Freshers Issue 2014

theMEDICALSTUDENT

Welcome to London

The Freshers Issue 2014

WE ARE TMS AND YOU CAN BE TOO

contact editor@themedicalstudent.co.uk

theMEDICALSTUDENT

Freshers 2014

The independent voice of London's Medical Students/www.themedicalstudent.co.uk

A Religion & Belief Code

St. Georges’ Offer Guidance page 6

Who was First?

Medicine’s Great Leaps

Page 8

A Career in the Closet

Don’t Fall into that Trap Page 13

The Return of the Doctor

What Did we Think of It? Page 19

What’s your opinion: Should we relax the cap on overseas students?

Krishna Dayalji Whilst leading a trade delegation in India recently, our deputy prime minister, Nick Clegg, has called for international students (non-EU students) to be excluded from immigration figures in conjunction with creating a more flexible approach to student visas to encourage bright youngsters from around the world to study in British universities.

This call comes amid claims that Britain may risk losing out in the battle for skilled workers against America and Australia, echoing similar demands made

by Tory former deputy prime minister, Lord Heseltine, for a change in approach.

Currently, international students are included in the government’s net migration target, and international students are the largest group of migrants from outside the EU counted in the figures, representing around a third of all people coming into Britain. Interestingly, according to new research carried out by Universities UK and thinktank British Future, the British public do not see international students as “immigrants”, and the two stakeholders argue that the government should remove international students from the net migration target and in place support and challenge universities to attract more international students to study in Britain.

Of particular interest to TMS are Mr Clegg’s further assertions that the UK should begin to reconsider the numerical cap that exists on overseas medical and dental students in British medical and dental schools. At present, the cap remains at 7.5

percent of each medical school’s intake. The British Medical Association further added that this figure was put in place to ‘manage NHS workforce supply and demand, and prevent a situation where public funding of medical education was spent on preparing a large body of international students who may then leave the NHS and return fully trained to their countries of origin.’

Whilst the Liberal Democrat leader has argued that foreign students would not deprive British students of places but rather increase rev-

enues, the BMA has urged caution and predicted competitive measures.

On the counter, BMA medical students committee cochair Harrison Carter added: ‘It was important that university authorities did not seek to increase the numbers of overseas students coming to study with them simply as a means of boosting their finances.’

He said: ‘The BMA believes in the importance of attracting the brightest and best to UK medical schools. However, any intake of international students should not be with the sole aim

of driving up revenue by UK universities. This could dramatically compromise the ability of an eligible UK student to be admitted to medical school in the UK. ‘We would be concerned at any proposal to remove or reduce the cap on medical student numbers which risks an oversupply of graduates, unemployment and poor value for money for UK taxpayers.

‘There are several recent developments which may further impact on numbers, such as the introduction of private medical schools and this suggestion

could exacerbate the problem.’

However, in accordance with the deputy prime minister, Professor Sir Christopher Snowden, President of Universities UK, added: “The poll is clear that the public sees international students as valuable, temporary visitors, not immigrants. It is also clear therefore that the current one-size-fits-all approach to immigration does not work and must be changed.

“While there has been a sharp increase in the global demand for higher education the UK has seen evidence in recent [Continued on Page 2]

[NEWS]

theMEDICALSTUDENT / Freshers 2014

News Editors: Krishna Dayalji news@themedicalstudent.co.uk

Hello everyone!

[EDITOR’S LETTER] Editorial Staff Editor-in-Chief / Rob Cleaver Assistant Editor / Peter Woodward-Court News Editor / Krishna Dayalji Features Editor / Anne Tan Comment Editor / Oscar To Culture Editors / John Park & Katy Bettany Doctors’ Mess Editor / Narmadha Vanan Sport Editor / Mitul Patel Treasurer / James Orr

Contributors Writers: Kea Horver, Tom Swaine, Utsav Radia, Simon Boyd, Jack Steadman, Rhys Davies, Harriet Williams, Sarah Brand, George Cross and Vernon McGeoch Illustrators: Karishma Dayalji (News) & Alexis Nelson (Doctors’ Mess)

I hope that all of you are refreshed and refuelled, raring to get stuck into yet another year of medical school. Of course for some of you this will be your first year and how envious of you we all are. We remember our faces unbattered by time, a world without the spectre of clinical exams and an innocent place where midweek activities were sought after and not something to be avoided!

If you are reading this and still feel like you’re a little lost in London, that you’re sinking below a sea of possibilities and opportunities – don’t worry, it is perfectly normal.

As long as you give your all when you’re studying and are equally dedicated to all of the extracurricular activities that you will inevitably end up sinking your milk teeth into, you’ll have a phenomenal year.

By the time that you get to the ripe old age of twenty three, the supposed crest of human intellectual potential, everything has gotten a lot more serious.

At the start of medical school I knew nothing about direct deb[Cotinued from front page] ...years of a slowdown in international enrolments. Although the UK remains one of the most attractive destinations in the world for international students, it is our competitor countries that are seeing large rises in international student numbers.

“With international students being caught up in efforts to bear down on immigration, there is a perception internationally that the UK is closed for business and does not welcome students. The call to remove international students from any net migration target has clear public support.

“If the UK wants to fulfil its potential in this growth area, it must present a welcoming climate for genuine international students and ensure that visa and immigration rules are proportionate and communicated properly. The UK benefits hugely from international students – financially, academically and culturally.”

Nevertheless, the BMA has further claimed that ‘the granting of training places to overseas students under the Healthcare UK scheme — a government initiative to attract international trade — will have an impact on UK training places.’ It also highlighted that on average, ‘inter-

its, pension plans or invoices and now my life is a collection of all three stapled together.

I still get time for my own entertainment but how envious I am of the supple nature of a first year timetable, bending and flexing to permit your escape from the lecture theatre to a coffee shop or a gig or a party.

It’s not all bad news though really. Medical school has given me so many opportunities that suburban Birmingham could never have afforded me. Last week I was feeling listless and wandered, via the rickety, muddy footprint flecked District Line, down to St. Pauls and the South Bank and onwards into the belly of the Tate Modern to stare up into the black heart of Mark Rothko’s dimly lit space.

No wonder he thought that those pieces were unsuitable for their original use; as paintings in a New York restaurant!

I laughed a little at a few pieces of impenetrable concept art, bought myself a postcard of a painting just like everybody else and then spent an hour leaning over the edge of the Millenium Bridge to listen to the lapping of the Thames. That is

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one thing in particular that I enjoy about London: the ability to be anonymous, the ability to be a tourist in your own city even after five years of living there.

In terms of opportunities that I can now hand down to you, there is good news to be heralded. We are currently looking for a new Co-News Editor, a Social Secretary as well as an Education Editor and of course we are always looking to tempt you to dip your toes into the waters of student journalism with a lovely article or two. If you are interested in writing for us or becoming a part in our great little team then get in touch. We’ll be having meetings and social events throughout the year so it would be great to meet you all there.

Finally, I wish to thank each of the outgoing editorial staff for all of their hard work. It has been a pleasure to work with you over the past few years. I also wish to congratulate the new editors and writers on their new positions, great ideas and superb articles for this issue. You’re all brilliant!

Rob

Reserve applicants allocated for Foundation Programme 2014 Krishna Dayalji News Editor Towards the end of the previous academic year, the UK Foundation Programme Office (UKFPO) announced that the remaining 18 reserve list applicants had been allocated foundation doctor jobs following the second batch allocation on 26 June 2014.

Last October, it was confirmed that there were more applicants than places available on the programme, and in April it was announced that 235 students had been placed on the reserve list.

As vacancies became available, students were allocated placements in the first batch al-

location in May. Professor Derek Gallen, UKFPO National Director added: “I am delighted that all reserve list applicants have been allocated a month earlier than expected, and therefore the final batch allocation that was scheduled to take place in July will not be needed. This gives the remaining applicants sufficient time to complete the required pre-employment checks, and means that all applicants to the Foundation Programme 2014 will be able to start their programmes in August.”

Whilst this is fantastic news, the ongoing debate with regards to oversubscription of the foundation programme and bringing forward the point of GMC registration remains.

national students studying medicine in the UK contribute more than £100m in fees a year’.

This wider debate is of particular relevance to both current medical students and junior

doctors. Whatever your opinion is, TMS would love to hear about it! Write us your thoughts at news@themedicalstudent. co.uk and we can publish them next month!

[NEWS]

theMEDICALSTUDENT / Freshers 2014

News Editors: Krishna Dayalji news@themedicalstudent.co.uk

Steve Tran & Mohammed Amer Medgroup Chairs Hello and welcome to the first edition of TMS! We are your newly elected Medgroup chairs and it gives us great pleasure to welcome back all returning med students and give a hearty greeting to those just beginning med school in one of the greatest cities in the world!

We are the UH Medgroup; a group comprised of representatives of the 5 medical schools in London, and we get together to give each other support on issues affecting your student lives and future careers. We also organise the great 999, which is coming back with a vengeance this October after last year’s no-show.

Lastly We’d like to give a warm welcome to the new Medgroup committee and SU officers who work so hard for your benefit. We all have great things planned for the upcoming year so enjoy freshers and hope to see you all on the sidelines at the thumping UH sports competitions, the hilarious UH revue and the hugely entertaining UH Sports night!

Adam Mayers GKT President Firstly, a massive thanks to the outgoing ‘King’s College London Medical Students’ Association’ committee, and in particular, President Juliet Laycock who put an incredible amount of work into the new role.

Secondly, KCLMSA is dead - long live GKT MSA! This has been a long time coming and marks the end of the College’s ill-advised ‘ban’ on the term GKT over the last 10 or so years. This is a result of students’ views being taken much more seriously by the School of Medicine – this has also included high levels of student involvement in the ongoing ground-up rewrite of the entire curriculum and, I believe for the first time, an MSA rep on the interview panel for senior staff.

Thirdly, KCLSU have a new sabbatical officer, VP for Education (Health) which should hopefully lead to more engagement from medical students with an organisation that has always had trouble in this area.

Finally, GKT is gearing up for our biggest Fresher’s Fortnight yet – with some of our finest traditions in place (expect to see the streets of SE1 paved with togas, PJs, and speedos over the next few weeks…) and some exciting new additions to the calendar, like the Freshers’ Fiesta and Outdoor Cinema!

Alex Fleming RUMS President As we approach the beginning of yet another year at RUMS, we look forward to the arrival of our new intake of students.

In addition to our traditional Freshers Fortnight activities (boat party, Mums & Dads, pub crawl and much more), we’ll be hosting events to welcome our colleagues who are transferring from Oxbridge. We also look forward to the forthcoming 999 pan-London medical student night out where RUMS will once again have the opportunity to show why we are the best medical school in London.

On the academic side of things, the new UCL curriculum is now running more smoothly, but certain areas are still subject to change, and the OSCE exam system is now being overhauled. RUMS is currently revising its system of student representation, and will continue to work to ensure that the voice of our students is heard clearly when these important decisions are undertaken.

Dheemal Patel SGUL President Hello! My name is Dheemal Patel and I am the incoming President for St George’s Students’ Union for 2014-2015.

It’s been a hectic but enjoyable few weeks since starting and I’ve been meeting lots of new people, attending various meetings and drinking lots of coffee! I’m very lucky to be supported by my two Vice Presidents this year; Natasha Lee (Welfare and Education) and Chris Raby (Finance and Student Activities), along with a strong team of 35 volunteer exec officers who will make sure that our students have the best university experience and are well looked after.

Preparations are well underway for our new intake.

Our postgraduate students will be starting this week and have a week of freshers events including a professional Sushi and Sake class, and our undergraduate students will be joining us in late September, coinciding with our two week undergraduate freshers weeks with events such as laser quest and of course the Freshers Ball!

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Dariush Hassanzadeh-Baboli ICSM President Hello medical students of London!

Things have been pretty hectic here at ICSM. We are currently preparing for our Freshers’ Fortnight and communicating with all the incoming students via Facebookl. They seem like an excellent bunch and are ready to get stuck in. They have already bought over 60% of our ‘Freshers’ Passports’, without having received any official information through their letter box from us! Beat that GKT! We were also abruptly told that all student sport will be suspended at our sports ground in Teddington. This was a complete shock and upset many students, as Mary’s have been using the facilities for over 80 years. A major concern that that has come out of this is that College made the decision such a dramatic decision, with no consultation with students and sports captains. However, we have managed to negotiate to host the UH Rugby 7’s there on 12th October. Please do come along and support your school!

I am also very pleased to hear that the UH MedGroup are bringing back the famous ‘999’ event in October. ICSM will be there to show you how to party, so we expect all of you to do the same!

