President's News, April 2019

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With anaesthesia being the UK’s single largest hospital specialty, and the College and our faculties representing a combined membership of 22,500, we take seriously our responsibility to support you throughout your career. This is why your College actively supports eradicating bullying and oppressive behaviour. Bullying has no place in healthcare, it is unprofessional and unnecessary. It affects the wellbeing of staff and the teams within which they work.  As anaesthetists, we work in multi-disciplinary teams and may witness, or be subjected to this behaviour. We know from our own research that 19 per cent of anaesthetists in training experience excessive levels of stress and as we are all too aware bullying and undermining behaviour can also have a detrimental effect on mental wellbeing.

In 2017, our Trainee Committee and the Association of Anaesthetists’ Group of Anaesthetists in Training launched #KnockItOut – a campaign to tackle bullying, harassment and undermining within the medical profession. Today the partnership continues and work to eliminate oppressive behaviour was boosted in April by the publication of an anti-bullying resource seeking to again spotlight the unacceptably high levels of workplace bullying and harassment in the NHS.

Following a September 2018 conference hosted by The Royal College of Surgeons of Edinburgh and the National Freedom to Speak up Guardian, medical and healthcare organisations came together to form an alliance to tackle unacceptable behaviour. I was pleased that Vice President, Dr Janice Fazackerley attended and ensured that our support was clearly communicated. Earlier in April, College Council member Dr Jamie Strachan represented the College at a joint event ‘Tackling Bullying and Undermining in the NHS’ run jointly by The Royal College of Surgeons of Edinburgh and the Royal College of Obstetricians and Gynaecologists. We do not have all the answers but by working together with all specialties much can be accomplished.

The publication of the anti-bullying resource, launched at the April event highlights great examples of best practice that help tackle undermining behaviour. It includes details on encouraging a culture of reporting, creation of anti-bullying ambassadors within hospitals and a range of anti-bullying toolkits among many other ways to make a tangible difference. It is possible to create an environment that empowers individuals to speak up if they experience or witness improper behaviour.

The 2018 NHS Staff Survey in England showed bullying incidents have increased in the past year so I am encouraged by the #KnockItOut campaign which continues to gather momentum. Currently the partnership is working on the creation of resources that can be used to combat poor behaviour in the workplace. Until this issue is resolved, finding ways to tackle harassment will remain high on the sector’s agenda and so it must. For some time now doctors across the country have been raising concerns about bullying and harassment and it is clear that honest conversations need to continue to find the best way of addressing the issues. Your College will continue to stay committed to the debate and remain a strong collective voice for all fellows and members.

The College’s 2018 Annual Review

The College’s 2018 Annual Review and Financial Statements 2017-2018 have been published and are available online.

The 2018 Annual Review summarises what was an important year for the College. It provides detailed reports from all College directorates, including highlights from the variety of events and activities the College participated in as it marked the NHS turning 70 and the 70th anniversary of the formation of the Faculty of Anaesthetists of the Royal College of Surgeons of England, which ultimately led to the creation of the College. From research, clinical quality and communications to training, examinations and events, the 2018 Annual Review outlines the College’s work across many areas to advance the specialty of anaesthesia.

Lifelong Learning update

Since the launch of the Lifelong Learning platform in August 2018, over 520,000 anaesthetic cases have been recorded using the Logbook functionality and nearly 53,000 personal activities have been documented.

Over 130 Annual Review of Competence Progression panels have taken place on the platform, with the team gathering feedback from these to improve member experience by improving functionality ensuring all members have the right level of access to the platform. For more information about how the platform is being developed, please click here.

Over 4,800 Education Supervised Structured Reports have been generated alongside 2,700 completed multi-source feedbacks, so the platform is performing well and of great benefit to fellows and members. 

In other Lifelong Learning related news, the most recent anaesthetists in training will move over to the Lifelong Learning platform this August. We advise all anaesthetists in training to download their portfolios onto a few different devices and/or USBs. If you have used the platform as an anaesthetist in training and still have your portfolio stored on the old system, please also ensure you download an offline version of your Portfolio record from the ‘view portfolio’ section. You can find a step by step guide on how to do this here.

