MEDISCOPE MAGAZINE ISSUE 8 by Andrew Cheng

Issue 8 February 2011

mediscope

The Manchester Manifesto Student Representation All you need to know about OCD Sports and Exercise Medicine Alternative Careers

Made in Manchester Manchester Medical Schoolâ&#x20AC;&#x2122;s Student Magazine

EDITORIAL TEAM Q+A: Where is your favourite place in Manchester?

Wai-Yee Cheung

W team.

elcome to issue 8 of Mediscope, the first edition of the year and the first to be produced by the new editorial

Our theme for this issue is ‘Made in Manchester’, chosen to celebrate innovations and achievements made close to home. The University of Manchester has long had a reputation for generating new ideas and pioneering research, demonstrated by the 25 Nobel laureates amongst the present and past staff. Research takes place in Manchester in a wide range of clinical disciplines, including a number of specialist research institutions that look into areas such as cancer studies, all of which are potentially accessible to students to get involved in via opportunities such as project option and intercalation. One example of the influence a Manchester medic has had is the work of John Charnley, whose contribution to orthopaedic science is described on page 11. However, as 21st century advances enable us to develop more complicated research techniques advancing scientific knowledge even further, it is important to take a step back and consider the ethical and legal consequences of research. Our lead features article describes a project pioneered in Manchester looking at problems surrounding the ownership of science and knowledge (‘The Manchester Manifesto’, page 8). Many in society are currently having to get used to change, especially due to the public sector budget cuts recently introduced by the coalition government. As medical students at Manchester, we are also looking at substantial changes over the coming few years. A new head of the medical school has already taken over, a new medical curriculum at Manchester has been proposed, and changes to foundation programme recruitment are planned for 2012. Making your views heard is especially important in times of change, a point emphasized by Prof. David Thompson in his first interview as head of school (page 6). It has been a pleasure to work on this issue and we hope it makes an informative and enjoyable read. Chris Jacobs Chief Editor 2010/11 Mediscope Editorial Team

Year: Intercalating: Ethics and Law Q+A: The Christmas Markets!

Alex Gawthrope

Year: 3, Hope Q+A: The Trafford Centre

Alastair Gibb

Year: Intercalating: MRes Q+A: Queen of Hearts - guilty pleasure..

Chris Jacobs

Year: Intercalating: MRes Q+A: The comedy store!

Want to write for us? Writing an article for Mediscope is a great way to voice an opinion, share experiences and impart knowledge. Getting published is also fantastic for your professional and personal development. We are always looking for talented writers from any year, course or university. The theme for our next edition (Issue 9) which will be published after Easter will be ‘Dispute and Controversy’, focusing on ethical debate and areas of controversy. In addition to themed articles we would especially welcome stories of personal experiences, reviews and career pieces. If you have an idea or would like some suggestions, please get in contact. Writers guide: www.mediscope.org.uk Submit to: articles@mediscope.org.uk Deadline: 14th March 2011

CONTENTS info

Issue 8 web www.mediscope.org.uk

5 6

editor editor@mediscope.org.uk articles articles@mediscope.org.uk advertising funding@mediscope.org.uk design and layout Alex Gawthrope Chris Jacobs front cover & contents photos Wai-Yee Cheung 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. All content is ÂŠ Mediscope 2011. All rights reserved. No content contained may be reproduced or copied without the prior permission of the editor. Feedback We would love to hear what you think of this edition and any suggestions for improvement. Please email the editor!

Medical School News Curriculum update Inspirational quotes News Snippets Local, national and international news Student Representation An interview with the new head of school and how to make your voice heard about changes

features

8 10 11

The Manchester Manifesto A project considering ownership of science Pioneering Embolectomy A procedure making a comeback that was pioneered in Manchester The Genius of John Charnley The contribution of John Charnley to orthopaedic surgery: A historical perspective

careers

12 14 16

A Career in Sports and Exercise Medicine An introduction to the field and an interview with a practicing medic Doubting Medicine? Guide to alternative careers Publish or Perish? An interview with a prolific publisher

education 18

Focus on OCD What you need to know about OCD

views and opinion

19 20 21 22

View from an International Student A perspective on life at medical school My Experience of Dissection Coming to terms with the reality of the DR Combining Motherhood and Med School Being a both a medic and a mum FUNSCOPE - New feature! Try the picture quiz The under-appreciated problem of Brain Freeze Ridiculous studies listed on Pubmed

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infoscope

News, Views, Events News

MBChB 2011 CURRICULUM

An update on the latest changes to proposed curriculum

n our last issue we reported the proposed changes to the current curriculum into a development named ‘MBChB 2011’. We spoke to Professor Paul O’Neill, previous Head of the Medical School, to find out the latest changes. The proposed changes to SSCs (now ‘Personal Excellence Themes’) aim to give students a more continuous experience and a better knowledge of specialties by creating a pathway through medical school – for example, if you were to pick oncology in first year, you could use your next PET to build upon the oncology knowledge gleaned from your previous PET. More subjects outside the usual curriculum are also being made available, such as global health or humanitarian aid. The National Student Survey is still being looked at to help the medical school improve its feedback. The feasibility of noting feedback in OSCEs electronically via the use of handheld devices is being considered, as it would enable automatic electronic feedback that could be easily distributed to individual students. Formative questions throughout the curriculum will also be given online to serve as checkpoints students are learning through PBL to the standard expected. ‘Guiding questions’ will also be given in PBL cases to the same effect. All students will also have access to the same introductory and closing lectures online across all training hospitals to provide some continuity.

Despite the medical school closely following the Browne report, the effect budget cuts will have is not yet clear. The report states “there are clinical and priority courses such as medicine, science and engineering that are important to the well being of our society and to our economy. The costs of these courses are high and, if students were asked to meet all of the costs, there is a risk they would choose to study cheaper courses instead… there will remain a vital role for public investment to support priority courses and the wider benefits they create.”1 This seems to suggest medicine is less likely to suffer than humanities subjects,2 however Professor O’Neill believes it is too soon to tell what the effects of the cuts will be. The creation of ‘house groups’ on entry to medical school is still planned for, to enable students to interact across all years in not only community based projects but also in medical learning – such as the Peer Assisted Learning system available at Salford Royal (Hope). With thanks to Professor O’Neill. .............................................................................................................................

Wai-Yee Cheung Mediscope Editorial Team

1. ‘Securing A Sustainable Future for Higher Education’; An Independent Review of Higher Education Funding & Student Finance. Lord Browne, October 2010. Section 3.2, Principle 1. Page 25. Available at: www.indepedent.gov.uk/browne-report 2. http://www.guardian.co.uk/politics/blog/2010/oct/12/higher-education-education

INSPIRATIONAL QUOTES

he Stopford reception area is being refurbished. As some of you may know, a contest for inspirational quotes to be displayed in the new reception was recently held. A total of 99 quotes were submitted, which were narrowed down to 15 quotes and then 10 quotes by the panel. The top 3 will be displayed in the reception area. This refurbishment will begin on the 28th February and is expected to finish on the 18th April. All those who submitted a quote will receive a thank you letter from Professor Thompson. The students who submitted the top 3 quotes will be notified over the next few weeks, but for now, here are the top 10 quotes as voted by the panel. NB: this order is not representative of the final ranking decision Panel: David Thompson (Dean of Medical School), John Shaffer (Academic Lead for Student Support) Emma Lewis (CBME Quality Enhancement Officer), Jacqueline Pass (CBME Project Manager) and the student representatives.

“He who asks is a fool for five minutes, but he who does not ask remains a fool forever.” Chinese proverb (submitted by Richard Colebrook) “The art of medicine consists of amusing the patient while nature cures the disease.” Voltaire (submitted by Shailesh Agarwal) “A diamond is merely a lump of coal that did well under pressure.” Henry Kissenger (submitted by Afiqah Aminuddin) “Education’s purpose is to replace an empty mind with an open one.” Malcom Forbes (submitted by Harpreet Bath) “Let the young know they will never find a more interesting, more instructive book than the patient himself.” Giorgio Baglivi (submitted by Aileen Dobbs) “The practice of medicine is an art not a trade, a calling not a business: a calling in which your heart will be exercised equally with your head.” William Osler (submitted by Hannah Irvine) “Life is like riding a bicycle. To keep your balance you must keep moving.” Albert Einstein (submitted by Michael Kemp) “Ability is what you’re capable of doing. Motivation determines what you do. Attitude determines how well you do it.” Lou Holtz (submitted by Aileen Dobbs) “Education is the most powerful weapon which you can use to change the world” Nelson Mandela (submitted by Savana Shakir) “Learning the science of medicine and the arts of healing.” Ahmad Roslan (submitted by Ahmad Roslan)

Societies

INTRODUCING: SEMSoc

The Sports and Exercise Medicine Society

ports and Exercise Medicine (SEM) is a rapidly growing field, offering exciting challenges and encompassing a variety of roles. The Sports Medicine Society (SEMSoc) was established to provide cutting edge information in this area, through lectures, events and our website which acts as a resource for professionals in this area. We hope to enable people to share opinions, experiences and ideas. We host regular lectures from a variety of guest presenters as well as running workshops, most recently a sports first aid course. In 2011 we hope to host a national sports medicine conference, which will offer the opportunity for students to receive lectures from top professionals in the field, partake in workshops and present work of their own. On the website, we publish content from both SEM professionals and students. From articles to case reports, we are interested if it provides information relevant to this evolving field. The goal of this is to create a resource which never goes out of date. Front line individuals are providing content that details what is happening now, not yesterday. For each author we include a short biography at the end of each article.