Sam Rowles BLSA President Hello, my name is Sam and I am the President of Barts and The London Students’ Association. August has been my first month in charge, and it’s been jampacked. Freshers’ Fortnight has been my main focus and I have been working around the clock with my elected team to try and make sure that everything is ready for what will undoubtedly be the best Freshers’ yet.

Alongside this, the rest of my time has been taken up with what seems like half a million training sessions and meet-and-greets. I must now be the most fire-safe, manual handling-proficient and health and safety-aware person in the University.

If anybody has any questions or needs any help, don’t hesitate to get in touch or even come and see me! Campus is pretty lonely with no students.

[NEWS] /6 St George’s introduces new ‘Religion & Belief Code of Practice’ theMEDICALSTUDENT / Freshers 2014

News Editors: Krishna Dayalji news@themedicalstudent.co.uk

Kea Horver Guest Writer There is great conflict between maintaining healthcare standards and religious practise when working in the medical profession. Whether this relates to differing health behaviours or medical ethics, the friction between religion and medicine is a well-publicised debate.

However at St George’s University, a new ‘Religion and Belief Code of Practice: Guidance’ has recently been published to help address the numerous enquiries I receive as the Equality and Diversity Manager at St. George’s University.

Over a hundred enquiries made each year are related solely to religion and belief.

It soon became apparent that both students and staff needed new, open guidance covering the most recurring concerns: religious dress, food and behaviour on campus.

In order to begin this task, I decided to learn all I could about the issues from our current staff and students.

The university has a strong Interfaith Forum which is made up of staff and students from different faith backgrounds. We were especially interested in consulting with the student members of the Forum to hear of any difficulties they might have experienced in reconciling their religious observance with the demands of healthcare practice. As a result, presidents of each student faith group were also asked to seek advice from their own members to help us improve our policy.

This research revealed that some new students were unaware of the reasons behind DH’s so-called ‘bare below the elbow ‘policy. Additionally many students did not

know that decisions related to preventing clinical infection are made locally by each NHS Trust.

At the same time, we talked to academic teaching staff and clinicians to try and understand this issue from their perspective. We found that as teachers of tomorrow’s health-

care professionals they wished to impress upon their students the need to always strive for the highest standards of healthcare practice.

However we also found that some staff were unaware of the range of clothing and practices related to religious belief. Some were confused about what ac-

commodations were available and whether or not it might be appropriate to offer these in lectures, in seminars or during direct patient care activity and if so, when. Such lack of clarity could lead to students who had made similar requests being treated inequitably.

However, we soon discov-

ered that the gulf between meeting healthcare demands and complying with religious observance was perhaps not as great as first thought. If all parties are well informed about what reasonable accommodations may be possible and continue to understand that patient safety remains of paramount importance, then sometimes it is fairly easy to make reasonable accommodations.

Once students, staff and placement providers were all happy with the guidance we were happy to share it as widely as possible.

St Georges has an excellent record in widening participation and so we already attract students from many different backgrounds. Unlike many dress codes this new document is illustrated with photos of our students wearing religious dress. We believe that showing images of our students engaged in healthcare helps ‘normalise’ diversity.

There has been an extremely enthusiastic response to this new guidance. The ‘Medical Schools Council’ which represents the interests of UK medical schools, and the ‘Council of Deans of Health’ which acts as voice of the deans and the heads of the UK university faculties for nursing, midwifery and the health professions both wish to share this guidance directly with all their members.

The Department of Health has described this guidance as “impressive” and asked permission to share it with any individual who raises the issue of religious dress and healthcare in the future. NHS Employers described the guidance as “really excellent” and have also published this guidance on their website.

We hope that both other universities and NHS Trusts may learn from our good practice.

Write for Us! The Medical Student is always looking for keen writers to get involved with the paper.

If you have an idea for an article, big or small, don’t hesitate to contact us; news@themedicalstudent.co.uk

theMEDICALSTUDENT / Freshers 2014

News Editors: Krishna Dayalji news@themedicalstudent.co.uk

Research In Brief BARTS AND THE LONDON, SCHOOL OF MEDICINE AND DENTISTRY Two key mutations in genes that lead to childhood leukaemia of the acute lymphoblastic type – the most common childhood cancer in the world have been discovered by scientists at the university. The study was conducted amongst children with Down’s syndrome – who are 20-50 times more prone to childhood leukaemias than other children. The researchers uncovered that two key genes, RAS and JAK, can mutate to turn normal blood cells into cancer cells. However, these two genes never mutate together, therefore this discovery means we can begin to identify which of the two genes are mutated in patients and developing individually tailored treatment.

ST GEORGE’S, UNIVERSITY OF LONDON Experts at the university have discovered that loss of sensation in the feet, a result of diabetes, may be a predictor of cardiovascular events such as heart attack and strokes. The new research, carried out using information on over 13,000 patients, with T2DM, shows that lack of sensation in feet, which can be easily identified by a patient’s GP, may also indicate future heart and circulation problems.

The new study suggests that testing for peripheral neuropathy, which is offered on an annual basis to all patients with diabetes, may provide a simple clinical way to identify those higher-risk individuals with diabetes who may need more intensive monitoring or treatment.

IMPERIAL COLLEGE LONDON Researchers from Imperial College in collaboration with the World Health Organisation have published a study reporting that the use of both live and inactivated polio vaccines could help speed up the global eradication of polio. A second inactivated vaccine was given to children in India already given the live polio vaccine, and was shown to increase immunity more effectively than an additional live vaccine. The study suggests this new vaccination programme may help the countries facing difficulties in eradicating polio.

KINGS COLLEGE LONDON A new study led by KCL has shown that stroke mortality is associated with nurse staffing but not weekend rounds by stroke specialist physicians. A prospective cohort study of weekend staffing with stroke specialist physicians for patients admitted to 103 stroke units in England was carried out. patients admitted to a stroke unit with 1.5 registered nurses per ten beds had an estimated adjusted 30-day mortality risk of 15.2% compared to 11.2% for patients admitted to a unit with three nurses per ten beds, equivalent to one excess death per 25 admissions. The authors acknowledge that because the study is observational, there could be unmeasured characteristics of stroke services that differ between groups.

UNIVERSITY COLLEGE LONDON Recent research at UCL has shown that whilst weight loss significantly improves physical health, the effects on mental health are less straightforward. The study has shown that those overweight and obese adults who lost 5% or more of their initial body weight over four years were more likely to report depressed mood than those who stayed within 5%. Other clinical trials of weight loss have been shown to improve participants’ mood, but this could be a result of the supportive environment rather than the weight loss itself, as the effects are seen very early on in treatment and are not related to the extent of weight loss.

Therefore, the research suggests that whilst it does not mean that weight loss necessarily cause depression directly, questions about the psychological impact of weight loss need to be raised.

[NEWS]

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A Tribute to Fellow Medical Students From the first day of medical school, we all begin to dream and plan our medical electives, one of the most rewarding aspects of our medical degrees.

Unfortunately, for two medical students from Newcastle University, their elective was brought to a tragic end.

Many of you will be aware of the devastating news of the passing of two fourth year medical students whilst completing their elective in Borneo, Malaysia.

Aidan Brunger and Neil Dalton were completing their sixweek placement with five other medical students when it was reported that the two students had passed away having acquired stab wounds after a con-

frontation with four local men as they were returning to their accommodation in the early hours of the morning following a night out. The news came as a complete shock and was received with great sadness by the entire nation.

Newcastle University has recently made the decision to award honorary degrees to both students in an effort to pay tributes to their continuous hard work, talent, dedication and academic efforts towards their medical degrees.

TMS would like to take this opportunity to share our sincere condolences with the families and friends of the students.

To Buy or Not to Buy? Krishna Dayalji News Editor Medical student leaders at the Brisith Medical Association have recently pledged that they will do all they can within their power to ensure poorer students are not dissuaded from entering medicine following on-going discussions at the Treasury to sell our student loans.

Current plans include shifting this public asset into private hands, thereby moving the borrowed money straight to private financial institutions.

Whilst this is one step towards managing the national debt, we may need to be careful of longterm consequences as current and future students.

At present, the Treasury loans students money via the Student Loans Company (SLC), for tuition fees and living costs for the duration of undergraduate courses. Repayments only being when students have graduated and earn more than £21,000 per year.

However, what many students do not realise is that by signing the declaration from SLC, we technically agreed and gave permission for the terms of those loans to be changed.

As a result many aspects of the

contract can be changed, for example, the amount of time a graduate can spend paying off their student loan (current cap = 30 years) and repayment rates (current rate = 1.5% on loans take before 2012).

Furthermore, the BMA has shrewdly pointed out that whilst universities would stand to profit if they purchased the debt, ‘there are fears that the Treasury might allow universities to charge more tuition fees if they were sharing some of the risk.’

BMA medical students committee have also voiced opinions and set up action plans.

Joint deputy chair Will Sapwell added: ‘We are watching these developments very closely and welcome future consultations.

‘We will, of course, seek to ensure that the outcome is as fair and equitable and possible. The MSC is committed to ensuring that no able student is dissuaded from pursuing a medical career because they feel they can’t afford to train.’

With the increase in tuition fees, there have been fewer students applying to university, and this reduction in financial security may further deter students away from higher education.

[FEATURES] /8

theMEDICALSTUDENT / Freshers 2014

Features Editor: Anne Tan features.medicalstudent@gmail.com

A Feature on Firsts To all the Freshers, The Medical Student (TMS) welcomes you to London and to medical school. We hope to be a companion and guide on this exciting journey. To everyone else, welcome back!

Every year at medical school is exciting and challenging as there are always new things to learn and experience. All first terms, in particular the one in the first year, bring with them new ‘firsts’. The first time you take blood from a real person, the first time you see a dead

body, the first time you see a baby being born. The first time you do an examination on a patient, the first time you take a history by yourself, the first time someone thanks you for doing something medically meaningful for them! The first time you realise you are not going to top the year (do try and remember that almost everyone in your year was top at their school, head girl/boy, sports captain etc), the first time you do CPR on a real patient…and you feel like a real ‘doctor’ for

the very first time.

In honour of the many ‘firsts’ of the first term, TMS decided to dedicate the feature of this year’s first issue to the ‘firsts’ of medicine. This feature is about the innovative and inspirational men and women who were not afraid to do something ‘first’ and in doing so made great contributions to medicine. We want to pay tribute to them and their achievements. After all, as Issac Newton said, if we “have seen further it is by standing on the shoulders of Giants”.

1.) The First Person to Or- tionised it. He did so by mak- today still use it as a reference ganise Medical Teaching: ing it an objective science that point when discussing ethical Hippocrates (460-370 BC) was the first man to organise medical teaching and make medicine a distinct discipline.

He is often seen as the father of western medicine as he revolu-

could be studied with observation and hypothesis, rather than a mystical punishment from the gods. He is perhaps most famous for penning the first code of conduct for doctors, the Hippocratic Oath. Many people

issues. (It is worth noting that there is recent evidence to suggest the Egyptians civilisation had more advanced medical practices even before Hippocrates was born.)

If I have seen further it is by standing on the shoulders of Giants.

460-370 BC The Hippocratic Oath “I swear by all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant: To hold him who has taught me this art as equal to my parents…and to regard his offspring as equal to my brothers in male lineage and to teach them this art… to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else. I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art. I will not use the knife, not even on

129-200 AD sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons…What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself…If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art…if I transgress it and swear falsely, may the opposite of all this be my lot.”

This classical version is based on the translation from the Greek

by Ludwig Edelstein.

From The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein. Baltimore: Johns Hopkins Press, 1943.

2.) The First Clinician to dissect human corpses, he his many findings, was that Scientist: based his research mainly on he proved the diaphragm was Claudius Galenus better known as Galen (129-200 AD) was the first clinician scientist. A surgeon to the gladiators, he became very interested in human anatomy. However, as it was prohibited by law at that time

animal specimens. His ground breaking research often flew in the face of the conventional understanding of the body. His perseverance (and arrogance) allowed him to continue and eventually make many significant discoveries. Among Hippocrates

used in breathing by cutting, what today we call the phrenic nerve, during an experiment.

He is also known as being physician to Marcus Aurelius, the last of the ‘Five Good Emperor’ of Rome.

