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In my role as a patient representative, I am committed to represent the patient voice to ensure it is at the centre of everything we do.

For those who may not know, CPOC is a cross-specialty initiative made up of 11 partners dedicated to the advancement and development of perioperative care. Perioperative care means the whole patient journey from the GP’s, to when a patient returns home after surgery. Our vision is to improve the health of people of all ages, at all stages of their surgical journey, by promoting the highest standards of perioperative care.

Improving perioperative care will make a difference to a lot of things important to patients, including getting fitter before surgery, better pain management (getting mobile quicker), recovery (getting out of hospital faster), reducing anxiety felt, and putting the patient at the centre of all decisions about treatment.

Following the murder of George Floyd in the United States in 2020, which moved and touched so many individuals and organisations across the world, the ‘Black Lives Matter’ campaign has acted as a catalyst for positive action and renewed debate about how best to address systemic racism in our society and issues that affect the Black, Asian and Minority Ethnic communities.

During this time the College published its own statement alongside the Faculty of Pain Medicine and the Faculty of Intensive Care Medicine; this was welcomed by members, staff and the public.

Authors

• Dr Anna Greenwood, ST7 Anaesthetics, Leeds Teaching Hospitals NHS Trust
• Dr Sue Walwyn, Consultant Anaesthetist, Mid-Yorkshire NHS Trust; Regional Advisor West Yorkshire
• Dr Joe Lipton, Consultant Anaesthetist, Guy’s and St Thomas’ NHS Foundation Trust;
• RCoA Lead for Assessment Anaesthetics Curriculum Development and Assurance Group

The concept of entrustment is as ancient as apprenticeship. Anaesthetists reeling from the effects of the pandemic are adjusting to the logistics of the new curriculum, and with it a paradigm shift in workplace-based assessment. 

Cynics may well have thought that it is all a rebranding exercise, yet it is a considered outcomes-based holistic approach to training. The old ‘tick-box’ process has been replaced by qualitative faculty judgements of capability, anchored to more clearly articulated learning outcomes. Progression is explicitly framed around increasing practice autonomy through ‘entrustment’ of responsibility for patient care. Entrustment-based assessment moves beyond the spiral curriculum and being ‘good enough’, replaced instead by promotion of the ideal of an excellent all-round professional anaesthetist.

In this issue we’re focusing on research, highlighting a small selection of the education and information resources available to you, our members. We showcase some of our work to support high-quality healthcare research and hope you find these resources useful.

The College’s Quality Network (QN) was formed to share learning, develop quality improvement (QI) knowledge, and encourage local improvement work. It is comprised of regional leads, who are aligned with the schools of anaesthesia, and local leads who are based within the hospitals of each region.

The College’s Quality Improvement Working Group wanted to make a fresh assessment of the QN to take stock of our progress and plan future work. A short national survey, to understand implementation of an important safety initiative, was felt to be an effective way to re-invigorate members and generate learning for future projects.

Prep Stop Block¹ (PSB) was created in 2021 to enhance the message of ‘Stop Before You Block’ (SBYB) and standardise national regional anaesthetic practice, aiming to reduce the incidence of inadvertent wrong-side block. It was launched with a training package and supporting resources. This new standardised operating procedure applies to all departments undertaking regional anaesthesia.

In the operating theatre environment, the perpetual demands, emotional toll, and the need for precision contribute to the potential vulnerability of anaesthetic staff to burnout.

What is burnout?

Burnout, as recognised by the World Health Organization in the International Classification of Diseases, is a syndrome characterised by ‘symptoms’ in three domains:

• feelings of energy depletion or exhaustion
• increased mental distance from the job or feelings of negativity and cynicism related to the job
• reduced professional efficacy.

Burnout is not classified as a ‘health condition’. Instead, it is an occupational phenomenon and due to chronic, unmanaged, workplace stress. People who are burned out are also at high risk of developing mental health conditions, for example depression and generalised anxiety disorder.

Authors:

• Dr Ee-Neng Loh, Anaesthetic NELA fellow
• Ms Lyndsay Pearce, NELA Surgical/ Research Lead
• Dr Sarah Hare, Deputy Director RCoA Centre for Research and Improvement 

Email the NELA team

The challenges of providing care for an aging surgical population require no further introduction. Perioperative clinical teams are often managing surgical patients with multiple complex co-morbidities, higher levels of frailty, and poorer physiological reserve.

In the eighth annual report of the National Emergency Laparotomy Audit (NELA), we found that more than half of the patients undergoing emergency laparotomy (EL) were 65 years old or more, and that around 20% were aged over 80 years.¹ Despite improvements in perioperative care, one in ten patients die within 30 days of their surgery and mortality risk doubles in patients living with frailty.^1,2 Are we doing more harm than good by subjecting these patients to surgery?

We're delighted to announce that since September 2022 we have welcomed new elected and co-opted Council members.

The main purpose of Council is to provide clinical leadership to the specialty, set standards for education, learning and examinations, and ensure adherence to evidence-based practice.

It is the role of Council members to make sure that the College represents the needs of members and the profession. Find out more about new Council members in this article.

Perioperative Journal Watch is written by TRIPOM (trainees with an interest in perioperative medicine) and is a brief distillation of recent important papers and articles on perioperative medicine from across the spectrum of medical publications.

It’s been nearly a year since we published our independent and internal reviews of the FRCA examination together with a commitment to develop our examination and review our processes. This article provides an overview of the positive steps taken since publication to enhance the quality and effectiveness of the examinations in the RCoA, FICM and FPM.