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I’ve been wondering recently how far I should be embracing or resisting my own background when speaking as a patient voice.

I took on the role of Chair of PatientsVoices@RCoA in September, and I’ve found it fascinating to learn about a whole range of issues that are new to me and to contribute to discussions about them. But I’ve also been struck by how often I’ve found myself thinking that the need for good communications lies at the heart of whichever issue is under discussion. And I’ve been wondering whether that reflects the reality, or my own particular interests.

Questions around financial viability, impact on relationships with the ‘parent’ College, and loss of corporate strength are all concerns I’ve heard following FICM’s statement. 

You might be interested to know that they were also the exact ones expressed at the time the Faculty of Anaesthetists went through their own journey.¹ The journey leading to the formation of the RCoA was not without setbacks and differences of opinion. Faculty board are cognisant of that history, and so are mindful that for our part discussions leading up to our separation are based in a friendly and constructive spirit.

This credentialing journey has been one long road, but 2024 will finally see us making further inroads.

When the General Medical Council recently approved the ‘Curriculum for the Credential for the Specialist in Pain Medicine’, we were delighted that six years of hard work has come to fruition.

To date, specialist training in pain medicine has largely only been open as part of the CCT training in anaesthesia or post-CCT for a small number of consultants who opted to pursue training.

Author: Dr Stuart Connal, Specialty Registrar in Anaesthesia, North Central London Deanery

Perioperative Journal Watch is written by TRIPOM (trainees with an interest in perioperative medicine – tripom.org) and is a brief distillation of recent important papers and articles on perioperative medicine from across the spectrum of medical publications.

The anaesthetic department at the Royal Devon and Exeter Hospital started a mixed social hockey team during the summer months. Critics who preferred non-team sports argued the organiser was trying to boost his weak CV prior to future consultant applications, but the main aim was always to have fun!

The GMC has recognised that the quality of clinical care and the safety of patients are crucially dependent on the quality of training provided within the health service, not only in relation to skills and knowledge but also in relation to professionalism. The GMC has recognised for many years that trainers must be trained, accredited, supported and quality-assured.

Specialty and Specialist (SASs) and locally employed doctors (LEDs) are the fastest growing part of our workforce, with numbers increased by 40% over the last five years. Projecting forward, they are expected to be the workforce’s largest group on the GMC register by 2030 (GMC workforce report 2022). Not only will the NHS depend heavily on this part of the workforce to provide services to patients, but also to train future generations of doctors and other healthcare professionals.

The 2021 SAS contracts set a clear expectation that specialty doctors should get involved in non-clinical activities to develop their range of expertise as well as ensure their progress through the higher pay threshold. Varied and relevant non-clinical experience and activity is an essential requirement for appointment as a specialist. Our appraisal and revalidation system sets an expectation of all doctors, regardless of grade, to be active in quality improvement, and encourages teaching, leadership, management, research and innovation.

Twenty five per cent of trauma deaths are directly caused by injury to the thorax and, while a minority will require emergency surgery, up to eighty five per cent of chest injuries can be managed without the need for formal surgical intervention.¹ In these cases, rapid recognition and management of life-threatening conditions are key to successful resuscitation.

Thoracostomy (the creation of an artificial opening in the chest wall) is a procedure performed for decompression of the chest, usually by our pre-hospital, surgical or emergency medicine colleagues. It is also the first stage to placing a tube thoracostomy or ‘open’ chest drain. In the context of trauma, emergency lateral thoracostomy is indicated in the following circumstances:

• traumatic tension pneumothorax
• massive haemothorax
• traumatic cardiac arrest.

When emergency cases are booked, they must be able to access theatre in an appropriate time frame. Assessing the operational pressure on the emergency theatre is a complex calculation considerate of the number of cases booked, their acuity, and expected duration. 

The National Emergency Laparotomy Audit (NELA) uses a classification for surgical urgency based on the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) and Surviving Sepsis.¹

• 1: Immediate (<2 hours)
• 2a: Urgent (2–6 hours)
• 2b: Urgent (6–18 hours)
• 3: Expedited (>18 hours).

Anaesthetic room walls are often covered with various posters and warnings reminding staff about recent incidents or safety hazards. Signs prompt us where to find dantrolene or intralipid, or how to confirm tube placement. 

When the RCoA changed its branding in 2016, professional designers were called in and consulted on the changes. When creating clinical informatics however, it is often left to clinicians; but a complex series of decisions that combine aesthetics, psychology, and ergonomics are required to make presentation effective.

In this, the first of a series of articles, we will explore some of the issues relevant to presenting information, beginning with iconography.

Aileen Kirkpatrick Adams was born in 1923 in Sheffield, where she qualified in medicine in 1945. She trained in anaesthesia at the Royal Free and Edgeware hospitals in London and at Bristol’s Frenchay Hospital under Dr Tom Wilton, and worked in Oxford under Sir Robert Macintosh. She also enjoyed a sojourn at the Massachusetts General Hospital under Henry Beecher. Finally, she was appointed as a consultant anaesthetist in Cambridge, England.