Membership Matters | Volume 3 | Issue 2 by Royal College of Obstetricians and Gynaecologists

Membership

Matters Volume 3 | Issue 2

Summer 2013

Your membership magazine from the RCOG: stories from the specialty

Membership Matters | Volume 3 Issue 2

Contents From the President

The RCOG and Wertheim’s Procedure for Hysterectomy

Centre COG Dr Kamini Rao FRCOG Wins Prestigious FIGO Award

Dr Geetha Nagasubramanian FRCOG MBE

Stories from the Specialty The British Society for Gynaecological Endoscopy: Endoscopic Skills and Simulation Training

Uterine Transplantation in the UK: Approaching the First Human Trials

Investment in Preterm Birth: Perils and Possibilities

NHS Change Day

International Fighting Maternal Mortality in Liberia

Helicopters, Sheep, Gorillas and Boats at the Maternity Patient Safety Day

Joining the Quest for Sustainability: An Update from the RCOG Green Group

The Retired Fellows and Members Society

The RCOG Takes on a Workplace Behaviours Advisor

2014 Invitation to Fellowship

2014 Invitation for Nominations for Fellowship ad eundem/ honoris causa

Getting to Know the Honorary Officers: An Interview with Dr Paul Fogarty FRCOG, Honorary Treasurer

2013 Committee Appointments

In Memoriam

Education Improving Training Improves Health Care: An Update from the Faculty Development Committee Curriculum Changes and Alignment with a‘Single Version’ of the Curriculum: An Update from the Curriculum Committee Royal College of Obstetricians and Gynaecologists 27 Sussex Place Regent’s Park London NW1 4RG Registered charity no. 213280 Tel +44 (0)20 77726200 Fax +44 (0)20 77723 0575 Web: www.rcog.org.uk Editor: Luke Stevens-Burt, Director, Membership Relations Assistant Editor: Rebecca Deegan, Administrator Resources Send all contributions and ideas to rdeegan@rcog.org.uk All materials © 2013 RCOG, unless otherwise stated Typesetting and layout: Fish Books Ltd.

College news

Achievers

International Women’s Day: End Forced Marriages

College archives

12 Illustration by Dr Naila Khan

From the President

ince the last edition of Membership Matters was published, the extremely profound second report by Robert Francis QC into the failings of a large hospital to provide humane and appropriate care was released. This analysis has been a shocking and serious reminder to all healthcare professionals of their professional responsibilities to patients. Many institutions have responded and the Royal Colleges are consulting with their members on the appropriate responses and implementations required. Although the Francis Inquiry is focused principally on elderly and frail patients and not on the care provided in maternity and gynaecological services, there are messages that resonate clearly for us: professionalism, putting the needs of patients first and the need for empathy and compassion. These are all basic elements of a doctor’s duty to their patients as highlighted in the GMC’s recently updated guide Good Medical Practice. Indeed, the Francis recommendations present us with the opportunity to focus on patient safety, team working, the problem of undermining and the importance of the need for accurate and robust metrics. Successful implementation of all these components should improve the quality of health care for women. The first of April or ‘April Fool’s Day’ had a particular significance in England this year with the introduction of the greatest structural change to the NHS since the inception of the service in 1948. The divergence of the NHS in the UK has been greatly highlighted by the implementation of the reforms of the Health and Social Care Act (2012). NHS England is now a reality and the commissioning responsibilities are now devolved to the NHS Commissioning Board and the clinical commissioning groups. The anxieties surrounding competitive tendering continue to pose a threat to some services but it is interesting how varied and divergent the responses have been to this matters across different specialties within medicine. The profession does not speak with one voice, when it comes to competition. The changes to the NHS in England are huge and will impact in all areas including education and training. The profession and specialty is fortunate to have Professor Wendy Reid as Medical Director of Health Education England. These changes are unique to England and magnify differences in the approach of the devolved nations. Revalidation started in December 2012 and, as I write this piece, I am aware that nearly 3000 doctors have been through the process. Having gone through the procedure myself, I feel that I have significant insight into the potential challenge necessary to comply with the requirements successfully. I found the RCOG e-portfolio extremely helpful but quickly became aware of the importance of keeping the log up to date. The 360-degree feedback from patients and peers is instructive although I believe that the tools will need more fine-tuning as the process develops. The RCOG helpdesk is up and running for those needing advice or

Dr Tony Falconer President, Royal College of Obstetricians and Gynaecologists

clarification about the system, quality assurance of which will be addressed by the GMC in the course of time. The implementation of the Governance Review will become apparent when the new Board of Trustees Board assumes responsibility for the charitable activities of the RCOG on 3 Monday June. From then, Council will be able to focus more on strategy and professional concerns. The following will sit on the Board of Trustees:

• • •

The President (Chair)

The Senior Vice President The Honorary Treasurer

Four selected lay Trustees following competitive interviews:

• • • •

Ms Naaz Coker

Mr Roy Martin QC Ms Linda Nash

Professor Eric Thomas

Two selected members following competitive interview:

• •

Dr David Farquharson FRCOG

Dr Daghni Rajasingam MRCOG

The member or fellow elected from Council will be determined at the next meeting.

The annual world congress in Liverpool will be on us in no time at all. The success of recent congresses has been a huge boost to the RCOG staff and in particular for those working in the meetings department. Liverpool is a magnificent location and the combination of an outstanding scientific programme, with social activities against a backdrop of music by The Beatles should satisfy most delegates. I look forward to greeting many of you from overseas and from the UK to this meeting. You will not be disappointed. Finally, I wish to congratulate Dr David Richmond, who has been elected as President of the RCOG from 27 September 2013. David has been an inspirational Vice President for Clinical Quality and has all the personal qualities and attributes to be an outstanding President. I am confident that the membership, both within and without the UK, will support him in his future drive to improve health care for women. Dr Tony Falconer, RCOG President

Centre COG 4

Achievers

Dr Kamini Rao FRCOG Wins Prestigious FIGO Award

Dr Geetha Nagasubramanian FRCOG MBE

Dr Kamini Rao, former President of the Federation of O&G Societies in India and the Indian Society for Assisted Reproduction, has been bestowed the prestigious FIGO Award for Women Obstetricians/Gynecologists. Awarded every three years since 1997, the FIGO award recognises women obstetricians and gynaecologists from around the world who have made a special contribution, internationally or nationally, to promote the development of science and scientific research in the field, and who, throughout their career have promoted better health care for women. For Dr Rao, the award is an acknowledgement of her work in the area of women’s sexual and reproductive rights (WSRR) for which, as FIGO WSRR Committee Chairperson, she has carried out extensive work with the aim of bringing about changes in medical practice and standards to make them gender sensitive and ethical.

Dr Geetha Subramanian has been working as a Community Gynaecologist in the borough of Tower Hamlets since 1986, and became a Consultant and Head of the Women and Young People’s Service in 1995. She has made significant changes to the way the service has been delivered in the areas of family planning, termination of unplanned pregnancy, female genital mutilation (FGM) and young people’s sexual health. With the support of a team of dedicated staff, she has taken the initiative to introduce and establish services such as early medical abortion, provision of religious and cultural male circumcision for babies from the local Muslim community, reversal of FGM and a specific team for reaching young people with the objectives of reducing teenage pregnancy and sexually transmitted infection through education and focused service provision. Over the last two decades, through her dedication, enthusiasm and zeal, Geetha has established THCASH as a leading and successful enterprise in the country.

Dr Kamini Rao FRCOG

Dr Geetha Nagasubramanian FRCOG MBE

We encourage our Fellows and Members to inform us about their own or their peers’ achievements, please send to rdeegan@rcog.org.uk.

