Victor Horsley

Sir Victor Horsley (1857–1916) was a pioneer who shaped the development of neurosurgery and the direction of clinical medicine through his work with the British Medical Association, Medical Defence Union, and General Medical Council. Before the nervous system could be imaged, Horsley operated successfully on the brain and spinal cord, and performed palliative procedures on patients dying from brain tumours. Nevertheless, he became a social pariah due to his support for nationalised health insurance, child welfare and women's rights, amongst other causes. In this fascinating biography, leading neurologist Dr Michael J. Aminoff places Horsley's life and work in the context of the society in which he lived and explores his influence on the development of neurosurgery and social policies still in effect. The many underlying themes to the book include the interplay of science and politics, and the responsibility of physicians to themselves and for the welfare of society.

A Cross-Sectional Study of Undergraduate Teaching of Trauma and Orthopaedics in the UK and the Relationship Between Medical Schools and Interest in Trauma and Orthopaedics as a Career

INTRODUCTION Adequate exposure and teaching of Trauma and Orthopaedics (T&O) to medical students is fundamental in order to obtain sufficient knowledge and sustain their interest in T&O as a career. The primary aim is to assess the exposure and delivery of T&O at all medical schools in the UK. The secondary aim is to determine whether there are any associations between attending a particular medical school and having a strong interest in pursuing a career in T&O. METHODS To explore the primary aim, all 33 UK medical schools were investigated in the study, by means of a questionnaire distributed to medical students. This did not include ‘new’ medical schools, defined as those established from 2014 onwards. To investigate the secondary aim of exploring associations between students’ and alumni's medical schools and their interest in T&O as a career, British Orthopaedic Training Association (BOTA) members were reviewed, using the General Medical Council register to identify the universities from which members had graduated. The authors have made the assumption that membership of BOTA signified an interest in T&O as a career. RESULTS Results were obtained for all 33 medical schools. The mean total teaching time specifically for T&O throughout medical school was 18 days, ranging from 3 to 60 days in total. 118 BOTA members were reviewed. No member of BOTA in the study had attended medical school in Keele, Liverpool, Plymouth or Lancashire. These universities taught below the national average number of days in T&O. DISUCSSION There is a large national variance in the number of compulsory teaching days provided for T&O. The authors advocate medical schools to aim for at least the national average in duration of T&O of 18 days.

Radiology and the medical student: do increased hours of teaching translate to more radiologists?

Objectives: The UK has a shortage of Radiologists to meet the increasing demand for radiologic examinations. To encourage more medical students to consider Radiology as a career, increased exposure at undergraduate level has been advocated. The aim of this study was to evaluate if formal Radiology teaching hours at medical school had any association with the number of qualified Radiologists joining the General Medical Council Specialist Register. Methods: Total number of doctors joining the GMC Specialist Register as Clinical Radiologists, and those with a primary medical qualifications awarded in Scotland, was obtained from the GMC (2010–2020). Graduate numbers from all 4 Scottish Medical Schools (2000–2011) were also obtained. Hours of Radiology teaching for medical schools in Scotland were obtained from validated AToMS study. Results: Two hundred and twenty three (6.6%) of 3347 Radiologists added to the GMC Specialist Register between 2010 and 2020 received their primary medical qualification (PMQ) from Scottish Universities. The number of Radiologists from Scottish Universities joining the GMC specialist register was 2.6% of the total number of Scottish Medical Graduates. There was no association between the number of hours (Range 1–30) Radiology was taught to medical students and the number that joined the specialist register as Radiologists (p = 0.54 chi square trend). Conclusion: Increased exposure to Radiology teaching does not influence medical students’ decision to take up Radiology as a career. While continued Radiology exposure remains important, other strategies are required in both the short and long term to ensure radiology services are maintained without detriment to patients. Advances in knowledge: Increased hours of Radiology teaching in medical school was not associated with increased radiologists joining the profession.

Doctors and the General Medical Council (GMC)

This chapter explores the role of the General Medical Council. It explains the importance of the register and the licence to practice. It also considers how doctors can be removed from the register or have restrictions on their licence to practice. It discusses how the General Medical Council promotes candour in the profession and investigates concerns about doctors.

