CMJ CATERHAM MEDICAL JOURNAL ISSUE 4
2024
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Contents Introduction by Dan Quinton . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Message from the Endorser Dr Luke Bashford PhD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Dr Bashford on Neurotechnology at the First Annual Wright Society Lecture . . . . . . . . . . . . . . 5 Reflection of the year Justin Leung & Katie Roberts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Lower Sixth Trip Katie Roberts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Meet the Medics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Vet Work Experience Simi Akingbade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 The Role of AI Technology in Medicine Hazel Tsang & Isabelle. S. Young . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
4 Pillars of Medical Ethics Leane Beukes & Emily Van As . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Medicine Through the Army Ava Floyd & Joel Veldtman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 mRNA Vaccine and its Future Applications Ambrose Chou . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Absence Seizures Emily Van As . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Head Injuries in Sport Leané Beukes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Dementia Hazel Tsang . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Computed Tomography (CT) Joel Veldtman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Forensic Pathology Lammi Pang . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Schizophrenia Bianca Lo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 The Darwin Society Marcus Kwok . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
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Introduction by Dan Quinton L
ast year I took the big decision to retire from full time teaching at Caterham, after 24 glorious years here, it was probably the toughest decision I have ever had to make. Caterham will always be in my heart and I hope to continue links with the school for many years to come. Having founded The Wright Society a few years ago now, it is something very precious to me. It’s aim is to help students who want to be medics, dentists or vets achieve their dream in what is a fiercely competitive environment. Having had extensive experience of both, it is tougher to get into med school than go to Oxford or Cambridge. The extra work required of MDVs to make a strong application is formidable. The Wright Society is not only for Caterham pupils, but the wider community and it is a pleasure to welcome each week students from partner state schools such as Oxted and Warlingham. Our Patron Dr Richard Wright and I are committed to expanding this aspect of this amazing society. I also want to pay tribute to Mrs Clare Brown who works tirelessly with me to deliver what I know is the best medics society in the country.
For example, her organisation of medic parents to deliver one on one and mock MMIs to stimulate the kind of interview our students will have to sit through is a huge task but done so willingly in her own time. I cannot thank her enough. Last but not least, our biggest asset is our students. None of what we do could be delivered without our U6 President and Vice President. Justin Leung and Katie Roberts have been extraordinary role models to our L6 aspiring medics. The work they have done and the kind and honest guidance and advice they have given to help the L6 prepare for their applications goes above and beyond the call of duty each week. As I write this they are about to embark on an extensive look at the dreaded UCAT exam and give their own perspective of the exam and how to approach it. I believe there is nothing more powerful for a student to hear not from a craggy old teacher, but from a peer who has recently been through the same daunting task. Thank you Justin and Katie for all you have done and working so closely with me.
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Message from the Endorser: The Medical Society of Caterham School
Dr Luke Bashford PhD
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t is with the greatest pleasure that I will give the first Annual Medicine Lecture, at Mr Quintons invitation, presented by The Wright Society. I am also delighted to see the hard work of the current pupils preparing to study medicine showcased in this exceptional magazine, CMJ. Although not a clinician myself, my research is conducted in very close collaboration with clinical colleagues. I am continuously inspired by the advances in medicine that are driven by the work of medical students through to leaders of their respective fields. I first began to study neuroscience in Year 10 at Caterham School. My passion for the subject has led me to a research career in neuroscience and neurotechnology, and I recently established a research group in Newcastle University. Prior to that I completed my studies at University College London and Imperial College London, UK, and my postdoctoral research at Caltech, California, USA. Caterham School has had a long and successful tradition of helping aspiring medics achieve their dream of studying medicine. Getting in to medical school is one of the hardest paths to take for any student, and it is incredible to see the amazing work of The Wright Society in fostering and supporting the ambition and talent not only at Caterham, but at our partner state schools in the area, so students achieve their dream. This edition of CMJ is not only a reflection, but also recognition, of the huge effort and work all the pupils have put in throughout an intense and demanding year. The result of endless reading, listening, learning, and writing. I am delighted therefore to endorse this magazine in the strongest possible manner. It is wonderful to see our next generation of medics so well
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prepared through The Wright Society and how enthusiastic they are for the challenges ahead. I wish the pupils the greatest success in their careers and challenge them to improve the quality of life for all through novel and exciting medical research and innovation. I hope you enjoy reading this wonderful publication.
Dr Bashford on Neurotechnology at the First Annual Wright Society Lecture By Joel Veldtman
The Wright Society was delighted to welcome Dr Luke Bashford on Tuesday 5 March to talk about his research on Brain Computer Interfaces (BCIs) and his career in neuroscience. His research has been transformative not only to neuroscience but also to the patients in the clinical trials such as giving a husband the ability to feel the sensation of his wife holding his hand again.
We would like to extend a huge thanks to Mr Quinton and Clare Brown who helped organise this monumental event, as well as Dr Luke Bashford for his incredible talk.
The lecture had a diverse audience comprising of pupils of all ages interested in vastly different branches of science from computer science to psychology, parents, old-cats and even other guests such as Dr Richard Wright – the patron of the Wright Society. Speaking to these people after the lecture, it seemed that everyone gained something from it, including the aspiring medics who were given the opportunity to seeing photos during the surgery done to implant these BCIs – apparently a relatively simple operation in the world of neurosurgery.
