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JOINT 2015
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JOINT
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British Orthopaedic Trainees Association
British Orthopaedic Association Offices
25-43 Lincoln’s Inn Fields
London, WC2A 3PE
020 7405 6507
bota.org.uk
JOINT
3
4
JOINT
Chapters
Incoming Presidents Address
7
Committee Reports and Profiles
9
Linkmen Reports
39
Educational Congress
55
Reviews67
Prizes and Bursaries
83
Education and Training
103
Dates for the Diary
114
JOINT
5
Editor’s Report
Sara Dorman
Welcome to this years edition of JOINT.
I would like to take this opportunity to thank
all our contributors who have taken time
out of their busy schedules to provide such
interesting articles for this year’s JOINT.
The aim of the journal is to keep trainees up
to date with the work of the committee but
also to raise awareness of current topics that
are relevant to all orthopaedic surgeons in
training.
This year BOTA have awarded
a record number of prizes
and grants, which I would
encourage, all of you to apply
for in the upcoming year.
Some of the featured articles in the review
section highlight the important work that
BOTA has been doing throughout the year
including our survey findings on WBA’s. In
particular, the linkman roadshow makes
for some extremely interesting reading,
highlighting huge variations in training and
opportunities around the UK. It is certainly
an opportunity for all of us to learn from
examples of good practice and consider how
we can engage to improve our own regions.
I would also like to draw your attention to the
prizes section. This year BOTA have awarded
a record number of prizes and grants, which
I would encourage, all of you to apply for
in the upcoming year. As you will see from
the winning reports the experiences and
opportunities gleaned are fantastic and not to
be missed.
I would also like to thank industry for their
continuing support towards BOTA, without
whom this publication would simply not be
possible. Finally I would like to thank Excel
Publishing who have been instrumental in
fundraising, and graphic design.
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6
MSc Trauma & Orthopeadics ad A5.indd 1
JOINT
14/04/2015 10:40
Incoming President’s Address
Mustafa Rashid
Dear BOTA members,
Thank you for your support over the last year.
It has been a busy year in terms of activity.
I know we have faced some challenges that
have been difficult to navigate, including the
UKITE changes, ST3 National Recruitment,
and the Shape of Training Review. We have
also been working very hard to ensure that
our members’ views are represented at the
highest levels including at the Specialty
Advisor Committee (SAC), Joint Council for
Surgical Training (JCST), British Orthopaedic
Association Council (BOA), Royal College
of Surgeons Council (RCSEng Council), and
many more.
I implore you to get involved
with BOTA through your
Linkmen, through the BOTA
Committee, and at our
events including the BOTA
Educational Congress.
Contact us to let us know your
thoughts on key issues that
affect you, and we will do our
best to make sure you are
represented. In the next year
I pledge to you that BOTA will
be more visible in its activity.
Having attended numerous meetings
myself in the last year, I can tell you that
we certainly do have a voice. The trainee
opinion on training matters is valued by the
chairpersons of these committees. We also
have some great opportunities to influence
major changes that affect all of our working
professional lives. Having spent the last few
years on the BOTA Committee, and especially
during my time as Vice President, I am all
too familiar with the level of apathy amongst
Trauma & Orthopaedic trainees in the UK. It
is important to remain optimistic, engaged,
and united going forward. Our voice is only as
strong as the large, cohesive, collective group
we need to be. Do not let others convince you
that it does not matter what you say. It does
matter to us and to the people who look to us
for advice on certain trainee issues.
I implore you to get involved with BOTA
through your Linkmen, through the BOTA
Committee, and at our events including the
BOTA Educational Congress. Contact us to
let us know your thoughts on key issues
that affect you, and we will do our best to
make sure you are represented. In the next
year I pledge to you that BOTA will be more
visible in its activity. We will strive to get more
trainees engaged to strengthen our position
at the table. We will endeavour to provide
you with up to date, accurate, and timely
information that affects you. Finally, we will
support you in every way we can. This means
through educational activity via courses (new
and established), through www.BONE.ac.uk
to help you complete audit and research
projects with minimum hassle, and through
our established channels of communication.
I hope you enjoy reading this annual BOTA
yearbook and all the pearls contained with
it. I look forward to seeing you at the BOA
Congress in September (check out our
session: “What does good Orthopaedic
Training look like?” A local, regional, and
national perspective), and at the BOTA EGM
on Saturday 9th January 2016 (Manchester
Conference Centre). If you wish to contact
me directly, I would be more than happy to
discuss any matters with you. My email can be
found online at www.bota.org.uk
Kind regards,
Mustafa Rashid
BOTA President 2015/16
JOINT
7
8
JOINT
Committee Reports and Profiles
Presidents Report
11
Past Presidents Report
13
Vice President Report
14
Treasurer’s Report
16
Secretary Report
18
Specialty Advisory Committees (SAC) Representative
18
British Medical Association (BMA) Representative
19
Academic Report
20
Educational Report
22
Web Report
24
Junior Report
25
Northern Ireland Representative Report
26
Scottish Representative Report
27
Welsh Representative Report
27
BONE Report
28
Incoming Committee Profiles
30
BOTA Position Statement
34
JOINT
9
President’ s Report
Peter Smitham
As I sit in a road service station on my way
back from the fantastic PanCeltic meeting in
Cardiff, waiting for a Skype call with the BOA
and the Royal College of Surgeons of England
on Shape of Training, I am reminded of David
Machin’s report when he was President of
BOTA. He mentioned that during the year he
had around 52 face-to-face meetings and over
9000 emails within the year. I cannot say I
have been counting but it certainly has been a
rather busy year.
BOTA has had a strong year and this would
not have been possible without a fantastic
committee forging ahead on a number of
projects simultaneously. This year we have:
• A new BOTA leadership course free to all
linkmen
• A new website
When talking to all the
Linkmen, what was
interesting was to find out
how proud everyone is of
their respective training
programmes and yet how
much variability there is
around the country in terms
of teaching and training
opportunities. The linkmen
have a tremendously
important position and are
key to relaying information
about the region to the
committee and in helping us
provide information about
the latest opportunities or
national important issues
that need to be raised.
• More fellowship and prize opportunities
than ever before for members
• A grant from ORUK in conjunction with
the BOA to develop a series of video and
podcasts
• Involvement in developing national
audits and research projects through
BOTA’s British Orthopaedic Network
Environment (BONE.ac.uk)
• Increased presence within the Federation
of Orthopaedic Trainees in Europe
• Undertaken a linkmen roadshow
interviewing almost all the linkmen from
around the country through a series of
Skype calls.
When talking to all the Linkmen, what
was interesting was to find out how proud
everyone is of their respective training
programmes and yet how much variability
there is around the country in terms of
teaching and training opportunities. The
linkmen have a tremendously important
position and are key to relaying information
about the region to the committee and in
helping us provide information about the
latest opportunities or national important
issues that need to be raised. We are
constantly looking at ways to improve our
communication with members and welcome
any suggestions.
It has also been a year for developing stronger
collaborations with other national trainee
organisations. This has been particularly
important given the Shape of Training (ShOT)
review and at the beginning of the year the
trainee and consultant contract negotiations.
For the first time we have an agreed
consensus statement from 15 different trainee
organisations and have launched a truly
national survey on the subject of ShOT. BOTA
have been key in constructing a workshop on
Creative Supportive Environments that will be
held in September by the Academy of Trainees
for Royal Medical Colleges.
Apart from a great committee this role would
not have been possible without the support
of my TPD, Prof Briggs. Given the level
of commitment required to be President
and knowing that this was also going to be
a busy year with my exams and research
commitments, I could not have done this
without his support. To ensure I kept my
logbook numbers up I attended extra lists on
weekends and took minimal holiday leave.
Luckily, bar a few bumps along the way, it has
been a good year. Finally, Helen and the kids
have been immensely patient this year and
living without a kitchen for 5 months during
a house conversion would test anyone’s
reserves and she has been a rock throughout
the year.
JOINT
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Past President’s Report
Jeya Palan
This year has been an immensely busy one
for the BOTA committee with many changes
afoot, not least with Shape of Training and the
issues surrounding national selection at ST3
level. BONE (British Orthopaedic Network
Environment) has really taken off with almost
480 members now signed up and several
projects up and running and will continue
to develop and grow over the next year. My
time as a member of the BOTA committee is
now at an end and it has been an enormous
honour and privilege. I have formed many
close friendships and met truly remarkable
people, who inspire, lead by example and
have training at the heart of everything they
do. Under the strong leadership of Peter
Smitham and the hard work and dedication
of the BOTA committee, BOTA has gone
from strength to strength. The revamped
website and JOINT are a shining testimony
of just how professional and effective an
organisation BOTA has become over the last
few years. This year’s Educational Congress
at Carden Park was fantastic, both in terms of
the educational lectures and workshops but
also as a social event celebrating the fraternity
that is Trauma and Orthopaedics. I have to
admit that the occasion was also tinged with
an element of poignancy, as this will be the
last time the BOTA Educational Congress will
be hosted at Carden Park, which has been
a glorious venue over the last few years and
will be missed. The new BOTA committee is a
force of nature with a proven track record on
delivering and with trainees passionate about
driving BOTA forward. Our new President,
Muzzy Rashid, will be very successful this
year and I wish him and the rest of the new
committee the very best of luck for this year.
It has been great fun!
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JOINT
13
Vice-President’s Report
Mustafa Rashid
There was fervent debate about the use of
the unique patient identifier on eLogbook
with an external body requesting a review
from the JSDGC to consider its removal. It
was felt that the eLogbook and ISCP systems
were sufficiently secure and that it would
require multiple systems breaches to be able
to match a patient to an operation. Secondly,
BOTA raised concerns about what would
be lost if the unique patient ID were to be
removed. Specifically, being able to track your
operations and reflect on your complications,
reviewing X-rays from previous cases for the
purposes of reflective learning, recording late
post-operative complications, and validation
of the operative record would be impossible.
The committee decided to leave the unique
patient identifier on ISCP but would review
the issue again in the future if needs be.
This past 12 months has been one filled with
lots of activity, both in terms of committee
meetings, challenges to training, and
responsibilities that come with the position.
Moving from Education Representative to
Vice President allowed me to continue to
build upon the strong relationships I had
cultivated with the BOA administrative staff,
Education Committee, and Mr. David Large
(T&O SAC Chair) to help get our training
issues heard at a national level. These would
prove to be essential in what I believe was a
successful year in the role. The Vice President
role is one that is very meeting heavy with the
Joint Surgical Data Governance Committee
(JSDGC), the ISCP Management Committee,
the JCST Quality Assurance Group, and the
JCST, all having regular meetings throughout
the year.
Joint Surgical Data Governance
Committee (JSDGC)
The JSDGC is an interesting committee
chaired by a Caldecott guardian and
experienced general surgeon. Some
interesting points came out of these
meetings. Specifically, BOTA members should
be aware that on getting to the end of the
road and starting up your consultant practice,
remember to register yourself, places of work,
computers that store patient information
with the Information Commission Office
(ICO). This is a legal requirement and can
carry a hefty fine if not done. The ICO is the
government body that fines trusts, individuals,
and organisations for mishandling data.
This committee has mandated that all surgical
examination bodies must now store and keep
a record of patients’ informed consent when
using patient video/photographs/x-rays/case
notes for the purposes of examinations.
14
JOINT
The issue of trusts requesting access to a
trainee’s training portfolio at consultant
interviews was also discussed and it was
agreed that this was inappropriate.
ISCP Management Committee
These meetings were very interesting and
yielded some important points that BOTA
members should be aware of. V10 of ISCP will
be launched soon in August, if all goes to plan.
This will include a major change to the MSF
format. The minimum number of raters for
a MSF to be signed off is going up from 8 to
12. This is to increase the breadth of feedback
being inputted into the assessment. This was
a difficult point to argue against, as they were
adamant this would improve the quality of the
MSF. The committee initially discussed the
idea of the AES being able to add, change, and
delete raters the trainee puts forward for the
MSF. I passionately debated against this, as it
would potentially be abused by some, to bully
trainees they had clashed with. The consensus
that was reached was that the AES would sign
off your MSF after feedback from 12 raters
(in a variety of healthcare professional roles)
were met. If the feedback, or breadth of
raters were inadequate, they could re-open
the MSF and request you add more raters
(for example, a couple more theatre staff) to
help you get a more balanced multi-source
feedback assessment.
JCST QA Group
There are concerns raised by this group about
the decline in JSCT Survey responses as it
was felt that this survey is a very good one to
determine surgical trainees satisfaction with
certain posts/hospitals. V10 will cue trainees
more clearly to fill in this survey every 6
months. Aside from the GMC survey, I feel
this one is the one most likely to lead to some
action in poorly performing posts as TPDs
have access to the results and are implored to
act on them.
The QA group has unanimously voted to
start inclusion of logbook data to help quality
assure posts for training. This will be initially
at department level but may be expanded
to trainer level and could be used by TPD as
evidence to pull certain low volume, low value
posts from their programmes.
JCST
The JCST is the overarching group that
devolves certain responsibilities to the
individual SACs. These meetings usually
focus on wider issues such as the Shape of
Training Review, which you will be glad to
read was also vehemently argued against at
the April meeting. Many consultants felt that
this would lead to a dumbing down of surgical
training and what it means to be a consultant.
Unfortunately, even the concerns of the JCST
could not stop this proposed overhaul to
postgraduate medical training to be halted.
Other issues being discussed are how to solve
the staggering of training posts start dates,
as it was felt that this would help reduce the
challenges around changeover time, especially
on the first Wednesday in August. No firm
proposals have been agreed upon to date.
Mr. Large raised some concerns at the April
JCST meeting regarding two matters that
affect T&O trainees currently. In the last 2
years there have been a handful of very senior
SAS doctors being successful in attaining a
NTN. They often ask for a signed form from
their TPD to count their previous experience
for up to 4 years of StR training (effectively
becoming ST7) and going down the CESR(CP)
route rather than CCT. Mr Large conveyed
concern from TPDs that this process should
be changed to reflect the robustness of the
CESR applications process. Work is being
down to make sure that “previous experience”
surmounts to more than just a form signed
by the TPD, and more in line with the body of
evidence that SAS doctors have to produce to
get awarded a CESR.
Secondly, Mr. Large also raised concerns about
ST3 trainees re-applying for national selection
in order to get a NTN in a region they prefer
to work in. This was felt to be “loophole” that
should be closed and such transfers should
be handled through the new inter-deanery
transfer system. BOTA junior members should
be aware that this loophole is likely to be
closed to be in line with the other surgical
specialties. If you apply for a NTN and rank
a particular deanery, be prepared to take up
that post if you get it. If you feel that you
would never want to work in a particular
region, then do not rank it as it is likely, in
the future, you will have to complete your 6
years of StR training in that region without the
option of re-applying for ST3 again.
BOTA Linkmen Clinical Leadership Course
Awards, Roadshows, and Other Activities...
This year I organised a course to give something back to our Linkmen
that have given up so much of their time, and put in a lot of effort,
to ensure their region is up to date with the latest training issues
through BOTA. The Linkmen Clinical Leadership course was held
on 9th January 2015 in the Manchester Conference Centre with the
help of a great and engaging faculty consisting of, Lisa Hadfield-Law
(BOA Educationalist), Prof. Phil Turner (BOA Education Faculty), Mr.
Mike Reed (TPD Northern Region and BOA EdComm Chair), and Dr.
Hesham Abdalla (Senior Lecturer at NHS Leadership Academy). The
course covered various aspects of clinical leadership, ways of impacting
change within the NHS, how to run a service improvement project,
and was tailored to suit the needs of Trauma & Orthopaedic Specialist
Trainees. The day was great fun and everyone found it very useful. The
course was followed by the Linkmen Dinner in the evening at Bem
Brasil (awesome Brazilian steakhouse in Manchester) and was a great
chance for the BOTA Committee to get to know some of our Linkmen.
The course will be running again next January (2016 in Manchester)
and every region will be invited. If your Linkmen cannot attend they
have been instructed to offer their place to a trainee from their region
to take up the slot on this fantastic course.
I have summarised my year as VP in this article in terms of the
discussion, and outcomes, of the many meetings and committees
I have been part of in the last 12 months. As VP, I have had the
pleasure of running the 2015 BOTA Trainer of the Year award, as well
as introducing a new award: The 2015 BOTA Training Programme
Director of the Year award. You can read about these awards and the
processes involved in decided them in JOINT. As Vice President, I have
embarked on a project called the BOTA Linkmen Roadshow Project,
which I will report on in a separate article in JOINT. This is a series of
teleconferencing events with all 28 BOTA Regional Linkmen. These
were conducted over the course of 9 months with myself, and Pete
Smitham (BOTA 2014/15 Past President). Each took around 60 minutes
and followed a structured 21-point agenda. The outcomes of this
project were fascinating and has shed a bright light on the tremendous
variability in training between regions. A more detailed report on the
2015 Linkmen Roadshow Project will be in JOINT and I urge you to
read it to find out about the key themes that became apparent.
It has been an absolute pleasure to represent BOTA members and
Orthopaedic trainees as the BOTA Vice President this year. It has been
a rewarding experience despite the challenges we faced with Shape
of Training, ST3 National Selection, and UKITE changes. I can assure
you that our collective voice is heard at the highest levels, and is
strengthened by your engagement. I strongly urge everyone to speak
up, raise issues with BOTA, and help us understand how you want to
be represented nationally.
BOTA Linkmen with Lisa Hadfield-Law, and Prof Phil Turner at the BOTA Linkmen Clinical Leadership Course.
JOINT
15
Treasurer’s Report
Steve Kahane
Our sincere thanks go to our sponsors
without which the Educational Congress
simply could not happen. Our sponsors for
2015 were as follows:
Diamond Sponsor:
B Braun
Platinum Sponsor:
Heraeus
Gold Sponsors:
Stryker, Orthofix, Zimmer
Silver Sponsor:
Arthrex
Bronze Sponsors:
AO UK, Acumed, CeramTec
The Association’s accounts remain in a strong
position. The issue regarding the UKITE
exams meant that in order to sit the exam,
trainees would need to be BOA members.
Whilst this slightly boosted our membership,
we must stress that this was not our decision
and actually, one we opposed, but it looks like
it is here to stay.
The committee has worked extremely hard to
secure £42,000 in sponsorship from industry
for the Annual Educational Congress. Due
to the splendour of Carden Park and the
fact that it has a spa and golf course on site,
we faced massive hurdles with compliance
departments, in gaining support from
industry for the Congress. Many companies
dropped out suddenly from what would have
been a record-breaking sponsorship total
and smaller companies admitted feeling the
financial pressure in these difficult times,
often being unable to compete due to the
strength and budgets of the larger companies.
Next year, as a result of these issues, we will
be moving to a venue that EthicalMedTech
deem compliant and hope some of the
companies that could not attend this year
will be able join us then. It also offers the
opportunity to expand the programme, which
should allow more trainees to attend than
Carden Park can currently accommodate.
The Royal College of Surgeons also helped by
providing the lanyards and bags this year for
which we are extremely grateful.
The whole weekend costs over £80,000 and
is completely not for profit. We run it for the
benefit of our members with the remainder
of the balance being covered from funds
generated through our membership. Ticket
sales for the weekend generated £24,528.81 in
total and combined with the sponsorship total
meant the accounts covered the remaining
shortfall of £13,471.19.
We have also generated a large income from
online advertising, which has provided close
to £6,500 this year.
My role as treasurer has been made much
simpler this year by our bank’s decision to
finally allow a business account user access
to internet banking. This has significantly
speeded up transactions and allowed my time
to be spent much more efficiently.
As in previous years we provided three
bursaries of £500 each to medical students
going on an Orthopaedic-themed elective.
We also pay one Euro per member to the
Federation of Orthopaedic Trainees in Europe
(FORTE) on your behalf.
After the sad passing of our friend and
colleague Andy Sprowson, who was Associate
Clinical Professor at Warwick Medical School
and a consultant trauma and orthopaedic
surgeon at the University Hospitals of
Coventry and Warwickshire NHS Trust ,
we donated £250 to “The Andy Sprowson
Fellowship” which will award a fellowship
every year to a young orthopaedic surgeon,
physiotherapist or nurse who will learn
something new or do some research that
will help to improve the care of orthopaedic
patients. This has raised over £12,800 to date.
Beside the expenses listed above, the
remainder of our expenditure covers travel
and accommodation for 16 committee
members, allowing us to make the many
important meetings that we attend on
your behalf and to meet up throughout
the year. This year we met at the Royal
College of Surgeons of England, the BOA
in Brighton, Dundee, Manchester (at the
BOA Instructional Course), Cardiff and
immediately prior to the Educational
Congress in Carden Park. The total cost to
date (excluding the Carden Park meeting) is
£11,172.39 (compared to £17,015.50 in 2014
and £15,838.99 in 2013). We remain mindful
of our responsibility to reduce outgoings
wherever possible. Committee members are
encouraged to advance-book train tickets, we
always advance-book hotel rooms, and we will
continue to seek additional ways to control
costs over the coming year.
We changed providers for this current
edition of JOINT and will now be making a
small profit on this having outsourced the
publication to Excel Publishing. We agreed a
rate of 25% on all earnings above £12,000 and
as of writing this they have already generated
over £15,000 (£750 profit so far) with more
adverts still expected.
Please also remember that the NUS have
formally recognised BOTA as a Student’s
Union and BOTA members are therefore
eligible to apply for an NUS card. Please
see the BOTA website for details on how to
do this but I am sure many are not taking
advantage of this exceptional deal!
If there is any particular issue that you feel
BOTA should be spending time or money
on then please get in touch by email at
[email protected]
16
JOINT
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modules which deliver highly practical teaching delivered by clinician
educators deeply committed to improving trauma care. The modules
will take the students through the range of trauma experience from the
most severe in extremis situations in the initial module to complex plastic
surgery and bone reconstructive options in the concluding module.
Cadaveric teaching is a central feature supplemented with detailed
simulations of the resuscitation scenarios and surgical procedures. Those
wishing to conclude their studies after this taught component may exit
with the diploma. Those who were enrolled for the MSc will undertake
a dissertation to complete the programme. Each module consists of
five days, and the curriculum has been planned so that each day has a
particular theme. It is possible to register for individual themed study days
without enrolling on the MSc/Diploma programme.
Trauma - The Disease
PMTM01
Trauma - The Turning-Point
PMTM02
Trauma - Healing &
Rehabilitation PMTM03
Regional Trauma PMTM04
Definitive Reconstructive
Trauma Surgery PMTM05
19th - 23rd Oct 2015
11th - 15th Jan 2016
29th Feb - 4th March 2016
11th - 15th April 2016
19th - 23rd Sep 2016
Trauma as a Disease.
Mechanism of Injury, Massive
Haemorrhage and the
Inflammatory Response to
Injury
The Unstable Patient:
Enhanced Care- Transport
& Transfer. Intra-operative
Decision-making. Multiple &
Mass Casualties
Road to Recovery- Surgical
Strategy, Pain Control and
Rehabilitation
Multi-system Trauma including
Trauma to the Thorax &
Abdomen
Limb Salvage: Problem
Analysis, Concepts and
Treatments
In Extremis: Immediate control
of catastrophic bleeding &
traumatic cardiac arrest
Damage Control for
Haemorrhage Above & Below
the Diaphragm
Closed Fractures- Bone
healing, treatment and
non-union
Traumatic Brain Injury &
Craniofacial Trauma
Plastic Surgical
Reconstruction: Local Flap &
Free tissue Transfer
Pelvic and Lower Limb
Junctional Haemorrhage
The Dysvascular Limb,
Damage Control External
Fixation & Compartment
Syndrome
Traumatic Wounds,
Debridement and Open
Fractures
Hand and Wrist Trauma
Circular Frames and Frame
Assisted Nailing in Lower
Limb Trauma
Thermal Injury, Traumatic
Wounds and Diagnostic
Imaging in Trauma
Trauma Critical Care, Damage
Control versus Early Total Care
& Interventional Radiology
Psychology of Injury, Recovery
& Disfigurement. Chronic pain,
PTSD and Amputation
Spinal and Brachial Plexus
Injuries
Complex Articular Fractures:
Acetabulum & Distal Femur
For further information please contact Ceri Jones, [email protected], 01792 703904
JOINT
17
Secretary’s Report
James Shelton
As Honorary Secretary for BOTA it has
been my task this year to organise the
logistics of our six meetings of the year
(predominantly chasing the committee for
reports!!) and supporting the rest of the
executive committee in their activities. I
also field queries from the membership,
industry and other specialist societies on
behalf of BOTA. I suppose that, in addition
to these roles, the secretary also has a
responsibility to ensure we minimise the
committee expenses for meetings so we
can put more equity into the Educational
Congress. This year we have been most
stringent with grade of accommodation
and location of meeting rooms in order to
minimise expenses and I am proud to report
that despite having an additional committee
member we have collectively reduced our
committee expenses by over £5000. Whilst
some of this has been recuperated through
“I would like to offer my
deepest thanks to the
outgoing committee and
congratulate all those who
have been elected this year.”
a London heavy committee minimising
travel costs I believe, through taking
advantage of advanced booking offers
for accommodation, we have been able
to significantly reduce our expenditure. I
would like to offer my deepest thanks to
the outgoing committee and congratulate
all those who have been elected this year.
Our goal this year is to re-engage with the
membership so if you have a question or
issue get in touch!
SAC Representative
Jerome Davidson
SAC
This is the workhorse of this role and the
meetings often stimulate vivid debate.
Core issues that have been discussed this year
included
1. Logbook numbers
Operative experience as evidenced by
trainee’s logbooks is a key feature of training.
Since the introduction of indicative numbers
it has certainly focussed the mind with
regards to this. There is national variation
amongst regions, which is understandable.
However most indicative numbers and overall
numbers were generally being met by training
programmes. As such the SAC has agreed to
not change the current numbers.
It has been my pleasure following on
from Nicholas Ferran as the BOTA SAC
representative over the last year. This was not
an easy task to follow, as my predecessor was
an excellent and well-experienced member of
the BOTA committee.
It has been a busy year as with this role I
have been fortunate to represent BOTA on
the Specialist Advisory Committee (SAC),
Intercollegiate Specialty (ISB) for Trauma &
Orthopaedics, and the Joint Committee on
Intercollegiate Examinations (JCIE)
18
JOINT
It has been noted that there are no indicative
numbers with relation to paediatric
orthopaedic experience. The SAC has
therefore agreed that there should be at least
1 indicative number that relates to Paediatric
Orthopaedics. Discussions regarding this are
on going but currently the likely procedure
will be a manipulation of a distal radius in a
child.
2. Validation of Logbooks
The SAC would like trainees to move from
paper validation of cases to using the
e-logbook electronic verification of cases. The
aim is to improve the integration between
ISCP and the logbook in order to make this
process easier.
3. Major Trauma & CCT
Currently there is a critical CBD on the
physiological response to trauma as part
of the CCT guidelines. The revision to the
curriculum in 2017 is likely to reflect major
changes in relation to trauma experience
and a critical CEX in major trauma may be
introduced.
4.Fellowships
The SAC continues to be of the view that
Fellowship training should be post CCT,
with the exception of National Interface
fellowships.
Intercollegiate Specialty Board (ISB) in
T&O / JCIE
This has been one of the most enjoyable parts
of this role. Studying for “the exam” filled so
much of my life that it was great to see what
happens behind the scenes. There is a lot of
effort placed into maintaining the internal
validity of the examination process.
New developments in the examination are the
use of standardised images, which I think has
made a real difference. There is currently on
going work into the use of standardised short
video clips.
I would encourage all senior trainees to
consider applying for this position once
they have passed their FRCS examinations,
as although a demanding role, it is a highly
rewarding one.
JOINT
18
BMA Representative
Marshall Sangster
The MSWG has worked tirelessly on the interdeanery transfer system with 50% of transfer
requests being successful in the last round.
The big area of concern is Core Surgical
Training and some higher training posts
going unfilled in the last round. Orthopaedics
has retained a 100% fill rate at the moment.
Poor quality Core Surgical Training posts is
something BOTA intends to highlight during
the upcoming year, maintaining our stance
on education and training as a top priority
in 2015. The CT’s of today are the registrars
and consultants of the future so lets support
them.
This year has been an exciting time at the
BMA. I was chosen to represent BOTA for a
second term at the Educational Congress at
Carden Park in June 2014. My second tenure
as BMA representative has been much more
productive. Building on my understanding
and contacts gained during my first year I was
able to have a greater impact during the BMA
Multi-specialty Working Group (MSWG) and
BMA Junior Doctors Committee meetings.
For a second year the JDC’s main focus has
remained on the junior doctors contract.
Despite the breakdown of the contract
negotiations last year, it is likely that the
BMA will return to the negotiating table. This
continues to be a very difficult process. As the
BOTA BMA representative, I have highlighted
the needs of surgical trainees and how
changes in the contract could help us.
The BOTA BMA representative observes on
the Junior Doctors Committee therefore I
would encourage orthopaedic trainees to
stand for local election to the committee so
we can have more of a say!
“The BOTA BMA
representative observes on
the Junior Doctors Committee
therefore I would encourage
orthopaedic trainees to
stand for local election to the
committee so we can have
more of a say!”
The Shape of Training review Led by Professor
David Greenaway has undergone a big
revamp since BOTA, ASIT and the BMA
condemned a significant number of its initial
recommendations. The suggestions BOTA
put forward look to have had a significant
impact. Orthopaedics has been singled out as
an excellent training system with all trainees
competent in the generality of trauma with
a subspecialist interest that can be tailored
to the needs of local hospitals. BOTA will
continue to engage with the Royal Colleges
and the BMA to steer Shape in a positive
direction.
I will continue to be involved on the BOTA
committee for another year, this time as
your SAC rep. I am really looking forward
to working with the new President Muzzy
Rashid, and I think we can make some great
changes over the next year. I will continue
the fight to improve trainee conditions and
resist change that will affect the needs of all
BOTA members by supporting James Shelton
the new BOTA BMA representative.
I would encourage you all to get involved at
the next Educational Congress. BOTA needs
the voice of its members to engage with the
BMA so we can stay one step ahead.
JOINT
19
Academic Report
Payam Tarassoli
Although having never attended a BOTA
Congress, a good friend and colleague (who
has since moved North due to a tragedy of
national selection) impressed upon me the
multitude of merits which made it a “mustgo-to” event and so I signed up. I was not
in the least disappointed, and furthermore,
I found myself driving back from Chester
the new academic representative for BOTA.
How had this happened? I suspect that my
speech was simply more amusing than my
opponent. Nevertheless, I have always been
heavily involved in academia and believed that
I could dependably represent trainee interests
nationally.
“For my election speech I
promised to increase medical
student involvement with
BOTA if appointed, and I like
to think I have delivered with
that respect. BOTA offers 3
prizes for elective bursaries
and this year we had almost
30 applications for the prize,
the highest number of any
year and almost twice the
average since the prize was
introduced. Furthermore, we
have increased the number
of student collaborators on
BONE, our research network,
and have launched the very
first student-led multi-centre
audit.”
20
JOINT
So enough about me, what has the job
involved this year? Well, Ramsay, the outgoing
Academic Representative did make a passing
comment about receiving more emails.
Perhaps a slight understatement. Organisation
is certainly key. Immediately I found myself
inundated with queries, having to chase
prize winners and ensure I booked leave well
in advance to attend all the meetings this
position required. This continued throughout
the year, and in a way, I’m thankful for
the ninja-like email response rate I have
developed since taking on the job.
The past twelve months hasn’t seen many
drastic changes to the academic climate from
when I took over. Indeed, with the maturation
of the clinical trials units and the publication
of studies such as PROFHER and DRAFFT,
there has been much more involvement
nationally to bring forward projects and get
structured, well-co-ordinated collaborative
work to the forefront of future research. The
trials units have also organised some excellent
courses, which I highly recommend to BOTA
members having attended one myself this
year.
I have had the privilege of sitting on a variety
of research committees this year. After
taking over from Ramsay, the first call of duty
was attending the annual meeting of the
BORS committee in Bath. It was interesting
to interact with a number of non-clinical
researchers and I learned about the BORS
travelling fellowship, a previous recipient
of which is none-other than our current
president Peter Smitham. A prestigious award
which allows one clinician, allied health
professional, bioengineer and bio-scientist to
travel together to leading centres around the
world in order to develop collaborations and
gain valuable insight into different research
environments. BORS have been key to
developing Bone and Joint Research (BJR),
an open-access journal under the umbrella
of the BJJ, which has offered BOTA, the
opportunity to publish without cost in the
journal for three selected papers from our
members. One of these was awarded to the
winner of this year’s podium presentation,
Parag Jaiswal. We encourage all our members
to submit original manuscripts if they want to
be considered for this in the coming year.
The RSM Orthopaedics section has continued
to flourish and expand, with some fantastic
educational events for trainees and students
alike. The Future Orthopaedic Surgeons
Conference was particularly well attended
and there has been much positive feedback
from trainees with regards to the Trauma
Symposium. In addition, the presidents
prize papers have this year attracted more
applicants and going forward the section seek
to promote further trainee involvement so I’m
sure we will hear more them this year.
In addition to assessing abstracts for the BOA
and BORS conferences this year, I have also
had the pleasure of judging the Cambridge
Orthopaedic Writing Prize which ran on the
title theme of “healthy living sucks”. Certainly
made for some amusing bed time reading!
One particular change that I have brought
about this year, and one which I’m quite
proud of, is developing closer ties to
Orthopaedic Research UK, who have been
particularly generous at increasing the
prizes for our Educational Congress. For
the first time we have been able to award
five prizes for posters and three for podium
presentations. They have also pledged to
support the development of a smartphone
app for BOTA which we hope to introduce
before the end of the year.
For my election speech I promised to
increase medical student involvement with
BOTA if appointed, and I like to think I have
delivered with that respect. BOTA offers 3
prizes for elective bursaries and this year we
had almost 30 applications for the prize, the
highest number of any year and almost twice
the average since the prize was introduced.
Furthermore, we have increased the number
of student collaborators on BONE, our
research network, and have launched the very
first student-led multi-centre audit.
Having been elected to a second term
(occasional comparisons to Sepp Blatter
have not gone unnoticed), I am quite excited
to achieve even more, considering that
there will be no learning curve (which has
been particularly steep!). Therefore watch
this space for more prizes, more student
involvement, the BOTA smartphone app, and
if all goes to plan, a BOTA funded research
fellowship.
2015
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2. Orthopaedic Data Evaluation Panel. ODEP product ratings. Available
from URL: http//www.odep.org.uk [Accessed 23/06/2015].
Educational Report
Simon Fleming
The other hot topic this year, that involved
not only the Education Representative but the
entire committee, was UKITE. A contentious
topic, this year, for the first time, was that
persons wishing to sit the exam had to be
a BOA member. There have been multiple
meetings on the topic of UKITE this year and
following the last meeting I will summarise
the relevant points
• There are 15,000 questions in the
question bank, many more than the FRCS
in fact;
• After a great deal of negotiating, trainees
will not be expected to write questions.
However, UKITE (and BOTA) is looking
for enthusiastic question writers, who
will be provided with portfolio evidence
that they held a formal role as a question
author.
It has been a rollercoaster year for the
education side of BOTA’s activities and I have
loved every, single minute of it. As I write this,
I have just left Carden Park, after another
hugely successful Educational Congress,
the highlight of the year for any Education
Representative (and also the cause of the
most sleepless nights…)
As always, the Education rep sits on the BOA
and Royal College of Surgeons Education
Committees, as well as the TSC (the Training
Standards Committee). The year started with
Education Committee sharing their vision
for the new BOA Instructional. They asked
for input from trainees as they hoped to
introduce a ‘critical condition’ aspect to the
Congress, as well as the usual high quality
lectures and seminars. It was also at this stage
that the topic of re-engaging SAS doctors
came up. Many SAS doctors, as with many
trainees, feel disenfranchised and it is felt that
they too, need support in their continuing
professional development, through
encouraging them to attend events such as
the BOA Congress and engage with things like
the ISCP and e-logbook.
The development of both a post graduate
curriculum, with more acknowledgement of
simulation (which will soon be augmented
by Trauma and Orthopaedics Bootcamps for
ST3s) and an undergraduate curriculum, with
a view to standardising the exposure medical
students have to Trauma and Orthopaedics,
appeared in both Education Committee
and the TSC. Engaging juniors in Trauma
and Orthopaedics is a goal across the BOA
and BOTA and this is mirrored by having
undergraduates and Foundation doctors at
this years Educational Congress and the new
Medical Student sessions at BOA Congress.
22
JOINT
• This year, one of the big issues, logistically,
was people trying to either join the BOA
or sign up to the exam with only hours
to spare. Thus, there will be a deadline
of 21st November 2015 for registration to
the upcoming examination
• Trainees can use UKITE to do mock
exams! Speak to your TPD and UKITE
about this… It’s an amazing resource for
your revision.
• If you aren’t a BOA member, you don’t
have to be. I personally think we should
all join the BOA, but that’s my view and if
you do not wish to, you can simply pay a
one off fee of £150 to sit the exam.
It’s been a busy year and it has been my
absolute pleasure to hold my role as
Education Representative. I do hope to see
our entire membership (wishful thinking
on my part perhaps) at the BOA Congress,
September 15th-18th 2015 and at the
BOA Instructional in January 2016. These
educational opportunities are the envy of the
surgical world and I really do commend you
all to make them if you can.
“Engaging juniors in Trauma
and Orthopaedics is a goal
across the BOA and BOTA
and this is mirrored by
having undergraduates and
Foundation doctors at this
years Educational Congress
and the new Medical Student
sessions at BOA Congress.”
PALACADEMY® – Effective Modern Learning
Orthopaedic and trauma experts are more and more confronted
with increasing medical complexity accompanied by incisive
economic limitations such as tight budgets and time pressure.
An interdisciplinary educational approach provides prospective
Orthopaedic and Trauma surgeons with the overall comprehen­
sion required for a successful patient’s outcome considering
this trend both in primary and in revision arthroplasty.
Modern learning in the Heraeus PALACADEMY® means inter­
disciplinary exchange, practical approach, local availability and
individual focusing.
Practice oriented interdisciplinary formats
The Heraeus PALACADEMY® educational programme offers
a broad spectrum of workshops and courses in the fields of
arthroplasty for orthopaedic and trauma surgeons at different
levels of experience. Interdisciplinary faculties, interactive
group discussions, and hands­on sessions allow for a high
practical relevance of the acquired knowledge and facilitate
peer­to­peer­exchange amongst the healthcare professionals.
A range of training courses is offered both online as well as live
at numerous international events.
revision surgery, with the emphasis on revision for infection.
The content has been developed to encompass the require­
ments of the orthopaedic curriculum for ST 3 entry level and
the competency expected at levels ST 7 – 8”, says Professor
David H. Sochart, North Manchester General Hospital and
Salford University and PALACADEMY® Expert.
iPad App “Essentials in Diagnostics of Periprosthetic Joint
Infection (PJI)”
Prosthetic joint infection (PJI) is a severe complication in
arthroplasty and has significant impact on patient’s well-being
and healthcare systems. One of the greatest challenges in man­
aging PJI is the “culture negative” prosthetic joint infection.
In published case series, the reported rate of culture-negative
PJI ranges from 5–41 %. A number of factors contribute to the
failure of microbiological cultures to isolate a pathogen.
With the PALACADEMY® iPad App “Essentials in Diagnostics of
Periprosthetic Joint Infection (PJI)” Heraeus Medical provides
an educational tool to learn about the challenges and how to
improve the diagnostic outcome.
To ensure a successful patient’s outcome within arthroplasty,
the close interdisciplinary collaboration has shown to be very
effective: As infections remain a big challenge, the didactical
concept of the PALACADEMY® courses sets a high focus on
the interdisciplinary exchange between experts in the fields of
microbiology and orthopedic surgery.
PALACADEMY® online – Learning with individual focus
Interactive and multimedia learning completes the concept of
PALACADEMY®. Registered users benefit from equal access to
lectures of both course levels (basic and advanced) to extend
their own level of experience, regardless their profession or
competencies.
Local instructional courses
PALACADEMY® instructional courses are surgeon­led and have
been developed by international experts from both clinical and
research backgrounds. “The courses have been designed to
cover the essential aspects of modern primary total hip and
knee replacement surgery, as well as the fundamentals of
Main topics of PALACADEMY®:
Pre­operative planning and surgical approaches
Bone cement properties and modern cementing
techniques
Cementing workshops
Discussion of case studies & pitfalls in primary and
revision arthroplasty
Diagnostics, prevention & treatment of periprosthetic
joint infections
Key features of the iPad app:
Cases: step­by­step along with a real case through the
diagnostic algorithm
Challenges: most frequent questions and problems
around PJI, practical tips, Videos
Media Library: commented literature review, graphs
and figures for download
Case Reports: clinical cases for exchange
www.heraeus-palacademy.com
JOINT
23
Web Editor’s Report
Danny Ryan
news, courses and fellowships. The aim is to
incorporate the best aspects of the current
site with more accessible media, such as
our current podcasts, and, in the future,
screencasts, with a responsive design layout
that will automatically adjust to laptop, pad or
smartphone screen sizes. With the move to a
‘paperless’ Educational Congress, the majority
of talks will be going online and will remain
available in the new ‘Education’ area of the
website.
Feedback from Linkmen has resulted in the
creation of an interactive map with a page
for each rotation: there has been some real
enthusiasm from a number of Linkmen, but
some rotations do not yet have any content, so
if this is your region, get on to your Linkman/
woman to put something together!
