Kids Save Lives' Festival - Learning CPR at an early age - rcoa.ac.uk - The Royal College of Anaesthetists
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March 2020
The 2020 anaesthetic CCT
curriculum: overview and
transition proposals
GPAS 2020: what’s new?
Demystifying KIT and
SPLiT days
‘Kids Save Lives’ Festival
Learning CPR at an early age
Page 44
rcoa.ac.uk
@RCoANews
Bulletin | Issue 120 | March 2020
RCoA Events Anaesthetic Updates
8–10 June 2020 LAST
%
rcoa.ac.uk/events Cambridge CHANCE
events@rcoa.ac.uk UK Training in Emergency Airway TO BOOK
Management (TEAM)
@RCoANews 8–9 June 2020
Solihull
Airway Workshop
Ethics and Law
GASagain (Giving Anaesthesia 9 June 2020
MARCH APRIL Safely Again) RCoA, London
Airway Leads Anaesthetists as Educators:
29 April 2020
RCoA, London
Airway Train the Trainer for Anaesthetists
5 March 2020 Teaching and Training in the 12 June 2020
%
RCoA, London Workplace RCoA, London
11 March 2020
Ethics and Law for Anaesthetists
2–3 April 2020 MAY GASagain (Giving Anaesthesia
RCoA, London
Edinburgh
11 March 2020 Safely Again)
%
Introduction to Leadership and
RCoA, London After the Final FRCA: Making Management: The Essentials 24 June 2020
%
the Most of Training Years 5 to 7 Bournemouth
Anaesthesia 2020
%
5–6 May 2020
Ultrasound Workshop
3 April 2020 RCoA, London
Primary FRCA Revision Course
Poster competition
13 March 2020
%
The Studio, Birmingham
RCoA, London Airway Workshop 30 June to 3 July 2020
Anaesthetic Updates 13 May 2020 RCoA, London
%
Anaesthetic Updates
24 April 2020 You are invited to submit a poster for presentation
%
Brighton
17–18 March 2020
%
RCoA, London
Southampton
JULY at Anaesthesia 2020.
Anaesthesia 2020
Leadership and Management: Cardiac Symposium If you have worked on a quality improvement or research
18–20 May 2020 Final FRCA Revision Course
Personal Effectiveness 23–24 April 2020 project using Perioperative Quality Improvement
%
Old Trafford, Manchester 6–10 July 2020
19 March 2020 RCoA, London Programme (PQIP) data and/or that
RCoA, London
RCoA, London addresses one of PQIP’s top five
UK Training in Emergency Airway
priorities, as outlined in PQIP’s
Developing World Anaesthesia
23 March 2020 Management (TEAM)
JUNE 2020 SEPTEMBER 2018–2019 Annual Report
23–24 April 2020 (pqip.org.uk/pages/ar2019),
RCoA, London
Wrexham Anaesthetic Updates UK Training in Emergency Airway submit a poster for a chance to
2 June 2020
%
Global Anaesthesia: Towards Management (TEAM) showcase your work to an
Health Equity Clinical Directors’ Network Bristol 21–22 September 2020 international audience.
24 March 2020 Meeting RCoA, London
27 April 2020 Anaesthetists as Educators: Submission deadline:
RCoA, London
Introduction
%
Birmingham Advanced Airway 30 March 2020
New to the NHS 3 June 2020 29 September 2020
%
25 March 2020 Anaesthetists as Educators: RCoA, London RCoA, London Visit rcoa.ac.uk/anaesthesia for
Anaesthetists’ Non-Technical
%
RCoA, London further information.
Skills (ANTS) UK Training in Emergency Airway Anaesthetic updates
Medical Training Initiative Management (TEAM) 29 September to 1 October 2020
%
27 April 2020
Hosts Day RCoA, London 4–5 June 2020 RCoA, London
27 March 2020 Bath
RCoA, London
Discounts may be available for RCoA-registered Senior Fellows and Members, Anaesthetists in Training, Discounts may be available for RCoA-registered Senior Fellows and Members, Anaesthetists in Training,
Foundation Year Doctors and Medical Students. See our website for details. Foundation Year Doctors and Medical Students. See our website for details.
%
%
Book your place at rcoa.ac.uk/events Book your place at rcoa.ac.uk/events | 1
Bulletin | Issue 120 | March 2020 Bulletin | Issue 120 | March 2020
Contents
The President’s View 4
News in brief 8
Guest Editorial 12
Faculty of Pain Medicine (FPM) 14
From the editor
Faculty of Intensive Care
Medicine (FICM) 15 Dr David Bogod
Clinical Directors’ National
Executive Committee 16
Welcome to the March Bulletin.
Revalidation for anaesthetists 18
Patient perspective 20 I’m a big fan of the TV panel show QI and the idea that most of what we know is wrong. Vikings wore horned
Society for Education in helmets? A construct of a 19th-century Wagnerian costume designer. Goldfish have a three-second memory?
Anaesthesia (UK) 22 Three months, better than mine. The Great Wall of China is visible from space? Not without a very big telescope.
Perioperative Journal Watch 25 And so, it seems, with the idea that thiopentone caused more American deaths at Pearl Harbor than the Japanese.
Tony Wildsmith points out in his ‘As We Were’ article that, actually, fewer than half of the casualties actually got
‘Bath tea trolley’ training (Part 2) 26
anywhere near a hospital, let alone a syringe of thio. What next, I wonder? Perhaps birds don’t fly south in the
PREP-WELL: outcomes, learning
winter and bears never defecate in the woods.
and future plans 30
Guest editorial Global Anaesthesia, Surgery and One thing is for sure, as the night follows the day (please tell me that’s right at least); William Harrop-Griffiths’
Obstetric Collaboration (GASOC) 32 Soapbox will cause controversy and dispute. The postbag in this month’s issue relates entirely to Will’s comments
Leadership for SAS doctors Inaugural Return to Work
about the Guedel airway. It’s touching – and slightly worrying – that so many of us can be moved by a bit of curved
plastic to put pen to paper, but please feel free to express your views on the rest of our content as well. A lively
Network meeting 36
“The key to successful leadership today is correspondence column is the sign of a healthy journal, so keep it coming.
