2016 July SCTS Bulletin

the Society for Cardiothoracic Surgery in Great Britain and Ireland July 2016Surgical teams are the key to mitigatingrisk averse behaviourRisk averse cardiac surgeons,please stand up!Audit and outcome reporting incardiothoracic surgeryMedical Student Engagement –what do the students think?An SCTS Fellowship JourneyThe story of the Belsey SpoonTraining outside of the workplace:The value of the pioneering SCTS Ethiconcurriculum aligned training programmeSCTS Bulletin 0716.indd 1 www.scts.org www.sctsltd.co.uk 18/07/2016 12:04

Intercollegiate Specialty Boards and The Joint Committee On Intercollegiate Examinations Panel Of Examiners Recruitment: Cardiothoracic Surgery The Intercollegiate Specialty Board in Cardiothoracic Surgery is looking to recruit new examiners to join its Panel. The Board would welcome applications from interested and motivated Consultants who have significant previous examining experience (e.g. MRCS or University undergraduate) or formal trainee assessment experience. Applications are invited from surgeons who hold a substantive (minimum 5 years) Consultant post in the National Health Service/Public Health Service (Ireland) wishing to be considered to join the Panel of Examiners in Cardiothoracic Surgery in all of the following areas: • Cardiac • Thoracic • Cardiothoracic The Criteria for Appointment and an application form are available to download from www.jcie.org.uk. Please note that there has been a change to the Criteria for Appointment in regards to examination experience. Or for further information please contact Eleanor Lynes, Specialty Manager [email protected] Tel: 0131 662 9222 International Examinations Office 2 Hill Place Edinburgh EH8 9DS UK Tel: 0131 662 9333 Fax: 0131 662 9444 [email protected] www.jscfe.co.ukSCTS Bulletin 0716.indd 2 18/07/2016 12:04

Society for Cardiothoracic Surgery July 20314bulletinthein Great Britain and Ireland July 2016Contents Editor: Vipin ZamvarPresident’s Report 4 Publishing SecretarySurgical teams are the key to mitigating risk averse behaviour 6Risk averse cardiac surgeons,please stand up, please stand up! 8 Contact:Update on audit and outcome reporting in cardiothoracic surgery 10 [email protected] & Allied Health Report 12SCTS Historian: The Development of Closed Heart Surgery (A Tale Of Two Presidents) 17Presidential Address SCTS Annual General Meeting 2016 18SCTS 80th Annual Meeting 21Medical Student Engagement – what do the students think? 22An SCTS Fellowship Journey (2015-16) 24The story of the Belsey Spoon(s) 25Ionescu Nursing & Allied Health Practitioners Fellowship Award 2015 My Experience 26Patrick Magee Medal 2016 Report 28The Cardiothoracic Trainees Research Collaborative 30Training outside of the workplace: An update on the value of thepioneering SCTS Ethicon curriculum aligned training programme 32There is no ‘I’ in the word TEAM 34Making cardiothoracic surgery attractive to medical students 37SCTS Student Engagement Day Report 38SCTS Education Tutors Report 40Developing Non-Technical Skills 433rd National Cardiothoracic Surgery Careers Day London 2016 44Obituary: Professor Geoffrey Smith 46SCTS Education Professional Development Programme 47New Consultants 47Other Appointments 47The 2015 SCTS Ionescu Scholarship for non-NTN doctors 48Obituary: Iain Mackay Breckenridge 49The Crossword 50 Society for Cardiothoracic Surgery in Great Britain and Ireland bthuelletin The Royal College of Surgeons of England, 35-43 Lincoln’s Inn Fields, London WC2A 3PE Designed & produced by CPL Associates, London Tel: +44 (0) 20 7869 6893 Fax: +44 (0) 20 7869 6890 Email: [email protected] Website: www.scts.org 18/07/2016 12:04SCTS Bulletin 0716.indd 3

4 theBulletinPresident’s ReportDear AllAs I write this, although England seem to be on top in the Review’ on our behalf. David Jenkins’ term as an elected Trustee3rd One Day International against Sri Lanka, it is gloomy has ended but he remains as Chair of the Audit Committeehere. There is talk of rain in Bristol on Test Match Special, as a co-opted Trustee. His role as Chair of the Adult Cardiacin Sheffield it is raining, yet again. Committee is taken by Andy Chukwuemea. The key personnel on the Committees are shown in the table. If any memberSo I will start by lamenting the deaths of Mr Iain Breckenridge wishes to make contact please do so with one of the co-chairs.and Professor Geoffrey Smith. Both were senior and respectedfigures when I was a trainee. Indeed I owe much of my progress Rajesh Shah and Mike Lewis have, as Education Secretaries, ledin the specialty to the support of Geoff Smith. I was one of the development of SCTS Education are also both moving on.many consultants who were privileged to have worked for him. Mike is now the Chair of the Intercollegiate Specialty Board inI can still hear his voice as he strode into theatre; “Cooper, is Cardiothoracic Surgery and Rajesh will be taking over as Chairthe mammary taken to your complete satisfaction?” I never of The Specialty Advisory Committee in Cardiothoracic Surgeryworked out how to answer that and of course there is no in the autumn. Their achievements for SCTS are evident.satisfactory answer. Geoff was President of our Society in 1992and 1993. I have been pleased to be a member of Faculty for the ST3a and ST8a courses in the past year. I hope I have made a usefulAnnual Meeting contribution but the contribution made by the other members of Faculty of these and all the other courses are crucial toOur Annual Meeting has made significant strides since their success. I have also been impressed by the attitudeGeoff Smith gave his Presidential Address to the meeting in of the delegates who, in my experience, have all shownLlandudno. Cliff Barlow, as Meeting Secretary, led the team that commitment to the courses and their educational objectives.organised our last two Annual Meetings; a joint meeting with It is disappointing to learn that this has not always been theACTA in Manchester in 2015 and possibly our most successful case. We all have to remember that in this sort of arena ourmeeting ever in Birmingham this year. Cliff took over at a behaviour reflects not only on us personally but also the widertime of considerable difficulty and I would like to take the specialty.opportunity to pay tribute to him for making the 2015 Meetingas successful as it was. OutcomesEnoch Akowuah takes over as Meeting Secretary, Carin Van Since we started publishing outcomes, the environment inDoorn takes over from David Barron as Chair of the Congenital which we practice has changed significantly. Over the years,Committee. David has put at enormous effort into first ‘Safe we have published mortality, and now survival, by hospitaland Sustainable’ and now the ‘New Congenital Heart Disease and by surgeon in various formats. These changes in format of presentation over the years have been in response to various Cliff Barlow took over at external pressures. These external pressures have never been related to patients’ requirements. a time of considerable The way data is currently presented does not meet the needs difficulty and I would like of patients. When I showed the outcomes data to the Patient Liaison Group of the Royal College of Surgeons of England, to take the opportunity an intelligent and interested group of patients, they did not find the data easily comprehensible. Nor did they consider the to pay tribute to him for publication of survival rates only anywhere near comprehensive enough. The following comments were typical: making the Annual Meeting • knowing the surgeons’ areas of strength as successful as it was • links to SCTS’ webpages on patient information on the different cardiothoracic operations • it would be helpful to have a search function that would allow the patient to tailor their search to take into account the following factors:SCTS Bulletin 0716.indd 4 18/07/2016 12:04

July 2016 5 Graham Cooper - the particular operation they will To meet the needs of patients we need to undergo (this would be very useful) develop the way we publish information and outcomes. Especially, we need to understand - where you live in terms of postcode the range of information patients want to see (i.e. not just region) and how we can present the outcomes data so that it is comprehensible to a lay audience.• information available on which surgeons Accordingly the Trustees and wider Executive carry out different procedures agreed last month to commission Picker Institute Europe to undertake a piece of work• PROMs information on our behalf to explore these issues. We hope to have this completed by the end of the year• a lot of the outcomes that patients are and be in a position to take a step forward in interested in are not clinical so wider forms providing patients information that they want of data would be useful to see in a meaningful way.• the inclusion of narrative text explaining Well, they are off for rain in Bristol but a hint what the data means in practice of the weather clearing here, let us hope it continues and I wish you all the best for the• more labelling of the graph and the dot to summer. explain what they meanCommittee StructureCommittee Meetings Audit Adult Cardiac Thoracic Congenital Education Professional Team Committee Standards Committee Committee Committee Committee Committee President President ElectTrustee Meeting President President President Honorary (Co-Chair) (Co-Chair)Members Secretary Elect (Co-Chair) Elect Secretary (Chair) (Co-Chair) (Co-Chair) (Co-Chair) David Andrew Juliet King Carin Van Rajesh Shah Andrew Jenkins Chukwuemea Doorn Owens (Co-Chair) (Co-Chair) (Co-Chair) (Co-Chair) (Elected (Co-Chair) (Co-opted (Co-Chair) (Co-opted (Elected Trustee) (Co-opted Trustee) (Elected Trustee) Trustee) Trustee) Trustee) Shyam Prakash Prakash Kolvekar Punjabi Punjabi (Elected (Elected (Elected Trustee) Trustee) Trustee) Clinton LloydOther Lay MemberMembers Chrissie Sarah Murray Bannister Isabelle Ferner Tilly Mitchell Helen Munday Sunil OhriSCTS Bulletin 0716.indd 5 18/07/2016 12:04

6 theBulletinSurgical teams are the keyto mitigating risk averse behaviour(Cardiac,Thoracic and Congenital)The Naked Surgeon by Sam Nashef is surgeons, 84% of whom had witnessed to prioritise a patient that has beena superb book written by a cardiac such behaviour in their colleagues and postponed once already.surgeon with an in depth knowledge 35% admitted that they had at someof measuring surgical outcomes. point behaved in a similar manner. So – back to Risk AverseHis account of doing an audit as a Behaviour.medical student on survival after This is not a good reflection on ourabdominal aortic aneurysm surgery specialty and a Daily Telegraph reporter This hasn’t just appeared since theis an immediate reminder where from the Literary Hay Festival seized publication of outcomes. The referringour profession has come from: his on this aspect of the book with the physicians always knew which surgeonsdiscovery that the non-vascular headline “One in Three Heart Surgeons to approach to get the decision theysurgeons had better outcomes was not Refuse Difficult Operations to avoid Poor wanted for their patient, but now MDTs,a welcome message and thankfully had Mortality Ratings – survey shows”. generic lists and larger surgical teamsonly a short term negative impact on make it more difficult for the physiciansSam’s stellar career progression. Is this another example where, as a to make such personal referrals. This professional group, we are aware of poor leads to differences of opinion – is anHis book reminds us of all the pressing behaviours and not finding solutions? operation indicated? If so, which one?reasons why we measure what we do And if so who’s going to do it and when?and why we share the results to improve The GMC in 2013 has clearly defined the And are colleagues giving opinionsoutcomes – and he also touches on the behaviours expected in “Good Medical influenced by their risk aversion?unintended consequences such as risk Practice” and in one of the very firstaverse behaviour. headings under “Knowledge, Skills and As doctors / surgeons we possibly remain Performance” they state that we ‘Make quite paternalistic – and we have aWhat is this behaviour in the care of your patient your first failing where we assume we know whatrelation to surgery? concern’. Clearly any decision that is is best for our patient without sharing influenced by our personal agendas will the choices, risks and benefits with theCould we define it as any decision made not meet this standard. patient themselves – this is typifiedby a surgeon or surgical team that places when an MDT makes a decision ratherthe performance measures of the surgeon Such headlines would suggest to than a recommendation in the absence of/ team over and above the interests of patients and their relatives that our very the patient. The right decision is the onethe patient? own majority view of our own colleagues the patient chooses after the consent is that we are not upholding the GMC process, but this too can be influencedTo strengthen his message in the book standards. by risk aversion. The choices need to beSam conducted a poll of UK cardiac presented in a non-biased way, whichsurgeons (with the support of SCTS) to Professionally we are continually battling immediately leaves the physician andget some measure if this behaviour was our human frailties that challenge our surgeon exposed to conflicts of interestwidespread. He had a response from 115 delivery of the excellence expected. Risk in the subtle ways they present the data - averse behaviour is understandably in all of which should exclude any personal Such headlines would the spotlight as the decision to operate agendas. The complex risks need to be suggest to patients is so clear cut, but there are plenty of considered as well as trying to give some and their relatives other examples where we might not measure of expected quantity and quality that our very own attain the perfection expected of us – of life to a patient who is often sick, majority view of our being late to clinic or theatre, cancelling scared and struggling to understand the own colleagues is that a case because of another commitment, complexity of the situation. we are not upholding influencing a patient to use private the GMC standards insurance etc etc. And of course those medical / surgical opinions on risks and benefits will On top of that we have responsibility to have further variance depending on our several patients at any one time, trying current knowledge, anecdotes and recent to balance ALL of their interests and experiences (positive and negative). make them our primary concern – the patient on the table, the emergency just Because of all these variances high risk referred to us, the first patient back on patients would benefit from multiple ITU bleeding, or a colleague who wantsSCTS Bulletin 0716.indd 6 18/07/2016 12:04

July 2016 7 Simon Kendallsurgical and medical opinions – when and weaknesses of each other and don’t collect anythese all align the patient may find the prevent the colleague from situations comprehensivedecision easier, but where there are not in the patient’s best interests nor data on thedifferences of opinion the complexity of their own. From the patient’s perspective cases we don’tthe situation becomes more evident to they experience a functioning service do. In lungthe patient and relatives, and hopefully that works in their interest, and they are cancer we havethey appreciate the deserved extra not exposed to individual variance. some measurecare and attention they are receiving. of resectionOccasionally it might even be indicated For extreme cases that have been referred rates but noto ask another unit for an opinion. by other units or are especially high risk, such measure in cardiac surgery. Is it Papworth Hospital has developed its possible for an organisation to protectSeeking other opinions should be seen ‘Star Chamber’ approach where the team its reputation by being risk averse and isas an indication of humility and pursuing agree if the referral is appropriate and only suspected when neighbouring unitsthe best interests for the patient, which surgeon (s) are best suited to help start receiving referrals that have beenalthough it can be misinterpreted as a the patient. This may be a model that surprisingly turned down? This requiresweakness due to a lack of decisiveness other units may well adopt, and through further research looking at equality ofor risk aversion. NICOR we have asked HQIP to consider access for the different conditions that endorsing this as best practice. we treat.Once the decision to operatehas been made then who In all of this is a desire to get the right This is such a complex topic, which startsbest to do it? surgeon (s) doing the right operation on with the simple aim that the patient the right patient. Every team will have a receives the right treatment. But fromThe days where the individual surgeon is variety of skills within its group and it is there on it all gets complicated:expected to accept any patient referred inappropriate for the patient to undergoto them from an MDT, clinic or during an operation by a surgeon who does not • The patient’s expectationstheir on call duties should be an out believe it to be in the patient’s interests,dated concept? And equally should any adhering to another GMC mantra ‘Do • The family’s expectationsindividual surgeon be telling a patient no harm’. Risk aversion because thethat an operation is inappropriate surgeon believes the surgery will cause • The physician’s expectationswithout offering to arrange a second harm should not be confused with riskopinion? When the surgeon recognises aversion due to performance gaming. If • The surgeon’s opinion – and all thethe complexity of the case or their own the patient is undergoing a procedure associated influenceslack of experience with the proposed then they deserve a surgeon utterlyprocedure they should be supported by a committed to the procedure, and it will • The support of the teamstructure and team where such cases can be the underlying functioning teambe considered to answer the pertinent structure that enables this to happen. • The support of the organisationquestions: In such a functioning team risk averse Of these perhaps the two most important• Is the referral appropriate? behaviour may be minimised as each factors are the patient’s expectations surgeon in the team prioritises the and the support of the team. This largely• Can any of the team do it? interests of the patient, and the surgeons avoids conflicts of interest and makes who previously had a tendency to risk the patient the primary concern. The• Is there a sub specialty interest such aversion will know they are supported challenge now is to get all of our teams as VATS surgery or mitral surgery? to perform to their strengths. Conversely to be functional. risk aversion by individuals may be a• Is the patient best referred to symptom of a poorly functioning team. How do we take this forward? It is for us another unit? all to learn from the good practice that However, there is also danger of already exists. And from there we can• Is that colleague performing well at institutional risk averse behaviour. continue to develop our teams and our the moment? Organisational reputation is very behaviours. important not only in influencing• Should two of us double scrub to referrals from physicians and the help the patient? associated income, but also in giving patients confidence in their treatment.Is this how the highly functioning team Although we have become reasonablywork? Which looks to provide the right good at measuring what we do we stillcare for the patient and support eachmember of the team? This sort of teamwill recognise and respect the strengthsSCTS Bulletin 0716.indd 7 18/07/2016 12:04

