mediscope April 2008
What the hell is going on?
Abdominal Examination Poster Care of the Elderly SSCs in Europe Reviews
Manchester Medical Schoolâ€™s Student Magazine
Issue 2 Apr 2008
Submit all articles to subeditor.mediscope @manchester.ac.uk 2
Manchester Medical School
CONTENTS 04 News Infoscope keeps you up to date with the latest local, national and international medical news. Including an article from Prof. O’Neill, Dean of the medical school.
06 Feature Care of the Elderly 06 Poem 07
08 Education 5th year electives 08 SSCs in Europe 09 Prof. Neyses Interview 10 Oncology 11 Pastest questions 12 Progress test tips 13 Abdominal exam poster pull-out 14
16 Comment Access denied 16 Worth the bother? 17 Sharing the Wealth 18
19 Society Find out about medical student activities past, present and future
23 Life Tackling Cardiac Arrest 23 Reviews 24 Living with a medic 26
torial i d E e h T nderson James A lquhoun o Jessie C elley K Thomas abherwal S Rohini liams il Anna W
A word from the editors... Left with the task of writing a foreword, I was somewhat lost for words. So I’ve decided to simply list reasons why this edition of Mediscope is worth a read: it’s free, it’s Manchester relevant and it will definitely keep you entertained for ten minutes on the toilet. Perhaps this isn’t appropriate. On a more serious note, having taken your comments into consideration we've tried to take a less is more approach in this edition, well, less words and more pictures. The “Ask the Dean” article was the first thing many of you turned to in the last issue, so in this one we tracked down the boss, Professor O'Neill, to see if he could lay rest to some medical school myths generated by the Stopford rumour mill. If you read one thing in this issue, read the feature poem. One consultant, after coming across it, printed it out for every nurse and doctor in the hospital to read. It’s not very often that you come across something that might actually change your attitude to the very old. A big thanks to everyone that has written for Mediscope so far. The upcoming September edition will be centred around Global Health, so if that inspires you to put pen to paper then send us an article: email@example.com Also, be sure to join our facebook group - just search for “Mediscope” on facebook. Lastly, Mediscope would like to wish all its readers in their upcoming exams. See you in September for the Freshers special. Anna Williams & Jessie Colquhoun
Front cover and formatting by James Anderson 3
Issue 2 Apr 2008
infoscope What the hell is going on?
Because no news is bad news
Prof. P O’Neill I am delighted to contribute to Mediscope, which I appeared in many years ago as captain of the Medics football team following a cup triumph. You also might be interested to know that I was recently sent copies of the Manchester Medical Students Magazine from the 1920s (which does predate my football career!) and there are similarities between the topics of discussion then as compared to now. In considering what I might write about with the Mediscope editorial team, a number topics and questions were suggested, so my article jumps about a bit to cover a range of issues. You will be pleased to hear that we recently signed a new agreement with St Andrews University. We have had a partnership with St Andrews since the early 1970s and which, at the time, supported the construction of the Stopford Building and the move of the Medical School from the old University buildings. We have always thought that the transfer of students from St Andrews brings a lot of benefits to our programme and we were keen to ensure that it continued. However, the partnership was seriously threatened by the ‘Calman’ review (Ken Calman, former chief medical officer for England and , who was responsible for the amalgamation of the Senior Registrar and Registrar grades to ‘Speciality Registrar’), which proposed retention of all the St Andrews graduates in Scotland. Subsequently, the two Universities have worked hard to put together a new agreement that will mean that 100 students are transferred to Scottish Medical Schools for
there would have to be consideration as to how some graduates might apply to different Foundation Schools, but it is a proposal that overall I support. I also agree with the Report in that there is a lot of excellent practice in the current Foundation programmes (particularly in the North West) and this should not be lost as a consequence of the uncoupling. The proposal is about ensuring that all of our graduates can complete their training and can obtain full registration with the GMC. At the moment, nothing is decided and the 2-year Foundation programmes remain in place and will continue to offer high quality experience in our Region. What is more concerning is the current outlook on availability of posts following completing of Foundation training. The current position is that jobs will be open to UK, EU and non-EU graduates and the expectation is that the overall ratio of applicants to posts is likely to be 3:1 or higher, particularly in certain specialities. I think that this will improve over the next few years as the Department of Health are consulting on the best way forward and Medical Schools have been expressing their views very strongly about the importance of sufficient training opportunities for U.K graduates. The Mediscope team also commented that the NHS always seemed to be changing and what it was that medical students needed to know. I find this difficult to answer as I am not entirely sure myself of all the changes that are happening. I think that the main thing to be aware of is the major NHS review being conducted by Lord Darzi who, apart from being a Health Minister, is an Aacademic Surgeon based in London. The focus of this is supposed to be listening to patients and Health professionals, but after many years of change, it is difficult not to be sceptical. I think that the proposals are likely to be farreaching and a taste of things to come has been the media coverage on ‘Poly-clinics’ where larger groups of GP’s would work alongside other specialists. Year 5 of our programme has not changed substantially since it was first run in 1998. Although there are many very good aspects to this, which we do not want to lose, the NHS, postgraduate training and education
completion of their training, but 80 students will continue to transfer to us, which, I am sure, is welcomed by everybody. Dominating a lot of talk and creating a lot of negative emotions over the last couple of years has been the reform of postgraduate medical training. The furore and mess over the Medical Training Application Scheme (MTAS) and all of the Modernising Medical Careers (MMC) reforms forced the Government into asking Sir John Tooke (Dean of Peninsula College of Medicine and Dentistry) to chair an independent enquiry. The draft ‘Tooke’ report was subject to intensive consultation before the final report was published. In it, Sir John proposes a large number of radical reforms to postgraduate medical training, which are based around the title and aim of ‘Aspiring for Excellence’. I will not go into details of the proposals as they are still under consideration by the Government and it is not clear, at the time of writing, what will be accepted and acted on. However, it is worth mentioning those proposals concerning the Foundation years. The report argues that Parliamentary statute decrees that basic medical training (undergraduate) is 6 years in length and that medical schools remain responsible for this. However, entry into the current 2-year Foundation programmes are open to applicants from anywhere in the EU. This means that graduates from UK medical schools are not guaranteed an F1 place and thus, in theory, could be prevented from completing their training, which would be a personal disaster and a great cost to the tax-payer. Due to this, the Report suggests uncoupling of Foundation Year 1 from If you do have F2 and beyond and guaranteeing all suggestions t o p ic fo s on which UK medical graduates an F1 place in Professor O r c o u ld ’Nei their local Foundation School. Lotalk then p lease contac ll gistically, this causes greatest prob- subeditor.med t us at iscope@manc lems for the London Schools and also hester.ac
Manchester Medical School
have all moved on in the last 10 years. We want to ensure that our graduates feel well prepared for clinical practice and are familiar with the approaches to education that they will encounter in the Foundation programme. The detailed plans for the major revisions to Year 5 are coming together, with ‘exempting’ assessments in January so that those students who need further support are identified early and can pass their Finals on time in July and other students can focus on clinical practice. All students will be given experience with work-based assessments as well as continuing to build their portfolio. There is a new ‘taster’ block in which students can choose experiences in different specialities for a short time. I know that the management team have plans for keeping people informed and I suggest that it would be good to take any opportunity to hear about the new Year 5. A few things that I have held over to next time are the thinking that has started about a major Year 4 revision, partly due to the large changes that are planned for women’s and children’s health services around Greater Manchester. I might also talk about assessment, including the Progress test and some specific areas such as statistics and critical appraisal…..? It would be good to have a few more suggestions to write about! Professor Paul O’Neill is Head of Manchester Medical School and Deputy Dean of the Faculty of Medical & Human Sciences
National News junior doctors often get no more than a 60 minute presentation on the subject and unlike nurses and pharmacists, doctors are not obliged to pass a test. Adult doses are standardised, however child doses are worked out individually according to weight, age and if they are premature. One study in the US stated that prescription errors were three times more common in children. Guardian 16/01/08
NHS is spending around £200m a year more than it should on medicines, says a report from the public accounts committee. New drugs are protected for up to 20 years before generic manufacturers can make cheap copies, enabling pharmaceutical companies to meet development costs. However companies frequently add small changes to the drug, giving them further protection. Edward Leigh, committee chairman says £850m is spent marketing these products to GPs every year, and is calling for all GPs to declare gifts they receive. Better dementia care is needed, says a Guardian 17/01/08 report by the House of Commons. Despite being on the increase, dementia is Prime Minister Gordon Brown has called not a priority for the NHS. Recognising for GPs to be more accessible in evenings the disease at an early stage greatly and weekends. GPs have been told they improves disease progression. The report must sign up to new working hour highlights a need for early diagnosis, and proposals or face salary cuts. The British improved training for care home workers. Medical Association has advised that this extra demand should be implemented with an increase in doctor numbers. www.bbc.co.uk Alcohol-related deaths could be reduced by up to 29% says the British Medical Association, if tax was increased by 10%. This comes as Tesco admits that the low price of alcohol encourages the British culture of binge drinking. The Doctors need more training in prescribing Government is now undertaking appropriate child doses says a recent legislation to regulate low prices; at the questionnaire. The London University moment some supermarkets are selling school of pharmacy and the Royal College strong larger for just 28p. of Paediatrics and Child Health found that
