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July 2021
The elephant in the anaesthetic
room
Delivering trainee-led research
during a pandemic
Vascular surgeons: the next
regional anaesthetists?
Sexism:
Why everyone
should be a
feminist
Page 14
rcoa.ac.uk
@RCoANews
Bulletin | Issue 128 | July 2021
RCoA Events
rcoa.ac.uk/events
events@rcoa.ac.uk
Developing World Anaesthesia
@RCoANews
27 September 2021 | Manchester
SEPTEMBER
Anaesthetists as Educators: Airway Workshop
Introduction 15 November 2021
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5 October 2021 RCoA, London
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The Essentials
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Health Services Research Online RCoA, London
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Leadership and Management:
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Developing World Anaesthesia RCoA, London 17 November 2021 rcoa.ac.uk/events
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Bulletin | Issue 128 | July 2021 Bulletin | Issue 128 | July 2021
Contents
The President’s View 4
News in brief 8
CEO Update 12
Guest Editorial 14
From the editor
SAS and Specialty Doctors 18
Faculty of Pain Medicine (FPM) 20 Dr Helgi Johannsson
Faculty of Intensive Care
Medicine (FICM) 21
Patient Perspective 22
Welcome to the July Bulletin.
An introduction to the Welcome to the July edition of the Bulletin, and I hope you’re enjoying the summer as we are (hopefully) emerging
2021 Acute Care Common further from lockdown and enjoying a few more freedoms. The spring has been eventful for anaesthetists throughout
Stem (ACCS) curriculum 24 the UK. After dealing with the surge earlier this year, we are now realising quite how colossal will be the task of
Integrating the new 2021 returning the NHS to providing an efficient service for the people of the UK. We still harbour the fear of a third wave in
anaesthetic/ACCS curriculum which we will again have to expand our critical care capacity, while many of us (including me) haven’t quite reached an
into the Lifelong Learning platform 26 even emotional keel after the experiences of the winter.
moTIVAtion 30
The last year has brought many inequalities to the forefront, with discussions on race, economic deprivation, and
Vascular surgeons: the next
everyday sexism. After the murder of Sarah Everard many of my female friends and colleagues talked openly about the
regional anaesthetists? 32
Guest Editorial Primary SOE practice:
discrimination they face every day, both overt abuse and very subtle innuendo. In this issue I am pleased to introduce
Dr Rebecca Barker, who writes eloquently about the challenges women face in the workplace, and I hope this will spark
Sexism: Why everyone should
a trainer’s guide 34 further discussions and a real change in attitudes (page 14).
The College's Environmental
be a feminist Advisor 38 In my last editorial I touched on how the career progression of our anaesthetists in training has been devastated by the
COVID-19 pandemic, and this was certainly borne out in the ST3 recruitment round in May, where more doctors than
Forty years on 40
ever were unable to secure a post. I am glad to read the message of support from Professor Ravi Mahajan in his last
Dr Rebecca Barker explores the reality of What is it like being an RCoA
President’s View (page 4), and I want to thank him here for his support and vision through his presidency. We will be
Council member? 42
subconscious sexist behaviours The Bezos Method enriches
welcoming Dr Fiona Donald to the post of president in September, and I know she will continue the College’s campaign
to increase training capacity and ensure those who were unable to secure an official training post can still make their
Page 14 Journal Club experience 44 experience count towards their training, or a CESR equivalence.
Human rights and maternity care 46
Our anaesthetists in training and SAS members have taken a big hit during the pandemic and worked hard, intensive
Vascular surgeons: the next The transformation of
President's View shift patterns – with the exhaustion that comes with it. I urge you to read my colleague and mentor Professor Harrop-
variolation to vaccination 48
In his final article as President, regional anaesthetists? The role of virtual education
Griffiths’s piece Forty Years On (page 40), in which he describes accurately the misery of 56-hour shifts where he was
Ravi addresses the issues affecting paid less than the cook serving his food in the canteen. Although things were beginning to improve in my training, I
Dr Ruth de Las Casas discusses a in the post-COVID-19 era 50
certainly remember the sheer exhaustion you felt on a Sunday afternoon when you still had another 24 hours to go.
anaesthetists in training service that improves both patient UHCWellbeing anaesthesia Things really weren’t better in the old days, and no one should be asked to work like that.
Page 4 care and safety initiative 52
The NIHR Associate Principal Hospitals produce a lot of waste, and the operating theatres have embraced a culture of disposables with open arms.
Page 32
Gone are the reusable gowns, reusable laryngeal mask airways (which were really good, I do miss them), and instead even
The elephant in the Investigator scheme 54
a minor operation now produces two to three rubbish bags’ worth of waste. The environmental impact of anaesthesia is
RCoA Small Research,
anaesthetic room Delivering trainee-led also extremely large, with the anaesthetic gases at the forefront of pollution (page 38). I am slowly moving to TIVA for
Education and Travel Grants 56
Is drawing up drugs stupid and research during a pandemic NIAA Research
many of my cases and have given up desflurane entirely; I hope our eco-friendly agenda will continue a pace.
dangerous? Dr Hambly argues for Dr Alexander Jones assesses the Grants: 2019 Round 2 58 I am proud of this issue and hope you find it an interesting read. In the meanwhile I hope we continue to experience a
prefilled syringes impact COVID-19 has had on Perioperative Journal Watch 59 low transmission rate, and I look forward to a day when I can see my colleagues and patients not just smile with their
Page 28 projects led by anaesthetists in As we were... 60 eyes, but with their whole face.
training Letters to the editor 62
Page 36 New to the College 64
Notices, adverts and
College events 65
2 | | 3
Bulletin | Issue 128 | July 2021 Bulletin | Issue 128 | July 2021
Professor Ravi Mahajan
President
president@rcoa.ac.uk
The College recognises the highly demanding circumstances that
many of our members, including anaesthetists in training, are facing
following the outcomes of the CT1 and ST3 recruitment and the
introduction of the GMC-mandated 2021 Anaesthetics Curriculum.
