January 2018 Issue 26

InBox News Addressing medico legal Issues at the CORE CURRICULUM

MOCK VIVAS / TRAINEE REVIEWS

A major logistical operation took place on Saturday, the 27th of January, which took four months

of preparation and required 24 consultants/post exam trainees, 1 Extern, 7 support staff and 55

trainees - Welcome to Mock Vivas / Trainees Reviews. Led by Mr Finbarr Condon, Director of

Training; the day was a great success. Thanks goes to all the trainers who volunteered their time,

Extern, Mr Mark Crowther, Mr Oisin Breathnach for calculating the scores, invigilators, Roddy

Ahern and Adele Meredith, Dr Helen Harty, ISCP, Barbara White, Team Lead, Surgical Training

Dept, Diarmuid Connolly, new T&O administrator, Amanda Wilkinson, IITOS Administrator and

Leah Daly, Surgical Training Dept. The day started at 07:30 and finished at 14:00. Special mention

should also be given to the RCSI catering team, Adrian Dallas (Catering Manager), Dorothea and

Costas, and Mr Oliver O’Flanagan, RCSI IT support. Congratulations to All!

Left- invigilators, Roddy Ahern and Edel Meredith Right - Trainers’ Committee meeting, 24 members were in attendance

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Tallaght Core Curriculum day on Medical Negligence

Organised by Mr Ruairi MacNiocaill and Mr John Quinlan. This very informative training day took place in the Boucher Hayes lecture theatre, RCSI, #26 York St. Photo above, leading Medical Negligence expert Mr Damian Tansey Speakers included: Mr Fergal Dennehy, Ronan, Daly Jermyn Solicitors Mr Mark Dinwoodie, Medical Protection Society and Mr William Kennedy, Irish Medical Council.

Organisers:

Mr Keith Synnott, Mr David Moore

Orthopaedic Trauma Association

of Ireland

6th ANNUAL CONFERENCE

Wineport Lodge, Athlone

14th April 2018

Page 6 Healthy Eating Tips ‘Taking the Lead’ - in Semi Retirement Page 7 FRCS’ers photo More Mock Vivas RCSI HPEC Charter Day Page 8 Info Board Acknowledgement Trauma Audit Report, NOCA Trauma Reform Update

Page 3 EBOT/FRCS Tips Fragility Fracture 7th FFN Global Congress, Dublin Page 4 Upcoming Events New Consultant Experience Page 5 News Bites Irish Shoulder and Elbow Society Conference Mock Clincals IPOS Annual Meeting

INSIDE THIS ISSUE

INBOX NEWS

IRISH INSTITUTE OF TRAUMA & ORTHOPAEDIC SURGERY

‘Implications for Trauma and Orthopaedics of the proposed Trauma

Networks Plan’ and ‘Disaster Preparedness’

Editor: Mr Tom McCarthy, Editorial Director: Mr David Moore

Associate Editor: Ms Amanda Wilkinson

EBOT / FRCS EXAMS

Amanda has asked me to share my experience with the EBOT and FRCS Exam. I find it difficult to give tips and advice on how to prepare for the exams as everyone has their own unique methods of studying and revising the vast expanse of the T&O curriculum. I found that asking colleagues for advice on their experience of the FRCS candidates beneficial. My usual approach to study was a crash course a couple of months prior to an exam however, this was just not going to cut it for the FRCS. I commenced my studies about a year beforehand and set realistic yet challenging study goals along the way. Cont’d p3

Mr Adrian Gheit, Ms Grainne Colgan, Mr Sven O’hEireamhoin

I found Miler’s 6th Edition very helpful for the SICOT and referred to the Harris examination techniques in Orthopaedics for the clinicals and Miller for VIVAs in January.

From there I focused on the MCQs section. As a group my colleagues and I had a whatsapp chat group. We also used Skype to discuss topics and scenarios. Some books recommend about 5000 to 7000 MCQ’s, and I have taken Sven’s and Neil’s advice on board and worked MCQ’s from Orthobullets (5600) and few MCQ books for a total of around 10000 MCQs. Sven suggested repeating unanswered and wrong MCQ’s in Orthobullets and this I found assisted me in remembering problem questions.

Apart from the UKITE, as a group we have also sat the EBOT Interim exam (European Version of the UKITE). One advantage of the interim exam is that it gives immediate feedback and splits the answers in to the 5 main topics and therefore, highlighting problem areas you may need to focus on. Most of us used Miller/Orthobullets for the MCQ’s. We have all booked the same location to sit the part 1(FRCS).

