A message from the President of RCSI

May 2026

Dear Fellows and Members,

As we look ahead to the RCSI Council Elections in the coming weeks, I am mindful that this is my last message as President of RCSI. It has been an enormous privilege to lead our College and to represent and advocate on your behalf.

In connecting with the global RCSI community, I have come to appreciate that, regardless of location, surgeons face very similar challenges: high demand for surgical services; patient populations with increasingly complex comorbidities; rapid innovation and changes to traditional training and practice. In addition to this, the level of public interest and commentary about surgical practice continues to increase, and expectations are high.

Meanwhile, surgeons do not always have the resources and supports required to deliver optimal care. In short, surgical practice has never been as demanding. And yet, over the past two years, I have continuously been impressed by our profession’s commitment to improving surgical care for patients, to embracing and innovating through new technologies and to showing true leadership in clinical practice. I remain convinced that surgeons are among the hardest working of all healthcare professionals.

When I assumed the role of President in June 2024, I identified several key priorities for my term. From supporting younger surgeons to safeguarding surgical practice as well as providing leadership around emerging technologies – it is my sincere belief that RCSI has made great progress on several fronts and kept pace with rapid changes within our profession and practice. And so, in this final update, I’d like to take the opportunity to reflect on some of the important work undertaken in the last two years.

Early career surgeons

Building upon the success of the Affiliate Membership programme for Core Surgical Trainees and aspiring Members, a key focus of my term as President was to support early career surgeons in their first years of independent practice.

RCSI’s Early Career Surgeons Network (ECSN) was established as a means of increasing connection between surgeons and the College during those early years of consultant practice or while on international fellowship. Launched at the 2024 Millin Meeting, the network is a way for younger surgeons to tap into knowledge, connections, and collaborations.

Over the past two years, under the leadership of ECSN Chair, Ms Christina Fleming FRCSI, Vice-Chair Mr Greg Nason FRCSI, Secretary Ms Emmeline Nugent FRCSI and Treasurer Mr Tristan Cassidy FRCSI, the network has delivered a series of highly engaging webinars as well as a widely-read blog series. In addition to this, the ECSN hosted a dedicated symposium at both the 2025 and 2026 Charter Meetings.

While members of the network certainly grapple with various challenges, what I have found particularly striking about the work of the ECSN is its focus on highlighting how early career surgeons are making a positive impact and important contributions in their departments, their hospitals and across our community.

That positive momentum also extended to a range of social gatherings organised by the network in Galway and Dublin. In addition to this, I was delighted to introduce the President’s Reception, held before each Fellowship conferring ceremony to welcome surgeons and their families to our Fellowship. The receptions, which are attended by family, friends, children and loved ones, are really special occasions marking the culmination of many years of hard work, determination and sacrifice.

Furthermore, in the last two years, we have taken steps to afford greater opportunities for the voice of younger surgeons to be heard within the College with representatives of the Irish Surgical Trainee Group (ISTG) and the ECSN now included as members on the Committee for Surgical Affairs and the Irish Surgical Postgraduate Training Committee.

I will look forward to watching the impact that these young surgeons will make in our College and our health system for years to come.

Safeguarding surgery

Our profession is experiencing a period of unprecedented scrutiny in a manner that often undermines the expertise and efforts of surgeons who are working hard to deliver high-quality, patient-centred care.

At such a time. I felt it was more important than ever that our College represents the voice of surgery and that we collectively step up to provide leadership in improving surgical care for patients, as well as safeguarding standards of practice. Over the course of my Presidency, I have worked with my colleagues on Council and across RCSI to lead the way in promoting healthcare improvement, in fostering clinical governance that protects patients, surgeons and innovation, and in supporting our professional surgical community.

In 2025, RCSI published the third edition of the Code of Practice for Surgeons, updated to incorporate several legislative and regulatory changes. This was the result of extensive work undertaken by Mr Dara Kavanagh FRCSI, Head of Surgical Policy and Practice Development RCSI and the Professional Development and Practice Committee, chaired by Mr Paddy Kenny FRCSI, RCSI Council Member. The code reflects wider changes in society, technology and indeed surgical practice, providing a straightforward set of principles that surgeons and surgical trainees may use to inform their own practice.

