Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights.

BACKGROUND: This observational study, paired with National Health Service (NHS) workforce population data, examined gender differences in surgical workforce members' experiences with sexual misconduct (sexual harassment, sexual assault, rape) among colleagues in the past 5 years, and their views of the adequacy of accountable organizations in dealing with this issue. METHODS: This was a survey of UK surgical workforce members, recruited via surgical organizations. RESULTS: Some 1704 individuals participated, with 1434 (51.5 per cent women) eligible for primary unweighted analyses. Weighted analyses, grounded in NHS England surgical workforce population data, used 756 NHS England participants. Weighted and unweighted analyses showed that, compared with men, women were significantly more likely to report witnessing, and be a target of, sexual misconduct. Among women, 63.3 per cent reported being the target of sexual harassment versus 23.7 per cent of men (89.5 per cent witnessing versus 81.0 per cent of men). Additionally, 29.9 per cent of women had been sexually assaulted versus 6.9 per cent of men (35.9 per cent witnessing versus 17.1 per cent of men), with 10.9 per cent of women experiencing forced physical contact for career opportunities (a form of sexual assault) versus 0.7 per cent of men. Being raped by a colleague was reported by 0.8 per cent of women versus 0.1 per cent of men (1.9 per cent witnessing versus 0.6 per cent of men). Evaluations of organizations' adequacy in handling sexual misconduct were significantly lower among women than men, ranging from a low of 15.1 per cent for the General Medical Council to a high of 31.1 per cent for the Royal Colleges (men's evaluations: 48.6 and 60.2 per cent respectively). CONCLUSION: Sexual misconduct in the past 5 years has been experienced widely, with women affected disproportionately. Accountable organizations are not regarded as dealing adequately with this issue.

This research examined sexual misconduct occurring in surgery in the UK, so that more informed and targeted actions can be taken to make healthcare safer for staff and patients. A survey assessed individuals' experiences with being sexually harassed, sexually assaulted, and raped by work colleagues. Individuals were also asked whether they had seen this happen to others at work. Compared with men, women were much more likely to have seen sexual misconduct happening to others, and to have it happen to them. For example, most women (63.3 per cent) experienced being sexually harassed by colleagues, as did some men (23.7 per cent). Women also experienced being sexual assaulted by colleagues far more often than men (29.9 per cent of women, 6.9 per cent of men). These findings show that women and men in the surgical workforce are living different realities. For women, being around colleagues is more often going to mean witnessing, and being a target of, sexual misconduct. Individuals were also asked whether they thought healthcare-related organizations were handling issues of sexual misconduct adequately; most did not think they were. The General Medical Council (GMC) received the lowest evaluations. Only 15.1 per cent of women regarded the GMC as adequate in their handling of sexual misconduct. Men's evaluations were higher, although the GMC was still regarded as adequate by less than half of men (48.6 per cent). Evaluations of National Health Service Trusts were rated similarly low. Only 15.8 per cent of women evaluated them as adequate (44.9 per cent of men). The results of this study have implications for all stakeholders, including patients. Sexual misconduct was commonly experienced by respondents, representing a serious issue for the profession. There is a widespread lack of faith in the UK organizations responsible for dealing with this issue. Those organizations have a duty to protect the workforce, and to protect patients.

Are tie-over bolster dressings necessary for healing or success of full thickness skin graft reconstruction following facial skin cancer excision?

Skin grafts are commonly used for reconstruction of defects following excision of facial skin cancers. Tie-over bolster dressings are routinely placed to secure these grafts, but are they necessary for healing or graft success?A total of 96 patients was treated from 2013-2019 who underwent full thickness skin graft (FTSG) reconstruction following facial skin cancer excision were retrospectively analysed. All patients were treated by one consultant with non-fenestrated FTSG's placed on defects varying from 10 to 55mm in maximum diameter. Grafts were sutured circumferentially with a continuous resorbable suture. Tie-over bolster dressings were not used, and the recipient site was dressed with MepitelTMand SteristripsTM. Primary defect sites where we used this technique included the pinna, the nose and face, and less commonly, the scalp. Graft harvest sites included the neck, pre-auricular, and submental regions.Complete graft take was noted in 94/96 patients. Partial graft failure was observed in two patients, one who healed and had successful late scar revision surgery and one who was managed conservatively and healed well. Two further patients with complete graft healing later underwent minimal revisional contour surgery with satisfactory results.This retrospective study has shown FTSG success in cutaneous defects of the head and neck to be excellent without the use of tie-over bolsters. This has significant benefits of saving operative time, reducing cost, and sparing the patient both unnecessary intraoperative steps, and the inconvenience of a bolster with its often-painful removal. We recommend that the use of tie-over bolsters in the management of most FTSG reconstructed head and neck cutaneous defects be considered an unnecessary step. We believe there are no adverse effects of our described simple technique, and that there are significant benefits to the patient.

Providing national level teaching to OMFS specialty trainees in a virtual classroom setting using learning theories of education.