Don't forget about the old
Nation of boozers
Errors in child drug doses
International News China
Beijing olympics: not looking too healthy International olympic committee warned that pollution levels in the city of Beijing may carry health risks for athletes competing in events that last longer than an hour. As one of the most polluted cities in the world, the committee has advised that some events could be rescheduled if, on the day, pullution levels are found to be especially high. This is a blow to organisers, especially on the last day of events, where they must now consider what to do if air quality is poor for the mens marathon. uk.reuters.com
Dengue fever epidemic could have been prevented So far 60 have died from dengue fever in one of Rio de Janeiro's poorest shanty towns since January, and 60 more deaths are being investigated. Thousands are in need of medical help, but government organised aid tents are a rare sight. The army has now set up a few field hospitals and one judge has ordered authorities to use private hospitals if necessary. Many health professionals say this is a crisis that could have been avoided by better planning and provision of resources. www.bbc.co.uk
Sudan The medical organisation, Medecins Sans Frontières is struggling to keep up with the demand for care in Southern Sudan. The civil war, and tentative peace agreement have encouraged many other aid organisations out of the area, and MSF is now the only organisation providing medical help in many regions. MSF is designed to provide short term service, but with an increase in long term patients, their ability to react to epidemics such as cholera is being sacrificed. At present there is one doctor for every 400,000 people. As a country that rarely receives media attention, this situation is predicted to get worse still. www.msf.org
Issue 2 Apr 2008
Care of the Elderly Jo Corrado I think most medical students would agree that thirty minutes is ample time to take a decent history, and this was exactly the time I had given myself to take what I thought would be an ordinary history from an ordinary patient. However, there was one crucial piece of information I had not considered; the patient in question was 86. From the moment I got the ball rolling with the essential introduction, the conversation didn’t dry up for at least an hour. We spoke about all sorts of things; which were far more interesting than just a bog standard history of presenting complaint. It turned out that the frail little old lady I was talking to was fluent in Spanish, had studied at Oxford and had spent the majority of her life living in Africa! Given that the story I have just described is typical of what happens on a care of the elderly ward, why then do both students and doctors alike hold such low opinions of geriatrics? I personally, have always wanted to specialise in geriatrics as it seems such a diverse field, treating patients from all walks of life suffering from an array of different illnesses. Patients who on the whole are a lot more grateful for the treatment they receive than the younger generation. If only more people would share my point of view. All too often you hear a medical student grumbling that they have been assigned a care of the elderly placement instead of a more ‘exciting’ specialty such as A&E or surgery. Many students presume that elderly patients are either too demented or frail to speak and that they are wasting their time. This is not the case! Elderly patients are only similar in one respect – their age. These patients have such a wealth of knowledge and are only too willing to share it with you. It is not only students who seem to disregard care of the elderly, doctors themselves can be guilty of this. On my first rather daunting visit to theatre, the surgeon struck a conversation which turned to what specialty we thought we would like to end up in. There came the usual chorus of ‘General Practice’ and of course the obligatory ‘perhaps surgery’, out of politeness. Then the surgeon looked at me. In my naivety, I answered confidently ‘Care of the elderly’, an answer which I thought was as good as any. Until everyone in the theatre, surgeons, anaesthetists and nurses alike started laughing. Although I too now look back at that incident and laugh, I feel strongly that we must change our attitudes towards elderly patients. Particularly seeing as our population is growing ever more elderly and therefore the vast majority of our patients will be old not young. Remember, many elderly patients spent a large amount of their lives working long hours in jobs that paid very little. It is high time that we treated them with the kindness and respect they deserve. Jo Corrado is a 4th Year Medical Student
Manchester Medical School
I'll tell you who I am as I sit here so still As I do at your bidding, as I eat at your will. I'm a small child of ten...with a father and mother Brothers and sisters, who love one another A young girl of sixteen, with wings on her feet Dreaming that soon now a lover she'll meet. A bride soon at twenty -- my heart gives a leap Remembering the vows that I promised to keep At twenty-five now, I have young of my own Who need me to provide them a secure happy home. A woman of thirty, my young now growing fast, Bound to each other with ties that should last. At forty, my young sons have grown and are gone But my man's beside me to see I don't mourn. At sixty once more, babies play round my knee Again we know children, my loved one and me
Dark days are upon me, my husband is dead I look at the future and I shudder with dread For my young are all rearing young of their own And I think of the years and the love that I've known. I'm now an old woman...and nature is cruel 'Tis jest to make old people look like a fool. The body, it crumbles, grace and vigor depart There is now a stone where I once had a heart. But inside this old carcass a young girl still dwells And now and again my battered heart swells. I remember the joys I remember the pain And I'm loving and living life over again. I think of the years...all too few, gone too fast And accept the stark fact that nothing can last So open your eyes, people, open and see Not a crabby old woman; look closer..... Author Unknown
PHOTO: www.flickr.com by dalbuio
What do you see, nurses, what do you see? What are you thinking when you're looking at me? A crabby old woman, not very wise Uncertain of habit, with faraway eyes? Who dribbles her food and makes no reply When you say in a loud voice, "I do wish you'd try!" Who seems not to notice the things that you do And forever is losing a stocking or shoe Who, resisting or not, lets you do as you will, With bathing and feeding, and giving me pills. Is that what you're thinking? Is that what you see? Then open your eyes, nurse; you're not looking at me.
When an old lady died in the geriatric ward of a small hospital near Dundee, Scotland, it was felt that she had nothing left of any value. Later, as the nurses were going through her meagre possessions, they found this poem.
Issue 2 Apr 2008
The fifth year elective is an important time for medical students. Sarah Gillingham, explores how she got the most out of hers.
Sarah Gillingham Electives: Getting the Balance Right
feel that one of the most important things that you have to do during your elective is to get the balance right between doing some sort of medicine (you need something to write about in your elective report!) and getting the opportunity to do some travelling. Without sounding too cheesy the travelling you do will teach you far more about yourself, will do wonders for your confidence and will give you some of your best memories of medical school especially if you go on your own. Although being on your own in a foreign country may seem a little daunting, especially if you have not done much travelling previously you’ll surprise yourself at what you’re capable of and what you can achieve. It also has the added bonus that you can do whatever you want to do without having to take into account another person’s interest or more importantly their budget. You will have to force yourself to talk to other people all of the time otherwise you will be lonely but if you’re staying in a ‘backpackers’ there is NEVER any reason to be on your own – unless of course you’re sick of people and just fancy a quiet night – believe me you feel like this at least once whilst your away. Choosing where to go obviously has a big bearing on your experience. I spent my elective at Wairau Hospital, Blenheim, New Zealand. I picked a relatively small hospital for two reasons, firstly you’ll get a lot more opportunities to do things you wouldn’t be able to do in the UK and secondly you don’t get too lost in the system and therefore you will make more friends. I found it also meant they were pretty laid back about time off to travel. Overall I spent about 4 weeks in the hospital split between Orthopaedics and Medicine. It was particularly in Orthopaedics that being in a small hospital paid off as for two weeks I scrubbed in on almost every operation and was often first assist getting to dislocate hips during total arthroplasties, drilling nails into fracture neck of femurs and fishing smashed radial heads out of the remnants of elbows. I also got to do plenty of travelling round the South Island managing to fit in along the way amongst other things white water rafting, horse riding, getting up close and personal with a glacier, a 20-
20 England v New Zealand cricket game and an evening in a Maori village. I sampled a wide array of the alcohol beverages on sale and now consider myself a bit of New Zealand wine connoisseur! I may have got involved in some skinny dipping in Milford Sound (a big lake fed by water from the Antarctic-way too cold – the boys I was with regretted it) and jumped out a cable car with just a piece of elastic attached to my ankles! I made some really good friends, both medics at the hospital and the people I
met along the way. I cannot recommend New Zealand enough, the country is beautiful, the people are friendly, it is impossible to be bored and the wine is fantastic. I would also encourage people to consider a small hospital. Make the most of every opportunity presented to you and to quote the Virgin advert “Life gets a lot more interesting when you say YES!” Sarah Gillingham is a 5th year medical student
Manchester Medical School
Paris L’hôpital Bichat
Madrid Hospital La Paz
Thoracic Surgery, Vascular Surgery, Lung Transplantation.