Last July, College Council member and Bulletin training are currently faced with. I’d like to use my
editor, Dr Helgi Johannsson, wrote about the final ‘President’s View’ article before I demit my post
prospect of spending his summer holiday in his as president in September to address these issues
garden. At that time, we were tentatively coming out directly. I hope this goes some way to explaining
of the first lockdown. This summer, we are looking more about the remit of the College.
forward to potentially being with and hugging our
Above all, I’d like to reiterate that the College
loved ones and the freedom planned in the UK’s
always has been, and always will be, an advocate
roadmap out of lockdown. In much the same way,
for its members. College staff, Council members,
however, many of us are hoping for good weather
my vice-presidents and I have been committed to
as we spend our holidays close to home.
ensuring that we secure the best outcomes for the
Amid the optimism, the success of the UK’s specialty and the majority of our members. While I
vaccination programme, and the positive reduction understand that some College decisions made may
in COVID-19 cases and deaths, I know there are not always be agreed with by all members, please
huge challenges facing our members. Firstly, I’d like let me assure you that the College always consults
to express my sincere condolences to all of those with members and representatives of anaesthetists
affected by the COVID-19 surges across India and in training. The College will continue to serve and
South Asia this spring. advocate on behalf of its membership and the
specialty we have all given so much of our lives to
I particularly want to express my sympathy and support work in. If members would like to be more involved
to College members separated from their families in the decision-making processes of the College,
while they work and train in the NHS across the there are many routes to do so. Our website has
UK. I encourage College members to reach out to an extensive list of ways to be involved, including
The President’s View colleagues of Indian origin who may need emotional
support during these challenging times. A kind word or
joining the membership engagement panel, please
ADDRESSING TRAINING
visit rcoa.ac.uk/membership/get-involved for more
show of emotional support may be all that’s needed to information. Of course, standing for Council is also a
provide reassurance to a concerned colleague. direct way to have your say in the strategic direction
of the College (see page 42).
CONCERNS
Acknowledging our anaesthetists in
training Role in recruitment
I also sincerely recognise the disappointing situation The total number of training posts is set by the
that many of our members and anaesthetists in statutory education bodies in the UK – Health
4 | | 5
Bulletin | Issue 128 | July 2021 Bulletin | Issue 128 | July 2021
Education England (HEE), NHS A workforce fit for the future I remain confident that the increased Every few years, the College develops and finalises a
Bulletin
of the Royal College of Anaesthetists
Education Scotland, Health Education flexibility in the new curriculum will allow strategic plan to outline how we plan to work towards our
The College has long recognised the
and Improvement Wales, and the anaesthetists in training to experience a vision, values and aims1 (see page 12). For 2018–2021, Churchill House, 35 Red Lion Square, London WC1R 4SG
shortage of fully trained anaesthetists
Northern Ireland Medical and Dental more streamlined progression through a core element agreed by our senior leaders was for 020 7092 1500
in the UK with our most recent
Training Agency, making use of funds the training programme. us to work to shape healthcare policy and practice by rcoa.ac.uk/bulletin | bulletin@rcoa.ac.uk
Medical Workforce Census 2020
allocated by central government. campaigning for change and by working collaboratively
demonstrating high and increasing I believe that the increased flexibility @RCoANews
with key partners including local and national government.
In May, we noted that the most recent vacancy rates in our specialty.3 Using introduced into this new curriculum will /RoyalCollegeofAnaesthetists
recruitment round saw a record number this and other information, we have allow members who were unsuccessful The College does not work in isolation; College staff,
Registered Charity No 1013887
of applicants to both CT1 (2,046) and continued to advocate for an increase during this recruitment round to Council members, trustees, our vice-presidents and I work
Registered Charity in Scotland No SC037737
ST3 (1,056) programmes for the August in UK anaesthetic training capacity to evidence their progress outside of to establish and maintain strong working relationships with
VAT Registration No GB 927 2364 18
2021 recruitment. The increase in address this shortfall. This is why we approved training posts and have our key partners. These relationships are crucial because,
applicants for core-training programmes will continue to engage with HEE and this experience count towards future while we work to influence and inform organisations, President Dr Hugo Hunton
is positively received and reflects the devolved nation statutory education training and their CCT date. Therefore, some decisions on important topics, such as confirming Professor Ravi Mahajan Lead College Tutor
bodies on behalf of our members to in principle, even members who were the number of ST3 posts during national recruitment
efforts being made by the College to Vice-Presidents Dr Kirstin May
increase the number of training posts. unsuccessful in ST3 recruitment may rounds, are beyond our remit. We can and, of course,
raise the profile of anaesthesia-related Dr Fiona Donald and SAS Member
be able to obtain a CCT sooner than do continue to strongly advocate for the benefit of our
careers among medical students and Professor William Harrop-
As an example of this, the College is members and the specialty. Dr Susannah Thoms
foundation doctors. they would have been able to with the Griffiths
currently working on a large influencing Anaesthetists in Training
2010 Curriculum. Finally, the changes
The College acknowledges that, due campaign called Anaesthesia – fit for
to anaesthetic training have to fit with
Thank you Editorial Board Committee
to the competition for each post, the future,4 which is gathering data In my last President’s View for our Bulletin, I take the Dr Helgi Johannsson, Editor Pauline Elliott
changes to other curricula, namely
there will be many applicants who will and developing a plan for how best opportunity to offer a few thanks – to Council and the Lay Committee
ACCS, emergency medicine and Dr Jonathan Thompson
be disappointed by the news of not the NHS could fill the gap in the College staff for all their support during my term of office,
intensive care medicine, meaning that Council Member Gavin Dallas
receiving an offer in this round. We also anaesthetic workforce and address the to my colleagues at Nottingham University Hospitals Trust
postponing the transition would be Dr Jamie Strachan Head of Communications
recognise the extremely difficult period retention challenge. In this campaign, for giving me the space to fulfil this important national
counterproductive. Council Member Mandie Kelly
that anaesthetists in training have been we make a further call that the role, and to my wife. I couldn’t have done it without you!
outcomes of the recent recruitment Dr Ros Bacon Website & Publications Officer
going through while being redeployed Two-way dialogue And finally to you, the fellows and members – thank you
and continuing their training and round is evidence that there should for the opportunity to serve you over the past three years. Council Member Anamika Trivedi
I understand that these are complex Website & Publications Officer
examinations – all during a global be an increase in higher posts in It truly has been an honour and a privilege. Dr Duncan Parkhouse
issues that impact our members’
health pandemic. As I pointed out in anaesthetics. Lead Regional Advisor
professional and personal lives. While It is with great pride I handover to our new President-elect,
the last issue of the Bulletin, we also Anaesthesia
the College is working to address Dr Fiona Donald. On her election to the post in September,
remember that anaesthetists in training Introducing a new curriculum
these issues, further information and Fiona will be supported by our two Vice-President elects, Articles for submission, together with any declaration of interest,
remain central to addressing not only Following a significant period of
support is available from your College Professor William Harrop-Griffiths and Dr Russell Perkins. I should be sent to the Editor via email to bulletin@rcoa.ac.uk
the NHS’s response to the pandemic, member and stakeholder consultation,
representatives. For more information look forward to seeing them continue to advocate for our
but also to the ongoing recovery and the College received approval to All contributions will receive an acknowledgement and
please see our website at: rcoa.ac.uk/ specialty, fellows and members in delivering the best care
clearance of the backlog. introduce the 2021 Anaesthetics the Editor reserves the right to edit articles for reasons of
college-representatives. Members of for patients. Congratulations to all three.
