Membership Matters

Volume 3 | Issue 2 Summer 2013

Your membership magazine from the RCOG: stories from the specialty 2 Membership Matters | Volume 3 Issue 2 Contents From the President 3 College archives

The RCOG andWertheim’s Procedure for 15 Centre COG Achievers College news Dr Kamini Rao FRCOGWins Prestigious FIGO Award 4 Helicopters, Sheep, Gorillas and Boats at the Maternity Dr Geetha Nagasubramanian FRCOG MBE 4 Patient Safety Day 17 Joining the Quest for Sustainability: An Update from the Stories from the Specialty RCOG Green Group 20 The British Society for Gynaecological Endoscopy: Endoscopic The Retired Fellows and Members Society 20 Skills and SimulationTraining 5 The RCOGTakes on aWorkplace Behaviours Advisor 21 UterineTransplantation in the UK: Approaching the First 2014 Invitation to Fellowship 21 HumanTrials 6 2014 Invitation for Nominations for Fellowship ad eundem/ Investment in Preterm Birth: Perils and Possibilities 7 honoris causa 21 NHS Change Day 8 Getting to Know the Honorary Officers: An Interview with Dr Paul Fogarty FRCOG, HonoraryTreasurer 23 International 2013 Committee Appointments 24 InternationalWomen’s Day: End Forced Marriages 9 In Memoriam 24 Fighting Maternal Mortality in Liberia 10 Education

ImprovingTraining Improves Health Care: An Update from the Faculty Development Committee 12 Curriculum Changes and Alignment with a‘SingleVersion’ Illustration by Dr Naila Khan of the Curriculum: An Update from the Curriculum Committee 13

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 [email protected] All materials © 2013 RCOG, unless otherwise stated

Typesetting and layout: Fish Books Ltd. From the Dr Tony Falconer President, Royal College of President Obstetricians and Gynaecologists

ince the last edition of Membership Matters was clarification about the published, the extremely profound second report system, quality assur- by Robert Francis QC into the failings of a large ance of which will be hospital to provide humane and appropriate care addressed by the GMC in was released. This analysis has been a shocking the course of time. and serious reminder to all healthcare professionals of their The implementation of Sprofessional responsibilities to patients. Many institutions the Governance Review have responded and the Royal Colleges are consulting with will become apparent their members on the appropriate responses and implemen - when the new Board of tations required. Trustees Board assumes responsibility for the charitable Although the Francis Inquiry is focused principally on activities of the RCOG on 3 Monday June. From then, elderly and frail patients and not on the care provided in Council will be able to focus more on strategy and profes - maternity and gynaecological services, there are messages sional concerns. that resonate clearly for us: professionalism, putting the needs of patients first and the need for empathy and The following will sit on the Board of Trustees: compassion. These are all basic elements of a doctor’s duty The President (Chair) to their patients as highlighted in the GMC’s recently • updated guide Good Medical Practice . • The Senior Vice President Indeed, the Francis recommendations present us with the The Honorary Treasurer opportunity to focus on patient safety, team working, the • problem of undermining and the importance of the need Four selected lay Trustees following competitive for accurate and robust metrics. Successful implementation interviews: of all these components should improve the quality of health care for women. • Ms Naaz Coker The first of April or ‘April Fool’s Day’ had a particular Mr Roy Martin QC significance in England this year with the introduction of • the greatest structural change to the NHS since the • Ms Linda Nash inception of the service in 1948. The divergence of the NHS Professor Eric Thomas in the UK has been greatly highlighted by the implemen - • tation of the reforms of the Health and Social Care Act Two selected members following competitive interview: (2012). NHS England is now a reality and the commissioning • Dr David Farquharson FRCOG responsibilities are now devolved to the NHS Commis - Dr Daghni Rajasingam MRCOG sioning Board and the clinical commissioning groups. The • anxieties surrounding competitive tendering continue to The member or fellow elected from Council will be deter- pose a threat to some services but it is interesting how mined at the next meeting. varied and divergent the responses have been to this matters across different specialties within medicine. The The annual world congress in Liverpool will be on us in no profession does not speak with one voice, when it comes to time at all. The success of recent congresses has been a competition. The changes to the NHS in England are huge huge boost to the RCOG staff and in particular for those and will impact in all areas including education and working in the meetings department. Liverpool is a training. The profession and specialty is fortunate to have magnificent location and the combination of an outstand- Professor Wendy Reid as Medical Director of Health ing scientific programme, with social activities against a Education England. These changes are unique to England backdrop of music by The Beatles should satisfy most and magnify differences in the approach of the devolved delegates. I look forward to greeting many of you from nations. overseas and from the UK to this meeting. You will not be Revalidation started in December 2012 and, as I write this disappointed. piece, I am aware that nearly 3000 doctors have been Finally, I wish to congratulate Dr David Richmond, who through the process. Having gone through the procedure has been elected as President of the RCOG from 27 myself, I feel that I have significant insight into the poten- September 2013. David has been an inspirational Vice tial challenge necessary to comply with the requirements President for Clinical Quality and has all the personal successfully. I found the RCOG e-portfolio extremely helpful qualities and attributes to be an outstanding President. I but quickly became aware of the importance of keeping the am confident that the membership, both within and log up to date. The 360-degree feedback from patients and without the UK, will support him in his future drive to peers is instructive although I believe that the tools will improve health care for women. need more fine-tuning as the process develops. The RCOG helpdesk is up and running for those needing advice or Dr Tony Falconer, RCOG President 4 Centre COG Achievers

Dr Kamini Rao FRCOG Wins Prestigious Dr Geetha Nagasubramanian FIGO Award FRCOG MBE

