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mediscope Issue 6 January 2010

Neglected Tropical Diseases 10 Tips for Project Option A Career in Psychiatry Primary Care in Africa

Manchester Medical School’s Student Magazine


EDITORIAL TEAM Q+A: What is your favourite country?

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Ambrose Boles

stimulating and enjoyable edition.

Justin Healy

‘World Medicine’ was chosen as the theme for this issue

Year: Intercalating: Ethics and Law Q+A: Wales - land of rain and glory

elcome from the new editorial team. We have strived to maintain the success of last year’s editors and

truly hope readers of this 6th issue of Mediscope find it a

for a variety of reasons, but most notably because the preservation of health is a commonly held interest of all people. Not only is the practice of medicine around the

Year: Intercalating: MRes Q+A: Egypt - for the mummies

Lucy Hollingworth Year: Intercalating: Ethics and Law Q+A: Italy

world a diverse and fascinating area, it is also something in which a wide spectrum of experience and knowledge exists among students and doctors alike. This collection of articles endeavours to present ‘World Medicine’ from a number of

Chris Jacobs Year: 4, Wythenshawe Q+A: Mali

different perspectives, thereby raising awareness of topics

Ami Pedersen

integral to it, both close to home and further afield. The

Year: 3, MRI Q+A: Anywhere with a beach

challenges and opportunities presented by infectious disease and tropical medicine are explored in ‘Amateurs Abroad’ and in ‘An interview with Dr Ustianowski’, while ‘Easily Made History’ and Professor Fenwick’s article, ‘Neglected Tropical

Khimara Naidoo Year: Intercalating: MRes Q+A: Thailand

Diseases’ introduce us to some realities of tropical disease. On a more local note, ‘Misbehaviour in Your Spare Time’ offers advice of how to protect your career from the effects of misconduct outside the medical setting, with some more personal accounts through which Manchester’s medical

Want to write for us?

production.

Writing an article for Mediscope is a great way to voice an opinion, share experiences and impart knowledge. It is also fantastic for your professional and personal development. We are always looking for talented writers from any year, course or university. Our next issue has the broad theme ‘health at home’ and will be published in the summer. Please read our writers guide if you are interested in contributing.

Mediscope Editorial Team 09-10

Writers guide: www.mediscopeonline.com Submit to: articles@mediscopeonline.com

students allow us to learn and benefit through sharing their experiences. Finally, it has been a pleasure to have worked on this issue and may we thank all those who have contributed to its

Deadline: 31st March 2010


CONTENTS info

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Issue 6

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web www.mediscopeonline.com

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editor editor@mediscopeonline.com articles articles@mediscopeonline.com advertising funding@mediscopeonline.com design and layout Chris Jacobs

christopher.jacobs@student.manchester.ac.uk

features

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All content is © mediscope 2010. All rights reserved. No content contained may be reproduced or copied without the prior permission of the editor.

Neglected Tropical Diseases Prof Alan Fenwick - the tropical diseases you dont get taught in med school Primary Care in Africa Amateurs Abroad Working for an NGO

education

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Mediscope is a magazine for medical students and other healthcare professionals. It is designed and edited entirely by medical students at Manchester University. All articles and statements printed are the responsibility of the authors and advertisers, not mediscope.

Learning in Clinical Environments Tim Dornan Misbehaviour in your spare time Timothy David News in brief National pathology week and the medical student research conference

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A Placement in A&E How to make the most out of your placement Easily made history How easy would it be to eradicate tropical diseases? Poster - fluid balance 10 top tips for project option Progress committee What happens when you’re sent to progress

careers

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An interview with... Dr Andrew Ustianowski, Consultant in infectious diseases and tropical medicine Career focus Why is psychiatry a great career choice? Careers in Humaniterian Assistance Global Health Opinion piece on global health Reviewscope - Blood, Sweat and Tea

views and opinion

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A view from the other side A student’s perspective on being the patient Elective reports Obstetrics in Mexico Private Healthcare A signup in a private hospital Societyscope All the latest from the medical school societies


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Learning in Clinical Environments Professor Timothy Dornan has 21 years experience in analysing medical teaching methods. In this article he charts the changes he has seen in medical education at Manchester.

Introduction As a clinician turned education researcher, my most abiding research interest has been in how medical students learn. That interest was fostered by my own very positive experience as an Oxford clinical student where, in the 1970s, year groups of 50 students were made to feel a very integral and welcome part of the clinical service. What I encountered in Manchester when I arrived 21 years ago could not have been more different, and I felt motivated to see what I could do to make a difference, first as a teacher and later as a researcher. Since I am at the end of my time working in Manchester, this article reviews my research, in which medical students have played a pivotal role.

PBL and clinical teaching The terminology is interesting. Before PBL came along, there was ‘preclinical’, where the dominant teaching method was ‘lectures’. Then there was ‘clinical’ in which something called ‘clinical teaching’ took place. Manchester decided in the early 1990s to adopt PBL and shift the focus from teaching to learning. PBL and self-directed learning are terms whose origins can be traced far back into learning theory, but ‘clinical teaching’ is a phrase which has no defined meaning. In my PhD thesis, I concluded that PBL lacks some important conditions for pro-

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fessional teaching and learning, whereas clinical learning helps students develop a professional identity through social interaction with practitioners.

and very successful it has been too.

Experience based learning

I set out to define a counterpart to PBL that could be progressively increased as students progressed through the curriculum and coined the term ‘experience based learning’ (ExBL) to describe it. The first thing I tackled was to develop a rationale for students to gain experience in clinical environments in the early years of the medical programme. Christine Bundy and I did a large qualitative survey of students and staff, resulting in a BMJ publication providing a rationale for early experience. Later, other researchers

Next, I researched medical students’ experiences of more or less positive experiences when based in hospital. Clinical learning, we found, was a complex and dynamic process which evolved as students progressed through the programme. Students wanted to help patients but, to do so, had to develop certain emotions, practical competencies and a sense of reward. They gained these attributes by participating in practice at the highest level their level of experience and the clinical situation permitted. Doctors and nurses helped them participate by coupling support with an appropriate degree of challenge. That, then, was ExBL - a theory that students

and I published a systematic literature review showing what early experience could offer. Our conclusion was that early experience could be expected to strengthen and deepen students’ learning. That was the premise on which early experience was adopted in Manchester,

learn in clinical environments through supported participation, a concept that fits very nicely with other contemporary learning theories. From this, we can define clinical teaching as part of a supportive learning environment that helps students rise to the challenges

Towards a new theory of clinical learning


info scope photo credit: imperial college london

of participating in practice, from which they learn.

Direction and self-direction Next, Judy Hadfield and I devised the iSUS (intelligent signup system) technology that Salford medical students used to manage their learning - until it had to be decommissioned in favour of Medlea. Evaluating the impact of iSUS found that self-direction was a method of learning that students defaulted to when support and guidance were lacking and they found supported participation more valuable. Viva ExBL! This also defined another dimension of clinical teaching – helping students access suitable opportunities from which they could learn as participants in practice.

environments. They concluded that the role of the teacher/practitioner was to facilitate the interaction between patient and student. Previous research had shown that patients speak very positively about contributing to medical students’ learning, a finding confirmed by Philippa and Nick’s work. More recently (and not yet published) Emma McLachlan has done a project option where more detailed qualitative research into patients’ experiences of teaching encounters showed how the benefit to them of interacting with students has tended to be exaggerated by other researchers’ methods. She found that patients were more indifferent to students than had previously been thought.

Teachers’ roles The dynamics of interactions between patients, students, and clinicians Philippa Ashley and Nick Rhodes did two closely related project options, which allowed us to examine how medical students learned from patients in clinical

Clinical learning, then, takes place though participation in a triadic relationship – I have written about students and patients, but what of teachers? Using the same qualitative technique as Emma McLachlan – phenomenology, I analysed the experiences of all of Hope

Hospital’s consultant physicians regarding our adoption of PBL. We found them very attuned to the social dimension of learning and with strongly positive attitudes towards students. However, PBL left them confused about how they could put those positive attitudes into practice. In Miles Kiernan’s very recent MRes thesis, he describes how he used a sophisticated qualitative technique – Foucauldian Discourse Analysis – to show how teachers’ accounts of clinical teaching and learning were influenced by their own experiences of being taught. They tended to reproduce values that were rooted in traditional concepts of education, and which gave rise to the perceived incompatibility between clinical teaching and PBL, and their preference for the former.

Conclusion Let it never be said clinical learning is a simple matter! It is deeply rooted in the culture, practices, and procedures of workplaces. Traditionally, clinical apprentices learned by helping care for patients. So, participation is as old as time, but support has become ever more important as numbers of students has increased, clinical practice has become more complicated, and society has become intolerant of learning by trial and error. My research has defined some core features of positive learning experiences and the challenge, now, is to ensure those are provided. Clinical learning takes place within the triadic relationship between patient, student, and practitioner and our job, as ‘teachers’ is to provide a level of support that allows students to rise to challenges within that relationship so both their practical abilities and emotions mature in preparation for entry to the medical profession. References available in online version. Mediscope Jan 2010

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Misbehaviour

in your spare time

“College pranks can blight your medical career, students told”

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his was the heading of an article in The Times on 2 July 2009, warning that medical students are being sent to fitness to practise hearings and risk the loss of their career for parking violations, slack form filling, nights out on the town or having a messy kitchen. Medical schools, it was reported, were using new GMC guidance “to enforce rules that the university creates at a whim”. What you do in your spare time is private (or is it?) You might feel that what you do in the evenings and at the weekends is a private matter and no-one else’s business. If so, you would be wrong. Your behaviour outside the clinical environment, and in your personal life, could have a profound impact on your career. Behaviour expected of medical students The GMC has published guidance on the professional behaviour expected of medical students in a document entitled “Medical students: professional values and fitness to practise”. It is available on the GMC website. The GMC sets standards for the behaviour of doctors (for whom the key document is called “Good Medical Practice”) and medical students.