Curriculum on 4 August. The GMC space or clarity.
In response to these circumstances, I the College’s Anaesthetists in Training
mandated the introduction of the new The College is keen to hear directly from anaesthetists in
have written directly to the Secretary Committee are also available for The views and opinions expressed in the Bulletin are solely
curriculum, and its approval represents training and trainers regarding recruitment, examinations
support at: rcoa.ac.uk/ait-committee. those of the individual authors. Adverts imply no form of
of State for Health and Social Care, and the introduction of the 2021 Anaesthetics Curriculum.
a key moment for our specialty. endorsement and neither do they represent the view of
Matt Hancock MP, offering solutions If you have any comments or questions about any of the
to recruitment situation. The College We also understand that this will be Working in partnership, not the Royal College of Anaesthetists.
issues discussed in this President’s View or would like to
has also written formally to HEE, adding to the uncertainty for some in isolation express your views on any other subject, we would like to © 2021 Bulletin of the Royal College of Anaesthetists
NHS leaders, deaneries and heads of our members. The College feels The College’s vision is clear – to advance hear from you. Please email presidentnews@rcoa.ac.uk. All Rights Reserved. No part of this publication may be
of schools of anaesthesia to strongly that delaying the introduction of the the delivery of safe patient care. We reproduced, stored in a retrieval system, or transmitted in
encourage them to follow our CT3 new curriculum would cause further are committed to improving patient References any form or by any other means, electronic, mechanical,
equivalent training guidance and to disruption and uncertainty for more of safety, wellbeing and outcomes through 1 RCoA Strategy and Vision (rcoa.ac.uk/strategy-vision). photocopying, recording, or otherwise, without prior
consider experience gained outside of our members as it would mean a longer the maintenance and advancement 2 Recruitment update, RCoA (rcoa.ac.uk/news/recruitment-update). permission, in writing, of the Royal College of Anaesthetists.
the training programme as counting wait until the improvements designed of standards in anaesthesia. Critical to 3 Medical Workforce Census Report 2020, RCoA
ISSN (print): 2040-8846
towards the progression of anaesthetists into the new curriculum can benefit UK this are our services, such as training, (rcoa.ac.uk/census-2020).
ISSN (online): 2040-8854
in training.2 anaesthetic training. examinations and patient information. 4 Anaesthesia – fit for the future, RCoA
(rcoa.ac.uk/anaesthesia-fit-future).
6 | | 7
Bulletin | Issue 128 | July 2021 Bulletin | Issue 128 | July 2021
NEWS IN BRIEF
News and information from around the College
President writes to Secretary of State Patient Information Publication Professor Iain Moppett appointed
on behalf of anaesthetists in training Updates of the GPAS as NIAA Health Services Research
The College
Perioperative Centre Director
has updated its
leaflet General
Anaesthesia a brief
Care chapter and The College is pleased to announce that
Professor Iain Moppett has been appointed
guide for young GPAS annual Director of the National Institute of Academic
Anaesthesia (NIAA) Health Services Research
people from 12
years old, with a chapter update Centre (HSRC). Professor Moppett will take up
brand new and the appointment with effect from 1 April 2022.
The College is pleased to announce
mobile-friendly the publication of Guidelines Professor Moppett is currently the Deputy
design, see the updated edition at: for the Provision of Anaesthesia Director of the NIAA HSRC and has been
rcoa.ac.uk/childrensinfo. Services (GPAS) 2021. This includes leading the work on the third Sprint National
a new chapter on services for the Anaesthesia Project (SNAP3) looking to examine frailty, delirium and the older
A video version of Rees Bear has an
Perioperative Care of Elective and surgical patient. He is Professor of Anaesthesia and Perioperative Medicine
The College is continuing to work closely with the Department of Health and anaesthetic has been produced, this is a
Urgent Care Patients. All the GPAS and Honorary Consultant Anaesthetist at the University of Nottingham and
Social Care, Health Education England and other devolved nation stakeholders to video aimed at young children to help
chapters are available on the College Nottingham University Hospitals. Iain's primary academic interests are in
negotiate a solution to ST3 recruitment. College President, Professor Ravi them learn about what happens when
website at: rcoa.ac.uk/gpas improving outcomes for older patients undergoing surgery and in perioperative
Mahajan, wrote to the Secretary of State for Health and Social Care in May, they undergo anaesthesia. The video is
available to view at: bit.ly/RCoA-Rees- patient safety. He is also the Chair of the CPOC National Safety Standards for
suggesting short-and-long term solutions. Chapter 2: Guidelines for the
Bear. Invasive Procedures (NatSSSIPs).
Provision of Anaesthesia Services for
Professor Ravi Mahajan, President of the Royal College of Anaesthetists said:
the Perioperative Care of Elective and Further information about the HSRC is available at: niaa-hsrc.org.uk.