8 theBulletinRisk averse cardiac surgeons,please stand up, please stand up!As a group of surgeons involved in Cardiac surgery we have within their confidence levels, there is no clear definition of abeen hearing a lot of talk of the possibility of risk averse risk averse surgeon and may never be. So does it matter thatbehaviour in our midst over the past years. Sam Nashef has we cannot define this behaviour? Yes it does. Because if wecovered it well in his recent book and this was reported in cannot measure it, we may be affected by the Dunning-Krugerthe press in the past month which led to a response from effect.our society. At every national meeting this is rumoured butit appears to be a very difficult subject to deal with. There Student Ratingwas even a recent letter from a Royal College president thatsuggested that if anyone was aware of risk averse behaviour Some of you might be aware of the work of psychologists,in our midst, we must report it immediately. Dunning and Kruger who published their work on university students. When students are asked to rate themselves as toI have been a consultant surgeon for 12 years, nearly all of it in how good they were on aspects that cannot be easily testedthe era of public scrutiny. After 9 years of having, a mortality, on, most students rated themselves in the average to abovearound the 2% mark, year on year, in my 10th year I took on average category. On testing them it was more obvious that asome difficult cases and had a run of bad results, that led my proportion of these students, were below average and had ratedmortality to jump to 5% in one year. As I was closely watching themselves higher than their abilities. A few rated themselvesmy performance, I was aware of this “bad run” quickly. So what lower than their ability too. This has been reproduced in manydid I do the following year? Did I look at ways to improve my different groups and is possibly best seen in action whileperformance? Did I go and watch better surgeons? Or did I just watching a live audition of a reality show on TV where peopleget risk averse? with below average talent for singing might still believe that the talent show judges are wrong not to put them through toI decided to take more of my complex cases to an MDT. There the next rounds. This effect is possibly the explanation in ourI found strength in numbers to be more selective. I was group that nearly all surgeons have seen risk averse behavioursurprised to find that at an MDT there was much more support among their colleagues but no body owns up to it themselves.to offer interventional options than to force high risk surgical If we cannot test for something then, we are more likely to besolutions. So I did not get risk averse, I just got more selective wrong in our self assessment.and once more have my mortality in the 2% area for the last16 months. Could there be risk averse behaviour in the current system? In the NHS, cardiac surgeons are on a contract that is timeSo, this brings me to the thorny topic of how do we define based in most institutions. The number of cases expected isrisk averse behaviour. Early in my career I was told by a highly not stipulated and if so needs to correct for case complexityregarded mentor of mine that “you learn quickly when to and so cannot be easily determined. Add to this the fact thatoperate and you spend the rest of your career learning when there is close scrutiny of any adverse outcomes followingnot to operate”. As surgeons we are always walking a fine line surgical intervention but no obvious penalties to surgeons,between being accused of being a “maverick” if you take on when patients are turned down for surgery. So when faced withcases deemed by peers to be high risk, or “risk averse” if you a high risk case, a surgeon can offer to take this case on.are seen to be more selective in offering your services. As every It will involve some amount of work to optimise the patientsurgeon has his or her own idea of what can be safely done for surgery, followed by a longer procedure due to possible anatomical or physiological challenges. Likely more input in You learn quickly when the post-operative care in both intensive care and on the to operate and you post-surgical ward. If the patient does well you as a surgeon spend the rest of your will feel the satisfaction of having taken on the challenge career learning when and getting the patient through. If something does go wrong not to operate during or after the procedure there will be colleagues who will question your ability and judgement. If the patient does not survive, the coroner will be interested in the details. And if these unexpected outcomes occur frequently, by chance, to happen together, you will be an outlier both in your institution and nationally with the consequences that comes with that situation.SCTS Bulletin 0716.indd 8 18/07/2016 12:04

July 2016 9 Joseph Zacharias Consultant Cardiothoracic Surgeon Blackpool Victoria HospitalIf when faced with a high risk case you suggest that surgery people there should be about 500 to 600 cardiac surgery casesis too risky a strategy, then your cardiology colleague may done. Of course there are many variables that can influencego ahead and offer a PCI solution on the basis that surgery this number. In countries where surgeons are incentivised perwas turned down or send the patient down the route of procedure the number, rightly or wrongly, is even higher asmedical management. There are no comebacks at the surgeon seen in America. It would be interesting to look at units thatwho made the decision. Cardiologists rarely push for second serve large populations and still do small number of cases asopinions as they are happy to provide a PCI solution even if an easy surrogate for appropriate provision of surgical services.it’s only targeted at part of the problem. The other option is to believe our cardiology colleagues who unanimously claim to seeing this behaviour increasingAvoiding Pain with each passing year. The final option is to measure the conversion of referrals made to surgical out-patients toIt has been shown in rats, that over time, the tendency is for operations performed, as this may give a crude denominator ofanimals to develop a coping strategy where pain is avoided and cases turned down. All these suggestions have in built flawsthe path of ease or pleasure is followed. The current system, that are beyond this piece, but as a group we do need to lookwhere the decision to operate can be punished more severely to find one or a combination of more than one way to definethan decisions not to, leads to a group of individuals who and measure possible risk averse behaviour.learn to work this system to their advantage. We as intelligentindividuals trapped in this system need to be aware of its To conclude, the current system in the NHS encourages a cultureeffect on us and our colleagues. I don’t believe that any of us of risk averse behaviour. We as a society need to do somethingare risk averse by nature, but we must all agree that we work urgently to protect the surgeons who take on high risk cases inwithin a system that encourages risk averse behaviour. And each institution from either ending up as outliers over time oruntil we find a system that can either measure it or test for it worse still, with burn out, with a constant barrage of high riskwe will all continue to suspect each other while not owning up referrals. If we do not act soon, a new norm will be set thatto it in our own practise. will be difficult to reverse. It may be bad for some surgeons, but it will be worse for our speciality and the people whoSo if we cannot test for risk averse behaviour, the next best pay the highest price, will be our employers the tax payers,thing is to look at activity levels based on population. It has who when in greatest need of our help, may be denied lifebeen established that generally for a population of one million extending options.bthuelletinAdvertisein the BulletinIf you would you like to advertise in the next issue of the Bulletin.Please contact Tilly Mitchell for full details and costs.Tel: +44 (0) 20 7869 6893 Fax: +44 (0) 20 7869 6890Email: [email protected] Website: www.scts.orgFull Page A4 and Half page advertising space available.SCTS Bulletin 0716.indd 9 18/07/2016 12:04

10 theBulletinUpdate on audit and outcome reportingin cardiothoracic surgeryFollowing the presentations and Over the last 3 years, SCTS has also devoting much of his professional lifediscussions at the last board of responded to membership questions to this field. Originally he chaired therepresentatives and annual business about data publication in other ways. Due database committee as a member of themeetings, I thought it would be useful to the lack of statistical discrimination SCTS executive, and then joined NICORto update colleagues about the current and perceived possibility of ‘risk-averse’ and became the NICOR clinical auditstatus of our audits and outcomes behaviour, all emergency surgery (Grant lead for adult cardiac surgery. He alsopublication. et al. Circulation; cardiovascular quality held posts at HQIP and was director ofI should start by congratulating the and outcomes. 2013;6:178-85.), surgery outcomes publication for the new COPdata managers and audit leads for adult on a ventilated patient, and more agenda. His enormous contribution tocardiac surgery on submitting unusual procedures eg pericardiectomy this field will be missed. In 2014, theall the validated data for 2012- SCTS executive reformed a new clinical audit committee15 to NICOR, for the first time It is important to realise and David Jenkins was askedwithout Ben Bridgewater’s to chair, with Doug West representing thoracic surgeryhelp and guidance. I am very that the decisions governing and David Barron congenital.pleased to announce that there the publication of outcome David Jenkins is a member ofare no alarm ‘outliers’ at unit the professional liaison group at NICOR, chaired by theor surgeon level in this audit data are not made by the BCS president, but remainscycle. It is the first time since independent to represent SCTS interests and is notoutliers have been reported SCTS executive, but by NHS paid by NICOR. I am pleasedin the public domain and is England and submission of to announce that Andrewa massive achievement for our data to the audits is not Goodwin has been recentlyour specialty. The congenital appointed to the NICOR auditheart disease audit has lead post as Ben Bridgewater’s replacement, and SCTS werealready published the 2012- voluntary.15 audit cycle in April, withno hospitals performing worsethan predicted.Doubts have been excluded from outcome involved in the selection process. David reporting in NACSA. As practices develop, Jenkins’ three year period as a SCTSWhilst I understand that some still have other procedures eg aortic debranching trustee was completed in March, but hedoubts about the value of publishing will also be examined. These important has been co-opted to continue his auditsurgeon specific data, it is important advances should reduce the concerns role on the executive as we continue toto realise that the decisions governing about high risk patients having surgery think that this ‘two person model’ hasthe publication of outcome data are denied because of risk-averse behaviour important advantages for membership.not made by the SCTS executive, butby NHS England and submission of our from surgeons. We have also updated Some have questioned why our threedata to the audits is not voluntary. For the advice on the SCTS website about audits report different outcomeunits governed by NHS Eng, consultant monitoring performance internally at measures. This is due to importantlevel publication of risk-adjusted a local level, so that changes can be differences in the case mix, risksurvival following adult cardiac surgery made before alarms are triggered at adjustment mechanisms and maturityis compulsory. In response to concerns NICOR. I would urge you all to read this of the audits. Adult cardiac surgeryfrom membership, Tim Graham wrote best practice document and use it for will continue to report in-hospital risk-to NHS Eng in 2015 and the reply was your local audit meetings: www.scts. adjusted survival at consultant and unitvery clear that Consultant Outcome org/_userfiles/pages/file/Professionals/ level, along with many other audits inPublication (COP) was not optional. Resources/Governance%20v4.pdf the COP programme. Thoracic surgeryThe letter and reply were copied to all started reporting in 2014; the individualmembers at the time. As many of you are aware, Ben outcome chosen for surgeons was the Bridgewater has changed career afterSCTS Bulletin 0716.indd 10 18/07/2016 12:04

July 2016 11 David Jenkins Chair of the audit committee SCTS executiveresection rate for the MDT for which have overtaken the adult cardiac audit in the last round were true outliers.they were core members. Unadjusted by reporting multiple measures and This important new understanding30 and 90 day mortality was reported the executive feel we need to divert reinforces our belief that alerts shouldat Unit level only. These outcomes will attention from the important but blunt not be published, but should precipitatecontinue for the 2016 report, but it is single outcome of in-hospital survival. internal review and reflection. Thelikely that in the near future individual We are aware that the data quality for NICOR/SCTS letters to outliers have beenconsultant surgeon risk-adjusted 30 and other outcome measures is less certain updated to appropriately reflect this new90-day mortality will be required to fit and untested. Therefore, NICOR have understanding of the uncertainty.with other COPs. Congenital cardiac agreed with us that we should notsurgery remains a special case because of proceed with reporting other outcome We acknowledge that the understandinga large number of different low volume measures at consultant level, but start and experience of outcome reporting isoperations, and will report risk-adjusted comparing anonymously at unit level to more developed than the structures insurvival by unit only. properly understand the ranges and data place to deal with identified outliers. variations. SCTS has contributed to improving thisDifferences anomaly with Simon Kendal and David Challenges Jenkins representing SCTS on the jointIn 2014, it became apparent that there cardiac societies group that producedwere differences in the interpretation of In response to challenges from one unit, ‘Maintaining good clinical practicesome fields in the adult cardiac surgery there was a further external review of – handling of potential consultantaudit, and this affected risk scoring. The the statistics used to identify outliers outliers’, published at: https://www.most obvious example was the ‘unstable in the audit. There have been two bcs.com/documents/7F8_Handling_of_angina’ field and this was important reviews of the statistical methodology Outliers_v_final_approved.pdf.as it contributed to the EuroSCORE in the last two years – the first bycalculation. This was subsequently Professor Nick Black and then by I think that the future will deliver morechanged and updated to take into Professor Spiegelhalter. Their findings useful data for patients, but also be faireraccount modern practice. David Jenkins were largely positive and supportive of to surgeons. Publication of outcome datachaired a specialist group in July 2015 to the methodology used by NICOR. The from individual consultants is expectedreview the dataset, modernise for current latest review by Professor Spiegelhalter to continue, but in the latest updatepractice, redefine the risk factors and resulted in a responsible report from from HQIP, COP has been renamedprovide objective guidance to improve NICOR – ‘NACSA false discovery rate ‘Clinical Outcomes Publication’, some ofthe uniformity of reporting. NICOR are analysis’, that for the first time identified you may feel that this is a further step indeveloping a user guide based on this the chance that a surgeon or unit could the right direction?work and the new definitions will be be identified as outlying, but was in factcirculated and go live for data collection performing within the chosen ‘controlin April 2017. Unlike some of the newer limits’. We now understand that becauseaudits, adult cardiac surgery only reports of the larger number of surgeons, thisone outcome measure (risk adjusted false discovery is greater for surgeonssurvival) and patients/commissioners than for units. At alarm level, assumingare demanding more information. that all actually have an acceptableLater in 2016, we will lead a group to performance, false identification wouldcritically examine potential measures be expected to occur once in 26 years forfor additional outcome reporting, as units and once in 3.5 years for surgeons.expected by HQIP and NHS England. Thus, the chance that those published asThe adult cardiac audit has been too alarm outliers in the last round were truefocussed on survival / mortality when outliers was 86% for surgeons and 98%there are so many other outcomes that for units. At alert level, it means thatare relevant to patients. Other audits only 50% of the 14 surgeons identifiedSCTS Bulletin 0716.indd 11 18/07/2016 12:04

12 theBulletinNursing & Allied Health ReportCardiothoracic Forum at from the United States, Europe and the again in Belfast and hope that throughthe SCTS Annual Meeting – UK. Once again we offered discounts on increased nursing and allied healthBirmingham March 2016 registration with one free registration participation we will have another for every five booked. successful University day.The 2016 annual meeting was heldat the International Conference The meeting in Birmingham ran over The CT Forum abstract committeeCentre, Birmingham. This gave all the entire three days in March; starting worked hard selecting the papers to beCardiothoracic Forum participants the with a Nursing and Allied Health presented during the main meeting.opportunity to network with nurses Professional stream at the SCTS Ionescu Unfortunately we only had 13 abstractsand allied health practitioners from University. Following the success of submitted this year, from advancedall aspects of cardiothoracic care, last years’ 1st Ionescu University nurse practitioners, SCP’s and theatreincluding those working in theatres and stream we again had a full practical nurses, whereas we normally receiveon cardiothoracic intensive care and day planned. The University day was about 20-30. However with a numberhigh dependency units. The 2016 forum split into a half cardiac / half thoracic of abstracts selected from surgicalfocussed on revalidation and assessed day, which enabled participants to trainees and Consultants we were ablepractice; we invited a number of guests either take part in the entire day, or to examine in-depth all aspects of carefrom the RCN to speak on different join for either the morning or afternoon related to cardiothoracic patients, andaspects in preparation for the start of session and then attend another looked at service development andrevalidation in April 2016. We also had University stream session with other improvements across the UK, European international faculty participating delegates. Kevin Austin and his team and the USA.with professionals from Nursing and from WetLabs provided us with an arrayAllied Health backgrounds attending of hearts and lungs, and it proved to In Birmingham we had a number be an exciting and educational session of fascinating plenary sessions. The for all participants. I would like to President of the RCN, Cecilia Anim, once thank all the company representatives again gave us an up-to-date nursing who worked with us, CardioSolutions, perspective within her opening remarks Covidien, Maquet and Stryker and also and Andrea Spyropoulos, the past RCN the surgical faculty that took time President, also attended. Both provided to teach the nurses, allied health some lively discussion points and food practitioners and all other participants. for thought. As already mentioned We look forward to working with you revalidation for nurses commenced in April this year. In relation to this we welcomed Anna Crossley from the RCN who gave a talk on demystifying the process of revalidation for nurses and JP Nolan who presented Advanced NursingSCTS Bulletin 0716.indd 12 18/07/2016 12:04

July 2016 13 Christina Bannister SCTS Nursing & Allied Health Professional RepresentativePractice in the UK. We Pages of the SCTS Education website: Ionescu Nursing andthank both for their insights and all http://sctsed.org. We have also created Allied Health Practitionerwere appreciative of the opportunity a short advertising film, and are going Fellowshipto ask questions on revalidation, and to send this to all units for nurses andunderstand the process more fully. AHP’s to see the exciting opportunities At the end of 2014 SCTS EducationPersonally, I came away from the they can gain from attending the annual advertised the opportunity for twopresentation a great deal wiser and meeting. Once this film is circulated Ionescu Nursing and Allied Healthhave been able to start my revalidation please send it on to all within your Practitioner Fellowships worth £2,500.portfolio based on the NMC downloads. units to view, and encourage nurses and Following interviews in Manchester theJill Ley, Clinical Nurse Specialist from AHP to participate. Ionescu Fellowships were awarded toSan Francisco, followed these two Emma Hope and Daisy Sandeman.fascinating presentations with an Each CT Forum we have held hasAmerican perspective, focussing on been a big success. We have gained Emma has gained insight into theRevalidation Practices in the US. All a network of core nurses and allied Aortic Aneurysm pathway and isthree then took questions from the floor health professionals across the country working towards creating an Aorticand answered any concerns the nursing that have in interest in progressing Nurse Specialist role for the servicecommunity had. training, development and service at Southampton General, through her provision with cardiothoracic surgery, planned visits to Liverpool Heart andJill stayed for the entirety of the from a wide range of backgrounds; Chest Hospital and the Queen Elizabethmeeting and participated in the Ionescu from nurses, medical staff, surgical II Hospital in Birmingham. Daisy isUniversity day; we all able to chat to care practitioners, physiotherapists, completing herJill and discussed global nursing and physician assistants and other alliedallied health issues with her, especially health professionals across the country. focussing on delirium in cardiacfrom an American perspective. I would like to take this opportunity to surgery; she visited John Hopkins thank all the plenary speakers, chairs, Institute in Washington, USA whereAt this years’ CT Forum meeting we presenters and participants without they have specialist teams and unitsfilmed all presentations which are now whom the CT Forum could not exist. Not dealing with post-operative delirium.available to view on the nurses & AHP Daisy is creating a risk assessment only do we all learn from others at the model which could be used in all Forum but the networking and shared centres in the UK and Ireland based on working practice information that we the knowledge she has gained. Both all get is invaluable. However this Fellows presented their experiences is only possible with the continued within the CT Forum plenary session participation from all cardiothoracic at the annual meeting in Birmingham. nurses and allied health professionals, They also are planning on sharing their so we encourage you all to spread the experiences by writing a paper for the details of the conference, especially SCTS website and Bulletin. the Ionescu University Day and to seek support from your managers and The 2016 Ionescu Nursing and Allied medical colleagues to attend. Health Practitioner Fellowship was advertised, but unfortunately no applications were submitted. The Fellowship is an excellent opportunity for nurses and allied health practitioners to expand their practice, and develop not only their role but that of the service they work within. I would like to personally thank Mr Ionescu for his support in creating these Fellowships for the nurses and allied health professionals, and will feedback the results of the 2015 visits. continued on next pageSCTS Bulletin 0716.indd 13 18/07/2016 12:04

