cardio 1208 bulletin - society for cardiothoracic surgery · ([email protected]). directive i...

Society for Cardiothoracic Surgeryin Great Britain and Ireland

New Patient Representative

Article 14 Applications

Mesothelioma & Lung Cancer Initiative

The Changing Cardiothoracic Workforce

Here to the North Pole!

Travelling Fellowship report

Annual Meeting 2009

Cardiac SurgeonsA Pain in the Neck!

the

December 2008

Cardio 1208 Bulletin 27/11/08 18:49

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Society for Cardiothoracic Surgery in Great Britain and Ireland

The Royal College of Surgeons of England35-43 Lincoln's Inn Fields, London WC2A 3PETel: +44 (0) 20 7869 6893Fax: +44 (0) 20 7869 6890Email: [email protected]

President’s Report 3

Secretary's Report 5

Revalidation 6

New Patient Representative 9

Mesothelioma and Lung Cancer Initiative 10

Article 14 Applications 11

Annual Meeting Bournemouth 2009 12

Cardiothoracic Surgeons: A pain in the neck! 14

Trainees Report 17

Treasurer’s Report 18

National Selection for Trainees 19

The Marian and Christina Ionescu Travelling Fellowship 20

SCTS Cardiac Scholarship 21

Here to the North Pole 22

Nursing Report 23

Society Cardiac and Thoracic Scholarship 25

Ionescu Travelling Fellowship 25

New Appointments 25

Forthcoming Events 27

Obituary 29

Applications for SCTS Treasurer 29

Crossword 30

Contents

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Edited by Sunil Ohri, Communications Secretary Contact: [email protected]

Designed & produced by CPL Associates, London


December 2008 3

President’s Report Leslie Hamilton

Now the Chair of the UK Lung CancerCoalition and the President of the RCSEnghave asked to meet us to see how we canincrease the rate of surgery for lung cancer.I have also been in discussion with thePresident elect of the British ThoracicSociety about closer cooperation.

In October, the Syntax trial (PCI vs CABG)reported its one year results. This hasprompted a new mood of realism andcooperation. We already have a goodrelationship with BCIS and they have setup a group to update the guidelines on PCI,particularly in the light of the NCEPODrecommendation that appropriate patientsshould be discussed at MDT meetings – weare represented on that group.

Technology

The technology for ventricular assistdevices is developing rapidly and theselook set to become a routine part of ourarmamentarium in the not too distantfuture. I was asked recently to give a talkon the artificial heart – my initial reactionwas that it would be a very short talk! I hadassumed that it had moved only from theworld of science fiction (my researchuncovered the fact that one of the StarshipEnterprise Captains in Star Trek had one)to an experimental phase. I was amazed todiscover that almost 800 Cardiowest(Jarvik 7) hearts had been implanted asbridge to transplant. The AbioCor heart(trans-cutaneous power source) has justbeen approved for Medicare / Medicaidfunding in the USA as destination therapyfor patients not suitable for transplant. Youmay have seen, on the news, the recentpress conference in Paris to launch the

Carmat heart by a group lead by AlainCarpentier – due for clinical implantswithin 2 years.

So exciting times. Yet there are pressures.The potentially unfair consequences offocussing on individual surgeon’s resultscontinue to cause angst among cardiacsurgeons. On the positive side, this putscardiac surgeons in a strong position withregard to re-certification. It re-enforces mydesire to move towards looking atmeasures of morbidity at unit level as ameans to improving quality of care – Iaccept that there are issues of definitionand data quality but these should be

challenges not problems. The need to haveoutcome measures for Thoracic surgeonsto inform recertification has provokedconsiderable debate and will have beendiscussed in detail at the Board ofRepresentatives meeting at the end ofNovember. I am hopeful that the Thoracicsurgeons will confirm their agreement (atthe Thoracic Forum) to collect the fulldataset (currently collected by 6 units),which will allow adoption of theThoracoscore.

On the subject of outcome measures: allpatients undergoing surgery for congenitalheart disease should be reported to thecongenital section of CCAD. Centres whichdo not do paediatrics are not used toreporting to congenital CCAD. The Board ofCCAD have asked that these patients arereported so as to give an accurate pictureof overall workload and outcomes – theycan be registered directly on-line to CCAD([email protected]).

Directive

I have to mention the European WorkingTime Directive. I think we should stopthinking about it! – the focus on 48 hours ismisleading. However we do need to thinkurgently how we are going to provide theservice in the future and on patient safety.Changes to immigration rules and the factthat the Deaneries are no longer going tofund the large numbers of FTTN posts wehad in the past, mean that we must findalternative ways of providing the service.At the request of the Executive I wrote to alChief Executives (letter on SCTS.org) tohighlight the impending crisis – theresponse was deafening silence! TheAussies and Kiwis have been looking at thequestion of patient safety (the EWTD isHealth and Safety legislation) - “SafeWorking Hours” is a very sensibledocument. They point out that workingcontinuously for 24 hours is the equivalentof a blood alcohol level of 100mg (ourdriving level is 80). If your trainee came towork with that level they would be in frontoff the GMC. They conclude that trainees

They say that a week is a long time inpolitics (and hasn’t that been reinforcedby recent events). Change may happen alittle more slowly in medicine but for us,as cardiothoracic surgeons, what adifference a year makes. We were beingtold that pills for lung cancer were justaround the corner; stents were going toconquer myocardial ischaemia and drugswould deal with heart failure.

The potentially unfairconsequences of

focussing onindividual surgeon’s

results continue tocause angst among

cardiac surgeons.continued on page 4


President’s Report continued

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should ideally have day working of nomore than 10 hours (maximum 14) andshould have a minimum of 8 hours sleep inevery 24. Could anyone reasonablydisagree with these? So should ourtrainees spend 16 hours providing nightcover for ICU (taking 16 hours away fromsurgical training time)? The College adviceis that trainees should not be on residentnight shifts. We have to develop new waysof providing the service.

Objectives

The Executive sets objectives at thebeginning of each Presidential term. Thecurrent ones are:

• Improving quality of care: aim todevelop the thoracic surgery databasewith appropriate outcome measures –Jim McGuigan and John Duffy aselected Trustees and Eric Lim havebeen putting a lot of work into this. Onthe cardiac side, look at outcomemeasures other than mortality – with amean mortality rate of less than 2%,focussing on mortality means ignoringthe care of the other 98%.

• Revalidation / recertification: SteveLivesey is our lead on theIntercollegiate Board – see his articlelater in this Bulletin. We (SCTS) havebeen given the opportunity to set thestandards and measures – we shouldtake it.

• Board of Representatives: the focusgroups who helped with the review ofthe Society gave a strong message thatwe needed a way of hearing the viewsof members. The Board is that conduitand the Executive feels very stronglyabout its importance – it should holdthe Executive to account. It is up tomembers to use it – each unit isrepresented. We had feedback that themeeting after the Annual Meeting inEdinburgh did not allow discussion –we have therefore extended themeeting at the end of November to afull day.

• Raise the profile of the Society: wehave set up a database committee, notonly to oversee the handling of data,but also to use the data to publish

articles on behalf of the Society. Wealso hope to develop the website of theSCTS Company commercially.

• Patient involvement: we have startedby appointing a patient representativeto the Executive. David Geldard (seelater article) has already shown that hewill be a valuable asset on thecommittee.

Measures of clinician’s performance andoutcome measures for patient care arevery high on the political agenda in the UK– all specialties will be assessed. Aninteresting development in the USA is thatof commercial websites for patientreporting: DrScore, Healthgrades andRateMDs give a flavour. The professionalbodies have responded by launching theirown: “Patient Charter for PhysicianPerformance Measurement” (BMJ 2008;337:a1408). Will these cross the Atlantic?Interesting times.

Leslie Hamilton

President


Secretary’s Report Graham Cooper

December 2008 5

And for a change, more change.We have received a recordnumber of applications formembership so far this year butare also losing two people. B.Sethia steps down as HonoraryTreasurer at the Annual Meeting in2010 and Rachel Woolf will beleaving after the Annual Meetingin Bournemouth next year.

Rachel joined SCTS in 2004 with responsibility, along with BSethia for managing the financial side of the Society, and runningthe Exhibition at the Annual Meeting. The financial side of her roleis little seen but is demanding and of vital importance. With B shehas vastly improved the accounting and tax return systems forSCTS. Most members, however, will know Rachel from her work atthe Annual Meeting. In this role she has shone; her engagementwith and responsiveness to the needs of our customers have ledto a massive increase in revenue from the Exhibition; in 2003 wesold 28 stands in the Exhibition and in 2007 we sold 60. As wellas increasing the size of the Exhibition, Rachel has been a vitalpart of the team that has developed all other aspects of themeeting. And she has been a great colleague. Rachel will bemoving to Israel and we wish her all the best for her future.

Stepping down

B Sethia steps down as Honorary Treasurer a year later. He hasmade a significant contribution to SCTS with his wise financialmanagement and played a vital role in changing theConstitution and developing the commercial arm of SCTS,SCTSGB Ltd. We will appoint B’s successor at the AnnualMeeting in Bournemouth to enable a year’s overlap. The postof Honorary Treasurer offers a significant opportunity. Theestablishment of SCTSGB Ltd provides exciting potential todevelop new revenue streams for SCTS. We hope that B’sreplacement will seize these and generate innovative ways offinancing SCTS. The advert appears in this Bulletin. Anyoneinterested should free to contact Leslie, B or me to discuss thepost.

As well as two significant departures we welcome a significantnumber of new arrivals. Applications for membership for theperiod April to October 2008 stand at 22, of which 10 are forAssociate Membership. This is a significant increase from the5 to 6 applications that we have received for this similar periodin the past five years. Please encourage those you work withto join. Associate Membership costs only £25 a year andbrings a reduction in registration fee for the Annual Meeting.Full and Trainee Members enjoy all the benefits membershipprovides.

