Although 59% (n = 10) of respondent medical schools (the actual UK figure lies between 31% and 78%) currently provide some form of teaching on spirituality, there is significant room for improvement. There is little uniformity between medical schools with regard to content, form, amount or type of staff member delivering the teaching. It would be beneficial to introduce a standardised curriculum on spirituality across all UK medical schools.

Laparoscopic cholangiography is a safe procedure. Use of an image intensifier should be the preferred method of obtaining images. Metal cannulas are more likely to obscure the ductal system. The proximity of the clip on the cystic duct to the CBD highlights the potential for injury caused by electrocautery or erroneous clip application.

Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.

Objective: To establish the attitudes towards and current status of self-training for medical students in UK medical schools. Methods: We emailed a short online questionnaire to the Deans of 34 medical schools in the UK to obtain quantitative and qualitative responses regarding attitudes to self-care training and its current status in each medical school. Results: A response rate of 44% (n = 15) was achieved. Although 80% (n = 12) of respondents agreed that the quality of care given by a doctor depends on the quality of care they give to themselves, only 67% agreed that self-responsibility through daily life choices is key to true health and wellbeing. Medical schools were divided as to whether a doctor's first concern should be to care for themselves so that they have a lived quality of care to give to others and 2/3 rd felt that the GMC requirement for doctors to put the patient's needs first did not lead to doctors subjugating their own needs resulting in burnout and maladaptive coping strategies, yet 73% (n = 11) felt self-care training had the potential to address current rates of burnout. Qualitative responses show there is a need and an appetite for self-care training that needs to be part of the culture of medicine. Some were keen to highlight that toxic systems, environments and culture also need to be addressed. Conclusions: Despite recognizing the importance and benefits of self-care training and its potential to address current rates of burnout, only 67% of medical school respondents felt that self-responsibility through daily life choices is the key to health and wellbeing. Medical schools are divided on the impact that always putting patients needs first has on the rates of burnout and maladaptive coping strategies. There is a need for true self-care education for those in charge of medical education in order to understand and appreciate the role of selfresponsibility in personal health and wellbeing and the empowerment it brings to address toxic environments and cultures as well as enhancing the quality of patient care.