Honours and thank yous 38
influence, not authority” Elsewhere in this issue, we carry two articles about the help available to those returning to practice, whether it
Airway Matters: improving safety
Page 12 through education 42 be after parental leave (KIT and SPLiT) or any other break from clinical work, due perhaps to sickness or taking
‘Kids Save Lives’ Festival 44 up managerial duties, when the College’s new RTW Network can offer useful support. Even if you are away from
the shop floor for a period, keeping up with clinical advances from home is becoming increasingly possible, and
The National Emergency
University College London are to be congratulated on their new MOOC (Massive Open Online Course) ‘Airway
The President’s View Demystifying KIT and Laparotomy Audit:
onward and upward 46
Matters.’ This is a remarkable free-to-access programme, entirely online, with 20 hours of top-quality teaching over
Dr Darrell Lowry gives us SPLiT days (Part 1) five weeks, and follows on from the successful MOOC on perioperative care by the same team. See Laura Elgie’s
his personal perspective Trainee-led education in
KIT and SPLiT days should be article on page 42 for more information.
of life as an anaesthetist in perioperative medicine 48
a wholly positive and valuable
Northern Ireland Meet the new If you are taking time off to start a family, you should be worried that your children might be learning more than
resource for doctors returning
Council members 50 you about resuscitation. Following on from Ada Ezihe-Ejiofor’s inspiring article about teaching CPR in schools (July
Page 4 from parental leave to have at
An insider’s view: Education 2019 – rcoa.ac.uk/bulletin), Rebeca Carter and Siew-Ling Harrison have updated us on the ‘Kids Save Lives’ Festival
their disposal held in south London in October last year. As the Jesuits never said: ‘Give me the child until they are seven, and I will
Programme and Quality
GPAS 2020: Page 34 Working Group member 52 give you the anaesthetist.’
what’s new? As we were... 54 This is my last edition as Editor of the Bulletin, a task I have greatly enjoyed (and so much easier than Anaesthesia…).
The GPAS recommendations The 2020 anaesthetic UK Training in Emergency I thank my wonderful and patient team of Mandie Kelly and Anamika Trivedi, ably led by Gavin Dallas, a man who
provide the foundation for the CCT curriculum Airway Management (TEAM) has tried, and occasionally succeeded, to keep me in line. I am delighted to hand over the reins to that well-known
Anaesthesia Clinical Services Course 56 style icon, bon viveur and Twitter influencer Helgi Johannsson (rcoa.ac.uk/dr-helgi-johannsson), who will hopefully
The curriculum has been
Accreditation (ACSA) standards submitted to the General Medical New to the College 58 be even harder to control.
Page 28 Council’s Curriculum Advisory Letters to the editor 60
If you want me, you’ll find me aboard my trusty narrowboat, the ‘Lady Mondegreen’ (bottle of claret for the first to
Group for review Senior Fellows and come back with the literary reference).
Members Club 62
Page 40
Notices and adverts 64
2 | | 3
Bulletin | Issue 120 | March 2020 Bulletin | Issue 120 | March 2020
The President’s View
VIEW FROM NORTHERN IRELAND
Professor Ravi Mahajan Dr Darrell Lowry
President Chair, RCoA Northern Irish Board
president@rcoa.ac.uk dlowry@rcoa.ac.uk
“While everyone across the United Kingdom has, for the past four
years, either been fixated, frustrated or enthused by the Brexit
debate, our colleagues in Northern Ireland have just emerged
from three years of their own turmoil. Until recently, there was no
government in place to address healthcare issues and improve care
services. A wholly unfortunate and trying situation for patients and
clinicians alike, but one I am pleased to see signs of resolution.
Dr Darrell Lowry, consultant anaesthetist and Chair of the College’s
Northern Irish Board gives us his personal perspective of life
as an anaesthetist in Northern Ireland and, while there may still
be challenges, why he remains optimistic about the future of
anaesthesia and healthcare in his country.”
Ravi Mahajan, President
Writing this in January, just after the restoration that we had no Health Minister, and no functioning
of the power-sharing government in Stormont, Executive to actually make any important decisions
there is a lot to hope for in 2020 for healthcare in or reforms. Behind the scenes, the Civil Service
Northern Ireland. Brexit looks like it will go ahead continued with the day to day running of the health
at the end of January too, so hopefully this will service. Richard Pengelly, the Permanent Secretary
lead to the focus of our politicians shifting back to for Health, did as much as he could to implement
issues on the ground that really matter to people, the transformation agenda for health here, and
such as the NHS? he is to be congratulated for this. The College’s
Northern Irish Board met with him in 2018, and had
For those of you unfamiliar with happenings on this a constructive meeting at which the then President,
side of the Irish Sea, we have had no local devolved Dr Liam Brennan, highlighted the work that
government here for just over three years. I will anaesthetists do and the role of the College.
