MS_February_2011 by The Medical Student

New 2013 FY exams Aademic quartile rankings and white space questions scrapped in favour of new assessment methods Page 4

Will tuition fees kill the modern doctor? Alex Isted examines the long-term impact of rising tuition fees on access to medicine Page 8

NHS reforms

Student protests

David Fisher warns that the newly devised GP consortium may be doomed to failure due to rash government decisions Page 10

Were the protests student activism at its best, or simply an excuse for mindless anarchy? Follow the debate Page 11 February 2011

the

medicalstudent The voice of London’s Medical Students

Bart’s students to be among the first to pilot new scheme

Features

Dean prioritises students in foundation programme shakeup Page 6

Culture

Students stuck in medical school for seven years? Neha Pathak In six months, the Medical School Council will be voting on new proposals that will rob students of their freedom. The course will be effectively extended to seven years, with students being forced to complete their first year as a doctor at their current medical school. This complete overhaul of the foundation programme could be piloted as soon as 2016. Currently, medical students apply for a two-year post during their final year at medical school with the choice of any deanery in the UK. Under the

new proposals, the national programme for foundation year one (FY1) would be scrapped. Instead students would compete within their medical school for affiliated posts within a designat- ed area. Foundation year two (FY2) would require a separate application. In 2008, the ‘Tooke Report’ was published in response to an apparent failure of the system to adequately train junior doctors and guarantee jobs. It strongly criticised the government’s approach to Modernising Medical Careers and was met with widespread support from the medical community. The new proposal is based on its recommendation to ‘un- couple’ the foundation years so that FY1

is linked to medical schools while FY2 merges with subsequent ‘core training.’ Potential advantages of the newly proposed system would include guaranteed foundation posts and improved patient care by training new graduates in familiar hospitals. On the other hand, it commits students to working in a particular region upon medical school entry thus remov- ing the choice that makes medicine an attractive career for many people. One shocked first-year student, who wished to remain unnamed, said, “I can’t believe we haven’t been told about decisions that could im- prison us within the system, the city

and the institution. With friends and family outside of London, I don’t want to delay life by another year.” Professor Roberts, Dean for Stu- dents at Barts & The London, supports the idea - “we would prefer a system whereby the medical school would have responsibility for the FY1 year. The reasons why you choose a medical school in London still stand. One year won’t make a difference.” However he admits, “This is prolong- ing the course by a further year.” Com- bined with a near-mandatory BSc, medical school could take up to seven years. Sadly, the Medical School Coun- cil was unavailable for comment.

The Wellcome collection. A destination for the incurably curious Page 12

Doctors’ Mess

The alternative means of intoxication the cool(?) kids are into Page 14

February 2011

News

medicalstudent

News Editor: Ken Wu news@medical-student.co.uk

Hannes Hagson GKT MedSoc VP Greetings all! South of the river everyone is hard back at work and working hard at play after a (for most) not very long Christmas break. At the time of writing we are in the midst of that oldest of traditions - RAG Week (Janu- ary 28th to February 4th). As always it is looking like it will be a great week filled with early mornings, late nights, snakebite and RAGging (whichever kind you prefer). There will also be a RAG Jailbreak on March 5th which I would recommend everyone to check out! The end of January also saw this year’s MedSoc Musical Theatre production: ‘The Little Shop of Horrors’ (interview found on page 13). March 8th is a date to remember as it is the date of the KCL Fashion Show. It takes

“We are in the midst of that oldest of traditions: RAG week. As always it is looking like it wil be a great week filled with early mornings, late nights, snakebit and ragging” place at the Hoxton Pony in Shoreditch and all money raised goes to RAG. A truly must-attend event. On the 16th of April all GKT medics halfway through their degree have something else to look forward to: The Halfway Dinner. It will take place in the Wren Room at The Grange, St Paul’s, and should be one of the great highlights of the year. ‘Golly!’ I hear you say, ‘where can I find out

more?’ – it’s easy: just search for ‘GKT Halfway Dinner 2011’ on Facebook or if you’re one of those individuals with “too much integrity” for social net- working, simply get in contact with one of us at MedSoc and we’ll let you know all you need to know. For now, that is all, and thus I shall simply leave you by saying: See you in Guy’s Bar

Laura Brenner BL It’s been a crazily busy start to the New Year here at BLSA. With several big projects on the go we’re looking well on the way to vastly improving our facilities. After many months (and in reality…years!) of planning and lob- bying, we look set to secure funding for our beloved Griffinn Bar in Wh- itechapel! In much need of some re- furbishment and TLC;; work is planned to start in the last term with an aim to be ready for Freshers 2011 and will include a brand new food service area and reception (not forgetting the bar). We’ve had some excellent events recently including our infamous Toga and Tequila night and an incredibly successful BL Panto of Cinderella (complete with Ugly Sisters from GKT, Imperial and UCL!). Up next are our most excellent BLAS Cultural Show and RAG Fashion show at Fabric which are set to draw in a massive crowd hoping to catch

“Sadly, our wonderful Warden, Sir Nicholas Wright will be leaving us in the summer. After ten incredibly successful years here at BL he has won a very special place in our hearts and will be sorely missed.” a glimpse of some honed and toned BL Fitties all in the name of charity. We’re also running our first ever ‘Bart’s Got Talent’ on the 11th Feb which show- cases some amazing BL talent… along with some of our more unique skills. Definitely not to be missed! Sadly, our wonderful Warden, Sir Nicholas Wright will be leaving us in the summer. After ten incredibly successful years here at BL, he has won

Luke Turner SGUL What a start to the academic year. Af- ter a wildly successful ‘Freshers Fort- night’ we thought: was it time to chill out and settle into everyday Univer- sity life? Wrong! We took part in the NUS marches against tuition fees, we witnessed medical students become engaged in public demonstrations, dis- proving the “political apathy” that student groups have apparently come to expect of us. Whilst all of this was going on, it was still business as usual at George’s. We saw our medics Revue “3 star sell out” Edinburgh show. Soon after this we saw Diwali show and Fash- ion show, raising £1,230 and £5,760 respectively. SGUL Isoc brought us an incredibly successful Charity week raising an impressive £10,369 for Is- lamic relief. By Christmas, Revue were back again with their incred-

a very special place in our hearts and will be sorely missed. In other words , he leaves a bloody ginormous pair of shoes to fill! Interviews have taken place with shortlisted candidates and I am confident that the college will make a decision on his successor very soon. I hope you all enjoy the rest of the f irst edition of the new “medicalstudent” and remember: your presidents are here to help so make sure you use them!

“On the sports front we have been holding our own with an undefeated title for our women’s rugby team and great a start to the year for our women’s boat club Fresher VIII, taking the Alom cup title.” ible seasonal show “the GleeMC.” On the sports front we have been holding our own with an undefeated title for our women’s rugby team and a great a start to the year for our women’s boat club Fresh- er VIII, taking the Alom cup title. So what is next? Well a huge RAG fortnight is around the corner packed with events, both old and new. If

that isn’t enough we have the play (A view from the bridge), Tooting show, George’s got talent and the musical (Footloose) all coming up this term. Finally I would like to finish by saying how thrilled I am to see the rebirth of the “medicalstudent” newspaper and to say a big thank you to all of those who made it happen

Editor-in-Chief John Hardie introduces the revived medicalstudent

ongratulations on find- ing a copy of the newly re-launched Medical Student newspaper. Af- ter a two-year hiatus spent wandering the tundra of London’s Kaf- kaesque administration, we’ve managed to emerge relatively unscathed. In the annals of the paper’s history, two years is but a drop in the ocean. In 1774, the London Adver- tiser announced the launch of the ‘Medical Magazine’. The publication, written for medical students and the general public, contained “Judicious criticisms on authors of the highest credit.” Although the paper has gone through numerous name changes, I’m sure you’ll agree that the writing quality established by this “society of gentlemen” has prevailed through to the present day. The Medical Student newspaper is older than The Times, The Guardian and the Daily Telegraph. Therefore, before you read on, politely address the person you find clutching one of

the filthy aforementioned rags and direct them to the far superior 80.9 grams of newsprint you are currently holding. To become part of this glorious lin- eage, simply email editor@medicalstudent.co.uk with your articles and comments. Whether you had your first major scoop by the time you left pre- school, or whether you’ve never penned an article, we’d love to hear from you. So…I’m sitting with palpita- tions from a minor caffeine over- dose - sun threatening at the horizon – and the issue still isn’t ready for the 7 a.m. print deadline. Two hundred and thirty seven years later and the editor still hasn’t learnt his lesson

The Editorial Team Editor-in-chief John Hardie GKT

Comment editor Sarah Pape GKT

News editor Ken Wu ICSM

Culture editor Robyn Jacobs ICSM

Features editor Neha Pathak RUMS

Doctors’ Mess editor Abe Thomas BL

Sub-editors Bibek Das Hannah Harvey Lucia Bianchi Hayley Stewart Radhika Khanna Martha Martin Giada Azzopardi Treasurer Alexander Cowan-Sanluis

Photographers & Illustrators Alan Liu Naoko McCabe Alexander Karapetian Sam Lee Storm Lonsdale Richard Berwick Peter Ziegler

medicalstudent

February 2011

News Negin Damali Amiri RUMS Senior President

ICSM dominates Adrenaline Ken Wu News editor Following the huge success of ‘999’ in October, ULU Medgroup launched its second event of the academic year, ‘Adrenaline’ on the 1st February at Tiger Tiger. With all of the London medical schools in attendance, the event proved to be an overwhelming success once again. With DJs in two rooms playing the usual assortment of club tunes, it was a thoroughly en- joyable night for everyone, with many students describing it as “absolutely epic”. The event further strength- ened the unique and historic bond shared by all five medical schools. As always, the old inter-medical school rivalries came into force, especially concerning the ticket sales. ICSM absolutely destroyed the opposition, selling 225 tickets in advance which accounts for 60% of all advance ticket sales. Barts came a respectable second, selling 114 tickets in advance. RUMS only managed to sell a meagre 16 tickets in advance whilst St Georges sold only four more at 20 tickets. Stu- dents f rom GKT were noticeably absent although they were suitably excused this time since ‘Adrenaline’ clashed

with the GKT RAG week. However, the actual ticket sales put students from RUMS and Georges in a slightly more sociable light with numerous people from both schools as well as Imperial Graduate medics buying on the door. In total, 510 people attended the event. Anil Chopra, the ULU Medgroup chair, commented that the event was “an absolutely great effort” and that he was “impressed with St Georges since all of their 1st and 2nd years had exams next week”. By contrast the 1st and 2nd years from ICSM had a lecture-free morning the following day so most students were quite happy to party the night away without the fear of a hungover lecture in the morning. Jeeves Wijesuriya, the event organ- iser, also said that the night was “a huge success that will hold us in good stead for the f uture” and wanted to “congratulate all who were involved and thank everyone who helped sell tickets, were on the door and all who came to the event”. ‘Adrenaline’ also proved to be a financial success, making a healthy profit of £700, which is currently funding the production and printing of the revived ‘medicalstudent’ newspaper. Plans are underway for a summer event to be organised by ULU Medgroup so expect another unforgettable evening coming to a medical school near you

