Awarded a Joint Royal College of Surgeons/Circulation Foundation research fellowship in 2020 to deliver the Peripheral Arterial Disease Quality Improvement Programme (PAD QIP). Member of the National Vascular Registry team, a National Clinical Audit commissioned by HQIP. Undertook a PhD at Hull York Medical School. Now working in Public Health  in the Nuffield Department of Public Health, Oxford.

PAD-QIP

Publications

 @pennybir

Publications

 @ellieroseatkins

Newly appointed.

I am incredibly grateful to the Vascular Society and the Royal College of Physicians and Surgeons of Glasgow for jointly supporting this inaugural Clinical Research Fellowship role which has allowed me to work towards an MD in frailty assessment in Vascular Surgery.

With an ageing population and advances in medical and surgical techniques, we are seeing increasing numbers of complexly comorbid and frail patients. It is well recognised that frailty is associated with adverse health outcomes and Vascular Surgery has a substantial proportion of frail patients presenting with urgent vascular pathology who commonly suffer turbulent perioperative courses and have complex multidisciplinary care needs⁽¹⁾.

The development of the Perioperative care for Older People undergoing Surgery⁽²⁾ service has kickstarted a new approach to improving how we care for these patients. Although this service has successfully been gaining momentum, it remains commonplace that service delivery can feel out of sync with the requirements of these patients. This fellowship represented an excellent opportunity to explore frailty assessment as a means to complement the progress made in the field of surgery in older adults. To do this, my research aims were to:

1. Quantify the approaches to frailty assessment in Vascular Surgery Literature and Clinical practice⁽³⁾.
2. Assess vascular surgeons’ and allied health care professionals’ perceptions and utilisation of frailty assessment in clinical practice.
3. Explore the feasibility of implementing routine frailty screening in a Vascular Surgery outpatient clinic setting⁽⁴⁾.

The work generated by this fellowship is an opportunity to positively influence clinicians and policy makers. In-line with the multidisciplinary requirements of these patients, the success of this fellowship is born from the collaborative efforts of the supporting bodies and multidisciplinary supervisors and I hope it will contribute towards ongoing efforts to improve healthcare outcomes for vascular patients.

References

1. Welsh, SA, Pathmanathan, MP, Hussey, K et al. Frailty in peripheral arterial disease. J. Vasc. Soc. G.B. Irel. 2023, 2(3): 128-133. https://jvsgbi.com/wp-content/uploads/2023/05/1c-Welsh.pdf
2. Perioperative Care for Older People undergoing Surgery Network (POPS) | Centre for Perioperative Care (cpoc.org.uk)
3. Welsh, SA, Pearson, RC, Hussey, K et al. A systematic review of frailty assessment tools used in vascular surgery research. J. Vasc. Surg 2023, 78(6): 1567 – 1579. https://pubmed.ncbi.nlm.nih.gov/37343731/
4. Welsh, SA, Hussey, K, Brittenden, J et al. Frailty Assessment in Vascular OUtpatients Review (FAVOUR) protocol: single-centre prospective cohort study comparing feasibility and prognostic value of commonly used frailty assessment tools. BMJ open 2023,13: e079387. https://bmjopen.bmj.com/content/13/12/e079387

Research Fellowship: MD (PhD) Cognitive load in surgical training

 Fellow in Surgical Sabermetrics - Applying athletics data science to enhance operative performance

Supervisors Steven Yule and Andrew Tambyraja

Chair Jurgen Schwarze

Advisory group Paddy Coughlin (VS), Ginny Bowbrick (Vascular SAC)

Co-author collaboration with Dr Heather Lillemoe, general surgeon in Texas, and the leading expert on preoperative educational briefing.

Collaboration with Ms Rosie Darwood, Clinical lead for vascular surgery at Leeds NHS Trust.

 @joe_norton54

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Background Cognitive load (CogL) is the extent to which a task places demands on cognitive resources, when these finite resources are overwhelmed, stress levels increase. Surgical trainers and trainees are often under considerable stress. Increased surgeon CogL influences fine motor skills, coordination, dexterity and decision making abilities, with clear potential impacts on patient outcomes (1).

Surgeons do not currently have access to real time objective information about their CogL during surgery, or bench simulation models to track development and management of operative CogL in high demand situations. Historically, CogL has been assessed by self-reported surveys, however, these instruments are at risk of bias (2). A novel field of Surgical Sabermetrics has emerged involving a quantitative and objective approach to assessing intraoperative CogL via physiological sensors combined with AV recordings to enhance insight, support professional development, and optimise clinical outcomes (3).

Non-invasive sensors monitoring physiological output, including heart rate variability (HRV), electroencephalography (EEG) and electrodermal activity (EDA) reliably measure surgeons’ CogL, and have previously identified cognitive overload resulting in preventable error (4,5).

Cognitive load in surgery is a rapidly expanding body of literature; recent work has examined the impact of the trainer/trainee relationship on trainer CogL and trainee educational experience, using the subjective self-assessment SURG-TLX tool (6). A critical gap in understanding is the role of CogL in surgical training.

Aims

The aim is that the Sabermetrics framework will allow for real-time feedback to the operating surgeon, providing a warning that surgeon CogL is reaching the point that may affect performance and patient care, allowing for both preventative strategies and timely intervention to avoid cognitive overload harming patients. 

