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July 2018
Setting up a perioperative anaemia
service: how do we do it?
Exams myth busting
An engineering approach to systems
improvement
Introducing the
Lifelong Learning
platform
www.rcoa.ac.uk
@RCoANews
Clinical Directors Meeting: Joint CPD Study Days
FEBRUARY
EVENTS CALENDAR with the AAGBI
27 November 2018
FPM Recent Advances
20–21 March 2019
RCoA, London
RCoA, London All days: £375 (£285 for trainees)*
Further information about all Invite only
4–5 February 2019
One day: £245 (£185 for trainees)
of our events can be found on RCoA, London
our website. British Ophthalmic Anaesthesia £175 (£140 for trainees)*
www.rcoa.ac.uk/events
Society (BOAS) Annual Scientific
Leadership and Management:
APRIL
Meeting
events@rcoa.ac.uk Leading and Managing Change Cardiac Disease Symposium
28–29 November 2018
@RCoANews 5 February 2019 3–4 April 2019
RCoA, London
RCoA, London RCoA, London
FPM 11th Annual Meeting £240 (£180 for trainees)* All days: £420 (£315 for trainees)*
30 November 2018 One day: £275 (£210 for trainees)*
Introduction to Leadership and Anaesthetists as Educators: an Final FRCA Revision Course
JULY Management: The Essentials Introduction
RCoA, London
£200 (£140 for trainees)*
11–15 February 2019 GasAgain
25-26 September 2018 31 October 2018 RCoA, London 25 April 2019
Final FRCA Revision Course RCoA, London RCoA, London All days: £420
2–6 July 2018 £420 (£315 for trainees)* £235 (£180 for trainees)* DECEMBER One day: £95
RCoA, London
£260
RCoA, London
All days: £400 Updates in Anaesthesia, Critical Winter Symposium Updates in Anaesthesia, Critical Developing World Anaesthesia
One day: £100 Care and Pain Management NOVEMBER 12–13 December 2018 Care and Pain Management 29 April 2019
25–27 September 2018 RCoA, London 25–27 February 2019 RCoA, London
UK Training in Emergency Airway All days: £420 (£315 for trainees)*
SEPTEMBER RCoA, London
All days: £515 (£390 for trainees)* Management (TEAM) One day: £275 (£210 for trainees)*
RCoA, London
All days: £515 (£390 for trainees)*
£220
One day: £210 (£160 for trainees)* 8–9 November 2018 One day: £210 (£160 for trainees)* Anaesthetists as Educators:
Advanced Airway Workshop
Teaching and Training in the
18 September 2018
Royal Infirmary Edinburgh
JANUARY Anaesthetists as Educators:
RCoA, London OCTOBER
£420 (£315 for trainees)
£475
Teaching and Training in the
Workplace
30 April – 1 May 2019
£260 (£195 for trainees)* Leadership and Management: Tracheostomy Masterclass
Workplace RCoA, London
GasAgain Working Well in Teams and Making 11 January 2019
27–28 February 2019 £450 (£340 for trainees)*
Clinical Directors Meeting: Joint 2 October 2018 RCoA, London
an Impact RCoA, London
with the AAGBI RCoA, London £260 (£195 for trainees)*
14 November 2018 £450 (£340 for trainees)*
19 September 2018
York Medical Society
£260 RCoA, London
Primary FRCA Masterclass
MAY
£240 (£180 for trainees)*
Invite only Anaesthetists as Educators:
Simulation Unplugged
15–18 January 2019
RCoA, London
MARCH Introduction to Leadership and
Joint Winter Scientific Meeting – Management: The Essentials
Leadership and Management: 3 October 2018 All days: £325 After the Final FRCA
Scottish Society of Anaesthetists 2–3 May 2019
Personal Effectiveness RCoA, London One day: £85 6 March 2019
15–16 November 2018 RCoA, London
21 September 2018 £235 (£180 for trainees)* RCoA, London
Apex City Quay Hotel, Dundee £420 (£315 for trainees)*
RCoA, London Airway Workshop
£165
£240 (£180 for trainees)* Anaesthetists as Educators: UK Perioperative Medicine Clinical 15 January 2019 Anaesthetists as Educators:
Teaching and Training in the Trials Network Meeting RCoA, London Leadership and Management: Anaesthetists’ Non-Technical Skills
Developing World Anaesthesia Workplace £260 (£195 for trainees)* The Essentials
19–20 November 2018 (ANTS)
24 September 2018 8–9 October 2018 13–14 March 2019
RCoA, London 8 May 2019
RCoA, London RCoA, London GasAgain
RCoA, London RCoA, London
£220 £450 (£340 for trainees)* SALG Patient Safety Conference 16 January 2019
£420 (£315 for trainees)* £235 (£180 for trainees)*
22 November 2018 Bradford Royal Infirmary
FICM Preparatory Course UK Training in Emergency Airway £260 Ultrasound Workshop
Civic Centre, Newcastle
24–25 September 2018 Management (TEAM) £205 (£130 for trainees)* 19 March 2019
The Studio, Leeds 29–30 October 2018 Patient Safety in Perioperative
RCoA, London
£275 RCoA, London Ultrasound Workshop Practice
£260 (£195 for trainees)*
£475 23 November 2018 31 January 2019
RCoA, London RCoA, London
£260 (£195 for trainees)* £220 (£165 for trainees)
*Delegates must be trainee members of the RCoA to be eligible for the reduced rate. *Delegates must be trainee or senior fellow members of the RCoA to be eligible for the reduced rate.
Book your place at www.rcoa.ac.uk/events Book your place at www.rcoa.ac.uk/events | 1
Bulletin | Issue 110 | July 2018 Bulletin | Issue 110 | July 2018
Contents
The President’s View4
News in brief8
Guest Editorial12
Professor Michael Rosen14
Faculty of Intensive Care Medicine
(FICM)16
From the editor
Faculty of Pain Medicine (FPM)17
Patient Perspective18
Revalidation for anaesthetists19 Dr David Bogod
SAS and Specialty Doctors20
Clinical Directors’ National Welcome to the July Bulletin.