Dr Kamini Rao, former President of the Federation of O&G Dr Geetha Subramanian has been working as a Community Societies in India and the Indian Society for Assisted Gynaecologist in the borough of Tower Hamlets since 1986, Reproduction , has been bestowed the prestigious FIGO and became a Consultant and Head of the Women and Award for Women Obstetricians/Gynecologists. Awarded Young People’s Service in 1995. She has made significant every three years since 1997, the FIGO award recognises changes to the way the service has been delivered in the women obstetricians and gynaecologists from around the areas of family planning, termination of unplanned preg- world who have made a special contribution , interna - nancy, female genital mutilation (FGM) and young people’s tionally or nationally , to promote the development of sexual health. With the support of a team of dedicated staff, science and scientific research in the field , and who, she has taken the initiative to introduce and establish throughout their career have promoted better health care services such as early medical abortion, provision of for women. religious and cultural male circumcision for babies from For Dr Rao , the award is an acknowledgement of her the local Muslim community, reversal of FGM and a specific work in the area of women’s sexual and reproductive rights team for reaching young people with the objectives of (WSRR) for which , as FIGO WSRR Committee Chairperson, reducing teenage pregnancy and sexually transmitted she has carried out extensive work with the aim of bringing infection through education and focused service provision. about changes in medical practice and standards to make Over the last two decades, through her dedication, enthu- them gender sensitive and ethical. siasm 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 [email protected] . 5 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 train- ing 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 – not unlike learning to ride a bike or swim! The opportunity to repeatedly practice specific move- ments 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 partic - ularly, our patients. Familiarity with new instruments can Endoscopic Training at the RCOG also be obtained, again without risk to the patient. Surgical competence, unlike the psychomotor element, requires the informs how well this is achieved and whether the cervical presence of a skilled tutor. However, some aspects of surgical canal and the uterine walls were avoided or touched, potent- procedures can be learnt in a laboratory setting. ially causing pain. The path to the tubal ostia is tracked and To help increase the opportunities for working on simu- shown; unnecessary moves are recorded and counted. Direct lation models we work closely with partner organisations, and immediate feedback gives the trainee a chance to discuss most notably the RCOG and the European Society for their technique while the tutor is present. Gynaecological Endoscopy (ESGE), and also partners in The hands-on sessions and the accompanying lectures industry on whom we rely for the technological advances provide an emphasis on ambulatory , which is that make possible so much of what we can undertake. The often favoured by patients and now supported by the Diagnostic and Operative Hysteroscopy Course run jointly changes in tariffs for hysteroscopic procedures. by the RCOG and BSGE, has recently evolved to include Laparoscopic skills are enhanced by simulation practice. hands-on sessions. Procedures explored include endometrial The BSGE has recently formed links with the company who ablation, fibroid resection, endometrial polypectomy and have developed LaproTrain ™, which also provides a series hysteroscopic sterilisation. The hands-on sessions make use of web-based modules covering basic laparoscopic skills. of various computer simulators and models pretending to be The simulation boxes attach to a television screen and the the , which vary from sheep hearts and pigs bladders modules are available on a monthly basis over a period of to potatoes, peppers and butternut squash. The models allow six months. Training is supervised by a local BSGE mentor. the use of instruments and fluid management systems that BSGE members can rent the box via Atia Khan who runs are used with patients. Guidance is on hand as to how to use the BSGE office based at the RCOG; an option to buy the the equipment from tutors who have expertise with the box is available. devices in the clinical setting. As yet, there are few validated tests of endoscopic skills The stations focus on classic skills as well as new ones. and it is not clear how such tests should be used. However, Traditional uterine resection is not neglected, with half the ones for laparoscopic procedures developed at the European time spent using the resectoscope. There is the opportunity Academy for Gynaecological Surgery, part of the ESGE, are to ensure that diagnostic skills are honed, as well as time close to completion; ones for hysteroscopic procedures are to practice simple techniques using graspers for taking under development too. Training programmes vary for each targeted biopsies and the removal of small lesions. of the European countries, reflecting the different ways that Computer simulation adds a different dimension to simu- each country delivers its health care. However, there is much lation training, as it provides sophisticated feedback on one's in common too, particularly the needs for gynaecological operative technique. Hysteroscopic sterilisation is a new endoscopic skills training and so there is the potential for procedure for many gynaecologists involving gentle increased cooperation and sharing of skills and knowledge, cannulation of the fallopian tube. The simulation model which the BSGE will endeavour to help develop. 6 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) UTn must satisfy, as any surgical innovation would, criteria was first performed in humans as defined by F . D. Moore. Progress in multiple solid organ in 2000 in Saudi Arabia on transplants has made UTn well within the technical capa- a 26 -year -old who had her bilities of many transplant centres. Animal transplants uterus removed as a result have confirmed that the fetus develops normally with no of postpartum haemorrhage. prematurity or growth restriction regardless of the vas- The transplanted uterus failed cular reconstitution. after three months. Although Equally important, UTn must satisfy accepted bioethical controversial and appearing principles and their application. Whether seen as inno- without precedent at the time, vative surgery or a medical study, eventually the early it resulted in a ‘re-focusing’ decisions to proceed in any venue should depend on appro- of efforts into UTn-related val by a duly constituted ethics review committee, the Mr J. Richard Smith FRCOG research. Current estimates participating institution, the local transplant team and , are that in the US , up to seven most importantly, the patient to whom the transplant will million women, age 15 –34 years, have absolute uterine be offered. 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 Uterine transplantation in the UK enlarges at the introduction of any potential therapy. UTn may be safely performed today because of important In addition to the Saudi case described above, seven more developments in transplantation surgery. These are exem- human cases have been attempted, one in Turkey (Professor plified by multivisceral, hand, larynx and face transplants. Omer Ozkan) in August 2011 and six in Sweden (Professor Unlike in these other nonvital transplants, the grafted Mats Brannstrom) over the past 12 months. The Swedish uterus (and the necessary immunosuppressants) will only team have ethics permission to perform a case series of ten be in place for the two to five years that are necessary for transplants. The Turkish case is the only one to be published one or two pregnancies to be achieved. 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 Surgery and alternatives to uterine transplantation had been previously operated on for vaginal reconstruction was the recipient. UTn consisted of orthotopic replacement UTn is therefore a ‘temporary’ treatment for AUFI only for and fixation of the retrieved uterus , revascularisation and women who cannot otherwise have a child either through end-to-site anastomoses of bilateral hypogastric arteries and adoption, surrogacy or any other method currently exist- veins to bilateral external iliac arteries and veins. The ing. The UTn recipient must, however, have produced patient menstruated 20 days after the transplant surgery and oocytes that have been fertilised in vitro resulting in has had 12 menstrual cycles since the operation, making it normal cryopreserved embryos. These embryos will have to thus, the longest-surviving transplanted human uterus to be successfully transferred into the uterus as the fallopian date with acquirement of menstrual cycles. Likewise, all tubes would not have been transplanted with the uterus. Swedish recipients are healthy, with no morbidity or In the UK, we plan to use a brain-stem dead heart -beating mortality. All have regular menstrual cycles and are current- donor, as opposed to a live donor. The advantage of using a ly awaiting embryo transfers approximately a year following deceased donor lies with zero surgical risk to the donor and their transplant procedure. a more extensive dissection of the vascular tree on the We will be drawing our animal work to a close this year uterine graft compared with a live donor. A more radical and are about to accompany organ retrieval teams in dissection leads to recovery of larger arteries and veins, thus London. We have presented to the RCOG ethics committee allowing for a technically easier vessel anastomosis. A and have an agreement in principle subject to finishing our disadvantage with using a deceased donor, compared with a current studies and there being successful fertility data live donor, is that graft survival may be negatively affected at available following human UTn. Our proposals to other brain death by major systemic inflammatory changes. ethics boar ds will be submitted later this year with the aim Surrogacy and adoption will remain treatment alter- of performing the first five cases in the UK in 2014/5. Our natives, but the risks associated with the former and the charity, Uterine Transplantation UK, website ( www.womb- obstacles with the latter means they may not be satis- transplantationuk.org ) and Advisory Board have been up factory to everyone. Regardless, t he majority of women and running for over a year. The uterine retrieval, gr afting with AUFI should be counselled and encouraged to pursue and fertility teams are all in place as is a list of potential alternatives to UTn. However, a need exists for additional recipients, of various ages and professions, whom we have options where surrogacy and adoption cannot suffice, in met in person. this case UTn . Centre COG | continued 7

