Surgical Specialty Associations Research Articles

Tackling the COVID elective surgical backlog: Prioritising need, benefit or equality?

The National Health Service (NHS) in the UK is currently facing a significant waiting list backlog following the disruption of the COVID-19 pandemic, with millions of patients waiting for elective surgical procedures. Effective treatment prioritisation has been identified as a key element of addressing this backlog, with NHS England's delivery plan highlighting the importance of ensuring that those with ‘the clinically most urgent conditions are diagnosed and treated most rapidly’. Indeed, we describe how the current clinical guidance on prioritisation issued by The Federation of Surgical Specialty Associations serves this aim. However, whilst there are strong reasons to prioritise elective surgery in accordance with clinical need, we argue that it would be a mistake to assume that prioritisation in accordance with clinical need requires only a clinical or scientific judgement. The understanding of clinical need that we choose to employ in a prioritisation system will be grounded by some key ethical judgements. Moreover, we may also have to make trade-offs between addressing clinical need, safeguarding equality, and achieving other benefits. As the UK faces up to the backlog, it is important that surgical prioritisation guidelines enshrine a broad range of values that we believe ought to determine access to care in non-emergency circumstances. Our analysis suggests that the current approach to prioritisation is not a sufficiently nuanced way of balancing the different moral values that are operative in this context.

Gender representation amongst editorials boards in United Kingdom surgical specialty journals

Females remain under-represented in surgery in the United Kingdom and around the globe. Gender representation on journal editorial boards is one of the key metrics of gender representation within academic surgery. The aim of this study was to quantify gender representation within the editorial leadership of journals affiliated with UK surgical specialties. A web-based search for each of the UK surgical specialty associations was conducted, followed by identification of the endorsed journals for each one. As of August 2022, data on the gender of the editor-in-chief and other journal leadership positions, including associate, section, and deputy editors, were collated. Gender classification was completed using first-name recognition, verified by a web search using the name and institution provided. Managing editors without clinical backgrounds were excluded. Ten journals were identified for the following surgical specialties: General Surgery, Trauma and Orthopaedics, Neurosurgery, Cardiothoracic, Urology, Paediatric Surgery, Ear Nose and Throat, Oral and Maxillofacial, Plastic and Reconstructive Surgery, and Vascular Surgery. In total, 242 editorial positions were identified: 207 were held by males (82.8%) and 35 by females (17.2%). There were no female editors-in-chief. The average female proportion of editorial leadership per journal was 18.8%. One journal had no female editorial leadership representation. Overall, the number of females in editorial leadership positions is comparable to the current proportion of UK female consultant surgeons (13.7%). Journals with an under-representation of females in senior editorial leadership positions compared with the parent specialty should consider initiatives that will encourage diversity, promote greater gender parity, and champion female representation.

SP1.2.9 Stylish surgical writing: the state of the art surveyed

Abstract Introduction Glaring gaps exist between what most readers consider proficient writing and what academics typically publish. This study aimed to assess the writing styles of the 13 journals held in the highest esteem by 11 surgical specialties. Methods The first 1,000 words of the initial 10 articles published in January 2018 from the 11 journals affiliated with surgical specialty associations were assessed as well as the BMJ and Lancet. The primary effect measures were Flesch-Kincaid Readability Ease (FRES, range zero (difficult) to 100 (easy)) and Flesch-Kincaid Grade Level (FGL, range -3.40 to infinity), related to journal Impact Factor and article citations. Results FRES median was 18.2 (1.4–38.2) and FGL 16.3 (12–26.2). FRES was directly related to the use of be verbs (p=0.004), but inversely proportional to numbers of common abstract nouns, words per sentence, characters per word, authors, references, level of evidence, and Journal Impact Factor (all p<0.04). Citations were inversely related to FRES (rho -0.292, p<0.001; critical value 14.5 (OR 0.20 p<0.001)) and directly proportional to FGL (rho 0.279, p=0.001; critical value of 15.5 (OR 5.04 p=0.05)). The journal with the highest FRES (most readable) was the British Journal of Oral & Maxillo-Facial Surgery (median 30.4; total citations 5). Conclusion Big differences in writing style and readability were plain with FRES varying 28- and FGL two-fold. No journals had a FGL of <12 (reading age of >17 yr.). Superior Journal prestige, Impact Factor, and citations were not associated with better Flesch-Kincaid reading ease.

Prioritising elective arthroplasty: a further challenge of COVID-19 Can a prioritisation scoring tool help with reducing waiting lists?

