Research issue: The challenges COVID-19 has placed on the research community - The Royal College of Anaesthetists
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November 2020 Remote pre-assessment for
cancer surgery during the
COVID-19 pandemic
Transforming paediatric major
trauma care
Simulation training – ‘It’s just like
flying a plane’
Research issue:
The challenges COVID-19 has
placed on the research community
rcoa.ac.uk
@RCoANews
Bulletin | Issue 124 | November 2020
RCoA Events Anaesthetic updates
4 March 2021
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rcoa.ac.uk/events
EVENTS AND COVID-19
Bristol
events@rcoa.ac.uk AaE: Introduction
11 March 2021
@RCoANews
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FULLY BOOKED Due to the ongoing COVID-19 situation we have
Developing World Anaesthesia moved the majority of our events on to virtual
15 March 2021 platforms, where this is not possible some of these
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RCoA, London events may be postponed or cancelled.
NOVEMBER
Developing World Anaesthesia Anaesthetists as Educators:
November 2020 Advanced Educational Supervision
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Global Anaesthesia
Virtual event 26 January 2021 16 March 2021
Please keep up to date by visiting our webpage:
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RCoA and RA-UK joint webinar:
blocks for the many
Airway Workshop
Birmingham RCoA, London rcoa.ac.uk/events
(not just the few) Anaesthetic Updates
November 2020 Leadership and management:
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10 November 2020 29 January 2021 The Essentials
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Virtual event
Evening webinar Southampton 16–17 March 2021
Clinical Directors Network DECEMBER Glasgow
Meeting FEBRUARY Leadership and management: AaE: Advanced
16 November 2020
Personal Effectiveness
Educational Supervision
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Virtual event Winter Symposium Presentation of Diplomates
26 March 2021
3–4 December 2020 Ceremony
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Leadership and Management: RCoA, London
Virtual event 1 February 2021
Working well in teams and 26 January 2021
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Central Hall, London Ultrasound Workshop
making an impact Invitation only 29 March 2021
Birmingham
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Less than full time (LTFT)
18 November 2020
matters webinar RCoA, London
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RCoA, London AaE: teaching and training in
9 December 2020 the workplace
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Anaesthetic updates
Anaesthetic Updates Virtual event 2–3 February 2021 March 2021
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19 November 2020
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Primary FRCA Online Revision RCoA, London RCoA, London
Virtual event FULLY BOOKED
Course
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Anaesthetists as Educators: December 2020 – February 2021 Innovations and interlectual APRIL
Anaesthetists’ Non Technical Virtual event
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property conference
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Skills (ANTS) 3 February 2021 After the Final FRCA
Final FRCA Online Revision Course
20 November 2020 RCoA, London 21 April 2021
December 2020 – March 2021
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Virtual event RCoA, London
Virtual event Anaesthetic updates
Anaesthesia Research 24–26 February 2021 Cardiac Symposium
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24 November
JANUARY 22–23 April 2021
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RCoA, London
Virtual event RCoA, London
RCoA and BJA joint webinar: GASAgain (Giving Anaesthesia MARCH AaE: Teaching and training in the
Safely Again)
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how BJA Editors decide which workplace
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papers to publish 13 January 2021 Airway workshop
28–29 April 2021
Bradford 1 March 2021
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24 November 2020 Edinburgh
Evening webinar To be confirmed
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.
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Book your place at rcoa.ac.uk/events Book your place at rcoa.ac.uk/events | 1
Bulletin | Issue 124 | November 2020 Bulletin | Issue 124 | November 2020
Contents
The President’s View 4
News in brief 8
Guest Editorial 12
SAS and Specialty Doctors 14
From the editor
Revalidation for anaesthetists 16
Dr Helgi Johannsson
Faculty of Pain Medicine (FPM) 17
Faculty of Intensive Care
Medicine (FICM) 18 Welcome to the November Bulletin.
Patient perspective 20
As you open your November edition of the Bulletin, I sincerely hope we have managed to prevent a large second
Society for Education in wave of coronavirus infection. But as I write we are finally seeing the increase in cases predicted of a second
Anaesthesia (UK) 22
wave. Still, in my hospital there are no patients with coronavirus on the intensive care unit, which gives me some
Creating capacity in a crisis 24 hope that we may be able to continue with the enormous task of getting the NHS’s elective work back on track
Perioperative Journal Watch 28 and reversing the colossal disruption that has affected all our lives.
Health Services Research Centre 29 COVID-19 has dominated the news and our conversations, and so it is no surprise that this month’s edition of
Frailty and delirium 30
the Bulletin contains a lot of pandemic-related articles. It’s not all bad news however, and the articles on pre-
Guest editorial Perioperative cardiac arrest 32
assessment show how the pandemic has focused our minds and streamlined so many pathways. In order to
access an operation, a patient may previously have had to attend several face-to-face appointments at different
What a difference a year makes! NELA: fellows past and present 34 times, many of which now occur remotely and at the mutual convenience of patient and clinician. It is also
wonderful to see the empowerment of nursing staff taking on extra roles, and the innovative use of technology. I
A year of two halves 36
Dr Lindsay Forbes gives a personal glimpse into personally found the tips on remote meetings very useful and hope that incorporating them will avoid humiliating
In a changing landscape 38
the experience of undergoing bariatric surgery and technical glitches happening at awkward moments – as we have all witnessed on TV and radio just as the person
A fellow in the field of rapid being interviewed is coming to the crucial point of the whole interview.
explains why it’s not a ‘quick fix’ qualitative research 39
This month we showcase research in anaesthesia, and I am delighted to see that, after the first wave, research
Page 12 Compassion through the
activity is up and running again. The topics covered are as important as ever – COVID-19 cannot be allowed to
COVID-19 crisis 42
stop our progress as a specialty. The same applies to education, where the article on remote simulation shows
A practical guide to improving that it can be done.