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Reflection of the year By Justin Leung and Katie Roberts
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s the President and Vice President of the Wright Society, it has been an absolute honour to be able to support aspiring medics in their goal of achieving a place at medical, veterinary, or dental school, which are some of the most competitive courses in the country. To see how they have grown in The Wright Society to develop qualities of a medic such as having excellent communication, it brings a tear to our eyes in the understanding that they would certainly be exceptional healthcare professionals in their respective fields. For the Lower Sixth, they have been extremely engaging in the society, presenting a wide variety of talks to their peers, with topics ranging from AI in medicine to war doctors. This has been a great opportunity for them to explore a huge variety of areas in medicine, understand the profession they plan to commit themselves to better and also develop presentation skills. In addition to presentations, the Lower Sixth have also tried to build the mindset of a medic in different ways, such as by helping post medicine related articles on the news board to keep up to date on recent developments and innovations. They have also been involved in a project comparing NHS to the healthcare systems of other countries to more deeply understand the healthcare system. Going forward, they will attend a series of presentations on the UCAT given by the current Upper Sixth to prepare them for the challenge ahead of them. We have full confidence that with their hardworking attitude, they will be able to overcome the test with flying colors. Afterwards, they will embark on writing the personal statement with the society’s assistance, which is a task that they will no doubt excel in with their wide range of work experience and volunteering.
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The Upper Sixth main focus this year has been doing interview preparation, which involved standing in front of the whole society and answering questions thrown our way in simulation of the daunting interviews ahead. We have been honored to receive feedback from Mrs Webster (Ethics teacher), Dr Wright (our patron) and Mr Quinton - all of which have been extremely helpful. We also would like to particularly thank Mrs Brown, who has helped invite many current medical professionals to aid in one-toone interview practice, which have been an invaluable experience in our preparation. Thank you all who have helped us in our journey. Though Mr Quinton has retired from teaching at Caterham School, he remains at the heart of The Wright Society, helping organize sessions, external speakers to talk to everyone and even trips beyond the school campus for members to learn more about medicine. Mr Quinton has been a vital part of all members of the society’s journey into medicine, veterinary and dental practice and we truly thank Mr Quinton for giving up so much time aiding us in our journeys. We would also like to give special thanks to Dr Wright, our patron and GP at Caterham school, who has delivered quite a few presentations to the society and shared his insights on being a doctor. His firsthand experience as a doctor have been very eye-opening and helpful to us all. We are honored to have been selected as President and Vice President of such a prestigious society and we look forward to our lives ahead as medics and wish much luck to all members of the society in the future. Again, thank you so much to everyone who has aided us in this journey which would not be possible at all without you.
Lower Sixth Trip By Katie Roberts
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ower Sixth members of The Wright Society had the opportunity to attend a medical school lecture by Dr Suneil Ramasseur in St Thomas’ hospital, London. Caterham students joined fourth year King’s college medical students in delving into the intricacies of pain, including its various forms, treatment and assessment. Dr Ramasseur also explained the concepts of Spinal anaesthetic and epidurals, and their applications in clinical practice. At the end of the lecture, pupils benefited from the chance to ask Dr Ramasseur, as well as a few current and willing medical students, about pain management, medicine as a profession, and life at medical school. A big thanks to Dr Ramasseur for allowing us to attend this lecture, as well as to Mr Quinton and Mrs Brown for organising and facilitating the trip, giving students a glimpse into what medical school may be like for them. 7
Meet the medics Justin Leung President Upper Sixth
The reason I strive to become a doctor is due to suffering from an uncommon disease called Ankylosing Spondylitis which has affected my daily life and I aspire to be able to support other people who may have similar conditions as me as much as I can. As the president of The Wright Society, I have greatly enjoyed my time supporting the L6 through their journey into medicine through organising different projects and I am also extremely thankful for all the support and help The Wright Society and Mr Quinton have brought to my individual medical journey. No matter where I go, I will try my best to maintain connection and continue supporting upcoming medics in The Wright Society.
Katie Roberts Vice-President Upper Sixth
Growing up, medicine was always a resounding part of my life. Progressing through GCSEs and A-Levels, my excitement about the career has grown, particularly the constant new discoveries and developments within the field. The support of Mr Quinton, Dr Wright, Mrs Brown and of course my peers within the Wright Society has been pivotal in my journey into medicine, and I am extremely grateful for the opportunities I have been presented with. I know the skills I have learnt in the society will not only aid my medicine application, but will also be incredibly beneficial for university and life beyond.
Tiffany Ku Upper Sixth
I want to be a doctor because science interests me a lot. Medicine involves a lot of science, from human biology and biochemistry to mathematical modelling, and being a doctor allows me to apply science to help people. Through The Wright Society, I have gained a deeper understanding of the profession and the NHS and I enjoyed listening to presentations and participating in workshops about different diseases and medical topics.
Marcus Kwok Upper Sixth
I think being a doctor is the most meaningful and enjoyable job in the world and that is the career I want to pursue, in hopes of becoming a specialist in oncology as the science and stories behind it are just fascinating. The Wright Society has helped me with this immensely by hosting talks and discussions with medical professionals, as well as aiding me in the journey to becoming a doctor like the UCAT and interview prep it has provided. I am very thankful for Mr Quinton and Mrs Seal’s help and I look forward to a future as a doctor!
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Lily Li
Upper Sixth My name is Lily Li, and I am an 19-year-old A-Level student living and studying in Caterham School. I am considering pursuing a medical career and I have a deep academic interest in Oncology. In the Wright Society, diverse medical topics are presented and discussed in degree level. Along with academic enrichment, we’re also able to see the mock interviews and taking notes during them. Understanding the science of a pathology in Wright Society and being able to relate these knowledge to patients’ experiences of disease during my work experience instated my passion to develop my knowledge further and study medicine at university.
Justin Liu Upper Sixth
To dive into the world of medicine is to pursue a pathway of limitless discovery. Aside from my deeply rooted interest in science, I have always admired a doctor’s ability to communicate clearly, critically think and make important decisions. Being able to directly apply knowledge learnt during work and alleviate people’s pains, as well as saving patients is such an amazing gift. Being part of the Wright Society has increased my exposure to the diverse language that is medicine, and I feel like I am one step closer in achieving my dream of becoming a medic.
Sophie Niven Upper Sixth
My aspiration to study medicine at university is driven by me wanting to help and support lots of people and to improve their quality of life. I have really enjoyed attending The Wright Society because I have gained insight into areas of medicine and science that I might not have heard about otherwise. I am interested in going into paediatrics in the future, however, I am not entirely set on a medicine career path currently.
