Minority Report Dr Olusegun Olusanya and Dr Adrian Wong discuss their experiences of training in the UK - The Royal College of Anaesthetists
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
September 2020
Swapping STIs for ICU
The story of CARDMEDIC:
breaking the PPE barrier
Raising the standards: a new
edition of the recipe book
Minority Report
Dr Olusegun Olusanya
and Dr Adrian Wong
discuss their experiences
of training in the UK
Page 26
rcoa.ac.uk
@RCoANews
Bulletin | Issue 123 | September 2020
RCoA Events
rcoa.ac.uk/events
events@rcoa.ac.uk EVENTS AND COVID-19
@RCoANews Due to the ongoing COVID-19 situation we have moved the
majority of our events on to virtual platforms, where this is not
possible some of these events may be postponed or cancelled.
Anaesthetic Updates
SEPTEMBER 19 October 2020 DECEMBER Please keep up-to-date by visiting our webpage:
%
rcoa.ac.uk/events
Virtual event
Anaesthetic Updates
Ultrasound Workshop The Winter Symposium
29 September 2020
%
3–4 December 2020
%
October 2020
%
Virtual event
Virtual event RCoA, London
Introduction to Leadership and
Management: The Essentials
%
NOVEMBER
30 September to 1 October 2020
The Studio, Leeds
JANUARY
Clinical Directors Network
Meeting Tracheostomy Masterclass
OCTOBER 16 November 2020 11 January 2021
%
Virtual event RCoA, London
Anaesthetists as Educators:
Introduction
Leadership and Management: GASAgain (Giving Anaesthesia The Winter Symposium 2020
%
Working Well in Teams and
%
Safely Again)
%
6 October 2020
Virtual event
Making an Impact
18 November 2020
13 January 2021 3–4 December 2020 | RCoA, London
Bradford
RCoA, London
Anaesthetists as Educators:
Primary FRCA Revision Course Join us at this year’s two-day symposium for a lively mix of lectures, debates and
Simulation Unplugged
%
Anaesthetic Updates 18–22 January 2021
%
7 October 2020 19 November 2020
interactive sessions.
%
RCoA, London
Virtual event Virtual event It has been a year of isolation, uncertainty and hard work: COVID-19 has taken it
Anaesthetic Updates
A Career in Anaesthesia Anaesthetists as Educators: out of all of us.
21 January 2021
%
8 October 2020
%
Anaesthetists’ Non Technical
%
Southampton End the year with the Winter Symposium. Regroup, network with colleagues new
Virtual event Skills (ANTS)
20 November 2020 Anaesthetists as Educators: and old, celebrate anaesthetists achievements and listen, debate and discuss a wide
Leadership and Management: range of topics.
Virtual event Advanced Educational Supervision
%
Leading and Managing Change
%
26 January 2021
16 October 2020 Airway Workshop Birmingham
Look forward to 2021 and come and join us for one day or two.
RCoA, London November 2020
%
GASAgain (Giving Anaesthesia
Virtual event
rcoa.ac.uk/events/winter-symposium-2020
Safely Again)
%
Developing World Anaesthesia
16 October 2020 November 2020
%
Virtual event Virtual event
Discounts may be available for RCoA-registered Senior Fellows and Members, Anaesthetists in Training, Discounts may be available for RCoA-registered Senior Fellows and Members, Anaesthetists in Training,
Foundation Year Doctors and Medical Students. See our website for details. Foundation Year Doctors and Medical Students. See our website for details.
%
%
Book your place at rcoa.ac.uk/events Book your place at rcoa.ac.uk/events | 1
Bulletin | Issue 123 | September 2020 Bulletin | Issue 123 | September 2020
Contents
The President’s View 4
News in brief 8
Guest Editorial 12
Election to Council 2021 15
From the editor
Faculty of Pain Medicine (FPM) 16
Dr Helgi Johannsson
Faculty of Intensive Care
Medicine (FICM) 17
SAS and Specialty Doctors 18 Welcome to the September Bulletin.
Clinical Directors’ Executive
Committee 20 Welcome to your September edition of the Bulletin. As I write this I remember hoping in the last editorial to be
in rural Bulgaria at this point, however, due to the pandemic Bulgaria morphed into the Peak District, which was
Patient perspective 22
no less wonderful, but a little wetter.
Revalidation for anaesthetists 24
The last few months have been tumultuous for healthcare in the UK, and many of us have changed the way
Perioperative Journal Watch 25 we work completely. We staffed makeshift intensive care units, anaesthetists became intensivists again, and we
Airway matters: airway welcomed doctors and nurses from many other specialties into our numbers when the surge was at its highest.
education on a global scale 28 An interesting development of this for me is that our surgical trainees seem much more familiar with our work,
Guest editorial Coaching through COVID- and clearly understand the issues when we struggle with a patient’s ventilation.
19: psychological safety and
A day in the COVID-19 ICU compassion 30 With this in mind, I make no apology for the fact that there are a lot of articles on the COVID-19 pandemic in this
issue, and I’m very much looking forward to welcoming more articles in the next few months on how the tumult
RCoA resources for patients:
Shameek Datta talks about his experience of working information you can trust 36
has changed the way we work – particularly on how we find new ways of delivering education and training.
in ICU more frequently than usual Simulation for professionalism After contracting COVID-19 in March (thankfully mildly) I am still slowly regaining my sense of smell, and
and human factors training 38 recognise many of the emotions expressed in Dr Richard Hay’s personal account of what happened when
Page 12
he contracted the infection (page 48).
A revolutionary wellbeing initiative 40
Family communication during During the summer, the Black Lives Matter protests after the murder of George Floyd in Minneapolis
The President’s View Swapping STIs for ICU COVID-19: our experience 42 caused us all to stop and think. I’m proud of the College for not only issuing a meaningful statement
Pregnant during the pandemic: (https://bit.ly/RCoARDDs) quickly, but for starting work on trying to improve issues of race within our training
The challenge of delivering Ellie Crook shares her experience
a bumpy ride 44 and workplace. I am delighted to welcome an article where Drs Segun Olusanya and Adrian Wong discuss
both paper-based and face-to- of being redeployed and cross-
their experience of training in the UK. Reading their reflections has confirmed to me how important role
face exams with restrictions in skilled to support colleagues in Raising the standards: a new
edition of the recipe book 46 models are in medicine. It is clear from his writing that Segun became a great role model to the black patients
place to reduce the transmission managing COVID-19 he wrote about, and I’m sure to black medical students, junior doctors, and those on work experience. Without
of COVID-19 Catching COVID-19: a trainee’s
Page 32 role models it’s very difficult to visualise your goal – from becoming a doctor, through to being a consultant, to
experience 48
Page 4 leadership positions, (and indeed Council membership). Role models show us what we can achieve and how we
Creating a unifying platform for
The story of advertising and finding
can get there.