The President’s View Health Services Research teleconferencing 44
The challenges COVID-19 Centre (HSRC) Pop-up simulation suite Your representatives – the College Council members – feature again in this edition, where Dr Kirstin May reflects
has placed on the research utilising Zoom videoconferencing 46 on where we have come, and how SAS-grade doctors have not only been indispensable in the response to
HSRC share how their work has
community COVID-19, but still are as we try to get elective work back on track. In our ‘As we were’ article we hear from Janice
been affected by the pandemic in Training outside the box 48
Fazackerley, our previous vice-president. Throughout her tenure she was a sensible voice of reason with a passion
Page 4 their 2020 Annual Report Simulation training – ‘It’s just like for the doctors and patients she represented. She will be much missed from Council, but I’m pleased to say that
Page 29 flying a plane’ 50
she very much remains a friend and a source of excellent advice.
Remote pre-assessment Meghana Pandit Safety Fellowship:
Transforming paediatric Finally, I want to extend my gratitude to Lyndsey Forbes for the moving and highly personal account of her
for cancer surgery during patient-safety perspectives in a
major trauma care different healthcare system 52 experience of obesity and weight-loss surgery. What we say in the coffee-room and see as mere ‘banter’ can hurt.
the COVID-19 pandemic We may forget what was said, but we will never forget how it made us feel.
Substantial work has seen ‘New to the NHS’ national MTI
A success story on delivering simulation programme 54
transformation of the paediatric Here’s hoping we’ll be able to spend Christmas in groups larger than six!
cancer care during lockdown from
trauma service from conception to Why become a
the Royal Marsden hospital College event speaker? 56
clinical practice
Page 26 As we were... 58
Page 40
New to the College 60
Notices, adverts and College events 63
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Bulletin | Issue 124 | November 2020 Bulletin | Issue 124 | November 2020
Professor Ravi Mahajan Professor Iain Moppett
President Deputy Director, Health Services
president@rcoa.ac.uk Research Centre
The COVID-19 pandemic has had significant impacts on research.
Some have been positive, while some are causing short-term and
possibly longer-term problems. Now is a good time to take stock
of where anaesthesia and critical care research is and how it is
placed to face challenges going forward.
When the pandemic hit, most clinical research was the other hand, some researchers are highlighting
halted or restricted to activities that were essential the benefits of enforced virtual meetings, with less
to maintain participant safety or the integrity travel time and fewer barriers to collaborations with
of the studies. Research-active clinicians and geographically dispersed colleagues.
research support teams across the country shifted
their work patterns to support their local clinical In addition to the changes it has prompted in
services. Inevitably this has delayed development, clinical practice, COVID-19 has given a kick to
recruitment, analysis and publication of research some perhaps overdue changes in research
projects, but with the easing of ‘surge’ rotas, practice. Virtual/telephone consent and follow-
colleagues are starting to catch up. There is a up is becoming much more the norm alongside
double-hit of reduced and variable clinical work electronic data capture.
impacting on the ability of studies to recruit in a
The pandemic has highlighted an undoubted
timely fashion.
strength of the NHS research infrastructure and
The limitations on face-to-face working have culture. Landmark studies such as RECOVERY
changed the nature of research, from the laboratory (Randomised evaluation of COVID-19 therapy)
through to large clinical trials. Universities have and REMAP-CAP (Randomised, embedded,
the same requirements for COVID-safe working multifactorial, adaptive platform trial for community-
environments as other businesses, and it is not clear acquired pneumonia) would not be possible without
The President’s View
RESEARCH AND COVID-19
exactly how social distancing requirements will a national research infrastructure. Nor would they
impact on traditionally close-working environments happen without the willingness of clinicians to enrol
such as laboratories. It is almost certain to increase and care for patients within randomised controlled
costs. Teleconferencing is the new normal for trials. The importance of clinicians supporting
research groups, but only time will tell how much patients’ participation in trials when there is scientific
the social and academic interactions within and equipoise, regardless of their own personal views,
between research groups in coffee rooms, seminars, cannot be overstated. Prior to RECOVERY, many
and conferences will affect future research. On clinicians may have held strong views for or
4 | | 5
Bulletin | Issue 124 | November 2020 Bulletin | Issue 124 | November 2020
Bulletin
against the use of steroids, but only by
recruiting to the trial do we have the Only by recruiting to studies will put into the public domain, whether on social media,
or as pre-prints or peer-reviewed publications. Sadly,
of the Royal College of Anaesthetists
we find the answers to important
answers. It would be good to see this but not unpredictably, much of this ‘research’ has not Churchill House, 35 Red Lion Square, London WC1R 4SG
approach spill over and continue in withstood scrutiny. Game-changing claims have been 020 7092 1500
future non-COVID research. quietly forgotten, and even the major journals have had to
clinical questions.
rcoa.ac.uk/bulletin | bulletin@rcoa.ac.uk
retract papers. We are fortunate that the anaesthesia and
However, the situation moving forward @RCoANews
critical care community has articulate and well-respected
remains uncertain. Funding of research /RoyalCollegeofAnaesthetists
researchers who have been able to offer context and
projects is likely to become more critique for both the clinician and the wider public. Dr Registered Charity No 1013887
difficult. Social distancing effects community. NHS and university data that can provide answers to some
Charlotte Summers from Cambridge has won praise for Registered Charity in Scotland No SC037737
may increase laboratory costs. Major clinicians and researchers have for a of the questions about how safe and
her ability to explain complex and sensitive topics in an VAT Registration No GB 927 2364 18
long time contributed to this exposure effective care can or should be delivered.
funders such as the National Institute engaging and informative way.
through medical student projects. The This isn’t to say that high-quality President Hugo Hunton
for Health Research will be hit by the
College, alongside the Association of randomised controlled trials are not It would be remiss not to mention some of the work Ravi Mahajan Lead College Tutor
costs of overrunning studies, not to
Anaesthetists, BJA Anaesthesia, and important. We are delighted to report that anaesthetists in training and fellows have somehow
mention the the wider economic impact Vice-Presidents Emma Stiby
the Neuroanaesthesia and Critical that the first Perioperative Medicine managed to pull out of the bag at the height of COVID.
