RCoA Bulletin

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Design and layout by The Royal College of Anaesthetists

Page 2 | Bulletin 83 | January 2014

ISSN (print): 2040-8846 ISSN (online): 2040-8854

© 2014 Bulletin of The Royal College of AnaesthetistsAll 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.

Fellows, Members and Trainees are asked to send notification of their changes of address direct to the College Membership Department ([email protected]) so that their copy of the Bulletin is not misdirected.

Articles for submission, together with any declaration of interest, should be sent to the Bulletin Editor via email to: [email protected]. All contributions will receive an acknowledgement and the Editor reserves the right to edit articles for reasons of space or clarity.

BULLETINof The Royal College of Anaesthetists

expressed in the Bulletin are solely those of the individual authors, and do not necessarily represent the view of The Royal College of Anaesthetists.

Views & opinions

The Royal College of Anaesthetists is grateful for the contribution to the production of this publication by Laerdal Medical Ltd and Dräger Medical UK Ltd.

The President’s Statement Page 4

Guest Editorial Page 6

Study leave usage by SAS grade staff Page 9

Revalidation for anaesthetists Page 11

Patient Perspective Page 13

The Faculty of Pain Medicine Page 15

The Faculty of Intensive Care Medicine Page 16

NIAA Health Services Research Centre Page 17

Complaint handling – a trainee’s account Page 18

Post-FRCA training: Oxford’s journey Page 21

The evolution of informed consent Page 24

Out of programme training (OOPT) in a developing country – how to do it and why Page 27

The Medical Training Initiative in the UK…the experience of two doctors Page 30

The role of the Bernard Johnson Adviser for the International Programmes Page 33

National recruitment – anaesthesia Page 36

The College Archive Committee – an update Page 40

A strategy for trainee engagement with academic anaesthesia Page 42

Post-CCT fellowships: experiences of a reformed sceptic Page 44

MATCH (Multidisciplinary Action Training in Crises and Human Factors) training for peri-operative teams Page 47

Report of the Senior Fellows Club Page 49

e-Learning Anaesthesia (e-LA) Page 50

As we were Page 52

Report of Council Page 53

Honours, Awards and Prizes Page 55

Programme of events 2014 Page 57

Notices and advertisements Page 66

Consultations Page 66

Please visit the News and Media section of the website for the latest news items at: www.rcoa.ac.uk/news

Download this and back issues of the Bulletin at: www.rcoa.ac.uk/bulletin

Please make your views known to us at: www.rcoa.ac.uk/letters

PresidentDr J-P van Besouw

Vice-PresidentsDr D Nolan Dr L Brennan

Editorial BoardDr N Penfold (Editor)Dr N JoshiDr P J H VennProfessor D J RowbothamDr R MarksDr I GeraghtyDr A KuttlerProfessor M MythenDr J Fazackerley Dr B ShippeyMs S Payne

Mrs M Kelly Website and Publications OfficerMs A Trivedi Communications Officer


Dr Nigel Penfold, Editor

From the EditorIt feels bizarre writing this before my local town of Bury St Edmunds has turned on its christmas lights, knowing that I need to start by wishing all our Fellows and other readers a healthy and productive new year.

2013 brought in much debate and seminal reports regarding the quality of health provision, and one somehow doubts if this topic will fade in 2014. How medical care improves though, depends much on the quality of training and, as I warned in the last edition, I expect the Bulletin and other college communications to feature this topic frequently in 2014 following the release of the Greenaway report Shape of Training. It is the editor’s prerogative to select the ‘guest editorial’ and given the importance of this publication, our view that we needed to make some initial comment and even more importantly the Bulletin publication schedule, I had little choice but to write this myself along with our Director of Training. At least it did ensure that both of us did read every sentence. Unless you are familiar with the report already then I suggest you read the section on ‘Shape’ in the President’s statement first to set the scene. One suggestion in the report is the development of post-CST (yes, not a typo of CCT) credentialing of training. Current post-CCT Fellowships could easily fit this concept, and Dr Ian Fleming expands on the benefit of undertaking such a post.

While ‘Shape’ will determine the future direction for medical training in the UK, (but do not expect major changes before the election in 2015) the College has an important role in developing anaesthetic standards and training throughout the world. I am indebted to Jo James, the RCoA Bernard Johnson Adviser for International Programmes for organising three articles. The Medical Training Initiative (MTI) was commenced in 2009 and replaced the Overseas Doctors Training Scheme, and is one of the few ways in which overseas doctors can access UK training. Jo explains her role the MTI process and also has encouraged two MTI doctors to share their experiences with us. Of note is (unpublished) data regarding the FRCA examination outcomes of MTI doctors, and the success rates are impressive at both parts of the exam. Finally, I direct you to Ben Gupta’s account of his out of programme training in Papua New Guinea and the challenges faced, including having your assessments reviewed by his remote supervisor, Rachael Craven.

As a new initiative I am absolutely delighted to direct you to an article on a topic I am sure you think you know about, but after reading will realise that your knowledge was rather superficial. The Society of Ethics and Law in Medicine has a very strong anaesthetic presence on its committee (just check out their website to see some familiar faces). Honorary Secretary, Kate McCombe has agreed to co-ordinate a series of articles starting with ‘The evolution of informed consent’. If the rest of the series matches this quality, then we are in store for a treat.

Not intentionally following a legal theme in this edition, Andrew Prenter bravely tells us of his experience of having a serious complaint unexpectedly arriving on his doorstep and ultimately leading to a court attendance. This is an experience few would want. Many complaints have ‘human factor’ components and an interesting and innovative training scheme has been developed (MATCH) which links closely to the messages from the Francis and Berwick reports of 2013.

Given that it is ‘CT1 interviews and ST3 application’ time I am sure that many trainees and trainers will look closely at the update of the national recruitment process into UK anaesthesia training and I am grateful for members of the RCoA Recruitment Committee in providing a timely review.

There are more interesting articles of course for you to indulge in during the dark winter nights, or heaven forbid during a ‘free-flap’ or any other ‘quick case’. Happy New Year!


The President’s Statement

our ACSA process, we can ensure that patients receive treatment at the right time, in the right place and by the right people.

Looking after the professionThe management of change and the potential impact of proposed changes to the delivery of healthcare will have repercussions for the profession and how it is perceived as a career option for medical graduates. Whilst seven-day working might appear inevitable to many and is likely to be a key component of the new contract, the consequences of its introduction, though desirable for patient care, will have a profound impact upon anaesthetic departments and intensive care units. Whilst it is true that the current generation of trainees are imbued in the practices of shift working in a 24/7 pattern, the prospect of this as a lifetime commitment – particularly as the age of retirement increases – is of concern particularly if not appropriately recognised or remunerated. There is a real need for us to debate the shape of our future workforce and career progression to match the aspirations and expectations of those within it or seeking to join it. There is a strong desire to see doctors leading clinical teams and managing clinical pathways as outlined in the Future Hospital Commission report from the Royal College of Physicians published in the autumn of 2013. These initiatives are a radical change from the long established patterns of consultant working and require careful consideration with regard to their delivery and impact on our specialty.

assessment of what and where we can deliver best care within a safe and sustainable environment for patients and staff. This will require us to manage both public and professional expectations as to what is deliverable and to challenge governments on undeliverable targets. We should also ensure that we not only appropriately utilise the resources we currently have but also stop waste.

Go with the flowAn essential component in improving efficiency and reducing the waste of resources is to improve patient flow across healthcare barriers. In its broadest sense this involves the integration of primary, secondary and social care services; this is primarily a political aspiration and high on the agenda of all parties across the UK. Within our working environment within the hospital setting we can, however, strive to improve integrated care through cross specialty team working to ensure the effective management of both elective and, more importantly, acute admissions. The initiatives on seven-day working and the involvement of senior staff in the decision-making pathway are actively debated within the media and supported by the College. Anaesthesia, intensive care and pain medicine are key to the management of patients in hospital; in extending our interest into the field of perioperative care and working collaboratively with others we can help make those marginal gains. Furthermore, by setting and reviewing standards for the environment within which that care is delivered through

The Big Issue(s)‘The aggregation of marginal gains’[Sir David Brailsford, Team GB Cycling, Programme Director]

It is of course a tradition of the New Year to resolve to improve one’s life and potentially that of others through a change in attitude and/or behaviour. To that end what should the College resolve to do in 2014 to improve things for our Fellows, Members and patients? Towards the latter end of 2013 we asked Council members to comment upon the The Big Ticket items for 2014. As you can imagine there was quite a diverse list of topics; however, there were a number of issues which found common resonance amongst Council members.

Money, money, money…The number one concern raised was that of financial and fragmentation pressures on health services; how do we ensure that the quality of care in an NHS with reduced finances is effectively maintained? This is of course an immensely complex issue; we must, however be truthful in our

Dr J-P van Besouw President


The President’s Statement

Getting into shapeWhilst the New Year might be the time for resolving to improve one’s physical fitness through dieting, exercise etc, the major issue exercising the College will be assessing how to implement the changes advocated following on from the publication of David Greenaway’s Shape of Training Review. The report sets out a path to train the future medical workforce to meet the changing needs of healthcare provision including the aging population and their abundance of co-morbidities. In advocating a more generalist rather than specialist approach to training it is envisaged that patients may be more effectively treated in a timely fashion. Inevitably, the devil will be in the detail and the implementation against a background of other issues will need careful planning and management. Work streams for consideration by the College will include:

J Collaborative working across specialties, regulators, and commissioners of education to ensure timely delivery.

J Dialogue with the GMC to facilitate the recommendations on transferable competencies.

J The current CCT in Anaesthetics is already a generalist based training programme as was stated in the College’s written evidence; however, we are mindful that there is much work to be done to ensure that the content of the current curriculum truly meets the requirements of the new proposals.

J The recommendation to allow trainees to progress at their own rate, if enacted, will require careful consideration. If this is focused on advance rather than delay then the proposal is sensible. Such a policy may exacerbate dealing with doctors in difficulty.

J Credentialing is very general and more explicit detail on pre/post CST is needed, particularly in respect of the involvement of employers in developing credentials to meet local needs.

J The emphasis on recognising the importance of job planning and appraisal for training purposes is welcomed. The delivery plan must be explicit in ascertaining the importance of job planning and appraisal and the appropriate time allocated for it. Colleges have the experience and professional knowledge to support CPD robustly enough to meet GMC standards.

This green and pleasant landAnother area in which anaesthesia should be making progress is in developing pathways to a clean and sustainable healthcare environment. Tom Pierce from Southampton has been leading College policy in this area. At a recent conference on the issue (www.cleanmedeurope.org) a number of avenues for future endeavours were identified and will be published in the route-map to sustainable health early in 2014. Topics under active consideration include:

J Reducing energy consumption associated with medical equipment and air handling.

J Publication of trust specific data on the use of medical gases.

J Collaboration with industry on production, distribution, packaging and disposal of single use devices.

Failure is the key to success?2013 was a year categorised by the exposure of the failure of healthcare delivery resulting in harm to patients. 2014 must therefore be the year to learn from those mistakes and to make those changes necessary to deliver the best

levels of care we can; this will require a reconfiguration of many aspects of what we do including the way we work, how we work and where we work.


Guest Editorial

How will we shape up?

The final report into the structure of medical training, Shape of Training: securing the future of excellent patient care1 was released on the 29 October 2013. This independent review, chaired by leading economist and Vice-Chancellor of Nottingham University, Professor David Greenaway, consulted widely including taking evidence from this College.2 The review followed on from Tooke’s enquiry in 2007 into Modernising Medical Careers, Aspiring to Excellence,3 and its main thrust is to ensure the training of doctors to be fit to practice in the UK, are able to meet patient and service needs and provide safe and high quality care given the changing demographics in this country. A previous Bulletin article4 gives background behind the commissioning of this review by the Academy of Medical Royal Colleges (AoMRC), the General Medical Council (GMC), the Medical Schools Council, Health Education England, NHS Scotland, NHS Wales Northern Ireland Department of Health and the Conference of Postgraduate Medical Deans (COPMeD).

The report has five main themes:

1 Patient needs drive how we must train doctors in the future

2 Changing the balance between generalists and specialists

3 A broader approach to postgraduate training

4 Tension between service and training

5 More flexibility in training

Key messagesThe report sets out a framework for delivering change to meet its objectives, recognising the need for minimum disruption to service, offering an approach to reach highest standards of training and meet changing patient needs into the future. Its sets out 19 recommendations within a timeline that many feel is challenging to say the least. Within the key messages are that patients and the public need more doctors who are capable of providing general care in broad specialties across a range of different settings. This is necessary due to the increasing number of people with significant multiple co-morbidities, an ageing population, health inequalities and patient expectations. However, of course there continues to be a requirement for specialists but numbers will be based on local patient and workforce needs. The report emphasises that these needs should drive training opportunities in specialties and bring into focus the concept of ‘credentialing’ in specific areas of practice. The report highlights

the requirements of flexibility in training across general areas of broad specialties. It aspires to ensure that Medicine remains a sustainable career with opportunities to change roles and specialties throughout doctors’ careers. It is without argument that academic training pathways are necessary for the advancement of patient care. Those wishing to be the academics of the future will need a training structure flexible enough to allow movement in and out of clinical training, but of course being able meeting the competencies and standards required in that branch of medicine.

Initial responsesRoyal colleges and the AoMRC among other organisations have in general welcomed the report and then added caveats to their comments, and are easy to find on the respective websites. A recurring theme is the lack of detail of the proposed training structure, but that is clearly intentional at this stage since the report runs to just 57 pages (with a longer appendix), since recommendation 19 is to set up a UK wide ‘delivery group’. One suspects that the name may change to a ‘steering group’ given the number of stakeholders that must engage to produce workable programmes. The membership of this group has not been released yet, but it is probably fair to assume that the sponsoring bodies will have representation and one hopes that the GMC and AoMRC will have an over-arching perspective of the requirements for patient care and

Dr N Penfold1 and Mr R Bryant2

Chair of the Training Committee, RCoA1 and Director of Training and Examinations, RCoA2


Guest Editorial

excellent training in secondary and community care. One also assumes that bodies such as the BMA and NHS employers will be involved.

‘Shape’ sets out principles and ideas, and as always the devil will be in the detail. However before this the report can be actioned it requires endorsement by the four Departments of Health and this process may well have occurred by the time you read this. National endorsement by the respective Departments of Health is likely to be supportive of the concepts but non-committal towards ‘delivery’ at this early stage, especially as no financial analysis has occurred as yet. Many of the recommendations will necessitate cross-specialty and cross-process collaboration, and it is unlikely to be an easy path to tread. Implementation of the recommendations will need careful planning on a UK wide basis and phased in a non-disruptive way. This transition period will allow the stability of the overall system to be maintained while reforms are being made. Trainers know that moving to a new curriculum is never as easy as planned but this may pail into insignificance given the magnitude of the proposed reforms.

What are the recommendations?Early yearsSome recommendations are easy to grasp, others more generic and generate a multitude of questions. One of the clearest begins early in medical training and is that full registration with the GMC should move to the point of graduation. This will mean that measures are in place to demonstrate that medical students are fit to practice on graduation. Patients’ interests must be considered first and foremost as part of this change, and the patient safety theme, quite rightly, flows through the report. Given that universities do

deliver the GMC curriculum in different ways, one suspects that ensuring medical students are fit for purpose on graduation may be challenging. In addition, this change might lead to some graduates moving abroad immediately since they will have full registration, and will allow EU doctors access to the Foundation programme. A consequence may be that it provides an answer to the current problem of inadequate numbers of foundation posts for UK graduates necessary to allow full registration. Some colleges have expressed concern at this plan, but this should have little impact on anaesthesia given the paucity of F1 posts in ICM or anaesthesia, despite their immense popularity.

The Foundation programme seems set to remain two years duration, but the report does mention the possibility of the second year being absorbed into the main tenant of ‘Shape’, specialty ‘broad-based’ training. Of merit is the statement that attachments will be of longer duration (four to six months at least) to development of team working, which some trainee groups have welcomed.

Broad-based trainingThe major change is after Foundation where the need is for doctors to be able to manage acute patient care across the broad base of that particular specialty. The focus is on creating more flexible, multi-disciplinary broad-based approach to training. After four to six years training (plus one year in a related specialty) trainees will reach the point of independent practice and attain a Certificate of Specialty Training (CST). This is welcome since the current CCT implies that training is complete, the clue being in the title ‘Certificate of Completion of Training’, which given the need for life long learning is clearly inaccurate. In addition it is clear that there is no talk of sub-consultant grades. However there are in excess

of 60 current specialties, 78 CCT programmes, of which 29 are in the ‘physician’ specialties, all the training patterns effectively run in silos with little cross connections. How these will be amalgamated into the patient care themes is unclear and the decision on which specialties a might amalgamate will be contentious and fraught with challenge. ‘Shape’ identifies three such themes (woman’s health, child health and mental health) and currently does not identify the others, although it is rumoured that the number will just reach double figures. Where and how anaesthesia, pain medicine and intensive care will fit in is unclear. (Maybe having a single CCT here is an advantage?) What is unlikely is that a one-size fits all approach to specialty amalgamation will work to deliver the ‘themes’. Maybe an ‘acute care’ theme will emerge during the ‘delivery or steering group’ phase? Again there is an opportunity to promote the concept of ‘perioperative medicine’, potentially a theme in itself, which could and probably should be delivered by ‘anaesthesia’.

Just how the concept of broad-based training will impinge on anaesthesia is uncertain. Will all trainees undertake something akin to ACCS before moving into a general CST in anaesthesia, and if so how long would each stage take? Clearly there will be need for our Faculties of Intensive Care Medicine and Pain Medicine to have input into the necessary training of these future specialists. The only mention of anaesthesia in the report (p53) states that ‘general specialties (like anaesthesia) and the craft specialties may need longer to develop the necessary technical knowledge, skills and experiences’. However this will still be within the four to six year envelope, but the report then states that the specific duration of training for different


Guest Editorial

specialties will have to be developed by the UK wide delivery group. Our reading of this is that colleges will need to be heavily involved in the planning of each CST programme, and that ‘Shape’ cannot be prescriptive at this moment across the whole of medicine.

The concept of broad-based training has obvious merit in the development of future doctors to care for the acutely ill with medical and surgical problems coupled with multiple co-morbidities. The balance of acute physicians to ‘ologists’ may have gone too far in a direction that has threatened the delivery of appropriate care to the majority of acute admissions in a timely manner. ‘Shape’ may be aimed at this group in particular since this report proposes to produce doctors to work in the general area of their broad specialty, recognising the need for some specialists. Furthermore it may address the flexibility needed in the future workforce and provide better value for money.

Credentialing and transferable competenciesCredentialing is brought clearly into focus in the report and is explicitly post CST. Thus it is not time-linked to the training pathway implying that it may be entered at any stage during a consultant career. There will be employer-involvement in how such posts are devised and presumably funded and their duration and maybe content. There is a real threat to the delivery and quality assurance of approved programmes from university and other providers.

Furthermore it is sensible for there to be UK-wide control of numbers to produce enough of the right specialists for the NHS, despite comments of local workforce needs determining posts. What we do know is that the GMC is already working on credentialing which will include the ability to

formally recognise specialist training via means other than CESR/CCT.

Will our advanced training modules become post-CST credentialed? What impact will this have on say intensive care or pain medicine? Perhaps the obvious part of our curriculum to move would be pre-hospital emergency medicine (PHEM) whose year of training could easily be ‘credentialed’. Assuming proper quality assurance of the posts it would fit neatly with the current post-CCT Fellowships (in say cardiac anaesthesia) that abound and appear necessary for consultant appointment.

‘Shape’ emphasises the need for flexibility and the need to allow doctors to move between specialties according to local needs. This would require the concept of transferable competencies, which we support, allowing easier movement between specialties without restarting at CT1, and thus cost effective but which needs a light touch by the regulator.

Selected highlightsIn several sections ‘Shape’ confirms that the delivery of training in both the community and hospital settings will be limited to locations providing high quality training and supervision, presumably by GMC approval. This is to be applauded, but implies that not all locations will have future trainees, a situation familiar in Europe. Maybe departments should seriously consider engagement with ACSA to help their case to retain trainees? Recommendation 7 allows trainees to progress at their own rate will require careful consideration. If focused on advance rather than delay then the proposal is sensible, but such a policy may exacerbate dealing with doctors in difficulty. Our current benchmarking at stages of training (Basic and Intermediate Level Training Certificates) are important gateways for progression and need

preserving. Perhaps surprisingly given the feminization of the workforce, LTFT training is not mentioned.

Next steps‘Shape’ was commissioned by major organisations in medical training and thus it is unlikely to remain on a ‘shelf’, but significant work and collaboration will be needed for implementation. As a start each specialty may need to ask itself (and no doubt other questions):

J What in your specialty should others know and be able to do?

J What generalist knowledge is needed in my specialty to be a day one consultant?

J What in the curriculum could be credentialed?

Absence of a realistic delivery timeline and any financial modeling are just two areas that need debate. ‘Shape’ does fit into the concepts of the RCP report on Future Hospital Commission5 and the AoMRC work on seven-day services.6

Taking on the Chair and Directorship of the Training Committee at the current time may not have been such a great idea at all!

References1 Shape of Training: securing the

future of excellent patient care. Shape ofTraining (www.shapeoftraining.co.uk/reviewsofar/1788.asp).

2 Shape of Training – review questions. RCoA (www.rcoa.ac.uk/node/14880).

3 Tooke J. Aspiring to Excellence: Findings and Final Recommendations of the Independent Inquiry into Modernising Medical Careers, London, 2008.

4 Shape of Training Review: the anaesthetic perspective. Bulletin 2013;79:36 (www.rcoa.ac.uk/node/12850).

5 Future hospital: caring for medical patients. Royal College of Physicians (www.rcplondon.ac.uk/press-releases/care-comes-patient-future-hospital).

6 Seven day consultant present care (www.aomrc.org.uk/publications/reports-a-guidance.html).


BackgroundSAS and consultant grade staff have a contractual entitlement to take up to 30 days' study leave in a three-year period. This may be noted to be on average an entitlement to ten days per year, but can be used flexibly. A survey by the British Medical Association (BMA) on SAS Doctors' Experience of Training and Appraisal1 looked at the amount of study leave taken. The response rate for that survey was 6.4%. Respondents took an average of 6.3 days' study leave in the year 2011, which was fully funded for 63% of SAS grade staff. It is to be noted that this is a low response rate compared with other surveys which have been undertaken. A survey of UK consultants in 2010 by the BMA,2 which had a response rate of 27.5%, found that respondents took an average of 6.6 days of study leave per year. A survey carried out jointly by the Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) looking into SAS concerns within their careers was reported by Alladi3 in 2010. The exact response rate was not noted, but responses were received from 431 SAS grade staff, with there being an estimated 2,000 SAS grade anaesthetists within the SAS, which would equate to a response rate of about 21.5%. This RCoA/AAGBI survey did not look at amount of study leave taken, but did note that 84% of respondents did not have problems in taking study leave. As employing trusts set the level of funding for study leave re-imbursement there is no indication of the order of funding provided.

As part of a project looking at both SAS career development funding use and study leave, SAS grade staff were asked about their use of study leave, including number of days, and level of expenses covered. The study was undertaken using a web-based survey of SAS grade staff in the East Midlands Deanery. This cluster sample had demographics which match that of the SAS group in England. Ethics approval was granted by both the University of Dundee, since the author was undertaking the study as part of an MSc in Medical Education, and by the local Research and Development Committee.

ResultsThere were 124 respondents out of a potential 694 SAS grade staff, being a response rate of 17.9%. One hundred

and fourteen of the 124 respondents had taken study leave in the previous 12 months, being 91.9% of the group.

For the 114 who had taken study leave, the amount taken was variable, ranging from 1–30 days. The most common amount of study leave taken by any individual was jointly four days and ten days with 14.0% of respondents taking this amount. Ninety-eight percent of respondents took 16 days or less, with the remaining 1.8% taking 30 days. The mean amount of leave taken was 6.9 days. See Figure 1.

Ninety-six (77.4%) respondents were aware that they have an annual study leave budget, with 4.8% stating they did not have an annual budget, and 17.7% indicating they did not know whether they did or not.

SAS and Specialty Doctors [email protected] www.rcoa.ac.uk/sas

Dr A Mowat, Associate Specialist and SAS Tutor, Anaesthesia, Pilgrim Hospital, United Lincolnshire Hospitals Trust Dr S Schofield, Lecturer, Centre for Medical Education, University of Dundee

Study leave usage by SAS grade staff

0

2

4

6

8

10

12

14

16

302928272625242322212019181716151413121110987654321

Figure 1 Number of days of study leave taken in previous 12 months (%)

Days of study leave taken in last 12 months (%)


SAS and Specialty Doctors [email protected] www.rcoa.ac.uk/sas

Of the 96 respondents who were aware of the presence of a study leave budget, 79 (82.3%) were aware of the amount of study leave budget to which they are entitled, though the financial amount provided by employing Trusts varied; see Figure 2. The largest group, comprising 42 respondents (43.8%), indicated their annual budget was between £751–1,000.

DiscussionThere have been no studies looking at levels of study leave expenses provision, and little information about the level of uptake of study leave time. The requirement to keep up to date for appraisal and revalidation means that all medical staff should be utilising study leave. It is very positive that 91.9% of SAS respondents had taken some study leave.

The BMA survey of SAS grade staff in the UK about Experience of Training and Appraisal1 showed that on average 6.3 days of study leave were taken by individuals in 2011. The BMA survey of consultants in 20102 showed an average of 6.6 days were taken by consultants. The average amount within this survey

is 6.9 days in the previous 12 months. As the entitlement is for 30 days in a three year period, it is expected that there will be some variation in amount taken between years, but it is of note that there is a similar order of utilisation. There were three outliers in this study who had taken 30 days within the last year, as they were undertaking secondments to other departments.