Executive Committee22
As you read this issue – assuming that it’s fresh out of the cellophane – the College is gearing up for the launch
National Emergency Laparotomy
of its new Lifelong Learning platform, an online facility which we will be able to use to keep track of clinical
Audit (NELA)26
experience, training, CPD, and reflection, and which will undoubtedly become an invaluable aid for providing
Perioperative Quality Improvement evidence in support of appraisal and revalidation. Russell Ampofo and Aaron Woods make light of the work
Programme (PQIP)28
involved in developing this tool, but we at Red Lion Square have seen them metaphorically crying into their beer
Guest editorial Chantelle Edward30 more than once over the last two years, and know that it has been quite an effort. Please try out Lifelong Learning
once it goes live in August and let us know what you think.
Society for Education in
British Journal of Anaesthesia – Anaesthesia (UK)34
For old fogies like me, the exam is a dim and distant memory. But I remember us asking exactly the same
your official journal
#AirwayHub: innovating questions that Mike Wilkinson and Toni Brunning use in this issue to debunk common myths. Apparently, the
multidisciplinary airway training36 College doesn’t spend all the exam income on wining and dining the examiners at the Ritz, there’s no secret
The working relationship between the RCoA and the BJA Out of the frying pan, fixed proportion of candidates who have to fail to keep the competition sharp, and you don’t have to be a posh
into the fire38 bloke from a teaching hospital to become an examiner. And if that’s not reassuring enough, Andy Lumb and his
Page 12
Differential pass rates in the FRCA: colleagues at the Exams Department have undertaken two projects to examine differential pass rates amongst
an update44 different candidate groups, as a preliminary to better targeting of pre-exam teaching.
Launching the Lifelong Setting up a perioperative Inter-agency learning for It has been a bittersweet month for me, College-wise. The man who gave me my big break in anaesthesia by
Learning platform anaemia service: how do human-factors training46 employing me as his research fellow, Mike Rosen, passed away in May at the good age of 90 years. His obituary
The new RCoA Lifelong Learning we do it? Taking the leap48 within these pages describes what he did for our specialty, but I hope to be able to paint a more personal picture
platform launches in August 2018 A workshop aimed at taking delegates Transforming the Mersey in a reflection I will be writing for the next issue. The week after Mike’s death, my old friend and colleague,
Page 24 through the process of setting up a post-fellowship meetings50 Professor Ravi Mahajan, was elected as our next President. I am delighted, not only for the kudos that this will
perioperative anaemia service bring to our department in Nottingham, but because we have a leader for the next three years with a proven
Improving anaesthetic training
An engineering approach Page 40 through Cognitive Apprenticeship 52
track record for wisdom, common sense, inclusivity and professionalism, a worthy successor to Liam Brennan.
There is, I guess, a generation between Mike and Ravi, and they are very different people, but I am buoyed by a
to systems improvement Information governance in context: sense of continuity. As long as we have great leaders, we and our patients will continue to thrive.
How we can continue to improve Exams myth busting Technology Strategy Programme54
the quality and safety of the care that We dispel some of the myths that Human factors–avoiding
we deliver surround the FRCA exam a bumpy landing 56
Page 31 Page 42 As we were...58
Small Grants and Awards 60
Perioperative Journal Watch62
New to the College63
Notices and adverts66
2 | | 3
Bulletin | Issue 110 | July 2018 Bulletin | Issue 110 | July 2018
Dr Liam Brennan
President
As my presidency draws to a close I want to use my last
President’s View to reflect on some of the highlights
during my term of office which have coincided with a
momentous time for anaesthesia and healthcare both
here in the UK and internationally.
Taking a strategic approach I am pleased to say the May 2018 AGM
As I took office, Council and I were determined approved Council’s proposed amendments
that the College should take stock and think to the Charter of Ordinances which will
carefully about our priorities and aims. Instead of ensure smoother day to day running of your
using so much energy and resources responding College. The changes include establishing
to external events I was keen that we should a separate Board of Trustees with expert lay
define a five-year strategy to ensure that the trustee representation; revising Council’s
College and the specialty continued to evolve, reporting processes and establishing student
improve how we operate and meet future and foundation membership categories. A
challenges impacting patients, members and transparent, robust and relevant governance
our clinical and regulatory partners. Over the structure is a critical component of the success
past two years the work of the College has been of any modern organisation and I am pleased
guided by our 2016 – 2021 Strategic Plan which the College now has this in place.
reflects our vision for the future of anaesthesia.
Supporting anaesthetists, setting and maintaining Looking after the workforce
standards, promoting the specialty and
There have been many areas of focus during
resourcing the future of anaesthesia are the four
The President’s View strategic goals the Council and I have set the
my presidency, but the perennial problem
of ensuring an adequately staffed and
...AND IT’S GOODBYE
College to deliver against.
experienced anaesthetic workforce remains a
top priority. Work in this area for me as president
Reviewing governance
commenced with the launch of the College’s
At the same time as writing the strategy,
2015 Medical Workforce Census. Rota gaps,
Council also recognised the need for a
FROM ME
comprehensive review of our governance attrition rates during core training and the fill-
structure – something not undertaken since the rates at specialist registrar level entry, the issues
granting of our Royal Charter in 1992. facing SAS grade colleagues, and the ageing
anaesthetist are all key workforce issues which
Since becoming a medical royal college we the College continues to address independently,
have grown enormously, and are now a thriving or in partnership with a range of stakeholders.
medium-sized business employing 100 staff, Latest results of our work on this can be found in
with an annual income of more than £13 million our March 2018 Workforce Data Pack.
and total assets, including our headquarters in
in London, of more than £40 million.
