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I write this month’s President’s View in the week following the death of Her Majesty Queen Elizabeth. On behalf of the College, I extend our condolences to the Royal Family. I hope that the expression of admiration and love felt for the Queen worldwide has been of some comfort to them. Her Royal Highness the Princess Royal has long been a dedicated and supportive patron of the Royal College of Anaesthetists, and our thoughts are with her at this time of personal sadness, with which many of us can empathise.

Aileen Kirkpatrick Adams was born in 1923 in Sheffield, where she qualified in medicine in 1945. She trained in anaesthesia at the Royal Free and Edgeware hospitals in London and at Bristol’s Frenchay Hospital under Dr Tom Wilton, and worked in Oxford under Sir Robert Macintosh. She also enjoyed a sojourn at the Massachusetts General Hospital under Henry Beecher. Finally, she was appointed as a consultant anaesthetist in Cambridge, England.

You may well ask why you should think of becoming an AAC (advisory appointments committee) assessor. Perhaps it will be too arduous/boring/difficult. We hope to persuade you that this is not the case, and further explain what it can do for you and your department.

When your department appoints a new consultant or specialist doctor, there are specific requirements that must be fulfilled. One of the most important of these is to hold an AAC. This is a legally constituted interview panel established by an employing body. Its function is to decide which, if any, of the applicants is suitable for appointment and to make a recommendation to the employing body.

Like Alexander of Macedon, the new curriculum has swept all before it. For Egypt, read regional anaesthesia; for the sacked cities of Tyre and Persepolis, read the subspecialties.

Although Pain may seem distant, much like Alexander reached India, the new curriculum has reached it.

In 2010 Pain featured as a module requiring a sign off (with 17 syllabus points) and Intermediate Level (18), and was optional at Higher and Advanced.

This has been replaced by compulsory HALOs at Stages 1, 2 and 3, with new and more generalised curriculum points.

The need for a diverse workforce

It is understood that in healthcare having a diverse workforce that reflects the population they care for can have better outcomes for patients, improve staff retention, and can positively improve staff morale.

Traditionally, medicine has been a career dominated by those from socioeconomically advantaged backgrounds.¹ Despite this, there have been progressive changes in this stereotype in recent times – for the last 25 years more than 50% of medical students have been female, and in 2017 59% of those accepted into medical school were women.² In contrast to this, there is currently a disproportionately low number of doctors who come from lower socioeconomic backgrounds. Data from 2015 shows that only 14% of new medical students were from lower socioeconomic groups, yet these groups represent 56% of the population.^3,4 The RCoA has pledged to develop equality, diversity, and inclusion within the specialty of anaesthesia.

Questions around financial viability, impact on relationships with the ‘parent’ College, and loss of corporate strength are all concerns I’ve heard following FICM’s statement. 

You might be interested to know that they were also the exact ones expressed at the time the Faculty of Anaesthetists went through their own journey.¹ The journey leading to the formation of the RCoA was not without setbacks and differences of opinion. Faculty board are cognisant of that history, and so are mindful that for our part discussions leading up to our separation are based in a friendly and constructive spirit.

Twenty five per cent of trauma deaths are directly caused by injury to the thorax and, while a minority will require emergency surgery, up to eighty five per cent of chest injuries can be managed without the need for formal surgical intervention.¹ In these cases, rapid recognition and management of life-threatening conditions are key to successful resuscitation.

Thoracostomy (the creation of an artificial opening in the chest wall) is a procedure performed for decompression of the chest, usually by our pre-hospital, surgical or emergency medicine colleagues. It is also the first stage to placing a tube thoracostomy or ‘open’ chest drain. In the context of trauma, emergency lateral thoracostomy is indicated in the following circumstances:

• traumatic tension pneumothorax
• massive haemothorax
• traumatic cardiac arrest.

• Dr Jonathan Rajan, Consultant in Pain Medicine and Anaesthesia, Salford Royal NHS Trust
• Dr Katharine Ireland, Pain Medicine Trainee, Northern Care Alliance NHS Foundation Trust
• Dr Victoria Winter, Pain Medicine Trainee, Northern Care Alliance NHS Foundation Trust
• Dr Helen Makins, Consultant in Pain Medicine and Anaesthesia, Gloucestershire Hospitals NHS Foundation Trust

Multiple reports have highlighted the importance of workplace wellbeing. Institutions that prioritise workplace wellbeing perform better, with improved patient experience, higher staff satisfaction and lower rates of sickness absence.

38% of NHS staff in England reported suffering from work-related stress, and the 2023 GMC Survey showed the proportion of trainees at risk of burnout to be the highest since they started tracking this in 2018. The impact of a career in pain medicine on the wellbeing of a pain physician can be significant, including the emotional burden of treating patients in distress, and the additional impacts of training, career development and examinations. Access to wellbeing support can be further nuanced in smaller subspecialties, with fewer trainees, less potential jobs and a far smaller community of working clinical practice.

With this in mind the issue was raised at the FPM Board, and work began to identify barriers to the reporting of uncivilised behaviour, and to identify possible solutions.