celebrating the future of anaesthesia

90 Pages·2016·3.42 MB·English

1 E
0 U
0t S S
h I h I
SSU 0 0t 25 years: the College
E 1 achieves a major
NOVEMBER 2016
milestone in its history
Our 25th Anniversary
plans
Women in medicine;
a brief history
2017:
celebrating
the future
of anaesthesia
www.rcoa.ac.uk
@RCoANews
Bulletin | Issue 100 | November 2016 2
From the Editor
President
Liam Brennan
Will Harrop-Griffiths, RCoA Member of Council Vice-Presidents
and Guest Editor, 25th Anniversary issue Jeremy Langton
Ravi Mahajan
Hopefully, it will not come as much
Editorial Board
of a surprise to any of the 17,000 Monty Mythen, Editor
Will Harrop-Griffiths, Guest Editor
Members and Fellows of the Royal
Jeremy Langton, Vice-President
College of Anaesthetists, and in
Simon Fletcher, Council Member
particular to any of the 80% of these who reported that Jaideep Pandit, Council Member
Lila Dinner, Lead Regional Adviser
they read the Bulletin in our recent membership survey,
David Booth, Lead College Tutor
that 2017 sees the 25th Anniversary of the RCoA. Kate Tatham, Trainee Committee
Carol Pellowe, Lay Committee
This edition of the Bulletin is part of our programme to launch our anniversary Gavin Dallas, Communications
celebrations, and therefore contains a number of articles that look back over the past Manager
25 years and look forward to the next 25 years and beyond. Twenty-five years may Mandie Kelly, Website and
not seem much when compared with other institutions such as the Royal College of Publications Officer
Surgeons of England (217 years old), Royal College of Physicians (499 years old), or Anamika Trivedi, Website and
indeed the college (703 years old) that saw me start my medical training back in the Publications Officer
last millennium, but it is a significant landmark in the development of our specialty
that deserves some note and the odd bit of flag waving (see Sharon Drake’s article on Articles for submission, together
our Anniversary plans for details). History lovers will enjoy reading Tony Wildsmith’s with any declaration of interest,
article on the origins of the College and Paul Clyburn’s article on the AAGBI and the should be sent to the Editor via
RCoA, which looks at the events from a slightly different angle. We are not the only email to: [email protected].
ones celebrating a significant anniversary next year: the Australian and New Zealand All contributions will receive an
College of Anaesthetists (ANZCA) also celebrates its 25th Anniversary, while our own acknowledgement and the Editor
Faculty of Pain Medicine sees its 10th Anniversary – there are articles by David Scott reserves the right to edit articles for
and Christine Ball (ANZCA President and Honorary Curator) and by Kate Grady and reasons of space or clarity.
Daniel Waeland – FPM Deans) on these two organisations.
The views and opinions expressed
While looking both forward and back, we have articles that address the anniversary in the Bulletin are solely those of
theme from the viewpoints of the Faculty of Intensive Care Medicine, the Lay the individual authors, and do not
Committee, trainees, SAS doctors and the RCoA’s Global Partnerships. Pierre necessarily represent the view of
Foëx looks back at 40 years of the Final FRCA course, Melanie Jones provides the Royal College of Anaesthetists.
us with a brief history of Women in Medicine, and the notable academic trio of
Moonesinghe, Grocott and Pennington-Ridge take a look at what may happen to © 2016 Bulletin of The Royal
Academic Anaesthesia in the next 25 years and beyond. Meanwhile, Ron Jones College of Anaesthetists
takes a characteristically quirky look at the first 99 editions of the Bulletin (the current All Rights Reserved. No part of this
issue being its 100th), I report an interview with J-P van Besouw, our immediate publication may be reproduced,
Past President, Jaideep Pandit and Kathleen Ferguson provide us with an update stored in a retrieval system, or
on SALG, and a new contributor to the Bulletin – the potentially pseudonymous transmitted in any form or by
Sebastian Parrott – provides us with three short, dysphoric pieces on what the future any other means, electronic,
of anaesthesia might hold. mechanical, photocopying,
recording, or otherwise, without
All in all, I hope that this 100th edition of the RCoA’s Bulletin offers all of you an
prior permission, in writing, of the
interesting summary of what the last 25 years have meant to the College and
Royal College of Anaesthetists.
to anaesthesia, and what the future might hold for us, for our patients, and for
anaesthesia, pain medicine, intensive care medicine, perioperative medicine and ISSN (print): 2040-8846
whichever other clinical direction we find ourselves travelling in. ISSN (online): 2040-8854
Happy Anniversary!