This year has been a busy one behind the
scenes from a web point of view, with the
launch of the new site at the Educational
Congress. Our plan was to create a website
that could become a real point of focus
for members, both as a learning resource
and as a place to find out about the latest
A ‘Course Alerts’ calendar has also been
incorporated into the footer bar, and the
section subdivided into specialties to make
it easier finding the right course for you. As
always, if you feel that something is missing, let
us know: the back-end of the website works on
the basis of a drag-and-drop editor, making any
changes straightforward for future web-editors
(without having to know any code!).
A number of members have been in touch
this year about problems with logging on
to the website, and often the case has been
either a delay in validation by a supervisor,
or a delay in communication of validation
between ourselves and the BOA, particularly
for members who are not stand-alone BOTA
members. We are still looking at ways to
streamline this process, but in the meantime
the old website will remain live for this
purpose. I will be working with the next
web editor on gradual increase of use of
the new website, and after the Educational
Congress all advertising and news will be
moving to the new website. This year I have
tried to keep disruption of site activity to
a minimum, but as always with computers
there are likely to be some teething
problems along the way, so please bear with
us!
Over the coming months the site will begin
to fill with more content, and plans are afoot
for committee blogs to keep up-to-date with
the latest news. We are always keen to hear
what you think is important, so do notify us
of any way you feel we can improve things
to make the website a hub for all BOTA
members!
RNOH EDUCATION
The Royal National Orthopaedic Hospital has
one of the largest CPD course portfolios in the
NHS. We provide high quality learning across a
range of specialties and professions working with
musculo-skeletal injury and disease.
The Stanmore FRCS Preparation Series
Preparation in Basic Sciences for the FRCS (T&O)
Preparation in Basic Sciences for the FRCS (T&O)
14-17 Sep'15
21-24 Mar '16
The Stanmore Orthopaedic Series
Acetabular Revision Techniques Course
18 Nov'15
Complex Hip Femoral Reconstruction & Revision Course 19 Nov'15
Casting Techniques for Orthopaedic Trainees
24 Nov'15
Casting Techniques for Orthopaedic Trainees
25 Nov'15
Essentials of External Fixators
2-3 Dec'15
External Fixation for Nurses & AHPs
4 Dec'15
5th Cadaveric Knee Replacement Course
25 & 26 Feb'16
19th Stanmore Fracture Course
11-13 Apr'16
21st Surgery of the Foot & Ankle
17-19 May'16
The Stanmore Paediatric Series
5th Vitamin D Conference
The Stanmore Resus Series
Advanced Life Support (ALS)
European Paediatric Life Support (EPLS)
General Instructor Course (GIC)
For further information and to register for a course go to: www.rnoh.nhs.uk/health-professionals/courses-conferences
or call the Teaching Centre Team on 020 8909 5326
24
JOINT
5 Nov '15
19-20 Sep'15
17-18 Oct'15
28-29 Nov'15
Junior Representative
William Nabulyato
appropriate SAC like body for Core Surgical
Trainees, the usefulness of current Core
Training Programs (not only in acquiring a
higher training number but also in ensuring
diverse surgical, leadership, management and
people skills), the need for strategic training
placements both in trauma centres and
departments where trainees aren’t competing
with the world for theatre and clinic
experience, as well as the increasing personal
and economic burden of training. I believe I
have been a strong voice in battling for the
rights of junior trainees in an era where time
is short and more is expected without the
pastoral apprenticeship model of old.
As the outgoing BOTA junior representative, it
has been an honour and privilege to represent
junior trainees across the UK. It has been an
a very political year; an arguably unforeseen
conservative majority won the parliamentary
election, the Scottish referendum saw
Scotland vote to stay within the UK, there
were stalls in the BMA contract negotiations
and the controversial Shape of Training report
led by Professor David Greenaway have all
impacted on the current and future training
of junior doctors. As ever BOTA has continued
to be a strong voice within the orthopaedic
community and beyond, advocating the
importance of high quality patient centred
training and ensuring trainees are at the
forefront of positive change.
Being a Newcastle University 2011 graduate,
a current core surgical trainee in East of
England Deanery and my role as Junior
Representative has allowed me to appreciate
the disparity that exists within undergraduate
and early year’s postgraduate surgical training.
There is a stark contrast in the levels of
motivation, mentorship and time allotted to
the development of surgical interests across
the UK and this is compounded further
by current political drives to decrease the
number of surgical foundation year posts in
favour of community placements.
Taking on the role from my predecessor,
James Shelton, meant I was fortunate enough
to sit on the Joint Committee on Surgical
Training Core Surgical Training Committee
(JCST CSTC). Being the only Core Trainee
on the committee afforded me a unique
perspective, allowing me to more accurately
express the challenges faced by aspiring
orthopaedic surgeons. The landscape
continues to evolve; key issues have been
tackled with regards to; the need for an
I think as a specialty going forward we have
to address the decline in national junior
engagement. BOTA continues to lead the
way but this year has shown the power of
collaborative efforts. Strengthening links with
committees such as ASiT, the Medical Student
Liaison Committee (MSLC) and Association of
British University Surgical Societies (ABUSS)
will allow us to do this on a greater scale at
a grass roots level. Furthermore we need to
reflect the diversity within the population we
treat and the medical community and it’s for
this reason I welcome the appointment of our
new BOTA Women in Surgery Representative.
This year saw Core Surgical Training
recruitment follow in the footsteps of ST3
recruitment by going to a complete national
selection process, as well as a sustained
increase in the number of ST3 NTNs. Both
processes have had their tribulations,
highlighting the need for transparency and
clear guidance in lieu of some candidates
not achieving their preferred programs
despite their potential eligibility. Despite not
being perfect these recruitment processes
have arguably made for fairer more robust
interview processes that BOTA will continue
to be a part of.
“I think as a specialty going
forward we have to address
the decline in national
junior engagement. BOTA
continues to lead the way
but this year has shown
the power of collaborative
efforts. Strengthening
links with committees
such as ASiT, the Medical
Student Liaison Committee
(MSLC) and Association of
British University Surgical
Societies (ABUSS) will allow
us to do this on a greater
scale at a grass roots level.
Furthermore we need to
reflect the diversity within
the population we treat and
the medical community and
it’s for this reason I welcome
the appointment of our new
BOTA Women in Surgery
Representative.”
Finally I end on the words said to me by
my supervisor Mr Jahangir Mahaluxmivala
when I became BOTA Junior Rep, “Future
orthopaedic surgeons need to possess
grounded surgical acumen, a strong
educational/research base and political
poise in order to fight for the future of our
profession.” These attributes are strongly
entrenched in every BOTA committee
member and I wish to take the opportunity to
thank them for their hard work and support
this year. I wish good luck to my successor
Oli Shastri, may he continue to build on the
work performed by those before him and
positively shape the future of orthopaedic
junior training.
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25
Northern Ireland Representative
Ciara Stevenson
Ireland has slowly begun to re-integrate with
BOTA. This was however to be my last year as
a committee member. Having passed FRCS
and about to enter ST8 and prepare to head
off on fellowship, I felt it was time to hand
over the reigns and let fresh blood take on the
challenge. My successor is Mr Paul Hegarty, a
newly appointed ST3 trainee who was voted
into position at the Educational Congress in
June. Paul is a great guy, who is enthusiastic and
driven and I wish him every success!
I would like to begin by congratulating our
trainees on their continued success at FRCS
examinations. Seven consecutive years with a
100% pass rate is remarkable. We have had seven
successful trainees in this years diet including
Gavin McLean, Fayaz Callachand, Richard Napier,
Kyle McDonald, Morgan Jones, Sam Sloan and
myself.
This has been the inaugural year to have a
committee member from Northern Ireland as
opposed to a link person for the region and I
hope that long may it continue. I had previously
been the link person for Northern Ireland for
two consecutive years and by hosting meetings
in Belfast and encouraging trainees to attend
the Educational Congress I hope that Northern
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I would also like to congratulate Miss Clare
Rowan, winner of the Martin Medal, our annual
registrar prize day, and Clare will now go on to
present at the Best of the Best at BOA Liverpool.
We wish her every success!
I would also like to congratulate Mr Niall Eames
for being our regional trainer of the year for the
third year in a row but who also became the
BOTA TOTY 2015. We have fantastic trainers in
Belfast and this recognition is greatly deserved.
Mr Brian Mockford, our TPD, has been in post
for just under 18months now and has already
attended the TPD forum in Carden Park. He
is passionate about helping trainees and we in
Northern Ireland are lucky to have him guiding
the way to CCT.
New developments in Belfast include
the development of a training and social
relationship with trainees from the Irish
Orthopaedic Trainees Association. Both TPD’s
from North and South have decided to coordinate a teaching day for all. This will be
an annual event to help integrate and build
relationships with our colleagues across the
border.
Lastly, it has been an absolute pleasure to sit
on the committee and work with BOTA in
representing the views of trainees across the UK.
It has highlighted the wide variability that exists
in the quality of training between deaneries and
that is why it is so important to have a combined
voice when tackling these issues at policy level.
I have no doubt that your incoming committee
will do their utmost best at trying to improve
training for all and I wish them all the best.
Scottish Representative
Mike Reidy
BOTA really does enable us to speak with
a clear voice on behalf of all orthopaedic
trainees. I have enjoyed the opportunity to
represent trainees at the SCOT committee,
the RCSEd T&O subspecialty group, the
Scottish Academy of Trainee Doctors Group
and the RCPSG trainee committee. I also had
the opportunity to attend the Surgical Forum
of Great Britain and Ireland when they met in
Glasgow and Edinburgh.
This year UKITE had been a particularly
difficult topic to deal with, as BOTA was not
involved in the decision to move the exam
to the BOA. We have since been actively
involved with the BOA to ensure that exam
will be an improved resource for trainees both
throughout training and peri-exam.
I have thoroughly enjoyed my year on the
BOTA committee. It has been a fantastic
opportunity not only to represent Scottish
trainees but also to work with trainees across
the UK. What became apparent to me very
quickly is that the many of the issues trainees
face locally are replicated right across the UK.
will affect our future professional lives and
that of the trainees coming after us.
I would Like to thank the four Scottish
linkmen for their help this year; Andraay
Leung (West), Tristan McMillan (North), Sarah
Gill (East) and Vitty Bucknall (South East).
They have been of great help and play a
crucial role in the way BOTA works.
Vitty is taking over the Scottish Representative
role and I have no doubt that she will do
a great job. I would like to thank all of last
year’s committee for the warm welcome,
it’s been a pleasure getting to know you and
working with you all.
The Shape of Training report and its
implementation has been much discussed
this year. By working with the other trainee
associations we were able to co-sign a letter
voicing the concerns of doctors in training
and calling for a pause in implementation.
I am sure that BOTA will continue to
highlight the implications of the report and
do everything they can to ensure the most
positive outcome for trainees. It is only by
engaging that we can shape the change that
Wales Representative
Vishal Paringe
engagement from the Welsh trainees on our
Whatsapp forum.
The committee has faced various difficult
situations this year namely UKITE, SHoT, ST3
recruitment etc. At times we have disagreed
but have always strived to find a solution to
every situation and have put the best interest
of the trainees at the forefront of decisionmaking.
In particular, this has been a year of firsts for
Wales. We managed to secure a full BOTA
session at the PanCeltic meeting 2015, which
wasn’t on the agenda in the past. I thoroughly
thank Mr Neil Price for his willingness &
encouragement to engage with BOTA Wales
to make this a reality. We can only hope that
this will be a stepping-stone for the future.
Looking back on my year as a part of this
fabulous BOTA committee I realise what an
immense learning experience it has been
for me and it’s been a privilege to represent
Wales on a national level. In the past year,
Wales has become closer to the mainstream
trainee community, become more engaged
than ever before, not to mention the regular
The highlight of the year was to host the
BOTA committee meeting in Cardiff. It was
evidence of the committee’s dedication to
improve engagement with trainees across
the board and understand the ground
realities. I have to acknowledge the industry
participation with Chris Anderson & Geraint
Morris from Stryker reinforcing their
commitment to provide educational resources
on behalf of Stryker.
With the impending arrival of the SHoT,
collaboration with ASiT on various forums
was crucial. In Wales, we have proposed a
formation of a Core Training Group with
inclusion of the three regional Core Surgical
Trainee Representatives along with the
ASiT Wales representative and BOTA Wales
representative to ensure seamless resolution
of local trainee issues.
Finally, a few words of congratulations before
I conclude my report, firstly to Miss Judy
Murray who has been selected as the Trainer
of the Year for her commitment towards
education. I would also like to specially
mention Mr Ibrahim Malek (Winner of Bone
and Joint Journal award at BHS, 2015),
Narendra Rath & Ben Hickey to securing
the research grants from the Welsh Arthritis
Research Network (WARN). Finally, would
like to congratulate all the trainees, who have
climbed the Everest of FRCS exams.
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27
British Orthopaedic Networking Environment Report
Jamie McConnell
is a retrospective audit to assess the
prevalence of intraspinal pathology in
cases of presumed idiopathic scoliosis.
There is no large series reported in
the literature, so this project has great
potential.
The British Orthopaedic Network Environment
is a project intended to facilitate collaborative
research and audit. Our website bone.ac.uk
is open to anyone with an interest in audit or
research, from medical student to professor.
Over the past year, the project has gathered
momentum rapidly. With membership now
standing at 495 registered users, it has already
become the largest surgical collaborative
network in the United Kingdom.
“Over the past year, the
project has gathered
momentum rapidly. With
membership now standing
at 495 registered users,
it has already become
the largest surgical
collaborative network in
the United Kingdom.”
A number of excellent audit projects have
been started during the past year, and three
of them have now completed their data
collection stage. In summary, these projects
are:
• Audit of Enhanced Recovery Programmes
in Lower Limb Joint Replacement. 47
collaborators joined this audit to establish
what constitutes current national practice
by consensus and determine adherence
to Enhanced Recovery Programmes in
NHS hospitals.
• Trauma Snapshot Audit. 46 people
participated in this one-week audit
of current practice in trauma surgery,
specifically looking at the case mix,
surgeon grade and anaesthetic cover, use
of thromboprophylaxis and antibiotics
and consultant cover.
• Audit of audit completion by UK
orthopaedic trainees. 17 trainees
collaborated on this audit of audit quality
and completion rates in orthopaedic
departments around the UK
At the time of writing, the following projects
are still actively recruiting collaborators:
• BSSH National Audit of Current Practice
in Managing Open Flexor Tendon Injuries
and Open Fractures. The British Society
for Surgery of the Hand is using BONE
to recruit collaborators to their 3-month
national audit of open hand fractures.
• TRAIN (Treatment and Radiological
Assessment of Intertrochanteric Neck of
Femur Fractures). This is a multicentre
audit/service evaluation study assessing
the quality of fracture reduction and
fixation (using a DHS or IM Nail) for
extracapsular hip fractures.
• Universal MRI screening for presumed
adolescent idiopathic scoliosis. This
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• Management of Proximal Humeral
Fractures – A Multi Centre National
Snapshot. The aim of this simple and easy
to complete project is to audit current
practice against the gold standard clinical
trial evidence.
• Audit of supracondylar fracture
management in children. Comparing
management to the British Orthopaedic
Association Standards For Trauma. This
project aims to establish compliance with
BOAST 11 for supracondylar fracture
management in children. Operative
outcomes, complication details, and
complication rates will be examined.
We were particularly pleased to see that
the most popular of these projects, the
Enhanced Recovery Audit, run by the Nuffield
Orthopaedic Centre, completed their data
collection in a few short months. This is a
really quick outcome for a multicentre audit,
and just goes to show the benefits of working
in collaboration with colleagues through a
network like this.
Our tie-in with Bluespier’s Amplitude™ system
to record outcomes in the Trauma Snapshot
was an interesting experiment. We heard
excellent reports from some users, who found
that data entry was simple. However, others
encountered show-stopping glitches, and
ended up reverting to collating their results
on a spreadsheet. Needless to say, we have
fed back your experiences to Bluespier. Whilst
we’d certainly be willing to consider similar
technologies in the future, we will have to
ensure that they are more user-friendly
In addition to audits, the BONE website can
also host research projects. The research side
is currently rather early along its adoption
curve and hence is somewhat light on
material. We hope that the early successes of
the audit side might inspire our members to
start develop collaborative research projects
in the future. Of course, any research units
who have projects in development are
welcome to use BONE to recruit potential
investigators.
Our goal for the coming year is to make
BONE more accessible and inclusive. We want
it to be a tool that can benefit every single
Orthopod in the country, not just those who
are already experienced at doing research and
audit.
Despite the massive number of people who
have already signed up, some trainees remain
sceptical about whether they will benefit from
taking part. We believe that there are three
important things that need to happen next, in
order for BONE to become more widely used:
Faster results, with single-day studies:
This is something the BOTA committee
are keen to push for over the coming year.
Think of a study question where the answers
could be obtained very easily on a local level,
which becomes really interesting when rolled
out to a national level. Even really simple
questions like “What’s on your trauma board
this morning? How many of those cases will
get done?” if reported by 100 collaborators,
suddenly give a valuable insight into the
activity levels around the UK. We’re sure that
there are BOTA members who can think of
many questions that could be asked in this
manner. We believe that if a few of this quickand-easy studies can be created, then it will
give many more people the opportunity to
get involved in collaboration.
Higher visibility, through publications:
The projects that have been completed will
no doubt make it into print in the near future.
Collaborators will see themselves published
in return for their efforts; concrete evidence
that the system works. We believe that this
kind of “social proof ” will help demonstrate
the benefits of working together, and should
encourage more participation in future
projects.
• Prof Amar Rangan (Middlesbrough, Chair
of BOA Research Committee)
• Prof Mark Wilkinson (Sheffield, Chair of
the NJR research sub-committee)
• Prof Matthew Costa (Warwick)
• Mr Grey Giddins (Bath)
• Prof Alan Johnstone (Aberdeen)
It may be worth re-iterating our policy
on authorship here: we recommend
all collaborators are credited as “the
BONE collaborative,” with the individual
contributors listed within the paper itself. In
this manner, papers can have hundreds of
authors, all of whom will be searchable on the
PubMed index. For further details, see: bone.
ac.uk/about/view/8
Stronger project design, with the
support of senior researchers:
The BOA Research Committee (“ResComm”)
have been following BONE’s progress with
interest, and have made a very generous
offer of assistance to anyone who wants to
run their project on the site. The committee
consists of the following eminent folk:
• Prof Andrew McCaskie (Cambridge)
• Prof Andrew Price (Oxford)
We thank the members of ResComm for
making their expertise available to our
collaborators. This is a fantastic resource
that could make a big difference to a lot of
projects. If you want to make contact, please
do so by emailing [email protected] in the
first instance, and we shall put you through to
the appropriate person.
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JOINT
29
President
Name:
Mustafa Rashid
Deanery:
London (North East Thames - Percivall Pott rotation)
Greatest Strength:
I am able to bring people together to work effectively towards a common
goal, which I believe is especially necessary for the BOTA committee and
our membership as a whole.
Greatest Weakness: Currently, my golf! Especially off the tee! At work, I find it challenging
knowing when to shut up and keep my head down!
Goal for this Year:
Leading BOTA as President to help increase the visibility of the work we
do, engage more Orthopaedic Specialist Trainees than ever before, make
sure the Shape of Training Review does not become a complete disaster,
and get down to a 13 handicap!
Vice President
Name:
Simon Fleming
Deanery NE:
Thames (Pott)
Year of Training:ST4-5
Greatest Strength:
Able to never lose focus of the bigger picture, while simultaneously
managing the minutiae!
Greatest Weakness: On a professional level, probably my inability to keep my hand down in a
trauma meeting. On a personal level, not knowing when its time to stop
watching a box set and go to sleep
Goal for this Year:
To enthuse a new generation of trainee surgeons to engage not only with
BOTA, but with Orthopaedics as a whole
Treasurer
Name:
Steve Kahane
Deanery:
NE Thames (Percivall Pott)
Year of Training:ST6
Greatest Strength:Organised
Greatest Weakness: Duck herding skills
Goal for this Year:
To increase both trainee attendance and sponsorship for the BOTA
Educational Congress.
Honorary Secretary
Name:
Sara Dorman
Deanery:Mersey
Year of Training:ST4
Greatest Strength:
Perseverance, ability to sleep anywhere in seconds
Greatest Weakness: Perfectionist, good food
Goal for this Year:
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To improve communication and dissemination of information to our
membership
Immediate Past President
Name:
Peter Smitham
Deanery:
NE Thames RNOH
Year of Training:
Fellowship in Adelaide
Greatest Strength:
Taking on many projects
Greatest Weakness: Taking on too many projects
Goal for the year:
Working on developing BOTAs international relationships with other
trainee organisations
SAC Representative
Name:
Marshall Sangster
Deanery:Severn
Year of Training:ST7
Greatest Strength:
Enthusiasm for orthopaedics, with a desire to ensure all exceed their
expectations.
Greatest Weakness: Taking on too much, and a little too optimistic at times…
Goal for this Year:
Ensure the ST3 selection process is fair and consistent for all candidates.
Improve access to the second part of the FRCS.
Publicity
Name:
Rupert Wharton
Deanery:
North West Thames
Year of Training:ST3
Greatest Strength:
Lover of ticking admin boxes, enthusiasm, organisation. Master of passive
aggression after five years of NHS employment
Greatest Weakness: Average salsa dancing skills, varus tibiae, limited bench-press
Goal for the year:
to increase engagement with BOTA, and set up a contact system
and drinks rendez-vous for BOTA members attending national and
international conferences – no longer shall we have lonely take-aways in
dingy hotel rooms not knowing anyone else in that city.
Education
Name:
Danny Ryan
Deanery:Severn
Year of Training:
ST4
Greatest Strength:
Work rate
Greatest Weakness: Saying “No”
Goal for this year:
Expand the volume and quality of educational material available to BOTA
members
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31
BMA Representative
Name:
James Shelton
Deanery:
Mersey
Year of Training:ST4
Greatest Strength:Determination
Greatest Weakness: Gluten
Goal for this year:
My goal for the year is to build on the links already founded by Marshall
the outgoing BMA Rep and continue to work closely on issues such as
Shape of Training and contract negotiations. I am a firm believer than
when the profession speaks as one the government must listen.
Academic
Name:
Payam Tarassoli
Deanery:
Severn
Year of Training:ST5
Greatest Strength:
Cool and calm under pressure
Greatest Weakness: Occasionally too laid back
Goal for this year:
To organise the first BOTA Travelling Fellowship
Web Editor & NI Representative
Name:
Paul Hegarty
Deanery:
Northern Ireland
Year of Training:ST3
Greatest Strength:
Computer skills and logical thinker
Greatest Weakness: Known for being a bit “OCD”!
Goal for this year:
Further develop and launch the new BOTA website
Bone Project Coordinator
Name:
Jamie McConnell
Deanery:
Thames - NE (Stanmore)
Year of Training:ST8
Greatest Strength:
I can brush aside loaded questions.
Greatest Weakness:Skittles
Goals for this year:
I want to make BONE more accessible. Let’s link up with trainees who
have ideas for really simple audit projects that could be done in a day.
Multiply that by a few hundred hospitals, and we’re talking serious
numbers. Email me!
Email:[email protected]
Twitter:@jsm
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Junior Representative
Name:
Oliver Shastri
Deanery:
West Midlands
Year of Training:CT1
Greatest Strength: I’m a ‘Yes-person’ - carpe diem (...& noctem)
Greatest Weakness: I’m a ‘Yes-person’ - live fast, die young? (...or just a nonchalant approach
toward cliché)
Goal for this year:
Run the 1st BOTA Basic fracture management & plastering course
Wales Representative
Name:
John Davies
Deanery:Wales
Year of Training:ST7
Greatest Strength:
Patients say I have a caring bedside manner that puts them at ease.
Greatest Weakness: My boss sometimes gets grumpy because I spend ages listening to
patient’s problems.
Goal for this year:
Increase involvement with BOTA amongst Welsh registrars and junior
doctors.
Scottish Representative
Name:
Vittoria Bucknall
Deanery:
South East Scotland
Year of Training:
ST 5
Greatest Strength:
To maintain an optimistic outlook and high levels of motivation even
when the odds are slim.
Greatest Weakness: The profound inability to rattle off a convincing Scottish accent.
Goal for this year:
To increase awareness of BOTA amongst Scottish trainees and create a
closer union between each of the four Deaneries.
Women In Surgery
Name:
Helen Vint
Deanery:
Northern Deanery
Year of Training:ST4
Greatest Strength:Communication
Greatest Weakness: Knowing when to be quiet!
Goal for this year:
To inspire more young female surgeons to choose a career in
orthopaedics.
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33
The Worsening Crisis in Medical Recruitment
and Retention in the NHS:
A response to the DDRB review, 7-day NHS services, and Mr. Jeremy Hunt.
The British Orthopaedic Trainees Association
(BOTA) is a representative group of doctors
in all levels of Trauma & Orthopaedic surgical
training in the United Kingdom. BOTA has 987
active members currently. Members of the BOTA
Committee are democratically elected at the
Annual General Meeting from the membership.
This statement highlights concerning trends
regarding the ongoing crisis in the NHS
regarding medical recruitment and retention of
doctors. It also sheds some light on the impact
of recent political news stories pertaining to
key documents including the recent DDRB
review, the future of 7-day NHS services, and
the comments made by Mr. Jeremy Hunt,
incumbent Health Secretary.
What is our position?
• Surgical recruitment and retention in the NHS
is in crisis with worrying trends regarding
fewer junior doctors pursuing surgical
careers, very low morale, and a perceived risk
that national policies may worsen this crisis.
• BOTA opposes the DDRB review of proposed
junior doctor contract changes (outlined
more specifically later in this document).
• BOTA opposes a move to 7-day elective
non-urgent NHS services in Trauma &
Orthopaedic Surgery but supports additional
funding and resources to support current
acute care services operating 7 days a week.
• BOTA invites Jeremy Hunt to engage with
our members via discussion with the BOTA
Committee on how the surgical recruitment
and retention crisis may be eased.
• BOTA supports the BMA as our trade union
and commends the co-chairs of the BMA
Junior Doctors Committee to be our voice
in these difficult times, and in their efforts to
protect the profession.
What does BOTA advise its members?
• BOTA is a trainee representative organisation
and not a trade union. BOTA advises all its
members, and all doctors to join the BMA
and engage with them. The BMA have the
means to voice your concerns, present our
views, and protect the profession. At a time
of political change that will affect all our
members, it is more important now more
than ever, to be a BMA member.
• Share your views with the BMA regarding
the DDRB review of junior doctor contracts,
proposed 7-day NHS services, and comments
made by Mr. Jeremy Hunt using www.bma.
org.uk, twitter (@TheBMA), and attend local
Junior Doctor Committee (JDC) meetings.
• Stay informed and up to date by engaging
with BOTA via www.bota.org.uk, on twitter
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(@BOTA_UK), or through the BOTA Regional
Linkmen. We try to keep you informed
regarding the latest information, listen to
your views and relay your concerns via the
numerous channels we have available to us.
Background
It is important to set the scene of the current
state of doctors-in-training in the NHS, before
tackling some of the key political issues that
have been discussed fervently amongst the
profession.
Surgical training in the UK has, historically, been
a very popular career choice for many medical
graduates (21.4% of medical graduates chose a
surgical career in 19961). More recently, a yearon-year trend of decreasing numbers of medical
graduates applying for surgical training in the
UK has been reported.
In 2011 the competition ratio for a surgical
training post was 3.7:1. In 2012 this reduced
to 2.1:1, and in 2013 it reduced even further
to 1.9:12. Going back to 2005, the competition
ratio for a higher surgical training in the UK was
6.96:12. In the 2014 round of recruitment in
Trauma & Orthopaedic Surgery, the competition
ration fell to an all-time low of 1:2.13.
Surgical training has not changed dramatically
since the introduction of Modernising Medical
Careers (MMC) came into being, in August
2005. So what has changed? What factors could
be influencing this declining trend in surgical
applications?
The number of junior doctors (in the first 2
years of their career i.e. foundation training) that
are planning on leaving the NHS (temporarily
or permanently) is rising. In a survey of one
region in England, only 7% stated they wish to
seek employment in the UK and another 13%
wished to work in the UK for service and not on
a training pathway. The majority (75%), did not
wish to continue on a specialty training pathway
(in any specialty) immediately after foundation
training4. So are junior doctors really leaving
the NHS? In the same survey, only 26% stated
they wish to seek employment outside the UK.
The national foundation programme destination
survey revealed the same trend. In 2013 64.4%
of foundation doctors continued in medical
training, compared to 67% in 2012 and 71.3% in
2011. In addition, 20.4% of foundation doctors
in 2013 made no application to any UK specialty
training programme4. Many members on the
BOTA committee have noted a distinct change
in the perceptions many junior doctors have
about training in the UK.
The latest BMA quarterly tracker survey (April
2015), sheds some light into why less doctors
are choosing to continue in their training. 502
randomly sampled doctors responded to the
latest BMA survey. Of these, 43% reported
morale was low or very low. Doctors in training
rated their satisfaction with work-life balance as
5.3 out of 10, with 29.6% stating their current
workload is unmanageable or unsustainable5.
Only 13% of doctors in training stated they never
do work outside regular hours. Over 70% of
doctors in training stated that the extra hours
worked (unpaid), was due to the workload.
In addition, 50% of doctors in training stated
their pay was unfair. 44.8% of all respondents
stated they have considered working less
than full time, 41.8% considered retiring early,
26.1% considered working overseas, and 25.5%
considered leaving the profession. In this most
recent iteration of the survey, when asked about
factors influencing consideration about their
career, 56.3% reported ‘changes to the NHS’,
and over 60% cited hours of work, or work
conditions, influencing considerations about
their career5.
So we have established the following:
1.Junior doctors are less likely to continue into
specialty training in the UK than ever before.
2.Junior doctors applying to surgical training in
the UK is at an all-time low.
3.A fifth of foundation doctors are not applying
to any specialty training programme.
4.Low morale, perceptions of work-life balance,
and excessive workload are major factors
influencing a significant proportion of doctors
considering leaving the NHS.
DDRB review
On July 16th The Review Body on Doctors’
and Dentists’ Remuneration (DDRB)
published an independent review on proposed
changes to the junior doctors’ and consultant
contract negotiations6. Whilst comment on
all the recommendations are not within the
remit of this position statement, several key
recommendations will be addressed:
1. Recommendation 6 / 7/ 18. Routine ‘standard
time’ is currently determined as 7am-7pm,
Monday-Friday. Hours worked outside
this time are paid as part of the banding
supplement. In reality, only the hours rostered
in a particular job plan is counted in the
banding supplement. Many junior doctors
work beyond their contracted hours to ensure
patient care is not compromised. This model
of working has been prevalent since the
conception of the NHS and the good will of
junior doctors has been identified by many,
as crucial in ensuring the service continues
to run. It is nearly impossible to estimate
the financial burden taken on by all junior
doctors throughout their career in the NHS,
relating to additional hours worked above
and beyond their contracts, in the name of
patient care and safety. Additionally, this is not
in the manner in which many of us approach
the profession. Counting minutes and
asking to be paid for extra time owed is not
a philosophy adopted by doctors in training
generally. Previously, this was never a big issue,
as the emotional and psychological rewards
of being a doctor far outweighed the cost of
staying late after a shift was over.
The DDRB recommends extending the
definition of ‘standard time’ to Monday
- Saturday 7am-10pm. In addition the
recommendations include a two-tier premium
rate for Sunday working hours (with hours
worked after 10pm attracting a higher
premium than those worked before 10pm
on Sundays). In real terms, this could mean
an up to 29.5% pay cut depending on how
many hours a doctor is rostered to work
outside of the current definition of ‘standard
time’7. As far as financial remuneration of
junior doctors goes, working Saturday at 9pm
will be paid at the same rate as Tuesday at
10am. Aside from the financial implications
of this proposed change, this has a profound
effect on the perceptions of many junior
doctors regarding their worth, value, and
contribution to the services provided in the
NHS. BOTA feels that this will only deepen
the feeling of disillusionment and the crisis
of medical recruitment and may be the final
straw that many are looking for to consider a
career change. Those that rated the work-life
balance as a factor influencing career change
will have to consider this further attrition to
that balance. Junior doctors often have young
families and a mortgage, which further adds to
the burden of these proposed changes, both
in fiscal terms and time away from family.
With morale and working conditions
reportedly very low, this widespread and
systematic widening of ‘standard time’,
leading to less pay, for more unsociable hours,
will have a dramatic effect on patients and the
NHS losing out in the skills drain that would
ensue.
2. Recommendation 17: “The wording on
contractual safeguards in Schedule 3 of the
draft contract should be strengthened to a
mandatory requirement to comply with the
requirements of Working Time Regulations
or any successor legislation.”6 BOTA opposes
the EWTD, in common with other surgical
associations, and does not believe legislation
originally designed for the haulage industry
is appropriate in the NHS. The current
banding system allows those doctors who
work busy unsociable rotas to be financially
recompensed. It also provides a robust
financial safeguard against doctors being
forced to work excessive hours for little or
no educational benefit. The removal of such
protections as proposed by the DDRB would
remove the choice from doctors who already
work in excess of the EWTD, replacing it with
a compulsion to work long hours for no pay.
3. BOTA does not support DDRB
Recommendation 9: “The contract should
include an availability allowance to recognise
an obligation to be on standby to return to
work, with the rate of the allowance varied
to reflect the frequency of on-call”6 Trauma
& Orthopaedic surgery has seen a shift away
from non-resident on call rotas in many
hospitals in the UK. The factors influencing
this change are plentiful, however, several
key features play a role. Firstly, very few “1st
on call” junior doctors (pre-ST3) in Trauma
& Orthopaedic surgery have chosen a career
in the specialty. In fact, many hospitals in the
UK utilise temporary, locum, doctors to cover
these rotas, many of whom are not in training,
or training in an entirely different specialty.
With increased pressures seen in Emergency
Departments around the UK, more patients
using the service in combination with junior
doctors with less hands-on experience in
the specialty, the chances of being called
frequently for advice or to come in whilst
non-resident is extremely high and likely to
continue to increase. This recommendation
from DDRB essentially downgrades the
premium paid for non-resident on call shifts
dramatically.
4. Recommendation 1 / 2 / 12 / 14: These DDRB
recommendations relate to pay progression
and pay protection. Trauma & Orthopaedic
surgery is a craft specialty and every amount
of experience counts towards giving patients
the best possible care. This experience
is often supplemented by extraordinary
costs burdened upon Orthopaedic trainees
to ensure their skills and knowledge are
continually progressing, in line with their
experience level. Every year, trainees
undertake courses, extra higher education,
attend conferences, hold teaching sessions
for others, organise out of hours journal clubs
and many other activities not because it is
mandated, but because it helps us build a
wider, deeper understanding of how best to
care for our patients. Incremental pay increase
based on level of training would not reflect the
incredible efforts doctors in training go to, to
ensure they are developing professionally on a
daily basis. Additionally, entrusted professional
responsibilities are not taken into account in
this model of pay progression (or lack of).
BOTA believes that experience should be
protected and supported in the new contract.
An ST3 doctor (first year of higher surgical
training) does not have the same experience,
skills and knowledge as an ST8 (final year of
higher surgical training), and the difference,
both in terms of experience and in terms of
contribution to the NHS, should be reflected
in terms of pay.
Out of programme placements in T&O are
often undertaken to help further expand
experience in both depth and breadth.
These include placements for experience,
placements for extra sub specialised training,
and placements to undertake research (often
as part of a higher degree, MD or PhD). These
recommendations would dramatically and
negatively affect these trainees that wish to
take time out of their training programme,
to develop their experience and broaden
their skills. These placements often carry
a significant personal cost and provide the
NHS with a wider benefit that would be lost
as the proposed recommendations make
them untenable. BOTA believes such activity
should be supported by protection of pay
progression.
5. Recommendation 10 / 11: The DDRB support
a move to use pay premiums to incentivise
recruitment to less desirable specialties.
BOTA feels that the problems experienced by
many specialties are not financially related.
They are a wider reflection of low morale,
work-life imbalance, lack of appreciation for
junior doctors, and excessive workloads.
Junior doctors are already giving up the
opportunities to progress in their careers
in favour of a temporary stint as a locum
doctor, where their skills are valued by what
the market is willing to pay, which is often
significantly higher than their NHS pay. In
real terms, pay premiums in the NHS will
never be able to keep up with the financial
incentives offered to doctors willing to work
on a locum basis and therefore are unlikely
to be successful. Furthermore, pay premiums
will not address the wider issues that are more
pertinent to the shortage of junior doctors
in the NHS. Junior doctors do not seek
wealth, but rather a sense of a good work-life
balance, flexibility to have a social life, and the
opportunity to care for patients in a way that is
not compromised by lack of staff or resources.
6. Recommendation 19: Fixed annual leave is
employed in some departments in the NHS.
Junior doctors are entitled to have a life, like
any other public sector worker. They are
entitled to get married when they wish, go on
holiday when it is most convenient for their
family and friends, and utilise their annual
leave entitlement flexibly (with adequate
notice). This DDRB recommendation accepts
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the use of fixed leave as necessary, and
therefore is not supported by BOTA. Fixed
annual leave is not necessary and there are
many examples in departments that can work
equally successfully without compromising
service provision within the NHS.
In summary, the specific DDRB
recommendations outlined in this document
are not supported by BOTA. We feel they will
mean less pay, more unsociable working hours,
removal of safeguards preventing hospital
employers from placing doctors in training
in out of hours service provision tasks, and a
reduction in pay for non-resident call shifts. The
recommendations send a message to all junior
doctors that extra experience, enhancement
of specific skills (i.e. research skills), and
commitment to continuing in specialty training
is not valued in the NHS and not financially
rewarded. It is difficult to accurately predict how
this will affect the future of the NHS workforce,
especially amongst Trauma & Orthopaedic
surgery. This organisation has major concerns
that these recommendations, if implemented,
will lead to a deepening in the recruitment and
retention crisis currently occurring in the NHS.
Those that complete their surgical training
will be more inclined to take their skills and
experience abroad, or into the private sector
where the perception on being valued, both
fiscally and clinically, is greater.
7-Day NHS services
On the 16th July Mr. Jeremy Hunt set out his
25 year vision of the NHS8. A key message was
regarding the government’s admirable plans
to have a 7-day NHS service. What remains
unclear is, what a 7-day NHS service actually is.
No details have been laid out as to what services
are lacking provision for a 7-day service. The
argument made by Mr. Hunt was that mortality
was increased if you are admitted on a Sunday
rather than a Wednesday, by 16%. The inference
was that this figure related to totally preventable
deaths if the NHS did not operate a “9-5 Monday
to Friday culture”8. The statistic, a guaranteed
hit for headlines in newspapers needed some
clarification, and many doctors jumped at the
opportunity to explore this in various blogs and
social media outlets.
In the quoted research published, by Freemantle
et al, in the Journal of the Royal Society of
Medicine (2010), 15 million admissions were
analysed and a relative risk ratio for mortality of
1:1.16 was calculated for admissions on a Sunday
versus Wednesday in the NHS9. This relative risk
ratio can be expressed as 16% more admissions
led to death if admitted on a Sunday compared
to Tuesday. This headline grabber is a clear
example of how statistics can be manipulated
and misinterpreted with ease. The mortality rate
in fact is 30-day mortality, meaning patients who
died in the next 30 days. In a typical month, a
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patient admitted on a Sunday will experience 9
weekend days in a 30-day spell, whilst a patient
admitted on a Tuesday will be in hospital for 8
weekend days on average. Secondly, in the study
by Freemantle et al, 94% of admissions were
emergency admissions9. Thirdly, the relative risk
ratio for dying on a weekend versus dying on a
weekday was 0.92, meaning you are 8% less likely
to die on a weekend if you are in hospital9. It is
not easy to accurately and completely represent
the research conducted in a scientific article
in a snappy speech or a newspaper headline.
Conversely, it is very easy to selectively choose
statistics to support your need to relentlessly
push an agenda for reform. The bottom line is
that the notion that more patients are dying after
being admitted on the weekends, which could
be prevented by more consultants working on
weekends is not evidence-based, and misleading.
The BMA, BOTA and doctors in general have
never opposed a 7-day NHS service. If the driver
for change is to reduce preventable deaths,
then first robust, unbiased, evidence must be
provided to supply the NHS and the public
with data to support this being a problem. If
this is done, and excess mortality is due to the
current model of weekend working, then extra
funding and resources must be made available
to reduce mortality for emergency admissions.
It is important to note that 7-day acute round
the clock care is, and has been, available in the
NHS for many years. With the systematic lack of
sufficient funding, staff shortages (both nursing
and medical), the NHS can just about stay afloat
running a 7-day acute service using skeleton staff
on the weekend, many of whom work longer
than their contracted hours due to the higher
workload. NHS staff have pleaded for extra
funding to allow the current model to continue
providing the service it does. More staff are
required during the week and on weekends, but
this has a financial cost.
BOTA supports the provision of acute
(emergency) services for 7-days in the NHS,
similar to what is offered currently, but with
significantly more funding to cover the costs of
increasing staff availability on weekends, as well
as increased social care provision to cope with
patients being discharged on the weekends.
