Blogs

Celebrating thirty years of the Basic Surgical Skills course.

As an SAS surgeon myself, it is my ambition that SAS surgeons receive recognition and the parity of esteem we deserve, writes Vinita Shekar.

This International Women's Day, join us as we take a look at six ways we are embracing equity at the College.

Join us as we count down this year’s ten most popular Bulletin pieces, as chosen by you, the reader.

RCS England members Kathryn Ford and Lilli Cooper established the Are You Cut Out For It? national surgical skills competition ten years ago. They tell us more about why they founded the competition and how it has evolved.

Pride Month is a chance to celebrate diversity and to not have to apologise for who I am, writes Ginny Bowbrick.

The environmental impact of PPE is significant. As we look ahead to achieving net zero emissions in the health sector, our reliance on single-use PPE will need to change, writes Nadine Sheikh-Sobeh.

A new report led by Professor Scarlett McNally looked into what we should call ‘junior doctors’. In this blog, she highlights how titles can perpetuate implicit biases.

Fasting Ramadan is one of the central pillars of Islam. Council member Miss Nuha Yassin looks at the practice of fasting and considers implications for surgeons and patients.

Chris Roche, winner of the 2022 Cutlers' Surgical Prize, shares more about his research and the world-first prototype he created to patch the heart using minimally invasive robotic surgery.

Current and former Vice Presidents, Tim Mitchell and Sue Hill, share their experience in fundraising for the College and express why others should do the same.

In his latest blog, President Professor Neil Mortensen expresses his gratitude for our College volunteers and faculty, as part of National Volunteer's Week 2021.

RCS England Member, Max Marsden, has become the first UK winner of The American College of Surgeons Resident Trauma Papers Competition. Max tells us more about his research, the competition and what it felt like to win, in this blog.

This International Women's Day, Laura Gartshore reflects on her experience of RCS England's Lady Estelle Wolfson Emerging Leaders Fellowship and how we can all choose to challenge gender inequality.

This Valentine's Day, Consultant Cardiac Surgeon Bil Kirmani offers suggestions for how to tend to matters of the heart and mind.

In these unpredictable times, the only thing I believe is certain is that we must look after our NHS colleagues’ welfare, and build back a health service that is more resilient and sustainable.

In this blog series, David Bleetman and Jacob Chacko detail their responsibilities in the intensive care unit, describe the requirements needed to maintain an on-call service, and as a second wave approaches, they highlight their eagerness to help again.

David Black is an ENT surgeon, currently on a head and neck fellowship in Brisbane, Australia. Living and working over 10,000 miles from home, Mr Black reflects on his separation anxiety from his family, friends and the NHS as the UK was hit by COVID-19.

Dr Nabina Bhujel is a Consultant in Paediatric Dentistry at Guy’s and St Thomas’ NHS Trust. In this blog series, she reflects on the impact of the coronavirus pandemic on young patients and highlights the value of communication skills.

Dr Simon Walton is one of the ICU leads on both COVID-19 and non-COVID-19 wards and he reflects on the journey that his hospital and anaesthetic team have been on over the last few months.

In this blog series, our authors discuss how organising an online journal club has maximised learning opportunities throughout the pandemic. ​

In this blog, our authors discuss setting up a team of surgical consultants to support the intensive care unit during the peak of COVID-19.

Ms Haneen Abed is a Core Surgical Trainee who was redeployed to the COVID-19 ward at the peak of the pandemic. In this blog series, she reflects on the changes she had to embrace with her team and the valuable lessons learnt.

Mr Ian Beckingham, Clinical Lead for Chole-QuIC and CholeQuIC-ER, is a laparoscopic surgeon based in Nottingham. In this blog, he discusses the importance of embedding quality improvement into surgery and ultimately improving patient care.

Mr Matthew Dunstan is an ST6 Trainee in General Surgery in South West London. In this blog series, he describes how, with the help of instant messaging, team dynamics have changed during the coronavirus pandemic.