Minority Report CARDMEDIC: breaking external CPD 50 So, gazing into my crystal ball towards publication in September, I sincerely hope we will be busy catching up
Dr Olusegun Olusanya and the PPE barrier Book Review: Death, religion with our elective work, and getting back to a semblance of normality. So far predictions of a large second wave
Dr Adrian Wong discuss their and law: a guide for clinicians 52 have proved unfounded and as I write the intensive care units in my trust are not looking after a single patient
Inspired by the story of a with COVID-19 pneumonia. I really hope I’m right, long may the overflow ICUs stay closed.
experiences of training in the UK Being a member of the
COVID-19 patient surviving an
Page 26 Membership Engagement Panel 54
ICU admission, CARDMEDIC is
designed to ease communication As we were... 56
with critically ill patients New to the College 58
Page 34 Letters to the editor 61
Notices, adverts and College events 63
2 | | 3
Bulletin | Issue 123 | September 2020 Bulletin | Issue 123 | September 2020
Professor Ravi Mahajan Fiona Daniels
President RCoA Head of Examinations
president@rcoa.ac.uk exams@rcoa.ac.uk
Events since March have posed a difficult situation for trainees
intending to take FRCA and Faculty examinations over the spring and
summer. The challenge of delivering both paper-based and face-to-
face exams with restrictions in place to reduce the transmission of
COVID-19, meant regretfully that a number of examinations had to be
cancelled. Since this time, the College has been working to find ways
to prevent further cancellations. This has required rapid but careful
planning on how to use available technologies to support a new
method of delivering our examinations.
Our digital transformation begins Prior to the pandemic, the College had released
a tender for a new exams management system.
Technology has played an increasingly critical
Primarily, this system needed to be suitable for the
role in our everyday lives since lockdown. It has
authoring, storing and maintaining of exam questions
adjusted the way we communicate, socialise and
but, to be future-proofed, it also needed to have
work. Indeed, the College has been supporting its
the ability to deliver exams online, as and when we
members virtually since the closure of our offices in
required it. The chosen supplier was TestReach, a
mid-March. We are now harnessing this enhanced
company that provides the ability to deliver formal
ability to continue to operate and conduct our work
exams within a cloud-based assessment tool, with
virtually, and in particular for the delivery of all our
the option of remote proctoring (invigilation) through
exams; written, OSCE and SOE.
their in-house invigilation team. This option to deliver
Our first step in this transformation, has been to proctored online exams was the obvious solution
provide members with the ability to take the written to the uncertainty around face-to-face social
exams online. This transition to online assessment gatherings, and fluctuating COVID-19 infection
has been part of the College’s long-term strategy rates. This new platform will enable trainees to pass
The President’s View for a major digital transformation of examinations, through their training programme with no further
however, the COVID-19 pandemic has expedited fear of cancellation or delays to written exams.
PROTECTING EXAMS IN A PANDEMIC this upgrade. The progression to online written
exams, not only modernises the way these exams are
delivered, it enables us to expand the opportunity to
A two-part approach
To ensure that we were ready to deliver our first set
a global audience of anaesthetists. of exams this autumn, the proctoring project would
comprise two phases. Phase one sees a short-life
4 | | 5
Bulletin | Issue 123 | September 2020 See the College’s statement Bulletin | Issue 123 | September 2020
on examination fees:
Bulletin
https://bit.ly/RCoAExmFees
project group transform the written the associated stress of sitting in a examinations. Clinical examinations are
exams from pen and paper to online test-centre environment. It also allows a critical part of trainee’s summative
of the Royal College of Anaesthetists
exams. In this initial phase, only the candidates to resize any area of their assessment, testing the knowledge Churchill House, 35 Red Lion Square, London WC1R 4SG
delivery mechanism changes, the exam screen during the exam, including and skills essential to the safe practice in the massive transformation of our examinations. This 020 7092 1500
structure, content, standard setting any resources, question stem and of anaesthesia, intensive care and will protect the College, candidates and the integrity of rcoa.ac.uk/bulletin | bulletin@rcoa.ac.uk
(the process by which we obtain the answer areas, and to highlight and pain medicine. The OSCE is the only the examinations from the current uncertainty until we
@RCoANews
pass mark) and the way we process the annotate text. component of our examinations reach a point where normal delivery can be resumed.
/RoyalCollegeofAnaesthetists
results remain the same. where the candidate is tested in a
A new word for new times? simulated clinical environment including Continuing to support the cost of Registered Charity No 1013887
Phase one, although significant, only
Proctor (prok·tuh): to monitor or communication with simulated patients. examinations Registered Charity in Scotland No SC037737
involves the proctoring system for the VAT Registration No GB 927 2364 18
supervise (an examination) or the more The amount trainees pay for each examination is
actual delivery of the exams. Phase two Protecting the delivery of our OSCE and
familiar, to invigilate. Moving our written calculated carefully to ensure that we can continue
will be a much larger project that allows SOE examinations against cancellation President Hugo Hunton
exams online with remote invigilation to provide the fairest, most valid and best quality
us to transfer our current question banks has entailed much thought, deliberation, Ravi Mahajan Lead College Tutor
resembles more closely the physical examinations during their training programme. The
(written, OSCE, SOE) to the new system, and collaboration between the examiner
exam environment than you may think. Vice-Presidents Emma Stiby
boards for FRCA, FICM and FPM. College does not make a surplus from UK examinations
and negates the need for the multiple Fiona Donald and SAS Member
Just as in the pen and paper delivery, and this will continue to be the case. As per our
platforms currently used by integrating During April, we undertook a risk analysis
an invigilator briefs candidates at the Mike Grocott Susannah Thoms
on a range of options for the delivery of announcement in July, College Trustees agreed the
exam sittings, candidate booking, start of the examination, reminding
these exams. The option we identified need to increase examination fees by five percent for Editorial Board Anaesthetists in Training
registration and correspondence and them of the dos and don’ts and
as best suiting our needs was the use of 2020–2021. However, the College appreciates the Helgi Johannsson, Editor Committee
processing and reporting of results. In putting them at ease.