not go into the reasons, suffice to say that the two
main political parties (the Democratic Unionist Party In January 2020, the Northern Ireland Assembly
(DUP) and Sinn Fein), disagreed on a number of finally reconvened after the British and Irish
issues, including an Irish Language act. This meant governments published a new agreement, entitled
4 | | 5
Bulletin | Issue 120 | March 2020 Bulletin | Issue 120 | March 2020
Bulletin
suggestions as to how we can try and influence the
I’m cautiously optimistic about the future of
Department of Health. Anaesthetists across all four nations
of the UK face similar challenges, so a united message from
the College really helps to focus this. Our trainees here are
of the Royal College of Anaesthetists
anaesthesia in Northern Ireland. We remain a part of the RCoA training programme, the appointment
process is via the national recruitment systems, they are Churchill House, 35 Red Lion Square, London WC1R 4SG
popular specialty, attractive to trainees, with a awarded a CCT by the GMC, and they all sit the FRCA
examinations. I am a co-opted member of the College
020 7092 1500
rcoa.ac.uk/bulletin | bulletin@rcoa.ac.uk
well-respected local training programme
Council, which gives our region a voice in the College, @RCoANews
and previously I have been Lead Regional Advisor. There is /RoyalCollegeofAnaesthetists
also Northern Irish representation on the relevant College
recruitment, workforce and training committees / groups Registered Charity No 1013887
– this is vitally important so that we are an inclusive partner Registered Charity in Scotland No SC037737
New Decade, New Approach. Health the UK, and that is clearly an area in by the RCGP, which meets regularly within the College. VAT Registration No GB 927 2364 18
features at the top of the immediate which we can get involved. The RCoA in Belfast. This group has membership President Hugo Hunton
I am presuming that by the time that you read this article
priorities for the restored Executive, with perioperative medicine agenda will also from all the local Royal College Ravi Mahajan Lead College Tutor
that the United Kingdom will have left the EU, and Brexit
promises of transforming the health be important going forwards, including representatives, and acts a bit like the
will have actually happened. It remains to be seen what Vice-Presidents Emma Stiby
service with a long-term funding strategy. the multi-professional approach to the Academy of MRC in England, although
challenges this may pose for healthcare, and anaesthesia, in Fiona Donald and SAS Member
This includes settling the ongoing patient journey, as promoted by CPOC. as yet in an unofficial capacity. The group
the UK and particularly Northern Ireland. It is likely that we Mike Grocott
pay dispute (nurses here recently took One of the new reforms introduced so far did write a joint collective statement, in Katie Samuel
will have a different customs union here with the EU than
industrial action over their pay, which had is the roll out of multi-disciplinary teams conjunction with the BMA and the RCN, Editorial Board Anaesthetists in Training
the rest of the UK – it remains to be seen what relationship David Bogod, Editor Committee
not kept parity with their colleagues in in general practice health centres. This just before Christmas which called for the
we will have with the Republic of Ireland in future. Certainly
mainland UK), reducing waiting times and integrated health care partnership model restoration of the Stormont institutions to Helgi Johannsson, Editor Elect Carol Pellowe
delivering reforms on health and social from an anaesthetic perspective, we have much in
brings together healthcare professionals address the deepening crisis in healthcare Lay Committee
common, and a partnership approach is to be encouraged Jaideep Pandit
care. Other measures promised are a (GPs, practice nurses, pharmacists, in Northern Ireland. Whilst this on its
and promoted. Some colleagues in your Department may Council Member Gavin Dallas
mental health strategy, extra nursing and physiotherapists etc) with the voluntary own did not force the politicians back
be Fellows of the College of Anaesthetists of Ireland (of Krish Ramachandran Head of Communications
midwifery undergraduate places, and a and community sectors, local council into government, it gained a lot of media
new graduate entry medical school in the coverage and showed that our collective course they are now the College of Anaesthesiologists… Council Member Mandie Kelly
reps, service users and carers. Currently
north-west of the Province. voice sends out a powerful message. We but that is a topic for a different article!), or may have trained Website & Publications Officer
there are four of these partnerships in Duncan Parkhouse
intend to hold further meeting, and keep in the Irish anaesthetic training programme. I am fortunate
operation, with plans for another thirteen. Lead Regional Advisor Anamika Trivedi
Issues that are of particular importance that, in my role as Chair of the Northern Irish Board, I am a
One of the potential sticking points with the pressure on the Department of Health Anaesthesia Website & Publications Officer
to anaesthetists are also given priority co-opted member of the CAI Council. Likewise our Board
all of these promised reforms however to deliver their promised reforms.
too. The Executive will reconfigure co-opt as members both the President and CEO of the Articles for submission, together with any declaration of interest,
hospital provision to deliver better patient is the funding. The parties here signed If you are still reading this, you may be CAI, and they often attend our meetings either in person should be sent to the Editor via email to bulletin@rcoa.ac.uk
outcomes, more stable services and up to the Agreement without any actual asking what is this to do with anaesthesia or via video link. We have many areas of common interest,
sustainable staffing. Improvements will figures being published in the document. All contributions will receive an acknowledgement and
in the rest of the UK? Well, I would and Dr Brian Kinirons, their President, and I are jointly in
be made in stroke, breast assessment, Already, as I write this in late January, the Editor reserves the right to edit articles for reasons of
venture that what has happened here agreement that our historic relationship should both be
there has been disagreement over the space or clarity.
urgent and emergency care and day over the past few years, whilst an extreme retained and strengthened. I am sure that many of you will
case elective care by the end of 2020. amount of funding available between the example, is not unique compared to the The views and opinions expressed in the Bulletin are solely
have enjoyed the Irish hospitality and craic when attending
This is certainly an ambitious plan – the Secretary of State, Julian Smith, and the rest of the UK. Workforce shortages, ever those of the individual authors. Adverts imply no form of
anaesthetic conferences in Dublin or Dingle?
Bengoa review, published over three local Finance Minister, Conor Murphy. lengthening waiting lists, breaches of endorsement and neither do they represent the view of
years ago, recommended reforming It remains to be seen whether there Accident and Emergency waiting times, To conclude, I am cautiously optimistic about the future of the Royal College of Anaesthetists.
healthcare here to make the system fit for is enough new investment to actually and funding shortages are common anaesthesia, and healthcare in general, in Northern Ireland.
© 2020 Bulletin of the Royal College of Anaesthetists
the 21st Century. This has not happened, make a meaningful change to healthcare across all regions. What the Northern We remain a popular specialty, attractive to trainees, with a
All Rights Reserved. No part of this publication may be
and it now falls on the new Health here, but we remain optimistic. One of Ireland situation has shown is that if there well-respected local training programme. The politics here
reproduced, stored in a retrieval system, or transmitted in
Minister, Mr Robin Swann, to try to the most frustrating points about the is no effective leadership (in our case are never straightforward, but at least we have had peace
any form or by any other means, electronic, mechanical,
implement these reforms. The Northern situation in Northern Ireland over the past no functioning government) to make for over twenty years, which is better for future generations
photocopying, recording, or otherwise, without prior
Irish Board would like to wish him well few years was that there was no Health decisions, and drive reforms, that the than any health reforms. My colleagues and I look
permission, in writing, of the Royal College of Anaesthetists.
in his new post, and we have already Minister to actually communicate with, or system will stagnate and things will only forwards to continue engaging with the College, whether
asked for a meeting with him as soon be held accountable. At least now there get worse. The RCoA have been very as Board members, committee members, examiners, ISSN (print): 2040-8846
as possible to outline how anaesthetists is actually someone in post who we can supportive to our Board, both at Council consultants, SAS doctors and trainees. And if anyone ISSN (online): 2040-8854
can help support and deliver some of attempt to influence, assist and engage level and also through the Policy and fancies working in a region with amazing natural beauty,
these proposals. The waiting lists here in dialogue with. There is now an All Public Affairs team, in communicating affordable housing, free schooling and friendly faces then
for elective surgery are the longest in Colleges Interface Group, co-ordinated with our members and also offering you will be made very welcome.
