Oxford Handbook of Expedition and Wilderness Medicine (Oxford Medical Handbooks), 3e (Dec 6, 2023)_(0198867018)_(Oxford University Press) Chris Johnson
Oxford Handbook of Clinical and Healthcare Research
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Oxford Handbook for Medical School
Editor-in-Chief
Kapil Sugand
Trauma and Orthopaedics Specialist Trainee and Surgical Research Fellow, Imperial College London, UK
Edited by Miriam Berry
Consultant Nephrologist, University Hospitals Birmingham, Birmingham, UK
Imran Yusuf
Ophthalmology Specialist Trainee and MRC Research Fellow, Oxford University, UK
Aisha Janjua
Obstetrics and Gynaecology Specialist Trainee and NIHR Clinical Lecturer, Warwick University, UK
Chris Bird
Consultant in Paediatric Emergency Medicine, Oxford, UK
Consultant Editors
David Metcalfe
Clinical Research Fellow in Musculoskeletal Trauma, Oxford University, UK
Harveer Dev
Urology Specialist Trainee and Wellcome Trust PhD Fellow, Cambridge University, UK
Sri Thrumurthy
General Surgical Specialist Trainee, University College London Hospitals, UK
1
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Dedication
We would like to wholeheartedly thank the following people for their constant support, efforts, and faith in us, in helping to realize this handbook after 7 years.
Sincere and heartfelt thanks to the following:
• The publishing team from Oxford University Press, especially Mr Michael Hawkes (Senior Assistant Commissioning Editor for Medical Books) for his patience, negotiation, and expertise. You have been there every step of the way and your efforts are very much appreciated.
• All members of the editorial team and the consultant reviewers for giving up so much of their personal time to assist the contributors and ensuring quality control of the content. Thank you for working so well as a team and bringing such superb ideas to the table.
• Our plethora of devoted contributors and educators from every field of medicine and surgery. Thank you for submitting work of such high calibre, your insights, and expert advice.
• Our colleague publishing houses for offering permission to use their images.
• Our internal reviewers for taking the time out to review, critique, and appraise our entire book and offering your constructive criticisms to improve the content.
• Our families for their love, encouragement, and motivation. Thank you for compromising and sacrificing quality time with us, once again, so that we could write this handbook for every medical student everywhere. Needless to say, we will be striving to make up for the lost time.
• Our international audience for wanting a book like this and supporting the project from the very beginning. This handbook has been written for you. We all hope that it will serve as a useful companion throughout your exciting time at medical school that will ultimately lay the strong foundations for a lifetime of clinical practice.
Foreword
This superb guide to the neophyte doctor ranges from one’s first approach to medical school and how to cope with such a complex process right through to a doctor’s decision on which specialty career to follow eventually. As always this Oxford Handbook covers a vast range of useful, relevant material, and this particular one will be of great value to anyone seriously considering medical school for their future career choice.
The contributors are a talented group of doctors whose expertise and interests span many different clinical specialties as well as having, between them, a vast experience in clinical academic research as well as a huge commitment in the modern complex process of medical education.
I am sure this book, where the nuts and bolts of virtually every specialty are most clearly laid out, will be a most useful guide worldwide for those not only considering a career in the medical profession but even those midway through their medical careers.
Peter Abrahams MBBS FRCS(ED) FRCR DO(Hon) FHEA
Prof. Emeritus of Clinical Anatomy
Warwick Medical School, Gibbet Hill National Teaching fellow 2011–14
Life fellow, Girton college, Cambridge
Visiting Professor LKC School of Medicine NTU Singapore
Preface
Medicine is a huge undertaking, both to study as an undergraduate and subsequently to practise as a doctor. During your preclinical studies, you are expected to learn anatomy, physiology, and biochemistry but also genetics, pharmacology, pathology, microbiology, the history of medicine, psychology, sociology, law, ethics, epidemiology, and statistics. The list is neverending! These are vast disciplines in their own right and medical students often struggle to understand what exactly they are expected to learn. The course objectives are frequently vague: ‘students should be able to identify the important anatomical structures of the pelvis and lower limbs’. You are also bound to see a course handbook state: ‘students may be assessed on any material from the lectures, group work, recommended reading, and anything else that the examiners feel students should know at this stage’. A common complaint of all medical students is that the material tested in exams feels disconnected from the topics taught. This is very different from the situation at secondary school in which core knowledge is tightly defined by a course syllabus. You would not be alone in becoming frustrated by the seemingly unpredictable, if not unlimited bounds of knowledge that appear to be expected by examiners.
