3-D printers were once the remit of science fiction but are now relatively cheap, available and simple to use. Dr Gohil and Dr Eleanor Whittingham from Warwick Hospital tell us how they used a 3-D printer to solve a safety issue.
Some are very familiar – a growing, aging population with increasing levels of chronic health problems and significant inequalities in care provision. Others are a factor of the Indian system which Ravi describes as ‘chaotic’.
A key issue underpinning that chaos is the distribution of physicians, 80% of whom practice in urban areas while 70% of the population live rural lives.
Ravi and colleagues are using cutting-edge digital technology to improve healthcare provision in India by introducing ‘comprehensive connected care’. This hub-and-spoke model uses digital connectivity to exchange data and information between centrally located expert clinicians and those caring for patients. For example staff in 5G-enabled ambulances transporting very sick people over long distances receive advice from critical care physicians who have all the patient’s clinical data at their fingertips.
At the recent College Tutors’ Meeting in June, the submissions for the annual poster competition were judged. The three highest-scored abstracts were selected for oral presentation at the meeting.
In anaesthesia they have been present for the last 10 years but have become more prevalent in the last four years. Many factors have led to this increase, but one of the biggest is the rise in the number of IMGs as new registrants on the GMC register. These totalled 40% of all new registrants in the last year.1 Other factors include training bottlenecks that have appeared as an unintended consequence of the changes from the 2010 curriculum.
This has led to increased competition for available posts, with significant numbers of doctors sitting in Locally Employed Doctor or Medical Training Initiative posts accumulating competencies that can count towards CESR. Understandably, trusts that can offer all the components of the curriculum in-house have recognised the potential to have a consistently high-quality, in-house workforce, with an ability to fill their own rotas when gaps appear. This is aided by the Lifelong Learning Platform being freely available to all members of the College, enabling training gaps to be easily identified and targeted with in-house training programmes.
VITAL is the first POMCTN-led study and a collaboration between the POMCTN (Perioperative Medicine Clinical Trials Network) and PQIP (Perioperative Quality Improvement Programme) teams.
We aim to test whether TIVA is superior to inhalational anaesthesia in terms of days alive and at home at 30 days (DAH30), and survival and quality of recovery among patients undergoing major non-cardiac surgery.
We have been recruiting well and have now passed the halfway point due to our fantastic sites. Here, one of our first site teams, at the Royal Marsden Hospital, shares its experience of recruiting to perioperative trials.
The Perioperative Medicine Clinical Trials Network (POMCTN) Research Leader scheme, previously named the Chief Investigator scheme, was founded with the aim of nurturing, training and supporting perioperative researchers to develop as future research leaders. Dr Mouton, a graduate from the Research Leader scheme, shares her experience.
December 2022 saw the final conversion of the initial dataset into a web-based survey tool. Further testing followed, which was exciting and challenging in equal measure. We are very grateful to our beta-testers who tested the questionnaire to destruction to ensure its future functionality.
Their feedback has been fundamental to the next steps in the project, even though their key finding was that the questionnaire was too long. The length of the form was originally dictated by airway experts from around the world with the aim of developing a set of questions they believed would capture all relevant data around an eFONA episode. To reduce its length, a ‘Delphi’ exercise is underway which will identify and agree on the fundamental questions to be answered when reporting an eFONA event.
I write this month’s President’s View in the week following the death of Her Majesty Queen Elizabeth. On behalf of the College, I extend our condolences to the Royal Family. I hope that the expression of admiration and love felt for the Queen worldwide has been of some comfort to them. Her Royal Highness the Princess Royal has long been a dedicated and supportive patron of the Royal College of Anaesthetists, and our thoughts are with her at this time of personal sadness, with which many of us can empathise.
In my last update, I mentioned that the College has been addressing some financial challenges.
We are committed through our current five-year plan to manage the College’s resources with care, and to ‘ensure the College is resourced and equipped to carry out its strategy: now and in the future’. One of our core values is being open and responsive, and in that spirit I am keen to share with you our current financial position, and what we are doing to improve it.
I started working part-time for GIRFT (Getting it Right First Time) as a POA (Preoperative Assessment) national advisor in September 2022. Most POA non-medical leads will recognise that you are often working in a silo in a POA department. While we have a number of expert multidisciplinary-team (MDT) professionals who feed into and out of the department, the core ‘everyday’ team are predominantly non-medical staff.
It’s an area that has seen significant variation across the country, but for many POA will be the sole job for the staff who work there. The reason? They absolutely LOVE IT! Highly skilled and hugely rewarding, this area brings a huge amount of satisfaction and unity to identify potential challenges for our patients undergoing elective surgery, and is an opportunity to help educate and inform on perioperative risk.
Post pandemic, we have seen pivotal changes to the perioperative pathway with a focus on early assessment and optimisation for patients ‘while they wait’.1 Working for GIRFT and NHS England (NHSE) colleagues, specifically in elective recovery, has brought a new dimension to my role and, I hope, skills of influence, engagement and innovation to help drive forward the importance of all POA clinics, everywhere.