Translations are available for the
“Anaesthetists in training have worked tirelessly to support the response to the Urgent Care Patients replaces the
following leaflets: You and your
COVID-19 pandemic and in doing so, many have experienced significant disruption following chapters:
to their training. This has been compounded by the disappointing situation where
anaesthetic, Your spinal anaesthetic, Your
child's general anaesthetic, Anaesthetic Guidelines for the Provision
New SALG website SAFE
many will have been unsuccessful in their recent applications for higher training ■
choices for hip or knee replacement, of Anaesthesia Services for In May the Safe Anaesthesia Liaison Group ANAESTHESIA
posts. I was therefore pleased to see the announcement from Health Education and LIAISON GROUP
Caring for someone who has had Preoperative Assessment and (SALG) launched a new website. SALG is
Improvement Wales that an increase in the number of anaesthetic training posts
an anaesthetic or sedation, Sedation Preparation a collaborative project to promote patient
in that nation is being delivered for August 2021. I hope to see similar decisions
explained, Anaesthesia and your safety across the perioperative pathway,
being made across the devolved nations and I look forward to working with the ■ Guidelines for the Provision
weight, Nerve blocks for surgery on the and is a partnership between the College,
Department of Health, Health Education England and the other Statutory Education of Anaesthesia Services for
shoulder, arm or hand. See the materials the Association of Anaesthetists and NHS
Bodies to help make this happen.” Intraoperative Care
on the College website at: rcoa.ac.uk/ England/NHS Improvement.
To read the full statement go to the College website at: rcoa.ac.uk/president- ■ Guidelines for the Provision of
patientinfo/translations.
secretaryofstate. Postoperative Care. The new site features:
■ a full list of upcoming events
All GPAS chapters have been
developed using our NICE ■ all back issues of SALG's quarterly Patient Safety Updates
accredited development process. ■ opportunities for funding and fellowships
New Faculty of Pain Medicine information leaflet NICE accreditation gives additional
credibility to GPAS, providing
■ various forms for reporting patient safety incidents
The Faculty of Pain Medicine has published a patient information leaflet on the use of cannabis and ■ alerts and recalls for drugs and medical devices
independent assurance that the
cannabis-related substances in the management of pain. The leaflet explains the current lack of guidelines are robust and evidence ■ monthly drug safety updates.
evidence in the use of cannabis and related substances for pain and is a freely available resource based.
Visit the new website at: salg.ac.uk.
(bit.ly/3eIRSl0).
8 | | 9
Bulletin | Issue 128 | July 2021 Bulletin | Issue 128 | July 2021
NEWS IN BRIEF
News and information from around the College
NAP7 launched Ysbyty Gwynedd becomes first hospital Recruitment to RCoA SAS Committee COVID-19 Lessons
in Wales to receive prestigious Royal The College is seeking up to four enthusiastic and self-motivated SAS Learn report
or LED (Locally Employed Doctor) anaesthetists to join the College SAS
College of Anaesthetists award Committee. We aim for representation from all four nations and would like
A short report
exploring ten lessons
the committee to reflect the diversity within the SAS/LED workforce. There
learnt during the first
are two elected SAS Council members, Dr Lucy Williams and Dr Ashwini
year of the pandemic
National Audit Project 7 (NAP7), Keshkamat.
has been produced
studying perioperative cardiac arrest, by the College and is
There are two SAS committee meetings a year, likely to continue with at
launched on 16 June 2021, after a one available at:
least one virtual meeting and hopefully one in person meeting in London.
year delay due to COVID-19. As with rcoa.ac.uk/10-lessons-
Successful candidates will have the opportunity to represent the SAS
previous NAPs, there will be three parts learnt. This is part of
workforce on other College committees, according to their interests.
to NAP7: a baseline survey of all the College’s ongoing COVID-19 campaign
Meetings will vary in frequency, but most are between two and four
anaesthetists and anaesthesia associates supporting members and advocating for
meetings a year with virtual working for at least half.
to evaluate anaesthetists’ previous impactful change during COVID-19.
experiences, preparedness and facilities; Other work between meetings is conducted via e-mail and you would be
© Gwilym Huws
an individual case registry to provide expected to actively engage in this. The lessons include importance of
The Anaesthetic department at Ysbyty Gwynedd in Bangor has been recognised retaining skills gained, adequate supply
detailed information about the
for providing the highest quality of care to their patients. If you would like to be considered for a position on the SAS Committee, of PPE, preparation for pandemics, digital
occurrence, management and
outcomes of all perioperative cardiac The hospital has become the first in Wales to be awarded the prestigious please send a brief outline of your career so far and how you would be innovations, perioperative care, critical care
arrests over a 12-month period; and an Anaesthesia Clinical Services Accreditation (ACSA) from the College. able to contribute (max 300 words) to: sas@rcoa.ac.uk. You must be in capacity, sharing information, wellbeing of
activity survey to create a quantitative good standing with the College. All applications will be anonymised and NHS staff, workforce and local decision
snapshot of anaesthetic activity in the The ACSA accreditation is the RCoA’s peer-reviewed scheme that promotes assessed by the current committee members. making.
UK. Both the baseline survey and case quality improvement and the highest professional standards of anaesthetic
service. To receive accreditation, anaesthetic departments are expected to The report is an opportunity for reflection
registry launched in June, while the
demonstrate high standards in areas such as patient experience, patient safety on the impact of the pandemic, highlighting
activity survey will launch this autumn.
and clinical leadership. how the NHS and specialty of anaesthesia
All reporting is confidential. The NAP7
rose to the occasion and adapted to
team is, as always, immensely grateful to
The Anaesthetic teamwork across the hospital provides anaesthesia services provide the best possible care for the sickest
the anaesthetic community whose hard
for all types of surgery, labour delivery suites, pre-operative assessments, pain COVID-19 patients under very challenging
work enable these projects to run.
services and are in charge of the Intensive Care Unit that looks after the most circumstances.
Learn more and follow us on Twitter critically unwell patients in the hospital.
@NAPs_RCoA In addition, where there were shortcomings,
For more information about ACSA visit: rcoa.ac.uk/acsa. these are highlighted also to encourage a
commitment to doing things differently. The
Anaesthesia 2021 report calls for commitment to equip the
NHS with the resources, staffing and capacity
Anaesthesia 2021, our flagship conference returned for three days of informative, immersive, and interactive talks, that it needs to embed what it has learnt so
workshops and presentations in May. It was the College’s most well attended conference to date. This year’s event was far and continue to learn and improve as the
entirely virtual so tickets could be purchased to watch the conference live or content viewed on demand at a later date. pandemic evolves.