irstly from my experience you learn a lot of medicine/surgery. Many of the medical words are very similar in French to what they are in English and so you can generally understand what’s going on even if you didn’t know the word beforehand. Most of the doctors speak English anyway so they can probably give you a helping hand when you get stuck. In France they do 3 years preclinical and 3 years clinical. The clinical students have much more responsibility than we do in England. For example, I was the resident on call all day and all night on my third Sunday. Therefore, any vascular/thoracic problems either in A&E or on the ward would come through to me first of all. If I could deal with it then I would, otherwise I would ring the interne who would be at home. This sounds scary, which it is (!) but you learn lots and develop confidence. Therefore, I do think it’s good for learning and developing medical skills. You need to force yourself to speak French as some doctors/students will see you as an opportunity to practise their English. Providing you do this the experience should really help you develop your language skills. I would recommend coming with someone from Manchester. I went by myself and for the first 10 days or so it was fairly lonely in the evenings. The Bichat hospital is really good and has a wide range of specialities. It’s a teaching hospital so they’re generally used to having students around and it’s also good as you get a chance to mix with the french medical students. Overall I would definitely recommend you doing at least one SSC in a country where your language is spoken. If you have any questions or want any information about accommodation/contact details etc then do not hesitate to contact me:
The European Option is hard work: attending lessons after a long day at hospital and maintaining a good level of fluency in a second language whilst keeping on top of medicine can be difficult. However, the pay back for this is that you are able to do Phase 2 SSCs in European cities. Undoubtedly, it is an excellent way to see how another healthcare system works, to develop your skills in the language and at the same time to travel and to see different parts of Europe. What do current students have to say about their time spent doing a European Option SSC?
fter studying Spanish for 10 years and waking up to yet another rainy English sky to go to hospital, I could not wait to organise my own SSC. I had previously fallen in love with Madrid for it’s quirky yet cosmopolitan atmosphere and decided this was where I wanted to spend the last four weeks of my third year. Despite the notorious reputation of Spaniards and their ‘mañana’ lifestyle, organising a placement was relatively easy. I got in touch with a consultant of General Medicine at the Hospital La Paz (part of the Universidad Autónoma de Madrid) who was more than happy to receive a student with whom he could practise his English in return for some teaching. On my first day, I arrived rather apprehensively for the morning ward round but was eagerly awaited by the consultant and his four ‘residentes’. Each of them looked after 3 to 4 patients who were then overseen by the consultant. A typical day was non-stop from 8 am with twice daily ward-rounds, chasing up investigations, going to seminars then finishing at 4 pm. I was frequently given one-to-one teaching and had the opportunity to examine and take histories from patients. Living in Madrid is enjoyable despite the chaos of being a capital. Rented accommodation is plentiful using websites such as loquo.com and there are also a large number of hostels in the city. Travelling was straightforward with a compact city centre and a cheap, well-established metro system. Food is also affordable with plenty of variety and bars and cafes open late into the night giving the city a constantly vibrant atmosphere. Doing a placement in a Spanish hospital gave me the opportunity not only to practice my language skills but to develop my self-confidence. Forward-planning and good communication are always essential to get the most of experiences like this but I found the effort extremely rewarding.
Issue 2 Apr 2008
Prof. Neyses An interview with...
Why did you choose this particular speciality?
I was fascinated by the opportunity of doing ‘manual’ work such as angioplasties in conjunction with helping patients through clinical work and academic research, which had always been a major goal in my professional choices. I love academic research with its intellectual challenges but have always enjoyed combining this with helping patients and doing ‘hands on’ work.
Tom Kelley asks Prof. Neyses a few questions and gets an insight into Cardiology. Interviews with specialists will be a regular feature in Mediscope
What are the pros and cons to working in this speciality? It is tough to combine both research and clinical medicine in an invasive speciality – get prepared for a long week – not to forget the on call nights and weekends even as a senior person. What is a typical week for you? Very varied and colourful – about 25-30 hours clinical work, the rest up to 70-90 hours is research. I travel to meetings etc - about 3 months a year. It is fascinating to get to know intelligent and interesting people around the globe – not to mention that an academic career gives you opportunities to go to other institutions and not get ‘rusty’ in one. Also, it gives you alternatives if your expectations are not met where you are… What advice would you give to a student/junior doctor keen to work in your area? Come and see me if you are interested in an academic career in cardiology – if well planned (as far as one can ‘plan’ a career…) it can be very rewarding intellectually, personally and not to forget – financially. Also, the job prospects in many countries including the UK are excellent for clinical academics – they are far and few between. Where do you see the field in 15 years? Ask a clairvoyant.
Professor Neyses Consultant Cardiologist and Professor of Medicine Manchester Royal Infirmary
Manchester Medical School
asked consultants from various oncology specialities whatâ€™s required
nder the current system of MMC it has become necessary to decide on a career path as early as possible, during the clinical years at medical school even, since swapping as a specialist registrar has been made more difficult than in the past. As a third year medical student I have just completed a vacation job at the Christie Hospital, a centre specialising in the diagnosis and treatment of cancer. Whilst there I decided to circulate a questionnaire to consultant staff with two aims:
were considered most important for particular subspecialites in cancer care. I listed ten personal and ten professional characteristics and asked for these to be prioritised. I obtained responses from 35 consultants in the following subspecialties: clinical oncology (10), haematological oncology (3), medical oncology (6), pathology (5), radiology (6) and surgical oncology (5). The five most frequently chosen personal qualities for the whole group were:
Ever thought of becoming an oncologist? - Common sense (22) For professional characteristics, the five most frequently picked were: - Communication of specialist information to patients and colleagues (28) - Problem-solving skills (24) -Technical skills (surgical or clinical) (24) - Research and Development (22) - Formulation of a management plan for patient care (22)
Certain qualities were given a greater em-Teamwork (picked 30 times) phasis by some subspecialties. - General communication skills (29) 1. To get their views on the attributes - Empathy and a sense of caring or com- 1. Problem-solving skills were chosen required to be a specialist in cancer care. passion (22) most frequently by the radiologists, pa2. To highlight which of these attributes - Ability to manage stress (22) thologists and surgeons. 2 .Clinical oncologists were more likely to pick out the formulation of a management plan for patient care. 3. Technical skills were prioritised by the clinical oncologists, radiologists and surgeons above other subspecialties. 4. The communication of specialist knowledge to patients and colleagues was highlighted by the radiologists. 5. Research and Development was given special emphasis by the medical oncologists. I also sought suggestions for what attributes a good doctor might possess from the Chief Medical Officer, Professor Sir Liam Donaldson. His responses, in terms of personal and professional qualities were: Personal qualities: - Judgement - Integrity - Communication skills Professional characteristics: - Analytical and policy-making skills - Disease prevention - Concepts in behavioural change - Quality improvement With it being important for medical students to try and match their strengths to particular career choices, this short survey provides information on the qualities possessed by medical practitioners in cancer care. Other resources do exist, for example the Medical Specialty Aptitude Test (http://www.meded.virginia.edu/specialties/), to try and provide some insights into the most suitable career pathways for individual medical students. Finbar Slevin is a 3rd year medical student at SMUHT
Issue 2 Apr 2008
Progress Test looming? Try your hand at some progress test-type questions provided by Pastest. You can find the answers on the Pastest facebook group.