I found the FRCS to be more difficult than the EBOT. The FRCS is longer, has 2 sections and a limited time to answer questions. In the EBOT, you have 3 hours to answer 100 questions.

Results took exactly 3 weeks for both exams. Viva/Clinicals Initially I found it difficult to decide what to study for the 2

nd part of the exams. I did study the 2

nd edition of the

Basic science book. The main book I have studied from was the 3

rd edition of the Postgraduate Orthopaedics. I

did find that the basic science and applied basic science section were quite good and certain topics were better explained than in Ramachandran’s book. I focused on the viva section of the book since the EBOT part 2(viva only) was in October. The group used skype to discuss topics and simulate viva situations. The EBOT exam was in Lisbon, so we (Ali & I) did some viva practice before the exam. The exam itself consists of 5 viva stations (UL, LL, Paeds, Basic Science and Spine) of 30 min each. As such I did not find a language barrier as many described to me, but I do suggest speaking slowly and clearly to avoid confusion or misinterpretation. Examiners were from all over Europe including the UK and I felt their examina-tion approach was fair. After the EBOT I focused on the clinical part of the exam using the Postgraduate Ortho-paedics and the Harris Examination book. We were for-tunate to have access to the IOTA room in Cappagh as well as other areas to simulate various examination scenarios and viva practice. We organised it so we each had the opportunity to simulate intermediate cases as well as do viva. This enabled us to critique and refine our techniques and get feedback from each other. Some of the consultant trainers and mentors provided us with teaching sessions that were hugely constructive in giving us guidance, support and preparing us for the exams and clinicals. Each member of the group has varied interests within the speciality of Orthopaedics and some brought with them past knowledge and

experience. This collaborative approach enriches the learning experience and I retained information based on the way it can be imparted by the exchanges we shared as we worked together. I had the benefit of hav-ing a willing participant in my viva practices at home. Others may favour the use of models or in some instances, a child’s doll. As they say, each to his own! Exam time: Most of us booked the same location to stay in and it was close to the viva venue. I would advice advance booking to ensure this happens and perhaps travelling a few days before to allow you to adjust to the surroundings and the climate. The clinical; it does require a lot of organisation from the host hospital/deanery, unfortunately from the candidate’s perspective it can be difficult especially if you are in the last group and must wait for hours until you are being examined. The cases presented are varied so you do encounter common cases like ACL tears, frozen shoulders, ankle impingement, rheumatoid joints and so on. However, rare cases such as Streeter’s dysplasia(ABS), PFFD, tethered cord, polio syndrome and nail-patella syndrome may crop up. It is important to keep it basic. I found the examiners to be very fair and they all tried to help as much as they could.

All would agree that it is a stressful and challenging time. I did find the viva section easier than the clinicals because we are fortunately faced with similar scenarios every January. In the viva section the questions advance from a basic question and progress in difficulty. Ciara and I were in Tallaght during the exam and found we had the absolute support from our institution during this time. Furthermore, individual consultants supported us through providing teaching sessions during their time off. Finally, it is important to not forget our families who support and reassure us during this challenging time. They are equally impacted upon during this part of our training. I would like to take the opportunity to wish all my colleagues the very best of luck in their exams and hope that you found some-thing of benefit from the above summary of my experience.

Regards, Adrian Cassar-Gheiti.

7th FFN Global Congress DUBLIN

5-7th July 2018

Royal College of Surgeons in Ireland

“Patient centred multidisciplinary care”

We are looking forward to welcoming you in Dublin in July.

Emer Ahern & Conor Hurson, Congress Chair Paolo Falaschi, FFN President

Link to further details

Congress information here

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Life as a Newly Appointed Consultant – Mr. Joseph Butler I started as a Consultant Spine Surgeon at the Mater Misericordiae University Hospital and Tallaght Hospital on 1