Anaesthesia 2021 offered a packed programme with incredible speakers, covering a diverse range of subjects as well
as opportunities to network and collaborate with peers using an interactive platform which proved hugely popular. The
College would like to thank all the speakers and chairs for helping to make this year’s event such a success. More details
about the 2022 event can be found on the College website at: rcoa.ac.uk/events
10 | | 11
Bulletin | Issue 128 | July 2021
CEO Update
CREATING A NEW STRATEGY
FOR THE COLLEGE
Jono Brüün
RCoA Chief Executive Officer
ceo@rcoa.ac.uk
We should be a home to members, staff
As the College, its members, staff, volunteers and clinical leadership, emerge and patients alike.
and impact, to ensure that our greater financial health as part of our
membership is getting real value from next strategy. To do that, we will ensure
together from the latest phase of the pandemic, our thoughts are turning to its subscriptions. It may be that, as that the strategy is underpinned by a
Creating an ambitious plan
the future and the next phase of our growth and development. a result of this process, the College clear financial and organisational plan,
Building on our shared values, we decides to reduce activities in some so that we can confidently say that the
The College’s current vision and managing the impact of the COVID- practical application to everyone who aim to create an ambitious strategic areas in order to focus effort elsewhere. vision is deliverable within the College’s
strategy comes to an end later this year.1 19 pandemic. I plan for this vision to comes into contact with the College. plan that understands and embraces And we’re expecting that to be quite a means, and contributes to its financial
This vision, set by the Trustees, Council address and provide solutions to the the future of the specialty. There are difficult process, but will result in a clear resilience in the future.
and Senior Management Team, clearly challenges and opportunities faced by To do that, a core working group challenges and opportunities ahead for rationale for taking forward current and
made up of Council members, patient So, all in all, a challenging but exciting
outlines a case for member support the College and our specialty in the the College, its Faculties, and members future work of the College!
representatives and staff will come few years ahead, which we hope will
and advocacy, the continued delivery years ahead. – in new technologies; developments
be reflected in our next strategy. I can
of high standards and quality patient together to consider the kinds of values in education; training and assessment; Facing up to our challenges
To create that vision, and to develop assure you that we will remain focused
care, the recruitment of tomorrow’s that can drive ambitious, productive interactions with the global anaesthetic
At this point, it’s probably fair to say on supporting our fellows, members,
a strategic agenda that will be as and respectful interactions at the community, and more – which we are
anaesthetists, and the establishment of that resources and finances at the
inspiring as the previous one, we staff and the specialty to ensure that
the perioperative care agenda at the College, along with high standards of keen to identify and embrace if they
College are under some pressure at we will be the best we can be for all of
have put in place a six-month period care and quality in performance. can have meaningful impact.
heart of the College. the moment. While our long-term
of review, evidence-gathering, and them.
Through the strategy process, our investments and assets remain strong,
This has been a transformative agenda. agenda-setting. We are aiming to be We aim to build a working culture that
Those goals have been underpinned as consultative as possible, so I wanted will see the College thrive in the years Trustees, Council and staff aim the pandemic, changing ways of References
to understand more about those working, and recent investments in 1 RCoA Strategy and Vision
by modernising our operations and to use this article to be open with our ahead. We need to get this right for
organisational structures – investing fellows and members about our goals, opportunities. But we also want to look much needed member services mean (rcoa.ac.uk/strategy-vision).
everyone who interacts with the College
heavily, for example, in technology, and to invite your contributions to the at our current agenda – what works that the College will have to direct its 2 Centre for Perioperative Care, (cpoc.org.uk).
– we should feel like the RCoA – to our
policy and communications, and in the process. You can do this by contacting now, what we can do better, and what resources very carefully in the months
membership, staff and the public. While
Centre for Perioperative Care.2 our Membership Engagement Panel via we should pause (or even stop) to and years ahead.
I certainly don’t want to pre-empt the
engage@rcoa.ac.uk create space for new initiatives that will
process or outcome, I hope the feeling This is no ‘three-alarm fire’, but it is
Evolving from one strategy we enshrine in our values is that of an
serve our membership better in the
certainly something we need to take
Starting with our shared years ahead.
to the next organisation that balances its role as into account when setting our new
We have a brilliant opportunity to values a setter of high standards of training, To help us in that process, I have strategy, and the Finance and Resources
develop a new vision for 2022 and The Trustees have agreed to build our education, clinical quality and patient asked our Boards to conduct reviews Board, Board of Trustees, Senior
beyond as the College, its members next strategy on a foundation of shared care with an approach that is warm, of their activities – evaluating these Management Team and myself are
and the NHS look to emerge from values that will have meaning and welcoming, inclusive and engaging. initiatives through a lens of investment firmly focused on the need to establish
12 | | 13
Bulletin | Issue 128 | July 2021 Bulletin | Issue 128 | July 2021
Guest Editorial Dr Rebecca Barker
SEXISM:
Consultant Anaesthetist and
Deputy Clinical Chair,
Sherwood Forest Hospitals
WHY EVERYONE
docbec@doctors.org.uk
SHOULD BE A be more damaging to women
as altering behaviour to match
about when women had children
and how this would affect their
toilets, the ‘mums’ group school
WhatsApp group, getting bookings
FEMINIST
these masculine preconceptions career. changed from Dr and Mr Barker to
of optimal leadership style, results Dr and Mrs Barker, the government
in backlash for not conforming Sexism advert to stay at home during
to feminine stereotypes. This Several interviews with medical lockdown– picturing women doing
is highlighted in the language professionals on the BBC over housework and home-schooling,
‘I mean, have you we use to describe the same the last year, have been guilty of and the man in front of the TV. The
characteristics in men and women. ‘untitling’. A woman’s professional frustration is all the more when
considered that you just I have never heard a man being title is removed, but a man’s is not; it impacts on work-life, ability to
maybe don’t have the described as 'bossy', he would be
'assertive', at worst a woman would
it is a form of bias perpetuating progress, and assumptions about
ability and dedication.
gender imbalance which has been
comportment of a doctor? be labelled as 'aggressive'. At some
described by Amy Diehl PhD, a
point the mounting subconscious Entitlement gap
Or the authority? bias turns women into ‘battle-axes’.
researcher and gender-bias expert.