1.13 Mark as true the five best matched statements about the menopause: A The current average age of menopause in the US is 51 years B LH levels rise before FSH levels C The ovaries become more resistant to the action of FSH D FSH levels rise before LH levels E Menopausal women are prone to vertebral crush fractures F The risk of myocardial infarction is reduced in menopausal women G Lack of oestrogen leads to osteopenia H Variation in cycle lengths is more common around the time of the menopause I High FSH levels cause hot flushes J Menopausal women rarely complain of dyspareunia 1.16 Which of the following disorders are inherited as an autosomal dominant disorder? A Sickle cell disease B Duchenne muscular dystrophy C Haemophilia D Huntington’s chorea E Cystic fibrosis
2.5 Which of the following are branches of the internal iliac artery? A Inferior epigastric artery B Uterine artery C Ovarian artery D Internal pudendal artery E Inferior mesenteric artery 2.31 Which of the following statements are true for pregnant women who are human immunodeficiency virus positive? A Antiretroviral agents taken during pregnancy increase the risk of fetal abnormality B Antiretroviral agents taken during pregnancy reduce the risk of vertical transmission from 45% to 23% C Breast feeding should be encouraged D Breast feeding should be discouraged E Antiretroviral agents taken during pregnancy reduce the risk of vertical transmission from 25% to 8% 2.35 The risk of premature delivery is increased by A urinary tract infection B obesity C essential hypertension D smoking E anorexia
2.40 Concerning menorrhagia A blood loss exceeds 80 ml per menstrual cycle B female sterilisation is a recognised cause of menorrhagia C thyroid disease is a recognised cause of menorrhagia D systemic coagulation disorders are a recognised cause of menorrhagia E blood loss exceeds 60 ml per menstrual cycle 2.45 Which of the following statements are true about cervical squamocarcinoma? A It is associated with human papilloma virus B Stage I disease is treated with intracavity radiotherapy C The primary treatment for stage III disease is chemotherapy D The primary treatment for stage III disease is radiotherapy E It is associated with herpes simplex virus 3.1 Concerning the pelvis A the transverse diameter of the pelvis averages 13 cm B the longest axis of the pelvis rotates through 120º from top to bottom C it is made up of three bones – two iliac bones and the sacrum
D the levator ani and the coccygeus muscle form the pelvic diaphragm E the outlet of the pelvis has equal antero-posterior and transverse diameters 3.3 Which of the following statements are true? A Oestrogens increase the vaginal pH by the action of Doderlein’s bacillus on glycogen B Progesterone increases the growth of the myometrium in pregnancy C Progesterone increases the motility of the fallopian tubes D Oestrogens increase the contractility of the myometrium E Oestrogen reduces the viscosity of cervical mucus 3.7 Which of the following statements are true? A The umbilical cord contains two veins and one artery B The fetal surface of the placenta is covered by the chorion C Amniotic fluid arises from the amniotic membrane and fetal urine D Maternal blood flow to the uterus is 100–150 ml/kg/min in late pregnancy E Oxygenated blood is carried directly into the left side of the fetal heart via the ductus arteriosus
This voucher entitles students at Manchester Medical School to 20% off all PasTest books. To see the full range of PasTest books visit www.pastest.co.uk. To qualify for your 20% discount enter this code 113582ADQN at the checkout. Your may also telephone 12
Manchester Medical School
progress test tips Tom
The editors share the ways they get through the Progress Test W e wa n your t to hear p surviv rogress tes t al tip Send s . them to:
Learn work as you go throughout the year. Go for breadth not depth. Learn the common things first, rare syndromes if you've got time. (Actually Tom's first response was 'know everything'. We all laughed until we realised he was serious) Rohini Questions, questions and more questions. Jessie Revise with someone in a different year to you. Start making a list of words synonymous with a specific condition. eg cannonball mets = lung metastases from renal cell carcinoma. James There is only ever ONE correct answer. There are no answers you can give that are deemed so terrible and incompetent that you are “flagged up” as risky. Do the “cover-up test”: obscure the answers with your library card and read the question properly. Try to get a feel for the sort of answers you are likely to uncover when you remove your library card. If you have an answer before you uncover, remove your card, and if its there, go with it, you’ll probably be right. There are NO red herrings ie all possible answers are real medical terms, diseases etc. There are NO trick questions, if you think you've found one, read it again. Anna Intercalate so that you don’t have to do it for a year. Websites with questions www.oneexamination.com You have to pay for this one. It's designed for 5th year finals, and compares you to other people taking the test (if you want) www.clinicaltutor.com You can build your own set of questions, and chose how many you want in the test. This has a large number of topics and again, you can compare your score if you want. www.fleshandbones.co.uk www.scrubbingup.com www.learning.bmj.com
Issue 2 Apr 2008
1. Introduce yourself
2. Obtain consent
“Hello my name is <include surname>, I’m a third year student doctor.”
“Would it be okay if I examined your tummy today? It shouldn’t be too painful, and will just involve me pressing on your stomach. Am I okay to go ahead? Do you have any pain anywhere?”
3. Wash hands, check na and DOB, position patient with one pillow for suppo arms by sides, expose pati to pubic symphysis.
10. Mouth Glossitis (sore, smooth tongue) Angular stomatitis – iron deficiency anaemia Swollen, red, “beefy” tongue – vit B12 def anaemia – ?malabsorption, Crohns Buccal mucosal a. Apthous ulcers – Crohns b. Pigmentation – Addison’s disease
11. Lymph nodes “At this point in my examination, I would examine the cervical lymph nodes. Within this, I would pay particular attention to Virchow’s node (Left supraclavicular node – gastric malignancy)”
12. Inspection of abdomen
9. Eyes “Could you look up for me, and down, there doesn’t appear to be any anaemia or jaundice present. There are no Kayser-Fleischer rings.” Yellowing of sclera Pallor of conjunctiva Kayser-Fleischer rings – Wilson’s disease
osce poster one
Symmetrical? Ask patient to take a deep breath, comment on any obvious masses or discomfort Ask patient to cough and look for any hernias, if masses present do they move with contraction of the stomach muscles Distension? – 5 F’s Fat | Fluid | Faeces | Flatus | Foetus | Flipping large tumour Visible peristalsis? – Intestinal obstruction Comment on any scars – length, position, recent, old, what for? Can ask patient – “Have you had any operations on your tummy before?” Striae? Stigmata of liver disease: a. Spider naevi (>5 is abnormal, women may have more if oestrogen therapy or pregnant) b. Gynaecomastia c. Caput medusae – portal hypertension d. Purpura, bruising e. Jaundice Bruising a. Around umbilicus – Cullen’s sign – pancreatitis b. Flanks – Grey-Turner’s sign – severe acute pancreatitis, abdo trauma, ruptured AAA
How to do an...
“Do you have any painful areas in your abdomen? warm and I’ll be as gentle as possible.” Squat at side of bed. Begin light palpation, looking into patient’s ey Continue with deep palpation still looking into Feeling for masses, guarding, tenderness, rebo Liver – normal liver span is less than 13 cm – s ly up to R hypochondrium Spleen – move hand from RIF to L hypochond gin, reach hand to posterior aspect of L ribs, fe Kidneys – use posterior hand to bounce kidne a. Unilateral enlargement – cancer b. Bilateral – polycystic kidneys c. Tenderness – stones, pyelonephritis
14 Checked by Dr Mark Holland, Consultant in MAU at SMUHT
Manchester Medical School
4. General inspection
stand at foot of bed and check: Any medications, IV drips, commode, urinary catheter, stoma bag Well? Cachexic? Comfortable lying flat? Alert? Shocked? In pain? Posturing? a. Lying rigidly still with shallow respiration – peritonitis b. Doubled up in pain – biliary colic, pancreatitis
look at both sides Temperature of peripheries – warm, clammy – thyrotoxicosis; cold – shock Clubbing (IBD, Coeliacs, liver cirrhosis, primary biliary cirrhosis) Leuconychia – whiteness of the nail bed in hypoalbuminaemia (chronic liver disease, malnutrition, protein losing enteropathy) Koilonychia – spoon shaping of the nails (Fe def anaemia, blood loss) Jaundice (bilirubin seen in skin at levels at or above 36umol/L) Palmar erythema – liver disease Dupuytrens contracture – thickening of the palmar fascia usually affecting the ring finger (liver disease) Pallor of palmar skin creases – Fe def anaemia Liver flap – hepatic encephalopathy
General appearance of face
“I’m feeling the warmth and sweatiness of the palms. There are no signs of finger clubbing, leuconychia or koilonychia. There is no palmar erythema, Dupuytren’s contracture, anaemia or jaundice. Could you hold your arms out for me please and cock your wrists, thank you, there is no liver flap present.”
Pallor – anaemia Increased pigmentation – Addison’s Moon face – Cushingoid Frank jaundice?
ame flat ort, ient
7. Take the Blood Pressure “At this point in my examination, I would like to record the BP.”
17. Cover and thank the patient “To complete my examination, I would examine the hernial orifices and external genitalia, perform a PR. I would dipstick the urine for glucose, protein and blood.”
use diaphragm R umbilicus – up to 3 minutes for bowel sounds Above umbilicus – aortic bruit (atheroma or aneurysm) 3 fingers above and lateral to umbilicus – renal artery bruits Liver – hepatic bruits – acute alcoholic hepatitis / friction rub – perihepatitis
15. Fluid thrill “If I thought that ascites was obviously present, I would try and elicit a fluid thrill.”
yes o patient’s eyes ound tenderness, board-like rigidity start in RIF, move hand progressive-
y Anna Williams & Vanessa Clay
“The pulse is regular at 68 beats per minute and of normal character and volume.”