4 | | 5
Bulletin | Issue 110 | July 2018 Bulletin | Issue 110 | July 2018
I am pleased that our efforts in
partnership with colleagues in some
Raising clinical quality
In line with the College setting and maintaining the highest
Bulletin
of the hard to recruit to regions across
the UK have been successful as the Working with colleagues ST standards for anaesthesia, our flagship Anaesthesia Clinical
Accreditation Scheme (ACSA) continues to flourish
of the Royal College of Anaesthetists
Churchill House, 35 Red Lion Square, London WC1R 4SG
fill rates have improved by
latest national recruitment figures have with over half of NHS trusts/boards across the UK now 020 7092 1500
seen the ST fill rates improve by 10% engaged with the scheme. This is a fantastic achievement, www.rcoa.ac.uk/bulletin | bulletin@rcoa.ac.uk
10% rising to 96%
compared to 2017, rising to 96%. and now rightly recognised by both the Care Quality
@RCoANews
Commission in England and Health Inspectorate Wales
As part of the College’s strategy to /RoyalCollegeofAnaesthetists
who are considering ACSA accreditation status as part of
support anaesthetists throughout their
their inspection methodology, demonstrating the esteem in Registered Charity No 1013887
career, a new membership service for
which ACSA is held remains well-founded. Registered Charity in Scotland No SC037737
undergraduates and foundation year
VAT Registration No GB 927 2364 18
doctors was introduced in November
Supporting research
2017. Alongside this, we also launched a morale is ongoing and closely linked Promoting global partnerships President Krish Emma Stiby
framework for undergraduate education to joint efforts by the College and the The College has continued to support high quality
Another element of the College, which Liam Brennan Ramachandran SAS Member
in anaesthesia, critical care and pain AAGBI to tackle fatigue, which has research and does so by working collaboratively through
has grown in stature over the past Council Member
the National Institute of Academic Anaesthesia. Research Vice-Presidents Carol Pellowe
medicine. Encouraging more students the potential to affect all anaesthetists few years, is our international work.
projects led by the College include the internationally- Ravi Mahajan & Joanna Budd Lay Committee
into a career in anaesthesia, is one way regardless of age, grade or experience. The College launched its first Global
renown National Audit Projects, NELA, and SNAPs to Janice Fazackerley Lead Regional
the College is working to address the Partnerships Strategy in 2017, informed Gavin Dallas
name a few. Under my presidency, the College has
current shortage of anaesthetists across Communications and external by the Lancet Commission report, Editorial Board
Adviser
Head of
taken great steps to define and implement a vision for
the NHS. Critical to the development of
affairs which showed that five billion people
perioperative medicine across the NHS. This is a core David Bogod Mike Jackson Communications
a sustainable anaesthetic workforce will worldwide lack access to safe, affordable Editor
Over the past two-and-a-half years the element of our strategy, which reaches across all College Lead College Mandie Kelly
also be the advancement of the role of surgical and anaesthetic care. This work
College has focused on developing directorates. In May 2018 I was proud to open the Simon Fletcher Tutor Website &
physicians’ assistants (anaesthesia). I hope is a key component of the College’s
an effective communications and conference launching NAP 6, focusing on perioperative Council Member Publications Officer
the government’s recent consultation will five-year strategy and represents a Kate Tatham
member engagement function, which anaphylaxis, which you can read about on page 11 of this
lead to their statutory regulation. major opportunity for the organisation Jaideep Pandit Trainee Committee Anamika Trivedi
is raising our profile with members, issue of the Bulletin.
to meet its global responsibilities. This Council Member Website &
Understanding welfare and key stakeholders and the public. The
strategy is multifaceted and enables the Publications Officer
College is now speaking with a more Investing in technology
morale College to work collaboratively with
authoritative and engaging voice. Our Over the past two years, the College has been investing Articles for submission, together with any declaration
In response to increasing pressures partners in resource rich and resource
policy and external affairs work has also in a multimillion-pound technology programme to of interest, should be sent to the Editor via email to
reported by anaesthetists in training in poor countries to share our experience
continued to evolve, with me and the enhance the membership experience by modernising and bulletin@rcoa.ac.uk.
December 2016 and January 2017 we in designing and delivering curricula and
chairs of the College’s Northern Irish, integrating our member-facing technology and improving
surveyed them to better understand assessment methods. All contributions will receive an acknowledgement and the
Scottish and Welsh boards meeting online accessibility and IT capability. The launch of the
their experiences of life on the frontline Editor reserves the right to edit articles for reasons of space
College’s new lifelong learning platform is now just one
of UK hospital care. More than 2,300 frequently with politicians and policy More events or clarity.
month away. Combining e-portfolio, CPD diary and
responded, representing 58 per cent of makers in Whitehall, Westminster and in I was incredibly proud to host our largest
logbook systems, this new platform will benefit thousands
all anaesthetists in training. The results the devolved nations’ governments. In ever Diplomates Day in May this year. The views and opinions expressed in the Bulletin are solely
of members when it is launched in August.
were worrying and received national April 2016 we also successfully revised With almost 400 diplomates and 700 those of the individual authors. Adverts imply no form of
press attention. To understand the the College’s brand to better reflect the guests, this was the College’s largest endorsement and neither do they represent the view of
Thank you the Royal College of Anaesthetists.
concerns the survey highlighted, I ran unique role of the College as a modern ever event and stands testimony to the
So as I hand the baton on to our new president, Professor
a series of Listening Events across the and forward-looking organisation. dedication, perseverance and hard work
Ravi Mahajan, a few thanks from me. To Council and the © 2018 Bulletin of the Royal College of Anaesthetists
UK. These events provided trainees with of the next generation of fellows of the
One publication, which needs no College staff for all their support during my term of office; All Rights Reserved. No part of this publication may be
the opportunity to discuss the issues College and associated Faculties. Delivery
introduction, is the British Journal of to my colleagues at Addenbrooke’s Hospital, Cambridge for reproduced, stored in a retrieval system, or transmitted in
they faced with me, other members of of the College’s annual programme of
giving me the space to fulfil this important national role and any form or by any other means, electronic, mechanical,
Council and senior College staff in an Anaesthesia (BJA). As a benefit of educational events is a mammoth task.
to my wife and family – I couldn’t have done it without you! photocopying, recording, or otherwise, without prior
informal and confidential forum. The membership to the College, the BJA’s With hundreds of events having been
permission, in writing, of the Royal College of Anaesthetists.
survey and Listening Events culminated impact factor has increased for the fourth held across the UK since the start of my And finally to you the fellows and members – thank you for
in the December 2017 publication of consecutive year to 6.24, making it the Presidency, the latest and most high profile the opportunity to serve you over the past three years. It ISSN (print): 2040-8846
the Report on the welfare, morale and world’s number one ranking anaesthetic on the annual calendar in May this year truly has been an honour and a privilege. ISSN (online): 2040-8854
experiences of anaesthetists in training: journal, something the College and the was our new flagship event: Anaesthesia
the need to listen. Work on welfare and BJA editorial board are rightly proud of. 2018 which was a sell-out success.