It is important to be familiar with, and comply with, GMC guidance. “Dirty kitchen ends medical student career” This is not a headline you will ever see in Manchester. Whilst there was a grain of truth in the piece in The Times, most of it was piffle. As Chair of the University of Manchester Faculty of Medical & Human Sciences Fitness to Practise Committee, dealing with cases from all five schools (Medicine, Dentistry, Nursing, Pharmacy & Psychology) I can assure you that we do not get referrals because of dirty student kitchens, playing loud music, parking violations or nights out on the town. What can blight your career? There are three categories of problem: criminal investigations and convictions, a miscellaneous group of problem behaviours, and health problems. Having dispelled a few myths, the aim of this article is to set out the major perils that lie ahead. For health professionals a criminal record is a scar for life. For ordinary members of the public, a criminal record is usually “spent” after

Which mediscope editor does this kitchen belong to? At least they won’t get thrown out of medical school for it...

By Prof Timothy David Pan-faculty lead for student fitness to practice

5 years. But, for those wishing to work in the health or social care services, employment will not be confirmed until an “enhanced” Criminal Records Bureau (CRB) check has been made, and for the purposes of an enhanced CRB check convictions are never spent. Your conviction for shoplifting or fare dodging will follow and haunt you for the rest of your professional life, and it will be disclosed each and every time you apply for a new job. Worse still, police investigations that did not lead to prosecution may also be disclosed with an enhanced CRB check. Recent examples include a police investigation of parents whose baby sustained an unexplained fracture, and a police investigation of a medical student involved in downloading pornography. The legacy of a criminal conviction The NHS may be more particular about offering employment than a University offering a place to study. The NHS may also be unwilling to accept a student on placement where that student has received a conviction, and we not infrequently come across healthcare students whose studies are halted because of difficulties arranging placements following a conviction. Cautions and penalty notices for disorder are just as important as convictions Some criminal offences are dealt with by the issuing of a “penalty notice for disorder” (PND) - a form of fixed penalty. Others are dealt with by offering the offender the opportunity to accept a “caution”. Both PND’s and cautions have the same potential career-limiting effect as convictions. It may be very tempting to accept a caution as a way of immediately clearing up a criminal matter, and


Other areas of concern regarding student fitness to practice

Some of these apply to your work and others to your behaviour outside of work: • Drug or alcohol misuse • Aggressive, violent or threatening behaviour • Persistent inappropriate attitude or behaviour • Cheating or plagiarism • Forging signatures and assessments • Dishonesty or fraud • Unprofessional attitude or behaviour

police and duty solicitors are apt to tell students (incorrectly) that cautions will have no effect on a future career. In the case of healthcare students, this could not be worse advice. In our experience, cautions are sometimes offered in situations where the police would have no realistic hope of securing a conviction if

the case came to court, and we recommend medical students ensure they obtain advice from the Medical School Student Support office before accepting a caution. Make sure you tell the Medical School immediately It is a requirement that you tell the Medical School if you have a run-in with the law. Do not wait for the court case, hoping you will get off. Minor motoring offences such as parking or speeding offences are not a problem, but driving under the influence of alcohol, or driving without insurance, would raise concerns. Health problems Health problems, particularly mental health problems, may raise concerns about fitness to practise, either because of the effects of the illness upon behaviour or because a student fails to recognise limits, lacks insight, or fails to seek treatment or to follow advice.

Conclusion It may come as a surprise to some medical students that if they wish their career to progress they have to do more than turn up to lectures and classes and pass examinations. As with all other healthcare profession undergraduate students, there is a requirement that students maintain a high standard of professional behaviour. An even greater shock may be that medical students need to be aware that their health and behaviour outside the clinical environment, including during their personal lives, may have an impact on their fitness to practise. The GMC emphasises that the behaviour of medical students at all times must justify the trust that the public places in the medical profession. There are numerous examples of perfectly competent health professionals who were struck off their professional register because of misbehaviour which occurred while they were not at work or on duty.

By Ami Pedersen

Also in the news... MANCHESTER ROYAL EYE HOSPITAL RESTORES SIGHT TO PATIENTS WITH GENETIC BLINDNESS.

FEMALE DOCTORS EARN LESS THAN MALE COUNTERPARTS SHOWS BMA STUDY.

NEW DEVICE COULD ELIMINATE THE NEED FOR WARFARIN IN PATIENTS WITH ATRIAL FIBRILLATION.

HIGH-RISK DONOR KIDNEYS SHOW PROMISE FOR RENAL TRANSPLANT PATIENTS.

A trial at Manchester Royal Eye Hospital involving bionic technology has restored basic sight to patients with retinitis pigmentosa. Peter Lane, 51, from Stretford was able to recognise basic shapes and read short words after becoming blind in his mid 20s. The patients wear glasses supporting a camera which relays information to a receiver in the eye. This, in turn, sends a signal via a minute cable to an electrode on the retina. Retinitis pigmentosa is a genetic disease affecting 1 in 3-4,000 people which causes apoptosis of the rods or cones in the retina.

A study funded by the British Medical Association has found that female medics earn on average £15,245 less than males in the profession. When making the comparison between doctors of similar age, experience and background a disparity of £5,500 more still remained in male doctors’ favour. Although the pay gap between men and women in general employment has been shrinking since the 1970’s, this study confirms that medicine, like other professions such as law, continues to harbour gender pay inequality.

A recently published study in The Lancet has shown that inserting an umbrella-like device into the heart is as effective as warfarin at preventing thrombus formation and stroke. The device, called the ‘Watchman™’, is inserted percutaneously and is fitted into the left atrial appendage, where most thrombi formed in the atria originate, preventing further thrombi formation. Instillation of a ‘Watchman™’ is likely to be used as an alternative when warfarin is contra-indicated as the long-term safety of the device is assessed.

Kidneys containing tumours have been given successfully to patients with renal failure in Baltimore, USA. Surgeons excised tumours from five kidneys, three malignant and two benign, before continuing with transplantation. Four of the five recipients are still alive with the one death being due to an unrelated accident. None of the surviving patients have subsequently developed cancer. Such novel usage of previously considered ‘high-risk’ donor kidneys could help combat the global shortage of kidneys for transplantation


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News in brief. NATIONAL PATHOLOGY WEEK National Pathology Week is a scheme organised by the Royal College of Pathologists, which took place between the 2nd and the 8th of November 2009. Its aim is to showcase the diverse range of specialties within pathology, and to allow students to gain an insight into the practice of the specialty. The popular image of pathology is that of a backroom specialty, divorced from patient care. National Pathology Week hopes to show that this is far from the case. In reality, pathologists often play a crucial role in proving advice on patient management, and in some sub-specialties, deal with patients face-to-face. In all clinical specialties, knowledge of pathology is highly relevant to patient care. Students were able to see first-hand what a career in pathology is really like in lab tours running throughout the week. For example, students on the virology sign-up were able to follow the journey that a swine flu swab takes from bedside to bench - learning how long the whole process

By Tom Sherman takes and the techniques that are used to generate results. In addition, a seminar was held that featured speakers from various specialties within pathology. This allowed the audience to get an overview of what life in each specialty is like, and also to see what current issues are of particular importance to specialists in those fields. An understanding of pathology allows future doctors to make more informed decisions about patient care. For instance, knowing the turnaround time of a blood sample facilitates good time management, and knowledge of lab techniques helps in understanding the strengths and limitations of results. Ultimately, a comprehensive knowledge of pathology results in better patient care. I’d like to thank all who attended the events, and hope that they found them useful. In addition, I would like to thank all members of the Manchester Medical Careers Society who helped with the event and Dr Godfrey Wilson and Dr Emyr Benbow for their help in organising the events.

NATIONAL MEDICAL STUDENT RESEARCH CONFERENCE On the 10th October 2009, the National Medical Student Research Conference was held in Manchester. It was hosted by the Medical Acorn Foundation, which has been set up to encourage medical student research. The belief of the foundation is that the power of fresh, uninhibited and enthusiastic thinking should not be underestimated and although undergraduate research is unlikely to win the Nobel Prize, participation in research as a medical undergraduate may sow the seeds for a successful career in medicine. The conference was attended by over 160 medical students from medical schools all over the country. The conference was supported by the majority of the Royal Colleges who sponsored prizes and helped to establish the event as an annual event in the medical student calendar. The Royal College of Surgeons of Edinburgh were the first to come on board and provided the catalyst for the conference. The College also helped publicise the event and attended to give advice on surgical careers. The keynote speech was given by Professor Woodcock, a Nobel prize winner for his work with asthma inhalers, who delivered a humorous tour of his work. The conference received a huge number of abstracts; universities from Edinburgh to Southampton were represented. The abstracts competed for 47 podium presentations and 50 poster presentations. The presentations were judged by a number of eminent clinicians, which included the Edinburgh’s Royal College of Surgeons own Honorary Regional Surgical Advisor,

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Mr Jeyaram Srinivasan (Consultant Plastic Surgeon). What impressed the judges was not only the outstanding research, but as Professor Hayden, the Northwest’s Postgraduate Dean put it, the “vibrancy of the participants”. The student presentations were inter-dispersed with workshops on career topics, including a lecture by Mr Hughes, Medical Director and former Foundation Director at Royal Preston Hospital, who used dating routines as his analogy to provide helpful tips on the current foundation application process. We won’t forget his “two timing” principle in a hurry! (Mr Hughes’s way of explaining we all need a plan ‘B’ in case we don’t achieve our chosen speciality). Medicine has a goal to attract talented vibrant individuals who are up for the enormous medical challenges of the future. Fostering this resource within medical undergraduates is critical to improving patient care and improving the efficiency of medical solutions. Given the impressive nature of the research presented and the commitment of the participants to medical research, it is perhaps not surprising that these individuals spent their Saturday sharing their work and learning how to develop further. It is anticipated that the conference will run annually, with the next being 9th October 2010. We look forward to seeing many of you there! The Committee

(Anthony Howard, Paul Hancock, Peter Jordan and Laura Neilson)


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photo: ~DSent

The Neglected Tropical Diseases (NTDs) are a number of usually chronic but, sometimes acute diseases that were first grouped together back in 2003 by the World Health Organisation (see Box 1). They have earned the name “neglected” almost by default because very little of the funding for health which goes to the poorest countries is directed at them. The fact is that most African countries depend on external funding for support to their Ministries of Health, and while some money goes for salaries, hospitals and infrastructure, and some is directed at individual high priority diseases, very little goes to the NTDs. The acute killers, (the big three as we call them - malaria, TB and HIV/ AIDs), can infect tourists, affect people living in major cities and even infect government officials, and so they attract money from major donors. In addition to being neglected for treatment, NTDs are also low in terms of the research and

control funding allocated to them both by donors and the pharmaceutical industry. Less than 10% of research funds are received for NTDs compared with Malaria, HIV and TB.