video-style conferencing technology. significant impact and disruption that COVID-19 has Carol Pellowe
essence, this solution creates an end- Jaideep Pandit
We felt that this option would require no had, and continues to have on trainees’ working lives. In Lay Committee
to-end examination process in one Once the candidate enters the Council Member
or very minimal change to the SOEs so view of this, we took the decision to defer the increase
secure system. With question banks online test environment, TestReach’s Gavin Dallas
until January 2021. The decision to keep exams running, Krish Ramachandran
transferred, our teams of examiners will own invigilators monitor a maximum would be the least disruptive to trainees. Head of Communications
by harnessing leading platforms in online assessment Council Member
more easily be able to securely author of six candidates (per invigilator) over With the dramatic increase in the use
is wholly appropriate for high-stake tests. The cost Jonathan Thompson Mandie Kelly
questions in the system from wherever the web. At all times, invigilators can of video-conferencing technology,
of these systems reflects their utility, innovation and Council Member Website & Publications Officer
they are based. This will better ensure see, hear and view the screen of examiners and trainees would also be
both familiar and comfortable when continuous development. Anamika Trivedi
that questions continue to represent the candidate. This is not a one way Duncan Parkhouse
transmission, candidates can talk with operating in this mode. Lead Regional Advisor Website & Publications Officer
best practice in anaesthesia and reflect Maintaining best practice in examinations
changes in training. the invigilator and communicate with Anaesthesia
The OSCEs have required more of a The FRCA examinations are reviewed every five years
them through instant messaging.
deeper consideration of viable options. to ensure that each aspect mirrors best practice in Articles for submission, together with any declaration of interest,
This is an exciting phase that will Having a human present in these
Certainly, video-style conferencing assessment, and that each component continues to should be sent to the Editor via email to bulletin@rcoa.ac.uk
support the development of all our virtual times makes all the difference
technology can be used for this form be fit for purpose. A ‘back-to-basics’ review of the
exams, written and clinical, and provide and represents more robust scrutiny All contributions will receive an acknowledgement and
of assessment but we would need to exams began in January 2020, comprising a range
candidates with a seamless online of the exam conditions than we the Editor reserves the right to edit articles for reasons of
change some elements of the exam of stakeholders from across examination and training
journey from booking to receipt of previously had. space or clarity.
where physical action was previously boards and with external consultation. Unfortunately,
results and feedback.
This method of delivering written exams necessary. To achieve this, the OSCE COVID-19 halted our progress with the review as The views and opinions expressed in the Bulletin are solely
online with remote invigilation has teams have been working tirelessly work transferred from business-as-usual to complete those of the individual authors. Adverts imply no form of
Delivering the written
been adopted by a number of Medical over the summer revising questions for transformation. Having made good progress in endorsement and neither do they represent the view of
exams online this new form of delivery in a way that the Royal College of Anaesthetists.
Royal Colleges and is fully supported redefining the purpose of the assessment and exact
In mid-July, as this is being written, by the four statutory education bodies maintains test validity. nature of what the assessments need to measure, the © 2020 Bulletin of the Royal College of Anaesthetists
the first cohorts of candidates for the and the GMC. review will restart in earnest at the start of this academic
In order to reach a position where All Rights Reserved. No part of this publication may be
FRCA Primary MCQ and the FFPMRCA year, taking forward the good ground work already
the College is ready to deliver the reproduced, stored in a retrieval system, or transmitted in
MCQ will have sat their exams using Maintaining clinical completed. Findings from this review will be reported any form or by any other means, electronic, mechanical,
our new online system, with Final exams, GMC approval was sought
examinations through and a significant amount of time was
later in the year. photocopying, recording, or otherwise, without prior
Written candidates preparing to sit
COVID-19 spent on system trials, preparing If you have any comments or questions about any permission, in writing, of the Royal College of Anaesthetists.
later this month.
This has perhaps been the most difficult trainees through demos, webinars and of the issues discussed in this President’s View, or
ISSN (print): 2040-8846
The online system is easy and area of assessment to address, not practice sessions in their trusts, and would like to express your views on any other subject,
ISSN (online): 2040-8854
straightforward to use. It removes the just by our College but all Medical for examiners – practice, practice, I would like to hear from you. Please contact me via
need to travel to the exam and reduces Royal Colleges delivering clinical practice. We thank everyone involved presidentnews@rcoa.ac.uk
6 | | 7
Bulletin | Issue 123 | September 2020 Bulletin | Issue 123 | September 2020
NEWS IN BRIEF
News and information from around the College
SAFE
Making the case for ANAESTHESIA
LIAISON GROUP
perioperative care
FICM opens new membership route SALG-BIDMC Fellowship
The Faculty of Intensive Care Medicine (FICM) launched a new membership category of ‘Pharmacist Member of the
The Safe Anaesthesia Liaison Group (SALG) is pleased to
FICM’ in July 2020. Critical Care Pharmacists are essential to the safe and effective running of critical care services,
announce the next round of its exciting programme of
supporting patients and improving outcomes. They form a central part of the multi-professional team, optimising
fellowships for anaesthetists interested in patient safety.
medication therapy, improving quality and safety by resolving errors and undertaking wider professional support activities.
In collaboration with the Association of Anaesthetists
Established clinical pharmacists working to a minimum of foundation level in critical care pharmacy should visit ficm.ac.uk
and the College, SALG are offering a unique programme
for more information on how to join, full eligibility criteria and member benefits.
of formal training through Harvard Medical School that
FICM will also be launching a Pharmacy Subcommittee in Autumn 2020 bringing together a strategic plan for both aims to develop international expertise in perioperative
pharmacy work streams within the Faculty and methods for pharmacists to take a closer role in the Faculty’s other activities. quality and safety.