If you require any further assistance, please email the Lifelong Learning team on: lifelong@rcoa.ac.uk

Continuing Professional Development is coming to Lifelong Learning soon

A major project to incorporate CPD functionality into the Lifelong Learning platform is progressing well. Since the College’s CPD Online Diary was launched in 2011 we have collected a wide range of stakeholder feedback in order to enhance the system. The opportunity to integrate this into the Lifelong Learning platform presents an ideal opportunity for these improvements to be made.

The project will be delivered in four ‘sprints’ (fortnightly bursts of development). At the end of each sprint – a day of testing has been incorporated to allow selected users to experience the site as members might, with feedback captured for further system enhancements. To date, two days of user testing has been incorporated. Thank you to those members who have been involved in the testing process so far.

Some of the system enhancements include CPD Learners being able to link activities and events to the Good Medical Practice Domains and will be able to add ‘real time’ reflection whilst attending a CPD-approved event. This means that they will no longer need to wait until the event’s conclusion to do this. The CPD Matrix is being replaced with a more intuitive and completely optional way for recording CPD skills in the Lifelong Learning platform and the CPD activity reports will be fully customisable.

Further information about the plans for CPD’s incorporation into the Lifelong Learning platform can be found here.

Research news – ‘there’s still time…’

…for you to submit a topic proposal for the next Sprint National Anaesthesia Project, SNAP3. SNAPs are short observational clinical research studies that aim to recruit a large number of patients from as many NHS hospitals as possible in a short timeframe. Submit your proposal to hsrc@rcoa.ac.uk by Friday 31 May 2019.

SALG issues their Patient Safety Update

The Safe Anaesthesia Liaison Group (SALG) has issued their October to December 2018 Patient Safety Update. This update contains anonymous case studies including:

  • items relating to perioperative steroid replacement
  • TIVA and unintended awareness during anaesthesia
  • regurgitation and raised airway pressure
  • allergy and anaphylaxis
  • fractured neck of femur
  • circulatory embolus
  • drug error
  • management of difficult intubation.

Please read and circulate the document as widely as you can. More information on SALG can be found here.

New speakers announced for Updates in Anaesthesia, Critical Care and Pain Management Event
17–19 June 2019 in Bristol

We have announced four new speakers for the three day Updates in Anaesthesia event in June.

  • Dr Mike Swart – Choosing wisely: Just because we can, does it mean we should?
  • Professor Mike Reed – Scaling up for safety: The lessons learnt from a hip fracture. quality improvement programme.
  • Dr Rohit Juneja – TIVA.
  • Dr Nuala Lucas – Obstetrics.

Discover what new developments are on the horizon from today’s thought leaders and learn how best to combat issues you will face in your anaesthetic practice. Connect with, and question the specialty experts, discuss your experiences with peers, and bring back new ideas that will improve your own practice.

College Update events sell out fast so book your place now.

Live Regional Anaesthesia Masterclass – 4 June 2019

Watch live interactive demonstrations of how to perform chest blocks and shoulder surgery at our first Regional Anaesthesia Masterclass. Study the pros and cons of safely using regional anaesthesia, by looking at the past, the present and future, including an in depth look at the latest research.

Discuss with other anaesthetists some of the hot topics around regional anaesthesia, including optimising patient access, attitudes to blocks and the pros of giving general anaesthesia. You will come away from the day more informed on the latest thinking behind regional anaesthesia with renewed confidence on achieving positive patient outcomes whilst using it.

This event is filling up fast so book your place on the 4 June Regional Anaesthesia Masterclass now.

Apply for the role of Bernard Johnson Advisor for Less than Full Time

The purpose of this role is to provide high-level representation on matters relating to less than full time training across the UK, as well as facilitate communication to enable sharing of information and coordination of feedback. The successful candidate will also share best practice in less than full time working policy in postgraduate medical education and training.

The role requires a commitment of a minimum of three hours per week and is unpaid, however all reasonable expenses will be covered by the College.

How to apply
Please complete the application form and submit this, along with a copy of your CV to Head of Training, Claudia Moran. For further information please see the job description.

