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I recently listened to two anaesthetists talking in a coffee-shop queue. One was of a certain age and clearly exasperated at having to contemplate the supposed burnout levels in my generation of anaesthetists in training. He simply couldn’t understand it. After all, in his day they worked hundred hour weeks! ‘Bloody snowflakes’, he reflected. The other nodded gravely.

‘Snowflake’ is a term commonly wielded by our elders to bludgeon what they deem to be a fragile, over-sensitive and under-resilient youth of today. A people unable to cope with life. It does however require a certain amount of historical amnesia to use this slight without some irony catching in the throat. Did they not enjoy rock bottom housing prices, free higher education and high levels of job security, only to then preside over their decimation?

As I sit down to write this article, I am very much aware that today is the anniversary of the death of my mother. A strong-minded, intelligent and, above all, proud woman, her greatest fear as she became increasingly physically frail was a loss of dignity, something she had witnessed in the slow demise of her own mother.

From middle age onwards, she wrote me detailed letters describing what she would and would not tolerate as she got older, and instructing me, the only doctor in the family, to do everything possible to help her to die peacefully when the intolerable became manifest. Sadly, the law forbade such measures and, despite receiving excellent care in her failing years, she suffered much of the indignity that she most feared before passing.

Author: Dr Richard Knight, Retired Anaesthetist, archives@rcoa.ac.uk

In April 1982, I was grinding through a locum session in a Swedish regional hospital when my wife telephoned me to tell me that the duty officer in my UK medical unit has asked her to say a single word to me – the super-secret word designating the necessity to report immediately to the unit. 

This was my initiation into Mrs Thatcher's plan to recapture the Falkland Islands.

Most men in the unit knew where Argentina could be found in an atlas, mainly because of the forthcoming football tournament starring Maradona. This had not been the situation when Dr David Owen as Foreign Secretary, had put the unit on stand-by to repel invading Guatemalans from entering British Honduras. Then, the staff sergeant was compelled to send his wife to the NAAFI to buy an atlas.

After days of packing and repacking equipment, the unit was trucked to Southampton to join 2 Para on board a North Sea car ferry. Cabins were allocated, in the best military tradition, by rank, but in reality were all the same tiered bunks. The major in the overhead bunk was to read and reread his copy of Herodotus, in Greek.

Authors: Dr Eleanor Warwick, Dr Rachael Brooks and Dr Michael Argent, HSRC/PQIP Fellows

Email the CR&I team

It has been another busy year for PQIP, and the project team are immensely grateful both to our participating sites and collaborators for their tireless efforts in data collection and investing in quality improvement, and to our patients who consent to be part of this study. 

PQIP has more than 50,000 patients recruited and this is entirely thanks to your efforts!

The SNAP-3 study is a prospective observational research study investigating the inter-relationship between frailty, multimorbidity and postoperative delirium. We aim to translate observational data into recommendations for clinicians and patients with a positive impact on patient care. 

A challenge for health services researchers is to discover new knowledge that is both relevant to clinicians and truly meaningful to patients.

Translational research describes the flow of scientific discovery through to population-level health impact. In this article, we will outline some of the principles we used in the SNAP-3 study to translate observational research into meaningful output through study design, analysis, and broad dissemination.

Part of the Quality Improvement Working Group’s (QIWG) role is to deliver the College’s Quality Improvement (QI) strategy. To accomplish this, we have been working to strengthen the Quality Network (QN), plan projects and events to promote QI development, and consider how best to engage members.

Context

After previously focusing on the QI compendium¹ and facilitating resource sharing during the COVID pandemic, this year the QIWG has worked to assess and strengthen the QN. Our ‘Prep, Stop, Block’ project was part of this strategy, a summary of which was included in July’s Bulletin,² with the full report available on the our website.

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.

Why did I apply?

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.