November 2014

theMEDICALSTUDENT

November 2014

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

Women in Medicine

GMC publishes its report - page 4

The War on PTSD

We interview a war veteran - page 6

Was Ebola Preventable?

Was enough done? - page 8

The BFI London Fim Festival The films to look out for - page 10

Medical Students may be Forced to Train as GPs

William Pickworth Guest Writer Medical graduates may have no choice but to apply for GP training in a bid to tackle the current GP recruitment crisis.

This year GP recruitment opened for a third round for the first time ever in a desperate attempt to increase the number of doctors applying. This comes as growing numbers of qualified GPs are choosing to emigrate, retire early or change medical specialty.

The Royal College of General Practitioners has estimated that

by the year 2020, an additional 8000 GPs will be needed to provide adequate access to primary healthcare. Ed Miliband stated at the Labour conference lately that he can guarantee this number of new GPs under a Labour government. This begs the question: how?

Given the 15% reduction in applications to GP training in the last year, leaving a total of 451 places in the UK unfilled, describing the situation as a crisis would not be an overstatement. In 2012 former health secretary Andrew Lansley set out a plan to ensure 50% of all trainees become GPs. In reality

this figure is well below the national target, around 40%.

David Cameron has promised to provide access to GPs 12 hours a day, 7 days a week by the year 2020. This all sounds great on paper, but how does he expect this to actually work?

The number of GPs retiring before the age of 60 is at record levels - the average age currently stands at 59. With a significant number of female GPs retiring in their 30’s, it seems this crisis is one of retention as well as recruitment.

The RCGP presented their manifesto prior to the political party conferences this year. It

requests a “promise to maintain and preserve ‘free at the point of need’ healthcare. This, funnily enough, was not directly addressed at said conferences.

The murky topic of ‘NHS privatisation’ may be coming to the forefront in the near future.

While the idea of incentivising graduates to apply has been put forward, this seems difficult to believe when the extent of government funding cuts threatens the overall stability of the NHS. It has been suggested that doctors could undergo ‘dual training’, which could lead to the evolution of GPs with specific skill sets required to meet the demands of an ever-ageing population.

The real solution to the dwindling number of GPs in this country may not be taken so kindly by the new generation of trainee doctors. An advisory group formed by Heath Education England is considering the option of limiting the number of non-GP training posts.

This effectively would leave many newly qualified doctors no option but to apply for GP training.

The Chair of the General Practitioners Committee, Dr Chaand Nagpaul has said “general practise is not seen as an attractive career option. Successive years of disinvestment has resulted in a workforce that is overstretched, lacking in morale… it does not paint an attractive picture.”

But why is the allure of general practice fading? A recent, inadvertently comical article in the Daily Mail casually placed all the blame on “moaning GPs”.

It comes as no surprise that the reasons for which GPs may be so disheartened were (accidentally?) overlooked. This is just one of countless examples of the media’s negative portrayal of doctors, in particular GPs. An anti-GP campaign has been gathering strength over the last decade, with a recent analysis exposing the gross imbalance of news reports covering doctors attending fitness to practise hearings or being struck off.

A local GP was willing to offer his opinion on the matter.

“GPs are under a lot of pressure, both from governing bodies and patients who have high expectations” he said. “With a significant reduction in funding and increase in workload, any GP in reach of retirement would be better off doing just that: reduce hours and increase remuneration. When medical students attend my practise for their GP placement, they see the whole practice struggling to meet demands. It comes as no surprise to me that the appeal of becoming a GP is diminishing.”

To add insult to significant injury, those who are quick to react with promise of an overgenerous pension would do well to examine the changes being implemented to NHS pension as of 2015. Not only will NHS staff pay more in to the scheme and receive less than is currently the case, the age at which full pension is awarded to doctors is to be hiked up to 67.

With this pretty picture mind, medical students: form an orderly queue. GP training is the (only) one for you.

[NEWS]

theMEDICALSTUDENT / November 2014 News Editors: Krishna Dayalji news@themedicalstudent.co.uk

An Autumn Update, A Winter Upgrade.

[EDITOR’S LETTER]

As the new term begins in earnest, we are drawn -slowly at first- back to the semblance of routine. Before we even know it we are the early risers, the first commuters and the sunrise ironers. With that feeling of entrenchment comes another issue of TMS, fresh from the festivities of Hallowe’en and Thanksgiving.

Returning to the wards after a year slumped in lectures has been like awakening from a dream. I, and many of you, have once more been thrust unto the breach, smiling at consultants and registrars that can easily visualise our incompetencies.

When I was recently asked to insert a catheter for a patient, I initially rendered myself in a near Parkinsonian state that began to abate once I realised that I had indeed picked up enough knowledge and practice to succeed. Confidence it appears, like the ability to iron a shirt before seven in the morning, can be reawakened.

Fifth year at ICSM is the Specialties year, a year in which you are tasked with the mission to accrue as much knowledge and experience of a full

house of different medical flavours as you possibly can.

It is a year many enjoy and, if letter writing were still a skill worth savouring, something that many of us would wish to write home about. Up until now there has been only one thing that has driven my own opinions on which job I might end up, pot belly positive, in my mid-thirties That sole influencer, that divine guider, has been the caffeine habits of the attending physicians. A brief dalliance with psychiatry revealed a fully bloomed communal coffee addiction, something I am very willing and increasingly keen to partake in.

However, my recent placement in ITU has enlightened me to the charms of enforced tea and coffee breaks. For years I have dreamt of these moments, alone with my thoughts and my coffee, in a brief banishment from the ward. There are no guilty Costa consciences on ITU these days, no spilt lattes rushing between patients, and no pain-auraisin choking incidents. There is calm and there is the beeping, the endless, echoing beeping.

This month’s TMS is another must read issue. We have a great Features section on military medicine and PTSD as well

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as another great instalment from Rhys as he goes On Call at St. Elsewhere’s in his Diary of an FY1. As we tread ever more deeply into the autumn term we are also approaching the SJT and there are some great tips from a doctor in the Education section for you to read through as well as some example questions for you to take a look at.

Culture this month is something to take a note of, as John talks us through the BFI London Film Festival and which films we need to keep our eyes peeled for in the coming weeks and months.

Much like those films, I also encourage you to follow TMS over the next few months, with those eyes widened and those notebooks ready, as we undergo several important changes and developments as we shift our concentration from the print issue over to the online format which is a little less archaic and a whole lot more flexible. There will be new things as well as old things done better and, like a student slowly perfects their examinations whilst simultaneously collecting new ones, our aim is to constantly improve.

Student journalism, like confidence and ironing before it, can be reawakened.

Ebola: How quickly can we find a cure?

Editorial Staff Editor-in-Chief / Rob Cleaver News Editor / Krishna Dayalji Features Editor / Anne Tan & Hygin Fernandez Comment Editor / Oscar To Culture Editors / John Park & Katy Bettany Doctors’ Mess Editor / Narmadha Kalai Vanan Sport Editor / Mitul Patel Treasurer / James Orr

Contributors Writers: William Pickworth, Christine Tan, Suborno Ghosh, Mahibur Rahman, Utsav Radia, Rhys Davies, Freddie Stourton, Sean Thomas Morgan & Jake Wilson

Christine Tan Guest Writer The Ebola crisis has become household talk as panic and fear has swept through the media.

Cases have been reported far from the source of the epidemic and the WHO has declared a global health emergency. The UN has confirmed that the lives of 4,033 people have already been claimed by the epidemic, including recent reports of the first victim in Europe and the death of international health workers in Africa. And worryingly, the UN claims that cases of Ebola have been doubling every three to four weeks, such that lives are being taken on an unprecedented scale.

Whilst accusations have been made against WHO for underestimating the impact of Ebola and failing to provide an adequate early response, now the main international impetus lies to find effective intervention as quickly as possible.

What we know so far: Ebola is transmitted through bodily fluids; if corpses are not

prepared with chlorine and sealed off with plastic, they can remain virulent for months.

Following an incubation period of 3- 21 days, patients quickly develop a disease characterised by haemorrhage and multiple organ failure. Quarantine is critical, however in spite of intervention the outbreak is yet to be controlled. A lack of awareness on the nature of the virus, and prevention of its spread, is common across West Africa.

Further burdening is the problem of scarce resources and a lack of medical treatment. At current, there is no cure to control the outbreak; management of patients is limited to palliative care and community efforts to keep the spread at bay.

The race is on: Preclinical testing of an immunotherapy agent, ZMapp, made from the nicotine tobacco plant, Nicotiana benthamiana is grown for several weeks before being treated with antibodies; it is subsequently grown for another week, before antibody proteins are harvested. In a recent trial, three doses ZMapp

were administered to macaque monkeys infected with a virulent strain of Ebola whose symptoms were gradually reversed subsequent to ZMapp administration. After three weeks, no Ebola viruses were detected in the subjects’ blood.

Since the preclinical trial, ZMapp has been administered to six health workers with beneficial results. Further testing would be difficult to conduct, given that intentional inoculation of human subjects is not possible and the limited availability of the agent due to depleting supplies.

At present, West Africa awaits for intervention to contain the uncontrollable spread of Ebola. David Nabarro from the UN special envoy, reports, ‘…there is no price on a human life. Barely an hour passes without another body to bury in West Africa’. International fear is palpable; the outbreak threatens to ravage communities beyond the source of the epidemic. Medical intervention is consequently desperately and immediately needed.

[NEWS]

theMEDICALSTUDENT / November 2014 News Editors: Krishna Dayalji news@themedicalstudent.co.uk

Steve Tran & Mohammed Amer Medgroup Chairs Welcome to the second edition of TMS! For all our sakes, thank goodness Freshers is over! We hope you’ve had an awesome time regardless of whether it’s your first or ‘last’ Freshers.’. UH Medgroup were able to bring back the popular pan-London 999 event.

This year we hosted it at St. George’s Union, so great thanks to St. George’s SU for having us. If you weren’t there, then you definitely missed out on the battle of the medschool DJs. The next major event in the calendar that involves all five London medical schools is UH Sports Night in aid of Right to Play. We’ve been told that it’s bigger than ever, as the organising committee have hired out INFERNOS in Clapham. So we look forward to seeing you there regardless of whether you play a sport on Wednesday 19th November!

