President – BSGE
Southmead Hospital, Bristol
We last met at Edinburgh at Dynamic Earth, that was an enormously successful meeting and I’m glad to see that this meeting has been equally well received. This is due, in great part, to the hard work of the fantastic local organising committee and my co-chair Richard Penketh. We have received excellent face-to-face feedback and there will be a more formal feedback process. Please take part in this- your opinions on the new innovations at ASM 2019 and the conference, in general, will help mould the meetings of the future.
The year has been very busy, we have run six meetings, both as standalone BSGE events and in conjunction with the College. The cadaveric training has been successfully run for several years and will continue under the leadership of Kirana Arambage, who has also been returned to Council as Chair of the Awards and Bursaries portfolio. Our President-elect Justin Clark devised and oversaw the inaugural meeting of the Ambulatory Care Network in Birmingham in March. The feedback has been outstanding and I’m glad to say that Justin intends to continue running these sessions regularly. I’d like to thank him for this newest high-quality addition to the BSGE’s activities. In the near future we are committed to running the RCOG/BSGE Benign Abdominal Surgery meeting and the RCOG/BSGE Diagnostic and Operative Hysteroscopy course, both in September, as well, of course, looking forward to ASM 2020 in Manchester in June.
The Council is aware that running meetings is time-consuming and demanding. They would be impossible to run without the many members who give up their time to act as faculty. We appreciate your commitment and dedication in supporting the training of others- but we want to recognise this input formally. Council has decided that going forward, anyone that acts as faculty on a BSGE run course, for a day or longer, will be rewarded with free ASM registration at the subsequent meeting. The value of the training you provide is immeasurable, but we hope this goes some way to showing the Society’s recognition for your dedication.
The Society has been active in training. The two jewels in our crown are the Advanced Laparoscopy and TLH course run in partnership with industry, which are hugely oversubscribed. The course run with Olympus received 41 applications for 12 places and the course in conjunction with Ethicon had 55 applicants for 12 places. The courses are rigorous and intensive, but trainees on the course derive an immense amount of skills and knowledge from attending. The Society, together with Olympus and Ethicon believe that this is a very valuable training asset. The industry partners are currently going through their budgets, but we hope they will commit to the continuance of the programmes over the next few months.
Karolina Afors ran the GESEA training and certification session as part of the pre-congress masterclasses. Karolina has done an outstanding job running GESEA and making it part of the Society’s established output; I’d like to thank her and the faculty that has supported the sessions.
The BSGE registrars’ group continues to grow, with RIGS networks, regional representatives and intermediate laparoscopy courses run across the country. I’d like to thank them personally, they can be justifiably proud of the contribution that RIGS makes to the Society.
The landscape of training is changing. The Advanced Laparoscopic Surgery ATSM was developed by myself and Alfred Cuttner many years ago. It was out of synch with other ATSMs in terms of the work, time commitment and centralised selection process. We felt it was better aligned to sub-specialty recognition, but at the time the College did not approve this. We have kept a watchful eye on developments and the GMC have now moved towards a process called credentialing,as part of a move to recognise the importance of lifelong learning:
‘Doctors may want to enhance their careers by gaining additional expertise in specialist areas and subspecialty training through formal and quality assured training programmes leading to a credential in that area.’
It’s difficult to negotiate with the GMC; it’s not really a two-way process! However, we have to be pragmatic and work within the paradigm to make advances and deliver high-quality training and clinical care. I’ve had meetings with the GMC and Janice Rymer from RCOG around credentialing. It’s a new concept and we’re all finding our way, whether the process will replace subspecialty training is still not clear. We’ll work with them to develop the concept further, and I’m delighted to announce that the College is using the Advanced Laparoscopic ATSM as the pilot project for the RCOG to put through credentialing. I think this is a positive thing; there is a mismatch between our advanced ATSM and the others across the board, and through this process, it should get a higher level of recognition.
We’ve expanded our awards and bursaries activity this year. There has been a substantial increase in the budget from £20,000 to £30,000, and with the introduction of three sessions, there is more opportunity to apply. Thanks to the work of Kirana Arambage, applications are now online and, I’ll let you into a secret, the chances of success are very high. You have nothing to lose if you apply, there’s money available in the budget and we’d like to give it away! I’d particularly like to encourage applications from our nurse and paramedic members, who often struggle to access funds for training.
In communications, we can be very proud of the information leaflet on outpatient hysteroscopy. The document was jointly produced with the College and very well received. This collaboration highlights the value of the Society working in partnership with others, as we do with industry, RCOG, NICE and others. Our complementary skills, knowledge and resources enable us to produce a very high value of output.
Looking forward, we are planning to develop our patient information programme. Together with RCOG, we are harnessing technology and using multi-media and web-based applications to improve our communication output. There have been two issues of The Scope this year; I would like to give thanks to Jimi and Jane as editor and assistant and encourage all of you to contribute. There are no rules. If you would like to report on a story, publicise an issue, raise a debate, or discuss a controversy, please contact the team with your ideas so that we can make the newsletter even more relevant, interesting and useful for members.