Bulletin | Issue 100 | November 2016 3
Bulletin
of The Royal College of Anaesthetists
Churchill House 35 Red Lion Square London WC1R 4SG
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CONTENTS
4 32 57
The President's view Australian and New Zealand College Trainees and the RCoA: the next 25
25 not out – the College achieves a of Anaesthetists years
major milestone in its history 25 years – past and future
58
12 35 Academia in 2042: what will research
Revalidation for anaesthetists An interview with Dr JP van Besouw in anaesthesia look like?
Revalidation and CPD since
Bulletin Issue 1 37 62
To begin at the beginning… Twenty-five years on: a former
13
President returns
Patient Perspective 39
25 years and looking forwards The origins of the Royal College of 63
Anaesthetists Join our 25th Anniversary celebrations
15
Staff and Associate Specialist (SAS) 42 68
and Specialty Doctors Forty years on An update on the Safe Anaesthesia
SAS doctors – the future… The Final FRCA Course, with some Liaison Group
observations on cardiovascular risk and
17 70
the management of that risk
The Faculty of Intensive Care Medicine Twenty-five years on: anaesthetic
(FICM) robots
46
– A potted history in four parts
From Newsletter to Bulletin
– An overview of some future Faculty 72
27 years of College publications
activities Report of a meeting of Council
19 48 75
The Faculty of Pain Medicine (FPM) Women in medicine: a brief history History of Anaesthesia Society
– An abbreviated history As we were ...
52
– Looking to 2017
RCoA Global Partnerships – the 77
21 legacy of Bernard Johnson Programme of Events
Health Services Research Centre
55 84
(HSRC)
The next five years: growing up, Twenty-five years on: excerpt from the Notices and advertisements
Bulletin, 1 April 2042
reaching out
86
24 56 Consultations
National Institute of Academic Intraoperative Hypotension in Elder
Anaesthesia (NIAA) Patients (iHypE): a RAFT study
– Anaesthetics: friend or foe to cancer
patients Cover image: John Snow (1813–1858) was a Member of the Royal College of Surgeons
– SPACE – a new frontier to explore whose work provided opportunities to conduct research into the developing field of
anaesthesia. This bust of John Snow sits in the RCoA’s Council Chamber and, for this 100th
postoperative morbidity
issue of the Bulletin, represents us celebrating the history of anaesthesia while also looking
– The John Snow Intercalated BSc
towards the future.
Awards 2015–2016
The Royal College of Anaesthetists is grateful for the contribution to the production of the Bulletin by
Bulletin | Issue 100 | November 2016 4
The President's view
25 not out – the College achieves
a major milestone in its history
It is a tremendous honour for me to be President of the Royal College of
Anaesthetists as we approach the 25th anniversary of receiving our Royal
Charter. The past quarter of a century has seen anaesthesia and our College
grow hugely in stature and so, on the eve of this pivotal moment in our history,
I am devoting this edition of President’s View to some personal reflections on
the past 25 years, combined with an overview of the College today and some
challenges for the future.
Looking back Surgeons – operating out of a few rooms the generosity of many individual
– to being a fully independent Royal Fellows who contributed independent
In 1992 I was a fresh-faced senior
College housed in its own premises. practice fees to our charitable
registrar (ST6 for younger readers) on
foundation. This was all the more
rotation at the Royal Brompton Hospital
It took considerable effort – and
remarkable when we recall that in the
and, to be honest, I wasn’t aware of the
courage – to leave the security of
early 1990s the UK was in recession and
work going on elsewhere in London to
Lincoln’s Inn Fields, where the fledgling
money was scarce (sounds familiar?). The
secure our specialty’s future. However,
College, and previously the Faculty of
innovative efforts of the fundraising team,
I now know how indebted we are to our
Anaesthetists, had been based since
led by Professors Rosen and Hatch, were
then College Council led by Alastair
1948. Leaving home is exciting but also
key in reaching the fundraising target,
Spence, Cedric Prys-Roberts and David
daunting, and records from the time
along with the support of the AAGBI,
Hatch (as President and Vice-Presidents
show that to become independent,
led by its President, Tom Boulton.
respectively) for the vision they showed
the new Royal College needed to raise
Incidentally, we have Tom to thank for
in guiding the College to achieving Royal
funds – some £5 million – to achieve
the College Coat of Arms with which we
status. Starting under Michael Rosen’s
its goals, including buying its first home
are all now so familiar.