Winston Tai Upper Sixth
My passion for pursuing medicine is derived from the capability of improving one’s quality of life. That capacity is extremely rewarding. A lot of jobs can provide a great satisfaction, however, the meaningfulness, the sense of duty and the art of communication involved with being a doctor is incomparable. Moreover, it is not solely about a career, but it is also about progressing to become a better individual with selflessness, integrity and empathy for life. Despite the expectedly tough journey, such challenge ahead does not deter me but rather excites and motivates me to work harder.
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Bert Wong Upper Sixth
My passion of studying medicine initiate from my dream of being a psychiatrist and helping people with mental illnesses. As I discovered more about medicine, I became more amazed and prouder. I’ve always enjoyed helping people and being a doctor is the most direct way to fulfill this desire. The Wright Society provides an encouraging atmosphere and enthusiasm around us, which is such an important trait for medical students.
Danyal Akbar Lower Sixth
My passion for pursuing medicine and aiming towards becoming a doctor was fuelled by my uncle who studied medicine for 16+ years in order to aid my sick grandmother. It brings me gratitude and satisfaction when helping others in times of need. The Wright Society has helped guide me in what things I should do, so that I can grab a spot in this competitive course, from listening to the talks presented by fellow students to guest speakers giving their knowledge. I hope to attend future meetings so that I’m one step closer to achieving my goal.
Simi Akingbade Lower Sixth
What inspired me to be a Vet was when I was younger I found a very thin squirrel near my house. That act of helping that animal made me want to help more. Learning about animals and their anatomy has always left me amazed and wanting to find out more. The Wright Society has helped focus and guide me on where my problems are and how to look like the best candidate as well as giving me more opportunities to learn.
Leane Beukes Lower Sixth
I was always an inquisitive child, especially in science, always wanting to know more. I would constantly search for more anatomy knowledge from my mum, browsing her anatomy books. Over time the more I learnt the more I wanted to know. I realised when our bodies don’t work it’s hard to live life to the fullest. Eventually I realised that medicine was the perfect place for me, looking after people, and helping them to thrive. The Wright Society has been a source of inspiration and guidance for my journey.
Ambrose Chou Lower Sixth
As my father is a doctor, since I was little, I have been taught various different medical knowledge, which also brought me interest in medicine and the idea of being a medic. Moreover, I think the job of medic is very meaningful as I can help saving other people’s lives and have a better life. As a student from Hong Kong, The Wright Society not only helps to know more medical knowledge, but also informs me about the UK medical system and tips to study medicine in UK, helping me to achieve my goal.
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Katrina Davis Lower Sixth
Dentistry has been a great passion for me for a long time because I’m really interested in the dental hygiene and healthcare sector jobs. After attending many courses on dentistry I have found out that I would really like to endure the challenges of working as a dentist in the UK. The Wright Society has helped me greatly understanding the healthcare system and with the process and requirements of entering our dream universities as well as providing us with opportunities to listen to and make our own talks.
Ava Floyd Lower Sixth
Being a kind person by nature who is also very curious lends itself well to the world of medicine, which is why I have wanted to be a doctor since I was little. I take great enjoyment in helping others and solving problems and I work best when I’m surrounded by other people. The Wright Society is excellent at keeping me on task with what I should be doing when and it also offers me amazing opportunities such as online courses which I wouldn’t have known about otherwise.
Luciel Kwok Lower Sixth
I have been inspired to pursue a career in medicine not only just because of my interest in neuropathology and pathology, but I have always admired how many medical professionals are able to assist those in need, as well as their motivation driving them to trail this path. The Wright Society has provided me with various opportunities and taught me many essential skills. I look forward to the many future lessons I would learn from this society, and greatly appreciate the support my teachers and peers have generously provided me with.
Bianca Lo Lower Sixth
I aspire to study Medicine because I would like to help make a difference in people’s lives whether it be large or small, and to leave the world a better place than how I found it. The Wright Society has been extremely helpful in helping me gain a better understanding of what it’s like to be a doctor and what I need to do in order to become one. Listening to presentations at TWS has helped me gain insight on a variety of topics that I would not have known about otherwise.
Lammi Pang Lower Sixth
I am motivated to pursue a career in medicine with the goal of becoming a forensic pathologist. I’ve always aspired to be able to determine the cause of deaths through autopsies to provide comfort to the deceased’s family or clues for an investigation. Through actively participating in The Wright Society, I am granted the precious opportunity to meet medics and professionals as well as other medicine related resources, offering me a deeper insight into medical science and the life of a medic.
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Isabel Tormay Lower Sixth
I want to become a doctor to create a positive impact on society as I have seen first-hand how vital doctors are and the impact, they have on patient’s lives. It has always been a dream of mine to become a neurosurgeon and I have always loved biology. TWS has helped me to gain a better understanding of what a career in medicine looks like and teaching us the skills needed for our Uni applications.
Hazel Tsang Lower Sixth
I want to improve people’s lives through the application of science, particularly in medicine and healthcare. I believe that being a medic will be a challenging career. The privilege to treat people is a great responsibility and provides a sense of fulfilment. I want to be able to help people throughout their lives, from birth to death; in illness and injury. The Wright Society is supporting and preparing me by developing my communication skills in addition to giving me an exposure of the medical profession via presentations and hospital trips.
Emily Van As Lower Sixth
I have always been interested science especially biology and human anatomy. I’ve been fascinated by diseases – their causes,symptoms and treatments this was further fuelled by the pandemic in 2020 and watching the NHS work tirelessly to save lives and figure outs vaccines and treatments. The Wright society has been extremely helpful with offering guidances and support.
Joel Veldtman Lower Sixth
After watching neurosurgery at Kings College Hospital, I was fascinated with the potential to positively impact lives through surgery, hooking me on the idea of becoming a doctor. The Wright Society has further strengthened my aspiration to attend Med-School through talks and similar experiences. One standout experience was attending a 4th-year lecture on pain. I am incredibly grateful to Mr Quinton, Justin Leung, Katie Roberts, and everyone else who supports the members of the Wright Society for providing these experiences and supporting us through our 6th form.