Centre COG

The British Society for Gynaecological Endoscopy: Endoscopic Skills and Simulation Training By Miss Mary Connor FRCOG, Honorary Secretary BSGE

The British Society for Gynaecological Endoscopy (BSGE) exists to improve standards, promote training and encourage the exchange of information in minimal access surgery techniques for women with gynaecological problems. Originally founded in 1989 by a small group of consultant gynaecologists, the society has since grown to over 650 members. In 2000, the BSGE was granted charitable status. Learning how and when to use new technologies is vital to the development of endoscopic services. It enables both those for whom formal training may have ceased, and those who are currently undertaking a training programme, to learn not only how to use new devices, but also their appropriate use. Providing and promoting such training is important and it is increasingly clear that simulation training is vital to the development of skills. The necessary psychomotor skills are a result of practice â&#x20AC;&#x201C; not unlike learning to ride a bike or swim! The opportunity to repeatedly practice specific movements is required and simulators allow this to be undertaken away from the pressures of providing a clinical service. This is not only to the advantage of the clinician, but more particularly, our patients. Familiarity with new instruments can also be obtained, again without risk to the patient. Surgical competence, unlike the psychomotor element, requires the presence of a skilled tutor. However, some aspects of surgical procedures can be learnt in a laboratory setting. To help increase the opportunities for working on simulation models we work closely with partner organisations, most notably the RCOG and the European Society for Gynaecological Endoscopy (ESGE), and also partners in industry on whom we rely for the technological advances that make possible so much of what we can undertake. The Diagnostic and Operative Hysteroscopy Course run jointly by the RCOG and BSGE, has recently evolved to include hands-on sessions. Procedures explored include endometrial ablation, fibroid resection, endometrial polypectomy and hysteroscopic sterilisation. The hands-on sessions make use of various computer simulators and models pretending to be the uterus, which vary from sheep hearts and pigs bladders to potatoes, peppers and butternut squash. The models allow the use of instruments and fluid management systems that are used with patients. Guidance is on hand as to how to use the equipment from tutors who have expertise with the devices in the clinical setting. The stations focus on classic skills as well as new ones. Traditional uterine resection is not neglected, with half the time spent using the resectoscope. There is the opportunity to ensure that diagnostic skills are honed, as well as time to practice simple techniques using graspers for taking targeted biopsies and the removal of small lesions. Computer simulation adds a different dimension to simulation training, as it provides sophisticated feedback on one's operative technique. Hysteroscopic sterilisation is a new procedure for many gynaecologists involving gentle cannulation of the fallopian tube. The simulation model

Endoscopic Training at the RCOG

informs how well this is achieved and whether the cervical canal and the uterine walls were avoided or touched, potentially causing pain. The path to the tubal ostia is tracked and shown; unnecessary moves are recorded and counted. Direct and immediate feedback gives the trainee a chance to discuss their technique while the tutor is present. The hands-on sessions and the accompanying lectures provide an emphasis on ambulatory gynaecology, which is often favoured by patients and now supported by the changes in tariffs for hysteroscopic procedures. Laparoscopic skills are enhanced by simulation practice. The BSGE has recently formed links with the company who have developed LaproTrainâ&#x201E;˘, which also provides a series of web-based modules covering basic laparoscopic skills. The simulation boxes attach to a television screen and the modules are available on a monthly basis over a period of six months. Training is supervised by a local BSGE mentor. BSGE members can rent the box via Atia Khan who runs the BSGE office based at the RCOG; an option to buy the box is available. As yet, there are few validated tests of endoscopic skills and it is not clear how such tests should be used. However, ones for laparoscopic procedures developed at the European Academy for Gynaecological Surgery, part of the ESGE, are close to completion; ones for hysteroscopic procedures are under development too. Training programmes vary for each of the European countries, reflecting the different ways that each country delivers its health care. However, there is much in common too, particularly the needs for gynaecological endoscopic skills training and so there is the potential for increased cooperation and sharing of skills and knowledge, which the BSGE will endeavour to help develop.

Membership Matters | Volume 3 Issue 2

Uterine Transplantation in the UK: Approaching the First Human Trials By Dr Srdjan Saso MRCS and Mr J. Richard Smith FRCOG

Background

Ethics of uterine transplantation

Uterine transplantation (UTn) was first performed in humans in 2000 in Saudi Arabia on a 26-year-old who had her uterus removed as a result of postpartum haemorrhage. The transplanted uterus failed after three months. Although controversial and appearing without precedent at the time, it resulted in a ‘re-focusing’ of efforts into UTn-related Mr J. Richard Smith FRCOG research. Current estimates are that in the US, up to seven million women, age 15–34 years, have absolute uterine factor infertility (AUFI) and may be appropriate candidates for UTn. As witnessed similarly with the advent of IVF in the 1980s, the extent of the likely disease population enlarges at the introduction of any potential therapy. UTn may be safely performed today because of important developments in transplantation surgery. These are exemplified by multivisceral, hand, larynx and face transplants. Unlike in these other nonvital transplants, the grafted uterus (and the necessary immunosuppressants) will only be in place for the two to five years that are necessary for one or two pregnancies to be achieved.

UTn must satisfy, as any surgical innovation would, criteria as defined by F. D. Moore. Progress in multiple solid organ transplants has made UTn well within the technical capabilities of many transplant centres. Animal transplants have confirmed that the fetus develops normally with no prematurity or growth restriction regardless of the vascular reconstitution. Equally important, UTn must satisfy accepted bioethical principles and their application. Whether seen as innovative surgery or a medical study, eventually the early decisions to proceed in any venue should depend on approval by a duly constituted ethics review committee, the participating institution, the local transplant team and, most importantly, the patient to whom the transplant will be offered.

Surgery and alternatives to uterine transplantation UTn is therefore a ‘temporary’ treatment for AUFI only for women who cannot otherwise have a child either through adoption, surrogacy or any other method currently existing. The UTn recipient must, however, have produced oocytes that have been fertilised in vitro resulting in normal cryopreserved embryos. These embryos will have to be successfully transferred into the uterus as the fallopian tubes would not have been transplanted with the uterus. In the UK, we plan to use a brain-stem dead heart-beating donor, as opposed to a live donor. The advantage of using a deceased donor lies with zero surgical risk to the donor and a more extensive dissection of the vascular tree on the uterine graft compared with a live donor. A more radical dissection leads to recovery of larger arteries and veins, thus allowing for a technically easier vessel anastomosis. A disadvantage with using a deceased donor, compared with a live donor, is that graft survival may be negatively affected at brain death by major systemic inflammatory changes. Surrogacy and adoption will remain treatment alternatives, but the risks associated with the former and the obstacles with the latter means they may not be satisfactory to everyone. Regardless, the majority of women with AUFI should be counselled and encouraged to pursue alternatives to UTn. However, a need exists for additional options where surrogacy and adoption cannot suffice, in this case UTn.

Uterine transplantation in the UK In addition to the Saudi case described above, seven more human cases have been attempted, one in Turkey (Professor Omer Ozkan) in August 2011 and six in Sweden (Professor Mats Brannstrom) over the past 12 months. The Swedish team have ethics permission to perform a case series of ten transplants. The Turkish case is the only one to be published to date. This described the first-year results of the second human uterus transplantation case from a multiorgan donor. A 21-year-old woman with complete müllerian agenesis who had been previously operated on for vaginal reconstruction was the recipient. UTn consisted of orthotopic replacement and fixation of the retrieved uterus, revascularisation and end-to-site anastomoses of bilateral hypogastric arteries and veins to bilateral external iliac arteries and veins. The patient menstruated 20 days after the transplant surgery and has had 12 menstrual cycles since the operation, making it thus, the longest-surviving transplanted human uterus to date with acquirement of menstrual cycles. Likewise, all Swedish recipients are healthy, with no morbidity or mortality. All have regular menstrual cycles and are currently awaiting embryo transfers approximately a year following their transplant procedure. We will be drawing our animal work to a close this year and are about to accompany organ retrieval teams in London. We have presented to the RCOG ethics committee and have an agreement in principle subject to finishing our current studies and there being successful fertility data available following human UTn. Our proposals to other ethics boards will be submitted later this year with the aim of performing the first five cases in the UK in 2014/5. Our charity, Uterine Transplantation UK, website (www.wombtransplantationuk.org) and Advisory Board have been up and running for over a year. The uterine retrieval, grafting and fertility teams are all in place as is a list of potential recipients, of various ages and professions, whom we have met in person.

