30 September 2020

Dear Fellows and Members,

I have held back from writing another newsletter for a couple of weeks as we have settled back into the ‘new normal’ following some respite during August. Unfortunately, all the predictions of a second surge of COVID-19 in the community have proven correct here in Ireland, and at the time of writing Dublin and Donegal are back to Level 3 restrictions. On 28 September, there were 390 new cases diagnosed and as might be expected the number of hospital admissions is increasing.

As a surgical community we are more prepared than we were. However, the surge, coupled with an expected winter trolley crisis, could bring scheduled care to a halt. The HSE 'Winter Plan' is welcome as it acknowledges the difficulties ahead and commits to 500 additional acute and ITU beds. These will take time to commission and to staff. The plan looks to enhance healthcare capacity in the community and to enable timely discharge from hospital – long overdue initiatives that can and will protect hospital capacity if fully implemented.

The RCSI Weekly Webinars on Wednesday evenings have kept us informed of the ongoing effects of COVID-19. Experience is similar across the country and across disciplines. Northern Ireland is faring little better as we heard from Mark Taylor, Consultant HPB Surgeon who spoke on the Wednesday, 16 September webinar. Last week, our Trauma and Orthopaedic surgical colleagues told us how flexible working arrangements and off-site consultations can help ease pressures on acute units. This week, we will hear how colleagues in Florida and Sweden are managing and Professor Tom Walsh who has recently moved to RCSI Bahrain will present on behalf of our colleagues at the Medical University of Bahrain. You can register for this week's webinar here.

The annual American College of Surgeons Clinical Congress will take place virtually this year, from 3-7 October 2020. Unfortunately, I will not be able meet our North American-based Fellows and Members in person, however I am pleased to say that this year RCSI will host a virtual reception in place of the usual Monday evening meet and greet session at ACS.

ACS President and RCSI Honorary Fellow Dr Valerie Rusch will extend a formal greeting to all RCSI participants. We will hear from Dr Keith Lillemoe, Surgeon in Chief at the Massachusetts General Hospital and Editor-in-Chief of the Annals of Surgery; Professor Mark Shrime, newly appointed O’Brien Chair of Global Surgery on his new role in RCSI; Professor Conor Delaney, newly appointed CEO of Cleveland Clinic Florida; Professor Vivian McAlister from London, Ontario; Dr Majella Doyle, based in St Louis on the effects of COVID on their practice; and RCSI Fellows in training Dr Ruth Tevlin and Dr Jamie Doody on their experiences of the last six months. I hope that Fellows and Members from around the world will be able to join this online webinar, scheduled to go live on the RCSI YouTube channel at 11pm GMT/ 5pm CST on Monday, 5 October.

The MRCS Part A examination was held two weeks ago as an online examination. Across the four Royal Colleges, nearly 4,000 candidates sat the examination, 97.5% doing so without technical difficulties. It is planned to hold a Part B diet in RCSI in the second week of October using a validated, socially distanced, 13-station (as opposed to 19-station) OSCE. At the same time, five centres in Great Britain will also hold diets of the examination. It is very important that there are sufficient numbers of examiners to facilitate the smooth running of the examination. All members of the Court of Examiners are asked to support this diet as progression of trainees from ST2 is dependent on completion of the MRCS examination. If you have an eligible trainee in your unit, please make sure that there is at least one representative available to act as an examiner. The Presidents of the four Royal Colleges together with the examination offices and the chair of JCIE, Mr John McGregor, are in constant contact regarding the Intercollegiate Fellowship Examinations, currently planned for November. The format will not include clinical examination and actors rather than patients will be used in clinical scenarios. Irish candidates will be allowed to sit the examination online in RCSI and will not have to travel to Great Britain. It is hoped that current COVID-19 restrictions in place will not be escalated and that the examinations can run as planned. Work is ongoing toward a new examination format, mapped to the planned new intercollegiate curriculum, due to be launched in August 2021.

The Presidents of the four Royal Colleges, together with the examination offices and the Chair of JCIE, Mr John McGregor, are in constant contact regarding the Intercollegiate Fellowship examinations, currently planned for November. The format will not include clinical examination and actors rather than patients will be used in clinical scenarios. Irish candidates will be allowed to sit the examination online in RCSI and will not have to travel to Great Britain. It is hoped that current COVID-19 restrictions in place will not be escalated and that the examinations can run as planned. Work is ongoing toward a new examination format, mapped to the planned new intercollegiate curriculum, due to be launched in August 2021.

This week will see the publication by the HSE of important external reviews of clinical audit within the national screening programmes BreastCheck, CervicalCheck and BowelScreen. The remit of the expert advisory groups was to ‘define the future audit processes and review guidance for interval cancers in the National Cancer Screening Service based on international evidence and best practice’. The reviews found that the programmes were performing to international norms, but that there is no international consensus on what constitutes best practice for audit and disclosure. Now that screening is recommencing, I have no doubt that the findings will engender debate in the media. It would be important for surgeons involved in the care of patients with bowel, breast or cervical cancer to familiarise themselves with the reports when published.

The 2020/21 academic year has recommenced at RCSI University of Medicine and Health Sciences. It appears that there has been no loss of student intake compared to last academic year; indeed the numbers may be slightly increased as RCSI has responded to the Government request to increase access for CAO applicants to highly competitive courses such as Medical, Pharmacy and Physiotherapy. As I have previously reported, there has been enormous preparatory effort to ensure in as much as possible the health and safety of patients, students and staff. Students on clinical attachment are being taught at our temporary campus at Croke Park. Regular COVID-19 screening of clinical students is being performed to reduce the possibility that an RCSI medical student might be responsible for an outbreak. The senior management team and staff deserve great credit.

The 2020 Times Higher University Rankings brought good news for RCSI University of Medicine and Health Sciences, as it retained its position within the top 250 Universities worldwide and also remained Ireland’s second-highest ranking university. Great credit is due to the Dean, Professor Hannah McGee, and the academic staff for maintaining this standard of excellence in the face of intense international competition.

RCSI also gained considerable publicity from an unexpected source – EU Commission President Ursula von der Leyen, who singled out RCSI student Suaad Alshleh, a Syrian refugee and medical student. A clip from President von der Leyen’s State of the Union speech is part of this interview with Suaad, which makes for very happy viewing.

Keep safe,

Professor P. Ronan O'Connell
President, RCSI