6 | | 7
Bulletin | Issue 110 | July 2018 Bulletin | Issue 110 | July 2018
News in brief
News and information
from around the College
ANAESTHESIA 2018
a look back
The future is bright
The College held its first annual two-day
international conference, Anaesthesia 2018, at the
British Museum in May. This new event replaced
the College’s Anniversary Meeting and Summer
Professor Symposium, combining the best of those two events,
Ravi Mahajan
adding debates, quick-fire talks and interactive
workshops to an already dynamic and varied
elected next programme.
President
Professor Stephen Powis, the Medical Director for
NHS England, delivered the keynote address, sharing
his personal reflections on delivering frontline care
Congratulations to Professor Ravi at one of the country’s largest foundation trusts, and
Mahajan who has been elected the next President of the College. giving his views on the innovations that might help to
Ravi, who was elected to RCoA’s Council in March 2007 and shape the future of healthcare.
Diplomates Day is always a special occasion and it
has been Vice President since 2016, has had a long association
was a pleasure to welcome the next generation of Delegates also benefited from presentations and quick-fire talks on various topics including pain medicine, airway
with the College in a variety of roles and is a highly respected
fellows of the College and associated Faculties at management, obstetric haemorrhage and the opioid. Professor Paul Myles shared with attendees an international perspective
member of the anaesthetic specialty. He will take up his new post
the 2018 Diplomates Day Ceremony. With more on the integration of patient care and perioperative medicine.
as President in September 2018.
than 1,100 Diplomates and guests in attendance,
Ravi has made a significant contribution to a number of areas this was our biggest Diplomates Day event ever. The highly anticipated panel discussion was chaired by the Health Service Journal’s Shaun Lintern and gave delegates the
of College activity, including work on our standards setting opportunity to put questions to key players in the health sector. RCoA President Dr Liam Brennan was joined on the panel
It was a wonderful occasion with our new
document ‘Guidelines for the Provision of Anaesthetic Services’ by John Appleby (Director of Research and Chief Economist at the Nuffield Trust), Professor Helen Stokes-Lampard (Council
Diplomates joined by their families at Central
to attain NICE accreditation; and as editor-in-chief of our Chair of the Royal College of General Practitioners) and Professor Mary Dixon-Woods (RAND Professor of Health Services
Hall, Westminster. The weather kept its end of
members’ peer review journal, the British Journal of Anaesthesia, Research at the University of Cambridge), who discussed the big issues influencing the NHS and anaesthesia.
the bargain with Diplomates treated to a day
helping it attain number one status for impact factor in the world of unbroken sunshine and temperatures of 25 Thanks to all speakers for giving their time to share expertise and knowledge over the two days. We hope all attendees
for anaesthetic journals. degrees! The ceremony was streamed live online enjoyed the two days of learning, networking and discussion.
President-elect Professor Ravi Mahajan said: “I am honoured by for family and friends unable to attend. It’s not
the confidence the Council of the Royal College of Anaesthetists too late to order your DVD of the ceremony here:
Fluid fasting before general anaesthesia in
has shown in me by electing me as President. The next few years will www.bit.ly/rcoa-dipsday2018dvd.
undoubtedly remain challenging for NHS doctors of all specialties, The guest speaker on the day was Tore Laerdal,
including anaesthetists. I will do my utmost, along with Council,
to represent the needs of patients and our fellows and members
Chairman of Laerdal Medical and Managing
Director of Laerdal Global Health. Tore’s inspiring
young children
in delivering high quality perioperative care. I would also like to words to our newest Diplomates will live long in The College supports the joint consensus statement from the Association of Paediatric Anaesthetists of Great Britain
congratulate Dr Janice Fazackerley and Dr Simon Fletcher for being the memory. Besides our new Diplomates, we also and Ireland, the European Society for Paediatric Anaesthesiology and L’Association Des Anesthesistes-Reanimatuers
elected as Vice Presidents and look forward to working with them. made various awards to distinguished individuals Pediatriques d’Expression Francais on updated fluid fasting guidelines for children prior to elective general anaesthesia. The
Finally, on behalf of all fellows, members, staff and Council, I would who have made exceptional contributions to joint consensus statement can be found here: bit.ly/fluidfasting-statement
like to thank Dr Brennan for his leadership over the past three years our College and its activities, as well as to our
as President. The College has made significant progress across many Based on the current convincing evidence base, unless there is a clear contra-indication, it is safe and recommended for all
examination prize-winners. Congratulations
different areas during Liam’s tenure – a legacy he should be rightly children able to take clear fluids, to be allowed and encouraged to have them up to one hour before elective general anaesthesia.
to everyone who was honoured on their well-
proud of.” deserved success. A special interest article providing further information is available in Pediatric Anesthesia: bit.ly/fluidfasting-pa
8 | | 9
Bulletin | Issue 110 | July 2018 Bulletin | Issue 110 | July 2018
ACSA on the Inspiring the future
News in brief
road The College actively News and information
promotes the work of our
specialty with patients and
from around the College
ACSA
Anaesthesia Clinical Services Accreditation members of the public.
Last month representatives
from the College attended
the Annual School Science
ACCREDITATION
Conference at the University
of Westminster. With
The highly-anticipated launch of NAP6!
approximately 300 young The 6th National Audit Project (NAP6) of the College, Anaesthesia, Surgery and Life-
With more than 50 per cent of people attending, the event Threatening Allergic Reactions, was launched at the Royal Society of Medicine on Monday
hospital trusts/boards in the UK was a valuable opportunity 14 April 2018. The largest ever prospective study of anaphylaxis related to anaesthesia and
engaged in Anaesthesia Clinical to showcase our specialty surgery, NAP6 investigated every case of life-threatening anaphylaxis during three million
Services Accreditation, there’s plenty and to share with students anaesthetics given in the UK over one year. The full report can be downloaded at
keeping the clinical quality team busy! information about the work of bit.ly/rcoa-nap6.
The past few months has seen the anaesthetists and intensivists.