Centre COG | continued

Conclusion Successful animal models resulting in pregnancy together with further seven human UTn performed over the last 18 months means that UTn is now a recognised and feasible procedure. Pregnancy following organ transplantation is complex but now commonplace. Closing on half a century of experience with pregnancy in solid organ recipients, an abundance of data has accumulated indicating satisfactory maternal and neonatal outcomes. Future UTn candidates, likely to represent a group not burdened by multiple co-

morbidities, should have a good possibility of pregnancy. Pregnancy after UTn will present new challenges. The only circumstance that could ‘derail’ the setting up of national uterine transplant programmes would be pregnancy-related disaster in the intended series of patients. Yet, as we await news of progress from the Turkish and Swedish case series, we believe that UTn has become a matter of ‘when next’ rather than ‘if’, both internationally and here in the UK.

Investment in Preterm Birth: Perils and Possibilities

By Professor David M. Olson, Ph.D., FRCOG, Professor, Departments of Obstetrics and Gynecology, Pediatrics and Physiology, University of Alberta, Edmonton, Canada; President, Livmor Diagnostics, Inc. and Maternica Therapeutics, Inc. Preterm birth is the major health problem in the newborn period worldwide but the field lacks effective means for diagnosis of risk and treatment. As such, the field is ripe for investment and one might expect considerable commercial activity. Sadly, this is far from the case. There is practically no appetite for investment at this time due to Professor David M. Olson the concepts (not necessarily FRCOG truths) that the market size is too small, the cost of clinical trials too high and the risk of litigation too great. The small market size is due to the traditional belief that symptomatic women, those with myometrial contractions, cervical effacement and ruptured membranes, are treated for only 48 hours to stop the preterm delivery or not. The cost of clinical trials is high because if asymptomatic women are treated, one treats all pregnant women or five times as many women as necessary. This leads to increased risk of an adverse outcome in two patients – the mother and her fetus – and possible litigation. For these reasons, major Pharma have abandoned attempts at developing new interventions to delay preterm birth. Beyond this, and in spite of an unmet medical need and a market gap, there are several hurdles that need to be overcome before more investment occurs. The market for arresting symptomatic preterm labour is quite large if a therapeutic agent better than atosiban can be found. Investors (Pharma and venture capitalists) are aware of the graveyard of compounds and are increasingly wary. Potential investors in any new therapeutic will be reluctant to invest before the end of phase II trials. Hence transitional funding (late preclinical to end of phase II) will be needed from nondilutive sources such as grants, governments and foundations – stakeholders who need to step up and fill the gap. The market for preventing asymptomatic preterm birth by prophylactic treatment of high-risk patients identified

by a biomarker or other test with a high positive predictive value is also large and attractive because high-risk women may be treated for the last 100 days of pregnancy if a safe intervention can be found. However, the clinical/regulatory pathway for the development of a therapeutic in this area is unclear. Progesterone cleared this hurdle but was not a new chemical entity, having been around since 1956. A new chemical entity for use in pregnant women in anything but the final moments of pregnancy will be subject to an excruciatingly high level of scrutiny by regulatory authorities. This fact will probably preclude venture capital funding at any stage earlier than phase III clinical trials. The success of a companion diagnostic in this area will be crucial. If one can accurately predict which patients will deliver early, therapeutic intervention at an earlier stage may be justified over time. Likewise, if a reliable and safe therapeutic treatment can be found, it is more likely that the use of a diagnostic test will become routine for pregnant women. The two markets are interdependent. For many other health concerns with larger markets, investors commit at an earlier phase of development out of the maturity of the field, experience and the anticipation of high returns. The ‘Valley of Death’ or low investment extends for a greater period for preterm birth. Another possible strategy is to capitalise on the substantial research that implicates inflammatory pathways as causal for preterm birth. By exploring the duality of prediction and prevention for preterm birth and inflammatory diseases, investors may be encouraged into early investment for new drugs for inflammatory indications, the proceeds of which could be used to fuel commercialisation of promising diagnostics and interventions for preterm birth. Solutions for the seemingly intractable problems of discovering and bringing to the clinic new diagnostics and interventions for preterm birth are possible if scientists, clinicians, health systems, governments, foundations, parents of preterm children and investors work together to find them. Acquiring the will and making the commitments to promote these advances requires an immediate collective action.

Membership Matters | Volume 3 Issue 2

NHS Change Day

By Miss Esther Moss MRCOG, Consultant Gynaecological Oncologist, University Hospitals of Leicester The 13 March 2013 was designated as NHS Change Day,1 a day to celebrate the sixty-fifth anniversary of the NHS. This milestone was to be marked by encouraging 65 000 individuals to take action and improve the experience and outcome for patients and their families/carers across all aspects of the NHS. The ‘action’ could take many forms and individuals were encouraged to pledge their resolution on an online pledge wall. Pledges took many guises, from generic statements of ‘keeping patient care at the centre of my practice’ to more specific pledges: in our directorate a group of paediatricians taste tested nutritional supplements and liquid antibiotics in order to gain a greater understanding as to which would be associated with poor compliance due to taste and tolerability. The rationale for the day was a call to action, encouraging us to take our attention away from the daily stresses and strains of our jobs and instead to refocus on the reason the NHS exists – the patient. Underpinning this call was the development of the ‘NHS Change Model’, which has eight components including improvement methodology, spread of innovation and transparent measurement, all with a central tenet of ‘our shared purpose’ of emphasising our personal responsibility as the driver for change in the NHS. So was NHS Change Day another gimmick designed to catch the eye of the media and deflect attention away from the Francis report, financial failings and patient dissatisfaction? I hope not. The enthusiasm of the young clinicians

and managers who instigated the day is genuine and infectious, judging by the 180 000 pledges that have been received. The idea that even small changes in practice and attitude can be magnified resulting in greater movement towards a better NHS Change Day at University NHS may seem idealised Hospitals of Leicester wishful thinking; however, we all know that seemingly insignificant gestures can have profound effects. Over the past 65 years, obstetrics and gynaecology as a specialty has helped to develop and deliver high-quality care to women and their children and we will continue to do so. I suspect that the NHS Change Day, although being a nice idea, will have little impact on the majority of us since we are striving every day of the year to bring change, rather than confining it to a single day, but maybe we could all benefit from this yearly reminder.

Reference 1 http://www.changemodel.nhs.uk

International

International Women’s Day: End Forced Marriages By Rebecca Jones, RCOG PR Officer

“Being coerced or forced into marriage is a form of abuse that is unacceptable in our modern society. Forced marriage also has many significant and worrying consequences including, higher rates of maternal mortality and morbidities as well as the associations with domestic violence, rape, sexual abuse and poor educational attainment,” RCOG Senior Vice President James Walker. A forced marriage is where one or both people do not consent to the marriage and pressure or abuse is used. The pressure put on people to marry against their will can be physical, emotional and/or psychological. Financial abuse can also be a factor. To mark International Women’s Day 2013, the RCOG held an event to raise awareness and focus on the impact and effects of forced marriages in the UK and around the world and to flag up its warning signs and symptoms. We are expecting an imminent announcement by the UK Government to make forced marriage a criminal offence and Department for International Development recently announced the implementation of a range of aid programmes to help empower women, by funding contraception access to prevent unwanted pregnancy and tackling FGM. Introducing the subject, Professor Walker said: “Forced marriage is complex problem and there are other interconnected issues such as early or child marriage, domestic and/or honour-based violence and even FGM. In all, victims suffer both physical and mental abuse and find themselves trapped in a spiral with long-lasting impacts on their health and wellbeing. Given the scale of this problem, I would argue that forced marriage is a public health issue.” Baroness Jenny Tonge, Chair of the UK All-Party Parliamentary Group (APPG) on Population, Development and Reproductive Health started the event by discussing its report A Childhood Lost addressing the causes and consequences of child marriage in the UK and worldwide. New figures released by the Forced Marriage Unit (FMU) reinforce the harsh reality of forced marriage in the UK and worldwide. Carla Thomas, Joint Head of the FMU, noted that the unit gave advice or support in 1485 cases in 2012 and at least 250 children in the UK have now been helped by the unit with the youngest case involving a two-year-old. Ms Thomas reinforced that RCOG Members should be alert to the signs of a possible forced marriage, for example, if they notice that a patient has been withdrawn from education by parents, has not been allowed to work, is closely accompanied by a partner or relative, if they show signs of depression, self-harm, early or unwanted pregnancy and FGM. If a woman presents with these signs, doctors should ask open questions like ‘how are things at home?’ remembering the ‘one chance’ rule, you may only

