nirmalasingham, University of Colombo, Sri Lanka Htar Nyein, University of Mandalay, Myanmar Alexander Seager, University of Leicester Mazen Soufi, Jordan University of Science and Technology

Diploma in Immediate Medical Care Clinton Paul Luke Jones, University of Liverpool Diploma in Retrieval and Transfer Medicine Clinton Paul Luke Jones, University of Liverpool

Diplomas of Membership in Orthodontics Asma Abdulla Al-Mulla, University of Dundee Maryam Mohammad Alsaleh, University of Kuwait Ibikunle Ayodele Aluko, University of Lagos, Nigeria Elinor Victoria Chalmers, University of Glasgow Lamis Khalid Koshak, King Abdulaziz University, Saudi Arabia Nicola Rani Sharma, University of London Jiten Vadukul, University of Birmingham

Diploma in Remote and Offshore Medicine Lee Elliott Boomer, Medic Certificate, Health and Safety Executive UK

Diploma of Membership in Periodontics Narinder Dhadwal, University of London

Certificate in Remote and Offshore Medicine Neil Sampath, University of the West Indies

Diplomas of Membership in Prosthodontics Lieke Blokland, University of Groningen, The Netherlands

Diploma of Fellowship in Dental Surgery in the Specialty of Restorative Dentistry James Christopher Darcey, University of Manchester

Mani Raghu Raman, University of Madras, India

Diplomas of Membership of the Faculty of Dental Surgery Sumira Bali, Rajiv Gandhi University of Health Sciences, India Claragh Jane Drake, National University of Ireland Aruna Kumar, Baba Farid University of Health Sciences, India Arun Kumar Madahar, University of Sheffield

Diploma of Membership in Endodontics Michael Philip Lloyd Jones, University of Sheffield

Diploma in Orthodontic Therapy Alison Mason, Institute of Postgraduate Dental Education, University of Central Lancashire

Diploma of Fellowship in Dental Surgery Without Examination (by application)

rcsed.ac.uk | 49

AGENDA

The Edinburgh MRCS OSCE Preparation Courses INTERNATIONAL These two-day courses use a combination of presentations, discussion groups, practice sessions and individual feedback, given by tutors experienced in the MRCS exam.

A major component of the course is the series of simulated MRCS OSCE stations covering clinical and procedural skills, applied surgical science and critical care, anatomy and surgical pathology and communication skills. Clinical OSCE stations use both real and simulated patients, and examiners give structured individual feedback, with candidates both observing and taking part in the mock sessions.

To book a place please visit the Education section of the RCSEd website www.rcsed.ac.uk or contact education@rcsed.ac.uk or phone +44 (0)131 527 1600.

50 | Surgeons’ News | September 2016

Locations Chennai 14–15 September 2016 £345 full course fee £300 if enrolled on the RCSEd Part B exam Myanmar 23–24 September 2016 £345 full course fee £300 if enrolled on the RCSEd Part B exam Kuala Lumpur 24–25 October 2016 £485 full course fee £455 if enrolled on the RCSEd Part B exam Chennai 8–9 December 2016 £345 full course fee £300 if enrolled on the RCSEd Part B exam

REGIONAL SURGICAL ADVISERS IN YOUR AREA

6

7

The College’s support and advice network throughout the country

11 10 8

9

1

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

21 39 40 22 34

Advisory Network Group Members 3 Stuart Clark, Manchester Royal Infirmary 4 David Exon, Leicester Royal Infirmary 5 Vijay Santhanam, Addenbrooke’s Hospital, Cambridge 6 Sean Kelly, Raigmore Hospital, Inverness

35 33

20 3 38

19 18

SCOTLAND

NORTH OF SCOTLAND 6 Morag Hogg, Raigmore Hospital, Inverness 7 Lynn Stevenson, Aberdeen Royal Infirmary, Aberdeen

29 4 14

30 31 37

WEST OF SCOTLAND 8 Lindsey Chisholm, Royal Alexandra Hospital, Paisley 1 Simon Gibson, Crosshouse Hospital, Kilmarnock

2

13

12 32 24

5

23

36 16 17

SOUTH EAST OF SCOTLAND 9 Farhat Din, Western General Hospital, Edinburgh 10 Robyn Webber, Victoria Hospital, Kirkcaldy

26 25

28 27

15

EAST OF SCOTLAND 11 Musheer Hussain, Ninewells Hospital, Dundee

ENGLAND

EAST OF ENGLAND 12 Andrew Gibbons, Peterborough City Hospital, Peterborough 13 Stuart Irving, Norfolk and Norwich University Hospital, Norwich EAST MIDLANDS 14 Sridhar Rathinam, Glenfield Hospital, Leicester KENT, SURREY & SUSSEX 15 Mike Williams, Eastbourne District General Hospital, Eastbourne LONDON 16 Cynthia-Michelle Borg, University Hospital Lewisham 17 Ziali Sivardeen, Homerton University Hospital MERSEY 18 Janardhan Rao, Countess of Chester Hospital, Chester 19 John Taylor, University Hospital Aintree, Liverpool NORTH WESTERN 20 Jeremy Ward, Royal Preston Hospital, Preston 20 Mike Woodruff, Royal Preston Hospital, Preston NORTHERN 21 Paul Gallagher, Wansbeck Hospital, Northumberland 22 Barney Green, James Cook University Hospital, Middlesbrough OXFORD 23 Richard O’Hara, Milton Keynes Hospital, Milton Keynes 24 Mike Silva, Churchill Hospital, Oxford