How important are the NTDs? In terms of burden of disease NTDs cause as much suffering as TB and malaria because of the numbers infected and the period of time people suffer the disabilities and the poor quality of life. For example, the intestinal worms and schistosomiasis together infect over 1 billion people but, they are chronic infections and very few deaths are attributable to them. Lymphatic filariasis causes horrible disfigurement, while river blindness and trachoma cause people to go blind – but do not kill them. Some other NTDs (e.g. sleeping sickness and visceral leishmaniasis) infect relatively few people but are quickly fatal.

Box 1: Important Neglected Tropical Diseases Schistosomiasis has infected 200 million people world-wide, mostly in Africa. It is a parasite infection, commonly chronic that can cause damage to internal organs. It can be easily treated with a single oral dose of praziquantel if available. Soil transmitted helminths are parasitic worms that live in the human gut and can cause misery, malnutrition and anaemia. It is estimated that a massive 1 billion people worldwide are affected. Can be expelled from the body with a single dose of bendazole. Elephantiasis (lymphatic filariasis) is another parasitic disease that can cause thickening of the skin and swelling of certain body parts. It is endemic in Africa and the Indian subcontinent, where it is thought 120 million people are affected. Trachoma is an infectious eye disease caused by a form of chlamydia, and nearly 8 million people world wide are visually impaired as a result.

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Onchocerciasis (river blindness) is a worm infection transmitted to humans through the bite of a black fly. There are thought to be 50 million infections in Africa. Control of symptoms is via annual treatment with Mectizan™. Guinea worm (dracumculiasis) is an infection that is close to eradication. See article on page 15. Other neglected tropical diseases that you can research if you have an interest in tropical medicine include: - Leishmaniasis - Leprosy - Buruli Ulcer - Chages disease - Human African Trypanosomiasis - Dengue fever - Echinococcus -Brucellosis - Rabies


If we look at the Millennium Development goals which the world’s politicians are trying to achieve, 5 out of the first 6 MDGs (see box 2) will never be achieved unless we can get treatment for these NTDs to the millions who are infected.

Box 2: Millennium Development Goals -

Eradicate extreme poverty and hunger – to eradicate poverty we must first treat the worms which cause the poverty

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Achieve universal primary education – dewormed children will go to school feeling more fit and healthy, and with a better nutritional status

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Reduce child mortality – if we treat the diseases they will be less likely to die

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Improve maternal health – we can lower anaemia by deworming and so improve birth outcomes

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Combat HIV/AIDS, malaria and other diseases. – again treatment of the “other diseases” will help reach this goal

What are the key risk factors? The NTDs are usually highly prevalent in rural areas where piped water does not exist and hygiene and sanitation are poor, because this first of all promotes hand to mouth infections, secondly is conducive to water borne infections, and thirdly allows insects to breed and so leads to vector borne diseases. Thus, three species of intestinal worms infect the “bottom billion” - those people who live in poverty in the poorest areas of the poorest countries of the world. They are hookworm (Necator and Ancylostoma spp), whipworm (Trichuris spp) and the round worm (Ascaris lumbricoides). These worms inhabit the human gut, live off the food we eat, and their eggs are passed out in the faeces. They have no intermediate hosts and in poor hygienic conditions the first two are ingested, while hookworm undergoes a free living stage before reinvading a human host through the skin. The misery and malnutrition and anaemia these worms cause is massive, and yet these worms can be expelled from the human body with a single 500mg tablet of a drug called albendazole, which costs as little as one penny per tablet from a generic manufacturer. It has been shown that annual doses of deworming tablets will have an amazing positive effect on their growth, nutritional status and school attendance. Other NTDs which can and should be easily treated are the schistosomes that cause schistosomiasis or bilharzia. These worms cause a variety of symptoms including blood in the urine and stool in the early stages and then more severe symptoms such as fibrosis of the bladder or liver, and death from bleeding or cancer. An estimated 200 million people are infected globally with schistosomiasis but almost 90% of those infected are found in Africa. Yet these worms can be killed by a single dose of the drug praziquantel at a cost of

less than 50 pence. Two other worms which can be easily cured are Onchocerca, which causes blindness and lymphatic filariasis that cause horrific swelling of the limbs and scrotum. These worms again can be treated with pills given once a year - thanks to the fact that the drugs used, Mectizan™ and albendazole are donated by the manufacturers (Merck and GlaxoSmithKline (GSK) respectively). We have calculated that if we could raise £200 million every year for 5 years these infections would be virtually gone from Africa, so we are conducting a campaign to raise funds to eliminate these diseases. Unfortunately, while we can eliminate these diseases, there are other NTDs which are not so easy to eliminate and some are more deadly. Examples are sleeping sickness, rabies and visceral leishmaniasis, and though we have a vaccine for rabies, we do not have a safe drug for the others. Other diseases for which money is needed for research include dengue fever, Japanese encephalitis and buruli ulcer – all horrible diseases for those infected. In summary, NTDs are a diverse group of infections which tend to affect the poorest of the poor and without something being done against them, the MDGs will never be attainable. For the one subset of NTDs an inexpensive rapid impact package of drugs can be delivered annually at minimal cost and could easily control or eliminate the suffering of up to a billion individuals . The asking price is about $200 million per year for 5 years.

Do the drug companies have a role to play? The pharmaceutical companies have been generous in donating their products which raise revenue in the west, but are unaffordable to those who need them in the poorer countries, but more drugs are needed for a second subset of NTDS. Merck & Co. Inc – donates Mectizan™ for as long as needed for onchocerciasis and lymphatic filariasis control in Africa GlaxoSmithKline – donates albendazole for lymphatic filariasis globally at least to 2020 Pfizer – has commited to donate up to 120 million doses of azithromycin for trachoma Novartis has a continuing commitment to Multi-DrugTherapy for leprosy Johnson & Johnson – donates mebendazole for removal of intestinal worms Medpharm (generic manufacturer) – has donated praziquantel and deworming drugs via Canadian donations E. Merck has committed to donate through WHO up to 200 million praziquantel tablets over 10 years Mediscope Jan 2010

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Primary Care

By Josh Jones the baby to the nearest hospital.” We were later told that the baby would probably die before receiving any medical assistance.

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n June 2009, I spent two weeks in Malawi with a Christian charity called STORM (Short Term Outreach Missions). I wanted to get an overview of Malawian healthcare and was able to spend three days working alongside a GP in a rural clinic. When we got to the clinic, we saw about a hundred people sitting outside waiting for an appointment. The Chief Medical Officer greeted and led us down the concrete corridor to the consulting room. We were soon left running the clinic alone with only a translator for assistance. This was pretty intense, especially as neither the GP nor I had any experience of tropical medicine! The clinic was desperately under-resourced. No stethoscopes. No otoscopes. No ophthalmoscopes. And with only 12 types of drugs in stock: 3 painkillers, 3 antimalarials, 3 antiretrovirals and 3 antibiotics, my BNF would have been no use. In fact, the only available copy of the MNF (Malawi National Formulary) was dated 1976. Despite these problems, a framed certificate hung proudly on the wall in recognition of excellent service provision. We saw one 50 year old woman who had generalised body pain, abdominal pain, a high fever and headache. The GP thought that this was a urinary tract infection, but with a roll of his eyes, the medical assistant told us it was malaria. This was a lesson learned – common conditions in the UK may not be so common in Africa. I found one consultation very upsetting. A baby was brought into the clinic and was struggling to breathe. She had a raging fever and her eyes rolled to the back of her head. After making a quick note, the medical assistant took a wad of cash from his pocket, thrust it into the mother’s hand and called a taxi to meet the mother on the main road several miles away. “Get

Though I found it difficult to remain composed, the medical assistant appeared unmoved. It was clear he’d seen it many times before. The types of illness seen in Malawian primary care are very different to those seen in the UK. Infectious diseases such as malaria, HIV/AIDS, syphilis and TB predominate. I saw no patients with chronic conditions such as ischaemic heart disease, COPD or diabetes – conditions that are a daily part of British primary care. Although chronic diseases do exist in Malawi, their prevalence is much lower for two reasons. Firstly, the Malawian diet is typically low in fat, and people often do labourintensive jobs. Secondly, the spread of infectious diseases like HIV means that people often don’t reach an age where such diseases become prevalent. According to the WHO the average life expectancy in Malawi is just 48. The Malawian healthcare system has been damaged by corrupt governments, poor infrastructure and wasted money. Progress, however, has been made with steady improvements in access to antiretroviral drugs to fight HIV/AIDS. Still much work needs to be done, and the emphasis should be on preventative medicine. For instance, mosquito nets can reduce the incidence of malaria and safe sex education will reduce STI transmission. During my time there I developed a real love for the people of Malawi, and also a passion to see an improvement in the country’s health care. Though life is often difficult, the people still remain positive and this was a something that I greatly admired. The experience also helped me to realise how privileged we are to have the NHS and how our gripes and problems with it are petty and insignificant compared to the problems facing Malawi. I am confident that one day I will return to Malawi to contribute to the work that is needed to further improve the health care system.