Parvathi Varma is a Core Surgical Trainee and Diana Kazzazi is a Plastic Surgery Registrar, both based at the Yorkshire and Humber Deanery. In this blog series, they discuss their respective experiences of the COVID-19 pandemic and the ways in which it has altered training.

Nick Faure Walker is a Consultant Urologist at King’s College Hospital in London. In this blog series, he draws parallels between the healthcare landscape during the COVID-19 pandemic and times of war.

Sala Abdalla is a Senior Specialist Registrar in Upper GI and General Surgery based at King’s College Hospital, London. In this blog series, she discusses the implications of COVID-19 on BAME communities and urges action to ensure we drive out systemic discrimination.

Miss Jessica Mok was one of the first volunteers at Nightingale Hospital London and was there when the first patients were received on 7 April 2020. She describes the importance of multidisciplinary care and camaraderie during the COVID-19 pandemic.

Mr Nanavati and Dr Vyas discuss the ways in which they have adapted their department to manage the coronavirus pandemic.

June Tay is a senior urology trainee currently working at Guy’s Hospital, London. In this blog series, she shares her experience as a pregnant surgeon working during the coronavirus pandemic.

Natasha Jiwa is a trainee surgeon in General Surgery and was redeployed while undertaking her PhD as a Clinical Research Fellow. In this blog series, Natasha reflects on the wide-ranging changes in the medical community that are the result of COVID-19.

In this blog series, the authors review how technology solutions are being used to help healthcare professionals stay connected, safe, and engaged throughout and following the coronavirus pandemic.

Professor Peter Hutchinson is the Director of Clinical Research at the Royal College of Surgeons of England. In this blog series, Peter highlights the importance of the newly launched COVID Research Group, which aims to support and coordinate major studies investigating the impact and challenges of COVID-19.

Mr Tim Mitchell is an RCS Council Member and newly elected RCS Vice President. In this blog series, Tim discusses how the COVID-19 pandemic could alter medical practice indefinitely.

Professor Martin Birchall explains how technology has helped his team to maintain distance and better communicate in the theatre.

Professor Michael Escudier offers reflection on the Faculty’s work over an unparalleled couple of months, for both the profession and the public. The blog explores guidance the Faculty has contributed to and how members survey responses helped inform conversations with government.

Rabindra Singh is a Consultant Maxillofacial/ Head & Neck Reconstructive Surgeon. Here, he writes about his concerns for cancer patients whose treatment has been postponed or amended because of the COVID-19 pandemic.

Professor Ian Loftus is a Consultant Vascular Surgeon and an incoming Council member of RCS England. In this blog series, Ian describes how workforce patterns had to be reassessed as his trust saw a rapid spike in COVID-19 related admissions.

Liam Poynter is a trainee surgeon in Colorectal and General Surgery. In this blog series, he reflects on his first experience of performing emergency surgery, while wearing full personal protective equipment (PPE).

Dr Sancia Fernando currently works as an Oral and Maxillofacial Surgery Senior House Officer in Northwick Park Hospital. In this blog series, she describes her experience of redeployment and details the contributions that the dental workforce can bring to caring for critically ill patients during the COVID-19 crisis.

Mr David Whitehead is a Consultant Ear, Nose & Throat Surgeon in Middlesbrough. He describes a week when he was on call, providing emergency ENT surgery to patients suspected of having COVID-19.

In the kickoff piece for our new COVID-19 blog series, Jonathan Glass looks at what we can create by sharing perspectives.

President of the Royal College of Surgeons of England, Professor Derek Alderson, pays tribute to Dr Adil El-Tayar and Mr Amged Al-Hawrani, and updates members on PPE, arrangements for trainees and for retired surgeons returning to work.

As we fight the COVID-19 pandemic, you must not put yourself, your colleagues or patients at unnecessary risk through potential viral exposure as a result of inadequate personal protection, writes Professor Derek Alderson.

Colonel Paul Parker is the most senior trauma and orthopaedic surgeon in the British Army. He is also a Consultant Orthopaedic Surgeon at the Queen Elizabeth Hospital in Birmingham and director of the Royal College of Surgeons’ ‘Damage Control Orthopaedic Trauma Skills’ (DCOTS) course.