We also serve as a networking site for individuals and groups involved in sports and exercise medicine, from orthopaedic surgeons to strength and conditioning coaches, nutritionists to physical therapists. This network allows professionals to interact across disciplines, as well as making it easy for students to contact individuals. The society is constantly evolving, and we intend to remain at the cutting edge of SEM. As such, we are always looking for input from individuals. If you wish to become involved in the society, or have any ideas or feedback then please contact us. If you have content which you wish to get published, please send it to us for consideration. For more details visit our website: www.semsoc.com and contact the editor. To keep up to date with the latest news please join the Facebook page. ................................................................................................................................................

Joseph Lightfoot President of SEMSoc Year: 4, Wythenshawe

Also in the news...

REVOLUTIONARY SUPPORTIVE TREATMENT FOR FLU TRAILED Wythenshawe hospital has been pioneering the use of ECMO treatment for patients most severely affected by the recent flu outbreak. Extra-Corporeal Membrane Oxygenation treatment was developed to support patients undergoing heartlung transplants, taking over the work of the lungs by oxygenating blood outside the body. Several critically ill flu patients were successfully treated last month allowing their lungs to recover.

Submit your news! Keep us up to date with any news by submiting your articles to editor@mediscope.org.uk

FOUNDATION PROGRAMME OVERSUBSCRIBED In late November it was announced that the UK Foundation Programme was oversubscribed for August 2011. The top scoring 7,073 applicants were placed on the Programme in December with 90% being allocated their first choice foundation school. The 184 reserve list applicants are to be allocated in batches on the 31st March, 26th May, 15th June, 4th July and 22nd July. The UKFPO remain confident that all eligible applicants will be succesfully allocated by this summer. Reasons for oversubscription are said to be in part the nature of the system; previous years have shown an inconsistent number of applicants for vacancies, as the number of jobs is dependent on the health service itself and its requirements. For more information: - See ‘Foundation Programme Oversubscription’ by Carrie Moore and Derek Gallen in BMJ Careers online (01/12/10) - See the UKFPO website and its ‘Latest News’ section (www.foundationprogramme.nhs. uk). There is a presentation detailing how the contingency plan will work alongside further details.

CRACKDOWN ON FAKE MEDICINES MAY CAUSE MORE HARM THAN GOOD The war on counterfeit drugs is harming the people who need treatment most, according to a new Oxfam report. Pharmaceutical companies are seeking enhanced intellectual property laws in a bid to combat the spread of fake medicines. However, Oxfam claims that this will only serve to hinder the availability of legal, generic drugs – vital to developing countries. The charity goes on to say that since the bulk of counterfeit produce is sold on the black market and without patent, the new measures will fail to address the real problem, only serving to inflate drug company profits.

Mediscope Feb 2011

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An Interview with... Prof. Thompson: New Head of School You may or may not know that things have been changing at the top of the medical school. A new head of school Professor David Thompson took over from Professor Paul O’Neill at the beginning of this academic year. On behalf of Mediscope, I met up with Professor Thompson to learn a little about his background, what the role involves and what he intends to do about improving aspects of our education. Professor Thompson is clearly experienced and has had a number of high-level appointments. Originally trained in London, he has spent the last 25 years working in Manchester at Salford Royal where he is a Professor of gastroenterology, co-ordinating a research group alongside clinical practice. For the last 5 years he has also been a non-executive director of the hospital. Also having an interest in the history of medicine, he was keen to stress the importance of experience and a historical perspective: “When looking at ways to improve medical education, learning from experiences in the past is invaluable in planning for the future. When I went to medical school there were 80 of us in each year, just 8 of whom were women. Today things are so different and over the years I have seen many different ways of teaching and organization methods; some have worked and some haven’t, but what has struck me is that often people do not learn from these experiences.”

as possible. I often liken it to being a head gardener; making sure all elements of the garden work together for the enjoyment of everyone. Running a medical programme of around 2100 students is logistically and organizationally very complex, I spend most of my time networking and liaising with the large numbers of people involved in delivering education making sure everyone is working together and the quality is good enough. Being head of school is all about talking and listening, I often feel I have upwards of 30 cups of tea a day with different people.”

Each head of school inevitably has a certain focus for their time in their role. Professor Thompson made clear his top priority whilst acting as head is to improve the link between the students and the medical school, to promote a more supportive environment: “I would like to give students more of a voice and have an involvement in decision making so we can all work as one. I believe the best way of doing this is through an active democratic system of student representation where students feel able to participate. We are using our elected reps to help this process and in addition we hope to soon recruit an MBChB student experience lead, whose role will be to interact directly with students to improve communication. I understand that a human face to the medical school is important, and I want to avoid an ‘us and them’ mentality between students and the medical school as “I often liken being head of school this is clearly c o u n t e r The exact role that productive. the head of the to being head gardener...” Q u a l i t y medical school plays is something I suspect many are assurance is also an important issue. not certain about, myself included. Ensuring high quality experiences The way in which Professor Thompson for a large number of students over envisions his role is somewhat a large area is a challenge, however different to what I expected: “I don’t we are working hard and introducing really have a job description in the measures to ensure that a high quality conventional sense. I see myself as of teaching is delivered everywhere. responsible for the student journey Feedback from students is especially through medical school, and my role important in this respect.” is to make that journey as valuable

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When asked if the large number of students on the Manchester programme detracts from the student experience, Professor Thompson believed this to be a false impression: “While I appreciate a large programme is more difficult to manage, I believe there are substantial benefits. Students at Manchester have opportunities to pursue a wide selection of intercalating options, experience diverse placements and take part in a large range of extra-curricular activities. Such opportunities do not exist to the same extent in smaller medical schools.” We wish him all the best for his term as head and look forward to reporting on what will hopefully be significant improvements in the near future. Chris Jacobs Mediscope Editorial Team

YEAR REPS Each year has two year representatives that sit on the medical school’s Staff/ Student Liason Committee (SSLC) and raise issues related to each year group. The SSLC acts as a forum for communication between students and staff and issues such as examinations, feedback, and quality of teaching are discussed in addition to any other general problems raised by students. Year reps are easily contactable, should be familiar with issues related to your year group and are a good first port of call to raise issues. Year 1: Ranga Fernando, Miriam Leach: Y1medicstudentrep@manchester.ac.uk Year 2: Graham Clarke, Neil Forbes: Y2medicstudentrep@manchester.ac.uk Year 3: Etaoin Farmer, Laura Maitland: Y3medicstudentrep@manchester.ac.uk Year 4: Chris Mansbridge, Philippa Mikolajski: Y4medicstudentrep@manchester.ac.uk. Year 5: Vardha Ismail, Elizabeth Reuben: Y5medicstudentrep@manchester.ac.uk.

There are numerous methods in place both nationally and locally within the medical school designed to give students a voice in how medical education is organised and delivered. With an array of year reps, programme reps, BMA reps and various advisors it can often be confusing who to contact about raising a particular problem. Outlined below are details of the student representation available and how to go about making your voice heard.

PROGRAMME REPS

NATIONAL REPS

Introduced this year, there are three programme representatives elected from the entire medical student body. Their role is to provide a student voice to decisions made within the medical school. They sit on both the SSLC and other committees such as the programme committee and the curriculum committee. By liaising directly with students, year reps and staff, they help to ensure a clear communication structure and regularly feed back information to students. The programme reps are easily contactable and keen to interact with students from any year, especially on issues such as changes to the curriculum and the quality of the student experience at Manchester.

The BMA’s Medical Students Committee (MSC) provides representation for medical students at a national and local level. The MSC lobbies on issues such as the foundation programme recruitment, tuition fees and national health policy. Each medical school has a representative who can be contacted and raise issues on either local or national issues.

Programme Reps Emmanuel Oladipo Nathan Huneke Emma Vaccari Email: medicprogrammereps@manchester.ac.uk Twitter: twitter.com/manmedreps Facebook: Manchester Medic Reps Join the facebook page for regular updates.