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photo: Medicine Sans Frontieres

AMATEURS ABROAD M

edical students have always been concerned about setting themselves apart from their peers. Volunteering overseas with NGOs or charities that run healthcare projects is often seen as a way of doing just this. The lessons learned could be clinical, interpersonal or philosophical. However, realistic options for unqualified students are limited; and further to this, medics sometimes root them out simply to provide ripe material for future application forms, possibly at the expense of choosing something genuinely beneficial. This unfortunate tendency to box-ticking aside, interesting voluntary projects can certainly be found. However, there is always the potential to stray beyond the boundaries of your competence and there may be a worrying amount of scope to do just that. This is especially true if your work brings you to the more underdeveloped regions of the globe. For it is here (where medics also see the juiciest opportunities to generate application fodder) that the lucky beneficiaries of these voluntary projects are most likely to implacably label students as doctor. This is an understandable problem, because, although medical students are essentially amateurs in the developing world, the presence of foreign volunteers in any healthcare setting gives an implied authority which is easily overused.

However beyond such pitfalls, from my own limited experience, voluntary work overseas can certainly be an educational experience, and can expose students to a variety of clinical situations not found in standard medical education. Be they of a practical or situational nature - this clearly depends upon the nature of the voluntary work itself. The time I spent in Southern India this year working with an Indian NGO, not only gave me practical opportunities but also exposed me to unfamiliar beliefs systems and attitudes surrounding healthcare. For instance, within the populace of the slum where my project was based, medical interventions are often seen as being either rapidly curative or ineffective; there is little comprehension of longterm treatment. This is clearly a problematic attitude to reconcile with modern medicine, and indeed it was something that my project was actively and tactfully combating,

By Andrew Green eager to increase compliance without discouraging participation in the first place. Although these sorts of experiences may not seem entirely relevant for British medical students, I think that exposure to unusual clinical settings encourages versatility. They promote skills which are readily adaptable, and encourage an understanding of healthcare which is applicable to medicine in the most general sense. So, as an educational experience, not simply a source of CV material, how valuable can volunteering overseas be? Clearly it will depend on the individual and the project they chose – from the many options, relatively few will be both appropriate and viable for a student at any given stage of medical education. However, in my opinion, working in a carefully selected healthcare project, for the right reasons, can be enormously productive.

The Lancet Student is a web journal for students from around the world, commanding a dynamic and exciting student community who are interested and passionate about global health issues. Whilst being founded by two editors of The Lancet (the world’s leading independent general medical journal), the Lancet Student is mainly organised and run by three Student Editors, who aim to encourage students everywhere to engage in global health. We want TheLancetStudent.com to be your site, and your contributions will help shape it into a leading global health resource. There are many ways for you to get involved, including becoming a peer reviewer and writing articles, blogs and elective reports. You can also vote in our polls, down load our podcasts, use our global health resources, as well as taking part in our debates and campaigns. Most importantly, send us your suggestions and submissions, tell us what you think, and 13 Mediscope Jan 2010 share your ideas by emailing student@lancet.com


education scope

I

was one of the lucky few third years to be placed on the Emergency Department. As it is a possible future specialty for myself and as I’ve been inspired by others who had experienced this area of medicine, I could not wait to get involved. Organised chaos - how A&E works A&E is always stimulating because you just don’t know what a patient will present with and as 80,000 patients come to Wythenshawe A&E each year – there is no shortage! When a patient arrives in the Emergency Department they are triaged to assess the nature of their illness or injury. Patients are streamed into different categories so patients with a more severe presentation of symptoms are seen earlier. A `Red’ category means the patient will be seen straightaway, while `Blue’ means they will be seen in less than 4 hours. As a student you can be the first member of the medical team to take a history and then present your findings to the doctor who then organizes a management plan. Classical signs and Catheterisation One patient came in as an emergency, they had missed an insulin dose and were dipping in and out of consciousness – they had diabetic ketoacidosis. Seeing a patient at such a challenging time was difficult, but at the same time it was interesting linking what we had learnt to a real patient. The doctor then told us that the patient needed catheterising so they could monitor his urine output, and asked if my clinical partner and

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I would like to have a go – we jumped at the chance to perform our first invasive procedure. We found it difficult but the doctor talked us through each step and finally the urine was flowing out of the catheter. 
The patient recovered quickly with treatment and it was very satisfying to see such a difference so quickly. The night shift A&E is one of the places in the hospital that tends to become a lot more interesting at night. We volunteered to do a night shift, and followed a variety of new and different patients throughout the night. We were getting ready to leave when the Emergency Specialist Registrar asked if we wanted to see a cardiac resuscitation attempt. We felt thrilled at the opportunity and followed the doctor to Resus. Shortly after, the patient

arrived and the reality of the situation struck me. We watched as doctors and nurses began the well-rehearsed procedure; monitors were switched on and defibirilators connected. Despite the best efforts of the A&E staff, the patient was pronouced dead after 6 minutes. The inexperience of two thirdyear students was clear by our shocked expressions. Looking Back My placement made me realise that working in A&E gives the opportunity to see a limitless variety of conditions and use a very broad knowledge base. There’s great satisfaction in being the first point of contact for the patient, collecting a detailed history, building a rapport and being able to follow the case through. I found it a valuable transition from pre-clinical to clinical years, it was intellectually challenging but it reinforced my drive to study medicine.

HOW TO MAKE THE MOST OUT OF AN A&E PLACEMENT Take Histories: There is never a shortage of patients to clerk, try and speak to and examine a patient then practice presenting them back to the doctor. Get Involved: A&E is a great place to practice procedures like catheterisation, cannulation and venepuncture. Spend as much time in the department as possible. Do a night shift: There is an opportunity to see a different side to the hospital at night.


By Ji Soo Kim

Neglected Tropical Diseases

Yaws (Treponema pallidum pertenue) doesn’t need dogs foaming at the mouth or blood sucking insects to spread. For Yaws, all it takes is direct human skin contact- a single touch can be enough. It may not kill, but it leads to a lifetime of disfigurement and social stigma. But there is no need for it to end like this; all it takes to cure Yaws is a single dose of penicillin. Fantastic! Another eradicated disease that we will never need to learn about. Of course, life is never that simple. Between 1950 and 1970 there was a global campaign to control Yaws, which saw about 50 million people being treated and the disease drop in prevalence by 95%. However, as political will ebbed in the 70s, cases began to creep back up and various attempts to regain control in the 80s failed. Today, the World Health Organization (WHO) refers to Yaws as ‘A forgotten disease’ – even among the other Neglected Tropical Diseases (NTDs). Yaws causes a distinctive painless skin lesions that frequently ulcerate and are highly infectious.

There are 14 diseases recognized by the WHO as NTDs. This list represents a huge variety in disease prevalence, pathology and prognosis. Dracunculiasis (guinea worm) is endemic in only 6 countries; Lymphatic Filariasis is endemic in 83. Some NTDs, like African Trypanosomiasis (sleeping sickness), are transmitted by vectors. Some, like Yaws, need no vectors to spread. Then there are the sequelae for the patient. The Buruli ulcer is hardly fatal, but is a social death sentence to its victim, owing to the irreversible and unsightly deformities it causes. In contrast, Visceral Leishmaniasis (kala-azar) is fatal in 2 years if left untreated. Common themes however, do run through these diseases. They thrive in impoverished areas, in conflict zones, slums and far off rural areas – places that have minimal sanitation, poor health care access and little political clout. The WHO estimates that 1 billion of the world’s 2.7 billion poorest are affected by one or more NTDs. These diseases affect local economies as well as individual health. Dracunculiasis, for example, causes extremely painful blisters and leaves the patient bedridden for up to a month, unable to work. The black fly that carries Onchocerciasis (river blindness) is found near fast flowing rivers. People are forced to abandon the surrounding fertile area and settle in less arable land. Though these diseases are devastating, they aren’t dramatic. They don’t sweep across continents and so they don’t get the media attention that is associated with conditions such as malaria or HIV/AIDS. They are neglected by the global community, by national health budgets, and by pharmaceutical research.

Dracunculiasis (guinea worm) is a human parasite contracted by drinking dirty water. The worms mate inside the body, then attempt to leave by burrowing through the skin... ewww!

Treatment for NTDs is incredibly limited due to their toxicity or cumbersome administration. The natural response would be to promote research to develop better drugs, but as it stands, only 21 out of the 1556 new drugs released between 1975 and 2004 were for NTDs or Tuberculosis. American Trypanosomiasis (Chagas disease), Dengue fever and Japanese encephalitis don’t even have a treatment. Aptly, these NTDs are classed as ‘tool-deficient’ by the WHO. However, the situation is not as bleak as it may first appear. In 2007, the WHO proposed a global plan for controlling NTDs: with one more push, Dracunculiasis, Leprosy and Lymphatic Filariasis could be completely eradicated by 2015. As for the tool-deficient diseases, the challenge is in promoting awareness and funding research. Here too, progress has been made. Organisations such as the student-led Universities Allied for Essential Medicines (UAEM) promote both research into NTDs and access to essential drugs in developing nations. All of this movement towards eliminating NTDs is incredibly promising. But the question still remains: will international political will regain the momentum it once had and make NTDs history... or will history repeat itself?

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education scope

Easily made history


Fluid Balance & On Inspection...

OSCE Station 1: Please examine this pa

Skin Turgor

Sunken Eyes

Pull the skin over the hand, arm or abdomen between two fingers. Hold for a few seconds, release and observe. Dehydrated skin will take longer than normal to return to its natural position.

Can be a sign of dehydration.

Oedema Look for sacral and ankle oedema. Press your finger firmly into the skin, release the pressure and observe. If an indentation is left, this is called ‘pitting oedema’, and can be a sign of fluid overload that may occur in heart failure, kidney and liver problems. If found, move up the leg to establish how far the oedema extends. You can also comment on ascites if present.

Which fluid to give? Keep in mind... A normal adult requires about 2.5 litres per day. A normal adult requires 1-2mmol/kg/ day of Sodium, and 0.5-1mmol/kg/day of Potassium. Fluid requirements increase if patient is fibrile, vomiting or has diarrhoea. They can decrease if suffering from heart or liver problems.