‘Entitlement gap’ is highlighted as
Or mannerisms?…’ Athanasopoulou, writing in
‘Default male’, is a term coined by an issue in research in The Female
Caroline Criado Perez, author of Lead: women who shape our world,
2017,3 described the concept of
Invisible women: exposing data bias by Edwina Dunn OBE. It describes
a highly effective 'gynandrous'
in a world designed for me, a book women being conditioned to
style of leadership, which
about data bias and how everything feel less entitled than men, less
embraces feminine and masculine
from seat belts to mobile phones comfortable ‘taking up space’,
stereotypes. Her work looked
to voice recognition software is and feeling they deserve less.
at characteristics of the most
designed for the average male, This combined with imposter
successful women CEOs and
with little female data. Unisex syndrome, also more prevalent in
found that they embraced
is a term commonly used, yet
The above is a response on twitter to a female junior doctor venting her both masculine and feminine
women, makes for inequity within
in reality it translates as ‘default workplaces. I remember being told
frustration at being identified as a nurse repeatedly. For many female doctors, leadership behaviours, but with
male’ – just look at scrubs, PPE, at my first ARCP after maternity
feminine being foremost. So
this is the lived reality of subconscious sexist behaviours within the workplace. in reality we do not need to
and X-ray gowns. X-ray gowns are leave that I would have to work
largely unisex but actually are not harder to prove my dedication to
I have had my title removed, been called ‘sweetheart’, and been talked over. ‘fix the women’, women just
designed for women’s bodies, and the specialty as a LTFT. This was
need to accept themselves in
have gapping meaning that breast despite having completed above
order to succeed. The article
Evidence was doing the introduction then just 53 more authority. I disagree with this,
also highlights perceptions of
tissue is not optimally protected. and beyond the requirements.
per cent of women were introduced as does the evidence. The Lancet
For those who think it is a comportment maternity leave and starting a Outside of medicine, in 2019
issue, evidence suggests otherwise.
correctly (p
Bulletin | Issue 128 | July 2021 Bulletin | Issue 128 | July 2021
Women are conditioned to feel less entitled
than men, less comfortable ‘taking up space’, The College has developed a toolkit that offers patients
and feeling they deserve less. the information they need to prepare for surgery,
including the important steps they can take to improve
health and speed up recovery after an operation.
around home-schooling, parenting, places but one key point is that you are Holding the mirror up and really The Fitter Better Sooner toolkit consists of:
emotional support, and working not alone, because however ‘together’ challenging ourselves about whether
through a pandemic are massive and we all look, everyone is frantically there is an equal playing field is ■ one main leaflet on preparing for surgery
statistically more common as a burden paddling just under the surface. So difficult. Sometimes it maybe that
■ six specific leaflets on preparing for some of the most
for women. There is a silent guilt among be kind to yourself; be realistic with there are presumptions that women
NHS workers battling with these while your expectations of yourself, and be are less likely to want leadership roles, common surgical procedures
particularly if they have children. Are
simultaneously working harder. It is accepting of what you can do and try to ■ an animation which can be shown on tablets, smart
like juggling multiple balls – inevitably lose the guilt. we sure that opportunities to advance
some will drop; the key is to identify are equally available and offered? phones, laptops and TVs.
the glass balls – the ones that you The future These subconscious presumptions are
can’t drop – and dropping those which often well intentioned, but present You can view the toolkit here:
It is always difficult to make sweeping
matter less and can be picked up later. statements about gender, and there will
and require a deep level of thought to rcoa.ac.uk/fitterbettersooner
Be kind to yourself; it is OK to drop actively overcome.
be exceptions. There is more research
some of the balls you are juggling. For and mounting evidence into gender I am lucky that the trust I work in
We have also created printable posters, flyers and stickers
me it is housework that gets dropped disparity and how to improve it. I have has embraced talks on sexism. I feel to help you signpost patients to the toolkit. The animation
first, but everyone is different in how taken part in a leadership course, and comfortable in my skin as a leader, a
they prioritise and there are no right or
can be shown on TVs in waiting areas. You can find all
one module required me to ask peers woman and mother of two children. I
wrong answers. about my positive leadership qualities want to lead by example, to hold the these additional resources and instructions on how to
Women are statistically more likely to
and those that I needed to develop. We ladder down to those below me and pull download the animation in MP4 format (or request a
laughed that developing a penis would them up. I also have hugely supportive
be involved in unpaid work around the
be helpful, and this is not an uncommon
version in PowerPoint) on our website here:
male colleagues who are allies. So I
house, childcare and care for other
joke, made quietly in corners where hope this article has made you think and rcoa.ac.uk/patientinfo/healthcare-professionals
dependents. Research by Professor
women would be listened to, taken consider feminism in a positive light to
Anne McMunn 2019 shows that
more seriously, advance more quickly challenge subconscious bias, to demand Please share this toolkit with colleagues in
average female 'breadwinners' spend
7.5 hours a week looking after the
if they were male. This is a problem equity, and to value a more diverse both primary and secondary care settings.
still. My path of educating myself and group of opinions.
house and family, with 45 per cent of
working to try and open people’s eyes
these women doing the majority of References
to the everyday subconscious sexism
tasks, compared with 12 per cent of
male 'breadwinners'. This has been
started after speaking to trainees. I 1 Duma N et al. Evaluating unconscious bias:
speaker introductions at an international
It has been shown that
realised that lived experiences hadn’t
even more true over the last year
with the COVID-19 pandemic. With
changed over the last 10 years. Coping
oncology conference. J Clin Oncology 2019;
37(36):3538-3545. people who improve
with sexism isn’t a badge of honour, it is
their lifestyle in the run up
2 Kang SK, Kaplan S. Working toward
that has come an enormous amount
unacceptable. Now, in a position with gender diversity and inclusion in medicine:
of guilt – guilt that we aren’t giving myths and solutions. The Lancet 2019;
more influence, I have a responsibility
our families enough attention, and
conversely guilt that we aren’t working
to challenge behaviours.
393(10171):579-586.
3 Athanasopoulou A et al. Claiming the corner
to surgery are much more
hard enough for our patients or to
support our colleagues. There are
While there are examples of overt
sexism, most is subconscious, making
office: female CEO careers and implications
for leadership development. Human likely to keep up these changes
Resource Management 2017; 57(2):617-639.
wellbeing sessions offered in many it harder to identify and challenge. after surgery.