One benefit for Consultant Members is support in applicationsfor National Clinical Excellence Awards. The number ofmembers SCTS is able to support is proportionate to the sizeof its membership. This year, in addition, we have increasedthe weight of our support by appointing a lay member of theSCTS CEA Committee, Lady Cynthia Irvine. The CEA Committee

is chaired by Pat Magee and this year members of SCTS have hada record haul.

This is a significant improvement on previous years, see table.Obviously recognition is down to the efforts of those individualsbut effective support from SCTS helps.

Finally, this year, as a trial we are extending this support toMembers applying for Local CEA awards. If requested SCTS willprovide a citation to your Trust in support of your application fora local award. Details have been communicated by e-mail and areon the members pages of the website. And for another change atthis time of year, I would like to wish you all the best for Christmasand the New Year and I look forward to meeting you inBournemouth in March.

2008 2007 2006 2005 2004

Bronze 6 6 6 4 3Silver 2 2 - 2 1Gold 2 - 1 - -Platinum 3 1 - 1 -

TOTAL 13 9 7 7 4

National CEA Awards to Members of SCTS


Revalidation and the SCTS

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To Recap...............Liam Donaldson’s report “Good Doctors,Safer Patients” (2006) and the subsequentwhite paper “Trust, Assurance and Safety”(2007) confirmed a system of revalidationfor doctors which would include anelement of specialist recertification forthose doctors on the specialist register.The recent pamphlet, “MedicalRevalidation - Principles & Next Steps”(July 2008) has set out the principles ofrevalidation. This will happen on a five-yearly cycle.

A doctor will be revalidated when he hasbeen relicensed – this will be the end resultof successful appraisal, and recertified –this will signify he/she has met thestandards set by his/her specialtyassociation.

For recertification, a doctor will need topresent evidence about their practice fromseveral sources. This will include: • evidence of continuing professional

development• meeting standards laid down by the

relevant Specialty Association andagreed by the Royal Colleges and GMC

• evidence that surgical outcomes areabove a minimum standard agreed bythe Specialty Association

The Approach of the SCTS

The Society has formed a working group todevelop our approach to recertification.This group has representation from acrossthe spectrum of membership as well as layrepresentation and has made theproposals outlined in this article.

The GMC’s principle is that a doctor shouldbe revalidated is his/her area of practice;these should not be defined too narrowly.It was agreed that the areas of practice forCardiothoracic Surgery should be:

• Adult Cardiac Surgery• Thoracic Surgery• Congenital Surgery

As part of the revalidation process eachsurgeon should give a more detaileddescription of his/her practise but alignthemselves broadly with one or more ofthe above, i.e., a cardiothoracic surgeonwith a mixed cardiac and thoracic practisewould need to meet the standardsdescribed for each of those subspecialties.It is recognised that some surgeons maynot fit comfortably into the standarddescriptors of an area of practise, e.g., athoracic surgeon with a large oesophagealpractice - standards for this type ofpractice will be developed in time.

Many of the building blocks for therecertification process have beendeveloped by the Pan-Specialty

Recertification Board under the aegis ofthe four surgical colleges. Their work hasfocussed on three main areas.

Standards & Assessment

The GMC’s new categories of Good MedicalPractice are likely to form the basis for thesetting of standards. The categories are:

• Knowledge, skills and performance• Safety and quality• Communication and teamwork• Maintaining trust

However, it is not yet clear to me exactlyhow the standards set will map to thesedomains.

The group considered how standardscould be set in the following areas:

• Development of a “Test of Knowledge”.My feeling is that this is unlikely to becompulsory but successful completionof a test of knowledge would be astrong piece of evidence of being bothknowledgeable and up-to-date. It wasfelt that as SESATS already existedadapting this for use in the UK shouldbe explored – this is currentlyunderway.

• Multi-source Feedback: The Academyof Medical Royal Colleges is working onthe development of MSF. It is indicatedthat information from MSF’s will berequired at least twice during a five-year revalidation cycle and would beadministered locally.

• Simulator tests: there is no evidencefor their use in assessing Specialistsand are unlikely to play a part inroutine revalidation

• Observation of practice: Again there isno evidence for this tool for the“routine” assessment of specialiststhough NCAS do use this tool to as partof the assessment of doctors who have“caused concern”. Other sources ofevidence: For example, the use ofminutes of Morbidity & Mortalitymeetings to assess performance wasdiscussed. It was felt that the NCEPODsystem of assessment of care inpatients who had died was useful and itwas recommended that Trusts adopt it.


December 2008 7

CPD

• Surgeons will be required to record, ina portfolio, their CPD according to thefollowing areas; Clinical, Professionaland Academic and should includeinternal, external and personal study.

• Surgeons should participate in abalanced range of activities that meetthe needs of their practice andpersonal development.

• Fifty credits per year over a five-yearperiod would be required. Credits willnormally be earned at the rate of oneper hour of activity – guidance will beissued for those activities that aredifficult to measure on an hourly basis

• Surgeons should participate inreflective learning.

Outcomes & Peer Review

The Darzi review – “High Quality Care forAll” had recognised the need for allsurgeons to move towards making theirsurgical outcomes available. It was theintention that outcome measuresdeveloped for recertification should alsolead to the improvement of quality overallrather than just be used for assessingindividual doctors. It was recognised thatdifferent sub-specialties would requiredifferent methodologies for assessment oftheir surgical outcomes and there is ahierarchy of quality of outcomes datawhich could be presented.1. National Clinical Audit. Data sets

utilising outcomes data down toindividual surgeon level (e.g. CCAD). Itwas felt that where national clinicalaudits are available, contribution ofdata to them would be mandatory.

2. Administrative data sets (HES, ID,PEDW, HIS, ONS mortality data). Thesub-group had undertaken an in-depthexamination of the potentialusefulness and limitations ofadministrative data sets. It is possible to use these data to showindividual surgeon’s outcomes forlength of stay, re-admission rates,mortality within a defined period andrevision rates for a given procedurecould be compared to their peers.These data are available and routinelycollected and can generate strong

evidence about the quality of outcomesto feed the recertification agenda

3. Process-based audit data sets(e.g. National Joint Registry)

4. Local audit data5. Peer review. This may be useful for

recertification where clinical outcomesare not amenable to rigorousinterpretation – e.g., some aspects ofcongenital surgery where volumes arelow. This could take the form of bothpeer review of the individual or theunit. Peer review would also form partof the mechanism for looking in moredetail at surgeons whose outcomesmay be outside accepted limits.However, the mechanism needs to berobust, rapid and non-stigmatising.

The need for administrative support fordata collection was recognised. Surgeonsmust be able to provide a “logbook” oftheir operative data whether this be anindividually maintained log or part of adepartmental contribution to a nationalaudit.The group agreed that both short term andlonger term plans were needed foroutcome analysis. The proposals for thesubspecialty areas were as follows: • Adult Cardiac Surgery should continue

to work on refining risk adjustment,outcome measures and mechanisms ofpeer review of outliers. It was also felt

that, in addition to national audit data,HES data could provide a useful basketof measures which could be presentedas evidence for recertification.

• Thoracic Surgery could consider usingadministrative (HES) data analysis inthe short term with a view todeveloping a comprehensive nationalclinical audit in mid-term.

• Congenital Cardiac Surgery couldconsider a combination of CCAD analysisand unit based peer review mechanismsof structures, process and outcomes.

Plans for Sub-Specialties

Generic Issues• Outcomes for M&M meetings should

feed into the recertification process.The Society strongly recommends thatthe NCEPOD Classification of care isused. All cardiothoracic surgeons willbe encouraged to produce evidence ofthis grading of care at their annualappraisals and Trusts should be askedto facilitate this.

• Further work is needed on the finalstructure of CPD before firmrecommendations can be made.

• If a Test of Knowledge is adopted it islikely to be based on SESATS andfurther discussions need to take placewith The American Board of ThoracicSurgery about the possibility ofadapting this for UK practise.

• Some assessment of the patient’sexperience of care will be essential forrevalidation. Although this should beassessed as part of routine appraisal, itwould form a valuable piece ofevidence of aspects of the careprovided by both individuals andteams. This was felt to be particularlyuseful in areas where routine outcomesmeasurement is not straightforward,e.g., congenital surgery.

Adult Cardiac SurgerySurgical performance would be assessedusing the data publicly available from oursubmissions to CCAD. Submission of datato CCAD will be a mandatory standard forrecertification. Should appropriateoutcomes data become available fromanalysis of administrative data (e.g., HES),

Steve LiveseyRevalidation Lead for SCTS

continued on page 8


Revalidation continued

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cardiac surgeons would be encouraged topresent these as part of their portfolio ofevidence.

Thoracic SurgeryAs yet there is no national database forthoracic surgery with sufficient nationalcoverage to be used for recertification. Itwas agreed that Thoracic Surgeons wouldwork, through the Society and the ThoracicForum, to develop a risk-stratified nationalclinical database, based on the“Thoracoscore”. Contributing data to thiswould be mandatory. It was felt that thiswould take three years to reportmeaningful outcomes data from thisnational clinical audit and thus, in parallel,work should begin on developing usefuloutcomes using administrative data.

Congenital Cardiac SurgeryThe difficulties of meaningful outcomesanalysis in this area was discussed – the

combination of small units with smallnumbers of any one procedure combinedwith the increasing practise of consultantsoperating together make this difficult. Thepossible reorganisation of paediatriccardiac units would help to make anyassessment process more robust.However, analysis of CCAD data and peerreview is likely to remain the cornerstoneof assessment of practice in congenitalcardiac surgery.