JVP If raised, it can indicate too much fluid. If it is low or absent, it can suggest dehydration.

Capillary Refill The WHO suggests applying pressure to the nail of the thumb for 3 seconds. The result is abnormal if colour has not returned within 2 seconds, and can suggest dehydration.

Poster Content: Ami Pedersen Poster Design: Chris Jacobs

Some common solutions Normal 0.9% Saline Is isotonic with plasma, with similar ratios of sodium and chloride. The fluid given will distribute throughout the intra and extravascular space. It is useful to give as replacement fluid in the hypovolaemic, and as part of an IV regime in those that cannot take fluids orally.

5% De Is a wa withou small tabolis water out all It is co norma those


Assessing Hydration

Background texture: eRiQ

atient for signs of dehydration or fluid overload

PULSE Dehydrated patients often have a tachycardia.

On Examination LISTEN TO THE LUNGS Oedema may also be present in the lungs, auscultating the bases may reveal fine crepitations. You can also percuss for a pleural effusion.

WEIGHT A good guide to hydration status is weight. A person with fluid overload will be heavier than normal. Patients are often weighed daily (‘daily weights’) to give a guide to the amount of fluid.

Ask the patient how thirsty they are!

s you may come across

extrose solution ay of giving pure water, ut the electrolytes. The amount of dextrose is mesed by the liver, leaving pure r that distrubutes throughl the fluid compartments. ommonly used as part of a al fluid regime, especially in with high electrolyte levels.

BLOOD PRESSURE Look for postural hypotension: take the BP while lying down, then soon after standing. Dehydrated patients may have a low blood pressure to start with, and may have a lower value on standing.

Gelofusine® Is a colloid, also called a plasma expander, which is often given to shocked patients to maintain blood volume. It stays within the intravascular space, and creates an osmotic gradient that draws fluid into blood vessels to maintain blood pressure.

URINE OUTPUT A normal healthy person should be passing 0.5 - 1ml/kg/hr. Any less than 500ml/24 hours is defined as decreased urine output - the cause of which could be dehydration. Also note the colour of the urine; dark may represent concentration of urine due to dehydration.

To Investigate I would... Blood Tests - Hypernatraemia can suggest dehydration. Urea, creatinine and haematocrit all give a good indication of blood dilution. U&E may suggest renal reasons for fluid imbalance. Liver function tests might suggest a hepatic cause for oedema.

Chest x-ray - Is helpful to investigate a cardiac cause for oedema.


education scope

Progress Committee

Harriet Staniforth

Many of us have heard about the Progress Committee, but few of us know how to prepare for it. This article has been put together from the experiences of several different anonymous students who have been through the Progress Committee. Having failed a re-sit, I spent the rest of the week upset, angry and exhausted. It was only after I started focussing on the Progress Committee meeting that I felt better; I had something to aim for and to work towards. Leading up to the Progress Committee It’s important to gather information about the process and dispel many of the myths that surround it. Contacting a PBL tutor or any trusted member of staff is the best way to do this. However, you should be aware that they may well be sitting on the Progress Committee themselves. Don’t shut yourself off. Talking to a friend or contacting the Student Advisory Service can help you put the situation into perspective.

Each year, fourth year medical students complete an eleven week ‘Project Option’. Each student is expected to arrange their own project and plan their work, which can be rather stressful. To help you out, here’s 10 tips for project option.

1

Plan early! Think about what you are interested in and what you enjoy. You have to spend eleven weeks in one speciality, so be sure you have a genuine interest in it.

2

Think about what you want to do. You have the choice between research, audit and a literature review. Each has benefits; seek advice from tutors and peers to ensure you make the right choice. Use this opportunity to do some detailed work that will look good on your CV. Having eleven weeks dedicated to a project of your choice is uncommonmake the most of it.

3

Approach key individuals who work in the speciality you’re interested in . They may have some work in the pipeline for you to complete or have some ideas for you. A project that enthuses both you and your tutor is more likely to be a success.

4

Be aware you may need ethics approval, especially for research projects. Ensure you check with your tutors as approval takes time.

5

Meet your tutor early. During your first meeting you should decide exactly what you want to do and set clear goals.

6

Keep a diary. Believe me, you will forget things, so write them down.

7

Make sure you are prepared when the 11 weeks start. Time goes quickly, so you need to be sure you know what you are doing. Make a plan and stick to it.

8

Keep a record of the journals you have read. It is a good idea to make a table including year, title, journal and key findings for everything. This will prove useful when you are trying to find references for your written report.

9

Make use of the support that is provided. Lectures are given with key information regarding project options and writing tips. It is a good idea to use these opportunities to ask questions. Also, bear in mind opportunities that may extend beyond the immediate scope of the project option period, such as presentations and publishing.

10

Don’t leave writing it to the last minute. It takes time to perfect your work; make an early deadline with some room for manoeuvre. When you have completed it, make preparations for your oral presentation.

Make sure you have all the correct facts and necessary paperwork ready for the meeting. In such a stressful situation, you may forget vital information and look as though you’re not telling the truth. The day of the Progress Committee Ask a friend or relative to come with you to the meeting. They may be allowed to come into the room, but are not allowed to participate. Try to arrive in good time and dress for an interview. Be confident as you enter the room and give the impression that you deserve to stay on the course. Don’t apportion blame, but instead be positive and focus on the future. Answer all the questions as fully as possible. Don’t worry if you become upset during the meeting. The Committee understand that you are in an incredibly difficult situation. After the Progress Committee Whatever the outcome, you’re likely to be very emotional after the meeting. It is important to take time to reflect over what’s happened. Ignore what other students say about their Progress Committee outcomes. Their results won’t have any bearing on yours, and they may not be telling the truth. I didn’t tell many people about having to go to Progress Committee before or after the meeting. Sometimes it’s good just to focus on the future.

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career scope

An interview with...

Dr Andrew Ustianowski Consultant in Infectious Diseases and Tropical Medicine North Manchester General Hospital

Q

Q

WHAT MADE YOU PURSUE A CAREER IN INFECTIOUS HOW DO YOU ENVISAGE INFECTIOUS DISEASE DISEASES? MEDICINE CHANGING IN THE NEXT 50 YEARS? I think it was always what I wanted to do. I wanted to travel, There are moves over the next couple of years to change and was more interested in roughing it than staying in the training structure. All will be expected to complete core the Hilton in Chicago. I hoped that travelling around the medical or acute common stem training and gain the MRCP developing world and medicine would combine quite well before entering into infection training at ST3 level. In terms in infectious diseases. More specifically, I was an SHO in HIV of the clinical work, it is always difficult (and foolish) to medicine in Brighton many years ago and loved that submake predictions. It may well be that there is an increasing speciality. Infectious diseases is a difficult career path, but I emphasis on the management and prevention of healthcare have no regrets at all and still love every moment. Each day associated infections such as C. difficile and MRSA. There is different and no two patients are ever the same. It is a lot will still be a huge workload in HIV and viral hepatitis. Then more varied and broad than most other there are the unexpected novel emerging specialities and is still truly multi-system. “Each day is different and no two infections that we continually look out The daily work varies from acutely unwell patients are ever the same” for. I could go on and on... patients who make a full recovery to those with chronic conditions such as HIV. Personally, I don’t WHAT DO YOU REGARD AS BEING THE GREATEST think I would have been happy in any other field of medicine. MEDICAL BREAKTHROUGH IN INFECTIOUS DISEASE? This is a hard one as there have been so many. In recent years WHAT OPPORTUNITIES AND CHALLENGES DOES A I would say it is the therapies that have been developed CAREER IN INFECTIOUS DISEASES OFFER? for HIV, which have completely revolutionised the care of It is a very competitive speciality and there are few posts infected patients. Historically, it may well be Jenner and either at training or consultant level. This is the main vaccination. It is interesting to reflect that the only diseases challenge, but for me it didn’t matter as it was all I wanted to truly curable in medicine are infections - the rest of medicine do. Due to its very varied nature, there is also a lot to learn is largely control and palliation. and keep abreast of. The opportunities are huge, including potential to subspecialise, getting involved in cutting-edge WHAT ADVICE WOULD YOU GIVE TO SOMEONE research, working for NGOs, and combining infectious EAGER TO FOLLOW A CAREER IN INFECTIOUS disease with general medicine or microbiology. DISEASE? You have to be completely dedicated and be sure that this is WHAT HAVE BEEN YOUR MOST INTERESTING / what you want to do. It is a very difficult career path to follow. CHALLENGING / UNUSUAL CASES? There are few posts available, and there will undoubtedly be There are too many. I am still most excited by some of the some major knock-backs. However, if it is truly what you want classical tropical diseases such as leprosy and different to do, like me, then you would not even consider anything worm and parasite infections. We also need to be on our else. I have absolutely no regrets. toes for emerging infections such as SARS and more recently H1N1 influenza. These will continue to develop and adapt, and infectious diseases is usually at the forefront in their management and research.

Q

Q

Q

Q

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career scope

Name: Alex Lee

Curriculum Vitae

Alex Lee explains why its never too early to start building up a medical CV,

Position: Medical Student

and offers some tips on

Having just attended a conference in London and searched far and wide myself for opportunities ‘out there’, it is intriguing to note how much goes on that Manchester undergraduates aren’t exposed to (at the Royal Society of Medicine, London, for example).

how to make yourself stand out from the rest

Courses, conferences, prizes and nation-wide “CV-boosting” opportunities are all within everyone’s grasp. Don’t underestimate the efforts you invested into obtaining a place at Manchester for we can all be our own biggest critic. .................................................................................................................................................................................................

A consultant will see numerous cases of the ‘weird and wonderful’. Ask if he or she has any cases that their Senior House Officers were perhaps too busy (learning for membership, for example) to put into case reports. Be honest about your intentions with your supervisor and say you are interested in developing a CV relevant to their specialty.

Ask the research nurse, consultant, audit office or academic department of your hospital if you can contribute to research or an audit. Try to present it regionally, nationally at the associated Royal College or even internationally.