Pleasingly, 77.4% were aware they did have an annual study leave budget, although 17.7% of these were not aware of the amount entailed. Forty-four percent indicated their annual budget was between £751 and £1,000 per year. Over 40% had utilised their entire annual budget, but the results did not indicate whether this was by respondents with a lower level of annual budget which would be more easily exceeded.

The good uptake of study leave indicates that staff recognise the ongoing need to undertake continuing professional development, especially in the light of revalidation.

Authors and source: Dr Mowat is the sole author of a Dissertation for a Masters in Medical Education used as the source of the article, and is the sole author of the submitted article. Dr Schofield was involved in the design of the study, and has critiqued and approved the final version of the dissertation and the article.

FundingNone.

References1 BMA Survey of SAS Doctors’

Experience of Training and Appraisal. BMA, London 2012. (https://bma.org.uk/search?query=SAS%20doctors%20experience%20of%20training%20and%20appraisal) (accessed 18/09/13).

2 BMA survey of the consultant contract in a changing NHS. Health Policy and Economic Research Unit. London. BMA, London, 2010 (https://bma.org.uk/search?query=Survey%20of%20consultant%20contract%20in%20a%20changing%20NHS) (accessed 18/09/13).

3 Alladi VR. AS Survey. Anaesthesia News 2010;276:20–23.

0

5

10

15

20

25

30

35

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45

50

Don't know£1,001+£751–1,000£501–750£251–500£0–250

9%

2.1%

43.8%

15.6%

11.5%

17.7%

Figure 2 Annual study leave budget (% respondents)

Annual study leave budget (% respondents)


Revalidation for Anaesthetists [email protected] www.rcoa.ac.uk/revalidation

One year ago, in an article in the January 2013 edition of the Bulletin, we described how the College CPD online system is a ‘one stop’ solution to support consultant and career grade doctors in planning and recording their educational and professional development activities.1 Access to the system is a member benefit available free of charge to all subscribing Fellows and Members of the College.

In January 2013 the system had 3,800 registered users and now, 12 months later, the number of registered users is in excess of 6,000. There has also been a very noticeable recent trend in doctors who requested an account several months ago now asking for a password reminder so that they can start using the system on a regular basis. Comments reveal this is a direct result of these doctors having received their revalidation date and realising the benefits of using this resource.

One key feature of the CPD online system is the database of approved CPD courses and events. Making reference again to the article from the January 2013 edition of the Bulletin, at that time the system included details of over 650 past and future approved events. Now, 12 months later, there are over 1,600 such approved events in the system.

The College is always responsive to the needs of Fellows and Members, and that the requirements of over 6,000 registered users of the CPD online system continue to be best reflected. To ensure this, the College Revalidation and CPD Team maintains a programme of continuous enhancement to the system. This article describes the recent

Mr C Kennedy

CPD and Revalidation Administrator

RCoA CPD online system – 12 months later

enhancements which have been made as well as some of the planned future developments. The College publishes an annual review of the CPD scheme and so this article also details some of the measures which are used to quality assure the process for approving events.

Enhancements made to the CPD online systemFollowing the successful launch of a PDF function, allowing users to report and reflect upon their completed CPD activities, the same functionality has now been implemented for a doctor’s personal development plan (PDP). Users of the CPD online system can set up a PDP following their appraisal, when their objectives have been identified, and during the course of the year these can be linked to personal activities completed, as well as attendance at College-approved CPD events. Details of all the linked CPD activities will then be included in the PDF report of the personal development plan.

The personal activity categories listed in the CPD online system were expanded to include ‘clinical governance’ and ‘developing clinical policies’ whilst, in response to Fellow and Member requests, the user guide and system FAQs, available in the Revalidation and CPD section of the College website, were also fully expanded and updated.

One important component of the CPD online system is the opportunity to link activities with the CPD Matrix – a resource to guide appraisal discussions around future CPD activities. For College-approved CPD events the CPD Matrix codes are assigned

automatically by the event provider and validated as part of the review process, whilst attendance at local clinical governance meetings and other events, and other personal activities such as reading and e-learning, can be easily added by the user so as to ensure a complete CPD record.

Six new CPD Matrix codes have been added to the CPD online system to help users more accurately record, describe and reflect upon their completed activities. Three of these codes, ‘Ophthalmic’, ‘Bariatric’ and ‘Military anaesthesia’ had previously come under the ‘Other clinical’ category, whilst three additions under the previous ‘Other non-clinical’ category have been ‘IT skills’, ‘Education and training’ and ‘Research’.

Planned future enhancementsThe introduction of a mobile enhanced version (‘app’) of the CPD online system has been a very popular request received from Fellows and Members. With a general trend towards access of web-based resources via mobile devices, the College has been working to develop a version of the system that can be accessed from a variety of phones and handheld/tablet computers.

This will enable the recording of CPD activity details – particularly reflection on how the completed learning can influence practice, and any further learning needs – ‘on-the-go’, such as on the train journey home, and the information will be uploaded into the user’s system account immediately and automatically when their device is back online.


Revalidation for Anaesthetists [email protected] www.rcoa.ac.uk/revalidation

The College Revalidation and CPD Team is currently exploring how the PDF functionality, available for reporting and reflecting upon completed CPD activities and for setting up a PDP, might be extended to report on which codes have been covered from the CPD Matrix during these activities. The Team will also be consulting with Fellows and Members about how the CPD online system might be enhanced so as to provide one single repository for all the supporting information required for revalidation.

Quality assurance: the CPD approval processThe College has a very well utilised process for the CPD approval of courses and events and the number of applications received during 2013 increased dramatically on the previous 12 months. This service is free to trusts/boards and specialist societies, and all approved events appear in the CPD online system and on the College website.

All event providers seeking CPD approval submit key information including the learning outcomes, the teaching methods which are going to be used, details of the faculty experience, and copies of the event programme and the delegate evaluation form.

The event information is reviewed by one from 69 specialist CPD assessors, including representatives from the CPD Board, who also give consideration to the appropriateness of any CPD Matrix categories which the event provider has used to underpin the programme content, before making a recommendation. As a result of specialist assessor input it is not uncommon for CPD approval to be dependent on further information being supplied by the event provider such as clarification on the faculty’s

experience or a request for more detailed learning outcomes.

As a key feature of the rigorous quality assurance process, the College Revalidation and CPD Team produces an annual report, an important component of which is a sample of the delegate feedback from many of the providers of CPD-approved events. This is done to ensure that the CPD awards are appropriate, and the process includes exploring any remedial action taken as a result of the evaluation process, as well as identifying shared good practice.

Data produced on how many times each of the codes from the CPD Matrix have been covered by approved events during the previous 12 months, to provide guidance for event providers on possible future provision.

The report includes information on the event reviews completed by the CPD assessors including the reasons why further information has been requested

from event providers, or why, in some cases, events have been declined for CPD credit approval.

The report also details the time taken for the reviews to be completed and whilst the Academy of Medical Royal Colleges1 says that an application for CPD approval should normally be made at least eight weeks prior to the event, the majority of reviews by the College CPD assessors were completed within a three-week timeframe. The College is very grateful for their support and expertise in this important role.

For further information about the CPD online system or the quality assurance report, please contact [email protected].

References1 Liu D, Kennedy C. RCoA online CPD

system – an evolving resource to support revalidation. RCoA Bulletin 2013;77:29–30.

2 Standards and Criteria for CPD Activities, A Framework for Accreditation. AoMRC, 2012.

CPD WEBCAST OF THE MONTH

The RCoA will release a monthly webcast with associated material to assist you in covering topics for revalidation.

January 2014

Anaphalyxis (1B01)CPD Study Days 2012: Anaphylaxis

Nigel Harper

To view the webcast, including additional educational material associated with the topic of Anaphalyxis and to record the time spent on CPD of the month:

Log into e-LA http://portal.e-lfh.org.uk

OR

You can view the webcast and manually log your CPD credits:

View the webcast www.rcoa.ac.uk/webcasts

Log your CPD credits www.cpd.rcoa.ac.uk/login

www.rcoa.ac.uk/webcastsWEBCASTSRCoA


Patient Perspective [email protected] www.rcoa.ac.uk/plg

Mr A Naughton, Patient Liaison Group

Careless talk saves lives

I come from a professional flying background where the safety culture is generally uninhibited and transparent, but I must say that I found the safety culture in the NHS, particularly in terms of event reporting, somewhat of a challenge to understand. It seems to have many residences, devoid of interconnection and indeed it may be that the whole is actually less than the sum of its parts. Much of this, I suppose, must be a consequence of the bewildering fragmentation of the service itself – an important part of initiation for new lay members is exposure to the dimensionless world of acronyms. The NHS Confederation ‘acronym buster’ site has over 600 commonly used acronyms. MHRA/MRSA – which is the infection? Or does it depend on your point of view? Perhaps because of the multiplicity of agencies, there doesn’t seem to be a central core with universal access, through which information and experience can be shared. Prevention is, of course, better than cure and dissemination of other people’s experiences is fundamental to the prevention process.

You might say that aviation events can be so spectacularly awful that glaring public scrutiny is necessarily unavoidable and that, therefore, the industry cannot claim to have any special safety expertise. This would be neither fair nor true. Forensic examination of tragedies is completed with the greatest urgency and rectification imposed regardless of commercial consequences, but the astonishing infrequency of major accidents to British airliners indicates the effectiveness of the industry’s

attitude to safety at all levels and, importantly, its co-ordinated nature. In a sense safety is negatively rewarding, in that its success is retrospective and statistical; you can’t identify the people you didn’t kill, but its triumph is not just in avoiding repetition of disasters. The pinnacle, which is its safety record, is supported by an enormous pyramid of information exchange provided by participants who do not look over their shoulders in fear of disciplinary consequences. Obviously, in cases such as gross negligence admission is not absolution, but the general picture is pretty much entirely positive. Aviation did not learn from some innate cleverness, but of necessity borne out of tragic human cost. The point is, others can get the lessons for free.

‘Never Events’ are interesting constructions:

‘So, never events are events that never happen?’

‘Well, er, no they do happen, but not very often.’

‘So if they do happen, why call them never events?’

‘Because they really, really shouldn’t happen at all, not ever, never.’

‘But they do happen. So why not call them Events That Really, Really Shouldn’t Happen At All, Not Ever, Never?’

‘Wouldn’t that be a rather ponderous title?’

‘Indeed, but wouldn’t it have a greater veracity? Events that never happen but do happen seem to have a duality worthy of Schrödinger’s Cat.’

‘That’s an absurd comparison however,

if the cat turned out to be dead that would be a vindicating never event and someone would have to answer for it.’

‘Don’t you think that a "never" event is unachievable and that, for staff, the expression itself is mildly threatening?’

‘No.’

‘So you can’t imagine, for example, a senior manager in a trust in England threatening staff with the immediate institution of disciplinary procedures should a never event occur?'

‘Unthinkable.’

‘You think so? Well I never.’

When an incident occurs in which a patient is harmed, the principal concern is naturally for the patient, but for the staff the effect must be devastating, so their welfare is also of paramount importance. The envelope of protection that an effective safety culture provides is equally beneficial to staff and patients, not just as harm has been minimised, but as the enhancement of a fulfilling, professional working environment. The construction of such a culture involves everyone. To refer to aviation for a moment, safety involves check-in staff, security personnel, baggage handlers, fuellers, engineers, airline management and so on, each with their incremental contribution, often quite subtle in safety terms but all having their ‘Swiss Cheese’ hole. This is, of course, the model where individual events or errors are compared to the holes in slices of Swiss cheese. If the holes line up, a clear and dangerous pathway is formed. If it requires a hundred events to lead to an accident and you had


Patient Perspective [email protected] www.rcoa.ac.uk/plg

individuals may feel more comfortable in some circumstances. The anonymised reports are published and they are an interesting and valuable addition.

It happens that, the day I wrote this article, consideration is being given to the use of cameras in inspections of care homes. I believe some trusts are considering siting cameras in wards. There may be issues with hidden cameras, but I can see no reason for concern in their open use in hospitals (with consideration for patient dignity). Aircraft have cockpit voice recorders and flight data recorders which, as you know, are remarkably better than pilots at surviving crashes. Their ability to determine what really happened is priceless. Flight crews are entirely comfortable with them and do not alter their behaviour because of their presence. I see no reason why they should not be widely used in hospitals. Recording does not need to be monitored, but stored under agreed protocols for the protection of all.

I haven’t specifically mentioned human factors as it’s outside the scope of the article and it is a big subject, but a very rich seam to be mined. There is a great deal of expertise and experience available and the potential benefits are enormous. This article is intended simply as a suggestion that an uninhibited and freely accessible incident reporting system works and diminishes the risk by sharing experiences. As far as I know, incident data in the NHS tend to be centrally held to determine trends, or remain within trusts. Spreading the word enhances safety. We need an open reporting system. Careless talk saves lives.

down until the facts are known, but is it acceptable that years may go by while litigation grinds and the truth is obscured? I mean that the priority is to avoid a repetition; the harm is done. I don’t wish to walk into the minefield of a ‘no blame’ compensation culture, but it might be worth a thought. Away from the catastrophic cases, there is enormous safety value in incident reporting where those reports are widely accessible. Recalling the Swiss Cheese model, even apparently minor reports can prevent major incidents by moving one of the cheese holes out of alignment and interrupting the sequence. Other people’s experiences are invaluable and can alert you to unrecognised hazards – ‘That could have happened to me’ or ‘I never thought of that.’ Experience and competence don’t protect us from mistakes or pits we didn’t know we could fall into.

Some years ago I remember a report by the captain of a helicopter which had landed on an oil platform. As he got out of his seat, with engines and rotors running, the sleeve of his jumper caught on the collective pitch lever – in simple terms the up and down lever – and raised it. There was another pilot at the controls but the lever rose, increasing power and briefly risking the aircraft getting airborne with personnel on the deck. The lever was immediately lowered, no harm was caused and when I first read the report I wondered why he had bothered to file it, but he was right and I was jolly careful with my jumper sleeves from then on. It seems such a minor incident, but it is this sort of incident reporting that can really enhance safety. Some incidents require mandatory reporting to the Civil Aviation Authority, clearly serious ones, but there is also a national anonymous reporting system called ‘Chirp’, where

ninety nine, you’d go home thinking you’d had a normal day. As I said earlier, the rewards of safety are not obvious day to day, but the satisfaction of working safely and well is what makes us want to carry on, and the protection of the health and safety of other human beings is the most sacred trust by ‘trust’ I don’t necessarily mean your employer!) in our professions.

The diverse structure of the NHS would seem to make the maintenance of an open and interactive safety culture difficult to achieve. As far as I can see, different trusts or organisations have different safety policies and procedures, which are not necessarily shared with others. There does also seem to be a very defensive culture where secrecy can dominate for fear of litigation and where fault must never be acknowledged. This is unhealthy as, I suggest, it is an impediment to safety rather than an enhancement. No one is going to be comfortable admitting fault, but it is a responsibility not to be evaded if there was genuine risk of harm. That acknowledgement is going to be so much easier if the organisation’s culture is progressive and understanding, rather than oppressive and judgemental. In British airlines, flight safety officers will have a direct and unimpeded line to the director of flight operations. Their voice will be heard and my experience has been that they will be approachable, independent and balanced. The appointment is, therefore, a critical one, as they must have the trust and respect of crews and management alike. It does work.

I called this article ‘Careless talk saves lives’ because, unlike a wartime situation where secrecy saves lives, the opposite is true in our working environments. If a medical event is catastrophic one can understand the instinct (lawyers may say, need) to close


[email protected] www.fpm.ac.uk

Dr K Grady, Dean

News from the FPM

The Shape of Training review was published on 29 October. We now await the response of the Sponsoring Board as to how and to what extent implementation is to be considered. The Faculty of Pain Medicine are affirmed that skilled pain management across inpatient and outpatient settings requires the input of those qualified in Pain Medicine to include assessment of complex cases, comprehensive understanding of physiological and pharmacological processes, identification of psychological drivers and the provision of skilled interventions for long term pain problems. The need to deliver this will be ongoing.

The Faculty will work with the College, the Shape of Training Sponsoring Board, the national training boards and the Academy of the Royal Medical Colleges to ensure that the practice of Pain Medicine continues to flourish and those caring for patients with unresolved or complex pain are appropriately qualified and trained.

As anaesthetists we may have sensed a wave of problematic opioid intake in the patients presenting to us. This was highlighted in Dr Cathy Stannard’s BMJ article of 24-31 August in which she describes worrying features of opioid taking in the USA. Prescribing of opioids for the management of non cancer pain has also increased in the last decade in the UK but tramadol prescribing has increased at a much faster rate than other drugs in this category. As a potent opioid treatment its relative benefits and risks need to be carefully considered, particularly in the face of a progressive rise in tramadol related

deaths in the UK. We are also aware of this risk posed to individuals of non medical use. The Faculty have responded to a consultation which seeks views on the Advisory Council on the Misuse of Drugs recommendation to place tramadol in Schedule 3 of the Misuse of Drugs Regulations 2001. We have supported the placing of tramadol in Schedule 3 which brings it in line with other strong opioids, with regard to prescription writing and storage. The outcome of the consultation is awaited however.

With further regard to opioids, and to other drugs used as analgesics, the Faculty has submitted a response to the Department of Transport on drugs and driving in which we have recommended zero tolerance of some substances such as ketamine and sativex and recommended limits for other drugs. We have highlighted an inconsistency in that only morphine, of the strong opioid class can be readily measured and this may result in diversion to other strong opioid both for legitimate medical intake and for illicit intake. We have upheld our responsibility to patients whist considering our responsibility to the public in taking this decision. The outcome of the consultation is awaited.

We are conscious of the evolving changing nature of the clinical role of the large number of Acute Pain Medicine specialists who are Fellows of the Faculty. The Faculty needs to give thought and planning in this regard. To this end we have co-opted Dr Mark Rockett, an acute pain medicine clinician to the Board and to the Training and Assessment Committee.

Mark has an established track record within the Faculty as an FFPMRCA examiner and writer of both science and MCQ questions. On the Faculty’s behalf he will become a member of the College’s newly formed peri-operative medicine working group, an area in which Pain Medicine will have a big role to play and a significant contribution to make.

In October the Pain Medicine section opened the RCoA’s Jubilee celebration meeting ‘Rising Stars in Anaesthesia, Pain Medicine and Critical Care’. Presentations were delivered by Drs Sibtain Anwar, Chris Green and Roman Cregg on the subjects of ‘Mechanisms and prevention of persistent post surgical pain’, ‘Neuropathic pain in the per-operative period and ‘Do we need new drugs or new receptors?’ The skill and work of these clinical academics in translating and presenting their research findings to an audience from both Pain Medicine and Anaesthesia certainly made them well deserving of the title ‘Rising Stars’ and has brought them to the fore as valuable assets to Pain Medicine.


[email protected] www.ficm.ac.uk

An overview of the Standards Strategy

Since March 2012, the Professional Standards Committee of the Faculty and the Standards, Safety and Quality Committee of the Intensive Care Society have combined to produce a Joint Standards Committee. This committee meets four times per year and is chaired jointly by myself and Dr Chris Danbury (ICS).

The joint committee undertakes joint projects in relation to the area of professional standards, including areas such as peer review and interaction with the National Clinical Reference Group (NCRG) for Adult Critical Care.

We discussed merging the old Critical Care chapter of the 'General Provision of Anaesthetic Services' and the Society’s 1997 publication, 'Standards for Intensive Care Units', into a new up-to-date service provision document for intensive care medicine. This work was swiftly paralleled in commissioning with the development of the Service Specification for the specialty.

Two strands of work have been since developed.

Core Standards for Intensive Care UnitsThe purpose of these standards was to provide a professional resource which could be used to underpin the NCRG’s Service Specification to inform commissioning. The initial work led by Dr Chris Danbury and Dr Tim Gould was completed in time for use this year by the NCRG. Support for the work has also broadened with the emergence of the Critical Care Leadership Forum (CCLF). The CCLF is a national and multi-professional

Dr C Waldmann Vice-Dean FICM

The Faculty ofIntensive Care Medicine

forum of the major stakeholder organisations in critical care created out of the Collaborating for Quality project. Professor Julian Bion has been appointed the first Chair of this Forum and he is ably supported by the election of a Deputy Chair, Dr Brian Cook, of the Scottish Intensive Care Society Audit Group.

The Service Specification lists the core standards of the critical care environment and the standards should either have strong evidence or strong professional support; preferably both. Of these standards, trusts may derogate from five of the standards. These standards need to be measurable such that the metrics can contribute to public domain specialty-specific dashboards.

General Provision of Intensive Care Services (GPICS)Core Standards for Intensive Care Units is not meant to just be a destination but a starting point. The joint committee is now embarking on a longer-term initiative, with input from all other organisations involved in intensive care medicine. This will develop into a General Provision of Intensive Care Services document, analogous to that published by the Royal College of Anaesthetists and other standards documents published by clinical specialty organisations (i.e. the Vascular Society). Core Standards and the Service Specification would become key components of this next stage.

GPICS standards will cover clinical care, audit, research, training and

CPD. This ambitious but necessary long-term development will be used for quality improvement, peer review and benchmarking. This will feed into the CCLF whose first meeting was on 16 July 2013. The focus will be to set standards defining best practice and improve the care of patients and their families.

The Board of the FICM and the Council of the ICS are currently in discussions about how best to see through this important new area of work. Visit our website for further developments in the months ahead (www.ficm.ac.uk).

prospective multi-centre observational study will investigate the epidemiology of severe critical events in paediatric anaesthesia. The APAGBI Professional Standards Committee includes the leads for Clinical Guidelines, Patient Information, Peer Review, Safeguarding Children and APA Linkmen.

Further details and contacts for additional information are available on the APAGBI website (www.apagbi.org.uk).

Improvement Lead will act as an advisor to APAGBI Committees, including the Scientific Committee and Professional Standards Committee, to support members implementing local and national APAGBI QI projects.

The APAGBI Scientific Committee supports research and audit by members. The APAGBI is a funding partner of the National Institute of Academic Anaesthesia and current funded projects include an international collaborative study evaluating airway changes following prolonged intubation. A recent multi-centre audit evaluated pain at home following surgery and will form the basis of additional studies. Centres across the UK and Ireland are also participating in the APRICOT study (Anaesthesia Practice In Children Observational Trial), and this European

[email protected] www.niaa-hsrc.org.uk

Dr B Bigham1, Dr K Wilkinson2 and Dr S Walker3 President of APAGBI1, Chair of Professional Standards Committee2, Chair of Scientific Committee3

Quality Improvement in paediatric anaesthesia

The Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) is requesting

expressions of interest from practitioners with expertise in Quality Improvement methodology who are interested in providing input to paediatric studies.

The APAGBI has over 1,100 members including consultants, trainees and allied health practitioners working in the fields of paediatric anaesthesia, critical care and pain medicine, at specialist paediatric and general hospitals throughout the UK and Ireland. It is envisaged that the Quality


National Institute of Academic AnaesthesiaNIAA

Health Services Research CentreH S R C


‘Complaint handling – what they don’t teach you at medical school’

Dr A Prenter ST5 Anaesthetics, Mersey Deanery

Dr M Lee Professional Services Director, Medical Defence Union

Complaint handling – a trainee’s account

The initial complaintThe process for me started in 2008 and finished in 2013. It very much came out of the blue. An A&E department in London that I worked in received a complaint about me. A couple of months after the event they asked me to write a response. I did so and outlined step by step what occurred, who was present and why I did what I did. My supervising consultant reviewed my statement and agreed with my actions under the unique set of circumstances with which I was faced, and didn’t think there was a case to answer. So, I handed in my statement and breathed a big sigh of relief.

Fast forward a year or so and one Saturday morning I heard a thud at the door. An envelope arrived containing a mountain of paper and a cover note from a solicitors' firm. It transpired that the patient, whom I shall now refer to as the claimant, was not satisfied with the written apology and explanation they received from our A&E department and was now starting formal legal proceedings. When I read through everything, including photocopies of all my notes from the A&E department and my statement from the year before, my heart rate rapidly escalated. However, it practically stopped when I read that the claimant’s solicitors were deeming my actions ‘negligent’. As a doctor you do not want this word in the same sentence as your name.

So started a long and drawn out process. The legal world undoubtedly moves slowly. This complaint was like a chronic illness, flaring up every two to three months over a five-year period. My solicitor tried to reassure me by telling me the next steps and that hardly any such complaints make it to court. The next step was to take my initial response to the complaint and draft it into a formal witness

statement. I also had the opportunity to read the claimant’s statement and the doctor they were describing was unrecognisable to me. I felt they were portraying me in a certain way to suit their claim. The next step was to exchange witness statements, obtain expert opinion and then wait. In the meantime I can’t begin to tell you how often you will turn the situation over in your mind. However, the legal process has to run its course. Months elapsed to the point that I’d forget about it until I got an email asking me to sign up to the law firm’s encrypted communication service. I was asked to explain why my witness statement differed to the claimant's – what did I have to say about this? Could I clarify this point and that point? I started writing to them explaining this was the only complaint I’d ever had and that I had letters of thanks from several patients – essentially trying to plead ‘I’m a good person really’. They are not interested. With hindsight, I now respect this. They were just being logical and exact with all the timings and events. In the end, the detail got us through, but I did not realise that at the time. Fast forward another year or so and I was told that the two teams of solicitors would be meeting and arguing whether there was a case to answer, and negotiating a settlement. No such agreement was reached, so preparations were made for court.

Court proceedingsAs a general point I’d suggest embracing the whole process, like you might an exam, as opposed to denying it's happening. Speak to colleagues who have spent time in court. (I spoke to my father who had been a civil servant and presented evidence in court many times.) Ultimately, it’s not going to go away so you may as well get involved.