Galen

[FEATURES]

theMEDICALSTUDENT / Freshers 2014

Features Editor: Anne Tan features.medicalstudent@gmail.com

8.) The First Anatomist:

3.) The First Person to and led him on to do further 5.) The First Person to the patient’s death he would Figure Out the Double research of the anatomy and Relate Symptoms to dissect their body to look for Circulation of the Body: plumbing of the heart. His short Pathology: underlying pathology. His morWilliam Harvey (1578 – 1657 ) was the first person to figure out the double circulation of the human body! His discovery was based on his calculations of the volume of blood in the body

book called De Motu Cordis is a summary of all of his work. Personally, I believe cardiac simulator dolls are called Harvey in honour of his discoveries.

1578-1657

First

Medical the other hand was Medicina

Strictly speaking, the first medical journal was published in French in 1679. The first English language medical journal on

6.) The Trial:

First

Clinical

We like to think of clinical trials as being modern but really the first recorded clinical trial was done on a ship by James Lind (1716 – 1794). He developed a theory that citrus fruit cured scurvy. He divided 12 men into two groups and gave one group oranges and lemons while controlling for other dietary factors.

In less than 6 days that group got better while the rest did not.

When he published his research it was widely ignored until James Cook (1728 – 1779) used his methods to prevent scurvy on his voyages. His empirical research has now been given a biological mechanism as it is now known scurvy is caused by a Vitamic C deficiency.

bid work was based on his belief that every disease manifests in symptoms because an organ is crying out for help. Cautious about his radical hypothesis, he waited till he was 73 to publish the summary of his findings in De Generatione Animalium.

1682-1771 1679

4.) The Journal:

Giovanni Morgagni (1682 – 6 December 1771) was the first person to relate presentation of illness to pathology in the person. He was known for his thorough recording of patient history and presentation. After

Curiosa, first published in 1684.

The New England Journal of Medicine is the oldest medical journal still in print. It was first published in 1812.

1716 1794

/9 British

One of John Hunter’s (1728 – 1793) great legacy is the Hunterian Museum (which is now owned by the Royal College of Surgeons in Holborn, London).

This impressive collection of pathological specimens was the personal collection of Hunter, who was also fondly called ‘Hunter the hunter’. This extensive collection is evidence of a life time of curiosity and a passion for science and medicine.

Working as an army surgeon his experimental surgery led him to make discoveries in previously unexamined spheres of dentistry/maxillary-facial surgery, gunshot management and inflammation. Not particularly eloquent, the treatises he wrote were not particularly popular.

Rather, Hunter lives on because his experimental dissection methodology.

1728-1793 1732

I applied my mouth close to his, and blowed my breath as strong I could.

William Tossach, 1744

7.) The First time CPR modern Western medicine, was performed: the first documented artificial This is a bit tricky as trying to resuscitate a person by clearing the airway and to give mouth to mouth is old. The earliest record is in the book of Kings in the Bible when the prophet Elisha placed is mouth on the mouth of an unconscious child to give the child breath. However, in

breathing was done by William Tassach. This British surgeon in 1732 gave mouth to mouth to an injured coal miner. Friedrich Maass in 1891, was the first person to be documented to have performed chest compressions to keep the heart beating in an unconscious patient.

[FEATURES] /10

theMEDICALSTUDENT / Freshers 2014

Features Editor: Anne Tan features.medicalstudent@gmail.com

9.) The First Successful Vaccine:

14.) The First Doctor to Understand the Molecular Origin of Disease:

Edward Jenner (1749 – 26 January 1823) was the inventor of the first successful vaccine, the smallpox vaccine. He based the vaccine on the observation that milk maids, exposed to the less virulent cow pox were immune to the human strain, which had a high mortality. His experimental work was notable because he specifically challenged his vaccinated patients to the human small pox to ensure that they were indeed immune. This ground breaking work is the foundation of modern immunology. Jenner’s vaccine with the help of some good public health initiatives have eradicated small pox by the 1980s and saved countless of lives.

There are few people in history who have so directly benefitted mankind. It is no surprise that Jenner was recognised as one of the 100 greatest Britons ever in a nationwide BBC vote!

11.) The First Use of a lems and he wanted to better Stethoscope: listen to her heart so he simply Rene Laennec (1781- 1826) is the French doctor credited with inventing the stethoscope in 1816. A post Morgagni (mentioned above) doctor, his medical training included pathology and many were trying to find ways to investigate pathology in a body before the post mortem. In Laennec’s Treatise of Mediate Auscultation (1819) he describes how the stethoscope was a product of necessity. He was attending a young plump female patient with heart prob-

1749-1823

rolled up some paper and the stethoscope was born. Once he realised the benefits of using an intermediate to listen to the chest, he strove to fashion a more precise instrument, settling for a wooden hollow tube with only one ear piece. It was George Cammann in 1852, who made the binaural stethoscope, we are familiar with today. A keen musician, Laennec also greatly contributed to the vocabulary used to describe chest sounds. General Hospital.

Rudolf Virchow (1821 – 1902).

Heard of the Virchow’s triad?

This Prussian doctor is known to be the first to describe the molecular origin of disease and how diseased cells form diseased tissue which eventually leads to a diseased body. He is also known for being the first to describe how a deep vein thrombosis can become a pulmonary embolism. He also believed his ideas on how parts affect the whole could be applied to society and was a great proponent for public health initiatives.

1821 1902

1816

1804

1818

1849

12.)

The First Hu- husband. Blundell’s work has 13.) The First Woman to the first to shun the disguises man to Human Blood origins in Jean-Baptiste Denis’s, Graduate from Medical and successfully complete her Transfusion: (1643 – 1704) who transfused School: medical education, graduatJames Blundell (1791 – 1878) in 1818 did the first effective human to human blood transfusion, when he transfused blood to a woman haemorrhaging during child birth from her

10.) The First Surgery Done Under Anaesthetic: The first recorded surgery under general anaesthetic was done by Seishu Hanaoka (1760 – 1835), a Japanese doctor, in 1804. He experimented with herbs to make an anaesthetic he called tseusensan. Reportedly, the tseusensan would be made into a drink the patient would have before an operation, his first recorded surgery under anaesthetic being a mastectomy.

This place in history could have belonged to William Green Morton, who in 1846 demonstrated the use of inhaled anaesthetics in Massachusetts General Hospital.

blood from animals into humans. Despite the success of these blood transfusion, transfusion did not become wide spread practice till Karl Landsteiner (1868 – 1943) works on blood groups.

Traditionally a male dominated profession, women before Elizabeth Blackwell (18211910) had tried to enter medical schools by pretending to be male. Blackwell was however

ing from Hobart College (New York, USA) in 1849. Known to not suffer fools lightly, it was said that her presence in the class made the other male students far more attentive!

[FEATURES] /11

theMEDICALSTUDENT / Freshers 2014

Features Editor: Anne Tan features.medicalstudent@gmail.com

15.) The First to Describe such as fermentation. Other the Germ Theory of than pasteurisation, this theory Disease: also resulted in Pasteur coming Louis Pasteur (1822 – September 28, 1895). Ever had some pasteurised milk? The process of pasteurisation (to boil milk to remove the bacteria in milk that turns it bad), was named after Louis Pasteur who was the first to describe the ‘germ theory of disease’. This theory acknowledges that disease can be caused by tiny infectious organisms and such microorganisms also cause processes

up with the anthrax and rabies vaccine. It is also worth noting that he was a great chemist as well! If you ever have a chance, visit the Pasteur’ museum in Paris which was the home of Pasteur and his family in the last few years of his life. Now a museum, it houses some of his original equipment among other family paraphernalia and gives insight into the life of this brilliant man.

19.) The First IVF Baby: Louise Brown on 25 July 1978 was the first successful ‘test – tube baby’. She born in Britain to Leslie and John Brown who had been infertile for 9 years due to Leslie’s blocked fallopian tubes. The IVF technique was developed by Patrick Step-

toe and Robert Edwards. Edwards was awarded the Nobel Prize in Medicine (2010) for this invention. The now common place procedure was and still raises ethical issues about whether it will turn women into baby factories and commercialise motherhood.

1978 17.) The First Antibiotic: Alexander Fleming (1881 – 1955) was a Scottish biologist who accidentally discovered antibiotics. He did so because he realised that the fungus contaminating his Staphylococci samples, Penicillium, were producing a lysozyme that was

1822 1895

killing the disease causing bacteria. Proof that sometimes being messy is a good thing! He announced his discovery on 14 Feb 1929. A former University of London lecturer, he shared the Nobel Prize in medicine (1945) with Howard Florey and Ernst Boris Chain.

It is our hope that in in ten, fifty, a hundred years from now, one of you reading this page will be among the greats of our field for your brilliant work!

1929 1947

2008

18.) The First Use of a dogs that suggested defibrilla- 20.) The First Bionic Hand ies where either patients with Defibrillator: tion would shock a heart back paralytic hands have them elec-

1895 16.) The First X Ray: Today, ordering an X-Ray to image the insides of a patient is common place. Have you ever wondered when the first radiograph was taken? Wilhelm Conrad Roentgen (1845 - 1923) was a German physics professor, who was the first to make X –ray images. His first image was of his wife was made in 1895. When he examined the image he created, he noted that the density of the material affected how it appeared on the radiograph, with opaque structures, such as bone and her wedding ring, being differentiated from translucent soft tissue. The first X-ray imaging department would be set up in Glasgow as soon as 1896.

Claude Beck was in surgery when he performed the first defibrillation by shocking his patient’s heart out of ventricular fibulation in 1947, saving the patient’s life. His work was based on early experiments done on

into sinus rhythm. Although the success rate of defibrillation is not as high as the media portrays, it is certainly a lifesaving tool. Hence Automated Electronic Defibrillators (AED) are available in most public places, see if you can spot them.

A bionic limb is no artificial replacement, it is one that is ‘lifelike’, which means it can also move. The first bionic hand was invented by Touch Bionics who created a multi –articulating hand in 2008. These hands are used in reconstruction surger-

tively amputated or patients that have lost their hands in accidents. The new hand is connected to the existing nerve and tissue in the patient’s wrist.

New technologies are allowing patients to even feel with the new hands!

Resources

listverse.com/2013/05/11/10-important-firsts-of-modern-medicine This is a website that gives more information about technological advances in medicine.

emj.bmj.com/content/20/4/316. full - This is a good online article about the Cholera epidemic and the use of IV fluids

If you want to know more about any of the people or breakthroughs in this month’s feature here are some sources that we found particularly useful when putting it together!

Doctors by Sherwin Nuland, published on 1988 is a good resource about the personalities that shaped medicine.

The Pain Clinic IV: Proceedings of the fourth international symposium. Edited by M. Hyodo, T. Oyama and M. Swerdlow. First published in 1992.

www.nature.com/news/historygreat-myths-die-hard-1.13839 This website gives interesting insights into the historical approach and the making of myths and heroes in science. www.nlm.nih.gov/changingthefaceofmedicine and http://womenshistory.answers.com/notablewomen/female-firsts-in-medicine These are both good websites about women who have made a difference to medicine.

www.heart.org/HEARTORG/ CPRAndECC/WhatisCPR/ CPRFactsandStats/History-ofCPR_UCM_307549_Article.jsp This website gives a really good history of CPR. beckerexhibits.wustl.edu/rare/ collections/classics.html This is a good website for an overall view on the great medical texts published through history.

For more Medical Firsts, check our website at : www.themedicalstudent.co.uk

[COMMENT] /12

theMEDICALSTUDENT / Freshers 2014

Comment Editor: Oscar To comment.medicalstudent@gmail.com

Becoming a Clinician: From Theory to Practice Oscar To Comment Editor You’ve slaved away learning the names of drugs that Ebbinghaus would be proud of, you can build a replica cell out of lego, your brain is a living almanac of medical knowledge and now you realise that you have to be able to talk to a person in front of you. Yes, a real, live, breathing, thinking person. And oh my goodness, the encyclopaedia of their life isn’t in print and you don’t have time to read it anyway. Welcome to clinical medicine, where you start to throw the science at the proverbial wall and hope that it sticks.

The true art of medicine lies in the fact that one is not sim-

ply a doctor. A doctor is much more; a mixture of actor, teacher, detective, priest… the list is endless. To be a doctor is far more than the six letter word that defines our role; it is an oath for the people we must be.

Don’t worry though, you’ve got three years to sort of get there, maybe.

The first realisation as a clinical student that you will likely make is that you do not spend most of your time in a lecture theatre anymore, you have to go to places where doctors work. These years are far more about being an apprentice and mastering the craft. The hospital is an uncaring place. Staff time must be spent on patients; after all it is what they’re there for. The reality is that to really take part in the medicine, you

must put your feet forward and start a furore. Some students will be lucky to find themselves on placements where the team treat you as one of their own, where you are given some responsibilities and are given room to grow and nurture your skills. These placements do exist, but they are few and far between; you’re on your own.