EP.TH.507An Audit of Consent Documentation and Chaperone Use in Patients Presenting to Acute Settings with Breast Complaints

Aim To compare current practice of documenting consent and offering chaperones when performing breast examinations in the acute setting, with standards set by regulatory bodies (General Medical Council, Royal College of Emergency Medicine and Royal College of Surgeons). Method Data was collected retrospectively from all patients presenting with breast complaints to either the emergency department (ED) or the surgical assessment unit (SAU) over a 34-month period. From the clerk-in notes, the role (Dr/Nurse), grade (FY1 to consultant) and gender of the examiner was noted, as well as whether consent was documented and if a chaperone was offered. Results Of the 64 patients presenting in this time frame, consent was documented in 7 sets of notes (11%). Furthermore, 17 were offered a chaperone (27%), of which examiners correctly documented the name and role of the chaperone on 11 occasions. Results also demonstrated that ED trainees were most likely to offer a chaperone and GP trainees were the best at recording consent. It also revealed that although male examiners offered a chaperone 50% of the time compared to 6% of female examiners, women examiners were better at documenting consent when compared to their male counterparts. Conclusion The audit results indicate that there is significant room for improvement across all roles, grades and genders with regards to documentation of consent and the use of chaperones within the acute setting, in order to meet current standards of practice as set out by regulatory bodies.

EP.TU.7A cross-sectional study examining the association between MRCS performance and surgeons receiving Fitness to Practice sanctions

Aims Fitness to practice (FtP) investigations by the General Medical Council (GMC) can be one of the most stressful experiences in a surgeon’s career. Demographic factors are known to alter the likelihood of GMC investigation. Despite this there are no studies assessing risk factors in surgeons for FtP sanctions. Thus, we used the newly created Intercollegiate Membership of Royal College of Surgeons (MRCS) examination database to identify risk factors for and the prevalence of GMC sanctions in early-career surgeons. Methods FtP sanction data contained in the GMC list of registered medical practitioners (LRMP) was linked at person-level to all UK graduates who had attempted MRCS Part A or Part B between September 2007 and January 2020. Data were anonymised by the Royal College of Surgeons of England prior to analysis. Results Of 11,660 candidates who had attempted the MRCS within the study period only 31 (0.3%) candidates had GMC FtP sanctions within the last two years. Of these, 12 had active conditions on their registration, 7 had active undertakings and 14 had warnings. Candidate demographics were similar between cohorts and there were no considerable differences between MRCS performance identified. Conclusion In this, the largest study of MRCS candidates to date, the prevalence of active FtP sanctions in early-career surgeons was 0.3%, significantly lower than the prevalence of sanctions across more experienced UK surgeons (0.9%). These data highlight early-career surgeons as a low-risk group for disciplinary action and should reassure patients and medical professionals of the rarity of FtP sanctions.

‘Capable of being in uncertainties’: applied medical humanities in undergraduate medical education

Numerous medical schools have been updating and modernising their undergraduate curricula in response to the changing health needs of today’s society and the updated General Medical Council competencies required for qualification. The humanities are sometimes seen as a way of addressing both of these requirements. Medical humanities advocates would argue that the humanities have a vital role to play in undergraduate medical education, allowing students to develop the critical tools required by the 21st-century clinician to deliver the best person-centred care. While we endorse this view, we contend that such training must be taught authentically to have maximal impact. This article arises from a collaboration between Imperial College London and Birkbeck, University of London, which aimed to embed the humanities into Imperial’s undergraduate medical curriculum. Here, we use a teaching session on graphic medicine and narrative as a case study to illustrate how the humanities can be a powerful tool for students to explore professional clinical complexity and uncertainty when taught in a transdisciplinary way. In this session, uncertainty operated on several different levels: the introduction of unfamiliar concepts, materials, and methods to students, transdisciplinary approaches to teaching, and the complexities of real-life clinical practice. Further, we argue that to manage uncertainty, medical students must cross from a scientific training based on positivist understandings of evidence and knowledge, to one which foregrounds multiplicity, nuance, interpretive critical thinking, and which understands knowledge as contingent and contextually produced. In facilitating such learning, it is crucial that the teaching team includes experts from both medical and humanities fields to scaffold student learning in an intellectually dynamic way, drawing on their disciplinary knowledge and wide range of personal professional experiences.