st August 2017. I landed

back in Dublin from Philadelphia on the evening of the 31st of July with

my wife and 3 young children. We arrived from the airport to a house in Dún Laoghaire with 5 DHL boxes waiting for us, our few remaining belongings from the last 3 years of travel (London, Boston & Philadelphia). We spent the night constructing a mixture of Ikea & Littlewoods furniture and got into bed at 2am! We could hardly sleep with the excitement of starting the next stage of our lives… We were finally back in Ireland!! My last 3 years had involved fellowship training at some of the best units in Europe and North America; from spine deformity and tumour surgery at the Royal National Orthopaedic Hospital, Stanmore; to spine trauma and degenerative spine surgery at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; and finally complex, revision and minimally invasive spine surgery in the Rothman Institute at Thomas Jefferson University, Philadelphia. My last year in Philadelphia had been an incredible experience, both personally and professionally. I did 500 surgical cases in the 12 months, wrote a myriad of papers and book chapters, presented at major international meetings, developed lifelong friendships with my co-fellows and established a strong network of international mentors for my future career As a family we absolutely loved Philly. We had previously lived in West Hampstead in London and Harvard Square in Boston, but this was different. Philadelphia is a city steeped in American history, with a real vibrant atmosphere and some of the best bars and restaurants in the US. We lived in Society Hill, the historical district, in a house built in 1850 that was restored to an incredible standard. Rent was half the cost of Boston and we had 3 times the space! We regularly visited the city’s historical landmarks, and often spent weekends at NFL or Baseball games or down on Jersey Shore!

“I worked mainly with a spine surgeon called Alex Vaccaro, a real dynamo. He would routinely email me at 4am (when his day started) about research ideas and the upcoming day’s cases. He ran 2 operating rooms 4 days a week”.

I would run one room and the other fellow would run the other. We put knife to skin at 6am and finished no later than 2pm. That was usually 8 cases. He needed fellows to be fast and efficient in the OR, no pressure! Then at 2pm….he was gone! He was the President of the Rothman Institute and had management meetings all afternoon. Fellows had research to complete. But working with him was like being on a reality TV show. He did ward rounds like he was a celebrity surgeon, he was constantly doing interviews for the media, he was doctor to the city’s NFL and baseball teams, he would routinely have dinner with members of congress and senators… and I got dragged to my fair share of Republican fundraisers!! In the months prior to my return I had heard noise that my life was about to get very busy on my arrival back to Dublin. One phone conversation with a senior Mater surgeon advised me to get off the plane, come straight to the Spinal Unit with a ‘sleeping bag’, a lot of work was waiting. Another conversation from a Tallaght surgeon told me that there were 100s of surgical cases that needed doing and to get back ASAP!... To be honest I was very excited at this prospect. I felt that this could be the ideal environment to hit the ground running from fellowship and use all the skills I had learned on fellowship. In fact, it has turned out to be everything I had ever hoped for as a start to clinical practice! My post is the first split site appointment in the hub-and-spoke model for national spine care. It is the first exclusive spine appointment, with no general orthopaedic trauma commitment.

Cont’d p 6

UPCOMING EVENTS

MARCH

1st-3rd, Thursday-Saturday Sylvester O’Halloran Meeting Details on discussion board here

8th, 9th Thursday, Friday Irish Hand Surgery Society Meeting Convener, Mr Pat Fleming

21st, Wednesday Core Curriculum, Surgical Approaches RCSI, Mr Peter Keogh, Mr Paddy Kenny

23rd, Friday Specialty Training Interviews RCSI

APRIL

14th, Saturday OTAI Meeting, Wineport Lodge, Athlone Conveners, Mr Keith Synnott, Mr David Moore

19th, Thursday Core Curriculum, Basic Science, biomechanics, biomaterials, statistics. Cappagh Prof John O’Byrne, Prof Kevin Mulhall

20th-22nd, Friday-Sunday MAC18, Organiser - Mr Derek Bennet Knockranny House, Westport Link

MAY

11th, Friday IOAFS Instructional Course Galgorm, email

18th, Friday Core Curriculum, Adult and paediatric musculoskeletal oncology. Mr Gary O’Toole, Mr Alan Molloy

25th, Friday Cappagh Foundation Meeting and Resident’s Prize. ‘Models of care in Paediatric Orthopaedics’

JUNE

25th, Monday Core Curriculum, Galway, Elective spinal surgery incl tumours. Mr Aiden Devitt, Mr Seamus Morris

30th, Saturday RITA G Sign Off, ST8s Trainers, Council Meetings, RCSI

JULY

5th-7th, Thursday-Saturday 7th Fragility Fracture Network Global Conference, Royal College of Surgeons Congress Chairs—Mr Conor Hurson, Dr Emer Ahern, Prof. Paolo Falaschi - Link

The Institute welcomes new Treasurer, Mr Aaron Glynn. Aarron is actively working on updating the membership database. For a standing order form, email amandawilkinson@rcsi.com

L-R Prof John O’’Byrne, Ms Olivia Flanner, Mr Marcus Timlin,

Mr Aaron Glynn at break time, Mock Vivas.