6 | | 7
Bulletin | Issue 120 | March 2020 Bulletin | Issue 120 | March 2020
NEWS IN BRIEF
News and information from around the College
The Faculty of Fifth NELA Patient Report released
AGM2020 Intensive Care Medicine The Fifth Patient Report of the National Emergency Laparotomy Audit
(nela.org.uk/reports) was released just before Christmas. A key finding was that
The 2020 Annual General Meeting of the Royal College
of Anaesthetists will be held as follows:
is 10 this year just a fifth of patients (19.4 per cent) who underwent emergency laparotomy
and who had signs of sepsis on admission received antibiotics within the
To celebrate FICM’s first decade, the Faculty has many exciting
Monday 18 May 2020 at 12.30pm recommended 60 minutes.
projects on the horizon, as well as a brand-new logo. FICM has
Old Trafford, Sir Matt Busby Way, Stretford, already introduced an ICM Trainer Award for excellent training in RCoA President, Professor Ravi Mahajan said: “The reduction in 30-day mortality
Manchester M16 0QG Critical Care as the first of the FICM10 initiatives, which was won by rates and length of hospital stay show that clinicians are learning from data and
The procedure for the submission of motions to the Dr Andy Campbell. implementing changes locally. We must see organisational change before further
agenda is set by the College’s Regulations (more improvements can be realised.” The report was featured in The Independent
Throughout 2020 there will be essay prizes, new
information is available on the website: (bit.ly/2GaReuD) and the British Medical Journal (bit.ly/2NKtAco). As ever, a
workstreams, new merchandise and further
rcoa.ac.uk/charter-ordinances-regulations). huge thank you to the army of local collaborators who work so hard to input
promotion of the specialty
Any motions for the meeting should be submitted to the data into NELA.
throughout the UK and
chief executive by midday on 3 April 2020 to: around the globe. See page 46 for an article by Dr Sarah Hare,
ceo@rcoa.ac.uk
NELA National Clinical Lead
Keep an eye out for
A full AGM agenda will be available online the month #FICM10 on Twitter and
before the meeting. check out the official
This AGM takes place as part of Anaesthesia webpage for updates
2020: the international meeting of the College throughout the year:
(rcoa.ac.uk/anaesthesia). If you are not attending ficm.ac.uk/ficm10
Anaesthesia 2020 and wish to attend the AGM only,
please email ceo@rcoa.ac.uk
GET INVOLVED:
Anaesthesia Associates
regulation
New College Chief Executive The GMC is calling out to all Physician Associates and
Anaesthesia Associates (AAs) for input into the process
At the beginning of the year, we welcomed our new Chief Executive Officer, of shaping regulation.
Jonathan Brüün (rcoa.ac.uk/mr-jonathan-bruun).
We encourage AAs, their trainers, healthcare colleagues
Jonathan (or ‘Jono’) joined us from the British Pharmacological Society, where and patients to work with the GMC to influence the
he was CEO since 2012. Jono brings a depth of knowledge in developing look of your regulation and sign up for the latest
and delivering organisational vision, mission and strategy in a healthcare updates here: socsi.in/451wW
setting. College staff, Council and Senior Management, are pleased to
work with Jono and to mark the shift into a new decade with a fresh look on
strategic leadership.
You can find out more about our new CEO in his welcoming
blog: bit.ly/RCoAblogJan20
8 | | 9
Bulletin | Issue 120 | March 2020 Bulletin | Issue 120 | March 2020
NEWS IN BRIEF
News and information from around the College
Reminder: you have the option
to Go Greener
The College is committed to embedding sustainability in
Call for CPOC
everything we do, one example being the possibility for
all fellows and members to opt out of receiving the print
case studies version of all College publications. This includes the Bulletin,
Inaugural
British Journal of Anaesthesia (BJA) and BJA Education. Simply
Do you have an example for great
College response to GMC’s email membership@rcoa.ac.uk with your name, College
Anaesthesia perioperative care to share? The reference number and request. You will still retain full access
first SAS and LE doctors Centre for Perioperative Care to the journals online, but need to choose between online or
Research event (CPOC) are always looking for case print use for all three publications.
survey studies on excellent care or new
held in York The College welcomes the publication of the GMC’s first ever
pathways to showcase on their More information on environment and sustainability, including our
website cpoc.org.uk Sustainability Strategy 2019–2022, can be found on the College
Our thanks to all attendees and presenters at the survey of Specialty and Associate Specialist (SAS) and locally website: rcoa.ac.uk/environment-sustainability
first ever Anaesthesia Research event in December, employed (LE) doctors (bit.ly/36gmWBr). Case studies should be no more
incorporating the BJA Research and all NIAA-affiliated than 700 words total and address:
activities across UK academic anaesthesia, including The survey showed that many doctors see SAS and LE roles
Got blog ideas? – send your
■ overview of the service/initiative,
the UK Perioperative Medicine Clinical Trials Network, as positive choices that provide fulfilling careers. Despite this
the implemented changes and
Health Services Research Centre and Discovery Medicine. the results found that 30 per cent of SAS doctors and 23 per
Congratulations also to our award winners: Dr Brendan cent of their LE counterparts had been bullied, undermined
how it was done
submissions
or harassed at work in the last year, either by colleagues or ■ any challenges experienced and
McGrath for the NIAA Research Award, and for the Every month the College publishes a blog and shares it through its
by patients and their families, and almost half of LE doctors how these have been overcome
NIHR/RCoA Awards, Dr Louise Savic (Consultant Prize), communication channels. If you have a story to tell that could be of interest
Dr Jennifer Noyes (Trainee Prize) and the STAR Network and 41 per cent of SAS doctors had difficulties accessing ■ outcomes and evaluation.
to the College’s membership and wider public audience, we would love to
(Trainee Network Prize). continuing professional development opportunities.
share your voice.
To submit a case study,
We are looking to hold the event again in late November/ The College council has two of its members represented please download and complete An ideal submission:
early December 2020. A date may have already been by SAS doctors; these doctors are fully integrated in every the submission form (cpoc.org.uk/ ■ has a maximum length of 600 words
announced by the time you read this – see niaa.org.uk aspect of the college business. Read our full response here: get-involved/submit-case-study)
bit.ly/SASLEsurvey ■ is written in a personal style and first person
and send it to cpoc@rcoa.ac.uk
■ provides links to mentioned sources
■ states author details including name, job title and place of work
The SAS Handbook Access all ■ includes a high-quality head and shoulder shot of the author.