Conclusion

Successful animal models resulting in pregnancy together morbidities, should have a good possibility of pregnancy. with further seven human UTn performed over the last 18 Pregnancy after UTn will present new challenges. The months means that UTn is now a recognised and feasible only circumstance that could ‘derail’ the setting up of procedure. Pregnancy following organ transplantation is national uterine transplant programmes would be preg- complex but now commonplace. Closing on half a century nancy-related disaster in the intended series of patients. of experience with pregnancy in solid organ recipients, an Yet, as we await news of progress from the Turkish and abundance of data has accumulated indicating satisfactory Swedish case series, we believe that UTn has become a maternal and neonatal outcomes. Future UTn candidates, matter of ‘when next’ rather than ‘if’, both internationally likely to represent a group not burdened by multiple co- 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 by a biomarker or other test with a high positive predictive health problem in the new- value is also large and attractive because high-risk women born period worldwide but the may be treated for the last 100 days of pregnancy if a safe field lacks effective means intervention can be found. However, the clinical/regulatory for diagnosis of risk and treat- pathway for the development of a therapeutic in this area is ment. As such, the field is unclear . Progesterone cleared this hurdle but was not a new ripe for investment and one chemical entity, having been around since 1956. A new might expect considerable chemical entity for use in pregnant women in anything but commercial activity. Sadly, the final moments of pregnancy will be subject to an this is far from the case. There excruciatingly high level of scrutiny by regulatory author- is practically no appetite for ities. This fact will probably preclude venture capital investment at this time due to funding at any stage earlier than phase III clinical trials. Professor David M. Olson the concepts (not necessarily The success of a companion diagnostic in this area will be FRCOG truths) that the market size is crucial . If one can accurately predict which patients will too small, the cost of clinical trials too high and the risk of deliver early, therapeutic intervention at an earlier stage litigation too great. The small market size is due to the may be justified over time. Likewise, if a reliable and safe traditional belief that symptomatic women, those with therapeutic treatment can be found, it is more likely that myometrial contractions, cervical effacement and ruptured the use of a diagnostic test will become routine for preg- membranes, are treated for only 48 hours to stop the nant women. The two markets are interdependent. preterm delivery or not. The cost of clinical trials is high For many other health concerns with larger markets, because if asymptomatic women are treated, one treats all investors commit at an earlier phase of development out of pregnant women or five times as many women as necessary. the maturity of the field, experience and the anticipation This leads to increased risk of an adverse outcome in two of high returns. The ‘Valley of Death’ or low investment patients – the mother and her fetus – and possible litigation. extends for a greater period for preterm birth. Another For these reasons, major Pharma have abandoned attempts possible strategy is to capitalise on the substantial research at developing new interventions to delay preterm birth. that implicates inflammatory pathways as causal for Beyond this, and in spite of an unmet medical need and a preterm birth. By exploring the duality of prediction and market gap, there are several hurdles that need to be overcome prevention for preterm birth and inflammatory diseases, before more investment occurs. The market for arresting investors may be encouraged into early investment for new symptomatic preterm labour is quite large if a therapeutic drugs for inflammatory indications, the proceeds of which agent better than atosiban can be found. Investors (Pharma could be used to fuel commercialisation of promising and venture capitalists) are aware of the graveyard of diagnostics and interventions for preterm birth. compounds and are increasingly wary. Potential investors in Solutions for the seemingly intractable problems of any new therapeutic will be reluctant to invest before the end discovering and bringing to the clinic new diagnostics and of phase II trials. Hence transitional funding (late preclinical interventions for preterm birth are possible if scientists, to end of phase II) will be needed from nondilutive sources clinicians, health systems, governments, foundations, such as grants, governments and foundations – stakeholders parents of preterm children and investors work together to who need to step up and fill the gap. find them. Acquiring the will and making the commitments The market for preventing asymptomatic preterm birth to promote these advances requires an immediate collective by prophylactic treatment of high-risk patients identified action. 8 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 and managers who insti- day to celebrate the sixty-fifth anniversary of the NHS. This gated the day is genuine milestone was to be marked by encouraging 65 000 individ- and infectious, judging by uals to take action and improve the experience and outcome the 18 0 000 pledges that for patients and their families/carers across all aspects of have been received. The the NHS. The ‘action’ could take many forms and indivi- idea that even small duals were encouraged to pledge their resolution on an changes in practice and online pledge wall. Pledges took many guises, from generic attitude can be magnified statements of ‘keeping patient care at the centre of my resulting in greater practice’ to more specific pledges : in our directorate a group movement towards a better NHS Change Day at University of paediatricians taste tested nutritional supplements and NHS may seem idealised Hospitals of Leicester liquid antibiotics in order to gain a greater understanding wishful thinking ; however, as to which would be associated with poor compliance due we all know that seemingly insignificant gestures can have to taste and tolerability. profound effects. Over the past 65 years, obstetrics and The rationale for the day was a call to action, encouraging gynaecology as a specialty has helped to develop and us to take our attention away from the daily stresses and deliver high -quality care to women and their children and strains of our jobs and instead to refocus on the reason the we will continue to do so. I suspect that the NHS Change NHS exists – the patient. Underpinning this call was the Day, although being a nice idea, will have little impact on development of the ‘NHS Change Model’, which has eight the majority of us since we are striving every day of the components including improvement methodology, spread year to bring change, rather than confining it to a single of innovation and transparent measurement , all with a day, but maybe we could all benefit from this yearly central tenet of ‘our shared purpose’ of emphasising our reminder. 