theMEDICALSTUDENT
March 2014
The voice of London's Medical Students/www.themedicalstudent.co.uk
New Foundation Programme What it means for us >> page 4
The Bigger Picture
Medicine as an Art >> page 10
Getting Published
Our top tips >> page 14
The First Female Doctor Elizabeth Garrett > page 7
Could Early GMC Registration Jeopardise Medical Education? Government postpones care.data programme Chris Smith
Krishna Dayalji Yes, say the British Medical Association (BMA) Medical Students and Junior Doctors Committees. In our January edition of TMS, we informed our readers of the proposal put forward by Health Education England (HEE) to tackle the persistent problem surrounding foundation programme oversubscription. The plan included moving forward General Medical Council (GMC) registration to the point of graduation, so that medical graduates could practise medicine either privately or through securing a place on the foundation programme by scoring adequately in a new selection test. However, the BMA Medical Students Committee (BMA MSC) and BMA Junior Doctors
Committee (BMA JDC) have argued that this new plan could threaten patient safety as well as harm UK medical education. Furthermore, in place of solving the oversubscription problem, the committees have suggested that the proposal is more likely to perpetuate the issue due to increased competition from European applicants. As part of the proposal, HEE suggested that by removing the current pre-registration year (F1), concerns surrounding patient safety would be resolved. However, the BMA have debated that: ‘If there is a patient concern about the preregistration year, we do not see how it can be resolved simply by moving the date the registration. ‘It should be resolved by
greater emphasis on appropriate supervision, training and support.’ Moreover, the BMA has advised that medical school curricula will be need to altered such that students are wellprepared for registration on graduation. They added that the proposal is a ‘waste of talent to an under-doctered NHS, a waste of personal and public investment in medical training and threatens the long-term security of NHS services in the event that applicants from outside the UK decide to return to their home country.’ Surprised that the proposal had been published before seeking advice from the association, the BMA have written a response letter to HEE, further highlighting the issue noted above. Mr Harrison [cont’n pg.2]
The controversial NHS project, care.data, that would harvest data from medical records has been delayed by six months in the face of opposition from doctors and patients. The announcement was made on the 17th February, following repeated concerns from GPs and patient groups. The British Medical Association led the calls to suspend the programme until people were better informed about it - and given more time to opt out, if necessary. The government announced that the scheme would be postponed for six months until assurances could be made that patient data remains confidential with no identifiable information. Officials claim the data will be used to spot trends and conduct evidencebased-medicine on the largest scale possible and identify poor care. Privacy experts have warned there will be no way for the public to work out who has their medical records, or what purposes their data will be used for. There have been questions raised about commercial companies buying data. The extracted information will contain a person's NHS number, date of birth, postcode, ethnicity and gender. Once live, organisations such as university research departments – but also insurers and drug companies – will be
able to apply to the new Health and Social Care Information Centre to gain access to the database. Last year it emerged that the private health insurer Bupa was one of four firms that had been cleared to access sensitive patient data. Some doctors' groups complained that the scheme, while valuable, was poorly understood and badly explained by NHS England, which has said the majority of the data would be anonymised or made impossible for patients to be identified. All 26 million households in England were sent leaflets about the plan but polls showed about two-thirds of people had not seen them. A number of GPs have opted out all patients registered at their practises in protests, with one GP told he could lose his job as a result. NHS England plans to run an awareness campaign to inform patients about the change. Tim Kelsey, national director for patients and information, said: ‘NHS England exists for patients and we are determined to listen to what they tell us. ‘We have been told very clearly that patients need more time to learn about the benefits of sharing information and their right to object to their information being shared. NHS England was meant to have delivered leaflets about the scheme to every household last month but many patients never received them. Furthermore, [cont’n pg.2]
theMEDICALSTUDENT / March 2014
News Editor: Chris Smith and Krishna Dayalji news@themedicalstudent.co.uk
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[Editor's Letter]
o man is an island, entire of itself; every man is a piece of the continent, a part of the main. If a clod be washed away by the sea, Europe is the less. Any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee.” So wrote John Donne whilst he was recovering from a near fatal illness. Death is a topic explored by very few during their time at university. Medical students are, however, called upon to look at death directly, from a number of different angles. Many of us start early, in the anatomy lab, slicing and dissecting intricate parts of the human anatomy on an embalmed, clay like body that
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> [cont’n from care.data article] two polls this week found that eight in ten GPs did not understand the project. Pressure group 38 Degrees plans to set up a website that would enable the public to log on and prevent their data being harvested, without having to see their GP. The delay came a day after
the solicitors Leigh Day began a legal challenge on behalf of a campaign group, medConfidential, arguing the leaflet sent to households was misleading. The online campaign group 38 Degrees polled 150,000 people, of whom more than 90% said they would opt out.
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somehow seems strangely nonhuman. The covered up face and withered features draw us away from wondering who this person really was, and what their life was like. On the wards we see people in a much greater, though still restrained, social context. We may clinically suck out the information we want to receive and little else from our patients, but it is impossible to avoid the human aspect when we see them. Indeed, many of the better doctors actively engage with it even though it could result in pain further down the line. Over the first few weeks of my gastroenterology placement I spoke briefly with a young patient who had been admitted with liver cirrhosis. I can scarcely
say I got to know her - I did little more than take a scatty history and perform a basic examination that my consultant later berated me for. The patient was gregarious and we enjoyed casual small talk. After this brief meeting, we woud smile at each other when the ward rounds took place during the week. When I returned on Monday and asked where Jane was, I was told she had developed cardiac failure secondary to her cirrhosis and passed away on Sunday. I looked at the empty bed where she had been - now with new sheets and ready to receive another patient. It seemed very empty. Despite my playing almost no role in this patient’s life and, when it comes down to it, really knowing nothing about her,
I was dejected - this person I had known and engaged with was gone. I had little time to cogitate on the loss - I was being called to the morning’s ward round. In the afternoon I was scheduled to see a post-mortem. The morgue was not dissimilar to the old anatomy lab, but when the pathologist pulled back the sheets the patient looked no different to an individual sleeping. At what seemed a brutal pace the doctor eviscerated the corpse and showed us the ‘interesting’ pathological detail. “Who was this patient?” I asked. “51 year old male - drug overdose.” he replied curtly. It was all finished remarkably quickly. “You’d better go” he said “You’ve seen the bulk of the process now. I’ve got five more of these to do before I go home.”
> [cont’n from GMC article] Carter (co-chair of BMA MSC) added: ‘We strongly believe a decision should not be taken on this important issue until all the implications of the proposals have been fully explored. ‘If steps are taken towards its implementation, a number of safeguards must be put in place to protect patients, medical graduates, and the high
standard of medical education and training in the UK. ‘We would strongly urge HEE and the Department of Health to consider the implications of a change in the timing of GMC registration in much greater detail before formalising proposals, and we would ask that the BMA be much more involved in any decision making on this subject in the future.’
The entire letter can be found on the BMA website. The BMA MSC firmly believes that it is vital that all UK graduates are allocated a place on the Foundation Programme to allow them to gain full registration with the GMC. So whilst oversubscription of foundation posts is remains an immediate problem, disputes surrounding the solution are on the rise.
Financial difficulties double for NHS Trusts Chris Smith News Editor The number of NHS Foundation Trusts in England in financial difficulties almost doubled in one year from 21 to 39, a study by the watchdog found. The study from Monitor, which regulates England's 147 trusts, found that their combined deficit was £180m, £12m higher than anticipated. Five trusts account for 60% of the deficit. Fourteen of the 38 trusts are in the Midlands. Mid Staffordshire, known for the its well publicised ‘scandal’, became the first trust to be put into administration in April. Most trusts breached waiting times in the last quarter for urgent cases. Seventeen trusts failed the target during the quarter; with general surgery, trauma and orthopaedics having the longest waits. The number of trusts breaching the government cancer target for 85% of patients
with suspected cancer to start treatment within 62 days of being urgently referred has more than quadrupled in a year. Twentyeight trusts failed the four-hour A&E waiting time target during the quarter. Overall waiting lists have risen with 1.6 million patients waiting in December 2013, a 14% increase over the previous year. Of 80 trusts where waiting lists have grown, 75% said a significant increase in referrals was the main reason. A fifth blamed reduced capacity to cope with the numbers and other issues such as data quality. The foundation trust sector as a whole remains in financial surplus, but "the size of the surplus has more than halved since this time last year, reflecting the tough financial climate and foundation trusts' response," Monitor said. The surplus stands at £135m so far this year, down on the predicted £173m. Efficiency savings have been 18% less than
planned with £867m saved so far. Monitor said the overall picture was that foundation trusts were "performing well in providing quality services to patients in challenging economic times". Labour's Shadow Health Secretary Andy Burnham said that the Government's “mismanagement” of the NHS had driven up waiting times.“David Cameron said his own re-organisation could be judged on its effect on waiting times. This is more proof it has failed on every level,” he said. “Patients with a lifethreatening illness should not face these unnecessary delays. He wasted billions of pounds of front-line cash and now the number of hospitals in deficit has doubled in the space of a single year.” Mike Hobday, director of policy and research at Macmillan said rising cancer rates meant that timely treatment was essential.
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theMEDICALSTUDENT / March 2014
News Editor: Chris Smith news@themedicalstudent.co.uk
Medgroup Chairs Dheeraj Khiatani & Mark Gregory For the majority of the UH medical schools, February has bought varying numbers of Valentines day cards and RAG week. Whilst I suspect only 1 of those events will end up helping people in need, both will be remembered for many months to come. RAG week takes on various forms at each of the 5 medical schools, and med school RAG history is littered with tales of success, excess and heroics from all areas. Recent years have seen RAG committees having to rethink strategies considerably due to the tightening of restrictions with regard to the tube, but this has in many cases resulted in creative genius. Whatever the final figure (which we look forward to hearing about), everyone on a RAG committee, and all those who gave up their time for the cause deserve a massive thank-you, and perhaps a free beer. Onwards to March and the UH rugby is set to dominate the back pages. With the semi-finals having been delayed due to inclement weather, the meat of the tournament is scheduled for the next few weeks. There’ll certainly be a few tense hours on the pitch. Best of luck to all the Barts final years who have finals this month; the light at the end of the tunnel is neigh!
GKT President Juliet Laycock This time of year is arguably the most depressing; with awful weather, exams looming and the buzz from Christmas very much over – it was going to take something quite incredible to save us from depression. And luckily for us at GKT, RAG week reared its beautiful head at just the right moment! This year’s ‘RAG the World’ was an unforgettable one… we watched love blossom at GKTake Me Out, we witnessed many a male fresher crumble at the hands of TIT Squad, we even took our RAG buckets all the way to Bristol and back – all in the name of charity! Thanks to all those that got involved, we’ll be announcing the total amount of money raised very soon. Looking ahead to March; the main event in the calendar is the Macadam Cup. Long-standing rivals KCL and GKT will come together on 26th March to battle it out on the sports pitches. With GKT only ever having lost this varsity competition once, we’re hoping to retain the Cup once again this year – this is an event not to be missed!
RUMS President Swathi Rajagopal It’s already come around to UCLU elections 2014! Check out candidates’ manifestos for RUMS officer and the sabbatical post and make your vote count! If you want to get involved in shaping RUMS, try running for one of the RUMS exec vice president positions for sports & societies, welfare or events. You can check out descriptions of the roles at rums.uclu.org/ and come along to the elections which will be held in late March (date TBC). Congratulations are in order for the RUMS welfare team and UCLU welfare officers for ‘Taboo Fortnight’ which tackled subjects such as disability, mental illness, sexuality and sexual health with various workshops. February also saw our pre-clinical students surviving their formatives, and RUMS welfare will be holding drop-in sessions for anyone who is worried about exams, revision or results. On the events front, RUMS exec have finalised two of the year’s biggest events so get these dates down in your diaries! Sports ball is to be held on April 26th at the Royal National Hotel and the finalist ball on 30th June at the beautiful Tower of London. Tickets will be up soon!
SGUL President Mohammed Amer Firstly I must apologise for the lack of an article for the past two issues, which was a problem in communication with the Editor! March sees the beginning of our Heritage week, focusing on the achievements and traditions of George’s, with students being asked to name their most legendary students past and present! Our themed weeks then continue with ethics week, focusing on environmental ethics, finishing with a delightful ‘Go Green’ Paddy’s Day disco to see off our Students to Easter! We also have three shows going on during March. We fight to claim our glorious dance and music titles once again at Face off, after winning the double last year (for first time in history I may add!). Our very own Tooting show, a dancing, acting and singing show kicks off in the same week, with the following week dedicated to our Musical Society, set to put on a fantastic performance of ‘A Tale of Two cities’, which is expected to sell out on the Friday as usual! All in all a busy yet exciting end to the second term, leaving everyone needing a much hard earned break this Easter!
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ICSM President Steve Tran The month of March kicks off on the Tuesday 4th March with ICSM’s finest strutting their stuff down the catwalk at our annual RAG Fashion Show. Maddison Gronager and her team have done a fantastic job in organising all of this! Varsity is our major event of March, where we will see our medic teams pitted against our IC rivals. This year it is hosted on Wednesday 12th March and concludes at the Stoop for a 7.30pm kick off for the Rugby Varsity. We are hopefully to reclaim the J.P.R Williams trophy this year as we have a strong team captained by our very own Vernon Mc Geoch. Elections are currently underway to elect next year’s ICSMSU Exec Committee. May the odds forever be in your favour for all candidates this year. Lastly, our sixth years start their Finals this month. Fortunately for ICSM, we enter this month on a high note as forty-two of our final years have already secured a place on an Academic Foundation Pathway ahead of the allocations. Good luck to all London final years receiving their allocations this month!