Handling a complaint is something that most of us will have done. A few may have gone on and drafted a witness statement for solicitors to use. However, only a very small minority of cases (around 5%)1 ever end up in court. I thought I’d share a few thoughts and tips about, firstly, complaint handling but also, if things escalate, the subsequent court environment.


the case was this same piece of paper. The judge seemed to place quite a lot of credibility on it, as I had written it just after the event (contemporaneous) so the details were fresh and, importantly, composed before any solicitors were involved (unlike a witness statement which may come years later) so it was a pure document free from any legal influence. So, I can’t overstate the importance of any initial reply you give to a complaint. Think carefully and consider running it by your defence organisation too. Mine kindly provided me with the following general advice when I asked them about it.

Advice from the MDUThe rate of claims and complaints against doctors has been rising dramatically for several years. In 2012, the MDU saw a 15.5% rise in the number of members seeking help with NHS complaints and the NHS Litigation Authority reports a 10.8% increase in the number of claims notified against trusts in 2012–13.2

Claims for clinical negligence very rarely reach the courts. Only around 1% of all claims notified to the MDU do so, the majority being successfully defended and others resolved with a negotiated settlement. However for the doctor who has to face questioning from solicitors during the preparation of the defence of a claim, or a barrister during a court hearing, it can be an unsettling and sometimes distressing experience, as this MDU member found.

We encourage members faced with involvement in a complaint or negligence claim to contact us early for advice and support. Even where the case is being managed by a trust or their solicitors, the medical defence organisations can offer independent advice and support, review draft witness statements or responses to formal correspondence and prepare to offer direct support if, for example, the matter progresses to a GMC or disciplinary enquiry.

solicitors and barrister. You will run over a few things here, and secretly hope the case gets settled and you can go home. However, it may not.

After swearing the oath, proceedings generally commence with being questioned first by your own barrister. You may even have some idea what these questions will be. They let you start off by stating your qualifications and where you work and this helps you settle into the environment. What you can’t really prepare for is the cross examination from the opposing barrister. For me the best preparation is to re-read your witness statement and be absolutely clear on the detail. Do not change your verbal account from this – you will lose credibility. I found their barrister trying to get me to deviate from it but because I’d been truthful from the start my mental recollection was very exact. At the same time be sure to talk calmly and slowly since the judge is non-medical and has to be able to follow and understand you. Receive the question from the barrister, but I’d suggest delivering the answer to the judge. Barristers have a few tricks to shake you – raising their voice, picking apart details, shaking their head in disagreement as you answer them to name a few. Do not rise to any of this. Deliver the facts and you’ll come through fine. If they shake their head as you are talking, then address the judge so you don’t have to see this. If they question you on a detail, a timing perhaps in your medical notes, just be honest and explain that notes do get written in retrospect – judges don’t know this necessarily. Honesty with absolutely everything is the best policy. Finally, if they offer you the choice of sitting or standing in the witness box I’d advise standing: my barrister told me that looks more authoritative. Your legs will feel like jelly but hang in there!

I’d like to finish full circle. This started with a reply to a complaint that I typed out and got my wife to read before handing it back to the A&E department. Five years later what won

So, I went to London (I’d moved by this time). A conference with counsel involves meeting with the solicitors representing your side and also your barrister. Although I didn’t appreciate it at the time, essentially they are sizing you up, trying to work out if they have a case or whether they need to accept liability and settle. If someone had told me this up front I’d have felt more positive about the whole thing. Following commencement of court proceedings, evidence and documents will be exchanged. Pleadings are set out where the claimant’s team sets out step by step the allegations of negligence to which your side in turn replies. Witness statements are exchanged; the expert witnesses may even issue a joint statement and try and agree on matters. In my situation they continued to disagree. Other forms of evidence included paramedic statements. For me it was a reassuring event as I could finally say out loud all the little things I’d been turning over in my mind. I was also buoyed by our expert witness who seemed thoroughly reliable and knowledgeable. I was informed that offers to settle from our side had been turned down in favour of pursuit for increased settlement and it was increasingly likely that we would be heading to court. I was told that settlements can be reached even on the day of court proceedings so I may not need to give evidence in court but I just felt it was inevitable. Although I wasn’t told this until after the case, based on what I said the barrister felt that we had a good case and, in me, a good witness to defend this large claim. This is why we went to court, as we refused to settle. If I’d have known that me being a witness was a key element in this I’d have felt better and more positive overall. As it was, I equated court with bad news. This is not so. The very reason you end up in court may be because you are a solid witness rather than, as I had assumed, a bad doctor.

A trial date will be set – mine was several days and you need to be available for all of them. You will start the day with a meeting with your


References1 Bagood D. The medico-legal expert.

RCoA Bulletin 2011;70:20–22.

2 Annual Review 2012/13 and Forward Look 2013/14. NHS Litigation Authority (www.nhsla.com/aboutus/Documents/NHS%20LA%20Annual%20Review%202012%20-13%20and%20Forward%20Look%202013-14.pdf).

Our advice to doctors facing an NHS claim:

J Ask for a copy of the relevant clinical records and details of the allegations before commenting.

J When drafting an account of your involvement make it chronological and base it directly around the entries you made in the clinical records – explaining abbreviations or your usual practice where appropriate.

J Keep your input entirely factual and focused on your own clinical involvement. Do not be drawn into speculation, commenting on the actions of others or expressing your views on the merits of the case.

J If you are uncertain about any aspect of the case – possibly because there has been a long delay in the claim being notified or you cannot read something in the records – then do not guess or try to fill in the blanks.

J The defence legal team may challenge you on your account. This is not necessarily because they doubt the veracity of what you have said but they may wish to test how well you, would stand up to cross examination in court.

J When asked to give oral evidence in court be sure you have a copy of your records and witness statement in front of you and refresh your memory of events using these sources before giving evidence.

J In court, stand up and look authoritative, speak up so you can be heard and appear confident in what you are saying and only give short direct factual answers to questions put to you.

J Seek advice, assistance and support from your medical defence organisation at the outset and throughout the process.


‘The current cohort of trainees will be leading the NHS of the future’

Post-FRCA training: Oxford’s journey

The National Health Service is going through arguably the most challenging and significant change in its 65-year history. Sweeping reforms are being made across the health sector and the ability of trainees to keep up to date with academic, managerial and strategic knowledge is vital to provide a well-prepared body of new consultants. The current cohort of trainees will be leading the NHS of the future, responding to events such as the Francis Inquiry1 and helping to implement these changes at local and national levels. With this in mind, creating a training programme to encompass all aspects of the RCoA syllabus must be addressed effectively by each school of anaesthesia.

Challenges to teaching provisionMaintaining the priority of delivering high-quality postgraduate teaching to trainees is under increasing pressure, with several competing factors. A British Medical Association report in 2010 found that more than a fifth of over 2,000 NHS consultants said that their supporting professional activities (SPAs) had been reduced, and almost a quarter (23.8%) reported that their employer had reduced the number of SPAs for newly-appointed consultants.2 The European Working Time Regulations (EWTR) have resulted in reported decreased training opportunities across many specialties.3,4 Compounding the problem is an expanding

curriculum as well as an increase in the number of doctors in less than full-time (LTFT) positions.5 These all conspire to make co-ordinating and delivering a formal post-FRCA syllabus a complex task.

To address this problem, in 2010 Oxford anaesthetic trainees established a group initially intended to provide formal delivery of a syllabus-based dedicated monthly teaching programme, named OxDAT (Oxford Deanery Anaesthetics Trainees). This has proven to be very successful and over time has evolved to encompass several aspects of working life outside pure curriculum-based teaching.

Teaching deliveryThe original remit of OxDAT was to provide a monthly full-day teaching session for all post-FRCA trainees in the Thames Valley LETB (formerly the Oxford Deanery). This is run by the Education Co-ordinator, a senior trainee who organises the programme for each meeting and ensures that teaching is matched to the RCoA curriculum. These sessions aim to cover all aspects of training including those that are often more difficult to deliver during clinical sessions such as human factors training, simulation, management and career development. The teaching days are rotated around the hospitals within the LETB taking advantage of the regional expertise and facilities available. Teaching is supported

Dr B Attwood ST7 Anaesthetics and ICM, Thames Valley LETB (Oxford); Vice President OxDAT and Chairman Trainee Advisory Committee, Oxford

Dr P Hughes-Webb ST7 Anaesthetics, Thames Valley LETB (Oxford); President, OxDAT, Oxford

The provision of post-FRCA teaching to senior anaesthetic trainees is a considerable challenge to each school of anaesthesia in the UK. Co-ordinating trainees across different sites within a local education and training board (LETB) and protecting teaching time in an increasingly crowded clinical schedule within the confines of the European Working Time Regulations (EWTR) make the prospect of delivering a curriculum-based relevant syllabus in the years prior to completion of training somewhat demanding. In this article, we outline the initiative of a trainee-led monthly training programme supported by the Head of School, the Training Programme Director and the LETB which has evolved to encompass aspects of working life outside pure curriculum teaching for all anaesthetists training in the region.


cases where practice has not been exemplary; we also acknowledge and highlight examples of good practice.

The Francis Report emphasises that trainees have an important role to play in the safe running of hospitals as set out thus:

‘Good practical training should only be given where there is good clinical care. Absence of care to that standard will mean that training is deficient. Therefore there is an inextricable link between the two that no organisation responsible for the provision, supervision or regulation of education can properly ignore. Trainees are invaluable eyes and ears in a hospital setting.’1

We provide an open forum whereby training issues may be discussed, most of which can usually be solved locally with the support of educational supervisors and College Tutors.

On the very rare occasions where local resolution is difficult or where a wider sharing of knowledge has been necessary, we have been central in highlighting issues to the Regional Adviser and forwarding any difficulties to the School Board for resolution. This has resulted in early investigation and sustainable measures to bring about improvement within a short timeframe without detriment to individual trainees.

Pastoral care and welfareIn our LETB the ST3 year is set in Oxford. The prospect of starting at a new hospital, the demands of a changing curriculum, the looming Final FRCA exam and, for many, growing family commitments can make the ST3 year a daunting experience for trainees. To alleviate this we provide a named senior trainee ‘buddy’ for each ST3 new starter in Oxford with the aim of providing support and guidance through the year. Although ST3 trainees do not participate in post-fellowship teaching (as they have their own dedicated programme), they are invited to attend committee meetings and pass concerns onto the OxDAT

invited speakers from our own trainee body including the most recent chair of the AAGBI’s GAT committee, one of the executive directors of the London Air Ambulance charity, and trainees who have completed international fellowships. Every lecture is rated by each trainee, the feedback is collated and a report sent to the speakers, College Tutors and Head of School. After submitting a successful business case to the postgraduate deanery we were fortunate to be granted a small bursary to cover speakers' expenses and administrative costs.

Clinical governanceEach month we run a mortality and morbidity session using the SBAR (Situation – Background – Assessment – Recommendation) format, which offers the opportunity to present and learn from collective experiences across all hospitals in the LETB in a non-threatening environment.6 However, this propagation of shared knowledge amongst trainees is not limited to

by the Regional Adviser and College Tutors ensuring that study leave is approved and protected for all senior trainees. Although attendance at teaching sessions is mandatory for all senior trainees across all the hospitals, it is not uncommon to find trainees attending voluntarily on their days off, which is taken as an indication of the value that is given to the programme. Protected teaching dates are set a year in advance and are cross-checked against major meetings and school holidays. Nominated study days are rotated through the working week to ensure that LTFT trainees have equal opportunity to attend the sessions. In the past 12 months, we have had a wide range of topics for study days, including talks from international experts in their field. Sessions are often organised in conjunction with sub-specialties (e.g. paediatrics and intensive care) facilitating consultants and trainees from non-anaesthetic specialties to participate and engage in multi-disciplinary discussion. We have also

ST4–ST7 REGISTRAR TEACHING08.30 Registration

08.45–09.45 Future directions of clinical services management. Director of Clinical Services OUH

09.45–10.45 Local and national incident reporting Consultant Lead for Clinical Governance

10.45–11.00 Break

11.00–12.00 Clinical management in a NICE age Clinical Lead of Specialist Surgical Services

12.00–13.00 OxDAT committee meeting (all trainees invited)

13.00–14.00 Lunch

14.00–14.30 Morbidity and mortality case presentations – SBAR format

14.30–15.30 The third healthcare revolution Director of the National Knowledge Service and

Chief Knowledge Officer for the NHS

15.30–16.30 Essentials of health service management Associate Medical Director for Governance (OUH)

16.30–17.00 Questions and discussion

17.00 Close of day (Pub)

Figure 1 Example day


group. We also organise social events and an annual dinner that brings together all trainees across the LETB.

Each hospital in the school is represented by a nominated trainee on the committee who gathers feedback on all aspects of training and welfare issues. Close communication across trainees has allowed recurrent issues to be identified and addressed both at local and school level where appropriate examples of excellence are highlighted – for example, this has led to a College Tutor in the region receiving a Deanery Education Award. As an example of good practice from one trust propagating throughout the region, in one hospital at the end of a rotational attachment trainees were asked to provide anonymous feedback on each individual consultant. This information allowed the College Tutor in that hospital to acknowledge examples of good practice as well as identify recurrent problems. This system is now being adopted across other anaesthetic departments in the region.

Less than full-time traineesIt is well known that the requirements of LTFTs can be complex and a challenge to accommodate in both clinical and educational needs. The LTFT representative on the committee has co-written a policy document to aid rota-writers around the region to accommodate LTFT trainee requirements and assist in their placements. The LTFT also has representation at School Board level.

The President of OxDAT attends the quarterly School Board meeting which represents trainees at a strategic level. Two elected trainees attend the Training Advisory Committee (which represents all specialties across the LETB) of whom one is currently chairman.

The futureWe aimed to create a sustainable self-regulated rolling training programme for all post-fellowship anaesthetic trainees in Oxford. However, the role of the group has blossomed to incorporate

many other aspects of the trainee journey including assisting training issues, pastoral support, sharing of difficult cases and examples of good practice. We hope that our positive experience might be helpful elsewhere to promote the education and self-management of trainees where time and financial resources are limited.

AcknowledgementsOxDAT was founded by two anaesthetic trainees, Dr Matthew Rowland and Dr James Shorthouse – we are grateful to them for their hard work in setting up the group. We would also like to thank the Regional Adviser, Dr Oliver Dyar, along with the College Tutors, rota organisers and consultants who have encouraged the development of the group and without whose support it would not have succeeded.

Conflict of interestNone.

References1 The Mid Staffordshire NHS Foundation

Trust Public Inquiry Report, 2;231 (www.midstaffspublicinquiry.com/sites/default/files/report/Volume 2.pdf)(accessed 24 June 2013).

2 Quality Time – Standing up for Doctors; The value of consultants’ Supporting Professional Activities to the NHS. BMA, November 2010.

3 Fitzgerald J, Marron C, Giddings C. The influence of specialty, grade, gender and deanery on the implementation and outcomes of European Working Time Regulations in surgery. Br J Surg 2011;98(S3):21.

4 Giles E et al. EWTD: incompatible with subspecialty training? Arch Dis Child 2011;96(7):699–700.

5 Jones M, Montgomery J, Thomas S. Flexible training has matured. BMJ Careers 2008.

6 Quality and Service Improvement Tools – SBAR-Situation-Background-Assessment-Recommendation. NHS Institute for Innovation and Improvement, 2008 (www.institute.nhs.uk/quality_and_service_improvement_tools/quality_and_service_improvement_tools/sbar_-_situation_-_background_-_assessment_-_recommendation.html).


Gaining consent to treat a patient should be much more than a process undertaken by the doctor with the aim of protecting himself from future litigation. Often, in an era where there is a perception amongst medical professionals that patients are becoming increasingly litigious, the underlying reasons for taking consent are forgotten. As Professor M Jones writes:1

'The underlying ethical principle of informed consent is that one should respect the patient’s autonomy: the capacity to think, decide and act on one’s own thoughts and decisions freely and independently.'

Capacity to give consent‘Capacity’ is the ability to understand and retain necessary information, weigh it in the balance, appreciate its implications and use these facts to make an informed decision about future action. The process of decision making that demonstrates that a patient has capacity is well defined as:2

'Informed, autonomous decision making is complex and includes several elements:

(a) The process must be free from coercion.

(b) The participant must be able to understand the information about treatment options and limitations or research involvement, including the risks and benefits.

(c) The participant must believe the information provided is valid.

(d) The participant must be able to remember the information.

(e) The participant must be able to weigh the risks and benefits and, in the case of treatment options, understand the effect of choosing no treatment'.

Capacity is decision specific, so whilst a patient may be able to make informed choices about certain matters, for example, whether or not to allow their blood to be taken, they may be ill-equipped to make others, such as, whether the benefits of taking warfarin for the treatment of atrial fibrillation outweigh its potential risks.

There is no standard test of capacity and though many surrogates have been devised in an attempt to aid the assessment process, for example, the Mini Mental State Examination,3

the decision as to whether someone has capacity remains one of clinical judgement and is, therefore, ultimately subjective. Under the Mental Capacity Act 2005, all people over the age of 16 have capacity unless proven otherwise, and all people in possession of capacity must first give their consent before investigation and treatment can begin, no matter how minor it may be.

The evolution of ‘informed consent’ from Plato to BolithoConsent is often thought of as a modern ideal but, in fact, the concept was discussed in ancient Greece by Plato in his work, ‘The Laws’.4 In this book, Plato describes how the doctor would take a medical history from patients, before explaining and discussing their likely diagnosis. Co-operation for

Consent to treatmentIn today’s medical practice it is necessary for a doctor to gain the permission of any patient who has capacity before proceeding with examination, investigation or treatment. Permission, or consent, can either be expressed or implied and may be given or withheld by any adult with capacity. If a doctor neglects to gain their patient’s consent before embarking with investigation or treatment, they may be found guilty of battery or negligence, crimes which will be explored in greater depth at the end of this article.

The evolution of informed consent

Dr K McCombe Anaesthetic Consultant, Frimley Park Hospital

The Society for Ethics and Lawin Medicine


and had the therapeutic privilege to withhold information from his patient if he thought it would cause undue distress or anxiety, or he simply did not think a risk warranted discussion.

However, the situation in America was not unfolding in the same fashion and, 15 years later in 1972, the case of Canterbury v Spence 8 came before the Court of Appeal in Colombia. In this case, a 19-year-old underwent decompressive laminectomy at the hands of neurosurgeon Dr Spence. Mr Canterbury did not ask about risks inherent in the surgery, and his mother, who gave consent on behalf of her son, a minor, was told that the operation was, 'no more serious than any other operation.' Surgery was difficult and, following it, Mr Canterbury fell out of bed during a period when he was left unsupervised. Subsequently, he complained of lack of sensation in his legs and difficulty breathing. He was taken back to theatre but, despite remedial intervention, became paralysed from the waist down. He sued the surgeon, whom he claimed had not warned him of the risks associated with the surgery, and also sued the hospital for leaving him unsupervised. In the Court of Appeal ruling, the judge declared,

'A risk is material when a reasonable person, in what the physician knows or should know to be the patient’s position, would be likely to attach significance to the risk or cluster of risks in deciding whether or not to forgo the proposed therapy.'

And so, in this ruling, the American courts moved away from the ‘reasonable professional’ test of negligence, towards the ‘reasonable patient’ test.

In 1985, the often-quoted case of Sidaway v Bethlem Hospital9 came before the House of Lords. Mrs Sidaway underwent cervical cord decompression to relieve chronic pain in her arm. She was not warned of the less than 1% chance of paraplegia following the operation, but this

permanently by the procedure and sued the surgeon in negligence and for failing to warn him of the procedure’s inherent risks. Justice Bray agreed that the doctors had a duty to warn Salgo of, 'any facts which are necessary to form the basis of an intelligent consent by the patient to the proposed treatment.' He opined that this was a logical extension of the concept of explaining to the patient the nature of the proposed treatment. Bray went on to say, 'In discussing the element of risk, a certain amount of discretion must be employed consistent with full disclosure of the necessary facts to an informed consent.' This case had far reaching implications in that it changed the legal landscape by asking not just whether consent had been given to the intervention, but whether that consent had been informed, and therefore valid.

In the same year in the UK, one of the most well known medico-legal cases of all was heard, that of Bolam v Friern Hospital Management Committee.7 In this case, Mr Bolam gave his consent to undergo electroconvulsive therapy to treat his severe refractory depression. During the treatment, he sustained hip fractures as a result of the intense muscle contractions provoked by the therapeutic seizure. He sued his doctor in negligence, claiming that he had not been warned of this potential complication. In contrast to verdict in the US case of Salgo, the British judge, McNair J, found for the hospital trust and issued the following statement, which is now referred to as ‘The Bolam Principle’, and has provided the basis for the rules governing medical negligence ever since:

'He is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art'.

Standards of consent: the reasonable doctor or reasonable patient test?In the UK then, the prevailing opinion was still that the 'doctor knew best'

treatment, or consent, was sought from the patient before the doctor prescribed his remedy. It is said that Plato thought that this therapeutic relationship was more likely to yield good health than a coercive one.

Medicine, however, remained true to the paternalistic beneficence model until fairly recently, and the doctor’s main role was to provide medical benefit to the patient, even at the expense of their autonomy with many believing that involving the patient in treatment decisions would undermine the physician’s authority. Hence, information, which was not always true or accurate, was given merely to ensure patient compliance, rather than to establish genuine consent.

It was not until 1767 that the question of permission, or consent, to treatment arose in the English courts. In the case of Slater v Baker and Stapleton5 a surgeon initially set the patient’s femoral fracture, but subsequently disunited the fracture and re-set it in an experimental device designed to stretch fractures, at a time when the usual practice was to compress them. The patient had not given consent to this procedure and sued the surgeon in battery. The judge in this case found for the patient and stated, 'a patient should be told what is about to be done to him, that he may take courage and put himself in such a situation as to enable him to undergo the operation.' Although the judge did not expound further as to what information exactly should be given to the patient, this is the first reported legal case in the UK turning on the issue of consent, and shows that societal attitudes towards what constituted acceptable treatment were changing; medical paternalism was being questioned.

Nearly 100 years passed before the phrase ‘informed consent’ was coined in the Californian courts in the case of Salgo v Stanford University, 1957. 6 In this case, Mr Salgo underwent an aortogram, but was not warned that paralysis was a potential complication. Sadly, Mr Salgo was paralysed


2002;34(4):211–217.

3 Folstein MF, Folstein SE, McHugh PR. Mini-mental state A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiat Res 1975;12(3):189–198.

4 Plato & Saunders T. The Laws. Penguin Books Ltd, London 2005.

5 Slater v Baker and Stapleton (1767) 95 Eng Rep 860 (KB).

6 Salgo v Leland Stanford Junior University Board of Trustees (1957) 317 P 2d 170 (Cal).

7 Bolam v Friern Hospital Management Committee (1957) 2 All ER 118.

8 Canterbury v Spence (1972) 464 F 2D 772, 780.

9 Sidaway v Bethlem Hospital (1985) 2 WLR 480.

10 Rogers v Whittaker (1993) 4 Med LR 79.

11 Smith v Tunbridge Wells Health Authority (1994) 5 Med LR 334.

12 Bolitho v City Hackney Health Authority (1998) AC 232.

ophthalmoplegia and becoming blind in both eyes following her operation. Unfortunately, this unlikely event occurred. The judge in this case stated:

'The law should recognise that a doctor has a duty to warn a patient of a material risk inherent in the proposed treatment; a risk is material if, in the circumstances of the particular case, a reasonable person in the patient’s position, if warned of the risk, would be likely to attach significance to it'…

Finally, in 1994, the reasonable patient test was upheld in British courts in the case of Smith v Tunbridge Wells Health Authority.11 In this case, 28-year-old Mr Smith was left impotent following rectal surgery. The courts maintained that it was unreasonable of the surgeon not to have warned him of this risk, despite the fact that many expert witnesses supported the surgeon in agreeing that they did not routinely warn of impotence. This case was important then, as it rejected the Bolam principle in the British courts; a particular practice was no longer acceptable merely because a certain body of experts could be demonstrated to practise that way. Now the practice also had to be reasonable.

In 1998, this idea was revisited in Bolitho v City Hackney Health Authority12 when it was stated clearly in the judgement that relying on the practice of a body of experts was no defence from negligence if that practice was not 'logical and defensible.' This judgment placed limits on the Bolam principle and underlined the fact that doctors and their opinions are subject to legal scrutiny. It is the court, and not the medical profession, that is the final arbitrator of standards of medical practice.

References1 Jones M. Informed Consent and Other

Fairy Stories. Medical Law Review 7, Summer, 1999;103–134.

2 Williams A. Issues of Consent and Data Collection in Vulnerable Populations. Journal of Neuroscience Nursing

complication befell her none-the-less. She sued the neurosurgeon, and the Maudsley Hospital, claiming that she had never been warned of the risk of damage to her spinal cord.

Four of the five Lords hearing this case found for the defendant, upholding the Bolam principle, reaffirming British sympathies with a ‘reasonable doctor’ test and distancing themselves from the US notion of ‘the reasonable patient’. Lord Bridge felt the case turned on the fact that the risk of paralysis was so small that a reasonable doctor was within his rights not to mention it. Had the risk been greater, 'for example, ten per cent', he felt there would have been a responsibility on the doctor to inform the patient of this: 'disclosure of a particular risk was so obviously necessary to an informed choice on the part of the patient, that no reasonably prudent medical man would fail to make it.' Lord Templeman commented that the surgeon could not be blamed for not giving Mrs Sidaway information for which she did not ask.

Lord Scarman dissented from this judgement and, ironically, his disagreement has more in common with the subsequent development of the laws surrounding informed consent. In his judgement he erred towards a reasonable patient test, stating that the doctor should have a duty to inform the patient, 'where the risk is such that in the court’s view a prudent person in the patient’s situation would have regarded it as significant.' Interestingly, however, Lord Scarman still found against the claimant saying that Mrs Sidaway had failed to prove that the risk of less than 1% would have been significant to her, had she known about it.