14 theBulletinNursing & Allied Health Report continuedFurther details from the Ionescu Fellows can be found in their nurses across the UK on both courses, feedback has beenBulletin Articles. positive and the course reviewed after each session to make enhancements. We are planning further courses later in theAdvanced Cardiothoracic Course year in London and the South of England.This year’s Advanced Cardiothoracic Course was held at Further details from the above courses can be found in TaraSolihull Hospital in Birmingham during October 2015. Bartley’s Nursing and Allied Health Practitioner EducationOnce again this was a highly successful course and over 30 Sub-Committee Bulletin Article.participants took part in the interactive teaching sessionsand wetlabs over the two days of the course. Feedback from SCTS / St Jude Medical Surgical Anatomythe course was excellent and we would like to thank WetLabs Courseand all the other companies and faculty that participated. Wewould also like to thank Cardiosolutions for their sponsorship On the 14th and 15th July 2016, we are commencing aof the event, and look forward to working with them again in joint venture with St Jude Medical and SCTS. We have thethe future. first theatre nurses’ surgical anatomy course at the St Jude Medical Head Office in Stratford. The objectives of theDeveloping an Advanced Allied Health course are to improve anatomical understanding of cardiacProfessional Practitioner Service Course structures, to acquire the skills and knowledge to assist in cardiac theatres and to increase knowledge to be able to helpDue to the changes in cardiothoracic workforce in the UK and support the physicians during the procedures.related to the EWTD and issues in recruitment of the juniordoctor workforce, a course was put together to examine the Details of the course are on the SCTS website and I lookrole of nurses and allied health practitioners in new ways of forward to providing feedback within the next SCTS Bulletin.working. The first course was held in December 2015 at the Our thanks go to St Jude Medical for their support with theRoyal College of Surgeons of Edinburgh in Birmingham, and course, and the entire surgical faculty who have given upAdvanced Nurse Specialists across the UK presented their their time to participate.experiences of setting up their services. The feedback wasvery positive, and we ran the same course again in early Surgical Care Practitioner UpdateOctober 2015, at St Thomas’ Hospital in London. We hada number of delegates from across the UK participating in Consultations with the Surgical Care Practitioners remainpresentations from centres with established advanced AHP ongoing, currently there are many streams of workservices, and we hope they returned to their units with fresh progressing.ideas of new ways of working, and also a new network ofcolleagues keen to share ideas and service developments. We Throughout 2016 there have been a number of Master Classeslook forward to continuing this course in 2016 and will post in Cardiothoracic Surgery held at the Manchester Surgicaldetails of the next course on the SCTS Nursing & AHP pages Simulation Centre, Manchester in collaboration with SCTSof the website. Education and Ethicon. All courses were well attended and feedback was excellent. We would like to thank the surgicalBand 5/6 Nursing Competencies and faculty and all the clinical international trainers from Maquet,‘Train the Trainers Course’ Sorin, Terumo, Sonasite and Karl Storz for their participation in these courses, and we also thank Ethicon for sponsoringFollowing feedback from ward nurses at the annual meeting the courses.in Edinburgh, the Nursing & AHP Education Sub-Committeemembers have created a Cardiothoracic Nursing Clinical Following consultations with the Royal College of Surgeons ofDevelopment Course ‘Core Principles of Cardiothoracic Edinburgh, the SCP exam was held in December at the RCS,Surgery and Care of the Patient following Surgery.’ This Edinburgh in Birmingham. There was a revision course heldcourse is aimed at Band 5/6 nurses and a framework of prior to the exam in September in the CTCCU seminar room,core competencies for ward based nurses that will underpin Wythenshawe Hospital, Manchester; details again on both thea 1-4 day programme have been created. The course is SCTS and ACSA websites. Work remains ongoing to update thecomposed of small group teachings and wetlab practical SCP course for the exam, with a rigorous QA process beingsessions that utilise the resources of formal lectures and developed. Thanks go to the RCS, Edinburgh for all their help,content provided by the SCTS. The aim is to create a national support and backing for this process. A ‘silver scalpel’ awardworkforce of nurses with appropriate knowledge to care for for the best candidate was again donated by Swann Morton,the cardiothoracic patient and to act as a benchmarking and was awarded to Carly Mills at the annual meeting dinner.assessment tool across the UK and Ireland. During 2016 wehave already run two courses, the 1st in Manchester and the CTSNet Allied Health Portal2nd in Glasgow. We have had excellent participation from The Allied Health Portal is now live on the portal section of CTSNet. This has been created by nurses, perfusionists,SCTS Bulletin 0716.indd 14 18/07/2016 12:04

July 2016 15physicians assistants and allied health practitioners from the SSI NetworkUS, UK and Europe. Throughout 2015 we have been havingregular meetings to establish the allied health pages with The Cardiac SSI (Surgical Site Infection) Network aims toclinical practice protocols, meeting presentations, published share best practices to reduce the incidence of SSI, as wellpapers, educational videos and an online discussion forum for as to share cardiac surveillance methodologies. This is alsoallied health professionals within the CTSNet site. These are a forum to collectively review new research and nationalnow available for all to view and we encourage all nurses and initiatives as to reduce the incidence of surgical siteallied health practitioners to log on and use the information infections. We have been able to discuss from a nationalon the site. For any nurses or allied health practitioners perspective issues around wound surveillance and surgicalthat would like to provide good clinical protocols, journal site infections, and have linked with the National Cardiacarticles or options for videos please contact me on Benchmarking Collaborative (NCBC) to create [email protected] definitions and data collection. This network is a fantastic forum for all units to work together to reduce the incidenceEACTS of surgical site infections. Presentations about current research have been presented in both the CT Forum at theThe postgraduate Nurses and SCTS annual meeting, at the postgraduate nurses and AHP dayAllied Health Practitioner day in EACTS, as well as within national cardiac conferences heldat EACTS is currently being in the UK. Work is ongoing to commence a number of multi-planned by nurses and allied centre studies.health professionals fromthe UK, the Netherlands, If you are a healthcare professional with an interestand Denmark. The 2016 in SSI surveillance in cardiac surgery we would bepostgraduate day is planned delighted to hear from you. Please either contact myselffor Sunday October 2nd 2016 at [email protected] or connect to the SSIin the Centre Convencions Internacional de Barcelona (CCIB), Network to join theBarcelona. group at https://www. networks.nhs.uk/nhs-The SCTS CT Forum top marking presentations are invited to networks/ssi-cardiac-present at this meeting, and we are also planning plenary networktalks from Specialist Nurses and Allied Health Practitionersfrom across Europe. We look forward to sharing knowledge Bupa/SCTS Patient Information Websiteand experiences with other nurses and health care Portalprofessionals from across Europe during the day. The patient information pages for Aortic Valve surgeryOnce again, the presentations will be peer reviewed and are now published on the SCTS and Bupa websites. TheseEACTS will provide an award for the best presentation. pages have both written information and videos fromThe 2015 award was given to Brenda Andrews, a Nurse patients, surgeons and nurses detaining pre and post surgeryCase Manager in Thoracic Surgery at Southampton General information, and experience undergoing surgery. We haveHospital, for her fascinating talk on the Nurse Case Manager created a central repository of Quality Assured informationand Advanced Nurse Practitioner role in Thoracic surgery at which provides accurate information regarding cardiac surgerySouthampton General Hospital. We hope to match this in for both patients and their relatives; and also provides a2016 and keep the award in the UK. Our thanks go to EACTS resource for nurses and allied health practitioners workingfor their continued support. with cardiac patients.The EACTS Quality Improvement Programme (QUIP) We are planning to expand this information to other areasprogramme still continues – looking in-depth at quality of cardiac surgery, and wish to create some aortic surgerystandards across Europe with the concept to bring together information. If any nurse or allied health practitioner wouldcommon aspects and setting a benchmark for establishing like to get involved in the project or has specific patientquality improvement. This involves a review of current nursing information they would like to share please contact me onquality outcomes; the implementation of a quality pathway [email protected] patients, and a review of outcome measures, examiningestablished protocols and practice guidelines. SCTS Nursing & Allied Health Professional Working GroupFor any nurses and allied health professionals that would beprepared to share good practice with our colleagues around At the end of the SCTS Annual Meeting in Belfast, MarchEurope and get involved with the QUIP programme please 2017, I will be standing down as Nursing & Allied Healthcontact Tara Bartley, Lead Nurse for QUIP at [email protected] Bulletin 0716.indd 15 18/07/2016 12:04

16 theBulletinNursing & Allied Health Report continuedProfessional Representative. After five College of Nursing. The Colleges useful links. Please continue to checkyears within the role I am going to aims were to champion a consistent these pages for up to date courses andfocus on enhancing patient involvement curriculum for nursing education, a information. If you have any courses towithin the society and improving the standard examination, and a register of be advertised please contact me on thecardiothoracic surgical information they qualified nurses. Over the past 100 years email addresses below. Please also linkreceive. I will miss organising the CT the RCN has expanded exponentially, to the SCTS Education website, againForum and meeting all the participants and has made many changes to nurses on the Nursing & AHP page for furtherfrom across the UK, Ireland, Europe and working lives and for those, the patients information.the US. they care for. Throughout 2016, the RCN is celebrating its centenary with The SCTS CT Forum Facebook and TwitterAt the 2016 meeting in Birmingham many events across the UK, one event pages continue. The CT Forum is for allwe held the interviews for the new for each year of the RCN’s history, and nurses and allied health professionalslead, and were greatly impressed by we urge all nurses to be involved in the to belong to and I encourage youthe applicants knowledge, passion and celebrations. all to sign up to these pages andcommitment not only to cardiothoracic help us to communicate between allcare but to the expansion of the CT These events are going to culminate in health care professionals working inForum, and education of nurses and an International Centenary Conference the field of cardiothoracics, whetherallied health professionals throughout on the 22-23rd November at the QE11 it be in outpatient departments,the UK and Ireland. Following Centre in London. The conference aims wards, intensive care, theatres or thediscussions with the surgical leads for to reflect on nursing developments, community. We would like as manythe SCTS we have decided to create a and look towards the challenges and nurses and allied health professionals toNursing and Allied Health Professional opportunities faced by the profession. join, to show that cardiothoracic healthworking group to promote Nursing and The five core themes cover a broad professionals have a voice and wantAHP working within all aspects of the scope of topics, from technology and to work together to improve the carespeciality. This shows the commitment innovation to society, communities and provided for all patients.of the surgeons to work collaboratively relationships. Keynote speakers includeand each sub-committee within the Maureen Bisognano, President Emerita The links for the pages are as follows,society now has a nurse or allied health and Senior Fellow at the Institute for please pass these details on to as manyprofessional connected. From March Healthcare Improvement; Dr Phumzile nurses and allied health professionals2017, when I step down this group Mlambo-Ngcuka, United Nations Under- that you all know and encouragewill be led by Helen Munday, Trust Secretary-General and Executive Director everyone to participate.Matron at Papworth, and I’m sure she of UN Women who will talk about thewill continue to do a fantastic job, and role nursing staff can play in promoting Follow us at Twitter - @SCTS_CTForumcontinue the integration of nurses and opportunities for women; and DrAHP’s within cardiothoracic surgery. Jim Campbell, Director of the Health Join the Facebook Group - SCTS CTCongratulations go to Helen Munday Workforce Department at the World Forum(Papworth), Bhuvana Krishnamoorthy Health Organization, who will share his(UHSM), Amanda Walthew (LHCH), vision of the future nursing workforce. If any of your colleagues would like toHeather Wyman (Harefield), Julie become an associate member of theQuigley (Papworth), Julie Sanders We encourage all nurses to join in these Society or would like to add their names(Barts Health) and Melissa Rochon events and 100yr celebrations. Please to the SCTS Allied Health Professionals(Royal Brompton). Tara Bartley and I link to the RCN website for details of all database so they can receive the emailslook forward to working with them all the events and also for the Congress in that are sent out, then please forwardthroughout the coming year and with Liverpool in May 2017. their name, address and title to mefuture endeavours. at [email protected] SCTS CT Forum Contacts or [email protected] orNational Nursing & Allied direct to Tilly Mitchell at [email protected] Developments The SCTS Website – the Nursing and Allied Health Professionals page, has Chrissie BannisterThis year the Royal College of Nursing a home page, meetings pages andcelebrates its centenary. In 1916 Dame Nursing & Allied Health ProfessionalSarah Swift, Matron-in-Chief of the RepresentativeBritish Red Cross, was supported bySir Arthur Stanley MP and matrons ofseveral leading hospitals to found aSCTS Bulletin 0716.indd 16 18/07/2016 12:04

July 2016 17SCTS HISTORIAN Philip KayThe Development of Closed Heart Surgery(ATale Of Two Presidents)My first article chronicled the September 1947 Brock invited him to Such research was already underway. Bigelowdevelopment of closed mitral valvotomy demonstrate the operation at Guys Hospital. in Toronto carried out the basic experimentswith Russell Brock (Guys) and Oswald on hypothermia showing that a reduction inTubbs (St Barts) building on the The pioneering work of Gross, Crafoord body temperature to 30 degrees Centigradepioneering work of Sir Henry Souttar. and Blalock lead to further approaches on prolonged the safe period of cerebral anoxia intracardiac pathology. O’Shaugnessy, in the from three to ten minutes. This was timeIt is interesting to note that though they text of a Hunterian Lecture, was the first to enough for repair of simple intracardiacalso both worked at the Brompton Hospital suggest that congenital pulmonary stenosis defects such as ASD closure and aortic andthey had a largely different surgical could be corrected by a valvotome inserted pulmonary valvotomies. In Denver Henryapproach to mitral stenosis. Brock, in a through an incision in the right ventricle. Swan used an ice bath for total immersionreport of 100 cases, used a valvotome Sadly he died during the evacuation of the of the patient. Holmes Sellors was one ofin only 22 patients, preferring his index British Army from Dunkirk before he could the first to adopt this method in the UK andfinger via the trans-atrial route. Tubbs was deliver the Lecture. Sir Thomas Holmes reported a series of over 200 cases of ASDgreatly influenced by a visit to Edinburgh Sellors was the first to apply this technique closure in 1960.where Andrew Logan used a dilator inserted on a 20 year old man with Fallots Tetralogy. Though successful the hypothermic baththrough the left ventricle. In the five years The operation was performed on 4 December technique was cumbersome and messy andafter 1954 Logan used this method in 82% 1947 at the Middlesex Hospital. His report the rewarming process slow. The ultimateof 537 cases. was published on 26 June 1948. goal was a still and bloodless field with no time limit. This required a device to takeThe late 30’s to the early 50’s were On 12 June 1948 Brock reported three over the essential function of the heart andinnovative times for other developments in successful pulmonary valvotomies performed lungs.cardiac surgery, and again Britain remained through the right ventricle, the first in This was indeed a golden era of Cardiacin the forefront. On 26 August 1938 Robert February 1948. Brock was to develop this Surgery in the UK. It was the tale of twoGross performed the first successful ligation technique using graded valvotomes, sleeve Presidents of The Royal College of Surgeonsof a Patent Ductus Arteriosus at the Boston punch forceps and expanding dilators of England; Lord Russell Brock who servedChidren’s Hospital. A year later Os Tubbs in patients with Fallots Tetralogy. This between 1963 and 1966 and Sir Thomasclaimed fame by performing the first ligation approach was considered superior to the Holmes Sellors from 1969 to 1972.of an infected ductus successfully treating Blalock procedure as it lead to betterthe sepsis. development of the often hypoplastic The day must surely pulmonary vasculature. The combined come when directDwight Harken, who had worked as a RSO procedure of pulmonary valvotomy and operations on theat the Brompton Hospital under Tudor infundibular resection became known as substance andEdwards, was recalled to the United States the Brock procedure and enjoyed some structure of theshortly after the declaration of War. He popularity until it was superceded by one heart will be asreturned to the UK in 1944 to be in charge stage total correction. firmly establishedof the American Surgical Chest Centre with and successfullythe 160th General Hospital of the US Army Thus it is clear that interpersonal and conducted as those onin Cirencester. There he carried out 134 interhospital rivalry in London is not a new the lungs and brain.operations for the removal of foreign bodies phenomenon. In the “race” to publicationof which 56 were within or directly related Holmes Sellors (Uncle Tom) was gracious in Russell Brock. 1948to the heart. The remarkable feature of this his article adding that Brock’s paper wasseries was that there were no deaths. admirable and dealt with the subject more thoroughly. Indeed Brock’s introductionThe 1940’s became a time when great was inspirational; “The day must surelysurgeons visited the UK to demonstrate their come when direct operations on theskills. On 19 October 1944 Clarence Crafoord substance and structure of the heart willperformed the first resection of a coarctation be as firmly established and successfullywith end to end anastomosis in Stockholm. conducted as those on the lungs and brain.Sir Clement Price Thomas arranged for We must attack the problem and begin thehim to demonstrate this operation at the development of a technique for intracardiacWestminster Hospital in 1946. operations, for unless begun the task can never proceed.” It was clear that directOn 29 October 1944 Alfred Blalock working vision of the intracardiac structures wouldat the Johns Hopkins Hospital in Baltimore be required.performed the first subclavian to pulmonaryartery anastomosis (Blalock-Taussig shunt)on a patient with Fallots Tetralogy. InSCTS Bulletin 0716.indd 17 18/07/2016 12:04