Our next UH Medgroup meeting will be focussing on student welfare and support, so if you’re interested in contributing to our discussions about any pressing student issues: please get in touch with your SU president or welfare officer to relay your concerns to us!

Adam Mayers GKT President Fresher’s events this year at GKT have been recordbreaking, with nearly a complete sell-out across the whole two weeks and every event (old and new) being a great success – thanks to everyone for coming!

Outside of socialising, we have been hard at work setting up the new MSA Peer Assisted Learning scheme, which has got off to a great start with 80 students signed up to tutor second and third year medics over the next year. News from the School is mainly that they are making a lot of changes to its structure, including a lot of changeover of staff – we’re hoping that this will build on the momentum of the positive changes that we are seeing at the moment.

The back half of this term will see both the GKT Xmas Comedy revue and MSA Musical Theatre make their annual performances to a packed Greenwood Lecture Theatre (albeit with very different levels of sobriety of cast, crew and audience…). We also have a very exciting Question-Time style event on “The Future of The NHS” with some excellent speakers, as well as the eagerly awaited return of the MSA Christmas Dinner!

Alex Fleming RUMS President #Bello from RUMS. The last couple of months have not been uneventful at RUMS, with developments coming thick and fast in the fields of social events, sport and academia.

Our Freshers’ Fortnight went off in style, with the usual series of events being well attended by the new cohort of students (with our Greek treasurer defying all the stereotypes to turn a profit on the events, a first in the history of RUMS!) RUMS (using the pseudonym UCL) claimed another Nobel Prize this month, with the award going to our very own Prof John O’Keefe for his discovery of the brain’s own “GPS”. Otherwise, RUMS are continuing to work with the medical school to decide on a new structure for the OSCE examinations following a recent decision to overhaul the system.

In the world of sports, our rugby club returned victorious from Munich having won the Munich 7s Plate. RUMS confirmed their continuing dominance over UCL on the sports pitch, with wins for RUMS Women’s Hockey and a notable 8-1 victory for RUMS FC 2nd team over their UCL counterparts.

Dheemal Patel SGUL President Hello! The past month has been incredibly busy here at St. George’s. Our Fresher’s week was a massive success and it was great to see so many students getting involved. Currently, we are in the process of electing Year Representatives for all year one courses. Our sporting teams have also started the year off very well with Rugby, Hockey and Netball having great wins.

Last Friday, St. George’s put on its first debut 24-hour musical. The cast and crew worked all night to put on the Rocky Horror Show, which went down a storm.

The annual charity week is also in full swing, and many students have been working hard to raise lots of money. Over the next few weeks, preparations are fully underway for many of our shows including the Diwali, Fashion and Revue shows, and lots of our students are rehearsing hard in the run up to the Christmas break.

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Dariush Hassanzadeh-Baboli ICSM President We have just come to the end of our Freshers’ Fortnight, and it is safe it say it was the most successful we have ever had. We pre-sold over 250 ‘Freshers’ Passports’, and made an active effort to get the Biomedical sciences and Graduate entry students involved. Fun was had by all and it is safe to say that the spirit of the Phoenix live on in Hammersmith!

We also hosted our ‘Teddington Alumni Day’, attended by over 300 current and old students, two weeks ago. It is very unfortunate that Imperial College decided to stop all student sport at the grounds, which was gifted to our medical school over 80 years ago, but we are successfully transitioning to our new grounds at Heston and Harlington.

Our Welfare Officer, Jennifer Watson, is currently gathering information to start a campaign with regards to student funding in the last 2 years of medical school. Both ICSMSU and the Faculty have been approached by a large number of students about lack of funding, and this greatly concerns us. We shall be publishing an article in the coming months to increase awareness about this matte, and gain support so that future students do not suffer.

Sam Rowles BLSA President Hi all, what a whirlwind first couple of months!

After our massive sell-out Freshers’ Fortnight, and record-breaking Sports and Societies sign-ups at the Freshers’ Fayre, things are finally starting to settle down a little around Barts and The London. Preparation for the much afeard first exams has started, and students have even been seen in the library.

It is important to still take breaks from the work from time to time though, so be sure to stick with those Clubs, Societies, Volunteering or whatever it is you decided to sign up for! You can even attend the occasional event, and still not have to worry about failing exams and/or subsequent death.

Sports fixtures have now begun too and I can only assume that, in the light of no contrary information, BL are romping to victories across all leagues. Good job guys, keep it up!

And lastly, BL Muslim Medics and Dentists are currently raising money for Charity Week. I know that this is something that is run across most London medical schools, but have to say, everyone has been working pretty hard raising money for it, and BL are hungry for that London top-spot! I look forward to seeing the results at the end of the week!

[NEWS]

theMEDICALSTUDENT / November 2014 News Editors: Krishna Dayalji news@themedicalstudent.co.uk

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Women in Medicine Today Krishna Dayalji News Editor A recent report published by the GMC in early October has found that the healthcare workforce is rapidly transforming. With more women entering male-dominated specialities and fewer women entering medical schools, the annual report highlights a rapidly changing environment.

‘The state of medical education and practice in the UK’ is the fourth annual report detailing what is happening in the medical profession and considers some the key issues the profession faces, such that further adaptations can be made to create even more adaptable doctors.

Particularly interesting is the success of women in the medical profession. Female doctors now make up almost half – 44 per cent – of all UK licensed doctors, with the number of female doctors increasing at twice the rate as men between 2010 and 2013.

Despite obstetrics and gynaecology, and paediatrics continuing to be the preferred speciality for female doctors in training, woman are now entering the traditionally male-dominated specialities of emergency medicine (44 per cent increase) and surgery (42 per cent increase), compared to a 12 per cent rise in the number of men entering the specialities.

And almost everyday we are hearing about the successful achievements of women in Medicine.

Not too long ago did we hear the news that Professor Jane Dacre had been elected the next President of the Royal College of Physicians.

Dr Deborah Gill, interim director at UCL, was also recently awarded the prestigious Women in the City Future Leader Award.

And most recently, whilst many of you will know that the Nobel Prize in Physiology and Medicine was awarded to John O’Keefe at UCL, did you know that he also shared the prize with ‘May-Britt Moser’ (…and Edvard I. Moser) for their discoveries of cells that constitute a positioning system in the brain.

And of most relevance to our readers is how the medical student demographic has changed over the past few years.

The report found that currently there is 40,625 medical students in the UK, with many of these students concentrated in particular cities. University College London, Kings College London and Manchester University each have more than 2,000 students and together make up more than a quarter of the UK medical student population. And Oxford and Cambridge account for more than one in 20 medical students.

Furthermore, The number of medical students in London (9,124), which has five schools, is greater than the combined total for Scotland, Wales and Northern Ireland (8,241).

The report also found that whilst there are still more female medical students in comparison to male students (57 to 43 per cent), the rise in number of women entering medical school is slowing down.

Yet, despite more than half of medical school entrants being women, women remains poorly represented in academic medicine. A recent conference addressing this very matter took place at the BMA in which they stated the root causes for this discrepancy needs to be examined.

They added, “The loss of maternity pay and leave, the loss of other employment rights when moving between NHS and academia and inflexible working

patterns may all be part of this.”

“We need to ensure academic medicine remains attractive to the best people, whatever their gender.”

What are you opinions on this matter? Male or female, TMS would love to hear you views.

Write to us at news@themedicalstudent.co.uk

Foundation Programme oversubscriped for the fifth consecBMA Medical Students Com- departments, however, the international- or UK-trained) tutive year Krishna Dayalji News editor For the fifth consecutive year, final year medical students across the country will have began their anxious wait as the UK Foundation Programme Office (UKFPO) have announced there were more applicants than places available for the programme commencing in August 2015.

The news follows the close of the application process on 17 October 2014. Once again, the news not only created further apprehension but also restarted the debate to solve this annual problem affecting all UK medical students.

Keen to solve the issue is the

mittee (MSC). Following this news, the MSC has called out to the government for a ‘workable long-term solution’.

As some of you may already know, entry in to the foundation programme is vital to enable General Medical Council (GMC) registration, and currently this is the only pathway through which one may register as a doctor.

There are approximately 7500 F1 places available each year. The top 7500 applicants are allocated a post whilst the remaining applicants are placed on a reserve list and allocated posts as and when they become available.

In previous year, additional posts have been created with extra funding from UK health

government do not feel this approach is sustainable longterm, hence alternatives are still under discussion.

A suggestion from Health Education England has been to move forward the point of registration to coincide with medical school graduation. However there are many outstanding questions and concerns remaining about the functionality of such a proposal.

Furthermore, the GMC has began developing a single, national licensing exam which any doctor wishing to work in the UK would need to pass before being able to register with the regulator, in bid to create a level playing field for entry into medicine in the UK, as well as ensuring all trainees (whether

meet the required standards.

Yet, once again, the MSC fear that an additional exam to the SJT and Prescribing Safety Assessment, will overburden finalist medical students, further distracting them from essential medical training. They argue that the introduction of this exam should be proportionate and provide equal opportunity for all students.

The GMC council will consider the issue again in June 2015.

Meanwhile, the UKFPO have stated that they will once again be working closely with medical schools to ensure pastoral support is provided to those unfortunate students placed in the reserve list in March 2015.

theMEDICALSTUDENT / November 2014 News Editors: Krishna Dayalji news@themedicalstudent.co.uk

[NEWS]

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Research In Brief BARTS AND THE LONDON SCHOOL OF MEDICINE AND DENTISTRY A pioneering research study has found that members of the British Muslim community who are most risk of radicalisation are more likely to have depression and be socially isolated. Researchers developed a new way of measuring risk of radicalisation based upon asking participants about their sympathies and condemnation towards 16 terrorist actions.

Those who showed most sympathies towards terrorist acts are deemed at most risk, and those who shoed most condemnation are most resistant to radicalisation. The community study, surveyed over 600 men and women of Pakistani, Bangladeshi and Muslim heritage in London and Bradford, aged 18-45. Respondents were asked questions on a range of factors such as social capital, political engagement, perceived discrimination, religion and general health.