BOTA does not support the provision of routine
elective services for non-urgent conditions
on the weekends. The main reason for this
opposition relates to the medical retention
crisis. Orthopaedic surgical trainees entered
the profession with no intention of sacrificing
every weekend to perform non-urgent elective
operations and clinics at the expense of face
time with their family and friends. If elective
Orthopaedic services are routinely provided on
the weekends, this will have a dramatic profound
effect on junior doctors considering the
profession as the work-life balance would have
been further eroded.
A recent BMA survey of 2000 people in England
showed that 68% did not believe the NHS can
currently afford to deliver 7-day services in
hospitals10. Additionally, 83% felt that there
should not be fewer doctors are available during
the week10. Finally, 85% felt that social care
services must also be available at weekends10.
To echo the financial argument, Monitor recently
wrote to 46 foundation trusts challenging their
financial balance sheets, calling their deficit and
expenditure “simply unaffordable”11. In May
NHS trusts in England reported a total deficit of
£822 million in 2014/15, an increase from £115
million the previous year11. The government’s
pledge of £8 billion to the NHS in response to
a request from the NHS England CEO, Simon
Stevens, will help only to keep the NHS above
water, providing the same service it does
currently, and clearly will not stretch to cover the
massive costs of running additional non-urgent
services on the weekend.
Most of all, BOTA, and many other doctors’
organisations, wish to hear detailed proposals of
what services the government wish the NHS to
deliver on the weekends that it currently does
not. Most importantly, NHS staff and the public
await the government’s proposal of how extra
services to be delivered on the weekends will
be funded given the financial crisis the NHS
is currently facing. Finally, BOTA is concerned
that a dramatic change to the expected job
plan of a Consultant Orthopaedic Surgeon (to
accommodate mandatory non-urgent clinical
duties on weekends) will have a negative affect
on future recruitment and retention into the
specialty, which is currently in crisis.
Mr. Jeremy Hunt’s comments on the NHS
At time of publication of this statement, the
petition for a vote of no confidence in the
Health Secretary is has 217,882 signatories12.
It is impossible to talk about DDRB, 7-day NHS
services, or any of the reasons for the slump in
applications to surgery, without looking closer
at the man who has stood on a podium and
publically, proudly, criticised the organisation he
leads.
Mr Hunt spoken about consultant pay. He is
quoted saying the average consultant pay is
£118,00013. The NHS consultant pay scale
for England is £75,249 rising to £101,451
after 19 years as a consultant14. This lack of
understanding of how doctors are remunerated
is mirrored in his plan for trainee pay; proposals
will cut GP trainee pay by up to 45% and other
specialty trainee pay by up to 29.6%6. Similarly,
he wants to take away hours protection and
allow working from 60-90 hours6.
Specialist Trainees are the consultants of the
future and these comments come at a time
when there is recruitment crisis in almost all
specialties. Jeremy Hunt has said that consultant
opt out was a significant barrier to 7-day
working. Freedom of Information requests have
been submitted to all Trusts in the UK and as of
yet, 41% have returned results and they clearly
demonstrate this is simply not the case. In fact,
less than 0.3% of consultants opt out of 7-day
service. Of the few that have opted out, the
overwhelming majority of them have actually
opted out of EWTD, so therefore actually opted
into elective work beyond contracted hours15.
advocating the denationalisation of the NHS,
and suspending independent (NICE) work on
minimum safe nursing levels for wards, has
led to widespread frustration by NHS staff, and
contributed to the worsening morale amongst
junior doctors. BOTA welcomes a parliamentary
debate as to whether Mr. Hunt is still the best
person for the role of Health Minister.
BOTA believes that Mr. Hunt may not have
considered doctors-in-training in his vision
for the next 25 years in the NHS. The BOTA
committee would happily engage in any
process whereby our views and thoughts on
the future of the NHS are sought. Mr. Hunt has
undoubtedly managed to alienate the healthcare
professions that keep the health service
afloat. His recent public actions and speeches,
denouncing the working habits of Consultants
and hospital staff, resulted in an unprecedented
outpouring of unity amongst NHS staff via
the twitter hashtags #ImInWorkJeremy,
#WeNeedToTalkAboutJeremy and
#SaySorryHunt.
BOTA believe that recent public condemnations
of aspects of the NHS as well as other previous
actions including co-authoring a book
References
1.Career choices at the end of the preregistration year of doctors who qualified in
the united kingdom in 1996. Goldacre MJ1,
Davidson JM, Lambert TW.
2.http://www.surgeryrecruitment.nhs.uk/how-toapply/competition-ratios.
3.http://www.yorksandhumberdeanery.nhs.uk/
recruitment/specialty_recruitment/specialties/
national_trauma__orthopaedic_surgery_st3_
recruitment_2015/
4.http://www.foundationprogramme.nhs.uk/
download.asp?file=F2_career_destination_
report_2014_-_FINAL_-_App_A_updated.pdf.‬
5.http://bma.org.uk/working-for-change/policyand-lobbying/training-and-workforce/trackersurvey/omnibus-survey-january-2015
6.https://www.gov.uk/government/uploads/
system/uploads/attachment_data/
file/445742/50576_DDRB_report_2015_WEB_
book.pdf
7.Illustrative example for a Trauma &
Orthopaedic Surgical Trainee on a Band 3 rota
using https://www.google.co.uk/
The Royal College of Surgeons of England
Supporting BotA And you
We will play a central role in educating, developing and supporting surgeons
throughout the whole of their careers.
Throughout the UK we provide a range of orthopaedic courses, support and advice
including the Affiliates scheme, Women in Surgery, events and a support line.
To find out more, visit www.rcseng.ac.uk
The Royal College of Surgeons of England | Registered Charity Number 212808
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Linkmen Reports
Linkmen Regional Reports 40
World Orthopaedic Concern
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Linkmen Regional Reports
Armed Forces
Major James Singleton
Introduction
Military orthopaedics remains in a somewhat transitional phase
with NTNs being awarded (see below) and redundancy forced upon
several existing trainees and consultants. I am pleased to report that
all affected trainees have transitioned to their local civilian deaneries.
BOTA have been extremely helpful in this difficult time and are
sincerely thanked for this.
Deployments
Major Jeremy Granville-Chapman was one of the final trainees to
deploy to Afghanistan last summer. The doors closed to Camp Bastion
as a UK/NATO facility in September and we look forward to the next
challenge, wherever that may be…
NTN and FRCS
Majors Louise Robiati and Tim Pearkes were awarded Army NTNs
and will commence registrar training later this year in Bristol and
Edinburgh respectively. Surgeon Lieutenant Commander Tom
Stevenson secured the Royal Navy NTN and will start his registrar
training in Oxford in September. All benchmarked highly at national
selection to be eligible for their military NTNs and should be rightly
proud of their achievement. At the other end of the training journey,
Majors Arul Ramasamy, Kate Brown and Mike Roger have all passed the
FRCS (Tr&Orth), well done to all.
Higher Degrees
Major Sushmith Ramakrishna completed his MSc in Trauma Surgery at
Swansea University in March 2015. Major Taff Edwards and Squadron
Leader Ed Spurrier continue their MD research at the Royal British
Legion Centre for Blast Studies at Imperial College. Sqn Ldr Paul
Hindle continues his PhD in Edinburgh, Major Neil Eisenstein has
commenced a PhD at Birmingham University and. Lieutenant Colonel
Will Eardley received his MD from Newcastle University. Major James
Singleton has submitted his MD to Imperial College London and awaits
his viva in due course.
Prizes/Fellowships
Major Ramakrishna earned an AO UK Grant in 2014 for his MSc
Project: ‘Stability of External Fixators.’ Major Granville-Chapman was
awarded the Wrightington Gold Medal, Major Edwards the Montefiore
memorial prize for the surgical trainee who has most distinguished
himself across the whole Royal Army Medical Corps for his research
into heterotopic ossification and Major Ramasamy the Alexander prize
at RAMC prize-giving for outstanding research on lower limb blast
injuries.
Defense trainees have been awarded three notable fellowships
over the last 12 months; the BOA Ram Kumar Chatterjee Travelling
Fellowship to Major Granville-Chapman, the British Elbow and
Shoulder Society MAYO Elbow fellowship to Surg Cdr Paul Guyver
and Major Brown has been awarded the Pulvertaft Hand Fellowship
to commence in April 2016. Major Granville-Chapman discharged his
responsibilities as BOA Young Ambassador by attending the Hong
Kong Orthopaedic Association Congress last November. Majors
Edwards and Singleton and Sqn Ldr Spurrier were all awarded Royal
College of Surgeons Military Research fellowships for their ongoing
research into varying aspects of blast injury.
Combined Services Orthopaedic Society
At the Combined Services Orthopaedic Society meeting held at 201 Field
Hospital, Newcastle, Major Eisenstein won the Philip Fulford memorial
prize for best overall presentation, and Sqn Ldr Spurrier was awarded
the Peter Templeton memorial prize for best presentation by a trainee.
Additionally Lt Col Hugo Guthrie was awarded the CSOS travelling
fellowship, visiting Boston, New York and Toronto.
Consultant news
Major Granville-Chapman has been appointed to Frimley Health NHS
Trust to start next April and Lt Col Guthrie took up a consultant post at St
George’s Hospital in April 2015.
Extra-curricular
Military orthopaedic trainees continue to support multiple charities
including The Soldiers Charity, Find a Better Way, Toe in the Water,
Combat Stress and Breast Cancer Care. Major Eisenstein was selected
to represent the Army sailing team in the Services Offshore Regatta this
summer. Finally, congratulations to Major Kate Brown who married Lt
Col Tom Wooley on 23rd May 2015 and to Surg Lt Cdr Stevenson on his
marriage to Naomi Stevenson (nee Brown) on 4th June 2015
London South East Thames
Lucy Cooper
South East Thames remains the place to be for young motivated
orthopaedic trainees, who are as comfortable dealing with gunshot
wounds and blunt axe injuries in South East London as they are dealing
with the worried well in the far outreaches of Kent and beyond.
We are still in a transition phase with reference to our teaching
programme and MSc. We have some extremely well motivated consultants
in our region who are keen to teach and mentor the current trainees.
Many of our senior trainees have just sat the first part of the FRCS.
Congratulations to those who have recently passed the exam and also to
those who have gained CCT. Good luck on your fellowships.
Our regional trainer of the year award went to Max Edwards. Most
definitely well deserved with some tough competition, well done! We
look forward to the coming year and all it has to bring.
London South West Thames
Robert Moverly
South West Thames has once again proven an excellent place to train
as reflected in the success of our FRCS candidates. Congratulations to
Edward Dawe, Zuhair Nawaz, Joshua Jacob and Karthick Raju who were
amongst the successful candidates. The hard work continues as they look
forward to CCT and organising sub specialty fellowships.
No doubt their success was helped in no small part by the excellent
teaching program our rotation benefits from. Taking the form of full
study days with additional Friday afternoon sessions, this year we have
benefitted from terms in hand, trauma and upper limb surgery. Teaching
is always well attended and led by experts from the region with occasional
support from industry for practical sessions.
Several of our trainees and other colleagues have featured in Channel
4’s fly on the wall documentary 24 hours in A&E, which has been filmed
at St George’s Hospital since the installation of their new helipad. Nerve
racking I’m sure but it’s been great to see our colleagues performing so
well under pressure.
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The region continues to have a strong research output spearheaded
by both Prof Richard Field’s team at the Elective Orthopaedic Centre
and the team at St George’s hospital. As well as producing many
publications over the last 12 months there was a very good standard of
presentations at the annual Sam Simmonds meeting. Congratulations
to Harlod Akehurst and Alex Vaughan who won first prize with their
research into Enhanced Recovery in Arthoplasty. At the same meeting
Mr Andrew Cobb was announced as trainer of the year, a worthy
recognition of his contribution to the region.
ARCP’s in South West Thames typically take place in January and
September. In keeping with other London regions we are required
to perform a minimum of 300 operations and submit 80 PBAs per
12-month period, as well as the usual audit and research requirements.
London North West Thames
Rupert Wharton
North West Thames congratulates a number of substantive
appointments this year. These include Simon Ball (Chelsea and
Westminster - knees), Kashif Akhtar (Barts and the London - soft
tissue knee), Ghias Bhattee (Northwick Park - lower limb), Arjuna
Imbuldeniya (West Middlesex - lower limb) and Jaykar Panchmatia
(Guy’s and St Thomas’ - spine).
Congratulations are also due to our successful exam candidates: Akash
Patel and Amarjit Anand (November 2014), Hani Abdul-Jabar (February
2015) and Sally Wright, Simon Macmull and Ahsan Sheeraz (April 2015).
Our Knee’s Up provides a great opportunity to introduce Sirat Khan,
Shilpa Jha, Alex Charalambous, Zafar Ahmad and Iris Kwok into the
Royal London Rotation family. We had some motivating talks on
passing the FRCS over a few beers.
The RLHOTS Academic Meeting is the highpoint of the Royal London
calendar and now in its 8th year. Year-on-year our horizons are
expanding, with a great line-up of speakers, we are attracting an
audience of over 100 trainees and trainers from around the region and
beyond. We were honoured to have the internationally renowned
shoulder expert Dr Stephen Burkhart share his vast wisdom in his
lecture titled: Massive Cuff Tear, Is There a Tear beyond Repair? Even
to lower limb surgeons (!) his Journey with Shoulder Arthroscopy was
truly inspirational. Prof Hans Zwipp gave us a tibia to toe whistlestop tour of fixing lower limb fractures the AO way. Our meeting aim
is to provide something for everyone. Prof Richard Field, Mr Robin
Allum and Kyle James eloquently discussed the Evolution of Hip
Replacement, 35 Years Experience of ACL Management and tips and
tricks in Supracondylar fracture management, respectively. Mr Mark
Loeffler, a Royal London training alum, gave an outstanding talk on
training in lower limb arthroplasty and measuring performance. The
event was rounded off by a great night out, providing enough stories
to keep us going till next year!
There was tough competition for the 2015 RLHOTS Trainer of the Year
which was awarded to Miss Swee Ang, commended for her lifetime
achievement, inspirational commitment to humanitarian work and
keeping a male-dominated department in check!
The rotation has also been doing its bit to increase the numbers of
future female orthopaedic surgeons and we were pleased to hear of
the birth of a number of baby girls: congratulations to Akash Patel,
Donald Davidson, Alex Shearman, Nawfal Al-Hadithy and Hani AbdulJabar and their partners. We are not aware of any male progeny this
year!
In its second year, the Training Hospital of the Year Award has been
well received and achieving its aim of rewarding hospitals going the
extra mile to support trainees and providing healthy competition
amongst consultants to help their hospital win in future years.
Congratulations to Newham Hospital with the Barts Health Elective
Orthopaedic Unit, our 2015 winners. Stay tuned on how to bring it to
your region in an upcoming JTO write-up.
We are grateful to Khaled Sarraf for the provision of an educational
programme in the past year, and look forward to Hani Abdul-Jabar’s
teaching programme for the year to come. He is faced with the
unenviable task of trying to work a teaching timetable at times that key
speakers can make themselves available, while considering the ability
of trainers to release their trainees while still maintaining provision of
service to patients. We wish him well in his new role.
Congratulations to Sam Heaton, winner of the RLHOTS travelling
fellowship, on his year at The Royal Melbourne Hospital. Well done
to Mohammed Sukeik with his BOA travelling fellowship award
where he visited the Hospital for Special Surgery and the Rothman
Institute. Good luck to Charlie Jowett, Shafic Al-Nammari, Alasdair
Thomas, Wisam Al-Hakim with your ongoing fellowships in Melbourne,
Baltimore, Adelaide and Liverpool, respectively.
The rotation looks forward to more active engagement with BOTA in
the year to come. Poor performances from JP St Mart, Nicola Blucher
and Rupert Wharton in the annual golf tournament at Carden Park
have been severely punished on a local level - the trainees concerned
now understand that academic and sporting excellence go hand in
hand, and have promised to hit the range before next year!
Following on from last year, the epidemic of marriages and babies has
slowed but nonetheless congrats to Sam on the birth of your son!
London North East Thames
(Royal London)
John Stammers
This year has been jam packed with success at the top of the rotation
with new consultant appointments for Ed Britton, Shafic Al-Nammari
and Hilary Bosman at York, Ipswich and the Homerton respectively.
Congrats to Chethan Jayadev and Sherif El-Tawil on passing the FRCS
and keeping the Royal London’s 100% 1st time pass streak alive. No
pressure for the guys coming up to the exam!
www.rlhots.org
London North East Thames
(Stanmore)
Syed Aftab
The last year has been another success for the Stanmore Rotation, with
a strong intake of ST3s and the outgoing trainees doing very well. This
year has seen a 100% hit rate in FRCS Trauma and Orth examinations.
This was due to a combination of strong trainee driven initiatives
and an equally strong commitment from the consultant trainers.
For those of us peri-exam, we were also given the freedom to tailor
our weekly teaching to a more exam focused effort. The initiative is
being continued with every new cohort of examinations and so far it
is going strong, with trainees from the surrounding deaneries joining
the “FRCS Wed Viva Group”. There is a database of information made
available to all in the group, along with membership of an ever-growing
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mobile messaging group which keeps people instantly updated with
plans and events. Perhaps the most helpful aspect of this is finding
revision partners with convenient geography and matching schedules.
The Stanmore programme remains excellent in its exposure to the
various facets of Orthopaedic Surgery, including the tertiary specialities
such as peripheral nerve injury, bone tumour and spine deformity.
While we do not have our 6 years of training rotations planned out
from the start, this is more than compensated for by the amount of
freedom, flexibility and choice offered to us when we express our
preferences.
Socially speaking Stanmore is getting stronger. Recently there has been
the advent of the “Stanmore Cricket Group” which has already played
(and won – but I must say that it was close and the opposition were
extremely welcoming, hospitable and graceful) against the Oxford
Rotation. We also have weekly nets sessions where anyone with a loose
affiliation to Stanmore is welcome.
London North East Thames
(Percivall Pott)
Mustafa Rashid
The past 12 months have been great for the Percivall Pott Orthopaedic
Rotation in terms of activity. We have had three consultant
appointments including Mr. Danyal Nawabi (Hospital for Special
Surgery, New York), Mr. Philip Matthew (Barking, Havering &
Redbridge NHS Trust), Mr. Arj Balaji (West Hertfordshire Hospitals
NHS Trust), and Mr. Dennis Kosuge (Princess Alexandra Hospital
NHS Trust). Additionally, we have three registrars gain their CCT and
start their fellowships: Mr. Marcus Baker (Royal Adelaide Hospital,
Adelaide), Mr. David McKenna (Nuffield Orthopaedic Centre,
Oxford), and Mr. Ioannis Pengas (University Hospitals Coventry and
Warwickshire NHS Trust).
We look forward to another great year.
London North East Thames
(UCH/Middlesex)
Paddy Subramanian
For the Middlesex &UCL rotation, this year will be a year to be
remembered for the many years to come. This year marks the
establishment of the Middlesex & UCLH Orthopaedic Society and the
inaugural annual meeting of this rotation. A tremendous amount of
gratitude must go to Shirley Lyle with the support of Prof Haddad for
founding this society. Already within a few months, the website is up
and running (www.orthopaedics.club) and the benefits to the trainees
on this rotation are inherently apparent.
This year has been quite a successful all round. Congratulations must
go to Kat Malik for delivering a beautiful baby girl (yes, the UCL/
Middlesex orthpods have a soft side too!) and Caroline Bagley who is
almost there too (for a second time).
Hats off to Kostas Tsitskaris and Karan Johal for passing the FRCS exam.
Congratulations are also in order to Alistair Hunter for being appointed
a consultant post at UCL hospital and Julian Leong at Stanmore. We
welcome Anna Panagiotidou back into the rotation following her
retreat into the world of pure research. She came back to the rotation
with her PhD and her strong research background led her in good
stead to take on and win the Sir Rodney Sweetnam Prize for the best
academic presentation.
This year has also seen Shelain Patel take over as our regional teaching
coordinator and together with the help of Mazin Ibrahim, they have
helped revamp our rotations teaching program. This time round, our
regional consultant trainer was a tie between Mr James Youngman,
at UCLH and Mr Graham Robbins, at Whipps Cross. Both these
consultants work exceptionally hard to deliver high quality training
over and beyond what is normally expected and the feedback from the
trainees on this rotation speaks volumes.
In summary, the boys and girls on this rotation continue to shine. We
wish all those taking the exam in the next sitting good luck and a warm
welcome to the newbies starting in October.
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We also welcomed six new ST3 appointments whom have all settled
in well to the programme: Mr. Neil Segaren, Mr. Kalpesh Vaghela, Miss
Sarah Rubin, Mr. Alexis Illiadis, Miss Suan Khor, and Miss Maureen
Monda.
We have two trainees currently on OOPR placements reading a
DPhil at the University of Oxford (Mr. Mustafa Rashid and Mr.
Prakash Jayakumar). Academic activity at the Royal London Hospital
(RLH) is high and ever-expanding. A recent exciting new consultant
appointment at RLH, Mr. Kash Akhtar, as a Consultant knee surgeon
and an academic educationalist, has generated significant interest in
Medical Education research locally.
Teaching Programme
The last year has seen continued improvement in the quality of our
Tuesday afternoon teaching programme led in conjunction by a group
of enthusiastic Consultant trainers, an Education Top Slot (Sulaiman
Alazzawi - ST5), and a number of Orthopaedic Specialist Trainees. The
format has been a good mix of Consultant and Registrar delivered
lectures, cadaveric sessions, simulation training sessions on the new
arthroscopic simulator, and industry sponsored dry bone workshops.
In addition to the great local speakers we have been privileged to have
taught us, the Education Top Slot and Consultant faculty have secured
some outstanding external speakers in the last year from all over the
UK. The standout session for me was Mr. Manoj Ramachandran’s talk
on “How to learn Basic Science for the FRCS exam” followed by his
good friend, medical illustrator and Consultant Orthopaedic Surgeon
from Glasgow, Mr. Tom Nunn on “How and What to Draw for the FRCS
(Tr&Orth).”
Annual Scientific Meeting (November 2014)
The 42nd Annual Scientific Meeting of The Percivall Pott Club was held
on Friday 14th November 2014, in the stunning Grade II listed Old
Pathology Museum, St Bartholomew’s Hospital. We were honoured
to be able to welcome many excellent speakers from the UK and
abroad. The meeting was attended by many Specialist Registrars and
Consultants in Trauma & Orthopaedic Surgery from our region. This
meeting and dinner is always an event to look forward to on our
rotation. The quality of the talks were outstanding this year and the
whole day went off without a hitch. This was due to the hard work of
the Pott Club Committee and especially the Pott Club Secretary, Mr.
Zac Silk (ST4).
The programme was kicked off by the 2014 BOTA Trainer of the Year,
Mr. Pete Bates, talking about “Tips & Tricks in Orthopaedic Trauma
Surgery” followed by Mr. Durai Nayagam’s (Royal Liverpool & Alder
Hey Children’s Hospitals) talk entitled “Footprints in Trauma Surgery”.
Both speakers were brilliant in their own way however, Mr. Nayagam’s
almost philosophical yet scientifically-based musings on why fractures
heal were profound, and left a lasting impression on many trainees.
The afternoon session included some equally eminent and charismatic
speakers notably, Prof. Tim Briggs (Royal National Orthopaedic
Hospital) and Miss Deborah Eastwood (Great Ormond Street
Hospital). The day was concluded with the Pott AGM chaired by our
TPD, Mr. Pramod Achan. The new committee was elected including Mr.
Prakash Jayakumar as our 2015/16 Pott Club secretary. The dinner was
held at the Bart’s Great Hall and it was great to see everyone and their
spouses catching up, and enjoying the lovely dinner.
ABC Travelling Fellows Dinner
Our international speakers this year were two heavyweights in the
their respective fields. Dr. Luigi Zarga (Past President of the European
Hip Society and Consultant surgeon at the Galeazzi Orthopaedic
Institute in Milan) gave a great talk on the prevention and treatment
of THR instability. The other international speaker was Mr. Malcolm
Smith (Chief of Orthopaedic Surgery, Massachusetts General Hospital,
Boston), who took the audience through a play-by- play of the day that
unfolded during his on call at the Boston Marathon bombing in 2013.
It was truly inspirational to hear how a well organised collective of
level 1 trauma centres dealt with mass casualties in a professional and
efficient manner. In contrast, Mr. Smith also spent some time doing
humanitarian work abroad and shed some light about the challenges
faced during his time in Haiti during the devastating Earthquake in
2010.
There were 9 very high quality registrar presentations this year with Mr.
Neil Segaren (ST3) being chosen as the winner and our rotation’s BOA
Best of the Best 2015 candidate for his research entitled: “Predicting
Leg Length Discrepancy After Proximal Femoral Varus Osteotomy”.
On Thursday 23rd April, Barts Heath NHS Hospitals Trust, Mr.
Achan, and the Percivall Pott Orthopaedic Rotation hosted the ABC
Travelling fellows from North America during the London leg of their
international journey. The day began with the trauma meeting at the
Royal London Hospital, and included a range of professional and social
activities including a Street Art tour of East London, and a taste of the
local cuisine on offer in Whitechapel. The evening dinner was held at
the Royal College of Surgeons (England) and involved plenty of fine
food, good wine, and excellent company. It was clear from the afterdinner speeches that the travelling fellows appreciated our hospitality
and some lasting friendships were founded. The Pott registrars seized
the opportunity to discuss and build connections with the ABC
Travelling Fellows, and we look forward to hosting them again in the
future.
The Pott rotation and BOTA
I am proud to see that our rotation is becoming more and more
engaged with BOTA, and I hope we can galvanise others in the region
to get involved. This year, we have three Pervicall Pott registrars on
the BOTA Committee (myself, Steve Kahane as Treasurer, and Simon
Fleming as outgoing Education rep / incoming Vice President).
East Anglia
Ross Coomber
Our deanery is growing in number with over 45 registrars now. We
have had a number of trainees who have gained substantive consultant
posts both in and out of the region.
There are two regional annual trainee meetings, the East Anglian
Surgical Club and the Cambridge orthopaedic club whereby trainees
are selected to present their latest work. The meetings include
presentations from guest speakers the last of which was from Prof
McCaskie on new developments in cartilage regeneration.
Mr Ravindra Kamath, Orthopaedic Consultant at Peterborough and
Stamford Hospitals NHS Foundation Trust was recently presented the
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Murray Mathewson Shield for Trainer of the Year at the annual Cambridge
Orthopaedic Club dinner.
Prof McCaskie is the newly appointed professor at Cambridge University
and has brought a great deal of expertise and funding to the department.
Addenbrookes hospital still continues to grow and is the major trauma
centre for the region.
Although our region is large geographically, the orthopaedic community
remains very close. We have weekly protected FRCS based teaching at
Addenbrookes every Thursday afternoon, which helps prepare everyone
for the exam. This is one of the reasons our trainees have almost a 100%
pass rate of the FRCS.
The strengths of the region are the excellent exposure to trauma, the
majority of hospitals ensure trainees gain a large amount of operative
experience with most trainees meeting the indicative numbers long
before their CCT date.
The trainees in the region have recently formed a research group, which
intends to join forces to carryout multi-centre studies, initially within the
region.
and post- exam will have coordinated tuition from nominated trainers
and those post-exam will be involved in delivering teaching for the more
junior trainees such as viva tables. Teaching is also looking at minimising
travel between sites and we look forward in liaising with Trusts in settingup video-links.
Other:
The national redistribution of junior foundation doctors away from
carrying out too much surgical work in their first two years is likely to
have some effect (precisely what remains to be seen)
Wessex
Toni Ardolino
Wessex has continued its strong record of success in the FRCS exam
with Duncan Avis, Hitesh Dibasia, Clare Langley, Daniel Marsland, James
Smith and Jim Turner all passing this year.
Congratulations on new consultant appointments for Nikki Kelsall as
locum trauma consultant in Poole, Charles Corbin as locum consultant in
Warrington and Neal Jacobs locum trauma consultant in Southampton.
There have also been outstanding achievements for which we are proud
to congratulate the following:
Kent, Surrey and Sussex
Shibby Robati
Firstly, I would like to thank Abhinav Gulihar for his work and
commitment as the KSS BOTA representative over the last two years. I am
looking forward to being part of the continuing successes and beneficial
changes to our training that will occur over the forthcoming year. Below is
a summary of the achievements in our region over the last year:
Rotation:
14 new ST3 appointments (6 in Sussex/Surrey and 8 in Kent). Sadly we
had one resignation from the programme and one transfer out of deanery.
Retirements:
Mr John Shepperd and Mr Stephen James (East Sussex) and Mr Avis
Ashbrooke (Frimley Park).
New consultant appointments:
Mr Simon Pearce and Mr Simon Hoskinson (East Sussex NHS Trust) and
Mr Chris James (East Kent NHS Trust)
Prizes:
Sam Simmonds Regional Meeting Podium Prize - Mr Chris Gee
Radcliffe Travelling Fellowship (University of Oxford)
- Miss Rebecca Mills
Health Education Award in Research & Development (East Kent)- Mr
Shibby Robati
TOTY award:
Mr Adrian Butler-Manuel (East Sussex)
Sam Yasen won the Sir Walter Mercer Medal for best FRCS exam
performance in the UK in 2014. As a result he has been appointed as the
BOA young orthopaedic ambassador to the UK, and will be travelling to
Hong Kong in this capacity in November as an invited guest to present at
the annual Hong Kong Orthopaedic Association congress.
In addition to this Sam Yasen also won the Macleod Medal for best
performance in the Diploma in Sports and Exercise Medicine exam in
the UK and Ireland. He has been invited to dinner with their president
for this success.
Darren Roberts was awarded the British Hand Diploma and is the
first trainee in Wessex to achieve this. He has also won the Ascot Gold
Cup for best Times Listener crossword setter of the year. He compiles
advanced thematic crosswords for the Saturday Times, Saturday
Independent and Sunday Telegraph.
Alex Aarvold attained several awards; BOA Ram Kumar Chatterjee
Travelling Fellowship,
RCSEd Cutner Travelling Fellowship, HCA International Travelling
Fellowship, and the Paediatric Orthopaedic Society of North America
(POSNA) Scholarship.
Wessex welcomes the new ST3 trainees who have been appointed
this year. As a region we now have 40% female registrars. Of note,
congratulations to Rebecka Asp who completed her core training in
region and came 6th in the country at national selection.
Outside of orthopaedics, Alex Nicholls spent a year project managing
his stunning house renovation which has since featured in Grand
designs magazine, Ideal Home magazine and on the front cover of
Homebuilding & Renovation.
Teaching:
The teaching programme has undergone some re-juggling this year and
looks set to see greater consistency and structure for the start of the new
term. The new set-up will see all new ST3’s have a designated trauma
year, with focus too on achieving good numbers on their trauma cases.
ST4-6’s will have a separate circuit to cover the subspecialties. Those per44
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Finally, a special mention to Joanna Higgins who has set up a charity
called “Let’s be tea friends”. Inspired by her partner Rob who sadly
passed away unexpectedly this year, her charity aims to support and
inspire people to help others and improve lives through small acts of
kindness. If you have a moment the website is: “letsbeteafriends.com”
Oxford
South West Peninsula
Richard Craig
Edward Matthews
2015 looks to be a year of collaboration for Oxford as this year sees
the formation of two new organisations. For the trainee body, there is
now an Oxford Orthopaedic and Trauma Trainees Association (OOTA)
to help facilitate a more active social and sponsored educational
programme. On an academic front, we are looking to maximise the high
quality research resources available in the region through a new Oxford
Orthopaedic Research Collaborative (OORC), which will in time become
a base for multi-centre prospective studies within the region allowing
trainees to contribute to some high impact research from an early stage
in their careers.
This year has been a strong one for the South West, but it is with great
sadness that we have suddenly lost one of our senior consultants, Mr.
John Marshall.
At the annual Duthie Day in November, prizes were awarded to Ben
Davies for his basic science project on stem cell harvest sites and
to Dan Rolton for his presentation “Could it be Magec?” reporting
the early outcomes in non-invasive spinal lengthening rods. The
guest lectures were themed to explore some different roles for the
modern surgeon as a researcher, an inventor, a manager and even an
adventurer. To round off, Professor Keith Willett generously gave up
his time away from NHS England to give the Duthie Lecture.
There has been expansion in the region and we would also like to
congratulate our trainees that have been appointed to substantive
consultant posts both in region and elsewhere.
Our trainer of the year was John Morley (Hip and Knee) from the
Royal Berkshire Hospital. In only three years, he has managed to
make a huge impact and his job is already highly sought after on the
rotation. His award was warmly supported by a good turnout at the
Duthie Dinner at the Randolph Hotel.
The success of meetings in Cornwall and Devon have continued. We
thank the organisers of these and commend those who walked away
with prizes. Thanks also go to Miss N Fine for organising the Annual
Registrar Dinner in Plymouth, which was enjoyed by all.
This summer, old rivalries with the Stanmore rotation have been
rekindled on the cricket field at Worcester College. In retrospect, the
Oxford team were perhaps a little overconfident in turning up with
fewer than the required eleven players. Even more generosity was
offered in the bowling extras, which ended up being the difference
between the teams with Stanmore posting 180 off 20 overs and
Oxford coming up just short on 148. A little more practice may be
required before a rematch next year.
Congratulations go to the T&O themed Oxford CT2s who have all
been appointed through to ST3 training, including one ACF. We wish
them well in their new posts next year.
We are pleased to have the on-going support from our excellent TPD
Mr Wainwright. This year he has initiated a newsletter for Oxford
Surgeons in Trauma and Orthopaedics (OST&Otome), which has
been a good way to keep track of everything going on around the
region.
We have welcomed Mr. Mike Butler as our new Training Programme
Director. His enthusiasm and commitment to training is without doubt
and we look forward to his continued efforts.
We would like to acknowledge those that have been successful in
negotiating the FRCS exam this year. Congratulations to you all!
The number and quality of nominations for our trainers in the TOTY poll
in region continues to give weight to the high quality reputation of the
South West. On this note we thank Mr. Mark Westwood, Derriford, for
his passion for training and thus his nomination of TOTY for our region.
Lastly, I would like to welcome the new trainees to the region and every
success to those trainees that have completed their training and we look
forward to the New Year.
Severn
Greg Pickering
I’m pleased to report that the Severn (or should that now be the
Southwest North?!) rotation continues to thrive, and this is reflected in
the fact that the programme ranked first nationally for overall trainee
satisfaction in the recent 2015 GMC National Training Survey. This all
comes despite major changes on the rotation, with reorganisation
of services in Gloucestershire, the opening of the new Major Trauma
Centre at Southmead and the centralisation of paediatric services to
the Bristol Children’s Hospital, all having their share of hiccoughs
and dramas along the way. Such an accolade in times of upheaval
is testament to the hard work, energy and effort that Trainers,
Administrators, Educators and everyone else associated with the rotation
gives on a daily basis. We as trainees remain extremely grateful.
Changes in the eligibility criteria have seen a rare hiatus in trainees
attempting the FRCS, but this has not seen a drop in teaching, revision
and viva practice sessions happening across the region. We wish those
candidates gearing up to take the exam the best of luck. Even higher
up the rotation the region has seen a number of trainee appointments
to substantive consultant posts including; Nick Howells (North Bristol),
Nav Atwal (Cheltenham & Gloucester), Andy McBride, Jimmy Barnes,
Anna Clarke (Bristol Children’s Hospital), Koye Odutola and Riaz Ahmed
(Weston), Andy Tasker (Swindon), Phil McCann (BRI) and Vijay Budnar
who has returned to India.
A number of trainees continue to participate in a host of roles both
within and outside of the rotation. Congratulations go to Lynn Hutchings
and Richard Murphy on completion of their respective DPhils and Julia
Blackburn for her MD. Peter Dacombe returned from his role as the
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National Medical Director’s Clinical Fellow to the GMC, and Johnny
Matthews now heads in the opposite direction to take up the same role
but this time as the inaugural Fellow to the Royal College of Surgeons
of England, we wish him a successful and productive year. We have
had a number of trainees in Africa - Henry Burnand spent the year on
a Sir Ratanji Dalal Research scholarship to Frere Hospital, South Africa,
Alasdair Bott enjoyed a similar if not briefer time on a BOFAS minifellowship to Malawi, and Nathanael Ahearn visited Nyahururu as the
BOTA Travelling Fellow to the Kenya Orthopaedic Project. ST8 Trainee
Hideki Nagata is currently a little closer to home, but enjoying the
experience none the less, as an Interface Group Advanced Trainee in
Hand Surgery over in Sheffield.
The Bristol Orthopaedic Registrars’ Group (BORG) has remained active
and influential under the stewardship of previous Severn/BOTA Linkman
Nathanael Ahearn, from assisting Mr Jason Webb with co-ordination of
the weekly Friday teaching programme, addressing trainee concerns
as they inevitably arise, co-ordinating collaborative research projects
and all whilst ensuring an active social calendar. Welcome bowling for
incoming ST3s was a great success, but we will certainly need more
lanes, shoes and bowling balls come August as we welcome 15 new
trainees to the rotation! The annual Registrars vs Consultants Golf Day
saw trainee success, whilst the annual cricket match saw a similar result
if not without a few more injuries along the way. You can imagine the
reluctance of volunteers to relocate a certain Professor’s dislocated
shoulder, but fortunately our upper limb specialist TPD Mr Mark
Crowther was on hand! Bike rides, wine tasting and BBQs are but a brief
selection of other events throughout the year.
The social highlight is of course the Annual BORG Christmas Dinner
which follows the Registrars’ Presentation and Prize Day. Congratulations
to Mr Richard Barksfield on his prize winning presentation ‘How to
make friends and influence people: an exploration of the Orthopaedic
Personality’. He will now go forward to represent the region at the
BOA’s Best of the Best. The day also saw Mr Mez Acharya (North Bristol)
named as BORG Regional Trainer of the Year. Despite his relative new
arrival to the region it was widely felt that this accolade was much
deserved, and Mr Acharya has already established himself as an ‘above
and beyond’ trainer within our rotation. Regional success saw Mr
Acharya nominated as our candidate for BOTA TOTY, where again such
commitment and enthusiasm for training was easily recognised by the
judging panel and he was voted into the top three Trainers nationally,
something both he and we are extremely proud of.
Our BOTA links do not stop there and we are pleased to see three of our
trainees elected to the most recent BOTA Committee; Marshall Sangster
(SAC Representative), Danny Ryan (Education) and Payam Tarassoli
(Academic).
There are numerous other aspects of the last twelve months that I could
cover but simply do not have the time nor word count! It would be
wrong for me to summarise the last twelve months without mentioning
JBORG, our flagship annual review journal. The above paragraphs
cannot even come close to summarising its contents. It was extremely
well received by Trainees, Trainers, Specialist Society Chief Executives
and even a Royal College President! Its contents and success not only
represents the hard work of its editors (this year Lynn Hutchings and
Greg Pickering) but like everything that has been written above, reflects
the amazing things that the men and women on this rotation do on a
daily basis.
We look forward to welcoming our new recruits in August and, with
every placement on the rotation filled with a numbered trainee for the
first time in at least 15 years, we look forward with anticipation to see
what successes the next twelve months will bring.
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Warwick
Daniel Westacott
This has been another fine year at Warwick Orthopaedics, albeit
tinged with sadness. We’ve been delighted to welcome Andy Grazette,
Sarah Henning and Chris Thomas to the rotation and see them
make themselves at home but have suffered two significant losses.
The death of Andy Sprowson has left a big hole at the heart of the
rotation that will be felt as keenly nationally as locally. It is also with
regret that we waved goodbye to Matt Costa who has moved on to
Oxford. We very much look forward to welcoming Andy Metcalfe as
Associate Professor to pick up the research reins and keep Warwick
Orthopaedics at the leading edge of national orthopaedic research.
The CAD trauma study has been a huge success and we hope will
contribute greatly to surgical education techniques. Our 100% record
in the FRCS (Tr&Orth) exam has been maintained as James Beazley
and Dan Westacott sailed through, further demonstrating the quality
of our teaching programme.
East Midlands South (Leicester)
Randeep Aujla
It has again been a successful, and progressive, year in the East
Midlands South region. We have to firstly say our goodbyes to our
TPD, Mr Bhaskar Bhowal, who is stepping down as TPD after 8 years
at the helm, but will remain a popular trainer on the programme. With
this, we also wish the best of luck for our new TPD Ms Claire Wildin.
Ms Wildin, an East Midlands South graduate, has been a popular
trainer and we are confident she can bring fresh ideas to build on our
already strong training programme.
We would like to congratulate our trainees who passed the FRCS this
last year and again our strong record is a compliment to the strength
of the training we receive. With this we wish our best of luck to
our graduating trainees Amit Kumar, Assad Qureshi, Robert Smith,
Veronica Roberts and Jennifer Nichols on the next leg of their careers.
One key success for our region is the close relationship between
trainees and trainers. Our own local Leicester Orthopaedic Trainees
Association (LOTA) provides us with a voice and significant influence
into decisions involving training. I would like to thank the committee
Amit Kumar, Bobby Siddiqui and Odei Shannak for their continued
efforts. Secondary to their efforts was the resounding success of our
2nd East Midlands South Orthopaedic Research Day (EMSORD),
which was capped with an enthralling talk from Dr Noel Fitzpatrick,
the SuperVet. Winning presentation went to Veronica Roberts who
takes the Aesculap Academia travelling Fellowship in addition to the
Joe Harper plate for consistently performing above par throughout
training.