We at RUMS are t ruly excited to see the rebirth of ‘the medicalstudent’ newspaper. It has been an amazingly busy year for us. After our recent fantastic sell- out at the 2010 Winter Ball we’re now set to prepare for what promises to be yet another successful event (the Sum- mer and Finalists’ Balls). Hot on our agenda for this term, and the next, are the effect of the rising tuition fees on widening participation and the future of NHS bursaries. We’re also looking into how the proposed changes to the UKFPO application process will af-

“Hot on our agenda for this term, and the next, are the effect of the rising tuition fees on widening participation and the future of NHS bursaries” fect our finalists in the coming years. Last but not least with our current curriculum undergoing a review, student representation has been central in the past few months. Our AGM will be happening on the 21st of March 2010 and I am looking forward to seeing as

David Smith ICSM President It is an absolute pleasure for me to welcome you to the first issue of ‘the medicalstudent’ since 2008! It has been a very busy few months for us at ICSMSU since term started back in October. We have held numerous events, most notably Freshers’ Fort- night, which was incredibly successful thanks to the hard work of Mike and his social team. An unprecedented 256 freshers bought a ‘passport’ which gave access to all events over the two week period. We have also hosted black tie balls, comedy nights, University Chal- lenge trials, numerous bops, a boat party and many more social events. RAG has run its first event of the year, the Halloween Collect, and special mention must go to Hamish and his team for their incredible work in raising a record total of £15,177. We are greatly looking forward to reclaiming our crown as the number one medical

“This year has also seen the Reynolds Bar undergo the first stage in its renovation, thanks to extremely kind donations from Imperial College Union and Imperial College Commercial Services.”

school in the RAG stakes this term! This year has also seen the Reyn- olds Bar undergo the first stage in its renovation, thanks to extremely kind donations from Imperial College Un- ion and Imperial College Commercial Services. The next stage in the rede- velopment involves plans to convert the downstairs meeting room into an alcohol free common room in a move that will hopefully bring us closer to catering for all of our students.

Anil Chopra ULU Medgroup Chair Hello and welcome to the first issue of the new and improved ‘the medicalstudent’. I believe the last time you saw this would have been the summer of 2008. I would like, firstly, to say thank you to John and all the team for getting this publication back up and running. I hope you will agree that as London medical and dental students, this is a fantastic asset. The point of the new newspaper is not only to report on current affairs relevant to medical students, share knowledge and advertise events but also to try and re- capture that old medical school spirit. Less than 30 years ago, there were 12 medical schools in London, each with their own identity, their own strengths and their own traditions – some of the old clan claim that the modern medical school has “lost its soul”;; I don’t think they could be more wrong … and this is where ULU Medgroup come in. Medgroup is a network made up of the Unions of the five London medical schools. We meet monthly to dis-

many of you there as possible. Remem- ber, this is your chance to share your opinion with us on some of the key issues affecting us all and for us to lis- ten and take action. Enjoy the rest of the year and please drop me a line with any comments, queries or questions

It is a great shame that the bar has been subject to some negative press coverage of late, especially considering the huge strides that are being made this year to reverse some of the trends mentioned. It was an extremely unfortunate piece, hugely exaggerat- ing practices which had already died out and painting individuals in an unfa- vourable light. Fortunately we have re- covered from this setback with our bar intact and live to fight another day!

“The focus for Medgroup over the coming weeks will be preparation for the BMA Medical Students conference due to take place in Edinburgh on the 1st and 2nd April and promoting our campaign for this year.” cuss current issues and work together to resolve them. We share best practice and use the knowledge and past experience to constantly maintain the high calibre of doctors that London produc- es. We also co-ordinate social events such as ‘999’ and ‘Adrenaline’ and I’m sure those of you who came found them to be great nights. The money raised from these socials has gone into the production of this newspaper. The focus for Medgroup over the coming weeks will be preparation for the BMA Medical Students Confer- ence due to take place in Edinburgh

on the 1st and 2nd April and promoting our campaign for this year. The Medgroup campaign, headed by Tha- rani Mahesan from GKT and David Hobden from St Georges, will focus on student welfare and specifically access to welfare services within your medical school. We believe that this is an important issue for medical students in particular, particularly with students who are on placements. If you would like to be involved with Medgroup or would be interested in coming to any of our meetings, please do get in touch

February 2011

News New selection method to the UK Foundation Programme set to begin for students graduating in 2013 Bibek Das Sub-editor In November 2010, the initial pilots of a new selection method to the U K Founda- tion Programme were completed. This new method is comprised of an Educa- tional Performance Measure (EPM) and a Situational Judgement Test (SJT). If further piloting demonstrates that these selections methods are an improve- ment on the current system, they will be used for applicants to the Foundation Programme beginning in August 2013. The current ranking system of medical schools in the UK for selection to Foundation Schools uses a combined score derived from answers to a set of white space questions (weighted 60%) and an academic quartile ranking (40%) provided by the applicant’s medical school. This score is then used to allocate applicants to one of several foundation schools, which applicants rank according to preference. The Medical Schools Council had been commissioned by the Department of Health (DH) to carry out an appraisal of the current system of selection. This revealed concerns about ‘the reliability, validity, comparability, NHS consultant time required, possible plagiarism and the longevity of the current online application system’. Following on from this, a Project Group was commissioned by the DH to appraise all the possible options for a new selection programme. After nine months of consultation and literature reviews, this group, chaired by Professor Paul O’Neill, head of Manchester Medical School and Professor of Medical Education, recommended that a new selection method should be piloted. The EPM would replace the current quartile rankings and the SJT would replace

Doctors don’t need doctors right? Not according to Medgroup who have been working on plans to increase access to important welfare services that Medi- cal students can often miss out on due to their working hours. There is great stigma attached to mental health issues, with many students unwilling or unable to seek help. Fears can range

Research in brief Robyn Jacobs Culture editor ICSM: Anti-prostate cancer protein discovered. Researchers have discovered an intracellular protein that sup- presses the growth of prostate cancer cells. There research can be propel led into future treatments of the disease. Published in Cancer Research. BL: Heart attack paradox solved. Folic acid lowers homocysteine levels which should, theoretically, prevent heart at- tacks. Research shows that the mechanism of action is the same as that of Aspirin, so folic acid may provide no extra benefit. Published in the current issue of the Public Library of Science.

the current white space questions. The EPM is aimed at assess- ing medical students’ performance throughout medical school. This may encompass separate scores for clinical skills and written knowledge and aims to be ‘more robust than quartiles, with all schools providing scores to a standard specification’. The SJT will be an invigilated multiple-choice test based on situations that applicants will face as foundation doctors, and will not require prior revision. Professor O’Neill, in an online interview with Nick Deakin, co-chair of the BMA Medical Students Commit- tee, explains why this will be a fairer system for medical students: ‘In the current system, academic quartiles are done differently by different medical schools in a way that is not known to everyone. The EPM will replace that with a transparent framework consist- ent between medical schools.’ Further- more, ‘the concerns about white space questions are that they’re done in a t wo-

Tackling the last taboo in student welfare Oliver Woolf Guest writer

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from how others will view them, ‘fitness to practice’ issues and the impact it might have on a future career. The GMC states that in order to dem- onstrate fitness to practice, students should seek medical or occupation- al health advice, or both, if there is a concern about their health, including mental health. So what barriers exist? Students are often unaware of the wealth of services available to them to deal with welfare issues. Advice and counselling services can offer both

week period and there are concerns that these might not be [the students’] own words, that they are done collaborative- ly or they had help. The SJT has now been used more widely across post- graduate training such as in General Practice. It looks at people’s judgements and their likely behaviour in situations that they will encounter as F1 doctors.’ Details of the framework of the as- sessments used to calculate the EPM remain unclear. Furthermore, the weight- ings of the EPM and SJT scores have yet to be decided. Later this year independent experts will be commissioned to offer advice on the best way to do this. Small-scale pilots of the SJT have been completed at Cardiff, Cambridge and Keele Medical Schools. The results from these pilots will be out be ana- lysed and will help inform a larger pilot of 8-10 medical schools which will run in Spring 2011. The pilots, involv- ing only final year medical students, comprise an invigilated test of approxi- mately 65 SJT questions completed

within 2 hours. If medical schools agree to pilot SJTs, there is no obligation for students to take part. However students are strongly encouraged to take part to increase the reliability of the findings as well as being a beneficial experience since SJTs are being increasingly used for selection into speciality training. Nick Deakin stated the position of the BMA is that any changes should only come in to place ‘if they are shown to improve the system as it stands now, and if they have the confidence of students’. Professor O’Neill replied that there would be no change ‘unless we can show that it is a definite improve- ment on what we currently do. The proposed alterations are about how the score is actually devised rather than how people are actually matched to posts.’ Medical students can express their views on the new system on the ISFP website. For now, however, Profes- sor O’Neill states that ‘nothing will change, other than intense piloting and evaluation of the proposals’

GKT: Research shows that low self- control in children leads to physical health problems. Research by KCL, Duke University and the University of Otago showed that children with lower self-control were more likely to have physical health problems, financial difficulties and a criminal record regardless of their background. RUMS: Breast is best? Current guidelines suggesting that breast feeding is best for the first 6 months of a child’s life is being questioned. The Child Insti- tute of health at UCL has published a report saying that exclusive breastfeeding could lead to iron deficiency anemia and coeliac disease. Published in the BMJ St Georges: Artesunate combined with cancer d rugs to improve efficacy. In vit- ro studies have shown that A rtesunate, a commonly used anti-malarial combined with cancer drugs make them work more effectively than when used alone. Treatment breaks were also shown to improve success levels. Published in International Journal of Cancer

practical and health support which users would agree has been invaluable.

“More than 50 per cent of medical students admit that they have sought help for depression or other mental health problems” Another fear might be how understanding a consultant will be if you say: “I need to take some time off for mental health reasons.” Students who were interviewed but wished to remain anonymous said they were “worried whether my consultant will accept this reason” whilst others stated that it would feel like “admitting defeat”.

It is well known that medical students are at increased risk of encoun- tering mental health issues during their course, the BMA says that more than 50 per cent of medical students admit that they have sought help for depression or other mental health problems. Access to services is often a big barri- er. BLSA president Laura Brenner said: “It’s time to really get the message out

there that these services are available”. She went onto raise the issue of out-of-hours services for those on out- firms: “it hasn’t been possible up until now to support those on placements outside London so well but this is something we are looking to change”. Issues regarding funding prevail but there is clearly a case here for more to be done

medicalstudent

February 2011

News

Are iPhone apps replacing traditional lectures? Rahul Ravindran Guest writer Currently, more and more hospitals are using the iPad as a source of medical knowledge. Described as a “medical bi- ble”, it brings into question the value of learning vast amounts of knowledge at medical school, especially with yearly “reductions” in course material deemed “too difficult” by the GMC. Why do we spend such a large proportion of our time learning things which can be looked up in a matter of seconds? Surely if medical students were taught only concepts and were able to look up anything that was easily accessible it would save us years of time in training? Imagine clinics where the symptoms a patient presented with were all fed into a computer. Software could be designed, with the aid of senior clinicians, to create a ‘check- list’ of signs the doctor should look for in order to arrive at a diagnosis.