The BSGE published and circulated a statement on outpatient hysteroscopy in December. It’s available on the website and I’d urge members to read it, it talks about giving patients a choice during decision making for hysteroscopy, and may act as a timely reminder for your teams about best practice and how hysteroscopy should be managed. We’ve worked very hard with the College on developing consent advice and patient information on morcellation. Members will be very aware of the controversy and changing evidence base on morcellation of fibroids, in particular in relation to unsuspected uterine malignancy. We have produced an entirely evidence-based document, which will initially be released for consultation among members of the Society with special interest in the area and then more generally. It will be a very important document, and I would encourage you to keep an eye out for it.
We are changing our view of the arena in which we work. The Society has always welcomed international colleagues; Alec Turnbull lecturers and honorary fellows come from across the globe. Last year it was agreed that BSGE would introduce international membership. It has now been successfully launched, thanks to the hard work and attention to detail of our Honorary Secretary, Shaheen Khazali. Yesterday Shailesh Puntambekar delivered a fascinating Alec Turnbull lecture and was awarded a fellowship, he was overwhelmed by the honour he received and will spread the word about the work we do, the culture we carry and the success of the Society, both in India and across the world.
BSGE Endometriosis Centres are no longer a project; they are now meshed into NICE guidelines, specialist commissioning and clinical service provision across the UK. The next. Chairman of the Specialist Commissioning Clinical Reference Group for women’s health is one of our own: David Rowlands. He intends to bring specialist commissioning for Endometriosis Centres and tertiary level endometriosis services to life, so that it becomes part of normal clinical care- similar to referral from cancer unit to cancer centre. The centre accreditation process has completed another cycle and is ongoing. The list of accredited and provisional centres is in the public domain and available through our website.
The Endometriosis Centres project is not standing still; it; it continues to progress and deliver a high-quality service. There has been patient concern about thoracic and diaphragmatic endometriosis. It’s thought to be moderately uncommon, but we know that the more you look for something, the more you find it! We’ve set up a systematic review led by Islam Gamaleldin, with academic oversight from Professor Andrew Horne, to see if we can synthesise some sort of evidence base from the published literature. At the same time, Endometriosis Centre Chair Arvind Vashisht and Martin Hirsch have circulated a questionnaire about thoracic and diaphragmatic endometriosis. I’m grateful to those who have replied; it will help us discover what the service should look like and how it would work.
At Celtic Manor, Krupa Madhvani presented a BSGE-funded study into TLH rates in the UK. The results were far better than I had expected, demonstrating a rise in TLH rates over six years, mirrored by a fall in abdominal hysterectomies. This shows that the work the BSGE does, in terms of training, education, discussion and debate, has been translated into an improvement in clinical services for women. If we ever stop to wonder ‘is it all worth it?’ The slide showing these results (shown below) tells me that it is all worth it. I want to thankKrupa, Tyrone, the team and the BSGE membership for contributing to the results shown on this graph.
Our Honorary Treasurer Andrew Kent has confirmed that the Society is financially stable, despite the surplus wine chit I signed off at one o’clock in the morning at the ASM! We have over 1200 members, 500 of whom attended ASM 2019. As a society, we are inclusive, innovative and we have a culture of our own. Colleagues, visitors and partners in industry comment on how friendly the BSGE is. Justin Clark observed that anybody who does general gynaecology, is part of a gynaecology on-call service, or treats ectopic pregnancies has a good home in our society. The BSGE is not just about complicated pelvic dissection for endometriosis; it is much more. So, my challenge is for you to go out, look at your departments and find a colleague that would benefit from the many high-quality activities the Society has to offer. If we each did that, the membership could double in size. It’s worth it for them, and it will be worth it for us.
Our mission statement says:
‘The British Society for Gynaecological Endoscopy exists to improve standards, promote training and encourage the exchange of information in minimal access surgery techniques for women with gynaecological problems.’
I think this address shows that we are currently fulfilling every aspect of that goal and meeting the high standards set by the pioneers who formed the Society. None of this is possible without the hard work and dedication of many people. I want to thank my fellow officers Justin Clark, Andrew Kent and Shaheen Khazali, the creative and sometimes challenging input from Council and the highly valued reciprocal relationship with our industry partners. No presidential address would be complete without heartfelt thanks to Atia Khan. Her workload is immense and her knowledge is extraordinary. I’d like to think she is so proud of where the Society is today because she is a big part of the reason we got here.
I would like to close by saying thanks to you, the BSGE members, for giving me the great honour of being your President. It’s been hard work, but it has been enormously rewarding and I am eternally grateful. This is my last Presidential address, next year I will hand over to Justin Clark, who I’m sure will take us to a bigger and better place. I wish him all the best in the role and express my personal thanks to you all.