We are proud of Mr Robert Ashford who was awarded the British
Orthopaedic Association ABC travelling fellowship, the first surgeon
from Leicester since 1948, and he has captivated us with the stories
ever since! Following this we hosted the ABC Fellows for their return
leg. We hope this will lead to further inspire our regions Consultants
to apply for such honours.
Finally I would like to welcome the new trainees to the region
including Daniel Howard, Shewidin Aziz, Herbert Gbejuade, Aziz
Haque, Paul Rai and Kantharuban Sanjitha. I hope your time in the
region will be fruitful and I wish you the best of luck.
East Midlands North
Faiz Shivji
The East Mids North Deanery has continued to enjoy great success.
Firstly, congratulations go to Jon Phillips, Ben Gooding, Dave Copas,
Kat Price, Sachin Badhe, Joby John, Alexia Karantana, Matt Jones, and
Nick Duncan who have all been appointed as Consultants either locally
or further afield. Our deanery now has no post CCT trainees without a
consultant job, which speaks volumes regarding the quality of training on
offer in the East Midlands.
With regard to academia, Conal Quah won the BOA Travelling Fellowship
to enable him to travel to the Alfred Centre in Melbourne, whilst Sami
Hassan was awarded the BSSH Travelling Fellowship with which he
travelled to the Mayo Clinic. Finally, Tanvir Khan has been granted the
NJR fellowship, commencing this August.
The annual Malkin Memorial Meeting in July showcased the high
quality research being conducted in our Deanery. We were delighted
to welcome the author Mr Bill Bryson and former BOA President Prof
Tim Briggs to Nottingham as guest speakers for the event. Dave Bryson
honoured his family name by winning the prize for best presentation for
his work on sarcopenia in trauma patients.
On the teaching front, the Deanery delivered 2 complimentary all day
cadaveric teaching sessions in York this year, which were brilliantly
received, and will be repeated each academic year.
This year, a special mention must go to Girish Swamy and Mr Tony
Westbrook who climbed Mount Kilimanjaro in December for a charitable
cause.
As with every year, we look forward to the new recruits joining us in
August, welcome to the Deanery.
West Midlands (Birmingham)
Guy Morris
The Birmingham training program continues to go from strength to
strength. The teaching program organised by our Program Director Mr
Khalid Baloch continues to improve year on year and is receiving very
positive feedback from our trainees. The meetings that we have held
enable the program to become even more productive. The FRCS viva
sessions are extremely useful and this is reflected in our high exam pass
rate again this year. We would like to thank the many consultants who turn
up week in week out in order to help us prepare for this. Congratulations
go to out to Michael David, Arul Ramasamy, Sameena Chaudhry, Scott
Evans, Richard Knight, Navi Bali and Amit Kotecha all of whom passed the
FRCS this year.
In February we welcomed Mohammed Mussa onto the training program as
a new ST3, we would like to congratulate him on his appointment.
It was a tight run race this year but in the end Mr Marcus Jiggins (Manor
Hospital, Walsall Healthcare NHS Trust) beat off some stiff competition to
win the regional Trainer of the Year Award. He received maximum points
from our online trainee survey. We would like to thank him for all his hard
work with his trainees.
Amit Kotecha was successful in his application for the IOSUK fellowship
following interviews at this year’s BOTA Educational Congress and Simon
Maclean will be leaving us for his Upper Limb fellowship in Adelaide later
this year. We wish them good luck.
From an academic point of view the region continues to turn out some
successes. Raj Nandra won the Jacques Duparc award at this year’s
EFORT in Prague. He has also won 2 research grants of substantial
amounts to further his research into fracture non-unions. Gulraj Matharu
continues with his success at the regional Naughton Dunn meeting,
again scooping the podium presentation prize for his paper on the use of
Ultrasound Scans in follow-up for Metal on Metal hip arthroplasty.
We had some unfortunate news that Mr Mohamed Arafa, Consultant
Hand Surgeon had passed away earlier this year following a battle with
illness. He is a loss to the trainees and patients in the region and to the
orthopaedic community as a whole. He worked tirelessly on the training
program and was a regular member on our ARCP panels. He will be
missed.
Lastly, I will be stepping down from my Linkman position in August. It
has been an educational and enlightening year in this role and one that I
hope to take up again sometime down the line. Thank you to my fellow
trainees for putting up with my badgering emails (and the rest of the
linkmen and committee for that matter!).
Oswestry and Stoke
Ross Fawdington
Trainees within the Stoke / Oswestry subdivision of the West Midlands
deanery continue to do well with the FRCS (Tr & Orth) exam with a
further year of everyone passing. There has not been a failure within
the last 120+ candidates (approx.). Trainees can therefore feel quietly
confident that they have a robust training programme but they still feel
the exam pressure, as they fear being the one that breaks the record.
Training cannot happen without good trainers though and this is
exemplified by Mr Phil Roberts who was nominated for our regional
trainer of the year award (TOTY). Although he did not win, he clearly
demonstrates the attributes of an excellent trainer. Mr Roberts is a
specialist in both primary and revision hip arthroplasty and clinical
lead for neck of femur patients, he allows his trainees to run his firm.
Currently Stoke treats almost 700 neck of femur fractures per year. The
trainee therefore not only develops their surgical ability but also their
leadership and management skills, which will be essential as a future
consultant.
As someone that is interested in furthering my own education and also
sharing a beer with colleagues, I have been fortunate to have worked
with both Stryker and Depuy Synthes. They have both kindly sponsored
an evening educational workshop with sawbone practicals. So far we’ve
had 3 this year and covered damage control orthopaedics with external
fixation, complex femoral nailing and tibial nailing with poller screws. I’m
now planning one a month for the next academic year and hope to get
more support from industry.
Sadly after 5 years of being the Stoke / Oswestry linkman, the time has
come to handover the baton. I am now an ST8 and will commence
an advanced training post in hand surgery next year and it’s therefore
appropriate to give someone else the opportunity to takeover. After
advertising the role to the current cohort, there were 5 people that were
interested and after completing a structured questionnaire, I’m pleased
to be handing over to Lawrence Moulton. Lawrence is an ST6 and has
recently joined us from the Welsh rotation. He has brought some fresh
ideas for how we can enhance our own training and has also been a keen
supporter of BOTA, having attended every annual conference since he
was a core trainee. I am confident he will be an excellent linkman for
BOTA.
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I would like to thank the BOTA executives who have worked tirelessly
throughout the years to develop orthopaedic training and congratulate
them for yet another superb annual conference.
Mersey
Mohammad Mohammad
Mersey deanery has had an excellent year with regards to passing
the exam. Ansar Mahmood, Danielle Wharton, Sujay Dheerendra,
Debbie Shaw and Daoud Makki all passed. We hope to have the same
success with our next cohort of exam candidates. We would also like to
extend our congratulations to Mr Grev Farrar who has been appointed
consultant at Leighton Hospital and Mr David Melling who has been
appointed as consultant at Aintree University Hospital.
Mersey Deanery is very fortunate to be hosting the Indian Orthopaedic
Society conference this year and we expect an excellent turnout with
many of our registrars presenting their research. This should be a very
exciting day and presents many of the trainees with the opportunity
to present at a National conference. The BOA Annual Congress is also
coming to town in September and we hope to see a large number of
you there.
The Deanery has been kind enough to pay for part of the BOTA
conference as part of our teaching programme and a large turnout
is expected. This weekend will be highly educational and a great
opportunity to meet and socialise with trainees from across the UK.
We would also like to extend our thanks for all the consultants who
have provided the trainees with excellent opportunities this year and a
further special mention to Miss Thorpe the Mersey trainer of the year.
She has been shortlisted in the top 3 for the national TOTY and we
wish her all the best and will be supporting her on the day.
This year Registrar day will be as exciting and fun as usual however
will be tinged with sadness as we say good-bye to Mr Braithwaite and
Mr Platt. Both have been instrumental in providing Mersey trainees
with one of the best education programmes. We are grateful for all
their hard work and dedication, we wish both of them the best for the
future.
Mr. Braithwaite moved from running the teaching programme to
our TPD 3 years ago and has worked tirelessly to try and ensure we
get signed off at the final ARCP. His friendly approach as well as his
cakes will be sorely missed. Mr. Platt took over from Mr. Braithwaite
and has ensured the teaching programmes high standards have been
maintained. For some reason he is heading to Brisbane to further his
interest in beaches and the sun and again we wish him all the best for
the future.
North West
Ronnie Davis
This has been another excellent year for the North West. Under the
guidance of Mr. Ryan, the Training Programme Director, the North
West programme continues to develop. Issues such as indicative
numbers do not appear to be a significant problem due to the high
quality of jobs across the region. Our STC reps, Jo Ring and Tom
Finnegan, have represented trainees’ views and needs well and the
programme has responded quickly to any issues. Changes are on
the horizon, with a merger with the Mersey Deanery having already
taken place to produce Health Education North West. At the moment,
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trainees are still working within their current regions, but it is quite
likely that there will be some cross-fertilisation of both training posts
and teaching programmes in the future.
Success has continued in the FRCS for North West trainees.
Congratulations to those who have recently passed, including Jim
Bourne, Farhan Alvi, and Jawad Sultan. This is a reflection of the high
standards of our excellent teaching programme, organised by Mr.
David Johnson. Year 4 exam-focused teaching is run by Mr. Ravi Goyal.
The professionalism and leadership skills course organised by Mr.
Aqeel Bhutta is in its third year for post-exam trainees and continues
to receive good feedback. Compulsory attendance at the educational
component of BOTA continues.
We expect that the major trauma collaborative currently comprising
three hospitals will be rationalised to fewer centres in the next few
years and it will be interesting to see how this impacts training: watch
this space! On-calls have generally remained non-resident, including at
most major trauma centres.
The annual research day showcased the high quality of research in the
region. We were also entertained and educated by a range of excellent
speakers. Your humble linkman won two prizes, including best paper,
and will present this work at the ‘Best of the Best’ session at BOA
Congress in September. As usual, the research day was followed by the
annual ball, which was again extremely well organised and attended.
James Mace won the trainee of the year award. The trainer of the
year award went to Professor Robin Paton (paediatric orthopaedic
surgeon). This is the second time that he has received this honour
and is a testament to the effort that he makes for each of his trainees.
The North West Orthopaedic Research Collaborative, headed by
Professor Tim Board and Mr. John Gregory is in its second year. It
has been successful in producing a number of publications and now
includes a pitching day for research proposals, which are selected to
be taken forward by a dedicated group.
Our local trainee website continues to be developed. It provides
all information on teaching, including file downloads relevant to
each teaching session. It also incorporates teaching feedback
and attendance monitoring, enabling each trainee to view their
own attendance record at a glance, and consultants to save their
own feedback. It will expand over coming years to provide a
comprehensive guide to the rotation and FRCS exam.
Northern
Will Manning
It has been another excellent year up North! Although now re-branded
Health Education North East, The HENE (Northern) Deanery has
grown in size and strength; taking on a wealth of ST3s last year.
The reconfiguration of post-graduate teaching and education under
the OrthNorth heading is one of several developments in the northern
region. Set-up with industry support, this project will invite leading
experts from around the UK to speak on our lecture program while
also increasing lab and workshop based teaching. Thanks to Mr
Candal-Couto, Mr Dalal, Mr Krishnan and the team for their continued
effort with this innovative development.
The CORNET trainee research collaborative has engaged in and
completed numerous projects. It received significant funding to run a
large multicenter trial on Exeter vs. Thompsons for patients with a hip
fracture, and that trial is recruiting fast and in line with target. We have
5 trainees out doing full time funded research.
Congratulations to Mr Nikhil Nanavati on completing his MSc in
Orthopaedic Engineering.
Our Registrar prize day and dinner – The Kreibich Day – saw an
increased turnout under the stewardship of Mr Jones and Becky
Morrell. In Memory of Andrew Sprowson passing, a minutes silence
was followed by a good few hours at the bar remembering our friend
and colleague. This year’s Kreibich Prize was won by Debbie Lees,
for her novel RCT examining the reduction in post-operative pain
associated with upper limb tourniquets. Accepted by the BJJ, the
advice to exsanguinate not elevate will be hitting you shortly. Mr Peter
Millner delivered an outstanding Jack Stevens Lecture asking the
learned audience to conjure names for odd medical devices; copyright
law and good taste prevent re-print of the eventual winner.
Congratulations to Mr Andrew Legg, Mr Owain Evans and Mr James
Tomlinson on completing their registrar training and gaining their
CCT. We look forward to hearing about the experiences they’ve gained
whilst away on their fellowships.
This year’s exam cohort were 100% FRCS positive, many
congratulation to Muhammad Mansha, Steve Borland, Riem Johnson,
Milton Ghosh, Munir Khan and Lisa Jeavons.
The Northern TOTY award went to Mr. Robert Gregory, who received
over 75% of trainee vote. An excellent trainer in his own right his
diplomacy as STC chair and commitment to delivering high quality
training across our region has been evident for many years. The
rotation was honoured that Mr. Mike Reed, our TPD since 2011,
received the inaugural BOTA TPD of the Year Award. As one of
our trainees phrased it ‘he is quite simply a force of nature, from
education, to innovation and academia, Mr. Reed’s commitment to
improve orthopaedic training both locally and national goes above and
beyond’.
The rotation says goodbye to an outstanding group of trainees this
year: Aravind Desai, Dan Dowen, Simon Jameson, Simon Chambers,
Tim Bonner, Suresh Thomas and Kiran Singhisetti, we wish you all the
best in future endeavours. Former trainers were invited to bid them
farewell at their graduation dinner. Fitting tributes were delivered
by all; special note must be given to the moustache of Mr. Desai,
described as a reassuring omnipresence in the turbulent world of the
modern NHS.
Following a recruitment drive that even entered the TPD forum at
BOTA “Inter-deanery transfers are available”. 2016 is shaping up to be
an eventful year.
South Yorkshire
(Yorkshire and Humber)
David Wood
Well it’s been another eventful year on the South Yorkshire rotation.
We welcomed three new Consultants to the region:
Mr Abhijit Bhosale completed his Registrar training in South Yorkshire
before undertaking his fellowship in Manchester. He was appointed
to Barnsley District General Hospital as a Consultant Trauma and Foot
and Ankle Surgeon.
Mr Tim Harlsey completed his Registrar training in London. He was
appointed to Rotherham District General Hospital as a Consultant
Trauma and Hand Surgeon.
Mr James Stoddard completed his Registrar training in South Yorkshire
before undertaking his fellowship in Harrogate and Coventry. He was
appointed to Northern General Hospital as a Consultant Trauma and
Soft Tissue Knee Surgeon.
This year our weekly Higher Surgical Teaching was organised and run
by Mr Yuvraj Agrawal, Mr Jonathan May and Mr David Wood covering
Hand, Knee, Foot and Ankle and Spine.
Our 25th Annual Orthopaedic Registrars’ Day was organised by Mr
Owain Evans. Guest of honour was Prof. Tim Briggs with Mr Mike Bell
as the local adjudicator. This annual event was held at the Sheffield
City Hall with all previous trainees and Guests of Honour invited back
to celebrate the 25th anniversary. As always each member of the
rotation presented a piece of work undertaken during the previous
year. There was hot competition for the Getty Plate which was
eventually won by ST5 Mr Jonathan May (for the second consecutive
year) presenting a project on modern biothesiometer compared to the
gold standard. The runner up was ST5 Mr Edward Holloway.
The Nick Kehoe Travelling Fellowship was awarded to Mr James
Tomlinson. The Aesculap/BBraun Travelling Fellowship was awarded
to Mr Andrew Legg for his trip to Germany.
The scientific meeting was rounded off in style at Mecure St Pauls
Hotel with the evening’s black tie ball. Mr Richard Gibson Consultant
Trauma Surgeon the Northern General Hospital was named Trainer of
the Year.
Our Annual Consultant vs. Registrar cricket match was played at Hallam
Cricket Club – a competitive game in the sunshine saw the Consultant
team over run the Registrars to extend their winning streak. Battle
lines will be have been redrawn by the time this goes to press!!
This year we welcomed Mr Paul Brewer, Mr Angus Fong, Mr Andrew
Hannah, Miss Charlotte Montgomery and Mr Nikhil Nanavati to the
rotation. All had undertaken their core surgical training outside the
region but saw the light and came to join us in the White Rose County.
We are pleased to have them with us and look forward to watching
their progress over the coming years.
This year we presented candidates for the FRCS examination. We
were thrilled to celebrate with Mr Yuvraj Agrawal, Mr Pavel Akimau
Miss Caroline Blakey, Miss Karen Robinson and Mr Scott Macinnes on
passing the FRCS Trauma and Ortho MCQ’s at the first attempt. We
hope their success will continue in to the autumn as they undertake
Part 2 in November.
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Yorkshire
Saif Hadi
This is my final report as BOTA linkman and it has been a privilege.
I strongly believe that the current committee is taking the vision of
BOTA forward and on to new realms, which stands in good stead for
trainees in the future.
Yorkshire has had another great year for FRCS results with 100% pass
rate, making it four consecutive years with no failures. This is most
probably a result of the numerous and rigorous hurdles that need to
be jumped before trainees are signed off.
The Trainer of The Year was awarded to Mr Ravi Dimri of Huddersfield
Royal Infirmary. He has been nominated numerous times in the past
but always pipped to the post. This time the vote was unanimous.
His dedication to helping trainees in viva sessions is unparalleled. He
has 8 planned sessions that run for 2 hours apiece for each diet of
the viva exam (that’s 3 times a year), giving up his personal time, be it
weeknights or weekends in his own home.
The standard of teaching and training in our unit remains at an
all time high with growing numbers of publications and academic
achievements. We are all proud of Iain Murray who won the New
Investigator Recognition Award at the ORS annual meeting for his work
on integrin depletion and muscle fibrosis. Well done!
Our outstanding trainers should also be congratulated for all of their
hard work over the past year, especially our local trainer of the year
Mr Ivan Brenkel (VHK Fife). Runners up included Miss Jane McEachan
(VHK Fife), Mr Timothy White (RIE Edinburgh) and Professor Steffen
Breusch (RIE Edinburgh).
Our annual Trauma Symposium goes from strength to strength and last
year was no exception. The SE was also successful in organising the
first international not-for-profit Biomechanics in Orthopaedic Surgery
Course (BiOS) in Reykjavik, Iceland. It was a roaring success and next
year will be moving to sunnier climates in Ibiza.
All ST8’s attained their CCT without much drama and have all gone
onto fellowships at home and abroad with the highlight being Ashish
Soni travelling to Pittsburgh to work with Dr Freddie Fu.
We look forward to the year ahead and I am certain that it will not fail
to excite and surprise us all.
The Friday afternoon regional teaching continues to be organised
effectively and positively by the Academic Programme Director
Mr Manjit Bhamra who’s impetus in the teaching programme was
recognised by his award of Trainer of The Year last year.
East of Scotland
Operative numbers continue to come easily to Yorkshire trainees
as the great clinical exposure means many registrars have all their
indicative numbers by the end of ST6.
It’s been a pleasure to train in God’s Country for the past 10 years and
I wish all the best to the incoming linkman Paul Dearden.
South East of Scotland
Vitty Bucknall
It has been another fine year for the South East of Scotland. We
welcome our newest recruits Paul Stirling, Liam Yapp, Rob Lambert and
Matilda Powell-Bowns with open arms. We look forward to working
with them over the coming years.
The FRCS results have been once again been phenomenal. Our
successful candidates have an exciting time planned ahead. Chloe
Scott winner of both the BOA Adult Reconstruction in Hips and Knees
Travelling Fellowship and the SCOT Zimmer Travelling Fellowship
will be heading off to Boston. Andre Keenan will be commencing
his Fellowship at the Golden Jubilee in Glasgow before starting
an Arthroplasty and Trauma Fellowship in Auckland New Zealand.
Sally-Anne Phillips has been successful in securing an Interface Hand
Fellowship in Newcastle and Robbie Ray has Fellowships in Canada and
Australia.
We extend our congratulations to Miss Sarah Mitchell and Mr Jonny
Cowie for their appointment as consultants at the Victoria Hospital,
Kirkcaldy, Fife. They are an excellent addition to the team and we are
very lucky to have secured them in our region.
We are however sad to be waving goodbye to Mr Rhys Clement who
will be undertaking an inter-deanery transfer to Wales. He is a fantastic
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colleague and although he will be greatly missed, will be an asset to
Wales. The very best of luck Rhys.
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Sarah Gill
Greetings from the East of Scotland Deanery! I am pleased to report
another enjoyable and productive year from our training region.
This year we welcomed Miss Samantha Conlin, Mr Alastair Mayne and Mr
Peter Davies to our rotation as ST1s. We’re delighted to have them and
they have already proved themselves assets to our registrar group and
region. We equally look forward to welcoming Mr Joesph Littlechild and
Mr Peter Hutchison in August 2015. Joe joined the department last year
as a core trainee and we are very pleased to keep him as a numbered
orthopaedic trainee this year.
Our very best wishes and a fond farewell to Mr Matthew Seah who leaves
our region to commence his grant-funded PhD studies. He is a man of
huge talent and our loss is certainly their gain. As a champion of patient
dignity (“Mr Whatshisface”) and precision (“…and whatnot”), Matt will
be greatly missed. On a serious note, we look forward to our orthopaedic
paths crossing with you in future; thank you for being a wonderful
colleague and enjoy your new adventure.
Congratulations to our Consultant colleague, Mr Arpit Jariwala, on his
award of the highly prestigious British Orthopaedic Association Travelling
Fellowship Award for 2014, and to our senior trainees who are currently
away from the region, having secured other excellent fellowships this year.
Major Simon Johnston is currently a fellow at the Pulvertaft Hand Unit in
the Royal Derby Hospital and Mr Amar Malhas has ventured west for an
Upper Limb Fellowship at Glasgow Royal Infirmary before heading south
to start in Wrightington in August. Mr Gerry Cousins was persuaded south
of the border and is the current Spine Fellow at the Northern General/
Sheffield Children’s Hospital in God’s Country. Mr Robert Lawton has
just returned from Chicago having been awarded the SCOT Travelling
Fellowship this year. May I take this opportunity to thank these registrars
for their contributions to our region during their training. All were
fantastic colleagues and role models and the footprint they each leave in
the department will last for a long time. In an ideal world all would remain
in the region as Consultants but should your career take you elsewhere,
they’ll be very fortunate to have you.
On that note, we are very pleased to announce Mr Fraser Harrold’s
appointment as Consultant Foot and Ankle surgeon at Ninewells in
summer 2014 following his CCT from the region earlier that year.
Fraser’s credentials would speak for themselves but, on a personal
level, his registrar colleagues are delighted to see him stay in the
region. Many congratulations to Mr Sam Roberts who returns to his
native Aberdeenshire as Consultant. You are already missed and well
done to Aberdeen for stealing him away!
Glasgow Royal Infirmary. Jim Huntley, one of our region’s previous
trainer of the year, is starting a one year sabbatical in the Middle East.
Congratulations to Miss Julie Smith who was awarded the ASME New
Researcher Award 2014 in reflection of her PhD work in Medical
Education.
Several regular and new education events were held with great
success. The annual Glasgow Meeting for Orthopaedic Research
featured key talks from Professors Chris Moran, Amar Rangan, Chris
Colton and Mr Mike Reed. The inaugural International Orthopaedic
and Trauma Symposium at the Royal College of Physicians and
Surgeons of Glasgow featured talks from Professors David Beverland,
Chris Moran and Mr Fergal Monsell.
Reflecting on this last year of training, we continue to build upon some
existing strengths here in the East of Scotland with excellent operative
numbers and clinical training opportunities. Credit should be given
to Mr Graeme Nicol for his excellent work as Chief Resident. His hard
work with the rota has allowed us to continue with a two-tier junior/
senior registrar rota and preserve the 24 hour on calls, which are so
beneficial for senior training, whilst maximising the normal training
hours for junior trainees. This is no mean feat in the face of reducing
training numbers but it is vital to the preservation of the excellent
quality of our training. Many thanks to Mr Mike Reidy, for his hard
work and dedication in post as both previous BOTA Linkman and now
outgoing Scottish BOTA Rep. Looking forward, we anticipate exciting
plans for the 5th Tayside Orthopaedic Research Club Annual Meeting
in November 2015.
On a final, but very important note, a huge congratulations to Vicky,
Graeme and Mike on the births of their first children and to Gerry on
the birth of his second. Your respective partners are all delighted you
are used to getting up overnight and the rest of us have assured them
that you’re all keen to do the lion’s share of out of hours work.
West of Scotland
Andraay Leung
The most significant development in the West of Scotland this year
was the closure of three central Glasgow hospitals and the opening
of the new South Glasgow University Hospital (SGUH). The Western
Infirmary, Victoria Infirmary, and Southern General Hospital were
closed and services transferred to the new hospital which cost the
Scottish Government £840 million. The Royal Hospital for Sick
Children (RHSC), locally known as Yorkhill, also moved into a new
building located next to the new SGUH. As a result the SGUH campus
will be where the majority of trainees are based in the future.
We have 60 trainees in our region this year. Congratulations are in
order for the formidable group of Sarah Maclaine, Sanjay Gupta,
Zoe Higgs, Alan Bennett, Iain McGraw, Colin Drury, Stephen Grant,
Matthew Torkington, Cameron Elias-Jones, James Gillespie and Bilal
Jamal, who have passed the FRCS Tr&Orth exams in the past 12
months.
It is with great sadness that we marked the passing of Gam Ayana in
February. Gam was a larger than life character, extremely popular and
with strong interests in training. He was our region’s postgraduate
training committee chairman and his successor will have a huge void
to fill.
North of Scotland
Tristan McMillan
The year saw success in the FRCS for Miss Clare Miller and Miss Kat
Treon, we wish them all the best for their future as they embark on
their Hand and Spinal fellowships respectively.
Anna Reimen has taken time out of training to complete a Welcome
Trust, Scottish Translational Medicine and Therapeutics Initiative
funded, clinical research fellowship. Her PhD is working on the role
of mesenchymal stem cells in the development of posttraumatic
osteoarthritis and we wish her all the best with this.
Our regional Trainer of the Year was Mr David Boddie of Aberdeen
Royal Infirmary. He works exceptionally hard, devoting a great deal of
his time to the Unit and trainee development. We are delighted this
has been recognised. We would also like to thank Mr Kapil Kumar, who
is due to step down from his role as TPD this coming August. He has
been an asset to the programme for the last 5 years, and trainees past
and present are greatly appreciative of his commitment and hard work
within the post.
Mr Iain Stevenson and Miss Adeline Clement continue to work hard on
the running of our deanery teaching programme, with its development
and expansion proving of great benefit to the trainees. A particular
highlight was the inter-deanery Bone and Soft tissue tumour event,
welcoming Mr Lee Jeys and Mr Will Aston as visiting speakers.
The department continues to expand with the welcome appointment
of two new consultants, Mr Sam Roberts and Mr Martin Mitchell.
Furthermore, we welcome Iain Rankin and Harry Sargeant to the
training programme.
Despite the ever-increasing workload in our region, we are delighted
that staff continue to find time for recreational pastimes and we would
like to congratulate Kath, Senthil, Chris, Santosh and Mr Andrew Frost
on the birth of their children.
A number of trainees have been successful in obtaining consultant
posts within our region; Fraser Dean, Nick Brownson and Odhran
Murray at the Spinal unit at the SGUH, Janet McCaul at the RHSC, Nick
Holloway and Findlay Welsh at the Golden Jubilee National Hospital.
We also wish Emily Baird and Adam Lomax well as they have secured
consultant posts in Edinburgh and Leeds respectively.
There have been movements at the consultant front as well. Drew
Shaw has moved from the Victoria Infirmary across the city to the
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World Orthopaedic Concern
Ashtin Doorgakant
To say that WOC-UK has had a productive year since BOTA’s last annual
conference is an understatement. Many of the projects under WOC’s
umbrella have gained strength, with new ones still cropping up. WOC
has been prominent at a number of high profile meetings and held it
second annual conference in June, which was a resounding success
with a turnout of about 40 people from around the country. This year
again, WOC-UK was invited to chair the meeting on less developed
world orthopaedics at EFORT in Prague and captured a very lively
audience.
WOC-UK’s membership continues to grow and the appeal to trainees
seems to be a big component of this.
WOC-UK worked very closely with BOTA just after last year’s annual
meeting to release a joint position statement about the new barriers
emerging against out of programme placements. We encouraged
all parties involved to look carefully into this and, in particular, to
recognise the benefits to the trainee and to the NHS of trainees
undertaking placements in low and middle income countries.
The 4 main meetings this year were:
1. & 2. The back-to-back Lancet commission on Global
surgery launch and the 4th edition of Global Surgical
Frontiers (GSF4) on 27 and 28 April at the Royal Society for
Medicine in London.
The Lancet commission, which has already had major consultation
meetings in Boston, Dubai, Freetown and Bellagio, launched the final
version of a new blueprint for surgical work in LMICs1: Global Surgery
2030. This in many ways replaces the Millennium Development Goals
(MDGs), which comes to a close this year. The MDGs neglected
surgery as a whole and this new movement spearheaded by the Lancet
aims to reverse that. The report is ambitious but it is the first of its
kind, and really does a brilliant job of crunching statistics into a more
digestible format. More information and resources are available at the
commissions website: http://www.globalsurgery.info
To have GSF4 the very next day at the same exquisite venue, with many
people fired up and eager to get involved in global surgery, couldn’t
have been more exciting. The meeting was massively oversubscribed
and an extra video link had to be opened to accommodate the
audience. WOC-UK ran an exhibitor’s stand at the meeting and
also presented a “lightning” talk, one of GSF’s trademark features,
notwithstanding the exceptional entertainment value provided by Prof
Lavy! Edutainment at its best!
3. EFORT
WOC had a prime time slot on the first day of EFORT congress in
Prague this year. The session was chaired by Steve Mannion who talked
about the earthquake in Nepal and improvements in the disaster relief,
through the IETR’s2 coordination and the UN cluster system. All three
other talks were from trainees. Laurence Wicks, ST5 Leicester, spoke
about his involvement in the development of a link between Leicester
and Gondar in Ethiopia. I presented a pilot project on a new database
for better epidemiological orthopaedic data specifically adapted for
the low resource setting. Jim Penny spoke about a pioneering surgical
approach to the neglected clubfoot in Malawi.
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The audience was very responsive and brought us in contact with
numerous people doing similar work to us from across Europe, with
the hope that partnerships will be formed in the future to improve
coordination of this international work.
4. Our annual conference was held at the BOTNAR research
centre in Oxford in June this year.
This is the second year we ran the conference in this format, with a
good mix of lectures on global surgery topics and reports of the myriad
of orthopaedic activities taking place around the world which are
linked to us in some way or form. We learnt from last year and made
further improvements, with all the credit going to Lauren and Laurence
Wicks, Deepa Bose and Prof Lavy again for the hard work.
Our keynote speaker was unfortunately unable to make it from Malawi
owing to unsurmountable barriers from our home office visa office.
Our Ginger Wilson fellowship holder wasn’t back yet from Malawi to
deliver his presentation, so we’ll hold on with bated breath for this at
next year’s conference.
Despite this we had a full day of varied talks with great audience
participation on a range of topics.
Alan Norrish (Consultant at Addenbrooke’s) spoke about how to
establish a THET partnership with Myanmar. Antoon Schlosser
(Netherlands) discussed the “Improve Trauma and Orthopaedic Care”
(ITOC) project in Zimbabwe. There was a real interest in developing
a regional East African version of the orthopaedic handbook released
in Malawi in 2013- Orthopaedic Care at the District Hospital (www.
orthopaedic-care.co.uk) and work on this is underway.
Our invited guest Mr Sailaj Ranjitkar, from the medical college and
teaching hospital of Kathmandu and Steve Mannion spoke about
the relief effort for the Nepal earthquake. They allowed us to see the
interventions from both sides, giving us very balanced perspective.
We also heard country reports, as per the tradition from
• Malawi- Steve Mannion
• Cambodia- Dalton Boot
• Ghana and West Africa- Paul Ofori-Ata
• Ethiopia- Laurence Wicks (and Rick Gardner- not present)
• Philippines Palawan- Louis Deliss
• WOC international- Antoon Schlosser
The final session saw some great scientific project being presented,
including:
As usual there will also be time allocated to free papers, which is a
fantastic way for trainees to add a prestigious line in their CV!
• The use of orthopaedic implants in the COSECSA region, by Prof
Lavy
• Pre-packing of cost effective antibiotic cement beads in treating
osteomyelitis, an inspiring piece of research by Saqib Noor while in
Cambodia (still ongoing)
• Comparison of orthopaedic training in English speaking (and Asian)
countries- Shakir Hussain (Birmingham rotation)
• Tourniquet use in Malawi- Greg Nichols (SHO Gen Surgery North
West)
• History of the Steinmann pin- John Guy former WOC chairman
• Steinmann pin availability and cost- is local production possible?Murtaza Khadum (Med Student)
• Feet First operation for neglected clubfoot in Laos and Malawi- Jim
Penny (ST5 Northern Deanery)
Steve Mannion was re-elected as our chairman at the AGM.
WOC-UK is moving from strength to strength and its trainee
involvement is stronger than before. With BOTA, the BOA and
EFORT all recognizing the invaluable contribution we make to global
surgery, there remains no doubt that WOC-UK is one of the key
links for anyone planning a placement in low and middle income
countries. There are two fellowships on offer every year and plenty of
opportunities to obtain poster or podium presentations. One of WOCUK’s main ambitions is to continue to build up on its already good
trainee membership and bring new blood, new ideas and new energy
into the organisation. We, the trainees, are the surgeons of the future
after all.
1. LMIC- Low and Middle Income Countries
2. IETR- International Emergency Trauma Register
WOC-UK will be chairing a session at the BOA congress in Liverpool
on Thursday the 17th of September and we look forward to having a
good turnout from trainees again. A sneak preview of what will be on
the agenda includes challenges with sarcoma detection and treatment
in LMICs; the SIGN nail initiative (a jig based locked intramedullary
nail system that doesn’t require image intensifier); other new LMICappropriate technology; and a digest of the Lancet commission’s
work and report for many people who still aren’t up to date with this
groundbreaking development.
MSc Orthopaedic Trauma Science
– distance learning
This two year online distance-learning
course uses innovative methods of
teaching and assessment for a fresh,
dynamic and interactive approach
to teaching orthopaedic trauma –
irrespective of location or time zone.
It has a rich pedigree and is offered in collaboration
between London’s most established Major Trauma Centre,
the UK’s lead centre for research into complex trauma
care and one of the oldest medical schools in the world.
For further information please contact:
Tel: 020 7882 6532
email: [email protected]
www.blizard.qmul.ac.uk
@orthomasters
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Educational Congress
BOTA Educational Congress 2015 56
Picture Gallery
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BOTA Trainer of the Year (TOTY) 2015
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Trainer of the Year 2015 Winner – Niall Eames63
BOTA Training Programme Director of the Year (TPDOTY) 2015
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BOTA Training Programme Director of the Year 2015
Winner – Mike Reed64
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The BOTA Educational Congress 2015
Simon Fleming
This year’s Educational Congress was a resounding success in
the face of adversity. We were on to break all previous records of
sponsorship when, mere months before the event, rules changed,
laws were modified and suddenly we were struggling against the
new industry compliance guidelines. It is only through the hard
work and support of the committee and our events organiser
Sue Dale, that we were able to run the amazing Congress that we
eventually did. Our Diamond Sponsor this year, BBraun, were
there in force, running fantastic workshops on their navigation
arthroplasty software, but we could not have done it without all of
our sponsors, for which we are indescribably grateful. A special nod
goes to Stryker and Lt Col Tom Rowlands, who, this year, were the
winners of the Best Industry Workshop 2015. Lt Col Rowlands tells
me he has already received emails confirming that trainees have
used the “diamond ex-fix” construct he described – truly the proof,
if ever some was needed, that the workshops can have a real impact
on surgical practice.
This year’s Congress was also nearly entirely paperless, with agenda,
feedback and handouts all based on our bespoke website and I
encourage you to check it out – read my report and then look at the
talks that take your fancy!
Day One
One of the most fun bits of any educational representative’s job
is building a world class faculty for their Educational Congress.
Equally, it says a lot about the amazing trainers we have that,
aside from people with pretty reasonable excuses like “I’m on
my honeymoon” or “I’m in Africa”, every single person I asked to
support BOTA by being a member of faculty, leapt at the chance.
My aim this year was to go for variety – a cohort of speakers, all
of whom are either involved with the FRCS exam or have been
highlighted as excellent trainers, speakers and inspirational
clinicians.
The Friday started with a welcome from Mike Kimmons, CEO of the
BOA, bringing us up to speed with where the specialty is headed.
The future of Orthopaedics might need a few tough decisions to be
made, but it is bright and I can’t wait to be a part of it.
The lectures began with Professor Robin Paton, delivering a two
part talk. The first was a bit of a challenge to our philosophy as
doctors and clinicians; our tendency to over investigate and label
conditions, even when they potentially have no impact on outcome,
management or prognosis. The second half of his talk was much
more case-based, with X-Rays and quizzing of the audience. Special
mention has to go to the poor medical student who, when asked
what the picture was, said, after a significant pause…”well, its an
X-Ray, Prof ”. Flawless VIVA technique on display – never say anything
wrong and start with the basics. This was built up with Prof ’s take
home message, “If I tell you to move on, you’ve either done very
very well or very very badly. Either way, zip it and move on!”
The next speaker was a bit of departure from the norm. One of the
things I noticed during my tenure as education rep, was how many
trainees want to know more about: the future of their training,
the challenges that are coming and what the people who have the
final say… have to say. It was with this in mind that I invited Mr Bill
Allum, JCST Chair (and general surgeon, for his sins). He not only
delivered a detailed and concise talk on Shape of Training, ISCP v10
and something that will effect all of us, the publication of surgeon
outcomes. He then, either bravely or foolishly, opened himself up to
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“One of the best things about the Educational
Congress is the mix of lectures, seminars and
industry supported workshops and breakout
sessions.”
questions from the floor and it was a credit to our trainees that the
questions were informed and insightful, just as it was a credit to Mr
Allum that his answers were open and honest.
One of the best things about the Educational Congress is the mix of
lectures, seminars and industry supported workshops and breakout
sessions. We had 5 this year; BBraun (our Diamond sponsor),
delivering Navigated Technology in Orthopaedics, Stryker and Lt
Col Rowlands with Indications for and Configurations of External
Fixators in damage control (winner of the Best Industry Workshop),
Heraeus ran their ever popular Basic Science VIVA session, Orthofix
delivered Galaxy – the Complete Damage. Control External Fixator
and also supplied the prize for our prize draw, a fully funded trip to
their Foundation of External Fixator course in Verona and Zimmer,
with their ‘Periprosthetic Fracture Fixation Workshop using the NCB
Periprosthetic Plating System and an IM Nailing Workshop using the
Zimmer Natural Nail. It has to be re-iterated that without the support
of industry, BOTA could not run the high quality Educational Congress
we do and I have to thank our sponsors again for their amazing
workshops. One of the perks of organising the Congress is being able
to step in and out of each room, so I can confidently say that each was
absolutely remarkable!
The lectures continued with Professor Chris Moran who ran,
probably the most interactive session of the Congress, as he took the
delegates through a single, challenging trauma call. The delegates
were enthralled with the case and how the superlative trauma team at
Nottingham’s QMC dealt with it. The learning opportunities at MTCs
are clear, not always what trainees want, but definitely what many
need.
The trauma theme continued as, on the back of the Chavasse Report
and Prof Moran’s talk, Lt Col Rowlands spoke to us of what we, as
civilian surgeons, can take from military practice. The idea of Standard
Operating Procedures has been taken into their clinical practice and,
with undertones of GIRFT, they produced their document Clinical
Guidelines for Operations, which removes argument over how best to
manage conditions encountered by the military surgeon. Thanks also
has to go to Lt Col Rowlands as, aside from running the award winning
workshop, he also was able to keep the audience enraptured until the
next speaker was able to arrive, as he was running late, ironically due
to, a major trauma on the M56.
Eventually, showing great commitment (it took him 3 hours to make
a 30 minute drive!), our final speaker arrived – Mr Mike Hayton. As a
trainee who aspires to be a hand surgeon, I was as enthralled as the
rest of the audience as Mr Hayton described his exposure to the sports
injuries suffered by hands. The fear many exam candidates suffer when
it comes to hands was hopefully assuaged a little as Mr Hayton made
complex hand injuries seem much less scary!
The day ended with the podium presentations of the three most
robust abstracts, each completely different but no less impressive. This
session was run by our academic rep, Payam Tarasolli and it is always
inspiring to see the high quality research that can be produced by our
finest academic trainees. The best podium was won by Parag Jaiswal
with “Early surgery for proximal femoral fractures is associated with
lower complication and mortality rates”
Friday ended with our dinner in the Shooting Suite, where trainees
from all over the country and further afield were able to mix and
compare ideas, as well as pick the brains of many senior clinicians. It
is these rare opportunities that make the Educational Congress a one
of a kind residential educational opportunity and as the night went on,
I am certain many a great idea was discovered, debated in depth and
then forgotten!
Day Two
Saturday started bright and early, with all our delegates bright eyed
and bushy tailed, ready to hear Professor Dias speak on the subject
for which he is widely considered to be a world expert, fractures
of the scaphoid. It is always a pleasure to hear Prof Dias speak on
scaphoids and lay out, in the clearest terms, how he manages this
tricky fracture. The audience couldn’t help but ask question after
question at the end, but we managed to stick to time as I was able to
introduce the next speaker; Fergal Monsell.