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 Reference the Francis report, financial failings and patient dissatis - faction? I hope not. The enthusiasm of the young clinicians 1 http://www.changemodel.nhs.uk 9 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 Left: Dr Luis Gomes Sambo, World Health Organization (WHO) and to flag up its warning signs and symptoms . Regional Director for Africa; Right: Poppy B Majingo, Minister Counsellor, Botswana High Commission We are expecting an imminent announcement by the UK Government to make forced marriage a criminal offence and Department for International Development recently have one chance to speak to a victim to save a life. It is also announced the implementation of a range of aid program- imperative to provide the victim with the opportunity to mes to help empower women , by funding contraception have a safe space to raise concerns and contact others. access to prevent unwanted pregnancy and tackling FGM . Other presentations came from Jasvinder Sanghera, Introducing the subject, Professor Walker said: “Forced Chief Executive of Karma Nirvana, a charity supporting marriage is complex problem and there are other inter- victims and survivors of forced marriage and honour -based connected issues such as early or child marriage, domestic abuse, and Diana Niammi, Director of the Iranian and and/or honour-based violence and even FGM. In all, victims Kurdish Women’s Rights Organisation, set up to provide suffer both physical and mental abuse and find themselves holistic advice and intensive case work to Middle Eastern trapped in a spiral with long-lasting impacts on their health women and girls at risk of domestic violence, forced and wellbeing. Given the scale of this problem, I would marriage, FGM and honour -based violence . argue that forced marriage is a public health issue.” The event concluded with Dr Sonji Clarke , Consultant Baroness Jenny Tonge, Chair of the UK All-Party Parlia - Obstetrician from Guy’s and St Thomas’ NHS Foundation mentary Group (APPG) on Population, Development and Trust, discussing the role of healthcare professionals in Reproductive Health started the event by discussing its matters such as domestic violence. report A Childhood Lost addressing the causes and “Healthcare professionals need to bear in mind that consequences of child marriage in the UK and worldwide. asking the ‘difficult question’ may be the most effective way New figures released by the Forced Marriage Unit (FMU) to determine whether a patient’s relationship with their reinforce the harsh reality of forced marriage in the UK and partner, guardian or relative is coercive or dangerous.” worldwide . Carla Thomas, Joint Head of the FMU, noted “Healthcare professionals must recognise the importance that the unit gave advice or support in 1485 cases in 2012 of the ‘one chance rule’. For many women and young girls, and at least 250 children in the UK have now been helped interaction with a health worker during pregnancy is the by the unit with the youngest case involving a two-year-old . only social interaction they may have outside of a coercive Ms Thomas reinforced that RCOG Members should be relationship, within a marriage or their family. If there is alert to the signs of a possible forced marriage, for example, one chance to ask difficult questions and ensure the safety if they notice that a patient has been withdrawn from of the patient, it should be taken but done so in a safe and education by parents, has not been allowed to work, is sensitive manner.” closely accompanied by a partner or relative, if they show As the professional body for women’s health, it is signs of depression, self -harm, early or unwanted preg- imperative for all speciality doctors to have the appropriate nancy and FGM. If a woman presents with these signs, knowledge and skills to advocate on behalf of women. To doctors should ask open questions like ‘how are things at this effect, the RCOG will work with the FMU to develop a home?’ remembering the ‘one chance’ rule , you may only forced marriage care pathway. 10 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 Once everything was under control the obstetrician Liberia. A girl was lying flat out on the operating table, her handed over to his assistant to finish up. I asked him what eyes fixated on the ceiling. I wasn’t certain if she was still he thought her chances of living were. He humbly replied, alive, there were no monitors beeping, in fact there were no “We don’t have much, but we do our best.” monitors at all. I went to Liberia in West Africa with a group of six The theatre looked like a battlefield – blood was every- healthcare workers from the UK in December last year. Save where, soaking the drapes and trickling onto the floor. Her the Children (www.savethechildren.org.uk/healthworkers ) abdomen was open as the obstetrician was fighting to save arranged for us to visit clinics in rural areas as well as some her life after her uterus ruptured during labour. hospital facilities. The experience was eye opening and I saw her take a breath. It suddenly dawned on me: she brought to life the dreadful World Health Organization was awake. (WHO) statistics on child and maternal mortality that Anna was 20 years old and this was her second pregnancy. previously I had only read in newspapers. Her last labour resulted in an obstetric fistula , which has Liberia is recovering from a decade of civil war that subsequently been repaired by doctors from an interna - ripped the country apart. Much of the infrastructure was tional charity. destroyed including basic health care. Today , Liberia’s She attempted a vaginal birth after government, doctors, nurses and a previous , with a midwifes are doing everything they traditional midwife in her village. can to rebuild the shattered health There could be many reasons for this : system. Liberia has one doctor for she had too little money to pay for every 3751 people; the UK has 48 times transport, had another child to care as many. for or had been influenced by the We saw the effects of UK and inter- untrained traditional birth attendant national aid and how it has helped to whose livelihood was reliant on set up facilities such as the hospital in Anna’s homebirth. Bong County, without which women Once again her labour was obstruct- like Anna would certainly die. We met ed and eventually her uterus ruptured dedicated Liberian healthcare work- and now she was fighting for her life. ers, working around the clock and in Sadly her baby had already died before some clinics there is no running water, she reached the hospital. no electricity and no lights. A midwife Anna had a spinal anaesthetic. A told me that she has to conduct deli- student nurse, still learning basic veries in the dark, using nothing but medicine, was injecting ketamine into her mobile phone light to see. her arm. There was only limited The visit has inspired me to camp- equipment to monitor her blood pre- aign for international health in my ssure and nothing to control her role as a Health Ambassador for Save breathing, not to mention the short- the Children. In Liberia I felt helpless, age of skills and experience. Looking that despite my skills acquired in the at Anna’s condition and the amount UK I was unable provide any practical of blood around her it was clear she care. But I learnt that aid must be needed blood transfusion. But blood sustainable being built by Liberians could only be provided if it was rather than relying on doctors from replaced by donation by family mem- overseas and that change can only bers, which is commonplace in Africa. happen through campaigning. An I was hoping someone outside was amazing campaigning result means arranging this quickly. that health care for women and child- At first glance I was horrified – ren in Liberia is now free. horrified by the fact Anna was in this One in ten Liberian children don’t situation in the first place and horri- make their fifth birthday ; however , fied by the short supply of well-trained this is an improvement as only a few health professionals and basic equip- years ago it was one in five. As doctors ment available. While this would be we can provide a powerful voice and considered substandard care and show our support for healthcare negligent at home in the UK I could workers abroad working in difficult see the courage, determination and circumstances that we find hard to compassion shown by the team. With comprehend in the UK . what they had available they were doing their best. Without their com- Scenes from Bong County Hospital, Liberia mitment and struggle, Anna would die Thank you to www.savethechildren.org.uk for certain. They gave her their all. for use of these images.