ST GEORGE’S, UNIVERSITY OF LONDON Children eating breakfast daily have a lower risk of developing of type II diabetes in comparison to those who skip breakfast or only eat it occasionally. Researchers also found that among children eating breakfast, those who eat a high-fibre breakfast cereal also have lower type II diabetes risk profiles, indicated by blood samples revealing insulin resistance, compared to children who eat a breakfast with a lower fibre content. More than 4,000 primary school children, aged 9-10 year from London, Birmingham and Leicester, were asked about their breakfast habits. Researchers said their findings could aid the development of strategies to combat rising diabetes levels in young people in the UK.

IMPERIAL COLLEGE LONDON A pilot study testing a new type of drug in patients with chronic diarrhoea has shown promising effects on reducing their symptoms. Bile acid diarrhoea (BAD) is a common cause of chronic diarrhoea, caused by excessive secretion of bile acids. The excess bile acids are not absorbed by the ileum and enter the colon causing watery diarrhoea.. The new drug, obeticholic acid (OCA), a farnesoid X receptor agonist, stimulates the production of FGF19, a hormome produced in the ileum which regulates the production of the bile acids in the liver.

KINGS COLLEGE LONDON A new study led by researchers at King’s College London in collaboration with the University of Manchester and Dundee has found a strong link between exposure to peanut protein in household dust during infancy and the development of peanut allergy in children genetically predisposed to a skin barrier defect. The studylooked at the amount of peanut protein children were exposed to in household dust in their first year of life by vacuuming dust from the living room sofa and measuring peanut in the dust. A group of 577 children were assessed at 8 and 11 years of age for peanut allergy and their DNA was checked for FLG mutations, which result in an impaired skin barrier allowing allergens to penetrate the skin. A three-fold increase in house dust peanut exposure during infancy was associated with a three-fold increase in risk of school-age peanut allergy.

UNIVERSITY COLLEGE LONDON A man who was paralysed from the chest down following a knife attack can now walk using a frame, following a pioneering cell transplantation treatment developed by scientists at UCL and applied by surgeons at Wroclaw University Hospital, Poland. The research is published in the journal Cell Transplantation and was jointly funded by the UK Stem Cell Foundation and the Nicholls Spinal Injury Foundation. The UK research team was led by Professor Geoff Raisman, Chair of Neural Regeneration at the UCL Institute of Neurology.

The technique involved using specialist cells from the nose, called olfactory ensheathing cells (OECs), in the spinal cord. These allow the nerve cells that give us a sense of smell to grow back when they are damaged.

The role of mitochondria in Multiple Sclerosis Suborno Ghosh Staff Writer Recent research on the role of mitochondria in the disease pathology of Multiple Sclerosis (MS) may shed further light on the incredible complexity of this disease overwhelming and debilitating disease.

Found largely in those between the ages of 20-40 and affecting almost 100,000 people in the UK, MS is an autoimmune, neurological disease, with numerous symptoms ranging from blurred vision and fatigue to problems with mobility and balance. However, unfortunately there is no cure for this distressing and life-changing diagnosis.

MS is where the immune system attacks myelin (the sheath-like material that insulates nerve fibres) resulting in small patches of demyelination along the nerve fibre, thereby disrupting the transmission of signals sent along the nerve fibres. Resolution of inflammation can leave behind scarring but ultimately these attacks by one’s immune system can lead to degradation of myelin and permanent damage of the underlying nerve fibre.

A critical hallmark in the aetiology of MS is the degeneration of nerve fibres with mitochondrial dysfunction being an established feature of MS. A mitochondrion is a complex organelle that is critical in the functions of respiration and energy production. To facilitate these processes, in particular the process of cellular respira-

tion, a single mitochondrion is comprised of 5 respiratory chain complexes each made up of multiple subunits. These subunits are encoded by both mitochondrial DNA (mtDNA) and nuclear DNA. Interestingly, recent work has shown that in patients with known mtDNA deletions and mtDNA depletions not all complexes are affected. Indeed complex IV is frequently impaired whilst complex II, which is encoded entirely by nuclear DNA, is spared or increased (Rahman S, et al. Brain 2000).

Recent investigations have tried to further elucidate the mechanisms involved in MS. In a relatively recent study, samples isolated from 13 secondary progressive MS patients and age-matched controls post mortem were examined for deficiencies in the respiratory chain complexes of mitochondria. Numerous mtDNA defects were found specifically in neurons of MS patients. The authors then went on to show a significant loss of neurons in MS patients, which may be a result of these mitochondrial defects (Campbell GR, et al. Ann Neurol 2011). In the cells that possess mitochondrial defects the lack of ATP generation would render the cells redundant and would therefore be catastrophic to cellular function. Further investigations are warranted to find out whether these defects are a cause or consequence of the disease process.

theMEDICALSTUDENT / November 2014

Features Editors: Anne Tan & Hygin Fernandez features@themedicalstudent.co.uk

[FEATURES] /6

Keep Calm and Carry On... the unwinnable

war on Post - Traumatic Stress Disorder

By Anne Tan

‘Keep Calm and Carry on’ was a slogan used by the British government to boost nationall morale before the start of the Second World War. Rediscovered in 2000, the slogan has now been parodied many times over and has become a British cultural icon in its own right, the mantra of the indomitable British stoicism.

But is it always possible to ‘Keep Calm and Carry on’?

Psychiatric diagnoses are perhaps some of the most controversial, precisely because they try to define the ‘appropriate’ emotional responses to a situation, classifying people on either extremes of the spectrum as ‘disordered’. Given how varied and multi-faceted the human experience is, this is certainly no easy task. Therefore it is not surprising that Post Traumatic Stress Disorder (PTSD) only became a psychiatric diagnosis in 1980, when it was added to the Diagnostic and Statistical Manual of Mental Disorders (a.k.a DSM) III.

“The fact is, PTSD is a new name for an old story—war has always had a severe psychological impact on people in immediate and lasting ways. PTSD has a history that is as significant as the malady itself.”

Steve Bentley

PTSD may be a relatively new diagnosis but it is by no means a new phenomenon.

Arguably it has been around at least as long as there have been wars. Scattered historical sources from as far back as 1000 BC (ancient Egyptian sources) have been found to describe the now ‘diagnostic’ responses of intrusive flashbacks and memories, hyperarousal and anxiety, anhedonia and avoidant behaviour… (DSM V has detailed criteria), lasting for more than a month following a traumatic event such as war.

Interestingly, the first army to recognise that soldiers required special psychological attention, was the Russian one.

The birth of military psychiatry happened during the 1905 war between Russia and Japan when a dedicated unit was set up on the front to help soldiers deal with ‘battle shock’. The aim was to get them to return to fighting. Despite their good intentions, they were not particularly successful and records show that only 20% actually returned to the battle field.

The most significant re-emergence of PTSD came after WWI. With the debut of artillery field guns and other modern weapons, man’s capacity to harm each other reached new heights and an unprecedented number of physically and psychologically injured soldiers returned from the battle field. Doctors used terms like ‘Shell shock’ and ‘War neurosis’ to describe the constellation of symptoms they saw. ‘Shell shock’ because they hypothesised that fragments of shell from bullets and cannon penetrated the skull causing the psychopathology a hypothesis that makes little

sense to us today!

Although the diagnosis of PTSD was not yet elucidated, the experience of it by soldiers was undeniably real. One such example is the poem, Dulce Et Decorum Est, written by famous poet and soldier, Wilfred Owen. In it he immortalises his feelings and thoughts which would not be out of place in a PTSD clinic today.

Based on this growing awareness of the effects of war, there, there was more effort during World War II to select ‘mentally fit’ soldiers to fight on the frontlines. The premise being that only ‘weak’ men were predisposed to being mentally ill after. This theory was proven wrong when despite selection, soldiers continued to experience psychological distress in large numbers.

In addition to the soldiers, Holocaust victims who survived concentration camps and victims of sexual assault also showed similar patterns of behaviour. All these circumstances contributed to the eventual recognition of PTSD. The precipitating factor to PTSD becoming an official diagnosis in 1980, was the overwhelming and characteristic anxiety that the soldiers returning from the Vietnam War (1955-1975) faced, upon their resumption of civilian life. Subsequently the aetiology of PTSD was broadened to include survivors of natural disasters, massive accidents and terrorist attacks.

Today we are better at recognising and offering support for patients suffering from PTSD than we were 3000 years ago.

However there is still a long way to. go. Perhaps slogans such as ‘Keep Calm and Carry on’ are not always helpful, as they imply that wilful, stubborn stoicism can overcome

Dulce Et Decorum Est

by Wilfred Owen (Poet and Solider, 1893-1918) Bent double, like old beggars under sacks, Knock-kneed, coughing like hags, we cursed through sludge, Till on the haunting flares we turned our backs And towards our distant rest began to trudge.

Men marched asleep. Many had lost their boots But limped on, blood-shod. All went lame; all blind; Drunk with fatigue; deaf even to the hoots Of tired, outstripped Five-Nines that dropped behind.

Gas! Gas! Quick, boys!—An ecstasy of fumbling, Fitting the clumsy helmets just in time; But someone still was yelling out and stumbling And flound’ring like a man in fire or lime…

Dim, through the misty panes and thick green light, As under a green sea, I saw him drowning.

In all my dreams, before my helpless sight, He plunges at me, guttering, choking, drowning.

If in some smothering dreams you too could pace Behind the wagon that we flung him in, And watch the white eyes writhing in his face, His hanging face, like a devil’s sick of sin; If you could hear, at every jolt, the blood Come gargling from the froth-corrupted lungs, Obscene as cancer, bitter as the cud Of vile, incurable sores on innocent tongues,— My friend, you would not tell with such high zest To children ardent for some desperate glory, The old Lie: Dulce et decorum est Pro patria mori.

(Dulce et decorum est Pro patria mori in English is: It is sweet and fitting to die for one’s country. A quote from Horace)

Vietnam War: In a 1968 Associated Press photo from Vietnam by Art Greenspon, a soldier guides an unseen medevac helicopter to a jungle clearing where wounded comrades wait.

the deepest human pain. Sometimes it cannot, and wanting to

be calm is not enough to enable us to carry on.