The Association of Anaesthetists published a new guideline handbook for Specialty and Associate publications and Questions and
submissions
Specialist (SAS) doctors. It provides a wealth of information and support for any SAS doctors
working in anaesthesia including: newsletters online can be sent to
ddollinger@rcoa.ac.uk.
■ support networks and organisations ■ addiction, sickness and return to work The new College website has a
Previously published
■ SAS contracts and job planning ■ clinical governance and professional dedicated hub for all College
blogs can be
■ revalidation and appraisal development. publications and newsletters. Lost your
found at:
■ working less than full time copy of the latest Bulletin or accidentally
rcoa.ac.uk/blog
deleted your President’s eNewsletter?
Download the full handbook here: bit.ly/SAShandbook Not to worry – they are all archived on
our website: rcoa.ac.uk/publications
10 | | 11
Bulletin | Issue 120 | March 2020 Bulletin | Issue 120 | March 2020
“The key to
successful
Guest Editorial
leadership today
Leadership for SAS is influence, not
doctors authority”
Kenneth Blanchard
Dr Lucy Williams
RCoA SAS Member of Council, Swindon
sas@rcoa.ac.uk
I recently organised a study day on leadership for SAS doctors. It was heavily A newer role could be setting up
and leading a sustainability group
oversubscribed suggesting an unmet need. It was cross-specialty, and about for theatres or critical care. Theatres
two-thirds of the participants were from my trust and a third from other produce a significant amount of waste
per patient, and anaesthetic gases are
organisations. Feedback was excellent, and there was an appetite for more all potent greenhouse gases. This is
learning in this area. a hot topic at the moment and very
much on the minds of a lot of younger
Leadership training has traditionally There are many ways to make a start. You can start in small ways by offering anaesthetists. A permanent member
been for senior trainees and consultants. Keep an eye out for local training, and to take on departmental roles or getting of the team has, or can build, the If you get really interested in the
SAS doctors can feel ambivalent and chat to your SAS tutor (if you have one) stuck in to quality improvement projects. connections that facilitate such work and underlying theories, there are many ways
uncertain about how it would be relevant or your Director of Medical Education. It For most of these, you will often need to can ensure long term viability of changes. to learn more. The College has regular
for them. If you look at the Faculty of may be possible to organise a local study work closely with colleagues from across Leadership and Management workshops
If you want to explore leadership in
Medical Leadership and Management day. There is often expertise within the the multiprofessional team. This gets you (see page 71). They are popular and early
more depth, there are any number of
(FMLM) website (bit.ly/2s2s8Kq), it trust or deanery, or there are a number noticed, and then invitations might come booking is essential. Keele University has
books on the subject, though most
clearly articulates the point that all of commercial providers. to get involved in other things. run a leadership course for SAS doctors
relate to the business environment
Please see our
doctors are leaders. How can you (bit.ly/364Kfy4) for many years. There
Basic courses often spend time Within the hospital there are a variety rather than healthcare. Check your
develop your leadership skills? are also commercial providers.
I started off simply by saying ‘yes’.
analysing how you prefer to interact
with others in the workplace and
of roles on committees or dealing with
serious incidents that are traditionally
postgraduate library.
The NHS Leadership Academy
website for further
My journey in leadership has been how you can recognise the working undertaken by consultants. There is
Some subjects, such as emotional
intelligence, are relevant in any work
(bit.ly/2Rt3xJA) has free online resources. information:
incremental and I have taken on styles of colleagues. This can be quite no reason why SAS doctors cannot It also has a number of programmes
situation. Learning a bit more about
challenging things, prepared just to give
it my best. When I joined Council four
illuminating and builds self-awareness,
which is a great asset across many areas
apply for these if they have the relevant
experience. Our medical director
negotiation could be useful. Recognising
that can be studied online in a modular
format. These are available to all NHS
rcoa.ac.uk/sas
what you have control over, being
years ago, I never expected to be chairing of work (and at home). Communicating recently invited us to undertake incident employees. The FMLM has resources
aware of the structures within which
the Finance and Resources Board. I effectively and building relationships investigation training so that we could available to members.
you work and then aligning your project
am writing this on my way back from a and networks are absolutely key skills for get involved if we chose.
with organisational objectives will vastly Various key reports into failing hospitals
Treasurer’s meeting with colleagues from extending your sphere of influence. This
increase your chances of success. have linked strong leadership to
other Colleges and Faculties. I am proud will help you to actually get things done.
Discovering how to do a stakeholder improved patient safety and outcomes.
to be representing our College and I
analysis properly will help you to identify Good leadership skills and behaviours
am learning all the time.
key people so that you can focus your can be learned and should be part of the
energy where it will be most effective. ongoing development of all doctors.
12 | | 13
Bulletin | Issue 120 | March 2020
Dr Danny Bryden
FICM Vice Dean
contact@ficm.ac.uk
Faculty of Pain Medicine (FPM)
ESSENTIAL PAIN MANAGEMENT Faculty of Intensive Care Medicine (FICM)
Evolving direction and Identifying as an intensive
significant progress! care doctor
I became vice dean of FICM in October 2019, having previously been
lead regional advisor and chair of the Careers, Recruitment and Workforce
Committee (CRW).
Dr Helen Makins Although 35 per cent of entrants Discover ICM followed on from the can be operationalised to deliver the
FPM Lead, EPM-UK to intensive care medicine (ICM) publication of Critical Foundation in service while supporting staff currently
contact@fpm.ac.uk training now don’t have an anaesthetic September 2019 (bit.ly/2Ln4nDR). working in intensive care and those who
background, I remain a fellow of the Critical Foundation illustrates ways in have had an absence for any reason,
College and have a small anaesthetic which intensive care units across the UK including periods of time away working
practice for complex spinal surgery in are supporting newly qualified doctors in another specialty. FICM celebrates
This year has seen significant development in the Essential Pain Management Sheffield, where the bulk of my clinical in getting exposure to intensive care its 10th anniversary this year, and these
UK (EPM-UK) project. There has been considerable interest from a number of work is in adult ICM. and developing the skills to assist in documents illustrate the ways in which
looking after ward patients. Intensive we continue to grow and develop
national training-curriculum groups, and we have expanded our EPM team to One of the key strands running through care is a popular option within the as an independent specialty, while
manage the increasing activity. CRW work is the need to reflect foundation year and in stand-alone ‘F3’ recognising the links that we have with
the variety of medical professional or clinical fellow posts, and there are our partner Colleges.