The reasonable patient principle was upheld in Australia in 1993 when the court rejected the Bolam test and found in favour of the patient in the case of Rogers v Whittaker.10 Despite asking of the risks of her operation, Ms Whittaker was not warned by her ophthalmic surgeon of the 1 in 14,000 chance of suffering sympathetic


‘I look back on my time in Papua New Guinea as one of the most useful periods of training I have had to date.’

Dr B Gupta ST5 Anaesthetic Trainee, Bristol

Dr R Craven Anaesthetic Consultant and College Tutor, Bristol Royal Infirmary

In this article the authors outline the process for setting up a placement, gaining approval from the relevant bodies and organising supervision which, in some cases, can be remote. They show also, from their own experience, the value of undertaking training in a developing country.

BenI have recently returned from six months working as the sole anaesthetist in one of the most remote places on earth, the highlands of Papua New Guinea. Whilst there, and with no direct supervision, I anaesthetised neonates through to the elderly, was responsible for supervising a nurse anaesthetist and was on call 24 hours a day. The next nearest physician anaesthetist was six hours away. Not only was this one of, if not the, most formative experiences of my training to date, but the time I spent in this wonderful and challenging environment will be formally recognised as valid training and therefore count towards my CCT.

Since the introduction of the new RCoA 2010 curriculum for a CCT in Anaesthesia, which includes the unit of training (UoT) ‘Anaesthesia in Developing Countries’, it has been possible to undertake work in a developing country, and, with the relevant pre-approvals in place, to count this work towards your CCT. A maximum time of six months can be counted towards your CCT.

Despite, however, what seems like an amazing opportunity to swap your local DGH for rural Africa or similar, uptake so far has been surprisingly poor. I hope to show that the process, although perhaps requiring slightly more forethought than a ‘traditional’ OOPT, can be straightforward, and the rewards of a successful placement incomparable.

RachaelI am a Consultant Anaesthetist and College Tutor at University Hospitals Bristol, and for the last eight years have also been a volunteer with Médecins sans Frontiéres. With these combined interests I was delighted to see a developing world unit of training in the new curriculum and am very keen to support any trainee who wishes to undertake this.

First stepsBefore you start the process of gaining approval for training you must have a firm plan of where you will go and what kind of work you will be undertaking. When making your initial plans, look at the Anaesthesia in Developing Countries UoT and think about whether your placement will help you to achieve the required competencies. There are many different ways of going to work in a developing country, but bear in mind that some sort of formal job description will be helpful in gaining approval for training purposes. Do not underestimate how long the research and set-up of a placement can take, so allow at least a year.

Short placements of, say, two weeks, are a useful way of deciding what you want to do. You should consider spending as much time as possible to get most benefits... six months to a year is recommended.

If you are a trainee you should have researched carefully the proposed job. You should find out if anyone has been there before, or worked for that organisation, so that you can speak to them and establish that the post will fulfil both your own and the curriculum’s requirements.

Useful sources of information include the World Society of Anaesthetists and the AAGBI International Relations Committee – who are in the process of compiling a register of

Ben Gupta is an ST5 Anaesthetic Trainee from Bristol who has recently returned from a six-month OOPT working for Médecins Sans Frontiéres in Papua New Guinea. Rachael Craven is an Anaesthetic Consultant and College Tutor at Bristol Royal Infirmary, who has experience working in developing countries. Rachael acted as Ben’s remote supervisor during his OOPT.

Out of programme training (OOPT) in a developing country – how to do it and why


everyone who does voluntary work overseas.

The RCoA Bernard Johnson Adviser for the International Programmes is also available to give advice.

You should discuss your plans early with your College Tutor (CT) and Training Programme Director (TPD), and if possible a consultant with overseas experience, to make sure what you are planning is feasible.

Before you goIn order to count your work in a developing country towards your CCT you will need to gain approval, prospectively, from three bodies – your deanery, the RCoA and the GMC, in that order.

Your TPD must agree to your plan and allow you the required time out of programme. Your deanery will also need to sign off on your plans before you can submit your proposal to the RCoA. This is often done by one of the Regional Advisers.

At the RCoA, the Training Committee will evaluate your proposal and decide whether to recommend that the time should be counted towards training. The College will want details of your planned placement and a firm justification of why it should count towards training. The very variable locations and nature of working in developing countries mean that a detailed description of your duties will be required. To maximise the chances of getting approval for the post the job plan should be mapped to the curriculum.

Not only the developing world UoT can be utilised – there may also be opportunities to cover competencies in remote medicine, transfer, obstetrics, trauma, paediatrics, teaching, management and audit. If the committee decides in your favour then your proposal will be sent to the GMC for final approval. This, usually straightforward, but can take time.

Another essential requirement is that you have an educational supervisor (ES). Ideally, this should be someone

you will be working with locally. There are many excellent local trainers but they may not have completed GMC level training 2 for ESs, and may feel they need some additional support.

In some circumstances, such as mine, where you have had some previous exposure to working in a developing country, you may be the sole anaesthetist.

You may therefore need a remote educational supervisor. This should be a consultant anaesthetist who has completed appropriate ES training and has had experience of working in a developing country.

The RCoA is at present compiling a list of suitable remote educational supervisors.

You also need to have completed a course in Developing World Anaesthesia.

Remote supervisionBenRemote supervision, as the name suggests, means that all supervisory activities take place by email or telephone, or possibly via videolink or Skype. It is essential to have some form of these means of contact. Luckily nowadays there are very few places where mobile telecommunications have not reached. I was in the fortunate position of having someone who could fulfil the role of remote supervisor in my Deanery whom I knew personally, but this is not essential.

I found the process of remote supervision to be excellent. My supervisor and I met in person before my trip, and both agreed a written supervision plan. In my case we agreed that I would submit my CBD and ALMAT reports via email with phone contact reserved for when advice might be needed in a shorter timeframe. We also agreed a minimum periodic contact time (two weeks) just to ‘check in’. Logbook review would take place on my return.

For CBDs I selected an interesting/challenging case and wrote down in

detail a case report of my anaesthetic management. I then detailed a number of discussion points along with an explanation of why I had managed the case as I had. This was then emailed to my supervisor who returned the document with her thoughts, comments and advice with regard to each of the discussion points. A similar process was followed for the ALMAT with a whole day’s cases included, and the focus of discussion points shifted slightly.

I believe that the CBDs I completed remotely are some of the most educationally useful I have undertaken. One reason for this is that the process of completing the report and giving my thoughts on the discussion points usually took place over a couple of evenings, allowing plenty of time for unhurried, thorough reflection on my part.

RachaelIs it reasonable to supervise a trainee remotely? The technical skills and knowledge required for these overseas posts have usually been mastered by an ST5+ trainee and the supervisor needs to be absolutely sure that this is the case. Most of the challenges relate to planning, decision making and team working – all perfectly possible to supervise remotely. Trainees must have completed their intermediate training and are post FRCA; arguably, in many countries in Europe they would be a specialist and able to work independently at this stage.

Prior to departure you need to meet with the trainee. Agree a programme of workplace based assessments and a timetable of 'supervision meetings'. Agree how the trainee will be able to contact you for emergency advice. These posts may be for several months so if the supervisor is going to be unavailable for a period they need to have a deputy. Having said that by using mobile phones and the internet I was able to supervise from various locations in the UK, France and Syria.

Did it work? Communication was easy and the regular checking in allowed


for discussion of minor problems and equipment questions. The degree and quality of reflection that went into the workplace based assessments was much higher than I normally see; it also covered a much broader range of areas with good reflection on non-technical skills. Use of email meant that we both had time to put more thought into our responses than is sometimes possible on a busy working day. Emergency advice was only required once by telephone – a twin pregnancy with severe pre-eclampsia requiring general anaesthesia for C-section who then had suxamethonium apnoea (outcome good). An appraisal form was completed by the project co-ordinator in the field (non-medical) commenting on behaviour and attitudes.

The training experienceBenI look back on my time in Papua New Guinea as one of the most useful periods of training I have had to date. The day-to-day work involved daily ward rounds with the surgeon, anaesthetising any cases that had come in overnight and, of course, treating any incoming casualties. The majority were young trauma patients, with an average age of 26. Mixed in with this we also operated on emergency obstetric and general surgical cases, burns and a lot of soft tissue infections. We had a good complement of drugs, spinal needles and airway equipment but inhalational anaesthesia was provided with halothane and a basic draw-over system.

My anaesthetic skills had to be adapted to the setting (rather than the other way round) and I learnt many new ways to perform familiar tasks, not least from my nurse anaesthetist colleague. You have to be flexible working in this kind of environment and, alongside my anaesthetic duties, I also found myself responsible for neonatal resuscitation, seeing patients in the surgical outpatients clinic, servicing the anaesthetic machine and teaching basic recovery skills to the ward nurses.

Perhaps one of the most useful aspects of my time away was the excellent

opportunity to develop my non-clinical skills. Among the things in which I now feel much more confident are working independently, supervising other anaesthetists, decision making when difficult cases arise, hospital management, interacting with non-medical team members, and time management and prioritisation. I anticipate that this will translate into benefits for me when working back in the UK. This is what Professor John Tooke had in mind when he recommended this kind of work as something to be encouraged in his report Aspiring to Excellence,1 and reiterated in the recent report on overseas volunteering and international partnerships by the All-Party Parliamentary Group on Global Health: Improving Health at Home and Abroad.2,3

RachaelAn excellent number and range of cases were covered. Probably more importantly were the wide range of challenges in terms of planning and decision making; these required a much broader view of the patient, the available skills – nursing, surgical and anaesthetic – and the facilities available.

Development of the ability to look at the bigger picture, weigh up many competing factors and prioritise appropriately with sensible plans is one of the key skills to be mastered in higher training. This post and others in developing countries provide excellent experience for development of this skill and should be directly transferable to UK practice. There was also excellent

exposure to the challenges of working in multicultural multidisciplinary teams, stress management, working as line manager for colleagues with the need to provide appraisal, management meetings, service development and the organisation of training programmes – all important skills for future UK consultants.

In addition, the employing organisation had an extra layer of advice and supervision not normally available to their anaesthetist in the field, with, hopefully, benefits for their patients. I felt very comfortable with the quality of care being provided and would be very happy to act as a remote educational supervisor again.

Most trainees take their time out in a developing country as an ‘OOPE’ with the time not counted towards training.

We hope that this article demonstrates the advantages of applying for this time to be counted towards training, both for the trainee and for the vulnerable patients. The process of applying is not too difficult and is definitely worthwhile.

References1 Aspiring to Excellence: Final Report

on the Independent Enquiry into

Modernising Medical Careers. Medical

Schools Council, 2007.

2 Improving Health at Home and Abroad.

All-Party Parliamentary Group on

Global Health, 2013.

3 How overseas volunteering from the

NHS benefits the UK and the world.

All-Party Parliamentary Group on

Global Health, 2013.

Ben in theatre – no ventilator or automated blood pressure!

Ben teaching basic life support to ward nurses


Dr S Zope Specialty Doctor in Anaesthetics, Darent Valley Hospital, Dartford; Former MTI trainee, Heart of England NHS Foundation Trust (3 May 2011 – 15 April 2013)

Dr A Keshkamat Specialty Doctor in Anaesthetics, Darent Valley Hospital, Dartford; Former MTI trainee, Heart of England NHS Foundation Trust (10 June 2011 – 9 June 2013)

Previous anaesthetic experienceWe had completed our anaesthetic training in the King Edward Memorial Hospital, Mumbai, one of the premier medical colleges in India, and had been working as senior registrars in anaesthetics for nearly a year. We had always wanted to experience anaesthetic practice in other parts of the world and learn new techniques. The concept of the NHS in the UK has always fascinated us and we were looking for opportunities to be a part of it.

Why MTI?Under MTI, training is made available to non UK/EU overseas doctors who meet the required eligibility criteria, including obtaining registration with GMC. For MTI doctors this is obtained via a professional sponsorship scheme with the relevant medical royal colleges.

Through information we sourced on the RCoA and AoMRC websites we decided that it perfectly suited our learning aspirations in a new health system. Among the major benefits for us were eligibility to sit the RCoA examinations and exemption from the PLAB test.

The MTI processPotential MTI placements are identified by trusts who then seek applicants through advertisements, organisational contacts or approaching a relevant medical royal colleges. Trusts need to ensure the placement is approved by their local deanery/LETB (local education and training board).

Doctors wishing to take up an MTI placement usually obtain GMC registration and licence to practise by applying for professional sponsorship by one of the GMC approved sponsors. This ‘sponsorship route’ is an alternative to taking the Professional and Linguistic Assessments Board (PLAB) test. The eligibility criteria applied by the GMC approved sponsors may vary slightly and details can be obtained direct from each of the sponsors.

Some GMC approved sponsors will help applicants find a suitable MTI placement; others require the applicant to have found the MTI placement before they apply for professional sponsorship for GMC registration. Finding a suitable placement will depend on the specialty and the individual’s circumstances. The medical royal colleges are a good starting point for advice. At present the RCoA does not help match applicants with trusts.

The Academy of Medical Royal Colleges (AoMRC) acts as the overall UK Visa Sponsor to enable participants to apply for a Tier 5 Government Authorised Exchange Scheme visa with the UK Border Agency – this is an integral part of the MTI scheme. The doctors can spend a maximum of two years in the UK, after which they must return to their home country.

Our journey to the postThe initial hurdle was to find an NHS trust which had posts approved under MTI. We were fortunate that one of our consultant’s friends was able to find one.

Our names are Sarvesh Zope and Ashwini Keshkamat, and we are anaesthetists from India. We would like to write about our experience of the Medical Training Initiative (MTI) programme.

We would like to describe both our professional and personal experiences. We have been married for four years; we have been trained in the same specialty and our careers have progressed near parallel. We both applied at the same time so this article describes our joint experience.

The Medical Training Initiative in the UK…the experience of two doctors


We expressed our interest to the Clinical Director of the Heart of England NHS Foundation Trust (HEFT) in Birmingham and sent our portfolios. HEFT had to apply to the RCoA MTI scheme to ensure its suitability as a training centre.

We had a telephonic interview for the posts and were both offered jobs a few days later. Once we had received the offer letter, we had to apply to the GMC to meet the criteria set out for registration.

The information and application forms for MTI sponsorship are available on the RCoA Training website. The RCoA acts on behalf of the AoMRC. Once we had completed these and had gained approval from the RCoA, we completed the GMC online registration application, who then granted us full registration.

HEFT then sent our visa applications to the AoMRC, who then issued a Certificate of Sponsorship with which we were able to apply for the visa from our home country. The visa for this scheme is classified as Tier 5; as mentioned before the maximum duration is 24 months, which cannot be extended further. The time from receiving the job offer through the various approvals to actually starting the post was an interminable nine months... but, looking back at it now, it was all worth it!

Early hiccupsWe were the first of the anaesthetic MTI trainees at HEFT. There were initially inconsistencies regarding the job description but the College Tutor and our educational supervisor were very supportive and attentive to our training needs. Our Regional Advisor encouraged us to take part in the academic activities of the department.

Coming to a country with a different cultural and professional background can be extremely daunting and it is possible to go through phases of insecurity and loneliness. This, however, was not the case with us as we had each other, though we missed

our friends and family. We were fortunate to meet people who were willing to help and guide us right from our first day. There were a number of fellow Indian doctors in the trust who were very caring and helped us to get acquainted to the system smoothly.

The jobAll MTI trainees are ‘International Fellows’ and our job title was ‘International Fellow in Anaesthetics and Critical Care’. In a meeting with the clinical director we discussed our mutual expectations from the post and were allocated our educational supervisors. There was a long and comprehensive meeting with each educational supervisor and the College Tutor who helped us set realistic goals for the two years of our stay in the UK in order to achieve skills and knowledge to better our anaesthetic practice.

The training...It was agreed that the two years would be divided into blocks of three months each to achieve the necessary competencies, training and service commitment. We had to pass the ‘initial test of competency’ which comprised workplace based assessments set by the West Midlands Deanery and described in the RCoA curriculum. After achieving this we were rostered along with the other trainees to provide service commitment out of hours in theatres, maternity and the intensive care unit. At the end of two years, we completed six months of ICM and 18 months of anaesthetics. We received the same training and supervision including assessments (DOPS, Anaes-CEX, CbD, MSF) and appraisals as other UK trainees on the rotation. We received an average of three consultant supervised lists per week and a summary of the above was sent to the RCoA every six months confirming that we were achieving the set standards/goals. We were subjected to an ARCP-like meeting at the end of each 12 months.

We both share common interests, so the department was able to allocate anaesthetic modules which incorporated sessions on regional anaesthesia, anaesthesia for bariatric surgery and a few sessions of thoracic anaesthesia, as the trust is the regional centre for thoracic surgery.

As part of our service commitment we were expected to work firstly at CT1/CT2 level and then progress to junior registrar (ST3 level) in theatres, maternity and the intensive care unit.

What did we gain?Looking back over two years, we had a very good case mix of different specialties and learned new techniques to improve our anaesthetic skills.

The maternity unit in Heartlands Hospital is very busy. Because of the dedicated labour analgesia service, we were able to perform good numbers of epidurals for labour and manage them effectively. We were fortunate to be a part of the team which uses cell salvage effectively. It is a cystic fibrosis referral unit, so we saw some challenging cases of this disease.

We gained experience using ultrasound for different procedures. We had good exposure to thoracic anaesthesia and handling of double lumen tubes, which we started as novices. Working in ITU, though exhausting, was extremely rewarding. We saw a good case mix in critical care. We developed better communication skills which form an essential part of patient care.

We participated in departmental presentations and attended the primary

‘We think the MTI programme is extremely useful for doctors qualifying outside the UK/EU who wish to learn different aspects of clinical practice in the UK.’


teaching course every week. We completed an audit in the maternity unit, ‘Maternal satisfaction audit’, and presented the poster at the ‘Midlands Registrars Prize Meeting’. We also attended courses relevant to our interests throughout the two years of our stay (ultrasound guided regional anaesthesia course, one lung simulation course, fibre optic intubation course... to name a few). One of us represented the trainees on the Cell Salvage Working Group.

ExaminationsAshwini: I attempted the Primary FRCA MCQ after one year of completion of my training in June 2012 and appeared for the OSCE/VIVA in October 2012, passing the OSCE section. I realised that it was getting difficult to find enough time to study, as I was to finish my training in early June 2013, and I did not pass the exam.

However, I passed the ‘European Diploma in Anaesthesiology and Critical Care’ Part 1 in Sept 2012, and the Part 2 in May 2013. The Diploma exempts me from the Primary FRCA.

Sarvesh: I passed the ‘European Diploma in Anaesthesiology’ and Critical Care Part 1 in September 2012 and Part 2 in March 2013. I did not attempt the Primary FRCA as I thought it would not be possible to complete both parts of the FRCA in two years.

Pros and consOverall, we think this programme is extremely useful for doctors qualifying outside the UK/EU who wish to learn different aspects of clinical practice in the UK. The practice here is much more standardised and patient centred than we were used to. It emphasises attention to detail and made us understand the importance of communication at all levels. We believe that this will improve our practices, and that spending time in the MTI posts has been most worthwhile.

We do, however, think that two years is a very short period when it comes to acclimatising to a foreign system and simultaneously preparing for the exams.

Post MTI…After completion of the MTI post we received the ‘Placement Completion' letter from the RCoA.

We returned to India as the 24 months allowed by the Tier 5 visa had expired, but have now moved back to the UK and we are currently working as a specialty doctors in anaesthetics at Darent Valley Hospital, Dartford, on a Tier 2 visa. We hope to complete the Final FRCA in the near future.

For those interested in MTIFor our future MTI trainee friends we would like to give the following advice:

Obtain as much information as possible before you start. The RCoA, AoMRC and GMC websites have the majority of the information. Acclimatisation, the transition and facing the challenges of a new system can be stressful but we definitely felt it was worth it.

During our tenure there was an induction day conducted by the AoMRC for MTI doctors in the UK in June 2011 and another held by the West Midlands Deanery for MTI doctors in that region in June 2012. Both were very useful and the faculty was able to answer many of our queries. We felt that the programme conducted by the deanery would have been more useful had it been around the start of our post.

Previous MTI trainees or trainees from non UK/EU countries often know the relevant immigration rules so it is worth asking their advice. They can be of immense help with queries that initially appear trivial but may be troublesome later.

It is important for trainees joining MTI to ensure their training needs are satisfied as well as fulfilling the service requirements. It is essential to have an educational supervisor, have regular meetings with them and have a record of career progress. It is also important to have a robust job plan agreed to suit both your own and the trust’s needs as two years is a relatively short time.

It is crucial to keep track of time if one is planning to take exams. It is very difficult to pass both parts of the FRCA in two years. Because of the limited time it is essential to start studying as soon as possible after settling down.

We really enjoyed our two years at HEFT. Gaining new skills and knowledge was most satisfying and worth all the effort. It is not all about work though. The UK has in itself a wonderful culture, beautiful landscapes and its own historical mysteries. Its people have a great sense of humour and a strong sense of ‘fair play’. Rest assured the experience is unforgettable!

We would like to thank Jo James, Bernard Johnson Adviser for the International Programmes, for giving us the opportunity to write this article.


Who was Bernard Johnson? Few people knowHe was a Consultant Anaesthetist and second

Dean of the Faculty from 1952–55, in the early days after anaesthesia had been established within the Royal College of Surgeons. He sat up the first Research Department of Anaesthesia there.

He had an untimely death in his fifties. The work he did promoting the specialty of anaesthesia is unparalleled, and a fund was set up in his memory. This was used to set up three eponymous Royal College posts.

Of the three so-called ‘Bernard Johnson Adviser’ (‘BJA’) posts, there is one for Academia, one for Less than Full-Time Training, and one for the International Programmes (IP).

It is fitting that there is such a position for IP, as Bernard Johnson was passionate about sharing the College’s standards of education and training with poorly resourced countries, and he travelled widely to promote this.

Role of the BJA-IPThe role covers many areas, but there are three main strands.

1. International medical graduates (IMGs)The scope is wide. The BJA-IP can offer advice and support to IMGs who may wish to train, or who are already working in the UK. The BJA-IP liaises with College bodies about IMG matters, and also links with external organisations such as the GMC, where necessary.

An important role is the management of the Medical Training Initiative.

Medical Training InitiativeThe Medical Training Initiative (MTI) was launched by the Department of Health in 2009, and replaces the old Overseas Doctors Training Scheme (ODTS).

It allows IMGs (who are not UK or EU residents) to come to the UK to train for a maximum of 24 months, after which they must return to their own country. The applicants must obtain the support of the relevant royal college.

The MTI system operates under the Government Authorised Exchange (GAE) sub-section of the Tier 5 visa category.

It is now one of the few ways in which IMGs can gain access to training within the UK. The training is of the same calibre as that experienced by the UK equivalents, and the IMGs can also sit the RCoA examinations. In addition to the high quality training they will have a unique experience of UK NHS practice, and will forge friendships and professional connections, all which will be useful when they return to their home country.

Dr J James Bernard Johnson Adviser (International Programmes)

One of the RCoA’s many goals is to foster and develop links with overseas organisations and doctors. This it does via the International Programmes department. This is led by the Bernard Johnson Adviser for the International Programmes (BJA-IP).

As a recent appointment to this role, I will, in this article, give an overview of the duties of the post, with particular reference to the involvement with the Medical Training Initiative.

The role of the Bernard Johnson Adviser for the International Programmes

‘The role of the Bernard Johnson Adviser for the International Programmes comprises three main strands. The Medical Training Initiative is an important component.’


How hospitals applyIn order for a doctor to come to the UK via MTI, the UK post must be prospectively approved by the RCoA. The UK hospital is responsible for obtaining this approval before appointing IMGs. Please see Table 3 for a brief indication as to what is required of an MTI post.

The criteria must be approved by the RCoA before an official appointment can be offered to the applicant. Once an IMG has obtained a UK post, they should ensure the UK hospital gains approval too. IMGs’ applications will not be reviewed until the offered post has been prospectively approved.

The post should be entitled ‘International Training Fellowship’, and must be appropriately funded.

Approval will remain valid for up to 12 months. If the post remains unfilled after this time, the hospital will need to reapply.

Table 3 Requirements for an MTI post

What is required of an MTI post

The post has specific aims and objectives

The trainee will receive the same training and supervision, as well as assessments (DOPS, Anaes-CEX, CbD, MSF) and appraisals, as other UK trainees on rotation in the hospital

The trainee will receive an average of three consultant supervised attached lists per week

A summary of the above is to be sent to the College, every six months, confirming the trainee is achieving the set standards/goals

The trainee will have an ARCP-like appraisal at the end of each 12 months

MTI doctors representing no more than 25% of the trainees on any rota

College Tutor and Regional Adviser confirmation of training capacity

Approval of the local Postgraduate Dean

Intensive care medicine posts must have the written support of local ICM Regional Adviser

(b) Eligibility to sit the FRCA examinations: successful sponsorship also allows doctors to register with the RCoA after which they are then eligible to sit the exams.

How IMGs applyThe applicants have to fulfil a list of requirements. Some of these are dictated by the GMC, others by the RCoA.

Successful applicants will receive a ‘Certificate of Sponsorship’ (CoS) from the RCoA. No doctor accepted onto MTI can take up a medical appointment without first having been granted Registration by the GMC. The GMC will not grant Registration until it has received the College’s CoS.

There are currently 76 MTI anaesthetists in post in the UK (October 2013). This number is increasing, as there is continuing spare capacity for training within trusts as the number of UK trainees is reduced and gaps in rotas become more frequent.