18 theBulletinPresidential AddressSCTS Annual General MeetingBirmingham, 14 March 2016“Whither Cardiothoracic Surgery In 2016?”Over a year ago on 50th anniversary Attlee. Imagine how disappointed and life and career be considered from theof his death I was given a present of let down Churchill must have felt at perspective of the Society in ordera series of books regarding Winston that time by the people he had led and to continue and maintain its futureChurchill. In seeking inspiration and supported. success? We can reflect on what hassimiles for the Presidential Address been achieved in the past 4 years.I was able to find an abundance in He remained an untiring Leader of thethe life of the man previously polled Opposition. In 1951, aged 77, he became We should have confidence in the nextas the greatest British person of all Prime Minister again, resigning in 1955 generation of surgeons and the surgicaltime – Sir Winston Leonard Spencer due to ill health. He died in 1965 at team; the education of this generationChurchill. the age of 91 and received a full state and all members of society; the potential funeral with honours. for innovation and the direction ofHe was born in 1874 at Blenheim Palace. travel of our clinical audits. We shouldFollowing an undistinguished school He had a most remarkable life with continue with the on-going beneficialcareer at Harrow, he went to military great professional highs and great lows. joint working with the SAC.school at Sandhurst and then saw active He knew both failure and success andservice in India and the Sudan. As a created admirers, friends and many The Next Generationnewspaper correspondent in the Boer enemies along the way. He had otherWar he was captured as a Prisoner of great qualities. He was an innovator, Considering the next generation – howWar. He became a Conservative MP in largely responsible for the invention of many surgeons of my vintage would have1900; becoming Home Secretary in 1910 the tank. He was an excellent painter achieved the A-level success that is nowand then First Lord of the Admiralty. In and a great writer, winning the Nobel required to get into medical school?1915 he was dismissed from this post Prize for Literature – famously saying These are the brightest and potentiallyfollowing the failures of the Gallipoli “History will be kind to me for I will write most motivated young people. Wecampaign and he then went to France to it”. He also experienced great personal were the first specialty to introducetake command of an infantry battalion tragedy with the death of a young child national selection in 2008. Followingon the Western Front. In 1924 he then and he had a dysfunctional family and he the initial bulge of ST3 applicationsserved as Chancellor of the Exchequer battled with ill health as he grew older. following reduced recruitment from 2003for five years. He then went into his – 2007, there has continued a ratio of“wilderness” years in the 1930s (during Many of these themes of success and applications to appointments of aroundwhat should have been his productive failure are familiar to all surgeons during 6:1. The number of posts has been50s) without office in government. their professional and personal lives. reduced since 2013 as ST1 selection wasFrom the back benches he warned of the Churchill had major qualities which introduced and there continues to bedangers of Germany and war. After a vote characterised his greatness – a positive an 8:1 ratio of applicants to appointeesof no confidence in the administration and combative attitude which clearly and the impression from the SAC is thatChurchill became Prime Minister, forming made a big difference. He had confidence these are a strong good group of traineesa coalition government. that his course of actions were right. – despite recruitment across the board in But to my mind a great quality was all surgical specialties declining for non-Then followed Churchill’s great leadership perseverance in purpose of action in specialty specific reasons.and statesmanship to maintain inter- spite of great difficulties and his greatestallied co-operation with America and strength was that of resilience – to So with good seeds we need to considerRussia and defeat the AXIS powers. adapt to both the considerable stresses the soil into which they are placedIronically he was not to share the final and adversities that he encountered – as so that they can flourish and grow.triumph of WW2 as Prime Minister as he famously said “When you are in hell, Previously training has been with a largein the General Election of July 1945, keep going”. case load exposure with non-structuredtwo months after Germany’s surrender, training; little feedback; and often self-the war-weary British people voted the How might these qualities of confidence, taught – a sink or swim approach. NowLabour Party into power under Clement perseverance and resilience which so with improved selection there is the defined Winston Churchill’s successfulSCTS Bulletin 0716.indd 18 18/07/2016 12:04

July 2016 19 T R Grahamdevelopment of core talents, there is his legacy – the annual funding of harmonised with the emphasis onstructured training with feedback with the Ionescu SCTS University at the survival not mortality. The congenitalISCP education and training processes Annual General Meeting which is set audit is possibly the strongest clinicaland in early consultant practice there to continue in perpetuity; consultant audit in the world and the thoracicis support and development. SCTS in clinical fellowships and recently the audit is now progressing at a pace.partnership with the SAC is contributing facilitation of the appointment of an We have been able to achieve furtherstrongly with bespoke courses and education administrator. Mr Ionescu understanding and clarity with review ofsubspecialty fellowships. The workforce has transformed SCTS’s ability to deliver the statistical methodology in the adultplanning we have undertaken is now education to the surgical team now and cardiac surgery audit and we hope to beregarded as reasonably accurate. in the future. able to remove the outlier control lines on plots for individual surgeons in theThe next generation of consultants are Innovation public domain. Our relationship with theand will be different – working in a other audit agencies have improved anddifferent environment. Matching the Innovation is challenging within the we are having increasing influence ontwo is the challenge with a key factor NHS environment and has recently policy. We have worked to improve thebeing the support for new consultants been a theme of the STS meeting in definition of risk factors and there iswith professional development courses; January where the qualities required for going to be a period of stable analysismentorship; fellowship; good governance innovators were considered. We have from year to year. We are developing awith the introduction of new techniques many individuals, particularly more staged approach to other useful outcomeand better team structure and dynamics. recently appointed consultants and measures and there are future projectsWith regards to education this has been current trainees who have these qualities such as a new “blue book” of 15 years oftransformed over the past 4 years. The in abundance. We anticipate this will UK Adult Cardiac Surgery planned withSCTS Education Committee has developed be led by the recently commissioned NICOR.a strong vision and delivered quality Research Committee. The Society aim toeducation across all the specialty. Of bring together these bright individuals The next area for SCTS to consider isparticular note has been the development and industry to have a positive impact resilience which is the ability to adaptof curriculum aligned courses for NTNs on the development of innovation and to stress and adversity. Cardiothoracicwith an industrial partnership potentially have taken this forward with a recentin excess of £1 million investment – showcase event at the Annual Generalthe envy of surgery in the UK and our Meeting in Birmingham.specialty internationally. There hasbeen continuation of the coveted NTN Audit Confidencefellowships towards the end of surgicaltraining and also the development of We should have increasing confidencenon NTN education. The Society has regarding our clinical audits due toalso benefited considerably from the the perseverance of the SCTS Executivephilanthropy of Mr Marion Ionescu and more recently in particular Davidwith whom the Education Committee Jenkins and Doug West. All the threeand the Meetings Team have developed clinical audits are becoming increasinglyThe Board of Representatives’ meeting in December 2015focussed on wider professional issues and behaviours - 15% ofthe potential workforce has either been dismissed or suspended.The take home message was that, even though externaldata could not confirm that there was more of a problem incardiothoracic surgery than in the other specialities, we needed agood look in the mirror.SCTS Bulletin 0716.indd 19 18/07/2016 12:04

20 theBulletinPresidential Address 2016 continuedsurgeons need to have this, both in appointment of a potentially important There are now courses being developedtheir personal and their professional funded post in cardiothoracic surgery and run for managing doctors inlives. In our personal lives we will know for this project in the near future. The difficulty and difficult doctors which is agreat periods of personal stress such other area for a need for resilience is to clear barometer for this issue. Consultantas bereavement, divorce and illness maintain the training environment. The dismissals and suspensions occur andand other personal difficulties. We are junior doctors’ (which I believe is an the impression has been in our specialtya self-selected group of doctors – high inappropriate term) dispute has caused that these have been increasing. Why isachievers who also need to deal with this and what evidence is there that thisdeath and complications in the patients Stress in the NHS is the case?that we treat and operate on. The need environment is clearly afor this resilience has recently been major factor and there National Clinical Assessmentbrought into focus, both for myself appears to be a disconnect Serviceand the hospital within which I work between the externalfollowing a CQC visit related to unit and agencies’ data and activity The National Clinical Assessment Serviceindividual outcomes released by HQIP and our experience within is a body whose purpose is to achieveon data up to March 2014 and then the the specialty. the resolution of concerns aboutsubsequent interactions between the professional practice. They are theTrust and the CQC and the media. conflict between the government and the body to whom trusts report and refer medical profession and has the potential individual consultants. There are overReslience to impact on the future of the NHS. The 7000 consultant surgeons in England and junior doctors and their training should Wales of which cardiothoracic surgeryAs a professional society SCTS needs be supported at this time as they are over the past 5 years has made up 4%. Into demonstrate resilience together in the future of the specialty and of future the 6 year period from 2009 to 2015 thereseveral areas with its members. The patient care and also rather selfishly were 42 referrals to NCAS in relation toNHS is complex and currently in a because the consultants and then all the cardiothoracic surgical consultants. Asdegree of crisis. Hospital budgets are other sectors of the health service will be a percentage of all the referrals for thein deficit of over £2 billion, targets for next in the spotlight. This consideration whole of surgery, cardiothoracic surgeryhealthcare are being missed and there of the training environment in the made up 4% of the NCAS referrals, ais a major unresolved doctors’ dispute. specialty of cardiothoracic surgery proportion apparently in keeping withThe Department of Health may fail however is not unique to the UK with the number of cardiothoracic surgeons.to balance the budget with possible the prevalence of depression amongst The Professional Standards Departmentconsequences for our political leaders. residents and interns worldwide being of the Royal College of Surgeons ofDonald Berwick from the Institute for reported at around 30% by the AATS – a England has developed an invitedHealth Care Improvement has recently concerning figure. There are challenges external review mechanism which trustsundertaken an “Improving Quality in for our trainees and as a consequence can use to obtain external opinionthe NHS in England Review” and his the future of the specialty which are advice on their services. 20 reviews haveearly conclusions were that the NHS is well known but need to be faced up to. taken place in cardiothoracic surgerya highly conflicted environment with These include the publication of surgeon since 2008. These numbers from thea demoralised workforce not likely to specific data; adequate operating external agencies do not seem to fit withreach its capabilities and he questioned experience; maintaining a satisfactory the incidence of issues being discussedthe ability of the NHS to continue to work/life balance and the development by the wider membership. In view ofsurvive in its current form on funding of of subspecialist practice and the ability this, as President I undertook a ratheronly 7% of the GDP. There may be some to innovate within the NHS. crude survey of cardiothoracic surgeonsrespite in that the Department of Health who have been in difficulty sinceare funding a clinically led Quality and The NHS is generally accepted to be 2009. There is no mandatory reportingEfficiency programme to support the becoming an increasingly difficult mechanism available for this and it isdelivery of the “NHS 5 Year Forward environment for doctors to work in. a very sensitive area. The methodologyReview” which has been proposed to of this survey could be criticised. Itimprove efficiency and to contribute to has been through a series of personalclosing the budget deficit gap in each conversations and discussions held atspecialty. SCTS are contributing to the meetings, in restaurants and bars andSCTS Bulletin 0716.indd 20 18/07/2016 12:04

July 2016 21SCTS 80th Annual Meeting13-15 MARCH 2016BIRMINGHAMover the telephone – but to the best Royal College of Surgeons of England Currently the strapline for SCTS is as theof my knowledge I have been able to Professional Standards Group and 360o Society for Cardiothoracic Surgery intriangulate this information. There feedback providers. You may not consider Great Britain and Ireland. I was recentlyhave been 10 consultant cardiothoracic that this direction of travel is appropriate impressed at the STS meeting when itsurgeons dismissed and over 55 have for the Society, however it is worth was clear to me that their mission wasbeen suspended, had restriction of reflecting on examples of unprofessional to enhance the ability of their memberspractice, taken early retirement or felt behaviour that we may all be guilty – cardiothoracic surgeons – to providethe need to emigrate to another post of and that we may have observed in the highest quality patient care throughdue to issues in the UK. Over 85% of our colleagues such as criticising and education, research and advocacy.these dismissals and suspensions were in undermining colleagues; inappropriate Although these are the same core valuesadult cardiac surgery. From 2009 to 2015 interactions with the media and use as SCTS, to me this represented a movethere were a possible 400 cardiothoracic of social media; providing inaccurate towards acknowledging the STS as asurgeons workforce in the UK and 65 out professional references, holding personal membership organisation principallyof this possible 400 – that is 15% of the conversations in front of patients; funded by membership subscriptions andpotential workforce – has either been making disparaging comments about possibly SCTS should consider returningdismissed or suspended. There has been patients, relatives or staff on the ward more towards this ethos.a variety of reasons for this but surgical rounds; or even being rude to a manager!outcomes and the publication of surgical Conclusionoutcome data has been specifically I would like to sign off with two finalcited in less than 20% of cases. Other thoughts. The question I have been asked SCTS and its members should be confidentreasons have been cited in more than on several occasions is what are the and see the opportunity in the difficulties80%. Stress in the NHS environment is benefits of membership of SCTS and what of our specialty and environment. Thereclearly a major factor and there appears do members get for the membership fee. will always be patients who require ourto be a disconnect between the external I could talk about the Annual General care and consideration. SCTS and itsagencies’ data and activity and our Meeting, the Universities, the excellent members should also persevere and beexperience within the specialty. educational package and developing resilient to keep a sense of purpose and website and even the expenses and not be distracted by the difficulties thatReview and reflection sandwiches at the BORS meetings! will inevitably be encountered, both However I would like you to consider professionally and personally.In view of this the Board of this in a different light. SCTS reallyRepresentatives meeting in December provides the only concerted voice in our It has been a privilege to be the2015 focussed on wider professional specialty for advocacy and lobbying on President-Elect and then President of theissues and behaviours. There was a series cardiothoracic surgical issues in the UK Society for the last 4 years. Thank you toof presentations and the take home and Ireland. To paraphrase President the membership for electing me. It hasmessage was that even though external Kennedy – ask not what the SCTS can been interesting times. I am confidentdata could not confirm that this was more do for you but what you can do for the that I am leaving the Society now inof a problem in cardiothoracic surgery SCTS – this is your specialty and your the capable hands of Graham Cooperthan in the other specialities, that the society and your patients. We have an and subsequently the recently appointedspecialty needed to look in the mirror. excellent example of this in that we President-Elect Richard Page, both ofWith this in mind SCTS are developing now have over 130 consultant surgeons whom have Yorkshire connections. Gooda strategy considering professional who are education faculty members. fortune to them both and to SCTS in thebehaviour and one of the first parts of this Please continue this engagement and future – and “wither” not cardiothoracichas been to commission a Professional involvement. surgery.Standards Committee. During the comingyear SCTS plan to further engage with T R Grahamexternal agencies including “Actionagainst Medical Accidents”; NCAS; the 22 March 2016SCTS Bulletin 0716.indd 21 18/07/2016 12:04

22 theBulletinMedical Student Engagement– what do the students think?ENGAGING WITH MEDICAL STUDENTS and trainees is vital on a cardiology placement to observe in theatre, or gettingif we are to ensure we recruit the best young doctors into involved in medical school surgical society events. It iscardiothoracic surgery. This has been recognised by the SCTS often these chance encounters that can lead to a student’sEducation committee and Aman Coonar has been leading on interest being sparked or confirmed. We are all potential rolethis agenda. Much progress has been made over the last models and a few words of encouragement (as well as helpfew years in this area, including an Annual Cardiothoracic with practical information and guidance) can go a long way,Careers Day (in collaboration with the RSM), bursaries for not to mention being rewarding.specific cardiothoracic placements and the formation of anetwork of medical students who share and disseminate In order to gauge how the above strategies are beinginformation (including a facebook page). One area that I perceived, I asked two medical students who are aspiringfeel must not be neglected is interaction at a local level cardiothoracic surgeons to share their thoughts on theirwith medical students. Whilst Cardiothoracic Surgery is not experiences of cardiothoracic surgery to date. Nicole Asemotaspecifically on many undergraduate curricula, we are all able is a 4th year medical student at Nottingham and Jeesoo Choito make small inroads such as inviting a student who may be is a third year student in London. I met them both at the SCTS annual meeting in March.Nicole Asemota Cardiothoracic Surgery is one of those specialties where every operation can genuinely add tens of years to someone’s lifeAlthough only in fourth year, I already know that I want to and I would be honoured to be able to give that gift tospecialise in cardiothoracic surgery. Being the practical type, I someone in a few years time.always knew I wanted to do surgery. So, combined with greatinterest in logical, yet mind-blowing physiology and anatomy Jeesoo Choiof the heart and lungs, cardiothoracic surgery seemed perfect. I first became interested in cardiothoracic surgery during theCardiac and thoracic surgery are two distinct fields, and within cardiothoracic rotation in my third year at medical school,each, there are a variety of different operations - this excites where I was taught by Mr Michael Sabetai (Consultant Cardiacme. Further sub-specialising means, you can operate on the Surgeon). It was the first time I was in theatre observing himchildren as a specialist paediatric surgeon, or perform rare perform a coronary artery bypass when I realised how muchheart and lung transplants as a specialist transplant surgeon. of a privilege it is to open your patient’s chest, and be ableYou can be the ‘go-to’ person on mitral valves or involved to hold and fix their heart. I have continued to work within developing minimally invasive surgery. The opportunities Mr Sabetai, who has both taught me an immense amount inare endless, and as the fields develop further, I foresee many theatre and has kindly mentored me.more sub-specialties becoming available. Our study on patient awareness of surgeon-specific andHaving decided early, I am using my time at medical school hospital-specific mortality data, conducted at St Thomas’to get exposure to the field. I’ve held a beating heart, I’ve Hospital, was accepted for presentation at multiple nationalhelped remove a very large cyst in the thorax, and I’ve watched and international conferences this year, including the SCTSthe repair of a large thoracic aortic aneurysm. I’ve met some Annual Meeting and the Association of Surgeons in Trainingamazing surgeons, who have each encouraged me further into conference. These have been incredible opportunities thatthe field. I made my final decision when I spent 4 weeks have opened my eyes to the wider surgical world. As wellwith some great cardiac and thoracic surgeons at Nottingham as really enjoying the chance to present our study, thereCity Hospital where I assisted in many operations. Active have been several inspiring speakers, interesting studiesparticipation has helped me to understand and get a greater and opportunities to network with cardiothoracic traineesdesire to be part of this specialty. and consultants. It has also been a chance to discuss issues current and future surgical trainees are and will be facing.I was able to present at and attend the 2016 SCTS Conference,where my understanding of the operations, training pathways The SCTS Careers Day held last November, was a veryand future developments grew exponentially. There I met Mr enjoyable day during which there were talks on thoracic,Michael Lewis, with whom I organised a great week in the cardiac, paediatric and transplant surgery and intensive care,Sussex Cardiac Centre and Professor Bhatti who is the only with wet labs in the afternoon. It was valuable to get a tastefemale cardiothoracic surgeon I know; it is inspiring to know of what the subspecialties involve and specifically to gainthat a woman can make it in the specialty. insight into the possible career pathways. With cardiothoracicSCTS Bulletin 0716.indd 22 18/07/2016 12:04

