JTO
02 Sep 2024

JTO - September 2024

Volume 12 Issue 3

From the Executive Editor

Congress is almost here! I can hardly believe it! Simon Hodkinson has asked us all to focus on the workforce this year with the theme of Recruit, Sustain, Retain being at the heart of all we have done. So it is totally appropriate that our Congress edition of the JTO has the workforce as our theme. As surgeons we have been working within an extended surgical team for some time and have long recognised the importance of multidisciplinary working. The names associated with various roles seem to have changed significantly over recent months and as always, change can be unsettling. The articles by Bill Allum representing the RCSE (p56) and by Adrian Andronic and Karen Chui for BOTA (p63) discuss the importance of understanding our recent workforce data.

Sally Stuart (p66) discusses the extended surgical team whilst Catherine Armstrong and Rachel Daw (p40) concentrate on the role of advanced clinical practitioners. Marc Patterson (p60) reminds us that there is more to work than what we think of as the ‘routine’! He suggests we explore and expand our boundaries to reinvigorate our joy in life! Our patients and our colleagues deserve kindness and respect and Deiary Kader and Paul Banaszkiewicz’s article (p32) is timely – we must beware of the rise of incivility and the real harm that is associated with it: they ask us to embrace the concept of radical candour or respectful confrontation and foster reciprocal respect.


It has been fun to read the SpecSoc reports and whether you are an elbow surgeon or a hip surgeon or feel that the big toe is our most important bit, the reports remind us that we are all part of one body and as such the BOA continues to work with you and for you.

If we need reminding, and I think we do from time to time, that it is the patient at the heart of all we do, then Katy Blackmore’s article (p28) asking ‘Do you see me?’ is an essential read. We must improve our ‘humanness’.

We know not all patients are the same and the elite athletes that we have been admiring recently as they throw further, run faster and jump higher are most definitely not your ‘average’ 9am appointment. The medico-legal article (p50) asks you to protect yourself whilst you accept the challenges of caring for them.

This editorial marks the end of my ‘formal’ involvement at leadership level of the BOA. I have thoroughly enjoyed the variety of tasks that I have worked on over the last few years and I must end with a big thank you to all who have helped me and worked with me at regional and national levels. I would recommend anyone who cares about their profession to consider joining the BOA Band be it as lead guitarist, roadie or stage manager.

Last year in Liverpool I asked my international speakers to incorporate a Beatles title into their talk and thus it seems fitting that I say goodbye with two corny song titles that perhaps speak for my time at BOA HQ: “With a Little Help From My (Our) Friends” “We Can Work It Out!”

Deborah Eastwood, Immediate Past President 

 

Subspecialty Section

References

The challenge of using AI for non-traditional data modelling in predictive analytics

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  2. Coppola A, Asopa V. A practical approach to AI in T&O. Journal of Trauma and Orthopaedics. 2024;12(2):30-2.
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  13. Dijkstra H, van de Kuit A, de Groot T, et al. Systematic review of machine-learning models in orthopaedic trauma. Bone Jt Open. 2024;5(1):9-19. 
  14. Farrow L, Zhong M, Anderson L. Use of natural language processing techniques to predict patient selection for total hip and knee arthroplasty from radiology reports. Bone Joint J. 2024;106-B(7):688-95. 
  15. Collins GS, Moons KGM, Dhiman P, et al. TRIPOD+AI statement: updated guidance for reporting clinical prediction models that use regression or machine learning methods. BMJ 2024;385:e078378.
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  18. Liu X, Cruz Rivera S, Moher D, et al. Reporting guidelines for clinical trial reports for interventions involving artificial intelligence: the CONSORT-AI extension. Nat Med. 2020;26:1364-74.