New T&O Administrator We would like to welcome Diarmuid Connolly to the T&O Admin team. Diarmuid has taken over from Barbara White who got promoted to HST Team Lead. We wish them both much success in their new roles and would especially like to thank Barbara for her contribution to the Orthopaedic Training programme.

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The second annual Irish Shoulder and Elbow Society conference was held in the RCSI on Saturday 13th January. The meeting was very well attended by orthopaedic surgeons, trainees and physiotherapists. Professor Pascal Boileau, from the University of Nice, was the guest of honour and he delivered excellent talks outlining new developments in shoulder arthroscopy and arthroplasty.

Ms Anju Jaggi, an expert in the management of complex shoulder instability was the physiotherapy guest speaker.

Free papers and posters were presented. The award for the best paper presentation went to Ronnie Davies and Cormac Kelly from Oswestry on the comparative outcomes of shoulder arthroplasty and hemiarthroplasty using a ceramic humeral bearing surface. The best poster presentation was awarded to Connor Montgomery for his work on the correlation of arthroscopic and MRI appearance of posterior labral tears.

The next event on the ISES calendar will be a specialty day at the Irish Orthopaedic Assocation conference in June. Dr Mark Mighell from Florida will be the invited speaker on that occasion.

Kieran O’Shea

IRISH SHOULDER AND ELBOW SOCIETY

ISES Annual Meeting, Centre, guest speakers, Ms Anju

Jaggi,Professor Pascal Boileau and Mr James Colville,

President, Irish Shoulder and Elbow Society.

Principal sponsor, Smith and Nephew

Irish Paediatric Orthopaedic Society Annual Meeting 12th/13th October. Convener: Mr David

Moore

"Sharing knowledge and understanding of paediatric orthopaedic disorders to advance their diagnosis and treatment."

The Mock Clinicals

The Mock Clinicals took place on Friday,19th in Tallaght. The convener was Mr Mike Leonard with help from SpR Peter Dawson. Thanks goes to the following examiners - James Sproule, Grainne Colgan, Oisin Breathnach , Ali Abdulkarim and Ciara Fox. The overall standard was impressive however there is still room for improvement of clinical skills.

Mike Leonard

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Taking the lead…

When I was a very junior SHO, the boss said to me one day over the operating table: “Young man, what do you think is your biggest problem in surgical training?” I didn’t know how to reply, so he carried on: “Your problem is that you have too many other interests!” He was referring to the fact that at the time I was well known to be actively involved in organising the hospital chapel choir. I politely thanked him for his observation, and we carried on with the case. However, I failed to mend my ways! In fact, over all the subsequent years, wherever I went, I would join a local choir. The two hours per week of rehearsal were sacrosanct. They provided a welcome break from the intensity of the surgical scene, and were enough to maintain a meaningful musical interest. In recent years, in addition to singing bass with our local chamber choir, I found myself thrust into the role of directing a four-part church choir. We have a committed group of singers whose enthusiasm is a stimulus to keep improving the standard. So when “semi-retirement” came last year, the opportunity arose for the musical activity to blossom. The church choir has been getting busier, and to date has taken part in four concerts. I’m also involved in a newly formed Irish Doctors’ Choir, a cross-border organisation which so far has done Mahler’s Second Symphony (with the European Doctors’ Orchestra) in Belfast – with lots more ambitious plans to follow! Also, this year, a group of us assembled a large choir in Waterford and put on a production of Handel’s Messiah. This group also has ambitions to continue the initiative into the future. I’ve always maintained that there’s more to life than work – and given that everybody faces the prospect of retirement, it’s good to remember that. In my case, forty-five years ago, at Leaving Cert stage, the choice was Medicine or Music, and Medicine won the battle. Now, with clinical practice somewhat reduced, it’s the turn of the music to take more centre stage! So the very first thing I did the week after “retiring” was to attend a choral conducting course run by the Association of Irish Choirs. This was a week-long residential course in the University of Limerick,

staying in student accommodation. For me it opened up a whole new world, provided an opportunity to develop a skill, and gave me a great new circle of friends and colleagues. I’m now looking forward to attending the course for the third time this coming August. This has all been the beginning of a new journey – and who knows where it could lead!!