Following the Paterson Inquiry report, Professor Derek Alderson writes a blog for the BMJ, outlining key recommendations and ongoing work to assure standards in the independent sector.

Past and current RCS research fellows visit Cairo on an historic trip by the RCS to further collaboration between the UK and Egyptian surgical communities.

Read our latest blog post by Mr Leslie Hamilton on what it takes to become an expert witness and the RCS's new guidance for surgeons considering this as a career path.

Specialty Association Spotlight: In this series representatives from the Specialty Surgical Associations write about a 'hot topic' within their specialty, with the aim of starting conversations within the different specialties.

Rhodri Williams is a consultant orthopaedic surgeon who specialises in all aspects of routine, complex and revision hip and knee joint replacement surgery

Consultant Colorectal and General Surgeon Mr Mark Szymankiewicz describes his experience of volunteering as a General Surgeon at St Augustine’s Hospital, Muheza, in Tanzania, East Africa.

“Prevention” is one of the most important words in healthcare today. It is at the heart of the NHS Long Term Plan (LTP). Published at the start of January, the LTP sets out the direction for the health service for the next decade and beyond.

Dr Clare Gerada is a GP, former chair of the Royal College of GPs, and the Medical Director of the Practitioner Health Programme (PHP) – a confidential NHS service for doctors and dentists with issues relating to a mental health, or addiction problems. She has recently been appointed as a co-chair of a new NHS assembly, which will advise NHS England and NHS Improvement on the delivery of the NHS long-term plan.

In this blog, medical student and BOTA Medical Student Representative, Berenice, gives her hints and tips on how you can make the most of medical school if you aspire to become a surgeon.

Every surgical specialty experiences a subgroup of patients who present with symptoms that cannot be resolved by surgery.

If we have learned anything in the last 30 years, it’s that we are exposed to new knowledge and its practical applications more rapidly than ever.

The Chole-QuIC project was initiated by the Royal College of Surgeons (RCS) in 2016. It aimed to reduce the time patients had to wait for urgent surgery to remove their gall bladder for patients with acute inflammation of the gallbladder, pain from a blocked bile duct, or gallstone pancreatitis. Mr Nabeel Qureshi, a consultant general surgeon, talks about his involvement in this Quality Improvement project and how it helped drive changes in his hospital.

The Medical Protection Society (MPS) runs a professional behaviours masterclass for surgeons who perform cosmetic surgery. Mark Dinwoodie, the former Director of Education at the MPS, explains how it can help surgeons to enhance their skills in areas such as consent and effective communication with patients.

A Consultant Oesophago-gastric surgeon explains how beneficial quality improvement initiatives have been in improving patient care and team work during his NHS career.

Up to 44,000 people in the UK die every year from sepsis and as many as 250,000 people are affected by the condition every year in the UK. At the UK Sepsis Trust, we are passionate about raising awareness of this potentially life-threatening condition.

Last month The Lancet published a report into survival outcomes in England for patients with major trauma, following changes that occurred in 2012 to trauma service provision. The study showed a 19% increase in the odds of survival since the introduction of these changes. 1,600 more trauma victims are alive today because of the developments that have been made in the management of trauma patients in England over the last six years.

Supporting NHS 70: Professor Harold Ellis CBE FRCS, who began working as a surgeon 70 years ago, looks back at how the NHS has evolved since its creation.

Supporting NHS 70: Nadine Hachach-Haram is a plastic and reconstructive surgeon at St Thomas’ Hospital, London, and co-founder of Proximie, an award-winning augmented reality technology company providing solutions to improve healthcare systems.

Congenital anomalies, also known as congenital birth defects, result in half-a-million childhood deaths globally every year – one of the top five causes of death in children under five. Ninety-seven per cent of deaths from congenital anomalies occur in low- and middle-income regions and, whilst the number of deaths has fallen in middle- and high-income countries over the last quarter-century, the number continues to rise in low-income countries.