Left: Dr Luis Gomes Sambo, World Health Organization (WHO) Regional Director for Africa; Right: Poppy B Majingo, Minister Counsellor, Botswana High Commission

have one chance to speak to a victim to save a life. It is also imperative to provide the victim with the opportunity to have a safe space to raise concerns and contact others. Other presentations came from Jasvinder Sanghera, Chief Executive of Karma Nirvana, a charity supporting victims and survivors of forced marriage and honour-based abuse, and Diana Niammi, Director of the Iranian and Kurdish Women’s Rights Organisation, set up to provide holistic advice and intensive case work to Middle Eastern women and girls at risk of domestic violence, forced marriage, FGM and honour-based violence. The event concluded with Dr Sonji Clarke, Consultant Obstetrician from Guy’s and St Thomas’ NHS Foundation Trust, discussing the role of healthcare professionals in matters such as domestic violence. “Healthcare professionals need to bear in mind that asking the ‘difficult question’ may be the most effective way to determine whether a patient’s relationship with their partner, guardian or relative is coercive or dangerous.” “Healthcare professionals must recognise the importance of the ‘one chance rule’. For many women and young girls, interaction with a health worker during pregnancy is the only social interaction they may have outside of a coercive relationship, within a marriage or their family. If there is one chance to ask difficult questions and ensure the safety of the patient, it should be taken but done so in a safe and sensitive manner.” As the professional body for women’s health, it is imperative for all speciality doctors to have the appropriate knowledge and skills to advocate on behalf of women. To this effect, the RCOG will work with the FMU to develop a forced marriage care pathway.

Membership Matters | Volume 3 Issue 2

Fighting Maternal Mortality in Liberia

By Dr Matthew Prior MRCOG, Health Ambassador for Save the Children I walked in to the theatre at Bong County Hospital in Liberia. A girl was lying flat out on the operating table, her eyes fixated on the ceiling. I wasn’t certain if she was still alive, there were no monitors beeping, in fact there were no monitors at all. The theatre looked like a battlefield – blood was everywhere, soaking the drapes and trickling onto the floor. Her abdomen was open as the obstetrician was fighting to save her life after her uterus ruptured during labour. I saw her take a breath. It suddenly dawned on me: she was awake. Anna was 20 years old and this was her second pregnancy. Her last labour resulted in an obstetric fistula, which has subsequently been repaired by doctors from an international charity. She attempted a vaginal birth after a previous caesarean section, with a traditional midwife in her village. There could be many reasons for this: she had too little money to pay for transport, had another child to care for or had been influenced by the untrained traditional birth attendant whose livelihood was reliant on Anna’s homebirth. Once again her labour was obstructed and eventually her uterus ruptured and now she was fighting for her life. Sadly her baby had already died before she reached the hospital. Anna had a spinal anaesthetic. A student nurse, still learning basic medicine, was injecting ketamine into her arm. There was only limited equipment to monitor her blood pressure and nothing to control her breathing, not to mention the shortage of skills and experience. Looking at Anna’s condition and the amount of blood around her it was clear she needed blood transfusion. But blood could only be provided if it was replaced by donation by family members, which is commonplace in Africa. I was hoping someone outside was arranging this quickly. At first glance I was horrified – horrified by the fact Anna was in this situation in the first place and horrified by the short supply of well-trained health professionals and basic equipment available. While this would be considered substandard care and negligent at home in the UK I could see the courage, determination and compassion shown by the team. With what they had available they were doing their best. Without their commitment and struggle, Anna would die for certain. They gave her their all.

Once everything was under control the obstetrician handed over to his assistant to finish up. I asked him what he thought her chances of living were. He humbly replied, “We don’t have much, but we do our best.” I went to Liberia in West Africa with a group of six healthcare workers from the UK in December last year. Save the Children (www.savethechildren.org.uk/healthworkers) arranged for us to visit clinics in rural areas as well as some hospital facilities. The experience was eye opening and brought to life the dreadful World Health Organization (WHO) statistics on child and maternal mortality that previously I had only read in newspapers. Liberia is recovering from a decade of civil war that ripped the country apart. Much of the infrastructure was destroyed including basic health care. Today, Liberia’s government, doctors, nurses and midwifes are doing everything they can to rebuild the shattered health system. Liberia has one doctor for every 3751 people; the UK has 48 times as many. We saw the effects of UK and international aid and how it has helped to set up facilities such as the hospital in Bong County, without which women like Anna would certainly die. We met dedicated Liberian healthcare workers, working around the clock and in some clinics there is no running water, no electricity and no lights. A midwife told me that she has to conduct deliveries in the dark, using nothing but her mobile phone light to see. The visit has inspired me to campaign for international health in my role as a Health Ambassador for Save the Children. In Liberia I felt helpless, that despite my skills acquired in the UK I was unable provide any practical care. But I learnt that aid must be sustainable being built by Liberians rather than relying on doctors from overseas and that change can only happen through campaigning. An amazing campaigning result means that health care for women and children in Liberia is now free. One in ten Liberian children don’t make their fifth birthday; however, this is an improvement as only a few years ago it was one in five. As doctors we can provide a powerful voice and show our support for healthcare workers abroad working in difficult circumstances that we find hard to comprehend in the UK. Scenes from Bong County Hospital, Liberia Thank you to www.savethechildren.org.uk for use of these images.

Education

Improving Training Improves Health Care: An Update from the Faculty Development Committee

By Dr M. Jane MacDougall FRCOG, Chair RCOG Faculty Development Committee “A teacher can never truly teach unless he is still learning himself”1 has to be a better approach to educator development than the old concepts of “see one, do one, teach one”. It is increasingly recognised that we can all improve how we teach, but we need help to do this. Many of you spend considerable amounts of time organising and delivering education to both under- and postgraduates. The RCOG values and is keen to support all those involved in teaching and training in our speciality. In addition, the GMC is introducing a new system to strengthen the role of medical trainers, and with the Academy of Medical Educators has developed a set of standards for educators. Following discussions last summer when the Faculty Development Committee was established, we are part way to defining a clear career pathway for educators in our speciality, all of whom will belong to the RCOG Faculty of Educators. As well as developing this framework the Faculty Development Committee is conducting a gap analysis of current

RCOG Faculty of Educators

training provision for trainers and is developing a means of quality assuring current and future courses. It is important to be on the lookout for better ways of providing training and we are committed to encouraging educational research within the speciality. We are also keen to identify what support Members and Fellows would require from their Faculty membership. At this early stage in development of our Faculty we welcome comments on the above from Members and Fellows involved in education. Please get in touch with myself (jane.macdougall@addenbrookes.nhs.uk) or Kim Scrivener (kscrivener@rcog.org.uk) at the College with comments or questions.

Reference 1 Rabindranath Tagore, Nobel Prize winner for Literature 1913.

