1 May 2020

Dear Fellows and Members,

I hope that you, your families and colleagues remain safe and well.

Your personal health and wellbeing remains a great concern to me and to your College. The COVID-19 pandemic is having a significant impact on healthcare professionals across Ireland. You face many challenging situations across every aspect of your work, from leadership to ethics and mental health. Managing yourself and others during this crisis will be especially challenging. To help with this, we have developed an extensive series of personal health and wellbeing resources for surgeons which are regularly updated. You can access these resources here.

From feedback we have received we are acutely aware that many of our trainees and trainers have questions about the impact the current situation will have on surgical training and progression. Trainees’ wellbeing and provision remains a high priority for us all and we are continuing to work to find the safest and most pragmatic solutions to the current situation. Following discussions between the Forum of Irish Postgraduate Training Bodies and HSE NDTP, all planned rotations for July 2020 will proceed. We will continue to take all public health advice into account, and, if the current plan to proceed with rotations needs to be deferred or changed we will let you know immediately. However, as of now, rotations will proceed as normal.

Our trainees have also shared their concern about their examinations. We are actively engaged with the intercollegiate bodies of JCIE, JCST and ICBSE to ensure we can provide the necessary specialty and basic surgical examinations. It is likely that gathering size and social distancing restrictions will be active for a number of months at least and consideration is being given to the implications of these restrictions on exams. We are working to increase our capacity for exam candidates. All those who had booked on diets of the exam prior to the suspension and those who need to take the examinations this autumn will be accommodated. Any changes will be communicated as early as possible.

This week we entered the firth week of our new COVID-19 webinar series. So far over 750 Fellows and Members have participated in this new and valuable resource. This week’s webinar involved a discussion on preparing for the recovery and the return to normal surgical service with updates from the Clinical Leads from the National Clinical Programmes for Surgery and Trauma and Orthopaedics, and the Anaesthesiology perspective from the President of the College of Anaesthesiology.

Next week's webinar will present the perioperative perspective on the planned return to surgical service with contributions from Michelle Cooke, Clinical Nurse Manager, 3 ASAU University Hospital Limerick, Mary Garvey General Manager to Roscommon University’, and Declan McNamara, Director of Nursing, Peri-Operative Directorate. You can register for the webinar, which takes place next Wednesday at 6pm GMT, here. The restoration of planned surgery will be guided by mitigating risk to the patient and healthcare personnel and the capacity of the health service to manage further COVID-19 surges.

The pent-up patient demand for care is immense but facility readiness to resume planned surgery will vary by geographic location. It is important to anticipate further surges and we need to retain our demonstrated ability to quickly repurpose for surge capacity locally and regionally, should it be needed again.

We should also take this opportunity to embed beneficial changes that we have collectively brought about in recent weeks. This includes supporting local initiatives and flexibility, strong clinical leadership and flexible and remote working where appropriate.

The National Clinical Programme in Trauma and Orthopaedics has identified that the continued consolidation of trauma and orthopaedic services will be an important component of allowing capacity to be preserved for further surges. Similar to the Trauma System for Ireland Policy recommendations, planned orthopaedic care should be delivered in a hub and spoke model. We are particularly well placed to do this, especially in the Dublin region. Cappagh Hospital is a standalone facility, which has the infrastructure, capacity and experienced staff to deliver planned care to a much wider catchment area. Trauma services are currently provided in six hospitals in Dublin, this is clearly now unnecessary and unsustainable.

The National Clinical Programme in Surgery is currently focused on three COVID-19 specific work streams:

• developing a national structured approach to the safe resumption of surgical practice for patients and surgeons
• developing clearly defined surgical pathways during COVID-19
• developing a structured framework of high priority procedures

This week, as part of this work, NCPS published their guide for prioritisation of urgent surgical conditions. You can access these guidelines here.

The programme is also conducting a modelling of the expected unmet surgical need and collating the surgical activity across the surgical specialties to determine the spectrum and volume of surgical activity. Combined with the clinical guidance the programme is developing, this work can inform the surgical workload requirement for the coming period and assist in developing a recovery plan to be implemented as Covid-19 restrictions are eased.

Across the College, there are additional initiatives underway to support you and your colleagues during the current crisis.

This week, we launched an RCSI ‘Comfort for Carers’ appeal to support ICU workers on the frontline and I would like to ask for your support and assistance. As we all know, doctors and nurses treating patients in ICU are working long hours away from their families to answer the required call. An early issue that was raised to the RCSI School of Nursing & Midwifery, Skin, Wounds and Trauma (SWAT) Research Centre was the skin abrasions and pressure ulcers resulting from wearing PPE for long periods on a daily basis. In response the RCSI team identified a Wound Care Kit to increase the comfort levels of the frontline staff. But we are not satisfied just to identify the solution. We want to provide staff with these Wound Care Kits for the duration of the crisis and also deploy our researchers to provide ongoing assessment of their impact. You donate to the Comfort for Carers Appeal here.

The RCSI Department of Simulation is working collaboratively with teams across the RCSI community to develop supportive COVID-19 specific training content and research focused simulation scenarios. This week, working alongside colleagues from the Department of Nursing, the team developed training videos for the management of prone pressure ulcers and prevention through an educational care bundle with supportive training videos. They are also supporting vital research in a journey towards safe surgery using unique PAPR PPE approaches. They are also collaborating with the Physiotherapy Department to develop a framework for adapting existing models of simulation based learning for the clinical education of physiotherapists in Ireland. The RCSI Institute of Leadership has developed training videos on After Action Review scenarios for healthcare staff debrief following COVID19 associated scenarios.

The Department of Surgical Affairs is supporting the various specialty associations with online engagements such as webinars and virtual specialty meetings. Next week, they will reintroduce ‘ENT Grand Rounds’. This will be in webinar format and will be dedicated to the issue of getting back to work.

In a collaboration with the HSE, the National Healthcare Communication Programme (NHCP) and International Association for Communication in Healthcare (EACH), RCSI is delighted to launch a free online course to help clinicians navigate telephone consultations with patients and prepare for potentially difficult conversations about COVID-19 treatment. This activity has been approved for 3 CPD Credits. Further information is available here.

Next week will see the virtual conferring of the Class of 2020, marking the end of a very trying period for these new doctors and the beginning of their career in medicine. It’s hard to recall a more difficult time to start working in healthcare and I ask you to provide any support and guidance to them that you can.

As your College, we try to support you in a number of ways, but probably our most important role is to effectively communicate with you, listen to your queries and concerns and assist in solutions to accessing what you need to support you. Please share any thoughts you have on other ways we can support you and your colleagues by emailing fellows@rcsi.com.

Please stay well and take care,

Mr Kenneth Mealy, President of RCSI