of COVID. Universities are facing Fiona Donald and SAS Member
Care Society, provides competitive Clinical Trials Network (POMCTN) Hopefully many members will have contributed to
significant shortfalls in the coming William Harrop-Griffiths
financial support through the John Snow led trial (Volatile vs total intravenous IntubateCOVID (Dr Danny Wong), reflected on the Susannah Thoms
years due to loss of income from
Intercalated Award. Many of these anaesthesia for major non-cardiac early analysis of deaths in healthcare workers (Dr Emira Editorial Board Anaesthetists in Training
teaching, hospitality and research. The
smaller projects have been laboratory- surgery [VITAL] trial, led by POMCTN Kursomovic), and digested the systematic review of ICU Helgi Johannsson, Editor Committee
opportunities to replace or appoint staff
based or volunteer-based work. There Deputy Director, Dr Joyce Yeung) outcomes following COVID (Dr Richard Armstrong and Carol Pellowe
are likely to be few and far between. Jaideep Pandit
may need to be a reimagining of how has been funded (£1.4 million) by the Dr Andrew Kane). Lay Committee
Universities are under pressure to Council Member
such projects will work in the future. NIHR Health Technology Assessment
deliver high-quality online and virtual COVID-19 has brought many challenges to the research Krish Ramachandran Gavin Dallas
programme. VITAL will be comparing
teaching to more medical students High-quality-data science research may community, with many more to follow. Anaesthesia and Council Member Head of Communications
patient outcome between inhalational
than ever before. Inevitably, university- play an increasing role in the future. critical care research are well placed to meet these, but will Mandie Kelly
and total intravenous anaesthesia and is Jonathan Thompson
employed clinical academics will be The NHS – as well as Health Services be working in an increasingly constrained and competitive Website & Publications Officer
a data-enabled trial which will use the Council Member
asked to provide more support to these Research Centre projects such as the environment. Above all, we could not be delivering
existing PQIP infrastructure. Anamika Trivedi
important roles. National Emergency Laparotomy research for the benefit of our patients and colleagues Duncan Parkhouse
Lead Regional Advisor Website & Publications Officer
Audit (NELA) and Perioperative Quality It will not have escaped the notice of without the continuing support of our members.
Early exposure to research is vital to Improvement Programme (PQIP) – College members that an awful lot of Anaesthesia
a healthy and continuing research provide high-quality, routinely collected If you have any comments or questions about any of
COVID-related ‘research’ has been
the issues discussed in this President’s View, or would like Articles for submission, together with any declaration of interest,
to express your views on any other subject, I would like should be sent to the Editor via email to bulletin@rcoa.ac.uk
to hear from you. Please contact me via All contributions will receive an acknowledgement and
presidentnews@rcoa.ac.uk the Editor reserves the right to edit articles for reasons of
space or clarity.
Turn to page 29 to read more about how the The views and opinions expressed in the Bulletin are solely
those of the individual authors. Adverts imply no form of
Health Services Research Centre’s (HSRC) work
endorsement and neither do they represent the view of
has been affected by the pandemic in their
the Royal College of Anaesthetists.
2020 Annual Report.
© 2020 Bulletin of the Royal College of Anaesthetists
All Rights Reserved. No part of this publication may be
reproduced, stored in a retrieval system, or transmitted in
any form or by any other means, electronic, mechanical,
photocopying, recording, or otherwise, without prior
permission, in writing, of the Royal College of Anaesthetists.
ISSN (print): 2040-8846
ISSN (online): 2040-8854
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Bulletin | Issue 124 | November 2020 Bulletin | Issue 124 | November 2020
NEWS IN BRIEF
News and information from around the College
Council Election
Don’t forget to vote in the election to Council, where you’ll be choosing your
representatives for one Consultant place and one SAS place. Ballots will be
sent by email on 16 November and voting will close on 14 December. Council
members play a hugely important role in the working life of the College and in Translations of patient information leaflets
advocating for all our members, so do get your vote in.
The College is working in partnership with the international translation charity Translators
Those eligible to vote are: without Borders to provide translations of our most popular patient information leaflets in the
■ Fellows (apart from Honorary Fellows), Members, Associate Members, 20 most common languages used in the UK, including Welsh.
Trainees and Senior Fellows and Members for the Consultant vacancy
You and your anaesthetic, Your spinal anaesthetic and Your child’s general anaesthetic are now
■ Members and Associate Members for the SAS vacancy available in the current selection of translations. Soon to follow – Anaesthetic choices for hip or
■ If your membership fits one of these categories and after 16 November you Scottish Board knee replacement.
haven’t received a ballot email, please contact ceo@rcoa.ac.uk, including
your college reference number. Election Please see our website for further details: rcoa.ac.uk/patientinfo/translations
Nominations for places on the RCoA
Scottish Board open on 4 November.
Put your name forward before the
closing date of 2 December for the
chance to join a board of colleagues
who meet three times a year to provide
RCoA responds to ‘Reducing
an important link between the College
and Fellows and Members based in
Bureaucracy’ consultation SAFE
ANAESTHESIA
Scotland.
LIAISON GROUP
The College has submitted its response to a consultation
Further information can be found on the from the Department for Health and Social Care (DHSC) on
College website and you can discuss the issue of ‘Reducing bureaucracy in the health and social
the opportunities in more detail with the care system’. See the full response at:
current chair, Dr Sarah Ramsay rcoa.ac.uk/rcoa-responds-reducing-bureaucracy-consultation
■
(sramsay@rcoa.ac.uk)
The College response highlights that the perioperative
pathway could be a solution in improving the bureaucratic
SALG-BIDMC Fellowship
pressures associated with the above areas, as supported by The Safe Anaesthesia Liaison Group (SALG) is pleased to
comprehensive evidence in the CPOC impact review. announce the next round of its exciting programme of
fellowships for anaesthetists interested in patient safety.
