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Authors:

• Dr Rachael Brooks and Dr Eleanor Warwick, PQIP Fellows and Anaesthetic Registrars, University College London Hospital
• Dr James Bedford, former PQIP fellow and Consultant Anaesthetist, University College Hospital NHS Foundation Trust
• Professor Ramani Moonesinghe, PQIP Chief Investigator

In 2023, the Perioperative Quality Improvement Programme (PQIP) is launching new postoperative morbidity variable life adjusted display charts (pomVLAD) for all sites recruiting patients undergoing colorectal surgery. Having previously been run as a pilot study in 10 hospitals, the quality-improvement dashboard has been refined and will now provide all sites with near-real time, risk-adjusted morbidity monitoring accompanied by the display of a number of key enhanced-recovery quality-improvement (QI) targets. 

For sites recruiting patients of other surgical specialties, there is also a newly developed QI dashboard which does not incorporate risk-adjustment. Dr James Bedford explains how they can be used to stimulate QI initiatives in your local hospital.

We would like to use this Bulletin article to focus on setting up a Personal Development Plan (PDP), some guidance on what should and should not get included, and to address a query about using your PDP in the Lifelong Learning Platform. In providing this advice we are making reference to the Mythbusters¹ guidance which has been produced by the Academy of Medical Royal Colleges.

The goals within the PDP should be taken from your appraisal, and should meet your needs and the context within which you work. It is recommended that goals are developed with your appraiser using SMART (Specific, Measurable, Achievable, Relevant and Timely) objectives, and it often helps to work out how you can demonstrate that a change planned as one of your goals has made a difference, by considering its impact on patients.

Authors:

• Dr Natalie Constable, ST6 Anaesthetic Registrar, Department of Anaesthesia, UHBW Foundation Trust, Bristol
• Dr Fiona Oglesby, ST6 Anaesthetic Registrar, Department of Anaesthesia, UHBW, Bristol
• Dr George Bainbridge, Anaesthetic Clinical Fellow, Department of Anaesthesia, UHBW, Bristol
• Dr Helen Howes, Consultant Anaesthetist, Department of Anaesthesia, UHBW, Bristol
• Dr Rachel  McKendry, Consultant Anaesthetist, Department of Anaesthesia, UHBW, Bristol

The Bristol Royal Infirmary’s Difficult Airway Response Team (DART), developed in 2017, is a successful, innovative, cross-specialty response unit designed to expedite the arrival of clinical expertise and advanced equipment to the patient’s bedside in complex airway emergencies. Five years following DART’s inception, we intend to highlight the challenges intrinsic to maintaining the service and how we have attempted to overcome these. 

The ‘DrEaMing’ care bundle supports patients to Drink, Eat and Mobilise within 24 hours of major surgery. This simple, patient-centred intervention is associated with decreased length of stay for patients and a lower rate of late postoperative complications.¹ 

Supported by the RCoA and Getting It Right First Time (GIRFT), DrEaMing is a Commissioning for Quality and Innovation (CQUIN) indictor, and was recently updated for 2023/2024. Containing the core features of more complex enhanced recovery pathways, DrEaMing aims to revitalise the quality-improvement (QI) efforts aiding patients’ recovery after surgery.

A positive collaborative culture, with cohesive working between the whole surgical multidisciplinary team, is essential for DrEaMing to become a sustained standard of care. The perioperative team are fundamental in delivering DrEaMing, but the other important party that can drive QI are the patients themselves!

With the rise of the Black Lives Matter and #MeToo movements in the last few years, media attention has been drawn to the abusive behaviours that have become embedded in our culture. Under the Equality Act 2010, it is against the law in the UK to discriminate against anyone because of nine ‘protected characteristics’. These are race, age, gender reassignment, being married or in a civil partnership, being pregnant or on maternity leave, disability, religion or beliefs, and sex and sexual orientation.

A survey among doctors and medical students highlighted that 76% had experienced racism in the work place at least once in the previous two years.¹ Similarly, 91% of woman doctors in the UK have experienced sexism at work,² and a survey among European surgeons revealed that 20% had considered quitting their job due to discrimination.³ While surgery is a specialty where discrimination and harassment concerns have been well documented, these issues have not been explored widely among anaesthetists.

I doubt there are many Bulletin readers who are old enough to remember the 1963 Disney film ‘The Incredible Journey’. Luath – a golden labrador, Bodger – an aging bull terrier, and Tao – a Siamese cat make a perilous journey across the Canadian wilderness to get to their home 300 miles away. As a little girl I sat in the Ritz Cinema with tears flowing because it seemed inevitable that Bodger had died in the final few miles of the journey. Of course he hadn’t. He trotted over the horizon to an ecstatic welcome from his animal and human family.

I was reminded of Bodger and his fictional achievement when I read about a dog called Pip. Last year Pip’s owner took him for a run in Leigh Woods, a beauty spot in Bristol. They became separated, and Pip’s frantic owner took to social media to get help finding him. Pip was soon spotted on the city’s security cameras. He crossed Brunel’s iconic suspension bridge, ran past the famous BBC studios in Whiteladies Road and was captured on camera running by the steps of the museum. Somehow he safely negotiated the notoriously dangerous traffic in the city centre and found his way to his front garden in Bedminster – about four miles from where he’d left his owner. In fact he got home before she did!

As your new elected anaesthetist in training (AiT) members of the Bulletin’s editorial board, we would like to welcome you to the AiT edition of the Bulletin. We're very excited to be taking over from Dr Susie Thoms and Dr Soumen Sen, and would like to thank them for their excellent work with both the Bulletin and The Gas Newsletter in recent years.

Looking at the current landscape, we wanted to touch on a few issues that we have recently been discussing within the College’s Anaesthetists in Training Representative Group and its Anaesthetists in Training Committee.

Cardiotocography (CTG) to monitor foetal heart rate is frequently used on the labour ward to monitor for foetal distress. Interpretation of CTG is routinely undertaken by the obstetric and midwifery teams to guide labour interventions, along with the mode and urgency of delivery. Anaesthetists are a key member of the multidisciplinary team, and we should therefore understand CTG. This knowledge can then help with joint decision-making, provide an additional set of eyes observing for foetal distress, and be an aid for choosing an anaesthetic technique.

Current training

The 2021 curriculum mentions CTG knowledge in both Stage 1 and in the Obstetric Anaesthesia Specialist Interest area.¹ However, there is a lack of clarity on how to obtain it. Despite there being excellent resources available for anaesthetists to learn about CTG interpretation, it is not formally taught or assessed.² It is left to the individual anaesthetist in training to obtain this knowledge, creating a lack of consistency in knowledge among anaesthetists.

You may well ask why you should think of becoming an AAC (advisory appointments committee) assessor. Perhaps it will be too arduous/boring/difficult. We hope to persuade you that this is not the case, and further explain what it can do for you and your department.

When your department appoints a new consultant or specialist doctor, there are specific requirements that must be fulfilled. One of the most important of these is to hold an AAC. This is a legally constituted interview panel established by an employing body. Its function is to decide which, if any, of the applicants is suitable for appointment and to make a recommendation to the employing body.