Advanced Clinical Practitioners in arthroplasty care

  1. National Joint Registry (2023) 20thAnnual Report. Available at: https://reports.njrcentre.org.uk/Portals/0/PDFdownloads/NJR%2020th%20Annual%20Report%202023.pdf (Accessed 05/06/2024).
  2. The Scottish Arthroplasty Project (2023). Scottish Arthroplasty Report 2023. Available at: www.publichealthscotland.scot/publications/scottish-arthroplasty-project/scottish-arthroplasty-project-12-september-2023. (Accessed 05/06/2024).
  3. Walton MJ, Walton JC, Bell M, Scammell BE. The effectiveness of physiotherapist-led arthroplasty follow-up clinics. Annals of the Royal College of Surgeons England. 2008;90:117-9.
  4. Kennedy DM, Robarts S, Woodhouse L. Patients are satisfied with Advanced Practice Physiotherapists in a role traditionally performed by orthopaedic surgeons. Physiotherapy Canada. 2010;64(4):298-306.
  5. Fan JCH, Lo CKM, Kwok CKB, Fung KY. Nurse-led orthopaedic clinic in total joint replacement. Hong King Medical Journal. 2014;20:511-8.
  6. Murphy MT, Radovanovic J. Patient satisfaction with physiotherapists is not inferior to surgeons in an arthroplasty review clinic: non-inferiority study of an extended scope model of care. Australian Health Review. 2021;45:104-9.
  7. Arthroplasty Care Practitioners Association.  The Arthroplasty Care Practitioner’s Association. Available at: www.acpa-uk.net  (Accessed 05/06/2024).
  8. Health Education England (2017) Multi-professional Framework for Advanced Clinical Practice in England. Available at: www.hee.nhs.uk/sites/default/files/documents/multi-professionalframeworkforadvancedclinicalpracticeinengland.pdf. (Accessed 05/06/2024).
  9. Perioperative Care Collaborative (2007). The role and responsibilities of the advanced scrub practitioner. London PCC.
  10. The Royal College of Surgeons of England (2014). Curriculum framework for the Surgical Care Practitioner. Available at: https://accreditation.rcseng.ac.uk/pdf/SCP%20Curriculum%20Framework%202014.pdf. (Accessed 05/06/2024).
  11. Nursing and Midwifery Council (2015). The code: Standards of conduct, performance and ethics for nurses and midwives. Available at: www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf. (Accessed 05/06/2024).
  12. Health and Care Professional Council (2012). Available at: https://zakon.co.uk/admin/resources/downloads/hcpc-yourguidetoourstandardsofcontinuingprofessionaldevelopment.pdf. (Accessed 05/06/2024).
  13. Czoski Murray CJ, Kingsbury SR, Arden NK, et al. Towards UK post Arthroplasty Follow-up rEcommendations (UK SAFE): protocol for an evaluation of the requirements for arthroplasty follow-up, and the production of consensus-based recommendations. BMJ Open. 2019;9(6):e031351.
  14. Lovecock TM, Broughton NS. Follow-up after arthroplasty of the hip and knee: Are we over-servicing or under-caring? The Bone and Joint Journal. 2018;100-B:6-10.
  15. National Institute for Health and Care Research (2022) Good Clinical Practice. Available at: www.nihr.ac.uk/health-and-care-professionals/learning-and-support/good-clinical-practice.htm. (Accessed 05/06/2024)
  16. Wood C. Leadership and management for nurses working at an advanced level. British Journal of Nursing. 2021;30(5):282-6.
  17. National Institute for Clinical Excellence (NICE) 2020 Joint replacement (primary): hip, knee and shoulder. Available at www.nice.org.uk/guidance/ng157. (Accessed 05/06/2024).

BOTA rising to the workforce challenge

  1. NHS England. Best practice solutions, Musculoskeletal health. Available from: www.england.nhs.uk/elective-care-transformation/best-practice-solutions/musculoskeletal.

  2. Royal College of Surgeons of England. UK Surgical Workforce Census Report. Advancing the Surgical Workforce: 2023 UK Surgical Workforce Census Report. Available from: www.rcseng.ac.uk/standards-and-research/surgical-workforce-census.