BLSA President Ali Jawad February is almost over and we’ve seen students doing some fantastic work. RAG week went well, culminating in our very own version of Take Me Out, and we also saw Islamic Awareness Week go without a hitch. In just a couple of days we have one of the biggest events (in London?!) the Dental Beer Race. Somehow Whitechapel Road manages to cope with 700 students in fancy dress staggering along it. Not so long after we will be supplementing our RAG total with the proceeds from the annual Fashion and Dance Show, Elegance (BLAS) and Charisma (BLACS). Nearer the end of term the finalists will (fingers crossed) be doctors and we’ll be celebrating it at our awards ceremony - The Association Dinner. Held in the Great Hall at Barts it’s always a rather grand affair and is a great way to recognise all the fantastic work done by our community at BLSA. We’re looking forward to the next month here at BL!
theMEDICALSTUDENT / March 2014
News Editors: Chris Smith and Krishna Dayaji news@themedicalstudent.co.uk
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Changes to the Foundation Programme 2015 Krishna Dayalji News Editior If you have not already heard about the changes to the Foundation Programme from either your medical school or through the grapevine, then TMS is here to update our avid readers on, once again, another change to the Foundation Programme Application Process. At the end of January, the UK Foundation Programme Office (UKFPO) announced that presentations will no longer qualify for points on the educational achievements criteria for Foundation programme 2015 and onwards. The decision comes following the annual review of the educational achievements criteria and process by the UKFPO Recruitment Rules Group. The group consists of representatives from each of the UKFPO’s stakeholder groups, including the British Medical Association Medical School Committee, General Medical Council, NHS Employers, medical schools and foundation schools, whilst the review takes into account the feedback received from applicants, clinicians and experts who participate in the National Verification Day. Following the most recent review, the group has made the decision that the maxi-
mum seven points for educational achievements will only be awarded for additional degrees and publications. Presentations will no longer qualify for points in the application process. Therefore, the total number of points available for the section will remain the same - up to five points for an degree and up to two points for publications. Previously, to be awarded an additional point for a presentation, the presentation must have taken place at a national or international conference, organised by a recognised medical professional or medical educational body. However, due to vast number of conferences that take place across the world every year, it is not possible to identify all the suitable events prior to National Verification Day. Due to the large number of individual verifications that need to be made, UKFPO added that it becomes very difficult to make consistently fair and objective judgements with every application, hence anomalies do occur. Additionally, from the sheer number of presentation-related enquires they deal with each year, UKFPO stated that it has become evident that it is difficult for applicants to comply with the criteria. Furthermore, UKFPO stated that 30% of ap-
plicants had their scores adjusted after claiming for points for presentations on their FP 2014 application. Despite these efforts, the news is understandably not welcoming for those students who work very hard and tirelessly to present at national and international conferences. However, it is expected that such work would most cer-
tainly be helpful for applications beyond the Foundation Programme. For those students hoping to apply to the Academic Foundation Programme (AFP), presentations can still be included in the ‘Academic Selection’ part of the online form. A handbook for the FP 2015 detailing these changes will be published by UKFPO in June
2014. However, in the meantime, if you have concerns that you would like to be raised about any of the recent updates, then get in touch with your medical school UKFPO Student Representatives prior to the upcoming National UKFPO Meeting, on 7th May.
theMEDICALSTUDENT / March 2014
News Editors: Chris Smith and Krishna Dayalji news@themedicalstudent.co.uk
NHS Change Day: 3rd March Krishna Dayalji News Editor This March, the National Health Service (NHS) will once again see all staff, students, patients and the public alike, make pledges to improve patient care as part of the second NHS Change Day. Described as a ‘game changer’ after the unprecedented success following its launch in March 2013, this grassroots movement has no single figurehead, but aims to make all pledgers leaders of change. NHS Change Day is a unique health and social care concept, the largest of its kind, with the aim of improving health and care. Developed by a group of emerging clinicians and managerial leaders, the aim of the project was to create a frontline led movement of staff to commit, simultaneously and publicly, to change and improve health and social care services in a single day
of collective action. It was hoped that a target of 65,000 pledges would be reached by the end of the day – 1,000 for each year since the NHS was established. However, with online pledges hitting a staggering 189,000, clearly the response to the firstever NHS Change Day was extraordinary. It was also believed that the timing was optimal. Having been in public scrutiny following a series of high profile scandals in the recent years, something was needed to boost the low morale of the NHS staff and its patients. The interim report following NHS Change Day 13.3.2013 added that: “Today, we are at a point in NHS history when there is a greater need than ever for those who value the NHS to contribute to making it fit for the future. NHS Change Day and the change movement it has sparked shows we can rise to that challenge.” It further added: “It was about making big change happen, not just thinking about it or analys-
ing it or suggesting how to do it but by simply doing something better together.” Examples of pledges made included a paediatrician tasting medicines he was prescribing to his patient, and when realising that many were unpalatable, he started working with his pharmacy to change the flavour. Another innovative pledge came from a student nurse who set up a mock ward for students to experience care from the patient’s perspective, whilst another GP spent the day in a wheelchair to understand how his disabled patients felt. However, the majority of pledges surrounded the theme of better patient care, the most popular of which were the simplest, for example: ‘to smile with patients’ or ‘take more time to listen with patients’. So whatever you decide to do on 3rd March 2014, let TMS know your pledges and what you think about the NHS Change Day project.
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Research In Brief IMPERIAL COLLEGE LONDON Researchers at Imperial College London believe they have found the cause to why passive smoking is known to worsen asthma symptoms in children and the impair the response to inhaled steroid treatment. Published in the journal Chest, the researchers have found that children with severe asthma with a parent who smokes at home have lower levels of the enzyme HDAC2 compared with those whose parents don’t smoke. The significance of this enzyme is that it is required for steroids to exert their beneficial anti-inflammatory effects in asthma. The mechanism that has been identified makes children less sensitive to inhaled steroid treatment, so they suffer more symptoms and might have to take higher doses of steroids, which may lead to side effects.
UNIVERSITY COLLEGE LONDON A new treatment for patients with acute respiratory distress syndrome (ARDS) has seen mortality rates plummet by about 80 per cent. The results of a Phase II trial led by Dr Geoff Bellingan have been published in The Lancet Respiratory Medicine. At the moment there is no effective drug treatment for the syndrome, so patients tend to be treated with mechanical ventilation and optimisation and support of vital functions.
KINGS COLLEGE LONDON Researchers at King’s college London have identified a new gene (P1M1), which could be an effective target for innovative treatments and therapies for psoriasis. Affecting around 2 per cent of the population in the UK, the study highlights for the first time the role of P1M1 and the IL-22 cytokine in skin inflammation such as that seen in psoriasis patients.
ST GEORGE’S, UNIVERSITY OF LONDON The requirement of bowel surgery is dramatically reduced by up to 60% in patients who develop Crohn’s disease if they receive prolonged treatment with drugs called thiopurines, says a new study. Researchers from St George’s, University of London and Imperial College London, monitored more than 5,000 patients in the UK living with Crohn’s disease for more than 20 years and looked at the effect of thiopurine drugs that suppress inflammation in the gut. They found patients taking thiopurines, such as Azathioprine, for more than 12 months had a 60% reduction within the first 5 years of diagnosis.
BARTS AND THE LONDON SCHOOL OF MEDICINE AND DENTISTRY New research from Queen Mary University of London has discovered 11 new DNA sequence variants in genes influencing high blood pressure and heart disease. It is hoped that this will eventually influence the development of new treatments, yet more immediately, the study highlights opportunities to investigate the use of existing drugs for cardiovascular diseases.
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Features Editor: James Wong features@themedicalstudent.co.uk
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#Neknominate – Undermining Dry January Joshua Getty Guest Writer Over the last month a new internet craze has taken hold of London’s student population - neknominations. Instead of memes and Spotted posts, which are mostly outlets for the great procrastinators amongst us, neknominate has a much more dangerous aspect having already claimed at least 3 lives in the UK and Ireland. According to Urban Dictionary, if you are neknominated you have 24 hours to record yourself downing an alcoholic concoction (typically at least 1 pint’s worth) of your own creation. Then you can
nominate others to take part. This is the same brand of entertainment as Jackass, amusing the masses by doing something stupid and harmful. Whilst some videos have genuine humour through self-deprecating sketches, there has been a notable escalation in the potency of the mixtures. The early videos posted by medical students were restricted to a pint of beer, but more recently students have been downing entire bottles of spirits. Not only is this reckless regarding their own health, it is also a professionalism issue. Drinking has always been a part of medical culture – as anyone who’s been
to a sports night can attest. Many senior consultants trained at a time when it was acceptable for doctors to drink to excess (by modern standards at least); therefore there is an attitude of benevolence towards this aspect of student life and there is minimal motivation to change. At one London medical school a group of prominent students ran an effective and commendable Dry January campaign to raise awareness of alcohol issues amongst the student body. Yet barely 48 hours into February and the self-same students were engaging in neknominations and posting the videos to Facebook.
At the very least this is sending contradictory messages to younger students and undermining their own admirable work throughout January. Yet a greater danger is posed by the public display of individual excess. Medical students are held by the GMC to the professional standard of doctors, yet are also part of the wider university community and reconciling the professional duty with student life is a key issue – embodied in this instance by neknominate. In 2012, the same medical school introduced a compulsory digital professionalism module to the curriculum. This serves as a
clear guide for students regarding what is and is not acceptable behaviour when using social media. Specifically it was emphasised that evidence of excessive drinking should be removed. Whilst the general public has little interest in the behaviour of university students, medical students are under greater scrutiny when it comes to medically harmful behaviour on the basis that medics should know better. Engaging in neknominations is dangerous and many naïvely assume that their privacy settings protect them, but when 18-24 years olds have an average of 510 Facebook ‘friends’, how private are our actions?
Exhibiting Murmurs: The Littmann Sound Builder app for iOS Devon Buchanan Guest Writer The Littmann Sound Builder app for iOS is like a museum. It contains some unnatural-looking heart sound specimens in pots on shelves, and it’s free to enter. The app can help you picture physiology better, but it’s so divorced from the real world that it won’t help you identify heart sounds in a clinical setting. The app itself consists of a list of fourteen lessons on subjects such as “third heart sound gallop”, “severe mitral stenosis” or “patent ductus arteriosus”. Each of these lessons follows the same format: four screens containing paragraphs describing the heart sound and its cause, a computergenerated version of the sound, a visualisation of the sound, and an animated heart spread. This app is made by a company that
sells stethoscopes though, so it does contain discreet links to their products and pictures of an expensive electronic stethoscope. The Littmann app’s computer-generated heartbeat can be helpful for understanding cardiac physiology. The fact the heartbeat is computer generated means it’s really easy to identify different parts of it, and the fact I’m not listening to a real person’s heart means nobody is going to be concerned if I listen to it for five whole minutes. The app’s discussion of physiology is inadequate for medical students, so I combined it with a textbook (the Oxford Handbook) and found the textbook was more understandable when I matched what it said to Littmann’s computergenerated heartbeat. For example, looping the sound of aortic regurgitation helped me relate the sound to which parts of the anatomy made them, then what
the pressure in each chamber was doing, where blood was flowing, and what this would do to the heart in the long term. Littmann could have improved the app’s ability to teach physiology by including more diagrammatic representations of the heart sound. Their animated heart could highlight the source of every sound to reinforce the link between anatomy and clinical signs (it currently highlights only some). They could have also included an animated diagram of pressure changes in the chambers and vessels to explain, for example, why aortic stenosis produces an ejection systolic murmur while mitral regurgitation produces a pan-systolic murmur. I could figure this out from the diagrams in my textbook, but animating the diagram provides a good opportunity to make important observations clearer. The Littmann app doesn’t ap-
pear to be of much use when trying to learn how to listen to and identify murmurs in their natural setting. Most of knowledge important to students in clinical situations is absent. It does not suggest steps to auscultate the heart. It does not help you predict findings from a patient’s history or examination. It does not include real recordings where heart sounds vary and lung sounds can obscure them. It does not tell you about the relative frequency of different murmurs so you can avoid diagnosing a condition the cardiology consultant has heard only once in forty years of practice. Littmann could have included the information above in their app, but there’s no reason students can’t read it in a textbook instead, like I did. Instead, including real heart sounds would be the best way for this app to teach identification of real mur-
murs. This is something paper textbooks cannot offer, and it could really help students discriminate which sounds are important, and which are just noise. Including several different real examples of each heart sound would be even better, allowing students to appreciate for themselves the variation in heart sounds. It’s surprising Littmann did not do this, since the app is partly intended to promote a £330 electronic stethoscope with the ability to send heart sounds wirelessly to a PC. Overall, this app misses a lot of opportunities to teach cardiac physiology, and contains little of what students need to know to locate and interpret heart sounds. This doesn’t make it a bad app, however, it just means students need to know how to use it best -- listen to it alongside a textbook to help relate abstract physiology to perceptible signs.