In collaboration with the Association of Anaesthetists
and the College, SALG are offering a unique programme
Proving the case for perioperative care of formal training through Harvard Medical School that
The Centre for Perioperative Care (CPOC) has published comprehensive evidence that aims to develop international expertise in perioperative
the perioperative pathway is associated with higher quality clinical outcomes, reduced quality and safety.
financial cost and better satisfaction for surgical patients. Never has there been so Further information and application details can be found
important a moment to institute rapid large-scale transformation. at: bit.ly/SALGFellowship
Read CPOC’s report at: bit.ly/3imZYiy
8 | | 9
Bulletin | Issue 124 | November 2020 Bulletin | Issue 124 | November 2020
NEWS IN BRIEF
News and information from around the College
e-Learning Anaesthesia
revision guides
Young
We have now published all three new titles in the
e-learning Anaesthesia revision guide series to
complement e-LA and support Primary Exam preparation.
anaesthesia
The series now covers Physics as well as Pharmacology
and Physiology. These guides are available to download Anaesthetic teams awarded for
for free onto your device for use offline and contain links
artist 2020 directly to useful e-LA learning sessions.
Download the Revision Guides at:
high quality patient care
This year the College is very proud to have recognised seven
rcoa.ac.uk/e-learning-anaesthesia anaesthetic departments for providing the highest quality care
to their patients. Departments at the five Trusts of the Countess
e-LA is always looking for volunteer module editors and of Chester, Frimley Health, Leeds, North Bristol and South
authors to make up the e-LA editorial board. Applications Tees achieved accreditation and the two trusts of Kingston
While COVID has impacted us all as healthcare workers and, with some of will be considered from all College members and and St Georges achieved re-accreditation under the Colleges
anaesthetists in training who have achieved or are within
us needing to spend more time away from our family than usual, it’s also a year of achieving their CCT.
prestigious peer review scheme Anaesthesia Clinical Services
Accreditation (ACSA).
taken its toll on the little people we love and care so much for.
To find out more please email: e-la@rcoa.ac.uk As well as meeting the standards, the departments demonstrated
We’d like to offer your young daughters, sons, nieces, Postal submission instructions: many separate areas of excellent innovative practice. These
nephews or grandkids the opportunity celebrate with us as ■ drawing or painting on paper or card included collaboration between hospitals in their trust, integrated
we take our first tentative steps to re-open your College, services, flexibility of patient care and many more, these have now
■ artists’ first name and age, with parent or guardian’s full
by asking them to send in their drawings or paintings of been highlighted for sharing through the ACSA network.
name and email address clearly written on the back of
their interpretation of either what you did whilst caring for
the submission To receive accreditation, departments are expected to
your patients, or of something they’ve enjoyed during the
strange times they’re living though at the moment. ■ posted to: Young anaesthesia artist 2020, c/o RCoA demonstrate high standards in areas such as patient experience,
Facilities Team, Churchill House, 35 Red Lion Square, patient safety and clinical leadership. Whilst the pandemic has
We hope that seeing this new world through the eyes of London, WC1R 4SG. meant that onsite visits are postponed until March 2021, new
our young family members will be a powerful and emotive anaesthetic departments can still register for the peer-review
insight into how this global pandemic has impacted on and Digital submission instructions: scheme and hold phone or video conferences to discuss the
is being perceived by the next generation. ■ A4 portrait or landscape drawing or painting – scanned benefits of engaging and get advice on the challenges involved.
or photographed
We’re planning to give this project pride of place in our The College’s website has all the information required for you
building’s entrance area, with each and every submission ■ high resolution (300dpi) digital file to be emailed to:
to understand how ACSA could work for your anaesthetic
being put on display – we’d of course love to receive as comms@rcoa.ac.uk with a subject heading of:
department (rcoa.ac.uk/acsa).
many as possible! Young anaesthesia artist 2020
artists’ first name and age, with parent or guardian’s full
Remember to get your flu jab!
■
Format: name provided within the email.
■ A4 portrait The College would like to encourage you all to get your free annual flu jab as soon as you
Deadline for submissions is 20 December 2020.
■ landscape is also welcome. can. This is a critical step to keep you, your family and your patients safe. With COVID-19
We hope this provides our young artists with an enjoyable in circulation it’s especially important to get the flu vaccine this year to protect those most
creative outlet and lots of fun. We can’t wait to see the vulnerable and control pressures on NHS staff and services by reducing staff absence.
creations from our UK and international members alike.
More information can be found at: bit.ly/2ZOdrst
10 | | 11
Bulletin | Issue 124 | November 2020 Bulletin | Issue 124 | November 2020
My declaration of interest on this is bias towards these patients; they are options – tell folk, or don’t go out
quite clear. Having been obese for most likely already terrified. socially. I decided it would be much
most of my life, I had a revision from easier for ‘life’ just to tell ‘my people’.
I originally had bariatric surgery back
gastric band to gastric bypass in June An excellent decision.
in 2007 when I got a gastric band.
2019. I corrected someone on twitter
I worked with it fairly well for about Its not all been a challenge though.
a few months ago who called bariatric
a year, then I went off to Australia, I’m much less tired; I sleep better;
surgery a ‘quick fix’ – I’d say its
fell out of follow-up, and did what I don’t have the anxiety that there
anything but. More about recognising
all 25-year-old junior doctors do in won’t be scrubs that fit every morning,
that there is a scary permanent option
Australia – PARTY! and don’t stockpile them in my locker
that involves not being morbidly
obese. A year and a half on, it remains anymore. The biggest anaesthetic
It’s hard to recognise when something
one of the hardest but best decisions achievement has clearly been coming
isn’t working; in reality I’d probably
I’ve made. third out of 73 on the Strava cycling
been thinking about revision to
segment on the way home from
bypass for a few years before I
My first recollection of being work; I need to gain 21 seconds
decided to do it. There is usually a
overweight was in primary school, to get second – I am considering
trigger that spurs you into action. For
when I first got a nickname that the addition of a sail to the bike to
me, as a coffee addict, that trigger
stuck right through to the end of achieve this.