News of the simple, reproducible and levels. We are in discussion with the Our newly appointed EPM-UK Regional backgrounds that bring people in to fantastic examples within this document
comprehensive system for teaching and Foundation Programme directors, the Leads are the first point of contact for work and train in intensive care. of innovative ways that ICM skills and
approaching pain management has Medical Schools Council and the information, advice and support. experience are being incorporated into
The Discover ICM (bit.ly/FICM-DICM)
spread with the help of anaesthetists Palliative Care Curriculum Group. As a training programmes.
I would like to thank Mike O’Connor resource was launched in October with
and pain teams across the country. We result, an EPM e-Learning package will
for his considerable work on the EPM the aim of providing direct information Autumn 2020 will see the release
have moved away from promotion of soon be included within the Foundation
project, as he will have retired from his and links to useful online resources about of a suite of Critical Staffing
the full EPM course, towards emphasis Programme platform, complementing
role as Deputy Lead by the time you a career in intensive care. Writing was led documents. These will focus
on the use of the Recognise, Assess and clinical teaching. For the first time in the
read this. Without doubt, getting EPM- by Richard Benson and Zoe Brummell with on ways in which some
Treat (RAT) structure. UK, all junior doctors will soon have
UK off the ground is substantially due the goals of allowing anyone interested to of the standards within
access to comprehensive pain training.
The RAT framework, although simple, to him and, while we wish Mike well find out what it is like to be an intensivist, Guidelines for the
acknowledges the complexities of The power of this project is in for the future, we will definitely miss his of gathering views from individuals from a Provision of Intensive
pain – in particular the physical and standardisation, and it only takes enthusiasm and wisdom. variety of backgrounds who train or work Care Services (Edition
psychological aspects – with emphasis minutes to frame any teaching in ICM and of providing information about 2, June 2019)
on non-pharmacological strategies within this structure. I would strongly Please find further details and contact the ways of applying for a training post. It’s (bit.ly/FICM-GPICS)
alongside appropriate prescribing. encourage all anaesthetists to consider information at: bit.ly/EPM-UK a great resource for trainees and trainers
This has given us the opportunity to incorporating this into teaching, to in ICM and our partner specialties.
highlight and address the existing facilitate the FPM initiative and ensure
gap in biopsychosocial pain training that we are leading by example!
at undergraduate and postgraduate
14 | © ICCU, City Hospitals Sunderland NHS Foundation Trust
| 15
Bulletin | Issue 120 | March 2020 Bulletin | Issue 120 | March 2020
I am an original member of the College’s Clinical Directors’ National Executive
Committee, having joined at its formation in 2013.
At that time I was clinical director for network and learn from others who had isolating, but made much more palatable
anaesthesia and critical care in Hull, similar or greater clinical management by working alongside a surgeon who
having worked at the trust since 1997. roles was enlightening and uplifting. is equally committed to the role. I think
I started my undergraduate medical It was reassuring to learn that we all it came as something of a surprise to
training in 1988 at Birmingham University. have very similar problems – doctors both of us that we could work so well
This was followed by anaesthetic training, in difficulty, challenging finances, together, and over time we have created
firstly in Edinburgh and Fife, and then significant vacancies, and frustrating a team that we are truly proud of, and
in 1997 I started run-through registrar demands from our higher management we have kept ourselves grounded, fair,
training in Hull. I was appointed to my teams and NHS bodies. consistent and honest.
consultant post in anaesthesia and
The second committee was the However, increasing management
critical care in September 2002.
Yorkshire and Humber Clinical Senate, demands mean that I deliver very little
My first management appointment which provides independent advice anaesthesia, and I have started to
came in 2005, when I became clinical about planned changes to all aspects miss patient contact. My clinical skills,
lead for critical care, working under a of healthcare provision in both our local especially the more practical ones,
clinical director who has remained to area and occasionally for other regions. have waned over time and I would like
this day a great friend and mentor. In I sat on the senate for five years and it them back. So I stepped down from the
2008 I became service director, which opened my eyes to the wider context medical director role in December 2019
was nothing more than a different title, of the NHS. and will return to full-time clinical work.
but in 2011 the big change came and I There is no doubt that taking on senior
Both committees have provided me
was promoted to clinical director. I was management responsibilities has been an
with huge opportunities to interact with
looking after all the recommended areas amazing opportunity for me. The depth
senior clinicians from all specialties of knowledge and experience I have
– anaesthesia, critical care, pain, pre-
and all corners of the UK, and I have about the NHS, including how we plan,
assessment, theatres, and sterile services.
been reassured to discover that we all create and adapt to change and how we
I remained in post through several
struggle equally. Anaesthesia impacts manage and support the staff that work
management restructures, and then in
on many areas of healthcare, but it is within it, is without doubt something
2014 my responsibilities were increased to
easy, even as clinical director, to remain that I could never have imagined
include cardiothoracic surgery and I was
largely within the confines of your own when I embarked on my consultant
given the title ‘associate medical director’.
department. I would strongly advise that, career. And I fully expect that once I’ve
It was during my time as clinical no matter what your role or seniority, scratched that clinical itch, I will return
Dr Caroline Hibbert director that I became a member of you embrace every opportunity that to clinical management as and when
Consultant Anaesthetist, Hull and East two additional committees. The first takes you beyond the boundary of your the opportunity allows.
Yorkshire Hospitals NHS Trust was the Clinical Directors’ National local anaesthetic department.
cd@rcoa.ac.uk Executive Committee of the College. I
had very little experience of the College I was promoted to the role of medical
before I joined this group and I was a director in January 2015. In our trust, our
clinical services are split into five areas
Clinical Directors’ National Executive Committee little intimidated by both the building
called ‘Health Groups’ with each one
and the clinicians that worked there.