SOUTH WEST PENINSULA 25 Simeon Brundell, Derriford Hospital, Plymouth 26 Neil Smart, Royal Devon & Exeter Foundation Trust, Exeter WESSEX 27 Anthony Evans, Portsmouth Hospital, Portsmouth 28 Arjun Takhar, University Hospital of Southampton NHS Trust WEST MIDLANDS 29 Ishan Bhoora, Cannock Chase Hospital, Staffordshire 30 Pradeep Kumar, Queens Hospital, Staffordshire 31 Ramanan Vadivelu, Royal Wolverhampton Hospital NHS Trust 32 Ling Wong, University Hospital Coventry and Warwickshire, Coventry 32 Giles Pattison, University Hospital of Coventry and Warwickshire, Coventry YORKSHIRE & HUMBER 33 David O’Regan, Leeds General Infirmary, Leeds 34 Mark Peter, Scarborough General Hospital, Scarborough 35 Mark Steward, Bradford City Hospital, Bradford

WALES

36 Sanjeev Agarwal, University Hospital Wales, Cardiff 37 Raymond Delicata, Nevill Hall Hospital, Abergavenny

38 Vaikuntam Srinivasan, Glan Clywd Hospital, Rhyl

NORTHERN IRELAND 39 Catherine Scally, Antrim Hospital 40 Colin Weir, Craigavon Area Hospital

www.rcsed.ac.uk | 51

OUT OF HOURS

Layer upon layer upon layer From crustaceans in Brisbane to Moroccan delights in London with a MasterChef finalist

52 | Surgeons’ News | September 2016

Grilled swordfish from Black Bird

Graham Layer Consultant Surgeon at the Royal Surrey County Hospital and RCSEd Vice-President

followed for a wind-blown lunch in the old electricity powerhouse on the banks of the river. So much care went into the presentation of the barramundi for the others and duck breast with a croquette of duck legs, attractive gnocchi trimmings and colourful squashes for me. Chocolate mousse was served in balls topped with candyfloss.

Next, I spent an evening in buzzy Black Bird overlooking the river, having a relatively simple but beautiful plate of colourful charcuterie and olives, the juiciest of Mooloolaba prawns served with purple gnocchi, followed by grilled swordfish perilously topped with a crispy potato cake and caviar (pictured above) and Australian mega-steaks. The dishes were made all the more exciting by the way the components were served in layers. We shared desserts and the pineapple tarte tatin was beautiful, decorated with bananas and rum-flavoured ice cream.

Back in the UK, La Garrigue in Edinburgh, between the College and Waverley Station, has earned an excellent reputation for real French food served in a rustic, almost chaotic, setting. The whole experience could be improved by smartening up the surroundings and the appearance of the otherwise superb food. I have never been fond of rabbit, having been brought up as a child to operate on and eviscerate them on the kitchen table after they had been hung in the garden shed prior to cooking. It always appears on truly French menus, often soaked in its own blood.

However, this restaurant does cater for wider tastes than mine, and its snails and duck gizzards is a starting choice; or perhaps pigs’ trotters or pigeon. I chose the excellent fish soup with garlic sauce and croutons served separately.

Main courses included a delicious lamb with aubergines and confit duck. Everything has to be confit these days it seems.

Brasserie Zédel in London, just off Piccadilly Circus, is a stablemate of The Wolseley, The Delaunay and The Colony, so I was expecting a glorious experience. Not so, as it is a

SWORDFISH: GRAHAM LAYER; MOMO: EMMA GUTTERIDGE

T

he artistry of food presentation was brought to my attention again recently when I was fortunate enough to dine in several riverside restaurants in Brisbane, Australia.

The freshest of local ingredients, particularly seafood, made an outstanding contribution to the finished plates, but it was the sheer cosmesis of the presentations that was so appealing. I commenced with an outdoor evening meal on the terrace of a fabulous Italian restaurant, Il Centro, where the sand crab (granseola) lasagne with creamed crustacean sauce is signature, and the veal scaloppini covered in parmesan and served with my favourite fettuccine carbonara were outstanding to eat and well served – plenty of orange-coloured sauces coating the stunning layers of spicy sand crab and the pasta nestling around the battered meat. Deconstructed tiramisu to follow was enticing.

Everything was arranged so perfectly on the plates.

Next, a riverside lunch in Stokehouse Q, almost under the Goodwill Bridge. It has a stunning setting with floorto-ceiling windows, and serves the most innovative menu, particularly octopus tentacle wrapped around a fillet of an unpronounceable fish similar to sea bass, decorated with mussels and prawns, and served on a jet-black plate. Also a brilliant plate of Moreton Bay bugs casually arranged around the green accompaniments, and their healthy (I am sure) take on fish and chips, a delicate array of tempura vegetables and barramundi, held together with Caesar mayonnaise.

This was followed by a magnificent banquet at Matt Moran’s Aria, sister to the restaurant beside the Opera House in Sydney. I had a spectacular meal as guest of a previous President of the Royal Australasian College.

Moreton Bay bugs were sublime, and a generous portion too – like a whole lobster tail served with erogenous sea urchin custard draped over the crustacean’s arched back, which was fresh and tangy, with a few scraps of exotic mushrooms nonchalantly surrounding the beast. The tender scallops and barramundi were similarly perfect. A towering banana soufflé was frothy and superbly presented in a copper vessel, and the intervening veal chop was perfection, with delicious sweetbreads of many differing shapes suggesting multiple internal organs of origin.