Take your time and learn the key skills of your craft: the history. The ability to reach into the seething mass of a patient’s history and drag out a differential diagnosis is not an easy one. The time it would take to do a complete medical history would be hours; every incident from birth to present day would have to be collated. The clinician’s skill is to hone in on what is relevant and exclude the rest.

The initial capacity of a medical student will likely be no more than doing a checklist relevant to the topic at hand; the breadth of knowledge necessary to explore the wide avenues of medicine simply do not exist to begin with. In time, your ability to see the whole picture will grow but it always has to start from somewhere. This is why the much vaunted ward round often falls short; to understand the nuances of management, the fundamentals must first be mastered.

However, knowledge of medical science is also only one hand of the practitioner; medicine is no longer a one sided affair but a partnership between the doctor and the patient. A doctor gains a unique privilege to ask sordidly intimate details

of a person; the oath of trust for this contract does not come with title of doctor. It is all too easy to focus purely on theory, particularly as medical school exams focus ruthlessly on these aspects. The untested skill of communication is a much neglected but also critical skill. One needs only to meet a patient with social problems to put this realisation into practice.

Most of all, the one thing to remember is that now is the time for you to start getting to grips with the job that you’ll have for the rest of your life. Sure, the responsibilities you have will change, as will the procedures you’ll be required to perform, but you’ll still be living in the system. Get acquainted with it now, you’ll regret not doing so later.

Curing Insomnia with Lectures may be Missing the Point Oscar To Comment Editor Mention the word lecture to any person you meet and what will they think? The word used in an everyday sense often has negative connotations, and the memories of most students in lectures will probably involve sleeping to the monotonous tones of an ancient professor.

And yet, you would be hard pressed to find a university that does not use this method to teach. How is there such a disparity between the public perceptions of the lecture compared to the heavy usage by universities as the dominant method of learning?

One simple argument is cost.

To teach in the manner that we were once accustomed to schools and colleges would be prohibitively expensive. However, some would argue that

time spent in lectures would be better spent alone in a library with a textbook. Is the lecture itself an unnecessary cost; token lecturing by professors to give our courses a sense of value?

Each student will have their own experience of lectures, but it is notable that these experiences comprise both good and bad. We need to take a step back, there are elements of the lecturer themselves that are to cause the misery of the lecture.

What makes a good lecture?

The lecturer no doubt forms the crux; they are the person delivering the lecture after all. But a charismatic lecturer is not the only ingredient. If one can only remember the jokes the lecturer told, the lecture may have been enjoyable but it still fails in its purpose of teaching.

This is the fundamental of the lecture: to teach. Yet how often is this the case? Many lecturers only do so because they are

highly respected in their field or to serve an academic commitment. Others teach to sign it off in their portfolios. Is this all the lecture is? A register for all parties involved, an obligation to fulfil, a means to an end? Is that all it means to be a doctor: a checklist of hoops to jump?

It is time we gave the lecture some respect. It should not be sidelined into an obligation of attendance. We should not assume untrained clinicians can be teachers by the virtue of their title. It is about time medical schools took lectures seriously by ensuring that lecturers are trained to do their job.

And there is no point in giving lectures to a sea of blank faces.

Lectures are not something one can simply sit and expect to absorb knowledge. To learn from a lecture is a skill in itself. Students should not be assumed to possess this by default, just as we cannot assume students can

write perfect essays by passing their A levels. These are all skills that need to be taught. It is not enough to tell lecturers or students to just deal with it on their own. After all, is that what you would tell a patient?

Medical schools do try, with feedback forms, though often with poor response rates.

This reflects the enthusiasm most lectures provide. In a sea of mediocrity, it is difficult to distinguish whether there was

any spark of excitement at all.

How are we expected to assess lectures when we cannot ourselves understand what made a lecture good or bad? We read reviews because experts are able to assess the overall structures and fine details that we fail to realise are there. Perhaps it is time we did the same for our lectures, tomorrow’s doctors deserve better than today’s drivel.

[COMMENT]

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Comment Editor: Oscar To comment.medicalstudent@gmail.com

/13

Share, Like, Retweet Oscar To Comment Editor It has never been easier to make friends with someone; after all, it’s just a click of a button away.

And you have more friends than your parents do by a long shot, you cool bean you. And goodbye actual paper, why use snail mail when keeping in touch is simple as whipping out your phone and twiddling your thumbs? If you’re really friendly, you can even use your voice to communicate.

Indeed, why should we even bother meeting people in person anymore. You can find similar minded people using the medium of Twitter. You can make a friendship with someone that you may conceivably never meet from the other side of the globe.

Social media has also made it infinitely easier to share things that make us tick, whether it be

our thoughts, delicious meals that we’re digging into or the super cool things that we’re doing. People can feel fulfilled when fellow friends like their posts or share them with other friends. With mobile technology we can be connected to our friends at every single ebbing of our lives - as long as we have signal!

But is it really about just sharing with each other things we’re doing or how we’re getting along? Getting a large amount of retweets can be an addictive drug in itself as we feel ourselves being accepted by the rest of the world. Our lives can begin to revolve around how we appear online with our massive followings but what does it really say about us, the individual making them?

Why is it that with more and more friends, we feel so much more lonely whilst weeping over our keyboards?

The reality is that we now

have more friends than we can count and yet feel no more fulfilled by them than we ever have; we may even be less happy. Photos seem no longer to recount a beautiful memory but a piece to score points with.

Social media appears to have dehumanised the experience of being alive. No longer are we human beings living for our own sakes; we live for likes.

We have managed to somehow convert our lives into a continual veneer of happy moments, witty comments and status updates for just a small amount of self-gratification. Our lives are now a show that we have the ratings for. However, we also spend time seeing other people’s posts, comprised of their own highlights montage; it is not healthy. Having your life in constant scrutiny is unlikely to help you feel confident about yourself, indeed it can often make you feel inadequate if you don’t seem to have a constant

stream of tasty meals to photograph. Studies even point out that beyond a certain number of friends, people begin to feel increasingly depressed about their own lives, as their feeds

revolve around other people’s success.

Maybe it is time for you to have that facebook friend clear out after all.

models, gay students may find themselves concluding that this is just what ‘professionalism’ means for LGBT medics: keeping your private life private.

A more accurate name for that kind of thinking is internalised homophobia. At its root

is the dangerous misconception that being openly gay is incompatible with being a professional. In actuality, workplace research is unanimous: people perform better when they can be themselves. The professional relationships you foster on placements are a sort of training wheels for the ones you will need in your career, and are better free from the constraints fear of ‘outing’ yourself create.

The law and the GMC recognise this, and protection against homophobic harassment is enshrined in the Duties of a Doctor. Whilst it may not seem that way, there are openly gay doctors (I work for an organisation full of them) to draw inspiration and support from, if you know where to look.

At its simplest, Medical School is about preparing yourself for a career that will last your entire lifetime; don’t let it prepare you for a career in the closet.

Out on the Wards!

Tom Swaine GLADD Student Co-Chair

Coming out is an odd experience; as much as it is portrayed as this key, dramatic, singular event in your life, the truth is the exact opposite. Not in the sense that is isn’t a key turning point in your life (it is), nor because it usually fails to deliver on drama (terrifying with even the most understanding friends and family). Coming out never ends. Instead, you go through variations of this ordeal with almost every new person you meet. Undoubtedly, the process is magnitudes easier with practice, and can, once you’re comfortable, be increasingly avoided entirely via word of mouth, visual cues, and the ‘interested in’ section of your Facebook. Eventually, most of us create a stable bubble of sorts in our social circles, where almost anyone we’re likely to have a meaningful interaction with either knows beforehand or can quickly figure it out, allowing us to banish the prospect of a potentially awkward coming

out anew from our day to day concerns.

That is, until we find ourselves thrust into the quasiprofessional world of clinical placements. Whilst our straight counterparts can continue unfazed through the innocuous exchange of pleasantries on wards, gay students find themselves caught out. How do you respond when the surgical registrar starts up some locker talk, or when the consultant whose clinic you’re sitting in all week asks about what you got up to on the weekend? Homophobic backlash is much harder to ignore when it comes from a superior, and what you get out of clinical placements is all too often based on the relationship you foster with your team. Unsurprisingly, when faced with these awkward and isolating situations, many gay medics find themselves back in the closet (this time filled with gauze, tourniquets and cannulae), and if a patient probes, that closet will be double-locked for fear of professionalism accusations.

Inevitably, some will start to wonder if this is really a bad

thing. Placements are finite, after all, and generally short - why not just suck it up till the next one? Coming out is a very personal experience, so surely it is inappropriate to disclose your sexuality to a patient? Without guidance and visible role

Tom is the Student Chair of GLADD, the Gay & Lesbian Association of Doctors and Dentists

[COMMENT] /14

theMEDICALSTUDENT / Freshers 2014

Comment Editor: Oscar To comment.medicalstudent@gmail.com

Forgetting Smallpox?

Oscar To Comment Editor As medical students, we may often find that medicine is simply a field to be learnt, where discoveries are to be made by far away researchers holed up in their labs. We are not exposed to the challenges that were once faced generations ago when the frontiers of medicine were being pushed by every practitioner. We should explore these many lessons learnt in the face of uncertainty and adversity should be remembered in order to ensure future successes.

One heroic advance was eradication of smallpox in 1979; this deadly disease is no longer something we need to fear. However, it would be mistaken to think it a simple process. Indeed, it took almost two centuries since the discovery of vaccination to finally eradicate smallpox. This was not through lack of want; children would not be counted by families until they had survived an infection.

In the 20th century alone smallpox killed at least triple the casualties of both world wars combined.

The first key discovery for preventing smallpox was variolation; a method that exposed a person to small amounts of

infective material to generate a light infection. Whilst still dangerous, this process gave significantly lower mortality. This process spread mainly among the rich who could afford it, leaving the poor to continue to suffering their burden. This stark inequality led to the first fever hospital made for the purpose of treating the infectious ill and offering variolation for free. Hospitals were of course built to allow the rich to show their patronage, but this gesture enabled people to receive treatment for the first time.

In 1796, a country doctor would discover a way to completely prevent smallpox: Edward Jenner had developed vaccination. This discovery of vaccination is now hailed as a key breakthrough but it was not always so; Jenner faced opposition from both the medical and religious groups. Religious generated a vitriolic scare similar to Wakefield’s modern MMR scare with images of people transforming into cows. Notably, whilst this caused problems with public perception, the scientific community seems to have ignored most of the issues raised; a trend it continues to this day. The ability of the scientific community to respond to controversy seems to have changed little in the space of

two centuries.

Jenner’s problems with the medical community were different; prior to the discovery of viruses and immunity, he could not explain how vaccination worked. His scientific findings had errors as a result. However, his method was undoubtedly effective and it quickly spread all over Europe. Jenner became revered, but was always a humble country doctor at heart; indeed he almost bankrupted himself several times giving free vaccinations. However, this reverence also meant British doctors took his every word as truth, leading to disastrous consequences when Jenner claimed the protection was permanent when it in fact needed topping up. This stresses the importance of proper scientific assessment above the word of a prestigious professor: always cite a source.

Nonetheless, mass vaccination in Europe eventually led to the smallpox becoming locally controlled. Indeed, smallpox had to evolve into a milder strain in the USA to allow it to avoid eradication and spread back to the UK. However, success brought about bigger ideas: achieving global eradication.

Eradication almost never got properly underway, with initial efforts were lacklustre with countries providing insignifi-

cant resources. The programme was almost abandoned until the USSR did something extraordinary. Having exiled itself from the WHO, the USSR returned, donating vaccines for use and an intensified programme to bring about eradication. These new efforts also lead to reflection by the WHO on why failures had occurred, some of which would seem shocking today.

One such finding was that the smallpox vaccine was not heat tolerant and became rapidly unusable in tropical climates.

Further tests on batches also showed that doses were often insufficient. These were failings of quality control, a now integral part to the production of any of our medical supplies.

In addition, vaccinators were trained in varying techniques, with inconsistent results. The development of the bifurcated needled simplified injections; even an illiterate person could easily learn the method, greatly improving delivery of vaccine.

Furthermore, considering the varying states of healthcare and infrastructure throughout the world, it would seem bizarre to impose strict uniform guidelines that were expected to be followed to the letter. The intensified programme instead used scientific method to the

full, with volunteers encouraged to try what they could.

Reports would be gathered and the best practice recommended throughout. These would vary from region to region due to the varying conditions and ensured adaption to the local environs.