Implementation

I think there is a realisation by the GMCthat there are varying degrees ofpreparedness for revalidation (andrecertification) across the country andbetween the various specialties. Theirinitial thoughts – that this could be rolledout according to a random process basedon GMC number – is not likely to bepracticable. Clearly the GMC would likethe process to get off to a good start – this

would mean asking for volunteers fromthose groups who thought they wereclosest to being ready. Because of ourhistory, cardiothoracic surgeons are nowaccustomed to using outcome data to lookat individual performance, and if asked, Iwould propose that we volunteered to beamongst those early implementers as away of testing out our proposals forrecertification.

The above proposals are therecommendations of the RevalidationGroup established by the SCTS. In linewith the new constitution they will havebeen presented for ratification to the UnitRepresentatives meeting on November28th 2008. There is clearly more work to bedone before our plans are finalised and Iwould be very pleased to receive feedbackon any of these issues. I can be contactedat [email protected]


New Patient RepresentativeThe SCTS welcomes David Geldard

December 2008 9

On graduating from my rehab programme Ijoined my local heart support group,Rochdale Heartbeat, and it was there that Icame across a flyer from the BHFadvertising a sponsored cycle ride fromJerusalem through the Negev Desert toEilat in April 1996. The very first overseasrisky fundraiser organised by any charity. Imanaged to raise £12,000. My training forthis event meant that I was taking myrehabilitation seriously, and another BHFride in Jordan in 1997 was closely followedby the Lands End to John O’Groats 1,069miles, staying in hostels and averaging 76miles a day. Joining the Cyclists’ TouringClub I have since ridden in South Africa,India, and the Santa Fe Trail in USA, whichwas another 1,200 mile cycle/campingepic. A ride in Indo China was more seriouswhen on our return a Foreign Office noticewarned Brits that a minibus load ofpassengers had been murdered on ourroute to Luan Prabang. Rides with my owncycle club in Europe and with Sustrans inUK have been an ongoing source ofadventure, except for the last twelvemonths when I have had two crashes thathave restricted my training. Since 1996,when I joined Trans Pennine Cycling Club,we have organised ten sponsored ridesinto the Pennines near Rochdale and “OverThe Edge” has so far raised £125,000 forthe British Heart Foundation.

In late 1995 my GP nominated me as thepatient representative on the local AreaHealth Authority’s Cardiac Taskforce, lateran invitation to join a pilot Cardiac Networkacross Greater Manchester and Cheshiremust have been successful enough toherald the 32 networks which nowembrace England and Wales.

It was in 2001 that a national pilot schemein extending choice for patients was

proposed with a focus on cardiac surgerycases. I was invited to join the TrusteeBoard as the patient representative.Members were allocated oversight ofspecific centres and mine were, CentralManchester, Nottingham, Birmingham, andSouth Manchester. In particular we wereexpected to note the strength andweaknesses of the scheme and advise onlessons learned from the pilot for the widerrollout of patient choice. Colleagues willrecall that this scheme was so successfulthat the project was curtailed at the end of2003, and choice was to be introduced as abenefit for all surgery patients.

By invitation I joined the National ServiceFramework CHD Task Force, theDepartment of Health’s CVD ProgrammeBoard and in 2003 I was asked to helpestablish a patient arm of the BritishCardiac, now Cardiovascular, Society thatwe called Heart Care Partnership (UK). Iwas vice-chair when we formed HCP, butthey soon made me chairman-cum-

president, and in October 2008 I handedon that position to Ken Timmis, but I stillcontinue to serve as a trustee. There areother groups and initiatives that I am keento support, particularly cardiacrehabilitation, Women’s Heart Health andsupporting the British Heart Foundation. Itwas Danny Keenan with his HCC hat on,and Ben Bridgewater with his mediacampaign, who involved us patients fromtheir Cardiac Board in consultations andadvice around the rollout and developmentof your public portal on surgical results –and hasn’t that been a huge success and areal benefit to patients and surgeons?

Nowadays there is no escape from patientinvolvement in medicine and I really washonoured when I was asked to considerbecoming a patient representative for theSociety for Cardiothoracic Surgery. Theinvitation coincided with the retirement ofmy own surgeon, Geir Grotte, who kindlyinvited my wife and I to his retirement

After thirty years as a Prison Serviceeducation officer and a few more as acollege Faculty Director, it was in July 2004that I turned myself in and declared aproblem with chest pain. Despite beingassured that I would be dead by Christmasif I didn’t agree to a CABG, it was thefollowing February when Geir Grotteperformed a six grafter at the ManchesterRoyal Infirmary.

continued on page 10


Mesothelioma & Lung Cancer Initiative

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I would like to inform you of this initiative, which is beingdriven by core members of the team which has reported theIASLC Lung Cancer Staging Project (Journal of ThoracicOncology, 2007). Surgeons performing thoracic surgery willbe aware of the revisions to Lung Cancer staging which wereproposed and are likely to be ratified in early 2009.

The current staging system for malignant pleural mesotheliomadates from a series of round-table meetings in Colorado in 1994,when a group of experts from the International MesotheliomaInterest Group decided the system by consensus. Thus it wasbased on opinion of the preceding systems, rather than dataanalysis. The best validation of the staging has been carried outin numerous surgical series of moderate size, with no effort to pulltogether data from multiple settings and institutions until now.

The IASLC/IMIG/MSP is co-chaired by Dr. Valerie Rusch (New York)and myself, with valuable input from Prof. Goldstraw, Dr. JohnCrowley (Cancer Research And Biostatistics, Seattle) andsignificant others from all disciplines. The team is beingexpanded and data acquisition ongoing. Funding has beenreceived from the Mesothelioma Applied Research Foundation forretrospective analysis of data combined from existing institutionalsurgical series and chemotherapy trials. Retrospective data willprovide a valuable insight into the accuracy and applicability ofpathological and clinical staging, doubtless giving rise to manyquestions to answer in the prospective phase.

Prospective data collection will start in 2009 and continue until2014; the dataset is being finalised. Submission is most likely to

be electronic, with systems beingdeveloped to allow easy transferfrom existing datasets. In the UK,we are in an excellent position tocollect data prospectively via theMDT systems. I appreciate that notall cancer networks have afunctioning specialistmesothelioma MDT, as proposedby the Mesothelioma Framework.However, the SM-MDT is the idealopportunity to record clinical(radiological) stage and I hope thatthe SM-MDTs will feed their datainto the IASLC/IMIG MSP. It isimportant to include data from all sources in the study, not justfrom centres of experience. I would ask that UK surgeons, lungcancer MDTs and specialist mesothelioma MDTs contributegenerously to the project, both with clinical and pathological data.Dori Giroux (CRAB) or I would be delighted to receive expressionsof interest or any other enquiries.

The IASLC/IMIG MSP will be holding a conference at the NationalHeart and Lung Institute, London, on February 26th and 27th2009. The faculty will include experts from around the world. Theprogramme will be both educational about mesothelioma andinformative about the Project. Further information will be e-mailed. I hope that we will see you there.

Contact: [email protected]

party. I always used to send him postcardsfrom my adventures abroad, and Iunderstand he used to keep them on hisnotice board for ages. Now I don’t expectat all that cardiothoracic surgeons shouldremember the names of their patients, butI’m telling you that your patients rememberyou and yours. Like it or not, you havebecome a close member of their extendedfamily. I will try to bring the patientperspective to your deliberations and, ifnecessary, cast wider to obtain anobjective view. We have contact with all thecardiovascular networks in England andWales, links with Scotland and NorthernIreland, and I’ve been on rugby tours andcycling tours in Ireland so there’s a start.

The involvement of patients does seem tohave an effect on deliberations and theiroutcomes, and discussions and decision

making becomes more objective and lessself focussed. It is important thatrepresentatives are not subservient, butthey do need to be comfortable with theirrole and their status. As this participationevolves I would see surgeons practicallyand subconsciously accepting theinvolvement of patients in all aspects ofclinical care and planning. We need toconsider how the needs of thoracicpatients can be met, and we need to seekways of funding the expenses for yourpatients and their carers to attend andparticipate in events like the annualconference. We already have soundworking relations with the Patient andPublic Involvement lead officer with theDepartment of Health’s Heart and StrokeTeam. We need to forge stronger links withthe DoH Health Improvement Programmeand with other national charities who

support cardiothoracic patients. I am alsothe Provincial Grand Charity Steward forthe Masonic Province of East Lancashire,and our Grand Charity has for many yearsbeen supporting initiatives with your RoyalCollege of Surgeons, there may be somemore useful links?

We seem to have made a good start.Patients are always expressing to me theirappreciation for the skills of theirsurgeons. Your President, youradministration officers and members ofyour Executive have been most welcomingand courteous and being a patientrepresentative with your Society is anexciting prospect. Remember, thewatchword of patient representatives is, “Nothing about us, without us!”

Thank you again, and Tally Ho!

John EdwardsConsultant ThoracicSurgeon, Sheffield

The International Study for Lung Cancer / International Mesothelioma Interest Group / Mesothelioma Staging Project

New Patient Representative continued


December 2008 11

Article 14 enables doctors who wish to join the SpecialistRegister who have not followed a full PMETB approvedCertificate of completion of Training (CCT) programme to applyunder Article 14 of The General and Specialist Medical

Practice Order for a Certificate confirming Eligibility forSpecialist Registration (CESR) ie enables them to join thespecialist register.

This route to specialist registration differs from routes underprevious legislation in that knowledge, skills and experiencehowever gained can be taken into account provided that theapplicant satisfies the ‘entry’ criteria. It is not just an assessmentof training.

You can apply under 14 (4) if you are applying in a CCT specialtyand 14(5) if you are applying in a non CCT specialty.

The 'entry' criteria for 14 (4) are that you have undertaken:· specialist training in a CCT specialty and/or· a specialist qualification in a CCT specialty.

Specialist training for this purpose should be for at least 6months.

If you satisfy this then all your knowledge, skills and experiencewill be taken into account. The standard that you need todemonstrate is equivalence to a CCT in the specialty in question.