July 2016 23 Farah Bhatti with Nicole Asemota and Jeesoo Choisurgery recruiting at ST1 level, it is vital for interested medical Finally, despite being constantly (and dishearteningly) informedstudents to be made aware of what is required, early on. I that cardiothoracic surgery is “the toughest specialty”, “aam currently organising the next Careers Day with Mr Aman dying field” and “not women-friendly” by several doctors, ICoonar, which is to be held in November 2016, and I would have received encouragement and support in even greaterstrongly urge all trainees and consultants to encourage the proportions. I am very lucky to have positive role models suchmedical students that they are teaching to attend. I am sure I as Professor Farah Bhatti and Mr Michael Sabetai, who aream right in saying that we appreciate all the effort consultants always interested in encouraging me to follow this career.and trainees have put in towards students engagement. I hopeto see many more students involved in these activities in thefuture! Society for Cardiothoracic Surgery in Great Britain and Ireland YOUR SPECIALTY NEEDS YOU Keen cardiothoracic (cardiac and thoracic) surgeons... ...Who have passed the FRCS ( CTh) exam...Who want to add to the achievements section of their appraisal portfolio ...Who need a good source of cpd ...Who want to contribute to an exciting new educational project The new exam for cardiothoracic surgical care practitioners. Training for the role will be provided. Please get in touch [email protected] Bulletin 0716.indd 23 18/07/2016 12:04

24 theBulletinAn SCTS Fellowship Journey(2015-16) Daisy Ezakadan Sandeman Clinical Nurse Practitioner Royal Infirmary of EdinburghI was awarded ‘The Ionescu scholarship’ following the SCTS 5. Get like minded people together,annual meeting in Manchester in 2015. It was surreal and you will see results.exciting but the most overwhelming feeling was that ofpride. I was the joint first awardee of this scholarship 6. Delirium care is everyone’s business.bestowed on nursing and allied health professionals. I 7. Keep awareness programmes goingwanted to reciprocate this honour by making the journeymost valuable to me and aspirational to others. throughout the year. I would like to extend my appreciation I am doing my PhD and my area to the SCTS & Mr Ionescu for granting me of research is “Delirium in Cardiac this esteemed fellowship. It has been a surgery”. I knew from the outset unique and rewarding experience. I feel this scholarship would be used to very privileged and hope to continue on my journey with the enhance my PhD. I attended the support of SCTS. I also take this opportunity to urge others to European Delirium Association apply for this award. However big or small your project, this meeting in London in September scholarship can facilitate and bring your vision to fruition. 2015. The interactions with [email protected] and international leaders in this field increased my [email protected] of delirium management. Networking at this Twitter: @daisy_varghesemeeting also helped me plan my Ionescu trip to Canada. Ivisited the Peter Munk Cardiac Centre in Toronto, Canada. It has The Delirium team:a proactive, enthusiastic and delightful group of people who Peter Munkform their Delirium steering committee. The team comprises Cardiac Centreof nurses, doctors, educators, project managers and patients (PMCC) Torontowho provide testimonials during ‘Delirium awareness week’ Dr Sanjeev SockalingamThey also help create educational materials. This group work Dr Rima Styratirelessly motivating staff, spreading awareness, ensure staff Ms Sandra Li-Jamesinterest and maintain an environment which promotes optimal Mr Arsalan Hamididelirium care. Dorina Baston Jeanne Elgie-WatsonI spent a week in the PMCC understanding the various Dr Katie Sheehanmechanisms set in place to treat delirium as ‘acute brain injury’. Joanna LynchI observed that the staff are trained in applying measuresto prevent delirium along with routines for early diagnosis,established order sets in treatment and effective follow up.The centre emphasises on ‘Partners in care’ in deliriumprevention and management. This means delirium care iseveryone’s responsibility from staff looking after the patientsto the relatives who attend to their loved ones. The resourcesprovided for delirium care in the PMCC appears to be primarilyfocussed on prevention. This has been shown to reduce theincidence of delirium and other associated complications.Take home messages:1. Delirium is common especially where there is high vulnerability.2. The interaction between vulnerability and precipitant is the key to understanding the pathophysiology of delirium.3. The pathophysiology is poorly understood but opportunities are many.4. Focus on the basics: Prevention is better than cure.SCTS Bulletin 0716.indd 24 18/07/2016 12:04

The story of the July 2016 25Belsey Spoon(s) Toni Lerut Honorary Fellow of SCTS of Great Britain and IrelandI read with great pleasure, and with some nostalgia, the The Mark IV anti reflux procedure, although in my opinion theintroduction to the thoracic community of a new use of the most “physiological” and elegant anti reflux procedure, hasBelsey spoon by Mr. Jules Dussek in the December issue of disappeared from the operating theatres since the introductionthe Bulletin. of laparoscopic surgery. But it is great to see that through the inspiration of JulesAs one of the very last registrars to Mr. Belsey (1974) I had Dussek the future of the Belsey spoon continues to look bright.the privilege to learn from the Master himself the Mark IV anti And all who have known Ronald Belsey will remember thatreflux procedure. he was a great epicure enjoying the pleasures of exquisite gastronomy and oenology. So I am sure that when lookingThe Belsey spoon comes into the picture when the distal 4 cm of down from, as he used to say, “The orbit” he will smile at Julesthe oesophagus surrounded by the 240 – 270 ° fundoplication with great contentment.will be reduced underneath the diaphragm and fixed to it(fundopexy). The spoon i.e. a modified teaspoon is introduced Fig 1 Belsey spoon the Frenchay versionunderneath the diaphragm (fig 1).The two carved notchesstabilize the spoon at the hiatal border and by compressing Fig 2 Peroperative viewthe diaphragm against the concave part of the spoon haplesspuncturing of abdominal viscera will be avoided (fig 2 ). Fig 3 Belsey spoon the BOG versionThe spoon was made by a technician at Frenchay Hospital who,in order to obtain a correct length (approx.35cm), interposed astainless steel rod in between the top end (the handle) of thespoon and the bottom end (the small bowl) and carving out inthe latter a notch, or indentation, at each side.A commercially made model of the spoon featured, if Iremember well, in the Pilling instruments catalogue but at, fora registrar, an exorbitantly high price. So every single registrarconsidered it as a personal trophy to obtain a genuine handmade Frenchay brand of the spoon (a tip was very helpful tospeed up the process).As pointed out by Jules Dussek I had invited the older membersof BOG (British Oesophageal Group) for once to come over to“the continent”, to hold the annual meeting in Leuven.For the dinner I wanted to surprise my guests and I had madea deal with the chef of the restaurant that he would serve asoup called “The Belsey Soup” so called because it was servedwith a special spoon but now modified into the BOG versionthat I had ordered from the technician in my Hospital.( fig 3).Just imagine every one trying to bring the soup up to themouth with a spoon having two carved notches on the sides!!I am sure that quite a number of ties (in those days wearinga tie was obligatory in restaurants!) after a while had beencovered with spots of soup!! Fortunately I never received abill.The day after, on Sunday, we all visited the trenches and warcemeteries in Flanders fields closing the day with an impressiveLast Post ceremony under the Menen Gate.But the end result of that meeting is that still today many ofthe attendees have a specimen of that spoon at home and ona regular base the story comes up at the occasion of the OldBoggers meeting.SCTS Bulletin 0716.indd 25 18/07/2016 12:04

26 theBulletinIonescu Nursing & Allied HealthPractitioners Fellowship Award 2015My ExperienceI was delighted, not to mention a little surprised, when week in September 2015, and again for a week in December.I found that I had been awarded the inaugural Ionescu From the outset and in fact even before I arrived, everyoneFellowship Award for Nursing and AHPs following an was extremely welcoming. At LHCH, they have an Aortic ANP,interview at the SCTS Annual Meeting in Manchester last so I based myself with her (the wonderful Tracy Hutson) andyear. attended daily ward rounds with her and the doctors. I learned about her role, spent time in theatres, and am very gratefulMy application for the award, was based around my work with to Prof Aung Oo and Ms Debbie Harrington who both took thethe Complex Aortic MDT at University Hospitals Southampton time to explain to me, the intricacies of the procedures they(UHS). We had established an Aortic Service in 2014, which at were performing. In addition, I spent time in their outpatientthe time of my application was still very much in its infancy. I clinics, attended the monthly MDT, met with the peoplewas keen to visit other centres to see how they had developed responsible for planning and coordinating operating lists, andand were running their Aortic Services, but as is usually the generally spoke to as many people as I could about aorticcase, it’s difficult to find funding, as well as the dedicated time surgery and the Aortic Service. I had a fantastic two weeksnecessary to do so. Chris Bannister drew my attention to the at LHCH, and came away not only feeling that I’d experiencedaward, so I applied, and the rest, as they say, is history! every facet of the service in action, but also having made some new friends.The £2500 Award is to pay for travel, accommodation andliving expenses to enable you to visit your chosen centre, orcentres in my case. Being able to visit somewhere for a longerperiod such as a week or more, enables you to truly see everyfacet of the service in action, rather than the snapshot whichwould only be achieved when visiting for a day. The purposeof my visits was to observe all aspects of the service in action,in order to see what ideas I could bring back to Southamptonand implement in order to move our Aortic Service forward.Because I wanted to visit somewhere with a similar patientdemographic and health service set up, I opted to stay withinthe UK for my visits. I primarily chose Liverpool Heart andChest Hospital (LHCH) as it has a well established dedicatedAortic Service, with 4 surgeons, who not only treat all electivepatients undergoing aortic surgery, but also cover all emergencydissection cases. As a stipulation of my award, the panel askedme to also include another hospital, and so Queen ElizabethHospital (QEH) Birmingham was also selectedIn view of my working in a small team, I had to split myvisits up into weekly blocks, to avoid my colleagues havingto cover too much of my work. Firstly, I visited LHCH for aThis has been a great experienceand I would recommend any nurseor AHP to apply for it if they havean interest they wish to pursue. Ican assure you it is well and trulyworth the effort.SCTS Bulletin 0716.indd 26 18/07/2016 12:04

July 2016 27 Emma Hope University Hospitals Southampton NHS Foundation Trust is that one day people are coming to visit us at UHS because it’s a centre of excellence for aortic surgery. I would like to thank Mr Ionescu for kindly funding this award and the SCTS for awarding it to me. This has been a great experience and I would recommend any nurse or AHP to apply for it if they have an interest they wish to pursue. I can assure you it is well and truly worth the effort.March 2016, I made my way to QEH to spend time with Mr. Forthcoming MeetingsJorge Mascaro and the team involved with their complex aorticsurgery. There is no Aortic Specialist Nurse there, so I based International VATS Symposium 2016myself in theatres with the SCPs and was well and truly lookedafter by Chrissie Birkett. Once again, I spent time in theatres Date 14th &15th October 2016with Mr Mascaro, who like the surgeons in Liverpool also spenta lot of time talking through the various procedures with me. Venue Royal College of Physicians, 11 St. Andrews Place,As I had done at LHCH, I also spent time in outpatients and London, NW1 4LEtalking to the surgical coordinators. Prior to visiting QEH, I hadwarned them that LHCH had set the bar very high in terms of Contact L.R. Associates – Ms. L. Richardson 58, Kiln Close,how welcoming they’d been, so that I had high expectations! Calvert Green, Buckingham, MK18 2FD.They rose to the challenge and more than met it, and onceagain I was made to feel very welcome and left with invitations Tel 01296 733 823to return any time. Fax 01296 733 823So, what did I learn? Having been able to spend time awaylooking at other teams at work, to my surprise, I realised that Mobile 077 111 32946we’re actually already doing a pretty good job in Southamptonand that there isn’t any need to make any huge changes. What is Email [email protected], I discovered, is a bit of tinkering here and there. Mostimportantly for me is the role of a dedicated Aortic Specialist Web www.internationalvats.comNurse. Currently I’m in the process of putting a business casetogether to present to management to try and change my role Birmingham review course into that of Aortic Specialist Nurse. Since my visits, I’m also cardiothoracic surgeryworking towards forming a patient support group – I have asmall number of patients who are happy to speak to pre-op Date 22nd – 24th september 2016patients on request, and I’m gradually recruiting more. I’malso working on compiling a patient information booklet. As a Venue Education centre,direct result of my visits, I have now secured the services of aGeneticist to become part of our team. I realized that this was Birmingham Heartlands Hospital,the one person we didn’t have on our team, who both we, andthe patients would benefit from having on board. Bordesley East, Birmingham, B9 5SS.Although my Fellowship year has come to an end, my journey Contact L.R. Associates – Ms. L. Richardson 58, Kiln Close,hasn’t. Currently I only work with elective patients, but I would Calvert Green, Buckingham, MK18 2FD.like to extend my role further to be involved in supportingpatients who have had Type A dissections, both in hospital and Tel 01296 733 823in follow up. I still plan to make a few more visits and continueto build up my network of contacts through the SCTS. My aim Fax 01296 733 823 Mobile 077 111 32946 Email [email protected] Web www.Birminghamreviewcourse.Co.UkSCTS Bulletin 0716.indd 27 18/07/2016 12:04

28 theBulletinPatrick Magee Medal2016 ReportThe 2016 Patrick Magee Medal enjoyed great This year’s entrants add to the 253 posters presented ininterest internationally. Forty-three abstracts preceding years. I have every confidence that through thewere presented by undergraduates. Work competition the positive influence of Pat will continue tooriginated from 22 UK medical schools combined permeate the SCTS for many generations to come.with international entrants from Brazil, Bulgaria,China, Ireland, Italy, Russia and the United States It is a fitting tribute to Pat’s legacyof America. The abstract titles are listed below. that in 2016, there were over 50It is a fitting tribute to Pat’s legacy that in 2016, undergraduate students present atthere were over 50 undergraduate students present the Annual SCTS Conference withat the Annual SCTS Conference with full participationin all aspects of the meeting. Informal feedback full participation in all aspects ofhighlighted their enjoyment of the academic sessions. the meeting.Many remarked on the beneficial experiences ofspeaking to surgeons and trainees. The recentlyformed student sessions were a tremendous successwith inspirational talks from Aman Coonar, JonathanUnsworth-White, Jonathan Afoke and Farah Bhatti.Pat was central to creating the SCTS UndergraduatePoster Prize. We are deeply honoured that theextremely worthwhile initiative lives on in hisname and confers his educational values to futuregenerations. As a tradition, we ask that one of his friendsor colleagues says a few words to describe Pat’s values andactions. In 2016, Mr Graham kindly spoke to describe thewisdom and charity of Pat.Tim described the enduring mentoring role that Pat afforded somany colleagues in the UK and abroad.The speech was both moving and inspirational. Norman Briffa(Sheffield Teaching Hospital), Neil Roberts (Barts HeartCentre), Donald Whitaker (King’s College Hospital) and TimGraham (President SCTS) served as the panel of judges.Ultimately the winner of the 2016 Patrick Magee Medal wasSamuel Schnittman from Mount Sinai Hospital, New York. Hepresented an abstract titled: “Long-term outcomes following bioprosthetic versus mechanical aortic valve replacement in patients aged 18 to 50 years.” This year’s competition has been a further step forward in the Patrick Magee Medal. It continues to act as a centre-point for undergraduate activity in the SCTS Annual Meeting and the society as a whole.SCTS Bulletin 0716.indd 28 18/07/2016 12:04

July 2016 29 David J McCormack FRCSEd (CTh)Patrick Magee Medal (2016) – List of PostersEarly outcomes of mitral valve replacement performed by Successful conservative management of a pustulant peri-aorticresidents on high-risk patients (A single centre experience) root graft collection using irrigation and antibioticsSelective in Advanced Medical Practice (SAMP); a model for An updated analysis of hemiarch versus total arch replacementincreasing medical student exposure to surgical specialities in acute type A dissection: A meta-analysis of 1860 patientsThe efficacy of Coronary artery bypass grafting (CABG) surgery Impact of patient factors on length of hospital stay followingA comparison between mitral valve replacement and repair in VATS lobectomythe surgical treatment of ischaemic mitral regurgitation The use of platlet rich plasma (PRP) and platlet poor plasmaAudit of Postoperative Pain Management in Cardiac Surgery (PPP) to aid haemostasis in a Jehovas Witness patientPatients undergoing emergency aneurysm repairA literature Review on Pain and Pain Management Following Management of lower limb ischaemia during operative repair ofCardiac Surgery acute Type A aortic dissection by distal cross over graftsIs there a volume outcomes relationship for patients undergoing Patients survey of their awareness and use of informationsurgical management of acute aortic dissection? published on the SCTS website on surgeon’s specific and unitAcute aortic thrombosis following a Stanford type A aortic specific mortality resultsdissection On-Pump and Off-Pump Coronary Artery Bypass GraftingAre Two better than One? – In patients undergoing coronary What is the best surgical option for managing prosthetic aorticartery bypass surgery, is the use of 2 arterial conduits associated valve endocarditis with root abscess?with improved patient outcomes? Long-term outcomes of bioprosthetic aortic valve replacementThoracic Aortic Dissection in a normal height patient: a family Review of Coronary heart disease in South Asians: earlywith Thoracic Aortic Aneurysm, Dissection and ACTA2 mutation assessment and managementPost-operative aortic valve competence following valve sparing Microparticles – endothelium interaction after transfusion inaortic root replacements (VSARRs) cardiac surgery patientsThe safety and efficacy of immediate, pre-emptive platelet Pain Management using PCA in Adults post Nuss Procedure: Antransfusion in patients undergoing coronary artery bypass graft analysis with respect to patient satisfactionsurgery: a retrospective cohort study Long-term outcomes following bioprosthetic versus mechanicalA Case of Quadricuspid Aortic Valve with Three Independent aortic valve replacement in patients aged 18 to 50 yearsCoronary Ostia A Rare Case of Massive Thymplipoma in PregnancyComplex lung resection for cancer increases the incidence of A review of the efficacy, safety and cost-effectiveness ofpost-op atrial fibrillation: A single centre study on incidence endobronchial valves in patients with severe emphysemaof AF Surgical Intervention for Kawasaki’s DiseaseStruma cordis Long Term Outcomes of Coronary Artery Bypass Grafting inMetastatectomy of a solitary lung melanoma of unknown Comparison to Percutaneous Coronary Intervention for theprimary in a patient with type 1 Neurofibromatosis Treatment of Coronary Artery DiseaseMuch Ado About Nothing - Are Patients Aware of the Mortality Atherosclerosis of the Left Internal Mammary Artery:Data Published by the Society of Cardiothoracic Surgeons? Histological Analysis of a Case and Literature ReviewAn audit of adherence to SAC case definition guidelines for Long-Term Patency of Saphenous Vein and Left Internalisolated coronary artery bypass graft surgery Thoracic Artery Composite Graft: a Case ReportOutcomes in End Stage Renal Failure (ESRF) Patients Undergoing Outcomes of Valve- in-Valve Percutaneous Aortic Replacement:Cardiac Surgery A Systematic ReviewThoracic Surgery – An Essential Adjunct to ECMO services – A Postoperative Bridging of Anticoagulation in Mechanical ValveTertiary Referral Centre Experience ReplacementIntraoperative Epicardial Pacing Wires in CABG patients;Propensity matched analysis of short and long term outcomesincluding requirement for permanent pacemakerSCTS Bulletin 0716.indd 29 18/07/2016 12:04