Manchester BMA Rep Patrick Green patrick.green@student.manchester.ac.uk

For particular problems related to specific teaching, firms or personal circumstances it may be more appropriate to contact the academic support team within your hospital, the medical school or alternatively your academic advisor. Mediscope Feb 2011

Who Owns Science?

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introducing...

The Manchester Manifesto

Society?

Drug companys?

By Sarah Chan

Research Fellow University of Manchester

cience plays many important roles in our lives today. It both stimulates and satisfies our curiosity; it provokes our hopes and also our fears; it is the source of great potential benefit, but also potential harm. The ways in which we direct, shape and define the course of science will have a critical influence on how science in turn affects us and our society, now and in the future: which of these roles will be fulfilled, whether our hopes or our fears will be realised. A major force in this regard and one that has increased significantly over the past few decades is the increasing commercialisation of science and innovation, the conceptualisation of science as a business or industry and the idea of ownership of science itself. The financial growth of the biotechnology and pharmaceutical sectors, the increase in activities such as filing of patents and the shift within the culture of scientific research itself to regarding commercialisation as a core driver of science, all point to the importance of addressing this aspect in any consideration of science within today’s society. The Institute for Science, Ethics and Innovation (iSEI) was established in 2008 with the mission “to observe and analyse the role and responsibilities of science and innovation”, towards the goal of steering the most ethical course for science and its uses in the real world in order to improve the welfare of persons now and in the future. It was therefore natural, even obvious, that in selecting a theme for the launch of iSEI in July 2008, we should choose to address the question of “Who Owns Science?” 8

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This question, deliberately open to broad interpretation, we felt gave the appropriate focus for our inquiry while leaving scope for exploration of wider issues. To quote from the Manchester Manifesto’s “Statement of the Problem”: Science is a rapidly growing industry. Beyond basic research, the commercialisation of technologies and development of new products from bench top to marketplace is a complex process. In asking “Who Owns Science?”, we are concerned with all aspects of this process: scientific discovery, development, application and distribution; and the interactions between each aspect. The way in which this is managed, and in particular the way in which access to technologies is facilitated and controlled, is having and will inevitably have an increasing impact on the course of science-based technological innovation. An important component of the innovation process has been the idea of “ownership” in science and technology. This concept has arisen partly in the context of profiting from research and development, but also has implications for much broader issues such as control of and access to scientific information and products that result from research, in terms of both the private and socio-political dimensions of ownership. The “Who Owns Science?” initiative was led jointly by iSEI, chaired by Professor Sir John Sulston, and the Brooks World Poverty Institute, chaired by Professor Joseph Stiglitz. To tackle the complex and wide-ranging issues raised, we assembled a group of international experts

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????????????????????????????????????????????????????????????????????????? ????????????????????????????????????????????????????????????????????????? ????????????????????????????????????????????????????????????????????????? ????????????????????????????????????????????????????????????????????????? ????????????????????????????????????????????????????????????????????????? drawn from across the spectrum of relevant disciplines, including ethics, science, economics, politics, law, innovation and public policy. The aim of the project was to develop, through the process of an interdisciplinary inquiry on the theme, new perspectives on the issues and problems raised by current systems of ownership and management of science and innovation. Over two meetings, the first in July 2008 and the second in January 2009, the group engaged in a discourse ranging from initial efforts to define the problem and map the territory, through identifying areas of particular concern, to discussion of potential solutions and important issues for further consideration.

adverse) effects on people and populations”. While criticism of intellectual property rights (IPRs) is not an especially novel angle, the justification for the development and publication of the Manifesto and for the approach taken is at least two-fold. First, by bringing a considerable weight of interdisciplinary scholarship to bear in developing our own arguments, we strengthen the force of similar arguments that have been made previously from the perspective of single disciplines, drawing on evidence and argument from across each relevant area to support the others. Second, although statements to the effect that current implementations of IPRs “can restrict or prevent public access to the benefits of research” may seem self-evident to those familiar with the relevant arguments, the challenges and criticisms levelled at the Manifesto (not least by those with a stake in the current system) indicate that there is still a need to go on critically examining and if justified, restating such a position. We see the Manifesto not as a final output of the “Who Owns Science” project but as just the beginning of further engagement with the problems – practical, legal, political, economic and scientific – identified therein. It is intended as both a call to action, “for further research towards achieving more equitable innovation and enabling greater fulfilment of the goals of science as we see them”, and a stimulus for ongoing discussion in itself. Through the Manifesto, we have attracted considerable attention that has succeeded in provoking further discourse and wider engagement with relevant communities.

Figure 1: Process of scientific discovery

At iSEI, we continue to pursue an active research agenda examining the impact of commercialisation and IPRs across various areas of science. Being concerned with the ethical uses of science, we feel a crucial point frequently overlooked in regard to all sorts of new technologies is that often, as in the case of stem cell research or synthetic biology, although the emotive or high-profile ethical issues may tend to capture the headlines, the most pressing ethical issue and the one that will actually make the most difference as to whether the research overall achieves the good it can, is the problem of over-restrictive IPRs and their effect on future research as well as access to knowledge and the benefits of science.

The outcome of these discussions took form as The Manchester Manifesto, published in November 2009: a document which sets out a broad ethical approach to the issues related to ‘ownership’ in science and highlights problems associated with the current dominant model of innovation. In particular, a key point of consensus was that “the current method of managing innovation (and perhaps in particular I[ntellectual] P[roperty] in its present form), whilst deeply embedded in current practice and hence of practical importance, also has significant drawbacks in terms of its effects on science and economic Sarah Chan efficiency, and raises ethical issues because of its (often The Manchester Manifesto is available online at http://www.isei.manchester. ac.uk/TheManchesterManifesto.pdf

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Pioneering Embolectomy By Brian Tay & Alex Gawthrope ‘The doors burst open. An ambulance team push through the hospital stretcher, carrying a man in his thirties, unconscious, an oxygen mask strapped tightly over his nose and mouth. A pale faced woman follows the path of the trolley, carrying a small child sleeping in her arms, anguish evident in her eyes. You glance at your watch and sigh; it’s quarter past three in the morning. Only moments ago, you were musing over the possibility that this could be a quiet night. As the man’s vitals are pushed into your hands, you glance at the monitor to see his blood pressure is at 70/40mmHg and is rapidly decreasing. An ECG reveals sinus tachycardia and a “S1Q3T3” pattern, suggesting strain on the right heart. Immediately a variety of possible diagnoses flash through your mind - aortic dissection, pulmonary embolism, and myocardial infarction. You order an emergency CTPA scan, and identify the presence of large saddle embolus, its mass preventing the efficiency of the thrombolytics that have already been administered. The administration of further thrombolytics does little to prevent the patient’s heart eventually ceasing to beat.’ The embolus had won. But could this story have ended differently? The word “embolus” itself derives from the Greek term “embolos”, meaning wedge or plug. An embolus is indeed a foreign or endogenous body which wedges itself within a blood vessel, resulting in an embolism (the resulting physical obstruction and emboli). It is then largely the size of the embolus that determines the site of obstruction and subsequent clinical presentation, ranging from the subclinical to sudden cardiovascular collapse and death. Given the latter circumstance of a “massive” pulmonary embolus, mortality rates can be as high as 70% within the first hour of presentation, strongly correlated with the degree of right ventricular dysfunction and haemodynamic instability.1 Fortunately, this scenario is uncommon, accounting for approximately 5% of acute pulmonary embolisms. However no universally agreed treatment algorithm exists for this group of patients.1,2 Traditionally, medical intervention such as low molecular weight heparin (LMWH) and fibrinolytic therapy is first-line, with surgical embolectomy being, reserved for “rescue therapy” when haemodynamic state deteriorates, thrombolysis fails or is contraindicated. In 1925, Sir Geoffrey Jefferson (1886 – 1961) performed the first successful embolectomy in England at Salford Royal Hospital in Greater Manchester. Educated at Manchester medical school

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and a pioneering neurosurgeon at Salford Royal Hospital and Manchester Royal Infirmary, Sir Geoffrey Jefferson played a crucial role in establishing neurosurgery as a speciality in its own right at a time when it was little recognised.3 Broadly, embolectomy can be achieved through catheter or surgical approaches, the latter involving direct incision of the vessel. Two forms of catheter embolectomy exist: balloon embolectomy, in which the clot is removed by the inflation of a balloon on the tip of a catheter that is subsequently withdrawn, and aspiration embolectomy, whereby the thrombus is removed via suction.4 However, in the age of thrombolytic therapy, the viability of the embolectomy is now highly debated. The use of pre-operative thrombolytic therapy clearly potentiates the risk of perioperative haemorrhage should embolectomy become necessary. However, current research evidence would suggest that embolectomy continues to have a place in modern medicine, given that the procedure has low mortality when performed early within a specific group of patients.1 Whilst there is some scope for debate in terms of the most appropriate treatment algorithm, what is apparent is that embolectomy is still a procedure that can potentially save lives in the modern era, akin to Sir Geoffery Jefferson’s first successful embolectomy in England 85 years ago.

