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Welcome to the course

Welcome video from Lead Educators Dr Abigail Whiteman and Dr Philip Sherrard.
Hello, and thank you for joining us on this four week course about perioperative medicine. I’m Abigail. And I’m Phil. And we’re the education leads for this MOOC. Each week we’ll be learning about a different aspect of perioperative medicine. In week two, we will focus on putting the patient at the heart of the decision-making process, using shared decision-making and practical risk assessment tools. Week three we will look at protocols being used to improve care in surgery, both in elective and emergency care. In week four, we will concentrate on the challenges of providing perioperative to the elderly– multi morbid frail patients– as well as looking to the economic difficulties of rising health care costs.
In this first week, we’re going to start off by investigating the surgical epidemic and why traditional models of care no longer work for every patient. We’ll examine the report from the Department of Health and the Royal College of Surgeons on the care of the higher risk surgical patient and hear from the director of the UCL Perioperative Medicine master’s programme Dr. David Walker on the need for change. Chief investigator professor Rupert Pearse then outlines the findings of the recent ISOS study. Afterwards, we will begin to examine perioperative medicine as a broad concept, including the vision of the perioperative care pathway from the Royal College of Anaesthetists and the perioperative pathway in practise at York Teaching Hospitals.
However, before starting the week, we’d like you to take a moment to reflect on what the term perioperative medicine means to you. When you’re done, restart the video and you can hear some thoughts from our expert faculty on what perioperative medicine means to them. Perioperative medicine is honestly why I got out of bed before the alarm clock every morning for the last three years– thinking about how I could come to work in the mornings to improve things for patients’ outcome. A team of people who look after patients having an elective surgery to ensure that it’s the safest possible journey and the best possible outcome for each individual patient.
Well I believe perioperative medicine is the care of the patient from the time the decision is made that they potentially need an operation to the time that the patient is fully recovered from that surgery, be it a few days, a few weeks, or a few months down the line. It’s great medicine. It’s reducing hierarchy. And it’s extending the duration of great medicine from longer before surgery than we used to and longer after surgery than we used to. Perioperative medicine is a specialty that should aim to provide better care before, during, and after surgery with a focus on improving patient reported outcomes, reducing variation.
Practise of patient centred integrated multi disciplinary care for patients undergoing surgery from the moment of contemplation of surgery until, hopefully, full recovery. Perioperative medicine is the treatment or management of a patient from the point of considering a surgical procedure to their long term survival following a procedure. It’s the whole pathway a patient goes through. So perioperative medicine is really ensuring the patients arrive in the operating theatre in the optimal condition– all their medical or surgical aspects are being sorted out before they get there. And I think also importantly to make sure that the ongoing care after they leave the operating theatre is a standardised and optimal care package and pathway delivered to every patient consistently and reliably.
It’s about getting health care professionals and patients together to try and work really effectively with the patients themselves and their physiology and their management to try and improve their outcomes. The prevention and the treatment of harm that results from surgery but also from anaesthesia. Well I think perioperative medicine is basically looking after the patient correctly with all the evidence behind it from when they start thinking about having surgery to when they heal, and get better, and go home.
It’s important because we should be able to make surgery invisible in that the patient’s life should be able to carry through the surgical episode with, in six months time, that operation not having any impact on that patient’s life other than good ones. I think it’s really important to ensure the safety of patients undergoing elective surgery with the right people to look after them. Because I think that if we’re going to spend a lot of money doing very expensive surgical procedures, then we need to make sure that we are getting the best possible outcome from that procedure for that individual patient, from their perspective. Just because you can do something, doesn’t mean that you always should.
And there will be some patients who benefit from an alternative path to surgery or alternative treatment options to the most invasive surgical option. So one of the things about perioperative medicine is about helping patients to make the right decision for them, based on their own individual needs and their own individual priorities. If you’re going to do surgery, let’s do it right. If you’re not going to do surgery, let’s not do it right and support the patient in that decision. And all of that definition is about the patient. It’s about the patient pathway and making sure that what we do is focused on that and not what we think our job is or what we think our work environment is.