Things to know about Post -Traumatic Stress Disorder: Epidemiology: 2-4% of the general population will experience PTSD once in their lifetime. The

Shell-Shocked solider being treated with Electrical Shock Treatment (Image source: http://www.electrotherapymuseum.com/2008/NMH2/ index.htm)

incidence is not actually higher within the military personnel population.

Aetiology: Soldiers who have fought in wars (but even military training has been shown to precipitate it), survivors of natural disasters, terrorist attacks, motor accidents, victims of sexual assault Management: Watchful waiting if disease mild. For moderate-severe PTSD, Trauma Focused Cognitive Behavioural Therapy, Counselling and Eye Movement Desensitisation and Reprocessing Therapy may be offered. Drug therapy may also be offered, these include Tricyclic Anti-depressants (eg. Mirtazapine and Amitriptyline) or Selective Serotonin Reuptake Inhibitors (eg. Paroxetine, Setraline, Fluoxetine).

Management of co-morbidities such as alcohol and substance abuse or physical ailments is also important.

[FEATURES]

theMEDICALSTUDENT / November 2014

Features Editor: Anne Tan & Hygin Fernandez features@themedicalstudent.co.uk

/7

In Remembrance of their Memories – An interview with a war veteran

By Hygin Fernandez

Venlafaxine I couldn’t stop vomiting – none of these pills worked for me”. switched me to and

Mr Glenn Owen was a soldier in the British army from 1974 -1986 and he was posted to Northern Ireland for the last 2 years of his career. When he first reintegrated himself with civilian life, all was well and he began work as a prison officer. For many years, he did not feel particularly troubled or bothered by any of his past experiences. Then in 1994, a full 8 years after he left the army, a traumatic incident at work triggered the start of severe flashbacks and nightmares.

“I

shut the door on eve-

rybody.

I

drank about

120

In addition to his medication regiment, he was also enrolled in both group and individual therapy sessions but these did not prove to be helpful as he never felt truly comfortable with open-ing up. Feeling that reliving his memories only made it worse, he would hide behind the stories of others and prefer not to say anything.

“We

were trained not to

reveal too much of what we were feeling.

It

was hard to

open up to civilians, they’re different

- they wouldn’t re-

units of alcohol a week so

ally understand what our

that

could sleep without

lives were like even if they

Mr Owen shared how he used alcohol to help internal-

With the myriad of NHS psy chiatric services leaving

I

the nightmares.”

tried.”

“I

was off the scale, it

was worse than when started

seeing

psychiatrist.”

the

I

first

NHS

Luckily for Mr Owen, this was the beginning of his improvement as he started to be able to open up and confront the issues from the past that were haunting him. Finally after 10 months of therapy, Mr Owen was able to come to terms with his PTSD, alcoholism and other issues that had been plaguing him for almost fourteen years.

Now Mr Owen leads a normal life and is giving back to the charity that made such a difference to him. He is now working for PTSD Resolution, acting as a first point of contact for distraught veterans, engaging them with his own experience so that they are more likely to want to open up and deal with their illness.

“I’m

very open about my

past experiences with mental illness and

I

speak to my ex-

comrades about them freely”

Engaging them on a personal level is particularly important due to the prevailing military culture that prevents veterans from being as open as they should be.

“The

training makes you

keep all you’ve seen at the

back of your mind. It only re-

Taken from: http://psychiatry.arizona.edu/sites/psychiatry.arizona.edu/files/uploads/119633.jpg

ally hits you when you leave.

At

most they talk about it

with their mates over a few

ise his pain. It however, only compounded his problems and he continued to be tormented for another 5 years. In 1999 things came to a head and he was faced with multiple physical problems as a result of his condition. Reaching the tipping point, he broke down in his doctor’s surgery. He was subsequently referred to an NHS psychiatrist who diagnosed him with Post –Traumatic Stress Disorder (PTSD). He was put on medication, which only seemed to make things worse for Mr Owen.

“They

put me on

Seroxat

and it just made me want to

end

it

all.

Then

they

Mr Owen feeling no better, h e was referred to his community counselling service. Fortunately for him, the councillor he was referred to was himself an exArmy/Navy officer.

“It

was as if someone had

turned the light on, it felt like finally

I

was given per-

mission to speak about my experiences.”

After some communication with the counsellor, he was then referred to PTSD resolution, a charity specializing in counselling war veterans.

This was a serendipitous intervention as by now it was 2007 and things were decidedly worse after his long journey.

pints but that’s not enough.”

living with

PTSD

is normal

and they don’t want to put

their hands up about it because of what it will do to their careers”.

This realisation is worrying to Mr Owen, given that the next crop of veterans who have returned from Iraq and Afghanistan are newly in the process of readjusting to civilian life in Britain. He postulates that a surge of PTSD cases might be imminent.

“The

current

cases

ex-military personnel, he finds that he plays a pivotal role, by being a middle man to these veterans. Getting them to take the first step to trust him, thereby allowing him to give them the confidence to confide their stories to trained counsellors.

Although he fears for the veterans who may be future PTSD sufferers he implores that they seek help early and insists that there is always hope.

“You

can get back to a

we

normal life but you must

have now are just the tip of

engage with the programme

the iceberg”.

Citing trust as a key issue, one mirrored in his own past, he feels that veterans with PTSD are very unwilling to speak of their experiences to non - military personnel. They feel that those who have not seen war

and then it can work for you.”

Mr Owen’s life has definitely been one of struggle and pain, but he has built upon his moments of turbulence to be a guiding light for others like him.

This insufficiency has made him see some of his fellow comrades take their own lives or slowly destroy themselves through alcoholism because they never got the help they needed. Mr Owen lays the blame squarely on the lack of targeted support given to PTSD-suffering veterans. He asserts that the current sociomedical infrastructure set up by the government and the Ministry of Defence is insufficient and simplistic.

“They

would rather fo-

cus on you forgetting the problem rather than dealing

with it…it doesn’t help you at all”.

In addition, he feels that stigma is still prevalent within the armed forces and this, in particular, holds back a lot of servicemen from coming forward to get treatment. This is especially so because any declaration of PTSD is likely to impact on the service person’s promotional opportunities.

“Many of them think that

Taken from: http://www.thegospelcoalition.org/article/ barton-and-copeland-the-bible-says-soldiers-should-not-suffer-from-ptsd

will not be able to understand their unique paradigm. Therefore, it is likely that the bulk of PTSD veterans from the two wars might still be in denial about their illness.

Due to the additional complexity of communicating about mental health among

Faced with such inspiration it is only right that we thank him for his services to his country, both in uniform and out of it.

[COMMENT] /8

theMEDICALSTUDENT /November 2014 Comment Editor: Oscar To comment@themedicalstudent.co.uk

Ebola: Predictable?

Oscar To Comment Editor The world is currently undergoing widespread hysteria over the possibility of a worldwide pandemic of Ebola. Fears that the disease could spill into the West are being bombarded by the media daily, and guidance has even been released to the public and medical professionals regarding Ebola. Could this have been prevented? The first cases of Ebola in the current epidemic happened in March. It is now October. Only in the last few weeks has there even been talk of other countries sending aid to Africa. But why do these countries need aid in the first place?

The epicentre of the Ebola epidemic has been in Western Africa, particularly Sierra Leone, the poorest country in the world. This sub-Saharan region is overall the poorest in the world. It is no surprise that there is little infrastructure here to treat disease. However, initial efforts with Smallpox eradication began in this region and led to the first successes that a programme could work here.

This led to the establishment of powerful surveillance tools that ensured that outbreaks could be swiftly controlled. These were to some extend maintained after smallpox became eradicated and acted as a base framework for the eradication of other diseases. However, these programmes rely predominantly on other outside organisations to implement rather than direct infrastructure development. The WHO’s funding has also been diverted since the eradication of smallpox as successor programmes have not had the same level of success, leaving these countries without any defences against potential outbreaks.

Nonetheless, this still doesn’t answer our question of why there is so little money to invest on infrastructure in these countries. Sure, they are poor but why? For any readers who want to wave a magic wand and say economics, sit back and realise that this is not an actual answer but an excuse. The reality is that Africa has a wealth of resources that continue to be exploited,

not by the people of Africa but by small minorities and other countries. This is nothing new; the commonwealth is a salute to the legacy of our brutal exploitative imperial past. This didn’t end when we gave these countries independence. The West has supported many corrupt governments that are rarely legitimate, such as Thatcher’s favourite apartheid state South Africa. Indeed stories of people breaking into isolated wards to free people stem precisely from lack of trust in corrupt governments.

These governments exist to enrich their allies and lead to the accumulation of wealth in the hands of a minority. Ironically however, due to the instability of their own countries,

they often hoard their wealth overseas in western countries.

Using tax havens, they are able to hide the source of these financial flows and this money reaches the hands of banks for investment. As a result, for each dollar of aid that reaches Africa, five times as much is leaked back; Africa is a net creditor for the globe. This problem cannot be solved by African countries alone. It will need significant intervention and reform to ensure transaction transparency across the entire world. These problems plague Western countries as well with businesses evading tax and perverse economics where lowering tax is the only way to get any tax income at all.

Barring these options, which cannot be done in the short

term, is there anything else we can do? There are currently talks of development of an Ebola vaccine which could be completed in weeks. However, the first outbreak was in 1976, why only now are we developing treatment?

The answer once again comes down to profits. As Ebola is a disease affecting a poor part of the world, there is little incentive to develop treatment for it as there is little money to be made, if any. Only now that there is a crisis that could affect western countries (which can fund the vaccine) has development started.

But could other bodies not intervene? What about the Bill Gates Foundation and other charities? The problems here

lie in the fact that the majority of their interventions only ever treat the symptoms and not the cause. For example, a great deal of diseases such as parasites could be stopped if only clean sanitation was developed, rather than sending volunteers to hand out drugs. But this is apparently too expensive; little money can be made out supplying water to poor parts of the world.

This is the issue. Fundamentally, Africa is not poor because it is inherently so; there are a wealth of resources. What stops Africa reaching its potential is a global system that exploits it, something that we must all fight to change.

theMEDICALSTUDENT / November 2014 Comment Editor: Oscar To comment@themedicalstudent.co.uk

[COMMENT]

/9

Success at what cost?