Additionally, we may be able to use the results of our work on preoperative educational briefing, team dynamics and the trainer/trainee relationship to contribute toward effective surgical training structure and format, to improve surgical education, performance, and ultimately, patient care.

• Examine the relationship between surgical trainer and surgical trainee
• Measure surgical trainees’ CogL during dynamic surgical simulation.
• Use these data to establish tools to improve surgical training and feedback for surgical trainers.

Other activity

Work in collaboration with the ASPIRE programme to contribute to human factors and non-technical skills teaching for vascular surgery trainees.

References

1. Gawande AA, et al. The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery. 1999;126:66–75.

2. Chrouser KL, et al. The influence of stress responses on surgical performance and outcomes: Literature review and the development of the surgical stress effects (SSE) framework. The American Journal of Surgery. 2018;216:573–584.

3. Sheridan TB, Stassen HG. Definitions, Models and Measures of Human Workload. In: Moray N, ed. Mental Workload: Its Theory and Measurement. Boston, MA: Springer US:219–233.

4. Budden A, et al. A systematic review of biological changes in surgeons’ acute stress levels during surgery. Surgery in Practice and Science. 2023;13:100174.

5. Moorthy K, et al. The effect of stress-inducing conditions on the performance of a laparoscopic task. Surg Endosc. 2003;17:1481–1484.

Fiona Kerray is a vascular surgery trainee in the Scotland Deanery.

Under the auspices of the Vascular Society, the Circulation Foundation and the Royal College of Surgeons Edinburgh she undertook an MD in “Human Factors and Digital Education in Vascular Surgery”.

Research report

I’m grateful to the Vascular Society, RCS Edinburgh and the Circulation Foundation for jointly supporting a 2-year Research Fellowship which has allowed me to work towards an MD in Human Factors Science and Digital Education in Vascular Surgery.

It is recognised that outcomes in surgery are the product of the interactions between people and the systems and environments within which they work. Human factors/ergonomics (HFE) is the scientific discipline that explores these relationships. Understanding relevant HFE principles in the operative context can optimise individual and team performance, enhance wellbeing, and improve patient safety. At present, HFE education in surgery largely comprises standalone, unfunded courses which are typically based around team training, or avoiding errors and adverse events. Although a positive addition, these opportunities often fail to highlight other less obvious elements such as biomechanics, thermal or noise environment, and human computer interactions, and rarely promote the role of HFE in successful outcomes.

Understanding and being able to apply HFE principles relevant to vascular surgery would provide trainees with knowledge and skills to optimise their theatre, improve their performance and enhance their wellbeing. My research aims were therefore to:

(i) Identify elements of HFE which impact operative performance in vascular surgery.

(ii) Establish which HFE elements surgeons perceive as contributors to adverse events.

(iii) Ascertain a baseline knowledge of HFE amongst vascular surgery trainees and identify barriers and motivators to participating in non-mandatory training.

(iv) Design and deliver a relevant, engaging, and accessible HFE education programme.

Other Opportunities

Time out of programme for research has allowed me to develop my own skills in academia (and time management), however it has also afforded me several unique opportunities to meet and work with a range of people whom I would never have otherwise met. The experience, advice and knowledge that they have shared regarding not just human factors/ergonomics, but also lessons from sporting achievements, legal and political influences, and challenges [and successes] encountered on a world stage have been unparalleled. In particular, the Global NOTSS Group - a team of psychologists, medics and educationalist from Boston, Rwanda, Nigeria, Malawi and the UK - kindly allowed me to work with them to deliver training in non-technical skills for surgical teams in several sub-Saharan countries. In addition, we have established a new multidisciplinary team in Blantyre, Malawi, with whom we are undertaking a local research project and collaborating with other groups, including Lifebox, to both improve safe surgical care and advance access to research opportunities for clinicians.

I’d like to take this chance to thank my advisory group, including Andrew Garnham, Keith Jones and Rachel Bell, and my supervisors Prof. Steve Yule and Andrew Tambyraja.

 @FionaKerray

To be appointed.

The American College of Surgeons is looking to award the John D. Corson Guest Scholarship, of up to US$10,000, to provide an academic Vascular surgeon residing in UK or The Republic of Ireland with the opportunity to attend and participate fully in the educational activities of the ACS annual Clinical Congress and additionally to travel to academic medical institutions in the USA to share knowledge of best practices and current surgical research.

The candidate selected should meet the following preferred qualifications:

• Under 40 years of age at the time the completed application is submitted.
• Is a member in good standing of a Royal Colleges of Surgeons in the UK or ROI.
• Holds a full-time academic or teaching appointment.

For more information on this scholarship, please visit the ACS website:

http://preview.acs.siteworx.com/member-services/scholarships/international/john-d-corson

The Travelling Surgical Society of Great Britain and Ireland is a group of surgeons, that travels to various hospitals and surgical departments around the world and in the UK. These are academic and clinical meetings and the purpose is to encourage educational and surgical exchanges.  

Sir Clement Price Thomas was the third President of the Travelling Surgical Club (as it was then known) from 1952 to 1972. 

The bursary for ST7+ and Consultants within 10 years of appointment will cover registration fees, travelling expenses, hotel costs and all organised meals for the Travelling Surgical Society. Recipients must deliver two lectures.

Price Thomas Flyer 2023