The 'entry' criteria for 14(5) are that you have undertaken:· specialist training in a non-CCT specialty and/or· a specialist qualification in a non-CCT specialty.

For 14(5) the qualification or training has to have beenundertaken outside the UK in a non-CCT specialty that isrecognised as a specialty outside the UK. In the case of specialisttraining it must have been at least 6 months in length. If yousatisfy this then your knowledge, skills and experience will betaken into account. The standard you need to demonstrate is thatof a day one consultant in the NHS.

The implication for this for cardiothoracic surgery is that anapplicant may be eligible to apply under 14(5) in thoracic surgeryor cardiac surgery provided that they meet the ‘overseas entry’requirements.

There is a further route to CESR under 14(5) which is the‘academic route’. This is unusual and is best explored at thePMETB website www.pmetb.org.uk.

How to apply

PMETB are the statutory body responsible for the Article 14legislation and process. They may ask the colleges (devolved tothe SAC in cardiothoracic surgery) and faculties to perform anevaluation but any decision is theirs.

Applications must be made directlyto PMETB. Full details andapplication forms can be found ontheir website. www.pmetb.org.uk.

The standard that you mustdemonstrate is discussed above.The onus is on an applicant to provide primary evidence todemonstrate this standard. For help, an applicant should refer tothe curriculum current at the time of application and the SpecialtySpecific Guidance available on PMETB’s website. It is worthstressing that structured reports and testimonials do not count asprimary evidence, but can be used to triangulate other evidence.

An applicant should consider how to best demonstrate what theyhave done and at what level, so evidence of logbooks and anyassessment and appraisal which comments directly on clinicalskills is very helpful.

As PMETB are responsible for the process you should contactthem for guidance and application forms. If you want to discussyour application you may contact Megan Wilson from the JCST on020 7869 6256 or [email protected] .

Article 14 applications in Cardiothoracic Surgery

Megan WilsonPolicy and Non-CCT Specialist

Registration Manager& Tim Graham

Chair SAC CardiothoracicSurgery


theBulletin12

There is a myth that Bournemouth isdifficult to get to! Bournemouth andSouthampton airports (20 minutes on thetrain) connect to the major UK / Irishairports and there are excellent train linksto the midlands, north west and northeast.

We hope that each and every one of youwill find a very significant amount ofinterest, education and enjoyment fromthe programme, which is now finalised andcan be accessed through the SCTShomepage.

In cardiac surgery we welcome Dr DavidAdams from Mount Sinai, New York, who

will give the Heart Research UK Lectureand Professor Friedrich Mohr from Leipzig,Germany who will present the St JudeLecture on his experience in percutaneousvalve replacement. Furthermore, ProfessorAlain Carpentier is also attending themeeting to present recent advances inmechanical heart devices.

In thoracic surgery we welcome DrTom DeMeester from SouthernCalifornia who is delivering thethoracic lecture and Dr AlessandroBrunelli from Ancona, Italy isjoining the thoracic symposium onrisk stratification in thoracicsurgery. We will also be joined byRichard Berrisford in his role assecretary general for the EuropeanSociety of Thoracic Surgeons.

Furthermore, Sir Bruce Keogh isjoining us for the UK activitysession and Sir Terence Englishwill receive his lifetimeachievement award at the AnnualDinner on 24th March.

We are delighted with thenumber and quality of theabstracts that have beensubmitted for this year’smeeting which have beenassessed by the 37 reviewersinvolved in the process.

The Programme Committee met on 27thNovember 2008 to allocate the successfulabstracts to the appropriate sessions - allscientific and clinical presentations will befive minutes long, leaving five minutes forquestions and we are asking ALLpresenters to bring a poster that can bedisplayed in the exhibition area during themeeting.

Besides the thoracic symposium there arethree other symposia arranged. OnSunday afternoon the Pulse Lecture will bedelivered by Professor Taggart, updatingus on the current evidence for conduitsusing coronary bypass surgery andMalcolm Dalrymple-Hay will update us onthe current techniques used to harvestconduit. On Monday afternoon there willbe a symposium about the experience andimplementation of percutaneous valvereplacement and on Tuesday afternoon

Annual Meeting

Bournemouth 2009

Simon Kendall

Meeting Secretary

Registration is now open for the 2009Annual Meeting, to be held at theBournemouth International Centre onSunday 22nd March to Tuesday 24thMarch 2009. For all of you who aremedically qualified there is a considerablesaving for early registrants before 11thJanuary 2009.

We hope that each andevery one of you willfind a very significantamount of interest,

education andenjoyment from theprogramme, which isnow finalised and canbe accessed throughthe SCTS homepage.

continued on page 14


13

SUNDAY 22nd March12.30 - 13.30 Trainees and Assistants Lunch

13.30 - 15.00 Trainees Meeting - Syneture Surgical Practicioners

presentations and debate ACSA

1600 - 16.45 Hunterian Lecture

16.45 - 17.00 Tea

17.00 - 18.00 Pulse Lecture: Professor David Taggart: The latest evidence in conduits for CABG

18.00 - 19.30 Annual Business Meeting ACSA

19.30 - 20.30 Welcome Civic Reception

MONDAY 23rd March8.00 - 9.00 Papers Covidien Symposium

8.45 - 10.00 Papers Presentations

10.00 - 10.45 Coffee

10.45 - 11.45 Moderated Papers Papers Ethicon Nurses Forum Database Managers CCAD

11.45 - 12.30 UK Heart Research Lecture: Dr David Adams

12.30 - 13.30 Lunch

13.30 - 15.00 Cardiothoracic UK Activity Guest: Sir Bruce Keogh

15.00 - 15.45 Tea

15.45 - 16.55 Thoracic Symposium Forum Papers Dr Alessandro Brunelli

17.00 - 18.30 St Jude Lecture: Professor Friedrich Mohr

18.30 - 20.00 Nycomed Symposium

TUESDAY 24rd March

7.30 - 9.00 Papers ATS Medical Symposium

8.45 - 10.00 Papers Forum Congenital Papers Thoracic Papers

10.00 - 10.45 Coffee

10.45 - 11.45 Moderated Paper Session Ethicon Nurses Forum Congenital Papers Thoracic Papers

11.45 - 12.30 DeMeester Thoracic Lecture

12.30 - 13.30 Lunch

13.30 - 15.00 Thoracic Cases NCEPOD: Heart of the Matter Symposium

15.00 - 15.45 Tea

15.45 - 17.00 Thoracic Posters Forum Congenital Papers Papers

17.00 - 18.00 President’s Address

19.30 - 23.30 Annual Dinner - Royal Bath Hotel - Sir Terence English

WEDNESDAY 25th March9.00 - 12.30 Unit Leads Executive

10.00 - 10.45 Coffee

10.45 - 11.45 Unit Leads Executive

Programme

Society of

Clinical

Perfusion

Scientists,

Great Britain

and Ireland

Workshops

Society of

Clinical

Perfusion

Scientists,

Great Britain

and Ireland

Workshops


theBulletin14

Cardiotharacic Surgeons:A pain in the neck!Cervical pain is fairly common among the wider population.Fortunately, it is often transient and not associated with long termside effects. However, on occasions it can be disabling withextreme symptoms, disturbing with uncertainty about recovery,and disruptive to ones career. We all know or heard of colleagueswho underwent surgery for cervical symptoms. However, theprevalence of cervical pain / radiculopathy and its subsequentimpact on surgical practice among cardiothoracic surgeons in theUnited Kingdom is largely unknown. Therefore, a questionnairewas sent out under the auspices of the Society of CardiothoracicSurgeons (SCTS) to the consultant members registered on itsdatabase via e-mail on 2 occasions.

A total of 105 replies (response rate 44.1%) were received from the238 questionnaires sent. 35.2% (37/105) reported experiencingeither neck pain or cervical root symptoms at some stage in their

career. The type of surgical practice did not appear to influence(22 cardiac, 4 thoracic, 11 mixed) the development of symptoms.Overall, a fifth (21/105) had radiological imaging (X-ray, CT or MRI)and approximately a tenth (10/105) were so severely affected thatthey required a period of sick leave to recover from theirpathology.

It would appear from this survey that cervical pain / radiculopathyaffects a significant proportion of cardiothoracic surgeons. Atleast 1 in 3 develop cervical symptoms and the majority appear toadopt the philosophy of ‘physicians heal thy self’ and workthrough the pain barrier. We could adjust the way we work(perhaps getting someone else to harvest the mammary artery orgo on annual leave!). Nevertheless, some surgeons are soprofoundly affected that their ability to operate is impaired withimplications for patient care and service delivery.

there is a symposium about the implementation of the NCEPODreport (Heart of the Matter).

Like last year we will run parallel sessions and the congenitalsurgeons are inviting Dr Andrew Cook, Morphologist to run aworkshop on atrial ventricular septal defects.

Tara Bartley has put together another very impressive agenda forthe Cardiothoracic Forum with the theme ‘The Delivery of QualityCare’. For the third year we will welcome back the President of theRoyal College of Nursing Ms Maura Buchanan to make theopening remarks.

The Database Managers are holding their fourth Annual Meetingwith us in conjunction with CCAD and we are delighted to welcomeback the Association of Cardiothoracic Surgical Practitioners(ACSA) who have elected to hold their Annual General Meeting inconjunction with ours.

The Society of Clinical Perfusion Scientists, Great Britain andIreland (SOPGBI) are holding their own workshops on Monday andTuesday on quality assurance as well as their own committeemeeting.

Prior to the Annual Dinner (when there will be some unusualentertainment) the meeting will be concluded by Leslie Hamilton’sPresident’s Address – which will include our final guest - Major-General Garry Robison, Commandant-General of the Royal British

Marines who will talk to us about leadership and team-working.

For non-medically qualified staff the registration has been kept ata very reasonable level at either: £50 per day or £75 for two days,if they register early.