How does it work?The Academy of Medical Royal Colleges (AoMRC) acts as the national visa sponsor of the scheme within the requirements of the UK Border Agency, issuing the Tier 5 ‘Certificate of Sponsorship’.

The RCoA acts as the ‘professional sponsor’ on behalf of the AoMRC.

Under the umbrella of MTI there are two major benefits for IMGs:

(a) PLAB exemption: all doctors need GMC registration to work or train in the UK and are normally required to pass the GMC’s Professional and Linguistic Assessments Board (PLAB) test. Successful MTI sponsorship will exempt the doctor from this exam.

Table 1 GMC minimum requirements

GMC’s minimum requirements are to

Have a basic medical qualification acceptable to the GMC1

Have completed at least one year in an internship post (Pre-registration House Officer)

Have been qualified as a doctor for at least three years

Provide evidence of being engaged in medical practice for a minimum three years out of the last five years outside the European Union, including the most recent 12 months

Provide evidence of good standing from the applicant’s local Medical Regulatory Council

Demonstrate knowledge of English by obtaining an overall score of 7.0, with minimum scores of 7.0 in speaking, listening, reading and writing, in the ‘Academic’ test of the International English Language Testing System (IELTS). IELTS certificates are valid for only two years

Have not previously failed any part of the PLAB Test

Table 2 RCoA additional requirements

The RCoA additional requirements

Provide evidence of all GMC criteria

At the time of MTI application, the IMG must be living and working outside the UK and European Union for the last 12 months minimum

Provide evidence of at least three years' anaesthesia training outside of the UK and European Union

Provide two structured, supportive references from supervising consultants; both must have worked with applicant within the last five years

Provide evidence of a Tier 5 Visa application (i.e. confirmation letter from UK hospital)

Provide evidence of postgraduate experience acceptable to the RCoA

Obtain a formal appointment to a pre-approved MTI UK post; all applicants must already have been selected for and have received written confirmation from the employing authority of the offer of an MTI post in the UK and must still be within their home country at the time of application


Future developmentsThe IP department will be developing all three strands of its role. Please watch the website for details. The department is keen to receive any queries or suggestions at [email protected].

References1 Acceptable Medical Qualifications. GMC

(www.gmc-uk.org/doctors/registration_applications/acceptable_primary_medical_qualification.asp).

2 Medical Training Initiative (MTI). RCoA (www.rcoa.ac.uk/node/1830).

3 Primary and Final FRCA Examinations Regulations – November 2013. RCoA, page 9 (www.rcoa.ac.uk/document-store/primary-and-final-frca-examinations-regulations-november-2013).

4 Lord Tooke. Final Report on the Independent Enquiry into Modernising Medical Careers. MMC, 2007 (www.medschools.ac.uk/AboutUs/Projects/Documents/Final%20MMC%20Inquiry%20Jan2008.pdf).

5 Lord Crisp. Global health partnerships: the UK contribution to health in developing countries, 2007.

6 How overseas volunteering from the NHS benefits the UK and the world. All-Party Parliamentary Group on Global Health, 2013.

7 Improving Health at Home and Abroad. All-Party Parliamentary Group on Global Health, 2013.

8 Anaesthetic Curriculum: Unit of Training for Working in a Developing Country. RCoA, 2010, page D-45 (www.rcoa.ac.uk/CCT/AnnexD).

9 Curriculum for a CCT in Anaesthetics. RCoA, page 77 (www.rcoa.ac.uk/system/files/TRG-CU-CCT-ANAES2010.pdf).

doctors taking time out to work and train in resource poor countries,4–7 for the doctor, the recipient country, and the NHS as a whole.

The RCoA 2010 Anaesthesia Curriculum includes an optional unit of training at the higher level for trainees wishing to take a period of time out of programme with up to six months counted towards their CCT.8,9

The RCoA would like to see many more trainees taking up this opportunity, and the IP department can advise interested trainees. A database of ‘remote’ educational supervisors is being compiled. The College also has a fund to support trainees undertaking this, as otherwise much of this time would need to be self-financed.

A trainee describes his experience of an ‘OOPT’ in a developing country on page 27 of the Bulletin.

3. Developing policy to aid teaching, training, examinations and curriculum for overseas countriesThe RCoA is developing a targeted strategy for overseas doctors to benefit from training opportunities in the UK to improve anaesthesia skills back in their home country.

In conjunction with the AAGBI, a DVD of educational resources (e-SAFE DVD) has been developed for use by doctors in developing countries, including videos, selected e-learning and a large library of articles.

This was launched in April in the presence of HRH Princess Royal, the College’s Patron. Anyone who wishes to receive a free copy of this DVD can do so by filling out a form via the RCoA website www.rcoa.ac.uk/e-SAFE.

Recently, a four-day ‘Training the Trainers’ course was held at the RCoA for Iraqi educational supervisors who wish to modernise their teaching, training and curriculum.

Important points J Sponsorship is a privilege, not a

right.

J More detailed information on the scheme, and the appropriate application forms are available on the International Programmes section of the RCoA website.2

J Applicants need to be reminded that undertaking these posts, though extremely rewarding, can cause major upheaval to their lives.

J Although the common duration of placements is two years, the posts can be any duration up to two years but not longer. Short placements may be an attractive proposition for IMGs in sub-specialties such as cardiac anaesthesia who wish to update their practice for e.g. six months in a cardiac unit.

J The RCoA appreciates that two years may not seem enough time for IMGs to settle into the NHS system of training. This time is, however, a decision made by the UK Border Agency. The RCoA fights hard to prevent this period being reduced but has no overall influence on the UK Border Agency’s decision.

J There is no requirement for the IMG to have passed the Primary FRCA exam prior to starting the post. Doctors at different levels of experience can apply, from trainees to consultants. It is important to remember that the rota duties will probably be at a registrar level.

J Some IMGs are PLAB exempt prior to application. These are the doctors who are exempted from the Primary FRCA exam.3 They must, however, fulfil all the other criteria described by both the GMC and the RCoA.

A description of two IMGs’ experience in an MTI post is given on page 30 of the Bulletin.

2. Supporting trainees who wish to work and train in developing countries:There is abundant evidence demonstrating the benefit of UK


Dr T Gale, Clinical Senior Lecturer, Plymouth University

Mrs C Kennedy, Senior Team Leader, Anaesthesia National Recruitment Office

Mr M Roberts, Senior Psychometrician, Plymouth University Peninsula Schools of Medicine and Dentistry

Dr J Langton, Chair, National Recruitment Committee

Ranking applications for interviewLonglisting and shortlisting are carried out by the National Recruitment Office. Longlisting involves checking that all applicants are eligible to apply for particular levels of training posts in each recruitment round. Shortlisting is used to match numbers of interviewees to available slots at selection centres and has been criticised in the past due to the difficulty in scoring traditional white space questions with multiple raters in each UoA. The RCoA has developed a self-score assessment based on applicants’ portfolio as a more objective and standardised marker for all UoAs. Applicants are then ranked in each UoA preference for interview slots based on portfolio self-score. Candidates are given explicit guidance on the levels of experience/qualifications required at each point in various classifications plus the evidence needed at interview to verify their self-assessment. Verification of portfolio self-score is undertaken in the first half of the Portfolio station. Good correlations have been found between self-score and verified portfolio score at interview for both CT1 and ST3 recruitment (r = 0.92 for CT1, r = 0.93 for ST3).

Role of national recruitment office The Anaesthesia National Recruitment Office (ANRO) has a very important part to play in the operations at all stages of recruitment from before application through to the communication of offers and fill rates for each UoA. Some of the roles of the ANRO include:

J Provide information on selection process to all candidates.

J Act as portal for applications.

J Carry out longlisting process to ensure that all applicants are eligible to apply.

J Match applicants to highest ranked UoA dependent on portfolio self-score.

J Ensure that all eligible applicants receive a single guaranteed interview.

J Provide access to assessor training resources.

J Collate interview scores, candidate and assessor feedback.

J Oversee offers process.

J Communicate fill rates to UoAs.

J Co-ordinate clearing process.

Assessor trainingAll assessors are required to undertake equal opportunities training and familiarisation with the national interview process. An online assessor training tool has been developed in order to facilitate familiarisation with the process and scoring methods used in national recruitment for all three standardised stations. The online resource also provides training in evidence-based techniques on interviewing skills and opportunities for benchmarking candidates’ performance using actor scripted video materials. To date over 600 assessors across the UK have accessed this training which has been identified by HEE as an

The RCoA Recruitment Committee is tasked with the implementation and evaluation of nationally standardised selection processes for entry into training posts in anaesthesia at CT1 and ST3 levels. This group is responsible for defining the person specification for UK training posts and ensuring that selection methods comply with standards set by Health Education England (HEE). The committee has representation from England, Wales, Northern Ireland and Scotland and includes members who are involved with the development of selection practices for entry to ACCS and ICM training posts. Regular workshops are scheduled throughout the year with stakeholders from all Deaneries/Units of Application (UoAs) to facilitate standardisation of selection methods and to ensure that the process is responsive to feedback from participants and assessors.

National recruitment – anaesthesia


exemplar model for training assessors in specialty selection. Feedback from assessors who have completed the training has been very positive with the video benchmarking exercises being particularly well received.

Selection centre modelThe selection centre model which is used for national selection was initially based on a blueprint developed in the SW Peninsula Deanery as part of the Department of Health Acute Specialties Selection Pilot.1 Attributes/non-technical skills were identified from job analysis studies of anaesthetists2,3 and selection centre stations developed to test those attributes.4 Three stations have been developed further for the purposes of national selection which test attributes included in the national person specification5 and the assessment blueprint is shown in Figure 1.

There are two assessors in each station so that candidates receive six independent assessments in total. A clinical interview station (ten minutes) designed to assess behaviour in

challenging situations is combined with a presentation station (ten minutes) and a portfolio station (20 minutes). The presentation topic is given to applicants ten minutes prior to commencement of that station so that candidates are tested on their ability to work under pressure rather than deliver a previously prepared presentation. The portfolio station has been extended to 20 minutes' duration in recent years so that candidates are allowed more time to show documents they have organised in their portfolio and demonstrate evidence of being a reflective practitioner plus commitment to specialty at CT1 and career progression at ST3. The portfolio station is given extra weighting (100 marks in total compared to 50 for other stations) since 50 marks are awarded for the portfolio content, an assessment of the candidates’ past academic and professional achievements. Assessors will verify or adjust the portfolio self-score based on evidence shown in the portfolio. UoAs can utilise an extra station in their local selection centre should they deem

this appropriate, as long as the station counts for weighting equal to the other stations in the national format (i.e. total marks out of 50) and that the station assesses attributes listed in the RCoA person specification. One in four UoAs uses an additional station and simulation based stations have been implemented in this way.

The national interview format has a total score out of 200 for the three stations. The selection centre structure is the same for both CT1 and ST3 interviews but there are differences in the complexity of questions used and the way in which the portfolio station is scored between CT1 and ST3. An appointability threshold has been set at national station scores of 100 for CT1 applicants and 110 for ST3 applicants based on criteria agreed during RCoA stakeholder workshops.

CT1 recruitment During 2013, 1,030 applicants were interviewed for 572 posts in anaesthesia and ACCS anaesthesia. 95% of these applicants were allocated an interview in their first or second

Figure 1 2013 selection centre scoring blueprint showing assessed attributes and maximum scores

Assessor

Interview Portfolio Presentation

TotalsA B C D E F

Commitment to specialty/ career progression

5 5 10

Communication 5 5 10

Clinical judgement and decision making

5 5 10

Organisation and planning 5 5 5 5 20

Reflective practice 5 5 10

Team working 5 5 10

Working under pressure 5 5 5 5 20

Global rating 10 10 10 10 10 10 60

Station tools 50 50 50 150

Content of portfolio 50 200

Attr

ibut

es


choice UoA and only 1% received no allocation due to the fact that they were identified as ineligible through the longlisting process. Anaesthesia and ACCS anaesthesia was the preferred specialty in 51% and 31% of candidates respectively. 53% of interviewees had applied to only one specialty. The introduction of new 10-point scales for the global rating of overall performance in each station has helped to eliminate halo effects seen in last year’s station score distributions but did not result in a reduction in inter-rater reliability. Fill rates for 2013 recruitment were 100%.

Feedback was received from the majority (89%) of CT1 anaesthesia and ACCS anaesthesia interviewees and indicated strong general approval for all aspects of the national selection process. Feedback ratings were even higher than last year in terms of the interview process, i.e. relevance

and fairness of the three nationally standardised stations (Table 1). 83% of candidates felt that the offer system was a fair and reasonable process compared to 1% who did not.

82% of participants agreed that the single guaranteed interview across anaesthesia and ACCS anaesthesia was fair with 86% agreeing that the interview matching process was fair and transparent. 77% felt that the self-scoring portfolio system was fair in allocating interview slots compared to 7% who did not. Furthermore, 79% of trainees agreed that the drop down options for self-assessment were appropriate compared to 4% who did not.

All aspects of selection centre organisation elicited favourable responses from over 90% of respondents, demonstrating that the organisation of the interview process was well received in all UoAs.

Ratings of the three national selection stations (Clinical interview, Portfolio and Presentation) for ‘fairness’, ‘opportunity to demonstrate ability’, ‘appropriateness to training level’ and ‘relevance to anaesthesia’ are shown in Table 1. On all aspects of the stations at least 83% and generally over 90% of candidates gave positive (‘Agree’ or ‘Strongly agree’) responses. Negative ratings (‘Disagree’ or ‘Strongly disagree’) were below 5% on all items. This is more favourable than last year when negative ratings for opportunity to demonstrate ability were above 5% in all three stations.

ST3 recruitmentDuring 2013 there were two interview rounds for ST3 applicants, six months apart. In Round 1 there were 454 applicants for 442 posts. Candidates who scored a minimum of 110 points in the three national stations were

Table 1 Frequency distributions of responses to items on the three nationally standardised stations

Strongly disagree Disagree Neutral Agree

Strongly agree

clinical interview

The clinical interview was conducted fairly 0.4% 0.8% 4.0% 56.0% 38.8%

It gave me an opportunity to demonstrate my ability 0.4% 3.3% 12.5% 54.2% 29.5%

The interview was set at an appropriate level for doctors at the end of foundation training

0.6% 0.9% 4.8% 58.7% 35.0%

The interview was relevant to selection for specialty training in anaesthesia

0.6% 0.8% 5.5% 59.7% 33.5%

portfolio station

The portfolio station was conducted fairly 0.3% 0.7% 4.2% 53.5% 41.3%


The portfolio stations was set at an appropriate level for doctors at the end of foundation training

0.4% 1.5% 4.4% 55.4% 38.2%

The portfolio station was relevant to selection for specialty training in anaesthesia

0.3% 0.9% 5.4% 53.4% 40.0%

presentation station

The presentation station was conducted fairly 0.2% 0.9% 4.3% 60.6% 34.0%


The presentation topic was set at an appropriate level for doctors at the end of foundation training

0.2% 1.2% 6.9% 56.7% 35.0%

The presentation station was relevant to selection for specialty training in anaesthesia

1.0% 1.7% 11.8% 55.3% 30.3%


Acknowledgements We would like to thank Mr Richard Bryant (Director of Training and Examinations) and staff at the ANRO for their continuous involvement in the development and evaluation of the national selection process.

References 1 Lam H et al. The Anaesthesia

Recruitment Validation Group (ARVG) Experience. RCoA Bulletin 2009;57:24–26.

2 Patterson F, Ferguson E, Thomas S. Using job analysis to identify core and specific competencies: implications for selection and recruitment. Med Educ 2008;42:1195–1204.

3 Kearney RA. Defining professionalism in anaesthesiology. Med Educ 2005;39:769–776.

4 Gale T et al. Predictive validity of a new selection centre testing non-technical skills for recruitment to training in anaesthesia. BJA 2010;105:603–609.

5 Anaesthetics National Recruitment Office, Health Education West Midlands (http://anro.wm.hee.nhs.uk).

deemed ‘appointable’ in any deanery. The performance of 14% of candidates fell below this threshold. The 6% of candidates who scored between 100 and 109 points were eligible to be invited for clearing. The overall fill rate for posts increased from 84% to 88% after national clearing interviews. Candidate feedback for ST3 recruitment was also very positive with a similar picture to that seen with CT1 recruitment.

Plans for 2014The RCoA is included in the HEE Oriel pilot for 2014 which affects the application portal for ST3 posts in multiple specialties. The front end of the web-based application system has been streamlined so that applicants can use one web-based platform for application to multiple specialties, booking interview slots and receiving offers. This should improve the trainee experience and will be especially valuable for CT1 recruitment when applicants commonly apply to multiple specialties – CT1 recruitment will be included at a later phase of the pilot.

During 2014 the ANRO will be running a LAT only recruitment round with interviews taking place after the Primary examination scheduled for May 2014. This will be run centrally for all UoAs by the ANRO. The overall quality of applicants in 2013 for LAT posts was very good and all UoAs will be encouraged to take part in this extra opportunity to fill training posts.

Another development for 2014 is the opportunity for neighbouring UoAs to cluster application processes so that trainees can sub-preference multiple training slots in two UoAs within one application. Benefits to UoAs which take part are the sharing of resources required for running selection centres and potentially higher fill rates for posts in that region. Peninsula and Severn are clustering their ST3 interviews for 2014.

Further information is available for applicants and assessors involved in national recruitment for 2014 at the ANRO website http://anro.wm.hee.nhs.uk.


'Initially, the Fellowship of the Faculty was awarded, by election only, to 170 "eminent" members of the specialty. They must all have been crucial to the early establishment of the specialty, but we do not know nearly enough about many of them.'

Dr A Thornberry Past Council Member, Gloucestershire

Conserving the pastBen began by starting to conserve, catalogue and digitally copy those, sadly far from complete, Faculty records held by the College. He also started to sort an early collection of unlabelled photographs and began a process of identifying the subjects. It was hoped that publishing photographs in the Bulletin might aid the process, but initial attempts have proven disappointing. As a result we plan to arrange a day at the College for those senior Fellows who have shown an interest so that they can work their way through the collection.

Records lost – and foundAs noted above, the College has very few records from the days of the Faculty at the Royal College of Surgeons in Lincoln’s Inn Fields. There are some very early committee minutes, but none of the Board of Faculty. Importantly, we have the Roll which is signed at the time of award of the Fellowship, and many of the early signatures (including the initial 150 appointed by election) are those of legends, including one simply reading 'Nuffield'. Unfortunately (although perhaps not surprisingly), not all signatures in the Roll are as legible as his, and we had no way of confirming who they are. Some lists of names were published in the early journals, but we still lack evidence that these are complete.

Because of these gaps, the President suggested that we should see what the RCS has in the way of relevant records, and kindly made the first approach so that Tony Wildsmith could review what is there. They have almost no

original Board of Faculty documentation either, but a breakthrough followed a visit to their library. From 1948 until 1971 regular reports went from the Board of Faculty for approval by Council so both major decisions and lists of Fellows are recorded. From 1971, until the establishment of the fully independent Royal College of Anaesthetists, ‘our’ minutes were bound with those of the Surgeons’ Council. These records have not been digitized, but discussions on how we can obtain either paper or electronic copies are planned.

The Lives of Fellows Project – historicalWith the prospect of achieving a complete list of Fellows the next target is to obtain biographical material on those who are no longer with us, they being the generation who were so important to the establishment of the specialty after the Second World War, and the eventual achievement of an independent Royal College. Information about the more prominent Fellows may be easy to find, with obituaries and local records a useful resource for others, but a potential problem is that the information will not be in the same format and therefore not easily accessible. It has been agreed that, for continuity and ease of access, a biographical project will build a library of material to be held by the College in the same standard format as that for current Fellows (see below). The History of Anaesthesia Society has indicated a willingness to be involved in this, and it is hoped that trainees may find it an interesting project too.

The College Archive Committee – an update

Archive activity in the College can be divided neatly into two components: researching and recording past activities, and building a framework to record contemporaneous activity for future historians. These duties are in the hands of a small committee chaired by the Honorary Archivist (Prof Tony Wildsmith) and assisted by a part-time archivist. At the time of my last report (Bulletin 78, page 35) the incumbent was Ben Hedley, but unfortunately (for us, not him!) he has moved on to full-time employment elsewhere. A replacement, while approved, has yet to be appointed, but much has been achieved in the interim.


group might be the basis for the second volume with an essay on the evolution of the Fellowship, award by examination having been introduced then.

Setting a deadline for publicationThere is a strong feeling within the Archive Committee that to we need to start putting these ideas into practice, and that it would be ideal if we could combine publication of our first volume of ‘Lives’ with a College anniversary celebration. We are too late for the 25th anniversary of the move from faculty to college status (2013), and another 25 years is rather long to wait, but fortunately there is another important anniversary coming that gives us an achievable target.

In 2017 it will be 25 years since the College of Anaesthetists (within the RCS) became the fully independent Royal College of Anaesthetists (16 March 1992). It was then that we received our Royal Charter and Coat of Arms (see image below), and the anniversary of that event will be a very fitting occasion on which to publish the first of what we hope will be a series of biographical collections.

little as you wished, but suggestions for content would be provided in an accompanying guideline.

ConfidentialityThe purpose of the exercise is to create an historic record that could be of value to historians and possibly genealogists in the future. No one would have access to the data, without your permission, within your lifetime. You would have the freedom to update or remove the record at any time, but we hope that the latitude allowed with this suggested format would encourage you to provide information in your biography for future generations to appreciate.

Publishing historic dataA number of other colleges have ‘Lives’ projects: they publish volumes of biographies at intervals, although doing that in traditional hardback format is an expensive exercise. That could be overcome by ‘publication’ in the same way that College reports are now dealt with: primarily online with some paperback copies if needed. The task of collating the data for all past Fellows of the College is a big challenge and it has been suggested that this be divided into manageable groups by starting at the beginning and considering, in sequence, those appointed during the term of office of each Dean/President.

Initially, the Fellowship of the Faculty was awarded, by election only, to 170 'eminent' members of the specialty. They must all have been crucial to the early establishment of the specialty, but we do not know nearly enough about many of them. Thus, the first Lives of Fellows of the Royal College of Anaesthetists would describe these individuals, perhaps with an introductory essay describing the foundation of the Faculty. In 1953 the Fellowship was extended to 131 more who were both holders of the DA diploma (previously allowed to be members of the Faculty) and had been appointed as a consultant in the new NHS. This similarly important

The Lives of Fellows Project – the futureThe establishment of a collection of biographical material on our Fellows is a project that has been under intermittent consideration for decades, but lack of financial resource has been a major issue. Digital storage is now an accepted and relatively cheap way of keeping records, and the workload can be kept down by asking everyone to submit their own biography in a structured electronic document. However, the sheer number of current Fellows (nearly 12,000) still makes collecting, cataloguing and storing the material a significant project. Archival assistance is essential for the project to be a success.

A semi-structured electronic record The development of a uniform record (‘one size fits all’) has been a challenge to all the many anaesthetists who have considered the Lives of Fellows project over decades. Clearly, it would help to use the same format for recording the biographies of past as well as current Fellows, but we are a diverse collection of individuals and times have changed. After much recent debate it has been agreed that less is more.

The current proposal is that the record should consist of four sections. The first would include some personal details, such as your name, date of birth, primary qualification and date of obtaining the Fellowship. Ideally, the majority of this information could be automatically filled in from the College database when the Fellowship is obtained. To this there would be the option to add a little more detail such as 'familiar name' which would overcome the problem of identifying individuals who are either known by their middle name or by a completely different one to that on their GMC registration!

The other three sections would simply have headings (Early Life, Anaesthetic Career and Other Matters) with space for free text. This would allow you to write as much or as

Royal Charter and Coat of Arms


'While it is important for the NIAA and our profession to support trainees in these posts, it is also important not to forget that there may be many others who need to be nurtured.'

Dr R Moonesinghe NIAA Academic Training Advisor These posts provide a huge opportunity

for a select few trainees. However, while the number and geographical spread of such posts are increasing, we know that demand from talented potential academics outstrips the supply. Thus, while it is important for the NIAA and our profession to support trainees in these posts, it is also important not to forget that there may be many others who need to be nurtured. Some may not have the opportunity to apply for these posts, and others (like me) may realise much later in their training that they would like to ‘dip their toes’ into academic waters. Another group may also believe that, due to geography or other circumstance, academic training is inaccessible to them.

Breaking out of the ‘ivory towers’Data published in the BJA recently highlighted that the majority of British peer-reviewed papers published in anaesthesia journals originated from a handful of institutions (the ‘ivory towers’ of UCL, Imperial, Oxford and Cambridge). However, one only has to glance at our academic leaders to see that many of them do not originate from these institutions, but from all over the UK, and some from – dare I say it – clinical departments which have not traditionally been attached to a university or in any way labelled as ‘academic’. Encouragingly, we can also feel confident that while most anaesthesia-related manuscripts will be published in specialty-specific journals, our more successful peers, many of whom are based outside the ‘ivory

towers’, are publishing in high impact general journals such as the NEJM, Lancet, JAMA and BMJ. This is a great result for them, and a great result for those of us who want to see our profession recognised by the wider medical community, as a key player in academic endeavour.

Challenging perceptionsI wonder what trainees’ perceptions of research are? Inevitably, the frame of reference will stem from undergraduate days, and this commonly involves basic science or ‘bench-top’ research for intercalated BSc projects. There are a number of flourishing basic science groups which have anaesthetists at the head, and are supporting postgraduate trainees to do higher degrees. Those who want to follow a basic science or translational research pathway will certainly need to join a university department to be able to pursue those ambitions. These departments lead exciting and innovative work ranging from drug and device development to genomics and metabolomics. However, there are also many other opportunities for trainees and consultants to get involved in research. Health services research (HSR) in perioperative medicine is flourishing. HSR describes research involving patients; it encompasses everything from clinical trials to epidemiology, healthcare evaluation, organisational development and improvement science. These areas are key to the professional development of all anaesthetists and central to ensuring our patients receive the best

A key part of the NIAA’s strategy is to support trainees who wish to engage in academic training. The 2005 ‘National Strategy for Academic Anaesthesia’, which was led by Professor Jaideep Pandit, perhaps inevitably focused on the importance of trying to attract trainees to a career in academic anaesthesia at a very junior stage – including those still at medical school. This strategy mirrors that of the ‘Walport report’ which led to the development of the National Institute for Health Research’s academic pathway. Trainees may enter this pathway during foundation training, early specialty training or after completion of a PhD or MD(Res).