12 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 training provision for trainers and is developing a means of himself” 1 has to be a better approach to educator develop- quality assuring current and future courses. It is important ment than the old concepts of “see one, do one, teach one”. to be on the lookout for better ways of providing training It is increasingly recognised that we can all improve how and we are committed to encouraging educational research we teach, but we need help to do this. Many of you spend within the speciality. We are also keen to identify what considerable amounts of time organising and delivering support Members and Fellows would require from their education to both under- and postgraduates. The RCOG Faculty membership. values and is keen to support all those involved in At this early stage in development of our Faculty we teaching and training in our speciality. In addition, the welcome comments on the above from Members and GMC is introducing a new system to strengthen the role Fellows involved in education. Please get in touch with of medical trainers, and with the Academy of Medical myself ( [email protected] ) or Kim Educators has developed a set of standards for educators. Scrivener ( [email protected] ) at the College with Following discussions last summer when the Faculty comments or questions. 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 Reference Educators. As well as developing this framework the Faculty Deve- 1 Rabindranath Tagore, Nobel Prize winner for Literature lopment Committee is conducting a gap analysis of current 1913.

RCOG Faculty of Educators Education | continued 13 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 most substantive recalibration of the curriculum since last year or so! Keeping the curriculum up to date is a bit its introduction in 2007, and has given us a head start like painting the Forth Road Bridge and it is with some over other specialties in implementing the single relief that we are actively engaging with the GMC’s recent version of the curriculum. instruction to move all trainee doctors in all specialties onto the most up-to-date version of their curricula. (In Following the final approval from the GMC for the Core O&G, trainees are following various versions of the core Curriculum at the end of April 2013, plans are in place curriculum and logbook depending upon the year the for the agreed curriculachanges to go live in August 2013. 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 Developing the curriculum for Tomorrow’s Specialist trainees to make sure that this move does not disadvantage anybody come August 2013. The RCOG is planning to As part of Tomorrow’s Specialist, the RCOG held a Curri- implement this change in August 2013 to allow plenty of culum Focus Day, facilitated by Professor Wendy Reid, Vice time for individual trainees to encompass any additional President for Education. It was a lively and interesting day, skills/competencies by the final date given by the GMC with attendance from a wide-ranging group of interested (end December 2015). parties. In particular we ensured several attendees represent- There is no doubt that this is a huge piece of work but once ing patients’ views. ‘Thinking outside the box’ was the it is done, and all trainees moved to the e-portfolio, it will be flavour of the day in terms of core qualities we want our much easier for trainees to keep up with changes on an doctors to have, apart from the important technical aspects annual cycle, which means they will be trained to the highest of our specialty such as ‘human factors’ or nontechnical standards relevant to contemporary practice in our specialty. skills (communication, leadership, situation awareness, Since the GMC changed its curriculum approval process decision making, team-working, etc.) and empathy. There last year, we have made three specific curriculum submiss- was a notable contribution from the lay representatives, ions: signalling perhaps a change arising directly from the recom- mendations of the Francis Report – ways of improving 1 The Academic Committee worked hard on a brand new patient and lay input into our curriculum will be actively curriculum for academic trainees. It has now received taken forward as a result of the Focus Day, as well as the GMC approval as a pilot for two years. There is a GMC- message of the overriding importance of patient safety. led national project underway to evaluate and improve The Committee values contributions from colleagues and the arrangements for academic training pathways in values input into the various subgroups working on specific postgraduate medical education, our pilot will contri- aspects of curriculum development. If you would like bute to the national deliberation. to contribute to a particular area that interests you, please contact the present Chair, Mr Kim Hinshaw (kim. 2 In January this year, we submitted a large number [email protected]) or Alice Lambert who supports the of changes to the Core Curriculum, the most signi- work of the Curriculum Committee (alambert@rcog. ficant of which was the move of many advanced org.uk). We will keep your details at hand and will contact competencies to intermediate level. This has been the as and when particular concerns arise.