Presidency, over a period of less than five
in Russell Square. This was achieved
years, the College was transformed from
in record time thanks to benefactors
being a Faculty of the Royal College of
from the pharmaceutical industry and
Bulletin | Issue 100 | November 2016 5
The College today
Today our College is virtually
unrecognisable from what it was at
its birth in 1992. Besides the obvious
expansion in membership and staffing,
the College has developed new
workstreams, with our Clinical Quality
Directorate, recently established
Communications and External Affairs
Directorate, and not forgetting the
Faculties of Pain Medicine and Intensive
Care. This reflects the increasing need
to promote all aspects of anaesthetic
practice and associated disciplines, and
to engage more effectively with our
membership and our patients, and with
Council of the College of Anaesthetists, 1992 other stakeholders involved in delivering,
regulating and funding healthcare. We
The RCoA in 1992 was very different the College empowered to remove hope this will make the College more
from what it is now. With around trainees and de-recognise hospitals accessible and responsive in this fast-
4,000 Fellows and no associated for training purposes if they were moving, multi-media world.
Faculties, it was considerably smaller offering poor training. This authority
than our current 17,500 membership has long since been lost by the Royal Our research portfolio, amounting to
(21,000 including FICM and FPM) This Colleges, and it is only in recent some £4.2 million, co-ordinated by our
was reflected in staff numbers, with years that we have regained some of Health Services Research Centre working
around 20 when we first moved into our previous influence in this crucial in partnership with the National Institute
Russell Square, compared to nearly area that affects all of our trainee of Academic Anaesthesia, is leading
100 people today. The Council was members. Finally, the FRCA was a the way with patient-centred, quality-
smaller: 20 elected members versus 24 three-part examination in 1992, oral improvement-based studies, which will
today, supported by the then Regional examinations were only just starting to undoubtedly be strengthened by our
Educational Advisers and our enduring be standardised, and the OSCE was new Clinical Trials Network.
cohort of College Tutors. in a very early stage of development.
As in 1992, examinations and training
With pass rates being 40% at best,
remain core College business. These
This structure served the College well, as it was common for trainees to pay
aspects of our work are highly regarded
our work then revolved predominantly several visits to the examinations
both in the UK and internationally, by
around the delivery of training and before achieving the Fellowship.
other Colleges and by regulators as
examinations. Professional standards
being exemplars in many aspects of
were in the early stages of being One aspect of the College that has
education and assessment practice.
defined, led by the Quality of Practice certainly progressed in the past 25 years
Committee, clinical audit was just being is greater diversity in our representation. The College estate is the envy of our
In 1992 our Council and Board of
talked about, and quality improvement peers, with spacious, modern headquarters
Examiners was predominantly white and
science, which occupies increased in Red Lion Square that we own outright.
male. Today the gender and ethnicity
amounts of time and resources today, Financially we are secure, with cashflow
profile of those in leadership roles
was a concept far in the future. and investments well placed to meet our
much better reflects the demographic
strategic aims and future challenges in
The College in 1992 had the ultimate profile of our membership. In 1992 less
order that we can further support our
say in constructing and delivering than 5% of FRCA examiners were from
members, and their patients.
postgraduate curricula, approving ethnic minorities and less than 10% were
training environments and delivering female. In 2016 these figures are 17% Finally, as in 1992, we are extremely
examinations. A visit from the members and 30% respectively. To put this in fortunate, despite the extremely
of the Hospital Recognition Committee context, 25% of our membership in the challenging landscape in which we
was anticipated with some trepidation recent member survey was from ethnic practise, to have a continuing number
– not unlike a CQC visit today – with minorities and 32% were female. of members willing to contribute
Bulletin | Issue 100 | November 2016 6
enthusiastically to the work of the College. The same census also highlighted the
Without their selfless support, the problem of our increasingly ageing
College would not be the robust, thriving anaesthetic workforce, considered
organisation it is today, so my personal in detail in the recent AAGBI report
thanks go to everyone who works or has ‘Age and the Anaesthetist’. A culture
worked on behalf of the College in the change by employers is urgently
past 25 years in whatever capacity. required to facilitate portfolio
careers for anaesthetists if they are
...and the future? to remain able to provide safe and
sustainable perioperative care late
If we are to live up to the legacy of our
into their seventh decade. Alternative
predecessors, we cannot be complacent.
staffing options, including expansion
The NHS is under unprecedented
of the PA(A) workforce, may also need
pressure and, as an essential part of
to be considered but, as we and the
secondary and tertiary care, anaesthesia,
AAGBI have emphasised, this is only
intensive care and pain medicine needs
a viable option if accompanied by
to dig deep to maintain high-quality
statutory regulation.
services for the benefit of patients. The
College’s role is to champion innovative
To conclude where we begun with a
practice that meets this aim, but also to
cricketing metaphor, the RCoA innings
warn and advise our national political
has only started but, despite some
leaders when lack of resources are
hostile bowling, we have bided our time,
an obstacle to providing safe and
defended well, and are now starting
sustainable patient care.
to play some confident shots with
increasing frequency.