Education | continued

Curriculum Changes and Alignment with a ‘Single Version’ of the Curriculum: An Update from the Curriculum Committee By Mr Kim Hinshaw FRCOG, Chair RCOG Curriculum Committee and Ms Kim Scrivener, Director Education Policy & Quality, RCOG Our Committee has had a particularly busy time over the last year or so! Keeping the curriculum up to date is a bit like painting the Forth Road Bridge and it is with some relief that we are actively engaging with the GMC’s recent instruction to move all trainee doctors in all specialties onto the most up-to-date version of their curricula. (In O&G, trainees are following various versions of the core curriculum and logbook depending upon the year the trainee entered training: ‘pre-2007=SpR’, ‘ST 2007–10’ and ‘ST 2010 to present’.) The relief is tempered with some trepidation as we work closely with Heads of School and trainees to make sure that this move does not disadvantage anybody come August 2013. The RCOG is planning to implement this change in August 2013 to allow plenty of time for individual trainees to encompass any additional skills/competencies by the final date given by the GMC (end December 2015). There is no doubt that this is a huge piece of work but once it is done, and all trainees moved to the e-portfolio, it will be much easier for trainees to keep up with changes on an annual cycle, which means they will be trained to the highest standards relevant to contemporary practice in our specialty. Since the GMC changed its curriculum approval process last year, we have made three specific curriculum submissions: 1

The Academic Committee worked hard on a brand new curriculum for academic trainees. It has now received GMC approval as a pilot for two years. There is a GMCled national project underway to evaluate and improve the arrangements for academic training pathways in postgraduate medical education, our pilot will contribute to the national deliberation.

In January this year, we submitted a large number of changes to the Core Curriculum, the most significant of which was the move of many advanced competencies to intermediate level. This has been the

most substantive recalibration of the curriculum since its introduction in 2007, and has given us a head start over other specialties in implementing the single version of the curriculum. Following the final approval from the GMC for the Core Curriculum at the end of April 2013, plans are in place for the agreed curriculachanges to go live in August 2013.

Developing the curriculum for Tomorrow’s Specialist As part of Tomorrow’s Specialist, the RCOG held a Curriculum Focus Day, facilitated by Professor Wendy Reid, Vice President for Education. It was a lively and interesting day, with attendance from a wide-ranging group of interested parties. In particular we ensured several attendees representing patients’ views. ‘Thinking outside the box’ was the flavour of the day in terms of core qualities we want our doctors to have, apart from the important technical aspects of our specialty such as ‘human factors’ or nontechnical skills (communication, leadership, situation awareness, decision making, team-working, etc.) and empathy. There was a notable contribution from the lay representatives, signalling perhaps a change arising directly from the recommendations of the Francis Report – ways of improving patient and lay input into our curriculum will be actively taken forward as a result of the Focus Day, as well as the message of the overriding importance of patient safety. The Committee values contributions from colleagues and values input into the various subgroups working on specific aspects of curriculum development. If you would like to contribute to a particular area that interests you, please contact the present Chair, Mr Kim Hinshaw (kim. hinshaw@lineone.net) or Alice Lambert who supports the work of the Curriculum Committee (alambert@rcog. org.uk). We will keep your details at hand and will contact as and when particular concerns arise.

College archives

The RCOG and Wertheim’s Procedure for Hysterectomy By Penny Hutchins, RCOG Archivist

The 170th anniversary of the first ‘subtotal’ hysterectomy in 1843 takes place in 2013. This article sets out to celebrate the achievements in the development of the procedure for hysterectomy and to reflect how this progress has been marked in the collections held in the RCOG Heritage collections. Hysterectomy is defined as ‘the surgical procedure to Charles Clay (1801–1893), an English surgeon practicing remove the womb’ and is carried out today for reasons of in Manchester, is credited with performing the first menorrhagia, fibroids, pelvic pain and ovarian, uterine or successful ‘subtotal’ hysterectomy in 1843 (removal of the cervical cancer. Early attempts at hysterectomy from the womb and retaining the cervix). Known as the ‘Father of Greek era to the eighteenth century were the results of Ovariotomy’ after having perfected the procedure for attempts to treat gangrene, ulcers or infections in the surgical removal of an ovary or ovarian tumour, it is now cervix and surrounding area. These attempts were accombelieved that his first hysterectomy was in fact intended to panied by a mortality rate of 90% and more, and even in the be an ovariotomy, and was only successful in as far as 1840s and 1850s, the lack of anaesthetics or recognition of the procedure – the chloroform led to death through haemorunfortunate patient did not survive The work of these rhage, infection and shock. beyond a few days. early-twentieth century The history of the development of the Ten years later in 1853, a US surgeon procedure for performing hysterectomies and early advocate of ovariotomy, surgeons should be is intricate and internationally based, with Walter Burnham (1808–1883) peracknowledged as an surgeons from the US and Austria building formed the first successful subtotal important stepping stone on the experiences of colleagues in the UK abdominal hysterectomy – again a in the advances made in and France. There is a story that the first consequence of surgery to remove an documented hysterectomy of the modern ovarian tumour. The first successful the treatment of cervical era was performed by accident. A Milanese total abdominal hysterectomy was cancer and in safer surgeon, Dr G Paletta, apparently found performed by Dr G Kimball in Boston, procedures for that he had removed the entire uterus Massachusetts, for the treatment of hysterectomy vaginally when intending only to perform fibroids. Over the next 23 years, he amputation of what he had diagnosed as a carried out 42 hysterectomies; only malignant cervix. The patient then died of peritonitis. nine patients are known to have survived. The first planned hysterectomy was probably performed The development of surgery for hysterectomy really accelby Dr J N Sauter Barden in 1822, once again as a vaginal erated in 1898, when the Austrian gynaecological surgeon, procedure. Unfortunately the patient’s bowel came out Ernst Wertheim (1864–1920) assisted at a hysterectomy for through the vagina and had to be kept reduced with a lint uterine cancer, it was this battle against cervical and uterine pack, following which the patient developed a fistula. cancer that was to be the real impetus in hysterectomy success. Wertheim went on to be at the forefront of the Austrian and German movement to develop a more radical hysterectomy for cancer of the cervix. Perfection of the procedure was led by his research on the timing and extent of the spread of cervical cancer throughout the uterine area. The procedure for radical hysterectomy as perfected and named after Wertheim, involves the removal of the womb and surrounding tissues, and is still the recommended method in cases of cancer. Although other surgeons are known to have pioneered the procedure still further in later years, aided by the availability of antibiotics and later the technology of laparoscopy, it is with Wertheim that the discussions relating to hysterectomy among the College papers begin. Two leading lights of the early-twentieth century London O&G scene were William Francis Victor Bonney (1872–1953) and Sir Comyns Berkeley (1865– 1946). Bonney was a staunch Fellow of the Royal Figure 1 Bonney's Wertheim Clamp, developed by Victor Bonney to assist in College of Surgeons and refused to join the new Royal retraction of abdominal walls. Held in RCOG Museum 73/774.

Membership Matters | Volume 3 Issue 2

16 College of Obstetricians and Gynaecologists, being made an Honorary Fellow in 1946 in recognition of his services towards the specialty; Berkeley was a Founding Fellow and Trustee of the British College of Obstetricians and Gynaecologists. Both worked for the Middlesex Hospital, and both were struck by the efforts in developing the hyste-

“Mr Meredith [Lockyer’s colleague] possessed a ‘carriage and pair’ and drove us all down to Plaistow on the date given which, if I remember rightly, was on a Sunday morning. Professor Wertheim operated. I assisted him. In the middle of the operation the house-surgeon’s help was sought by Wertheim to aid in the retraction of the abdominal walls. Since Wertheim scorned artificial retractors and likewise the use of rubber gloves.” rectomy procedure of their fellow surgeon, Cuthbert Henry Jones Lockyer (1867–1957), a gynaecological surgeon and pathologist on the staff of the Charing Cross Hospital, Samaritan Hospital, Royal Northern and St Mary’s, Plaistow. Among the papers of the RCOG Honorary Secretary in 1950, Humphrey Arthure, is a letter written to him by Cuthbert Lockyer describing how he invited Ernst Wertheim to come to London on 23 July 1905 while visiting Great Britain, and demonstrate his operation [Archive Reference: RCOG/A7/1/2].