Over summer 2020, the Centre for Perioperative Care
(CPOC), commissioned a series of rapid evidence reviews Further information and application details can be found
New elected Board members to support us in ‘making the case for perioperative care’. here: https://bit.ly/SALGFellowship
The first review offers new evidence that perioperative
FICM has elected three members to its Board. Dr Sarah Clarke, Dr Dale Gardiner and Dr Jack Parry-Jones (re-elected for a pathways and their components can help:
second term) will commence their four-year terms on the Board in November 2020.
■ increase how prepared people feel for surgery
Patient Safety
We congratulate all three on their election. ■ increase how empowered, active and involved people Conference 2020
are in their care
The Patient Safety Conference will be held virtually this year
■ increase communication between people having on Thursday 8 October. It will be an insightful morning of
surgery and healthcare teams engaging lectures around patient safety with topics to include
increase people’s satisfaction with their care human factors, simulation, and remote areas, as well as
COVID-19 effects on NELA
■
■ reduce complications after surgery. learning outcomes from COVID-19.
The National Emergency Laparotomy Audit (NELA) has added a This online conference is being organised by SALG co-chairs,
The review also offers evidence that perioperative
short set of COVID-19 specific questions to the dataset to capture Dr Peter Young from the Association of Anaesthetists and
pathways can help:
information on how the coronavirus status of patients may have Professor Jaideep Pandit from the College
affected the NELA cohort (https://bit.ly/NELA-COVID). After ■ reduce the time people stay in hospital after surgery
and will provide valuable knowledge
receiving regulatory approval to add these, the questions went live ■ reduce use of intensive care units after surgery
for doctors engaged in clinical
at the beginning of July 2020. ■ reduce complication rates after surgery anaesthesia, pain management
■ reduce the cost of care or cost the same as and intensive care medicine
The NELA team realise that changes to the dataset causes
disruption and apologise that this request has come later than conventional care. who have an interest in Patient Safety
they would have wanted. The NELA project team is composed of
improving patient safety. Conference
CPOC looks forward to publishing the findings of this
anaesthetists and surgeons who have also experienced an increased and two further evidence reviews over the coming Details can be found at 2020
clinical workload, some of whom only finished resident night weeks and months. https://bit.ly/PSConf2020
shift rotas recently. As always, the NELA project team thanks all
participants for their hard work in contributing to the audit. SAFE
ANAESTHESIA
LIAISON GROUP
8 | | 9
Bulletin | Issue 123 | September 2020 Bulletin | Issue 123 | September 2020
NEWS IN BRIEF
News and information from around the College
RCoA in the media
A new section called ‘RCoA in the media’
has been launched on the College Translations of patient information leaflets
website. The page acts as a hub to
The College is working in partnership with the international translation charity Translators
host a selection of key media coverage
without Borders to provide translations of our most popular patient information leaflets in the
championing the specialty of anaesthesia
20 most common languages used in the UK, including Welsh.
and the College’s work. This includes
national and international press articles You and your anaesthetic, Your spinal anaesthetic and Your child’s general anaesthetic are now
as well as radio and TV appearances. available in the current selection of translations.
Visit rcoa.ac.uk/rcoa-media to stay
up-to-date with the latest news. Please see our website for further details: rcoa.ac.uk/patientinfo/translations
Education and professional
development e-Learning Anaesthesia (e-LA)
COVID-19 has had a huge effect on the College’s face to face events. A
During the past months as we have been looking for alternatives to face-
major part of our five-year Educational strategy is to increase the digital
to-face educational experiences e-LA has seen a 20 per cent increase in
education offering to our members. Due to COVID-19 we have reviewed
session launches and users. The platform is consistently being kept up-to-
this a lot faster than previously expected and are excited about our
date with updates made to module 7 – Pharmacology as well as the National
upcoming digital events programme that we are able to offer you.
Tracheostomy Safety Programme. In the coming months we will be updating
We launched our first two digital events in July, the Primary FRCA and the Anaesthesia and the Elderly module as well.
Final FRCA revision courses which have been hugely popular with 900
delegates across both. These digital courses gave delegates access to pre-
We have also launched the first in a series of revision guides to complement Preparing for
recorded video lectures, presentations, interactive MCQ questions and Recruitment e-LA and support Primary Exam preparation. These interactive PDFs currently
cover Physiology and Pharmacology and contain direct links to e-LA
COVID-19 surges
and winter
live Q&A webinars.
The CT1 and ST3 Recruitment for sessions. Download the Revision Guides here: https://bit.ly/e-LfHportal
Our Autumn events will take a similar format, with a mix of pre-recorded February 2021 are already underway.
e-LA is always looking for volunteer module The Academy of Medical Royal Colleges
lectures, live talks and discussions as well as the opportunity to interact with
Invitations to interviews will have already editors and authors to make up the e-LA editorial issued a paper on Preparing for COVID-
speakers and panel members. In addition, formal CPD accreditation now e-Learning Anaesthesia
gone out this month, with the interview board. Applications will be considered from all 19 and winter. Based on a previous report
applies to virtual as well as face-to-face learning. Please visit our website for e-LA Revision Guide:
window commencing in October. College members and anaesthetists in training by the Academy of Medical Sciences, the
full details of the programme: rcoa.ac.uk/events Pharmacology
who have achieved or are within a year of paper identifies areas for action to ensure
For further information on the interview
achieving their CCT. To find out more please that healthcare organisations locally are
process and for the applicant guidance
email e-la@rcoa.ac.uk prepared for a potential further wave and
on how the interviews will run during
the pressures of winter. Read the full paper
this current climate, please go to the
here: https://bit.ly/AoMRCAction
Anaesthetics National Recruitment
Videos Webinars Podcasts website https://anro.wm.hee.nhs.uk Dr Mark Rezk
Dr Andrew McIndoe
10 | | 11
Bulletin | Issue 123 | September 2020 Bulletin | Issue 123 | September 2020
Guest Editorial
A DAY IN THE COVID-19 ICU
My experience
The alarm wakes me up from a disturbed
night’s sleep. I reach for the snooze button, but Prayer is what we seem to be relying
suddenly realise I must get ready. Another long
day in ICU awaits. Putting on my backpack, I on increasingly these days
walk through deserted streets, their emptiness
Dr Shameek Datta no longer a surprise. I make a quick phone call Changing into my scrubs, I try not to debate and discussion of all to transfer him. His oxygen saturations
Clinical Fellow MTI, to my family back in India. My dad has made let my spirits drop. ‘Today is a new possibilities. Dr C used to challenge are running low, and it’s becoming
Anaesthetics, Bedford day’, I whisper. There are seven of us our knowledge with his different increasingly difficult to ventilate him.