Antibiotics were identified as the most frequent cause of anaphylaxis, in contrast with
College host some of its biggest Four energetic and previous studies which found the main culprit to be muscle relaxants. Teicoplanin, regularly
events of the year, with Diplomates enthusiastic anaesthetists in used for patients who reported allergy to penicillin, was 17-fold more likely to cause
Day, Anaesthesia 2018 and the training attended the event anaphylaxis than penicillin and similar drugs. As 90 per cent of patients who report penicillin
Updates meeting all seeing hundreds on behalf of the College, allergy are in fact not allergic, better identification of true allergy would reduce risk.
of delegates interact with the work of sharing tips, information about
the College and its staff. The ACSA medical and anaesthetic While most patients survived their anaphylactic reactions, 40 had a cardiac arrest and 10
team has been at each of these events training, and giving interactive demonstrations to GCSE students. It was a positive patients died. Patients at most risk of cardiac arrest or death were the elderly, those with cardiac disease, those taking certain
and had delegates from anaesthetic experience for them, as their feedback below suggests: cardiac medicines and the obese. Also of concern was the average waiting time of more than 100 days for patients to
departments across the country engage attend an allergy clinic.
with us to learn more about ACSA and “I was demonstrating the use of ultrasound to identify and distinguish arteries from
how their hospital can engage in the veins. A very rewarding day and one which I would very much involve myself in the Report author Professor Tim Cook said: “We have identified areas where changes might reduce the risk of anaphylaxis and
quality improvement scheme. future.” others where improvement is required such as during management of the most severe cases.”
Dr Lina Fazlanie
To arrange for the ACSA team to A big thanks to the NAP6 review panel and the dedicated NAP6 local coordinators who made the study possible.
Education Fellow at the RCoA
present at your department please
email ACSA@rcoa.ac.uk. If you are
“I’m lucky to have an incredible job and I want to ensure the next generation PQIP releases first Annual Report
understand what it is we do and encourage them to consider anaesthetics as a
interested in becoming a clinical The Perioperative Quality Improvement Programme (PQIP) has published its first Annual Report.
possible career option.”
reviewer for ACSA our next training PQIP, a research study being led by the National Institute of Academic Anaesthesia Health
Dr Karen Stacey FRCA
day is 19 October – contact us to Services Research Centre, working on behalf of the Royal College of Anaesthetists and a range
Specialist Registrar, Imperial School of Anaesthesia
book your spot. More information can of stakeholders, aims to improve patient outcomes from major surgery. Hospitals collect data on
be found at www.rcoa.ac.uk/acsa. “We spoke about the role of the anaesthetist and encouraged students to interact patient characteristics, quality of care and postoperative complications – patients provide their
with airway and ultrasound equipment. Hopefully we’ll see some of the students own feedback on satisfaction with care and longer-term quality of life.
The statutory function of the College back at the College in the future as budding anaesthetists!”
to nominate assessors to sit on Since PQIP started in December 2017, over 6,500 patients have been recruited from 79 hospitals
Dr Helen Church MRCA
Advisory Appointments Committees across England, with sites in Scotland and Wales due to join soon.
Clinical Fellow, Chesterfield Hospital
(AACs) is regarded as an important part
“Today’s Year 9-11s are tomorrow’s doctors! A large proportion of the children had The 2017-18 Annual Report outlines PQIP’s top five national improvement opportunities for
of the maintenance and improvement
had an anaesthetic before and were really pleased to spend a bit of time learning 2018-19, including a focus on individualised risk assessment, adherence to enhanced recovery
of standards of practice in anaesthesia.
about the people who took care of them while they were ‘sleeping’.” principles, and the optimisation of anaemia, diabetes, and postoperative pain.
If you are interested in becoming an
external representative on interview Dr Safeena Afzal FRCA
The report can be found at bit.ly/pqip-annualreport. A personalised report of local data for every participating hospital is also
panels visit www.rcoa.ac.uk/aac or ST5, University College London Hospital
available – contact your PQIP principal investigator for a secure login to www.pqip.org.uk.
contact AAC@rcoa.ac.uk.
10 | | 11
Bulletin | Issue 110 | July 2018 Bulletin | Issue 110 | July 2018
Since the founding of the NIAA we have
Guest Editorial given approximately £6m to research in
British Journal support of our charitable aims
of Anaesthesia
– your official
and (vi) a lay director. Until recently the knowledge and skills in all branches portfolio of international awards. Since
RCoA president has served as a voting of anaesthesia, critical care and pain the founding of the NIAA (BJA is one
director. This year a new BJA–RCoA medicine…and to disseminate related of the founding partners) we have
journal
liaison group was established to foster knowledge and skills…’. The greater part given approximately £6m to research in
closer links and enhance communication of our income derives from academic support of our charitable aims.
between both organisations, and to subscriptions and consortia sales. Our
I hope that you now have a little better
recognise that the College and the BJA biggest single group for individual copies
understanding of the way BJA works,
are two independent charities. The BJA of our journals is you – the fellows
and that when you have finished reading
is also the official journal of the College and members of the Royal College of
this Bulletin you will make a start on
of Anaesthetists of Ireland and the Anaesthetists for whom the BJA is your
your copy of the BJA and BJA Education.
Hong Kong College of Anaesthetists. official journal. Currently the College
Access to these titles is a fantastic RCoA
The board of BJA meet twice per makes a contribution to the BJA on
membership benefit, and I hope you
year, and our directors meet at least behalf of each fellow and member for
can now see that the funding made
four times per year including the two your journals – each year, 12 issues
Professor David Lambert available to ‘team anaesthesia’ from BJA
main board meetings. The following each of BJA and BJA Education, plus
Chair of Board of British Journal of Anaesthesia in some small measure comes from your
committees of the journal feed into the six editions of the RCoA Bulletin. An
subscriptions as fellows and members,
decisions made by the directors: (i) the additional income stream is derived
and, importantly, as readers of, and
BJA Editorial Committee, (ii) the BJA from our (ethical) investments. The BJA
contributors to our journals.
Education Editorial Committee, and (iii) has a managed portfolio designed to
the Grants Committee. Governance and generate at least £750,000 income
In the same package that brought you this issue of your Bulletin you will have Nominations Committees are currently (revised upwards from £500,000 at the
Reference
1 Lambert DG. 2017: A year of change
received the British Journal of Anaesthesia (BJA) and the British Journal of working up terms of reference. Within end of 2017), to disburse in the form of for British Journal of Anaesthesia. BJA
our editorial board there is the BJA-Editor grants for anaesthesia and its related 2018;120(1):1-2.