Jayson Wong Lower Sixth
When I was young, my parents would come back from work every day and talk about their patients and cases, which I would always find interesting though I didn’t understand most of the things they were saying. This led to me enjoying the sciences, biology in particular, which I felt were steps closer to understanding them, and it just so happens that I will have more help for my next step towards medical school – The Wright Society.
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Vet Work Experience By Simi Akingbade
I recently had the opportunity of working in New Priory Vets in Brighton. The practise has a 24-hour dedicated emergency service line with Head Veterinary Surgeon Dr Bronwen Eastwood. I was able to accompany her on consults, blood analysis and meet many patients. I thoroughly enjoyed my time there and gained a better understanding of what the day to day life is like in a vet practice. I got to interact with animals and see various cases. What’s the job like? The life of a vet in many ways is similar to the life of a doctor I found. Although I was given a much slower day, I was able to see the busy nature of an extremely structured day. I sat through only consultations but on a usual day there would be surgeries in between consultations on top of emergencies. They were all back-to-back without a break. Even during the 1-hour lunch break, time was spent doing blood analysis, admin and ordering drugs that were out of stock.
The facilities have their own labs, prepping room, kennels and a surgery room. Therefore, the practice has a lot to offer to its patients and have to do less referrals.
Patient and Customer Care In these consultations I got to grasp the time it takes to find out what is wrong with the patient. Many of the problems are visual, so by looking for infection, general deterioration, the slightest change of posture or glossier looking skin can help the vet diagnose the problem. There are many questions for the owner to answer and an extensive record shared between practices to understand the pet’s medical history. Some conditions or allergies are also connected to certain breeds so it is something the vet would also consider. One thing the vet does is check the heartbeat and the pulse at the legs to see if they are in sync. For older dogs some conditions are left untreated especially if there aren’t a lot of procedures or medications to help. For example, a beagle had a large benign tumour on the back of his leg. Due to him being 17 (in human years) they decided to leave it and focus on easing his arthritis. They gave him a drug (Librella) which eased the joint pain. Overall, it was an enlightening experience. 13
The Role of AI Technology in Medicine By Hazel and Isabelle. S. Young
AI in Diagnostics Traditional diagnosis can take a long time due to slow scans and a global shortage of radiologists. This is why AI has had such a huge impact on medicine as it speeds up the process of diagnosing and frees up doctors by using algorithms to analyse patient data such as medical images, lab results, electronic health records etc. AI does this through machine learning where large datasets are used to train the systems so it can discover relationships and trends. Some data such as imaging technology and genetic data are now processed and analysed by AI algorithms which can yield insightful information and can produce estimates based on the patients’ medical history, symptoms, test results and other data. They can find hidden associations, biomarkers and disease 14
associated risks which help AI to identify and locate tumours, abnormalities and other medical conditions as early as possible. This offers oncologists insightful information about the stage, rate of growth and potential for metastasis of tumours by comparing outcomes with prior data. AI can also evaluate genetic data and find genetic variants linked to higher risk of developing a given disease.
Drug Discovery and Development By considering patients’ risk assessments and specific attributes such as genetic makeup, medical records and lifestyle habits, AI can customise individualised treatment plans specific to the patient. Additionally, AI is being used for target identification and is trained on large datasets to understand the biological
mechanisms of diseases and to identify proteins and/ or genes that can be targeted to counteract those diseases. For example, there is a prototype which can predict what combination of drugs will be most successful to cancer patients in 24 hours. They can also analyse data of tumour samples and predict how the patient will respond. This use of AI has been found to be more accurate than manual methods.
Analysing X-ray Images AI algorithms have been remarkable in processing medical images and allowing doctors to acquire accurate and in-depth findings. AI can process X-ray images, MRIs and CT scans in a fraction of the time doctors can so patterns can be quickly analysed to retrieve data, solving the issue of the growing demand for medical imaging especially CT and MRI and the shortage of radiologists globally. In Denmark an AI tool was used to analyse the chest x-rays of 1529 patients. The AI tool identified abnormal x-rays with 99.1% sensitivity which was overall better than the radiologists. They could find no major mistakes by the algorithm with any of the chest x-rays, concluding the AI works excellently for outpatients.
Virtual Wards AI is also used to support people in virtual wards, who would otherwise have to be in hospital to receive the care and treatment they need, in their own home. Virtual wards use remote monitoring technology such as apps and medical devices which involve AI that can assess a patient’s healthcare whilst they’re at home.
What May AI Bring in the Future? Moving forward, there are proposed patient and public involvement and engagement (PPIE) activities that facilitate citizens’ involvement in the development of AI, increasing the transparency of the AI system, and gaining opinions from patients and doctors. The NHS aims to become the first healthcare system to digitalise its outpatient system by embracing technology.
Ethical Issues with the Use of AI The 4 pillars of medical ethics are autonomy, beneficence, non-maleficence and justice. For autonomy, algorithmic transparency is an ethical dilemma as patients may not understand fully how AI works to give consent. Additionally, the gray area regarding competency makes it difficult for the AI to judge who is competent. How does the AI weigh
up the risks and benefits to decide the best course of treatment? Non-maleficence is the “duty to do no harm”: the AI would need to define harm and good in its system without introducing bias. Justice means to “treat everyone equally and equitably”. If input data is biased, it may exacerbate existing racial or societal biases, giving a biased output. Another big issue is that AI has no emotions. Human connection is important in the treatment and clinical outcome of patients. When coping with bad news and treating terminal disease patients it is particularly important to show care and support, which AI cannot replace.
Legal Issues with the Use of AI Currently there is no legislation specifically for the use of AI in healthcare, only general laws like the UK Medical Device Regulations 2002 or the Data Protection Act 2018. The usage of confidential patient information as input to continue development of the AI system may also cause legal issues to arise. With digitalised data, hacking and corruption is problematic as confidential patient information may be leaked. Furthermore, there is the big question of who takes responsibility for when something goes wrong. Doctors may be held responsible as they choose to implement the AI’s suggestion into their judgement, whereas technologists may be held responsible as the input data may be biased to cause biased outputs. However, neither are bound by the law to be accountable for mistakes.