“Why should we spend so much time memorising this much when the information is easily accessible?” Pictures of the signs could be shown on the screen to avoid any confu- sion and there could be ‘tick-boxes’ for the clinician to make sure they go through everything systematical- ly. Then the computer could suggest the appropriate tests to exclude certain conditions and eventually come up with a diagnosis and treatment plan. This seems to be what students

learn for the majority of their clinical years but why should we spend so much time memorising this much when the information is easily accessible? More and more resources are becoming electronic, an example is the Oxford Handbook of Clinical Medi- cine recently being available on the iPhone: do we really need to memo- rise the causes of hyponatraemia when this information can be sought within seconds? A direct consequence of less memorising would be drastically shorter training times, which means less cost to the taxpayer. Following on from this we could have more doctors, so waiting times would also be reduced. Another benefit is that the latest guidelines could be incorporated directly into the database of information. If trials suggest that hypertension medica- tion should be altered then the computer would tell the doctor exactly what to pre- scribe based on the information about the patient. Doctors would also easily be able to share information across the country, commenting on side effects of drugs directly onto a database rather than having to fill out a card about it. There are, u nfortunately, some d raw- backs to this system. First of all, with-

out having a broad foundation it is very difficult for doctors to make progress in science. Medicine is such a dynamic field that can always be improved upon. It would be naïve to think of ‘scientists’ and ‘clinicians’ as two separate groups of people with no overlapping in role. Medicine should be considered an art as much as a science. A computer can be given data and come up with a solution, but patients can present in certain ways that can be identified by a senior clinician that can’t be broken down into words. With experience we devel- op a way of seeing patients as a whole and not simply the sum of their symptoms. This is described as Gestalt psy- chology – an example is in endocrinol- ogy, where the physician gets a ‘sense’ of problems patients have before they even start explaining their symptoms. While medical students are required to learn vast quantities of information, it is justified. Patients come to their doctors to help them with their problems and no computer is able to offer the reassurance of a human. There is a place for computer- aided diagnosis in medicine but our knowledge base is a pillar our patients can lean on and put their faith in

Minimum alcohol pricing: the real price of alcohol on students Hannah Harvey Sub-editor In view of the millions of pounds spent on public health warnings about the dangers of alcohol, surely by now the NHS ought to be reaping the benefits of such investment. With an exponen- tial growth in the demands placed on liver services, groaning transplant list and a resource starved NHS, the sober- ing truth is that the aftermath of happy hour, seems distinctly sour. Alcohol damage is projected to cost the NHS in excess of £2.7 billion by 2015 . 35% of all A&E attendances in Britain are alcohol related, rising to 70% in peak times.

As media friendly topic, alcohol has a unique versatility in terms of possible narrative angles. Alcohol may fill barrels and bellies, but it also fills col- umns, TV scheduling slots, satisfies a demand for health ‘news’, and supports the sales-driven media machine of con- temporary British society. Regrettably, instead of acting as a guardian of public interest and debating the real issues surrounding alcohol, sensationalist stories about binge drinking predominate. At a governmental level, alcohol has begun to successfully permeate the political agenda. The recent introduction of minimum pricing to alcohol has created a media frenzy and although its effects are minimal, especially at the

student level, it is certainly a positive sign. Making alcohol more expensive and less ubiquitous will perhaps not deter the seasoned alcoholics, nor the affluent, but will inevitably result in a more generalised reduction in d rinking. The increasing tobacco prices serve as a perfect example of a highly effective control mechanism. The worry is that the positive repercussions for al- coholic liver disease will be offset by damage to the health of the economy. Today’s economic gains from the alcohol industry are bound to feel great, just like the effects of alcohol in the bloodstream at the end of a long week. What we overlook in both instances, is the price we will pay tomorrow

Alex Nesbitt braves the might of the Atacama

n the 2nd of March, I’ll be packing my bags, saying farewell to the other Sabbs in our office at UCLU, and will head to Heathrow to catch my flight to Santiago, Chile. I’ll then be catching an internal flight and taking a coach trip to a little town called San Pedro de Atacama, situated in the vast Atacama Desert. I’m taking this trip to embark on a challenge unlike anything I’ve done before, just to see if I can do it and raise a bit of money for charity whilst I’m there.

The Atacama Crossing takes place at altitudes between 2400m and 3000m, adding to the burden of dealing with the 40°C temperatures expected. It has been running since 2004” This challenge is the Atacama Crossing, one of the 4 Deserts series of 250km footraces. They have been rated one of the toughest endurance races on earth by Time magazine, and each consists of 250km run over seven days across the Atacama, Sa- hara and Gobi Deserts, as well as the Last Desert, the Antarctic Peninsula. The Atacama Crossing takes place at altitudes between 2400m and 3000m, adding to the burden of dealing with the 40°C temperatures expected. It has been running since 2004,

ICSM SU responds to the Daily Mail exposé

CSMSU (Imperial College School of Medicine Students’ Union) and Imperial College Union do not condone the excessive consumption of alcohol. For those students who do consume alcohol, we encourage responsible drinking. For example, we have dedicated pages about alcohol on the Union’s website which encourages students who drink to stay within the recommended limits, and warns of the dangers of excessive drinking (see www.imperialcollege- union.org/information-and-advice/ health-wellbeing/alcohol and http:// www.union.ic.ac.uk/limits/). We also offer extensive welfare services for all students, including any student with a problematic relationship with alcohol.

and has over 20 nationalities represented by the 140+ participants each year. It will be a great experience, but will most likely be a painful one too, and I’m sure the blisters on my feet will be a sight to behold once I’m back. I’m taking part to raise money for a charity that I volunteered with a couple of summers ago, called Cheka Sana Children’s Trust. They are based in Mwanza, Tanzania, and run a residen- tial centre for street children and a football academy. They’ve also been building a nursery, but that has had to stop because of a lack of funds. I’m hoping to raise some money to go towards that, and am well on my way. My Justgiv- ing page is www.justgiving.com/alex- satacamacrossing or you can search Alex Nesbitt on Justgiving if you feel like donating;; every little helps! I’ve seen first-hand the great work that they do, and I’ll be thinking of them as I push through the pain in the desert!

He kinda wished he hadn’t forgotten his Tom-Tom Wednesday nights are an opportunity for members of sports teams to so- cialise with the rest of their club. The vast majority of students do not drink to excess and many students who do not drink alcohol take part in the fes- tivities of a Wednesday night. That said, we do our best to ensure that any drinking that does take place is in a safe and controlled environment. The buckets are a precaution for anyone who has had too much to drink. The Union has stewards who work alongside external doormen, bar staff and security staff, to help ensure the safety of the students in the building. Any student who may have had too much to drink is looked after by the stewards, who make sure that they are taken home safely. This year, a group of students volunteered to help with stewarding and we were delighted to accept this help. We have a zero tolerance stance if any club is seen to be encouraging rowdy behaviour or excessive drinking, and any such club is heavily fined by the Union. We also run numerous alcohol-free events throughout the year such as quiz nights, comedy performances, movie & ice cream nights, and cultural nights

February 2011

Features

medicalstudent

Features Editor: Neha Pathak features@medical-student.co.uk

The Godless students of Gower Street and other stories Maria Knöbel Guest Writer

Once upon a time in a “land of poor sanitation”, there was a medical student called Cinderella. She was “beautiful, intelligent, and quick- witted. Quintessentially Barts… She had four ugly sisters Listeria, Gon- orrhoea, Salmonella, and Flu. one from Imperial, one from UCL, one from GKT, and one from St. Georges. Horrible girls. Horrible institutions.” So read the opening narration for a pantomime staged by the drama society at Barts & The London Medical School this year. Everyone is familiar with this harmless rivalry exhibited amongst the medical schools of Lon- don. For many, it is so natural that no one stops to consider its origins. Was it always this way? When did it begin?

A Duelling Start Rivalry amongst the medical schools in London dates far back to their foundations. In 1826, to the great disapproval of the elite, London University (now Uni- versity College London) was founded with the support of non-Anglican Christians, Jews, and Utilitarians. It aimed to differentiate itself from the religious nature of the Uni- versities of Oxford and Cambridge. King’s College London was founded almost immediately after in 1829 to create a religious Anglican institution in response to UCL. ‘Duel Day’,still celebrated at King’s College annually on the 21st of March, marks the date of the famous duel in 1829 between the Earl of Winchilsea and the Duke of Wellington—both patrons of the newly established King’s. The Earl of Winchilsea wanted King’s to admit only members of the Church of Eng- land and accused Wellington of being too supportive of the Catholic cause. No blood was shed. both the Earl and the Duke, fired, deliberately missed, shook-hands, and reconciled. How- ever, King’s and UCL clearly got off on the wrong foot from the cradle, and thus was the beginning of a rivalry that was to last into the next century. This verse of a satirical song set to the melody of the British national anthem provides good insight into how the religious and secular divi- sion from the beginning was central to the rivalry of the institutions: ‘King’s College lads arise! New Universities

Shall quickly fall;; Confound their politics, Frustrate their teaching tricks, O, Church! on thee we fix Maintain us all.’ The lyrics condemn the secular nature of “the Godless University of Gower Street”, and sentence it to fall without protection of the church. UCL’s non-religious nature also played a key role in the jostle for the position of third oldest university in England - a title King’s also laid claim on. Although UCL was founded 3 years before King’s, it was unable to obtain a Royal Charter due to its sec- ularity and also because it claimed the title “university”. King’s College received its Royal Charter the same year it was established, simply because it provided Anglican education and didn’t seek to become a university. In truth, the word “university” didn’t feature in its original charter at all. However, neither institution was able to confer their own degrees until the establishment of the University of London in 1836, of which they both became colleges. In the meantime, students sat exams to receive degrees of Oxford or Cambridge. Tough times. Today in the spirit of fairness, despite having achieved royal charter first, King’s only claims to be the fourth oldest university in Eng- land on their official website and leaves UCL to claim third position. Soon after the formation of the Uni- versity of London, there was a period of rapid expansion and other institutions began to join. One of the early birds to join was St. George’s Hospital Medical School, which had already been teaching medicine since its establishment in 1733. Other smaller medical colleges in London continued to exist in- dependently of the University for over 150 years, and it wasn’t until the 1990s

that all the current big medical schools of London as we know it came into existence. The nineties saw the formation of Barts and The London in its current structure from the fusion of the Lon- don Hospital Medical School, Queen Mary & Westfield College, and the Medical College of St. Bartholomew’s Hospital (which had been teaching medicine since 1123, making it the oldest surviving hospital in England). Then Imperial College School of Medicine was formally established by merging St Mary’s Hospital Medical School, Charing Cross and Westminster Medical School, the Royal Postgradu- ate Medical School, and other medical bodies. Still within the same decade, the current UCL Medical School was formed f rom the University College and Middlesex School of Medicine and the Royal Free Hospital School of Medicine. And finally, King’s College Medical School was reborn from King’s College Hospital and the United Medical and Dental Schools of Guy’s and St Thom- as’ Hospitals. It was a busy decade for alliances. When the nineties were over, we were left with our current big five.