I would encourage you to look at the programme online as it willdemonstrate what excellent value for money our Annual Meetingprovides.

We look forward to seeing you there.

Annual Meeting

Bournemouth 2009


Bournemouth 2009 Rates

Membership category Early Late On Site

(Before 12/1/09) (By 13/03/09)

Entire meeting attendance

Member £250 £295 £370

Non-member £320 £425 £450

Non-medically qualified practitioner (member) £50 (one day) £75 (two days)

Non-medically qualified practitioner (non-member) £80 (one day) £110 (two days)

Day attendance

Membership category 1 day 2 days

Member £150 £300

Non-member £220 £440

Non-medically qualified practitioner (member) £50 £75

Non-medically qualified practitioner (non-member) £80 £110

15

Sing Yang Soon, Peter Charleston

& Mark Jones, Wythenshawe Hospital, Manchester

Faced with such a prevalent condition, it is prudent to not only tohighlight the issue but also to address various remedies available.Preventive measures are usually the simplest and mostsuccessful. Measures such as avoidance of extremes of neckmovements and prolonged fixation in one particular position withregular counter position neck stretching throughout the length ofoperation are advised. If symptoms develop, one should to seekhelp early from the local occupational health department. Earlyinterventions are also more likely to be successful with shorterduration of treatment required. Data for 105 Survey Respondents (44.1%)

Mark Jones


December 2008 17

Trainees Report

Considerable effort has been expended in getting the rightbalance between the number of trainees and the futurerequirement for fully trained consultants. There are newchallenges on the horizon including the European Working TimeDirective. We need to start at the grassroots and improve thesomewhat tarnished image of cardiothoracic surgery amongstmedical students. We need to encourage more medical studentsto rotate through the subspecialty to appreciate the nature of thework. This can be achieved by having representation at theuniversities and influencing undergraduate curriculum.

ST3 level entry

At the moment entry into specialty is at ST3 level. We thereforehave to influence education and training at ST1, ST2, CT1 and CT2levels and develop cardiothoracic opportunities at this level. Inaddition thought should be given to Foundation Year doctorshaving exposure to the specialty and having a positive experience!

The number of trainees entering at ST3, previously as SpR1, wasreduced in the years 2004 to 2007. In 2008, 5 trainees wereappointed at ST3 level via a national selection process in England.Scotland and Wales appointed 1 each outside this process. In2009 there will be UK wide selection and the number of posts willbe increased to 14 - 16 with numbers rising to 20 in 2010 and in2011. There will be academic training opportunities alsoadvertised and appointed within this process in 2009 and 2010.

All trainees with CCT since 2005 are in employment. Of the 17 CCTholders in 2005, 15 are in a substantive consultant post and 2 arein a locum consultant post. In 2006, 16 CCT holders, 14 aresubstantive consultants, 1 is a locum consultant and 1 is a clinicalfellow. In 2007, 28 CCT holders, 22 are substantive consultants, 4are locum consultants and 2 are clinical fellows. So far in 2008, 12CCT holders, 5 are substantive consultants, 2 are locumconsultants and 5 are clinical fellows. As more consultant postsare advertised the above ratios will change. On the whole mostCCT holders have attained a substantive consultant post.

Assessment

There is an ongoing review of Cardiothoracic Transplantationservices in the UK. This will assess current and future consultantmanpower and opportunities for training at the peri-CCT level inthis area of the specialty. Generally, there is a need for an

increased number of consultants in this area over the next fewyears.

The SCTS Annual Meeting is in Bournemouth from 22 to 24 March2009. All trainees are invited and expected(!) to attend themeeting. The Trainee Forum will be on Sunday 22 March 2009 andan informative session has been organised with various speakers.This dedicated session for Trainees’ and those interested inbecoming trainees’ provides the opportunity to find out answersto all your questions…..this is your one chance in the year to comeand put the SAC and the Exam Board on the spot; so come andjoin in!

Merry Christmas and a Happy New Year to all the trainees from theSAC!

Cardiothoracic Surgery as a subspecialty has been through adifficult period not only in United Kingdom but also in manyWestern Countries. There has been uncertainty amongst traineesregarding their future in the field and budding cardiothoracicsurgeons have been somewhat deterred from entering thespecialty. Various measures were taken and also due to changesin the cardiology field and lung cancer treatment the future ofcardiothoracic training is again looking brighter.

Sunil BhudiaTrainee Representative

& Tim GrahamSAC Chairman

There has been

uncertainty amongst

trainees regarding their

future in the field and

budding cardiothoracic

surgeons have been

somewhat deterred from

entering the specialty.


B SethiaTreasurer

Treasurer’s Report

theBulletin18

I have had the privilege of being theHonorary Treasurer of our Society fornearly 5 years now so it seemsappropriate, at a time when we will belooking for my successor very shortly, toexpand upon the events of the past fiveyears and clarify the current remit of thejob.

Trustee of the Society

The Hon. Treasurer of the Society is one ofthe Office holders of the Society and is aTrustee. All Trustees have obligationsunder UK Charity Law to act with integrityin the interests of the Society and toensure that the activities of the Society aremaintained in line with the stated aimswithin our constitution. Failure to complywith their obligations, for instance actingdishonestly or in their own interestscontrary to the aims of the Charity, is acriminal offence. Any person holding theposition of Honorary Treasurer could easilycontravene some of the CharityCommission regulations, particularly withrespect to the management of theSociety’s financial resources. Therefore,there needs to be a regular external auditof all the Society’s financial activities. I willnot expand upon the considerablelegislation in this area but any personinterested in this position should read theGood Trustee Guide, NCVO publications aswell as the Charities Act 2006 – ‘whattrustees need to know’ (published by theCharity Commission).

What does the Hon Treasurer do?

The Hon Treasurer is the custodian of theSociety’s funds. He/she has to anticipatethe likely cash flow requirements of theSociety and ensure that adequate fundsare available to run the day to dayactivities of the Society whilstadministering the funds for SocietyScholarships and the other areas, eg thefinancial support to the CardiothoracicTutor at the RCS England. All decisionsrelating to major expenditure arepresented to the Executive for discussionand authorisation. The main sources ofSociety income derive from membersannual subscriptions and the income fromthe Annual General Meeting. The mainexpenses are the organization of the AGMand the maintenance costs of our

a d m i n i s t r a t i o noffice, includingemployment ofIsabelle Ferner andRachel Woolf. Duringmy time as HonoraryTreasurer we havebeen able tomaintain a steadycurrent accountbalance despite theplethora of newinitiatives and theexpenses inherent inthese developments.The costs ofmembership have, inreal terms, fallen significantly during thistime and even though your Executive hasrecently authorised a small increase innext year’s annual subscription, the actualamount of money paid by the membership,especially those paying by direct debit, isno higher than that received in 2003. TheTreasurer presents the financial status ofthe Society at the AGM and any membermay, on direct application in writing,receive a copy of the Society’s auditedaccounts.

The Hon Treasurer has to sign off the VATsubmissions on a quarterly basis and isresponsible for administering the payrollfor our staff. I have delegated part of thisfunction to our auditors but anunderstanding of the mechanics of VAT is arequirement for any person undertakingthe Hon Treasurer role.

The Hon Treasurer is a member of theExecutive of our Society and, as such,attends meetings 4 times yearly. This is aninvaluable opportunity to contribute notonly a financial perspective for the benefitof other members of the Executive but alsoto actively help to determine the futuredirection of our Society.

How are our funds managed?

As indicated above, our funds deriveprimarily from the membership and theAGM. An important development over thepast five years has been the funding of aScholarship by Mr and Mrs MarianIonescu. Their generosity, enhanced by giftaid tax reclaimed by the Society, currently

provides a fund of approximately £240,000which is restricted entirely to the provisionof the Ionescu Scholarship. These fundsmay not, by law, be used for any otherpurpose within the Society. A number ofour members have benefited from thisgenerous Scholarship (£10,000 per year). Iwould like to take this opportunity toencourage members to consider donatingfunds to the Society, either in the form ofgifts (which can be on a lump sum or anannual recurring basis) or by means oflegacies. If any member wishes to discussthe practicalities involved in this type ofdonation I would be happy to discuss thematter with them.

The remaining part of our current funds areeither maintained on deposit at the Bankor are invested in equities. The decision toinvest on a diversified basis was taken bythe Executive following advice from ourauditors and the Charity Commission. Theprinciple of our Investment Strategy hasbeen conservative (with a small c!) and Itook a decision to limit the amountinvested in the equities market to a totalof £150,000 despite other advice that wecould consider a larger investment. Thesefunds have shown a small loss in recentmonths – unsurprising in view of the globaleconomic downturn – but I will continue toreview this aspect of our financial strategywith our Brokers and hope, given thenature of our portfolio, to demonstrate areasonable profit within the next 18months. The balance of our cash funds,approximately £128,000 is held on depositwith a view to achieving the highest return.


December 2008 19

National Selection for Trainees: Posts

to Increase in 2009

It will also include two Academic Clinical Fellows (AFC) one for theNorthern Deanery working with Professor Dark and the other forthe South West working with Professor Angelini. The selectionprocess will be administered by the West Midlands Deanery andshort listing will take place in February with selection in March.Candidates will be invited in January to apply for the posts and theshort listed candidates will be asked to rank the programmes intheir order of preference. The SAC is currently receiving bids fromall the training programmes so that the successful programmeswill appear in the adverts. The successful candidates will bematched with their ranked training programmes, if a candidatedeclines the programme, which is offered they will be passed over,and the programme (and NTN) will be offered to the next in line.My advice, therefore, to the applicants is to be prepared torelocate if you want a career in cardiothoracic surgery.