16 | | 17Bulletin | Issue 128 | July 2021 Bulletin | Issue 128 | July 2021
Dr Lucy Williams
RCoA SAS Member of Council
sas@rcoa.ac.uk
care. Regular College and Faculty will be able to access increasing
SAS and Specialty Doctors meetings with every part of the amounts of electronic educational
WHAT HAVE THE ROMANS
healthcare infrastructure have been content as we progress through 2021.
taking place, including meetings with
I see the College as representing the
the Secretary of State and devolved
interests of the specialty and value the
governments. Our excellent data
EVER DONE FOR US?
benefits I have described, though this
on workforce shortages is reaching
is not a comprehensive list. I believe we
those who need to know. We hope
are stronger together, and that fellows
this translates into better workforce
and members should elect colleagues
planning to support long-term
to represent them and set the direction
sustainability. Major media coverage
of travel for the profession. There is a
can be found on the College website.
membership category for everyone. If
The College continues to invest in you are reading this as a non-member,
technology that will benefit our fellows check the website at: rcoa.ac.uk/
and members. You may be most familiar membership for more details and join us.
with the Lifelong Learning platform,
www
but the examination system is being
upgraded, as well as many other areas
that are important but less visible.
Exams might not seem like much of a
member benefit, but they are essential
for maintaining high standards for the
specialty of anaesthesia in the UK.
Examiners volunteer their time, and
Where can I find more
there is a small and dedicated staff
information?
team to keep things running smoothly. Further information can be found on
Anyone who has their FRCA can apply the College website using the links
Sometimes I am asked why anyone should be a member of the Royal College of of the College, as well as making a
to become an examiner, and we eagerly below:
wider contribution to all aspects of
Anaesthetists. It makes me think of those immortal words from Monty Python’s College work.
await our first SAS examiner.
SAS and Specialty Doctors
‘Life of Brian’. So much of what the College does is not immediately apparent. I chair the SAS Committee, and we
Other resources to maintain standards rcoa.ac.uk/sas
include the Guidelines for the Provision
can be contacted by email at: sas@ Lifelong Learning platform (LLP)
The College supports your professional The most tangible member benefit is The College has a strong network of Anaesthesia Services. These are
rcoa.ac.uk. Our focus is on training, rcoa.ac.uk/lifelonglearning
development wherever you are in your subscription to the British Journal of professional support. College evidence based and developed in a
your career. You can use the Lifelong of Anaesthesia (BJA) and BJA Education Tutors have primary responsibility standards and wellbeing. We are
systematic way, with regular review E-Learning for Anaesthesia
Learning platform (LLP) to record each month. These are internationally for anaesthetists in training, but most not normally involved in contracts and updates. They form the basis (e-LA)
training activity and assessments – respected journals. You are easily able will be happy to help, or point you in and terms and conditions of service, for the Anaesthesia Clinical Services rcoa.ac.uk/e-learning-
useful if you plan to return to training or to opt out of paper copies to do your the right direction. Regional Advisors however, there have recently been Accreditation standards. ACSA anaesthesia
apply for CESR. There is a Logbook and bit for the environment by emailing (Anaesthesia) have a wider remit for the contract negotiations for Specialty is a peer-review assessment and
the functionality to record CPD activity the Membership Engagement team at: training and professional development. Doctors and the new Specialist role. accreditation process. SAS doctors can Regional Advisors (Anaesthesia)
and reflections for revalidation. You can membership@rcoa.ac.uk. They can offer advice on career options. Through the Academy of Medical Royal get involved at their own hospital but rcoa.ac.uk/RAA
produce a pdf summary to import into A list of regional advisors is available on Colleges, the College has been directly can also apply to be an ACSA assessor
The College’s membership magazine, involved in formulating the generic Guidelines for the Provision
most trusts’ appraisal software systems. the College website. and to visit other hospitals.
the Bulletin, is posted to members capabilities framework and person-
of Anaesthesia Services
E-Learning for Anaesthesia (e-LA) is every other month and is available There are two SAS Council members, description for the new Specialist grade, The College delivers a huge range of rcoa.ac.uk/gpas
an interactive web-based resource on the College website. Up-to-date currently myself and Dr Ashwini as well as drawing up guidance on educational events through the year.
developed by the RCoA. It is available to information can be found in the ‘News’ Keshkamat. We are elected by members Of necessity, these have been virtual Anaesthesia Clinical Services
Advisory Appointment Committees.
any healthcare worker with an NHS email section of the College website, and a and associate members. We represent events in the last year or so, but when Accreditation standards
address and is provided at a discounted monthly ‘President’s News’ summary is the interests of SAS anaesthetists COVID-19 has significantly raised the live events are running again they will rcoa.ac.uk/acsa
price for our overseas members. emailed to all members. throughout the Boards and Committees profile of anaesthesia and intensive be held all over the country. Members
18 | | 19Bulletin | Issue 128 | July 2021 Bulletin | Issue 128 | July 2021
Faculty of Intensive Care Medicine (FICM)
FICM AND CICM
Dr Alison Pittard, OBE Dr Danny Bryden
Dean, FICM Vice-Dean, FICM
contact@ficm.ac.uk
Dr John Hughes
Dean, FPM 2020 was the 10th Anniversary of both the FICM and the College of
Faculty of Pain Medicine (FPM) contact@fpm.ac.uk
Intensive Care Medicine of Australia and New Zealand (CICM). Both bodies
PAIN MANAGEMENT –
had discussed a desire to work more closely together, and ironically the
pandemic’s effects on our respective workforces, travel restrictions, and a
OPPORTUNITIES
general move towards more remote working has made it clearer how we
might achieve that.
Recovery and renewal are important Our initial plans focus on educational join metaphorical hands across the
themes as we move away from an and assessment themes, and especially world. None of us expected that what
There are several forces at play that bring the importance of pain management NHS dominated by COVID-19 towards on the sharing of exams-related had seemed an exciting opportunity at
into clearer perspective, be it at a community/primary care level, within the a COVID-19-endemic NHS of the experience. FICM has successfully the start would become an important
future influenced by our experiences. run two remote FFICM exams via way of approaching the future of our
perioperative pathway and inpatient setting, or at a specialist level. The Faculty has already started to zoom, creating new materials suitable specialty.