Oscar To Comment Editor Doctors have a special place in society. We are responsible for looking after others and ensuring their wellbeing. We are able to delve into intimate details of people’s lives by the nature of our title. We go where most people cannot; we are there from birth until death. Our great power comes at great responsibility. Indeed, we have a whole body, the GMC, present to protect the very virtues that being a doctor must entail. But is it enough?

Ethics is a whole body of theory that accompanies the very practice of medicine. However, unlike the rest of ethics, medical ethics seems to focus around specific events. Indeed, many principles of many ethics are reactive; only once after an

event happens do we enshrine it within medical ethics. Indeed, the word probably invokes thoughts of Bolam, Gillick and the advent of abortion and genetics. This strikes out a vital principle in itself; medical ethics revolves around mistakes.

Not that many students take ethics seriously anyway, as the dominant view is that this is a wishy-washy extra bit of information that hardly matters in the grand scheme of being a doctor. The same goes for other things like medical law, statistics and the oh so dreaded reflection on my own actions. Indeed, if it doesn’t blare out science or guideline, most things are apparently pointless hoops to jump through.

Talk to some finalists and they will no doubt be complaining about the SJT. This Situational Judgement Test is the bane of

many finalists. Why? Because it distorts the points they have already achieved from their academic prowess. This is in spite of the fact that situational judgement tests form the backbone of many other professions such as military officers. But for medical students, this is just one step too far.

The fundamental reality is that almost all medical students come from backgrounds where they have always succeeded.

This environment breeds a set of people who have no concept of failure, driving a culture that involves living for the exam, following rules unwaveringly and expecting a reward.

Whilst this may generate a good set of doctors to perpetuate the hierarchy in hospital, it almost certainly causes other issues. For example, even prior to qualification, it skews the pri-

orities students choose to take on. Everyone knows a student that prefers to stay at home and vigorously learn material for exams in order to get the top mark; this comes at great cost to their actual clinical experience.

There is also a great deal of snobbery, particularly against non-doctors. This is not conductive to the effective running of a hospital which requires co-operation, team work and respect. How can we expect to treat patients well if we don’t see each other as people?

Even doctors do not see each other as allies. We see each other as rivals for a small pool of jobs, justifying stabbing each other in the back and being unproductive, at a cost not only to each other but to patients. Instead of helping each other develop as professionals, we only seek to step over one another

in the bid for our vainglorious achievements. It is no wonder many doctors have poor teaching skills; they have been conditioned to help no-one but themselves.

The most damning issue is that this kind of environment supports only following the rules. Sure, it is useful to follow guidelines and that is undisputable. However, just doing things because that’s how they’ve always been done is not. This leads to only perpetuation of the existing order and stagnation. This is worst in situations where existing standards are not on par, such as recent events in Mid-Staffs, where events such as patients drinking from plant pots and being left for hours in faeces became part of the established order and were treated as day to day events.

Indeed, these attitudes mask the reality that we need to accept; failure is inevitable. We feel that imposing conditions that make others more likely to fail protects us but if we all take this role, it is a zero sum game; we are all losers. This contributes to why areas such as ethics and reflection do not appeal to us; they expose a naked acceptance of failure but also of reform.

What we need to promote is a fair and transparent system, where we can expose people who insist on cheating their way to top, and ensure they receive their just desserts. We should aim to protect whistleblowers instead of leaving out to dry. These people take risks to bring about change and they are shunned. We feel that they could threaten the very lies we have spun for ourselves.

We must stop seeing mistakes as total and absolute. Only by making them, do we appreciate a need to develop and succeed.

Fancy writing for Comment?

Email us at: comment@themedicalstudent.co.uk

[CULTURE] /10

theMEDICALSTUDENT / November 2014

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

2014 BFI Londo John Park Culture Editor

My Old Lady UK Release Date: 21/11/14

White Bird in a Blizzard UK Release Date: Not yet available

Kat (Shailene Woodley) has a lot of sudden growing up to do when her mother, Eve (Eva Green) suddenly disappears.

Was there foul play? Or did Eve simply want out from her boring, monotonous life with her kind but dull husband (Christopher Meloni)? Part mystery, part coming-of-age drama with some excellent performances, both from rising star Woodley and Green, who can portray unhinged and unstable like no other actress on his planet. Some of it plays like a hypnotic dream, weaving together strands of past and present to make sense of what is happening, although the final twist that attempts to be unpredictable and shocking disappoints, due to a lack of real credibility.

Men, Women & Children UK Release Date: 28/11/14

The New Girlfriend UK Release Date: Not yet available

It would be best to walk into this one without knowing a whole lot about it. A young woman (Anaïs Demoustier) is shocked to discover a secret her late best friend’s husband (Romain Duris) has been carrying all these years. That is it. That is all you need to know. That and the fact that François Ozon makes what could have been a farcical premise rather endearing, addressing the nature of human sexual behaviour/desire and when the moment is right, outrageously funny.

A hyperlink drama in which we are reminded of what technology can do to our lives, Jason Reitman’s newest feature never digs deeply enough into any of his plot strands to convincingly show just how far Facebook, Twitter, Instagram, texting, gaming, internet dating/ hook-ups interfere or enhance modern lifestyle. The strong cast and consistent humour are the film’s major saving grace, starring an unforgettable ensemble cast of Adam Sandler, Rosemarie DeWitt, Jennifer Garner, Dean Norris, Ansel Elgort, Judy Greer, as well as some impeccable voiceover work from Emma Thompson.

Although an uneven mixture of low-key comedy and a serious look at the potential fall-outs of having an extra-marital affair, the whole thing is kept together thanks to Kevin Kline’s masterful lead performance. Kline is Jim, an aimless, recovering alcoholic who inherits a house in France from his late father.

There he finds Mathilde (Maggie Smith) and her daughter Chloe (Kristin Scott Thomas), along with some surprising facts about his own family. The script never does the ladies justice, in that it does not give them enough to do, instead focusing all of its words and energy on Kline alone.

Rosewater UK Release Date: Not yet available

There is potential controversy to be had in the casting of Spanish actor Gael Garcia Bernal in the role of British-Iranian journalist Maziar Bahari, who was imprisoned and interrogated in Iran for more than 100 days.

But it becomes irrelevant as Bernal excels in the role of a man wrongly locked up for providing a balanced coverage on the upcoming Iranian Presidential Election. There is a sense that for a man rotting in prison, Bernal looks far too well-kept, and there is also a noticeable lack of desperation and urgency in certain parts of Jon Stewart’s otherwise highly informative and intriguing debut feature.

Wild UK Release Date: 16/01/15

An excellent role for Reese Witherspoon who goes above and beyond to portray Cheryl Strayed, a woman who goes on a hike across the Pacific Crest Trail.

The film is beautifully edited together offering us glimpses of Cheryl’s volatile past, giving the audience a real insight into what triggered this inspirational, soul-searching journey. Intensely moving.

Testament of Youth UK Release Date: 16/01/15

Vera Brittain’s war-time memoir, chronicling how the First World War turned her world upside down is given an adequate big screen adaptation.

It benefits greatly from having Alicia Vikander as the young Vera, strong-willed and brave despite the circumstances, although the film fails to establish the close relationships between the essential characters to give certain deaths in the film much emotional resonance, thus never quite capturing the truly tragic losses Vera suffers during this four-year period. The film has a lot to squeeze in to the running time, and thanks to the good performances it gets by.

The Salvation UK Release Date: Not yet available

On paper, Kristian Levrig delivers a bog-standard Western, dealing with a revenge story of a man whose wife and son are horrifically taken away from him. But with stunning visuals, a neat action finale, Mads Mikkelsen in the lead role giving off silent but potent charisma, plus Eva Green as a mute damsel in distress doing her usual piercing gaze, it becomes so much more.

theMEDICALSTUDENT / November 2014

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

[CULTURE]

/11

on Film Festival Whiplash UK Release Date: 16/01/15

Without doubt one of the best films of this year, showing that jazz music can be electrifying and that just focusing on the jazz drummer can be one exhilarating experience; featuring outstanding performances from Miles Teller as a talented young hopeful, and J. K. Simmons, an egomaniacal conductor who torments his band with his ever-so colourful use of insults as well as resorting to physical violence at times. The musical scenes are expertly directed, and the film is careful in avoiding all the cliches of a musical-prodigy drama.

A film so brilliant and uplifting that you will want to give a standing ovation once the credits start to roll.

Son of a Gun UK Release Date: 30/01/15

The Face of an Angel UK Release Date: Not yet available

When JR (Brenton Thwaites) is locked up for a minor crime, he quickly catches the eye of Brendan (Ewan McGregor), who provides him with protection, and in return wants help breaking out of prison. Complications follow afterwards, with loyalties tested and twists turning deadly. This small-scale Australian thriller deals with familiar characters and plot and never truly aims high, but it gets its job done in having a neat structure and keeping up the tension.

A film that is so concerned about being different and edgy that it fails to tell anything interesting about a murder trial and the media circus surrounding it, Michael Winterbottom’s film, based on the events of the Amanda Knox trial, is the most pretentious, self-indulgent film you will see, despite a strong debut performance from Cara Delevigne.

Winter’s Sleep UK Release Date: 21/11/14

The epic running time of this Turkish Palme d’Or winner will be a deterring factor for many, and it is not as though the film’s content makes it any easier to make it sound at all appealing. It is essentially a series of conver-

Kate Winslet is Sabine De Barra, a landscape-gardener picked

by André Le Notre (Matthias Schoenaerts) to design a part of the grand gardens at Versailles, thus putting her in direct contact with King Louis XIV (Alan Rickman, also directing). The most interesting part of the story, that of Madame De Barra designing this specific part of the garden, never given quite the full attention it deserves, with the plot instead deviating to tell a disappointingly formulaic love story between the two leads.

sations had between characters that include a hotel owner (Haluk Bilginer), his sister (Demet Akbag), and his wife (Melisa Sozen). They range from serious to hilarious, with obvious conflict arising from the well-educated, condescending Aydin, the hotel owner, and pretty much everyone else, as they are put off by his incessant need to be a bit of an ass. The film is certainly quite an experience.