30 theBulletinThe CardiothoracicTraineesResearch CollaborativeThe Cardiothoracic Trainees Research Collaborative (CTRC) Traineesis the national research group for Cardiothoracic Traineesin Great Britain and Ireland. We aim to promote research We are a veryamongst trainees by facilitating their involvement andleadership in research projects, provide inspired research welcoming grouptraining and by fostering an environment of collaborationbetween cardiothoracic units. and anyoneThe collaborative approach under theCardiothoracic Trainees are spread throughout Great Britain ‘trainee’ banner isand Ireland. This large geographical area can provide asignificant amount of data, which is representative of the welcome to joinpopulation we serve. The SCTS National Adult Cardiac SurgeryAudit1 has been a major advance and inspiration, but there are us. This includesstill so many clinical questions to be answered. Good researchquestions are frequently generated, but their data collection clinical fellows,and analysis is often confined to the local hospital or a smallgroup of ‘friendly’ centres. As a result patient numbers are low, junior doctorsstatistical power is compromised and generalisability is calledinto question at every stage from journal review to the end (yet to get auser – the Cardiothoracic Surgeon who hopes the paper caninform their practice. The size of the specialty lends itself well training post) andto collaboration on a national scale and CTRC has set out, sinceits foundations, to exploit this great geographical network that medical studentswe have available to us as Cardiothoracic Trainees. There is no“I” in team. If we can work together so that research questions interested inare considered within this framework, large patient numberswill increase applicability, strengthen results and support more pursuing a career in Cardiothoracic Surgery. To facilitate this,convincingly the conclusions drawn. we have regional links (see table below for your local contact)The model and a medical student link.At a trainee research day, held at the Royal College of Surgeonsof England, presentations from Neurosurgery, Plastic Surgery You can contact us at [email protected], sign up to ourand General Surgery were delivered. The results of these newsletter and/ or follow us on Facebook.studies were outstanding in terms of the numbers of patients,the production of robust results and the clear collaboration We have already published3 and have presented at boththat had occurred. Conference presentations and publications national and international conferences, but are always lookingin quality journals have been achieved. The first randomised to expand. The group offers the chance to engage with (andcontrolled trial organised by a trainee collaborative came from learn about) research, even when in a clinical (non academic)General Surgery – The Rossini Trial2. It was commended for post. There are opportunities to join an existing study orrecruiting ahead of target across 21 centres and named all those propose your own.who collaborated in the eventual paper. This demonstrates thattrainees can not only manage high quality research projects, Consultantsbut also make collaboration work to everyone’s advantage. We would value your involvement. This may appear contradictory for a trainee research group, but actually it is vital. To develop as good researchers, we need good consultant mentors. Our projects allow trainees to take ownership and be involved at every stage of the research process, but each project still requires guidance and mentorship from a Consultant Supervisor. By pairing with a trainee, consultants can use the collaborative’s network and support research training. We have already benefited from good senior support in reviewing our protocols, data collection and analysis - in particular, we would like to thank Professor Treasure whose kind help in the early stages has allowed the group to flourish. We have also had excellent training provided by Consultants at our meetings and we run a regular feature in our quarterly newsletter where Consultants can share their research wisdom.1 http://www.scts.org/intro.aspx 3 Lang, P. Manickavasagar, M. Burdett, C. et al. ‘Suction on2 Pinkney, TD. Calvert, M. Bartlett, DC. et al. ‘Impact of chest drains following lung resection: evidence and practice arewound edge protection devices on surgical site infection after not aligned’, Eur J Cardiothorac Surg (2016); 49 (2): 611-6.laparotomy: multicenter randomised controlled trial’, BMJ (2013);31: 347.SCTS Bulletin 0716.indd 30 18/07/2016 12:04

July 2016 31Please be supportive when a trainee asks to collect Alan G. Dawsondata at your hospital, as the projects are multi-centre Academic Clinical Fellow & East Midlands CTRC Repand require co-operation to succeed. Urszula SimoniukIn Summary… Specialty Trainee & CTRC Meetings SecretaryThe research ethos in surgery is gaining momentum, Clare Burdettwith an increasing emphasis on developing research Specialty Trainee & CTRC Leadskills amongst trainees. The Royal College of Surgeons(England) has promoted trainee involvement in [email protected] and, specifically in Cardiothoracic Surgery, http://www.ctrc-uk.comSCTS has established an Academic and ResearchCommittee (led by Professor Gavin Murphy), whichencourages research endeavour in the specialty andsupports our initiative.So there has never been a better time to get involved– and all are welcome. REGION Figure 1: Our Collaborative Committee 2016 East of England East Midlands LOCAL LINK Ireland Daniel Sitaranjan London (2 posts) Alan Dawson Mersey Open to applications Northern England Amir Sepehripour & Duncan Steele Northern Ireland Thomas Theologou North West Mohamed El-Saegh Scotland Open to applications South West (2 posts) Ana-Catarina Pinho-Gomes Wales Peter Lang Wessex Udo Abah & Rick Karsan West Midlands Tom Combellack Yorkshire & Humber Danai Karamanou Medical Student (National) Yassir Iqbal Azar HussainSCTS Bulletin 0716.indd 31 Shruti Jayakumar 18/07/2016 12:04

32 theBulletinTraining outside of the workplace:An update on the value of the pioneering SCTSEthicon curriculum aligned training programmeThe detrimental effect of European Working time Directives Does it work?on training surgeons has been well vocalised in recentyears, with a responsive surge of simulation, technology Simulation and wet-lab training is a big bucks business in theand intensive ‘bootcamp’ programmes to bridge the gap. current climate with investment in facilities and equipmentHowever naturally talented, the surgeon’s craft requires across all surgical specialities. The challenge faced bytime, practice, repetition, directed feedback and evolution educationalists and surgeons, is demonstrating its usefulnessof skill for each individual trainee to learn muscle memory within clinical practice. Assessment of candidates in simulatedand build appropriate patterns within their practice. circumstances following a simulated educational event, showsEuropean legislation has led to reduced exposure in the little more than an improvement in the candidate to simulate.workplace, and the requirement of additional means of While one might anticipate a transfer of skills to the worktraining to reach competencies. place, there is little evidence to show ability in a wet-lab equates to a better surgeon.Cardiothoracic surgery in the UK has led the way in bridgingthis gap with integration of a robust, curriculum-oriented We sought to establish objective assessment of the impact ofprogramme of continuous learning, delivered over the 6 years the ST3A course on return to clinical practice using the currentof speciality training. SCTS Education under the guidance of ST3 year group as the focus of a single-subject design researchour SCTS tutors offers trainees the opportunity to attend two project.fully funded, stage-appropriate and SCTC accredited trainingcourses per year with full support of the SAC and Training The projectprogramme directors. Objective assessment of all 20 candidates was undertaken byThe delivery of each course is multifaceted including simulation, a consistent clinical or educational supervisor before and afterwet-lab, case studies, group and lecture based teaching. ST3A course attendance. The direct observational procedureImportantly, the focus is to augment knowledge obtained in forms (DOPS), while not formally validated were based on thepersonal study, and develop skills which are required in the widely accepted UK and USA work-based assessments for thedaily practice of a competent cardiothoracic registrar at that cardiothoracic skills : Video-assisted thoracoscopic pulmonarylevel. As such the ST3A course covers the introductory anatomy, wedge resection and cardiopulmonary bypass management.physiology, pathology and clinical scenarios alongside wet-labskill practice of chest opening and closing, mammary harvest, Both of these skills were felt to be relevant to ST3 levelcannulation, wedge excisions, bronchoscopy, tracheostomy trainees, and were taught in theory and practical sessions onand chest drain management expected of a first year registrar. the ST3A course. Alongside the forms, supervisors were asked to complete a rapid online questionnaire regarding their overall response to the trainees involvement in the educational programme. And? The initial analysis shows a significant improvement in the surgical skills of the trainees. The simple breakdown of the positive impact within the operating theatre is clear.Chart 1: Objective supervisor assessment of pulmonary wedge resection before and after Candidates showed improvement in each andST3A course. every component of both skills between the two assessments, which were on average a week before (Pre ST3A) and four weeks after the course (post ST3B). Furthermore, supervisors were asked their overall impression in four domains (knowledge,SCTS Bulletin 0716.indd 32 18/07/2016 12:04

July 2016 33 Louise Kenny This evaluation of the impact of SCTS accredited ST3A training course shows huge promise in skill development when assessed objectively within the normal professional working environment. Importantly, the study revealed that participation in this simulation and wet-lab based course improved confidenceChart 2: Objective supervisor assessment of CPB management before and after ST3A in both trainee and trainer, resulting in a subsequent increase in trainees participation in technical aspects.clinical decision making, technical skills and confidence in the ST3B, the second course over the training year has justOR) specifically in relation to attendance to the ST3A course. completed, with data currently being returned. We are hopefulThe majority of supervisors reported noticeable improvement that the overwhelmingly positive trend continues, and analysisacross all four domains of confidence in the OP, technical of DOPS alongside case and part-case numbers for each traineeskills, clinical decisions and knowledge. will show incremental improvement related to the courses. WeAs the final assessment of impact of the course on the trainees implore trainees and supervisors to engage thoroughly withclinical practice, surgeons were asked there level of agreement this process, in order to secure the involvement and dedicationwith the following statement: of faculty and funders for future years of training.“I felt more confident to allow the trainee to perform more of the With great thanks to all faculty, the Sorin National Wetlabtechnical aspects of subsequent operations” Centre in Gloucester and Ethicon and Sorin for supporting the project.70% of supervisors either agreed or strongly agreed withthe above statement, suggesting the course not only has animpact of the actual skill of the surgical trainee, buton the conceived competency by their supervisor,confidence in their ability and subsequently ontheir daily training activities.Where next?The generation of surgeons trained through endlessand exhaustive hours can often be quick to dismisstraining courses outside of the workplace, perhapsthrough a misunderstanding of content or afrustration of registrars missing days at work. Inthe current climate of prescriptive training yearsand reduced hours, which may, in light of recentevents, be teetering on a EWTD brink, innovativeand exciting ways of progressing trainees must beintegrated and accepted.SCTS Bulletin 0716.indd 33 18/07/2016 12:04

34 theBulletinThere is no ‘I’ in the wordTEAMThe main stay of our outpatient department. Theybusiness is in the title are now, however, enquiringNational Health Service. It about other aspects of theiris a “service”. We are all care including efficacy,here to serve our patients. experience and quality; woundThe dictionary definition infection, stroke and delaysof service highlights the predominate their thinkingimportance to render help, about hospitalization andto aid and to be useful. It these parameters are affectedincludes the words duty or by the whole system. We willwork of public servants. not be able to put the ‘cat backWe work in a privileged in the bag’ as far as mortality isservice industry. No other concerned but we can certainlyprofession works with total change the focus conversationstrangers, counsels them, Figure 1 The outcome4 of the patient is dependent on the surgeon, from the individual to thebrings them into hospital the system and the patient. This typology offers the questions: team. Can we? Should we? When We?and then interferes with The function and cohesion of atheir most vital organs. The of increasing co-morbidities. We are team are paramount to deliveringrelationship between a patient and the all familiar with the arguments for and safely and quality. The individual artsurgeon is special. It is defined by an against producing surgeon specific can be practiced but high quality is notindelible scar that is an emblem of our data. This has been eloquently debated guaranteed and comes at a high cost. Alabour. It means we are remembered for at a recent international meeting. We more reliable, sustainable and effectivelife by our patient as an individual, as all understand that the outcomes are standard of quality can be only achieveda surgeon, as a leader and as part of a dependent on many factors related to by rigorous application of evidence basedteam. Performance is defined, not only the surgeon, the system and the patient medicine and standardised operatingby what we say as an individual, but – it is multifactorial as shown in Figure 1. protocols (SOPs) figure 2.what we do as team. The complexity But there is a problem. Firstly, SOPsand knowledge required to deliver a The first principle of a service industry are often frowned upon and are seen ascomprehensive service is beyond the is to front load with the expert, ie the an anathema to most surgeons and ancapability of the lone individual. consultant. Much of our service is already affront to what is commonly perceived consultant led and delivered. There is as a well-earned autonomy concomitantThe SCTS and its membership deserve a tension implicit in the system as we are with the consultant status. Secondly, itlot of credit for their transparency and dependent on a lot of people to deliver is well documented that doctors makeleading the way with surgeon specific the service, yet it is our name above the decisions predominantly on experiencemortality. Despite the publication of bed and we are held accountable. ‘The and not evidence. The biases andresults, the mortality for the procedures Captain of the Ship’ argument holds heuristics generated by surgeon specificwe offer has fallen against a background although this has somewhat different data certainly will influence decision legal interpretations in different parts making especially in the high risk patient The first principle of of the world. No matter what our and impact on compliance with SOPs. a service industry is interpretation, we cannot abrogate our responsibility to lead and participate in Team participation demands other to front load with a team delivered service. skills that to date have not been fully the expert, ie the appreciated. Non-technical skills of consultant. Much of Customers and Markets surgery are recognised and taught, our service is already but are we really addressing the issues consultant led and It is well recognised in business literature of attitude and behaviour? Culture is that perceptions and expectations of often cited as the cause or solution to delivered. the ‘customer’ market change over time organisational/team success or failure. especially if base line criteria are met. It is loosely defined as the ‘way things Survival is now expected and almost are done around here’. Edgar Schein, a assumed by the patient coming to our professor at Massachusetts Institute ofSCTS Bulletin 0716.indd 34 18/07/2016 12:04

July 2016 35 David J. O’Regan Leeds General InfirmaryTechnology in Boston - USA and guru on control. We are all guilty of leaking our encouraging consultants to move aroundthe subject, best described culture as frustrations and it is very easy for this to find best fit? A consultant job is for‘A+B=C’ - attitude plus behaviours equal to be used destructively rather than an life but does it have to be in the sameculture (personal communication). opportunity to coach and learn through place? mutual respect.It is our attitudes and behaviours as In order for the SCTS to meet theteam members that contribute to local We all need to be cognisant of the challenges of the future we do need tocultures. These are subject to increasing fact that consumerist society values, re-consider the appointment processaccountability and scrutiny. It transpires beliefs, are changing expectation and and reinforce the attributes of teamthat most the reports to the GMC are entitlements. The workforce is likewise playing. We also need to think throughcentred on this very issue. Staff are quite subject to significant socio-demographic the implications of having a morerightly empowered to challenge and hold changes including age, gender, and migrant consultant workforce and theeach member of the team to account, multiculturalism. All this brings richness social, domestic and financial impact. Itas it is this shared responsibility that to the way we deliver care and the is pleasing to see the establishment toensures that the care we deliver is necessary diversity of opinion required a governance lead but is it going to bedignified and safe. when seeking a better way. But, have possible to establish a code of conduct we changed as a profession and are and will the SCTS be able to apply this in a fair, transparent and consistent our own attitudes manner that enables us to maintain and behaviours standards of professional conduct as well congruent with as capability that reassures the patients the time? The and our employers? Perhaps the role autocratic surgeon should be extended to examine attitudes is, in many respects, and behaviours of troubled teams with being left behind a SCTS directed governance agenda and potentially focused on advice and coaching that can exposed through mitigate political and personal agendas? an evolutionary mismatch figure 3 ‘IMSAFE’ is an acronym used by the airline overleaf. industry as a process of self-calibration: Illness, Medication, Stress (personal, The expectation and financial, time pressures), Abuse (alcohol or recreational substances and the responsibility hangovers) Fatigue (physical and mental including sleep deprivation) Emotion Figure 2: Relationship between the delivery mode and degree of of the consultant (anger, aggression, depression, personaldisease management. Adapted from the paper by McLaughlin and goes far beyond grief/loss) Eating (hypoglycemia andKaluzny. All the consultant surgeons deliver independent practices just being able to hydration). How are often are surgeons working when feeling below par and and are very defensive about their professional autonomy. The operate and deliver what support is on offer? Psychomotorservice provided is of an extremely high standard but, as outlined a safe service as skills of the experienced surgeon are in the rubric, it is of high cost. Improvement and change could we participate in generally preserved in times of difficultybe affected, as shown by the blue arrow, by adopting an evidence high performance but cognitive skills are attenuated. Do teams with an we see a future where the surgeon can based best practice and moving towards mass exercise self-calibration without feeling guilty or under pressure? The decline in inherent natural cognitive function can ameliorated by having the team on board but this isDown side interdependence. conditional on a level of self-governance Performance does not just happen; it and a supportive team. A declaration and request for help in times of difficultyThere is a down side. We, not has to rehearsed, practiced and coached.infrequently, find ourselves asserting the How can we assess this at an interview continued on next pageneed for improved performance but this and why are we not assessing thisassertion is defended with accusation of throughout training? The SCTS flirted‘bullying’. Yes, this is an easy defence with the idea of having mentors tofor the person who is not delivering to support the newly appointed consultantstandard but it is a difficult balance but what are we doing about teamsthat requires a mindfulness and self- that are dysfunctional? Why are we notSCTS Bulletin 0716.indd 35 18/07/2016 12:04