  3. Baird B. The trainer’s toolkit: A practical guide to maximising training opportunities. Journal of Trauma and Orthopaedics. 2024;12(1):46-9.
  4. Sugand K, Tanaka H. Guidance on the role of simulation in formal training by the British Orthopaedic Association. Journal of Trauma and Orthopaedics. 2024;12(2):26-8.
  5. Mahase E. Trainees and locums will get “NHS passports” to cut admin when they work between sites. BMJ. 2019 Sep 6;l5473.
  6. Harries RL, Gokani VJ, Smitham P, Fitzgerald JEF. Less than full-time training in surgery: A cross sectional study of surgical trainees. International Journal of Surgery. 2016 Nov;36:S105.
  7. Lenihan J, Ngu AWT, Vince A, Kang SN, Sanghrajka A, Tansey R, et al. Access and feasibility of orthopaedic training in the independent sector – A Deanery’s experience. The Surgeon. 2022;20(5):291-6.
  8.  Kontoghiorghe C, Morgan C, Eastwood D, McNally S. UK pregnancy in orthopaedics (UK-POP): a cross-sectional study of UK female trauma and orthopaedic surgeons and their experiences of pregnancy. Bone Jt Open. 2023;4(12):970-9.
  9.  World Orthopaedic Concern. Guidelines for T & O TPDs relating to overseas placements in low resource settings [Internet]. 2019. Available from: https://wocuk.org/wp-content/uploads/2019/08/GuidelinesforTPDsonlowresourceplacements.pdf.
  10. Raza M, Trompeter A. Taking time out of training: a Malawi experience. Eur J Orthop Surg Traumatol. 2022;33(3):611-5.
  11. Berwin J, Brown M, Bucknall V, Bose D, On behalf of the BOTA Committee. Attitudes towards orthopaedic volunteering in low-resource settings. Bulletin. 2020;102(4):144-9.
  12. Arnaouti M. Core Trainee Prize 2021/2022: Global orthopaedics: the norm, not the exception. Bone & Joint 360. 2023;12(5):6-10.
  13. Yeomans D, Le G, Pandit H, Lavy C. Is overseas volunteering beneficial to the NHS? The analysis of volunteers’ responses to a feedback questionnaire following experiences in low-income and middle-income countries. BMJ Open. 2017;7(10):e017517.
  14. The non-financial cost of surgical training. ASIT Report 2024

  15. BOTA Census working group (James Archer, BOTA Academic Representative and Mr James Allen, BOTA Webmaster).

Addressing workforce issues: The role of the SCP within the extended surgical team

  1. Rothrock, J. C., 1999.  The RN first assistant. An expanded perioperative nursing role, 3rd ed. Philadelphia (PA): Lippincott.
  2. NHS Management Executive., 1991. Junior doctors. The new deal. London: NHS Management Executive.
  3. Poulton, E. C., Hunt, G. M., Edwards, R. S., 1978. The performance of junior hospital doctors following reduced sleep and long hours of work. Ergonomics 21:279-95.
  4. United Kingdom Central Council., 1992. The Scope of Professional Practice. London: UKCC.
  5. Dunn, L., 1997. A literature review of advanced clinical practice  the United States of America. Journal of Advanced Nursing. 25: 814- 819
  6. National Association of Theatre Nurses, 1994. The Nurse as Surgeon's Assistant. Harrogate, NATN
  7. National Association of Theatre Nurses, 1993. The Role of the Nurse as First Assistant in the Operating Department. Harrogate, NATN
  8. Farrell, J., 1999. Enhancing perioperative nursing practice: Developing a course for the surgeon’s assistant. British Journal of Theatre Nursing. 9(5):202-208
  9. 9Health Education England. 2104. Working towards a common education and training programme to support a route to statutory regulation for Physicians’ Assistants (Anaesthesia), Physician Associates, and Surgical Care Practitioners in England. London: HEE
  10. British Medical Association. Available at: www.bma.org.uk/news-and-opinion/enough-is-enough-junior-doctors-conditions-putting-patient-safety-at-risk.
  11. Bampoe, S., 2015. Physicians’ assistants in anaesthesia: colleagues or competitors? British Journal of Hospital Medicine. 76, 610.
  12. Abraham, J., Bailey. L., Coad, J., Whiteman, B., Kneafsey, R,. 2019. Non-medical practitioner roles in the UK: who, where, and what factors influence their development? British Journal of Nursing. 28(14):930-939.
  13. Daniel W. Scholfield, 2016. How will the introduction of surgical care practitioners affect future surgical training and practice? Surgery. 34 9, pp. 484-486.
  14. Julies, E., Williams, T. and Hall, S., 2021. The Surgical Care Practitioner role in Achilles tendon re-rupture: A case study, Journal of Perioperative Practice, 31(12), pp. 454–462.
  15. Department of Health, 2006. The Curriculum Framework for the Surgical Care Practitioner. London, DH.
  16. Royal College of Surgeons of England, 2014. The Curriculum Framework for the Surgical Care Practitioner. London: RCSEng.
  17. Royal College of Surgeons of England, 2022. The Curriculum Framework for the Surgical Care Practitioner. London: RCSEng.
  18. Health Education England, 2017. The Multiprofessional Framework for Advanced Practice in England. London: NHS.
  19. National Health Service England, 2023. NHS Long Term Workforce Plan. London: NHS England

 

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