3 Hearts UK Release Date: Not yet available

Monsters: Dark Continent UK Release Date: 28/11/14

A loud, ugly film about loud, ugly people doing loud, ugly things to loud, ugly monsters, there are very few redeeming features in what is supposed to serve as a sequel to Gareth Edwards’ more subdued, genuinely creepy Monsters (2010).

It is far too long and bloated, without a single character who is grounded enough to relate to.

The White Haired Witch of Lunar Kingdom UK Release Date: Not yet available

A film that turns problematic whenever characters speak is never a good thing, but this new Wusha film is just that. The martial arts choreography is wonderful, but everything else, the characterisation, pacing, ridiculous subplots, are all terribly done, and the less that is said about the ending, the better.

A Little Chaos UK Release Date: 17/04/15

Falling in love with two sisters is the awkward position Marc (Benoit Poelvoorde) finds himself in, having first met Sylvie (Charlotte Gainsbourg), but then unwittingly entering Sophie’s (Chiara Mastroianni) life. French screen legend Caterine Deneuve also stars as the mother of the sisters, in this refreshingly bold, honest take on a complicated love triangle.

[EDUCATION] /12

theMEDICALSTUDENT / November 2014 Education Editor: TBC education@themedicalstudent.co.uk

Ten Top Tips to Improve Your Score in the SJT

By Dr Mahibur Rahman Emedica

The Situational Judgement Test (SJT) for final year medical students plays an important part in your ranking for the applications for Foundation training (FPAS). Whether you have a great Educational Performance Measure (EPM) score or not, the SJT will influence which placement you get.

1.) Understand the basics The exam lasts 2 hours and 20 minutes and has 70 questions, although only 60 of the questions are marked – the other 10 are pilot questions. Pilot questions are mixed in with the examined ones, so you need to treat them all as live questions.

There are two types of question – ranking and selection. In a ranking question, candidates will be presented with a scenario and 5 options – the options need to be ranked from best (1) to worst (5). This format makes up two thirds of the exam, with each question being marked out of 20.

Selection questions have 8 options, and candidates should select the 3 options that taken together make the best response to the scenario. This format is a third of the exam, with each question marked out of 12.

Sample questions for each type are given in box 1.

2. Learn the domains being tested The SJT questions are written to test whether you have the attributes deemed important to be a good Foundation doctor. These are divided into 5 domain areas. A good first step in your preparation would be to understand the key attributes and behaviours being tested.

Learning what is being assessed will help you pick between options based on how well they demonstrate these attributes.

The domains and some of the key attributes are: Commitment to professionalism – punctuality, honesty, taking responsibility for own

actions, challenging unacceptable behaviour, ethical practice, respecting confidentiality.

Coping with pressure – remaining calm and in control when dealing with difficult situations, good judgement, seeking support when required, dealing with confrontation appropriately.

Effective communication – sensitive use of language, adapting communication according to the needs of patients and relatives, using clear and understandable language, good written communication.

Patient focus – empathetic towards patients, showing respect to patients, putting the patient at the centre of care, providing reassurance appropriately, willing to spend time with patients and relatives, considering patient safety at all times.

Effective team working – understanding the roles of team members, willing to take direction, showing respect to colleagues, delegating and sharing tasks effectively, sharing knowledge and expertise with colleagues.

The full list is available in the official SJT monograph.

3. Revise the core knowledge being tested While the SJT does not test clinical knowledge, there are questions that assess knowledge of what is deemed to be good practice based on core guidance from the General Medical Council (GMC). Most of this comes from Good Medical Practice and some of the explanatory guidance published by the GMC. This includes areas such as confidentiality, maintaining boundaries, care of children and younger people, raising concerns, end of life care and advanced directives, and even the use of social media. The SJT asks you to answer what you “should do” rather than what you “would do” – i.e. what does the guidance say a good doctor should do in the ideal situation. This is much easier to do with a good working knowledge of the key guidance.

4. Spend lots of time on the ward A useful technique to deal with scenarios in the SJT is to try to picture the situation in your mind. This is much easier if you have spent lots of time on the wards. Try to observe how the doctors communicate with patients and relatives, how the team interact with each other, and the roles of different members of the multidisciplinary team. If there are areas from the GMC guidance that you are unclear about, it can be really helpful to talk through potential issues with a junior doctor – they may have encountered similar situations in real life and can talk you through approaches they used to deal with it.

5. Work through the official practice paper The official Foundation Programme SJT practice paper is a complete 70 question SJT paper. There is an interactive version that you can do on a computer, and also a paper version.

Doing the paper version, and getting used to completing the paper marking sheet will help familiarise you with the format and improve speed on the day.

There is a marking key with detailed explanations so you understand the rationale behind why some questions are ranked the way they are.

6.

Read the scenario carefully Sometimes keywords have a big impact on the best response in both ranking and selection questions. Try underlining important words as you read. For example, your approach may differ in a situation where you suspect inappropriate behaviour compared to when you are certain of inappropriate behaviour. This small difference might change where you ranked waiting to gather more information, compared to raising an issue with a senior colleague for example. For ranking questions, there are different types of question – most ask you to rank from most to least

appropriate, but some ask you to rank according to the order in which you would do things, or how important considerations are to the situation.

7. Use only the information provided in the question In some scenarios there will be limited information. In real life, it might be possible to get clarification or gather more information from the patient or a colleague. In the exam, your answers should be based only on what you are told in the scenario and the options. Do not make any assumptions – an incorrect assumption may lead you to a poor response.

8. Make sure your choices make sense when taken together In the selection questions, all 3 options that you select should be looked at together as a combined response to the scenario.

In some cases you can eliminate options if they would contradict each other or would not make sense when taken together. If you are confident that an option that suggests seeing a patient when a chaperone is available is correct, then you could eliminate another option that suggested seeing the patient immediately without a chaperone. A good way to check if your answer is likely to be correct is to read all 3 options back together and see if they make sense together. If they don’t you should consider changing at least one of the options.

9. Double check you have marked the correct options.

The SJT paper is machine marked so check that you have marked the answer sheet correctly - transcription errors are a silly way to lose marks. In ranking questions, if you accidentally marked option A and option E as the best options (rank 1), you will be awarded zero marks for BOTH these options. In the selection questions, if more than 3 options are marked, the total score for the entire question will be zero.

If you transcribed the answers to question 1 to the box on the answer sheet for question 2, it would be possible to accidentally mark all the later questions in the wrong box and have a serious impact on your overall score.

10. Keep to time To complete the entire paper, you have just 2 minutes per question. Try to be disciplined – if you are not entirely sure of the best answer, it is better to put down your best guess and move on. You will still get marks for answers that are not perfect but close to the best answer. For ranking questions, you get 8 marks for the worst possible ranking. If you are fairly close, but not quite perfect, you can still get 16 or 18 marks. Spending an extra 2 minutes to get the perfect answer may only increase your score for that question from 18 to 20 (2 extra marks) – whereas using that 2 minutes to answer another question will get you at least 8-20 extra marks. Even worse – the question you spent a long time on could turn out to be one of the pilot questions, and so carry no marks.

Summary The Foundation SJT plays an important part in determining where you will be placed for your first two years after qualifying. Understanding the attributes that are being tested, and learning the core GMC guidance will give you the basic tools to help you prepare. Practising sample questions and getting used to the format and time pressures will help you to get the best possible score on the day.

Dr Mahibur Rahman is a portfolio GP and a consultant in medical education. He is also the medical director of Emedica. Emedica offers courses and online revision to help medical students prepare for the Foundation SJT www. emedica.co.uk

theMEDICALSTUDENT / November 2014 Education Editor: TBC education@themedicalstudent.co.uk

[EDUCATION]

states that she asked the lady a with the ward round later E - Ignore the request. The few minutes before she became nurse knows you are on the unresponsive if she would acpost-take round and can ask cept blood products if her life was threatened and again she A - Ask the nurse what drugs you later. said no. Her husband is holdthe patient needs and the diing his new born daughter and agnosis, so you can quickly Answer: BDEAC states you must do everything note this on the discharge paperwork and keep up with the Sample Selection Questions you can to save her even if that means giving her blood. ward round B – Explain that you are You are an FY1 working in Choose the THREE most apbusy at the moment but that Obs & Gynae. You see a lady on you will come back and do it the labour ward who is having propriate actions to take in this as soon as the ward round is a massive postpartum haemor- situation rhage. In the last few minutes A. Give blood products as complete C – Sign the paperwork and she has become very unwell and this is an emergency and they ask the nurse to complete the is now unresponsive and con- may be life saving B. Do not give blood prodsummary and medication while tinuing to bleed. From reading her notes you know she is a Je- ucts even if it means she comes you join the rest of the team D – Check the patient’s hovah’s Witness and has signed to harm C. Put aside the patient’s notes and complete the paper- a form in antenatal clinic stating work with a summary of the she declines all blood products wishes as her decision suggests admission and all required even if her life is threatened. a lack of capacity D. Explain to the husband medication - you can catch up The midwife looking after her

Sample Foundation SJT Questions Sample Ranking Question While working on the medical wards as an FY1 you are asked by a nurse to complete the discharge paperwork for a patient you are not familiar with.

This includes a summary of the admission as well as drugs to be taken home when discharged.

You are in a hurry and on the post-take ward round. The rest of the team is about to start discussing the next patient that was admitted overnight.

Rank in order the following actions in response to this situation (1= Most appropriate; 5= Least appropriate)

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that you have to respect the patient’s decision E. Ask the husband to give formal consent on behalf of his wife to give blood products F. Do everything else you can to save the patient’s life G. Do nothing else as she will inevitably die without blood products H. Contact your consultant and ask them for permission to give blood products in the best interests of the patient Answer: BDF These questions are adapted with permission from the Emedica online situational judgement test revision service. Detailed explanations for both questions are available at www.emedica.co.uk/foundationsjtanswers.html

Revolutionising Treatment for Multiple Myeloma Utsav Radia Staff Writer Scientists at Imperial, led by Professor Guido Franzoso, have developed a new drug to be used in patients with multiple myeloma, a rare type of cancer affecting 4,800 new people every year in the UK. Multiple myeloma results from the proliferation of cancerous antibody-secreting cells (called neoplastic plasma cells) in the bone marrow and other tissues. Physiologically, these plasma cells are responsible for synthesising protective immunoglobulins (a family of proteins that include antibodies) in response to a specific antigen (which is usually foreign). However, in a cancerous state, these plasma cells start to secrete lots of abnormal (and often immature) immunoglobulin molecules, known as paraproteins.