The need for a great organisation to oversee all this was also paramount. The WHO would be able to undertake the necessary steps to ensure the surveillance of outbreaks and co-ordinate responses, allowing precision targeting of limited resources to the neediest areas. Other attempts to eradicate diseases such as Rinderpest failed until this was implicated.

However, this required governments to be transparent; the programme was delayed when countries stopped WHO access and lied about outbreaks.

Smallpox left a legacy in extended programme for vaccination, aiming to eradicate other diseases such as Polio.

However, these to date remain pipe goals, disappointingly for similar reasons that the initial smallpox programme failed; lack of funding, lack of organisation, lack of will. It seems history will repeat itself, until we take on the lessons we learned.

And Finally, Welcome Freshers!

Oscar To Comment Editor A warm welcome to the new medical students that begin their journey this year. For many of you, this will be your first degree and your first time away from home. In as little as five short years, you will be a doctor. Long time away though, right? Your first steps will start this year, but it won’t be an easy road, full of twists, turns, bumps, and most importantly, choices. These are the years that will define your future, make the most of it.

Most freshers will be moving out for the first time from the communal family home for the first time, and with it

come a variety of opportunities and responsibilities. Everyday things some people make take for granted such as cleaning, laundry and most horrifyingly, cooking are now things that you need to be able to manage as part of your day to day life. Additionally you now also have control of is your finances.

Try not to play Jesus and convert your bank account into wine, at least not all at once; your hedonism will be repaid in poverty. Have fun, but remember that money does actually run out now unless you borrow more from the bank of mummy and daddy.

Another thing to consider is support from home. Sure, you can call your friends and family but they won’t always be avail-

able for you, and it can get difficult. Universities provide support services for people who are having difficulties, from finance to mental health. Use them: they’re there to help you.

However, just as you are moving away from your old set of acquaintances, you are also finding a new set. University gives you a chance to re-invent yourself, lead your life the way you want it, and be who you want to be. The Fresher’s week is a confusing affair, you’ll often briefly make friends with the people you happen to live around. Don’t feel constrained by the acquaintances you happened to make first, find a group that you fit into.

And conversely, don’t try to be something that you’re not. Even

though Freshers week is aimed at copious amount of drinking and #TakingASelfie, don’t feel that you have to do it if you don’t want to. Some people enjoy being a BNOC, whilst others are happy being quiet and reserved; be who you are and don’t let others define you.

You might by chance also meet people, but take advantage of opportunities available at university. There is a whole community for you to explore.

Ever wanted to try out a new sport? Now is the perfect time to give it a go. If you have an interest in something, you’ll also likely find a society that does it.

For example, if you enjoy writing and journalism, get in touch with us @TMSnewspaper.

But there’s also more to uni-

versity than the social side unfortunately. You have to actually do something (shock horror) to get that nice £54000 sheet of paper you’re paying for. Firstly, you’re no longer by default at the top of academic food chain.

If you really want to insist on being in the top decile, you’re going to have to work. What used to qualify you as genius now only places you as average. This might be difficult for some of you to accept, but the reality is that being top academically isn’t everything, it is, after all, just a number. If a number was all it took to define the person you are, then we’d all be mathematicians.

Make the most of your time in university; it’ll be over before you know it.

theMEDICALSTUDENT / Freshers 2014 Education Editor: TBC education.medicalstudent@gmail.com

[EDUCATION]

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Stem Cells to Rescue Stroke Patients?

Utsav Radia Guest Writer Every year, there are approximately 152,000 strokes in the UK, costing the economy a whopping £7 billion. Last year, 19,710 people were admitted to hospital following a stroke in the UK. It is predicted that 20% of strokes are fatal – those that survive fall prey to the aftermath of disability and distress.

Currently in England, more than 900,000 people are living with the effects of stroke, with 50% dependent on someone else for assistance with even the simplest day-to-day activities such as getting dressed and eating.

Fortunately, a recent breakthrough by researchers at Imperial College London, led by Dr Soma Banerjee of Imperial College London NHS Trust, may provide a means to revolutionise the way we treat stroke.

Dr Paul Bentley, from the Department of Medicine at Imperial College and co-lead author of the study, said it is “the first trial to isolate stem cells from human bone marrow and inject them directly into the damaged brain area using keyhole techniques”. The study, published in the journal Stem Cells Translational Medicine, used haematopoietic stem cell precursors to stimulate angiogenesis and improve functional recovery in patients with ischaemic stroke.

A stroke, or cerebrovascular accident (CVA), is defined as: ‘the interruption of blood flow to the brain or the brainstem resulting in impaired neurological function lasting more than 24 hours’; whereas, if the neurological impairment resolved within 24 hours, it is called a transient ischaemic attack (TIA). Broadly speaking, there are two main types of stroke: ischaemic and haemorrhagic.

Ischaemic strokes are those that are caused by emboli (generally blood clots) that migrate into and block smaller intracranial blood vessels; they are accountable for up to 85% of strokes. On the other hand, haemorrhagic strokes are caused by rupture of a weakened blood vessel wall.

Common risk factors include hypertension, diabetes, smoking and male gender – similar to cardiovascular disease. Although the incidence is greater in over 65s, underlying clotting

disorders, use of oral contraceptives and illicit drug use are common causes of strokes in younger adults and children.

Evidently, it is crucial that a stroke is diagnosed accurately so that effective and potentially life-saving treatment is administered in time. Validated tools such as FAST (Face Arm Speech Time) are suggested to screen for stroke and TIAs in out-ofhospital environments. Despite the recent questions raised on its safety, under NICE guidelines, alteplase (a recombinant tissue plasminogen activator) is recommended for treating acute ischaemic stroke, albeit by trained and experienced physicians. However, in order to be functionally effective, it must be administered within 3-4.5 hours of the thrombotic episode and is contraindicated in haemorrhagic stroke, where it can exacerbate the bleeding.

Haemorrhagic stroke is diagnosed mainly by a CT scan.

These stringent regulations mean that unless specialised imaging and rapid response facilities are at hand, the use of fibrinolytic agents is limited. Previously, it was suggested that neuroprotective agents (such as glutamate antagonists, calcium and sodium channel blockers and NMDA receptor antagonists etc.) aimed at limiting the damage done on the outer edges of the lesion would be useful clinically. Unfortunately, these drugs were reported to fail at the clinical trial stage in animal models and so the concept wasn’t taken any further.

Stem cell therapy has been an emerging new therapeutic concept and is based on the premise that certain parts of the human brain are capable of regenerating. The ‘endogenous’ approach involves stimulating haematopoietic precursors in the individual to release chemical factors such as GranulocyteColony Stimulating Factor (GCSF) that aid with brain tissue regeneration and angiogenesis.

The ‘exogenous’ approach involves transplantation of stem cells, delivered locally or systemically to the individual for more direct effects. However, as with other uses of stem cells, there have been many ethical and legal questions raised regarding the origin and safe harvesting of therapeutically used stem cells.

The new research done by

scientists at Imperial College London involved harvesting bone marrow from each of the five patients sampled and sending it to a specialist laboratory where specific CD34+ cells could be isolated. These cells were then subsequently delivered via catheter angiography (a process that involves inserting a wire through an artery that supplies the brain) into the brain using the ipsilesional middle cerebral artery as a bypass.

The idea behind this was that the CD34+ would stimulate angiogenesis (the growth of new, healthy blood vessels) which would facilitate the growth of new nerves and healthy brain tissue as well as release antiinflammatory mediators that stimulate tissue regeneration.

In this study, patients were treated within seven days of the stroke, as opposed to other trials that involve treatment after 6 months or later. Patient outcomes were measured using the Modified Rankin Scale (MRS) and NIHSS score over a 6 month follow-up period; all patients showed improved clinical function.

Understandably, the clinicians involved in the trial agreed early intervention for stroke patients holds the key to successful clinical outcomes. Dr Soma Banerjee, lead author of the study, said “the treatment appears to be safe and the improvements we saw in these patients are very encouraging” but was modest in mentioning that “it’s too early to draw de-

finitive conclusions, we need to do more tests and work out the best dose and timescale for treatment before starting larger trials”. Also thrilled with the findings was Professor Nagy Habib, from the Department of Surgery and Cancer at Imperial College, who said the data is “exciting” and explained “evidence from our lab further supports clinical findings. Our aim [now] is to develop a drug, based on factors secreted by stem cells, that could be stored in the hospital pharmacy”. Although, it seems as though the research is in its initial stages of development, it seems we are not far off from being able to provide another means of immediate and long-term treatment for stroke patients.

theMEDICALSTUDENT / Freshers 2014

Culture Editors: John Park and Katy Bettany culture@themedicalstudent.co.uk

[CULTURE] /16

Where is Jessica Hyde?

Simon Boyd Special Guest Writer Series 2 of Utopia recently finished, a show that in the UK has gained the kind of obsessive fans to rival Breaking Bad’s. It is a dark and twisted tale, receiving many complaints for its violence and portrayal of real world events.

The show weaves elements of modern ethics with a tight well paced story which in equal parts terrifies, haunts and excites.

The show follows a group of mismatched strangers brought together over a graphic novel about a scientist making a deal with the devil. Whilst some enjoy the comic for the artwork, others see it as a chilling prophecy of a global conspiracy, with each character having their own hidden agendas.

It is set in the very near future, and really cuts close to the bone with its philosophy. The world is overpopulated, as we know too well, and Utopia asks the uncomfortable questions that have yet to be answered.

It is a very slick affair, with

an immediate style that still remains unique. Colours are over saturated and the violence is hyper realistic. The twisted electro tinged soundtrack perfectly complements the action, as the plot twists and turns at an incredible pace. At times the convoluted storylines can seem to get a bit ahead of themselves, but with it delivered in such an unapologetic way you can’t help but be swept along for the ride.

Utopia’s strongest suit is that you never quite know who you agree with. The motives of each character are slowly but concisely laid out and it’s isn’t a matter of not trusting the characters’ intentions, but not really knowing who you want to succeed. One particular character arc of fan favourite Wilson Wilson is almost Shakespearean in it’s delivery.

The acting is universally phenomenal, and the script gives them some cracking lines.

I’ve deliberately kept plot details to a minimum for fear of spoilers as it reaches some extreme places. However it guides you so surely that what would seem shocking appears with a definite frame of reference.

Series 2 started boldly, with the first episode more of a prequel featuring completely different actors and set in the 70s. No allowance was made for newcomers and it isn’t a show you can just drop in and out of. The final episode of the second series was clearly a begging letter for a third and I would have perhaps preferred more closure.

As much as I love the series, and I really do, part of me hopes that they have one more series and then call it a day. Series one and two have the workings of the classic three act structure and a final series would make it an incredible trilogy. Not that I have any idea how you would end such a piece of work, the story is so relevant that there will be disagreement however it ends.

If you havent seen it, I really recommend it. It isn’t always an easy watch, and the brutality will force you to consider some fairly uncomfortable truths about the world we live in. However it is one of the most original and surprising experiences of the last decade, and completely unforgettable.

The Honourable Maggie Thatcher Gyllenhaal John Park Culture Editor “Who do you trust? How do you know? By how they appear? What they do? We all have secrets. We all tell lies, just to keep them from each other, and from ourselves. But sometimes, something can happen that leaves you no choice but to reveal it. To let the world see who you really are. Your secret self. But mostly we tell lies, we hide our secrets from each other, from ourselves. So when you think about it like that, it’s a wonder we trust anyone at all” - these are the fitting words every episode of The Honourable Woman opens with.

The ongoing conflict in the Middle East, more specifically, the continuous turf war going on between Israel and Palestine

serves as the backdrop of this taut, highly ambitious mini-series. With everything that is going on in the world, the timing could not have been more perfect for BBC to commision such a production, and with every deadly new twist the characters and plotlines here feel all the more genuine and hit closer to home.

Maggie Gyllenhaal, sporting her perfected English accent, is

Nessa Stein, the current AngloIsraeli President of the Stein Group, whose continuous influential work with her company to bring peace and harmony to the Middle East catches the eyes of many.

Being the head of such a powerful group attracts all sorts of characters from both sides of the conflict, and The Honourable Woman shows us the struggle of trying to stay away from

corruption, avoiding getting compromised by either side.

Because whether a character is from Israel, Palestine, Britain, or even the United States, everyone has their own secrets and their agendas.

That is what makes The Honourable Woman so fun yet often draining and exhausting. There is just the right number of characters doing their own thing, furthering their goals, clashing, and inevitably the body count does go up and up. The series opens with a pretty brutal assassination that generally sets the tone for the upcoming episodes.