Perioperative medicine (POM) as a
concept is gaining momentum with the
At 25, we are confident of making 50
specialty from the grass roots upwards,
and then onwards to our first century!
and this surely must be a key part of
our future. Emphasising as it does the
pivotal role of the physician-anaesthetist
in managing increasingly frail, complex
patients in partnership with other
healthcare professionals, this initiative
aligns perfectly with current Government
policy and puts the specialty and the
College at a distinct political advantage.
Our first-ever College strategy, which
heavily references POM, will hopefully
keep us on course and prevent us from
being deflected by having to react
constantly to external events.
The pressure on the anaesthesia
workforce, as highlighted by our recent
census, will be an issue that we must
address if our specialty is to meet
future expectations. This will require
us to lobby political decision makers
responsible for training budgets, as
well as to contribute to the debate
and highlight the consequences of
limiting freedom of movement of
health workers in the post-Brexit era.
Bulletin | Issue 100 | November 2016 7
Patient Safety
Conference, Edinburgh
Date: 30 November 2016
Venue: Royal College of Physicians of
Edinburgh
A ROYAL OCCASION
The Safe Anaesthesia Liaison Group is delighted to announce that the Royal College
of Anaesthetists’ Royal Patron, HRH The Princess Royal, will be attending our annual
Patient Safety Conference in Edinburgh this year.
The event will be held at the Royal College of Physicians of Edinburgh on 30 November 2016.
This is a single-day meeting which consists of lectures, each of which is followed by ample time for discussion and
networking opportunities. It is intended for doctors engaged in clinical anaesthesia, pain management and intensive care
medicine who have an interest in improving patient safety.
Experts will present up-to-date information on a wide range of patient safety related topics, and we are delighted to confirm
that the Chief Medical Officer for Scotland, Dr Catherine Calderwood and Shona Robison, MSP, Cabinet Secretary for
Health and Sport will both be addressing the conference. Please see the event page on the Royal College of Anaesthetists’
website for the programme and further details (http://bit.ly/salgPS).
To book a place on the event, please visit http://rcoa.it/booknow. You will be taken to the Event Online Booking system
where you simply log in or register to complete the booking process.
CPD
5
credits
Registration Fee: £215 | Event Organiser: Professor J Pandit | [email protected] | Twitter #SALGPS
Dress code: day dresses and lounge suits
Bulletin | Issue 100 | November 2016 8
News in brief
News and information
from around the College
Forging global
partnerships:
The World Congress of
Anaesthesiologists
Delivering global partnerships to improve
The World Congress of
anaesthesia Anaesthesiologists meets every four
years and the timing couldn’t have been
Through our new Global Partnership One example of our most recent
better coming just one month after the
Strategy (http://bit.ly/GPstrategy), the international partnership work is
launch of the College’s new strategy. The
College is committed to forging and the signing of a Memorandum of
strategy sets a bold vision for our work
developing international partnerships Understanding (MoU) with the Hong
in the UK and globally and was warmly
with doctors and health education Kong College of Anaesthesiologists
received by delegates, societies and
providers in multiple countries to deliver in August this year. This MoU is set to
other Colleges.
high quality anaesthetic training to local enhance the development of standards
doctors and clinicians. for anaesthesia in Hong Kong through With over 6,000 delegates in
a framework of collaborative work attendance, the major theme of the
Only through this close collaboration
in education, training, assessment, Congress was The Lancet’s 2015
with professionals, national bodies and
examinations, continuing professional Commission on Global Surgery which
health ministries (or equivalent), can
development, e-learning and research. found that over five billion people lack
we work to strengthen international
access to safe and affordable surgical
healthcare systems to ensure the long For more information about the MoU,
and anaesthetic care and that a further
term stability and access to healthcare please read our brief press release:
2.2 million anaesthetists, surgeons and
for previously excluded patient groups. http://bit.ly/2bBjncl.
obstetricians will be required worldwide
to satisfy this demand. The RCoA’s
strategy states ‘To meet this challenge we
‘We’re pleased to be working with our Hong are committed to working in partnership
with organisations to improve healthcare
Kong colleagues to share our knowledge
provision across the world’.
and experience of developing standards for
In working towards that point in
anaesthetic education, training, assessments our strategy and, during a packed
Congress programme, a small College
and continuing professional development. There’s
delegation led by president Liam
Brennan, signed a memorandum of
a considerable amount of work taking place
understanding with the Hong Kong
on the back of our new Global Partnership College of Anaesthesiologists on exams
and training and convened a meeting
Strategy and I look forward to updating
with the presidents of anaesthetic
members on this over the coming months.’ Colleges around world to discuss better
partnership working. Through our
attendance at the Congress and our
DR JEREMY LANGTON
collaborative activities around its fringes,
VICE-PRESIDENT AND CHAIR
the College ensured that UK anaesthesia
GLOBAL PARTNERSHIPS COMMITTEE
was well represented on the global stage.