Anaesthesia Education. These are benefits of your membership of the Royal in Chief (EiC), and eight main editors plus specialties. This funding is disbursed via
College of Anaesthetists, and an indication of the close working relationship CME and Letters editors and the BJA NIAA processes on the advice of our
Grants Committee. We also financially
between two organisations with very similar objectives. Education-EiC. These are remunerated
support NIAA structures and educational
within a budget envelope determined
between the EiCs and the directors. The activities. Our investment income is used
Founded in 1923, BJA remains the incorporated in 2007, and, importantly, non-voting members. As you would
BJA is also served by an associate board to fund undergraduate research projects
oldest and largest independent journal is recognised as a charity by the expect for an international journal,
of 36 members. There is an independent in the form of John Snow intercalated
of anaesthesia, and is currently ranked Charity Commission for England and about half the board members are from
board of 18 for BJA Education. student awards, clinical research training
number one in category based on Wales. The BJA brand also includes outside the United Kingdom. There fellowships (clinical PhDs – jointly with
impact factor. You may also have noticed the BJA Research Forum (formerly the is a board of directors comprising six Like most organisations, BJA has income the Medical Research Council), non-
Anaesthetic Research Society). If you
that BJA has moved publishers from voting members with the following and expenditure, and as a charity these clinical PhD studentships, project grants
have ever wondered how the BJA brand
Oxford University Press to Elsevier, portfolios: (i) chair, (ii) administration, need to match our charitable aims. (now exceptionally up to £100K each),
‘works’ then read on. These are (paraphrased) ‘to advance large clinical and non-clinical career
and there were significant changes in (iii) finance, (iv) governance, (v) business
2017.1 The British Journal of Anaesthesia BJA is comprised of a main editorial development and grants (this member and improve theoretical and practical development awards, and a growing
is a company limited by guarantee board of 30 people, excluding co-opted also chairs our Grants Committee),
12 | | 13
Bulletin | Issue 110 | July 2018 Bulletin | Issue 110 | July 2018
Professor Michael Rosen
however. Never lacking in ambition or others, an honorary member of the way, that his life on earth was completed.
vision, he was the ideal person to lead Irish College of Anaesthetists, the A firm and vociferous believer in the
the AAGBI to its then new home in Japanese Society of Anaesthesiologists, individual’s right to choose the method
CBE, Hon. LLD, FRCA, FRCOG, FRCS (Eng) Bedford Square, serving as President the Australian Society of Anaesthetists, and time of his passing, Michael, greatly
between 1986 and 1988. Perhaps his and the American Association of weakened by his illness, felt he had no
1927–2018 greatest achievement was in persuading
the anaesthetic establishment in the
University Anesthesiologists. In 1988,
he was awarded the CBE for medical
legal alternative other than to refuse to
eat, and he followed her two weeks later.
late 80’s that the time had come to contributions to Wales, and in 1996 Those who saw them together could
move out from under the wing of the an Honorary LLD by the University never imagine them apart.
Royal College of Surgeons. Until then, of Dundee for his medicolegal work.
Dr David Bogod
Professor Michael the Faculty of Anaesthetists had lived Uniquely, he was a gold medallist of
Former Research Fellow,
in offices in the surgeons’ building both the Association of Anaesthetists
Rosen CBE, the first in Lincoln’s Inn Fields, but Michael of Great Britain and Ireland and of the
University Hospital of Wales and
RCoA Member of Council
(and only) President argued cogently, often against strong Obstetric Anaesthetists’ Association.
opposition, that the largest hospital
of the ‘College of specialty needed its own College. In
His passion remained undimmed in
his later years, when he focussed his
Anaesthetists’ after 1988, the Faculty became the College of
attention on achieving standards for
Anaesthetists, and moved into premises
its establishment but in Russell Square. Michael was elected
pain relief for babies undergoing ritual
before it was granted as the first President of the College the
circumcision. His Jewish faith, although
never in the foreground, was an important
same year, and his term of office ended
its royal charter, passed in 1991, the year before the Royal Charter
and abiding comfort to him, and many
away after a long was granted.
Cardiff co-religionists will recall, often
with a shudder, being given a mandatory
illness, borne with Michael maintained a variable collection tumbler of whisky to break their 24-hour
characteristic humour, of research fellows, both from the UK and Yom Kippur fast chez Rosen.
overseas, and treated them all with great
grace and fortitude, kindness and generosity, often acting in
Notwithstanding his professional
passions and his relentless drive, his
on 2 May, 2018. loco parentis, and not infrequently quietly
family was the very heart of Michael’s
putting his hand into his pocket to help
life. He married Sally in his 20’s, and
Michael Rosen was born in Dundee them with financial problems. Many of
they were together for 62 years. He
in 1927 to Israel and Lily. One of four his protégés are now to be found at the
described her as the centre of his
siblings, two sisters died in the first few forefront of anaesthetic practice and
thoughts, trusted her judgement entirely,
years of life and his brother in his thirties. research around the world. His concern
and loved her deeply. They were
He attended Dundee High School for others also resulted in his working with
immensely proud of their three children,
Kenneth Rawnsley, Professor of Psychiatry
before studying medicine at St Andrews, Timothy, Amanda and Mark, their eight
published over 170 papers, and edited much for granted. He was also one of in Cardiff, to pioneer the innovative “Sick
the first in his family to attend university. grandchildren and great-grandchild. In
or wrote seven books. He was awarded the parents of individualised and effective Doctor Scheme” for anaesthetists in the
After qualification in 1949, he joined the his later years, Michael suffered from
a personal chair in 1983, the first non- postoperative pain relief, having helped mid 1970’s, which ultimately led to the
RAMC, where he rose to the rank of increasingly debilitating Parkinson’s
university NHS post holder in Cardiff to to develop the prototype Cardiff Palliator formation of the National Counselling
captain and served in Egypt and Cyprus. disease. Despite this, he maintained
be so honoured. and then organising the international Service for Sick Doctors at the British
his immaculate appearance, helped by
Michael trained in Bradford, Newcastle- Medical Association.
conference that coined the term an extensive collection of cashmere
upon-Tyne and Cleveland, Ohio, gaining Michael’s early career was marked by a
‘patient-controlled analgesia’. Michael’s During his long career, Michael’s sweaters of all pastel shades. Always a
his Fellowship in 1957. He was appointed flurry of research projects, and he rightly
enthusiasm and drive were legendary and, contributions were recognised by many firm believer in the motto “mens sana
in 1961 to a consultant post in Cardiff, identified his work on standards for
although some of his research proposals national and international bodies. He in corpore sano”, physical fitness was
where he spent the rest of his working medical suction as being a landmark in
were, to those of more pedestrian outlook was awarded honorary fellowship of important to him and, up until his 88th
life and retirement. At that time, the patient safety – it is difficult to imagine
at least, rather fanciful, they were nothing the Royal Colleges of Surgeons of year, he was a regular at the local gym.