15

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 . Early attempts at hysterectomy from the womb and retaining the ). 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 or ovarian tumour, it is now cervix and surrounding area. These attempts were accom- believed 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 haemor- unfortunate patient did not survive The work of these rhage, infection and shock. beyond a few days. The history of the development of the early -twentieth century Ten years later in 1853, a US surgeon procedure for performing surgeons should be and early advocate of ovariotomy, is intricate and internationally based, with acknowledged as an Walter Burnham (1808–1883) per- surgeons from the US and building formed the first successful subtotal on the experiences of colleagues in the UK important stepping stone abdominal hysterectomy – again a and France. There is a story that the first in the advances made in consequence of surgery to remove an documented hysterectomy of the modern the treatment of cervical ovarian tumour. The first successful era was performed by accident. A Milanese cancer and in safer total abdominal hysterectomy was surgeon, Dr G Paletta, apparently found performed by Dr G Kimball in Boston, that he had removed the entire uterus procedures for Massachusetts, for the treatment of vaginally when intending only to perform hysterectomy 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 accel- by 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 (1864–1920) assisted at a hysterectomy for through the 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. Per- fection 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 per- fected 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 pio- neered the procedure still further in later years, aided by the availability of antibiotics and later the tech- nology 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 (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. 16 Membership Matters | Volume 3 Issue 2

College of Obstetricians and Gynaecologists, being made an Unfortunately, the house surgeon had been dressing a Honorary Fellow in 1946 in recognition of his services septic case immediately prior to this operation and had not towards the specialty; Berkeley was a Founding Fellow and finished washing his hands in theatre, and consequently Trustee of the British College of Obstetricians and the patient died on the third day after the operation. Gynaecologists. Both worked for the Middlesex Hospital, Lockyer successfully took up the operation with a mortality and both were struck by the efforts in developing the hyste- rate of 18% in 115 patients, and stimulated Berkeley and Bonney to start their Middlesex Hospital series, the con- sequence of which was the introduction of Wertheim’s “Mr Meredith [Lockyer’s colleague] possessed a operation in the UK. From 1907, Bonney and Berkeley ‘carriage and pair’ and drove us all down to treated all cervical cancer cases presented to the Middlesex Plaistow on the date given which, if I remember Hospital, and so were able to keep track of success rates in rightly, was on a Sunday morning. Professor patients, even five or ten years after surgery. Publishing evidence and statistics of success rates was important for Wertheim operated. I assisted him. In the middle of overcoming the scepticism with which Wertheim’s original the operation the house-surgeon’s help was sought paper on his operation was greeted by older British gynae- by Wertheim to aid in the retraction of the cologists, mostly due to the high mortality rate associated abdominal walls. Since Wertheim scorned artificial with the procedure. retractors and likewise the use of rubber gloves.” 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 rectomy procedure of their fellow surgeon, Cuthbert Henry and 1930s. In this research he was joined by Professor Miles Jones Lockyer (1867–1957), a gynaecological surgeon and Harris Phillips, of Sheffield, who engaged in historical pathologist on the staff of the Charing Cross Hospital, research to support theories about O&G practice, and Samaritan Hospital, Royal Northern and St Mary’s, among whose papers can be found discussions with US Plaistow. peers on vaginal hysterectomy and success rates (Archive Among the papers of the RCOG Honorary Secretary in Reference: S97). 1950, Humphrey Arthure, is a letter written to him by Bonney wrote to Fletcher Shaw in January 1930, mainly Cuthbert Lockyer describing how he invited Ernst Werth- about College Fellowship matters, but also enclosing a eim to come to London on 23 July 1905 while visiting Great small chart of figures showing “five-year cure rates” for Britain, and demonstrate his operation [Archive Reference: operations performed by Wertheim, Mayer, Stoeckel, RCOG/A7/1/2]. 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]

Fletcher Shaw’s initial interest was in hysterectomy follow- ing 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 hyste- rectomy 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 Figure 2 Victor Bonney, 1922 RCOG Photograph Collection operation is taken the greater the mortality.’ 17

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.

