The first face-to-face BAUS in three years began with a welcome reception in the Library of Birmingham. There was a great buzz of conversation between colleagues and friends, who potentially hadn’t seen each other since before the start of the pandemic. Tim O’Brien gave the President’s Welcome and chaired the presentation of awards. The BAUS Gold Medals were awarded to Professor Duncan Summerton and Nitin Shotri. The Golden Telescope Award was presented to Professor Caroline Moore, the first female recipient and an inspiration and champion for women in urology. The John Anderson Award was presented to Chandra Shekhar Biyani while the Keith Yeates Medals went to Flora Rodger, Craig Jones and Neha Sira for their performance in their FRCS(Urol). Finally, certificates of distinction in industry were presented to Alan Roberts (Coloplast) and Simon Alesbury (Lawmed).
The conference proper kicked off with ‘Fitness to practice: where do we stand today?’ this was a very interesting session looking at the dreaded GMC letter from four different perspectives: Dr Chaand Nagpaul, chair of the BMA; Dr Andrew Hoyle, Assistant Director for Decisions GMC Counsel; Dr Carol Roberts, a Deputy Medical Director; and Professor Steve Payne, a Consultant Urologist who has experienced a GMC referral. It certainly sparked much debate. Discussions included the need for reform and change to a no blame compensation pathway, and focusing on system reform rather than individual blame. There was a focus on ethnic minorities being singled out by the GMC and ways to overcome this. Unfortunately, many doctors have and will receive referrals to the GMC, however, the majority of these do not proceed past the initial referral stage. The general take home message was that, despite recent change, more is required, and the GMC needs to take action to deliver promised improvements. Andrew Hoyle stated that he was listening and will try and put GMC promises into action.
BURST gave a whirlwind tour through the projects it has completed and continues to work on, as well as an insight into future plans. With the development of risk calculators and practical recommendations from studies such as FIX-IT, projects have clear applicability to our everyday work. The session ended with hands-on training in ultrasound for testicular torsion (the basis for the RESCUE study) which was well received.
A brilliant skills course ‘Newer ambulatory treatment options for benign prostatic enlargement’ was held and had much to offer people at all levels. It included stations on iTIND, Rezūm™, GreenLight™ and UroLift®. It offered the opportunity to try each technique on the simulation models guided by expert consultants, to troubleshoot and to discuss the evidence and guidelines on these newer treatment modalities.
Another skills course ‘Urology NTN simulation interview’ held mock interviews with six stations and was a fantastic opportunity for those hoping to apply for a urology national training number in 2023. Rumour has it in-person interviews may return so this face-to-face interactive experience with realistic stations was much needed after our two years of remote interaction and assessment. This was a great opportunity, with instant feedback, to gain insight into where skill development and refinement is required. A useful and valuable session run by BSoT.
Tuesday got off to an early start for 40 keen joggers who completed a sunny 5k to raise money for TUF. Others took a more leisurely approach and attended some of the breakfast meetings. The anatomical drawing meeting, led by anatomical artist Dr Lucy Lyons, offered great tips including focusing on holding the pen loosely towards the distal end to give more fluidity of movement, starting with light rough shapes, concentrating on drawing the spaces behind the objects first to give more accuracy of measurements and the use of shading. It was a thoroughly enjoyable hour.
In a fascinating session Prof Caroline Moore, winner of the Golden Telescope Award, described her feelings of ‘imposter syndrome’ and how it wasn’t all plain sailing to become the successful surgeon and academic she is now. Sophia Cashman, 2021 winner of the Keith Yeates Medal, gave an honest account of her struggle with imposter syndrome and how, after contemplating resigning from training, she tackled it head on with support from family and colleagues. Even the charismatic Tim O’Brien described a few occasions when he felt imposter syndrome. Dr Manuela Untanu, Clinical Psychologist, then discussed the concept and impact of imposter syndrome, the demographics of those it often affects and ways to approach and overcome it.