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Features Editor: James Wong features@themedicalstudent.co.uk
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Observing the Post-Mortem Narmadha Kali Vanan Features Sub-Editor You never forget your first. No, this isn’t a clichéd line about newfound love. It’s about my first time observing a postmortem. Not very romantic, but equally interesting, I kid you not. Before the actual post mortem itself, I wasn’t quite sure what I had gotten myself into. Part of me was extremely excited, being part of something you usually see on television (thanks, Hannibal), you have to admit, is pretty cool. And figuring out a cause of death sounded like it was in line with the Sherlock Holmes theme of the month. But part of me was unsure, how would I react to the dissection of a recently dead person (a child or a baby, no less)? A real person, in the flesh. With a story and a family. This wasn’t going to be
like seeing a preserved cadaver during an anatomy practical, trying to follow the course of the vagus nerve, that was for sure. So, it’s clear that a storm of uncertainty and mixed emotions was raging within me as I slipped on my shoe covers and walked into my gown as it was held out by one if the assistants. Stepping into the clean white room, my gaze was drawn towards an opened up body, half stuffed with cotton wool at the end of the room. I was quickly distracted by several hunched figures towards the other end of the room, before I could react to it. “We’ll be done in a second,” one of the figures called out as I tip toed a little to peer at the two bits on the table. It was a pair of fetal kidneys, with the adrenals still attached. The pathologist carefully sepa-
rated the adrenals from the kidneys, weighed each one and placed them into a little plastic bag, which was already filled with some viscera, presumably from the earlier part of the post mortem. She sliced the kidneys thinly, looking to see if there were any visible abnormalities. My eyes drifted to the case from which the kidneys had come from; it was a baby, a very empty one. Proclaiming that they were normal, she gingerly picked them up with the forceps and placed them in the plastic bag. “This will be going back into the body. And we’re done. What’s next?” she said. After wiping down the table, a small package was placed on the table. Unwrapping the package, it was another foetus. We went through the notes provided before beginning the post mortem, lending
us some context as to how this foetus came to be before us that day. As expected, knowing the story behind the body was slightly unsettling, the harsh hand of reality playing its game once again. The pathologist then began a systematic disassembly of the body; removing, slicing and weighing different organs. I have to admit, seeing these organs in a non-preserved state was exciting and I could hear myself running through all the weird names in my anatomy lectures as I listened to her point out abnormal features and things that she found intriguing. As the post mortem progressed, I slowly pushed the fact that the organs laid out before me used to be a living individual out of my mind, such was the extent of depersonalisation of the procedure. Towards the end of the
post-mortem, when the technicians started to stuff the remaining shell of the foetus with cotton wool and the plastic bag containing its viscera, the crushing realisation that I would not be much more than a skin bag of organs after I died came down on me. I was surprisingly accepting of this proposition, which may seem a tad grim for an ending to this. Observing a post-mortem has definitely elucidated the fragility of life for me and lent me some perspective on why a family would have reservations on having one performed on their dearly departed. In terms of post-mortems being part of the curriculum, I believe that it is a great way to see pathologies first hand and serves as revision for our extensive anatomy, but it will not sit well with everyone, that’s for sure.
Chinese Restaurant Syndrome Daryl Cheng Staff Writer If one eats at Chinese restaurants enough, a complaint is sometimes heard, a topic of lively discussion over dim sum, over the various purported health effects of Chinese food. The symptoms range widely from things like headache and palpitations, to sweating and even chest pain. So many people are convinced that the food is to blame and even propose various remedies, a nice cup of tea perhaps, or a refreshing glass of cola. Even if they can’t decide on a remedy, they are united in their conviction that MSG, or monosodium glutamate, is to blame. Perusing the aisles of an oriental supermarket, one may see bags of this magical powder on display, with the three letters brazenly plastered across the packet. The story of this strange syndrome and the chemical which follows it begins many decades ago, in a well esteemed medical journal. Robert Ho Man Kwok, MD, wrote to the editor of the New
England Journal of Medicine, published April 4, 1968, about some strange symptoms that he and his friends had experienced whenever they went to get dinner at their local Chinese. His short letter mentioned they wondered whether the flushing, chest pain and parasthesia they experienced was at all related to the food they had been having. He termed it ‘Chinese restaurant syndrome’. He then made some guesses as to the cause, including soy sensitivity, liberal cooking wine use, or excessive salts such as monosodium glutamate. The light-heartedness of this conjecture certainly did not seem to have been lost in translation with subsequent letters published in May of the same year, and various follow ups, including ‘Japanese restaurant syndrome’, ‘Chinese restaurant asthma’, and the delightful ‘Szechuan purpura’. However, others seemed to take this poorly defined entity slightly too seriously, with Schaumburg et al confidently proclaiming “Monosodium L-glutamate is the cause of the Chinese restaurant syn-
drome and can precipitate headaches.” And as this factoid permeated (somewhat) popular culture, so the scientific community responded with slightly more sober and level-headed reasoning. Morselli and Garattini pleaded in Nature that no one had bothered to do any sort of blinded trial. And when they did give 24 healthy volunteers three different broths, with one containing three grams of MSG, using a double blinded crossover technique, they found no significant difference in their reports of symptoms. Nevertheless, as the media picked up on this delicious morsel of column filler, the conjecture that MSG causes ‘Chinese restaurant syndrome’ (whatever that might be) slowly became truth through an endless litany. The subsequent decades of ever larger trials, all showing no relationship between MSG and any ill effects could not undo the damage. But what really is MSG? If you harassed someone at Whole Foods buying organic quinoa on their opinion of the stuff, you may get some
attempt at persecuting this wonderful molecule as an ‘unnatural chemical’. Everything we eat, is of course, a chemical, and MSG is as natural as they come. It was isolated by Kikunae Ikeda in 1908 as the component of the Japanese taste umami (perhaps most accurately described as the savoury taste), and a vital part of Japanese stocks, dashi. A cursory search will reveal message boards of concerned mothers and other health conscious individuals demonising MSG: it would seem like they thought it was carcinogenic, lobbying for the FDA to label its use and ban its sale. But lest you think it is only a component of Japanese and Chinese cooking (it is naturally abundant in shiitake mushrooms, for example), various cuisines have found plenty of delicious foods full of MSG. Those truffles (the mushroom) that people pay through the nose for? That lovely piece of steak aged for weeks by the butcher? Or that wedge of Parmesan that tastes so good by itself or melted over everything? You guessed it, chock full of MSG. So next time you go out for
some Chinese and order your favourites, you can rest easy. It’s probably not very good for you, but it isn’t because of the MSG.
REFERENCES Kwok, Robert Ho Man. “Chinese-restaurant syndrome.” N Engl J Med 278.20 (1968): 796. Schaumburg, Herbert H., et al. “Monosodium L-glutamate: its pharmacology and role in the Chinese restaurant syndrome.” Science 163.3869 (1969): 826-828. Morselli, P. L., and S. Garattini. “Monosodium glutamate and the Chinese restaurant syndrome.” Nature (1970): 611-612. Lindemann, Bernd, Yoko Ogiwara, and Yuzo Ninomiya. “The discovery of umami.” Chemical Senses 27.9 (2002): 843-844.
[FEATURES]
theMEDICALSTUDENT/ March 2014
Features Editor: James Wong features@themedicalstudent.co.uk
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iBSc Review - Medical Education Hannah Bradbury Guest Writer Earlier this year I began intercalating in Medical Education at Barts and the London. Having already completed 4 years of medicine, I witnessed first hand the transformative power of effective teaching, but also the detrimental effect of poor instruction on the learning process. I’m sure we can all name that lecturer who mindnumbingly reads from slides in a monotonous voice for an entire 60 minutes, or the clinical placement where you were cast aside and made to feel that your mere presence was a hindrance. Hopefully, however, we have also had teachers whose confidence and passion could even make histology appear interesting and possibly inspired our future career paths. Well I want to be the latter kind of educator; therefore a BSc which allowed me to develop my teaching skills and increase my knowledge of basic educational theory and effective educational strategies, was an opportunity too good to pass up.
So a bit about the structure of the course. The course is made up of 5 compulsory modules and the project- the fundamentals of education (Fun Ed), theory behind teaching and learning (TBTL), teaching methods teaching skills (TMTS), assessment, evaluation, quality and curriculum (AEQC) and finally issues and methods in educational research (IMER). The term starts September and ends in mid May, that said all the teaching and exams are done by mid March, leaving April and May for the dissertation. So yes that does mean you have a long summer and no you don’t have exams at the end of the year, however, this results in an extremely stressful and hectic first term. In the lead up to Christmas there are continuous deadlines and the first 2 modules (Fun Ed and TBTL) are mainly taught through PBLs requiring a lot, and I mean a lot, of reading. Then at the end of all that you don’t even have Christmas to relax, with exams on the first day back. So please don’t consider medical education if you’re one of those stu-
dents who wants to intercalate for a relaxed ‘year out’, the course really does demand a great deal. However, the workload eases up after January and the course content is very interesting to someone like me fascinated by the theoretical and practical basis of good teaching. Throughout the year we have learnt all about educational theory such as how groups learn, how memory works, what factors affect success and how to assure quality in a medical curriculum. We were then able to apply these principles in practice in the TMTS module, where we facilitated PBLs, taught anatomy, clinical and communication skills. This allowed me to not only increase my understanding of theoretical teaching principles but to also critically evaluate and develop my teaching skills. Then there is the research project. There were a range of varied and interesting projects offered this year, from prescribing skills training to resilience in medical students. Students can also self organize if they are interested in a particular area
and the proposed project is feasible. My project concerns first year medical student’s views of diversity teaching, a requirement in all medical curricula, but with little agreement on how best to deliver this type of teaching. Like all other medical education students at Barts, I will submit my project abstract to an international conference and I look forward to presenting my findings to an audience of experts in this field. I really appreciated moving from a class of over 300 students to only 16. With most other BScs the students are split up with optional modules, modules taught in conjunction with other degrees and individual lab work, however, in medical education all teaching is delivered to the entire class. As a result, we (like previous medical education students) have become a really tight knit group. We have 5 students from other universities and hearing about their institutions, curriculum and assessment was very interesting, adding experience and a new dimension to the whole group.
Despite the unexpected workload, I am certainly glad I chose to intercalate in medical education. I have developed new skills in research, such as how to critically appraise, different approaches to research and how to design a project. Throughout the course we have to keep a portfolio, something I have never done before, which has made me far more reflective and provided good preparation for the future. In addition, with the extensive number of essays to write throughout the year and them forming the end of module assessments, I have been able to refine my writing skills, something I had little opportunity to do in medicine. As stated in ‘Tomorrow’s Doctors’, doctors are now expected to develop the skills and practices of a competent teacher. This course provides the perfect opportunity for that and with it changing from a BSc to MSci next year, if you’re interested in becoming a future educator then there has never been a better time to intercalate in medical education.
iBSc Review - Medical Sciences with management Ajayavelu Singaravelou Guest Writer “You’re fired” growls Lord Sugar, announcing the demise of yet another contestant. I think it was at this moment, perched with my family in our usual Wednesday ritual that I decided to go ahead with my BSc in management. To clarify, I was not expecting my year at Imperial to be my own impromptu Apprentice season, one can always hope, and there was (a little) more to my decision making than this. Hopefully this review will allow you to make a far more informed decision than my harebrained efforts. I should start by saying that despite my best efforts to sabotage my BSc year, it was one I enjoyed thoroughly and one that should feature very high in your considerations if you would like to take a brief sojourn from the science heavy medical world.
You will be told on your very first day that this course is about learning the language of business. This is a sentiment I could relate with, having seen first-hand the disconnect between the management and medicine in my local hospital. You may not be fluent in the language come July, but you will know enough of the vocabulary of accounting or business strategy to hold a conversation. Without sounding too trite, the course also teaches you to look at things a little differently, to be more analytical with your choices. In hindsight, of course I should have constructed a balanced scorecard to carefully assess my options. The course is structured in a modular fashion with the winter and spring terms each hosting five modules. These vary from very typical business courses such as accounting or marketing, to those with a much more medical slant: Information Sys-
tems in Healthcare and Managing Healthcare Organisations. Having these more medically orientated modules interspersed with the others does a very good job of adding variety and acts as a reminder of the clinical significance of the more traditional topics, which can be a little hard to see when working through a particularly dry accountancy problem. The summer term begins with exams on the previous terms modules and continues apace with the conclusion of the Group Project. The Group Project is a very significant component of the course which generally spans most of the year and accounts for a quarter of the final grade. It is here that I feel I have done a grave disservice in labelling this degree a sojourn in any way. While the first two terms are comparable in workload to a preclinical year the final term will be unbelievably hectic. There will be tears, sleepless nights and innumerable meetings to hone the
presentation and final report. As a result, the projects are all almost invariably of a very high standard and many will result in publication and/or presentation at a conference. There is an immense sense of pride as you will surprise yourself with the quality and scale of the project. The breadth and scope of the projects offered is also fantastic, ranging from more economically centred topics to those on global health and ethical discussions. It is worth noting that almost every module will incorporate group assessed work. This means that around 30-40% of the final grade will involve group work which I feel is entirely justifiable as working within a team is a key component of management. However this is something to consider if you prefer to work on your own terms and your own pace. The course is also an excellent opportunity to improve your presentation skills as well as time
managements as there will always be deadlines to meet, meetings to attend and presentations to give. Management is often stereotyped as the initial steps on the path to being a GP or even for those feeling sufficiently disillusioned to consider exchanging medicine for the City but there is more to it than that. The fact is that there are not enough medically trained personnel who are business literate. Even if you have no interest in the business aspect of medicine, management is unavoidable regardless of what path you choose. Whether that route leads you to be a hospital consultant, into the business department of a hospital, into public health or even into general practice, you will be part of a team and you will be managing people. If you are keen to do a less medicine focussed BSc and willing to offer the toil and tears required, I recommend Management wholeheartedly.
[COMMENT] /10 The Art of Good Practice theMEDICALSTUDENT / March 2014
Comment Editor: Rob Cleaver comment@themedicalstudent.co.uk
Oscar To Staff Writer
thermore, the fact that you can read a book and feel empathy for the characters and themes discussed highlights how good communication can be; the words on a page translate themselves to feeling in spite of the fact that you are not actually seeing anything.