All this rivalry is just fun and games, and we all get along dandy. Or do we? Fun and Games Any medical student at any medical school, will more often than not be extremely loyal to their institution, and be all too eager to dish out less than flattering remarks about their rival universities. There is the famous George’s song, now revamped and modernised, that quite cheer-

A MODERN DAY RAG King’s Vs Imperial In keeping with tradition, King’s can be found at the centre of RAG rivalry. Bored with their long-standing competition with UCL, they have moved onto ICSM (more affectionately known as ‘Gimperial’). However, they seem to be lacking in the planning (or brain) department. In 2009, KIng’s planned their biggest raid of Imperial (think Grafitti et al) but made the schoolboy error of announcing it on facebook. Naturally the ‘Gimps’ discovered it, brought in security and had them promptly disciplined. Good work. The following year, ICSM retaliated. They tactfully invaded a King’s lecture theatre and “improved” the powerpoint presentations. Much to the lecturer’s surprise, the audience was met with ‘GKT Scum’ scrawled across a slide. And if King’s are still wondering about those “missing signs” a little birdie tells me that they’re safe at ‘Gimperial’ now...

fully denigrates the other schools: The legend behind the song is that ‘I don’t want to go to Mary’s I don’t want to go to Bart’s And they say the Royal Free, is not the place to be And Tommie’s is a place for high-born fairies UCL’s a dump in central London King’s is a hovel on the strand ON THE STRAND! I’d rather go to George’s, To merry, merry George’s ‘Cos George’s is the finest in the land, ‘Cor Blimey!’ St. George himself wrote the original words in celebration after heroi- cally slaying the great dragon. Al- legedly, there are two more verses to the song that are shrouded in secrecy. In the years since, other London medical schools have created their own songs, or re-written the George’s song in retaliation. One slightly ruder version of the song that GKT graduate Lu- cas Rehnberg was delighted to sing for me, replaces lines four onwards with:

The popular parody musical duo Am- ‘And George’s are a bunch of high class w**kers UCL is f***ing boring And King’s is a hole on the Strand ON THE STRAND! I’d rather go to Guy’s! To Merry, merryGuy’s! And fornicate my f***ing life away ‘Cor Blimey!’ ateur Transplants consisting of Dr. Adam Kay and Dr. Suman Biswas who both studied medicine at Imperial, have also written songs ridiculing their rival London medical schools. Their song “Snippets” mocks the competence of consultants at King’s, and “Careless Surgeon” plays on the popular stereo- type of Barts students not knowing any anatomy. Finally, in case you were beginning to think some were spared, “Al- ways Look on the Bright Side of Life” ridicules every other medical school. But we clearly love it. Amateur Transplants have had huge success amongst medical students and fre- quently performs live at the very medi-

medicalstudent

February 2011

cal schools mocked in their songs. All this rivalry is just fun and games, and we all get along dandy. Or do we?

One particularly inspired episode saw Reggie the lion’s painful emasculation by UCL students with a tin opener. The heads of Imperial College and UCL thought so. In 2002, they hatched a plan to merge and form a London “su- per-university”. The plan was to potentially create the “greatest university in the country, attracting more research funding than Oxbridge and compet- ing with global giants like Harvard.” But within weeks the idea was torn to shreds by opposition from academic staff, as many saw it more as a takeo- ver from Imperial rather than a merger. In an interview to The Guardian, Sir Derek Roberts (the then acting provost of UCL) admitted to feeling disappoint- ed at the animosity expressed by the staff of the institutions. “An enormous amount of antipathy and ill-feeling has been generated by various groups. I am quite disgusted and amazed,” he said, disheartened. UCL reacted particularly strongly by forming an anti-merger committee and websites such as www. saveucl.net and www.cucl.org which focused on attacking Sir Richard Sykes (the then rector of Imperial College) one of the proposers of the merger. It is evi- dent that rivalry amongst the London institutions doesn’t end with students, and that academic staff share similar feelings. Nonetheless, Dr. Michael Schachter, a Senior Lecturer at Impe- rial believes that “at staff level there is at least as much co-operation as rivalry on a wide range of issues. We exchange ideas with colleagues across London and the UK, and beyond, all the time.”

Reggie gets ‘Ragged’ Historically, student rivalry amongst the colleges was centred on their mascots. UCL had a wooden tobacconist’s

Features sign of a kilted Jacobite Highlander called Phineas Maclino as their mascot (originally stolen f rom outside a shop in Tottenham Court Road), while King’s had Reggie the lion. Both mascots were victims of repeated kidnapping attempts after the Second World War. Some famous incidents include Reg- gie’s abduction by UCL students to be transported to Inverness, and then un- ceremoniously dumped in Surrey. One particularly inspired episode saw Reg- gie the lion’s painful emasculation by UCL students with a tin opener. It took a team of engineers and medics to skill- fully restore him to his previous glory. After repeated kidnapping incidences, the hollow copper lion was eventually filled with concrete and chained to the wall to thwart further attempts. The great RAG of 1922 saw the battle between King’s and UCL reach a zenith. King’s captured UCL mascot Phineas and ignored a deadly serious ultimatum for his return. Hundreds of UCL students were ferried to Ald- wych in furniture vans and hundreds more swarmed out of the nearby Un- derground station and descended upon the King’s quad. Although King’s were expecting them and had Phineas sur- rounded by a personal bodyguard of engineering students armed with rotten fruit and vegetables from Covent Garden Market –they had no chance. Part of the King’s College stone balustrade was torn down in this siege and police were called in to enforce a truce. As with most previous RAG incidents, the situation was resolved in good spirits amongst students. How- ever the press widely reported on the “premeditated and deliberate aspect to the violence” as well as on the collapse of the balustrade. The College authorities didn’t seem too disapproving and simply demanded students from both Colleges to share the bill for repairs. The 1927 RAG was characterised by a fortnight of revelry. UCL captured Reggie and filling him with rotten apples before surrendering him back to King’s. The following morning a group of King’s students marched into UCL chanting ‘For Reggie!’ to capture the preserved body of UCL founder Jeremy Bentham, and provok- ingly paraded him outside UCL. Un-

Even today, UCL claim more ‘sense and science’ as the 4th best university in the world. Image from KCL archives. surprisingly, hostilities continued a week later with a rotten egg, fruit, and vegetable fight in the UCL quad result- ing in police shutting the gates and t rap- ping many (including Reggie) inside. Somehow at least six students were injured during this violent exchange of rotten foodstuffs and taken to Uni- versity College Hospital for treatment. The intercollegiate wars continued in this way until the mid 1950’s (only interrupted briefly by World War II).

Modern antics between the London medical schools tend to occur on a much smaller scale and involve a lot less f ruit. Nick Constantinou, a graduate from Imperial recalls delightedly how in retaliation to Imperial stealing Jeremy Bentham’s “picked head”, a contingency of K ing’s students “dressed in scrubs and wearing surgical masks stormed into SAF [the medical building at South Kensington campus] and trashed it!”. Clearly, students are less creative today.

From religious rivalry, the big five were born; the devil’s spawn? Illustration by Gemma Goodyear.

Happily ever after... Asked if the rivalries ever had a negative impact, Dr. Schachter argues “Of course whether it is football or university people like to compete and think they are doing better than the people down the road, and this can be quite positive. In general most of the rivalry is harmless and fun, these days it very rarely gets malicious, less than it did 20+ years ago.” Nowadays university league tables also play a key role in rivalry as Professor Tom MacDonald suggests. “Currently, we make lots of jokes about Georges because they are below us in the pecking order, but this may not always happen and do not fool yourself into thinking that UCL and IC students don’t think they are better than [Barts].” However he believes that ‘London medicine’ and London medical schools are together a very strong brand and this bond is represented by the or- ganisation called London Medicine “which speaks on behalf of all medical schools, apart from Imperial which thinks it is too grand.” But as Profes- sor MacDonald points out, the ties that bind us together are stronger than what separates us, and everyone is proud of being part of London medicine

February 2011

Features

medicalstudent

Will tuition fees kill the ‘modern’ doctor?

Shackled to looming debt, the medical student has so far to go. Illustration by Gemma Goodyear

Alexander Isted Guest Writer

The debate in Parliament and in the media about tuition fees has focussed on whether or not the increased tuition fees levied on graduates is a fair solution to the problem of higher education funding (at a time when the government faces a large structural budget deficit)! While this debate is certain to continue, a more fundamental issue arises for the medical profession – will higher tuition fees undermine modern medicine, by undoing years of progress in shaping the doctor of today?

A steep climb There was a time when the term ‘doc-

tor’ painted an image of an elitist, upper-middle class, privately educated individual. Characteristics such as arro- gance and self importance were deemed acceptable in a bygone era in which patients took a passive role in deciding treatment. Doctors’ advice was taken as Gospel and the social hierarchy implicit in a consultation went unquestioned. This kind of doctor is fortunately becoming a distant memory. Today’s doctor is a friend;; someone that the patient can relate to and should feel respected by. One of the most important factors in facilitating this change is a widened base of medical student recruitment which now represents a far broader cross section of society, encompassing men and women from all ethnicities and socioeconomic backgrounds. This has largely been achieved via university access programmes to ensure that the best students are encouraged to apply

and are subsequently selected, regardless of their school or financial status. Now in its seventh year, King’s College London’s Extended Medical Degree Programme (EMDP) takes in students from London’s ten lowest-performing non-selective state schools, offering a six-year degree in which the first two years of a typical five-year course are extended to three. The students are required to pass the same exams with the same pass marks so no double standards are applied. Since the success of the EMDP program at King’s,

The estimated total debt will be £70,000. the Universities of Southampton and East Anglia have begun similar pro-

grams. St George’s University has developed an “adjusted criteria scheme [which] considers student applications to study medicine in relation to the peer group within which they studied”. This means that pupils from state comprehensives who achieve grades that are 60% greater than the aver- age for their school will automatically be offered a medical school interview. Medical students themselves are also getting involved in dispelling myths. UCL’s ‘Target Medicine’ Out- reach Scheme, for example, sees current medical students visiting non-selective state schools to speak honestly about their experience at medical school and give school pupils the confidence to pursue medicine as a career. These programmes, combined with increasing f inancial support in the form of scholarships and bursaries, have led to the gender and ethnic makeup of to-

day's medical profession. The GMC medical register shows that at present, practising doctors in the UK are com- promised of 58% men and 42% women, and in terms of ethnic background, 35% are white British, 10% are white non- British, 19% are Asian and 3% are black. It is not just the changes in the social background, gender and ethnicity of doctors which has modernised the doctor-patient relationship. The manner in which the core teaching principles of autonomy, beneficence, non- maleficence and justice are taught and practised today has radically changed. There is greater emphasis on producing well-rounded doctors with good communication skills as well as having a strong intellect. The GMC’s ‘Good Medical Practice’ guidelines stress that “to fulfil your role in the doctor- patient partnership you must be polite, considerate, honest [and] treat patients

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February 2011

with dignity”. Furthermore, access to medical information via the internet has developed a patient body that would increasingly like to play a more active and informed role in their health care. Changes in the medical school curriculum have, in response, placed greater emphasis on communication skills: videotaping clinical interviews, writing reflective essays and implementing the Calgary Cambridge pathway. This emphasises the importance of doctors communicating effectively as well as understanding or relating to the experience of an individual which is, arguably, achieved by having doctors from as broad a range of backgrounds as their patients. However, the uphill struggle to create a more representative body of doctors continues. The number of privately educated students gaining places at medical school is still disproportionately large. Even now medical school applicants from private school have roughly 66% chance of getting a place compared to the state school applicant’s 50% chance.