An excellent service offered at every face-to-face BAUS since 2013, are the mentor sessions. This year five trained mentors (Nancy Redfern, Anaesthetist from Newcastle, Gordon French, Anaesthetist from Northampton, Tim Terry, Urologist from East Midlands, Mary Brown, Urologist from Glasgow, and Veronique Spiteri, Paediatric Orthopaedic Surgeon from Birmingham) ran sessions for around 50 mentees. It offered time for a holistic discussion on career issues and opportunities. The mentors use the Egan Skilled Helper Model to help the mentee assess their current situation, where they want to go and how this can be put into action. This mixture of informal and formal mentoring approach is not paternalistic in nature but more a discussion challenging your assumptions and encouraging new ideas. I was particularly impressed with the insight and holistic approach my mentor Tim Terry offered me towards achieving my career goals. The aim is to expand the mentoring service and make it available to BAUS members at other times during the year which would be a very welcome and worthwhile service.
Another incredibly useful session was on financial wellbeing. Advice on financial issues is much needed and realistically should be covered within medical school and / or training. It covered simple things we can do to minimise tax, information on NHS pensions and good financial housekeeping among others. A key point for me was the explanation of tax rates. Earning over £100,000 seems a long way off for someone starting training but tax rates are important to keep in mind as a consultant when nearing that bracket. More relevant to current trainees are the things we can do now, such as claiming tax relief on expenses (www.medicsmoney.co.uk/free-guide is a free website which can help you make these claims yourself). In essence this session gave some great valuable financial advice and is well worth revisiting.
Another discussion on ‘the dreaded letter’ aimed more at education from the GMC. It outlined the legal framework, gave an overview of what happens at a Medical Practitioner’s Tribunal (MPT), provided guidance on how to navigate the process and gave example of some cases. The take home message was that the GMC’s main concern is maintaining confidence and trust in the profession; their aim is to preserve the safety of the public and not to punish the doctor. Within an MTP they want to see that the doctor has demonstrated insight and remediation, and this is what can have most impact on determining the final sanctions. Other good advice was to read Good Medical Practice and hopefully avoid such dreaded letters!
The session on ‘the management of urinary retention’ was a whistle stop tour of how to manage acute and chronic urinary retention, the role of urodynamics and GIRFT. The stand-out lecture for me was by Feras al Jaafari ‘Decisions, Decisions, Decisions’. The expert in the area is not the one that can do the operation but the person who can adequately counsel the patients re the differing treatment options. He advocates shared decision-making at a one-stop clinic with the presence of a nurse specialist to help empower the patient to make the correct decision for them. The session in general sparked much debate, and discussions at the end highlighted the use of intermittent self-catheterisation (ISC) as an alternative to long-term catheterisation (LTC) as an acceptable option for the patient in acute retention. A good learning point for trainees was that not every low-pressure chronic retention requires a catheter or intervention – ‘treat the patient not the residual’.
The BSoT afternoon session was a great discussion on urological emergencies. With regards to testicular torsion, Milan Gopal suggested that, while we obviously need to explore high-risk patients, with low-risk patients we should consider ultrasound and prognostic score indicators to aid our decision. Persistent severe bladder haematuria can be difficult to manage and there is not much high-level evidence. Regarding patients on novel oral anticoagulants (NOACs), if haematuria is recurrent and persistent, we need to remember the importance of being pragmatic and engaging in patient counselling and shared decision-making. The answer may be to stop the NOAC as recurrent hospital admissions and general anaesthetics also increase stroke risk and can reduce quality of life. The session concluded with three index cases regarding renal trauma and discussed the assessment and management options.
Tim O’Brien concluded his BAUS presidency giving an inspirational President’s Address on steering BAUS through a difficult time, highlighting the impressive recent achievements of the organisation and reflecting that in his year of qualification the flexible cystoscope was not quite developed and there was no CT scanner in his unit! Tim O’Brien formally handed over the presidency to Jo Creswell, who commended his exemplary work.
This was my first BAUS conference and it definitely won’t be my last. A welcome addition this year was the Creche, which provided comprehensive and highly competent childcare for the whole event. To invest in this initiative not only allowed attendees to come who otherwise would have struggled with childcare, but also demonstrated to the whole BAUS community a commitment to inclusivity. Hopefully other surgical conferences will follow suit!
BAUS 2022 demonstrated a wonderful welcome back to face-to-face conferences with the added benefit of delegates also being able to attend virtually. I look forward to the continued efforts of BAUS in the coming year under the guidance of Jo Creswell and to attending the conference in 2023!
SAVE THE DATE - BAUS 2023
19-21 June 2023, Birmingham, UK