Read why our founding associate members joined the RCS and what membership means to them.

Congenital anomalies, also known as congenital birth defects, result in half-a-million childhood deaths globally every year – one of the top five causes of death in children under five. Ninety-seven per cent of deaths from congenital anomalies occur in low- and middle-income regions and, whilst the number of deaths has fallen in middle- and high-income countries over the last quarter-century, the number continues to rise in low-income countries.

I am an ST5 in general surgery. I’ve always been ambitious. I did well in my medical school exams at the University of Cambridge and King’s College London, and I had a fantastic time on my trauma surgery elective in South Africa. Nevertheless, I didn’t know if I had what it took to be a surgeon.

The Royal College of Surgeons is involved with the development of surgical standards in just about everything it does. Not only do surgeons look to the College for guidance, but the public also expect surgeons to maintain the highest possible standards, whether in their training, their examinations or in their professional behaviour. Whilst the Specialist Associations remain responsible for guidance on specialty specific issues, there remain large areas of generic skills and practice which are relevant to all surgeons and where the College seeks to raise the bar.

The Royal College of Surgeons has called on NHS England to stop clinical commissioning groups (CCGs) from imposing minimum waiting times on surgery for patients who need a non-urgent operation.

If 600 kids aged 18 and under were being hospitalised every year as a result of their mobile phones exploding, there would be a huge outcry and steps would be taken to remedy the problem. Yet because these are kids stabbing kids, almost all from deprived backgrounds, little is being done.

We are on the edge of a healthcare revolution. Technological developments are beginning to converge that will provide innumerable benefits to patient and surgeon alike. The Royal College of Surgeons has set up an independent commission to explore this very area and imagine the future of surgery. From innovative use of big data to personalisation of care, the surgery of the future will look very different to the present day.

The Royal College of Surgeons has launched its new Commission on the Future of Surgery. As the name suggests, the Commission will look forward to what surgery might look like in 5 years, what it could look like in 10 years and what it might be in 15 to 20 years. Ros Levenson, chair of the RCS Patient and Lay Group considers why the Commission is so important for patients.

This autumn, the Royal College of Surgeons of England, supported by Health Education England (HEE) and in association with the Joint Committee on Surgical Training (JCST) are launching a new pilot surgical training scheme. Entitled ‘Improving Surgical Training’

Those of us intending to apply for core surgical training this year have a new training programme for general surgery to consider – Improving Surgical Training (IST).

Surgeons realise the huge impact of people living longer but suffering ill-health for more years. We see patients waiting for social support before they can go home, elective patients having surgery cancelled through a lack of hospital beds and some patients nursed in ‘escalation areas’.

On Monday night (16 October) BBC Panorama will broadcast an important investigation into standards in the private sector.

When clinical evidence of efficacy and safety, high cost-effectiveness, NICE guidelines and international consensus by all relevant professional organisations are not sufficient to ensure appropriate access to bariatric/metabolic surgery, then it becomes clear that misconceptions and the stigma of obesity are the main barriers.

There are limited surgical skills courses pitched at core trainees or pre-specialty surgical trainees, and those that do exist are often expensive. We identified the potential of an alternative type of training course that encompassed fun and teamwork as well as friendly rivalry.

The Sunday Times (23 July 2017) reported on “unprecedented” bans on routine hip and knee operations for people who are obese and for people who smoke, as well as similar threats regarding access to cardiac surgery. Professor Derek Alderson, RCS President, is right to describe these restrictions as “illogical and prejudicial”.

As someone who has undergone a significant amount of Plastic Reconstructive and Aesthetic Surgery myself, I know just how important it is for a patient to have the utmost trust in the medical practitioner helping them.

Despite polls and pundits predicting a comfortable majority, in the end the Conservatives lost 13 seats and ended on 318 MPs – 8 short of an overall majority. This has left Theresa May under intense pressure from the media, her own party colleagues, and an emboldened Labour opposition. Under Jeremy Corbyn, Labour finished the night with an additional 30 MPs, with post-election polls even putting them ahead for the first time since Corbyn became leader. So what are the implications for the NHS?