A costly change In order to combat the current economic deficit, the coalition government has devised new legislation on student tuition fees, based partly on the Browne review. They have recommended an upper limit of £6000 and a cap at £9000 when universities comply with specific requirements. The actual fees would be determined at the discretion of the university, with the Browne review’s sug- gested pay back scheme for graduates. This was a major compromise made by the Liberal Democrats given the

Features importance of student support in their election campaign and has been met with great hostility. 57 subsequently elected MPs signed the National Union of Students’ ‘Vote for Students’ pledge against any increase in fees during and in support of putting pressure on the government to introduce a fairer alternative. Signatories included the now Deputy Prime Minister Nick Clegg and the Secretary of State for Business Vince Cable. During the lead up to the controversial vote on the Bill, much of the student anger was directed towards the Liberal Democrats for apparently ‘selling out their principles’. Despite the large scale demonstrations leading up to the Commons vote, the legislation will come into effect in September 2012.

A poor medic For medical students applying for the 2012/13 entry, the estimated total debt will be £70,000. This is almost twice the previous £45,000, not considering the additional cost of studying for an intercalated BSc. Students applying to study in London will also have to consider additional living expenses. For some this will not impede their decision to study medicine, but for many, particularly poorer students, the total debt will be a major deterrent to applying. The government has been criticised for poor communication to prospective students regarding details of the new fees system, as many students do not realise that there are no up-front costs. As it is, applying to medical school has never been harder. Increasingly higher g rade requirements including the new A* grade, months of work experi-

ence, additional application exams such as UKCAT and BMAT and evidence

“Ultimately, this legislation is a damaging move” of a wide range of extracurricular ac- tivities have made the process more and more difficult. The entrance criteria are among the toughest for any degree in the country. These factors combined, make the idea of applying to study medicine seem unachievable to many. Factor in a dept upwards of £70,000 and the process is even more daunting. The month of student demonstrations from the tenth of November to the ninth of December has clearly highlighted that the fees will be a likely deterrent. With images of riot police, burning placards and smashed windows at Whitehall, this was the first major political demonstration of the new generation. Senior individuals in the medical education system are now split between a wish to keep their student bodies happy, an obligation to increase funds and a need to maintain high teaching standards. Professor Sir Nicholas Wright, War- den of Barts and The London School of Medicine and Dentistry, believes that “the prospects of attracting debt- averse prospective students from lower income families - whatever bursary scheme comes into being - will be very low and will do little to widen access to medicine”. However, Professor Sir John Tooke, Head of UCL Medical School, observed, “without an increase in student fees, universities would be un-

The Browne Review 2010 aka The Independent Review of Higher Education Funding and Student Finance. The review was chaired by Lord Browne Madingley (former chief executive of BP) and spent £68,000 on research. It makes several recommendations for the future of higher education funding in England:

. .. . .

The £3290 cap on annual tuition fees to be scrapped and universities should decide on the maximum amount The fees to be paid up-front by the government Students to pay 9% of earnings above £21,000 (previously £15,000) The option of graduate tax was considered and rejected;it did not meet the required time-frame and unfairly discriminates on the basis of merit ‘Forgivable loans’ to be offered for more costly courses and those deemed to have “significant social return”; this includes medicine. able to balance the books”. He also ob- serves that “on the plus side [increased fees] will ensure universities attend far more to the quality of the student experience. [We are] committed to providing value for money and minimis- ing the impact of the change in funding on widening access to medicine”. However, the British Medical As- sociation disagrees and is campaign- ing against the rise. Nick Deakin, executive member of the ‘BMA Medical Students Committee’, has said;; “the BMA does not find the proposal that a graduate will still be paying back tuition fee loans up to 30 years after fin- ishing their studies acceptable. Ulti- mately, this legislation is a damaging move that will place substantial financial barriers in front of the next generation of students, particularly those from low and middle-income families”.

What now?

Over the next decade, poorer students

will see medicine as even more un- attainable Conversely, it may be that newer philosophies of patient care may now be too engrained in the medical psyche to allow doctors’ characteristics to revert back to the old fashioned, doctor-centred approach. Universities must continue widening access to the broadest range of students possible in order for the medical profession to be representative of the population. In the words of Professor Sir Nicholas Wright, Warden of Barts and The London, “I suppose the take-home messages are (1) never, ever believe anything a poli- tician says;; (2) make sure, without en- dangering life or property, that the Government knows exactly what medical students think about this;; (3) keep your nerve – a medical career is worth it, and finally (4) don’t be frightened to seek help - most medical schools have schemes to help students in financial trouble, and we are thinking hard about what else we can do. So keep in touch with your Dean and his/her mates – he/she is there to help you.”

Seven long years in medical school Abe Thomas discusses the controversial foundation programme proposals in an exclusive interview with the Dean of Students.

hink back to when being a doctor was the most secure job in the world. A time when we were told that there will always be sick people and you’ll never have to worry finan- cially. Today, thousands are qualifying without being guaranteed a first job in the UK. As Dean of Students for Barts & the London, Professor Mike Roberts is involved in the Medi- cal School Council’s decision-making process in which he aims to repre- sent the views of the medical school

and students alike. His enthusiasm for the new proposals was infectious. The new proposals mean that foundation year one will be linked to a student’s medical school while FY2 will be incorporated into subsequent ‘core training’. This would mean that students controversially cannot apply to a different region for their f irst year as a doctor. Speaking of the current system, he says, “we have found over a number of years that our students are disadvan- taged as they are almost forced out of the local area. It seems to us that the system is just there to satisfy EU employment law more than anything else.” He emphasised that a new system needs to be in play that not only caters to the NHS but also to the educational needs of the foundation doctors and that this is best achieved by “keeping local contact with students rather than Bart’s and the London FY1 doctors working in over 60 different

hospitals scattered around the UK”. So who is at an advantage with the current system? In theory, the better foundation schools are able to recruit the best doctors in the country and not just f rom the local area. But on the other end of the spectrum, “other areas will end up getting students and graduates who are bottom end of the skills section. Not a good thing for a NATION- AL health service”. He argues, “it’s better to have a range of skills rather than some really good doctors in one hospital and really bad doctors in another”. The new system aims to offer more educational support to weaker doctors;; ergo producing better UK graduates. “The big disadvantage of the current system is that is provides a disloca- tion between the undergraduate training and the undergraduate trainers.” Under the new proposals, foundation placements would be dependent on your medical school. Some argue that

this, rather unfairly, means that a 17 year old A-level student would have to decide, not only what part of the country he wants to study in but also where he would be for his first job as a doctor. Professor Roberts counteracts this with a persuasive argument - “It protects jobs. You can guarantee jobs for every student in the local area.” This is especially important in the context of rising tuition fees. He did state, however, that the borders of deaneries would need to be modified to make sure that the number of g raduating medical students is the same as the number of jobs available. And what about the patients? Do they benefit? “Having students familiar with the hospitals, familiar with the firms, they can start on day one with confidence instead of them not knowing the hospital and not knowing the doctors. The prescription charts are different, arranging for a CT scan is different, even antibiotics used

vary between hospitals...This varia- tion in undergraduate training across the country is very bad for patients.” He also talks about a group of students that are not always considered. “One of the big disadvantages currently is that there are students who have health, social and academic problems and we want to support those students which are impossible to do if they’re in Yorkshire, for example.” The Medical School Council is voting in six months to decide the future of the foundation programme. Al- though the prospect of upheaval seems daunting, Professor Roberts has out- lined that there are advantages to consider – for the students, the doctors who train them, the patients, and the NHS at large. Currently, all we can do is wait with baited breath and hope that all UK graduates can one day be guaranteed a job after their long slog to qualifying. Fingers crossed.

February 2011

medicalstudent

Comment Comment Editor: Sarah Pape comment@medical-student.co.uk

Titanic NHS reforms David Fisher Guest Writer

The N HS is steering towards an iceberg of ill-conceived change. Unless it recali- brates its compass it is going to sink. The Government is under pressure to solve two problems: to cut the budget deficit, and to improve healthcare services in the NHS. Both are colossal issues and demand an overhaul of the system. The proposed answer is to dissolve primary care trusts, a mistake Unison has described as, “of Titanic proportions.” The proposed changes will shift ac- countability for purchasing £80 billion of healthcare to competitive markets, freeing f iscal forces to save money. GPs will supervise, ensuring appropriate al- location of resources. There are many services that could be improved or become more widely available - if competition were injected into the system. Currently few incentives exist to shorten waiting times for scans. Drugs, such as Avastin are denied from NHS patients, but can be purchased privately. The government believes engaging with the private sector is the way to rectify this. However an outcry of opposition from the medical profession has met the recommendations for reform. They are nervous about a conflict of interest

where they must decide which treatments should be made available to their patients, balanced against the cost. They also believe that dealing with an establishment the size of the NHS in such a rash way is negligent and potentially destructive, protesting that it is unrealistic to reform the NHS as a means to cut the deficit. Healthcare quality should not be sacrificed on the altar of economic recovery. A more long- term, considered approach should be able to preserve standards in the NHS, whilst providing economic return.