9
Driving Perioperative
Medicine
Attitudes and experiences survey
In early 2017, we are due to survey
College members to find out their
attitudes to and experiences of
perioperative medicine. Responses
will not only inform the College’s
POM work, but will also provide a
Examinations
basis against which to measure the
development of perioperative medicine
The examinations team has been busy over the past few months preparing and
over the coming years.
managing the exam processes for the current 2016–2017 academic year. With 435
candidates having sat the Primary MCQ and another 406 sitting the Final Written
POM Leads’ event
examinations in September, it’s been another busy year. The next Primary OSCE/SOE
On 31 January 2017 an all-day meeting,
takes place w/c 7 November. There remains one further sitting of the Primary MCQ
Developing perioperative medicine across
exam for 2016, which is scheduled for 15 November, while the next Final SOE takes
the UK, is being held at the College for
place w/c 5 December. Then following the seasonal break there are further sittings of
all POM Local Clinical Leads. These
the exams scheduled for January, February, March, May and June 2017.
Leads play a crucial role in the delivery
of the Colleges’ POM programme and Exam results are published on the website (http://bit.ly/2cyFpNm), following the
it‘s through them that best practice in relevant standard setting process.
perioperative medicine can be effectively
developed and spread. The list of current Over the months preceding these exams, examiners meet at the College to write and
RCoA Local Leads can be found on select new questions for their relevant sections. Discussions also take place between
the POM microsite, along with the job the groups of examiners to avoid question clashes and ensure questions reflect
description for each role. Please contact a wide coverage of the relevant curriculum for each exam. The College provides
the Lead within your hospital – if a Lead various resources to assist exam candidates in preparing for their exams – all of
has not yet been identified and you are which are available on the College website (http://bit.ly/2cyBksL). The College’s
interested in the role please contact us YouTube Channel (http://bit.ly/rcoaYouTube) also hosts a series of exam videos; the
on the email address below. OSCE spotlight videos and Primary and Final SOE videos are particularly helpful to
candidates preparing for the forthcoming OSCE and SOEs.
[email protected]
WWW.RCOA.AC.UK/PERIOPERATIVEMEDICINE
10
Membership
Department –
working for you
By the time this issue of the Bulletin
lands on members’ desks, the November
Senior Fellow Club meeting in York
(http://bit.ly/2cyLrxE) should be only
days away and is the Membership
Department’s most prestigious event it
has the honour of managing.
www.rcoa.ac.uk
@RCoANews
Established in 2001 and currently chaired
by Dr Ian Calder, the Senior Fellows
Brand new College Club is open to all College or Faculty
members who have come to the end of
a career in substantive employment. The
Since being made public at our College Tutors’ meeting and Summer Symposium in
club meets approximately twice a year.
June this year, our new logo and brand continues to be rolled out across the College.
There is an annual fee, which is managed
Produced after a consultation period of several months, the new brand and logo by the Membership Department, and
have been designed to instil a sense of trust in the fact that, as a professional entitles Senior Fellows to use College
specialty, anaesthetists are all doctors and have the patient’s needs at heart. The ‘A’ facilities, receive the Bulletin, continue
symbol within the new logo contains two circles, inspired by the relationship between to vote in specific College elections and
attend College meetings at half price.
patient and anaesthetist. This suggests that we are ‘by your side’ and represents
the vital supportive and collaborative role the College plays for members, patients
While the aims of the Club are for
and healthcare in general. The College crest will be retained for ceremonial uses,
networking purposes, the President
including examination certificates and formal documents.
or a Vice-President provides members
with an update on the work of the
Our new brand clearly communicates what we do as a medical Royal College, why
College during each meeting.
we do it and how we do it. Supporting our five-year strategy, it makes clear our
pursuit of excellence, our focus on supporting our membership, the value we place If you wish to become a member of
on collaboration and our vision of the central role anaesthesia plays in the future of the Senior Fellows Club, please e-mail
healthcare. As members, you would have also noticed the new brand at conferences, the Membership Department via
events and on publications, social media and websites. We hope you like it. [email protected].
Visit our 25th Anniversary website for information on all our planned activities
WWW.RCOA.AC.UK/RCOA25