Unfortunately, the house surgeon had been dressing a septic case immediately prior to this operation and had not finished washing his hands in theatre, and consequently the patient died on the third day after the operation. Lockyer successfully took up the operation with a mortality rate of 18% in 115 patients, and stimulated Berkeley and Bonney to start their Middlesex Hospital series, the consequence of which was the introduction of Wertheim’s operation in the UK. From 1907, Bonney and Berkeley treated all cervical cancer cases presented to the Middlesex Hospital, and so were able to keep track of success rates in patients, even five or ten years after surgery. Publishing evidence and statistics of success rates was important for overcoming the scepticism with which Wertheim’s original paper on his operation was greeted by older British gynaecologists, mostly due to the high mortality rate associated with the procedure. William Fletcher Shaw, co-founder of the RCOG, and consultant at Manchester, was forefront in the discussions relating to hysterectomy from 1912 throughout the 1920s and 1930s. In this research he was joined by Professor Miles Harris Phillips, of Sheffield, who engaged in historical research to support theories about O&G practice, and among whose papers can be found discussions with US peers on vaginal hysterectomy and success rates (Archive Reference: S97). Bonney wrote to Fletcher Shaw in January 1930, mainly about College Fellowship matters, but also enclosing a small chart of figures showing “five-year cure rates” for operations performed by Wertheim, Mayer, Stoeckel, Zweifel, Franze, Bumm, Bonney and Fletcher Shaw, and this explanation:

“As regards your Wertheim figures, I have simply put them under your name in a small table I have drawn up showing the results obtained by the principal performers of the operation, such as Wertheim, Mayer Franze, Bumm etc. I enclose a copy of the table as it will appear in my paper. If you would sooner it did not appear do not hesitate to say so, but personally I think the association with so many famous surgical names is an honourable one.” [Reference RCOG/A1/29]

Figure 2 Victor Bonney, 1922 RCOG Photograph Collection

Fletcher Shaw’s initial interest was in hysterectomy following caesarean section and ‘accidental haemorrhage’, but this moved through the years to a debate on the merits of subtotal hysterectomy and absolute hysterectomy, and to the use of radiotherapy in conjunction with hysterectomy for cases of cervical cancer. The work of these early-twentieth century surgeons should be acknowledged as an important stepping stone in the advances made in the treatment of cervical cancer and in safer procedures for hysterectomy, and the association of the College in these developments is further shown by the work of Fellow Patrick Steptoe, who in 1967 wrote the first English text on laparoscopy, which was introduced into Europe during the 1940s (with the first laparoscopic hysterectomy being performed by Harry Reich in Kingston, Pennsylvania in 1988). We must be thankful that these words of Sir William Fletcher Shaw are no longer the case: ‘The chief cause of death is shock, and the wider the operation is taken the greater the mortality.’

College news

Helicopters, Sheep, Gorillas and Boats at the Maternity Patient Safety Day By Mrs Anita Dougall, Director, Clinical Quality

The first RCOG Maternity Patient Safety Day on 15 February 2013 saw 76 delegates treated to real-life examples of the patient safety experiences of clinicians from across England and Wales. anyone interested in being part of the development of the Miss Gubby Ayida from Chelsea and Westminster Hospital indicators and piloting the thermometer to contact her via kick-started the day with a rousing presentation about her the College (adougall@rcog.org.uk). trust’s experience of implementing best practice. Helicopter From national initiatives, comes local improvements and handovers, checklists and pro formas have become the the team lead by Frances Bolger in Ipswich demonstrated norm on delivery suite, but they still face the challenges of the changes they had made as a result of being involved in how to ensure that resuscitaires are checked and that the King’s Fund ‘Safer Births Initiative’. Using photos and retained swabs really are a ‘Never Event’. describing real-life scenarios (including attending a home The spotlight was turned onto the delegates when Vijaya birth on a boat), they explained how they had used pro Nath, from the King’s Fund, laid down the challenge for formas, risk assessment, community-based training and maternity service leaders to question cultures, routines and standardised equipment bags to prevent a recurrence of rituals. She directed the audience to the Safer Births toolkit three serious incidents that had prompted their application for information on team-working, communication, training, to the King’s Fund to improve the management of obstetric information and guidance and staffing and leadership emergencies in the community. (http://www.kingsfund.org.uk/publications/improvingStaying in the East of England, the audience implored Dr safety-maternity-services). Martin Cameron not to be so hard on himself and his unit The Maternity Collaborative was formed as part of the when he told us about his “failures” at the Norfolk and national 1000 Lives Plus programme, backed by the Welsh Norwich Hospital. They set off on an ambitious project to Government (http://www.1000livesplus.wales.nhs.uk/mater compare themselves with the Matching Michigan work to nity). Phil Banfield and Cath Roberts presented the work reduce patient safety incidents. They found that they had they have led to develop care bundles, based on the Institute to discontinue using the statistical process charts (SPCs); of Health Improvement (IHI) Model for Improvement, to as they realised the project was too big and too improve the experience and outcomes for women, ambitious to be sustained. However, they have babies and their families within maternity They also had success with their ‘Safe Hands’ meetings services. They also described how they have described how that are continuing to provide a forum for modified guidelines in order to make them they have multidisciplinary handovers on delivery suite. applicable to their population (and how they use The final slot for the day fell to the College’s sheep to practice insertion of chest drains!). modified Research Fellow, Hannah Knight, where she Mr Kim Hinshaw introduced the delegates to guidelines in unveiled the RCOG Clinical Indicators Project. the importance of ‘nontechnical’ or human order to make Using risk-adjusted data from the Hospital factors training. With the aid of a video involving them applicable Episode Statistics database, the project has a walking gorilla, he demonstrated the importuncovered wide variation in intrapartum care ance of remaining alert for changes in a patient’s to their among English maternity units in terms of 11 condition while focusing on a particular task. population carefully selected indicators. Following her Kim also gave an overview of the tools that can presentation, Hannah took questions on the be used to improve the way that teams compossible role of poor coding in explaining some of this municate and work together to improve patient safety on variation, and addressed the matter of whether the the labour ward. Situation, Background, Assessment, obstetric trauma rate, traditionally used as an indicator of Recommendation (SBAR) tools have been in use for some patient safety, should continue to be used in this way given years, but few in the audience may have been aware of Nonthat low tear rates can also indicate under-reporting and technical Skills for Surgeons (NOTSS) training to improve underdiagnosis. The first report is due out in April and is situational awareness, decision making, communication keenly anticipated. and teamwork and leadership. Eddie Morris drew the day to a close and summed up the ‘Harm-free care’ is something all clinicians strive for and day highlighting the quote from Debby Gould who said: Debby Gould explained the aims of this NHS Quest project and the development of the maternity safety thermometer, which provides a ‘temperature check’ and can be used “where there’s variation, there’s the chance alongside other measures of harm to measure local and of improvement”. system progress. Debby is now leading work to develop a maternity safety thermometer using indicators such as Planning is now underway for the next Maternity Patient perineal trauma, women’s experience, postpartum haemorSafety Day on 21 March 2014. In the meantime, look out for rhaging (PPH), Apgar scores and infection and, she urged improvement training opportunities here at the College.

Membership Matters | Volume 3 Issue 2

Joining the Quest for Sustainability: An Update from the RCOG Green Group By Benedetta La Corte, RCOG Policy and Project Lead

RCO2G

The RCOG Green Group was established in 2008. In the last five years, it has worked to reduce the environmental impact of the College, achieving, among other objectives, a 47% reduction in paper consumption.