Mr Monsell was kind enough to deliver a much better talk than
the one I asked him to deliver, instead speaking on the changes in
his practice over the past few decades. Paediatric Orthopaedics,
especially limb reconstruction and trauma, is always a cause from
anxiety amongst trainees and yet Mr Monsell managed to make the
topic seem far less daunting, even for the most junior trainees in the
room.
The final speaker of our lecture series was Professor Fares Haddad,
who ended on a topic very close to his heart as well as a common
theme in the FRCS, hip arthroplasty and implant design. The sign
of how utterly fascinating his talk was, is that there were so many
questions at the end I had to cut the session short, for fear that
people would rather give up their coffee and cake just to be able to
pick the Prof ’s brain.
This wasn’t their only opportunity to pick his brain though as, after
the lectures, the consultant workshops began, with Prof Haddad
running a session on how to get published, Mr Dawson-Bowling and
Mr McNamara speaking on how to get a consultant job, Mike Reed
(TPD of the Year) speaking on how to run an improvement session,
Professor Beard (Head of Education at the RCS) on Non-Technical
Skills and Mr Alberto Gregori describing how he utilises navigation
in his practice. These workshops fitted in again with my theme of
“something for everyone” and I was proud to see that each room was
utterly rammed with a plethora of enthusiastic, engaged delegates,
ready to get stuck in and ask probing questions and really push the
faculty.
Day Three
After a great deal of thought, this year I made the Sunday have
a slightly later start. This was to allow people to check out in an
unhurried fashion and still be able to make the morning’s events and
this was borne out as, after a leisurely breakfast, the AGM began and
we elected our new Committee, with a remarkably packed room for a
Sunday morning.
The President brought everyone up to speed with the big changes
that have occurred this year, the Treasurer confirmed that he is, in
fact the tightest man alive (which is absolutely what you want from a
Treasurer), the new BOTA website was unveiled to much “oohing” and
“ahhhhing” and a number of votes occurred, including increasing the
fee BOTA members pay and the creation of a BOTA Women in Surgery
representative. I am proud to be part of this new Committee and I
can say that each member of that group has expressed a real passion
for training and Orthopaedics and I’m certain that next year will be an
amazing year for BOTA and the specialty as a whole.
“I am proud to be part of this new Committee
and I can say that each member of that group
has expressed a real passion for training and
Orthopaedics and I’m certain that next year
will be an amazing year for BOTA and the
specialty as a whole.”
It was after this that we had our yearly TPD Forum. This year’s hottest
topics were interesting mirrors of each other – increasing engagement
in trainees and increasing engagement with trainers. The only way to
standardise the experiences and training delivered and the only way
to improve training is to get ‘buy in’ from both sides. The work will
continue under the watchful eye of Mr Simon Hodkinson, as new chair
of the TPD Forum and we have great hopes that positive changes are
afoot.
It has been an amazing year for me as the education representative.
I know I’ve said it before, in person and in print, but again, I need to
thank the BOTA Committee, Sue Dale, all of the industry sponsors, the
world class faculty and my long suffering and infinitely patient wife, Dr
Ruth Bird for this year and helping me make the Educational Congress
2015 the great success it was.
I welcome Danny Ryan to the post and cannot wait to see each and
every one of you reading this at the next big event.
It was after the workshops and a relaxed lunch that the social
programme began. Whether golfing, taking part in the team events or
relaxing in the spa, the social aspect of the Educational Congress is a
big part of what makes it popular – the ability to let off some steam
and socialise with trainees from different regions.
The prizes from these events, including Best Duck Herder
(apparently not part of a golf game), were announced at the everpopular Gala Dinner. After grace from Mr Kimmons, and speeches
from our President, Pete Smitham, the night took off in style as
Muzzy Rashid, our then VP, now President, announced the Trainer of
The Year of the Year and the inaugural TPD of the Year. Both winners,
as well as all those shortlisted were truly inspirational and the room
gave them well deserved standing ovations.
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The British Orthopaedic Trainees Association (BOTA) 2015
Trainer of the Year (TOTY) award
This year, for the first time, we invited the top three shortlisted
candidates to interview. These were held at the BOA Offices in London
on 2nd June. Each interview lasted 45-60 minutes and followed a
structured format asking each candidate questions within 7 domains.
These domains included:
1.
2.
3.
4.
5.
6.
7.
The British Orthopaedic Trainees Association has been running the
Trainer of the Year (TOTY) award for many years. Many eminent
trainers have been awarded this title, which carries with it a distinct
recognition of their efforts to train Orthopaedic Specialist Registrars.
This year was no different in its meaning but very much refined in its
delivery. I sat down with Pete Smitham at the beginning of the year and
outlined my proposal to change the process by which the TOTY would
be decided. From previous experience with this process, I found that
it was very difficult to choose between all the nominations that were
put forward (one from each training region). It often came down to
which BOTA Linkmen wrote most passionately, and emotively about
their TOTY nominee. I had no doubt that any consultant trainer put
forward by their region was clearly an exceptional trainer within that
programme however, I wanted to inject more transparency, robustness,
and objectivity into the process.
The BOTA Linkmen form a key part of BOTA’s activities, no more so
than in the nomination of the Trainer of the Year candidates. Each
Linkman choose their TOTY candidate by running a local process
by which trainees in that region are invited to give their opinion on
why a particular trainer should be nominated. Some regions use a
separate local process that runs concurrently with the winner of that
process being put forward for the BOTA national award. After each
region put forward their nomination, these were anonymised and
compiled into a master list. These blinded nominations were sent
to the BOTA Committee, Training Programme Directors (TPDs),
and invited members (David Large - T&O SAC Chair, Lisa HadfieldLaw - BOA Educationalist, and Phil Turner - BOA Education Faculty).
Everyone was asked to rank their top three nominations, which were
then allocated points (10 points for 1st, 5 points for 2nd, and 2 points
for 3rd). BOTA Committee members were not allowed to vote for the
TOTY representing their region. Additionally, BOTA Linkmen were not
invited to rank the nominations as to avoid bias. After all the rankings
were collated the following candidates emerged as our top three
shortlisted candidates:
1. Mr. Niall Eames - 114 points - Northern Ireland Region
(Nominated by NI Linkman: Ciara Stevenson)
2. Miss Philippa Thorpe - 47 points - Mersey Region
(Nominated by Mersey Linkman: Simon Robinson)
3. Mr. Mehool Acharya - 44 points - Severn Region
(Nominated by Severn Linkman: Greg Pickering)
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Motivating Trainees
Maximising Training Opportunities
Organising Structured Teaching
ISCP / WBA Engagement
In Theatre Experiences
Aiding and Supporting Trainees In Trouble
Miscellaneous (inc. the future of training in the NHS, hurdles to
good training, innovation in training T&O Specialist Trainees)
The interview panel consisted of the BOTA President (Pete Smitham),
BOTA Vice President (Mustafa Rashid), BOTA Education Representative
(Simon Fleming), Mr. David Large, and Miss Lisa Hadfield-Law. The
interviews were absolutely incredible and very insightful into what
makes these exceptional trainers tick. One thing was for sure, each
TOTY shortlisted candidate have developed their NHS practice with
their Orthopaedic Specialist Trainee at the centre. They all maximised
training opportunities in their own ways.
We heard from Mr. Mehool Acharya how his clinics officially start at
9.45am but patients arrive at 9am to allow him to sit and observe his
trainee consulting on 3 patients and completing CEX/CBD assessments
during this time. An absolutely amazing example of how training and
service can work synergistically. We heard from Miss Philippa Thorpe
how she expects her trainees to “See one, Do the rest!” as long as they
treat her patients with compassion and in line with the values of the
NHS. We heard from Mr. Niall Eames about how he tries to inspire his
trainees by flying over eminent European spinal surgeons to give them
talks about their sub specialist interests.
I have to say, I thoroughly enjoyed being on the other side of the
interview table, and I hope the candidates relished the opportunity to
demonstrate how they go above and beyond for their trainees. No one
can deny that it was very robust, gruelling even, and thorough process.
One candidate referred to the TOTY interview as “more nerve-racking
than my FRCS viva!”, whilst another stated “This is more robust than
my consultant interview!”. Each panelist was asked to mark a grid that
reflected the 7 domains detailed above. Each domain score was split
into Satisfactory (2 points), Above Average (5 points), and Outstanding
(10 points). The total score (max 350 points) for each candidate
was collated and added to the ranking scores from the blinded
nominations.
The winner of the 2015 British Orthopaedic Trainees Association
Trainer of the Year was Mr. Niall Eames (356 points). Miss Philippa
Thorpe came 2nd with 259 points, and Mr. Mehool Acharya was 3rd
with 248 points. Mr. Niall Eames was presented with the BOTA Trainer
of the Year award at the BOTA Educational Congress Black Tie Dinner
(Saturday 13th June in Carden Park). The winning nomination written
by Ciara Stevenson (NI Linkman) is found below.
BOTA 2015 Trainer of the Year (TOTY)
Northern Ireland Region Nomination: Mr Niall Eames
Trainees often say that working for outstanding and
inspirational trainers makes them enthusiastic, motivated and
confident about whatever sub-specialty that trainer practices
in. How does this trainer support and enthuse his trainees in
learning and developing during their post.
This is the THIRD year in a row he has been unanimously nominated
for TOTY. Having attended Carden Park last year as a finalist it goes
without saying that the trainees in this deanery are passionate about
his recognition.
Despite service pressures, he trains and inspires. As spinal surgeon to
the National Rugby team he employs the sports psychology used for
elite athletes to motivate and influence his trainees. His goal is trainee
progression and all who work for him aspire to be like him in all
aspects of life.
His calm and effortless nature provides an excellent learning
environment that puts the trainee at ease. Every case is a training case
and he is proactive throughout. He is critical when necessary but never
humiliates. He is held in such high regard amongst his peers… his
good opinion is invaluable.
Excellent Orthopaedic trainers often go out of their way to
ensure their trainees have a variety of learning opportunities
during their job. How does this consultant go above and
beyond what is expected from an Orthopaedic trainer?
This trainer goes above and beyond the call of duty on a daily basis.
The following are but a few examples:
1. FRCS examiner – trainees attend his home on a regular basis for
mock viva and clinicals during the 12months prior to the exam. He
co-ordinates other consultants to attend so that all specialties are
covered.
2. Research – In 2012 he founded a local research group that has
produced prize-winning papers and projects including Brit spine
2014
3. Fellowship – In 2013 he personally applied for and set up a Spinal
Fellowship within the unit despite service crisis.
4. Education – He developed a local teaching curriculum for spine
in response to the critical CBD’s and CCT requirements. He has
paid actors to attend teaching to simulate clinical scenarios for
assessment.
In busy clinics training remains a priority. Every patient is discussed
and any case he feels of benefit to the trainee (with his FRCS hat on)
will be highlighted and presented in a case based manner. This allows
for work-based assessments to be completed in real time.
One fifth of trainees in this deanery wish to become spinal surgeons…
enough said.
Regional training programmes often have several good
trainers within their rotation, however, the contribution of the
rare “great”, stand out ,trainer is often significant. What would
your rotation miss the most if this trainer were to retire or
move to another unit?
He is our regional training treasure and our rotation would not wish to
consider losing him.
What more can be said that has not already been said in previous
nominations. He is above and beyond in every aspect of training. The
guidance and reassurance offered in the 12 months pre-exam are
invaluable. He offers advice about the importance of balancing life/
family/work, which is so important during the dark exam months. His
positivity and enthusiasm are inspirational. There is nobody more
deserving of this award.
5. Journal Club - He founded and hosts a monthly spinal journal club
and invites speakers from Europe to attend and lecture.
Not only has he provided this rotation with an award winning research
group, he has flown guest speakers from mainland Europe to give
lectures on ‘hot topics’ in spinal surgery relevant for the exam. He is
largely responsible for the preparation this rotation receives for the
FRCS and the 100% pass rate we enjoy is undoubtedly due to him.
6. Pastoral care – He takes responsibility for the pastoral care of the
trainees. He has helped many in difficulty both at work and at
home. We feel that he is someone to talk to, not just a teacher or a
role model…a friend.
Last but by no means least; he has supported a few of our trainees that
have experienced personal difficulties over the last year. Inviting them
into his home, he has provided them with encouragement, hope and
guidance.
What would this rotation miss the most? Our teacher, our role model…
our friend.
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The Inaugural British Orthopaedic Trainees Association (BOTA)
2015 Training Programme Director of the Year (TPDOTY) Award
BOTA has been running the Trainer of the Year (TOTY) Award for many
years now, recognising the great achievements of exceptional trainers at
providing their Orthopaedic Specialist Trainees with outstanding training.
However, I felt that there may be a group of influential trainers that we
do not recognise with this award. Training Programme Directors (TPDs)
have been chosen by their region to take on the mantle of leading the
training programme. Some have gone above and beyond to ensure their
programme improves with regards to the quality of the training delivered.
They often do not get nominated for the TOTY award because they have
either won it before, do not directly supervise trainees any more so that
they can focus on the wider training landscape within their region, or some
other reason.
This year, Linkmen were invited to nominate their TPD if their region felt
that they have been instrumental in improving the training on offer in their
programme. We particularly wanted to hear about novel, innovative and
truly inspirational ways in which these TPDs have brought about a change
for the better. Nine regions opted to nominate their TPD for this inaugural
award, which was decided by a blinded vote.
All nine nominations were anonymised and distributed to the BOTA
Committee, and invited members (inc. Mr. David Large - T&O SAC Chair,
Miss Lisa Hadfield-Law - BOA Educationalist, and Prof. Phil Turner - BOA
Education Faculty and former NW Deanery TPD). They were asked to vote
for their winner and the overall winner was the nominee that received the
most votes of course.
The overall winner was a TPD I had met several times before. In fact, he
kindly agreed to be faculty at the BOA/BOTA Linkmen Clinical Leadership
Course that I organised for all BOTA Linkmen in January 2015. During this
course we were talking about the TPD-trainee relationship. I still recall
something he said that really struck a chord with me. Talking about trainees
he said, “You are just like me, only younger. I, therefore, communicate with
you like you will be my consultant colleague in a few years time because
that is exactly what you will be.” He has revolutionised how training posts
are quality assured to ensure trainees allocated to these posts meet their
learning needs. He has engaged all his trainees and senior trainers to work
together to form an Educational arm to the programme, securing industry
sponsorship to run cadaveric courses for his trainees. Referred to as “iconic”
and “a ground-breaking innovator”, this TPD clearly has demonstrated his
passion to improve the quality of the regional training programme.
The winner of the 2015 British Orthopaedic Trainees Association Training
Programme Director (TPD) of the Year was Mr. Mike “Speedy” Reed
(Northern Region). Mr. Reed was presented with the award at the 2015
BOTA Educational Congress Black Tie Dinner (Saturday 13th June in
Carden Park). The winning nomination written by Will Manning (Northern
Linkman) is found below.
BOTA 2015 Training Programme Director of the Year (TPDOTY)
Award Winner – Mike Reed
and e-logbook, he also Chairs the BOA Education Committee, himself being
fundamental in evolving explicit outcomes for training, setting the benchmark for good training in the UK. An extremely inspirational trainer in his
own right, he genuinely wants trainees to be good operators and decision
makers. Compelling them to get the best without pressurising, he remains
approachable and fair even if trainees don’t achieve his super-human
standards.
Using examples where appropriate, illustrate why this Training
Programme Director has developed the training programme in
your region to be one of the best rotations at delivering Trauma &
Orthopaedic higher surgical training.
TPD since 2011 and formally an SpR in the region “Speedy” is quite simply a
force of nature. His overriding drive to improve training is evident in every
aspect of our deanery. From education, to innovation and academia, the
commitment to improve our program goes above and beyond his regular 4am
emails.
The design of every training program must begin with learning objectives.
Co-authoring both the 2010 and 2013 StR curriculum he pioneered the
introduction of e-logbook, UKITE, OCAP and PBA’s. National Lead for UKITE
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Treating trainees as equals, ideas to improve the region are met with infectious
enthusiasm peculating throughout the rotation. Instigating an electronic
system for post matching (Spinfusion), he introduced a fair points-based
allocation for high demand jobs. Creating our trainee webpage and email
network the domain is still funded from his pocket. Reformatting the research
prize day, it became more inclusive, breaking down institutional/unit barriers
and improving the event’s social aspects. Our TPD’s personal approach with
trainee’s shines through, happy to problem-solve over a drink, common sense
prevails with unbiased swift resolution to any training issues. Continuing
improvements under his tenure allowed the Deanery to achieve Top UK
Hospital and TOP Deanery for T&O Trainee satisfaction (GMC Survey, 2014).
A powerful driving force behind any research project, this TPD ensures
deadlines are set and achieved with over 175 publications; all involving at
least one trainee. He empowers trainees to get the most from their work
encouraging the creation of CORNET (UK’s 1st local T&O trainee-led research
collaborative). Allowing space in the teaching program for meetings, he
helped CORNET attain successful grants awarding >£500,000 in funding
which now runs a number of deanery-wide projects including a major RCT.
As TPD’s go, we believe ours to be unparalleled. Tireless in all that he does,
a figurehead for good training, ground-breaking innovator and a paper mill
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Reviews
Linkman Roadshow 68
Work Based Assessment (WBA) Survey Report
74
Deanery Selection
76
Management in Medicine
80
UKITE Update
81
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The Linkmen Roadshow Project: What does good Orthopaedic
Training look like on a regional level?
Mustafa Rashid (2014/15 BOTA Vice President)
Spoiler alert:
What you are about to read is a narrative about various aspects of Trauma & Orthopaedic training garnered from in-depth
discussions with regional BOTA Linkmen. It is intended to highlight regional variances and areas of outstanding training. It is
not intended to name and shame individual trainees, trainers, TPDs or regions. The information is intended to be used to share
novel and unique ways that different regions deliver good training.
When asked by the BOTA President, Pete
Smitham, to lead a national Roadshow project
with all 28 BOTA Regional Linkmen I did not
really appreciate what a mammoth task this
actually would turn out to be. Who would have
thought organising a 1 hour teleconference
with 28 Orthopaedic Registrars would be so
challenging! Well, a fistful of perseverance,
127 emails, over 1600 minutes on Skype,
and 12 months later, I can say this project is
complete (well, almost!). I say almost because
we had some extenuating circumstances that
prevented us from doing three Roadshows
(a newborn baby and 2 brand new Linkmen
namely). I also say almost because the findings
were so fascinating, it has spawned several
other projects including the forthcoming BOTA
session at the BOA Congress in Liverpool (Sept
2015) entitled: “What does good Orthopaedic
Training look like? A local, regional, and
national perspective.
The Regional Teaching Programme:
The Outlier (the good kind!): Pete and I had heard all the rumours
about the Oswestry teaching programme with their 100% FRCS pass
rate and gruelling teaching schedule. Nothing could have prepared us
for what we heard from our Oswestry Linkman, Ross. He described
such an intensive and FRCS-focussed teaching programme that he even
stated the biggest criticism is mainly from ST3-4 trainees who stated “It
is too exam focussed!” That sounds like a teaching programme I want
as a trainee! So why is it so good? Well, every year there is a bi-annual
FRCS mock exam that is as close to the real thing as you can get. At the
end of that process, the four ST7+ trainees that scored the highest are
deemed “FRCS exam ready” by the TPD. They then spend the next 6-12
months in one of four “Hot Seats” during their weekly Friday afternoon
teaching, which runs from 2-6pm on two sites (Oswestry or Stoke).
There is a good mix of patient case conferences, MCQs, and lectures.
Each Hot Seat trainee gets 30 minutes to do a history, examination, and
review radiology in a mock FRCS style. This alone sounds like a great
way to teach, especially for the FRCS exam, as Ross stated most trainees
who go through the hot seat become “desensitised” to being grilled.
So much so, that the reports post exam are that the actual examiners
“…were much nicer than I was expecting!”. It does not stop there
however, the sheer abundance of teaching on offer on this rotation
is staggering. From 8.30-9.00am every day during the week there is
teaching, often in the plaster room. Monday is Paediatric Orthopaedics,
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Tuesday is Lower limb arthroplasty etc… with around 30 minutes of
vivas and a chance to “find out what you don’t know”. Fridays 5-6pm
is usually a guest lecture with a mix of regional and external speakers.
Cadaveric teaching with the on-site Oswestry cadaveric dissection lab is
regular feature in this teaching programme.
Every 4-5 weeks is a teaching weekend (all named of course). One
example, is the “Shrewsbury Weekend”, with each weekend being run
by teams of consultants tailored for each subspecialty. On Tuesday
evenings, there is a biomechanics teaching sessions with invited
engineers to go through common basic science FRCS topics including
free body diagrams and tribology. Additionally, in the spring/summer,
there is dedicated Paediatric teaching on the Tuesday evenings. Closer
to each diet of the exam, Mr. Simon Hill puts on Thursday evening Foot
& Ankle FRCS-specific teaching. All their teaching is bleep-free and
protected. There is no register generally, as everyone appreciates how
good it is and so makes the effort to attend!
What was clear from this rotation, was the great emphasis and pride
everyone has towards the maintenance of the quality of the teaching
programme. They all appreciate their stellar FRCS pass rate is all due to
the commitment of the trainees to attend/engage, but also due to the
vast number of consultants that put on a high quality programme that is
frequent, exam-focussed, and broad in its delivery style.
Honourable Mentions:
Sheffield Region - The Sheffield rotation also has a great programme
with an assigned Educational Deputy Director that organises a very
structured teaching programme that moves around different hospitals
on a Friday afternoon 2-5pm. Each session includes a patient clinical
case where the pre-FRCS trainees are grilled in the style of the exam.
As with many other programmes, it is split into blocks that rotate, with
3 blocks per year. The standout feature from this programme is that
they have 4-5 mock FRCS exams per year! These are on fixed Fridays
and interspaced throughout the year with 1x full run-through of the
FRCS in February over two days. Patients are brought in, trainees go
round in pairs to be examined alternately and each hospital on the
rotation organises one exam per year.
North West Region - Trainees at different levels have different
learning needs from the teaching programme. In the North West this
principle is very close to the heart of their TPD clearly, as this rotation
has no less than four distinct teaching programmes at any one time!
For the first 8 weeks of the academic year, the new ST3 trainees have
an 8 week introductory teaching programme aimed at getting them
up to speed with the extra responsibility and skills required to be a
competent registrar on call. For the 12 months prior to your exam,
in the NW, the senior trainees are fortunate enough to have their
own FRCS-specific structured teaching programme. Then there is
the main teaching for everyone on Friday afternoon which is run in
terms. Finally, the post FRCS trainees benefit from an 8-week teaching
programme aimed at professional skills like management, leadership,
being a NHS consultant etc. Truly remarkable. In addition, every term
has one session called the research collaborative meeting, where
trainees pitch projects and proposals for research to a panel. They
too have an annual mock FRCS exam (clinical and vivas) for everyone,
which is run by the post-exam trainees and some consultants.
Summary (What have we learnt?) - Clear themes came through
from those teaching programmes that clearly had the best trainee
satisfaction. Here is a non-exhaustive list of what seems to work well
from around the UK:
- Education Lead (Consultant in charge for the teaching). Several
regions had these in an almost Deputy TPD role. Some regions ask
groups of consultants to organise the “terms”.
- Terms/blocks. 3-4 terms per year seem to allow sufficient time
to cover most topics on a 2-3 year cycle. Haphazard sessions run by
random consultants on their pet project should be avoided!
- Mock FRCS exams! Sounds horrendous right? Wrong! I never
thought I would ever state that trainees want more exams. The
fact of the matter is, the more your practice for the real thing, the
better your performance will be. The Part 2 of the exam is often
failed on nerves, lack of preparation, and poor technique rather
than lack of knowledge/skill/talent.
- Mix of teaching style. Didactic lectures are dull. Information is
rarely retained and most of us lose focus after 20 minutes! The best
programmes utilised a mix of lectures, workshops, and patient case
conferences. Bringing patients to teaching to be examined in a
FRCS style is golden! Additionally, trainees were really not in favour
by being lectured by fellow junior registrars (please avoid this!).
Finally, trainees LOVE cadaveric workshops focussing on surgical
approaches / clinical anatomy / operative technique.
- Structured FRCS teaching. Most regions have a handful of
keen bosses that give up their time to teach and viva the pre-exam
trainees. The best programmes either incorporate this into the
teaching programme or have a separate structured programme
specifically directed at FRCS preparation.
- Record the session / put it online! Some programmes have a
regional website and all recorded lectures and powerpoint slides
are put on the website so that trainees can access them at any time.
Who can really remember how that random paediatric syndrome
presents 8 months after teaching on it?
- Protected, covered, and bleep-free. The most well run and
established programmes make it very clear to all the hospitals that
trainees get sent to, that a specific time in the week (usually Friday
pm) is reserved for teaching. All trainees are released to attend
this and in several rotations, the local hospitals are expected to get
cover for the session including on calls, rather than the trainee
having to fight with the rota master to get cover to attend their
regional teaching programme.
- If I am permitted one negative comment about some teaching
programmes is that in some regions that are geographically
massive, trainees sometimes have to drive over 2 hours to get to
teaching. Split site teaching seems to work well in some regions.
One region managed to change their teaching structure due to
poor attendance (which was mainly felt to be partly related to
travel and partly due to poor quality teaching on offer) from a
weekly afternoon session to a monthly all day session, which
caused their attendance to soar. The downside is that they have to
get approval from their trust for the time off to attend.
Allocation to training posts / QA of training posts
A fellow trainee and friend, after getting his NTN in T&O, was told by a
senior registrar “You will get some bad training posts for some of your
training; you will hate it and find the training to be substandard or
non-existent; keep your head up and it usually evens itself out over
the 6 years.” He took that advice to heart, and I certainly have heard
of several occasions where trainees have been in posts that just plainly
did not meet their training needs. Whether it is just a personality
clash with the boss, or more visceral than that, these posts can lead to
anxiety, “wasted time”, and falling behind in a system that has already
taken a hit with EWTD, increase in shift-working, and performance
outcomes influencing trainers to give up fewer cases to their trainees.
I would challenge all of us in the Orthopaedic Community that this
phenomenon can be eradicated from our training system. In fact, I can
prove it! One hugely beneficial observation I made having conducted
these Roadshows, was to learn about the novel and insightful ways that
some Training Programme Directors have managed to ensure that all
their training posts meet the needs of their trainees. The holy grail in
this regard, is to place the right trainee, with the right trainer, in the
right environment, at the right time. So how have they managed it?
Truly anonymous, honest feedback - several regions have
introduced their own survey of training posts. These are usually done
over a 3 year period to avoid feedback being linked to one trainee
only. In an era where trainees receive survey requests almost every
other day, these are very different. Firstly, they are run by the TPD
who makes it very clear that the purpose of this survey is to quality
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assure each training post in the region, whittle down the bad ones,
and highlight the good ones. This gets trainee buy-in. It goes from
being a survey where the backlash may be high and people avoid filling
it in honestly, to a tool to improve the overall training programme.
Secondly, the feedback is truly anonymous. Trainees either use a
common general email address, an online portal where no identifiers
are asked for, or some other method. The key is that confidence is
instilled to avoid any direct backlash on the trainee. The regions that
employ this survey method use the data at LETB level to make a case
for shifting the number of trainees going to certain trusts or on a more
local level by not allowing a particular trainer to supervise a trainee.
Central electronic allocation method - Northern region, under the
guidance of Mr. Mike Reed (TPD), have implemented a system called
SpinFusion. This system basically allows trainees to preference posts
from a list of trainers. Trainees, based on seniority and preference, are
allocated to posts. Their training needs, particularly CCT indicative
number deficiencies, are taken into account. This works for ST4+
trainees, with more junior trainees being allocated by the TPD to fill in
the gaps in pre-assured posts. This region uses a points-based system,
which allows trainees to get a higher preference over their peers by
rewarding educational/academic/clinical activity. The TPD achieved
buy-in from the trainers because all were asked to go online and create
a profile of themselves and the training post they can offer. That way,
only engaged trainers made it onto the list. Similarly, in the Leicester
and Mersey regions, a points-based electronic system is run to allocate
trainees to posts. Although there is debate about what types of activity
should garner certain points, it generally produces a fair system
whereby poorly performing posts are removed from the matching
process.
I have outlined in the section on teaching programme, the extensive
use of patients for FRCS-style history/examination purposes. I
also touched on their use of the on-site cadaveric lab for surgical
approaches and anatomy dissections. Weekly incorporation of
simulation training is the gold standard and I will try to summarise
what seems to work best from around the UK later in this section.
The Northern region, have set up a consultant-trainee group called
OrthNorth, which is the Educational arm of the training programme.
Through this they set up dedicated cadaveric sessions for ST3/4s to
improve their confidence on surgical approaches. This occurs over 4
days throughout the year.Study budget was top-sliced to cover this but
has lead to overwhelmingly positive feedback.
Honourable mentions:
Trent (Nottingham) rotation - Smith & Nephew take all their
trainees twice a year to York to use all the trauma kit with trauma
consultants provided tips and tricks for complex fracture management.
SW Peninsula region - regular patient simulated history/
examinations at teaching, lots of industry lead cadaveric workshops,
and a mock FRCS exam once a year.
Logbook review - In some regions, and sometimes at ARCP, logbooks
of several trainees in a particular post are scrutinised. This practice
is applied to the whole rotation and it quickly becomes clear that
certain jobs are low volume and insufficient for a 6 month training
post. In one region (Royal London rotation), the BOTA Linkman ran
an exercise with the TPD to analysis logbook activity by hospital to
provide a ranking of all the hospitals in the rotation and give a prize
to the best hospital in terms of logbook numbers. The key to both of
these practices is that the trainee is not in the middle being pointed
out as the reason for lack of operative numbers. Most trainees, not in
difficulty for whatever reason, identify that they must take advantage
of all the theatre opportunities presented to them. In my experience,
they do just that, and so a trainee in good standing who achieves less
than the minimum 150 cases in a 6 month post, is a sign of a possible
low volume post for any number of reasons, rather than a lack of
motivation to take advantage of learning opportunities. Regular review
of these posts with several trainees logbooks collated is a useful activity
that TPDs have used in several regions to identify where their highest
volume posts lie in their regions.
Summary
Access to simulation training
3. Arthroscopic simulators (cadaveric or not) where junior registrars
can develop 3D spatial awareness and basic arthroscopic skills.
Simulation training is high on the agenda of the GMC with the
governing body challenging all LETBs to review what simulation
training is on offer in their locality. At the beginning of the year, I
heard from the JCST about how their survey on simulation training in
surgery was flawed and that the results showing low levels of access to
simulation (around 45%) was due to the trainees “not understanding
what counted as simulation training”. To that end, I made sure to
include this in the Linkmen Roadshow agenda with a preceding spiel
that went something like “Assuming we count all aspects of simulation
including patient case conferences, mock exams, dry bone workshops,
cadaveric session, team role playing sessions etc, how much simulation
training do you get?”
The Outliers (the good kind again!) - North West / Oswestry
/ Northern / Nottingham regions. Running theme right? I have no
financial disclosures for this article (should have mentioned that
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earlier!). So basically, like every other aspect of training we delved
into, simulation training access was highly variable throughout the UK.
The North West has one session per term that includes a dedicated
simulation session, either at the medical school’s new sim lab, or the
once per quarter Stryker sponsored viva session. The trainees starting
their placement with a shoulder surgeon all go to York to the Smith &
Nephew cadaveric lab to do a day on shoulder arthroscopy.
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In regions where they have access to one of the five NHS on-site
cadaveric labs, trainees usually get very good and regular cadaveric
simulation, which trainees of all levels seem to find very useful. Several
regions have regular patient case conferences where trainees are
observed consulting on real patients in a mock FRCS setting. Some
regions have good links with Industry who regularly sponsor free
places on course run at the local cadaveric lab. Some centres (King’s
in London for example) have shiny new arthroscopic simulators and
these are sometimes utilised as part of the teaching programme to
run workshops. There are five distinct areas of simulation that is more
common around the UK than others, which has also been highly
regarded by trainees:
1. Cadaveric simulation for 1-2 days, 1-3 times per year, where
trainees and consultants go through surgical approaches.
2. Regular patient case conferences at teaching where pre-FRCS
trainees are observed taking a history and examining real patients.
4. Mock FRCS viva examinations with real patients organised 1-2
times per year.
5. Dry bone workshops sponsored by industry - good at developing
familiarity of the instrumentation and kit but not great for those
already performing such cases with confidence.
The main hurdles to overcoming this lack of access to simulation is
financial it seems. However, one could argue that a mock FRCS exam,
regular patient case conferences, and industry sponsored cadaveric
days are not that expensive compared to a £150,000 haptic feedback
high fidelity arthroscopic simulator! We need to move away from
thinking of Orthopaedic simulation training as those done purely on
high fidelity simulators and start looking at the regions providing the
above simulation training to look at models for financing it as part
of a regular programme. There still remains issues with out of hours
access to simulation, which is rare around the UK. Additionally, some
regions reported little or no simulation training, which is clearly not
ideal moving forward. Finally, even in regions where there is quite a
lot of simulation on offer, it is often not incorporated into the teaching
programme and usually means trainees taking study leave or annual
leave to attend these days.
CCT indicative numbers / In Theatre experiences
Operative exposure around the UK does show some variability by
region with two distinct peaks as represented graphically below.
As a side note, many Linkmen reported a focal issue over the last
winter and the ED crisis in the NHS. We heard from many regions
how elective lists were decimated, Orthopaedic beds were blocked by
medical patients, and as a result, a noticeable ripple in their logbooks
were noted.
Study leave / Study budget
Study leave and study budget was again highly variable. This probably
reflects a push to a more locally driven process with the creation of
LETBs from Deaneries. No region reported a problem with getting
study leave time allocated off. Some stated that their trust expected
certain rules to be qualified, such as 6 weeks notice, and on call
commitments swapped, which is entirely reasonable. Every Linkman
stated they felt they had enough days of study to take if they needed.
Where the variability is very noticeable is in the financial amount, and
process in which reimbursement is done.
The financial reimbursement ranged from £400 to £1800 per annum
per trainee. Some regions top sliced the budget for certain projects
and simulation training initiatives. All but a few regions stated they
had a local, paper driven form-based process that required multiple
signatures. Some regions had a central electronic form that is signed
off online. Most regions were generally not restrictive on what the
budget was used for although it was common practice to not cover
travel/accommodation expenses. It also became apparent that the
ATLS Instructors course was not deemed reasonable for study budget
use by 4 regions. One region in particular has a very restrictive study
budget that only covered a ATLS course and registration to the EFORT
conference. There did not seem to be much rhyme of reason for this
other than an email from the Head of School of Surgery stating that
trainees have abused the policy of study leave, and that the budget was
well into the red, leading to a clamp down on what could be covered.
The above diagram is not scientific in any way and is purely a reflection
of the impression we got from speaking to each Linkman. What was
clear in some regions was that each region had its own local problems
with one or more of the SAC indicative numbers (for example first
ray surgery was a real problem in one region due to lots of surgical
podiatrists locally). Another region with a big MTC struggled with tibial
IM nails, due to the local treatment policy towards IM tibial nails and a
preference for ex-fix.
It can be misleading to speak to a BOTA Linkman to gain insight
into the operative exposure of the whole region. However, it is clear
in some regions (ones that are on the right of the spectrum in the
diagram above) they do not struggle with in-theatre opportunities.
The overriding sentiment is that the trainers in this region have strong
culture of training. These are regions where the prevailing feeling is
that the registrar does all the cases under supervision. It is very much
expected for the trainee to be first surgeon in almost all cases. In these
regions, Linkmen often reported that the norm was for the trainees to
achieve all the CCT indicative numbers by end of ST6 at the latest.
In regions in the red zone (see above), trainees often reported being
scrubbed in with 1 or 2 other trainees holding retractors, being reallocated to a service provision task, working for bosses that refuse
to let them operate on any case, and there is a distinct lack of this
culture of training. In these regions, the Linkmen often reported that
trainees were being held back at ST7/8 regularly for lack of operative
experience. It is not the place of this article to name and shame. It is
also not likely that in these regions, ALL training posts are inadequate
for operative experience and so there will be a levelling out of
experience as the trainee moves around the region. The question
is - how do we reduce this variability? How do we quality assure each
post is fit for purpose? How do we ensure that only trainers that wish
to train are allocated trainees? How can trainers be supported and
rewarded for providing good training?
Generally speaking, trainees were happy that they could get study
leave days approved and that they were about right in terms of amount
per year. Most trainees felt that they would like more in terms of
funding as some courses now cost more than there annual budget
allowance. Most regions use a local paper-based application process
signed by the AES / CD / Rota master / LETB administrator.
OOP / The resurgence of the pre-CCT fellowship!
Most regions reported a couple of trainees on Out of Programme
placements for various reasons. Some had a preponderance to
academia, such as Oxford and Coventry, which had over 8 trainees
on OOPR for MD/PhDs! There were clearly some regions that were
happier than others to approve OOPC and OOPE for trainees to leave
the programme to work in Malawi, Kenya, South Africa, New Zealand
and other wonderfully exotic places. In fact, one of our Roadshows
was with the newly elected East Anglia Linkman, Ross, all the way
from Malawi! That seemed to be a better location (in terms of signal
strength) for a three way Skype call than Tristan, our Linkman in
Aberdeen (Sorry Tristan!).
An interesting observation was that some regions are allowing trainees
to undertake OOPT (Out of Programme Placement for Training) in
another region in the UK. This is usually done in ST7/8 and most
commonly post FRCS. This is basically the resurgence of the pre-CCT
fellowship and its use is very variable. Some regions have outright
stated to their trainees that all OOPTs are prohibited, whilst others
are allowing them for post-FRCS trainees in good standing at ARCP.
To clarify, an OOPE or OOPC does not extend your training so if your
LETB allow you to leave the programme for a year, you still have the
same amount of time left to CCT when you come back. An OOPT
counts towards your CCT and all almost exclusively restricted to the
UK, where your new AES in another region is also on ISCP and can
meet the requirements for being a trainer. Although unclear, some
Linkman (more than 3) stated that they personally knew trainees
in their region that went abroad for a pre-CCT fellowship but could
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not explain the logistics of how this was arranged. I would take this
statement with caution as it could not be qualified with any evidence.
I recall being at a BOTA Committee meeting 2 years ago when we
heard that the TPD forum at the BOA Congress in Birmingham had
discussed, unanimously voted on, and subsequently ruled, with SAC
support, that all pre-CCT fellowships were to be prohibited. The main
reasons cited were workforce planning issues covering rota gaps,
and the need to level the playing field around the UK addressing the
variation in regions allowing trainees to do pre-CCT fellowships. It is
concerning to see that this two-tier system has divided regions in the
UK once again, with some regions allowing OOPT in another region in
the UK whilst others strictly banning them.
Tackling the tsunami of trainee apathy
Point 9 of 21 on the Linkmen Roadshow agenda was about the
Linkman’s personal and regional feelings towards BOTA. Almost
every Linkmen stated some regional apathy amongst a variable
proportion of their trainees. Some regions were very supportive
in parts but many Linkman stated that it was getting more difficult
to get people to engage. I have thought long and hard about this
issue of disengagement. I think one facet of the problem is the lack
of visibility in what BOTA is doing for its members. This Linkmen
Roadshow project has highlighted areas of good practice and areas
of improvement. The variability within aspects of training between
regions is vast and unpredictable. In my mind, one thing is very clear;
if we do not work together, engage our members, and share successful
strategies to improve training on a regional level, we will all lose out
eventually.
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I hope that we can continue to disseminate these variations in training
but more importantly, by raising awareness, and providing gold
standards from case studies, we can significantly improve aspects
of training on a regional level. Improvements and projects can be
successful. These are often a result of several things being perfectly
aligned. To start, we need an engaged cohort of trainees, willing to
speak up and feed back, without the risk of being punished, when
things need to change. We need trainers to listen, take on board this
feedback and be motivated to make changes for the better. We need
TPDs to support trainers and lead a charge to improving aspects of
their training programme piece by piece. Finally, we need our TPDs
and trainers to be supported by the Head of Schools of Surgery
and the Deans in the LETBs to empower them to strive for better
quality training. I still firmly believe that overall, training in Trauma
& Orthopaedic Surgery in the UK is the best in the world however,
we can always improve and try to reduce the variability seen in this
project.
Aside from publishing this article of our experience engaging and
discussing with regional Linkmen about their training programmes,
BOTA will be running a session at the BOA Congress on some of the
key topics raised by this project (see start of this article). We hope to
see you there, as well as many other trainees, trainers, and TPDs from
different regions. I hope you have enjoyed this report and I apologise
unreservedly for my inability to write prose concisely or coherently - I
hated English Literature at school!
ANNUAL EDUCATIONAL CONGRESS 2016 A NEW PROGRAMME WITH AN EXCEPTIONAL FACULTY 16-­‐19th JUNE 2015 – Hinckley Island Hotel, Leicestershire WHAT'S INCLUDED Consultant delivered lectures
Accommodation for 3 nights
Consultant led workshops
All meals and refreshments included
Industry workshops
Informal BBQ
FRCS preparation workshops
Drinks reception and black tie dinner
Annual TPD forum
Social programme (not sponsored by industry)
AGM and committee elections
Prizes for oral presentations
Industry Exhibition
CHANGE IN VENUE Please put the dates for next year's educational weekend in your diary.