“If the system fails, it will be virtually impossible to reverse the changes” The rush to implement these changes is also worrying. The Bill was only introduced to Parliament on 19th Janu- ary, yet primary care trusts are already being scaled down. Unlike the rest of the Government’s plans, the NHS proposals were not included in the election manifesto. The House of Commons Health Committee published a report on 18th January 2010 examining the proposals. They concluded that insti- tutional reorganisation was “subject to little prior discussion and not foreshad- owed in the Coalition Programme”. Surely it would have been prudent to have had a few consortia test the system before the rest of the country implement- ed the changes. 141 consortia have al-

ready entered the “pathfinder scheme”, representing half the country. Conse- quently, if the system fails, it will be virtually impossible to reverse the changes. It would appear the Government has performed inadequate research about the ramifications of their plans. We are left wondering what else they may have overlooked, and whether the fast pace of headstrong change will leave no time to rectify mistakes. In particular, it is unclear how the system will work during the t ransitional period, between the clo- sure of primary trusts and the finished opening of GP consortia in April 2012. Undoubtedly, the economy needs to be improved, and the NHS needs reform. The National Health Service Act in 1946 expressed the duty of the Government, “to provide or secure the effective provision of services”. A commission ought to be appointed to investigate whether the private sector renders better healthcare than the public sector. Conceivably, introducing market forces to the NHS will be the most efficient way of achieving this. It will cost money to undergo this trans- formation, but the current economic climate should not frighten us from what will inevitably be a cost-cutting exercise. Now is the time to begin the process of reforming the NHS, but it should not be initiated rapidly under pressure to save money. Unlike the current plans, it would not imminently save billions from the budget, but in the long term it would assure us of much higher care standards that are simul- taneously economically sustainable.

Imperial versus the Daily Mail

The editor gets lonely and would dearly like to hear from you. If there is anything you’d like to tell us about, either related to the paper or medical students, please write to us.

editor@medical-student.co.uk

Unsteady foundations Zoya Arain discusses the difficulties of securing FY1 jobs

ince its invention in 2005, the selection process for the Foun- dation Programme has been dogged by criticism. While completion of the foundation years of training is a prerequisite for full reg- istration by the GMC, the 2010/11 application cycle has seen 184 more applicants than training posts available. The foundation programme was introduced to provide structure and uni- formity to post graduate training, and to contain it within a finite time frame. Although in many ways it has been successful in doing so, from an employment perspective a number of applicants could be left without a post. Derek Gallen, co-ordinator of the programme, has justified not increasing the number of places to accom- modate all graduates with reference to the problem of under-subscription in 2009. Due to an unexpectedly low number of applicants to the programme, many deaneries were left short staffed.

“It is estimated that 10% of graduates will be unplaced until as late as July”

Guest Writer Odhran Keating s some of you may be aware, the Daily Mail published an article entitled “Pass the sick bag: Students have always got drunk, but the nihil- istic antics of these Imperial College medics should worry us all”. Purporting to reveal the “sicken- ing” behaviour of some members of ICSM sport clubs, re- porters infiltrated the Reynolds Bar. Traditional home of ‘Sports Nights’, members of the clubs congregate and cel- ebrate or commiserate over the day’s results. What caught the Mail’s attention was the provision of orange buckets in case of student vomiting. They condemned these drinking habits, labelling them incompatible with a medical career. Imperial College took swift action, releasing a statement that it “does not encourage or condone excessive drinking”. Furthermore, students are no longer allowed to buy alcohol in jugs and the provision of orange buckets is banned. The Imperial College Union will also be organising cam- paigns to remind students of the risks that excessive alcohol consumption holds for their health and their careers.

Letters to the editor

But what have the Daily Mail actually exposed? An article written in Felix, the student newspaper, interviewed many students who felt that the article was sensationalist. Professor Laycock of the Faculty of Medicine is quoted saying “I certainly don’t think that our students are any different from many of their peer group”. Indeed many of the comments left underneath the online version of the article seem bemused, with one reader posting: “It’s student life, practically a right [sic] of passage. Get over it” This would not be the first time the Mail has courted controversy, notably with Jan Moir’s article on the death of Stephen Gately. The paper has also taken a recent swipe at Oxbridge students taking part in the “Valley Rally” at Val Thorens ski resort. Now if the students involved, their faculty heads, or even the general public don’t see the article as indica- tive of the moral collapse of 21st century medics, what point is the Mail trying to make? It would seem the Mail is generating acrimony merely for the sake of it.

In light of the oversubscription expected in 2010, the UKFPO imple- mented a contingency plan, where they placed applicants in batches according to application score;; the most highly scoring were placed on the primary list and allocated posts before Janu- ary, the remainder on the reserve list, placed in batches between March and July.. The promise that 98% of eligible applicants will be placed is encouraging, however the time-frame over which this occurs could be problematic. It is estimated that 10% of graduates will be unplaced until as late as July. In addition a potentially unstable variable has not been fully addressed;; the number of international applica-

tions, which varies significantly from year to year. In accordance with Eu- ropean employments law, all eligible UK, EEA and non-EEA applicants with a right to work in the UK have to be considered equally. Therefore little can be done to curb a potential increase in the number of eligible international applicants. Criticism has been voiced over this including a comment from a previous national facilitator and Obstetrician, Laurence E Wood, “The suggestion that we regard a medical degree from anywhere in the world in any language to the bespoke uk 6yr preparation to core training… sacri- fices any understanding of curriculum on the altar of political correctness;; it is not equal opportunity to substitute a brief snapshot selection process for 6 or 9 years of education and assessment in the practice of UK medicine”. Ultimately the debate raises the question of whether all UK medical school graduates should be guaranteed training posts if they wish to apply. A strong case can be made for this: UK taxpayers contribute £60,000 for the training of each medical graduate, meaning unemployed graduates are economically wasteful. Further- more, as medicine is a vocational degree, the training posts will be sought after by the vast majority of its students and hence should be provided. In his inquiry into the MMC in 2008, Professor Sir John Took sug- gested a direct link being established between medical schools and FY1, in contrast to the follow on between FY1 and FY2. Furthermore, FY2, ST1, and ST2 would be combined to form three further years of core training. I for one think, that after having completed 5 or 6 years of a r igorous and intellectually demanding degree, medical g raduates do not appreciate this Rus- sian Roulette style selection process. It is time for the parties involved to reform the system to ensure that a t raining post is guaranteed to everyone who applies.

medicalstudent

February 2011

Comment

Head to Head

Are you a student protester?

Speaker’s Corner It’s just a soap

Yes

No Liz Cosgrove

hatever your views, the student protests of 2010 were nothing if not controversial. Public opinion was- and is- heav- ily divided over whether the cause and the way they were carried out was justified. Injuries caused to individuals aside, I believe there is reason to support the student protests and the way they were conducted. Firstly, protests aim to draw attention to an issue or an injustice so the fact that they are still being discussed is an indicator of their success. Whilst protests exist as a means for the populace to voice their anger at decisions being made by governments and other organisations, they are also an effective way to attract publicity. It is un- pleasant but true that controversy and violence sells newspapers.By stimu- lating debate, the protests have thus encouraged people to consider the im- plications of r ising t uition fees for both themselves and others. This is important to prevent out politicians f rom creating policies without fear of having to answer for them. Perhaps then, the sometimes aggressive nature of the protests was price paid for close scruti- ny of the decisions made in Whitehall.

“Protests exist as a means for the populace to voice their anger” Secondly, whilst the protests may have seemed heavy handed, we must not forget why the students are so an- gry. Here is a government composed of politicians who did not have to pay to go to university, voting for a policy that will see f urther education inacces- sible for many in generations to come. To add insult to injury, many of those politicians signed a pledge to say they would oppose a rise in tuition fees, a promise they did not keep once elected. It is all very well to say that the money will only be repaid upon starting graduate employment, but a debt of £27,000 (without even considering loans for living costs) whenever and however it is paid back is extreme. Starting your working life already knee-deep in debt is a heart stopping prospect. Further- more, the people hit hardest will not be the lowest or highest income fam-

ilies, but rather those in the middle - students who aren’t wealthy enough to afford the changes comfortably;; not quite poor enough to qualify for extra help. I am one of these students, and I completely sympathise with the anger of those who were protesting. Whilst people from different classes already receive different standards of primary and secondary education in this country in many cases, it is a sad day when this extends to the once uniformly available opportunities at university. Lastly, the protests and the manner in which they were conducted demon- strated two important characteristics of our generation. The fact that students came out in such numbers and with such force to oppose the new policy illustrates the value they attach to the education they have received at school and university. Here is a generation who believes that education is worth fighting for. Politicians heard the students’ message loud and clear: not in my name. Nelson Mandela once said “education is the most powerful tool you can use to change the world”. Whatever the student protests were - extreme, violent, heavy handed - they showed that that tool would not be taken from f uture generations without a f ight. As the government and the rest of the country moves on f rom t uition fees, parliament square is tidied, and scars have begun to fade, it seems the sun has set on the chance of the policy being over- turned. But at least we k now that despite the injustice of what was proposed and passed, we did what we could to stop it. Heavy handed they may have been, but the protestors gave a voice to the voice- less. They stood up for the innocent victims and when this is considered, how could the ends not justify the means?

Neha Pathak speaks out.

Clare Jones

he year 2004 was an important time. It marked the end of Britney Spears’ reign as America’s sweetheart;; the world was introduced to Ron Bur- gundy in Anchorman;; and the master- piece that is Dirty Dancing 2: Havana Nights was released. However, despite producing the aforementioned cin- ematic masterpieces, 2004 had it low points. On 1st July the Higher Edu- cation Act was passed, which meant that universities could charge up to £3000 for courses beginning in 2006. I’ll be completely honest, tuition fees sneaked up on me. An Act that will ultimately cost me over £12,000 completely passed me by. It’s for this reason that when I f irst heard about the demonstrations against raising the cap on tuition fees, I whole-heartedly supported them. Having been apathetic and com- placent when it was my turn to protest, I was glad that someone had the d rive to stand against the r idiculous hike in fees. On the day of Demo-lition, the first of the big student protests, I found myself wandering around Parliament Square. Was I trying to atone for my previous lack of interest? Not exactly. I was in fact looking for the number 12 bus stop. The atmosphere was electric, and my disappointment that the number 12 would unsurprisingly not be coming within a 100 miles of Parliament Square soon disappeared. The protesters were very vocal, but mostly peaceful and listening to police advice. They had a message and were getting it across. It was only later on that I became aware of the mayhem surrounding Millbank and the huge amount of damage caused. Protesting against tuition fees that will saddle future students with huge debts? That I agreed with.

Kicking your way into the Conserva- tive Party HQ, throwing rocks and bottles at police, hurling fire extin- guishers off buildings? That I didn‘t. It was no longer a protest but a riot.