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

20 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

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, RCO2G among other objectives, a 47% reduction in paper consumption. It was thanks to a small group of committed individuals, College members and fellows, Honorary Officers and staff. supported by senior management and Honorary Officers Collating information to generate a comprehensive ‘carbon that the College began to take action on its environmental footprint’ of the RCOG in all its activities is a big endeavour, responsibilities by establishing the Green Group in 2008. which relies on the goodwill and spare time of the Green The Green Charter, launched in 2009, set out a ten-point Group members. plan to reduce the College’s impact on the planet, with The year 2013 marked the start of a budget allocation to targets to be reviewed at regular intervals. the College’s environmental work. This is an important So far we have achieved a 5% reduction in electricity symbol of the College’s commitment to ingrain sustain - usage, and a staggering 47% reduction in paper con- ability in all its practices. sumption. Our catering services have greatly contributed to Being an organisation that has relationships with a variety the environmental efforts, by (among other things) adopt- of stakeholders, the RCOG is ideally positioned to make and ing biodegradable packaging and completely eliminating spread sustainable change across a wide spectrum of society, polystyrene cups. Recycling facilities are available in including women and their families, clinicians and our local strategic places around the building, and spot checks are in community in London. Social value, procurement and health place to monitor the switching off of lights and computer promotion are among the areas we will be looking to monitors at the end of the day, as well as the departments’ strengthen our focus on. printing patterns. If you would like to know more about the RCOG Green But there is still much to be done. In the past year, the Group and its sustainability work, please email blacorte@ Green Group has been working on setting a sustainability rcog.org.uk . We would also welcome your comments and agenda that encompasses not just the environmental suggestions on how we should drive the environmental impact of 27 Sussex Place, but also that of the travelling of 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 therapy. Celia is now an active campaigner for same-sex at the College on 22 March 2013 where we had a record marriage and hopes to remarry her wife following her gender number of over 40 attendees, with both members and their reassignment. partners welcomed to the meeting. We were also pleased to Mr Chris Naylor FRCOG the first speaker to present to the welcome a retired Fellow from Tasmania who was holiday- society for a second time reminded the group of incidents ing in the UK; the society would encourage any other when obstetricians and midwives have been charged with overseas members who might be in the UK at the time of manslaughter. These were mainly in relation to the compli - the next meeting 15 November 2013 to come along. cations of contemporary clinical practice in the 1970s. He Mr Jeremy Wright FRCOG recounted his experiences of highlighted the role of hubris described as a ‘red mist’, his late ‘gap year’ to Ethiopia. The obstetrics he saw ranged which was a significant risk when armed with the Kiellande from obstructed labour, ruptured uterus and destructive Forceps, a status symbol for some time but now much less operations; in gynaecology there were many cases of popular. carcinoma of the cervix and the useful advice to treat leeches The date of the next meeting is 15 November 2013 at 1pm, in the vagina with lemon juice. Finances were limited but the partners are once again welcome. The confirmed speakers community had cycle-ambulances and waiting houses. His are Professor John Studd FRCOG, who will be addressing trip was subsidised by the RCOG and through private donor the group on nineteenth-century attitudes to sexuality in support and in discussion one had proposed the Warren literature, art and music, Dr Brigid Hayden FRCOG will be Buffer Charity Funds as a useful source. discussing her experiences in Liberia. Should you wish to Miss Celia Macleod FRCOG gave a sensitive and personal attend this event please contact Miss Rebecca Deegan experience of gender reassignment in her lecture ‘From ([email protected] ) 020 7772 6228. The event is £15, Colin to Celia – one gynaecologist’s journey into woman- which may be paid in advance via cheque or credit card. hood’. Celia gave an account of the emotions and changes in Join the Retired Fellows and Members Society on her family life to the eventual publicity of her story, discuss- LinkedIn . ing her counselling, significant surgeries and hormone College news | continued 21 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 and a number of other trainees will be at the workshop, and Southampton NHS FT. I work clinically part-time as I have I intend to discuss progress and get ideas from the Trainees’ two other roles. The first is Director of Education for the Committee on a regular basis. I can be contacted at Trust and the second is Head of School for Obstetrics, [email protected] with any ideas you have for Gynaecology and Sexual Health for the Wessex Deanery. improving things, or with general concerns, though please At the interview I was asked if I wanted to take this post note that I am unable to deal with individual complaints on because I had been bullied or because I was one myself. unless they have been through your deanery channels. A good question. The answer was neither. That said my first I don’t think there is a simple solution to undermining clinical experience as a third-year student was being public- and bullying. I think the reasons for our low standing as a ally humiliated by an eminent professor who felt that specialty are multiple and complex. What I can promise is although we had not been shown or taught how to examine that the College is fully signed up to improving the current a patient I should have done it anyway before the ward situation and we will be working hard to make a real round. Otherwise “how was I going to learn anything”? Not difference. 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 beha- viour on others and, not being perfect, I have occasionally had to apologise when my frustration with a situation gets 2014 Invitation to Fellowship the better of me. So why did I apply for the job? I had hoped since my medi- Members approaching 12 years standing (the minimum cal school days things had moved on but it seems that this time before election to the Fellowship) are invited to submit is not universally the case. I became more involved with this an application for consideration for election to the a few years ago when the GMC Trainee Survey data first Fellowship, further information can be found on the appeared and the specialty appeared as an outlier. After College’s website http://www.rcog.org.uk/content/general- hearing Helen Richardson (Associate Dean) from the guidelines-election-fellowship. The deadline for Northern Deanery speak at a Heads of School meeting applications is 5 December 2013 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. 2014 Invitation for Nominations for First, I produced videos on undermining and bullying for the College that are still available via StratOG. Sadly these Fellowship ad eundem/honoris causa were all true stories collected from trainees (and trainers). Although these are a good resource, watching a video The RCOG is now accepting nominations for Fellowship ad does not change behaviour and therefore these do need to eundem and honoris causa: be used as part of a wider intervention especially where there are concerns. In Wessex we then went on to develop a Fellowship ad eundem is bestowed by the College to multiprofessional workshop run within departments to individuals who have demonstrated through research or raise awareness of undermining and bullying. We will be clinical commitment, major contributions to obstetrics, publishing the research on the impact of these soon but gynaecology or reproductive health and advanced our they do seem to have a positive effect. We continue to roll specialty through those endeavours. Candidates should be these out in every unit. Other deaneries such as East of of an extremely high scientific calibre and must have England and West Midlands have also developed unipro- contributed to the advancement of the science or practice fessional workshops for a similar purpose. of O&G in a substantial way. So what now? One of my first actions in this role will be jointly facilitating a workshop with the Royal College of Fellowship honoris causa is bestowed by the College to Midwives in April, with representatives from a wide range individual(s) who has (have) demonstrated: the highest of stakeholders including the Royal College of Paediatrics level of dedication and achievement in clinical care; or the and Child Health, and the Obstetric Anaesthetists’ Assoc- highest level of support to the development of women’s iation. Our aim is to agree a series of initiatives and work healthcare services; or the highest level of work/support for streams to enable and support deaneries and individual the RCOG. departments in resolving these matters. The outputs from the workshop will also help us produce guidance for O&G Please find more information on the College’s web- trainees and trainers, including FAQs and a list of site http://www.rcog.org.uk/honorary_fellowship. The resources. Ted Adams, Chair of the Trainees’ Committee deadline for applications is 7 October 2013