was experiencing shoulder pain, not
secondary school – ‘Fatty Forbes’. It is
only with eating but also on drinking As usual, I’ll add my Oscar-esque
unfortunate being round and having
my morning latte – DISASTER! finale and thank all my Chichester crew
a surname that starts with F when
Guest Editorial you’re seven years old. In medical Undoubtedly the worst part was
for being awesome, in particular Ruth
school I was given a paper to present Prosser and Guy Slater. And I will finish
going to theatre as a punter, even
to my group by the professor of with a reminder to us all: people will
when you’ve handpicked the
pharmacology in a fifth-year special forget what you said, people will forget
Dr Lyndsey Forbes anaesthetist and surgeon. The week
study module. After looking me up what you did, but people will never
before, my anaesthetics had involved
Consultant Paediatric Anaesthetist, and down, he had handed me a paper forget how you made them feel.4
liberal doses of both emergency
Royal Hospital for Children, Glasgow on Orlistat and told me that it was the drugs and buzzers. So my triple-figure References
lyndseyforbes@me.com ‘most appropriate’ paper he could tachycardia was perhaps unsurprising,
find for me. Nowadays I’d have pulled 1 Tamara A, Tahapary DL. Obesity as a
despite the Remifentanil hitting like a
WHAT A DIFFERENCE
predictor for a poor prognosis of COVID-
him up on it, but at the time I certainly full bottle of tequila. 19: a systematic review. Diabetes Metab
didn’t have the confidence or self- Syndr 2020; 14(4):655–659.
esteem to follow it through. You just Initially, the most challenging aspect of 2 RCGP apologises after backlash over
want to keep your head down and having a bypass for me was eating out. branding Covid-19 a ‘lifestyle’ disease
A YEAR MAKES!
(bit.ly/32ozO8l).
get on with it; you’re mortified when About three months post op, I was at
3 Selak T, Selak V. Communicating risks
anyone brings it up, but know it’s an a conference when I declined a beer
of obesity before anaesthesia from the
issue as you do actually own a mirror. from an old boss I hadn’t seen in 12 patient’s perspective: informed consent or
years. On declining the offer of beers fat-shaming? Association of Anaesthetists
Fast forward a few years to the place I was firstly asked if I was pregnant. 2020 (doi.org/10.1111/anae.15126).
where I’ve probably heard the most ‘No!’ Secondly, I was asked if I was an 4 Maya Angelou quote, goodreads
We have heard a lot about obesity in 2020 – that it predisposes to judgement about obesity – the alcoholic. ‘No!’ And thirdly I was asked
(bit.ly/32lHRD3).
anaesthetic coffee room. Never
a worse outcome in COVID-19;1 that the Royal College of General aimed at me, but I’ve definitely
why on earth I didn’t want a dessert. It
made me feel uncomfortable and very
Practitioners has branded COVID-19 a ‘lifestyle disease’;2 and that noticed that, as a group, we are very selective about going out socially for a
judgemental. From a ‘harpooning
the Society for Obesity and Bariatric Anaesthesia are considering whales’ on labour ward, to a having a
few months.
formulating guidelines regarding consent for obese patients, ‘right heifer’ on the list, to an ‘OMG I kept it very quiet till about six
they’re h-u-u-u-ge’. It might be just months post op, because I thought I’d
leading to the question of at what point this should happen coffee room ‘banter’, but we all need be judged. Then came the Christmas
preoperatively in an Association of Anaesthetists’ editorial.3 to be mindful of our perceptions and party, when I decided I had two
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Bulletin | Issue 124 | November 2020 Bulletin | Issue 124 | November 2020
Locally, outside of London, we have
had enough warning of the first wave
risk factors. In my personal experience
of more than 26 years in the NHS this SAS doctors
are a much
to organise ourselves, crosskill, upskill, is a shift-change away from a ‘one
and practise multidisciplinary drills. size fits all’ approach. We are learning
The sense of common purpose was a different way of looking after staff,
palpable in my hospital and has greatly
improved interdisciplinary working and
and some of that has been achieved
with the help of the public: better food
needed staff
team spirit. The improvement in morale
I have witnessed is reflected in some of
provision, availability of shower and rest
facilities, soap and handcream, etc.
group
our College COVID survey results.
Most of us have in the past gone
Who knew how many consultations to work even if feeling unwell. The
could be done electronically to mutual pressure to not leave your colleagues innovation and harnessing fresh
satisfaction? How multidisciplinary – already stretched – with your work thinking, and an opportunistic abuse of
and anticipatory care plans, made on on top of their own has led many a an exhausted, distracted workforce.
admission, would be the new normal, sniffly nose, a hacking cough, a fever,
not a much-chased ideal? How we could and an ‘iffy’ stomach to turn up at work. When meeting you at College
change our working patterns or areas Those who are sick have felt guilty events, many of you talk to us about
of practice at a moment’s notice? How and often returned too early. We now dissatisfaction with job plans and terms
specialists who had barely ever crossed have to provide a safer workforce and and conditions. While such employment
its threshold could become valued team protect ourselves, our colleagues and issues are not part of the College’s
members in intensive care? How we our patients better. Personal protective remit, we try and signpost in the right
would run clinical governance meetings, equipment has taught us to take breaks. direction – which is usually the BMA.
business meetings, and educational Presenteeism is dead! However, we can also give you the
events via videoconferencing, with confidence that we as SAS doctors are a
better attendance than before? Roll up your sleeves much needed and difficult to recruit staff
group with a significant vacancy rate.
The pause or slowdown in many
We have learned new things about Many of you have worked in the same
services has now created a large
ourselves: we – and the NHS – can job and same location for years and are
backlog, and the consequences will
Dr Kirstin May be very flexible if required. Changes
only gradually come to light. We need
understandably reluctant and anxious to
RCoA SAS Member of Council, Banbury contemplated for years can be change. If you have recently changed
to use some of the clinical innovations
sas@rcoa.ac.uk implemented quickly if desired. We the way you work and where you work,
and gains made to create momentum
can regain our common sense of taken on different areas, taken part in
as quickly as possible to get work done.
purpose. We can create efficient different rotas, or been successfully
SAS and Specialty Doctors teams with flattened hierarchies and
Relaxation of bureaucracy and flexible
KEEP THE CHANGE…?
redeployed, maybe this is the time to
thinking should help. We must resist
made up of previously considered reconsider your options…
attempts to return without question to
unlikely team members. We can refresh
business as before. Work desperately Opinions are my own and not the views
old knowledge or learn new things,
needs doing, but rest and recuperation of the RCoA.
regardless of age. The public values
are important. It is our duty to look after
‘The greatest danger in times of turbulence is not the turbulence, it is to act with yesterday’s logic’ the NHS and can adapt to new rules or
ourselves and our colleagues for us to Further reading
ways in which healthcare is offered.
