MANCHESTER MEDICAL SOCIETY
(Registered Charity No 222800)
C/0 John Rylands University Library, Oxford Road, Manchester M13 9PP

SESSION 2000/2001

NOVEMBER 2000

The second meeting of the Section for the current session was held on Thursday 9^th November 2000 in Theatre 2 of the Lecture Theatre of the Medical School at 8.15 p.m.

The invited speaker was Dr Andrew McIndoe, Consultant Anaesthetist at the Bristol Medical Simulation Centre, whose title was "Medical simulators -a carrot or stick approach".

After a brief introduction from the President, Dr C L Tolhurst-Cleaver, Dr McIndoe thanked the Society for inviting him to speak that evening. He commenced by commenting that the Bristol Medical Simulation Centre was the first of its kind in the UK, having been up and running since November 1997. There are now four such centres within the UK, and he felt that this would be a growing trend in the future. His talk was divided into five different areas, which were:

    1. What is a simulator?

    2. Learning in a simulator

    3. Appraisal

    4. Assessment

    5. Revalidation

Considering the simulator itself, this is essentially an adult mannequin, with its own physiologically programmed computer on which practical and clinical skills can be practised in a real time environment. The most difficult aspect of this environment, Dr McIndoe commented, was putting people at ease. The brain of the system essentially was a Pentium PC with a virtual CVS system.

The learning process in the simulator had been studied at Bristol for the past three years. It provided a dynamic system in which stressful problems could be simulated and correct management developed. It had been interesting to discover that once the problem had been set, there was initially an incorrect diagnosis in over 75% of the training episodes. Early recognition therefore had been a problem, and the correct management strategies needed to be developed over a period of time. This theory practice session was then reviewed by debriefing at which a video of the whole process could be analysed and feedback obtained from it. All trainees who had undergone this simulator problem based medicine had found it worthwhile with over a 90% acceptance rate. Confidence with handling of patients and familiarity with equipment had been improved by this practice. Attendees at these sessions had included nurses, medical students, consultant and trainee anaesthetists, GPs and representatives from the pharmaceutical industries. Dr McIndoe then showed a short video outlining a stressful problem being simulated, in this case an oxygen failure episode, and showed how the trainee anaesthetist managed to eventually cope with the problem.

Considering the appraisal process, Dr McIndoe commented that this was a personal review with feedback, at which one sets your own objectives and targets to promote self-learning and this aided professional development. He reflected that one loses the ability over the years to adapt and these scenarios helped train for the unexpected once in a lifetime scenario. Human factors were most interestingly a common problem area encountered in these training episodes. A second video was then demonstrated to show how stressful interpersonal relationships could deflect from proper clinical management of a patient in a difficult scenario.

4. Assessment was then considered briefly by Dr Mclndoe. He considered that this was a public process and it served as a gatekeeper function. For trainees these scenarios could be used to pass certain hurdles, giving insight into their performance, and for consultants it offered a possible way of re-certification in the future. Knowledge, Dr Mclndoe felt was best obtained through study and examinations, whilst skills could be assessed best perhaps in OSCEs. Within the simulator environment attitudes and behavioural patterns could best be assessed, with no risk to the patient.

Finally considering revalidation, Dr Mclndoe felt that these simulators provided an ideal environment for targeting CPD development, with critical incident training and management, for CVS / respiratory problems, anaphylaxis, malignant hyperpyraxia and gas embolism. They provide an ideal dress rehearsal for these scenarios should they occur in real life.

Following his talk there was an extensive question and answer session from the floor, lasting for some twenty minutes, and at the conclusion of this, Dr Tony McClusky provided a vote of thanks.

Over forty members had attended the meeting, which had been preceded by a dinner in the University Refectory held in honour of Dr Mclndoe attended by some twelve members and guests.

DECEMBER 2000

The meeting of the section was held on Thursday 14^th December 2000 at 8.15 pm in Theatre 2 of the Stopford Building, University of Manchester.

The speaker for the night was Dr Oliver Dearlove, Consultant Anaesthetist at the Manchester Children’s Hospital NHS Trust.

The President, Dr Tolhurst-Cleaver gave a brief introduction outlining Dr Dearlove’s medical career. A Cambridge graduate he initially read law before training in medicine at Guys. After a spell in general practice, he developed an interest in Anaesthesia and trained in Plymouth before taking up his consultant post in Manchester in the 80s. His most recent achievement was election to the Council of the Royal College of Anaesthetists. After his introduction Dr Tolhurst-Cleaver invited Dr Dearlove to address the audience on his chosen subject "Law and Paediatric Anaesthesia".

Dr Dearlove commenced by thanking the society for the invitation to speak this evening.

There then followed a scholarly and entertaining 45-minute presentation, outlining the law governing negligence, and how this relates to manslaughter. Dr Dearlove described what the law considers reckless behaviour by doctors. He discussed the law of agency, and he went on to define or illustrate how a breech of duty could occur in ones practice – be it for indifference, running a known risk or appreciating a known risk and trying to avoid the known complications. He carried on to consider the more recent concept of corporate killing, in which a Trust maybe considered liable for the actions of its employees.

The second half of his talk considered in particular anaesthetic cases which have been featured recently in the public domain. In particular he drew the audience attention to a recent BMJ article in November of this year, outlining medical errors. Of the seventeen cases highlighted, four were anaesthetic mishaps, through which the doctors had suffered at the hands of the law. These cases included dental chair malpractice, a kinked endotracheal tube, a disconnection episode and an unrecognised pneumothorax.

Following his presentation there was a vote of thanks from the President, and the meeting closed at 9.30 pm. Prior to the presentation a meal was held in honour of Dr Dearlove in the University Refectory at which fifteen members and guests attended.

FEBRUARY 2001
The fifth meeting of the session for the Section of Anaesthesia, of the Manchester Medical Society, was the Astra/Zeneca and Abbott Registrars’ Prize Evening. The evening was held on Thursday 8^th February 2001 at 8.15 pm in Theatre 2 of the Medical School, University of Manchester.

Dr C L Tolhurst-Cleaver, President of the Section, introduced the speakers and their titles for the evening’s competitions as follows :-

ASTRA/ZENECA

Dr D H Conway
"Intra-operative fluid optimisation using the oesophageal doppler
during bowel surgery: effect on outcome"

Dr M J Sanchez del Auila
"Long-term stability of Diamorphine in Ropicacaine solution: the effect of
different temperatures and solutions"

ABBOTT

Dr S Basu
"Evaluation of a novel electromechanical device for teaching the correct
application of cricoid pressure"

Dr C Carroll
"Analgesia post day case diagnostic arthroscopy. A comparison between intra articular tenoxicam, bupivacaine a combination of the two with normal saline as placebo"

The judges all felt that the papers were of a very high standard and contributed to what was a stimulating evening. After much consideration the Astra/Zeneca prize (£100 and a trophy) was awarded to Dr D H Conway. The Abbott prize (£250) was awarded to Dr S Basu.

Prior to the meeting an informal dinner was held in the University Refectory in honour of all four candidates and they were entertained by members and guests of the Section.