Watt, or New Farmer’s Kitchen depending where you sit,

You almost believe you are in a real Arab souk in London’s Momo

Seven shades of grey brasserie and not a Grand Café or restaurant in the true French style. It was much more ordinary – and therefore affordable – but in a magnificent setting, sort of a semibasement. The menu was also familiar and predictable – French onion soup, snails, kidneys, scallops, entrecote with mushrooms and fries. It is well worth sharing the oozing tarte tatin. Not so much artistry in the food, but the room itself is extraordinary.

And now for something completely different hidden in a cul-de-sac parallel to Regent Street, London: Momo. We dined in this den with my MasterChef nephew. You feel as if you are in an Arab souk – amazingly realistic and somewhat uncomfortable seating arrangements and shared tables, but magnificent Moroccan delights await following the small, open-kitchen entertainments. Predictably, we shared a number of the spicy items on offer: classic houmous, tiny aubergines with pesto and Labneh cheese, barbecued octopus that was stunning served with beetroot! The crispy prawns were with mango and avocado, and the scallops with an unusual mix of sweet potato and vanilla. These worked well and we proceeded to various dishes mostly served with a perfect couscous – lamb tagine, predictably, chicken and olive tagine, lamb chop with Jerusalem artichoke and prunes, and a Momo mixed grill of lamb chop, chicken, lamb kebabs and Merguez sausage served with imagination, piled high on the plate with the added colour of confit tomatoes all bound together with a harissa-flavoured yoghurt. All immensely unusual for my palate, but hugely enjoyable and in a terrific atmosphere.

To finish, I enjoyed an otherwise grey bank holiday Monday in Syon Park, supporting the four MasterChef finalists, two of whom were publicly demonstrating their art and artistry in a culinary theatre. To watch a contemporary version of coronation chicken with crispy chicken skin and samosas being prepared live with such finesse, and with some unusual surgical techniques, by another Layer, made me appreciate even more the talents and ‘non-technical skills’ of these innovative amateur chefs.

Season of mists and mellow fruitfulness with Bernard Ferrie

G

rey can be so distinguished – so are Pinot Gris wines. Alsace, Oregon, New Zealand and Germany are our autumn hunting grounds.

Same grape as Pinot Grigio just richer, rounder – a sort of middle-aged spread.

M Signature Alsace 2014 (£8, Morrisons) has hints of spice and honey – fabulous value. Pfannenheim 2012 (£11.20, Tanners) is rich, intense, aromatic, peachy and honeyed with some lemon – perfect with smoked ham and cheese.

Oregon’s The Eyrie Vineyards’ 2012/13 (£15.80, Savage Selection) is a delicate wine of extraordinary longevity, deep-coloured and honeyed. Opened up well after a day or two. Try with red Thai curry.

A NZ trio: Pronounced grey-wacky, Greywacke Pinot Gris 2012 (£19.50, Worths) – is ripe and rounded with quince, peach, pear and nutmeg flavours. Generous, honeyed, fleshy style from Marlborough, full, satisfying and neither grey nor wacky. Kumeu River SM4 2014 (£11.99, Majestic) is just north of Auckland. The floral wine has hints of apple, white pepper and herbs, slightly off dry – goes well with poached salmon. So does Waimea Estate 2014 (£11.99, Majestic) – pear, honey, spice and apple but 13.5%.

Villa Wolf Pinot Gris 2014 (£9.75, Worths) Pfalz, Germany. The Antipodean lady who sold me the bottle approved of my choice. She had enjoyed a bottle on a slow train to London – definitely beats a rail sarnie and tannic tea – a strong argument against HS2. Fresh, dry with tiny bubbles to be savoured. Lovely – if only more German wines were like this and no indecipherable gothic script on the label. The pick of the bunch. Even the men in grey suits would drink this.

rcsed.ac.uk | 53

DATES FOR YOUR DIARY The latest surgical and dental events, seminars and courses

AUGUST 25–28 26–27

MFDS Part 1 Revision Course (Dubai) The Edinburgh MRCS OSCE Preparation Course (Oman)

SEPTEMBER 1–2 3–4 4–6 5–6 8–9 8–9 10–13 12–13 14–15 17–18 19 21 22–23 22–23 23–24 24 26–27 28–29 29–30

Anatomy for MRCS OSCE (Wade Programme in Surgical Anatomy) The Edinburgh MRCS OSCE Preparation Course Mock MRCS OSCE Exam Course (Aberdeen) Core Skills in Urology Course Modules 1 & 2 Basic Surgical Skills NOTSS for Urology Trainees (Birmingham) Scottish Surgical Boot Camps (Inverness) Basic Surgical Skills (Hong Kong) The Edinburgh MRCS OSCE Preparation Course (Chennai) The Edinburgh MRCS OSCE Preparation Course (Manchester) Basic Surgical Skills Course (Eindhoven) Arthroscopy of Ankle and Hindfoot – A Cadaveric Course Higher Surgical Skills Course Basic Surgical Skills Course (Hong Kong) The Edinburgh MRCS OSCE Preparation Course (Myanmar) Surgical Anatomy of the Head and Neck – One-Day Practical Review (Wade Programme in Surgical Anatomy) (St Andrews) Basic Surgical Skills (Hong Kong) Emergency Abdominal and Thoracic Surgery for the General Surgeon (Dundee) Basic Surgical Skills (Hong Kong)