Figure 1: Management of pulmonary embolism where emcolectomy is available1

References 1: SAMOUKOVIC, G., MALAS, T. and DEVARENNES, B., 2010. The role of pulmonary embolectomy in the treatment of acute pulmonary embolism: a literature review from 1968 to 2008 Interactive cardiovascular and thoracic surgery, 11(3), pp. 265-270. 2: GOLDHABER, S., VISANI, L. and DEROSA, M., 1999. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER) The Lancet, 353(9162), pp. 1386-1389. 3: SCHURR, P.H., 1997. So That Was Life: Biography of Sir Geoffrey Jefferson Royal Society of Medicine Press Ltd. 4: TODORAN, T.M. and SOBIESZCZYK, P., 2010. Catheter-Based Therapies for Massive Pulmonary Embolism Progress in cardiovascular diseases, 52(5), pp. 429-437.

The Genius of John Charnley One man’s contribution to the world of orthopaedic surgery There are very few medical students who also happen to be interested in history. If an orthopaedic surgeon mentioned the name John Charnley to a student, chances are they wouldn’t have a clue who he is. However, the history of orthopaedic surgery owes a lot to the genius of John Charnley as he is credited as a pioneer of total hip arthroplasty which was named ‘Operation of the Century’ in the Lancet.1 He was born in Bury, Lancashire in 1911 and studied medicine at Manchester University where he obtained his MBChB, MRCS and LRCP in 1935. At the age of 25 he became the youngest physician to receive Fellow of the Royal College of Surgeons. A year later he started his training in general surgery at Salford Royal Hospital in 1937, where he acquired excellent diagnostic and operative skills. However it was not until two years later that he was exposed to orthopaedics when working in Manchester Royal Infirmary. The onset of World War II had a significant impact on Charnley’s career. He enlisted in the Royal Army Medical Corps as a volunteer and was stationed in an orthopaedic centre in Cairo. There he invented and improved on a number of surgical instruments and also worked with electrical and mechanical engineers, all of whom were skilled technicians. After the war Charnley returned to England and became a consultant orthopaedic surgeon at Manchester Royal Infirmary. He began to develop a special interest in hip arthritis and managed to establish a hip centre at Wrightington Hospital in Wigan. There he started experimenting with artificial joints,

Figure 1: Charnley’s hip replacement

providing all funding of the experiments himself. The road to developing total hip arthroplasty that lay ahead was long and full of difficulties. Charnley first of all realised the prostheses used at the time were inefficient due to increased frictional resistance and increased torque. His first major breakthrough was an attempt to overcome these faults by reducing the diameter of the femoral head component, thereby reducing both friction and torque at the articular interface of the implants. By doing so he also had to balance the risk of dislocation, as choosing an inappropriately small component would ruin the joint’s stability. His first attempts to reduce friction included using a self-lubricating polytetrafluoroethylene socket. He had spectacular success at first, but the wear of the material eventually proved too high and the resulting wear debris was causing adverse tissue reactions. Subsequently, he tried an ultra high molecular weight polyethylene (UHMWP) socket combined with metal femoral head component. Due to the low friction and high wear resistance UHMWP became the material of choice for total hip arthroplasty. Charnley’s second major contribution was the use of a form of acrylic cement to anchor the femoral prosthesis. He made a notable improvement to the pre-existing technique by using the bone cement as a grout instead of a glue. His technique improved fixation by a factor of two hundred. He published those results in a groundbreaking article, ‘Anchorage of the Femoral Head Prosthesis to the Shaft of the Femur’,2 which revolutionised hip arthroplasty. The durability and longevity of the cemented total hip replacement operation is greatly affected by the technical skill of the surgeon, because the bone cement has to be prepared during the surgery.3 Nowadays this operation is less frequently performed due to newer and more advanced methods having been invented. However,

most of the new procedures, implants and materials are still compared to Charnley’s total hip arthroplasty in terms of long-term survivability and as such, Charnley remains an icon in orthopaedics. Summer 2011 marks what would have been John Charnley’s 100th birthday. Wrightington hospital will be commemorating his work in the upcoming months through centennial conferences and orthopaedics workshops, as well as providing public access to Charnley’s lab, where much of his pioneering work occurred.

Georgi Georgiev Year: 3, Hope Hospital References: 1: Learmonth ID, Young C, Rorabeck C., 2007. The operation of the century: total hip replacement. Lancet, 370(9597), pp. 1508-1519. 2: Charnley J., 1960. Anchorage of the femoral head prosthesis to the shaft of the femur. J Bone Joint Surg.,42-B, pp. 28-30. 3: Gomez PF, Morcuende JA., 2005. A historical and economic perspective on Sir John Charnley, Chas F. Thackray Limited, and the early arthoplasty industry. Iowa Orthop J., 25, pp. 30-37.

A Career In..

Sports

Exercise Medicine By Alastair Gibb

Introduction

n inquisitive mind is a great asset in medical practice – that same curiosity should be nurtured as a student in the exploration of potential career choices. As we proceed down the path of undergraduate medicine we will be exposed to an assortment of core specialties. Everyone will get a broad taste of both medicine and surgery, working with the young and old, as well as dealing with the psychosocial challenges woven throughout the cases we see. These experiences will form the foundations of our medical training and prepare us for life as a junior doctor - but what about the lesser known branches of medicine? The Joint Royal Colleges of Physicians’ Training Board (JRCPTB) oversees training in no less than 30 medical specialties alone! Here we focus on one of the newest... Among the myriad of physician training programmes covered by the JRCPTB, Sports and Exercise Medicine (SEM) is one of the youngest in the family. It was only formally recognised in 2005, with the first cohort of trainees starting two years later. Despite the specialty being in its infancy, it can trace its roots back to the early 20th century - yet it is what SEM can offer in the 21st century that is of greater importance. GPs’ surgeries and hospital wards are inundated with patients whose diseases are related, in part, to an unhealthy lifestyle. The public health issues associated

with conditions such as diabetes, obesity and cardiovascular disease must be addressed to tackle the ever-increasing costs of healthcare in this country. SEM physicians focus on primary and secondary prevention to help identify and treat illnesses in those who would like to exercise or who would benefit from it. In doing so the specialty aims to improve the wellbeing of the general population, not just the sick. This role can be fulfilled as an integral member of a multi-disciplinary team, in a number of different environments. Training in SEM takes place in the community, hospitals and specialist centres. Of course the glitz and glamour of professional sports teams are understandably what some might aspire to; however, a consultant may find themselves involved in an emergency care setting or perhaps choose to ply their trade at a national level, helping to formulate policy on disease prevention. Read on to learn more about the training routes into SEM and get a professional perspective from our interview with the doctor for the Manchester Phoenix Ice Hockey team.

Goalkeeper Steve Fone leaves the ice with a deep laceration to his brow. After assessing for concussion, neck injury and cleaning the wound, Steve was sent to A&E for stitches.

Defender Ben Wood can’t continue after injuring his right shoulder in a high speed barge into the boards. There are three possible routes to choose after completing your second foundation year (F2): Core Medical Training (CMT, 2 years), the Acute Care Common Stem (ACCS, 3 years) or General Practice (GP, 2 years). At the end of this period, the relevant membership exams must have been passed i.e. MRCP Part 1, Part 2 and PACES, before progressing to the specialist training programme from ST3 onwards. The training programme from ST3 – ST6 covers everything that a doctor needs to experience to become a consultant of SEM, including placements in General Practice, Public Health, Orthopaedics, A&E, Cardiology, Respiratory, Rehabilitation medicine and working with professional sports teams. The Diploma in SEM is completed alongside these placements during ST3 and ST4.

A Professional Perspective...