Patients with multiple myeloma usually present with bone pain or a pathological fracture.

Others may even present with symptoms of blurred vision (that may result from hyperviscosity of the blood due to high levels of paraprotein), kidney

damage, anaemia or even infection. Interestingly, in the early stages, multiple myeloma usually doesn’t cause any symptoms and is usually picked up after a routine blood or urine test, due to the presence of the abnormal immunoglobulins.

The clinical and pathological features of multiple myeloma are mainly due to direct effects of the tumour (bone invasion or fractures), metabolic effects of the neoplastic cells (high plasma uric acid and calcium), the damaging effects of the paraprotein (such as peripheral neuropathy or renal failure) and impaired immunity as a result of reduced healthy immunoglobulins.

Currently, multiple myeloma is treated with two aims in mind: to help keep the myeloma under control and to help with symptom relief. Treatment combinations to control the myeloma usually consist of three classes of drugs: a chemotherapy drug (e.g. cyclophosphamide), a corticosteroid (e.g. prednisolone) and either thalidomide or velcade. Unfortunately, often patients tend to relapse in which case additional anti-myeloma treatments have to be given, which add to the

plethora of side effects that patients experience.

Researchers at Imperial have reported laboratory findings that show the new drug, DTP3, kills myeloma cells in human cells and mice without causing any toxic side-effects. The drug uses a completely different mechanism of action compared to other cytotoxic drugs. DTP3 targets a biochemical step in a process called the NF-KappaB pathway, which is implicated in switching off the normal cellular mechanisms that naturally lead to cell death, hence prolonging (cancerous) cell survival.

Professor Franzoso, lead of the study, explained “we had known for many years that NF-KappaB is very important for cancer cells, but because it is needed by healthy cells, we did not know how to block it specifically...blocking the GADD45Beta/MKK7 segment of the NF-KappaB pathway with our DTP3...[that] selectively kills myeloma cells could offer a completely new approach to treating patients”.

Further work is now being done to commercialise DTP3 and other candidate drugs

based on Professor Franzoso’s research to ensure the quickest and safest way to administer this treatment in patients with multiple myeloma. A trial of

this drug, funded by the MRC, US National Institutes of Health and Cancer Research UK is due to take place in late 2015.

theMEDICALSTUDENT / Freshers 2014

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

By Rhys Davies St. Elsewhere’s

[DOCTORSMESS] /14

DIARY OF AN FY1

Life as a junior doctor is filled with monsters of all shapes and sizes. My bleep, for example, is a hellish cross between a black widow spider and a particularly cancerous growth that clings to my hip and shrieks at me.

Then there is the god of phlebotomy – I always take spare blood bottles when I venupuncture to appease him and ensure bountiful blood-taking for the autumn season. But the greatest of all monsters a junior doctor face is The On-Call.

At St Elsewhere’s, the OnCall takes two forms. During the week, On-Call means hanging around for a few more hours, mopping up the jobs that the other FY1s haven’t got round to doing. Taking bloods, checking chest x-rays, rewriting their chickenscratch drug charts. Or, if there are a lot of patients coming through the A&E doors, you have to roll up your sleeves (roll them up further – bare below the elbows) and get busy clerking. It’s a temporary annoyance, much like norovirus, and lasts for about as long.

Then there’s the weekend On-Call, which is an entirely different disease. At St Elsewhere’s, it’s a hat-trick of Friday, Saturday and Sunday.

Friday is like any other weekday On-Call but Saturday and Sunday are at least twelve long hours of solitude each.

My first tangle with this monster came a few weeks ago.

Gather round and listen to my tale.

Friday. Due to an astrologically unique alignment of the planets, my team finished our ward-work by 10 in the morning. As a gesture of goodwill, I handed myself over to the OnCall SHO. He put me to work clerking patients.

Looking back, it doesn’t seem possible that they all had right iliac fossa pain and yet McBurney’s here, Rovsing’s everywhere!

Saturday began with a group huddle in the doctors’ mess, with the night SHO handing over the patients admitted overnight. When she left, the registrar, SHO (locum) and

me were the sum of all surgical staff in the entire hospital.

The registrar and I began our rag-tag ward round of both the on-take patients and the regular (resident?) patients, while the SHO sorted the acute abdomens from the chaff in A&E. Other than make sure they were still alive, and would remain so until Monday, there was little we could actually do. Any imaging more complicated than a Polaroid would require a telephone discussion with the very unimpressed on-call radiologist. Elsewhere, there was only one pharmacist in the hospital so we couldn’t easily order any exotic drugs – Though, as surgeons, we did well enough with just “cef&met.” In fact, the only group of allied health professionals to maintain an effective presence over the weekend was the canteen staff. Their hot food gave me succour for most of the afternoon, even if they boiled all integrity out of their pasta, right down to the atomic level.

If things had carried on like this, that would have been fine.

But for one patient on our ward round, the registrar decided that he warranted surgery. Not surgery next week, not surgery on Monday but surgery that day. An incarcerated hernia that the registrar was determined to release. He acquired the locum SHO from A&E and handed me both their bleeps. I’ve already compared my bleep to a tumour; now it had metastasised.

He promised me that I wouldn’t have to do anything, just accept referrals and assure that a real doctor would come and see the patient eventually. Swallowing hard, I toddled off to take care of my growing list of jobs.

Here’s the thing about bleeps.

Nine out of every ten of your jobs as an FY1 are fine, simple chores. Written out on paper, you look at them and think, I’ll be done in no time. Then the bleeps start coming. You’re halfway through a discharge summary when someone bleeps you about a cannula. You’re trying to site a cannula and you’re bleeped about rewriting a drug chart. And you have to work out where this new job falls in your existing list of priorities. The perfidious bleep-imp

ensures that you can’t develop a rhythm for anything. Everything is done in a stop-start staccato fashion. When you are slave to three bleeps, progress moves at a glacial slowness.

But it was fine. That hernia was a small operation. It wouldn’t take long, the registrar had assured me. Two hours and three bleeps later, I was beginning to think that he had been optimistic.

Sunday followed a similar pattern to Saturday but now I knew what to expect. The main difference was that the phlebotomists don’t work on Sundays.

I was grateful that they worked Saturday, even if they only took “urgent” blood tests (There’s a rush on Friday afternoons as all the FY1s mark all the blood tests for their patients for the next day as urgent. The greatest devaluing of a word since “literally”). With a ward round of around fifty patients, even only bleeding a pragmatic fraction of them soon adds up. No antecubital fossa was safe.

I was glad to keep busy, even with any attempt at flow punctuated by my infernal bleep. St Elsewhere’s on the weekend was really, really quiet. Other than my minimalist team, the only other doctors I saw were the medical and orthopaedic on-call FY1s and they were too ground down to talk much.

There was no wit, no badinage to be found. No man is an island, entire of itself; twelve hours of loneliness really wears you down.

Twelve hours is a mean length for a shift, I reflect. Ten hours is mean but I could pull through it. But those last two hours drained me of my reserves more than the ten before them. Maybe I’m a wimp but God bless the European Working Time Directive. That’s how the On-Call monster devours its prey – slowly, cumulatively, with the patience of inevitability. Any on-call that lasts for three or more days is essentially a game of Russian Roulette.

Spin the barrel, pull the trigger and…sooner or later, you will lose. Thankfully, I escaped St Elsewhere’s unharmed. This time.

Nolit te bastardes carborundorum.

theMEDICALSTUDENT / Freshers 2014

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

[DOCTORSMESS]

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Getting to Know the Netherlands

Narmadha Kalai Vanan Doctors’ Mess Editor

Spending most of my summer in London sent my wanderlust into overdrive. I had to get out and I had to get out fast! There it was, my chance to escape, a cheap bus ride to Amsterdam - should I? I didn’t know much about the Netherlands besides vaguely following their national team’s progress at the World Cup – with their bright orange jerseys, it was hardly possible to miss them. Amsterdam… isn’t that a sin city of some sort?

Brushing my doubts aside, I did a quick search, wondering – what else is there to this country? Within a few minutes, I had drawn up a plan to include two other cities and then, I clicked the big, blue button that said ‘Book Tickets’. The adventure was afoot!

A week and a ten-hour journey later, I was in Amsterdam.

Its many canals snaked through the city, their waters stagnant under rustic-looking bridges with railings that had countless bicycles chained to them. It looked absolutely lovely. Taking a deep breath in to let out a sigh of contentment, however, was probably a bad idea as the pungent smell of marijuana filled my nostrils, sending me into a fit of coughs instead. Looks like Amsterdam was already living up to its reputation.

Visiting the Anne Frank House was an eye-opening and emotional experience. I never expected to relate so much to the story of Anne’s life and get such a realistic glimpse of the plight of so many others during WWII. Everything seemed slightly muted after leaving the museum; conversations were peppered with more thoughtful silences than usual. The Van Gogh Museum was also worth the visit. Appreciating his masterpieces in person and also learning more about the development of his trademark style which still leaves a lasting impression today was truly invaluable.

An attraction that might particularly appeal to you, dear readers, is the ‘Body Worlds’

exhibition by Gunther von Hagens, just a short walk away from Amsterdam’s train station.

Although most of the exhibits were reminiscent of the specimens in my anatomy practicals, the stars of the show made up for it entirely. Who knew plasticised human bodies in various positions like playing sports would be so fascinating? I must admit, I was tempted to yell “Welcome to my world!” to the other unsuspecting members of the public who were peering curiously at cross sections of livers and brains.

With that, I bid Amsterdam farewell and headed off to the second city on my list. Rotterdam seemed like it was a world away from Amsterdam. The charming, higgledy-piggledy canal houses and meandering streets along the canals were substituted for shiny skyscrapers and busy city roads. A definite must-visit for modern architecture junkies! I was greeted by a boisterous street festival- complete with samba dancers and hyperactive bongo players; Rotterdam was proving to be a vibrant, modern city which had much to offer.