Furthermore, the clinical years bring their own particular challenges. You are thrust into unfamiliar environments in which busy and overworked staff are trying to manage complex tasks with little time set aside to teach students, due to constant understaffing and lack of resources. The material that you painstakingly learned during the preclinical years somehow seems irrelevant to—or at least wholly insufficient to understand—what is going on in a practical and clinical setting. There are hierarchies, conflicts, and unwritten rules that you will navigate with varying degrees of success. You will never quite overcome the feeling of always being ‘in the way’. The overwhelming burden of boundless learning returns as you wrangle with over 60 different branches of medicine and surgery, from anaesthetics to urology. The knowledge expected of you by a cardiologist in a heart failure clinic will differ wildly to that expected by a skull base neurosurgeon in the operating theatre.
Hence, this handbook was conceived as a partial solution to the complexities of learning medicine in the twenty-first century. Sir William Osler famously wrote, ‘he who studies medicine without books sails an uncharted sea’. This handbook should serve as your map through the countless obstacles that you must overcome on your journey to qualifying as a doctor. First, it will help define the core knowledge that is expected of all medical students, which is often distinct from the niche interests of individual teachers. Second, it will identify ‘high-yield’ information and suggest what you should know (and so are likely to be asked) in any given clinical setting. Besides serving as a quick reference guide, this handbook introduces core topics to help guide you with further reading in your own time. It will also help you to prepare for some of the unfamiliar settings (such as etiquette
and conduct in the operating theatre, on wards, and in the emergency department) where you are likely to find yourself over the next few years until retirement.
The Oxford Handbook for Medical School will provide you with succinct, precise, and accurate facts about medicine and surgery that are bound to come up on a daily basis whether in or out of your time in hospital. The core motivation was to bequeath all the important lessons about the medical course and subject matter to the next generation of NHS leaders, pioneers, and consultants as well as to reflect on what we would like to have known back when we were medical students. Whether you are in the cardiology clinic, on the surgical wards, in theatre, or witnessing emergency care, this handbook includes carefully selected clinical scenarios that will explain the logic behind the management plans as well as improve your confidence in explaining it to your examiners. With aide-memoires, mnemonics, pictures, and seminal research accompanied by concise text you will be able to easily deconstruct abstract principles into digestible and memorable information. Since medical school is not only about clinical attachment as it encroaches into your personal life too, there is plenty of useful information on managing finances, health issues, planning electives, and career guidance to improve your chances of professional success from an early stage. Not many other books, at least known to us, can say the same. We have also ensured that the handbook does not preach or lecture but communicates with its audience on an informal and conversational level.
Needless to say, writing this compendium has been one of the biggest professional challenges to the editorial team but if it means that we manage to improve the quality of medical education globally, uplift the competence of medical students in all corners of the world, and give you another reason to fall in love with this vocation, then all the personal sacrifices, compromises, and struggles will have been all the more worthwhile. Medicine is obviously voluminous and it is sometimes discouraging when the sudden realization dawns on you that there is much work to be done in order to carry out the responsibilities for your vulnerable patients. Hopefully the Oxford Handbook for Medical School will serve as a friendly companion to ease your stress throughout your studies as well as introduce you to other speciality-specific Oxford Handbooks for further information with our cross-referencing style.
