Luminary Learning Gastrointestinal Disorder- Issue 1

‘Clinicians Versus Clinicians Versus Managers’ or a New Patient Centred Culture That Eradicates... •  47 Case Study: Vascular Surgeons and Interventional Radiologists In the past, most vascular procedures were performed by vascular surgeons through large inci- sions that required hospitalisation with prolonged recuperation. Over the last few years advances in technology have seen the growth of endovascular procedures that are performed through a small tube placed in the artery. The removal of blockages in the artery or vein becomes a less invasive process for the patient and after the endovascular procedure, the patient recovers quickly and hospitalisation is unlikely to be required. The rapid development of endovascular techniques, while having a significant impact on both the diagnosis and treatment of patients with vascu- lar disease, has at the same time also created conflict between the two main clinical specialists involved: interventional radiologists and vascular surgeons. The demand for endovascular tech- niques in the future will make up to 40–70% [11] with possibly 90% in the future of vascular pro- cedures being less invasive, as safer treatment modalities have evolved [11]. Scope of practice will change and evolve over time, but registering changes or advances in ‘scope of practice’ services the legal and credentialing framework, it does not guarantee patients that a professional is a safe and competent practitioner. Canada has recognised that a surgeon will change their scope of practice over time and provides guidance for this, however it also adds: “ the performance of innovative techniques or procedures within the context of a speciality or family of medicine, while new may not constitute a change of practice ”. It could be argued that the growth of endovascular surgery fits within this definition as it is the use of a particular technique that offers the vascular surgeon a wider range of skills to utilise in his/her intervention with patients. However, in 2010, in the UK, consultant radiologists devel- oped a sub-specialty of radiology called ‘interventional radiology’ a new role created to provide this intervention within vascular services which had a major impact on both the professions of vascular surgeons and radiologists. Although IR was officially given subspecialty status by the GMC in 2010—radiologists have been performing these procedures since these procedures were conceived by Charles Dotter and presented in his talk at the Czechoslovak Radiological Congress in 1963 [12]. While there are now attempts to understand the procedure as integrated ‘vascular interventional radiology (VIR)' the Royal Colleges continue to serve to represent the separate social identities of the separate medical profession of radiologists and vascular surgeons. Healthcare employing organisations have an important role to play in the facilitation of new and developed ‘hybrid’ roles that will deliver high quality of care to patients. The development of integrated service models, which are defined by clinical and non-clinical competencies will bring both vascular surgeons and interventional radiologists to the table to develop new service specifica- tions of joint and collaborative team working. SIT could help to facilitate an understanding of the challenges and the tensions that could be encountered along the way. Working from a ‘them’ and ‘us’ position towards a people centred service for patients has been successful elsewhere [11, 13]. The lack of uniformity in credentialing criteria for the performance of endovascular pro- cedures adds to the complexity of the problem and there have been calls to modify the training programmes most closely focused on vascular disease, vascular surgery and interventional radi- ology [11, 13]. The delivery of endovascular services differ substantially [11] and mini fellow- ships of 3 months in endovascular techniques are not seen as adequate for physicians with limited