OCTOBER 6–7 8–9 10 15

Basic Surgical Skills (Birmingham) Foundation of Surgical Gastroenterology Interview Skills for Core Surgical Training Surgical Anatomy of the Trunk – One-Day Practical Review (Wade Programme in Surgical Anatomy) (St Andrews) 15 Future Surgeons: Key Skills (Manchester) 16 Future Surgeons: Key Skills (Manchester) 19–20 Basic Surgical Skills (Hong Kong) 21 Annual Conference of the Faculty of Surgical Trainers – Training

by Numbers: Competence vs Time in Surgical Training 21 Preparation for the Diploma in Implant Dentistry (Sydney) 21 Future Surgeons: Critical Care 24–25 The Edinburgh MRCS OSCE Preparation Course (Kuala Lumpur) 26–27 Basic Surgical Skills (Lyon) 26–28 Core Skills in Orthopaedic Surgery 27–28 MFDS Part 2 Revision Course 28 The Orthopaedic Symposium 2016 29–1 Nov Scottish Surgical Boot Camps (Inverness)

NOVEMBER 1 2–3 2–4 7–8 8–10 10–11 12–13 12–13 14 14 15–17 16

Basic Skills in Paediatric Surgery Training the Trainers: Trainer Development Course Advanced Trauma Life Support (ATLS) Core Skills in Urology Course Modules 3 & 4 Basic Surgical Skills (Riyadh) Basic Surgical Skills Basic Surgical Skills (Manchester) Foundation of Clinical Surgery Radiology for Surgeons Musculoskeletal Course for GPs/GPSTs (Birmingham) Neurosurgical Approaches to the Cranial Compartments Preparation for the Diploma in Implant Dentistry (London)

For further information, please email education@rcsed.ac.uk or telephone +44 (0)131 527 1600.

All events are in Edinburgh unless otherwise stated.

ANNUAL REPORT

2016

RCSED OFFICE BEARERS AND COUNCIL SEPTEMBER 2016 Back row, from left: Miss Anna Paisley; Mr Sanjay Gupta; Mr Timothy Graham; Mr Alastair Gibson; Miss Elaine Griffiths; Professor Simon Frostick; Professor Rowan Parks; Ms Clare McNaught; Mr Simon Paterson-Brown; Mr Ahmed Nassef; Ms Victoria Dobie; Ms Alice Hartley Council Members not pictured: Mr Roger Currie; Professor Steven Wigmore

Front row, from left: Mr Charles Auld; Mr Pala B Rajesh; Dr Judy Evans, Honorary Secretary; Professor John Duncan OBE, Vice-President; Mr Michael Lavelle-Jones, President; Professor Graham Layer, Vice-President; Professor Richard Montgomery, Honorary Treasurer; Professor William Saunders, Dean of the Faculty of Dental Surgery; Professor Michael Griffin OBE

www.rcsed.ac.uk | 57

ANNUAL REPORT

Report from the Trustees

T

MR MICHAEL LAVELLEJONES

his report marks the end of another highly successful year for our College and, following the election of the Office-Bearers, a seamless transition from one administration to another.

The last three years have been universally successful and it is my challenge to continue the progressive development of this College upon the stable platform that I have inherited from Ian Ritchie and his team.

Visitors to the College will realise that 2015 was the year when the College campus in Edinburgh ‘came of age’, with the completion of the Lister Project, the official reopening of the College Museums and the dedication of the Prince Philip Building by His Royal Highness in September. The impact has already been felt, with a campus that now has the capacity to deliver the College’s core activities in education and training.

Success following the Museum refurbishment can be gauged by the significant increase in visitors, which contributes positively to the profile of the College in Edinburgh and beyond. None of this would have been achieved without the major financial contributions of the Heritage Lottery Fund and the Wohl Foundation, along with your generous donations, all of which have underpinned the Lister Project.

With so many activities in the College this year, I have chosen to concentrate on several themes.

The College continues to champion the use of new technologies to assist in education and training. We have teamed up with Touch Surgery to offer educational opportunities via a surgical simulation app that is easily accessible on any smart device. RCSEd has also collaborated with the Glasgow School of Art’s Digital Design Studio supporting the 3D Definitive Human Anatomy Project. The first images of the 3D Definitive Human were unveiled in November 2015 and, in due course, will be available to our entire membership, providing a valuable anatomy educational resource.

It has also been another very busy year for our Examinations Department, which processed in excess of 6,000 applications, split one-third UK and two-thirds from the international community. This year, we have expanded the number of international venues that offer our portfolio of examinations, with a consequent increase in candidate numbers compared with 2014. The MRCS examination continues its popularity internationally with the Part A assessment being offered in 21 centres in 15 countries. The November diet of the Part II OSCE examination held in Khartoum attracted 114 candidates, a record for the College.

We strive to maintain our reputation for excellent standards and, as such, quality assurance of the examination process continues to be of the highest importance to the Examinations Department.

EDUCATION AND ASSESSMENT: THE HEART OF THE COLLEGE’S ACTIVITIES

ENGAGING WITH OUR MEMBERSHIP: OUR YOUNGER FELLOWS

Educational activities are at the core of our College’s mission and once again we have delivered above expectation in this area. The College has engaged with the Specialty Associations and values their support in delivering and expanding our educational portfolio.

The College’s e-learning programme sustained its impact with courses run both from the Edinburgh campus and elsewhere in the UK, including the Birmingham centre. During the year we have attracted more than 4,200 participants from the UK and from the international community, with a substantial increase among overseas delegates.