At Charter Meeting 2026, A Framework for Surgical Clinical Governance was published, coinciding with a very well-attended symposium focusing on best practice in clinical governance. The framework is the culmination of almost two years of work undertaken by an expert group led by Mr David Moore FRCSI, RCSI Council Member, that also involved significant consultations, including feedback from more than 340 RCSI Fellows and Members.

Aligned with international best practice, the framework provides clear, practical guidance for hospitals on embedding effective patient-centred clinical governance across four key domains: morbidity and mortality meetings; multidisciplinary team engagement; patient safety and clinical audit; and the governance of innovation, research and new technologies. The framework is RCSI’s constructive contribution to the national effort to improve patient safety and support our surgical workforce, providing practical guidance for surgeons, clinical leaders and healthcare organisations. I want to thank David, the members of the expert group and RCSI Council for this huge undertaking and producing such a comprehensive piece of work, which will form RCSI policy in the area of clinical governance in surgery for years to come.

Since its publication in February, we have worked closely with the HSE to identify the supports needed at HSE, regional and hospital level to fully implement its recommendations.

Improving access to surgery

Collaboration between RCSI and the HSE is important to ensure that surgery remains at the heart of decision-making and planning for the future of our health service, especially at this time of change. I would like to acknowledge all the surgical leaders who work so tirelessly on our behalf, through the National Clinical Programmes. Their work requires patience and determination and often goes unseen.

During the last two years, I was delighted to see further excellent progress in relation to elective care and surgical hubs. The first hub is now open with two more to follow this year and others at various stages of development around the country. Our teams in the clinical programmes have been instrumental in pushing this initiative forward. I want to especially recognise the publication of the National Clinical Guidance for Elective Care Facilities by the National Clinical Programme in Surgery (NCPS) under the leadership of Ms Bridget Egan FRCSI, RCSI Council Member and Co-Lead for the NCPS. Building on the work of recent years, the guidance is critical to embedding the ‘day case first’ philosophy. Of course, while welcoming expanded day surgery access, we all recognise the need to continue our advocacy to ensure that access to major surgery is preserved and expanded.

Innovation and training

Surgery is undergoing rapid innovation arising from the ongoing digital and technological revolution. This has resulted in many changes to traditional teaching and training in areas such as new technologies, devices and digital tools. RCSI has taken the initiative in this area – not just keeping up with the rapid pace but also taking proactive steps to supporting innovation while maintaining patient safety.

In early 2025, RCSI launched a Clinical Governance Framework for Robotic Surgery to provide additional safeguards for surgeons who are introducing this new technology into their practice. This framework addressed a gap in governance by providing clear, actionable recommendations for hospitals to integrate robotic surgery programmes with a focus on training and credentialing. I am delighted to say that this framework was endorsed by the HSE.

More recently, under the direction of Professor Barry McGuire FRCSI, Professor of Postgraduate Surgical Education and Academic Development at RCSI, the College published a curriculum and introduced a national programme for robotic surgical training to ensure that trainees develop a shared foundation in robotic safety, technical competence and non-technical skills.

The framework and the new curriculum are further supported by a €2.3 million institutional investment from RCSI in robotic surgical education. This reflects the College’s commitment to ensuring that the safety of patients remains paramount while also enabling and protecting the ability of surgeons to innovate. I look forward to seeing the impact of this investment in the years to come.

We are also about to publish the final report of our short life working group on technology, AI and digital medicine, chaired by Professor Micheal O’Riordain FRCSI. This report will lay out a strategic direction for RCSI’s approach, highlighting both the opportunities and the challenges of these transformative innovations in surgical practice.