An award, ‘honours’ or prize in your 1st or 2nd year of medical school could drive your CV into the ‘Yes tray’ for an ST Job. For those who settle for an “S” (for satisfactory) at each OSCE, Semester or Progress Test – perhaps it would be worth striving for an ‘Honours’ which you can later list in your CV’s ‘Undergraduate Education’ section. I also urge you to consult the Royal Society of Medicine website for their annual competitions.

At the MDT meeting, journal club or academic meeting. I find as I come to tailor my CV for postgraduate life, I can create a section within my CV entitled “presentations” detailing talks I’ve given voluntarily or had to give as a prerequisite of the medical course.

Mediscope and The Student BMJ are always looking for interesting articles, for example pieces on educational topics that are poorly understood in undergraduate syllabuses. You may need senior backing from a clinician.

It’s essential. Use other peoples’ CVs as examples. Having attended courses myself and contacted the Manchester Careers Department about this article – they recommend that you check the ‘events’ link on their website. The career service has career advisors specifically tailored to medical students. They are also able to advise medics who are considering leaving clinical medicine to pursue a corporate or scientific path, for example. The world is your oyster.

Courses in electrocardiography, IT, surgical skills, Ethics and Good Medical Practice are all topics that look great from an employer’s perspective. If your anatomical knowledge is weak, attend the annual course at the RSM. Become a community first responder, nursing or health-care assistant.

Masters or BSc, they are all exciting and indisputably add something to your CV. However, it would be a mistake to pursue a year’s extra study just for career advancement –you need to be sure you’ll enjoy the course and that you can afford it.

Royal Society of Medicine: www.rsm.ac.uk/students/ BMJ Events: student.bmj.com/student/notice-board.html Manchester Careers Service: www.careers.manchester.ac.uk

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career scope

Why is psychiatry a great career choice?

I

have worked in psychiatry for 10 years now and have never looked back. Each day is different and just as rewarding as the previous one. What could be more fascinating and useful than to have some understanding of the human mind? Where else can you incorporate biology, sociology, psychology, neuroscience, literature and anthropology in one speciality? Where else can you find so many choices of specialisation (Figure 1)? Not only that, but you get the time to really build a relationship with your patients, which is both satisfying and rewarding. Psychiatry develops and utilises key skills such as effective communication, empathy and listening, all of which are important for personal development. It also involves patience, openness, and a desire to understand what a person is feeling, which requires emotional strength (Figure 2). Why don’t medical students choose psychiatry? A survey of 300 medical students in England rated surgery as their top career choice, followed by paediatrics. Psychiatry came in at the bottom of the heap. Interestingly, those who knew someone with mental illness ranked it much higher, possibly because they were comfortable with the subject, and knew the myths to be untrue. Another survey carried Figure 1: Specialities in Psychiatry • General Adult Psychiatry - for ages 16-65 • Old Age Psychiatry - for over 65 • Child & Adolescent Psychiatry – from birth to school leaving • Forensic Psychiatry - with offenders in courts, prisons & special hospitals • Learning disability - incorporating neurology, genetics & epilepsy • Psychotherapy - many different types of therapy to choose from • Liaison psychiatry - mental health needs of patients in general hospitals • Social & rehabilitation psychiatry - long-term and complex problems • Addiction psychiatry - mainly drugs and alcohol • Academic psychiatry - research, but can continue clinical work

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BY DR NEEL HALDER ST5 IN PSYCHIATRY HOPE HOSPITAL

out by the Royal College of Psychiatrists found only 30% (out of 1000 medical students in UK) felt there was adequate opportunity for careers’ advice in psychiatry. Despite positive experiences on their placements, students were unlikely to pursue a career in psychiatry. Studies show that only about 4% of medical students are choosing psychiatry. Some high profile figures have become involved, including Ruby Wax: “It used to be the ‘C’ word – cancer that people wouldn’t discuss. Now it’s the ‘M’ word – mental health.” Stephen Fry who has the largest Twitter following posted: “Come on medical students! Choose psychiatry!” Myths dispelled The following are actual quotes from medical students. “Psychiatrists don’t cure people.” Actually this is not true. Many people with an episode of depression, psychosis or mania recover completely with no further episodes. Those with long term illnesses such as schizophrenia or bipolar disease are similar to those with hypertension or diabetes, where good control is the key. “People with mental illness like schizophrenia are dangerous.” The rates of homicides by those with mental illness have stayed steady (50 per year) for decades, despite the overall homicide rate increasing. You are nearly 10 times more likely to be killed by a drunk driver. In my 10 years of working in psychiatry, I have never been attacked or felt my life was in danger. “There’s no scientific basis; it’s all a bit woolly.” There are scores of scientific journals on psychiatry. Our understanding in the field is increasing at a faster pace than any other speciality. Advances in genetic research and fMRI are shedding new light on this intellectually challenging field. Figure 2: Psychiatry Incorporates • Knowledge – medical, psychiatric, and social sciences • Skills – in assessment, pharmacological and psychotherapeutic treatments • Professional attributes – managerial, ethical, communication, collaboration


Speciality training in psychiatry takes 6 years to complete and is divided into 3 years of core training (CT1-3) and 3 years of speciality training (ST4-6).The recent increase in investment means that there are 67% more consultant psychiatrists now than in 1997, meaning career progression should be smooth. In my training I have been well supported and valued. I have also been able to get time off to pursue other interests such as completing an MSc, working as trainee editor for a Royal College journal and gaining a diploma in cognitive behavioural therapy (CBT).

I’m interested- What do I do now? • Join the Manchester Psychiatric Society - it’s free to join with no membership fee. It aims to support students interested in psychiatry and raise profile of mental health issues. For more information seek out your year rep or contact the current Chair, Matt Norman.

career scope

After medical school After medical school, there are many opportunities in Manchester to do a placement in psychiatry in the two years as a foundation trainee.

• Become a student associate of the Royal College of Psychiatrists - it’s free! It entitles you to a free annual conference specifically designed for undergraduates, free e-subscription to journals and newsletters, and a 10% discount on college publications at www.rcpsych.ac.uk/medicalstudents. • Intercalate in Psychiatry or Psychology. • Consider doing an elective in a mental health unit.

Even if you don’t choose psychiatry as a career, it is vital to assess and acknowledge the mental health of all patients in any medical speciality. Approximately one in four people in the UK will suffer from a mental illness at some point in their lives. At least a third of all patients who see a GP have some mental health issue (which may not be obvious at the outset). Remember, there’s no health without mental health.

• Go to Psychiatry at the Movies – learn about mental health issues through film. • Enter the Neel Halder Prize in Psychiatry.

THE NEEL HALDER UNDERGRADUATE PSYCHIATRY PRIZE 2010 DEADLINE: Midnight, 2nd May 2010 Please read the guidance and submit the essay via email to editor@mediscopeonline.com

GUIDELINES • Essays can be of any length up to a maximum of 2500 word. • The text should be typed, double spaced, and justified, using at least a size 12 font. • References should be in the Vancouver style. • A summary should be included at the beginning of your essay that gives a brief overview of the main points. This should be a maximum of 100 words and will not be included in the overall word count. • Photographs, charts, and other illustrations are welcome. • The authors are encouraged to use their own style of writing and layout - there is no right or wrong way. • All papers will be marked by Dr Halder with authors’ names removed to reduce bias.

Students are asked to pick one essay title out of the following: 1: How do we attract more students into psychiatry? 2: From the ‘C’ Word - cancer, to the ‘M’ word mental illness; how negative attitudes are shaped and overcome 3: New ways of teaching students in Psychiatry. Explore and discuss. BENEFITS OF ENTERING • All entries will receive certificates for their portfolios • All entries will receive structured feedback to help with future publications • 1st prize £200; 2nd prize £100; 3rd, 4th & 5th prize of £50 each • Opportunities for conducting research with Dr. Halder as a supervisor • Potential for 1:1 coaching and mentoring for research and career advice (Dr. Halder is trainee Editor for a Royal College Journal, a Medical Education Fellow, and an OSCE examiner)

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career scope

Careers in Humaniterian Assistance By Cat Black

W

e all know that citing a desire to “help those in need” in a medical school interview is more likely to elicit a sigh from a bored interview panel than to guarantee a ticket into medicine. Sadly, a desire to help seems no longer to be regarded as valuable an asset for medical students as ensuring they are able to progress in their careers. It’s easy to get caught up in exams and medic nights out, and to lose sight of the reasons why we got into medicine in the first place. It seems that between CVs, portfolio and MTAS, many of us end up on a conveyor belt from foundation training to specialisation. This can make some of us alarmingly cynical by the time we’re clutching our degrees and sipping champagne on Oxford Road. At this point, pursuing a career in humanitarian assistance may seem like an unrealistic dream, incompatible with a serious career in medicine, especially within the NHS. There is no obvious career path into humanitarian assistance. The depth of knowledge and experience available on the issues surrounding humanitarian work are rarely presented to intrigued medical students. There is a definite need for clear, easily accessible information on the subject, so that students can consider the route they need to follow in order to pursue this challenging career. In 2007, the

Credit: DIVSHUB’s photostream

Crisp Report recommended measures to provide a career path to humanitarian work. It also proposed a system for sending medics abroad to get the single most vital skill in the humanitarian aid – experience. However, so far these recommendations have yet to come to fruition. Having a medical degree obviously isn’t a necessity for working in the humanitarian domain, yet it provides skills that can be invaluable in crisis situations. There ought to be a means by which the laudable intentions of medical students can be conveyed into successful careers or experience in the field. It is unfortunate that thus far medical undergraduates, the doctors of tomorrow, remain a largely untapped resource for the humanitarian arena.

Infobox Humanitarian Assistance is the initiative aimed at providing basic aid, care and protection of dignity for the world’s most vulnerable people.