shameek.datta@bedfordhospital.nhs.uk me promise to call him daily. Hearing each in ICU today – two consultants, two theories. The room seems a I tweak the ventilator to increase his
other’s voices is the only reassurance of safety registrars and three SHOs. The theatre little subdued recently. ‘Did you tidal volumes and pray that he benefits
team are tending to non-COVID write down the plan?’ D nudges me. from that. Prayer is what we seem to
right now. I tune into the radio to push aside patients in recovery. I start scribbling. be relying on increasingly these days.
my concerns for them. ‘Okay, let’s get started’, said Dr C in his After the rounds we divide into two
He is only 42. ‘Hold on mate, help is
arriving’, I mutter.
usual gruff voice. teams. One would look after the
It’s been three weeks since we started getting COVID-19 patients in ICU. We
treatment of patients, and the other At the other end, D has started
were very much prepared for this logistically – protocols in place, staff trained ‘Bed Y is a 59-year-old lady with no would prone and unprone them and unproning patients who were prone
to don and doff PPE, theatres designated for intubation of COVID patients, and significant co-morbidities, day 12 in insert or change lines. I am in the overnight to improve their ventilation. I
surge planning. And yet no one can prepare you for a pandemic. In these three the unit, remains ventilated on high latter group. join them. It is a mighty task, especially
weeks we’ve struggled to understand how the disease manifests, to establish a pressures, and oxygen saturations for patients with big stature. Each
trend with the disease markers, and to protocolise a reliable ventilation strategy. have just been acceptable. She is on a I gulp down some water and head to patient has several tubes and lines.
We have seen deaths. Helplessly. smidge of Noradrenaline but she isn’t don the PPE. ‘Did you hear there is a Any mistake could be grave. But the
making much urine, so the plan today nationwide shortage in PPE? Luckily, nursing team is very efficient and
The smiling face of A brings me back to reality. She is going home after her
is to filter her’. we still have stock’, D exclaims. I the log-roll method they use is safe.
night shift. She’ll be back tonight. When I enter the department, tired faces
do not want to think what would After unproning Mr M, we realise his
greet me. E does not forget to crack a joke. ‘Bed Z – 50-year-old gentleman on happen if we run out. face is severely swollen. How much
day 10, with history of hypertension,
‘How was the night?’, I ask. he will benefit from further proning,
still needing high pressures to ventilate As I wear the FFP3 mask, the nurse
his lungs’ …. my mind wanders off. in charge, L, informs us that Bed Z given this was his third, remains to be
‘Bad’, he says. ‘Bed 9 did not make it’. I freeze. We were hoping he would
Ward rounds used to be so interactive. is deteriorating and that his ECMO seen. We move on.
turn a corner.
Every patient was different, with referral has been accepted. A
team from Cambridge is coming
12 | | 13
Bulletin | Issue 123 | September 2020 Bulletin | Issue 123 | September 2020
Election to Council 2021
Just before lunch, we gather for the The Med Reg was right. Mr RW looks With ventilated patients, the risks
afternoon round. I stay back to help the exhausted and is struggling to complete are huge. But you sign up for these
ECMO team who have just arrived. As I sentences. I inform him that he requires when you decide to do intensive
SAVE THE DATE
bring up Mr Z’s details on the computer, ventilator support in ICU until he can care medicine.
his bedside monitor starts beeping. start breathing normally. We know by
‘Sure’.
It’s a cardiac arrest. We all rush in and now that recovery rates of patients
initiate cardiopulmonary resuscitation. needing ventilator support are not very
Even after four rounds, no ROSC. The promising. ‘Would you like to talk to
‘Good, P will accompany you. She’s
been looking after Mrs G today.’
Could you make a difference to the College?
ECMO consultant starts inserting lines. your family and let them know you are
L advises me to take my wallet. And a
In September, we will announce details of our elections for
We look at each other and nod. We going to ICU for a few days?’, I ask with
are not giving up. After 50 minutes of a heavy heart. ‘I’ll be fine. I walk two sandwich. She understands I might not new Council members. Successful candidates will take up their
herculean effort, we see some success. miles everyday’, he tries to smile my return before midnight. Luckily, I have a
positions in March 2021, for an initial six-year term, and will play
He is put on ECMO and transported concerns away. ‘We will take good care day off tomorrow.
away. He still has hope. of you, sir’ I promise, handing him over a hugely important role in the working life of the College.
We set off at 8.00pm. To Norwich.
to the theatre consultant for intubation.
Its 3.00pm. Exhausted, I head towards The ambulance crew, me, and P, Joining Council provides an excellent Election to RCoA Devolved Nation Boards
the staff room to grab lunch. The FFP3 ‘Mr T in bed 3 has responded very well all in full PPE. Blue-lighting our way opportunity to contribute to the College, If you are active in Scotland, Northern Ireland
mask has left its mark. Someone on to spontaneous breathing trial. We plan through the deserted M1. Like a influence our professional policy, and represent or Wales, you may also be interested in
Instagram had compared them with to extubate him tomorrow’ – G was beacon of hope and resistance against our members at all stages of their working supporting anaesthesia through election to
battle scars. Battle it is indeed. exuberant. Much needed good news. this deadly virus. lives. We are keen to achieve a diverse and the RCoA Devolved Nation Boards. Board
Today is his 16th day here, unaware that representative Council and welcome applications members will have opportunities support the
The staff room is full of food and thank he has lost his brothers in the pandemic. Acknowledgements from a wide range of candidates. specialty and improve outcomes for patients
you cards. The community has been
Dr Sarah Snape, Dr Anwar Rashid, in their nation, and to maintain close ties
pouring their heart out. It feels good to ‘Did we inform his wife?’ I ask, sipping Over the past year, Council has helped lead the
Dr Anagha Tambe, Dr Indrani Banerjee with the College.