“The demonstrations had been high-jacked by anarchists” Later protests followed the same pattern and, whilst the violence that marred the f irst protest was unexpected and impromptu, it became apparent in later demonstrations that the violence was premeditated. The cost of polic- ing the demonstrations and the clean- up operation afterwards cost hundreds of thousands of pounds, which did not endear these ‘students’ to anyone. The sight of Charlie Gilmour, son of the millionaire Pink Floyd guitarist David Gilmour, swinging from the Cenotaph seemed to symbolise what the protests had become. Gilmour later claimed he did not k now it was the Cenotaph, a per- fectly plausible excuse from boy studying history at Cambridge University. Such episodes deflected the spot- light from the vast majority of students that had protested peacefully. The N US leadership also came under fire, ap- pearing hypocritical when condemning the violent protesters after a number of NUS officers were spotted in the thick of the action. It seems the demonstrations had been high-jacked by anarchists and other people after a fight. Despite this, in the midst of this mayhem there were moments of comedy brilliance as well as well considered opinions. One of my fa- vourites occurred when journalists fe- verishly reported that Camilla, Duch- ess of Cornwall, had been ‘poked with a stick’. God, I thought, that’s a bit personal to be reporting on BBC news. Some of the placards carried by the students were also brilliant. One of the best was by a group of student nurses which read, ‘We’re used to dealing with crap, but this is ridiculous!’. Ultimately it was g reat to see young people voicing their anger over decisions that will directly affect their lives. I just feel it was a pity the demonstrations descended into chaos allowing politicians to focus upon the anger and violence, opposed to the hor- rendous debt future students will face.

New Year’s in Britain is incomplete without a soap-opera tragedy;; the cot-death storyline from Eastend- ers certainly didn’t disappoint. Has it overstepped the mark this time? The record 10 500 complaints suggest it has. I’m not sure I agree. New mother Ronnie finds her baby James dead from Sudden Infant Death Syndrome (SIDS). In a fit of madness, she swaps him for neighbour Kat Moon’s baby Tommy, leaving the Moons grief stricken and herself unable to mourn. It does not make for comfortable viewing. Critics describe it as “unrealistic”, “hurtful” and a “cynical ploy to make headlines by creating deliberate controversy”, while Justine Rob- erts, founder of parenting website Mumsnet, criticised the BBC for in- sulting bereaved mothers by portray- ing them as “deranged and unhinged”. Of course it’s unrealistic. That’s sort of the point. Just because Ronnie switched a baby in Eastenders does not mean every bereaved mother does this in real life. Furthermore, though she does come awcross as “deranged and unhinged”, it is balanced by the sensi- tive examination of the Moon family’s more typical bereavement reaction. SIDS claims the lives of 300 babies each year in the UK and this certainly merits the media attention. Indeed, the Foundation for the Study of Infant Deaths (FSID) praised the storyline- “We are very grateful to EastEnders for their accurate depiction of the dev- astating effect that the sudden death of an infant can have on a family. We hope that this story will help raise the public’s awareness of cot death.” I agree wholeheartedly and shook my fist when Ann Diamond said, “the BBC missed an opportunity to educate a whole new generation of mothers.” Firstly, it is not a documentary. Secondly, before one can educate, one needs to raise awareness. FSID hotline traffic has already increased five-fold. Surely, this is a success. Sadly, the storyline is ending pre- maturely and apparently, it’s going to be a happy ending. Presumably, Baby James is going to come back to life, Baby Tommy will go back to Kat and everyone will think that SIDS doesn’t even exist. And then there’ll be even more complaints. Great.

February 2011

medicalstudent

Culture Culture Editor: Robyn Jacobs culture@medical-student.co.uk

Drugs aren’t cool: High Society Kathryn Dickson Guest Writer “The jazz just isn’t the same when I’m not stoned”. The 65 year old in the psychiatric outpatient clinic smiles sweetly. He gave up cannabis five years ago thanks to its tendency to push his bipolar disorder into depression. I feel for him because this clinic just isn’t the same without a black Americano. For him, the pub isn’t the same without a Jamesons-coke or the cold walk home without a badly rolled Golden Virginia. As the current ‘High Society’ exhibition at the Wellcome Collection points out, very few people live their life without some kind of mood- or mind-alter- ing substance. Drugs have been used throughout history and across conti- nents. Yet drug culture is so intolerable to society that not only do we criminal- ise it, but we turn its use into medical syndromes. As a society, and as a medical profession, we attempt to balance conflicting demands of an individual’s autonomy against the need to protect from the harm that drugs can cause. Drugs are used to alter our bod- ily functions for a variety of purposes - medical, recreational, religious, ex- perimental. Using the idea that ‘the alteration of consciousness is a univer- sal human impulse’, ‘High Society’ ex- plores mankind’s use of drugs. Videos of the Tukano tribe taking ritual Aya- huasca to achieve a spiritual connec- tion with their ancestors play opposite engravings of opium dens, whilst man- uscripts of Kubla Khan lie next to pro- hibition propaganda. A heroin addict describes the experience of withdrawal in front of a case of Sativex (a cannabis based analgesic licensed in 2010 for MS). The wide range of materials in the exhibition is clearly its main selling point, although the diversity does add to the romanticism surrounding drugs. With only a slight nod to modern research, it could be argued that the exhibition focuses more on the curious than the current. However, with

the tagline ‘A free destination for the incurably curious’, perhaps this is to be expected. The chilling note of so- briety is as one leaves – a giant post- er charting the cost and purity of heroin as it travels from grower to user. The exhibition has an emphasis on the broadness of the term drug, which encompasses many substances. When we use the term we primarily think of those which alter the mind’s function- ing. Drugs give us the power to alter the world we perceive. One of the most commonly used metaphors for a drug experience is a trip, drugs literally being able to transport us to a different world. For some, this deepens our understanding of what it means to be human, but it is these drugs that are problematic. Dangers of altered mind aside, are we demanding fair play in our de- monisation of drugs? We are forced to suffer the pain of the sober world, why should others be able to opt out? In December, the government released their drug strategy-‘Reducing demand, restricting supply, building recovery’. In recent years there has been a move towards the aim of harm reduction instead of criminal justice. Now the focus is on recovery, although whether this is drug reduction or absti- nence is still unclear. The proposition to cut benefits of drug users refusing treatment has not been carried through, although six pilot schemes to “explore how payment by results can work for drug recovery for adults” are to be set up. In perhaps more relevance to the future medical profession, the manage- ment of drug and alcohol services is to move from Local Authorities to the re- formed NHS and a new Public Health for England body. Is this simply policy to bring power to a more local level, or a reflection of our attitude towards ad- diction as a medical problem and a disease? Becoming responsible for strategy will force doctors to take a clearer stance on the problem of d rugs and alcohol, and the associated ethical debates. The NHS is changing, doctors are to be held responsible for the strategies and policies we may have previously been able to hide behind. As ‘High So- ciety’ neatly demonstrates, drug use is a u niversal habit, one which poses com- plex questions for society. If answering these is to fall to the medical profession, we must find our minds educated and open. This is what ‘High Society’ does;; it challenges all attitudes. The exhibition offers no conclusion, these are the things that we do, and the problems that we are left with. The rest is up to us.

THE KING’S SPEECH Pranav Mahajan sees a film that sp...sp...speaks volumes for the Dr-patient relationship...

he King’s Speech documents the rise of Prince Albert (Colin Firth), son of King George V and second in line to the throne. Though crippled by a pro- nounced stammer, Albert ascends to the head of the monarchy in an age where for the first time ever, royal speeches were expected to be delivered into the home of every subject, via the cutting edge technology of wireless radio. The opening of the film introduces us to not only the Prince, but also to the severity of his disability. As Firth attempts to give a speech to a packed Wembley stadium, the anticipation of all is apparent. As the Prince ago- nisingly stumbles over every word, the faces of those around him display bemusement and disappointment, none more so than that of his wife Elizabeth (Helena Bonham Carter). The f ilm cuts to a despondent Prince undergoing a speech-therapy session. The upper-class three-piece suit-wearing doctor fails to make any headway with the Prince’s speech impediment and is made to seem an almost laugha- ble f igure. Frustrated by the latest failed

attempt, Albert gives up on any further therapy. However, his long suffering wife persists and enlists the help of Li- onel Logue (Geoffrey Rush), an Aus- tralian speech therapist based on Harley Street. After the death of King George V, and the abdication of his eldest son, Albert becomes a reluctant king. The beginning of his reign was tainted with the declaration of war against Germany. It was a radio address to the entire K ing- dom, both home and abroad, that would bring Albert his biggest test so far. It is the relationship between Al- bert and Logue that allows the Albert to overcome his obstacles. Initially, Albert plays the role of a difficult patient, sceptical about anything Logue suggests. Logue, in stark contrast to the ‘upper class, three piece suit-wearing doctor’, remains patient and, and after his own stuttering start, eventually breaks down the barriers that ex- isted between himself and Albert. This opened Albert up to new ideas and techniques for tackling his problem. Eventually, by building rapport and trust, Logue is able to get the Prince to disclose personal problems, despite

his initial insistence that he would not, thus allowing him to explore the psy- chological core of Albert’s impediment. The film is brilliantly directed, with a star-studded British cast. The attention to historical detail, from the won- derfully authentic props to the wobble of Winston Churchill’s jowls, adds extra dimension to a remarkable visual experience. Firth brilliantly depicts raw emotion, his character’s frustration and awkward irritation at his inabilities is so well portrayed, that those feelings are readily shared by the viewer. It comes as no surprise that his performance is tipped to earn Firth his first Oscar, having already won a Golden Globe for best actor in his portrayal of the King. The film will also be making a theatre debut in the West End later this year. The King’s Speech would appeal to anyone, but the importance of Logue’s relationship with Albert, makes this a must see for medical students wanting to explore patient communication techniques. The importance of listening, patience and rapport building are all on display in a real master class in establish- ing a good doctor-patient relationship

Student Artwork of the Month By Jiyu Lim “A boy sets out on a journey in search of his long lost mother, whom he is told is a ‘mermaid’. The boy spends all his childhood looking for his mother, only to realise that sometimes the truth is best left unknown”

The exhibition ‘High Society’ is running at the Wellcome Collection until 27th February. For more info visit www.wellcomecollection.org

If you would like to see your artwork, photography or poetry featured, please email culure@medical-student.co.uk

medicalstudent

February 2011

Culture AN INTERVIEW WITH...

The Perfect pint?