Cardiff anaesthetic department was pre- now but, before this, both anaesthetic and
if not visionary. England and of Obstetricians and When his beloved Sally passed away,
eminent, and he worked alongside such surgical suction not infrequently failed
Gynaecologists. He was, amongst he decided, in his typically determined
luminaries as Professors William Mushin to deliver, and it is a mark of his success It is as a medico-political leader that
and Bill Mapleson. During this time, he that we now take this essential tool so Michael will be most remembered,
14 | | 15
Bulletin | Issue 110 | July 2018
Faculty of Pain Medicine (FPM)
Training and Assessment
Committee: update
Dr Jon McGhie
Chair, FPM Training and Assessment Committee
Faculty of Intensive Care Medicine (FICM)
Key FICM training updates In the last few months, the committee has been analysing information from the
most recent pain census, planning the pain-curriculum rewrite, and analysing
the impact of GMC credentialing on pain medicine.
The pain medicine workforce census was while the latter will be assessed within of pain training and will also allow access
completed in the autumn of 2017, and a higher and advanced training. Overall it to advanced pain medicine by a broader
Dr Tom Gallacher
full summary has been published.1 There is hoped that the burden of assessments group of specialists, which may help to
Chair, FICM Training Assessment and Quality Committee
was a 76.8% response rate and this will be simplified to give fewer, higher- mitigate the future workforce shortfall
time the census went beyond recording level outcomes. identified by the census.
only demographic information. It also
Alongside this process, we have another Reference
made enquiries as to chronic, acute
The Faculty had a preliminary meeting with the GMC to discuss our curriculum and paediatric pain working patterns,
working group which is at the preliminary 1 Transmitter, Faculty of Pain Medicine, Spring
stages of developing advanced pain
rewrite and how it meets the new standards required by the GMC and the multidisciplinary involvement, SPA
training as a credential under the GMC’s
2018. Cole,P www.rcoa.ac.uk/faculty-of-
pain-medicine/transmitter.
support, and asked whether recent tax
requirements of the Shape of Training review. We presented our position, which and pension changes have influenced
new training proposals. We hope this will
was then discussed in depth, and the GMC have asked the Faculty to provide retirement planning. As the majority of
provide a GMC-endorsed recognition
pain specialists who responded stated
answers to specific questions and to provide further data to support its curriculum that they were over 50 years old, there
submission. A further meeting is planned with the GMC in the autumn. remains a skewed workforce that could
see a flurry of retirements within a short
Stage 2 ICM/higher anaesthesia A dual anaesthetist in training appointed within 10 (previously 7) years of passing timeframe. It has been noted separately
specialist modules are dual counted in ST5 to the ICM training programme the relevant Primary exam. that the uptake of advanced pain training
for both programmes since some having commenced their higher posts has also been lower in recent
competencies can be acquired in either anaesthesia training, will have any When the newly approved Royal years. Ongoing monitoring of both
an anaesthesia or an ICM placement. specialist module undertaken as part of College of Physicians Internal Medicine situations will be required to ensure pain
However, some can only be acquired in higher (but not intermediate) anaesthesia (IM) curriculum is introduced in 2019, training throughput remains sufficient in
training counted towards their Stage 2 physicians in training will spend three the coming years.
theatre or on the intensive care unit, and
ICM training, assuming the appropriate
the College and Faculty have agreed that months in ICM in Year 2, to prepare The curriculum rewrite for pain medicine
ICM competencies have been signed off
dual anaesthetists in training, during their them for the role of Medical Registrar is running in parallel with the RCoA’s
by their Educational Supervisor.
Stage 2/higher anaesthesia specialist in IM Year 3. The RCP and Faculty have curriculum rewrite, and will see the
modules (paediatric, neurosciences and As a result of a change to the examination worked closely together to implement creation of generic and specialist pain
cardiothoracic), should spend some time regulations, it is now possible to sit the this, and we encourage regions to medicine competencies. The former will
in both theatre and the intensive care unit. FFICM exams (MCQ and OSCE/SOE) facilitate this welcomed training initiative. be developed at early stages of training,
16 | | 17Bulletin | Issue 110 | July 2018 Bulletin | Issue 110 | July 2018
Revalidation for anaesthetists
Revalidation: the next five years
Carol Pellowe Chris Kennedy
Chair, RCoA Lay Committee RCoA CPD and Revalidation Coordinator
Patient Perspective It has now been five-and-a-half years since the launch of revalidation and, as
Should Aunt Dot be worried?
of 1 May 2018, the GMC had reviewed 236,026 submissions of which 81%
had been revalidated whilst 18.7% had been deferred. Detailed information is
available from the new Data Explorer resource on the GMC website.1
When I decided to retire after working full time for more than 30 years, I Looking ahead to the next five years, platform. We have been gathering a reviews, which is another good reason to
wondered how I would spend my new-found freedom. I need not have worried, we have updated our guidance on ‘wish list’ of future enhancements to get involved in this important role.
patient and colleague feedback and on the CPD Online Diary, both from the
for no sooner had that thought entered my head than the phone started ringing. continuing professional development user perspective and from the event For further information on any of the
I seem to be at that age when everyone around me is falling apart healthwise. (CPD). Both documents, which are provider position (for example, it should above please contact Chris Kennedy,
available on our website, have been be possible to save and return/edit Revalidation and CPD Coordinator at
Last year in my circle of family and that this made the patients very anxious the operation when other things may be made more concise, and also feature applications which have been made ckennedy@rcoa.ac.uk.
friends we had three cases of bowel as to whether their pain was normal and on their minds. Surgical staff can forget that real-life examples based on questions for CPD approval). Plans also include
cancer and one of prostate cancer, two to be expected, or if it meant that there what to them is routine or minor surgery received in our Revalidation Helpdesk; a much more user-friendly method for
Reference
had spinal operations and two had knee was something wrong? Dealing with the is anything but that for the patient, who is for example, the role of the employer CPD Assessors to complete their event 1 Date Explorer resource, GMC
(http://bit.ly/2rubtM9)
replacements, and on top of that there pain affected their mobility, which in turn anxious and in an alien environment. They in CPD, the required quantity of patient
were five deaths! So, as you can imagine, delayed their recovery. Was adequate need reassurance and good pain control, feedback returns and the need to for
I’ve had a fair bit of hospital visiting and analgesia written up for them, or was its and very specific information (both verbal special consideration to be given to
writing of get-well cards. inadequacy due to staff not being available and written) regarding pain management seldom-heard groups.
to administer the drugs? I do not know, but before discharge.