One of the College’s priorities is to foster relations with its younger Fellows. New and future consultants need to work together to address the challenges they face daily, to develop new skills and to have a pathway to voice their views, opinions and concerns. To facilitate this, the College has established a Younger Fellows Group, which is open to those within 10 years of receiving the FRCS. Led by Council member Clare McNaught, the group has proved hugely popular, with events held throughout the UK during the year.

The Touch Surgery surgical simulation app can be used on any smart device

58 | Surgeons’ News | September 2016

DEVELOPING THE COLLEGE’S REACH AND REPUTATION The international activities of the College continue to be a priority and are co-ordinated through the College’s International School of Surgery (ISS), which was launched in 2013 with the aim of promoting effective engagement with the College’s growing international membership and partner organisations around the globe.

This year, ISS has helped facilitate a variety of exciting projects. Examples include our Examiner Training programmes held with the College of Surgeons of South, East and Central Africa (COSECSA) and with the West African College of Surgeons. Our work with the Oman Medical Specialty Board exploring joint ventures in assessment and education, along with various collaborative educational events held in Indonesia, the

COSECSA graduates who have benefited from the Examiner Training programme, one of the projects the ISS helped facilitate

Philippines and Sri Lanka have also been facilitated by the ISS. Support for surgeons and training in the international community is of critical importance to our College.

The International Medical Graduate Sponsorship Scheme (IMGSS) has run for many years and during 2015 sponsored 79 international graduates into training posts. This year saw the launch of a complementary scheme, the RCSEd International Surgical Fellowship Programme. It differs from the IMGSS scheme in that it will provide opportunities for international trainees with specific training requirements but who have not themselves been able to identify a post. Our College will act as a broker, helping to match trainees to suitable educational opportunities within the UK and providing quality assurance. The popularity of this new scheme can be judged by the 120 enquiries the College has received in the first few months since its launch in September.

I am also proud to witness the expansion of our portfolio of international charitable activities aimed at improving access to surgery across the globe. In 2015, the College supported a new surgical training project in Rwanda and our capacity development work in urology training and education in Myanmar, led by Past President David Tolley, has gone from strength to strength. It is likely this work will roll out to other surgical disciplines in Myanmar and the surrounding ASEAN community.

This year, too, we awarded an Honorary Fellowship to Myanmar’s pro-democracy campaigner, Aung San Suu Kyi, in recognition of her contribution to healthcare in her country.

ENHANCING THE COLLEGE’S PROFILE AND CHAMPIONING PATIENT SAFETY Closer to home, our Policy Department based in our Birmingham office has been a driving force in improving the College’s visibility and influence, not only among our Members and Fellows, but also with parliamentarians and policymakers. The College now has clear positions and lines to take on policies that affect both the College and its membership and regularly responds to consultations on matters related to healthcare provision and patient safety, as well as to the development of national clinical guidelines.

Tim Graham, our recently elected local Council member from Birmingham, will take forward the College’s Standards Office. During 2015, this office has further refined the College’s Invited Review process, including the development of a pool of trained reviewers.

In future, we shall be better placed to respond to requests from trusts and health boards for reviews of surgical performance at individual or unit level. We are keen to support institutions and clinical teams to help benchmark surgical practice through the provision of expert, independent, objective advice.

Another key project delivered in 2015, through the College’s Patient Safety Board under the leadership of Council leader Simon Paterson-Brown, has been the surgical ward-round toolkit. This applied the College’s flagship NOTSS (Non-Technical Skills for Surgeons) system to reduce errors and improve safety on surgical wards. The toolkit is now available on the College’s website.

PROTECTING AND PROMOTING THE COLLEGE’S HISTORY We are justifiably proud of our College’s history. Our Museums are home to one of the largest and most historic collections of surgical pathology material in the UK. In our well-resourced medical and surgical library, historical documents dating back to the inception of the College co-exist with the latest in texts, journals and electronic resources. The importance of these collections has been acknowledged by Museums Galleries Scotland, which granted the Museum the label of Collection of National Significance in 2009.

It will certainly not have escaped your notice that the Museums were closed in 2014 and 2015 during its extensive, ambitious 18-month redevelopment. The refurbishment of the Surgeons’ Hall Museums and the College’s library and archives was undertaken in order to improve physical and intellectual access to the College’s collections and to preserve these historic assets for the benefit of future generations. As part of the process, a programme of ‘contemporary collecting’ has taken place to ensure that the displays and archive encompass many of the latest forms of surgical technology.

These are just a few examples of the progress and innovation that have taken place across the College during the year. I am indebted to the hard work of all involved, especially the senior management team and Office-Bearers, past and present, supported by our Council and our membership in all their roles, who have made this possible.

Looking ahead to 2016, I am quite sure that our work across the four UK nations and in the international community will continue unabated and I look forward to reporting our progress in 12 months’ time. www.rcsed.ac.uk | 59

ANNUAL REPORT

Report from the Chief Executive

I

MS ALISON ROONEY

am pleased to report on what has been a successful, exciting and pivotal year for the College. As 2015 drew to a close, we welcomed Mr Michael LavelleJones as our new President, while Professor John Duncan and Professor Graham Layer were elected Vice-Presidents of the College. I would like to take this opportunity to thank our Immediate Past President, Mr Ian Ritchie, for his positive leadership while in office; with the help of our new team of Office-Bearers and all of Council, we will endeavour to build on his good work and to keep delivering our strategic plan.

Several points deserve to be highlighted in the preamble: the continued growth of our membership brought about by the sustained efforts of many departments across the College; the success of the Birmingham centre as it matures beyond its first year; a continued and successful engagement with pupils and medical students; the refurbishment of Surgeons’ Hall Museums, along with ongoing campus development projects; the success of Surgeons’ Lodge Limited (SLL) with its pivotal role within core activities of the College; and positive fundraising developments beyond the Lister Project.