Joe O’Beirne Waterford

Amanda asked if I would write something on healthy eating for the February newsletter, so I thought why not! After all, with all the greens and grains I take, there’s a few things I can share. Although my kitchen is well equipped with blender, food processor, spiralizer, dehydrator…. you get the picture.... the 2 items I could not live without are my Magimix blender and food processor! I better mention Spirulina or any trainees who have gone through Connolly will be worried!! Spirulina is one of the highest forms of natural protein. Not particularly nice in powder form solo, but certainly the tastiest spirulina drink recipe is from The World of the Happy Pear. Blend 1-2 bananas, 50g goji berries, 80g walnuts, 2 tablespoons cacao powder, 2 tablespoons bee pollen and 1 tablespoons of spirulina with ½ litre water. Although the drinks are important, they don’t all fill you up! Lots of snacks and treats are essential, especially on a Monday to get us through the trauma list! Food processor may be needed. The top 3 are : Caramel slices from The Happy Pear (these were Emmet’s favourite), Raspberry muffins from The World of the Happy Pear, which are John’s favourite Applesauce and cinnamon cookies from Susan Jane White’s The World of the Extra Virgin, which are Hunky Bear’s favourite! I have my own variations to suit me, and the lads seem happy enough!! For Recipes and full write up click here

Healthy Energy Drinks & Snacks

Olivia Flannery

L-R John Gibbons, Mark Berney

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Successful FRCS Part 2 Trainees, L-R, Mr Adeel Memon, Ms Ciara Fox, Mr Adrian Gheiti, Mr Ali Abdulkarim, Mr Rob Bruce-Brand, Mr Jamie Hepburn. Photo taken at the Core Curriculum, RCSI, #26 York Street.

Dr Helen Harty, ISCP, entering data at Mock Vivas in January. Thanks Helen for all the hard work!

Mr Oisin Breathnach and Ms Olivia Flannery. Oisin had the onerous task of entering and collating Mock Vivas scores.

RCSI CHARTER DAY

The first Orthopaedic session at Charter Day kicked off at 10:00 in the Houston Lecture theatre, RCSI. It was a very animated discussion indeed with Mr Keith Synnott vs Mr Finbarr Condon, we can’t even print some of the words used on slides here! Link to programme here

Health Professions Education Centre

HPEC

About HPEC

Meet the Team

Teaching and Learning

Research Activities

Technology Enhanced

Learning

This was followed by a further vigorous debate over the pro’s and cons of research by Prof James Harty and Mr Paul O’Grady. Political correctness was not high on the agenda but Photoshop certainly was!

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Report - Trauma Care Reform

Report - Proposal on Trauma Care

NOCA Major Trauma Audit Report

Joe Butler, cont’d from p 3

My post involves a very busy elective degenerative practice based at Tallaght and a complex and emergency spine practice based at the Mater. It can be challenging to split time between two sites on opposite parts of town but this first 6 months has been an incredibly enjoyable learning curve. I have experienced all the trials and tribulations of attempting to establish a reasonably controlled elective practice in a very large underserved catchment area, along with the experience of pushing my skill set in terms of case volume and complexity as part of a busy national referral service for emergency cases. Although it has been very satisfying to perform surgical cases in the way I was trained on fellowship, dealing with my complications is still something that I am slowly adjusting to! Nevertheless the first 6 months of practice has been an incredible experience.

Outside of work, it has been a real source of satisfaction to see my wife and 3 boys settle back in Dublin, even if my eldest (Barra, Age 4) wrongly considers himself American, wants the Eagles to win the Super Bowl and continues to be Donald Trump’s biggest fan! With baby number 4 due next

summer, maybe it is time to start using that Type C contract I have!! In what has been a whirlwind start to my first 6 months of practice I would like to acknowledge the strong support of my colleagues at both Tallaght and the Mater, who have made my transition from fellow to ‘name above the bed’ very easy. Although we might not have all the resources we need, the good collegiate support I am fortunate to have goes a long way when attempting to provide the best clinical care in an environment of limited resources.

Mr. Joseph S. Butler

This is Eddie Brady,

one of the longest

serving porters in the

Royal College of

Surgeons with 20

years service this April.

No doubt you will see

him around when you

are in the College.

Eddie is very helpful

and always goes that

extra mile. Don’t forget

to say Hello if you see

him in passing.

Amanda

If you would like to share your interesting story about: Life on the SpR Programme Life as a Fellow Life as a Newly Qualified Consultant Encore Years - Life in Retirement

Email: amandawilkinson@rcsi.com

TRAUMA REFORMS

Update, 6/02