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The President Writes - June 2018

"We can all learn from the high levels of efficiency in the military services"

In recent weeks, I have had the chance to reflect on the impact of our College’s Triennial Conference held at the end of March. The theme, ‘The Modern Surgical Team: The Future of Surgery’, generated huge interest and Conference Convenor Rowan Parks and his team are to be congratulated for putting together such a thought-provoking programme, which was well received by the audience and beyond. I cannot overlook the power of social media, with #TriConf18 making 2,750,000 impressions worldwide – a considerable outreach!

There is much that we can all learn (and did learn) from the high levels of efficiency and team working in the military services as described by the keynote speaker, Brigadier Tim Hodgetts, and as outlined in the trauma care session. There were many common themes, with good communication and team training clearly the bedrock on which an effective service can be delivered.

Going forward, embracing and valuing the contribution of extended role nurse practitioners and the professions allied to medicine will be pivotal if we are to deliver a quality service in the NHS. The Faculty of Perioperative Care (FPC), which we established in 2016, lays down a marker of the College’s engagement with this group of professionals. Be sure to save the date for the FPC’s fourth annual conference with the theme ‘The Perioperative Practitioner: Working Within One’s Scope of Practice’, which will be in Birmingham on 3 November 2018.

Timing is everything and our conference followed hot on the heels of the judgement on Dr Hadiza Bawa-Garba, who was struck off after the GMC won a High Court appeal against an earlier medical practitioners tribunal ruling that had led to a 12-month suspension following her conviction of gross negligence manslaughter. This judgement has unsettled – and angered – the medical profession in the UK, especially with regard to issues surrounding reflective practice, although this is only one of many issues in this case. Sir Ian Kennedy QC, keynote speaker at the Triennial Conference and a leading professor of health law and ethics, tackled the issues raised in the Bawa-Garba case regarding criminal law and medical manslaughter head on. His position was reported widely, and consequently he has been able to contribute his experience and insight into this complex issue to the review of gross negligence manslaughter in healthcare that is being chaired by Sir Norman Williams.

More than 700 surgeons in training attended the ASiT Conference in April, held for the first time in Edinburgh. The theme of this year’s conference, ‘Nurturing Excellence’, is hugely relevant to us all, whether we are trainers or trainees (and we are still looking for a better, less pejorative descriptor here!). Helen Mohan is to be congratulated on putting together such a perceptive conference programme, which left few stones unturned. As usual, the President’s Q&A session was well subscribed, and highlighted the concerns about the costs of training, the potential impact of extended-role nurse practitioners on surgical training opportunities in the UK and the difficulties of balancing training needs with service delivery. There are no easy answers to these searching questions, but I hope we provided some reassurance that the surgical colleges in the UK and in Ireland recognise and are fully engaged with these issues. A session on the Improving Surgical Training project and the imminent introduction of the pilot scheme in the UK provoked the greatest response from the audience, and there are clear and understandable concerns that two parallel systems in training have the potential to disadvantage one group against the other. Gareth Griffiths, the Joint Committee on Surgical Training Chair, is well aware of the potential risks and I am persuaded by his argument that the close monitoring that will be in place will provide the necessary protection.

An international dimension to training was provided by Hilary Sanfey, past Vice-President of the American College of Surgeons and a recent Ad Hominem Fellow at our College. Hilary brought her wealth of experience as a leader of education and training in the US at many levels. Among the numerous points of interest she raised was the level of experience attained by US residents in training, who have difficulties in achieving some competencies despite working longer hours. Interestingly, training assessment in the US seems likely to go down the Entrustable Professional Activities (see President’s Report 2017/2018) route on which the new Competencies in Practice outcomebased assessment of training in the UK is modelled. A highlight for me was the Silver Scalpel lecture, and last year’s award winner Rachel Hargest sharply reminded us that in training we should be striving for excellence rather than settling for competence – a clear and thoughtful message. Finally, I must extend my congratulations to Stella Vig, a consultant vascular and general surgeon from Croydon University Hospital, who was a worthy winner of this year’s award.

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