MEMBERSHIP GROWTH AND ENGAGEMENT

Membership is the raison d’être of the College and it is our role to make sure that we develop, maintain and promote a broad range of services that meet the expectations of our Fellows, Members and Affiliate Members. We have seen sustained growth across all categories over the past few years and, as of 31 December 2015, our total membership was just under 24,000 in more than 100 countries worldwide.

I am particularly happy to note the ongoing development of our Faculty of Pre-Hospital Care and our Faculty of Surgical Trainers.

I reported briefly last year on the membership survey that was launched at the beginning of 2015, and I would like to provide some further observations on the outcome of that campaign. We were delighted by the response rate we achieved, and I want to thank all of our members who committed to give us their views on the services we provide as well as on professional issues. In order to build on the findings of the survey and the information gathered from focus groups that took place with different segments of our membership, we made developments to the College’s website: we now offer members a bespoke private section to manage their membership profile and subscriptions. An enhanced version of the website was launched in June this year to provide a more efficient online experience and facilitate the use of digital resources or the booking of courses and examinations. The enhanced site is a precursor to further digital and web developments that we expect to deliver within the next two years.

60 | Surgeons’ News | September 2016

DEVELOPING OUR PROGRAMME OF OUTREACH ACTIVITIES The College takes pride in offering a very rich programme of outreach activities targeted at a wide range of audiences, from Senior Fellows to schoolchildren and including medical students, junior doctors, prospective members and medical professionals around the globe. The College regularly runs activities such as careers workshops, exam lectures, course taster sessions, professional exhibitions and events aimed at schoolchildren considering a career in medicine.

We also coordinate a very active network of Regional Surgical Advisers and Regional Dental Advisers who provide support and guidance to our membership across the United Kingdom.

It is worth noting the ever-growing place of our Birmingham centre, which has been in operation for two years. The Birmingham centre was established to provide a rallying point for the College’s membership based principally in England and Wales, and to give them a more ‘local’ base where they can interact with the College and use its services and facilities.

As well as being a base for the College’s healthcare policy and public-affairs activity, the centre provides the required infrastructure for the College to deliver membership, education and examination regional activities. For instance, the team delivered and participated in 52 outreach events, 13 of which were new activities. While the majority (34) had a surgical focus, 18 were related to the College’s Faculty of Dental Surgery.

There were 347 events hosted in Birmingham, including commercial bookings, examinations, educational courses and professional meetings. I am glad to note that the centre has naturally become a second ‘home’ to Office-Bearers and Council Members, and I travel to Birmingham frequently to keep in touch with our team there or to meet with regional partners.

In November 2015, the College launched its second Communication Skills Video Competition. This was open to medical students, doctors and trainees, and invited them to record a three-minute video demonstrating good communications practice (a skill

The financial performance of the College continues to be very good. In order for the College to develop and deliver its broad portfolio of activities, the focus has been placed on raising funds through commercial ventures and other activities

essential to patient safety). Following the success of the first two events, we will be holding the competition again in 2016/2017. It will be opened to entrants in the second half of the year.

Looking ahead, we are also planning to hold our third Surgical Skills Competition and our third Dental Skills Competition simultaneously in 2016–2017. The heats for both will be held across the United Kingdom over the autumn and winter this year, with the grand finals in March and February 2017, respectively.

FINANCIAL SUSTAINABILITY AND COMMERCIAL DEVELOPMENTS I am delighted to report that the financial performance of the College continues to be very good. In order for the College to develop and deliver its broad portfolio of activities, the focus has been placed on raising funds through commercial ventures and other activities. This has permitted the College to develop initiatives beyond its core activities, to invest in areas of innovation and growth and to support the charitable aims of the institution.

Major projects carried out in 2015 have allowed for the expansion of Surgeons’ Lodge Limited (SLL), the entity established to run the commercial activities of RCSEd, principally its hotel and commercial events business. The addition of new venues to the College’s campus have indeed allowed SLL to grow its operation and to host more commercial events. This has been taken forward in tandem with a new joint venture with Heritage Portfolio Limited, providing an integrated catering operation between the two organisations across the Edinburgh campus and realising efficiencies for both parties.

I would like to congratulate the whole SLL team after an excellent 2015, as they had their most successful Edinburgh Festival trading to date. They have also seen their hard work crowned with the award of Conference Hotel of the Year for the second year in a row at the Scottish Hotel Awards, while Ten Hill Place Restaurant received a rosette for Culinary Excellence.

During 2015, a Development and Appeals Strategy (2015–18) was developed and agreed by College Council.

This strategy sets out the vision for the College’s fundraising activities and delineates objectives to achieve the College’s funding priorities over the coming years.

As part of the funding requirements for the Heritage Lottery Fund, the College was required to raise match-funding in respect of its Lister Project to refurbish the College’s Museums, library and archives.

This allowed the College to fully finance the Museums refurbishment without utilising existing reserves which, in turn, has released this funding for other projects and priorities. Moving forward, we are looking to raise funds to increase the College’s Research Fellowships’ portfolio, and to offer more small research grants and Travelling Fellowships.

CAPITAL PROJECTS AND DEVELOPMENT OF INFRASTRUCTURE Building upon our healthy financial position, we have been able to allow for a demanding programme of maintenance and development works.