? Okay that’s great, my hands are
drium, when reach L subcostal mareel spleen anteriorly eys into the anterior hand to assess
6. Take the radial pulse
14. Percussion usually resonant due to gas content of colon All 9 areas Liver – RIF upwards – dull at costal margin, from top downwards – dull at 5th intercostal space (level of nipple) Spleen Bladder – umbilicus downwards (dull +/- tender = urinary retention) Shifting dullness – percuss from umbilicus to LIF, at point where note changes from resonant to dull leave you finger. Roll patient on to LHS and wait 10 seconds. Percuss again. If fluid present, will be resonant not dull Poster design and layout by James Anderson 15
Issue 2 Apr 2008
commentscope Access Denied
ome of the most desperate and vulnerable people in this country are about to lose the right to all NHS treatment. The government is currently considering proposals to strip those judged not to be ‘lawfully resident’ in the UK of the right to access their GP free of charge having already deprived them of that right in NHS hospitals. The stated aim of this being to “ ensure that living illegally becomes ever more uncomfortable and constrained until they leave or are removed”. The people who are going to be affected by this include failed asylum seekers, undocumented migrants and trafficked people. These are people who have no right to remain in the country and should most certainly be removed through the correct legal channels. However, this is not about the rights and wrongs of immigration - this is about the methods used by the government to deal with the problem. The method being proposed is nothing short of breathtaking barbarism – to enlist illness and disease as a crutch for a failed immigration policy is morally indefensible. To abuse the NHS in such a way as to induce ill-health utterly ignores the first core principal of our health system. “The NHS will provide a universal service for all based on clinical need, not ability to pay. Healthcare is a basic human right. Unlike private systems, the NHS will not exclude people because of their health status or ability to pay.” By our own admission we are denying people that basic human right to healthcare – we are turning away some of the most vulnerable people in our society to suffer and in some cases die. Perhaps the most repugnant aspect of these proposals is they make no distinction between the age of the person being denied treatment. That means that a family with a sick child could be forced to make a choice between the health of their child or whether to return back to their, often highly dangerous, home country. Using sickness as a stick to beat people out of this country is simply outrageous. Such a policy, if implemented, would turn doctors and nurses into immigration officers. The primary duty of a health worker is to the care of their patient and yet this suggests that they first check immigration status – they would be forced to make up for home office failings by utterly disregarding their professional ethics. The government has tried to justify this legislation by invoking the concept of ‘health tourism’, claiming people come into the country with the sole aim of abusing our free health system. It is astonishing
“We are denying people that basic human right to healthcare”
therefore that the government is utterly unable to provide any statistics or firm evidence to show that this is a significant problem. Unsubstantiated fear mongering can never be grounds to deny people healthcare. In fact this could end up costing the NHS more; under the proposals A&E care would still be universally free at the point of use but if you deny people access to their GP then their illness will inevitably progress to the point where they literally have no choice but to go to A&E. An ambulance journey plus an A&E consultation costs the NHS around £450, which dwarfs a £20 GP appointment. Diseases such as tuberculosis or HIV may be missed because a person feels they cannot afford the cost of a GP consultation and so won’t go when they start getting symptoms – this could lead to a public health disaster. It is important to understand that this is not about immigration, if someone has been fairly judged to have no legal right to remain in this country then of course they should be removed. This is beyond question. The problem arises when the government starts to use brutal and unnecessary methods to enforce the law. Rather than improving existing immigration services, this government is considering mutilating the founding principals of our NHS. Rather than improving our border control, this government is considering abusing people’s human rights until they’re forced to leave. As future NHS workers it is our responsibility to ensure that patients are put before politics and that we do not allow our health system to be perverted by politicians. Justin Healy is a 3rd Year Medical Student
Manchester Medical School
So Why Bother? Louise Olson
PHOTO: www.flickr.com by CXK
he National Institute for Health and Clinical Excellence (NICE) has advised the NHS that drugs used to treat moderate and late stage Alzheimer’s disease are not to be distributed to those patients suffering from mild symptoms. The NHS will not pay this mere £2.50 per day for these sufferers but will prescribe methadone quite freely to heroin addicts. Is this fair when treatment with methadone costs as much as £8.22 per day? This question is highly debatable and is a view held by many. A Home Office official stated in 1982 that “addicts have no rights simply because they are addicts.” Heroin use is self inflicted, not an illness, so why should £3000 per year, on medication alone, be spent on these people? Wouldn’t money be better spent developing medicines for terminally ill patients or attempting to solve the ‘postcode lottery’ which exists for many of our so-called wonder drugs? To fund their £12,000 annual habit, UK heroin addicts commit roughly 432 crimes each year. Disturbingly, 60% of crime in the UK could be drug-fuelled and as such it could be argued that addiction parallels illegal activity; thus these criminals should be punished, not assisted. Shouldn’t we just lock them up and throw away the key? As easy as it is to criticize the management of those who have been unfortunate enough to become addicted to this opiate, choose to support heroin rehabilitation. Apgovernments proximately 300,000 British, 900,000 American and 385,000 Australian heroin dependents are “a devastating reality,” to state a few figures.
In a National Health Service that seems persistently strapped for cash, Louise Olsen explores the controversial topic of heroin addiction and how it is managed by the NHS.
Methadone treatment economically beneficial. Drug related crime has decreased by 20% since 2003 and more than 1900 drug-misusing offenders enter treatment each month through government led UK ‘Drug Intervention Programmes.’ For every £1 spent on treatment, £9.50 is estimated to be saved in criminal justice and health costs, which is the equivalent to a massive £78.09 saving per day per patient. Over 70% of heroin addicts registered on methadone programmes in America have reduced or eliminated criminal activity in their first year of treatment. These effects have a major impact not only financially for the individual and governments, but also assist in getting a life back on track with improved personal relationships, employment and social status. Families and friends also benefit from treatment as they have suffered the addict’s use. For over 30 years methadone has been regarded as the gold standard therapy used to treat opioid addiction. Yet critics view MMT as “substituting one drug for another.” Methadone also has a greater addictive potential than heroin and if treatment is withdrawn, over 80% patients will relapse to heroin use within one year of terminating the treatment. So why bother? Methahave different properties. Methadone aims done and heroin to treat the addiction motivated behaviour and cravings experienced by heroin addicts and can allow the individual to lead a ‘normal’ life. 6,11Since 2001, an expensive alternative to methadone, buprenorphine, has been offered. Decisions of whether to prescribe methadone or buprenorphine are made on an individual basis. Controversially, heroin itself could be the best detoxification method and is currently undergoing trials within the NHS. Careful monitoring would reduce effects associated with impure heroin and dirty practices. Why not complement current needle exchange centres with heroin distribution? Apart from creating glorified drug dealers out of our health services, heroin costs an enormous £12,000 per year per person as opposed to the £3000 for methadone.. In addition methadone is administered orally, therefore relatively safe as opposed to smoking or injecting heroin. MMT programmes allow monitoring of family relationships, including quality of parenting and domestic violence. Also, by offering comprehensive advice and testing for hepatitis C, HIV and sexually transmitted diseases, the prevalence of these conditions are likely to decrease. Social support networks and counselling can assist with personal difficulties. Therefore, by governments funding the treatment for heroin addiction a whole array of problems can be addressed. However, society’s perception of any addiction still remains prominent, that addiction is a preventable, immoral behaviour. The stigma surrounding heroin addiction will seemingly never be overlooked by some, creating this debate around the world as to whether health services should finance rehabilitation. Nevertheless, a practising doctor must remove all prejudices and treat patients in the same manner. Smokers, the severely obese and alcoholics all have self inflicted conditions. Are heroin users any less deserving? Any decision on rationing healthcare and prioritisation of commissioning different areas of the health service is difficult but it needs to be made objectively and without prejudice. However, whatever individual feelings we hold it cannot be ignored that there are overwhelming financial and social gains to be had from treating heroin addiction. Louise Olson is a 3rd Year Medical Student
Issue 2 Apr 2008
Sharing the Wealth Daniel Bye
From anaesthetic machines to theatre apparatus, millions of pounds of equipment rendered redundant under UK regulations are failing to be redistributed to areas worldwide in desperate need of them. This is despite the attempts of different charities who have tried to salvage such equipment through negotiations with hospital management teams.