It was thanks to a small group of committed individuals, supported by senior management and Honorary Officers that the College began to take action on its environmental responsibilities by establishing the Green Group in 2008. The Green Charter, launched in 2009, set out a ten-point plan to reduce the College’s impact on the planet, with targets to be reviewed at regular intervals. So far we have achieved a 5% reduction in electricity usage, and a staggering 47% reduction in paper consumption. Our catering services have greatly contributed to the environmental efforts, by (among other things) adopting biodegradable packaging and completely eliminating polystyrene cups. Recycling facilities are available in strategic places around the building, and spot checks are in place to monitor the switching off of lights and computer monitors at the end of the day, as well as the departments’ printing patterns. But there is still much to be done. In the past year, the Green Group has been working on setting a sustainability agenda that encompasses not just the environmental impact of 27 Sussex Place, but also that of the travelling of

College members and fellows, Honorary Officers and staff. Collating information to generate a comprehensive ‘carbon footprint’ of the RCOG in all its activities is a big endeavour, which relies on the goodwill and spare time of the Green Group members. The year 2013 marked the start of a budget allocation to the College’s environmental work. This is an important symbol of the College’s commitment to ingrain sustainability in all its practices. Being an organisation that has relationships with a variety of stakeholders, the RCOG is ideally positioned to make and spread sustainable change across a wide spectrum of society, including women and their families, clinicians and our local community in London. Social value, procurement and health promotion are among the areas we will be looking to strengthen our focus on. If you would like to know more about the RCOG Green Group and its sustainability work, please email blacorte@ rcog.org.uk. We would also welcome your comments and suggestions on how we should drive the environmental agenda, both inside and outside of the College.

The Retired Fellows and Members Society

By Mr Harvey Wagman FRCOG, Chairman of the Retired Fellows and Members Society The Retired Fellows and Members Society meeting was held at the College on 22 March 2013 where we had a record number of over 40 attendees, with both members and their partners welcomed to the meeting. We were also pleased to welcome a retired Fellow from Tasmania who was holidaying in the UK; the society would encourage any other overseas members who might be in the UK at the time of the next meeting 15 November 2013 to come along. Mr Jeremy Wright FRCOG recounted his experiences of his late ‘gap year’ to Ethiopia. The obstetrics he saw ranged from obstructed labour, ruptured uterus and destructive operations; in gynaecology there were many cases of carcinoma of the cervix and the useful advice to treat leeches in the vagina with lemon juice. Finances were limited but the community had cycle-ambulances and waiting houses. His trip was subsidised by the RCOG and through private donor support and in discussion one had proposed the Warren Buffer Charity Funds as a useful source. Miss Celia Macleod FRCOG gave a sensitive and personal experience of gender reassignment in her lecture ‘From Colin to Celia – one gynaecologist’s journey into womanhood’. Celia gave an account of the emotions and changes in her family life to the eventual publicity of her story, discussing her counselling, significant surgeries and hormone

therapy. Celia is now an active campaigner for same-sex marriage and hopes to remarry her wife following her gender reassignment. Mr Chris Naylor FRCOG the first speaker to present to the society for a second time reminded the group of incidents when obstetricians and midwives have been charged with manslaughter. These were mainly in relation to the complications of contemporary clinical practice in the 1970s. He highlighted the role of hubris described as a ‘red mist’, which was a significant risk when armed with the Kiellande Forceps, a status symbol for some time but now much less popular. The date of the next meeting is 15 November 2013 at 1pm, partners are once again welcome. The confirmed speakers are Professor John Studd FRCOG, who will be addressing the group on nineteenth-century attitudes to sexuality in literature, art and music, Dr Brigid Hayden FRCOG will be discussing her experiences in Liberia. Should you wish to attend this event please contact Miss Rebecca Deegan (rdeegan@rcog.org.uk) 020 7772 6228. The event is £15, which may be paid in advance via cheque or credit card. Join the Retired Fellows and Members Society on LinkedIn.

College news | continued

The RCOG Takes on a Workplace Behaviours Advisor

By Dr Jo Mountfield, FRCOG, RCOG Workplace Behaviours Advisor

Jo Mountfield has recently been appointed as Workplace Behaviours Advisor for the College. So who is she and why did she want to take this on? Jo explains. I am a Consultant Obstetrician in University Hospitals Southampton NHS FT. I work clinically part-time as I have two other roles. The first is Director of Education for the Trust and the second is Head of School for Obstetrics, Gynaecology and Sexual Health for the Wessex Deanery. At the interview I was asked if I wanted to take this post on because I had been bullied or because I was one myself. A good question. The answer was neither. That said my first clinical experience as a third-year student was being publically humiliated by an eminent professor who felt that although we had not been shown or taught how to examine a patient I should have done it anyway before the ward round. Otherwise “how was I going to learn anything”? Not an auspicious start to one’s clinical career. Am I a bully? I hope not although I am assertive and senior and so have to work on the approachability angle. I think it is important for all clinicians to be aware of the impact of their behaviour on others and, not being perfect, I have occasionally had to apologise when my frustration with a situation gets the better of me. So why did I apply for the job? I had hoped since my medical school days things had moved on but it seems that this is not universally the case. I became more involved with this a few years ago when the GMC Trainee Survey data first appeared and the specialty appeared as an outlier. After hearing Helen Richardson (Associate Dean) from the Northern Deanery speak at a Heads of School meeting about her success in reducing undermining in surgery by running workshops in every unit, I felt we should be able to make similar efforts in O&G. First, I produced videos on undermining and bullying for the College that are still available via StratOG. Sadly these were all true stories collected from trainees (and trainers). Although these are a good resource, watching a video does not change behaviour and therefore these do need to be used as part of a wider intervention especially where there are concerns. In Wessex we then went on to develop a multiprofessional workshop run within departments to raise awareness of undermining and bullying. We will be publishing the research on the impact of these soon but they do seem to have a positive effect. We continue to roll these out in every unit. Other deaneries such as East of England and West Midlands have also developed uniprofessional workshops for a similar purpose. So what now? One of my first actions in this role will be jointly facilitating a workshop with the Royal College of Midwives in April, with representatives from a wide range of stakeholders including the Royal College of Paediatrics and Child Health, and the Obstetric Anaesthetists’ Association. Our aim is to agree a series of initiatives and work streams to enable and support deaneries and individual departments in resolving these matters. The outputs from the workshop will also help us produce guidance for O&G trainees and trainers, including FAQs and a list of resources. Ted Adams, Chair of the Trainees’ Committee

and a number of other trainees will be at the workshop, and I intend to discuss progress and get ideas from the Trainees’ Committee on a regular basis. I can be contacted at undermining@RCOG.org.uk with any ideas you have for improving things, or with general concerns, though please note that I am unable to deal with individual complaints unless they have been through your deanery channels. I don’t think there is a simple solution to undermining and bullying. I think the reasons for our low standing as a specialty are multiple and complex. What I can promise is that the College is fully signed up to improving the current situation and we will be working hard to make a real difference.

2014 Invitation to Fellowship Members approaching 12 years standing (the minimum time before election to the Fellowship) are invited to submit an application for consideration for election to the Fellowship, further information can be found on the College’s website http://www.rcog.org.uk/content/generalguidelines-election-fellowship. The deadline for applications is 5 December 2013

2014 Invitation for Nominations for Fellowship ad eundem/honoris causa The RCOG is now accepting nominations for Fellowship ad eundem and honoris causa: Fellowship ad eundem is bestowed by the College to individuals who have demonstrated through research or clinical commitment, major contributions to obstetrics, gynaecology or reproductive health and advanced our specialty through those endeavours. Candidates should be of an extremely high scientific calibre and must have contributed to the advancement of the science or practice of O&G in a substantial way. Fellowship honoris causa is bestowed by the College to individual(s) who has (have) demonstrated: the highest level of dedication and achievement in clinical care; or the highest level of support to the development of women’s healthcare services; or the highest level of work/support for the RCOG. Please find more information on the College’s website http://www.rcog.org.uk/honorary_fellowship. The deadline for applications is 7 October 2013

College news | continued

Getting to Know the Honorary Oﬃcers: An Interview with Dr Paul Fogarty FRCOG, Honorary Treasurer Dr Paul Fogarty FRCOG, Honorary Treasurer

Describe your College role in one sentence.

