Introduction This study aims to better understand the lived experience of head and neck cancer survivors who suffer from radiation induced fibrosis (RIF). Recording the lived experience of RIF will better inform us on the use of autologous fat grafting (AFG) as a therapy. Methods A focus group (n=5, M=3, F=2) was facilitated, centred around the impact of RIF on head/neck function, appearance, emotional and psychological wellbeing, and socio-economic aspects of participant's lives. Participants discussed the wider issues of cancer survivorship, patient education, and healthcare service provision. Coding and thematic analysis of the verbatim audio transcript was undertaken. We compared this data to currently available patient reported outcome measures, notably the University of Washington Quality of Life Questionnaire (UW-QOL) and modified our survey to encompass these experiences. Results Eight main themes were highlighted, listed in order of importance to patients; 1-Physical head and neck functions 2-Relationship with healthcare providers 3-Socioeconomic aspects of life 4-Appearance 5-Psychological and emotional wellbeing 6-Freedom and independence 7-External/Personal knowledge and sources of information for patients 8-Pain. Quantitative validation of our modified questionnaire, based on these results, and distribution to a wider patient cohort has further demonstrated the severity of symptoms experienced by these cancer survivors. Conclusion There is a clear unmet need for long-term support and novel treatments for this patient group. Future research should focus on treatments such as AFG, which could improve functional outcomes, appearance and emotional wellbeing in RIF patients.

A 33-year-old Caucasian pregnant woman with a gestational age of 20 weeks presents following an excision biopsy of a hyperpigmented, irregular lesion of the forearm increasing in size over the past five months.

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Aim During the Covid-19 pandemic there has been a gross effect on surgical training at all grades. A cohort that has been affected but reported less frequently are medical students and foundation doctors (junior trainees), whose interest in the field and clinical skills may have been affected by reduced service provision. Method A survey of junior trainees was conducted to analyse their perceived adequacy of surgical teaching in light of the effect of Covid-19. An online teaching course was then designed to target areas of weakness identified in the survey. The content was designed with the Imperial College London surgery curriculum and was vetted by a consultant surgeon. Results Of the 713 people surveyed, 393 (55%) had received little or no surgical teaching and 496 (70%) respondents said they were “not” or “slightly” confident in managing common and emergency surgical presentations. A free text box highlighted that deteriorating patients, clinical decision-making, and initiating management were the greatest concerns. This was used to design an international online teaching course for junior trainees, that focused explicitly on clinical care. The sessions were run live on MindTheBleep via Facebook live, to answer questions in real time and examine cases with live audience participation, receiving feedback after every session. This model has reached trainees in >30 countries with >200 feedback responses and an average rating of 4.5/5. Conclusions Junior trainees are a key cohort whose interest and education in surgery has suffered due to the pandemic. An innovative, online, clinically orientated course is assisting to re-engage trainees internationally.