Of course, there is no innovation without research. Historically, surgical research has been underfunded and poorly resourced. Over the last number of years, RCSI has invested heavily in surgical research capacity building through the National Surgical Research Support Centre. We have also developed a showcase for the NSRSC at the annual Millin Meeting, where tangible evidence of progress has been visible in the presentations by emerging surgical researchers. This year, clinical trials in surgery have received HRB funding for the first time and the centre continues to evolve, with the establishment of the iSTAR network.

Connecting the community

In the initial weeks of my term as President, we launched the new RCSI Fellows and Members Portal, bringing greater integration of resources, supports and important documentation to our network of members. The Portal also enabled us to complete our first Fellows and Members census, which has now become an annual exercise. The census provides clear insights into where our Fellows and Members are practicing, their areas of specialty and their career stage. With more than 11,000 Fellows and Members working in 90 countries worldwide, this data will assist us in planning for the future and help us to support you better.

Throughout my Presidency, I have seen first-hand how connecting with surgical colleagues helps us to remain resilient and to keep abreast of changes. Over the past 24 months I have had the pleasure of meeting surgeons around Ireland and across the world through attending meetings and conferences in the US, UK, Malaysia, Australia and the Middle East, as well as hosting a number of social gatherings for Fellows, Members and Alumni in several different countries.

Closer to home, I was proud to work with our fantastic team to deliver the annual Millin and Charter Meetings. These meetings provide an invaluable opportunity for Fellows, Members, surgical trainees, NCHDs and researchers to gather, connect and hear from world-class speakers and panellists. In refreshing these meetings, we expanded networking opportunities for surgeons through the introduction of an early-morning breakfast at each Millin Meeting and a buffet supper at Charter Meeting 2026.

Recognising that social outlets are an important way for members of our community to remain connected, we introduced a hugely popular Family Fun Day to the programme of events and last November held a Rugby ‘Watch Party’ in College Hall, which was really well-received.

An additional priority, I focused on was ensuring that our Fellows and Members Office profiled the wealth and depth of knowledge, talent and stories that we have within our surgical community. We now have a regular readership worldwide and many of you comment on the fantastic interviews and Q&A articles that feature within the monthly Surgical Bulletin, as well as the range of important topics covered in our dedicated membership magazine, Surgeons Scope.

In my very first monthly letter, I outlined my hope to strengthen the ties between us by providing occasions for people to connect with each other, opportunities for people to share their stories and experiences as well as highlighting opportunities for individuals to get involved. Now, two years later, I feel very proud of our inclusive and connected community.

Final reflections

As I enter the final few weeks of my Presidency, I would like to take the opportunity to extend my sincere gratitude to my colleagues on Council, the management and staff of RCSI, and our community of Fellows, Members and trainees for their support over the last two years.

The members of RCSI Council have been unstinting in their dedication and commitment to the College. They have displayed incredible advocacy and leadership across a range of issues with the goal of ensuring that patients benefit from the excellent surgical care both in the present day and into the future. As a community, we are very fortunate to have such expertise working on behalf of our network. Personally, my colleagues on Council have also shown me enormous support and encouragement, for which I am truly grateful. Likewise, the Past-Presidents have been very generous in their support and kindness to me.

Within RCSI, I wish to acknowledge Professor Cathal Kelly FRCSI as well Kieran Ryan and his team in the Department of Surgical Affairs; the hardworking staff across the National Clinical Programmes; the fantastic planning and organisation of RCSI’s Conference and Events team; and many other wonderful colleagues across the College and University. A lot of incredible work is undertaken quietly, behind the scenes, but has a huge impact on surgical practice and the profession.

Finally, I want to extend my heartfelt thanks to all of you. It has been the most extraordinary privilege to meet, speak, and correspond with so many of you over the course of the last two years. I have been inspired and humbled by the immense talent, expertise and dedication that I’ve witnessed among this College’s Fellows and Members, attributes that are matched by the deep sense of vocation shared by our community. I am especially excited by the enormous potential and talent displayed by our trainees and our early career surgeons. They will have my full support and encouragement as they step into leadership roles in our profession and our College.

Thank you for affording me the trust and opportunity to lead on your behalf.

Yours sincerely, 

Professor Deborah McNamara
President, RCSI