outline a strategy as to how this might for remote examining in the process;
There is the new NICE guidance on workforce factors (skills, knowledge pain and outpatient chronic pain. It is Reference
look for our specialty and role. Wider the ability to have CICM examiners
chronic pain1 that includes assessment and experience) and integration to excellent to see trainees coming forward
engagement with healthcare leaders observe our exams provides useful 1 COVID-19 Hub
of chronic pain and management of ensure the right patient sees the right with a genuine interest in pursuing (icmanaesthesiacovid-19.org)
and a move away from a silo mentality external triangulation. As travel barriers
chronic primary pain. This ambitious professional at the right time. a career in pain at both levels, and I and attitudes have been important gradually lift, opportunities for working
document acknowledges the size encourage them to talk to the faculty factors in our pandemic response, and overseas during training or as a later
of the problem and the need for a On the perioperative front the
tutors (pain) or regional advisors in pain this has contributed to a wider public career sabbatical become more open,
comprehensive assessment. It also Surgery and Opioids Best Practice
medicine in order to make the most of understanding of the nature of working and will help guide our joint desire to
alludes to the complexity and partial Guidelines 20212 have been published,
the regional opportunities. There is also in a critical care unit ‘on the frontline’. work towards mutual recognition in our
understanding of pain as well as its providing a multi-organisational and
the newly launched FPM Learning hub respective countries, and make that
individual nature. multidisciplinary collaboration and Sharing of resources and information
on the website that is open source and easier. There is a great deal of
setting out the guiding principles has also been seen to be of benefit,
available to all trainees and, if I dare say work to do with other agencies
There are areas of significant concern in opioid management in the as has working together to achieve
it, others may also find it of interest. such as Health Education
discussed within the document, but perioperative period. a common goal: the RCoA-hosted England and the GMC in
by highlighting these important issues COVID-19 Hub1 is just one high-
References the UK, but the desire is
there is now an opportunity to assess From the training perspective, the new
profile example. The respective there.
the whole process of the delivery of 2021 anaesthetic curriculum is going 1 Chronic pain (primary and secondary) in
over 16s: assessment of all chronic pain and
executive officers of FICM and CICM
pain management across the healthcare live. Pain medicine modules occur have already met and outlined a The initial idea
management of chronic primary pain. NICE
system. This involves looking at a broad at all three stages of the curriculum, (nice.org.uk/guidance/ng193). wide strategy for potential mutual in linking up our
national structure and governance for along with more advanced modules for 2 Surgery and Opioids: Best Practice development. organisations was to
regional implementation, including those wishing to specialise in inpatient Guidelines 2021. FPM (bit.ly/3etcEVL).
20 | | 21Bulletin | Issue 128 | July 2021 Bulletin | Issue 128 | July 2021
Patient Perspective
Science and COVID-19
Jennifer Dorey
Member, RCoA Lay Committee
For more than 12 months COVID-19 has disrupted so many aspects of life for the development and application of parts of our society, such as business, anticipate and respond to them. I hope
evidence-based treatment protocols. politics, media, art and sport, science that the experience of this pandemic
us all. Different nationalities and their governments have reacted in varying To me science means: should be seen as being for anyone to will mean we are better prepared for
ways, but almost universally science has played a key role. ■ unbiased observation,
own and engage in. whatever is coming our way.
documentation and evaluation of The pandemic is far from over, and ‘Science is a way of thinking much
For the headmistress of my girls-only It was not until the Education Reform not understand the basic principles of
data the next few months and years will more than it is a body of knowledge.’4
grammar school, the pinnacle of Act of 1988 that science education was science and do not routinely apply them
hypothesising, testing, questioning not be easy, but in relation to our
achievement for her pupils was that made compulsory in UK state schools, to everyday situations. ■
and triangulation perception of science maybe there is References
we would study French at Oxford, or alongside English and maths. Thirty years
During the pandemic, science has an opportunity for some positives in 1 Stem Learning,
possibly Cambridge. Science was more later, all school children in this country ■ critical evaluation of information
the long term. I hope and believe we (stem.org.uk).
contributed in so many ways, from the sources and the appropriate use of
tolerated than encouraged, but by the now have the opportunity to study the will see: 2 Speakers for Schools,
initial genetic sequencing of the virus, statistics
age of 16 a few of us had already chosen sciences throughout their primary- and (speakersforschools.org).
evaluating potential treatments for
to pursue science-based careers. In secondary-school education. Initiatives ■ risk-benefit analysis ■ an increased appreciation and 3 British Science Association,
COVID-19, developing vaccines and (britishscienceassociation.org).
such as STEM1 (Science, Technology, keeping an open mind and adapting valuing of science
our sixth-form we were able to study antigen and antibody tests, to ongoing ■
4 Carl Sagan, May 1996 (bit.ly/33OGyO3).
zoology and chemistry at A level, but Engineering and Mathematics) in the light of new evidence ■ an increased interest in science
modeling and pharmacovigilance.
physics and applied maths were not Ambassadors, Speakers for Schools,2 the ■ respecting, collaborating with and from citizens in all walks of life and
British Science Association3 and others Scientists have become much more challenging colleagues application of scientific thinking and
on offer. The only option was to join
are actively inspiring young people to visible to the general public at principles to everyday situations
the A-level classes at the local boys’ ■ communicating clearly and
widen their aspirations, whatever their government briefings and through an increased enthusiasm, particularly
grammar school, a short walk across completely. ■
background or culture. Whether or not interviews with the media and have in young people, for science-based
the town. I was just one girl among 30
they follow a science-based career, the been consistently clear in reporting These qualities and competencies have careers.
boys, in a class taught in a very different
life skills they acquire studying science and discussing the latest evidence, been recognised by many people as
way from my very genteel girls’ school. even when it is not conclusive. As a We know that during the rest of this
in school will benefit them for the rest of important during the pandemic, but
Worst of all, the boys’ school had classes
their life. lay member of the Royal College of they are also applicable to all spheres century there will be more and Find out more about
on Saturday mornings and I had to be Anaesthetists, I have been privileged of our daily life, both individually even greater challenges for this
there. The experience was very character Sadly, the legacy of the limited curriculum to see at close quarters the very country and the rest of the world,
the Lay Committee at:
and collectively. The British Science
building, and I was determined my and different attitudes all those years ago considerable contribution of science Association‘s vision is that science not least in respect of climate rcoa.ac.uk/
grades would be as good as the best of means that today there are still many through the day-to-day care provided should be at the heart of culture and change. Science needs to be
lay-committee
them – and they were! people throughout our society who may to patients, the clinical research, and society, not set apart from it. Like other a fundamental part of how we
22 | | 23You can also read