36 theBulletinThere is no ‘I’ in the wordTEAM continuedFigure 3: Society expectations are changing and challenging the system at multiple levels. The surgeon is potentially exposedincluded in the team brief will go a long The job is difficult enough as it is and is David J. O’Regan MBA MD BMway - after all we are human! getting tougher. The SCTS is in a good FRCSEd C-Th. FFSTEd position to consider the nuances ofWe also need to consider the collegiality the appointment process, team playing Room 146, E Floor, Jubilee Buildingof our profession. We are all fellows of and doctors in difficulty. We do need to Leeds General Infirmarya college of surgeons. Implicit in the examine our own and collective attitudesword fellow is support and respect for and behaviours. Change will not come Email: davido’[email protected] another. This does not necessarily from top down control but from withinmean friends but more a recognition ourselves and our profession. If we can Twitter @david-ukanand acknowledgement of an individual’s do this then it becomes a tool, howeverroles, responsibilities and contributions if left to other authorities it mostto the team. Negative behaviours and certainly will become a stick! We have toderogatory comments about colleagues want to do it. We need to support eachcan and do erode at a person’s emotional other through thick and thin. We needwellbeing. This should not be tolerated to foster team playing, drive qualityat any level. The first response to through standard operating protocolsa colleague in difficulty should be and above all respect each other’s rolessupportive and in kind. James Reason and contributions to this amazing andproffered a simple clear algorithm to use privileged specialty.when faced with doctors in difficulty.Sanction and exclusion are really last Referencesresort and should only be taken whenpresented with irrefutable evidence. We McLaughlin, C. P. & Kaluzny, A. D. 2000,do seem to be in a culture of ‘shoot first “Building client centred systems of care:and then ask questions’? The SCTS can Choosing a process direction for theand should position itself to offer wise next century”, Health Care Managementcounselling for the individual, teams and Review, vol. 25, no. 1, p. 73.employers alike in order to bring somecommon sense and calm to situations Human Error; James Reason: Cambridgethat appear to be getting out of control University Press; 1990– perhaps we could even offer a helpline?SCTS Bulletin 0716.indd 36 18/07/2016 12:04

July 2016 37Making cardiothoracic surgeryattractive to medical studentsOver the last couple of years cardiothoracic surgery has remained the most competitive Michael Goosemanof surgical specialities. With an ST1 entry point, exposure to cardiothoracic surgery Yorkshire and the Humberas an undergraduate has become increasingly important. Despite this, one of theproblems voiced locally was that it was a difficult specialty to gain experience of In Sheffield,with very few clinical attachments available. Over recent years the SCTS has worked with excellenthard to involve medical students in cardiothoracic surgery. The annual meeting consultant supportprovides opportunities to present research and audit and has become highly we have beenregarded by medical students. Other opportunities have been made available such able get numerousas a clinical attachment in Middlesbrough – something I have been told provides medical studentoutstanding clinical experience. In Sheffield, with excellent consultant support, we initiatives goinghave been able get numerous medical student initiatives going with good success. with good success.Presentations provide an easy opportunity to connect with large numbers of medicalstudents. There is not a great deal of emphasis placed on careers counselling andstudents value any information that will make them competitive and improve theirCV. A talk on the life of a surgeon can be extremely effective and can provide astimulus for students to seek further experience in the specialty. Medical schoolsare extremely grateful when doctors show interest in teaching and mentoring andwill support any teaching efforts.Basic science courses with wet tissue skills stations are used heavily in postgraduatesurgical training and we have found them to be useful when teaching medicalstudents. The teaching programme we use begins with anatomy teaching usingporcine tissue and builds up throughout the day to basic clinical skills such asknot tying. It focuses on delivering teaching with an emphasis on mentorship. Ifstudents are able to leave the course confident that they can contact someone fromwithin the specialty it can greatly increase their motivation. We have run numerousundergraduate courses and seeking support from medical schools can improve thequality and relevance of teaching provided.Cardiothoracic surgery does not have any significant presence in undergraduatemedical curriculums. With increasing emphasis being placed on producing doctorswho are able to work in primary care this is something that will not change. Surgicalattachments are always popular with students but are being reduced. A positiveway of dealing with this is for units to create high quality attachments that can bechosen as student selected components (SSC). Organising a teaching programmeover a couple of weeks is easy and effective – students can spend dedicated timeon cardiac and thoracic wards, in theatre and in ITU. It can be an opportunity toget involved in audit and research and again can help students identify a mentor.SCTS Bulletin 0716.indd 37 18/07/2016 12:04

38 theBulletinSCTSStudent Engagement Day ReportAfter a very successful event in Bristol last year, the SCTS Surgical trainees demonstrating a resuscitation scenariostudent engagement day was run this year by Cambridge At the wetlab!University Medical Students and Papworth Hospital.The event took place on Saturday 21st November 2015 where60 delegates from all over the UK and visitors from Brazil andIreland truly enjoyed a fantastic experience in the field ofcardiothoracic surgery.The day started with TEDx-like lectures in Cardiothoracicintensive care (Dr Nicola Jones), Adult Cardiac surgery (MissFarah Bhatti), Cardiothoracic Transplant surgery (Mr StephenLarge), Thoracic surgery (Mr Aman Coonar), PaediatricCardiothoracic surgery (Mr Shafi Mussa) and the Cardiothoracictraining scheme (Mr Phil McElnay).In addition, a 40-minute post-surgical emergency simulationwas led by trainee cardiothoracic surgeons with the involvementof students. This demonstration was a great way to get studentsinvolved in a typical emergency situation and illustrate therole of each healthcare professional.The afternoon session consisted of four practical stations:aortic anastomosis, chest drain insertion, thoracoscopic skillsand suturing. This provided a greater exposure to students ingetting involved with common skills utilised in cardiothoracicsurgery. Practical stations were truly enjoyed by all students.Furthermore, it provided fantastic opportunities for medicalstudents to engage with each other and collaborate withcardiothoracic trainee surgeons and Consultants.At the end of the day, certificates of attendance were handedout. Speaking to quite a few students, a very positiveresponse and feedback was provided with “excellent andinspiring teaching” and “great hands-on practical sessions”.Everyone gained more experience and exposure in the field ofcardiothoracic surgery. The organising committee learnt newskills and we all made professional connections.Cambridge University medical student committee:Oliver Brewster, Vinci Naruka, Rob Piper, Millie Ngaage,Saigeet Eleti, Charlotte Cardus, Elena The and led by Mr AmanCoonar.SCTS Bulletin 0716.indd 38 18/07/2016 12:04

July 2016 39 Vinci Naruka 5th year Medical Student University of CambridgeSuturing session and laparoscopy station Thoracic anatomy and chest drain insertionSCTS Bulletin 0716.indd 39 18/07/2016 12:04

40 theBulletinSCTS EducationTutors ReportPortfolio of training Training courses for Core were Nur Ismail (Thoracic Surgery), withcourses Trainees & Foundation her robotic thymectomy video, and John Doctors Taghavi (Cardiac Surgery), with his valveSince being appointed a cardiac and sparing aortic root replacement video.thoracic surgery tutors for the Society of In addition to the portfolio of courses The shortlisted videos are available toCardiothoracic Surgeons of Great Britain for nationally appointed cardiothoracic view on the SCTS Education website.& Ireland, we have set up a portfolio of surgical trainees, we also have set up We would encourage all cardiothoraciccardiothoracic surgery training courses introductory courses for core surgical trainees to submit at least one video perfor nationally appointed cardiothoracic trainees and foundation doctors. year, in a similar manner to producingsurgical trainees. It has taken a fantastic This year both will be run at the West a manuscript and an audit, as it willteam effort with support from the Midland Surgical Training Centre in be discussed at the annual review ofSociety Executive, Cardiothoracic Surgery Coventry, which has fantastic facilities, competency progression (ARCP).Specialty Advisory Committee (SAC), including access to cadaveric materialsTraining Programme Directors and most for simulation teaching. The ST2 course Professionalismimportantly, the members of the faculty, is also run free of charge with financialwhose time and effort have enabled support from Ethicon for all nationally Recently, issues of professionalism haveus to deliver a fantastic programme of appointed ST2 trainees on a run-through occurred at the recent training courses ineducation to complement the training programme, as well as for other core Hamburg with trainees either turning upthat occurs in the workplace. The complete trainees interested in cardiothoracic late or absent from the last day of teachingportfolio has now been delivered, with surgery, with support from their core following effects from the night before.the successful running of the recent ST8A surgical training programme directors. Unfortunately, as well as reflecting poorlyCardiac Surgery and Thoracic Surgery Pre- on the individual trainees involved, itConsultant Courses. This course taught The Foundation Year Course is aimed at does not send out a good message onsenior trainees the important principles those exploring Cardiothoracic Surgery as the value that the trainees place on thisof becoming a Cardiac or Thoracic Surgery a career choice and allows trainees to get unique educational opportunity and mayConsultant, allowing them to practise hand-on experience at performing cardiac affect funding for the programme asthe skills of emergency surgery in a and thoracic surgical procedures, such as a whole. It is important to stress thatlive operating model, such as repair of a coronary anastomosis or a lobectomy. trainees are expected to attend the coursean acute aortic dissection, post-infarct This course is run with great financial completely and abide by the standardsventricular septal rupture or bronchial support from Medtronic. of behaviour expected in the work placetear. Consistent with previous courses, set out by the General Medical Councilthe programme was very well received by SCTS Education Operative (GMC), as well as the professionalismthe trainees with excellent feedback. The Video Prize expected of a SCTS member. Wherefeedback also allows us to continually issues of professionalism arise, a reportevolve the courses to meet the changing Over the past year we have also is sent back to the training programmeneeds of the trainees. To the best of our successfully ran the SCTS Education directors for further discussion at theknowledge this is the only portfolio of Operative Video Prize. The premise behind annual review of competency progressioncourses that has been designed to mirror this is to empower cardiothoracic surgical (ARCP). We would encourage all traineesthe specialty ISCP curriculum and that is trainees to actively participate in their to make the most of these educationalprovided free of charge to all trainees. own education. It involves the trainees opportunities and to treat them withThis is made possible by fantastic creating a short 5 minute video of a appropriate respect.financial and logistical support from our surgical procedure or part of a procedureindustry partners, principally Ethicon. from a list of 120 cardiothoracic Quality assurance procedures or operations, with the viewThe boot camp venture of SCTS was over the next few years to create an Finally we have been working with thepresented in the ASiT meeting and won SCTS quality approved library of videos, Education Department of Royal Collegethe best prize award. accessible by trainees so that they can for of Surgeons of Edinburgh to inspect and example review a new procedure before quality assure our programme. Dr Hurst, performing it in the operating room. the head of the department, has visited The 6 best cardiac and thoracic surgery our courses and has given valuable videos were viewed and voted on by the feedback. It was very gratifying to learn trainees at the SCTS Annual Conference that we have been delivering the courses during the Trainee meeting. The winners in keeping with educational standards.SCTS Bulletin 0716.indd 40 18/07/2016 12:04

July 2016 41 Narain Moorjani SCTS Cardiac Surgery Tutor Sri Rathinam SCTS Thoracic Surgery TutorWe wish Mike Lewis all the very best in his role as the Intercollegiate BoardChair. Mike and Rajesh as Education secretaries have been greatly supportivein our role as tutors.We thank our entire faculty and course directors who made this programmea success.Forthcoming SCTS Education Courses 14th – 16th Nov 2016 Introduction to Specialty Training in Cardiothoracic Surgery21st – 22nd July 2016 Course (ST3A)Non-Operative Technical Skills for Surgeons (NOTSS) Course J&J Pinewood Campus, Wokingham(ST5B) Course Directors: Ravi De Silva / John PillingAdvanced Patient Simulation Centre, St George’s Hospital,London 28th – 30th Nov 2016 Course Directors: Tim Jones / Mike Lewis / Ian Hunt / Gianluca Essential Skills in Cardiothoracic Surgery (ST2)Casali West Midland Surgical Training Centre, University Hospital, Coventry23rd Sept 2016 Course Directors: Mobi Chaudhry / TBCIntroduction to Cardiothoracic Surgery for Foundation YearDoctors & Core Trainees (ST1) 5th – 7th Dec 2016 West Midland Surgical Training Centre, University Hospital, Core Cardiac Surgery Course (ST4A)Coventry J&J Pinewood Campus, WokinghamCourse Directors: Heyman Luckraz / Karen Harrison-Phipps Course Directors: Joseph Zacharias / Ishtiaq Ahmed10th – 11th Nov 2016 Professional Development Course (ST8B)J&J Pinewood Campus, WokinghamCourse Directors: Stephen Rooney / Mike LewisAberdeen Royal Infirmary:Locum Consultant Cardiothoracic Surgeon NeededThe North of Scotland Cardiothoracic Surgery Unit are currently lookingto recruit a Locum Consultant Cardiothoracic Surgeon at Aberdeen RoyalInfirmary effective from 1st August 2016 or soon afterwards.If you have any interest in this post please contact Mr El-Shafei’s secretary,Sandra Adam on 01224 555907or email [email protected] Bulletin 0716.indd 41 18/07/2016 12:04

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July 2016 43Developing Non-Technical Skills G Hardman, AH WalkerTraditional health-care education and training is discipline each module reflective practice is facilitated using an onlinespecific and focuses on clinical knowledge and technical discussion forum and participants are encouraged to applyskills but up to 80% of errors in healthcare are consequent their learning within the working environment.on failures of non-technical skills. Cardiothoracic surgeryaccounts for some of the most common and technically Between each module Modified “awareness of patient safety”challenging procedures performed in the UK today. The and “attitudes to team working” questionnaires were distributedcardiac operating theatre is a highly demanding, high-risk within the department along with post-course questionnairesenvironment, reliant on multiple interactions between to candidates completing the course.subspecialist individuals and complex technologies toprovide safe care for patients with severe cardiac disease Using a Likert scale (1=poor, 5=excellent) the course increasedand multiple co-morbidities. The contribution of human knowledge of non-technical skills (2.6 pre-, 4.4 post-course,factors to patient safety in the cardiac operating theatre is p=0.005) and their impact on patient safety (3.2 pre-, 4.2well recognised1. post-course, p=0.0077). The course also provided tools to enhance participants confidence (2.8 pre-, 4.0 post-course,In January 2015 funding was secured from Health Education p=0.0003) and skills (2.6 pre-, 4.2 post-course, p=0.001) inNorthwest Enhanced Learning Environments for the introduction non-technical skills within their work environments.of an innovative interprofessional learning (IPL) programme,using simulation and technology enhanced learning for the The provision of protected time for teaching across all disciplinesdelivery of non-technical skills training to the cardiac surgical within a busy service has been challenging but through thisteam. Training an existing multi-disciplinary team, who are work we have embedded an improved patient safety cultureestablished in working practice was a novel proposal. By within the team and the practice of all professional groupstraining the MDT together, our aim was to improve working within our department.relationships, aid understanding of individuals’ roles and theirvalue within the team, and to allow direct application of All staff members in our department will ultimately participatelearning outcomes to everyday practice, ultimately improving in this programme. We aim to extend the programme to a secondpatient safety. Cardiothoracic unit in late 2016, with regional expansion through the Northwest School of Surgery in early 2017.Prior to course development, all staff members in our departmentwere invited to participate in 2 online questionnaires; Safety ReferencesAttitudes and Safety Climate questionnaire and the TeamSTEPPS Team work attitudes questionnaire2. The results of this 1. Wahr JA et al. Patient safety in the Cardiac Operatingneeds analysis highlighted an awareness of the importance of Room: Human Factors and Teamwork: A Scientific statementnon-technical skills, but a perceived difficulty in achieving from the American Heart Association. Circulation.this within the department. 45% of respondents felt that 2013;128:1139-1169“communication breakdowns are common” and 21% disagreedwith the statement, “Doctors and nurses work together as 2. Colla JB et al. Measuring patient safety climate: A review ofa well-coordinated team”. Staff satisfaction was low and Surveys. Qual Saf Healthcare 2005;14:364-366the consequent effects of poor communication and poorcollaboration between team members on patient safety culture G Hardmanwithin our department was recognised. ST4 Cardiothoracic Surgery, Health Education NorthwestA working group of representative parties convened to design acurriculum based on learning needs specific to our department, AH Walkeridentified from local incident reporting, along with local andnational serious incidents, with a focus on communication, Consultant Cardiac Surgeon, Lancashire Cardiac Centre,team-working, situational awareness and decision making. Blackpool Victoria HospitalThe pilot programme commenced in June 2015 with 9individuals from the existing cardiac operating and intensivecare teams participating. The programme curriculum wasdelivered over five 2-hour sessions, with simulated scenariosfollowed by video-assisted facilitated de-briefing. BetweenSCTS Bulletin 0716.indd 43 18/07/2016 12:04

44 theBulletin3rd National Cardiothoracic SurgeryCareers Day London 2016ST1 application means positive and innovative culture to medial TED - style talk by Stevedecisions are better made in students elsewhere. Large, Cambridge onmedical school transplant progress SCTS sees this as an opportunity toST1 selection was recently introduced for nurture students from an early stage by “It can be very daunting when you getcardiothoracic surgery. The first batch providing access to the specialty and these accomplished people talking toof successful applicants is still early in also a framework to help committed you about their amazing careers as youtraining. Limited training spots at both students build their portfolio of skills so listen with envy but having them tellST1 and ST3 and the stringent selection they can succeed in national selection. you about the road they took to get onprocess make it important for aspiring top of this ‘huge mountain’ is so usefulstudents to express interest and build This builds on and is complementary and inspiring!” – medical studenttheir competitiveness for their chosen with the work of partners including thespecialty earlier than before. This is the RSM, ASIT, student societies and Royal This event also serves as a platform forsituation in many other countries. colleges. the delegates to clear their doubts onIn the current medical curricula, exposure possible barriers that might hinder theirto cardiothoracic surgery is often scarce. The Cardiothoracic Surgery career in cardiothoracic surgery. CurrentThere is also some negativity about career Careers Day issues like women in cardiothoracicopportunities. Basic suturing techniques surgery are addressed a successful womenand surgical skills are sidelined and are Realising the need to make up for cardiothoracic consultants themselves.not a compulsory part of the academic the lack of surgical exposure at thetimetable. Hence, there is a need to primary medical degree level, Society of The first two meetingsoffer information, experience and our Cardiothoracic Surgery (SCTS) Education and team want to inspire the next Two successful events were hosted inCambridge 2016 generation of surgeons who will lead Bristol and Cambridge, in 2014 and 2015 respectively, earning highly positive the nation’s cardiothoracic feedbacks from the participants. service. The National Moreover, the events were run by a full Cardiothoracic Surgery committee of medical students. They Careers Day serves as a managed to organise surgical workshops platform for the delegates in the afternoon session, which were to get a personal very popular amongst the delegates as insight into the life as a well. The workshops were led by trainees cardiothoracic surgeon. and consultants in cardiothoracic The delegates hear about surgery and with the high number of the life of a CT surgeon in volunteers, many of the delegates were different subspecialties, able to obtain personal attention from getting into the specialty the tutors. and training. This is combined with skills Last year, the Cambridge team opened sessions. their doors to 6th form students. It was a major success and it managed to fulfil the initial dream when the event was first introduced, which is to foster the interests in cardiothoracic surgery. This event will continue to be an outreach event to inspire budding cardiothoracic surgeons in coming years. Bristol 2014 18/07/2016 12:04SCTS Bulletin 0716.indd 44