Nessa’s brother Ephra (Andrew Buchan), her bodyguard Nathaniel (Tobias Menzies), her close friend Atika (Lubna Azabal), those involved in MI6, Sir Hugh (Stephen Rea) and Dame Julia (Janet McTeer), various other governmental figures, all play

their part in an ensemble of shady figures, with not a single one of them who can be classified simply as “good” or “evil”.

As can be deduced from the opening narration, it’s Nessa and whatever she is trying to hide that propels the story into dangerous territory. What is she so afraid of that she needs to lock herself away in a panic room to sleep at night? What is it about the past that she’s trying so desperately to conceal? Some may be able to piece together parts of the story, but the overall arc includes so much intricate detail that to make sense of it all will require essential viewing of all the episodes.

Gyllenhaal herself has said in an interview that this is an exquisitely put-together thriller.

And that is precisely the right description for this unique 8-episode series.

theMEDICALSTUDENT /Freshers 2014

Culture Editors: John Park and Katy Bettany culture@themedicalstudent.co.uk

[CULTURE]

/17

Guardians of the Marvel Galaxy Jack Steadman Guest Writer Iron Man showed the world Marvel Studios were finally ready to step up to the big leagues, and start making their own films.

Thor showed that Marvel films could succeed without being set on Earth. The Avengers showed that Marvel films were serious – big – business. The Winter Soldier showed Marvel weren’t afraid of taking big leaps of faith with their over-arching story-telling. And now it falls to Guardians of the Galaxy to show – and I quote here – while some characters may be “total aholes, at least [they’re] not 100% a dick.”

So goes the line on Chris Pratt’s Peter Quill, or as he’d prefer to be known: Star Lord. It’s a line that typifies the approach of the entire script: eminently quotable, and endlessly hilarious.

Throw in a gleeful embrace of all things unconventional – from the goofy, anti-hero with a heart of gold Star Lord and the gang of misfits that make up the Guardians, through Bradley Cooper and Vin Diesel as a talking raccoon and a walking tree respectively, all the way to a joyful willingness to embrace big moments of heroism before brutally undermining them (in the greatest of spirits, naturally).

It’s a kind of joy that runs through the entire film, even in its darker moments: a pure, unadulterated joy that’s nothing short of infectious. It’s impossible not to grin at frequent intervals – provided, of course, you’re prepared to embrace the sheer silliness of the entire concept. A talking raccoon and a walking tree are only the first hurdles to be vaulted. Fortunately, if you give it the chance, Guardians doesn’t so much vault the hurdles as side-step them entirely and forge its own path.

It knows it’s silly, it knows it can be big, dumb fun that’s also wickedly sharp and armed with a knowing grin. It knows all too well the heritage it now has to live up to – to compete with, even – but it also knows that it owes a greater debt to influences far older than the Marvel film pantheon, and it’s more than happy to brazenly name-check them to prove that this is very much a film that’s in on the joke.

Guardians has a swagger to it, a swagger belying the fact it knows exactly what kind of film it is, and a swagger that allows it to have the confidence and the faith in its audience that they’ll come along for the ride. There’s almost an air of expectancy hanging over it – the unshakeable belief in itself and in the fact that the audience can work out the details for themselves. Much like Rocket’s plan for a prison break-out: all the elements have been figured out in advance, but when it comes down to it, it all turns into a mad-cap dash to stitch it all together with no time for explanation. Keep up, or get left behind.

This isn’t to say Guardians is hard to follow, or an unforgiving plot that will punish even a moment’s lapse in attention. Far from it. The plot itself, including its villains, is fairly formulaic.

There’s a MacGuffin (yet another Infinity Gem – albeit one which is this time acknowledged, in one of the lines you’re sure to see in every review you read, as the film’s “Ark of the Covenant, [its] Maltese Falcon.”), the good guys want it (although to sell on for big bucks, in yet another neat twist), the bad guys want it (to kill everyone), and it all bounces back and forth before the big finale.

But that simplistic summary does so little justice to what Guardians is actually about. This is a film in the vein of The Avengers, a film about a team coming

together, only here it manages to deal with everything, from the characters’ origins to the team coming together, in a mere shade over two hours where its closest comparison had an entire series of films as back-story.

Guardians stands apart from what came before, and in spite of all its galaxy-spanning antics, it feels unflinchingly personal, and deeply human.

This is, perhaps, mostly down to the decision to focus around Pratt’s Star Lord, in what might just be the greatest piece of casting Marvel has just pulled off to date (which is, naturally, saying something in the face of previous casting decisions). Pratt is nothing less than perfect, filling the boots of this child of the 80s raised amongst the stars with impossibly endearing charm.

His story is one of loss, and of growing to accept his truly heroic nature in the face of all his instincts to do otherwise, and it’s wonderfully handled by director/writer James Gunn and team. When added to the fact that the script so beautifully juggles its central cast, allowing every member of the team to have organic moments with each other, forming bonds between all of them, it makes for something truly special. The scene where the team finally come together – stand together – is wonderful, and it’s made all the better by the fact it’s so earned. It feels right, it feels like these are genuinely characters

who would fight and die for one another because they choose to, not because the story demands it. And to have reached that point organically a little over half-way into a two-hour film is certainly something.

The rest of the cast cannot go without praise – Cooper is pitch-perfect as the sardonic, mouthy Rocket, while Vin Diesel manages to turn a motioncapture performance with a vocabulary of a mere three words into a performance that is truly special. Zoe Saldana as Gamora feels like the most under-used of the five Guardians, despite putting in an excellent performance, while Dave Bautista is quite possibly the film’s secret weapon.

Of all of the Guardians, his was least represented in the marketing, and it now turns out he’s a comic marvel. A fighter with no concept of metaphor (“Nothing would go over my head. My reflexes are too fast. I would catch it.”), it’s a performance of physicality, emotion, and humour.

The villains are given something more akin to short shrift – Lee Pace and Karen Gillan both give good evil as Ronan the Accuser and Nebula respectively, but the film opts to (rightly) focus more on the relationships between the heroes than between heroes and villains, meaning that the villains themselves are almost relegated to the role of additional MacGuffins that cause the team to come together. Josh Brolin’s Thanos,

meanwhile, is the film’s biggest (albeit only) disappointment, feeling distinctly non-threatening in his brief appearance.

We’re told he’s among the most terrifying, powerful being in existence, a true threat, and yet the only words that really spring to mind are “aren’t you a little short for a Titan?” We can only hope Age of Ultron can set him up as more of a viable opponent to the Avengers.

It’d be unfair to end the review on a bum note, so it’s probably time to throw a few quick jabs of praise in for the rest of the film – the cinematography is gorgeous, and the action is fantastically shot, putting most of its fellow blockbuster compatriots to shame. The score is a treat, flickering between 80s hits and sweeping compositions (although it occasionally threatens to time over into downright manipulative), and the special effects are jaw-dropping. They’re without a shadow of a doubt the best to come out of Marvel so far – a claim that might just be true of the whole damn film.

Nobody’s 100% of a dick, as the film wryly points out, but James Gunn might just be 100% of a genius. It’s sure enough 100% of a fantastic film

theMEDICALSTUDENT / Freshers 2014

Culture Editors: John Park and Katy Bettany culture@themedicalstudent.co.uk

[CULTURE] /18

The Godfather of Soul John Park Culture Editor Every musical biopic of a famous name tells the exact same story over and over again. Some sort of a tough childhood where the boy/girl was inspired to dream big and become a worldwide star, struggle during adolescence, with no-one interested in giving that talented individual a break into the tough, oversubscribied industry, but then the success happens where the crowd goes wild. But then there is of course the inevitable decline from fame. Usually it’s due to extra-marital relationships, addiction to alcohol and drugs, as well as the stars becoming too full of themselves, alienating all those around them. But in the final scenes there is some sort of redemption, a tear-filled reunion, when our protagonist realises the error of his ways.

Sound familar? That’s the exact template of how musical legends have been portrayed on screen. Get on Up, Tate Taylor’s biopic about James Brown, does not deviate away from this, not for a single moment.

That’s the difficulty with telling these types of stories. Essentially it’s nothing the audience have not seen before, and yet to

keep it fresh and original, every good biopic needs to find a niche that separates itself from the rest of the musical biopics. Here, the film’s major saving grace is the top-notch performance from its leading man Chadwick Boseman.

Boseman is no stranger to biopics himself, having already played Jackie Robinson in 42, but in playing James Brown, he takes things to a whole new level. An Oscar nomination should be a definite guarantee, and even going so far as to win the Best Actor award would be a well-deserved prize for his phenomenal work here. His best moments come when he gets up on the stage to entertain the crowd. Boseman himself didn’t sing, but it’s difficult to tell in the film because the sheer energy he displays even whilst miming is ferociously intense to say the least. And when it comes to the dancing, there is nothing more mind-blowing than seeing how he conducts himself on stage.

Even if the name James Brown means very little, his electrifying work here deserves to be seen.

A special mention should also go to Viola Davis, who has a knack for making even the briefest moments count. Here she has a less sympathetic role, and far too little screen time overall, but

she makes it a heart-wrenching one just the same.

What director Taylor also chooses to use as a part of his trying to make his musical biopic stand out is to bring in a confusing, misjudged storytelling device that insists on bombarding the film with unnecessary flashbacks and flashforwards that do not serve much purpose.

The narrative jumps around from one decade to another, with little to no link to establish why the two scenes were placed next to each other in the first place, and with this the film loses momentum, and makes it a big challenge to connect with the central character. This method however, is not something that is seen throughout, and the film therefore works best when the story is being told in a normal, linear fashion.

The extent of Brown’s achievements is very hastily glanced at, quickly summed up in the final scene, with a lazy postscript that almost seems like an afterthought.When it comes to a condensed movie that chronicles the life of a legend, lots can be missed out, but Get on Up seems to put a whole new meaning to the term “scratching the surface”.

What happens in The White House... ...clearly does not just stay in The White House, as Olivia Pope (Kerry Washington) is about to learn in the third season of the mega-successful show Scandal.

Pope is Washington D.C.’s fastest-talking, best-dressed fixer whose crisis management skills are second to none. But when a sensational news story outlining her steamy affair with the President of the United States (Tony Goldwyn) becomes public knowledge, all eyes are on her, and it would appear that it’s the fixer that needs the fixing.

And so begins Shonda Rhimes’ political thriller, going stronger than ever in its third year, overtaking the viewer numbers and ratings of yet another highly profitable concoction of Rhimes, Grey’s Anatomy. That she already has two hugely popular television shows under her belt

bodes well for ANOTHER show she has planned for the 2014-15 season, this time a legal thriller, titled the ominous How to Get Away with Murder, but let’s not get too carried away here.

Scandal is, without doubt, bonkers. It takes a large ensemble cast of larger-than-life characters and lets them battle it out with dense monologues, drunken fights, and dramatic showdowns. How well an actor performs depends largely on how convincingly he/she can chew the scenery. But impressively, everyone in the ensemble is up for the challenge. The more heated events gets, the better the actors come across.

Led by the charismatic, Emmyworthy Kerry Washington as Olivia Pope who power-walks everywhere with a stern look of determination on her face

at every turn, the show works best when there is a confrontation of some sort: Olivia vs the President, Olivia vs the First Lady (Bellamy Young, whose role is becoming more and more significant with each season the actress playing the part gets the chance to show off a bit), Olivia vs her team of “gladiators in suits” (Columbus Short, Darby Stanchfield, Katie Lowes, Guill-

ermo Diaz), Olivia vs her on-off boyfriend Jake (Scott Foley), let’s not forget other relevant players in The White House: the President’s Chief of Staff Cyrus (Jeff Perry) and his journalist husband James (Dan Bucatinsky), and the mega-religious Biblebashing Vice President (Kate Burton, excellent). But the main highlight of season 3 is the further exploration of Olivia’s fam-

ily. Her father Rowan (Joe Morton) and mother Maya (Khandi Alexander) are such worthy additions to the cast that despite this being the most personal season so far, with Olivia being more vulnerable than ever, the problems start piling up like crazy even from episode 1 that towards the season finale, so much has happened your head will be spinning.