Almost uniquely amongst the sciences, medicine is considered not simply a pure science, but also an art form. Nonetheless, the majority of our teaching is focused on scientific knowledge and fact learning, especially during pre-clinical years. And yet suddenly, a miraculous transformation occurs at the end of these years and we gain communication skills. The fundamental reality of medical school teaching is that the arts feature as a fleeting glimpse at best. There are few arts studied during the course, to the point where ethics, law and social sciences are considered to fill these roles. Yet these subjects are nonetheless treated by most students as accessory topics that only need to be passed. Who can doubt students that make this choice when most universities set these areas as pass or fail exams? And do we really need all these “artsy-fartsy” skills when clearly scientific theory is at the heart of medicine? Well, if the Francis Report is anything to go by, the answer is a clear and obvious yes, unless we find the continual dehumanisation and downright abuse of patients to be an act acceptable of repetition.
[The arts, when taught well provide two key skills for medics; empathy and communication] The arts, when taught well provide two key skills for medics; empathy and communication. Our medical education places an intense emphasis on memorising vast quantities of facts and scientific knowledge, and whilst this is undoubtedly necessary to some degree in the practise of medicine, is there a finer balance that could be achieved? For example, the majority of facts that any student learns is purely for the purpose of sitting an exam. And in the real clinical world, the action of one molecule on a receptor
[We must realise that no matter how much we learn, an inability to understand a patient will only hamper our ability to deliver effective care]
is hardly going to allow us to treat the patient in front of us. Furthermore OSCE marking systems favour students who can remember all the points on a checklist rather than students who are actually able to engage well with a patient. Communication is taught to a limited degree in most medical schools using actors; this art is to be perfected via personal diligence in history taking. However, these limited scenarios only really give us a snapshot of how to respond to a situation particularly as not all students get a go at a given scenario. Students are asked to reflect, but
given only a framework. Useful reflection requires a far deeper process than following the questions on a sheet; it needs the understanding of communication in its own right.
[Reading a book and feeling empathy for the characters highlights how good communication can be] Another key skill is the ability to convert our medical jargon into something comprehensible to the lay person. It’s all well and good that one can recite the myriad of pathologies that can
affect a patient with hypertension, but whether you can convince a patient that it’s a problem they should care about is another matter entirely. But how do the arts actually improve our communication skills? An oft heard phrase by senior clinicians is that students are very good at handling information vertically but not horizontally. I.e. we are good at reciting everything about one topic but not at connecting separate topics. The approach in arts however favours collating information together to produce a coherent narrative to form a discussion. Fur-
Empathy is viewed by many as an innate skill. However, the Francis report argues it is the culture of certain institutions that produces bad care; empathy can be moulded by our environments. The majority of medical students come straight out of sixth form and enter the medical profession with what can in most cases be considered minimal life experience at best, especially as the vast majority of us will come from privileged backgrounds. Most patients we meet will not only be older than us, but will have lived through hard times that we simply have not experienced. Patients often do not have only problems with their health; they often have social problems that are passed dismissively to a social worker. Short of actually gaining all this life experience before qualifying, a shortcut can be made by simply ensuring that students study other walks of life. Even the act of watching a film can open up the mind of a person to the issues that really affect patients in a way no textbook can reflect. Students must realise that no matter how many hard facts they choose to learn, an inability to understand a patient at their level will only hamper their ability to deliver effective care. Only by immersing ourselves in the world beyond the walls of medicine’s ivory towers can we begin to connect to those that need us most: the people that we are treating, the people to whom our understanding matters most.
Send your unadulterated thoughts to comment.medicalstudent@gmail.com
[COMMENT] /11 Going in Search of the Elusive Female Surgeon theMEDICALSTUDENT / March 2014
Comment Editor: Rob Cleaver comment@themedicalstudent.co.uk
Jingjie Cheng Staff Writer Back in the time when my future was still a massive blur of possibilities, I discussed the viability of a medical career with my mother, herself a doctor. The conversation went something like this: “I think I want to be a surgeon. A neurosurgeon would be cool,” I said, stroking my chin. “Are you mad? Do you know what the hours are like? You won’t have time for your family,” my mother replied, waving her hand as if swatting the preposterous idea away. “Why not? I can have good work-life balance and anyway, why can’t the husband do some chores too?” I insisted. “Well, have you seen any high-ranking female surgeons around yet? Why do you think they are so few? The hours are punishing, especially for a girl who has family responsibilities. You’ll die of stress. Unless you don’t want to get married…”
[Despite the number of women in medical school being higher than men, they make up only 8.7% of consultant surgeons in England ] Indignation swelled up in my chest, and I was about to retort when I realised that my mother was right – in all the local hospital attachments I had been on, I had not seen a single female consultant surgeon. I come from Singapore, where one might grudgingly
concede that the last remnants of “traditional Asian values” suggest that women should be the main carer of the family. In a more liberal, Western country like the UK, such limitations should not exist, right? Wrong. Statistics show that despite the fact that in the past few decades the number of females accepted into medical schools across the UK has been slightly higher than males, in 2011, women made up only 8.7% of consultant surgeons in England.
[In a liberal, western country like the UK, such limitations should not exist, right? ] If one is to believe what surgeon Professor Thomas wrote in the Daily Mail last month, this disparity is because female doctors tend to avoid more time-demanding specialties and gravitate towards general practice, often going part-time after starting their families. This, he argued, was hurting the NHS because “it is necessary to train two female doctors so they can cover the same amount of work as one full-time colleague”, and having part-time GPs compromise the continuity of care. “Medical school places should be given to those most likely to repay their debt to society,” he concluded. During my mother’s time, it was said that our local medical school limited the number of female medical students they took in, on the assumption that they would be wasting valuable, heavily subsidised places in medical school if sometime
in the future they decided to quit their profession or go parttime to start a family. This is no longer the case, but I remember being furious that such things happened. There are several issues in question here – why do female doctors tend to avoid more time-demanding surgical specialties, and should that be a reason for accepting fewer girls into medical school? Taking the figures Professor Thomas cited into consideration, it does make economic sense that taxpayers’ money be spent on nurturing male doctors. However, the numbers he cited do not make up the full picture. In a response, the Royal College of Surgeons pointed out that according to the NHS, women may make up 66% of the part-time workforce, but that 83% of female doctors work 30 hours or more. Besides, it is not true that general practice is an easy way out, as he seems to suggest. They are necessary in the community and the diversity of cases poses unique challenges. More importantly, even if female doctors do tend to take more time off work to fulfil family commitments, why are these figures taken as unshakeable social trends? Instead of implementing policies to fit these trends, why don’t we ask ourselves why these trends are present in the first place? The number of female specialists in the UK is climbing, but the number of female surgeons remains low, a phenomenon I believe is true across the world. And why is that?
It seems to me that in our society it is unquestionable that women should be the ones to take time off work to take care of the children. I cannot think of any good reason why this should be so. After about a century of feminist movements, I think we can agree that childrearing should be shared responsibility between both parents. Pregnant women can still work, and can return to work soon after giving birth. Aside from that biological difference, I can see no other reason why women should be more responsible for domestic chores. Domestic responsibilities will not vanish with the snap of the fingers, but if our social expectations can change, then there should be as many men willing to sacrifice career advancement to take care of the family as there are women.
[It is in the country’s interests to encourage a work-life balance for both genders in the profession] Thus, instead of blaming women for not being committed to the medical profession, we should be looking at ways to make family responsibilities more equally shared between the genders – by giving more paternity leave, for example. There can also be better childcare facilities within hospitals and surgeries, allowing both parents to dedicate more time to their work. Training medical students is hugely expensive, but raising children is also very important to the state – hence,
it is in the country’s interests to encourage a work-life balance for both genders in the profession.
[There are things that cannot be compromised and these include meritocracy and the freedom of choice] By suggesting that training female doctors is not a good investment for the state because they take on domestic responsibilities is accusing them of something that may not be entirely under their control, and punishing them for it. In any case, I am of the opinion that regardless of economic reasons, there are some things that cannot be compromised, and these include meritocracy and the freedom of choice. If a female student wants to become a doctor and is bright enough, she should not be denied a place in medical school simply because statistics show she is more likely to go parttime than a male peer. Ultimately, anyone who decides to enter medical school and embark on a lifelong journey in Medicine, regardless of gender, must understand that it is a commitment larger than himself. It is about pledging our time to the healing of others and shouldering the responsibility of helping others where they cannot help themselves. On the way sacrifices to our personal lives must be made. If we cannot embrace this immense undertaking, then perhaps we should question our choice – after all, it is a choice.
[COMMENT] /12 I am no Slave to a Textbook theMEDICALSTUDENT / March 2014
Comment Editor: Rob Cleaver comment@themedicalstudent.co.uk
Rob Cleaver Comment Editor There are many people who rely heavily on their textbooks to get them through medical school, dipping in and out like a nervous toddler at the poolside looking for that little factoid, that little bit of knowledge that they are certain will get them through their exams. I am no slave to a textbook, I have never knowingly bought a textbook nor actively sought one out. We live in a digital era, a time where knowledge constantly evolves and mutates, shapeshifting before our very eyes until we know the nature of a thing through research, experimentation and the occasional bit of luck. This is too quick a process for print publishing to keep up with - there are only so many editions that can be put out of a book before
it becomes obsolete. Medicine moves too quickly for the printing presses.
[We live in a digital era, a time where knowledge constantly evolves and mutates, shapeshifting before our very eyes] In my recent exams when I needed references for data or ideas in a lecture I could only just remember I did not browse the library aisles for a book to light my way, as I thought I might have had to do, but instead I used our trusty friend, the internet, to search for research published on the topic. This is where cutting edge medicine is found these days, this is where the themes central to my exams were most likely to be hiding. You could argue that I am still a slave then to reference material, published work on a
Dear Doctor..
D
ear doctor, I had a gastric band fitted for my wedding day so I could look great in the photos but now I am worried because I’m really struggling to keep a whole meal down and feel very tired and lethargic a lot of the time. Is there anything you can do to help me? My wife is embarrassed when I only order a starter! An anxious newlywed
H
ello, Most people I know when committing themselves forever to the pleasure and pain of marriage tend to have a jazz band or at least an insipid quartet equipped only with the skills to perform
Coldplay covers and the compulsory James Blunt tearjerkers. Therefore I believe that you may have got mixed up about what a wedding band entails. Enjoy your soup. Dr. Hatespop
D
ear doctor, My friends are increasingly worried that I am not going to pass my finals exams. They’ve been revising for them since the beginning of the year and so will have had a full four years to prepare for them once they arrived. I’ve not even started revising for my first year exams yet and they keep shaking me by the shoulders telling me to wave up and smell the competitiveness. I don’t think that I am being wreckless but my friends are start-
topic that can be used to flesh out the skeletal form of my own knowledge and you would be right. It is different though to a textbook, meaty and intimidating on a bookshelf, last withdrawn from the library in 2008 by someone you’ll never know. In those intervening years it has passed its sell-by date and is decomposing at the back of the fridge. The world has sped up and so has its knowledge base, the old tomes are just that. Pubmed and databases like it hold far more in them that is applicable to our future practices than textbooks can. It is from these studies that pioneering treatment will precipitate and as those seep into common practice we will modify our practice to be in line with these recommendations. We’ll never go back to the interventions that the textbooks of our education told us because medicine moves forward rather than backwards. We’ll have to read
Have you got a problem? Let us solve it! ing to ignore me when on study breaks in the library
H
Keenan Fresher
ello Keenan, I believe that you may be the most boring human being that I have ever written to. I apologise for saying that because obviously your friends are even more boring tham yourself but I have not had the opportunity to reach them in writing. Therefore I ask you to do my bidding for me. Firstly, you are not doing anything wrong, you are a fresher and you should be at university as little as possible and in Picaddily Institute paying £17 for a single drop of warm lager as often as you can. Your friends need to understand this. Just because you’re paying £9,000 a year doesn’t mean you should turn your back on the delightful,
from academia as doctors so we should encourage ourselves to do it every so often at medical school. Learning has undoubtedly
evolved but the humble textbook has been left behind and just like its Jurassic acquaintances it is soon to become extinct.
institutionalised weirdness that occurs during medical school. Hijack these study breaks with alcohol, devise drinking games that involve medical knowledge so that your exciting friends can get involved, invite me round to play them too because I miss medical school so much and I just want to get drunk and not have to look at drug charts or have responsibility any more. I’m sorry Keenan, I’ve failed you and myself.
the cold, death stare riddled ride on the London Underground. I look forward to hearing from you.