Sustainable Healthcare In Medical Education: The Student Perspective

Background:It is now a General Medical Council requirement to incorporate sustainable healthcare teaching (SHT) into medical curricula. To date, research has focussed on the perspective of educators and which sustainable healthcare topics to include in teaching. However, to our knowledge, no previous study has investigated the perspective of both undergraduate and postgraduate medical students in the UK regarding current and future incorporation of SHT in medical education.Methods:A questionnaire was circulated to clinical year medical students and students intercalating after completing at least one clinical year in a London University. The anonymous questionnaire consisted of sections on the environmental impact, current teaching and future teaching of SHT.Results:163 students completed the questionnaire. 93% of participants believed that climate change is a concern in current society, and only 1.8% thought they have been formally taught what sustainable healthcare is. No participants strongly agreed, and only 5 participants (3.1%) agreed, that they would feel confident in answering exam questions on this topic, with 89% agreeing that more SHT is needed. 60% believe that future teaching should be incorporated in both preclinical and clinical years, with 31% of participants preferring online modules as the method of teaching.Conclusion: Our novel study has stressed the lack of current sustainable healthcare teaching in the medical curriculum. From a student perspective, using online modules throughout medical school presents an attractive method of incorporating sustainable healthcare teaching in the future.

108 Neck of Femur Fractures: Streamlined Approach to Improve Consenting Practices

Aim Neck of femur fractures (NOFs) are synonymous with frailty, and successful outcomes are achieved with operative fixation. The United Kingdom’s General Medical Council guidance governing consent highlights the importance of thorough pre-operative discussion of risk with the patient. We aimed to audit consenting practices in NOF patients within our unit against the British Orthopaedic Association’s (BOA) criteria, with the addition of delirium as a risk factor. Method In cycle one all operatively managed NOFs over a two-month period in October-November 2019 were retrospectively reviewed. Consent forms 1 (CF1) and 4 (CF4) were assessed against BOA-endorsed criteria. Our intervention included a standardised sticker detailing 14 important risks was introduced and a departmental seminar on delirium. A second cycle was undertaken from August-October 2020 to close the audit loop Results No consent form documented all BOA-approved risk factors in cycle one (N = 35). Of cycle two’s 35 patients, 70.8% CF1 were completed using the novel sticker. All of these had 100% BOA-approved risk documentation. Consent forms without the sticker in cycle two documented 9/14 risks (mean value). No CF4 had any risks documented in either cycle. Delirium was documented in 51% in total and in 75% patients with CF1. Delirium documentation improved from 2.9% in cycle one to 51.4% in cycle two. Conclusions Clear lapses in operative consenting processes were identified, especially regarding delirium and CF4 documentation. The introduction of a novel consent sticker drastically improved compliance with BOA guidance for CF1. Recognition and departmental education regarding delirium significantly reduced incidence between cycles.

1405 Improving Documentation of Per Rectal (PR) Exams in An Acute Surgical Unit

Aim A PR exam is routinely performed as part of the complete examination of surgical patients. The General Medical Council (GMC) has provided guidance on the use of chaperone during intimate exams stating that consent should be obtained, and a chaperone offered to all patients and documented accordingly. We aimed to assess and improve our documentation of PR exams. Method Data was collected prospectively from surgical admission documentation. The number of patients with consent and presence of chaperone documented during PR exam was recorded. Following a period of data collection, a proforma was implemented with education on correct documentation as per guidelines. A second audit cycle was performed where formal inclusion of the sticker in the admission booklet was implemented. Results 20 patients were included in the initial data collection, 95% of which had incomplete documentation of PR exam on admission. A sticker was designed to prompt accurate documentation and inserted into the acute admissions booklet. Following this, 50% of PR exams were correctly documented. The remaining 50% without documentation had no sticker in the admission booklet. The second intervention included changing the hardcopy of the admission booklet. Following this, 80% of patients had consent documented and 90% had documented chaperone. Conclusions GMC guidelines state that documentation of consent and the presence of chaperones during intimate medical examinations are crucial. The implementation of a prompt in our admissions booklet has greatly improved our documentation in PR examination.