A strategy for trainee engagement with academic anaesthesia


website for further details (www.niaa-hsrc.org.uk/article.php?newsid=147). An aspiration is to set up similar fellowships in other parts of the country – I would be keen to discuss how this might be possible, with potential supervisors or trainees.

Finally, the NIAA is keen to support the development of trainee research networks. The SWARM group based in the South West has achieved great success in terms of recruiting patients to studies and getting a large number of trainees involved in research activity. More of these networks are cropping up across the country. Enthusiastic trainee leadership and strong consultant support are required to sustain these exciting enterprises. We look forward to working with those such as Tom Clark and Gary Minto who are providing guidance and support for those who want to set up their own local network. The first SNAP (May 2014) (www.niaa-hsrc.org.uk/SNAPs) will hopefully be an important national project for fledgling trainee networks to engage with.

In summary, the future is bright for academic anaesthesia. If you have any questions please contact me via the NIAA website (www.niaa.org.uk).

time to come, we will be able to build a more complete picture of academic training activity. To that end, we are very keen for trainees to join the NIAA’s researchers database, and to recommend to their supervisors that they do the same. We would like this to be a resource which trainees anywhere in the country can use to find research opportunities and contact potential mentors or supervisors. The key to trainees achieving academic success is linking with a high quality supervisor. One of the aims of the database is to make this possible and more accessible to trainees everywhere (www.niaa.org.uk/researchDb).

The HSRC itself has a fellowship programme. Matt Oliver who is the current HSRC Fellow is entering the second year of his PhD which is based around the NELA and supervised by myself and Mike Grocott, the HSRC Director. We are keen to appoint more fellows. The posts are supported by the HCA London Clinic, and a modest clinical commitment as an RMO on their ICU is remunerated with a full salary enabling approximately 80% of working time for research. These are open vacancies, so, if you are interested in applying, please look at the HSRC

quality perioperative healthcare. The creation and early successes of the NIAA’s Health Services Research Centre (HSRC) have hopefully brought these areas of academic activity to the attention of a wider audience. The National Audit Projects (NAPs), the new Sprint National Anaesthesia Projects (SNAPs), and the National Emergency Laparotomy Audit (NELA) all fall under the governance of the HSRC. Many of the individuals who drive such projects are not professors and do not hail from ivory towers; hopefully, such examples should encourage trainees to engage in HSR.

How the NIAA is trying to reach youThere are a number of different ways in which the NIAA and others are trying to ‘grow’ academic trainees. First, education, education, education. The academic strategy group of the London Academy of Anaesthesia recently joined forces with the NIAA to host a two-day ‘Introduction to Academic Anaesthesia’ course. The course was fully booked and brilliantly received by the trainees who attended. As the course was held in London, most speakers were London-based in order to keep the costs low and therefore to provide the meeting free of charge; however, trainees who came from outside the capital left enthused and wanting to hold regional meetings. The NIAA is keen to support such meetings featuring local speakers, so that trainees from all over the country might have local academic endeavours brought to their attention.

The NIAA has published its first academic trainee brochure. We have invited contributions from all trainees who responded to our call (via schools of anaesthesia) to let us know if they were in academic placements. We hope that this report will showcase the breadth and depth of academic anaesthesia training in the UK and highlight that opportunities abound. We suspect that we have tracked down only a small percentage of academic trainees this year, but hope that, in

Drinks after the Joint London Academy/NIAA Introduction to Academic Anaesthesia Course


‘The expectations of life depend upon diligence; the mechanic that would perfect his work must first sharpen his tools.’ – Confucius

The award of a certificate of completion of training (CCT) determines a clinician has acquired the knowledge, skills and attitudes to deliver the elective and emergency duties required within that specialty. Given the demands of a long and challenging training programme, what might be the appeal in undertaking a post-CCT fellowship, and what is driving their expansion?

Dr I Fleming, Post-CCT Fellow in Liver Transplantation and Cardiac Anaesthesia, King’s College Hospital NHS Foundation Trust

Post-CCT fellowships: experiences of a reformed sceptic

Pressure is on trainees like never before to deliver prompt exam success and keep pace with the demand of workplace assessments. Competency-based progression is required of the RCoA by the General Medical Council (GMC) and the public at large, yet for the aspiring clinician satisfactory outcomes defined by competency-based training and professional fulfilment are different entities.

Post-CCT fellowships are positions where specific personal interests can be mastered through advanced, targeted training. Developments in competence, confidence and sub-specialist skills are the main reasons to undertake such posts. Recent years have seen a dramatic increase in their number, yet their existence has proven contentious.

This is a time of considerable uncertainty. There is political and economic pressure to provide 24-hour consultant-level care for sub-consultant costs. To many trainees, the reward for completing a long, prescriptive training scheme should be the ability to perform (and be paid) at the level to which they are trained. The British Medical Association (BMA) has expressed concern that post-CCT fellowships may undermine the value of the CCT, stating explicitly that the award should remain the end point in training and define eligibility for consultant selection.1 In May 2013, the BMA Junior Doctors’ Conference voted to resist job roles that prolong the path to consultancy, including sub-consultant and post-CCT fellowship posts.

Approaching the finish line For most of my training, the notion of continuing in a non-consultant capacity beyond completion of training was an

unappealing proposition. In becoming eligible for consultant selection, I did not intend to become distracted by alternatives. Only in my final year, when required to seriously consider the options, did I contemplate the merits of pursuing training beyond CCT.

As the CCT date approached, I felt prepared for the clinical pressures of independent practice, and comfortable (within reason) of managing whatever came next. To this end the training scheme had delivered on its objective. Before settling into consultancy, I wished to explore sub-specialties in which I had little prior experience. This would complement a career interest in anaesthesia for major surgery, and benefit patients I manage in future. Ultimately, I decided to pursue precisely what I had earlier ruled out: a post-CCT fellowship.

Fellowship roleFollowing competitive interview, I secured a fellowship in liver transplantation and cardiac anaesthesia in King’s College Hospital, London. King’s has the largest liver transplant programme in the United Kingdom, and an international reputation as a centre of excellence. This combined post is aimed at senior trainees, and is suitable for qualified anaesthetists seeking an advanced training period. There is a 1-in-5 on call commitment for liver transplant theatre, with remote on call for out-of-hours transplants and emergency surgery for hepatobiliary patients. Consultant-led care requires that senior colleagues are present for elective and emergency cases, providing ample learning opportunity. One day a week is dedicated to cardiac theatres,


providing complementary exposure to major surgery. The hospital has a strong track record in audit, research and development, and service innovation. Engagement in non-clinical projects is expected and well supported.

The right decision?The prospect of working in high-risk specialties in a respected institution, coupled with warm personal recommendations from former fellows, convinced me the experience would be valuable. Without competition from mandatory training requirements, I relished the more open-ended nature of personal development goals. From an educational perspective, conditions are ideal for effective learning since many pre-requisites are met, including intrinsic motivation, relevance and emotional engagement with the subject matter.

Focused exposure to high-risk patients, both adult and paediatric, challenged existing understanding and enhanced competencies acquired during formal training. For example, I found that drug doses and fluid volumes required for liver transplantation are markedly different to those expected from conventional indexing to patient body mass. Regular management of massive haemorrhage and reperfusion toxicity in comorbidity-ridden patients has afforded a fluency readily transferable to other specialties, such as trauma and vascular anaesthesia.

My colleagues are personable, highly accomplished clinicians who have made the learning curve a rewarding experience. I have been treated as a competent and accredited anaesthetist, able to contribute meaningfully to the work of a highly specialised team.

Time was apportioned to management, leadership, and clinical governance activities. This included useful experience with quality of care indicators through leading a large survey of patient satisfaction, the results of which contribute towards departmental audit and revalidation. There was direct relevance with my

aspirations for, and expectations of, consultant life.

Was the decision to accept a fellowship role whilst passing over potential consultant appointment sensible? I am delighted for some of my training colleagues who secured substantive consultant posts directly from training. However, I have no regrets since the professional fulfilment has offset the lower pay and the knowledge that the consultant selection process remains ahead of me. Once in a consultant post, a similar opportunity is unlikely to present again.

Nationwide, the quality of fellowships is not assured. Some positions confer excellent training whilst others are designed more to fulfil service provision requirements. Such variation may be explained by the lack of quality assurance frameworks for post-CCT fellowships that are pre-requisites for training positions. Considerations when opting for a post-CCT fellowship include the following:

J Be clear about how the post will enhance career prospects.

J Ensure training is consistent with your existing curriculum vitae and, if not, be prepared to explain this at interview.

J Feedback from current and previous fellows.

J On-call arrangements.

J Roles and experience of consultant trainers.

J Institutional record in the specialty.

J The extent to which non-clinical work is supported.

J Study budget and availability.

J Effect on family life.

Drivers for change Post-CCT fellowships have gained prominence in recent years. A pan-specialty survey of 1,581 surgical trainees in the United Kingdom demonstrated that three-quarters have, or intend to, undertake a fellowship (77.6%).2 Motivating factors include a perceived ‘value added’

when differentiating candidates for consultant selection, and achieving the requisite confidence and competence for independent practice. Interestingly, this survey revealed little support for making fellowships compulsory for consultant appointment (19.9%).

Despite some criticism, changes to the training curriculum and the implementation of Working Time Regulations do not appear to have had an adverse influence on training. GMC surveys of training show that overall satisfaction levels are high, supervision has been maintained and trainees feel confident about meeting required competencies.3

Workforce modelling performed by the Centre for Workforce Intelligence (CfWI) projects that, at the current trajectory, there will be a mid- to long-term surplus of fully-trained hospital doctors than required by expected demand.4 An extensive CfWI review is underway specific to anaesthesia and intensive care medicine (ICM), suggesting numbers are better aligned; the latest is that anaesthetic training numbers should remain essentially unchanged with a small increase in ICM CCTs possibly required.

Though regional and specialty-specific variation exists, competition for consultant posts can be substantial. Especially for more popular vacancies, possessing additional fellowship experience may confer a selection advantage. There will inevitably be a knock-on effect for future trainees completing the training scheme, where additional fellowships may become the norm rather than the exception.

There appears a mutual need for such posts to exist. For the individual, time is allocated to enhance one’s curriculum vitae through more audit, research, publications, leadership and management roles prior to consultant interview. For the service, there is a financial incentive, whereby it is cheaper to employ a clinician of sub-consultant grade. Furthermore, service delivery demands are fulfilled


more readily through greater ability to staff on-call rotas. Providing more qualified anaesthetists on site out-of-hours delivers part of the solution to the planned shift towards 24-hour consultant cover.

Ensuring quality and sustainabilityThe key to success of post-CCT fellowships is that the professional development and career prospects conferred must outstrip potential drawbacks of reduced pay and rota staffing requirements. Overwhelmingly, the raison d’être must be on training and development, rather than service provision.

The United States has a well-developed fellowship system, whereby quality assurance is maintained through annual reviews required by the Accreditation Council for Graduate Medical Education (ACGME).5 ACGME is responsible for credentialing over 9,000 residency programmes involving 116,000 residents.

The Royal College of Surgeons of England (RCS), in response to concerns over the quality assurance of many posts in the United Kingdom, has followed suit. In 2012, the RCS initiated the National Surgical Fellowship Scheme.6 The purpose is to select, manage and quality assure post-CCT fellowship appointments in England, Wales and Northern Ireland. The approval process requires that the post offers a high quality, structured educational experience in a surgical sub-specialty that is not readily available during the training curriculum. Accredited posts are expected to be more competitive through their ability to attract high calibre applicants.

Similar progress is being made with hospital physician training. The Joint Royal Colleges of Physicians’ Training Board (JRCPTB) is piloting an accreditation process for post-CCT fellowship posts, which allows physicians to identify appropriate posts to further specialist training.7

The rate of proliferation of fellowship programmes has exceeded the rate at which they can be regulated. In anaesthesia, with its proud history of innovation and development, it is perhaps surprising that we find ourselves behind in this area. A national strategy to credential post-CCT fellowships in anaesthesia is awaited, and the RCoA is working to ameliorate this issue. In time, such training should become a real asset to the holder, and of demonstrable quality to potential employers and the public.

Future directionAt the time of writing, final publication of the Shape of Training (SoT) review is awaited.8 This independently seeks to identify issues and propose options to reform postgraduate medical training in order to best serve the needs of patients, trainees and the service. One theme under scrutiny is the balance of the workforce between generalists and specialists. Publication of this review may have repercussions for the standing of fellowships. A plausible scenario is the SoT advocating a more ‘generalist’ training, with specialist interests accommodated through post-CCT fellowships. This is consistent with the RCoA’s ambitions of developing and credentialing such posts. Despite the BMA’s objections to their existence, an increasing number of sub-specialties have witnessed these appointments become a de facto requirement to be competitive for consultant selection.

Notwithstanding earlier reservations, I have become an advocate of post-CCT fellowships. Completion of training is a defining stage in one’s career, yet reaching this point does not equate to fulfilling one’s potential. This experience has proven a great ‘finishing school’, allowing me to attain competencies exceeding those demanded from the training scheme. And now, just the small matter of tracking down a consultant post…

References1 Shape of Training: Call for ideas and

evidence – BMA response. BMA, 2013 (http://bma.org.uk/working-for-change/negotiating-for-the-profession/nhs-education-and-training/shape-of-training-review).

2 Fitzgerald JEF et al. Clinical Fellowships in Surgical Training: Analysis of a National Pan-specialty Workforce Survey. World J Surg, 2013;37(5):945–952.

3 National Training Survey. GMC, London (www.gmc-uk.org/education/surveys.asp).

4 Shape of the Medical Workforce: starting the debate on the future of the consultant workforce. Centre for Workforce Intelligence, 2012 (www.cfwi.org.uk/publications/leaders-report-shape-of-the-medical-workforce).

5 Accreditation Council for Graduate Medical Education (www.acgme.org/acgmeweb/).

6 National Surgical Fellowship Scheme. Royal College of Surgeons of England (www.rcseng.ac.uk/surgeons/training/fellowships).

7 JRCPTB accredited post-CCT fellowships project. Joint Royal Colleges of Physicians’ Training Board (www.jrcptb.org.uk/trainingandcert/Pages/Post%20CCT%20Fellowship.aspx).

8 The Shape of Training Review (www.shapeoftraining.co.uk) (accessed 25 October 2013).


'Improving patient safety must be a national priority'

MATCH (Multidisciplinary Action Training in Crises and Human Factors) training for peri-operative teams

Dr E Cook MATCH Fellow and SpR in Anaesthesia, Royal London Hospital

Dr Hunningher, MATCH Lead and Consultant in Anaesthesia, Royal London Hospital

The national need for team trainingRecent reports by Francis and Berwick have highlighted the importance of the culture of care and of engaging teams in every part of each NHS organisation.1,2

The Francis report, published in February 2013, followed a public inquiry into poor standards of care at the Mid Staffordshire NHS Foundation Trust. Francis identified factors that came together to produce a negative culture within the Trust. He compiled 290 recommendations, to guide a shift towards a more positive culture within the NHS. Openness, candour and transparency were identified as essential values for all. Francis felt that re-emphasising the importance of common values and fundamental standards of care was paramount and, above all, the patient should be first in everything we do.

In response to this, Dr Berwick, a long-term advocate of the NHS and its values, was invited to produce a report to guide the UK government and the NHS towards improvements. He stated that improving patient safety must be a national priority. He identified that in order for the system to improve there must be recognition of the need for cultural change. To achieve better care, we must work closely with patients and carers towards a more transparent, safer NHS and we should give support to staff, to learn, develop and improve patient care themselves.

Francis and Berwick suggested that we must focus on the indisputable need for safer patient care but that this is inextricably linked to staff contentment. Staff satisfaction can only be improved through empowerment, effective leadership, adaptability and accountability, communication and a commitment to learning and skill development.3

David Dalton, the Chief Executive of Salford Royal Foundation Trust, defined organisational culture as ‘shared views on the way staff should work together and treat each other and their patients’.4 His team’s work has focused on human factors training as a means to improve teamwork, communication and leadership. This, backed by a supportive executive team that listen to staff, has helped Dalton to be within reach of achieving his ambition to become the safest hospital in the NHS. Salford Royal has the lowest mortality rates in the North West.5 As an indicator of staff engagement Salford Royal can boast that it achieved the best acute trust results nationally in the NHS Staff Survey in 2012.

The evidenceThere is a growing body of evidence that has guided the development of the MATCH Training Day. Poor teamwork is often cited as a major factor in adverse events.5 Teamwork and communication deficiencies can predict clinical error.6 There is a positive link between team briefing practices and attitudes towards safety and, also, briefing and debriefing tools have been shown to improve theatre efficiency.7, 8

What is MATCH?Driven by the national focus to change culture and improve safety in the NHS, a group of front-line clinicians and educators at Barts Health have developed a perioperative team training programme: ‘MATCH (Multidisciplinary Action Training in Crises and Human Factors).’


and Nick Sevdalis. Future seminars are also planned, focusing on the MATCH raison d’être: safety, teamwork and human factors. It is hoped that the MATCH programme will lead to a more psychologically safe culture in theatre and better patient care. We aim to embed the Berwick mantra ‘A promise to learn, a commitment to act!’ in every member of the perioperative team. We hope we can achieve this game, set and MATCH!

Follow us at: Culturechange@MATCHTeamtime.

References1 Francis R. Final report of the Mid

Staffordshire NHS Foundation Trust Public Inquiry, 2013 (www.midstaffspublicinquiry.com/report).

2 Berwick D. A promise to learn – a commitment to act. Improving the safety of patients in England. National Advisory Group on the Safety of Patients in England, 2013.

3 Reh J. Company Culture: What it is and how to change it (http://management.about.com/cs/generalmanagement/a/companyculture.htm).

4 Dalton D, Moran S. Human factors and safety culture in healthcare. The Health Foundation, 2013.

5 Salford Royal NHS Foundation Trust (www.drfosterhealth.co.uk/hospital-guide/trust/Salford-Royal-NHS-Foundation-Trust-113.aspx).

6 Sevdalis N, Hull L, Birnbach D. Improving patient safety in the operating theatre and perioperative care: obstacles, interventions, and priorities for accelerating progress. BJA 2012;109: (suppl 1):i3–i16.

7 Manser T. Teamwork and patient safety in dynamic domains of healthcare: a review of the literature. Acta Anaesthesiologica Scandinavica 2009:53(2):143–151.

8 Bethune R et al. Use of briefing and debriefing as a tool in improving teamwork, efficiency and communication in the operating theatre. Postgrad Med J 2011:doi:10.1136/pgmj.2009.095802.

9 Andrews S, Cronin, G. After action reviews: a new model for learning. Emergency Nurse 2009;17(3):32–35.

10 King HB et al. TeamSTEPPS: Team strategies and tools to enhance performance and patient safety. Advances in patient safety: New directions and alternative approaches. 2008;3. AHRQ.

positive feedback from all participants and generated ideas for further development of the programme.

The next phaseOver the last six months, the project has grown and developed and has won a local trustees award to take the work forward. Five core principles have been identified to provide focus for discussion and training, adapted from TeamSTEPPS:10 a validated multidisciplinary training course developed in the USA. These five core principles comprise team communication, team co-ordination, leadership, mutual support and situation monitoring. The revised programme was launched last summer with a series of seminars, including a lecture by the inspirational Professor Michael West from Lancaster University ‘How to develop a culture of high quality care’, and an evening seminar with the title ‘What makes an effective team?’ with a selection of speakers including Mr Ajit Abraham (Safety improvement), Professor Shona Brown (Organisational development), Judy Walker (AAR), Dr Chris Sadler (Human factors) and Dr Pete Shirley (Checklists). A robust research protocol has also evolved, in collaboration with Professor Della Freeth, Queen Mary’s University, in order to capture data to support the implementation and growth of the new training programme. Team briefing and debriefing will be promoted as tools to improve communication. Staff will be encouraged and empowered to utilise AARs in order to learn from incidents and develop the team in the operating department, and not just rely on incident reporting systems. In addition to the core team training day, there are strategies to encourage staff engagement and sustainment of the anticipated improvements, in particular by the use of email, a MATCH website, Twitter and developing resources including perioperative emergency signage. The MATCH faculty team has grown and developed and is benefitting from training from human factors experts, such as Jane Carthey

The pilotMATCH training was first piloted in November 2012, supported by a London Deanery grant. The one day course was written and developed by Dr Annie Hunningher and Tim Stephens, lead nurse for patient safety. The logo was created, putting the patient at the centre, with all members of the multidisciplinary team around them. The MATCH training day used small group discussions, presentations and team based exercises to explore ideas around effective teamwork, team briefing and debriefing and the use of the WHO surgical checklist. The entire MDT, including surgeons, anaesthetists, ODPs, nursing staff, HCAs, porters and recovery staff were included. The After Action Review (AAR) technique for debriefing was introduced. This process encourages open, blame-free communication and team learning, in response to events the team experience together.9 Team members attended a day of training away from theatres and, in addition to sharing lunch together, were given the book by Atul Gawande ‘The Checklist Manifesto’, along with a golden lanyard displaying the MATCH logo. The pilot demonstrated the feasibility of the training day, boosted staff morale and introduced clinical staff and trust management to the concept that team training could aid improvement measures. It elicited

Front: Helen Mills, Annie Hunningher, Omaima Glesa

Back: Alastair Mulcahy, Della Freeth, Alison Stonehouse, Esther Cook, Shona Brown, David Annan, Ajit Abraham, Jane Carthey

MATCH Faculty Team training day


Report of the Senior Fellows Club 17 October 2013

The Chairman welcomed the fifty members and guests to the autumn meeting of the Senior Fellows Club held at The Assembly Rooms, Newcastle upon Tyne. It is intended that members would be able to bring guests to the out of London meetings. She thanked Ms Karen Slater and Ms Rosemary Sayce for the administration of the meeting and in particular for compiling the list of attractions, hotels and restaurants in Newcastle.

Dr John Crowhurst, Honorary Archivist of the Obstetric Anaesthetists’ Association, gave a short presentation to ask members to send any information they have of the development and achievements of the sub-specialty to him at [email protected]. He intends to link this work with that from Australia and the EU.

Dr Anna Batchelor, a member of the College Council representing the President gave an update on College matters. She reported that:

J Independent Review of the Shape of Medical Training has recommended more generalist initial training (akin to CCT) before proceeding to specialist training. Commissioning groups would decide on the number of specialists required which would make workforce planning difficult.

J Trusts are reducing the number of PAs allocated to professional development in favour of service. This has caused some difficulty in recruiting examiners as well as for other work for the College.

J More than 30 departments have declared interest in the ACSA (Anaesthetic Clinical Services Accreditation).

J e-learning and e-portfolio have been extremely popular.

The guest speaker was Professor John Norman, formerly Professor of Anaesthesia at the University of Southampton, and his subject was 'The Legends of R J Mitchell, Aircraft Designer'. Professor Norman’s interest in Reginald Joseph Mitchell (1895–1937) was stimulated after an unexpected visit in 1975 to his house by Gordon Mitchell, the son of R J Mitchell. Professor Norman lives in the house that R J Mitchell built in 1927 in Southampton.

He started his talk with a short clip of the 1942 film 'The First of the Few' starring Leslie Howard as Mitchell. Mitchell left school at 16 and became an apprentice at an engineering firm before joining in 1917 the Supermarine Aviation Works in Southampton where he rose very quickly to become Chief Designer in 1919, and then to Chief Engineer and Technical Director. When Vickers took over Supermarine in 1928 it was on condition that Mitchell stayed with them as designer. He designed several seaplanes, light aircraft, fighters and bombers. Mitchell designed a plane which won the Schneider trophy for Great Britain in 1931 but he is probably best remembered for designing the famous Spitfire fighter in 1934. Although both Spitfire and Hurricane were vital to winning the Battle of Britain, it was the Spitfire which caught the public’s imagination. The basic Spitfire design was capable of development to which major improvements in engine technology contributed. In total 21,131 Spitfires were built until production ceased in 1949 and some 300 survive around the world of which some 50 are still airworthy. They can be seen at various museums including the one based at RAF Manston. Mitchell was awarded the CBE in 1932 and died in

1937 from carcinoma of the rectum. He was a leader, team builder and a brilliant designer and engineer.

The chairman thanked Professor Norman for a most interesting and fascinating presentation.

Date of next meeting The spring meeting will be held on Tuesday June 3, 2014 in London when the guest speaker will be Mr David Rendall, opera singer.

Dr K Matheson, Chairman


[email protected] www.e-la.org.uk Dr A McIndoe and Dr E Hammond, Joint Clinical Leads

e-Learning Anaesthesia (e-LA)

CPD topic of the month

Figure 1 Webcast lecture recording from Nigel Harper’s ‘Anaphylaxis’ presentation at the RCoA study day held in October 2012. Within the browser, slide views of the presentation are shown in the main window, with a smaller audio-video view of the lecturer inset. It is possible to pause and review any aspect of the talk by clicking on earlier or later slides

e L A

Throughout the year the Royal College of Anaesthetists hosts an impressive series of CPD lectures by experts in their respective sub-specialty fields. Since 2011, a range of these lectures have been recorded and made available online as webcasts. For anaesthetists used to long days (and evenings) at work, the system is similar to the concept of ‘catch-up’ television such as ‘BBC iPlayer’.