Dr. A Nostalgic-Rugbylad
D
ear doctor, I am a medical student from Hull and in a recent Dear Doctor you suggested that Hull was an, and I quote, “undesirable place to live”. I would like to fiercely contest this and seek an apology or at least a clarification of your opinion in print. Hull is a great city with a vibrant heart and exciting top level sports clubs too. There is a real sense of community spirit here and is a far more friendly environment than
Some bloke from Hell
D
ear Hull, you are a city that exists. I cannot and will not deny you that right. Dudley isn’t a city nor is Reading. These are places that exist too but I think they are rather more aware of their own failures as places to not get pushy about it. Hull is the empty husk of a hellhole where I spent my foundation years, sandwiched in between the concrete and the deserted victorian terraces I can’t say that I enjoyed my time on humberside, often hoping that the Princes Quay shopping centre would topple off of its stilts into the water to save me from my prison sentence. Nowadays I am safe, a survivor of the dark days and functional in London. I hate Hull, always - clear enough? Dr. I Still-Hatehull
theMEDICALSTUDENT / March 2014 Education Editor: Sarah Freeston education@themedicalstudent.co.uk
[EDUCATION]
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Out of the lecture theatre into the fire Anonymous If there was ever anything to make you re-evaluate your position as a medical student, and as a human being in general, it would be the first year formative OSCE. I’ve never heard so many threats to drop out, some ‘for the good of all future patients’, than I did after staggering out of the final station. The handfuls of comforting haribo and chocolate – a surprisingly palatable combination – only eased the pain slightly. A rotational whirlwind of triumph and trauma that leaves students both adrenaline pumping and emotionally scarred, the OSCE boasts to provide a real-life demonstration of how one should assert themselves as a medical professional in different situations. Allegedly, the idea is to test your clinical and communication skills integrated with scientific principles in a clinical setting. Scheduled for a sadistic
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8:30 start, the first bleary-eyed cohort of students and I made our way to the room of doom. Hair tied up, clinic clothes on, feeling professional; ready to save some lives. Anyone who has experienced the delight that is the MMI medical school interview process will have the rotational set up clearly imprinted on their mind. That fear of having to win over dif-
ferent examiners over and over again. No time to flutter your eyelashes. The miniscule amount of time in between stations is barely sufficient to read the briefing for the next station, let alone forget what just happened and compose yourself. All the while a military klaxon sounds the beginning and end of each session. It’s a bit like a barn dance around
the room: the redness of my cheeks certainly suggested there was some sort of exertion involved. Despite the first station demonstrating that data is not always easy to interpret, I set off to a steady start. Unfortunately, my most major hiccup occurred when having to negotiate some unwieldy medical equipment. After getting
http://www.ku-med.com
this blunder out of the way early, the subsequent stations weren’t quite as horrific: I had resigned myself to the fact that I was entirely unprepared for this. I could only clarify what was being asked of me so many times before I had to concede I had no idea. This didn’t stop me gushing several potential answers in the hope that the examiner’s face would momentarily light up in glee if I hit the jackpot. After remembering that the order you do things in doesn’t always matter, I found myself introducing myself 3 minutes in to the discussion. What a mess. After moving from this station I saw the ‘patient’ whisper something to the examiner – probably ‘what exactly are the entry criteria for medicine these days?’ or perhaps ‘who was that clown?’ Aside from some questionable advice and some relatively worrying gaps in my knowledge the remainder of the OSCE went off without too many hitches. I at least have marks for hand washing (fingers crossed). I washed them so often they were smoking. I also made the mistake of licking my fingers after tucking in to my totally excessive postOSCE breakfast (yes, it was still early enough for breakfast). Bleuuugh, I think it made me drunk.
theMEDICALSTUDENT / March 2014
Education Editor: Sarah Freeston education@themedicalstudent.co.uk
[EDUCATION] /14
Conquering PubMed Sarah Freeston & Louis Hainsworth Education Editor & Guest Writer Getting published is increasingly becoming the holy grail for medical students. With fierce competition over foundation programme places, medical students are seeking any way to get ahead of their peers. Publications account for a maximum of two points in the application, following the changes for 2015 applicants, providing a small consolation to make up for some questionable SJT answers. Therefore, students can often feel pressured to get published as early as possible with little understanding of how the process works, which adds to the stress of medical school.
Others jump on the bandwagon too late and find that finals need to take priority. Therefore, I would suggest finding out the hows whys and whats of getting published early on and then be looking out for publishing opportunities before clinics take too strong a hold. Publishing is a long and laborious process and help from seniors is a necessity. So what is it that motivates people to spend those hours researching, analysing and editing when there’s plenty of examinable facts to memorise? Academic writing and publication have far-reaching benefits that stand you in great stead for speciality training selection and the rest of your medical career. CV enhancement is the obvious advantage. But writing articles
Illustration by Dominik Chapman
also allows students to pursue areas of their own interest and further develop their knowledge, be it basic science, inpatient management or evidence evaluation. This can enhance a students’ understanding and lead to other opportunities, such as presenting at a conference or teaching more junior medics. Although the bright lights of establishing the evidence through novel research can be blinding, audits (that is, assessing whether guidelines are actually being followed and improving patient safety) are equally important. Foundation doctors need to complete an audit to get signed off and the GMC also stipulates that all doctors should engage in quality improvement programmes. So it’s worth honing these skills early, such as how to mine vast quantities of data from patient records, knowing how to design a study to ask the right questions and how the data you’ve got can be analysed to answer that question. Just be careful that what you’re doing is still teaching you something – students are a fantastic source of cheap, enthusiastic labour, which can easily be taken advantage of by busy seniors. Ok, I’m interested, but what can I write about? Case reports are probably the easiest way to get on the publishing ladder. However, not all articles have to be based around a research question or case report but can be about your own personal experiences of being a medical student and the impact these have had on you. Where can I publish? Obviously, the aim is Nature. But let’s be a bit more realistic! There are journals out there that cater specifically for medical students: the International Journal of Medical Students, Medical Student Research Journal and Stanford Medical Student Journal to name a few. My interest in biomedical publishing has led me to sit on the editorial board for Res Medica. Res Medica is a peer-reviewed journal of the Royal Medical Society, founded in 1957. An editorial board of medical students currently runs the journal with
input from senior clinicians who stand on the international advisory board. The journal’s aim is to encourage the academic interests of medical students through promoting academic writing and publication. Medical students can learn more about the process from article submission to publication by peer reviewing submissions. Being a junior reviewer allows students to learn more about how to critically analyse a paper; an essential skill for doctors as it allows us to interpret and understand research papers and ultimately use the results to impact care. It’s fascinating to experience the world of publishing from the other side. Res Medica is currently accepting submissions – deadline 31st March.
Top tips for getting published: 1) Choose a topic that interests you: you will be spending lots of time on this so make sure it’s enjoyable. 2) Speak to senior colleagues about your ideas: they will be able to give you practical advice on what is possible, how to win over editors and how to accomplish your goal. 3) Search the literature to see what has already been done: journals are more likely to publish an article that is new and innovative. 4) Write the abstract first to focus youself and then rewrite it at the end to make it better. This is the first (and sometimes only) part the editors will read. Ensure the aim of the paper is made very clear and is in-line with the conclusion. 5) Choose your journal carefully. Look at the article types they publish (there are some case report-specific journals). Do they accept articles from medical students? What is their main audience type? You want the right people to see your article. Is it specialist of generalist? Wise up on the journal’s submission instructions - don’t get caught out on word counts or missing article sections. Remember patient consent and any disclosures. 6) Make the article easy to read with clear headings for each section and clear, concise sentences. Avoid the temptation for fluffy language - it’s not a poetry competition. 7) Ensure there are no spelling or grammar errors. If the article is filled with errors the content of the article will get overlooked. 8) Persist with your article submission. If it gets rejected from one journal use the feedback they provide, alter the article and try another. Make sure you alter the journal-specific criteria and are targeting the right audience at the right level: it’ s highly unlikely that a student will get published in Nature or Science.
[CULTURE] /15 “Welcome to the Dallas Buyers Club”
theMEDICALSTUDENT / March 2014
Culture Editor: John Park/culture.medicalstudent@gmail.com
Janan Sathiendran Guest Writer Dallas Buyers Club had a troubled production history. The script had been in the works since the mid-90s, but could never garner the interest of industry executives at the time. A film asking the audience to root for a homophobic cowboy who gets AIDS? Hollywood laughed; there’s no money to be made in this. The film was pitched to [director / lead] Dennis Hooper / Woody Harrelson, Marc Foster / Brad Pitt, Craig Gillespie / Ryan Gosling; but during all this time, it was unable to secure the financial backing it needed. Finally, in 2008, Jean Marc-Vallée and Matthew McCounaghey signed up. And Marc-Vallée was given half the budget he’d hoped for, and 25 days to film everything. Given all this, Dallas Buyers Club is a pretty remarkable achievement. It tells the story of Ron Woodroof (Matthew McConaughey), a Texan troublemaker with few redeeming qualities. He’s unhealthily skinny, mouths off, takes and deals drugs, has his way with prostitutes far too often; he’s awful, and yet I could only pity him. After all, he really looked terrible; credit to McConaughey for the 23kg (50 pounds) he lost for the film. He completely embraces his character, both mentally and physically, and by doing so creates a very real person for us to watch - not an archetype. So when he’s diagnosed with HIV, we are allowed to feel sympathy, for two reasons; because he’s not an incomprehensibly bad guy, and because we realise that no-one deserves to be afflicted with life-long, life-threat-
ening illness. The sequence in which Woodroof remembers the unprotected sex he had with needle-sharers, and realises the distressing reality of his situation, is heartbreaking. McConaughey plays the emotions so well; grief at his diagnosis, pained anger at the homophobic stigma he comes to be on the receiving end of (he himself isn’t gay, which arguably makes him feel even worse); and the expression of these feelings is multiplied in the frailness of his face and neck, in which we see the most delicate changes. The beginnings of respect for Woodroof come in when he, naturally, refuses to accept the news that he’ll die in 30 days, and decides to take matters into his own hands. He refuses to accept the idea of being involved
in a double-blinded clinical trial for a drug with little working evidence, made worse by the fact that he might just be on a placebo anyway. So he travels to Mexico, and receives FDA-unapproved treatment there. Then, being a drug dealer, he naturally has another ‘brilliant’ idea: sell the drugs in the US. And he does this successfully through identifying a loophole in the law - and thus the ‘Dallas Buyers Club’ is born. Through all these antics, we’re able to appreciate Woodroof’s cheek, his humorous disregard for the law, and his persistent fight for survival. I also found myself questioning my own opinions - what right do we have to our healthcare? Should a terminally ill patient have the right to treat himself with whatever medication he feels will be of most benefit to him, regardless of its legal status? But still, we witness a change in Woodroof’s attitude; in the end he isn’t fully, explicitly, accepting of homosexuality, but he’s close. There’s a beautiful scene in which he shops in a supermarket and comes across one of his previous ‘friends’. Woodroof introduces him to his transgender business partner, Rayon, which provokes his friend to make a rude homophobic remark, when Woodroof requests that he shake her hand. Furious, Woodroof immobilises him, and then, in wonderfully
condescending fashion, forces him to shake Rayon’s hand. And his friend is shamefully disgusted. It’s made very clear at this point, who deserves our respect, and who deserves our disdain. Which brings me to Rayon, who is played by 30 Seconds to Mars frontman, Jared Leto. He also lost a huge amount of weight for the role, and again that helps him convincingly portray an AIDS-afflicted transgender woman. Interestingly, Rayon did not exist in real life, neither by name nor an equivalent to her, but it’s obvious why her character exists; she’s the total personification of everything Woodroof is uncomfortable with. She’s happier, pushes him to converse with her and tests his discomfort without succumbing to it and letting him be so easily. Her character makes Woodroof’s gradual acceptance of people like her more obvious, and more personal. Jared Leto plays Rayon gracefully. It’s difficult to say whether she’s perhaps quite archetypal, but she’s definitely sweet, and funny, and those who are more willing to accept her become so easily drawn to her charming personality. But she’s not without her problems; she’s also addicted to and abuses drugs, which Leto again brings across well. In many ways, she’s just like Ron Woodroof - something he perhaps realises in the back
of his mind, but refuses to acknowledge initially - but she’s more optimistic, and that carries through to us; we feel that optimism too, and also see it blossom in Woodroof. I had a few small problems with the film; firstly, at times the story felt a little slow. I think this came down to a combination of directing and writing errors, but there were moments when I felt like the plot had come to a pause. This might also be due to the second problem I had: a lack of proper development in Woodroof and Rayon’s relationship. The film didn’t spend enough time displaying the deeper changes happening within Woodroof, and his reasons for gradually accepting and embracing Rayon as wonderful company. We instead see this happen more on a surface level, and while that’s pleasing enough, I just thought that there was some emotional depth missing. But none of that hinders the film too greatly, and in the end, the career-best performances from McConaughey and Leto, along with the film’s great supporting cast, made watching Dallas Buyers Club a wonderful experience. I can’t imagine the endless hard work that had to be put in to tell an amazing story under such huge production constraints, but that’s just what Jean Marc-Vallée has done here.
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theMEDICALSTUDENT / March 2014
Culture Editor: John Park/culture.medicalstudent@gmail.com
March 2014 at the cinemas
Paranoia
Half of a Yellow Sun
20 Feet from Stardom
Labour Day
The Past
Liam Hemsworth (Gail from The Hunger Games franchise) has a go at trying to headline a film, although even with the backing from some big names such as Harrison Ford and Gary Oldman, can’t lift this borderline unwatchable turkey. Adam (Hemsworth) is a tech company employee whose hot-headed behaviour gets him in trouble with his tough boss Nicholas Wyatt (Oldman). He’s forced to spy on Wyatt’s biggest competition, Jock Goddard (Ford), and gets tangled up in the complicated, deadly world of corporate espionage. Sounds exciting enough, but it really isn’t. To start with, the two big bosses don’t seem to have a brain to share between them, although the worst offender of all is Hemsworth, whose blandness does nothing to solidify him as a leading man. It’s a ridiculous set-up that becomes more preposterous as it rumbles on. There is also that absurd, obligatory love line thrown in there with Amber Heard for marketing purposes and getting its stars conveniently nude when the plot runs out of interesting things to say which is often. It doesn’t live up to its title of Paranoia, hardly delivering any such moments of tension.
