Tim Lane
Editor-in-Chief of the Annals
After six years as Editor-in-Chief of the Annals, it is time to move on. I have thoroughly enjoyed my time in the Editorial Chair and hope that I have remained true to the guiding principles of our founding Editor, Sir Cecil Wakeley. While the nature of our submissions has dramatically changed over the years, we have remained steadfast in our aim to remain a clinically based journal focusing on the practice of surgery for the benefit of our fellows and members. I would like to thank all the Editorial Team, including Vicki Ciborowska, Olivia Stevenson, Michelle Jones, Kim Lewry and Nicola Rowe for all their support and encouragement in recent months. I would especially like to thank Matt Whitaker, former Head of Publishing, who identified some of the key challenges to the journal shortly after my appointment. While the need for elemental changes had been long recognised, there remained an understandable reluctance to embark on an extensive review. The American novelist, James Baldwin, once wrote that ‘nothing can be changed unless it is faced’. During my tenure, together, we have all faced and embraced the digital era as well as addressing some of the other publishing challenges which are in no way unique to the Annals. We have moved from a paper-based publication to a digital platform, which allows articles to be viewed on a variety of tablets via a Royal College of Surgeons Journals app. Associate Editors now represent each subspecialty interest and we have encouraged many more of our colleagues to join our family of reviewers; the life-blood of any academic publication. Visual abstracts now disseminate the message of key papers far beyond the confines of our surgical community, while those areas of commonality have been explored in greater detail in periodic supplements. An annual ‘Sir Cecil Wakeley Medal’ is now awarded by the President of the College to the trainee who has first-authored the clinical paper judged to have made the most significant contribution. And while the current pandemic has delayed the introduction of podcasts and further supplements, we are likely to see these and further changes introduced as and when ‘normal’ activity resumes.
Some would argue that the Royal College of Surgeons of England is at a similar juncture in its slowly transitioning life-cycle. More still would suggest that it is in need of significant reform if it is to remain relevant to its membership. There has been much discussion recently – on a variety of social media platforms – that has digressed from a more traditional narrative and which now openly challenges this establishment’s ability to represent an increasingly diverse workforce when those in high office consistently fail to reflect the ethnic and gender balance of our wider surgical community. Surgeons in theatre coffee rooms, throughout the length and breadth of the country, openly question the relevance of this institution in the day-to-day activities of its fellows and members, and express significant misgivings as to the ability of its leaders to truly understand the concerns of the surgical workforce when they themselves are seldom engaged in busy NHS practice. The Retired College of Surgeons appears to be a more whimsical interpretation of our historic initialism. The link between the electorate and their representatives is not always clear, with members of Council having vastly different democratic mandates. While most are appointed in open and transparent elections, others are selected by subspecialty committees – an anachronism which remains unchallenged by the executive. Likewise, the election of the College’s officers has more in keeping with a Papal enclave – albeit without the fumata of white smoke – than a modern day professional organisation. Edicts and judgements passed down from Ivory Towers from an executive who has lost touch with those who fund the College are rarely appreciated. For many, the annual subscription fee is simply the price they pay for the continued use of the College’s post-nominals. A tax-deductible requirement for professional activity. No more. No less. Surgical engagement abbreviated to a direct debit. But surely it does not have to be this way? The recent pandemic has demonstrated how the College can rise to the challenge to provide desperately needed workplace support and nuanced guidance to its fellows and members. In the absence of a believable government narrative, which has proffered ‘scientific’ advice from anonymised committees, it has been refreshing to have heard a robust dialogue from colleagues who have openly challenged a political discourse which has been widely discredited. It reflects both a willingness and an ability to respond to the membership’s needs. In doing so, it provides us with a glimpse of what this organisation could be.
Jean-Baptiste Karr’s famous epigram ‘plus ça change, plus c’est la même chose’ roughly translates as the more things change the more they stay the same. It would appear curiously apposite at this time. Over the decades, as the Royal College of Surgeons of England has evolved to reflect the changes in surgical practice and clinical priorities, each realignment has signalled a significant milestone in the development of our craft. And while such changes have appeared apropos, they have preserved, at its heart, a phylogenetic remnant of a bygone age which spectacularly fails to reflect the needs or embrace the diversity of its membership. It is an anomaly that no sticking plaster solution can hide or brain stem reflex can deny. It is time for change.