know you are not alone in this fight. I away at my tea. College’s response to the COVID-19 pandemic,
and Dr Paran Kiritharamohan.
start going through the cards. Husband in which anaesthesia has been at the forefront. Again – details of the timetable and
‘Would you like to do that?
of Mrs F; son of Mr L – I remember Council members have contributed to a huge vacancies for Devolved Nation Board
I’ll admit RW’
they were told not to attend for a last range of vital activities including consultations, members will be available once
visit to prevent spread of infection. And ‘Sure. She will be relieved. They have government briefings, exam and curriculum confirmed, at rcoa.ac.uk. We’ll also
yet they have thanked ICU staff for suffered a lot.’ reviews, financial and organisational strategies, be in touch via the President’s
caring for their loved ones in their last championing the specialty and representing e-newsletter and by College For more information
moments. It makes me want to cry, but By the time I finish my call it is 7.00pm. our views across the national media, and the social media. So, please keep an
the bleep saves me. It’s the Med Reg. I sink into the couch. The nurses are development of key initiatives such as CPOC and on any of the College’s
eye out for these notifications.
handing over. our global engagement programme. upcoming elections,
‘Do you remember we discussed Mr
RW in Pilgrim ward yesterday? He ’No surprises for the next hour, please’ Details of the timetable and vacancies for Council
please contact:
is more tachypnoeic today, and his I say pleadingly. places will be available at rcoa.ac.uk from mid-
September. We’ll also be in in touch via the
Rose Murphy
saturations are dropping. He was on
non-invasive ventilation overnight but
The bleep goes off, mocking me cruelly.
President’s e-newsletter and by College social CEO Office Manager:
It’s Dr J, the consultant. ‘Shameek, we
on blood-gas he is still hypoxic’. media. So, please keep an eye out for these ceo@rcoa.ac.uk
are at maximum capacity. We had
notifications, and consider whether
‘Looks like he needs to come to us. hoped to step down two patients but
you can make a difference at the
Okay, I will be there shortly’. I gobble that no longer seems feasible. We must
College in future.
down my lunch and head down to see transfer some patients to make room for
him. In the lobby a theatre nurse is new admissions. Are you happy to go
deep in conversation with D. She looks on a transfer?’.
distraught. Her sister, a nurse in the Acute
Admissions Unit, has been admitted with
severe respiratory distress. We assure her
we will monitor her round the clock. But
her words, ‘Please look after her, she
is one of us’, keep reverberating in my
head as I go to review Mr RW.
14 | | 15
Bulletin | Issue 123 | September 2020 Bulletin | Issue 123 | September 2020
Faculty of Pain Medicine (FPM) Faculty of Intensive Care Medicine (FICM)
Update from the Training and Update from the Professional Affairs
Assessment Committee and Safety Committee
The last few months have been challenging for all I write this update as we are emerging from the
anaesthetists in training, with the great majority huge challenges placed on the specialty from
being redeployed in order to help provide intensive COVID-19. Lockdown is being relaxed, and I hope
or high-dependency care within hospitals across that we are not in the middle of another surge
the UK during the current pandemic. associated with a second peak at the time this
Dr Lorraine de Gray Dr Peter Macnaughton
update is published.
Chair, Training and Assessment This has had a significant impact on Compounding the situation are Chair, Professional Affairs and
Committee; FPM Vice-Dean training in pain medicine across all regional variations in commissioning Safety Committee
The response to COVID-19 has, not Advanced Critical Care Practitioners
contact@fpm.ac.uk levels. Pain services across the UK have of pain services, with some clinical contact@ficm.ac.uk
surprisingly, impacted on the work of (ACCPs) are now firmly established in
also been disrupted, although a recent commissioning groups appointing
the committee as this has been the many units, where they are an essential
survey of fellows and members has alternative providers only for delivery of
focus for recent activity. We have all part of the permanent critical care
shown that 77 per cent of services have services. This creates further challenges
become adept at video conferencing, workforce, supporting medical rotas
continued to provide skeleton services, in the provision of training at all but
which I suspect is a change that is and seen as key to the future success
albeit mainly by remote access. core level. Moreover, progress with
here to stay in conducting many of of the specialty. Experienced ACCPs
the proposed credentialing in pain
The FPM has issued guidance to help our meetings. are gaining additional competencies,
medicine and the new curriculum
support and reassure trainees, and, and the committee is working with
have been put on hold, as the GMC As a new disease, there was a very
together with schools of anaesthesia, the ACCP subcommittee to develop
has rightly directed all its attention to steep learning curve in managing
will continue to ensure that no trainee is an advanced airway-skills training
supporting the NHS in this pandemic. COVID-19, and there was a need for
penalised as a result of the disruption in pathway. This will include competencies
the rapid production of guidance, in managing unexpected extubation
training. Units of core and intermediate The FPM is committed to ensuring that
with frequent revision as experience in ICU, supervising the transfer
training can be deferred for up to 12 training and pain services are delivered
increased and new evidence emerged. of intubated patients, and airway
months, and complementary methods to the high standards required, and that
77%
The normal process for producing management during percutaneous
of training can be suggested to help trainees will be enabled to progress and
guidelines needed to be streamlined, tracheostomy, all of which will allow the
trainees complete their units. complete their training.
and committee members have been role of ACCPs to be enhanced.
active in contributing to the guidance
of pain Delivering higher and advanced
pain training, however, continues to published on the joint COVID-19 hub. An audit tool has been developed with
services have pose challenges, since trainers and (icmanaesthesiacovid-19.org) the Intensive Care Society to allow
trainees alike are having to adapt to units to self-assess against the standards
The committee has worked with NHS
continued an evolving situation as pain services and recommendations of Guidelines
Improvement, who host the National for the Provision of Intensive Care
are adopting alternative modalities
Reporting and Learning System
to provide of service delivery and learning from
challenges faced in realtime. These
database, and have established a
Services, Edition 2. Criteria for
compliance have been produced;
data-sharing agreement. This will allow
a skeleton include remote consultations, reduced
face-to-face consultations, alternative
analysis of safety incidents involving
the tool was due to be released
earlier this year, but this has been
service during
critical care, with the aim of sharing delayed due to the pandemic
ways of delivering multidisciplinary
lessons to our membership through a and it should be available in the
pain management, and dilemmas and
icmanaesthesia
the pandemic
regular safety newsletter. near future.