Peter Drucker be able to look after our patients. 1 Third Covid Membership Survey, RCoA.
(rcoa.ac.uk/news/third-rcoa-covid-19-
Focus on wellbeing and
As we look back over the last few months (time of writing is August), we are personal risk
Is this relevant to SAS membership-survey).
2 Workforce Data Pack 2018. RCoA
reflecting on the many changes the COVID-19 pandemic has forced us to doctors? (rcoa.ac.uk/media/5256).
Doctors from ethnic minorities are
Attempts have been made to use
make within a short timeframe. There have been myriad changes to the way over-represented among SAS and
changes in working patterns agreed as
trust-grade doctors, and their increased
we work, and many of us are feeling exhausted and psychologically affected vulnerability to COVID has focused
short-term measures during the crisis to
embed longer-term changes, leading to
by the experience. Among the chaos and upheaval it has been astonishing to attention on personal risk and how to
an erosion of job plans and terms and
manage it. This does not only apply to
see how everything has suddenly come to a stop and we have reconfigured. ethnic background, but also to other
conditions. There is a fine line between
14 | | 15
Bulletin | Issue 124 | November 2020 Bulletin | Issue 124 | November 2020
Revalidation for anaesthetists Faculty of Pain Medicine (FPM)
‘Top tips’ for making PAIN MEDICINE –
a successful CPD Chris Kennedy
RCoA CPD and
MOVING FORWARD Dr John Hughes
Dean, Faculty of Pain Medicine
event application
contact@fpm.ac.uk
Revalidation Co-ordinator
cpd@rcoa.ac.uk I am writing this FPM strategy update just before the schools return. This
seems strange, as COVID-19 has overtaken much of this year’s work,
It was reported in the September edition of the Bulletin how the College’s introducing both dilemmas and opportunities. Clinically there have been
CPD accreditation process has now been extended to virtual learning events. significant challenges, but redeployments are reversing, allowing the practice
An increasing number of these are being provided in response to ongoing of pain medicine to return. Many centres have maintained some service for
concerns about local lockdowns and social distancing measures, potentially those most in need, which has been very encouraging.
resulting in short-notice cancellations of face-to-face versions. Last September the FPM reviewed its
strategy. This has allowed consistent
Consideration can be given to We would like to use this article to ■ CPD skills – the incorporation messaging across the areas of training;
events which are appropriate to the provide some ‘top tips’ on how to make of CPD into the LLP has seen a professional standards; research;
professional development needs of a successful application, and one which Framework of CPD Skills replace and public, professional and political
non-trainees and for events which will be most visible and attractive to what was formerly the CPD Matrix. interaction. There have been disruptions
are targeted at a regional, national or your potential audience: This is an entirely optional resource and delays, but we can list here
international audience. There is no to map events against, although highlights going forward.
charge for NHS trusts and hospitals, ■ event URL – all events accredited doing so, and also mapping against
registered charities and specialist for CPD appear in the Lifelong the Good Medical Practice domains ■ Pain management needs to
societies and associations, and the Learning platform (LLP) and on the and the Domains for Medical be attractive and sustainable if
event reviews are completed by College website, and so you are Educators, will further increase the patients are to benefit. Anaesthesia
independent, specialist CPD assessors, encouraged to provide a direct URL visibility of your event in the LLP is a cornerstone for pain
who are clinicians experienced in the to increase visibility specialist development, and pain
■ supporting documents – while the
subject matter. ■ keywords – events are searchable management is a fundamental
application process requires event (with the Medicines Advisory Group relationship with the British Pain
by keywords in the LLP, and so component of the anaesthetic
providers to submit three mandatory leading), and includes maintaining Society. These interactions have
adding some unique words will curriculum. There is also a role for
documents – the event programme, the ‘Opioids Aware’ resource. allowed statements and publications
further increase visibility broader access to pain medicine;
information on the speakers and a to be co-released (both those that
aims and learning outcomes copy of the feedback form, you can this is being actively explored with This all feeds the strategy to get the
■ ■ are COVID-related and those that are
– the overall aim(s) and learning specify which of these, if any, you the GMC credentialing process, best service for our patients. This more general). Closer to home, there
outcomes of your event should be which is now back up and running.
would like to be visible in the LLP. common objective is shared with the is ongoing engagement with the
clearly defined so as to manage the ■ These link with the strategic aim of ‘Core standards for pain management Centre for Perioperative Care.
expectations of the delegates as well We hope that this information will help; looking at the Faculty’s educational services’ document, with outcome
as to provide guidance for the target for further guidance please contact role with respect to healthcare as The Faculty staff team provides the
measures, with commissioning
audience. The learning outcomes cpd@rcoa.ac.uk. a whole. They comprise several support that enables these activities to
support, and with dialogue with NHS
should be measurable and should independent strands that are being be undertaken and delivered in a timely
England and other statutory bodies.
indicate what knowledge or skills the focused within a single hub to manner. I salute them, as they have
This has continued throughout the achieved this against the background of
participants are expected to obtain ensure consistency, improve access,
COVID pandemic, with new links distance working, and the arrival of a new
as a result. These are particularly and make the best use of resources.
important because the attendees’ being forged. The multidisciplinary Associate Director of the Faculty together
reflection will be based on these. The appropriate use of pain nature of pain management is with other staff changes.
