Surgical Research Report 2017/18
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Surgical Research Report 2017/18 The Royal College of Surgeons of England Contents 4 Chairman’s Introduction 6 Research Fellows’ Reports 60 Pump Priming Reports 68 Surgical Trials Initiative 72 Clinical Effectiveness Unit 76 Research in the Faculty of Dental Surgery 80 Prizes & Travelling Awards 82 Higher Degrees for Intercalated Medical Students 92 Elective Prize Reports 102 Lectures Delivered in 2015–2016 103 Fundraising in Focus 104 Picture Gallery 2 3 Chairman’s introduction Research is not an optional add-on, it is the very lifeblood of surgery. We need to introduce new technologies safely and effectively, we need to understand basic mechanisms of disease and we need to do the things we are doing now, but better. Most important of all, we need to inspire the surgeons of the future to see this as part of their mission in improving the experience and standards of care for our patients. Neil Mortensen Chairman, Research Fellowship and Lectureship Selection Group 4 The Royal College of Surgeons The Surgical Trials Initiative introduced Professor Sir Peter Morris who with through its Research Fellowship in 2012 has developed rapidly. There great foresight started the Research scheme has committed more than are now seven chosen Surgical Trial Fellowship scheme in 1993 has £40million to support over 700 Centres in the UK and there are 15 recently retired as Director of the individual trainee members during appointed Surgical Specialty Leads Centre for Evidence in Transplantation. the past 24 years, and this year we with the task of promoting trials and We are particularly grateful to Claire have approved a further £2million trial recruitment, and providing a link Large who has retired as CEO of funding for some 30 new Research between surgeons, investigators the Dunhill Medical Trust, who have Fellowships. The quality of the and the trials centres. Some 25,746 been major supporters of the College applicants has been outstanding and patients have been recruited to 85 research initiatives in research related most are either starting or completing trials across the surgical specialties. to the elderly. a PhD, which now means three A particular success has been the Martyn Coomer and Jonathan years of funding. The College does development of trainee research Fountain and their staff have worked not undertake the research itself but collaboratives. We are especially tirelessly to underpin all this activity. provides seedcorn funding for grateful to the Rosetrees Trust for Jonathan has moved on to a new job start-up projects which then attract their support for these developments. for which we wish him all the best. funding from such bodies as the Professor Derek Alderson has been Wellcome Trust, CRUK and MRC. We need to inspire the inspiring our focus on surgical trials and Professor Dion Morton as Director This yearly round of appointments surgeons of the future in depends on our many donors to whom of Clinical Research has with great we remain immensely grateful, but improving the experience energy and enthusiasm helped make we can always do so much more. and standards of care for it happen. We have added to our Research our patients To all our many funders we are most Fellowship partnerships the British grateful and hope that on seeing our Society of Endovascular Therapy many successes you will continue to (BSET), the Virginia Mason Hospital The Surgical Technology Evaluation help us with our work. Seattle, and Addenbrooke’s Charitable Portal (STEP) is run jointly with the Trust. Two novel Fellowships in Clinical NIHR to help with the rapid assessment Leadership have been introduced with of new technologies and was launched the Faculty of Medical Leadership earlier this year. This will provide and Management and McKinsey. Our technology companies with access to prestigious Fulbright Fellowship to the clinical advice and appropriate patient USA agreement has been renewed. groups to ensure the safe introduction of new procedures. The Clinical Effectiveness Unit (CEU), a joint programme with the London Over the last 20 years many University School of Tropical Medicine and Departments of Surgery have been Hygiene, continues to provide a closed or subsumed into larger major focus for national audits in groupings with a consequent loss oesophagogastric, bowel, breast of surgical academic leadership. and prostate cancer, as well as If these exciting new programmes are vascular surgery, cleft lip and palate, to be successful this decline needs emergency laparotomy and falls and to be reversed and in 2017/2018 the fractures. These important studies College is planning to establish new provide the facts on which to base chairs in surgical clinical research. health policy and improve outcomes We need to raise some £2.5million. for our patients. Over the last 20 years many University Departments of Surgery have been closed or subsumed into larger groupings with a consequent loss of surgical academic leadership. 