risks in delivering pain intervention
procedures, among others. covid-19.org
16 | | 17Bulletin | Issue 123 | September 2020 Bulletin | Issue 123 | September 2020
SAS and Specialty Doctors The COVID-19 pandemic has fundamentally changed the nature of
healthcare all over the world and is likely to impact upon our ways of
Nights revisited: working for years to come. Anaesthetists of all grades have stepped up,
taking on new roles and responsibilities as a key part of preparedness for
changing roles during
the crisis. The flexibility and transferable skills of SAS doctors have made
them invaluable in the initial response. Here, two members of the College’s
SAS Committee reflect on their experiences.
the pandemic
Dr Lucy Williams Dr Rob Fleming
RCoA SAS Member of Council, Swindon Specialty Doctor, Nottingham and Board Member,
sas@rcoa.ac.uk Association of Anaesthetists
I managed to escape resident nights more than The biggest surprise was just doing the overnight Those who read my previous Bulletin articles how stressful this would be for me and were an
20 years ago due to an unconventional career shift rather than the whole 24 hours. It makes such may remember that a significant part of my important source of strength.
path. Normally my work is split between pain a difference to spend the day pottering around, decision to leave training was to stop working
with an afternoon rest and a bath before dinner I realised that many of my colleagues were
medicine and general anaesthetic duties. With at night. Damaging experiences while working
and then work. I am lucky not to be juggling child likewise apprehensive about the coming changes
only two or three lists a week, the anaesthesia is out of hours made it difficult for me to continue
care and home schooling as many are. to their work patterns, as well as the risks
not that specialised, being mainly elective with a as a trainee, and I had hoped that becoming
associated with being an anaesthetist during the
smattering of trauma lists. a specialty doctor would mean never working
The work itself has been interesting, though less pandemic. There would be no better time to face
nights again.
I am about to finish our emergency on-call rota busy than normal on-calls. We definitely saw some demons and challenge myself than when
with a final night as first on-call. Back in March, a reduction in patients presenting to hospital, Early in the response, SAS anaesthetists in everyone else was doing so and we all had a
we all had to radically change our work pattern but when they did come they were often quite my department were asked to join consultant part to play. Knowing that it would be temporary
in readiness for COVID-19. My clinics were poorly. I have been refreshing dormant skills and colleagues on a resident rota covering obstetrics, made it more manageable.
suspended, and elective operating was pared learning a lot from my colleagues in training. as well as filling some trainee rota gaps. When I
They are so knowledgeable and were very In April, I worked night shifts for the first time in
back to urgent cases only. We were all asked how was asked, a lot of the feelings I had as a trainee
supportive, though initially unsure what to make eight years. I struggled a great deal before the
we could contribute to the on-call rotas, which returned. Anxiety, never too far away, bubbled
of me. I was so grateful to have an ICU ACCS first set, but I was in a team with excellent people
had additional tiers with everyone resident. to the surface. However, I found the support
trainee attending a medical emergency team call and I got through them.
of my colleagues very reassuring. Several I had
I have no caring responsibilities to limit when I with me recently. I felt rather out of my depth worked with when we were trainees recognised
could work, but I only felt comfortable covering (other than popping an ET tube in easily), and she
the first on-call. I have no recent obstetric managed all the phoning and getting us ready to
experience and have never attended an advanced Conclusion
go to CT scanning then ICU.
trauma life support course. Some younger Doctors of all grades and in all specialties could write about how their work has changed and
colleagues were quite surprised to see a ‘senior’ Overall, the experience was better than I feared. the anxiety this has caused. There have been many descriptions of how individual doctors and
anaesthetist covering the work of a core trainee. However, I cannot recommend an inflatable bed departments have risen to the challenges they faced. As we move into the restoration and recovery
on the office floor as an aid to restful sleep! phase, there will be further challenges ahead, but also opportunities. Looking to the future, hopefully
I only had to fill half a slot on the rota with my share this willingness to rise to the occasion will be recognised by politicians and the public, and some good
of nights. This was not something I looked forward can come out of these difficult times.
to. I am in my fifties now and need my sleep.
18 | | 19Bulletin | Issue 123 | September 2020
Dr Richard Davidson
Consultant in Intensive Care Medicine and Anaesthesia,
Bradford Teaching Hospitals NHS Foundation Trust; Deputy Chair,
Clinical Directors’ Executive Committee
cd@rcoa.ac.uk
Clinical Directors’ Executive Committee
Impact of coronavirus on a I was the first ‘advance trained’
consultant in ICM appointed at the trust
the event, I developed a mild cough,
headache and fatigue. By day seven I
recognise that I was contributing less
and less of value and made the decision
clinical manager
some 20 years ago, joining two other realised I wasn’t going to succumb, at to step back after nearly 20 years of
incumbents, and the ensuing years have least not this time, and decided it was clinical management.
seen many changes. Five years ago, I time to ‘get a grip’ and return to work.
The combination of my own personal
relinquished my ICM clinical work to
A PERSONAL VIEW
Prior to the pandemic, I had clinical circumstances and the coronavirus
focus on clinical management (as well
managerial responsibility for planned pandemic has encouraged me to
as to take the opportunity to drop night-
care. As all the planning was reflect and re-evaluate. I’ve rekindled
time working), so I was interested to see
understandably focused on unplanned my enthusiasm for clinical work and
how I would fare being incorporated
care, suddenly I had a great deal more now have capacity to explore many
into the new COVID-19 ICU rota. I
I was working from home on the Friday prior to a recent bank holiday weekend found that little had changed and that I time on my hands. I contributed to setting other interests. I have already reduced
on call, when my wife returned from work and immediately harangued me for missed none of it. Many of the COVID- up the Yorkshire and Humber Nightingale my working hours and, once the fun
hospital in Harrogate (not only was it of working in full PPE wears off, am
failing to notice the rank-smelling water of the flowers next to me. This was 19 patients were older than me with
interesting to be involved but there was fortunate to be in the position to reduce
co-morbidities, but a nagging minority
attributed to domestic ineptitude on my part. were just like me. Prior to COVID-19, also a shorter commute). I endeavoured them further.