NIAA Comprehensive Review published

The National Institute of Academic Anaesthesia has published its 2016-2018 Comprehensive Review. As this encompasses the NIAA’s 10th anniversary year, the Review looks at not only the NIAA’s grant awarding and other activities, but also back across the first decade of its existence. I served as Chair of the NIAA from 2010-14 and was very fortunate to work with some amazing people and organisations.

I agree entirely with current NIAA Chair Professor Mike Grocott, who says: “The NIAA is the jewel in the crown of UK anaesthesia. The sustained and effective collaboration of its partners is unique in academic medicine and has created an organisation that is the envy of other medical specialties and internationally admired as a model of academic co-operation.

Global Partnerships update

March 2019 was a busy month for the Global Partnerships team, with the following events taking place…

Global Anaesthesia: Engaging the Collective

Our international conference attracted 60 delegates who engaged in a series of discussions about challenges and opportunities when working in low resource settings. Focus was given to both essential surgical and anaesthetic care. There were a wide range of speakers, including anaesthetists in training and international speakers, with varied interests and experiences but with a common aim of engaging to improve global anaesthesia.

MTI Hosts Day

With the increase of Medical Training Initiative (MTI) doctors coming to the UK to train for two years, the Global Partnerships team felt it necessary not only to induct the newly appointed doctors (through our ‘New to the NHS meeting’) but also their hosts including supervisors, clinical MTI leads and medical staffing, all key groups responsible for MTI doctors while in the UK.  The aim of the event was for hosts to understand their role, how best to support their MTI doctors and what the College’s expectations were. With this in mind, the team ran the first ‘MTI Hosts Day’ in February 2018 and due to its success, ran and hosted (in partnership with the Royal College of Surgeons and Royal College of Physicians), a second in March 2019.  Feedback for this event continues to be very positive and the team is planning to host another event in 2020.

College of Anaesthesiologists of East, Central and Southern Africa (CANECSA)

The College has joined an alliance to actively support the development of the College of Anaesthesiologists of East, Central and Southern Africa (CANECSA). As part of this exciting project, members of the College’s Global Partnerships committee, its partners, and representatives from the African constituent countries met in Arusha, Tanzania, to define CANECSA. This is work in progress and we look forward to updating you on developments in due course.

Lay perspectives on simulation

Members of the Lay Committee recently visited a simulation centre to witness first-hand the benefits of simulation training. Two visits to the centre at the Royal London Hospital gave all those on the Lay Committee a chance to take a closer look at simulation training and observe trainees going through the process.

During the Lay Committee visits there were four trainees and three trainers supporting the day. Attendees took part in several role play scenarios and were given feedback by trainers who alternated so the sessions always remained fresh, with new perspectives on approaches. 

Trainees too rotated, playing various roles including anaesthetists, second anaesthetists, surgeons, operating department practitioners and nurses. All were observed via two - way glass and on computer screens. This type of training enables everyone to see how the team works without the distraction of the trainees being obviously observed.

The Lay Committee found that whilst the trainees did not know each other prior to the simulation training, they were able to work well as a team when faced with immediate day-to-day theatre scenarios. Committee members commented that it was interesting that ‘knowing your equipment’ played a key part in their reactions and ability to handle situations. The reliance on equipment and understanding how to deal with malfunctions was something that had not really been considered by Committee members before. The scenarios were well thought through, felt real and were often complex. Key themes from the day were:

  • thinking about the emergency
  • quick independent and team planning
  • clear communication
  • knowing your equipment and its location
  • the ability to self-assess
  • care for the patient
  • honesty.

The committee members were impressed by the calibre of the trainers. They were sensitive and supportive, encouraging and pragmatic yet created the right environment of care along with a touch of humour. One of the trainers was working on her day off and mentioned that most of them take part in training when they are off duty.

Overall, the Lay Committee reported that it was an excellent day, with Committee members gaining a better understanding of the part simulation plays in training. The entire Lay Committee would like to express their thanks to everyone involved in organising the day.

Council members help reduce the College’s carbon footprint

Hot on the heels of the College publishing its first Sustainability Strategy – members of College Council took the serious task of reducing the organisation’s carbon footprint one step (or cycle ride) at a time. In April, Council members either walked or cycled the entire or last part of their commute into the College for the April Council meeting. Inspired by the recent #WalktoWorkDay initiative and the expressed desire to act on the College’s new sustainability principles, Council members documented their carbon neutral commutes on social media.

