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Ali Abdall-Razak Tel +44 79 201 4001Email ali.abdall-razak@outlook.comThe application to the United Kingdom foundation programme (UKFP) is a generally uncompetitive process. Across the country, there are 20 foundation schools that a graduate can rank, in order of their preference. Each foundation school will have a specific number of positions available and, depending on a variety of reasons, will receive different levels of application of a first-preference basis. Overall, across the 20 schools, 6998 positions were advertised in 2019, with 7421 first-preference applications made - putting the overall competition ratio at 1.06 applications per position.1 Of course, while some foundation schools, such asWest Midlands North (which received just 117 first-preference applications to its 252 positions) are entirely uncompetitive, others, such as the North Central and East London foundation school (which received 672 first-preference applications to its 337 positions) are far more competitive.

IntroductionLeaders in nurse staffing face many challenges in the modern National Health Service (NHS). With political unrest due to the Brexit vote, financial instability, and insufficient recruitment levels, managers of nursing have much to consider in long term NHS strategy.AimsTo assess the managerial challenges with the objective of prioritising them to help develop a strategy. To determine the front-line opinions regarding Brexit’s effect on nursing leadership decisions.MethodsQualitative Study. Expert interviews were conducted with nurses from Band 6 to Directors of Nursing within a large London-based Trust. Transcripts of the interviews were analysed for themes, and strategies were suggested accordingly.ResultsThe main challenges facing management are poor leadership training for nurses transitioning to higher bands, avoiding high turnover rates within a Trust, and domestic recruitment to the career. There was unanimous agreement (11 interviews) that Brexit was a non-factor in long-term strategy. European Union (EU) nurse retention was low. This was attributed to the introduction of the International English Language Testing System (IELTS) in 2016, and their overall short-term career goals within the UK. Thus, recruitment efforts had already shifted to the Asian subcontinent.ConclusionStrategies should focus on leadership training, lowering turnover rates, and domestic recruitment. As such, the development of formal leadership programmes specific to nurses will be crucial in training cost-aware, and proficient leaders. An advice package to Trusts collating successful retention methods will empower managers to quickly uptake strategies. Career campaigns are recommended to improve local recruitment. Throughout, the long-term nurse management strategy should not lend itself too heavily to Brexit.

Medical students are required by the General Medical Council to reflect on their practice but few opportunities are presented for group-based reflection at medical school.A two-session near-peer led reflective practice course was created for intercalating medical students undertaking group coursework. The first session involved a group discussion of one student’s team experience to analyse causative factors for the feelings and behaviours of individual members that weaken group response to challenges. Students also discussed their existing reflective practice and created their own course learning objectives to foster commitment. The second observed session consisted of students conducting their own reflective exercise to their peers.From the discussions, students most frequently reported a reluctance to assign leadership roles in peer groups, as it was discordant with the ingrained group social dynamic. Following the course, students were much more willing to generate an action plan to approach challenging team members for an honest and collaborative conversation. Student feedback emphasised the value of near-peer observation in encouraging information sharing with the group and discouraging relapse into counter-productive discussion and blaming. Following the course, students also reported using increased and broader opportunities for reflection and this was unrelated to the outcome of the situation.These findings show students are an untapped resource for developing better, sustainable and more accessible reflective practice in medical education. It suggests the value of near-peers as role models to favourably cast the active pursuit of reflection, thereby increasing student internalisation of group reflection. Student-led reflective groups may address important gaps in the development of leadership skills in medical education. These skills have utmost relevance in training students to become part of the clinical workforce and improving patient safety.

The field of robotic surgery is an exciting and growing field that has bolstered its way to become a mainstream application in a number of surgical disciplines. The application of robotic surgery in cleft surgery is novel and has captivated many with the benefit it provides: the slender and small arms with wrist articulation at the instrument tip; motion scaling; tremor elimination; and high fidelity, three-dimensional visualization make the robot a very attractive platform for use in confined spaces with small surgical targets. The story of the origin of robotic surgery in cleft surgery is an interesting one, and one that has arisen from other allied surgical specialities to render robotic cleft surgery as its own specialised field. A field that has coined its own terms and has demonstrated a number of applications for its use. This review details the origins of robotic cleft surgery, its evolution and its current status and elaborates on future directions to enhance its application.