Those of us who call Northern Ireland home may have been disappointed, but not shocked, to see a return to so-called ‘tribal voting’ in the devolved nation after a roller coaster year. But those responsible for maintaining the Democratic Unionist Party (DUP) website almost certainly had the biggest surprise of all: a website meltdown brought about by the highest volume of traffic ever witnessed, as a direct result of the hung parliament. So, who are the DUP, what have they said about health and social care and what can we expect from their negotiations with the Conservatives?

This week sees the launch of the RCS Postgraduate Certificate in Surgery. Aimed at the junior tier of aspiring surgeons. How is the PGCert in Surgery different? E-learning is nothing new, and the benefits are well-documented: easy to access, available at any time, allowing efficient transfer of information.

With revalidation now in its fifth year, Clare Barton, Assistant Director of Revalidation at the General Medical Council answered some of our members’ questions on the process.

On the front of a recent issue of the BMJ there was an illustration comparing the appointment to top NHS trusts of a crop of new chief executives from abroad with football team managers. No doubt there will be an increasing market for high flying CEOs in the future and while they may not command the salaries of the premier league bosses, some will still be taking home half a million before tax. That’s four times more than most consultants and ten times as much as many of the hospital staff.

In recent years, the NHS has increasingly struggled financially as costs have risen faster than income. When funding is tight in a labour-intensive sector such as the NHS, finding ways to stimulate labour productivity will be a key element in achieving these savings.

It is well-known that people who are seriously obese will develop other medical conditions as a result. This often compounds the obesity and takes a toll on their general health, and the healthcare economy. It’s also been established that for some, surgery can help them lose significant weight and return to a healthier lifestyle. It is proven to be safe, effective and saves the NHS money in the long term. So it is clear that bariatric surgery should be made more readily available to those who need it when everything else has been tried.

Reflecting back on my Emerging Leaders experience, the dominant tone was that of inclusion and interest. On that first morning, however, I asked myself what I was doing there...

The GMC says that doctors “should make the care of your patients your first concern”. But we don’t. We put our personal practice, our unit and even our “empire” first. Understandable. That is human nature. And no one likes change. But at a time of significant change in the patient population we serve and in the expectations of our patients, is it not time for a fresh look?

"This winter has already demonstrated the enormous pressures in the NHS across the UK. For most of us it seems it is the worst we have experienced in our working lives."

Nigel Poole QC considers the landmark judgment in Montgomery v Lanarkshire [2015] which affects the surgeon/patient relationship. The Supreme Court held that patients have the right to exercise autonomy over their own bodies and over the treatment they undergo.

Whilst on the surface it appears that the gender gap in medicine as a whole is decreasing or perhaps even inverting (fifty-six percent of foundation year 1 doctors are female), in surgery the statistics tell a different story.

One way or another, it is absolutely clear that workforce morale requires much greater priority. Let’s try some simple things now – they may make a difference.

"I recently told a 30-year-old woman she probably has breast cancer. I say woman, but she looked like a young girl to me. Even as I approach 50, I feel young and that there is a long future ahead."

"The report highlights the importance of doing the simple things right and doing them first time round. Many patient readmissions with acute pancreatitis could be avoided if the underlying cause is identified and treated during the first admission."

"To many patients, an elective - or planned operation - can be a daunting experience. However, what most people do not realise is that an emergency bowel operation is the most high risk surgery in England and Wales."

"Is it fair that a doctor from New Zealand will have to prove their English language skills in a clinical setting to be able to practise in the UK while a doctor from the EU only has to prove their everyday English skills?"

"Involving lay people, whether as patients, carers or as members of the wider community, should be a continuing process and not an ‘event’. It is a bit like continuing professional development – always ongoing, always offering new challenges and always suggesting new ways of working."

"There is no magic formula for success, but a combination of commitment, hard work and top tips from successful academics may propel the novice academic to publishing success."