For more informati on campaign and how t about this o donate and any o ma t www.m-i-s her questions plea terials -t.org or se visit: daniel.bye @student.m contact anchester .ac.uk
erfectly safe, functional equipment is collecting dust because it fails to sell at the commercial value set by the trusts asset register; others are sold at auctions to buyers like vets or scrap merchants. This equipment could otherwise be used to save lives in field hospitals and medical centres in disaster areas around the world. Shockingly, it is not due to excessive demands placed upon the hospitals that impede the process; external charities offer to help channel these resources thus reducing the hospitals workload to the simple authorisation of the move. The charity M-i-S-T (Mobile International Surgical Teams) set up by a Clinical Director of Orthopaedics, Mr Khan, works with doctors and nurses committed to investing what available time they have to working in humanitarian crisis regions worldwide. In rotating teams of twenty, M-i-S-T provides lifesaving emergency medical aid and what hospital equipment they can obtain despite the bureaucracy of hospital policy impeding the charity’s attempts. M-i-S-T have a working partnership with MSF and The Red Cross, this, and their concept of rotating teams provides continuity of care to ensure rehabilitation as well as life saving measures. Having worked, and being in the process of setting up medical centres, in Pakistan, Indonesia, Peru, Sudan and Malawi, M-i-S-T is a charity dedicated to salvaging resources that save lives. What is evidently a legitimate non-governmental organisation is refused unwanted hospital equipment by hospital administration involved in procurement and selling; this refusal is based on the grounds that there is potential for equipment to be sold privately on the black markets of foreign countries. This argument is maintained despite the apparatus being in the hands of medical professionals of a registered charity who are willing to sign any waver accepting responsibility in this event. They, further, refuse to place this equipment in the hands of anyone apart from renowned and respected charities and medical institutions. Mr Khan comments, ‘even foreign governments are not involved because of the risk of corruption that would prevent the equipment getting to the people who really need it.’ The whole point of Foundation Hospitals is to decentralise government regulation and put the decisions in the hospitals’ own hands including the future of redundant equipment. Thus it seems that the only people preventing the authorisation are the managerial staff who refuse to entertain the idea. The consequence is that we are only able to salvage roughly 20% of unwanted equipment which we fight tooth and nail for while the other 80% is lost, a travesty which ends simply in lives being lost’, Mr Khan added. While each hospital policy varies the vast majority impose similar regulations, and it is up to a national campaign hopefully with the support of Medsin to prevent this.
Manchester Medical School
Sarah Wright, Fin Slevin, Yusrah Shweikh Interested in Expedition Medicine?
skills to the test. Arriving back to camp in one piece (just) and caked in a kilo of mud we sat down to a quiz where we were able to prove that Manchester is indeed the best medical school. The weekend was organised by the BirOnce upon a time (February 2008) ten mingham Wilderness Medical Society. It intrepid explorers (medical students) set was also accredited by the Royal College out for the adventure of a lifetime (a of Surgeons; as proven by our certificate; weekend). They set foot where no man a handy little filler for the portfolio. The had been before; the most dangerous certificate however did not come easily terrain known to man (the Lake District); we had to sit an exam to prove that we where their medical, navigational and had learnt at least 50% of what we were drinking skills were tested to the limits. taught over the weekend. Manchester The busy schedule started early on Sat- Wilderness Medical Society is planning urday morning with training in map and its own weekend away in the near future. compass work; essential skills to the inCertain specialities lend themselves to trepid explorer without a nifty GPS. We expedition medicine for example, the each took turns in navigating the group to trauma and triage skills of A&E, the a given point on the map. Some people broad knowledge gained in General Pracproved better at this than others but luck- tice and a rotation in surgery. Yet so ily we always had our mountain guide on much more than just medical skills are hand to get us back on the right track. necessary to break into this field of mediWe were taught how to manage and cine. All members of an expedition team treat medical problems seen in the wilder- have a hand in navigation, driving, setting ness such as trauma, hypothermia and up camp and cooking. Physical fitness is sun stroke. We are now able to splint bro- also an obvious must. ken legs, improvise a stretcher and stabilise cervical spine injuries. Long after the sun had cebook group; ed join the fa ety 2007 or st re te in set we headed off into the e ar If you ne Soci lderness Medici fells with only our comnchester.ac.uk Manchester Wi ma t. en vin@stud le .s ar passes and the stars to nb fi l emai guide us. This put our newly acquired navigational Thou shalt 1. Join the Manchester Wilderness Medics society 2. Improve/maintain thy physical fitness 3. Learn how to cook (if being a student hasnâ€™t forced you to already) 4. Learn basic rope skills 5. Learn navigational skills 6. Be trained in driving off road 4 x 4s and minibuses 7. Join the Royal Geographical Society 8. Strive for national governing body qualifications 9. Obtain experience in disciplines such as A&E, general practice and surgery 10. Never accept a mere 10% discount in return for your multitude of wondrous skills. At the very least, demand a free trip and preferably a tidy sum of cash!
The 10 Commandments of becoming an
Find out about medic societies and charities both new and old on these pages
Manchesterâ€™s Medical Student Charity Manchester Medical Student Charity hit the ground running four years ago. The brainchild of Dr Cotter, hospital dean at Manchester Royal Infirmary, MSC started as a small local project, aiming to encourage MRI medical students to arrange fundraisers for local charities. A successful first few years has seen the charity expand to incorporate students from all base hospitals. Committee members meet weekly to brainstorm and organise a variety of social, sporting and academic fundraisers. Past events include curry nights, five-aside football tournaments and OSCE revision sessions. Each year, a different local charity is chosen to receive the proceeds from the various events arranged, with a grand total being handed over at the end of the year. Charities supported in the past include Francis House Children's Hospice and the New Children's Hospital Appeal, with ever increasing amounts being raised. This year, our chosen charity is Manchester Kids, a charity that supports voluntary projects working with disadvantaged children locally. With a bit of hard work and lots of support we're well on our way to reaching last year's grand total of ÂŁ2,300. Weekly meetings at Trof are a relaxed affair, generally starting with a catch up over hot chocolate and cake before discussing any business. All suggestions for possible events are welcomed, so people have the opportunity to organise activities of particular interest to them, or events that may be overlooked in everyday university life. Being involved with the charity provides plenty of opportunity: there are people to meet, a chance to organise some alternative events whilst simultaneously doing some good, for both other people, and your CV! Upcoming events include another five-a-side football tournament, more of those infamous OSCE revision sessions and some more social events.
Interested in getting involved? Come along to meetings, or get more information by emailing firstname.lastname@example.org or visiting the facebook group
Issue 2 Apr 2008
Gone were the lined red silk chairs. Gone were the dramatic, sophisticated curtains to close the end of each act. Gone was the fresh, crisp appearance of a prestigious stage standing proudly out from the audience. Instead, a lowly dark hall, the scent of alcohol engrained into the dark and somewhat interestingly stained floorboards, coupled with a strange feeling of déjà vu…Friday night. First Year. OP bar. The Bop. Good idea at the time. This year the medics’ pantomime dug up its roots and headed towards the OP Main Hall, it did not seem the obvious location for the December production. However, housing a room full of rowdy, intoxicated medical students had clearly taken its toll on the theatres of Manchester; none of them would take us back! That’s right, ‘The Medics’ Pantomine’ has now become so notorious that establishing its venue was almost as taxing as producing the production itself. Ok – so one year the director was rushed off to hospital after downing a bottle of gin, and one year we managed to set off fire alarms with over enthusiastic smoke machines….and maybe every year the stage is left lined with boggy layers of trodden, rotting vegetables and chicken produce but come on…we can’t be that bad? Luckily, Owen’s Park is more than used to the species that is, ‘The Student.” They opened their arms to ‘Jack and his Beanstalk’ and even encouraged its drinking behaviour. Once installed with over £15 000 worth of sound and lighting (a nice little upgrade of the school hallesque style location) it actually looked,
for Manchester Rape Crisis whilst having a great time along the way. and sounded, worthy of housing our 2007 Let’s hope that next year’s team can do even better… musical extravaganza.