Nigerian Gone with the Wind? Not quite, but it sure looks like it, and you have to give it credit for trying its hardest. A story of two sisters Olanna (Thandie Newton) and Kainene (Anika Noni Rose) who are torn away at various stages of the film, may it be due to love, politics or war, the cinematic adaptation of Chimamanda Ngozi Adichie’s best-selling novel is a grand, sweeping epic that deserves to be seen on the big screen. Set during the chaotic times of the Biafran War, when the Hausa and Igbo people clashed for the control of the government, we focus on a handful of people and how this unpredictable conflict affects their lives. Enormously educational as well as it is gripping and deeply moving, their personal dramas are surrounded by constant reminders of an unstable regime that could topple at any moment. Plenty of newsreel footage lets the audience keep up to date with which year/timeline the film is focusing on, and you will never be lost in following the various significant time jumps. A special round of applause must also be given to Nigerian actress Onyeka Onwenu, playing Olanna’s strong-willed, stubborn mother-in-law.
Ever wondered as to who sings all the “oohs” and “aahs” in those many beloved songs that went straight to the top of the charts? For what may be the first time ever, the spotlight of this documentary is on the back-up singers, the ones that don’t appear on the album jacket cover, and the ones who stand in the hidden corners of a concert stage. With interesting input from musicians who have made it big in the industry (Mick Jagger, Bruce Springsteen, Bette Midler, Sting, Stevie Wonder), we are invited to the lives and careers of the very talented and under-appreciated individuals who help shape the music we listen to today. It contains some of the best singing you’ll ever hear as these extraordinarily talented individuals sing their heart and soul out who truly do this out of their love for music. So why hasn’t fame and fortune followed for these women? Why weren’t they offered solo careers? Some aren’t interested, others tried but it was never meant to be. Talent isn’t the only important factor when it comes to this oversubscribed industry. Heart-breaking and entertaining in equal measure, there is a reason why this currently holds a 99% Rottentomatoes rating.
Filmed in the warm, sunny backdrop of New Hampshire’s suburbia, it was supposed to be an ordinarily quiet, uneventful Labour Day weekend for Adele (a well-cast Kate Winslet) and Henry (Gattlin Griffith, excellent). That is until they run into an escaped convict, the dangerous-looking Frank (a brooding, charismatic Josh Brolin) who at first uses intimidation to force his way into their home. And yet as the hours pass, Frank’s more gentle nature surfaces, as well as a true coming-of-age story seen in the eyes of the 13-year-old Henry, and it would appear as though fate has brought these people who desperately need each other together for a special few days. It sounds corny, and it is (the ending especially), but the wonderful chemistry the three protagonists share, and the different stories they have to tell are what keep the film in focus, and it’s not difficult to start rooting for their happiness, no matter how many challenges they have to face. A nosy neighbour, plus an overly-friendly police officer threaten to jeopardise the whole thing, which starts building to an intensely captivating climax, a shift in tone that serves the film’s final few moments well.
It’s a slow-moving yet increasingly absorbing family drama that shows the tragic consequences of a series of mistakes made by deeply flawed but ultimately completely relatable individuals. Marie (Cannes Best Actress winner Berenice Bejo, last seen on The Artist) rather foolishly invites her soon to be ex-husband Ahmad (Ali Mosaffa) to stay over at her place whilst they sort out the final few details of their divorce. Marie is ready to move on with her new man Samir (Tahar Rahim), although even this new relationsihp isn’t without its complications. Add children of different paternities into the mix to throw even more fuel to the fire that’s already starting to burn in this uncomfortable set-up of people who should make it their mission in life to let go and move on. The performances here are all excellent, especially Bejo whose restraint in times of showing obvious frustration and disdain is only topped by her very own occasional fiery outbursts when it all becomes too much to bear. Certain contrived plot elements make their appearances as more is revealed, but there is much to be praised and admired at the in-depth portrayal of a dysfunctional family.
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theMEDICALSTUDENT /March 2014
Culture Editor: John Park/culture.medicalstudent@gmail.com
Outlaws on television John Park Culture Editor The Great Train Robbery
The Great Train Robbery: A Robber’s Tale opens with a killer opening sequence, a slick, fastpaced and stylish scene in which Bruce Reynolds’ (Luke Evans) gang of thieves snatch a box of cash. The problem is, there isn’t enough in there. Looking for the next big score, they receive a tip that could potentially bag them millions, by robbing an unguarded train transporting cash from Glasgow to Euston. A Robber’s Tale tells the process and the immediate aftermath of the robbery in the eyes of the thieves, whereas A Copper’s Tale, the second part of the mini-series, deals with the ensuing 8-man police investigation, headed by DCS Tommy Butler (Jim Broadbent). Both Tales do not spend too much time getting caught up in getting into the deep characterisations of all the individual players involved. There is only a handful of recognisable faces, and you can forget about trying to remember all the names and their roles. The important thing is the acting ensemble remains convincing throughout, and both parts of the series succeed in portraying the volatile dynamic that is bound to occur when a group of ambitious men are placed in a high-pressure environment. Whichever side of the law you are on, there are bound to be unexpected challenges and surprises, developments that complicate your objectives. Both Robbers and Coppers move at an extraordinary pace although they are remarkably different in tone. With the Robbers, the film has a tendency to give it a more glamourous, jazzy feel of the Swinging Sixties, which is when the event took place, something that is reflected most in the soundtrack. Coppers however, takes a startlingly different approach to telling its story; it has a more serious atmosphere, playing out like an extended episode of CSI: 1960s London where the smart, competent and
workaholic Broadbent leads the charge against the robbers who made off with what is worth more than 40 million pounds today. It’s a handsomely-crafted, tense two-part mini-series that smoothly shifts focus between the two startlingly different view points concerning the same crime. Both are led by strong lead actors who head their respective gangs. Yes, the series as a whole is very thin and lacking in characterisation, putting more emphasis on the progression of the many events and stories that surrounded the robbery and the investigation process. But often it works better this way, in a production that is as informative as it is entertaining. Having these two parts also makes the series a balanced viewing, without any over-the-top glorification,
re-telling the sequence of events as it happened. Bonnie and Clyde: Dead and Alive
Remaking an iconic genre-defining classic is never a good idea, especially one that has been loved and admired for decades. Warren Beatty and Faye Dunaway are screen legends whose shoes are certainly difficult to fill but Emile Hirsch and Holliday Grainger have a more than decent stab at recreating the roles of Clyde Barrow and Bonnie Parker, respectively, for themselves. This two-part mini-series gets off to a slower start than how the 1967 film gets going, and puts a lot more emphasis on the
pair’s love and idea of destiny/ fate that surround the couple. Here Clyde has weird psychic powers that allows him to see a glimpse of his future (huh?) that attempts to inject more drama into the story although the foreboding flashforwards that obviously mean nothing good are more distracting than effective storytelling mechanisms. Almost an hour needs to go by before we see anything worthwhile, and until then the audience just has to settle for a pair of very convincing performances from Hirsch and Grainger who exude confidence and magnetism that make them perfectly suited for their roles. Aside from this the first episode feels largely redundant. Eventually the Barrow gang gets together to start robbing banks as a smooth team - one
that consists of Bonnie, Clyde, his brother Marvin “Buck” Barrow (Lane Garrison), his wife Blanche (Sarah Hyland) and Ray Hamilton (Desmond Phillips). The second episode is where the show decides to have more fun. And with the entry of William Hurt, as the main man of the law who starts hunting them down. Another memorable supporting performance comes from Holly Hunter, who puts on a heart-breaking performance as Bonnie’s mother who doesn’t have much of a choice but to look on from a distance as her daughter, once a sweet little girl with dreams of making it big in Hollywood, now robbing banks with her new-found boyfriend. What begins as an uninspired effort manages to redeem itself once the more energetic second episode kicks in.
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theMEDICALSTUDENT / March 2014
Culture Editor: John Park/culture.medicalstudent@gmail.com
Who do you think you are? John Park Culture Editor There is a reason why television critics can’t stop talking about Tatiana Maslany. The fact that her work on the first season of Orphan Black missed out on an Emmy nomination which damn well should have resulted in a win over Claire “I do the same boring crazy spy skit every episode” Danes was scandal enough, but the recognition from the Golden Globes as well as several high-profile wins have justly placed her excellent new science-fiction show on an entirely new, wider playing field. The month of April 2014 sees the long-awaited return of the almighty, epic Game of Thrones, but you also need to be gearing up for the second season premiere of what probably was 2013’s best new show. We start with Sarah Manning (Maslany), a low-life English hustler in Canada who has just left her drug-dealing, abusive boyfriend Vic (Michael Mando) and is looking to connect with her daughter Kira who is currently being looked after by Mrs S (Maria Doyle Kennedy), Sarah’s foster mother, who emigrated from Ireland to the States many years ago. One day she witnesses a suicide. The odd thing being that the lady who jumped in front of a train looked exactly like her. Brushing this off as being a massive coincidence, Sarah steals Beth Childs’ (Maslany, again) identity. Although complicating the matters is the fact that Beth is a cop and is in the midst of a complicated shooting incident. Beth’s police partner Detective Art Bell (Kevin Hanchard) senses something’s up, and it doesn’t get any more awkward when Beth’s boyfriend Paul (Dylan Bruce) shows up. But that’s not all. It seems Beth was up to some investigating of her own. She has been in contact with several of these “lookalikes” and it doesn’t take long for the truth to finally come out. Sarah is one of many clones who were created in a mysterious scientific experiment that went a little awry. And all having grown up in different backgrounds, all these women born in 1984,
have grown up to become completely different human beings. We have the hustler, the cop, a soccer mom housewife, a nerdy scientist, a German who pops up out of nowhere, a Ukranian with some scary, severe psychological issues and that’s just season 1. And in portraying this vast range of characters who are so completely different from one another (they look very different too, sometimes it’s easy to forget they’re played by the same actress - so kudos to the hair/make-up/costume teams), is the immensely talented Canadian actress Tatiana Maslany. Not only does each clone feel like someone whole, there are distinct characteristics that make them all stand out even in a seemingly crowded ensemble. She has a way of making every clone stick to the viewer’s mind, and where several clones appear in one scene, her interaction with herself (acting doubles are used, and edited fragments put together taking almost 17 hours to shoot a single scene where three of the clones are together) appears seamless. Her accents, too, shuffling back and forth mainly between English and American, with some Eastern European thrown in there too, are effortlessly done. Further seasons will only give more room and opportunities for Maslany to expand her versatility as a compelling actress, which is one of many appealing qualities of the show.
With every episode there is a brand new set of twists and turns that both shock and amaze at the bold steps the show is not afraid to take. The writers aren’t interested in making it an easy road for Sarah and the rest of the clones and with many challenges come exciting plot points that become more and more addictive. After one necessary lie, there is another lie, more coverup, and it’s not long before a whole web of lies becomes too confusing to handle even for the protagonist, which There is some excellent cast integration work at play here too. Not only do the clones cooperate (for the most part) for survival, the growing number of supporting players who get in on the mind-boggling sciencefiction conspiracy action keep the pace alive and healthy. Art is a smart detective who, along
with his new partner Angela Deangelis (Inga Cadranel), isn’t too far from putting all the pieces together. Vic, Sarah’s ex, has a way of complicating everyone’s lives just by showing up, which is great news for the audience as the level of tension and drama continues to build. Paul, Beth’s lover and Sarah’s new boy-toy so to speak, isn’t just there to get naked, because his character starts building too throughout the season. Felix (Jordan Gavaris), Sarah’s foster brother, is let in on the clone secret from the get-go, and not only provides some sharp, timely comedy but also invaluable input to the show’s core plot. Most intriguing however is Mrs S, played stoically by Maria Doyle Kennedy. There isn’t a whole lot revealed to us about the strict, no-nonsense Mr S until right towards the season 1 finale, and
given what kind of juicy subplot she may have to play with, her expanded role will almost certainly boost the show’s enjoyment factor next season, as if there wasn’t enough to thoroughly enjoy here anyway. Who are the villains here? Aside from a certain psychopath out to kill everyone it’s an everevolving mind-game to determine where people’s loyalties lie. Even with the clones their individual lives that they have had over the years influence the decisions they make, and just because they share the same genetics, doesn’t mean their priorities are all the same. Conflicts of course arise, and with pressure from shadowy figures who are constantly lurking somewhere, you certainly get the feeling that no one is ever safe, and there will be a whole lot of running and fighting until these characters find some peace. Graeme Manson, one of the creators of the show, has claimed he would like 8 seasons overall plus a feature film of Orphan Black. It’s a show of endless potential, with so many interesting directions it could take. The near-perfect season 1 has been a brilliant set-up. Throw in more clones, remember to ruthlessly kill some too, let Tatiana Maslany do what she does best, keep up the pace, make great use of the non-clones, slowly but surely reveal the villains, have some double-crossing, back-stabbing, but most of all, keep the surprises coming; as the number of jaw-dropping moments in the starter 10-episode season alone was extraordinary. Here’s to 7 more seasons of such brilliance.