My role is to provide a strategic business approach to the RCOG activity and to promote clinical and technological innovations keeping us at the forefront of national and international medical institutions.

How do you see the role of Honorary Treasurer changing in light of the changes to the College’s governance structure?

As the Chair of the new Finance and General Purposes Committee, the Honorary Treasurer now has a pivotal role in ensuring the smooth running and survival of the RCOG as a business while establishing strong links between Council and the Board of Trustees.

What attracted you to becoming an Officer?

As a College Officer there is a unique opportunity to make a significant contribution at a national strategic level to the whole range of concerns influencing women’s health in the UK. These include setting standards for the education of O&G specialists and for the delivery of the high-quality evidence-based clinical services. The international work carried out by the College also provides the opportunity to contribute to women’s health matters on a more global scale.

As Chair of the Congress Committee can you tell us how the scientific programme is planned?

The process works differently for Congresses held in UK and those held oversees. When the RCOG World Congress is held in the UK, the Honorary Director of Conferences puts together the scientific programme with input from the Congress Committee. This year, for the first time, we have actively sought the involvement of the UK’s Specialist Societies in the creation of the scientific programme for the World Congress in Liverpool. Many have designed their own sessions with world-renowned speakers from the UK and further afield to share their expertise and knowledge. When the World Congress takes place overseas, the Local Organising Committee put together a programme with input from the RCOG Officers and the Congress Committee. The World Congress brings together clinicians from all over the world so it is important for the programme to showcase best practice from around the globe and provide a forum for topical and controversial debate.

If you could go back in time now and give yourself one piece of professional advice, what would it be?

“You only get one chance to make a first impression.”

If you could choose anyone, who would you pick as your mentor/role model?

There are many classical leaders but as someone from the emerald isle working in London one famous Anglo Irish Leader springs to mind – Sir Ernest Shakleton. Along with Captain Scott and Amundsen he was one of the great polar explorers and a remarkable leader of men epitomised in his heroic open boat rescue when his ship the Endeavour was trapped and crushed in the pack Ice. I highly recommend a great book Shackleton’s Way: Leadership Lessons from the Great Antarctic Explorer by Morrell and Capparell.

What mark would you like to leave at the end of your career at the College?

I believe the success of the College is a result of the combined efforts of all the Officers and College staff. While individual Officers take the lead in their specific areas of responsibility successful outcomes are dependent on the combined support and efforts of the whole team. One area which I have enjoyed leading has been the RCOG World Congress, which has become one of the flagship events of the College Calendar. I am sure that with the continued support of the Officers, the excellent College staff and the Fellows and Members the Congress will continue to grow and develop, further enhancing the College’s global reputation.

You have a love of India. What do you hope will be the outcome of the RCOG’s work there?

I love the people and culture of this remarkable country. Their respect, support and loyalty to the RCOG are unwavering. It was very natural that the specific educational agenda was formulated and developed in India and I am delighted that we are bringing the World Congress there next year (rcog2014.com)

If you could trade places with any other person for a week, famous or not famous, living or dead, real or fictional, who would it be?

Wouldn’t it have been great to have spent a week with Steve Jobs and not just because we have similar beards! To have experienced his vision in the thrilling and exciting ways that technology could change our lives but also having the tenacity to deliver what others thought impossible.

When you are not working what do you enjoy doing?

I have a great love for travelling and scuba diving preferably combined the two in exotic warm-water locations.

What is one of your favourite quotes?

“Don’t sweat the small stuff…and it’s all small stuff”

Richard Carlson

Membership Matters | Volume 3 Issue 2

2013 Committee Appointments The College is extremely grateful to those who put themselves forwards to contribute to and engage in the College’s work through committee membership. Appointed at the AGM in 2013 were: Academic Committee Professor Z Alfirevic FRCOG Chair

Part 2 MRCOG MCQ subcommittee Mr S M Hughes FRCOG

Assessment subcommittee Mr N A Myerson FRCOG Miss R J Goddard FRCOG Dr N Mukhopadhaya MRCOG Dr S Khazali MRCOG

Part 2 MRCOG EMQs subcommittee Dr S I McNeill MRCOG Dr J S Kallat MRCOG Mr S D K Visvanathan MRCOG

DRCOG subcommittee Mr A S El Fara MRCOG Dr A D Gumma MRCOG Mr F Imoh-Ita FRCOG Faculty Development Committee Professor D J Cahill FRCOG Global Health Policy Advisory Board Professor A N Fiander FRCOG Chair Global Placement Committee Dr S G Barnfield MRCOG Dr M E Murnaghan MRCOG Mr R S V Cartmill FRCOG Mr J J S Waugh MRCOG Miss J I Tay FRCOG Guidelines Committee Dr H K Sidhu FRCOG Dr P S Arunakumari MRCOG Part 1 MRCOG subcommittee Dr U D Gordon FRCOG Dr M S A A Allam FRCOG Dr M A Sharma MRCOG

Prt 2 MRCOG Oral Assessment subcommittee Mr D J Burch FRCOG Chair Dr A J Thomson MRCOG Dr R G Hughes FRCOG Dr S A Abdel-Fattah FRCOG Part 2 MRCOG Short Answer Questions Miss S J Ward FRCOG Chair Mr M R Cohn FRCOG Dr A G Bhide FRCOG Patient Information Committee Dr L E Caird FRCOG RCOG Women’s Network Dr A L Wright FRCOG Research Committee Professor L Poston FRCOG Chair Revalidation Committee Dr J T Preston FRCOG Safety and Quality Committee Mr T C Hillard FRCOG Chair Dr C A Burrell MRCOG Dr S K Harding DRCOG

Scientific Advisory Committee Professor S M Nelson MRCOG Chair Dr A W Horne MRCOG Dr M E M E Metwally MRCOG Dr I J G Harley MRCOG Scottish Committee Dr A W Horne MRCOG Dr V A Mackay MRCOG Specialty Education Advisory Committee Mr A J S Watson FRCOG Chair Subspecialty Committee Dr R S Mathur FRCOG (British Fertility Society) Mr J T S Kehoe FRCOG (British Gynaecological Cancer Society)

Election of new Oﬃcers 2013 The present Officers and Council of the RCOG are pleased to announce that the following have been elected as new College Officers: Dr Paul Fogarty, Senior Vice President (Global Health)

Dr Clare McKenzie, Vice President (Education)

Professor Alan Cameron, Vice President (Clinical Quality) They will take up post from 27 September 2013.

2013 Honorary Appointments Convenor Basic Practical Skills Courses Mr W C Yoong FRCOG ATSM Officer Dr A J Campbell MRCOG Advisor on Workplace Behaviour Dr S J Mountfield FRCOG Simulation Officer Dr A Gale FRCOG Convenor for Train the Trainer’s Courses Dr A A Taylor MRCOG Assistant Convenor Mr R V M Haughney FRCOG

In Memoriam Dr Manickam Kanagalingam, Malaysia

Dr Ralph Maurice Hampstead Malone, Canada Dr Jean Orr Struthers, Scotland

Mr Peter Ashley Robertson Niven, England Ms Maimoona Dossa, Wales

Professor Robert Geoffrey Edwards CBE, England

Dr Andre Alexius Visser, South Africa

Dr Margaret Alison Bigrigg, Scotland

We would like to encourage the membership to submit feedback, ideas and features for Membership Matters. So, please let us know if you have any suggestions for content or articles for submission.