Will AI Take Over Jobs in the Healthcare System? Currently AI is used to assist medics in their work and medics make the ultimate decisions in each treatment. It would require a large high-quality dataset for AI to make accurate decisions on its own. The dataset would need to be updated and frequently tested to adapt to every scenario e.g. a pandemic like COVID-19. It may be hard for the older generation to adapt since they may feel more comfortable with humans than machines. Doctors are also better at dealing with specific situations like people with symptoms but no illness or drug-seekers. They would deal with it accordingly instead of diagnosing and prescribing medication wrongly. Even though AI can perform some jobs more efficiently than humans, it will likely exist to support and not replace humans in the healthcare system in the near future. 15
4 pillars of medical ethics The four pillars of medical ethics are extremely important in the medical profession as they form the basics of clinical judgement and decision-making when confronted with a problem in the medical world. By Leane Beukes and Emily Van As
2. Beneficence 1. Justice Justice has 3 main parts: Distributive justice, Rights based justice and Legal Justice. Distributive justice is the fair distribution of limited resources. Rights based Justice is respect for people’s rights, such as prohibition of discrimination; and Legal justice is respect for the law. On a patient level there are obvious elements to justice such as not discrimination based of race, religion and ethnicity. Yet more broadly doctors do their best to maintain focus on the patient, but doctors may need to balance the patient’s rights and needs against the equitable allocation of healthcare funds, as they have to decide fairly between competing claims. Therefore, each treatment must be weighed up benefits against cost.
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Beneficence is a core principle in medical ethics, it is the moral duty of a doctor to promote the best course of action in the best interest of the patient; the principle of beneficence is to act with empathy and dedication; always placing the patient’s welfare at the core of every decision. It is good to think of beneficence as the process of ranking the available options for the patient from best to worst- this may vary for each patient. When considering beneficence as a doctor, you often consider the patients expectations and circumstances as well as what is medically good for the patients as you are treating human beings; this is known as patient centric care. Beneficence is important because it ensures that doctors consider the individual circumstances of each patient as every patient is different as what is good for one patient may not be the best option for another.
4. Non-Maleficence 3. Autonomy Autonomy means that a patient is actively involved in their diagnosis and treatment. It also means that the patient gets a say in the matter of their treatment in relation to their own desires, values and beliefs. Part of autonomy is consent; a patient has the right to give and withhold consent. Any procedure that is performed without consent is considered assault. However, for the consent that has been given to be valid there are some conditions. The consent has to be voluntary, informed and the patient has to be competent. Also under Autonomy is confidentiality, which is the right of a patient to privacy. So, doctors are not allowed to disclose patient information to others. While this can come with problems, doctors should still strive to practise confidentiality, unless by breaking confidentiality foreseeable harm has been prevented. Confidentiality also extends to a patient’s records, so patient’s records must be accessed in line with GDPR guidelines, and they must be accessed with a specific purpose with regards to a patient’s treatment.
Non-Maleficence is the duty to do no harm or allow harm to the patient through neglect. In some ways nonmaleficence is similar to beneficence but they differ in two keyways. Firstly, it acts as a threshold for treatment; if one of the treatment causes for more harm than good then it should not be considered for the patient. Secondly beneficence is used more in specific situations such as determining treatment and picking the best option for that individual whereas nonmaleficence is constant in clinical practice. To demonstrate the difference between non maleficence and beneficence here is an example: A 52-year-old man collapses in the street complaining of severe acute pain in his right abdomen. A surgeon happens to be passing and examines the man, suspecting that he is on the brink of rupturing his appendix. The surgeon decides the best course of action is to remove the appendix in situ, using his pen knife. From a beneficence point of view, the successful removal of the appendix in situation would improve the patients life, but from a non-maleficence perspective you would consider: the environment and penknife are likely to be unsterile so there is a high risk of infection, the surgeon has no clinical staff available or proper surgical equipment meaning chances of successful operation are lower, and the surgeon has probably never operated in that environment and unless there is no hospital close by, then it is a disproportionate intervention.
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Medicine Through the Army By Ava Floyd and Joel Veldtman
Completing your medicine degree through the Army can not only provide a significant financial support, but it can also provide you with an understanding of medicine like no other and once in a lifetime experiences as well. Application This article will focus on joining the army after med school (either applying during or after) as joining as a consultant is very different. It is also important to note that when applying to join the army it is worth considering the other UK armed forces as they offer different benefits and drawbacks. 18
The entire application process takes about a year from start to end (provided there are no unforeseen delays). It starts off quite simple with an online application made to the army’s website. You then have a basic interview with your local army careers centre and your health and fitness is assessed to see if you have the physical capacity to be in the army. Then you go on 2 residential trips, the second longer than the first. During these, you are interviewed again, you carry out various tasks assessing different qualities of an army doctor such as leadership. Finally, you attend the RAMC Selection Board (where RAMC stands for Royal Army Medical Corps) which is a formal interview (akin to medical school interviews) that decides whether you will be accepted or not.
Post Medical School After completing medical school you must complete foundation years 1 and 2 at one of the Defence Medical Group Units. These are a group of hospitals across the UK including Frimley Park, Northallerton, Portsmouth, Plymouth and the Queen Elizabeth hospital where army doctors must do their placements. There are specific specialities which you must do in your rotations these include emergency medicine, trauma and orthopaedics, general surgery, acute medicine and general practices). The applicant is then given a place on the Commissioning Course Short which is an 8-week course at Sandhurst which focuses on physical and field training as well as weapon handling and drill. After this you will do a Postgraduate Medical Officer Course, this is a 6-month course which specialises on what you need to know as a military doctor, for example you would be taught about tropical medicines and trauma specifically. After this you are commissioned into the Army Medical services and are now a key member of the Royal Army Medical Corps.