The new venue promises exciting changes, with popular guest speakers fronting the
increasingly popular educational programme.
All sessions are consultant-led and this year new prizes will be available for oral presentations.
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Results of the BOTA Work-Based Assessments Survey
D. Ryan
Introduction
In recent years a number of external influences have changed training
throughout the surgical specialties (ISCP Management Group, 2012).
Since the introduction of the European Working Time Directive
(EWTD), the Royal College of Surgeons of England estimates that
400,000 hours of surgical time have been lost, and with it a huge
capacity for training. In August 2010 a survey of surgeons discovered
that 80% of consultants and 66% of their trainees felt that patient care
had deteriorated since the EWTD was put in place (Royal College of
Surgeons of England, 2010; Association of Surgeons in Training, 2009).
Driven by these concerns about training and by government quality
assurance requiring accountability and transparency in training and
practice, and to ensure that patient safety standards are maintained,
the Intercollegiate Surgical Curriculum Programme (ISCP) was
introduced, with Work-Based Assessments (WBAs) forming the
mainstay of assessment. They are intended to be used formatively as
part of the competency-based surgical curriculum (Ali 2013), though
their application, reflected by the rapid impact that ISCP has had on
surgical training, has been interpreted differently by the high number
of trainers and trainees utilising these tools.
In an effort to identify important trends and value of the WBAs BOTA
invited all trainees to respond to a survey on the subject.
Results
19% of trainees completed their WBAs on ISCP within 24 hours, with a
further 44% doing so within one week. However, 52% of trainers took
longer than a week to return/validate forms.
37% of WBAs were completed on ISCP on work computers, with 61%
of trainees completing them at home. 92% of trainees received less
than 10 minutes of verbal feedback, with 60% receiving less than 5
minutes. This translated to a sentence or less of written feedback for
84% of trainees. 31% of trainees never return to review feedback from
their WBAs.
142 trainees responded to the survey. There was an even division
in terms of number of WBAs performed per rotation, with 1/3rd
completing 0-40, 1/3rd 50-70 and 1/3rd more than 70. In total 5%
performed more than 90 per rotation.
89% of respondents were given verbal feedback at the time of
assessment, but then filled the ISCP form later for validation. Less than
10% completed the ISCP form at the time of assessment.
62% of trainees found the PBAs to be the most useful WBAs, though
only 50% found the performance levels provided an accurate
reflection of ability. 56% felt that the addition of further intermediate
performance levels would not be useful in providing further clarity.
64% thought that the current 50:50 balance of operative vs. nonoperative WBAs is fair.
Discussion
Our results showed that while the majority of trainees are achieving
more than the required number of WBAs per rotation, they
rarely receive structured written feedback from trainers. ISCP
recommendations are that feedback should take between 5-10
minutes, but 3/5ths of trainees receive less than this. Combining these
two observations, it is not surprising that a common theme amongst
trainee free-text comments was that they found WBAs to be of little
value, and just a ‘tick-box exercise’, especially in areas where more
than 80 WBAs are required per year. Delayed completion of WBAs,
despite the development of a smartphone app, is likely to contribute
to decay in value of feedback given following a learning event, but
trainees cited service commitments as an obstacle to performing WBAs
in real-time, which is supported by evidence that most enter their
WBAs at home, rather than in the work environment.
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Trainees recognise the need for a mixture of assessments, but PBAs
are largely considered to be the most useful form of assessment.
Half of trainees found the current performance rating unhelpful, and
a common experience is that standards vary considerably between
trainers.
Results of the survey are strikingly similar to those in a similar survey
amongst core trainees in 2012 (Ryan et al. 2015). Unfortunately,
this means that over the past 3 years, attitudes to WBAs and ISCP
remain unchanged. Trainees perceive WBAs as “unhelpful” and a
“tick-box exercise”, and with minimum numbers increasing, the issue
is worsening. Service commitment remains a problem, and, with
limited time, quality of feedback is poor. Sadler (1998) emphasised
timely feedback in formative assessment as a key process in improving
performance, with Hattie (1999) going one step further, to call it “the
most powerful single moderator that enhances achievement”. Under
the current system, trainees are struggling to get this valuable resource
from their trainers. Suggestions for improvement include review of the
structure of WBAs; decreasing minimum numbers in some areas of the
country and introducing a minimum number of WBAs that a trainer
must fill in per rotation.
There have been a number of survey by trainees, however a survey by
trainers might highlight areas, which can be used to improve trainer
engagement with the process.
Conclusion
The survey has shown that the majority of WBAs were performed
with verbal feedback and later entry for validation. However, feedback
given was brief, with service provision and the high minimum
number requirements providing obstacles to performing WBAs in a
useful manner. There is an ongoing need to improve how WBAs are
performed, and attitudes to their use, in order to aid more beneficial,
accurate feedback. These results and the views presented by our
members will be presented to the T&O Training Standards Committee
for discussion at the next meeting.
Ali J. (2013). Getting lost in translation? Workplace based assessments in
surgical training. The Surgeon. 286-289.
Association of Surgeons in Training. (2009). Optimising working hours to
provide quality in training and patient safety.
General Medical Council. (2011). Learning and assessment in the clinical
environment: the way forward.
Hattie, J. 1999. Influences on student learning. University of Auckland, New
Zealand: Inaugural professorial lecture.
ISCP Management Group. (2012). ISCP Evaluation Report.
Royal College of Surgeons of England. (2010). Surgery and the European
Working Time Directive: Background Briefing.
Ryan D, Kar A, Jones S and Rangan A. Work-Based Assessments: Results of a
Core Surgical Trainee Survey. Core Surgery Journal. Accepted for publication
2015, personal correspondence.
Sadler, DR. 1998. Formative assessment: revisiting the territory. Assessment in
education 5.1.77-84.
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JOINT
75
Deanery selection for Specialist Training in Orthopaedics:
what factors influence trainee choice?
Laura E Johnston1†, Malin D Wijeratna1‡
1Department of Trauma and Orthopaedics, Peterborough City Hospital, Peterborough PE3 9GZ
†Orthopaedic Research Fellow
‡Orthopaedic Specialist Registrar
Corresponding e-mail: [email protected]
Introduction
In 2013, National selection was introduced in Trauma and
Orthopaedics in an attempt to establish a fair, transparent and costeffective method for appointing the best candidates to specialist
training, whilst eliminating unfairness or bias [1]. The process involves
a single interview at a National Selection centre. Applicants were
required to decide in which deaneries they would accept an offer, and
arrange them in order of preference prior to allocation of training
numbers. This is in contrast to the previous system, where candidates
attended local interviews in their preferred deanery or deaneries.
The aim of this study is to establish the factors applicants considered
when choosing their preferred deaneries and whether the availability
of further information relating to FRCS pass rates and geographical
area would alter the decision applicants would make.
Methods
An online survey was created following discussion with a focus group
of Specialist Training applicants. The survey consisted of four sections;
demographics, factors involved in applicant deanery preference,
presentation of further information about deaneries and re-assessment
of applicant preference taking into account the information provided.
The majority of deaneries (80%) publish a list of hospitals available on
their website; the remainder were contacted via telephone. A list of all
the training hospitals within each deanery was compiled, allowing the
geographical midpoint to be calculated using a free online calculator
(http://www.geomidpoint.com/). Travel times by car were then
calculated using Google Maps (https://maps.google.co.uk/).
The results were analysed using Pearson’s chi-squared test to check for
statistical significance.
Results
The survey was emailed out to 307 junior members of BOTA. We
received 88 responses (29% response rate).
Demographics:
The average age of respondents was 30.4 (range 24-56) years old.
The largest groups were aged 25-29 (47.7%) and 30-34 (41%). 85%
of respondents were male. 40% of the respondents were single,
39% married and the remainder with a long-term partner. 17%
of respondents had children aged <18 years old. The majority of
respondents (45%) were working as middle grades, with 44% in Core
Training (CT1-3). 49% of respondents were involved in this year’s
recruitment process.
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Table 1:
Location of respondents at the time they completed the survey.
Current Deanery
No of respondents
North East Thames
North West Thames
South East Thames
South West Thames
East of England
Kent, Surrey and Sussex
West Midlands
East Midlands South
East Midlands North
Mersey
Northern
North Western
Oxford
Scotland East
Scotland North
Scotland South East
Scotland West
Severn
South West Peninsula
Wessex
Yorkshire and Humber
% of total respondents
13
14.77
3
3.41
3
3.41
3
3.41
3
3.41
6
6.82
2
2.27
2
2.27
5
5.68
22.27
55.68
7
7.95
44.55
1
1.14
0
0
1
1.14
2
2.27
1314.77
2
2.27
44.55
7
7.95
43 respondents (49%) were involved in the ST3 application process
in 2013. 70% of these respondents provided information regarding
the number of deaneries they included when ranking their preferred
locations. 73% of respondents ranked every available deanery whilst
6.7% were only willing to take a post offered in their first choice
deanery. The remaining 20% of respondents ranked between 2 and 6
deaneries.
44 respondents (50%) were not involved in the ST3 application
process in 2013. One applicant declined to answer whether they were,
or were not involved. Of those that were not involved in applications,
15 (34%) were either in their first year of Core Training (CT1) or in
the Foundation Programme. 4 respondents (9%) were Core Training
year 2 (CT2) or 3 (CT3). 10 respondents (23%) were already in
specialist training positions. The remainder of respondents described
themselves as ‘middle grade’ doctors but did not specify whether they
held a National Training Number (NTN).
Tables 2-4 describe which factors both applicants and non-applicants
deemed the most important. Interestingly, those respondents involved
in the 2013 application process were significantly more likely to rank
the location of their immediate family as the most important factor
compared with those respondents who were not involved in this
round of applications.
Table 2:
Most important factor when ranking deaneries.
Most important factor
Most important factor
Total
P value
(applicants) (non-applicants)
31 responses (72%)
15 responses (34%)
Location of immediate family
Location of Core Training
Location of Medical School
FRCS pass rate
Presence of specialist hospitals
Travelling times between hospitals
Location of extended family
Location of Foundation Training
Number of hospitals
21 (67.7%)
3 (9.7%)
3(9.7%)
1 (3.2%)
2 (6.5%)
1 (3.2%)
0
0
0
5 (33%)
3 (20%)
3 (20%)
3 (20%)
1 (6.7%)
0
0
0
0
26 (56.5%)
6 (13%)
6 (13%)
4 (8.7%)
3 (6.5%)
1 (2.2%)
0
0
0
0.027
0.330
0.330
0.058
0.978
0.482
Table 3:
Second most important factor when ranking deaneries.
2nd most important factor
(applicants)
2nd most important factor
(non-applicants)
Total
P value
Location of extended family
Location of Core Training
Location of Medical School
Presence of specialist hospitals
Travelling times between hospitals
Location of Foundation Training
Location of immediate family
FRCS pass rate
Number of hospitals
8 (25.8)
7 (22.6%)
4 (12.9%)
3 (9.7%)
4 (12.9%)
2 (6.5%)
2 (6.5%)
1 (3.2%)
0
1 (6.7%)
2 (13.3%)
2 (13.3%)
3 (20%)
1 (6.7%)
3 (20%)
2 (13.3%)
1 (6.7%)
0
9 (19.6%)
9 (19.6%)
6 (13%)
6 (13%)
5 (12.2%)
5 (12.2%)
4 (9.8%)
2 (4.3%)
0
0.125
0.459
0.968
0.252
0.524
0.166
0.437
0.592
Table 4:
Third most important factor when ranking deaneries
3rd most important factor 3rd most important factor
Total
(applicants)(non-applicants)
P value
Location of Foundation Training
Location of Core Training
Presence of specialist hospitals
Travelling times between hospitals
Location of immediate family
Location of Medical School
Location of extended family
FRCS pass rate
Number of hospitals
7 (22.6%)
6 (19.4%)
5 (16.1%)
4 (12.9%)
3 (9.7%)
2 (6.5%)
2 (6.5%)
1 (3.2%)
1 (3.2%)
0.761
0.959
0.372
0.524
0.709
0.978
0.978
0.592
0.592
4 (26.7%)
3 (20%)
1 (6.7%)
1 (6.7%)
2 (13.3%)
1 (6.7%)
1 (6.7%)
1 (6.7%)
1 (6.7%)
11 (23.9%)
9 (19.6%)
6 (13%)
5 (12.2%)
5 (12.2%)
3 (6.5%)
3 (6.5%)
2 (4.3%)
2 (4.3%)
22 (25%) respondents said the information we provided regarding FRCS pass rates would alter the order of their preferred deaneries. 34 (39%)
respondents did not feel this information would alter their preferred order and 32 (36%) declined to answer.
15 (17%) respondents said the information we provided regarding travel times between hospitals within a deanery would alter the order of their
preferred deaneries. 33 (37.5%) respondents did not feel this information would alter their preferred order and 40 (45.5%) declined to answer.
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77
Discussion
Specialist training in orthopaedics requires a minimum of 6 years and
typically occurs at an age when many people are making important
steps in their personal lives. The location of immediate family is likely
to be important when choosing preferred deaneries. The ability to
commute throughout the deanery from a central point, thereby
minimising the need to move house during training, was also identified
as a potentially important factor.
Obtaining the UK Certificate of Completion of Training (CCT) requires
trainees to complete their Fellowship exams [2]. Information
regarding pass rates for the Fellowship of the Royal College of
Surgeons (FRCS) exam is another important factor to consider when
making decisions regarding training. .
Specialist training in Trauma & Orthopaedics requires a significant
commitment from trainees; they need to be able to perform in their
day job, as well as study for exams and be involved in teaching, audit
and research. During specialist training, there are often significant
changes in personal lives as well, with many trainees starting a family
during this period. National applications mean that applicants to
specialist training can apply to any deanery in the country via a single
interview. However, if a deanery was not included by an applicant as
one of their preferred locations, the applicant would not be offered a
training post in that deanery. The training post would be offered to the
applicant with the next highest score who had included that deanery
when ranking their preferred locations. We asked what factors
applicants considered when choosing their preferred deaneries, and
whether increased availability of FRCS pass rates and travelling times
within deaneries would alter their decisions.
There is limited evidence looking at the geographical movements
of medical graduates throughout their training, although studies
have shown a tendency for trainees to remain in the same region for
specialty training as their medical school [3]. More general location
based studies from Australia have found that graduates with experience
of rural living are more likely to train and work in rural locations [4],
although there is also evidence to suggest cultural variation with
doctors of ‘Non-European descent’ more likely to choose city based
practice [5]. This is not something we have investigated as part of our
current study.
In line with previous evidence [6], we found the most important factor
when applying for specialist training was the location of immediate
family. The location of Core Training was found to be the second
most important factor. This may reflect the increased likelihood
that immediate family would be living in the same region in which
applicants completed their Core Surgical Training.
Interestingly, the presence of specialist hospitals or the location of the
applicant’s medical school within a deanery were both equally as likely
to be in the top 3 reasons for applying to a deanery. This may be more
specific to Trauma and Orthopaedic trainees than applicants to other
specialty training programmes where sub-specialty training may be of
less importance.
Previous studies suggest that more than 20% of hospital Specialist
Trainees compromised on geographical location in order to obtain a
NTN [7]. In light of this it is perhaps not surprising that almost 50% of
respondents had ranked all the available deaneries when applying for
specialist training, suggesting they would be willing to move anywhere
a NTN was available.
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JOINT
17% of respondents felt that further geographical information may
have altered their preferred location for training. 25% of respondents
reported that information regarding FRCS pass rates may have altered
their preferred training location. It is unlikely the applicants that
included every deanery when providing their preferred locations for
training had all the available information regarding FRCS pass rates,
individual training locations and geographical data. This information
was not easily available and our results suggest that applicants would
appreciate access to this information.
Applicants for Specialist Training must consider a range of factors
when choosing their preferred geographical location. The location
of immediate family, Core Training and medical school were deemed
to be the most important factors. The National Selection process
enables prospective trainees to apply to deaneries they have not
worked in, and as such may have limited prior knowledge of. Our
findings suggest that increasing the availability of information about
FRCS pass rates and which hospitals are included in specialist training
rotations, particularly those deemed to be specialist hospitals, would
allow applicants to make informed decisions at what is undoubtedly an
important stage in their careers.
References:
1. Briggs & Manning. (2013) Proposal for selection into ST3
[Internet] British Orthopaedic Association; 2013 [cited 2013 Nov
13]. Available from: http://www.boa.ac.uk/Publications/Documents/
Proposal%20for%20selection%20into%20ST3.pdf
2. Calman KC, Temple JG, Naysmith R, Cairncross RG, Bennett SJ.
Reforming higher specialist training in the United Kingdom—a
step along the continuum of medical education. Medical
Education. 1999 Jan;33(1):28-33
3. Goldacre M, Davidson J, Maisonneuve J, Lambert T. Geographical
movement of doctors from education to training and eventual
career post: UK cohort studies. Journal of the royal society of
medicine. 2013 106: 96 – 104
4. Stagg P, Greenhill J, Worley PS. A new model to understand
the career choice and practice location decisions of medical
graduates. Rural and remote health. 2009 9:1245 (published online
28/11/2009)
5. Ward A, Kamien M, Lopez DG. Medical career choice and practice
location: early factors predicting course completion, career choice
and practice location. Medical education. 2004 38:239-248
6. Invorvaia AN, Ringley CD, Boysen DA. Factors influencing surgical
career decisions. Current surgery. 2005 62(4):429-35
7. Lambert T, Goldacre M. Progression of junior doctors into higher
specialist training. Medical education. 2005 39: 573-579
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Management in Medicine:
turning to the dark side or seeing the light?
A reflection of a year spent as a McKinsey clinical fellow
Chrishan Thakar
“Who are your patients?” This simple question was posed at an inspiring
lecture a few years ago. It made me evaluate my role as a clinician,
triggering the start of my journey into healthcare management,
culminating in a year as the inaugural fellow at McKinsey & Company,
a leading management consultancy firm. Here I hoped to immerse
myself in the world of management, learning more about myself and
the cogs of the NHS from “the other side”. Having climbed a significant
proportion of the medical career ladder, I found myself on the bottom
rung of a career path I knew very little about. Immersed in a new culture
and way of working I became exposed to a new language and way of
thinking. There was also the sudden realisation that my Power Point and
Excel skills were in need of serious up-skilling.
Today, the NHS faces a plethora of challenges with morale amongst
colleagues at a significant low. Frustration from the perceived inability to
make change happen has slowly been replaced by apathy. Why has this
occurred and how do we face these challenges? What skills do we need
to make real change happen thus delivering meaningful impact, and are
clinicians the right people to do it?
Delivering excellent care to the patients we see is only half our job,
but yet our professional identity seems to be more or less defined by it.
What about the patients we don’t see, the individuals who have been
waiting to see a doctor for weeks if not months and those who may
require our help in the future? What about the system and organisation
that we work for?
A significant proportion of a consultant’s time is spent on management
and yet no formal training is required to complete this role, especially
surprising in this modern era of competency-based training. There
appears to be a “them and us” culture seen within the NHS between
management and clinicians, with the often-cited remark of turning
to the dark side about those who try to bridge the divide. Whilst we
are seeing greater clinical leadership across the organisation, it would
appear that we as a profession have not developed fast enough to
meet the needs of the NHS. Historically, medical training has primarily
focused on clinical skills and knowledge but despite nearly all of us
going on to work for the NHS, very little time is spent on helping
us understand the very organisation that we work for. In addition,
the hierarchical and vocational nature of medical training may also
explain why our profession has been slow to develop with individuals
traditionally focusing on their specialty alone. Shifting traditional
mindsets and behaviours is very often challenging.
The terms clinical leadership and medical management are increasingly
being used but why are clinicians weary of embracing these? Matthew
Limb 1 highlights the perceived top-down culture of management, the
lack of a defined career pathway and lack of management exposure
throughout trainees’ careers as some of the significant reasons for
clinicians not taking up more management and leadership roles.
In his interview with Vijay Nath, King’s Fund’s assistant director for
leadership, Tom Moberly2 , also identifies a lack of confidence to step
out of one’s clinical comfort zone
and the concern of undermining a clinician’s position as the patient’s
advocate by taking on these roles in leadership and management.
Learning how to transform a number of hospital operations as part of an
organisation’s wider strategy has made me understand why we struggle
as clinicians to make change happen. Often there is a lack of awareness
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of the organisation that we work for and a failure to understand why
certain targets are set and their implication for us as employees and
the patients we are trying to treat. All too often, poor communication
between management and front line staff lies at the heart of the
problem. Bridging this gap is ultimately what clinical leadership is about.
Often you hear clinicians state that their role is to treat patients and
that managers should manage the organisation to allow them to treat
their patients. This unfortunate thinking may explain why doctors don’t
seek to understand the organisation that they work for and take greater
responsibility. Evidence shows that organisations with greater clinician
involvement in management score almost 50% higher on key measures
of organisational performance compared to low clinical leadership3 .
Having the capabilities to challenge the organisation and communicate
meaningfully to both the frontline and management will effect change.
Identifying the relevant stakeholders and financial opportunity will
assist clinicians in implementing change that not only serves patients
better but is also the wider community as whole through cost efficiency
savings.
Throughout my journey it has become evident that many similarities
exist on “the other side” with regards to the way we think and the skills
required. The preconceived notion that clinicians are not equipped
to manage is incorrect. We have the skills but need to learn how to
translate them into being effective managers. Being able to negotiate,
influence and persuade are vital for success as well as working effectively
within teams. One of the greatest challenges I identified was that change
takes time. As clinicians we see the results of our actions often very
quickly but with management time and patience are required.
As doctors we need to reconsider our professional identity and take the
opportunity to collectively drive change, leading to improved outcomes
for patients in the long term. A more holistic approach to patient care
needs to be considered. As highlighted in the Francis report4 following
the failings at Mid-Staffordshire, we need to embrace and value clinical
leadership. Mechanisms need to be established to support leadership
and management development from the early years of training if we are
to ensure patient safety and continue to improve quality care. Medical
training traditionally has not sufficiently valued/priortised leadership and
management due to the focus on clinical knowledge and skills. Support
and training of softer skills such as communication and IT have for a
long time been ignored. These skills amongst others are necessary to
help us engage with the system to diagnose, design and deliver effective
change.
Taking greater ownership of the organisation for which we work and
working in partnership with management rather than against it is
required for successful change. We need to shift the mindsets and
the deep rooted culture away from the, “them and us” to “us” as a
collective body working together with the shared purpose of providing
the best possible care for our patients. Failure to grasp the bigger
picture and the continued practice of working in silos will slowly hinder
the development of improved patient care. The cogs of this complex
machine will gradually grind to a halt and the NHS will remain firmly
within the 20th century if we are not prepared to respond.
As I return to clinical practice, I hope I will be able to draw on these
new perspectives to confidently challenge the status quo, identifying
problems and contributing to implementing solutions to what are often
simple problems. One individual alone won’t make a difference but I
hope that I can inspire others to seek out similar opportunities that
enable one to gain a new skill set invaluable to a modern day hospital
consultant. I would like to think more colleagues will view management
in medicine as seeing the light rather than turning to the dark side.
References:
1. Limb M. What is deterring doctors from management roles? BMJ
Careers, April 2014
3. Castro PJ, Dorgan S, Richardson B. A healthier health care system
for the United Kingdom. McKinsey Quarterly. February 2008
2. Moberly T. Doctors need to “step up” to leadership roles to help
improve patient care. BMJ Careers, June 2014
4. Francis R. Report of the Mid Staffordshire NHS Foundation Trust
public inquiry. 2013: www.official-documents.gov.uk/document/
hc1213/hc09/0947/0947.pdf.
Key learning points:
• Clinicians need to drive change and should be comfortable acting
as role models to the wider health community. Role modelling best
practice and having greater visibility within the organisation will
help others within the organisation to drive successful change.
• The NHS is a complex organisation that requires a greater
understanding by us as employees to see beyond our own
service/ specialty. The continued practice of working in silos
needs addressing through shifting mindsets and behaviours and
challenging current practices and cultural values.
• Managers and clinicians need to find a common language to enable
cohesive working. Too often the barriers that exist between “them
and us” arises from the failure to communicate using a common
language that bridges the clinical and management aspects of
patient care.
• Key performance indicators (KPI) and how and why they are being
measured need to be explained to front line staff. The relevance of
each KPI to the delivery and impact of patient care should be made
clear to ensure that best practice achieves these standards without
them being necessarily the prime focus.
• Greater awareness of the transferable skills that clinicians possess
to manage is required. Persuasion, influence and negotiation
are key skills that can help individuals develop in their role as
managers. Understanding oneself and how to influence mindset
and behaviour are key leadership skills.
• Leadership and management roles should be encouraged earlier
in a clinician’s training. To meet this need, earlier training and
support is required. The development of formal leadership and
management programmes both during training and as consultants
should be further encouraged.
• Each level of the organisation should be encouraged to take
ownership and shared accountability for the organisation as a
whole. Collective responsibility for service delivery across the
organisation will help drive improved standards of care, efficiency
and consequently cost savings.
Call for abstracts 2016
British Orthopaedic Trainees’ Association (BOTA)
Orthopaedic Research UK (ORUK) poster prize 2016.
British Orthopaedic
Trainees Association
The annual BOTA ORUK poster prize will be
awarded at this year’s BOTA Educational
Congress on the 16-19th June, Hinckley Island,
Leicestershire.
We invite you to submit abstracts of any original
research / audit related to trauma and orthopaedic
surgery.
Presenting author will be expected to register for
the Educational Congress in order to present the
poster.
The top 3 posters will be invited to give an oral
presentation. There will be monetary prizes for the
oral presentations and for the “top five posters”
following judging on at the congress.
Submission guidelines:
250 words (including subheadings) under the following
headings: introduction, objectives, methods, results and
conclusions.
Presenting author must be a member of BOTA their
membership number included with the submission.
Names of BOTA members to be underlined in the author list.
Please submit a single document in .doc format. The entire
text including headings should be in arial size 12 font.
Please include a blinded and unblinded copy of the text
(i.e. one copy with no names of authors or institutions)
Abstracts to be submitted to [email protected] by the
1st February 2016. Results will be announced by the
1st March 2016 to allow sufficient time to register.
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Prizes and Bursaries
ORUK prizes
84
Junior Essay Prize
91
Cambridge Orthopaedic Writing Prize – Healthy Living sucks
92
Kenya Orthopaedic Project BOTA/ Hereus Travelling Fellowship
94
BOTA Medical Student Elective Bursary Winner- Malawi
96
BOTA Medical Student Elective Bursary Winner Toronto/ Los Angeles
98
IOS UK Prize
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83
ORUK Prizes
The BOTA Educational Congress once again provided an excellent
opportunity for trainees around the UK to showcase their research and
compete for BOTA ORUK Research Prizes.
The standard this year was excellent with over 100 high quality
abstracts submitted. A panel of judges assessed the posters over the
two-day conference and five prizes of £50 each were awarded to the
top five poster presentations.
For the second year we also ran a podium presentation competition
with first place winning £150 and a publication in BJR. Two runnerup prizes of £50 were also awarded. This years podium presentation
was won by Parag Jaiswal for his work on “ Early surgery for proximal
femoral fracture sis associated with lower complication and mortality
rates”. Runners up were Jonathon Craik and Chris Bretherton.
We would like to thank ORUK for their continued support with prizes
and certificates.
Orthopaedic Courses 2016
The Cuschieri Skills Centre in Dundee has developed a comprehensive orthopaedic
course portfolio of courses suitable for trainees from FY2 to ST6 level. Each course
has been matched to the BOA curriculum.
Feb - New for 2016: Introduction to Knee Arthroscopy Arthroscopy Simulators and Cadaveric Anatomy Models
Mar - Principles of Knee Arthroscopy - Thiel Cadaveric Course
Apr - Principles of Shoulder Arthroscopy - Thiel Cadaveric Course
May - ACL Reconstruction - Thiel Cadaveric Course
Endorsed by:
Cuschieri Skills Centre, University of Dundee
Level 5, Ninewells Hospital, DUNDEE, DD1 9SY
Phone: +44(0)1382 383400 Fax: +44(0)1382 646042
Website: cuschieri.dundee.ac.uk Email: [email protected]
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To register your interest
in any of these courses
please visit our
website or email us
[email protected]
Podium Presentations
Overall Winner: Parag Jaiswal
Early surgery for proximal femoral fractures
is associated with lower complication and
mortality rates
Jaiswal, PK., Khong, h., Smith, C., Railton, P., & Powell J
Introduction
The purpose of this study was to compare the mortality rates in
patients who had operative treatment for proximal femoral fractures
within 48 hours of presentation to the emergency department and
those that did not.
Objectives
We hypothesised that a delay in surgery will adversely affect the length
of stay (LOS), mortality and complication rates.
Materials & Methods
Data was collected from multiple centres in Alberta, Canada on all
patients that underwent operative treatment for proximal femoral
fractures between April 2009 to 2013. The primary outcome was the
in-hospital mortality rate. Secondary measures were length of stay
and medical complications. Multi-variate analysis was used to assess
whether age, gender, Charlson Co-morbidity index and timing of
surgery had an effect on the aforementioned outcomes.
Results
There were 13429 procedures performed (mean age 77.8 years,
67.5% females). 76% of patients received surgery within 48 hours. The
in hospital mortality rate was 4.2% (558 patients). Independent of
age, sex and co-morbidities, patients that had a delay in surgery had
higher probability of mortality (odds ratio=1.75, p<0.001), medical
complications (odds ratio=1.3, p<0.001). The predicted LOS is 3 days
longer if surgery is delayed.
Conclusion
Delay in surgery by more than 48 hours has an adverse effect on
length of stay, mortality and complication rates. Patients presenting
with proximal femoral fractures should be adequately resuscitated,
medically optimised and prioritised to undergo surgery on the next
available trauma list.
Runner-up: Jonathon Craik
Runner-up: Chris Bretherton
Femoral medialisation, fixation failures and
functional outcome in trochanteric hip fractures
Human Evolution and Subacromial
Impingement
Bretherton, CP & Parker MJ
JD Craik, R Mallina, V Ramasamy & NJ Little
Introduction/ Objectives:
Epsom and St Helier University Hospitals NHS Trust
Femoral medialisation has been associated with fixation failure of
trochanteric hip fractures; intramedullary (IM) nails theoretically reduce
medialisation. This study used data from within a randomised controlled
trial comparing a sliding hip screw (SHS) versus an IM nail for the
treatment of trochanteric hip fractures.
The aim was to determine if femoral medialisation influences residual
pain and mobility and to determine if fixation method or fracture pattern
influences the tendency to medialise.
Methods
538 patients presenting to Peterborough City Hospital with a trochanteric
hip fracture were randomized to fixation with a Targon PF Nail (BBrawn,
Tuttlingen) or SHS. Femoral medialisation was calculated from follow up
x-rays at a minimum of 28 days post fixation. Pain and mobility scores were
assessed at 1 year by an independent blinded observer. Fractures were
classified according to AO classification as 31 A1, A2, A3.
Results
Patients with >50% medialisation had worse pain (p=0.012) and
mobility scores (p=0.013) at one year. They also had more fracture
healing complications (p=0.021) and required more revision procedures
(p=0.014). Fractures treated with SHS were more likely to medialise
>50% compared to IM nail (p<0.001). A2 and A3 fractures were more
likely to medialise and A3 fractures were more likely to undergo >50%
medialisation (p<0.001).
Discussion
Our study demonstrates the previously theoretical susceptibility for
hip fractures treated with SHS to undergo femoral medialisation and
correlates this with worse functional outcomes. Unstable fractures may
be better treated with intramedullary devices, which resist femoral
medialisation.
Introduction
Subacromial impingement syndrome and secondary rotator cuff tears
have been associated with several features of scapular morphology in
humans. However this condition does not appear to affect other Great
Ape species indicating that factors have evolved in humans to increase
disease risk.
Objectives
Our study objective was to determine if any of the reported anatomical
risk factors for impingement and rotator cuff tears have evolved
independently in humans. We hypothesise that anatomical features
unique to humans may play a more direct role in disease aetiology.
Methods
Orthogonal photographs of 22 human, 17 gorilla, 13 chimpanzee
and 12 orangutan dry bone scapula specimens were analysed using
a calibrated digital image technique. Anatomical risk factors were
measured, scaled according to scapula vertebral border length, and
means compared between the species.
Results
Ten anatomical risk factors for impingement and rotator cuff tears
were identified from the medical literature. None were shown to be
accentuated in humans and significantly different to the other species
studied. However the size of the supraspinatus fossa was significantly
smaller in humans.
Conclusion
These results suggest that, in addition to the reported anatomical
risk factors, an alternative primary aetiological factor must exist. A
reduction in the size of the supraspinatus fossa suggests that muscular
insufficiency or a change in rotator cuff force vectors could play a role.
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Introduction of the Early Traumatic Hip on Elective List Pathway (ETHEL)
Judith Johnston, Kate Spacey, Karam Sarsam, Safwan Sarsam
Background
Results
Three days a week, an elective list starts early with the
aim of knife to skin at 08:30, allowing one NOF fracture to
be added to an elective list.
The ETHEL pathway accommodates:
• Cemented or uncemented hemiarthroplasty
• Dynamic Hip Screw (DHS)
• Cannulated screws
The ETHEL pathway was introduced with the aim to:
• Increase surgical capacity to cater for NOF fractures
• Improve 36 hr national target to operative
management
Method
Retrospective data was collected from the initiation of the
ETHEL pathway for 1 year. Data included:
• Procedure performed
• Elective list overruns
• Elective cancellations
• 36 hour NICE guideline target
The Average Pathway
• Total 62 ETHEL patients (utility of pathway 40%)
• 4 cancelled on morning of surgery
• Equivalent of gaining 21 trauma sessions
• 4 unagreed pathway procedures performed
Effect on elective work
• 18.6% of lists had elective cancellations (11)
• Equivalent of 4 sessions lost in cancellations
• Cancellations most commonly due to:
Theatre overrun, too late to send (55%),Inadequate
communication of ETHEL added (18%),
Effect on finance
Lost £78400 by cancelling elective cases
ETHEL cases earned £324934
Net earned £246531
Late starts most commonly due to: have knife to skin 09:08
• Ward not ready (35.7%)
• No TSW available to collect patient (14%)
• Anaesthetic or Radiographer delay (14%, 14%)
Effect on failing 36 hour NICE Target:
Pre ETHEL
28%
Post ETHEL 30%
Conclusion and Recommendations
• Underutility of ETHEL, no additional lists required
• Significant increase in operative capacity
• ? ETHEL pathway to occur only on full day lists
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A complete audit cycle of BOAST 7: fracture clinic
services in a major trauma centre
J Kukadia, R Fawdington, W Mahmood, H Ribee and J Lim
RESULTS
INTRODUCTION
OBJECTIVES
700
Our aim was to audit the quality of our outpatient fracture
clinic services against the BOAST 7 guideline and identify
areas for service improvement and then re-audit.
500
400
Cycle 1
Cycle 2
300
Graph B shows the criteria achieved in both cycles
of the audit. Criterion 1 corresponds to the
percentage of patients seen within 72 hours.
200
100
0
Total number
METHODS
Total 'new'
Total included
A
o All patients coded as ‘new’ attending fracture clinic
EXCLUSION CRITERIA
o Incorrectly coded as new e.g. elective / ward follow-up
o Rearranged appointments or patients who did not attend
o Where it was not possible to determine a referral date
o Already seen by an orthopaedic surgeon on call
o Non-acute injuries
In cycle 1, 81% of patients were seen within 72
hours of initial presentation, with a further 3% on
suspected scaphoid fracture pathways, who are
deliberately seen 10-14 days after the initial injury,
when they can be clinically re-assessed. Therefore
16% were not seen in 72 hours.
Achievement of audit criteria
120
100
80
Percentage
INCLUSION CRITERIA
After cycle 1 the results were discussed at our
departmental audit meeting. The suggested
recommendations to improve our outcomes are in
the discussion table below.
600
Patient inclusion
All new patients attending fracture clinic over a one week
period in March 2014 were included and audited against
BOAST guidelines. Following recommendations of the first
audit cycle, the criteria were re-audited in November 2014.
Following our exclusion criteria, a total of 173 and
218 patients were included in the final analysis of
the respective audit weeks, refer to Graph A.
Numbers according to inclusion/exclusion criteria
800
Number of patients
A significant amount of acute soft tissue and bony injury is
seen within Emergency Departments and primary care,
often requiring specialist input from Trauma and
Orthopaedic surgeons. In August 2013, the British
Orthopaedic Association Standards for Trauma (BOAST)
published guidelines for the care of fracture clinic patients.
60
Cycle 1
Cycle 2
40
20
Criterion 3, 5, 10 and 12 are those which were
partly met (see discussion).
0
1
2
3
4
5
6
7
8
9
10
11
12
13
B
Audit Criteria
AUDIT CRITERIA
In cycle 2, 89% of patients were seen within 72
hours, with 2% on the scaphoid pathway. A
further 4% were found to have required specialist
opinions e.g. hand, paediatrics. Therefore only 5%
of patients were not seen within 72 hours.
DISCUSSION
The table below displays the audit criteria in the order outlined by the BOAST 7 guidelines and
the recommendations suggested after discussion at our departmental audit meeting.
Criteria
1
Cycle 1
Cycle 2
Notify referral sources of the 72 hour
Although there was an improvement, 5% were
target.
not seen with 72 hours of initial presentation.
2
3
Written management plans are only sent
to GPs. The department decided not to
routinely send letters to patients.
4
5
Only scaphoid fractures have an agreed
protocol. As there are many different types
of injuries, cases will be discussed with the
radiologist on an individual basis.
6
7
8
9
10
Leaflets for common injuries / exercises
were not available although plaster care instructions were and we aim to provide these.
11
There is no agreed CRPS pathway. We
plan
to
design
one
with
the
A CRPS protocol is yet to be established.
pain
management team.
12
Although patients requiring surgery had
Modification to our trauma admission sheet is
planned admissions, a maximum time period still being evaluated to state an ideal maximum
was not specified.
time period for surgery.
13
CONCLUSION
After the first audit cycle, we achieved 7 out of 13 of the standards set out by BOAST. With areas of
service improvement identified, we proposed and implemented the above recommendations. On
re-audit, we improved upon 3 criteria. Ongoing recommendations include establishing a CRPS
protocol and stating a maximum time period for planned operations, with scope to improve the
number of patients seen within 72 hours of referral.
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Extensor tendon spatial anatomical relationship with the distal radius: An MRI
study relating to distal radius fractures.
S. Al-Himdani, V. Paringe, L Lougher
Department of Trauma and Orthopaedics, Morriston Hospital, Swansea, UK.
.
Results
(Continued)
Introduction and Aims
Volar plating for distal radius fractures is a commonly performed orthopaedic
procedure, often undertaken by trainees. Rupture rates of extensor tendons
associated with volar plating for distal radial fractures are reported to be between
4.4-8.6%.1-3
Rupture may occur secondary to poor intraoperative technique or due to a prominent
dorsal screw leading to chronic attrition rupture.1-3
We aimed to evaluate the anatomy of the distal radius and the geometric relations of
the extensor tendons to the dorsal bone cortex on magnetic resonance imaging
(MRI) using 1.5 T MRI.
8%
8%
Figure 3:
Indications
for MRI scan
in patients
included in
the study
TFCC Tear
Ganglion
ECU tendinopathy
Other
NAD
40%
16%
28%
Figure 1: Six
extensor
compartments of
the wrist
(copyright by AO
Publishing,
Switzerland)
ECU
EDM
EDC
Tendon
Figure 4:
Average
distance to
dorsal bone
cortex of
extensor
tendons
EIP
EPL
ECRB
ECRL
APL
EPB
0
Methods and Materials
The length between the dorsal bone edge and each of the individual tendons of
the six extensor compartments was measured.
Distances were measured and agreed on by the two authors.
Exclusion criteria included:
•  MRI scans undertaken for fracture indication
•  MRI scans where the resolution made it not possible for both authors to
calculate the distances
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
Average distance from dorsal bone cortex
6
Figure 5:
Average
distance to
dorsal bone
cortex of each
of the extensor
compartments
5
Extensor compartment
The authors reviewed 50 MRI scans performed for various non-fracture
scenarios between August 2014 and April 2015. An axial image two cuts
proximal to the last visible articular surface with Lister’s tubercle visible, was
selected.
0.2
4
3
2
1
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Average distance to dorsal bone cortex
Figure 2:MRI measurements
undertaken by two authors
Discussion
The close proximity of the extensor tendons exposes them to significant risk of
intraoperative or chronic attrition rupture following volar plating of distal radius
fractures.
Extensor tendon rupture may occur if the incorrect length screw is selected.
Extensor tendons of the first, second and third compartments lie particularly
close to the dorsal bone cortex. We found that APL (0.57cm), EPL (0.59cm) and
EPB (0.59cm) were the tendons located in closest proximity to the dorsal bone
cortex.
In the literature, EPL, is reported as the most commonly ruptured tendon. The
close location EPL to dorsal bone cortex and the position of the holes in the plate
may predispose to EPL damage and rupture.
Results
A total of 26 female and 24 male MRI scans were assessed. The mean age was
42 years (range 13-81 years). 29 MRI scans were of the right hand whilst 21 the
left hand.
The average distances between the dorsal bone edge and the extensor tendons
were EPB 0.59mm, APL 0.57mm, ECRL 0.65mm, ECRB 0.62mm, EPL 0.59mm,
EIP 1.64mm, EDM 1.52mm and ECU 0.81mm.