We are delighted to welcome you, a global community of healthcare workers, to the course. Over the next four weeks we hope to introduce to you the key concepts behind perioperative medicine and describe how you can make a difference to patient outcomes.

Each week you will have the opportunity to read articles about key topics, listen to interviews with our expert faculty and most importantly hear from patients about their experiences of the perioperative pathway.

This course has been developed in association with and formally endorsed by the Royal College of Anaesthetists (RCoA) and also endorsed by the World Federation of Societies of Anaesthesiologists (WFSA).

Four weeks, four themes

Each week we will explore a different theme within perioperative medicine.

This Week we will explore why a change to the traditional model of surgical care is needed and introduce perioperative medicine as a concept.

In Week 2 we will introduce the need for patient-centred care and demonstrate practical shared decision-making. We will then discuss preoperative risk assessment and explore online tools to help risk stratify patients. We will finish the week by looking at why outcome measures are important and the RCoA PQIP project.

In Week 3 we will outline the need for protocols in both elective and emergency surgery. We will explore the evidence base behind the enhanced recovery programme and outline ideas to ensure both healthcare workers and patients engage with it. We will then introduce some of the major quality improvement programmes being undertaken to improve outcomes after emergency surgery.

In Week 4 we will concentrate on the challenges of providing perioperative care to elderly patients and introduce a model of care that is improving outcomes. We will also examine the economic difficulties of rising healthcare costs and how perioperative medicine may contribute a solution to this. New to the September 2020 run, we also explore the challenges of offering surgery now that COVID 19 is endemic.

Spanish Translation

EN: Welcome to all our Spanish speakers from across the globe. Spanish translation will be available for all steps as a PDF in the ‘Downloads’ area of each page, along with subtitles for each video. There are learner polls throughout the course – these will also be available in Spanish. For some key diagrams and links, you will be referred to the ‘live page’ of the course – this is the interactive web page (in English) for the corresponding step on the FutureLearn website. All numbered references in the Spanish text will also be found in the ‘References’ section at the bottom of the live page – these are live links that will take you to each reference online.

ES: Damos la bienvenida a los hablantes de español de todo el mundo. Habrá una traducción al español de todos los pasos disponible en formato PDF en la sección «Descargas» de cada página, además de subtítulos para cada grabación. Las encuestas para estudiantes también estarán disponibles en español a lo largo del curso. En el caso de algunos diagramas y enlaces, se le animará a que consulte la «página en vivo» del curso, es decir, la página web interactiva (en inglés) y el paso que corresponda dentro del sitio web de FutureLearn. Todas las referencias numeradas del texto en español podrán encontrarse también en la sección «Referencias» situada en la parte de abajo de la página en vivo. Estos enlaces directos le llevarán a cada referencia en línea.

Learning from each other

Already in the opening discussions we have seen contributions from healthcare workers from across the globe. We hope, with this wealth of experience and knowledge, that the comments area of each step will be a valuable place for you to share your experience and ask and answer questions, so that we learn from each other as well as from the content in the course.

If you have already begun to contribute, other learners may have replied to you. You will receive notifications of any new ‘Replies’ in the top right of the page. You can ‘like’ comments if you agree with what’s been said or if you have found something particularly interesting. You can also filter the comments by ‘Most liked’, and ‘Follow’ those individuals who are of particular interest to you.

Upgrading this course

There is the option to upgrade to gain extra benefits from the course. When you upgrade you will get unlimited access to the course for as long as it exists on FutureLearn, so you can move through the course as quickly or slowly as you wish. You will also be able to access a Certificate of Achievement when you meet the criteria. Healthcare professionals might find the the Certificate of Achievement for this course useful for providing evidence of Continuing Professional Development (CPD), or commitment to their career.

Find out more and upgrade now

Meet the team

You might like to follow members of the course team to highlight their participation in course discussions, and can do so by following the links on their names below.
Lead Educators: Dr Abigail Whiteman and Dr Katie Samuel

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Perioperative Medicine in Action

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