Global Health: A fad of our generation

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or a lot of people, studying medicine is an opportunity to aquire new skills in order to help others. Increasingly, this seems to be in relation to international health and development; global health and humanitarian work have become the ‘sexy’ topics within medicine. There are new global health partnerships emerging all the time and notably, a further six international development degrees will be starting in 2010. In medical schools across the country, there are talks about how global health topics should be integrated into the curriculum, and students are continually pushing for universities to offer student selected components in global health. However, I feel that people should give more attention to what is going on in their own backyard. People, especially students, feel great about helping in developing countries. It looks glamorous, we can experience a different culture and it looks good on our CV. Unfortunately, many of the negative aspects are often overlooked. There is the carbon cost of travelling to distant places for often a short amount of time. Furthermore, the money spent on these projects could often be better spent on training local people, thus empowering the community for long-term. There is also the problem of students performing procedures that they would not be

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By Sadhia Khan

legally allowed to perform in the UK. Our generation has the power to make a positive difference in the world. I just hope that those who are interested in global health are motivated by the right reasons, other than their CV or MTAS form. Empowerment is great and as medical students, it is perhaps our moral imperative to do all we can to ensure that people across the world have equal access to healthcare. However, consider why you are doing something: put the good of others at the centre of your decisions and recognise that projects closer to home can be just as worthy. WEBSITES TO CHECK OUT IF YOU’RE INTERESTED IN VOLUNTEERING ABROAD www.benevolenttouch.org - This is a charity sending medical students abroad www.ifmsa.org - This is a network of medical students from around the world www.mensin.org - This is a network of medical students with an interest in international health www.thelancetstudent.com - This has many articles relating to global health


Book review

By Chris Jacobs

Blood, Sweat and Tea - Tom Reynolds

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om Reynolds is the pseudonym of an Emergency Medical Technician working for the London Ambulance service. Tom started an internet blog in 2003 detailing stories from his daily working life, which has now been condensed into a more palatable published version. The book is divided into short diary entries, each giving an insight into an area of the frontline NHS that gets a lot of attention on TV dramas, but that very few of us have had experience of during our training. You may well be surprised at some of his stories; I certainly was. The entries are well written with a cynical, witty humour that brings his patients to life and seems to be a pre-requisite for surviving as a paramedic. From dealing with alcoholics and tragic accidents, to delivering a baby and the art of driving an ambulance like an F1 car, he doesn’t hold back describing what his life is like. For anyone who has been interested in what happens to patients before they reach the hospital, I’d definitely recommend this as some light reading.

His blog is available online at: randomreality.blogware.com

Verdict:

4/5

What’s been your most embarrassing OSCE moment?

“My ‘friend’ was doing Rinne and

Weber’s tests in an OSCE and had come to the point of using the tuning fork. She drew a blank at what to hit the tuning fork off and unfortunately thought the most appropriate thing would be the patient’s head! ”

“A friend told me a story of a student who had been asked to

give basic life support to a model baby. When he was performing heart massage the head of the model baby fell off. Apparently it was a natural reaction to then kick the baby’s head in order to catch it again. The examiner wasn’t impressed.

“ I approached a good

looking simulated patient for a respiratory exam and simply said “Now, I’m just going to have a feel of your chest…”! The examiner nearly fell off his chair laughing.

“I have millions of bad OSCE

moments… I flicked a cervical brush at an examiner, I told an examiner I had the time of my life with him, I was unable to put an apron on and for some unknown reason tried to talk French to a 6 year old in a paeds OSCE!

Mediscope Jan 2010

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review scope

film reviews book reviews course reviews film reviews book reviews course reviews film reviews book reviews course reviews film reviews book reviews course reviews film reviews book vi


your scope

A

s medical students, we are taught how to break bad news. But, how would it feel to be on the receiving end? In February of this year an eminent cardiac surgeon told me I had two options: to have a heart transplant or to undergo a valve replacement. I sat staring at him as he continued to explain what the surgery entailed. Did he think that because I was familiar with medical terminology that I would be okay with this news? I tried to sit there and take on board what he was saying, nodding at appropriate intervals. What I found hardest to understand was that all this applied to me. Rather than sitting in awe of this great surgeon, I suddenly felt alone, scared and disheartened as he informed me of the complications as if it were a casual chat about the weekend. From this point I was no longer a “ I was diagnosed with medical student; I became Ebstein’s Anomaly at birth” a patient watching the days pass as my date for heart surgery grew ever closer.

A View from the Other Side... By Katie Misselbrook 4th year medical student, Wythenshawe

I was diagnosed with Ebstein’s Anomaly at birth, an extremely rare congenital disorder of the tricuspid valve. When I entered 4th year I began to struggle and I feared I would not be fit to start work as a doctor. I got to the point where I would arrive at a patient’s bedside having scuttled after the consultant, only to arrive looking ten times worse than the patient. My thoughts drifted to where the nearest seat was or how wonderful it would feel to lie down on the patient’s bed. No, it was at this point I needed to face up to my dodgy ticker with the reality that it would be me and not the patients requiring a cardiac arrest call. The morning of April 21st 2009 was when I adopted the role of a patient. I felt prepared to lose a little dignity, experience pain and feel vulnerable, but the reality that I may not reawaken filled me with fear. Despite this, I was more than a little alarmed when my day began at 6 a.m with a trip to the showers to be SCRUBBED down with hibiscrub. Did anyone else know that pre-surgical patients undergo this? It’s certainly not in any of my textbooks. This of course occurred hours before the medical student rocked up to theatre, probably feeling extremely cool in scrubs, with the added excitement of seeing heart surgery. Having an anaesthetic is a daunting process. The anaesthetic room is filled with people lunging at you with sticky ECG patches, wrapping your arm in a BP cuff and tapping the back of your hand to raise your veins. It’s hard not to be intimidated by all the faces. As the minutes dragged by, the prospect of my surgery became overwhelming. I had just said goodbye to my parents and boyfriend, trying my hardest not

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to cry. Despite knowing the surgeon’s excellent reputation, I couldn’t help think that these might be the last people I would ever see. 10,9,8,7,6... Too late to go back.

the crash team around me. I cringe to think of the people who saw me being dragged back to my bed by a collection of nurses with nothing but my towel.

Trying to predict how you will feel moments after coming Learning to deal with patient emotions can be challenging. round from heart surgery is an impossible task; mild discomI cannot emphasise enough that it is the small things that fort, severe disorientation and very sleepy. My first memories we do as doctors that patients remember and that putting are of hearing people moving, voices seemed distant and my yourself in their position will help you predict reactions. For body detached. A gag turned into a cough and I was extubat- example, is it normal for a patient to be upset when you ed 6 hours post opera- “A highlight of recovery is the first shower. However, return for the third time that day to tively. So far I had only take blood samples? In your opinion, being washed by a nurse when you are feeling needed a small amount they shouldn’t complain, after all extremely frail is a harowing process” of inotropes and my it’s only 3 small pricks. But, they are heart had remained in sinus rhythm. The operation had been experiencing an ordeal, to which this contributes. a success but my ordeal had only just begun. As a medical student I found intensive care units very intimidating: alarms As a patient, I had the opportunity to observe doctors in ringing 24/7, nurses perching tentatively at the end of their action. A particular patient will forever linger in my memory. patient’s bed. A quiet whimper was all that was needed to An elderly lady was awaiting a coronary artery bypass graft gain their attention. I drifted in and out of consciousness for (CABG), which had already been postponed 4 times. A final two days, disrupted by arterial blood sampling or the admindate had been promised for the coming Wednesday. On the istration of morphine. My legs felt lifeless, rapidly losing any Tuesday evening, a smart young surgeon swaggered onto muscle that I once had. Breathing was laboured, my chest the ward, his surgical gown billowing as he marched towards aching with the slightest movement. her. Without drawing the curtain or introducing himself he announced, “So we’re on for Friday then?” There was a pause, Day 2 and it was time to have my chest drain removed. I was followed by a whimper as she adjusted to the news of yet reassured that once the drains are out, patients experience another disappointment. After he left the lady broke down, less pain. I had become allergic to morphine and so the conbelieving that she would never have the operation. That sultant anaethetist prescribed paracetamol as an alternative. night, she deteriorated and was transferred up to ICU, requirIf I’d been able to I would have hollered “Are you mad?” That’s ing imminent surgical intervention. Over the next two weeks what you prescribe for headaches, not to relieve post-opershe never returned to the ward. I hope and pray she is okay. ative pains after heart surgery! To have the drain removed I was required to sit out in my chair. This had to be yet another I hope I can use my experiences positively in my practice of joke? However, with the help of two nurses, myself, my drip medicine. I had a harsh view from the other side; one that I and catheter bag survived the manoeuvre. The problem ocwould not wish upon anyone. But, even those of you who curred when the stitch failed to close; I was left with the drain have never required medical help, remember that medicine is hanging, supported by the nurse, whilst waiting for the anaabout the person behind the illness. What may seem routine ethetist to appear. There was a delay of 2 hours; the excuse to you may be life altering for another. Be supportive, kind being that he was lecturing medical students! and calm. Above all, remember how you would feel if it were you. A highlight of recovery is your first shower. However, being washed by a nurse when you are feeling extremely frail is a harrowing process and I realised that there was no way Factbox I could maintain my dignity. Do we feel as medical profesCongenital heart malformations are sionals that because the patient is ill, they won’t mind being common, occuring in upto 1% of live showered off naked on a wheelchair, hibiscub substituted for births. Ebstein’s anomaly is a rare defect, shampoo? Well, I guess not. The best I could do was to hang where the tricuspid valve is displaced on for dear life. I had already had fainting episodes, but the towards the apex of the right ventricle, shower experience, combined with my reaction to the reflecmaking the right ventricle smaller and weaker than usual. source: ebsteinsanomaly.org tion in the mirror, ended with me waking up in my bed with Mediscope Jan 2010

