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      • Preparing your mind before surgery
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      • Accessible resources and translations
      • For healthcare professionals
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      • The Patient Information Group
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      • PatientsVoices@RCoA commitment on equality, diversity and inclusion
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      • The anaesthesia team
      • A to Z of medical terms
      • Anaesthesia & the environment
      • External patient resources
  • Training & careers
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    • Considering a career in anaesthesia
      Considering a career in anaesthesia
      • What do anaesthetists do?
      • The stages of training
      • Medical school anaesthesia societies
      • Career resources
    • Training Hub
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      • Recruitment into anaesthesia
      • 2021 Anaesthetics curriculum
      • Stage 1
      • Stage 2
      • Stage 3
      • Supporting resources
      • Flexibility in training
      • Supervising and assessing
      • Portfolio Pathway
    • Working in anaesthesia
      Working in anaesthesia
      • Industrial action advice and FAQs
      • AACs and JD approvals
      • BJA Education online
      • Anaesthesia Associates
      • Revalidation
      • SAS and Specialty Doctors
      • Workforce planning
      • Simulation
    • Lifelong Learning
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      • Account request form
      • CPD accreditation of courses and events
      • Change of School form
      • Curriculum change form
      • Contact the Lifelong Learning team
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      • Change Request Form
    • College Representatives
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      • Become a College representative
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      • External Adviser for ARCP
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    • Primary FRCA examination
      Primary FRCA examination
      • Examination Syllabus Stage 1
      • Primary FRCA MCQ examination
      • Primary FRCA OSCE examination
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      • Temporary Examination Eligibility (TEE)
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      • Examination Syllabus Stage 2
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      • Final FRCA SOE examination
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      Research bodies
      • National Institute of Academic Anaesthesia
      • Centre for Research and Improvement
      • Perioperative Medicine Clinical Trials Network
      • Trainee Research Networks
      • NIHR Clinical Research Networks
    • Research projects
      Research projects
      • National Audit Projects (NAPs)
      • National Emergency Laparotomy Audit (NELA)
      • eFONAr: Emergency Front of Neck Airway Registry
      • Perioperative Quality Improvement Programme (PQIP)
      • Sprint National Anaesthesia Projects (SNAPs)
      • Children's Acute Surgical Abdomen Programme (CASAP)
      • Timeliness to Emergency Laparotomy
    • Get involved in Research
      Get involved in Research
      • Research grants and awards
      • Research priorities
      • Academic training
      • CR&I Fellowships
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    • Anaesthesia Clinical Services Accreditation
      Anaesthesia Clinical Services Accreditation
      • ACSA Online Portal
      • The ACSA standards
      • The ACSA process
      • Who is accredited?
      • ACSA resources and information
    • Guidance and resources
      Guidance and resources
      • Guidelines for the Provision of Anaesthetic Services
      • Coronavirus COVID-19
      • Consultation and Endorsement
    • Patient safety
      Patient safety
      • Cappuccini Test
      • Flash card team training
      • Patient safety strategy
      • Safe Anaesthesia Liaison Group
      • Sustained Exhaled CO2
      • Unrecognised oesophageal intubation
    • Professional support
      Professional support
      • Clinical Leaders
      • Invited Reviews
      • Networks
      • Prehabilitation
    • Quality Improvement
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      • The Quality Improvement Working Group and Vacancies
      • Quality Improvement Strategy
      • Raising the standards: QI Compendium
      • Quality Network
      • Career Development Programme and QI Training Resources
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      • Quality Improvement Newsletter
      • QI and BJA Open
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      • Trustees’ Fiduciary and Environmental, Social & Governance Investment Statement
      • Equality, Diversity and Inclusion
      • Perioperative care
      • A new home for the College
    • Global Partnerships
      Global Partnerships
      • Global Partnerships Strategy
      • Our global projects
      • Overseas doctors training in the UK
      • Working in Low and Middle Income Countries
      • International Academy of Colleges of Anaesthesiologists
      • Global Fellowship Scheme
    • Venue hire
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      • Our rooms
      • Capacity and prices
      • Contact the venue hire team
      • Terms and conditions
      • Book now for up to 30% off room hire in July and August
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      • History Articles
      • History of Anaesthesia
      • Influence of two World Wars
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Assisted dying and the Royal College of Anaesthetists

"As I sit down to write this article, I am very much aware that today is the anniversary of the death of my mother. A strong-minded, intelligent and, above all, proud woman, her greatest fear as she became increasingly physically frail was a loss of dignity."

As I sit down to write this article, I am very much aware that today is the anniversary of the death of my mother. A strong-minded, intelligent and, above all, proud woman, her greatest fear as she became increasingly physically frail was a loss of dignity, something she had witnessed in the slow demise of her own mother.

From middle age onwards, she wrote me detailed letters describing what she would and would not tolerate as she got older, and instructing me, the only doctor in the family, to do everything possible to help her to die peacefully when the intolerable became manifest. Sadly, the law forbade such measures and, despite receiving excellent care in her failing years, she suffered much of the indignity that she most feared before passing.