Just a ferry ride away, an entire array of old windmills welcomed me to the village of Kinderdijk. With the largest concentration of windmills in the country (19 of these colossal structures!), Kinderdijk has been a UNESCO World Heritage Site since 1997. Cycling on a lovely sunny day down the paths along the rows of windmills with the countryside spanning as far as the eye could see – it all felt quintessentially Dutch. Another highlight was being able to enter one of the still-functioning windmills which also had the rooms of the family who lived within its walls perfectly preserved – allowing a rare glimpse of the lives of the people whose livelihoods revolved in tandem with these windmills.

Rotterdam stayed awake throughout the night (unlike Amsterdam which tucked itself in by 9pm); the impromptu street-wide party that was happening on the street I lived on wasn’t quite done until the next morning! The night view of

the city was breathtaking and I was itching to get a more aerial view. My curiosity got the better of me, and I found myself in the midst of a party happening on the 15th floor of a swanky hotel by the banks of Nieuwe Mass, complete with a viewing platform! Looking down at the Erasmus Bridge (Erasmusbrug) from my perch, I was fascinated by how alive the city was, it was practically throbbing with its own heartbeat.

After a lazy morning spent by the Old Harbour, it was time to head on over to the final city on my little roundtrip.

The Hague is the administra-

tive capital of the Netherlands, so it served as the starting point for several day trips rather than being the place of interest itself – a quick self-directed walking tour was sufficient to get an idea of Dutch government buildings and important monuments scattered around the city.

One such day trip was to Delft, famous for its Delft Blue pottery. It was a quiet little town, with its quirks which made me glad I made the effort to go there, except the fact that Delftware might not suit the average student’s souvenir budget! Another day trip was to Scheveningen which is to The Hague

as what Brighton is to London, except it’s closer and there’s a lovely sandy beach instead of a pebbly one! Watching the sunset there seemed like a fitting way to spend my last evening in the Netherlands.

The next day, I was back in Amsterdam to catch the bus back home to London. As I dangled my legs down the canal edges while waving wildly to tourists on boat rides, I couldn’t help but think visiting the three largest cities of the Netherlands was a wonderful adventure indeed.

WE ARE TMS AND YOU CAN BE TOO contact editor@themedicalstudent.co.uk

[SPORT]

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

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Right to Play Hits Ground Running Mitul Patel & Freddie Stourton Sports Editor & Guest Writer Imperial Right to Play kicked off their 2014-15 fundraising campaign by entering 30 runners into the Royal Parks Half Marathon on Sunday 12th October.

Right to Play is an international charitable organisation that aims to use the power of play through sport to educate and empower young children in the developing world. In the last academic year, Imperial Right to Play raised £12,000.

The Royal Parks Half Marathon was established in 2008 and is renowned for being one of the most visually aesthetic courses in the country, taking competitors through Buckingham Palace, the London Eye, Houses of Parliament and the Royal Albert Hall, as well as four of London’s eight Royal Parks; Hyde Park, Green Park, St James’s Park and Kensington Gardens.

Sustaining these historic parks is a key aim of the Royal Parks Foundation and being ‘green’ is a unique property of the race; last years event saw only one-third of waste going to landfill as waste for recycling doubled from the year before.

Since its inception, the Royal Parks Foundation Half Marathon has raised more than £18m for causes around the

UK, with more than 559 partner charities, including Right to Play.

With Imperial’s runners committed to raising a minimum of £350, the event raised in excess of £10,000 and was a huge statement of intent for the fundraising to come this term.

Competitor and committee member Freddie Stourton, who completed the event in 1:53:39, shared, “I found myself standing among 16,000 other people in Hyde Park, feeling very cold and rather nervous, on the eve of my first Half Marathon. The last 800 metres was up a gentle incline – an absolute killer. I was absolutely knackered by the end, I couldn’t even speak for a good 10 minutes after I crossed the line!”

The next sporting fundraiser for Imperial Right to Play is the annual Tough Mudder event; enough to test any human’s stamina being just shy of a half marathon in distance and laiden with obstacles including electric wires, monkey bars, and underwater tunnels.

The event in Winchester was held on Sunday 25th October.

Elsewhere, Right to Play’s first non-sporting venture of the year takes place on Wednesday 17th November, with the return of UH Sports Night (UHSN), where

UH sports clubs date across the capital and converge at Clapham Infernos until the early hours of Thursday.

Last year’s event attracted over 800 students and raised over £8000 for Right to Play, money that went towards teaching children peace keeping and leadership skills though sport.

Right to Play have higher hopes for this year’s event, aiming for a greater attendance and boosted by the news that DJ Gentleman George headlining at the afterparty.

Right to Play and themedicalstudent would like to draw

your attention to the details highlighted to the right, which outlines how club captains can

UH SPORTS CAPTAINS Meal

Email imperialrighttoplay@gmail.com with how many spaces you want. THERE ARE LIMITED SPACES AVAILABLE!

register their clubs’ attendance!

Afterparty Available from https:// www.imperialcollegeunion. org/shop/club-societyproject-products/rightto-play-products/7724/ uh-sports-night-afterparty

An Update on United Hospital Tennis League: Endings & Beginnings Sean Thomas Morgan Staff Writer

As September concluded and marked the start of Autumn, the 2013/14 United Hospitals’ tennis season was bookended by the Mixed Doubles Cup final and the opening of the new season, with the United Hospitals’ Lawn Tennis Club AGM at the All England Club, Wimbledon.

The Mixed Doubles Cup

final was a familiar affair, with a repeat of last year’s final between the two giants of UH Tennis, Barts and the London and Imperial College Scool of Medicine.

Barts took an early advantage, winning the opening tie. It appeared that this early defeat motivated the proud Imperial medics, playing their first game at the new home of Imperial sport, Heston, with each of the subsequent ties going in

their favour, bringing home the cup with an 8-1 victory.

The performance of the day was from the big hitting Akash Kansagra, who sealed the victory by saving two break points and hitting a blistering forehand winner on championship point.

It was a sad farewell to Simon Lee of Barts, playing his final match after five years of dedication to UH Tennis and Barts Tennis.

Celebrations for Barts

and Imperial continued at the AGM with Catrin Morgan (Barts) being elected as Ladies’ Captain and Akash Kansagra (Imperial) as Mens’ Captain. Bension Tilley (Imperial) and Sean Morgan (Barts) complete the newly election coalition, as Social Secretary and Secretary respectively.

The evening concluded with an end befitting to its historic surroundings, the Debentures’ Lounge of Cen-

tre Court, with the presentation of the second oldest trophy in all of Tennis, the United Hospital’s Cup, to the victors of the 2013 campaign.

Everyone at UH Tennis would like to extend a huge thank you to Professor Mortimer, UH Tennis President, for organising such a wonderful event.

[SPORT] /18

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

RUMS Dominate the UH 7s

Last years runners up are victorious as UH bids farewell to Teddington Jake Wilson Staff Writer The annual UH Rugby 7s tournament took place on 15th of October and saw Teddington sports ground on Udney Park Road host its last major sporting competition.

ICSM were the dominant force at last years event, and were determined to hold onto their title. As reported themedicalstudent earlier this summer, Sport Imperial haddeclared that sporting activities at Teddington Sports ground would be terminated, and the boys from West London were desperate to give a fitting farewell to their home for the last 77 years.

This year’s tournament however was won by RUMS, who overcame GKT in the last fixture of the day to win for the first time since 2010.

With the exception of the Vets, all constituents of UH had a strong turn out, each providing two teams.

The days proceedings started with upsets, as both Bart’s 1s and Imperial 1s lost early games to put themselves immediately out of contention for the cup.

In contrast, RUMS came flying out of the blocks, beating GKT 2s 52-0, a result which both eased any mental pressure the earlier results may have provided and set the tone for the rest of the group games.

RUMS demonstrated efficienct link up in attack and, together with their usual or-

RUMS 1s winning VII; Back Row from left: Joe Hearle, Ben Hardy, Mike Nally, Jake Wilson (President), Andrew Edwards-Bailey, Charlie Holden, Coach Carter; Front Row from left: Dele Famo, Hugo Wigginton, Tom Burt (Captain), Ben Pattenden, Luke Thompson, Derek Effiom ganised defence, followed up their drubbing of GKT with victories against Bart’s (24-7) and Imperial 2s (46-0).

RUMS 1s comfortably won their group, however the story was slightly different in group 2 with RUMS 2s’ solitary victory only granting them progress into the plate competition., where they were joined by both ICSM sides and Barts 1s.

Perhaps disillusioned by

the second tier, Bart’s left the competition prematurely without even playing their semi final; putting Imperial 1s into the plate final by a walkover.

Nevertheless, the other half of the draw did go ahead and rewarded the spectators with a spectacle of tries from both sides.

RUMS 2s stole the early advantage against ICSM 2s and looked like they were on

course for victory, but dogged defence in the dying moments of the second half saw a determined Mary’s side land one decisive try, knocking RUMS out and setting up an all ICSM plate final, which the 1s ran away 31-5 winners.

The first Cup semi-final promised to be a tight affair between two well drilled sides in RUMS 1s and George’s 1s.

On the back of defeat to the North Londoners only a few

weeks previously, George’s quest for revenge started well in a first half that saw them score and convert, whilst RUMS only answered with an unconverted try.

The second half was too tight to call, but some strong dummy lines by RUMS saw them eventually break down the stubborn George’s defence and allowed RUMS to release their wingers; resulting in two scores in quick succession.

RUMS attempted to park the proverbial bus in an effort to make the final, but George’s took advantage of some defensive errors to score one last try. It was however a case of too little, too late, and RUMS creeped into the final 17-12.

The final pit RUMS against GKT, who had been dominant throughout the day. Excellent defensive work from both sides made for a cagey affair, with chances few and far between as both sides provided an excellent display of 7s style standing off and cutting lines.

The game turned on its head at the end of the first half where RUMS powered over three unanswered tries and it proved to be too large a deficit for GKT to overturn, as they could only manage one score towards the end of full time, allowing RUMS to celebrate their first victory in this competition for four years and also giving them the first bragging rights of the UH Rugby Calendar.

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