Life in the army From here you would begin as a general duties medical officer (GDMO) who can be deployed across the world and provide medical support across the regiments. At this point in time, similar to in the NHS, the GDMO would be supervised by a more senior member of staff. After some time you would be promoted to a Regimental Medical Officer, who usually works with a combat unit specifically and their job is to command the unit’s medical detachment, support the unit’s health in training and operations and advice on medical health as well as make assessments on if someone is fit for service. Alongside this Army doctors also assist on exercises carried out as training for the Army this can be either abroad or at home. Furthermore, one of the most exciting aspects of an Army Doctor’s life is the ability to take part in activities that wouldn’t be available to you otherwise as an example Army Doctors frequently have the opportunity to do Adventure Training courses like no other from skiing to climbing to hikes up mountains, the variety you see in your everyday life is endless. You will also gain medical experience like no other when being faced with some of the most complicated emergencies with limited resources and no senior staff to turn to, you become very skilled at thinking on your feet.
Advantages: Medical Experience: by practicing medicine in the army, you will be exposed to a wide variety of problems that will test and improve your skills as a doctor Responsibility: where in the NHS it takes quite a while to have a lot of responsibility, in the army you have enormous responsibility from the beginning Finance: if you apply during medical school, you can apply for a bursary where you get given £10,000 for each of your last 3 years at medical school and then a lump sum of £45,000 after completing your training. Additionally, during your years as a Junior Doctor, you get paid significantly more. Making a difference: practicing medicine in the allows you to be personally involved in many global events.
Disadvantages Missing Life: as a doctor in the army you will spend about 200 days ‘out of bed’. Which is to say 200 days where you are not living at home. This can mean you miss many key events such as weddings or birthdays, much more than a doctor in the NHS. Delay in Specialty Training: in the army it takes a lot longer to become a fully qualified doctor. This is because while you are helping the army as a junior doctor, you are not training therefore all the time you spend helping the army sets back your training. Danger: you are exposed to more danger working in the army than you would be exposed to in the NHS. It may not be quite the amount of danger you expect however there is still elevated risk in the locations you would be sent to.
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mRNA Vaccine and its Future Applications By Ambrose Chou
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s a significant development of vaccine technologies, mRNA vaccines are safer, more effective and easier to make than traditional vaccines as it only requires a piece of mRNA, which corresponds to a viral protein, instead of viral components or whole viruses. By injecting the piece of mRNA intramuscularly, viral antigens will be produced in vitro by body cells through translating the mRNA, which is done by ribosomes, stimulating the body’s primary antigen-specific immune response, providing protection to the body when it faces the same kind of live pathogen. The piece of mRNA can be easily manufactured and altered, which lowers the requirement of machineries and the risk of infection while providing the outstanding effect that is equivalent to a whole virus vaccine. This is also why the piece of mRNA is the only active ingredient. The other components include lipids, salts, acids/acid stabiliser and sugar. Lipids are used to transport the mRNA into cells. Lipid nanoparticles (LNPs), which are liposomers that are made of ionisable cationic lipids, helper lipids, cholesterols and polyethenylene glycol (PEG), traps mRNA in it, fuses with cell membrane of cells, and releases the mRNA into it. LNPs are formed in low pH environment and can keep its positive charge or neutral form depending on the environment’s pH. This brings several benefits. Firstly, its charge can help trapping mRNA and fusing with cell membrane, which are both negatively charged, effectively. Also, when it is in vitro, neutral pH in body will cause the 20
lipids to turn neutral, which can lower its in vitro toxicity. As a result, mRNA can be delivered in vitro safely and efficiently. Salts and acids/acid stabiliser helps further ensure a stable in vitro pH after the vaccine is injected. Lastly, sugar enables molecules in the vaccine to stay in shape and allows the pH to be stored for a longer time. When pandemic of Covid-19 broke out, mRNA companies quickly started to develop mRNA vaccines for it. On 23/8/2021, Comirnaty, which is developed by Pfizer and BioNTech, is approved by the U.S. Food and Drug Administration, letting Comirnaty to be the first approved Covid-19 mRNA vaccine. It proved that mRNA vaccine is applicable and allows vaccines to be quickly made, helping to resolve pandemics. On the other hand, scientists are now developing personal mRNA cancer vaccines, which are manufactured by specific molecular features of tumours, normally neoantigens as they are more different from self-antigens. Then, it directs the immune response to the tumours in order to let the body’s own immune system to attack the tumour. Apart from infectious diseases and cancer, scientists are also working on its application on immunotherapy, genetic disorder and regenerative medicine. However, as it is a new technology, scientists are still developing its uses and abilities. As scientists continues to develop, mRNA vaccine can definitely do more and more, playing a more and more important role in the future.
Absence seizures By Emily Van As
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bsence seizures are a type of generalised onset seizure; this means that both sides of your brain are affected from the start. These seizures are characterised by short periods of loss of awareness; you will not know what is happening around you or be able to respond to any physical stimulus or questions during the seizure. In some cases, your eyelids might flutter, and you might have slight jerking movements of your limbs or body. It is quite common to have hundreds of absences a day and most will go unnoticed as they are often mistaken as daydreaming or ‘blanking out’ - the seizures only last a few seconds. After an absence seizure you will be able to go on normally, but you will have no memory of the seizure.
Types of Absence Epilepsy Typical absences: During a typical absence, the person becomes blank and unresponsive for a couple of seconds. Atypical absences: Similar to typical absences but they start and end more slowly than a typical absence. During an atypical absence, the person might fall down and their limbs may go floppy. Childhood absence epilepsy: CAE is a common epilepsy syndrome which affects young children; it usually starts between the ages of 4 and 10 years old. CAE is part of a group of epilepsies called idiopathic generalised epilepsies which have a strong genetic link. Juvenile absence epilepsy: JAE is less common than CAE but is also a general idiopathic epilepsy, and usually starts between the ages of 9 and 13 but can
also start later than this. Some may develop JAE after being diagnosed with CAE.