On 28 September 2015, the College’s Patron, HRH Prince Philip Duke of Edinburgh, opened the Prince Philip Building, the College’s new multipurpose events space. We have also started up our own café, Café 1505, which is operated by SLL. It is open to both visitors to the refurbished Museums and to the general public.

After an 18-month closure, the refurbished Surgeons’ Hall Museums, which features the magnificent Wohl Pathology Museum, reopened in September 2015. Since reopening, the Museums have hosted a variety of public, professional and education events. A partnership has been set up with the Children’s University as a learning destination, and we have welcomed disability groups within the Museums or as part of outreach visits.

Between September 2015 and the end of the year, the Museums welcomed 18,000 visitors, a figure exceeding the target and showing an increase of 100% compared with the same period in 2013. This success has been acknowledged through a number of awards, such as Best Permanent Exhibition in the UK at the prestigious Museums + Heritage Awards for Excellence 2016, where the project was also highly commended in the ‘Innovation’ category for its digital dissection in the new Anatomy Theatre display. The College was also Highly Commended in the Royal Institute of Chartered Surveyors (RICS) Awards 2016 in the ‘Building Conservation’ Category.

Finally, the College was delighted to win two Silver Star Awards at the Marketing Society Awards 2016, the biggest of its kind in the UK, for its marketing and advertising campaign for the reopening of the Museums.

We won in both the categories in which we had been shortlisted – ‘Cause-Related and Charity’ and ‘Tourism, Leisure and Sport’.

Information and communications technology continue to play an increasingly important and central part in the delivery of the College’s activities and, as such, it is crucial that the College provides to members and staff an IT infrastructure that meets 21st-century requirements. In recognition of this, the College has been undertaking an initial review of its IT systems and infrastructure and will be following this up with an in-depth review programme to ensure they remain fitfor-purpose and designed to deliver maximum benefit to the College and other users.

DEDICATED STAFF My final word is for the staff of this College.

I never cease to be impressed and inspired by the achievements of our institution; these are possible only because the College’s hard-working staff are motivated, enthusiastic and dedicated to making it a place fit to achieve its ambitions. www.rcsed.ac.uk | 61

ANNUAL REPORT

T

HONORARY TREASURER

MR RICHARD J MONTGOMERY

his is my second report as your Honorary Treasurer since I started in November 2014.

Over the last two years, we having been living in interesting times, both as a nation and as a College.

The College has gone through a period of extensive development of our faculties, courses and examinations. Recently, our new Museums welcomed their 50,000th visitor in less than a year; the Prince Philip Building contributes strikingly to the visual impression of the campus, as well as serving a real need for meeting spaces; and our office in Birmingham enables us to have a facility closer to our membership.

In the wider context, the College has watched the gyrations of the various political parties and global economic developments – particularly in interest and exchange rates – while trying to anticipate their impact on the College.

All these factors are closely scrutinised by the various College financial committees, which include members of the legal, financial and banking professions. We are extremely grateful for the valuable contributions these distinguished individuals make to our charity.

Like all organisations, the College continued to manage its financial affairs during the periods of

Balance sheet at 31 December 2015 31/12/2015 31/12/2014 £000

£000

83

–

24,372

19,994

Heritage assets

3,875

3,875

Investments

6,550

6,775

Current assets

11,622

12,112

Creditors: amounts falling due within one year

(5,503)

(5,002)

Creditors: amounts falling due after more than one year

(4,013)

(4,387)

36,986

33,367

5,239

5,233

Unrestricted funds – other

16,549

15,921

Restricted funds

12,069

9,096

3,129

3,117

36,986

33,367

Intangible fixed assets Tangible fixed assets

Represented by: Unrestricted funds – revaluation reserve

Endowment funds Net assets

62 | Surgeons’ News | September 2016

uncertainty. The closing reserves at 31 December 2015 were £36,986,000 (2014: £33,367,000) comprising £21,788,000 of unrestricted funds, £12,069,000 of restricted funds and £3,129,000 of endowment funds.

The income and expenditure account aggregate surplus of £3,619,000 (2014: £2,137,000), as shown on the consolidated statement of financial activities, consists of a surplus of £634,000 on unrestricted funds (normal activities), a surplus of £2,973,000 on restricted funds and a surplus of £12,000 on endowment funds.

Overall income generated for the year was £19,216,000 (2014: £16,375,000), with £11,832,000 of income generated through charitable activities.

The principal sources of income for the group continues to be membership subscriptions, examinations and other trading activities.

Performance in 2015 also includes an increase in the receipt of restricted income year-on-year, and this is primarily related to funding directly related to the College Museums’ upgrade.

Total resources expended for the year were £15,623,000 (2014: £14,295,000). This increase in cost relates primarily to additional resources expended on charitable activities and other trading activities.

As part of its Lister Project, and in line with the funding requirements for the Heritage Lottery Fund, the College raised matched funding to refurbish the College’s Museums, library and archives. This allowed the College to fully finance the Museums’ refurbishment without utilising existing reserves which, in turn, has released this funding for other projects and priorities.

Surgeons Lodge Limited (SLL) is a College-owned company that runs the College’s business ventures, principally its Ten Hill Place Hotel, conference and events, and catering activities.

SLL had another award-winning year, improving services and facilities for customers. The expertise of the SSL Board, under the Chairmanship of George Borthwick, and Commercial Director Scott Mitchell and his team, continues to develop the brand and business. In 2015, SLL had a turnover of £4,245,000, generating a profit of £546,000, despite the temporary closure of the Museums. A priority for the current year is to drive more of the income generated to the bottom line by cost control.