The next Clinical
The clinical
Before this I had only attended the being headed by a medical director. I
College for exams and the occasional look after the Surgery Health Group Directors’ Network
(which includes anaesthesia), and I
educational event, and I didn’t really
Meeting will be held on
director –
see it as a friendly or inviting place. share my medical director role with
Within a short space of time my attitude an orthopaedic surgeon. During 27 April in Birmingham:
changed, and it is a credit to those our five-year tenure we have seen
turning full circle
who work within the structure of the our services struggle, fail and, rcoa.ac.uk/events/
College that it is incredibly supportive more recently, flourish. The medical
of all those it represents. To be able to director job is both challenging and clinical-directors-
network-meeting
16 |Bulletin | Issue 120 | March 2020
We hope that all CPD learners
enjoy using the Lifelong Learning
Platform, and we remain available
Platform”, and from Dr Paul McAndrew: We have received some feedback to provide further guidance and
Lifelong Learning
“I had made the decision to stick that the Lifelong Learning Platform
support via cpd@rcoa.ac.uk
with the old system, as I was part way should retain a method to report on
through a year of CPD, but I have now which CPD Skills have been covered
started to use the new system, which I by the CPD learner, and there will be
find more intuitive, less prescriptive and the opportunity for future functional
Revalidation for anaesthetists better laid out.” enhancements to be made if there is
the Lifelong Learning Platform nor
enough demand for these.
CPD functionality in the
Dr Desiree Choi added: “Having used the will the details of previously CPD-
College online CPD system since 2012, Now that CPD functionality has been accredited, events (prior to September
it’s been a reliable way to record CPD delivered, we would remind all users 2019). By the end of April 2020, users
Lifelong Learning Platform
through the year and initially it seemed that the CPD Online Diary is going of the CPD Online Diary will need to
a shame to change from this. However, to be decommissioned at the end download any documents which they
I moved to using the LLP CPD function of April 2020. As was the case for wish to keep, which in many cases
this summer and found it easy to enter the anaesthetists in training e-Portfolio, should be just the CPD activity report
information and produce a CPD activity historic user records from the CPD which will have been used as the
report for my recent appraisal.” Online Diary will not get migrated into appraisal evidence for revalidation.
Chris Kennedy
One important change saw the
RCoA CPD and Revalidation Coordinator
discontinuation of the CPD Matrix,
“I have now started to use the
cpd@rcoa.ac.uk
because there had been previous
misconceptions that its use had been
compulsory, and some event providers
had commented that mapping their
new system, which I find more
CPD functionality in the Lifelong Learning Platform (LLP) has now been live for programmes to individual codes from
intuitive, less prescriptive and
four months, and this article provides an overview of the development of this the Matrix had been a level of detail
project, information on the user experience since its launch, and an important
too far. There had however been
contrasting comments that many CPD
better laid out”
reminder about the future of the old CPD Online Diary. learners and event providers found
Dr Paul McAndrew, Tyne and Wear
benefit in having a structure against
The project commenced in January 2019 had participated in the event both as variety of promotional activities including which to plan and record CPD.
and consisted of three strands: delivering a member of the faculty (‘delivering use of the College media (website, In response, the Lifelong Learning
new and enhanced functionality for education’ is an approved CPD Bulletin, Twitter and President’s News) Platform features an entirely optional
CPD learners in the Lifelong Learning category) and as a delegate. and via ‘Alerts’ in the CPD Online Diary. Framework of CPD Skills to provide a
Platform; developing an improved more logical and streamlined way for
application form for event providers For event providers seeking CPD We are delighted to report that during
guiding indicative content. For example,
seeking CPD accreditation; and making a accreditation, the old application form did the first week of full ‘go-live’ a total of
airway topics, which had previously
number of adjustments to streamline the not allow for mapping to be done against 376 personal CPD activities were added
appeared across all three levels of the
administrative processes at the College, the Good Medical Practice domains and and reflected upon, and since then a
former CPD Matrix, now appear under
including the allocation of event reviews the Standards for Medical Educators. The daily average of 80 such activities have
one overall heading, and all of the
to CPD Assessors. application form also extended over three been recorded. The areas which have previous codes, for example 1C02 and
pages, and it was subject to time-outs seen the highest usage of the system 3A01, have been removed.
These requirements had been informed and the risk of information which had have included the North West and East
by previous stakeholder feedback. For previously been input getting lost. of England regions, Scotland, and south The illustration opposite shows an
example, the CPD Online Diary had London: further more detailed data is example of how the former 2E03 basic
only allowed reflection to be added The project was delivered using an ‘Agile’ assessment and management of chronic
available from cpd@rcoa.ac.uk
once a CPD-accredited event had approach, with four fortnightly ‘sprints’ pain from the CPD Matrix now appears
concluded, and the old system only of development followed by stakeholder User feedback has been positive, under the overall ‘Pain’ heading in the
allowed one set of reflections to be testing. A ‘soft launch’ commenced in including, from Dr Toni Brunning: “A Framework of CPD Skills in the Lifelong
linked to a CPD-accredited event. late July 2019 and the full ‘go-live’ took much more user-friendly system, and Learning Platform.
This was not ideal where CPD learners place on 13 November 2019 with a well integrated into the Lifelong Learning
18 | | 19Bulletin | Issue 120 | March 2020 Bulletin | Issue 120 | March 2020
Patient perspective
A civilised society – Worrying about
are we really? whether one
should eat today
Carol Pellowe
Chair, RCoA Lay Committee
rather than heat
laycomm@rcoa.ac.uk
the home must
In the run up to Christmas there was a buzz on the high street, encouraged by
be a stressful
Black Friday and by endless tempting offers to spend – maybe spend what we dilemma
do not have. This was followed by the new year sales – and on it goes.