Each webcast is broadcast as an audiovisual, streamed recording presented in its own web browser window. The window itself is configurable into different formats but each format allows a high-resolution view of each slide as it would have been presented on screen, accompanied by a video view and audio feed from

Anaesthesia). The webcasts are being packaged in combination with extensive background information drawn from existing e-Learning Anaesthesia sessions, CEACCP articles, AAGBI guidelines, and accredited MCQ self-assessment sessions. Collectively, these resources provide a complete overview of current anaesthetic practice related to a targeted CPD subject.

The January 2014 topic of the month covers ‘Anaphylaxis’ and comprises:

J Webcast lecture: Anaphylaxis Study Day (18 October 2012) lecture by Dr Nigel Harper

J e-LA: ‘Allergies including latex’ by K-L Kong

J e-LA: ‘Presentation and identification of anaphylaxis’ by Marc Davison and Samantha Walker

J e-LA: ‘Immediate management of anaphylaxis’ by Marc Davison and Samantha Walker

J e-LA: ‘Secondary management of anaphylaxis’ by Marc Davison, Samantha Walker and Sashika Selladurai

J e-LA: ‘Anaphylactic shock: the science’ by Ben Walton

J e-LA: ‘Acute management of anaphylactic shock’ by Ben Walton

J e-LA: ‘Allergy and inflammatory response’ by Potteth Sukumar Sudheer

J CEACCP article: ‘Anaphylaxis’ (August 2004) by Sally-Ann Ryder and Carl Waldmann

J CEACCP MCQs: ‘Anaphylaxis’ (August 2004)

J AAGBI guidelines for management of suspected anaphylaxis during anaesthesia

the lecturer. Slides are advanced automatically as they were when the original lecture was captured (Figure 1).

This facility is a tried and tested format common to most modern day university courses, where it (allegedly) works well for those students unable to rouse themselves for that 9 o’clock lecture following late night team building sessions the evening before. For the College, it provides an invaluable resource allowing access for a wider audience who might otherwise be unable to secure study leave cover or expenses to attend a national venue.

CPD Topic of the Month launches in January to make use of this bank of excellent CPD material via the www.e-la.org.uk portal (e-Learning


Collectively, this represents four hours of College-accredited CPD material. When accessed through e-LA, time credits for each component are automatically recorded on the Learning Management System (LMS) so that evidence of CPD activity can be presented electronically at appraisal or for revalidation.

Please take time to try ‘CPD Topic of the Month’ (Figures 2 and 3.) A new topic will appear each month fully supported by material drawn from the extensive library of background sessions and articles already available in the ‘My Learning’ area of e-LA (www.e-la.org.uk). You can also view the recorded lectures from CPD Topic of the Month and access e-LA through the college website (www.rcoa.ac.uk/webcasts). Access through e-LA will ensure that the time spent on each session is recorded in your learning history.

[email protected] www.e-la.org.uk Dr A McIndoe and Dr E Hammond, Joint Clinical Leads

e-Learning Anaesthesia (e-LA)

Figure 2 Anaphylaxis: : CPD Topic of the Month January 2014

Figure 3 CPD Topic of the Month can be accessed under 'My Learning' as a module within e-Learning Anaesthesia. A different topic will be covered each month and previous topics will remain available online within the module

e L A


I was now promoted to be Assistant Surgeon by our chief, and was given charge of seventeen patients... On 23 October I had to perform my first amputation. It was the removal of a portion of a foot, which had been crushed by a wagon wheel. The patient, I should explain, lay in a private house, at the rear of the Quai du Chatelet. Dr Mackellar, who had kindly given me the operation, and Jean the Turco, assisted me. But when I had made the first incision, Jean bolted out of the room, and tumbled downstairs in a faint.

I went on with my task; but no sooner was it completed, than we were both taken aback on finding that my subject had been given an overdose of chloroform: his face was livid; and it seemed that he had already ceased to breathe. In a moment, we flung the windows and doors open, and were slapping him with cold wet towels, and using artificial respiration. To my great relief, in a few seconds the poor man breathed freely again, and before long came back to himself. He made a very prompt recovery; was convalescent, and able to hobble about on crutches in a fortnight, and had still a useful limb.

My patients increased daily, until from seventeen they became double that number. At this time it was my duty to stay up every fifth night.

***

I have not, so far, given a description of our new Hospital... The Church of Ste. Euverte at Orleans is a fine old Gothic building... it had now become the third Hospital which we of the Anglo-American Ambulance had set up in this hotly-contested city... It was late on Christmas Eve that I repaired to the Church, and took my turn of night duty... In the stillness of the Christmas night the tones of agony and suffering echo through the Church, which for centuries has resounded at that hour with the grand and solemn music of the Midnight Mass. I begin my rounds, visiting first the more urgent cases. To some of the greatest sufferers I give morphine in pills, or else introduce it in solution under the skin, by means of a syringe with a sharp perforated needle affixed. The effect is wonderful. In a few minutes they are out of pain, and fall asleep quietly. In this manner I am compelled to silence those whose groans would disturb the other patients. I now go on in succession, stopping at every bed to satisfy myself as to the condition of its occupant, giving medicines when required, arranging bandages here and there, and soothing with hypnotics those whose wounds prevent their sleeping.

***

Just about this time it happened that I got permission from Dr May to amputate a thigh midway between the hip and the knee. As I was on the point of making the first incision, who should walk up to the operation table but Professor Langenbeck of Berlin? (sic) This great person had come into the hospital to glance at our surgical work, and the father of German field surgery made me very uncomfortable. However I regained my self-possession pretty quickly, and was fortunate enough to get through the operation without a hitch or misadventure, receiving at the end a gracious bow, and a “Sehr schön, mein Herr,” from the old veteran, who diligently smoked a cigar all the while. I need hardly add that my confrères had a great laugh over the incident, and at my sudden exhibition of panic, which they assured me was quite evident.

************

Charles Edward Ryan, a medical student in Dublin, volunteered for service with any military hospital or ambulance on the French side that he could get an attachment to, during the early stages of the Franco-Prussian War. His friends looked on him as ‘little better than a mad fellow,’ and some of his professors good humouredly wished him godspeed and a pleasant trip, ‘adding that they were sure I should be back again in a few days.’ In fact he was there many months, helping first one side then the other as the tide of battle flowed backward and forward, and gaining invaluable experience, and memories which lasted a lifetime. He found himself working with eminent volunteers, notably the American surgeon, James Marion Sims (1813–1883), who had performed the first successful repair of a vesico-vaginal fistula.

This most interesting book may be downloaded free from the Gutenberg website.

Reference: Ryan, C.E. With an ambulance during the Franco-Prussian War – personal experiences and adventures with both armies. Aberdeen, University Press; and New York, Charles Scribner’s Sons, 1896.

AsWeWere


Report of CouncilAt a meeting of Council on Wednesday, 16 October 2013, the following appointments/re-appointments were made (re-appointments are marked with an asterisk):

Regional AdvisersThere are no appointments/re-appointments this month

Deputy Regional AdvisersThere are no appointments/re-appointments this month

College Tutors

Anglia*Dr A V Patil, Addenbrookees Hospital

OxfordDr C Morris, Buckinghamshire Healthcare NHS Trust (in succession to Dr A J Ankers

Northern*Dr A Holtham, University Hospital of North DurhamDr O Shalaby, North Tees and Hartlepool NHS Trust (in succession to Dr A K Sharma)

North Thames WestDr N D Stranix, Charing Cross Hospital (in succession to Dr J Poncia)Dr A A Kalbag, Charing Cross Hospital (second College Tutor post)

North Thames CentralDr A Kambli, Lister Hospital

South West Peninsula*Dr G F Rousseau, North Devon District HospitalDr J Elliott, Derriford Hospital (in succession to Dr S M Boumphrey)

Wales*Dr Sandby-Thomas, Llandough Hospital

West MidlandsDr E J F Jayadoss, New Cross Hospital (in succession to Dr J Dyer)

Head of SchoolDr Bret Claxton, Yorkshire Deanery School of Anaesthesia (in succession to Dr Robert Cruickshank)

To note recommendations made to the GMC for approval, that CCTs/CESR (CP)s be awarded to those set out below, who have satisfactorily completed the full period of higher specialist training in anaesthesia.

South EastDr Mohamed AliDr Narayana PemmarajuDr Oliver Hargrove

North CentralDr Emily HabermanDr Tonis SousalisDr Nadine Dobby

Bart’s and The LondonDr Alvina LoneDr Ashan Khan

East MidlandsDr Mhamad Al-Hashimi

OxfordDr Kim Carter

Tri-ServicesDr Jonathan Round

BirminghamDr Parvez EllaheeDr David Christie

West Yorkshire (Leeds/Bradford)Dr Nicholas Freeman

At a meeting of Council on Wednesday, 20 November 2013 the following appointments/re-appointments were made (re-appointments are marked with an asterisk):

Regional AdvisersThere are no appointments/re-appointments this month

Deputy Regional AdvisersThere are no appointments/re-appointments this month

South West Peninsula*Dr R Langford, Royal Cornwall Hospital

South Thames WestDr K Stringer, Kingston Hospital (in succession to Dr K S Paramesh)

South Thames EastDr A Barry, Queen Elizabeth Hospital, Woolwich (in succession to Dr D Leschinskiy)

Dr O Rose, University Hospital Lewisham (in succession to Dr K D Nirmala)

SheffieldDr S Siddiqui, Barnsley District General Hospital (in succession to Dr T N Wenham)

West Midlands NorthDr H Wibley, Hereford Hospital NHS Trust (in succession to Dr C A Stevenson)

Head of SchoolsThere are no appointments/re-appointments this month

To note recommendations made to the GMC for approval, that CCTs/CESR (CP)s be awarded to those set out below, who have satisfactorily completed the full period of higher specialist training in anaesthesia. The doctors whose names are marked with an asterisk have been recommended for Joint CCTs/CESR (CP)s in Anaesthesia and Intensive Care Medicine

South EastDr Oliver Long

North CentralDr Tahira ButtDr Jonathan Bramall *Dr Gordon Bird *

Bart's and The LondonDr Trudie PhillipsDr Nimisha PatelDr Ming-Li Kong *Dr Michael Husband

Imperial Dr Nicolas Price *Dr Anish GuptaDr Tanya Smith

Kent, Surrey, SussexDr Tahsin Kilic *

LeicesterDr Deepak Malik


NottinghamDr Michal CzernickiDr Lakshmipathy PurushothamanDr Shruti Contractor

MerseyDr Suganthi SingaraveluDr Joanne HaidonDr Amit Dawar

North WestDr Mofolashade Onaolapo

Northern Dr Joanne Dawson

OxfordDr Stewart Campbell

South West PeninsulaDr Anothony BradleyDr Mark Davidson *

Tri-ServicesDr Craig Pope

WessexDr James WalkerDr Richard Partridge *

StokeDr Shanawaz Abdul RasheedDr Ramu BhandariDr Miran BabanDr Derrick Clarence

WarwickshireDr Sophia JacobsDr Joyce Yeung

WalesDr Vidhi Misra

East ScotlandDr Stephen Humble

South Yorkshire (Sheffield)Dr Helen Findley

Appointment of Members, Associate Members and Associate FellowsThe College congratulates the following who have now been admitted accordingly:

Members Dr Andrea Brinker Dr Shaukat Hayat Khan Dr Vittaldas Ramanath Shetty Dr Robert Peter Jones Dr Yasin Said Al-Makadma

Associate Members Dr Leon Jeremy Hickinbotham Dr Shabnam Saleem Dr Attila Petri Dr John Martin Boselli Dr Aikaterini Vlachou Dr Attila Elseg

Associate Fellows Dr Gabor Szekely Dr Stelios Michael

Affiliate (Clinical Science)Mr A Nayak

Appointment of Fellows to consultant and similar postsThe College congratulates the following Fellows on their consultant appointments:

Dr M N Barnard, Derriford Hospital, Plymouth

Dr P A Clarke, Royal Gwent Hospital, Newport

Dr O D’Mello, Wigan, Wrightington and Leigh NHS Trust

Dr P Goyal, Kingston Hospital

Dr K Kotur, Freeman Hospital, Newcastle

Dr C Parcha, Queen Elizabeth Hospital, Birmingham

Dr R Sachdeva, University Hospital Birmingham

Dr J Shorthouse, Poole NHS Foundation Trust

DeathsIt is with regret that the College records the deaths of those listed below.

Dr G M Archer, London Dr J Crook, North Yorkshire Dr R Davys, Dublin, Ireland Dr J N T Hutton, South Croydon Dr G M Jordan, Bristol Dr R D Levis, Hampshire Dr D J Penney, Swindon Dr B S Perera, Sri Lanka Dr R Simionescu, Romania Dr C W Suckling, Herts Dr M West, Herts Dr I C Sutherland, Hampshire Dr Helen Wardill, Australia

The College is able to receive brief obituaries (of no more than 500 words), with a photo if desired, of Fellows, Members or Trainees. These will be published on the College website (www.rcoa.ac.uk/obituaries).

Please email your text and any photo to: [email protected].

66th Anniversary Dinner12 March 2014

The 66th Anniversary Dinner will be held on Wednesday, 12 March 2014 at 7.00 pm for 7.30 pm in Clothworkers’ Hall, London EC3R.

Dress will be black tie.

If you would like to attend the dinner, please contact Steph Robinson [email protected]


Humphry Davy Award presented at the Jubilee Current Concepts SymposiumCitation for The Lifebox Foundation – Dr Iain Wilson and Dr Isabeau Walker

It gives me great pleasure to present a citation for the Lifebox project. The project has been awarded the Humphry Davy certificate which was received by Dr Isabeau Walker and Dr Iain Wilson.

The Lifebox Project, set up in 2011, is the only international NGO focusing specifically on the improvement of safety in surgery and anaesthesia. Its mission is to reduce deaths in surgery globally. Its primary tools are the use of the WHO Surgical Safety Checklist and the provision of easier access to operating theatre monitoring for colleagues

in low-resource countries.

At present 70,000 theatres worldwide have no access to a pulse oximeter.

The project has sourced one which is cheap, robust, and simple to use. Since 2011 it has distributed 6,200 worldwide in 90 countries, and has trained 2,500 healthcare workers in its use.

It is also actively rolling out the WHO surgical checklist. A modified form has been piloted in Rwanda, and is being scaled up to other hospitals in Africa.

It is estimated that a combination of both the checklist and the oximeter, if instituted worldwide, will lead to a 30% reduction of surgical mortality, possibly half a million patients per year.

Dr Isabeau Walker is a consultant anaesthetist from GOSH. She has had a long-term interest in and involvement with overseas healthcare. Isabeau managed the first large-scale oximetry distribution project set up by the Lifebox project in Uganda in 2011 when 80 oximeters were distributed. She has taken a leadership role in the development and deployment of educational materials for the charity.

Dr Iain Wilson is a consultant anaesthetist from Exeter. Iain’s interest in overseas healthcare blossomed in the 1980s when he spent two years as a lecturer in anaesthesia in Zambia. The Lifebox project was started during his presidency of the AAGBI, and his influence was pivotal. He was involved with developing the specifications for the Lifebox oximeter, and today plays a major role with procurement.

Because of the monumental effect the project is having on raising safety standards throughout the world, I believe the Lifebox project to be a worthy recipient of the award.

Dr Jo James

Dr Iain Wilson, Dr Isabeau Walker and Dr J-P van Besouw

Honours, Awards and Prizes The following were presented at the Jubilee Current Concepts Symposium and the Patient Safety Conference.

Humphry Davy Award presented at the Jubilee Current Concepts SymposiumCitation for Dr Andrew Lim

After Marlborough College, Andy went to the Middlesex and ultimately became an Associate Specialist in Bath, conveniently facilitating his passion for motorsport; he remains one of the most experienced doctors on the medical team for the British Grand Prix, is an ATLS instructor and has a keen interest in trauma management.

His positive attitude and enthusiasm for teaching and training have made him an excellent role model for Staff and Associate Specialist doctors. Andy was one of the first two SAS doctors elected to Council, subsequently serving ten years as a full Council member. As Chair of the SAS Committee he actively promoted the interests of SAS doctors and the College alike.

He was a founding member of the Academy SAS group and contributed to the AAGBI.

Andy’s other interest is information technology, a skill he used in developing the critical incident reporting database for the National Patient Safety Agency.

Andy has helped to create a sense of worth amongst the SAS body, espousing the view that all grades of anaesthetist, whether SAS, trainee or consultant, are doctors first, anaesthetists second and perhaps most importantly are all people with hopes, fears and aspirations. All need to be treated equally.

Dr Roger Laishley

Dr Andrew Lim and Dr J-P van Besouw

Frederic Hewitt Lecture presented at the Patient Safety ConferenceCitation for Professor Stephen Bolsin

As a newly-appointed Consultant in Bristol, Stephen Bolsin was concerned about the outcome of babies and children having cardiac surgery. He began to meticulously audit the results and outcomes. His data was shared with the Royal Colleges and with staff at Bristol University, who were all impressed with the need for change. Many animated discussions took place, and his pioneering work attracted national attention.

His work led to a six-fold drop in mortality, a dramatic improvement in outcome.

At the time it was considered highly unusual for multidisciplinary audits to be carried out in this way, and he became known as the 'Bristol Whistleblower'. He had to contend with some difficult interpersonal relationships that eventually led to him leaving the country.

He now works in Geelong, Australia. The cardiac unit that he set up there has one of the lowest complication rates in the literature. He has a prolific academic output, especially in the fields of outcome audits and adverse incident reporting.

His work led to the routine adoption of audit and clinical governance, and has transformed medicine. Professor Bolsin’s work has had a dramatic and lasting effect on both the practice of anaesthesia and the wider medical culture.

Dr Richard Marks

Professor Stephen Bolsin and Dr J-P van Besouw


Gold Medal presented at the Jubilee Current Concepts SymposiumCitation for Professor Steven ShaferProfessor Steven Shafer is one of the foremost academics of his generation. In addition to establishing and developing substantial lines of enquiry around drug disposition, drug action and interaction, he has trained and inspired many other investigators who are themselves now well known.

As Editor-in-Chief of Anesthesia and Analgesia, he has been a campaigner for academic integrity and publication standards, and boldly exposed academic misconduct on many occasions.

In the public eye Professor Shafer was universally acclaimed as the outstanding witness at the trial of Conrad Murray, the doctor whose negligence led to the death of singer Michael Jackson. A working pro-bono, Shafer explained patiently, clearly and without compromise the pharmacology of the drugs involved and most importantly spelled out the responsibilities of clinicians to their patients to a worldwide television and internet audience.

Overall, Steven Shafer is an exemplary clinician, academic, leader and communicator.

Professor Robert Sneyd

Gold Medal presented at the Jubilee Current Concepts SymposiumCitation for Dr David Zideman LVO

David Zideman was a consultant anaesthetist at the Hammersmith Hospital from 1980 until his retirement in 2010. David was a founding member of the Resuscitation Council (UK) and was Honorary Secretary for eight years. He was Honorary Secretary of the European Resuscitation Council (ERC) for five years from 1997 and Chair of the ERC for five years. David has been a very active member of the International Liaison Committee on Resuscitation (ILCOR) since its foundation in 1994. He was Co-chair of the ILCOR Paediatric Task Force and is currently Co-chair of the ILCOR First Aid Task Force.

David has maintained an active interest in prehospital medicine throughout his career. He chaired the British Association for Immediate Care (BASICS) and he continues to undertake prehospital medical shifts for London BASICS and the London Helicopter Emergency Medical Service (HEMS). The pinnacle of David’s career in prehospital medicine came when he was appointed Clinical Lead for Emergency Medical Services for the 2012 London Olympic and Paralympic Games.

David’s services to the Royal Family, as a Queen’s Honorary Physician, were recognised by his award of Lieutenant in the Royal Victorian Order (LVO) in the 2008 Queen’s Birthday Honours List.

The Gold Medal is the highest award that can be made to a Fellow of this Royal College and it is awarded only rarely. David Zideman has been a friend and mentor to me for much of my career and it is a huge pleasure to see him awarded this honour.

Dr Jerry Nolan

Professor Robert Sneyd, Professor Steven Shafer and Dr J-P van Besouw

Dr David Zideman and Dr J-P van Besouw


[email protected] 020 7092 1673 www.rcoa.ac.uk/events

CPD Study Day: Pre-habilitation: Strategies to optimise patient fitness prior to major surgery

20 March 2014 (code: C72)RCoA, London Registration fee: £200 (£150 for RCoA registered trainees and affiliates)

CPD Study Day: Anaesthetic Emergencies

27 March 2014 (code: D04)The Teacher Building, Glasgow Registration fee: £200 (£150 for RCoA registered trainees and affiliates)

uk training in emergency airway management (team) course (Wrexham)

27-28 March 2014 (code: G08)Wrexham Maelor Hospital Registration fee: £450

Quality improvement and patient safety: improvement science in anaesthesia training

28 March 2014 (code: G18)RCoA, London Registration fee: £150

Joint Clinical Directors Meeting (with the AAGBI)

8 April 2014RCoA, London By invitation only

Cardiac Disease and Anaesthesia Symposium

9-10 April 2014 (code: F47)RCoA, London Registration fee: £445 (£335 for RCoA registered trainees and affiliates)

CPD Study Day

24 April 2014 (code: C19)RCoA, London Registration fee: £200 (£150 for RCoA registered trainees and affiliates)

Airway Workshop, London

24 April 2014 (code: C12)RCoA, London Registration fee: £260 (£195 for RCoA registered trainees and affiliates)

Primary FRCA Masterclass

13–16 January 2014 (code: D26)RCoA, London Registration fee: £305

Simulation unplugged

16 January 2014RCoA, London FULLY BOOKED

Final FRCA Revision Course

20–24 January 2014 (code: A82)RCoA, London Registration fee: £395

faculty of pain medicine acute pain management and diagnostic investigations study days

3–4 February 2014 (code: B28)RCoA, London Registration fee: £315 (£255 for RCoA registered trainees and affiliates) for both days or £165 (£135 for RCoA registered trainees and affiliates) for a single day

Recent Advances in Anaesthesia, Critical Care and Pain Management

5–7 February 2014 (code: C68)RCoA, London Registration fee: £490

Airway Workshop

6 February 2014 (code: B53)RCoA, London Registration fee: £260 (£195 for RCoA registered trainees and affiliates)

CPD Study Day: Burns and Plastics

24 February 2014 (code: C63)RCoA, London Registration fee: £200 (£150 for RCoA registered trainees and affiliates)

Anaesthetists as Educators: Teaching and Training in the Workplace

24–25 February 2014 (code: C84)RCoA, London Registration fee: £425 (£320 for RCoA registered trainees and affiliates)

Ultrasound Workshop

27 February 2014 (code: D23)RCoA, London Registration fee: £240 (£180 for RCoA registered trainees and affiliates)

airway workshop, cardiff

5 March 2014 (code: C96)Hotel Marriott, Cardiff Registration fee: £260 (£195 for RCoA registered trainees and affiliates)

After the Final FRCA: Making the most of training years 5 to 7

6 March 2014 (code: B16)RCoA, London Registration fee: £165

The Faculty of Intensive Care Medicine Annual Meeting

7 March 2014 (code: F33)RCoA, London Registration fee: £160 (£85 trainees)

research methodology workshop

10 March 2014 (code: D39)RCoA, London Registration fee: £150

Leadership and Management: Leading and Managing change; success with service development

11 March 2014 (code: C41)RCoA, London Registration fee: £220

Anniversary Meeting – Trauma

12–13 March 2014 (code: A03)The Mermaid, London Registration fee: £445 (£335 for RCoA registered trainees and affiliates)

Safeguarding Children

18 March 2014 (code: C77)RCoA, London Registration fee: £160

RCoA

EVENTS EVENT ONLINE SERVICESEVENT ONLINE SERVICES

CPD Study Days

29-30 April 2014 RCoA, London (code: B54) Registration fee: £355 (£265 for RCoA registered trainees and affiliates)

Ethics and the Law for Anaesthetists

13 May 2014 (code: D19)RCoA, London Registration fee: £200 (£150 for RCoA registered trainees and affiliates)

Airway Management: Training the Trainers

14 May 2014 (code: A74)RCoA, London Registration fee: £260 (£195 for RCoA registered trainees and affiliates)

RCOA annual Congress

15–16 May 2014 (code: D10)National Museum, Cardiff Registration fee: £390 (£290 for RCoA registered trainees and affiliates)

Introduction to Leadership and Management: The Essentials

29-30 May 2014 (code: B56)RCoA, London Registration fee: £445

Anaesthetists as Educators: an Introduction

4 June 2014 (code: C18)RCoA, London Registration fee: £220 (£165 for RCoA registered trainees and affiliates)

Research Methodology Workshop

5 June 2014 (code: C85)RCoA, London Registration fee: £150

recent advances in anaesthesia, critical care and pAIN management

9-11 June 2014 (Code A32)Action Stations, Portsmouth Registration fee: £490



15–16 May, National Museum Cardiff

The Royal College of Anaesthetists

ANNUAL CONGRESS2

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RCoA


This year the RCoA Annual Congress boasts an exciting programme, supplemented with targeted workshops for both trainees and consultants.

In addition to this, the College will host a social evening at the Museum on the evening of 15 May for all attendees of the conference.