therapies is topical and important reflected in the good working
16 | | 17Bulletin | Issue 124 | November 2020 Bulletin | Issue 124 | November 2020
Dr Carl Waldmann Dr Joel Meyer and Dr Andy Slack
Chair, Life After Critical Deputy Chairs,
Illness (LACI) Working Party, Life After Critical Illness (LACI)
FICM Working Party, FICM
contact@ficm.ac.uk
evidence base to justify their funding quality indicators. In 2017, NICE These benefits include feedback from
or their existence, many failed to be published its Quality Standard (NICE patients and caregivers (family) to
sustainable. Some centres did manage QS 158), and since then there has ICU staff that can influence changes
to evolve rehabilitation and outpatient been more of a concerted effort for in practice within the ICU, the
follow-up services for patients after all intensive care services nationally enabling of revalidation for healthcare
critical illness/injury. However, unlike to provide rehabilitation and follow- professionals, and the provision of
specialties such as trauma, cardiology, up. However, there still remains the a narrative of individual patients’
respiratory medicine, and stroke problem of how to fund such services. outcomes for staff, which can improve
medicine, where rehabilitation pathways To date, this has been primarily morale. The ICU multidisciplinary team
are now quite well established, intensive achieved by local intensive care are expertly placed to understand,
care has been unable to develop a units developing and submitting a interpret and plan the recovery phase
specific rehabilitation pathway. business case to local commissioners. of the patients’ illness and signpost
Unfortunately, these efforts often fail them appropriately to other hospital or
© ICCU, City Hospitals Sunderland NHSFT In 2009, NICE provided guidance due to a lack of supportive clinical community-based specialties.
with the headline statement ‘Given evidence and a challenging financial
the individual impact on patients, and The patient feedback for these critical
climate in the NHS.
ripple effects on families and society in illness recovery clinics consistently
Faculty of Intensive Care Medicine (FICM) general, poor-quality rehabilitation and It is clear that recovery from critical highlights the benefit of hearing a
LIFE AFTER CRITICAL ILLNESS
impaired recovery from severe illness illness is complex. Since 2010, the term narrative account of their ICU stay,
should be regarded as a major public ‘post intensive care syndrome’ (PICS) along with the review and normalisation
health issue.’ [NICE CG83]. has been increasingly used to describe of their ICU delirium experience.
the complex long-term sequelae of
Unfortunately, this only achieved limited Some patients will have very severe
The development of the critical illness aftercare service has been in the forefront traction. In 2015, the Scottish Intensive
critical illness affecting both survivors
ongoing disability following discharge,
and their families. PICS has three key
of the Faculty of Intensive Care Medicine’s strategy and formed a part of Care Society Quality Improvement patient-centred domains at its core
which requires specialist inpatient
Group published guidance making or community-based rehabilitation.
the publication in 2017 of Critical Futures. Life After Critical Illness (LACI) was critical care rehabilitation one of its
that can be impacted upon by critical
Others require a variety of community-
illness: the physical, the cognitive and
deemed to be an important workstream for the Faculty to undertake, working the psychological domains, the latter
based rehabilitation/support
services, including cardiopulmonary
across multiple organisations. affecting both patient and family.
rehabilitation, sports and exercise
The question of who should provide
medicine, psychological, vocational
The aims of the workstream are to: Provisional guidance has been published to support the intensive care aftercare services has
support, etc. All of these services need
a present a UK-wide survey of current practice pandemic and provide a national framework for future stimulated debate about whether it
to be working in coordinated networks
critical illness recovery services. The Life After Critical Illness should be intensivist-led or otherwise.
b provide an outline of existing service models to optimise the care of patients who
Working Party (LACIWP) of the Faculty will now continue its The argument for these services being
c present examples of business cases have been critically ill.
work on their full guidance document, and this will take into provided by intensive care staff is hard
d make recommendations about the future need for account any additional learning from the pandemic. to contest, with numerous benefits for
resources for these programs patients as well as for staff.
Until recently there was little in the literature about what
e outline future research proposals to evaluate existing
happened to survivors of critical illness after they left hospital.
services and outcomes.
In 1989, a King’s Fund report stressed that ‘there is more to
Download the FICM Position Statement and
The multiple organisations involved reflect the requirement life than measuring death’. Following on from this, there were Provisional Guidance at: bit.ly/2Qob36Y
for close collaboration across a spectrum of multidisciplinary several attempts in the UK to establish outpatient follow-up
organisations when exploring the optimal approach to programmes, some of which were successful. However, due
planning and delivering. to a lack of funding and because of the perceived lack of an
18 | | 19Bulletin | Issue 124 | November 2020 Bulletin | Issue 124 | November 2020
Patient perspective
SPOTLIGHT ON
CRITICAL CARE
Pauline Elliott
Lay Representative, FICM
laycomm@rcoa.ac.uk
Imagine that you’re an awake patient or their relative in a critical care unit. Representative on the FICM Board, a straightforward way. They very environment. This helps ensure that
had the idea of creating a multimedia generously offered these to the what the patient wants is always the
You’re in a frightening, alien environment. There are unfamiliar machines. hub for the FICM website. The aim was project. The videos explore different focus of decisions about their care.
Lots of them. They flash. They glow. They display restless neon numbers and to answer some of those challenging themes associated with critical care.
questions people ask about critical care, Importantly they cover rehabilitation
tracings. It’s often noisy. Very noisy. Equipment bleeps continuously. Raucous presenting the information in different and recovery, including the physical and
alarms sound insistently. Staff, dressed in identical scrubs, focus intently formats using everyday language. psychological consequences of critical
care. Each video includes frank narrative
on their patients or huddle around charts and computer screens. They talk I was very pleased to be asked to provide from real critical care patients which is
quietly in an unfamiliar language which seems to consist solely of letters and lay support for Richard’s initiative. Dr deeply moving. Everyone involved in
Will English and Sarah Bean from the critical care should watch those videos;
numbers. Mainly numbers. Royal Cornwall Hospitals NHS Trust also they’re a clear window into the reality of
joined the group. They have considerable life after critical care.