"Change, challenges, setbacks, and advances are the hallmarks of modern medical careers. We can either let "Brexit" type moments consume us, whispering from the sidelines, or show the leadership necessary to deal with the uncertainty which now confronts us... "

"I spent years working as a doctor in emergency medicine, so I know from personal experience how cumbersome data collection can be, especially if it is implemented at odds with spending time on patient care. Then again, I also know how powerful data can be when it is correct and used in the right way."

"Standing in a dark, windowless operating room in the Republic of Congo a few years ago when a power failure cut the lighting mid-surgery was a troubling reminder that many of the resources we take for granted at home are often a luxury for our colleagues working in low-resource settings."

"A never event is a terrible misnomer for serious untoward events that, despite the introduction of the WHO safeguards, are occurring over 200 times a year in the UK."

"Dr Styner developed and delivered a local trauma training programme that was taken up by the state of Nebraska and then nationally a year later... Today, the course is delivered in over 75 countries"

"Training pathways must be sufficiently integrated to allow the trainee to develop their trauma ambitions without negating aspirations to cultivate an elective sub-specialty or emergency (non-trauma) practice."

"Mention “global health” and most people in the UK, even doctors, think of malaria, tuberculosis, HIV and possibly Ebola. Few think of surgery... "

"Any bleeding persisting for more than a week or so, or occurring when there are no other symptoms of piles, needs to be taken seriously and properly investigated"

"As soon as I saw my breast ultrasound I knew exactly what lay ahead. All the possible complications and worst-case scenarios flashed before my eyes"

"Despite the very real challenges facing acute hospitals and the complexities of how they deliver services, we have seen how outstanding innovation is improving patient care."

"It’s fantastic to see the difference the transplant made in the child’s life and we’re now aiming to use 3D printing to support safe and successful transplantation in similar cases."

"The cancellation of planned operations is driving up waiting lists and leaving us and theatre teams faced with having to tell patients that we are not able to operate today. This should not be the case when it is not due to clinical reasons."

"In 2016 we will continue to work towards delivering our three strategic priorities, underpinning the College’s vision of advancing surgical care."

"For the NHS this first working week of January will be remembered for the headlines of hospitals in crisis, patients on trolleys and cancelled operations."

"The New Year is an opportunity to set out resolutions for improvement and challenges the NHS, and indeed our College, to learn from the concerns expressed by junior doctors to better support the entire medical workforce"

"Is it any wonder there is low morale amongst surgical trainees, or why junior doctors are either leaving surgery, the UK or the medical profession in droves? Trainees and trainers must remain united to address this crisis, to protect our beloved profession, before it's too late!"

"At the Royal College of Surgeons we want to support and encourage local surgeons and hospitals to offer non-specialist surgical care for children in both elective and emergency situations."

"Mentoring is about exploring how an individual wants to develop or change, often letting them verbalise their thoughts and come up with their own solutions with guidance..."

"While debates often focus on lack of access to treatments (such as worsening waiting times, life-extending cancer drugs, or IVF), the OECD found that in the UK access to care is good, with unmet care needs and waiting times for elective surgery below the OECD average."

"I hope you will join me in preparing and applying for certification. Let’s protect patients and help them to identify appropriately qualified and experienced surgeons from individuals who should not be operating."

"A minimum standard of surgical knowledge, skills and understanding for every doctor should improve patient care. It should also allow those considering a career as a surgeon to have a sound basis for their future development."

"As President of the College, I will continue to seek every opportunity to persuade the government and NHS Employers to find a way forward with the BMA and the Junior Doctors’ Committee, that reflects the importance of trainee doctor workforce."

"My experience has shown that patients with a learning disability or impairment have a lot to teach us. We just need to give them the time and respect, to enable us to tap into that valuable resource."

"Health Secretary Jeremy Hunt has warned that obesity will overtake smoking to become the biggest public health challenge over the next five years."

"The social media campaign #ilooklikeasurgeon highlighted just how many women surgeons there are working in the UK and around the world."