The Oxford Handbook for Medical School is the result of efforts from eight doctors from a range of specialities to offer a one-stop survival guide for every medical student to make the most of their course from the very first day to the very last. There was a vision and intention to pose the commonest clinical scenarios, how to excel at medical school, and improve career potential early on. There are clearly many textbooks available on the market with too little or too much information, written formally as if you were being lectured, and with dense data that risk losing your attention. This survival guide synthesizes advice from over 100 doctors. It has been said that ‘you should learn from the mistakes of others as you do not have time to make them all yourself’. The time you spend reading this handbook could well be one of the best investments you make at medical school.
Finally, on behalf of the editorial team, we would like to take this opportunity to wholeheartedly thank everyone involved in the success of this handbook. We welcome your feedback to constantly improve the content of this handbook in subsequent editions and we hope that the Oxford Handbook for Medical School will serve you well.
David Metcalfe and Kapil Sugand Members of the Editorial Team Oxford Handbook for Medical School May 2018
Contributors
John R. Apps
(Chapter 54: Getting ahead)
Paediatric Specialist Oncology Trainee, Birmingham Women’s and Children’s NHS Foundation Trust. Birmingham, UK, Honorary Research Associate, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
Bilal Azhar (Chapter 42: Upper gastrointestinal and hepatopancreatobiliary surgery)
Vascular Surgery Specialist Registrar, London Deanery, London Postgraduate School of Surgery, UK
James R. Bentham (Chapter 26: Paediatrics)
Assistant Professor and Consultant Paediatric and Adult Interventional Cardiologist, Department of Paediatric Cardiology, Leeds General Infirmary, UK
Miriam Berry
(Chapter 3: Preclinical medicine; Chapter 5: Intercalated degrees and special study modules; Chapter 21: Nephrology; Chapter 48: Clinical assessments; Chapter 50: Clinical examinations; Chapter 54: Getting ahead)
Consultant Nephrologist, University Hospitals Birmingham, Birmingham, UK
Chris Bird (Chapter 3: Preclinical medicine; Chapter 6: Going clinical; Chapter 26: Paediatrics; Chapter 45: Practical procedures; Chapter 46: Basic investigations) Consultant in Emergency Paediatric Medicine, Birmingham Children’s Hospital, UK
Lesley Black (Chapter 17: Genitourinary medicine)
GP Specialist Registrar, Severn Deanery, Bristol, UK
Deborah Bowman (Chapter 47: Ethics and law) Professor of Bioethics, Clinical Ethics and Medical Law at St George’s, University of London, UK
Lois Brand (Chapter 53: Making decisions) Consultant in Emergency Medicine, John Radcliffe Hospital, Oxford, UK
Elsa Butrous (Chapter 54: Getting ahead)
GP Specialist Registrar, Oxford Deanery, UK
James Butterworth (Chapter 34: Colorectal surgery) Surgical Specialist Registrar, Clinical Research Fellow, Department of Cancer and Surgery, Imperial College London, London, UK
William Butterworth (Chapter 34: Colorectal surgery)
Core Surgical Trainee, General Surgery, Princess Royal University Hospital, London, UK
Nandini Datta
(Chapter 6: Going clinical)
Senior Resident Medical Officer, Emergency Department, Gosford Hospital, Central Coast Local Health District, Australia
Fungai Dengu (Chapter 42: Upper gastrointestinal and hepatopancreatobiliary surgery)
ST5 General Surgery Registrar
Oxford Deanery, Clinical Research Fellow in Transplant Surgery, Nuffield Department of Surgical Sciences, University of Oxford.