Then there’s a sudden, unexpected burst There were straightforward questions ‘It is really important to not lose sight of
experience of successfully producing
of activity as a new patient is admitted. about everyday activities, like eating who is the focus of our work. We may The hub is live on the FICM website
information for critical care patients and
After 20–30 minutes of toing and froing, and drinking. There were also difficult all have our own views and ideas but, at at: ficm.ac.uk/intensive-care-guide-
their families. Anna Ripley, Education
everything settles down and anxious questions, especially about decision- the end of the day, if this is not what the patients-families-friends. Richard’s
and Standards Manager from FICM, also
patient would want it is irrelevant.’ vision is that it will be expanded and
relatives are shown to the bedside. making. ‘What if I don’t want to be joined us. ICUSteps, a charity working
continually developed to fulfil its
ventilated?’ Who makes decisions I’m the Lay Representative on the FICM with patients and families who have
Most people haven’t experienced this potential as a key information source
about my care when I’m unconscious?’ Board, where I support FICM’s work and experienced critical care, gave invaluable
and hadn’t thought much about critical for patients, their families, and critical
‘Will my family be involved in those particularly help critical care professionals lay feedback on draft materials.
illness beyond hoping it didn’t happen care professionals.
decisions?’ ‘Who decides whether my communicate effectively with patients
to them – until COVID-19 came along. The group decided to work around the
ventilator is switched off?’ and the public. Dr Pittard succinctly sums For most patients and their families,
Then the spotlight was switched on. theme of the patient’s journey in critical
up the value of the lay role: critical care units are strange,
People (and the media) started asking These are extremely challenging care. That became the focus for a series
scary, alien places. Accessible
The hub can be
questions about critical care. They questions for critical care professionals ‘Having someone to represent the of plain English FAQs for critical care
information, produced through accessed at:
patient voice keeps us grounded and on patients and their families.
effective collaboration
wanted to know what it was all about and they have to be answered clearly
the right track.’
between professionals and lay
ficm.ac.uk/intensive-
and what it would be like for them and and openly. As Dr Alison Pittard, Will and Sarah’s work in Cornwall
their families if they became critically ill Dean of the Faculty of Intensive Care When the spotlight turned onto critical representatives, can help people care-guide-patients-
resulted in a series of excellent videos
with COVID-19. Medicine (FICM), says: care, Dr Richard Benson, Trainee offering accessible information in
understand the critical care families-friends
20 | | 21Bulletin | Issue 124 | November 2020 Bulletin | Issue 124 | November 2020
BABY-BOOMERS GENERATION X MILLENNIALS GENERATION Z
Society for Education in Anaesthesia (UK)
Intergenerational differences
and medical education
Dr Janet Barrie
Consultant Anaesthetist, or organisation, and they may value also may need support in critical analysis Of course these descriptions are
Royal Oldham Hospital the chance to make a difference. of information available online. oversimplifications – perhaps to
janet.barrie@pat.nhs.uk They have been entirely raised in the the point of being caricatures. It is
digital era with immediate access to Despite the differences, some common important both to recognise that
information, and dislike uncertainty themes emerge. Both Millennials and people are individuals and to treat
and waiting for situations or answers to Generation Zs may respond better each other as such. Part of this
to learning which is immersive and
A new generation is said to evolve every 20 years or so1 with attributes, emerge. However, their interaction with
interactive and includes visual as well
individuality, however, reflects the
information and reality has changed ‘social, environmental and technological
attitudes and motivations different from preceding and succeeding with the emergence of digital ‘echo as audio input. They appreciate a influences’ 2 on doctors of different
degree of freedom in determining how
generations. They are based on defining historical events and societal trends, chambers’ which reinforce viewpoints
their learning objectives are met. They
generations, and an understanding of
and close down meaningful discussion these differences may help trainers to
rather than strict genealogical generations as such. with little critical analysis or engagement. appreciate feedback, particularly when
better support their trainees.
In addition, they may have an active this is given at, or shortly after, the event
Our anaesthetic department in a large learners may not be optimum for They may therefore respond positively rather than at interim meetings.
digital persona which may or may not References
district general hospital comprises Generation Z, while both may be to teaching which has clear goals and
reflect their true identity. This may lead These differences may be summed 1 Schenarts PJ. Now arriving: surgical trainees
staff from across these generational foreign to their Baby-boomer trainers. timeframes and which aims to develop
to distress if the digital and real personae from Generation Z. Journal of Surgical
boundaries. While the majority of critical thinking skills rather than rote up in attitudes to email. A technique
Education 2019; 77:246-253.
Millennials entered adulthood at or are in tension or if their real life is felt which did not exist when Baby-boomers
consultants are ‘Generation X’ with learning, yet includes a degree of (doi.org/10.1016/j.jsurg.2019.09.004)
around the year 2000. Their view to be less perfect than the online life of entered training is seen by Millennials
birthdates between 1965 and 1985, a freedom in how the learning outcomes 2 Roberts DH, Newman LR, Schwartzstein
of authority has been described as their peers. This may be one factor in and Generation Zs as old-fashioned, RM. Twelve tips for facilitating Millennial’s
few of the older consultants lie in the are achieved.1,2 They have also grown up
‘unimpressed’, and they may need to the increase in depressive symptoms and taking too long, and obsolete! learning. Medical Teacher 2012; 34:274-278.
tail end of the ‘Baby-boomers’ (born with social media and may need a more
be convinced of the value of rules self-harm in Generation Z individuals, 3 Shatto B, Erwin K. Moving on from
1947–1964). Similarly the majority of collaborative, team-based approach to Millennials: preparing for Generation Z.
rather than expected to accept them with increasing numbers seeking help There is virtually no peer-reviewed
anaesthetists in training are ‘Millennials’ learning than earlier generations. Journal of Continuing Education in Nursing
uncritically. This can lead to frustration from mental health services. For this research into this area in medical
(born 1981–1993 or so), but an 2016; 47: 253-254.
in Baby-boomer trainers, who are more The characteristics of Generation Zs as reason, Generation Zs too may need education, and the references
increasing number of foundation and
likely to be rule followers. Millennials are adults are only just being revealed. It is access to support during training.1,3 They given here are just opinion pieces.
core trainees belong to ‘Generation Z’
technologically sophisticated and used predicted that they will have a strong
(born after 1993). Our department is
to immediate access to information, work ethic and be more risk-averse and
probably not atypical, and there is the
which they appreciate being presented traditional than Millennials. They are
potential for generational differences
There is the potential for generational
in an engaging, interactive manner. predicted to be achievement-focused
to lead to misunderstandings. Different
However the legacy of ‘helicopter rather than participation-focused and
generations also prefer to teach and
differences to lead to misunderstandings
parents’ means that they may need to want their careers to have a positive
learn in different ways – which increases
guidance and focus in their learning impact. This may be harnessed to affect
the potential for misunderstandings,
with opportunities for support available. positive change in the department
and techniques preferred by Millennial
22 | | 23You can also read