COVID-19 has resulted in an expansion of webinar-based teaching globally. Socially distanced e-learning is the new normal. The delivery of regional OMFS teaching programmes in the UK and the Republic of Ireland, for Specialty Trainees (ST's) under the Joint Committee on Surgical Training (JCST) and Intercollegiate Surgical Curriculum Programme (ISCP) umbrellas is variable. We recognised the need to provide additional teaching to supplement this teaching, at a time of crisis in our countries and healthcare systems, which had jointly led to a significant impact on the progression of training. The membership category of Specialty Trainees within the national specialty association-the British Association of Oral and Maxillofacial Surgeons (BAOMS) is Fellows in Training abbreviated to FiT. We designed an OMFS FiT (Fellows in Training) webinar series based on the current Oral and Maxillofacial Surgery (OMFS) curriculum. Senior trainers delivered weekly national web-based teaching using learning theories of education. Thirteen webinars were conducted between the 14th of May and the 4th of August 2020. Webinars were attended by 40-75 ST's with 98 percent of trainees rating the webinars as 'excellent' or 'very good', and 99% found the content 'extremely useful' or 'very useful'. We discuss the learning theories used for this teaching which include - Bloom's taxonomy, Bruner's spiral model, Vygotsky's zone of proximal development, the flipped classroom model, and Knowles' andragogy model. This pilot national teaching programme has been extremely well received by OMFS trainees and is here to stay!

Lockjaw from a metastatic uterine leiomyosarcoma- case report and review of the literature.

BACKGROUND: Leiomyosarcoma (LMS) is a malignant tumour formed of cells with distinct smooth muscle features. Leiomyosarcomas rarely metastasise to the oral cavity and this literature review details all reported cases of metastasis to the mandible found in the literature. This offers a unique perspective by specifying mandible as the site of metastasis of leiomyosarcoma. CASE PRESENTATION: A 53-year-old female presented to her General Practitioner (GP) with heavy menstrual bleeding and was diagnosed with multiple fibroids. Folowing a hysterectomy and removal of both tubes and ovaries for these symptomatic uterine fibroids, an incidental diagnosis of low grade leiomyosarcoma was made. A CT scan found no evidence of residual or metastatic disease and no further treatment was deemed necessary. 6 months later she presented to A & E with a numb lower lip but it took another 6 months for the diagnosis of metastatic LMS to the mandible to be made. DISCUSSION: Leiomyosarcomas are aggressive tumours which are liable to metastasise and therefore have a poor prognosis. An extensive literature review was undertaken to explore the frequency of metastasis in the maxillo-facial region. CONCLUSIONS: Although metastasis to the oral region is very rare as suggested from the literature review, when patients present with unusual symptoms after a diagnosis of LMS, physicians should be aware of the possibility of LMS metastases.

Single-centre experience of primary cutaneous Merkel cell carcinoma of the head and neck between 1996 and 2014.

We retrospectively reviewed the management at our centre of 25 patients with Merkel cell carcinoma (MCC) of the head and neck. We obtained details of the operation, including wide local excision, sentinel lymph node biopsy (SNB), neck dissection, postoperative radiotherapy, and clinical outcomes, from patients' records. All patients were white, 11 were men and 14 women, mean age at presentation 81 years (range 67-90). At the time of diagnosis, 18 patients had stage I disease, and 7 stage II disease. Twenty had wide local excision and radiotherapy, and 5 had wide local excision alone. Wide local excision and radiotherapy are successful treatments. In patients with no sign of metastases, SNB at the time of excision is a well-researched option and should be considered the gold standard of care.

Management of regional metastatic disease in head and neck cutaneous malignancy. 1. Cutaneous squamous cell carcinoma.

This overview is the first of 2 articles on the current evidence for management of the neck and parotid in cutaneous cancers of the head and neck. In this paper we discuss cutaneous squamous cell carcinoma (SCC) and review the latest evidence for management of the regional nodes.

Management of regional metastatic disease in head and neck cutaneous malignancy. 2. Cutaneous malignant melanoma.

This is the second of 2 articles giving an overview of the current evidence for management of the neck and parotid in cutaneous cancers of the head and neck. We discuss cutaneous malignant melanoma and review the latest evidence for management of the regional nodes.

Case of tuberculosis of the temporomandibular joint.

Tuberculosis (TB) of the temporomandibular joint (TMJ) is rare and misdiagnosis is common. We describe an unusual case of the disease in a 27-year-old Zimbabwean woman.

Follow-up after treatment of squamous cell carcinoma of the oral cavity: current maxillofacial practice in the United Kingdom.

Although patients are commonly reviewed after primary treatment for squamous cell carcinoma (SCC) of the oral cavity, there is little evidence about the frequency and duration of such a review. To try and obtain further information about current practice within the United Kingdom we used a structured telephone questionnaire to contact 50 units. Most of them (n=40, 80%) had developed follow-up protocols, and 38 (76%) reviewed patients for 5 years. All units examined patients monthly for the first year, and 90% of patients were seen 2-monthly for the following year. Slight variations for follow-up existed in years 3 and 4, but by the fifth year, 6-monthly review was almost universal (96%). Despite this surprising concordance, few units implemented a risk-adapted follow-up protocol that was aimed at targeting those people likely to be cured of relapsing disease.