Absence Status Epilepticus Absence status epilepticus is a prolonged absence seizure that usually lasts many hours and can even last for days. The main symptom is an altered state of consciousness; the patient is always alert but partially responsive. During the seizure, the patient will be confused and may be unable to answer simple questions such as the date and where they are. Most patients who are diagnosed with ASE will already suffer from idiopathic generalised epilepsy, but some ASE cases may appear de novo (without warning). ASE is usually misdiagnosed as focal status epilepticus or epileptic prodrome (pre seizure symptoms) or confusional non-epileptic condition, for example a confusional migraine. ASE can be terminated by antiepileptic drugs such as clobazam.
Prognosis Some children may grow out of their absence seizures -7 in 10 children with absence seizures stop having them by the age of 18. However, children who start having absence seizures after the age of ten are less likely to grow out of absences and are therefore more likely to have to start on a medication as other seizures can emerge; there is an 8 in 10 probability that they may develop tonic clonic seizures (convulsive seizures) without anticonvulsant treatment. 21
Head injuries in sport By Leané Beukes
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any sports including rugby, ice hockey and lacrosse have high injury rates, especially traumatic brain injury rates due to the physical nature of the sport.
What is a traumatic brain injury? Concussion is the most common form of traumatic brain injury. It occurs when there is strong contact to the head or neck, such as a shoulder to the face. The contact causes the brain to move forward in the skull and hit the cranium. This may cause swelling and bruising to the brain, as well as damage to the nerve fibres and blood vessels.
Diagnostic criteria Often, at higher level games a pitch side assessment by a medical professional will take place (using SCAT5) if there has been suspected head contact or a player reports head contact. If any of the following symptoms are displayed or reported, then the player is immediately removed form play: headaches, nausea or vomiting, balance problems, confusion, loss of consciousness and memory problems. This assessment often includes a memory test which will require the player to answer question such as: ‘What half is it now?’ or ‘Who scored last?’ If no symptoms are observed, the player may be allowed back into play, but will be observed again after 3 hours. The observation will continue for up to 48 hours in case symptoms present late. If there is no medical professional pitch side, it is best to take the injured player to A&E.
Short term effects of a concussion and recovery The short-term effects of a concussion are classified as Post Concussion syndrome. These effects include cognitive difficulties, confusion, trouble concentrating, delayed thinking, and shortterm memory loss. There is little treatment for a concussion other than rest and painkillers. It can 22
take anywhere between 1 week and 12 months to recover from a concussion. Often athletes will start their journey to return to non-contact sport after 1 week of being symptom free. There are multiple phases to return. After each phase players must be monitored for 24 hours for symptoms. If the player displays symptoms while in a return phase, they can try the phase again after further rest and 24 hours of being symptom free.
Long term effects of head injuries The long-term effects of a concussion include depression, anxiety and decreased brain function. Players are also more likely to develop Dementia and Parkinson’s later in life. Research has shown that one concussion increases risk of Dementia by 25% and two or more concussions doubles the risk. Multiple concussions also put players at risk of developing early onset Dementia. Therefore, after a number of concussions, players are advised to stop playing contact sport. Elite and children’s sport are typically well monitored, while concussions in intermediate sport are often overlooked. This is why it is so important that everybody who participates in sports are aware of the health risks of concussions. Competent referees are needed so that they can discourage dangerous play and ensure that safety equipment is properly worn. As much as some players will try to ignore it, rules and equipment are there to protect them. Ignorance of concussions puts players in a precarious position, as playing concussed can lead to further brain damage. This puts not only players health, but also their careers at risk.
Dementia By Hazel Tsang
What is Dementia?
Treatment
Dementia refers to the impaired ability to remember, think or make decisions that interfere with doing everyday activities. Types of dementia include vascular dementia, Lewy body disease etc, but the most common type is Alzheimer’s disease. Dementia is caused by damage to or loss of neurones and their connections in the brain. Scientists have recently identified abnormal aggregates of a protein TAF15 in the brains of individuals with early-onset dementia. Dementia is often diagnosed through cognitive and neurological tests used to evaluate thinking and physical functioning, assessing memory, problem solving, sensory responses etc.
There is currently no cure for dementia as the brain is very complex, with clinical trials involving betaamyloid and tau proteins having so far failed. Donepezil, rivastigmine, galantamine and memantine are commonly used to ease symptoms and slow down progression. In 2023, the FDA approved lecanemab for people with mild Alzheimer’s disease and mild cognitive impairment as they found it slowed cognitive decline in people with early Alzheimer’s disease.
Risk Factors for Dementia Dementia is not inherited but some other medical conditions can lead to dementia like Huntington disease, brain injury, infections etc. For people aged between 65 and 69, around 2 in every 100 people have dementia, a person’s risk roughly doubles every 5 years. Vitamin D deficiency, depression and diabetes have recently been found to increase the risk of dementia as well. To reduce this risk, you can drink less alcohol, not smoke, stay mentally well and keep a healthy diet.
Symptoms of Dementia Dementia is split into early, middle and late stages. Its progression and the life expectancy of the person is dependent on several factors like age and how soon their diagnosis is. Symptoms depend on the area of the brain that is damaged, so it can affect people differently. Most common symptoms are memory loss, difficulty concentrating, mood changes, confused about time and place, difficulty communicating etc.
Caring for Someone with Dementia When caring for someone with dementia, it is important not to trigger them by a change in routine and should avoid asking if they remember something or reminding them a loved one is dead. You should also help make daily tasks like going to the toilet and dressing easier. You should encourage activities that are stimulating and enjoyable as well as support them to maintain skills and an active social life. You can also register for support schemes run by health and care partnerships.