2007 Pantomime Review
For this year, it certainly was an extravaganza. With full live band in tow, the pantomime raised the bar. It offered more singing-dancing combinations than ever before (with clever and original lyrics), a familiarly faced musical beanstalk and the most original script yet. The larger than life characters were also of essence to the success of Jack and his Beanstalk 2007. Notably, the stylishly singing janitors, the overly excited Hugh Heffner, the scantily clad and ditzy Bunny Girls, the (not so) scouse Likely Lads of Liverpool, the sexy transvestite ‘Boobs’ and let’s not forget the Heads of the Medical School, the (particularly short) Giant and (the somewhat familiar) Professor Monday. More importantly it was obvious that the cast were having the time of their life. Every inhibition had fled (especially that of the Rugby Captain with his annual naked pantomime appearance.) Even the quietest members of PBL were up on stage dancing away to “Baby Got Back!” They do say that the best Doctors are well rounded individuals. The Medics Pantomime is a fantastic yearly tradition. It brings the 5 years together, gives a great sense of camaraderie amongst fellow students and be a drinker or not, guarantees a high level of fun. This year the teamwork was admirable and the audience clearly felt the energy from the cast. I thank everyone who participated and supported the Medics’ Pantomime this year. We raised over a thousand pounds
Jenna Burton was the director of “Jack and his Beanstalk” in 2007
Manchester Medical School
ing surgeon, but for all Manchester medical students from the first to the fifth year who have not made any definitive career decisions. I, for one, fall into this category and we expect many of you do – particularly those towards the junior end of the medical school. Our aim is that by the end of 2008, through attending some of our organized and affiliated events, we will have helped you make an informed decision about whether or not you are a future surgeon. For the surgical enthusiasts, we hope to provide an appreciation of the range of surgical specialities on offer including those remote from the medical curriculum, and what to do , as an undergraduate and beyond, to build an irresistible CV for that job you’ve always wanted. We hope that over the course of 2008, you find our events and activities informative, entertaining and perhaps even inspiring – and that by the end of the year you are closer to deciding what you want to do with your well deserved medical degrees. Imran Yusuf is Vice President of Scalpel
PHOTO: www.flickr.com by aesop
affiliated events, including those orhis year, 2008, is expected ganized by the Royal College of Surto be the most competitive year on record for Specialist geons in London and Edinburgh. We have integrated an online forum for Training (ST) posts in the all medical students to ask questions, NHS with an anticipated provide feedback, and to discuss any23,000 applicants for 9,000 jobs. Although new immigration rules com- thing from the trivial to the imperaing into effect in 2009 will reduce the tive. Over the course of 2008, we intend to collate the experiences of number of applicants from outside surgeons from across the specialties the EU by around 4,000, the general restructuring of postgraduate training in our careers sections, and build revicoupled with the growth of UK medi- sion resources to help you to pass the cal schools will ensure that ST train- surgical elements of the progress tests and OSCEs. Senior ing posts - essential medical students are for all aspiring GPs, y an If you have would like currently reviewing medics and sursuggestions, or e on any their own experiences geons - will prove ur to hear a lect more competitive or by any to advise you on how c pi to al to get the most out of for our generation of surgic please do not surgeon, at your surgical placemedical graduates te to email us ta si he k u ments and where to than previous ones. c. email@example.com travel for the better As Kaivan Khavandi scalpe ill organize it and we w surgical electives. alluded to in the last Confirmed Scalpel issue of Mediscope, events in 2008 include lectures on the UK’s postgraduate training sysplastic surgery and burns managetem expects a definitive career deciment, ophthalmic surgery, and emersion during foundation training so gency medicine, although we that appropriate ST posts can be sought to train junior doctors to con- anticipate more. In addition, we are sultancy. However, given the nature organising a series of evening lectures of the competition for these jobs, it is on clinical anatomy, revolving around becoming increasingly important for the more popular topics in undergradmedical students to focus their career uate examinations. aspirations at the undergraduate level In April we will be organizing a trip to the Bodyworlds exhibition at the so that intercalated degrees, original research, clinical audits etc can be tai- Museum of Science and Industry, and lored to a selected field – and thereby later in the year to the Royal College increase the relevance, and therefore of Surgeons in London. In June we are hosting an all day trauma event the ultimate value, of these achieverun by a team of senior medical and ments. surgical staff in Preston with a series In response to the increasing pressure on medical students and record- of lectures and practical demonstrations on trauma management. Suturbreaking postgraduate competition, Scalpel, Manchester’s undergraduate ing workshops with Dr Hilary surgical society, anticipates 2008 to be Elsworth and other plastic surgeons at The Christie Hospital will continue as its most active year to date – to help all of you to be aware of, and to begin we expand the programme to accomto prepare for the larger hurdles that modate more students. There will be ongoing essay competitions throughexist beyond the finishing line of out the year for both pre-clinical and medical school. In March 2008, Scalpel launched its clinical students with prestige and prizes to be won. Finally, at the end new website at www.scalpelmanchester.co.uk. We of the year, we will be hosting an anhope that over the course of the year nual dinner with a high profile guest and beyond, it will serve as the inter- speaker from the surgical world. We don’t intend for Scalpel to only face that informs all Manchester be a society for the committed aspirmedical students of our hosted and
Issue 2 Apr 2008
The G-Project is set to run again next year, with plans already in place to help more students get involved. Students interested in getting involved should check out www.myspace.com/g_project07 and can contact the team at firstname.lastname@example.org
Making a Before
yakiti, a town in the Eastern Region of Ghana, was the location for a health and education project organised this year by a group of fourth years. Working with other students from Birmingham and Ghana, the team raised funds to renovate the local school and organised a weeklong programme of events, including a sports-day, a series of lessons on health and environmental issues and screening clinics for diabetes and hypertension.
The scheme, aptly named GProject, was the brain-child of Naomi Adjepong, who was originally born in Ghana and studies medicine in Manchester. Other team-members included Martha Brown, Jessica Coughlan and Jodi Lestner as well as many students who helped to raise money with a series of fundraising events. Naomi, speaking at the local Ghanaian festivities said, â€œThis year has been a real success for the project, but this is only the beginning and we want to make a real, permanent difference to this community.â€?
Manchester Medical School
lifescope Christopher Ashley
n the event of a sudden cardiac arrest, every second counts. Defibrillation of the heart must happen quickly as with every minute that passes the chance of survival decreases by 14 per cent. The solution is the automated external defibrillator (AEDs). AEDs are small machines in public areas, which improve cardiac arrest survival rates dramatically. Seattle in America is famed not only as the setting for Grey’s Anatomy, but as the leading city in its AED and CPR program. It was the first to have AEDs in all police cars, and its CPR programme has trained an incredible 771,000 people. I was inspired by Seattle achievements and I felt that if it’s good enough for America, then it’s good enough for the UK. Four years ago, I launched the CPR and AED save lives campaign in Stockport. My campaign aimed to promote the teaching of CPR to the public, raise awareness, and have more AED’s located around the town. The campaign started with a petition of 370 signatures that I presented in the council chamber at Stockport Town Hall. I met many local councillors, MPs and worked closely with Stockport Primary Care Trust. I met the manufacturers of AEDs and promoted the campaign through media sources including newspapers, radio and television. As a result of the publicity, I was later elected as the youth MP for Stockport in 2004.
The campaign was a fantastic success. Funding was secured to install AEDs in the Stockport area and there were free CPR training sessions for everyone. I was also invited on to the Stockport Heartstart group, overseeing the funding and organisation of public services and initiatives. In the future, I’d like to see AEDs as common as first aid boxes and fire extinguishers. It would also be good to have more people learning CPR so that everyone knows how to deal with a cardiac arrest situation. Christopher Ashley is 2nd Year medical student
For anymore information , contact Chris at: christopher.j.ashley@studen t.manchester.ac.uk
Issue 2 Apr 2008
I am not exaggerating when I say that Dr. Crutchley’s text book “Medicine for Medical Students” made up a significant part of my revision in the weeks leading up to the exam. It helped me cover a great swathe of medical knowledge quickly, easily and logically so that significant knowledge-holes could be swiftly identified and fixed. Due to its trimmed, simple nature, I was only covering areas that would almost certainly prove useful – that all-important core knowledge – and I was remembering it. My progress test mark leaped back up to satisfactory. This book is not for everyone but most medical students will find it an invaluable resource in their revision armoury. Moreover, I would argue that it is unique in its position as an accessible means of revising usefully for the Progress Test, something I know many find impossible.
Medicine for Medical Students
Dr. Marc Crutchley has attempted something quite interesting with Medicine for Medical Students, something quite interesting indeed. On reading the front cover, a stressed medical student cannot help but be tantalised by the tagline “The complete guide to both OSCE and written exams”, a feeling further bolstered by the book’s unintimidating thickness and weight. Could something so relatively short and light be so complete? Its stark black and white cover screams simplicity, hinting at an author who might just have the refreshing and straight-to-the-point approach medical students crave from revision material. At first glance, it does not appear to be your average revision text, sticking as it does to one font and one colour, and very few diagrams. In fact, one could be forgiven for thinking that this was merely a set of printed, personal notes with an ISBN number on the back. However, on deeper inspection, it becomes clear that considerable thought has been given to the content and layout. Dr. Crutchley has made every effort to trim down what is a huge amount of information into bite sized chunks of hearty medical knowledge, without losing those really vital parts. A masterstroke is his division of topics into the three areas History, Examination and Revision, making targeted reviewing of each of these areas for specific exams easy and useful. Most chapters of the book can be read properly in 30 minutes to an hour, making breaks painless and practical to take, and re-reads less daunting. The danger with textbooks such as these, is that the stressed medical student sees it as a substitute for any kind of real work, renouncing all other resources. I would warn that this book is no substitute for involved study and it would be quite confusing if the topic was new. As a reminder of a topic that has been covered thoroughly before , it is invaluable, particularly with a view to examinations. OSCEs and the Progress Test are the bane of most Manchester medical students. I am sure, like me, you have often thought there is so much to remember and so little time. How do you get all those notes, lectures, books and handouts to stay in your head? Well, usually, you don’t, and you go in to the exams with what you think you need to know. Sometimes this works, and sometimes it doesn’t. Last year, for instance, it didn’t work for me – I didn’t quite know what I needed to know and scored a gut-wrenching, heart-rending unsatisfactory grade in
James Anderson is a 4th Year Medical the summer progress test. I was disStudent and a co-editor of Mediscope traught, and I was unable to fathom what exactly went awry. For this Visit www.them year’s winter Progress Test, I had to edicalstudent.co find out how to get a copy m to get back into that comfortable satisor contact Dr. Ma rc Crutchley factory zone, and in order to do that directly at info@theme dicalstudent.com I needed to know what I needed to know.