Currently there are no unemployed cardiothoracic surgical CCT(CCST) holders. Not all are in consultant posts but this is a greatachievement considering the concerns of five years ago when weappeared to have far too many trainees. There continues to be asteady number of new consultant posts annually and hopefully wehave now achieved a balance with new trainees and predictedconsultant posts. The SAC and the workforce review team will beassessing the required training posts annually. My concerns are

that the young would becardiothoracic surgeons do not knowthat our specialty will be appointingnew trainees (ST3) annually and theyare being advised by their mentors tolook at other specialties. Indeed I havespoken to medical students who arebeing told that there will be no careerprospects in cardiothoracic surgery.This is simply not true and I urge thoseof you who are involved with medicalschools to spread the word that our specialty is recruiting. We willnever be recruiting large numbers and the competition will bestrong but we want to appoint the best (of the best!). ST2/CT2trainees should be encouraged to apply as the “lost tribe” of thehigher degree holders is diminishing.

The 2009 SCTS meeting in Bournemouth is my last meeting asDean for the Society. It has been an interesting 5 years and I haveenjoyed the challenges that have been laid before me. My term ofoffice ends in August 2009. When I began as Dean one of mypersonal goals was to see every trainee at the Annual Meeting butI fear this goal will not be achieved. I would have liked attendanceat the Annual Meeting to be a requirement for every trainee’s RITA(ARCP). The meeting is the only opportunity where trainees canmeet with the Dean, the Chairman of the SAC and the Chairman ofthe Intercollegiate Examination Board to freely and openlyexpress their opinions. I hope, therefore to see a great turn out inMarch 2009.

As always, contact me at [email protected].

The report of the national selection for ST3 posts incardiothoracic surgery, which was held in March, has receivedpraise from the Department of Health and MMC. We have theapproval to continue with national selection. Next year we willappoint 16 trainees. This will include Scotland, Northern Irelandand Wales.

Steven HunterCardiothoracic Dean

A new part of our financial strategy is dueto emerge as this article goes to press.One of the necessary arrangements whenthe Constitution of the Society wasrewritten was to form a limited company –SCTS GB and I Ltd. The purpose of thiscompany is to enable the Society toengage in activities, which cannot beconducted via our charity, for instancedeveloping advice on job contracts. Weare looking to access new sources ofincome in order to support the activities ofthis company and therefore, ultimately,

the Society as a whole. The first majorinitiative agreed by our CommunicationsSecretary Sunil Ohri and myself is to setup a job centre on our web pages whichwill, hopefully, be used by medical andnursing staffing offices to advertise theirposts. We hope to develop further newfiscal initiatives in due course.

The Future

Who can predict the financial future?Evidently not the Banks or the market!Within our current resources I believe that

we are well placed to take advantage ofnew opportunities for the benefit of ourmembership and our patients. Thedevelopment of new initiatives will, Ihope, enable us to prosper but these willalways be dependent upon adequatelong-term funding. I believe that it ispossible to achieve this at a relatively lowcost for individual members (especiallywhen you remember that subscriptionsare a tax deductible expense), and I hopethat my successor will find this job asenjoyable and stimulating as I have done.


theBulletin20

I have now returned from the UnitedStates having spent 5 weeks looking atsome of the best examples of quality andpatient safety. I have met the great andthe good. These have been interestingtimes what with the Wall Street crash andthe elections. More significantly, on 4thOctober the HMO organizationsannounced that they are now only goingto pay for and reward quality. This is aparadigm shift in the delivery ofhealthcare in America and it will have asignificant impact on us in due course.

Cardiac Surgeons crossed the Rubiconwhen our mortality data entered the publicarena. I believe that we need to movebeyond bean counting and look at quality.A good way to make an impact in ourmortality and morbidity in the short tomedium term is to examine how we deliverour services. It is not about working harderit is about working smarter. Gary Kaplan,CEO of the Virginia Mason Medical Centre inSeattle has removed all the non-valueadded waste in the patient pathway.Moreover, Gary and others are designingtheir services around their patients and notfor their own convenience. Actually, staffare happier because there is less timewastage and they get home earlier!

The Executive Patient Safety OfficerProgramme run by the Institute of HealthImprovement in Boston is one of the bestcourses I have ever attended. I wasprivileged to meet the faculty andpersonally talk to Don Berwick, thePresident of the Organization and to‘Chuck’ Denham CEO of Leapfrog and NQF.It complimented all the principle learning ofmy MBA. People have been overwhelmingin their generosity of time and advice. Theyhave tolerated questions about anythingand everything and answered with candor.Consequently, I have 31 formal interviewson file. These are filled with wisdom andexperience. The journey from East to WestCoast has been an odyssey as well as apersonal epiphany.

We are often compared to airline pilots. Totake this metaphor further we shouldseriously consider why the risk to a personflying in an airplane is 1 in 3,000,000 whereas the risk to a person entering our

hospitals is 1 in 300. We need to recognizeour systems are not reliable. We take it asan affront to our clinical autonomy when webegin to talk about standardizing.However, the only way that we are going toimprove our systems and the delivery ofhealthcare is to consider standardizingsome of our processes. This is being done- Peter Provonost’s work in intensive carehas made him Time magazine man of theyear. He is leading the USA on blood streaminfection. Geisinger Healthcare are nowoffering a 30-day warranty on all electivecardiac surgery.

The most striking thing when talking topeople is the alignment of all (regardless oftheir specific positions or roles) to thestrategies of patient safety, quality andexperience. They work and focus onconversations and communications in theform of play back in ITU, SBAR (SituationBackground Assessment Recommend-ation)in clinical environments and crew resourcemanagement in theatres. Briefing and de-briefing in theatres is mandatory at JohnsHopkins and has been proven to improvepatient safety through teamwork - ChuckDenham refers too this as the JERK factorand implores us not to be jerks! This doesnot cost money and requires minimal effort.

There are only 256 Cardiac Surgeonslooking after a population of 66 million inthe United Kingdom. As a talented and veryable group of people we have the capacityto lead and change our organizations. Thequality agenda will enable us to put the ‘P’back in professionalism and enable theSociety to continue to lead. It is not difficultbut it does require a different way ofthinking - “because it has always beendone like that around here” is not toleratedin the hospitals I visited. I would like to askanybody who is interested to contact me,so that we could trial some of theseinitiatives and learn together from ourexperience.

My American experience has had asignificant impact on me and will changemy practice forever. I would like to thankMr. and Mrs. Ionescu and the Society forgiving me this award. My blogs areavailable on the following URL:www.cihm.leeds.ac.uk/themes/managers/Doctor%20manager%20USA

David O’ReganYorkshire Heart

Centre, Leeds

Amy Edmonson and Anita Tucker

Professors, Harvard Business School

David B Nash, MD MBA

Chair, Department of Health Policy,

Thomas Jefferson

Donald M. Berwick KBE MD, MPP, FRCP,

President and CEO, IHI

Gary S. Kaplan, MD

Chairman and CEO, VMMC

Charles R Denham, Chairman, Leapfrog

Group, NQF Safe Practice Program

The Marian & Christina Ionescu Travelling Scholarship 2009


December 2008 21

The SCTS Cardiac Scholarship

Had I known quite how much would beinvolved in securing a fellowship positionin the United States, I might haveembarked on a simpler task, such asmapping the human genome!

My six-month “to-do” list prior to leavingfor the US included passing the UnitedStates Medical Licensing Examination,publishing a book, and sitting the finalFellowship exam (which, like water-boarding, simulates a near-deathexperience in order to elicit every last pieceof information you may know on a topic), inaddition to completing the reams ofpaperwork required for national, state andinstitution credentialing in America. Hencethe first of many thanks are due to myfamily, and to Messrs Fountain andTownsend at Harefield Hospital, withoutwhose support and forbearance over thosesix months I would have failed miserably atthe first of these hurdles.

The effort was certainly well worth it. I haveenjoyed a superb time at Mount SinaiMedical Center in New York, as well as astint at the Univesität Leipzig Herzzentrum.Ani Anyanwu, a Harefield trainee whocompleted a fellowship at Mount Sinaiunder Dr David Adams, and then accepteda position there two years ago as Directorof Heart and Heart-Lung Transplantation,wrote a comprehensive account of hisfellowship experience in the December2005 edition of the Bulletin. His articleclosely reflects my experience, so I will notduplicate his comments here. I hope itsuffices to say that his account of hisfellowship operative experience as firstsurgeon at Mount Sinai, which includedVADs, transplants, complex mitral valvereconstruction and advanced aortic rootand arch surgery, was the primary reason I

applied for the same fellowship; andtalking to senior fellows at institutionsranging from the Harvard teachinghospitals to the Cleveland Clinic hasemphatically confirmed the exceptionalnature of the operative teaching here.

I planned to spend one year at Mount Sinai,but extended it to two years because of theunparalleled learning opportunity, and I amvery grateful for this chance to thank thesuperlative clinicians and teachers withwhom I was lucky enough to work. I oweparticular thanks to Dr Paul Stelzer whosefocus is aortic root surgery and who helpedme to do Bentall, David and Rossprocedures; Ani who enabled me to docomplex, re-operative VADs andtransplants; Dr Randall Griepp who taughtme the principles of thoracoabdominal,arch and aortic root work; cardiologist DrValentin Fuster who has been unstinting inhis support; and finally Dr David Adamswho, even more importantly than teachingme how to plan and perform complexmitral, tricuspid and aortic valvereconstruction, has been an absolutelyphenomenal role model, mentor andsupporter.

My original intention was also toincorporate a three-month endovascularfellowship at the Cleveland Clinic into thefellowship year, funded by the CardiacScholarship of the Society forCardiothoracic Surgery in Great Britain andIreland, as I thought that this wouldcomplement my UK training in minimallyinvasive and robotic surgery. I am extremelygrateful to the Society for its generosity andalso for its flexibility when I requestedsupport for a change of plan. With the helpof Dr Adams and the Society I was insteadable to spend the time under ProfessorFriederich Mohr at his outstanding unit inLeipzig, where he leads highly successful,high-volume transcatheter and trans-apicalaortic valve replacement and minimallyinvasive mitral valve surgery programs.This tremendous experience has enabledme to take on a role focused on developingminimally invasive mitral repair and trans-catheter aortic valve programs at Mount

Sinai. The latter has become particularlyrelevant as Dr David Adams was recentlynamed as the primary investigator of thepivotal FDA trial of percutaneous aorticvalve replacement with the CoreValve ®Device.