The mean height of the radius was: 16.2mm on the radial side, 21.3mm at
Lister’s tubercle and 18.2mm on the ulnar side of the radius.
Conclusions
Prudent screw placement and precision of screw length is imperative to avoid
adverse functional outcomes.
References
(1)  Al-Rashid M, Theivendran K, & Craigen MAC. Delayed ruptures of the extensor tendon secondary to the use of volar locking compression plates for distal radial fractures. Journal of Bone & Joint Surgery 2006.
British Volume, 88(12), 1610-1612.
(2)  Sügün TS, Karabay N, Gürbüz Y, Özaksar K, Toros T, & Kayalar M. Screw prominences related to palmar locking plating of distal radius. Journal of Hand Surgery 2011 (European Volume), 36(4), 320-324.
(3)  Benson EC, DeCarvalho A, Mikola EA, Veitch JM, & Moneim MS. Two potential causes of EPL rupture after distal radius volar plate fixation. Clinical orthopaedics and related research 2006 451, 218-222.
Hip Fracture Radiology Audit
T Murphy, J Matthews, A Stevenson and H Sandhu
Low Energy Trauma
? Neck of Femur Fracture
Introduction:
New guidelines were introduced at
the Royal United Hospital, Bath in
March 2014 with regards to the
imaging with radiographs of patients
admitted with a fractured neck of
femur. They aimed to improve
efficiency by ensuring all necessary
radiographs are taken with one
patient visit to the department and
prevent all unnecessary imaging.
AP HIPS
(Centred on symphysis pubis)
Is it Displaced Intra-capsular?
NO
YES
Does fracture exit below greater
trochanter on the lateral cortex
NO
LATERAL
needed
YES
NO
LATERAL HIP +
AP & LAT FULL
FEMUR VIEWS
LATERAL HIP
ONLY
CHEST X-RAY
Methods:
Using the PACs system and the trust’s hip fracture database we analysed all radiographs
taken in patients with fractured neck of femur between the dates of 31/03/15 to the
12/05/15. By identifying the type of fracture in each case we were able to establish
whether or not the appropriate films were taken in each case.
Results:
66 neck of femur fractures
37 intra capsular
(56%)
26 displaced
(39%)
11 undisplaced
(17%)
29 extra capsular
(44%)
17 exited
above the GT
(26%)
12 exited
below the GT
(18%)
66 patients admitted with a fractured
neck of femur. In the time period The
guideline was adhered to in 49 cases
(78%).
Adherent to the guideline in 78%
• Chest radiographs not performed in 15%
• Lateral views not performed in 5 cases when required.
• Lateral views performed unnecessarily in 2 cases
No. of Radiographs
1
2
3
4
5
6
% patients in cohort
2%
23%
44%
9%
18%
4%
Conclusions:
We are not yet fully adhering to the guideline, however, we feel that the guideline is
likely to be reducing the number of unnecessary lateral views performed.
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Lower Limb Venous Blood Flow With
Ankle Joint Immobilisation
JD Craik, A Clark, J Hendry, AH Sott, PD Hamilton
Epsom and St Helier University Hospitals NHS Trust
Introduction
Below knee cast immobilisation is associated with the development of deep vein thrombosis
secondary to venous stasis. However the effect of weightbearing in different methods of ankle joint
immobilisation on venous blood flow, and therefore DVT risk, is unknown.
Methods
Blood flow was measured using ultrasonography of the
popliteal vein in ten healthy volunteers (figures 1&2).
Measurements were taken whilst performing nonweightbearing and weightbearing exercises, before and
after ankle joint immobilisation.
Figure 1. Technique of ultrasonography to image the popliteal vein in
longitudinal section.
Duplex ultrasonography is sensitive to motion artifact
and obtaining accurate measurements during the
normal gait cycle is not possible. Therefore exercises to
simulate the different phases of the gait cycle to limit
motion artifact were performed (figure 3).
Results
There was no significant reduction in venous blood
flow measurements when fully weightbearing in a
neutral cast or pneumatic walking boot compared with
full weightbearing without immobilisation. However, a
significant reduction in venous blood flow was
observed whilst full weightbearing with the ankle
immobilised in equinus and with partial weightbearing
exercises (50% body weight). Blood flow whilst
ambulating non-weightbearing was not significantly
different to resting blood flow.
Figure 2. Venous blood flow velocity tracing showing peaks in venous
blood flow during weight-bearing.
Figure 3. Simulating the gait cycle. (Left) Stance phase and technique of
flat-foot loading without immobilisation and with immobilisation. (Right)
Toe-off phase and technique of heel raise exercises without
immobilisation and forefoot loading with immobilisation.
Conclusion
These results demonstrate that cast immobilisation alone should not be regarded as a risk factor for
the development of deep vein thrombosis without an appreciation of the position of the ankle joint
and weightbearing status.
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Junior Members Winning Essay 2015
Is 3D printing the future to picture perfect orthopaedics
surgery?
Sheena Seewoonarain
Once upon a time, in the not too distant future, a young unconscious
man is hurried into A&E strapped to a stretcher. Another victim
of a road traffic accident. The multidisciplinary trauma team don
their protective gear and start their familiar drill: oxygen is given,
the c-spine secured and with venous access established; blood is
taken and medication is pushed through. As the team continue, the
realisation sets in that he may not make it. The number of suspected
injuries too great: fractured pelvis, multiple lower limb fractures and a
severed foot. With time, the skill and experience of the dedicated staff
pervade as the patient is stabilised and rushed to the Computerised
Tomography (CT) scanner and the Magnetic Resonance Imaging (MRI)
scanner.
Radiologists and surgeons review the images generated and then they
wait. The next stage in this patient’s treatment has begun.
The images garnered from the scanners are converted into a digital
file, and using a 3 dimensional (3D) modelling programme, the
software slices the digital model into thousands of horizontal layers.
A 3D printer reads every slice, printing the model, layer by layer,
whilst blending them with no visible sign of layering. A 3D prototype
is built, which in this case is a scale model of the patient’s pelvis and
lower limbs.1,2 The orthopaedic surgeons hold the physical model
in their hands and pull it apart, analysing the fracture configuration
and surrounding soft tissue for the optimum internervous approach.
They pause to ruminate over the plethora of materials available before
utilising a 3D printer with laser sintering capability to build patient
specific guides, jigs and implants.3 Through tactile feedback, they
improve their dexterity and ensure a stable fixation.
Decisions that were once intra-operative are minimised thereby
minimising the waste and cost of inappropriate operative materials by
getting it right first time. There is no need to open multiple packets
of pre-sealed prostheses as sizing has already been determined on the
3D models.3 The orthopaedic surgeons go through the steps again on
multiple prototypes, actively perfecting their fixation.
The images of the patient’s remaining foot have been mirror-imaged
to create geometric data for the severed foot. A ‘bio-printer,’ fabricates
thousands of miniature channels that will form interconnected fibres,
serving as the mould for capillaries. This structure is covered with
cell-rich proteins, the bio-printed fibres are removed to leave behind a
network of capillaries lined with endothelial cells.4 Rapid prototyping
techniques are used to build a scaffold layer of interpenetrating porous
networks. The patient’s own cells, especially his muscle cells, are a
source of undifferentiated progenitor cells or “stem cells”. They are
able to differentiate into other cell lineages including osteoblasts,
adipocytes and chondrocytes, becoming fully functional mature cells.
These cells are deposited on the porous scaffold and an influx of
human growth factors and nutrients harvest growth. The end product
is a transplant ready, fully functioning replica of the patient’s limb,
unperturbed by the limitations of earlier graft techniques such as
availability, topography, shape restriction, inconsistency and defect
specific remodelling.5
The patient is prepped for theatre. The surgeons have honed their
skills and customised their implants. The patient is on the table. The
lead surgeon picks up the scalpel and begins.
Several weeks later, a class of junior surgeons are being taught, using
case based discussion, to learn about managing acetabular fractures.
The images of the trauma patient are used. The lead surgeon teaching
the class explains the mechanism of injury, the fracture pattern and the
operative management required. And then he hands out a 3D model of
the patient’s pelvis to each pupil. They can hold the model, discuss the
treatment and practice achieving a stable fixation themselves.6
Elsewhere in the hospital, the patient is being put through his paces by
the physiotherapist. He is making steady progress and counts himself
fortunate to be reaping the wonders of modern medicine.
The above narrative may seem like a vision firmly embedded in the
distant future. The truth is that the realisation that CT imaging could
be used to create 3D physical human models was first proposed
by Alberti in 1979.7 It was in this year that a polystyrene pelvis was
built to allow a customised implant be designed for a patient with
fibrosarcoma. Over the next thirty years, with the development
of new materials, these initial theories have progressed into an
industry that has revolutionised manufacturing and will change
the field of orthopaedics. 3D printing arguably has the potential
to reduce absolute surgical costs to the individual or institution by
minimising waste of surgical materials, increasing availability of specific
components, negating shipping costs with onsite manufacturing and
ensure healthcare in geographically challenging locations.8 The above
processes described in this patient’s journey are happening now in
laboratories across the world. 3D printing has a number of applications
in orthopaedics, from creating patient specific prosthesis, to reforming
the way this speciality is taught. This balance of technology and
medicine will enhance patient care, improve surgical outcomes and
provides innovative, exciting prospects for the future of orthopaedic
surgery.
1. Brown, GA,. Firoozbakhsh, K., DeCoster, TA., Reyna, JR, & Moneim, M.
Rapid prototyping: the future of trauma surgery? J Bone Joint Surg Am.
2003; 85(4): 49–55.
2. McGurk, M., Potamianos, P., Amis, AA., & Goodger, NM. Rapid prototyping
techniques for anatomical modelling in medicine. Ann R Coll Surg Engl.
1997; 79 (3): 169–174.
3. Frame, M., Leach, W. DIY 3D printing of custom orthopaedic implants: A
proof of concept study. Surg Technol Int. 2014;24:314-7.
4. Windisch, G., Salaberger, D., Rosmarin, W., Kastner, J., Exner, GU., Haldi-Brandle, V., & Anderhuber F. A model for clubfoot based on micro-CT
data. J Anat. 2007; 210 (6): 761–766.
5. Gibbs, D., Vaezi, M., Yang, S., Oreffo, R. Hope versus hypre: what can additive manufacturing realistically offer trauma and orthopaedic surgery?
Regenerative Medicine. 2014; 9(4), 535-549.
6. Bertassoni,LE., Cecconi, M., Manoharan, V., Nikkah, M., Jkortnaes, Cristino,
AL., Barabaschi, G., Demarchi ,D, Dokmaci MR, Yang Y, Khademhosseini A,
Hydrogel bioprinted microchannel networks for vascularization of tissue
engineering constructs. Lab Chip. 2014; 14(13): 2202-11
7. Alberti, C. Three-dimensional CT and structure models. Brit J Rad. 1980;
53: 261–262.
8. Frame, MC. DIY 3D printing of custom orthopaedic implants: the radial
head. Bone Joint J. 2013; 95(30): 62
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Healthy Living Sucks
Simon Fleming
I have been alive for longer than the written word. I have seen
empires rise and fall, humanity at its best and at its worst. It is with this
in mind that I can say, with virtually no hesitation, that the single worst
thing in human creation is...
... tofu.
I say this as a generalisation, of course, as I don’t want to be hunted
down by the Tofu Industry and hung (with hemp rope, I imagine).
I include in my grand sweeping statement all of that type of thing
- soya, quorn, nearly everything that is gluten free, low GI or lactoseintolerant friendly.
Let me give you some background, so I sound less like a vegiaphobe
and more like the rational chap I am. I was born at some point just
before 3300 BCE in what most people today would call Syria, the
academics would call Mesopotamia and what I, for the first nineteen
years of my life, called home. It was at about nineteen years into my
existence when I died. This was not as shocking as you might think,
as to be fair, if you lived past twenty-five in those days, you were
considered a wizened old man and ready for your SAGA holiday (had
such things existed). The biggest issue was that about three days after
my death, I woke up again. Which I can assure you was as big a shock
to me as it was to my wife and family.
Sadly this wasn’t a Jesus-thing or a zombie thing, or even a ‘whoops
you weren’t actually dead thing’. You see, this was, and you must
take my word for it here, a vampire thing. Turns out, the ‘ravenous
beast’ that had torn a bloody furrow through my neck and left me
to bleed out on the dry desert floor was, in fact, one of the living
dead. No glittery angst for me. Just searing pain and then an abyss of
nothingness, followed by the sudden realisation that I was staring at
the stars I’d known my whole life. It was with a sense of joy and elation
that I sprinted back to our little settlement to announce my return. My
arrival was not treated with fanfare and sweet fruits and wines though.
It was more of a “spears and lynching” affair. Long story short, I
managed to get away and you’ve all read and seen enough vampire tat
to know the rest. The thirst hit me like a tidal wave. An irresistible urge
to rend and tear and drink and feed. So I did.
Over the years, as you might imagine, I developed certain tastes. I
prefer to feed from men for example. The best way to explain it is that
women taste like the richest haute cuisine, whereas men are lasagne.
Or maybe spag bol. Y’know, comforting. I can use these references
because I can still eat normal food, it just does nothing for me, either
nutritionally or to slake the thirst that’s always with me. Similarly, I find
that people from different cultures taste differently. It’s a truth that
those from India taste of spice and heat and warm, long days. Those
from Eastern Europe taste of pickling salts and warm broths; a blood
that sings of goulash and snow.
Americans taste of bacon. Figures.
To return to my original premise, it all started with the popularity
of ‘dieting’ in the 19th century. Before then, fat was fabulous. Being
rotund meant you were one of life’s winners, a success. But in the
19th century people started trying to lose weight, trying to live right. I
noticed it as a fad, but nothing more. It was only when healthy eating
became a real ‘thing’ that I sat up and took notice. There had always
been vegetarians and the like in the world but I’d simply not minded.
Cultures based on that had built an entire food repertoire that ignored
meat and it was just dandy.
The problem was, when people started depriving themselves of all the
good things in life. Like butter. And fat. And sugar. And red meat.
Suddenly I noticed people started tasting bland, like an epicurean
white noise. I live in a trendy part of town and for the last few years,
I’ve had to avoid eating anyone who lives within walking distance of a
health food shop.
I do get it though. As an immortal, I can’t say I’m concerned with my
cholesterol or trans-fats, but I can see why people might be. I just don’t
understand a life where one deprives oneself of one of the simplest of
life’s pleasures, a delicious meal.
It’s an interesting phenomenon, healthy eating. I don’t suggest that
I’m an expert, as I pretty much exclusively eat people, but I existed for
5000 years before microwaves so I reckon I can still offer an informed
opinion. Here’s my theory; People seem to think that healthy eating
means exclusion. Means suffering. Means less. Means… deprivation.
I’m simply not so sure. I think that people do best when they have
everything in moderation, even moderation, which is one of many
things Oscar Wilde had right.
Instead of eating nothing but processed mock protein cooked in
pseudo-quasi-kinda oil, simply eat a balanced diet. Eat sweet and sour
and hot and spicy and rich and subtle and everything in-between. Fair
enough, if there’s a medical reason, a real reason, not “I read on the
internet that dairy causes acute blindness in left handed babies”, then
fine, leave whatever it is out. But otherwise, I think healthy eating
should just mean eating well. If you get fat, do some exercise and eat
slightly less. Don’t go on a fad diet and don’t suddenly decide that
crème fraiche can replace double cream. It can’t.
Eat everything in that little food pyramid, from the very top to the very
bottom. Just remember, at the very pinnacle of the pyramid is me and
to me, you’re just a burger with a debit card.
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The title for next years junior essay prize is...
How should we train
orthopaedic surgeons
in the UK
Limit: 2000 words • Open to all junior BOTA members • Cash prize
File: 212017-15ASIT Uni of Oxford
Ad size: A4 1/2L (185mm wide x 130mm high)
• Deadline: 1st November 2015
MSc in Surgical Science and Practice
The University of Oxford invites applications for its MSc in Surgical
Science and Practice, commencing in October 2016.
Developed jointly by the Nuffield Department of Surgical
Sciences and the Department for Continuing Education, this is an
internationally recognised postgraduate taught course dealing with
vital areas of surgical training. It attracts the future leaders of the
profession and provides broad-based postgraduate training that will
allow participants to develop their careers in a number of different
directions.
This part-time course is designed to be completed in two to three
years by full-time surgical trainees. Six modules cover:
• Becoming a Medical Educator
• Human Factors, Teamwork and Communication
• Introduction to Surgical Management and Leadership
• The Practice of Evidence-Based Health Care
• Quality Improvement Science and Systems Analysis
• Surgical Technology and Robotics
Each module includes access to online
resources, as well as one week of intensive
teaching in Oxford. In addition, participants
produce a dissertation which may be based
on a work-related project.
Each module may also be studied as a short
course.
For further details of entry requirements and how to apply see our website: www.conted.ox.ac.uk/ssp or email:
[email protected], telephone: + 44 (0)1865 286954
212017-15ASIT Uni of Oxford.indd 1
30/01/2015 10:40
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Kenya Orthopaedic Project BOTA/Herus Travelling Fellowship
Nathaneal Ahearn
Despite having a mother born in Luanda who
was raised in Kinshasa until her teenage years
ended, I can count on one hand the number
of times I have been to Africa. It was therefore
with a mixture of excitement and trepidation
that I approached the trip to Kenya as part
of the MEAK team, having successfully been
awarded a BOTA traveling fellowship, as part
of the Kenya Orthopaedic Project. There were
some issues surrounding even getting out
to Africa, with the Ebola crisis reaching its
pinnacle and the cancellation of all medical
practitioners leave from Derriford Hospital, a
group who originally would have contributed
a large number of the travelling party. We
were individually offered the chance to
postpone the trip, but having calculated that
Nairobi was as far from the Ebola epicentre in
Sierra Leone as Bristol, I felt it was probably
safe for me to travel.
I met the rest of the travelling party
(consisting of consultant anaesthetists, a
consultant orthopaedic surgeon, a full scrub
team, physiotherapists and an administrator)
at Heathrow Terminal 4 and we embarked on
the flight to Nairobi. Upon landing the smell
of recent rain in the air greeted our arrival.
We piled our luggage onto the minibus,
our driver balancing them precariously on
the roof, and travelled to Nyahururu. The
town lies in the Rift Valley, around 100 miles
northwest of Nairobi, and due to its elevation
is frequented by marathon runners for
endurance training due to its high altitude
(around 2300m according to Strava!). We were
staying at the Thompson Falls Lodge, arguably
the most luxurious accommodation in the
town, built on the site of the Thompson Falls
waterfall from which the town originally got
its name. The 75m high waterfall provided a
picture postcard backdrop for our stay.
After a day of travelling we made our
way to a welcome lunch at the local NHS
equivalent hospital. It was built in 1928,
and serves a local population of around 350
000 people, with 150 inpatient beds. It has
on-site maternity, paediatrics, and surgery/
medicine, with two operating theatres and a
single consultant general surgeon covering
the spectrum of all surgical specialties. Our
first full day in Kenya was spent in a massive
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eight-hour clinic. Patients had travelled from
miles around, the majority new patients, keen
to experience the westerners in their midst.
Between the two surgeons and two GPs of the
MEAK team we saw and triaged 186 patients.
The vast majority were patients who could be
managed conservatively and would benefit
from the specialist physiotherapy input. We
saw a multitude of differing pathologies: knee
pain secondary to osteoarthritis in a 147 kg
man (obesity is a problem in Africa too!),
chronic shoulder/elbow dislocations around
6 months old, congenital contractures, an
ACL rupture in an army recruit, a 7 year old
boy with ‘lump’ in his shoulder that was a
clavicle fracture, a pathological hip fracture
in a patient with HIV, a mal-union of a distal
tibia, and a paediatric femoral non-union who
had been left with no treatment as a small
snapshot. The clinic consultations were run
with a local nurse and also an anaesthetist.
This was a new way of working for me, with
the decision to operate made by a surgical
and anaesthetic assessment performed
simultaneously. The clinic would not have
worked without the local team being able to
translate not only language but the constraints
of the local system.
At the end of clinic there was a chance to
visit the ward. This is where we were able to
meet the in-patients who the local surgeons
had decided our expertise was required for.
They had brought in cases specifically as
they knew we were coming with equipment
and skills not available locally. There was a
patellar fracture, a native hip dislocation, and
a 6-week-old intracapsular neck of femur
fracture. There was also acute trauma with a
panga machete flexor tendon injury following
‘mob justice’, and an open tibial fracture that
had presented the day of our arrival, having
had the most basic of washouts on the ward
as the only treatment (a far cry from BOAST
4!). By the end of the day we had identified
a potential 35 patients who would benefit
from operative intervention. The evening was
spent prioritising those in terms of clinical
need and available kit. The vast majority of
patients seen, however, would benefit from
the daily physiotherapy clinics taking place in
the hospital gym.
The aim of our visit was not just service
provision. The charity aims to provide not only
medical, but also educational aid to Kenya.
The big educational topic we brought to the
local hospital team was the introduction of the
WHO checklist. Every morning in theatre the
days operating was discussed and planned with
the whole theatre team. Before every case the
now routine stops to check patient identify
and procedure were performed, which were
completely new practices for the local team. It
was interesting to witness how over the course
of the week the initially sceptical theatre
staff really took on board these simple safety
measures, and the theatre sister has decided to
implement these procedures into routine daily
practice in the theatre complex.
The theatre complex has no laminar flow,
no image intensifier and unfortunately on
our first day had no electricity or running
water either, despite the hospital water tower
overflowing from the torrential downpour the
day before! The situation was readily fixed,
and at 0915 we sent for the first patient, with
knife to skin at 0945 - a relatively prompt start
for a NHS hospital! In total we performed
5 procedures in our first day of operating,
which was pretty good going considering the
circumstances. Over the course of the next 4
days we completed a total of 23 operations.
These ranged from 6-month-old femur nonunion ORIF in a 9 year old, to multiple flexor
tendon repairs following a Panga attack, and
tension band wiring of a 4 week old patellar
fracture. We had the opportunity to use
intramedullary nails, the SIGN nail that can
be used without fluoroscopic guidance being
fully jig locked, and this was the first time the
local surgical team had seen such devices. The
patients would normally have to pay for every
part of their operation - from the anaesthetic
agents and antibiotics, to every screw and
plate used intraoperatively, to crutches or
plaster casts used for rehabilitation. This is
seen with the care patients guard their own
X-rays, and the gratitude shown to us for
being able to provide even relatively simple
care.
The way the trip was organised really
developed an ethos of teamwork and
collegiality. Every meal was spent together,
the theatre team walked to and from work
together, and following a daily pre-dinner
debrief countless hours were spent discussing
issues over a Tusker beer in the evening.
There was also the chance to impart skill and
knowledge to the local operating surgeons.
The FY1 surgery equivalent was performing
around 150 operations per month in her 1
in 2 oncall rota, albeit mostly drainage of
abscesses and Caesarean sections. It was an
opportunity to show them basic principles of
orthopaedic fixation and new kit - they were
particularly impressed with the intramedullary
nails!
The trip wasn’t all work though, and we
had the opportunity to experience a truly
fantastic safari in the Abedare national park. I
doubt I will ever see a Leopard posing 3 feet
away ever again! The opportunity to visit the
luxury surroundings of ‘The Ark’ was in stark
contrast to the walk around the markets of
Nyahururu.
If you want to experience a challenging
way of working, in a foreign environment,
with people you’ve never met before, the
experience is absolutely fantastic! I cannot
recommend it highly enough. You have to be
prepared to challenge conventional wisdom
and be creative in improvising solutions.
What have I learnt from this experience?
The first thing was learning how to work
effectively and safely, whilst being outside of
my comfort zone. However bad we may think
our NHS hospital existence is, it is actually
pretty good. The luxury of having image
intensifier views in theatre, the ability to have
two working theatre lights, the simple fact of
always having a scrub nurse operating with
us and an unlimited supply of antibiotics and
plastering material, we just take for granted.
Not anymore! I have learnt that despite these
challenges you can still help patients and
the second key thing I will take from the trip
is the importance of teamwork to optimise
patient care. Experiencing a different way of
working, with new colleagues you have only
recently met, whereby you are limited in
your ability to provide your routine working
practice relies on good communication and
leadership. The final thing I will take away
from the trip is the fact that no matter how
hard we try, unfortunately we cannot help
everyone. We had to turn people away and
were limited in the surgery we were able to
perform. This was challenging as there is
clearly an immense amount of work to be
done, much more than a single trip could
ever possibly do. The aim though is to
hopefully provide a basis for future trips with
the aim of enabling the local surgical team to
perform procedures themselves. It would be
great for me personally to re-visit Nyahururu
in the not too distant future and hopefully
see the impact of the trip by following up the
patients seen and operated on.
Overall I had an awesome time and am
keen to go back again, but I cannot end any
account of the Kenya Orthopaedic Project
without saying a big thanks to the rest of
the team and in particular Ellie Gregory. It is
their hard work and dedication that makes
it possible for us to experience these life
changing trips to Kenya.
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95
From the Ground up: Perspectives of Global Surgery in Malawi
and the World Health Organisation
Zahra Jaffry
The Beit Cure International Hospital in Malawi is a sanctuary in the
middle of a busy industrial city. Before it was built in 2002, there were
no orthopaedic surgeons in the entire country and now over 1000
operations are performed at the specialist centre annually. Originally
set up by surgeons from the United Kingdom and United States, the
hospital sees patients from as far as Mozambique while adhering to the
principle that “Adults pay a fee so children can walk free”. Sustainability
of the hospital is also aspired to through training programmes for
surgeons, clinical officers and medical students. My four weeks were
spent attending ward rounds, clinics and theatres. The warm and
welcoming environment resulted in an abundance of opportunities to
learn.
On a single ward round, the conditions seen ranged from limb
deformities to burn contractures. Mothers carried their children to the
hospital on their backs in the hope of not just a cure for their child’s
disability but for a life of independence, free of stigmatisation. The
physiotherapists ran a clubfoot clinic once a week where they would
carry out the Ponseti treatment for those with clubfoot under the age
of two. This was a relatively simple plastering procedure compared
to what was needed for older children. Older children with neglected
The Paediatric Ward
Theatre
clubfeet would be wheelchair-bound for many weeks while external
fixators were slowly adjusted to correct the position of the foot. Even
so, this would not stop play time. The ward was a lively place and there
was always time to get to know everyone.
The theatres were like any you would find in the UK. During my time
there, I never noticed a shortage of any supplies, though, the very
occasional power cut was a little unnerving till the generator kicked
in. I had a chance to scrub in and assist in osteotomies for varus
and valgus deformities including a double osteotomy for Blount’s
disease, which has been one of the most incredible operations I’ve
seen. Sequestrectomy and hip capsule biopsy for cases of suspected
tuberculosis were other common procedures carried out. Even in the
face of high case loads, surgeons would take the time to teach me
about the conditions from presentation to management. I found that
trying to learn this from patients and their notes was rather difficult as
many parents were unable to remember details such as onset or even
dates of birth.
It wasn’t long before I realised that perhaps the hospital wasn’t
representative of the health care received by most of the population
so I asked to visit a government hospital nearby. The difference was
noticeable immediately and was by far the greatest in theatre. It
was crowded. I had to take my own scrubs over and in hindsight I
shouldn’t have been surprised. There was no mobile X-Ray machine
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in the entire hospital, the drill was a Black & Decker make wrapped
in a surgical drape and often equipment wasn’t available meaning
the surgeons had to adapt on the spot. Above all, there was very little
communication with the patient. A few of the operations were dealing
with complications that had resulted from treatment received at a
district hospital. It was definitely a visit I will always remember and it
was this that motivated my work in the second half of my elective.
Dr Meena Cherian started the Global Initiative for Emergency and
Essential Surgical Care (GIESSC) at the World Health Organisation
in 2005. This global forum has members from 114 countries working
towards reducing death and disability from injuries, pregnancy-related
complications, congenital anomalies, disasters, and other surgical
conditions in low-and middle-income countries. As an intern working
with Dr Cherian in the midst of the Ebola outbreak I was able to see
the way the WHO responded in a crisis situation as well as the day to
day running of a single department. After my time in Malawi, I was
interested to learn more about how strategies for safe and high quality
surgery could be made into policies that could then be implemented
in hospitals in even the most rural areas. The Situational Analysis
Tool (SAT) has already
been widely distributed to
create databases containing
information on the
infrastructure of hospitals
and surgical care received
in various countries around
the world. My role was to
invite more members to
join GIEESC and expand
this database by asking
more people to fill in the
SAT. This data is invaluable
in advocating for the
cause. The figure for the
burden of disease in Africa is 24%, while it has only 3% of the world’s
health workers. I therefore focused on task sharing with traditionally
non-surgical members of the health workforce as a solution to the
problem. Without information on current surgical competencies
of general practitioners, clinical officers, nurses and midwives it is
difficult to create standards that can be implemented later on. For the
remainder of my time at the WHO I collected this information.
Overall, in Malawi, I was able to broaden my knowledge of certain
diseases and the impact of disease in different cultures. More
importantly however, I was able to see first-hand the problems with
access to safe and good quality surgical care and how successful
projects such as the Beit Cure International Hospital can be. I then saw
the process on a much larger scale at the WHO. This will be invaluable
not only as an aspiring orthopaedic surgeon but as a member of the
emerging field of global surgery. I hope that one day I will be able to
make a contribution similar to those that have inspired my elective
placements.
I would like to take this opportunity to thank Professor Justin Cobb,
Professor Chris Lavy, Dr Nicholas Lubega, Dr Linda Chokotho, Dr
Meena Cherian, Ms Mwanza Nkowane, Ms Teena Kunjumen, Mr James
Campbell, Mr Andy Leather and of course the British Orthopaedic
Trainees Association for their support throughout this unforgettable
experience.
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BOTA elective report in paediatric orthopaedics
in Canada and the USA
Alexander Schade
Academic Foundation Doctor
Royal Stoke University Hospital
Why did I choose these locations?
I have been interested in Trauma and Orthopaedics for a long time
and elected to do two paediatric orthopaedic placements, each of four
weeks duration: first at The Hospital for Sick Children (SickKids) in
Toronto, followed by the Cedars-Sinai Medical Center in Los Angeles. I
wanted to compare the orthopaedic surgery I had observed in the UK
and low-income countries to that of North America. Both hospitals I
attended are well established and respected centres of excellence both
for their breadth of academic research, and clinical management of
musculoskeletal disorders.
I) The Hospital for Sick Children, Toronto, Canada
Clinical case of femoral mal-union and rotational osteotomy
3) Clinical Cases
Some pathology was similar to that of the UK, but due to the nature of
a tertiary centre I was also exposed to more unusual cases.
Downtown Toronto from Leslie Spit peninsula
SickKids Learning and
Research Building
1) Introduction
Established in 1875, The Hospital for Sick Children (SickKids) was
the first paediatric hospital in Canada and is now one of the world’s
top children’s hospitals. It has 370 beds, 768 physicians, 16 operating
rooms (two of which are dedicated orthopaedic rooms) and four
image guided therapy suites. The orthopaedic clinic is the third
busiest in the hospital with 16,000 visits in 2009-2010. There are 11
orthopaedic consultants, each with an area of special interest.
2) My experience
My mornings would start at 6.30am with the residents meeting on
the ward; we would discuss the cases admitted over night and review
the radiographs. The residents were very welcoming and it was an
important part of my experience to follow the patient’s journey from
the ward to surgery.
At 7am, there would be a team meeting, which would be an
opportunity to listen to each surgeon present their evidence and plan
the challenging cases. This varied from pre-operative or post-operative
ward rounds, to audits about how we could improve the delivery of
care.
During one of the routine follow-up general orthopaedic cases, I saw
an 11-year-old female who first presented in 2013 with a femoral malunion secondary to trauma/infection sustained at the age of 2 years old
in Somalia. She had an apex anterior and external rotation deformity.
She was treated with an osteotomy and Talo-Spatial frame correction.
I followed her up in clinic 3 weeks post surgery with very good early
functional results (see picture 3).
I was particularly interested in some of the tumour pathology that
I hadn’t seen in the United Kingdom. Most memorably, I assisted in
a resection of a proximal femoral benign fibrous Histiocytoma. The
case lasted for 10 hours, three hours of which were spent dissecting
out the vessels and nerve. The original plan was to dissect the medial
circumflex artery, perform a fibular graft and anastomose the fibular
vessels. Unfortunately, the vessels were completely obliterated by
the tumour and required en bloc resection. I particularly enjoyed the
tumour operations as the careful dissections revealed spectacular
anatomy, an important skill to master for any surgeon in training.
4) Lessons and benefits
This elective greatly improved my communication skills. This can be
particularly challenging in a paediatric population. A lot of effort was
made to make the environment child friendly and all the staff were
specialists in dealing with children. I learnt to adapt my consultation
skills to a specific age and person. In particular during sports medicine
clinic, I found it particularly successful to discuss the adolescents
interests in sports teams, to help build a rapid rapport.
II) Cedar-Sinai Medical Center, Los Angeles, USA
At 8am, I was given the timetables of each surgeon and allowed
free reign to choose sessions likely to provide the most educational
benefit. I elected to spend time with each surgeon to gather a general
understanding of each sub-speciality such as DDH, club foot, brachial
plexus injury, adolescent sport injury, bone tumours, spina bifida and
general orthopaedics.
Los Angeles view from Runyon Canyon
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Mark Goodson
Orthopaedic Centre at
Cedars-Sinai
1) Introduction
4) Benefits and lessons learnt
Cedars-Sinai was founded in 1902 and has evolved to become one
of the largest non-profit hospitals in the western United States.
Specifically, the orthopaedic programme was named as one of the top
in the country by U.S. News & World Report’s 2010-11 “Best Hospitals”
issue –the programme ranked No. 22 in the widely respected survey
of almost 5,000 medical centers. It has 866 beds, over 2,000 physicians
and over 10,000 workers in every clinical speciality.
During this elective, I got the opportunity to see rare conditions
that taught me a more holistic approach to the patients and the
multidisciplinary approach necessary to rare syndromes.
2) My Experience
My time was mainly split between paediatric orthopaedics, arthroscopy
clinics, sports medicine and hand clinic.
A surgeon I was shadowing had high-level managerial roles and as
a result I learned a lot about team management. One of the key
messages he emphasised was the importance of appreciating the work
of your employees. He advocated a zero toleration policy to rudeness
and aggression from patients, employed excellent team leadership
skills and was very well respected by his peers.
I was most impressed about the doctor-patient relationship in
the United States. The atmosphere was positive, the staff were
friendly and, during consultations, managed to create an immediate
connection with their patients. After briefly reading the patient’s notes,
the consultation would shift to addressing the patient’s concerns and
expectations.
3) Clinical cases
The surgeon I was shadowing was known for treating rare skeletal
dysplasia and I was lucky to observe some rare syndromes that I have
never seen or heard of before.
During one clinic, I was called to see a patient with Kniest syndrome;
a type of rare collagenopathy characterised by dwarfism, enlarged
joints and other skeletal abnormalities. The patient was well known
to the department and had been treated for spinal deformities as an
infant. In her early 30’s she was referred back for consideration for
arthroplasty due to gross hip deformity. The patient was so grateful
and impressed with her childhood spinal surgery that she requested
her hip arthropalsty to be performed by the same surgeon.
During a routine clinic, I saw a child with Desbuquois syndrome; a rare
autosomal recessive osteochondrodysplasia characterised by severe
micromelic dwarfism, facial dysmorphism, joint laxity with multiple
dislocations, vertebral and metaphyseal abnormalities and advanced
carpotarsal ossification. Diagnosis relies upon recognition of clinical
and radiological features and I was lucky to observe some of these
including advanced carpal and tarsal bone age, broad femoral neck
with a spur-like projection and prominent lesser trochanter, producing
characteristic ‘’monkey wrench’’ (Swedish key) appearance.
In the USA, they are very strict regulations around the presence of
medical students as observers and this usually involves a mountain of
paperwork and fees. Unfortunately, I was authorised to attend theatre
as an observer only and I was not able to scrub which was made
learning from certain cases challenging. Therefore, I found it more
valuable to attend clinics and teaching where people where more
receptive to the presence of a medical student.
II) General conclusions
Overall, I am very grateful to BOTA for contributing to my very valuable
and enjoyable elective. At SickKids and Cedars-Sinai, I was exposed to
less common conditions that I have not yet seen in my musculoskeletal
training, such as rare bone tumours and syndromes involving spinal
deformity. The management of musculoskeletal disease differed from
that of the NHS, with its availability of vast specialised equipment and
facilities. Working within a multi-disciplinary team structure alongside
surgeons, rheumatologists, radiologists and physiotherapists, I was
able improve my understanding of the impact and responsibility of
each speciality involved in these diseases as well as benefit from their
teaching.
“Working in a large hospital with
many different specialities has helped
me develop my communication skills
between different teams in order to
improve coordination of patient care.”
In outpatient clinics, I learnt a lot about self-management. Observing
clinicians educate parents and children about their responsibility in
the recovery will help me to engage, actively participate and empower
patients in their treatment. This has given me a better understanding
of the perseverance required with physiotherapy when advising
patients later in my career. Working in a large hospital with many
different specialities has helped me develop my communication skills
between different teams in order to improve coordination of patient
care and thus create a better patient centred and holistic approach to
the patient’s experience.
Another patient had Goldenhar syndrome which is a rare congenital
defect characterised by incomplete development of the ear, nose,
soft palate, lip and mandible. The patient presented in orthopaedic
clinic because it is commonly associated with scoliosis. Observing
the treatment of patients with life-long conditions, I gained an
understanding of the challenges and holistic needs of chronic
conditions.
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BOTA/IOSUK Travelling Fellowship
This year has been a year when BOTA has made giant strides in
building bridges with like-minded organisations, BOTA- IOSUK
Travelling Fellowship has been a result of one such partnership. BOTA
was only glad to accept an offer from Mr Vikas Khanduja (IOSUK
President) and hit the ground running, advertising the travelling
fellowships to India on the new BOTA website and social media
platform @BOTA_UK & BOTA FB. Five excellent post-FRCS candidates
were interviewed by a panel consisting of four BOTA committee
members & Mr Amit Sinha (IOSUK Past President). I have to say it was
a learning experience for all of us sitting on the other side of the table
listening to these focused and dedicated trainees. All of the candidate’s
demonstrated insight and a clear plan outlining what they wanted
to gain from the fellowships, which included operative experience,
learning new treatment philosophies, and a quest to give something
back to society. After a tough round of discussion and debate,
ultimately three winners were selected: Damian Clark, Christian
Thakar & Amit Khotecha to undertake three fellowships of their
choice. Additional benefits include a sought after presentation at the
IOSUK annual meeting and fellowship report published in JOINT/BJJ.
We are convinced that Damian, Christian & Amit will prove excellent
ambassadors for BOTA in India. The BOTA- IOSUK partnership is here
to stay and blossom further.
“BOTA was only glad to accept an offer from Mr Vikas Khanduja and hit the ground
running, advertising the travelling fellowships to India on the new BOTA website and
social media platform.”
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Education and Training
The New FRCS
104
NOTTS108
How to survive ST3
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PanCeltic Meeting 2015
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103
The New FRCS
The Intercollegiate Examination in Trauma and Orthopaedic Surgery
Section 1
This article will look at Section 1 of the
Intercollegiate examination in Trauma and
Orthopaedics. It will describe how the
section is written, administered and used to
determine who will be allowed to proceed to
sit Section 2 (clinicals and vivas). If candidates
understand more about the nature of this
section of the exam they may be more relaxed
when they come to face it, and may therefore
perform better!
David Limb
Leader of the Section 1 writing group
Section 1 of the Intercollegiate Examination
in Trauma and Orthopaedics is the ‘written’
component, now actually computerbased testing sat at Pearson View centres
around the country to avoid the need for
candidates to travel and incur hotel costs.
It is designed to test knowledge across the
curriculum and, insofar as is possible, does
so using questions that require higher-order
thinking (rather than asking for a fact, it
looks for the application of knowledge to
solve problems, often clinical scenarios). An
ongoing development of the examination is
the progressive rewriting of questions in the
bank that are currently recorded as level 1
questions (factual knowledge) into higher
order questions. Exams are beginning to
contain more ‘harder’ questions but this does
not affect the standard to pass, as will be
decribed.
A characteristic of all Intercollegiate exams is
the extraordinary attention to ensuring the
consistency of standards from one diet to the
next, and one decade to the next. It is worth
looking at how the paper is compiled, marked
and decisions made about who passes and
fails.
Questions have come into the bank from
many sources, but always through the
question-writing committee. Prior to section
1 changing from short essays to ‘MCQ’ type
questions a committee of examiners was
put together tasked with writing ‘Single Best
Answer’ (SBA)and ‘Extended Matching Item’
(EMI) questions covering as much of the
curriculum as possible. All examiners were
likewise tasked, and successful candidates
were also asked to submit questions. It was
the job of the MCQ writing committee to
take proposed questions from all sources
and identify those that could be written into
a format consistent with best educational
practice before being placed into the question
bank. Later the questions in the bank were
coded to the curriculum so that the bank
could more easily be interrogated and, for
example, question writing could be focused to
address areas of relative deficiency.