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your scope

Elective reports

Obstetrics in Mexico Fiona Mackie

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f you are having difficulty arranging your elective in a particular country, or really want to submerge yourself in the local way of life, then using a medical electives company could be the answer. As a Spanish European Option student, I wanted to do my elective in Latin America and I chose Mexico because they could accommodate the speciality that I wanted to do. Having organised it with a company, I stayed with a host family which opened up opportunities I would not have had otherwise. I attended a Mexican family reunion of over 300 people, I had dinner at a cowboy’s house and I had access to invaluable local knowledge. All my food was included so I ate home-cooked Mexican food everyday - it was delicious and much easier than having to cook for myself! I also met other international volunteers and we explored the local area together. My time in hospital was brilliant. I was based at a public maternity hospital where Mexican women with no money or health insurance come for obstetric care. I usually worked from 7am to 2pm, Monday to Friday. From 7am to 8am there was a case discussion with medical students from the local university and the rest of my day was spent in a particular obstetric department, for example an antenatal clinic or theatre. The highlight for me was delivering my first baby; an opportunity that medical students in the UK rarely have. The hospital averaged thirty-three deliveries per day, compared to eleven at the NHS Hospital where I did my obstetrics & gynaecology placement. While this meant there were plenty of opportunities to practice various skills, it also meant that the hospital and its staff were incredibly busy and this affected patient care. The hardest thing to comprehend was the difference between the level of obstetric care that women receive in Mexico and the standard that exists in the U.K. In Mexico, women were left alone during labour; they were reviewed every 30 minutes or when their screams escalated. At the last moment, they were wheeled into theatre where a doctor delivered the baby. There were no midwives, no partners, no birth plans, just a scared woman in a lot of pain being told to push, not scream. However, I did get used to the Mexican way, and tried to help a little by talking to the women and offering encouragement. Arranging your elective through a company is more expensive than doing it yourself, but Mexico itself is much cheaper than the UK, with a Corona costing as little as 60p and a bus ride 25p. I had an amazing time, and would recommend it to anyone. To be able to work in a different health care system, experience a different way of life, and meet so many interesting people was an incredible opportunity and one that I will never forget.

Projects Abroad offers a wide variety of medical placements overseas for students studying Medicine, Physiotherapy, Dentistry, Nursing and Midwifery.

www.projects-abroad.co.uk Tel: +44 (0) 1903 708300

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Consultation? £150. Blood test? £100. Peace of mind? Priceless...? BY WAI-YEE CHEUNG

A THIRD YEAR’S ACCOUNT OF A SIGN-UP IN A PRIVATE HOSPITAL

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f I’m honest, whenever someone says “private healthcare”, the image of a pound or dollar sign often comes to mind. My prejudice is probably reinforced by watching too much American television. Despite this, I was looking forward to spending an afternoon in the ‘Casualty Plus’ Department of a private hospital in Greater Manchester - I was curious to see if the doctors there had horns and pointy tails and, being in third year, the word ‘casualty’ immediately brings the prospect of excitement to my naïve little brain. Imagine my surprise when a friendly young doctor greeted me with, “So you’re the medical student? Excellent!” – which, as any third year medic will know, you’re not exactly accustomed to hearing. He had no horns on his head nor pound signs in his eyes. It also turned out that the ‘Casualty’ Department was not entirely faithfully named – in four hours, I saw a repeat prescription, a mild ear infection and a man who cut his leg on glass three weeks ago, experienced no pain or redness in those three weeks and was worried that it might still have glass in. Incidentally, it didn’t. Things picked up when Mrs K came in for a second opinion. She had a swollen knee and muscle weakness in all four limbs, which had progressed over two years to prevent her driving and picking up her children. She had been to her GP multiple times, and to A&E this morning, neither of which had helped. As we were running at a rate of 1 patient/hr the doctor could afford to spend a lot of time with Mrs K. He ran through a list of investigations and possible diagnoses, which caused Mrs K to burst into tears. She didn’t believe she would get the same

response from her GP and claimed she wanted to go private despite the fact she did not have insurance cover. The doctor explained that the level of care does not differ and that even if she did take up insurance now, it would not cover her for this particular problem. Nevertheless, she asked to see a price list and an hour and a half later she left with a bill of £200 (consultation price) but relieved someone was at last taking notice. This experience of private healthcare made me realise the consequences of not taking a patient’s concerns seriously as a doctor. Mrs K has had two adverse experiences with NHS doctors compared with over an hour’s consultation accompanied by a cup of tea. This has led her to believe that going private is her only option. However, it was clear by Mrs K’s reaction to the price list of investigations, each priced at £100 or more, that she could not afford to go private. There will also be treatment and follow-up to consider. It’s quite likely that in order for Mrs K to go private she will have to make some serious sacrifices on her side. Secondly, I have to admit that I was wrong in my preconceptions of private healthcare doctors. This doctor tried to persuade the patient to use the NHS for her own financial sake. However, even if I was wrong about the doctors, I find there is something strangely contradictory about treating a worried patient and then giving them a bill for £200 or more afterwards. While I found the day an interesting peek at an area of medicine rarely seen by students, I’m not sure I would recommend it as a useful learning environment. The department is basically a GP surgery without waiting times and with free tea, where those who can afford it spend much longer with the doctor.


society scope

SocietyScope

Elspeth Hill and Ambrose Boles

S

calpel Undergraduate Surgical Conference was held on 7 November 2009 at Wythenshawe Hospital. It was the first national conference of its kind, and drew medical students from all over the country. The event was held in collaboration with The Royal College of Surgeons (RCS), The Association of Surgeons in Training (ASiT) and Doctors Academy. The conference was attended by 120 medical students from as far away as Dundee and Peninsula Medical Schools. It provided a platform for students to present their original research, audit or case reports at a national level to other student and a select panel of surgeons with a passion for teaching and research. The best presentations were awarded prizes, which were generously sponsored by Mr Peter Richardson, Mr Rory McCloy, and the London Student Journal of Medicine. The day was chaired by our local eminent surgeon, Professor Gus McGrouther. Speakers included Professor Nanchahal from Imperial College London, whose fascinating lecture

THE MANCHESTER ONCOLOGY SOCIETY

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hroughout the five years of undergraduate medicine, oncology is a consistent curricular thread. From the initial study of carcinogenesis in year one, through to the oncology block in final year, it continues to be both an engaging and demanding topic for students. The Manchester Oncology Society (MOS) seeks to assist students in their academic engagement with this exciting field, and to nurture their interests and skills. The society will provide expert-led lectures on diverse and multi-faceted topics relating to cancer study. We seek to cover both basic pathology and clinical applications, and thus be relevant to students in all years of undergraduate medicine. It is our belief that oncology as a career has retained a low profile amongst medical students, and exposure to the clinical speciality is rather limited. It is our hope to raise awareness of medical, clinical and surgical oncology and to attract students to these rewarding sub-specialities. Manchester is an excellent location for those interested in oncology. It is not only home to the largest cancer hospital in Europe, the Christie, but also to the world class Paterson Insti-

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covered the advancements in plastic surgery research. Professor Stanley, a local orthopaedic surgeon, discussed the role of the surgeon and shared wisdom from a full and varied career. The keynote address came from Miss Helen Fernandes, a consultant neurosurgeon from Cambridge and the Chair of Women in Surgery. Her talk covered the history of surgery, as well as her experiences as a female surgeon and the aspects of neurosurgery that drew her to choose it as a career. A fantastic array of workshops was available, kindly supported by Doctors Academy and the RCS. This was a great opportunity to learn some practical surgical skills or ask expert advice about getting into surgery. A lively evening dinner was held at Red Chilli restaurant, which allowed delegates to relax and share their experiences of other UK medical schools. The conference was the climax of a triumphant year for Scalpel, which has been gaining momentum since it’s re-launch in 2006. A second conference is planned for 2010, which promises to be even better than the last!

tute for Cancer Research. A number of our committee members are currently working at the Paterson on breast cancer and lymphoma research projects. To reflect our interest in research, we hope to facilitate journal clubs for those looking for some extra-curricular stimulation. Critical appraisal skills are of great importance to future clinicians, and we hope to provide you with a head-start! Most of the money to fund cancer research is provided by charities. Cancer Research UK currently spends over £300 million pounds a year on research, and as a group of students we want to contribute through fundraising activities. Whether you’re simply looking for something to spruce up the CV, want help with finals revision, or want to meet up with like-minded geeks, the MOS has something to offer you. Please get in touch and come along to our events! Benjamin Hunter, Chair of the Manchester Oncology Society benjamin.hunter@postgrad.manchester.ac.uk

Join our facebook group: The Manchester Onclogy Society


society scope Early December saw the return of the annual Medic’s Pantomime and this time it was the turn of ‘The Wizard of Oz’ to be churned through the Medics PantoMachine. Its making was a long journey that began deep within the minds of its directors. Grueling writing sessions gave way to hours of rehearsal and slowly the story began to take its form. Set design gave Oz some life and the costumes gave the characters some glamour. Professional sound and lighting, and a great band were added all just in time for the curtains to open. The story begins with Dorothy in the midst of OSCE revision when she finds herself whisked away to a strange land where she must find help in the most unlikely of characters. Prayed upon by a Wicked Witch and her evil Dentist army for having the legendary ‘Guyton and Hall: 59th Edition’ in her possession, Dorothy must race to find the Wizard who can make sense of it all and send her home in time for exams. It was certainly a unique vision of Oz. A pun-loving Crow embittered by the economic downturn, a communist tree with a grudge against the Wizard and the threat of a Swine Flu Pig with deadly ‘fluey teats’ all combined to make the experience surreal to say the least. But it was fun, and in spite of its weirdness it was suitably puerile and true to the medical self indulgence of former pantomimes. The audiences were fantastic and full of laughter, and Owens Park Hall was filled both nights despite a fire alarm prematurely ending the first performance,. All the work paid off and the journey ended in the way any great pleasure should – with lasting smiles of disbelief, complete satisfaction and utter exhaustion. A resounding applause and sense of success accompanied final song as it rang out: ‘…But don’t you all fear for we’ll be here next year with another Medic’s Pantomime!’


CELEBRATING THE EIGHTH EDITION OF THE OXFORD HANDBOOK OF CLINICAL MEDICINE A GUIDING STAR FOR 25 YEARS

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Mediscope Issue 6