The event will include:• Diverse talks with experts • Consultant Workshop

- Cardiac output monitoring• Trainee Workshops

- How to get published- CV building post FRCA- Presentation skills

• Poster Presentations• Prizes and Awards• Trade Exhibition• Social Evening for all attendees

Code: D10Registration Fee:£390 (£290 for RCoA registered trainees and affiliates) 10 CPD credits anticipatedEvent organisers: Dr R Verma and Dr J Williams

For more information please visit: www.rcoa.ac.uk/education-and-events/rcoa-annual-congress



RECENT ADVANCES IN ANAESTHESIA, CRITICAL CARE AND PAIN MANAGEMENTDate and venue: 5–7 February 2014 (code: C68) RCoA, London

Registration fee: £490

Event organisers: Professor P Foëx and Dr J Carlisle

DAY 2 � Doctors in the dockDr S Bennett, Hull

� Paediatric emergencies for the generalist (2D01, 3D00)Dr T Whittington, Oxford

� What brain imaging has taught us about pain and analgesia (1A03, 3E00)Professor I Tracey, Oxford

� Acute pain management (1D02, 2E01)Dr J Quinlan, Oxford

� Persistent post-surgery pain (2E03, 3E00)Dr E Kalso, Helsinki

� Burns management (2A02, 3H00)Professor J Kinsella, Glasgow

� What is new in the delivery suite (2B06, 3B00)Dr A McGlennan, London

� Anaphylaxis (1B01)Dr N Harper, Manchester

� Perioperative optimisation (2A03)Dr J Carlisle, Torbay

� Acute kidney injury (2C05)Dr J Down, London

DAY 3 � Patients with pace-makers, defibrillators (1A03, 2A03)Dr A Morley-Davies, North Staffordshire

� Perioperative dysrhythmiasDr A Goodwin, Bath

� Minimising the risk of cognitive dysfunction (2A04)Dr D Green, London

� Anaesthesia and the elderly (1A01, 1A02)Speaker TBC

� Unexpected difficult intubation (1B02, 2A01)Dr M Sandby-Thomas, Cardiff

� Implications of aortic stenosis (3G00)Dr J Berridge, York

� Update in Intensive Care Medicine (3C00)Professor J Bion, Birmingham

� The weight challenged patient (3I00)Dr C Nightingale, Wycombe and Stoke Mandeville

DAY 1 � The College in 2014 (1I05, 3J00)Dr J-P van Besouw, President

� Mechanisms of anaesthesia (1A02)Professor J Lambert, Dundee

� Regulators and InspectorsDr A-M Rollin, Epsom

� Anaemia, ErythropoietinColonel R Thomas, Wales

� Awareness: lessons from NAP5Dr T Cook, Bath

� Management of severe asthma (2C04, 3C00)Dr J Blakey, Liverpool

� The patient with coronary stents (2A03, 3G00)Professor P Foëx, Oxford

� Vascular access in 2014 (2G01, 3A09)Dr A Bodenham, Leeds

� Fluid’s: what’s in and what’s out (2A05)Professor M Mythen, London

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AIRWAY WORKSHOPDate and venue:6 February 2014, RCoA, London (code: B53) 5 March 2014, Marriot Hotel, Cardiff (code: C96) 24 April 2014, RCoA, London (code: C12)

Registration fee: £260 (£195 for RCoA registered trainees and affiliates)

Event organisers: Drs R Bhagrath and T Turley

� 9.00 amRegistration

Delegates will be split into three groups – all groups will rotate through the following topics:

AM SESSIONS

Station 1FIBREOPTIC HANDLING SKILLS

2A01 RED GREEN

Brea

k

BLUE

Station 2SUPRAGLOTTIC AIRWAYS

1C02 BLUE RED GREEN

Station 3RESCUE TECHNIQUES 2B02 GREEN BLUE RED

PM SESSIONS

Station 1AWAKE FO INTUBATION 2A01 RED GREEN

Brea

k

BLUE

Station 2VIDEOLARYNGOSCOPY

1C01, 1C02, 2A01

BLUE RED GREEN

Station 3EXTUBATION

1C01, 1C02

GREEN BLUE RED

� 4.00 pmClose

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ULTRASOUND WORKSHOPDate and venue:27 February 2014 (code: D23) RCoA, London

Registration fee:£240 (£180 for RCoA registered trainees and affiliates)

Event organiser: Dr A Gaur

CPD matrix codes covered:

3A08, 3A09, 3B00

Outcome The workshop will provide delegates an opportunity to learn directly from experts regarding the use of ultrasound in regional anaesthesia. The groups are small to allow a chance for adequate hands-on experience of various scanning techniques. Delegates will also get an opportunity to learn how to hold the ultrasound probe and perform various types of needle insertion techniques using real time ultrasound guidance on turkey legs. The workshop is designed to provide more than just basic textual knowledge and intended to improve the psychomotor and cognitive skills; and to raise the standards of ultrasound guided regional anaesthesia.

Delegates will be split into small groups to rotate through

eight workstations (40 minutes per station)

Station 1 Upper limb – above clavicle

Station 2 Upper limb – below clavicle

Station 3 Lower limb – femoral and LFCN

Station 4 Probe and needling

Station 5 Lower limb – sciatic/ popliteal

Station 6 Epidural spinal

Station 7 Abdominal

Station 8 Lumbar plexus

� 5.00 pmClose CPD

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ANNIVERSARY MEETING: TRAUMADate and venue: 12–13 March 2014 (code: A03) The Mermaid, London


Event organisers: Dr S Howell and Dr T Moll

DAY ONESESSION 1

� Trauma systemsProfessor C Moran

� Trauma scores and databasesProfessor F Lecky

� Bastion to Birmingham: How civilian patients can benefitProfessor Sir K Porter

SESSION 2 � Prehospital anaesthesia – the same but differentProfessor D Lockey

� Transport of the trauma patientDr G Davies

THE JOHN SNOW ORATIONSir Bruce Keogh

SESSION 3 � Haemodynamic changes in traumaDr E Kirkman

� Triage – Rank LectureProfessor P Cameron, Australia

ANNUAL GENERAL MEETING

SESSION 4 � Coagulation in traumaLt. Col R Thomas

� Orthopaedic damage control resuscitation and surgeryProfessor C Moran

� Abdominal damage control resuscitation and surgeryMr A Brooks

� Interventional radiologyDr S Chakraverty

DRINKS RECEPTION FOR ALL

DAY TWOSESSION 5

� The trauma teamProfessor L Leenen, The Netherlands

� Lessons from motorsportDr T Moll

� ATLS in the 21st century: fit for purpose?Dr M Wiles

SESSION 6 � Managing the anti coagulated head injured patientDr S Mason

� Role of hyperthermia in trauma careProfessor P Andrews

PRESENTATION OF COLLEGE AWARDS

MACINTOSH LECTUREProfessor T Cook

SESSION 7 � Critical care for trauma – is it different?Dr R Winter

� Trauma outcomes and rehabilitationCol J Etherington

� Oxygen in trauma: friend or foe?Dr J Nolan

SESSION 8 � Knives and gunsProfessor A Grabinsky, USA

� BurnsProfessor J Kinsella

� PaediatricsDr M Lyttle

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CPD STUDY DAY: PRE-HABILITATION: STRATEGIES

TO OPTIMISE PATIENT FITNESS

PRIOR TO MAJOR SURGERY

Date and venue: 20 March 2014 (code: C72) RCoA, LondonRegistration fee: £200 (£150 for RCoA registered trainees and affiliates)Event organiser: Professor G DanjouxCo-organising committee:Dr S Howell, Dr D Yates, Dr E Kothmann and Dr D TewCPD matrix codes covered:2A03, 3J03

� 8.30 amRegistration and refreshments

SESSION 1: WHO NEEDS PREHABILITATION?

� Is preoperative frailty a risk factor?Professor J Young, Bradford

� Preoperative aerobic fitness and surgical outcome: the evidenceDr C Snowden, Newcastle

SESSION 2: OPTIMISATION

� Cardiorespiratory conditioning in the elderly – mechanisms, strategies and evidenceDr G Tew, York

� Musculoskeletal conditioning in the elderly – mechanisms, strategies and evidenceProfessor S Harridge, London

� Preoperative anaemia – importance and optimisationMr T Richards, London

� Preoperative nutritional status – importance and optimisation Dr M Stroud, Southampton

SESSION 3: GENERAL THEMES

� Preoperative exercise interventions – is there evidence of benefit?Dr S Jack, Southampton

� Optimisation prior to referral – the role of primary careDr J Slade, Suffolk

� Putting it all together – the ‘ideal’ pathwayDr J Dhesi, London

SESSION 4: CHALLENGES ABOUT TRANSLATION

� The North American experienceDr J Myers, California, USA

� Discussion forum and expert panel

� 5.05 pmClose

SAFEGUARDING CHILDREN

Date and venue: 18 March 2014 (code: C77) RCoA, London


Event organiser: Dr K Wilkinson

CPD matrix code covered:3D00

� 9.00 amRegistration

� Introduction and welcomeDr K Wilkinson, Norwich

� Recognition and response to safeguarding concernsDr A Mott, Cardiff

� Legal aspects of safeguardingMr J-P Garside, Norwich

� Multi-agency working and next stepsMs S Jenkins, London

� What happens when a child dies?Dr S Steel, Norwich

� Case scenariosRotational workshops: all groups rotate through each station

WORKSHOPSWorkshop 1

� Communication with the child/young person and their familyDr L Brennan and Dr A Mott

Workshop 2 � Communicating with other professionalsDr A Cranston, Dr H Glaisyer and Ms S Jenkins

Workshop 3 � Case scenariosDr S Steel and Dr K Wilkinson

� Feedback and panel discussion � 4.30 pmClose

THE ROYAL COLLEGE OF ANAESTHETISTS AND THE ASSOCIATION

OF PAEDIATRIC ANAESTHETISTS OF GREAT BRITAIN AND IRELAND

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Quality Improvement and Patient Safety:Improvement Science in Anaesthesia Training

Date and location: 28 March 2014 (code: G18) RCoA, London


Event organiser:Dr J Colvin

A one day meeting to support the introduction of quality improvement and improvement science to the anaesthesia training curriculum with a mixed format of lectures and workshops. This event is great value for money as delegates will receive a full day of training at a reduced rate. This event is primarily suitable for Consultant Anaesthetists particularly RAs, DRAs, College Tutors and Senior Trainees, however all are welcome.

09.15 – REGISTRATION

SESSION 1 – PLENARY

� Patient safety and quality improvement in NHS EnglandDr M Durkin, Director of Patient Safety, NHS England

� Learning to make a difference – quality improvement in core medical trainingDr E Vaux, RCP London

� Quality improvement training in anaesthesiaSpeaker TBC

SESSION 2 -WORKSHOPS

� Developing a QI project � Measurement for improvement � Delivering QI training

SESSION 3 -PLENARY

� How to make it happenProfessor C Peden

� National patient safety and quality improvement – the value of widespread medical engagementProfessor J Leitch, Clinical Director, Scottish Government

� 16.30 – Close

ETHICS AND THE LAW FOR ANAESTHETISTS

Date and venue: 13 May 2014 (code: D19) RCoA, London

Registration fee: £200 (£150 for RCoA registered trainees and affiliates) Event organisers: Dr R Iqbal and Dr E Combeer

CPD matrix codes covered: 1F01, 1F02, 1F03, 1F05

GMC codes covered: 1.1, 2.1, 2.2, 3.3

� 9.00 am – Registration � Medical ethicsDr C Hooper, London

� The Trust Legal TeamJ Harrison, Surrey

� The legal status of clinical guidelinesDr A Bodenham, Leeds

� Workshop 1 Organ donationDr G Moorlock, Birmingham

� Workshop 2 Ethicoloegal considerations of teachingDr R Iqbal, London

� Workshop 3 Paediatric consentDr A McLeod, London

� 4.15 pm – Close

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CARDIAC DISEASE AND ANAESTHESIA SYMPOSIUMDate and venue: 9–10 April 2014 (code: F47) RCoA, London


Event organisers: Professor P Foëx and Dr H Higham

DAY ONE � 8.55 am – Registration

SESSION 1: PREOPERATIVE ASSESSMENT OF THE CARDIAC PATIENT

� Human factors and outcome in cardiac patientsDr H Higham, Oxford

� Heart disease in pregnancyDr F Walker, London

� Reducing perioperative risk in non-cardiac surgery: Should we screen for cardiac disease?Dr M Stewart, Middlesbrough

SESSION 2: THE ADULT WITH CONGENITAL HEART DISEASE

� Overview of GUCHProfessor J Deanfield, London

� Anaesthesia for non-cardiac surgery in the GUCH patientDr R Cope, Southampton

KEYNOTE LECTURE

� The new guidelines on perioperative management of patients with heart disease undergoing non-cardiac surgeryProfessors L Fleisher, Philadelphia

SESSION 3: THE LESSER CIRCULATION IS IMPORTANT

� Pathophysiology of pulmonary hypertensionProfessor S Gaine, Dublin

� Perioperative management of the patients with pulmonary hypertensionDr A Vuylsteke, Papworth

SESSION 4: CARDIAC ELECTROPHYSIOLOGY AND FUNCTION

� Cardiopulmonary testing (CPX) for all?Dr J Carlisle, Torbay

� Pacemakers, internal defibrillators and cardiac resynchronisers Dr A Morley-Davies, Stoke-on-Trent

� ArrhythmiasDr N Sabhawarl, Oxford

DRINKS RECEPTION

DAY TWO � 8.30 am – Registration

SESSION 5: THE SURGICAL PATIENT WITH CORONARY DISEASE

� Pathophysiology of coronary heart diseaseDr C Forfar, Oxford

� The patient with coronary stents Dr G Flood, Dublin

� Perioperative protection: alternatives to beta-blockersProfessor Pierre Foëx, Oxford

SESSION 6: VALVULAR HEART DISEASE � Pathophysiology of valvular heart diseaseDr S Myerson, Oxford

� Anaesthetic management of the patient with valvular heart diseaseDr M Patrick, Manchester

KEYNOTE LECTURE � Protecting the patient rather than the heart Professor M Mythen, London

SESSION 7: CONTROVERSIES AND CHALLENGES � Invasive cardiology under anaesthesia Dr K Grebinik, Oxford

� Non-invasive cardiac output monitoring: pitfallsDr M Jonas, Southampton

� Arterial hypertension still a problem Dr S Howell, Leeds

� Optimising and managing the patient with LV dysfunctionDr J Berridge, Leeds

� 4.05 pm – Close and refreshments

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ACUTE PAIN MANAGEMENT STUDY DAYDate and venue: 3 February 2014 (code: B28) RCoA, London

Registration fee: £165 (£135 for RCoA registered trainees and affiliates) or £315 (£255 for RCoA registered trainees and affiliates) when booked with FPM Diagnostic Investigations Study Day on 4 February 2014

� Effective acute pain management – identifying the challengesDr N Singh, Scunthorpe

� Pain management in the opioid dependent patientDr C Stannard, Bristol

� Pain management in the paediatric patientDr D Patel, Manchester

� Pain management in the obstetric patientDr N Lucas, Harrow

� Pain management in the morbidly obese patientDr A Mallick, Leeds

� Enhanced recovery after hip and knee arthroplasty – the Oswestry success storyDr J C John, Oswestry

� Enhanced recovery after surgery – what’s regional anaesthesia got to do with it?Dr M Checketts, Dundee

� Evidenced-based postoperative pain management: what’s it all about?Dr B Fischer, Redditch

� Ultrasound guidance for identifying epidural space – the hows and whys?Dr V Kumar, Scunthorpe

DIAGNOSTIC INVESTIGATIONS IN PAIN MEDICINEDate and venue: 4 February 2014 (code: B28) RCoA, London

Registration fee: £165 (£135 for RCoA registered trainees and affiliates) or £315 (£255 for RCoA registered trainees and affiliates) when booked with FPM Acute Pain Management Day on 4 February 2014

� Role of Investigations in pain medicineTBC

� Indication and interpretation of a normal and abnormal MRI scansDr Chandramohan, Bradford

� Indications and interpretation of a normal and abnormal CT scansDr C Groves, Consultant MSK Radiologist, Bradford

� Indications for X-rays, bone scan, ultrasound scan in pain medicineDr T Muttukumar, London

� Nerve conduction studies: indications and limitationsDr A Purves, London

� Ultrasound guided diagnostic blocksDr S Balasubramanian, Coventry

� Ultrasound guided diagnostic procedures for neck and shoulder painDr A Krol, London

The Faculty ofIntensive Care Medicine

ANNUAL MEETINGDate and venue: 7 March 2014 (code: F33) RCoA, London

Registration fee: £160 (£85 for trainees)

SESSION 1: HARD TIMES DELIVERING HIGH QUALITY HEALTHCARE DURING A WORLD RECESSION

� What consultancy can offer: case studies in driving efficiencyDr Dash, Partner McKinsey and Company, London

� The role of the regulator in a time of financial constraint: MonitorMr A Masters, Monitor, London

� The role of external review Mr D Behan, CEO, CQC

SESSION 2: ASSESSING QUALITY � How should we assess quality?Dr R Lilford, Birmingham

� Patient safety: how to measure itProfessor M Dixon-Woods, Leicester

SESSION 3: ENVIRONMENTAL EXTREMES – RELEVANCE TO CRITICAL ILLNESS

� High altitudeProfessor M Grocott, Southampton

� Diving medicineDr M Glover, Chichester

� Hibernation in the biological kingdom – parallels to critical illnessProfessor M Singer, London

SESSION 4: THE FACULTY ANNUAL REPORT AND AWARDS OF FELLOWSHIPS

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The RCoA Bulletin is published bi-monthly and distributed to over 15,000 anaesthetists worldwide, the vast majority being in the UK. Being so widely distributed, it is obviously seen by many other professionals who work alongside anaesthetists. Advertisements for courses and meetings from anaesthetic societies, or those organisations that are of interest to anaesthetists, are accepted with prior approval of the Editor or Editorial Board.

Advertisements must fit with the aims and aspirations of the RCoA and be related to anaesthesia, critical care and pain medicine. Please contact [email protected] for separate commercial advertising rates.

Rates below are valid from 1 July 2013 to 30 June 2014:

Quarter page (85 mm by 124 mm) £270 +VAT

Half page (85 mm by 252 mm) £535 +VAT

Full page (175 mm by 252 mm) £855 +VAT

Please go to www.rcoa.ac.uk/node/461 to complete the necessary Terms and Conditions of Business and to submit your advert.

BULLETIN ADVERTISING

Please see below consultations that the Royal College of Anaesthetists has responded to in the last two months.

Originator Consultation

Independent Commission on whole person care

Consultation on general principles

NHS England Paediatric Surgery Clinical Reference Group – views sought on specifications of services

Academy of Medical Royal Colleges

Sustaining services, ensuring fairness' on migrant access to NHS services

National Institute for Health and Care Excellence (NICE)

Intraveous Fluids Therapy in Children – scope consultation


GMC academic training review – questionnaire for AoMRC

General Medical Council GMC Quality Assurance Review: QA Inspections – A Discussion Paper

NHS England NHS Hospital data and datasets: a consultation

NHS Employers Working longer review – call for evidence

Department for Transport Regulations about the new offence of driving with a controlled drug in the body above a specified limit

National Assembly for Wales – Health and Social Care Committee

Short inquiry into the work of Healthcare Inspectorate Wales (HIW)


Mental Capacity Act 2005

Department of Health Right care, right place, right time: How can we improve health and care for vulnerable older people?

The King's Fund Commission on the Future of Health and Social Care in England – call for evidence

British Medical Association Decisions relating to cardiopulmonary resuscitation – guidance for consultation

Trust Special Administrator (TSA)

Draft recommendations on the future of services for local people using Stafford and Cannock Chase hospitals

National Assembly for Wales Inquiry into access to medical technologies in Wales

The British Association of Paediatric Surgery

Commissioning guide on the provision of children’s surgery

Scottish Government Provision of specialist residential chronic pain services in Scotland


Comments on Seven Day Consultant Present Care – Part 2

Working Time Directive Taskforce

Call for evidence

RCPCH Children's Medicine Committee

Guidance for the administration of codeine and alternative opioid analgesics in children

Consultations




Course Dates 2014 CapacityPrimary OSCE Weekend 03 – 05 January 25 – 27 April 26 – 28 September 48Primary OSCE/Orals 10 – 17 January 09 – 16 May 17 – 24 October 48Primary Viva Weekend 17 – 19 January 02 – 04 May 03 – 05 October 72Primary MCQ/SBA 07 – 13 February 01 – 07 August 10 – 16 October No LimitFinal MCQ/SBA 14 – 20 February 08 – 14 August No Limit

Final SAQ Weekend 21 – 23 February 15 – 17 August No Limit

Final ‘Booker’ Revision 23 – 28 February 17 – 22 August 90

Final Viva Revision 17 – 23 May 01 – 07 November No Limit

Final Viva Weekend 13 – 15 June 28 – 30 November 72

The Writers Club for the Final FRCA and FCAI Written Papers

The Writers Club has seen more than 450 trainees through the SAQ and E&SAQ Papers with a first-time Pass Rate of between 80 and 90 percent for those who have kept to the necessary disciplines. But many trainees apply far too close to the examination to derive anything like the full benefit from Membership.

Benefits include:

J Membership sustained at no further charge until successful. J Free Admission to the SAQ Weekend Courses. J Acquisition of a large and useful Collection of Answer Sheets. J Valuable Motivation to Revision.

Candidates are urged to join as soon as they have decided sit the examination.One-off membership fee: £400

See website for more information

To see details of all of our courses please visit:www.msoa.org.uk or email: [email protected]

Mersey Deanery Trainees should consult the website for special concerns and conditions.

PLACES ARE LIMITED SO PLEASE APPLY EARLY

Registration fee: £260 includes a copy of SBA – Basic Sciences book, breakfast, lunch and refreshments

For further details please contact:[email protected] 024 7696 8722 www.anaesthetics.uk.com

COVENTRY PRIMARY FRCA MCQ/SBA COURSE

11–13 February 2014 19–21 August 2014 � A three-day course with intensive MCQ/SBA practice

in physiology, pharmacology, physics and clinical measurement under strict exam conditions

� A three-hour test paper on day three and candidates will receive feedback on their performance

� Over 350 MCQs and 180 SBAs will be analysed � Access to pre-course material including past MCQs � Access to all course presentations and further MCQs on the

web � Interactive discussion of Single Best Answer questions

using Turning Point technology � Pre-course MCQ practice and feedback starts 6 weeks prior

to the course

20–21 March 2014 24–25 March 2014

� Mock exams: OSCE & SOE with individual feedback � Revised material based on previous feedback � Group OSCE/SOE practice with experienced faculty � Revision of past exam questions � Clinical skills/practical procedures on simulator � Communication skills: simulated patients � Key topics in anatomy � Radiology for Primary FRCA

Registration fee: £200 Breakfast, lunch & refreshments

are included

For further details please visit our website

www.anaesthetics.uk.comOr contact:

[email protected] 024 7696 8722

PRIMARY FRCA OSCE/SOE COURSE

COVENTRY AIRWAY MANAGEMENT COURSE

19 March 2014 at University Hospital, Coventry � Basic fibreoptic intubation � Oral and nasal fibreoptic intubation � ILMA and C Trach � Fibreoptic intubation through LMA � Fibreoptic intubation through ILMA � Videolaryngoscopes � Lung isolation techniques � Optimisation of direct laryngoscopy � TTJV and cricothyroidotomy � Human factors and non-technical skills � Awake fibreoptic intubation � Extubation

PLACES ARE LIMITED SO PLEASE APPLY EARLYApproved for 5 CPD credits (1I02, 1B02, 1C01, 1C02, 2A01, 3A01) from the RCoA

Registration fee: £95 includes refreshments and lunch

For further details please contact: [email protected] 024 7696 8722 www.anaesthetics.uk.com

17–19 February 2014 11–13 August 2014at University Hospital, Coventry

� MCQ practice in medicine, surgery, clinical measurement, intensive care medicine, anaesthesia and pain management under strict exam conditions. SBA practice in clinical anaesthesia, pain and intensive care medicine.

� SAQ practice in intensive care medicine, neuroanaesthesia, chronic pain, cardiac anaesthesia, paediatric anaesthesia and trauma.

� Mock exam in SAQ and MCQ/SBA. � Interactive discussion of Single Best Answer questions

using Turning Point technology. � Pre-course SAQ practice and feedback starts two months

prior to the course.

Registration fee: £260 Includes a copy of SOE in clinical anaesthesia book, breakfast, lunch and refreshments

For further details please contact Gillian Prior [email protected]

024 7696 7083 www.anaesthetics.uk.com or www.mededcoventry.com

FINAL FRCA MCQ/SAQ COURSE


VACANCYClinical Lead ‘NAP6 – Perioperative

Anaphylaxis’National Audit Project of the

Royal College of Anaesthetists

This post is a fixed term RCoA appointment to lead NAP6. NAP6 will examine perioperative anaphylaxis in NHS hospitals in England, Scotland, Wales and Northern Ireland. The successful candidate will work closely with Dr Tim Cook, College Advisor for National Audit Projects (NAPs).

The project is managed on behalf of the RCoA by the Health Services Research Centre (HSRC) of the National Institute of Academic Anaesthesia (NIAA). The HSRC will provide administrative and organisational support for the project.

The role will span the duration of the project (expected May 2014 to March 2017). The post is supported by 1 period of professional activity (1 PA) per week in order to enable the successful candidate to dedicate a minimum of four hours per week to the project.

Applicants should submit a one page CV and one page letter of support from their Head of Department/Line Manager to Miss Maddy Humphrey (NAP & HSRC Administrator) at [email protected]. This must include contact details (daytime telephone and email address).

Further information including the job description, person specification and information on former NAPs is available from the NIAA (www.niaa.org.uk) and College (www.rcoa.ac.uk) websites.

Those who are interested are strongly advised to discuss the role with Dr Tim Cook by email ([email protected]) or by telephone (07970 025209).

The successful candidate will start their role at a NAP6 planning meeting in spring 2014.

Closing date for applications: Monday, 17 February 2014.

Interview date: Wednesday, 12 March 2014.

Royal College of AnaesthetistsLondon WC1R 4SG