Urology Specialist Trainee and Wellcome Trust PhD Fellow, Cambridge University Hospitals NHS Trust, UK
Kate Drysdale (Chapter 14: Gastroenterology)
Hepatology Clinical Research Fellow, Queen Mary University of London, London, UK
Tegwen Ecclestone
(Chapter 56: Career planning)
Core Trainee, Northern Deanery, UK
Daniel Fitzgerald (Chapter 56: Career planning)
Medical Doctor, Médecins Sans Frontières, Operational Centre Paris, France
Neil Gupta (Chapter 44: Radiology)
Consultant Interventional Radiologist, Joint College Tutor for Clinical Radiology, Radiology Fellowship Program Director, University Hospital Coventry & Warwickshire, Coventry, UK
Ruofan Connie Han (Chapter 49: Preparing for clinical examinations)
Specialist Registrar in Ophthalmology, Oxford Eye Hospital, John Radcliffe Hospital, UK
Adam Handel (Chapter 50: Clinical examinations)
Clinical Lecturer in Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford
Ayad Harb (Chapter 39: Plastic surgery)
Consultant Plastic Surgeon, University Hospital North Midlands NHS Trust, UK
Amy Hawkins (Chapter 55: Electives)
Specialist Registrar in Palliative Medicine, London, UK
Fiona Hayes (Chapter 31: Rheumatology) Consultant in Rheumatology and Acute Medicine Southend University Hospital NHS Trust, UK
Specialist Registrar Paediatrics, Royal Derby Hospital, UK
Alexander J Hills
(Chapter 37: Oral and maxillofacial surgery)
Specialist Registrar, Oral and Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, Sussex, UK
Thiagarajan Jaiganesh
(Chapter 12: Emergency medicine)
Consultant in Adult and Paediatric Emergency Medicine, Emergency Department, St George’s, University of London, UK
Aisha Janjua
(Chapter 23: Obstetrics & Gynaecology
Chapter 50: Clinical examinations; Chapter 51: Written exams)
Obstetrics and Gynaecology
Specialist Registrar and NIHR Clinical Lecturer, Warwick University, UK
Mhairi Jhugursing
(Chapter 9: Critical care)
Consultant Anaesthetist, West Middlesex Hospital, London, UK
Irfan Jumabhoy
(Chapter 2: Studying at medical school; Chapter 54: Getting ahead)
Core Surgical Trainee, Plastic and Reconstructive Surgery, Nottingham University Hospital NHS Trust, Nottingham, UK
Raghunath Kadiyala
(Chapter 13: Endocrinology and diabetes)
Consultant in Diabetes and Endocrinology, Stoke Mandeville Hospital, Buckinghamshire
Healthcare NHS Trust, Aylesbury, UK
Sheirin Khalil
(Chapter 52: Other assessments)
GP Specialist Registrar, James Paget University Hospital, Great Yarmouth, UK
Harry Krishnan (Chapter 50: Clinical examinations)
Specialist Trainee, Trauma and Orthopaedics, Northwest Thames Rotation, UK
Kar-Hung Kuet (Chapter 10: Dermatology)
Specialist Registrar, Dermatology, Royal Hallamshire Hospital, Sheffield, UK
Mong -Loon Kuet
(Chapter 35: Ear, nose, and throat surgery)
Specialist Registrar, Ipswich Hospital NHS Trust, Ipswich, UK
Suhas S. Kumar (Chapter 7: Anaesthetics)
Consultant, Department of Anaesthesia and Critical Care, Norfolk and Norwich University Hospital, Norwich, UK
Lily XLi
(Chapter 40: Trauma and orthopaedic surgery)
Orthopaedic Specialist Registrar, North West London rotation, UK
Firas Maghrabi (Chapter 20: Infectious diseases and tropical medicine)
Clinical Research Fellow in Infectious Diseases, The National Aspergillosis Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
Consultant, Emergency Department, Derriford Hospital, Plymouth, UK
Arjun Odedra
(Chapter 5: Intercalated degrees and special study modules; Chapter 54: Getting ahead)
GP Specialist Registrar, Royal Surrey County Hospital, Guildford, UK
Nicola Okeahialam
(Chapter 6: Going clinical)
Specialist Registrar, Obstetrics and Gynaecology, Chelsea & Westminster Hospital, London, UK
Vishal Patel (Chapter 32: Breast surgery)
Breast and General
Surgery Specialist Registrar, North West London Deanery, UK
Nikhil Pawa
(Chapter 34: Colorectal surgery)