INTRODUCTIONThe COVID-19 pandemic has had a significant impact on the delivery of elective orthopaedic care in the UK, leading to a hugely increased number of patients on waiting lists. The focus has therefore now turned to reducing the backlog. We sought to develop a clear, objective and reproducible system for prioritising elective hip arthroplasty.METHODSThe prioritisation scoring system was constructed using the Federation of Surgical Specialty Associations (FSSA) guidelines as a framework. This included current Oxford hip scores, review of imaging, waiting list duration and previous cancellations. The inter-rater and intra-rater reliability for the final prioritisation scores was tested using the Kappa statistic by two blinded surgeons independently reviewing a selection of patients on two separate occasions.RESULTSA random sample of 20 scores from 125 of the 136 patients on the waiting list were included in the study. The level of prioritisation was assessed by two consultant surgeons. No statistically significant intra-rater or inter-rater reliability was demonstrated.CONCLUSIONSDeveloping an equitable hip arthroplasty prioritisation system is an essential but challenging task. This scoring system was designed as an objective means of determining prioritisation for the elective arthroplasty waiting list within the FSSA categories of priority 3 and 4. Further refinement in light of the evolving guidelines will allow improved reliability.

Timing of elective surgery and risk assessment after SARS-CoV-2 infection: an update: A multidisciplinary consensus statement on behalf of the Association of Anaesthetists, Centre for Perioperative Care, Federation of Surgical Specialty Associations, Royal College of Anaesthetists, Royal College of Surgeons of England.

SummaryThe impact of vaccination and new SARS‐CoV‐2 variants on peri‐operative outcomes is unclear. We aimed to update previously published consensus recommendations on timing of elective surgery after SARS‐CoV‐2 infection to assist policymakers, administrative staff, clinicians and patients. The guidance remains that patients should avoid elective surgery within 7 weeks of infection, unless the benefits of doing so exceed the risk of waiting. We recommend individualised multidisciplinary risk assessment for patients requiring elective surgery within 7 weeks of SARS‐CoV‐2 infection. This should include baseline mortality risk calculation and assessment of risk modifiers (patient factors; SARS‐CoV‐2 infection; surgical factors). Asymptomatic SARS‐CoV‐2 infection with previous variants increased peri‐operative mortality risk three‐fold throughout the 6 weeks after infection, and assumptions that asymptomatic or mildly symptomatic omicron SARS‐CoV‐2 infection does not add risk are currently unfounded. Patients with persistent symptoms and those with moderate‐to‐severe COVID‐19 may require a longer delay than 7 weeks. Elective surgery should not take place within 10 days of diagnosis of SARS‐CoV‐2 infection, predominantly because the patient may be infectious, which is a risk to surgical pathways, staff and other patients. We now emphasise that timing of surgery should include the assessment of baseline and increased risk, optimising vaccination and functional status, and shared decision‐making. While these recommendations focus on the omicron variant and current evidence, the principles may also be of relevance to future variants. As further data emerge, these recommendations may be revised.

Association of surgeons in training 40th anniversary conference: Liverpool #ASiT2016.

The Association of Surgeons in Training (ASiT) is a professional body and registered charity working to promote excellence in surgical training for the benefit of junior doctors and patient alike. ASiT is independent of the National Health Service (NHS), Surgical Royal Colleges and specialty associations, and represents trainees in all ten surgical specialities. We were delighted to be celebrating our 40th Anniversary Conference in the fantastic city of Liverpool with over 700 delegates in attendance and in the company of many ASiT Past Presidents. The conference programme focused on how to overcome threats to training in light of the recent turbulent events associated with the junior doctor contract dispute with inspiring talks from Professor Sir Bruce Keogh, NHS Medical Director and Rt Hon Heidi Alexander MP, Shadow Health Secretary. The other central topic to the conference was 'celebrating excellence in surgical training' and we were thankful to many other high profile speakers who attended to help in this celebration. In addition, over £4000 was distributed between more than 30 prizes and was awarded by the incoming President, Mr Adam Williams, to delegates who presented the highest scoring academic work from over 1200 submitted abstracts.

Organisation and provision of head and neck cancer surgical services in the United Kingdom: United Kingdom National Multidisciplinary Guidelines.

This is the official guideline endorsed by the surgical specialty associations involved in the care of head and neck cancer patients in the UK. This paper summarises the current state of play in the organisation and provision of head and neck cancer surgical services in the UK.