When planning this fellowship I neverconsidered the possibility that I would takea consultant post in the US; and soaccepting Dr Adams’ offer to stay on atMount Sinai required careful thought. I amtherefore very grateful for the help andadvice I had from so many people,particularly Mr Alan Wood, Mr PatrickMagee, Mr Thanos Athanasiou, andProfessor John Pepper, as well as myProgramme Director Mr Anthony de Souza.There is so much to learn from spendingtime with experts in another healthcaresystem, in another country, particularlywhen those experts see teaching andmentoring as a key priority and are able todevote real time and resources to it; and Iwould be very happy to talk to any traineeswho want to explore fellowship options. Iam incredibly excited by the opportunitiesand challenges presented by taking up thisconsultant post, and I cannot thank theSociety enough for helping to make thishappen.

This fellowship year was also funded by an HCA International Travel Award Repairing a mitral valve with

Dr David Adams

Jo Chikwe Attending Surgeon,

Mount Sinai MedicalCenter, New York, USA


Here to the North PoleReflections on a Thoracic

Fellowship in Alberta, Canada

theBulletin22

The first thing is to decide what you want,a busy job with more operating room (OR)time than you can imagine or a prestigiousinstitute on the CV. Of course they are notnecessarily mutually exclusive, but as onefellow with one resident working with 3surgeons the odds of being needed(actually needed!) in the OR were prettygood in Alberta and few of the ‘big’ centresoffer such a nice ratio. Next is to work outwhat skills you want to acquire andwhether you are looking for a broad caseexperience or super-specialized (again apersonal choice but consider what youown practice is likely to be). Edmontonbecause of its location and set up has tooffer the full general thoracic repertoireincluding procedures typically performedby the gastroenterologist andinterventional respiratory physician in theUK. In fact when I asked where we coveredas a thoracic surgery service, my bossquipped “pretty much everywhere fromhere to the North Pole” and he wasn’tkidding!

Knowing what a unit’s practice is like canbe tricky as it requires a little insideknowledge. Again, a simple browse of thecurrent issue of the Annals may give yousome clues to your likely operative

exposure and seeing the ‘big cases’ is avery reasonable motivation in choosingyour institute. But do you really think youare going to be performing a robotic-assisted thorascopic carinal resection inyour daily practice? Talking to previousfellows is an obvious thing to do (being thefirst thoracic fellow in Edmonton did causeme a few sleepless nights!).

What the 3 surgeons in Edmonton offeredbeyond more work than they knew what todo with (180 lung resections and 50oesophagectomies a year for starters) wasthe opportunity to learn VATS lungresections. I knew Eric Bedard, one of the 3surgeons in Edmonton when he was Dr RobMckenna’s fellow at Cedars in LA and I alsoknew that Eric was trying to develop areputation as a leader in minimallyinvasive thoracic surgery in Canada. Hehas probably performed more VATS lungresections than any other surgeon inCanada. All 3 surgeons now performaround 60% of lung resections minimallyinvasively. Their approach is unified andeasily reproducible. They are all eager toteach (personally I suspect a desire toteach combined with nobody to teach isthe single most important attribute whenchoosing your out of training experience!).The unit’s approach to many of theminimally invasive procedures carried outby thoracic surgeons is refreshing and wellthought out, typically reflecting a unit that

performs a high proportion of prettycomplex thorascopic techniques. Even ifyou do not believe VATS lobectomy is a‘proper cancer operation’ (whatever thatmeans considering the variability you seeamongst surgeons performing ‘open’lobectomy) an opportunity to develop theskills needed to approach and performadvanced thorascopic procedures isinvaluable.

What else have I learnt, in the long timepreparing my out of training experienceand the brief time I have had in Edmonton?The obvious first: decide what you wantfrom the experience both personally andprofessionally; then do your ownhomework (that means find out about thesurgeons you will be working with andmost definitely visit before committingyourself to a place); seek advice (but takethat advice ‘on face value’); securefunding; and finally remember to ask yourpartner if you can go! Pack warm. email:[email protected]

Choosing to spend a year abroadparticularly if you have a family can bedifficult enough but where to go is alwaystricky. Internationally recognized centreswith a proven track record are a saferoption but concerns about ‘small fish bigpond’ situations must be considered.

Decide what you want

from the experience;

then do your

homework.

Ian HuntMinimally Invasive

Thoracic Surgery Fellow,University of Alberta,

Edmonton, Alberta,Canada


December 2008 23

The programme the Cardiothoracic Forum2009 has now come together with thetheme ‘Quality Care: can we deliver’. Wecongratulate Maura Buchanan on her re-election as the President of the RCN for afurther term and are delighted that shewill return to deliver the Forum openingremarks. The plenary sessions for 2009are exciting and topical.

I have pleasure in confirming that LisaKitteridge who you may have read about inthe national press will join us. Lisadeveloped cardiomyopathy while pregnantwith her second child April 2008. Followingan emergency caesarean at thirty-fiveweeks gestation she had an LVADimplanted. She and members of theclinical team from the Queen ElizabethHospital Birmingham are going to sharetheir experience.

The document ‘Towards a framework forpost registration nursing careers: anational consultation’ has sought healthprofessionals’ opinions on postregistration careers. It asked if nursingcareers should be organised around thepatient pathway and what should underpinthe framework for future nurse education.Clearly this document is of majorsignificance to health professional so I amproud to announce that Dr David Foster,Programme Director for ModernisingNursing Careers from the Department ofHealth, will be speaking on the impact ofMNC on postgraduate career pathwaysand Christina Pond, Executive Director ofStandards & Qualification, Skills for Healthwill discuss the strategic impact ofchanging the workforce.

The pressure for trusts to meet the 18-week target has led the HeartImprovement Programme to initiate anational project with pilot sites around theUK. Wendy Grey, the lead for this venturewill outline to project.

I am also delighted to underpin the themeof quality care with a presentation from DrAnn Keogh on the National Patient SafetyProject and its impact on practice.

For the thoracic delegates in particular MrEric Lim will present the new BTSguidelines on Cancer staging, and reviewthe impact this will have on surgicaldecision-making process.

In addition to the plenary sessions therewill be eleven presentations that havebeen selected from the plethora of abstractsubmissions. There is a wide range ofsubjects that will, I believe, make the 2009Cardiothoracic Forum Meeting stimulatingand thought provoking. We will of coursebe amalgamating with the surgeons’meeting to complement the programme.

Rates

May I take this opportunity to remind youthat for the second year running theSociety has agreed extremely competitivesubscription rates for non-medicaldelegates. They are as follows;

• £50 for one day for associate member• £75 for two days for associate member• £80 for one day for non-associate

member• £110 for two days for non-associate

member

So I look forward to seeing you and yourcolleagues in Bournemouth to share in anexciting conference. The MidlandsCardiothoracic Forum has delayed theirannual cardiothoracic study day. It is to berescheduled and will have lectures andworkshops looking at autogel woundmanagement and echo among othersubject. I would also like to inform youabout an exciting development takingplace at Birmingham Heartlands Hospital.They have developed a one day ‘ThoracicSurgery Practical Course’ combininglectures with clinical wet lab sessionsenabling delegates to familiarisethemselves with chest anatomy, surgicalprocedures and disease process. Thecourse is open to nurses, doctors,physiotherapists, surgical carepractitioners and other members of themultidisciplinary team. It is held twice ayear in January and July. Currently there area few places left on the 30th January 2009course and they will shortly taking

reservations for the course to be held 19thJuly 2009. For further information [email protected]

We have updated and tested the database,which is working well. There are nowcontacts for all nurses who wish to beincluded; a lead contact in each unit intheir critical care, ward and theatres; andthoracic contacts. If any of your colleagueswould like to add their names so they canreceive the emails then please forwardtheir email addresses to me [email protected].

Membership

I also encourage you to take advantage ofthe greatly reduced Associate Membershipof the SCTS. From 2009 the annual fee is£22, which ensures that you receive theBulletin issues, reduced rate to the Annualmeeting and other benefits, which are onthe SCTS web site.

Finally I am hoping to review roledevelopment throughout theCardiothoracic Centres so I will becontacting you in the near future to seekinformation about how nursing andsurgical care practitioner roles areexpanding to meet the European WorkingTime Directive and accounting for theimpact of Modernising Medical Careers.

Tara BartleyNursing RepresentativeNursing Report

We congratulate MauraBuchanan on her re-

election as the Presidentof the RCN for a furtherterm and are delightedthat she will return to

deliver the BournemouthForum opening remarks.


25

Society Cardiac& ThoracicScholarships

The IonescuTravellingFellowship

Requirements for applicants are:

• Age – usually under 35 years

• Eligibility – must be a member of the Society

• Tenancy – any University Institution or Institutions recognized for trainingin Cardiac or Thoracic Surgery

• Purpose of visit – 3 or 4 paragraphs summarizing the intended work to beundertaken and the reasons for wishing to visit there

• CV of applicant to be enclosed

• Other sources of funding – to be stated

• Receipts required – eg international plane ticket

• Other documentation required – statement from host institution ofwillingness to accept candidate

• Letter of support from current Chief of Service in support of theapplication.

All successful candidates are expected to provide the Society with a summaryreport of their visits/s and may, if requested, be required to present theirexperience at the Annual Meeting of the Society

This is for the sum of £10,000 which isdirected at Young Consultants (normallywithin 5 years of appointment) wishing toadd to their educational experience and inparticular for the purpose of bringing newtechniques back to their department.