That the show is so unafraid has its drawbacks. From time to time it demands quite the excessive level of suspension of disbelief. And no, hardly anyone talks like they do in Scandal. But we must remember that we’re in Shondaland, and therefore we must play by her rules. The rules are that there are no rules. What season 4 has in stores for us no one knows. And to be honest, I cannot wait.

theMEDICALSTUDENT / Freshers 2014

Culture Editors: John Park and Katy Bettany culture@themedicalstudent.co.uk

[CULTURE]

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Paging Doctor Capaldi Katy Bettany Culture Editor I decided to watch the Doctor Who series eight opener, ‘Deep Breath’, with a few friends who had never seen it before. As a dedicated Whovian, I could hardly have predicted the levels of confusion it caused, for it was definitely not an episode for beginners. I imagine my friends felt like the only children starting at a new school – on the wrong side of all the in-jokes and left wondering what the hell was going on. Gone is the friendly bow-tied Doctor to guide them through the episodes, leaving in his wake only a rude, ‘attack-eyebrowed’ Scot.

Worse still, thanks to a mixed performance from writer Steven Moffat, the plot was thin and, truthfully speaking, would have provided limited entertainment as a standalone piece.

Despite this, the episode still had a lot of makings of a classic episode. It had character development in droves. The Doctor, fresh from his regeneration from

Matt Smith’s goofy, loveable incarnation to Peter Capaldi’s darker, ruder one, showed us his challenging side. Identity was a prominent theme – one scene, probably Moffat’s best to date, had the Doctor holding a mirror up to the episode’s villain – a clockwork droid who had been rebuilding itself from the organs of harvested humans.

Seeking to explain to the droid the futility of rebuilding oneself, he delivers a poignant analogy – if you have a broom but replace the handle, then the brush, and do it over and over again, is the broom you are left with the same as the one you started out with? Reflected by the back of the mirror we see the Doctor’s new face, and realize he is also talking about himself. Who, we are left to ask, is the Doctor, and does regeneration mean just a new face, or a new man? As for who the Doctor is – there were some dramatic moments that challenged our view of him as a righteous, ethical man. Will he abandon Clara? Is he capable of murder? Whatever the answers are, it’s clear that Moffat is try-

ing to tell us that the Doctor is just as flawed as everyone else.

Clara, the doctor’s assistant, finally grew a personality of her own. And thanks to the Doctor either being asleep or wearing a costume made of human skin for much of the episode, we got to see more of it than usual. We’d been promised longer scenes this year (rather than the usual running about), and we got a few – mostly starring Clara, which allowed some sharp and clever dialogue to unfold. Her young, flirty doctor had been replaced by the older, staunchly un-flirtatious Capaldi, and it took Clara the better part of an hour (and several aforementioned long-ish scenes) to get over that fact. We even got a surprise cameo to make extra sure Clara (and every fan-girl watching) was too.

Another hallmark of a classic episode is a sense of ridiculousness, and Deep Breath had a lot of this too. It started with a T-Rex vomiting out the TARDIS, just because. Comedy was provided throughout with the hilarious married interspecies

lesbians Vastra and Jenny, and Sontaran,Strax (please someone get this trio a spin-off series.) The episode also conveyed a sense of history that is so important to the Doctor Who story. The clockwork droids themselves were a throwback to 2006 (‘Girl in the Fireplace’). There was a subtle reference to Tom Baker’s Doctor too, with Capaldi deciding not to wear a long scarf because it “looked stupid.”

Essentially, there were some lovely moments in ‘Deep Breath’, and an excellent first performance from Capaldi, who is clearly one of the more talented actors to play the part – although he may have strayed into Malcolm Tucker territory at points. I think he’ll quickly become a popular incarnation of the Doctor, provided he gets some good screenplay to work with in future. I’ve tried to make like River Song and withhold any spoilers, so if you haven’t seen the episode, do, (but if you’re a newbie, read up a bit first.) Oh, and Moffat: focus on the story - else you’ll never bring any new fans into the fold.

Not at all Dreadful John Park Culture Editor Things are about to get crazy in the supernatural world of Penny Dreadful. The new horror television series broadcast on cable channels (Showtime in the States, Sky in the U.K.) offers a dizzying mix of iconic characters and creatures, throwing them all into the same show, and letting them have their fun with it.

We get vampires, werewolves, spirits, Dr Frankenstein, his monster, Dorian Gray, and even the humans have their deep, deep flaws.

It starts off with Sir Malcolm Murray (Timothy Dalton), a renowned explorer, looking for his missing daughter Mina, with help from her childhood best friend Vanessa Ives (Eva Green).

Having to face forces of dark-

ness, they also enlist the help of American gunslinger Ethan Chandler (Josh Hartnett).

Being broadcast on cable television, the show does not shy away from elements that would otherwise face heavy censorship.

There is plenty of blood and gore abound, and sexual tension between everyone in the cast excluding Dalton runs rampant.

Tension which leads to some downright bizarre and creepy scenes of sexual pleasure. But it is the bold, unhinged approach of storytelling that makes Penny Dreadful such a unique, entertaining show. The shock factors are always welcome, and a few of them work so well within the context of the twisted Victorian England 1891.

Then there are of course the excellent performances. Dalton in particular, who has of course aged since his days as 007, has

not however lost any of his charismatic, commanding screen presence it seems.

But it is Green who simply dominates every single scene she is a part of. Even from the opening episode the audience gets the sense that all is not well with Miss Ives, and as the series progresses, we see her deterioration, and in the show’s climax episode comes Green’s best work. She has always been good at playing dark roles, and here is a role that is perfect for her.

With a second season renewal, the show is on the right track to become an essential watch. The first few episodes spend a lot of time establishing characters and the scenery. Now the writers can have even more fun, given the cliffhangers we were left with.

theMEDICALSTUDENT / Freshers 2014

Doctors’ Mess Editor: Narmadha Vanan doctorsmess.medicalstudent@gmail.com

By Rhys Davies St. Elsewhere’s

[DOCTORSMESS] /20

DIARY OF AN FY1

You can always spot a medical student when you’re out and about on the wards. The nearlyironed trousers, that stiffened, anxious way of walking, the glint of what is surely a stethoscope stuffed hastily into their satchel. These are even more reliable indicators than large neon signage.

It turns out these signs are also pretty good at picking out newbie doctors. Late in July, I followed one such example to the hospital where we were about to start shadowing. It was like looking in a mirror. After six long years at medical school, I had somehow convinced people that I knew enough medicine to be let loose on the general public. The spectre of outrageous fortune, in the guise of the SJT and FPAS, had discharged me to-- Actually, let’s not get into specifics.

Let’s just say I have arrived in a pleasant district general hospital somewhere in the leafy exurbias around London. Let’s call it St Elsewhere’s.

So I started at St Elsewhere’s in July for a week of shadowing.

This grace period gave us the chance to learn our aspirin from our enalapril, to learn where to get the best coffee in the hospital and where the most secluded supply cupboard is for that necessary first day breakdown.

It was also an opportunity for a thoroughly anaesthetic series of lectures. On the plus side, I now know how to correctly lift a box.

Shadowing also gave us a chance to meet the outgoing FY1s. They were all very friendly, attractive and effortlessly competent in their (soon-to-be my) job. God, how I hate them.

Still, it is reassuring to know that is what I will look like in a year’s time.

The FY1 who I am to replace gave me his biro. It was a totemic gesture, a handing down of responsibility. With that pen, he was saying, “These are my patients. Love them as I have loved you.” A sacred and professional bond that cannot be broken. Left speechless with

emotion, I accepted with tears in my eyes. I think I’ve lost that pen now.

All too soon, the first Wednesday in August rolled around and the training wheels fell off. And yet, it was all very gentle. The registrar who led the ward round spoke slowly just so I could keep with the note-taking. For doctor’s writing, chickenscrawl is acceptable but to be slow is a grave sin. His pity only went so far – By the time I had returned the notes, the rest of the team had left the ward. Survival of the fittest, I guess – Or was it something I said?

After the ward round came the jobs. Working on a small urology team means we don’t have many patients and those we do have are mostly pretty well. Thus, the jobs were, dare I say it, manageable. Although, I do wonder how well six years of medical school prepared me for byzantine layers of administration and paperwork. Maybe I missed the lecture about bleeps and pagers, or the PBL session on using Windows 98 for everything.

Bleeps are a fun thing. It quickly becomes a Pavlovian response to look down at my belt loop whenever a bleep goes off.

It’s not just bleeps either. The mess microwave pinged to signal that someone’s lunch was ready and all the junior doctors present instantly looked down.

The topics that you get bleeped about are equally diversionary.

It’s either a wrong number, a decision far above your ahead or one that you already documented that morning. Oh, and “This patient’s systolic blood pressure has dropped to 40…is that bad, doctor?”

Outmoded computers and pagers I can handle but I draw the line at fax machines. Why are they still a thing?! I think they might be my nemesis – if you make a mortal enemy from office equipment. There are surgeons out there operating with Google Glass and I’m sending email down a phone line. In my final year of medical school, we were given clinical iPads – Now I have to work with technology that reached its zenith in the first act of Die Hard 2.

Having said that, communicating with departments that only accept faxed referrals has given me a chance to work on my penmanship. I filled a page with cramped prosaic chickenscratch to politely ask for a clinical review. When I put the paper down, I knew I had created art. My new FY2 laughed at my naiveté – an arduous FY1 year had crushed his sense of wordcraft and freedom of expression. The SHO who came to review our patient remarked that it was a very lovely referral – the equivalent of a Pulitzer in my esteem.

In fact, all the staff have been very kind to us newbies. They can obviously spot the fear in the eyes, and smell its stench from two wards away. The nurses have long perfected that combination of matronly concern and pity. The pharmacists have been very conscientious in phoning me to list all my mistakes on the drug charts and TTO orders in the vain hope that I will make fewer mistakes next time. But it’s the microbiologists who are the epitome of patience. Hidden away somewhere in the hospital, they wisely explain all things bacterial and antibacterial. “I can see you prescribed co-amoxiclav.

You chose…wisely.”

It has been a turbulent few weeks but I am grateful that this beginning has been calm enough, in brief moments, for me to find my feet. It was a pleasant surprise to find I had survived my first day as a doctor, and so had my patients. Being called “doctor” is still very, very weird. It might be going too far, especially at this early stage, but I feel I might be becoming less incompetent with each day that passes.

Rhys was previously a medical student at Imperial College School of Medicine and wrote for The Medical Student for several successful years, including a stint as the Comment Editor between 2011 and 2012.

If you have any questions you would like to ask Rhys about his first year as a doctor, email the Editor at editor.medicalstudent@ gmail.com

theMEDICALSTUDENT / Freshers 2014

Doctors’ Mess Editor: Narmadha Vanan doctorsmess.medicalstudent@gmail.com

[DOCTORSMESS]

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TEN TOP TIPS FOR STARTING CLINICAL MEDICINE Harriet Williams & Sarah Brand Guest Writers

The start of the clinical years is a big stage in your medical career and possibly the most daunting. Gone are the days of falling asleep in warm lecture theatres, 9am starts and knowing what’s in the exams. Say hello to the 8am start (yes, you heard it here first), erratic and incomprehensible timetables and the feeling that you are permanently in the way. It is also, however, a lot of fun, an opportunity to meet some amazing people and a world away from those dull second year pharmacology practicals.

So, we’ve come up with 10 things we really wish we’d taken notice of last September.

We hope it helps you in those first few weeks. Remember: if in doubt – wash your hands and dispose of the sharps (SAFELY!!)

1. Smile! “Medical students are the luckiest people in the hospital – you’re not ill and have no responsibilities – enjoy it and smile”. So said a very wise consultant on a ward round last year. If you walk onto a ward smiling and keen to help out, staff will be a lot more willing to help find you an interesting patient for the case presentation or to supervise a cannula for sign off.

2. Meet as many patients as you can. Books are a great way to help pass exams; but they are no substitute for hands on experience with patients. You need to meet, and examine, as many patients as you possibly can, not only to pass the OSCE but also so you can become a competent FY1. Patients who are willing to talk and not too ill can be surprisingly difficult to track down in the London teaching hospitals. The Medical Assessment Unit is always a safe bet, but for patients who have time to talk and are fairly well, try the elderly stay rehabilitation wards, ambulatory care or see if you can do a few shifts in A&E over a weekend.

3. Ask the nurses. Although often only seen as fast moving objects in the peripheral vision as they speed from one job to another, nurses can be a fantastic resource for help and information. From supervising

procedures to locating mysteriously lost notes, nurses are often the ones to turn to. In addition, they know their patients and can tell you when is/ is not a good time to see them.

4. Eat lunch! It doesn’t matter what you eat (full English, quinoa salad, Happy Meal) but do eat, if only so you can have 30 minutes of time out from your busy schedule. A lunch break is also a good way to get to know new students and you will really need these friends later on in the year when things get tough.