Announcements: Autumn 2024

Find out the latest appointments approved, and with sadness we record the deaths of some of our fellows.

Find out the latest appointments approved, and with sadness we record the deaths of some of our fellows. 

CEO update: Spring 2024

Jono Brüün, our CEO updates you on our governance and introduces you to our three new lay trustees to our board, and tells us more about their areas of expetise.

In previous updates I have written about the changes to our governance which have reshaped our Council and Board of Trustees

Last year the Privy Council approved amendments to the College’s Charter and Ordinances, which enabled us to comply more completely with Charity Commission regulations, manage the College more transparently, and improve our efficiency. As part of our ongoing programme of improvements last summer the College’s governance team circulated a board skills audit to our elected Council members, Trustees and Executive Team. The audit's aim was to identify the skills, experience and knowledge that would most benefit the College over the coming years.

Trustees have responsibilities for the College’s finance and assets, delivery of our charitable objects, developing and implementing College strategy and ensuring legal and regulatory compliance. These are huge responsibilities and having expertise from outside our members’ clinical experience is extremely valuable. Lay trustees are a vital part of the Board of Trustees and directorate boards.

Shared decision making: are we practising what we preach?

This article explores shared decision-making, in which patients and clinicians collaborate to make the best evidence-based decision within the context of the patient’s values.

The success of an anaesthetic is traditionally judged by our ability to safely get our patient through an operation. Yet, the more evolving challenge of our specialty is identifying those patients at high risk of postoperative complications where the best course of action may be no surgery at all. A further challenge is that of empowering patients to consider the available evidence to make the best decision for their circumstances.

Shared decision-making, whereby patients and clinicians collaborate to make the best evidence-based decision within the context of the patients’ values, is recognised as a vital component of perioperative care. The benefits of shared decision-making are accepted by NICE and the Centre for Perioperative Care (CPOC), yet evidence suggests we may not be doing it as well as we should. A recent CPOC survey showed that 39% of patients desired more support or information regarding treatment choices. In another study, 14% of patients expressed regret, and said that they would not have had surgery had they understood the risks and alternatives. View the ‘three-talk’ model of shared decision-making suggested by CPOC.

Euthanasia: ‘no opinion’, is not neutral and a valid expression of some truths

Dr Barry Miller, former Dean, Faculty of Pain Medicine looks at assisted dying and why this is such a complex topic.

‘You always own the option of having no opinion. Things you can't control are not asking to be judged by you. Leave them alone.’

Marcus Aurelius (121–180 CE)

For the record: I am a full-time NHS consultant in pain medicine and anaesthesia, and the sole provider of ‘interventional pain procedures’ to my local hospice, where I have a weekly session to see inpatients, outpatients and discuss complex pain problems in the end, and not-so-end, of life scenarios. I am also a former dean of the Faculty of Pain Medicine.

Discussions have started within the RCoA on whether the College, and its faculties, should take a stand on the issue of ‘assisted dying’.

They should not. Not pro, anti, or neutral (this last stance is multifaceted and arguably not ‘neutral’ at all).

Old problem, new solutions: tackling timeliness in emergency surgery

Dr Carolyn Johnston tells us about a new project aiming to find ways to improve the time it takes for patients to have their surgery.

Announcements: Spring 2024

Find out the latest appointments approved, and with sadness we record the deaths of some of our fellows.

Find out the latest appointments approved, and with sadness we record the deaths of some of our fellows. 

Announcements: January 2023

Find out the latest appointments approved, and with sadness we record the deaths of some of our fellows.

Patient perspective: Wondrous excellence - the contribution of Islamic medicine to modern healthcare

"When I was first asked by the College to write a short article on the talk I had given earlier in the year on the history of medicine, I was initially hesitant for the simple reason that the subject was so vast to do justice to, and moreover that it had to be accessible to everyone."

When I was first asked by the College to write a short article on the talk I had given earlier in the year on the history of medicine, I was initially hesitant for the simple reason that the subject was so vast to do justice to, and moreover that it had to be accessible to everyone. The diplomatic and persuasive skills of my colleagues encouraged me to write this short article on an extremely fascinating and illustrious period in the life of medicine and healthcare – the period from the 8th to the 15th century.

I am passionate about patient-centred and evidence-centred medicine, and hope to show how these principles were taken to unprecedented levels of excellence and refinedness in this period by Islamic medicine in a way that is to be seen in very few other areas of the history of medical science. When one elucidates each story in this history it can only be described by Bolt’s phrase: sophistication upon sophistication. Due to prescribed editorial limits, the article will centre on only three illustrious individuals: Abulcasis, Ibn al-Nafis and Avicenna. Firstly, the article looks at the overall contribution, and then secondly at the specific contribution and impact of these master clinicians.

Announcements: Winter 2024

Find out the latest appointments approved, and with sadness we record the deaths of some of our fellows.

Find out the latest appointments approved, and with sadness we record the deaths of some of our fellows. 

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