The recipient is expected to provide areport and/or a presentation to theSociety’s Annual General Meeting Scientificsession. Similar requirements, with theexception of a reference from Chief ofService, are expected from applicants.

New AppointmentsName Hospital Specialty Starting Date

Shilajit Ghosh University Hospital of North Staffordshire Thoracic June 2007

Tim Bachelor Bristol Royal Infirmary Thoracic May 2008

Hasnat Khan The Essex Cardiothoracic Centre Cardiothoracic Aug 2008

Indu Deglurkar Golden Jubilee Hospital, Glasgow TBC August 2008

Arjuna Weearasinghe The Essex Cardiothoracic Centre Cardiothoracic September 2008

Onyekwelu Nzewi Royal Victoria Hospital Belfast Cardiothoracic October 2008

Heyman Luckraz New Cross Hopsital, Wolverhampton Cardiothoracic October 2008

Fraser Sutherland Golden Jubilee Hospital, Glasgow TBC TBC

Other AppointmentsName Hospital Specialty Starting Date

Karen Redmond Harefield Hospital September 2008 Locum Consultant

December 2008


December 2008 27

Diary of

Forthcoming Events

Date: 16 January 2009 Meeting: Yorkshire Advanced Chest Imaging CourseVenue: Radiology Academy, Leeds General Infirmary, Leeds

LS1 3EXTown: LEEDS UNITED KINGDOM Contact: Dr R J H Roberson, Consultant RadiologistEmail: [email protected]

Date: 22 - 23 January 2009 Meeting: Valve Technology Symposium -

Day One: Transcutaneous Aortic and Aortic ValveIntervention - Day Two: Mitral Valve, AtrialFibrillation & Ventricular Disease

Venue: St. George's Hospital, at the Royal Society ofMedicine

Town: LONDON UNITED KINGDOM Contact: Frances Williams, Symposium AdministratorPhone: +44 20 8725 2652Fax: +44 20 8725 5173Email: [email protected] information: www.valvetechnology-sgh.co.uk

Date: 6 February 2009 Meeting: Introduction to Cardiothoracic SurgeryVenue: Royal College of Surgeons of EdinburghTown: EDINBURGH UNITED KINGDOM Contact: Laura McQuade

Course Co-ordinatorPhone: +44 (0) 131 668 9238Fax: +44 (0) 131 668 9241Email: [email protected]

Date: 25 - 26 February 2009 Meeting: 4th Advanced Video-Assisted Thorocoscopy and

Thoracic Endoscopy CourseVenue: St James University Hospital, Institute of OncologyTown: LEEDS UNITED KINGDOM Contact: Lorraine Richardson

L R AssociatesPhone: +44 (0)1296 733 823Fax: +44 (0)1296 733 823Email: [email protected] information: www.vatscourse.com

Date: 13 MARCH 2009 Meeting: Emergency Support of Heart and LungsVenue: National Heart and Lung Institute, Imperial College

– Royal Brompton Campus, Dovehouse St, London,SW3 6LY

Town: LONDON, UNITED KINGDOM Contact: Lorraine Richardson

L R AssociatesPhone: +44 (0)1296 733 823Fax: +44 (0)1296 733 823Email: [email protected]

Date: 22 - 24 MARCH 2009 Meeting: Annual Meeting of the Society for Cardiothoracic

Surgery in Great Britain & IrelandVenue: Bournemouth International CentreTown: BOURNEMOUTH, HAMPSHIRE, UNITED KINGDOM Contact: Isabelle FernerPhone: +44 020 7869 6893Email: [email protected] information: www.scts.org

Date: 3 April 2009 Meeting: Functional Ischaemic Mitral Regurgitation (FIMR) Venue: National Heart and Lung InstituteTown: LONDON UNITED KINGDOM Contact: Karina Dixon

Dovehouse Street, National Heart and LungInstitute,

Phone: +44 (0) 20 7351 8172Fax: +44 (0) 20 7351 8246Email: [email protected] information:

www1.imperial.ac.uk/medicine/about/conferences/nhli_events/shortcourses/events/fimr/

Date: 17 April 2009 Meeting: Coronary Artery Surgery WorkshopVenue: Royal College of Surgeons in Ireland, DublinTown: DUBLIN, IRELANDContact: Orla MocklerEmail: [email protected]

Date: 22 - 24 JUNE 2009 Meeting: The Edinburgh Thoracic Symposium. Minimally

Invasive Management of Lung Cancer: An UpdateVenue: Royal College of Surgeons of EdinburghTown: EDINBURGH UNITED KINGDOM Contact: The Edinburgh Thoracic Symposium

c/o Lorraine Judge, Head of Education SectionPhone: + 44 (0)131 668 9209Email: [email protected]


John Anthony

Morgan

December 2008 29

Tony grew up around CardiganBay in South Wales beforebecoming a scholar at EpsomCollege in Surrey. His love oforgan recital music took himto Cambridge Universitywhere he was DuckworthExhibitioner of Jesus College.He also found time to studymedicine and did his clinicalundergraduate training atGuys in London. After his

graduation in 1971 he trained in general and cardiothoracicsurgery in London but moved to Groote Schuur Hospital inCape Town in 1976 to continue his training. It was there thathe became a consultant in thoracic surgery, a post he was tohold for six years. In 1987 he moved again, this time toGermany. After several positions, he settled in Frankfurt/Oderas head of the Department of Thoracic and Vascular Surgery.

During the late 1990s, there were major changes in theDepartment of Thoracic Surgery in Bristol as the specialtymoved from its historical base at Frenchay Hospital to joincardiac surgery at Bristol Royal Infirmary. At the same time,“Jey” Jeyasingham retired. Tony moved from Germany to jointhe department, but when Chris Forrester-Wood also retiredseveral years later he found himself working single-handedand trying to cover a huge geographical area. However, he stillmanaged to develop his two main areas of expertise -endobronchial therapy and pectus surgery.

During his later years in Bristol he was joined first by MarkYeatman and then by Tim Batchelor. Having now re-established the department, his death was both sudden anduntimely. He has left a huge gap not only in the service butalso in the lives of those that worked closely with him. As istypical of many surgeons of a certain age, there was a degreeof inflexibility in the way he worked, particularly in hisencounters with managers (or “bean counters” as they werealways referred). What was always clear, however, was hisdeep commitment to patient care and his rapport with hispatients. They, too, have mourned his death.

Tony was a bon viveur who lived his life until the moment hedied. His passions included organ and classical music and fastcars. He died in Scotland, a place he loved, while on holidaywith his wife Ann. He is survived by his three children to whomhe was devoted.

Tim BatchelorMark Yeatman

December 1946 - September 2008

Applications are invited from Full Members ofSCTS for the post of Honorary Treasurer.

B Sethia leaves office at the Annual Meeting in 2010,we will appoint his replacement at the 2009 AnnualMeeting. The appointee will shadow B Sethia in theintervening year before taking full responsibility from2010. The term of office is 5 years.

This is an exciting opportunity; with the formation ofour limited company SCTSGB Ltd, the potential nowexists for innovative approaches to fund raising. Theappointee will work closely with the CommunicationsSecretary to increase revenue and strengthen thefinancial base of the Society.

The Honorary Treasurer is a Trustee of SCTS and as such is required to run SCTS according to the rules laid down in the Constitution(www.scts.org/sections/society/constitution/index.html)

The Honorary Treasurer will have responsibility for allfinancial matters relating to the Registered Charity TheSociety for Cardiothoracic Surgery in Great Britain andIreland and the limited company SCTSGB Ltd.

A job description is available from Isabelle [email protected].

Informal discussions may be held with Leslie Hamilton(President), B Sethia (Honorary Treasurer) or GrahamCooper (Honorary Secretary).

Applications should consist of a brief CV and a shortstatement outlining the qualities that make you suitedto the post and your vision for the role.

Please send applications to [email protected] by 30/1/09, shortlisted candidates will be informed by 13/2/09 and interviews will be held at the Annual Meeting in Bournemouth between 22/3/09 and 24/3/09.

C A L L F O R A P P L I C A T I O N S

Society forCardiothoracic

Surgeryin Great Britain

and Ireland

SCTS Honorary

Treasurer



by Samer Nashef

Across 1 16 across family enquiry (4,4,6)8 Back in the CIA, someone recognised a

pattern (6)9 Singing in action jewellery (8)10 OK, done, with mushroom included (8)13 Has a go at compositions (6)16 Indecently clad - like pants off for a bit of

this? (4,3,6)19 Pilsner beer, he's drunk: that's disgraceful

(13)22 Glad of July break (6)24 1, 16, 29 across online (8)27 Beast of a worker has run away (8)28 River virago (6)29 16 across is something else (1,3,2,3,5)

Down 1 Illicit booze bit of a hoot; cheers! (6)2 Western healthy sperm, for example (5)3 Cathy capsized boat (5)4 Regularly turns weird, being single (5)5 Brew essential to windsurfer mentality (7)6 Roof turnstile (5)7 Notes boy with ugly sister (9)11 Calm exercise champion (5)12 Take out opponents on time (5)14 Low joint where some drank lemonade (5)15 Pot-plant (9)16 Agent takes in work that's emotional (5)17 Girl embarrassed to be sexy (5)18 Wobbly bum that is about to fill (5)20 Hothead, getting on, turned to resist (4,3)21 Diary note I read first (6)23 Fast boats (5)24 European rumour of threat to king (5)25 Well done eggs served up on trains of

yesteryear (5)26 15 may be in this pest (5)

Send your solution to: Samer Nashef, PapworthHospital, Cambridge CB23 3RE or fax to 01480 364744by 31 January 2009. Solutions from areas over 10 milesfrom Cambridge will be given priority.

Last issue’s winners:The winner of the July 2008 Crossword is RichardMilton, St James University Hospital, Leeds

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