5. Tired all the time? Don’t worry! I’m afraid you have medical student syndrome.

This terrible condition presents around the first week of clinical attachments, with feelings of exhaustion, sleepiness and lethargy. With early starts and late finishes, plus spending hours wandering hospital corridors looking for your next tutorial or desperately trying to locate the ward round, there will be days where you are exhausted. This is to be expected (especially at the start of the year) so don’t

beat yourself up when you get home and just can’t look at another page of the cheese and onion.

6. Get organised. Different hospitals, different seminar rooms (often buried somewhere in a maze of corridors which all look the same), with different doctors (many of whom you will not have met before), are all conducive to spending a lot of time lost and late. Having a rough idea where you are supposed to be that morning, how long it takes for you to navigate your way to your locker and how long you’ll have to wait for a lift (warning: often a LOT longer than you think – consider taking the stairs!) can all help to turn up on time.

7. If you don’t ask you won’t get. As clichéd as it sounds, in the clinical years, you really get out what you put in. If you want to see an interesting surgical procedure, ask the consultant if you can observe and perhaps scrub in. The worst anyone can say is ‘no’! Likewise, if you meet a really inspiring consultant or

enjoy a particular attachment, why not ask them if they could offer you any extra shadowing or audit opportunities. These kind of extra activities will boost your CV and allow you to begin to show commitment to a particular specialty.

8. Common things are common! Whilst all medical schools are different, it’s fair to say they all share some similarities when

it comes to setting exams. It may be tempting to follow your friends to an evening lecture on systemic sclerosis but the truth is, you’re probably better off revising your key conditions well and knowing them back to front. It’s great to know something about some rarer conditions but only after you know lots about the common ones.

9. Get a life! We’ve all been told it a million times but… make sure you have good work-life balance. Exercise, see friends, write a masterpiece, anything but medicine! This will be the year when you realise quite how challenging that can be, but also how important it is for your sanity. It’s also a great time to reconnect with friends who don’t do medicine, as they are more likely to point out when you are becoming a boring medic.

10. Marathon, not a sprint.

The first clinical year is the longest academic year you have ever had, and at points you will feel like it is never going to end. The important thing to remember, therefore, is pace yourself. This is a year which requires stamina and endurance, so don’t burn out too early. Regular breaks, enjoying holidays and down time alone or with friends will all help you to make it through.

The first clinical year can be really tough, exhausting and exasperating, but also your first taste of what it’s like to practice as a doctor. You’ll have fun, make friends and learn loads. I Hope all of our tips help you!

Enjoy!

WELCOME TO THE DOCTORS MESS!!!

Narmadha Vanan Doctors’ Mess Editor

Hi there, I’m Narmadha and I’ll be your new Doctors’ Mess editor for this year! I’m planning to revamp this section a little and perhaps make it into a platform for sharing stories

about your travel adventures and your creative writing as well. If you have anything to you’d like to share, do send your pieces in (be it a short story, a poem or a travel piece) to mess.medicalstudent@gmail. com. Can’t wait to hear from you all, cheers!

[SPORT]

theMEDICALSTUDENT / Freshers 2014 Sports Editor: Mitul Patel sport@themedicalstudent.co.uk

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Save Teddington Sport Imperial sells historic ground without student consultation Mitul Patel, George Cross and Vernon McGeoch Sports Editor & Guest Writers

The close of the 2013/14 season brought shock and disbelief to the ICSM student body as Sport Imperial announced that Teddington sports ground, the home of sport of St Mary’s Medical School and now ICSM, would no longer be used as a playing venue for students as of September 1st 2014.

The ground at Udney Park Road has an illustrious sporting history, having been donated to St Mary’s by philanthropist Lord Beaverbrook in 1937. It has been renowned for its quality of pitches and its atmosphere by the vast majority of those who have had the privilege to play there.

With facilities for football, netball, cricket, tennis, lacrosse and rugby, Teddington is acclaimed by many to be one of the best around.

Appallingly, the decision to sell the complex, which has been ingrained in the history of this medical school for over threequarters of a century, was made by Sport Imperial without consultation of the student body. In addition, there appears to be no plan for review, leaving students dumbfounded as to why the decision was made, and why their subsequent inquiries into the matter have been met with silence.

The suspension of sporting activities at Teddington will mean that training and fixtures are moved to a new facility purchased in Heston, East Hounslow.

Sport Imperial claim “With the acquisition of Heston we’ll be taking stock of the facilities we now have and the best way to make use of them to deliver a good service, suspending College sporting activities at Teddington sports ground until we can properly assess the new arrangement. The College has a responsibility to ensure that all of its assets are used efficiently and effectively” On face value, the site at

Heston is impressive; a 27 acre space for five football and two rugby pitches as well as tennis and netball courts, cricket facilities and a shooting range, alongside indoor facilities for squash and basketball as well as three bars and a theatre.

Nevertheless, transferring sporting activities to Heston poses a number of practical difficulties for students. Geographically, there is very little difference between the distances separating the two grounds and centralised campuses; however, public transport links around Heston are far worse than Teddington so the mean journey time for students to travel to the ground inevitably increases. Medics who are on rotation at non-centralised campuses will be inconvenienced further; a problem that does not apply to non medical students.

Sport Imperial have continually emphasised that Heston is “conveniently located near Heathrow and just minutes away from the M4” to address the location arguments posed.

Disregarding that the proximity to Heathrow means nothing to students without private helicopters or jets (the vast majority, even at Imperial), suggesting that driving to fixtures

and training would be a solution for the inconvenience posed has baffled students, who are keen to point out the large costs of car parking permits in London, which the College does not subsidise. Those that cannot drive will be increasingly reliant on their club to provide minibus transport, which is an added financial strain because the College has cut, and is likely to continue to cut, funding for Medical clubs across the board.

Despite the practical difficulties posed, the real issue that remains is that the College made such a big decision regarding student life without consulting the very students they cater for. That the decision disregarded a huge part of medical school tradition only adds insult to injury. It becomes even more surprising given that the Student Consultation Framework, a document detailing how students should be consulted in any change that affects their student experience in a meaningful way, was created only last year.

A Union statement after the decision had been made suggested that the Union President, ironically a medical student himself, had been aware of the decision but was not al-

lowed to communicate or object to it on the grounds of commercial sensitivity.

The statement claims that “It was clear from the discussion that the purchase of this new facility would have an impact on Teddington but the extent and pace of this change was not clear at the time”.

It would perhaps be too extreme to suggest that this decision was made purely on financial terms. The new site will provide first class sporting opportunities for students in the future and if the College decides to address travel subsidies further, inconvenience can be limited. However, the undertones of “efficient use of assets” and “commercial sensitivity” highlight that balancing the books remains a priority for the College, and obviously history and tradition remain footnotes in this matter.

This is not the first time a medical school ground has been sold off. The Chelsea and Westminster ground at Cobham was sold to Chelsea football club some years ago and the grounds of other medical schools have been lost too. Furthermore, the fact the ground was originally a donation for the sporting purposes of the medical school means that any change in usage, be that sale or renting out, morally

contradicts the spirit of the gift; a notion which has been echoed by many doctors and also the archivist at St Marys hospital. It is already rented out at times to international sevens teams and for BUCS tournaments but this has never impacted medical school sport in a negative way, and only adds to the prestige of this illustrious ground.

The ICSM president echoed students’ disbelief, stating, ‘Such big decisions, that disrupt the history and traditions of our medical school, should not be made without the students being consulted.’

Whether student sport returns to Teddington one day or not, the levels of disrespect shown by Sport Imperial to the ICSM student body in this decision making process is unacceptable. Fans’ Associations of professional sports clubs would not accept it if their club changed their kit colour, badge, ground, or anything pertinent to the history of the club without consultation of the fans themselves. Turning a blind eye to inquiries and appeals and glossing over this act with new facilities, a bar refurbishment or free iPads only serves to further mock the decision that medical students made when they joined Imperial College.

The decision to suspend sport at Teddington has been met with uproar amongst both the student body and alumni of the university. Sportsmen and women at ICSM would also like to show their gratitude for the support that has been pouring in from clubs from other medical schools, the medical school union and Imperial College Union itself, all of whom are against the loss of Teddington. Progress seems to be slow but any support for the cause helps. You can follow it on twitter at #saveteddington and also please sign the petition at: w w w. i p e t i t i o n s . c o m / p e t i tion/save-teddington-sportsground

[SPORT] A Summer to Learn From theMEDICALSTUDENT / Freshers 2014 Sports Editor: Mitul Patel sport@themedicalstudent.co.uk

Mitul Patel Sports Editor

I have said previously that the summer for medical students is usually one of three things; a chance to go travelling, a chance to get a job so that one day you can go travelling, or a chance to relax and unwind at home whilst your Facebook and/ or Instagram feed fills up with posts of people who are travelling.

Unless you have actually been travelling in a country without wifi this summer, you would know it has been dominated by sport. I have never believed in repeating national/international sport in this paper as you all have apps on your phones that will do that for you; instead I would like to suggest what we as medical students can learn from the sporting feast that has been dished up over the sweltering summer break.

1) Do not fear disappointment Too often do we hear the phrase ‘having no expectations means you will never be disappointed’. England’s World Cup campaign was a resounding disappointment after 1 point from 3 games in the group stages at the 2014 FIFA World Cup, despite entering the tournament with no expectations of winning. Whether you have just finished your Alevels or are thinking about revising for finals, the majority of us will enter a ca-

reer where we will encounter disappointment, be it from others or of ourselves, regularly. Having goals/ expectations of ourselves and believing we can conquer these difficult moments will lend us better to dealing with them as and when they arise, instead of turning around and scratching our heads wondering where it all went wrong.

2) Persistence breeds success Two of the biggest success stories of the summer were the Germany national football team, who finally won the FIFA World Cup after finishing 2nd, 3rd, and 3rd in the previous three, and Rory McIlory, the Northern Irish golfer who won back to back major championships in the Open and the US PGA after a winless 2013 where he admitted he felt ‘brain dead’. Silencing doubters and proving worth to ourselves is never easy. If it is a missed cannula or a failed interview, draw confidence from your own abilities instead of shying away from challenges that face you.

3) Medicine is our oyster Jo Pavey’s victory in the 10km run at European Athletics Championships, at the age of 40, should serve to remind us all how young we are and how much of life there is to live.

Similarly Steve Way, the ex-arteriopath chain smoker who ran the marathon

for England at the Commonwealth games in Glasgow, demonstrates how much time and opportunity we have to shape our lives.

Coming out of medical school does not mean you are on a conveyor belt to consultancy, and if you don’t know what you want to do, where you want to do it, or who you want to do it with, you have the luxury and fortune of time, and unlike other professions, almost universal job security and employability worldwide, until you find out.

4) Keep your friends close There are people in this world you can always rely on. Alastair Cook defied the cricketing world by not stepping down as England National Captain following a pathetic summer drawing to a pin after a loss against India at Lords. He claims he drew strength from his wife and ultimately turned his own, and his team’s fortunes around by drubbing the tourists in the subsequent three games. His show of character would be inspiration to any human on this world, medical student or not.

Conversely, the dispute between Lewis Hamilton and Nico Rosberg in the Formula 1 Championship shows the ugly side of our profession, when we are put in a position where we have to choose between our careers and our relationships. When times inevitably get hard, draw strength

Write for Sport!

Mitul Patel Sports Editor

As I enter my final year at Imperial, and my third and final year as Sports Editor of themedicalstudent, I am writing this short plea if you like for any aspiring writers to get in touch in Autumn this year!

I am a strong believer in tradition and camaraderie both within and amongst our medical schools and believe Medgroup and TMS is an important part of our identity as medical students in London, akin to the colleges of Oxbridge.

If you are interested in sport and enjoy writing, be it match reports, sport-

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ing issues, or editorials like above, get in touch with either the editor or myself and see what an enjoyable and rewarding experience it could be.

You never know, this time next year you might be the one with my job!

Mitul

Clockwise from top: Joe Pavey celbrates her 10km victory; Alastair Cook lifts the Investec trophy; England Manager Roy Hodgson is left baffled after England’s World Cup Campaign [Photos courtesy of google images]

from those close to you and do not be surprised by what you can ultimately achieve.

5) Find out what you love Amongst all the highs and lows of the summers sport, there is an underlying sense that these are all

humans doing something that they love. All too often I have heard doctors tell me what a sh*t career medicine is! Use your time at medical school/ beyond to find out what genuinely makes you happy and fulfilled, and do not let it slip when you find it.

Fancy yourself as a bit of a sport fanatic?

Write for Sport!

Email us at sport@themedicalstudent.co.uk

T: @TMSNewspaper f: /TMSNewspaper W: www.themedicalstudent.co.uk