I had never identified personally with to maintain cancer services displaced to
As a footnote: I had antibody testing.
The following day in acute theatre in universal PPE at an early stage, and On the Sunday back at the trust, I shared any of the patients who died, but now the local private hospital, whose entire
The result was negative!
full PPE, the surgeon and scrub nurse I was fastidious in my donning and the information with a colleague, who I began to feel quite vulnerable. In resources (including staff, ventilators and
started gagging over a particularly doffing, social isolating, and using video promptly rolled her eyes, asked me if I had addition, the death of my father earlier syringe pumps) had been redeployed to
malodorous procedure. As you will be conferencing for my various meetings. I heard of coronavirus, and took charge, this year (he managed to time things so support a huge critical care expansion at
aware, there is often a 20-second delay even ensured that I didn’t hang around sending me home to self-isolate while his funeral just avoided lockdown) made the trust, the need for which fortunately
before the olfactory experience reaches me reflect on my own mortality. never really materialised.
in the theatre coffee rooms, recognising arranging short-notice cover of my clinical
the top end … but nothing. I went for a
closer sniff … again, nothing. But, then
that these were the most likely places to responsibilities. I had a polymerise chain
I developed a growing sense of doom Following the strict social distancing More information
pick it up. There was also the fact that reaction (PCR) swab the next day and a rules, I assiduously dialled into the
again, perhaps this was just an example regarding my personal wellbeing and
of a particularly effective fit-test. You’d illness happens to other people rather positive result 24 hours later – provided tried to ignore the conviction that I daily clinical reference group ‘Gold
on the Clinical
have thought I might have put two than me. At home that evening, I shared almost apologetically by someone would catch coronavirus and do poorly, Command’ meetings, although the Directors’ Network is
and two together and recognised my these observations with my wife, and who advised me rather ominously to so the positive PCR swab was not technology meant it was more difficult
anosmia as a symptom of coronavirus, we conducted sufficient sniff testing to call 111 if things didn’t go well, and who welcome. I waited at home for my own to contribute as effectively as those
available from:
but no. Our trust had implemented convince me it was all in my mind. departed with ‘Good luck!’ inevitable personal cytokine storm. In physically in the room. I began to
rcoa.ac.uk/clinical-
20 | director-networkBulletin | Issue 123 | September 2020 Bulletin | Issue 123 | September 2020
Most would cite missing their family and contact. Looking after our community I must admit to some trepidation
friends as the biggest change. We are, became a key feature. An elderly aunt at travelling on the underground.
Carol Pellowe after all, social creatures, and we enjoy did not need special deliveries, but she No matter, the trains were empty!
Chair, RCoA Lay Committee the company of others. Retired folk who agreed to phone three people a week However, I have found several people
laycomm@rcoa.ac.uk provided precious childcare for their to chat and check on their welfare. very wary of travelling again, and this
grandchildren were the hardest hit, as Several people have commented that fear of venturing out again is going
they were forbidden from seeing them they felt their neighbourhood was more to be a major problem, particularly
and, in many cases, told to shield for friendly and well mannered. Was this for those who have been at home for
their own protection. This means that the result of the obligatory queue at most of the lockdown.
Patient perspective they will be the last to mix with others. the shops? Local shops became more
Reflections on lockdown
I had my first experience of remotely
Although my grandson does not require popular as they rose to the challenge of
attending a funeral in a crematorium.
childcare, he now looks suspiciously at finding yeast, eggs, flour, etc.
It was dreadful – the sound was poor
me as if to say, ‘I thought you lived on a
The re-evaluation of who and and the service was very fast. It was
television screen’!
what is important has been quite a hardly a suitable way to say goodbye.
Now the lockdown is hopefully becoming a With pubs, restaurants, gyms, cinemas,
theatres, and concert halls shut, how
learning curve. The hand-clapping
acknowledged the value of you in the
Afterwards, the family had to circulate
the eulogy as people online had
distant memory, I think it is useful to consider we spent our leisure time was severely NHS and of other key workers. I just not heard it. I am not suggesting
affected. By the time you read this hope it results in better pay and more they are all like this, but crematoria
what we have learnt, and how we might many will have started to re-open, but PPE! And delivery people – those who could look at making the experience
change as a result. the fate of concert halls, theatres, and
pubs may take some time to resolve.
deliver milk, post, food, or parcels – we
could never have kept going without
more user-friendly.
The worst aspect of lockdown has been
How many of them will have survived is you. But did we always say ‘thank you’
the number of deaths. Despite all our
an even bigger problem. to you before? Although he is not open
best efforts, at the time of writing this
yet, I shall greet my hairdresser with
On the positive side, not being ruled article, 45,759 people have died; the
great joy. I never truly appreciated the
by a diary and slowing down were a loss this represents is truly shocking.
wonders he worked.
great bonus. A friend admitted that Whenever I hear people say that this
she no longer feared FOMO (fear of There were of course downsides has been such a productive time, I feel
missing out!) and in future would refuse too. This was particularly so for like retorting, ‘Tell that to those who lost
invitations she really was not interested those with large families in high-rise family and friends’!
in. Having the time to appreciate the accommodation with no access to open
I hope there is not a second wave, but
garden, bird song and the regimen of spaces. Home-schooling has been
should there be one let us remember
the daily walk became things to savour difficult for those with limited facilities.
the positive aspects and work to
and enjoy. It was an opportunity to get How does one school and work at
avoid the bad.
in touch with friends we had not heard home when you all need the same
from and catch up. Forgotten projects computer or mobile phone? Despite
were completed, new interests were furlough arrangements, many are very
taken up, and clearing drawers became worried about their financial situation,
a regular event. Many a household and the number accessing food
is waiting for the charity shops or banks has soared.
recycling centre to open to deposit
the excess. I had an interesting time
removing packages from the freezer
that had lost their label and using
them for supper!
I am sure many have improved their
IT skills. Who knew or used Zoom and
other such platforms beforehand?
Yet now many households use them
regularly for meetings, classes, and
22 | | 23You can also read