Dr Alan Sweeney

EM is still in a period of transition. I spoke with Dr Alan Sweeney, who has recently become team doctor for the Manchester Phoenix Ice-Hockey club, to shed light on the current state of play within the specialty and find out what drew him to it. Dr Sweeney’s C.V. is testament to the time and energy he has invested into pursuing his chosen career. He explained, however, that he hasn’t always thought this way: “I entered medical school wanting to be a paediatrician as I spent four years teaching Judo to children before university. Then I discovered orthopaedics; I loved trying to learn all the bones, muscles and ligaments of the body and how correct examination technique can pinpoint pathology without the need for expensive scans – but quickly found out that I didn’t enjoy being in theatre!” The intellectual attraction of neurology led to him completing an intercalated degree in Neuroscience. Yet it was his discovery of SEM as a 4th year medic in 2007, which was pivotal: “I remember the day clearly, as it was the day before PBL and I was meant to be planning a presentation on ovarian pathology, but instead ended up randomly searching the internet for ‘how to be a sports doctor?’ and ‘sports medicine qualifications’. This was how I came across Professor Charles Galasko’s introductory speech at the opening ceremony for the new Faculty of Sports and Exercise Medicine (FSEM) in 2005 [1]. I read the

Curriculum Vitae • MBChB & intercalated BSc (hons) Neuroscience (UoM) • Team doctor for Manchester Phoenix Ice-Hockey Team • Ringside doctor at Amateur Boxing Association • Pre-tournament screening for England RFU team • Careers advisor for Sports Med Soc • Immediate Medical Management On the Field Of Play (IMMOFP) to legally cover Rugby League matches • Elective with Sydney FC and Sydney South’s Rugby League • Conference Poster and Oral presentations

speech from start to end, and immediately knew that this was what I wanted to do for the next 50 years.” In years gone by it was commonplace for sports physicians to be GPs or orthopods with a special interest in sports medicine. Doctor Sweeney, who has opted to follow the Core Medical Training programme, I immediatley knew that describes how the career this was what I wanted to pathway has changed do for the next 50 years and where he sees himself in the future:

“

”

“For the past 5 years, SEM has been recognised as a standalone medical specialty, meaning that doctors can decide to train in this field from ST3 level onwards and become an ‘SEM Consultant’ rather than a ‘GP with a specialist interest in SEM’ – much in the same way that one might decide to become a consultant of cardiology, dermatology or psychiatry. Within 10 years I hope to be a fully trained SEM consultant involved in outpatient exercise clinics, fracture and soft tissue injury MDT clinics, working part-time for a professional sports setup (preferably combat sports or another hard hitting sport such as rugby) in addition to academic responsibilities with both post- and under-graduates.” Dr Sweeney informed me that there are approximately 50 registrars dotted around the country who are on the SEM training scheme. Despite the paucity of positions available, SEM is still not as competitive a specialty as compared to those that are more established. This stands to change with increasing awareness of the training course and the upcoming Olympic Games in London. Take a look at Dr Sweeney’s advice on boosting your chances of getting on the SEM career ladder.

Dr Sweeney’s advice on how to get ahead in Sports and Exercise Medicine Read everything on the BASEM and FSEM websites, paying particular attention to names of influential doctors who work locally – don’t be afraid to get in touch. I’ve “shadowed” doctors in professional rugby, boxing, wrestling and ice-hockey simply by sending the team doctor an email/letter and asking. Elective in Sports Medicine: I tracked down and wrote a letter to the team doctor of an A-League football team in Australia. Thankfully, he was more than happy to have me and I learned.

Try and think of an original audit or bit of research - ask a senior doctor to guide. Submit your abstract to any upcoming conferences you can find. The worst they can do is say no!

I’ve attended 2 conferences as a helper, a Shoulder Ultrasound Course as a model and an Emergency Care at Equestrian Events course (ECEQE) as an “injured jockey”. The attendance and contacts made were totally free.

References 1: http://www.fsem.co.uk/DesktopModules/Documents/DocumentsView.aspx?tabID=0&ItemID=32010&MId=5261&wversion=St aging

career scope

Photo credit: Many thanks to Tom Hansen and Ajay Bear.

Doubting Medicine?

It is not uncommon for students to question medicine as a career choice at some point during their time at medical school. This article offers some practical advice on what to do and outlines some possible alternatives to clinical medicine.

ast your mind back to your medical school interview. You were probably asked, “Why do you want to do medicine?”, or had to explain yourself in 4,000 characters according to UCAS guidelines. You were probably told in preparation to come up with some wonderful new way of saying why it is you’ve chosen medicine without using the dreaded cliché “I want to help people.” However, a career decision made by many undergraduates at the age of 16 or 17 (and at any age, for that matter) is not always an infallible or a permanent one. For some students, the reasons given on application to medical school may not carry them through their training to become clinical doctors. A taboo can exist when it comes to leaving medicine. Worries can include financial burdens, the reactions of fellow colleagues, the time spent in medical school and training, and uncertainty over what to do next. Medics that visit the University’s Careers Service are often those who are having doubts. As the Careers Service extends for three years after graduation, the majority of those seeking advice are in fact foundation doctors – or even those having done one year’s speciality training. This may come as a surprise to those who feel they are alone in their doubts.

WHAT DO I DO NEXT? Is it really all or nothing?

Ask yourself what it is that you like and dislike about medicine, and where it has clashed with prior expectations. Is it the specific rotation or job you are doing at the moment that you dislike, or is it the subject as a whole? Do you want to leave medicine entirely, or could you work within medicine? Remember, medicine is by no means a small field – it takes time to find your niche.

Completing your training is usually advised.

By finishing your degree, you are by no means starting from scratch, as a medical degree is highly thought of in many other professions. Many also recommend finishing your foundation years, enabling you to get your GMC 14

Mediscope Feb 2011

license and thus making it easier to return to medicine if you should so wish.

Get advice and help.

A trusted member of University staff or your base hospital will have a better knowledge of the training system and may know others who have chosen the same option. The University of Manchester’s Careers Service is also a useful and perhaps more neutral resource, and is happy to help. These resources may also be able to help with questions about funding.

‘Know thyself’

Consider other interests you might have, and your strengths and weaknesses. Do you like patient interaction but dislike the subject itself, or vice versa? Psychometric tests that identify your strengths and weaknesses are available from the Careers service and website.

Case Study Ronnie Tan

Ronnie was halfway through his foundation year training when he decided he wanted to leave medicine and pursue a career in law. Having watched his friends discover their niche in fourth year, he realised he hadn’t the enthusiasm his friends had for any particular specialty. He didn’t struggle in his foundation years but rather considered the responsibility he would have to shoulder; “I saw the registrars and saw how good they were. Not only did I think I could never fill their shoes, I also realised I didn’t have the desire to.” He then did much of the research into a legal career on his own, “it really felt like a stab in the dark at first”, using the internet and speaking to friends who were currently on law courses. He managed to find out which courses offered law conversion, when to apply, and the technicalities that came with finding a contract with a firm. He then balanced his work as an FY2 with applications and interviews for law firms, as well as informal work experience in medical law. He also applied for GP training, “I got through stage 1 and 2, and was invited back for stage 3, but by then I knew I definitely wanted to do law instead.”

Law

Options Related to Medicine...

Nature: Medics are required for any expedition, science or charity based. Expeditions are to safari, jungle, marine, polar and mountain destinations. Entry: Previous experience in emergency and infectious disease medicine. Various training courses are available.

Many thanks to Alex Langhorn for this contribution

see Stephen Hearns, ‘Expedition Medicine’ in sBMJ 2000 (8):278-279

see ‘case study’

Armed forces

Nature: Requires you to take basic military training and to work in war zones. Entry: Royal Navy and RAF accept applications for Medical Officers straight from medical school. The Army require FY1/2 and sometimes specialist training first. see www.armyjobs.mod.uk, www.raf.mod.uk/careers www.royalnavy.mod.uk

Medical writing

Nature: Communicating scientific concepts to others can be academic, journalistic or educational writing Entry: Start by keeping a portfolio of written work. Submit articles for the student journals, e.g. sBMJ &the student Lancet. see www.mjauk.org (Medical Journalists Association)

His advice for those who are thinking of leaving medicine is to try as many options as you can within the field, and not to assume what you see in medical school and foundation years is all that there is. “It’s important not to choose something just to get out, especially if you haven’t explored all the avenues in medicine. You shouldn’t have to ‘make-do’. However, if you have a burning desire to do something else, then by all means go for it.” Ronnie is currently undertaking a law conversion course and has a future training contract with Irwin Mitchell, a large international law firm, with a strong reputation in medical law and clinical negligence claims. “I really landed on my feet, and found out what I wanted to do for the rest of my working life,” he says with a smile, and you really do believe him. Ronnie has kindly offered to speak to anyone who would like advice on converting to law. Please contact the Medicsope team at editor@ mediscope.org.uk.