Latest News on Dementia Landais Alzheimer is a village in South-West France where everyone has dementia. Villagers are encouraged to visit the shop, restaurant and theatre to join activities. It is often seen that entering an institution accelerates cognitive decline, but this is not the case here as villagers are still experiencing real life despite their condition. South Tyneside and Sunderland NHS Trust has opened its first fully dementia-friendly ward, using colour to create a calm environment for dementia patients. Additionally, in Cambridgeshire, to help monitor people with dementia who live at home, scientists are trying to develop AI which is able to learn a patient’s regular behaviour and alert carers to problems or changes in patterns. 23
Computed Tomography (CT) By Joel Veldtman
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nformation is key for doctors to make life-altering decisions about patients. Computed Tomography or CT refers to a non-invasive procedure which provides doctors a detailed, 3D pictures of patient internal anatomy, enabling them to make better informed decisions.
CT Scanner Mechanism CT Scanners have a narrow beam of X-rays emitted from a source which is spinning around the patient on a ring. These X-rays shoot through the body and are received by digital X-ray detectors opposite the source. These detectors rotate with the emitter to ensure they stay opposite. This data is digitally compiled into a tomographic image or a “slice” which 24
represents 1-10mm of patient anatomy. After each slice, the patient is moved slightly so the next slice can be taken. The slices are finally “stacked together” to form a CT scan.
CT Scanner Safety X-rays are a form of ionizing radiation. This means that they have the possibility of causing cells to mutate, causing cancer. This risk however is proven to be incredibly small however the threat increases with multiple scans. Children and babies are more sensitive to ionizing radiation therefore doctors avoid administering CT scans to them or to the abdomen of pregnant women. If a CT scan can’t be avoided, the machine can be adjusted to be safer for children.
Forensic Pathology By Lammi Pang
What is forensic pathology? First and foremost, what is pathology? Pathology is the study of disease and injury and is a branch of medical science that is focused on the study and diagnosis of disease. Forensic pathology is a subspecialty of medicine within the field of pathology and focuses on determining the cause of death by examining a corpse. Forensic pathologists predominantly examine deceased individuals to determine the cause and manner of death, often of those that are considered non-natural or suspicious, often referred to as reportable deaths. A reportable death is any death that occurs unexpectedly such as when a person has not been under medical care for heart, lung or other diseases.
What do forensic pathologists do? Forensic pathologists are physicians who investigate these unexpected and unnatural deaths, typically by performing autopsies. Autopsies are performed usually during the investigation of criminal law cases and civil law cases in some jurisdictions. Autopsy reports contains mainly the pathological process,
injury or disease that directly results in or indicates a series of events that lead to a person’s death and the manner of death, which mostly include homicide, accidental, natural, suicide and undetermined. Their work involves both medical and legal matters such as testifying in court and they can serve as expert witnesses in courts of law.
Autopsy During the course of autopsy, various laboratory tests are performed, including x-rays, retention of body fluids such as blood and urine and small samples of tissues such as liver or brain for toxicological analysis and cultures of body fluids and organs for evidence of infection. The forensic pathologist is responsible for correlating all the information into an autopsy report.
Are forensic pathologists considered doctors? Yes, some might not think so but forensic pathologists are physicians trained in traditional medicine and the forensic sciences. They have knowledge of not only medical science, but also toxicology, trace evidence, wound ballistics, DNA technology, and forensic serology. 25
Schizophrenia By Bianca Lo
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chizophrenia is a syndrome where an individual might see, hear, or believe things that are not real. It affects approximately 1 in 300 people, and onset is most often during one’s early twenties, but differs among men and women.
Phases of Schizophrenia The first stage a patient will go through is the prodromal phase. In this phase, the patient will be withdrawn and spend most of their time alone (experiencing mostly negative symptoms). Following the prodromal phase is the active phase where patients will experience more severe positive symptoms. Then comes the residual phase where the patient will experience cognitive symptoms and/or negative symptoms.
Diagnosis of Schizophrenia There are three types of symptoms to look for in a patient who potentially has schizophrenia: positive (psychotic) symptoms, negative symptoms, and cognitive symptoms.
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Examples of positive symptoms would be delusions, hallucinations, disorganised behaviour, disorganised speech, and catatonic behaviour. Negative symptoms might involve avolition (lack of motivation), alogia (poverty of speech), and flat affect (inappropriate responses). Cognitive symptoms would be difficulty in remembering things and trouble concentrating. For an individual to be diagnosed with schizophrenia, they must display at least one of the following: delusions, hallucinations, and disorganised speech. These disturbances must also be ongoing for at least 6 months, with 1 month of active-phase symptoms.
Treatments Antipsychotic medications are used to treat Schizophrenia, and they work by reducing symptoms by affecting the neurotransmitter dopamine. Cognitive Behavioural Therapy (CBT) can also be used to treat Schizophrenia by identifying the patient’s delusions or hallucinations, and finding ways to manage these thoughts and respond to them differently.
By Marcus Kwok The Darwin Society is where you can always go to for a high-quality talk. Since its launch by Mr Dan Quinton and Izzy Singleton (grad. 2023) last year, we have had a range of talks from L6th and U6th pupils, topics varying from chemotherapy and plastic surgery to disease modelling and insect mimicry.
See you there!
The society usually runs during Wednesday lunchtime, where the pupil gives a 30-minute presentation on any biological topic. Not only are they required to do the talk without notes, but our hardworking speakers also have to research way beyond their slides to face the intense questioning afterwards. Me and my co-head Winston Tai are always very happy to see the room always packed with the large audiences that attend, consisting of students from 3rd year and up.
If you would like to be part of the best science society in Caterham School, just take a look at the many, many, many posters scattered around the science block for information on the next talk, or ask any of the bio teachers if you want to present on something you are passionate about!
Guest Speakers We have also been fortunate to have had guest speakers come to Caterham. These speakers are all professionals in their field, like Dr Joe Rose (photo 2), who came to talk about biological innovations in the healthcare industry, and Dr Victoria Revell from the University of Surrey (photo 1) , who talked about sleep and circadian rhythms. As of right now (Jan 2024), we are planning to welcome Dr Mike Rossiter who will talk about his work as a consultant in sports medicine and his experiences from his medical appointments like in the GB hockey team!
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C AT E R H A M SCHO O L