If we look at the journey of a typical question
104
JOINT
now, from conception to regular use, we
would see the following. A question will
be proposed – lets say it is brought to the
question writing committee by a member who
had been asked at the previous meeting to
write an SBA on a specific curriculum topic
where a question was needed. The question
would be projected for the committee to
review and about half (in T&O at least)
will, after 15 minutes or so of debate, be
rejected. Otherwise the debate will continue
with numerous edits being made and, over
the course of typically up to an hour, the
question will be rewritten until it satisfies the
committee. The question is then coded and
banked as a new question. It is available for
selection into an exam but when it is used,
it is flagged as new and its performance
compared to established ‘superbank’
questions that have a track record of solid
performance. It is no exaggeration to say that
an A4 side of statistical data is produced on
the performance of each and every question
in every diet of the exam. Only if the new
question performs adequately will it count
towards the final mark of candidates in the
exam and be available for use in subsequent
diets. If its performance falls short it is
removed from the exam, does not affect the
final mark of any of the candidates, and it is
returned to the question writing committee
for review.
It is worth looking at the format of the
questions, and this is described in templates
that are freely available from the JCIE
website. SBA questions are exactly what the
name suggests. A question will be set and
the candidate has to choose the best from
5 possible answers. It is important to note
that this is not a ‘Single Correct Answer’
question but a ‘Single Best Answer’. In fact
all 5 possible answers could be ‘correct’
but candidates are asked which is the ‘Best’
answer given the information presented in
the stem. As questions are designed to test
higher order thinking, this may mean that
not all of the information needed is in the
stem – some of it may need to be judged from
your knowledge of the available evidence.
Questions about which some candidates
complain ‘There was more than one correct
answer’, ‘the question was ambiguous’ etc are
often the best performing questions on the
paper!
Questions are also written to avoid cues being
taken to allow guessing. There has been,
and continues, a huge amount of input from
Educational Psychologists at all stages in the
Intercollegiate exam. Suffice it to say that
there is no point in using some of the tricks
that can get you through poorly constructed
exams. For instance the order of possible
answer choices is simply alphanumeric.
The possible answer choices are adjusted
to be of similar length (in lesser exams the
possible answer that is longer or shorter than
the rest is the correct one!) and all possible
answers will be of the same nature (eg if being
asked about a diagnostic test the possible
answers will all be radiological investigations,
for example, rather than 4 radiological
investigations and one blood test). The
bottom line is that you should not try to
look for patterns or clues – if you want to
guess just guess. Its still worth it – there is no
negative marking so everyone will guess the
questions they can’t work out and get about
20% of them right.
The above also applies to EMI questions,
which lend themselves to clinical scenarios –
for example data is given on a patients history
and examination findings along with test
results and a diagnosis has to be chosen from
a list of 8 or more possibilities – the same
list is used for blocks of three EMI questions
with differing clinical scenarios. Again the
information provided may be incomplete
and what is needed is the most likely correct
response from the list when you combine the
information provided with your knowledge
of the evidence and clinical experience (just
like the decision making process that you
will have to undertake as a consultant, and
that has to be safe). A typical evolution of
an EMI question is that the first time it is
used in an exam it is flagged up as ‘too easy’.
It is removed from the exam, comes back
to the question writing committee, and a
debate takes place about what information
is essential and what is provided but could
differ in the real world without altering the
correct response. Information is stripped
out, the question returned to the exam
and its performance reviewed. Often it is a
better question but if the 2 were looked at
side by side the original would have looked
superficially to be preferable.
An exam is compiled by ‘random’ selection
of questions from the bank by a computer –
random in parentheses, as rules are followed.
The proportion of questions from each
coded section of the curriculum is the same
for all exams and each exam has blocks of
established well performing questions, new
questions and rewritten questions. Candidate
feedback after every exam always contains
self-cancelling comments eg ‘there were far
too many upper limb questions’ and ‘there
were far too many lower limb questions’
etc. The first draft, which contains a few
more questions than needed, is sent to
the chairman of the Examination Quality
Assessment (EQA) Group securely. His job
is to check that there is no duplication of
questions and that SBA and EMI questions
aren’t covering exactly the same material.
He will also check that, for example,
knee questions include the same trauma
component that a trauma question covers
when it deals with the knee. Similar and
overlapping questions are removed to bring
the papers down to the correct number
of questions while maintaining balance.
This second draft is then considered by a
convened EQA group meeting whose job
it is to go through the paper with a fine
toothcomb and pick up potential problems
that can be ironed out before the exam. Even
at this stage questions can be removed and
substituted. Even with several read-throughs
spelling mistakes and typo’s creep through,
some that even make the question impossible
to answer. Don’t worry – any rogue question
will not contribute to your final mark!
The exam itself is sat at Pearson View centres
simultaneously around the country in 3 diets
a year. The papers are automatically marked
and at this stage there is simply a raw mark
indicating how many correct responses
each candidate achieved. However, as noted
above, extensive data is collected on how
each and every question is answered. As an
example of the sort of data collected, the final
scores of candidates are ranked and divided
into quintiles. For each possible response
to each question data is generated on how
each quintile of candidates responded.
One measure of question reliability will be
to look at how it predicts the final result
of a candidate – a ‘good’ question will be
answered correctly by almost all of the
candidates who end up in the top 20% and
incorrectly by most candidates who end up
in the bottom 20%. All of this data is stored in
the bank with the questions and is available
when questions are reviewed. Facility refers
to how easy a question is – if 90% of all
candidates get a question right or wrong it is
too easy or too hard and is actually a useless
question. In fact, such questions are removed
from the exam and do not count toward
the final mark, but they are sent back to the
question writing committee. If the purpose of
the exam was to identify the best and worst
candidates in the country reliably, giving a
National rank, then these questions would be
vital. However the exam has to discriminate
reliably around a pass mark based on specialty
standards and by removing ‘too easy’ and ‘too
hard’ questions from the final consideration
the middle ground becomes ‘stretched out’
and separates candidates better around the
pass mark.
The crunch therefore is how do we set
the pass mark? It is not true to say that
there is any sort of regulation of the flow
of candidates through to the next stage by
manipulation of the pass mark. The mark for
eligibility to proceed (the correct term) is that
which would be obtained by the candidate
who just meets the standards required by the
specialty and the GMC, often loosely defined
as the day one consultant who has spent an
appropriate period of time revising for the
specialty exam. At all stages from allocation
of a candidate number before the exam is
sat through to signing the Standard Setting
outcome at which the eligibility to proceed is
defined, the candidate details are anonymous.
Indeed the examiners setting the eligibility to
proceed mark do not even know what marks
candidates have achieved. Let us consider
how a Standard Setting meeting runs.
Around 20-25 experienced examiners will
convene in Edinburgh. They will first be split
into 2 groups to look at some of the SBA
and EMI questions that have been flagged
statistically as possibly poor performers.
Some questions will already have been
removed automatically – for example all of
the questions that proved too easy or too
hard (usually new questions, as any question
previously used would have passed through
this hurdle already). The examiners will
review each question and decide whether
it is a fair question that should stay in the
exam, or is flawed and should be removed
and returned to the question writers. Typical
reasons for the latter would be ambiguity that
had not previously been recognized, new
evidence that has challenged the previously
decreed correct answer, or simply that the
answer in the bank is wrong. It is worth noting
that some very good questions end up being
flagged as having possible wrong answers yet
remain in the exam. If a question is hard so
that only 20% of candidates answer it correctly
then 80% will chose a wrong response.
Lets say 40% chose one of the incorrect
stems – this flags as a possible wrong answer
automatically, as more candidates have chosen
a specific incorrect response than the correct
one.
Once the poorly performing questions are
weeded out the examiners sit down with
the papers and consider each question
individually using an Anghof procedure.
Each examiner works independently and
considers every question in turn. The
essence of an Anghof procedure is that it
determines the difficulty of each question
individually. What the examiner is tasked
with doing is considering what proportion
of borderline candidates would answer each
question correctly. The examiners are not
told the answers – they do not need the
answer paper to recognize how a borderline
candidate will behave faced with a particular
question, each having had considerable
experience of borderline candidates both
in their roles as trainers and as examiners.
To simplify matters, if we consider that the
JOINT
105
whole exam had only 10 questions and all of
the examiners independently concluded that
6 of every 10 borderline candidates would
get each question correct then a pass mark
of 6 out of 10 (60%) would mean that 50% of
borderline candidates would pass and 50%
would fail. The pass mark therefore divides
the borderline candidates down the middle.
If the exam has a lot of hard questions the
pass mark will be lower. If there are a lot of
easy questions it will be higher. The mark is
unique to each diet. The Anghof-derived pass
mark is not the mark determining eligibility to
proceed, however. The GMC argue that there
is some uncertainty in judgements made in
this way, which can be expressed statistically
as the Standard Error of Measurement (SEM).
For patient safety reasons the GMC would not
want incompetent candidates being allowed
to proceed, even if removing them means
some potentially competent candidates are
prevented from doing so. The eligibility to
proceed mark is therefore the Anghof derived
mark plus one SEM. When this step was first
introduced the historical performance of
candidates scraping through was reviewed
and it was noted that they went on to fail
section 2, so this rule in fact saves some
candidates a whole lot of money!
Finally it should be noted that not only is
every question in every exam statistically
dissected, but so is each paper in each exam,
and each exam compared to all previous
exams. We thus have data on the reliability
of the examination including statistics such
as Kronbach alpha, which scales from minus
one to plus one. For high stakes professional
examinations such as the FRCS(Tr&Orth) the
standard to be aspired to is a Kronbach Alpha
of +0.8. Around the world few professional
examinations, particularly in medical
specialties, achieve this. Section 1 of the
FRCS(Tr&Orth) never drops below +0.9.
So what can be said to help candidates
tackle the exam? I would say that the best
preparation is doing the background reading
but applying it by solving problems in clinic
and theatre and questioning the boss about
how they make decisions throughout training
and especially as you approach the exam. It
doesn’t work without the background reading
bit. Don’t go in thinking you will be treated in
any way unfairly – you will be a number and
an enormous effort will be put into making
sure the decision made on your eligibility
to proceed is sound – even if the questions
seem ambiguous or incomplete. No-one
will know whether you have attempted it
before. Training programmes are designed
to deliver the curriculum for T&O, which is
what the Intercollegiate exam tests. For this
reason alone, the pass rate is much higher in
those on training programmes than in those
who are not. Good performing candidates
in UKITE are usually good performing
candidates in the FRCS(Tr&Orth) – the
huge effort related to Quality Assessment
and Standard Setting makes sure that when
pass/fail is decreed in the FRCS(Tr&Orth)
it is done so by a process that is sound by
the standards of the most rigorous external
review. That’s why its so expensive! Don’t
look for patterns in the answers. Don’t start
to panic if there seem to be a lot of hard
questions – if its true, the pass mark will be
lower or if the questions are very hard they
will be removed from consideration. A word
of caution about practice papers – examiners
are not allowed to write books about the
exam, so any published practice questions are
written by someone with no experience of the
FRCS(Tr&Orth) writing group. Questions in
the bank evolve from exam to exam – subtle
changes make big differences to the correct
answer. If you practice on a website and
think you recognize the question in an exam
be very careful indeed – there are a number
of question which, when used, generate
very interesting responses. Clearly there is a
correct answer that is agreed by all examiners
present but a whole cohort of otherwise
sensible people plump for the same incorrect
answer – now why are they doing that?
David Limb
Leader of the Section 1 writing group
FRCS
Trauma &
Orthopaedic
Surgery
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Non-technical skills for surgeons
Mrs Eleanor Robertson BMSc (hons) MBChB MRCS, LAT ST3 Plastic Surgery, Derriford Hospital, Plymouth [email protected]
Professor Jonathan Beard MB BS BSc ChM MEd FRCS Professor of Surgical Education, Royal College of Surgeons of England [email protected]
Acknowledgements to:
- Maria Bussey, Head of Intercollegiate Surgical Curriculum Programme (ISCP)
- Jeremy Brooks-Martin, Head of Professional Support, Professional Skills and Standards RCSEng
- Bill Allum, previous Chairman of the ISCP
Background
Categories (four)
Elements (3 per category)
The provision of safe and reliable healthcare is a great challenge of
modern medicine. Investigation in to patient morbidity and mortality
revealed an unacceptably high rate of iatrogenic harm ranging from
3-16%[1]. The root cause of these errors have been attributed to
errors in communication in 26 – 31% of healthcare incidents[2].
Attempts have been made to reduce the burden of harm through
introducing improvement interventions focusing on different parts of
the healthcare system. These interventions can be considered using
the systems engineering in patient safety model (SEIPS), where by the
healthcare system is split in to the component parts of: technology and
tools; people; environment; task and organisation[3]. Non-technical
skills assessments and interventions have been successfully applied
from the aviation industry to healthcare to improve the ‘people’ aspect
of the healthcare system[4-6]. Non-technical skills are the critical
cognitive and interpersonal skills that underpin surgeons’ technical
abilities[5]. The function of other system interventions, such as the
WHO surgical safety checklist, rely upon good team working for its
success, so it is possible to view this intervention as a prerequisite or
adjunct for subsequent improvement techniques[7].
Situational Awareneness
1. Gathering information
2. Understanding information
3. Projecting and anticipating future state
Non-Technical Skills for Surgeons (NOTSS)
Well-deployed non-technical skills primarily look to positively influence
the professional workings of team members by attributing specific
patterns of behaviour to specific scores, thereby resulting in a valid
observation assessment method. Aviation NOTECHS rating scales
were adapted and validated in the surgical setting. Since then, a raft
of whole team [8 9]and single discipline [10-13] rating scales have
been developed in order to describe current work patterns as well as
provide quantitative evidence of workplace improvement following
healthcare interventions[14 15]. The ISCP project (https://www.
iscp.ac.uk/static/help/NOTSS_for_the_Uninitiated.pdf) has recently
launched a new voluntary workplace assessment utilising NOTSS (nontechnical skills for surgeons) [16]. NOTSS splits observable behaviour
in to four descriptive categories: situational awareness; decision
making; communication and teamwork and leadership. Each of these
have three elements which give broad descriptions of both positive
and negative behaviour. (Table 1). Each of these elements are rated on
a five point scale: not demonstrated; poor (endangers patient safety),
marginal (cause for concern), acceptable (satisfactory) and good
(consistently high standard). The rating of NOTSS by trained observers
has been shown to be reliable in the clinical environment, with eight
or more assessments being found to give reliability in comparison with
independent assessors[12 17].
Decision Making
1. Considering options
2. Selecting and communicating options
3. Implementing and reviewing decisions
Communication and Teamwork 1. Exchanging information
2. Establishing a shared understanding
3. Co-ordinating team activities
Leadership
1. Setting and maintaining standards
2. Supporting others
3. Coping with pressure
Table 1 Categories and Elements of NOTSS rating system
The NOTSS assessments are accessible via ISCP under the ‘WBA’ tab.
Once the trainee feels ready to be assessed, the whole theatre team
should be made aware that they are the lead surgeon for the duration
of the assessment (i.e. one case to one list). The supervising senior
surgeon should permit the trainee to demonstrate their leadership
and decision making in all situations unless they are concerned about
the safety of the patient. The team should be encouraged to address
all questions to the trainee surgeon throughout the case. Feedback
should occur immediately after the assessment, utilising the NOTSS
framework. The trainee form (Figure 2) is completed by the trainee
and sent to the assessor for scoring and validation. Trainees are free
to select their raters from scrub practitioners, consultant anaesthetists
and surgeons. Prior to this the raters would have to register with ISCP
and then complete the NOTSS online training. A link is automatically
provided to this training which is hosted by the RCSEd. Once this has
been undertaken the raters can evaluate the trainee’s performance
using the online assessment form(Figure 3). The raters should be
encouraged to detail exemplar behaviour to aide the learning potential
of the evaluation.
Figure 2 Trainee NOTSS form
(https://www.iscp.ac.uk/static/help/step_by_step_guide_NOTSS_Trainees.pdf)
108
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Relevant organisations
- Clinical Human Factors Group: http://chfg.org/
- Chartered Institute of Ergonomics and Human Factors:
http://www.ergonomics.org.uk/
References
1. de Vries EN, Ramrattan MA, Smorenburg SM, et al. The incidence and nature
of in-hospital adverse events: a systematic review. Quality and Safety in Health
Care 2008;17(3):216-23
2. Riesenberg LA, Leitzsch J, Massucci JL, et al. Residents’ and attending
physicians’ handoffs: a systematic review of the literature. Academic medicine
: journal of the Association of American Medical Colleges 2009;84(12):1775-87
doi: 10.1097/ACM.0b013e3181bf51a6[published Online First: Epub Date]|.
3. Carayon P, Schoofs Hundt A, Karsh BT, et al. Work system design for patient
safety: the SEIPS model. Qual Saf Health Care 2006;15 Suppl 1:i50-8 doi: 15/
suppl_1/i50 [pii]
10.1136/qshc.2005.015842[published Online First: Epub Date]|.
4. Flin R, Martin L, Goeters K-M. Development of the NOTECHS (non - technical
skills) system for assessing pilots’ CRM skills. In: Harris D, Muir HC, eds.
Contemporary issues in human factors and aviation safety. Aldershot: Ashgate,
2005.
5. Yule S, Flin R, Paterson-Brown S, et al. Non-technical skills for surgeons in the
operating room: A review of the literature. Surgery 2006;139(2):140-49 doi:
http://dx.doi.org/10.1016/j.surg.2005.06.017[published Online First: Epub
Date]|.
Figure 3 Rater NOTSS form
(https://www.iscp.ac.uk/static/help/step_by_step_guide_NOTSS_Cons.pdf)
Summary
Good non-technical skills improves patient safety through optimisation
of theatre team performance. Training in non-technical skills aids
the surgical team in their readiness for procedures as well as in the
mitigation and recovery from un-planed events. Poor non-technical
skills, in particular rudeness, arrogance and undermining behaviour
have been shown to decrease the ability of the team to function at
their optimal level[18 19].
The routine use of NOTSS will improve the non-technical skills of
surgeons but they are only one member of the team. Use of the WHO
checklist and training of the whole theatre team in human factors are
the other essential components That are required to improve team
performance and patient safety in the operating theatre.
Tips on how to improve your non-technical skills:
- Pre-list briefing: raise your whole team’s situational awareness
- Involve your team in decisions: benefit from the shared knowledge
- Use NOTSS framework and consider your behaviour
- Ask your team to rate you at work using NOTSS
- Model yourself on someone you admire
- Attend a non-technical skills training course
Available online resources:
- NOTSS handbook:
https://www.iscp.ac.uk/static/help/NOTSS_Handbook_2012.pdf
- NOTSS in a box, RCSEd online learning:
https://www.rcsed.ac.uk/notss/
- eLPRAS (plastic surgery online learning):
http://portal.e-lfh.org.uk ‘02_01_02_02 Team Behaviour in the Operating Theatre’
6. Yule S, Flin R, Paterson-Brown S, et al. Development of a rating system for
surgeons’ non-technical skills. Medical Education 2006;40(11):1098-104 doi:
10.1111/j.1365-2929.2006.02610.x[published Online First: Epub Date]|.
7. Haynes AB, Weiser TG, Berry WR, et al. Changes in safety attitude and
relationship to decreased postoperative morbidity and mortality following
implementation of a checklist-based surgical safety intervention. BMJ Qual
Saf 2011;20(1):102-7 doi: 10.1136/bmjqs.2009.040022[published Online First:
Epub Date]|.
8. Mishra A, Catchpole K, McCulloch P. The Oxford NOTECHS System: reliability
and validity of a tool for measuring teamwork behaviour in the operating
theatre. Quality & safety in health care 2009;18(2):104-8 doi: 10.1136/
qshc.2007.024760[published Online First: Epub Date]|.
9. Robertson E, Hadi M, Morgan L, et al. Oxford NOTECHS II: A Modified
Theatre Team Non-Technical Skills Scoring System (vol 9, e90320, 2014). PloS
one 2014;9(6)
10. Hull L, Arora S, Kassab E, et al. Assessment of stress and teamwork
in the operating room: an exploratory study. The American Journal
of Surgery 2011;201(1):24-30 doi: http://dx.doi.org/10.1016/j.
amjsurg.2010.07.039[published Online First: Epub Date]|.
11. Fletcher G, Flin R, McGeorge P, et al. Anaesthetists’ Non‐Technical Skills
(ANTS): evaluation of a behavioural marker system†. British Journal of
Anaesthesia 2003;90(5):580-88 doi: 10.1093/bja/aeg112[published Online
First: Epub Date]|.
12. Crossley J, Marriott J, Purdie H, et al. Prospective observational study to
evaluate NOTSS (Non-Technical Skills for Surgeons) for assessing trainees’
non-technical performance in the operating theatre. British Journal of Surgery
2011;98(7):1010-20 doi: 10.1002/bjs.7478[published Online First: Epub
Date]|.
13. Mitchell L, Flin R, Yule S, et al. Evaluation of the SPLINTS system for
scrub practitioners’ non-technical skills. Proceedings of the Human
Factors and Ergonomics Society Annual Meeting 2011;55(1):690-94 doi:
10.1177/1071181311551143[published Online First: Epub Date]|.
14. McCulloch P, Rathbone J, Catchpole K. Interventions to improve teamwork
and communications among healthcare staff. British Journal of Surgery
2011;98(4):469-79
15. Catchpole KR, Dale TJ, Hirst DG, et al. A multicenter trial of aviation-style
training for surgical teams. J Patient Saf 2010;6(3):180-6 doi: 10.1097/
PTS.0b013e3181f100ea[published Online First: Epub Date]|.
16. Yule S, Flin R, Maran N, et al. Surgeons’ non-technical skills in the operating
room: reliability testing of the NOTSS behavior rating system. World journal of
surgery 2008;32(4):548-56
17. Beard JD, Marriott J, Purdie H, et al. Assessing the surgical skills of trainees in
the operating theatre: a prospective observational study of the methodology.
Health technology assessment (Winchester, England) 2011;15(1):i-xxi, 1-162
- Essentials of patient safety, Charles Vincent:
18. Porath CL, Pearson CM. The cost of bad behavior. Organizational Dynamics
2010;39(1):64-71
http://www1.imperial.ac.uk/resources/5D671B2E-1742-454E-9930-
19.
Porath CL, Erez A. Overlooked but not untouched: How rudeness reduces
ABE7E4178561/vincentessentialsofpatientsafety2012.pdf
onlookers’ performance on routine and creative tasks. Organizational
Behavior and Human Decision Processes 2009;109(1):29-44
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How to survive ST3 – A registrars perspective
James Shelton
Welcome new ST3s in Trauma & Orthopaedics!
Firstly, congratulations you should all be very proud. The bad news is
that the work does not stop now, it has only just begun, and there are
many more hurdles to overcome This article is designed to help you
get through your first year as an Orthopaedic Specialist Trainee.
Surviving your first year as a registrar is entirely achievable, but does
require organisation, enthusiasm and a drive to take advantage of the
learning opportunities on offer. The goal at the end of ST3 is to pass
your ARCP, to make a dent in the indicative numbers, and to have
learnt to be a safe colleague. We aim to tackle each of these topics in
turn.
The Annual Review of Competency and Progression (ARCP)
This yearly (and sometimes an interim review at 6 months in ST3)
assessment causes some anxiety to trainees, however it does not need
to, especially if you plan your year in advance. It will consist of a panel
of senior consultants including your Training Programme Director
(TPD), a representative from the Specialty Advisory Committee (SAC
Liaison member) (usually a senior consultant from another region for
quality control) and a number of other consultants from your region.
The name of this is fairly self-explanatory, however it is up to you to
evidence this in your Intercollegiate Surgical Curriculum Programme
Portfolio. It is important to remember that the ARCP panel want to
pass you, but they need the evidence to do so. Your deanery will
have an ARCP guide and checklist. Be sure to look at this now so that
you know what you need to have completed by your ARCP. We have
compiled a baseline of activities you should be aiming to complete by
the time of your ARCP in the table shown opposite.
Paying attention to the factors in the table will allow you to work
methodically towards this goal and should prevent any last minute
rush to complete forms etc. The panel wants to see evidence of
progression though the year, which includes timing of assessments.
Visit the JCST website where the CCT guidelines and waypoints for ST4
& ST6 can also be found as they help to show you what is required:
http://www.jcst.org/quality-assurance/cct-guidelines
Organisation is key in evidencing your activities. Get your initial
learning agreement signed off as soon as you come into a post, fill it
in in advance with your perceived educational needs and allow your
AES to see you are aware what you need to do. They may add a couple
of objectives but on the whole will be impressed by your reflection
on previous practice and identification of learning needs. Midpoint
learning agreement means a two month review so you can get your
final meeting signed off in plenty of time for your ARCP at four months.
This is a brief chat to ensure you are getting the experience you
require and making headway on an audit or two. Your final meeting
and AES report sign off should be completed before your ARCP which
is often a couple of months before you finish the job, for this you will
need your clinical supervisor report. Make sure you get your timing
right, as bunching of your meetings towards the end of your job may
be viewed negatively. Your AES may not be proactive in organising
these meetings so when you finish one meeting, stick the next in the
diary with them there and then.
Workplace Based Assessments (WBA’s) are the backbone of your
evidence as a clinician and surgeon. You are required to have a
minimum of forty per year and, in many deaneries, more (50 in Mersey
and above 80 in London), so make sure you know what your target is.
Again bunching can be seen negatively. I personally find that saving a
pre-populated assessment containing my views on how the procedure/
clinical encounter went then before/after clinic getting your consultant
a cup of tea or coffee, sitting them down in front of the computer and
making them read, add to and sign off my reflection works well to
110
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keep the WBAs going week after week. Lastly, there is the option to
link curriculum topics to your assessments, this is important as by the
end of your training you need a level 4 CBD on all critical conditions
and Level 4 in the SAC indicative numbers.
A minimum of one Multi Source Feedback (MSFs) is required per year
but I would recommend one per placement, particularly in first year
whilst your TPD is getting a feel for what you are like as a surgeon.
Again, get them signed off in plenty of time as it often takes time to get
all nine raters to complete the form. The MSF seems to be a popular
topic at ARCP, particularly if you have any negative feedback, so try and
get your AES to release them prior to the ARCP and add a reflective
piece in your journal if your have any negatives.
Personal development plans are your time to show the panel that you
know what your educational needs for the year are and how you are
going to address them. It is unacceptable to give vague platitudes and
general aspirations, here. It can be useful to use the acronym SMART
(Specific, Measurable, Attainable, Relevant and Time-bound). Make
sure you are humble and accept you are on the rotation to learn skills.
You are not the best (yet).
Evidence – this is your chance to show what you have been doing in
addition to going to work. Your deanery may have a list of suggested
courses to go on (ours recommend an arthroplasty and arthroscopy
course in ST3 for example) and it is here that you can evidence
your audit and research (be it complete or on-going). Record any
publications and your teaching activities. You do not have to provide
exhaustive reflection on each project but it is handy to have your audit
(one per six month job) and research (two first name author peer
reviewed publications) protocols documented in order to signpost
these to the panel “as evidenced on ISCP I have a research protocol”
etc. Documentation of your job plan is also important, this allows the
panel to estimate what they think your logbook should contain as the
number of lists, clinics etc. differs between jobs.
“Having a trainee is one of the major
differences between being an SAS
doctor and a consultant so you need
to be able to demonstrate evidence of
teaching activities, be it teaching medical
students, juniors, or even organising
or presenting at journal clubs.”
Teaching is becoming more and more important particularly when
applying for consultant jobs. Having a trainee is one of the major
differences between being an SAS doctor and a consultant so you need
to be able to demonstrate evidence of teaching activities, be it teaching
medical students, juniors, or even organising or presenting at journal
clubs. Make sure you get assessments through observation or teaching
assessment (OOT)
Clinical experience and operative skills
When I started ST3 last year, one of our senior registrars gave us some
lasting advice. “To operate on a patient is a privilege not a right.” If
you look after the patients on the wards, support your junior doctors,
nurses, theatre staff, allied health professionals, anaesthetic staff and
everyone else involved in the care of your consultant’s patients, this
means your consultant does not have to worry about his/her patients
being looked after well and can place his/her trust in you. Operative
Continued overleaf
ISCP-related
Essential
Learning Agreement
Personal Development Plan
Pay your JCST fee
Midpoint meeting (use this review to raise any concerns you have about
the post to your trainer in a constructive way. Don’t just complain, but
present them with solutions and get these down on ISCP).
Final meeting signed off
Clinical Supervisor report (usually as CS comments section if you have a
different CS to your AES)
WBAs
Critical
Condition CBDs
Audit
Research
GCP training
Teaching
AES report signed off
40x WBAs*. Spread these out. For some it is just a continuation of what they
did as Core Trainees. For others, it is a massive culture change. Whether you
agree with them or not, they are here and it is what the ARCP use to assess
your progress. Build these into your practice. Keep the ISCP window open
in fracture/elective clinics and fill in CBDs as/when you discuss a case with
the boss. At the end of each theatre case ask your boss for direct feedback
on the case then ask them if you could put these comments in a PBA
and send them to him/her. Log on to eLogbook to update your logbook,
and then log into ISCP to send the boss a PBA. Make sure you fill in that
reflective comments section - they look at those at ARCP!
MSF (at least 1/year)
There are 10 of these conditions (can be found in the topics section when
doing a CBD). 6 of them are spine-related, 4 are paediatrics or trauma
related. If you are on a spine/paeds job, make sure you do them all! Aim to
get over 75% done by end of ST4.
1 per year (need min of 6 over 6 years with 2x re-audits)
2x peer-reviewed publications in 6 years (I would recommend not worrying
too much about getting a publication in your first year but certainly start to
put in place projects that may yield one or two in the next few years).
T&O SAC have approved recruiting 5 patients into a surgical trial as
equivalent to publishing papers so make use of the opportunity if you are
at a centre that recruits into trials (even if not in T&O!). Evidence this (Trial
number for example) on your ISCP in the “Other” section.
Good Clinical Practice training is essential for anyone wishing to do any
form of research and is now essential for CCT. Get yours done early - its
actually quite useful. Most trusts do a short course for free. There are
several online ones that do not take long at all to complete. Make sure you
evidence completion in your ISCP.
Some LETBs employ a strict attendance at regional teaching. Find out
about yours from more senior trainees. Make sure you attend all the
sessions you can - you are paying for it with your study budget! It is also
a good opportunity to meet the TPD regularly if you need to and get to
know the other trainees. Building a social professional network is very
helpful for your next 6 years.
ATLS
Theatre
experience
Minimum of 300 cases in 12 months. If you do not achieve this, and
others in that post have, then it does not look good. Do not double and
triple code every case - that will not be looked upon favourably. If you are
struggling because of rota issues for example, raise this with your AES and
get him/her to make a record of that concern on ISCP.
Index Operating These are available on eLogbook, ISCP, and JCST websites. Beware that the
Procedures
SAC filter on eLogbook may not be accurate. Only STU, STS, and P count to
these. Only certain codes also count.
Desirable
Regular (up to 2-3) CS comments (especially if you had some
issues with lack of theatre or too many clinics on your rota.) Use
this as evidence that you have been proactive and tried to do
something about the issue (as evidenced by CS in a comment
on your ISCP)
Some LETBs require more (Mersey = 50, London = 80!). Check
with your LETB at the beginning of the year. ST4s may also be
helpful here.
Highly recommend 1 per job!
OOT (for any teaching you do if you get a consultant to
supervise)
Try to seek out bosses willing to have a discussion about a case
relating to one of these or even a simulated case and make a
dent in signing these off. Many ARCPs wont look at these, even
at ST8, meaning some trainees get caught out.
1x per job. You are a Registrar now, find a junior colleague who
is keen, help them register the audit and give them guidance
on how to collect the data you need after identifying the audit
standards. Easy! Gone are the days where you HAVE to sit in
front a set of notes trawling for the op notes for audit! Use www.
bone.ac.uk to see what other people are doing around the UK
and get involved in multi-centre audits (more impact!). Speak to
colleagues in the years above you who were at the same hospital
as you are at now and ask them what audit they did - re-audit
theirs and put both your names on it!
http://www.clinicaltrials.ed.ac.uk/LinkClick.
aspx?fileticket=CWpFUNDhLOc%3D&tabid=339
Use OOTs where you can. Teaching is important but it is not
directly looked at in many ARCPs. Don’t neglect your juniors. For
many FY doctors, T&O is a bogey job. Don’t make it that way for
them. Everyone can either be inspired by some good teaching
or even taught the basics to make YOUR life easier. Don’t restrict
yourself to junior doctors, think of the ENPs in ED - they are
usually crying out for more T&O teaching!
Chances are you have a valid ATLS certificate. Think about
when to recertify. It is also a good opportunity to get onto the
Instructors course, which looks good on the CV.
Do not worry too much about your numbers in the first few
months. The apprenticeship model is tricky these days with
EWTD meaning we have less face time with our trainers so they
can take a few months to build their trust in you. Over the 6
years it evens itself out but always keep an eye on your logbook
to make sure you are not falling behind. If you feel you are, meet
with your TPD, raise your concerns well in advance, and try to
arrange a high volume post for your next job.
Good split of Trauma / Elective operating (1:3).
Good mix of activity i.e. not just assisting or observing!
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“Be keen and enthusiastic. It doesn’t matter what area of orthopaedics you wish
to subspecialise in, being interested will get you more operating.”
opportunities will often be far more plentiful if you show these
additional skills outside the operating theatre.
Be aware that you are a very visible member of the team and people
you may not know who you are – so be nice! Be mindful that the
consultant body will know everything about you. They are in a
substantive position and have worked with the staff for many years.
Remember they will feedback to them if you are difficult but also
big you up if you are doing well! More importantly, when you are
sweating over an operation, chances are the scrub nurse with 20 years
experience will have seen the problem numerous times before. If you
are nice to them they will tell you how to get out of it, if you are not
they might just let you sweat!
Be keen and enthusiastic. It doesn’t matter what area of orthopaedics
you wish to subspecialise in, being interested will get you more
operating. We have a set number of primary procedures to get a
within our training (indicative numbers) and with limited training
opportunities thanks to EWTD, shift patterns and loss of team
structure: you need to maximise your operating throughout all six
years of your training. There is no resting on your laurels in ST3 getting
used to the job.
Your role in Patient Safety
You are now the senior surgeon in the hospital for Trauma &
Orthopaedics and yet, yesterday, you were the SHO on call. The
transition is tough and you need to find a balance between confidence
and attempting to manage things beyond your competency. Gone
are they days of being shamed for having to call the boss overnight,
the majority of whom would prefer a five minute phone call to an
uncomfortable day at the coroners court. If you find you are in a
scenario where you have “run out of talent”, then get some help.
Also remember that amongst the busy duties of on calls that careful
documentation is key. We are often extremely time pressured but
be sure to carefully document red flags and neurovascular status
(amongst other key findings), remembering that if it is not written in
the notes, by law you cannot easily prove it was done.
And finally ...
Enjoy it! – The step up from SHO to registrar is fantastic. It is the ageold cliché that you get out of it what you put in. Be proactive, plan
your year in advance, support the juniors and nurses, be kind to your
patients and make sure you know what is going on with all of them.
Do all these things, and you WILL survive ST3. Finally, remember, The
British Orthopaedic Trainees Association is behind you and wishes you
luck in your first year as a registrar!
BOA Instructional Course 2016
Saturday 9th - Sunday 10th January
Manchester Conference Centre
REGISTRATION NOW OPEN
www.boa.ac.uk/events/instructional-course
The British Orthopaedic Association’s Annual Instructional Course is a highlight of the BOA’s training and education calendar, bringing
together trauma and orthopaedic trainees at all stages of their postgraduate training, to prepare for their FRCS examination.
Places are extremely limited!
The 2015 course proved to be extremely popular so register early to guarantee your place for 2016!
The key focus of the 2016 Instructional Course will be on paediatrics and trauma,
and trainees will have the opportunity to gain up to 5 CBDs in the following areas:
• Neurovascular injuries
• Painful hip in a child
• Painful spine in a child
• Necrotising fasciitis
• Open fractures
Guest lectures include:
• Professor Andy Carr “The Orthopaedic Surgeon of the future:
Surgical Technician or Surgical Scientist, what can we learn from Astronauts”
• Miss Deborah Eastwood on Paediatric Orthopaedics
• Miss Leela Biant “Surgical management of articular cartilage defects”
Contact: [email protected]
112
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PanCeltic 2015: Dedicated BOTA Session
The last year has been a year of firsts for
BOTA Wales, undoubtedly due to its thriving
relations with the BOTA infrastructure. The
PanCeltic meeting, held every 3 years, saw
the introduction of a full BOTA session for
the first time. Mr Neil Price played a very
supportive role in bringing this to fruition.
There was an impressive menu for the
listeners, with Mr Pete Smitham (BOTA Past
President) delivering a passionate talk on
ShoT followed by Miss Judy Murray ( TOTY
Wales 2015) talking about the structure of
FRCS exams. The final act was delivered in
style by Lisa Hadfield- Law, talking about
the intricate system of Trainee & Trainer
symbiosis. This session was very well received
by both the PanCeltic Trainers & Trainees.
An all round excellent weekend and we look
forward to seeing you all at the next meeting.
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113
Dates for the Diary
National Meetings 2015/6
BOA Congress
www.boa.ac.uk
15-18 September (Liverpool)
BSSH (British Society for Surgery of the Hand)
www.bssh.ac.uk
15-16 October (London)
BOFAS (British Foot and Ankle Society)
ww.bofas.org.uk
11-13 November (Guildford)
BHS (British Hip Society)
www.britishhipsociety.com
26-27 November (Milan)
BOA Instructional Course
www.boa.ac.uk
9-10 January (Manchester)
OTS (Orthopaedic Trauma Society
www.orthopaedictrauma.org.uk
20-21 January (Warwick)
BSCOS (British Society for Children’s Orthopaedic Surgery)
www.bscos.org.uk
10-11 March (Stoke Mandeville)
BASK (British Association for Surgery of the Knee)
www.baskonline.com
30-31 March (Liverpool)
BASS (British Association of Spinal Surgeon)
www.spinsurgeons.ac.uk
6-8 April (Nottingham)
BLRS (British Limb Reconstruction Society)
www.blrs.org.uk
16-18 March (Liverpool)
AAOS
www.aaos.org
1-5 March (Orlando)
EFORT
www.efort.org
1-3 June (Geneva)
BOTA Educational Congress
www.bota.org.uk
16-19 June (Leicestershire)
BOTA Deadlines 2015/6
114
Junior Essay prize
1st November 2015
Cambridge Orthopaedic Writing Prize 2015
31st December 2015 (TBC)
Medical Student Elective Bursary
1st December 2015
BOTA ORUK Poster Prize
1st Feb 2016
TOTY 2016 Nominations
26th Feb 2016
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Training & Education for Orthopaedic Surgeons & ORP
2015-2016 COURSE LISTING
AOTrauma Courses for Surgeons
2015
AOTrauma Course – Hand Fixation
Leeds
5 – 7 October
INFORMATION
AOTrauma Course – Advanced Principles of Fracture Management Basingstoke
10 – 13 November
AOTrauma Course – Basic Principles of Fracture Management
16 – 19 November
Register
REGISTER YOUR INTEREST TO BE ALERTED TO UPCOMING
Basingstoke
2016
AOTrauma Course – Basic Principles of Fracture Management
Dublin
25 – 28 January
AOTrauma Course – Periprosthetic for Surgeons
Leeds
4 – 5 February
AOTrauma Course – Paediatric for Surgeons
TBC
10 –11 February
AOTrauma Course – Basic Principles of Fracture Management
Edinburgh
29 Feb – 3 March
AOTrauma Course – Shoulder & Elbow (cadaveric)
Newcastle
21 – 23 March
AOTrauma Course – Current Concepts (cadaveric)
Coventry
27 - 29 April
www.aotrauma.org
AOTrauma Course – Foot & Ankle (includes cadaveric)
Bristol
18 - 20 April
www.aocmf.org
AOTrauma Course – Wrist (cadaveric)
Coventry
8 – 9 June
AOTrauma Course – Basic Principles of Fracture Management
Leeds
COURSE REGISTRATION OPENINGS:
Full course information, listings and online registration for UK
and international courses can be found by visiting:
27 – 20 June
Or, for an overview of UK based courses, please visit:
AOTrauma Course – Advanced Principles of Fracture Management Leeds
28 June – 1 July
www.aouk.org
AOTrauma Course – Pelvic
London
5 – 7 September
AOTrauma Course – Hand Fixation
Leeds
3 – 5 October
AOTrauma Course – Advanced Principles of Fracture Management Basingstoke
8 – 11 November
AOTrauma Course – Basic Principles of Fracture Management
14 – 17 November
Basingstoke
AOTrauma Courses for Operating Room Personnel
If you have any enquiries do not hesitate to contact us:
2015
AOTrauma Course – Basic Principles of Fracture Management
Basingstoke
17 – 19 November
Dublin
26 – 28 January
AOTrauma Course – Advanced Principles of Fracture Management Leeds
29 June – 1 July
2016
AOTrauma Course – Basic Principles of Fracture Management
Contact
AOUK & Ireland
Tel: +44 1707 823300
Email: [email protected]
Web: www.aouk.org
AOCMF Courses for Surgeons
2016
AOCMF Course – Basic Principles in Cranio-maxillofacial Fixation
Leeds
4 – 5 May
Leeds
5 – 6 May
techniques
AOCMF Courses for Operating Room Personnel
2016
AOCMF Course – Basic Principles in Cranio-maxillofacial
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