Sports medicine

Nature: Utilising your skills for fit and well patients; evening and weekend work patterns; potential for travel. Entry: Postgraduate degrees can be done alongside specialty or GP training. (see page 12 for details) see www.basem.co.uk (British Society of Sports and Exercise medicine)

Pharmaceutical medicine

Nature: Learning detailed science, willing to do lab work. Can involve more individual lab work or working as a team with other scientists clinical research posts, drug safety officers, medical advisers in small and large centres. Entry: Previous research experience will help. see www.abpi.org.uk (the Association of British Pharmaceutical Industries)

Nature: Options exist in protection, defence, risk management, and forensics. Entry: Prior clinical experience (at least FY1/FY2), law conversion courses (1 year), training contracts (recruit early). Beware the expense of postgraduate legal education and the competitive nature of finding a training position afterwards.

career scope

Expedition Medicine

Public health

Nature: Health economics and strategy. Entry: The Faculty of Public Health provides a training programme for those who have completed their foundation training. see www.fph.org.uk (Faculty of Public Health)

Humanitarian aid

Nature: Tropical & infectious diseases, conditions uncommon to those experienced in medical school, disaster medicine, emergencies, desire to travel and willing to work with limited resources. Entry: Prior experience in areas above - significant previous clinical experience is a must. see www.msf.org.uk (Medecins Sans Frontieres), www.merlin.org.uk

Other areas entirely outside of medicine are endless and include business, finance, management (the NHS and GMC both run management schemes), the arts (music, etc), charity work, to name but a few. You will need to explain how your medical skills are transferable to whichever discipline you choose, and to provide your grades transcript as medical degrees are not classified in the way other degrees are (i.e. firsts, seconds, thirds). Bear in mind there are skills that can be taken from a medical degree that can apply to a completely different profession. Successfully completing your years of medical training demonstrates dedication, diligence, good time management and intellectual ability, all of which appeal to other professions. Your medical degree is not a waste of time and can be utilised. Wai-Yee Cheung Mediscope Editorial Team

More resources to help you... www.medicalcareers.nhs.uk – online tools to identify which specialties may appeal to you. This

is useful for medics who are undecided about their specialities as well. www.support4doctors.org.uk – click on ‘career and employment’ section. Provides details about alternative careers as well as ways to manage your current medical job. http://www.prospects.ac.uk/ - graduate website, type in ‘medicine’ for detailed options on alternatives.

http://www.careers.manchester.ac.uk/students/applicationsinterviews/psychometric/ taketheassessment/ - access to a psychometric assessment that gives you a detailed printout of your results (includes learning styles, personality types, etc.)

career scope

Publish or

Perish? Confronting reality on manuscript matters

eclined on a sofa in a top floor apartment in the heart of Beirut city centre, sipping on a freshly prepared cocktail of fruit juices, I could be forgiven for not having my mind on medical matters. There is a sudden ring of the door bell however and the host of the abode welcomes his latest guest, a rather unassuming chap to whom I am introduced, who also happens to be, as it turns out, a fellow medic. It is world cup time and the fever has spread to the Middle East in remarkable fashion; the rooftops and streets are bustling and boisterous with mostly Brazil and Germany supporters. Not one to be intimidated or taken lightly, I try to manifest my patriotism and represent the English contingent with sporadic outbursts of, â&#x20AC;&#x153;Rooney, Rooney!â&#x20AC;? In the meantime, I return to the medic who I have been introduced to and with nonchalance enquire about his interests. My mood quickly changes, however, for what I reveal is a journey that others, I am certain, will find truly inspirational... Throughout his last year of medical school and his successive year as a postgraduate research fellow, Dr. Khaled Musallam has published over 70 manuscripts in international peer-reviewed medical journals (including two book chapters), almost all as a main author, many as original articles, and some in journals with a JCR impact factor of more than 10. Dr. Musallam also had an exclusive opportunity to discuss the status of research in Lebanon with Lord Leslie Turnberg at the House of Lords, former President of the Royal College of Physicians. Dr. Musallam has held several training workshops in medical writing for medical students and residents. The series of lectures were highly Dr Khaled Musallam commended and will continue to be held for an even larger audience in the following years 16

Mediscope Feb 2011

Ahmed Hankir

Former Mediscope Editor Ahmed Hankir interviews recent American University of Beirut graduate Dr. Khaled Musallam on medical student article authorship. which he intends to expand and take further nationally and internationally. AH: Thank you for accepting my invitation to be interviewed for Mediscope Journal. My first question is this: how did it all begin? KM: As I started to advance in my medical studies and progress into my clinical rotations I started to realize that the provision of clinical care was not entirely reliant upon knowledge acquired in the traditional method i.e. standard reference textbooks, but more so from up-todate evidence-based medicine derived from cutting edge medical research. What sparked my interest was the whole concept of how a single published article could transform the direction of clinical care. So I wanted to be a part of that. I decided to approach Professor Ali Taher, a foremost authority on haematological disorders, the subject I found most interesting. He then suggested a topic which we could jointly write about. It was essentially a literature review article just in order for him to gauge my writing skills. At that point I was completely lost; I was clueless as to where to start, and what to do with what I eventually produced. With hindsight, I realize that that anxiety compounded by other pressing academic and clinical commitments could have prevented me from taking my interest in publishing any further. But I decided to give it a shot and persist. Next thing I knew, the review was accepted in the number one journal of paediatrics (Pediatrics). AH: How did that make you feel? KM: We are all familiar with that feeling when after waiting for what seems forever we receive the result of a difficult exam and discover that we have done well. Now take that feeling and multiply it by a thousand and that may give you

AH: So what kind of impact does this have on your future career and furthermore, what can publishing articles do for medics? KM: It is an accomplished fact that progress in academic medicine is highly, if not entirely, reliant on research productivity i.e. how many quality peer reviewed articles have you managed to churn out. At all levels of transition, from medical student to specialist training to sub-specialization all the way to tenure and professorship

and beyond you will inevitably be questioned on research accomplishments. The benefits may not always be monetary however the recognition that you receive, at times from world authorities on a particular subject matter, and how far-reaching your achievements are can be incredibly satisfying. As pleasing as applying the optimum treatment protocol may be, I would personally find far greater satisfaction in actually conceiving the treatment protocol itself and observing others use it. And this is the reality of a career in academic medicine.

career scope

an idea of the kind of exhilaration that seeing your name in print can only give you. That feeling rapidly escalated into an unquenchable thirst for more publications. So I started getting involved with several investigators at my institution in different components of research. You name it, research design, data collection (the nastiest part!), statistical analysis and medical writing; I was responsible for all of these aspects of publishing. What bridged the gap between these different and diverse dimensions was what my supervisors would call my innate talent to communicate but that of course would not have been enough; I also had to work on developing my skills in the aforementioned fields and I mostly did that independently resorting to sifting through published articles and books on research methods and medical writing and even at some points referring to the ‘help’ option on statistical software.

AH: What is your advice to medical students in the UK? KM: I achieved all of these goals in my final two years as a medical student in a developing country where resources are often limited. My message to you is this: don’t be deterred from pursuing a career in academic medicine. Make the most out of the numerous opportunities and expertise that are available in the UK (the UK are faring rather well in the international arena) and most of all, believe in yourself! Ahmed Hankir Year: 5, Wythenshawe

Got an opinion?

How important do you think getting published is as a medical student? If you have an opinion let us know: editor@mediscope.org.uk

Projects Abroad offers a wide variety of tailor-made Elective placements overseas for students of Medicine, Physiotherapy, Dentistry, Nursing and Midwifery. If you are searching for an elective with: • Specific specialties

ELECTIVES

• The chance to make a difference in a developing country • A new and exotic backdrop to your studies, Projects Abroad can arrange it for you!

www.projects-abroad.co.uk info@projects-abroad.co.uk

Aldsworth Parade, Goring, Sussex, BN12 4TX

Tel: +44 (0) 1903 708300

education scope

Focus on... Obsessive Compulsive Disorder Tell me something: How does Obsessive Compulsive Disorder fit into your life? It doesn’t? Think again. The typical media depiction of vigilant hand washing has resulted in a hugely underestimated depiction of this disease in society, especially as most people have mild obsessive tendencies. It is only at the far end of the spectrum that it acquires the label of OCD. The profound loneliness and emotional torture experienced by sufferers of this dark disease is not well known by most.

OCD

The disorder is divided into two parts: Obsessions Intrusive and severely distressing, obsessive thoughts/images uncontrollably swim around the sufferers’ mind. Compulsion The active need to repeat an action in order to neutralise the obsessive thoughts, in order to gain relief and freedom. The acts are overt (openly observable) or covert. The sufferer makes an active choice to carry out these acts. A distinguishing feature of OCD is the extreme specificity and meticulous detail with which the actions must be carried out. Whilst striving to gain more control through the brief neutralising actions, sufferers can in fact validate further the condition, relinquishing more control in the long term. Blindingly obvious to the sufferers themselves, this illogical behaviour results in feelings of worthlessness and embarrassment.