5 Fellowships are awarded to subscribing members of the College in a training post, or trainees who have passed the MCQ papers and will sit the final MRCS examination at this College. All applications are rigorously assessed by a panel of experts to ensure that the research, surgeon, supervisor and facilities are of a high standard, and that the proposed work will be valid, beneficial and original. The fellowships cover salary, on-costs and some running expenses. Fellows may study any aspect of surgery or surgical care including basic science, diagnosis, treatment, surgical technology, logistics or audit. 6 Research Fellows’ Reports Zaid Awad Dafydd Edwards Elizabeth Maughan Bynvant Sandhu Marc Bailey Jason Fleming David Metcalfe John Saunders Basil Bekdash Mathew Gardiner Anita Mohan Annabel Sharkey James Berry Katherine Gash Aadil Mumith James Singleton John Broomfield Michelle Griffin Suzanne Murphy Anna Slovick Marc Bullock Rachael Harrison Sumit Nandi Peter Szatmary Andrew Cowie Jasmine Ho Liza Osagie Tanujan Thangarajah Helen Cui Amel Ibrahim James Paget Peter Vaughan-Shaw Andrew Currie Zita Jessop Karl Pang Christopher Wearn Praveena Deekonda Matthew Kirkman Keval Patel Michelle Wilkinson Harveer Dev Kathryn Lynes Henrietta Poon Hugh Wright Nicholas Eastley Dermot Mallon Jason Powell Rasheed Zakaria Ellie Edlmann Gulraj Matharu Stuart Roberts 7 Structured, rigorous and validated assessment which integrates simulation and workplace modules can help deliver better surgical training. Better training equates to better and safer patient care. A comprehensive evaluation of workplace and simulation-based assessment in otolaryngology training FELLOWSHIP/SPONSOR: 2. Utilisation, reliability and 2. Cold steel tonsillectomy Colledge Family Fund validity of Clinical Evaluation simulator: using silicone to Exercise in otolaryngology train future trainees, Annual SUPERVISORS: training. Awad Z, Hayden L, Meeting of the Faculty of Surgical Neil S Tolley, Paul Ziprin and Muthuswamy K, Tolley NS. Trainers, RCSEd, Edinburgh Ara Darzi Clin Otolaryngol. DOI: 10.1111/ 22 Oct 2014 SITE OF WORK: coa.12400 PRIZES: Imperial College London PRESENTATIONS: 1. Nan Blofeld Travelling PUBLICATIONS: 1. Construct validity of cadaveric Fellowship, University College 1. Construct validity of cadaveric temporal bone simulation in London Hospitals Charity, temporal bones for training and mastoidectomy training, Annual Feb 2015 assessment in mastoidectomy, Meeting of the Faculty of Surgical 2. HCA International Traveling Awad Z, Tornanri C, Ahmed S, Trainers, RCSEd, Edinburgh Fellowship Grant, HCA Tolley NS. Laryngoscope. DOI: 22 Oct 2014 International Foundation, Zaid Awad 10.1002/lary.25310 Oct 2014 The otolaryngology curriculum requires piloted and models were tested for Sixty trainees and 40 consultants trainees to show evidence of operative feasibility, face, content and construct participated in the process and found competence before completion validity, before being incorporated into it of great educational value. of training. The General Medical the North London training programme. We concluded that assessment with Council recommended that structured The outcomes of workplace- and structured feedback is integral to surgical assessment be used throughout training simulation-based assessments of all core training. Assessment using validated to monitor and guide trainee progression. and specialty otolaryngology trainees simulation modules can complement Despite the reduction in operative were collated and analysed. that undertaken in the workplace. The exposure and the variation in trainee The outcomes of 6,535 workplace- outcomes of structured assessments performance, a ‘one size fits all’ approach based assessments were analysed. can be used to monitor and guide continues to be applied. The number of The strengths and weaknesses of trainee trajectory at individual and procedures performed remains the main four different assessment tools were regional level. The derived learning indicator of competence. highlighted. Validated platforms utilising curves can shape and audit future Our objectives were to analyse the cadavers, animal tissue, synthetic otolaryngological training. utilisation, reliability and validity of material and virtual reality simulators workplace-based assessments in were incorporated into the curriculum. otolaryngology training, to identify, develop and validate a series of simulation platforms suitable for incorporation into the otolaryngology curriculum and to develop a model of interchangeable workplace- and simulation-based assessment