As the family and friends are spread across it highlights a need to review patients in the Focusing on CPD, we are keen to hear
the country, it has been interesting to So, as Aunt Dot prepares for her urological from members who would be willing to
first 24 hours after surgery.
see and hear of variations in treatment procedure, should I hope that: (a) her act as a CPD Assessor in reviewing the
and care. On the whole, surgery has At a recent Perioperative Quality hospital is participating in PQIP so she may event applications which we receive for
been very successful, but information Improvement Partnership (PQIP) meeting, be enrolled on to the enhanced recovery approval. Further information is available
and postoperative pain control varied the point was made that one should programme; (b) her frailty will be noted and on our website at http://bit.ly/2jEJkhK
considerably. It made me question whether manage people’s expectations regarding extra care taken over her management, and there are some additional resources
the postcode lottery was a reality, or if it is pain in the preoperative phase – that is, or (c) there is an opportunity to meet the and case-studies available following an
the short length of stay that stops people before surgery. The pre-assessment visit is anaesthetist at pre-assessment? information day which was held at the
from taking in information. I was particularly a busy time, as so much information needs College last September.
Thinking about it, maybe the most
concerned that pain management to be exchanged in both directions. In
important thing is that on the day there is
immediately after the operation was addition not everyone sees an anaesthetist Work will soon be commencing on the
a bed available for her!
poor in two surgical procedures, and then, and many must wait until the day of CPD aspects of the Lifelong Learning
18 | | 19Bulletin | Issue 110 | July 2018 Bulletin | Issue 110 | July 2018
Think about what excites you and what skills you
have to contribute
I was elected to one of the two SAS The Association of Anaesthetists of doctors to be ambitious and maximise
seats on College Council. Until three Great Britain and Ireland (AAGBI) is the their potential, and she spoke at the
years ago, one of these seats had been other national membership body for excellent AAGBI SAS Seminar last year,
vacant for some time because nobody anaesthetists. They also have an SAS stressing the importance of loving the
came forward to stand for it. There has Committee, which is chaired by Olivera job you have and carefully considering
been a lot of behind-the-scenes work to Potparic. They are very involved in your work and non-work values. This will
move SAS issues up the College agenda; developing and delivering educational help you to identify what really matters to
the SAS Committee has recently been content for AAGBI. The membership you and to prioritise your development
reinvigorated, and has representation department at AAGBI is considering needs accordingly. What is holding you
from around the country. Look out for how to engage better with SAS grades, back? Are some of these things within
SAS and Specialty Doctors advertisements in the Bulletin for vacancies so look out for any news. The AAGBI your control? They may be personal
or for vacancies on the boards in the has also produced an excellent SAS attitudes and confidence. Some external
SAS DEVELOPMENT:
devolved nations (all of which have an SAS Handbook which is available on their factors may also be modified after
member now, which is most encouraging). website (http://bit.ly/2jlaY3f). This will be discussion with the right person. Some
This enables the SAS perspective to be regularly updated. things are just outside your control and
THE BIGGER PICTURE
reflected at all levels of College work. have to be accepted.
The other major national body you could
If you have a particular subspecialty get involved with is the British Medical You need to set realistic and achievable
interest, you might consider applying Association. This is for all doctors, and goals for career and personal
to join the appropriate GPAS chapter- has a much more political remit. Some development. You may have an excellent
development group. GPAS (‘Guidelines people feel very strongly about subjects and supportive appraisal process to
for the Provision of Anaesthetic Services’) such as contract negotiations, the state assist with this. Other options include
is the living document that sets our of the NHS, and social care more widely. mentoring, which may be available in
Dr Lucy Williams anaesthetic standards, and it is constantly Places to start include your regional your trust or through the AAGBI. This
RCoA SAS Council Member being updated. The chapter-development SAS meetings. Details can be found at can be a useful tool to help you discover
groups include anaesthetists of all grades. (http://bit.ly/2FARvEm). Each regional more about yourself and consider what
Further information can be found on the committee sends a representative to direction might be appropriate right now.
College website (http://bit.ly/2w5n3mn). the national SAS Committee. More
Hopefully you now have a flavour of
Most of the work of these groups is information can be found on the SAS
what you could consider. This is not an
done electronically, and so is a bit more pages of the BMA website.
‘If we all did the things we are capable of doing, we would literally astound ourselves’ manageable if it will be difficult to get
exhaustive list of suggestions – think about
Thomas Edison 1847–1931 You do not need to limit yourself to what excites you and what skills you have
time out of work.
SAS issues. The BMA has a lot of other to contribute. Be persistent – not achieving
RCoA allows SAS doctors to be examiners, specialist committees, and sometimes your goals should prompt reflection
In a Bulletin article last year, I made some suggestions for self-development at but you must have your fellowship. This when you put yourself forward for and reappraisal. There is something to
a local level. In this article, I will focus on regional and national opportunities. is a big commitment but is tremendously one thing, you are asked to consider learn from setbacks. Use that to fuel your
development, not ambush it.
This will not be for everyone, and you need to consider carefully how much rewarding. As well as attending the
examinations themselves, there is a lot of
another. Anthea Mowat is an Associate
Specialist in anaesthesia and chronic
time you can commit. Your trust may be supportive and offer you some time work writing questions and quality assuring pain, and is currently the Chair of the
for national work. If not, would you be prepared to use up some of your own the exams. More details can be found at BMA Representative Body. She regularly
(http://bit.ly/rcoa-examiner). speaks at meetings to encourage SAS
study leave or annual leave?
20 | | 21You can also read