The College’s investment portfolio is managed prudently by our investment managers, Cornelian Asset Management, and in 2015 achieved between 3% and 4% gross income yield. The Investment Committee considers this performance to be acceptable for a low-to medium-risk portfolio in the current volatile investment climate. The College does not invest in companies associated with tobacco or arms manufacture.

The number of Members and Fellows in good standing now stands at 21,739, a small increase. The College endeavours to keep subscription increases to a minimum, and believes its subscriptions to be lower than those of many other Royal Colleges. Subscriptions and examinations together provide over half of our income, although trading income is catching up. Ultimately, we foresee that trading income could allow us to become

Donations, bequests and gifts

Total incoming resources

£19.2 million

Subscriptions

25%

Examinations

24%

Courses

4%

Faculties

6%

Grants

16%

Trading income

19%

Investment income

2%

Other

3%

Fundraising and trading costs Subscriptions Examination costs

Total resources expended

£15.6 million

1%

20% 5% 20%

Courses

4%

Property

9%

Faculties

7%

Publications

5%

Grants

3%

Professional activities 14% Governance and support costs Other

even more competitive with our subscription levels.

The College operates in a sector where inflation is higher than in the general economy. This means that in order to maintain sound finances, we will have to consider a modest subscription increase

1% 12%

across all categories in 2016.

Overall, thanks to the efforts of our Fellows and Members, our dedicated staff, and the input from our supporters and Regents, our College remains in sound financial health.

Treasurer's statement on the summarised accounts of the Royal College of Surgeons of Edinburgh The financial statements on these pages are not the full statutory consolidated financial statements of the Royal College of Surgeons of Edinburgh, but are derived from the financial statements of the Royal College of Surgeons of Edinburgh, Hill Square Educational Trust and Surgeons Lodge Limited, a wholly owned trading subsidiary of the Royal College of Surgeons of Edinburgh.

The figures included in these statements/ summary are extracted from draft consolidated statutory financial statements currently subject to audit that is expected to conclude in September. Should any material variations arise between these and the final audited financial statements, they will be reported in the following edition of Surgeons’ News.

The summarised accounts may not contain sufficient information to allow a full understanding of the financial affairs of the College.

For further information, the full financial statements should be consulted. A copy of the full financial statements will be available from the Library, the Royal College of Surgeons of Edinburgh, Nicolson Street, Edinburgh.

R J Montgomery Honorary Treasurer

www.rcsed.ac.uk | 63

FROM THE COLLECTIONS

The specimen that helped physicians make the link between coal dust and lung disease

EUREKA MOMENTS

I

n 2014, Professor Ken Donaldson came to work at the Museum as a volunteer having specialised in lung disease and toxicology at the University of Edinburgh. He was key in helping the Museum develop its pathology exhibits for the Lister Project and was fascinated by our collection of respiratory specimens. Among these, he noted a particular specimen, GC.2100, which we believe is the first recorded example of coal-miner’s lung disease.

The specimen is described as: “A lung (GC.2100) showing blackening of the lungs and disease caused by the constant inhalation of airborne dust whilst working in a coalmine.”

In the 19th century, a burgeoning British coal-mining industry supplied fuel for the Industrial Revolution. By the 1830s, around 200,000 British miners were producing around 36 million tons of coal per year. It seems obvious now that inhalation of dust-laden air by colliers might result in harmful accumulation of dust in their lungs, but this was not initially apparent to physicians and surgeons.

In fact, the first report of a link between working as a coal miner, the accumulation of a black pigment in the lungs and debilitating lung disease was not made until 1831. In that year, the physician James Craufurd Gregory received John Hogg, aged 59, into his care at Edinburgh Royal Infirmary. Hogg had worked as a miner in Dalkeith

REFERENCE Case of peculiar black infiltration of the whole lungs, resembling melanosis. By James Craufurd Gregory, M D, FRSE, Fellow of the Royal College of Physicians, and one of the Physicians to the Royal Infirmary of Edinburgh.

Edinburgh Medical and Surgical Journal 1831; 36; Art. XI: p389

The first report of a link between working as a coal miner, the accumulation of a black pigment in the lungs and debilitating lung disease was not made until 1831 for the previous decade and was suffering from severe cardiopulmonary impairment.

When Hogg died three weeks later, Gregory carried out an autopsy and noted: “When cut into, both lungs presented one uniform black carbonaceous colour, pervading every part of their substance”. There was also a considerable degree of concurrent lung disease. Gregory speculated that the black pigment might be coal dust and handed the lungs to Sir Robert Christison, the Edinburgh physician/toxicologist famed for forensic investigation.

Christison analysed the black pigment extracted from the lungs and confirmed that it was coal dust. Gregory published his famous paper, the first to record that lung disease arose from employment in coal mines. In it, he suggested that the coal-mine dust “…remaining unabsorbed and acting 64 | Surgeons’ News | September 2016

as a foreign body… led ultimately to disorganisation of the pulmonary tissue”.

In addition, he issued a perceptive public health warning to medical practitioners in coal-mining areas regarding “…a disease to which a numerous class of the community would appear to be peculiarly exposed”.

Although prescient in this regard, Gregory could scarcely have imagined the epidemic of lung disease that was to develop throughout the world due to coal mining.

In 1840, Christison gave Hogg’s lung to the College Museum, where this historic specimen is on display.

Ken Donaldson and Chris Henry Surgeons’ Hall Museums

The blackened lung of collier John Hogg, on which staff at the Museums believe the first published description of coalworker’s pneumoconiosis was based

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