King’s MedSoc Musical Theatre Society Michael James talks to the team behind their latest show

or those of you who aren’t aware, this is the section where some grouchy misanthrope (yours truly) goes around with pen and paper in hand and interviews members of the ‘in’ society from ‘insert medical school here’. Luckily, this time round it happens to be King’s MedSoc Musical Theatre group with their production of ‘Little Shop of Horrors’. This particular production happens to be a big favourite of mine, combin- ing science f iction, comedy and a 60’s rock/ Motown score into a g reat show. I’m head- ing to Guy’s campus to sit in on a bit of the rehearsals in the run up to the production. When I get to the rehearsal venue (The Spit in Guy’s campus) I’m let in by David Thaxter, the shows director. He tells me they’re currently mid-scene and sets me down on a couch to watch until the break. I look around and see a buzz of activity: a group in the corner of the room practicing a coordinated dance routine, others dotted around with their backs against the wall, whispering to each other, reading, doing work, and waiting for their scene to start. And then there’s the main rehearsal. The scene is between the protagonist Seymour Krelborn and his boss at the flower store he works at, Mr. Mushnik. The musical itself, David tells me during the break, is about Seymour and a plant. A mutant venous f lytrap f rom outer space to be precise. “The story starts in 1960’s New York on Skid Row, in a f lorist shop owned by Mush- nik. Seymour works there along with shop assistant Audrey, whom he’s deeply in love with. But Audrey’s going out with a sadistic dentist. Seymour one day sees a venous flytrap in the flower market and decides to bring it back to the florist shop. The minute they put it in the window, it starts attracting a lot of business for Mushnik’s store. Because Seymour’s in love with her,

Line learning got to the stage where only threats would work...(Photography by Francis Trapp) he names the plant after Audrey, hence the name Audrey II. The only trouble is, he can’t find out what it eats, and he’s worried that it’ll wilt and die and he’ll lose everything the store has gained”. A bit of a pickle for our friend Seymour, but what does the plant eat? “Blood. Seymour tries everything that he can, and he f inds out the plant likes blood. So he feeds it his own and it starts g rowing at an alarming rate”. So fast, in fact, that after a while blood alone cannot sustain the mutant plant and it begs Seymour for something a bit more “fresh”. Cue sadistic dentist. “It’s really a sort of ‘be careful what you wish for type thing’. After feeding the dentist to the plant, it grows bigger, more powerful and out of control, and everything the plant promised to Seymour grows fainter and fainter. So he decides to try to get rid of it.” It’s certainly an odd story, with a mix- ture of absurd scientific horror/gore and fun music, not to mention the over the top characters. But all of this works in the shows favour, at once creating a real sense of suspense and drama, while not taking itself too seriously so you can still sit

In a quest to find that perfect pint, Odhran Keating considers the greatest beer in the world....

back and laugh at the idea of a massive plant with a thick, soulful voice similar to Levi Stubbs (he played Audrey II in the 1986 film). “I was a massive fan of the 1986 film version with Steve Martin”, says Mike An- drews the Musical Director of the show, “plus I really liked the work of Howard Ash- man and Alan Menken. It’s a really witty and dark show and it’s been great fun to direct such a varied score. I’d never been musical director of a show before, and so I found it really fun to get involved” says Mike. Do David and Mike have any advice for people who are directing for the first time? “En- thusiasm comes to mind” laughs David. “If you have the ability to go home after a rehearsal and sit there, thinking about how it could have been better, then that commitment is going to show.” The show ran from the 26th-28th Janu- ary, so some of you may have missed out, but the enthusiasm shown by both David and Mike was infectious, and I would certainly recommend anyone at King’s to get involved with the society, and for anyone from further afield to go and see the next production

magine clearly for a moment the greatest beer in the world;; bring it to the forefront of your mind. It’s cool and refreshing on a hot summer’s day but also warms your insides on a cold winter night. It slides down your throat easier than water and feels smoother than Weissbräu from Munich’s famous beer gardens. When you drink it, you feel only happiness and contentment. When you wake in the morning, there isn’t a hangover. Hell, this stuff is good for you;; zero calories with added iron and calcium! Good news! It exists! Anyone who has compared the feeling they get when they look at their cash balance at the start and end of term will understand. Something that exists is vastly superior to something that doesn’t. So, if this greatest beer didn’t exist, then it would be impossible to imagine a more perfect beer. However, we have a contradic- tion, to have a beer greater than the greatest beer imaginable, we would have to imagine an even greater beer. This greatest beer must exist otherwise how could it be the greatest? Confused yet? Ecstatic news I know, but there may be a few problems. This argument was made in the eleventh century by St Anselm as a proof of God’s existence. It is known as the Ontological Argument and was later reworked by René Descartes as follows 1) God can be conceived of as a being who possesses all perfections, He is All-Per- fect, 2) Existence is perfection, 3) Therefore God Exists. But bad news for all you beer lovers, Descartes himself countered the argument to bring anything into existence, by stating that God alone has a special kind of ‘necessary’ or independent existence that we can clearly perceive. This is different to the idea of a perfect beer which is hard to objectively imagine. For example;; how sweet is the perfect sweetness to suit everyone? However, most feel the Ontological argument was put paid to by Kant when he wrote that “existence is not a predicate”. Simply put, this means that existence is not a property that can be ascribed simply by saying “God exists” the way “God is omnipotent” or “God is benevolent” can. To say God exists is to say that you can have a concept of God with all the properties attached to him. In order to confirm that God does in fact exist, then we would need to experience proof of his existence. Whether this is a more worthy ideal than trying to find the most perfect beer is up to you.

Still want to find the perfect pint of beer? Visit the Great British Beer Festival at Earls Court Exhibition Centre, 2-6 August 2011. Tickets available from March via www.gbbf.camra.org.uk

Calendar of Events

BL Barts Got Talent 11th February

GKT

ICSM

SGUL

RAG week RAG dash to Edinburgh Comedy night 30th Jan –4th February 4th-6th February 15th February Valentines Ball Battle of the bands v BLAS Cultural Show 15th February ICSM 1st March 22nd February RAG week RAG Fashion Show 21st-25th February A view from the bridge 15th March 24th-25th February RAG Fashion Show RAG week 15th March George’s Got Talent 17th-25th March 1st March Battle of the bands v George’s Footloose 22nd February 9th-11th March

RUMS RAG week 14-18th March

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4. Bee stings

Wann beehiv a catch a bu stings e and provo zz? Then wh cau ke yn producse pain and s the bees intoot hang arou welling tion of nd a stingin ‘intens do b g lead toe feelings of pamine andut also cause you? Bee venom hallucinatio satisfaction cortisol lea increased recept contains o ns. Accordin’ and in some ding to o v stings rs and blood er 40 substang to experts cases can have b b een us vessels to incces that act o ee sting ed the r n nerv e a se b ra Side ef fects in pain, and pa peutically ar lood flow. Bee rasth thritis, clud e nerve dizzinee pain, itchin esia. g, feve ss and r ear bu zzing! , weakness,

This study inspired me to go in search of alternative methods of intoxication used around the world. After extensive research - here are the Top 5 weird ways to get HIGH.

2. Reindeer pis s

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t t u B A K A m e k n e 1. J Hash

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Answers:

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All for one and one for all

g n i k c i L d a o T . 3

Sun Rise

Recently a group of Danish medical professionals, clearly bored at work, decided to get together and test out the urban myth that it is possible to get drunk by submerging the feet in alcohol. The three aged 31- 35 years (shouldn’t they know better by now?), kept their feet in a washing up bowl filled with 3 bottles of off licence vodka for 3 hours. Unsurprisingly results of the study found the feet are impenetrable to alcohol. However, the authors claimed it is possible to get drunk if the beverage had a higher alcohol content, absinth for example, or if the participant could facilitate uptake of alcohol through an ulcer.

g e m t u N 5.

Three Blind Mice

Poo Sniffing

NHS Cuts The British Medical Association has weighed in on the new Prime Minister David Cameron’s health care proposals. The Allergists voted to scratch it, but the Dermatologists advised not to make any rash moves.. The Gastroenterologists had a sort of a gut feeling about it, but the Neurologists thought the Administration had a lot of nerve. The Obstetricians felt they were all labouring under a misconception. Ophthalmologists considered the idea short-sighted. Pathologists yelled, “Over my dead body!” while the Paediatricians said, “Oh, Grow up!” The Psychiatrists thought the whole idea was madness, while the Radiologists could see right through it. The Surgeons were fed up with the cuts and decided to wash their hands of the whole thing. The ENT specialists didn’t swallow it and just wouldn’t hear of it. The Pharmacologists thought it was a bitter pill to swallow and the Plastic Surgeons said, “This puts a whole new face on the matter....” The Podiatrists thought it was a step forward but the Urologists were pissed off at the whole idea. The Anaesthetists thought the whole idea was a gas but the Cardiologists didn’t have the heart to say no. In the end, the Proctologists won out, leaving the entire decision up to the twits in London ..

Funny Unforseen Conundrums Unleashed on Patients We all have those moments where medicine just gets a little out of control. Some of these stories are funny, some are sad, some are cringy, some are tragic, some will leave you confused and seeking your teddy and others will make you pity the NHS! But scarily, All.of.these.stories. are.100%.true... Steve was on a geriatrics ward and was on a ward round when they came to a woman with PR bleeding. After the patient was covered in a sheet from below her waist, the consultant and registrar performed a per rectum examination on the woman. They then offered Steve the opportunity to perform his first PR on the patient after getting her consent. Being nervous, Steve gloved and lubed up and went straight in and had a feel around. The consultant then asks, ‘Can you feel the mass on the left hand side?’ Not wanting to appear incompetent, Steve lied and said he did. There was silence as Steve spent another minute pretending he knew what

he was doing. The consultant then calls Steve outside along with the registrar and as soon as they are out of earshot of the patient they burst into laughter. The consultant then asks a confused Steve – ‘You didn’t really feel anything did you?’ Embarrassed, Steve whimpers – ‘Sorry, it was my first time…’ to which the consultant says – ‘It shows, you didn’t do a PR exam at all! That was her vagina. And I think, technically, you just raped that poor woman…’ Sam was hungover from Wednesday tables and was being briefed by the consultant on all the patients before the medical ward round. ‘And most importantly, we must be very careful with Mr Fisher. His results are back and we must give him a warning shot before we tell him that he has been diagnosed with end stage renal cancer.’ They got started on the ward round but Simon found it very hard to stand and not be nauseous. The consultant, noticing his dismissive attention

The Alternative Dictionary

span, decided to call him out on it. ‘Sam, you seem very bored. Are you familiar with this patient’s medical notes?’ To which Sam’s curt response was – ‘Course I am, this is the one with cancer isn’t it?’ Fiona found herself at a sight impaired station in her OSCE exam with only 1 minute of preparation. Not knowing the first thing about leading a sight impaired person, she was very nervous as she said – ‘So, how can I help you?’ The ‘patient’ replied – ‘Well, I believe you’re supposed to offer me you arm and lead me down this corridor’. Fiona then grabbed the ‘patient’ by the arm and went through the corridor side-by-side with the patient causing the patient to pinball off the walls. After embarrassingly emerging out the other end, Fiona had to offer some information to the patient. ‘Would you like your information in Braille or on tape?’ The patient asked that it be sent to him by email. A very confused Fiona then stutters ‘But, you’re blind...’ just as she looks over to the examiner sternly shaking his head. She failed.

Dingbats Man Utd 4 – 1 Liverpool Chelsea 4 – 1 Man City Spurs 4 – 1 Blackburn West Ham 4 – 1 Newcastle Birmingham 4 – 4 Tranmere Rovers

Artery: - The study of paintings.

Barium: - What doctors do when patients die.

Cauterize: - Made eye

contact with her.

Dilate: - To live long.

Fester: - Quicker than someone else.

Fibula: - A small lie. Impotent: - Distinguished, well known.

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