Consultant General & Colorectal Surgeon, West Middlesex University Hospital Middlesex, UK
Benjamin Pinkey
(Chapter 6: Going clinical) Consultant Paediatric
Radiologist, Department of Radiology, Birmingham Children’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, UK
Emma Prower (Chapter 11: Elderly care)
Intensive Care Specialist Registrar, Kings College Hospital, London, UK
Tasneem Rahman (Chapter 19: Immunology and allergies)
Specialist Registrar in Immunology and Allergy, Department of Immunopathology, Royal London Hospital, London, UK
Fatimah Ravat (Chapter 2: Studying at medical school)
Postgraduate MSc Student, Deanery of Biomedical Sciences, University of Edinburgh, Edinburgh, UK
Imran Raza
(Chapter 34: Colorectal surgery)
Specialist Registrar in Colorectal and general surgery, University College Hospital, London, UK
Isabel Rodriguez-Goncer (Chapter 20: Infectious diseases and tropical medicine)
Senior Clinical Fellow in Infectious Diseases, The National Aspergillosis Centre, Manchester University NHS Foundation Trust, Wythenshawe hospital, Manchester, UK
Shahbaz Roshanzamir (Chapter 11: Elderly care)
Consultant Geriatrician and General Physician, Department of Ageing and Health, Guy’s & St Thomas’ Hospital, London, UK
Hazim Sadideen
(Chapter 39: Plastic surgery)
Department of Surgery and Cancer, Imperial College London, London, UK
Ahmed-Ramadan Sadek (Chapter 36: Neurosurgery)
Senior Neurosurgical Registrar, Jason Brice Fellow in Neurosurgical Research, Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, UK
Ashraf Sanduka (Chapter 28: Pathology)
Consultant, Department of Histopathology, West Suffolk Hospital, Bury St Edmunds, Suffolk, UK
Guy Schofield (Chapter 27: Palliative medicine)
Specialist Registrar in Palliative Medicine, Wellcome Trust Society and Ethics Fellow, Centre for Ethics in Medicine, University of Bristol, UK
Katherine Schon (Chapter 16: Genetics)
Specialist Registrar and Academic Clinical Fellow, Department of Clinical Genetics, East Anglian Medical Genetics Service, Addenbrooke’s Hospital, Cambridge, UK
Specialist Registrar, Department of Cardiothoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Stephanie Slater (Chapter 51: Written exams)
Senior House Officer, Acute Medicine, Croydon University Hospital, UK
Carmel Stober (Chapter 31: Rheumatology)
Locum Consultant in Rheumatology, Department of Rheumatology, Cambridge University Hospitals
NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
Amit Sud
(Chapter 18: Haematology)
Clinical Research Fellow, The Institute of Cancer Research/ The Royal Marsden NHS Foundation Trust, London, UK
Kapil Sugand
(Chapter 1: Starting as a medical student; Chapter 3: Preclinical medicine; Chapter 5: Intercalated degrees and special study modules; Chapter 8: Cardiology; Chapter 12: Emergency medicine; Chapter 15: General practice; Chapter 30: Respiratory medicine; Chapter 34: Colorectal surgery; Chapter 40: Trauma and Orthopaedics; Chapter 41: Vascular surgery; Chapter 43: Urology; Chapter 49: Preparing for clinical examinations; Chapter 50: Clinical examinations; Chapter 53: Making decisions; Chapter 54: Getting ahead)
Editor-in-Chief for OHMS, Trauma and Orthopaedics
Specialist Registrar and Surgical Research Fellow, Imperial College London, UK,
Quen Tang
(Chapter 40: Trauma and orthopaedic surgery)
Specialist Registrar in Trauma and Orthopaedics, North West Thames Rotation, Department of Trauma and Orthopaedics, Chelsea and Westminster Hospital, London, UK
Hannah Tharmalingam
(Chapter 24: Oncology)
Oncology Registrar, Department of Oncology, Mount Vernon Cancer Centre, Northwood, UK
Jemma Theivendran (Chapter 29: Psychiatry)
Specialist Registrar in Child and Adolescent Psychiatry, South West London and St George’s Mental Health Trust; Honorary Clinical Lecturer, St George’s, University of London, UK