A myth blown up

A common misconception about OCD is that it is a disorder of cleanliness, where the sufferer feels the need to obsessively and irrationally clean themselves. In actual fact, there are four common groups in to which obsessive thoughts can be classified:

Germ contamination • Unfounded fears of contracting illnesses from objects • Excessive concerns about the spreading of germs • Repulsion of bodily secretions Item placement • An overwhelming desire for symmetry • An abnormal desire to be neat •Being repulsed by someone who is not neat (as defined by you) •Continuing to repeat an act until it has been done perfectly Doubting • Being worried that something has not been done e.g. locking doors • Overreacting if someone else has failed to do a simple task Intrusive thought • Can be of a sexual nature • Being overly concerned with moral issues, and right or wrong behaviour • Experiencing repeated, unwanted images of violence

Table 1: Obsessive thoughts Treatment

Owing to the extensive and often inaccurate media coverage, many sufferers hide their illness and attempt to treat themselves most commonly through facing their fears. Other attempts include hypnotherapy although there is little evidence to justify its efficacy. Cognitive Behavioural Therapy (CBT) This treatment uses the idea that negative thoughts can trigger negative behaviours and so encourages individuals to reevaluate their ideas of negativity. Exposure and Response Prevention (ERP) By facing the triggering situations in a controlled environment with a therapist, sufferers can learn other methods of dealing with their fears. Initially this can prove to be fairly traumatising for the patient. NICE guidelines recommend a combination of ERP with CBT. Although CBT without ERP is less effective, many patients understandably choose this option. It should be noted that there is no evidence

that psychoanalysis, transactional analysis, hypnosis or couple therapy improve OCD. Selective Serotonin Reuptake Inhibitors (SSRIs) can also be useful if therapy alone is not working. These antidepressants focus on lifting the mood which can increase the efficacy of therapy.

How ‘OCD’ are you?

OCD operates as a spectrum and most people have niggling thoughts about something. It is only when a person cannot let a thought pass that it poses a problem. This tends to appear in people who have more qualifications, a higher IQ and are of a higher socioeconomic background. Medical students and doctors fit into this category perfectly. It is interesting to note some common mild manifestations of OCD which can occur in everyone: • A fear of being late • Over-checking whether windows and doors are locked • A need to line up objects • Being unable to discard objects in case they are ever needed • Playing with fire to relax i.e. candles, lighters, matches • A constant need for reassurance • Making lots of lists • Needing to perform tasks ‘just so’

Table 2: Common mild OCD symptoms One can argue that many of these points can be justified rationally e.g. doors should be locked to prevent burglaries. However non-sufferers will be fairly flexible and rational about these tendencies. Whilst media coverage has served to raise awareness of this disorder, the lighthearted and often flippant approach has led to a disposition of fear and inadequacy amongst its sufferers. OCD is widely referred to as ‘the secret illness’ with 60% of sufferers remaining undiagnosed. Do you have a secret that needs sharing? Viveka Biswas Year 3, Wythenshawe With thanks to: Dr Neel Halder References available online

your scope

Reflections from an International Student In the entrance interview to medical school for any overseas student, the question ‘Why do you want to study abroad?’ is common. For many, the answer would involve a desire to experience a different culture. Now, coming to the end of my five years in England, I would like to share some interesting cultural differences that I have observed.

Work

Like everybody else, I found the PBL method a little difficult to cope with, but I enjoyed it very much as there is no set syllabus or a standard textbook for everyone to read. What I found more difficult to understand was the attitude taken to learning by some students here. Since primary school days, I was trained to take education very seriously. My teachers would not hesitate to spare the rod, even for the most trivial offences like mistakes in arithmetic. I resented the rigid system but it built a rock solid foundation for me in my approach to education for the rest of my life. In contrast, I found that here, doing the work for PBL was not always taken very seriously and was often done last minute. I would also wonder why students and consultants would complain that Manchester didn’t teach anatomy, when some students did not complete their anatomy booklets making the dissection session a waste, or turned up late from a hangover. This wouldn’t be tolerated in the educational system I was brought up in, and although I know this does not reflect all British students, when this did happen I found it hard to relate to.

Play

On the other hand, I salute the British students for excelling at play. It did not take long for me to realize that play is just as important as, if not more as work. Attendance at pub crawls felt almost compulsory. There are parties for every occasion. My first year PBL group was the ones responsible for making me drunk for the first time in my life. However, social events in general involved way too much

alcohol for my liking. Again, I found this very different, as back home bars are often associated with vice and drugs. No-one here has ever forced me to drink or go out, but the peer pressure is always there, and so I do feel like a social outcast when I decide to exclude myself from many of these social events.

Life

I loved the endless opportunities to pursue my interests, especially in voluntary activities. It is hard enough to muster enough courage to speak up amongst a group of native speakers, let alone lead them. But I was never judged by my accent or nationality; instead I was judged by my passion and capabilities. It has been rewarding to see my ideas turned into reality, at the same time making a difference to other people’s lives. There are also little things here that you may not have noticed which I really appreciate. When I first came over, I did not understand why people kept asking me the pointless question of ‘how are you?’ each time we met when I was sure they already knew the answer. I didn’t realize that it was simply a form of greeting. I found people here generally very courteous, with more pleases and thank yous in a conversation than anyone else in the world. People also give way to pedestrians, hold the door for the person behind, form orderly queue and keep to time. Never take this for granted. I lived in a country where these simple etiquettes are not always observed and it can be rather annoying! Overall, the past five years have been a steep learning curve for me, both in and out of medicine. It is an amazing privilege to be given the opportunity to experience a totally different culture. I will be forever grateful to all my British friends who looked after me. The international students may seem awkward because of our different cultural background. We try our best to blend in but it is not always easy. You make it easier by continuing to engage and accommodate us in everything you do. We love to learn about your culture, but there are some things that we are not able to relate to even if we try, and we hope that you will accept it and still continue to include us in whatever you do. Yee Yen Tan University of Manchester Graduate Mediscope Feb 2011

your scope

My experience of.. Dissection

’ll take Saw to a chick-flick any day, but when I stepped into the dissection room for the first time the only thing I could think of was how much I wanted to leave. At 18, being told to touch a cadaver in order to “familiarise yourself with the feeling,” I immediately stepped back, whilst my more eager (and frankly insane) peers stepped forward to prod the new addition to our group. The week after my first anatomy session I dreamt I had stolen prosections from the dissection room and arranged them across my bedroom floor. The next night I dreamt I had hidden a head beneath my bed sheets. These dreams weren’t particularly disconcerting; I would only remember them later on in the day, but if this was my subconscious telling me I secretly loved anatomy, I wasn’t convinced. As time went on I found I still wasn’t adjusting. I remember one session where a technician and his spray bottle decided to attack a prosection immediately adjacent to me with formaldehyde, some of which accidentally reached my hand. My self destructive imagination notified me that if death was imminent, my entire body would rot leaving behind a lone preserved hand. Later, I was sad to learn that the soap in the dissection room had converted to the dark side. Failing to deliver its flowery scent, it now only emitted the odour of the anatomy room. I knew I only thought this way because my brain associated the two smells but with my trust in soap forever lost, alcohol hand gel, talc, moisturiser and perfume became crucial contents of my bag. To my great dismay, I soon began smelling the dissection room in books, my bedroom and after getting a whiff of it on my sheets one night, I showered the bed with the two things closest to me at 3.15am; Mr Muscle and olbas oil. I then choked as I searched meticulously for a hidden head.

Mediscope Feb 2011

It seemed as though I was the only one affected this way. Everybody else appeared to be fine, but dissection wasn’t something I particularly disliked, it just seemed to dislike me. However, I soon realised my lack of enthusiasm during anatomy, combined with being painfully shy, only made me look stupid when asked questions. Fuelling myself with that pre-UCAS I-desperately-want-to-be-a-doctor determination, I began learning anatomy like I needed it to live. I would volunteer to dissect every week and soon enough I began to appreciate dissection. We must remember how privileged we are at Manchester to work with cadavers and that people have donated not just an organ, but their entire body for the purpose of teaching future doctors. Unfortunately semester 4 saw me relapsing into my previous state, demonstrating the need to confront problems. However, as this was my last semester studying anatomy, I had developed a blasé attitude regarding my distaste towards dissection and trudged along happily hiding behind the keener and taller medic. I’m about to go into my third year now and I genuinely will miss anatomy. If you are have trouble adjusting to dissection remember you’re definitely not the first and you won’t be that last. Don’t make the same mistake I did and suffer in silence. Make the most of it; revise the work beforehand, engage with your demonstrator and remember to speak up if something’s bothering you. Amna Sadiq Year: 3, Hope Hospital

your scope

Combining Motherhood & “…So now certain sectors of the NHS virtually grind to a halt during half term. I mean I know the feminisation of the profession has been long awaited, but do you really think that’s a good way to run things?”