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theMEDICALSTUDENT / March 2014
Culture Editor: John Park/culture.medicalstudent@gmail.com
Me Before You - Jojo Moyes Ashra Omr Guest Writer There’s something about reading a book knowing that it will make you cry. You might build yourself up for the tears; prepare yourself with a box of tissues and even make sure no one else is in the room with you. What Jojo Moyes delivers in this book, is not a just a single paragraph to unleash the tears, rather a continuous journey to melt even the hardest of hearts. Me Before You centres on Lou Clark, a quirky but directionless young woman who likes the simplicity and stability in her life. That is until she loses her job at the tea shop (much to the dismay of her family) and has no choice but to take on the role as a carer for a young man. Will Traynor had everything before the motorcycle accident – a high-profile, high-earning career coupled always with a beautiful woman by his side. Then one fateful day, it just took mere seconds for his life to change forever. Will, a man who had the power and the ability to do as he pleased, to travel the
world, to ‘enjoy life’ was soon reduced to just the limited use of his hands and arms. This book enables you to uncover the journey and the relationship that blossoms between Lou and Will. For someone who initially thought a quadriplegic was just “when you’re stuck in a wheelchair”, Lou discovers the sheer extent and magnitude of this condition. Will, understandably, has become a man cocooned in his own bitterness and anger and there’s only one thing he wants to do. However, his parents have employed Lou to make him change his mind. To make him realise there is much left to live for, to explore and to accomplish. Lou has the arduous task to achieve this in 6 months, and there is not a day in which she doesn’t try. Moyes has perfected this story to combine an array of emotions. Undoubtedly, there is constant background sadness, but there are also moments of unexpected hilarity and romance that may spring tears of joy. Will is a man used to independence, freedom and he only ever had himself to think about. And along comes
Lou, who has to feed him, change his clothes and constantly keep him occupied. Albeit she is initially greeted with his temper and sarcasm, she stands her ground and even has some strong words for him. Thus begins a very humorous and dynamic friendship. Laughter aside, the book raises key issues surrounding euthanasia, disability and capacity – all significant topics we may face at one point or another in our medical career. This book gives you a glimpse into the life of a person with quadriplegia. You are able to understand the struggles Will faces on a daily basis and you unmask the pain that underlies his words. You sympathise with his parents whose days are filled with agonising and emotional hardships. And finally, you are moved by Lou with her efforts and sheer determination to make a change. Don’t let the tears dissuade from reading this book. Each chapter is filled with courage, love and possibilities. A truly riveting and thought-provoking read that will keep you gripped until the very end.
She doesn’t give up that easily
John Park Culture Editor Hostages, that started airing on Channel 4, has an excellent premise that would have worked well as a feature film. But as a 15-episode series-long run? Less so. Maybe a show like 24 could have used something like this for Jack Bauer to tackle. But here, the show loses some of
its steam in its overlong run. Ellen Sanders (Toni Collette) is a surgeon about to operate on the President of the United States (James Naughton) who has lung cancer. The day before the most important event of her career, Ellen’s home is invaded and her family is taken hostage (hence the title) by a group led by Duncan Carlisle (Dylan McDermott). What Duncan wants is simple: the President dead.
The reasons? Not so clear in the beginning, although it becomes increasingly clear that Duncan is not an all-out bad guy, but more an anti-hero who the audience is asked to sympathise with on numerous occasions but is not all that easy to do so. Aside from the obvious problems that face Dr Sanders’ family, they also have other issues to deal with: her husband has been cheating on her for quite a while, her daughter is pregnant, and her son is dealing drugs. The show’s scope expands considerably as this conspiracy to have POTUS killed is not just orchestrated by Duncan himself but also by individuals higher up in power (aren’t these things always?). The supposedly shocking reveals the show is so intent on hiding do not come as
huge surprises, as many unsubtle hints are dropped. And as more plot points are twisted and new players introduced, the less believable everything gets. The ambition here to tell a taut conspiracy thriller is more than admirable, and in certain episodes, nail-biting tension is achieved. But once it becomes clear the show is getting too bogged down in giving everyone a subplot, and a lot of them not all that consequential to the final overall story arc. Yet Collette is always watchable and she is the one who keeps the show together. First going from a scared surgeon stuck in an impossible situation, as she starts to take matters into her own hands and tries outsmarting the bad guys to varying degrees of success, it’s her
relentless, resourceful fight for survival Collette portrays so well. One season is plenty enough for a set-up like this: even as a 15-episode series several muddling episodes that go nowhere threaten to slow the whole thing down even in its short, limited run. There is also one little bit of dodgy medical plot line thrown in there for us all to scoff at. But overall it’s an enjoyable show to pass your time, one that is not all too challenging to engage in with just enough conpiracy madness and preposterous twists. If there is, by some miracle, a renewal of the show, it will be wise to use an anthology structure - a new cast and plot every season, to keep it all fresh.
The Doctors’ Mess
Dear Medical Students After twenty-one years of being known to psychiatric services I am not embarrassed to speak on issues that I have limited qualifications to speak about. I can confirm that I have been under the care of more than four hundred psychiatrists. Some psychiatrists would now be retired and some were foreign, but nonetheless, I calculate that I have been seen by not less than five per cent of all the consultant psychiatrists practising in the UK today, either as a registrar, locum, or in their capacity as a consultant. If I say so myself I have gleamed a certain level of knowledge around psychiatric services. I recall a lady I met at Crossfields Day Centre in the London Borough of Camden. She was heavily medicated and recently discharged from Broadmoor. She took a shine to me, told me that her children had been taken into care, which caused her much heartache. She invited me back to her place. I declined for two reasons. The first reason was the lady had previously worked as a commercial sex worker and was vulnerable to sexual exploitation. The lady could not serve on a Jury and it would be questionable if she had the mental capacity to legally consent to sex. The other reason was her accommodation was known to me, a hostel for the mentally-ill in Mornington Crescent, NW1 where drug
addicts shoot up in the garden, leaving behind their used needles. Over time I had a number of conversations with her which repeatedly related to the removal of her children. I have now lost contact with her, she may be homeless, or living in a bedsit, or she may be back inside a secure (as oppose to an acute) psychiatric unit. Ms Zeb’s description of her depression is the most good-natured account I have ever read about the condition. Normally depressives are people one wants to avoid for they are persons of a single topic; their depression. Alcoholics, if dry, are the most pleasurable to listen to, they value life, and if talking about their wet past, can supply fantastic tales of lost weekends that lasted six weeks! But clinical depressives, what can we do with them? Fry their brains with ECT? You may be surprised for some it works. It is the only thing that does work. Others are never the same after ECT living permanently impaired lives with large holes in their memory. Did a philosopher once say we are the sum of our memories? In the debate whether antidepressants help, I take my guidance from Dr Joanna Moncrieff, a consultant psychiatrist and the authoress of The Myth of the Chemical Cure, and she has a position at University College London. I once heard Dr Joanna Moncri-
eff say “that there is no drug out there to treat depression.” I wish to thank Ms Zeb for her review of Depreso, however, the author of the graphic novel could be better placed than Ms Zeb to comment on the efficacy of medication. Personally I do not know the answer to: are antidepressants are effective? But according to anecdotal evidence, fifty per cent or more of all antidepressants are flushed down the toilet bowl, which, indisputably, is a terrible waste of the finite resources of the NHS. Your humble servant, Liam PS – CULTURE - the worst offenders. I quote, “my flatmates found me in the foetal position surrounded by scrawled notes with various conspiracy theories demanding they hand me the Zapruder footage,” was this an attempt at humour at the expense of catatonic psychotics? PPS – the above PS highlights that there can be over concern and under concern and how do you find a middle way?
Dear Liam Thank you for your open and honest letter - it was humbling to read. I am very grateful for your kind words regarding my article on my depression. It’s always scary for me to write about my depression, but it is not all that I talk about - my friends are glad to know! With regards to my review on Depresso, no one can know if antidepressants are helpful, but many people in my support group, my depressed friends, and I personally have benefitted from anti-depressants. Granted it’s not for everyone, and fortunately it’s no longer for me, but I feel I must object when someone argues anti-depressants aren’t effective. For some people it makes a huge difference; for people like me, it helped through the worst patches. It may not solve the problem or be the most effective treatment, but it’s an extra support that I appreciated having access to. Statistics do show some medications are no better than placebos in mild-moderate depressives but I don’t think that’s a reason to write them off all together. With anti-depressants, some people find them a huge help in their life - a close friend says she couldn’t live without them. For others, it sadly doesn’t do much. I simply don’t want people dismissing them as a serious option if they ever need help because they heard or read medications do nothing. But I do agree with the graphic novelist that they are prescribed willy-nilly
History Corner - First Female British Doctor The first female British doctor (practising as a female) was Elizabeth Garrett Anderson. Living between 1836-1917, Elizabeth, born in Whitechapel, was inspired by the female American physician Elizabeth Blackwell, to become a doctor, completely unheard of in 19th century Britain. Male dominated medical schools rejected her application, but Middlesex Hospital enrolled her as a nursing student. Keen to rebel, Garrett snuck into male medical
classes until she was barred. In 1865 she passed the Society of Apothecaries exams, gaining a certificate allowing her to practise as a medical attendant, as the Society did not specifically bar women from taking their examinations. After Garrett, the Society changed its rules to prevent other women entering the medical profession. By 1870, Garrett was made a visiting physician to the East London Hospital where she met James Anderson, a successful businessman, who
she married in 1871. Still determined to get that medical degree, Garrett - now Anderson - taught herself French and went to the University of Paris, finally earning her qualification which the British Medical Register refused to recognise. In 1872, Anderson founded the New Hospital for Women in London, staffed entirely by women (a big middle finger up to 19th Century British society), and continued to campaign for women’s rights to practise medicine result-
ing in the 1876 act permitting women to enter the medical professions. In 1883 Anderson was appointed dean of the London School of Medicine for Women which she had helped found in 1874. In 1902, at the age of 66, Anderson retired, before passing away in 1917, at the age of 81.
with no other option available and shouldn’t be seen as the answer. They are I suppose an extra in the treatment package that should be offered to depressed patients. Sadly the world isn’t the way any of us wish it to be. I write my experiences and my opinions in the hope medical students, who like my friends and family will never grasp the reality of depression (and hopefully will never experience it), can at least be less ignorant and more empathetic to any future patients they may treat. My experiences certainly don’t make me an expert on depression and I never speak for anyone but myself, but I feel we have to speak so our stories get heard and people realise, mental health is truly diverse with no two depressions the same, and what one person says doesn’t work isn’t enough to disregard that method of treatment as an option. What medication, treatments and methods of self-help work for one person may never work for another, and that is the point I want future medics to keep in mind. I wish you all the best, Zara
Send your letters to mess.medicalstudent@gmail.com. We would love to hear from you.
theMEDICALSTUDENT / March 2014
Doctors’ Mess Editor: Zara Zeb/ mess.medicalstudent@gmail.com
Prize Crossword Causes of Anaemia
Diagnostic Corner 1. What is the most common symptom(s) of anaemia? a. tiredness and lethargy b. dyspnoea c. pale complexion and dry nails d. no symptoms at all 2. How is iron deficiency anaemia diagnosed? a. blood test b. electrphoresis c. genetic history d. drug history 3. What is the main cause of bleeding in stomach and intestines in men and post-menopausal women? a. non-steroidal anti-inflammatory drugs b. peptic ulcer c. stomach or bowel cancer d. all of above 4. What are the cmmon casuses of iron deficiency in women of reproductive age? a. pregnancy b. irregular periods c. lack of iron in diet 5. Which statement is true regarding treatment of anaemia? a. It cannot be cured, only managed. b. It can be cured with iron supplements but the patient attends follow-ups. c. It is treated with iron supplements, but this leads to complications.
ACROSS 2 Type of anaemia in which mean corpuscular volume is between 76 and 96 fl (10) 7 Autosomal recessive cause of anaemia found more commonly in those of an African origin (6, 4) 8 Inherited anaemia with symptoms of jaundice, splenomegaly and leg ulcers (13) 9 Term for reduced number of eythrocytes, leukocytes and platelets (12)
DOWN 1 Anemia associated with poor intake, e.g. in alcoholics (6, 10) 3 Anaemia related to chronic bleeding, e.g. from a peptic ulcer (4, 10)
6. What can severe iron deficiency anaemia increase the risk of developing? a. tachycardia or heart failure b. lung collapse c. myocardial infarctions d. stroke 7. What is the characteristic shape of vitamin B12 deficient red blood cells?
4 A macrocytic anaemia found in autoimmune conditions due to vitamin B12 malabsorption (10) 5 Microcytic anaemia mainly affecting people of Mediterranean origin (12) 6 Enteropathic condition with megaloblastic anaemia (7, 7)
10 Term for varying shapes of blood cells (12)
a. abnormally lage b. abnormally small c. taregt cell 8. What is the most common cause of vitamin B12 deficiency? a. pernicious anaemia b. poor iron intake through the diet c. alcoholicism 9. What is another role for vitamin B12 other than producing red blood cells?
Congratulations to Rob Michael from Barts and the London School of Medicine and Dentristy for winning our Prize Crossword: Causes of Joint Pain in our February issue! ONLY THREE MORE FANTASTIC PRIZES TO BE WON! For your chance to win a copy of the Interpreting Chest X Raysprovided by Scion Publishing Ltd, simply send a photo of your completed crossword to: doctorsmess@themedicalstudent.co.uk
a. reduces the risk of birth defects in unborn babies b. keeps the nervous system healthy c. helps absorb nutrients from the intestines 10. Which of these statements about the treatment of vitamin B12 deficiency are true? a. B12 supplements are given by injection at first and then by tablets. b. B12 supplementary tablets or injections may be required for life. c. Dietary changes can negate the use of vitamin B12 injections and supplementary tablets. 11. What sort of condition is pernicious anaemia?
March means EASTER!...
a. hormonal b. dietary c. autoimmune
Means two thirds of the way through the year...
12. Which organ does pernicious anaemia affect?
... And my inbox is lonely, so please drop me a hello, ask me questions, or send your contributions to doctorsmess@themedicalstudent.co.uk.
a. stomach b. spleen c. pancreas
Answers: 1a. 2a. 3d. 4a. 5b. 6a. 7a. 8a. 9b. 10a, 11c. 12a.