College news | continued 23 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. If you could choose anyone, who would you pick My role is to provide a strategic business approach to the as your mentor/role model? RCOG activity and to promote clinical and technological There are many classical leaders but as someone from the innovations keeping us at the forefront of national and emerald isle working in London one famous Anglo Irish international medical institutions. Leader springs to mind – Sir Ernest Shakleton. Along with Captain Scott and Amundsen he was one of the great polar How do you see the role of Honorary Treasurer explorers and a remarkable leader of men epitomised in his changing in light of the changes to the College’s heroic open boat rescue when his ship the Endeavour was governance structure? trapped and crushed in the pack Ice. I highly recommend a As the Chair of the new Finance and General Purposes great book Shackleton’s Way: Leadership Lessons from the Committee , the Honorary Treasurer now has a pivotal role Great Antarctic Explorer by Morrell and Capparell . in ensuring the smooth running and survival of the RCOG as a business while establishing strong links between What mark would you like to leave at the end Council and the Board of Trustees. of your career at the College? I believe the success of the College is a result of the What attracted you to becoming an Officer? combined efforts of all the Officers and College staff. While As a College Officer there is a unique opportunity to make individual Officers take the lead in their specific areas of a significant contribution at a national strategic level to the responsibility successful outcomes are dependent on the whole range of concerns influencing women’s health in the combined support and efforts of the whole team. UK. These include setting standards for the education of One area which I have enjoyed leading has been the RCOG O&G specialists and for the delivery of the high -quality World Congress , which has become one of the flagship evidence -based clinical services. The international work events of the College Calendar. I am sure that with the carried out by the College also provides the opportunity to continued support of the Officers, the excellent College contribute to women’s health matters on a more global staff and the Fellows and Members the Congress will scale. continue to grow and develop, further enhancing the College’s global reputation. As Chair of the Congress Committee can you tell us how the scientific programme is planned? You have a love of India. What do you hope will The process works differently for Congresses held in UK be the outcome of the RCOG’s work there? and those held oversees. When the RCOG World Congress is I love the people and culture of this remarkable country. held in the UK, the Honorary Director of Conferences puts Their respect, support and loyalty to the RCOG are together the scientific programme with input from the unwavering. It was very natural that the specific edu- Congress Committee. This year, for the first time, we have cational agenda was formulated and developed in India and actively sought the involvement of the UK’s Specialist I am delighted that we are bringing the World Congress Societies in the creation of the scientific programme for the there next year (rcog2014.com) World Congress in Liverpool. Many have designed their own sessions with world-renowned speakers from the UK If you could trade places with any other person and further afield to share their expertise and knowledge. for a week, famous or not famous, living or dead, When the World Congress takes place overseas, the Local real or fictional, who would it be? Organising Committee put together a programme with Wouldn’t it have been great to have spent a week with Steve input from the RCOG Officers and the Congress Committee. Jobs and not just because we have similar beards! To have The World Congress brings together clinicians from all over experienced his vision in the thrilling and exciting ways the world so it is important for the programme to showcase that technology could change our lives but also having the best practice from around the globe and provide a forum for tenacity to deliver what others thought impossible. topical and controversial debate. When you are not working what do you enjoy doing? If you could go back in time now and give I have a great love for travelling and scuba diving preferably yourself one piece of professional advice, what combined the two in exotic warm-water locations. would it be? “You only get one chance to make a first impression .” What is one of your favourite quotes? “Don’t sweat the small stuff …and it’s all small stuff” Richard Carlson 24 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 Part 2 MRCOG MCQ subcommittee Scientific Advisory Committee Professor Z Alfirevic FRCOG Chair Mr S M Hughes FRCOG Professor S M Nelson MRCOG Chair Dr A W Horne MRCOG Assessment subcommittee Part 2 MRCOG EMQs subcommittee Dr M E M E Metwally MRCOG Mr N A Myerson FRCOG Dr S I McNeill MRCOG Dr I J G Harley MRCOG Miss R J Goddard FRCOG Dr J S Kallat MRCOG Dr N Mukhopadhaya MRCOG Mr S D K Visvanathan MRCOG Scottish Committee Dr S Khazali MRCOG Dr A W Horne MRCOG Prt 2 MRCOG Oral Assessment Dr V A Mackay MRCOG DRCOG subcommittee subcommittee Mr A S El Fara MRCOG Mr D J Burch FRCOG Chair Specialty Education Advisory Dr A D Gumma MRCOG Dr A J Thomson MRCOG Committee Mr F Imoh-Ita FRCOG Dr R G Hughes FRCOG Mr A J S Watson FRCOG Chair Dr S A Abdel-Fattah FRCOG Faculty Development Committee Subspecialty Committee Professor D J Cahill FRCOG Part 2 MRCOG Short Answer Dr R S Mathur FRCOG Questions (British Fertility Society) Global Health Policy Advisory Miss S J Ward FRCOG Chair Mr J T S Kehoe FRCOG (British Board Mr M R Cohn FRCOG Gynaecological Cancer Society) Professor A N Fiander FRCOG Chair Dr A G Bhide FRCOG

Global Placement Committee Patient Information Committee Election of new Officers 2013 Dr S G Barnfield MRCOG Dr L E Caird FRCOG Dr M E Murnaghan MRCOG The present Officers and Council of Mr R S V Cartmill FRCOG RCOG Women’s Network the RCOG are pleased to announce Mr J J S Waugh MRCOG Dr A L Wright FRCOG that the following have been elected Miss J I Tay FRCOG as new College Officers: Research Committee Dr Paul Fogarty, Senior Vice Guidelines Committee Professor L Poston FRCOG Chair President (Global Health) Dr H K Sidhu FRCOG Dr P S Arunakumari MRCOG Revalidation Committee Dr Clare McKenzie, Vice President Dr J T Preston FRCOG (Education) Part 1 MRCOG subcommittee Professor Alan Cameron, Vice Dr U D Gordon FRCOG Safety and Quality Committee President (Clinical Quality) Dr M S A A Allam FRCOG Mr T C Hillard FRCOG Chair Dr M A Sharma MRCOG Dr C A Burrell MRCOG They will take up post from 27 Dr S K Harding DRCOG September 2013. 2013 Honorary Appointments

Convenor Basic Practical Skills Courses In Memoriam Mr W C Yoong FRCOG

ATSM Officer Dr Manickam Kanagalingam , Malaysia Dr A J Campbell MRCOG Dr Ralph Maurice Hampstead Malone , Canada Dr Jean Orr Struthers , Scotland Advisor on Workplace Behaviour Mr Peter Ashley Robertson Niven , England Dr S J Mountfield FRCOG Ms Maimoona Dossa , Wales Simulation Officer Professor Robert Geoffrey Edwards CBE, England Dr A Gale FRCOG Dr Andre Alexius Visser , South Africa

Convenor for Train the Trainer’s Courses Dr Margaret Alison Bigrigg , Scotland Dr A A Taylor MRCOG We would like to encourage the membership to submit feedback, Assistant Convenor ideas and features for Membership Matters . So, please let us know if Mr R V M Haughney FRCOG you have any suggestions for content or articles for submission.