hen this question was posed in a lecture, I was so shocked I had to double-check with a friend that I had heard it right. I had. It was a rhetorical question that invited no response, but I’d like to try to offer one anyway.   I’m a mother and a second year medic. I fit studying in around trips to the park, playing with dinosaurs, and an endless mountain of laundry. My Facebook statuses are all about nappies and breastfeeding, not nights out on the town. Student support admitted that I was the first person to ask about facilities for pumping breastmilk. But they sorted me out straight away, arranging permission for me to use the dedicated nursing and pumping room in the Michael Smith building, by lunchtime on the first day of term. Motherhood makes keeping up with med school a bit more challenging, but really, compared to most working mums I’ve got it easy – few jobs offer so much flexible time as studentdom, or the opportunity to do much of my work from home. There are only a few of us trying to combine parenthood and medical school, but in five years or so many of the people studying medicine now will be combining parenthood and work as a doctor. You might find yourself going to work entrusting your own bundles of joy to childcare (and occasionally stumbling into work bleary-eyed from a sleepless night with a teething baby). For the traditional male doctor this was easy - his wife would look after the kids while he focused on work. Childcare and school holidays were not his concern. The feminisation of the profession has taken a long

time. The number of women entering medical school has increased almost 10-fold over the last 50 years, and the discrimination faced by women doctors is certainly decreasing, but sexism is still an issue, in employment within the NHS and in lectures. Certainly, some of the men on the course will soon be amongst those juggling childcare responsibilities and a medical career, and some female medics will not become mothers. The solutions needed to enable mothers to fulfill careers as doctors will also help medical fathers taking on childcare. But let’s face it, responsibility for children does still fall predominantly on women, making it a women’s issue.   The recent report to the Chief Medical Officer – ‘Women Doctors: Making a Difference’1 - outlined many of the changes the NHS needs to make to ensure that women doctors can continue their careers as far as their skills and desires take them. Changes to the way childcare is organised and paid for, increased opportunities for part-time work and career breaks, and revalidation processes that take into account newer working patterns are all important. Planning and human resources management needs to take account of the increasing numbers of doctors using or seeking more modern working patterns. Significantly, the North Western Deanery is seen as a desirable model of practice regarding postgraduate training and childcare arrangements, which is encouraging for those of us hoping to stay in the area after we graduate.   Of course attitudes are important too. Doctors seeking to use these newer work patterns should not be discriminated against or made to feel inferior. Support should be available to women doctors seeking to enter positions of leadership where women are currently under-represented. The medical profession is likely to be the first previously male-dominated profession to achieve parity. The NHS we enter as new doctors needs to be able to prioritise patients’ needs while ensuring that all doctors are able to continue their careers. The NHS invests nearly a quarter of a million pounds per doctor in training us up to registration, so it has a clear interest in enabling us to carry on working to the best of our abilities.   So, in answer to the question - if some sectors of the NHS suffer during school holidays, please don’t blame the women entering the profession. Solutions to support doctors combining medical work and childcare need to be addressed by men and women in the NHS. The burden of the problems may fall disproportionately on mothers of children under 16, but we can all be part of the solution: let’s start by being aware of how we identify and describe problems.

Xen Hasan

Year: 2, University of Manchester Mediscope Feb 2011

Thunderstorms and iPods — Not a Good iDea (Image left)

Heffernan EJ, Munk PL, Louis LJ. - N Engl J Med. 2007 Jul 12;357(2):198-9. PMID: 17625137

“We have recently become aware of an additional, albeit uncommon, hazard associated with the use of [iPods]”... That is conduction of a lightning strike through the head of course. WARNING: Using an ipod in a thunderstorm; if only you had performed a literature search first...

Can shoe size predict penile length?

Shah J, Christopher N. - BJU Int. 2002 Oct;90(6):586-7. PMID: 12230622

In short, no.

Development of skill of children in performance of the family computer game “Super Mario Brothers” Kawashima T, Satake H, Ueki S, Tajima C, Matsunami K. J Hum Ergol (Tokyo). 1991 Dec;20(2):199-215. PMID: 1842968

Desperately scraping the barrel for excuses to play video games... Images in clinical medicine. A foreign body. (Image right) Flores-Suarez R, Reyes-del Valle J. N Engl J Med. 2010 Oct 28;363(18):1748. PMID: 20979475

“...And I suppose you tripped this time too, Mr Smith?” Penile entrapment in a plastic bottle - a case for using an oscillating splint saw. May M, Gunia S, Helke C, Kheyri R, Hoschke B. Int Urol Nephrol. 2006;38(1):93-5. PMID: 16502059

“Honest doctor, I stepped out of the shower, slipped on a bar of soap... and would you believe it...”.

“A FOREIGN BODY”: This is not a laughing matter...

Can playing the computer game “Tetris” reduce the build-up of flashbacks for trauma? A proposal from cognitive science. (Image right) Holmes EA, James EL, Coode-Bate T, Deeprose C. PLoS One. 2009;4(1):e4153. Epub 2009 Jan 7. PMID: 19127289

The research suggests a prophylactic dose of tetris may just do the trick post-traumatic stress disorder. Rollercoaster asthma: When positive emotional stress interferes with dyspnoea perception Rietveld S, van Beest I. Behav Res Ther. 2007 May;45(5):977-87. Epub 2006 Sep 20. PMID: 16989773

Recipient of the satirical Ig Nobel Prize of Medicine 2010. The group discovered that symptoms of asthma can be relieved with roller-coaster rides.

TETRIS VS TRAUMA: Participants were subjected to a traumatic film, before being randomly allocated to a “no-task” or “Tetris” group; tetris playing occured for 10 minutes. Flashbacks were monitored for 1-week. The results suggested that the “Tetris” group, in comparison with the “no-task” group, had a significant reduction in flashback frequency over 1-week.

Can you name them all? (Answers at bottom of page) Rhinotillexomania - Habitual or obsessive nose-picking, reaching a pathological threshold. Consecotaleophobia - Fear of chopsticks. Nintendonitis - (See PMID: 11130299) A form of repetitive strain injury caused by playing computer games. (Above) Clinical Sign and a Condition?

“Werewolf Syndrome” (Hypertrichosis) – (Left) Disease and Procedure? Excessive and abnormal hair growth on the body. (See image right)

(Right) Name the Device (Below): Name the Pathlogy

Vampire syndrome (Porphyria) – Symptoms may include photosensitivity, purple urine, and the thinning of gums and lips to expose the canines. (Does not cause sparkly skin)

Foreign Accent Syndrome - This syndrome causes people to speak their native language as if they had a foreign accent. Note: Whilst these conditions are unusual in nature, the effects upon the individual can be serious, and should be treated as such.

NOT JUST FOR CHRISTMAS By Simon Simonian The issue of Brainfreeze has been a problem for all living creatures. Previously it was believed that homo erectus evolved as a direct anticipation of an ice age thanks to effective weather forecasting by Michael Fish. Its characteristic “stroke and knives” sensation has plagued mammals since we crawled out of the oceans, but now scientists have proposed a new evolutionary theory – The Height Theory. I quote fellow author Tom Hodgson: “These are exciting times.”

in the USA declared a Brainfreeze epidemic following the introduction of iced coffee in Starbucks branches. A recent, ground breaking publication by Darkin et al. entitled ‘How come people don’t find feet sexy?’ demonstrated a casual correlation between smaller brained individuals, such as the small brain of the Neanderthal, and resistance to Brainfreeze. Recent studies found correlations between reduced Brainfreeze and other smallbrained conditions such as Alzheimer’s sufferers, chronic alcoholics and dentists.

Simple Science: The science can be explained by the brain being placed higher on the body, it is further from the cold ice on the floor (See Figure 1.) THE BRAINFREEZE REFLEX

CLINICAL FEATURES OF BRAINFREEZE

The now widely accepted Height Theory maintains that H. erectus overcame their drawbacks initially by attempting to grow taller, placing the brain higher on the body further from the cold ice on the floor. This evolutionary mechanism is still seen in modern day Scandinavians, their height helping them escape the icy floors of their country. The discovery of fire allowed a small numbers of H. erectus to discover an effective approach to combat the other source of Brainfreeze. By cooking their food, they overcame the problem of cold objects suddenly entering the oral cavity.

The most common feature of Brainfreeze is a sudden, sharp and debilitating global headache, accompanied by a loud, verbalised groan. Others include disorientation, dizziness, partial paralysis and a transient loss of continence. EPIDEMIOLOGY Prior to the 1900s, Brainfreeze attacks were relatively rare, and often seasonal. Unfortunately, the recent rise in Brainfreeze attacks can be traced back to the increasing popularity of iced drinks and snacks in society. Two key examples are first the development of Mr. Whippy in 1935 by Margaret Thatcher and her time, arguably more destructive to British society than her time as prime minister. The second is the 2001 Starbucks Incident, where the Surgeon General

HEIGHT THEORY

Fig 1: Advanced Mathematics Supporting the Height Theory of Evolution

This article proposes that further research be done into the control of frozen and iced foods, to curb the recent rise in Brainfreeze.

Answers (From Top to Bottom): • Hereditory Haemorragic Telangiectasia (HHT). Systemic sclerosis may also yield a similar presentation • ERCP - Multiple gallstones within the gallbladder and cystic duct. • BAHA – “Bone-Anchored-Hearing-Aid”, surgically implanted to allow direct conduction of sound through bone, bypassing the external and middle ear apparatus. • Retinitis pigmentosa.

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