[SPORT] /22
theMEDICALSTUDENT / March 2014 Sports Editor: Mitul Patel
UCL Squeezed Out in Battle for Top Spot but the fleet footed KCL player managed to sneak it with effective use of ang l e s . U C L’ s p l a y e r m o u n t ed an immediate response. Having played his way into the match, he began to read his opponent’s shots and play the ball consiste n t l y e a r l i e r. T h e p r e s s u r e was too much even for t h e h o m e t e a m’ s s p e e d i e s t member and UCL levelled the tie with this 11-8 5-11 5 - 1 1 3 - 1 1 v i c t o r y. The match had come to a deciding rubber between the second seeds. It proved to be an attritional affair
KCL Squash Men’s 1st team Photo Courtesy of James Wong James Wong Features Editor T w o o f L o n d o n’ s f i n est student squash teams fought for top position o f t h e B U C S M e n’ s S o u t h Eastern 1A league last month as the finale of the s e a s o n’ s p l a y h a d K C L and UCL first teams pitted against each other in a v a r s i t y - e s q u e e n c o u n t e r. The derby match took place on KCL turf, where possibly the coldest pair of courts in central London traditionally make for tough playing conditions with returning balls falling devastatingly short; a veritable feast for the shotmakers. The evening delivered a closely contested battle. The first seeds opened proceedings with predominant front court play involving a number of memorable drop-counter drop exchanges, soft hands by both players and even flourishes of showboating a n d t r i c k e r y f r o m K C L’ s captain. It was four corner stuff with UCL fearlessly attempting to kill the ball
into the nick from the far recesses of the court. The pace was frenetic but KCL squeezed a hard fought 1 1 - 7 1 2 - 1 0 1 2 - 1 0 w i n , h a ving converted first time to take both tie breaks in the last two games. The first game between the 4s featured long testing rallies, jostling for the central T position. U C L’ s p l a y e r f o u n d a g o o d weight of stroke from the start, hitting predomin a n t l y t o l e n g t h . K C L’ s number four struggled to keep the pace, and UCL saw the match out in clinically 5-11 7-11 4-11 to equalise the tie. The game between the 3s demonstrated a large contrast in styles. Searingly hard hitting from K C L’ s m a n a n d s t r u c t u r e d r a l l y b u i l d i n g b y U C L’ s captain. The severity and dazzling barrage of cross court nicks by KCL sealed a convincing 11-2 11-7 11-7 win to give Kings the overall lead after three matches. The knock up between the fifth seeds won its meed of attention. The first game was a lottery
of cat-and-mouse squash. UCL drew first blood , taking a comfortable game with impressive shot making and started the second in equally strong fashion. Though under the cosh for m a n y o f t h e r a l l i e s , K C L’ s man took the punches and his consistency saw him through the next two games to lead 2-1. The safety of his high percentage squash came at substantial cost with U C L’ s p l a y e r t a k i n g f u l l advantage of his opponents acquired fatigue as he absolutely steam-
rollered him in the fourth game, racking up an 11-3 victory in the fourth to leave the entire tie hinging on their deciding game. Laboured breathing and noticeable delays before the service were the story of the a fifth. Although margins were small, it was the KCL man who played the smarter game by extending the rallies and squeezing errors out of his tiring opponent to prevail 4-11 11-6 11-8 3-11 11-7 and bring victory to his side.
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[SPORT]
theMEDICALSTUDENT / March 2014 Sports Editor: Mitul Patel
/23
Remember the Immortals Dexter Valencia Guest Writer
American football is more than Hollywood films centred on inspirational speeches, the Superbowl (and half-time nude celebrity exposés), and a perception of a sport that is rugby with helmets. Honestly. American football has recently been recognised as a BUCS sport and the BUCS championship now has over 60 teams competing nationwide. At university level, all teams have eight regular season games with a chance of playing post-season playoff fixtures to compete for the national championship.
The Imperial Immortals are the American Football team for Imperial College. In 2006, the club joined the BUAFL (The British University American Football League), and perhaps predictably for the newbies, they suffered a miserable eight straight losses in their debut season. But, like all good comeback stories, eight years on, the Immortals are having their best season ever, gaining eight consecutive victories to win the London Conference, and secure a spot in the national championship playoff rounds. Their season started with a comprehensive 26-0 rout of Westminster Dragons followed by a close fought tri-
umph in a low scoring game at Greenwich Mariners. Two home victories against KCL and Royal Holloway followed, the latter of which a nail-biting 22-20 thriller. The winning run continued with a 14-10 defeat of Brunel, and another clean sheet victory against Kingston on their own patch. Their conference-winning victory was an emphatic 36-0 drubbing of City Sentinals. Imperial aside, is there a place for American football in the sporting calendar for a medical student in the UK? Tradition has it that our profession centres around rugby, and certainly some of the oldest rugby clubs in the country, and the world, are UK medical school clubs. The relative obscurity of the sport and scarce opportunities to play prior to university would have, until recently, pushed it further down a prospective students’ list of potential extra-curricular activities. Imperial Immortal and ICSM student Dexter Valencia (I am confused by the decision to quote yourself in your own article -Ed) states, “If there was a medic team I’d definitely play, but unfortunately there isn’t.” Regarding its apparent unpopularity in comparison to uni-
versity rugby, Valencia points out, “anyone of any size can be trained to fit a specific position on the team without feeling left out. It’s very unique in how you train for it and how games are played.” Currently there are five medical students playing for Immortals. First years Adam Walker and Toby Sinclair surprisingly said no to university rugby despite a combined twenty years of playing experience prior to arriving at Imperial. Walker reflected that American Football’s ‘size does not matter’ approach appealed to him, “I was always aware that I was relatively undersized and in later years this limited my ability to be a key player on the [rugby] team, however the fantastic thing about American football is that there is such an array of different positions and body types required that I soon found a position which I love playing and I don’t feel out of place at all.” Meanwhile, quarterback Sinclair reflects the nostalgia portrayed by most Hollywood films about the team spirit at the centre of the sport, “I have never been part of a team where everybody is so appreciative of the role that every-
Sochi: The Bare Bones Mitul Patel Sports Editor Eighteen months on from London 2012 and Olympic fever , or perhaps chills, were back as team GB emulated their best ever medal haul at Sochi 2014. The 22nd Winter Olympics saw over 2800 atheletes participate in 98 different events. 88 nations competed at Sochi; 62 of whom went home empty handed The media hero will be Lizzy Yarnold who won GB’s only gold in the skeleton. Jenny Jones took bronze in the snowboard slopestyle and the curling teams brought home one
silver and a further bronze. The zero was sadly Elise Christie who defied the odds to be disqualified from all her speed skating events; particularly heart breaking for the Scot who won bronze at the worlds last year. GB sat 19th out of 26 medalwinning nations in the overall standings, exactly the same place where they finished in Vancouver 2010 following one gold, again in the skeleton, by Amy Williams. Hosts Russia boasted mostgold medals and total haul; winning 13 golds, 11 silvers and 9 bronze. Just under half of their golds came in the skating events. Norway were second placed
with 11 golds and 26 medals in total; cross country skiing bringing them an impressive return of 11 medals; 5 of which were gold. Across the pond, holders Canada beat USA to third place with 10 golds, despite USA having a greater total haul at 28 medals. The Netherlands won 23 of their 24 medals in speed skating, and broke 7 olympic and 2 world records en route to their eight gold haul. The 2018 Winter Olympics is due to take place in Pyeongchang, South Korea. The hosts will look to build upon an 8 medal haul including 3 golds at Sochi, and will be eager to finish ahead of rivals China
GB Olympic Gold Winner Lizzy Yarnold in the Skeleton (Photo courtesy of BBC)
body else plays, no matter how big or small. I immediately felt that everyone in the team is treated equally, regardless of position or age.” American football is a closely knit amalgamation of planned strategy and athletic ability, and hence the weekly training schedule arguably makes even an average week demanding for an Immortal, with chalkboard tactics sessions, training and game time usually amounting to atleast five sessions a week. When asked about the secrets to their success thus far this year, fourth year medic Kyung-Hoon Moon points towards the club’s six voluntary coaches. “They install a tough physical and mental mindset in all the players and expect perfection for the season.” The American footballers at Imperial have grown quickly over the last few years, and in the long term they hope that medical student participation continues to flourish as the sport emerges from the shadows of sports more traditional to the roots of a medic in the UK. For now, the onus is on the Immortals to continue their fairytale season as they aim to become national champions.
ICSM Break Course Record ICSM men’s 1st VIII continued their dominance of UH rowing in 2013-14 by winning the first long distance event of the academic year, UH head, in record time. Helped by a heavy stream, they completed the 4km course in 10:55, 30 seconds ahead of second placed GKT. The men’s intermediate category was also won by ICSM who finished 12 seconds ahead of holders RUMS in 11:43. GKT won both the women’s categories with their seniors edging to a 3 second victory over RUMS, and their intermediates easily overcoming the rest of UH. This year’s novice categories were cancelled for safety reasons.
[SPORT] /24
theMEDICALSTUDENT / March 2014 Sports Editor: Mitul Patel
Kings of the Ring
Jack Johnstone Guest Writer Your local lecture theatre is a marvellous place. Not many venues boast the credentials of offering first class education, social inter-
action opportunities, prime spots for advertising, as well as a place to sleep away from home all in one! But, would you ever expect to see someone getting kicked in the face live from the safety of your usual seat? KCL Muay Thai Society host-
ed the inaugural “King’s of the Ring” event in the Greenwood Lecture theatre on 29th January. The venue swapped the usual drone of medical lectures for KCL’s first ever showpiece fighting event, with fighters from across London participating. Originally from Thailand, Muay Thai is also known as the art of eight limbs – signifying the use of punches, kicks, knees and elbows. It is renowned for being one of the most physically and mentally demanding martial arts, and combines this with a rich cultural history. Preparation began with the fighters weighing in hours before the doors opened and construction of the ring following the conclusion of the day’s lectures at 4pm. The completed ring sat bathed in red light, waiting for
the evening’s combat. The event, supported by the King’s College Community Fund, was due to host ten fights with representation from corresponding societies at UCL, Imperial, University of Westminster and Queen Mary’s. Prior to the arrival of the spectators, the empty lecture theatre reflected the quiet nerves of the fighters in the warm up room, and a visit backstage revealed a floor littered with hand wraps and water bottles, and bins overflowing with banana peels. The battles opened with an exhibition fight between Kings’ own Hut Chaiyo and Yong Khung Mun. After two no decision fights the crowd were treated to the excitement of a first round knockout by Kings’ Cristain Miere over UCL’s Tom Jones.
KCL followed up on Miere’s success with victories in all the other fights they were involved in, with Parwez Semnakay coming through with a well earned points victory, and both Catalin Frona and Yordan Tordanov finishing their bouts in the second round with a technical knock-out and knock-out respectively. The only two fights to have not included KCL students gave victories to UCL, with Freddie McNicholas and Tayo Adesina finishing with points victories over their opponents from Imperial. KCL and UCL Muay Thai can now look forward to their Varsity match on 9th March, the fixture having finally been accepted as a varsity match-up following tireless campaigning by those involved.
Barts miss hat-trick in UH cup Jack Healy & Louis Peters Guest Writers Barts firsts went into the opening UH cup roundrobin fixture against ICSM confident after beating the West Londoners twice in consecutive games earlier in the season. It promised to be a fantastic game of football as the fixture was a double header with the victors to pick up a vital three points in the BUCS league, and traditionally going on to challenge favourites GKT 1s for the title in the UH cup. However, this game saw the return of several important players for Imperial, and the added quality proved to be the difference as they fought back to win 3-2 and picked up a vital 6 points in this BUCS league/ UH cup double header. Barts may lament the fact
that all three of Imperial’s goals will surely be contenders for their goal of the season, with right winger Michael David scoring two outstanding free kicks and the third a curled effort from distance in open play. The opening goal came mid-way through the first half with David rocketing one into the top corner from all of 35 yards. Imperial went on to dominate the first half, hitting the woodwork on three occasions, but failed to add to their account as the scoreline read 1-0 at the interval. ICSM were made to pay for their profligacy in front of goal early in the second half, as a strong ten minute spell for Bart’s brought them back into contention. The equaliser came after a cross from the left wing evaded the efforts of the man at front post, and continued across the face of
goal, allowing Barts’ right winger to steal in for an easy finish. Within minutes, the score was 2-1 as Bart’s again exploited the left wing. As their left back took advantage of some poor tracking back, Bart’s overloaded the Imperial defence, leaving men free at the far post. Imperial’s goalkeeper managed to save the first effort on goal, but couldn’t prevent the rebound from hitting the back of the net. Without a win in 10 games, it would have been easy for Imperial to let their heads drop. However, they quickly equalised as a flowing one touch move down the left wing involving most of the midfield ended with a curled effort into the top corner from 25 yards by midfielder Avi. The turnaround was complete when David outfoxed Bart’s keeper with a curled
free kick from the edge of the box. Imperial defended their lead resolutely without giving away any more real chances to Barts; holding on for a vital 6 points that could see them on the way to BUCS survival and the UH final. Meanwhile, Bart’s chances of BUCS promotion are now slim, and they probably cannot afford to lose again if they are to have any UH success. Meanwhile, ICSM 2s started their UH Cup campaign with a late victory over GKT. GKT had deservedly equalised after going into the break 1-0 down, but ICSM struck the winner deep into injury time after “Zoobs” buried a loose ball from the edge of the area. The result was dissappointing for GKT 2s who also lost their first round fixture 2-0 at the hands of Georges. Elsewhere, GKT 4s thrashed ICSM 3s in
their opening round fixture 5-2 thanks to braces from Jonathan Thirunavugarasu & Ryan Elliot.
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