OSCES for Finals Vol. 1 This is a DVD that includes demonstrations along with detailed explanation of the following skills: Male catheterisation Nasogastric tube insertion Inhaler technique Abdominal examination Abbreviated mental state exam Respiratory examination Chest pain history Cranial nerve examination Confidentiality, Personal and professional development New Oral Contraceptive Pill Teach It is specifically produced for OSCEs and so it guides you through each of these skills in a step wise manner, illustrating all of the necessary points that you must include in an OSCE station. It also gives you examples of potential questions that an examiner might ask at each stage of the exam – the answers are also included. A written booklet has also been produced with the DVD, providing written documentation on each skill. It is produced by a number of senior doctors including a Consultant Obstetrician and Gynaecologist and a Consultant Respiratory Physician. I think it’s an excellent way to watch these skills being performed in a “perfect” way. Although we should know how to perform such skills, when you watch this DVD there will undoubtedly be extra points that you will pick up – once you know the way to perform a skill and have done it a few times I think watching it done by an expert is a good way to learn and indeed to remember how to perfect the skill.
or in purchasing this If you’re interested sit vi em other titles then al.co.uk or email th ic ed em ar qu ns to al www.d .uk .co quaremedical at enquiries@daltons
Tom Kelley is a 3rd year medical student and a co-editor of Mediscope
Manchester Medical School
Mediscope at the cinema
t the recent Cannes Film Festival, Michael Moore's premier of Sicko was an overwhelming success. It received a 15-minute standing ovation when the curtain went down, and according to the American Society of Registered Nurses, “had made even the most hardened journalists weep.” This film depicts the story of the American health system in crisis. Despite being an avid fan of various American medical series like ER, I had no inkling of the catastrophic reality of the American healthcare system. In quintessential Moore fashion, the viewers are introduced to regular folks with and without health insurance who voice their stories of frustration, pain and loss. There is much in the film to cause sleepless nights: we didn’t realise that doctors are forced to turn away patients without health insurance, and that millions of Americans who dutifully pay their insurance premiums often get strangled by bureaucratic red tape. A mother tearfully recalls losing her 18-month-old daughter, who was refused treatment for a 104-degree fever because the ambulance that brought them to hospital wasn’t part of her insurance company’s system! One scene shows a clip of Congressional testimony given in 1996. Dr. Linda Peeno, a former medical reviewer for a health insurance company, said her job was to save money for the company. "I denied a man a necessary operation", she testified, referring to a decision she made in 1987. Her story forced us to reexamine our values and principles. What kind of doctors do we want to become and for what kind of system do we want to work ? How does it feel to be doctors with access to the best treatment and technology in the world, yet cornered by politics to refuse it to people who can’t pay? Sicko helped us imagine the dilemma and heartache for US doctors faced with this struggle everyday. Michael Moore then whisks his viewers on an interesting journey to explore alternative models of healthcare systems in Canada, the United Kingdom, France, New Mexico and Cuba which provide universal health coverage. For doctors who are interested in a different working environment or medical students considering elective options, this footage might be worth the while for a sneak-peek into the health care systems of these various countries. As we made our way into hospital the next morning, we both unwittingly smiled in appreciation as we caught sight of the big blue and white NHS logo. The NHS has suffered its fair share of criticism and yes, it may not be a perfect system but at least, it’s a system that leaves no one behind. Official site: www.sicko-themovie.com
Sicko Director: Michael Moore Reviewers: Stephenie Tiew and Yoon Tze Lai Official Mediscope Rating:
Issue 2 Apr 2008
The trials and tribulations of living with a medic Sally Fordham & Emily Legg
anthelasma? Wuchereria? Meningoencephalocele? As far as we’re concerned, they may as well be discussing the recent landing of aliens on the moon while speaking Kikongo, the traditional language of the Bakongo people on the West coast of Africa. So far, living with a 4th year medic has been really rather interesting. Mornings are spent awaiting the arrival of a still under the influence or painfully hung-over housemate stumbling down the stairs after yet another legendary Medics Party. In our case, this happens often, last Sunday our medic returned from the ‘best night ever’ at 11am wearing a striking pink/orange number (which was not her elegant emerald ballgown worn 15 hours before on her way to the ball).
“Mornings are spent awaiting the arrival of a still under the influence or painfully hung-over housemate”
Afternoons (especially around exam period) are spent trying to avoid the desperate eyes willing you to partake in practice histories or examinations. ‘Today you will be Ethel – your forty-five year old son has spontaneously erupted
From left: Sally Fordham, Anna Williams, Emily Legg 26
in pink and yellow poker dots all over his body and started talking Parseltongue whilst requesting an audience with Harry Potter’ please diagnose…. We love learning about the medical procedures you would go through whilst diagnosing Ethel’s child, but when all you want to do is watch the next episode of The Hills this becomes somewhat exasperating. Evenings at our house are quite often spent pretending to be interested in (or even vaguely comprehending) medical discussions. While these are often both fascinating and topical, sometimes us ‘non-medics’ prefer to discuss the lighter things in life such as Britney’s latest escapade. Ok, so we’re not claiming living with a medic is all bad. They notoriously have the best parties with giant bucking bronco willies (which we attend from time to time), have the hottest men of all other university categories (debatably), and being hypochondriacs it’s often calming to know there’s a medic close by with a stethoscope in hand. Sally Fordham and Emily Legg have proper jobs
Manchester Medical School
As foretold by the mysterious Rebecca Heath, Student of the 4th Circle
June 22 - July 22
July 23 - August 22
August 23 - September 22
September 23 - October 22
October 23 - November 21
November 22 - December 21
It’s time to admit you’ve tried to see the best in someone who is a needle in your side. Don’t let them become a drain on you it will be very painful and may have complications. Don’t neglect exercise—it is good. Ensure your BMI and waist circumference are kept in the GREEN - consider cycling to hospital. Lucky day: any in which you exercise.
Mars the energy giver moves into a very special zone in your solar plexus this month, causing more than your imagination to rise. This could be good for romance. All the frustrations of the past few weeks will fade as you hear of positive MMC developments affecting your future career.
Wear something loose and flowing as with your kidney moves retrograde for the second half of the month. A night out dancing will solve a problem that’s been bothering you. The lunate eclipse in your opposite sign will make you let go of unrealistic expectation.
People seem to like your ideas this week but don’t let it go to your head as your sphenoid sinus might explode. Keep your sphygmomanometer handy as Mercury crosses the systolic path of your sign affecting matters of the heart. Don’t worry if your love life misses a beat - all will be well controlled by summer.
The Sun is in the erythematous part of your sign from the 21st, heralding the start of a new placement. Don’t leave anything to chance, check all the facts, you'll be wrestling with tricky situations when Uranus sits in the personal sector of your horoscope in the back end of the month.
The luckiest sign in the Zodiac. With your eyes closed keep your feet on the ground and watch for any unwanted movements. Don’t neglect your mental health, ignore your inner voice and what it tells you.
December 22 - January 19
January 20 - February 18
February 19 - March 20
Aries March 21 - April 19
Aftershocks from Thursday’s full moon are probable but you have the magic touch and by Sunday a shared passion could provide sutures to a relationship. It’s time to let your myocardium rule your cranium.
The Dean has been watching you, so tread carefully along the corridors. After some hard work, love and harmony reign on the 18th and the new moon shows that the seeds of your future are buried deep in your psoas muscle.
Emotional tensions between friends and lovers come to a head on the 23rd, so take cover. It’s all too easy to get into a power tussle with loved ones and that puts too many peaks on your ECG. Piscean NHS advice line 0915 962 6868 (now gone up to £72/min).
It’s the 19th before romantic fireworks ignite but take care that there isn’t any C3H5OH around or there could be explosions. Good time to check out your LFTs and other finances. A mysterious drama is about to come to a close and you’ll have to nurse your disappointment in private side room.
Taurus April 20 - May 20
Gemini May 21 - June 21
You're not the type to buy on impulse, so if you are tempted this month think twice - a trochanteric bursary will not be able to bale you out. Love blossoms, a new romance or rekindling of passion is in the stars. Wow, lucky you. Get an STD check before the next full moon.
Wind your way to the library for solitude. This will bring many hidden rewards; someone tall, dark and handsome near the Pharmacology section has been waiting to meet you. In this case, NSAID stands for Notoriously Sexy Amorously Irresistible Doctor. Lucky shoe: the left croc.
Issue 2 Apr 2008