I was struck before Christmas by Kate The Channel 4 programme, Growing in a clinic and told I didn’t need to visit
Milner’s new book for four-year-olds, It’s up poor: Britain’s breadline kids gave a again as I could manage my dressings
a No-Money Day, which tells the story graphic description of life on the edge.2 at home. No one asked if there was
of visiting a food bank from the child’s The poorest 20 per cent have access someone at home to help, or if I knew
perspective.1 While a beautiful book, it to 2 per cent of the nation’s income, what to do. Fortunately, I have a good
describes something truly obscene. In and many have found themselves in circle of folk to call on and we managed,
the past, story books were somewhere that position as a result of one incident, but even now I am not sure I would have
that children could get lost in a world such as a death, separation or ill health. said ‘I cannot do this.’
of fantasy, farm animals or cuddly toys: Worrying about whether one should eat
today rather than heat the home must These families have poor diets lacking
today they reflect the harsh reality
be a stressful dilemma. Deteriorating in protein and vitamins. Do we think
for many of them. While the book
parental mental health affects the about this or about how we might assist
is sympathetically written, it is, sadly,
children, and currently 800,000 children their healing? In your own area do you
obvious that the mother is going without
are caring for their parents, rather than know where is the nearest food bank
food for the sake of her daughter.
vice versa. Not managing at school, or Food Aid? Ironically, the Channel
Despite attempts by previous poor exam results and incidences of self- 4 programme showed advertisements
governments to abolish child poverty harm rise as a result. If nothing is done during the intervals for the National
as an evil of our time, we seem to have to improve the situation, the number of Lottery and Bet365.com! We seem to
failed. Today more than four million people in poverty will rise by an extra have become a nation of gamblers and
children live in poverty, which is the four million by 2023. borrowers, without any thought for the
equivalent of nine in every class of 30 effect on others. So back to my question:
So, what has the above to do with us?
children. Many food banks are run by are we a civilised society or not?
To those in poverty it is often seen as
the Trussell Trust, and at the beginning of something shameful and to be hidden.
References
2010 they had 57. They now have 428! When meeting a patient, do you ever
1 A Chakrabortty. Food banks used to be an
What should have been a temporary think about their home circumstances?
aberration. Now they’re in children’s books.
solution has become an emblem of Often, we imagine their home as like The Guardian, Journal 2019 (bit.ly/38ytFsP).
society’s failure to provide adequately for our own, but in many cases this is far 2 Growing up poor in Britain: Britain’s breadline
those who are worst off. from the truth. Recently I was reviewed kids. Channel 4, 2 December 2019.
20 | | 21Bulletin | Issue 120 | March 2020 Bulletin | Issue 120 | March 2020
Some evidence is more generic, for ongoing revalidation. Of course, we less obviously they do so by acting as
example feedback from multi-faculty are striving for an appraisal which goes positive role models. A well conducted
courses, the results of the GMC trainees’ beyond the minimum, in accordance educational appraisal is a helpful tool
survey, or participation in recruitment or with our position as role models. for the development of the educator,
Society for Education in Anaesthesia (UK) in the ARCP process. It can be difficult Such an appraisal includes two key which is to the benefit of the trainees, the
EDUCATIONAL APPRAISAL
to tease out from this kind of evidence further aspects: department, and ultimately the patients.
those aspects which refer to the
individual educator, but they can still be ■ what are the CS/ES’s areas of strength References
used to guide development. and weakness? What can help build
1 Professional standards for medical, dental
on the former or advance the latter? and veterinary educators. AOME, 2014
A key principle, whatever type of ■ what are the plans of the CS/ES for (bit.ly/2PGIuR4).
evidence is used, is that it should the remainder of their revalidation 2 Promoting excellence: standards for
Dr Sue Walwyn* Dr Janet Barrie be combined with reflection that medical education and training. GMC, 2015
cycle? What is required to bring this
Consultant Anaesthetist, Mid- Consultant Anaesthetist, Royal relates the content of the evidence (bit.ly/2shLStQ).
about, and how can it be achieved?
Yorkshire Hospitals NHS Trust Oldham Hospital to the practice of the individual
educator. It is this reflection that both These form the basis of a personal
demonstrates and drives learning and development plan (PDP), helping the *Corresponding author:
appraisal become a proactive rather than president@seauk.org
development; otherwise the evidence
Annual appraisal should reflect the entirety of the doctor’s scope of practice. becomes evidence of action without a reactive activity.
As part of this, individuals involved in clinical or educational supervision need evidence of development.
CSs and ESs contribute to the learning
to include evidence supporting their educational practice. For clinical and This provides the minimum for environment and culture of the
the educational appraisal to meet department. They do this directly via their
educational supervisors this occurs as part of the general appraisal process, the requirements of the GMC for educational and supervisory activities;
but the principles of educational appraisal remain poorly understood.
The professional standards for educators overall supervision and management One piece of ‘evidence’ can
were initially set by the Academy of of a specified trainee’s educational demonstrate development in more than
Medical Educators in 2009, and then progress during a training placement one domain. However, that begs the
adopted by the General Medical or series of placements”.2 A CS has to question, ‘What counts as evidence?’ It
Council (GMC) as part of Promoting meet requirements of domains 1–4 is obvious that attendance at meetings
excellence. These are:
1,2
plus domain 7 of the domains listed or updates, completion of e-learning,
above, while all seven domains have or formal educational qualifications
1 ensuring safe and effective count as CPD. However these only
to be met by an ES.
patient care evidence development of knowledge
2 establishing and maintaining a safe Clinical and educational supervisors and not of the development of the skills
environment for learning are subject to revalidation as educators; necessary in supervision.
3 teaching and facilitating learning this takes place over a five-yearly cycle,
4 enhancing learning through The second major source of evidence is
usually synchronised with the clinical
assessment direct personal feedback on educational
revalidation cycle. In order to retain
5 supporting and monitoring activities. This evidence may be from
clinical/educational supervisor status the
educational progress participants’ responses to teaching, from
supervisor has to fulfil three requirements:
6 guiding personal and professional feedback from trainees on their role as
development ■ present one piece of evidence a supervisor, or from the annual review
demonstrating continuing of competence progression (ARCP)
7 continuing professional development
as an educator. professional development (CPD) as panel on their ES reports. Alternatively,
peer observation and feedback can be
an educator each year
A clinical supervisor (CS) is “a trainer who a powerful tool for development, often
is appropriately trained to be responsible ■ present evidence of continuing
highlighting hidden areas for feedback.
for overseeing a specified trainee’s clinical professional development over the This can work both ways, with the
work and providing constructive feedback revalidation cycle against each of observer using the experience as a focus
during a training placement”, while an domains 1–4 for a CS or 1–6 for an ES for their own professional development.
educational supervisor (ES) is “a trainer ■ present at least three different types of These are better evidence of their skills
who is trained to be responsible for the evidence over the five-year cycle. as an educator than attending courses.
22 | | 23You can also read