The Sustainability Strategy devised by Council member, Dr Lucy Williams states that the College will support relevant initiatives aimed at mitigating further global temperature rises and climate change. The walk/cycle to College initiative aligns to the College’s partnership with the UK Health Alliance on Climate Change – an alliance which brings together healthcare professionals to advocate for responses to climate change that protect and promote public health.

The College is committed to embedding sustainability in everything it does and the creation of a comprehensive Sustainability Strategy encompasses this. It details the strategic priorities, implementation plan and measurement criteria for how the College will ensure that achievements clearly align to its commitment. More information about the College’s Sustainability Strategy can be found here.

Sandwell and West Birmingham NHS Trust take home the Anaesthesia and Perioperative Medicine Team of the Year award

The anaesthetic team at Sandwell and West Birmingham NHS Trust was named Anaesthesia and Perioperative Medicine Team of the Year at the 2019 BMJ Awards held in London on Wednesday 24 April.

The BMJ Awards celebrate excellence in the delivery of clinicians and the teams they work. The team won the College sponsored award for their excellent work in consultant-led perioperative trauma care.

With the age of the population increasing so too does the number of patients presenting with hip fractures and multiple comorbidities. Previously there had been disappointing results in the National Hip Fracture audit. This led to the team at Sandwell and West Birmingham NHS Trust starting a seven day, consultant-led perioperative trauma care bundle to improve the outcome of these patients.

As a result of the bundle initiatives, the uptake of patients receiving FIBs increased from 28 per cent in 2014 to 96 per cent in 2018.

Dr Subash Sivasubramaniam and the team at Sandwell and West Birmingham NHS Trust have shown leading work in consultant-led perioperative trauma care.

Patient-centred work is key in the field of anaesthesia and making sure that patients are treated from preparing for surgery to recovery as this can make a huge difference.

The team at Sandwell and West Birmingham NHS Trust have shown that perioperative medicine and taking a new approach to trauma care can improve outcomes significantly for patients as well as the NHS as a whole.

Discount member rates for NHS Confederation Annual Conference (Confed19)

The Academy of Royal Colleges (AoMRC) has secured an agreement with the NHS Confederation for free and discounted places for Colleges for attendance at the NHS Confederation Annual Conference (Confed19) to be held on 19-20 June in Manchester.

The Confederation Conference remains the premier event for leaders across the health and care system. Last year’s conference had over 2,000 attendees with 125 different speakers. Confed19 will look at how the NHS Long-term plan in England will be implemented and what equivalent plans there are in Scotland, Wales and Northern Ireland.  Speakers announced so far include:

Details of the event can be found here.

AoMRC and NHS Confederation are keen to ensure strong representation from colleagues across the medical royal colleges and have agreed the following arrangements

  • discounted Confed19 member rates for medical royal college members – £599 (two-day) and £389 (one-day)
  • members can also get up to 20 per cent discount on bookings for three or more places - this represents a saving from the full rate of £790 and £515 respectively
  • members are also eligible for group bookings discount - 10 per cent discount for bookings of three, 15 per cent discount for bookings of four and 20 per cent discount for bookings of five or more people (to take advantage of this group discount, all delegates must be booked on together)
  • trainees can access exhibition only pass for a discounted rate of £149.

If you are interested in this offer, please select book now on the Confed19 website. If you have any problems when making your booking, please email eventbookings@nhsconfed.org.

Confed19 is CPD accredited and will contribute towards your continuing professional development (CPD). 

2019 Annual General Meeting

The College’s Annual General Meeting (AGM) will take place on Tuesday 21 May in London as part of our Anaesthesia 2019 event at etc venues St Paul’s.

If you are not attending Anaesthesia 2019 but would still like to attend the AGM please email ceo@rcoa.ac.uk.

If you have any comments on the issues highlighted in this e-newsletter or would like to express your views on any other matter, I would like to hear from you. Please contact me via presidentnews@rcoa.ac.uk

Professor Ravi Mahajan
President