July 2016 45 David Tang Chuk, Barts & London Jeesoo Choi, Kings Aman Coonar, SCTS Lead for student engagement“As a Sixth Form student I found the and Dentistry and King’s Collegeexperience to be extremely valuable London will be hosting the 3rdand one which I contributed to National Cardiothoracic Surgerythe success of my application to Careers Day in St Bartholomew’sMedical School. I was able to speak Hospital, in London on the 5th ofto experienced surgeons, surgical November 2016.trainees and medical students - allof whom were more than happy Save the date - 5.11.16to offer me advice with regardto my University application and Widening access to 6thparticularly the interview skills which form studentsI would need, in addition to offeringme a realistic understanding of what This year, 6th form students will alsoit is like to study and work in the field be given a chance to obtain adviceof Medicine and, more specifically, for medical school application,Cardiothoracics. Furthermore I anatomy demonstration usingfound being in a room full of like- animal models and a tour in theminded individuals extremely historic Barts Pathology Museum.encouraging, while the practical We have partnered with varioussurgical skills sessions simply further schools including those from lessfuelled my passion for surgery affluent areas as we wish to openand my desire to study medicine.” the doors to cardiothoracic surgery6th form student ever wider.“The workshops are also very hands More information on the event can TED style talk - Steve Largeon, … we did chest drains on sheep be found on the event website.necks and sutured pig aortas together www.cardiothoraciccareers.- there are very few opportunities co.uk/ and on facebooklike this out there and I cannot https://www.facebook.com/recommend this more for someone cardiothoracicsurgerycareersday/who wants to pursue a career insurgery - even if you are not sure, We also run an event at the mainyou will get a pretty good insight!” SCTS annual meeting and publicisemedical student 2016 any courses we hear about.This year, students from Barts andthe London School of Medicine Inovus low cost VATS simulatorSCTS Bulletin 0716.indd 45 18/07/2016 12:04

46 theBulletinObituaryProfessor Geoffrey Smith11 November 1937 - 24 January 2016I am sure all members of the society are aware of Geoff’s In collaboration with Sheffielduntimely death in January of this year due to metastatic University and the British Heartcolonic cancer. Speaking on behalf of the family it was a great Foundation, Geoff competedcomfort to see so many colleagues attend the funeral service with other centres to have heartand I would like to thank members for their many messages. transplantation in South Yorkshire. He was appointed Professor ofGeoffrey Harry Smith was born in Derby and educated at Derby Cardiac Surgery in 1987 and with the help of Richard Cory PierceGrammar School. He was admitted to medical school at St. and Gianni Angelini set up a transplant service. I assisted GeoffMary’s, Paddington qualifying MB.BS with Honours. on the first transplant in Sheffield in October 1989. The patient was a young teacher who had a further 10 years of good qualityAs a student he moved from a flat in Hampstead to ‘mixed’ life. Geoff enjoyed medical politics and Chaired the Nationalaccommodation at Fellowship House in Holland Park. There he advisory group on the reconfiguration of medical specialtiesmet his wife to be Brenda and so began a long and happy in London 1993. There were many news headlines and publicjourney together. In 1960, they married in Kensington and soon outcry about reconfiguration particularly the proposed closurehad three daughters. He later became a proud grandfather of of Harefield. He was on the Education committee for thefour grandchildren. European Association of Cardiothoracic Surgeons Hospital and through the EACTS made many International friends.He was Senior Registrar at the London Hospital of Diseases ofthe Chest and moved to Sheffield to further his training and A highlight of his career was when he became President of thewas appointed Consultant in 1969 along side Desmond Taylor SCTS 1992-1994. He was a popular president of the societyand Alan Norman the latter performing mainly thoracic and and at his Presidential address to the society in Bristol thereoesophageal surgery. was a standing ovation for his speech on “Investment and Reinvestment” in the specialty. This was well received and aCardiac surgery in the late sixties and seventies was still subtle reminder that all senior experienced surgeons shouldevolving and Geoff was instrumental in taking the specialty give something back to the specialty and not be seduced by theforward in Sheffield and creating a skilled team at the Northern yellow brick road of private practice. He had a unique talentGeneral Hospital. The unit grew and Geoff was a catalyst in the to motivate, empower and get the best out of his trainees anddevelopment of the Chesterman Unit amalgamating the service staff.from the Royal Hallamshire Hospital. This unit has now becomea major teaching centre for both cardiac and thoracic surgery. After retirement in 1993 he kept active. He was Chief of Cardiac Services in Abu Dhabi. Visiting Professor at Umea, Sweden. ViceMy first emergency operation as a ‘Thoracic surgeon’ was Chancellor at the Asian Institute of Medicine in Kedah Malaysiaa ruptured abdominal aortic aneurysm and had to put in a 2009. He also acted as Medical Advisor to the British Council.bifurcation graft as cardiothoracic surgeons in those days alsodid all vascular surgery. Older members will recall the society was At home he was fond of opera particularly Mozart, bread making,called the Society of Thoracic and Cardiovascular surgeons for wine and golf. He was very fond of his time in Ulverston in theseveral years. With his charming smile he also asked if I could Lake District, was a keen hill walker and many colleagues havehelp with the cardiac programme! He was a great supporter for witnessed Brenda and Geoff’s hospitality there.thoracic and oesophageal surgical development in Sheffield. There have been many tributes to Geoff since his death andGeoff’s achievements were many and his principle interests were here I quote some of the many comments.in valve surgery, postgraduate education and the delivery of “Always entertaining to talk to”cardiac surgical care with accurate reporting of results. Latterly, “Kind and supportive” Geoff was particularly “Great trainer” impressed with the book “Still owes me a fiver” ‘The Naked Surgeon” by “Few people influenced me more in my career than Prof Smith” Sam Nashef. This book “Great Mentor” should be mandatory “Compassion for family life” reading for all surgeons “A true professional and family man” whatever their Andrew Thorpe, Leeds discipline. Sam Nashef’s experience in Sheffield ignited a passion for honest reporting and analysis of patient outcome data.SCTS Bulletin 0716.indd 46 18/07/2016 12:04

July 2016 47SCTS Education ProfessionalDevelopment ProgrammeIn challenging times it becomes harder to lead and develop Next SCTS coursesservices. On top of that, we work in a pressurised and time- Leading Successfully in the Complex Healthcareconsuming specialty. SCTS recognises this and to support our Environment members we have set up a rolling programme of 1-day smallgroup sessions each focussing intensively on a particular 13th September 2016topic. Our educational partner is Academyst a leadinghealthcare management educator. Over a five year period Effective Influencing & Negotiation Skills each day will be repeated at least twice. Attendance at these 4th November 2016courses will assist with revalidation and also help consultantsand senior trainees in their professional roles. Currently these Aman Coonarcourses are run in central London. SCTS Education lead for professional development Andrew VincentThe course benefits from a huge subsidy so that there is only Academyst LLPa nominal charge for SCTS members who attend! Non-SCTSmembers can attend but are charged the full price which istypically £250-300/day.Feedback from our most recent course: ‘Healthcaretransformation’. May 2016. ‘Outstanding. Very helpful todiscuss with colleagues in our specialty. Eye-opener’.New ConsultantsName Hospital Starting Date SpecialtyAlan Soo Galway University Hospitals May 2016 C ardiothoracicAmit Modi The Royal Sussex County Hospital August 2016David McCormack Nottingham University Hospital October 2017Other AppointmentsName Hospital Starting Date SpecialtySuvitesh Luthra Derriford Hospital, Plymouth August 2015 Locum Consultant Cardiac Surgery Locum ConsultantPaul Whitlock John Radcliffe Hospital, Oxford December 2015 Adult Cardiac Surgery Locum Consultant Adult Cardiac SurgeryDaniel Robb Royal Victoria Hospital, Belfast February 2016 Locum Consultant Cardiac SurgerySunil Bhudia Harefield Hospital, Middx February 2016 Locum Consultant Thoracic Surgery Locum ConsultantSyed Suhail Ahmed Qadri Castle Hill Hospital, Hull April 2016 Adult Cardiac Surgery Locum ConsultantAndrew Selvaraj John Radcliffe Hospital, Oxford June 2016 Selvaraj Shanmuganathan Nottingham University Hospital September 2016 SCTS Bulletin 0716.indd 47 18/07/2016 12:04

48 theBulletinThe 2015 SCTS Vivek SrivastavaIonescu Scholarshipfor non-NTN doctorsThe ‘SCTS Ionescu scholarship’ for non-NTN doctors was thoracotomy) as well as routine cases. It was impressiveintroduced by the Society for Cardiothoracic Surgery in 2015. that such a large facility functioned so smoothly, but thenThe application process required a CV, two references and a plan. it’s all been routine to them for several years now.There was no restriction on how the funding could be utilisedbut this also made it more difficult as there was no precedent. 4. The last project was the visit to Mount Sinai Hospital,I have a developing interest in minimally invasive cardiac New York. This did require some advance planning andsurgery (MICS) and therefore, following discussions with my organisation - from finding an appropriate time-slot tomentors/referees, I proposed to use the funding as a ‘travelling completing a significant amount of paperwork. I neededfellowship’. The main aim was to improve my understanding of immunity tests and supplemental immunisations and onethe variety of these procedures especially mitral valve surgery extra on-site day solely for security clearance and trainingand also the functioning of some of the large centres providing on various policies. But once cleared to visit theatres, itthese as a routine. Broadly, my proposal included a course on was just a treat observing Dr. Adams operating, making itMICS and three separate observerships with eminent surgeons all worth it. His is a mitral valve reference centre with repairat centres of excellence. rates of 99%! Over 4 days, I saw a glimpse of why - three simultaneous theatres with diverse MV pathologies repaired1. Re-Evolution Summit - course on MICS. It is organised by the with a variety of techniques including redo repairs and not Methodist Hospital, Houston, Texas, USA at their Methodist one replacement. Institute for Technology, Innovation & Education (MITIE), a fantastic facility for training through simulation. It included Overall it has been a busy year juggling schedules to fit travel training on all varieties of MICS and robotic procedures plans into work commitments. But it has been a thoroughly including CABGs, aortic valve procedures and mitral valve enriching and rewarding experience. I have gained a deeper procedures through didactic teaching and demonstrations understanding of surgical procedures and have also learnt on cadavers and simulators. The faculty included prominent to some extent how large centres function and how smaller surgeons from all over USA and it was a delight first-assisting individual-led practices can deliver superior outcomes based experts with the entire range of procedures covered over purely on a commitment to excellence. I have met and seen three days. some brilliant surgeons at work and it has been an inspirational journey.2. The first observership aimed at minimally invasive mitral surgery was with Prof. Jean-François Obadia at Hopital Louis This initiative of the SCTS in recognising the contribution Pradel at Lyon, France. The application/ approval process was of non-NTN doctors is a very refreshing and welcome move simple - an email to him requesting the observership and a and I am grateful to Mr. Marian Ionescu and the ‘Society’ for prompt welcoming reply from him. The four days there were instituting this scholarship. I will remain indebted to my spent learning valuable tips from Prof. Obadia and watching mentors and referees who supported me for the scholarship and him perform the procedure with amazing slickness. He made to the Society tutors who judged me worthy of this opportunity. sure I gained as best from my time there as possible - so I And finally, through this forum, I would encourage all non- also watched some fantastic off-pump CABGs (Prof. Farhat) NTNs to take advantage of the scholarship for furthering their and valve sparing root replacement (Dr. Robin). professional development and growth.3. The next leg was a week-long trip to the Leipzig Heart Centre, Vivek Srivastava, Clinical Fellow, Department of Germany. Leipzig Heart Centre is, of course, well known for Cardiothoracic Surgery, The James Cook University Hospital introducing several new minimally invasive techniques in Middlesbrough, U.K. cardiac surgery under the leadership of Dr. Friedrich Mohr. The centre has visitors throughout the year and I was warned it could be difficult finding suitable space. Luckily for me, I could find a slot which allowed me to follow up the observership with the ‘Latest techniques in Cardiac Surgery’ meeting (famously organised by Prof. Mohr and Dr. Michael Mack of USA). The department is fully geared to receive observers, even providing on-site accommodation and discounted meals. It is a huge centre – nine theatres spread over two floors and constantly at work. Over five days, I saw several minimally invasive operations - AVRs, MV repairs, CABGs (including MIDCABs and multivessel grafting throughSCTS Bulletin 0716.indd 48 18/07/2016 12:04

July 2016 49ObituaryIain Mackay Breckenridge26 March 1934 - 23 January 2016It is about 18 years since Iain in Wales. This was challenging and development of young surgeons bothretired from cardiac surgery after demanding work and set the scene for in terms of their practical developmentan extremely successful consultant Iain’s intense focus and commitment to but also supporting their research. Incareer spanning some 25 years clinical work and the best interests of addition, his wide circle of professionalworking his entire consultant life his patients. contacts meant he was able to send hisat the University Hospital of Wales trainees to successful careers elsewhere(UHW), doing “missionary work” as The 1970’s and 1980’s were periods of in the UK and across the world.he put it away from his native and massive expansions in adult cardiacbeloved Scotland. surgery with the development of Every one of these surgeons will have coronary artery surgery. Iain working fond memories of working with Iain,Iain had an unorthodox entry into with his long time consultant partner excellent clinical training, lots of abuse,the cardiac surgical world. Originally Eric Butchart set about expanding both a rich vein of professional stories, someat the Hammersmith Hospital in the the activity and the scope of cardiac sad stories but mainly professional1960’s Iain was a cardiology trainee. surgery at the University Hospital success and a fondness and respectHe became involved with the cardiac of Wales. They developed effective for Iain. Iain loved a drink whethersurgical programme through his programmes of coronary artery surgery beer, wine or malt whisky, alwaysinvolvement in running the heart- and prosthetic valve replacement entertaining and hospitable.lung machine and almost accidentally eventually reporting on one of thebecame involved with the cardiac largest series of Medtronic-Hall valves in Even in retirement Iain maintainedsurgical programme developed the world. his links with colleagues at UHWby Professor Hugh Bentall at the and colleagues were delighted toHammersmith. Iain went on to train Iain was an outstanding doctor, welcome him as an honoured guestat the Brompton Hospital and Great academic heart surgeon and senior to the inaugural meeting of the WelshOrmond Street working with Jarda Stark colleague. He was meticulous in Cardiothoracic Society in the Vale ofand many of the leading figures in assessing patients for surgery. He was a Glamorgan as recently as November lastUK cardiac surgery of the time. It was careful and extremely effective surgeon. year.during this period that Iain met his His methodical and systematic approachbeloved late wife Elizabeth working as was hugely beneficial to trainee Iain was predeceased by his wifea nurse. surgeons and he was extremely popular Elizabeth in 2007 and leaves 5 children with his trainees. He cared for his and 9 grandchildren. Iain died in UHW,At the end of his training, Iain patients any time of the day or night the hospital where he had spent hisundertook what was something of a on the intensive care unit and this was whole consultant career, after a shortpilgrimage to undertake a fellowship in the time before full time intensive care illness.Birmingham, Alabama with John Kirklin. specialists when the surgeons had aAt the time Birmingham was the leading major role in the care of their patients. Alan Bryancentre in the world for cardiac surgery He was keen to adopt new techniquesand in particular for paediatric cardiac and when colleagues had been away Indu Deglurkarsurgery and many outstanding surgeons to learn new techniques he was alwaysfrom that era worked or spent time eager to see these integrated intowith John Kirklin. After a successful his practice. Iain was never afraid tofellowship Iain was appointed support his registrar or senior registrarConsultant Cardiac surgeon at the UHW to undertake new procedures with him ifin about 1972. At the time he was one he had confidence in the individual.of the first fully trained truly moderncardiac surgeons ushering in the modern Although on occasions a fearsome figureera. With cardiological colleagues like Iain was loved by nurses, and traineeLG Davis he immediately set about surgeons alike. He always supported hisdeveloping a programme of paediatric team and was generous in his praisecardiac surgery and performed some when things went well. Iain was alsoof the first complex repairs in infants very committed in his support in theSCTS Bulletin 0716.indd 49 18/07/2016 12:04

50 theBulletin Samer NashefThe Crossword Send your solution by 31 December 2016 to: Sam Nashef, Papworth Hospital, Cambridge CB23 3RE or fax to 01480 364744 Solutions from areas over 10 miles from Cambridge will be given priority.Across Down8 Musical creatures (4) 1 Dressing from the county clinic (4)9 Arouse woman to secure consent (5) 2 Hoping for drug note (8)10 Return of number 1 lord (head, of 17?) and one of the big 3 The old blokes and one Arab (6) 8 (4) 4 Their (y)ears are long (7)11 B14 like 32 (6) 5 Yet their collars may be blue! (8)12 Most perverse family that is in Grand Street (8) 6 No bail out for this country (6)13 Only bit I represented is the aristocracy (8) 7 Follows setters, perhaps (4)15 Like 7 in African inefficiency (6) 14 Love grape bearer, like 31 (5)17 Dig monk out of this country, say (7) 16 Final life for 8: the next one (5)19 Like 1,9 like 4 (7) 18 Eggs may be too simple (4,4)22 The Spanish in penalty like 8 (6) 20 Pest annoys us and 15 (8)24 Broadcast secure, without loopholes (8) 21 Dutch Amsterdam’s pet (7)26 How his personality welcomes rumours (8) 23 Cell groups topped the subjects under discussion (6)28 Pennies evolve (6) 25 Ready essential cooking instruction providing excellent30 They are quiet in church, our fellow planners (4) easy starters (6)31 They are easily led in quiet backwater (5) 27 Welcome precipitation (4)32 Stock bullies (4) 29 Garment that’s good to have (4)SCTS Bulletin 0716.indd 50 18/07/2016 12:04