"The NHS needs to make a £22 billion saving by 2021. Delivering care more appropriately to help to reduce costs remains a key priority for NHS England. "

"At the RCS our aim is to instigate a cultural change towards improving the transparency of surgical trials, and we urge others with influence over trials on surgical and other non-regulated interventions to do the same."

"Surgical services need to change. Seven-day care is required to reduce weekend mortality; integrating health and social care would help to care for older people with multiple conditions; and services providing complex surgery need rationalisation to improve outcomes for patients... "

"It's not just weekends which pose significant patient safety issues. August is the traditional month of summer holidays and junior doctor change over. ..."

"Hip fracture care has improved radically over the last decade. New analysis published today shows that time to surgery and death rates reduced among older people with hip fracture following the launch of the National Hip Fracture Database (NHFD) in 2007."

"Providing evidence of achieving standards is undoubtedly a burden; however, the vast majority of effort expended in achieving accreditation is actually related to doing the things necessary to improve the quality of the service."

"For all their successes, the 18-week waiting times targets have been rather confusing and unfair since they were introduced in England nearly a decade ago... "

"Amid the concern about the future of the NHS one point is worth emphasising. The current standard of health care provided in the UK is the best it has ever been."

"Learning to communicate is a lifelong journey that never ends in medicine. At the heart of this learning has to be the patient's experience; everything about even the shortest conversation may be remembered for a lifetime by that person... "

"Continuity would offer the NHS space to focus on the real challenges facing the health service, particularly well-established cultural and financial risks."

"As a medical student, it was inspirational to watch a leprosy surgeon in Nepal perform complex hand surgery, in a small hospital in the foothills of the Himalayas, with the most basic of surgical instruments. The challenges of balancing career goals with a normal family life is no different whatever your gender."

"Both smoking and high BMI are risks to manage with patients as soon as they are referred to a surgeon. This is entirely comparable with how other risks, such as uncontrolled diabetes, should be managed. Hard-and-fast rules denying or delaying surgery to patients in pain are unethical."

"Many years ago, when I was a trainee, I saw a patient who had been referred for oral rehabilitation following surgery to remove a large tumour in the roof of her mouth... "

"Working as a surgical trainee over the holiday season is often bitter sweet. On one hand, the drive into work was tranquil and the wards were full of good food. On the other hand, winter pressures were in full swing with the surgical wards full of patients."

"As a practising surgeon, looking after cancer patients, it is heartbreaking seeing operations cancelled on the day of surgery... "

"Freezing, on the platform at Plymouth station yesterday evening, I heard that familiar refrain of the Christmas carol sending tidings of "comfort and joy" from the adjacent church hall. After an amazingly vibrant and energising two days in Truro and Plymouth visiting their surgeons I really felt the reality of those words."

"Carers should be involved with decisions about treatment and support, and must be consulted when it comes to planning around discharge. Taking on unpaid caring responsibilities can be a stressful and bewildering experience... "

"What really matters in our quest for improvement is that we use outcomes to understand our own work and have honest and informed conversations with patients about the nature of surgery and their chances of successful outcome."

"This national, multi-centre, student-led collaborative research and audit project has been a world-first. The learning curve has been steep, but the enthusiasm with which students from across the UK and Ireland have taken to it suggests that with the right mentoring and support, surgical research has a bright future ahead."

"There are times when a pat on the back is very welcome and the bariatric healthcare community can feel suitably cheered by the second report from the National Bariatric Surgery Register (NBSR)."

"Being a doctor has always been both a nightmare of juggling demands amidst the wonderful small clinical encounters that make each day worthwhile and no three-letter acronym will ever quite sum up what I do."

"The financial situation facing the NHS is a subject which has dominated party conferences this year. Statistics and predictions have ricocheted across the halls and the fringe debates in a rather chaotic fashion... "

"Achieving the highest standard of patient care requires more than surgical excellence which is a base on which to build trust with both patients and colleagues. Leadership skills, and an environment of collaboration with the patient and the wider clinical team, are essential."