FSSA statement on individual surgeons’ outcomes data

The Federation of Surgical Specialty Associations (FSSA) comprises the presidents of all the surgical specialties recognised by the General Medical Council. Together with the presidents of the four royal colleges, the FSSA constitutes the Surgical Forum of GB and Ireland. The FSSA is therefore representative of surgical opinion in the UK and Ireland, irrespective of specialty, College affiliation or place of work. As the corporate body of the Surgical Specialty Associations, the primary aim of the FSSA is to represent and coordinate the views, aims and policies of surgeons from across the UK and Ireland. The FSSA is committed to advancing, promoting and protecting the highest standards in the practice of surgery in the best interests of patients. The FSSA supports the publication of surgical outcomes. This transparency informs patients and provides assurance that care is safe. Importantly, it also allows surgeons to benchmark their outcomes against their peers and this leads to improvement in the quality of patient care. However, the FSSA has misgivings about the publication of individual surgeons’ crude outcomes data.

Length of surgical training must be reviewed, BMA annual meeting hears

Surgical training must be reviewed by the General Medical Council, the BMA, and the royal colleges to decide whether it is long enough to train an NHS consultant surgeon, delegates at the BMA’s annual representative meeting have said. Delegates voted in favour of a motion that called on the BMA, the GMC, the surgical royal colleges, the Joint Committee on Surgical Training, and the surgical specialty associations to determine whether the current length of training was “fit for purpose.” The motion included concerns that “the implementation of Working Time Regulations (EWTR) …

RCS invited Review service

For several years, the College has offered an advisory service to healthcare organisations to help them determine whether there is cause for concern about the practice of either an individual surgeon or a surgical team. This Invited Review service is delivered by means of close collaboration between the Royal College of Surgeons, the surgical specialty associations and the RCS patient liaison group.

Jaw jaw, not war war

There is no getting away from it: the Health and Social Care Bill still dominates at the time of writing. I have said previously that surgery would be at the forefront of change but I had not realised just how much we would be in the eye of the storm. Our Council believes that we should remain in critical engagement with the government. We are not alone in this stance but nevertheless we are in the vanguard of the royal colleges. Our position has not changed since the bill was first mooted and has recently been endorsed by Council with an overwhelming majority. Very importantly, our independent Patient Liaison Group is also very much in favour of our position, as are the College's regional directors of professional affairs, the heads of the schools of surgery and the Federation of Surgical Specialty Associations.

Surgical Workforce: Planning Today for the Workforce of the Future

The Royal College of Surgeons in collaboration with the surgical specialty associations has just published the results of the first comprehensive survey of the surgical workforce in England, Wales and Northern Ireland. As part of our commitment to maintain the highest standards of surgical practice and patient care, we aim to support a dynamic workforce planning process for delivering the best possible care for the population.

Workplace‐based assessment: assessing technical skill throughout the continuum of surgical training

The Royal Colleges of Surgeons and Surgical Specialty Associations in the UK have introduced competence-based syllabi and curricula for surgical training. The syllabi of the Intercollegiate Surgical Curriculum Programme (ISCP) and Orthopaedic Curriculum and Assessment Programme (OCAP) define the core competencies, that is, the observable and measureable behaviours required of a surgical trainee. The curricula define when, where and how these will be assessed. Procedure-based assessment (PBA) has been adopted as the principal method of assessing surgical skills. It combines competencies specific to the procedure with generic competencies such as safe handling of instruments. It covers the entire procedure, including preoperative and postoperative planning. A global summary of the level at which the trainee performed the assessed elements of the procedure is also included. The form has been designed to be completed quickly by the assessor (clinical supervisor) and fed-back to the trainee between operations. PBA forms have been developed for all index procedures in all surgical specialties. The forms are intended to be used as frequently as possible when performing index procedures, as their primary aim is to aid learning. At the end of a training placement the aggregated PBA forms, together with the logbook, enable the Educational Supervisor and/or Programme Director to make a summary judgement about the competence of a trainee to perform index procedures to a given standard.

A 60th Anniversary

A 60th Anniversary

Selecting the best from the rest

The current method for selecting surgeons of the future is neither objective nor relevant to present day needs. An assessment is needed which ranks potential trainees according to aptitude, motivation and diligence, all of which is validated. This task should be a core duty for the Royal Colleges of Surgeons working in close co-operation with surgical specialty associations.

Hospital practice.

Averil Mansfield is Vice-President of the Royal College of Surgeons of England and is the immediate Past President of the Section of Surgery of The Royal Society of Medicine. She is a Vascular Surgeon and the Professor of Surgery at Imperial College School of Medicine at St Mary's Hospital, London. She has been President of the Association of Surgeons of Great Britain & Ireland, The Vascular Surgical Society of Great Britain & Ireland and was founding Chairman of ‘Women in Surgical Training’ of the Royal College of Surgeons. She has chaired the Intercollegiate Board in General Surgery, The Federation of Surgical Specialty Associations and the Intercollegiate Committee of Continuing Medical Education for the Senate of Surgeons. Her medical training and initial consultant appointments were in Liverpool.